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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.

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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

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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.

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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

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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.

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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

Cancer, In the News, Nutrition, Patient Care, Surgery

“Prehab” routines before cancer surgery help patients bounce back faster

Surgery_flickr_thinkpanamaIf you’ve ever had surgery, especially an orthopedic one, you’ve probably had rehabilitation therapy. In recent years, orthopedic surgery plans have begun to include a period of “prehabilitation” exercise to help prepare patients for their procedure. Now, researchers have demonstrated that a pre-surgery work-out routine combined with some dietary changes may be able to help cancer patients regain their baseline strength levels sooner. A story on NPR’s Shots blog described the recent study:

Researchers from McGill University in Montreal studied 77 patients scheduled for colorectal cancer surgery. A kinesiologist gave the patients aerobic exercises and strength training to do at home. A registered dietitian gave them nutritional counseling and prescribed a whey supplement to make up any protein deficits, and a psychologist provided anxiety-reducing relaxation exercises.

Half of the patients were told to start the program before surgery – an average of about 25 days before – and to continue afterward for eight weeks. The other group was told to start right after surgery.

Not surprisingly, the group assigned to prehabilitation did better on a presurgery test that measured how far they could walk in 6 minutes. And it paid off.

Two months after surgery, the prehabilitation group walked an average of 23.7 meters farther than when they started the study. Rehab-only patients walked an average of 21.8 meters less than when they started. (A change of 20 meters is considered clinically significant.) And a greater proportion of the prehabilitation group was back to baseline exercise capacity by then.

Because of the methology the researchers used, it’s not clear how the diet or the exercise prescribed in the pre-surgery regimen affected the outcome. Previous studies that looked at exercise-only regimens did not show post-surgery improvements. A larger study with a more varied pool of patients is likely needed for definitive answers.

Previously: Wellness after cancer: Stanford opens clinic to address survivors’ needs and A call for rehab services for cancer survivors
Photo by thinkpanama

Health and Fitness, Nutrition

Eat well, be well and enjoy (a little) candy

Eat well, be well and enjoy (a little) candy

260823789_3eda4b0439_oAs Halloween treats fill cupboards, jack-‘o-lanterns and workplace counters, I bet you’re hunting for a middle ground between candy glutton and candy curmudgeon. Anticipating this tricky balance, Stanford dieticians Rosalyne Tu, MS, RD and Raymond Palko, MS, RD, offered some healthy eating tips in this BeWell@Stanford feature:

What are some common pitfalls during the holidays that can contribute to weight gain?

RP: Often, the concept of “moderation” can undermine our good intentions. Moderate eating does not mean consuming two pieces of pumpkin pie instead of three. Rather, it means having a small slice of pie, one or two times over the course of a week.

RT: Sometimes we are too “good” about budgeting our calories and we skip meals or under-eat during the day to save up calories for large holiday meals. This strategy can backfire on us because our appetite hormones get very strong and we end up in less control of our appetites, causing us to overeat later. Our bodies were designed to treat starvation as our worst enemy; therefore, when we are hungry, we naturally crave highly caloric foods (high sugar and fat). For some people, giving in to these foods brings on feelings of guilt when the biological response was natural.

RP: Increased alcohol consumption is another road bump. At parties, alcohol can flow freely, and it is very calorically dense without any nutritional benefits.

RT: Liquid calories are often empty calories. Alcohol, specifically, can promote overeating because of its ability to break down willpower while causing blood sugars to drop — both of which could encourage overeating.

But it’s still possible to enjoy your favorite treats, the two dieticians said:

RT: Food is meant to be enjoyed! Give yourself permission to enjoy your favorite treat and practice eating mindfully. Eat your treat like it is a fine dining experience: slow down, savor every morsel, and minimize the distractions like the television and computer. Eating mindfully helps your body decide how much it is truly hungry for.

Previously: When it comes to weight loss, maintaining a diet is more important than diet type, Where is the love? A discussion of nutrition, health and repairing our relationship with food and How to avoid a candy-coated Halloween
Photo by Juushika Redgrave

Applied Biotechnology, Genetics, In the News, Nutrition, Public Health, Research

"Frankenfoods" just like natural counterparts, health-wise (at least if you're a farm animal)

"Frankenfoods" just like natural counterparts, health-wise (at least if you're a farm animal)

cow2More than a hundred billion farm animals have voted with their feet (or their hoofs, as the case may be). And the returns are in: Genetically modified meals are causing them zero health problems.

Many a word has been spilled in connection with the scientific investigation of crops variously referred to as “transgenic,” “bioengineered,” “genetically engineered” or “genetically modified.” In every case, what’s being referred to is an otherwise ordinary fruit, vegetable, or fiber source into which genetic material from a foreign species has been inserted for the purpose of making that crop, say, sturdier or  more drought- or herbicide- or pest-resistant.

Derided as “Frankenfoods” by critics, these crops have been accused of everything from being responsible for a very real global uptick in allergic diseases to causing cancer and autoimmune disease. But (flying in the face of the first accusation) allergic disorders are also rising in Europe, where genetically modified, or GM, crops’ usage is far less widespread than in North America. It’s the same story with autoimmune disease. And claims of a link between genetically modified crops and tumor formation have been backed by scant if any evidence; one paper making such a claim  got all the way through peer review and received a fair amount of Internet buzz before it was ignominiously retracted last year.

But a huge natural experiment to test GM crops’ safety has been underway for some time. Globally, between 70 and 90 percent of all GM foods are consumed by domesticated animals grown by farmers and ranchers. More than 95 percent of such animals – close to 10 billion of them – in the United States alone consume feed containing GM  components.

This was, of course, not the case before the advent of commercially available GM feeds in the 1990s. And U.S. law has long required scrupulous record-keeping concerning the health of animals grown for food production. This makes possible a before-and-after comparison.

In a just-published article in the Journal of Animal Science, University of California-Davis scientists performed a massive review of data available on performance and health of animals consuming feed containing GM ingredients and  products derived from them. The researchers conclude that there’s no evidence of GM products exerting negative health effects on livestock. From the study’s abstract:

Numerous experimental studies have consistently revealed that the performance and health of GE-fed animals are comparable with those fed [otherwise identical] non-[GM] crop lines. Data on livestock productivity and health were collated from publicly available sources from 1983, before the introduction of [GM] crops in 1996, and subsequently through 2011, a period with high levels of predominately [GM] animal feed. These field data sets representing over 100 billion animals following the introduction of [GM]crops did not reveal unfavorable or perturbed trends in livestock health and productivity. No study has revealed any differences in the nutritional profile of animal products derived from[GM]-fed animals.

In other words, the 100 billion GM-fed animals didn’t get sick any more frequently, or in different ways. No noticeable difference at all.

Should that surprise us? We humans are, in fact, pretty transgenic ourselves. About 5 percent of our own DNA can be traced to viruses who deposited their  genes in our genomes, leaving them behind as reminders of the viral visitations. I suppose that’s a great case against cannibalism if you fear GM foods. But I can think of other far more valid arguments to be made along those lines.

Previously: Ask Stanford Medicine: Pediatric immunologist answers your questions about food allergy research, Research shows little evidence that organic foods are more nutritional than conventional ones and Stanford study on the health benefits of organic food: What people are saying
Photo by David B. Gleason

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