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Cholesterol

Question: How Does Cholesterol Effect One's Risk for Heart Disease?
Answer: (Show Answer)

September is National Cholesterol Education Month. With heart disease as the number one cause of death in America, there is no better time to understand the effect of cholesterol on your risk! By learning about the role cholesterol has in heart disease and the impact of a healthy lifestyle, you will be well equipped to prevent its onset.

To begin our conversation, it is important to review the different fats (or lipids) circulating in your blood. First we start with cholesterol, a fatty substance made by the body for use in cell membranes and hormones. A certain amount is needed to maintain health, but when too much is produced it becomes a concern for heart health. When given your Total Cholesterol number, it is in fact a summary of different types of fats circulating the body. Aim for this number to be less than or equal to 200 milligrams per deciliter (mg/dL).

Regarded as the "good" guy on the cholesterol block, high-density lipoprotein cholesterol (HDL-C) protects against heart disease. How? It removes "bad" cholesterol. So, the higher its number, the better! Men should aim for greater than or equal to 40 mg/dL, while women should be greater than or equal to 50 mg/dL. To increase levels of HDL-C, participate in physical activity each day, substitute trans and saturated fat in your diet with unsaturated fats, and focus on omega-3 fats. Unsaturated fats, including omega-3s, are liquid at room temperature and can be found in plant-based oils, seeds, seafood, nuts, olives, and avocados.

The infamous "bad" guy, low-density lipoprotein cholesterol (LDL-C) is dictated by both genetics and diet. Aim for less than 130 mg/dL (less than 100 mg/dL for individuals diagnosed with heart disease or diabetes). Maintaining a healthy weight and limiting the intake of saturated and trans fat can help keep your level as low as possible. Saturated fat is solid at room temperature and can be found in food like butter, cream-based soups, meats and baked goods. The major source of trans fat in American's diets is "partially hydrogenated" oil found in deep-fried food, baked goods, crackers, margarines and frozen meals - so eat these foods less often.

Triglycerides are the last major component of blood lipids we will cover. Unlike the other fats listed above, triglycerides are formed when excess nutrients (excess calories from protein, carbohydrates, fat and alcohol) are stored as fat. Aim for this number to be less than 150 mg/dL and reduce your level by eating a low-fat, low-sugar, calorie-controlled meal plan that focuses on whole grains, lean proteins, vegetables and unsaturated fats.

By following these steps, including foods with plant sterols and soy protein in your diet, managing stress, not smoking and staying away from second-hand smoke, you can reduce your risk for high cholesterol and heart disease.

To learn more about National Cholesterol Education Month, visit the National Heart, Lung, Blood Institute website at http://hp2010.nhlbihin.net/cholmonth.

This question was featured in the September 10, 2008 The Republican Plus Paper, Springfield, MA.

Colon Cancer

Question: How can I prevent colon cancer?
Answer: (Show Answer)

The 3rd most common form of cancer (excluding skin cancer), nearly 50% of all cases of colon cancer are said to be preventable through lifestyle changes. As we age, the probability of being diagnosed with colon cancer also increases. Unfortunately, the prospect of being diagnosed with cancer can be overwhelmingly frightening for some individuals, causing them to stay clear of regular medical check ups. Having cancer is not a situation where ignorance is bliss. The odds of successfully fighting cancer are greater when it is diagnosed in the early stages. For colon and rectal cancer, the American Cancer Society (ACS) states of the 52,180 expected to die from the cancers this year, appropriate testing could save more than half.

Here's what you can do:

#1-Get tested for colon cancer.

At fifty years of age, the ACS recommends one of the following: a yearly fecal occult blood test (FOBT) or fecal immunochemical test (FIT), a flexible sigmoidoscopy every 5 years, a yearly FOBT* or FIT, plus a flexible sigmoidoscopy every 5 years, a double-contrast barium enema every 5 years, or a colonoscopy every 10 years. If you, or your family, have a history of colorectal cancer, or you have chronic inflammatory bowel disease, they recommend screenings occur more frequently and/or earlier.

#2-Maintain a healthy weight.

The higher one's body mass index (BMI), the greater their relative risk for colon cancer.

#3-Be mindful of how much red meat and processed meats you eat.

Researchers are starting to see trends for diets high in red meat and processed meats. The larger the daily intake of red meat is (~4 ounces), and the greater the weekly intake of processed meat is (~2 1/2 ounces for women, ~9 1/2 ounces for men), the greater an individual's risk for colon cancer.

#4-Watch the glycemic load of your calories.

Glycemic load is defined as the quality and quantity of carbohydrates. As the glycemic load of one's calories increases, so does their risk for colon cancer. This can be addressed by eating a moderate amount of carbohydrates in your diet and choosing less processed higher fiber whole grain foods most often.

#5-Get plenty of folic acid, calcium and vitamin D.

All three nutrients appear to have impressive roles in preventing colon cancer. Eating plenty of fruits, vegetables, fortified foods, and taking a daily multi-vitamin will do the trick for folic acid. Let dairy foods be your source of calcium. Make sure to couple proper sun exposure with additional supplementation for vitamin D.

#6-Eat 25-35 total grams of fiber each day.

Researchers are still trying to figure out what role, if any, fiber has on colon cancer. Regardless if the benefits are coming from total fiber, a certain kind of fiber, or the foods themselves that provide fiber, you will benefit from eating 25-35 grams of fiber per day.

#7-Reduce your alcohol intake.

#8-Exercise Daily.

As one becomes more physically active, their risk for colon cancer drops. So, what are you waiting for? Get moving!

This question was featured in the May 16, 2007 The Republican Plus Paper, Springfield, MA.

Fats

Question: What type and how much fat should I eat?
Answer: (Show Answer)

After the fat-free diet boom of the nineties, confusion about fats sky rocketed. To address this issue, the American Heart Association (AHA) has released a new web-based calculator called My Fats Translator. This tool is meant to clear up any confusion there may be around fats by first calculating your calorie needs and then explaining how this translates into the amount of fat you should be eating. The AHA's fat translator is a part of as section called Face the Fats. Face the Fats provides an abundance of information about fats, with a slue of recommendations on how to eat within your fat goals.

To get you started thinking about fats, here are few facts:

We need fat. It provides energy, supports cell growth, and protects vital organs. Fat also helps regulate body temperature, absorb important nutrients, and produce hormones.

There are four different kinds of fat: monounsaturated fat, polyunsaturated fat, saturated fat, and trans fat. Each one differs in chemical structure and how it affects our body.

Saturated fats and trans fats are often called "unhealthy" fats. These fats are typically solid at room temperature (like butter) and are known to raise LDL cholesterol ("bad" cholesterol) levels. Since they put us at a greater risk for heart disease, it is recommended to be keep the proportion of saturated and trans fat from the food we eat below 10% of our daily calories (My Fats Translator recommends no more than 7% from saturated fat or 1% from trans fat).

Monounsaturated and polyunsaturated fats are considered healthier types of fats. They are liquid at room temperature (like olive oil) and do not raise LDL cholesterol. In fact, monounsaturated fats may also help raise HDL cholesterol ("good" cholesterol), while polyunsaturated omega-3 fatty acids may help reduce blood pressure and triglycerides.

The calorie content of fat is the same across the board, no matter what kind you are eating. One gram of fat provides 9 calories. Therefore be mindful of the amount of total fat you eat each day, because an excess will lead to weight gain.

Although it is great if a product claims to be trans fat-free, it doesn't mean it is healthy. Consider the rest of the product ingredients before deeming it healthy or unhealthy. It may not have trans fat, but it could be high in sugar and saturated fat, while low in fiber, vitamins and minerals.

In the end, eat a diet that has fruits, vegetables, and whole-grain, high fiber foods as the base. Eating fat-free or low-fat dairy products, lean meats, poultry, and fish (twice a week) will provide the fats you need (healthy fats), while being low in unhealthy saturated and trans fats. Never forget- you do not have to give up the foods you love to follow a healthy diet. Everything can be included in moderation with consideration to your overall meal pattern.

To learn more, and what your fat goals are, visit the American Heart Association's fat translator at www.myfatstranslator.com.

This question was featured in an April 2007 The Republican Plus Paper, Springfield, MA.

Fiber

Question: What exactly is fiber and why is it so important?
Answer: (Show Answer)

Dietary Fiber is the fibrous component of the plant foods we eat that are resistant to breaking down during digestion. There are a number of different molecules that make up what we generally label "fiber" in our foods. With that said, fibers do tend to be divided into two categories- insoluble fiber and soluble fiber. Insoluble fibers are usually the components of fruits, vegetables, and grains (like cereal bran) that add weight to stool. These are the fibers one thinks of when they are looking to promote a healthy colon by "increasing their fiber intake" to have regular bowel movements. Soluble fibers are primarily thought to be more viscous in nature than insoluble fibers (although not all insoluble fibers are viscous). Viscous fibers help reduce blood cholesterol levels (by-way of reducing the amount of "bad" cholesterol in our blood) and for individuals with diabetes, promote blood sugar control (due to reducing the amount of glucose dumped into our blood after eating). Soluble fibers can be found in fruits (apples), vegetables (potatoes), legumes (beans), and grains (barely, oat bran, oatmeal).

The role specific (soluble or insoluble) fibers play in disease risk is open for discussion. Both large population and small group observational studies seem to indicate diets high in fiber can reduce the risk of cancer, heart disease, and diabetes. When smaller clinical studies are conducted, researchers find it harder to support such observed cause and effect relationships. This simple deviation between observational studies and clinical trials is a very important piece to understanding nutrition science- the overall relationship between the foods we eat and how they work together may be the power of prevention for diseases rather then specific, isolated nutrients and molecules. Therefore, not one food component is ever working alone! What a great reason for eating all foods in moderation.

The average American diet falls 10-20 grams shy of the daily recommended amount of fiber. Hence, the American Dietetic Association recommends following a diet with a modest increase in fiber through fruits, vegetables, whole- and high-fiber grains to work towards the daily recommended 25-35 grams of dietary fiber. As a bonus, diets higher in fiber also tend to be greater in volume (i.e.: large quantity of foods), but lower in calories, fat, and simple sugars. These secondary benefits of following a high fiber diet may also help with weight management because you would find yourself feeling more satisfied and full of energy while consuming a lower amount of calories. As you work on increasing your fiber intake, just remember to do so slowly while increasing your fluid intake to help prevent against both diarrhea (too much fiber) and constipation (too little water).

This question was featured in the February 21, 2006 The Republican Plus Paper, Springfield, MA.

Folic Acid

Question: Able to become pregnant? Take your folic acid.
Answer: (Show Answer)

It's rare that scientists observe a clear positive effect caused by a single nutrient's consumption. But for folic acid, this is exactly the case.

Studies indicate that the consumption of folic acid prior to conception and within the first trimester of pregnancy reduces the incidence of neural tube defects (NTDs) by 50-70%. These dramatic findings prompted the U.S. Public Health Service, in 1992, to recommend all women of childbearing age capable of becoming pregnant consume 400 micrograms (mcg) of folic acid daily. In 1998, the Food and Drug Administration started requiring certain grain foods (enriched breads, cereal, flour, pasta, rice, etc.) be fortified with folic acid to help increase women's intake.

You may ask yourself- "If I'm not pregnant, and have no plans to be anytime soon, why should I care about folic acid?" Easy- the Centers for Disease Control (CDC) estimates 50% of pregnancies in the United States are unplanned. That's right, even if you think you won't have an unplanned pregnancy, there's a 50/50 chance you will. And if you do unexpectedly find out you're pregnant, you'll more than likely learn of it too late for folic acid's help.

Folic acid helps in cell growth, division and replication. Therefore, it is one of the nutrients needed early in pregnancy to ensure all goes well while fetal cells grow and multiply to form baby. NTDs occur when the tissues of the brain and/or spinal cord do not close completely (i.e.: anencephaly or spina bifida). Depending on the degree and region affected, infants may have paralysis, be stillborn or die shortly after birth.

In laymen terms, without enough folic acid in the first few weeks of pregnancy, baby may not have what is needed for its spinal column or brain to fully develop. With 50% of pregnancies being unplanned, this means the window of opportunity for folic acid may be shut before mom learns she's pregnant. In fact, the CDC states 3,000 pregnancies each year in the United States are affected by spina bifida or anencephaly. Thus, the presence of folic acid is of utmost importance prior to and days after conception.

What can you do to reduce your risk? Start taking a daily supplement of 400 mcg of folic acid today. You can do this by taking a multivitamin that contains 400 mcg of folic acid, a supplement of just 400 mcg of folic acid or eating a cereal that is fortified with 100% of the Daily Value for folic acid each day.

Healthcare providers, this goes for you too! A study released in the May 2006 Maternal and Child Health Journal found that only 50-65% of healthcare providers surveyed recommend multivitamins or folic acid to women during well care visits. Of which, those providers taking multivitamins themselves were twice as likely to recommend supplementation.

Need a little more convincing? The CDC cites the average cost of caring for a child born with spina bifida for life is about $636,000.00 per child. The cost of daily supplementation with 400 mcg of folic acid is $0.01-$0.02.

This question was featured in the October 22, 2008 The Republican Plus Paper, Springfield, MA.

Nutritionist?

Question: Aren't nutritionist and dietitian the same thing?
Answer: (Show Answer)

Today, my trainer asked this question. Do you know the difference?

When thinking of a professional to consult for all things nutrition, dietitian and nutritionist tend to go hand-in-hand for most people. BUT, these two titles can be worlds apart in definition.

Almost anyone can call themselves a "nutritionist." Dietitians undergo academic and hands-on training in nutrition and must pass a national registration exam. Being a registered dietitian indicates one has received the highest level of training needed to serve their community safely by dispensing accurate, science-based information.

Nutritionist is not a legally protected title. Therefore, it does not specify education, experience, or ongoing training. In fact, many states allow individuals to call themselves a nutritionist without having any form of education or training in the field of nutrition. That said, one nutritionist may be a highly qualified nutrition researcher while another could be a body builder dispensing tips to his training buddies.

The bottom line is nutritionist is not a regulated title, but dietitian is. Dietitians have to prove and continue proving their nutrition knowledge to a regulatory board (i.e. Commission on Dietetic Registration). Nutritionists do not.

What's the difference?

You may find a nutritionist, or nutrition counselor, dispensing advice but it doesn't mean they have undergone the same extensive education needed to become a dietitian. Why does this matter? Because the type, depth and tone of the advice could be off mark. Take the following as an example:

If you want to be happy, lose and keep of your excess weight, you need to give up "bad" foods like pizza, candy, soda, French fries and cake for good and start eating only "good" foods like organic vegetables, fruit and grains and even consider going on a raw food diet.

Would a dietitian advise this for a client? I should hope not (and if you hear of one, let us know!). Unfortunately, this type of one-sided, extreme and highly impractical advice often comes from individuals otherwise qualified to provide nutrition counseling.

As a dietitian, we learn to meet our clients where they are- What is realistic for them? What is their relationship with food like? Where can we make the most impact on their health? How can I help them reach their ultimate goal?

Versus alienating them and turning them off to the idea of making behavior change- What needs "fixing" in this person's diet that I can point out? If they succeed in what I tell them to do, then they're good and were listening to me. If they do not, then they don't have enough willpower or just wasn't listening.

See the difference? When in doubt, look for the credentials RD.

Have a nutrition question? Ask us by e-mailing at askcarrie@bigy.com.

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