Nutrition & Physical Activity

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Liposuction — Permanent fat removal?

Dear Reader,

You and your husband are probably not the only ones having this debate. Various health professionals have also been in disagreement regarding the long-term outcomes of liposuction. The problem is that much of our evidence about the long-term outcomes of liposuction is based on anecdotes, which indicate that some people maintain the weight/fat loss, others re-gain the weight, and some people even gain more weight/fat than their pre-liposuction amounts. This debate will likely continue for some time.

Truth be told, multiple factors including gender, age, lifestyle, and genetic factors all impact weight. A one-time removal of 4-6 pounds of fat (even in very obese individuals no more than 20 pounds of fat is typically removed in one surgical procedure) must be accompanied by dietary changes and physical activity to maintain the weight loss. In the absence of these lifestyle changes, the individual can regain weight (and fat) that was lost during the liposuction procedure. While liposuction does remove entire fat cells, the fat cells remaining in the body can increase in size and can signal that more fat cells be created if there is an excess of fat in the body that must be stored. In other words, if the individual eats more calories than the body can store with its current supply of fat cells, the body will create more storage space to accommodate the excess fat.

Regarding your husband's argument, people are not born with all of the fat cells they will ever develop. Instead, cell number continues to increase throughout adolescence. After this point fat cell number may become fixed unless the individual gains a significant amount of weight. In this case, existing fat cells will be filled to their limit of about 1.0 microgram of fat per cell (normal is approximately 0.5 - 0.6 of a microgram), and more fat cells may be produced if needed. Pregnancy also seems to permit formation of new fat cells.

Cosmetic motivations aside, some people may opt for surgeries like liposuction to reverse medical complications from extreme obesity. However, research suggests that losing weight by achieving a negative energy balance (by reducing food intake and increasing energy expended through exercise) is important for achieving the metabolic benefits that go along with weight loss (like decreased risk for chronic diseases, increased endurance, and so on) (1). Also, liposuction procedures tend to target the abdominal area and sometimes the back of the upper arms and legs, but fat can be deposited in muscle, on organs, and in several other places throughout the body. These other locations where fat may be stored would be reduced in size when the person loses weight the traditional way. Although some good research has been done, more research with large sample sizes studying the long-term effects of liposuction is needed.

Alice
(1) Klein, S., Fontana, L., Young, V.L., Coggan, A.R., Kilo, C., Patterson, B.W., & Mohammed, B.S. (2004). Absence of an effect of liposuction on insulin action and risk factors for coronary heart diseases. The New England Journal of Medicine; 350(25), 2549-2557.

A healthy model is a model of health

Dear N,

Rather than prescribing you a "model's diet," as there are probably as many of them as there are models (both healthy and unhealthy), a better suggestion would be to follow the guidelines for a model diet — that is, start by resisting the urge to compare yourself to other models. Focusing on what's healthy for you is the healthiest runway to strut on.

You have already taken a step in the right direction by taking good care of yourself and your health:

Exercising regularly is fantastic for health and wellness. For a well-rounded exercise plan, be sure to include both cardio and weight training workouts. Current recommendations for a healthy dose of exercise for adults include 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week, plus muscle-strengthening activities on 2 or more days per week that work all major muscle groups (legs, hips, back, abdomen, chest,  shoulders, and arms).

Meeting with a nutritionist or dietician can help you figure out a specific eating plan tailored for your energy and nutritional needs. According to the USDA’s 2011 MyPlate Plan, a healthy diet for a typical woman aged 19-30 includes 6 ounces of grains (with 3 ounces coming from whole grains), 2.5 cups of vegetables, 2 cups of fruit, 3 cups of dairy products, 5 1/2 ounces of protein (lean meats and beans) and up to 6 teaspoons from the oil group. Recommendations for a typical man aged 19-30 includes 8 ounces of grains, with at least 4 ounces coming from whole grains, 3 cups of vegetables, 2 cups of fruit, 3 cups of dairy products, 6 1/2 ounces of protein (lean meats and beans) and up to 7 teaspoons of foods from the oil group. With a balanced diet, men and women can eat still eat sweets and treats in moderation and maintain a healthy diet.

Getting your beauty sleep is important — both on and off the runway! While six solid hours can be enough for some people, others, especially people in their late teens and early 20s, need as many as nine or ten to be completely rested and alert. For sleep tips, you can check out the A!Sleep Site.  

Only your dietician can tell you how often you should meet with her/him in a given period of time. In addition, you might also meet with a health care provider at your university's health service for a physical or check-ups to make sure that your body stays healthy while you continue with your eating, exercise, and would-be modeling plans. Columbia students can make an appointment to discuss their nutritional concerns online through Open Communicator, or by calling x4-2284.

Good luck with your modeling debut. Following the above tips can help you make a lasting impression along your path to becoming a model of good health!

Alice

Dancing for health

Dear Reader,

According to researchers at the Mayo Clinic, social dancing provides the body with many health benefits. It may help reduce stress, increase energy, and improve strength, muscle tone, and coordination. Dancing can also burn as many calories as walking or riding a bike. One factor that determines how many calories you will use is the distance you travel while grooving to the beat. In one study, researchers found that square dancers covered five miles in a single evening. That's a lot of do-si-doing!

Other aspects of dance that contribute to your cardiovascular conditioning depend on how long, how often, and how intensely or vigorously you boogie and get down. The National Heart, Lung, and Blood Institute (NHLBI) recognizes the benefits of dance in lowering coronary heart disease risk, decreasing blood pressure, and managing weight. Another plus of dancing is that the weight bearing movements of your steps can strengthen the bones of your legs and hips, important for maintaining bone health as you age. As a result, dancing may be used as part of a rehabilitation program, of course with appropriate supervision.

While we may not all be hip-hopping into our nineties, dancing is one activity we can (hopefully) do for the rest of our lives... and the sociability it provides is part of its allure. It's a great way to make new friends, be creative and expressive, and just plain old enjoy life. And, the best part of dancing is the fun you can have while you're doing something great for your body.

Whatever your preference, there's sure to be a style to get your toes tappin'! Whether it's belly dancing, funk, swing, ballet, jazz, tap, square, hip-hop, the hustle, the tango, or modern dance, classes are popping up all over. Columbia students can join one of numerous student dance clubs (ballroom, latin, swing, oh my!). Visit the Clubs & Organizations page for more information. In addition, you can contact your local gym, YW/YMCA, recreation/community center, or dance studio to see what they offer.

Well, now that you know that dancing is good for you, put on your dancin' shoes and cut a rug!

Alice

Best exercise equipment for quick weight loss

Dear Goldilocks looking for something "just right,"

In your question, you bring up two issues — how to fit exercise into a hectic schedule and how to achieve quick weight loss. Let's deal with the quick weight loss issue first.

First of all, despite what the infomercials say, there is no particular piece of equipment that will help you lost fat better than another. Losing fat is a result of expending more energy than you consume, not what type of equipment you use. Second, no matter what you read, hear, or imagine (again, forget what the infomercials say!), quick weight loss usually is not permanent, because our bodies just DON'T burn fat very fast. When you see a dramatic drop on the scale, it's usually from water loss.

Theoretically, to lose one pound of fat, a person must have an energy deficit of about 3500 calories, meaning one has to eat 3500 fewer calories than one needs, burn 3500 more calories than one eats, or find a combination somewhere in-between. To lose ten pounds, a person has to generate a deficit of 35,000 calories (yes, that's thirty-five THOUSAND). Since most women of about your weight need approximately 1800 to 2200 calories a day to meet their total energy needs, this could take some time to accomplish. Women who are trying to lose weight still need to consume at least 1200 calories a day (any less can have unhealthy effects on your body).

Instead of focusing on quick weight loss, it is a good idea to focus on ways to keep healthy and active in order to reach your long-term fitness and weight management goals. You may also want to look at why you want to lose ten pounds. Consider asking questions like, do I have the energy to do what I need and want to do? Is my weight keeping me from other participating in other activities? Based on the information in your question, you appear to already be at a healthy weight for a person your height and gender.

Now, onto your scheduling issue. If getting to the gym proves difficult, consider other ways to keep fit. Without investing large amounts of money on fitness equipment that ends up becoming a high-tech clothes hanger, try:

  • Investing in a jump rope — put on some lively music and skip to the beat. With a jump rope you can alternate between jump rope sets with strength builders, such as sit-ups, push-ups, and other free weight exercises.
  • Incorporating more activity, that really won't take up any extra time, into your regular routine; for example, climb the stairs instead of using an elevator or escalator at every opportunity.
  • Going for an early morning walk, jog, or run first thing if you typically get too bogged down later in the day.
  • Checking out websites or mobile apps that feature workout videos on-demand.

Remember that exercise doesn't have to be an "all or nothing" endeavor. Do your best during the busy times, and try not to let the exercising itself become a source of stress.

Sticking to a balanced eating plan will also help you to manage your weight. Starving oneself or restricting your calorie intake by too much can lead to overeating later on. Instead, concentrate on nutrient dense foods rather than calorie dense ones; they will be more satisfying in the long run. And during busy times, having a light snack before a party or event can help to keep hunger in check and may help prevent you from overindulging later.

Here's to enjoying your food and your workouts!

Alice

Low protein diabetic (renal) diet

Dear Reader,

Great question! Diet is one of the most important ingredients for treating kidney, or renal, insufficiency. When a person has renal insufficiency, it means that some of the nephron function in the kidneys has been lost, and the fluid, protein, and electrolytes are not filtered as efficiently through the kidneys. In order to delay renal insufficiency and prevent it from worsening, it is important to limit the amount of electrolytes (i.e., sodium, potassium, phosphorus, and calcium), fluids, and protein that one ingests.

Diabetes is the main cause of kidney insufficiency, which can eventually result in kidney failure. The reason for this is that increased blood sugar damages the capillaries and nerves that support kidney function. In addition to your low protein diabetic diet, you should also be sure that you are testing your blood sugar daily, exercising, and following your health care provider’s instructions.

Depending on the degree of your renal insufficiency, various protein restrictions would be necessary. At this point, you could plan a diet that balances your intake of phosphorus, potassium, and calcium. If you have fluid retention, decreased urinary output, and/or hypertension, it could be necessary for you to have a sodium and fluid restriction as well. In this case, you should speak with to your health care provider about how to restrict these nutrients.

When you eat large amounts of protein, extra stress is placed upon the kidneys. This is because they excrete waste products derived from protein. Since someone in your situation needs to eat a reduced amount of protein, the protein you eat should come from sources that are easily assimilated into body tissue. This type of protein is termed High Biological Value (HBV for short). The highest HBV protein is from an egg — other sources with slightly lower HBV protein include fish, beef, and poultry. In renal insufficiency, about 70 to 80% of your protein should come from these sources.

Various health care providers, such as a registered dietitian, can formulate an eating plan designed to meet your specific needs. If you are a Columbia student, this service is free for you at the Health Service. You can make an appointment with Medical Services through Open Communicator, or by calling x4-2284. You can also check out the American Dietetic Association to locate a Registered Dietitian in your area.

For more information on diabetes, you can try the following resources:

Alice

Diets and treatments for hypoglycemia (low blood sugar)

Dear Not So Sweet,

Oh, you're probably sweeter than you think…. Hypoglycemia is the medical name for low blood sugar. Excess insulin, along with glucose deficiency, usually causes hypoglycemia. We need glucose because it provides energy for our brain, central nervous system, and all of our body's cells. If someone is unable to maintain adequate blood glucose levels, major organs such as the brain are deprived of the fuel they need. When someone has low blood sugar, s/he may experience sweating, weakness, hunger, dizziness, trembling, headache, palpations (thumping in the chest), confusion and altered mental status, blurred vision, irrational behavior and aggressiveness, moodiness, and uncoordinated movements. S/he can appear to be intoxicated and have an increased heart rate. S/he may also have cool, moist skin and may even have a seizure. Over time, a hypoglycemic individual can experience allergies, sleeplessness, anxiety, depression, and is more predisposed to weight gain. S/he can also have recurrent headaches, poor memory, lack of confidence, and reduced libido.

Hypoglycemia may be caused by several factors. One cause is type I diabetes, also known as juvenile or insulin-dependent diabetes mellitus (IDDM). Type I diabetes is a chronic disease that impairs a person's ability to produce an adequate amount of insulin to control glucose levels (check out the diabetes-related questions below). Insulin must be injected and hypoglycemic drugs can be taken in order to lower the glucose level in the body. Other causes include too much medication, not eating enough carbohydrates, skipping meals, not eating soon enough, and too much exercise. Excessive alcohol consumption and insomnia have also been found to be causes of a low glucose level in the body.

A person with hypoglycemia can benefit from changing some of her/his behaviors:

  • Instead of three large meals a day, have six small meals, which can help stabilize blood glucose levels throughout the day.
  • Eat fewer simple sugars (i.e., candy, sweets, sugar, honey) and more complex carbohydrates. Complex carbohydrates are found in foods such as bread, cereals, pasta, rice, vegetables, and legumes (beans and peas). The body's primary source of glucose comes from the breakdown of carbohydrates.
  • Eat more fiber.
  • Choose fresh fruits as opposed to canned fruits and juices.
  • At each meal, consume foods high in protein, such as fish, poultry, meats, and dairy products, such as low- or non-fat milk and cheese.
  • Avoid alcohol, and limit coffee, tea, colas, chocolate, and cocoa.
  • Maintain a healthy body weight by consuming a healthy diet and engaging in adequate exercise.

In case carbohydrate supplies run low, protein can be broken down to supply glucose for the body to use. This process, known as gluconeogenesis, is more likely to be a last resort for a person since proteins are needed for other body processes, such as tissue repair. Gluconeogenesis is also more frequently associated with fasting or starving.

If you have been experiencing signs and symptoms of hypoglycemia, and you believe you may have hypoglycemia, it's advisable to visit a health care provider so that you can be correctly diagnosed and receive any needed treatment. Students on the Morningside campus can contact Medical Services for an appointment; students on the CUMC campus should contact the Student Health Service.

For more information about hypoglycemia or low blood sugar, check out the related questions below. Enjoy the sweet life!

Alice

Achilles tendon injury

Dear Reader,

The Achilles tendon attaches to the calf muscle and to the heel bone. The calf muscles and the muscles along the shin are needed to protect against shock in high-impact exercises. This muscle group is very strong and is used constantly. Because of this, your Achilles tendon is put under a lot of pressure. The Achilles tendon handles forces that range from two to three times the body weight in walking, to four to six times the body weight in running and jumping. When it is overused, or if you continue to use it when it is injured, inflammation of the Achilles tendon could lead to local degeneration and recurrent injury, which may result in a partial, or even a complete, rupture. It was very wise of you to take a break before gradually resuming exercise.

As you get back into an exercise routine, make sure that you follow up with your health care provider and/or a physical therapist to be certain that you are not doing any more damage to your Achilles tendon. If you are a Columbia Student on the Morningside campus, you can call 212-854-2284 or log into Open Communicator to schedule an appointment. For students on the Medical Center campus, contact the Student Health Service by calling 212-305-3400.

Stretching and strengthening exercises can certainly play a role in taking care of your body. Remember that all stretching should be slow and static and that you should listen to your body — feel your muscles stretching, but stop if you feel pain. Specific to the Achilles tendon and surrounding muscles, consider the following:  

Stretch #1 — Calf Stretch

  1. Stand about a foot from a wall, extend one leg behind you, keeping both feet flat on the floor, toes pointed straight ahead, and your rear knee straight and your front knee bent.
  2. Move your hips forward, keeping your lower back flat.
  3. Lean into the wall until you feel tension in the calf muscle of the extended leg.
  4. Hold for 10 seconds, then stretch the other leg.
  5. Repeat at least two more times.

Stretch #2 — Calf Stretch

  1. Stand arm's-length distance from a wall (or tree, or lamppost — whatever is handy and gives you support).
  2. Put your hands on the wall, keep your back and your legs straight, and make sure your heels are flat on the floor.
  3. Bend your arms and lean forward, trying to touch your chest to the wall.
  4. Feel the stretch in your calf muscles.
  5. Hold it for a few seconds.
  6. Relax and repeat at least two more times.

Stretch #3 — Achilles Tendon Stretch

  1. Stand with one leg in front of you, slightly bent, and the other leg extended back.
  2. Lower your hips downward as you slightly bend the knee of the extended leg.
  3. Keep both heels flat on the floor and toes straight ahead.
  4. Hold the stretch for 10 seconds, and then stretch the other leg.
  5. Repeat at least two more times.
    Note: This Achilles tendon stretch requires only a slight feeling of tension at the back of your ankle. Also, be sure that you do not bounce, and that you stretch gently and completely.

Besides jogging and running, the Achilles tendon can be injured from any activity that has an impact component. To help prevent injury to the Achilles tendon, consider exercises that put less stress on the Achilles tendon, such as bike riding and swimming. Also, abnormal pronation and muscle imbalances can be a problem for a recurring inflammation of the Achilles tendon. If you decide to get back into running, you need to have a physical therapist check out your running shoes to make sure they are not causing extra stress on your Achilles tendon and calf muscles. Be sure that you always wear running shoes that are not worn out, and try to avoid uneven or hard running surfaces. You may want to run on soft surfaces, such as running tracks, or soft trails without holes or ditches.

A reference to mythology seems unavoidable — stretch and allow your body to heal so your tendon doesn't become your Achilles heel. 

Alice

Could drinking too much soda lead to osteoporosis or kidney failure?

Dear Curious,

You may want to screw the cap back on that cola! It appears that there is an association between soda consumption and osteoporosis, as well as an association between soda consumption and markers for kidney disease in women who have a low to normal Body Mass Index (BMI). As with most foods and drinks, moderation is key to good health. A little information can go a long way, so keep on reading to learn more about these links.

Studies have shown an association between regular intake of colas that contain phosphoric acid and negative effects on the bone. Researchers hypothesize that a high level of phosphoric acid may lead the body to tap the bones for calcium to neutralize acids. Alternatively, researchers believe that osteoporosis could be a result of diet displacement — that is, heavy soda drinkers may not be drinking enough milk or fortified juices that are good sources of vitamin D and calcium. Just to note, the link between soda and osteoporosis was previously thought to be due to the carbonation in the soda — research has shown this association to be false.

As for kidney function, studies have found that women with low to normal BMIs who drink more than two cans of soda daily have about double the risk of developing albuminuria (the presence of the protein albumin in the urine) relative to those who don't drink that much soda. Albuminuria is a marker for developing early kidney disease. Researchers believe that this effect is more pronounced in low to normal weight women, because obesity already damages the kidneys and the extra damage from soda is likely to be less observable. It is unknown why the same effect is not seen in men. Additionally, studies have shown mixed results on the relationship between soda consumption and the development and recurrence of kidney stones.

In any case, reducing soda consumption can't be a bad thing. Not only are you playing it safe with regards to osteoporosis and kidney function, you're also avoiding a lot of extra calories and damage to your teeth. For tips on cutting down, check out Getting off colas, sodas, pop, fiz...oh, whatever!. Now raise your glass to better health! 

Alice

May 18, 2012

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Hmm...interesting. I also heard that cow's milk contains some protein which prompts the bones in your body to release calcium. There's supposodly support for high cow milk consumption and...
Hmm...interesting. I also heard that cow's milk contains some protein which prompts the bones in your body to release calcium. There's supposodly support for high cow milk consumption and osteoporosis.

How can I eat well at college?

Dear Confused and College Bound,

You are not alone with your concerns. Going to college is a big step in a person's life involving major changes. You and those around you may be living on your own for the first time, making decisions on a buffet of issues, including what to eat.

Eating healthy at college is possible. Many college dining services are offering more healthy choices and are often quite receptive to students' concerns and dietary preferences. But, this is only part of the challenge. In an environment where time, friends, and finances may combine in new ways, having options available only solves some of the puzzle. It's important to experiment with what works best for you. For example, that traditional idea of three square meals a day has been updated with a more contemporary concept of eating five smaller meals spread throughout the day. Steer clear of diets or fads, especially those that drastically limit a particular nutrient. Remember, balance, moderation, and variety win out over trendy and extreme. For some practical tips, navigate through the many options on Choosemyplate.gov. Columbia students can also take advantage of the resources from the Get Balanced initiative. Plan ahead when possible so you don't have to rely on vending machines when you're hungry; think of ways to incorporate fruits, vegetables, and whole grains on a daily basis. Eating more of these will fill you up and possibly even enhance your already stellar brain power.

Making time for physical activity is important, too. Most college fitness centers have a variety of movement classes and options. When the weather is right, grab a friend and walk, run, bike, or blade outdoors. If you are Columbia affiliated, you can connect with the CU Move initiative.  CU Move encourages members of the Columbia community to engage in active lives that include regular physical activity. The program provides participants with motivation, incentives to be active throughout the year, and event calendars with access to plenty of free and low-cost physical activity options on campus and around NYC. 

Now, to address the second part of your question: an eating disorder, such as anorexia nervosa, is less about food, eating, and body weight. It has more to do with mental health, emotional, physical, socio-cultural, and family issues. If this is a particular concern of yours, you might want to take a look at Eating disorders vs. normal eating. Additionally, if you are a Columbia student, you can make an appointment with a health care provider or a registered dietitian to discuss your concerns by contacting Medical Services (Morningside) or the Student Health Service (CUMC).

Give yourself some time to adjust to a new environment and ask for help when you need it. Everything in moderation, even moderation. 

Enjoy your time at college,

Alice

Nutritional differences between canned, frozen, and fresh veggies?

Dear Reader,

A busy lifestyle and a rigorous semester may not always allow us to have fresh vegetables on hand. But, there are benefits and drawbacks of fresh, frozen, and canned vegetables. For starters, no matter which way you store it, a vegetable is always going to contain carbohydrates, protein, vitamins, minerals, fiber, and other plant chemicals, known as "phytochemicals," all of which are good for us no matter what. You’ll be happy to know that none of these nutrients are completely lost from processing.

While most people feel that fresh veggies are optimal, they may lose nutrients before they even get into your stomach. Raw vegetables lose some vitamins just by sitting around. It could take up to two weeks from the time they've been picked until they reach your plate. By this time, 10 to 50 percent of the less stable nutrients may have disappeared. Still, raw, lightly prepared, or minimally processed veggies (and fruits) often have a higher nutrient value than well-cooked ones. To help preserve the nutrient content of veggies (and fruits) during cooking or other preparation:

  • Stick with shorter cooking times and lower temperatures (e.g., avoid deep frying)
  • Cook with little or no water to help retain water-soluble vitamins, such as vitamin C and the B vitamins. For example, steam or microwave rather than boil. To limit exposure to heat when cooking this way, wait until the water is boiling before adding veggies.
  • For more information, read Cooking veggies and vitamin loss?

Frozen and canned vegetables are often processed shortly after they are picked, so that nutrient losses would not occur during shipping, on the grocer's shelf, or in your home. Frozen vegetables actually retain a high proportion of their original nutrients. Sometimes, though, they are blanched (dipped in hot water), which preserves color and texture, but may compromise some vitamins. In order to avoid extra calories, salt, and/or fat, choose frozen vegetables without added sauces or cheese. Sodium is often added to canned products. A portion of this may be rinsed off with water, or you can choose the low sodium or no sodium that are often available (check the label!).

Whether fresh, frozen, or canned fits into your lifestyle, select any type that you'll enjoy eating. The number of servings needed in a day varies depending on your age and other factors, however, adults generally need about 2.5 to 3 cups of vegetables and 1.5 to 2 cups of fruit each day. Read Food Guidelines — How much is a serving? in the Go Ask Alice! Nutrition & Physical Activity archive for specific veggie and fruit serving size information. You can also check out Choosemyplate.gov for personalized recommendations.

As a side note, you may think that nutritional supplements are a quick and easy way of getting the nutrients you need in case you don't follow a healthy eating plan. However, a well-balanced diet rich in veggies and fruits can offer you much, much more than these supplements ever could, such as phytochemicals, which could protect against cancer, heart disease, other illnesses, and who knows what else? Beneficial substances such as these are found in vegetables no matter what form they are in.

Alice

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