Question: Is it recommended to see a dietician?

Answer: Not necessarily, although registered dietitians (RDs) have training and expertise in nutrition far beyond that of the average lay person. These individuals are usually expert in his or her understanding of diabetes and therefore, can teach you how the food you eat changes blood glucose level and how to coordinate diabetes medications and eating.

RD’s can inform you on how many calories to eat each day? How to reduce fat in your meals? How to make eating time more interesting through food choice variety? An RD can help you learn the answers to these, and lots of other, questions. A dietitian can work with you to create a healthy eating plan that includes your favorite foods, but that does not force you onto a diet. These people are more inclined to help you make wise choices so that with a good nutritional plan and exercise regimen you can enjoy the many facets of your life. Please refer to additional information within our “Diet & Nutrition” section and throughout this Internet site.

Question: What are the general guidelines for eating foods that have high sugar content?

Answer: The rule for these foods is moderation. Eating too much will: 1) send your blood glucose level soaring; 2) you’ll fill up but without the nutrients that come with vegetables and grains; and 3) worst of all, you’ll gain weight due to depression of your fat burning metabolism. Sugar is perhaps the main culprit in creating severe weight-loss problems for those interested in losing weight. You do not have to pass up a slice of birthday cake or an occasional treat instead, at the next meal, eat a little less bread or potato and be sure to take a brisk walk to burn some calories. Please refer to our section on blood sugar under the “Health & Wellness” category.

For those with diabetes, sugar intake must be regulated! Eating a piece of cake made with sugar will raise blood glucose levels, but so will eating an orange, corn on the cob, a tomato, or even lima beans. While sugar has gotten lots of attention and a bad reputation, people with diabetes can and do eat sugar however, they must be careful on what types to eat and how much. This will depend on the type diabetes one has. Thus, it is always good to consult your physician and/or registered dietician for questions regarding this subject.

Question: I want to lower my cholesterol. Can I eat eggs?

Answer: About 20% of the cholesterol in the bloodstream derives from cholesterol in food. If you are serious about lowering your cholesterol, you should not eat eggs. I would use a product such as “Egg Beaters” that are cholesterol free, but look and taste like the real thing, especially if you eat eggs for breakfast on a frequent basis. Try the egg beaters most of the time and have real eggs, 2 per portion, only one day per week. This will avoid high cholesterol input and help reduce it.

Question: Will losing weight help my diabetes?

Answer: There are two primary ways in which weight loss helps those with diabetes: 1) it lowers insulin resistance, which allows natural insulin (in people with type 2 diabetes) to work better at lowering blood glucose levels. Sometimes, if you take insulin or a sulfonylurea, losing weight may allow you to quit taking it. 2) weight loss improves blood fat and blood pressure levels. Persons with diabetes are about twice as likely to get cardiovascular disease as those that don’t have diabetes. Lowering blood fats and blood pressure is a healthy way to reduce that risk.

Question: How can I cut fat in my diet?

Answer: Cutting fat in your diet usually requires one to alter their current diet or nutritional regimen or perhaps change it altogether. Begin by avoiding fat, fried foods such as fried chicken, French fries, etc. In lieu of putting butter and so forth in vegetables and the like, try steaming them. Rather than use oil to fry meats or certain vegetables, try using a non-stick cooking oil/spray to barely coat the pan and great reduce the oil content and bake or broil the food. Try using no-cholesterol margarine in a tub rather than butter. Use stir-frying as a method of food preparation and utilize foods that have been marinated in tiny amounts of oil and seasonings to taste. Choose nonfat or low-fat selections in an appropriate portion size.

Question: Are some fats better than others?

Answer: This is a great question and the answer is yes! Monounsaturated fats are healthiest for your body. Nuts-such as almonds, cashews, hazelnuts, and peanuts, as well as avocados contain this type of fat. Choose olive or canola oil for cooking. Polyunsaturated fat is the next healthiest fat. This is found in margarine, corn oil, safflower oil, soybean oil, and mayonnaise. Avoid saturated fats, i.e., animal fats such as butter, lard, and meat fats, bacon, and shortening. There are also lower-fat versions of saturated fats like sour cream and cream cheese that can make for a healthier choice. A healthy diet includes less than 30% of calories from fat, with less than 10% of these from saturated fat. Fore example, for a 2000 calorie per day diet about 600 calories could come from fat. This would be about 67 grams of fat since fat has 9 calories per gram.

Question: Are there foods I can eat a lot of to satisfy cravings of hunger?

Answer: Don’t even think about it. The primary key to healthy living is moderation. There are foods such as celery that you can eat lots of. However, although it will fill you and satisfy hunger pains, there is little nutritional value derived for energy use and minerals and vitamins. Foods such as hot air-popped popcorn are low in fat if you don’t apply butter, but it still has calories, about 25 per cup. The best method is to control portion size, eat a wider variety of foods, including your favorites, and make wise choices on food selections such as low fat, lower sugar, and so forth.

Question: What should I do if I overeat over the holidays?

Answer: It seems like we all tend to overeat at this time. Not necessarily in large portions, but in constant snacking of candy, and holiday favorites sitting about. One thing I recommend is to drink 2-3, 8 ounce glasses of water before the meal. This will limit caloric intake by reducing the amount of food you can consume. Failing this, the best thing to do is to control your urges. Also, try walking off your meal and burn some calories. Take a brisk walk of 2-3 miles, about 40 minutes of exercise time. It’ll help reduce your guilt feelings as it burns calories. Spend your extra holiday hours making sure you take a 30- or 45-minute walk once or twice per day. Take a friend, loved one, or the whole family. It’s a good way to talk and share the company of someone close in addition to burning calories.

Question: Can I use all the artificial sweetener I want?

Answer: Artificial sweeteners are generally safe for everyone except pregnant or breastfeeding women. If you are pregnant you should not use saccharin. People with phenylketonuria should not use aspartame. Calorie-free sweeteners like aspartame, saccharin, and acesulfame-K do not increase blood glucose levels, but like all other foods and condiments, they should also be used in moderation. For example, if I can’t drink 2-3 cokes per day, why would it be okay to drink 2-3 diet sodas per day? There is no concrete research on why you shouldn’t consume all the artificial sweetener you may like, but we still don’t know all there is to know about such things. The sugar alcohols, i.e., xylitol, mannitol, and sorbitol-have some calories and do slightly increase blood glucose level and eating too much of any of these can cause gas and diarrhea.

Question: Recently, I went on a diet, lost 26 pounds and was thrilled with my new weight and dress size. Now, the weight has returned. What can I do?

Answer: Diets do not, never have, and never will work. With today’s competition and ‘fast lane’ lifestyles, fad diets invade our society like the proverbial plague. These reasons include, money making, fame, and quick fix adages. These quick fame and quick success plans (restricting one or more macro-nutrients–carbohydrates, proteins, and fats) always fail, leaving you worse off than before. Don’t succumb to these bogus ‘body busters.’ Years of proper nutrition is what makes you better, not an 6-12 week, quick-fix diet plan. Since we are biochemically different from each other, it’s another reason to stay away from these avenues of nutrition. You are generally as healthy as what you eat! You starve yourself for weeks, get skinny, and then when you quit the diet, your body goes into binge mode. You find it difficult to resist eating everything in site and bingo, you’re back to where you started. Plan a good nutritional plan combined with an exercise program; you’ll be glad you did and you’ll keep the weight off. This is the only way unless you want to be sucked into continual dieting for the rest of your life!

Question: I’ve tried to diet and found that it didn’t work, at least the one I tried. How can I recognize a fad diet compared to a good one?

Answer: How can you recognize a fad diet? Here are the common characteristics: 1) They promote quick weight loss, which usually results from glycogen, sodium, and lean muscle mass depletion. All of these methods lead to a loss of body water; 2) These diets limit food selections and dictate intake of specific food at specific times such as only fruit for breakfast; 3) They typically utilize testimonials from famous people and relate or tie the diet to well-known cities such as Hollywood or New York; 4) They portray themselves as a cure-all, i.e., that they will work for everyone of any race or gender; 5) Often, they recommend expensive supplements, some that can be harmful because of high dosage rates, i.e., vitamins A, D, or B-6; 6) They make no attempt to permanently change your eating habits. Normally, one stays on the diet until the desired weight is reached, then stops. Once achieved, a person typically reverts quickly back to their old eating habits. This never, never works; and 7) Most of these fad diets generally proclaim skepticism about the scientific community.

More often than not, fad diets suggest that dieticians and doctors don’t want you to lose weight and encourage you to look outside these trained professionals areas of expertise for correct advice. Such claims are totally absurd. Do you think that a busy medical professional for one minute wants a person to occupy his valuable waiting room just so he or she can tell you that “you’re fat.”

The most cruel characteristic of all fad diets is that they guarantee failure for the dieter! None of them are designed for permanent weight loss or change of eating habits. And, you have to change both your eating and exercise habits to succeed at what you’re trying to do. This requires work. Are you up to the challenge? Also, food selection in most diets is very limited, which makes it impossible for a person to remain on the diet for the long term. Instead of losing fat, you lose lean muscle mass that is deleterious to proper fat loss. If you retain lean muscle, you will have the best advantage of truly losing your fat. Quackery is the most common characteristic of fad diets. Following is a list of the diet approaches that fad diets normally illicit: 1) Moderate Calorie Restriction; 2) Macronutrient Restriction; 3) Low Fat; 4) Novelty Diets; 5) Very-Low-Calorie Diets (VLCDS); 6) Formula Diets; and 7) Premeasured Diets. These are the signs and symptoms of a fad diet.

For the second part of your question, what about a good diet? In regard to basic information sources, if you wish to stay in contact with reality about weight loss, please consult the Journal of the American Dietetic Association, the Journal of the American Medical Association, or the New England Journal of Medicine. If any important aid for weight loss is discovered, you can be sure that these professionals will issue a detailed scientific report about it. You will do yourself a great favor not to rely on paperback books or newspaper advertisements for information about weight loss, this includes many of the fitness ‘Lay magazines’ as well as most are geared to making money by either sales or advertising and kickbacks from promotions.

Let me present you with an analogy, to disregard the advice of a physician or expert in this area in comparison to adhering to the advice of those who refute exercise and nutritional science to make a quick buck, would be for me to say to you that if you want the best advice on how to play golf, instead of asking Gregg Norman, Tiger Woods, or other well known golf pro, that you should instead ask others who might have better expertise, such as Mario Andretti the race-car driver or Harrison Ford the actor. Does this sound reasonable?

Now, here’s the remaining story, no punches pulled. If you came to my office I would tell you bluntly to “stop eating so much and get on an exercise program!” You may not want to hear that, but I know what I’m talking about. The best diets you’ll find and I don’t like to call them diets because they are not, are logically designed nutritional plans. These can be found on this site, the Internet, and in numerous books at the bookstore. Such diets or nutritional plans are good ones because they will recommend that you eat a variety of nutritious foods, high in fiber, vitamins and minerals and low in sugar and that the plan should be combined with a good exercise regimen. Diets that do not prescribe such will never work.

Here are sure keys to weight loss: 1) Begin an exercise program; 2) Stick to it like sparkle to a diamond – a great diamond; 3) Develop a good nutritional program and follow steps 1 and 2 with it. These fit together like hand to glove. Do not use excuses!

Question: Are there any guidelines about drinking diet drinks?

Answer: Currently, there are no dietary guidelines on the quantity of diet drinks a person can or cannot consume. The best practice would be to use moderation as mentioned previously. For example, you should ask yourself, I purchased an entire six-pack of diet soda, why shouldn’t I drink all of them? After all, they won’t increase my blood sugar levels. Well, why did you buy them in the first place? Wasn’t it because they are a treat for your hard work, but they just don’t have the sugar content? Thus, use them as a treat, sparingly, as you would an occasional slice of bacon or a cookie. By doing this, you’ll develop good self control that can carry over to consumption of other foods.

Question: How much weight should I lose each week?

Answer: Healthy weight loss should be limited to ½ to 1 pound per week. Losing more than one pound per week will deny the body of water and nutritious foods it needs and can also cause physiological dysfunction in some people. A slow, steady weight loss is the key to keeping lost weight off combined with a good exercise program.

Question: Can I drink alcohol?

Answer: First, ensure that personal medications don’t require avoiding alcohol. Get your doctor’s approval if you are on any medication. Otherwise, you can consume alcohol in moderation. This is defined as two drinks per day for men and one drink per day for women. Examples would be a 5-ounce glass of wine, 12-ounce light beer, or 1-1/2 ounces of 80-proof distilled spirits, and so forth.

Question: Isn’t glucose control easier if I eat the same things every day?

Answer: Yes, because you know exactly what to eat each day, but this method of blood glucose control is not usually as nutritious as a varied diet and can be very boring, creating the urge to consume foods that probably should be avoided or used more sparingly. One of the keys to good nutrition is eating a variety of foods each day. Test your blood glucose about an hour after meals to learn how different foods affect blood glucose levels. With experience, you will be able to predict how foods and food combinations will alter your blood glucose levels.

Question: Are there specific vitamins that will help my diabetes?

Answer: A vitamin or mineral deficiency can cause problems with glucose control. As an example, one research study found that consuming the trace element chromium improved glucose control in subjects who had a chromium deficiency. Factually, we don’t know enough about this area of nutrition; more studies need to be done. The best way to ensure adequate vitamins is to eat nutritiously, choosing a variety of fruits, vegetables, grains, and meat each day. If you feel you need extra, take a multi-vitamin and mineral supplement each day. Choose a brand that says “chelated” on the label.

Question: How do you get enough calcium if you don’t consume dairy products?

Answer: Calcium-rich foods include many dark, leafy green vegetables (kale, collards, bok choy, mustard greens, broccoli), figs, almonds, and brands of tofu made with calcium sulfate. Sugary foods like molasses and calcium-fortified orange juice are rich in calcium, but the calcium may not be well retained by the body because of the sugar. Loss of calcium in the urine can be avoided by eliminating from the diet the excess protein from animal flesh and eggs and by minimizing salt and sugar intake. Also, limit consumption of dark cola drinks that are high in phosphoric acid that can create a phosphorus:calcium imbalance.

Question: Are there herbs that will help my diabetes?

Answer: It has been suggested that many herbs supposedly have glucose-lowering effects, but not enough data has been gathered on any herb to recommend it for use for those with diabetes. Herbs are not considered a food by the Food and Drug Administration and are not tested for quality or content. Consequently, there are a great number of products on the market that are promoted as helping health conditions without any evidence to support the claim. One should research these carefully. Discuss any herbal dietary supplements you find appealing with your doctor or dietitian before using them. There is always the risk that they may interact poorly with diabetes or other medications. There has been a commonly used vegetable treatment that many swear by to help lower cholesterol. This is a combination of kale, asparagus, and egg plant 2-3 times per week (sauteed as a side dish).

Question: What is a vegetarian diet?

Answer: Essentially, a vegetarian diet includes grains, vegetables, fruits, nuts, and seeds. Lacto-vegetarians consume dairy products, and ovolacto-vegetarians consume eggs as well. A total vegetarian diet, also called a vegan (vee’ gun) diet, excludes all animal products.

Question: What do vegetarians eat?

Answer: In addition to the obvious fruit and vegetable salads, there are many possibilities and choices. Soups of various kinds; a wide variety of pasta dishes; vegetable stews; casseroles; whole grains breads, bagels, and muffins; and Oriental dishes are just a few of the choices. There are soy, sesame, and other vegetable-based burgers, even soy-based hot dogs. Excellent frozen dinners are also available in the frozen section at the supermarket.

Question: I’ve been told that a vegetarian diet is dull and bland?

Answer: While the taste of fat that most are accustomed to is absent at first, one can learn to savor the subtleties of flavor in various vegetables, herbs, and spices that taste quite excellent. Generally, due to lack of larger quantities of fat in the diet, individual tastes become more sophisticated and it’s reported that one will enjoy the clean, fresh taste that food is supposed to have.

Question: Is a vegetarian diet healthy?

Answer: On average, medical research shows that vegetarians live longer and become sick less often. Diets high in vegetarian foods can greatly reduce the incidence of heart disease, most of the major forms of cancer, high blood pressure, obesity, adult-onset diabetes, kidney stones, gallstones, and other chronic ailments. The primary element here is likely due to both the reduced intake of animal fats and also much lower sugar intake.

Question: Is a low-fat diet as healthy as advertised?

Answer: There is significant evidence that a low-fat diet will lower the risk of heart disease and cancer. The fact is, we all love fat because it makes food tastes good and leaves one satisfied for a longer period of time, a term called satiety. A low-fat diet may require some adjustment in terms of taste, but adaptation will occur.

Typically, we should not consume more than 30% of our calories from fat so, our small dietary requirement for fats can generally be met by the fat naturally present in whole grains, vegetables, nuts, and seeds. Nuts are low volume, high energy food due to their fat content and as such make excellent snacks when consumed in moderation. As an example of food fat content, whole wheat flour derives 5% of its calories from fat.

One well-known research study, the “Lifestyle Heart Trial” showed that coronary atherosclerosis (hardening of the arteries) can be reversed by a regimen that included a no added oil vegetarian diet, exercise, and meditation (for stress reduction). This study was a “vegetarian based” study, but makes sense when compared to the dietary requirements for fat intake. A diet with added olive or canola oil can also produce a favorable cholesterol profile in many people if a reduction in consumption of animal fats is practiced.

Question: Is taking a supplement as good as eating lots fruits and vegetables?

Answer: Not really. To obtain the full spectrum of health-promoting phytochemicals (plant nutrient-chemicals), you must consume fruits and vegetables. Also, the nutrients in supplements do not always assume the same form as those in foods. For example, synthetic beta-carotene supplements primarily contain one form of beta-carotene, all-trans-beta-carotene. In comparison, foods also contain significant amounts of the cis forms of beta-carotene that can be stronger antioxidants than the all-trans form.

Vitamin E is also an excellent example. Some studies indicate that vitamin E from foods, as opposed to that from supplements, may help prevent certain diseases. It is believed that in nature, vitamin E assumes eight forms, four tocopherols and four tocotrienols. Although alpha-tocopherol is the best known form, gamma-tocopherol predominates in the diet. This gamma-tocopherol can be a better antioxidant than alpha-tocopherol with regard to certain oxidants. Also, many tissues of the body seem to concentrate it. Such findings may explain why higher levels of gamma-tocopherol in the blood are associated with a lower risk of heart disease. And, the tocotrienol forms of vitamin E may be even better antioxidants.

Unfortunately, vitamin E supplements, even those marketed as “mixed tocopherols,” generally consist primarily of alpha-tocopherol and without FDA testing, the manufacturers can make any claim they wish. Consequently, supplements are not a good substitute for the full spectrum of dietary vitamin E. The richest sources in the diet are soyfoods, whole grains (wheat germ), pistachios, pecans, peanuts, walnuts, and Brazil nuts.

Question: Should refined sugar be avoided?

Answer: Sugar is a natural constituent of fruits and vegetables; it is present in every diet. Excess sugar causes the loss in the urine of several important minerals, including calcium, magnesium, zinc, and chromium. These losses may increase the risk of certain chronic diseases. Sugar also increases the levels of triglycerides and lower the levels of HDL cholesterol (the “good” cholesterol) in susceptible individuals. Consequently, cholesterol levels are frequently higher among individuals who ingest too much sugar.

Refined sugar does not affect the body any differently from unrefined sugar, contrary to what most health food stores will tell you. Sugar also does not have any immediate ravishing effects on mind or body.

Preferred forms of sugar include blackstrap molasses, rich in both iron and calcium, and fruit juice concentrates, which may retain a little of the fruit’s nutrients.

Question: By changing my diet to mostly fruits and vegetables, is there a high risk of nutritional deficiency?

Answer: No. Any poorly planned diet can be deficient and create the same risk. Generally the risk of deficiency is lower with a vegetarian diet because of the great variety many use in food selection choices. While it is true that vegetarians should supplement with vitamin B-12, less iron and zinc is absorbed from the average vegetarian diet as compared with the usual Western diet. However, a well balanced vegetarian diet should supply adequate amounts of both. Also, while it is true that there is little vitamin D in unfortified vegetarian foods other than mushrooms, vitamin D is really a hormone best obtained by exposure of the skin to sunlight.

Typically, vegetarian diets are much richer in vitamins C and E, both of which are important antioxidants, especially for those who exercise frequently. They are also much richer in important minerals like magnesium and manganese, which are often lacking in Western diets. An adequate supply of magnesium may help prevent a whole range of illnesses, including osteoporosis, high blood pressure, adult-onset diabetes, kidney stones, and heart disease. Vegetarian diets are also much higher in fiber, which is completely absent in animal products. Finally, vegetarian diets are much richer in phytochemicals, which are plant nutrient-chemicals that have been proven may help prevent cancer, heart disease, and other related health problems. The deficiency in phytochemicals is probably the most important drawback of meat-based diets.

While vegetarian diets are good, by adhering to the USDA Food Pyramid guidelines, one can have a great diet without being one extreme or other, i.e., a vegetarian only or a mostly meat eater. Once again, the key is moderation. Best recommendations would include a diet high in fruits in vegetables using meat sparingly, mostly in winter when energy demands are higher by the body’s attempt to stay warm thus, helping to burn off associated fat calories more efficiently than in summer months.

Question: Why is vitamin B-12 important?

Answer: Currently, hygienic methods of food production eliminate soil-derived bacteria that produce vitamin B-12. The deficiency of vitamin B-12 usually results in cognitive (thinking, memory) and other neurologic problems early on. Following this, anemia generally occurs later. The daily requirement for B-12 is 2.4 micrograms per day for adults with normal digestive systems (slightly more is necessary for pregnant or lactating women). Foods such as fortified soy milk, cereals, or other foods can provide the necessary amount. If you don’t ingest these foods, a supplement of 1,000 micrograms weekly or 2,000 micrograms biweekly should be sufficient. Eggs contain some vitamin B-12, but may not be as well absorbed as that derived from other animal products. If you are an ovo-vegetarian, you should supplement somewhat.

Occasionally, some people, especially the elderly (1 out of 8 persons over age 65), develop vitamin B-12 deficiency due to gastrointestinal absorption problems, and this occurs regardless of what they eat. For these individuals, injections or high oral doses under the supervision of a physician are usually necessary.

Question: How does one assure adequate iron intake?

Answer: A well-planned diet high in fruits, vegetables, legumes, and some lean meat is perhaps the best to obtain adequate, but not too much iron.

Some foods such as tea inhibits iron absorption and should not be consumed with meals. Other foods such as dairy products contain almost no iron and may even inhibit iron absorption, so their use should be minimized. Vitamin C greatly increases the absorption of iron from plant foods thus,vitamin C-rich foods consumed with meals can help. Dark, leafy green vegetables, potatoes, watermelon, and strawberries are examples of foods that are good sources of both vitamin C and iron. Additional sources of iron include lentils, garbanzo beans, almonds, sesame seeds, and blackstrap molasses.

Question: Do children need to drink milk?

Answer: They should not drink cow’s milk if he or she is under one year of age. At this age, cow’s milk may cause intestinal bleeding and promote anemia and may also cause colic, even when consumed by a mother who is nursing her infant. Cow’s milk is very different from human milk, being lower in iron, vitamin E, and essential fatty acids and too high in sodium, potassium, and protein. The Committee on Nutrition of the American Academy of Pediatrics recommends that cow’s milk not be given to infants under one year of age for these reasons.

Question: Is dairy (cow) milk healthy for children over age one?

Answer: Although controversial, vitamin-D milk consumption by children may increase the risk of juvenile diabetes. In adults, it has been linked in some studies with ovarian cancer and with lymphoma. Also, the saturated fat in milk can raise blood cholesterol levels. This is why there has been a major shift in recommending that you drink more fat-free or 1% fat content milk than whole milk. It’s just healthier in the long term. Children who do not drink milk, however, should consume at least four or five servings of calcium-rich foods every day. Over the age of one, they should have good sources of calcium, this does not necessarily have to be milk.

Question: What are the best sources of food combinations to make a complete protein?

Answer: These combinations would include all whole foods, including grains, vegetables, and fruit. By avoiding what we term “junk” foods and eating a sufficient variety of whole foods to maintain current body weight, one can easily meet protein requirements. The average Western diet contains too much protein, which may increase the risk of kidney stones, osteoporosis, and cancer.

The term “complete protein” is a myth. The protein in most whole grains contains all of the essential amino acids, i.e., the building blocks of protein that must be supplied by the diet. Some vegetable proteins may have more of some amino acids than of others, but because nutrition is a long-term process, i.e., our bodies do not use every nutrient that we ingest each day, but stores them up to be used later, we do not have to consume amino acids in the exact proportion used by our bodies. Additionally, if a diet is a little low in certain amino acids, the body adapts and retains more of those amino acids. If you ate enough of any one vegetable’s protein to meet daily protein requirements, you would also normally be meeting the requirement for each of the essential amino acids.

Question: Why is it healthier to eat whole grain as opposed to refined flour products?

Answer: Refining of flour causes the loss of the majority of its nutrients. This is why it’s better to steam vegetables than to boil them. Most of the nutrients are in the boiled water that is typically discarded and not ingested. Many of us think of fiber when we think of whole grain products, but most of the mineral content, including magnesium, zinc, selenium, copper, and manganese, is lost upon refinement. Only iron is replaced. Likewise, some of the lost B vitamins are replaced, but vitamin B-6 and pantothenic acid are not.

Whole wheat flour is rich in a wide spectrum of the natural forms of vitamin E, including the tocotrienols with their special properties. In refined flours, almost all of this vitamin E is lost during the refining process. Important phytochemicals (plant nutrient-chemicals) are also lost, including lutein, the carotenoid that gives whole wheat its golden color, and phenolic acids like ferulic acid, which are antioxidants.

Many past nutritional studies often ignored the differences between whole and refined grains. However, there is renewed research interest in this area. A recent study showed that people who infrequently consumed whole grains have five times the risk of soft tissue sarcomas (cancer) as people who consumed whole grains frequently. Other studies have also shown a lower risk of heart disease in women who consume higher amounts of whole grains. Consequently, whether you’re eating bread, spaghetti, bagels, or rice, your best food choice would be whole grains.

Question: I constantly hear the terms overweight, overfat, and obesity. How can I determine which term to use on myself or are they all referring to the same condition?

Answer: There is much confusion regarding the use of these terms when applied to body composition and related health risks in terms of having excess body fat. While each term often takes on a different meaning, I’ll attempt to make a distinction between them. In the medical profession, the term overweight is used to describe someone in an overfat condition, even if no body fat measurements have been taken. Using this context, the term obesity refers to a person at the extreme of the overweight continuum, which is also the frame of reference used by doctors to delineate the body fat continuum by the BMI or Body Mass Index.

Question: What is the body mass index?

Answer: The BMI is used to assess the “normalcy” for a person’s body weight. In essence, it exhibits a higher association with body fat and risk of disease such as coronary artery disease and other diseases related to body fat content.

The BMI is calculated by BMI = body mass (kg) ? (body height in meters)2. For example a female is 110 lbs or 49.9 kg (there are 2.205 lbs/kg) and is 5’5” tall or 1.7 m (there are 39.2 inches/meter); thus, BMI = 49.9 ? (2.89) = 17.3 kg m-2. This means that this person is about 17 pounds overweight.

Question: What is the BMI for which a person would be considered overweight?

Answer: This number is 25. Persons with a BMI of 30 or more are considered obese and at this latter level a person is beginning to be associated with moderate to higher risk of disease. The higher your BMI above 30, the greater your risk of stroke, heart attack, and so forth.

Question: How do I know if I’m fat because I overeat or because of a medical disorder? The reason I ask is that I’ve tried diets, exercise, and everything I can think of and still cannot keep my weight off.

Answer: This is a good question because sometimes we think that simply cutting back on food will provide a permanent weight reduction. However, obesity results from the complex interaction of a variety of factors including environmental, genetic, physiologic, metabolic, behavioral, and social parameters. Currently, some research is showing that it may also arise from cultural/racial differences. The factors that predispose us to being overweight include our eating patterns and environment, body image, food packaging, level of spontaneous activity such as fidgeting, and a host of others. Let’s get to the root of the problem.

Answer the following questions either yes or no: 1) I eat more than 2000 calories per day; 2) I work out infrequently or no more than 20-30 minutes per day only 3-4 days per week; 3) I snack several times per day, often with a cookie or other treat; 4) I’m mostly sedentary at work; 5) I often skip breakfast and may eat lunch; 6) Dinner is my largest meal most days; 7) I ride and sit more than I walk; 8) I would classify my lifestyle as mostly to moderately sedentary; 9) I find myself on the go constantly and frequently eat at restaurants or fast-food establishments; and 10) I drink coke, iced tea (sweetened), orange juice, or other sugared beverages with one or more of my meals each day.

If you answered yes to more than five of these questions, it’s likely that your weight problem is environmentally, behaviorally, and/or socially induced. Thus, you can control it and that’s great news. If you answer no to more than five of these questions, you may wish to be checked by your doctor for thyroid dysfunction, cellular ATP levels, lipoprotein lipase levels, basal body temperature, enzyme levels, and other parameters. Discuss with your physician your problem and they will be happy to help. If you think your problem is severe, consult a specialist in weight control and obesity.

Question: I’ve been performing lots of thigh and abdomen exercises at the gym because a friend told me I can spot reduce my fat, but nothing is happening, why?

Answer: First, there is no such thing as “spot reduction”. The fat was added in layers and will burn off in the same way. When you work a muscle or group of muscles to burn fat, there is absolutely no way to control which part of the body the fat burns from. Typically, both men and women gain fat on or around the midsection first, followed by the external oblique area (sides above the waist) or thighs. Once it has accumulated there it will slowly build up to the shoulders, down to the knees, and to the arms and lower legs depending on how much fat is gained. As a rule of thumb, fat burn loss will be first noticed on the shoulder and leg areas as loss proceeds to the midsection. When exercising, the blood carries fat from all over the body to provide energy. As you work and build muscle mass, fat will be lost leaving lean muscle in its place, but lost from many areas at once, not one specific location.

Sometimes muscle growth beneath a fat deposit or layer can give the appearance of spot reduction. This happens because overlying fat is stretched over a greater surface area due to larger muscles and the fat layer appears thinner, but the total amount of fat is the same. Think of putting on a surgical glove that is too small for your hand. The glove can be put on, but because of your hand size, it stretches the material so thin that you can see your hand fairly clearly. However, even though the glove is stretched, it still has the same volume of material. This is likely how the spot reduction myth gained popularity.

Question: How do I know if I’m exercising long or hard enough to burn fat?

Answer: When exercising, we always burn fat at one rate or another, but you burn most when your body is in what is termed the cardiovascular or aerobic range, i.e., your maximal heart rate zone. After 20 minutes in the aerobic zone, you will be burning more fat than carbohydrates. Some research shows that this takes place as early as 12-15 minutes. By increasing cardiovascular activity to 30 minutes or longer, a larger percentage of calories will be burned from fat. There is disagreement whether longer duration at lower intensity or shorter duration at higher intensity is best. If time is a limitation, exercising at higher intensity will maximize cardiovascular benefits in a shorter duration. Regardless of the method you choose, muscles will continue to burn fat after both aerobic and anaerobic (muscle training) exercise.

Question: What is the better method for losing or burning fat, resistance training or aerobics? I always hear that running is absolutely the best, is this true?

Answer: This is likely the most common question by those concerned with weight loss and control. Many believe that running is the best way to burn fat or that any aerobic exercise will burn more fat than other exercises. While running or any cardiovascular/aerobic exercise is a significant component to a weight loss program, along with diet, there are actually better exercises to burn fat.

First, let us look at the fuel sources used for various exercises from the three main areas of fats, proteins, and carbohydrates (FPC). A session of weightlifting burns about 60% fat, 4% protein, and 26% carbohydrates (FPC) for the fuel sources. For high intensity sprinting and hurdles the FPC fuel ratios, in percent, are about 12:4:86; for cycling and basketball, FPC ratios are 32:4:64, while for running FPC ratios are about 45:10:45. From this we can determine that the most used fuel source in weightlifting is fat, while running has equal use of both fat and carbohydrates. To burn fat in this scenario, weightlifting is superior to running.

Let us look at additional examples. For the same sports above we can list the calories burned per minute (cpm) for a 110 pound female and a 210 pound male, respectively. These are: hurdling (10.7 – 21.3), sprinting (10.1 – 20.2), cycling (8.5 – 16.1), basketball (7 -14.1), running (9.7 – 18.3), and weight lifting (10.1 – 20.3). Most of these exercises are primarily working one major part of the body such as the legs in cycling, sprinting, or running. If we compare these to exercises that use multiple, compound muscle groups, i.e., the full body, we obtain a significantly higher amount of calories burned per minute. For example, speed-strength training, which involves a combination of full-body weight lifting rather than body parts, plyometrics and ballistics; the female:male cpm is 14.9 vs 29.7. This type of exercise is usually performed by collegiate, Olympic, and professional athletes, but is superior to all others. So, we now have a better comparison based on calorie use.

The particular item of importance in this instance is that we must be careful to do a proper comparison. As an example, all numbers given for the exercises listed are for average or moderate level workouts. This means that those lifting weights, whether male or female, are lifting moderate level weights for their respective experience or strength level. Also, those running are running at an average pace comparable with a majority of recreational runners. Keeping this in mind, it would be unfair to compare the amount of calories burned by a world-class mile speed to an average weight lifter.

I believe that one thing that has led to the myth that running is the best fat burning exercise is that the highest number of calories burned is used in most magazines, but this number would be comparable to about a 5 to 5 ½ minute mile. This is much faster than the average recreational running pace of about 9-10 minutes per mile, which burns significantly less calories per hour. For example, the fast pace listed (5 min/mile) burns about 850 calories per hour compared to about 450 calories per hour for the moderate pace of 9 or so min/mile. Quite a difference and one reason why we have to ensure that when we calculate energy requirements for ourselves that we are accurate. If we overestimate the calories necessary for exercise, one will gain weight rather than lose it and vice versa. Also, running, actually jogging, which is what most people do, is much easier than weight lifting, hurdling, sprinting, speed-strength and other exercises. Because of this, many gravitate to running.

Thus, to fairly compare running to weight lifting, the comparison would have to be with a world-class weight lifter who is lifting very heavy weight versus a world-class runner; both would be burning many more calories. So, if we order the exercises strictly by the number of calories burned, the best fat-burning activities are in order: 1) speed-strength; 2) hurdling; 3) sprinting; 4) weight lifting; 5) running; 6) cycling; and 7) basketball.

To obtain these numbers for yourself while working out, it is import to develop a light to moderate sweat throughout the exercise. Also, for all of the exercises, the best thing to do is to time yourself and to know your weight load or intensity level. This will help in your effort to balance nutritional needs with exercise.

Question: If I know that a particular exercise burns either fats or carbohydrates as the main fuel source, should I eat more of that food source before, during, or after the exercise?

Answer: No. The fuel source will be utilized through proper physiological functions within the body. Nutrition balances itself during long-term practice. Because an exercise such as weight lifting burns more fat as the fuel source than running, about 60% vs 45%, does not mean that your diet should be 60% or 45% fat. Your diet should be about 10-25% fat, 20-25% protein, and 50-55% carbohydrates. The ratios will depend on your intensity level and purposes. For example, track and field athletes can consume a higher amount of fat in their diet than most people because of their strenuous training regimen. As a result, they are likely to burn it off without long-term detriment.

Question: What is the best intensity to workout at to burn the most fat?

Answer: Based on current research, a moderate intensity workout burns the most fat. At a heart rate equal to about 75% of maximum, fat burning will approach about 1/2 gram – 1.0 gram of fat per minute. These numbers, as before would compare a 100 pound female on the lower end and a 200 pound male on the upper end, i.e., ½ to 1. As exercise duration continues beyond 60 minutes, fat burning will increase slightly, about another 10%. This is relatively the same for most exercises.

At mild intensity, 85 – 90% of calories expended are fat calories, but the absolute level is only about 60% of the moderate intensity. At high intensity levels, fat burning declines to a level of about 65% of the moderate pace because glycogen (cell sugar) stores supplies the remainder. The high rate of glycogen burning exhausts the limited glycogen supply in cells and causes muscular failure. It should be noted however, that these rates are derived from individuals performing cycling who are well trained aerobically. Less fit individuals burn less fat and more sugar (part of aerobic conditioning is greater reliance on fat burning for energy). Yet another reason why running is not the best method for burning fat, especially for novices.

Also, when performing exercises that involve larger numbers of muscle groups, greater amounts of fat can be burned at each intensity level, as much as 40% higher. For example, a 110 pound female performing a speed-strength exercise such as a power clean or clean and jerk can burn about 0.7 gram per minute of fat during the duration of the exercise only.

Let us make an analogy as we begin. Presume that your body is a car. Instead of food, the energy source to make a car operate is gasoline or some type of petroleum based fuel or natural gas. If you are traveling down a level road at a constant pace, the car will consume a constant supply of energy, i.e., fuel. This is also true for your body. On a typical day, your body will generally burn the same amount of fuel that it is accustomed to.

Now, as a car travels up hill, you must depress the accelerator further to give the car additional energy to enable it to arrive at the hills crest. Likewise, if you exercise, your body will also burn more fuel, than when you do not exercise. Just like the car when comparing a level road to a hill. Exercising is to your body as the hill is to the car. In either case, there must be a constant source of energy for the car or your body to complete its task. If there is not enough energy present, the task cannot be easily accomplished. If you do not feed the body properly before or after a major workout, you will find yourself lagging. And, most of us do not feed the body properly to help us feel our best.

The primary neglect of many if not most, is that of not eating frequently enough. Let’s illustrate why this is so. Many of us will eat breakfast and a huge dinner and that’s about all. We simply don’t take the time to feed our body throughout the day. The body becomes accustomed to all sorts of habits very quickly, this includes eating.

When you eat breakfast and then do not eat again for 6 to 8 hours, most of the nutrients are stored as fat. This is because the body knows its not going to get any more food for awhile. Consequently, as a built in safety mechanism, most of the consumed food is stored as fat, hopefully to be used later. This is rarely the case however since a great many do not exercise enough to utilize the unused calories.

To make matters worse, for those who exercise longer than 2 hours per training session, the entire time the body is working or training with no food, muscle tissue can be cannibalized for energy, thereby making one even fatter, i.e., the muscle is burned off, but the fat is left remaining. It’s a double edged sword and is also why many, who have been exercising for several years, are just as overweight at the end of this time as when they began.

People who don’t eat well are commonly the ones that complain about injuries, overtraining, chronic fatigue, lack of fat loss and poor muscle growth.

There is a simple answer to this problem: meal frequency. You should eat 5 or 6 meals per day (we recommend 6). By doing this, you trigger a number of positive factors that will increase energy, melt off fat, put on lean muscle mass, raise body metabolism, and more importantly, increase recovery rate.

The principle of meal frequency has been taught to athletes for decades and has now filtered down to the general public through lay magazines. The goal is not to eat 6 huge meals per day, but to eat 5, 6, or perhaps more small meals throughout the day, utilizing the same amount of calories in all meals that you would generally consume for the 2-3 meals you generally have.

The first meal will be early in the day; don’t skip breakfast as so many do. This first meal will raise body metabolism and is why breakfast is the most important meal, not because of nutrition, but because the earlier you eat, the sooner your body metabolism will increase and speed fat burning. All other meals should follow breakfast about 2-3 hours apart.

The later you have your first meal, the slower the body metabolism will be to that point. Meal frequency will generally be shorter between meals in the morning and further apart in the afternoon. For the morning, frequency will be about 1.5 to 2 hours and for the afternoon, 2.5 to 3 hours.

Meal Frequency Example

The following example is based on a 2,000 – 2,800 Calorie per day diet and thus, depends on your activity. The specific food choice is up to you, but this will give you a general idea of what to look for. It’s a rule of thumb so, adjust it as necessary. i.e., if you eat breakfast at 6:30 then, the second meal/snack would be at 7:00 and so forth. You may eat even more frequently depending on you schedule and activity level, but make sure to adjust total caloric intake to Calories expended.

Meal 1
7:30 a.m.
Breakfast (2 eggs, toast, coffee, juice, etc.)
500-600 Calories

Meal 2
9:00 a.m.
Snack (nuts, dried fruit, granola bar, etc.)
200-400 Calories

Meal 3
11:00 a.m.
Turkey sandwich and salad
500-600 Calories

Meal 4
1:30 p.m.
Snack, protein supplement, etc.
200-400 Calories

Meal 5
4:30 p.m.
Dinner (broiled chicken, green beans, mix of other foods)
500-600 Calories

Meal 6
7:30 p.m.
One cup of rice & two pieces of fruit
100-200 Calories

Total Daily Caloric Intake
2,000-2,800 Calories

Meal frequency works – feed your body as it needs energy.

Carbonation
Carbonation from soda’s and other beverages does not appear to affect the stomachs emptying rate. Various studies have found no difference in the gastric emptying rates of water, carbonated water, or carbonated carbohydrate drinks. Carbonated colas that contain an average of 160 Calories per 12 ounces and a caffeine equivalent to four ounces of coffee, are a favorite drink of many athletes when they are not in the last few weeks before competition.

As sugar concentration increases, several risks arise. For speed athletes, some studies have shown a greater tendency for muscle pulls such as hamstring tears. Endurance type athletes have the risk of nausea and bloating. Most athletes and fit persons can tolerate a 7 to 10% concentration of glucose, but endurance athletes for long events can often tolerate solutions of up to 15% to 20% glucose. Further, the use of polymers will allow more carbohydrates to be ingested and absorbed while limiting somewhat the overall concentration of the solution.

A fluid replacement rate of 500 ml per hour are appropriate for most athletes, cyclists, and runners during prolonged exercise, but rates of up to 1 to 2 liters per hour have been reported in some events such as the Ironman Triathlon and the Tour de France. The risk with the larger volumes is hyponatremia. For example, beginning an event with 400 ml of an 18% glucose polymer solution in the stomach and drinking 100 ml each 10 minutes will deliver 108 grams of carbohydrate with 600 milliliter (cc) of fluid each hour.

Following a vigorous exercise, there is what exercise physiologist refer to as a “glycogen window.” Ingesting a carbohydrate supplement within 4 hours immediately following exercise will allow the ingested carbohydrate to be converted into muscle glycogen at about 3 times the normal rate (and “the earlier the better” as some data suggests a 50% fall in the conversion rate by 2 hours and a complete return to normal repletion rate by 4 hours).

The above vigorous activity refers to a long-term event such as running. If you are a speed athlete, the “glycogen window” is narrower and ingestion should occur within 1-2 hours after the event. One hour is likely optimal although no studies have pinpointed the exact time.

Muscle glycogen repletion after two hours of vigorous activity generally proceeds at a rate of 5% per hour. Although it may require up to 48 hours for complete muscle glycogen replacement, most replacement occurs during the first 24 hours (post event). This is important for long-distance running and cycling events. If you are an athlete who trains daily, or are performing in a multi-day event, you can use the “glycogen window” to your advantage to get a jump on the normal repletion process and minimize the chance of chronic glycogen depletion, as well as the fatigue that accompanies it.

There is evidence that muscle stiffness that occurs after vigorous exercise is related to muscle glycogen depletion. Consequently, rapid repletion may have an added benefit of minimizing this effect. As a note, many simple carbohydrate snacks such as chocolate chip cookies contain more than 30% fat. Consumption in large quantities may exceed your planned daily fat intake of a suggested 20-30% of daily Calories.

THE PERFECT DIET?
Is there a perfect diet for intense exercisers or athletes? Perhaps, but more importantly, there is significant research and supporting evidence, which show that adequate dietary carbohydrates are necessary for maximum performance. As a matter of fact, at least 10 grams of carbohydrates per kilogram (2.2 pounds) of body weight are required per day. However, it is the absolute amount of carbohydrates that appear to be important, not the percent of total daily Calories that are derived from carbohydrates.

For athletes who perform or compete in multi-day endurance events, there can be an advantage to several weeks of moderate fat intake. The amount of fat consumed should be equivalent to 30% of total daily Calories. However, since good nutrition is a long-term activity, there is no evidence that fat intake for only one day is beneficial in this area. Also, there can be long term health consequences if you consume too much fat each day, i.e., exceed more than 30% daily percentage of your diet.

And what about protein? There is absolutely no evidence that more than two grams per day of protein are beneficial to performance in any athletic activity, including bodybuilding.

In summary, the body’s normal liver and muscle glycogen will support the first 1-2 hours of exercise at 70% VO2 max. without need for supplementation. A good training program will normally postpone the onset of glycogen depletion and fatigue.

Also, ingesting carbohydrates during your event provides an additional source of glucose for energy that will postpone the time at which you may hit “the wall.” However, this is more important for activities longer than 2 hours duration. As a general rule, the body can utilize 60 grams of ingested carbohydrate per hour to supplement muscle glycogen stores. Also, the stomach can handle 1-2 quarts of fluid before nausea occurs.

This will give you some guidelines for developing your own program. Also, using solid food supplements is appropriate as long as enough fluids are consumed with them.

Carbohydrate loading is okay for long-term events like cycling and running, but not for activities such as football and other type team sports or sprinting type activities. When carb loading, eating a high carbohydrate diet for several days prior to the event will maximize internal glycogen stores and prolong the duration of activity until fatigue occurs. However, it will not increase the muscle’s maximum energy output during the event.

The principles of training nutrition and performance are similar to those for any athletic event longer in duration than two hours.

Simple Steps for Determining Diet Intake vs Performance Output

1. Everyone needs to know how to ready food labels so that he or she knows the number of grams of each food type, i.e., carbohydrates, fats, and proteins being ingested.
2. Calculate the number of calories needed for yourself on days when you do not exercise (see our diet and nutrition section). This is termed the REE or resting energy expenditure. As a rule of thumb, you can obtain a ball-park figure by multiplying body weight by 10 and adding 200. Let us use a 120 pound person for an example, REE = 120 pound x 10 + 200 = 1400 kcal energy required per day on days he or she does not exercise. This is just to maintain current body weight.
3. For exercise days, add the number of calories expended for the exercise to those determined from your REE in step 2 above (see “comparison” in the diet and nutrition section).
4. Adjust as needed. If you are slowly losing weight and you do not desire to do this, ingest extra calories on a daily basis. If you are gaining weight, ingest fewer daily calories.

Doing this will ensure that your diet matches your activity level. Thus, you will be the best you can be. For those who are involved in more intense activities, competitive fitness, or professional sports, please read the following section.

Performance and Calories
I am often asked if one can perform well on a low calorie diet with the primary goal of the individual being to lose weight. The answer is no.

Your performance in any physical activity is directly linked to the energy your body can supply to muscles and cells. What happens when we cannot supply the energy we need to our cells for the activity we are doing? If the activity is done for only 2-3 hours, you will promote fat loss after exercise if this is an occasional event. However, if this is an everyday occurrence, the final answer is that protein will be used for the energy source and muscle mass will be cannibalized. And, it’s well known that the more lean muscle one has, the better able he or she is to control weight and possible obesity.

Again, the key is to balance input of food energy with output of energy used.

For example, muscle fatigue such as “hitting the wall” in running, generally occurs when the body’s internal carbohydrate stores are depleted and there is a shift towards fat metabolism as the energy source for muscles. At this point, maximum energy output is generally limited to approximately 50% VO2 max. (VO2 max. is the region in which oxygen consumption plateaus or increases only slightly with additional increases in exercise intensity, i.e., this is the maximal oxygen consumption). Logically we might assume that if adequate carbohydrates are ingested to offset those expended, that we can maintain our pace indefinitely. Unfortunately this is not the case. Athletes and fitness buffs with low muscle glycogen stores, but high blood glucose levels still experience fatigue at some point, even though the time to onset of fatigue may be delayed by ingesting carbohydrate supplements. We are not sure why this occurs, but it could be related to physical changes in muscle cells since this type of fatigue is more common in the untrained person or athlete.

Fats provide over 50% of the Calories expended during moderate exercise at less than 50% VO2 max., even when adequate carbohydrates (glycogen) are available. As the level of exercise increases towards 100% VO2 max., the proportion of the total energy expenditures replaced by fats decreases. Also, in maximum performance events, where metabolism becomes anaerobic (greater than 100% VO2 max.), fat metabolism ceases and only carbohydrates are available as an energy source; sprinting is a good example of this.

Protein is a maintenance material used to repair muscle (and other) cell injuries – including the micro-trauma that occurs in training.

When designing a nutritional program to supplement the body’s energy stores for an athletic event, the rate of digestion and absorption of foods must be taken into account. The time required for the stomach to start the digestive process, empty its contents into the small intestine, and have the foods absorbed into the bloodstream will directly affect how quickly any food energy will be available for muscles to provide the supplemental energy for exercise.

Four factors influence this digestive process, over which you have some control.

1. Solid vs liquid – liquids are expelled or emptied from the stomach more quickly than solids.
2. Fat content in foods – fat slows the digestive process and delays the availability of any Calories in the food to the muscles. This is why you don’t want to consume fats until at least two hours after exercise.
3. Sugars – a sugar content of more than 10%, especially in liquids, will slow stomach emptying. However, the use of complex carbohydrates, due to a decreased osmotic effect, will offset this somewhat and offers an alternative strategy to maximize Caloric intake to offset the metabolic needs of exercise.
4. Physical activity level – digestion is slowed by any vigorous activity, usually starting at 70% VO2 max. Except in short, all out events such as sprinting, this is generally not an issue. Also, in events such as running, the additional component of mechanical stimulation of abdominal contents from the sport itself slows digestive processes and tract functioning.

The consequences of this are that: 1) The optimal food for a rapid, high energy boost during sustained, fast paced exercises such as running or cycling would be a semi-liquid or liquid carbohydrate with little or no fat. 2) If you are an endurance athletes competing at a lower VO2 max., ingesting a complex carbohydrate with fat added for improved taste (generally in a solid form), will slow emptying from the stomach and prolong absorption for a greater period of time.

• Avoid excess alcohol consumption
• Reduce Stress
• Guard against depression.
• Reduce boredom and frustration
• Avoid poor eating habits
• Avoid a sedentary lifestyle.
• Perform aerobic exercise for at least 30 minutes a day, 3 times a week and try to increase physical activity in general by walking rather than driving, and climbing stairs rather than using an elevator or escalator.
• Reduce consumption of food that is high in fat and sugar.

For additional help in losing weight:

• Join a support group or ask help from a friend to keep you motivated and to report your progress to. Many people find it easier to follow a reduction diet and exercise program if they work with a friend or join a group of people with similar problems.
• Avoid over-the-counter drugs that claim to aid in weight loss – most are ineffective, and some can be dangerous. So, don’t waste your money or your health on them.

Also, be sure to set realistic goals for weight reduction. A loss of ½ to 1 pound a week may seem slow, but losing weight too fast often does not work. Weight lost quickly is usually regained quickly. If you are not able to lose weight on your own you should consult your physician. Often, it is difficult to break the ‘sweet-tooth’ habit, but it may not be overeating of simple sugars that is the problem for a few.

Generally, during your physical examination, the doctor will have you answer a few questions that will help him or her pinpoint the main problem of your obesity. Examples of these follow so that you can perform your own self assessment.

Medical history questions documenting obesity in detail may include:

Time pattern
1. Has there always (or since childhood) been a tendency to be heavy?
2. Has the person been slender until recently, and then begun to gain weight?*

Eating habits
1. Has diet changed recently?*
2. Have eating habits changed?*
3. What percent of the daily calories are from fat?*
4. How many meals are eaten in a day?* What type?
5. How many snacks? What type?*

Exercise habits

1. Has activity level changed?
2. Has there been a decrease in daily activity?*

Other factors
1. Is there an increase in emotional stress?*
2. Have you increased your alcohol consumption?*
3. What other symptoms are occurring at the same time?

If you answered yes to those questions marked with (*) then, there is a good chance that weight gain is primarily associated with both increased food intake and decreased activity. This is good because it’s something you can control. Also, during your visit to the doctor, skin fold measurements may be taken to assess body composition. Blood studies to test endocrine function may also be performed.

Treatment for Being Overweight or Obese:
Medications are usually not recommended as an aid for intentional weight loss. They often cause harmful side effects or adverse reactions. At best, the drugs control appetite only for short time periods and don’t help change eating habits. For the most dire cases, gastric outlet stapling may be indicated for the morbidly obese. Unless there is absolutely no other alternative, these are not recommended.

What About Those Who Are Not Obese?
Generally, we only consider those among us who are obese, but there are also those who do not eat enough carbohydrates or other macro-nutrients to maintain good health. For these, they typically develop nutritional deficiency. A condition caused by inadequate intake or inadequate digestion of nutrients. It may result from eating an inadequate or unbalanced diet, digestive problems, absorption problems, or other medical conditions. Such problems can arrange due to too much focus on body image, eating disorders, lack of control, which typically leads to eating disorders, emotional stress, and a host of other factors.

Your goal should be to eat a balanced, nutritious diet, using moderation in consumption of all foods, and have a daily exercise regimen.

The rates of obesity are climbing. An ominous statistic is that the percentage of children and adolescents who are obese has doubled in the last 20 years. During this same time, the per capita consumption of sugar, from 20 pounds per person in 1930, has risen to 135 pounds per person today, especially among children. While there is no clear link to diet yet, eating too much sugar may be a major cause among children in juvenile onset diabetes. Also, their seems to be a direct relation between sugar intake and obesity, i.e., the more refined or simple sugars one ingests, the more likely they are to become overweight, especially as they age.

The basic nutritional needs of most people are approximately 2,000 calories a day for women, and 2,500 for men. However, a professional athlete or manual laborer may need 4,000 or more. Pregnant women and nursing mothers require about 300-500 more calories/day than women who are neither pregnant nor nursing.

Because the body cannot store carbohydrates, the excess intake is converted to fat and stored. One pound of fat represents about 3,500-4,100 excess calories.

Obesity increases a person’s risk of illness and death due to diabetes, stroke, coronary artery disease, hypertension, high cholesterol, and kidney and gallbladder disorders. Obesity may increase the risk for some types of cancer. It is also a risk factor for the development of osteoarthritis and sleep apnea.

Genetic factors also play some part in the development of obesity – children of obese parents are 10 times more likely to be obese than children with parents of normal weight.

Common Causes of Obesity

• Consumption of more food than the body can use
• Excess alcohol intake
• Sedentary lifestyle

As a note, alcohol carbs average 7 calories per gram compared to 4 for normal carbs from bread, etc. And, the energy from alcohol serves immediate calorie needs, which means additional calories are stored as fat – in simple terms.

To increase intake of complex carbohydrates in the diet we recommend that you:

• Eat more fruits and vegetables.
• Eat more whole grains, rice, breads and cereals.
• Eat more beans, lentils, and dried peas.

Following are some recommended serving sizes for foods high in carbohydrates:

• vegetables: 1 cup of raw vegetables, or 1/2 cup cooked vegetables, or 3/4 cup of vegetable juice
• fruits: 1 medium size fruit (such as 1 medium apple or 1 medium orange), 1/2 cup of a canned or chopped fruit, or 3/4 cup of fruit juice
• breads and cereals: 1 slice of bread; 1 ounce or 2/3 cup of ready-to-eat cereal; 1/2 cup of cooked rice, pasta or cereal; 1/2 cup of cooked dry beans, lentils, or dried peas
• dairy: 1 cup of skim or low-fat milk

Also, following is a sample 2,000 Calorie menu of which 50 to 60% of total calories are from carbohydrates:

Breakfast

• 1 cup of raspberries
• 1 1/2 cups of unsweetened cereal, with 1/2 sliced banana
• 1 cup of skim milk
• 1 slice of whole wheat toast
• 1 teaspoon of margarine
• 1 teaspoon of jelly
• coffee (black) or tea

Lunch

• turkey pita pocket sandwich (2 slices of whole wheat pita bread, 3 ounces of lean turkey breast )
• 1/2 cup of shredded lettuce
• 1/2 cup of diced tomatoes
• 1/2 cup of green peppers
• 1 tablespoon of salad dressing
• 1 cup of skim milk
• 2 fresh medium-sized peaches

Dinner

• 4 ounces of broiled salmon with 3 tablespoons of lemon juice and sprinkled with paprika
• 1 cup of pasta
• 1 dinner roll
• 6 steamed broccoli stalks with sprinkled black pepper
• salad:
  1 cup lettuce
  1/4 cup of sliced mushrooms
  1/2 cup of sliced tomatoes
  1/2 cup of sliced carrots
  1 tablespoon of salad dressing
  1/2 cup frozen unsweetened strawberries, sweetened with 1 teaspoon of sugar
• 1-inch slice of angel food cake
• 1 cup of skim milk

These are simple examples. There are so many foods and many choices you can make, just make wise choices.

Carbohydrates can best be defined as a large group of sugars, starches, cellulose’, and gums that contain carbon, hydrogen, and oxygen in similar proportions.

The primary sources of carbohydrates in our diet are:

Complex carbohydrates (a good source of minerals, vitamins, and fiber) are starches found in:

• breads
• cereals
• starchy vegetables
• legumes
• rice
• pastas

Simple carbohydrates also contain vitamins and minerals. They naturally occur in:

• fruits
• milk and milk products
• vegetables

Simple carbohydrates are also found in processed and refined sugars such as:

• candy
• table sugar
• syrups (not including natural syrups such as maple)
• regular carbonated beverages

Refined sugars provide calories, but lack vitamins, minerals, and fiber. In excess, these types of carbohydrates should be considered the enemy as they contribute substantially to weight gain. We’ll talk more about this later.

The primary function of carbohydrates is to provide energy for the body, especially the brain and the nervous system. The body breaks down starches and sugars into a substance called glucose, which is used for energy by the body.

Your individual dietary consumption recommendation is generally between 40 to 60% of total daily calories. We recommend that these come from complex carbohydrates (starches) and naturally occurring sugars rather than processed or refined sugars such as candy and soda pop.

Energy Balance

This balance is dependent upon energy input and energy output. Both influence energy stores in the body and whether or not we build adipose tissues, i.e., become fat, uh, anorexically challenged!

Think of energy balance this way:

Food Intake – Energy Output = Weight Change.

It’s a very simple concept. If you eat 3000 kcal (common term is calories) per day and only expend about 2000 calories per day because you’re overeating the energy requirements your body needs, e.g. your intake is more than your output, you will gain weight. Someone eating this way would gain about 100 pounds over 12 months. Impossible? No! People have actually done this.

If you eat 100 calories per day more than you need, you will gain 10 pounds during 12 months, on average.

Eating more than you expend, will lead you to a positive energy balance and a weight gain.

If you eat less than you expend, you will be in a negative energy balance and will lose weight.

To maintain your weight, you must expend the same amount of energy that you eat, which will result in no change in weight.

Energy Intake

Energy demands by the body are met by food intake, represented by the numbers of kcal that we eat each day. Determining the appropriate amount of calories and the type of food we should eat to match our energy requirements is a big challenge for a great many of us.

The problem we have currently is that, given ever present supplies of foods, many of us seem to be too successful in attaining the food energy we need. Today, instead of hunting food in the wild, our hunt leads us to the nearest vending machine, drive-up windows, parties, and even office desks where someone always seems to be celebrating something. This really helps us in our quest to overeat and have a fit, trim figure. Also, many of us become junk-food junkies.

How Much is Too Much?

You must match exercise activity to caloric needs. Scientists do this with what we term the resting energy expenditure (REE). Without getting too difficult, let’s use this formula:

Body Weight x 10 + 200 = REE.

It’s an approximation, but works well and will assist you in your initial quest. For example, if you weigh 150 pounds, you would need 1700 kcal daily to maintain your current body weight. This is without exercise.

If you exercise, you will need to determine how many calories you expended during exercise and add that to the above. As an example, suppose you rode a stationary bike for one hour and burned 450 kcal as indicated on the monitor on this device in your gym. You then must add 450 + 1700 = 2150 kcal for this day’s caloric intake. Ah, but this means you’ll have to know how many calories you burned during a given exercise.

As we have discussed in other sections, the benefits of regular exercise are many and varied. However, performing general exercise activities compared to intense athletic ones such as those athletes do, can mean an extra energy demand for the body. This may require extra food intake, extra vitamins, minerals and other food stuffs.

Progressing from a sedentary type lifestyle to a very fit one will require extra energy due to greater exertion, which will allow you to reap even more health benefits. As a note, a good diet won’t substitute for neither training nor genetic makeup. However, a poor diet can harm athletic performance.

Athlete versus General Fitness

Initially, the key difference between the energy demands for athletes versus general fitness practitioners is due to the intensity of exercise performed. This is important because of the association with weight gain versus energy output. For example, a small person might need only 1800 kcal daily to sustain normal daily activities without losing body weight, while a large, muscular man may need 4000 kcal daily. Thus, there is a wide range in caloric needs.

If you are 100 pounds and perform typical exercises for either aerobics, average jogging, or circuit-weight training using machines, your total daily caloric needs on activity days may be up to 1800 kcal. However, an athlete that performs 4 hours of cycling over steep terrain can require an additional 1300 calories per day. As a result, some athletes, especially those ranging up to 200 pounds or more, may require up to 7000 kcal daily just to maintain body weight during training, whereas others may need only 1800 kcal or less.

How Do We Know If One is Consuming Enough Food Energy?

There is a simple procedure to answer this question. First, measure your body fat. For male athletes, it should range from about 5-15% and for female athletes, about 10-25%. If you are a general fitness practitioner the respective ranges would typically be 15-20% and 20-28%. Second, monitor your body weight on a regular basis, i.e., weekly. Third, if your body weight starts to fall, food energy must be increased; if it rises, food energy should be decreased. However, if weight increases, check to see if body fat has also increased. If it has, you should eat less.

A logical approach is to decrease food intake by 200-500 kcal per day, while maintaining regular exercise programs, until you reach the desirable body-fat percentage. Reducing fat intake is the best nutrient-related approach to lowering body fat, but not to the point of exclusion. If you need to gain weight, add the above amount of food energy per day. However, if you are an athlete, increase food intake by 500-700 kcal per day, which will eventually lead to weight gain. Make sure that you have a good mix of carbohydrates, fats and proteins, as well as enough exercise training to ensure that any weight gain is mostly from lean tissue and not adipose (fat) tissues.