SUZANNE

Suzanne a 48 year old lady is our most recent client today, and she tells us she is experiencing menopause. After carefully examining her diet with her, we find out that her daily intake of calcium is only about 600 mg/day from the foods that she eats.  Suzanne does not take vitamins either.  The best recourse to take with Suzanne is to provide education in order to help her understand why she is going through her menopause so soon, and based on the given information.  Calcium is needed for our heart, muscles and nerves to function properly and for blood to clot. Inadequate calcium significantly contributes to the development of osteoporosis. Many published studies show that low calcium intake throughout life is associated with low bone mass and high fracture rates. National nutrition surveys have shown that many women and young girls consume less than half the amount of calcium recommended to grow and maintain healthy bones.  However, calcium alone cannot prevent osteoporosis and is not a substitute for medication that may be needed to curb excessive bone loss. Menopause is characterized by the loss of estrogen production by the ovaries. This may occur by natural means or by the surgical removal of both ovaries. This loss of estrogens accelerates bone loss for a period ranging from 5 to 8 years. The reason I use menopause in this explanation, is to make the client aware of the consequences this disease can have on her later in life. There in terms of bone remodeling the lack of estrogen enhances the ability of osteoclasts to absorb bone. Since the osteoblasts (the cells which produce bone) are not encouraged to lay down more bone, the osteoclasts win and more bone is lost than is produced.  Taking only 600 mg/ a day is not nearly enough, Suzanne should be getting 1000mg a day for her age.  Suzanne should also be exercising regularly.  She must be sure to eat a well-balanced diet a day also.  If she is a smoker then Suzanne should quit and consider all the other fact that come with smoking, it can make osteoporosis worse.  Susanne may want to talk to her doctor about HRT (Hormone Replacement Therapy) or other medicines to prevent or treat osteoporosis.  It’s usually best to try to get calcium from food. Nonfat and low-fat dairy products are good sources of calcium. Other sources of calcium include dried beans, sardines and broccoli.  If she is not getting enough calcium from the food she is eating, Suzanne’s doctor may suggest taking a calcium pill. Take it at meal time or with a sip of milk. Vitamin D and lactose (the natural sugar in milk) will help her body absorb the calcium.  The main four essential multivitamin supplements that women require are Calcium, Vitamin D, Magnesium and Vitamin K in order to ensure good bone health.  The best way to get all the nutrients you need is to eat a sensible balanced diet with lots of fruit, vegetables, beans, yogurt, bread and potatoes, together with smaller amounts of  very lean meat, lower-fat cheese and oily fish (esp. sardines). In addition, have at least half a pint of low-fat milk per day. Lastly, cut down on red meat, chocolate, caffeine, nicotine and alcohol, as all these things tend to weaken our bones and increase the risk of getting Osteoporosis. The goal of educating others about their health is a very important factor in prevention.  It does not matter how much medicine some patients receive, there is always a need for the patient education.  As a health educator; it is my responsibility to see that Suzanne is properly instructed as to what she must do to prevent osteoporosis and why.    

References:

 

Cashman, K. (2007, Nov.). Diet, nutrition, and bone health. The Journal of Nutrition, 137(11S), 2507S.  Retrieved from Proquest at

Doyle, L., & Cashman, K.D. (2004, May). The DASH Diet May Have Beneficial Effects on Bone Health. Nutrition Reviews, 62(5), 215-221.

Harkness, L. (2004, Jan/Feb). Soy and Bone: Where Do We Stand? Orthopaedic Nursing, 23(1), 12-18.

Lanham-New, S. (2008, Jan.).  The Balance of Bone Health: Tipping the scales in favor of potassium-rich, bicarbonate-rich foods, The Journal of Nutrition, 138(1), 172S. 

Rafferty, K., & Heaney, R. (2008, Jan.).  Nutrient effects on the calcium economy: emphasizing the potassium controversy. The Journal of Nutrition, 138(1), 166S.

Tylavsky, F., Spence, L., & Harkness, L. (2008, Jan.). The importance of calcium, potassium, and acid-base homeostasis in bone health and osteoporosis prevention. The Journal

The Kids Just Aint Eatin’ Right

Obesity remains a public health epidemic the United States is facing.1-3 Children and adolescents in the United States have not escaped from the obesity epidemic. The prevalence of overweight has doubled for US children aged 6-11 years-and tripled for American teenagers over the past 2 decades. Approximately 17% of children and adolescents between the ages of 2 and 19 years are considered overweight and 34% are at risk for becoming overweight.  Childhood obesity is associated with many health risks. It is the leading cause of pediatric hypertension and associated with type 2 diabetes mellitus, orthopedic complications, increased risk of coronary heart disease, and increased stress on weight-bearing joints.6-10 Hospital cost for diseases/conditions related to childhood obesity has increased dramatically in the past 20 years. Wang and Dietz analyzed the economic burden of obesity in youths 6-17 years of age and found that obesity-related annual hospital costs (based on 2002 constant dollar value) increased more than 3-fold over the 2 decades between 1979-1981 and 1997-1999 from $35 million to $127 million.  This portion of the article above was taken from; School-Based Obesity Interventions: A Literature Review  by Fadia T Shaya, David Flores, Confidence M Gbarayor,and Jingshu Wang  from The Journal of School Health. Kent: April 2008 Vol. 78, Iss. 4; pg. 189, 8 pgs.  

In today’s society we note the need for better nutrition programs, to assist in the challenge that has given birth to adolescent obesity.  With progress seemingly far out of sight, there are a few programs out there that can help.  The school systems around the country are working to solve some of the problems that are help the obesity situation along.  By improving the nutritional value of the foods that are being served within the school cafeterias across the country, we can improve the quality of health for our children.  One program that stood out in my mind had no particular name, but it was a school in Alaska (Robert Service High School) that actually served small Subway sandwiches in it nutrition curriculum.  The program is a simple but smart approach to the growing childhood obesity epidemic in the country today.  In order to improve a more health conscious group, the school had decided if fast foods were intervening in the nutritional care of the students, then why not make it Subway.  This presents a healthier choice then most other fast foods.  Setting up a program as such can prove to be very good for the student and this can also teach them how to make the right choice when making food decisions.  It would be wise to offer the sandwich choice over the Sloppy Joe, hamburger with fries, or hotdog with the works choices often given in most schools.  Even the snack machines have a bad habit of selling less than nutritional valuable items, i.e.; Hoo Hoo Cakes, Bear Claws, and other items saturated with an abundance of fats and sugars .  By educating the student at a young age on how nutrition effects each and everyone us we reduce the risks associated with childhood obesity.  By adding health conscious snacks to the snack machines, we are helping the students make smart decisions and by serving the Subway sandwiches we open up a new door to the nutrition of the student, helping them to learn to make the right choices when eating.

References:

by Fadia T Shaya, David Flores, Confidence M Gbarayor,and Jingshu Wang 

Yaussi, S.C.

American Association of Pediatrics

Hey Steve Over Here

Here again we find ourselves in the common dilemma that embraces most Americans each day.  What is good for me and what is bad for me, do I eat this or that, how do I figure all this out.  In this age of growing nutrition fads, it is hard to tell what is good and what is bad for you.  Remember Jim the 47yr old former weight lifter?  We attempted to set him up with a great program and even planned to monitor his success. So now meet Steve.  As we watch the fitness field grow, we find ourselves surrounded by many “Fitness Professionals”  who make extravagant claims on a day to day basis to the uneducated masses.  By soliciting what is believed to be the good knowledge necessary for a long and healthy life, they open us up for serious health risks.  This is largely due to the fact that most “professionals” give out the wrong information.   It would seem that once again we are having the argument of Good Cholesterol ( HDL) versus bad Cholesterol LDL), again, and as usual the client has gotten the wrong information.  It is imperative that we as nutrition specialist and fitness trainers understand this, if you are giving out this information and unaware of the correct response then consult a professional.  Steve is a 50 y/o, who recently consulted with a personal fitness trainer about what he should be eating.  During the visit he was informed that fat and high density lipoprotein (HDL) cholesterol in the diet are generally harmful to cardiovascular health.  This advice is very sound to the uneducated ear, those of us who rely on our “professionals” to give us clear and sound information concerning ourselves and healthy living.  This advice is terribly wrong.  We will actually discuss a few types of fats.  Let’s start with the fats Steve was told not to eat by his fitness instructor - good fats.  These are the unsaturated kind that helps fight the very diseases that consuming excess fat was said to cause. These unsaturated fats are divided into Monounsaturated fats and polyunsaturated fats, and both types are thought to have beneficial effects on cholesterol levels.     Monounsaturated fats help lower LDL (bad) cholesterol while also boosting HDL (good) cholesterol.  Polyunsaturated fats are also thought to help lower total and bad cholesterol. But monounsaturated fats are favored over polyunsaturated fats because some research suggests that polyunsaturated fats are less stable, and can reduce levels of good cholesterol as well as bad.  But let's not ignore polyunsaturated fats. These are often a good source of omega-3 fatty acids, found mostly in cold-water fish, nuts, oils and seeds, and also in dark leafy greens, flaxseed oils and some vegetable oils. One kind of omega-3 fatty acid is an "essential fatty acid," which cannot be manufactured by our bodies, so eating these foods is the only way to get them. Omega-3 fatty acids are thought to lower blood pressure, combat LDL (bad) cholesterol, fight inflammation and protect the brain and nervous system.  Most cooking oils are made up primarily of unsaturated fats. When it comes to choosing cooking oils, each type of cooking oil varies in its ratio of monounsaturated to polyunsaturated fats. Two oils stand out for their high levels of monounsaturated fats: canola oil and olive oil. Other than nonstick cooking spray, these two oils should be in your pantry.  At the end of the day, a good fat is still a fat in terms of calories. Any labels on cooking oil that describe the oil as "light," are referring to the taste or color, not the fat or calorie content. All oils are 100 percent fat and are worth around 120 calories per tablespoon.  Then there are the bad fats—those artery-clogging saturated fats from meat and dairy products. These fats are solid at room temperature. Saturated fats not only clog our arteries, they also directly raise total and LDL (bad) cholesterol levels. Avoid them as much as possible. But, we are told, some saturated fats may not bad at all: some argue that coconut oil and palm oil may actually be beneficial because their particular fatty-acid make-up means they are metabolized differently in the body. So it could be that plant-based saturated fats may be more beneficial, or at least more neutral, than we think, but there is no broad consensus on this yet. And while coconut oil and palm fruit oil have been rehabilitated in the eyes of some, there are fewer proponents of palm kernel oil.

 

Reference:

Fiona Haynes (Fitness and Nutrition Going Hand in Hand)

Lopez-Miranda, J., Badimon, L., Bonanome, A., Lairon, D., Kris-Etherton, P.M., Mata, P. et al. (Monounsaturated Fat and Cardiovascular Risk. Nutrition Reviews, 64(10), S2-S13.)

Pignone, M. (Low-Total-Fat Diet Did Not Reduce the Risk of Cardiovascular Events. Clinical Diabetes, 24(3), 143-145)

Byrd-Bredbenner, C., & Finckenor, M. (Journal of Nutrition Education, 32(1) American Dietetic Association: Fiber Facts.  Plant this idea: Fill up on fiber

American Heart Association. (2007) Cholesterol: AHA Scientific Position

 

Jonathan’s Bones

What is Osteoporosis?  Well here is the accurate definition.  Osteoporosis is a disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture.[1] Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis, but may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis (SIOP or GIOP). Given its influence is the risk of fragility fracture; osteoporosis may significantly affect life expectancy and quality of life.  (Taber Cyclopedia of Medicine) . 

Jonathan, a 54 year-old male client walks into our office for his initial meeting.  After a brief round of questions and answers and we begin our conversation concerning any possible bone instability and or damage as we go over this with every client.  Confident of himself; Jonathan tells us that he does not have to worry about getting osteoporosis because healthy bones are things that a person is born with and have absolutely nothing to do with nutrition, and osteoporosis is an extremely rare disease that only affects elderly women and not men.   Therefore it is not a very serious or significant disease.  Now this statement will send up some red flags, because here is a gentleman who is not concerned that he could be at risk for osteoporosis.  I would most definitely disagree with the two statements made.  The reasoning of this client is otherwise influenced possibly by television or some form of literature claiming incorrect information.  The fact is that osteoporosis affects quite a large number of people, and in most cases it is due to inadequate dietary intake.    Osteoporosis can be a cause of significant morbidity and mortality in postmenopausal women as well as men. In both men and women, increasing age and low bone mineral density (BMD) are the 2 most important independent risk factors for an initial vertebral or nonvertebral fracture (Bonnick SL. Department of Biology, University of North Texas).  Osteoporosis is in fact a major public health problem, affecting millions of individuals. Dietary intake is an important factor for bone health. Inadequate intake of nutrients important to bone increases the risk for bone loss and subsequent osteopomsis. The process of bone formation requires an adequate and constant supply of nutrients, such as calcium, protein, magnesium, phosphorus, vitamin D, potassium, and fluoride. However, there are several other vitamins and minerals needed for metabolic processes related to bone, including manganese, copper, boron, iron, zinc, vitamin A, vitamin K, vitamin C, and the B vitamins. Although the recommended levels of nutrients traditionally related to bone were aimed to promote bone mass and strength, the recommended levels of the other nutrients that also influence bone were set on different parameters, and may not be optimal for bone health, in view of recent epidemiological studies and clinical trials.

(The Role of Nutrients in Bone Health, from A to Z Cristina Palacios Critical Reviews in Food Science and Nutrition. Boca Raton: 2006. Vol. 46, Iss. 8; pg. 621, 8 pgs).

 

Here are some things that Jonathan may need to take into consideration also;

 

Causes of Secondary Osteoporosis in Men:

 

    * Glucocorticoid medications

    * Other immunosuppressive drugs

    * Hypogonadism (low testosterone levels)

    * Excessive alcohol consumption

    * Smoking

    * Chronic obstructive pulmonary disease and asthma

    * Cystic fibrosis

    * Gastrointestinal disease

    * Hypercalciuria

    * Anticonvulsant medications

    * Thyrotoxicosis

    * Hyperparathyroidism

    * Immobilization

    * Osteogenesis imperfecta

    * Homocystinuria

    * Neoplastic disease

    *Ankylosing spondylitis and rheumatoid arthritis

    * Systemic mastocytosis

 

This should be more than enough to help Jonathan re think that last statement.

References:

National Institute for  Arthritis and Musculoskeletal Diseases and Skin Disease

The Role of Nutrients in Bone Health, from A to Z Cristina Palacios Critical Reviews in Food Science and Nutrition. Boca Raton: 2006. Vol. 46, Iss. 8; pg. 621, 8 pgs

Bonnick SL. Department of Biology, University of North Texas