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How Many Calories Do I Need? And Other Questions From The Boys & Girls Clubs Fit Family Challenge

December 19th, 2012 by Dr. Val Jones in Health Tips

Tags: Boys And Girls Clubs Of America, Calories, FAQ, Fit Family Challenge, How Many Calories Do I Need, Nutrition Questions, Salt, Sports Drinks, Triple Play, WHO

This year’s finalists for the Boys & Girls Clubs’ Fit Family Challenge are about to be announced. I’ve had the privilege of acting as nutrition coach for the semi-finalist families, and have had fantastic interactions with them about common nutrition questions. In my continuing Q&A series, I thought I’d share some of our email conversations:

Q: How many calories do I need per day, and how many should I eat to lose weight?

I like to use this Mayo Clinic calculator to get a rough estimate of daily caloric needs.   If you enter your height, weight, age, and activity level it will tell you approximately how many calories/day you need to maintain your weight. To lose one pound a week, you need to subtract 500 calories/day from that number. So, for example if the calculator suggests that you need 2000 calories/day – you should follow a 1500 calorie/day diet to lose 1 pound a week. Studies have shown that people who drop more than 500 calories below their daily maintenance needs have a hard time sticking to their diet. You may feel weak, trembly, and irritable if you cut down too low too fast. You will have to play with the amount a little bit since the calculator is not exact – if you don’t see the scale moving when you cut out 500/day, then you have to wonder if you’re counting calories correctly or perhaps if you have to go a little bit lower still. Unfortunately, the “reward” for losing weight is that you have to permanently eat less when you are at your desired goal because there is less of you to feed!

Q: What do you think about sports drinks? Do my kids need them when running races?

As far as sports drinks are concerned, their benefits are often over-hyped and exaggerated. That being said, I believe they do have a role in hydration during endurance sports like long distance running. When you do strenuous exercise for long periods of time (over 1 hour of effort) you lose a lot of body salt and minerals (electrolytes) in your sweat. It’s important to replace certain key electrolytes so your body doesn’t become depleted and begin to cramp. This is more likely to happen to folks running very long distances, such as marathons and triathlons. However, if it’s hot during your race, you could be at risk for dehydration and electrolyte loss as well.

Regular Gatorade (made by Pepsi Co.) has water, sugar, sodium, and potassium in it. Powerade (made by Coca Cola) has water, sugar, sodium, potassium and B vitamins. Powerade has a little bit higher sugar concentration, which could be an advantage on a long run. Both are reasonable choices for hydration during a race.

The rough rule of thumb is to take in 6-12 oz of fluid for every 20 minutes of running. Water is sufficient for runs that last less than an hour. Sports drinks (or adding electrolyte gels/chomps to water) are helpful if your run will last longer than an hour. It’s better to sip the water slowly at regular intervals than to dry to gulp it all down at one time. You may feel nauseated or have a “sloshy stomach” feeling if you don’t spread out your hydration.

Sports drinks can be quite expensive – and you can easily create your own at home. The World Health Organization has a simple recipe for rehydration fluids, and I found this (probably slightly tastier) version on a blog site.

Outside of endurance sports, I don’t see a physiologic need for sports drinks (with the exception of extreme sweating in hot weather or during illness with vomiting and diarrhea) – they can add unnecessary calories to your diet.

Q: Should I cut down the amount of salt in my diet?

Not necessarily. Too little salt, as well as too much salt, have both been shown to be unhealthy. If you’re eating a lot of fast food, you’re probably getting too much salt. If you cook for yourself and focus on fruits and veggies, whole grains, and lean protein you may not need to cut back. Unless you have a kidney problem or very high blood pressure, salt is generally not dangerous for you. About 2.5g of salt/day (roughly a teaspoon full) is optimal, but for most people up to 4g/day probably won’t hurt (and at least one study suggests that heart disease risk doesn’t increase until the daily intake of salt exceeds 7g/day).

How Can I Get My Kids To Eat Healthy Food? More Q&As From The Boys & Girls Clubs

December 11th, 2012 by Dr. Val Jones in Health Tips

Tags: BGCA, Boys And Girls Clubs Of America, Children, Diet, Fit Family Challenge, kids, Nutrition, Pediatrics, Recipes

I’ve continued to have terrific email questions and answers with the Boys & Girls Clubs’ Fit Family Challenge participants. I thought I’d publish some of our conversations so that you can participate as well. The Lang family shared this image of their son eating dinner next to the latest USDA dietary recommendations “MyPlate” materials. A picture’s worth 1000 words, isn’t it?

This cute fella is a healthy weight, he is very athletic, and he’s also wondering where chicken nuggets, french fries, and pizza fit in to the MyPlate dinner plans… His mom asked me how to make more “kid friendly” healthy meals. Perhaps some folks reading this have some success stories that they’d like to share? Here’s what I had to say to the Langs and others…

1. My son doesn’t think the MyPlate suggested meals are kid friendly. What can we do?

I wonder if your son would be open to trying healthier variations of the foods he likes? You could make a pretty tasty pizza with whole wheat crust, grilled veggies, a little pesto or tomato sauce and some ham cubes (ham is much lower in fat than sausage or pepperoni) and low fat shredded mozzarella. You can get a pizza stone to help crisp the crust in a regular oven. The pizza would probably reheat well so you could make it in advance too.You can bread chicken strips and bake them (instead of frying them) to simulate healthy chicken “nuggets.” Same for fish sticks. You can try sweet potato fries for a healthier fry option – bake them in the oven with a little olive oil, salt and pepper. More nutritious, kid-friendly recipes may be found at KidsHealth.org

2. Do my kids need 8 cups of water a day?

As far as water is concerned, the amount you need really depends on how much liquid you’re getting from other sources (food, beverages) as well as how much you’re sweating (exercise), how hot/dry the environment is and how much you weigh. Eight cups/day is a very rough rule of thumb. Some people need more or less depending on the day. Unless you are doing extreme exercise (in the heat) that requires fluid replacement before you notice that you’re thirsty, thirst is a good indicator of whether or not you need to drink. Also, I’ll tell you a doctor secret – all you need to know about hydration is in your urine color. Urine becomes very concentrated (dark yellow) when you are dehydrated. If you drink enough water to keep your urine a nice light yellow, then that’s all you need.

3. What are the best vegan protein substitutes for meat?

Concentrated vegetable protein is primarily derived from soy (tofu and tempeh) and wheat (seitan). Nuts and seeds also contain some degree of protein, as well as beans, lentils, and rice. Tofu, tempeh, and seitan can be molded into burger and hotdog shapes and may be prepared to mimic meat flavors. Keep in mind that concentrated soy or wheat proteins may not agree with your intestinal tract (some complain of excessive gas and bloating). So if you have those reactions, at least you’ll know that it’s quite common.

4. Is it healthy to be a vegetarian? Is there such a thing as too much fruit and veggies?

Vegetarianism can be healthy, though it takes some effort to ensure that adequate amounts of nutrients are received – especially if you’re vegan (no dairy, no eggs). The most common deficiencies for vegans are iron, B12, calcium, Omega-3 fatty acids, protein, and Vitamin D. (You can read more about how vegetarians can overcome these deficiencies here.) I guess my main concern with veganism is the low omega-3s. It is basically impossible to get enough omega-3 fatty acids from plant sources (certain seeds, you may have heard, have a good amount of omega-3 fatty acids but what they won’t tell you is that plant omega-3′s aren’t processed by the body so they remain inactive and don’t provide much benefit.) Omega 3 fatty acids form a protective layer on the outside of cell membranes by reducing inflammation. This is particularly helpful in the reduction of plaque build up in heart arteries, and reducing the risk of various dementias (such as Alzheimer’s) that have an inflammatory cause.

Excellent sources of omega 3 fatty acids are oily fish (sardines, salmon, mackerel, sea bass). This is why the American Heart Association (and MyPlate.gov) recommend 2 servings of oily fish/week for optimal health. Vegetarians are missing out on this important benefit.

As far as eating too many fruits/veggies is concerned – I can’t think of too many potential harms from eating large amounts of fruits/veggies (other than weight gain if you really eat a lot of fruit – they have quite a bit of natural sugar). The real harm comes from excluding vital nutrients by eating plants exclusively (without a careful strategy to get the right plant sources of vitamins and minerals, along with omega-3 supplements).

Debunking Nutrition Myths With The Boys & Girls Clubs Of America

December 7th, 2012 by Dr. Val Jones in Health Tips

Tags: ADA, BGCA, BGH, Cancer, Fit Family Challenge, Fluoride, Hormones, Milk, Myths, organic, Prevention, rbST, Screening, Vitamins

This year’s Fit Family Challenge competitors are smart, savvy, and full of great nutrition-related questions! I just finished a one hour conference call with 10 family finalists from across the U.S. and Hawaii. As part of their challenge to adopt healthy diet and exercise practices, they were asked to send me their most burning nutrition questions. One mom told me that her goal was “to teach her girls how to think critically” about health information. I was so pleased to see those values being promoted that I thought I’d share some of our mythbusting FAQs here on the blog:

1. I live in a community that doesn’t add fluoride to the public water supply. Do my kids need to take fluoride supplements?

Fluoridation of our water supply is considered to be one of the top 10 most effective public health initiatives of the 20th century. Enhancing the natural fluoride content of water results in up to a 60% reduction in tooth decay for kids! The cost to a community of adding fluoride to the water supply is about 50 cents per person per year, so it’s really quite affordable. I’m not sure why your community water hasn’t been fluoridated, but it’s estimated that about 1/3 of Americans still live in communities that haven’t supplemented their water with fluoride (so you’re not alone).

Our teeth use fluoride to strengthen our enamel – and we can get fluoride to our teeth in two ways: 1) from our blood stream (e.g from the water we drink, digest, and absorb) and 2) topically (e.g. from toothpaste). Studies have shown that it’s best to get fluoride via both routes for optimal enamel strength. For children living in areas where the water is not fluoridated, the American Dental Association (ADA) recommends fluoride vitamins until at least age 16. There are two strengths of fluoride vitamins, and the dosage required depends on the fluoride levels in the local water supply (you can ask your local Water Department for that information if you haven’t already). Keep in mind that most children’s permanent teeth (with the exception of “wisdom teeth”) erupt by age 13 – and before that age there is no way to get fluoride to them except via the blood stream. So digesting fluoride (via water or vitamins) is critical to strengthen those teeth that haven’t broken through the gums yet.

For more information about fluoride, see this helpful ADA guide.

All mammals release trace amounts of hormones into their milk. Cow’s milk naturally contains a small amount of bovine somatotropin (bST) which is a protein that is quickly broken down by our stomachs when we drink milk. Some farmers give their cows additional amounts of the hormone to stimulate milk production. This rbST (or BGH) is virtually identical to naturally occurring cow hormones and the decades of research we’ve collected has been reviewed by the FDA (Food and Drug Association), WHO (World Health Organization), NIH (National Institutes of Health), AMA (American Medical Association), and ADA (American Dietetic Organization) – and all agree that rbST is safe for human consumption in the levels it occurs in cow’s milk. Interestingly, studies have shown that milk hormone levels in organic milk is essentially identical to levels in regular milk. There is therefore no advantage in buying organic milk insofar as hormones are concerned.

I believe that cow’s milk is safe and nutritious for kids (so long as they have no milk allergies or lactose intolerances). The milk/hormone scare is kind of an urban legend, so I wouldn’t be too worried about it. Your girls haven’t suffered any harm from drinking regular milk – and it’s great that you all enjoy the skim variety, by the way. Lower calorie options can help you maintain your weight over your lifetime.

For more information about milk and hormones please check out this helpful link full of research resources.

You are right that there are lifestyle choices that can substantially reduce your risk (and your childrens’ risk) of getting cancer. However, there is no way to guarantee that you’ll never get cancer, no matter how carefully you control your diet and lifestyle. Nevertheless it’s an excellent idea to do what we can to reduce our risks. Cancer is actually a complicated collection of different diseases, and so specific behavior changes may reduce the risk of certain cancers but not others. For example, a high fiber diet may reduce the risk of colon cancer, but not skin cancer.

Also note that it’s very hard to prove that any one dietary change (such as consuming a larger amount of one particular vitamin or herb) has a direct impact on cancer risk. What works is sometimes more general (such as avoiding becoming obese). Here are some  behavior changes that have been scientifically proven to reduce cancer risks or prevent certain cancers:

1. Smoking cessation
2. Regular use of sunscreen
3. A diet rich in fiber (i.e.lots of fruits and veggies and whole grains)
4. Maintaining a healthy weight
5. Regular exercise
6. HPV vaccines (especially for young girls – can prevent cervical cancer) and hepatitis vaccines (can prevent liver cancer)
7. Drinking very little alcohol (no more than 1 drink/day)

Screening for cancer is also important – because catching a cancer early is often the best way to cure it. The most effective screening tests are:

1. Colonoscopies (for adults over age 50)
2. PAP smears (for sexually active women and women who haven’t had hysterectomies)
3. Physical exams to check for skin cancer, oral cancer, and testicular cancers

Mammograms and prostate blood tests are less effective at catching cancers early, but they are recommended by most medical professional associations.

I recommend reading this page at the National Cancer Institute for more information about avoiding cancer risk factors:

Multivitamins are not recommended for cancer prevention. Although it would seem that vitamins could help reduce the risk of cancer, large studies have shown that they do not reduce the risk of cancer, and may even increase one’s risk (especially vitamin E.) The best source of vitamins is healthy food – and their fiber benefits are excellent as well. For a nice summary of the unhelpfulness of vitamin supplements, please see this ABC News summary of recent research.

Why Pumping Iron Is Great For Brain Cells

December 4th, 2012 by Julie Robillard, Ph.D. in Health Tips, Humor, Research

Tags: Brain Cells, Brain Health, Exercise, Geriatrics, Healthy Aging, Neurology, Neurons, Neuroscience, Resistance Training, Strength Training, Weight Training

In my last post I told you that I would reveal the one thing you can do to have a significant, positive and lasting effect on your brain health as you get older. See if you can spot it in the following list:

a) Learn to dance Gangnam style
b) Join a choir
c) Catch a wave
d) Pump some iron

Ok, that was a trick question. All of these answers are somewhat correct, but I was looking for the “most” correct answer (flashbacks to undergrad, anyone?): Pump some iron.

I realize I sound like a broken record – I’ve already written about how aerobic exercise can promote healthy aging here and here, and I’ve even already written about resistance training, or lifting weights, here.

So why am I at it again? Because it’s important!

I’m fresh out of the 2012 Aging and Society Conference, where researchers came together to discuss what works and what doesn’t when it comes to healthy aging. It turns out everyone pretty much agrees that exercise is hands down the most effective intervention to keep your brain cells happy into old(er) age. All sorts of different types of exercise, ranging from simply walking to attending resistance training classes, are associated with different types of improvements in cognition, memory, and even brain size.

Of course, there are different levels of effort involved with different types of exercise, or even when talking about a single form of exercise. When my friend Jess asks me to go for a walk, she means a power walk: it usually involves going up hills, sweating like a pig (even though pigs, ironically, don’t sweat much), and barely having enough breath for girl talk (though somehow we always seem to find it). When my friend Al and I go for a walk, what he means is a “mosey”: we stop to look at the view, pet the dog, chit chat with strangers, and have more than enough breath for lengthy discussions about life, work, and the possibility of alien lifeforms. When it comes to brain health, whether you’re walking or pumping iron, a little sweating and effort can go a long way. For example, resistance training has been proven to be most effective when the load, or how much weight you are working with, increases over time. So kick the intensity up a notch: there will still be plenty of time for chit chat around a post-exercise, antioxidant-rich mug of matcha (my new obsession – stay tuned).

Now that the obvious has been (re)stated, I want to take this opportunity to discuss the idea that perhaps lifestyle interventions such as exercise could be prescribed by your doctor. We know that exercise can improve cognition in aging but also conditions like depression. Should physicians prescribe lifestyle changes? Or are diet, exercise, and other lifestyle activities choices we should make ourselves? How would you feel if your doctor prescribed you exercise instead of pills? Would you be more motivated to exercise if the prescription came from your doctor instead of from your friendly Internet science blogger? Your thoughts in the comments!

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Dr. Julie Robillard is a neuroscientist, neuroethicist and science writer. You can find her blog at scientificchick.com.

Should You Get A Mammogram?

November 26th, 2012 by Dr. Val Jones in Health Tips, Opinion, Research

Tags: Bleyer, Breast Cancer, Controversy, NCI, NEJM, Oncology, Radiology, Risk of Death, Screening Mammograms, Should You Get A Mammogram, Welch

A recent mammogram study in the New England Journal of Medicine was so controversial that the authors (Drs. Welch and Bleyer) decided to make a YouTube video to defend and explain their conclusions. Now that’s a first, isn’t it? Well kudos to the study authors for their creative approach to getting ahead of a controversy. However, their video (created for the “general public”) is still a bit too technical in my opinion. I’d like to take a crack at distilling it further.

A question on most women’s minds (as they turn 40 and beyond) is whether or not they should get a screening mammogram (x-ray of the breasts). If you have found a lump in your breast or you have a family history of breast cancer the answer is yes. No need to read any further. However, for the majority of us lumpless, family-history-free women, a screening mammogram is far more likely to expose us to unnecessary follow up testing than it is to catch a tumor early.  Dr. Welch explains that screening mammograms aren’t very good at identifying aggressive breast cancer early enough to make a difference in whether one lives or dies anyway. That’s very disappointing news.

Dr. Welch goes on to explain that most of the gains we’ve made in breast cancer survival have been because of improved breast cancer treatments, not because of early detection with mammograms. He estimates that every year in the U.S. 1.3 million women are “over-diagnosed” with breast cancer because of screening mammograms, subjecting women to unnecessary biopsies, surgical procedures, and further follow up studies. In the video, Dr. Welch doesn’t explain exactly what these “over diagnosed” cancers end up being exactly (Cysts? Benign calcifications? Early non-aggressive cancers that the immune system kills on its own?) But suffice it to say that they don’t contribute to the cancer death rates.

So, given the fact that you are more likely to suffer through a false alarm than to discover a cancer early (and even if you do find it early, if it’s the “bad” kind you may not survive) are you willing to undergo a screening mammogram? That’s a personal question that we each have to answer for ourselves. As time goes on, however, I suspect that the answer will be made for us since health insurance companies (whether public or private) will begin to balk at paying for tests that do more harm than good overall. I think this issue is really at the heart of the controversy (the perception of rolling back a health benefit that women currently “enjoy”). Eventually screening mammograms may become an out-of-pocket expense for women who simply prefer the peace of mind that a normal test can give – even at the risk of going through a false alarm.

That being said, it sure would be great if we could find a screening test that identifies breast cancer early – especially the aggressive kind. Perhaps a blood test will do the trick one day? At least it is comforting to know that we have made great strides on the treatment side, so that fewer women than ever before die of breast cancer. More research is needed on both the screening and treatment sides of course.

As for me, I do regular breast self exams – though because I have no family history of breast cancer I’ve opted out of screening mammograms because I feel the cost/benefit ratio is not in my favor. I certainly hope that a better screening test is developed before I face a potential diagnosis. I respect that other women will disagree with me – and I think they have the right to be screened with the only option we currently have: the mammogram. I’m not sure how long it will continue to be covered by insurance, but at a price point of about $100, most of us could still afford to pay for it out-of-pocket if desired.

The bottom line of this controversial research study is that screening mammograms don’t actually catch death-causing breast cancers early enough to alter their course. Even though it makes intuitive sense to be screened, long term observations confirm that overall, mammograms do more harm than good. So now we wait for a better test – while some of us continue with the old one (as the National Cancer Institute recommends), and others (like me) don’t bother.

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Thanks to ePatient Dave and Susannah Fox who brought the issue to my attention on Facebook. Isn’t social media grand?