Nutrition & Physical Activity

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Dancer thinks she may have an eating disorder

Dear Confused!,

It sounds as though your school did a good job in raising awareness of eating disorders, but you're fuzzy on whether or not this actually applies to you.

Lots of sports — including dance — focus on attaining a certain "body type." Some people are naturally born to look a certain way, while others are not. Striving for an ideal that is not always attainable (or even realistically possible) can lead some people to develop obsessions and unhealthy behaviors.

Eating disorders are not always "black and white." As a result, health care professionals use a designated set of criteria to medically diagnose an eating disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), these include:

Anorexia Nervosa

  • Refusal to maintain minimal body weight for age and height
  • Intense fear of becoming fat or weight gain despite being underweight
  • Misperception of body size and shape
  • Missed three or more periods in a row

Bulimia Nervosa

  • Regular and repeated binge eating bouts, followed by self-induced vomiting; misuse of laxatives, diuretics, enemas, or other drugs; starvation; or, excessive physical activity, to prevent weight gain
  • Both bingeing and compensatory behaviors take place about two or more times a week for at least three months
  • Self-evaluation is overly based on body size and shape

Sometimes people exhibit certain conditions of these eating disorders, but not all. What does this mean? They could have disordered eating and/or body image distortions, but not a fully developed eating disorder. Even so, it is preferable for a health care professional to diagnose the situation, because s/he can then refer a patient to the right people. Obtaining the appropriate resources can help a person identify the issues behind the eating and/or body image concerns.

You may want to speak with a parent(s), trusted friend, teacher, or mentor about your thoughts. Perhaps you can also make an appointment with your health care provider and/or with one of the professionals who spoke at your school. S/he could assess your situation and help you develop a healthy relationship with food, your body, and dance.

For further information, eating disorder resources are available on the web, including:

Here's to dancing to the beat of healthy living,

Alice

Is rest the best relief for muscle soreness from intensive training?

Dear Concerned wife,

Unfamiliar or newly strenuous activity, among other factors, can contribute to delayed aches and pains after exercise. Some intensive regimens, such as your husband's, do not accommodate for a sufficient break to help the muscles to recover. You're 100 percent right — rest is most helpful in overcoming muscle soreness.

Firefighting is a physically demanding occupation and it's certain the training is intense and exhausting. It's likely that your husband is performing exercises that incorporate a full range of motion involving two types of muscle contractions. Concentric contractions occur when muscles shorten as they overcome resistance. Think of a bicep curl — raising the weight up produces a concentric contraction. Eccentric contractions happen as muscles act to oppose gravity. In this phase, the muscle is actually lengthening. During a bicep curl, think of lowering the weight — this is the eccentric contraction. It is well documented that the eccentric contractions during exercise contribute to the soreness felt after a workout. The tendons and some connective tissue of stiffer muscles are unable to absorb the stresses of the lengthening part of exercise.

People prone to stiffer muscles may be more susceptible to muscle damage after physical activity than others. They may benefit from warming up first, as this has been shown to reduce symptoms of additional damage, and may possibly protect against further soreness. It's a good idea to start by elevating the pulse rate slowly with some light aerobic activity, such as a brisk walk or easy jog. It's best to stretch once the body has had a chance to warm up a little. Static stretching (i.e. holding a stretch in place for several moments, without bouncing back and forth) can help get muscles ready for any type of training. There is some controversy regarding the usefulness and safety of certain stretches, so it would be a good idea for your husband to get tips from a health care provider or personal trainer on how to stretch. The related Q&A's below provide some tips as well.  

Hydration and nutrition can also play a role in helping the body heal from activity of any intensity. Dehydration is a frequent contributor to soreness and your husband should be hydrating before, during, and after training. Water is the best bet for quenching thirst and a low sugar sports drink can help replace electrolytes for prolonged periods of training. A well-balanced diet with fruits, vegetables, plenty of protein, and complex carbohydrates can help the body perform under intense conditions. Potassium can also help reduce soreness, so your husband may want to consider adding a banana or two to help with recovery. Avoiding excessive alcohol or caffeine use can also prove beneficial.

In the mean time, massage can feel really good to fatigued muscles. So if you're inclined, a relaxing rubdown may be greatly appreciated by your tired, aching husband. To be fair, the two of you could trade massages so you can each relax and recover from the day!

Alice

Fruitarian teens: Are they stunting their growth?

Dear Reader,

Feeling fruity? Devoted fruitarians say they feel better eating in this style, that it makes their life easy, and they feel it is beneficial for the environment. Fruitarian diets include all sweet fruits and vegetable fruits — including (but not limited to) tomato, cucumber, peppers, olives, avocadoes, and squash. Some fruitarians add grains, beans, nuts, and seeds to their eating plans. If these foods are included, the proportions are generally about 70 - 80 percent sweet and vegetable fruits, with some beans, smaller amounts of grains and tofu, and a sprinkling of nuts and seeds. Many fruitarians prefer to eat their food raw. Depending on which items are included, some may have to be cooked.

The human body needs a variety of nutrients. Because fruitarian diets provide fewer calories and protein than vegetarian diets, they are not suitable for teens. For a teen, the implications of missing many nutrients can have long lasting effects. Following this eating plan can cause your body to fall short on calcium, protein, iron, zinc, vitamin D, most B vitamins (especially B-12), and essential fatty acids. Not only could your height be affected, your bones may not reach their peak density, and vital nutrients for nervous system development may be missing in your diet. It's important to understand that one food cannot provide the multitude of nutrients found in a mixed eating plan.

Such a restrictive eating plan for a teen also presents other concerns. Have you thought about why you feel this eating style might be right for you, and what the ramifications also could be? If you're considering fruitarianism as a means to lose weight, or deflect attention from food issues, you are better off addressing these concerns directly. Restrictive eating can lead to hunger, cravings, and food obsessions. Also, keep in mind that a diet of one food (or of one food group) is not an effective way to cleanse the body.

As you move into adulthood, you may become interested in trying out different diets to improve your health and nutrition. For your future reference, it is recommended that adults only adhere to a fruitarian diet for a limited period of time. This is because fruitarian adults (just like their teen counterparts) can experience deficiencies in calcium, protein, iron, zinc, vitamin D, most B vitamins (especially B12), and essential fatty acids.

Lastly, keep in mind that a limited diet may cause certain social disruptions. Meals with family and friends may become more difficult. Some people with less flexible food options report social isolation.

Just planting a few seeds to think about. Now let your knowledge grow!

Alice

Forgot to refrigerate leftovers — still okay to eat?

Dear Sleepy cook,

Sounds like a very tasty meal — one that would be tragic to discard. Unfortunately, it is likely that while you were sleeping, bacteria were partying on your stove and reproducing at alarming rates. Bacteria thrive at 40 to 140 degrees F and reproduce quickly. Thus, you should probably toss the sauce. Perishable foods should not be away from the fridge for more than two hours; seven hours would really be pushing it. Here are a few basic guidelines to follow in re-heating and refrigerating leftovers:

  • Tempting as it may be, do not taste food to determine if it is spoiled. You may get sick even from a small taste and your taste buds may not always detect good sauce gone bad.
  • Invest in a meat thermometer.
  • When initially cooking beef, chicken, or pork, make sure the meat reaches a minimum internal temperature of 160 degrees.
  • Make sure fish reaches a minimum temperature of 145 degrees.
  • Reheat all leftovers to 165 degrees.
  • Bring leftover sauces, soups, and gravy to a boil.
  • When wrapping up freshly cooked leftovers, store in multiple smaller containers so they cool more quickly.
  • Know that eating perishable foods that have been away from the fridge longer than two hours can be risky.

While it's ultimately up to you whether you eat or toss, wise eaters are wary of food that has been out a couple hours or more. Best of luck with future leftovers,

Alice

August 6, 2013

534185
Thank you! That was very helpful. I made a large batch if stew and had it in a large container. It would have taken a long time to cool down. I used 4 different containers after reading this post so...
Thank you! That was very helpful. I made a large batch if stew and had it in a large container. It would have taken a long time to cool down. I used 4 different containers after reading this post so it would cool down faster instead of one so bacteria would less likely grow ! Thank you!

Fiber supplements — Safe to use every day?

Dear Regular,

Some of the fiber supplements (available in powder and pill forms) you are referring to are designed to help alleviate constipation, and are to be used for a limited time only. That's because if a person has chronic constipation, the cause needs to be determined. Other products can be used as supplements, as long as there are no underlying medical issues, such as chronic constipation. Two steps to determine how you use supplements are 1) read the labels carefully to find a fiber product that can be used daily, and 2) speak with your health care provider to determine if you should be taking a daily supplement.

For people who experience constipation or other irregularity with their bowel movements, some causes may be: 

  • Inadequate fiber consumption
  • Lack of exercise
  • Insufficient fluid intake
  • Change in one's daily routine
  • Ignoring the urge to move one's bowels
  • Certain diseases
  • Some medications

Luckily for you and anyone who needs more fiber, fruits and vegetables aren't the only good sources for getting more fiber into your diet. Here are some fiber boosting tips:

  • Have a higher fiber cereal for breakfast — try to select one that contains at least 5 grams per serving.
  • Add beans to salad, or dine on a cup of chili for lunch. Each ½ cup of beans contains 3 to 4 grams of fiber.
  • Choose whole wheat bread, which has 2 grams of fiber per slice.
  • Munch on berries (one serving = ½ cup), pears (1 medium with skin), and oranges (1 medium). If you eat just two servings of these a day, you'll add 7 to 8 grams of fiber.
  • Snack on popcorn (go for air-popped). You get 1 gram of fiber per cup (equal to about 2 to 3 handfuls).
  • Have a baked potato, which has almost 4 grams of fiber.
  • Chomp on a medium carrot, which can add 2 grams of fiber.

Part of the benefit of getting fiber through food is that you will also take in the abundant vitamins, minerals, and plant chemicals (phytochemicals) that are present — you'll get lots of important nutrients, such as vitamin A, thiamin, riboflavin, niacin, folate, vitamin C, vitamin E, chromium, copper, iron, magnesium, potassium, and zinc; also in these foods are disease fighting plant chemicals, such as anthocyanins, alpha and beta-carotene, isoflavonoids, and phytosterols, among others.

If you do take a fiber supplement, you'll want to be careful because too much fiber can bind important minerals, such as calcium, iron, and magnesium, decreasing their absorption by the body. If you have more questions about your use of supplements, it would be a great idea to ask your health care provider, who knows your medical history and can recommend the best source of fiber for you. If you're a Columbia student, you can make an appointment with Medical Services (Morningside) or the Student Health Service (CUMC).

Wishing you continued regularity,

Alice

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

Managing high blood pressure through diet

Dear Reader,

Hypertension is known as the "silent killer" and is one of the most common diseases of the cardiovascular system. It is defined as a condition of sustained elevated pressure in the arteries of 140/90 or higher. In this case, 140 is the systolic pressure. Simply put, systolic pressure represents the blood pressure against the arteries while the heart is contracting or beating. The number 90 is the diastolic pressure, meaning the blood pressure while the heart is relaxing or between beats. People who are genetically sensitive to sodium experience high blood pressure from excesses in salt intake. People who are most likely to be salt sensitive include children of parents with hypertension, African Americans, and people over 50 years of age. It is important to keep in mind that not everyone is salt sensitive. As hypertension in the body becomes prolonged, the risk for heart failure, vascular disease, kidney (renal) failure, and stroke increases.

Although there has been no cause identified for hypertension in 90 percent of people, dietary factors have been shown to influence blood pressure. People with hypertension can use the following food guidelines:

Avoid foods high in sodium.
Sodium causes vasoconstriction, the narrowing of blood vessels. Therefore, the amount of space blood has to travel through decreases. This decrease creates an increase in the resistance the blood has to overcome. This increased resistance makes it more difficult for the arteries to expand with each beat of the heart, causing the internal pressure to rise. High sodium foods include processed meats, salted snack foods, cheeses, and canned foods.

Eat foods high in potassium.
Good dietary sources of potassium include bananas, potatoes, avocados, tomato juice, grapefruit juice, and acorn squash. Potassium helps maintain intracellular osmotic pressure, which is the force required to stop the flow of water across a membrane.

Limit adding salt to foods, particularly in restaurants.
Most foods, especially at restaurants, are already high in sodium.

Use salt substitutes.

Eat calcium and magnesium rich foods to help reduce blood pressure.
Food sources rich in calcium include low-fat milk, green beans, sardines with bones, broccoli, spinach, and tofu. Good sources of magnesium-rich foods include any legumes and seeds, such as navy beans and sunflower seeds.

Lower saturated fat intake.
Saturated fat increases the level of low density lipoproteins (LDL), which tend to stick to the sides of the arterial wall. This deposit of fat is known as atherosclerosis. Atherosclerosis begins with the accumulation of fatty streaks on the inner arterial walls. When this fatty buildup enlarges and becomes hardened with minerals, such as calcium, it forms plaque. Plaque stiffens the arteries and narrows the passages through them. Thus, blood pressure rises. This rise in blood pressure is due to the arteries' lack of elasticity.

Hypertension can also be treated with drugs, including diuretics, beta blockers, calcium channel blockers, and ACE inhibitors. Talk with your health care provider to see what treatment is best for you, if you need it.

According to a Harvard research study, the DASH! Diet could be another possible way to decrease blood pressure. DASH! stands for Dietary Approaches to Stop Hypertension. The Dash trials began with 459 adults with systolic pressure of less than 160 and diastolic pressure between 80 and 95. The Dash study randomly assigned people to one of three diets for eight weeks. The first diet was the Control Diet. This diet had levels of fat and cholesterol that matched the average American's diet. It had lower than average levels of potassium, magnesium, and calcium. The other two groups were divided into a "Fruit and Vegetable Diet" and a "Combination Diet." The Fruit and Vegetable group matched the control group in fat, saturated fat, cholesterol, and protein. However, the difference was that this diet had more potassium and magnesium. The fruit and vegetable diet reduced systolic blood pressure 2.8 mm Hg more than the control diet. It also reduced diastolic blood pressure 1.1 mm Hg more than the control. The Combination Diet had less total fat, saturated fat, and cholesterol than the fruit and vegetable and control diets. The combination diet, rich in fruits, vegetables, and low-fat dairy products, also had more potassium, magnesium, calcium, fiber, and protein. This combination diet reduced systolic blood pressure 5.5 mm Hg more than the control diet. It also reduced diastolic blood pressure 3.0 mm Hg more than the control diet.

To adapt the Dash Diet into your lifestyle, follow these guidelines:

  • Make gradual changes in your eating patterns.
  • Center your meal around carbohydrates, such as pastas, rice, beans, or vegetables.
  • Increase consumption of fruits and vegetables.
  • Treat meat as one part of the whole meal.
  • Decrease use of fat.

For example, total number of servings in a 2,000 calorie per day menu would look like this:

Food Group Servings
Grains 8
Vegetables 4
Fruits 5
Dairy Foods 3
Meats, Poultry, & Fish 2
Nuts, Legumes, & Seeds 1
Fats & Oils 2.5

For more info on the Dash Diet, you can go to the Harvard Medical School Family Health Guide website.

Finally, weight loss is recommended if you are overweight. Obesity can worsen hypertension. Extra adipose tissue means miles of extra capillaries through which the blood must be pumped. Weight loss can be accomplished through aerobic activity. Aerobic exercise will utilize fat stored in the body. This, along with weight training, will increase your muscle mass, which, in turn, will raise your metabolic rate. Therefore, you will expend more calories throughout the day.

Alice
[Material adapted from:

Marieb, Elaine N. Human Anatomy and Physiology. CA: The Benjamin/Cummings Publishing Co., 1997: p. 710.

Whitney, Eleanor and Sharon Rolfes, eds. Understanding Nutrition. Minneapolis/St. Paul: West Publishing Co., 1996.]


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

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

Partner is bulimic — what can I do to help her and myself?

Dear Tim,

When a loved one shares such personal information, or you come to realize there is someone close to you that may need support, it's not unusual to feel shock, confusion, hurt, grief, guilt, mistrust, and/or other strong emotions. There are a host of feelings you may have experienced since discovering that your partner is, and has been, bulimic. Your reactions are understandable since you probably assumed that you knew almost everything about your partner. Remind yourself that your partner probably did not intend to hurt you by keeping her bulimia a secret. She may have wanted to let you know, but could not bring herself to tell you about it. People with bulimia almost always carefully hide their behaviors from others, especially loved ones.

So, what should you do? It's clear that you have a lot of questions that you want answered, but it also appears that your partner is not yet ready to answer them. She probably needs more time before sharing such personal, and likely painful, information with you. For now, just let her know that you are there for her when she needs you. Also, if possible, try to encourage her to seek the professional help that will help her on a path to overcoming bulimia, if she hasn't already. If she is not open to your suggestion, then it may be best to approach her about this at another time.

It is also important to know that people with eating disorders are not the only ones who seek help; their families and friends also seek and find assistance. If your partner is not ready to talk, you may want to learn more about bulimia from some other reputable sources. You can start by browsing the related questions below. Other options include speaking with someone who understands, and share your feelings with her/him.

You and your partner are lucky to have a variety of good resources to aid you in your processes, individual and joint, to get help. By getting help, you and your partner may be able to better cope with, and understand, the varied emotions you have been feeling. You should be able to get a referral to a therapist and/or registered dietician by talking with your health care provider.

You and your partner may also want to contact the The National Eating Disorders Association. Don't forget to search through the Go Ask Alice! Nutrition and Physical Activity archive for more information about bulimia. In particular, read Eating disorders vs. normal eating for more general information. And, an excellent book for you to read that is written specifically for families and friends of people with eating disorders is, Surviving an Eating Disorder: Strategies for Family and Friends, by Michelle Siegel, Judith Brisman, and Margot Weinshel.

It's important to keep in mind that if your partner is not ready for professional assistance at this time, you can still seek the help you need. Take care of yourself first; in that way, you can be a stronger support person for your partner.

Alice

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