Published by
Stanford Medicine

Category

Nutrition

Behavioral Science, Health and Fitness, Nutrition, Obesity, Public Health, Research

Perceptions about progress and setbacks may compromise success of New Year’s resolutions

3336185391_60148a87fa_zMy physical therapist is constantly telling me to pause during the workday and take stretch breaks to counter act the damage of being hunched over a computer for hours on end. After every visit to his office, I vow to follow his advice, but then life gets busy and before I know it I’ve forgotten to keep my promise.

So I decided that one of my New Year’s resolutions will be to set an alarm on my phone to serve as a reminder to perform simple stretches throughout the day. Keeping in mind that a mere eight percent of people who make resolutions are successful, I began looking for strategies help me accomplish my goal. My search turned up new research about how the perception of setbacks and progress influence achievement of behavior change. According to a University of Colorado, Boulder release:

New Year’s resolution-makers should beware of skewed perceptions. People tend to believe good behaviors are more beneficial in reaching goals than bad behaviors are in obstructing goals, according to a University of Colorado Boulder-led study.

A dieter, for instance, might think refraining from eating ice cream helps his weight-management goal more than eating ice cream hurts it, overestimating movement toward versus away from his target.

“Basically what our research shows is that people tend to accentuate the positive and downplay the negative when considering how they’re doing in terms of goal pursuit,” said Margaret C. Campbell, lead author of the paper — published online in the Journal of Consumer Research — and professor of marketing at CU-Boulder’s Leeds School of Business.

Given these findings, researchers suggest you develop an objective method for measuring your progress and monitor it regularly.

Previously: Resolutions for the New Year and beyond, How learning weight-maintenance skills first can help you achieve New Year’s weight-loss goals, To be healthier in the new year, resolve to be more social and Helping make New Year’s resolutions stick
Photo by Laura Taylor

Nutrition, Parenting, Public Health

“Less is more”: More holiday eating tips from a Stanford nutrition lecturer

"Less is more": More holiday eating tips from a Stanford nutrition lecturer

cake-buffet-58682_1280My grandmother is fortunate enough to live within an easy drive of the Shady Maple Smorgasbord, a Pennsylvania Dutch-style dining extravaganza in Lancaster County. It’s the size of a large auditorium, packed with tables and two gigantic buffet lines. It’s the biggest restaurant, serving the most food, to the most people, that I’ve ever seen.

For dinner, each day the buffet includes: “46 salad bar items, 3 soups, 8 homemade breads & rolls, 4 cheeses, 8 meats, 14 vegetables, 10 cold desserts, 3 hot desserts, 8 pies, 6 cakes, sundae bar & many beverages.” Plus the daily specials. On Tuesday, for example, there’s also: “salmon, Cajun catfish, cod, oyster stew, beef brisket, New York strip steak and baked potatoes.”  A surfeit of tastiness, abundance beyond words — mmmm, mmmm, let’s go!

Not so fast, Stanford-based dietician, Maya Adam, MD, would say. “Size matters. We can enjoy absolutely any food, as long as its consumed in moderation,” she writes in a Healthier, Happy Lives Blog post, published today by Stanford Children’s Health.

That means no King Size KitKat and no seconds at the smorgasbord dessert line, either. Try using smaller dishes, Adam suggests. Cut servings in half, eat half, save some for later or share with a friend. And pay attention to the food. No texting, TV watching or mindlessly shoveling food into your mouth. Savor each bite, Adam writes:

The truth is, when we eat real, fresh food in modest amounts (even if it’s cooked with a pat of butter and a sprinkle of salt) it doesn’t take much to leave us feeling completely satisfied.

Don’t flip out if you just can’t resist that smorgasbord. But practice moderation — that’s the real way to think big about food.

Previously: Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian, Where is the love? A discussion of nutrition, health and repairing our relationship with food and “Less is more”: Eating wisely, with delight, during the holidays 
Photo by Hans

Nutrition, Parenting, Pediatrics, Public Health

Tips on how parents with a history of eating disorders can enjoy the holidays

Tips on how parents with a history of eating disorders can enjoy the holidays

5294777976_8eb6ae86d9_zThe holiday season is often a joyful time when friends and family hit pause on their busy schedules to enjoy each other’s company. There’s also lots and lots of food involved, which can be challenging for parents with a history of eating disorders.

Recent research has found that parental eating disorders (either a past or current condition) are associated with numerous problems in child feeding, including difficulties in transitioning to solid foods and deciding which types of foods to offer and in what quantities. Studies observing the interactions of mothers with eating disorders and their young children noted greater conflict and more controlling behavior over eating, appetite, and food choices. Mothers with eating disorders often tell researchers and clinicians that their children’s troubling eating patterns are associated with their own eating habits, and shape and weight concerns  too often intervene in the decisions parents make in feeding their children.

Holiday celebrations can make these feeding relationships even more complex. Traditions of eating together with family or friends may create additional stress for parents. Additionally, family gatherings can reawaken memories of negative experiences parents may have had as children at the dinner table, adding another layer of worry and hyper-vigilance.

So what should parents with a history of eating disorders, or those concerned about their children overeating, do during the holidays? Here are some tips for having a more pleasurable and relaxing time:

  • Plan ahead: Talk to your partner about your concerns and come up with a strategy for how to cope with stressful situations around eating. Talk about what you’ll do if there is food on the table that you typically don’t eat, or if your child asks for second and third servings of foods. A rule of thumb should be to allow the child to experience a variety of food to a certain extent, as long as it doesn’t contradict any significant beliefs or preferences (such as non-kosher food).
  • Talk with your child before things get out of hand: Walk your child through the social gathering beforehand and discuss potential conflicts that may arise. The discussion should be appropriate to the child’s age. With children ages 2-3, parents could talk about the meal, mention that it will be probably very tasty, and set some limits. For instance, one could say that after dinner the child can have one or two desserts, but not more. With older children, parents should encourage autonomous eating based on the child’s regulation of hunger and satiety. This is an opportunity to discuss with children the differences between families, as well as your normal routine and special events. You should also discuss general boundaries and choices of your household.
  • Add fun activities that don’t involve food: Many celebrations and traditions revolve around food. To participate with your family in more neutral activities that are less nerve-wracking, parents should think of supplementary pastimes that all family members will enjoy. Shifting the focus away from the meal for part of the time can help parents “lower the volume” of their eating disorder when they spend time with their children.
  • Unwind: Despite being worried that loved ones will gain excessive weight during the holidays, parents should remind themselves that in a healthy-eating style, people don’t become overweight following a few specific meals. In addition, you should focus on the positive aspects of the social gathering for them and for their children – meeting family members or friends you may have not seen in a while, catching up with things you do not have time for during the year, and strengthening your relationships with your children. Before anxiety-provoking situations, parents should use any method of relaxation and stress-reduction that works for them and fits the context – have a long relaxing shower, drink a hot tea, listen to music, or stay away from the dinner table until the meal begins.

The holiday season can be a better experience for you and your family once you work through and resolve any concerns involving children’s eating.

Shiri Sadeh-Sharvit, PhD, is a psychologist and a visiting instructor at Stanford. She’s now recruiting mothers with a history of eating disorders to a parenting program study at Stanford. For more information contact shiris@stanford.edu.

Photo by Micah Elizabeth Scott

Nutrition, Obesity, Stanford News, Videos

Easy-to-follow tips to avoid overeating this holiday

Easy-to-follow tips to avoid overeating this holiday

‘Tis the season for overindulging. A recent report showed that we can easily consume 2,000 calories (or more) during a holiday dinner, particularly if the celebration includes appetizers and a few glasses of wine. As Neha Shah, a registered dietitian at Stanford, explains in the above Stanford Health Care video, overeating during this time of year is tied to many factors. She says, “There is so much food available at one given social setting that it’s easy to overeat and not realize it.”

There are simple techniques, however, that can help you resist the temptation to pile your plate high and go back for seconds. Watch the full video to learn easy-to-follow tips for making healthier choices this holiday season as you eat, drink and be merry.

Previously: “Less is more:” Eating wisely, with delight, during the holidays, Eat well, be well and enjoy (a little) candy, Learning tools for mindful eating and Enjoying the turkey while watching your waistline
Photo in featured-entry box by George Redgrave

Clinical Trials, Nutrition, Pediatrics, Research, Stanford News

Participant in Stanford food-allergy study delves into lifestyle-changing research

Participant in Stanford food-allergy study delves into lifestyle-changing research

Kari N and patient - smallerWhen I was 10 months old, I was diagnosed with an anaphylactic food allergy to wheat, rye, oats and barley. As I’ve written about in my article, “Pizza and Oreos would have killed me, but they’re now my medicine,” which can be found here, I was always extremely cautious, for only a couple of crumbs could have put me into anaphylactic shock. And over the years, I’ve had my share of scares, involving trips to the hospital and EpiPen injections. My family and I were hoping that someday, a genius researcher/doctor would appear and help do something about food allergies. We finally found that person, and I enrolled in a food allergy study at Stanford led by Kari Nadeau, MD, PhD. Ever since then, my life has changed dramatically.

As I have been a participant in the study for roughly two years now, I’ve never fully understood what has been happening to me. It occurred to me a few months ago that I should probably try to learn about the science behind my food allergy, and how the oral immunotherapy was scientifically changing my body. These changes in my lifestyle were infinite, but how was all of this even possible? Who was behind the scenes, making sure that everything was safe, and okay to be conducted? My brain swelled with all of the questions racing through my mind, so I needed to think of a way to at least try to find out about what was happening to my body.

I’m fortunate enough to attend a school that provides students in their junior or senior year the opportunity to create independent studies. The student designs the curriculum, builds a framework for the class and chooses the best fit teacher to guide the research.

I thought to myself, ‘Why not try an independent study?’ How often is it that students can do research on a project that is directly affecting their life, while simultaneously changing their body? Especially a science project. I kept thinking of ways that I could go about the independent study. I sat with my parents, and asked them about what I should do. They suggested that I write down ten or so questions that I’ve developed throughout the course of the study. And so I did. I brought them in to my science teacher the next day. He looked them over, and we decided to think about ways that we could find the answers to these questions. We scheduled a conference call with the lead doctor of the allergy study at Stanford, Dr. Nadeau.

Kari Nadeau: A mother of five; two sets of twins, and an older boy, proud owner of multiple pets, ranging from rodents to dogs, wife of a brain surgeon and lead doctor of a food allergy study at Stanford. This woman made the time to talk to me, and my science teacher. She is just incredibly organized. Kari explained to us what she and her employees do in the lab at Stanford, and why they do the things they do. I presented my questions, and asked her how I should go about researching them. She graciously invited me to her lab in Palo Alto to meet the lab assistants and get a little taste of what they do. At the lab I could research some of my questions and her mysterious lab assistants could direct me on the path to find answers and plan out an independent study.

I was so overwhelmed, yet so excited. When I get an opportunity like that, I take advantage of it. My parents and I planned the summer and made adjustments so that I could go to Dr. Nadeau’s lab. We figured out a way to make it work.

Continue Reading »

Ask Stanford Med, Chronic Disease, Nutrition

Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian

Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian

famers_market

Despite greater awareness about diabetes in recent years, a recent study found that nearly three in 10 Americans have the disease but don’t know it. The findings also showed that among those who were diagnosed with diabetes, a significant percentage weren’t meeting goals to control their blood sugar and blood pressure or lower their LDL cholesterol.

This Thursday, Kathleen Kenny, MD, a clinical associate professor at Stanford, and Jessica Shipley, a clinical dietitian at Stanford Hospital & Clinics, will discuss why eating healthy is a key component of diabetes management and prevention. The Stanford Health Library event will be held at the Arrillaga Alumni Center on campus; those unable to attend the event can watch a live webcast of the discussion.

In the final installment of our two-part Q&A with Kenny, she offers tips to avoid overindulging on sugary treats during the holidays, explains why you should consider limiting your consumption of red meat, and outlines the benefits of a vegetarian diet.

Many of us have a hard time refraining from indulging in high-calorie foods during the holidays. What’s your advice to those trying to make healthy choices during holiday season?

The holidays don’t have to be a stressful or trying time for patients with diabetes. Patients can adhere to a few simple strategies to help prevent weight gain and hyperglycemia. Some people will find it beneficial to eat a nutritious snack, particularly one that is high in fiber, and to drink lots of water in advance of a holiday party, rather than arriving hungry.

Buffet tables and appetizer trays can be problematic. Count toothpicks and stop snacking when you reach a certain number of toothpicks in your pocket. It is always a good idea to find the smallest plate available, when there are options, so as to reduce portions. Another tip is to limit alcohol intake; not only will this itself reduce liquid calories, but it will help individuals to make smarter choices. Substitute sparkling mineral water with lemon or lime. Eat lots of veggies at snack tables. Avoid calorie and sugar-dense sweets, or limit to one.

The most important aspect is to devise a plan in advance of a holiday gathering, and stick to it. Set your predetermined limits. Spontaneous choices will tend to be less healthy ones. Finally, if you are going to indulge a bit more, try to take a brisk walk afterwards to help reduce the glycemic impact of your meal.

Previous research has shown that decreasing your red meat consumption can lower your type 2 diabetes risk. Why does eating red meat influence a person’s diabetes risk? 

A study published in the Journal of the American Medical Association last year found an association of higher-diabetes risk with increased intake of red meat (about 30 percent higher with average increased red meat intake of ½ serving daily, adjusted for weight and BMI), and the converse, a lower risk in those who decreased their red meat consumption over a four-year period in the subsequent four years (14 percent reduction in diabetes risk by reducing consumption by more than ½ red meat serving daily over the baseline measure, some of which was mediated by reduced BMI with lower red meat intake).

This data was based on food questionnaires, and was a compilation from three prospective cohort studies involving almost 150,000 men and women. One of these cohorts, the Women’s Health Study, showed a 28 percent increased risk of developing diabetes in women in the highest quintile of red meat intake.  On further analysis, this seemed to be largely mediated by higher intake of processed meats such as hot dogs and bacon. Note that these studies do show an association, but not clear causation in terms of red meat and diabetes risk.

One theory of causality proposed is that compounds such as nitrates and nitrites added in meat processing  (sandwich meats, hot dogs, bacon), can be converted to “N-Nitrosamines”, which are thought to be toxic to the pancreas insulin-secreting beta cells. Thus, eating a bologna sandwich may be different in risk than eating grass-fed organic beef. But we don’t have enough data at this time to be clear on this.  Regardless of the nitrate content, red meat is still high in saturated fats, and this in and of itself is associated with higher cardiovascular disease risk. Additionally, higher red meat intake was associated with more weight gain and higher BMI in this analysis.

Continue Reading »

Behavioral Science, Health and Fitness, Nutrition, Parenting

"Less is more”: Eating wisely, with delight, during the holidays

"Less is more": Eating wisely, with delight, during the holidays

309295507_10531bb128_zSome multi-culture families celebrate their heritage by adding more holidays, writes Maya Adam, MD, a Stanford lecturer who operates the nonprofit Just Cook for Kids. “For our family, with its unusual set of Indian, German and Jewish South African roots, this season seems particularly out of control because we celebrate all of these holidays, one after another. And if we’re not careful, we can easily end up suffering from a severe case of sugar shock.”

Sugar shock, or rather, avoiding sugar shock is the topic of Adam’s blog post on the Healthier, Happy Lives Blog, published by Stanford Children’s Health.

For me, the whole moderation thing is a particularly daunting challenge. Either yes or no seems much simpler. Eat lots or say “no thanks” — none of this healthy balance baloney for me.

But with three simple guidelines, Adam makes moderation seem possible, even doable. Numero uno: Offer healthy alternatives. If potato chips are accompanied by fresh veggies and hummus, it’s much easier to go for the veggies. Dos: Model good behavior for your kiddos. As Adam writes: “When kids see that their parents are able to enjoy a small treat on occasion — and then stop — they learn a great lesson: Less is more.”

And for the third tasty pointer, I’ll let you check that out for yourself. Mmmm, mmmm, it’s a good one.

As Adam writes: “Holidays should be happy times — and sharing food with the people we love is a big part of that happiness.” Bon appetit!

Previously: A physician realizes that she had “officially joined our nation of fellow sugar addicts”, Eat well, be well and enjoy (a little) candy and Pediatrics group issues new recommendations for building strong bones in kids
Photo by Laura

Ask Stanford Med, Chronic Disease, Events, Nutrition

Diabetes and nutrition: Why healthy eating is a key component of prevention and management

Diabetes and nutrition: Why healthy eating is a key component of prevention and management

grocery_produce

The prevalence of type 2 diabetes is expected to rise sharply over the next three decades. Recent data from the Centers for Disease Control and Prevention shows that if current trends continue, an estimated 1 in 3 adults will be diagnosed with the disorder by 2050. Eating healthy is a key component of managing diabetes and reducing one’s risk for developing the disease. But what does eating right for diabetes actually mean?

Kathleen Kenny, MD, a clinical associate professor at Stanford, and Jessica Shipley, a clinical dietitian at Stanford Hospital & Clinics, will answer this question during a talk focused on diabetes and nutrition on Dec. 4. The Stanford Health Library event will be held at the Arrillaga Alumni Center on campus, where attendees can also have their blood glucose checked. The conversation will also be webcasted for those unable to attend in person.

To promote discussion on the topic in advance of the lecture, I reached out to Kenny and asked about nutrition principles and guidelines for patients with diabetes and others interested in how healthy eating can prevent or delay onset of the disease. In the first installment of a two-part Q&A, she explains the advantages of eating a Mediterranean diet and the importance of eating fiber-rich foods.

Are there any ways to reverse or slow the progression of pre-diabetes? Are there specific diets that may be useful to help prevent or control diabetes?

One of the most common questions my diabetic patients ask is how they can reduce or eliminate diabetes medications. Others are found to be pre-diabetic on the basis of an “A1c” or an impaired fasting glucose, and want to know how to prevent diabetes. Several randomized trials have shown that healthy diet and exercise can reverse and also delay the onset of diabetes.

One of the largest trials is the often-cited Diabetes Prevention Program, which randomized more than 3,000 patients to diet/lifestyle versus metformin versus placebo. The most effective strategy was diet and lifestyle, showing a dramatic 58 precent reduction in the rate of developing diabetes. This surpassed the drug therapy with metformin. Approximately 5 percent of patients in the lifestyle group developed diabetes annually, as compared to 11 percent in the placebo arm. Notably, there was a 16 percent reduction in diabetes risk with every 1 kg reduction in weight. This seems attainable for many patients.

There was also meta-analysis last year looking at different diets for patients with known diabetes, in terms of weight loss and improving their diabetes control. In this data compilation, the Mediterranean diet had the greatest weight loss, followed by the low carbohydrate diet. In terms of A1c reduction, the Mediterranean diet had a reduction of -0.47 percent, and the low carbohydrate -0.12 percent. But all the diets studied resulted in better glycemic control. Many studies have shown that diets high in glycemic load are linked to higher diabetes risk (particularly in overweight women), and contribute to central body fat , so it is recommended that diabetics or those at risk limit their intake of high glycemic index foods both to delay and to help control their diabetes. Additionally, there are some data suggesting that adherence and success rate may be higher for low-carbohydrate diets in patients with diabetes and insulin resistance.

Continue Reading »

Nutrition, Pediatrics, Research, Stanford News

Taking a bite out of food allergies: Stanford doctors exploring new way to help sufferers

Taking a bite out of food allergies: Stanford doctors exploring new way to help sufferers

allergen powdersPeople with food allergies and their families live lives of unremitting worry.  They are perfectly healthy unless they eat an allergen and then suddenly they are at death’s door.

When 9-year-old Maya Bodnick went on a skiing trip with her cousin, her aunt let her pick out some malt balls from a candy bin.  Within minutes her face began to swell, her throat hurt, and she vomited. When Tessa Yates Grosso was eight, she ate some spring rolls that turned out to contain wheat, which was one of her allergies – soon she began to lose consciousness. Her mother watched, terrified, as a medical team struggled to revive her by injecting two syringes of epinephrine and an array of other drugs. When my son Kieran was a toddler, he got hold of a cookie that contained eggs and nuts – both of which he was allergic to – and although I got the cookie out of his mouth before he bit down, and I rinsed his mouth out with water, he stopped breathing on the way to the hospital.

But for all three kids and their families, that life is now over after participating in a trial of a radical treatment for food allergies, headed by Kari Nadeau, MD, PhD. The treatment, known as oral immunotherapy, retrains the immune system by giving the patients micro-doses of the allergen and gradually working up – over months or years – to a full serving.  Nadeau has recently discovered that oral immunotherapy actually causes epigenetic changes – physical changes in patients’ genes that affect the way they are expressed.

Food allergic people are initially astonished – and terrified – by the suggestion they should eat the foods that had once poisoned them. But it turns out that – no matter how severe the allergy – everyone’s immune system can be retrained. Moreover, Nadeau discovered, the treatment works equally well for children and adults. At the newly created Food Allergy Center, Nadeau and her team will continue to research not only oral immunotherapy, but treatments for food allergies that do not involve eating the food. The center will also treat food sensitivities and intolerances, which patients frequently confuse with food allergies.

Read more about Maya, Tessa and Kieran’s treatment – and their new lives – here.

Melanie Thernstrom is a freelance writer.

Previously: Stanford Medicine magazine traverses the immune system, Simultaneous treatment for several food allergies passes safety hurdle, Stanford team shows, Researchers show how DNA-based test could keep peanut allergy at bay, A mom’s perspective on a food allergy trial and Searching for a cure for pediatric food allergies
Photo of allergen powders by Art Streiber

Nutrition, Obesity, Public Health

A physician realizes that she had "officially joined our nation of fellow sugar addicts"

A physician realizes that she had "officially joined our nation of fellow sugar addicts"

sugar_11.11.14Over on CommonHealth, Terry Schraeder, MD, an internist at Mt. Auburn Hospital and a clinical assistant professor at Brown University, speaks candidly about her realization that she was consuming way too much sugar – likely more than 22 teaspoons – each day.

Her addiction started with a sugar-laden drink disguised as sparkling orange juice and spiraled into regular consumption of flavored coffees, muffins, snacks, desserts and “healthy foods” containing hidden corn syrup. In the piece, Schraeder explains that a high triglyceride level convinced her to change her eating habits:

For the past eight weeks, I have tried to limit adding sugar in any form to my food and started searching nutrition labels for sugar content. If the food lists the grams of sugar on the nutrition label (these may be natural or added), then I check the list of added ingredients to see if there is any added sugar in the form of corn syrup, sucrose, fructose, brown sugar, juice concentrate, honey, molasses, etc. If there is, I know it is “added” sugar. I try to limit my added sugar to less than 24 grams (or six teaspoons) each day.

It has not been easy but it has been well worth the effort. For the first time in years, my moods and energy are more level, the sweet cravings are gone and I feel calmer. The fat around my belly has disappeared. My teeth feel smoother and cleaner despite the same oral hygiene. The late afternoon slump and brain fog are no more. I will have my triglycerides rechecked soon.

I feel great but I am still in shock. I had no idea I was consuming too much sugar. If you had asked me, I would have denied it. For years, I have railed against fat and calories, smoking and lack of exercise. I had not considered my own sugar intake.

The piece is worth a read and may inspire you to take a closer look at your own daily sugar intake.

Previously: Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes, What do Americans buy at the grocery store? and Mindful eating tips for the desk-bound
Photo by Moyan Brenn

Stanford Medicine Resources: