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Friday, October 1
 



Ask the nutrition expert
drkoop.com

Sharon Howard has more than 20 years of practical and educational experience as a registered dietitian. She is the president of Nutrition for Living, nutrition counseling and consulting service. In this role, she has assisted thousands of clients in achieving their nutrition goals, which included lowering their cholesterol levels, losing weight, controlling diabetes, recovering from eating disorders, and managing renal diets.

Dear Expert:
I have been researching calorie distribution for fat, carbohydrates and protein. I have found that there is a great deal of conflicting information. In your article, you say that 15 to 20 percent of our daily calories should come from protein sources; however, another article from drkoop.com, entitled "Understanding Food Labels," suggests 10 percent as a daily recommendation for protein. Can you tell me which one is correct and what source you used to obtain this information?

Answer:
The guidelines are considered general in nature, so ranges are appropriate. Minimums are established for protein and maximums are determined for fat. Fewer than 50 grams of carbohydrates is not recommended. You will see legitimate recommendations in these ranges of total calories:

  • protein -- 10 to 25 percent
  • fat -- 20 to 30 percent
  • carbohydrates -- 50 to 60 percent

In calculating a healthy diet, dietitians start by keeping the fat percentage under 30, as recommended by the American Heart Association. Then, they plan a minimum of 10 percent protein. After that, they adjust the carbohydrates on the remainder of the calories.

Some people prefer more protein, less fat and a carbohydrates percentage closer to 50. All of these are within normal ranges and provide a healthy diet. Harshly restricting any of these three components of the diet may limit nutrients from those food groups, such as vitamins and minerals, as well as cause possible metabolic disturbances. The American Diabetes Association recommends the following breakdown:

  • protein -- 10 to 20 percent
  • fat -- 30 percent
  • carbohydrates -- 50 percent

The minimum recommended daily protein intake is 10 percent of your total calories. This is what is used on food labels as the Daily Value. The amount of protein you need, determined by the RDA of the Food and Nutrition Board of the National Academy of Sciences is, for a healthy adult, 0.8 grams per kilogram of desired body weight per day. Recommendations can go as high as 1.4 grams of protein per kilogram body weight (for athletes and people trying to increase body weight). This may work out to be 25 percent protein for total calories.

Let us say that you are an adult female, 5 feet 8 inches, and your desired weight is 150 pounds. Converted to kilograms (divide by 2.2 pounds), that is 68 kilograms. This is a minimum goal for good health:

68 kilograms   x   0.8 grams of protein per kilogram   =   54.4 grams of protein a day.

Next, let us say that you eat about 2,000 calories a day.

55 grams of protein   x   4 calories per gram   =   218 protein calories.
218 / 2,000   =   11 percent of total calories.

If you are trying to lose weight, and you limit yourself to 1,500 calories per day, then 55 grams of protein is about 15 percent of 1,500 calories.

Let us look at fat. Thirty percent of fat in a diet of 1,500 calories per day would be 450 calories, or 50 grams of fat per day (9 calories per gram of fat). So, how many calories are left for carbohydrates?

1,500   –   218 protein calories   –   450 fat calories   =   832 carbohydrate calories

This is 55 percent of your total daily calories.

So, this plan works out as follows for a diet of 1,500 calories per day:

  • protein -- 55 grams (15 percent)
  • fat -- 50 grams (30 percent)
  • carbohydrates -- 208 grams (55 percent)

If you plan the appropriate protein level and keep the fat below 30 percent, the carbohydrates will fall into the 50 to 60 percent range.


Dear Expert:
Recently my doctor told me that my cholesterol is higher than it should be. He suggested medication and a diet. What kind of diet helps reduce cholesterol levels?

Answer:

Diet is the first line of treatment for lowering cholesterol. If diet changes fail to bring the cholesterol below 200mg, and the LDL cholesterol ("bad cholesterol") below 130 mg, doctors then add medication to the diet treatment.

A diet for lowering blood cholesterol, as recommended by the American Heart Association, is designed to have less than 30 percent of calories from fat and less than 10 percent from saturated fats. Here is a list of diet changes that can help lower your cholesterol.

A diet for lowering blood cholesterol, as recommended by the American Heart Association, is designed to have less than 30 percent of calories from fat and less than 10 percent from saturated fats. Here is a list of diet changes that can help lower your cholesterol.

  1. Limit daily cholesterol to 300 mg or less. Cholesterol is found in liver, egg yolks, shrimp, lobster and caviar.
  2. Calculate how much fat you should have a day. Estimate how many calories you eat, divide by .30, and then divide the number of fat calories by nine (calories per gram) to get the actual fat grams you should not exceed a day. For example, let's say you hold your weight at 2000 calories a day. Thirty percent of 2000 calories is 600 fat calories. 600 fat calories divided by 9 calories per gram is 67 fat grams a day. Get a fat gram counter, read labels, and track your fat gram intake for a week. You quickly will find where to make different food choices. Remember, less than 10 percent fat in the diet is not healthy either.
  3. Limit saturated fats. These fats add to the artery-clogging problem. Saturated fats are mostly found in animal fat, such as lard, butter, beef fat and cream. Use the leanest cuts of meat, avoid the skin of poultry, and use skim or low fat milk, yogurt and cheese.
  4. Avoid tropical oils such as palm, palm kernel and coconut oils. These highly saturated oils are not sold separately, but they are hidden in coffee creamers, whipped toppings, commercial baked goods and chocolate candy.
  5. Increase monounsaturated fats such as olive oil and canola oil. These fats lower LDL cholesterol.
  6. Use polyunsaturated fats, like corn oil, safflower oil, soybean and sunflower seed oil, to lower your total cholesterol by substituting them for saturated fats. All of these fats must fit within your 30 percent allotment.
  7. Avoid trans fatty acids -- these are a type of fat created when the food chemists take liquid oils and partially hydrogenate them to make then solid -- like brick margarine. Some can be found in commercial baked goods, fried foods, and prepared convenience foods. Margarine that is "trans-free" is your best choice, even over butter.
  8. Increase fish intake to get Omega-3 fatty acids. The oil in fatty fish is protective. Include more salmon, tuna, blue fish, sardines, herring and mackerel in your diet. Limit red meat to 9 ounces a week or less.
  9. Increase fiber in your diet, especially soluble fiber. Remember the oat bran craze? Oats offer cholesterol-lowering properties, along with other soluble fiber foods such as legumes, lentils, barley, and vegetables and fruits such as apples, pears, plums, oranges and grapefruit. These reduce the fat and cholesterol that enter your body and help eliminate bile salts.
  10. Strive to be at your ideal weight. Even a five to 10 pound weight loss can show an improvement in your blood cholesterol.
  11. Increase the use of fruits and vegetables for their antioxidant benefits. Antioxidants protect the arteries of the heart from accumulating plaque. Many cardiologists recommend vitamin E 400 Iu and vitamin C 250mg. High doses of beta-carotene remains questionable. Continue eating colorful fruits and vegetables such as sweet potatoes, dark green leafy vegetables, cantaloupe, squash and broccoli.
  12. Get enough folic acid. Low folic acid levels cause a rise in homocustein, which is a negative factor in heart disease. Researchers recommend 400 micrograms a day. Folic acid is found in spinach, orange juice, fortified bread and cereal, peanuts, beans and wheat germ.
  13. Exercise will decrease bad cholesterol and increase the good cholesterol.
  14. The active ingredients in garlic are proving to lower cholesterol. Use garlic generously in cooking.
  15. There is a range of diets offered to lower cholesterol. In addition to the American Heart Association, Dean Ornish proposes a very low-fat vegetarian diet plan, and others promote the Mediterranean Diet. All suggest less saturated fat and cholesterol and more fruits and vegetables.

Good luck. Perhaps a healthy diet can reduce your need for medication. Give it a try.


Dear Expert:
I have been exercising regularly (four to five days a week) at the gym at work. I have also been trying to monitor my diet. I have not been able to lose more than one to two pounds over the course of 11 months.

I am now thinking of consulting a nutritionist in my area, but would like your advice on how best to find a nutritionist? What are the correct criteria and associations, and what are the basic charges I need to be aware of? Any information you could give me is appreciated.

Answer:
A registered dietitian is the only professional with a certification and accredited college degree to offer sound, ethical, nutritional advice. Check the American Dietetics Association Web site for a list of dietitians in private practice under Nutrition Referral Network. These dietitians will list the kinds of specialty areas they work in. You can also open your phone book, and look under dietitian, nutritionist or weight control. Or, call the local hospital dietitian and ask for a name of an R.D. who can see you.

Each state has a Dietetic Association, and the ADA can help with getting in touch. Your doctor also may be able to give you a name. Some health clubs have consulting dietitians, who specialize in sports nutrition, weight loss and exercise physiology. Look for R.D. behind the name, and ask for the area of expertise.

Private practice dietitians charge between $45 to $100 for a one-hour consult, and less for follow-up visits. About the same as a massage! You would need only a few visits to know what you need to do differently.

Beware of people who call themselves nutritionalists. They do not have credentials. Registered Dietitians can call themselves nutritionists. L.D. will designate a licensed dietitian who also will be registered, but not every state offers this as yet.

All R.D.'s must complete a post-graduate internship, sit for an exam to get their credentials, and maintain that R.D. status with 75 credit hours of continuing education every five years. This is a far cry from the vitamin sales person who was trained by the company or read a nutrition book or two, and then suggests what is wrong with you and what supplement will fix it.

Ethical dietitians cannot order blood tests and diagnose conditions -- this is up to a medical doctor. Dietitians can treat problems with diet alterations, as well as other nutrition counseling tools, techniques and education.


Disclaimer:
The information, including opinions and recommendations, contained in this website is for educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis or treatment. No one should act upon any information provided in this website without first seeking medical advice from a qualified medical physician.






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