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Student Health

Student Health

Love the Planet with Every Bite

Earth Day is coming up and at the Nicholas School of the Environment at Duke we’re celebrating it on Friday, April 17th and Saturday, April 18th.  While we’d love you to take part in the events those days and throughout the month, it’s important to think about sustainability on a daily basis.  We only have one earth after all!

Here are 5 tips to incorporate impactful lifestyle changes into your life.

1.       Buy local and in season products.  When you purchase local food items, not only does that produce use less fuel to get to you (think less of a carbon footprint), but you reap the nutrition rewards.  Why’s that?  In-season produce is at its nutrient and flavor peak.  While you’re on campus, check out the Duke Campus Farm and get involved by helping with a farm work day.  It’s a great chance to spend time outside and meet new friends, all while assisting the farm.   Did you know that the produce grown at DCF is used in both Marketplace and Penn Pavilion?  If you eat off-campus, head to the Durham Farmers’ Market.  They even have a helpful chart to let you know what’s in season when.

2.       Think outside of the box.  Make note of the items that you use frequently (i.e. oatmeal, nuts) and see if you can buy them in bulk at places like The Durham Co-Op or Whole Foods.  This will save packaging material each time you buy.

3.       Bring your bags.  When you shop, use reusable grocery bags rather than plastic. 

4.       Go organic when possible.  Organic produce means fewer pesticides, which is much better for the environment.  We understand this swap can be costly, so prioritize first with “The Dirty Dozen”.  These items tend to test high for pesticides so are a good place to start going organic.  The DD includes apples, celery, cherry tomatoes, cucumbers, grapes, nectarines, peaches, potatoes, snap peas, spinach, strawberries and sweet bell peppers.  Can’t make organic happen?  Choose items in the Clean 15-these choices typically have the least amount of pesticides.

5.       Veg Out.  If plant-based meals aren’t part of your weekly rotation, start with Meatless Monday.  Vegetarian protein sources, such as beans and tofu, are much easier on the environment than meat.  DYK that cutting out 1 burger a week is like driving your car for 320 less miles?  Remember that balanced eating is important, even when eating vegetarian-based dishes.

We’d love to hear what you do to make a difference with your fork (or spoon).  Please leave a comment below!

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Student Health Services, Graduation, and Summer Health Fees

Congratulations to all graduating students!

The Student Health Fee for Spring Semester 2015 EXPIRES at 5:00 pm on Friday, May 15th. This means that all Duke students who have paid the Spring Fee can continue to utilize Student Health Services (SHS) through May 15th. Depending on your status at Duke, there are different rules that apply after that date. If you are:

Graduating on May 10th – After May 15th, you can no longer be seen as a patient at the SHC. You must find another source for health care. The only exception to this is if your SHC provider requests that you follow up for a condition for which you were seen prior to May 15th.

Taking summer classes at Duke – Students who are taking summer classes pay the Summer Health Fee each term.

            Summer Term I                        May 13 – June 25                    $121.00

            Summer Term II                      June 29 – August 9                  $121.00

            Summer Term I and II             May 13 – August 9                  $242.00

If you are taking classes for the first term or both terms, you can continue to utilize SHS uninterrupted. If you are taking classes during the second term only, you must elect to pay the first term health fee to be allowed to utilize SHS between May 15th and the start of the second summer term. Likewise, if you are only taking classes during the first term, you must elect to pay the second term health fee to continue to utilize SHS throughout the whole summer.

Not taking classes, but staying in the area – Students who will return to Duke for the Fall 2015 Semester but are not taking summer classes can elect to pay the Summer Health Fee, utilizing SHS uninterrupted between Spring and Fall Semesters.

Prescriptions, Refills:

Prescriptions can be renewed at the discretion of the prescribing provider for up to 30 days after graduation (e.g. June 10, 2015). After June 10th, only returning students can have prescriptions written or phoned in by SHS providers.

Medical Records:

Students may request that copies of their records be forwarded to other providers. Appropriate release will be required. For more information, visit our website:  http://studentaffairs.duke.edu/studenthealth, click on Forms & Policies and look under the “Clinical Forms” section. Alternatively, you may call 919-681-9355 and press menu option 6.

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Healthy Skin from the Inside Out

Well that warm golden blob in the sky has finally decided to appear and it is actually starting to feel like spring. This of course means that warm weather clothing is making an appearance along with more skin.

Skin is an organ just like you heart or liver (in fact it is the largest organ of your body), but it’s easy to take for granted.  You might think that slathering on expensive lotions is the best way to keep skin healthy and looking its best but the real work begins on the inside.

Here’s a quick guide to foods that help you have great looking healthy skin:

Foods high in Vitamin A- Experts agree that vitamin A is one of the most important components of healthy skin cells. Where do you get it? Low fat dairy foods. Here’s why-some people lack the ability to convert beta carotene found in carrots and other veggies to Vitamin A so going directly to the source is your best bet. Vegan or just don’t do dairy? No fear, the majority of non-dairy milk alternatives has just as much A as their dairy counterpart.

Don’t forget about yogurt either. Since yogurt with live culture is good for your digestive tract it’s also good for your skin. Happy gut equals good digestion and glowing skin.

Foods high in anti-oxidants- Think blues, deep reds and purples or berries, plums, red and black beans. These foods help protect damage to skin caused by free radicals which can be caused by sun exposure.

Healthy Fats-Fats are a key component of healthy cell membranes so remember to include fats like salmon, nuts, flaxseed, avocado and olive oil in your diet.

Water- Well-hydrated skin is healthy looking skin and hydration happens from the inside. So drink plenty of water each day, especially in extremes temperatures.

We don’t want to minimize the need to protect your skin from the damage caused by sun exposure, dermatologists recommend using a sun screen with an SPF factor of 30 or greater.

Enjoy these sunny days! 

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Got Milk? … What Kind?

Walking into Joe Van Gogh a few mornings ago, I can’t say I was very surprised to see macadamia nut milk being advertised as the newest addition to the menu.  In February, coffee-giant Starbucks started offering coconut milk, and just a quick trip to the Lobby Shop presents you with rice, almond, and soy alternatives to your classic dairy staple.  Alternative milks are trendier than ever, but before you get swept up in this cow-less chaos (or strain your brain pondering how to milk an almond), it’s important to evaluate the nutritional differences that exist amongst the plethora of dairy-free options.

Cow’s Milk:

After coming from the cow, traditional milk is pasteurized (heated, then quickly cooled) to kill bacteria.  Then, depending on the type – non-fat, 1%, 2% or whole – the liquid is “skimmed” to remove a certain percentage of milkfat.

A cup of dairy milk contains between 90 and 150 calories (depending on the milkfat level), and is a good source of protein with 8 grams per cup.  Dairy milk ranges between 0 to 8 grams of fat and contains 12 grams of naturally occurring sugar per cup. A cup of cow’s milk contains 30% of the recommended daily value of calcium and is fortified with vitamin D.

Why vitamin D you ask?

Vitamin D is necessary for the body’s absorption of calcium.  It’s also important to note that D is a fat-soluble vitamin, meaning your body needs to consume some fat – either in or alongside the milk – for effective absorption.     

Nut Milks (Almond, Cashew, Macadamia):

Nut milks are made when almonds, cashews, or macadamia nuts are blended with water and later strained.  This liquid is then enriched with nutrients like calcium, vitamin D, and vitamin E.  It’s helpful to think of nut milks more like nut “teas” – these liquids contain the flavor of the nuts but, due to the straining process, lose most of the fat and protein typically associated with the nuts themselves.  Unsweetened nut milks have fewer calories than dairy milk (~30 cal/cup) but also less fat and protein (2g fat, 1g protein/cup).  Nut milks have more calcium than milk (45% daily value) due to the fortification process.    

Soy Milk:

Soy milk is made in a similar fashion to nut milk – soy beans are pressed into water, insoluble fiber is removed, and vitamins and minerals are blended into the liquid.  Unlike nut milks however, soy milk largely retains the soy protein with 7-8 grams per cup, comparable to dairy milk.  Most soy milks contain around 100 calories, 4 grams of fat, and 45% of your daily calcium per cup making it quite similar to low-fat dairy milk.    

Rice Milk:

Rice milk is made by boiling brown rice with water, pressing the substance through a mill, straining, and lastly, fortifying with calcium and vitamin D.  A cup of rice milk has a calorie count close to dairy milk (90-120 calories) but contains little to no protein and is low-fat (2.5 grams).     

Coconut Milk:

Non-dairy refrigerated coconut milk (not to be confused with canned coconut milk, which is a high-fat cooking ingredient rather than a beverage) is made by husking coconuts and pressing the pulp to release a cream that is blended with water and fortified with vitamins and minerals.  Unsweetened coconut milk has fewer calories than dairy milk (around 45 per cup) while containing 5 grams of fat, but no protein.  Like other alternative milks, coconut milk contains more calcium than dairy milk (45% of DV), but this is due to fortification.

So, how to choose the milk that’s right for you? 

In terms of calorie count and calcium, these milk varieties are all very similar.  Your first key consideration then should be allergens – avoiding lactose, nuts, or soy if necessary.  Next, think about protein – dairy and soy milks can serve as protein sources while other milks cannot.  Third, think about fat – remember you need some fat to absorb vitamin D and calcium.  Finally, it’s necessary to mention taste!  It’s important to be aware of sweetened and flavored alternative milks; just like sweetened and flavored dairy milk, these versions contain added sugars and can tack on empty calories.  

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There’s An App for That-But Should I Use It?

Have you noticed that now-a-days there appears to be a mobile app for everything: one to monitor our sleep, our exercise, our diet, our breathing, our heart rate and so on and so on.  But the question begs, just because the app exists, is it really always in our best interest to use it? As dietitians we hear a lot about calorie and physical activity tracking apps, so we’d like to review a few of the more popular ones. Important point to remember is that both diet and exercise are behaviors, which are not typically tracked using numbers: mindfulness, hunger/satiety, feelings; whereas apps tend to be all about “the numbers”; calories, fat, protein, carbs, sugar, time spend exercising, intensity of exertion, number of days, minutes, hours etc.  Just because the numbers “hit” your target, doesn’t mean you’re engaging in healthy behaviors. It’s important to try to create healthy behaviors and habits that are long lasting, not just for immediate gratification.  

1.       My Fitness Pal-Tracks food intake and exercise and is focused on weight loss. Estimated calories burned during exercise are added to “daily allowed calories”.  Allows users to connect with a community for support, which is an important predictor of long term success (healthy support system).  Concerning is that exercise becomes a reward to eat more or leads one to believe that you’ll lose more weight the more you do, which is not necessarily true. Weight loss is complex and doing more and eating less, doesn’t always lead to more weight lost. Be careful not to set goals that are unattainable, especially long term.

2.       Lose It!-Very similar to MFP in that it is primarily for those who want to lose weight (just like the name!) but also tracks some other nutrients beside the regular carbohydrates, protein, and fat, such as cholesterol, sodium, sugars and fiber.  This app also includes a social aspect. This app might be appropriate for someone wishing to increase fiber or lower saturated fat intake to reduce cholesterol, but as with any weight loss app, be careful with weight loss goals.

3.       Recovery Record-Target audience are those struggling with disordered eating, but can be used by anyone.  This app uses no “numeric” values but rather focuses more on “mindfulness” of meal timing, balance as well feelings and emotions. Users can collaborate with their treatment team (dietitian, therapist, MD) if the practitioners also have the app. 

4.       Couch to 5K-This is a physical activity app that gives the user a specific fitness plan to work up to running a 5K.

5.       Health Watch 360-This app not only allows the user to track food and exercise, but over 500 conditions and symptoms (sleep, anxiety, etc.). Most comprehensive of all the apps which is a nice way of reminding us that there is more to “health” than just eating and exercise.

While some number tracking can be helpful for a short period of time to increase awareness of certain behaviors; i.e how much one eats based on “energy intake” or how much you are moving (steps), these apps are very detail-oriented and can cause someone to micromanage food and/or physical activity, which is not the goal.  If focusing on diet and exercise is preventing you from getting sleep or going out with friends (because you’ve already eaten your day’s quota), it’s time to move away from the app and reconnect with the bigger picture.

Unsure of what to eat? At Duke you can take advantage of meeting with one of the dietitians at Student Health-it’s covered by your health fee.  If you’re not inclined to do that, then just be wise to the fact that apps may be fine, temporarily, in conjunction with other behavioral changes, but using apps exclusively to make changes may not get you the results you wish.

 

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Are You a Moody Foodie?

I remember several years ago as a young adolescent my daughter and her friend dressing up in homemade Halloween costumes as “We’ve Been Dumped Girls”. The costumes consisted of PJs, bathrobes, fuzzy slippers, hair in sloppy ponytails, smeared mascara and of course empty containers of Ben and Jerry’s ice cream.  Creative-Yes! Accurate? Let’s see…

New research shows that people with temporary mood lows generally bounce back pretty well on their own regardless of what they may eat. Those with more prolonged mood lows may turn to food on a more regular basis for comfort but the resulting lift in spirits is generally short lived and may result in cyclical emotional eating patterns. For these folks consulting a qualified therapist for an evaluation is the best advice.

But for the majority of us who experience temporary emotional lows the “comfort” we receive from eating certain foods may have more to do with associations we have with that food than any magical mood lifting powers. For example did you and your mom (or dad) make cookies together for fun? Did you share an ice cream cone with a beloved grandparent?

 The memory of the good feelings may be what is actually helping.

Although we do know that foods high in carbohydrate temporarily make you feel better, a piece of fruit or a granola bar will do the job just as nicely as ice cream or brownies or chips—although these foods will probably not be the thing that comes to mind first.

Here is a list of some “comfort” with a healthier twist”

·         Oatmeal

·         Fresh fruit and a little nut butter

·         Nuts and dark chocolate

·         Bean soups

·         Grilled cheese sandwich on whole wheat bread

·         Whole grain granola bar

Let’s face it though; sometimes you do just want a little ice cream because it tastes good. Enjoy it for that reason alone.

 

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Why Are We Celebrating Our Bodies?

Beginning next Monday, February 16th, Nutrition Services is partnering with many offices across campus to host a positive body image week.  In the past, we’ve celebrated National Eating Disorder Awareness Week, but found that students are already aware of eating disorders.  Renaming the week and focusing on learning to embrace our bodies can help students to move away from some of the behaviors that might increase risk of developing disordered eating and exercise patterns.

Here’s a breakdown of the events we have going on next week, all of which are free and do not require tickets.

Monday, February 16th:

From 11am to 1pm, The Center for Multicultural Affairs is offering lunch at their Monday Motivation titled “Being Fine with Who You Are”.  At a roundtable discussion, students can discuss culture and body image with Mazella Fuller, PhD, MSW, LCSW from CAPS, J’nai Adams from the CMA and Kate Sayre, MPH, RDN from Student Health.  Courtney E. Martin will join the discussion.

Our keynote speaker’s talk and launch of our “Identity Over Image” campaign will take place at 7pm in the Nelson Music Room.  Courtney E. Martin, author of Perfect Girls, Starving Daughters and TED talk presenter, will discuss how effortless perfection is harming young women.  One of her quotes that we find most powerful is “We’re a generation of young {people} who were told they could be anything and heard they had to be everything”.

Tuesday, February 17th:

Have you heard of the “fitspo” movement?  These “inspirations” to exercise can be much more damaging than helpful.  We’re hosting a “true fitspiration” event in Brodie Gym from 5-7:30pm.  Here students can focus on positive reasons why they work out.  It may be to build strength, relieve stress or be able to sleep better.  It’s important we think of these benefits rather than superficial ones.

Those of us who treat eating disorders are often asked by students how they can approach a friend who they think is struggling with disordered behaviors.  Partnering with Duke students, we’ve created a recurring event called “Is This Normal?: How to Help a Friend with Disordered Eating”.  Embody Carolina is joining us to empower our community members to help each other.  This session will start at 6:30pm in McClendon 2.

Wednesday, February 18th:

WHOspeaks images remain powerful reminders of how we view our bodies.  The Women’s Center is hosting a showcase of these pictures as well as a discussion from 2-4pm.

Thursday, February 19th:

Me Too Monologues just wrapped up another very successful year.  We’re grateful to those who shared their stories, the actors and all in attendance.  We’re hosting a screening of past monologues that discuss body image.  Join us in the Keohane Atrium at 6:30pm.

Friday, February 20th:

To wrap up our week, we’re kicking it back at the Center for Sexual and Gender Diversity from 3-5pm.  Karen Kuebler, the art therapist from Veritas Collaborative, is leading an activity titled "Using Visual Language to Promote Self-Compassion and Positive Body Image". We’ll be creating individual and collective positive art and would love you to join us.  Food will be provided.

With this week of events, we’re hoping to start and continue conversation on campus of how we can better treat ourselves and our bodies.  If you aren’t able to attend the events, we ask that you do your part.  Use positive language, disallow “fat talk” in your social circles, and celebrate your body for all it is capable of.  If you’re concerned about your own behaviors, please take our anonymous screen to assess.

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Time to Rethink the Midnight Snack?

As a Duke student, I am no stranger to the late-night cram session the night before an exam, or the essay-writing marathon that stretches into the early morning hours.  For many of us in college, day and night have become flexible terms that more often than not misalign with being awake and being asleep.  When burning the midnight oil, we often crave a snack to keep us going through the night.  However, a recent study by the Salk Institute for Biological Studies (reviewed here in the NY Times) suggests that these late-night nibbles may be messing with our bodies’ internal clocks.

Published this past December in the journal Cell Metabolism, the study used mice to look at the relationships between meal times, weight gain, and overall health.  Mice were allowed to eat on two different schedules – one group had access to food all day long, while the other group of mice had access to food for only 9 or 12 hours per day.  The results showed that even though all of the mice consumed the same number of daily calories, those mice that only ate during the 9 to 12 hour window were healthier, gained less weight (some obese mice even lost weight), and had more lean muscle mass than the mice that ate all day long.

Scientists believe that the results seen in the mice may have significant implications for humans too.  Although the exact mechanism is still being researched further, this study hypothesizes that meal times affect the body’s circadian rhythms, even more so than dark and light cycles.   Circadian rhythms are our bodily processes that run on an approximately 24-hour cycle, and they affect how our genes work.  This study suggests that eating only within a 12-hour time window allows for our genes and metabolic pathways to synchronize and work together more effectively, keeping our bodies leaner and stronger.  While the old adage goes, “we are what we eat,” it may be more likely that “we are when we eat. “

This being said, it can be nearly impossible to avoid those midnight cravings all the time, so it’s important to be smart when choosing a late-night snack.  To give yourself a boost of fuel at any hour, pair a carbohydrate (fresh or dried fruit, whole grain crackers, veggies) with a protein source (yogurt, cheese, nuts, hummus) – check out this Smart Snacking resource for more ideas!  Also, be sure to feed yourself well and regularly during the day to meet your daily energy needs, so when nighttime rolls around, you’re still feeling satisfied and productive.  Your body and its clock will thank you!

      

 

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Count calories? Maybe it’s better if we don’t.

It’s ironic that at a time when new legislation will demand that restaurants (having more than 20 locations), and vending machines (anyone owning more than 20) will have to disclose calorie and nutrition information, we are also learning that counting calories might be counterproductive to addressing the obesity epidemic in this country.

It’s not rocket science to figure out that calorie counting might not be working – it’s been done for years and look where it got us. Believe me, I realize that our obesity epidemic is not just about calorie counting: obesity is actually very complex, we always just want to over simplify it by bringing it back to calories in and calories out.  We now know that the source of calories consumed have different effects metabolically in our bodies.    

There are times where calorie counting may be beneficial; such as to offer perspective on energy intake, when someone has no idea of how much they are eating. Our food label information, for instance, is currently based on a 2000 calorie diet and for many this means very little. Perhaps counting calories for a day might assist in increasing awareness of how our intake compares.  However, that is more or less where it ends. Counting calories, or counting nutrient values for that matter, diminishes the food we eat to a numeric value.  Inherently that removes the pleasure, joy and satisfaction we derive from eating only to have it replaced with worry, guilt and an overall unsatisfying dining experience.  If you look at countries that are not struggling with weight issues, or hadn’t until recently, it’s not because they’ve been counting calories all these years.  Perhaps it is because they eat food and not nutrients, they appreciate the flavor, color, texture and origins of the food that they are eating and enjoy the company of the people they are eating with. It’s really not about calories, it’s about balance, and it’s just taking us a little longer to realize that.

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The Flu Forecast

The forecast isn’t great for the flu season this year.  It started a little earlier than usual; one of the strains that is going around – H3N2 – is a little more aggressive than usual; and even though this year’s vaccine targets H3N2, it isn’t a great match for the strain that’s actually going around.

The flu can cause mild to severe illness, and people who have it usually experience the sudden onset of fever, cough, sore throat, runny or stuffy nose, muscle aches, headaches, fatigue and occasionally nausea and vomiting.

People with flu can spread it to others up to about 6 feet away through droplets made when they cough, sneeze or talk. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose. You can avoid spreading the flu to yourself and others by staying away from sick people and avoiding others if you are sick. Covering your cough and washing your hands often with soap and water or alcohol-based hand sanitizer is also a good idea.

The single best way to prevent the flu is to get your flu vaccine, even during seasons like this one when there is a less than ideal match for one virus. (Flu clinic: Wednesday, 1/21, from 5-8pm in Wilson Rec.) The vaccine may protect against the other viruses floating around, and antibodies made in response to vaccination with one flu virus can sometimes provide protection against different but related viruses.

All Duke Students can get a flu shot at the Student Health Center or one of the flu shot clinics we offer around campus.

Luckily for most Duke Students, the flu will resolve on its own after a few days of feeling crummy with the help of rest, fluids and over the counter pain and fever reducers.  However, there are prescription medications that can shorten the duration of the illness in severe cases if started early enough. If you are worried that you might have the flu, call the Student Health Center to speak to one of our nurses or make an appointment to see one of our health care providers.  We are here to keep you healthy!

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