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Archive for February, 2009

Guides For the Health-Conscious Traveler

The ”Health & Travel” section of this blog focuses specifically on health issues in connection with travel, such as vaccination/immunization requirements and recommendations, guidelines for dealing with medical emergencies, precautionary measures that should be taken with regards to food and water supplies, etc. While you can’t expect to avoid all possible unpleasantries, a little knowledge and forethought can to make your journey reasonably safe.

How to Travel
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Modern Day Travel
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Making the “Bucket List”
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An Experience of a Lifetime – Make It a Good One
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Travel With Children in Africa
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Modern Day Travel

Travel used to be a simple matter. You traveled for business or pleasure. If you traveled for pleasure, you were on vacation. For most people, that meant taking their families on the road and staying at a particular destination until it was time to return home. Locations were mostly chosen because of their accessibility and convenience. Going on vacation was like an annual ritual, often limited to a few favorite spots that became like a home away from home.

By contrast, today’s travelers are thrill seekers and adventurers. They want experiences. They explore the unknown and seek the exotic. Distances no longer matter. High mountain tops, deep oceans and dense jungles are the places to be now. Opulence and luxury, at sea or on safari, are considered standard fare even for a once-in-a-lifetime experience. Read more »

The Drive-Thru Diet, Fact Or Fiction?

Christine Dougherty claims she lost 54 pounds in two years, which comes to about half a pound per week. Why is this news? Because Christine wasn’t really on a diet. She ate like millions of other Americans eat every day – mostly fast food and such. And like millions of other Americans, she ordered, purchased and consumed her meals in her car. Her preferred eatery was (and still is) Taco Bell®, also because it is conveniently located next to her home. Since neither she nor her husband are inclined to cook, it is only natural that they have developed eating habits that are easy to satisfy and fit their busy lifestyle.

When Christine eventually reached her weight loss goal without ever giving up on her fast food fetish (so we are given to believe), the husband encouraged her to write a thank-you-note of sorts to Taco Bell® headquarters and tell them the great news – namely that she got thin from eating their tacos. The rest is history, or perhaps the stuff fairy tales are made off. Christine is now an official (and supposedly well-paid) spokesperson for Taco Bell’s® latest ad campaign called “Drive-Thru Diet.”

Of course, Christine did not lose weight because she ate lots of tacos and burritos, but rather because she managed to reduce her calorie intake. She could have accomplished that with any kind of food. It is actually surprising that it took her so long to shed 54 pounds, considering that a 500 calorie reduction per day allows most people to lose one pound per week.

Taco Bell’s® ad campaign is by no means original. A few years ago, another happy customer, Jared Fogle, became the poster boy for Subway®, when he professed that his weight loss efforts succeeded simply by sticking to a Subway® “sandwich diet.”

In all fairness, it must be said that Taco Bell® has never suggested that its products are designed for weight loss. However, when you see Christine on the home page of the company’s website holding up her old pants, made for someone twice her size, one must admit that the hints are less than subtle.

All that aside, it is gratifying to see that more consumers are looking for health-conscious alternatives to their traditional food choices, and that even fast food chains are taking note. For instance, McDonald’s® “Go Active” meals and Pizza Hut’s® “Fit N Delicious” were created in response to this trend. In principle, this is a welcome change and should not be dismissed as pure sales gimmicks.

Taco Bell’s® “Drive-Thru-Diet” caters to customers who are too pressed for time to linger in a restaurant or supermarket, but still want to make better diet choices. Seven items on the menu have detailed information listed about calorie and fat content. At a first glance, the numbers look reasonable: Between 150 and 340 calories and 8 grams or less of fat per serving is not bad.

The picture changes, however, when you realize the high levels of sodium. Three out of seven items contain more than fifty percent of the recommended daily allowance of 2,300 mg of sodium. For people who suffer from hypertension and heart disease, the tolerable dose would be lower, about 1,500 mg. In other words, one “Drive-Thru-Diet” meal almost covers your allowance for the whole day. Again, for folks with hypertension or heart disease, eating this kind of food on a regular basis will only make matters worse.

What does all that mean in practical terms? Well, for one thing, it means that there is no substitute for cooking healthy meals from scratch and with fresh ingredients. I congratulate Christine and everyone else who has managed to lose weight in any which way. But I would also advise you to take some cooking classes and start cutting back on foods you can eat in a hurry.

“Organically Grown Produce” – Is It Worth the Extra Money?

Dear Timi,
For many years, I have been careful to buy only organically grown produce. Unfortunately, organic fruits and vegetables are becoming more and more expensive than the non-organic version. I’m convinced that organic foods taste better and are overall healthier. I‘m also concerned about health risks posed by pesticides, fertilizers and other agricultural pollutants. However, I begin to wonder whether the difference in quality is worth the ever increasing costs.

Dear Reader,
Yes, there is a significant price difference between organically and non-organically grown produce – as much as 50 percent and more, depending where you do your shopping. Whether it’s worth it to spend that much more money is a matter of personal choice.

Originally, organic farming started out as a grassroots movement. The initial intent may have been to return to pre-industrial farming methods, whatever people thought they were. In that sense, organic farming was first and foremost a countercultural phenomenon. But then the whole thing evolved into a profitable industry and the federal government became involved by putting out strict regulations and giving it its own seal of approval. Consequently, many common agricultural practices were restricted – such as the use of certain pesticides and fertilizers as well as certain animal farming methods – in return for the government’s endorsement. Unfortunately, many of these policies, as well-intended as they may have been, have also caused widespread confusion among consumers. As a result, a lot of myths have been created about the meaning of organic farming.

Since I cannot address here all the pros and cons of organic versus regular farm products, let me just make a few sketchy remarks: Limiting your exposure to toxic chemicals, whether they stem from pesticides, fertilizers or unsound animal farming methods, is always a good idea and, if necessary, worth the extra investment. However, “organic” does not automatically mean “safe,” it does not even have to mean “healthy.” You can buy “organic” crackers or cookies – that does not make them more nutritionally beneficial than others. I personally prefer to buy foods that are “locally grown,” or use “sustainable farming methods.” Why? Because it gives me a chance to meet my food suppliers directly. By developing personal relationships with local farmers at the farmers market or by visiting their farms, I’m in a much better position to judge the quality of the food I’m buying. Last but not least, buying directly from the source also eliminates the middleman, making the prices more affordable.

Gastric Surgery For Overweight Kids – Last Best Chance Or a Bridge Too Far?

With childhood obesity dramatically on the rise, some pediatric hospitals have begun to offer gastric bypass surgery for teenagers and even younger children. The Texas Children’s Hospital in Houston, for example, reports the performance of two or more bariatric procedures on adolescents almost every month.

In recent years, gastric surgery has become an acceptable, although drastic measure of last resort for adult patients who suffer from extreme obesity and have not been successful at weight loss by traditional means.

The intent of the procedure is to modify the gastrointestinal tract by either reducing the size of the stomach or by altering the intestinal drainage, for the purpose of reducing food intake. An alternative to permanent stomach size reduction is called “banded gastroplasty,” which is designed for similar purposes, but uses a rubber-band-like device.

Both techniques have shown some success among adults, however, there is no established track record available yet for adolescents and younger kids.

Some pediatricians have voiced concern about making such severe alterations to the gastrointestinal tract at a young age, when many of the patients are in fact still growing up. Especially during growth spurts, children and adolescents need all the nutrients they can get. If their digestive system is inhibited at that crucial time, they may face additional health risks, e.g. from malnutrition.

Undergoing the operation, of course, is only the beginning, and perhaps the easiest part. We don’t have enough data yet to let us predict how these children will fare in later years. We know that a certain percentage of adults, who had the procedure, have gained at least some of their weight back.

Life-changing interventions of such severity can only succeed if certain conditions are put in place. Especially young people are extremely dependent on support from their social environment when they undergo significant lifestyle changes. Competent follow-up counseling is also required.

Last, but not least, the parents must understand that if they are not part of the solution, they are part of the problem, and their kids will keep paying the price.

Dear Reader – February 2009

Timi Gustafson, R.D. It is certainly not easy to keep our cool these days. The flood of bad news never seems to ebb, wherever we turn. In response, one can clearly sense a different atmosphere now, something most of us have never known in our lifetime. More people seem to adopt a pessimistic view regarding their future prospects, and comparisons to the “Great Depression” in the 1930s are made frequently.

Anxiety produces stress, of course, and when high levels of stress persist over long periods of time without relief, people get sick. Sick people don’t function well, which is especially disastrous when they need their strength the most. This can quickly lead to a downward spiral that can be hard to reverse.

So, let’s be mindful in these difficult times that staying healthy and fit really matters. Giving our bodies lots of nutrients is key to strengthening the immune system. Keeping physically fit and strong through cardiovascular and resistance training is the best antidote against stress damage. Avoiding toxic substances, such as alcohol, drugs, sleeping pills, etc. is extra important when we deal with serious challenges. Let’s take good care of ourselves, especially right now…
Go to Newsletter of February 2009…

Reshaping the Nutritional Environment for Our Children

Under the leadership of the First Lady, Michelle Obama, the White House has launched a new initiative to combat the childhood obesity epidemic in America. Obesity rates among the young have more than tripled over the past thirty years. Today, almost one in three kids is diagnosed as overweight or obese. Other weight-related health problems, such as diabetes, hypertension, heart disease, asthma and cancer add to the urgency to tackle this issue.

While former government administrations have mostly favored an approach of personal responsibility in the fight against childhood obesity, the Obama campaign is decidedly less focused on individual behavior and more on structural conditions.

This is a step in the right direction. In fact, the White House has adopted a message that nutrition experts have been proclaiming for a long time, namely that the nutritional environment plays a significant role in the formation of eating habits at a young age.

Too many children grow up in a nutritionally hazardous environment. School lunches, especially in less affluent school districts, are notorious for their low nutritional quality. Thankfully, some of the largest school lunch suppliers in the nation have now agreed to review their current meal plans and have pledged to make efforts to reduce excessive fat, sugar and salt content over the next five years. It’s a start.

Another persistent problem is the lack of access to quality food outlets in poor neighborhoods. Healthy foods, like fresh fruits and vegetables are not only more expensive, they are literally out of reach for many low-income families. More initiatives to attract grocery stores and supermarkets with fresh produce departments to these areas are needed. Urban farms and farmers markets in inner cities must be promoted and, if necessary, financially subsidized.

In addition to improving nutrition, the Obama campaign also emphasizes regular physical activity as a central component in the fight against childhood obesity. The importance of exercising has been an often-repeated mantra of the Bush administration as well, but it was mostly regarded as a matter of personal choice. By contrast, the new program considers what structural conditions may be needed for the promotion of physical activity among children. That includes the creation of more public spaces where children can play sports and games, such as parks, pools and recreation areas. Child-friendly improvements of the existing infrastructure are also badly needed, such as safe bike paths and sidewalks in residential neighborhoods and near schools. Needless to say that Physical Education (PE) must be brought back and made mandatory in all public schools.

It is heartening to see government recognizing that it can (and should) play a role in the promotion of public health, especially when it concerns our youngest members of society. The hands-off policies of the past have been left in place far too long. The damage is now plain to see and will be for a generation or more.

May We Stay Forever Young

Last year, my daughter, now herself a mother, went to a rock concert that was held at one of the local wineries. She was a bit disappointed. “Mom,” she said, “they’re all from your generation.” Well, I thought, then I should give it a try. So I got tickets for the Doobie Brothers – mostly because I recognized the name from way back then. My daughter was right! As a grandmother, I did not at all feel out of place.

Actually, it was quite heartening to watch this middle-aged (plus) crowd coming to listen to the old beat. And yes, it was indeed a far cry from the days of Woodstock and Monterey. Unlike in the olden days, this was no spontaneous gathering that would last for days through severe weather and harsh living conditions. People here expected much more than to survive on love and music alone. Gourmet chefs cooked up a storm and sommeliers advised expertly on the wines to pair with the food. Extremely comfortable camping chairs and picnic tables laden with goodies from Whole Foods and Starbucks bore witness to the times that were a changing – even for the flower children. But then, the Summer of Love was forty years ago. Everyone who remembers those days must be approaching retirement or is already there. The drugs are different now too – mostly to treat Arthritis, Osteoporosis and all that stuff guys are worried about. Read more »

Tips For Leaner Cooking Techniques

Cutting back on calories and fat starts in the kitchen. The nutritional value of the best ingredients can be offset by careless cooking habits. Knowing about alternative cooking styles and leaner substitutes can make a real difference. Here are some useful ideas for leaner cooking techniques without taking away from quality and taste.

Meats, Fish, Poultry

Use Teflon® or other non-stick pots and pans. Keep using oils and fats at an absolute minimum. In most cases, the inherent fat of the meat itself will suffice.

When sauteing, add stock instead of fat to prevent burning.

Apply cooking methods that require less fat ¬– such as steaming, poaching, roasting, baking or broiling – as opposed to frying.

Choose leaner cuts of meat, such as tenderloin or top sirloin. USDA “Choice” meats have less fat and marbling than USDA “Prime.”

Buy free-range poultry for better flavor and less fat.

Remove all poultry skin prior to cooking to reduce fat content.

Replace traditional bacon with Canadian or turkey bacon for less fat.

Sauces, Gravy

When using cornstarch as a thickener, make a slurry with equal parts of cornstarch and liquid. Cooked and pureed vegetables make better thickeners for sauces. Use arrowroot in the same way for sauces to remain clear.

Reduce stocks until they are dark and flavorful to add body to sauces.

Replace cream with evaporated skim milk, mix in with cornstarch and whisk into a simmering stock.

To make gravy without fat, blend a tablespoon of cornstarch with a cup of broth and shake in a jar. Simmer until thick, adding the rest of the broth.

Stock, Soups, Stews

Sweat vegetables in chicken or vegetable broth, instead of oil or fat.

Replace cream or whole milk with evaporated skim milk when cooking soups.

For mashed potatoes, use homemade chicken stock or canned low-sodium broth, instead of cream and butter.

Instead of sour cream to garnish cream soups, use foamed skim milk, as you would on a café latte.

Eggs

Always use egg yolk sparingly. Keep the egg white of two thirds of the eggs you are using. Egg substitute works just as well and can also be mixed with real eggs.

Baking

Spray traditionally deep-fried items with cooking spray, instead of dipping them in oil. Then bake in the oven at 450º until crispy. It will have the same fried flavor without the large amount of fat.

Use pureed fruit (e.g. prune or apple butter) as a fat substitute in baked goods. You eliminate up to 75% of the fat you get from butter.

You can make a lower fat cheesecake with yogurt cheese. Use nonfat plain yogurt. Line a colander with cheesecloth. Set it over a large bowl, cover with plastic wrap and refrigerate for up to three days. Discard the liquid. Three cups of drained yogurt make about one cup of yogurt cheese.

Salt Reduction, Flavor Enhancement

Utilize fresh ingredients as much as possible. Limit the use of canned and frozen products. Check nutrition facts labels for sodium content, high-fructose corn syrup, artificial preservatives, sweeteners and coloring. Choose brands with the lowest amount of any of these.

Fresh herbs and spices are preferable to dried ones.

Make chicken, fish and vegetable stock from scratch, instead of using bouillon cubes or broth in cans.

Use natural salts, such as gray salt, fleur de sel and alea salt, instead of iodized salt. These salts have essential minerals and less sodium.

Herbs and spices enhance natural flavors. Here are some examples:

• Red meat – cumin, soy sauce, bay leaf
• Pork – sage, dry mustard, dried fruits
• Fish, chicken – lemon, basil, thyme
• Potatoes – chives, mint, poppy seed
• Cabbage – ground caraway seed, onion
• Asparagus – nutmeg, lemon juice, sesame seed

These are just a few random ideas you can take advantage of in your quest for leaner cooking techniques. You are invited to submit your own suggestions for smarter and lighter cooking.

A Pantry Stocked For Healthy Eating

A well-stocked pantry is an important part of any functioning kitchen. Having the right staples available allows you to be more creative and more flexible with your meal plans. Learning what to stock up on and what to keep out of your pantry is a good start for healthy home cooking. The  ♥ symbol indicates especially heart healthy items.

Herbs, Spices and Baking Products:
• Allspice • Parsley, dried • Sugar, brown
• Basil, dried • Pepper, black • Sugar, powdered
• Bay leaves • Peppercorns • Honey
• Celery salt • Poultry seasoning • Molasses
• Chili powder • Red pepper flakes • Unbleached flour
• Cinnamon • Rosemary, dried ♥ Whole wheat flour
• Cloves • Saffron, dried • Pancake mix, low-fat 
• Coriander • Sage, dried  
• Cumin  • Salt  
• Dill, dried • Sea salt  
• Garlic powder • Sesame seeds  
• Ginger • Tarragon, dried  
• Italian seasoning • Thyme, dried  
• Marjoram • Tumeric  
• Nutmeg • Baking powder  
• Onion powder, dried • Baking soda  
• Oregano, dried • Cornstarch  
• Paprika • Sugar, granulated  

 

Oils, Condiments and Flavorings:
♥ Olive oil, extra virgin • Soy sauce • Relish
• Canola oil • Teriyaki sauce • Capers
• Mayonnaise, low-cal • Chili sauce • Olives
• Salad dressings, low-cal • Worcestershire sauce • Almond extract
• Balsamic vinegar • Hoisin sauce • Vanilla extract
• Red wine vinegar • Salsa • Maple syrup
• White vinegar • Mustard, Dijon, honey • Jam, low sugar
• Rice wine vinegar • Catsup • Marmalade, low sugar

 

Grains, Legumes and Nuts:
• Pasta, whole-grain • Quinoa ♥ Walnuts, unsalted
• Soba noodles ♥ Oats ♥ Almonds, unsalted
• Rice noodles • Couscous ♥ Soy nuts, unsalted
♥ Rice, brown • Lentils, dried • Water chestnuts
• Rice, basmati • Beans, dried, mixed • Canned beans, low sodium 
• Rice, Arborio • Beans, canned, mixed  

 

Cereals, Crackers, Cookies and Miscellaneous:
♥ Oatmeal, steel cut • Chips, baked, low sodium • Jell-O, low sugar
♥ Oat bran • Pretzels, unsalted • Soups, low sodium & fat
• All bran • Popcorn, air-popped • Peanut butter
• Cereals, whole-grain • Gingersnaps • Tea & coffee
• Crackers, low sodium • Vanilla Wafters • Herb teas

 

Fruits and Vegetables:
• Artichoke hearts • Potatoes • Dried cranberries, raisins
♥ Beets, red & yellow ♥ Tomatoes • Prunes
♥ Bell Peppers • Tomatoes, sun-dried • Lemon juice
♥ Carrots • Tomatoes, canned • Lime juice
♥ Garlic • Tomato, paste ♥ Fresh fruit, seasonal
♥ Mushrooms • Tomato & V-8 Juice • Fruit, canned, water packed
♥ Onions, yellow • Applesauce  

Crash Diets – Do They Work?

Dear Timi,
I’m considering going on a quick weight loss diet to get ready for a reunion. My husband says I look great as I am, but I want to lose about ten pounds, just for the event. Unfortunately, I have only a few days left to achieve my goal.  Should I have any health concerns about “starving” myself just for a short period of time?

Dear Reader,
Many of my clients expect radical measures when they go on a diet. They are willing to suffer as if they were given a penance for their “sinful” indulgences. That’s human nature. But let me be clear on this: Extreme diet measures – also called “crash diets”– rarely ever work. Nor are they desirable from a dietary perspective. Generally speaking, if you feel “starved,” you will not maintain any diet over time, no matter how effective it may be.

Also, your primary goal should not be a quick fix but lasting healthy eating habits that allow you to maintain your ideal weight naturally. What you may really need is to change your lifestyle and perhaps your relationship to food. If you decide that you should lose a few extra pounds, you should go on a diet for the sake of your health and well-being, not just for one particular short-term purpose.

By cutting back just 500 calories a day from your regular food intake, you can achieve an average weight loss of one pound per week! The good news is that even small changes in your diet can add up to big calorie savings. And yes, even when you eat only healthy meals, you still need to watch your portion sizes.

One great way to improve your eating habits is to increase the quality and taste of your food. If your food is tasteless and leaves you dissatisfied, you will probably continue to feel hungry and look for more. Paying attention and savoring good tasting food will not only make you enjoy it more, it will also be a more satisfying experience beyond stilling your hunger. If you eat too quickly or absentmindedly, you won’t be able to keep track of how much you consume.

The last thing you want to become is what we call a “yo-yo dieter,” that is someone whose weight goes up and down time and again. So, lose the weight you need to, but then make every effort to keep it down for good.

Counting Calories at the Coffee Shop, But Not the Fast Food Places

The New York Times reported this week that some people have indeed started paying more attention to the “calorie counts” that are on display in coffee shops and other food outlets. You may remember another report from not long ago about a different study that came to the opposite conclusion, namely that postings of calorie contents had no significant influence on most customers’ choices. The Times now concludes to the contrary that “…when people can read how many calories there are in their … food, they do cut back.”

This is good news, of course. However, the same report makes a distinction between customers who frequent coffee shops, in particular Starbucks, and customers of fast food places, such as McDonald’s or Wendy’s. The high-end coffee places registered the most behavior changes of their clientele – the fast food joints, not so much. These discrepancies suggest, according to the Times writer, that “calorie counts will be most effective in higher-income neighborhoods, where consumers are better educated.” Maybe…

But here’s the thing: Coffee shops and fast food places attract their clientele for different reasons. Starbucks’ world-wide success is largely based on people’s need for caffeine in the morning on their way to work and later in the day to get through the afternoon slump. That has little to do with the folks who grab a bite to eat at a drive-through, who want a quick meal for little money.

Both groups look for different experiences. There is also no clear separation. In fact, the demographics overlap. Lots of people go to Starbucks in the morning, eat lunch at Wendy’s and pick up a hamburger for dinner. Income differences may play a certain role, but people of all income levels welcome efficiency and value. In my professional experience, the “education” argument does not hold water either. I have counseled a great number of patients who held ivy-league degrees, but had no clue how to control their weight and eat healthy.

I am certainly not against posting of detailed nutritional information in food outlets. The more customers are enabled to make educated choices, the better it is for us all. The main problem, however, remains unaddressed, namely that the ways this information is given does not really educate. For the average consumer, calories are just numbers. We may have heard that eating fewer calories is better for our waistline. But that is about the extent of our common knowledge.

Most people don’t look at their food in terms of numbers. They look for instant gratification and a deal that gives them the most bang for the buck. We have to try harder to communicate clearly what’s at stake here. We must find better ways to explain to the public the issues of health and nutrition, and do so in simple, user-friendly terms.

We all, regardless of class or education, should have the right to know exactly what goes in the food we eat and why some of it is harmful to our well-being, especially when it’s consumed in oversized quantities.