From the Inside Out: Optimal Nutrition for Beauty

Healthy eating is important for overall wellness but a healthy diet has an added bonus to keeping you looking as young as you feel. Eating aside, antioxidant-rich foods and spices can also be used to make DIY beauty products devoid of harsh and toxic chemicals. Follow these 5 tips to look and feel fabulous.

#1 Drink plenty of water. Water keeps your skin lush and soft while allowing nutrients to move efficiently through blood to fuel your body. How much is enough? Divide your body weight in pounds by 2. That is the number of ounces to drink daily. Avoid sugar-sweetened beverages, which cause damaging free-radicals to wreak havoc on your cells (including your skin). Add fresh fruit and herbs like basil or mint to your water for an antioxidant and flavor boost.

#2 Drink green tea. Green tea is known as a high antioxidant drink with weight loss wonders. It burns more fat, yet has less caffeine than coffee. Drink unsweetened or add a smidgen of honey and slice of lemon for flavor. Refrigerate used tea bags and place on eyelids for 10 minutes to decrease under-eye puffiness.

#3 Fill half your plate with fruits and vegetables. The various colors of the rainbow represented in fruits and vegetables are visual indicators of their antioxidant potential. Eating enough, as well as a variety of colors is important. Vitamin C particularly is beneficial for skin health, as it is needed to make collagen, the compound in skin that provides elasticity. Skip the OJ; it is loaded with calories and the longer it is exposed to oxygen the less vitamin C it contains. 1 cup of strawberries provides more vitamin C per serving than an orange. Add to a smoothie or mash with granulated sugar for a vitamin C-rich skin exfoliator.

#4 Spice things up. Spices provide the most potent sources of antioxidants available and they taste delicious to boot! You can add them easily to any drink or meal and use them generously in DIY body scrubs, soaps, and moisturizers. Sprinkle cinnamon on sliced apples or pears to prevent browning, add turmeric to meat dishes, and ground cloves into oatmeal or baked goods.

#5 Eat lean meats and plant proteins. Protein provides the building blocks for every enzyme, cell, and structure in our bodies. With literally thousands of uses in the body, protein is arguably the most important nutrient to life. Protein is found in small quantities in plant foods like beans, lentils, nuts/seeds and whole grains. Higher protein foods include meats, dairy, and eggs. The  types of food and the conditions animals are raised in, impacts the nutrient content in the food you consume. Choose products from organic, pastured animals (grass-fed versus corn-fed), as the content of fat is a healthier variety and contains no harmful pesticides or hormones, which may cause skin breakouts. 

Stress-Free School Lunches

Make half your plate fruits and vegetables! Whether or not kids eat it or have refused it in the past, be consistent anyway. It can take up to 20 times before your child will readily accept a food.

Make healthy eating fun. Add a variety of color and cut items into fun shapes. Playing with food is how kids experience all aspects of the food. ENCOURAGE this behavior as it will help kids try new things.

Figure out what is available at school. How much time is there for lunch/recess? Does your child have access to a fridge/microwave? The option for keeping things cold and reheating is important as is the amount of time actually available to eat.

Healthy Meal Options

• Colorful veggies with Greek yogurt ranch dip: Combine 1 packet of ranch seasoning dressing with 1, 16 oz container of plain, non-fat Greek yogurt. For an even healthier option, dice up Italian parsley, a clove of garlic, chop chives and add lemon juice to taste. Not a fan of ranch? Try homemade hummus with cut up veggies instead.
• Fruit with cinnamon-honey Greek yogurt dip: Combine honey (a little), cinnamon and vanilla extract to plain, non-fat Greek yogurt for a sweet and protein-packed dip to pair with any fruit. Great snack for after sports practice!
• Tuna or Salmon Salad Sandwich: Reduce the amount of mayo, add plain Greek yogurt, mustard, chopped veggies (celery, carrots…). Keep in separate container from bread or wrap. Consider putting in a big lettuce leaf for a crunchy way to increase veggies in the diet.
• Be creative with leftovers. Whether it is pork, beef or chicken add a little BBQ sauce, mustard, Greek yogurt/mayo mixture some chopped veggies and wrap it up, throw it on a salad or slice of bread. For example, if you had chicken for dinner, chop it up with a little mayo and Greek yogurt, diced grapes, chopped celery and walnuts for a healthy chicken salad sandwich (or wrap).

Meal-Packing Tips

• Skip soda. Stick with water, regular milk or 100% juice (but limit to 4-8 oz total per day).  NOTE: 1 cup is much less than you think!  When in doubt, measure it out!
• Nix chips. Pretzels, chips, goldfish crackers, fruit snacks etc. have no nutritional value, which means they have the ability to displace healthy foods (by filling up your kid’s tummy without any good nutrients). Don’t be fooled by “organic” or “natural” versions of these either. Stick with real, whole fruits/veggies and use dips (like yogurt options above) or nut butters to encourage intake.
• Go nuts. Nuts/seeds and nut butters contain healthy fats and protein as well as important vitamins and minerals. They make a great addition to any lunch. Be sure to contact your school regarding rules for peanut allergies as some schools have restrictions. TIP: Store natural nut butters upside down in your fridge to evenly distribute oils and preventing the need to stir.
• Don't Ditch Dairy. Dairy provides the highest amount of absorbable calcium per serving compared to other foods. Bones act like a bank for calcium and ‘save’ up calcium through adolescence. After the age of 18 however, absorption of calcium decreases significantly, so it is very important to make sure calcium intake is adequate during youth. If your child has an intolerance or allergy make sure they are getting fortified sources of calcium elsewhere. String cheese, yogurt, cottage cheese all make for great protein and calcium snacks for lunches. Lactose intolerant? There are great calcium-fortified milk alternatives to boost bone development.

Sodium: The Hype in Hypertension?

Hypertension, or high blood pressure, is caused by a number of factors: genetic susceptibility, ethnicity, diet, exercise and stress. While an individual cannot control their genetics, adjusting lifestyle factors can help to decrease blood pressure. 

According to the Centers of Disease Control and Prevention, the average American consumes over 3400 mg of sodium a day…

Decreasing sodium intake helps 6 out of 10 people reduce blood pressure. These individuals deemed “salt-sensitive”, tend to be of African American decent.

The remaining 40% of people with hypertension do not see a benefit from sodium restriction alone.

The dietary change that does seem to be effective for more individuals is increasing intake of potassium-rich foods. The American Heart Association supports increasing intake of potassium-rich foods as a means to control blood pressure. Potassium is high in fruits, vegetables, beans and nuts/seeds.

The following tips provide practical ways to reduce sodium intake and amp up potassium.

·      When dining out and cooking meals at home, consider flavoring foods with spices or herbs to pump of flavor without salt.

·      Politely request restaurants to hold the salt while preparing your meal and serve all dressings and sauces on the side.

·      Reduce your portions and frequency of eating fried and packaged foods.

·      Eat fruits or vegetables at every meal and snack. Be sure to eat the skin as for most produce, this is where potassium is concentrated.

·      Limit prepackaged foods, as they tend to be high in sodium and low in potassium.

·      Match sodium intake with potassium. Having a 1:1 ratio of both minerals helps to control blood pressure.

·      Adequate hydration is also important for managing blood pressure. Aim for half your weight in ounces of fluid daily (80 oz for 160 lb person). 

In addition to dietary changes, regular exercise and stress management also play a role in treating and preventing hypertension. Instead of a lifestyle overhaul, pick one or two goals to focus on and once those become a habit, move on to the next goal to conquer.

Sources:

CDC: Americans Consume Too Much Salt - http://www.cdc.gov/features/dssodium/

American Heart Association: Potassium and High Blood Pressure- http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/Potassium-and-High-Blood-Pressure_UCM_303243_Article.jsp

Clinical tests more valuable than scale to gauge health

Health is much more than the number you see on a scale or your dress size. At Superior Sustenance (www.superiorsustenance.com), the goal of improving your health requires use beyond the typical tools of the dietitian trade. Changes in blood pressure, cholesterol and body measurements all motivate you to continue dietary and lifestyle changes even if the scale refuses to budge. Remember, you can be unhealthy internally even if you are at a healthy weight. 

Here is a list of recommended tests or vitals to obtain from your primary care doctor. It is recommended to get a baseline of these prior to making any diet or lifestyle changes and then monitor the values every 3-6 months. If you are taking medication for blood pressure or cholesterol, you may need to have your doctor follow up on these more regularly to make medication adjustments.

Please note that blood tests should be done fasting (no food or drinks besides plain water) for 10-12 hours.

• Blood pressure - while stress and genetics play a role in blood pressure there are dietary and lifestyle changes that will dramatically decrease levels. A few changes can prevent high blood pressure or lower your levels if already elevated. 
• Serum Cholesterol (total cholesterol, triglyceride, HDL and LDL cholesterol) - Cholesterol levels are very sensitive to recent meals so accurate results are obtained only when fasting for a minimum of 10-12 hours. Again, dietary changes can significantly reduce risk of heart disease by improving cholesterol. And contrary to popular belief, cholesterol in food that is consumed has actually very little to do with the cholesterol found in your blood. 
• Fasting insulin and glucose levels - whether diabetic or not, these levels can shed light on what the composition of your meals should be. Insulin resistance can cause intense food cravings and make it difficult to lose weight (as insulin promotes fat storage). Even normal weight individuals can have insulin resistance but diet, exercise and certain supplements (if needed) can improve insulin sensitivity. 
• Complete Blood Count - Can unveil anemia or risk for anemia. 
• Complete Metabolic Profile - Shows protein level in the blood which is a sensitive marker of inflammation as well as electrolyte levels. 
• Ferritin - Ferritin is the storage form of iron. If the body is depleting stores, you can make dietary changes to increase iron and prevent anemia. 
• Vitamin D - This 'vitamin' is actually a hormone and research is exploding in linking deficiency to various health ailments. Ask for 25-hydroxyvitamin D levels to be checked as this form is the most accurate indicator of vitamin D status in the body. 

Depending on your current health history, medications or personal concerns, this list may change, but this is a good starting point for the average person. A dietitian or other health professional can give you specific recommendations based on your individual needs. 

Beware of Junk Food Under Healthy Disguise

Most people know that French fries are not going to help you meet your health goals, but there are TONS of food products out there that may look or claim to be healthy. If you carefully examine the nutrition label, you’ll find it is really just junk food in disguise. Here are some examples and how you can shop wiser and get healthier.

Granola: Sure, oatmeal is a whole grain, loaded with fiber which helps you stay full and lowers cholesterol but what most people fail to see is how calorie dense granola is, meaning it contains a lot of calories in a small amount. Take a look at a serving size and you will find that a measly ¼ cup (4 tablespoons) contains 120 calories and 3 grams of fat (for Bear Naked Fit granola). Doesn't sound so bad until you take into consideration that people typically eat about 1 cup of cereal, which would be 480 calories and 12 grams of fat. 


Try this instead: 1 cup of plain, cooked oatmeal which is 120 calories and 2 grams of fat. Add some fruit or a drizzle of honey to sweeten it up and pair it with high protein eggs or yogurt to round off the meal.

Diet Juices: While fruit juice contains more vitamins than soda, the sugar content is nearly identical. Anyone that has made fresh-squeezed orange juice knows how many oranges it takes to make just 1 glass. Like granola, a small serving size packs a big calorie punch. So what do food manufacturers do? They make lower sugar versions, which means they take juice and dilute it with water and usually add an artificial sweetener to make up for taste. 


Try this instead: Buy 100% juice and dilute it yourself with water at home, but 1 cup (8 oz) is about as much as the width of 4 fingers. Standard glasses are at least twice the size. Measure it out in a measuring cup to really see how little a serving is. Better yet, at fresh fruit to regular or sparkling water. You will get a different flavor without any additional calories. 

Dried fruit: Hear me when I say that fruit is good for you. It provides necessary vitamins and minerals as well as disease-fighting antioxidants. BUT sugar and extra oils is almost always added to dried fruit. And the rare cases when it is not, the serving size is much smaller than fresh fruit (1/4 cup of raisins = 1 cup of grapes). Sounds like a duh moment, but volume plays a big part in making you feel full. 


Try this instead: Choose fresh fruit over dried and you will feel fuller on fewer calories.

Frozen fruit:  Some frozen fruit, particularly berries, have sugar added to them. Check the ingredients to make sure that all you see listed is just fruit. Sucrose or fructose are different names for sugar, don’t be fooled!


Try this instead: unsweetened, frozen fruit. Or buy fresh fruit when on sale, wash, dry and freeze yourself. 
Wheat bread: Before you gasp and refuse to read anything else, let me clarify: wheat bread is NOT the same as WHOLE WHEAT BREAD. Tricky, little food manufacturing devils cause this confusion. Contrary to popular belief, you cannot tell if your favorite sandwich companion is wheat by its color. White whole wheat bread has similar benefits to whole wheat bread, it is just made from a different type of wheat. However, many companies use enriched flour, made with some wheat and some refined flour to make bread. It has less fiber and vitamins and minerals than whole wheat bread. Before fiber was added to every food under the sun, you could look at the fiber content to recognize which bread was whole wheat and which was enriched/refined, but now fiber is added to enriched products. The only way to be sure what you are getting is whole wheat is to look at the ingredients. The first one item listed should have the word ‘whole’ in it; whole wheat flour or whole grain flour. If it lists enriched flour then put it back on the shelf.


Try this instead: Check out your local farmer's market or natural food store for freshly whole grain bread. It does not last as long as enriched breads, so you may want to refrigerate or freeze part of the loaf depending on how much bread you and your family eat. 
Protein bars: If you haven’t noticed a running theme yet, many processed foods are the culprit in junk food's disguise. Any level of processing has the potential to remove beneficial nutrients and add calories or preservatives. Protein bars are no exception and fall into one of two catagories: nasty tasting cardboard, covered in what appears to be chocolate but tastes like wax; or a candy bar. The former may have a more appealing nutrition facts label, lower in calories, but it tastes horrible. And the latter, well is self-explanatory. Candy and weight loss go together like oil and water. What the two catagories have in common is a host of ingredients you and I can’t pronounce, which equates to heavy food processing and little nutritional benefit. 


Try this instead: Choose a small handful of raw nuts instead when you are pressed for time.

Peanut butter:  I love nut butters, almond is my personal favorite, but many traditional peanut butters are loaded with hydrogenated oils (increases bad cholesterol) and sugar, which take away from what would otherwise be a healthy addition to a meal or snack. You may have tried the ‘natural’ versions, but be sure to read the label and avoid any with hydrogenated oils and lots of extra sugar. 


Try this instead: Natural nut butter without hydrogenated oils or significant amounts of sugar. Store nut butters upside down in your fridge to prevent the oil from separating out.

If you see an item with claims that it is low-fat, low-sugar, low-carb, gluten-free or that something healthy is added to it, like whole grains, fiber, calcium, magic pixie dust… whatever it may be, BE SKEPTICAL. Remember the low-fat craze, when Snack Wells cookies made low-fat cookies? They were loaded with extra sugar. If you are going to take something out of a product, then to make it palatable, something else has to be added. The substitution may impact the nutrition content negatively as can adding something healthy to a product. For instance, when calcium is added to orange juice. Orange juice is thought of as a drink high in vitamin C. SIDENOTE: It’s actually not, because vitamin C is easily oxidized, meaning that as it is exposed to oxygen, the amount of vitamin C decreases. Depending on how it is made, stored and how long the container is open all impacts how much vitamin C is actually available. But that aside, vitamin C and calcium COMPETE for absorption in the body. So, by adding calcium, you are decreasing your ability to absorb either nutrient effectively; making it relatively pointless to consume it at all.

Bottom line: Stick with whole, minimally processed foods as much as possible. Read labels carefully and keep your eye out for health claims that may be too good to be true!

Weigh in on QNEXA

Hopefully, this drug will fail before taking off and making pharmaceutical companies BILLIONS of dollars, but just in case, I am writing this as a warning to those who are considering the drug for personal use. And if you know better, at least illustrate how important it is to research medications, supplements and herbs before you trust regulatory agencies that it is safe.

Contrary to statements made by Vivus, the manufacturer of QNEXA, about their concern on rising obesity rates, their only concern is the bottom line. The more they can cloud the truth and make this drug appear safe, the more money they get in the end. But if you succumb to their deception, the things you are likely to lose is your money and possibly your health, but not excess weight.

I base my position on this from a few different perspectives. First of all, my education. As much as one would like to believe that taking a pill will cure obesity, my two degrees in Nutrition have taught this much - obesity is multi-faceted problem, no one solution will fix it for everyone.  Superseding the body’s natural regulation of hunger (which is the mechanism for QNEXA) will only go so far since there are numerous reasons of why we eat what we do, that go beyond these physiologic cues. Secondly, my experience. I work with patients who have epilepsy and many are on topiramate, one of the drugs used to make QNEXA. I’ve seen the side effects first hand and while it is successful at decreasing appetite and inducing weight loss it comes at a cost. I’ve also worked with adults and children to promote weight management. Everyone is different and success at achieving a healthy weight needs to be addressed as such. Finally, but most important, research. After reviewing the results of the trials and researching the side effects of the drugs used, I’ve concluded that the risks far outweigh the benefits.

QNEXA is described my Vivus as a drug intended to be used by overweight or obese candidates, based on a BMI >27 kg/m² AND also must have co-morbidities associated with obesity such as high blood pressure, type-2 diabetes or abnormal cholesterol levels. While many Americans fall into the category of BMI >27, not all of them have these co-morbidities. The reverse is also true; many people have these conditions but are at a normal weight. According to a recent study published in the International Journal of Obesity, researchers found that 29% of people classified in the “normal” BMI range (<25), have heart disease risk factors similar to people who are obese. So, to say that QNEXA will make a significant difference in obesity risk factors is an overstatement, as its target will be only a portion of the obese population.

The pill itself is a combination of topiramate and phentermine, which are both FDA-approved medications. Topiramate is used for treatment of migraines and seizures and phentermine is a well-known drug for weight loss. The FDA originally denied approval of the QNEXA in 2010, stating that the risks associated with the drug were too high and long term effects were unknown, given that the trial was only 1 year. QNEXA extended the trial and gave the FDA advisory panel 2 years worth of data, which they have now surprisingly endorsed in a 20-2 vote. While the FDA does not have to take the advisory panel's recommendation, it is likely they will. So what changed the panel's mind?

The results of the Vivus trials averaged about a 10% weight loss in a year. For example, a 200 lb individual lost 20 lbs. Research shows that modest weight loss such as 5-10% of your body weight can reduce your risk of chronic disease. What is interesting is the sharpest drop in weight is seen in the first 4 to 8 weeks. The first 4 weeks subjects were being titrated onto the full dose, so they weren't actually receiving the full dose until week 4. Obviously, the subjects were geared up for the weight loss trial and were changing their diets and activity levels which resulted in weight loss. Even the placebo group experienced the same trend of weight loss initially, albeit not as great as the QNEXA group. The graphs of this can be seen on page 67 of the initial report from 2010 to the FDA (link is below). The weight loss continues to trend but begins to plateau after 6 months. Many people who change their lifestyle with the help of dietitians, personal trainers and organized programs such as Weight Watchers experience far greater results in much less time. Even if the weight loss was far greater, that completely avoids the issue of maintaining the weight loss after you stop taking the pill. As far as I could find, no trials have been done to see how long people were able to maintain the weight loss after they stopped taking QNEXA. The positive effects like decreased sleep apnea and lowered blood pressure can be explained by losing weight alone, the pill itself does not reverse those conditions. A magic bullet, QNEXA is not.

As for their risks, the manufacturers state side effects of faster heart rate and incidence of cleft lip or palate in children for women who become pregnant during the trial. They argue, that with education to health care providers to encourage birth control use and monthly pregnancy tests, this is controllable. Sounds reasonable. Except for the part where one of the many side effects of topiramate is that it makes birth control pills LESS effective! I’m curious to know how they justified that to the FDA.

Since we are talking about side-effects of topiramate and phentermine, let’s list them all out. Topiramate can cause decreased appetite and weight loss, but for some also increased appetite and weight gain! It can also lead to nausea, diarrhea, constipation, changes in how food tastes, indigestion, dry mouth, gingivitis, abdominal pain, decreased liver and kidney function, tremors, confusion, mood changes, nervousness, depression, back pain, apathy, fatigue, weakness, muscle pain, edema and menstrual changes. Phentermine can cause nausea, vomiting, diarrhea, constipation, can increase blood pressure and heart rate, tremors, dizziness, headache and insomnia. Phentermine can also be habit-forming and it is recommended to avoid alcohol and caffeine. It is also noted to be used with caution in those with diabetes as it can alter diabetes medications.

I lost my appetite just reading those side-effects.

To sum up, QNEXA claims to reduce risks associated with obesity, yet the two drugs used to make QNEXA are cautioned against being used in that very population! It is targeted to treat people with conditions that are contraindicated (diabetes and high blood pressure). The fact that this was completely disregarded by the FDA is frankly, frightening. Yes, obesity has its risks and treatment is important, but the QNEXA drug has the same risks, if not to an even higher degree. If this were the only option to help people improve their health, then I would understand accepting the risks, but there are other tried and true methods and QNEXA is not one of them. This is plain and simple all about money. And no amount of money is worth your life. 

FDA Bless Weight-Loss Pill http://online.wsj.com/article/SB10001424052970203960804577239642544675320.html

Zaneta M. Pronsky, MS, RD, LDN, FADA . Food Medication Interactions. 13^th Edition, 2004.

Qnexa Advisory Committee Briefing Document. July 2010.
http://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/drugs/endocrinologicandmetabolicdrugsadvisorycommittee/ucm218821.pdf

Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. International Journal of Obesity (2012) 36, 286–294; doi:10.1038/ijo.2011.100; published online 17 May 2011 http://www.nature.com/ijo/journal/v36/n2/abs/ijo2011100a.html

Vitamin C Controversy

Feeling sleepy, achy and a tad congested has me at home today. As I sit drinking a cup of tea and resting to prevent whatever my body is fighting off from becoming a full-fledge illness, has me thinking of alternative treatments. I work with children with special health care needs and I regularly hear parents ask what they can do to prevent illness. The common cold or the flu may have the average person feeling miserable for maybe a week, but these sicknesses for a medically compromised child can wind up in a trip to the ER and a hospital admission. Beyond reducing exposure to germs and good hand hygiene, what else can you do?  

The controversy over vitamin C and its benefits in fighting the common cold has dominated since the 1970’s. Studies seem to be split on the ability for vitamin C, taken daily to prevent colds or therapeutically during illness, to be of any benefit. Anecdotally, people claim vitamin C to work wonders even beyond the realm of immune boosting capabilities. It is likely to be one of the most commonly taken supplements aside from a regular multi-vitamin. But do the claims stand up to evidence? And if the research is inconclusive is there really any harm in taking it?

The Cochrane Library published a review of research done on vitamin C and colds and concluded that prophylactic doses, or daily supplementation meant to prevent illness, of 200 mg or more was effective in reducing the duration of illness. The review of 29 studies found that in adults, vitamin C reduced the duration of a cold by an average of 8% and in children 13%. Placebo-controlled studies analyzing the therapeutic effects of vitamin C are few and far between. Only 7 studies were found that compared vitamin C and a placebo to cold symptoms and the results showed no significant differences in the length of illness or severity of symptoms.

While vitamin C may help, but the extent seems minimal. There are a variety of other factors to consider that many research studies do not take into account. Activity level, quality of overall diet and medical conditions all impact one’s immune system. Taking vitamin C supplements will not compensate for a poor diet or sedentary habits. Not to mention that nutrient needs vary for each individual. Lifestyle factors like stress and smoking may increase need for certain nutrients including vitamin C.

But when we look at any potential harm of supplementing vitamin C, aside from the financial cost of supplementing if you really don’t need it, the risks are minimal. Large doses of vitamin C can cause diarrhea, but decreasing the dose solves the problem.

Do I think that vitamin C is the cure-all for the common cold? No. Do I believe it plays a role in our immune systems? Absolutely. But so do vitamin A, D, iron and protein. Besides adequate nutrition, stress management and proper sleep is important as well. For myself, I’ve noticed sleep to be the primary key for staving off illness. So for now, I’ll stick with my routine of healthy eating, exercise and rest and hopefully keep this bug at bay!

References:

Vitamin C for Preventing and Treating Common Cold. Cochrane Library. March 2010.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000980.pub3/abstract

How to boost your immune system. Harvard Health Publications. http://www.health.harvard.edu/flu-resource-center/how-to-boost-your-immune-system.htm