Should We Enable Obesity?

By Nancy Clark MS RD CSSD

The joke goes like this: Americans don’t need to build bombs. We just need to export all of our junk food and spread obesity to the rest of the world so we all self-destruct together. Ha-ha-ha. But it’s not really funny, is it. It’s sad.

While attending the Institute of Coaching’s Fifth Annual Conference in Boston along with 700 other health and leadership coaches (, I had the opportunity to listen to public health guru Dr. David Katz spread his health message that we, as a society, need to curb the obesity epidemic. Though you, my readers, are likely fit, I’m sure every one of you has been affected by an overfat relative or friend who is dealing with cancer, heart attack, stroke, and/or diabetes. While they’ve undoubtedly heard the public health messages to eat cleaner and exercise more, they have not felt motivated to make lifestyle changes. Instead, they are suffering from the so-called diseases of aging that are really diseases of inactivity and overnutrition. They aren’t having much fun at the doctors’ offices….

According to well-documented research presented by Dr. Katz, if we don’t stop the obesity epidemic, an estimated 42% of all Americans will be obese in 18 years. One-third will be diabetic. Our kids will die at a younger age than their parents, and the healthcare system will be bankrupt.

By preventing obesity, we can see stunning benefits. That’s why Mayor Michael Bloomberg is working hard to change the obesogenic environment in New York City.  The naysayers may be complaining he is taking away a person’s right to choose, but he’s not taking away soda. NYC is just not enabling that bad choice.

In our modern world, we are victims of our own success. We have engineered out the lifestyle that kept our parents and grandparents fit and strong, including riding bikes to work, walking to school, and hanging laundry outside to dry. We have engineered in processed foods that come in huge portions and taste yummy. No surprise less than 2% of Americans eat the recommend number of fruits and vegetables! How can we motivate people to take better care of themselves? We need to focus on the personal benefits–longer life, less pain, and more fun.

The good news is obesity is strongly linked to behaviors we can control, including the foods we choose to chew and the amount of exercise we get. Granted, other factors also have an impact, including gut microbiota, sleep deprivation, and genetics (and genes can be changed with positive food choices.) So if we will be able to have more fun, let’s do it!

According to Dr. Katz, each one of us has a choice to either help solve the obesity problem, or become part of the problem. We need to build a levy to hold back the flood of fattening foods that pervade our environment. We need lots of individuals to contribute a sandbag or two to the levy. For example, smaller-sized soda pop is one sandbag. More activity is school classrooms in another. Healthier choices in vending machines are a third. The NuVal food ranking system is a fourth. (NuVal ranks foods according to healthfulness so that consumers in 1,700 supermarkets across the country can easily compare foods to determine the better loaf of bread, brand of soup, and better choice of any food.)

Employers who encourage their staff to exercise contribute a very effective sandbag and they get a good return on that investment. Not only are their employees healthier and take fewer sick days (think lower healthcare costs), they are happier and more productive. The Cleveland Clinic’s employee wellness program has saved millions of health care dollars. The clinic has made changes in the work environment that has transformed the disease-inducing culture to a culture of wellness with loss of 330,000 pounds in five years.

If you want to take steps to change your work environment, check out You’ll find lots of ideas and toolkits, including how to create a program that encourages people to take the stairs not the elevator, and how to improve vending machine choices. Hospital workers might want to pass along this URL to an influential VIP. The goal of the initiative is to enroll at least 2,000 hospitals over the next three years to buy and serve healthier foods.

For your own personal activity program, take a peek at Activity Bursts Everywhere offers free activity videos that last from 3 to 8 minutes. The videos are organized by setting (office, home, waiting room), body part involved (lower body, upper body), and whether the exercise is performed standing or seated. Pass along the info to your friends and relatives who have “no time” to exercise; they’ll lose all excuses for why they cannot get a few more minutes of activity each workday.

Empowering kids to be active is an essential health initiative. If you are a parent or a teacher, check out www.ABCfor (Activity Bursts in Classrooms). These fun exercise videos insert educational activity into the curriculum during downtimes when the kids aren’t really learning anything (before lunch, end of the school day). Dr. Katz believes the answer to hyperactive kids can be more activity, not more Ritalin.

Not everyone loses weight easily, so Dr. Katz has started a website for frustrated dieters, (National Exchange for Weight Loss Resistance). This site wants to connect frustrated dieters with researchers so we can find solutions to the “Why can’t I lose weight?” problem. Maybe you know someone who can contribute his or her experiences.

While changing the work and school environments is helpful, lasting changes really need to be made at the family level. Kids are a driving force; they have the power to change parents’ food and exercise habits. Kids are unlikely to make choices based on health, but rather on pleasure. When they understand that health means more fun, they’ll start making the right choices–just like victorious sports teams that win with good nutrition. Unjunk Yourself, a YouTube video for teens ( gets kids (of all ages) to think more about choosing what they chew. Isn’t it time for us to all work together to make it cool to fuel well?


 Nancy Clark, MS, RD, CSSD (Board Certified Specialist in Sports Dietetics) counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her Sports Nutrition Guidebook and food guides for new runners, marathoners, and soccer players offer additional information. They are available at and

Undesired Sideliners: Side Stitches and Runner’s Trots

By Nancy Clark MS RD CSSD

“I’m afraid to eat before I exercise … I might get a side stitch.”

“I always carry toilet paper with me when I go on a long run.”

“How can I change my sports diet to so I don’t need pit stops..???”

Little is more frustrating to a competitive athlete than to be well trained for an event and then get sidelined with a side stitch or diarrhea. Yes, the sports diet that’s intended to enhance your performance can also bring you to a screeching halt! Sound familiar?

Transit troubles and gastrointestinal (GI) concerns are common among athletes, particularly those who run and jostle their intestines. An estimated 30 to 50% of distance runners experience exercise-related intestinal problems, with women experiencing more problems than do men.

If you are among the many active people who fear side stitches, loose stools, and GI distress, keep reading. The goal of this article is to offer some information and advice that can help you manage, if not reduce, your transit troubles.

Side stitches

A side stitch—that stabbing pain in your gut that can bring you to a stand-still—is familiar to about 60% of athletes. Because getting attacked by a side stitch is unpredictable (that is, one day you might get one but the next day you don’t), they are hard to research.  The available data suggests they commonly occur in the same spot: on the upper right side of the abdomen where the liver is attached to the diaphragm by two ligaments.

While we aren’t 100% certain what causes a side stitch, the prevailing theory is exercise creates stress on the ligaments that connect the liver to the diaphragm. Stitches can be provoked by a heavy dose of pre-exercise food/fluids, minimal training and inadequate pre-exercise warm-up. Wearing a tight belt can help reduce organ jostling and reduce the symptoms. You could also record your food and fluid intake to try to detect triggers (too much pre-exercise water? too large a meal?). With repeated dietary tweaks, you can hopefully discover a tolerable portion of pre-exercise fuel.

To treat a side stitch, many athletes bend forward, stretch the affected side, breathe deeply from the belly, push up on the affected area, tighten the abdominal muscles, and/or change from “shallow” to “deep” breathing. (Pretend you are blowing out candles while exhaling with pursed lips.)

Dreaded diarrhea

Marathoner Bill Rodgers may have been right when he commented more marathons are won or lost at the porta-toilets than they are at the dinner table! Diarrhea is a major concern for many athletes, particularly those who run. Understandably so. Running jostles the intestines, reduces blood flow to the intestines as the body sends more blood to the exercising muscles, stimulates changes in intestinal hormones that hasten transit time, alters absorption rate, and contributes to dehydration-based diarrhea. Add some stress, pre-event jitters, high intensity effort—and it’s no wonder athletes (particularly novices whose bodies are yet unaccustomed to the stress of hard exercise) fret about “runners’ trots.”

Exercise—specifically more exercise than your body is accustomed to doing—speeds up GI transit time. (Strength- training also accelerated transit time from an average of 44 hours to 20 hours in healthy, untrained 60-year old men.) As your body adjusts to the exercise, your intestines may resume standard bowel patterns. But not always, as witnessed by the number of experienced runners who carry toilet paper with them while running. (They also know the whereabouts of every public toilet on the route!) Athletes with pre-existing GI conditions, such as irritable bowel or lactose intolerance, commonly deal with runners’ trots.


Solutions for  intestinal rebellion

To help alleviate undesired pit stops, try exercising lightly before a harder workout to help empty your bowels.  Also experiment with training at different times of the day. If you are a morning runner, drink a warm beverage (tea, coffee, water) to stimulate a bowel movement; then allow time to sit on the toilet to do your business prior to exercising. When exercising, visualize yourself having no intestinal problems. A positive mindset (as opposed to useless fretting) may control the problem.

The following nutrition tips might help you fuel wisely and reduce the symptoms:


1) Eat less high fiber cereal. Fiber increases fecal bulk and movement, thereby reducing transit time. High fiber = High risk of distress. Triathletes with a high fiber intake reported more GI complaints than those with a lower fiber intake.


2) Limit “sugar-free” gum, candies and foods that contain sorbitol, a type of sugar that can cause diarrhea.


3) Keep a food & diarrhea chart to pinpoint food triggers. For a week, eliminate any suspicious foods–excessive  intakes of juice, coffee, fresh or dried fruits, beans, lentils, milk, high fiber breads and cereals, gels, commercial sports foods. Next,  eat a big dose of the suspected food and observe changes in bowel movements. If you stop having diarrhea when you cut out bran cereal, but have a worrisome situation when you eat an extra-large portion, the answer becomes obvious: eat less bran cereal.


4) Learn your personal transit time by eating sesame seeds, corn or beets–foods that can be seen in feces. Because food moves through most people’s intestines in 1 to 3 days, the trigger may be a food you ate a few days ago.


5) Stay well hydrated. GI complaints are common in runners who have lost more than 4% of their body weight in sweat. (That’s 6 lb. for a 150 lb. athlete.) Runners may think they got diarrhea because of the sports drink they consumed, but the diarrhea might have been related to dehydration.


6) When all else fails, you might want to consult with your doctor about timely use of anti-diarrhea medicine, such as Immodium. Perhaps that will be your saving grace.


The bottom line

You are not alone with your concerns. Yet, your body is unique and you need to experiment with different food and exercise patterns to find a solution that brings peacefulness to your exercise program.



Nancy Clark MS RD CSSD (Board Certified Specialist in Sports Dietetics) counsels both casual and competitive athletes in her practice at Healthworks, the premier fitness center in Chestnut Hill MA (617-383-6100). Her Sports Nutrition Guidebook and food guides for new runners, marathoners, cyclists and soccer players are available at See also



Healthy Lunches and Healthy Snacks for Healthy Kids

By Barbara Day, M.S., R.D., C.N.

            When my sons were in school, I always made brown bag lunches for them.  In high school, they usually took extra money to enhance the lunch that I provided  because they were growing boys who needed lot of extra calories.  Trying to come up with lunch choices that would taste good by noon after being stuck in their warm locker all morning  was a challenge.  But, today’s children have more options to keep their brown bag lunches at an optimal temperature.  Food safety has become paramount.  But the bottom line is what you pack for your child must be something they will actually eat.  If they are trading the lunch you pack or simply not eating it –  what’s the point.  Here’s some suggestions.

Rules for Packing Lunches for Your Kids That They Will Actually Eat

  1. Talk with your child about lunch likes and dislikes and what works and what doesn’t.  A bag lunch is different from a fresh lunch.
  2. Get your children involved with the process.  Don’t send things the child does not like.
  3. Come up with a list of foods that your child would like to eat at lunch – not one that you want him/her to eat.  The trading game is very popular.
  4. Rotate the lunches so your child will not tire of the same old thing – plus a variety of foods offer a variety of nutrients.
  5. Purchase an insulated lunch box to ensure that foods are kept at their proper temperature and wash it routinely to prevent bacteria buildup.
  6. Pack hot foods in a thermos – as long as your child can remember to bring it home.
  7. Keep cold foods cold by using an ice pack or freezing juice boxes.  Juices will be thawed out by lunchtime and will be good and cold to drink, too.
  8. Stay away from pre-packed lunch-ables – they are high in fat and calories and low in nutrients.  They are expensive as well.
  9. Keep the lunch simple.


Sandwich choices:

•     Use a variety of breads: bagels, rolls, pita pockets, English Muffins, raisin or multigrain bread.

•     For the younger children, you can use cookie cutters such as a star or triangle to make some designer sandwiches that will be fun to eat.


Protein choices:

•     Luncheon meats – lean cuts of turkey, ham, or roast beef.  For the artistic parent of a younger child, you can get thicker cuts of meat and use a cookie cutter to design the protein source as well as the bread.

•     Chicken, tuna or egg salad using light mayonnaise or salad dressing. Besides using bread you can serve in a pita pocket or in a small cup or container.

•     Add raisins, Cinnamon Trail Mix (see recipe below) or granola to add some pizzaz to the plain peanut butter and jelly sandwich for added nutrients and added crunch.

•     To boost the protein and calcium in the lunch, pack a slice of string cheese or add

cheese slices to the sandwiches.

•     You can also add a container of yogurt which will boost the protein and calcium content.  Yogurt can also serve as a dessert.


Vegetable Attack

•     Pack raw vegetables such as carrot, peppers, cucumbers or celery sticks. Serve with fat free plain yogurt  dip or fat free sour cream dip which provides a good source of calcium ((Fat Free Flavored Dip see recipe below).

•     Add vegetables slices to the sandwiches such as tomatoes, green, red or yellow peppers and a deep green lettuce or spinach to boost the nutrient content of the sandwich.


Healthy Snacks for Healthy Kids


Snacking is an important part of growing up. Growing kids need to snack but  making good snack choices is a challenge especially since there are many not so good snacks on the market.  And, kids see all those enticing commercials on TV that offer some very poor snack choices.  Parents are often pressured into purchasing these types of snacks as a result. But, keep in mind parents are in the drivers seat, not the children.  You are the gate keeper as to what comes into the house to eat.


Snack Ideas


Graham crackers

Whole-wheat crackers like Triskets® (you can reduced fat ones, too)

Spicy Cinnamon Trail Mix (see recipe below)

Granola bars

Frosted miniWheats® (made with whole grains)

Yogurt  (you can add whole grain Grape Nuts® for an added crunch and extra nutrients)

Homemade tortilla chips, bagel chips (see recipes in the October issue of KHF Magazine) or pita crisps with chunky salsa or with Fat Free Flavored Dip (see recipe below)

Frozen Fruit Nuggets (see recipe below)

Fruit Smoothies (fresh fruit, yogurt, milk, ice and put in a blender)

Pizza Bagel –  add a little pizza sauce, mozzarella cheese, and fresh veggies then  place under broiler until heated


Crunchy GORP

Makes: 1 serving

Nutritional Information: 296 calories, 9 gram of fat, 4 grams of fiber, 259 milligrams of sodium, 8 grams of protein, 51 grams of carbohydrate, 69 milligrams of calcium

Preparation time: 5 minutes


¼ cup Wheat Chex

¼ cup Corn Chex

¼ cup pretzels

¼ cup raisins

2 tablespoons peanuts

Combine all the ingredients in bag.  Shake it up.  Then enjoy!


Frozen Fruit Nuggets

Grapes, bananas, strawberries, blueberries, raspberries watermelon, cantaloupe, peaches or other fruits.


Clean as needed.  Cut fruit into bite-sized pieces.  Spread fruit on a cookie sheet and cover.  Put into freezer for 1 hour.  Place individual pieces into baggies and store in the frezzer.  (You can also buy frozen fruit in the frozen section of your supermarket.  Make sure they have no added sugar)


Cinnamon Trail Mix

Makes: 10 servings

Nutritional Information: 156 calories, 2 gram of fat, 2 grams of fiber, 222 milligrams of sodium, 3 grams of protein, 33 grams of carbohydrate, 45 milligrams of calcium

Preparation time: 5 minutes  Baking time: 20 minutes


3 cups oat squares cereal

3 cups mini-pretzels

2 tablespoons margarine, melted

1 tablespoon brown sugar packed

½ – ¾  teaspoon cinnamon*

1 cup raisins or other dried fruit


*If you like the cinnamon taste – use more cinnamon.


Preheat oven to 325 degrees.  Combine the oat squares in a large plastic bag or plastic container with a lid.  Melt margarine.  Add brown sugar and cinnamon to melted margarine.  Mix well. Pour this mixture over the cereal mixture.  Mix well by gently shaking until well coated.  Pour mixture onto a baking sheet.  Bake uncovered for 15 – 20 minutes stirring once or twice.  Completely cool.  Then add raisins or other dried fruit.  Store in airtight container or small zip-lock individual bags.



Fat-Free Flavored Dip

Makes: 16 – 2 tablespoon servings

Nutritional Information: 25 calories, 0 gram of fat, 0 grams of fiber, 260 milligrams of sodium, 2 grams of protein, 4 grams of carbohydrate, 40 milligrams of calcium

Preparation time: 5 minutes


1 eight-ounce container of fat-free plain yogurt or sour cream

(you can use reduced fat or light yogurt or sour cream as well)

1 package of onion soup mix, vegetable dip mix or other mixes


Combine  yogurt/sour cream with package mix and blend well.  Serve with veggies, baked tortilla chips, bagel chips or pita crisps. 

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition,, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, Barbara writes nutrition and health columns for as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 12 grandchildren.    



Back to School with Allergies and Asthma

by James Sublett, M.D.

When most parents think about preparing for a new school year, the first thing that comes to mind is probably school supplies – books, folders, backpacks, clothes, etc.  But as a parent of a child with allergies or asthma, a return to school can involve a whole different type of preparation.

School children with allergies and asthma must learn how to manage their environments before the environment takes control of their health.  While at home, allergies and asthma are more effectively managed because parents can ensure the carpets are regularly vacuumed, furniture dusted, filters changed, mold killed, foods eliminated, etc.  But at school, you can’t always protect your child from the allergens that might induce an allergy or asthma attack.  So what can you do to safely prepare your child for a return to school?

  • Meet with the school nurse, administrator and teacher to make sure they understand your child’s allergies and/or asthma. Bring along a letter from your allergist outlining your child’s asthma/allergies in detail, precautions that need to be followed and the prescribed medication and treatment plans. Make copies of this letter for the nurse, teachers and for your child’s file. You have the right to ask that potted plants be removed from classrooms (they grow mold), class pets be avoided (pets can trigger attacks) or windows be closed while the grass is being mowed.
  • If your child has food allergies also request a meeting with the cafeteria manager.  Provide the school with written instructions for response to any allergic reaction, administration of medications and phone numbers to use in case of emergency.  Make sure all involved understand the severity of food allergies.  If your child has peanut allergies, request a “peanut-free” lunch table.
  • By law, children are allowed to carry inhalers and Epi-pens with them, instead of having to store them in the school office.  Still, be sure the teacher and school nurse understand how to use these in case the child cannot administer on his own.
  • Ask school administrators to inform you in advance of renovation or construction repairs, such as new carpeting, painting, removing ceiling tiles, resurfacing the parking areas or tarring the roof. Fumes and dust from these activities can be bothersome to even the healthiest of lungs and nasal passages; however, to a child with asthma or allergies, the irritants can trigger the inflammatory process and bring on days or weeks of symptoms.
  • If your child suffers from exercise-induced asthma, meet with the physical education teacher and discuss inhaler use if needed or other measures to reduce triggering symptoms.

If the child is old enough, he or she can also take an active role in controlling allergies at school. Allow the child to be in charge of packing his own lunch.  Make sure plenty of “allowable” food is included so he can share with friends. This way the child can feel his or her food is appealing.  When snacks or treats are brought into school, allow your food-allergic child to bring his own treat so he may also take part.  If the parents and classmates are aware of the child’s food allergy, many will try to bring something your child can eat.

Children with asthma miss more than 10 million school days a year in the U.S. When you add allergies to the equation, the numbers soar even higher. However, with the right precautions, the school environment should be a healthy place for your child to learn and grow.  Contact your local allergist/immunologists with any questions about additional steps that can be taken to ensure your child has a healthy return to school.

James L. Sublett, M.D., is a clinical professor and section chief of pediatric allergy at the University of Louisville School of Medicine. He is also Co-Founder andManaging Partner of Family Allergy & Asthma (, a multi-site allergy practice with offices throughout KY and  southern Indiana.



Calories, Protein, Carbohydrate (CHO), Fat, Sodium, Fiber and Calcium Recommendations for Children*

By Barbara Day, M.S., R.D., C.N.

If we are going to conquer childhood obesity, responsible parents need to know how many calories their children need and how many calories their children are actually eating per day.  In addition, if you children are playing sports, knowing their calorie needs will help to ensure they are getting enough to eat for their sport and for growth, too.

Keeping a Food Diary/Journal to get an idea of how many calories your child is eating at mealtime, between meals, types and amounts of fluids are drinking is an effective way to track calories.  There are many apps that are FREE that you can use to help with this process. Patents can also get most nutritional information from food labels as well. Meat and seafood along with produce typically have nutrition information listed at the meat & fresh produce department. Matching the calories eaten versus the calories required will help parents to determine what strategies need to be employed to help their child lose or gain weight or excel at their sports.

If your child goes to a Jefferson County Public School (JCPS), you can go online and get the nutritional information for the breakfast and lunch menus. If I were a JCPS parent, I would ask JCSP to add the calories to all their menus posted online to make it easier for busy parents to help them steer their children into making good choices at school. Today, you can get the information online in many PDFs and you have to sift through all the information yourself. (  If restaurants are required to post calories for all their menu items, schools should also be required to post their calories as well for convenience. At JCPS, lunches have gone up $.10 each lunch meal for regular paid students to pay for all the new healthier choices offered by the USDA School Lunch Program.        

Below are tables that will be useful to get an idea of how many calories & macronutrients you child would need each day. You can also use the online calculator to get a better estimate.


Table 1: Nutritional Needs for kids age 2 – 3.


Girls & Boys: ages 2 -3

Calories (kcal)

1000 – 1400 depending on growth & activity level

Protein (g) 5 – 20%

13 to 50 g for 1000 kcal

CHO (g) 45 – 65%

113 – 163 g for 1000 kcal

Fat (g) 30 – 40%

33 – 44 g 1000

Sodium (mg)

1000 mg

Dietary Fiber (g)

14 – 20 grams

Calcium (mg)

700 mg


Table 2: Nutritional Needs for girls ages 4 to 18.


Nutrient Girls ages 4 – 8 Girls ages 9 – 13 Girls ages 14 – 18
Calories (kcal) 1200 – 1800 1400 – 2200 1800 – 2400
Protein (g) 10-30% kcal 30 – 90 g for 1200 kcal 35 – 105 g for 1200 kcal 45 – 135 g for 1200 kcal
CHO (g) 45 – 65% kcal 135 – 195 g for 1200 kcal 158 – 228 g for 1400 kcal 203 – 293 g for 1800 kcal
Fat (g) 25 35% kcal 33 – 47 g for 1200 kcal 39 – 54 g for 1400 kcal 50 – 70 g for 1800 kcal
Sodium (mg) 1200 mg per day 1500 mg per day 1500 mg per day
Dietary Fiber  (g) 17 – 25 g/day 20 – 31 g/day 25 – 34 g/day
Calcium (mg) 1000 mg/day 1300 mg/day 1300 mg/day


Table 3: Nutritional Needs for boys ages 4 to 18.


Nutrient Boys ages 4 – 8 Boys ages 9 – 13 Boys ages 14 – 18
Calories (kcal) 1200 – 2000 1600 – 2600 2000 – 3200
Protein (g) 10-30% kcal 30 – 90 g for 1200 kcal 40 – 120 g for 1600 kcal 50 – 150 g for 2000 kcal
CHO (g) 45 – 65% kcal 135 – 195 g for 1200 kcal 180 – 260 g for 1600 kcal 225 – 325 g for 2000 kcal
Fat (g) 25 35% kcal 33 – 47 g for 1200 kcal 44 – 62 g for 1600 kcal 56 – 78 g for 2000 kcal
Sodium (mg) 1200 mg per day 1500 mg per day 1500 mg per day
Fiber  (g) 17 – 25 g/day 22 – 36 g/day 28 – 45 g/day
Calcium (mg) 1000 mg/day 1300 mg/day 1300 mg/day


*Based on the 2010 Dietary Guidelines for Americans.


Here’s an online calculator that you can use to determine your child’s calories based on gender, age and activity level.

Activity Level Definitions:  

Sedentary: a lifestyle that includes only the light physical activity associated with typical day-to-day life.

Moderately active: a lifestyle that includes physical activity equivalent to walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day.

Active: a lifestyle that includes physical activity equivalent to walking more than 3 miles per day at 3 to 4 miles per hour, in addition to the light physical associated with typical day-to-day life.

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition,, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, Barbara writes nutrition and health columns for as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 12 grandchildren.    


Sunscreen Safety

By Ashley Barnes

It’s already hot and sunny here in Kentuckiana and my girls have been enjoying the neighbor’s pool for hours on end.  Their pink cheeks and emerging tan lines reminds me that it’s time start buying sunscreen again.   The easiest choice is to hit my local discount store for some SPF 75+ and hit the pool, right?   Well, maybe not.  Not all sunscreens are created equal — or safe.  Each year the Environmental Working Group (EWG) releases information about the safety and efficacy of hundreds of sunscreen products.  Here’s some things to keep in mind for 2011.

Not all active ingredients are made equal
Sunscreen has a noble mission, but it’s also made up of active ingredients, not all of which are safe or beneficial.  Oxybenzone, the most common ingredient, is a associated with allergic reactions as well as potential hormone disruption, and experts have called on parents to avoid using it on children.  Women dealing with hormonal imbalances should avoid putting anything on their bodies that could further disrupt their hormones either.  So read the labels.  Chemicals such as Avobenzone, Mexoryl XS, zinc, and titanium have the lowest concern for human exposure and toxicity.  Also, choose a cream or lotion over a spray or powder, to avoid inhaling small particles (particularly zinc and titanium nanoparticles) that that may also be harmful to breathe.  Finally, purchase new sunscreen every year.  The active ingredients become less potent over time and therefore offer less skin protection.

High SPF isn’t necessarily best
Claims of high SPF can be misleading and give a false sense of security.  Most people do not put on enough sunscreen initially or reapply often enough for the higher SPF to make a difference.  Then they stay out longer, thinking they’re protected by the higher SPF, and get as many sunburns as those using a lower SPF sunscreen. Choose a sunscreen with lower SPF (15-50), reapply often, limit your direct sunlight exposure, and use natural shade, light clothing, and/or a hat to better protect your skin.

The problem with Vitamin A 
Vitamin A, an antioxidant, is used in many body lotions and face creams to help slow skin aging.  However, limited FDA studies have shown that vitamin A in the forms retinyl palmitate or retinol has photocarcinogenic properties that may speed the development of skin tumors and lesions.  More testing is needed, but why not be safe in the meantime?  About 30% of sunscreens contain vitamin A, so again, always read the labels and choose a sunscreen without this potentially dangerous ingredient.

Get your Vitamin D
If you’re going to spend more than 20-30 minutes in direct sunlight, it’s definitely important to protect your skin from damage.  However, we need natural sunlight to produce adequate amounts of vitamin D, which helps to keep our bones strong and healthy and supports our immune system.  Unfortunately, many people are low or even deficient in vitamin D due to our largely indoor lives.  So get some direct sunlight exposure every day during the summer months, get your vitamin D levels checked regularly, and ask your health practitioner about supplementing if you’re low.

Prevent Sunburn from the Inside Out
In addition to protecting your skin while you’re in the sun, you can also incorporate foods into your diet that will help boost your body’s internal sunblock.  Foods rich in lycopene and beta-carotene have been shown in studies to have a protective effect for your skin.  Tomatoes and watermelon are standard summer foods that are both rich in lycopene.  Beta-carotene (an antioxidant) is found in colorful fruits and vegetables, as well as leafy green vegetables.  Load up on your favorite red, yellow, orange, and green foods such as carrots, red, yellow, or orange bell peppers, mangoes, apricots, melons, tomatoes, kale, spinach, and broccoli. Combining healthy food choices with safe skin protection is a great start to a fun and healthy summer!

Be sure to check out EWG’s website to read the complete Sunscreen Guide, including the best (and worst) sunscreens, lip balms, moisturizers, and makeups, additional sun safety tips, and even a free iPhone app!

Ashley Barnes is a holistic health coach supporting women facing serious health and life challenges with finding a healthy diet, stress reduction, personal empowerment, and spiritual practice .  She trained with the Institute for Integrative Nutrition in NYC and also has an M.S. in Training & Employee Development and a B.S. in Psychology.  To schedule a FREE Discovery Session, contact Ashley at (502) 889-7955 or visit


Universal Break-Up Truths

By Kathryn Berlá, Ed.D.

Lately I have had several friends go through rough break-ups.  I’m talking about divorce-caliber break-ups—the kind where one’s whole idea of the future gets turned on its head.  I am hearing a few variations on the it-was-all-so-perfect-until-she-just-up-and-left-me theme, which I know from years of professional experience is really code for “There were problems in the relationship that I just didn’t want to acknowledge, and I am now so broken that I don’t think I will ever know a moment’s happiness again for the rest of my life.”

It is important to remember that during the shock and grief stage of a break-up, there are certain tricks the mind can play on you. Looking at life through the lens of depression can lead to distorted thinking.  What is remarkable is how universal the pattern of distortion can be.  That is, there are universal “truths” that almost everyone comes to believe when in the throes of post-relationship anguish.  Since the “truths” are rarely ever really true, it is helpful to identify and acknowledge them as a way to ultimately surmount them.  What follows is a brief description of “truths” that at one time or another may have been “true” for you:

Truth: Everything, everywhere reminds you of your ex, all the time. Remember on Grey’s Anatomy when Meredith broke up with McDreamy for the first time.  She opined to her friend that she would never be able to look at another ferry boat again for as long as she lived because McDreamy liked ferry boats and she never cared about ferry boats until McDreamy talked about them and now ferry boats were ruined for her forever? It is a universal truth that a painful break-up will lead you to avoid, dread, or loathe certain objects, days of the year, songs or other entities because they remind you of your ex.  Things that never had a lick of significance to you now take on gargantuan importance. Like now you can never read the works of Voltaire because your that was your ex’s dissertation topic.  The Bangles make you cry because your ex had a broken “Doll Revolution” CD cover on the floor of her car. You can’t get out of bed on the first Thursday of every month because that was your ex’s bowling league night. You can’t engage in normal daily activities without wondering if your ex is doing the same. Everything around you becomes a potential minefield of pain.  You switch your brand of toothpaste because the old one was the one your ex used. You feel betrayed by friends who still have contact with your ex.  You feel similarly betrayed by things like tap water.  And air.

Truth: You will never have anything fabulous in your life again/your ex will have everything fabulous. Part of the significance of this truth is the inverse relationship that your level of misery has with the level of joy that your ex is feeling.  You believe that not only will you never eke out an iota of enjoyment of life again ever, but just as importantly, your ex is living an ecstatic existence right this very moment that will last forever! You are at home on Saturday night reorganizing your Netflix queue while your ex is out doing something popular, exciting, sexy, and expensive with other attractive people.  You see no reasonable prospect for anything different on your horizon, and you anticipate nothing but smooth sailing for your ex, who clearly has only experienced a change for the better and who is having so much fun that he or she doesn’t have room in their brain for any lingering thoughts of you.  Meanwhile your thoughts…(well, refer back to the previous “truth.”)

Truth: Your ex’s new date is better than your new date. Your ex-boyfriend will soon be dating Jessica Biel. You are relegated to the fix-up by the person in your office who has a buddy from Kling-on camp that he wants to introduce you to. Yep, that’s how it works. After a devastating college break-up, I came to embrace the “truth” that my ex-boyfriend was going to end up with Mariah Carey, or someone who looked just like her.  (Hey—it was 1991—I was only twenty, and she was hot back then.  It was before the marriage to Tommy Mottola and all the rehab.  It was a different world.) Since then, “Mariah Carey” has come to be the code name for all my exes’ future girlfriends and wives.  You have a “Mariah Carey” too, if you are just honest with yourself.  When going through and end-of-the-world break-up, there is someone that is your best worst fantasy of who your ex will end up with that will make them much happier than you did.  It might be a celebrity like Mariah Carey or it might be a real life hot person that your ex once commented upon regarding their hotness.  Whichever it is, that is who you believe you will see on your ex’s arm the next time you are picking up carry-out for another exciting Netflix Friday night.  They will be at the corner table looking well-coiffed, smug and delighted. You will be wearing sweats.  The ones with the paint stains.

Truth: Your ex was your last best chance. It happens every time—whichever relationship just ended was your last reasonable shot ever and for all time at having a soul-mate, partner, and/or best friend.  You are convinced you will never meaningfully connect with another human being– never ever ever again.  You might as well get a head start on collecting those 78 cats that will be your only solace and companionship in your waning years.  You rent “GreyGardens” and start thinking that headscarves might be a good look for you too.  You. Are. Doomed. To. Be. Alone. Always.

Except that you’re not. Remember, this is flawed thinking. It is your grief talking. Once you have known enough people in the same position, you realize that this is simply part of the routine.  Do you really look around at all the newly single people you know and believe in your heart that they will be single forever?  Then why do you believe it about yourself?  You may be special, but you are just not that uniquely tragic.  It may have some romantic appeal to think that you will suffer so nobly for the rest of your life, so if you need to hang onto that belief for now, go ahead.  I will hold the hope for you until you are in a place where you can take it back for yourself. That time will come eventually.  And that’s the real truth.

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Dr. Kathryn Berlá, Ed.D. is a licensed psychologist in private practice in Louisville. She can be reached at 412-2226 or at




James L. Sublett MD, FACAAI

  1. No smoking inside the home at any time.
  2. Measure the indoor humidity and keep it below 50%.  Do not use vaporizers or humidifiers. You may need a dehumidifier. Use vent fans in bathrooms and when cooking to remove moisture. Repair all water leaks.
  3. Remove wall-to-wall carpets from the bedroom if possible. Use a central vacuum or a vacuum with a HEPA filter regularly. Remember it takes over 2 hours for the dust to settle back down.
  4. Keep pets out of the bedroom at ALL times. Use a HEPA Air Cleaner in the bedroom with an adequate CADR (Clean Air Delivery Rate) for the size of the room.
  5. Encase mattresses and pillows with “mite-proof” covers; Wash all bed linens regularly using hot water.
  6. Install a high efficiency media filter with a MERV rating of 12 in the furnace and air-conditioning unit.
  7. Leave the fan on to create a “whole house” air filter that removes particles that may cause allergies.
  8. Change the filter every three months (with the change of the seasons) to keep the air cleaner year round.
  9. Have your heating and air-conditioning units inspected and serviced every six months.
  10. Gas appliances and fireplaces should be vented to the outside and maintained regularly.


James L. Sublett, M.D., is a clinical professor and section chief of pediatric allergy at the University of Louisville School of Medicine. He is also Co-Founder and Managing Partner of Family Allergy & Asthma (, a multi-site allergy practice with offices throughout KY and  southern Indiana.


Little Sneezers to Chronic Wheezers – the Role of Allergy in Asthma

James L. Sublett MD FACAAI

 “But, Dr. Sublett, I understood that Johnny would probably outgrow his asthma.”

This all too frequent a parental lament, from the mother of an eight-year-old asthmatic, is one of the most understood myths about childhood asthma. In fact, the life-long severity of asthma is established between the ages of six to nine. Asthma, because it is an episodic disease, will wax and wane throughout an individual’s life.  Childhood appears to be the critical time to recognize, diagnose, and treat asthma. Of the 20 million people in the U.S with asthma, nearly all begin in early childhood. Current statistics indicate that nearly 80% begins before the age of three. As asthma progresses, without treatment, the disease tends to worsen and by mid-childhood, the dye is cast. We now recognize that the earlier treatment interventions begins, the better the life-long outcomes. Large ongoing studies of wheezing infants and young children have established certain risk factors for asthma. They include parental smoking, either parent (especially the mother) diagnosed with asthma, food allergies in infancy, atopic eczema, and chronic nasal allergies (a runny nose or cold that lasts for more than a couple of weeks, or reoccurs frequently). Some infants and children under the age of three may start to wheeze with viral bronchial infections (usually RSV) and then tend to wheeze even with common colds up to about age four or five. The majority of these children will stop wheezing with colds by school age, thus the myth that they have outgrown asthma, when they actually do not have asthma. Experts now agree that it is primarily young allergic children who develop asthma that continues throughout childhood into their teens and adulthood. The day-to-day lives of these children can be impacted dramatically. Asthma is the leading cause of hospitalization in children, one of the most common causes of school absenteeism, and can lead to dramatic restrictions in activities if not treated.

The goals for the management of asthma in children are simple: sleep, play, and learn without restrictions. The treatment of asthma can be divided into three components, which I often refer to as a “three-legged stool”:

  1. Avoidance of triggers ( allergic substances and irritants)
  2. Medications
  3. Allergen Immunotherapy (to be considered, but not recommended, for all).

The identification of those things causing the allergic reactions that trigger the asthma is best established through simple allergy skin testing by a board-certified allergist. A myth concerning allergies is that children have to be at least two before they can be tested. The allergy antibody is active at birth and there are examples of children sensitized shortly after being born. Per the American Academy of Pediatrics, age is not a barrier to skin testing.

Asthma is a chronic disease that begins in childhood. Treatment can allow the child to live a normal life and impact the lifelong progression of the disease. I divide the medications for treating asthma into three categories: Control, Prevent, and Rescue (CPR for asthma).

The most commonly used controller medicines are inhaled corticosteroids (ICS). They are the “gold standard” for treating persistent asthma symptoms. The newer ICS are available for either use in nebulizers for young children, and over the age of four in inhalers. Used regularly, they are effective in controlling symptoms and may prevent the progression of the disease.

Preventive medications are added if the ICS alone are not controlling the symptoms. Remember, our goal is nearly zero symptoms, no missed school, no exacerbations, and the ability to play at will. The two most common add-on prevent medications are either inhaled long acting bronchodilators or a leukotriene modifier. One popular inhaler combines the Control and Prevent medications in one discus. Very mild asthma may be treated with the leukotriene modifier tablet alone.

Finally, all asthmatics should have a “rescue” inhaler or nebulizer solution available in case of sudden exacerbations. Sometimes it is recommended to use the rescue inhaler regularly before exercise. A spacer should used with any pump type inhalers to assure good delivery of the medication.

Since asthma is often episodic and our goal is optimal control, step-up, step-down treatment is a common way of adjusting the treatment plan. All asthmatic children should have a written action plan for treatment. Some children may benefit from having a device called a peak-flow meter to measure their airflows at home.

Allergy shots may be recommended in children with significant allergies to things they cannot avoid. The immunotherapy is effective in asthma and is actually the closest way to “curing’ the underlying problem by down-grading the allergic immune response.

James L. Sublett, M.D., is a clinical professor and section chief of pediatric allergy at the University of Louisville School of Medicine. He is also Co-Founder and Managing Partner of Family Allergy & Asthma (, a multi-site allergy practice with offices throughout KY and  southern Indiana.

Dental Implants: A Great Option for Replacing Permanent Teeth

By Jamie A. Warren, DMD, MD

More than 178 million Americans are missing at least one permanent tooth and over 35 million Americans have lost all of their teeth.  If you happen to find yourself in this statistic, you may be wondering what options you have for tooth replacement.    Missing teeth can affect a person’s ability to chew food properly, can interfere with alignment of adjacent teeth and adversely impact one’s self- confidence and quality of life.  For many, a dental implant restoration has become the solution to these problems.  Dental implants are useful for replacing missing permanent teeth or simply to provide increased retention for a removable denture.  When considering the different treatment options available for tooth replacement, dental implants are frequently the treatment of choice.

Prior to the mid-1980’s, the only legitimate options available for tooth replacement were removable dentures or a fixed bridge.  Removable dentures rest on the gum tissue, resulting in instability and poor retention.  When preparing a fixed bridge, tooth structure must be removed from the adjacent healthy teeth in order to anchor the fixture properly.  This will compromise the health of these teeth and also creates a food trap which presents an obstacle to oral hygiene measures.  Luckily, patients do not have to settle for these options anymore.   Clinical research and outcomes have powered implant technology into the forefront of restorative dentistry.  With the advent of the dental implant as we know it today, millions of implants have been successfully placed, giving patients and treatment providers a better choice.

Before the placement of a dental implant, it’s important to understand that a team approach is a necessity when developing and executing the plan to completion.  This team usually consists of the patient, restorative dentist, and an oral and maxillofacial surgeon.   Once a treatment plan is generated and accepted by the patient, the treatment can then be initiated.  In some cases, treatment may begin with a bone grafting procedure if the quantity of available bone is insufficient.  Once a sufficient amount of jaw bone has been ensured, the oral and maxillofacial surgeon will place a titanium post or fixture into the jaw bone. This initial procedure generally takes less than one hour depending on how many implants are being placed.  Over the next 10-16 weeks, this post will anchor to the jaw by fusing to the surrounding bone, and hence, become the foundation of the implant restoration.  Once integration is complete, the abutment is then connected to the implant post and this will protrude from the gum line and into the mouth.  At this point, your restorative dentist will take an impression of this area and a crown is fabricated from this.  The crown will be secured to the abutment and this will complete the restorative process.

One of the primary concerns for most patients is what to expect while undergoing this treatment process.  Aside from some soreness and mild swelling, the post-implant recovery process is mostly benign.  My patients will typically take only one day off from work and will require very little modification of their day to day routine.  A prescription for a mild pain reliever is usually given along with an antibiotic to help lower the risk of infection.  I will ask my patients to try and avoid chewing food in this area for a few days to help give the gum tissue plenty of time to heal.  It is also important to keep the implant site clean to help promote an ideal healing environment.  I schedule a follow-up appointment in 1-2 weeks to check the healing and to remove any sutures at that time.   Over the next few weeks, the implant will continue to integrate to the bone, and once complete, the restorative process can then be finished.

The overall success rate for the placement of a dental implant is around 95%.  This high success rate is directly dependent upon operator skill, the quality and quantity of available bone, the patient’s compliance with oral hygiene and showing up to their regular dental check-up appointments.  The dental implant needs to be cared for just like a natural tooth.  It should be brushed and flossed daily and care should be taken to avoid trauma to this area.

Whether you get a dental implant as a replacement for missing teeth or simply as a way to secure and provide retention for removable dentures, both can have a significant improvement on a person’s quality of life.  The benefits are countless…dental implants all but eliminate the daily frustrations that patients face when missing teeth or when dealing with an ill-fitting denture.   Patients can enjoy a more well-rounded diet, socialize without the fear of denture slippage, and have an improved physical appearance.  This leads to greater self-confidence and ultimately a better life.  If you feel like this is something that you could benefit from, you owe it to yourself to contact your dentist or oral surgeon for more information.

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Dr. Jamie Warren is a native of Louisville, KY and attended Saint Xavier High School and received his undergraduate degree at Bellarmine University.  He completed his dental school, medical school, and oral & maxillofacial surgery residency at the University of Louisville.  He is board certified and practices at Kentuckiana Oral & Maxillofacial Surgery with three convenient office locations near the Summit Shopping Center, Jewish Hospital downtown, and Mt. Washington, KY. For more information, about Kentuckiana Oral & Maxillofacial Surgery check out