Michael J. Rovito

Cheat Sheet / Updated 03-27-2016

Clinical nutrition is the study of the connection between your body’s overall state of wellness and the foods you eat each day. If you go beyond the details of how diet affects health — how particular nutrients can produce particular health outcomes or what kind of diet most effectively helps you reduce your risk of developing diseases like diabetes, heart diseases, hypertension, and so on — you realize that what you eat really matters. This cheat sheet identifies the diseases that wise dietary decisions can help you avoid, explains what researchers say about common dietary supplements, and introduces you to health behavior terms all clinical nutritionist should know.

Article / Updated 03-26-2016

From the cruciferous vegetable family (home to foods like cabbage, broccoli, cauliflower, and brussels sprouts), kale has enjoyed a surge in popularity in the past few years. Evidence suggests this superfood wards off cancer, helps regulate blood cholesterol levels, reduces the risk of heart disease, and promotes eye health. So eat kale. The following list gives you ten ways to incorporate kale into your diet: Eat it raw. Eating kale raw is a good way to get all the vitamins, minerals, and fiber kale has to offer. Eating it raw can be difficult because of how fibrous the vegetable is and because of its slightly bitter taste. A great way to overcome these challenges is to slice it finely and add it to salads that include sweet elements like raisins or apples to offset the kale’s natural bitterness. Sauté it. Sautéing kale is a good way to break down the hearty fiber. Sauté the kale for about a minute in olive oil with a pinch of sea salt and serve it with lean meats, like chicken breast or turkey. Use it as a substitute for spinach. Any dish you can make with spinach, like dips or quiches, you can just as easily make with kale. To break the texture down a bit, wilt the kale very briefly — place it for 10 seconds or so in a pan — but be careful not to cook it too long because doing so cooks out all the nutrients. Cooking vegetables too long actually breaks down the nutrients in the food. This doesn’t matter if you’re making soup, because the vegetables leak their nutrients into the broth, which you eat anyway. But in canned food, a part of the vitamin content (vitamins B and C, specifically) actually ends up in the water that most people drain off before heating and serving. Make kale chips. Heat olive oil on medium high for 3 to 4 minutes. Chop the kale into 2-x-2-inch pieces. When the oil is hot enough (it sizzles when you place a drop of water in it), place the chopped kale in the oil and cook until slightly crisp. Transfer the chips from the pan to a paper towel and salt to taste. Enjoy. Add it to soup. Add kale to any vegetable, bean-based, or sausage-based soups. As it wilts in the broth, the kale’s nutrient content infuses the whole pot. Make kale smoothies. Sounds odd, but a kale smoothie is delicious and makes for a fantastic snack or breakfast substitute. Place some red berries (like raspberries or strawberries), blueberries, orange juice, a medium-size apple, and a small carrot into your blender. Add a leaf or so of kale and some ice to other ingredients. Then blend it up and enjoy. Put it on pizza. Wilted kale makes for a great topping on any pizza, whether you’ve ordered it in or made it yourself. Mix the kale with some bacon and mushrooms, and you’re on your way to making a truly delicious dinner. Juice it. Whether you drink it on its own or as an ingredient of some other drink, kale juice is great for you . On its own, juiced kale has a strong flavor and smell that takes some getting used to. Try adding a shot or two of kale juice to other juiced fruits and vegetables to help mask the strong flavor. Mix it with pasta. Thinly slice the kale and mix it with any drained, cooked pasta — the heat and moisture from the drained pasta will wilt the kale slightly — and serve the dish with your favorite marinara sauce. Fantastico! Freeze it. A good way to get kale into your diet without tasting it is to freeze it. Place the kale in a clear food storage bag and, after it’s frozen, crush it in the bag. Then sprinkle the frozen kale crumble on top of pretty much whatever you want — mac and cheese, mashed potatoes, ice cream, and so on. You won’t taste it, but you will get all the nutrients. Frozen kale is convenient. It will keep for months and is a great way to incorporate kale in a number of foods you wouldn’t otherwise add it to! Just make sure you keep it frozen because the kale becomes a mushy mess if you let it thaw.

Article / Updated 03-26-2016

Health behavior theory is a field of public health science that tries to deconstruct human behaviors to see why people do the things they do. In other words, it’s a way to evaluate behaviors to uncover what influences them. Using health behavior theory techniques can make your attempts to help others (or even yourself) change health and wellness habits more effective. One popular health behavior theory is the Theory of Planned Behavior. This theory suggests that, if you intend to do something, you will eventually perform the behavior. It also suggests that the following factors influence your intentions to perform a behavior: Behavioral beliefs: Your attitude about the behavior Normative beliefs: Peer pressure and the influence of people in your social circle, such as family and friends, on the behavior Control beliefs: Your perceived ability to physically perform a behavior These beliefs can bolster or undermine your own desires. In other words, even though you may want to change a certain behavior, behavioral, normative, and control beliefs can determine how successful — or not — your efforts will be. How so? Consider a hypothetical example of Tom, a 30-year old man who wants to lose weight and become healthier. He is trying to give up drinking six cans of cola per day to achieve this goal. Here’s how you would use the Theory of Planned Behavior to help Tom achieve his weight-loss and health goals: First, assess his attitude (behavioral beliefs) to find out how he feels about cola. Ask questions about why he drinks cola over other beverage options. Perhaps he loves the taste and the fizz. He doesn't care to for the taste of water because it’s too bland. Then try to uncover information about why he wants to give it up drinking cola and to determine whether he is committed to the effort. Chances are that Tom will answer in one of the two following ways: He is unhappy with his weight or has heard that drinking so many colas per day can lead to obesity, diabetes, or something worse, and he wants to avoid these outcomes. He doesn't really want to do stop drinking cola because he feels it’s not that big of an issue. If Tom’s responses indicate that he doesn’t really want to stop the problematic behavior, you then need to assess his circle of support and other sources of influence on his behavior choices (normative beliefs). Perhaps Tom’s wife is making him give up drinking so much cola per day because she wants him to be healthier. He may not be 100 percent behind the idea, but his partner’s influence over him may be more powerful than his own possible reluctance to give up soda. Now take a look at his control beliefs, or his perceived ability to physically quit drinking six cans of cola per day. In this portion of the assessment, you discover that Tom believes that alternatives to cola, like juice, are too expensive for he and his family to afford, and you know that from his attitudinal assessment (Step 1) that he won’t drink plain water because he needs something with taste. Your challenge in helping Tom cut back on the six cans of cola a day is to help him find an alternative that is both affordable and tasty. All these factors influence Tom’s intention of actually quitting. Combined, some beliefs may be more powerful than others. It all comes down to individual personalities. As you can see, a simple decision to not drink six cans of soda per day can actually be a very complicated behavior. The scenarios you’ll deal with as a nutritionist are often even more complex than this scenario. Therefore, you need to be skilled in the field of health behavior theory. By comprehensively understanding your patients’ decision-making processes, you can provide suggestions and strategies that can more effectively help them alter behaviors to improve their health.

Article / Updated 03-26-2016

Exercise is one of the best things you can do to foster a long, healthy life. Regular, even vigorous, exercise has a positive effect on your overall fitness. It helps you maintain a healthy weight; improves your cardiovascular health, brain functioning, and more; and helps prevent the development of conditions like diabetes, heart disease, stroke . . . the list goes on and on. As beneficial as exercise is, too much exercise, especially when coupled with other unhealthy behaviors, can actually become detrimental and hurt, rather than improve, your health. The Female Athlete Triad is one such scenario in which exercise produces negative health outcomes. Defining the Female Athlete Triad The Female Athlete Triad involves is a condition in which excessive exercise, coupled with other unhealthy behaviors, produces negative, rather than positive, health outcomes. The Female Athlete Triad involves a series of three health conditions: Amenorrhea (menstrual cycle disruption or irregularity) Some type of disordered eating (anorexia, for example) The onset of osteoporosis or decreased bone density at earlier than expected ages (normal bone loss typically begins in a woman’s 40s) Identifying athletes most at risk The Female Athlete Triad is usually seen in younger female athlete populations (high school and college-age women), but can also be seen in females in their 40s. Those most at risk for this health condition are girls and women who participate in sports that require athletes to be thin or lean and that involve rigorous training regimens. Sports whose participants are most vulnerable include gymnastics, figure skating, cheerleading, ballet, and long-distance runners. Understanding how the Triad affects health Usually, the long, arduous training demanded by certain sports and the physical characteristics that participants are encouraged to attain (typically a very slim body shape) lead to a situation in which athletes begin eating very restrictive, unhealthy diets as a way to attain or support the preferred body shape. This combination of behaviors — highly restrictive diets coupled with excessive exercise — produces an environment that affects menstruation and, eventually, bone health. When a person doesn’t have enough body fat (which is used as fuel for activity) and is being forced to exercise at increasingly strenuous levels, the body is placed under excessive stress to keep vital bodily functions working. These functions include Regulating body temperature (females suffering from Female Athlete Triad frequently complain of being cold) Maintaining bone strength Regulating the production and release of hormones, most notably estrogen This series of adverse health events leads to irregular menstrual cycles (lessening estrogen production), osteoporosis (stemming from a poor diet and interrupted estrogen levels), and possibly, if left untreated, death. Recognizing the symptoms To diagnose the condition, health professionals look for these symptoms: Interrupted menstruation Fatigue Frequent stress fractures Unhealthy obsession with being thin or lean Intense caloric restriction Excessive exercising Various mental health concerns, like severe anxiety or even depression Preventing the condition To avoid developing Female Athlete Triad, you can do the following: Ensure you’re getting the appropriate amount of nutrients in your diet. Regulate how intense and lengthy your training program is. Monitor your calorie intake to ensure it doesn’t drop to unhealthy levels. Avoid restricting calorie levels to near starvation levels. Your body mass index (BMI) level should not drop below normal (18.5 BMI). At this level, you body will struggle to maintain its functions. Eat a diet full of calcium and vitamin D. Doing so ensures the development of healthy bones. To get sufficient amounts of calcium and vitamin D from healthy sources, eat dairy products and leafy, green vegetables. Get help. If you struggle with eating healthily or feel that your need to exercise or excessively restrict calories is beyond your control, seek help from a physician. Being healthy is more important than anything else, including sport success. However, with good information and enough training on how to achieve your goals in a healthy way, you can achieve both optimum health and athletic excellence.

Article / Updated 03-26-2016

The digestive system processes the fuel your body needs for survival. This system is one of the most important in your body because it is connected to and works in tandem with almost every other body system. When your digestive system isn’t working properly, you can experience an almost endless series of physical and even mental health effects. Take, for example, the effects of being constipated (lacking regular or satisfying bowel movements). Physical effects of constipation: Constipation can bring on bloating, feelings of fullness, lethargy, abdominal pain, and other physical discomfort. In addition, not being able to empty your bowels is theorized to raise the risk of developing cancer in your intestines. Mental effects of constipation: People often become anxious, nervous, and, if the problem becomes chronic, possibly even depressed. Assuming that no underlying physiological issue — like malfunctioning intestinal motility (the ability of your intestinal wall muscles to move digested food through the bowels — is causing your constipation, the best way to keep your bowels working properly is to keep your diet balanced, healthy, and fresh: Balanced: Eat an appropriate amount of healthy food from each food group to ensure you get the appropriate nutrition. Make sure that approximately 50 percent of your caloric needs come from whole grains and other carbs full of fiber. Also make sure you drink plenty of water. Healthy: Opt for more foods that are lower in saturated fat, salt, and sugar. Examples include fruits, vegetables, lean protein sources, and healthy fats. Fresh: Eat whole, garden-fresh fruits, vegetables, dairy, and meats rather than processed foods. Such a diet ensures that you get plenty of fiber, which helps bulk up stool and provides for faster, easier passage from the body. Additionally, ensure that you get sufficient exercise and that you refrain from smoking and limit your alcohol consumption. Here’s another tip to keep your digestive system working properly: Drink lemon or lime juice in a glass of warm water. This reliable remedy for constipation has been used for thousands of years, and it’s a lot cheaper than expensive fiber supplements. Follow these steps: Mix the juice from half a lime or lemon to warm water and drink it before you go to bed. Overnight, the citrus/water mixture helps loosen you stool. Upon waking, drink another glass of the mixture, wait about 30 minutes, and then attempt to move your bowels. Repeat these steps for a week. If you’re eating and exercising properly but still find yourself constipated, consult a physician. The problem may be medication (some include constipation as a side effect) or stress, or it may indicate a hormonal problem. Your doctor can help you uncover and address the cause.

Article / Updated 03-26-2016

Carrots are filled with beta-carotene, a plant pigment that gives color to vegetables such as carrots, mangoes, and yams. Leafy greens are another major source of this antioxidant. Beta-carotene is the most common and well-known member of the carotenoid family. Carotenoids are compounds that the body converts into vitamin A. This is why people say that eating carrots is good for eyesight because vitamin A is essential for retinal health. Yet ingesting too much beta-carotene may pose a health risk. Carotenemia is a health condition in which very high levels of beta-carotene in your body can give your skin an orangish-yellow tint, a condition called xanthoderma. In most cases, carotenemia results from eating too many foods with high levels of beta-carotene, like carrots, squash, and sweet potatoes. Although carotenemia is a harmless cosmetic issue, new research now suggests that too much beta-carotene cancels out the benefits of vitamin A, which may lead to much more serious health issues, including night blindness and other eye disorders. Carotenemia is common in the following groups: Infants: Commercially prepared baby food has large amounts of carrots and other foods with high levels of beta-carotene in them. Light-complexioned people: Whether they have higher rates of the condition is unknown; however, their light coloring makes the condition more apparent. People who eat a strictly vegetarian diet: Vegetarians typically eat larger amounts of beat-carotene-rich foods than nonvegetarians do. Those who take high levels of beta-carotene supplements: These supplements can lead to the disease. Before panicking and eliminating carrots and other orange vegetables from your diet, take this advice: Relax and enjoy your carrots or pumpkin, just don’t eat too much.

Article / Updated 03-26-2016

Many people take supplements to ensure that they’re getting the right amount of vitamins and minerals and to improve their health. Yet many researchers are on the fence about just how beneficial supplements are and, even more importantly, how safe they are. The following sections identify four of the more popular supplements — multivitamins, fish oil supplements, meal replacers, and energy drinks — explain what each is used for, and summarize what the science says about each supplement’s effectiveness and safety. Before taking any supplement, consult your physician. He or she can give you answers to these very important questions: Do you need the supplement? Is the supplement safe? What is the appropriate amount to take? Do nutrition experts have any concerns about the supplement’s effectiveness? Multivitamins Individuals usually take multivitamins as insurance against future diseases ranging from the cold and flu to cancer. Using what is often called a “shotgun approach” to wellness, many people take a bunch of supplements to avoid as many health issues as possible. Healthy individuals who eat a lean, balanced diet typically do not need to take supplements. However, supplements may be necessary for those with certain health conditions, such as an inability to process certain dietary nutrients, in which case. The supplement is used to augment the diet. Relatively little or no harm comes from taking multivitamin supplements. Fish oil Individuals take omega-3 fatty acid supplements because their anti-inflammatory effects are believed to help reduce risks of cardiovascular and cerebrovascular disease, reduce overall cholesterol, and decrease the risk of cancer. Research is spit on the effectives of these supplements: Some research indicates that omega-3s are anti-inflammatory and may, therefore, provide some protection against cardio- and cerebrovascular disease, high cholesterol, and cancer. Other research suggests that the supplement offers no benefit over a balanced diet that includes appropriate amounts of actual fish (salmon, mackerel, tuna, and sardines, specifically). In addition, recent research suggests that up to 30 percent (perhaps more) of these supplements are mislabeled or are of low quality (some of the supplements that were tested had spoiled, for example, and others had less than the advertised amounts of omega-3s). Meal replacers Meal replacers are usually presented as a powder form and mixed with water or milk to create a smoothie or drink of some sort. Individuals who are on weight-loss programs consume these in place of actual meals to assist with weight loss. If consumed appropriately and in conjunction with an exercise program that burns sufficient calories, people who eat meal replacers can increase their chances of losing weight. However, many treat the meal replacers as beverages to drink with a meal and, as a result, end up gaining weight. Over consuming meal replacers or consuming them in addition to an actual meal can result in toxicity issues with certain nutrients, particularly the fat-soluble vitamins A, D, E, and K. Furthermore, many meal replacers are not regulated by a nutritional assessment board for either effectiveness or safety. Energy drinks Individuals consume energy drinks to feel more energized throughout the day or to achieve enhanced performance. Yet no research exists that proves energy drinks work both effectively and healthily. Energy drinks typically come in one of two varieties — caffeine-based and B-vitamin–based. Here’s what the research says about their effectiveness and safety: Caffeine-based: These supplements can actually harm you more than help you. B vitamin-based: Although these don’t present the problems that caffeine-based ones may, their actual effects may not be worth the price you pay for the supplement. Furthermore, the recommended dosage is determined, not by any nutritional agency (energy drinks are not regulated), but by the manufacturers themselves. More alarmingly, individuals often take more than this recommended amount. A more effective and healthy way for you to stay active and alert throughout your day is to get a good night’s sleep, exercise regularly, eat healthily, and drink plenty of water.

Article / Updated 03-26-2016

According to health behavior theory, sooner or later, the decisions you make now will determine your health and wellness status well into your future. A collection of many variables unique to each individual — his or her perceptions, values, personality, beliefs, habits, cultural influences, family history, and so on — affect disease prevention, health maintenance, and treatment choices. Nutritionists apply the principles of health behavior theory to help alter their patients’ behaviors related to nutrition and healthy living. The following list introduces some of the key terms and variables that create the foundations of the field: Intention: The will of the individual to eventually perform a behavior. According to health behavior theory, a person who intends to do something eventually does it. Therefore, getting a patient to state an intention is a key indicator of whether he or she can successfully make the change. A patient who states that the intention to eat healthily, for example, will, within a specific time period, perform the behavior. Control beliefs: An individual’s perception that he or she can physically perform a behavior. If you recommend that a patient eat two servings of vegetables with every dinner, the individual’s control beliefs would include, for example, whether she believes that she can buy the vegetable, prepare it, and then eat it. Such perceptions weigh into the person’s decision to actually adopt the behavior. Normative beliefs: The generally held beliefs in a society. Normative beliefs impact how the individual believes his peer group will respond to him when he adopts a given behavior. For example, your patient may want to eat vegetables with every meal, but if his spouse, family, or friends are not supportive, or even overtly oppositional, their opposition can produce conflicting feelings in your patient about whether to eat vegetables or not. Behavioral beliefs: How the individual feels about adopting the behavior. Usually called attitude, behavioral beliefs are the core beliefs an individual has about the behavior. For example, does the individual want to actually want to eat vegetables or does she refuse to be told what to do about their health by another person? Perceived severity: The individual’s perception about how serious is the health threat or how negative is the outcome of a given behavior or disease. Behaviors that are perceived to be highly threatening or diseases that are perceived to produce highly negative outcomes are more likely to spur change than those that are perceived to be less threatening or negative. Perceived severity has a more powerful influence on behavior than actual severity. If you perceive that smoking cigarettes isn’t dangerous, for example, you’ll smoke, despite how dangerous smoking really is. Perceived vulnerability: How susceptible to the disease a person believes she is. If a patient believes that she is highly vulnerable to developing cancer because of her dietary choices, she will be more inclined to change her diet to reduce her risk. If she believes that diet has little impact — that is, her perceived vulnerability to getting cancer due to dietary choices is low — she will be less inclined to adopt healthier dietary choices. Cues to action: A system of reminders an individual uses to spur himself to perform a behavior. Cues to action can take the form of peer support, sticky-notes posted on the refrigerator, and so on.

Article / Updated 03-26-2016

A poor diet — one that is high in fat and sugar and low in fiber and nutrients —puts you at risk of developing a variety of preventable diseases and health conditions, like diabetes, high blood pressure, and more. The following table summarizes some of the most prominent health risks associated with poor dietary habits, identifies the dietary component that increases your risk, and offers some tips on how you can change your diet to reduce your risk. Health Issue Description Dietary Component That Puts You at Risk Ways to Reduce Risk Anemia Deficiency of red blood cells Lack of iron Eat lean protein sources, such as shellfish, red meat (occasionally), oatmeal, and beans/legumes. Goiter An enlargement of the thyroid gland Lack of iodine Eat eggs, dairy, seafood, and iodized salt. Neural tube defect Defects, such as spina bifida, caused when the brain and spinal cord do not develop properly in the growing fetus Lack of folic acid in a pregnant woman’s diet Eat whole grains or fortified sources of carbohydrates (wheat flour, for example) or take a prenatal vitamin that has all the essential B vitamins. Rickets (children) or Osteomalacia (adults) Softening of bones due to poor calcification (in children resulting in distorted bones and bow legs) Lack of vitamin D, calcium, and/or phosphorus Eat dairy products and leafy, green vegetables. Celiac disease A gluten intolerance (gluten is a kind of protein found in wheat and other grain products that produces the elastic texture in dough) Ingesting products that contain gluten Avoid foods with gluten, such as wheat, rye, and barley. Acne A skin condition caused by an overproduction of sebum, a natural oil produced by hair and skin Usually hormonal, but outbreaks triggered by certain dietary habits, such as eating refined sugars (elevated blood sugar has been shown to increase risk of acne) Avoid foods that can spike your blood sugar. Hypertension (high blood pressure) A condition in which the force of the blood bumping through your arteries is higher than normal, leading to coronary heart disease, heart and kidney failure, and stroke A diet high in fat and salt Reduce your intake of fat (specifically saturated and trans-fats) and salt. Follow the DASH (Dietary Approach to Stop Hypertension), which focuses on fruits and vegetables, lean meats, and whole grains. Type 2 diabetes A potentially life-threatening condition in which your body either doesn’t use insulin efficiently or doesn’t produce enough insulin to maintain a normal blood-glucose level A diet high in sugar and fat Refrain from over consuming sugars and other refined carbohydrates, and exercise (proper amounts of exercise help regulate blood glucose levels).