Tuesday, March 5, 2019

Diet Studies: What the Numbers Don't Tell You

This week I read a terrific article from last year by one of my favorite health journalists - Julia Belluz of www.vox.com.  She took a look at 4 dieters who were all participants in a study that compared a low-fat diet to a low-carb diet. Both diets produced pretty much the same results after a year - 11 pounds lost for low-fat dieters and 13 pounds lost for low-carb dieters. Those numbers are averages.

But averages are, of course, averages. What happens in a lot of weight loss studies is that some people do really well and lose a lot of weight. Others don't lose any weight at all or actually gain weight. And some are right there in the middle. So the average weight loss looks mediocre at best. But there are rich and instructive stories in each participant's experience that get lost in the averages. Why did the people who lost a lot of weight do so well? What kept the people who didn't lose weight, or even gained, from succeeding? Averages don't tell their stories. But Ms. Belluz takes a look at 2 people who succeeded - one on each diet. She did the same with 2 people who gained weight - one on each diet. She tells their stories here. Take a look:  

Why Do Dieters Succeed or Fail? 

What we see is where we fail as nutrition and diet experts. It's not just about the diet - it's about life. Our jobs, our environment, our families, our friends all have a big effect on our health and behaviors. Now, how do we design programs and studies that really help when all those factors are not helping? 

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham 


Wednesday, December 12, 2018

Vitamin C – Should You Supplement?



When you get a cold, do you start popping the vitamin C tablets? If you do, you might want to think twice. Vitamin C supplements don’t do a whole lot to cut your cold chances and they might even be bad for your kidneys.

Does vitamin C prevent colds? Taking a vitamin C supplement regularly before you get a cold, may decrease the time you have the cold – but just a little. An analysis of 44 studies showed that 1000 mg a day can cut the time you have a cold by about half a day. The usual recommendation is 500 mg twice a day. But taking vitamin C after you have a cold, probably won’t do you much good. 1000 mg a day may also lower your risk of gout. A lower dose 60 to 250 mg may help prevent cataracts – but too much can actually increase your risk of cataracts.   

But, too much can be dangerous. Taking 2000 mg a day for a long time may damage the kidneys and increase the risk of kidney stones. So if you do supplement, keep it to 1000 mg a day or less. Vitamin C supplements can also cause diarrhea and intestinal upset.

I don’t typically recommend vitamin C supplements for my patients.  I do recommend that you get lots from your foods. Some studies show an association between higher intakes from food and a lower risk of stroke, some cancers, and overall health. Men need 90 mg a day of vitamin C and women need 75 mg a day. It’s a good idea to get more than that from your diet for optimal disease prevention. Luckily, it’s easy to get lots of C from your foods.  

How can you increase your dietary vitamin C intake? Here is a list of the foods highest in vitamin C:

Foods High in Vitamin C:
 
1/2 cup red pepper                  95 mg
¾ cup orange juice                  93 mg
1 cup strawberries                   84 mg   
1 orange                                  70 mg
1 medium kiwi fruit                  64 mg
1/2 grapefruit                           42mg
1/2 cup raw broccoli                80 mg 
½ cup cooked broccoli            58 mg
baked or sweet potato            25 mg
1/2 cup turnip/collard greens  20 mg

So as you can see, a diet high in fruits and vegetables can easily supply your daily need for vitamin C – and then some. Does this mean you should ditch your vitamin C supplement? Not necessarily – just don’t overdo it. Stick with no more than a 500 mg twice a day if you want to continue vitamin C supplements.  Just don't let a vitamin C supplement take the place of high C foods!

Hemila H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013 Jan 31

Beth Kitchin PhD RDN
Assistant Professor, Nutrition Sciences 
University of Alabama at Birmingham 



Monday, August 20, 2018

I Body Shamed My 4-Month Old Kitten. What Kind of a Monster Am I?




Beatrice the Kitten
A feral momma cat gave birth to her kittens at the top of my back steps this past March. This is how I came to adopt Beatrice who, with her Dalmatian spotted body and tiger striped head, is an oddly beautiful chimera of a cat. I couldn’t bear to give her up, despite the horrified glares of Francesca and Atticus Finch, my two adult cats. Nor was my boyfriend’s cat allergy enough to dissuade me because, you know, benadryl. I dismissed a psychologist friend’s warning that “more than two cats per capita in a household is a sign of psychosis”, because she was born at the top of my back steps. It was meant to be.

As my beautiful kitten grew, I began to notice a protrusion of saggy skin under her abdomen. As she grew, it grew – flapping unattractively side to side as she chased ribbons, attacked fuzzy felt mice, and trotted out to greet me when I walked in the door. I had pictured her growing into a sleek, elegant cat – abdomen firm, muscles sinewy – delighting guests with her feline prowess and balletic form. “How beautiful” they would say, “where did you get her?” I would proudly reply:  “She was born at the top of my back steps”, as though the Egyptian cat goddess Bastet had placed her there, just for me.
Beatrice and her primordial pouch 

But my kitten has a primordial pouch. Yes, that’s what it’s called. I know this because I googled “my kitten has saggy skin hanging down from her abdomen, what is that?” It’s a primordial pouch. Some cats have it and others don’t. It’s not a result of eating too much or spaying. Both male and female cats can have one. It’s simply excess skin and fat that allows cats extra flexibility and movement and helps them to wriggle loose in a fight. Wild cats often have them and it’s a breed standard for the Bengal and the Egyptian Mau. This last primordial pouch fun fact gave me cold comfort since Beatrice’s heritage is urban feral, making her ineligible for pageant competition.

So, when I took Beatrice in for her last round of vaccinations, I said to my vet, in a practiced tone that was half kidding, half serious, “Hey, you know she’s got a primordial pouch. So when you spay her next month, how about a little nip and tuck to tighten that thing up?” I added a little half-laugh to make sure she didn’t think I was seriously requesting cosmetic surgery on a kitten. But I was hoping she’d say “Sure – no problem, we do that all the time”. Instead, she said, “Oh, primordial pouches are normal. Perfectly healthy.”

So there it was. I had just body shamed my 4-month old kitten. I should know better. After all, I was body shamed when I was a teen in high school. This was back in the 70’s and 80’s when we didn’t call it “body shaming”. My “primordial pouch” was a nose that was too big, breasts that were too small, and a rotund butt that would have to wait decades before Kim Kardashian would make it fashionable. Everything about my looks was wrong, disproportionate – and some of the other students made sure I knew it. One male classmate called me “TT”. The first “T” was for “tiny”. I’m sure you can guess what the second “T” stood for. Another classmate once told me I was ugly. While I knew I was not ugly, I also knew I was not pretty and would never be considered so. These memories flashed back to me as I tried to humor my vet into giving a kitten a tummy tuck.

Thankfully Beatrice is and will remain unaware that I body shamed her. She’s a cat. But it made me wonder, what if I had not been so fortunate? What if the people who were supposed to love me had body shamed me? It made me think of a day a long time ago, when I was 14 or 15. It was summer. The phone rang and my mom answered. I heard her say, “well maybe you should ask her” and handed the phone to me. It was a woman from the county fair wanting me to participate in the yearly county beauty pageant. While she likely got my name from a list of girls from the high school, I felt patronized. Didn’t she know what I looked like? Didn’t she think I knew? I knew I was not pageant material. And I didn't care. “No thank you, I’m not interested”, I said and hung up the phone. My mother didn’t say anything as she continued cooking dinner, but I noticed a slight smile on her face. I knew she was proud of me – primordial pouches and all.

So now, I look down at Beatrice who is curled up in my lap purring.  And I know I will love her forever – not because she is beautiful, but because she was born at the top of my back steps.

Beth Kitchin PhD RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham

Thursday, July 26, 2018

Let Me Eat Cake!


Recently I was at a friend’s birthday party when an all-too-familiar comment came my way. It was time for cake and a friend of mine said “well, I guess you won’t be having any”. I said “why?” knowing full well why. He replied “well, you’re a nutritionist, aren’t you?”  This happens to me all the time. Someone expects me to eat, or not eat, something because I’m a Registered Dietitian/Nutritionist by trade and training. But comments like this always bother me – for several reasons.
First of all, it suggests that all nutritionists adhere to some sort of Spartan diet program where no food that is deemed "unhealthy" can pass our lips. People make all kinds of assumptions about me. They've assumed I am a vegan vegetarian, that I don’t eat white bread, and that I count calories, carbs, or whatever is in vogue to count at the moment. A colleague once ordered baked chips for me at a lunch meeting. When I reached for the regular chips he said “oh I got you baked chips because I assumed that’s what you ate”. When he offered to eat the baked ones so I could have his regular chips, I took him up on his offer. No one’s going to ruin my lunch because they assumed that when I put “potato chips” on my lunch order I really meant “baked chips”. Chips means chips – and don’t you forget it.
Secondly, comments like this make me realize that most people don’t understand what healthful eating means. Eating a healthy diet does not mean every single thing you eat must be whole grain, unprocessed, unrefined, baked-not-fried, or sugar free. Cake will not kill you. Neither will bacon. No food in and of itself is bad for you.
But the worst part of the “you-can’t-possibly-eat-cake” comment was that I then felt obligated to eat the cake. I felt obligated not because I wanted to be polite but because I felt a need to prove that I am not an extreme nutrition nut who only shops at Whole Foods and drinks kale shakes for breakfast. In reality, I didn’t want to eat the cake. I didn’t want to eat it because it was white cake with white icing. And white cake with white icing, to me, is boring. So is vanilla ice cream. And oatmeal cookies. White chocolate is boring and also an oxymoron. If that had been chocolate cake with chocolate icing, I would have elbowed my way to the front of the line to get a corner piece. Corner pieces of chocolate cake have a one-to-one icing to cake ratio which is perfection. You see, I love food so much that I don’t waste my taste buds on foods that I don’t love – or at least really like. That’s where I do say “I’m not wasting my calories on that”. 

So please, if you see me at a party, let me eat cake. Or not. And if it’s chocolate, you may just want to get out of my way.

Beth Kitchin PhD RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham 

Tuesday, July 17, 2018

Apple Cider Vinegar: Is It All Hype?

Many of the claims about apple cider vinegar are hyped up. But there is a nugget – or core – of truth to some of them. But if you’re expecting apple cider vinegar to miraculously melt away the pounds or cure your diabetes, you will be disappointed. So far, there is no evidence that apple cider vinegar helps with digestion, balances your pH (which your body does on its own anyway), or reduces heartburn. In fact, some studies have shown that it can worsen heartburn and acid reflux symptoms.

However, it might help a little bit with blood sugar control and weight loss.  Let’s look at what the studies show:
  • A few very small studies have shown that in people without diabetes or with pre-diabetes have shown some benefit. Drinking ½ tablespoon of apple cider vinegar in 1 ½ ounces of water with a meal had lower blood sugar after the meal than people who drank the placebo drink.
  • Apple cider vinegar studies in people who have type 2 diabetes have been mixed. One study showed a slightly lower blood sugar level in the morning after drinking apple cider vinegar with a snack before bed.
  • There have been two pretty good studies showing that drinking apple cider vinegar might help modestly with weight loss. The biggest study was done in Japan. Men and women who drank 1 tablespoon of apple cider vinegar diluted in a cup of water twice a day after breakfast and dinner lost a little over 4 pounds over 3 month compared to no weight loss in the placebo group.
So while the benefits of using apple cider vinegar aren’t huge – who wouldn’t want a few extra pounds of weight loss just from drinking some in water? There can be some risks. If you don’t dilute it or you drink too much, it can damage the esophagus (the food pipe) or cause heartburn. So be sure to follow these tips:
Tips on Using Apple Cider Vinegar Safely: 

·         Don’t Buy Apple Cider Vinegar Supplements: All of the studies with apple cider vinegar have used apple cider vinegar in liquid form. It’s the stuff you can get in the grocery store for a little over a dollar for a bottle. Apple cider vinegar pills don’t have any studies backing them up and they vary widely in the actual amount of acetic acid they state they have. Don’t waste your money on them.

·         Buy Liquid Apple Cider Vinegar in the Grocery Store: Organic vinegar with “the mother” still in them (that’s the stringy clump of fermented yeast and bacteria and cellulose that ferments the apple cider) are more expensive. We don’t know if they are better, so for right now, don’t feel like you have to spend the money on them. The cheap fermented regular brands may work just as well!

·         Dilute the Vinegar! Don’t drink it straight up or you could damage your food pipe or erode your tooth enamel.

     Take the Right Dose: For blood sugar control, try ½ tablespoon of apple cider vinegar in 1 ½ ounces of water with meals. For weight loss, take 1 tablespoon diluted in a cup of water after breakfast and dinner. 

So, give it a try if you're working on weight loss or controlling your blood sugar. But also do all of the other things that we know have a bigger impact on these health challenges - like eating healthfully, not eating too much, and exercising! 

Beth Kitchin PhD, RDN
Assistant Professor Nutrition Sciences
University of Alabama at Birmingham


Tuesday, July 10, 2018

Can You Drink Too Much Water?


It’s hot. You need to drink more water, right? Most of us do need more water at this time of the year but surprisingly you can drink too much. When people drink too much water, it dilutes the sodium in the blood to a level that's too low. Low blood sodium is called "hyponatremia". This very low level of blood sodium can cause nausea, vomiting, headaches, convulsions, the brain to swell, and even death. Some of these symptoms are the same as dehydration, which is also dangerous. So how do you know if you’re drinking enough, but not too much, water?

Water & fluid guidelines: 

Follow your thirst. Thirst is actually a good indicator of whether or not you need fluids. An exception to this is older people who can become fluid deficient quickly, particularly in hot weather. 
Drink fluids during activity. Whether you’re out walking, gardening, or running a marathon, you should drink fluids before and during activity – roughly 4 to 6 ounces every 20 minutes. You don’t need gallons of water during activity – which is where some people have gotten into trouble with over hydration.

Weigh yourself after your workout. Wouldn't it be nice if that weight you sweat off wasn't just sweat? If your workouts are intense, you might find you've lost several pounds afterwards. Drink 16 ounces of water for every pound lost during exercise to replace what you've lost.

Check your urine. When you are well hydrated, your urine should be pale to clear. This is the best way to tell if you've had enough water. Don’t drink excessive fluids beyond this. If your urine is dark or very small in volume, then you need more fluids!

The 8-cups of water myth. While the average fluid lost from our bodies does turn out to be around 8 cups a day, you don’t need to replace all of it with plain old water. We get water replacement from fruits, vegetables, and other beverages such as milk, tea, soda, and yes, even coffee! However, water is the best fluid for boosting body fluids because it is absorbed the fastest of all the fluids!

Beth Kitchin PhD RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham 

Sunday, June 17, 2018

Here’s Why I Don’t Buy Unsalted Nuts


Today I bought a container of mixed nuts – salted. Why wouldn’t I choose unsalted? First of all: the taste. Unsalted nuts don’t taste nearly as good as their salted brethren. Secondly, I don’t have high blood pressure so I don’t need to worry too much about sodium. But even if I did need to cut the sodium in my diet, salted nuts would not be the place I’d do it. Why? Because they’re just not that high in sodium.


People assume that if something tastes salty that it’s high in sodium. But if you take a look at the label on the mixed nuts I bought today, you’ll notice that they only have 90 milligrams of sodium. That’s a scant 4% of the daily limitation. Why sacrifice taste for such a small cut in sodium?

If you need to cut sodium, read labels and go for the big offenders. Canned soups, frozen dinners, and fast foods can all easily top out at over 700 to 800 mg or more. Some fast food meals have well over half of your day’s limitations. When you’re reading labels, always make sure you look at the serving size first. Let’s say you eat the whole can of soup and there are two servings in the can. If the label says 700 mg of sodium per serving, you’re actually getting 1400 mg! While some foods will shock you at their high sodium content, you may also be pleasantly surprised that some of your salted favorites really aren’t that bad!

Beth Kitchin PhD RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham