Fueling on a Budget for Traveling Sports Teams

sports teams

By Nancy Clark MS RD CSSD

“When we travel as a team, we eat at fast food places because they fit with our small budget.What’s the best fast food for athletes…?”

“After my workout, the last thing I want to do is cook dinner. Where can I buy affordable but healthy sports meals…?”

A limited food budget creates a fueling challenge for many athletes, including college teams traveling to games, students responsible for their own meals, parents of active kids, and semi-pro players hoping to get to the next level. The name of the fueling game is: How can you buy enough healthy calories with the least amount of money? These practical tips can help optimize a low-budget sports diet.

1. Encourage the team bus (or your car) to stop at a large supermarket.

Everyone can find something they like: vegetarians,  gluten-free eaters, picky eaters who want to lose weight, and chowhounds who need lots of calories. By walking around the inside perimeter of the store, you will find the makings for a balanced meal—even hot meals, if desired. Shop for:

Fresh fruit: Banana, apple, pear, grapes. Buy what’s on sale.

Fresh veggies: While you can easily create a colorful salad at the salad bar area, it might be a bit pricey. The simpler option is to simply buy: a green  or red pepper (eat it whole, as you might eat an apple), a bag of baby carrots (along with a container of hummus), or a container of cherry tomatoes. Enjoy the whole thing; a hefty dose of veggies on one day can help compensate for another day when you have none.

(To clean the fresh produce, plan ahead. Pack extra water to rinse the produce before getting on the bus. Or nicely ask  an employee in the store’s produce area if he or she could help you by giving the fresh produce a quick rinse.)

Protein: Buy a quarter-pound of deli turkey, roast beef, or ham along with a few whole wheat rolls to make sandwiches. Small or large tubs of cottage cheese, tuna packets, and peanut butter are other popular protein options. Share a rotisserie chicken with friends (or save the leftovers if you can refrigerate them within an hour.)

Grains and other carbs: Pita, wraps, baked chips, whole-grain crackers and  pretzels are carb-based options that refuel your muscles. Look for freshly baked whole-wheat rolls, hearty breads, and whole-grain bagels. You might be able to find a plastic knife at the salad bar so you can slice the rolls to make a nice sandwich with deli meat and lowfat cheese. Pop a few cherry tomatoes between bites, and you’ll have a balanced meal with all 4 foods groups: 1) lean meats/beans/nuts, 2) lowfat dairy or calcium-alternative, 3) fruit/vegetable, 4) grain.

Calcium-rich foods: You can easily buy a small or large tub of lowfat yogurt, a single milk chug—or even a whole a quart of chocolate milk if you are really hungry. For athletes who are dairy-free, soymilk is a fine alternative. Pick up some pre-sliced lowfat cheese in the dairy or deli area. (Note: Hard cheese, such as cheddar, is lactose-free and comes in convenient single portions.) Add an apple and whole grain crackers—voila, a balanced sports meal! While it may not be the hot meal your mom had in mind, it will do the job of contributing needed nutrients to refuel from the day’s event, fuel-up for tomorrow, and invest in future good health.

Beverages: You can save a lot of money (plus save space in landfills) by packing your own gallon jug of water. To spend money on plain water (void of calories, carbs, and vitamins) seems wasteful when tap water is free. Instead buy 100% juice (orange, grape, carrot, V-8) to boost your fruit/veggie intake and simultaneously boost your immune system with anti-inflammatory phytochemicals. Plus, 100% juice is a strong source of carbohydrate to refuel depleted muscles, as well as fluid to replace sweat losses. Chocolate milk is another winning beverage, with protein to build and repair exhausted muscles, as well as carbs to refuel them.

If the team bus (or your car) is pulling into a fast food restaurant, at least choose one that will support the nutritional needs of athletes. Here are a few suggestions:

• At Taco Bell, you can get the most amount of healthy calories for a bargain price when you order their bean burrito. Two bean burritos cost only $2.20 and provide 750 (mostly quality) calories.

• At a burger place, choose a grilled chicken sandwich (no fries). It will be more expensive and offer fewer calories than a burger, so plan to supplement the sandwich with some Fig Newtons, pretzels or raisins that you pre-packed from home.

•At a pizza place, order the cheese pizza, preferably with veggie toppings like mushroom, pepper, and/or onion. Nix the pepperoni, sausage and other greasy meat options, as well as the double cheese. You’d end up fat-loading with that type of pizza. It would fill your stomach but leave your muscles poorly fueled. Remember: muscles need carbs (such as thick pizza crust) to replenish glycogen stores.

• Be cautious of super salads. While they have a seemingly healthy glow, they can be unfriendly for many sports diets, particularly if you are weight-conscious.Making a substantial salad with not only colorful veggies but also grated cheese, chopped egg, diced chicken, slivered almonds, pumpkin seeds, and olives offers you a hefty dose of calories, but not enough grains/carbs to refuel your muscles. Adding even a little bit of dressing to a big salad often adds  400 or more calories. A sandwich can have fewer calories….

• Hungry athletes who need lots of inexpensive calories can do well by packing sandwiches made with peanut butter & jelly (or PB & jam, honey, raisins, banana, pickles or even cottage cheese—whatever tastes good to you). Peanut butter is versatile and a great sports food because it offers protein, B-vitamins, and good fats that knock down inflammation. It’s inexpensive, travels well without refrigeration, is good for you, and tastes great! It’s even good for dieters because it keeps you feeling fed, and curbs the urge to eat cookies. For the $2 needed to slap together a hefty 600-calorie PB&J (made with 2 slices Pepperidge Farm Bread, 3 Tbsp. Teddie all-natural peanut butter, and 2 Tbsp. Welch’s grape jelly), you couldn’t even buy a Muscle Milk ($3.69 for 230 calories). Shop wisely and fuel well!

Image from: www.sheknows.com/parenting/articles/809104/how-to-deal-with-over-competitive-coaches

Boston-area sports nutritionist Nancy Clark MS RD counsels both casual and competitive athletes at her private practice in Newton (617-795-1875). Her Sports Nutrition Guidebook and her food guides for runners, cyclists and soccer players are available at www.nancyclarkrd.com. For online education, visit www.sportsnutritionworkshop.com and www.NutritionSportsExerciseCEUS.com.

Caffeine: Performance Enhancement in a Mug


By Nancy Clark MS RD CSSD


Whether you are looking for a hit, boost, pleasing stimulant, or excuse to socialize with your friends, coffee is the go-to beverage for many athletes. Coffee-drinkers enjoy the way a cup of morning brew enhances their feelings of well-being and their ability to accomplish daily tasks. An estimated 80% of us drink coffee daily. Why, we are more likely to drink coffee than eat fruit! Thank goodness moderate coffee intake is typically not associated with health risks.

For athletes, caffeine is a proven performance enhancer. In their new book Caffeine for Sports Performance, sports dietitians Louise Burke and Ben Desbrow and exercise physiologist Lawrence Spriet address all-things-caffeine that an athlete might want to know. Here are just a few tidbits that I gleaned from this comprehensive resource. Perhaps the information will help you add a little bit of zip to your workouts.

Note: No amount of caffeine will compensate for a lousy diet. If you choose to use caffeinated products to enhance your sports performance, make sure you are also fueling wisely!


• A cup of pre-exercise coffee can help most athletes work harder—without realizing it. Caffeine has been shown to enhance performance by about 1% to 3%, particularly in endurance sports. For example, cyclists who consumed caffeine prior to a 24-mile (40-km) time-trial generated 3.5% more power than when they did the ride without caffeine.


• Athletes vary in their responsiveness to caffeine, from highly effective to negative. Some of the side effects associated with too much caffeine include higher heart rate, anxiety, “coffee stomach”, irritability, and insomnia.


• The recommended performance-enhancing dose of caffeine is about 1.5 mg/lb (3 mg/kg) body weight. This can be consumed 1 hour before the event, and/or during the event (such as a caffeinated gel or defizzed cola every hour). For example, triathletes commonly consume caffeinated gels before each segment, to distribute the caffeine throughout the event rather than have a big pre-race jolt that might make them feel shaky and unable to concentrate. Some athletes delay caffeine intake until fatigue starts to appear, and then they ingest 0.5-1 mg/lb (1-2 mg/kg) body weight.


• Caffeine’s ergogenic effect maxes out at about 200 to 250 mg caffeine. (This is much less than previously recommended.) More is not better.  Experiment during training to learn what amount (if any) works best for your body!


• Because the amount of caffeine in coffee and tea varies, elite athletes commonly use caffeine pills or commercial products to ensure the desired intake.  A comparison of the caffeine content in 16 ounces of coffee from 20 coffee venders ranged from about 60 to 260 mg. Even when the researchers purchased the same brand of coffee (Starbucks Breakfast Blend) on six consecutive days, the caffeine content ranged from about 260 to 565 milligrams per 16 ounces.


• Research suggests the caffeine content of espresso also varies. A customer might get served 0.5 to 3.0 ounces of espresso (depending on the barista’s generosity) with a caffeine range of 25 to 214 mg. In general, the larger venders (such as Starbucks) offer a more consistent product. But this means you don’t know what you will be getting if you plan to purchase a pre-exercise espresso or coffee.


• Energy drinks are a popular source of caffeine. A study of 500 college students in North Carolina reports 51% drank at least one energy drink in an average month in the semester. Sixty-seven percent used the energy drink to stay awake; 65%, to increase energy; and 54%, to drink with alcohol while partying. Of the party-drinkers, 49% consumed 3 or more energy drinks. That makes for a wide-awake drunk who may believe it’s OK to drive a car…


• Caffeinated chewing gum is popular among (sleep deprived) soldiers. The gum effectively boosts physical and mental performance and helps maintain reaction time, vigilance, and ability to think clearly. The caffeine in chewing gum gets delivered quicker than via a pill (achieving significant levels in the blood in 5 vs. 30 minutes) because it gets absorbed though the cheeks, not the gut.


• Caffeinated colas offer not only caffeine but also a hefty dose of sugar. Colas, taken later in an event, can provide a much-needed source of fuel so the combination of caffeine + sugar can provide a nice boost! Hence, some athletes claim defizzed Coca-Cola is their preferred sports drink despite having only 35 mg caffeine per 12-ounce can.


• Caffeine is only a weak diuretic and is no longer considered to be dehydrating. A novice coffee drinker can become tolerant to the diuretic effects of caffeine in 4 to 5 days of regular caffeine intake. Even high doses (3 mg/lb; 6 mg/kg) have no significant effect on urine production in coffee or tea drinkers. Hence, there appears to be no hydration-related reason for athletes to avoid caffeinated beverages.


• Caution: Consuming caffeine might contribute to negative effects. For example, let’s say you are running, rowing, or swimming in more than one competitive event in a day. If caffeine helps you go harder in the first event, will that “fry” you for the second event? Can taking another dose of caffeine counter that fatigue? With a weekend tournament, will too much caffeine on the first day ruin your sleep, so you are unable to perform as well on the second day? More research is needed to answer those questions but for the moment, these situations provide good examples of why advice to use the smallest effective dose of caffeine is sensible.


• In 1984, caffeine was banned by the International Olympic Committee (IOC) and the World Anti-Doping Agency (WADA). But in 2004, WADA reversed the ruling. New research indicated the amount of caffeine needed to reach the threshold dose was detrimental to performance. Although caffeine is no longer banned by WADA, it is on the banned list for NCAA, the governing body of collegiate sports. Collegiate athletes can be cited for doping if their caffeine level is higher than 15 micrograms/ml urine. (A normal urine caffeine level is between 1-2 micrograms). Unlikely but possible.


• Youth athletes should be fully mature and eating an optimal sports diet before even considering the use of caffeine. Again, no amount of caffeine will compensate for lousy fueling practices.


• For even more helpful tips and tid-bits, get a copy of Caffeine for Sports Performance. You’ll actually stay awake while reading it; this book is not a snoozer!


Boston-area sports nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes. Her private practice is in Newton, MA 617-795-1875). For information about her Sports Nutrition Guidebook and her food guide for marathoners, cyclists, and soccer players, see www.nancyclarkrd.com. For online education, see www.sportsnutritionworkshop.com.





Common Sources of Caffeine


For a 150-pound (68 kg) athlete, the recommended dose of caffeine is about 200 mg one hour before exercise. That’s the amount in a large mug (16 oz) of coffee. No problem for most coffee-drinkers!


Brewed coffee 250 ml (about 8 oz; small) 80 (ranges 40-110)
Starbucks Breakfast Blend 600 ml (20 oz; venti) 415 (range 256-564)
Tea, black 250 ml (about 8 oz; small) 25 -110
Tea, green 250 ml (about 8 oz; small) 30-50
Coca-Cola 1 can (12 oz / 335 ml) 34
Red Bull 1 can (8 oz / 250 ml) 80
PowerBar caffeinated gels 1 pouch (1.25 oz / 40 g) 25 – 50
GU caffeinated gel 1 pouch (1 ox / 32 g) 20-40
Jolt Caffeine Energy Gum 1 piece 33
NoDoz 1 tablet 200 (USA), 100 (Australia)



Getting Older, Day by Day


By Nancy Clark, MS RD CSSD

Like it or not, every one of us is getting older, day by day. As a fitness exerciser or an athlete, you might wonder how aging impacts performance—and what you can do to retain youthful fitness. The following information is gathered from a workshop (www.sportsnutritionworkshop.com) presented by Dr. William Evans, an exercise physiologist and expert on aging, muscles, and protein. The following information can help you chart a healthy course into your future.

• The average person loses about 1% of their fitness per year. Aerobic capacity goes down, particularly after age 60. Staying active helps maintain a slighter higher ability to uptake oxygen than a non-athlete, but the rate of loss is the same.

• Muscle is an active tissue (as compared to body fat). The more muscle you have, the more calories you can eat without getting fat. Yet muscle loss creates a subtle change in metabolism that can contribute to weight gain with aging.

• We lose muscle as we age, starting as young as age 20, with a steady decline year after year. To treat this age-related loss of muscle, you need to lift weights or do other forms of resistance exercise. Yet, even strong athletes still lose some muscle with aging.

• With aging, the average person loses more fast-twitch muscle fibers (used in sprinting) than slow-twitch fibers (used for endurance). This loss starts early in life and explains why elite sprinters peak in the early 20s. In comparison, elite distance runners maintain their slow-twitch muscle fibers until age 40ish. But even top athletes notice they slow down after age 40, at which time the nerves that connect to muscles start to die off, resulting in a loss of both slow- and fast-twitch fibers. Athletes can lose about 20% of their muscle fibers between ages 40 and 70.

• With age, we not only lose muscle but also tend to gain fat. It’s easy to eat more even though we need less. The cause of weight gain is not due to a “slow metabolism.” Metabolic rate remains constant, but daily activity easily declines. A study with obese people suggests they sat three hours more per day than their lean peers; this saved them about 350 calories a day.

• Body fat secretes adipokines (hormones) that have negative effects on muscle strength and contributes to increased inflammation, particularly after ages 60 to 70. Inflammation leads to heart disease and diabetes. Hence, fatness can be a powerful predictor of disability in people ages 50 to 75. Stay lean!

• When young people gain weight, about one-third of the weight gained is lean muscle. When older people, in particular older women, gain weight, it’s all fat. When older people lose weight (due to illness or a low-calorie diet), half of the weight lost is muscle. Hence, yoyo dieters who gain fat and lose muscle are on a downward spiral. Being fat but fit is preferable to going on and off diets.

• Muscle loss is the key reason why older people become frail and end up in nursing homes. When they stop exercising, they experience a steep drop in strength. The good news is they can do something about frailty: lift weights! In only12 weeks, 60- to 70-year-old men regained the fitness they had lost over 15 years.

• To maintain (but not gain) strength, a person can lift weights just one day a week. Lifting weights does not stress the heart nor increase blood pressure. Aerobic exercise actually causes a greater increase in blood pressure because it uses more muscles and more oxygen, which means the heart has to pump more blood than with strength training.

• Even 90-year-olds in a nursing home can triple their strength in 10 weeks. That means they can walk faster, get to toilet by themselves, be less depressed, and stay in the independent living part of elder-care housing. Tell your parents and grandparents to start a weight lifting program so they can stay out of the nursing home!

• How much weight should people lift to build muscle? Three sets; the first two sets should have 8 reps; the final set is to exhaustion. If you can lift a weight 12 times in the final set, you need to lift heavier weights the next time. Because muscle damage stimulates muscles growth, you want to spend more time lowering the weight than lifting it.

• Most strength gains occur in the first 3 months of starting a lifting program, due to early neuro-muscular changes. The nervous system learns how to recruit muscles more efficiently and this stimulates more muscle cells.

• Strength training helps prevent bone loss. In a year-long study with post-menopausal women, all of the women who lifted weights improved their bone health. Those who did not lift weights lost ~2% bone density in one year. Exercise is better than osteoporosis drugs—plus, you’ll get stronger!

• By lifting weights and building muscle, older people should be able to eat more calories (which boosts their intake of health-promoting protein, vitamins, minerals). Yet, adding exercise does not always entitle a person to eat more calories. In a study with 62-year-old people who walked briskly for one hour a day (five days/week) for 3 months, their daily energy expenditure remained stable—despite the brisk walking. How could that be? They became more sedentary the rest of the day; they napped more and slept longer. They compensated for having exercised…

• About 25- to 33-percent of people older than 65 years are eating too little protein. This results in loss of muscle and bone—and leads to expensive medical problems. The goal is to eat at least 0.55 grams of protein per pound of body weight each day to maintain and build muscle. For a 140-pound person, this equates to about 75 grams of protein, or 25 grams per meal (for example, Breakfast: 3 eggs; Lunch: 1 can tuna; Dinner: 4 oz. chicken).

The Bottom Line: Stay young by staying active and by lifting weights or doing some type of resistance exercise to strengthen both muscles and bones. And remember the words of gerontologist Water Bortz: “No one really lives long enough to die of old age. We die from accidents and most of all, from disuse.” Use it or lose it!

Image from: spectrumwellness.net/would-you-like-to-live-to-be-100-years-old-in-perfect-health/

Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sport Dietetics) counsels active people in her private practice in Newton, MA (617-795-1875). For more information, read the new 5th edition of her Sports Nutrition Guidebook or her food guides for marathoners, soccer players, and cyclists. They are available at www.nancyclarkrd.com. Also see www.sportsnutritionworkshop.com for online CEUs.


Healthy Back. Healthy Life.

By Julie L. Lyles, DC

One of the least understood but most important parts of the human body is the spine.  The spine is the lattice work and foundation for every other soft tissue and organ.  The spine is composed of 26 moveable segments.  Hear that?  Moveable! Each joint is angled in a certain way to provide optimal motion and optimal protection.  When loaded correctly and free of fixation, there is nothing more brilliant!   So, why such confusion?  Why such a lack of respect?  Why so little education on the value and importance of healthy joint mobility and postural balance?  Maybe it’s a lack of understanding of the complex simplicity of the spine and its care.

When a child is born, she has 2 curves in her spine:  the mid-back and the sacrum.  As the child starts to get nosey, she lifts her head while on her belly and starts to develop the curve in her neck.  The forces that the back part of her neck feels is what triggers her body to pour calcium in the right places until the age of 25.  (Wolff’s Law” of Physics states that bone models and remodels in response to the mechanical stresses it experiences so as to produce a minimal-weight structure that is ‘adapted’ to its applied stresses.”)

Later on, she gets a little more nosey and goes to all fours, dropping her belly with her head lifted up, developing the curve in her low back.  And, off she goes…through a stage of crawling, building necessary brain and body strength, and mechanical and neurological synchronization.  Then, only when she and her spine are ready, she will start to pull up, with ideally, a properly curved spine that has been fortified by normal instinctive motions and body positions.

When the curves in the spine are not properly formed, as is becoming the norm due to a decrease in “belly-time,” walking too soon without first crawling, more sedentary lifestyles and of course, technology posture, the body reacts profoundly!  Look at the body this way, the back or posterior, is the foundational structure, whereas, the front or the anterior, is where all of the organs and pipes are that supply the body with nutrition and eliminate waste.  If you place the weight of your head, shoulders, and hips in the back and heels, you are correctly putting stress in the purposefully larger, denser bones intended to carry such weight and leaving the front to “flow.”  If you place the weight of the head, shoulders, and pelvis in the front, you are blocking flow of nerve supply, blood supply, and lymphatic supply and compressing all of your vital organs, ultimately leading to dysfunction and disease.

What are common symptoms of joint fixation and postural distortion?  Headaches, neck and back pain, numbness, tingling, and weakness in the upper and lower extremities.  Big deal?  Motrin or Tylenol can help you live with those symptoms, right?  Well, every seven years when the body remodels bone and every year when your organs try to replace their tissues, you are allowing dysfunction and disease to continue…until, of course, you get the symptoms that you can no longer cover up and no longer live with.  What are some conditions that are on the rise, linked to postural distortion and joint fixation: hypertension, migraine headaches, ADD/ADHD, sinusitis/allergies/asthma, reflux and GERD, osteopenia/osteoporosis, infertility, and constipation to name a few.  All of these conditions typically lead to a less active you.  The decreased motion in your body further accelerates the deterioration of the joints and the organs through fixation and stagnation.

What can you do?  Look at yourself and your family and notice if the center of your ear is close to the back of your neck and in line with your shoulders?  Are your shoulders lined up with your hips?  Are your hips lined up with your heels?  Do you have any of the aforementioned conditions and use a lot of over the counter medications? Do you have trouble turning your head or bending it forward, backward, or sideways?  Do you avoid bending over or leaning back? Have you become less active and accepted “feeling bad” as your norm?  Or, has disease set in?

Seek out a health care professional whose specialty is the structure and function of the human form, one whose skills, through manual correction, proper education, and physical retraining can help restore your body to the strong balanced flowing structure capable of brilliant healing powers: The Doctor of Chiropractic.

Image from: www.masharosen.com

Dr. Julie Lyles, DC is a doctor of chiropractic who practices chiropractic care and also owns GetWell Solutions which is focused on Nutrition Counseling, Well Coaching, and Corporate Wellness Programs. For more information, contact Dr. Lyle directly at drjulie@askdoctorjulie.net.  




Losing Weight: Dieting, Food & Exercise

By Nancy Clark MS RD CSSD

As an athlete, you are unlikely obese, but you may have concerns about your weight or have relatives who struggle with their weight. To address the complexities of how to deal with undesired body fat, the Weight Management Group of the Academy of Nutrition & Dietetics held a conference (Indianapolis, April 2013). Here are some highlights.

Dieting and weight

•  An estimated 35% of all US adults are not only overfat but also pre-diabetic, including 50% of adults over 65 years. Relatives who have watched a loved one needlessly die from diabetes see first-hand the need to prevent themselves from going down the same road. There are clear benefits from eating wisely and exercising regularly! Losing just 5% of body weight can reduce health risks attributed to diabetes.

•  Most dieters want to lose weight quickly. The problem is that plan tends to backfire. You can lose weight fast or lose weight forever—but not lose weight fast and forever.

• Most dieters regain about two-thirds of their weight loss within a year and all of it within 3 to 5 years. Tips to maintain weight loss include: exercise regularly, eat fewer fatty foods, watch less TV, have strong social support, and sleep more than 5 hours a day.

• Chewing gum can help lean people consume fewer calories, but that is not the case for obese gum-chewers. (Perhaps the act of chewing increases their desire to eat?)

•  To stay on track, successful dieters should plan ahead by predicting everything that could possibly go wrong with their eating plan and develop strategies to deal with the unexpected. For example, if the waiter serves the salad soaked with dressing (not on the side, as requested), the dieter knows he can send it back, not eat it, or eat less of it.

• If you “blow your diet,” please don’t hate yourself. Just regret you over-ate and learn from the experience. You learned to overeat for a reason. (For example, overindulging in birthday cake may have been your “last chance” to eat cake before your diet started again the next meal.) The better plan can be to enjoy a reasonable slice of cake for several days. You’ll feel less need to overindulge when you know you can have more cake the next day (just fit it into your calorie budget).

• Other success-promoting dietary habits include using portion-controlled foods and keeping food and weight records. High-tech diet aids include: tracking steps by wearing a pedometer (goal: 10,000 steps a day), and wearing an armband or other body-activity monitor that detects changes in activity over time. Some popular high-tech tools include New Lifestyles-1000 pedometer, FitBit Zip, and Nike Fuel Band.  (Note: Accuracy of the high-tech tool is less important than day-to-day reproduce-ability.)

• Websites or apps like FatSecret.com, CalorieKing.com, LoseIt.com, and MealLogger.com can also be helpful. In the near future, you’ll be able to take a photo of your meal and an app will then calculate the calories. This info will be very helpful when eating in restaurant with super-sized meals.

Food and weight

•  An estimated 80% of weight loss happens by eating fewer calories; 20% relates to exercise. You need to change your diet to lose weight and change your exercise to keep weight off.

• Overweight people tend to eat by time cues. Noon is lunchtime, regardless if the clock is significantly wrong!

• Adults may eat more of a food if it is deemed healthy. That is, subjects ate more oatmeal cookies when they were described as high fiber, high protein as compared to high sugar, high butter. And yes, even healthy high fiber and high protein calories count!

• In contrast, adolescents (who are heavily influenced by their peers) tend to eat less of a food labeled healthy.  For teens, eating carrots is just not as acceptable as eating chips.

• People who eat a high protein diet (25% of calories) tend to eat fewer calories per day. A protein-rich breakfast with 25 to 35 g protein helps manage appetite for the rest of the day.

• The decline in hearty breakfasts mirrors the rise in obesity. Try eating an 800-calorie protein-rich breakfast and see what that does to your appetite for the rest of the day!  You’ll undoubtedly notice you feel less need to “reward” yourself with evening treats.

• A 100-calorie portion of natural whole almonds actually has only 80 available calories due to digestibility. The same likely holds true for other high fiber, high fat “hard” foods, such as other kinds of nuts. People who frequently eat nuts are actually leaner than folks who avoid nuts;; hence, you need not fear them as being “fattening” (in moderation, of course, as with all foods).

Exercise and weight

• Weight loss is about quality of life; exercise is about health. However, exercise strongly predicts who will be able to maintain their lost weight. While the reason for this is unknown, some researchers wonder if purposeful exercise allows the reduced obese person to eat more calories? (You know—the more you exercise, the more you can eat.) Or perhaps exercise is a marker of discipline and dedication to maintain a healthier eating style and lifestyle?

• Lifting weights is a good entry point for unfit people who want to start exercising. First they get strong, and then they can add on the walking, jogging, and aerobic activities.

• Lifting weights reduces the loss of muscle that occurs with diet-only reducing plans and creates the same health benefits of slimming the waist-line and improving blood glucose levels (hence reducing the risk of diabetes).

• Because weight loss without exercise contributes to loss of muscles and bone-density, some health professionals advise against weight loss for older people. Instead they recommend that people over 60 years focus on adding on exercise rather than subtracting food. You are never too old to lift weights!

• An effective exercise program includes 110 minutes per week of moderate to vigorous physical activity and two times a week of lifting weights for about 20 minutes.

• Men who maintain a stable weight tend to be active about 70 minutes a day. In comparison, obese men are less active and likely to be frail. Do obese people become frail—or do frail people become obese?

The bottom line: Keep active, enjoy whole foods that are minimally processed, live lean, and be well!

Image from: ic.steadyhealth.com

Nancy Clark MS RD CSSD (Board Certified Specialist in Sports Dietetics) counsels both fitness exercisers and competitive athletes in her private practice in the Boston-area (617-795-1875). Her Sports Nutrition Guidebook, Food Guide for Marathoners and Cyclist’s Food Guide all offer additional weight management information. The books are available via www.nancyclarkrd.com. See also www.sportsnutritionworkshop.com.



Urinary leakage: taking your life back!

By Ganesh S. Rao, M.D.

It’s embarrassing and usually happens at the worst times. Technically we call it female incontinence, but simply put it is the accidental release of urine. If you are a woman with this condition, you are not alone. 10 to 30% of adult women are affected, and at least 50% of elderly women have female incontinence. It causes women to avoid an active lifestyle, shy away from social situations, and constantly search for the nearest bathroom. Some women are even uncomfortable talking to their doctor about the condition.

Uncontrolled release of urine can occur when you laugh, sneeze, cough or exercise. Or, you may have a sudden need to run to the bathroom, but don’t make it in time. Sometimes incontinence is caused by a urinary tract infection, medications, or even constipation.

There are several types or classifications of incontinence; stress, urge, mixed and overflow.

Stress incontinence is urine loss during physical activity that increases abdominal pressure; like coughing, laughing, and sneezing. This is the most common type of incontinence in women. You may leak a small to medium amount of urine.

Urge incontinence is urine loss with the urgent need to void, accompanied by involuntary bladder contractions (also called overactive bladder). With this condition you may leak a larger amount of urine that can soak your clothes or even run down your leg.

Mixed incontinence is a combination of stress and urge incontinence. The most troubling type of incontinence is overflow, or the constant dribbling of urine where the bladder never completely empties.

Bladder control problems can be caused by weak muscles in the lower urinary tract, or problems or damage either in the urinary tract or in the nerves that control urination. Stress incontinence can be caused by several factors like childbirth, weight gain or other conditions that stretch the pelvic floor muscles. When these muscles cannot support the bladder properly, the bladder drops down and pushes against the vagina. Since the muscles that close off the urethra cannot be tightened, urine may leak because of the extra pressure on the bladder when you experience some physical activities. Urge incontinence is a bit more mysterious – and is caused by an overactive bladder that expels urine out of the bladder uncontrollably. It may be caused by irritation of the bladder, stress, or even some medical conditions not associated with the urinary system.

There are several surgical and non-surgical treatments for both stress and urge incontinence. One of the most promising procedures for the treatment of stress urinary incontinence (SUI) is referred to as ‘sling’ procedures.

One such product is the TVT Sling, where the doctor inserts a strip of PROLENE polypropylene mesh tape in a 30-minute, minimally invasive treatment performed in an outpatient setting. The tape-like strip of mesh is woven through the pelvic tissue and positioned underneath the urethra, creating a supportive sling. When pressure is exerted, the tape provides the support needed to allow the urethra to maintain its seal. It is a procedure that can be performed under local anesthesia while the patient is awake. The results can even be tested and the tape adjusted for maximum effectiveness during the procedure, improving success rates.

The sling is also advantageous since patients may be able to go home a few hours after the procedure, with a two to three week recovery period, experiencing very little interference with daily activities. The treatment has been performed on over one million women worldwide, and a recent study showed that even seven years after treatment, 81% of women treated remained dry, with an additional 16% experienced significant improvement. Since all medical procedures present risk, patients are encouraged to ask their doctor about rare, but potential complications associated with sling treatment.

Whatever type of incontinence you suspect you may have, consult your physician for advice and testing to determine the best path of treatment. With today’s treatment options, there is no reason to endure this embarrassing, uncomfortable condition. Take your life back!

Image from: www.thehealthage.com

Dr. Ganesh S. Rao, M.D., F.A.C.S, received his bachelor of medicine and surgery at Mysore Medical College, University of Mysore, India. He was a research associate in the Division of Urologic Surgery at Washington University School of Medicine in St. Louis, Missouri, from 1996 to 2001. Between 1997 and 2000, he completed his internship in surgery and his residency in urologic surgery. He is certified by the Educational Commission for Foreign Medical Graduates and is a member of the Indian Physicians Association of Kentucky. Dr. Rao is certified by the American Board of Urology and is a Fellow of the American College of Surgeons. He joined Metropolitan Urology in 2001.




America’s Big Health Problem: OBESITY

By Carlos Rivas, MS, CSCS 

            The obesity epidemic is a big contributor to the skyrocketing healthcare costs in the United States.  The most recent estimates indicate that more than 66% of adults are classified as overweight, 32% as obese, and 5% extremely obese.  What is more frightening is that childhood obesity seems to be rising at alarming speed as well. Childhood obesity rates have more than tripled since 1980 and it seems that it will continue to climb along with the adult rate.  Overweight and obesity are linked to numerous chronic diseases, including cardiovascular disease, diabetes, many forms of cancer, and numerous musculoskeletal problems.  It is estimated that the direct and indirect costs of obesity are in excess of $117 billion.  Obesity is also the leading cause of Type 2 diabetes, a disease that is totally preventable.  In fact, 57 million Americans have what we call prediabetes, a disease defined as having a blood pressure higher than 130/80; triglyceride levels greater than 150; fasting blood glucose levels greater than 100; and a waist line greater than 35 inches for women and greater than 40 inches for men. 

Adult obesity rates have increased in 23 states and did not decrease in any state in the past year.  Sixteen states experienced an increase for the second year in a row, and eleven states had an increase for the third consecutive year. The percentage of obese or overweight children in the United States is above 30% in 30 states.  As you can clearly see, the only way we as a country are going to be able to compete with the rest of the world is by changing our health behaviors.

            The management of our body weight is dependent on energy balance, which is affected by energy intake and energy expenditure.  In other words, for a person who is overweight or obese to reduce body weight, energy expenditure must exceed energy intake.  A weight loss of 5% to 10% provides significant health benefits, and these benefits are more likely to be sustained through better eating habits and participation in habitual physical activity. 

            The Proformance Professional Personal Trainers and Wellness Coaches follow the FITT principles as stated by scientific evidence to work best for those who are overweight or obese. 

Frequency: 5 days per week

Intensity: Initial exercise training intensity should be moderate (40%-60% Heart Rate Reserve).  Eventual progression to 50%-70% of Heart Rate Reserve resulting in further health benefits.

Time: Performance of 10-minute segments of continuous exercise 3 times per day.  Eventual progression of 30-45 minutes of continuous exercise activity per day.

Type:  The primary mode should be aerobic physical activities that involve large muscle groups.  As part of a well-balanced program, resistance-training exercises need to be included.  Resistance exercise will enhance your muscular strength and physical function.

Bottom Line:  You must know why you are deciding to eat better, drink more water, and exercise more!  You must have a compelling reason why you have decided to make major improvements in your lifestyle.  My major reason for following a healthy lifestyle has always been to avoid taking unnecessary medications.  I want to have the energy needed to help as many people as I possibly can.  Having dis-ease does not make it easy for me to accomplish my goals, so I choose to avoid disease by following a simple lifestyle management program I call “5 of 5”.

Image from: http://www.livescience.com

Carlos Rivas, MS, CSCS, ACSM-CPT is the Director of Fitness and Wellness Operations for Proformance Fitness, located at 2041 River Road, Louisville, KY, 40206. He is also the founder of FitCorp, a Highly Individualized Worksite Wellness Company.  Carlos has a Master’s degree in Exercise Physiology and has over 20,000 hours of Professional Personal Training and Wellness Coaching experience. Carlos can be reached by phone at 502-741-9428 or by email: carlosfitpro@gmail.com

Preventing Gardening Injuries

By Amanda Edsell, OTR/L, CHT   

Many Americans give up their love of gardening every year due to persistent pain and stiffness in their hands, hips, knees, and back. According to the Arthritis Foundation, over 46 million men, women, and children have doctor-diagnosed arthritis (osteoarthritis, rheumatoid, or juvenile).

Practical Pain Free Gardening Tips

  • Break up large tasks into several timed sessions.
  • Work at a steady pace; take intermittent rest periods during the course of the day to avoid over-fatigue and over-stress of joints.
  • Stretch upper and lower limbs before going to work.
  • Take frequent breaks, and use the strongest and largest joints and muscles available for each job.
  • Use proper body mechanics to lift objects so that the legs are being used to lift rather than the arms and back. Keep the weight of the object close in to the center of your body.
  • Use ergonomic equipment such as long-handled spades, bulb planters, and weeding forks to avoid back strain, extreme postures of the knees and hips, and extended reach of the shoulders.
  • Avoid loose-fitting, bulky gloves as they can actually increase the workload on your hands as they attempt to hold onto and maneuver tools/items.
  • Spring-loaded pruners, loppers or any tools that increase leverage while cutting will decrease the amount of force exerted through the hands and upper extremities.
  • When kneeling is preferred or necessary, individual strap-on knee pads or padded mats can reduce mechanical stress on the resting surface of your lower extremities.
  • Consider raised flower beds or flower boxes for easier access or utilize a wagon or stool for prolonged sitting.
  • Stack the most commonly used tools in a cart, wagon, or other gardener’s helper that does double duty as a seat for planting and weeding.
  • Consider low-maintenance plants such as daylilies, hydrangeas, hostas, boxwood or yew shrubs, and groundcover (i.e. English ivy) when planning new landscaping.

Image from: www.womenfatburntips.com/benefits-of-gardening-for-health/

Amanda L. Edsell OTR/L, CHT graduated from Spalding University in 2002 with a Bachelor’s degree in Occupational Therapy. In 2008, she became a Certified Hand Therapist (CHT). Amanda is certified to perform augmented soft tissue mobilization (ASTYM), Functional Capacity Evaluations (FCEs), and is trained in the application of kinesiotaping as well. She joined our KORT team in 2004.


How to Manage the Aches & Pains of Pregnancy

By Tricia S. Brown PT, DPT, OCS, STC 

Although pregnancy is a time of great joy and excitement, it also brings with it numerous aches, pains and real discomfort. For decades, medical providers have documented the physical pain women experience as a result of pregnancy. In fact, the Mayo Clinic estimates that 50% of pregnant women experience back pain, the most common pregnancy related complaint.

As women undergo anatomical changes related to pregnancy, the body alignment and weight distribution are altered, causing differing levels of pelvic, leg, joint and low back pain. As your belly grows, your center of gravity changes making every muscle in your body work differently.  It also puts additional stress on other muscle groups leading to leg, foot and calf cramping, shin pain, and abdominal pain. Fortunately, recent research has documented the success of physical therapy in reducing pregnancy related pain.

Students from Texas State University reviewed best practices to track the most productive techniques in reducing pregnancy related pain. The researchers focused on interventions and patient education to specifically address mobility, weakness, and pain in the pelvic girdle and low back region. By utilizing two manual therapy techniques and three therapeutic exercises, a physical therapy specific management plan was found to be very effective in decreasing pain complaints among the expectant moms.

Their findings showed that physical therapists, focusing on the individual needs of each client, were able to successfully reduce the pain and discomforts often associated with pregnancy. Starting an early stabilization program prior to the onset of physical issues can help reduce the amount of pain a patient experiences. Physical therapists can guide the program through stages and customize a routine according to safe standards during each trimester. I sometimes see my pregnant patients sporadically throughout their pregnancies to help progress them through each trimester.

Common Pregnancy Complaints and Solutions

  • Low back pain: Sleep on your side, pillow between your legs. Consult a physical therapist for proper lifting and bending techniques to help reduce strain on the low back.
  • Leg pain: Wearing shoes that have insoles with some padding which will help cushion your feet and legs. Take a break and put your feet up to help with swelling.
  • Sciatic nerve pain: Try different stretching techniques for your hamstring, piriformis and psoas muscles. Many of these will need to be altered to avoid lying flat on your back, but a physical therapist can give you suggestions.
  • Joint pain: Swimming is best exercise to relieve joint pain and maintain muscle strength during pregnancy. The nearly weightless environment provided by the water allows for physical activity without the associated joint and muscle strain. A physical therapist can provide pregnancy specific water workouts.
  • Mobility: Especially in the final trimester, patients find moving around more difficult and painful. The excess weight and changes in center of gravity lead to issues with remaining mobile. Manual physical therapy techniques can be used to help patients maintain their mobility making pregnancy and recovery easier and less painful.

Image from: www.blog.northwestmed.com/

KORT Tates Creek Clinic Director and Physical Therapist Tricia S. Brown PT, DPT, OCS, STC is the clinic director and has been a physical therapist since 1999. A graduate of East Tennessee State University, she has worked primarily in outpatient orthopedics but also has experience in inpatient settings, home health care and nursing home care. She received her Sports Therapy Certification (STC) from The University of St. Augustine in 2006 and her Orthopedic Certified Specialist (OCS) certification in 2010. She has special interests in sports-specific care and rehabilitation, general orthopedics, manual therapy, and the treatment of cervical pain and headaches. www.kort.com







How Many Calories Do You Need Each Day?

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

There’s an App for this!

Knowing how many calories you need each day will help keep you energized while you are training for your event and doing all the things you need to do each day: work, manage a family, take care our your home or lose weight.  There are some FREE apps that you can use to help to determine how many calories you need each day.

A FREE app, My Fitness Pal, for your smart phone or online at can help to determine how many calories you need each day: www.myfitnesspal.com/tools/bmr-calculator and how many calories you burn when playing soccer or lifting weights: www.myfitnesspal.com/exercise/lookup. Add the calories plus the calories you burned practicing to get how many calories you need on most days.

Once you determine how many calories you need each day, the timing of your food intake is also important. Eating 5 – 6 times per day will help give you bullets of energy but keeping the calories in line with your overall calorie needs will maximize your performance. Never skip breakfast.

Other excellent apps and websites to determine calories are: LOSE IT! (www.loseit.com), SPARK PEOPLE (www.sparkpeople.com).

The Old Fashion Way to Determine Your Calories

To determine how many calories you need each day, you can calculate the calories the OLD FASHION WAY by using the HARRIS BENEDICT EQUATION to determine your resting metabolic rate (RMR) then choosing an activity factor to estimate the total calories per day.

Harris Benedict Equation


RMR = 88.362 + [1.889 X HT (in)] + [6.089 X WT (lbs)] – (5.677 X Age)


RMR = 447.593 + [(1.219 X HT (in)] + [(4.20 X WT (lbs)] – (4.7 X Age)

HT = height in inches   WT = weight in pounds   age = age in years

Activity Levels

Very Light-seating and standing activities, driving, no regular exercise.

Light – child care, walking on a level surface 2.5 – 3 miles per hour, some regular exercise.

Moderate – walking/running 3.5 to 4 mph, cycling, regular exercise 3 to 4 times/week -30 to 40 minutes duration.

Heavy – walking uphill with a load, basketball, soccer, regular exercise 4 times/week 40 minutes or more in duration.

Very Heavy – distance running, hiking with backpack up and down hills, regular exercise 5 times/week for at least 1 hour in duration.

TABLE 1.  Activity Factors. Choose your activity level from the table below. Then do the math.



Little to no exercise

RMR X 1.2

Light (1 – 3 days per week)

RMR X 1.375

Moderate exercise (3 -5 days/week)

RMR X 1.55

Heavy exercise (6-7 days/week)

RMR X 1.725

Very heavy (twice/day heavy workouts)

RMR X 1.9

Example, 1300 X 1.55 (moderate) = 2015 calories/day

You can also determine how many calories you burned by wearing a heart rate monitor that determines calories burned during exercise. (Not all heart rate monitors calculate calories). Then you can add those calories to your resting metabolic rate calories to get an estimate of active calories burned while exercising.  Example, 1300 X 500 calories = 1800 calories.  So, you could safely eat at least 1800 calories without gaining weight.

Again, it’s just an estimate. Weigh only once a week about the same time.  I suggest weigh after the first void in the morning before drinking anything with as few clothes as possible.

 Using Oxygen Consumption to Calculate your Personal RMR

The BodyGem Resting Metabolic Rate device is the handheld, portable and an effective tool that gives you an accurate RMR measurement result in 10 minutes or less. To perform a measurement, you simply breathe into the indirect calorimeter, which measures their oxygen consumption (VO2), the resulting RMR number is clearly displayed on the device’s LCD screen. It has been validated against the gold standard Douglas Bag, and other commonly used metabolic carts. The test costs anywhere from $75 to $150 per test. For the best results, you should take the test when you are fasted. But you still need to estimate the active calories you burn.

Body Media FIT™ On-Body Wellness Core Armband Monitor

The BodyMedia FIT CORE which is promoted by Biggest Loser is another way to determine how many calories you burn each day. The CORE’s biggest plus is that it track calories burned for 24/7. It cost about $119.  Unlike other fitness trackers, which estimate calories burned using an algorithm of steps and weight, the CORE uses special sensors to track not just your activity but also your body’s reaction to that activity. This makes it much more accurate as a calorie tracker, so you can realistically see how many calories you’re burning. But you have to buy subscription-based Activity Tracker in order to find out how many calories you have burned in the 24 hours.  The CORE Armband does not display any information on the device itself.  That will cost you  $6.95/month or you can opt to purchase a $69 optional display, which syncs with the CORE and lets you see a quick view of progress toward your daily goals. If you want to track your progress, you’ll still need to purchase the Activity Tracker.

What’s the Take Home Message?

I think it’s helpful to know how many calories you need each day so you can manage your health. In today’s world, lifestyle is the major contributor to increasing your risk of many diseases like heart disease, stroke, diabetes, and cancer.  Lifestyle includes your diet and also your daily activity.

Image from: www.greatist.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 13 grandchildren.