Nutrition & Physical Activity
Regardless of your activity level, breakfast is an essential part of a healthful lifestyle and is also important for maintaining energy all day long. The motto here is anything for breakfast is better than nothing at all. Think of your body as a car and food as gas. Without gas, your car cannot get from one place to another.
The rate at which your body uses calories for energy is known as metabolism. Think of metabolism as the motor of your car. Metabolism is directly related to energy levels, so the higher your metabolism, the more energy you have throughout the day. When you are sleeping, your body naturally decreases its metabolism. When you wake up, there is an increase in metabolism, which peaks by noon. How much energy you have during this time is contingent on how much food calories your body has to use for energy. Breakfast becomes the first stop to the gas station before your road trip. So basically, eating breakfast actually helps maintain high energy levels throughout the day. In fact, the more hearty a breakfast you have, the more your metabolism motor will roar!
You do have to stick to some guidelines, of course, to promote optimal energy.
The best range of calories for breakfast is between 350 to 500. Below 350, your body will not fulfill the requirements for morning energy usage; above 500, your body may store unneeded calories as fat.
Plan and eat a balanced breakfast meal including complex carbohydrate, protein, fat, and a fruit or vegetable.
Quantity to Aim for
- 1 to 2 servings of complex carbohydrates. One serving equals 1 piece of bread, ½ cup of cooked oatmeal, 1 cup of dry cereal, 1 English muffin, ½ bagel, ¼ cup of granola, 1 small muffin.
- 1 serving of protein. For example, 1 cup of yogurt, ½ cup of cottage cheese, 1 ounce of cheese, 1 large egg, 2 ounces of smoked salmon, 1 cup of milk or soy milk, 2 tablespoons (T) of peanut butter, or ¼ cup of nuts or seeds.
- 1 serving of fat. E.g., 1 teaspoon (t) of butter, 1 t of oil, 1 tablespoon (T) of cream cheese. But check your protein and carbohydrates for fat, there's no need to add extra if you have a serving of fat in your granola or omelet.
- 1 serving of a fruit or vegetable. That is, 1 medium piece of fruit, 1 cup of cut fruit, ¼ cup dried fruit, 6 ounces of fruit juice, 1 cup of raw or ½ cup of cooked vegetables, 1 cup of vegetable juice.
Some examples of energizing breakfast meals include:
2 pieces of toast
2 T of peanut butter
1 medium banana
2 servings of complex carbohydrates
1 serving of protein
1 serving of fat
1 serving of fruit
1 serving of complex carbohydrates
1 cup of cooked oatmeal with
1 cup of 2 percent fat milk
¼ cup of raisins
2 servings of complex carbohydrates
1 serving of protein
1 serving of fat
1 serving of fruit
1 small muffin
1 cup of plain low fat yogurt
1 cup of orange juice
1 serving of complex carbohydrates
As you see, there are many delicious ways to get from point A to point B every morning. Imagine your surprise when you see the results with more energy!
The American College of Sports Medicine (ACSM) defines exercise intensity by percentage of maximum heart rate, rate of perceived exertion, and METS (metabolic equivalents) in their Position Stand, Recommended Quantity and Quality of Exercise for Development and Maintenance of Cardiorespiratory and Muscular Fitness and Flexibility in Healthy Adults. Moderate activity has been defined as 55 - 69 percent of maximum heart rate (MHR). ACSM defines "hard" exercise at 70 - 89 percent MHR, and "very hard" at 90 percent and above, with 100 percent being maximal exertion. Check out Minimum and maximum heart rate for aerobic exercise in the Go Ask Alice! archive to learn the calculations and more.
You can also use the "Rate of Perceived Exertion" (RPE), a subjective rating that a person can use to rate his or her exercise intensity. If someone doesn't have any other way to rate workout intensity (i.e., has no watch to use to count heartbeats, or doesn't know how fast s/he is walking or running), RPE is a low-tech method of determining this calculation. For example, a person can consider walking at a leisurely pace a 6, and perhaps a mad dash to catch a bus or a flyaway $100 bill a 19; so, rating activity in-between is a way to rate one's exercise intensity. The ACSM Position Stand uses the original scale from 6 - 19 to identify the perceived level of difficulty of physical activity, as follows:
6 - 8: Very, very light 9 - 10: Very light 11 - 12: Fairly light 13 - 14: Somewhat hard 15 - 16: Hard 17 - 18: Very hard 19: Very, very hard
Moderate intensity, using this scale of a person's self- perception of his or her own exercise difficulty, is 12 - 13, hard exercise is 14 - 16, and very hard activity is at 17-19.
The last measure — METS — has nothing to do with baseball players from New York; instead, it refers to metabolic equivalents. One MET is equivalent to your resting metabolic rate; 2 METS is any activity that requires two times your metabolic rate, etc. This measure is determined by the amount of oxygen consumed, which indicates the level of intensity a person is working. At 1 MET, an average man would be consuming 250 milliliters (ml) of oxygen per minute; an average woman would be consuming 200 ml of oxygen per minute. For those of you who wish to be even more exact, one MET is equal to 3.5 ml of oxygen per kilogram (kg) of body weight per minute (1 kg = 2.2 pounds). Since we are not going around measuring how much oxygen a person's body is consuming, assigning a MET equivalent can give us an idea as to how intense an activity is. At 1 MET (resting metabolic rate), a 55 kg female would use about 60 calories per hour, and a 65 kg male would use about 70 calories per hour. Two METS would be double that intensity, or consuming twice the amount of oxygen than at 1 MET. In other words, 2 METS means that one is working at twice his or her resting metabolic rate (which is relatively easy or achievable), 3 METS is 3 times someone's resting metabolic rate, and so on.
The ACSM rates moderate intensity using METS as decreasing with age. For men, moderate intensity by age is:
AGE (years) # METS (moderate) #METS (hard) # METS (very hard) 20-39 4.8 - 7.1 7.2 - 10.1 >10.2 40-64 4.0 - 5.9 6.0 - 8.4 >8.5 65-70 3.2 - 4.7 4.8 - 6.7 >6.8 80 and over 2.0 - 2.9 3.0 - 4.25 >4.25
For women, mean values are 1 - 2 METS lower than for men.
Some examples of how METS are associated with activity are as follows:
|1||resting quietly, watching TV, reading|
|1.5||eating, writing, desk work, driving, showering|
|2||light moving, strolling, light housework|
|3||level walking (2.5 mph), cycling (5.5 mph), bowling, golfing using a cart, heavy housework|
|4||walking (3 mph), cycling (8 mph), raking leaves, doubles tennis|
|5||walking (4 mph), cycling (10 mph), ice or roller skating, digging in the garden|
|6||walking (5 mph), cycling (11 mph), singles tennis, splitting wood, shoveling snow|
|7||jogging (5 mph), cycling (12 mph), basketball|
|8||running (5.5 mph), cycling (13 mph), vigorous basketball|
|9||competitive handball or racquetball|
|10||running (6 mph)|
The Centers for Disease Control and Prevention (CDC) standards for moderate activity are more succinct, defining moderate intensity as an activity allowing for sustained, rhythmic movements that are carried out at:
- an RPE of 11 - 14, or
- 3 - 6 METS, or
- 3.5 - 7.0 calories expended per minute (The number of calories per minute depends on a person's estimated body weight, fitness level, and intensity. Many charts are on the Internet that calculate energy expenditure for various activities, including the Fitness Partner calculator. An abundance of software, as well as exercise books, are also available for people who want to track this measure.)
Examples of such activity as defined by the CDC include mowing the lawn, dancing, swimming, or biking on a level surface.
Hope these explanations motivate you into moderate activity, so you can reap all its benefits.
Many women athletes, once they end competitive play, work on reducing the size of their muscles in different parts of their bodies. As both a softball and soccer player, you are most likely performing power movements in order to train your legs. These power movements probably involve lifting very heavy loads for a few repetitions while weight training and performing explosive movements, such as pressing off of your pivot leg when sprinting.
The amount of muscle in your thighs can be reduced, but it may hamper your athletic performance if you are still active in softball and soccer. As a power athlete, you probably have a larger proportion of fast-twitch muscle fibers (Type II) than slow-twitch fibers (Type I), found predominantly in endurance athletes. Most of your muscle type will not change, as the type of muscle fibers do not predominantly change over the course of one's life. Basically, you are born with the primary type of muscle fiber that you will always have; however, a small amount may adapt to changes in your workout regimen. Resistance and endurance training enlarges Type I fibers, while inactivity causes them to atrophy. Likewise, training may alter Type II fibers, which come in two varieties: hybrid fibers (Type IIa) and glycolitic fibers (Type IIb). Weight training converts Type IIb fibers into larger Type IIa fibers. With disuse, Type IIa fibers revert back to leaner Type IIb fibers.
If you are no longer playing or simply have a strong desire to decrease the muscle size in your quadriceps and hamstrings that make up your thighs, consider cutting back on lifting heavy weights while strength training. As opposed to performing one to four sets for three to five repetitions at a very heavy weight (85 to 100 percent of your one-lift maximum, which is the most you can lift for only one repetition, after which, you cannot repeat the exercise), begin doing three sets for 15 to 20 repetitions at a low weight (approximately 50 to 70 percent of your one-lift maximum). Below are some leg exercises to include in your training:
- Leg press
- Leg curls
- Leg extensions
- Seated and standing calf raises
Another option to lessen the size of your thigh muscles is to introduce distance running into your training regimen, as long as you do not have or are not prone to any joint pain in your legs. This activity can transform the size and structure of your legs. This is because distance runners adapt to this form of endurance training by developing leaner muscular legs (even though the muscle type will predominantly remain the same). You may consider starting with one mile and then build up to five to ten miles during a training session.
People may be genetically predisposed to have strong leg muscles in their thighs. This might not only apply to you, but also may be a reason for your athletic success. Although your legs may not look traditionally feminine, it's important to recognize their beauty in performing strong, powerful moves when scoring a goal or running to home. Since it sounds as if you're still active in softball and soccer, you might come to terms with your priority — to stay competitive in these sports, to play at a more leisurely level, or to stop for the time being. Your choice will determine whether, how much, and for how long you can transform the muscle mass in your thighs.
The bottom line will be deciding whether it's more important to you to have strong muscles that serve you athletically, or smaller muscles and less athletic prowess (or power). If you desire both, and you cannot change what is in your genes, then you may be able to change how you view your powerful, capable body.
It's great to spend some of your free summer time getting more physically fit by starting an exercise program. Indeed, exercise is one component of a healthful routine — especially if you're looking to drop a few pounds. Depending on the types of activities you enjoy, try to get either 30 minutes of moderate exercise (increased heart rate, but still able to carry on a conversation) on at least five days per week, or 20 minutes of vigorous exercise (sweating, breathing heavily) on at least three days per week. There isn't one "quick" exercise that will help you shed pounds, but if you follow the guidelines above, and eat a sensible diet, you'll be on your way to a sustainable, healthy weight for you.
In order to lose weight, most people need a combination of increased activity and reduced caloric intake. Beyond weight control, exercise yields important health benefits, including:
- reduced blood pressure
- improved sleep
- stress management
- increased level of good cholesterol (HDL)
- improved blood sugar levels (among numerous other positive effects)
We can't pick and choose where on our bodies we lose fat. Although it's possible to tone and strengthen specific muscles, fat won't be diminished in a specific area by lifting weights or doing certain exercises focusing on that body part. Body fat is decreased when we expend more calories than we take in — but we can't control exactly where fat loss will take place. For instructions on activities that'll help tone and strengthen your thighs, stomach, and hips, check out the Related Q&As listed at the end of this answer.
Since your schedule can be particularly tight, you can incorporate exercise into your daily travels. Biking or in-line skating to your destinations is a possible option, perhaps as a way to keep active during the school year as well. Taking the stairs whenever possible, getting off the bus or subway 1 or 2 stops earlier, parking further away if you drive, or even walking to work or school all contribute to your goal of being healthier by incorporating more movement into your life.
If you're looking for a "total body workout" for the summer, consider swimming — which can also be a cooling activity if your summer is a hot one. Swimming engages many muscles and provides cardiovascular benefits, too. Varying strokes can help work other muscles (such as the breast stroke) or provide greater cardiovascular benefits (such as the butterfly).
There's no secret easy answer, short-cut, or abbreviated workout that will yield magical results. Working each muscle group at least twice a week helps strengthen muscles. Although everyone responds to exercise at different rates, usually one or two sets of 8 to 12 repetitions, working the muscle to fatigue, is usually sufficient for strength building.
To maintain a fit body, it's essential to carve some time into your schedule for exercise and planning healthy meals and snacks -- however, as you can see, it doesn't have to be a lot of time. Scheduling these kinds of activities in your calendar as you would with social activities may help. You can also make plans to exercise with a friend, multi-tasking this way can give you plenty of time to socialize and exercise. Columbia students can score some extra motivation by signing up for Columbia's CU Move motivational emails. You can also visit the CU Move webpage for other physical activity related information. Best of luck getting started!
A cup of warm milk is no magic sleep potion, yet it is probably the most common food associated with bedtime. Milk contains two substances that are known to be related to sleep and relaxation, the hormone melatonin and the amino acid tryptophan. The amount of melatonin in a glass of milk is minute, much less than what would be taken in a supplement. The amount of tryptophan in milk is also small. In addition, our digestive process is complex. Considering these factors, it is unlikely that a glass of warm — or cold — milk would shorten the length of time that it takes to fall asleep.
Though milk components and serving temperature are not likely to influence the onset of sleep through physiological means, warm milk might have psychological significance. The routine of consuming a glass of warm milk may elicit memories of mom, home, and comforts of childhood that help us to relax. This is part of the natural transition from wakefulness to sleep. Recommendations include practicing stress reduction techniques, sticking to a regular sleep schedule, creating a relaxing bedroom environment, and avoiding caffeine or heavy meals close to bedtime.
For some individuals, particularly those with lactose intolerance or milk allergies, a glass of milk can be followed by uncomfortable digestive consequences. Lactose reduced, soy, almond, and rice milk are options that are more likely to be tolerated. If you have no allergy or intolerance, and warm milk simply grosses you out, you could try flavoring it with a bit of honey, vanilla, or cinnamon, but there is no reason that you need to continue attempting to use it as a sleep aid. Keep drinking your cold milk, to meet your daily calcium needs, and try other sleep improvement techniques.
February 27, 2012507786
November 12, 200821491
I am a lover of milk and love it cold or warm. I have always had success w/ warm milk lulling me to sleep. I have even had occasions when I've had a decaf coffee drink w/ steamed...
I am a lover of milk and love it cold or warm. I have always had success w/ warm milk lulling me to sleep. I have even had occasions when I've had a decaf coffee drink w/ steamed milk and it did me in for the rest of the work day. It really has worked for me in all the years that I have been doing it. As a matter of fact, it's a cool night where I am tonight and I'm going to have a nice warm mug of milk and maybe add a little honey and vanilla, curl up in my bed, and read until I'm done partaking... yum, what a treat! Sweet dreams, ya'll...
January 10, 200721178
I have been having trouble falling asleep and do not wish to use pills. I have found that 1 measuring cup of warm milk does put me to sleep. There is very little time between the...
I have been having trouble falling asleep and do not wish to use pills. I have found that 1 measuring cup of warm milk does put me to sleep. There is very little time between the actual drinking of the warm milk and my being asleep. This is not usual for me to fall asleep so fast, so it must be the warm milk.
March 3, 200621030
Just wanted to add that in most microwaves a minute is all you need to get it hot. 3 minutes is like cooking!!
Just wanted to add that in most microwaves a minute is all you need to get it hot. 3 minutes is like cooking!!
Dear Perplexed by protein,
You're not alone — this can be a confusing subject. First some clarification — a complete protein is a protein that contains all nine essential amino acids (the building blocks of protein, which can only be obtained through eating food). Complete proteins come from animal-based products (meat, poultry, dairy, eggs, fish, etc), soy, and quinoa (a grain). An incomplete protein contains fewer than all nine essential amino acids, however incomplete proteins can be combined in meals to make a complete protein (for example by combining rice and beans or peanut butter and toast). These foods don't need to be eaten at the same time in order to be used by the body to build protein, as once was thought. We just need to eat these complementary proteins within 24 hours. Incomplete proteins come from plant-based foods, such as beans, rice, grains, legumes (other than soy), and vegetables.
Our bodies use amino acids from foods to make proteins. As a matter of fact, the amazing human body manufactures all types of substances — from hormones to muscle tissue, blood cells, enzymes, hair, nails, and many others — given the right proportions of amino acids.
All of the foods you mention contain amino acids, and therefore varying amounts of protein. Just because they don't contain all of the amino acids we need doesn't negate the fact that they contain some protein.
Although protein is a vital nutrient, our bodies don't require quite as much as you may think. The U.S. Recommended Dietary Allowance (RDA) of protein is 0.8 grams/kg per day for adults. This recommendation has been shown to meet the needs of 97.5 percent of the population. For a woman weighing 125 lbs (57 kg), her needs would be met with an intake of 46 grams of protein per day. For a man weighing 154 lbs. (70 kg), his needs would be met with 56 grams of protein a day. A person must be taking in sufficient calories to maintain their weight for these values. Dieters need larger amounts of protein, because some is burned for energy. Athletes require slightly more protein as well.
It's believed that people usually eat a variety of foods, thereby getting the amino acids needed to manufacture complete proteins. Granted, if a person only ate bread, s/he would be missing an essential amino acid. The same would be true if a person only ate vegetables. However, if these vegetarians added legumes to their diet, they would be able to obtain all of the essential amino acids needed to remain healthy. The Food and Nutrition Board of the National Academy of Sciences (which sets the RDAs) spell out the amount of each essential amino acid needed to form complete proteins. However, it isn't necessary to go that far, as long as you are covering your protein needs with a varied eating plan.
To determine your protein needs according to the RDA, divide your body weight in pounds by 2.2, which gives you your weight in kilograms, and then multiply that number by 0.8. Consult the following charts for protein content in various foods. Adjust for the serving size and the number of servings you actually eat.
|Animal Sources of Protein||Serving Size||Protein (in grams)|
|Cottage cheese||½ cup||14|
|Egg white only||1||3|
|Plant sources of Protein||Serving Size||Protein (in grams)|
|Tofu, raw, firm||3 oz.||13|
|Legumes: (Black beans, Kidney beans, Chickpeas, etc.)||½ cup||7 – 8|
|Peanut butter||2 T.||8|
|Bread||1 oz. (1 slice)||3|
|Vegetables||½ cup cooked or 1 cup raw||3|
|Pasta or rice||½ cup||3|
So, as you can see, it's not difficult to reach your daily protein needs, as long as you include a variety of foods in your daily intake. Incomplete proteins needn't be too much of a concern. Vegetarians who consume complementary proteins are usually able to easily meet their protein requirements. Columbia students who would like more information can meet with a Registered Dietitian who can provide individual counseling and help students understand and meet their unique nutrition needs. If you're interested in learning more about healthy eating habits for yourself, please schedule an appointment. Students on the Morningside campus can contact Medical Services for an appointment and students on the CUMC campus can also schedule an appointment with a Registered Dietitian.
Vegetables can be a wonderful source of vitamins, minerals, and other nutrients that people need to stay healthy. The problem is that preparation can put a damper on the benefits that vegetables provide. In fact, according to the American Dietetic Association (ADA), improper preparation can cut the nutrient content of certain fruits and vegetables in half.
When cooking vegetables in water, some of the nutrient content, especially water-soluble vitamins including vitamins B and C, may leach into the surrounding water. But, as you suggest, using that water (or broth) in a soup or a gravy can, in fact, be a way of saving those nutrients and putting them to good use.
Still, high temperatures and long cooking times can degrade vitamins that are more sensitive to heat. While this is hard to avoid with soups, it is much less of a concern than leached and wasted vitamins.
If you're planning on preparing vegetables to eat alone, you may want to try steaming them briefly until they are crisp and tender. It's almost always best to keep cooking times low: microwaving, steaming, blanching, and stir-frying take the cake when it comes to speed. Also, you may want to eat your veggies raw; salads and crudité are a great way to enjoy fresh vegetables and their full range of nutrients. Generally, the less cooked the better — overcooked vegetables don't only lose nutritional content, they also lose much of their flavor and color. This doesn't mean you should stop adding vegetables to your soup. The ADA recommends that you consume at least 3 to 5 servings of vegetables every day, so it may be a good idea to vary your preparation on a daily basis. Bon apetite!
Dear In dire need of a diet/workout routine,
While you may be low on motivation right now, don't fret; it's never too late to get back on track.
Instead of thinking about the negatives related to lack of exercise and poor diet (excess weight, feeling sluggish), thinking about the positive benefits of healthy exercise and eating patterns may help your motivation return. Exercise and a healthy eating plan can help promote long-term health, but they also have more immediate effects. Exercise helps relieve stress and causes the brain to release mood-improving compounds called endorphins. Time spent on exercise is time spent on you, time for you to consider the issues of the day or to simply clear your head. Working out improves sleep quality, so we have more energy to take on work, school, and the next workout. In the past, what positives have you experienced from exercising and eating well?
Having established some pros, you may want to consider the barriers that are keeping you from eating healthily and doing regular physical activity. One example might be that you don't see healthy lunch options at your workplace or school. Another could be that some fitness center memberships are too pricey. What are all the barriers you can think of? (Hint: start writing them down!) Once you know what you're up against, you can brainstorm solutions and take a step-by-step approach to implement your solutions. For example, with the lunch time conundrum, would it work to pack a healthy lunch two or three times per week? Or could you start to scour the menu and deli shelves for healthy options that may be hidden away? Some folks find that rewards are part of the solution. What are some non-calorie rewards that would give you the incentive you need to stay active and eat well?
Feeling sluggish can be related to giving your body more fat, sugar, and calories than it needs. An energy boosting, balanced diet includes plenty of fruit, veggies, low-fat dairy, lean proteins, and whole grains. Look at the Related Q&As listed below, or visit the Academy of Nutrition and Dietetics or Choosemyplate.gov web sites for tips and guidelines that will help you to put together a healthy and tasty eating plan. As you change your eating patterns, you may even chart your moods in a daily organizer, to see the foods that are making a difference.
Another great way to get back on track with exercise and healthy eating is to gain the support of an ally. Working out with a buddy will make it easier and more enjoyable, and will keep you accountable for those days when you want to skip your exercise. By varying the time of your workout and/or the activity you do, you can prevent getting bored with your same old routine. Sharing a home-cooked meal with a friend can be fun and healthy.
If you prefer, you could also get a professional perspective. Columbia students can schedule time with a trainer at Dodge Fitness Center. For healthy meal planning, Columbia students can set up an appointment with a registered dietitian by contacting Medical Services (Morningside) or the Student Health Service (CUMC). You can also participate in Columbia's physical activity initiative by joining CU Move. 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. If you are not part of the Columbia community, you likely have personal trainers at your university fitness center, local gym, or YM/YWCA.
Be realistic, have fun, take small steps toward your goals, and you'll be on your way to getting big rewards!
Dear To sneeze or not to sneeze,
People in the United States spend billions of dollars a year trying to escape the misery of the common cold. Though some swear by remedies ranging from vitamin C to garlic to exercise, scientists have not conclusively found anything that will prevent, cure, or shorten the course of the common cold. The manufacturers of Airborne claim that the unique combination of herbs, amino acids, antioxidants, and electrolytes "offers vitamin and mineral support for hours," and imply that it helps the body fight bacteria and viruses by boosting the immune system. They have withdrawn their original claims that their product cures or prevents colds.
In addition to vitamins, Airborne contains Echinacea, an herbal supplement some people take on its own for colds or the flu. Similar to research on vitamin C, studies draw a mix of conclusions about whether Echinacea works in preventing or treating colds. There are many products on the market, as well as natural remedies, that successfully treat the symptoms of the cold: body aches, sore throat, stuffy nose. However, as of yet, there is no proven cure.
Some people may feel that Airborne works for them, but it's tough to say conclusively. Colds can last anywhere from one to ten days and a person's immune system will eventually fight it off, even without vitamins or supplements. There has been one study on the effectiveness of Airborne. The clinical trial was a double-blind, placebo study, meaning that neither the researchers nor the participants knew who took the real supplement and who took the placebo until after the trial ended. The study found that Airborne out-performed the placebo, however many people question the potential bias of this study because the research was conducted by the manufacturer.
Additionally, some people have expressed concern about the amount of vitamins A and C contained in Airborne. According to the Food and Drug Administration, the average adult should have 5000 units of vitamin A each day, and 60mg of vitamin C. One dose of Airborne contains 5000 units of A and 1000mg of C, and the package recommends taking a dose every three hours. That means taking significantly more than the recommended daily allowance of both. Overdosing on vitamin A may cause nausea, vomiting, headache and dizziness. Too much C can cause diarrhea and excess gas.
Subways and other enclosed spaces with many people can be germy, especially in cold season. Medical professionals say your best defense against the common cold is maintaining a healthy lifestyle. That includes: eating a balanced diet, being physically active, and getting plenty of sleep. On top of that, thorough hand washing with soap and water, especially before you eat, can keep the subway germs at bay. So, before you go out and buy the new very berry flavor of Airborne or a similar supplement, it might be wise to take its claims with a grain of salt (mix with 8 ounces of water and gargle!).
Your friend is lucky to have a friend like you, who observed a change that concerned you enough to ask for help and learn more about what could be going on. A twenty-five pound weight loss in one month is definitely cause for concern. Losing that much weight in such a short period of time could indicate a medical problem. Has your friend seen a health care provider recently? If not, you may consider urging her to schedule an appointment with a medical provider for a physical exam to make sure she is okay. This may or may not be an easy thing for you to do. Strategies to consider when encouraging a friend to see a health care provider include:
- Validating your friendship
Convey that you care for her and that your concern is genuine. You can say, "I value our friendship, and I hope you know that I care about you."
- Thinking about your approach
Plan what you will say. Be direct with your concern, and focus on your friend's health rather than on her weight. Sometimes it's easier to identify an aspect of someone's health or behavior. For example, "I've noticed that you seem tired all the time"; or, "I've noticed that you seem kind of blue lately." If she's an athlete, you might be able to comment on her decreased performance. Whatever you choose to say, keep the emphasis away from weight, appearance, and food, because sometimes the most seemingly innocent statement can be misinterpreted and unwittingly close a door you had planned to open.
- Offering a plan with options
Sometimes it's not enough to express concern. Follow up your observation with action-oriented ideas. For instance, "Is there a health care provider you feel comfortable scheduling an appointment with? If not, I'd be happy to help you find one." Or, "I can go with you to your appointment with the health care provider, if you like, or perhaps there is someone closer to you whom you might like to go with instead."
- Recognizing your own limitations
- Perhaps going to a health care provider with your friend is outside of your comfort zone. That's okay. It's important to know what you feel comfortable with so you avoid overextending yourself. Maintain whatever boundaries you need to so as not to get stressed out. Choosing to stay within your limits doesn't mean you're not supporting your friend.
It is not clear whether or not your friend has bulimia; however, you have noticed that she is in a serious situation and needs to be seen medically, since her health may be at risk. If you think your friend has an eating disorder, consider the following:
Individuals with bulimia nervosa tend to be of normal to slightly overweight range. Bulimia typically involves regular and repeated, often secretive binge eating bouts followed by purging, or other compensatory behaviors, to prevent weight gain. In general, purging is accomplished by self-induced vomiting and/or misuse of laxatives, diuretics, or enemas (purging type). People with bulimia may resort to other extreme behaviors, such as excessive physical activity or self-induced starvation (non-purging type) to avoid weight gain. Bulimia is highly correlated with substance abuse. People with bulimia often have a history of misusing alcohol and/or other substances.
Anorexia nervosa is characterized by an unwillingness and inability to maintain a healthy body weight. Typically, someone with anorexia is at 85 percent or less of her/his healthy body weight. S/he has a severe fear of fat and weight gain, and has a distorted body image. The seriousness of the significant weight loss is often denied by someone with anorexia.
Binge eating disorder is similar to bulimia nervosa in that it is typically characterized by regular and repeated binge eating episodes. An episode of binge eating involves rapidly and uncontrollably eating a large amount of food in a single time period at one sitting until uncomfortably full. Unlike bulimia nervosa, binge eating disorder does not include purging or other compensatory behaviors. Affected individuals are usually obese and have had problems with fluctuations in their body weight. For a majority of these individuals, binge eating begins during a diet.
- Eating Disorders Not Otherwise Specified (EDNOS) describes individuals who show signs of anorexia and/or bulimia, but do not fully exhibit the behaviors necessary to be clinically diagnosed with anorexia or bulimia. Someone with EDNOS may purge but not binge eat, or binge eat less than twice per week. So someone with disordered eating may not fit into the category of anorexia or bulimia, but still have an eating disorder that requires treatment.
A medical problem can trigger such significant weight loss in a short period of time, and so can depriving and/or ridding one's body of calories. Body weight remains stable when people eat just enough food to give their bodies the energy (calories) that they need for daily activity — calories taken in or ingested need to equal calories out or expended for weight maintenance. People gain weight if they consume more calories than their bodies need and use. If people eat fewer calories than they need and use, their bodies will take the energy from their storage, body fat, and will lose weight. Significant weight loss indicates that there may be multiple factors involved.
Based on your observations, the sooner you take action, the better. If you're comfortable, consider your approach if/when you talk with your friend. Timing is important, so choose when you two can sit in a relaxed environment that allows enough time to talk. Think about what you will say without coming across in a threatening or accusatory manner. Use "I" statements to express your feelings about what you've noticed that seems to be happening with her: "I'm worried that something is going on with your health." Try not to let the discussion turn into an argument or power struggle. If the conversation becomes hostile, back off and resume after you both have had time to calm down and think. Be prepared for rejection the first, fifth, or tenth time you express your concern with her. Persistence could pay off at some point, as the road to recovery is a process. If your friend denies she has a problem, a common reaction, don't take it personally; at least your friend now knows that she can come to you if/when she's ready to ask for or to get help.
If you're a college student, you can get help and support for your friend and even for you in dealing with your friend, from your resident adviser (RA) or residence hall director (RD), dean, advisor, or from someone in the Counseling Department. If you are at Columbia, you can reach out to the Health Services' Eating Disorders Team, Counseling and Psychological Services (CPS) at x4-2878, or a nutritionist or medical provider at Medical Services at x4-2284. As you can see, there are many opportunities to begin to get the help you need to be able to help your friend. It is important to remember that she needs medical care, and that you alone cannot fix her. She's lucky to have someone like you who cares enough to reach out.
In an emergency situation, however, you need to involve your friend's RA, RD, and/or dean to make sure she gets appropriate help immediately. Signs that indicate an urgent situation include sleeping all day, blacking out, suicidal thoughts or attempts, or significant weight loss, such as in this case. You may feel reluctant to blow the whistle on your friend, but you will be a better friend by helping her get the assistance she needs than by respecting her privacy in this specific situation.