Wednesday, December 26, 2012

What's the Best Way to Lose Weight?

This a very common question--with so many diets, diet books, fad diets, diet pills and meal plans, how do you know what really works, or what may even be harmful? I've come up with a short list to help you determine if a diet will work long term for you. Check to see that it incorporates these 5 F's:

1) Food: Is there real food on this plan? Or do you have to make powdered shakes, heat frozen meals, or order supplements from a company? The closer the plan is to how you usually eat, the easier it will be for you to follow. Consider what will happen if you run out of pre-packaged meals or feel like munching on something instead of drinking your breakfast. Sometimes substituting a shake in place of a meal will work; but if you have to keep it up, will you be able to for long?

2) Flexibility: Ideally the diet plan will allow for some changes. If it's a set-in-stone, "this is what you must have for lunch on Tuesday" type of diet, think about what will happen if you have company, want to eat out, have lunch served to you at a business meeting, etc. Good weight-loss plans shouldn't be only black or white: You should be able to substitute a food item, switch off meals during the day and between days, and include some "free" foods if you need a snack. Weight Watcher's is a great example of a flexible plan: you get a certain number of points to use during the day and YOU choose what you eat and when.

3) Financials: How expensive is this plan to follow? If it's all organic or requires a certain brand of snack bar or pre-made meals, you could be in for some sticker shock. How long will you be able to afford this meal plan? There are lots of diet plans that don't require any expensive add-ons. 

4) Filling: Will you be satisfied, or starving? If a diet leaves you continually empty and miserable, chances are you won't be able to stay with it for long. Healthy diet plans incorporate lots of fiber-containing foods to assure your stomach isn't growling long before it's time to eat again. The DASH diet is a great example of a filling and healthy diet.

5) Forever: The best diet is one you'll be able to stay on forever, literally. If you learn to change your habits, eat a bit less and move a bit more, it will simple become your lifestyle; not something you go on and off repeatedly.
The Beck Diet Solution is a great example of how you can change the way you think to change the way you eat. Judith Beck has books and workbooks available to guide you day by day to make these changes. Join us for a group teleclass (that means you can live anywhere in the world and participate with us); find out more and register here. Grab a friend and join us now!

Thursday, December 20, 2012

How Accurate are Online Calorie Calculators?

I looked online for a calorie calculator today because I'm trying to figure out how many calories I should eat each day. How accurate are these online calculators? I am a 21 year old female, 5'6" tall and 118 pounds. The answer was 1800 calories a day, but I am full when eating just 1600 calories. Should I continue eating more even though I am full at 1600?  Thanks, Donna L.

Hi Donna,

Many of these calculators work on scientific formulas that can very closely estimate your calorie needs based on your height, weight, gender and age.
The 1800 calorie level is the estimated amount necessary to maintain your weight, but is also based on your activity level. If you are more active you may need even more calories to maintain your weight. If you consume fewer calories you are likely to lose weight. 

You have to play around with the numbers a bit, as everyone is different. 

If you find you cannot maintain your weight with what you are eating, there are a few ways you can do this. One is to get less exercise (not usually recommended!) and another is to try to get more calories in. If you need to eat more calories, but get full too soon, consider cutting back a bit on high fiber foods like raw vegetables and replace them in softer form (cooked vegetables, soups or juices); or consider adding calories in the form of beverages like milk or juice.
There are  commercial high-calorie beverages like Boost, Ensure, and Carnation Instant Breakfast drink that can add 200 or 300 calories a day to your intake, bringing your calorie level right to where you need it.

Friday, November 30, 2012

How Can I Eat Without Gaining Weight Over the Holidays?

I am 23 years old, 5'4" and 130 pounds. I have started eating healthier and exercising to lose a few pounds. I'm doing well now, but I'm concerned about my trip home for Christmas. My family cooks a lot of really delicious foods, including special holiday cookies. I want to be able to enjoy the meals with my family, but can I eat some of these treats without undoing the work I've already done?  Melissa G.

Hi Melissa,

Congratulations on your resolve to eat better through the holidays. One of the theories of obesity is not that people stuff themselves every day, but that they gain 1 or 2 pounds over each holiday/vacation, and never take it off! So you can really save yourself a lot of trouble in the future by watching what you eat now.

Have a plan: keeping a food diary is an excellent idea because it keeps you aware of what you are eating. There are many websites (like and that help you do this, and an app called LoseIt if you have a smart phone. You could also just get a tiny notebook that is easy to carry around (intake should be recorded within 15-20 minutes of eating, or people tend to forget what they nibbled).

What is a reasonable number of cookies for you to have each day? Would it help to save them until the end of the day? Would a set plan like, "I will only have one cookie at a time and I will sit at the table to eat each one slowly and savor it" help?

Consider in what ways you are likely to overeat and then write up a strategy for yourself. Rules like "I will only eat when I am hungry" or "I will only eat while sitting down" can be helpful.

It might also help you to have a "mantra" that you repeat to yourself often throughout the day that describes how you want to get through the time at home: for example, "Food is a small part of enjoying this time with my family. Having a taste of something will be even more satisfying than eating a big portion because I'll be happy with myself at the end of the day for making the right choices."

If you'd like, send me your plan and I'll give you some feedback so you'll be set in time for the holidays!

Sunday, October 28, 2012

What Can a Registered Dietitian (RD) Do For Me?

Here is a video from the Academy of Nutrition and Dietetics that shows how a dietitian can help you with all your nutrition needs, from sorting through all the confusing information on diets to helping you manage chronic diseases like diabetes.
Contact me and I'll help you find an RD in your area so you can get started on the journey to good health!

Wednesday, October 24, 2012

Cooking and Baking Measurements and Equivalents -- A Pictorial Tutorial

If you aren't a regular when it comes to food preparation, the amounts and measurements can be quite confusing. But it's important to know how many teaspoons are in a tablespoon if you've lost your cough-medicine measuring cup (!) or when you're trying to cut a recipe in half.

So here are some common household measurement and their equivalents:

3 Teaspoons = 1 Tablespoon
There are 3 teaspoons in 1 tablespoon. This is true for liquid measures as well as powders, such as sugar, salt, flour and herbs and spices like parsley or cinnamon.

It's also helpful to know that teaspoon is commonly abbreviated as tsp or just a small "t" while tablespoon is often indicated by Tbsp or a capital "T".

One quarter cup has 4 T. If you wanted to cut a recipe in half and it called for 1/4 cup of brown sugar, you could measure 2T and it would be equivalent to half of the 1/4 cup (1/8 c measuring cups are not common and 2T will do just fine!)

Liquid items are most often measured in ounces. One cup of fluid is usually 8 ounces (measured by volume and not by weight. In other words, don't try weighing 8 ounces on a kitchen scale, just use the lines on the measuring cups. That's what they're there for!)

Okay, so we have 8 ounces in one cup. This means 1/2 cup is 4 ounces and 1/4 cup is 2 ounces.
Simple, right? Here's another good measure to know: There are 2 Tablespoons in one ounce (and, remember, 2 Tablespoons in 1/8 cup. You can figure out there is one ounce in 1/8 cup since there are 8 ounces in a cup).

This conversion is helpful when you try reducing recipes to make half a batch of, say a pasta salad with dressing. If the recipe serves 8 and you want to make a batch with just 4 servings, you will want to halve the 1/4 cup of red-wine vinegar it calls for. Since many measuring cups do not have a 1/8 cup indicator (which is actually one ounce), knowing that 1/4 cup equals 2 ounces (and therefore 4 Tablespoons) your best bet would be to measure 2 Tablespoons of vinegar, instead of trying to guess what 1 ounce is with a standard 8-ounce measuring cup.

Ditto with the medicines that may call for 1/2-ounce dose for your child (which might be the green line on the plastic measuring cap, but what if you lost it?) Now you know one tablespoon will be the right amount to cure that headache without worrying about overdosing.

What about pints and quarts? Sometimes a recipe calls for a pint of buttermilk. How do you measure this when you have a rather large container of milk?
One pint = 2 cups  just measure 2 cups of the milk and you have your pint!

You should also know that 2 pints = 1 Quart

This means one quart = 4 cups

Pictured here is a 4-cup measuring cup, which is 32-ounces and is also equivalent to 2 pints as well as 1 quart. If you don't remember all that, look at the label where it tells you how many ounces are in the container.

You can clearly see that 32 ounces of juice are in this carton and that is the same as one quart (indicated on the label as 1QT). Sometimes pint is abbreviated as PT.

The milliliters (946 ml on this label) aren't used often in the US since that's part of the metric system. If you happen to find a recipe from the UK it will be helpful to know that 1 liter (they spell it litre over there!) is nearly the same as our quart.

This photo on the left shows the relationship of 2 quarts to one-half gallon. You know there is a quart in the Vruit juice container (from the label close-up shown above) and there is a quart of water in the 4-cup measuring cup. Together they make 8 cups--also measured as 4 pints, or 2 quarts, or one half-gallon. If you look closely to a half-gallon label on a container of milk or juice it will often say "64 ounces".
To the right is a photo of one gallon of milk on the right side of the equation, and one gallon of assorted other fluids on the left. Let's add them up:
- one quart of water
- one quart of Vruit juice
- two quarts (one half-gallon) of cranberry juice
A total of 4 quarts.

4 quarts = 1 gallon

A helpful way to remember there are 4 quarts in a gallon is that there are 4 quarters in a dollar. The term "quart" indicates that it is a "quarter" of the whole gallon.

Remember to look on the label for helpful reminders. Here is a close-up of the milk label showing that one serving is 1 cup. On the next line you'll note how many servings are in the entire container, "about 16". So you can calculate that there are 16 cups in a gallon. It might be easier to do this in steps:

One gallon contains 4 quarts
One quart contains 4 cups
4 x 4 = 16  
That's it! 16 cups in a gallon.

Monday, September 17, 2012

How Many Grams in a Teaspoon of Sugar?

I'm trying to read labels to help me choose the best foods for me and my family. I have an idea of how many grams of protein and grams of fat to aim for in a day. But I want some more understanding of grams of sugar. I take it we don't actually need to have any sugar in a day (since we can get energy calories from complex carbs, starches, etc). But, is there a recommendation for a healthy number of grams? And just so I know, how many teaspoons of sugar are in, say, a 20 oz. bottle of soda that states 67 gm sugar on the label?
Julie M.

Hi Julie,
You may have seen the recent research showing that women who read food labels tend to weigh less, so you know it can't hurt to be observant. Good for you for taking the extra steps to feed you and your family the best choices.

You're right about us not needing any sugar, per say, in our diet. But I wouldn't encourage people to aim for zero grams of sugar in a day. For starters, there is naturally occurring sugar in milk, fruit and fruit juices. Avoiding these products will eliminate some foods that are good sources of some major nutrients.

If you're talking about added sugars, a limit is probably a good idea. That range, however, depends on all sorts of things, like your daily calorie intake, whether or not you are trying to lose weight (or possibly gain weight), and how healthy your diet is in general.
For an average adult who takes in 2000 calories a day, I think 20-50 grams is a good ballpark figure. This includes sugars found in baked goods, desserts, breakfast cereals, and added sweets like honey, jam, and sugar used in beverages.

Regarding grams per teaspoon, there are about 4 grams of table sugar in a teaspoon (this provides about 16 calories). So a bottle of soda with 67 grams has the equivalent of close to 17 teaspoons of sugar--a number that should make you take a pause before drinking another one of those!

Sunday, September 16, 2012

Trying to Lose 20 pounds (I blame my husband!)

Hi Laurie,
I was at my best weight 6 years ago when I got married. After 2 years, eating to keep up with my husband (big mistake!) I gained 20 pounds. It's been very hard to take the weight off. I'm 28 years old, 5'5" and 150 pounds. I actually lost 5 pounds over the past year walking 3 miles a day and keeping my calorie intake to 1600-1700 a day. I do have a drink or two (alcoholic) a day, but I include that in my calorie intake. I had a good report at my check-up last month and my weight isn't at a very unhealthy point, but I would feel a lot better to get back to 125#. Any advice?    Tina R.

Hi Tina,

Well, you are in the same boat as a whole lot of people. 
The fact that you've lost 5 pounds over the past year is quite good news! Keep it up, and you'll be at your goal in another 5. I'm sure you want to lose more quickly than that, but in order to lose faster you'll have to make some changes.

1) Seriously consider cutting out the alcoholic beverages, or limiting as much as you can (a drink or two a week?) Each drink has at least 100 calories (and some can have 300 or 400 depending on the size and ingredients).  For every 100 calories you cut out of your diet (and by cutting out these drinks you are making no nutritional compromises) you can lose a pound each month. Cut out 200 a day, lose 2 pounds a month. The question you'll have to answer each day is, "Do you want a drink to make you happy for an hour? Or would you rather weigh 125 pounds and be happier 24/7?"

2) Consider walking farther or faster. Or finding some additional exercise. Can you join a gym and try out some fun classes? Zumba, spinning, step and kettle bells all have their fanatic followers. If a gym is not in your budget you can find a DVD and work out at home very inexpensively.

3) Keep a food diary. Write down everything you eat, shortly after you eat (or drink). We often forget a few hundred extra calories here and there. Some great websites to help you do this are FitDay, SparkPeople, and LoseIt (which also has a phone app). Enter your food intake and these programs track your daily calories, subtract from the total when you enter exercise, graph your weight loss, and let you buddy up and chat with others going through the same thing.

4) Think about joining my Lifechanging! Weight Loss series starting late 2012). We meet by telephone (think virtual conference room) and follow along with the Beck Diet Solution workbook for 8 weeks. Here's the registration and information page .

Do some serious thinking on this: You'll have to make a commitment to make some changes (even slight ones) if you want to see changes on the scale.

Saturday, September 15, 2012

How Can I Burn 300 Calories?

My question is How can I burn 300 calories fast? What is the best method to burn 300 calories so people can still eat cake, but not gain weight. What exercise is most effective for burning calories? What can you do to speed up your metabolism?  Alyse E.

Hi Alyse,

This cool site lets you enter your own weight to calculate calories burned in various activities.
The more you weigh, the more calories you burn; it takes energy to move more mass.

If you run or walk about 3 miles you'll burn close to 300 calories. Walk a 20-minute mile and it will take an hour; run a 10-minute mile and burn 300 calories in 30 minutes.

One good workout is circuit weight training. You burn calories working out, then burn more even when you aren't exercising since you'll be building up muscle mass. Muscle burns more calories than fat, so keeping fit means you'll burn more calories than a person of the same weight with less muscle, regardless of whether you are exercising.

PS You could also try having a smaller piece of cake ;)

Thursday, September 13, 2012

Binge Eating Help!

Hi, Laurie!  I'm 32, 5'4, and 172 lbs.  I'd like to lose a minimum of 30 lbs to get to a healthy weight.  I walk 5 miles a day Monday-Friday and am slowly losing weight.  However, I can't stop binge eating.  I eat a sensible breakfast in the morning and then 20 minutes later, I eat again.  I consume 1,000+ calories and then feel guilty and full all day until dinner.  I feel like I'm sabotaging myself.  I've tried to stop, think, drink water, but I still just can't stop eating!   I feel like I'm stuck on a binge/starve/guilt cycle!  Any advice?   Sheila R.

Dear Sheila,

First of all, congratulations on taking the steps towards a healthier lifestyle that will get you to a healthier weight. Keeping up with the walking is a big commitment and you should be proud!

Now, regarding the binge eating: I could ask you all sorts of questions about that behavior:
- Have you had a major life change recently?
- Is this binge eating brand new for you?
- Are you getting enough sleep?

But all good intentions aside, the way you've described what's going on sounds characteristic of disordered eating. I don't want to alarm you, and I certainly cannot diagnose an eating disorder. 

My guess is, though, that your mind is so crowded with "what can I eat/when can I eat/I shouldn't have that/I can't resist it/ I shouldn't have eaten that/ I feel so awful/ I've failed today/ I'll start again tomorrow" that you aren't able to experience your life and all the pleasures you should be able to enjoy.

If that sounds familiar, rest assured, you are not alone! The National Eating Disorders Association estimates millions of Americans suffer from some type of eating disorder, including binge eating disorder.

The good news is there are kind and understanding counselors who deal specifically with eating disorders (including anorexia, bulimia, orthorexia, and binge eating disorder--also called BED). Counselors who treat people suffering with obsessive thoughts about food, eating, and diet really know what you are going through and can help.

The experts at NEDA can help you find someone in your area who can address this behavior and help you get back to a normal and happy life! Click on the NEDA link above and call to get started right now.
And do write back to let me know how you are doing.

Friday, September 7, 2012

Can You Live on a Liquid Diet?

My question is, can someone live their whole life on a liquid diet?
Amanda K.

Yes, Amanda, it is quite possible and many people require liquid diets for periods of time that may span the rest of their life.
I have provided prescribed liquid diets to patients with a broken jaw, for example, who are not going to be able to chew for several weeks. But the diet must include a variety of foods to meet nutritional needs, paying close attention to calorie needs. Merely drinking beverages instead of eating food may result in a diet that is not balanced; for instance, if you drink mostly soda (which has no nutritional value). Even if you drink milk and juice--healthy beverages-- the diet must still be carefully planned to include a balance of essential nutrients.

Many people live on liquid diets because of certain conditions. Examples include diseases that prevent safe swallowing, such as throat cancer or some strokes; a complication of diabetes called gastroparesis which prevents the stomach from emptying normally; people who are respirator dependent in some cases; and those who are in a coma. Formulas like Ensure and Boost (which can be found at your local grocery or drug store) are provided in amounts to meet 100% of the daily requirements for the nutrients we know are essential; even fiber is provided in some formulas. And many formulas are adapted for other conditions the person may have, such as diabetes, kidney failure, or high protein needs.

The bottom line is, a nutritious and well-balanced diet can be provided in liquid form and someone can live with that for many years. Just drinking whatever you feel like, however, can easily lead to lack of essential 

Tuesday, September 4, 2012

Are Artificial Vitamins Harmful to Me or My Children?

I was recently researching whether or not 1% fat or skim milk is a healthier alternative compared to whole milk. I read that since all the fat is stripped away, the vitamins have to be "replaced" by synthetic ones and in time, could actually harm the body more than the high-fat whole milk. 

There is SO many different answers/information online that I just do not know what to believe, although I DO want to eat and drink what is best for me. (and my 3 children) Any of your educational input would be GREAT!
Christina P.

Hi Christina,

Low-fat or fat-free milk is better than whole milk for some people because it is lower in fat and cholesterol. If your children are young and active, whole milk may still be appropriate for them.

Vitamins A and D are fat-soluble so the vitamins naturally present in milk are in the fat; therefore, fat-free milk has only trace amounts of vitamin A, and no Vitamin D.

It's quite difficult to find milk that is not fortified with these vitamins; particularly vitamin D. In the first half of the 20th century, when rickets--the deficiency disease of vitamin D--was found rampant, especially in areas of the country where children rarely had exposure to the sun, healthcare providers recommended supplementing milk with vitamin D, since that was a food consumed by almost every child. It was a good way to assure most of the children in the US would get the vitamin D they needed, and the incidence of rickets has been quite low ever since.

There are brands of milk that do not fortify with vitamins and you are more likely to find these in health food stores or organic aisles. But I don't know of any harm that would come to humans from consuming added vitamins as opposed to those naturally found in foods (other than toxicity from excess ingestion). The chemical composition of vitamins in pill form is identical to vitamins occurring in nature.

When you're looking for accurate information, look for agencies that have no obvious conflict of interest (eg, the dairy council will certainly tell you how great milk is, while PETA will have a host of reasons why milk/meat is not healthy). Look to the NIH (National Institute of Health), FDA, USDA (including, the American Heart Association, American Cancer Society, MedlinePlus, or CDC (Centers for Disease Control). 

Monday, September 3, 2012

Can Spray Butter Help Me Lose Weight?

Hi, I was wondering about these spray butters... is there something in them that helps you lose weight? How much would I have to use to start seeing results? And the same question for spray salad dressings also.
Raymond F.

Hello Raymond,
The spray form of butter and salad dressing save calories not just by changing their formula, but by changing their method of application. You end up using less since the spray can cover more area using less of the fat.

A couple of examples:
Salad Dressings
-Wishbone spritzers variety salad dressings provide 15 calories in 10 sprays. That is enough to wet a good portion of a small salad. Even if you usually pour a "light" raspberry vinaigrette over your salad, that's 80 calories in two tablespoons. This is what they call a serving, but try measuring two tablespoons some time, then put it on your salad. Does this cover enough lettuce, tomato, and cucumber for you to be satisfied? If not, you might be using two, three, or even more 'servings' when you dress your salad! If you use regular dressing, something like Creamy Caesar dressing contains 170 calories in the same two tablespoons: Measure how much you use on your next salad to figure out how many calories you'll be saving by switching to the spray method.
You don't have to buy this particular brand. You could actually use any light dressing, put it in a spray bottle and use less dressing.

Butters and Spreads 
-On your toast, corn cob, or in a fry pan, a tablespoon of regular stick butter provides 100 calories. Spreads that come in a squeeze bottle (the more liquid, the lower in saturated fat) provide about 60 calories per tablespoon. Whipped butter comes in lower at only 50 calories per tablespoon. But the lowest of all is the "I can't believe it's not butter" spray with less than one calorie in five sprays. Now, it may take you 20 or 30 sprays to cover your entire bagel in the morning, but that's still fewer than 10 calories.

Imagine how many calories you consume by covering your food with fats like butter and salad dressing; think about how many you can save by switching to the sprays.

Wednesday, August 29, 2012

I Need Some Good and Healthy Snack Ideas.

Hi Laurie,
Now that it's back to school for the kids (and back to work for lots of us, too) I find myself getting frustrated trying to plan healthy snacks for the whole family. I like to keep some in my desk at work, send my husband to his job with something healthy to tide him over, and have things at home for the kids (10, 12 and 15) that are at least somewhat good for us and not too many calories.
I know fruit is a good idea, but that does get boring after a while. And it seems like fruit or 100-calorie snack bags are not enough to last until dinner at 6:30 pm lots of times.
Are there any snacks that are good for you and filling?
Thanks, Brenda R.

Hi Brenda,
Snacks are definitely a fact of life! While snacking too frequently or on foods too high in fat and calories is not helpful, many people depend on snacks to supplement calories, protein and nutrients in their diet that they might not get during their three daily meals. What the best snack is for you and your family members depends largely on what else they eat during the day, as well as how active they are.

For active young people, snacks can supply necessary nutrients for growth and activities.

For the person who has a physically demanding job (or workout) snacks can (and should) be higher in calories.
And for the sedentary worker or dieter trying to lose weight, snacks can provide fiber, vitamins and minerals in few calories, while tiding you over until the next meal.

Here are some considerations to guide better choices for each individual:

1) Do you want a high-calorie (more than 200) or low-calorie (less than 200) choice? For high-calorie choices think more along the line of a mini-meal than a fattening treat: A peanut butter sandwich and a glass of milk, for example, provides as many calories as a cinnamon roll, but with a lot more nutrition. Think about protein foods to get more calories at the same time as more nutrition: cheese and crackers, deviled eggs, nuts, even prepared items--like protein bars or Carnation Instant Breakfast--can help meet daily protein needs and tide you over until dinner time. Low-calorie snacks can still supply protein, but think lower fat and carb: a turkey wrap, cottage cheese and fruit, or a granola bar can be filling snacks without additional empty calories.

2) Do you want to eat it fast or take your time nibbling? If your purpose is to get some nutrition in before heading to the gym, you don't want to fill up or eat a very high-fiber snack. Some of the protein bars are ideal for this purpose. If you are fighting boredom, eating at your desk (which is basically not a good idea!), and trying not to consume too many calories, consider a snack of carrot sticks or celery for plenty of munching: Add hummus or salsa--both low in calories--for texture and flavor. A cup of dry cereal can also satisfy the munchies without too many calories and often with a healthy dose of vitamins. Don't forget about beverages! Sometimes we think we crave food when we are actually experiencing thirst. If you worry about diet soda or other artificially sweetened beverages, find alternative ways to flavor water, like with a splash of fruit juice or a flavored tea bag. Skip the regular soda and sweetened tea at all costs--they are purely empty calories!

3) What nutrients are you missing during the rest of your day? Snacks can be a good time to get in a serving of calcium, fiber, vitamins and minerals. Think low-fat yogurt, a high-fiber cereal with fat-free milk, fresh fruits and veggies, low-fat cheeses (like babybel) or nuts. 

4) Do you have room for 'treats' in your diet? Guidelines suggest no more than 10% of your calories should come from "treat" foods. This means 200 calories of "junk food" are alloted for a 2000 calorie diet, which is one serving a day, tops! Cookies and chips are alright some of the time, but use common sense for these extras: Keep calories low with low-fat muffins, baked chips, and pre-portioned servings (either 100-calorie snack bags, or snacks you portion out at home ahead of time to prevent over-indulging). If you're planning on a glass of wine or dessert after dinner, go with something nutrient-dense and low-calorie in the afternoon. You'll be glad you did the next time you step on the scale!

For a lot more information about snacks, including a list of 50 ideas, view the "smart snacking" ebook (in the Choose to Lose section) on my products page. Choose any other product and get the Smart Snack e book for free through September 30, 2012!

Tuesday, August 28, 2012

The Doctor Won't Order Intravenous Nutrition

Hello, I have a concern I hope you can help me with. My mother, who has always been in good health, is now in her 80s and has started to have her health fail. She is in the hospital for work-up, finally, but suffers from a very poor appetite and weight loss. It seems she won't be able to fight whatever is wrong without building up her strength. We have asked the doctor to start intravenous nutrition (they call it TPN) but he refuses. He says he can have a tube put into her stomach to feed her, but we feel this is quite invasive. What do you make of the situation?
Kevin T.

Hello Kevin,

I'm sorry to hear your mother is ill. I have seen cases just like this over the many years I've worked in hospitals as a clinical dietitian to help patients become as well-nourished as possible. Your doctor is, in my opinion, giving you the best and safest option. 

While a tube into the stomach may seem invasive (whether it is threaded through the nose, or through a small opening made in the skin near the stomach), it maintains the body's usual form of receiving nutrition. Nutrients go directly into the digestive system. There are very few risks with these tubes. Perhaps the most serious is aspiration, where the formula can regurgitate and end up going into the lungs. (This happens most often in unresponsive patients who cannot sit up and may not have their normal swallow reflex).

Intravenous (or Total Parenteral Nutrition) feeding consists of making an opening into a large vein and delivering concentrated sources of nutrients that do not require digestion. The side effects of this procedure are numerous: Complications during the surgery can be serious; once the line is in place it's an opportunity for infection, and bacteria entering into the blood stream has quite severe consequences; nutrient delivery does not go through the usual route and causes some abnormalities in liver function; high blood sugars are common, and triglycerides can rise in the blood to potentially hazardous levels; over-feeding can occur and it can be difficult to maintain normal mineral and electrolyte levels while on TPN. And finally, not using the gastrointestinal tract leads to atrophy of the cells in the intestine, which are actually an important part of the body's immune system.
The only reason TPN should be used is when the GI tract cannot be used (severe vomiting or diarrhea, blockage, or removal of part of the intestine prohibiting feeding into the gut).

In cases such as your mothers, the dietitian should be called in to consult, and steps taken to work from least to most invasive. First, your mother should be offered foods she likes; secondly she should be offered snacks or smaller meals so she has more chance of taking in enough nutrition if her appetite is small; third is the offering of nutritional supplements like Ensure or Boost, which can provide hundreds of calories with mere sips of the drink taken all day long; another option is prescription appetite stimulants which work very well in some patient populations. Finally, once the source of her illness is discovered, working to treat that may cause her appetite to return.

Tube feedings are one of the last options (largely because the patient is not often willing to have one placed) but are an extremely important weapon in combating malnutrition. Low body weight, low blood protein levels, and minimal nutritional intake may call for this intervention. And better sooner than later.
TPN is THE last option and should not be considered unless there are no other options to nourish your mother, or any other patient.

I hope your mother feels better soon. If you don't see her poor intake being aggressively addressed, ask for the dietitian to be consulted and keep in touch with her about your mother's plan of care.

Friday, August 24, 2012

My Personal Trainer Recommends a High Protein Diet; What Do You Think?

I recently purchased an online program with a trainer guiding me for 12 weeks. I just wanted to get the independent opinion of a dietitian on the diet I am following and the results I'm looking to achieve. 
A bit about me: I am 34 years old, 5'6" and 112#. I have lost 5 pounds so far on this program in 4 weeks. I do 45 min of cardio 3 x a week, 35 min of interval cardio 3 x a week, and 45 min of weights followed by 20 min of cardio  3 x a week.
I eat 1200-1500 calories a day divided as follows: 125 gm protein, 50 gm carbs, 35 gm fat.
My goal is to get my body fat from 18 percent down to 14 percent. I want to be toned and not just thin.
Does this sound like a good plan to you?
Thanks, Renee L.

Hi Renee,

To be honest, there are a few things I find concerning about your program:

1 - You were already a bit below "ideal" body weight for your height, and at the low end of "average" body fat for women as well.  I think it's fine to prefer a toned physique, but I'm not sure why your trainer has advised a weight-loss regimen (or gone along with your request for one).

2 - You don't mention whether or not you're an athlete. I might assume you are, based on the amount of exercise you're doing and also based on your initial weight. It sounds like you're probably exercising every day, and more than one time a day on some days (since there are 9 periods of exercise in the program). It sounds a little much for a typical woman's schedule (keeping in mind I deal mostly with overweight people who rarely exercise--but still it seems more than usual to me). 
I wonder if there is any preoccupation on your part with exercise and weight loss or some elements of an eating disorder or body image disorder involved. I don't mean to be an alarmist, but I'd like you to ask yourself: Do you focus on your body, your weight, your diet and your exercise to an extent you feel is excessive? To the exclusion of other activities? (Would you skip a friend's bridal shower or turn down an invitation to go to a vacation destination because it would mean missing work-outs and having to deal with 'forbidden' food offerings?)

3 - The macronutrient breakdown you've shown me adds up to just over 1000 calories; not anywhere near 1200-1500.  These and other details bring me to my most important question:

4 - What kind of licensure, certification or training does this person have who you've hired? There is a reason for laws against people without proper training and licensing practicing nutrition. It's because there are cases in which it can truly be harmful to follow certain regimens. For example, you are consuming more than 1 gram of protein per pound body weight. In people with kidney failure the protein intake must be limited to about 1/3 of this level. 
If you were my client I, as a registered dietitian, would have conducted a thorough medical interview before working with you. Did this person ask you any medical questions or ask to see any of your blood work from a family physician? Did they inquire as to your weight history, medical history or any medications you are taking? (If a person with diabetes suddenly dropped their carbohydrate intake to a level like you are following they could go into insulin shock  from their usual insulin dose and this can be fatal).

Chances are you aren't going to suffer any long-term ill effects from this regimen. But you are right to question the validity and sensibility of the program. I would question the person giving you advice to put my mind at ease about the regimen that has been suggested for you.

Tuesday, August 14, 2012

Recipe Makeovers: How Can I Modify Recipes to Make Them More Healthy?

I am a 31-year old mother of 4, trying to eat more healthy, for myself and also to prepare more healthy meals for my family. I have recipes my family loves and that have been in the family for generations. How can I adjust them to be more healthy?   Linda C.

Hi Linda,

This is a great question, and I'm sure many people are wondering if they can still use those old recipes. It seems people back then didn't pay any attention to lard or sugar content!

To lower fat content in entree recipes: Many recipes calling for cream or whole milk can be adjusted by using low-fat or fat-free (skim) milk. If you need the consistency to be thicker, like with a sauce, consider using a bit of flour (start with a small amount and stir it quickly and constantly over heat, mixing with the other ingredients) or cornstarch. You may use pureed vegetables, too, depending on the dish--adding pureed tomato to a creamy pasta sauce, for example, might just be an improvement on the recipe!

For casseroles that call for cream soup, just reach over to the next row for the "light" soups that are reduced in sodium and/or fat. My pantry is always stocked with low-fat cream of chicken and cream of mushroom soups for those creamy casseroles that go over so well on a cold winter day.

To lower fat content in baked goods: Lots of desserts call for sticks of butter or cups of crisco. You can cut down the fat content by using a lower fat product, or less of the full-fat ingredient. Some light butters are great substitutes for butter sticks, but read the label first--some indicate they are not appropriate for cooking.
I think you can always skimp and cut up to 1/4 of the fat out, but if you're going to cut out more than that, you'll need to replace with another ingredient to keep the final texture pleasant.
For waffles I have substituted yogurt for the oil, and you can use either plain or flavored--the flavored yogurt lends its fruity taste to the waffle and keeps it moist.
For quickbreads and cookies I'll cut the fat in half and replace the missing half with applesauce, vanilla or lemon yogurt, or light sour cream. You'll need to experiment, and be sure to make notes on your recipe card so you can remember what you tried and what worked!
For cake mixes I love the idea which someone told me came from their Weight-Watchers group: Instead of adding egg and oil as directed, just pour in one can of soda! That's all--just a can of diet or regular soda, and you're taking about 100 calories off each serving of cake. The texture is a little more like sponge-cake and some people will notice the difference (like my husband did) but I think it tastes just great!

To lower sugar content in baked goods, in my opinion you can automatically cut the added sugar by at least 1/4 or 1/3 without noticing. I just baked a peach crisp this weekend and left off not just the 1/2-to-1-cup of sugar they suggested pouring over the peaches (I sprinkled 2 tsp over the top--and that's just because I also mixed some cherries in and they were tart), but cut the cup of brown sugar to mix into the crumb part by 1/3 as well. It still tastes fabulous, as any fruit-containing dessert will!
Sometimes I replace 1/2 the fat with applesauce when making gingerbread, banana bread, etc, and in this case you are getting the sweetening power of the applesauce so again you can cut down on the sugar by 1/3 to 1/2.
Fans of artificial sweeteners use them in place of sugar. I'm not a fan of the taste, so I can't speak to personal experience with this substitution, but I understand it works well for many bakers.

Let me know if you have a particular recipe in mind and I'll make suggestions for replacements!
And feel free to post other tips on reducing fat and sugar in cooking and baking below so we can all try them out :)

Monday, August 6, 2012

Why Six Meals a Day?

First I would like to point out that your blogs are some of the most helpful tools I've found during my weight loss process, so thank you. I'm 21 years old, use to be a heavy smoker and about 170lb. I'm currently 125lb no longer a smoker however my question (s) for you guides more towards changing into a more fitness life style. I'm aware I have to start eating 6 meals a day and add a before working shake and an after work out shake, however I'm just not sure how much I should be eating, and what I should be eating? Supplements? if you could reply and maybe help me out i would be extremely grateful.  I will be continuing to read your blogs :) thank you again.  Olivia C.

Hi Olivia, 
Congratulations on your weight loss! I'm so glad my writing was of help to you.

As to your question: I'm not sure what your goals are: for what reason would you change to eating 6 meals a day in addition to shakes? These are eating habits we may see for a body builder who is trying to bulk up, and needs to eat a lot of calories.
How were you eating when you lost nearly 50 pounds? If it was a healthy diet, you may want to just continue with a similar plan.

If you are working out heavily and no longer desire to lose weight, a supplement/shake might work for you to get in some additional calories and protein. Something like Carnation Instant Breakfast drink is fine (calories, protein, taste, and affordability) if you don't have the appetite to eat more. Personally, I would rather eat 250 calories than drink them or get them in a small protein bar! 

When eating 6 meals a day, they will have to be small ones, or you will gain back the weight you worked so hard to lose! Consider three meals and two snacks, perhaps. A snack containing from protein (egg, peanut butter, cheese, yogurt) and some complex carbs (crackers, cereal, whole grain bread) is a good starting place.

Sites like,, and help you calculate your energy (calorie) needs based on your height, weight, goal weight, and activity level.

I wish you continued success in your healthy lifestyle!


Sunday, August 5, 2012

How Long Can You Live on 700 Calories?

If someone had an eating disorder. Say a female, 5'5 and 18 years old. How long could they live on 700 calories a day ? If they didn't do extreme exercises. And started out at a normal weight of 125. How long before they died ?  Mindy D.

Hi Mindy,

I sincerely hope you aren't asking this because you are suffering from an eating disorder yourself.
People with eating disorders can live for quite a number of years. The body has a lot of defense mechanisms. Theoretically, a person's metabolism will slow and get used to the 700 calories that are available each day. Weight loss will slow, and maybe even stop when the woman gets under 100 pounds.

The issue equally important is that when eating 700 calories it's not possible to get all the nutrients needed. Without enough protein, the vital organs will eventually shrink in size and capacity. Often, death results from heart failure or kidney failure since the shriveled organs are no longer able to carry out their essential functions. The studies we've seen on this came from starving Jews in the Warsaw ghetto in the second world war (Publicized years later when one of the doctor's wife found the notes, the findings were published as "The Hunger Disease"). The enemy prevented food from getting into the city, and people gradually starved to death. Research was conducted by the doctors living there, such as weighing the organs at the time of death and realizing how small the hearts had become in the bodies of the dead.

Others, like Karen Carpenter (a famous singer in the 1970s), died of a heart attack thought to be caused by a deficiency of potassium (possibly from laxative abuse). Without essential electrolytes in the blood--which come from minerals in the diet--there is danger of halting neurotransmissions, one of which is the signal to the heart to beat.

Along the way, undesirable symptoms arise from other vitamin and mineral deficiencies--rashes, thinning hair, brittle nails, weak bones, anemia, and other conditions that keep life unpleasant to say the least.

It's a terrible, drawn out way to die.
If you are looking for help for yourself or for a friend I would gladly help you get in touch with professionals in your area who can provide the necessary support.


Saturday, August 4, 2012

What's A Good Snack?

Hi, I have a question about snacking between meals. How do I know what a good snack is? Is it okay to have something like popcorn, or should I always have something healthy like an apple? Thanks! Kara J.

Hi Kara,
What you choose for a snack depends on your dietary goals: Are you on a daily calorie limitation to maintain or lose weight? Are you trying to gain weight? What else are you eating during the day?

A snack can add nutrition and balance to your daily dietary intake. It can also throw a healthy diet out of whack by adding too much fat, sugar and calories.

When I think of a healthy snack, I think of one that will provide some good source of nutrition. Fruits and vegetables are usually low in calories and high in vitamins, minerals and fiber. So they are usually a good choice, but often not what we crave.

On the opposite end of the spectrum are cookies, chips and ice cream: Lots of calories but not a lot of nutrition.

Some guidelines: 
(1) Look for a snack under 200 calories, unless you are trying to gain weight. 
(2) Look for a concentrated source of at least one nutrient.
Examples would be a carton of low-fat yogurt (meets calorie guidelines and provides protein and calcium); a granola bar (B-vitamins, often some fiber, and under 200 calories); cheese or peanut butter and crackers; a bowl of oatmeal; 1/2 sandwich with egg, tuna or turkey; non-fat latte (more milk with calcium and protein).

If you're really craving something sweet or salty that's not a particularly nutritious food, stick to small portions. The 100-calorie snack bags are great for this purpose, as well as portioned ice-cream treats. 

For a lot more on healthy snacks check out my e-book "Choosing Smart Snacks" from the "Choose to Lose" e-book series here .

Six Tips to Keep from Going Hungry on Your Diet

I am a 32 year old woman, trying very hard to get back in shape and lose weight. I am following a 1400 calorie diet and hope to lose 45 pounds by the new year. The problem is I am constantly hungry. Sometimes I give in to the hunger and ruin my calorie limit for the day. Even if I don't, it's always on my mind and very hard to live like this. Is there some way to combat the hunger so I can stick with this weight-loss plan for the next 6 months? Will my body eventually get used to this calorie level so my life can go back to normal?  Thanks, Winnie K.

Hi Winnie,
I have a few tips that may help you: Try them all out and see what works best for you. 

1. Be sure to eat all the food that's allowed on  your diet plan. Sometimes people get super-motivated and skimp on the calories they're allowed. This will obviously keep you more hungry, so eat all you are allowed.

2. Eat Breakfast! Even when you aren't hungry in the morning, your body will definitely appreciate the energy you feed yourself. It appears to prevent hunger later in the day and reduce the amount of food people crave all the way until bed time. Try to include some whole grains for fiber, and lean protein to stave off hunger pangs well into the morning.

3. Fill up on Low Calorie Foods: Keep carrot and celery sticks cut up in a dish of water in the fridge (this keeps them nice and crisp), zucchini sticks, apple sections, whatever your favorite fruit and veggie snacks are. Filling up on high-fiber foods that also contain a lot of water keep your body from nagging you to eat more.

4. Stay Hydrated. Sometimes your brain signals you to drink and you interpret it to "eat". Your first line of defense when a hunger craving hits is to have a glass of water. It will give you the satisfaction of putting something into your digestive system, even though there are no calories.

5. Keep a healthy balance in the other aspects of your life. Many things signal us to eat, most of which are not the need for nutrition. Sometimes we need sleep, water, a walk or a distraction. Stress, sleepiness, anxiety and boredom can all trigger the craving to solve the problem with a snack. Instead, think about what you really need each time hunger hits. Aim to put off eating for 15 minutes while you go for a walk, call a friend, check your email or just stretch and zone out for a minute. After 15 minutes, give yourself permission to have something--you will often find by that time you've forgotten about it and the craving has passed.

6: One of my favorites, from the author of The Beck Diet Solution: "Remember that hunger is not an emergency." It's an urge like many others that come and go during the day, many of which we must choose to ignore. After all, you don't give in to other impulses that are less-than-acceptable, such as napping at work, scratching certain itches, or hauling off and smacking an annoying, smart-mouthed colleague :)   If you ignore the hunger and continue with what you were doing, nothing bad will happen and the urge will soon pass.

Monday, July 16, 2012

Help! My Diet is Boring.

I am a 28-year old woman about 20 pounds overweight. I have been trying to lose weight for about a year now. I know what to do, and I do pretty well for weeks in a row. Then I just get bored and find myself straying. So after a few months of losing successfully, it just creeps back on over the next few months. How can I stay on the diet long enough to get all the weight off?  Jenny R.

Hi Jenny,
Your problem is a very common one. It takes lots of focus and determination to stay on track until you've developed new eating habits that will become easy and routine. The key is to keep inserting some more fun and challenge into your plan, to keep your mind from telling you, "This is awful! I'm tired of feeling deprived. I'm tired of avoiding things I want to eat and dragging myself off to the gym".
Here are a few tips to change your mindset and keep yourself on track:

1) Change the focus from avoiding foods to adding foods to your diet:
Rather than keeping in mind what you can't have, plan to add one or two items to your diet plan each week to establish healthy new habits. Focus on including 8 glasses of water a day, a fruit with each meal, or 4 veggies a day. Aim for 25 grams of fiber a day, 2 or 3 dairy products, or more meatless meals. When you're trying to include more of something in your diet you move away from feeling deprived and into feeling like you're getting--well-- more

2) Keep a journal and make it fun:
People who keep a daily food log lose more weight and keep it off. But diet diaries can become a bore. Use one of the many websites that help you keep things interesting (Fit Day, The Daily Plate, Spark People or Lose It!) by letting you friend others, earn badges, and track your progress. Put a twist on it by tracking the calories you saved: When you almost give into that cookie in the mall, but keep walking, log your 230 saved calories and add these up during the week to see how many pounds you kept off!

3) Establish a Reward System:
I like to use little scrapbook stickers of smiley faces or flowers to stick each day in my calendar that I accomplish a goal like walking 10,000 steps or eating fewer than 1600 calories. I have a chart to show what each number of stickers are worth: save 10 and get a manicure, 20 for a pedicure or a new book and 30 for a massage or a new work-out top. This way, all the stickers are helping you work towards something. There are no penalties, but if you start slacking it takes much longer to get to your reward.

4) Games and Blogs:
If you like to write, this could be the answer for you. Starting a blog is free and easy on sites like BlogSpot. You can make your journal private so no one else can find it. Or make it public for more motivation! 
One blogger asked for a "sponsor" for each week of her diet during a year. Whoever was her support that week, she thought every day "I'm doing it for so-and-so this week" and that kept her going.
One journalist tweeted what she ate to give her accountability. She knew everyone could see her intake, and she also knew they were rooting for her. Sometimes she would tweet, "Help! Driving by DQ and craving a blizzard" and the comments would fly in from her cheerleaders: "you can do it--just keep driving!"
Check out the game I developed called the Healthy Eating Lineup. Played like bingo, you list a healthy habit in each square: drink 5 glasses of water today, go for a walk, make healthy choices at a restaurant, etc. Be sure to have a reward in mind for each time you complete a full row.

Strive to make healthy eating and activity more fun any way you can. It's the best way to keep going until these new actions become habits and you find you never have to go on a diet again!