House Call, MD

by Leah Frankel,  MS RD | frankel@myhousecallmd.com

Every January approximately half of all Americans resolve to eat better and lose weight. With increased portion sizes and the evolution of coffee drinks that have more calories than a burger and fries, more and more people are reducing their sugar consumption by choosing low calorie or calorie free sugar substitutes. There are a number of artificial and natural sweeteners on the market, including recently approved Stevia, but which one is really the best choice? We’ll explore the difference between artificial and natural sweeteners, as well as learn about the newest low calorie sweetener, Stevia.

What is the difference between Artificial Sweeteners & Natural Sweeteners?

Artificial sweeteners are chemicals or chemically altered natural compounds that provide sweetness like sugar but with fewer calories. Natural sweeteners taste like sugar but occur naturally as opposed to being synthetically manufactured like artificial sweeteners. Individuals with diabetes have been using artificial sweeteners for years; these “fake sugars” taste like sugar but the body does not utilize them like regular sugar and therefore they don’t raise your blood sugar levels.

In addition to use by diabetics, artificial sweeteners are commonly used to aid in weight loss since they’re low in calories or calorie free. While artificial sweeteners may contain little or no calories, the foods that contain these products may be high in calories, fat or carbohydrates. Let’s look at a few examples showing how artificial sweeteners may aid in weight loss or inhibit it. A regular 12 oz can of coke contains 140-150 calories but a diet coke is calorie free therefore, if we want to cut down our calorie count, the diet coke containing artificial sweeteners would be a better choice. Now another scenario: one serving of Oreos (34g) contains 160 calories. An equivalent serving of CarbWell Oreos, the sugar free version, contains 113 calories.  Murray’s Sugar Free Chocolate Sandwich Cookies contain 131 calories for the same serving. When we look at sugar free cookies vs. regular cookies the ideal choice isn’t as black and white.

Common Artificial Sweeteners

There are a variety of different artificial sweeteners available, each with different chemical properties that allow some of the products to withstand heat, while others cannot. For each sweetener we’ve included the ADI (Acceptable Daily Intake), which is the maximum quantity that is safe to be consumed per day, based on body weight in kilograms (kg) (Note: weight in lbs/2.2 = weight in kg, for example a weight of 150 lbs/2.2 = 66 kg).  As a side note, imagine the lab in which they were testing the “maximum amount of artificial sweetener that can be consumed.”  We’d love to find out what happened there.  Maybe even just see a picture of the whole operation.

Aspartame: Common products containing aspartame include Nutrasweet and Equal.  Aspartame is 200 times sweeter than sugar!  It is safe to consume 50 mg/kg a day which is equivalent to 18-19 cans of diet cola per day (based on body weight of 150 lbs).  We do not recommend trying this.  If you do, however, please let us know what happens with can #20 so we can utilize your discovery for the betterment of mankind.  Aspartame does not withstand heat and therefore cannot be used for cooking. Aspartame is not safe for people with Phenylketonuria (PKU), and an appropriate warning is required on all products containing Asprartame. Aspartame can be found in a number of products including soft drinks, sugar free cookies, chewing gum and yogurt.

Saccharin: Common products containing saccharin include Sweet ‘N Low and SugarTwin.  This sugar-alternative is 200-700 times sweeter than sugar. It is safe to consume 5 mg/kg per day which is equivalent to 9-12 packets of sweetener per day (based on body weight of 150 lbs).  Saccharin is able to withstand heat and is thus can be used for cooking.  Saccharin is most commonly used in diet sodas.

Acesulfame K: This sugar-alternative is 200 times sweeter than sugar and is found in Sunette and Sweet One. It is safe to consume 15 mg/kg a day which is equivalent to 30-32 cans of diet soda per day (based on body weight of 150 lbs). Acesulfame K is able to withstand heat and cooking. Acesulfame K is commonly found in baked goods and diet sodas.

Sucralose: Common products include Splenda and it is 600 times sweeter than sugar. It is safe to consume 5 mg/kg a day which is equivalent to 6 cans of diet cola per day (based on body weight of 150 lbs). Splenda is able to withstand heat and cooking. Sucralose is commonly found in diet sodas, protein bars and sugar free baked goods.

Common Natural Sweeteners

Stevia: The most recent natural sweetener on the market in the US is Stevia. While Stevia has been used internationally for hundreds of years, the FDA only put Stevia on the GRAS (Generally Recognized as Safe) list in late 2008, allowing its use as a sweetener. Stevia is an herb that is grown around the world, particularly in China and South America, that, when purified, is 200-300 times as sweet as sugar. Stevia is virtually calorie free and does not raise blood sugar levels, so it can be beneficial for diabetics or people looking to lose weight. While Stevia has been recognized as safe, people taking anti-hypertensive or diabetic medications should be cautious due to possible interactions with their medications (i.e. talk with your doc before jumping on the Stevia train if you’re on these meds). Some people may experience mild side effects including nausea or a feeling of fullness after eating.  A component of the Stevia leaf known as Rebaudioside A (Reb A) is used to make the sweetener. There are several brands of sweetener that use Stevia (these brands vary the components used in their sweetener but all contain Stevia):

• SweetLeaf Sweetener contains only Stevia and is a zero calorie natural sweetener.

• PureVia uses Reb A in addition to erythritol (a sugar alcohol), cellulose powder and natural flavor.  The product is 97% Reb A. PureVia can be found in 0 Calorie Sobe Lifewater as well as other Pepsi Products.

• Truvia contains rebiana (a form of stevia), erythritol (a sugar alcohol) and natural flavors. It is safe and possible to cook with Truvia. Truvia can be found in products including VitaminWater 10, Odwalla, and Sprite Green.

Sugar alcohol: Examples of sugar alcohols include sorbitol or mannitol. Sugar alcohols contain 2 calories/gram vs. 4 calories/gram found in sugar. Sugar alcohols are carbohydrates that resemble sugar and alcohol and therefore are considered “sugar free”. These substitutes are not completely absorbed and therefore can cause gas and diarrhea; any product that contains sugar alcohol will contain a warning label that states that excess consumption may have a laxative effect (i.e “diarrhea” which is scientifically classified as “not fun”).  The American Dietetic Association advises that consuming greater than 50 g/day of sorbitol or 20 g/day of mannitol may cause diarrhea. Sugar alcohols are commonly found in sugar free hard candies, sugar free baked goods and soft drinks.  In addition, sugar alcohols are found naturally in fruits and vegetables.

Honey: Honey contains disease-protecting antioxidants that may help reduce the risk of cardiovascular disease and cancer. Honey is sweeter than sugar and can cause blood sugar spikes.  As such, it should be used sparingly by diabetics.

Agave nectar: Agave nectar comes from the same Mexican plant that is used to make tequila. While it contains higher calories per teaspoon than sugar, it is a sweeter alternative and therefore less is needed to obtain the same level of sweetness. Agave is favored by vegans who are opposed to the use of honey (no bees are harmed in the making of agave nectar…party on vegans!).

So what should we choose as a sweetener?

Any of the artificial or natural sweeteners we’ve discussed, as well as sugar, are fine in moderation. According to the National Cancer Institute, there is no risk for developing cancer if you consume artificial sweeteners in moderation. If you’re a diabetic or trying to lose weight it may be beneficial to choose a low calorie sweetener instead of sugar to control blood sugar and caloric intake. At the same time, this does not means that you should only consume foods with low calorie sweeteners; a diet consisting of diet coke and sugar free cookies may be lower in calories but it is also missing some key nutrients (and sounds pretty horrible to have to eat every day). Remember that the most natural form of sugar can be found in nature’s candy: fresh fruit!

References:

Artificial Sweeteners and Cancer. 2009. Available at: http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners. Accessed Feb 10, 2010.

Mayo Clinic Staff. Artificial sweeteners: A safe alternative to sugar? Find out the benefits and portenital pitfalls of using artificial sweeteners. 2008. Available at: http://www.mayoclinic.com/health/artificial-sweeteners/MY00073. Accessed Feb 10, 2010.

PureVia: Available at: http://www.purevia.com/. Accessed Feb 11, 2010.

SweetLeaf Sweetener. Available at: http://www.sweetleaf.com/. Accessed Feb 11, 2010.

Truvia. Available at: http://www.truvia.com/. Accessed Feb 11, 2010.

by Tania Houspian, PharmD 2011

You can picture it now: Your New Year’s resolution to get in shape finally realized. You’re on the beach in your Speedo with your muscles glistening in the sun. Ok, maybe that’s not exactly what you are imagining the finished product to look like. Perhaps your New Year’s resolution was geared more towards building bigger muscles and getting in better shape rather than becoming the next World’s Strongest Man (skin bronzer, shaving, and Speedos may not be your style).  Nonetheless, you do want to become more muscular.  If so then creatine is the one supplement all your Google searches for “build more muscle” will undoubtedly produce.  Creatine is possibly the most widely used and talked about dietary supplement in the world of bodybuilding.   It’s definitely something a lot of people come into pharmacies and nutrition stores looking for. The question, of course, is “Does it work?”

Before we answer that question here’s another one: What is creatine?

Creatine is not, I repeat, is NOT a steroid. Creatine is a protein your body (specifically your liver) makes. You also get creatine from foods like meat and fish. The creatine that is made by your liver or that is absorbed from food is then stored in muscles. An average 70kg (154 lbs) person has about 120g of creatine stored in their muscles and metabolizes about 2g of creatine each day (which is easily replenished from your diet or liver).  In the muscles, creatine acts as a battery charger.  In this case the battery is your body’s energy stores called ATP.  When muscles use up ATP to perform an action it is converted into ADP. Creatine is able to convert ADP back into ATP, which can once again be used by your muscles to perform actions.  This is a quick and easy way for the body to create more energy (twice as fast as the bodies normal way of deriving ATP from glucose).  Sounds great, right?  The downside is that the creatine is depleted pretty quickly and the body has to go back to breaking down glucose to make more ATP.  So when an athlete takes creatine, their hope is that it will help their muscles maintain the ATP levels for a longer period of time subsequently allowing them to train longer before becoming fatigued.

Aside from increasing the amount of work your muscles can perform before becoming fatigued, there are other theories about how creatine helps build more muscle:

1. Creatine pulls water into muscle cells via osmosis (remember osmosis from high school chemistry?), helping keep muscle cells hydrated and making your muscles appear rounder and fuller…possibly the origin of the common gym phrase, “Getting swoll”

2. By delaying the muscles’ use of glucose to generate ATP, creatine also helps delay the creation of lactic acid (a byproduct of glucose use). Lactic acid is what makes your muscles burn and causes you to feel sore the morning after a tough workout (yes, lactic acid is to blame for the “I was just hit by a big rig” sensation).

So far we have discussed theories about creatine’s ability to improve muscle building.  What we really want to know is if any of them have been proven.  The answer is yes and no. Given the popularity of creatine as a workout supplement there have been hundreds of studies done to examine its efficacy and safety. The studies reviewed asked participants to consume 20 grams of creatine supplements a day for five days (called creatine loading). Then the subjects were asked to consume 5 grams of creatine per day for 21 days. Theoretically, this would increase the stores of creatine in their muscles. The participants were then asked to perform various exercises and their results were compared to their pre-supplementation results. The studies show that creatine does help increase body mass and it does help increase endurance in short-duration, high-intensity exercises (they specifically looked at number of bench press reps, leg press reps, and vertical jump height). However, creatine did not help the men in long endurance exercises such as running a 12 mile race (creatine actually hurt test subjects in long endurance exercises, possibly because they were carrying around excess body mass).  Creatine also did not decrease the amount of post-workout soreness reported by the subjects. The amount of soreness felt was the same before using creatine and after the supplementation period.

The Verdict: Creatine is not a wonder supplement.  You can’t take it, go to sleep, and wake up with bulging muscles.  It is, however, something you can take if you are serious about working out as it may help you increase your stamina and strength with specific workouts.

Now to the most important information: Is it safe and are there any side affects?

Initially, there were reports of creatine causing dehydration, cramping, and kidney & liver damage.  Athletes taking creatine were subsequently warned to not work out on hot days and to be cautious of any cramping the experienced.  That sounds pretty ridiculous to us: if you’ve ever worked out hard you know that cramping is bound to happen from time to time.  To test out these claims more studies were done. The main study on this subject was performed on 14 football players who were told to consume creatine for 8 weeks.  They chose football players as the athletes to use as guinea pigs…I mean test subjects…because football is considered a high-intensity, short-duration exercise (which is exactly the kind of activity creatine is supposed to aid in).  During the 8-week time period the athletes’ kidney function, liver function, and over health were closely monitored. Their results regarding creatine efficacy paralleled those of other previous studies showing that body mass increased and the athletes’ abilities to perform high-intensity, short-duration exercises did improve.  As far as toxicity goes, no signs of kidney or liver damage were seen in any of the patients.  In addition, none of the football players became dehydrated or had more cramping than they did at baseline.

Before we go waving our “Creatine is Safe” flag, a few things should be pointed out.  First, the studies were done on healthy, young males.  People who have liver or kidney problems to begin with should not further challenge their organs unless they are under the close supervision of a health professional.  Studies have not been done with people who have kidney or liver problems so it is hard to say how it may affect them.  Second, all these studies were short term (8 weeks was the longest one performed) so no one really knows the long-term effects of taking creatine.  Many of the problems initially reported with creatine supplementation could have been due to impurities in the creatine supplement people were purchasing thus it’s always important to buy supplements made by a well known and trusted company (i.e. don’t order it off the web from some no name company just because shipping is free).  In addition, be sure to consume plenty of water when using creatine.  Remember that creatine pulls water into your muscles (and out of your body’s circulation).  You need to make sure that you are replacing this displaced water while using creatine to prevent dehydration.

The Final Verdict: If you are serious about working out and are looking for a supplement to provide you with additional stamina to help you strength train for longer periods of time then creatine may be the way to go.  Some things to keep in mind when shopping around:

1. Most of the studies used creatine monohydrate powder as their creatine source (there are more expensive formulations with fancy names but this formulation seemed to work well in the studies).

2. No consistent standards were set for the loading phase of creatine use but 20 grams per day (split into 4-5 grams doses throughout the day) for 5 days seemed to be the most common approach. Note, however, that consuming that much creatine is going to upset your stomach.

3. It was recommended that the average person who wants to gain body mass should supplement with 2-5 grams of creatine per day when working out.

4. Make sure you’re buying high quality creatine from a reputable manufacturer at a reasonable price.

Now go hit the gym mister.

References:

Bemben M, Lamont H. Creatine Supplementation and Exercise Performance Recent Findings. Sports Med 2005; 35 (2): 107-125

Cancela P, Ohanian C, Cuitiño E, et al., Creatine supplementation does not affect clinical health markers in football players. 2008 Sports Med 42: 731-735 .

Dalbo V, Roberts M, Stout J, et al. Putting to rest the myth of creatine dehydration and supplementation leading to muscle cramps. Br J Sports Med 2008 42: 567-573

Herda T, Beck T, Ryan E, et al. Effects of Creatine Monohydrated and Polyethylene Glycosylated Creatine Supplementation on Muscular Strength, Endurance, and Power Output. 2008. The Journal of Strength and Conditioning Research.

Lopez R, Douglas C, McDermott B, et al. Does Creatine Supplementation Hinder Exercise Heat Tolerance or Hydration Status? A Systematic Review with Meta-Analyses. 2009; Journal of Athletic Training. 44(2), 215-223.

by Leah Frankel, MS, RD

Have you ever looked at your recently-turned-vegetarian friend and wondered what the heck they are thinking? With more and more people now considering themselves vegetarians it makes us wonder, “How do they do it?”  You’re probably wondering why someone would ever want to give up meat. Additionally, aren’t vegetarians missing some key life-sustaining nutrients.  We are omnivores for a reason.  We’ll learn about the different varieties of vegetarians, why people chose a vegetarian lifestyle and what nutrients vegetarians need to be sure they include in their meals to have a well-rounded diet.

Types of Vegetarians

By definition, a vegetarian is someone who doesn’t consume meat, poultry or fish.  The spectrum of vegetarians is vast and we’re here to help you decipher the differences. Even within each classification of vegetarian, there are variations depending on the individual’s needs or reasons for becoming a vegetarian.

Pescatarian: A pescatarian is someone who eliminates all poultry and meat but consumes fish and seafood. This has become increasingly popular due to health advantages of fish consumption or as a first step in becoming a vegetarian.

Semi-Vegetarian: Someone that follows a semi-vegetarian diet follows a vegetarian diet the majority of the time but occasionally eats meat, fish or poultry.

Lacto-ovo Vegetarian: People who follow a lacto-ovo vegetarian diet avoid meat, poultry and fish; however they do eat dairy (lacto) and eggs (ovo). In addition, some people are either lacto vegetarians (consuming dairy, but not eggs) or ovo vegetarians (consuming eggs, but not dairy).

Vegan: A vegan is a person that, in addition to not consuming meat, poultry or fish, does not eat any foods that are of animal origin including eggs, dairy, gelatin and honey. In addition, many vegans refrain from wearing leather or other products made from animals, as well as products that are tested on animals.

Reasons to “Go Veggie”

Religious reasons: A variety of religions promote vegetarian or vegan diets including Buddhism, Jainism, Taoism, Hinduism, and Seventh day Adventists. Each religion encourages a vegetarian diet for a variety of reasons including health benefits (in the case of the Seventh day Adventists) and respect for living creatures (as seen with Buddhism).

Health reasons: There are a number of health benefits associated with following a vegetarian diet including:

• Lower rates of obesity

• Decreased risk of chronic diseases including type 2 diabetes, heart disease, high blood pressure and certain types of cancer

• Longer lifespan

• Reduced risk of food-borne diseases

• Nutrient intakes that are closer to current nutrition recommendations

Ethical reasons: Some people choose to eliminate meat from their diet due to the treatment that animals receive, including how they are raised, transportation to slaughter houses, processes used to slaughter animals and believing that animals have rights, similar to those of people.

Environmental reasons: There are a number of benefits for following a vegetarian diet in terms of protecting the environment including: preserving water resources, preventing water pollution, preserving the earth’s ecosystems, and reducing the consumption of the earth’s resources.

Getting Your Vitamins from A to Zinc

In order to plan a well-rounded vegetarian diet there are a few nutrients that vegetarians and vegans need to be cognizant of and be sure to incorporate into their diet:

Protein: Most people assume it will be difficult to meet their protein requirements as a vegetarian, however most American’s consume twice as much protein as they need; most vegetarians are able to meet their protein requirements with a little planning. Daily requirements for protein depend on gender and body weight.  Symptoms of protein deficiency include edema (swelling, usually on the extremities), weight loss, thinning or loss of hair, general weakness, slowness in healing of wounds and bruises, headache, and difficulty sleeping. Vegetarian sources of protein include: beans, lentils, tofu, chickpeas, dairy (for lacto- or lacto-ovo vegetarian) and eggs (for ovo- or lacto-ovo vegetarian).

Vitamin B₁₂: Vitamin B₁₂ is only naturally found in foods derived from animals. A lacto-ovo vegetarian likely will have an adequate intake but a vegan may not. Options for meeting your vitamin B₁₂ requirements include taking a B₁₂ supplement (pill form), eating foods fortified with vitamin B₁₂, or receiving regular vitamin B₁₂ injections from your physician (usually monthly).  Symptoms of vitamin B₁₂ deficiency include anemia (particularly one subtype called megaloblastic anemia), fatigue, weakness, constipation, loss of appetite, weight loss, numbness or tingling in hands and feet, depression, confusion, and dementia.  Daily requirements for vitamin B₁₂ vary by age and gender.  egetarian sources of vitamin B₁₂: fortified cereals, nutritional yeast, soymilk, and soy products.

Iron: There are two types of iron: heme iron and non-heme iron. Heme iron is the iron found in hemoglobin (which carries oxygen in a red blood cell).  This form of iron is only found in animal products and is more readily absorbed than non-heme iron. However, non-heme iron’s absorption is improved when consumed with vitamin C (so be sure to include vitamin C in your iron-enriched meal).  Daily iron requirements vary by age and gender.  Symptoms of iron deficiency include anemia, fatigue, pale skin, weakness, shortness of breath, headache, dizziness, cold hands/feet, and brittle nails.  Vegetarian sources of non-heme iron: pistachios, cashews, chickpeas, sesame seeds, dried fruits, and spinach.

Calcium: Since vegans and ovo-vegetarians don’t consume dairy, it’s important to ensure adequate calcium intake. Symptoms of calcium deficiency include twitching, seizures, and tetany (extreme stiffness and rigidity in your muscles).  Vegetarian sources of calcium: kale, collard greens, broccoli, legumes, figs, almonds, tofu, and fortified soymilk.

Omega-3 Fatty Acids: The primary source of omega-3 fatty acids is fish, so unless you’re a pescatarian it can be difficult to have an adequate intake. Vegetarian sources of omega-3 fatty acids do not contain the active form of the nutrient that your body needs so supplements with flax seed oil may be necessary. Daily omega-3 fatty acid requirements vary by age.  Symptoms of omega-3 fatty acid deficiency include fatigue, dry/itchy skin, brittle hair, weak nails, constipation, depression, and poor concentration.  Vegetarian sources: soy, walnuts, canola oil, flaxseeds and pumpkin seeds.

Will following a vegetarian diet make you healthier? Not necessarily. As people often forget, vegetarian diets can include plenty of unhealthy foods including french fries, donuts, pizza and ice cream. However, most vegetarians consume more fruits and vegetables, and eat less unhealthy fats (trans and unsaturated) than their meat-eating counterparts. Not ready to completely change your diet? Try going veggie once a week and discover fun new vegetarian dishes!

by Leah Frankel, MS, RD

With a plethora of special occasions and excuses to indulge, the holiday season can wreak havoc on your diet unless you’re prepared to tackle those festive buffets and eggnog-filled nights. Preventing holiday weight gain and maintaining your normal healthy diet is definitely possible with a little planning.  First, don’t accept the mentality that you can indulge now and start your diet and exercise regimen when New Years comes around.  You’ll be fighting an uphill battle with even more calories to burn!  Food is meant to be savored, just not in excess!  Enjoy the tips below that outline how to navigate your way through the holiday season as well as some ideas for healthy variations of your traditional holiday favorites!

Tips for Holiday Health:

Have a plan before attending a holiday gathering. Adjust your diet and workout schedule, if necessary, the day of the party to compensate for the food you’ll be eating later that night. If you know you’ll be at a party tonight, skip the desserts at work during the day.

Maintain your exercise schedule, or modify it to fit your situation. If you’re not going to be home for your usual workout, bring running shoes with you to enjoy exercise outside with family and friends.  A game of catch or tennis before dinner is a great way to spend time with family and stay fit.  You can also research gyms in the area where you’ll be staying and make exercising a family activity.  Remember that working out can help reduce stress, regulate your appetite and maintain your weight.

Eat a snack before hitting up the holiday party. If you go to a party or holiday dinner hungry you’ll be more likely to overeat and will have more difficulty resisting the tempting high calorie and high fat treats. A good pre-party snack should include a glass of water, some protein and high fiber carbs, such as an apple with peanut butter or whole grain crackers and cheese.

Use small plates. This is a good tip for all year, not just during the holidays. Studies show that people who switch to smaller plates or bowls consume fewer calories. Grab an appetizer plate instead of a large entrée plate to prevent overindulging.

Assess all the food options and choose which foods you really want to eat. While you might really love chocolate chip cookies, remember that your Aunt Molly’s pecan pie only comes once a year.  Think through which foods you really want and choose a combination of small portion of your “treats” mixed with healthy foods like fresh fruits or vegetables.

Stay away from the buffet table. Once you’ve filled your plate, moving away from the table can prevent overeating. Remember that the holidays are about spending time with family and friends, so enjoy their company instead of eyeing the food table. If your hands feel empty once you’ve finished your food, keep them busy with a low- or no-calorie beverage.

Bring your own dish so you can guarantee a healthy option. Most hosts would love help with the cooking.  Ask them what they’re preparing and suggest some dishes you could prepare. Check out the suggestions below for some healthy culinary ideas.

Beware of calorie-laden drinks. Alcoholic drinks can pack more calories than a burger and fries at McDonald’s and drinks during the holidays are no exception (see our previous article, Know thy Liquor: What’s in a Drink).  Eggnog, hot cocoa and cider all contain excess calories.  Try to stick with your low-calorie choices such as wine, light beer or mixed drinks made with low- or no-calorie mixers. Also, try to drink a glass of water between alcoholic beverages.  It helps prevent hangovers (see The Hangover: Make it go Away!) and keeps your waistline the way you want it.

Pay attention to what you’re eating. Food is meant to be enjoyed so slow down and savor the foods you’ve chosen. Take small bites and chew your food thoroughly to prevent overeating and to truly appreciate your food. Your host has spent hours slaving away in the kitchen.  Why not slow down and savor all that hard work?  Also, beware of mindless eating which can happen if you settle down on the couch with your hand in the chip bowl.

Beware of snacking. Mindless snacking while cooking or socializing can add hundreds of excess calories that you don’t ever realize you’re consuming. Eat a nutritious snack or chew gum while cooking to prevent yourself from snacking mindlessly.

If you’re full don’t be afraid to say no to seconds.  While family members or friends may push you to eat more, remember that it’s your decision what you eat.  You’ll feel better afterwards if you say no to seconds when you’re full, than if you keep eating.

If you overeat don’t beat yourself up. Just because you ate too much at one meal doesn’t mean you should give up your health-conscious ways and stop eating healthily. Make sure your next meal is lighter and then return to your usual eating pattern. Remember that one meal alone won’t make you gain weight.  It takes 3500 excess calories to gain a pound.  Lastly, a nice long workout later that day or the next can help burn those excess calories you consumed during your holiday splurge.

Transforming Holiday Classics into Healthy Well-Balanced Dishes:

Instead of Mashed Potatoes: Choose mashed sweet potatoes which contain more nutrients including fiber, vitamin C, potassium, and vitamin A. If you want to make traditional mashed potatoes, consider replacing milk and butter with broth. Adding cauliflower to mashed potatoes provides extra fiber and nutrients and will be equally filling with fewer calories.

Instead of Dark Meat Turkey with Gravy: Choose white meat and skip the skin. Turkey is a great source of lean protein if you choose the right parts. If you want to drizzle a small amount of gravy on top, try refrigerating the gravy beforehand and skimming the fat off the top to cut calories and fat in your savory topping.

Instead of Corn Bread Stuffing: Try making your stuffing with whole wheat bread and add healthy additions like nuts, fruits, and vegetables. The added fiber in the bread, fruit, and vegetables will keep you full with fewer calories and less fat.

Instead of Pumpkin Pie: Serve pumpkin pie filling with cool whip.  Cutting out the crust will save calories and fat, and pumpkin is a good source in beta-carotene. You can also substitute low fat evaporated milk or light cream into your pumpkin pie recipe.

Instead of Green Bean Casserole: Modify the recipe by choosing a low fat cream of mushroom soup or using light butter. You could also serve green beans as a cold salad with nuts, onions and light Italian dressing.  Green beans are a great source of many nutrients including vitamin C, vitamin K, vitamin A and potassium and can be an excellent healthy addition to a holiday feast if prepared correctly.

by Leah Frankel, MS, RD

The last time you were in the grocery store or a health food mart did you notice the aisles filled with gluten-free foods? Ever wonder what those gluten free foods are and if they provide any health benefits? We’re here to give you the rundown. Gluten-free foods are intended for people with celiac disease. But what is celiac disease? In honor of National Celiac Disease Awareness Month it only seems appropriate to learn a little about celiac disease and the role of gluten-free foods, since approximately 1 in 133 Americans are affected by celiac disease.

What is Celiac Disease?

Celiac disease, also called celiac sprue, gluten-sensitive enteropathy, gluten intolerance, and non-topical sprue, is an autoimmune disorder that is passed down genetically.  It affects affect both adults and children. When a person with celiac disease eats foods containing gluten (don’t worry we’ll explain what gluten is later on) their body responds with a strong an immune response that causes damage to the small intestine. In a normal, healthy individual villi (tiny hair-like projections in the small intestine) are designed to absorb nutrients in the small intestine (see the top two pictures below for an idea of what a normal intestine and villi look like).  In someone with celiac disease, the immune response to gluten causes the villi to be damaged and decrease in number, known as villous atrophy (the bottom two pictures below show atrophy of the villi in the intestines from celiac disease).  These individuals’ villi are unable to absorb nutrients leading to malabsorption (i.e. you don’t absorb the food you eat).

While most people with celiac disease have a variety of symptoms, some have no symptoms at all. Symptoms in adults can include: change in appetite, weight loss, stomach cramping, fatigue, muscle cramping, pain in your bones and joints, abnormal stools, or weakness. In addition, celiac disease can manifest itself as Dermatitis Herpetiformis, itchy blisters most commonly found on the face, elbows, buttock, knees and ankles (you would know if you had these). In children, common symptoms include: projectile vomiting, stunted growth, and behavior changes in older children.

There are several tests that are used to diagnose celiac disease. The first is a blood test that checks for the presence of certain auto-antibodies in the blood. Auto-antibodies are antibodies that attack your body’s own tissues as opposed to normally functioning antibodies which attack foreign substances in the body like viruses and bacteria. The auto-antibodies we look for in celiac disease include immunoglobulin A (IgA), anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). Depending on the result of your blood work, a biopsy of the small intestine may be done to confirm the diagnosis of celiac disease. Finally, if the biopsy suggests the presence of celiac disease, improvement of your symptoms while adhering to a gluten-free diet would help confirm the diagnosis.

The only treatment option for those with celiac disease is to completely eliminate gluten from their diet. The effects of a gluten-free diet are seen almost immediately with symptoms resolving within a few days. After a few weeks on a gluten-free diet the small intestine will heal and begin to function normally. If celiac disease it not treated with a change in diet it can lead to long-term complications including osteoporosis, anemia, vitamin/mineral deficiency and cancer.

What is gluten and what constitutes a gluten-free diet?

Gluten is a protein found in certain grains. It is responsible for the elasticity in dough and structure in bread. The easiest way to remember which grains contain gluten is the acronym BROW: barley, rye, oats and wheat.

There is some debate regarding whether oats need to be completely eliminated from the diet in people with celiac disease. It is possible that some people may be able to tolerate small amounts of oats. However, since there is no way to determine if someone will be able to tolerate oats, and oats are frequently cross-contaminated with gluten, it is best for people with celiac disease to avoid oats.  Verdict: No go on the oats.

People who follow a gluten-free diet can consume starches including: corn, rice, potato, beans, quinoa, millet, buckwheat, arrowroot, and nut flours. It is important to pay attention to ingredients that are derived from gluten as well including malt, modified food starch and bran. A gluten free diet does allow for plenty of unprocessed foods including meat, fish, fruit, eggs, and vegetables.

With an increased awareness of celiac disease, manufacturers are now providing gluten-free versions of many foods including pasta, pizza, cookies etc. In addition, many restaurants now offer a gluten-free menu or gluten-free options.

Is it a good idea to follow a gluten-free diet if I don’t have celiac disease?

Not necessarily. While there is no question that people with celiac disease should follow a gluten-free diet, eliminating any type of food from your diet comes with some risks and thus it may not be a good idea if you don’t have celiac disease. Many people following a gluten-free diet turn to gluten-free processed items to fill in their cravings for bread, pasta and cookies. Gluten-free products are typically lower in fiber, B Vitamins, calcium, Vitamin D, zinc, iron, and magnesium when compared with products containing gluten. Switching from whole wheat bread or cereal to products made with rice or potato flour can lead to a lack in fiber intake, causing constipation. In addition, many gluten-free items are higher in fat than their non-gluten-free counterparts including sweets like cookies, cakes and crackers.

On the other hand, there is one advantage to following a gluten-free diet: Individuals who follow a gluten-free diet are less likely to consume processed foods since many processed foods contain gluten. Yeah, it’s a stretch but we’re trying to stay positive.  Also remember, you don’t have to go gluten-free to keep your diet healthy.  Keep it well balanced with fruits, vegetables, lean proteins and whole grains!