Recently my local grocery began selling a product called Cocolites. These crispy, airy, Frisbee-ish discs are basically flour and water. The dough is forced into a machine ensconced behind safety glass and is forcibly expelled at 100 mph, nearly beheading the poor bakery attendant assigned to work the machine. The result, a cross between pita bread and a rice cake, is devoid of any nutritional value whatsoever. And, it has merely 16 calories per serving! If you’re ravenously hungry, these guys will fill you up without filling you out.
Beef Up Your Energy: All About Anemia
August 15th, 2011
Doctors are terrible patients. Five years ago, I found myself dizzy, unsteady, headachy and exhausted beyond my usual 9 pm bedtime. After a visit to the ear nose and throat specialist, an MRI of my brain and neck, and eight weeks of general suffering, I had a blood count that showed profound iron deficiency anemia. Duh.
Iron deficiency is the most common cause of anemia worldwide. There are other less common causes such as vitamin B12 deficiency and folic acid deficiency, neither of which will be discussed here! Dietary iron is absorbed in the intestines and the body uses it to make hemoglobin. Hemoglobin is essential for transferring oxygen in your blood from the lungs to the tissues. Anemia is simply low hemoglobin levels, roughly less than 12 for adult women and 14 for adult men.
Causes of Anemia
Iron deficiency anemia is very common and can be divided into two categories: not enough coming in (poor dietary intake, poor absorption, or increased needs) or too much going out (bleeding from the gastrointestinal tract or other sources). Often there are multiple factors.
Symptoms of Anemia
Most people’s iron levels will gradually diminish, therefore the symptoms can be confusing. Patients will often present with fatigue, weakness, pallor, dizziness, lightheadedness and depression. Less commonly, they can have tongue irritation, ice craving or restless leg syndrome. A rapidly developing anemia can also cause fainting and low blood pressure.
How Anemia is Diagnosed
A simple blood test can diagnose low hemoglobin and iron studies can give your doctor an idea of the levels of iron in your body. Once a low level is found, the source must be determined. Most patients will need a test for microscopic blood in the stool and a urinalysis. If these are positive, referral to a specialist may be necessary.
Ways to Increase Iron Intake
Regardless of the cause, once iron deficiency is diagnosed, you’ll need to change your diet to include iron rich foods. Animal based foods are rich in heme iron, which is better absorbed than plant based foods containing non-heme iron. Cooking these foods in an iron skillet can boost iron content as well.
| Iron Rich Foods containing Heme Iron |
| Excellent Sources | Good Sources | ||
| · Clams
· Pork Liver · Oysters · Chicken Liver · Mussels · Beef Liver |
· Beef
· Shrimp · Sardines · Turkey
|
|
Iron Rich Foods containing Non-Heme Iron |
| Excellent Sources | Good Sources | ||
| · Enriched breakfast
· Cooked beans and lentils · Pumpkin seeds · Blackstrap Molasses |
· Canned beans
· Baked potato with skin · Enriched pasta · Canned asparagus |
Multiple factors affect your ability to absorb iron. Make certain you’re not swigging back your iron supplement with black tea!
Iron Absorption Enhancers |
Iron Absorption Inhibitors |
|
|
Anemia is a sneaky one. If you’re feeling sluggish, ask your doctor to check some labs. Iron intake is part of a well-balanced diet. Do as I say, not as I do!
Seasonal Allergy: It SNOT Funny!
July 29th, 2011
Allergic rhinitis (also known as nasal allergy or hayfever) is a common disease that affects about 40 million people in the United States. Atopy, which is the broad group of diseases that includes nasal allergies, eczema and asthma, is a condition where the body overreacts to external stimuli and then releases a cascade of chemicals that make you feel terrible.
Quick Facts
- Most people who have nasal allergies have a parent, brother, or sister who has allergic rhinitis, asthma or eczema.
- Allergies can begin at any age, but most often begin in late childhood or early adulthood.
- Symptoms vary widely: runny nose, sore throat, post-nasal drip, decreased sense of smell, dizziness, decreased hearing, headaches, cough, itchy eyes or throat, watery eyes are the most common ones.
- If you’re prone to outdoor allergies, you’ll eventually develop them wherever you reside.
- Allergy testing can be via bloodwork or skin test
- Your primary care doctor can manage most allergies.
- Sometimes it can be difficult to tell the difference between allergy and infection. Seasonal patterns and timing can be clues for allergy; fever is a clue for infection.
Treatment Options
The best treatment is to avoid what causes your allergic symptoms in the first place.
ANTIHISTAMINES
Antihistamines work well for treating allergy symptoms, especially when symptoms do not happen very often or do not last very long.
- Sedating Antihistamines (OTC): Diphenhydramine, Brompheniramine, Chlorpheniramine, Dimenhydrinate, Doxylamine. These are available in many combo medications labeled “Allergy”.
- Non-Sedating Antihistamines (some OTC, some prescription)
Loratidine (Claritin), Cetirizine (Zyrtec), Fexofenadine (Allegra)
- Azelastine (Astelin) is an antihistamine nasal spray
CORTICOSTEROIDS
- Nasal corticosteroid sprays are the most effective treatment for allergic rhinitis.
- Examples are Flonase, Nasalcort, Nasaryl, Nasonex. All are prescription.
- Nasal Sprays need to be used on a continual basis, with breaks during your “off” season.
DECONGESTANTS
- Decongestants work by temporarily reducing swelling in the nasal passages
- Over the counter pill options include Pseudoephedrine and Phenylephrine
- Nasal spray decongestants (such as Afrin) are addictive and should not be used for more than 3 days.
RANDOM TREATMENTS
- The leukotriene inhibitor Singulair is a prescription medicine approved to help control asthma and relieve the symptoms of seasonal allergies.
- Cromolyn Sodium is available as a prescription nasal spray and may reduce allergy symptoms.
- Flushing the nasal passage with saline spray can be helpful. Be careful when using nasal sprays that contain benzalkonium chloride. These may actually worsen symptoms and cause infection.
NON-MEDICATION SOLUTIONS
- Check the local pollen count daily (www.pollen.com). When counts are high, avoid outdoor activities.
- Keep your windows closed during the pollen season.
- Use central air conditioning when possible. Leave the fan on to continuously circulate the inside air through the filters (use extended surface multi-pleat filters if you need disposable filters).
- Avoid outdoor exposure during midday and early afternoon when pollen counts are highest.
- Save outdoor activities for after a rain when pollen has been washed out of the air, but be aware that some molds only release their spores into the air on rainy days or when the humidity is high.
- Wear glasses to avoid getting pollen in your eyes.
- After being outdoors, shower, wash your hair and change your clothes.
- Wear a mask when doing yard work.
- Avoid using sedating antihistamines in you are operating machinery or driving your car.
The good news? Most seasonal allergy sufferers get relief after the first frost. Winter is just around the corner.
Potato Chips and Couch Potatoes
July 15th, 2011
My daughter Abby loves potato chips so much that on her ninth birthday a friend gave her an enormous container as her gift. Earlier this year, we surprised our kids with a tour of the Herr Potato Chip Factory in Pennsylvania. It was fantastic, although I’d prefer a handful of cherries to chips any day. Children who regularly consume potato chips gain an average of 1.69 more pounds over 4 years when compared to children who don’t (New England Journal of Medicine, June 2011). This got me thinking; if Abby is so obsessed with them, are other people too? Are my parenting skills suspect? What can I do to make sure she is healthy?
Consider This:
- Americans consume more potato chips than any other people in the world.
- As a world food, potatoes are second in human consumption only to rice.
- U.S. potato chip manufacturers sell over 16 billion a year worldwide.
- Potato chips usually contain only potatoes, oil and salt.
- Fancier versions, including flavored chips, low-fat versions and multi-grain versions are amped up with chemicals galore. A sour cream and onion version has 20 ingredients including MSG, Palm oil, and artificial colorings.
- A single serving of potato chips contains only 150 calories, 10 grams of fat and 180mg of salt. That’s less than 10% of the daily calories of most people, about 15% of the fat, and 8% of sodium intake.
- Acrylamide, a potentially dangerous chemical, is produced when frying potatoes at high heat. There has been some hubub about acrylamide and cancer risk, but the National Center for Cancer Research says the following:
“French fries, potato chips, crackers, and other high-acrylamide foods are often high in calories and low in nutritional value. High consumption of these foods has been linked to increased cancer risk for reasons that have nothing to do with acrylamide. People who eat lots of these foods tend to crowd other foods off the plate (foods such as vegetables, fruits, beans and whole grains, which have been shown to provide protection against certain types of cancer). Eating a lot of fat and calories also contributes to obesity which can increase the risk for many cancers.”
Plan of Potato Attack
1. Simpler is better. Stick with original, unflavored chips. They have the fewest chemicals and additives.
2. Portion control! Try not to wolf down the entire bag of chips before dinner. Avoid buying the supersize bags at Costco unless you’ve got an iron will. Instead, purchase individual packages or separate that big bag into individual servings in Ziploc bags.
3. Low sodium chips are stupid. You’ll just eat more of them. Even if you’re on a low salt diet, a single serving of chips won’t be your undoing.
4. Don’t rely on chips for nutrition or sustenance. Substitute carrots or popcorn for that late afternoon crunch craving.
5. Get up and move! Don’t be a couch potato. If you’re craving chips, take a walk around the block and then dive in.
Forever Flatulent
July 4th, 2011
Human beings emit an average of 14 farts per day. Considering that most of mine occur while in a business meeting or on a dinner date, I began to wonder exactly what causes gas and how it can be prevented. Call me superficial, but this week I’ve chosen to enlighten my readers on the mysteries of intestinal emissions.
Gas occurs as a result of the breakdown of food products (usually carbohydrates). As food passes through the large intestine, hydrogen, carbon dioxide and methane are produced. The amount of food and trigger type for gas varies widely from person to person. It is also related to the natural bacterial balance in each person’s colon.
Causes of Gut Busting Gas
1. Lactose
Lactose is the main sugar in milk products. Adults are commonly deficient in the enzyme necessary to break down lactose, so when the sugar enters the colon, it is broken down into gas-forming elements. This causes cramping, diarrhea and gas.
2. Sorbitol
This is a natural sugar found in apples, pears, peaches and prunes. It is a sugar alcohol and is commonly used as an artificial sweetener in gum and candy.
3. Raffinose
Beans contain large amounts of this sugar, as do cabbage, brussel sprouts and broccoli. The resulting flatulence is the most odiferous around.
4. Fiber
Too much insoluble fiber (the kind found in supplements) causes gas. In order to make their food labels appear healthy, processed foods contain undigestible fiber and artificial sweeteners. That’s why a Fiber One bar is fart city.
Fart Fixers
1. Eliminate Dairy Products
Try this for two weeks. You may indeed be lactose intolerant. While technically not an allergy, this problem is life-long and can be quite a nuisance. You can either avoid lactose or take an enzyme supplement (Lactaid), at mealtime. For more information on lactose intolerance, check out http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001321/
2. Skip Sweeteners
Avoid sugar free gum and beverages (sorbitol, lactitol, maltitol, erythritol and xylitol, to name a few). Gum also causes you to swallow air; leading to belching and farting. Pretty soon, you’ll be sitting on the couch in a wife-beater tee and watching professional wrestling.
3. Probiotics
Available at every drugstore, these capsules contain millions of healthy bacteria. These bacteria reset the colon, promoting healthier digestion. Try them daily for 2-3 months and then stop.
4. Beano
IT REALLY WORKS! This over-the-counter supplement contains enzymes that help break down sugars. It must be taken with meals in order to prevent gas. Beano won’t relieve gas once it’s started or if it’s related to Lactose deficiency or fiber overload.
5. Gas-X
Once gas strikes, this is your only option. Simethicone, the active ingredient in Gas-X, is like soap. It enters the intestine, coating the gas with surfactant, and breaking it up into tiny bubbles. Theoretically, it should reduce bloating and gas. The truth is, it doesn’t work very well.
6. Add Fiber Gradually
Don’t decide to turn over a new leaf by eating 30 grams of fiber. You’ll be miserable (and so will your family). Your colon needs some time to get used to dietary fiber. Begin with 5 grams daily for the first week. As each week passes, increase your intake by 5 grams, until you reach a goal of 25-30 grams per day.
7. Charcoal
Believe it or not, the same stuff that makes your babyback ribs taste delicious can reduce your flatulence. Activated charcoal is available on the internet and in health food stores. Talk to your doctor before considering this; it has side effects and drug interactions.
Do your best to identify and avoid your flatulence-inducing foods. If you’re like me, the realization is always too late. Worst case scenario? Blame it on the dog.
Not So Smart Ones
June 20th, 2011
Ever wonder how food companies manage to cram “ziti pasta in a delicious marinara sauce topped with mozzarella, monterey jack and parmesan cheeses” into 320 calories or less? I have. Culinology is an emerging field which manages to meld the artistry of chefs with food science. Last Summer, I took a course at my local community college and was shocked to learn the tricks of the trade in this exploding market.
I’m realistic. Most people don’t scour the farmer’s market on Saturday for beets, roast them on Sunday, cool them, peel them, refrigerate them and toss them with a homemade citrus vinaigrette and goat cheese for Monday’s lunch. It’s far simpler to grab a Lean Cuisine.
Are these frozen meals a healthy option? Yes and no.
The Pros
1. Portion Control
The little black plastic tray forces you to limit your portion size (provided you only eat one meal!) These meals can serve as a wakeup call to all of us; we’re simply eating too much.
2. Convenience
Frozen meals are super-convenient. When you take them to work, make sure you keep them frozen until they’re microwaved. If they defrost in your car or cubicle, you’re risking bacterial contamination.
3. Cost Control
These suckers are cheap! Look for weekly sales at your grocery. Try budget brands and closeouts. The food manufacturers are constantly changing their packaging, so take advantage.
The Cons
1. Artificial Everything
The ingredient list on frozen meals is appalling. They’re loaded with trans fats, high fructose corn syrup, fillers and preservatives. These ingredients make them cheap, tasty and freezer-stable.
2. Plastic
I really, really worry about plastic. For more information, see my blog http://emilyfrankmd.com/plastic-plastic-everywhere/. Despite assurances from food manufacturers, I doubt the safety of the “microwaveable tray”. Everything we eat seems to touch plastic these days.
3. Sodium
Everyone knows that processed foods contain salt, but why is this? Salt is an inexpensive way for the food companies to provide flavor and it works as a preservative and binder. Sodium can masquerade on an ingredient list as baking soda, sodium bicarbonate, monosodium glutamate, sodium benzoate, sodium saccharin and sodium nitrate. How much is too much? If your blood pressure is normal, aim for about 2,000 mg of salt each day. That means that your frozen lunch should contain no more than 1/3 of this, about 700 mg.
Should You or Shouldn’t You?
An occasional frozen meal isn’t going to kill you. Let’s face facts: sometimes you need a quick lunch. A little penne with meatballs beats the Wendy’s Drive Thru any day. It’s a matter of picking your evils! Try to add a piece of fresh fruit or some carrot sticks to round things out. And, next Saturday, instead of nursing a hangover, head out to the farmer’s market to find some beets.
Food Label Frenzy
June 13th, 2011
What’s the most important information on a food label?
I’ve asked this questions hundreds of times. It’s my best material. And nobody ever gets the answer correct. It doesn’t matter how knowledgeable you are, you’re missing the boat. When I head down the grocery aisle, I see confused, uniformed shoppers searching for information. They select the prettiest package of cookies, flip it over to look at the label, pretend to understand what the hell it says, and throw it in the cart to join the rest of the processed slop.
Food labels were introduced in 1994 as part of the Nutrition Education Labeling Act. They are an attempt by the FDA to inform consumers in a clear, standardized way about the foods they eat. David Kessler, the director of the FDA at the time (and author of “The End of Overeating”), was prescient enough to know that the processed food industry would expand in the coming years. The food label now graces over 6.5 billion packaged foods.
SO, WHAT IS THE MOST IMPORTANT INFORMATION ON A FOOD LABEL?
SERVING SIZE
You must know the serving size to understand how much of the food you are supposed to eat. All of the remaining information depends on it. Many times I’ve wolfed down a half box of Cheez-Its, only to realize the serving size is ten measly crackers. That’s ridiculous!
Beyond serving size, how you read a food label is based upon your dietary preferences. I don’t want to inundate you with nitty-gritty. Life’s hard enough, so here’s how I break it down:
1. Ignore all adjectives on a package. Food companies use cute words to attract you to their products. Read only the nutrition label and the ingredients.
2. SERVING SIZE!
3. If you’re watching your weight, next, look at the calories.
4. I never care how much fat is in an item. Fat has 9 calories per gram. If a food is high in fat, it will be high in calories. I do, however look for items that are low in saturated fat (because these raise your cardiovascular risk). You should eat about 50 grams of fat per day and no more than 15 grams of saturated fat.
5. If a food label lists trans fats (like the one above), don’t buy the product. Trans fats are horrible. See my blog, http://emilyfrankmd.com/hydrogenated-fat-heart-attack/
6. I personally believe that % Recommended Daily Allowance (RDA) is bunk. These were established in the 1940’s at a time of famine and food rationing. Today, we are fighting an epidemic of obesity so nutritional deficiencies are practically unheard of. The vast majority of processed foods are chemically fortified with vitamins and minerals, basically amping up the processed crap so it looks nutritionally sound. I prefer to get my nutrients from Mother Nature.
7. Read the ingredients. They are listed in order of amount. The more things you can’t pronounce, the worse an item is for you.
8. I look at fiber content next. You need 25 grams of fiber daily. Try to get it from fruits and vegetables. If you’re eating breakfast bars and processed grains, know that the food manufacturer has beaten, whipped and morphed the ingredients into something palatable, taking away all nutritive value, subsequently adding fiber at the end to make it look healthier. In processed foods, aim for 2 grams of fiber for every 90 calories.
And finally, a general recommendation. Try to think like a marketing team. What are glamorous keywords? If a product boasts “New” or “Heart Healthy”, what does that really mean? Are you going to be a sucker or a savvy consumer?
At Yeast The Bread Was Good: Making Healthy Choices When Eating Out
June 5th, 2011
21 million American eat at a full-service restaurant every day. Since you’re likely to be one of them, it’s time to make better choices and face facts: the bread basket is nearly irresistible. Here’s the scene: you’re famished and sitting at your favorite trattoria. The waiter delivers a basket loaded with crusty, warm, fragrant rolls. The butter is soft and spreadable. The air is festive. At family dinners, my sisters and I would pounce. It was a mad rush to grab the best piece (middles), slather on the butter and salt it (!!!) liberally. Pretty soon we’d downed three pieces and blown an entire day’s worth of calories.
Sound familiar? Here are some tips on how to avoid this dietary downfall.
- Tell the waiter you don’t want bread. This requires an iron will and can “out” you to your buddies, but it’s by far the safest solution.
- Make up your mind to eat just one piece. Tear off small amounts at a time, savoring each one.
- Order soup right away. It is already prepared, waiting in a steaming crock, and will quell your hunger.
- Pay attention to olive oil. Does your bread really need to be slathered in fat? One tablespoon of olive oil contains 120 calories. And while small amounts are healthy, your bread sponge can sop up hundreds of hidden calories.
What happens if you’re at a sandwich shop? There’s a pretty good chance you will be soon, since Subway has 34,605 stores in 98 countries! They have twelve different types of bread; all with delicious, healthy sounding names like Honey Oat and Nine Grain Wheat. How do you decide which is best?
- Look it up! Nearly all chain restaurants have websites that disclose nutritional information. The best way to be informed is to get informed!
- In general, the more whole grain a bread contains, the higher the fat, sugar and calories. For example, the whole grain bread at Jimmy Johns has 350 calories compared with their white bread at 250. Don’t automatically select the whole-wheat option. You’re often better off ordering the white bread and loading up on vegetables for your fiber and vitamins.
- Avoid bagels and buns. Bigger isn’t better when it comes to sandwiches.
- Never, ever eat a wrap. You’ve been tricked into believing they’re healthier, but they contain the same number of calories as bread. Wraps usually are slathered with mayonnaise and sauce to make them edible and they simply don’t fill you up. Avoid!
- For more information on sandwiches, check out my recent blog http://emilyfrankmd.com/sandwatch-out/
Strive to make better choices; don’t sabotage yourself by eliminating bread entirely. You’ll just end up gobbling down a biggie bagel. Don’t beat yourself up! There’s always tomorrow.
Emily’s Video Debut
May 24th, 2011
Amy needs to make better choices at home for herself and for her family.
Click the link below to see how it unfolds!
http://link.backlight.tv/nutritiond/videos/inshape-indiana-amys-story-part-11.html
Bran New Ideas: Part One of Two Blogs About Bread
May 23rd, 2011
I don’t often take advice. Any advice. But when my husband advised me to blog about bread, I listened. He tells me he’s confused about bread. Should he? Shouldn’t he? How much? What kind? Oft maligned, this gooey, delicious dietary staple continues to be a hot topic.
Bread is an important part of a balanced diet. In the 1930’s the U.S. government began requiring that bakeries use fortified flour for their bread. It was enriched with Niacin and Folic Acid in an attempt to prevent nutritional deficiencies and birth defects. To this day, all the bread you buy in the grocery is fortified.
Never say never. The minute you’ve decided that bread is off limits, the little green gremlin in your brain starts nagging you to stop at Pizza Hut for breadsticks. Don’t exclude bread entirely. Learn healthy ways to incorporate it into your diet and exercise moderation.
In The Grocery
The bread aisle is a confusing place. Piled high with soft mounds of doughy goodness, I’m often overwhelmed by the deliciousness and selection. Loaves of bread are too big. Everyone in my family likes a different kind. We only use 3 hot dog buns and 3 hamburger buns, leaving 5 of each to sprout green mold on the counter each week. How does one buy bread that is economical, nutritious, tasty and appeals to everyone?
- Each slice of bread should contain 110 calories or less and at least two grams of fiber.
- The first ingredient should say “100 % Whole Wheat”. Nothing else is good enough. Manufacturers know that you are looking for healthy options and they’ll trick you with sayings like “Enriched”, “Organic”, “Stone-Ground”, “Unrefined” and “Unbleached”. These words are meaningless. If a bread package states “A good source of whole grain”, it means absolutely nothing.
- Ignore the banners and sayings on the front of the package and learn to read the nutrition label and ingredients yourself.
- Bread can be made with only three ingredients (flour, yeast and water). Look for breads with the shortest ingredient lists.
- Never buy bread that is sweetened with high fructose corn syrup. Most breads contain sweeteners such as Sucrose, Fructose or Dextrose. Look for it lower down in the ingredient list.
- Never buy bread with hydrogenated oil or partially hydrogenated oil.
The Life Expectancy of a Loaf
- Store-bought bread is chock-full of preservatives. It travels thousands of miles to your store shelves and is baked days to weeks before arriving in your kitchen. You can buy preservative-free bread, but expect it to spoil within two to three days.
- Bread freezes beautifully. Keep half the loaf out on the counter and store the rest! You must wrap the bread tightly, removing any air. Then, double bag it. It will retain all the nutrition and moisture if wrapped properly and will be good for about three months.
- Don’t store bread in the refrigerator. Your fridge is like a giant air conditioner. It will dry your bread out, rendering it inedible.
- Keep the heels on the loaf. Although we’re crust-averse in my house, I use the heel to keep the preferred interior pieces soft.
- Use crusty bread for croutons or french toast. Just like the mushy-banana-turned-quickbread, old loaves can be repurposed.
Half-Baked: Making Your Own
- Don’t be scared. Making bread is easy and it will make you look like a superstar.
- The smell of fresh-baked bread trumps any candle in the world.
- My favorite cookbook is Artisan Bread in 10 Minutes a Day. Check out their website at www.artisanbreadinfive.com
- Experiment with different flours and grains. You’ll find that homemade bread is far superior to anything you can buy.
Stay tuned for part two next week! At Yeast The Bread Was Good: Making Healthy Choices When Eating Out
