Calories in = Calories out? Factor Affecting the Energy Balance Equation

When I first started my career as a cardiac dietitian, I memorized the Harris Benedict equation, which is a long mathematical equation for calculating the resting energy expenditure for men and for women.  Resting energy expenditure (RMR) is the number of calories that a person needs to stay alive while resting. RMR accounts for about 60-75% of total daily energy expenditure so it is important that the equation used to estimate this number is pretty accurate. While Harris Benedict has been around since 1919 and is generally considered to be the gold standard, The Mifflin-St. Jeor Equation created in 1990 has a smaller overall margin of error and is consider most accurate for the average US population. If you have ever calculated your energy needs using an online tracking system like FitDay.com, MyFitness Pal.com or the government tool ChooseMyPlateSuperTacker.gov, then you most likely entered your height, weight, gender and age and a number was spit out stating that you need XXXX calories per day. This number was most likely calculated using one of these formulas. However, similar to how the calculation for BMI (Body Mass Index) does not account for lean and fat mass, neither do either of these RMR equations. There is another formula you can use if you have these numbers, the Katch-McArdle formula, but accuracy still depends on a correct measurement of body fat percentage.

So why am I telling you all of this math mumbo jumbo? Because energy balance is so much more than calories in = calories out. On top of the calories needed to sustain life, we burn calories in our day to day activities, through food digestion and in physical activity. A couple of important points here: The American College of Sports Medicine recommends 2000 calories of exercise per week for weight loss and 1000 per week to improve health. When people start a weight loss and exercise program they often have that 1000 calorie number on their minds which might mean about 2-3 hard spin classes a week not realizing that they need double that for weight loss.

In light of all of these challenges, why not shift your initial focus away from calorie goals and number of calories burned in structured physical activity to your NEAT (nonexercise activity thermogenesis) activities throughout the day. NEAT calories can vary drastically from one individual to another and can add up quickly. Think things like fidgeting, walking to the bathroom at the very end of the hall, taking several walk breaks throughout the day, chopping vegetables and cooking instead of going through the drive-thru, etc. Simply list your typical Monday-Friday schedule on a log similar to this:

TIME OF DAY	ACTIVITY
Midnight-06:30 am	sleeping
06:30-07:30 am	Preparing for work
Continue with your schedule

Use this information to identify the problematic areas of your day, i.e. times when you are sedentary for long periods of time, and challenge yourself to get moving more.  You might be surprised how increasing your NEAT is just the boost your metabolism needs to jump start your weight loss or break out of that plateau. Hopefully you will find that the more you move the more you will want to move!

Cocoa: The Food of the Gods

I grew up in Pennsylvania and one of the highlights of my summers was the annual trip to Hershey Park. The lampposts are topped with Hershey Kiss shaped streetlights and the air in the town is infused with a pleasant chocolate smell. There is a museum/factory where you can take tours and learn all about chocolate but the real fun is the amusement park and the Sooper Dooper Looper!

Funny thing is that I have never been much of a chocolate eater and it is only in recent years that I have added cocoa to my arsenal of nutrient dense foods. I am sure that everyone has heard somewhere from someone that chocolate is “good for you” but what exactly does that mean? How much, what type and really what does it do?

While you might flag this and say “conflict of interest”, Hershey has an entire Center for Health and Nutrition devoted to studying the health benefits of this food. The site is full of great information and is worth a look http://www.hersheys.com/nutrition-professionals/default.aspx For instance, cocoa powder is the end product after much of the fat or cocoa butter is removed, natural cocoa powder has no modifications, and alkalized or “Dutch” cocoa is treated to raise the pH and reduce some of the bitterness.

Research on the health benefits center on the antioxidant compounds in cocoa. Think of antioxidants as substances that counteract damage to your cells caused by environmental pollutants, substances in our food and water, aging, and even exercise. This is where the concept of nutrient density enters the equation again. Food choices that are whole and unprocessed and include fruits, vegetables, teas, beans, and seeds that are rich in antioxidant activity can help to minimize the damage our cells undergo on a day to day basis. While still in their infancy, studies on the compounds in chocolate and cocoa have revealed benefits for the heart, brain, managing blood sugar and decreasing the signs of aging.

Both dark and milk chocolate contain flavanols but dark chocolate has more and white chocolate has none. If you want to add this food to your diet as a way to increase the quality of your nutrient intake, then I would suggest using organic unalkalized cocoa powder and/or cacoa nibs. Cacao nibs are made from crushed beans and are the original chocolate chip. They are crunchy and flavorful. For the organic cocoa I buy NOW brand http://www.nowfoods.com/Foods/real-food/Products/M074399.htm as they list the actual flavanol content. Nativas Naturals is a brand of the nibs that can be found at Whole Foods http://www.navitasnaturals.com/products/cacao/cacao-nibs.html

So the next question is: how much cocoa is needed to provide health benefits? Most studies used much more than you would want to add to your diet so there are no clear guidelines as of yet. And don’t get confused by the recommendation to add cocoa flavanols to your diet and translate that into “eat more chocolate.” Chocolate is high in saturated fat, sugar and calories. To reap the health benefits of the flavanols stick to unprocessed cocoa powder, bittersweet chocolate, unsweetened unprocessed dark chocolate and cacao nibs.

Here are some suggestions for adding this nutrient rich food to your diet:

· Add 1 tablespoon cocoa powder to your recovery smoothie

· Add 2 tablespoons cocoa powder to your favorite black bean soup recipe

· Add 1 tablespoon cocoa powder or nibs to hot cereals

· Add ¼ cup cocoa powder to pancake batter or muffin batter

· Get out of your recipe rut and try a recipe for mole – chocolate is a key ingredient

· Stir a tablespoon cocoa powder or cacao nibs into your yogurt

· Add cacao nibs to salads, trail mix, anywhere you would use chocolate chips

This Valentine’s Day why not treat yourself to this luscious recovery smoothie:

2 Tbs organic cocoa powder

1 cup frozen cherries (also full of antioxidants)

1 scoop protein powder or 1 cup high protein yogurt like Greek yogurt

1 cup low-fat chocolate dairy or soy milk

Enjoy adding this nutritious food to up the quality of your diet!

Healthy Thanksgiving Side Dish

Thanksgiving is a time to give thanks and celebrate the abundance the season has to offer. Unfortunately for most Americans this means overindulging in high calorie and high fat foods. I read in my American Council on Exercise newsletter (http://www.acefitness.org/pressroom/392/hard-to-believe-average-thanksgiving-meal-equals-3) that the average Thanksgiving meal with all of the fixings can be in the vicinity of 3000 calories and 229 grams of fat! Now unless you are competing in an Ironman race in the days before Thanksgiving, (a 160 lb person would need to run at a moderate pace of four hours, swim for five hours or walk 30 miles to burn off ~3000), you might want to think about incorporating at least one or two healthy options in your meal. Oh and that number doesn’t even include the appetizers and pre-meal snacking so you would probably need to add in a bike ride of an hour or two as well.

Personally, I won’t be feasting until I have done my run, maybe ridden my bike and of course walked my dog. I also know that I am in the minority when it comes to what will be on my Thanksgiving table. I will be cooking a Tofurkey (http://www.tofurky.com/tofurkyproducts/holiday_products.html ), green beans, Brussels, maybe some lima beans, and my healthy pumpkin muffins for dessert. However, I wanted to encourage everyone to add at least one very healthy side dish this season so thought I would post a “mock” mashed potato recipe.

The Mayo Clinic website has a nice basic recipe for cauliflower mashed “potatoes” http://www.mayoclinic.com/health/healthy-recipes/RE00142 but I just can’t look at a recipe without putting my personal spin on it. So the one posted here is a combination of several that I looked at.

Ingredients

1 head cauliflower

1 leek, white part only, cut into pieces

1 clove garlic

¼ cup skim milk or soy or almond

1-2 Tbs olive oil

Salt, pepper, and paprika

1. Place cauliflower, garlic, and leeks in a steamer basket; place in a saucepan over 1 inch of water. Bring to a boil; cover and steam for 8-10 minutes or until tender. Cool slightly.

2. Place the milk and oil in a food processor or blender. Add the vegetables, salt and pepper; cover and process until blended.

3. Either transfer to a bowl and serve immediately; or pour into a baking dish, sprinkle with paprika and bake until bubbly.

The nutritional analysis using 1 Tbs olive oil and 4 servings is:

100 calories, 3 grams of fat, 15 grams of carb, 6 grams of fiber, and 5 grams of protein.

Enjoy the holiday and practice moderation!

Heart Healthy Book Review

I was recently asked to complete a book review of a work designed to provide consumers with practical steps and actions that can be taken to reduce their risk of heart disease. The book is authored by Joseph Piscatella and Barry Franklin and is called 109 Things You Can Do: Prevent, Halt, & Reverse Heart Disease.

When I first started my career as a registered dietitian, I held the position of cardiac dietitian at United Medical Center in Cheyenne, WY. I worked with cardiac patients who either had heart attacks, catheterizations, stents, etc., or who underwent bypass surgery. My job was to assess their nutrition risk and follow them through their hospital stay by monitoring their diet and providing nutrition education. I also worked in the outpatient cardiac rehabilitation center where I provided grocery store tours and conducted cooking classes. In my experience people are overwhelmed when they discover they have heart disease and they find it difficult to take action in the areas of their life that will have the greatest positive impact.

That is where this book can come in handy. The book is divided into four steps: Assess Your Risk, Manage Daily Stress, Make Exercise a Habit, and Balance Your Diet. Each of these steps provides background information that is easy to understand and based on scientific evidence. The sections then include ways to put the advice into action. The sections provide self-assessments as well as recommendations for everything from normal blood pressure to which foods have a high or low glycemic index. I found the book to contain a gold mine of information for anyone interested in lowering their risk for heart disease. The book concludes with a section on medications, treatments, and cardiac rehabilitation programs.

While not a substitute for medical advice or dietary advice from a registered dietitian, this book can serve as a valuable resource and adjunct to someone at high risk for heart disease or someone who has recently had a procedure. I will continue to use it as a reference for my clients as well.

February is Heart Health Month!

As an athlete you may think that you are immune to heart disease since you incorporate physical activity on a regular basis. However, do you really know what an optimal heart-healthy diet should include? There is so much misinformation available that I thought a review of some dietary habits and facts pertinent to heart health were in order.

Let’s start with a quiz!

1. Is it more important to reduce total dietary saturated fat or avoid trans fats?
2. The fiber is which of these foods will lead to a reduction in blood cholesterol – bran cereal or oats?
3. Which of these foods is not high in potassium – green seedless grapes, oranges, potatoes, tomatoes, or bananas?
4. What is considered normal blood pressure?
5. What are desirable levels for total cholesterol, LDL, HDL, and triglycerides?
6. Why would a high intake of refined carbohydrates and simple sugars increase your risk for heart disease?

Now that I have you thinking, let me fill you in on what you need to know to keep your heart healthy. While it is important to keep your saturated fat in check (full fat dairy, fatty cuts of meat, fast food, etc), trans fat is more harmful to the heart. Read the ingredient list of foods you purchase and avoid those containing partially hydrogenated vegetable oils.

We need both insoluble and soluble fiber in our diets in order to remain healthy. The insoluble fiber that is found in foods like whole-grain bread, vegetables, and bran cereal contribute to colon health. The soluble fiber in foods like oats and beans can decrease cholesterol by binding with it so that it is excreted.

Potassium is a very important mineral for athletes since it is one of the main ones lost in sweat (in addition to sodium). But it is also extremely important in terms of blood pressure regulation and most Americans don’t get enough. The recommended intake is 4700 mg for adults, which is actually harder to get than you might think. One banana has around 400 mg. Wow – that’s a lot of bananas! Seedless grapes are low in potassium but the others in the question are good sources.

Normal blood pressure is <120/<80 mm HG. Do you know yours? Go to your local pharmacy and use the self-check blood pressure machine. What about cholesterol numbers? Total cholesterol should be <200 mg/dl, LDL (lousy or bad cholesterol) < 100 mg/dl, HDL (good cholesterol) >40 mg/dl (the higher the better : 60 is considered high), and triglycerides <150 mg/dl.

The last question is a tricky one when it comes to athletes. Yes you should be fueling during exercise with those simple carbs like gels and gus and sports drinks, since they delay fatigue and provide a ready source of fuel. Simple sugars such as those found in low-fat chocolate milk are also ok for athletes when used as a recovery drink. However I think athletes sometimes overdo the gels, gus and other engineered foods and research has shown that a high intake of refined starches and sugars can depress HDL, raise triglycerides, and raise inflammatory factors. My suggestion is to go easy on these products when your training volume is lower and during the off season. Opt for “real foods” instead like an apple or banana since you will also get some fiber and complex carbohydrates with those foods.

A few other ways to eat for heart health include eating 2 servings of fatty fish a week, or if you are a vegan or don’t like fish, including flax oil or hemp oil. Make sure to load up on lots of antioxidant rich fruits and vegetables, use olive oil when you can, and snack on heart healthy nuts a few times a week. Finally, let’s not forget those phytochemicals and heart protective flavonoids such as the ones found in green tea and dark chocolate. Just watch the portions of the chocolate and aim for a one ounce portion per day and a brand that contains 200 mg of cocoa flavanols per serving.

While not an exhaustive list, the suggestions here should put you in the right direction for heart health.