Mindfulness, Breathing, & Increased Awareness. Could It Be For You?

Depression, stress, and anxiety are quite present in today's society and a range of first-world lifestyle factors may be contributing to their increased prevalence. Today I'm going to focus on two iPhone applications which may help you to relax when feeling anxious, stressed, or sad.

Stop, Breathe, and Think is an application created by a non-profit organization called Tools for Peace. The application asks you to select your mood or specific feelings you may be experiencing at that time and then gives you options of certain mindfulness meditation/ relaxation exercises which may help you feel calm and relaxed. Some sessions are as short as 3 minutes while others can be up to 8 minutes. The application also tracks your progress and how much time you have spent meditating.

Breath2Relax is an application created by the National Center for Telehealth and Technology and focusses on diaphragmatic breathing exercises. The length of inhalation and exhalation can be set by the user along with calming background music.

Both applications share information about mood and stress; Stop, Breathe and Think offers more variety, has attractive visuals and tracks mood and progress, while Breathe2Relax focuses solely on breathing and may be appealing for those who want to specifically set a length of time for their exercise and/or get great relief from deep breathing.

Interventions based on mindfulness and awareness have become increasingly popular. Mindfulness is a state of active, open attention on the present. When we are mindful, we are aware, attentive, and observe our thoughts and feelings from a distance without judgment. It has been associated with enhanced relaxation, attention regulation, emotion regulation, body awareness and cognitive re-evaluation. Multiple 2013 and 2014 studies suggests it may play a role in pain management, irritable bowel syndrome treatment, diminishing cravings, fatigue, and insomnia management (see links below for details). A 2013 study with 56 pre-hypertensive patients showed a greater improvement in participant blood pressure who underwent mindfulness-based stress reduction exercises over an 8 week period. While another small 2013 study showed diaphragmatic breathing and muscle relaxation to promote more weight loss in overweight, Greek women when compared to those who did not receive a stress-management program.

Overall, it is difficult to definitively link mindfulness, meditation, and diaphragmatic breathing to an entire list of positive outcomes since many of the studies conducted involve small groups of people. However, the results seen are often positive; so if you experience stress, anxiety, or mood issues, why not give yourself a few minutes to relax, breathe or become more aware?
Also, if you've used alternative applications that have helped you, I welcome you to please feel free to post in the comments below and share!

Information Sources
http://www.ncbi.nlm.nih.gov/pubmed/24719001
http://www.ncbi.nlm.nih.gov/pubmed/24461370
http://www.ncbi.nlm.nih.gov/pubmed/24239587
http://www.ncbi.nlm.nih.gov/pubmed/24127622
http://www.ncbi.nlm.nih.gov/pubmed/23627835

So You're Thinking About Oil Pulling..

Oil pulling is an Indian folk remedy that has been used traditionally to strengthen teeth, gums, and jaws and to prevent decay, oral malodor, bleeding gums and dryness of throat, and cracked lips. 1-2 teaspoons of sesame, olive, or coconut oil is placed in the mouth and swished around for 15-20 minutes, and then spit out. Some sources suggest that this removes toxins, plaque and bacteria from the oral cavity. A 2009 study involving 20 participants gave half of the participants a chlorhexidine mouthwash and the other half sesame oil. Results showed that both groups had a reduction in plaque and aerobic microorganisms in the mouth. Another 2011 in lab study (in vitro) suggested that sesame oil did not have antimicrobial affects but the process of oil pulling could lead to emulsification and saponification (process that produces soap) which could help clean the oral cavity. To date, most scientific studies involve few participants; positive results in 10 individuals don't necessarily predict what would happen in every person, therefore studies with larger participant numbers are needed.
The Cleaveland clinic suggests that oil pulling may be used as a mouthwash to maintain oral health but is not a replacement standard oral hygiene recommended by your dentist.
Currently there is no scientific evidence to prove that oil pulling improves or cures chronic diseases. However, it is likely a safe to use as a natural mouthwash as long as you're don't forget about that toothbrush and floss!

Information Sources:
http://www.ncbi.nlm.nih.gov/pubmed/21911944
http://www.ncbi.nlm.nih.gov/pubmed/19336860
http://www.ncbi.nlm.nih.gov/pubmed/21525674
http://health.clevelandclinic.org/2014/04/is-oil-pulling-your-best-choice-for-dental-health/

Fast Food? Get Some Fast NFACTS!

Fast-food fast NFACTS? Sounds like a tongue twister! The point of this post is to give you fast, easy access to the nutrition facts of common restaurants. In the previous post I encouraged you to take charge, find out what you are putting in your body and find out what is in the food you are eating. I've taken it a step further and made it even easier by providing links to common fast-food nutrition information. Take a look at the sodium or saturated fat content of that burger you eat every Friday, and maybe, consider trying a different, lower sodium, lower saturated fat, higher fiber or higher protein option next time? If you're ready to make positive health conscious changes, how would you know that you're making better choices without looking at the nutrition facts? You possibly wouldn't.. So click away, become informed, gain knowledge, and make choices based on what you learn.

• Arby's  www.arbys.ca/pdf/CanadaNutrition2010.pdf
• A&W  http://www.awrestaurants.com/A&W_Nutritional_Information.pdf
• Booster Juice  http://boosterjuice.com/products/menu
• Burger King  http://www.bk.com/en/us/menu-nutrition/index.html
• Dairy Queen  http://www.dairyqueen.com/us-en/Company/Nutrition/?localechange=1&
• Extreme Pita  http://www.extremepitast.ca/public/Nutritional%20Guide.html
• IHOP  http://www.ihop.com/-/media/ihop/PDFs/nutritionalinformation.ashx
• KFC  http://www.kfc.ca/en/assets/pdf/KFC11834_NutritionalChart_Eng.pdf
• Little Caesars  http://www.littlecaesars.ca/OurMenu/Info/Nutrition.aspx
• McDonalds  http://www1.mcdonalds.ca/NutritionCalculator/NutritionFactsEN.pdf
• Milestones  http://www.milestonesrestaurants.com/nutrition_selector.php
• Montana's  http://www.montanas.ca/pdf/nutritionals.pdf
• Olive Garden  http://www.olivegarden.com/Menu/Nutrition/
• Papa John's  http://order.papajohns.com/nutrition.html
• Pizza Hut  http://www.pizzahut.ca/Nutrition.aspx
• Red Robin  http://redrobincanada.com/home/nutritional-information.aspx
• Starbucks  http://www.starbucks.ca/menu/nutrition-info
• Subway  http://www.subway.com/nutrition/nutritionlist.aspx
• Swiss Chalet https://www.swisschalet.com/nutrition-allergies
• Taco Bell  http://www.tacobell.com/nutrition/information
• The Keg  http://www.kegsteakhouse.com/en/nutritional-charts/
• Tim Horton's  http://www.timhortons.com/ca/en/menu/menu-info.html
• Wendy's  http://www.wendys.ca/food/Nutrition.jsp

Fast Food, Convenience, & Our Developed World

Fast food... it's convenient, it's easy, it's everywhere around you. As soon as you leave your home or as soon as you get walking or driving to work, you'll surely be exposed to some sort of advertising for a fast food or restaurant meal. 2 for 1 lunches, buffets, 1/2 off Tuesdays, happy hour... Have you been so easily manipulated by this "money saving" or "value" meal that you've forgotten about the actual nutrition value of the meal? We all have likely have fallen for such marketing strategies, I know I've purchased at least 1 Groupon for a 50% off restaurant meal over the last month.

But do these companies care about your health? No, not necessarily. What they do care about is money, and how you spend yours. So my next question is who cares about your health? If they don't and you don't, what's happening to you body? Your blood pressure? Your heart? Your blood sugar? What is in the food you eat? Do you know? Do you ever ask? So again, if they don't care about your health, and you don't, who is taking responsibility of your health and your choices?

I encourage you to take control. Eat out and enjoy it, but know what is in your food. Ask the waitress how your meal is cooked, in what type of oil? What type of seasonings are used? How is the sauce prepared? Can you have your sauce on the side? Is there a whole wheat or whole grain option instead of a white flour based option? Is your coffee made with whole milk? Can you have skim milk? Ask for the nutrition facts. "The what" you say? The nutrition facts! Most fast food chains have paper copies of the nutrition information of their meals available and many restaurants also offer this information if you ask for it. This information is rarely voluntarily offered, so know that you can ask! Many restaurants and fast food chains also provide detailed nutrition information online; checking this out before you meet your friends for supper may decrease any social awkwardness you may feel if asking questions about your meal.

However, my next question is: why should we feel awkward about wanting to know more about our food? Did you know that most fast food meals have over 1000mg of sodium and 22% of restaurant meals have more than 2300mg of sodium; Between the ages of 9-50 years old, we only need 1500-2200mg per day. Long-term high sodium intake can increase risks of high blood pressure, chronic kidney disease, heart attack and stroke. In addition to high sodium, fast food is often high in saturated fat. This fat can increase our LDL or "bad" cholesterol and increase risks of heart attack and stroke. So I ask, is it worth not knowing what is in your food because it seems inconvenient or it may feel awkward asking a few questions?

The choice is always yours. I encourage you to empower, educate, and care for yourself. Ask questions, share the answers with your loved ones, and make positive choices for yourself and your family.


Information Sources:
http://journal.cpha.ca/index.php/cjph/article/view/3683

http://www.hc-sc.gc.ca/fn-an/nutrition/sodium/index-eng.php

Is Anxiety Getting In Your Way?

The goal for today's post is definitely not to open up a can of worms, seeing as we could discuss anxiety and its associated disorders for hours! Also, I'd like to be the first to clarify that I am no expert in counseling patients for anxiety disorders; I'm a registered dietitian, not a counselor, but I do deal with patients on a daily basis who are struggling with anxiety, stress and depression. With that in mind, I'd like to provide a brief outline of what anxiety is, symptoms associated with anxiety, and what methods can be successful in treating anxiety.

The Anxiety Disorder Association of Canada states that anxiety disorders are the most common mental health concern in Canada. They define anxiety as "when various symptoms of anxiety create significant distress and some degree of functional impairment in daily living. A person with an anxiety disorder may find it difficult to function in areas of life such as social interactions, family relationships, work or school."
It is important to understand that everyone experiences anxiety at times. Anxiety is our body's common response to real danger during a "fight or flight" situation e.g. roller-coaster ride; running into a bear while camping; the ability to jump out of the way of a moving vehicle; feeling nervous before an interview. When this response is activated in situations where there is no (or limited) actual danger and it gets in the way of everyday activities, this would be a red flag that you may need to seek help from your physician or counselor.
Common symptoms of anxiety include but are not limited to:

• Rapid heart beat; rapid breath
• Chest pain
• Light-headedness
• Headache/ Dizziness
• Muscle tension
• Dry mouth
• Upset stomach- nausea, diarrhea, gas, abdominal discomfort
• Cold and clammy palms
• Numbness or tingling sensation
• Insomnia; fatigue
• Difficulty concentrating or forgetfulness
• Irritability
• Fearfulness
• Self-consciousness
• Difficulty communicating

Anxiety disorders are commonly treated with evidenced based Cognitive Behavioural Therapy (CBT). CBT is a technique that promotes an awareness of how our thought process may contribute to anxiety and encourages a new way of thinking about your problems. It can be done with a therapist, independently, or in group settings. Medications can also be used in conjunction with CBT to help manage symptoms. Anxiety BC states that CBT is "one of the most effective treatments for anxiety and can also effectively treat depression, chronic pain, disordered eating, anger issues, addiction, and low self-esteem."
In addition to CBT, many studies suggest that meditation and relaxation techniques can reduce symptoms of anxiety. Calm breathing exercises involving long deep breaths in through the nose and out of the mouth can help control symptoms in addition to muscle relaxation exercises which involve tensing muscle groups and relaxing them periodically. I often ask my patients to come up with a list of 5-10 activities that bring them joy and relaxation; why don't you try this at home, put that list up somewhere you'll see it and try one of those activities the next time you feel anxious?
Many studies show that even a small amount of physical activity can improve mood and prevent depression. Other techniques may include stretching, listening to music, yoga, having a warm bath or shower, calling a friend, working on a puzzle, regularly getting 6.5-8.5 hours of sleep/night, writing in a journal to recognize thoughts that lead to anxiety, asking yourself if your thoughts are realistic or not and then challenge unrealistic thoughts objectively as if you were not part of the situation (or as if you were like a jury in a court case looking at both sides of a situation).

To learn more about anxiety, CBT, challenging your thoughts, relaxation, and videos check out Anxiety BC.
To learn more about relaxation exercises check out The University of Maryland, NHS Choices, explore online or on YouTube.

If you're struggling with anxiety, try to challenge unrealistic thoughts, find what relaxation techniques work for you and work with your healthcare team!

Information Sources:
http://www.anxietybc.com/
http://ajp.psychiatryonline.org/article.aspx?articleID=168746
http://www.anxietycanada.ca/english/index.php
http://www.ncbi.nlm.nih.gov/pubmed/24559833
http://www.anxietydisordersontario.ca/
http://www.ecentreclinic.org/Depression_Factsheet.pdf
http://umm.edu/programs/sleep/patients/relaxation
http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/ways-relieve-stress.aspx
http://www.youtube.com/watch?v=EIJQsE8C5Is#aid=P9w4zsv1mvY

The Importance of Hydration

 

Some say 6 cups, other say 8, while others say 9 or 10! So what is all the fuss over water and how much do we need?

The human body is 60-70% water. Without water, humans can live for only a few days. It is important to replenish our fluids because fluid helps to:

• Flush toxins and waste through the body
• Protect and cushion joints and organs
• Carry oxygen and nutrients to the body's cells
• Control body temperature- in order to cool the body in hot climates and during physical activity, the body looses fluid from sweat. If the fluid lost in sweat is not replenished, the body may sweat less to conserve water; an increase in body temperature may then be seen along with electrolyte imbalances, decreased plasma volume which reduces the output of blood from the heart, and reduced blood flow to muscles.
• Regulate blood pressure, blood volume, heart rate. Without enough fluid, the volume of blood in the body can be low; the effects of this can be seen in low blood pressure when the position of the heart (or entire body) is changed. This orthostatic or postural hypotension could have symptoms of lightheadedness after standing, dizziness, instability, blurred vision, vertigo, and/or nausea, and can be prevented with adequate fluid intake.
• Protect the kidneys- when fluid supply in abundant, the kidneys function efficiently to clean the blood and rapidly eliminate waste and excess water. When fluid supply is inadequate, the kidneys must work harder to concentrate the urine; this process utilizes more energy and can wear down renal tissues.
• Prevent constipation when enough fluid and fiber are consumed.
• Possibly prevent headaches and/or migraines caused by intracranial dehydration
• Prevent the formation of stones in the bladder or urinary tract which can cause infections and reduce kidney function

Want to know if you're getting enough?
First check your urine; if it's dark yellow and you're not making much urine through the day, you may not be getting enough fluid flushing through your kidneys. The urine color you're aiming for is light yellow or clear.
Second, ask yourself if your mouth is dry or if you feel thirsty; if the answer to either of those is yes, you may not be drinking enough fluid. Some sources suggest that once you feel thirsty the body is already slightly dehydrated.
Finally, consider how you feel. If you're tired, irritable, feel light headed, have headaches or trouble focusing, it may be a sign you're dehydrated.

How much fluid each person requires is very individual. Anywhere between 6-10 cups/day could be enough for you, but looking at the other signs such as urine color, thirst and mood will help you determine if you're getting enough!

Information Sources:

http://www.dietitians.ca/Your-Health/Nutrition-A-Z/Water.aspx?categoryID=58

http://www.eatrightontario.ca/en/Articles/Water/Facts-on-Fluids---How-to-stay-hydrated#.UvwwcsHn_IU

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908954/
http://www.aafp.org/afp/2003/1215/p2393.html

Using Raspberry Ketones for Weight Loss? You May Want to Read This First!

As a registered dietitian, I understand that millions of people struggle with preventing weight gain and promoting weight loss. One of the newer proposed "magic" weight loss pills on the market is raspberry ketones. This product has been endorsed by Dr. Oz, however, even though Dr. Oz is an actual doctor, this doesn't mean that every claim made on his show is supported by strong evidence. On the positive end, I must admit that the famous MD does note that the product doesn't necessarily guarantee results in everyone and is not a replacement for a healthy lifestyle.
So now it's time I dig into the evidence behind this product so that you can make an educated and informed decision about your health. Raspberry ketones are an aromatic compound that comes from red raspberries. It has been suggested that raspberry ketones can alter lipid/fat metabolism and increase lipid breakdown.
In one study conducted on rats, it was suggested that rats who were fed a high-fat diet and then given raspberry ketone did not show an increase in weight related to their diet, had decreased liver triacylglycerol (fat) content with supplementation (after liver fat had increased with high fat diet), and showed increased hormone-induced lipid breakdown in rat fat cells in the epididymis (male reproductive organ where sperm is stored). Another 2010 study completed on cells in a lab found that raspberry ketones increased lipolysis (fat break-down) and the secretion of adiponectin from fat cells. Adiponectin is a hormone secreted by adipocytes (fat cells) involved in the metabolism of lipids, glucose, and may have anti-inflammatory effects. Low levels of this hormone has been linked to obesity, insulin resistance, and heart disease in humans.
Up to this point, only one study including raspberry ketones has been conducted on humans. However, in this study the supplement included raspberry ketone with caffeine, capsaicin, garlic, ginger and Citrus aurantium; isolated raspberry ketone was not used. 45 obese participants completed 8 weeks of diet and exercise with a raspberry ketone containing supplement or placebo. The placebo group showed beneficial changes in body fat, however the supplemented group had greater loss of weight, fat mass, waist and hip girth, and increased lean body mass. It is important to note that since the supplement was a combination of ingredients, it is difficult to determine if effects seen were only related to raspberry ketone.
It is difficult to conclude that because studies in rats, fat cells in a lab, or in 45 humans show encouraging weight loss results, that the same results would be seen in every person. In addition, little is known about the safety of the long term use of this product in high doses. Some sources suggest it may interact with Coumadin (blood thinner), while other sources suggest that its structure is similar to a stimulant called synephrine which may not be safe for patients with high blood pressure or heart disease. Furthermore, the supplement may contain additional ingredients whose safety has not yet been determined.
At this point in time, as a health-care provider I cannot encourage the use of this product until further research regarding it's effects in humans has been conducted. However, if you still choose to still give it a try, make sure to let your doctor, pharmacist and dietitian know to ensure that you're making a safe decision, and recall that your food choices and physical activity can always support your journey!

Information Sources:
http://www.ncbi.nlm.nih.gov/pubmed/20425690
http://www.sciencedirect.com/science/article/pii/S0024320505001281
http://www.todaysdietitian.com/newarchives/090112p80.shtml
http://www.doctoroz.com/videos/miracle-fat-burner-bottle
http://www.ncbi.nlm.nih.gov/pubmed/23601452
http://www.webmd.com/vitamins-supplements/ingredientmono-1262-RASPBERRY%20KETONE.aspx?activeIngredientId=1262&activeIngredientName=RASPBERRY%20KETONE

Could Your Eating Speed be Connected to Your Weight?

It has been suggested that the faster we eat, the more likely we are to eat more. One study included 70 participants in which half were obese and the other half were within suggested normal weight ranges. Both groups underwent 2 scenarios:
-Participants were encouraged to take small bites of their lunch meal, chew slowly, and put their spoon down between bites 
-Participants were encouraged to eat lunch under a time constraint and were told that they needed to take large bites and chew quickly

Results showed that normal weight participants ate fewer calories when eating slowly while obese participants' caloric intake did not differ based on eating speed. Researchers found that both groups drank more water when eating slowly and participants reported feeling full for longer after eating slowly. Interestingly, it was also found that participants in the obese group ate fewer calories that those in the normal weight range (possibly due to feeling self-conscious).

Another study investigated 529 male workers in Japan in 2000 and 2008. Data such as alcohol consumption, self-reported speed of eating, weight, and height were collected in both years and compared. Results showed that fast-eating participants had greater average weight gain of 1.9kg than slow/medium speed eating participants who gained an average of 0.7kg. Results were statistically significant for participants in the 20-29 year age group and when  researchers adjusted data to not be biased for age, smoking, drinking, and exercise, a relationship between eating speed and rate of weight gain was still suggested.
Additionally, a New Zealand study of women aged 40-50 years suggested that faster eating was associated with higher body mass index (BMI); a 2.8% increase in BMI was observed for each increasing category of speed of eating.
Furthermore, Dr. Arya Sharma, a leading obesity expert from Edmonton, Alberta suggests that speed of eating at the age of 4 years old could be a predictor for obesity, and that it could also be pre-determined by our genetics.

So, what to make of all this? Studies suggest that there may be a link between speed of eating and weight gain. If you've been struggling with your weight, becoming aware of your eating speed, attempting to slow down with smaller bites, taking sips of water during meals, and putting the fork down after each bite may be techniques that help you prevent over-eating, manage your weight, and allow your body enough time to recognize when it's full. Remember, the successful weight management/ loss game is always about adopting healthy habits that can be easy enough to follow for a life time!


Information Sources:
http://www.sciencedirect.com/science/article/pii/S0195666311001383
http://www.nlm.nih.gov/medlineplus/videos/news/Eat_Speed_123013-1.html
http://www.sciencedirect.com/science/article/pii/S0002822311005840
http://www.slideshare.net/Aryasharma/slow-eating-protects-from-childhood-obesity

What About Stevia?

The use of sugar substitutes is becoming more and more popular these days as low or zero calorie sweeteners can be quite appealing to those attempting to lose weight, manage their blood glucose or minimize dental carries.
Stevia comes from the sweet leaves and extract of the plant Stevia rebaudiana. Originating in South America, stevia is sold under brands such as PureVia and Truvia. Purified stevia extract (>95% pure) known as steviol glycoside is 200 times sweeter than sucrose (table sugar) and has been approved by Health Canada as a table top sweetener and food additive in some foods such as cereals, nut spreads, baking mixes, chewing gum, and unstandardized beverages, condiments and candy.
It is important to understand that whole stevia leaves and crude extracts have not yet been approved by Health Canada or the FDA due to incomplete scientific data on the safety of their use; purified stevia/ steviol glycosides/ rebaudioside A are versions that have been approved as safe for use. The U.S Food and Drug Administration has considered rebaudioside A "generally recognized as safe" since 2009.
Now that I've gotten you confused, lets confuse you some more! Although purified extracts have been approved by Health Canada and the FDA, the Center of Science in the Public Interest (CSPI) suggests a need for further research to determine the safety of stevia. The CSPI suggests that guidelines require new food additives to be tested on rats and mice for 2 years. Rebiana (high purity rebaudioside A) had been tested only on rats and not mice, and some studies found rebiana-related substances to cause DNA damage in rats.
Ovcourse, just because high doses of a related substance may cause toxic damage in rats, does not mean that similar affects would be seen in humans. Stevia has been used for years in South America, Central America, and Japan, however, whether or not it is associated with negative side effects in humans remains unclear with some critics.
In the end, choosing conventional sugar or sugar substitutes is always up to you. Extensive use of sugar or sugar substitutes could create a preference for sweeter foods, increase cravings for these foods, and make it more difficult to manage weight and/or diabetes. And don't forget, conventional sources of sugar are still an option if you can manage how much you use and how often you use it!

Information Sources:
http://www.dietitians.ca/Nutrition-Resources-A-Z/Factsheets/Food-Safety/Artificial-Sweeteners.aspx
http://www.hc-sc.gc.ca/fn-an/securit/addit/list/9-sweetener-edulcorant-eng.php
http://www.hc-sc.gc.ca/fn-an/securit/addit/sweeten-edulcor/index-eng.php
http://www.cspinet.org/stevia/
http://www.healthcastle.com/diabetes_stevia.shtml

What is the Deal with Sodium?

The other day I had a really great question from a friend, she asked me "why is salt so bad for you?" I informed her that over the long term, high salt intake can promote our bodies to hold onto a greater amount of fluid. If our bodies are carrying more fluid, this can increase blood pressure, and then this high blood pressure over time can damage blood vessels and lead to heart disease. However, I had a feeling this explanation didn't quench her need for a more detailed explanation, so here we go!
We normally need 1500-2300mg of sodium/day. Foods such as deli meats, canned soups, sauces, cheese, pickles, pizza, and fried foods can have up to or more than 1000mg of sodium per serving~the equivalent of more than half of our sodium needs for the entire day!
The kidneys in our body function to filter our blood, remove toxins, and remove excess fluid. By the process of osmosis and a balance between sodium and potassium, extra water is drawn out of our blood and removed as urine. If we have a long-term diet high in sodium, this can increase the sodium levels in our blood. In response, to keep our sodium in balance our bodies attempt to dilute this high salt, hold on to fluid, and make it more difficult for the kidneys to draw water out of the bloodstream. This extra fluid in the bloodstream can increase blood pressure and can cause extra strain on the vessels of the kidneys. Over time, high blood pressure can permanently damage the kidneys and lead to kidney failure. In later stages of kidney failure, toxins and fluids build up and cannot be removed by the body; this build up can poison the body and external removal through dialysis may be needed.
High blood pressure also strains arteries. In response to the pressure, artery walls can become thicker and  harder which can make the space inside the artery even smaller (picture a garden hose that gets thicker and more rigid over time). High pressured blood flowing through a tight restricted space, can further increase blood pressure. Over time the pressure can cause arteries to burst or become clogged, limiting blood flow and oxygen to the heart, brain, and other parts of the body. This limited blood flow can result in heart attack, dementia, and/or stroke, where parts of our heart and brain die due to the lack of oxygen from blood.
I normally don't go into such physiological detail, and in no way am trying use physiology as a scare tactic, but the easiest thing you can do to protect your kidneys, arteries, heart and brain is to become more aware of your daily salt intake and consider alternative, lower sodium options.

For low sodium food ideas take a peek at the detailed Edmonton Southside PCN Low Sodium Brochure

Information Sources:
http://www.mayoclinic.com/health/sodium/NU00284
http://www.bloodpressureuk.org/microsites/salt/Home/Whysaltisbad/Saltseffects
http://www.cdc.gov/salt/

Astragalus

This post was motivated by a patient who chose to take astragalus supplements instead of receiving steroid-based medication to treat a flare up of their inflammatory bowel disease. Whatever treatment you choose, the choice is yours in the end. But you deserve to have all the information you need to make an educated decision.
Since I hadn't heard much about this supplement, I decided to conduct a bit of research to assess the scientific evidence behind the use of this product.
Astragalus can be found as a supplement from the plant Astragalus membranaceus. It has been used in traditional Chinese medicine for immune system support; In China it has been used for chronic hepatitis, colds, upper respiratory tract infections, cancer therapy, and heart disease. The root of plant is often used in soups, teas, extracts, or capsules.

The National Center for Complementary and Alternative medicine suggests that the evidence to support health claims for this product is lacking. They also state that the supplement is safe for most adults, but certain species that are not usually in supplement, can be toxic. There is a possibility that astragalus may interact with medications that suppress the immune system and may affect blood sugar and blood pressure.

Some studies (not on humans) have found astragalus to inhibit human gastric cancer cell growth in lab. Another study on humans suggested it could have potential in treatment of cancer-related fatigue. While a 2011 study of 90 participants suggested that daily astragalus + perindopril improved heart contraction. However, this study did not include a control group which was not receiving astragalus (to compare results to). In addition, it is not clear if positive results obtained could also be related to the medication perindopril (medication used to manage blood pressure and promote blood to flow more smoothly).

The American Cancer Society suggests that "the ability of astragalus to enhance the immune system and fight diseases, including cancer and heart disease, comes mostly from lab and animal studies."
It is important to understand that it cannot be assumed that effects seen in a test tube in a lab or in animals would be the same as in humans. The Cancer Society concludes that "available scientific evidence does not support claims that astragalus can prevent or cure cancer in humans or decrease the toxic effects of chemotherapy or other cancer treatments." More experiments in humans are needed to determine if there are benefits to the use of astralagus.

If you're still interested in using astragalus, speak with your physician and pharmacist first to ensure its safety. Doses found to be safe by Health Canada can be found on their 2010 Astragalus Monograph.

Information Sources:
http://nccam.nih.gov/health/astragalus
http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/astragalus
http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monoReq.do?id=36&lang=eng
http://www.ncbi.nlm.nih.gov/pubmed/24152941
http://www.ncbi.nlm.nih.gov/pubmed/22309959
http://www.ncbi.nlm.nih.gov/pubmed/21390582
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a602017.html

Pumpkin Spice Latte

As the days get a bit cooler and we get closer and closer to winter, I notice an increase in advertising for the beloved pumpkin spice latte. The latte is available not only at Starbucks now, but at many other cafes such as Second Cup. Today I thought to break things down and let you know what is really in your pumpkin spice latte, and how a few, small, changes could make a big difference!

A grande, 16oz Pumpkin Spice Latte, made with 2% milk and whipped cream contains:

• 380 calories (average person is recommended to have 2000 calories/day)
• 49 grams sugar (more than 12 tsp sugar)
• 220 mg sodium (sodium should be limited to 2300mg/day)
• 50 mg cholesterol (American Heart Association suggests that people with high LDL ("bad" cholesterol) to limit intake to 200mg/day)
• 8 grams saturated fat (recommendations from the American Heart Association are to limit saturated fat to less than 14g/day)
• 14g protein

If we take replace 2% milk with skim milk, remove the whipped cream, and switch to a tall 12oz pumpkin spice latte, the drink contains:

• 200 calories
• 37 grams sugar (more than 9 tsp sugar)
• 170 mg sodium
• 5 mg cholesterol
• 0 grams saturated fat
• 11 grams protein

Approximately 16 grams of the sugar in this 12oz beverage comes from natural lactose in milk while the remainder comes from the pumpkin spice syrup.
Each pump of syrup contains approximately 5 grams of sugar. If you are interested in managing your sugar intake, asking for 1 or 2 less pumps would decrease the sugar content another 5-10 grams.

There are many ways to control what goes into your body. Choosing a smaller beverage size, opting for skim milk, requesting less pumps of syrup, trying a flavorful full leaf tea, having a plain latte with a small amount of honey or adding cinnamon and/or nutmeg for flavor are all steps in direction of making sure your comforting drinks aren't packed with calories, sugar, and fat.
You can even play around with the cafe's websites, searching for nutritional information in order to make more informed choices the next time you're in that cafe!

Nutritional Information for Starbucks beverages and food can be found at:
http://www.starbucks.com/menu/catalog/nutrition?food=all#view_control=nutrition

Nutritional Information for Second Cup Lattes can be found at:
http://www.secondcup.com/best-latte/?nutcat=5

Information Sources:
http://www.mayoclinic.com/health/heart-healthy-diet/NU00196
http://www.starbucks.com/menu/drinks/espresso/pumpkin-spice-latte

Will PGX Solve My Problems?

I don't know how many commercials I've seen for the weight loss product PGX. So today I thought to take a look into what is in PGX and if the product itself has evidence to support its claims of weight loss and feeling full for longer.
PGX or PolyGlycoplex states that it will "change your life." It technically is a viscous fiber (polysaccharide) supplement.

One study including 10 subjects found that small quantities of this supplement before meals can decrease glycemic index of common foods (meaning that it can limit blood sugar spikes).
Another study of 64 subjects involved 32 obese Japanese participants taking 15g of PGX per day for 14 weeks, and another 32 participants taking an placebo. After 14 weeks, the PGX group showed a greater decrease in LDL (bad cholesterol) and waist circumference. However, it is difficult to say that 32 Japanese people could represent the entire population.
Finally, a third study of 35 participants was conducted over 3 days. Women were on a strict 1000calorie/day diet; one group received 5g of PGX at breakfast, lunch, and supper, while another group received a placebo. The PGX group reported decreased appetite, hunger, and desire to eat. However, the study didn't assess what would happen with this strict decrease in calories over a long period of time.

An adverse affect of overloading your body with a high quantity of fiber supplements may be symptoms of bloating, abdominal discomfort, gas, diarrhea, and/or constipation. On the other hand, if you were to use a small quantity of this supplement between meals, or before meals you may be likely to eat less because you feel more full from the fiber.

From a dietitian's perspective, I wouldn't openly recommend this product to my patients due to the lack of enough studies with large amounts of participants. However, if you really want to try PGX, your could double check with a member of your healthcare team and trial small quantities to see how you tolerate it. If you are unsure about the product, my personal recommendation would be utilize high fiber grains, vegetables, and plant sources of protein (beans, peas and legumes) to make you feel full for longer. These foods also provide additional antioxidants, vitamins, and minerals that cannot be found in a pill. If this is combined with exercise, your odds of losing weight and keeping it off go higher.

Remember, a powder, a pill, a magic drug, or a sports drink shouldn't be responsible for changing your life, you are! If you lose weight, it is because of your efforts; so be sure to recognize small, healthy, changes as successes along your path and use your healthcare team of dietitians, doctors, and friends for education and support.

Information Sources:
http://www.ncbi.nlm.nih.gov/pubmed/22017917
http://www.ncbi.nlm.nih.gov/pubmed/23512917
http://www.theglobeandmail.com/life/health-and-fitness/ask-a-health-expert/will-fibre-capsules-help-me-lose-weight/article4182609/

Vitamin B and Stroke Prevention?

Today I'm going to look into a new review that suggests that taking Vitamin B supplements may reduce risk of stroke. In the review, 14 studies were analyzed including nearly 55,000 participants who were followed for at least 6 months. Participants were separated into 2 groups, one group was given a placebo while the other was given a Vitamin B supplement. Over this time, nearly 2500 strokes occurred and a 7% reduced risk of stroke was seen in participants taking B vitamin supplements. However, no changes were seen in the severity of strokes or in risk of death from stroke in the supplemented group.
In this study it was suggested the folic acid (Vitamin B9) supplements reduced beneficial affects of Vitamin B supplementation while Vitamin B12 supplements had no affect on stroke risk.
On the other hand, a 2007 meta-analysis by Wang et al. suggests that folic acid supplementation over 36 months may help decrease stroke risk.

What to make of this information? A 6 month trial doesn't tell us how long people should take these supplements for, nor does it tell us what the results of long-term supplementation are. In addition, some studies that suggested folic acid reduces stroke risk looked at changes in an amino acid, homocysteine, to predict stroke risk. High homocysteine can indicate risk of heart disease, but reducing its levels is not currently believed to be linked to reducing risk of heart disease or stroke. Therefore, the reliability of studies only looking at changes homocysteine is unclear.

Sometimes I find it easier to go back to basics.
If you can control any of the better known risks of stroke such as smoking, high trans fat/ saturated fat diet, lack of exercise, high blood pressure, obesity and/ or high cholesterol, that may be a good starting point.

And  lets say you do your own research and find that you'd like to have more Vitamin B in your diet, take a look at the list below. Rich food sources of B Vitamins include (but are not limited to):

• Turkey, poultry, tuna, liver, beans, lentils, eggs, fish, shellfish, nuts
• Whole grains, enriched cereals
• Milk, cheese, yogurt

If choosing to take a Vitamin B supplement, be sure to check with your physician, pharmacist, and/or dietitian to find the safest dose for you!

Information Sources:
http://circ.ahajournals.org/content/106/3/388.full
http://www.sciencedirect.com/science/article/pii/S014067360760854X
http://www.nlm.nih.gov/medlineplus/news/fullstory_140788.html
http://www.healthcastle.com/nutrition101_vitaminB6.shtml
http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Homocysteine-Folic-Acid-and-Cardiovascular-Disease_UCM_305997_Article.jsp 

What is The Deal with Vitamin Water?

Many of us have considered, or currently choose to drink vitamin water instead of regular water. My own husband has a flat of it in our pantry, so today is the day I give you (and my husband) the scoop on what is in Vitamin water (this has been a long time coming).

Vitamin water falls under the "natural health product" category, therefore, a nutrition facts table is not required. Today I'm looking at Glaceau Vitamin water which states it contains 120 calories/bottle. The fluid and vitamins are not a source of calories, therefore these 120 calories likely come from sugar, suggesting that the 591mL bottle contains approximately 30 grams of sugar. 

30 grams, what does that even mean? One can of regular Coca-cola contains 39g sugar, so we're not far off from the amount of sugar in one can of coke. If quantifying the amount helps, 30g of sugar is 7.5 teaspoons of sugar (4g sugar= 1 teaspoon). Even I found this to be surprising because if you've tasted this Vitamin water, its actually kind of bland!

Now onto the vitamins. The bottle in my hands contains:

• 375 mcg RAE (Vitamin A)
• 5 mg Vitmin B3
• 2.5 mg Pantothenic acid
• 0.5 mg Vitamin B6
• 1.5 mcg Vitamin B12
• 150 mg Vitamin C
• 3.4 mg Vitamin E
• 100 mg Calcium
• 100 mcg Folate

Now lets look at how much of these vitamins and minerals we need in a day.

Health Canada's Daily Recommended Dietary Allowance of these vitamins and minerals for the typical adult age 19-50 is:

• Vitamin A-   700-900 mcg RAE
• Vitamin B3-   14-16 mg
• Panthothenic Acid-   5 mg
• Vitamin B6-   1.3-1.7 mg
• Vitamin B12-   2.4 mcg
• Vitamin C-   75-90 mg
• Vitamin E-   15 mg
• Calcium-   1000 mg
• Folate-   400 mcg

So what does this tell us? Yes, vitamin water contains vitamins, however, it also contains sugar, artificial colour, natural flavours whose source and contents are unknown, and other additives. An interesting point was that on the bottle I was analyzing, it also stated "made for coca-cola refreshments canada company."

In my professional opinion, if a vitamin "boost" is what you're looking for, then taking a daily multivitamin may be a better idea. The best option would be to simply eat the foods that contain many of these minerals and vitamins, as drinking this vitamin water would not provide the fibre natural food sources would contain. 

Water or milk may be better beverage options, but as long as you understand what is in what you're drinking, the choice is up to you. Remember, any foods or drinks can fit into a diet, the key is always how much and how often!

Information Sources:

http://www.healthcastle.com/water-vitamins-or-just-plain-liquid-calories

http://www.hc-sc.gc.ca/fn-an/alt_formats/hpfb-dgpsa/pdf/nutrition/dri_tables-eng.pdf

Update

After a whirlwind 6-8 months I'm finally back! Needless to say the last few months of my life have been extremely fast paced and exciting. Traveling through Europe, attending a wonderful friend's wedding in Hawaii and organizing and having my own wedding and moving to another province have all come and gone. Now back to sharing what I know and learn, and turning the focus back to food, nutrition, health, and positivity.

Evening Primrose Oil

Yesterday I had a patient who was taking evening primrose oil each day for leg weakness. Standing in front of this patient I wondered about the evidence behind the use of this supplement, so here we are, time to look at some scientific evidence!
Many people use evening primrose oil for treatment of scaly itchy rashes (atopic dermatitis), rheumatoid arthritis, and for relief of menopausal and premenstrual symptoms.
A Cochrane review published in 2012 showed that dietary supplements such as Vitamin D, primrose oil, hempseed oil, and sea buckthorn oil had no benefits in patient with eczema.
Studies that looked at using primrose oil for menopausal and premenstrual symptoms appear to show negligible results similar to participants who had been given a placebo.
A 2011 Cochrane review suggested that there was moderate evidence to support the use of oils containing gamma linoleic acid (in evening primrose, borage, or blackcurrant seed oil) in relieving symptoms of rheumatoid arthritis. However, the review also mentioned that further investigations into how effective these oils are and their side effects are warranted.

My 2 cents? Health Canada's review of evening primrose oil states that it is safe to consume 1300-1600mg/ day "for maintenance of good health." If your dose falls within these safe guidelines and you feel a benefit from its use, I'd suggest that it's likely safe to continue using it unless otherwise recommended by your health care providers.

Information Sources
http://www.ncbi.nlm.nih.gov/pubmed/22336810
http://www.ncbi.nlm.nih.gov/pubmed/22139538
http://www.ncbi.nlm.nih.gov/pubmed/21328257
Evening Primrose Oil Health Canada Monograph

Artificial Colors?

Even as a dietitian, food additives can confuse me. I often have patients who avoid foods that contain artificial colors. So what's the fuss, why are people avoiding this ingredient? The first thing to consider is processed food, and what type of foods are a part of your diet. If you eat a lot of packaged or pre-prepared meals, you're likely consuming a large amount of preservatives and additives. Often times, the scientific community is still unclear on how some of these additives affect our bodily functions

Artificial colors can be found in foods such as juices, soda, candy, condiments, icing, baked goods, cookies, cereals, yogurts, soups and even in some medications. Some are concerned that artificial colors have been linked to attention deficit hyperactivity disorder (ADHD) in children and allergic reactions.While others argue that the evidence supporting negative claims behind artificial colors is insufficient. The 2010 Food and Drug Association report stated that exposure to food additives and artificial colors may be associated with adverse behaviors in "susceptible" children with other behavior problems. However, to determine which child is "susceptible" and which is not is a whole other debate. Additionally, a 2011 study in the Journal of Clinical Pediatrics stated that a sub-group of children show significant symptom improvement when consuming a diet free of artificial colors

So whats the conclusion? The debate is still going! If your child is consuming common foods with no trouble, restricting their diet "just because" may not be the answer. However if you notice significant behavior changes with foods that contain artificial colors, a trial restriction of  artificial colors with the guidance of a physician or dietitian may be warranted in children who haven't responded to conventional treatments.

Information Sources
http://cpj.sagepub.com/content/50/4/279.short
http://www.huffingtonpost.ca/lisa-tsakos/artificial-food-colours-labels_b_1281843.html
http://www.healthcastle.com/which-food-additives-avoid
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261946/
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/FoodAdvisoryCommittee/UCM248113.pdf
http://www.ncbi.nlm.nih.gov/pubmed/21127082

HealthTip: What to do About Gout?

If you are suffering from gout, the following suggestions may help limit painful gout attacks:

• If you are overweight, work with your friends, family, doctor and dietitian to try to reach a healthier weight.
• Drink 8-12 cups of fluid throughout the day to help flush uric acid out of the body and limit crystallization in joints.
• Pay attention to your meat, fish, and poultry intake. These foods are high in purines and decreasing portion sizes may help limit the amount of uric acid in the blood. Beans, peas, lentils, tofu, nuts, seeds, and low-fat dairy are other sources of protein that you may want to add to your diet.
• Pay attention to saturated fat. Saturated fat may decrease the body's ability to eliminate uric acid. Try choosing foods with lower amounts of saturated and trans fat and higher amounts of mono- or poly-unsaturated fat ...check out the nutrition label!
• Limiting or avoiding alcohol, especially beer, may limit gout attacks, as alcohol interferes with elimination of uric acid from the body.
• Fructose is a sugar that may increase uric acid. Read food labels to see if your juices, candies, or treats are sweetened with high-fructose corn syrup.
• Some studies suggest that low-fat dairy may decrease risk of gout. Try adding skim or 1% milk, yogurt, or low-fat cheese to your diet.
• Whole grains high in fiber, vegetables, and fruits add variety at meal time and may limit foods high in purines.

In a nutshell, these recommendations are very similar to the recommendations of a healthy diet rich in whole grains, low-fat dairy, vegetables, fruit, and protein from plant and animal sources. These changes would likely not be a replacement for prescribed medications in those with severe gout, but they may help limit the frequency and severity of gout attacks. Speak with your doctor and dietitian about what changes you can make on your own!

Information Sources
http://www.mayoclinic.com/health/gout-diet/MY01137
www.mayoclinic.com/health/gout/DS00090
http://www.nejm.org/doi/full/10.1056/NEJMoa035700

HealthTip: What Is Gout?

Gout is an complex form of arthritis which involves sudden, severe attacks of pain, redness and tenderness in joints, often in the big toe.  It occurs when high levels of uric acid in the blood accumulate and form crystals around a joint. The body produces uric acid when it breaks down purines. Purines can be found in common foods such as meats (especially organ meats), anchovies, herring, asparagus, sardines, mushrooms, and beer. A 2004 study from the New England Journal of Medicine suggested that higher consumption of meat and seafood was associated with increased risk of gout, while a high intake of dairy was associated with a decreased risk of gout. The study also suggested that high intake of purine-rich vegetables did not increase the risk of developing gout. Other studies find that those who are overweight or obese are also at increased risk.
If you suffer from gout, speak with your family physician about what diet changes and medications may be right for you. For more information on small changes you can make to help with gout attacks see my following post.

Information Sources
http://www.mayoclinic.com/health/gout-diet/MY01137
www.mayoclinic.com/health/gout/DS00090
http://www.nejm.org/doi/full/10.1056/NEJMoa035700