WebMD Live Events Transcript
These days it's easy to find nutrition information, in best-selling books, on the Internet, and even on fast food menus. The hard part is digesting all those food facts and finding out what's truly healthy. Dietitian Elena Carbone joined us on March 25, 2004 to ease our caloric confusion.
The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Welcome, Dr. Carbone. With the arrival of spring so many of us want to adopt a healthier lifestyle -- especially when it comes to what we eat. However, there is so much information out there, we aren't sure what is fact and what is fiction (i.e. marketing). Can you help us?
Really focusing on some basic information, you may want to start with self-evaluation, doing an assessment of your usual intake. That might mean keeping a food diary, keeping track of how much you eat, when you eat it, and also the mood you're in when you eat it.
In addition, physical activity is key. That doesn't mean having to go to the gym or running; it can mean your usual activity pattern, including shopping, walking, gardening -- activities of daily living.
Once you've evaluated yourself and identified your problem areas, some of the things to think about are aiming for a healthy weight, being realistic, building a healthy base by eating vegetables, fruits, and grains, choosing sensible portion sizes, and being just as sensible about physical activity, starting slowly and being realistic.
|"The bottom line is to be sensible and realistic; set small goals for yourself; realize that weight gain did not happen overnight, so it's not going to come off overnight... "|
Sensible is a nice word, but how do we know how much fiber, how much protein, etc. is sensible?
There are specific guidelines to determine what is sensible. For example, for adults under age 50 there are specific guidelines for fiber. For men it would 38 grams, for women, 25 grams. For adults over 50, for men it would be 30 grams, for women 21 grams. What are grams and what does all that mean? On the food label you'll see the grams of fiber, so you can use that help guide your intake.
Be careful of eating too much fiber too fast, or adding too much fiber too fast. As with everything, start slowly, and be sure to drink plenty of fluids when you're increasing your fiber intake. Look for things like:
- Whole grains
- Whole wheat
- Brown rice
You asked about the other nutrients. What we can look at in the big picture is balancing carbohydrate, fat, and protein. Those are called the macronutrients.
- Carbohydrates: Although there's been a lot of talk about reducing carbohydrate intake with these low-carbohydrate diets, they're still very important for a balanced diet. So you want to aim for about half of your calories from carbohydrate, 45% to 65%, and that means between six and 11 servings of grains and grain products per day.
- Protein: For protein, you want to aim for between 10% and 35% of your total calories. Protein can come from meats and eggs and nuts, and you want to aim for two to three servings a day, focusing on lean meats. There's also some protein in other food groups, for example in the dairy group, and again you want to focus on the lean and low-fat version of these.
- Fat: The remainder, the remaining 25% to 30% of your calories, can come from fat, being sure to focus mostly on the lower-saturated fats. So, for example, you ought to focus more on the vegetable oils as opposed to the higher-saturated fats that would come from coconut oil or lard, palm oil, that sort of thing.
Now, these are general guidelines; a lot depends on your physical activity level. The bottom line is to be sensible and realistic; set small goals for yourself; realize that weight gain did not happen overnight, so it's not going to come off overnight, and think of this as a long-term process to change a lifestyle, as opposed to a short-term, quick-fix weight-loss diet.
I've read South Beach. It is written by a medical doctor with good credentials, the same with Dr. Ornish, and the same with several other diet doctors. And then there is Dr. Atkins. How do I know which doctor is right?
There is lots of confusion with all of the diets out there. One thing to keep in mind is if anything promises a quick fix, be wary. Now, many of these diets are based upon some truths. In addition, people will experience weight loss quickly to start with. A lot of this is as a result of water loss, and it can be also overall reduction in calorie intake that's very severe that will lead to a weight loss initially.
The problems: First of all many of these diets don't focus on behavior and lifestyle changes. Some of my favorite fad diets I've heard about are the grapefruit diet, eating by your blood type, or eating by your astrological sign. All of these catch people's attention, but over the long run, think about if it's a diet that includes foods from all of the food groups -- fruits, vegetables, dairy products, etc.
The other question is in terms of analyzing the diets is are they requiring you to purchase a lot of their products and specialized foods? That's something to keep in mind.
|"Right now, the general guidelines from the American Dietetic Association and other national organizations still recommend that fat intake be controlled, especially saturated fats and trans fat, to reduce the risk of heart disease, some types of cancer, etc."|
One more thing to add that's very important with these low-carb diets: We don't have long-term data or evidence that suggests that these are healthy over the long-term. What we do know, however, is that they can cause some problems, especially if they're restricting specific types of foods, and low-carb diets can cause ketosis, which, over the short-term and long-term, can be problematic, including development of kidney stones or gout.
For example, the low-carb diets tend to be high in protein and fat, which can increase your risk over the long-term of heart disease and even sometimes cancer. So the bottom line is, look between the lines. Read carefully and just because it has a physician's name attached to it doesn't necessarily mean it's right for you. You need to weigh the benefits and the potential risks, and if you have questions you can talk to a dietician.
It seems the medical community is changing its collective mind about what causes heart attacks. It's not necessarily clogged arteries, according to an article I read this week, and raising good cholesterol may not be so important. Does this mean watching how much fat you eat will be less of a concern for heart heath in the future? I'm confused.
New research is coming in all the time. We continue to learn new things and develop new insight about diseases. That's both the good news and the bad news. The good news is we're always learning, but the bad news is it gets very confusing. Right now, the general guidelines from the American Dietetic Association and other national organizations still recommend that fat intake be controlled, especially saturated fats and trans fat, to reduce the risk of heart disease, some types of cancer, etc.
Where can I find information on what foods are high in protein?
The U.S. Department of Agriculture (USDA) has information about nutrient content of different foods at www.usda.gov/cnpp/. The American Dietetic Association also has information at www.eatright.org. And many basic nutrition related textbooks or brochures from these organizations can provide this information. For both of these, they provide good general nutrition information, and at the ADA site you can find a nutrition professional in your area.
I try to read labels, but just when I think I understand what I am reading, something new will pop up. What are "net carbs?" What does it mean when it says a product is "natural?" Does "free-range" mean it is healthier meat and poultry? I know there is a real legal definition of "organic" but am not sure about so many of these other descriptions.
|"Fat is needed in the diet as a source of energy. It's also needed to support fat-soluble vitamins."|
There are definitions for some of the terms; for others, there are not. Net carbs refers to the total carbohydrates, including both simple and complex. Simple carbohydrates refer to, for example, refined sugars. Complex carbohydrates refer to, for example whole grains and fiber.
I think terms such as natural and organic are becoming more and more prevalent. Many food companies are trying to promote the healthful benefits of their food products. As more of these terms are used, there's more consumer demand to define them.
In addition, when health claims are made in relation to certain foods or terms, for example if a food is labeled "to reduce the risk of cancer or heart disease or osteoporosis," then that must be approved by the federal government. In other words, specific health claims cannot be made without approval of the government. So the Food and Drug Administration is one of the organizations at the federal level that works to define these terms for the public.
Keep reading those labels!
Yes. Fat is needed in the diet as a source of energy. It's also needed to support fat-soluble vitamins. These include vitamin A, vitamin D, vitamin E, and vitamin K. Each of these vitamins have specific and crucial roles in the body, regulating organ function, cell growth, acting as an antioxidant, and promoting blood clotting, for example. So, yes, the body does need fat in order to survive and maintain a healthy balance.
Earlier you mentioned keeping a food journal. Any tips on how to do that?
Food journals don't have to be anything fancy. The most important thing is that they work for you. For example, it might be helpful to keep a small pad of paper with you in your purse, in your backpack, even next to your bed, to write down when you're eating it, the foods that you're eating, the amount that you're eating, as I mentioned before, the mood you're in, how you're feeling when you're eating it.
It might also be helpful to write down the time of day, because it can be very revealing and provide you with insight about your own dietary habits. Many of us don't think about all that we put into our mouths during the day, and this is one way to help us become more aware.
Once I have kept track of what I am eating and how much I am eating, how do I translate that into a healthier eating plan?
|"Different things work for different people, but one thing many people find helpful is to find a friend or a support system to work with."|
Oftentimes I would suggest that people talk to a dietician to help them with the next steps. If that's not possible or feasible, what you can do is really look at the information you've collected. And by the way, don't just collect it for one or two days; I would suggest you collect the information for at least three days, including both weekdays and weekends, because many of us eat differently during the week than we do during the weekends.
Really look at the information and see what stands out for you. Are there a lot more chips than you thought? Is there a lot of soda? Perhaps there are snack foods or fried foods that individually may not seem like very much, but when you look at it as a whole and see a pattern that might be very revealing and identify a place where perhaps you can start making some modifications.
I don't want you to focus on the negatives; focus on how you are doing with fruits, vegetables, with lean meats, low-fat dairy products, and you can also include physical activity, as well. Use this information to identify both your strengths and areas that you can target for improvement.
It can be very helpful to talk to a dietician to get you started, to work out a plan of action, and once you've worked out a plan, it has to be a plan that works for you. Different things work for different people, but one thing many people find helpful is to find a friend or a support system to work with. That can be a coworker; it can be a member of your family; it can be anyone who can work with you to help you support healthful behavior changes.
How can we apply a plan that works for the entire family? I am responsible for meals for my family and don't want to be the food police for everyone, but I don't want to make separate meals for everyone.
This is always a challenge. One suggestion is to get children involved in the food planning, shopping, and preparation so they're more invested, if you will.
Another thing to think about is modular foods, meaning, for example, having healthy dinner that consists of making tacos or burritos, or making a pizza, meals that the children can add to whatever they want. You may have some members of your family that don't eat a lot of meat. They can make an individual pizza with lots of fresh vegetables, and if another member of your family prefers to have meat he or she can add low-fat meat, whether it's lean beef or even turkey bacon or some of the other leaner cuts, or chicken. This is just one example of having a meal that can be tailored to the individual food preferences of your family members.
Can taking pictures of all things that you eat help in identifying where to make modifications?
If it works for you. This method of taking pictures can certainly make a person more aware of what he or she is choosing and eating. It may not always be easy to do this, but again, if it works for you that can be very helpful. A challenge might be in identifying portion sizes when you take pictures, so you still may need to keep track of some of the more specific information that may not be captured in an individual image.
It's very important. Here are some suggestions to estimate portion size, using something we all bring with us -- our hand:
- A teaspoon can be the first knuckle of your finger.
- A tablespoon is up to about the first knuckle of your thumb.
- The whole thumb is about equivalent to an ounce.
- The palm of your hand is equivalent to about two to three ounces.
A fist is about equivalent to a cup.
|"Focus on lifestyle and behavior changes that you can make that are right for you and that you can incorporate as part of your life for the long- term."|
It is very important when reading food labels to look at what they are calling a single portion. I recently was reading a pickle label and discovered that they called half of a pickle "one portion."
Before we wrap up for today, do you have any final comments for us, Dr. Carbone?
I think that there is a lot of information out there, which, as I mentioned before, can be both a good thing and a bad thing. People do get access to a lot more information, but it can be confusing. Focus on a couple of key points:
- If something is promoting itself as a quick fix, be wary.
- If you have some reservations about information that you're reading, ask a dietician or health care professional.
- Always work with the idea of moderation and balance.
- And finally, be true to yourself. Focus on lifestyle and behavior changes that you can make that are right for you and that you can incorporate as part of your life for the long- term.
Thanks to Elena Carbone, DrPH, RD, LDNs, for sharing her expertise with us. And thanks to you, members for your great questions.
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