Chicken Spinach Enchiladas


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

I love this recipe because it’s a way of hiding spinach in a kid-friendly Mexican enchilada if you have a kid who won’t eat any green vegetables. The garlic & cheese overpowers the spinach but the good news is this recipe really tastes good, too. The recipe is excellent as a leftover and can be warmed up easily in the microwave. In addition, you can cut the recipe in half as well before you cook it. If you want to lower the fat and calories in this recipe you can also use fat free cream cheese.  You can use canned chicken breast or you can poach your chicken which is very easy to do.  See the recipe below.


Nutritional Information Per Serving: 395 calories, 29 grams protein, 15 grams of fat,  32 grams of CHO, 4 grams dietary fiber, 895 mg sodium.

Preparation Time: 15 minutes  Cook Time: 35 minutes

Serves:  8 servings; one taco each



  • 1 cup diced onions
  • 3 garlic cloves, minced or ¾ tsp dried minced garlic
  • 1 tbsp olive oil
  • 2 cups chopped baby spinach
  • 2 cans (4.5 oz) chopped green chilies, drained
  • 3 cups shredded cooked chicken breast (see how to poach chicken below)
  • 1 (8 oz) package of low fat cream cheese, cubed and softened
  • 2 cups (8 oz) shredded low fat pepper jack cheese
  • 1/3 cup chopped fresh cilantro
  • 8 (8-inch) soft taco whole wheat tortillas

Spoon 1 tbsp of bottled Tomatillo Salsa or Thick Salsa per tortilla before serving



Preheat the oven to 350 degrees. Sauté the onion and garlic in olive oil under medium heat for 5 minutes until tender.  Add spinach and green chilies.  Sauté 1 to 2 minutes or until spinach is wilted.  Stir in chicken and cream cheese, pepper jack cheese and fresh cilantro.  Stir continuously until the cheeses melt. Spoon ¾ cup of chicken mixture in center of tortilla. Roll up tortilla.  Placed the rolled tortilla seam side down on a 13 X 9 inch baking dish that has been sprayed with cooking spray.  Bake for 30 to 35 minutes or until golden brown.  Top with 1 tbsp Tomatillo or Thick Salsa per tortilla.


Shopping List

  • onions
  • 3 garlic cloves or dried minced garlic
  • olive oil
  • chopped baby spinach
  • 2 cans (4.5 oz) chopped green chilies
  • 2 pounds chicken breast
  • 1 (8 oz) package of low fat or fat free cream cheese
  • 8 oz shredded low fat pepper jack cheese
  • fresh cilantro
  • 8 (8-inch) soft taco whole wheat tortillas
  • bottled Tomatillo Salsa or Thick Salsa


How to Poach Chicken
To poach boneless, skinless chicken breasts, place them in a large pot or skillet and add 1-2 cups of water or chicken broth. Bring to a boil, reduce heat, cover, and cook for 9-14 minutes until chicken reaches 160 degrees F. about 15 minutes.

You can also poach in the oven. Place chicken in a single layer in a roasting pan. You can add lemon slices, peppercorns, or any other spices or herbs. Bring 4 cups of water to a boil and immediately pour over chicken. Cover and bake at 400 degrees F for 20-35 minutes, checking for an internal temperature of 160 degrees F.

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition,, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s website which is an on-line health & wellness magazine, Barbara writes nutrition and health columns for as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.    


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!

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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 For online education, visit and

Super Sports Foods: Do They Really Need to be Exotic?

clark super foods

By Nancy Clark MS RD CSSD

 Do you ever get tired of reading yet-another headline about The 10 Best Super Sports Foods, only be instructed to buy exotic fruits, ancient grains, and other unusual items? Do we really need chia, spelt, and quinoa? Is anything wrong with old-fashioned peanut butter, broccoli and brown rice? Doubtful! Powerful nutrients are found in standard foods that are readily available at a reasonable cost. You know, oranges, bananas, berries, oatmeal, almonds, hummus, lowfat yogurt, brown rice, tuna … the basic, wholesome foods recommended by the government’s My Plate ( Are those foods exotic? No. But do they still do a great job of offering super nutrition? Yes!

To add to the confusion about exotic sports foods, the sports food industry touts their list of engineered super sports supplements. Ads lead you to believe you really need to buy these products to support your athletic performance. The question arises: Are there really special nutrients or components of food that can help athletes to go faster, higher or stronger? If so, can they be consumed in the form of whole foods or do we actually need special commercial supplements?

At a 2014 meeting of Professionals in Nutrition for Exercise and Sport (, exercise researchers from around the globe discussed that topic and provided the following answers to the following thought-provoking questions.


Is there any difference between consuming pre-exercise caffeine in the form of pills, gels or coffee?

Regardless of the source of caffeine (pill, gel, coffee), it is a popular way to enhance athletic performance. Take note: High doses of caffeine (2.5 to 4 mg/lb body weight; 6 to 9 mg/kg) are no better than the amount athletes typically consume in a cup or two of coffee (1.5 mg/lb; 3 mg/kg). Hence, drinking an extra cup of coffee is unlikely to be advantageous, particularly when consumed later in the day before an afternoon workout and ends up interfering with sleep.


Do tart (Montmorency) cherries offer any benefits to sports performance? If so, what’s the best way to consume them?

Tart cherries (and many other deeply colored fruits and veggies) are rich in health-protective antioxidants and polyphenols. Tart cherries can reduce inflammation, enhance post-exercise recovery, repair muscles, reduce muscle soreness, and improve sleep. Athletes who are training hard, participating in tournaments, or traveling through time zones might be wise to enjoy generous portions. Yet, to get the recommended dose of cherries that researchers use to elicit benefits, you would need to eat 90 to 110 cherries twice a day for seven days pre-event. Most athletes prefer to swig a shot of tart cherry juice concentrate instead!


What about food polyphenols such as quercetin and resveratrol?

Polyphenols are colorful plant compounds that are linked with good health when they are consumed in whole foods. Yet, polyphenol supplements, such as quercetin or resveratrol, do not offer the same positive anti-oxidant or anti-inflammatory benefits. An explanation might be that once in the colon, where most polyphenols go, parts leak into the bloodstream during heavy exercise. These smaller compounds create the anti-inflammatory effect. Athletes who routinely eat colorful fruits during endurance training offer their gut the opportunity to distribute good health!


Does curcumin reduce chronic inflammation?

Curcumin (an active constituent of tumeric, the spice that gives the yellow color to curry and mustard) has beneficial properties that have been shown to help prevent cancer, enhance eye health, and reduce inflammation. Subjects with osteoarthritis (an inflammatory condition) who took curcumin supplements for 8 months reported less pain (due to less inflammation) and better quality of life. Unfortunately, curcumin is rapidly metabolized and therefore has low bioavailability when consumed in the diet. To increase absorption, supplements often contain curcumin combined with piperine (black pepper extract).


Does green tea help improve body composition in athletes? What is the best way to take it?

Green tea reportedly enhances fat oxidation and helps with weight loss, particularly when combined with caffeine. But the amount of additional fat burned is minimal, and the 10 to 12 cups of green tea needed to create any effect is a bit overwhelming. (Hence, most studies use a green tea extract.) Because green tea has not been studied in lean athletes, we can only guess that it is unlikely to offer a significant improvement in body composition.


Is watermelon juice a powerful stimulant for sports performance?

Watermelon juice is a source of L-citrulline, an amino acid that contributes to production of nitric oxide. Nitric oxide helps relax the blood vessels and thus enhances blood flow so more oxygen can get transported to the working muscles. One study with athletes who consumed L-citrulline supplements reports they attained a 7% higher peak power output as compared to when they exercised without L-citrulline.

Yet, when athletes were given watermelon juice (contains L-citrulline) or apple juice (that has no L-citrulline), the peak power was only slightly higher and the L-citrulline gave no significant benefits. The bottom line: Watermelon is a nourishing fruit and a welcome refreshment for thirsty athletes. You would need to eat a lot of watermelon to get the equivalent of L-citrulline found in (expensive) supplements. Your best bet is to enjoy watermelon in standard portions as a tasty addition to your sports diet.


What can be done with pea, hemp, or other plant protein to make them as effective as whey for building muscle?

In general, plants (such as peas, hemp) contain less leucine than found in animal proteins. Leucine helps drive the muscle’s ability to make new protein. Hence, to increase the muscle-building properties of plant proteins, you need to either eat large portions of, let’s say, hemp or pea protein (to get a bigger dose of leucine), or you can combine those plant-foods with leucine-rich proteins, such as soy, egg, or dairy foods.


The bottom line: Your best bet to optimize performance is to optimize your total sports diet. No amount of any supplement will compensate for lousy eating, though a few just might enhance a proper diet.

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 (new 5th edition) and food guides for runners, cyclists and soccer players, see For online education, also see




Grilled Cedar-Planked Salmon

cedar plank salmon

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

My favorite fish is salmon & I especially like it cooked on a cedar plank. I usually eat the cedar plank salmon at a restaurant but here’s a really great recipe you can make at home!

Nutritional Information Per Serving:  208 calories, 23 grams protein, 11 grams of fat,   grams of CHO, <1 grams dietary fiber,  270 mg sodium.

Preparation Time: 10 minutes  Plank Soak Time: at least 4 hours 

Serves:  8 four-ounce servings


  • 1 untreated cedar plank (14 X 7 X 1 inch)*
  • ½ cup Kraft Sun Dried Tomato Vinaigrette Dressing
  • ¼ cup finely chopped fresh parsley
  • ¼ cup finely chopped oil-packed sun dried tomatoes
  • 1 tbsp oil
  • 2 lb salmon fillet 1 inch thick (red snapper, orange roughy)



Put plank in water & make sure it is completely submerged & soak for at least 4 hours or you can soak overnight. Mix dressing, parsley, & tomatoes.  Brush the plank with oil, then top with salmon.  Put plank on medium heat grill.  Grill for 20 minutes or until the fish easily flakes with a fork. After 10 minutes of grilling salmon, add the dressing mixture to top the salmon.


Shopping List

  • 1 untreated cedar plank (14 X 7 X 1 inch)
  • Kraft Sun Dried Tomato Vinaigrette Dressing
  • fresh parsley
  • oil-packed sun dried tomatoes
  • vegetable oil
  • 2 lb salmon fillet 1 inch thick

*You can grill on a sheet of heavy-duty foil instead.

Adapted from:

Image from:


Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition,, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, Barbara writes nutrition and health columns for as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.     

Sports Nutrition: What’s Old? What’s New?

running in the snow

By Nancy Clark MS RD CSSD

Once upon a time, warriors (the original athletes) ate lions’ hearts. Today, athletes seek out energy drinks and protein shakes. Clearly, times have changed! In case you are wondering what else is old—and new—when it comes to sports nutrition, I’ve compiled this update to resolve confusion and help you fuel for success.

OLD: The lighter you are, the better you will perform.

NEW: The athlete who is genetically lean and eats enough to have well-fueled muscles has an advantage over the athlete who is genetically heavier and has to skimp on food to maintain an unnaturally low weight. Research indicates elite female swimmers who restricted calories in the pursuit of thinness lost speed (but not body fat) during a 12-week training cycle, while those who ate adequately swam faster. (1) Thin at any cost often comes with a high price tag.

OLD: Female athletes who train hard and have too little body fat will stop having regular menstrual periods.

NEW: Lack of fuel, not lack of body fat, tends to determine if a female athlete’s body will menstruate normally. That is, many very lean female athletes do have regular menses. Although they may have very low body fat, they eat enough to support both their exercise and normal body functions.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 OLD: Eat fat, get fat.

NEW: Yes, excess calories of dietary fat can easily convert into body fat. But healthful fats (i.e., nuts, olive oil, avocado, salmon) are an important part of a sports diet; they help reduce inflammation. Athletes also need dietary fat to absorb important vitamins such as A, D, E, and K. Fat also fuels the muscles; small amounts of fat get stored within the muscles and can enhance stamina and endurance. Research suggests runners had more endurance when they switched from a very low fat to a moderate fat diet. (2)

OLD: If you want to lose weight, you need to go on a diet.

NEW: Diets do not work. If diets did work, then everyone who has ever been on a diet would be lean. Not the case. Rather than going on a diet, try to make just a few basic changes, such as 1) choose fewer processed snacks in wrappers and instead enjoy more fruit (fresh or dried) and nuts, and 2) get more sleep. Lack of sleep can contribute to not only weight gain but also reduced performance.

OLD: The recommended dietary allowance for protein (RDA) is the same for athletes as for non-athletes.

NEW: The RDA for protein (0.8 grams per kilogram body weight.) is less than the 1.2 to 1.7 g pro/kg currently recommended for athletes. Most athletes eat that much (plus more) as a part of their standard meals, so you are unlikely to need protein supplements. You do want to distribute your protein intake evenly throughout the day, and not pile it all into dinner, so your muscles have a consistent supply of amino acids (the building blocks of protein).

OLD: Slabs of roast beef help build bigger muscles.

NEW: Because the body can utilize only about 20 to 25 grams of protein at one dose, you won’t build bigger muscles by eating jumbo portions of beef in one sitting (4). Your better bet it to cut that one-pound slab of beef into four pieces. Enjoy those deck-of-cards-sized pieces at least every four hours, so you get 20 to 25 grams of protein at each meal and afternoon or evening snack. Weight lifting—not eating excessive protein—triggers muscles to grow bigger. To have the energy needed to lift heavy weight, you want to eat meals based on grains, fruits and veggies (with protein as the accompaniment). Those carbs provide the fuel needed to lift heavy weights.

OLD: Don’t drink coffee before exercise; it is dehydrating.

NEW: Pre-exercise coffee is not dehydrating and it can actually enhance performance (5). Caffeine boosts alertness and reaction time, as well as makes the effort seem easier so you work harder without feeling the extra effort. If you are sensitive to caffeine (a mugful gives you a “coffee stomach” and the jitters), you’ll be better of abstaining. But athletes who enjoy drinking coffee will likely notice positive benefits.

OLD: Energy drinks contain magical ingredients, such as taurine.

NEW: The magical ingredients in energy drinks are caffeine and sugar. Although taurine has been reported to enhance performance, the limited research was done on rats. Newer research suggests taurine offers no ergogenic benefits (6). To save your money, simply add a heaping tablespoon of sugar to your coffee. You’ll get the same boost. Better yet, eat wisely and sleep more; you won’t need an energy drink.

OLD: Don’t eat before or during exercise. The food just sits in the stomach and does not get digested.

NEW: You can digest food during exercise as long as you are working at a pace you can maintain for more than 30 minutes. Fitness exercisers can benefit from a small pre-exercise snack as tolerated (such as a banana, granola bar, or packet of oatmeal) to get their blood sugar on the upswing. Endurance athletes who exercise for more than 90 minutes will benefit from both pre-exercise fuel and then carbs during the extended workout. The target is ~250-350 calories of carbohydrates per hour. That’s more than just a swig of sports drink! Be sure to practice fueling prior to and during exercise, so you can learn what works and what doesn’t.

OLD: Refuel as soon as possible after you workout.

NEW: If you do exhausting workouts twice a day, you’ll benefit from eating soon after the first bout of exercise to fuel-up for the next bout. But if you are a fitness exerciser, simply back your workout into the next meal. You’ll have plenty of time to recover before your workout the next day.

OLD: Orange slices are perfect for half-time of a youth sporting event.

NEW: While chomps, gels, and sports drinks may seem better than cut-up oranges and water for half-time fueling at youth sports events, kids actually should be taught that natural foods work well. Orange slices, pretzels, and water provide more nutrients and electrolytes (a.k.a sodium and potassium) than sports drinks. Even adult athletes can do well with real foods. While elite athletes might prefer engineered products during intense exercise, most of us can perform just fine with real food. Go back to enjoying more orange slices, please. Sometimes the old ways can be preferable to the new!



Selected References:

1. Vanheest J, C Rodgers, C Mahoney, MJ DeSousa. Ovarian suppression impairs sport performance in junior elite female swimmers. Med Sci Sports Exerc 46(1):156-66, 2014.


2.  Horvath, P, C Eagen, N Fisher, J Leddy, and D Pendergast. 2000. The effects of varying dietary fat on performance and metabolism in trained male and female runners. J Am Coll Nutr 19(1):52-60.


3.  Mah CD, Mah KE, Kezirian EJ, Dement WC. 2011. The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep. 34(7):943-50


4. Phillips, S. van Loon, L. 2011. Dietary protein for athletes: From requirements to optimum adaptation.  J Sports Sci 29(S1):S29-S38.


5. Armstrong, L, A. Pumerantz, M. Roti, et al. 2005. Fluid, electrolyte, and renal indices of hydration during 11 days of controlled caffeine consumption. Int J Sport Nutr Exerc Metab 15:252-265.


6. McLellan TM, Lieberman HR. 2012. Do energy drinks contain active components other than caffeine? Nutr Rev. 70(12):730-44.


Image from:

  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 new Sports Nutrition Guidebook, 5th Edition, and her food guides for runners, cyclists and soccer players, see For online education, visit


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 For online education, see





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)



Regional Interdependence: Treat the knee without treating the knee.


By Josh Bixler PT, DPT

           Picture this: You’re an avid runner and you’ve recently ramped up your training for the upcoming mini-marathon.  In doing so, you’ve developed some nagging pain in your right knee.  Being the pro-active person you are, and aspiring to do well in the race, you decide to seek the care of a physical therapist.


During the evaluation, the physical therapist takes a thorough history from you, examines your right knee, but also assesses the rest of your body.  They end up treating your left foot and providing home exercises for your hips and trunk.  Curious as to why this was the choice of treatment, since the right knee is clearly the source of pain, not the hips or the foot, you ask the therapist for clarification.  The therapist responds “regional interdependence.”  They explain that your left foot lacks the mobility (motion) you need, your hips and trunk are weak, and it appears these deficits caught up with you during your training.


In this instance the right knee was the victim, and the foot and hips were the problem.  The therapist went on to explain the importance of looking at the body as a whole, and not chasing symptoms.  With this treatment approach, they feel confident you’ll be back to pain-free running in no time.


The aforementioned case is one example of the musculoskeletal examination model termed “regional interdependence.”  Regional interdependence is the concept that potentially unrelated impairments above and/or below the patient’s area of complaint; this is necessary to determine if those areas are contributors or not.  Intervention is then applied to those areas deemed as impaired with the expectation of producing a result at the source of complaint.  The interventions could be anything from hands on techniques to exercise.  The result could be improved range of motion, decrease pain, or improved strength just to name a few.  Now this is not to say the area of symptoms is not impaired, it very well may be, however there are often additional areas involved that may have contributed to the problem and deserve attention.


The regional interdependence model came about due to the need for a better approach to explaining and treating musculoskeletal and treating musculoskeletal disorders.  As the field of rehabilitation has progressed, so too has our knowledge of how the body works and the limitations of the old approaches to treatment.  It is important to note that regional interdependence applies to addressing impairments above and below one’s source of symptoms, and not that of referred pain, or pain being felt in a different area from the actual source.


Given this information, you might be saying to yourself, “This concept sounds great in theory, but is there evidence to support it?”  Absolutely!  The current literature has many articles referencing regional interdependence either directly or indirectly.  The literature contains thoracic spine (mid-back) interventions for the cervical spine interventions for the shoulder; cervical spine interventions for the elbow; hip interventions for lumbar spine (low back); hip, ankle, and foot interventions for the knee.


Clinically speaking, assessments of an athletic population may involve impairments even further up or down the body.  When assessing a baseball pitcher with elbow or shoulder pain, one must not only look at those areas, but also consider the neck, shoulder blade, thoracic spine, lumbar spine, hips, legs, knees, and feet.  This approach is similar for runners, where abnormal breathing patterns could also potentially contribute to impairments.


With the acceptance and growth of the regional interdependence examination model, assessments have been developed to further assist healthcare professionals.  One of those assessments is the Selective Functional Movement Assessment, or SFMA.  The SFMA is a tool that allows clinicians to assess patient movement patterns starting at the neck and working down to a body-weighted squat. From there, movements identified as “dysfunctional” can be further broken down into mobility versus stability problems.  This approach, along with best current evidence and clinician expertise, can help guide the clinician with decision making.


In a time with rising healthcare costs and with money tight, patients have come to want and expect care that produces meaningful outcomes.  In the case of the runner, the right knee was the victim and a thorough assessment using the regional interdependence examination model helped to “treat the knee without treating the knee.”


DO you have pain or just a want to take a pro-active approach like this runner?  Consult your physician, the professionals at KORT, or visit www.kort.come to learn more.


KORT Old Brownsboro Crossing Clinic Physical Therapist Josh Bixler
 PT, DPT, graduated with his Doctorate of Physical Therapy from Bellarmine University, and also has a BS in Exercise Science from the University of Indianapolis. He is currently finishing up an orthopedic residency and is trained in using both the Selective Functional Movement Assesment and Functional Movement Screen. Josh is a University of Michigan sports fanatic (Go Blue!) and also enjoys rooting for the Colts, White Sox, and Red Wings. His personal interests include anything relating to physical therapy, injury prevention, fitness, nutrition. For more information go to

No-Bake Pumpkin Pudding Cheesecake


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

Here’s an easy no-bake pumpkin cheesecake recipe for the holidays. But pumpkin shouldn’t just be for Thanksgiving. Pumpkin is high in vitamin A and C plus it’s has some dietary fiber as well.

Nutritional Information Per Serving:   226 calories,  3 grams protein,  8 grams of fat,  37 grams of CHO,  2 grams dietary fiber,  393 mg sodium.

Preparation Time: 15 minutes   Chill Time: 3 hours

Serves:  12


  • 4-oz  reduced-fat cream cheese, softened
  • 1 tbsp skim milk
  • 1 tbsp sugar
  • 1 ½ cups reduced-fat whipping topping
  • 9-inch prepared graham cracker crust
  • 1 cup COLD skim milk
  • 2 – 3 oz pkgs vanilla flavor instant pudding & pie filling
  • 16-oz can solid pumpkin
  • 1 tsp cinnamon
  • ½ tsp ground ginger
  • ¼ tsp ground cloves


Mix softened cream cheese, 1 tbsp milk, & sugar in a large bowl with a wire whisk until smooth. Gently  stir in whipped topping. Spread on the bottom of prepared crust. Pour 1 cup skim milk in a bowl. Add pudding mixes & spread over cream cheese layer. Stir in pumpkin & spices, and spread over cream cheese layer. Refrigerate at least 3 hours or until set.

Shopping List

  • 4-oz  reduced-fat cream cheese
  • skim milk
  • reduced-fat whipping topping
  • 9-inch prepared graham cracker crust
  • 2 – 3 oz pkgs vanilla flavor instant pudding & pie filling
  • 16-oz can solid pumpkin
  • cinnamon
  • ground ginger
  • ground cloves

Adapted from Year-Round low-Fat & no-Fat Holiday Meals in Minutes by M.J. Smith, R.D. 1995.

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Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition,, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, Barbara writes nutrition and health columns for as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.    




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 ( 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!

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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 Also see for online CEUs.


Crockpot Lasagna Made Simple


If you are short on time but love homemade lasagna here’s the perfect recipe for you. You can even fix it the night before in your removable crockpot casserole dish,  refrigerate & then pop it into the crockpot. Serve with a spinach salad with mandarin slices & you have a healthy family meal.

Nutritional Information Per Serving: 347  calories,  32 grams protein,  12 grams of fat,  25 grams of CHO,  3 grams dietary fiber,  813 mg sodium.

Preparation Time: 15 minutes Slow Cooker Time: 4 – 6 hours low

Serves:  8


  • 1 pound extra lean ground beef
  • 1 jar (24-ounce) spaghetti sauce
  • 1 cup water
  • 1 container (15 oz) reduced fat cottage cheese or ricotta cheese
  • 1 pk Shredded Mozzarella cheese (7 oz), divided
  • ¼ cup grated reduced fat Parmesan Cheese, divided
  • 1 egg, whisked
  • 2 tbsp fresh or dried chopped parsley
  • 6 lasagna noodles, uncooked


Brown the beef in a large skillet & drain.  Add spaghetti sauce and water to the meat. Mix in the cottage or ricotta cheese, 1 ½ cup of mozzarella cheese, 2 tbsp parmesan cheese, egg and parsley. Spoon 1 cup of meat sauce in the bottom of the slow cooker, then ½ noodles (broken to fit) and ½ cheese mixture. Cover with 2 cups of the meat sauce. Next layer: top with remaining noodles cheese mixture, and meat sauce. Cover with lid. Cook on low for 4 to 6 hours or until the liquid is completely absorbed. Note: For best results, do not cook on high. Sprinkle with the rest of the mozzarella cheese and parmesan cheese. Let stand, covered, around 10 minutes or until cheese is melted.

Note: You can make ahead by layering the lasagna using a crockpot liner & store in the refrigerator overnight and then pop in the crockpot the next day.

Revised from

Shopping List

  • 1 pound extra lean ground beef
  • 1 jar (24-ounce) spaghetti sauce
  • 1 container (15 oz) reduced fat cottage cheese or ricotta cheese
  • 1 pk Shredded Mozzarella cheese (7 oz)
  • grated reduced fat Parmesan Cheese
  • 1 egg
  • fresh or dried chopped parsley
  • lasagna noodles

 Image from:

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition,, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, Barbara writes nutrition and health columns for as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.