Approximately two-thirds of Americans are overweight or obese spiking health care costs and lost productivity secondary to premature morbidity and mortality.  So what is causing our waistbands to continue to expand?  Is it wheat (gluten), or maybe high fructose corn syrup (HFCS)?  Personally, I don’t believe there is one simple reason, in fact I believe it is a complex issue which I would like to explore with you, and this is the first of a three part series on “What’s making America fat?”

            There are multiple factors leading to our expanding waistlines.  The obvious issue is our eating habits or patterns, which is what I will focus on in this first article.  Another issue is our physical activity and then one you may not have thought about is our coping skills.

Let’s look at some eating patterns that lead to overeating and weight gain.  First there is the “meal skipper”.  Do you skip meals?  How do you feel when you do?  For example, if you skip breakfast can you make it to lunch without snacking and if you do can you control your intake?  Most often when someone skips a meal they are so hungry at the next meal that it is more important to get food in their stomach than it is to take their time to eat slowly and make good food choices. Your plan should be to eat three meals on a daily basis, with the most important meal of the day being breakfast.  Breakfast should be no more than two hours after waking up; this should be followed with a meal every four to six hours with lunch and then dinner.    If you find that you get hungry between meals have a healthy snack, something in the 100-200 calorie range, such as a 6-ounce container of light yogurt topped with ¼ cup high fiber cereal, or a piece of fruit with a stick of string cheese.

Could you be a nighttime snacker?  You ate your three meals today, but at night when you are relaxing you find you are still hungry so you start the “mindless” snacking in front of the TV.  Here’s a few ideas, eat a little more for your midafternoon snack, and make sure you have a balanced dinner, include a lean-protein, a starch, and half of your plate should include vegetables and/or fruit.  If you feel you still need a nighttime snack make it healthy, something in the 200-calorie range, such as low-fat pudding cup with 1/2-cup of fresh fruit, a whole grain tortilla with ¼-cup bean dip and salsa, or maybe 100-calorie cup of ice cream with chopped fresh fruit.   Another good idea is to just remove unhealthy foods from the home, if the chips and cookies are not in the house; it’s difficult to eat them in the evening.

            Could you be a victim of portion-distortion?  Do you know portion sizes?  Here are a few examples to help you estimate: a serving of dry cereal is one cup, you can visualize this to be about the size of your fist.  Half of a baseball is a serving of cooked pasta, rice, and potatoes (1/2 cup), and a deck of cards or the palm of you hand equals a serving of meat, which is three-ounces, cooked.  Research shows that we eat with our eyes, so if you use a large plate and try to change to proper portions you may feel as if you are depriving yourself.  Instead, switch to a smaller plate (9-inch diameter), bowl, and glassware, this way your plate will look full and you will not feel as if you are sacrificing.

There are several “portion traps” you should be aware of and here are a few easy tips to consider.  One portion trap is the buffet at your favorite restaurant, I would suggest just avoiding them, but if you can’t, or won’t, use the two-plate rule – fill your first plate with fruits and vegetables only, use your second plate for small amounts of only three of your favorite choices.

Another trap is the grocery store, number one rule – DO NOT GO HUNGRY.  Also, shop from a list, and choose two-for-one deals only if they are for healthy items, such as fruits, vegetables, whole grains (brown rice, whole wheat), or lean proteins (fish or chicken).

If you mindlessly eat the tortilla chips or bread from the bread basket a good tip would be to keep them off the table, or at least push them to the opposite side.  Portion control is just one piece of bread or 10 chips. It’s also a good idea to keep the food in the kitchen and not on the table during meals, this helps to cut back on second helpings.  Of course there are exceptions to this rule, such as fruits and vegetable side dishes, keep these on the table and encourage seconds!

These are just a few of the eating patterns/habits and suggestions for change to help you achieve and/or maintain a healthy weight.  Remember the perfect plate consists of at least half fruits and veggies, a quarter grains and/or starchy veggies (corn, peas), and a quarter lean proteins.

One more tidbit – studies show it takes 21 days to make or break a habit, so give yourself some time to make the changes you need to improve your eating pattern.

Stay tuned, next we’ll explore physical activity or lack thereof! 

The pro-plant dietary movement is growing in popularity and is known by a relatively new term: “flexitarian”, which is a combination of the words “flexible” and “vegetarian”. According to Dawn Jackson Blatner, RD “following a flexitarian diet simply means eating more plant-based meals and less meat”, this approach minimizes meat, but doesn’t exclude it, in other words, it is pro-plant, not anti-meat!  The Vegetarian Resource Group estimates 30-40% of us in the U.S. are flexitarians.

There are multiple factors motivating someone to become a “flexitarian”, one being wellness and health.  Studies have shown that a plant based diet can lower cholesterol, reduce the risk of heart disease, type 2 diabetes and cancer, lower blood pressure, and improve your body mass index.  Environmentally, livestock generates more carbon emissions than transportation and is a major source of land and water degradation. Therefore, a plant based diet is more environmentally friendly.  And lastly, the US Department of Labor Consumer Price Index (February 2012) points out that following a flexitarian diet is less expensive, beans are two-and-a-half times less expensive than lean beef.

Are you a flexitarian?  We eat roughly 21 meals per week, if you eat six meatless meals per week you are considered a beginner, and if you consume 9-12 meatless meals per week you are an advanced flexitarian.  Consuming 15 or more meatless meals per week? You can consider yourself an expert!  It should be noted that amongst the flexitarians fish is a “limbo” food.  Some include it, some don’t.  If you do include it, you should aim to eat 12 ounces of a variety of fish per week.

Are you concerned about the nutritional aspects of a flexitarian diet?  Does this way of eating provide enough protein, omega-3 fatty acids, iron, zinc, iodine, calcium, vitamin D, and vitamin B12?  The short answer is “yes”, but if you are new to this approach here are a few easy steps to follow to ensure you are getting the necessary nutrients your body needs. For your protein, iron, and zinc needs incorporate beans, lentils, nuts, and seeds into your daily meals.   To achieve your vitamin B12, calcium, and vitamin D requirements include milk or fortified soy, rice, or almond milk daily.  Obtaining omega-3 fatty acids are a bit more difficult unless you include fish in your weekly diet.  Plant based omega-3s include flaxseeds/oil, walnuts/oil, and chia seeds and all contain ALA fatty acids (see my article  for detailed information).  Unfortunately, very little ALA is converted to EPA or DHA (FYI: ALA has to be converted). Remember, EPA and DHA are associated with heart health by lowering total triglycerides, and food sources include fish and fish oils.  If you don’t consume the recommended 12 ounces of fish per week I would recommend a good omega-3 DHA supplement.

A flexitarian can easily follow the 2010 Dietary Guidelines by using the MyPlate approach.  The plate has three sections, 25% protein, 25% starch, 50% fruits and veggies.

We typically think of protein as beef, pork, poultry, or fish, for the new flexitarian here are a few suggestions for protein “swaps”.

Note: one ounce of meat = one-fourth cup of beans.

I’m writing this article as my marinara sauce is simmering on the stove top, my polenta is baking in the oven, and my garden salad is crisping in the fridge. If you haven’t tried a plant-based diet for a meal or two a week, I invite you to give it a try.  Be creative, be healthy and don’t forget to include your protein, fruits and veggies, and starch at every meal!

Food labels appear on virtually every food item. The only foods that do not need to carry nutrition labels are plain coffee, tea, and spices.  Foods produced by small companies and those prepared and sold in the same establishment are also exempt.  However, many of these producers choose to use nutrition labels.

The first thing that you want to look at when reading a nutrition label is the serving size.  The US Food and Drug Administration (USDA) has established specific serving sizes on some foods.  For instance, a beverage serving size is 8 fluid ounces and an ice cream serving size is ½ cup. This makes it easy to comparison shop for these items.  However, some food serving sizes are not regulated.  This is why it is so important to read the serving size first.  It is easy to assume that some food packages only hold one serving.  Little bags of potato chips are one such food.  Some of those bags actually contain what the manufacturer considers as 2 ½ servings.  If you just look at calories and see 150 calories, you may think that the entire bag contains 150 calories, when in fact it contains 375 calories because it contains 2 ½ servings.

Labels present nutrition information in two ways, quantities (such as grams or milligrams) and percentages of daily values (DV). The amount of fat a person should consume in a day is not a set amount. Instead, recommendations are based on a percentage of calories.  The “% DV” column provides a ballpark figure of how individual foods contribute to the overall diet.  You can see that every food label bases the % DV on a 2000-calorie diet. Your daily values may be higher or lower depending on your calorie needs, but these figures still provide a way for you to compare different food items.  For example, if one type of food contains 25% of the DV for fat and another provides 30%, it’s probably wiser to choose the one containing 25%.

You still need to watch portion sizes when choosing foods that are described as “nonfat” or “sugar free”.  Many low-fat foods are still high in calories.  In fact, manufacturers may add even more sugar to food in an attempt to make up for the lost taste from fat removal.  Sugar-free foods still contain calories from other carbohydrates, fat, and protein.

Below is a small quiz to see how much you know about food labels, have fun!

1. How many calories can a serving of food contain to state “low calorie” on the label?

a. 20 calories

b. 40 calories

c. 60 calories

2. How much fat can a serving of food contain to state “low fat” on the label?

a. 1 gram (g)

b. 2 grams

c. 3 grams

3. How much fat, saturated fat, and cholesterol can 3.5 ounces of meat, poultry, game meat, and seafood contain to state “extra lean” on the label?

a. 5 g total fat, 2 g saturated fat, and 95 milligrams (mg) cholesterol

b. 7 g fat, 4 g saturated fat, and 200 mg cholesterol

c. 9 g fat, 6 g of saturated fat, and 295 mg of cholesterol

4. How much of a nutrient must a food contain to state “excellent source of…”, “high in…”, or “rich in…” on the label?

a. 15% or more of the Daily Value (DV)/serving

b. 20% or more of the DV/serving

c. 25% or more of the DV/serving

5. How must a “light” or “lite” food compare to the standard product to carry that label?

a. One third fewer calories or less than 50% of the fat content

b. One half the calories or less than 75% of the fat content

c. Three fourths of the calories or less than 85% of the fat content

6. How much trans fat can a food product contain/serving to state “trans-fat free” on the label?  What is the daily limit for trans fat for adults?

a. 0g; 1g

b. 0.5g; 2g

c. 1g; 3g

7. Which of the following is true of milks that carry the organic seal?

a. The cows must receive only organic food

b. The cows cannot receive antibiotics, even if they are ill

c. The cows still are allowed to receive hormones

8. True or False: Food labeled as fat free can still contain fat.

9. Which of the follow would not appear as a serving size?

a. 2 slices

b. 20 pieces

c. 0.20 ounces

d. ½ package

10. If a product is considered “high” in a particular nutrient, what % Daily Value (DV) must it contain?

a. 10%

b. 20%

c. 30%

d. 40%

11. True or False: The % DV listed on the Nutrition Facts label applies to everyone.

12. In what order do ingredients appear in the ingredient list?

a. Alphabetical order

b. With the most nutritious ingredients listed first

c. With the longest words at the end for appearance purposes

d. With the ingredients provided in the largest quantity appearing first

click here for the Answers

Sugar and our health has been in the news a lot lately.  Perhaps you saw the CBS 60 Minutes segment titled “Is sugar toxic?”  Dr. Lustig, a pediatric endocrinologist at the University of California, San Francisco concluded that sugar, more than any other substance, is to blame for obesity, type 2 diabetes, hypertension, and heart disease.  Bonnie Liebman, Director of Nutrition at Center for Science in the Public Interest recently wrote that for years researchers have found a higher risk of type 2 diabetes, heart disease, high blood pressure, high triglycerides, gout, and weight gain in people who consume more sugar-sweetened beverages.  And a flurry of new studies suggests that our out-of-control sweet tooth is connected to our out-of-control belly fat.

The average American consumes 22 to 28 teaspoons of added sugar a day mostly in the form of high-fructose corn syrup (HFCS) or ordinary table sugar (sucrose).  Since its peak in 1999, intake from total sugars is down 8% and HFCS is down approximately 9% for the same time period, yet our obesity rates continue to rise dramatically during this same time period.

Since the 1970s we have been warned to lower our fat consumption to reduce our risks of heart disease.  I remember the explosion of “fat-free” or “low-fat” products in the cookie and snack aisle.  Consumers bought these items freely thinking they were being “healthy”, but our obesity rates continued to rise.  How could this be?  When you take the fat out of products they don’t taste very good, so the food manufacturers simply replaced the fat with sugar, and over time sugar was replaced with HFCS.  A slice of Starbucks Reduced-Fat Cinnamon Swirl Coffee Cake has 10 teaspoons of added sugars!

First I would like to remind everyone that sugar from any source in non-nutritive, in other words – it’s just calories.  With few exceptions (like agave and corn syrup), most sweeteners and naturally occurring sugars in fruit break down into roughly half fructose and half glucose in the body (see the chart below).

 Source: USDA Nutrient Database.

In three different studies, scientists randomly assigned people sugary beverages (made with sugar or HFCS) versus diet beverages for three to 10 weeks.  No surprise, the people who consumed the sugar or HFCS drinks gained weight.  So why does HFCS get such a bad rap?  Sweeteners high in fructose do not affect blood sugar because fructose is metabolized in the liver very quickly.  Research shows that when there is more sugar than the liver can process, it converts the sugar to fat.  Some of the fat goes into the bloodstream, and that’s why we get elevated triglycerides and increase one’s risk for heart disease.  It may also increase the risk of metabolic syndrome/insulin resistance, which leads to type 2 diabetes.

The bottom line:

It is recommended that women should consumer no more than 100 calories (6 ½ teaspoons) and men 150 calories (9 ½ teaspoons) from added sugars a day, which is roughly 5% of a 2,000 a day diet.  It’s the excess that leads to the problems. Remember that Starbucks coffee cake?

Limit fruit juice consumption to no more than 6-8 ounces a day.  Avoid sugar-sweetened beverages.

Limit all added sugars (see chart above).  Even Agave syrup, which has become popular among the health conscious, it may be low on the glycemic index, but it will still affect your triglyceride level more than HFCS.

Don’t worry about the naturally occurring sugar in fruit, milk, and plain yogurt.

Eat a balanced diet and get most of your calories from fruits, vegetables, grains, milk, meat, fish, poultry, and oils.  That doesn’t leave much room for empty calories!

National Nutrition Month® is a nutrition education and information campaign created annually in March by the Academy of Nutrition and Dietetics.  This campaign focuses attention on the importance of making informed food choices and developing sound eating and physical activity habits.  This year’s campaign “Get Your Plate In Shape” uses the latest dietary guidelines, released in January 2011, called “MyPlate”.

MyPlate is exactly that, a visual of what your plate should look like when you sit down to eat a healthy meal.  MyPlate, your dinner plate, is divided into four sections.  The veggie and grain sections are each a little larger than a fourth of the plate.  While the fruits and protein sections are each a little smaller than a quarter of the plate.  Off to the side is a smaller circle representing dairy, with three meals per day that would include three servings of dairy.  This could include a glass of low-fat milk, low-fat cheese, or low-fat yogurt to obtain your daily calcium and vitamin D.

“Get Your Plate in Shape” is all about balancing calories with physical activity and consuming an overall healthy eating pattern.  It is suggested to eat more low-calorie, nutrient-dense foods, which means to make sure you are eating you fruits, vegetables, and whole grains on a daily basis.  Fruits and vegetables are naturally cholesterol free, low in fat, low in calories and high in fiber, vitamins, minerals and phytonutrients.  Research has shown that we eat with our eyes, and fruits and veggies add a lot of color to a plate which is pleasing to our eyes.  These different colors are very important, for example the red provides lycopene which is important for healthy cells.  Green fruits and veggies provide vitamin A, C, folate and lutein necessary for healthy cells, lung, liver and eye health.  Orange – beta carotene helps our vision, immune system, and growth and development.  Purple provides anthocyanin for our heart and artery health.

  I often tell people to make at least half of their daily grain intake “whole” grains. According to the Whole Grain Council, whole grains or foods made from them contain all the essential parts and naturally-occurring nutrients of the entire grain seed. This definition means that 100% of the original kernel – all of the bran, germ, and endosperm – must be present to qualify as a whole grain. So why is this important?  Whole grains reduce the risk of stroke by 30-36%, type 2 diabetes by 21-30% and heart disease by 25-28%.  Whole grains are also beneficial for better weight management.  Some suggestions for whole grains are brown rice, barley, oats, quinoa, millet, buckwheat, and wild rice.  Why not try something new this month?

Protein should be a little less than a quarter of your plate per meal, a serving is 2-3 ounces of meat, poultry, or fish, two eggs, two tablespoons nut butter, or a third cup of dry beans. You should strive to eat a variety of protein foods each week. And remember to keep it lean. Protein is important for building and repairing body tissues, and it regulates body processes, such as water balancing, transporting nutrients, and making muscles contract.

It’s not just food – you’ve got to move!  Part of this year’s campaign includes being physically active your way.  Pick an activity you like and start by doing what you can, at least 10 minutes at a time.  General guidelines are children and teens need 60 minutes or more a day of physical activity and adults should strive for 2 ½ hours or more per week of a moderate activity such as brisk walking.

Use MyPlate as an easy visual when planning your meals; remember that half of your plate should be colorful with fruits and veggies.  The other half of your plate should include your grains and protein, and don’t forget you daily servings of dairy.  To achieve this year’s theme you also need to include your daily/weekly activity to fully “Get Your Plate in Shape”.

Peggy Korody is a Registered Dietitian and owner of RD4Health Nutrition Counseling, LLC in Rancho Santa Fe. She is also a Certified LEAP Therapist – Helping people who suffer with food sensitivities which can lead to - IBS, Migraines, Fibromyalgia, and other inflammatory conditions.  Her first cookbook, “Little Hands in the Kitchen” is available on her website. For more information on services offered please visit RD4Health.com or email pkorody@RD4Health.com, 858-401-9936. 

Are you suffering from a stubborn health problem that won’t go away no matter what you try?  Or perhaps the medications and treatments you are taking aren’t actually getting at the root cause of your illness – but you want something that will.  If you feel this way, consider some important facts:

-         Medical Research has shown that sensitivities to foods and food-chemicals can be involved in a wide array of painful symptoms and chronic health problems.

-         If foods and additives in your diet are causing your illness, whatever medications you take will ultimately fail because they only mask the symptoms.  They don’t treat the underlying cause of the symptoms.  And as is too often the case, many medications have side effects that can lead to other health problems.

-         If food sensitivities are causing your illness and you don’t properly address them, you could easily end up suffering for many years, spending thousands of dollars for treatments that will never work the way you want.

Food and chemical sensitivities can result in an immune system reaction with the release of mediators which cause pain and inflammation in the body.  The immune system is the first line of defense in which it identifies “self” and “non-self.” This is very beneficial for protecting us from unwanted bacteria and viruses.  However, if the immune system decides that a food or chemical is dangerous and should be destroyed, the result is the release of mediators which cause inflammation and pain.  This is how food and chemical sensitivities develop.

Millions of Americans suffer from food sensitivities.  Conditions such as irritable bowel syndrome, acid reflux, migraine and other headaches, weight imbalances, fibromyalgia, muscle or joint pain, chronic fatigue, skin eruptions, brain fog and many other uncomfortable lingering health problems are often directly related to specific immune reactions to the foods we eat.  Even so-called “healthy” foods such as salmon, chicken, apples, or garlic can provoke symptoms in sensitive individuals.

Individuals with food and chemical sensitivities benefit from avoiding the foods and chemicals that trigger pain and inflammation.  Keeping a food intake diary and logging symptoms is of little benefit in detecting food sensitivity because the onset of symptoms may be up to three days after ingestion of the offending food.  Fortunately there’s a program called LEAP (Lifestyle Eating And Performance) that can help you quickly overcome even the most troublesome food sensitivity related problems.  With the patented blood test called MRT (Mediator Release Test) your individual reactions to foods and food chemicals are identified.  The results of the blood test are used to create an individualized healthy eating plan for significantly reducing or eliminating symptoms.

I am a certified LEAP therapist (CLT) and can help you achieve wellness. If you would like to hear more about this testing, I have a special “Leap Day” offer: schedule your initial assessment by February 29th and the initial fee will be waived.

February is American Heart Month and unfortunately, most of us know someone who has had aheart attack or stroke. Cardiovascular disease (CVD) is the leading cause of death in the United States; in fact one in every three deaths is from heart disease and stroke, equal to 2,200 deaths per day, according to the Centers for Disease Control and Prevention (CDC). Also, more women die of heart disease than all forms of cancer combined, and CVD is the most common cause of death in patients with celiac disease.

Celiac disease is an autoimmune disease that damages the small intestine and interferes with absorption of nutrients from food. It can be difficult to detect, for example some of the symptoms can include: bloating/gas, diarrhea and/or constipation, fatigue/lethargy, joint pain, and headaches, all of which are common symptoms for many of us!  But if you have one or more of these symptoms this does not mean you have a sensitivity to gluten or celiac disease.  If you suspect that you have Celiac disease, you may want to get tested. It is important to note that one needs to be consuming gluten for accurate results.  The first step would be to have a blood test to test for certain autoantibodies, which is a protein.  If you test positive, an intestinal biopsy would need to be performed to confirm the diagnosis. Celiac disease is hereditary, so if a family member has been diagnosed, you may want to get tested too. Internationally, one-percent of the worldwide population has celiac.  On the west coast of Ireland and Sub Sahara (Ethiopia) the statistics are slightly higher with 1 in 65 being diagnosed, and Northern China and India have a higher rate than the rest of Asia.

Recent findings show inflammation is a risk factor for atrial fibrillation (Afib), an irregular and often rapid heart rate, and there is a positive correlation between celiac and Afib, in both before and after diagnosis. Therefore, patients with celiac disease have an increased risk of Afib.  If you have been diagnosed with celiac disease you are at a 19% increased risk for coronary heart disease, which is the narrowing of the coronary arteries. The reason for the inflammation and increased risk for celiac patients is unknown. One theory is that the increased risk may be related to poor dietary compliance. A gluten-free (GF) diet is not an easy diet to follow, unless you love to cook all your own meals! Let’s look at some of the issues with the GF diet.

Typically a wheat-based diet is naturally high in fiber and B-complex vitamins, and it offers great taste, variety and palatability. Wheat based foods are required by the FDA to be enriched or fortified with iron, thiamin, niacin, riboflavin and folate.  Specialty gluten-free products on the other hand are not required to be enriched or fortified, and these products do not typically offer all of the nutrients the body requires. GF products use starches that are dry, which causes foods to crumble; therefore the manufacturers add fat, sugar, salt, and palm oil to compensate for texture. So, compared to wheat-based products you receive an increase in fat and calories, and a decrease in fiber and B-complex vitamins, leading to nutrient deficiencies, increased risk of heart disease, and weight gain.

So if you have celiac disease or are sensitive to gluten I would suggest using a “food as medicine” approach to your diet. You should focus on WHOLE foods versus highly processed GF-free packaged foods, use nutrition-dense alternative ingredients, and learn some culinary skills for cooking with GF-free foods.  Here are a few grains you may want to add to your GF diet.  Buckwheat, a great source of protein, is high in fiber and a good source of B vitamins.  Use it in soups, hot cereal, and pasta dishes (it has a nutty taste).  Millet, which is one of the oldest grains, is high in magnesium, vitamin A, B-complex, and fiber (good as a side dish).  If you can find millet flakes, you can eat them as a cereal or use for baking.  Another great grain is quinoa, which is high in protein. In fact, it is very similar to the protein you get from milk.  Also, quinoa is a good source of fiber, B-complex, and iron.  Quinoa can be used as a side dish, in salads, for baking, and with pasta.

February is the month to focus on heart health. As you can see, if you have celiac this is even more of a challenge. I suggest you visit the CDC website at www.millionhearts.hhs.gov and take the “Million Hearts™ pledge”, which includes being physically active for at least 30 minutes most days of the week and knowing your ABCS.  Ask your doctor if you should be taking Aspirin every day.  Find out if you have high Blood pressure or Cholesterol, if you do, get effective treatment.  Finally, if you Smoke, get help to quit.  Everyone should strive to eat a heart-healthy diet, especially if you have celiac.  This would include being aware of you calorie intake, including fresh fruits and vegetables on a daily basis, and limit your sodium and trans fat intake.  Also remember, if you need help with how to make these changes look for a Registered Dietitian, who is the best source of practical, affordable and credible food and nutrition information!