You may or may not have heard about the latest recommendations from the government advisory board, the Institute of Medicine’s (IOM) U.S. Preventive Services Task Force. News headlines over the past two days have read: women who are postmenopausal should not take vitamin D and calcium for bone health – these supplements do not prevent fractures. Did the IOM get this right?

The IOM states that, “Vitamin D and calcium supplements do not prevent fractures in adult men or women, according to a report published in the journal Annals of Internal Medicine.” Side note: statin drugs do not lower the risk of heart attack or frequency of heart attack and yet, I have heard no such recommendation to remove statin drugs. But yet, I do digress.

The topic of bone health is an important one for women and men. The often conflicting recommendations made regarding what to take and what not to take on the evening news, simply increase consumer confusion. To best manage your healthcare, find a health care practitioner that you feel is a partner in your health. The two of you will decide the right course of action.

I had the pleasure of attending a lecture by Dr. Michael McClung in Portland last year, speaking on bone health “Current Issues and Conventional Treatment Updates in Osteoporosis.” Dr. McClung is a member of the global advisory board on osteoporosis and bone health.

It was an interesting lecture. He spoke to a large group of naturopaths, nutritionist, etc (all grouped as ‘alternative practitioners’). It is always interesting comparing the approach of MD versus ND. I personally have a pet peeve regarding my certification being lumped under ‘alternative practitioner.’ If all practitioners addressed clinical nutrition needs, we would have far less need for medications.

Dr. McClung’s view point was an interesting one; made even more interesting after I heard of this latest recommendation from the advisory board. During his presentation he made the following points:

1. The Institute of Medicine (IOM) states that 20ng/ mL Vitamin D levels are adequate in the body.
2. Cautions about going over 30ng/ mL
3. Most labs report ’20-30ng/ mL’ as standard adequate range
4. Studies looking at vitamin D levels have not focused above 30ng/ mL. The max seen in the studies is 22ng/mL (*note this level, this is an important point in this discussion). The studies used 200-800IU (800IU max) vitamin D as a daily supplement level to bring levels to 20ng/mL and called this a ‘repleted’ level.

I asked Dr. McClung a question, ‘What level of vitamin D do we see in surfers and farm workers (those out in the sun constantly).’ His reply, ’50-80ng/ mL.’ So, why the shortfall? Why not consider 40-50 ng/mL as a more ideal range for vitamin D levels versus 20ng/mL? His reply to me, ‘We are talking about supplementing and not getting this from the sun.’ This last answer didn’t sit very well with me. If someone is iron deficient, we bring their iron levels back up with supplements. If B12 deficient, we offer shots or supplements to bring their levels back up. We are simply not in the sun as much as we once were. Sun screen is in makeup and is overused whenever the sun makes an appearance (however brief) and we are working more and more hours indoors. In the Northwest, there are 2.5 months during the year that we can absorb and convert vitamin D from the sun’s rays. These all reduce our chances of building adequate levels of vitamin D.

So, when you hear these new recommendations to stop taking calcium and vitamin D because they do not improve bone health or reduce factures, it has to be put into context. The doctors that made this recommendation are looking at 20ng/ mL of vitamin D – nowhere near the level of vitamin D that the body would naturally prefer to regulate itself at 50-80ng/mL (if offered adequate sun exposure).

“Everyone wants vitamin D to be the new magic bullet to prevent all kinds of chronic disease, but the evidence is inconsistent and inconclusive at this time to warrant levels beyond our recommendations,” says Harvard’s JoAnn Manson, PhD, MD, and member of the Institute of Medicine (IOM) vitamin D and calcium committee. Interesting side note: well-known Harvard physician Dr. Walter Willet, wrote a rebuttal to the IOM findings, stating that their calcium recommendations were too high (we’ll get to this in a minute) and the recommended vitamin D levels were too low.

Vitamin D levels with respect to mortality are mapped as a ‘J curve.’ If a person’s vitamin D levels are under 20ng/mL their risk for mortality goes up. If over 80mg/ mL their risk for mortality goes up. It simply does not make sense that we would assume that at 20ng/mL a person is repleted. This may be the very, very low range of repletion and yet not the optimal range, which is likely closer to 40-50ng/ mL.

If you remember back in 2010, this same advisory group recommended an increase in the daily vitamin D dose from 200IU to 400IU. Again, in context, this makes sense. The majority of studies done in this area are looking at 200-800IU of vitamin D and 20ng/mL as a repleted level. Why are they doing this? Dr. McClung said that they came to this conclusion, that 20ng/mL was a repleted level, because, “this is the current average vitamin D levels for Americans.”

So, if we are all depleted, this is the new standard that we compare to? How scientific is that?

The new IOM recommendations for vitamin D:

1. Ages 1-70: 600 international units (IUs) per day. Older than 71: 800 IUs. The IOM previously said 200 IUs was adequate for people aged 50 and younger, 400 IU for people aged 51-70, and 600 IUs for people older than 70.
2. The tolerable upper limit (UL) is 4000 IUs for ages 9 and above (up from 2000 IU in the IOM’s previous guidance).

To note, the IOM committee has made this recommendation to postmenopausal healthy women with respect to bone health and fracture risk. One glaring issue here is the huge body of evidence that shows the important role of vitamin D in the body beyond its role in whether it prevents facture risk (at 20ng/mL vitamin D). The body makes vitamin D when exposed to sunlight. But the IOM committee didn’t factor that into the recommendations, because many factors (including, skin color, and geographic location) affect that process. Nor did the committee make any recommendations regarding supplements. To put this all into perspective, your body can produce 10,000IU units of vitamin D per hour from unobstructed sun exposure.

There has been evidence that higher vitamin D levels increase bone density. In the very large population-based NHANES analysis, bone density increased with higher vitamin D levels far beyond 50 nmol/l (20 ng/ml) in younger and older adults. This is further evidence that the IOM threshold recommendation is too low for optimal bone health in adults.

The IOM’s findings are controversial among many medical doctors. In his book, The Vitamin D Solution, Michael Holick, PhD, MD, author and vitamin D researcher, recommends an upper limit of 10,000 IUs for adults and 5,000 IUs for children. Robert Heaney, MD, a vitamin D researcher and Creighton University professor, agrees with the IOM for raising the upper limit of vitamin D from 2,000 to 4,000IU but would like to see it even higher, stated, “I am delighted the upper limit for vitamin D has been doubled to 4000 IUs per day, although this is a conservative level, considering the body of scientific evidence indicating it should be 10,000 IUs,” Heaney says. “However, few people need more than 4000 IUs, which will meet the needs of most healthy people, give physicians confidence to recommend supplementation, and allow research at higher vitamin D levels.” This last point is important. Just like vitamin E in the alpha-tocopherol from is the form most often used in studies (based on guidelines laid down by government advisory boards) so too are the levels of vitamins used in studies. Meaning that, the bulk of studies will not look beyond using 2,000IU of vitamin D if the IOM states that the upper limit of vitamin D per day is 2,000IU. Now that it has been raised to 4,000IU, larger doses of vitamin D will be used in studies.

Let’s talk calcium…

The new recommendations of the IOM call for a calcium:

1. 700 milligrams (from all sources, mainly food) for children ages 1 to 3 up to 1,200 milligrams for women 51 and older.
2. Compared to the last IOM report, calcium recommendations remained largely the same with a small reduction for men age 50 to 70 to 1,000 from 1,200 milligrams per day. The panel confirms a safe upper limit of 2,000 to 3,000 milligrams of calcium per day for adults.

This is in contrast to what you heard on the news.  The headline that I led with in this article is the same headline that all the major news casts led with: “Women who are postmenopausal and looking to improve bone health should not take vitamin D and calcium – these supplements do not prevent fractures”

At the conference in Oregon, Dr. McClung made these following points about calcium:

1. If vitamin D deficient and taking calcium supplements, there is an increased risk of side effects (heart attack among them)
2. The max calcium intake per day should be around 1200mg/ day (including food)
3. If a person is dairy free, assume they are getting 300 mg/ day calcium from their current food sources
4. So, The max calcium intake from supplements per day should be 500-600mg

I do agree with Dr. McClung’s recommendations for calcium supplementation. I feel that the IOM’s recommendations are too high. We do get some calcium from food. Instead of looking at large single nutrient supplementation, we need to first consider food sources (what the person is getting from food), second consider focusing on food sources (so they can increase their intake of the nutrient from natural sources) and third, consider the blend of nutrients that will best support health. Nutrients are rarely consumed in large single doses. There are 19 key nutrients in bone building – calcium is just one among them.

For example, the type of vitamin E in most supplements is ‘alpha-tocopherol.’ There are many forms of vitamin E. Alpha-tocopherol, beta-tocopherol, delta-tocopherol and gamma-tocopherol are among them. When vitamin studies are done, vitamin E in its alpha-tocopherol form is used. When alpha-tocopherol is given in large doses, one effect is that gamma-tocopherol levels decrease in the body. Gamma-tocopherol inhibits platelet aggregation (when platelets form in an artery, plaque buildup occurs). So, studies based on vitamin E (alpha- tocopherol form) are shown to increase instances of plaque buildup in the arteries, which increases heart attack rise. The conclusion is: ‘Vitamin E increases plaque buildup and risk for heart attack.’ When, in reality the study design that was flawed. Vitamin E should rarely be taken in one form. When taking a vitamin E supplement, the best choice is to take a ‘mixed tocopherol vitamin E;’ one that contains all forms of vitamin E.

This same point holds true for the flawed nature of supplement studies; those on calcium included. Based on flawed analysis, one meta-analysis concluded that calcium supplements increase heart attack risk by 27%. Excluded from these studies were people who took vitamin D, magnesium or other nutrients typically found in bone protection formulas. In other words, calcium-supplemented study subjects (who the analysis claims suffered higher heart attack rates) may have been deficient in vitamin D and magnesium — two essential nutrients that protect against heart attack.

The doctors who compiled this analysis also dismissed two major clinical trials showing that those with higher calcium intake had significantly lower cardiovascular rates (NHANES analysis referenced earlier in this article). I do want to emphasize, however, the need to supplement with other nutrients when taking calcium for optimal effect.

As we age, the body’s internal regulators of calcium deposition become less efficient. New studies have uncovered a deficiency of vitamin K as being a factor that enables calcium to infiltrate the inner lining of arteries to cause arterial calcification. Consider the person on a typical American diet who is taking large doses of calcium, say 1500mg/ day and who is not getting in adequate magnesium (nuts and seeds), vitamin D (lack of sun) and vitamin K (dark leafy greens). This person may be at higher risk for arterial calcification AND be at greater risk for osteoporosis because there are 19 synergistic nutrients that work to support bone health in the body (most of which are not going to be provided in a typical American diet).

By ensuring optimal vitamin K status, calcium is directed to the bone and away from the arterial wall. With new studies showing the effectiveness of K2, vitamin K (in the form of K2) should be added to a therapeutic regimen. In a previous FORUM posting on osteoporosis, you may have noticed that I recommended a supplement protocol that included K2 (vitamin K), calcium/ mg in a 2:1 ratio (600 mg calcium: 300mg magnesium), and 2000IU vitamin D3.

Magnesium is a critical nutrient for bone and cardiovascular health. Of interest, magnesium is considered a natural calcium-channel blocker that supports endothelium-dependent relaxation of blood vessels. For optimal bone AND cardiovascular health, a combination calcium, magnesium, K2 and vitamin D offers a balanced support.

Optimal bone health and protection against atherosclerosis requires a multifactorial approach that involves far more than taking only calcium in large doses. The recently published meta-analysis, does offer one valuable lesson – large doses of single nutrients (vitamins OR minerals) do not often evoke the desired response and may even be harmful.

Angela Pifer, Certified Nutritionist with Nutrition Northwest. Seattle Nutritionist

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Yesterday, both the FDA and Sen. Dick Durbin (D-IL) dropped policy “bombs” on those of us who use dietary supplements. It is no mere coincidence that both were released on the Friday before a holiday weekend.
By timing the introduction of their anti-supplement legislation and regulatory guidance this way, the FDA and Sen. Durbin are both hoping to evade negative publicity. We think it is better to keep American citizens fully informed, and with your help, we will get the word out. Please send this communication far and wide.

First, the FDA has issued draft guidance for complying with the New Dietary Ingredient (NDI) notification protocols contained by the Dietary Supplement Health and Education Act (DSHEA). As you may recall, DSHEA said that supplements already on sale prior to the passage of the act were “grandfathered” in, and did not have to be reviewed by the FDA. New supplements developed after the Act have been in a kind of limbo
waiting for the FDA to spell out the procedures to be followed.

These new supplements have always been at risk because of the uncertainly surrounding their regulatory status. And many of these new supplements are extremely important for our health. We won’t name them, because to do would be to put a bull’s-eye on them for the FDA to shoot at, but you would recognize many of them and may be currently taking them.  DSHEA was passed in 1994. The FDA has thus taken seventeen years to provide regulatory guidance for these new supplements. Now a draft version of guidance is here, and it isn’t good. It is just another effort by the FDA to suffocate the supplement industry so that everything—supplements and drugs alike—will go through the vastly expensive drug approval process, a process that pays for FDA salaries. We have said it before and we will say it again. Supplements cannot usually be patented. No non-patentable substance can be taken through a drug approval process that on average costs a billion dollars. If supplements are treated like drugs, there simply won’t be any supplements. The FDA knows this perfectly well.

The new draft guidance is written in the usual regulatory non-English, but buried within it are definitions of “new supplements” that will make more and more supplements subject to the new rules. The rules themselves are designed to make it harder and harder to market new supplements, all of which will need to submit notification to an agency that is fundamentally hostile to the supplement industry. Not only does each supplement require its own notification, a separate notification must be submitted by each company that offers it. Additionally, notification must be submitted again if the supplement is reformulated in any way or offered in combination
with any other supplement or ingredient. Based on what the FDA has done in the past, many more applications will be rejected than accepted and the cost of the whole process will be high.

The FDA is required to give us 90 days to comment on their proposed guidance. Our experts are busy analyzing the proposal in all its detail and we will report on it again and provide an Action Alert in our next newsletter right after the holiday. We already know this needs to be stopped. With your help we will do everything we can to change it. Your ability to use supplements not already documented as having been on the market under
the same exact name and formulation prior to 1994 will depend on it.

As we mentioned above, Sen. Durbin’s much-feared Dietary Supplement Labeling Act of 2011 (S.1310) has been formally introduced in Congress. The language is not available online yet, but the draft procured by ANH-USA yesterday reaffirmed the analysis we sent you earlier this week. Look for our in-depth article and Action
Alert on S.1310 in our newsletter on Tuesday, July 5th!

The Alliance for Natural Health USA
1350 Connecticut Ave NW, 5th Floor, Washington, DC 20036
www.anh-usa.org

Both the U.S. Department of Agriculture’s icon and its recently released dietary guidelines ask Americans to limit their intake of sweeteners and fat- and cholesterol-heavy products, including meat and dairy, and to eat more fruits and vegetables. But more than 60 percent of agricultural subsidies in recent history have directly and indirectly (corn production for feed) supported meat and dairy production. Less than 1 percent goes to fruits and vegetables.

Angela Pifer – Certified Nutritionist

Offices in Bellevue, Woodinville and Seattle

Corn Sugar – doesn’t this sound harmless, unprocessed and natural? In fact the corn industry has already started marketing with this term by creating a new website and has commercials saying, “High fructose corn syrup HFCS — corn sugar — has been used in the food supply for more than forty years to make high fiber foods palatable, maintain freshness and enhance flavors in foods and beverages. Additionally, high fructose corn syrup keeps our foods affordable.” Audrae Erickson, president of the Washington-based group, says that the new name would help people understand the sweetener. Really?

I am not sure how renaming this product will help people better understand it. Instead the industry should take the time to educate people on the difference between HFCS and sugar. Both compounds contain two simple sugars, fructose and glucose. The difference between these two compounds is that sucrose is 50% fructose and 50% glucose. HFCS is made up of 55% fructose, 42% glucose and the remaining 3% are higher saccharides, larger sugar molecules. The fructose in HFCS is more easily absorbed and utilized because it is free and unbound (in sucrose, every fructose is bound to a glucose molecule and must go through an extra metabolic step before it can be utilized in the body). When fructose is quickly absorbed and metabolized, it is done independent of insulin. Though this may sound like a good thing, it is not. If insulin is not signaled and released then leptin is not signaled and released (a key signaling hormone that regulates food intake and body weight). When this signaling system is bypassed, the body will continue to crave food. Studies have shown that beverages with added sweeteners may enhance caloric overconsumption.

The industry should offer statistics on the amount of HFCS people consume and its availability:

• On average, Americans consume 60 pounds of HFCS per person per year.
• HFCS accounts for 40% of caloric sweeteners in the United States.
• The consumption of HFCS increased more than 1000% between 1970 and 1990, far exceeding the changes in intake of any other food or food group.
• The increased use of HFCS in the United States mirrors the rapid increase in obesity.

Instead of starting a new site and using the name corn sugar (prior to approval by the FDA) they should start a site that talks about recent studies published on HFCS. Until now, the majority of studies have been short term studies and the results have been mixed. A new study from Princeton researchers published in February 2010 looked at both short term and long term affects of HFCS on body weight, body fat and triglycerides. The study showed that over the course of 6-7 months mice that had 24 access to an 8% HFCS “drink” and mice chow gained significantly more body weight (specifically adipose fat in the abdominal region) and had elevated triglyceride levels. Previous studies from Princeton has firmly established that if you give rats access to a 10% table sugar “drink” in addition to their normal feed (mice chow), they do not gain additional fat. In other words, their bodies are able to metabolize the extra calories without creating more weight.

The take home message? Sucrose is not ‘better’ than HFCS, other than it is natural and we can metabolize it. If weight loss is your goal, keep all natural sugar intake to a minimum and remove every bit of HFCS from their diet. Limit the intake of natural sweeteners like honey, agave nectar and real maple syrup.

How to spot added sugar on food labels

Sugar is easy to spot on an ingredient label. Look for words ending in ‘ose’ (flucose, fructose, lactose), this indicates sugar. The following terms also indicate added sugar:

• white sugar
• brown sugar
• icing sugar
• invert sugar
• corn syrup
• high fructose corn syrup
• maple syrup
• honey
• molasses
• brown rice syrup
• cane juice
• evaporated cane juice
• all fruit juice concentrates, including apple and pear

Angela Pifer, CN Seattle Nutritionist

Seattle Weight Loss Programs – Get Results!

If you have high cholesterol, chances are you were instructed to reduce your intake of total fat, specifically animal fats, from your diet, become more active and to work on weight loss. What you weren’t told is that you should also address your sugar intake. A new study published in the Journal of American Medical Association looked at the blood profiles and sugar intake of more than 6,100 adults (whose demographics were representative of the American population). On average, study participants consumed 21.4 teaspoons of sugar a day (24 teaspoons equals ½ cup!). Those who took in more sugar had lower levels of HDL (‘good’) cholesterol and higher levels of triglycerides. It seems that the message is clear, added dietary sugar is connected with poor lipid profiles.

This is the first study to look at the connection between how much added sugars and ‘empty’ calories people consume and the effect on blood lipid profiles. Some factors for heart disease, like family history, cannot be changed. By identifying added dietary sugars as a contributor for a poor lipid profile people at risk can now begin to address what can be changed.

In addition, the study found that:

• On average, people consumed 10.6% more calories from sugar a day than they did in the 1970’s.
• The higher the intake of added sugar, the lower the person’s HDL (“good”) cholesterol. Participants consuming 10% of total calories from added sugar had three times the risk of having low HDL than someone who took in half that much sugar.
• Participants with a higher intake of added sugar tended to have higher triglyceride levels as well.
• **Women who took in more added sugar also had higher LDL (“bad”) cholesterol.

How much Added Sugar is Too Much Sugar?

To make matters more confusing, medical and health organizations do not agree on a current recommendation. Depending on whom you ask the daily consumption of added sugars should fall below:

• 25% , according to the Institute of Medicine
• 10%, according to the World Health Organization
• 6% or 7%, according to the American Heart Association

The Type of Sugar Matters

Though it would seem that Americans are eating a lot more sugar now than they did forty years ago, they are not. Sugar calories are up just 10% over those consumed in the 1970’s. What is different is the type of sugar people are consuming. In the 1970’s people consumed on average 343 calories a day of refined cane and beet sugar and only 2 calories from high-fructose corn syrup (HFCS). High-fructose corn syrup has now risen to 41% of Americans total sugar intake. It is also the single most consumed caloric nutrient for the American Population.

The Cost of Calories

One of the reasons Americans are eating more calories from high-fructose corn syrup today than in the 1970’s is due to government incentives on corn production and tariffs on sugar. It is simply less expensive to produce HFCS than it is to produce cane or beet sugar.

A person might expect that added sugars, along with other food groups, have increased equally over time in response to inflation. That person would be wrong. The inflation-adjusted cost of added sugars has dropped by half since 1970. This change can be credited to the steep rise of low-cost ‘foods’ containing high-fructose corn syrup over the last thirty years.

Over the past forty years, the price of added sugars has dropped significantly more than the purchase price of each food group:

• Fruit sources: 30% increase
• Vegetable sources: Unchanged
• Grain sources: 29% decrease
• Dairy sources: 38% decrease
• Fat sources: 38% decrease
• Protein sources: 50% decrease
• Sugar sources: 50% decrease

What Can You do?

• Read nutrition labels and take note of how much added sugar you consume.
• Reduce or replace foods containing corn syrup, high-fructose corn syrup, cane or beet sugar or sucrose.
• Replace soda with water, sparkling water or mineral water.
• Choose whole foods whenever possible. Fruit is a perfectly healthy addition to your eating plan. Eat frequently across the day and incorporate into green salads and grain dishes.
• Be patient. As you move away from sugar added foods it will take some time for your taste receptors to lower for perceived sweetness. Whole foods may taste a little bland at first, but as your taste receptors begin to adjust you will be able to taste the sweetness in real whole foods.

Angela Pifer, MSN CN Seattle Nutritionist

Seattle Weight Loss Programs that Get Results!

For nearly three decades, obesity, heart disease and high cholesterol, have been linked to the fat content in the American diet. Regrettably, the low fat foods of the 80’s have not resulted in healthier weights. In fact, quite the opposite has occurred, the obesity rates for Americans have doubled in the last 20 years, coinciding with the arrival of the low-fat revolution. With all the conflicting messages in the media and policies handed down by the government, which type of diet is the right diet? Let’s explore the trends of the past few decades and take a look at the affects of lowing or increasing fat, carbohydrates and proteins on the American waistline and identify the right approach to eating healthy.

In 1964 Americans ate 39 percent of their calories from fat and only 13 percent were obese. Now, while most Americans get only about 33 percent of their calories from fat, two-thirds, more than 190 million Americans are overweight or obese.  New studies are showing that the type of fat consumed is more important than the total fat consumed.

Studies show that Americans today consider low fat content as the most important factor when they buy food and read food labels. The actual number of fat grams consumed per day has changed little since 1971 due to the increase in overall calories consumed daily. According to the National Health and Nutrition Examination Surveys (NHANES), American women increased their daily calorie consumption 22 percent between 1971 and 2000, from 1542 calories per day to 1877 calories. During the same period the calorie intake for men increased 7 percent from 2450 calories per day to 2618 calories.

Because of its prominence in fast foods and processed foods, it is now estimated that an astounding 20 percent of calories in the American diet come from a single fat source: soybean oil. In fact, refined vegetable oils, such as soy oil, are used in most of the snack foods, cookies, crackers, and sweets in the American diet as well as in fast food. These oils are sources of omega 6 fatty acids which increase inflammation. Before Americans relied so heavily on convenience foods, it is estimated that omega 3 and omega 6 fatty acid intake were roughly in balance. Today, omega 6 fatty acid intake far outweighs that of omega 3.

Omega 3 fatty acids reduce inflammation in the body. Unfortunately they are not as readily prevalent in the American diet; sources include walnuts, flax seeds, and fish.

This dietary imbalance may explain the rise of inflammatory related diseases like asthma, coronary heart disease, many forms of cancer, autoimmunity and neurodegenerative diseases, and has also been linked to depression, dyslexia and hyperactivity. Studies are now showing a strong link between the imbalance between omega-3 and omega-6 fatty acids, inflammation and obesity.

The low fat policy pushed in the 1980’s caused an increase in carbohydrate consumption. Women increased their carbohydrate consumption from 45.4 percent of daily calorie intake to 51.6 percent and men increased their calorie consumption of carbohydrate calories from 42.4 percent to 49 percent. During the same time, protein consumption for both men and women remained about the same. Total calories need to be addressed along with a focus on healthier fats.

Where should the blame be placed – is it portion sizes? The typical cheeseburger has more than 333 calories today than it did 20 years ago. Is it the overabundance and availability of convenience foods and overuse of soybean oil in our foods? How about government social policies, subsidizing corn, soy, wheat and rice, the main sources of processed foods, when compared to fruits and vegetables, which drives up the prices of healthy foods? What about personal responsibility?

Taking control of your health and weight is easier if you focus on gradual changes. The first recommendation offered here, ‘Balance out your calories across the day’ is the most important recommendations to help you reduce your overall calorie intake. You could simply choose to work on this recommendation for the next two weeks.

1. Balance out your calories across the day. Your goal is to eat ½ your calories before 1PM and the other ½ after 1PM. Work on the daily pattern: Breakfast, Snack, Lunch, Snack, Dinner. Specifically focus on eating your midmorning snack 10-10:30 and your midafternoon snack 3-3:30. (This will help you eat fewer calories in the evening, where most people tend to overeat on unhealthy options).

2. A healthy dietary model is 30-40% healthy fat: 40-50% complex carbohydrate: 20% lean protein

3. You will need to cut calories to lose weight. Move away from ‘diet foods’ offering low fat or non fat options and choose whole food options. If you see ‘high fructose corn syrup,’ ‘hydrogenated,’ or ‘soybean oil’ on the ingredients label, choose a different food.

4. Focus on healthy fats, raw nuts, seeds, nut and seed butters, avocado, and healthy oils, walnut oil, extra virgin olive oil and extra virgin coconut oil.

5. Eat a protein at each meal or snack. The presence of a lean protein source at each meal or snack will slow down the digestion of the carbohydrates you are eating. This will help keep blood sugars and hunger swings in check. I most often see protein neglected at breakfast and snack time. Add a 5 raw walnuts to your oatmeal or switch to a healthy whole grain breakfast cereal and have 12 raw almonds or 1 T almond butter (milk does not have enough protein to balance out the meal).

6. At snack time, pair up a carbohydrate with a protein serving: 75%: 25% visually. Snacks should be around 150-200 calories. (Example: an apple and string cheese OR 12 raw almonds OR 1 T nut butter). Whole fruit is best here, but you can replace this with 3-4 pieces of dried fruit (no sugar added). KIND Bars, Raw Organic Bars or Lara Bars stand alone as a snack (these have a nice balance of carbohydrate and protein).

7. Don’t replace food with coffee or other caffeinated beverages. Time and time again I see the same pattern: little to no breakfast, coffee midmorning, a late lunch and then the majority of calories come in around dinner time and into the evening. Caffeine suppresses appetite and will leave you hungrier and tired in the afternoon. If you must have your coffee, then have it along with your breakfast or snack midmorning.

8. We should all be increasing our intake of healthy omega-3 fatty acids. Include food sources of omega 3 fatty acids: walnuts, flax seeds, and fish and purchase a high quality omega 3 fish oil (be sure that it contains only omega 3 and does not include omega 6 or omega 9 – we get plenty of these fats). Use walnut oil or flax oil to replace extra virgin olive oil in homemade salad dressings.

Angela Pifer, MSN, CN Seattle Nutritionist

Seattle Weight Loss Programs – Get Results! Visit www.NutrionNorthwest.com

Angela works locally, as well as nationally through Skype.

New estimates place 12.5% of children as obese. Though most efforts target schoolchildren, new reports say this is not earlier enough. The best time to prevent weight problems may be in infancy and more likely, the womb, reports Roni Rabin in Tuesday’s Science Times. She writes:

New research suggests that interventions aimed at school-aged children may be, if not too little, too late.

More and more evidence points to pivotal events very early in life — during the toddler years, infancy and even before birth, in the womb — that can set young children on an obesity trajectory that is hard to alter by the time they’re in kindergarten. The evidence is not ironclad, but it suggests that prevention efforts should start very early.

Experts say change may require abandoning some cherished cultural attitudes. “The idea that a big baby is a healthy baby, and a crying baby is probably a hungry baby who should be fed, are things we really need to rethink,” Dr. Birch said.

During my time at Bastyr University I remember vividly the day in class when our professor told us that current studies were showing our efforts to reach school aged children were not enough. We (nutrition students) all gasped and looked at each other. How could this be? Most of us were going through school to help this generation and it seemed all for not. The more I have researched this, the more studies have revealed, the uterine environment should be the focus of our interventions.

Robin Rabin’s story eludes to the new efforts are being made to reach deeper into the development of the child, in utero, in the hopes that childhood obesity will be warded off.

To learn more, read the full story, “Baby Fat May Not Be So Cute After All”

Angela Pifer, MSN, CN Seattle Nutritionist

Seattle Weight Loss Program that gets results! Angela works locally as well as nationally through Skype

www.NutritionNorthwest.com

Many recent headlines have been based on studies, based off the data collected from the Nurses’ Health Study I, II and III. The Harvard Fertility Diet among them. The NHS has had extremely large study populations, following well over 100,000 registered nurses over the past few decades. This study population is almost unheard of in the scientific community where a good majority of the studies are based on populations well below 50 participants. This makes the NHS studies particularly enticing to the scientific community.

Registered nurses enrolled in the studies received questionnaires pertaining to a wide range of health topics. One of these was a food frequency questionnaire. Basically participants were asked to recollect how many servings of this food or that food they ate on average over a period of time. This method of recall is simply flawed bringing many of the studies based off the NHS data linking health conditions, labs and disease to eating patterns under question.

If at the end of your day, you sit down and try to recall what and how much you ate and drank, you will probably get some things wrong. You may have forgotten that you ate something or miscalculated the amount you did eat. Would you be able to accurately identify if you had two servings of fruit and three servings of vegetables? Imagine then, going back and trying to accurately recollect how many servings of fruit or vegetables you had over a week, a month or a year. Now consider how accurately you could identify your patterns over four years, as was done with the Nurses’ Health Study II. Food frequency questionnaires were mailed to participants once every four years.

In my private practice I experience daily a person’s inability to accurately recall what they eat and drink. During our first sit down consultation, my new patient is all too eager to share with me their ‘typical’ day. I obligingly write this down knowing that after they journal for me for four days eating as normally as possible and recording their intake in real time, their actual intake will differ greatly from their ‘typical’ day. My point is that no week is really ‘typical.’ People seem to believe that they eat a specific way when in reality it is often another. They may like to think they eat on average three servings of fruit each day, but in reality it may only be one.

The creators of this study believed that because of their training, nurses would be able to respond with a higher degree of accuracy to brief, technically worded questions. I disagree with this point specifically in regards to the food frequency questionnaires. I took the undergraduate course Nutrition and Nursing at the University of Washington. This is the only nutrition class nurses receive during their training. The class loosely covers the food pyramid, the exchange system and offers a very basic education on nutrition fundamentals. With all the amazing things that nurses’ do in their job, offering nutritional advice, specific to portions, servings and meal plans are not among them. Hospitals use dieticians and diet techs to perform this task, so the information that nurses learned in the class is not practiced, making them no more likely to recollect how many servings of fruits or vegetables they had in their diet over the last four years, than any other person.

These same points carry over to how this study was performed; the study looking at alcohol intake and weight involved 19,220 registered nurses from the NHS over the age of 38 who were of normal weight. Researchers asked the women (questionnaire) about their alcohol consumption over the past year and recorded how much of four different types of alcoholic beverages they consumed — beer, red wine, white wine and liquor. This group of nurses was followed for thirteen years.

See if you can answer these two questions: If you drink wine in the evening how many glasses do you have? In that same evening, how many servings of wine did you have? You may or may not be surprised to learn that the answer to these two questions is most likely not the same answer. Most wine glasses hold two to three servings. So you may think that you drank one glass of wine and had one serving, but it is more likely that you had one glass of wine and two servings. Most nurses may know that 3.5 ounces of wine is a serving, but do they also know how many ounces of wine their wine glass holds and how many ounces they actually pour? I have my patients pour themselves their usual serving and then pour that into a Pyrex container to measure their pour. This exercise is very enlightening and is really the only way to get an accurate measure of how much someone drinks. I would be more impressed with a study design that had participants keep a daily journal of their drink intake (after being taught how to properly measure a pour or better estimate the alcohol content in a mixed drink). This can easily be done online with a daily email reminder.

I do acknowledge that it is very difficult to have controlled studies with human participants. Let’s face it; it would be hard to find 100 people who want to stay in a science lab for one week let alone a month. We do need to rely on other means of collecting data. I respect the work that my fellow colleagues are doing. I simply feel we should place less emphasis on these types of studies and not create a media frenzy around unfounded, uncorrelated findings that lead to further confusing people trying to make healthier choices.

Angela Pifer, MSN, CN Bellevue Nutritionist

Seattle Weight Loss Programs  – I work Nationally through Skype

www.NutritionNorthwest.com

I want to stress that a shortage of the flu vaccine does not mean a shortage of options that make it less likely to get a cold or even the flu. In my practice, I have had great success recommending an approach that focuses on building a strong immune system. Adhering to the approach outlined below will not only help ward off the flu, but will be your foundation for improved overall optimal health. Your risk of absenteeism will be greatly reduced as your company charges full steam ahead. Building your immunity against all invaders is a much more comprehensive approach than the singularly focused flu vaccination and can be accomplished by following five easy steps:

1.    Hygiene

2.    Diet

3.    Supplementation

4.    Sleep

5.    Reducing Stress

Step 1: Hygiene — Why Hand Washing in the Usual Fashion is Not Enough

The flu, as with colds, is spread from person to person. The way these germs are spread is not by inhaling them, but by picking them up on our hands and spreading them to our face where they can gain entry to our body. This is why the Center for Disease Control (CDC) recommends health habits to prevent the flu such as: wash your hands often and avoid touching your eyes, nose, or mouth. While this is good advice, it may not be enough. Cleaning the hands in the usual fashion only rids them of a small percentage of all potential pathogens. Furthermore, as most people will wash with an antibacterial soap, these soaps are harsh and can destroy the natural defenses the skin has in order to protect us from potential illness.

The first step of hygiene starts with a semi-soft natural soap. I instruct my patients to push their fingertips into the soap in order to address the area in and around the fingernails, an infectious hotbed where the overwhelming majority of germs on the hands reside. Think about your habits. Your fingertips come in contact with elevator buttons, computer keyboards, telephone buttons and your eyes, nose and mouth. Even the most religious hand washer will get sick if they do not clean under their nails. Use a nailbrush and frequently put the nailbrush through the dishwasher cycle or heat it in the microwave (if it does not contain metal). While you are washing your hands, be sure to sing Happy Birthday all the way through, to ensure that you spend enough time at the sink.

Use cleansing wipes on your computer keyboard, telephone (cell phones too!) and door knobs daily.

Step 2: Diet

A whole foods-based diet adds to overall human health and immunity. Examples of “immune-enhancing foods” are locally grown meats, poultry, dairy, fruits and vegetables raised organically and chemical-free. Fresh fruits and vegetables are especially vital in this capacity. While no health official would argue with the consumption of fruits and vegetables, we can take our diets a step further if we really want to bolster our immune system!

Maintenance of optimal blood sugar will significantly reduce infection with most (if not all) pathogens. The best way to insure proper blood sugar control is to avoid added sugar and highly refined starches such as pasta, rice, potatoes and breads. Unfortunately, these starchy foods are the backbone of the “comfort foods” that make up our diet during this time of year. Focus on small frequent meals, bright colors and pair up a carbohydrate with a protein at each meal and snack.

Step 3: Supplementation

In general, I recommend my patients use supplement formulas made from “whole foods” that have been fermented. Since the majority of the immune system is located in the gastrointestinal tract, balance of intestinal bacteria is vital to helping our bodily defenses function properly. Key supplements to help bolster immunity include:

Probiotics: Probiotics improve the body’s ability to fight infection and enhance the immune response.

Whole food Mushroom Blend: Mushrooms can enhance immune-competent cell activities, have immunostimulating properties, and can pack a “one-two punch” for increased immunity when paired with probiotics.

Omega 3: Studies indicate that high omega-3 fatty acids (found in cod liver oil and other foods) positively modulate immune response and have increased survival rates and reduced disease severity. Cod Liver Oil is also one of nature’s richest sources of vitamins A and D. However, since high dose Vitamin A can be potentially toxic (usually when taken over a long period of time and not in the mycelized form) a knowledgeable health practitioner should be consulted before using this remedy.

Coconut Oil (minimally processed): Lauric acid found in coconut oil is anti-viral, anti-bacterial, and anti-protozoal–and monolaurin (found in lauric acid) can destroy lipid-coated viruses such as influenza.

Whole food supplements: Herb and spice extracts such as goldenseal, elderberry, garlic, ginger, oregano and horseradish have been used traditionally for thousands of years. Formulas that utilize a combination of herbs seem to be most effective.

Vitamin C supplement: 500 mg/ twice a day can best be obtained through whole foods and supplements. At symptom onset, effective dosing seems to be in the range of 3-4 grams (that is 3000-4000mg) per day in 3-4 divided dosages. It also seems to be most effective when taken within the first 24 hours of symptom development. Dosages in this range are probably best taken in a powdered form. As with all mega-dosing, a knowledgeable health practitioner should be consulted.

Not into taking supplements? Try using traditionally healing herbs and spices in your cooking and teas to give another immunologic punch to your diet.

Step 4: Sleep

Consistent, adequate sleep is vitally important to overall health and paramount to a healthy and well functioning immune system. Recent studies have shown that proper restful sleep is intimately tied to the balance of a number of hormones, most notably cortisol and melatonin. Adequate levels of these hormones are vital to a properly functioning immune system in order to prevent both acute infections and long term illnesses (such as autoimmune disorders and cancer.)

More important than how long you sleep is when you sleep. To insure proper glandular function, sleep is optimized when in sync with the day-night cycle. That means the optimal spring/summer bedtime is between 9 and 10 p.m. and the optimal fall/winter bedtime is between 8 and 9 p.m. It also appears that sleep cycles started before midnight are far more effective than those started after midnight– regardless of the number of hours slept.

While admittedly these parameters are very difficult to observe given our lifestyles, if you feel like “you are coming down with something,” rest and proper sleep may be one of your cheapest and most enjoyable remedies!

Step 5: Reducing Stress

Stress is linked to six of the leading causes of death: Heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide–and too much stress also hinders the immune system. Constant stress could increase risks associated with a variety of conditions such as heart, allergic, and immune diseases.

While most of us equate stress with psychological challenges, physiologic stress also must be considered. While moderate strenuous activity and exercise can be immune-enhancing, if we begin to cross this line, these activities can be immune-weakening. An ounce of common sense can spell the difference between a healthy versus a “sickly” cold and flu season.

Overall, if you can’t try all of the five tips for avoiding the flu, in my opinion the single best choice would be to practice correct hygiene. However, I believe that if you are willing to try all of these five practical tips for avoiding the flu that you’ll feel healthier all year long – not just during flu season – and your clients will thank you for it!

Angela Pifer, Certified Nutritionist

Seattle Nutritionist– I work Nationally through Skype

www.NutritionNorthwest.com