And let me tell you why:

 Who’s Steering this Ship?

Vitamins and all other supplements are NOT regulated by the FDA.  This is so important, I’m going to repeat myself:  Vitamins and all other supplements are NOT regulated by the FDA.  To the consumer, this means a couple of things.  First, it doesn’t technically need an ingredient list on it, so you might have additional unknown ingredients in your supplement.  Also, the origin of the nutrient and the amount of nutrients contained in the supplement may be inaccurate.  The FDA only steps in if there is a reported death or other serious reported harm. 

  Ta-Da!!  Food is Always the Answer (or at least it’s always my answer!)

My dad likes to tease me that he gets all his nutritional information from The Wall Street Journal.  He sent me an article this week that looked at the results of a study of vitamin use and disease prevention in post-menopausal women.  The results indicated what fledgling dietitians learn in Nutrition 101:  Pills aren’t really a great substitute for whole foods.  When you take a multivitamin, you are not getting the benefits of fiber and other micronutrients call phytochemicals. 

 Now, I haven’t looked up the actual paper to look at the variables and results (nerd), but this leads me to another conclusion I’d like to discuss:  If you’re going to use a vitamin supplement, use a MULTI-vitamin supplement.  You should never (unless you’re working with your doctor) take the vitamins individually because you run the risk of storing toxic amounts of fat soluble vitamins (A,D,E and K) in your body. 

 Vitamin C and the B Vitamins are water soluble.  Your body will use what it needs and then the rest, well, ends up in the toilet.  Most people need about 70-95 mg/day of Vitamin C to function.  People with scurvy, severe vitamin C deficiency, are given 100-500 mg/day.  So if you’re taking a 1000 mg Vitamin C supplement to prevent a cold, you’re likely just wasting your money. 

 Did you ever wonder why it is recommended that you eat at least 5 servings of fruits/vegetables daily?  Because theoretically, if you did this, you’d get all the vitamins and minerals (and fiber and phytochemicals) you could ever need. 

 Here are some tips on choosing your daily 5: 

• Fruit juice is fine, but limit that to just 1 serving/day.  You’re not getting any fiber out of the deal and after 1 glass it just becomes a high calorie drink. 
• Choose 5 different colors, (another tip from my 4-year-old cousin).  If you ate 5 apples today, yes, you technically had 5 servings of fruit/vegetables.  However, you limited your vitamins and minerals to just what is in an apple.  Where’s your Vitamin C?  B vitamins?  Try mixing it up.  Have an apple, 1 glass of orange juice, broccoli, a banana and then a handful of blueberries.  There’s a whole lotta fiber in that 5 and you’ve got most of your vitamins. 
• Sneak vegetables into your meals:  I generally find Rachel Ray annoying, but she is excellent at this.  She’s always chopping up some kind of vegetable and tossing it in some unexpected place.  Grate in some carrot and/or zucchini into a meatloaf.  Put a little spinach or some slices of red bell pepper between the cheese and the bun of your cheeseburger. 
• Generally, one half of a cup is considered a serving.  For an apple or an orange, something the size of a tennis ball is considered a serving.  But remember, no one ever gained too much weight by eating too many fruits and vegetables.
• Give the ranch a rest.  If you need to cover your vegetables in sauces or dressings to eat them, practice going without.  You’re taking a naturally low fat/calorie food and turning it against you.  I find that I like a vegetable EITHER raw OR cooked, but not both ways.  So if you’re not a fan of raw broccoli, try it cooked.  You might be surprised at the difference in taste. 

Have an excellent day:

Beth

 Now, I’m not going to tell you not to eat your favorite-once-a-year-fair-foods, but some food choices are going to be better than others.  Please pay attention to what you eat as you can easily eat a week’s worth of calories/fat/sodium in a single visit to the fair. 

 A couple of years ago, the Iowa Heart Center gave some excellent tips.  I didn’t see an updated list this year, but these tips still apply:  http://www.iowaheart.com/content/viewcontent.aspx?art=433

 1.   Forego the cave-man-size turkey leg for a turkey tenderloin – they’re both tasty but at 1,400 calories and 55 to 60 grams of fat, that turkey leg could stay with you for years. At just 350 calories and 30 grams of fat, the turkey tenderloin is the heart-healthy alternative.

 2.    Go with the Pork-Chop-on-a-Stick instead of sausages or brats – Although it sounds decadent, Iowa’s famously flavorful “Pork Chop on a Stick” wins by a mile when it comes to nutrition and calories versus a large Italian sausage. While the meaty pork chop has about 500 calories and around 10 grams of fat, the Italian sausage will pack on 1,200 calories and between 55 and 60 grams of fat.

 3.    Sweet tooth nagging you? Have a big, sticky cotton candy rather than a funnel cake. Cotton Candy weighs in at about 150 calories against the funnel cake’s whopping 800 calories.

 4.    Stagger your beers with water – rather than downing beer after beer at 250 calories for a large regular beer, try following each beer with an ice-cold bottle of water. The water will also keep you hydrated and help you avoid the bad effects of too much alcohol in the heat.

 5.    Kettle corn over nachos with cheese – Just one helping of nachos with cheese will add 900 calories and 35 fat grams. Sure, Kettle Corn has some fat, sugar and salt, but it’s far fewer calories than a much smaller volume of nachos.

 6.    Dippin’ Dots over a Wonder Bar (bonus points if you can tell me what a Wonder Bar is) – Dippin’ Dots calorie and fat count: 170 and 10 grams in a half-cup serving.

 7.    Feel like something on a stick? Try roasted corn-on-the-cob rather than a corn dog. At just 250 calories and zero grams of fat (not counting butter), you’ll fend off the corn dog’s 700 calories and 35 to 40 grams of fat.

 8.    Banana-on-a-Stick or watermelon rather than a deep-fried candy bar (or deep-fried pineapple.  I’m not sure how I feel about that one yet): How many calories in a deep-fried candy bar? Really, you don’t want to know – OK, we warned you: the deep fried candy bar will set you back 800 calories and 40 grams of fat.

 9.    Pork loin sandwich over a fried pork tenderloin – For filling, high-quality protein, the lean pork loin sandwich beats the fried tenderloin hands down.

 10. Carmel apple rather than a bloomin’ onion or fried cheese curds. Yes, there’s caramel on the outside, but there’s an apple on the inside. At about 500 calories each and nearly 40 fat grams, the caramel apple is a sweet-and-sour treat on the healthier side.

 And the good people of the Iowa State Fair were kind enough to provide a list of healthy options and their locations:  http://www.iowastatefair.org/services/fooddirectory.php

Healthy Food Choices

• Salad on a Stick at The Salad Bowl (west balcony of the Agriculture Building; Cultural Center) – an iceberg lettuce wedge with carrots and tomato served kabob-style, served with dressing.
• Baked potatoes and corn-on-the-cob at Westmoreland (south of the Anne and Bill Riley Stage)
• Salads at various locations: Campbell’s (Elwell Family Food Center), Diamond Jack’s (west of the Livestock Pavilion), The Salad Bowl (west balcony of the Agriculture Building; Cultural Center), The Greek Garden (north of the Varied Industries Building and southeast of the Administration Building), Master Jack’s (west of the Grandstand) and Steer and Stein (east of the Grandstand)
• Sandwich wraps at The Salad Bowl (west balcony of the Agriculture Building and Cultural Center Courtyard)
• Mixed fruit cups, melon cups and shish-kabobs at Beattie’s Melon Patch (west of the Giant Slide) and mixed berry cups at Stockman’s Inn (southwest corner of the Cattle Barn)
• Veggie corn dogs at Veggie Table (north of the Varied Industries Building)
• Turkey tenderloins at the Iowa Turkey Federation (west of Anne and Bill Riley Stage) – the turkey breast sandwich has less than 5 grams of fat and is low in calories.
• Pork chops on-a-stick at the Iowa Pork Producers Association (main location: east end of Grand Avenue; satellite locations: east of the main stand and on Rock Island Avenue west of the Livestock Pavilion)

So have a great time at the fair, and please, please, please remember to drink plenty of water or other non-caffeinated, non-alcoholic beverages.

And just for your food information, I was watching The Travel Channel or The Food Network and they featured a vendor at some state fair that sells the Krispy Kreme Burger.  Oh yeah.  One cheeseburger with bacon that substitutes the bun with 2 Krispy Kreme Donuts.  So let’s say 1 Krispy Kreme is roughly 270 calories.  A restaurant-style cheeseburger like those at Red Robin (sans bun, mayonnaise and pickles) is going to be about 530 calories.  This means your Krispy Kreme Cheeseburger (made with 2 donuts) is going to be about 1070 calories.

 Today’s M&M Math began as such:  When Dan was but a high schooler, he said he had a wellness day where each kid in his class was lined up on the football field and given 1 plain M&M.  Each kid was asked to eat the M&M and start walking.  They could stop at the distance they thought it would take to burn off the calories consumed.  Dan and the rest of the crew were floored to learn that to walk off 1 plain M&M, they would need to walk the length of the football field, end to end, all 120 yards.  One M&M.  Plain.  No peanuts, no peanut butter, no pretzels. 

 Thinking like a dietitian, this morning, Dan went to the vending machine, threw down his 70 cents and bought a pack of plain M&M’s.  This is what he found:

• “Out of curiosity and the fact that my first session was a bust, I went and bought one pack of regular M&M’s. 53 total M&M’s in the package. At 240 calories per package, each piece of candy contains 4.5 calories. At the rate of having to walk 120 yards to burn off 1 piece of candy, I would have to walk 6,360 yards. That equals out to be 19,080 feet or 3.61 miles!!!!! That’s a lot of walking for 1 package of candy. It’s easy to see why a sedentary lifestyle can get you those extra pounds in a hurry.”
• (Dan then proceeded to eat the pack of M&M’s.  All in the name of science.)

 Now, exercise only counts if the activity is above and beyond what you do in your regular day-to-day activity; all the walking the therapists and nurses do during their daily tasks doesn’t count, (sorry).  So I asked Dan what this meant in terms of walking back and forth from the therapy gyms to the nursing hub:

• “From the PT/OT gym to the nursing hub is roughly 200 feet. That means someone would have to walk down to the hub and back to the gym roughly 50 times (in order to burn off the calories from 1 pack of plain M&M’s). That’s a lot of walking!!! “

 So then we got to thinking about the industrial-sized candy jar.  We were both curious as to the amount of calories in the entire jar and the above-and-beyond-distance one would have to walk to burn off all the calories.  I had already thrown away the packaging, and in a much less scientific manner, I visited Walmart over lunch to examine the nutrition labels on each type of candy.  Remember, these were the large bags.  This is what I found:

• Peanut M&M’s:  1 serving size consisted of about ¼ of a cup of M&M’s and one serving will cost you 220 calories.  One forth of a cup holds about 17 peanut M&M’s (flush to the top, not heaping).  Each peanut M&M is roughly 13 calories.  The package informed me that it contained about 13 servings for a total of 2,860 calories in the entire bag.
• Peanut Butter M&M’s:  This food label read much the same as peanut.  A serving was ¼ of a cup which is about 24 M&M’s. One serving was 220 calories, and one PB M&M is then about 10 calories, (which, honestly, seems low to me.  I thought the PB M&M’s would be more than the peanut).  This package contained 12 servings for a total of 2,880 calories in the entire bag.
• Pretzel M&M’s:  The new kid on the block, pretzel M&M’s, had an addition to their food label: instead of the confusing ¼ cup serving size, (seriously, who carries measuring cups around with them?) it explains that 1 serving is about 17 M’s, or 10.5 calories per M.  One bag of pretzel M&M’s is about 1980 calories. 
• If you’re keeping track, there’s a grand total of 7,720 calories in the industrial sized candy jar. 

 Dan oh so nicely did the math for me while I attended today’s Person Served conferences:

• “Crunched the numbers. Double checked my math and figured that a person would have to briskly walk 105.27 miles to burn of those calories. That’s the equivalent of walking from here to Mason City, IA. (almost that far, give or take a few miles).”
• Also recall that one pound is 3,500 calories.  If you didn’t get any activity above and beyond what you do day-to-day, and you ate 1 pack of plain M&M’s a day, you’d gain 1 pound every 14.5 days. 

 Now, we’re not in this for the scare tactic.  We realize that no one is going to sit and eat the entire jar of candy on their own and think to walk to Mason City.  But if you take anything away from our project today, focus on what Dan said earlier:  “It’s easy to see why a sedentary lifestyle can get you those extra pounds in a hurry.”  And, while it was probably nutritionally irresponsible of me to leave a bunch of M&M’s where people can get to them, I (Beth) am a firm believer in factoring in some “discretionary” calories in the day just for fun foods.  Did you eat a bunch of candy today?  Then eat some fruit after dinner for dessert. 

 Also, be curious about what you’re eating.  Look at your food labels.  If you don’t understand them, come and ask your questions.   

 And we know that there’s a lot more to weight loss than simple calories-in-calories-out.  Your current weight, height, gender, genetics, medical history and a whole host of other factors play in.  But this weekend, dust off those pedometers and see how far you get.  Are you walking far enough to burn off 1 pack of plain M&M’s?

 Our chance for sushi came later on this week when a group of friends invited us out to an Ankeny area restaurant after a sand volleyball game.  The group consisted of 3 couples who knew their sushi well, 1 couple who were complete sushi newbies and then Peter and one other guy and me who had eaten sushi before, liked what we ate, but were pretty lacking in any further knowledge.  When we got to the restaurant, I thought this is where restaurant grading is a perfect idea.  If I had not tried it previously, I would have probably balked at the idea of eating raw fish.  And I can completely understand why people are leery.  I would no more eat sushi in Iowa than I would have ordered a steak in North Carolina.  Sushi isn’t even native to the United States let alone this land-locked region.  It would be most excellent to see the restaurant with a big ol’ “A” posted for everyone to see so that if you didn’t like your inaugural sushi run, you could at least rest assured that you probably wouldn’t get sick from it. 

 Anyway, our sushi experience was as success.  Those with experience were able to point out items that the novices would probably like.  Everyone ordered something a little bit different so we could all share.  The newbies had fun and all participants agreed that they would return to the restaurant to try more and different rolls. 

 And then the question I had been waiting for, and secretly dreading:  How many calories in sushi?  And my answer:  I have no idea.  Fish is good for you:  it is relatively low in calories and is rich in omega 3 fatty acids.  Yet most rolls contain varying amounts of white rice which is basically a nutrient wasteland.  Sushi never entered into my meat-and-potatoes dietary upbringing or education.  I’m not going to lie, I was stumped.  I could take a shot in the dark, but it’s something I needed to look up.  And guess what?  Sushi doesn’t appear in the USDA National Nutrient Database for Standard Reference, so I had to hit the internet.  I found a pretty decent website, and pretty much the entirety of the following information came from them.  It’s a well-thought out web site.  I especially appreciate the sections entitled, “Sushi for Beginners” and “Sushi Terminology” under the “Sushi and Sashimi” section.  If you’ve never visited a sushi restaurant before, I recommend reading those pages before heading out.

http://www.sushifaq.com/sushi-calories.htm

 This table from the web site includes the nutritional information per roll of some of the most common sushi rolls.  The website is quick to point out that this information did not come from a dietitian.  The information is a best guess and comes from restaurants that post their nutritional information.  AND, since this is a food item that is made by hand, some of the more calorically dense items such as cream cheese, mayonnaise, white rice and other sauces/condiments could vary from place to place. 

 .  Here are a few things to keep in mind:

 Go with someone with sushi experience.  If you are alone and completely clueless, ask your server.  He or she will be able to point out some conservative choices for you. 

• Nearly all sushi establishments serve a California Roll which is a completely Americanized roll usually containing imitation crab, cucumber and avocado.  This is a good place to start for a beginner. 
• If you’re completely dead set against eating raw fish, there are vegetarian rolls and things with cooked seafood out there.  Ask your server to point those out.
• Anything with the term “Tempura” in the title will involve battering and frying.  These are pretty good for a beginner, but will be highest in calories and fat, (see chart above:  Shrimp Tempura Roll)
• Generally shrimp is not raw in sushi, but ask your server to be certain. 
• Don’t be scared of the seaweed, (that dark material holding everything together).  It has a really neat, unique texture and flavor and is really high in a lot of minerals and folate.  If you’re still concerned, you might try sashimi, where the piece of fish is simply draped over a rice ball. 
• There’s a rule of thumb that if you like a piece of seafood cooked or smoked, chances are you’ll be ok with it raw.  I like salmon and tuna and do well with them raw.  I’ve never tried anything more exotic like eel or octopus and don’t think starting out raw would be in my best interest. 
• If you’re worried about getting sick after eating raw fish, keep this in mind:  The FDA recommends that fish intended for raw consumption be frozen to an internal temperature of -4 degrees F for 7 days or at -31 degrees F internal temperature for 15 hours to kill parasites. The Food Code recommends these freezing conditions to retailers who provide fish intended for raw consumption. Women who are pregnant or nursing and people who have auto-immune diseases shouldn’t consume raw or undercooked foods. 
• Alton Brown has an episode of Good Eats called “Wake Up Little Sushi” which is very informative.  Check it out. 
• Don’t worry if you can’t figure out chopsticks.  Sushi is finger food.  Just pick it up and go with it. 

This has barely scratched the sushi surface, and while I can point you in a couple of directions if you have questions, my knowledge of this food/art form is minimal at best.  If you get anything out of this letter this week it is this:  Don’t be afraid to try new things.  Get out and see what’s out there.

 1)     DO stay away from familiar chain restaurants.

1. Seriously, you’re on vacation in a new place.  Why are you eating at Applebee’s?  Let your taste buds go on vacation too; you can get a cheeseburger anywhere.  What’s local?  Ask a hotel employee where he likes to eat.  Google the area surrounding your hotel.  Once you find a place, if you’re still stuck after reading the menu, ask your server what’s his/her favorite, or look to see what the guy at the table next to you is eating.
2. The gentleman who loaned us his house left us with a list of local restaurants, so we had a pretty good guide.  We did not, however, have a recommendation for BBQ.  We asked our waiter one night at a seafood place called The Ruddy Duck who sent us to a restaurant two towns over.  Good idea in theory, but while most chain restaurants have set hours, some of the local guys can have hours that vary to suit their needs.  We didn’t know Roland’s would be closed on Wednesdays. 
3. We even ate at unfamiliar fast food chains.  There was a Waffle House at about 95% of the interstate exits and so of course we had to eat at one of those (because we were on vacation).  We also ate at a Bojangles which has “legendary” chicken and biscuits.  I’m not going to lie, it was pretty tasty.  And in looking at the nutrition information just now, I know why!  580 calories and 22 grams of fat in 1 chicken biscuit.  Adding sweet tea (more on this later) can easily net you 1000 calories.

2)     DO drink plenty of non-caffeinated, non-alcoholic beverages during the day: 

1. Focusing on hydration is incredibly important while on vacation because your daily routine is different.  No longer are you sitting at your desk with a glass of ice water to the right of your computer screen.  If you can, carry a water bottle with you.  If you or your loved one starts getting cranky after a morning of walking around in town, it’s time to drink something.  A change in mood can be a sign that under-hydration is starting to settle in. 
2. I usually don’t agree with non-athletes drinking sports drinks purely for hydration, but if you’re going to be sitting out in the sun, a sports drink might not be a bad option.  Gatorade now comes in sort of a diet form called G2-Low Calorie which is 20 calories per 8oz serving with the same electrolytes, which your body sheds when it sweats.  This will help to prevent under-hydration and muscle cramps.  Remember, water is always an excellent choice for hydration.  But if you’re going on vacation, and the beach or other outdoor activities are planned, maybe the G2-Low Calorie Gatorade would be a good choice for you. 
3. In addition to sampling local food menus, we sampled local microbrew.  We also spent much of the day outside in the sun.  With average temperatures in the 90s with 70% humidity, the air was a sticky mess.  After waking up a couple of times in the middle of the night just out of thirst, I determined that better hydration was a must.  We stopped by the local grocery store (a Piggly Wiggly.  It lacked a “no shirt, no shoes, no service” sign, but it displayed a sign depicting “no firearms”.) and bought some Gatorade.  This Piggly Wiggly had an enormous refrigerated section where one would expect to find dairy products and not-from-concentrated juices and lemonade.  But the vast majority of the space was taken up by sweet tea.  I had a glass of sweet tea, (because I was on vacation) and I’m fairly certain this is a top contributor to obesity.  I started to notice in restaurants that this was always offered first as a beverage, “Would you like sweet tea?  We also carry Coke products and have a full bar”.  I also noticed that people think there’s something wrong with you when you ask if the tea in question was made with sugar or artificial sweetener. 

3)     DO split meals in restaurants instead of ordering separate entrees.

1. Even though many restaurants will charge you a few dollars to split the plate, this is both inexpensive and calorie conscious.  Sandwiches are easily cut in half, and that mound of fries can be shared for a more manageable meal.  If you feel as though you might still be hungry, start with a salad or order an a la cart vegetable to sneak in some vacation produce. 
2. We failed miserably in terms of portion control.  Honestly, we didn’t even try.  In fact, as we read the menu we made sure to order different things so that we could sample each other’s plates…..that is except for seafood bisque day.  I now know why people like to use real butter and heavy cream while cooking; it was so velvety and gorgeous, Peter is still talking about it.  This was some of the best food I’ve ever eaten.  Period.  We tried to go back to that restaurant, Clawson’s 1905, but there was too much traffic surrounding the drawbridge into town.  I now regret this decision.  That is how good the seafood bisque was.

4)      Do keep some raw fruits and vegetables handy for snacks. 

1. Just like your mom told you as a kid, raw fruits and vegetables make excellent snacks.  They come in their own packaging and need minimal prep to eat.  Many of these items would be safe to keep out on a table in a hotel room, but most hotel rooms have mini-fridges in them anyway so you’re covered.  If not, fill that ice bucket and throw those carrots on ice.  It’s important to at least attempt to get your daily 5 servings of fruits and vegetables (and adequate water) while on vacation in order to ward off Vacation Constipation. 
2. We bought apples and carrots on our trip to the Piggly Wiggly.  We also bought tortilla chips, salsa, potato chips and cereal bars.  We were tempted to buy boiled peanuts, (something seen at most road-side stands, but also available canned at the PW) and ALE8-1, a sort of pop (soda) manufactured in Kentucky.  We failed to purchase either item as there were no small quantities available and we didn’t want to be stuck with products we didn’t like. 

      5)    DO tell people you’re on your honeymoon.

1. You receive a lot of dessert this way J.

 So I’m home and unpacked.  And as a result of our food-laden beach holiday, I’ve regained all the weight lost with the pre-wedding flu.  It was worth every bite, but back to the treadmill.

 I do, however, love me a big Farmers’ Market.  And so since the Des Moines Downtown Farmers’ Market (DFM) opened a week early this year due to popular demand, I thought this week we could discuss why we should all support this local beauty.

 Buy Fresh Buy Local:

Not being local myself, I was impressed that the DFM has been around for 35 years, and they have a campaign called Buy Fresh Buy Local where they encourage consumers to look for locally grown/produced products.  This supports the area farmers and gardeners to ensure that the DFM will be around for generations to come, and the dollars we spend stay in our community.  There is a BFBL booth at the DFM where the staff will answer all of your questions, help you set up farm tours, provide you with samples, recipes and a list of up coming events.  So if you have questions about setting up your own garden, this organization might be a good place to start! 

 (Sidebar:  The DFM also is in its second year of a program called Meals From the Market.  This program accepts donations of fresh produce to donate to area food banks –an excellent way to distribute excess produce at the end of its growing season)

 Try Something New:

My first exposure to a truly sizable farmers’ market didn’t come until I was in grad school where I was introduced to the West Side Market in Cleveland, OH.  After my first visit, I was hooked.  Not only did this place sell produce, but they had a whole inside section that sold local meats, cheeses, seafood, bread and other confectionary delights, (my mouth is watering just thinking about a piece of chocolate from a place called Oooooooh… Fudge).  Through this market, I tried my first Heirloom tomatoes, Yukon Gold, blue and purple potatoes, wild blackberries, white asparagus, arugula, kohlrabi, pomegranate, broccoli rabe, jicima, and a variety of apples I’d never heard of.  I ate fresh pasta for the first time there, although I was not quite brave enough to try the squid ink variety (oddly, something I regret now).  It was the goal of my roommates and me to try something new every week.  And while I have to imagine that some of the more exotic fruits and vegetables may have been imported, (although maybe not……greenhouses and high tunnels are amazing things anymore) it was still a weekly taste bud explosion, and easy on our wallets.  This is something you could easily do here to encourage your kids to keep their eyes and their minds open to trying new foods. 

 Do it for Your Health:

There’s a meal plan out there called the DASH Diet (Dietary Approaches to Stop Hypertension) developed after the results of a 1992-ish, MASSIVE, multi-center study showed that dietary patterns can affect blood pressure.  The results and subsequent meal plan are supported by the American Heart Association, National Heart, Lung and Blood Institute among other importation organizations.  Basically (and this is a bare-bones explanation of the results), if people control their sodium intake, eat plenty of whole grains, and focus on whole, fresh fruits and vegetables, people with hypertension could see considerable drops in blood pressure.  What better place to look for whole, fresh fruits and vegetables than your local farmers’ market. 

 Now, if you’re interested in the DASH Diet, there is an official DASH Diet book that I’m sure is in bookstores everywhere, and all sorts of cookbooks that use the concept.  The website, www.dashdiet.org also does a decent job of outlining the basics.  But if you feel like you’ve got a good understanding of how many fruits and vegetables you should be eating daily, and just want some new recipes, I can recommend 2 cookbooks.  I have both, if anyone wants to borrow them.  The first is called “Jamie At Home”, a book by Jamie Oliver (my new hero).  I believe this was also a show on the BBC.  But it features recipes using the produce Jamie grows in his garden, and tips on growing the vegetables.  If, after while, you’ve found your inner monolog sounds British, you may want to switch to “EatingWell in Season:  The Farmers’ Market Cookbook”.  This book, developed by the fine people at EatingWell, provides recipes using produce broken down by season.  Each recipe comes with a nutrition breakdown so you can see what nutrients you are getting with each recipe.

 Revolutionizing the Farmers’ Market:

Does anyone else think it is strange (appalling) that there’s a McDonald’s INSIDE the Mercy Medical Center?  While it would make Fast Food Friday much easier, I think it sends an awful message to patients and their families.  A growing handful of hospitals feel the same way and this is why these hospitals sponsor their own farmers’ markets.  It started with one doctor on the west coast with a chain of not-for-profit hospitals by Kaiser Permanente.  Dr. Preston Maring decided that enough was enough and to make a long story short, he started a weekly Farmers’ Market in the parking lot of his Oakland Medical Center near San Francisco.  Dr. Maring even set up a system with the growers to deliver produce to medical offices so that if people couldn’t get out to get their veggies, the veggies came to them.  And, Dr, Maring’s idea was so revolutionary that EatingWell invited him to write the introduction to their aforementioned Farmers’ Market cookbook. 

 It caught on.  As of last summer, 29 west coast KP hospitals as wells as facilities in Colorado, Hawaii, Oregon, Georgia and Washington DC all have regular Farmers Markets’ in their hospital parking lots.  Just briefly scanning through a Google search, high profile hospitals at Duke and Johns Hopkins have started their own farmers’ markets as well as hospitals in Pennsylvania, New York and Indiana. 

 Which makes me wonder if the next SWELL Committee bake sale shouldn’t be an OWL Farmers’ Market……just food for thought.

 So support your local Farmers’ Market.  If you don’t want to navigate the crowd downtown, there are farmers’ markets all over the place in Polk County.  Here’s a link to a list.  Do something good for yourself and your community and check one out!   http://www.polkcountyiowa.gov/pages/farmersMarkets.aspx

 Who Thinks of This Stuff:

Seriously, I wish I was smart enough to think this up.  This involves some seriously heady math.  According to the website, an independent, diverse group of panelists (smarties from such prestigious institutions as Yale, Baylor College of Medicine, American Cancer Society and Albert Einstein College of Medicine) developed this patent-pending, mathematical equation called the Overall Nutritional Quality Index (ONQI).  This complicated algorithm looks like something the smart kid in your calculus study group would have come up with.  It weighs healthy nutrients and unhealthy nutrients using recommendations by the FDA, USDA and the Institute of Medicine’s Dietary Reference Intakes.  Things like the type of fat, quality of the protein and the caloric density are also figured in.  Both the numbers from the good nutrients (vitamins, minerals, anti-oxidants, Omega-3 fatty acids) and the “bad” nutrients (trans-fats, saturated fats, cholesterol and sugar) are entered into the equation, and the NuVal number pops out.  This is literally nutrition by the numbers.  As far as I can tell, this is utterly objective; there are no statistics to manipulate to make something look better or worse than it is.  Now if I lost you at the word “algorithm”, have no fear.  The science behind the score can be found at the NuVal website.  And if offers a much better explanation that I gave here, so check it out if you feel you need the information.  http://www.nuval.com/Science/

 Where Can I Find This:

The Des Moines area Hy-Vees have had this in place for about a year.  Some Hy-Vees provide store walk-throughs to introduce the consumers to this new system.  Not all foods are scored yet, but the overall list is continually being updated.  Both nation-wide brands and store brands are being scored.  I don’t believe this is available through Dahl’s or Fairway. 

 Why I Like This:

Believe it or not, I’m kind of a numbers person, and this system is numbers HEAVEN!  How much simpler do you need it to be?  No more looking at food labels.  No more worrying about misinformation provided by the manufacturer.  No more getting sucked in by marketing propaganda.  You do not need to be a dietitian to figure this out.  If you’re trying to decide between 2 different types of peanut butter, just go with the higher number.  I can’t wait for all the labels to be posted online so I can finally have a more objective answer to, “Which is better, butter or margarine”.  I want to know if the trans-fats in margarine weigh heavier than the saturated fat in butter.  The NuVal website indicates that an online score posting is in the future.

 Why I DON’T Like This:

As a numbers person, I like looking at how statistics are manipulated to see if something is reported to be better or worse than it really is.  Since this is supposed to be completely objective, the way the algorithm is set up, weighing the good nutrients against the bad, some of the scores seem odd.  Keep this in mind:  Fresh broccoli was awarded the perfect score of 100.  A boneless, skinless chicken breast, a food that I would consider mighty healthy, has a score of 39.  Now, as a protein, the chicken’s vitamin and mineral content is not nearly as good as that of the broccoli.  But broccoli has virtually no protein, while the chicken is chock full of high biological value amino acids.  Also, Fanta, a brand of pop (soda) has a low, low score of 1 while “Monster Khaos”, a brand of energy drink, (a product I would consider near the root of all evil, worse than pop), scored a 23.  I would imagine this is because energy drinks have B-vitamins and protein added.  I, however, a nutrition professional, consider energy drinks a poor choice because of the amount of caffeine and sugar in them. 

 The website is quick to point out that humans need a well-balanced diet with a diverse group of foods.  But the way the math works, not all food groups will have a member with a perfect score, i.e. meat.  The “fresh meats” category averages scores in the 40’s.  Atlantic Salmon scores an 87. 

 Also, the website mentions that toxin potential (i.e. Salmonella and E.coli) is not weighed into the score, nor is there any evidence as of yet to provide organic foods with an automatically higher score just for being organic. 

 Overall, I think this is brilliant.  I would love it if they would score the State Fair Foods this year.  It’s no secret that picking out healthy foods is challenging.  So if you’re in the store and wondering if one brand of breakfast cereal is going to be better than the other, pick the one with the higher score.  Just keep in mind that if you use the NuVal scoring system, you can’t eat a perfect score of 100.

 Vitamin D is important for getting calcium into your blood stream, and maintaining the amount of calcium and phosphorus you’ve got in your blood stream, which in turn helps to keep your bones and muscles healthy.  If you’re taking a calcium supplement without getting enough vitamin D with it, you’re not getting the full benefit of the calcium.  A deficiency of vitamin D is known as rickets (a bowing of the long bones with overall muscle weakness) which has an interesting history.  In the late 1800’s British scientists noticed that children living in impoverished, rural villages throughout the British Empire had a lower incidence of this condition than well-nourished children living in the middle and upper classes urban settings.  Furthermore, they noticed that treating these children with rickets with cod liver oil (ewww!) showed great improvement.  So these scientists concluded 2 things:

 There must be some nutrient in cod liver oil that is essential to human growth and development.

• There must be something about sunshine that is essential to human growth and development. 

 Another group of scientists, a little later on found that if they induced rickets in animals, and then irradiated (exposed to UV rays) the foods these animals ate, they could cure the rickets.  It was thus vitamin D was discovered.  And through more testing and photobiology and chemistry, more conclusions followed:

 Irradiation of food or food fortification is necessary because the only good food sources of vitamin D are in the flesh of cold water fish and cod liver oil (ewww).

• Humans can get vitamin D through UV ray exposure. 

 Vitamin D is actually pretty confusing (unless you’ve got a textbook sitting right in front of you) because anything that looks or acts like vitamin D, (and the 2 hormones made from vitamin D) is just called vitamin D.  Vitamin D probably has properties closer that those of hormones than the other vitamins.  So let’s break it on down.

 First, we have Vitamin D2 or ergocalciferol.  500 billion years ago, it was thought that this form of vitamin D served as a sort of sunscreen to primitive oceanic cellular life.  This is a plant-based vitamin D isolated in the 1920’s that only pops up if you irradiate fungi.  It was patented and sold to pharmaceutical companies.  If you have to take a prescription form of vitamin D, chances are it’s vitamin D2.  Today, most foods that we would consider good sources of vitamin D, (milk, yogurt, orange juice and grains) are generally fortified with vitamin D2, although there is a growing body of evidence that suggests that D3 is more appropriate for fortification.

 Vitamin D3, or cholecalciferol, is the kind of vitamin D that humans make in their skin through exposure to UV rays.  There are various studies out there with the exposure guidelines, but one can get their needed vitamin D if their limbs are exposed to midday or early afternoon sunlight for about 5-30 minutes at a time.  This is tricky because sunscreen with an SPF as low as 8 can block the UV rays.  And, most medical professionals I know laugh at the idea that tanning beds are a good way to get vitamin D because the risk of skin cancer is so great. 

 This form of vitamin D can be produced in a lab, and many manufacturers of multivitamins are changing their formulas to include vitamin D3 as the structure is overall more stable and it seems to be more biochemically active than its vitamin D2 counterpart. 

 So the bottom line is that vitamins D2 and D3 travel along the same biochemical pathway, however, vitamin D3 may do it a little better.  And if you’re afraid of outdoor UV exposure, you can sure supplement your vitamin D in pill form since it isn’t hugely available in food.  If you take a calcium supplement, make sure it also has a vitamin D supplement with it, or that you take an additional multivitamin with vitamin D. 

 I know that vitamin D is about as clear as mud, so please email me if you have any questions.

 And so I apologize in advance for offending people or making them nervous, but I think there needs to be a frank discussion about the growing waistlines in America.  Let’s look at the past:  In 1976-1980, 25% of American adults were obese.  From 1988-1994, that rate jumped to 23.2%.  In 2005-2006, the rate advanced to 35.1%.  Today, roughly two-thirds (or 66%) of adult Americans are categorized as overweight or obese.  This means they have a Body Mass Index of >25 (overweight) or >30 (obese).  Americans spend about $150 billion (yep, that’s billion, with a “B”) annually on medical complications associated with being overweight/obese such as cardiovascular issues, hypertension, renal complications and, the big one, diabetes. 

 But scarier still are the statistics associated with kids.  The following statistics were taken from the Center for Disease Control’s (CDC) web page:  (http://www.cdc.gov/obesity/childhood/index.html)

 “Data from NHANES surveys (1976–1980 and 2003–2006) show that the prevalence of obesity has increased: for children aged 2–5 years, prevalence increased from 5.0% to 12.4%; for those aged 6–11 years, prevalence increased from 6.5% to 17.0%; and for those aged 12–19 years, prevalence increased from 5.0% to 17.6%.”  The good news is that according to this study, obesity is increasing at a slower rate than previously estimated.  The bad news is that Americans have quite a hole from which to dig themselves, and it’s still getting deeper. 

 Kelly Brownell, a professor at Yale University featured on a January 2010 CBS Evening News spot had more to add.  He reminded viewers that about $30 billion a year is spent on food advertising, much of it is targeted towards kids, and we eat it up.  In an interesting twist, (one that I really like), he compares junk food to cigarettes.  Before cigarettes had taxes and advertising restrictions, in 1965, a pack of smokes cost $0.30 and roughly 42% of Americans smoked.  Now that tobacco is taxed, and there are restrictions on advertising, a pack costs roughly $4.80 and about 20.6% of Americans smoke.  Why not tax junk food?  Just by taxing a penny per ounce, Brownell estimates billions could be raised to fight obesity.  Unfortunately, most Americans do not support this idea; Peanut M&M’s don’t carry the same cancerous stigma that cigarettes do.  But maybe they should.  We’ve all seen that second hand smoke can lead to cancer in non-smokers, but is there such a thing as “second hand weight gain”?  Did you know that if one parent is overweight/obese, the child has a 50% chance of developing the same?  A child has an 80% chance of being overweight/obese when both his/her parents are overweight/obese.

 (Sidebar Regarding Advertising:  Remember, if it sounds too good to be true, it probably is.  I am reminded of this when I watch commercials for Poptarts.  There is one that features a happy, (thin) animated child who dances around his kitchen as his happy, (thin) animated mother hands him a newly toasted Poptart.  Happy, pretty confetti flows through the kitchen and spills out into the neighborhood, because all of the (thin) animated kids on the block have Poptarts for breakfast.  All the while, a disembodied voice is telling consumers that because of the vitamins and minerals, and since it’s made with real fruit, the Poptart is a good and healthy thing to give to your family….It is a Poptart; there is nothing remotely nutritious about it.  One tart is 200 calories and 5 grams of fat.  There are B-vitamins in there because they have to be by law.  Same as bread, same as cold cereal, same as pasta)

 So where does this leave us?  What happens when we respond to this $30 billion dollar campaign designed to drive us to buy unnecessary products?  What happens when Burger King shifts its meal sizes so that what was once a small is now the medium size, but still labeled small and so forth?  What happens to us when Starbucks adds the new 31 oz “Trenta” to all menus?  What happens when our pop (soda) consumption outweighs our consumption of water?  What happens when grocery stores stop carrying fresh produce to make room for pre-packaged meals? 

 This means that our waistlines continue to grow.  This means that airline travel will continue to be more expensive because the airplanes are too heavy to hold both passengers and luggage.  This means that restaurants, churches, stadiums, and other public places will face remodeling obstacles in order to have space for people to sit.  This means your insurance rates will skyrocket.  This means that Gen X-ers can look forward to time in a nursing home because they can’t care for themselves.  This means that we will continue to spend more for prescription medications for hypertension and diabetes.  This means that children will need medications for hypertension and diabetes.  This means that today’s children can look forward to joint replacements in their 30’s. 

 This means that for the first time since the Civil War, this generation of American children has a lower life expectancy than their parents. 

 Do I have your undivided attention yet? 

 More to come with Part II:  A Food Revolution.

 I believe I touched on cholesterol not too long ago, but I’m still running into people who don’t know what the numbers mean, so here we go.  When you get your cholesterol checked, chances are you’ll receive 4 numbers, (and I’m just speculating here, but when I get mine done at my doctor’s office, this is the set up) and the acceptable levels of these numbers may be a bit different that what I’m typing out, but that’s ok.  The acceptable levels usually differ a little from lab to lab. 

 Lipids:  The Numbers Game:

• Total Cholesterol:  Less than 200
• Triglycerides:  Less than 150
• LDL:  Less than 100
• HDL:  If you’re a man, greater than 45, if you’re a woman, greater than 55

Now, it’s good to have your overall cholesterol low, but more and more, doctors are looking to the LDL and HDL as the more major indicators of risk.  LDL is the bad cholesterol, and the HDL is the good cholesterol (think “L”ousy and “H”ealthy).  Lowering your LDL takes both diet and exercise.  You need to avoid saturated and trans fats, and make sure you get 25-30 grams of fiber daily.  I’m always on the look out for high-fiber foods that don’t taste like cardboard.  I like the Thomas-brand 100% whole wheat bagels, but their whole wheat English muffins leave something to be desired.  The Pepperidge Farm brand English muffins aren’t too bad.  And please don’t forget about the fiber in fresh fruits and vegetables.  I know they’re pretty pricy at the moment, but berries have 3.6-7.6 grams of fiber per 1 cup serving depending on the berry.

The link below will take you to the CDC’s physical activity recommendations for healthy adults.  I’ll let you read that on your own, but basically it recommends that healthy, non-pregnant adults get about 30 minutes of moderate intensity aerobic exercise 5 days a week, and resistance training 2 days a week.  The web site also does a really good job of describing what light vs moderate vs intense aerobic activity is. 

http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html

As we touched on with the “Chocolate and Beer” Wellness Letter, you can improve your HDL with a combination of moderate alcohol and exercise.  If you recall, moderate alcohol consumption consists of 1 serving/day for women and 1-2 servings/day for men.  And, just in case you forgot, 1 serving is 12oz beer, 5oz of wine and 1 shot of hard liquor.  You cannot save your servings and binge one night a week. 

Calculating Body Fat %:  The Most Un-Scientific Process in the World:

 The table below (from The American Council on Exercise) is a description of what you body fat % should/could be:  Again, the numbers will vary depending on what source you use.  This table seemed reasonable to me. 

 Here’s a couple of things to remember:  The numbers for women look unfair when compared to the men’s numbers, but women naturally have more fat deposits in men, that’s just the way we’re made.  The Essential Fat refers to the amount of fat we need to complete physiologic functions.  At this percent, women may not menstruate.  The percent listed for Athletes refers to people who compete on the professional level, although after watching the Olympics, those numbers look a little high.  Fitness refers to people who are in good shape and work out regularly. 

 Here’s where the line gets smudged.  There are a bunch of ways to figure out your body fat%, and some are waaaaaaaaay better than others.

 1)     Skin Fold Calipers:  If you’ve ever had this done, you won’t forget.  It involves these pinchy things (calipers) that test the thickness of your skin and therefore the thickness of the layer of fat you have under your skin.  The people pinching you need to be very experienced with this or else you’re going to have skewed measurements and giant bruises.  This is generally reserved for lab work, or people participating in health care studies.  I occasionally see practitioners wielding the calipers at health fairs, but not very often any more.  Not very practical for home use, but if you get someone who really knows what they’re doing, it can be really accurate.

2)     DEXA Scans:  Generally used to measure bone density, DEXA scans (full body scan) can also be used to calculate what % of your body is lean muscle mass, bone, and what % is fat tissue.  This is probably the most accurate since all the subject has to do is lay there.  There is no pinching involved either.  This would have to be done at a hospital or clinic and probably not covered by insurance unless you were being scanned for osteoporosis too. 

3)     Underwater Weighing:  Also generally reserved for lab work, the subject sits on a scale and is submerged in a tiny tank.  The subject then needs to quickly expel all air from his or her lungs and sit very still for the longest 5-10 seconds of his/her life.  The data collected is calculated out in a textbook equation.  It is supposed to be pretty accurate provided the subject can really, really get all the air out, and can sit very, very still.  This is not for people who are claustrophobic or afraid of the water.  It is all together an unpleasant experience.  Let’s move on. 

4)     Bioelectrical Impedance BEI):  This one is probably the most user friendly, but less accurate than the previously mentioned methods.  Basically, you have 2 conductors attached to you and a small ripple of electricity is sent through (you won’t feel anything).  The machine measures how easily the electricity moves through your body; it moves easier through muscle mass than fat because muscle tissue contains more fluid.  Now when I was a guinea pig in school we tested BEI 3 different ways:  a hand-held device, a sort of scale you stand on, and by laying down with one conductor on your ankle and one on your shoulder.  Option number 3 where you lay down is reported to be the most accurate because the electrical current goes through your whole body.  With the hand-held device, the current goes from 1 hand through your abdomen and into the other hand.  Similarly, when you stand on the scale option, the current goes up one leg, through your abdomen and down the other leg.  So with these 2 devices, your whole body isn’t really being taken into consideration.  Another draw back to BEI is that if you’re underhydrated, your body fat% will be falsely high, and if you drink a large quantity of water before you’re tested, your body fat% will be falsely low.  Hand-held and scale body fat % devices are available at many large retail outlets.  When at health fairs, I see the hand-held devices used the most often.  They are pretty portable and people don’t have to take their shoes and socks off to use them.

5)     Anthropometric Measure:  When I googled “body fat percent” just to see what would pop up, all of these websites appeared with body fat% calculators.  Seriously, I thought this was made up.  After spending so much time as a guinea pig trying the previously mentioned methods, I was outraged to learn that I could have figured this out just by doing a little math.  But I emailed a friend of mine in the Air Force, and he said that these types of calculations are used in the military to determine appropriate height/weight ratios and body mass%.  I thought surely this couldn’t be accurate and proceeded to check out a few of them.  Most of them require you to type in your measurements, in inches, of some combination of your waist, hips, neck, wrist and forearm.  All of them asked for your weight, some asked for your height.  After trying 5 of them, I have a body fat% somewhere between 16.7% and 32.5%.  So according to one, I’m an athlete, and by a different set of measurements, I’m obese. 

 Let me put this into perspective.  I swam regularly in grad school, and I walked between the campus and my apartment because parking was atrocious.  Using the laying down method of BEI, my body fat% was calculated out at 17%.  That was 6 years ago.  I currently work out regularly, and although I am admittedly not as lean as I was in grad school, my current Body Mass Index is 22.0, right smack in the middle of “normal’ ; I know I’m not obese.  If I had to guess, I’d place myself between 23% and 26% for body fat.  I’m interested to see what I’m measured as at the Wellness Fair.

 So the On With Life Wellness Fair is Tuesday, March 9 from 11-2 in the TR gym.  Please stop by and have your cholesterol and body fat% checked out.  They are good, generally indicators of health and risk for developing health issues.