Nearly Half of All Americans Will Be Obese Within Two Decades, Study Projects

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A study by the Centers for Disease Control and Prevention (CDC) predicts that obesity rates in the United States will reach up to 42 percent of the population by the year 2030. More than 10 percent will be classified as “morbidly obese,” which is 100 pounds plus over a healthy weight range. If these predictions come true, health care costs in the U.S. will increase by well over half a trillion dollars.

The study report was presented at a conference sponsored by the CDC, titled “Weight of the Nation” (May 7 to 8, 2012) in Washington D.C. and simultaneously published in the American Journal for Preventive Medicine.

Two U.S. Government Agencies
Warn of Dire Prospects for
The Nation’s Health

While it is difficult to make these kinds of forecasts, it is clear that obesity trends that started in the 1980s and 1990s continue on their paths. Currently, over 60 percent of Americans have weight problems and over 30 percent are diagnosed as obese. Even more worrisome are the growing rates among young people. Over 20 percent of children and adolescents are obese today.

Obesity can cause a host of chronic health problems such as cardiovascular disease, diabetes and also certain forms of cancer. Many people who develop weight-related illnesses during childhood are likely to face at least some of the consequences throughout their adult-lives.

“The prospect of such increasing rates, particularly those of severely obese Americans, is alarming, especially since efforts aimed at helping people to lose weight have so far proven relatively ineffective,” said Dr. Eric Finkelstein, one of the authors of the CDC report.

For a long time, the causes of obesity have been in dispute. One popular explanation is that people just eat too much and exercise too little. Some health experts say it’s not that simple. In a separate report on America’s obesity epidemic that was also released at the “Weight of the Nation” conference, the Institute of Medicine (IOM) concluded that the crisis is deeply rooted in the environment we live in, which is, as the report called it, “obesogenic.” According to the IOM, it is not so much people’s behavior that has changed over the past few decades but rather a number of factors that are beyond any individual’s control, including agricultural policies and food manufacturing.

“When you see the increase in obesity, you ask, what changed? The answer is, the environment,” said Dr. Shiriki Kumanyika, a professor at the University of Pennsylvania of Medicine and IOM committee member in an interview with Reuters. “The average person cannot maintain a healthy weight in this obesity-promoting environment.”

Instead of appealing to “personal responsibility,” the report suggests for policy makers to pursue structural changes like shifting subsidies from corn and wheat farms to fruit and vegetable growers, creating more pedestrian-friendly infrastructure, and limiting the number of fast food outlets near schools and residential areas and so on. The hot-button-issue of imposing surtaxes on sodas to curb consumption was also mentioned.

The Center for Consumer Freedom, an advocacy group for the food manufacturing and restaurant industry, rejected the IOM report and argued that Americans should be free in making their own food choices but should act responsibly. It accused the IOM of joining forces with the nation’s “food nannies,” according to a Reuters report (5/8/2012).

By contrast, the IOM panel said that blaming obesity on a failure of personal responsibility and individual willpower has long been used by the industry as the basis for resisting legislative and regulatory efforts to address the problem.

The costs for treating obesity and obesity-related diseases are responsible for about 20 percent of all spending on healthcare today, about $190 billion annually, not counting rising insurance premiums, lost productivity and missed work days due to illness. The IOM urges employers and insurance companies to participate more aggressively in the fight against obesity, if for no other reason than their own bottom line.

Minorities Are Hit the Hardest by the Obesity Crisis

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Obesity rates continue to rise in the United States across all demographics, but African-Americans and Hispanics are most affected, according to the National Center for Health Statistics (NCHS), which is part of the Centers for Disease Control and Prevention (CDC).

Obesity is commonly associated with increased health risks, reduced quality of life and rising health care costs. Diseases in connection with weight problems include diabetes, high blood pressure, heart disease and some forms of cancer.

African-Americans and Hispanics
Have the Highest Rates of Weight Problems

The current obesity rate of Mexican-American adults is about 41 percent, significantly higher than the overall national average of about 36 percent of Americans who are obese, which is considred as roughly 30 or more pounds over a healthy weight range, according to the NCHS special report on nutrition and chronic health conditions of Hispanics living in the U.S. (3/28/2012).

African-Americans have the highest obesity rates at almost 50 percent. Among African-American women, the numbers are especially dramatic. Four out of five are overweight or obese, according to the Office of Minority Health (OMH), a subdivision of the U.S. Department of Health and Human Services (HHS).

In response to these alarming statistics, the U.S. government set as a specific goal the elimination of health disparities among racial and ethnic populations. “Given the overall high prevalence of obesity and the significant differences among non-Hispanic blacks, non-Hispanic whites and Hispanics, effective policies and environmental strategies that promote healthy eating and physical activity are needed for all populations and geographic areas, but particularly for those populations and areas disproportionally affected by obesity,” states a CDC report in 2008, titled “Differences in Prevalence of Obesity.”

Health problems affecting minorities are a grave concern for the country as a whole. The Hispanic population is the fastest-growing ethnic group in the U.S., and Hispanics of Mexican origin account for the largest portion. It is estimated that by 2050 over 130 million Hispanics will be living here.

Already over 20 percent of Mexican-Americans suffer from high blood pressure and high cholesterol levels caused by weight problems, and by all indications these numbers will keep rising. In terms of future health care costs, the prospects are dismal as well. Only about half of the Mexican American population has health insurance, according to the CDC’s National Health and Nutrition Examination Survey (NHANES). For many, emergency care will be their only option for treatment.

First generation immigrants seem to be less prone to develop weight problems due to changing environments and lifestyles than their descendents. Second and third-generation Mexican-Americans are more than twice as likely to become obese, according to a study conducted by the Arnold School of Public Health at the University of South Carolina and published in the Journal of Nutrition. One reason may be changing preferences from a traditional Mexican diet, dominated by fresh foods like corn, beans and vegetables, to an American-style diet based on meat products and processed foods.

Socio-economic circumstances and lack of nutritional education may also play a role. Healthier food items like fresh produce are often too expensive for low-income immigrant families. Many minority women are completely unfamiliar with concepts like counting calories, balancing food groups and adopting leaner cooking techniques. “The typical Mexican recipe calls for ‘enough’ or ‘not too much’ of an ingredient, rather than specific measurements, said Dr. Nangel Lindberg, a researcher at the Kaiser Permanente Center for Health Research in Portland, Oregon, and lead author of a study funded by the National Institutes of Health (NIH), which was published in the Journal of Immigrant and Minority Health.

In connection with the study, a “culturally tailored weight management program” was established to help participating Hispanic women better understand how portion sizes and calorie intake can be controlled and educate them about healthier cooking styles. The one-year program, named “De Por Vida” (For Life), by itself was a success as it helped most participants to lose on average over 15 pounds.

More Americans Suffer from Asthma

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Asthma rates in the United States have been on the rise over the past decade and are now at an all-time high, according to the Centers for Disease Control and Prevention (CDC). Almost 26 million Americans had asthma in 2010, the last time data on the disease were reported. Seven million of those were children and adolescents.

According to the CDC, asthma ranks among the leading chronic illnesses affecting young people. It is one of the most frequent causes of school absenteeism. About 10 percent of school children miss classes because of asthma at least once a year.

Chronic Airway Disorders Are on The Rise

Especially low-income populations are at an increased risk. 11.2 percent of Americans living below the poverty line are reportedly affected. Females seem more prone to developing the disease than males.

Asthma is a chronic inflammatory disorder of the airways. This can include narrowing of the bronchial tubes, swelling of the bronchial tube lining and an increase of mucus secretion to the point where the airways become blocked. In case of a so-called asthma attack, a person’s airways are so obstructed that it becomes difficult to breath, which can lead to a life-threatening situation. Thanks to faster intervention and preventive treatments, death rates in connection with asthma have dropped by a third compared to 10 years ago.

Asthma is often misdiagnosed as allergies. Not all people who experience allergy symptoms have asthma. Like allergies, asthma is associated with exposure to allergens and also smoking, chemicals and air pollution.

Identifying and controlling potential triggers of asthma attacks is crucial for effective treatment. Although there is no known cure or even prevention of asthma, multiple steps can be taken to limit exposure to allergens and other irritants.

The CDC recommends the creation of more asthma-friendly environments such as schools by implementing policies and procedures that allow students to successfully manage their asthma. These can include providing access to asthma care clinicians and school nurses, educational and awareness-building programs, training of teachers and school staff, community outreach and so forth.

In the home, it is recommended to keep dust and dirt from accumulating. Dust mites are notorious asthma attack triggers. Ventilation and air filtering is equally as important. Pet animals can be a significant source of allergens and should be kept away from asthma sufferers. Exposure to a whole range of potential irritants, including tobacco smoke, wood and coal fire smoke, strong odors from cooking, household chemicals, paint fumes and cosmetic products should be avoided as well.

Even dietary precautions may be necessary. Some food-borne allergens can become triggers and it is crucial to identify and eliminate them as much as possible. Some people may be able to tolerate smaller amounts of foods they are allergic to. Only experience can determine the limits.

There is no medication that can cure asthma. But medications are available to control asthma symptoms. There are different types and they come in different forms such as pills, aerosol inhalers, powder inhalers, liquids and injections.

The two main types of medications are anti-inflammatories and bronchodilators. Anti-inflammatories reduce swelling and mucus production in the airways. They can lower the intensity of asthma symptoms and allow for better airflow. Bronchodilators relax the muscles around the airways, thereby easing breathing. Bronchodilators are especially effective during asthma attacks.

The primary purpose of taking asthma medications is to control and relieve. Most asthma medications must be taken regularly, often daily. So-called reliever or rescue medicines are only to be used during acute attacks.

How often an asthma patient has to take medications depends on the severity of his or her symptoms. Some are affected only during certain times of the year, e.g. in the spring. However, no one should experiment with asthma medication dosages without prior consultation with a doctor.

Sports Nutrition News You Can Use

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By Nancy Clark, MS, RD, CSSD

More than 450 members of the Sports, Cardiovascular, and Wellness Nutrition (SCAN) practice group, the nation’s largest professional group of Sports and Cardiovascular Nutritionists (SCANdpg.org), convened in Baltimore in April 2012 to celebrate its 30th birthday and to learn the latest sports nutrition news. Here are a few highlights to help you “eat to win.”

• Beets, like rhubarb and arugula, are rich sources of dietary nitrates, a compound that gets converted into nitric oxide (NO). Nitric oxide dilates blood vessels, lowers blood pressure, and allows a person to exercise using less oxygen. In a study, cyclists consumed pre-ride beets, and then three hours later (when NO peaks), they rode in a time trial. Every cyclist improved (on average by 2.8 percent) as compared to the time trial with no beets. Impressive! The amount of nitrates in 7 ounces (200 grams) beets is an effective dose. How about enjoying beets or a bowl of borscht in your next pre-game meal?

• Fuel up while cooling down is a wise mantra for athletes who exercise intensely. Immediate replenishment of carbs and protein can decrease muscle soreness and inflammation, plus enhance muscle repair. What you eat before you exercise can also effectively reduce post-exercise recovery. In a study, trained athletes consumed two 10.5-oz. bottles per day of tart cherry juice a week before an excruciating exercise test. They recovered faster and lost only 4 percent of their pre-test strength, compared with 22 percent loss in the group without cherry juice.

Tart cherries can help not only athletes but also individuals who suffer from the pain and inflammation associated with fibromyalgia and osteoarthritis. Consuming tart cherry juice (two 10.5-ounce bottles/day for 10 days) reduced the muscle soreness associated with “fibro-flares” and enhanced recovery rate. Similar findings occurred in people suffering from osteoarthritis. Drinking tart cherry juice for three weeks reduced arthritis pain.

Tart cherries (the kind used in baking pies, not the sweet cherries enjoyed as snacks) have both antioxidant and anti-inflammatory properties. Other foods that have high antioxidant and anti-inflammatory activity include raspberries, blackberries, and strawberries. Fruit smoothies, anyone?

Research to date has studied the effects of drinking 21 ounces of tart cherry juice per day for one to three weeks. (That’s the equivalent of eating 90 tart cherries/day). More research will determine the most effective dose and time-course. Because 21 ounces of tart cherry juice adds 260 calories to one’s energy intake, athletes will need to reduce other fruits or foods to make space for this addition to their daily intake.

• Sleeping used to be our most common “activity,” today it is sitting. The average person sits for nine hours a day. Prolonged sitting is a risk factor for heart disease and creates health problems, including deep vein thrombosis (as can happen on planes and during long computer work/games). Athletes who exercise for one or two hours daily still need to do more activity instead of sitting in front of a screen all day. How about a treadmill desk or “desk-ercycle”?

• While we may be sitting more than in past years, we’re sleeping less. 80 percent of teenagers report getting less than the recommended nine hours of sleep; nearly 30 percent of adults report sleeping less than six hours per night. Not good. Sleep is a biological necessity. It is restorative and helps align our circadian rhythms.

Sleep deprivation (less than five hours per night) erodes well-being, has detrimental effects on health and contributes to fat gain. When we become tired, grehlin, a hormone that makes us feel hungry, becomes more active and can easily lead to overeating. Sleep deprivation is also linked with type 2 diabetes, high blood pressure and heart disease.

Sleep deprivation is common among athletes who travel through different time zones. This can impact performance by disrupting their circadian rhythms and causing undue fatigue and reduced motivation. By comparison, extending sleep can enhance performance. A study involving basketball players indicates they shot more baskets and completed more free throws when they were well rested versus sleep deprived. For top performance, make sleep a priority.

• In a few communities in the world, an usually high number of people live to be older than 100 years. What happens in those communities that contributes to the longer life? Some factors include choosing a plant-based diet, rarely overeating, having a life filled with purpose and meaning, connecting with others in the community, moving naturally and/or socially (as in bike commuting and walking with family and friends), enjoying alcohol socially and in moderation, and not smoking. If you want to join the centenarians, take steps to re-create those life-enhancing practices.

Creating that life-extending culture has been done, to a certain extent, in Albert Lea, Minnesota. The “Blue Zone” project included improving sidewalks and building walking paths around a lake. Restaurants supported the program by not bringing a bread basket automatically to customers, and not serving French fries (unless requested) with meals. These and many other environmental changes contributed to a healthier lifestyle that resulted in an impressive 40 percent drop in city employees’ healthcare costs over two years.

• Many athletes, as well as obese people, commonly struggle with the belief that their body is not “good enough.” This struggle gets too little attention from health care providers who focus more on the medical concerns of heart disease, cancer and hypertension. Yet, whether you are lean or obese, having a poor body image often coincides with having low self-esteem. This combination generates poor self-care.

In a five-year study with teenagers, low body satisfaction stimulated extreme and destructive dieting behaviors that led to weight gain, not weight loss. The same pattern is typical among many seemingly “healthy” athletes. If you want help finding peace with your body, please seek it from a sports dietitian. Use SCAN’s referral network, www.SCANdpg.org, to help you find someone local. What are you waiting for?

Nancy Clark, MS, RD, CSSD (Board Certified Specialist in Sports Dietetics) counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her “Sports Nutrition Guidebook” and food guides for new runners, marathoners and soccer players offer additional information. They are available at www.nancyclarkrd.com and sportsnutritionworkshop.com.

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

Can Following a Vegan Diet Be Appropriate for Children?

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Vegan Food on Child's PlateGoing totally vegan is becoming increasingly popular among health-conscious adults and many encourage their children to follow suit. But some parents are unsure whether diet restrictions they find healthful for themselves are also a good choice for their kids.

With the Right Precautions
Nutritional Deficiencies Can Be Avoided

The idea of bringing up youngsters as vegans is controversial, even among nutrition experts. Critics warn that an exclusively plant-based diet may be inappropriate for young children because of the risk of malnutrition when essential nutrients provided in animal products are missing.

Infants and toddlers have special dietary needs because of their rapid growth and development. For those reasons, no dietary restrictions should be applied under the age of two.

Proponents claim that following the dietary guidelines of vegans is beneficial at every stage in life and in any case preferable to the typical American diet, which offers higher amounts of calories and fat but is of lesser nutritional quality.

Veganism, the strictest form of vegetarian diets, excludes all animal food products, including eggs and dairy products. Less stringent variations are semi-vegetarianism (includes fish, poultry, eggs and dairy products but no beef, lamb or pork), lacto-vegetarianism (includes dairy products) and ovo-vegetarianism (includes eggs).

According to the Academy of Nutrition and Dietetics (formerly the American Dietetic Association), “appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain diseases.” The Academy also stresses that “vegetarian diets in childhood and adolescence can aid in the establishment of lifelong healthful eating patterns.” In other words, early adherence to vegetarian eating styles can lay a good foundation for nutritional health, whether those patterns last or change later in life.

A predominantly vegetarian diet is recommended for both children and adults who have weight problems, diabetes, heart disease, high blood pressure and high cholesterol levels. One in three children living in the United States today is overweight or obese and will likely develop some diet-related health problems over time, according to the Centers of Disease Control and Prevention (CDC). Switching to a vegetarian-style diet, sooner rather than later, can help prevent many of these negative health effects.

While it is true that following a strict vegan diet can have its challenges in terms of nutritional balance, vegans can plan their meals carefully to ensure sufficient access to a full range of important nutrients, including so-called “complete” protein. For children in their growing stages, lack of protein can cause serious health problems, including stunted growth and other developmental setbacks.

Only animal and soy proteins are considered “complete” because they contain all amino acids (the building blocks that make up protein) the human body requires. Plant foods can only offer “incomplete” proteins, lacking one or more amino acids. But vegans can make up for these deficiencies by combining different plant foods, for example by eating grains together with legumes, vegetables with legumes, vegetables with nuts, grains with nuts and so on. Because amino acids stay in the blood stream for several hours, complimentary proteins don’t have to be consumed all at once but can be distributed over several meals.

Calcium and iron are two nutrients more easily derived from animal products than from plant foods. Green leafy and cruciferous vegetables such as kale, spinach, broccoli and Brussels sprouts are good sources of calcium. Iron can be found in greens too. Vitamin C-rich foods like citrus fruits enhance iron absorption.

Harder to come by is vitamin B12, which is essential for the health of both blood and nerves. B12 cannot be found in plant foods at all, but the body’s needs can be met by drinking fortified soymilk, eating fortified breakfast cereals or by taking multivitamin supplements.

Iodine is a trace mineral important for the regulation of thyroid hormones. Dietary sources include iodized salt, seafood, eggs, dairy products and crops grown in iodine-rich soil. If these are excluded, smaller amounts are available in green leafy vegetables, potatoes (with skins), seaweed and kelp.

Vitamin D is a nutrient needed for growth and the formation of healthy bones and teeth. It is also harder to get from plant food than from animal products. Thankfully, some vitamin D can be obtained through sun exposure. If sunlight is limited (e.g. you stay indoors or live in Seattle), dietary sources must make up the difference. Fish and fortified milk are good providers, however, if they are excluded, there are only a few plant-based options, such as cauliflower. A multivitamin supplement may be your best solution.

Omega-3 fatty acids are essential fatty acids. They are not made in the body but are important for many bodily functions, including fighting inflammation. Richly present in fish, omega-3s can be supplemented by taking a daily tablespoon of flaxseed or rapeseed oil.

Looking at all the options, it seems very possible to raise healthy children on a vegan diet, especially as they grow older and become adolescents. As long as parents are aware of potential pitfalls and take proper precautions, they should feel confident that they are doing their kids a good service. “The real issue is not whether a child’s diet is vegan or not, or restricted or not. The important thing is whether it’s healthy,” says Amanda Baker, a media spokesperson for the Vegan Society. There are plenty of kids who are not vegan but lack all sorts of nutrients because of their poor diet. It is actually easier for vegans to meet the government’s dietary recommendations for fruits and vegetables servings than for most people, according to Baker.

Ruby Roth, the author of two books about veganism for children, titled “Why We Don’t Eat Animals” (2009) and “Vegan Is Love” (2012), says that introducing children to vegan-style eating has other benefits besides healthful nutrition as well, including instilling interest in environmental and animal rights issues at a young age.

What matters most is that children don’t feel forced to stay within strict dietary limits that don’t allow for some flexibility. If the parents themselves are new to vegetarianism and are trying to get their youngsters to join in, they should start slowly, let’s say, by having one or two meatless nights a week and then progress from there. It’s the same with all diet and lifestyle changes – if they don’t become natural, they won’t last long.

So It Is Possible to Reduce Salt in Our Food

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The salt content of popular fast food items like chicken nuggets can vary considerably, depending where you buy them, according to a study report by an international group of scientists that tested products of leading multinational restaurant chains. What they found were dramatic differences in the amounts of added salt in the same kinds of food, made by the same companies, only in different parts of the world.

For the study, researchers from Australia, Canada, France, New Zealand, the United Kingdom and the United States analyzed fast food items from McDonald’s, Burger King, KFC, Domino’s Pizza, Pizza Hut and Subway in each of their respective countries and compared notes.

Study Compares Salt Content in Fast Food Items
Around the World and Finds Startling Differences

Although fast food is known for being notoriously high in salt wherever you go, the study results are nevertheless startling. The U.S. and Canada were reported to have the highest levels of salt compared to other countries – in some cases nearly twice as high.

One reason for the differences could be government guidelines for salt reduction like in the U.K., said Dr. Norman Campbell of the University of Calgary, Canada, one of the authors of the study report. The British government has set voluntary targets for the food industry, although not yet for fast food restaurants. Still, a growing number of food manufacturers and restaurant operators have committed themselves to meeting the proposed levels as soon as possible and are already using their pledges for advertising purposes.

What this study shows is that reducing salt in our food is indeed feasible and that the technology to do so exists despite of the food industry’s long-standing assertions to the contrary. If it can be done in one country by the same manufacturers and with virtually identical items, it can be repeated elsewhere and certainly here in the U.S.

“Consumers should not have to bear all the responsibility for their diet choices,” said Dr. Campbell. 80 percent of most people’s daily salt intake doesn’t come from the saltshaker on the dining room table but is already added to many processed foods, including items that don’t even taste salty.

The best strategy for reducing salt consumption is for governments to intervene and regulate the use of salt in food processing, he said. All other attempts have been proven unsuccessful. Education campaigns like the National Salt Reduction Initiative here in the U.S. may be well-intended, but they can only work if supported by binding regulations for the food industry.

Dr. Campbell doesn’t believe that trying to further educate the public will produce better outcomes. “We have a highly educated population that is aware of the issues. They are trying to eat healthy and a lot of them perceive they are eating healthy.” What persists is widespread confusion because people don’t know how ubiquitous salt is in their food supply. They eat their food as it’s presented to them, trusting that – although it may not always be perfectly healthy – it will do them no harm.

Another frequently made argument by food manufacturers is that Americans love salty foods and would not buy them if they had a bland taste. “That is because they are used to higher salt levels,” said Dr. David Katz, director of the Prevention Research Center at Yale University. In other words, it’s an acquired, not a natural taste.

According to a study in the New England Journal of Medicine, it is estimated that cutting back just 3 grams of salt (1,200 mg sodium) a day could save the lives of almost 100,000 Americans annually. If the industry substantially reduced the levels of salt it currently uses for food processing, it could translate to large gains for the health of the population, wrote the researchers in their concluding summary. How much longer do we have to wait?

Eating for Two

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By Shana Hopkins, MS, CN

Nutrition is never more critical than during pregnancy when needs are super-heightened. What you eat not only affects you, it affects your baby’s health beyond nine months, and into childhood. As a woman, your body requires more of everything during pregnancy: More calories, water, protein and certain vitamins and minerals.

Morning sickness can be the hallmark of the first trimester. There are, however, some tricks to minimize its effects. For instance, eating small, frequent meals throughout the day staves off hunger, preventing you from overeating.

Other helpful tips to relieve stomach upset: Drink small amounts of fluid between meals rather than with them. Avoid heavy, fried or spicy foods that are hard to digest. Instead, look to bland foods like applesauce, bananas, brown rice and oatmeal on days when no food looks or sounds good. Sip on ginger tea, or take 50 mg of vitamin B6, one to two times per day, both antidotes that settle pregnancy-induced nausea.

A Healthy Pregnancy Begins with Proper Nutrition

When it comes to calories, women may think they need to literally ‘eat for two.’ But this expression is misleading, and eating twice the amount of food as normal can cause excessive and unhealthy weight gain. In fact, during the first trimester, there is no need to add additional calories at all. During the second and third trimesters, you can up your daily intake by 300 calories per day. That’s the required number for appropriate weight gain and adequate calories, so your baby develops properly.

However, where these extra calories come from is just as important. Choose nutrient-dense foods for the optimal growth and success of the pregnancy. These foods can include lean meats, chicken, fish, nuts, milk, whole grains, beans and dark leafy greens. Opt out of that empty-calorie ice cream or other sweet treats to fulfill your supplemental calorie requirement.

Folate, also known as folic acid, is a critical nutrient you need to take, even before pregnancy. Folate prevents birth defects of the brain and spinal cord, specifically spina bifida. The Dietary Guidelines for Americans stress that all women of childbearing age take a daily folic acid supplement and eat folate-rich foods.

Supplemental folic acid is actually better absorbed in the gut than the folate found in foods. However, good dietary sources of folate exist. These include dark greens like kale, collards, and spinach, as well as whole grains and citrus fruits. Again, be sure to supplement with 800 mcg of folic acid per day before, during and after pregnancy for your as well as your baby’s health.

Iodine is one mineral we don’t think much about, but it needs consideration. A pregnant woman’s daily requirement is 220 mcg per day, well over the 150 mcg requirement for a non-pregnant woman. Iodine is a mineral that is used by the mother’s thyroid gland to produce thyroid hormone. Consequently, adequate thyroid hormone is needed for proper brain development in the fetus. The American Thyroid Association recommends that all pregnant and breastfeeding women in the U.S. take a supplement containing 150 mcg. However, a study conducted by researchers at Boston University found that only 51 percent of U.S. prenatal vitamins contain iodine.

For the most part, Americans receive iodine through iodized salt. If you’ve cut your salt intake or use non-iodized salt like sea salt, you may require supplementation. Be sure your prenatal supplement contains 150 to 220 mcg of iodine. Good food sources of iodine include cod, shrimp, potatoes with their skins, cow’s milk and iodized salt.

Two other must-have minerals include iron and calcium. When you are pregnant, you are much more susceptible to iron deficiency anemia because blood volume increases. You’ll need 27 mg of iron per day. Look to food sources like red meat, eggs, salmon, whole grains, legumes, almonds, brazil nuts, pumpkin seeds, sesame seeds, kelp and blackstrap molasses.

Be sure to get your calcium, crucial to forming the infant’s skeleton. In fact, the fetus obtains most of its calcium during the last trimester and can draw between 250 to 300 mg of calcium per day from maternal blood. Calcium intake should reach 1,200 mg per day during pregnancy. Remember, if you aren’t getting adequate calcium during the third trimester, it will be taken from your bones. Dairy foods are rich in calcium, but other great sources include kale, collard greens, cabbage, turnip greens and sesame seeds.

High levels of vitamin A can cause birth defects and should be avoided during pregnancy. Take care not to take more than 5,000 I.U. per day. Try to obtain your vitamin A from beta-carotene, benign at higher intakes. Beta-carotene, found in most red, orange, and green vegetables, chemically converts into Vitamin A as your body needs it.

Protein intake also needs to increase during pregnancy to help grow the new life. Aim for at least 75 to 100 grams per day. If you drink milk, you’ll obtain both calcium and protein. However, don’t rely on milk to serve all your protein needs. Opt for two or three more servings of protein-rich foods per day, like eggs, cottage cheese, lean meats or fish. Best are fish high in omega-3 fats, like wild salmon or black cod. For vegans, beans, whole grains, soy, nuts and seeds can provide protein.

Research indicates that omega-3 fats, specifically DHA, aid early human development. This essential fat accumulates in the infant’s body during late pregnancy and early infancy and is found highly concentrated in the brain, nervous system and eye tissue. DHA is an essential fat found primarily in coldwater fish like salmon, black cod, herring and sardines. Consume three to four servings of DHA-rich foods per week during pregnancy and after birth while breastfeeding. A high-quality fish oil supplement during pregnancy helps you meet your daily needs.
You will want to take a superior prenatal supplement during pregnancy to make sure your calcium, iron, vitamin B6, folate and omega-3 fats intake, among other nutrients, are met.

Shana Hopkins MS, CN is the Resident Nutritionist at the Washington Athletic Club (WAC), where she teaches and empowers members to make smart health and lifestyle choices. For more information, please visit the Washington Athletic Club or call 206.839.4782

This article first appeared in the April 2010 edition of WAC Magazine, a publication of the Washington Athletic Club.

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

Mid-day Workouts Can Give You a Much Needed Energy Boost

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Lack of time is the number one reason why Americans say they don’t exercise enough. Long commutes, stressful jobs, household chores and family commitments make it almost impossible to squeeze in even a minimal amount of daily physical activity. No matter how you feel the need for it, there never seem to be enough hours in the day to take care of your physical fitness.

Early risers may find it easier to exercise at home or go to a gym before their day starts. But even serious fitness enthusiasts are not always inclined to get their heart rate up just after coming out of a slumber. Waiting until evening can be tricky, too. After a long day, most people are too exhausted or still too busy for a swift walk on the treadmill or a round of lifting weights. Being able to fit in a short but intense workout in the middle of the day would seem ideal, however, this may not always be possible depending on your line of work or your employer.

Maintaining an Exercise Regimen
Includes Smart Scheduling

In a best-case scenario, you would be able to exercise without leaving the office. Many larger corporations have well-equipped gyms on campus. Google, for instance, offers its employees on-site fitness centers in almost all of its office complexes. But also smaller businesses all over the country are beginning to recognize the importance of investing in the health and fitness of their work force. So, if you can count yourself among the lucky ones who have a health-conscious employer, you should make the most of it.

If no such opportunities are available at your work place, you may have to become a little more creative. Perhaps, you can find a gym, a public park or a sports facility nearby. Try to talk some of your colleagues into joining you for a run, a fast walk or a game of volleyball on the front lawn during lunch hour. If all else fails, you can take the stairs in your office building as a substitute stair master. Your imagination is the limit.

The benefits of a mid-day workout are multiple. Exercising at noon (or thereabouts) increases your metabolism for the rest of your workday instead of just the evening hours. It also invigorates you, getting you more easily through the usual afternoon slump. You are also less likely to skip your session due to tiredness or the need to tend to more urgent matters before you go home.

It is also important that you develop a regular schedule and deviate as little as possible. If you are neither an early bird nor a night owl, mid-day may be your best slot. If you exercise consistently around the same time of the day, your body will adapt to your schedule and be ready for peak performance.

Remember that not only your body needs a boost. Stretching your legs and flexing your muscles can also help you clear your mind and reduce stress. It will make you more alert, focused and productive during your remaining work hours. A study by the Leeds Metropolitan University in the U.K. found that workers who exercised during lunch break got more work done, used up fewer sick days and had lower medical expenses than their non-exercising colleagues.

So, if your boss considers mid-day exercising as a way of slacking off, show him or her those statistics. Maybe you’ll have company next time.

Ten Things You Need to Know About Gluten

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By Elisa Zied, MS, RD, CDN

Earlier this week, I wrote a brief article for MSNBC.com about how Miley Cyrus took to Twitter to credit a gluten-free diet for her recent weight loss. Because gluten-free diets have become ridiculously popular in recent years, are very challenging to follow, and aren’t always warranted, I turned to one of my colleagues, noted gluten expert Shelley Case, B. Sc., RD, author of “Gluten Free Diet: A Comprehensive Resource Guide,” to share what you need to know about gluten (and celiac disease). Here’s Case’s top 10 list:

1. Celiac disease is serious
Celiac disease is a serious autoimmune disorder that affects one in100 people, yet only about 5 to 10 percent with the disease are diagnosed. Symptoms of CD are variable, may occur at any age (including the elderly), and involve not only the gastrointestinal system but many other organ systems. Infants and young children can present with bloating, gas, diarrhea, weight loss, poor growth, irritability, dental enamel defects and/or anemia. In older children and adults, symptoms can be mild to severe.

Some may present with only a few symptoms while others can have many different symptoms. These include: Anemia, nausea, reflux, bloating, gas, diarrhea or constipation (or both), lactose intolerance, weight loss (CD can also occur in obese individuals), mouth ulcers, extreme fatigue, irritability, bone and joint pain, easy bruising of the skin, menstrual irregularities, miscarriage, infertility (in both women and men), migraines, depression, ataxia, seizures, neuropathy, elevated liver enzymes.

2. Test first, diet later
It is critical that you get tested for celiac disease before going on a gluten-free diet because once on the diet, it is difficult to get an accurate diagnosis. The blood and small intestinal biopsy tests require that you stay on a gluten-containing diet for at least 6 to 8 weeks. In some cases, you may need to be on it for months for the tests to be positive.

3. Get screened
If you feel better on a gluten-free diet, it’s possible you may actually have undiagnosed celiac disease. Without a confirmed diagnosis, you may not be motivated to follow the lifelong strict gluten-free diet to prevent complications of celiac disease such as anemia, osteoporosis, development of other autoimmune disease and cancer. Also, celiac disease affects between 5 to 15 percent of first-degree relatives, so it’s important for your family members be screened as well. This may not occur to you if you don’t have an official diagnosis.

4. See if you’re sensitive
If the tests come back negative for celiac disease, it is possible that you may have non-celiac gluten sensitivity (GS). New research from the Center for Celiac Research in Baltimore indicates that up to 6 percent of the population may have non-celiac gluten sensitivity. Symptoms of GS are often similar to those of celiac disease. Currently, the only way to diagnose GS is to rule out celiac disease. For more information about GS, see: http://www.biomedcentral.com/content/pdf/1741-7015-10-13.pdf

5. Gluten-free after diagnosis
The only treatment for celiac disease is a strict gluten-free diet for life. It is thought that those with GS also need to follow a gluten-free diet, but it is not known whether the diet needs to be followed as strictly or for life. More research about GS is needed.

6. Eat with caution
A gluten-free diet requires that all forms of wheat, rye and barley, including spelt, kamut, einkorn, emmer, faro, durum, couscous, semolina, bulgur and triticale, barley malt extract/flavoring, malt vinegar and brewer’s yeast must be avoided. The diet is very challenging to follow because gluten is found in such a wide variety of foods like breads and other baked products, cereals, pastas, soups, sauces such as soy sauce (which is often made from wheat and soy), seasonings, salad dressings, snack foods, prepared meats (e.g., deli meats, hot dogs, hamburger patties, imitation seafood), beer, flavored coffees and teas, some candies (e.g. licorice) and chocolate bars as well as some nutrition supplements and medications. Because of the complexity of the diet, it is essential that you consult with a registered dietitian for a nutritional assessment, education about the diet, and to ensure your diet is healthy.

7. Focus on naturally gluten-free foods
A wide variety of foods that are naturally gluten-free include plain meat, poultry, fish, eggs, pulses (legumes), nuts, seeds, milk, yogurt, cheese, fruits, vegetables, as well as many gluten-free flours, cereals and starches* that can be substituted for wheat, rye and barley. Distilled alcoholic beverages and wines are also allowed, however beer derived from barley must be avoided. There are a variety of gluten-free beers made from sorghum, buckwheat, rice and other grains. All vinegars are gluten-free except for malt vinegar (made from barley and is not distilled).

*Gluten-Free Flours, Cereals and Starches are amaranth, arrowroot, buckwheat, corn, flax, pulse flours (bean, chickpea/garbanzo, lentil, pea), mesquite flour, millet, nut flours (almond, hazelnut, pecan), potato flour, potato starch, quinoa, rice bran, rice polish, sago, sorghum, soy, sweet potato flour.

8. Don’t be fooled
A gluten-free diet is not always synonymous with a nutritious diet. Many gluten-free products are higher in fat, sugar and calories, lower in fiber, iron and B vitamins because they are often made with refined flours and starches (e.g. white rice flour, potato, corn and tapioca starch), and not enriched with vitamins and minerals as their gluten-containing counterparts.

9. Go for gluten-free grains
Incorporate more gluten-free whole grains in your diet. For tips and recipes see http://www.glutenfreediet.ca/img/WholeGrains2.pdf

10. Stay in the know
For more information about celiac disease, gluten sensitivity, and the gluten-free diet see www.glutenfreediet.ca

Elisa Zied, MS, RD, CDN is a nationally recognized Registered Dietitian and award-winning author of “ Nutrition at your Fingertips,” “Feed Your Family Right,” and “So What Can I Eat.” She is also a past national media spokesperson for the American Dietetic Association. For more information, go to www.elisazied.com

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.