“Eat Your Vegetables!” – The Importance of an Alkaline Diet

Did she really have all the information we do today or was this just instinct?  What we really should eat hasn’t changed that much for a very long time.  It is what we DO eat that has created the current health crisis.  Not only have we gone away from real food and towards predominately eating processed food but the decrease in consumption of fruits and (especially) vegetables has increased tremendously!

Chard, Red & Yellow Bell Peppers

More and more research is coming to the forefront about the importance of having fruits and vegetables as the major portion of our diets.  According to the Center for Disease Control and Prevention, “At least one-third of annual cancer deaths in the United States are related to dietary factors.  Increased fruit and vegetable consumption can reduce cancer risk, but less than one-third of U.S. adults eat the recommended servings of fruit and vegetables every day.”  Yet, the idea is not new.  Books have been written for years on this subject.  Some say the concept goes back as far as Hippocrates. 

So what exactly is the big deal?  Why are these foods so much better for us? 

To begin, fruits and vegetables are high in vitamins, minerals and fiber.  They are loaded with antioxidants which keep our cells from being broken down so easily by free radicals.  They are nutrient dense.  In other words they are loaded with lots of healthful ingredients and low in calories so you can eat a ton of them, be completely satisfied and still be way lower in calories than you would be when eating junk or processed foods.  Best of all, they provide your tissues with an alkaline environment.     

Alkaline environment… what does that mean?  When foods are metabolized or broken down by the body, they provide the body with energy and leave behind ash.  That ash can either be alkaline-forming or acid-forming; based on the mineral content of the foods.  The alkaline forming minerals are calcium, magnesium, sodium, potassium, iron, and manganese.  The acid forming minerals are phosphorous, sulfur, chlorine, iodine, bromine, fluorine, copper and silicon.    So, those foods that are high in alkaline-forming ash will provide your body with a healthier environment.

If you consume too many foods that are acid-forming, it can wreak havoc on you.  As said by Dr. Theodore A. Baroody, author of Alkalize or Die, “ in my opinion, acid wastes literally attack the joints, tissues, muscles, organs and glands causing minor to major dysfunction.  If they attack the muscles, you could possibly end up with myofibrosis (aching muscles).  If they attack the organs and glands, a myriad of illnesses could occur.” 

Amongst the biggest culprits for acid-forming ash are fast foods, processed foods, refined sugars, drugs, and chemicals.  Proteins such as meat, dairy, and fish are also acid-forming and yet are important in the diet when taken in proper amounts.  Grains and legumes are also acid-forming.  Too many of any of these substances consequently leads to an acid environment in the body and can result in disease, infections and especially inflammatory conditions such as arthritis.   

In addition, we need to have an alkaline reserve in our body for other situations.  Lack of exercise can be acid-forming for exercise helps to regulate the acid/alkaline balance via respiration.  Stress is a big acid-forming condition.  If we are stressed out or angry, our bodies produce large amounts of acid-forming ash.  Since this is quite prevalent in today’s society, offering your body more of the alkaline-forming foods is that much more important. 

As you can see, there is a fine balance.  This balance is referred to as pH or the measure of concentration of hydrogen in the body.  A pH above 7 is alkaline.  Theories vary as to how alkaline our body (ash) needs to be and yet the range is narrow.  Most say a pH of around 7.4 is ideal.  Based on what I’ve read that number can vary slightly and how to measure your precise pH (in your body) is actually quite difficult to determine.  Having said all this, we do need to be on the alkaline side of the chart and this is mostly determined by what we eat. 

Before we get into the foods themselves, let us look at one other major factor – an acid called hydrochloric acid or HCL.  This is the only acid our body actually produces and it is essential to life.  It is the first substance in the stomach that breaks down our foods.  Lack of it and our foods would just be a mass of undigested waste.  Along with water and enzymes, HCL digests protein into the eight essential amino acids vital to life.  Without it, we would not be able to absorb B12 or folic acid.  In addition, this strong acid kills most bacteria that enters our body with the food we eat.  Last, it keeps us alive by maintaining the proper alkaline/acid balance and becomes alkaline itself after doing its job.

Lack of or excess amounts of hydrochloric acid have the same symptoms – heartburn, burning sensation in the stomach.  Most times, people think it is ‘too much acid’ rather than not enough and end up taking anti-acid tablets, thus decreasing the amount of HCL even further.  It is more common that there is not enough HCL.  Hydrochloric acid production starts to decline around the age of 40.  If you suffer from heartburn, are over 40 or have eaten poorly for an extended number of years, you might consider consulting with a nutritionist about taking a HCL supplement.

So now that we know all this, how are we supposed to eat?  To begin, let us look at the side of food that is confusing.  One of the greatest alkaline-forming foods is the lemon.  We often think of a lemon as being very acid in nature and yet the end result is the opposite.  Lemons produce a very alkaline-forming ash due to their mineral content.  As mentioned before, the minerals calcium, magnesium, sodium, potassium, iron, and manganese all end up creating an alkaline-forming ash.  Well, lemons happen to be high in potassium, calcium and magnesium!  See how it works? 

Generally all fruits and vegetables are alkaline-forming while all other foods are acid-forming.  To maintain a healthy body, it is suggested that your diet is a minimum of 70% alkaline and 30% acid-forming foods.  This ratio is even better at 80% to 20% respectively.  If you suffer from any type of disease, inflammatory condition or have a great deal of stress in your life, you might consider upping the ratio to 90% and 10% respectively.  Also, based on the degree of alkalinity to acidity (for example some foods have a greater degree of alkaline or acid), you can play with what you eat.  I have provided a chart showing you most foods.  Simply download this pdf and keep it on your refrigerator.  Last, to make it easy when you are eating out, think about your plate being 70-90% full of vegetables and fruits with the rest of the plate being filled with protein.  You may think this is impossible but just ask.  I often ask for steamed spinach or extra vegetables instead of the bread or pasta they offer.  Usually they are glad to accommodate you.  (For thoughts on grains, listen to this podcast.)

For many of you this might be a new concept and very different way of eating.  I strongly suggest you start slowly.  Gradually add in more fruits and vegetables, with vegetables being the major addition.  At the same time start decreasing the worst of the acid-forming foods first – such as junk food, fast food, processed food, and sugar.  Give yourself several months to make the changes.  Over time you will be amazed how much better you feel and how much more energy you have!

Why Healthy Posture is So Important!

Regaining Good Posture

Posture.  Just mention the word and we tend to sit up straighter.  We think of our mothers harping on us as children, ‘sit up, don’t slouch!’  Yet do we really understand the consequences of both good posture and poor posture?  Can we imagine how the world would treat us if our posture were different?  No matter what your posture looks like, you are subconsciously being assessed.  Not to mention the role posture plays on the health of your joints, muscles, energy and more.

Let us look at this in greater depth.  The body is designed to work at an optimal level within gravity.  Joints, bones and ligaments are stacked in such a way to use the least amount of energy to hold us upright, to be able to stand or sit effortlessly.

Have you ever watched a young child sit?  Do you notice they don’t typically lean back in the chair but rather naturally sit quite straight with no effort?  What happens as we go through life that we start to rely on that chair back to hold us up?  Or that we stand in such a way as to put more pressure on our entire being?  These are some of the questions that started to arise as I became professionally involved in health. 

I have been a Certified Massage Therapist for 19 years and involved in health education in various ways for 30 plus years.  I came from an allopathic family.  Although I respect this school of thought, I found myself looking for an alternative way to address health.  With an analytical mind, I approached massage from a therapeutic place.  I started teaching treatment oriented massage shortly after graduating.   My practice brought many clients with various pain complaints.  I started really looking at the whole person in regards to their pain and often found that there were physical issues that often played into all or a portion of their complaints.  This brought me deeper into functional and structural assessment.  I was amazed at what I found.

To begin, posture plays a large role in how we approach life.  If we are hunched over or in pain from poor posture, it shows.  We give off signs of lack of self confidence, lack of intelligence, being overly tired, shyness, and more.  In addition, if our posture isn’t optimal, the amount of energy it takes to go through daily life increases exponentially.  No longer can we rely on the structural body to hold us up but rather our muscles now must be recruited to fight gravity, causing us to expend a great deal of energy.  Our entire being is compromised and energy that should be used to enjoy life is used just to hold us up, literally.

So what really happens?  To start, we have become a sedentary society.  No longer do most of us make our living by working in the fields, walking long distances, carrying packages, and so forth.  Instead we spend long periods of time sitting at a desk followed all too often by sitting in front of the computer or television when we get home.  Our bodies have become lazy.  Some muscles hardly have to work much at all in these situations.  Not only do they not have to engage but, allow them to be in a shortened position for a long enough period of time and they will stay shorten indefinitely.  Other muscles, at the same time, will be in an elongated position with some working overtime and others just becoming weaker.  All this results in our muscles being imbalanced and our joints compromised.  Along with these changes, we can experience pain, burning, numbness, weakness, tingling and more.  Depending on the situation, nerves can be compressed and lead to syndromes such as Thoracic Outlet Syndrome and Carpal Tunnel.   Low back pain, which is all too common, is often a result of poor posture and muscular imbalance.   Consequently the typical answer to these complaints, often result in surgery or pain medications.  Although this might be necessary under certain circumstances, they should never be the first choice of treatment.

Let’s start with looking at the head and neck.  Under normal circumstances, the head should sit right on top of the shoulders, with the correct position being the ear vertically in alignment with the shoulder joint.  Unfortunately all too often the head starts to jut forward.  Some of the common reasons for this are from slouching, trying to read something that is too small (so you lean forward to read it), lack of lumbar support while sitting or from improper positioning of a computer screen.  Our head typically weighs between 12 – 15 pounds; a lot of weight when you think about it and yet if sitting as it should, effortless for the muscles.  Take it out of that ideal position however and multiple problems can arise.  Dr. Rene Cailliet says that for every inch the head is forward of its’ ideal position adds 30 pounds of pressure onto the posterior neck muscles!  In addition, this position can result in:

  • Added pressure to the facet joints of the vertebrae which have a great deal of pain receptors, thus causing pain perception to increase
  • Constriction of blood flow to the muscles, resulting in unhealthy muscles that become prone to injury
  • Tight muscles that tend to refer pain to the head, resulting in headaches
  • The health of the temporomandibular joint causing TMJ dysfunction
  • Carpal tunnel symptoms

Learn stretches to keep your neck healthy!

Let us move on to the shoulders.  Typically the upper back has a slight convex curve.  When in this position, the vertebrae are stacked properly and the ligaments on either side of the vertebrae maintain this position.  As we start to slouch forward, the shoulders tend to round inward.  The muscles in the upper back are in an overstretched position and are now having to work hard to keep you from falling over forward.  The muscles in the front of the chest are becoming shorter with the potential to compress the nerves that innervate the arms.  One of the most common results is known as Thoracic Outlet Syndrome.  In addition, the following complaints can arise:

  • Burning between the shoulder blades
  • Chest pain
  • Shoulder pain
  • Carpal Tunnel syndrome
  • Arm pain
  • Inability to take a full deep breath

Learn how to stretch and strengthen the shoulder muscles!

Next is one of the most common areas of complaint – the lower back.  A great deal of work has been missed in our country from low back pain and much of it can be avoided.  To begin, we will look at the role sitting plays.  When sitting for a long period of time, the muscles in the front of the hips, known as the hip flexors, are in a very short position.  They are used a great deal during walking so they do not tend to get weak, as the upper back muscles, but they do become very short.  This results in changing the normal position of the pelvis and creating what is known as an anterior pelvic tilt.  A small degree of anterior pelvic positioning is normal for women whereas men’s pelvis should stay neutral.  The issues arise when this position is exaggerated.  The pressure tends to be moved posterior to the discs, putting a great deal of pressure on the facet joints.  Remember as mentioned earlier, facet joints are loaded with pain receptors. 

In addition to sitting, the pelvis can end up in an anterior position due to being overweight, especially when we carry our fat in our bellies.  Belly fat puts a great deal of added weight in front of the body.  The only way to compensate for this added weight is to shift the positioning of the pelvis into that exaggerated anterior pelvic position, once again causing an increase in low back pain.

Along with general pain complaints from the low back, the following issues can arise:

  • Hip pain
  • Sciatica
  • Neurological complaints in the legs

Learn to keep your back healthy and strong!

So what do we do about all this?  It would be great if we could move away from sitting for extended periods of time but this is unlikely.  Rather we need to work within the parameters of our society.  The following is a list of ideas that can have a positive impact on our posture thus decreasing or eliminating the negative results of poor posture:

  • Movement or regular exercise:  By getting the blood to flow throughout the entire body, the muscles are receiving fresh nutrients and eliminating waste products.  These waste products in and of themselves can cause pain.  Also by moving, we are taking the muscles through a greater range of motion which can be a start to add length and strength to the muscles.
  • Stretching:  Working to lengthen the shortened muscles before strengthening the elongated weaker muscles will aid in realignment of the skeletal system.  It is important that specific stretches are given in order to lengthen the appropriate muscles.
  • Strengthening:  Once the shortened muscles are working towards being longer, it is then time to add in exercises to strengthen those muscles on the elongated side of the joint.  This is important to allow the body to regain a healthy posture where the joints and ligaments are able to do their job thus decreasing the amount of energy it takes to remain upright in gravity.
  • Ergonomics:  Assessing the position of the person to the height of the desk, the relationship to the chair, the positioning of the computer and so forth is a key.  Only focusing on ergonomics will not change the posture by itself but rather help to maintain the healthier posture with the aforementioned suggestions. 
  • Diet:  Although not directly involved in posture, it does play a large role in the health of the muscles.  Eliminating fast food, sugar, refined foods, soda, excess caffeine and more will enable the muscles to receive the nutrients need for maintaining health.  A healthy diet will also decrease constriction of blood flow thus allowing the entire body to process waste products at a healthier rate.

These are just some suggestions to creating a healthier posture.   Remember posture is much more than just looking good.  By having a body that is fully supported by the appropriate joints and ligaments, we will have more time and energy to enjoy all aspects of life and to live it to its’ fullest.  Isn’t it time to take a good look at your body?

I am excited to tell you that my eBook, Regaining Good Posture IS NOW AVAILABLE! 

Learn about:

  • Which muscles are potentially short or weak
  • How to assess your own body
  • Which stretches you need to do and how to do them
  • Strengthening Exercises to maintain a healthy posture

Included is a video presentation of each stretch and strengthening exercise. 

GO HERE to check it out!

After reading my article on posture, Dr Phil said this:

“Couldn’t agree more – great article examining in detail the importance of good posture. The advice is all spot on.”

He has a great software product called PostureMinder that you might like to check out!

Testimonial from D.M. Shepard, Torrance, California –

“As I mentioned, I was a personal trainer years ago and I still refer to my anatomy books to diagnose surprise aches and pains.  Suddenly a couple of weeks ago I developed major discomfort in my left groin and lower back so I limped around my business office for a full week before I searched online for treatment for the iliopsoas muscle.  Your video demonstration reminded me that sitting at a desk all day will reduce flexibility, shorten muscles and over time compromise posture.  The best part of your video was the stretch you demonstrated to lengthen the iliopsoas muscle area.  My discomfort was remarkably improved after only one day of stretching and I just about have regained full range of motion.

The trend these days is for people to live longer lives.  As a professional financial advisor, I have to prepare more ‘preventive’ investment strategies for my clients to stay ahead of potential financial problems later in life.

I see the same ‘preventive’ value for regaining and maintaining healthy posture and stretching flexibility, to assure functionality and better quality of life.  Certainly posture and stretches are cheaper than pills and surgery!

Thank you, Julie!”

Life’s Little Changes – The Fat vs Muscle Factor

Fitness

It is a known fact that as we age our bodies change.  Starting around the age of 45 we start to lose muscle mass at a rate of approximately 1% per year.  Although this doesn’t sound like a big deal, it really is.  The reason being is because at the same time our bodies are starting to lose muscle mass, most people are starting to gain weight.  The average American gains 1-2 pounds of weight per year as they age.  Again that doesn’t sound like a lot but if you average that over 10 years, you have gained 15 pounds! 

Let’s look at that.  Muscle is about 18% denser than fat.  In other words, think about weight verses volume.  A pound is a pound but the amount of space one takes up verses the other is the key factor.  For an extreme example think about the weight of one pound of feathers verses one pound of brick.  Since the brick is so much denser, it would take up much less space than one pound of feathers would.  You get the point?

So, if muscle is 18% denser than fat and we are losing mass yet gaining weight what do you think we really gaining?  Fat, of course.  Our bodies are either staying the same size or, in many cases getting physically bigger.  Consequently our ratio of muscle to fat is changing dramatically.

Less muscle means less strength thus decreasing our ability to do even the little things.  I met a woman who could no longer carry her own groceries into the house because they had become too heavy and she was not very old!  Verses the woman who still lifts weights at 68 years old, looks fabulous and carries just about anything and everything she wants.  Big difference.  This doesn’t even address the bigger picture of doing the fun things.  I have a 77 year old friend that plays tennis like no body’s business.  She competed in a league a few weeks ago, played for 3 hours to win the overall competition, and she was playing against women in their 50’s.  Now that’s living!

A decrease in muscle mass does not only equate to less strength.  With less muscle, a decrease in bone density rises thus leading to the potential for osteoporosis.  In addition studies have shown that an increase in strength can:

  • Result in a decrease in arthritic pain[1]
  • Improve balance and flexibility
  • Assist in balancing blood glucose levels
  • Have a positive impact on our emotional being
  • Strengthen the heart
  • And much more

So let us start by figuring out our own ratio of body fat to lean muscle.  There is a means of measuring this called the Body Mass Index or BMI.  BMI is a comparison of your height to weight.  This formula is being used more and more in the medical field and yet it is not necessarily an accurate way to measure body fat, in my opinion.  Take the individual who is very muscular and consequently quite lean.  They will come up on the BMI chart as having too high of a body mass index for their size.  Again this is because of the fact that muscle is so much more dense than fat.  A very small person, with a body fat of say 15%, will appear fat on with this measurement.  Or the body builder that is 5’6” and weighs 240 pounds.  His body fat may be around 12% and yet on a BMI chart he will show up obese.

A better way to determine the ratio is through actual measurement of body fat.  This can be done at a gym by using calibrators where skin is lifted from the muscle and measured on various parts of the body.  It can also be done in a pool by measuring how fast you sink; supposedly a better way and yet not too easily found.  For those of you that don’t have access to these kinds of measurements, I did find a source online that seems pretty accurate.  Simply go here to take that test  

Once you have this information you have the power to change it.  Rather than think, ‘I’m doomed!’ it is time to think positive.   It means you have an opportunity to make changes that can have an incredible impact on your health, your future and how to enjoy the balance of your life.  An Encore Life.  How great is that?

As time goes on and the kids are grown, there is more time to focus on ourselves separately and together with our partners.  It is a time to engage in new endeavors.  To think outside the box.  To explore things that we might have thought about in the past but just didn’t have the time to try.  It is time for an even better life!

Building muscle requires resistance.  When a muscle is challenged physically it puts stress on the bone.  The bone in response creates additional osteoblasts or cells that produce more bone.  The process is known as the piezoelectric effect.  Greater stress = more cell production=denser bones.  And, as mentioned, this is an excellent way to prevent osteoporosis.

Not only will that additional muscle strengthen your bones but it will increase your basal metabolic rate or BMR.  This is the basic amount of energy needed per day to function.  Additional muscle mass = higher BMR = additional calories burned.  Therefore a person with a higher ratio of muscle to fat can and actually needs to eat more.  Now isn’t that a great thing!  Of course what we eat is important as well.  To create these positive changes requires a blend of exercise and diet but for the purpose of this article let us focus on the exercise portion.  The diet will be addressed in a future article.

For now, let us take a look at the ways in which we can increase our muscle mass.  Of course there is the obvious – going to the gym to lift weights.  This is a great way and works fantastically for some.  For others this sounds like a death sentence!  Here are some additional ideas that can be really fun, give you a cardiovascular workout as well and offer resistance training:

Hiking Outdoors is good for the body, mind & soul!
Hiking Outdoors is good for the body, mind & soul!

Hiking up and down hills (my personal favorite).  Although this doesn’t address the upper body it is great for your legs and hips.  You would need to supplement with some upper body training.

Just started doing this... wow what a workout & so fun!
Just started doing this... wow what a workout & so fun!

Rowing.  This fun sport actually uses both your upper body and (to my surprise) a great deal of legs.  Overall it can really offer resistance as well as cardiovascular fitness.

Ok I'm not there yet... you?
Ok I'm not there yet... you?

 

Yoga can be a good form of resistance training, expecially the more challenging types such as Ashtanga Yoga.

Doesn't this look fun!
Doesn't this look fun!

Taking classes such as certain forms of dance, boot camps and so forth.

Why not?
Why not?

Kayaking.  This is more for building upper body strength but it is fast-paced and fun!

This is great to do indoors as well.
This is great to do indoors as well.

Rock Climbing.  Now this one might really take you to a new place!

This is used by all ages.
This is used by all ages.

Even the Wii Fit can offer those that want to stay inside a great workout.

These are just some ideas.  Play around with different types of activities that you enjoy and see if it fits into a strength or resistance training category.  Do not buy into the, ‘well I’m getting older…’ mentality.  Step out and up and make tomorrow even better than today!  You will be amazed at just how much you can change your body and fitness level!  We are only limited by our imagination so be creative, build muscle and head towards a more dynamic, healthy future! 


[1] Study at Tufts University

TV – OBESITY AND HEALTH

Last week there was a statistic in the Daily Camera about the number of hours people watch TV on average per month.  The number astounded me… 151 hours!!!  That equates to about 5 hours per day!  I just can’t imagine.  Not only can’t I imagine, but it has gotten me thinking about the inundation of commercials this puts into our brains.  These commercials teach us about eating fast food and taking lots of medications.

When I was in nutrition school in NYC, we had a speaker talking about commercials.  Although I can’t remember who exactly it was, the impression he left has not gone away.  Basically what he presented was how commercials lure you into thinking that your life is not complete.  Companies present you with these idyllic lifestyles, showing people that are healthy and happy.  They then indicate this would not be the case if it weren’t for a certain drug or food that the people in the commercial are consuming. 

Whether we like it or not, this gets into our subconscious and we start down the path to finding this nirvana that only comes with something outside of ourselves.  It is a wonder we are overweight, obese, taking too many medications and generally not healthy?  Think about it.  

How many hours a day do you watch TV?  What do you gain from it?

I would like to challenge you.  Buy a little notebook.  For at least one week, write down how many hours a day that you sit in front of the tube.  Record the shows you watch and mostly record what is being advertised during that time.  Then, do the following:

  • Ask yourself if the show stimulated your brain in some healthy way. 
  • Watch how much you respond to those commercials. 
  • Do you get hungry for some fast food that would have never crossed your mind had you not seen an advertisement for it? 
  • More than that, do you respond? 
  • Do you go out and eat some junk food that not only doesn’t fulfill you but supports you being less than healthy?
  • Last, do you find yourself thinking that “If only I took that medication I too would feel better!”

Is this the way you want to live your life?  Do you want someone else influencing you what to eat and what medications you are told you need to take?

I believe this process will help you to take back control of your own life.  Once you see how much marketing can influence your thoughts and actions you may choose to do something different. 

Start making a list of things you can do that stimulate your brain, offer you exercise, make you notice the amazing world around us, and provide you with a social setting where you can have great conversation rather than all just staring at the tube together.  Once you have your list, start implementing some of those things into your evenings and weekends rather than watching television.  I think what you will find will be a richer, more rewarding life that provides you with healthy alternatives to the dreaded marketing gurus on TV!

Whole Grains, Are They Really a Health Food?

Health & Nutrition Experts Podcast

ARE YOU A CARBOHYDRATE JUNKIE???

Carbohydrates such as pasta, bread, cereals, and all sorts of grains have been a part of our diet for a long time.  In fact, for many people, these foods have not only become a staple but a major portion of a daily diet.  Is this a good thing?

I am excited to bring to you a new source of information – the podcast.  On a regular basis I will have professionals bring you information that you can download and listen to whenever and wherever you have time.  It’s free and a great way to take in information.

This series is starting with Dan Butterfield.  Dan has been involved in health and nutrition for many years and has studied extensively.  As new research has come about, Dan has altered his own diet to support a healthier and healthier way of living.  In this first podcast Dan will be speaking to you about grains and their role in the diet.   To many of you, this information may be new and seem like a big deviation from your current diet.  I strongly suggest you listen to the podcast several times and really try to apply the knowledge Dan is providing you with. 

I know for myself, gradually I have changed the way I eat especially the quantity in which I consume carbohydrates such as pasta, bread, and many grains.  Over the last several years, I have lost about 8 pounds, have less bloating and digestive problems and find my energy levels are more equal throughout the day.  You may too. 

Go here to listen to Dan’s podcast.  It may make you feel better as well!

To your health,  Julie

Hypertension: Sodium & Other Possible Causes

I was reading an article the other day about children who are getting hypertension or high blood pressure.  It seems that there is an epidemic going on in Canada.  This particular article talked about the amount of sodium in most Canadian’s diets, especially children’s.  Their focus was on all the packaged foods that have sodium that you would never think would.  The result was shown in the example of a 14 year old boy who was diagnosed with hypertension.  Even though he was of normal weight and very active he had unusually high blood pressure.  It was determined that he ate a large amount of processed foods which dramatically increased his sodium to unhealthy levels.  Seems he is just one example of children in Canada suffering from this syndrome.

Let us take an example of just how quickly sodium adds up:

For breakfast you have 1 ½ cups of Special K ….. 

IMG_2814 320 mg of sodium

 

 

 

 

 

 

Or better yet you have 1 ½ cups of Nutty Nuggets ….

IMG_2810

 

 

 

 

 

 960 mg of sodium!

 

During the day you are hungry and have 12 Snack Sticks .…

Snack Sticks
Snack Sticks

 

 

 

 

 

320 mg of sodium

 

 

Or better yet 14 Ritz Toasted Chips, Dairyland Cheddar ….

IMG_2803

 

 

 

 

 290 mg of sodium (now who can only eat 14 chips???)

 

 

After dinner you have 2 Double Stuf Oreos ….

IMG_2799

 

 

 

 

 

 160 mg of sodium

 

Or maybe 2 Nilla Cakesters ….

IMG_2797

 

 

 

 

 

 135 mg of sodium

 

Given these foods, on the best day of eating you would have consumed 745 mg sodium.

The worst case scenario you would have consumed 1,440 mg of sodium!!!

And that is only with eating a cereal for breakfast, snack during the day and cookie for dessert.  Imagine just how many total milligrams of sodium someone could consume if they ate more processed foods during the day and added table salt into their home cooked meals.

Although sodium can play a large role, about 50% of people with high blood pressure are salt-sensitive, it is not the only issue.  Here are some other things to look at:

Obesity and hypertension go hand in hand.  It can result in a range of metabolic syndromes including high blood pressure, high cholesterol and insulin issues. 

Stress and how we respond to it will often affect hypertension.  If we don’t manage our stress healthfully it will impact our bodies in negative ways.

Dietary practices will have a big impact on it.  Certain foods will benefit blood pressure levels while others will increase it.

Age is considered to play a role and yet I struggle with buying into this too much.  I feel we have a choice in how we age whether it is gracefully and healthily or poorly and sedentarily.

Genetics can have an impact.  If we have parents that have hypertension then the chances of getting it are higher.  In this situation, it is even more important to be mindful of all the above categories.

Let us begin by having an understanding of exactly what hypertension or high blood pressure means and what are the health concerns that arise from it.   We will start with a description from the Prescription for Nutritional Healing, 4th Edition:

“When the heart pumps blood through the arteries, the blood presses against the walls of the blood vessels.  In people who suffer from hypertension, this pressure is abnormally high.  If blood pressure is elevated, the heart must work harder to pump adequate amount of blood to all tissues of the body.”

This can result in damage to the heart, blood vessels, brain and kidneys.  Hypertension is considered the ‘silent killer’ because the aforementioned damage has started even before one realizes they have high blood pressure.  It is the major risk factor for heart failure, kidney disease and stroke. 

So how does it cause all this?

In the blood vessels, hypertension:

  • Causes a thickening of the tunica media, which is the middle coat of the artery or vein which gives it its’ elasticity
  • Increases the development of atherosclerosis; an accumulation of fat-containing material on the walls of the arteries
  • Coronary artery disease; a narrowing of the coronary arteries, and a systemic or generalized vascular resistance

In the heart, hypertension:

  • Forces the ventricles or the lower chamber of the heart to work harder to eject the blood
  • This in turn can cause muscle damage and fibrosis or a buildup of collagen in between the muscle fibers
  • This can eventually cause the left ventricle to enlarge, weaken and dilate

In the brain:

  • The arteries are less protected than other arteries in the body and can eventually cause them to rupture causing a stroke

In the kidneys, hypertension:

  • Can damage the arterioles or microscopic sized arteries that deliver blood to capillaries
  • This can result in a decrease of blood to the kidneys causing them to secrete more renin which will  elevate the blood pressure even more

As you can see, regularly increased blood pressure is not a good thing! 

So what is normal?  It used to be that 120/80 was considered ideal but that was changed in 2003 by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure as studies were indicating even readings at this level increased the potential risk for cardiovascular disease (CVD).  Now normal is less than 120 systolic[1] and less than 80 diastolic[2].  Note:  For each 20/10 increase above normal blood pressure, the risks for CVD doubles.[3]

Now that we have an understanding on blood pressure and it affects on the body, let us take a look at things we can do to positively affect it. 

Sodium

Most diets are high in sodium due to excess dietary salt.  Dietary salt is 40% sodium and 60% chloride.  Sodium needs differ depending on the amount of exercise and sweating.  Generally speaking, a minimum of 1,500 mg per day and up to 2,300 mg per day is ideal.  One teaspoon of commercial salt contains about 2,000 mgs.  When purchasing processed or packaged food sodium can add up quickly, as you previously saw, so really read your labels!  Remember sodium can be disguised as salt, soda, Na, MSG, meat tenderizers and so forth.  Note:  An ideal form of salt to use is Celtic Salt as it is a non processed food that is gathered off the shores of places like Southern France.  It is high in many minerals and actually enhances the taste of foods rather than masking them like table salt.  Due to its great taste, you only need to use a little bit. 

Obesity

“The best treatment for high blood pressure… loss of even a few pounds helps reduce blood pressure in overweight hypertensive people.”[4]   As you can imagine, this is an article in and of itself.  This will be addressed in a future blog.

Stress

Finding ways to manage your stressors is essential.  Meditation, yoga, and biofeedback can be very effective in lowering high blood pressure.  All of these can assist in decreasing the release of epinephrine and norepinephrine from the adrenal glands.  For more details on stress and its affects, read THIS ARTICLE.

Diet

Eating a diet rich in fruits and vegetables will provide your body with good sources of fiber and the necessary minerals, potassium, calcium and especially magnesiumAdequate amounts of these minerals are associated with lower risk of hypertension.  Eating a diet rich in Omega 3’s will keep your cell membranes healthy and flexible.  For detailed information on these, read THIS ARTICLE.  If you are a grain eater, use the following whole grains – rye, oats, amaranth and especially buckwheat.  Proteins should include primarily fish.  Avoid eating much, if any, red meat.  Avoid all highly refined foods as they not only deplete your body of essential nutrients but also tend to put a lot of excess stress on the adrenal glands.

Liquids

Consume enough water daily.  It is the most important and abundant inorganic compound in all living systems.  It is a conduit for almost all the body’s chemical reactions.  Water can be depleted by many things, including other items we drink.  It is therefore suggested to avoid excess caffeine and alcohol.  Avoid soft drinks all together. 

Exercise

Regular moderate exercise will assist in burning fat, decrease weight, increase blood flow, and aid in stress reduction.  Excess can have negative effects, especially if you have had a sedentary lifestyle for some time.  It is more beneficial to gradually increase your levels, give yourself rest days, and focus on moderation and enjoyment.  It is determined that moderate exercise, even brisk walking, several times a week for 30-45 minutes can lower systolic blood pressure by about 10 mHg.[5]

Rest

It is common to not get enough rest and sleep.  Try to reevaluate your daily routine to see if you are getting adequate amounts.  Sleep should be closer to 8 hours per night rather than the 6 or less many people get.  This will assist your entire system in recovering and rejuvenating.

This is just a beginning list of ideas and suggestions.  There are many excellent books available to offer you more thoughts and details.  Begin by working on the aforementioned suggestions that you feel will have a positive impact on your blood pressure levels. 

Last but not least, make sure to take your blood pressure regularly as it is the only way you will know if you are having positive effects.[6]

If you enjoyed this article, you might consider joining our mailing list in order to receive notification as to all the new monthly information on the blog.

 

 


[1] Systolic = measured when the heart muscle contracts and ejects blood into the aorta

 [2] Diastolic = measured while the heart muscle is relaxing between beats

 [3] Understanding Normal and Clinical Nutrition, Seventh Edition

[4] Principles of Anatomy and Physiology, 11th Edition

[5] Principles of Anatomy and Physiology, 11th Edition

[6] Of course regular checking with your doctor is a given.

The Effects of Stress

STRESS AS A NATURAL OCCURRENCE

Our bodies are designed to handle variations from diet, exercise, stress and weight.  It regularly produces assorted hormones for a period of time to take care of these situations.  All this is a normal cycle for the body. 

STRESS & HORMONES

The challenge is when that stressor continues for a prolonged period of time.  This causes the body to overproduce hormones, thus stressing the entire system, breaking down cells, tissues, and organs.

When our body undergoes a stress, the adrenal glands produce adrenaline aka epinephrine.  This hormone stimulates the heart muscle, alters the rate of blood flow, and raises basal metabolic rate.  This is known as the fight or flight syndrome.  Epinephrine also prompts the secretion of glucagon by the pancreas, causing the release of nutrients from storage.  The steroid hormone cortisol is also produced.  It enhances protein degradation, which raises amino acid levels in the blood so that they become available for conversion of glucose.  The two other hormones induced by stress, aldosterone and antidiuretic hormone both help to maintain blood volume.[1]

Epinephrine does not stick around very long in the body however, when stress is prolonged, cortisol does.  This hormone will affect the body in many detrimental ways.  [2]Excess cortisol will:

  • Decrease metabolism by inhibiting thyroid function
  • Depletes protein in the muscles, bones, connective tissue and skin which can cause fatigue, weakness, thinning of the bones, and bruising
  • Decreases the production of androgens and growth hormones which build muscles
  • Can cause insulin resistance[3]
  • Increase fat accumulation, especially in the belly
  • Increase appetite and carbohydrate cravings
  • Will cause depression, anxiety, and mood swings

Is cortisol related to abdominal obesity?

“Yes. There is a link between high cortisol levels and storage of body fat, particularly “visceral” abdominal body fat (also known as intra-abdominal fat). Visceral fat is stored deeper in the abdominal cavity and around the internal organs, whereas “regular” fat is stored below the skin (known as subcutaneous fat). Visceral fat is particularly unhealthy because it is a risk factor for heart disease and diabetes.”[4]

The challenge with cortisol and weight is this.  First, when you are stressed you produce more cortisol which will lead to weight gain.  When you are overweight the adrenal glands produce more cortisol so it is a viscous cycle. 

 ADDITIONAL AFFECTS FROM STRESS

Free radical production

THE NEGATIVE ROLE OF CERTAIN FOODS & DRINKS

Food can play an important role in both exacerbating the problem and relieving the problem. 

The following list will cause the adrenal glands to produce adrenaline and cortisol.  Over the long term this will eventually exhaust the adrenals:

  • Caffeine, especially beyond one or two cups a day on a regular basis will actually act like long term stress in the body
  • Chocolate in excess as it will act as a stimulant
  • Soda will affect blood sugar levels as well increase production of stress hormones
  • Heavy alcohol consumption will cause the adrenals to overreact
  • Refined foods and sugar will affect insulin production and consequently blood sugar spikes and falls
  • Refined foods will deplete the body of essential vitamins and minerals thus stressing the entire system
  • Refined salt is chemically cleaned and devoid of all minerals and will increase blood pressure
  • Can create a more acid pH in the body, which allows for disease to develop

THE ROLE OF HEALTHY FOODS

The following is a list of vitamins and minerals that will support the body during stressful times and therefore should be included in your daily meals:

  • B Complex is necessary for the production of all neurotransmitters including Seratonin, which is a calming neurotransmitter, and it vital for the functioning of the adrenal glands.  Foods high in the B vitamins include:  dark leafy green vegetables, wheat germ, brewer’s yeast, most grains
  • Vitamin C is depleted with prolonged bouts of stress and is also required for normal functioning of the adrenal glands.  Sources include:  fruits especially citrus and berries, tomatoes and green vegetables
  • Vitamin A is an antioxidant thus maintaining the health of the cells.  Foods rich in A include:  milk, eggs, butter, and fruit
  • Vitamin E is also an antioxidant.  Foods rich in E include:  nuts, germ oils and green leafy vegetables
  • Minerals, especially magnesium which relaxes muscles.  Sources of magnesium include:  leafy green vegetables, beans and legumes, vegetables, seaweed, nuts (almonds, cashews and filberts especially) and seeds (especially sesame)
  • Omega 3 fatty acids have a positive effect on moods.  Sources include:  salmon, tuna, sardines, flax seed oil, pumpkin oil, dark green vegetables
  • Night shade vegetables as they have an expansive effect and therefore might be beneficial for someone tense from work, stress or activity which takes great concentration.[5]  Nightshade include;  all peppers, tomatoes, potatoes, eggplant

 WHAT YOUR DIET SHOULD INCLUDE

  1. Salmon
  2. Eggs
  3. Lots of leafy and dark green vegetables
  4. Night shade vegetables, if you can handle them
  5. Almonds, cashews, filberts and sesame seeds
  6. Beans and legumes
  7. Citrus fruits and berries

OTHER THINGS TO LOOK AT TO REDUCE THE AFFECTS OF STRESS

        EXERCISE

  • Moderate levels are best with a duration lasting less than one hour
  • Critical to maintain optimal cortisol levels and hormone balance
  • Helps handle stress by improving cardiovascular and musculoskeletal systems
  • Improves insulin resistance (studies have shown that as little as 3 weeks of regular exercise can lessen insulin resistance[6])

        LAUGHTER

  • Using a similar protocol, the current research found that the same anticipation of laughter also reduced the levels of three stress hormones. Cortisol (termed “the stress hormone”), epinephrine (also known as adrenaline) and dopac, a dopamine catabolite (brain chemical which helps produce epinephrine), were reduced 39, 70 and 38 percent, respectively (statistically significant compared to the control group).  Chronically released high stress hormone levels can weaken the immune system. [7]

        MEDITATION

  • The study, done in China, randomly assigned college undergraduate students to 40-person experimental or control groups. The experimental group received five days of meditation training using a technique called the integrative body-mind training (IBMT). The control group got five days of relaxation training. Before and after training both groups took tests involving attention and reaction to mental stress.
  • The experimental group showed greater improvement than the control in an attention test designed to measure the subjects’ abilities to resolve conflict among stimuli. Stress was induced by mental arithmetic. Both groups initially showed elevated release of the stress hormone cortisol following the math task, but after training the experimental group showed less cortisol release, indicating a greater improvement stress regulation. The experimental group also showed lower levels of anxiety, depression, anger and fatigue than was the case in the control group.
  • “This study improves the prospect for examining brain mechanisms involved in the changes in attention and self-regulation that occur following meditation training,” said co-author Michael I. Posner, professor emeritus of psychology at the University of Oregon. “The study took only five days, so it was possible to randomly assign the subjects and do a thorough before-and-after analysis of the training effects.”[8]

        YOGA[9]

  • Asana are the physical postures that help with muscle relaxation
  • Savasana is usually at the end of a class and it is a pose for complete relaxation
  • Pranayama breathing practice

        BREATHING

The challenge is to not stress yourself out by trying to do all these things at once.  Pick one, two, or at most three of the aforementioned benefits and start incorporating them into your life.  As these become habit, start adding more.

To your health!     Julie

Future articles will include more details about free radicals and paradoxical breathing.  Sign up for our monthly newsletter which will keep you up to date when the newest articles come out.  (We will never sell your name!)


[1] Understanding Normal and Clinical Nutrition, 7th Edition

[2] Hormone Balance, Scott Isaacs

[3] A reduced sensitivity to insulin in muscle, adipose, and liver cells, Understanding Normal and Clinical Nutrition, 7th Edition

[4] Tom Venuto is a certified personal trainer, natural bodybuilder and author of the #1 best selling diet e-book, “Burn the Fat, Feed The Muscle

[5] Healing with Whole Foods by Paul Pitchford

[6] Per Hormone Balance, by Scott Isaacs

[7] The research is entitled Cortisol and Catecholamine Stress Hormone Decrease Is Associated with the Behavior of Perceptual Anticipation of Mirthful Laughter. It was conducted by Lee Berk with Stanley A. Tan, both of the Oak Crest Health Research Institute, Loma Linda, CA; and Dottie Berk, Loma Linda University Health Care, Loma Linda. 

[8] http://www.sciencedaily.com/releases/2007/10/071008193437.htm

[9] Yoga can reduce cortisol levels, a finding which was documented in the October 2004 issue of the journal, Annals of Behavioral Science.

[10] http://www.kundaliniyoga.org/pranayam.html

Health Food Fraud – Agave Nectar

Up until recently we regarded agave nectar as a relatively benign, low glycemic sweetener.  No more.  Recent articles in the Townsend Medical Newsletter and Wise Traditions, the quarterly publication of the Weston Price Foundation, as well on Dr. Mercola’s website, reveal that it is a chemically processed syrup made the same way as high fructose corn syrup with likely the same negative health effects as high fructose corn syrup.  Continue reading for more information.
Agave Nectar
Agave Nectar

May’s health tip of the month is brought to you from Dan and Talitha Butterfield.  Both have been involved in health and wellness for more than 35 years.  I have had the honor of knowing and trusting their insights and knowledge for almost 20 of those years.  For more information on them, please visit their website.

Here is what they have to say: 

Agave syrup, a refined fructose product is being cleverly marketed in the health food industry as a wholesome, natural, low glycemic sweetener.  Even the word “nectar” is deceiving, as if it is dripping fresh from flowers or fruit.

Agave nectar, or more accurately refined fructose agave syrup was created in the 1990’s using technology devised by corn refiners to chemically convert corn starch to corn syrup, known as high fructose corn syrup, the sweetener that has done much to increase obesity, insulin resistance and increased heart disease and diabetes.  The main carbohydrate in agave is starch, which, like corn starch, is chemically converted to highly refined fructose.

The sugar that comes from fruit is levulose.  The word “fructose” is cleverly used by corn refiners to make you think it is a natural fruit sugar.

Fructose is not absorbed like other sugars.  It does not go directly into the bloodstream, but instead it goes to the liver where it is converted to triglycerides and fat.  “Low glycemic” makes it sound safe.  It is anything but safe.  High fructose corn syrup is 55% fructose.  Agave “nectar” is about 70% fructose.

While refined fructose agave syrup won’t spike your blood sugar levels, it will deplete minerals, inflame the liver, harden the arteries, cause insulin resistance leading to diabetes, obesity and cardiovascular disease, and may be toxic for use during pregnancy.

So don’t use this unnatural sweetener or “health foods” that contain it.  As always, read labels so that you can make informed choices about what you put into your body.

 Hope this is helpful.       Talitha & Dan Butterfield

I need your insight!

I was recently at a reunion of my family.  We all got together in Texas where one of my sisters lives.  There were four of us – my mother and two sisters.  This is the first time we have all been together in years.  Every time I do get together with them I am reminded what a different path my life took from that of my sisters.  I first joined a gym in my teens and started becoming aware of health at that point.  My life took me through gradual changes in the choices I made to be as healthy as possible.  I changed my eating habits little by little; gradually eating healthier with each year.  As I learned new discoveries about what to eat and why, I applied them to my life.  Now, years later, I find myself feeling really great with little to no aches and pains.

When I got together with my family, I was especially surprised to see how much my oldest sister had aged.  She complains of rheumatoid arthritis, numbing in the hands, pain in the back, pain in the leg, pain in the foot, swelling in the foot.  I could go on and on as she did for the entire trip.  I not only found it sad that she focused on her poor health so much but was incredibly frustrated that she does not work to eat better.  She knows what I do for a living and what I practice in my daily life.  In fact, she even commented on how healthy I seemed to be and yet whenever I tried to bring up the idea of her starting to make better food choices, she not only ignored it but talked about the burrito that she likes from Taco Bell, about eating pizza, or how she just doesn’t have the time to eat well. 

Now I do realize that there are limitations on what is available depending on where you live yet this particular sister lives in Southern California where the choices are as great as here in Boulder, Colorado.  Given this, I find it baffling why she doesn’t choose to learn more about health – she could read my blog or ask me.  I do know that there are statistics that indicate that what you eat as a young person will most likely affect your food choices as you become an adult.  To some extent I can buy into this.  On the other hand, the two of us grew up in the same household so this tells me that we can also adapt to better choices and habits if we so choose. 

This brings me to the reason for this blog entry.  My ultimate goal is to educate people about health and healthy choices in life.  I really want to find ways to affect people to the extent that they want to become healthy.  I am trying to figure out just what makes this happen.  I did speak with a woman, a friend of my ‘Texas’ sister, about her health.  Apparently she had been very overweight and sick, with lots of pain, for a long time.  At some point she had had enough and started down that path to health.  Today she is a healthy weight, is very aware of what she puts in her body, and seems pretty much pain free.

As far as I can tell my oldest sister must be in as much discomfort and yet still chooses to remain unhealthy.  I am therefore asking each and every one of you that has made the decision to become healthy just what was the deciding factor?  What is it that motivated you to change?  What could I do or say to someone that would really have enough impact to make them want to take a different path?  I would appreciate any and every insight you can offer me.

Thanks and I look forward to your comments!

Julie

May Health Tip – Calcium

Of the calcium, 99% is stored in the bones with the balance being stored in the body fluids.  In the bones, it not only acts to maintain a strong skeletal structure but also serves as attachment points for the tendons of the muscles.  The calcium in the body fluids circulates as iodized calcium which helps to regulate muscle contraction, blood clotting, transmission of nerve impulses, the secretion of hormones and the activation of some enzyme reactions.

 Calcium by itself cannot be absorbed by the body.  It needs other nutrients to enable that to happen.  Those nutrients include magnesium, phosphorus, vitamins A, C and D.  An example of this is magnesium.  Magnesium stimulates the production of a hormone called calcitonin.  This hormone is what keeps the calcium in the bones and out of the soft tissue.  It is believed that many forms of arthritis are due to an increase of calcium in the body fluids and a lack of calcium in the bones[i].  Another example is the need for Vitamin D.  Typically we absorb about 25% of the calcium we ingest.  Vitamin D helps to make the calcium-binding protein which is needed in order for us to absorb that 25%.  So as you can see, it is a bit more complex than we think.

To take this a step further, the 1% of calcium in the body fluids always remains the same.  If we are not consuming enough calcium through our diet, the body will actually take the calcium out of the bones to maintain that appropriate level in the fluids.  This process is silent, meaning we might actually not know this is happening.  Unfortunately as we age however, this can show up as osteoporosis. 

With all of this said, it is important to make sure we are getting an adequate amount of calcium and its carriers in our diet.  The average adult should consume between 1,000 – 1,200 milligrams of calcium daily[ii].  This may sound like a lot but it really isn’t!  Let us take a look at what foods actually contain high amounts of calcium.

Of course the dairy industry wants you to believe that their source of calcium is the best.  Although cheese and milk do contain a high amount of calcium, often people are intolerant to dairy.  This can be due to being lactose intolerant, a deficiency in the enzyme that breaks down the lactose in the milk, or because high dairy diets can cause heavy congestion in some people.

Personally I do ingest dairy but try to focus on the use of goat or sheep products rather than cow.  Goat and sheep tend to graze rather than be grain fed.  Grazing increases the nutrient value of the milk as the animals are ingesting more nutrients from the plants.  In addition, the fat molecules of the milk from these types of animals are smaller, thus easier to digest.  They are also lower in fat.

In addition to dairy there are some fantastic sources of calcium.  Below is a list of some of the best:

  • Dried seaweeds such as wakame, kombu, kelp, hijiki, and arame
  • Beans such as soy, garbanzo, mung, aduki, black and lima
  • Nuts and seeds such as almonds, sesame, cashew, and filbert
  • Whole grains such as buckwheat, millet, amaranth, and rye

Of course my favorite source is GREEN VEGETABLES!  Leafy green vegetables not only contain a good amount of calcium but they also contain lots of chlorophyll.  In the center of the chlorophyll molecule is found magnesium.  In addition, chlorophyll is a great source of phosphorus, vitamins A and C.  How can there be a better way of getting your calcium and all its carriers than eating green vegetables? 

Having said all that, let us look at some of the best sources of vegetables for calcium:

  • Mustard greens
  • Turnip greens
  • Bok Choy
  • Kale
  • Parsley
  • Watercress
  • Broccoli

We tend to think of spinach and chard as great sources of calcium as well but surprisingly they are not.  Although they contain a lot of calcium, they also contain oxalic acid.  This substance binds chemically with the calcium thus preventing it from being absorbed.  Now this is not to say that these vegetables are not chocked full of other nutrients, they are!  Just don’t use them as a source of calcium.

So start playing around with ways in which you can increase the amount of calcium in your diet.  Chances are you might be able to take in much more than you think.  This month’s recipe offers you a tasty salad that is high in calcium.  Check it out!

 

 


[i] Paul Pitchford, Healing With Whole Foods

[ii] Understanding Normal and Clinical Nutrition, Seventh Edition