Nutrition & Physical Activity

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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

November 18, 2014

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This was very helpful. I have been suffering with severe Hypoglycemia for over a year. I am on Octreotide injections 100mcg 3x daily. I have had increasing and daily headaches over the last 6...
This was very helpful. I have been suffering with severe Hypoglycemia for over a year. I am on Octreotide injections 100mcg 3x daily. I have had increasing and daily headaches over the last 6 weeks that I didn't even consider them related and this opened my eyes.

Will sex-ercise shed those extra pounds?

Dear Curious,

Burn, baby burn — talk about a great workout! While you may experience some of the same physical effects during sex as you would during a vigorous workout (sweating, rapid heartbeat), you may not want to rely on sex as a main source of exercise.

It is estimated that the average 175-pound person burns 150 to 200 calories during 30 to 40 minutes of sex. Of course this will vary, depending on a person's weight, the type of sexual activities involved, and a person's overall fitness level. When compared with activities such as running, cycling, or rollerblading, however, sex does not burn as many calories. A research article on sex and the heart suggests that the maximum energy expenditure during sex occurs during orgasm but returns to normal within two to three minutes after. So, while you may burn more calories during orgasm, this higher rate of metabolism is not sustained after orgasm has ended.

Keep in mind that the number of calories burned during sex depends on a variety of factors, including duration, intensity, length of orgasm, type of sexual activity (i.e., oral, vaginal, anal), and position. Individual factors such as age, weight, and body composition also influence how many calories are burned during sex as with any other physical activity. It may be helpful to check out What exactly does moderate intensity mean? in the Go Ask Alice! fitness and nutrition archives for more information on energy expenditure and how it is calculated.

If you are interested in finding ways to burn calories and/or achieve a higher level of fitness, you may want to consider starting/maintaining a regular exercise program. If you are a student at Columbia, you can check out the offerings at the Dodge Fitness Center and/or join 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 and incentives to be active throughout the year. You can also check out the Centers for Disease Control and Prevention for more information on physical activity and calorie-burning.

So, while sex-ercise may not be the primary option for shedding pounds, you can still enjoy sex for the other benefits it provides.

Alice

Ephedrine (ma huang) — Uses and dangers?

Dear Reader,

It's smart of you to ask, since there's been considerable controversy over the safety and use of ephedra. In fact, there's been enough reported cases of harmful side-effects and even deaths associated with ephedra that the Food and Drug Administration (FDA) decided to prohibit the sale of ephedra in the United States in 2004. When the substance was re-evaluated in 2007, the FDA chose to continue the ban.

Ephedrine, also known by its traditional Chinese name, ma huang, is an extract of the desert shrub, Ephedra sinica. Originally ephedrine was used to relieve asthma symptoms, which it accomplished through dilating the bronchioles that supply the lungs with oxygen. But in the late nineties ephedrine gained popularity for its stimulant properties, raising blood pressure and heart rate, and stimulating thermogenesis, or heat production, actions similar to those produced by other stimulant drugs like amphetamines. Because of its heat-producing, calorie-burning, and appetite-suppressing qualities, ephedrine became a popular fat-burning supplement. Prior to 2004, the drug was available in scores of nutritional supplements, energizers, and dietary teas, as well as in herbal ecstasy, which was the impetus for its controversy.

However, on April 12, 2004 the FDA made any products containing ephedrine illegal for over-the-counter sales after it "...received an increasing number of reports of adverse reactions. These reported reactions vary from the milder adverse effects known to be associated with sympathomimetic stimulants (e.g., nervousness, dizziness, tremor, alterations in blood pressure, headache, gastrointestinal distress, etc.) to chest pain, myocardial infarction (heart attack), hepatitis, stroke, seizures, psychosis, and death." Some 32 deaths were attributed to this drug.

In fact, many diet drugs are found to be unsafe, and are often taken off the market once their brief stint of popularity has proved harmful. If you're interested in weight management or loss, try the following exercise and nutrition recommendations:

  • Eat breakfast — this jump starts your metabolism for the day.
  • Experiment with eating five to six small meals instead of three large meals a day to help keep metabolism high.
  • Participate in regular aerobic exercise, which helps to reduce stored fat. This activity also allows your body to continue to expend calories at a high rate for a short amount of time after exercise.
  • Participate in a weight lifting program to build more lean muscle mass since this will increase your basal metabolic rate (BMR), thereby expending calories even when you are not exercising.
  • You can also make an appointment with a health care provider or a nutritionist if you're wondering what a healthy weight is for you, or if you want guidance in planning a diet or exercise plan. Columbia students on the Morningside campus can make an appointment by logging into Open Communicator or by calling 212-854-2284. Students on the CUMC campus can also make an appointment with a provider or nutritionist by calling the Student Health Service at 212-305-3400.

Thanks for asking, and take care!

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.

Ginkgo biloba and physiological impotence?

Dear Reader,

Some people swear by Ginkgo biloba, calling it a miracle herb with the power to fix anything from Alzheimer's to erectile dysfunction. But what are the facts? Scientifically speaking the data is less clear.

According to available research, Ginkgo has been used effectively to improve cognitive function in patients with Alzheimer’s disease and dementia, as well as to improve memory in healthy adults and to treat peripheral vascular disease. Though it shows some potential with sexual dysfunction, the results have been mixed. In fact, Ginkgo’s effectiveness appears to be limited to relieving sexual dysfunction that is caused by selective serotonin reuptake inhibitors (SSRI) anti-depressants and not more generalized physiological causes. Some of ginkgo’s success with treating sexual dysfunction is believed to be the result of the placebo effect.

Though ginkgo is considered safe, there are some side effects such as headache, nausea, upset stomach, vomiting, and irritations around the mouth. Because of ginkgo’s ability to thin the blood, experts advise that you not take ginkgo if you are currently taking medication for diabetes, aspirin, ibuprofen or anticoagulant drugs such as heparin and warfarin. Doctors also advise caution to patients with bleeding disorders or those who are taking drugs, herbs (such as garlic, ginseng and red clover), or supplements that may increase the risk of bleeding.

Ginko biloba is usually sold as an extract because many of the plants parts, including its seeds, are considered poisonous and their consumption could lead to seizures and death. You may want to avoid these altogether.

Overall, Ginkgo could work for you either through the placebo effect or because of actual biochemical interactions — it just might not be your best bet. If you are interested in help with impotence you may want to speak with a health care provider. S/he can help you determine possible causes, the best treatment options, as well as answer any other questions you may have about Ginkgo biloba and its effects. Columbia students on the Morningside campus can make an appointment with Medical Services using Open Communicator or by calling 212-854-2284. Columbia students at the Medical Center can make an appointment with Student Health by calling 212-305-3400.

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

Wants to build muscle mass through weight lifting and a healthy diet

Dear Reader,

A healthy, varied diet of nutritious foods along with an appropriate exercise program can help get your bod in buff condition; however, remember that women in general do not bulk up to the same degree as many men do when they work out to increase muscle mass.

The road to muscle mass must begin with a sound weight training program. A program of lifting every other day, or doing a lower body workout one day and an upper body workout the other day, is recommended. The minimum frequency is two times a week. Remember, never work the same muscle group two days in a row. Your muscles need 24 to 48 hours of recovery time before the next life. In lifting weights to build muscle mass and strength, research supports three sets of 8 to12 repetitions max. (This means you can't lift the 13th time.) If you are a beginner, begin at a weight that you can lift 15 times before feeling fatigue, and gradually increase the weight and decrease the repetitions as the weeks go by. For more information on weight lifting, read Weight training: Do I need to change my workout to see results? and Weightlifting and still fat.

Adding aerobic activity to your weight lifting workouts will help reduce body fat stores. An aerobic workout of 30 to 60 minutes most days of the week is your target. Of course, you can build up to that ideal over time. For more information on aerobic exercise, read  Minimum and maximum heart rate and aerobic exercise.

Search through Go Ask Alice!'s Nutrition & Physical Activity archive for questions and answers that describe how to eat a healthy diet; in particular, read Food Guidelines — How much is a serving?. The Academy of Nutrition and Dietetics also has information on what types of foods might help support healthy muscle mass, like complex carbohydrates and foods with healthy fats.

Good luck on your road to more muscle mass!

Alice

What's more important: Calories or fat grams?

Dear Reader,

A calorie is the standard unit for measuring energy released from energy-yielding nutrients, such as fat, protein, and carbohydrate. Fat is an essential nutrient that helps the body transport and absorb fat-soluble vitamins (e.g., A, D, E, and K), among other functions. Whereas proteins and carbohydrates have only four calories of energy per gram, fat has nine. Food labels are federally standardized to help make it easier for the consumer to know what's in a particular food. You can calculate the percentage of calories from fat by looking at the column marked "Percent Daily Value" for total fat and simply add up these percentages. It's recommended that fat make up no more than 30 percent of your daily diet (meaning less than or equal to 30 percent of total calories a day from fat).

Although it is important to watch both calories and fat grams, it's best to focus on  the total number of calories consumed, which often seems to be forgotten. With the introduction of low-fat and fat-free versions of many common foods, you'd expect people to lose weight. Instead, many are either staying at the same weight or even gaining weight. Sometimes you can eat more of these foods than their full-fat versions for the same number of calories. However, sometimes low-fat foods contain more sugar than their full-fat cousins, and hence as many calories per serving. Ultimately, if you eat more calories than your body expends, regardless of whether these calories come from fat, protein, or carbohydrates, you will gain weight. Unused energy is converted and stored as excess body fat.

The amount of calories a person needs is based on body weight, age, gender and physical activity level. Generally, 1200 to 1400 calories per day is considered low, and anything above 2400 is considered too much. To find out how many calories you should be getting a day, check out the MyPlate website. This USDA-sponsored site will ask you to input your age, gender, weight, height and physical activity level in order to determine what caloric intake will be right for you. You can also check out Ideal Caloric Intake? in the Go Ask Alice! archives for more information on calorie counting.

Alice

Vegetarian — Vitamin B-12 deficient?

Dear Animal Lover,

Vitamin B12 is important in the formation of nerve cells and red blood cells. Natural food sources of the vitamin are found primarily in meat and other animal products, which mean those who stick with a plant-based diet have to find their source elsewhere. Though there are some foods that your friend may want to add to her/his diet, vitamin supplements may also be something to consider. However, because of the serious symptoms and long-term risks involved with B12 deficiency, consulting with a health care provider and/or a registered dietitian may help as well.

Contrary to popular belief that B12 deficiency takes many years to develop, it actually may only take a matter of two to four years to become symptomatic. A recent meta-analysis found that the prevalence rate of B12 deficiency among non-pregnant young adults who followed a vegetarian diet (lacto- or lacto-ovo) was at about 32 percent and among vegans, ( those who eschew all animal products: meat, eggs, dairy, honey, leather, silk, etc.) prevalence was at 43 percent. Symptoms of B12 deficiency include anemia, fatigue, weakness, constipation, loss of appetite, and weight loss. Long-term effects may be neurological changes such as numbness and tingling in the hands and feet. Additional signs of B12 deficiency include difficulty in maintaining balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue. But be advised that these can also be symptoms of many different ailments, so having a blood test from a doctor like your friend did can help with diagnosis.

The recommended daily allowance (RDA) of B12 for adults is 2.4 micrograms (µg) and there are actually two forms of B12, active (which the body can actually use) and inactive (a.k.a.,pseudovitamin B12). Now, for the good news: Both vegetarians and vegans have various options for obtaining sufficient amounts of vitamin B12. Some varieties of mushrooms, green and purple nori (seaweed), and some fermented foods like sauerkraut and tempeh (fermented soy beans) are recognized as plant-based sources active B12. Fortified foods like some cereals, soy products, or meat substitutes are options for both vegans and vegetarians. Milk, yogurt, and eggs are rich in vitamin B12 and may also be added to a vegetarian diet. And while it is possible to get sufficient amounts of the vitamin from these sources, many vegans and vegetarians don’t seem to eat enough of these products. As such, it might be a good idea to look into vitamin supplements that contain B12. Due to the low absorption rate of the vitamin through supplements, taking a 250 microgram (µg) dose is recommended. Seeking out the guidance of a registered dietitian may prove helpful for your friend to identify where B12–rich sources can be added in her/his diet.

Happy healthy eating!

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Services (CUMC)


Exercise motivation... for stress reduction

Dear Reader,

A high-impact yes to your question! In fact, there aren't many better pursuits than exercise for stress reduction. Before we delve deeper into why exercise is so great, however, let's first make sure we're on the same treadmill about our definition of "exercise." According to the Physical Activity Guidelines for Americans, it’s recommended that adults (ages 18 to 64) get 150 minutes of moderate physical activity or 75 minutes of vigorous activity each week. Physical activity is considered moderately intense if you are working hard enough to break a sweat, but you are still able to hold a conversation. If you're breathing hard and fast, your heart rate is up and you're not able to get many words in, that type of activity can be described as vigorous. Additionally, two or more days of muscle strengthening activity per week is also recommended.

Before you run in the other direction, consider some of the health-promoting and stress-controlling benefits of aerobic activity. Most notably, aerobic exercise strengthens your heart and lungs. These two vital organs — especially the heart — bear the brunt of the body's physiological stress response, as they are constantly being called upon to "fight or flee" from job, school, family, financial, relationship, and every other kind of stressor we confront daily.

You brought up another exercise plus: weight loss and maintenance. For many of us, looking good also means feeling good and vice versa. Exercise improves physical appearance, enhances self-esteem and self-confidence, and offers other mental health goodies. Regular exercisers report more energy and better ability to concentrate. Oh, and don't forget about improved quality of sleep, reduced stress reactivity (not getting as stressed out about things as you usually do), and, yes, maybe even a slowed aging process!

Exercise as stress-management strategy is easier said than done, so here are some tips that have helped many health-seekers to start and stick with exercise programs:

  • Begin slowly. If you are not accustomed to exercising, start out with ten to fifteen minutes twice a week and build up from there.
  • Snag a workout partner — there's nothing like the motivation of another sweaty, panting humanoid to keep you going.
  • If the gym will be "workout central" for you, take a quick lesson from a trainer on proper equipment use. Simple direction from experienced health club personnel can reduce gymphobia (and possibly injuries) while improving the quality of your workout. Your gym should offer this one-time service free of charge to newcomers, but this doesn't mean that you can't ask for guidance down the line, too.
  • Let friends and family know that you are exercising for your health — let them cheer you on.
  • Finally, make your workout sessions regular and real. Schedule them in your calendar, just as you would record business appointments, classes, and social engagements.

If you are thirty-five or older or have any heart trouble, blood pressure problems, or other medical conditions, you will want to get a medical clearance from your health care provider before you choose your exercise plan.

By the way, you have a variety of exercise options, and you don't have to join a gym to partake. Walking briskly, running, biking (mountain if it sustains your heart rate), swimming, calisthenics, playing tennis or basketball, and cross-country skiing are just a few possibilities. Check out some of the archived questions in the Nutrition & Physical Activity category to learn more about your options for making physical fitness a priority in your life. Columbia University students, faculty, staff, and alumni can also participate in 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 and incentives to be active throughout the year.

In addition to exercise, try to take breaks from your high-stress job. Walk around outside, take lunch, or sit in the bathroom for a few minutes if that's the only time you can get away. Just a few breathers during a hectic day can go a long way toward stress relief.

Good luck getting moving!

Alice

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