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.