Exercise is Medicine: The Benefits of Exercise

From www.exerciseismedicine.org

The Problem

Physical inactivity is a fast-growing public health problem and contributes to a variety of chronic diseases and health complications, including obesity, diabetes and cancer.  In addition to improving a patient’s overall health, increasing physical activity has proven effective in the treatment and prevention of chronic disease.  Even with all the benefits of physical activity, in the US and many other countries, levels of inactivity are alarming.  We are facing what is now referred to as an “inactivity epidemic,” with tremendous costs.

More than 56% of adults do not meet the recommendations of 150 minutes per week of activity. In a study of older adolescents and adults in the US, participants spend almost 8 hours a day in sedentary behaviors, while as much as 36% of adults engaged in no leisure-time physical activity at all. In fact, a study in 2008 shows that physical inactivity costs the US Health Care System $330 per person each year, which equals more than $102 billions annually.

The Benefits

Many research studies have shown the benefits of regular physical activities. The US Federal Physical Guidelines and many studies show that 150 minutes per week of moderate intensity activity is required to achieve these health benefits.

  1. Regular exercise can:
    1. Reduce mortality and the risk of recurrent breast cancer by 50%.
    2. Lower the risk of colon cancer by over 60%.
    3. Reduce the risk of developing Alzheimer’s disease by approximately 40%.
    4. Reduce the incidence of heart disease and high blood pressure by approximately 40%.
    5. Lower the risk of stroke by 27%.
    6. Lower the risk of developing type II diabetes by 58%.
    7. Be twice as effective in treating type II diabetes that the standard insulin prescription and can save $2250 per person per year when compared to the cost of standard drug therapy.
    8. Can decrease depression as effectively as Prozac or behavioral therapy.
    9. Research shows that a low level of physical activity exposes a patient to a greater risk of dying than does smoking, obesity, hypertension, or high cholesterol and for older men, regular exercise can decrease the risk of death by 40%.
    10. Active individuals in their 80s have a lower risk of death than inactive individuals in their 60s.
    11. Adults with better muscle strength have a 20% lower risk of mortality (33% lower risk of cancer specific mortality) than adults with low muscle strength.
    12. A low level of fitness is a bigger risk factor for mortality than mild-moderate obesity. It is better to be fit and overweight than unfit with a lower percentage of body fat.
    13. Regular physical activity has been shown to lead to a higher SAT scores for adolescents.
    14. In an elementary school setting, regular physical activity can decrease discipline incidents involving violence by 59% and decrease out of school suspensions by 67%.

Image from: www.behealthy.baystatebanner.com

Exercise is Medicine: 2008 Physical Activity Guidelines for Americans

Compiled by Barbara Day, M.S., R.D., C.N.

Physical inactivity contributes to many chronic disease and health complications. BE WISE AND EXERCISE FOR YOUR HEALTH.

Here’s the current physical activity guidelines for Americans. There are NO guidelines for children under 6. With the new parks through the Parklands,  the new Pedestrian Bridge downtown, and all the great parks in and around Kentuckiana there are plenty of places to do some scenic walking with your family. Having an exercise partner or a group to exercise helps to give you more incentive to be activity.

Age No Chronic Conditions Chronic Conditions
Children & Adolescents (6 – 17) 60 minutes or more of physical activity every day (moderate* – or vigorous**- intensity aerobic activity) 

Vigorous-intensity activity at least 3 days per week


Muscle-strengthening and bone-strengthening activity at least 3 days per week.

Develop a physical activity plan with your health care professional BUT avoid inactivity.
Adults (18 – 64) 150 minutes a week of a moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic physical activity. 

Muscle-strengthening activities that involve all major muscle groups performed on 2 or more days per week.

Develop a physical activity plan with your health care professional.  Be as physically active as possible BUT avoid inactivity.
Older Adults (65+) Follow adult guidelines or be as physically active as possible. Avoid inactivity. 

Exercise that maintain or improve balance if at risk of falling.

Develop activity plan with your health care professional.


*Moderate-intensity physical activity means working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation.  Examples: brisk walking, ballroom dancing or general gardening.

** Vigorous-intensity physical activity causes rapid breathing and a substantial increase in heart rate. Example: jogging, aerobic dancing or jumping rope.


Source: U.S. Department of Health and Human Services. Physical Guidelines for Americans. Washington, DC: 2008.

Image from: www.momokd.com

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, www.DayByDayNutrition.com, 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, www.KentuckianaHealthWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com 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.    



ACL Injury in Children, Adolescents or the Skeletally Immature: Diagnosis and Treatment


By Stacie L. Grossfeld, M.D.

The ACL injury is difficult to manage in children, adolescents and the skeletally immature.  An excellent review article was published in the Journal of the American Academy of Orthopaedic Surgeons,  in February, 2013.  Drs. Frank and Gambacorta were the authors.
Listed below are key facts regarding the incidence, diagnosis and treatment of the ACL injury in the pediatric athlete:

– In the past 20 years sports injuries in the pediatric and adolescent population has significantly increased
–  Approximately 38 million young athletes compete per year in the US.
– 2 million a year are injured to the point that they require medical attention. A large percentage of those injured are under age 14.
– Increased injuries are thought to come from increased emphasis on year round sport competition , single sport focus and more intense training.
– The incidence pediatric / adolescent mid substance ACL tears has significantly increased as the amount of sports participation has increased.
– The highest rate of the ACL injury in high school athletes is first in female soccer players and second in male football players.
– Management of the ACL injury in the skeletally immature athlete is challenging because of their open growth plates in both the tibia and the femur. A standard ACL reconstruction would pass right through the growth plate and could potentially cause damage to the growth plate. It  damage occurs it could cause premature closure or partial  closure of the growth plate. If that occurs the leg could grow crooked or become malaligned or shortened.
– Presenting signs and symptoms are similar to the adult ACL injury. Swelling typically occurs within 12 hours of the jury, there is usually a pop heard or felt at the time of the injury, and the athlete is unable to finishing playing the game.
– 70% of the injuries occur as non contact injuries.
– MRI imaging as a 95% sensitivity for detecting ACL tears in the pediatric patient.
– The doctor must determine the pediatric patient’s skeletally maturity.

This is key to decide what type of ACL surgical reconstruction can be performed. The there are several different ways this can be determined. The use of the Tanner Stages of Maturity which unitizes the athletes physiologic maturity. The other common way to determine skeletally maturity is the use the Greulich and Pyle atlas. This requires an x-ray of the hand of the patient be obtained and then it gets compared to other x-rays in the atlas to determine their bone age.

Historically non surgical treatment options for the skeletally immature patients has consisted of activity modification, functional bracing and physical therapy . Unfortunately this does not work well in most athletes. There is a high noncompliance rate in this group of patients. They want to return to sports and do even if told not to return.  They end up sustaining secondary injuries secondary to their unstable knee that is irreparable: meniscal tears and articular cartilage damage.

The only group that surgery is not recommended is the patients that have only a partial ACL tear, are highly compliant, low demand person with no additional intra-articular pathology such as meniscal tears.
Surgery is recommended for all complete ACL tears or partial tears in activity patients with other intra-articular pathology . Surgical technique will be based on the age of the pediatric athlete. The younger the patient with an ACL tear the less invasive the procedure needs to be to the growth plate. The surgical procedures are divided up into physeal sparing  with extra articular and intra articular construction, transphysesl reconstruction with small graft and metaphysical fixation  or an adult type reconstruction with autograft. Post operative rehab will be based on the type of construction that is performed.

Image from:  www.chsolutions.typepad.com/elevatingathletes/acl_injury/

Stacie L. Grossfeld, M.D., is an orthopedic surgery with Orthopaedic Specialists. She is Board certified in Orthopaedic Surgery and Sports Medicine. For more information you can call Dr. Grossfeld at 502-212-BONE (2663) or www. louisvillebones.com.



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 www.nancyclarkrd.com. See also sportsnutritionworkshop.com.



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, www.DayByDayNutrition.com, 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, www.KentuckianaHealthWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com 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 (www.familyallergy.com), 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. (http://www.jefferson.kyschools.us/Departments/NutritionServices/education/index.html#1).  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, www.DayByDayNutrition.com, 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, www.KentuckianaHealthWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com 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.    


A Journey from Athlete to Athletic Trainer and Sports Performance Coach

By Nick Sarantis, ATC, CSCS

August 2001 in Drexel Hill, Pennsylvania and I just left my first physical therapy appointment for low back and adductor (groin) pain. This was my first experience in sports medicine sadly it was not my last, and now thankfully I can say that I am involved in sports medicine every single day.

My name is Nick Sarantis and I am the Director of Sports Performance for Baptist Sports Medicine. For the coming months I will be writing articles on sports medicine, sports performance, and personal training topics.  This first article will describe my journey from a high level athlete to athletic trainer and now to my current role on the sports performance side of things, while giving a background and what made me the clinician/coach I am today.

I was a soccer player, I did not just play soccer, but I was a soccer player I was consumed and defined by the game.  School was not my favorite thing in the world, but it was something I knew I must succeed in to further my soccer career. I played high school soccer in a suburb of Philadelphia where the softball and baseball fields intersected with the soccer pitch.  The center circle was used each November for the huge bond fire held before the big Thanksgiving Day football game.  Needless to say facilities were not up to par from a soccer standpoint, but not up to par from an injury prevention standpoint either. I played club soccer for various clubs throughout the area, traveling, and playing 3-4 times per week.  Soccer was life and I was ok with that. My junior year of high school is when I first started to feel pain in my adductor as well as my low back. Various doctor and physical therapy appointments told me nothing more than a strain and should clear up in a few weeks’ time.  Eventually it felt good enough for me to play, and I was able to have a very successful high school and club career.  Before my freshmen year in college my parents got me a personal trainer at a local gym to get me stronger.  This is 10 years ago now so the training was based on body building principles with muscle group splits each day.  Movement patterns were not trained, and come to think of it I cannot even remember doing a squat yet alone a hang clean.  This was my first introduction to the weight room and strength and conditioning.

College soccer took me to Farleigh Dickinson University in Teaneck, NJ. It was a 2 hour drive from family and friends, and they had made it to the elite 8 of the NCAA tournament the year before, the fact that they wanted me to play there, I was sold.  Made it through my first and only preseason camp of my career healthy and that transferred over to a starting position the first week.  It was a highly successful year from a team standpoint having a national ranking as high as #8, however we were upset in the NCAA tournament.  By the end of the year my adductor and lower abdominal region were feeling weak and painful. I went to multiple doctors referred to me by my athletic trainers and they told me nothing more than a strain or maybe some tendonitis.  Back to physical therapy weekly as well as rehab with my athletic trainers daily.  This was during the offseason so the combination of rest and rehab I felt back to normal after 2 months, perfect timing because spring soccer was starting soon.  Due to my injuries I never had time for strength and conditioning, and it was not a huge priority at the University at that point. Played very well the first few games, and then again the pain returned rendering me to 75% of the player I could be.  During this time I started to realize that FDU was not the school for me, so I started to explore my transferring options.  The University of Louisville and I immediately made contact and I was on my way there for my recruiting trip. After standing in the middle of Cardinal Park’s field I was sold, and was enrolled for summer class starting in July.


Preseason camp was about to begin and we had to get our annual physicals.  I revealed I had pain in my adductor area, and after being poked and prodded by a few doctors I got my first anti –inflammatory injection (cortisone). Due to the trauma of the shot I was held out of the first week of preseason practice, which left me playing catch up to the rest of the squad.  It was not until about a month into the season and after daily rehab with my athletic trainer did I start to feel close to 100%.  With my physical conditioning improving and pain decreasing my play was getting back to where I felt like it needed to be and my playing time started to increase.  My first game back was 60 minutes against Ohio State in an overtime tie, which led me to be packed in ice for the next 2 days.  I recovered in time for the next match and played well, but the maintenance of keeping my body going was starting to become overwhelming.  The season ended with me in pain and frustrated with both my body and my play.  Spring season led me to another round of doctors visits, MRI’s, X-Rays anything that could potentially lead to a diagnosis.  An arthrogram MRI of the hip was ordered to look for an acetabular labrum team.  An athrogram MRI is when contrast dye is injected into the joint in question which can help show a potential cartilage tear.  I remember standing in the athletic training room HOPING that it was torn! I just wanted to know what it was, I really did not care how bad it was, I just want to know.  But alas it was negative and I was devastated.  My mind started to wonder am I just being a wimp?  Am I really in pain? Do my coaches and team mates think I am just faking this whole thing? So off to the next doctor and we started to talk about a potential athletic puablga or “sports hernia” injury, and all the symptoms were right on target.  Pain and weakness in the aductors, pain in the lower abdominals, pain only during exertion, pain subsiding when at rest but would return with activity. Check, check, check, check, check.  However at this point there were 2 surgeons in the world renowned for this procedure, one was in Munich, Germany, and luckily the other one was in Philadelphia, Pennsylvania.  To Philadelphia I went to be examined by Dr. William C Meyers who had operated on many of the best athletes in the world.  He had already reviewed my diagnostic pictures and he did a quick hands on exam of me and he was convinced that I was suffering from an athletic pubalgia on the right side. I was scheduled for surgery the very next day. I was elated, excited, thrilled, happy anything you can think of that someone had found what was wrong with me.  I could have cared less about the surgery, I was just excited to be fixed.  Surgery was a breeze he made a 3 inch horizontal incision in my lower abdominal wall and proceeded to fan out internal sutures over the micro tearing put a band aid over the cut and I was going home.  Standard rehabilitation protocol would allow me a full recovery in 3 months, just enough time to get back in shape for preseason.  The rest of the spring and summer was spent rehabbing and trying to get back in shape for the season.  I had an offseason strength and conditioning program provided to me from the strength and conditioning coaches at Louisville which is very comprehensive. However the biggest issue for me that I was still limited from many of the exercises due to pain, or due to doctors recommendations.

Preseason camp was upon us and I was not back to 100% yet.  I spent preseason still mostly rehabbing and training on the side trying to get back to 100% without further injuring myself.  3 games into the season we were playing the University of Cincinnati and I was inserted into central midfield at half time, and I would never leave the field again that season.  I felt great, I was playing great this is what I had worked so hard over the years to get, to be playing Division 1 soccer at a high level.  It was a fantastic season personally and I was so excited to build upon my junior year to have a great senior year.  We went through a coaching change which brought many good things, but lots of adjustments for all involved.  Our weight training programs were becoming more functional and more soccer specific.  I was getting myself in great physical shape in the weight room while also staying on top of my groin injuries.  Spring season rolled around and about a week in a felt a similar feeling in my right groin that I was all too familiar with.  I tried to play through the pain which left me unable to perform well, in pain the compensation led to pain in my left side as well.  After communicating with Dr. Meyers again, back the to the surgeon I went.  This time he cut open both sides and repaired athletic pubalgia injuries on both sides.  This time however the rehab protocol was advanced so that I could try and be back playing in one months time.  Dr. Meyers and I communicated daily on my rehab plan, and although I started running sooner, and passing a soccer ball sooner, it was still 3 months for me to feeling anywhere near 100%.  So again I missed most of preseason camp which as the senior team co-captain I hated more than usual.  However this time the pain never really went away.  So I started to receive monthly cortisone injections into the scar tissue in my groin to help me deal with the pain.  It helped me get back on the field and was able to play at high level for a few games.  As the season wore on my body continued to break down and I was unable to perform close to where I thought I should be.  Then finally in a practice about half way though the year I fell on my outstretched arm, heard a pop, a crack, and a crunch and my senior season was finished.  Tests revealed a torn labrum in my shoulder which would require surgery.

My soccer career was a love and hate relationship on a daily basis.  I loved the game so much and everything it had given me, but I also hated it because of everything it had done to me.  The amount of time it took me to get my body ready for a practice or game left me burnt out. However in my junior year I finally realized what career I wanted to follow: Athletic Training.  I completed the appropriate pre requisites and off to the University of Arkansas I went to complete my masters degree in athletic training.  It was at this time that I was able to match the book knowledge that I was reading about with all the experiences that I have had in the past.  I worked with multiple sports while I was there and saw a variety of injuries and techniques to dealing with them.  I also observed the strength and conditioning coaches work on a daily basis as well which again showed much different techniques then I used back in high school.


With my degree in hand I accepted the job to be the athletic trainer for Oldham County High School employed through Baptist Hospital Northeast. I was responsible for over 500 athletes on an annual basis to fix injuries, implement rehabs, everything and anything the athletes would need to be able to perform.  During this time however I quickly realized that as a high school athletic trainer that I did not have time to implement injury prevention techniques.  Once I got the athlete healthy enough to practice, he or she was back at practice and we would never get the chance to find out what truly caused that injury.  This frustration led me to complete my Certified Strength and Conditioning Specialist test (CSCS), and I started to do strength and conditioning training on the side for athletes that were looking for extra work.  Great results led me to work with Baptist Sports Medicine on implementing a sports performance area in the new clinic located in Baptist Eastpoint. Now I am the Director of Sports Performance for Baptist Sports Medicine building faster, stronger, quicker, more powerful and healthier athletes.  Through all my experiences and education I am able to connect with athletes and their current experiences based on my past.  My goal is to give athletes all the information and techniques that I did not have and really was not even around 10 years ago.  Continue to check for articles and posts related to all sports medicine, sports performance, and personal training topics.

Nick Sarantis is the Director of Sports Performance at Baptist Sports Medicine. He is a certified Athletic Trainer (ATC) and a certified Strength and Conditioning Specialist (CSCS) through the National Athletic Training Association and the National Strength and Conditioning Association. He earned his Master’s degree from the University of Arkansas and his Bachelor’s degree from the University of Louisville. While obtaining his Bachelor’s degree, he was a co-captain and starter for the University of Louisville Men’s Soccer team. For more information: www.BaptistSportsMedKy.com.



A Parent’s Road Map Detailing Performance Nutrition for their School Aged Athlete

Sports Dietitian/Nutritionist, Barbara Day, M.S., R.D., C.N., will give a FREE presentation entitled A Parent’s Road Map Detailing Performance Nutrition for the School Aged Athlete  on August 5 at 3:30 p.m. at Swag’s East located at 9407 Westport Road # 127.   Barbara is the former sports nutritionist for the University of Louisville Athletic Department and the US Navy SEALs.   If you are a parent who wants to know what you should feed your school aged athlete you won’t want to miss this presentation. Barbara will discuss: How many calories the student athlete needs to maximize their sport performance. What are the recommendations for a daily training diet. What to eat and drink before, during, and after practice or competition. Plus preventing and treating dehydration during summertime training. For more information, call 502.749.7924.

Image from: http://rivals.yahoo.com/highschool/blog


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 (www.familyallergy.com), a multi-site allergy practice with offices throughout KY and  southern Indiana.