How Much Fluid Do We Really Need?

During these “dog days of summer” one wonders how much water is enough.

As you may have guessed, water needs will vary depending on the temperature, humidity, how much you weigh, as well as exercise intensity and duration.  During hot and humid weather, or when physically working hard in a hot environment, it is easy to become dehydrated. If dehydration isn’t corrected, it is possible to get a heat stroke, which requires immediate treatment by a medical provider to bring body temperature down.  Symptoms of a heat stroke can include nausea, vomiting, flushed or reddened skin, rapid breathing and heart rate, headache, changes in sweating or mental state or behavior, and a body temperature of 104 degrees or above. Even mild dehydration can make you feel tired and can drain your energy.

Keeping in mind fluid needs will vary from person to person and with environmental changes, the National Academy of Sciences determined that an adequate daily fluid intake with average temperatures, is 12.4 cups per day for men and just over 9 cups per day for women.  This intake does not include what is consumed through fruits or vegetables, which normally accounts for 20% of a person’s intake.  All fluid sources can contribute, though water is best as it is readily available, calorie-free, and inexpensive.

Some signs to gauge whether one’s fluid intake are adequate, according to the Mayo Clinic:

  1. Color of the urine. It should be colorless or light yellow.

  2. Whether thirst is present.

Vitamin D And Our Health

Vitamins are needed to keep the body running properly.  Some are needed in small, others in larger quantities. Some are fat soluble and some water soluble. Let’s talk about a fat soluble vitamin—D. Vitamin D is stored in fatty body tissues.

Q:  Why do we need it:

A:  Vitamin D is important for calcium absorption, building and maintain strong bones, maintaining our immune system and decreasing inflammation in the body.  There have been promising study results using vitamin D against colon cancer.

Q: What foods contain Vitamin D?

A: Best food sources are: * Mushrooms, exposed to UV light * Salmon = 3 ounces* Cod liver oil= 1 teaspoon*Tuna Fish canned in oil= 3 ounces *Halibut= 3 ounces*Milk fortified with Vitamin D= 1 cup* Soymilk fortified with Vitamin D= 1 cup*Yogurt nonfat, fortified with Vitamin D = 1 cup * Ready to eat Cereals, fortified with Vitamin D= 1 ounces.

Q: How Much Do We Need?

A:   Recommended Dietary Allowances

Ages 1- 70 years of age= 600 IU    Over 70 years of age= 800 IU

NOTE:  600 IU may also be expressed as 15 mcg and  40 IU=1 mcg

Q: Can we get too much?

A: We know it is possible to consume toxic amounts of vitamin D through supplements but highly unlikely through normal food intakes or even when exposed to excessive amounts of sunlight which, when it hits the skin, causes a production of vitamin D.

What are the Current Heart Healthy Exercise Guidelines?

Heart disease is still the #1 cause of death for men and women in our country, taking 610,000 lives or 1 out of 4 lives, each year.

Regular physical activity is essential for good heart health, including blood pressure and blood lipids.  The American Heart Association recommends aiming for 150 minutes of moderate-intensity aerobic physical activity per week with not more than 2 days between exercise (ex: 30 minutes./day for at least 5 days/week.). Check with your physician if you have any questions or have not exercised regularly for some time.  At least twice a week, strength training is recommended to work all major muscle groups.

Though not an exercise for cardiovascular fitness, the American Diabetes Association also recommends flexibility and balance exercise, as well as strength training, at least a few times per week.  All forms of exercise can result in improved blood sugar or glucose levels, which, in itself, can reduce risk for heart disease. When your blood sugar is high, your cholesterol levels increase.

The American Diabetes Association website, has written descriptions of recommended exercise for strength, flexibility, balance, and aerobic exercise.  Look under “Food and Fitness” for practical ways to stay active without undertaking a formal exercise program.

Keeping Our Hearts Healthy

February is “Heart Month” so reviewing tips on keeping heart-healthy may prevent or minimize damage from heart attacks (the biggest cause of death in our country) and strokes.

  1. Know the symptoms of heart attacks (nausea, pain or discomfort in chest and arm) and strokes (leg or arm numbness or weakness, slurred speech, dizziness, fatigue) can be a start.   Taking action quickly if these suspicious symptoms occur by calling your doctor or going to Urgent Care within 24 hours, can be the difference between life and death or disability.

  2. Know your levels of blood pressure, cholesterol, blood sugar, and weight and how they trend from year to year to allow you to see if your risk for vessel disease is increasing, staying the same, or decreasing.  Check with your healthcare provider for your recommended levels, as this can vary based on other risk factors.

  3. Eat a heart-healthy diet and stay physically active, checking with your doctor for recommended level of physical activity.

Future blogs will be devoted to the dietary habits and exercise recommendations that can reduce the risk of cardiovascular disease.

I Hereby Resolve To...

Are you resolving to be healthier this year but are paralyzed by fear because resolutions have not worked for you in the past?  Chances are you may have set unrealistic expectations for yourself, such as “I resolve to omit sweets entirely from my diet” then find, after a few weeks, it was just too difficult to avoid them entirely.

Take time to consider what you really want to change and what it will take to get there.  As an example, if you want to be more active but have not exercised since you can’t remember when, think what baby steps you can take to be more active.  This might mean starting to walk, not setting a time goal at the beginning but just getting up and doing it a few times a week. Or, if you want to lose some weight, will that involve reducing soda intake or making snacks healthier or controlling portion sizes or getting others in your household to bring in healthier foods or to store unhealthy snacks out of sight?  Having a support system is always helpful in promoting change, whether it is a walking partner who helps you keep faithful to your plan or someone who encourages you to make healthier food choices or a friend you check in with periodically to compare progress.

Also having a means of monitoring your progress such as a simple calendar on which you mark the days you have walked can help show you that you are making positive changes or keeping a daily food diary to be more aware of your food intake.  It may take up to 18 months to establish a new habit so be patient with yourself and give yourself credit for making small, positive changes. You will be surprised, over the course of the year, how much you will have accomplished and how good that will make you feel.

For ideas and professional encouragement to develop positive eating and exercise habits, please give me, Diane Machcinski, M.Ed.,RD, a call at 858-279-5124.  I listen to your priorities, find out your eating patterns and help you develop a realistic plan.

Armed with a few simple, but concrete changes, lasting change can occur, over time, as progress and motivation build.

What Does It Take To Lose Weight And Keep It Off?

For many individuals who have lost weight, keeping the weight from coming back can be even more challenging than losing the weight in the first place.

There is a National Weight Control Registry composed of 5,000 individuals who have lost an average of 66 lbs. and have kept if off for at least 5 years.  Here are some things the majority are doing to keep the weight off:

  • 78% eat breakfast daily (Helps boost metabolism and generally curbs heavier intake or snacking later in the day)

  • 75% weigh themselves at least once a week (Allows them to reverse any weight gain before it becomes overwhelming)

  • 62% watch less than 10 hrs. of TV per week (If a person is not watching TV, there is a good chance that the person is moving more)

  • 90% exercise, on average, 1 hr./day (This amount of exercise may not be necessary for all to lose weight but is what the registry participants have averaged.)

Though a variety of methods were used to keep the weight off, if you are having a tough time losing weight or keeping it off, you may want to look at your current routine and consider incorporating changes that those on the registry have been making to keep the weight off.

Should I Take Supplements?

Based on hundreds of scientific studies, the recommendation is to use a dietary supplement only if a nutrient is lacking in your diet.1

Numerous studies have demonstrated more harm than benefit from taking excessive supplements.  Here are a few examples:

In two major vitamin E lung cancer studies, the studies were stopped as individuals with lung cancer or lung disease got worse with the use of vitamin E supplements.

High doses of calcium worsened existing prostate cancer in another study.

Aspirin, vitamin E, and fish oils all keep the blood from clotting readily, so taken at high doses or taking all together, can be dangerous, especially if someone is already on a medication to thin the blood.

Further, there can be interactions with drugs a person may already be taking.  It is important to consult with your doctor, pharmacist, and registered dietitian  before investing in a supplement that may pose harm.

Consuming a well balanced diet full of colorful and flavorful fruits and vegetables, whole grains, lean protein sources and dairy, is still at the heart of a healthy diet, without posing the risk of a toxic overdose.


1 The American Cancer Society, American Institute for Cancer Research, as well as the US Dietary Guidelines Committee 2015-2020.

Send the Kids Off With A Safe Lunch

According to the Centers for Disease Control, 1 in 6 Americans suffer a foodborne illness each year.   Much of this is preventable. To insure packed lunches can be safely consumed, attention to proper food preparation and storage are essential.   When packing lunches, it is important to not only wash hands before handling food but also to keep knives and cutting surfaces washed thoroughly with soap and hot water between uses and not just “dusted off” of crumbs and meat.  I have 2 cutting boards, one for meat, and one for vegetables and fruits. Keeping each separate can prevent raw meat juices transferring to fresh vegetables and fruits which can cause illness.

Bacteria rapidly multiply between 40-140 degrees Fahrenheit, so it is important to keep cold foods as cold as possible and hot foods hot.  If food is not refrigerated or kept to a proper temperature, consume within 2-3 hours to prevent food borne illness and its symptoms (abdominal cramps, diarrhea, nausea and vomiting, the most common).  Also, if protein-containing foods have been in the refrigerator for more than a few days or have reached their expiration date, it is best to discard them, rather than to send them in a lunch when bacteria may already have reached unsafe levels.

When packing cold foods such as sandwiches, lunchmeats, or cheese, it is advisable to pack them in a hard-sided plastic container and then “sandwich” that container between blue ice, wrap securely in a small plastic produce bag and rubber band it before putting into a small insulated lunch bag to insure the cold foods stay cold.  Wrapping food tightly in a lunch bag may help keep the blue ice in place, especially if it needs to be in a backpack with books.

When packing soups or stews for lunch, keep them cold until ready to reheat.  This will avoid bacteria from flourishing, and then reheat thoroughly before eating.  If hot foods or soup is packed into a thermos, be sure to preheat the thermos by pouring boiling water into it and draining it out, before adding the hot food, so as to keep the food hotter and at a safer temperature.

Taking just a few minutes to handle and pack food properly can make a huge difference in temperature and food safety and may prevent food borne illness from occurring.

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Low Calorie Sweeteners - Are They Safe?

Many people suspect that the low calorie sweeteners are less healthy for the body than sugar or other natural sweeteners but extensive scientific research of more than 100 human and animal studies, has not shown a clear relationship between the low calorie sweeteners and a detrimental effect on health nor increased body weight, preference for sweet taste nor sweetness sensitivity.  In fact, when low calorie sweeteners were used in place of sugar, it helped to reduce calorie intake and body weight.

On the other hand, excess sugars or natural sweeteners, have been associated not only with obesity, but also heart disease, high blood pressure, and stroke in a number of studies.

So perhaps it would be wise to find ways to reduce our overall use of sugars, whether using water or tea or coffee in place of sugar-sweetened beverages, using tasty fresh fruit more often in place of sweetened desserts, and not fear using FDA-approved low calorie sweeteners (acesulfame K—Sunett, Sweet One; advantame—most recently approved; aspartame—Equal, Nutrasweet; neotame—Newtame; saccharin– Sweet and Low, Sugar Twin;  Siraitia grosvenoril swingle (SGFE) or Luo Han Guo—Nectresse, Pure Lo, Monkfruit in the Raw; sucralose—Splenda; and stevia or Truvia, Sweet Leaf, PureVia, Enliten) in moderation.

Is There an Association Between Body Fat and Cancer Risk?

According to the American Institute for Cancer Research (AICR), excess body fat is a cause of approximately 132,800 U.S. cancer cases every year.  There is significant research evidence that excess body fat increases the risk for 11 cancers, most notably, cancers of the esophagus, kidney, colon, rectum, breast, pancreas, and endometrium.  There is also sufficient evidence of increased risk for cancers of the liver, stomach, gall bladder, and ovaries associated with excess weight, according to the AICR.

The mechanism of this increased risk is attributed to the excess body fat triggering increased estrogen production which increases cell production.  Increased cell production, as experienced by those especially with an “apple” shape or a waist circumference that exceeds that of the hips, means a greater likelihood that cancers can develop and grow.

Excess body fat can also trigger an inflammatory response in the body.

So, to reduce body fat and cancers associated with it, the AICR recommends:

  • Avoid sugar drinks and limit intake of calorie-dense foods.

  • Eat more of a variety of vegetables, fruits, whole grains, and legumes such as beans

  • Exercise at least 30 minutes/day which, even in normal weight individuals, can help to reduce the likelihood of developing certain cancers

What Are The Latest Exercise Recommendations?

It is customary to ask a person if he/she got their exercise session in for the day.  In the future it may be, how much time have you spent on your feet. A recent study of people with Type 2 diabetes is causing us to question the notion that the duration and intensity of exercise are sufficient to assess whether a person has had enough exercise.  When the group of study subjects were on their feet more (walking 2 hrs and standing 3 hrs per day broken up over the course of the day) they reduced their blood sugars 36 per cent more in a 24-hour period than when they only stood 1 hr. and walked 1 hr. They also decreased their insulin resistance over a 24 hr. period more than when they biked for 65 minutes all at one time.  Turned out that when biking, the group was sitting more overall, than when the group was walking/standing for the total of 5 hrs.

The conclusion is not to give up the cardiovascular activity which, in the study improved glucose levels as did the walking/standing group, but consider ways of reducing overall sitting time, since the walking/standing group also experienced less insulin resistance, so overall better glycemic control.  This study involved people who have diabetes but could, if confirmed by other studies, help reduce the development of type 2 diabetes, since insulin resistance is a large factor in the development of type 2 diabetes.

So, the challenge is to find ways to build more activity into our routine, whether it be standing when talking on the phone or getting up every 30 minutes from a sitting position, as the study group did, to walk or to do a few exercises, taking stairs instead of elevator, parking farther away, etc.   We are all likely to benefit from less sitting time, whether it be improved bone density, joint mobility, cardiovascular benefits (blood pressure), body fat, better sleep, or even just from an improved sense of well-being.

2015 Dietary Guidelines for Sugar

The latest guidelines for Americans, recommends limiting added sugars to 10% of calories.  For an average adult who needs 1800-2200 calories, this is 11-14 teaspoons of added sugar per day.  Keep in mind, that “added sugar” does not apply to foods high in natural sugar such as milk, yogurt, bread, unsweetened cereal, rice, beans, all  vegetables and unsweetened fruit. Added sugars. or “empty calories” which have no nutritional value contributes to extra calories and extra weight which can  put us at risk for diabetes and heart disease. A 12 ounce can of soda has 9-12 teaspoons of sugar.

We consume about half of  our calories from added sugars from sodas, juice drinks, flavored coffees and teas and pastries and candies. Here are some practical recommendations to begin reducing your sugar intake:  Drink water in place of sugary drinks. Don’t like plain water? Add some flavor, by putting a few cucumber slices, lemon slices or a few strawberries in your water. Buy a “fun size” or regular candy bar instead of the large bar or the entire package of candy.  At the office or at home, keep fresh fruit or natural fruit cups, baby carrots, prepackaged natural peanuts, and single serving raisins in your desk drawer or on the counter at home. Craving ice cream? Go out to purchase one cone or better yet, buy your ice cream in a cup.

A healthy diet consists of a variety of protein, fats and carbohydrates for essential nutrients to fuel our bodies. This will help keep your calories in a reasonable range to manage your weight.  The Dietary guidelines were developed by the Department of Health and Human Services and USDA health and nutrition experts after reviewing scientific information.

Are You at Risk to Develop Diabetes?

Many people think unless they have symptoms of diabetes such as excessive thirst, frequent urination, blurred vision, or pain and/or numbness in their feet or hands, they will not develop complications. What is just as important to know is blood sugars can be high without any of the usual symptoms of diabetes and can be doing harm to your vessels in the eye, kidney, heart, or damage nerves leading to the feet or hands, without a person knowing it is happening. According to the California Department of Public Health, in California, approximately 1.5 million or 5% of our adult population has diabetes but doesn’t know it.

Are you aware of the risk factors for diabetes?

  1. Age 40 or older

  2. Immediate family member with diabetes

  3. Being  obese ( generally 30-40 pounds or more about ideal weight)

  4. Had diabetes during pregnancy

  5. Being Male

  6. Being diagnosed with high blood pressure

  7. Being physically inactive

If you have 2 or more or the above risk factors, check with your doctor to see if additional testing is needed. Prevention is the key. With awareness and some simple lifestyle changes, diabetes can be controlled and one’s quality of life can be maintained or improved.  Developing complications can often be minimized or avoided, if detected and acted upon early.

What is Prediabetes?

Prediabetes is a condition identified by a blood test your doctor orders.  Many people find out through a routine physical. If your doctor tells you your blood glucose values are higher than normal, but not high enough to be diagnosed as having diabetes.   It can be diagnosed by 3 different blood tests in the laboratory–fasting glucose test in which someone has not eaten for at least 8 hours, a 2 hour (75 gram) glucose test when you are asked to drink a sugary solution and then a blood is taken to see how your body handles a load of “sugar”, or an A1C or estimated average glucose test which does not have to be performed in a fasting state and reflects the average glucose levels over a 3 month period.

Test                                     Normal           Prediabetes  Diabetes

Fasting                                <100 mg/dl              100-125 mg/dl          >125 mg/dl

2 hour (75 g) glucose            <140mg/dl                140-200 mg/dl         >200 mg/dl

A1C(est. Ave. Glucose)        <5.7%                       5.7-6.4%                 >6.4%

Coconut Oil–Good or Bad?

Coconut oil is made from coconut milk or dried coconut meat. It is used in a variety of settings, including cooking, skin care, and even as an alternative fuel source, just to list a few. It has been a staple in tropical regions of the world for thousands of years. Dietitians have known and used coconut oil for some time now since it has been used medically in individuals with compromised fat digestion or sensitive gastrointestinal tracts. It usually comes in a jar and it is commonly hardened, or as a solid. It quickly changes into liquid form (oil) when heat is applied. Coconut oil, as with coconut milk, contains saturated fat, so a moderate intake of coconut oil is recommended. As consumers, look for virgin coconut oil which contains a type of saturated fat that raises both good and bad cholesterol levels. So overall we recommend moderation when consuming this oil while looking for ‘virgin’ on the label.

Coconut Milk–Is It Something You Want to Give Your Children?

Coconut milk and coconut milk-made products like yogurt or ice creams are also very popular among vegetarians and  individuals with a cow’s milk allergy or dairy intolerance. Coconut milk is made by grating the meat of the coconut and  collecting the liquid. Coconut milk is high in saturated fat and is an ingredient in many Southeast Asia (Thailand, Malaysia, Indonesia, Singapore, and Philippines) recipes and many cuisines. Let’s remember that saturated fat is a type of fat that raises the level of total cholesterol in the blood, also containing higher calories, so moderation is key.

When dealing with children, parents who prefer coconut milk rather than cow’s milk for their children should realize that cow’s milk contains various vitamins and minerals that are essential for a child’s growth and development. Coconut milk’s is not a substitute for cow’s milk, it is lower in protein, calcium and other nutrients found in dairy milk, that could lead to nutrient deficiencies. As well, the effects of a too much coconut milk in a child is unknown. If children do consume coconut milk, they should also add other foods and beverages to their diet to complement the lack of specific nutrients.