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Healthy Holiday Eating

Eating healthy can sometimes be a struggle for people.  When we are so overloaded with information on various diet trends through books, television, the Internet, and any number of friends who are trying to be helpful, sometimes we can get confused about what works and what doesn't.  The truth about nutrition is that you need a balanced diet, not one that cuts out specific foods or food categories.  Carbohydrates, for example, have gotten a bad reputation lately as the reason Americans are overweight.  What the people trying to sell you those books and diet foods aren't telling you is that carbohydrates are the primary source of fuel for the brain.  Without enough carbohydrates in your diet, you will start to feel sluggish, forgetful, and generally blasé.  
A balanced diet is one you can maintain for a lifetime, not just a diet that you stick to for a few weeks and then go back to your normal eating habits.  “Yo-Yo Dieting” as it is called when you go on and off of diets, can actually cause problems with your health.  It’s called “Yo-Yo” because your weight goes up and down like a yo-yo.  This is because your metabolism actually slows down while you are on the diet and then doesn't speed back up when you go back to eating more then you did on the diet.  Therefore, the weight comes back faster and oftentimes, you gain back more then you originally lost.  So, when changing your eating habits, you need to make sure it is a lifetime change toward healthy eating instead of just a “Diet”.  
Healthy eating isn't really all that hard.  It is a matter of making sure you are eating things that will cause good health effects instead of things that will cause bad health effects.  For example, if you have high cholesterol, you would want to eat things that help lower your cholesterol and not eat things that will increase it.  Eating fewer egg yolks can help reduce blood cholesterol.  An egg yolk contains about 2/3 the recommended daily cholesterol limit. Egg whites, on the other hand, are high-protein and fat and cholesterol free.  Often you can substitute 2 egg whites plus a teaspoon of vegetable oil for each whole egg when baking.  Egg whites can also be used in egg salads and omelets.  Egg substitutes are another option, but simply discarding the yolks and using just the egg whites is a less expensive alternative.
Adding fiber to your diet is another healthy change you can make.  We don’t like to talk about it, but as we age, all of our systems slow down, including our elimination systems.  Fiber helps keep us regular, which in turn will help decrease the risk of colon polyps and cancer.  Fiber is the part of plant foods that is not digestible.  The less processed the food, the more fiber it contains.  For example, a cup of whole-wheat flour, which retains the wheat germ, has about 15grams of dietary fiber.  A cup of all-purpose flour, from which the germ has been removed, contains only a little more then 3 grams.  Be sure to increase fiber intake gradually—don’t overdo it.  Also, be sure to drink plenty of water to help offset the increased amount of fiber in the diet.
I hope you find the following healthy eating tips helpful!

5 Ways to Cut Cholesterol
1. Use nonfat yogurt as a topping for fruit or other desserts.  Also, use low-fat cheeses, and nonfat or low-fat milk products.
2. Cook poultry or fish without fat by steaming over low-sodium broth.  Add herbs and lemon to the steamer basket for extra flavor.
3. Use a nonstick skillet to cook meats and vegetables.  This type of pan requires little or no added fat for stovetop cooking.
4. Fill up on breads and pasta.  Opt for all-fruit jams and vegetable based sauces instead of high fat spreads and sauces.
5. Include fish in your diet as a low-fat alternative to meat.  Fish contains omega-3 fatty acids, which help lower cholesterol.
5 Ways to Add Fiber to Your Diet
1. Eat plenty of fresh vegetables.  High-fiber choices include cabbage, broccoli, potatoes (especially with the skins), corn, and carrots.
2. Enhance green salads with fiber-packed additions, such as raisins, nuts, shredded carrot, sunflower seeds, and fresh apple slices.
3. Add wheat germ or bran to crumb toppings for casseroles or desserts, and try to use whole-wheat breadcrumbs.
4. Breakfast cereals, hot or cold, can be good sources of fiber.  Check labels to find good choices.  Top with fruit for even more fiber.
5. Make cooked beans a staple at mealtimes.  Especially rich in fiber are black beans, navy beans, and kidney beans.

What Is A Serving?
Weight loss can start with the weight of your plate.  Cutting back from "Supersized" portions to a regular serving can cut a lot of calories.  Unfortunately, most people don't know what a serving size actually is.  Below are some examples of actual serving sizes of some popular foods.  When trying to determine an actual serving size, remember these 4 things:
1. Many single servings of food fit in the palm of your hand. 
2. Fresh fruits and veggies should be approximately the size of your clenched fist. 
3. Three ounces of cooked meat, poultry, or fish is about the size of a deck of cards. 
4. One ounce of cheese is about the size of one of your fingers or a one inch cube. 
Bread Group:   1 slice of bread; 1/2 small bagel, muffin, or bun; 1/2 cup cooked cereal, pasta, or rice; 1 ounce ready-to-eat cereal (between 1/2 and 1 cup)
Vegetable Group:   1 cup raw, leafy veggies; 1/2 cup other veggies cooked or raw; 3/4 cup (6 ounces) vegetable juice
Milk Group:   1 cup (8 ounces) milk or yogurt; 1 1/2 ounce natural cheese; 2 ounces processed cheese
Fruit Group:   1 medium fresh fruit; 1/2 cup cut or canned fruit; 3/4 cup (6 ounces) fruit juice
Meat Group:   2-3 ounces cooked, trimmed, boneless, lean red meat, skinless poultry, or fish; 4 ounces tofu; 1/2 cup cooked dried beans; 1 egg; 2 tablespoons peanut butter
Fats, Oils, & Sweets:  1 teaspoon butter, margarine, sugar, or jelly; 1 tablespoon mayonnaise or salad dressing; 2 tablespoons sour cream; 1 ounce cream cheese; 12 fluid ounces soft drink or fruit drink
Holiday Eating Tips
1. Serve yourself small portions and fewer items.
2. Include 2 or more fruits and vegetables to help fill up.
3. Eat slowly and enjoy each mouthful.
4. Have a small snack before a holiday event.
5. Don’t skip breakfast.
6. Plan your holiday meal—including healthier choices like fruit platters and lots of vegetables.
7. Roast your turkey instead of deep-frying.
8. Increase your physical activity during the holidays even if it is in small amounts.
9. Make sure your friends and family know about your healthy eating habits so that they can be prepared for serving you at their events.

Healthy Holiday Meal
Fruit Platter Fantasia
1 cup orange or grapefruit sections
1 medium peach, sliced
1 cup watermelon balls
1 cup seedless red or green grapes
1 cantaloupe or honeydew melon, peeled and cut into thin wedges
Mint leaves and grated orange peel for garnish
Arrange on serving platter.  Cover with plastic wrap and chill for 1 hour.
For the Dip:
4 ounces light cream cheese, softened
2 tablespoons sugar-free orange marmalade
1 teaspoon grated lemon peel
¼ teaspoon ground ginger
1 container (8 ounces) vanilla nonfat yogurt
In medium missing bowl, using an electric mixer set on high speed, beat cream cheese until fluffy.  Beat in marmalade, lemon peel, and ginger.  Stir in yogurt.  Mix well.  Chill 1 hour or overnight.
1 serving equals 1 cup fruit and 2 tablespoons dip.  Per Serving:  163 calories, 30g carbohydrates, 5g protein, 4g fat
Notes:  Fruit provides plenty of vitamins and complex carbohydrates, keys to a healthy diet.  Nonfat yogurt has lots of calcium, which is good for building strong bones and preventing osteoporosis. 
Stuffed Turkey Breast
1 teaspoon vegetable oil
½ cup chopped yellow onion
½ cup chopped mushrooms
½ cup frozen chopped spinach, thawed and squeezed dry
½ boneless turkey breast, with skin
3 ounces sliced turkey ham, cut into ½ inch wide strips
Preheat oven to 375 degrees F.  In a medium nonstick skillet, heat oil over medium-high heat.  Add onion; cook for 4 minutes.  Add mushrooms; cook until most of the liquid from the mushrooms has evaporated, about 3 minutes.  Remove from heat; stir in spinach.  Set aside.
Place Turkey, skin side down, on plastic wrap on a cutting board.  Starting on a long side, cut breast horizontally without cutting through.  Unfold and cover with another piece of plastic wrap.  Pound turkey gently with meat mallet to 1-inch thickness.
Remove top piece of plastic wrap.  Lay turkey ham strips lengthwise over skinless side of turkey breast.  Top with cooled spinach mixture.
Fold skin side over filling.  Tie with kitchen twine in several places.  Place in shallow roasting pan.
Roast turkey, brushing occasionally with pan drippings, until an instant-read meat thermometer inserted in thickest part of the meat registers 165 degrees F., about 1 hour.  Place turkey on a carving board; let stand for 10 minutes. Slice into ½ inch thick slices and serve immediately.
1 serving equals 2 slices.  Per serving:  214 calories, 2g carbohydrates, 28g protein, and 10g fat
Notes:  Can be substituted for a traditional turkey for smaller families or for variety.  Just a little turkey ham adds smoky flavor.  The breast is the leanest part of the turkey.  Spinach adds iron and vitamin E.


Classic Roast Turkey
2 Tablespoons olive oil
1 teaspoon dried thyme
1 teaspoon dried rosemary
1 clove garlic, minced, plus 5 cloves garlic, peeled
1 10-lb. roasting turkey, trimmed
2 lemons, halved
¼ teaspoon salt
¼ teaspoon black pepper
Preheat oven to 325 degrees F.  In a small bowl, combine oil, herbs, and minced garlic.  Mix well.
Rinse turkey inside and out and pat dry with paper towels.  Tuck wings under.  Gently loosen skin covering breast.  Rub some of the herb mixture underneath the skin.  Rub remaining herb mixture in cavity and over skin.  Place garlic cloves and lemon in cavity.  Using kitchen twine, tie legs together.  Sprinkle salt and pepper over turkey.
Place turkey on rack in roasting pan.  Roast for 1 hour.  Tilt to release juices from cavity into pan.  Baste and return to oven.  Roast until an instant-read meat thermometer inserted in thickest part of thigh registers 180 degrees F.  Baste every 15 minutes.
Place on serving platter and let stand for 15 minutes.  Carve and serve.  To cut fat, do not eat skin.
1 serving equals 3 ounces.  Per serving:  228 calories, 1g carbohydrates, 31g protein, 10g fat.
Notes:  Lemon, garlic, and herbs add intense flavor.  For perfect presentation, tie the legs together with kitchen twine and tuck the wings under the turkey before roasting.  This will also insure even cooking.  Use a V-shaped rack to roast the turkey.  The rack will help the bird hold it’s shape, as well as allow the fat to drip away easily during cooking.


Savory Potato Gratin
4 medium russet potatoes, peeled and cut into ¼ inch thick slices (about 4 cups)
2 Tablespoons light olive or corn oil
4 medium yellow onions, sliced (about 5 cups)
2 cloves garlic, minced
1 Tablespoon chopped fresh thyme or 1 teaspoon dried thyme
½ teaspoon salt
¼ teaspoon freshly ground black pepper
½ cup skim milk
¼ teaspoon paprika
Preheat oven to 400 degrees F.  Spray a shallow 2-quart oval or rectangular baking dish with vegetable cooking spray and set aside.
Place the potatoes in a large saucepan and cover with cold water.  Bring to a boil over medium-high heat and cook until potato slices are just tender, about 10 minutes.  Drain and set aside.
While potatoes are cooking, in a large nonstick skillet, heat oil over medium-low heat.  Add the onions and garlic; cook until onions are softened and beginning to brown, about 15 minutes.
Spread a thin layer of potatoes in prepared dish, sprinkle with thyme, salt, and pepper and top with a layer of onion mixture. Repeat layers twice, ending with onion mixture.  Pour in milk and sprinkle paprika over the top.  Bake until potatoes are lightly browned, about 20 minutes.  Serve immediately.
1 serving equals 1 cup.  Per serving:  273 calories, 47g carbohydrates, 6g protein, 8g fat.
Notes:  The term “gratin” refers to baked or broiled dishes with crusty tops, which often include breadcrumbs and cheese.  Besides potatoes, other vegetable combinations, poultry or fish dishes, and even fruits can be prepared this way.  For best results, make as many layers of ingredients as possible, seasoning each layer as you go.   Gratins are best baked in shallow, ovenproof dishes that fit easily under the broiler.  And because of the large surface area, there will be lots of crisp, savory crust to enjoy. Potatoes are high in potassium and complex carbohydrates.  Onions may be linked to lowering blood pressure levels.



Broccoli In Garlic Butter
1 bunch broccoli, cut into flowerets (about 4 cups)
2 Tablespoons unsalted butter
1 Tablespoon olive oil
2 cloves garlic, minced
½ teaspoon dried rosemary
¼ teaspoon salt
¼ teaspoon freshly ground black pepper
¼ cup grated parmesan cheese (optional)
In a large saucepan, bring a small amount of water to a boil over high heat.  Place broccoli in a steamer basket and place basket in pan. Cover and steam just until crisp-tender, about 5 minutes.  Drain well and set aside.
In a large nonstick skillet, heat butter and oil over medium-high heat.  Add garlic and rosemary; sauté for 1 minute.  Add broccoli to skillet; stir to coat with butter mixture.  Cook until heated through, about 1 to 2 minutes.  Season with salt and pepper.
Place in serving dish.  Sprinkle with cheese and serve immediately.
1 serving equals 2/3 cup.  Per serving:  72 calories, 4g carbohydrates, 2g protein, and 6g fat.
Notes:  Broccoli is a great source of vitamins A and C and has anti-cancer properties.


Cheese-Topped Vegetables
2 cups small broccoli flowerets
2 cups small cauliflower flowerets
1 cup thinly sliced carrot
½ cup frozen green peas, thawed
For the Sauce:
2 teaspoons vegetable oil
1 Tablespoon all-purpose flour
¾ cup skim milk
¼ cup reduced-sodium chicken broth
¾ cup shredded reduced-fat cheddar cheese, divided
¼ teaspoon ground black pepper
Preheat oven to 400 degrees F.  In a large saucepan, bring 2 quarts of water to a boil.  Add broccoli and cauliflower.  Cook for 3 minutes.  Add carrot and cook for 2 minutes.  Drain.  Place mixture in a 2-quart baking dish.  Stir in peas; set aside.
To prepare sauce, in a small saucepan, heat oil over medium heat.  Add flour; cook, stirring constantly, for 1 minute.
Gradually whisk in milk and broth.  Bring to a boil and cook, whisking frequently, for 3 minutes.  Remove from heat.  Stir in ½ cup of cheddar and pepper.
Pour sauce over vegetables; stir until coated.  Sprinkle remaining cheese over top.  Bake until cheese is bubbling, about 5 minutes.  Serve immediately.
1 serving equals 2/3 cup.  Per serving:  113 calories, 11g carbohydrates, 8g protein, and 4g fat.
Notes:  Carrots are a rich source of vitamin A.  The cheese sauce is made from skim milk.  Cauliflower and broccoli add iron.  Short cut—use frozen vegetables instead of fresh.  There is no need to precook them.


Poppy Seed Dinner Rolls
3 cups all-purpose flour, divided
1/3 cup yellow cornmeal
2 Tablespoons granulated sugar
1 envelope (1/4 ounce) rapid-rising yeast
¾ teaspoon salt
1 cup low-fat milk
1 Tablespoon margarine
1 large egg, lightly beaten
1 teaspoon water
2 teaspoons poppy seeds
In a large bowl, combine 2 cups flour, cornmeal, sugar, yeast, and salt.  Mix well.
In a small saucepan, heat milk and margarine over low heat until temperature reaches 125 degrees F.  Stir milk mixture into flour mixture.  Set aside 1 teaspoon of the egg; add remainder to flour mixture.  Stir in enough remaining flour to form a soft dough.  Turn out onto a floured work surface; knead for 8 minutes.  Cover with a kitchen towel; let stand for 10 minutes.
Spray three 6-cup muffin tins with vegetable cooking spray.  Divide dough into thirds. Divide each third into 6 pieces; roll into balls.  Place in prepared pans.
Fill a large shallow pan half full with boiling water.  Place a wire rack over pan; place muffin tins on rack.  Cover with kitchen towel; let rise until doubled, about 30 minutes.
Preheat oven to 375 degrees F.  Beat remaining egg with water.  Brush egg mixture over tops of rolls; sprinkle with poppy seeds. 
Bake until golden brown, about 10 minutes.  Place on a wire rack; cool for 10 minutes. Serve warm.
1 serving equals 1 roll.  Per serving:  110 calories, 20g carbohydrates, 3g protein, 2g fat.
Notes:  Yellow cornmeal offers fiber, as well as potassium and magnesium.  For best results, use a yeast thermometer to test the temperature of hot liquid before adding yeast.  If the liquid is too cool, the yeast will not activate;  if it’s too hot, the yeast will die.  Rapid rising yeast allows dough to rise twice as fast as dough made with regular active dry yeast.  There is no need to proof the yeast—just make sure that it is used before the expiration date on the package.  Because fast rising yeast has a finer grain, it does not need to be dissolved in liquid before it is added to the dry ingredients.


Harvest Pumpkin Pie
2 cups canned pumpkin puree
2/3 cup firmly packed light brown sugar
¼ cup granulated sugar
2 Tablespoons all-purpose flour
1 ½ teaspoons ground cinnamon
½ teaspoon nutmeg
½ teaspoon ground ginger
1 ¼ cups low-fat milk
2 egg whites, lightly beaten
1 ½ teaspoons vanilla extract
Pastry Leaves for Garnish
For the Crust:
1 1/3 cups cake flour, sifted
1 Tablespoon granulated sugar
½ teaspoon salt
¼ cup corn oil
3 Tablespoons cold water
To prepare the crust, in a medium bowl, stir together cake flour, sugar, and salt. Stir in oil and water until mixture forms a ball.  Wrap ball in plastic wrap; refrigerate for 30 minutes.
Preheat oven to 400 degrees F.  Roll dough between two sheets of waxed paper until 1/8 inch thick.  Place in a deep 9-inch pie plate.  Trim excess dough.  Crimp edges.
In a large bowl, stir together pumpkin puree, brown and granulated sugars, and all-purpose flour.  Add spices; stir to blend.  Whisk in milk, egg whites, and vanilla.  Pour pumpkin mixture into prepared crust.
Bake until filling is set but still slightly loose in center, about 40 to 45 minutes.  Place pie on a wire rack and cool completely.  Garnish with Pastry Leaves.
1 serving equals 1/10th of pie.  Per serving:  233 calories, 39g carbohydrates, 4g protein, and 7g fat.
Notes:  Spices give flavor without added calories.  Sweet pumpkin puree is low in sugar and high in vitamin A.  For a change of pace, you can substitute cup for cup, pureed butternut squash or sweet potato for the pumpkin puree and proceed as directed.


All-American Apple Pie
¼ cup packed light brown sugar
¼ cup granulated sugar
1 Tablespoon all-purpose flour
1 teaspoon grated lemon peel
¼ teaspoon ground cinnamon
¼ teaspoon ground nutmeg
6 medium baking apples, peeled, cored, and thinly sliced
1 cup dark raisins
2 unbaked, ready-made 9-inch piecrusts
For the Glaze:
1 large egg, beaten
1 teaspoon granulated sugar
Preheat oven to 425 degrees F.  In a large bowl, combine brown sugar, granulated sugar, flour, lemon peel, cinnamon, and nutmeg.  Mix well.
Add apples to sugar mixture; stir until coated. Stir in raisins.  Spoon into piecrust.  Place second piecrust on top of filling.  Trim edges, pressing against edge of pan.   Using a sharp knife, cut steam vents in piecrust.  To glaze, lightly brush piecrust with beaten egg.  Sprinkle with sugar.
Bake until piecrust is golden brown, about 35 to 40 minutes.  Place on wire rack to cool for 30 minutes.  Serve warm.
1 serving equals 1/10th of pie.  Per serving:  226 calories, 43g carbohydrates, 1g protein, 6g fat.
Notes:  Apples lend fiber, vitamins, and minerals to this dessert.  Raisins provide a good source of iron.

Setting Macros

I wanted to address another thing I see questions about all the time.  How much protein shouid I eat?  How many carbs do I need?  Should I do 40/30/30?   There is no set number of calories or specific percentages for macros. It is all dependent on the persons goals, disease status, and workouts. 

First of all, you need to know how many calories you need.  You can look below to find out how to determine your Total Daily Energy Expenditure and go by that. If you want to lose body fat, eat no less then 80% of your TDEE. If you want to stay the same weight, eat at TDEE. If you want to gain lean mass, add about 85 calories per day from protein to gain about a pound of lean tissue per week. Unlike fat which is 3500 calories per pound, muscle is only 600 calories per pound so you don't have to increase your intake a whole lot to increase lean weight. Just remember that the initial gains will be glycogen and water stored in the muscle and then eventually the actual muscle gains will happen. 

Second, do you have any kind of issues with your kidneys, high blood pressure, diabetes, IBS, etc.? Those will effect your ranges of macronutrients based on the way the body processes the different macros.   If you have any of these issues, then we need to adjust your macros accordingly so you can't just go with the following recommendations or any other generic diet plan.  Ask your doctor for a referral to a dietitian.

Assuming you don't have any conditions that would effect your needs, then you can look at your workouts. If you are doing standard gym workouts or no exercise, then 0.8 grams of protein per kilogram of body weight is all that is needed. If you are a strength athlete (IE: someone who is training for body building or power lifting), then you need 1 to 1.5 grams per kilogram of body weight. If you are an endurance athlete (IE: someone training for a marathon or who does a lot of long workouts), then you need 1.5 to 2 grams per kilogram of body weight. Yes, I know this seems backwards, but endurance athletes actually need more protein then body builders because they are more likely to break down muscle and need the protein to rebuild and repair the muscle damage. Plus, body builders actually benefit from added carbohydrates because it leads to more glycogen storage in the muscles which will lead to the eventual gain of muscle fibers. 
Now, that you know how much protein per kilogram of body weight, you can determine your percentage from protein. First multiply your grams of protein by your kilograms of body weight. Then multiply by 4 to get calories from protein. Divide calories from protein from the total calories you want to eat to get the percentage from protein. 

For Carbohydrate, again, look at your workout status. If you are a strength or endurance athlete, then you need to get 6-8 grams per kilogram of body weight to fuel your workouts. The day before a marathon or other high endurance activity, then you can go up to 10 grams per kilogram of body weight as a one day carb load, or you can follow a more traditional 3 to 7 day carb load plan. If you aren't an athlete and have no medical reason to limit carbs, then you need 3-5 grams per kilogram of body weight. Again, multiply your gram number by your body weight in kilograms to get grams per day. Multiply your grams per day by 4 to get calories from carbs. Divide calories from carbs by total calories per day to get the percentage. Also, remember that the minimum grams of carbs recommended to maintain brain and red blood cell function is 120 grams per day. 

Now, you can take the 100% of your total daily intake and subtract the % from protein and the % from carbs to get the % from fat. Take that % and multiply it by your total daily intake to get calories from fat. Divide calories from fat by 9 to get the grams per day of fat. 

BMR, RMR (EER), and TDEE Formulas

Okay, since I've seen a LOT of posts lately about how to figure your TDEE, I figured I would go through the steps for a simple estimate for everyone and post it on my blog so I don't have to type it over and over and over again. ;-)  I know it is confusing, but it's not really rocket science.  If you can do basic multiplication and division (or work a calculator), then you can figure your numbers.  Here's how:


BMR = 1 kcal x 24 hours per day x lean body mass in kg (You have to subtract out your body fat from your total weight to get lean body mass. Also make sure you are using kilograms and not pounds. Divide pounds by 2.2 to get kilograms. Multiply total body weight by body fat % to get pounds or kilos of fat. Subtract Fat pounds or kilos from total body weight pounds or kilos to get lean body mass.) 

RMR (EER) = BMR x Activity Factor (Note RMR here is referred to as Resting from your normal exercise routine, not complete bed rest. Complete bed rest is BMR. I had two different professors who taught this concept, one used RMR and one used EER [Estimated Energy Requirement], so call it RMR or EER, whichever works for you.) 

Sedentary (Up and walking around less then 30 minutes a day )= 1.0 to 1.4 
Lightly Active (On the feet equivalent to walking 2 miles per day) = 1..4 to 1.6 
Moderately Active (On the feet equivalent to walking 7 miles per day) = 1.6 to 1.9 
Very Active (On the feet equivalent to walking 17 miles per day) = 1.9 to 2.5 

TDEE = RMR (EER) + Exercise Calories (Note that this number will change DAILY based on the amount of exercise you do. Anyone using the SAME TDEE everyday is wrong because they either aren't accounting for exercise that day or they are accounting for exercise they didn't do that day.) 

To lose body fat, eat no less then 80% of TDEE. No, this doesn't give an easy number of Calories for your deficit because it may or may not be the 500 Calories per pound of weight loss per week, but it tells the body to preserve muscle and use fat for fuel. The easiest way I've found to use MFP for eating the right amount of Calories is to put your RMR (EER) as your goal Calories. Then when MFP adds your exercise Calories and changes your "Goal" Calories, it is figuring your TDEE for you. If you don't exercise then your RMR (EER) is your TDEE. At that point you can then take the new "Goal" (TDEE) number and multiply it by 0.8 to get the MINIMUM number of Calories you should eat. Subtracting your intake from your new "Goal" (TDEE) will give you the deficit you are now eating at so that you can estimate your weight loss. If you eat right at your "goal" (TDEE) then you should stay the same weight because that is your Maintenance level. Eating over should result in weight gain.  

16 years Certified Personal Trainer and Group Exercise Instructor 
9 years Certified Sports Nutritionist 
Bachelors in Exercise Physiology with a Minor in Nutritional Science 
ACSM Certified Clinical Exercise Specialist 
NSCA Certified Strength and Conditioning Specialist

Study Essay

Study of Additional Interventions on Cardiac Rehab Patients at Tift Regional Medical Center

March 2012

Tonya L. Davis-Miller



The purpose of this study is to assess the need for further intervention with cardiac rehab patients, specifically as they would affect weight and body fat loss.  Initially, 6 patients were chosen to begin personalized interventions including both nutrition tracking with specific kilocalorie recommendations and additional exercise to be added outside of the cardiac rehab setting.  When one of the six patients had to leave the study within the first week an alternate was chosen.  A week later, the alternate left the cardiac rehab program due to financial reasons and therefore did not complete the study.  Four weeks into the study, another participant stopped coming to cardiac rehab due to financial issues, so she received the recommendations for kilocalorie intake and additional exercise at home but did not come back in for a final evaluation.  Therefore, the completed study information included only 4 participants, three in Phase IV and one in Phase II. 


Each of the participants were given instructions for logging their daily food intake and exercise so that it could be tracked and correlated to their eventual weight loss or gain.  Two of the participants (Phase IV Patient 1 and Phase IV Patient 2) opted to log their food intake and exercise online using the application.  The other two patients (Phase IV Patient 3 and Phase II Patient 1) opted to log their food and exercise manually and turn in their logs to have their food intake and exercise entered into the application for them.  The application allows for logging of food intake with the ability to manually enter the nutrition information from the package or restaurant or to choose preloaded nutritional information which makes it easy to estimate kilocalorie intake.  The application also allows for the entry of exercise with either a kilocalorie burn estimate from a heart rate monitor or using the program to estimate kilocalorie burns based on the weight of the participant and the estimated MET level of the activity.  Each participant was weighed and measured and their individual measurements entered into the body density and body fat percentage equations listed in the ACE Personal Trainer Manual.  <!--[if supportFields]><span style='mso-element: field-begin'></span><span style='mso-spacerun:yes'> </span>CITATION Ame03 \l 1033 <span style='mso-element:field-separator'></span><![endif]-->(American Council on Exercise, 2003)<!--[if supportFields]><span style='mso-no-proof:yes'><span style='mso-element:field-end'></span></span><![endif]-->  This method of body composition analysis was chosen because of the possibility of a patient having a pacemaker and being unable to use the Omron handheld bio-electrical impedance machine. Personalized nutritional recommendations were given to each participant based on their individual health status and the recommendations from Nutrition and Diet Therapy. <!--[if supportFields]><span style='mso-element:field-begin'></span><span style='mso-spacerun:yes'> </span>CITATION DeB08 \l 1033 <span style='mso-element:field-separator'></span><![endif]-->(DeBruyne, Pinna, & Whitney, 2008)<!--[if supportFields]><span style='mso-no-proof:yes'><span style='mso-element:field-end'></span></span><![endif]--> 

Specific kilocalorie per day recommendations were given based on the formula in Nutrition for Health, Fitness, and Sport <!--[if supportFields]><span style='mso-element:field-begin'></span><span style='mso-spacerun:yes'> </span>CITATION Wil10 \l 1033 <span style='mso-element:field-separator'></span><![endif]-->(Williams, 2010)<!--[if supportFields]><span style='mso-no-proof: yes'><span style='mso-element:field-end'></span></span><![endif]--> and a modification to that formula of using the lean body mass instead of total body mass as recommended by the dietitians on staff at Tift Regional Medical Center.  The participants were instructed to subtract no more than 20% of this estimation in order to create a kilocalorie deficit.  Therefore, their recommended range of kilocalorie intake was given as the formula estimate of kilocalorie need as the maximum recommended and 80% of that formula estimate as the minimum recommended.  Each participant was evaluated and given workout cards outlining exercises that they could do at home that would assist in meeting their needs based on specific exercise limitations and abilities.

The individual daily information was recorded for the participants weight, kilocalorie intake, carbohydrate intake in both grams and percentage of total kilocalories, protein intake in both grams and percentage of total kilocalories, fat intake in both grams and percentage of total kilocalorie intake, saturated fat in both grams and percentage of total kilocalorie intake, sodium intake, exercise kilocalorie expenditure, and a determination of whether they were in the recommended kilocalorie range, over the recommended kilocalorie range, or under the recommended kilocalorie range.  With the exception of the number of days in the recommended kilocalorie range, over the kilocalorie range, and under the kilocalorie range, this information was then averaged for each participant to be extrapolated into correlations of which component had the most effect on weight lost or gained, body fat percentage lost or gained, body fat in pounds lost or gained, and lean body mass in pounds lost or gained.   The number of days in, over, or under the recommended kilocalorie range was totaled to determine if there was a correlation between them and weight lost or gained, body fat percentage lost or gained, body fat in pounds lost or gained, and lean body mass lost or gained.  This information can be seen in the Breakdown by Patient table attached.

After the completion of the study, each participant was matched with another cardiac rehab patient who most closely matched their age and beginning weight.  These patients are considered the control group to see the difference in weight loss between those with the additional intervention and those using the standard cardiac rehab program.


Phase IV Patient 1 is a 78 year old male with a history of heart disease resulting in stent placement in 2001 and CABG in 2003.  Additional health issues include hypertension, hyperlipidemia, mitral regurgitation, and previous skin cancer.  Other surgical interventions he has had in the past include knee surgery and kidney surgery.  He is 5’9” tall and had a beginning weight of 236.4 pounds, waist measurement of 49”, iliac crest measurement of 46”, hip measurement of 44”, body fat of 42.9% which calculated to 101.5 pounds, and lean body mass of 134.9 pounds.   His recommended range of kilocalories was calculated to be between 1639 and 2049 kilocalories per day.   Throughout the course of the study, he was given informational handouts including his kilocalorie recommendations, percentage recommendations for total fat intake and saturated fat intake, recommendations for sodium intake, DASH diet information, and exercise cards for resistance bands, stretching, Pilates, Tai Chi, and other therapeutic body weight exercises.

He is being compared to Phase IV Control 1, who is a 75 year old male with a history of heart disease resulting in stent placement and CABG both in 2003.  Additional health issues include hypertension, hyperlipidemia, angina, anemia, pancytopenia, leucopenia, Barretts Esophagus, sleep apnea, and diabetes.  He is 6’ tall and had a beginning weight of 241.3 pounds.

Phase IV Patient 2 is a 47 year old male with a history of sudden cardiac death.  The patient is an avid runner who collapsed on the track for his first myocardial infarction and on the treadmill in the cardiac rehab department for his second.  His history includes PTCA, pacemaker, and heart valve repair, all in 2011.  The patient also has comorbidities of hypertension and hyperlipidemia.  He is 5’11” tall and had a beginning weight of 237.8 pounds, waist measurement of 42”, iliac crest measurement of 43”, hip measurement of 45.5”, body fat 30.2% which calculated to 71.9 pounds, and lean body mass of 165.9 pounds.   His recommended range of kilocalories was calculated to be between 2099 and 2624 kilocalories per day.   Throughout the course of the study, he was given informational handouts including his kilocalorie recommendations, percentage recommendations for total fat intake and saturated fat intake, recommendations for sodium intake, DASH diet information, and exercise cards for resistance bands, stretching, and resistance exercises using both machines and free weights.

He is being compared to Phase IV Control 2, who is a 59 year old male with a history of heart disease resulting in stent placement.  Additional health issues include hypertension, hyperlipidemia, and atrial fibrillation.  He is 6’ tall and had a beginning weight of 222 pounds.

Phase IV Patient 3 is an 85 year old female who is in cardiac rehab after a stent placement in 2004 and myocardial infarction in 2010.  Additional health issues include hypertension, hyperlipidemia, mild congestive heart failure, cardiomyopathy, carotid artery stenosis, colon polyps, diverticulosis, sleep apnea, and osteoarthritis.  She is 5’3.5” tall and had a beginning weight of 224.3 pounds, waist measurement of 42”, iliac crest measurement of 47”, hip measurement of 51.5”, body fat of 58.2% which calculated to 130.7 pounds, and lean body mass of 93.6 pounds.   Her recommended range of kilocalories was calculated to be between 1219 and 1523 kilocalories per day.   Throughout the course of the study, she was given informational handouts including her kilocalorie recommendations, percentage recommendations for total fat intake and saturated fat intake, recommendations for sodium intake, DASH diet information, and exercise cards for resistance bands, stretching, Pilates, Tai Chi, and other therapeutic body weight exercises.

She is being compared to Phase IV Control 3, who is a 74 year old female with a history of heart disease resulting in CABG.  Additional health issues include hypertension, hyperlipidemia, Meniere’s Disease, diverticulitis, hernia, and previous breast cancer.  She is 5’2” tall and had a beginning weight of 183.6 pounds.

Phase II Patient 1 is a 70 year old male with a history of heart disease resulting in CABG in 2002 and stent placement in 2002 and 2009.  Additional health issues include hypertension, hyperlipidemia, stable angina, COPD, and stroke.  He is 5’9.5” tall and had a beginning weight of 182.9 pounds, waist measurement of 40”, iliac crest measurement of 39”, hip measurement of 44.5”, body fat of 33.8% which calculated to 61.7 pounds, and lean body mass of 121.2 pounds.   His recommended range of kilocalories was calculated to be between 1618 and 2023 kilocalories per day.   Throughout the course of the study, he was given informational handouts including his kilocalorie recommendations, percentage recommendations for total fat intake and saturated fat intake, recommendations for sodium intake, DASH diet information, and exercise cards for resistance bands, stretching, and exercises for the wrist and hand to work on negating the effects of his stroke.  Because of the loss of function in his left hand after his stroke, his grip strength was also reviewed to be able to see any changes with the intervention.  He began the cardiac rehab program on January 9, 2012—3 weeks prior to beginning the study—with a right grip of 32 kilograms and a left grip of 24 kilograms.

He is being compared to Phase II Control 1, who is a 70 year old male with a history of heart disease resulting in CABG both in 2002 and 2011.  Additional health issues include hypertension, hyperlipidemia, stable angina, arthritis, hernia, and left eye blindness.  He is 5’6” tall.  As he is in Phase II, he had a full assessment at the beginning of his program which included bio-electrical impedance, waist measurement, and grip strength assessment on the 12th of January.  He had a midpoint assessment for the cardiac rehab program on the 29th of February, approximately 6 weeks from his beginning assessment, so those measurements are being used for his final measurements to compare to Phase II Patient 1.  His beginning measurements included a weight of 173.4 pounds, body fat of 28.8% which calculated to 50.98 pounds, lean body mass of 122.4 pounds, right grip strength of 35 kilograms, and left grip strength of 33 kilograms.


Phase IV Patient 1 saw a loss of 11.9 pounds total body weight, 2.7% body fat which calculates to 11.1 pounds of body fat loss, and 0.8 pounds of lean body mass loss.  He also lost 1.5 inches at the waist, 2.25 inches at the iliac crest, and 1.5 inches at the hips.  Phase IV Control 1 gained 3.8 pounds of total body weight. 

Phase IV Patient 2 saw a loss of 6 pounds total body weight, 6.15% body fat which calculates to 16 pounds of body fat, and a gain of 10 pounds of lean body mass.  He also lost 3 inches at the waist, 2.25 inches at the iliac crest, and 1.5 inches at the hips.  Phase IV Control 2 lost 2 pounds of total body weight.

Phase IV Patient 3 saw a gain of 4.7 pounds of total body weight and a loss of 0.32% body fat.  When calculated out, this equates to a gain of 2.69 pounds of body fat and a 2.01 pounds of lean body mass.  She also lost 2 inches at the waist and 3 inches at the iliac crest.  She gained 0.5 inch in the hips.  Phase IV Control 3 also saw a gain of 4.7 pounds.

Phase II Patient 1 saw a gain of 2.5 pounds of total body weight, 0.46% body fat which calculates to a 1.7 pound body fat gain, and a gain of 0.8 pounds of lean body mass.  He increased his grip strength by 2 kilograms on the left and had no change on the right.  His waist measurement remained the same while he gained 2.75 inches at the iliac crest and lost 1 inch in the hips.  Phase II Control 1 saw a loss of 0.8 pounds of total body weight, 0.6% body fat which calculates to a loss of 1.27 pounds of body fat, and a gain of 0.47 pounds of lean body mass.  He saw a decrease in grip strength on the right of 4 kilograms and an increase of grip strength on the left of 2 kilograms.

The Breakdown by Patient chart lists the data used to correlate changes in body weight, body fat, and lean body mass with intakes of kilocalories, carbohydrates, protein, fat, saturated fat, and sodium and with exercise expenditure and the number of days in, over, and under the recommended kilocalorie range.  The Correlations of Various Intakes and Expenditures on Weight Lost or Gained, Body Fat % Lost or Gained, Body Fat in Pounds Lost or Gained, and Lean Body Mass Lost or Gained chart shows all of the correlation coefficients (r) for the same information.

Based on these correlations, the strongest link was between the kilocalories expended through exercise and the number of pounds of body fat lost with r=0.99111.  This link is reinforced with a correlation of r=0.92282 for body fat percentage loss based on exercise kilocalorie expenditure. This shows a very strong, positive possibility of high kilocalorie expenditure through exercise increasing the amount of body fat lost.  The next strongest relationship was between grams of carbohydrate consumed and percentage of body fat lost with r=0.98434.  This shows a very strong, positive possibility of increased carbohydrate intake resulting in increased percentage of body fat lost.  The relationship between the number of days under the kilocalorie range showed the strongest correlation to total body weight lost with a correlation of r=0.98084.  This shows a very strong, positive possibility that a calorie deficit of more than 20% of kilocalorie need will result in greater total body weight loss.  However, when looking at the relationship between body fat loss and the number of days in, over, or under the recommended kilocalorie range, the days in the range had the strongest correlation with r=0.87868 for the body fat in pounds lost and r=0.86774 for body fat percentage lost.  This seems to indicate that if body fat loss is the goal it is more important to eat no less than 80% of the body’s kilocalorie need.  Exercise kilocalorie expenditure had the next strongest relationship to total body weight loss with r=0.85544.  The relationship between grams of protein consumed and lean body mass lost had a correlation of r=-0.98052.  This would show a very strong, negative correlation indicating that increased protein intake decreases the likelihood of losing lean body mass.


There was a dramatic difference between Phase IV Patient 1 and Phase IV Control 1 in total body weight change with Phase IV Patient 1 losing 11.9 pounds and Phase IV Control 1 gaining 3.8 pounds.    This would seem to indicate that the extra intervention with the patient was beneficial at least from a total body weight loss standpoint.  There was also a difference between Phase IV Patient 2 and Phase IV Control 2 in total body weight change with Phase IV Patient 2 losing 6 pounds and Phase IV Control 2 only losing 2 pounds.  Again, this seems to indicate that the extra interventions were beneficial.  It is important to note that Phase IV Patient 1 and Phase IV Patient 2 were the only participants who logged their food and exercise via the application where they could see their intake values and kilocalorie expenditure through exercise.  Also of note are that these two patients are also the patients who logged the most exercise and highest exercise kilocalorie burns both in cardiac rehab and at home.

Both Phase IV Patient 3 and Phase IV Control 3 gained 4.7 pounds of total body weight.  While there appears to be no difference in the effects of the intervention on this patient, it is also of note that she had the most physical limitations with regard to adding additional exercise at home.  Also, while she logged her food and exercise, it was done manually without the benefit of actually seeing the breakdown of intake or expenditure.

It is more difficult at first glance to see the reasons for the differences in the 2.5 pound gain of total body weight in Phase II Patient 1 and the 0.8 pound loss of total body weight in Phase II Control 1.  While Phase II Patient 1 gained both body fat and lean body mass, his counterpart, Phase II Control 1, lost body fat and gained lean body mass.  These differences, however, could be accounted for by observing both men in the cardiac rehab setting as it is apparent that the control subject is progressing farther in his exercise abilities and has added resistance training to his program, whereas the study participant has only increased his exercise intensity by adding incline while walking on the treadmill.  This particular participant also had difficulty in adding in exercise at home due to a fear of causing another cardiac event.  He has only started doing his home exercises in the past couple of weeks, so hopefully, he will see results in the future from those added efforts.  Also of note is that this patient has drastically cut his alcohol consumption as a result of participating in the extra intervention.  When he first started logging his intake, he was consuming an average of 3 beers per night.  At the end of the study, he had cut that back to 1-2 beers and only consumes them a couple of nights a week.  This is a significant improvement that should also lead to better results in the future.

The correlations primarily show that exercise expenditure has a greater effect on body fat loss then dietary intake.  The fact that large deficits in kilocalorie intake had a greater impact on total body weight loss is not surprising, but this study highlights the need for additional exercise intervention in order to achieve greater losses in body fat which is more important in the long run.  The effects of carbohydrate and protein intake on the loss of body fat and lean mass were interesting.  Due to the small sample size, however, further research would be needed to see if those same trends are shown throughout a larger sample of people.

Based on these results, it is beneficial to incorporate additional interventions with cardiac rehab patients.  These interventions should include a way of monitoring both kilocalorie intake and expenditure by the patients where they can see the estimates of what they consuming and expending, as the only patients in this study who saw significant weight loss were using the application where they were seeing if they were within their ranges or not.  The two participants who experienced significant weight and body fat loss were also both expending an average of over 300 kilocalories per day.  Therefore, finding ways for future cardiac rehab patients to burn more calories at home would be beneficial in helping them achieve greater overall kilocalorie expenditure and achieving better weight and body composition results.  Further research is needed to determine set points for kilocalorie expenditure per day for best results, as well as for populations with additional metabolic diseases.  All of the patients expressed the fact that this intervention has motivated them to attempt additional activities at home that they wouldn’t have tried otherwise.  These activities ranged from adding in exercise such as Tai Chi for Phase IV Patient 3 to building a shed at his home for Phase IV Patient 2.  Therefore, it is definitely beneficial for the patients belief in their own abilities to have additional intervention in providing home exercises that they are capable of doing in their daily lives.


Works Cited

<!--[if supportFields]><span style='mso-element:field-begin'></span><span style='mso-spacerun:yes'> </span>BIBLIOGRAPHY <span style='mso-element:field-separator'></span><![endif]-->American Council on Exercise. (2003). ACE Personal Trainer Manual (Third ed.). (P. Cedric X. Bryant, & D. J. Green, Eds.) San Diego, CA, USA: American Council on Exercise.

DeBruyne, L. K., Pinna, K., & Whitney, E. (2008). Nutrition and Diet Therapy (Seventh Edition ed.). Belmont, CA, USA: Wadsworth/Thomson Learning.

Williams, M. (2010). Nutrition for Health, Fitness, & Sport. New York: McGraw-Hill.



*****Sorry, I couldn't figure out how to add the tables from Excel into this post.  If anyone knows how to do that, please let me know so you can see the data too. 

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Goals 2012


If you've followed my blog since last year, then you know that I don't make resolutions, but I do set goals for the year around New Years.  I do this because resolutions always seem to get broken, but I'm pretty good about achieving goals.  LOL  Anyway, as a help to others who are planning their goals for the new year, I wanted ot explain a little about how I set my goals.  I use a format as if I was writing a story, because in a way I am writing the story of what my life will be for the next year.  When you write a story, you have to answer a few questions....Who? What? When? Where? How? and Why?  Well, it's obvious that the Who is me (or you if you're using this format).  Then I answer the other questions and write out the goal as a sort of mission statement for what I will achieve, when I will achieve it, where I will achieve it, how I will achieve it, and why I want to achieve it.  Failing to plan is planning to fail, afterall, so I make sure it is a good plan for achieving my goals.  Anyway, here are my goals for 2012.


I will bench press 200 pounds for 6 sets of 12 reps by December 31, 2012. I will achieve this goal by designing a monthly strength training program with proper progression that I can follow both in my home gym and at the gym. I am going to achieve this goal because increasing upper body strength helps decrease my back pain and risk for further injury. As an added benefit, this goal will help me with muscle building for future body building competition.

I will squat 300 pounds for 6 sets of 12 reps by December 31, 2012. I will achieve this goal by designing a monthly strength training program with proper progression that I can follow both in my home gym and at the gym. I am going to achieve this goal because improving lower body strength will improve my mobility as I age. Squats will also strengthen my spine through an axial load so I have less arthritis pain. As an added benefit, this goal will help me with muscle building for future body building competition.

I will pass the ACSM Clinical Exercise Specialist Certification by May 1, 2012. I will do this by setting up a study schedule for January through March while doing my internship and scheduling the test at their testing center for April. I am going to achieve this goal because it is one of the certifications that meets the graduation requirements for my bachelors program. It is also the highest level certification I am qualified to take and will allow me to work with people with injuries or illnesses in a fitness setting.

I will pass the NSCA Certified Strength and Conditioning Specialist test by May 1, 2012. I will do this by setting up a study schedule for January through March while doing my internship and scheduling the test at their testing center for April. I am going to achieve this goal because I want to fulfill this option for certification as part of my BSEP and it will allow me to work with collegiate and professional athletes.

I will complete the writing of my book by December 31, 2012. I will do this by planning the various chapters and scheduling time at home to write at least 1 chapter per month. I will achieve this goal because I want to help others on their journey to a healthier body and lifestyle.

I will volunteer at physical therapy offices in Fitzgerald, Tifton, and Adel by August 1, 2012. I will do this by meeting with the managers/owners of these locations and scheduling the times with them. I am going to achieve this goal because I need the volunteer hours in order to apply to PT school if I choose to in the future. This goal will also allow me to help those in need of new ideas for exercises while dealing with injury or disease.

I will start my masters in exercise science program at the University of South Florida in Tampa by August 31, 2012. I will achieve this goal by moving, finding a job, getting set up in a GA position, and setting up student loans. I am going to achieve this goal because I want to learn as much as I possibly can about the effects of exercise on the body, how to do different exercises with different populations, and how to do research on the effects of exercise on various diseases and populations.

I will maintain a maximum body fat % of 15% throughout 2012. I will do this by continuing with my healthy eating and exercise plans both at home and at the gym. I am going to achieve this goal because I am happy with where my body is now and feel that it is a healthy starting point for when I start preparing for body building competition in a few years.

I will do all 500+ of my video and DVD workouts by December 31, 2012. I will do this by finishing my inventory and making time at home to do at least 10 per week. I will achieve this goal so I don't feel guilty about buying more. This goal will also allow me to sort through what I have so that I know what I'm willing to part with to donate to others who may need them but can't afford them.

I will make at least 2 quilts by December 31, 2012. I will do this by spending part of my time at home cutting out quilt squares and putting them together. I will also spend a little of my school refund money on batting and backing for them. I am going to achieve this goal because I need to use the material I inherited from my Mom instead of leaving her things unused as a shrine to her and so I can accept the fact that she isn't coming back for them. And I need more quilts because I'm cold! 




Made my body fat goal for the year! Time to set a new goal!!!

Just updated my profile and stats and looked back at my progress for the last year.  I made my body fat % goal for the year!  As some of you know I set my goals for the year instead of making resolutions.  One of my goals was 15% body fat or less per the bioelectrical impedance scale and today I saw 14.5% on the scale!  When I look back at my progress, that's down from 29.5% on the first of the year, so I've literally cut my body fat in half this year.  That's like 30 pounds of fat loss, even with very little loss on the scale (9-ish pounds), so about 20 pounds of lean body mass gained (added muscle and glycogen stored in water).  Goes to show what focus on healthy eating and exercise can do!  For the past few years, I've been too focused on school and not on my eating and exercise.  I may have been ruled out of donating a kidney because of my endometriosis / adenomysosis, but going through the process of trying to donate has certainly focused me on what needs to be done to be healthier, which is why I've seen these results.  Now, it's on to the next goal--Olympia by 50!  Yep, I'm now planning to compete.  I figure I have 4 1/2 more years of school to focus on the right exercise and nutrition plan to get cut and add muscle so that by the time I graduate with my doctorate I'll be ready to start competing in the new physique division after it has passed the new phase and has more set standards.  Then after grad school, I'll have 5-6 years of competition to earn the pro card and make the Olympia by 2022 when I'm 50 years old.  Yeah, I know that sounds old for physique competition, but there were women that age in the Olympia figure division this year, so I'm sure I can do it, too, at that age.  


My new motto:  Dream Big, Achieve Bigger! 

The Secret to Weight Loss is.....


......there is no secret.  High carb, low carb, high fat, low fat, clean eating, eating junk within calorie limits, with exercise, without exercise, whatever.  It all works for someone.  Unfortunately, too many people who find the combination that works for them, think they have found the secret and try to push it on everyone else regardless of whether it is right for them or not.  I've even been guilty of that earlier in my nutrition education.  As I've expanded my knowledge, however, I've realized just how dangerous this can be.  

Each person should evaluate their nutritional needs based on their own specific health issues and fitness needs.  We can't all follow the standard recommendations.  Take Irritable Bowel Syndrome for example.  Different spectrums of IBS will have different needs.  Someone with diarrhea or dumping (when you have to go to the bathroom within an hour of eating) issues can't have a high fiber (IE, lots of whole grains, fruits, and veggies) eating plan or it will make their issues worse. They will need to eat more processed foods so that the fiber has been removed to keep from having problems.  Yes, white bread and junk food is actually better for them then whole grains and fresh fruits and veggies.  Someone with constipation issues, however, will need to focus on the standard recommendations of high fiber (whole grains, fruits, and veggeis) and avoid excess protein (that takes longer to digest) so they should follow more of a vegetarian or low protein plan.  There are a lot of different issues that require the manipulation of nutrition in order to alleviate symptoms.  Diabetics have to watch their carbs and regulate them so that their blood sugar stays fairly even thoroughout the day.  Because they are hyperglycemic, they need to eat in the lower end of the carb range.  Someone with hypoglycemia, on the other hand, has a problem with their blood sugar going too low, so while they still need to manipulate their nutrition to keep their blood sugar up, they should eat more carbs and yes, even simple sugars are good for them.  People with kidney issues have to avoid excessive protein and may even need to be on a low protein (<15%) diet.  People with elevated cancer risk need to be on a low fat (<15%) diet.  Marathon runners need to plan their nutrition for fueling during their activities, which may mean a straight glucose supplement halfway through their race.  Body builders need more carbs (yes I said CARBS) to help them store extra glycogen in the muscles to fuel their lifts and to give the muscle a pumped look, and also to spare their protein intake for actual muscle growth instead of having to be used for energy production.  Small children, pregnant women, and those with nervous system injuries need to consume a higher fat (preferably mono and poly unsaturated fats) diet in order to provide the building blocks of the nervous system.  

Another thing to consider is that not everyone is in the same circumstances emotionally, financially, or culturally to be able to make what most would consider the healthiest choices in foods.  For someone who is going from a 3500 calorie a day diet to a 2000 calorie a day diet, just cutting the calories is a major life change.  Trying to eat perfect foods to live up to the standards of others may be overwhelming for them and a reason to quit making any healthier choices.  So, before offering nutrition advice, or trying to be helpful in saying, switch your processed foods for fresh foods, we should all step back and think about the individual.  Do they have nutritional needs that differ from your own?  Are they making the best choices they can for their circumstances?  Are they making better choices then they did prior to starting their journey?  If you can answer yes to any of those questions, offer encouragement but shut your yap with your advise about the "secret" to weight loss being your plan.  

The Perfect 10 Back-To-School Challenge

Our schools here locally will be starting back in 4 weeks.  Four weeks is also the time it's estimated to take in order to make something a habit.  So, it sounded to me like a great time to make sure we're in the habit of healthy living before starting back to school.  I'm calling this a Perfect 10 challenge, not because we're all going to be perfect 10s on the hottie scale when we're done, but because I want you to aim for doing 10 of the things on the following list each day so that you can estabilish them as healthy habits.  Healthy habits don't necessarily have to be exercise related, either.  Some of the things on this list focus on your physical health, some on nutritional health, and some on mental health.  You don't have to do the same 10 each day.  Just pick any 10.  I know that sounds like a lot, but they are really small things you can do each day to improve your own well being. The numbers on the list are minimus so if you do an hour of cardio, it counts as the 30 minutes of cardio on the list.  You can't double up by doing an hour of cardio and counting it twice either.  ;)  I'm listing both calories and points because I know there are some people following calorie counting plans and others on Weight Watchers.  I don't expect you to do both of those, just one or the other.  If you're not currently counting grams or calories, but wish to start, let me know and I can help you figure your individual needs.  If you don't wish to count those things, there are still plenty of things on this list to be able to meet the 10 without ever doing some of them.  Pick and choose according to your own individual plan.  Please check in daily to say if you were Perfect in your 10.  You can post the 10 things or not, that's up to how much you wish to share.  What you share with me or the world isn't as important as establishing your own healthy habits!  Enjoy!!!!


The List 

  • 30 minutes cardio
  • 30 minutes resistance training
  • 30 minutes circuit training
  • 15 minutes HIIT
  • 15 minutes flexibility training
  • 30 minutes relaxation
  • 5 servings of veggies
  • 3 servings of fruits
  • 2 servings of dairy
  • 2 servings of meat or beans
  • 6 servings of whole grains
  • Eat withing calorie range
  • Eat within points range
  • Eat within carb gram range
  • Eat within fat gram range
  • Eat within protein gram range
  • Drink 64 ounces of water
  • 30 mintues of educational reading
  • 30 minutes of fun reading
  • Do a good deed for someone else

Kidney donation testing rambling--warning probably TMI

So, for the past couple of days, I've been working on the next round of kidney donation testing.  First I had to collect my urine for 24 hours.  Yeah, that's sounds like fun, huh?  Would have been a lot easier if it weren't for the fact that apparently I GO more then the average person.  I had to go back to the hospital halfway through my 24 hours to get another collection jug.  They only give you a single 2 1/2 liter jug unless you ask for more.  So, if you are like me and drink a lot and pee a lot, be sure and ask for a second jug when you pick up the first one.  Oh, and ladies, ask for a hat too.  They don't give you one of those unless you ask either.  I thought they had just given me the male version of the collection kit, but no, they just don't give you the sit down part unless you ask.  Seems strange, but if you ever have to do a 24 hour urine collection, ask for a hat.   ;-)

Couple of really funny things at the registration.  When the lady asked me how I was feeling today as I walked in her office, I said, "Kinda strange carrying around a gallon of pee." and it seriously took her a minute to get the joke since I was literally carrying in the 24 hours of urine.  Then when she gave me the paperwork to sign, there's a form that asks if you are an organ donor.  I'm there to be tested to make sure I can donate a kidney, so being the smart ass I am when she asked if I was an organ donor, I said, "No, I'm just having them harvested for no apparent reason."  Took her a little longer to get that one.  Guess my sense of humor isn't funny to others.  Oh well, I thought I was hilarious, but it could have just been the lack of brain frunction from the 12 hours of fasting prior to going in there.    ;-)

So then I finally get back to the lab part, and the first thing I have to do is give a urine sample. Yeah, apparently the gallon I brought them wasn't enough.  Seemed strange to me, but okay.  Then about 12 vials of blood.  Then drink a 16 ounce bottle of glucose goop that tastes like orange Triaminic and wait 30 minutes.  8 more vials of blood.  30 more minutes of waiting, another vial of blood. An hour of waiting, another vial of blood.  4 total hours at the hospital, 22 vials of blood, and 16 ounces of goop all on an empty stomach.  Yeah, I feel like crap now!  I'm so sluggish from lack of fuel.  I've sucked down 2 different kinds of macaroni and cheese and a liter of Pepsi and I'm slightly better, but still need more fuel.  Unfortunately, my stomach says it has to empty before I can put more in.  LOL  So, in another hour, more food!  Still have to do a TB skin test but at least the worst of the testing is done, so I won't have to do that ridiculous fast again.  Until the next time they want to play Dracula, that is.    ;-)

Determining Body Fat %

Because so many people are talking about body fat percentage as the word gets out that BMI is inaccurate for most people, I figured I would post some about the different ways of determining body composition to help out those who haven't had the experience of body fat analysis yet.  There are several different ways to determine body composition and which one you choose will be based on many factors, from cost to level of comfort with the proceedure to time committment.  The secret to body composition analysis is to pick one method and stick with it.  The ways of determining body composition are not 100% accurate or comparable to each other. So, whatever method you pick, stick with it to compare results to be able to monitor changes over time. So, in order of accuracy (most accurate to least accurate), here are some bits of info on the various body composition analysis methods. 

DEXA Scan: This is like getting an x-ray or CT scan of the whole body. It literally looks at the inside of the body to see what is fat and what is bone, muscles, etc. The drawback to this method is that it only looks at one side (front or back) of the body and assumes that each part of the body is symmetrical all the way around and that isn't necessarily true. For example, some people have larger quadriceps muscles on the front of the legs and more fat around the hamstrings on the back of the leg, or more fat in the stomach then in the low back. Another drawback is that it does use x-rays to determine body fat, and excessive exposure to them can be harmful. Plus, depending on where you live they may or may not be accessible or affordable. 

Hydrostatic Weighing: This is a measurement of what you weigh underwater by measuring water displacement.  It is based on the fact that fat has less density then water and muscle, bones, etc. have a higher density then water so you are essentially only weighing the muscle, bones, etc. in the body. It has been the gold standard of body composition testing for years, but has recently been surpassed by DEXA scanning. The drawbacks are that you have to wear very little clothing while in a lab setting, plus you have to exhale all the air possible and hold your breath while under water to get an accurate reading. Generally, it is only accessible in a lab setting so it can be financially inaccessible. 

Bod Pod: This is a measure similar to hydrostatic weighing only it uses the weight of the body and the air displacement of the body to determine body composition. The drawbacks to this are similar to the hydrostatic weighing. This is also hard to get to in some areas, although some large cities now have more accessible versions. 

Bio-Electrical Impedance: This is the technology used by the body fat scales and the handheld devices. It basically uses an electrical current running through the body to estimate body fat because fat is not as conductive as muscle, bones, water, etc. in the body. There are several different versions of bio impedance though. The most accurate is the version in some gyms that uses an electrode at the hand and another at the foot so that the current goes through the full length of the body. The scale version would be the next most accurate because it measures from foot to foot so that the current flows through the midsection and lower limbs, which is where most people store most of their fat. That being said, it can give a higher reading then the actual body fat % because it assumes that the whole body is just as fat as the area where the current flows. The least accurate is the handheld device because the electrical current flows from hand to hand and through the shoulder region of the body. The reason it is the least accurate is that most people don't carry as much body fat in this area then they do lower in the body, so it will give a lower body fat reading then is actually in the whole body. Because of the differences in the way they determine body composition, there are different charts for what an acceptable body fat is based on the piece of equipment used, so if you choose one of these methods be sure to go by the chart in the book that comes with it. The drawbacks of this method are that hydration level can effect the reading quite a bit. So, if you use this measurement, make sure you are drinking plenty of water, haven't worked out in 12 hours, and don't compare measurements at different times in the menstrual cycle. 

Calipers: Calipers determine body fat based on pinching skinfolds at various places on the body. If you use a formula that uses more skinfold sites on the body it is more accurate then the 1 or 3 site formulas, but they still only measure body fat at the skin level. The drawbacks are that they can't "see" the body fat around the organs (which is the most dangerous body fat) so their accuracy is a lot lower then the other methods. Also, there is a lot of variability in the skill level of the people using the calipers. They can artificially decrease body fat readings by pinching too hard or artificially increase body fat readings by pinching muscle in with the fat. Although they are available at any local supplement shop or online for anyone to use, they should only be trusted when used by someone who is specially trained in using them and can only be compared to their previous measurements if done by the same person due to variability in how each person does the measurements. 

Measurements / Measurement Formulas: These are the least accurate for determining body fat because they can't tell if they are measuring muscle or fat, but they are great for seeing losses not shown on the scale. The formulas used to turn measurements into body fat % vary in accuracy so if you choose this method, be sure to stick with the same formula. This is probably the least expensive way of estimating body composition, but is also the least accurate, so you have to weigh your options.  From the ACE Personal Trainer Manual here are the formulas for figuring this way: 

Body Density for Women = 1.168297 - (0.002824 x abdomen in centimeters) + (0.0000122098 x abdomen in centimeters squared) - (0.000733128 x hips in centimeters) + (0.000510477 x height in centimeters) - (0.000216161 x age) 

Body Density for Men = 1.21142 + (0.00085 x weight in kilograms) - (0.0005 x iliac measurement in centimeters) - (0.00061 x hip in centimeters) - (0.00138 x abdomen in centimeters) 

Once you have body density you get percent fat with the following formula (495 / Body Density) - 450 

The abdomen measurement is at the waist.  The hip measurement is at the fullest part of the butt.  The iliac measurement is the measure around the body at the iliac crest (the bony part of the pelvis at the top), what some call the lower abdominal area as it is typically below the navel.
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