Tuesday, October 27, 2009


According to surveys, every year losing weight appears in our first three New Year goals. Let’s aim to succeed this year, by eliminating confusion.

Your questions:

Q: I am a 25 year old female, 5'8" 155 pounds. I started gaining weight about two years ago. I went from 135 pounds to 161 pounds. Of course, like numerous other young women, I am trying to lose the weight, but I also want to tone and develop muscle mass. I am trying to obtain a physically fit, yet feminine physique. It has been 5 weeks; I have lost 6 pounds. I do realize that every body type is different. What agenda works for one female, may not work for the other. I have been reading about supplements which "supposedly" aid in weight loss. I wanted to know your thoughts about supplementation. If you are a proponent, which ones would you advise? How much weight loss should not be exceeded in a week?

A: You have been doing very well. Losing six pounds in five weeks is excellent. Keep it up. Although, every body type is different, the same rules apply - eat well and be active. Supplements that promote weight loss may contain stimulants with side effects. I am nervous to recommend them. Aim to lose one to two pounds a week and you'll reach your goal soon.

Q: I was wondering about two diets, both contain diet pills. Do they work and if so are they dangerous?

A: Pills are not the way to lose weight and can have side effects such as dizziness, heart palpitations, dry throat, sleeplessness and a general unhealthy feeling. I don't recommend either. (I don’t mention the names of the pills.)

Q: I've read several books, which recommend eating a low-carb diet. Most of these books state that sugar is one of the worst foods - and it should be avoided at all costs. How bad is sugar for you?

A: Sugar can be eaten occasionally. I love sweets, cookies, chocolates and desserts. If I eat too much, I get fat. In fact, if too much of any foods are eaten, the excess calories will result in weight gain. I don’t recommend a low-carb diet, as some of my clients have gained weight on eating too much protein. However, I do recommend replacing sugary foods with high fiber carbs. This rule alone will lower your carb intake.

Q: From Singapore: I would like to have leaner arms and thighs and a flatter tummy, but can't seem to achieve my goal. How can I effectively trim these areas and have these fats burn off?

A: It is difficult to lose weight in specific parts of the body. Losing weight will lower the fat content around your muscles so you’ll get a better definition. For exercise, work out with weights, do aerobics and stomach crunches to help you get into better shape.

Q: I was so glad to read a site about diets that didn't tell me to stop drinking my three cups of black coffee. I have been trying to lose weight for ten years now. I am 27 years old and nothing seems to work, I have tried every diet in books, magazines, you name it. My problem is BREAD - any kind of bread, and I love rice. I work long hours at the office, and home also. What can I do? I would greatly appreciate any advice you can give me.

A: Overeating on specific foods can lead to weight gain. Your weaknesses, and those of many, are bread and rice. Fortunately you recognize this. Limit bread to whole wheat and only two slices a day - fresh slices. Limit rice to brown rice and only one cup a day. No more. You will find your weight will move when you watch your quantities.

Q: I would like to lose some weight, but I don't know how many fat grams I should consume a day. I am about 40 pounds over-weight.

A: I limit fat grams to 40 grams a day. Find a dietitian on www.eatright.org to help set you a healthy meal plan.

Q: I am a 24 female, 5'4" and weighed 190 pounds in June. I lost 16 pounds since then but my question is this, how many calories should I be eating to lose at least 1 to 2 pounds a week? I exercise at least 30 minutes per day.

A: Start at 1800 calories a day and adjust to reach your goal of 1 - 2 pounds a week.

Q: I am 22 years old. Since I was a young teen I have tried my best to keep fit by doing sports after sports. The problem is I never paid any attention to my diet. I now realize that " you are what you eat" is a completely true statement. I am trying to trim a few pounds without losing any energy and it doesn't seem to be working. I am in Korea right now so I don't have to many choices of food to eat, but this is what I have been eating
Morning: A grain drink and two hard-boiled eggs.
Afternoon: Some rice and see weed.
Evening: A can of tuna and some rice.
Throughout the day I drink plenty of fluids such as water, tea, aloe juice and at least one cup of coffee. I would really appreciate it if you could tell me anything I am doing wrong and give me some advice.

A: It looks like you aren't eating much at all and there is no variety in your diet. You should be skinny. If you are gaining weight, I can only assume your quantities are too large and there may be snacks you don’t count.
Weight loss is never easy, however results go back to basics: eat too much and you gain weight. It's not fair, but that's how it is. Good luck!


In all the talks I give, the main concern of my audience members is weight loss.

We just need to look around and see that Americans reaching obesity levels is increasing due to temptations, poor eating habits and less activity.

With major chronic health problems related to obesity such as heart disease, diabetes, high blood pressure and cancer, you’d think the motivation was obvious. Yet with my clients this is rarely the reason people want to lose weight, physical appearance is the main reason. Now there’s nothing wrong with wanting to be more attractive. In fact, any reason to obtain a healthy weight is fine by me, if you become a healthier person in the end.

You know that when your weight is up, you don’t feel attractive and you feel less inspired to eat well. Together with increased weight is the low energy level and low feeling of confidence that comes with overeating. For some people, being active is the answer. For many of my clients, it’s food quantity and food choices that are the main problem - for myself as well. I am active every day but when I give in to temptation, I can gain five pounds in one week, no problem!

Here are the 4 Big Tips:

1. Eat two vegetables at lunch and dinner, before deciding on the rest of the meal. The vegetables should take up half your plate. The more colors the better, such as dark greens (broccoli), reds (tomatoes) and yellows (squash). Be sure they’re your favorite vegetables. You can prepare them stir-fried in a little oil, as a salad in a low-fat dressing, or steamed.

2. For many, a sweet tooth surprises you every afternoon or evening, and each time you rush out and buy a cookie, brownie, pastry or ice cream. Satisfy your sweet tooth with a fruit, dried fruits and yogurt or glass of milk - tasty foods that contain vitamin C and calcium. Eat something nutritious first and you’ll find you’ve satisfied your cravings.

3. When you think carbohydrates, be sure to think high fiber. We love breads, rice, pasta and potatoes. Yes, you can and should eat them, just switch to whole grain breads, brown rice, whole-wheat pasta and potatoes with skins. You will enjoy the richer flavor, fill up quicker, prevent constipation, lower your risk for cancer, and feel better afterwards. Many bonuses.

4. Avoid buffets. Researchers did a study published in the American Journal of Clinical Nutrition and found that people who consume a greater variety of foods were more likely to consume excess calories and be obese. This makes sense. If you are given a plate of pasta only, no bread, wine, salad, vegetables or dessert, you’ll soon get bored. Yet, if you went to a buffet, you would want to try all your favorite foods. You will end up leaving the restaurant feeling stuffed. Variety is important, but more important is variety in fruits, vegetables and whole grains, not variety in fried foods and pastries.

It isn’t easy to change a habit. When I give a talk, I can motivate the audience for three days. To change a habit, you need to keep focused for three weeks and you need to be focused on one change only. Too many changes and you end up being stressed out by making too many commitments and not succeeding.

Decide which change you’d like to make, keep focused and Feel Fantastic.

Monday, October 26, 2009


Here are some tips, based on science and common sense:

  • · Lower your lung and prostate cancer risk by increasing your intake of cruciferous vegetables (cabbage, cauliflower, kale, Brussels sprouts). The isothiocyanates in these vegetables will protect you from both of these deadly cancers.
  • · Trans fatty acids, considered more harmful than saturated fats, are made through the process of hydrogenation. This process solidifies liquid oils and increases the shelf life and flavor stability of foods such as stick margarine, cookies, cakes, microwave popcorn, crackers and fast foods. Limit your intake of these foods.
  • · If you are a vegan and concerned about your vitamin B12 intake, eat fortified cereal every morning. This vitamin is easily absorbed because it is sprayed onto cereal during processing.
  • · Drink orange juice to lower your cholesterol levels. The effect could be due to citrus pectins, flavanones (hesperetin and naringenin) or other health-promoting polysyllables we still have to discover (and pronounce).
  • · The words "whole wheat flour" or "100% whole wheat" should be first on the ingredient list for breads that are truly made with whole-grain wheat.
  • · Be adventurous with whole grains. Try bulgur, kasha (roasted buckwheat), quinoa, barely and wheat berries.
  • · Phenolic compounds (in wine and olives) are a category of phytonutrients with strong antioxidant effects. Enjoy both foods in small amounts.
  • · You can add ground golden or brown flax seeds to your salads and cereals. They contain beneficial omega-3’s.
  • · Even if you are sensitive to lactose, you don’t have to give up a little milk in your cereal. Research shows that people with mild to moderate lactose intolerance can drink milk with meals and in small amounts throughout the day.
  • · You don’t have to avoid all cheeses if you’re lactose intolerant. Firm cheeses such as cheddar and mozzarella contain very little lactose. You may be able to enjoy them.
  • · Brown rice is rich in vitamin E, an antioxidant which could protect cells from damage that can lead to cancer, heart disease and cataracts.
  • · White and brown rice have the same amount of calories, except that brown rice is tastier, crunchier and has twice as much potassium, six times more fiber, ten times more folate and twenty times more vitamin E.
  • · For a better cholesterol profile, consume one ounce of vegetable oil per day and eat fatty fish four times a week.
  • · Eat vegetables rather than drink them. ½ cup cooked carrots supplies 25 calories and 2 gm fiber. 1 cup (8 oz) bottled carrot juice supplies 120 calories and 1 gm fiber. Vegetable drinks are higher in calories, lower in fiber and lose many phytochemicals, which we are still discovering.
  • · Large vegetable bottles contain 16 oz. and 240 calories. That's a lot of calories from vegetables if you want to lose weight. That being said, vegetable juices are better than no vegetables at all.
  • · A diet high in fruit, especially apples and tomatoes, may protect against respiratory illness, according to a study presented at the American Thoracic Society conference.
  • · Fruit juice lacks fiber and can be consumed more rapidly and in larger servings than whole fruit.
  • · Some “juice” drinks contain mostly water and sugar. Be sure to check the drink contains 100% juice.
  • · Probiotics in a pill or powder might not be live, so they might not be effective. Buy yogurt that says “live and active cultures,” then get it home and refrigerate it as soon as possible.
  • · Keep bacteria-containing yogurt handy if you are taking antibiotics.
  • Eat yogurt when you are traveling to prevent traveler’s diarrhea and enjoy the sights other than bathrooms.
  • Obtaining sufficient daily quantities of folate – 400 micrograms - is easy. Folic acid has been added to bread, cereal, pasta, flour, crackers and rice, and is found in fruit, juices, green leafy vegetables and legumes.
  • Enjoy your caffeinated coffee, tea and diet soft drinks in moderation - maximum 4 cups tea or coffee and 3 cans of diet soft drinks/day. A recent study found that men with higher levels of coffee and caffeine intake had a lower incidence of Parkinson’s disease.
  • Hate the thick, mucus-y feeling in your throat from drinking whole milk? It may just be in your head. In a study in Australia, people found no difference in mucus formation between chocolate-disguised cows' milk and soy milk. If it bothers you, drink nonfat milk instead.
  • 3 oz calamari supplies 140 cal, 2 gm fat, 4 gm carbohydrate, 25 gm protein. Even though it’s fat content is too low to supply heart-healthy omega 3 fats, it is still tasty and adds to variety to your diet. Enjoy, but watch out for preparation methods. Avoid fried and breaded calamari in favor of grilled, steamed, or baked.
  • Eating low salt high potassium foods may reduce your risk for high blood pressure and stroke. Examples of high potassium foods are orange, grapefruit, tomato and pineapple juices; green peas, potatoes, bananas, meat and milk.
  • Sometimes studies give us results we really like. Researchers found that vitamin B6, which can be found in beer, reduces homocysteine levels in blood, which may reduce heart risk. Daily recommendations are one beer for women, two for men.
  • Fish and seafood are excellent low-fat sources of many nutrients including protein, omega-3 fatty acids and minerals such as calcium and zinc.
  • Vitamin A is crucial for good vision, immune function and other bodily functions. Never eat more than 3,000 micrograms of Vitamin A/day, because higher levels can cause severe liver disease and, in pregnant women, birth defects.
  • Vitamin A deficiency is very rare, because we have so many foods full of the nutrient: meat, fish, eggs, vitamin-fortified breakfast cereals, and dark-colored fruits and vegetables like oranges, carrots and spinach.
  • Peanuts are a source of essential protein, fiber, vitamin E, folic acid, copper, selenium, magnesium and zinc. Sprinkle on salads to add flavor and crunch.
  • If your diet requires you to consume more than the usual recommended amount intake of vitamin C, eat 1 orange, I apple, ½ cup broccoli, ½ cup peas and 1 potato in one day. Easy.
  • If you can’t sleep because of hunger and you don’t feel like eating, drink a glass of warm milk.
  •  Eat fish and a variety of plant foods to get in your daily iodine requirements. If you don't eat fish, you should use iodized salt to be sure to get your daily iodine requirements.
  •  Enjoy fortified cereals for breakfast. The folic acid content decreases homocysteine levels, a risk factor for heart disease.
  • Keep magnesium-rich foods in your cupboards to maintain good heart health. Foods such as bran, avocado, wheat germ, shredded wheat, pumpkin seeds, cashews, spinach, peanut butter, potatoes, lentils, bananas, broccoli, baked beans, almonds and whole wheat bread.
I hope all these health tips will help you enjoy your food now.


When “Eat less than 30% of your calories from fat” guideline came into effect, it meant we should eat less fat. And it seems we have.

However, “eat less fat” does not mean “eat fat-free foods only.” The media and food industry took the lower fat recommendation to the extreme. Now consumers say low fat diets don’t work. Yet the experts have always said, “Eat less fat,” not “Eat no fat.” With the newest research work, we can now say, “When you eat fat, eat the healthy type.”

However, we still have the problem of obesity, for all ages. The reason is that calories have increased, although the percentage of fat has decreased. Now we are eating too many low-fat foods. As excess calories lead to excess weight, our obesity problem is increasing in children and adults.

The Teen Problem

Teens are of particular concern. They love fast foods and snacks, increasing their fat intake substantially from low nutrient foods. For some of them, nearly one third of their calorie intake comes from cookies, chips, hamburgers, tacos, muffins, Caesar salads, pizza, ice cream and milk shakes. In a recent survey, it was found that teen boys consume 33% of their calories from fat. This sounds good except that 34% of these calories came from foods that are very low in protein, vitamins and minerals. For teen girls, it’s 27% of calories from fat with 30% of fat coming from low nutrient foods.

How do we convince teens to eat healthier sandwiches, drink low fat milk and eat their fruits and vegetables? Especially when the reason for their eating habits are social and peer pressure. Encouraging healthy eating is an important problem we have to solve. Here are some suggestions:

Change to oils
Perhaps teens will enjoy their vegetables more if they were stir-fried; salads more if the dressing was homemade from flavorsome oils. Fat is necessary. It is needed to help with the absorption of carotenoids in vegetables and fruits, including the well-known beta-carotene, the pre-cursor of vitamin A, a fat-soluble vitamin. It doesn’t help to eat salads and vegetables with no fat at all if you want full health benefits. Fat will help with the absorption of healthy phytochemicals and add taste. Adding taste of course results in more vegetables eaten. Throw in some olives, nuts and avocado (with heart healthy mono-unsaturated fats) and you have a crunchier and tastier salad.

Add fish to meals
Teens don’t order fish first. It doesn’t enter their mind. Yet they don’t mind canned tuna. As I like people to eat fish three times a week, tuna sandwiches or tuna salads can be tasty meals for children. In fish, the healthy fats are omega-3 fatty acids, which benefit the heart. Yum, I’ve just made myself a sardine sandwich – tasty! High fat fish are trout, herring, mackerel, salmon and sardines. Lower fat fish types include haddock, shrimp and tuna, canned in water. As teens need energy, let them eat the high-fat types. Any kind is good.

Cereals for breakfast
Cereals made from flax seed will also be high in omega-3 fatty acids. Children who eat breakfast are smarter and have more energy. Encourage a little fat in the first meal of the day.

For Parents

- Baked goods
- High fat cuts of meats
- High fat dairy products
- Tropical oils – palm and coconut

Get your fats from:
- Canola oil for stir-frying vegetables;
olive oil for salads; peanut, sesame and other tasty oils
- Avocados, humus, olives
- Margarine
- Nuts

Enjoy your fats, but the right fats!

Sunday, October 25, 2009


Sometimes you just need a new cholesterol lowering tip to keep you motivated. 
Here are a few: 

1.    Check your cholesterol if you have a family history of heart disease or if you're overweight. Start with cholesterol tests from the age of 30 and every 5 years after that.
2.    When you have your cholesterol levels tested, don't eat anything for 12 hours prior to your blood test for more accurate results.
3.    If your cholesterol level is high, check a month later for a more accurate picture.
4.    Cholesterol levels drop in three months with changes in lifestyle. Make eating and activity changes and you'll be delighted with the results.
5.    Frying eggs (high in cholesterol) in butter (high in saturated fats) gives you a double whammy; rather fry eggs in canola oil or an oil spray.
6.    If you do not have time to prepare fish, open a can of tuna and add to your sandwich or salad.
7.    Some of your favorite fruits won't be eaten unless you cut them up, cover them and put them in a bowl in the fridge. Eat when you feel like something sweet.
8.    Make a bean and vegetable soup for the week. Throw together canned beans, prepared or frozen vegetables and soup lentil mixes. Cook and flavor. What you can't use in a week, freeze in one-portion containers. Delicious, nutritious light meals will be available at short notice.
9.    Fat free is not the way; good fat is. Add small quantities of olive to salads, lightly fry fish in canola oil, add olives to spaghetti sauce and sunflower seeds to a fruit salad.
10.    Spoil yourself at the vegetable counter: make a stir-fry medley to last for 3 days. Simply reheat every day.
11.    As an appetizer, humus (made with chickpeas and olive oil) served with whole-wheat pitas is very tasty.
12.    Buy different low fat cheeses and find one you enjoy. Keep handy when you don’t have a planned protein for lunch.
13.    Peanut butter contains protein and good fat. Use 2 tablespoons for a sandwich; no eating out of the jar.
14.    When guests come over, for dessert serve a delicious fruit salad with non-fat yogurt and sprinkle some nuts on top.

15.    Exercise helps increase the HDL (good) cholesterol. Be active every day.
16.    If you or your spouse have high cholesterol levels, have your children checked. Your home may need to follow a diet low in cholesterol and saturated fats.
17.    Go to www.eatright.org for registered dietitians who can set personalized meal plans for you and your family.


People with normal serum cholesterol, blood pressure, and no smoking are at lower risk for heart disease and live 6 to 10 years longer than people with all three risk factors. That sounds good.

There are many ways to lower your cholesterol levels. This will also lower your triglycerides, the other bad fat. Avoid or limit foods high in:

•    Saturated Fats: high fat meat cuts, butter, full-fat dairy products, poultry skin and coconut and palm oils.
•    Replace saturated fats from animal products with mono and polyunsaturated fats from plant oils
•    Trans Fats: in cookies, crackers, fast foods and processed foods.
•    Cholesterol: eggs (more than 3 per week) and organ meats
•    Increase intake of:
•    Fatty fishes, like salmon, swordfish, tuna and trout
•    Foods containing soluble fiber
•    Lose weight if you carry excess pounds
•    Keep up your aerobic physical activity
•    Quit smoking.

Below is a list of foods to include in your diet if your cholesterol level is high:

Oat cereals, oat bran, barley
Breakfast cereals: minimum 4g fiber per portion with psyllium or flax seeds.
Whole wheat, whole grain or high fiber bread, buns, pasta, pita bread, flour
Brown rice, potatoes, corn on the cob, unbuttered popcorn

Fresh, frozen or canned vegetables and fruits, including: apples, strawberries, citrus fruits, cranberries onion, watercress, vegetables, leeks, spinach, carrots, artichokes, avocado, broccoli, kale Brussels sprouts and cauliflower. Homemade vegetable soups (no cream).

Milk: skim, 1%, buttermilk
Yogurt: 0% or 1% fat
Cheese: Low fat, part-skim or fat free

Soybeans, edamame, soybean products, tofu
Legumes: dried or canned beans, peas, lentils
Fish: Salmon, swordfish, tuna, trout
Lean Meat: chicken breast, pork loin, lean beef

Nuts: pecans, walnuts, soy nuts, almonds, etc.
Oils: canola and olive
Stanol-containing spreads

Add liberally to foods for enhanced flavor without additional fat and salt.

In moderation include: tea, dark chocolate, red wine

So, there's still plenty to eat! 

Cholesterol Shopping List

Are your cholesterol and triglyceride levels high? This is no longer just your problem; it’s now the problem of your family members and friends.

Show them you care by preparing meals with cholesterol-lowering foods. Below is a shopping list of foods that should be in your shopping cart.

Print out:

Oat cereal

Cereals containing flaxseed or psyllium

Whole grain cereals

All types of fruits, especially currants, grapes, strawberries, blackberries, raspberries, citrus fruits, apples.

Pecan nuts, walnuts, olives, soy nuts

Dried or canned beans, peas and lentils

Corn, fresh, frozen or canned

Soybean products

Whole wheat bread

All vegetables especially onion, watercress, vegetables, leeks, spinach, carrots, artichokes, avocado, broccoli, kale Brussels sprouts and cauliflower

A variety of flavorings, herbs and spices, especially fresh garlic

Lean meats and chicken

Salmon, swordfish, tuna and trout

Canola and olive oils

Soft margarines and stanol containing spreads

Teas: black or green

Dark chocolate

Beer, wine or liquor, especially red wine

Low fat dairy products

Saturday, October 24, 2009

Diabetic Issues

  • If you're a diabetic and traveling in a foreign country, contact the International Diabetes Federation. They can give you a list of organizations and medical groups who can help you understand prescription laws and standards in other countries.
  • If you are a diabetic and going on a long flight, check with your airline at least two days before the flight for meal options. Your meal should be low in sugar, fat and cholesterol.
  • Diabetes is the main cause of kidney failure. Lose weight the healthy way to lower your risk for Type 2 Diabetes.

Hypoglycemic or Neurotic?

Do you become irritable during the day? Do you lash out at people and regret it afterward? Are you too busy to stop for a snack? You may be suffering from low blood sugar.

This is not the hypoglycemia (hypo=low, glyc = sugar, emia = in the blood) that can be measured with a glucose tolerance test, this is the hypoglycemia I see regularly in my practice, and suffer from myself. Last week I went out to dinner with a couple of friends. As usual, because I’m a dietitian, people feel that any social occasion is counseling time. One of my friends started to tell me her problems. She doesn’t eat meat, is anemic, forgets to eat until she’s ravenous and gets tired and irritable quickly. She thinks her blood glucose is low. Her doctors (she’s been to a few) say she doesn’t have the clinically diagnosed hypoglycemia, it’s psychological/all in her mind and perhaps she should gain weight and go into counseling. So frustrating! Why don’t doctors send these patients to dietitians? The problem is obvious to us once we take a dietary history. Even over dinner, I told her hypoglycemia is a real problem, the symptoms are real and they affect one’s quality of life.

The best news is that it’s totally treatable with a small change in eating habits. Usually the symptoms are with women, occur mid-morning and mid-afternoon, and seldom at night. They include a feeling of hunger soon after breakfast or lunch, dizziness, weakness, nervousness, shakiness, rapid heartbeat, fatigue, stress, headache and agitation.

To prevent these symptoms, simple rules need to be followed:
Avoid certain foods:
• High sugar foods and beverages
• Refined starches
• Alcohol on an empty stomach

To keep your blood glucose steady, your meal plan will now include:
• Three smaller meals (to maintain weight)
• Two larger snacks (keep snacks handy for emergencies)
• A light snack in the evening (optional)
• High fiber starch, protein and a little fat at each meal
• No skipping of meals
• No late meals
• Alcohol on rare occasions, only after food is eaten.

Examples of three day’s food intake are below. Exchange foods according to your taste:

Day 1:
Breakfast: ½ cup cereal containing 6 gm fiber; ½ banana; ½ cup 1 % milk
Snack: 1 slice whole grain bread and 1 tbs. peanut butter; coffee with milk
Lunch: Large salad with a wide variety of vegetables, ¼ cup tuna, 1 oz. cheese and an oil and vinegar dressing; tea
Snack: 1 cup yogurt; chopped apple; 1 tbs. nuts (together it’s like a dessert)
Dinner: 1 oz. ground beef, 1 cup pasta, ½ cup pasta sauce, ½ cup carrots, 1 cup green beans; tea
Snack: 1 apple

Day 2:
Breakfast: 1 slice whole wheat bread, 1 tsp margarine, 1 scrambled egg, ½ cup orange juice; coffee
Snack: 1 piece of fruit (the breakfast will sustain you longer); café latte
Lunch: ½ bought vegetable sandwich with one slice of cheese, small salad,1 fruit
Snack: ½ bought sandwich; tea
Dinner: 3 oz fish, 1 cup brown rice, ½ cup peas, 1 cup ratatouille
Snack: ¼ papaya, 1 cup of 1% milk

Day 3:
Breakfast: ½ cup granola; 2 tbsp raisins; 1 cup low fat yogurt; coffee with 1 % milk
Snack: 1 slice whole grain bread and 1 oz cheese
Lunch: Large salad with a wide variety of vegetables, chicken pieces and an oil and vinegar dressing
Snack: ½ cup nuts and raisin mix (keep in drawer or bag for emergencies); café latte
Dinner: Baked potato with stir-fried frozen mixed vegetables and 1 oz. cheese
Snack: ½ mango

For the low iron count, I recommend one multi-vitamin and mineral tablet every day, containing around 15 gm iron. Take the pill with a meal, as iron is hard on the stomach. Keep your fiber intake high as iron supplements can cause constipation.

If you want to start eating meat, start with one ounce twice a week, gradually increasing to three ounces twice a week. A sudden large piece of steak will lead to great pains in your stomach and it will be quite some time before you’ll try it again.

Follow the suggested meal plans and see how different you feel. Don’t let people think you’re neurotic. Every time you lose your temper, reread this column. Enjoy your new energy, happy disposition and normality.

For individual meal plans, find a dietitian near you at www.eatright.org.

Friday, October 23, 2009

Feel Fantastic Through Fitness

Do you want to burn fat? Fantastic! Is there a magic exercise you can use to achieve fat loss? Unfortunately, no! Fat burning is actually pretty simple. When the energy you expend during a day is greater than the energy you’re ingesting, you will lose fat. A balanced diet is fundamental to weight loss, and any form of exercise and any exercise intensity will help to motivate you to maintain a healthy weight.

A report published in the American Journal of Clinical Nutrition found that exercising while you diet not only boosts your mood, it also helps you stick to your diet. In this study, women who exercised lost more weight and ate less calories than the non-exercisers. Bear in mind that fat loss will not occur unless calorie intake is reduced.

So many people have excuses not to be active. Find your excuse and learn how to overcome it.

Excuse #1: “I don't have time”
Solution: Change your priorities.
There are hours in the day when you might be bored, feeling restless or down. These are the hours when you should plan to be active. Spend half an hour enjoying a brisk walk at lunchtime - you will feel much better and your mind will be clearer. Convince a colleague to walk with you.

Excuse #2: “I don't lose weight when I exercise”
Solution: Change your philosophy.
Do not exercise to lose weight, exercise to feel better. Feeling good, an immediate benefit is reason enough to continue with your exercise program. Regular exercise is important for maintaining a healthy weight; a balanced diet results in weight loss.

Excuse #3: “My gym is too far from me”
Solution: Change your gym.
No matter how much you like your gym, if it includes one hour of traveling time, you simply won't go regularly. Your gym can also be your family room; get out those exercise CDs and get moving. Remember that walking is easy and available anywhere, anytime.

Excuse #4: “I feel intimidated in a gym”
Solution: Change your gym.
Make sure the gym you choose suits your needs. Visit several gyms in your area before you join. Take a tour and don’t worry if the people look amazing in their fashionable outfits, you’re not joining a health club to impress anyone; your intention is to feel good. Make sure the gym’s staff are concerned with your interests and understand your needs. They should offer to assess your level of fitness and flexibility, keep your record on file and give you a copy. The staff should plan exercises and activities to suit you, and a reassessment should be done every six months.

Excuse #5: “I feel like a klutz in my exercise class”
Solution: Change your reaction to other people
When you start an exercise class, it takes a while to assimilate the routine, become familiar with the people in the class and feel comfortable. Take a place in the back row. Concentrate on your steps and the fun you get out of moving. Try to get your feet to follow the steps before adding the arm movements. After five or six classes, you will feel coordinated and part of the group.

Excuse #6: “Exercise hurts my knee/back”
Solution: Change your type of exercise.
If certain exercises hurt your back or knees, try other forms of activity. Instead of using a stair climber, use the stationary bike with a backrest. Whenever you begin a fitness program, remember that the cardiovascular system (heart and lungs) is more forgiving than the musculoskeletal system. Muscles and tendons need to be gently coaxed into action; otherwise the result will be overuse injuries.

Excuse #7: “I feel too lazy”
Solution: Change your attitude.
If you’re not motivated to go to the gym, put on an exercise CD at home and watch it. Once it’s playing, you will find you want to try the stretching. Once you start stretching, your energy increases rapidly, before you know it, you are into the workout. Don’t underestimate yourself. Push the “play” button now! You will never regret it.

Excuse #8: “Exercise cuts into family time”
Solution: Change your time management.
Do not separate exercise from your family. Be active with family members. Go walking/running/skiing with your partner or children. Exercise will benefit your whole family. Family time and exercise time can be one and the same.

Excuse #9: “Exercise is boring”
Solution: Change your activity.
While effective aerobic exercise should be at least thirty minutes, it doesn’t have to be boring. I read the newspaper while on the stationary bike. If I don’t work out, I don’t read the paper - I lose out twice. Some people listen to music or watch television. Another tactic is to alternate workouts from bike to weights, machines, aerobics, Pilates, step or stretching classes or yoga. Search for new ways to be active. You know what you like; there is no need to get bored.

Excuse #10: “I don’t like to exercise because I always hurt the next day”
Solution: Change your approach.
A well-structured exercise program may leave you a little stiff, but it’s a nice stiffness. Feeling slightly sore for a few days after starting a new activity is okay. The more often you exercise, the more your body won’t fight back. You’ll start to enjoy working out even though you feel a little stiff. As one of my clients said: "For the first time I can feel and see my muscles, and I’m 50 years old!”

Excuse #11: “I don't want to build up muscles”
Solution: Change your weight routine. Use lighter weights and increase repetitions.
The muscle definition you then develop is attractive and gives you a smooth, sleek look. Consult with the gym staff to help you develop a weight routine that is geared to you.

Excuse #12: “I travel too much to be active”
Solution: Change your strategy.
People who travel a lot need exercise too. Pack sneakers and exercise clothes. Hours sitting in an airplane, or in a car, may drain your creative energy. Exercise will help. When traveling, always find out where the closest gym is - usually it’s in the hotel. Then check it out and dress accordingly. For example, when I travel I may do the stationary bike for thirty minutes and weights for fifteen minutes or swim for twenty minutes and machines for ten minutes and I always stretch to relax my back. If possible, I walk and explore the city, and then do stretches in the hotel room.

Once you start exercising regularly, you will have more fun, increase your energy level, meet interesting people, feel good and relaxed, forget worries, feel accomplished, increase your self-image, control stress, improve your mood and feel attractive. Not bad for just 30 minutes a day!
The long-term benefits of an active lifestyle are not as obvious but equally important.
They include: reducing body fat, building muscle, lowering the risk of heart disease, diabetes, osteoporosis, high blood pressure, back problems, injury and disability, and increasing metabolism.
Aren’t those benefits great! You deserve to take advantage of them every day. So, get moving!

Marathon Foods, Fluids and Formulas

When I gave talks at Niketown in San Francisco and New York, general nutrition questions were easy to answer, however I made sure I could answer difficult questions by marathoners. Not being a long-distance runner myself, I turned to the experiences of my clients and published research.

Please note the advice I’m giving you is for a marathon. You don’t need to go to such extremes if you’re working out for an hour at the gym; just follow good eating plans from my other articles.

As a marathon runner, you are competitive and serious about your food and fluid intake. You need to prepare your body for the big event to prevent fatigue, low blood sugar and hunger, keep your glycogen stores filled during the race, enjoy maximum performance and recover nicely afterwards (if there is a nice way – such pain!). Those of you still on the high protein diet (any left?), can expect to “hit the wall” within an hour.

In general, everyday eating should follow common sense with emphasis on a carb-rich diet. Carbohydrates (carbs) are needed to supersaturate your muscles with glycogen before the marathon and fuel your muscles during this strenuous event. Carbohydrates get converted to glucose, part of which is stored as glycogen in the liver and, to a lesser extent, in muscles. The body has a somewhat limited ability to store carbohydrates as glycogen, so replenishing is an important part of your regime.

Before the race:

How much should you eat?

Carbo-loading is very important for every training day and the days before the big race, 300 – 400 grams carbohydrate intake is recommended. Where do we find carbohydrates? In a wide variety of foods such as grains, cereals, breads, dairy products, potatoes, vegetables and fruit.

Carbohydrates also comes in different forms such as glucose, fructose, sorbitol, etc. A giveaway is the –ose and –ol behind the long words on package labels.

You will need to do a little math to measure your carbohydrate intake. Let me help you.

For the six days before the race, reduce your exercise regime to 90 minutes and allow your muscles to rest, keeping your carbohydrate at 60%. Because you are decreasing your activity before the marathon, you may gain three to four pounds. Don’t worry about that. It will be necessary to fuel your running and keep you going longer. This is not the time to increase your fat intake, so avoid increasing your use of margarine, oils and salad dressings.

An example of 60% carbs:

For a 3000 calorie diet, 60% of carbohydrates = 1800 calories.
There are 4 calories per gram therefore 1800 / 4 = 450 g carbs per day

4 days before event : 40 minutes for exercise - 60% carbs per day
2 days before event : 20 minutes for exercise - 70% carbs per day
1 day before event : 0 minutes for exercise - 70% carbs per day
3 - 4 hours before event: large meal

All of the following foods contain 15 grams of carbohydrates:

½ cup cooked pasta, starchy vegetable, potato
1/3 – ½ cup cooked dried beans and peas, rice, grains
1 slice bread, ½ roll or ¼ bagel
¼ to 1 ½ cups cereal (read label for serving size)
30 grams pretzels, crackers
1 cup skim milk
¾ - 1 cup yogurt (read label)
1/3 to ½ cup fruit juice
1 small to medium fruit
1 – 2 cups vegetables
½ - 1 cup sports drink (read label)
¾ cup pop

Here’s an example of a 450 g daily carbohydrate intake is:
2 cups cereal 30
1 cup milk 15
¾ cup yogurt 15
1 large baked potato 60
1 large orange 30
2 cups cranberry juice 60
3 cups pasta 90
1 cup tomato and vegetable sauce 15
Fresh bagel 60
1 cup frozen yogurt 45
Large banana 30
Total: 450

There, that was easy. Now plan your carb intake including your favorite foods.

• 2 – 3 hours before the event: high carb snacks. Give yourself enough time to digest the food before running. A large meal may lead to abdominal distress, cramping or indigestion. Continue with the snacks that have been working for you. Here are some ideas:
2 slices of toast, bagel or English muffin with jam
Cereal with skim milk
French toast or pancakes with syrup
Bran muffin
8 wheat crackers with one-ounce low fat cheese
1 banana or two fruits
Fig bars or dried fruits such as two small packets of raisins
Bread sticks
2 rice cakes with 1/4-cup cottage cheese
1 fruit with 175 ml yogurt
Energy bars
Blended, liquid meal. Not too much as it may slosh in your stomach

Avoid soft drinks, fruit juices and sweets unless you’ve been experimenting with them. The initial “sugar boost” may disappear quickly and leave you feeling tired!


When you run your marathon, the body needs fluids to replace what’s lost through sweat and to help carry glucose to those exercising muscles.

Choice of Fluids:
1. Water
2. Diluted juices
3. Watery foods
4. High carb sports drinks

Water is fine for the first hour, after that replenish your glycogen stores with some carbs.

Fruit juices and soda pop exceed a 10% carbohydrate level and can lead to abdominal cramps, nausea, and diarrhea. This you certainly do not need. These drinks should be mixed with 1/3 water. Drinks containing between 6% and 8% carbohydrate (sugars) are absorbed into the body as rapidly as water and provide energy to working muscles. This extra energy delays fatigue and improves performance.

If you drink a sports drink, you can maintain your blood sugar level even when the sugar stored in your muscles (glycogen) is running low. This allows your body to continue to produce energy at a high rate. Don’t dilute sports drinks as you won’t get enough energy from your drink to maintain a good blood sugar level. Drinks containing less than 5% carbohydrate do not provide enough energy to improve your performance.

Before the race:

Drink two cups of fluids two hours before your race. If you’re participating in hot weather and sweat a lot, increase your fluids to three to four glasses before the race.

During the race:

Drink small amounts of fluids on a regular basis. Aim for 1/2 cup every fifteen to thirty minutes even if you don’t feel thirsty. Cool fluids are absorbed a little better than room temperature drinks and rarely cause cramping.
After five hours of running, you will need to replace the electrolytes you lose in sweat. Use diluted fruit juices (one part juice, one part water), like orange juice or a sports drink - 60g of carbs every hour, that’s a 240-calorie drink. Try your drink or snack of choice before a big event; you don’t need surprises like cramps or diarrhea.

What about sodium?
Sodium is needed to help maintain fluid balance in your body and help your body absorb and retain more water. Fluids from an 8-ounce serving of a sports drink with 6% carbohydrates (sugars) and about 110 mg of sodium absorbs into your body faster than plain water.
Some parents, coaches, and athletes are concerned that sports drinks may contain too much sodium. However, most sports drinks are actually low in sodium, similar to a cup of milk. Most of us get too much sodium, the main culprits being chips, crackers, soups, salad dressings and fast food; certainly not sports drinks.

After the marathon:
You’ve just finished your marathon and are feeling very thirsty, get your energy back with the same fluids: water, diluted fruit juices, fruits and sports drinks.

Any magic formulas?
Have you tried caffeine type drinks? You can drink 2 cups of coffee 2 hours before your run, when practicing. Don’t try it for the first time on the day of the race. If you have heart disease, I wouldn’t recommend the caffeine stimulant together with the stress of running.
Energy or sports bars, gels or puddings can be used to replace your depleted glycogen stores in the muscles while running.

For the serious runners, buy one of Nancy Clark’s books such as Food Guide for Marathoners on www.nancyclarkrd.com. She is THE sports nutrition expert.

You have all the basics for good nourishment, get out there and run! I wish you every success with your next marathon.

Exercise Tips

Sometimes we just need reminders to get us moving:
1. Talk to your physician before you start any exercise program.
2. Plan today your exercise for tomorrow. Fit one hour in somehow.
3. Can’t make it to the gym? Try on the spot walks, jumps and stretches in the living room tonight.
4. Pack your workout clothes the night before so you aren’t rushed in the morning.
5. Put your workout bag at your front door. You won’t forget it. You’ll have to fall over it to get to work in the morning.
6. When stretching, don’t lock your knees, as it will create an unnecessary strain on your joints. And breathe normally; you need to send oxygen to your muscles.
7. Buy slimmer fitting workout gear, and watch your body shape improve.
8. Working out at 6 PM? Don’t forget a light snack at 4 PM: slice of bread and peanut butter and fruit; yogurt and fruit; half your lunch sandwich.
9. Start a squash or basketball team at your work. Be the initiator.
10. For regular healthy lifestyle encouragement, contact the registered dietitian nearest you on www.eatright.org.
11. Aim for a Healthy Waist Measurement: less than 35” for women and less than 40” for men.
12. Use the stairs at work, bike with your kids after dinner or walk the dog.
13. Two to six hours before an endurance event, depending on individual preference, a meal providing 85 - 200 g carbohydrate should be consumed.
14. A liquid meal supplement that provides a balance of fluid and nutrients may be helpful for athletes with pre-competition jitters and gastric distress.
15. If you’re an athlete preparing for a big event, you will find that carbohydrate-containing sport beverages are better tolerated than solid foods during the activity.
16. Drink fluid at fixed times during your activity, regardless of thirst.
17. Begin eating high-carbohydrate foods, such as fruit, bread, rice, and pasta, as soon as possible after heavy exercising to replete your muscle glycogen.
18. If you are active and become pregnant, continue to exercise after getting the thumbs up from a physician.
19. If time for exercising is impossible, start activity with 10 minutes, three times per week and slowly increase to one hour, three times per week. You’ll find the time.
20. Include a variety of activities that you enjoy and you’ll look forward to feeling fantastic.
21. If you get bored with your exercise routine, try something else. Keep moving.
22. Drink plenty of water before, during and after activity, especially in hot weather.
23. Eat a high carbohydrate foods such as a bagel, pretzels, fruit or non-fat yogurt, two hours before you start your workout to prevent hunger pangs.
24. Make sure your exercise regimen is consistent with your stamina. Exercise should be fun and not painful.
25. Tired of sitting at the computer, stretch until you feel a gentle pull, not a sharp pain.
26. Leave your computer on, get up and put on your sneakers. Go for a walk around the block. If the weather is bad, walk on the spot with your arms swinging vigorously at your sides. Come back and you’ll feel invigorated.
27. When you’re bored or stressed, go for a brisk walk. Concentrate on walking fast and let your mind wander. Swing your arms to propel you quicker. You’ll feel so invigorated; you will want to walk regularly.
28. A good reason to get out and walk: a study of almost 40,000 female health professionals aged 45 years or older found that vigorous activity reduced risk of heart disease by 47%, and walking two or more hours per week reduced risk by 52%.
29. Are you at risk for gallstones? If so, exercise. Several studies have shown that regular exercise prevents gallstones.
30. Quitting our exercise goal is our problem. More than 23,000 women participated in a free nationwide health program called "Choose to Move." Most who finished significantly improved their diets and activity levels. Unfortunately, nearly 20,000 dropped out.
31. During lunchtime, meet with a friend or colleague and walk for half an hour. It’s more motivating than going it alone. Decide to say positive things only.  
32. If you are going hiking, prepare for climbing up the hill by going to the health club and walking on a treadmill at a 15% incline or using a stair climber. Some health clubs may even have hill climbing equipment. 
33. If you are going hiking, prepare for your downhill journey by doing squats, presses and weights. 
34. Feeling depressed? Go and work out. Exercise works as well as prescription drugs in treating and preventing the return of clinical depression . 
35. It’s important to take part in active sports during the winter, but don’t ski when tired. Most accidents happen when skiers are tired at the end of the day. 
36. Keep active all year round, so you can be fit enough to shovel snow in winter. Most heart attacks occur in the cold months as the arteries in the heart constrict and blood pressure rises.

Activity Questions

Many readers have questions on being active, which may give you some ideas.

Reader: After reading all the letters from your readers, and your responses, I get the feeling you don't consider "exercise" an important part of losing and maintaining the weight loss. It seems to me you are suggesting diet alone as a way of losing weight.

Maye: Thank you for your feedback. Exercise is VERY important in helping you lose weight and maintain weight loss. In my book, Feel Fantastic, I go through all the excuses you can have to avoid exercise, and how you can change your lifestyle to make activity an everyday event.

I am one person who is active every day, not only to maintain my weight, but also to keep up my energy and my body supple. As I spend a lot of time in front of my computer or counseling clients, I need to get up and move.

Be sure to be active for at least 30 minutes every day. Some of you will be at the stage of life where you’re terribly hectic, working long hours, commuting, getting kids to school, etc.

Some ideas:

· If you sit all day, every 50 minutes stretch and walk for 10 minutes.

· If you work at a computer, make a point of stretching your fingers and wrists, turning your wrists around and loosening them up.

· Take advantage of the time of day when you’re bored, and use that time to go for a walk.

· If you love watching television, do your stretching exercises during your favorite television programs.

· Invest in an exercise video and work up a sweat in your living room.

· In winter, it’s great to belong to a health club. You can spend an hour working out without any interruptions.

Reader: How can someone expect to eat and not exercise, yet lose weight? You have to burn calories, good or bad. If you eat all the healthy food in the world and sit and watch television, you will still gain weight. Proper diet and regular exercise are the keys to a "healthy lifestyle".

Maye: I’m glad you’re getting the right message and passing it on. Proper diet and regular exercise are definitely the keys to a healthy lifestyle.

I’ve had many clients who have lost weight through better eating habits. Yet it’s when they start exercising they feel so much better. Psychologically they’re happier, they have more energy, feel positive and their self-esteem shoots up. It’s wonderful to see.

The reason they feel so much better is that the endorphins in the brain are released with activity. These hormone-like substances are the body’s natural painkillers and give you an enhanced feeling of wellness. Can’t beat that.

Reader: I began decreasing my activity because, I guess, I was so discouraged.

I used to love to walk my dog and that was the real only exercise I got, along with riding my stationery bike. I could do this for an hour no problem, with still no results. I didn’t lose weight. Now, I have developed heel spurs. Walking even short distances is very painful for me. Everything the doctor has done, physiotherapy, specially made insoles, pills etc, have not worked. This had made exercise more or less impossible. They suggested riding my stationery bicycle, but that hurts also, not at the time but when I am finished, because of all the stretching of the muscles in my foot when I peddle. I suppose the extra weight does not help the pain either.

Maye: Sometimes when we’ve decided to start an exercise program, we become too ambitious with exercise and our body cannot handle it, especially if we’re carrying extra weight. Sorry about the heel spurs, I had them once and they are very painful. Why don’t you aim to eat better to lose weight? Then alternate walking, stretching and stationary bike for 10 minutes, 4 times a day. You will get stronger as you lose weight, and can slowly increase your exercise over time.

Thursday, October 22, 2009

Disease and Illness Prevention

  • Triglycerides are a type of fat that travels in the bloodstream along with cholesterol. They are the storage form of fat. For some people, high triglycerides in the blood are a risk factor for heart disease.
  • Recommended ways to lower triglycerides are weight loss, exercise, and reducing consumption of alcohol or carbohydrates, especially sugars.
  • You don’t need to resort to nasty methods to “cleanse” your body. We have our own blood purification system (organs) to protect us from toxins.]
  • The DASH Diet can be good for those who suffer from hypertension, aka high blood pressure. DASH (Dietary Approach to Stop Hypertension) is rich in vegetables and fruit, low in saturated fat and cholesterol and uses low-fat dairy products. Recent studies find this diet lowers blood cholesterol levels as well.
  • Common factors among those with high HDL (good cholesterol) levels are being a healthy weight, exercising, drinking alcohol in moderation and being a non-smoker. Being a female also helps.
  • Many clients who come to me with migraines find relief when they start eating more consistently throughout the day, which prevents hunger-related headaches.
  • Have your cholesterol checked every five years.
  • If you need to lower your triglycerides, start by cutting down on refined starches, sugars and alcohol.
  • Those with high cholesterol don’t have to avoid seafood. To lower cholesterol, cut down on saturated fats. Seafoods are high in cholesterol but not saturated fats. You can eat shellfish; just don't eat them in the same meal as butter or animal-type fats.
  • Don’t waste your dollars on hair analysis for diagnosing nutritional problems and toxins. According to a recent study, hair samples sent to six labs produced varying and often opposite results.
  • When on long flights, wear loose clothing, eat light meals, avoid drinking too much alcohol and get up frequently to lessen the risk of potentially fatal blood clots. Sitting still for long periods can cause the condition.
  • Another way to reduce your risk of heart disease is by lowering the homocysteine level in your blood. This can be achieved by eating lots of fruits and vegetables to increase your folate and B6 intake.
  • If your cholesterol is low, eat well but do not follow a low-cholesterol diet. Recent research has found that people with too low cholesterol levels are also at risk for heart disease. Check your cholesterol levels with your doctor.
  • A study of nearly 80,000 American women adds to evidence that eating fish may be healthful, suggesting that even modest amounts can significantly reduce the risk for the most common type of stroke.
  • High blood pressure is the second-leading cause of kidney failure. Losing weight helps lower your blood pressure and reduces the severity of kidney failure.

Preventing Osteoporosis

Using good nutrition to keep your bones strong.

Sheila came to see me out of fear of osteoporosis. Her doctor had told her she was osteopenic, suffering from mild bone loss. This may lead to osteoporosis, a crippling disease resulting in a stooped back and bones that break easily. Besides the cost of this disease, she was more concerned about losing her independence and lowering her quality of life.

I gave her the facts:

- Ten million Americans have osteoporosis – two million men and eight million women – and 34 million are at risk of osteoporosis as they have low bone mass.

- One study published in the Journal of the American Medical Association (JAMA) involving 160 healthy women 50 and older, found full-fledged osteoporosis in seven percent and low bone density in an additional 40 percent. After one year, the fracture rate in women with low bone density was nearly double that of women with normal bones, and four times higher in women with osteoporosis.

- A bone feels like a rock but it isn’t, it's living tissue. The body is continuously making new bone and replacing old bone. We need to give the body a constant supply of bone-building calcium or else we lose bone material.

- Sheila has missed her years to build up maximum strength in her bones, up until age 35, so now she needs to keep her bones strong by knowing what can be done.

Risk factors

- Female: the incidence of osteoporosis is higher with women (25 - 30%) than with men (12 - 15%). Higher consumption of fruits, vegetables and cereals (assessed by a food-frequency questionnaire) was associated with greater femoral bone mineral density in men in a study of 907 adults aged 69-93 years old. (Bone mineral density and dietary patterns in older adults: the Framingham Osteoporosis Study. Am J Clin Nutr 2002;76(1):245-252.) Sheila’s dietary changes will help her husband optimize his bone strength too.

- Menopause: After menopause , estrogen falls to the point where women can't absorb enough calcium to replace the bone they naturally lose. Sheila has always carried a little extra weight, about 20 pounds, which increases her estrogen levels. A little plumpness after menopause is good for her bones.

- Small, thin frame: Sheila is not one of the petite women we envy. She is big-boned and is therefore at lower risk.

- Age: Being 60, Sheila is at increased risk for bone loss. However, a recent study showed that women over 65 reduced bone loss by 12 to 25% over 2 years if they received adequate calcium intake. She has hope.

- Race: Sheila is Caucasian of northern European descent; together with Asians, she is at higher risk. She mentioned her neighbor, an African-American woman, also 60, who does not seem to have the same problem. Actually, African- American people have greater bone mass, although in a study with 18,000 black women, the prevalence of low bone mass and osteoporosis among them was still significant.

- Family history: Genetics play a role as body types run in families. Her mother doesn’t have any fractures. One of Sheila’s grandmothers was in good health and walked upright until she died at age 90 after a stroke. Her other grandmother died at 50 in a car accident and was healthy until then, however we have no bone history with age.

- Poor diet. I went through Sheila’s diet:

- Low calcium intake: This is the main mineral that builds up bone density. Sheila drank milk as a child but does not drink milk, other than in coffee, at present.

- Nutritional deficiencies: Other nutrient deficiencies increase the risk for osteoporosis such as vitamin D, magnesium, manganese, Vitamin K and boron. Sheila is inclined to eat too many empty calorie foods such as bagels and muffins that contain negligible amounts of these nutrients.

- Anorexia: She was never anorexic but mentioned a niece with an eating disorder whose menstruation has stopped. I told her this leads to low estrogen production and increased bone loss and that she should see a registered dietitian right away.

- High protein intake: She had tried a high-protein diet but had stopped it, as she couldn’t cope with the monotony of it. She now realizes that meat and other high-protein foods tend to be high in phosphorus, a mineral that depletes calcium out of the bone. The more phosphorus you consume, the more calcium you need to maintain your bone mineral density.

- Soda: As Sheila only drinks one to two cups of diet soda a day, I was not concerned with the amount of phosphorus from these beverages.

- Vegans (people who eat no animal products at all): A few years ago Sheila tried a vegan diet with no animal products at all. As calcium in milk and dairy products is better absorbed than the calcium found in vegetables or supplements, strict vegetarian diets containing no milk may increase her risk of osteoporosis. She only stayed on this diet for a month but found it too restricting.

- Certain vegetable compounds: Sheila had read that certain vegetables should be avoided. She was not quite right. The oxalates in spinach and sweet potatoes and phytates in legumes and grains do decrease the absorption of calcium but they do contain some calcium themselves and should be in the diet together with calcium rich foods.

- Salt: Should Sheila avoid salt? Well, a high salt intake does increase loss of calcium in the urine, so I gave her a list of high salt foods to limit.

- Coffee: As Sheila loves her morning coffee, I let her keep that. More than two cups a day can decrease bone density in older women. For her second cup I suggested a café latte to compensate for the calcium decrease.

- Alcohol: Sheila wasn’t a big drinker, sometimes having two glasses of wine at a social event. I told her not to have more than one glass of wine a day and to start with a glass of water, taking a sip of water between each sip of wine.

- Excess Vitamin A supplementation: I told her to bring in her supplements. Adding the total vitamin A content of all her supplements reached very high levels however she usually forgot to take them. I sorted out what she had and told her not to buy any supplements in the future without discussing them with a registered dietitian first.

- Poor Habits:

- Smoking. Sheila had stopped smoking in her 30’s, which is good as smoking depletes minerals from the bone and decreases bone-preserving estrogen in her blood.

- Sedentary lifestyle: Sheila goes through phases of being active and not. As sitting around increases the loss of calcium I will plan activity for her.

- Drugs: Drugs can rob the bones of calcium. These include: cortisone, prednisone, thyroid hormones, anticonvulsants and aluminum-based antacids. Sheila is on a thyroid hormone so we will definitely have to focus on calcium-rich foods.

Sheila's Plan

As I explained to Sheila, there are some things you cannot change to lower your risk for osteoporosis: sex, race, build and age.

What can she do to improve her bone strength?

Well, it’s back to common sense: eat well, be active and supplement if necessary.

Eat Well

- I started with planning her daily intake of calcium-rich foods. See table below.

- Milk (including skim milk and 1% milk) is the best. Milk contains lactose and is enriched with vitamin D; both nutrients help with the absorption of calcium. She didn’t have lactose intolerance. Many people who have trouble digesting lactose can drink one or two servings of milk with solid food and not have problems. (Journal of the American College of Nutrition 2000;19 (2S))

- Cheese, fortified cottage cheese and yogurt are also good sources of calcium. Low fat options contain the same amount of calcium as high fat types.

- Canned salmon and sardines with bones

- Other sources of calcium, especially if she felt like trying a vegan day every now and again: calcium-enriched tofu and other soy products, calcium fortified orange juice, collards, turnip greens, rhubarb, broccoli, kale, oranges, almonds

- Vitamin D recommendations are 200 IU/day for people under 50, 400 IU/day for those 51 – 70 years, and 600 IU/day for people over 70 years of age. Supplements greater than 2000IU/day could become a health risk. Vitamin D is not hard to find in food: in fortified (added to) milk, eggs, salmon and sardines with bones, cheese, fortified margarine and fortified breakfast cereals

- Sun: although it’s best to keep out of the sun, a little can supply Sheila with the essential vitamin D. She needs to expose sun to her hands, face and arms three times a week for 5 - 15 minutes before sunscreen is applied. That should be adequate as 80 - 90% of vitamin D comes from exposure to sunlight. During the winter, when Sheila travels to the Northern and Eastern United States where the sun is weak, one cup of milk will supply her with all the vitamin D she needs each day.

- Other nutrients in plant products can increase her bone density: magnesium (seeds, soybeans, wheat germ, seafood); manganese (nuts, avocados, oatmeal); Vitamin K (spinach, broccoli, green cabbage, tomatoes); and boron (applesauce, peaches, pears, cherries). She loves them all. Even fats play a role. Saturated fats can influence bone density negatively, whereas omega 3 fats can be positive. See articles on fats.

- Soy protein and its isoflavones, genistein and daidzein may have a mild protective effect on osteoporosis. More data is becoming available on the use of soy products. In the meantime, include soy-type foods in your diet three times a week. A tasty snack is edamame, the actual soybeans in their pods. They come frozen and can be cooked up in 4 minutes. Frozen soy burgers or a miso soup from the Japanese restaurant contain tofu in a tasty form.

- Lower salt, soda, caffeine and alcohol intake: With Sheila’s awareness of nutritious choices, she will not be consuming these items in excess

Activity (important for bone strength)

- The easiest is walking for a ½ hour 3 times per week. Sheila is already doing this.

- The next best step is to walk every day for a ½ hour to one hour. Sheila plans to increase her walking time.

- Swimming strengthens muscles and gives a good stretch. She will go to a pool near her twice a week.

- Stretching exercises will be done when she watches television, to make her feel good and move her joints

- As Sheila would like to start with weights, I have recommended she find a fitness trainer near her to get her started. Weight-bearing exercises have been proven to prevent bone loss. But there is no need to be too enthusiastic and get hurt.

- Recommended reading for getting started with strength-training: Strong Women Stay Young by Miriam E. Nelson, PhD, exercise physiologist (Bantam Books: New York, 2000)


As Sheila plans to increase her calcium intake from foods, she will not need a daily supplement.

Should a person not get enough calcium from food, and a supplement is needed, which one is best? Studies show that calcium citrate is better absorbed than calcium carbonate. Small doses should be taken throughout the day together with 6 to 8 cups of water to avoid constipation. Be careful when prescribing a calcium supplement for yourself. Preferably, don’t supplement with bone meal or dolomite as these may contain lead. Over supplementing can lead to decreased absorption of iron and zinc as well as kidney stones, so seek professional advice before you buy (and I don’t mean the cashier at the health food store).

What about me?

Do I take supplements? - I’m a woman, Caucasian, postmenopausal and am not on estrogen replacement therapy. No, I don’t take any calcium supplements. Why? Because I love dairy foods, milk in my cereal for breakfast, actually eat scoops of yogurt and cottage cheese as a snack during the day, eat well most of the time, am active nearly every day, have never smoked, and have a moderate intake of caffeine and alcohol. Recommendations for postmenopausal women without estrogen replacement therapy are 1200mg, with estrogen 1000mg calcium per day. Do I get in 1200 mg per day? Probably close, but there is no history of osteoporosis in my family and I am only slightly osteopenic.

What about my mother Wyn?

"At 90, I take one Celebrex every two days for my arthritis. For calcium, I eat three dairy foods a day: milk in my cereal; yogurt as a snack; cheese or cottage cheese. I exercise to keep my bones moving. My father died at 95 of old age and my mother died at 85 from cancer. They did not suffer from bone fractures. I walk with a cane as my one leg is a bit shorter than the other and use a walker when I do my daily walks. My older son, a neurologist, has made me aware of the rapid deterioration of health after bone fractures in older people which keeps me careful. I do have a little arthritis in my back, hand and knees but don’t complain about it."


With the latest study on hormone replacement therapy (HRT), many people were surprised. The results were that a HRT regimen taken by six million American women did more harm than good. In a study with 16,000 women, researchers found that the drugs, a combination of estrogen and progestin, caused small increases in breast cancer, heart attacks, strokes and blood clots. Those risks outweighed the drugs' benefits - a small decrease in hip fractures and a decrease in colorectal cancer. These drugs are also effective for symptoms of menopause, such as hot flashes and night sweats. No woman needs to panic over these findings, as the danger to any individual woman appears very slight. Alternative drugs are available for the prevention of osteoporosis and hip fractures.

Health Tip: Measure bone mineral density, particularly postmenopausal women who have had fractures or a family history of osteoporosis, and all women 65 and older.

The bottom line

1. Increase your intake of low fat dairy products and calcium-fortified foods.

2. Be active.

3. Enjoy life.

I gave this Calcium Content list to Sheila so she could add up her calcium intake every day for a week. This will ensure that she is getting adequate intake. Use this table for your calculations:


Bread, 2 slices, 50 mg

Cereal, 1 cup, 20 - 400 mg (read label)


Orange, 1 medium, 50 mg

Broccoli, cooked, 1/2 cup, 50 mg

Kale, turnip greens, cooked, 1/2 cup, 105 mg

Butternut squash, 1/2 cup, 40 mg

Orange juice, fortified, 1 cup, 300 mg


Milk- skim, 1%, 1 cup, 315 mg

Cottage cheese, 1/2 cup, 80 mg

Cottage cheese, calcium fortified, 200 mg

Firm cheese: e.g. cheddar, swiss, 1-1/2 oz, 350 mg

Soft cheese: e.g. camembert, 1-1/2 oz, 200 mg

Parmesan cheese, 1 tbsp, 75 mg


plain, 3/4 cup, 250 mg

fruit-flavored, 3/4 cup, 250 mg

frozen, 1/2 cup, 150 mg


Salmon, canned with bones, 3 oz, 225 mg

Sardines, canned with bones, 11 small, 210 mg

Tofu, calcium fortified, 1/3 cup, 150 mg


Baked beans, soybeans, white beans, 1 cup, 150 mg

Chickpeas, 1 cup, 85 mg

Kidney beans, lima beans, lentils, 1 cup, 50 mg

Soy beverage, calcium fortified, 1 cup, 300 mg


Almonds, 1/2 cup, 200 mg

Sesame seeds, 1/2 cup, 105 mg


Soup made with milk, 1 cup, 190 mg

Cereal with 1/2 cup milk, 160 mg

Chili con carne, 1 cup, 65 mg



Cereal plus 1/2 cup milk, 160 mg

Orange, 50 mg


1-1/2 oz. cheddar cheese, 350 mg

2 slices bread, 50 mg


175 mL yogurt, fruit flavored, 250 mg


1/2 cup broccoli, 40 mg

1 glass skim milk, 315 mg

Total: 1215 mg plus small amounts in other foods.

Plenty for her, what about you?