What are the benefits of eating this way?
Chronic inflammation causes the body stress and has been linked to many diseases, such as cardiovascular disease, cancer and Alzheimer’s disease.
Eating anti-inflammatory foods provides your body with the essential vitamins and minerals, fatty acids, fiber and phytonutrients that it needs to function optimally to reduce your risk of inflammation and many diseases.
- Whole grains such as brown rice, whole wheat bread, quinoa and bulgar
- Olive and canola oils, omega-3 fatty acids, nuts and seeds
- Fruits and vegetables
- Lean protein, such as fish, lean cuts of meat, beans and tofu
- Processed and fast foods
- Refined carbohydrates, such as white bread and rice
- Sunflower, safflower, and mixed vegetable oils as well as saturated and trans fats
- Fruit juices and soda
- High fat meats
Balance Your Vegan Plate
A vegan (or strict vegetarian) diet is one in which only plant products are consumed.
You will want to include foods from all the food groups represented on the plate, focusing on getting a good balance of protein, grains, vegetables, fruits and fats.
If you have decided to follow a vegan diet for whatever personal reasons you may have, it is important to put some thought into finding the right balance of nutrients for optimal health.
A vegan eating plan isn’t just about what you don’t eat, but also what you do eat.
While most vegetables and even grains contribute some protein to your diet, it is important to focus on including other high protein foods at every meal.
We recommend consuming a variety of foods high in protein every day:
And in particular getting a minimum of 2 servings of nuts or seeds and 3 servings of legumes (beans, lentils, soy) per day.
Typical portion sizes for plant based proteins one serving equals:
• Protein Nutmilk (standard nut and rice milk contain little to no protein)
• 8 oz soy milk• ½ cup legumes (beans)•
• 4 oz tofu (soybean product), tempeh (fermented soybean product with a slightly nutty taste), seitan (wheat gluten), or TPV (Textured Vegetable Protein)
• 1 oz nuts (small handful)• 1 oz soy cheese• 2 Tbsp nut butter
• Pea protein as a substitute to whey in a smoothie.
However depending on your weight and activity level you may need more than this.
Fill the rest of your plate with vegetables, fruits, whole grains and fats.
Be sure to get enough:
B12 – which is only found in animal products. It can also be found in fortified cereals and grains. It may be wise to take a supplement to assure you are getting enough.
Calcium – aim for 2-3 servings of calcium fortified products such as juices and soy/almond/rice milk per day. Plant based sources of calcium include dark green veggies and almonds. Again if you don’t think you will be able to consume enough calcium in your diet then opt for a supplement to be on the safe side.
*note the supplement should include vitamin D.
Vitamin D – if you are consuming 2-3 servings of fortified soy/rice/almond milk daily then you are covered. If however this is a challenge for you, you should take a supplement. Vitamin D is difficult to get from diet alone and most people do not get the daily sun exposure needed to make enough of this vitamin.
Iron – Iron is found in legumes, fortified grains and cereals, dark green veggies and tofu. Adding a food high in vitamin C at each meal will help you absorb the iron in that meal. (see list of foods high in Vitamin C below)
Foods high in Vitamin C
• Citrus fruits and juices (oranges, grapefruit, pineapple)
• Baked potato
• Bell peppers
• Tomatoes and tomato products
• Dark leafy greens• Mango and papaya
Zinc – As long as you consume whole grains, legumes, green veggies and nuts you should be meeting your needs.
Omega 3 fatty acids – aim for two servings per day of walnuts, canola oil, milled or crushed flax seed or flax seed oil.
Calories – be sure that you are eating enough to meet your daily energy needs. If you begin to lose weight quickly or are feeling sluggish, contact your doctor or Duke Nutritionist to review you diet.
Balance Your Vegetarian Plate
A vegetarian eating plan is one that excludes the consumption of meat, fish and poultry. If egg and dairy products are consumed, this is called a lacto-ovo vegetarian diet.
When following a vegetarian style of eating, it is just as important to consider what you “do” eat as what you “don’t” eat. For example, someone who doesn’t eat meat fish or poultry but only eats cheese and pasta—is technically following a vegetarian style of eating—it’s just not balanced or nutritious.
You will want to include foods from all the major food groups represented on the plate, focusing on getting a good balance of protein, grains, vegetables, fruits and fats.
While most vegetables and even grains contribute some protein to your diet, it is important to focus on including other higher protein foods at every meal. Here are some examples:
One serving equals:
(based on your weight and activity level you may need more than one serving at a meal)
• 1 whole egg
• 8 oz milk/soy milk or yogurt
• 4 oz of cottage cheese
• ½ cup legumes (beans)
• 4 oz tofu (soybean product), tempeh or lentils (fermented soybean product with a slightly nutty taste), seitan (wheat gluten), or TPV (Textured Vegetable Protein)
• 1 oz nuts or seeds (small handful)
• 1 oz cheese
• 2 Tbsp nut butter
• 1/2 cup quinoa or amaranth
Fill the rest of your plate with vegetables, fruits and whole grains and some fat.
Be sure to get enough:
B12 – which is only found in animal products. It can also be found in fortified cereals and grains. It may be wise to take a supplement to assure you are getting enough.
Calcium – dairy products are your best source – aim for 2-3 servings of dairy or calcium fortified products such as juices and soy milk per day. Plant based sources of calcium include dark green veggies and almonds. Again if you don’t think you will be able to consume enough calcium in your diet then opt for a supplement to be on the safe side.
*note the supplement should include vitamin D.
Vitamin D – if you are consuming 2-3 servings of milk, fortified yogurt or fortified non dairy milk alternative daily then you are covered. If however this is a challenge for you, you should take a supplement. Vitamin D is difficult to get from diet alone and most people do not get the daily sun exposure needed to make enough of this vitamin.
Iron – Iron is found in egg yolk, legumes, fortified grains and cereals, dark green veggies and tofu. Adding a food high in vitamin C at each meal will help you absorb the iron in that meal. (See list below)
Foods high in Vitamin C
• Citrus fruits and juices (oranges, grapefruit, pineapple)
• Papaya , mango
• Baked potato
• Bell peppers
• Tomatoes and tomato products
• Dark leafy greens
No Bones About It!
Unless you’ve just broken a bone, or happened to be sidelined for a stress fracture, most people don’t give their bones a second thought. In America there has been an increase in osteoporosis over the last decade and researchers are working hard to find an answer to this debilitating problem.
Three Key Components to Keeping Bones Healthy
1. Adequate dietary calciumand Vitamin D
2. Normal estrogen production
3. Weight bearing exercise
Although our bodies have a large calcium reserve (our skeletons) ideally, our dietary calcium intake should support our daily needs. If you like dairy products and are not lactose intolerant, then this may be a relatively easy task.
How much do we need?
The recommended amount of calcium is 1000-1200 mgs/day.
Two to three glasses of milk (ideally skim) provide approximately 600-900 mgs. of calcium. Add to that some cheese and yogurt and you will be close to this daily recommendation. The table on the back lists some good sources of calcium to help you reach your daily needs. While dairy and cheese are the obvious best choices, there are other good choices as well. Tofu is also a good source of calcium along with broccoli, mustard and collard greens, kale, shellfish, canned salmon with the bone, sardines, puddings and custards.
Normal Estrogen Production
Estrogen allows for healthy bone formation. Right before, during and after menopause, when women begin to produce less estrogen and ultimately very little at all, the risk of osteoporosis increases dramatically. However, there may be times long before becoming elderly where you might be putting yourself at risk for osteoporosis. Women, who don’t menstruate regularly, or at all (who are not on birth control), are at high risk for stress fractures, premature osteoporosis and possibly increased risk of complications due to osteoporosis. Estrogen is a key component in regulating menses (periods). Please check with a health care provider if you have concerns about the regularity of absence of your period. There is little evidence that taking oral contraceptives to induce a period has any protective effect on bone health.
What about calcium supplements?
Especially for lactose intolerant individuals, reaching the daily recommendation of 1000-1200 mg. can be very difficult without supplementation. Therefore, it is often recommended that a supplement of calcium carbonate or calcium citrate with vitamin D be taken. Supplements don’t have to account for the total calcium requirement, as your diet should be providing some as well. Calcium from a supplement is not as readily absorbed as calcium from foods, therefore many people do supplement the full-recommended amount.
Recently the recommended amount of Vitamin D, also very important in bone health, was increased to a range of 1000-2000 IUs, (although the RDA for Vitamin D remains 600 IUs) per day. These amounts are often not contained in calcium supplements, so an additional Vit. D. supplement is necessary.
A diet high in phosphorus (soda – regular or diet) and low in calcium increases risk of osteoporosis. Do yourself a favor and make sure you are drinking your milk or getting your calcium, somewhere in the diet.
Moderate to high alcohol intake has also been linked to an increased risk of stress fractures. If you drink, do so wisely and limit the quantity. Your future may depend on it.
Weight Bearing Exercise
Participating in weight bearing exercises can help keep your bones dense, i.e. compact. Weight bearing refers to any exercise that requires weight to bear down on the skeleton or bones such as jogging, walking, and weight lifting. However, biking and swimming, although good exercises, are not weight bearing.
Who is at Risk?
Women more often suffer from osteoporosis than men, but that does not exclude them. Individuals who are small framed, short in stature, light in weight, smoke and or drink alcohol, and have a family history are at increased risk of osteoporosis. Men are more likely to experience osteoporosis in their later years.
Common Calcium Sources
Food / Serving Size / Calcium content (mg.)
Skim Milk / 1 cup / 300 mg.
Plain low-fat yogurt / 6 oz. / 311 mg.
Fruited yogurt / 6 oz. / 235 mg.
Swiss Cheese / 1 oz. / 270 mg.
Tofu (with calcium sulfate) / 1/2 cup / 260 mg.
Salmon (canned with bone) / 3 oz. / 205 mg.
Dried figs / 3 each / 80 mg.
Orange Juice (calcium fortified) / 3/4 cup / 225 mg.
Broccoli / 1/2 cup / 45 mg.
Pinto Beans / 1/2 cup / 40 mg.
Edamame / 1/2 cup / 35 mg.
Almonds / 1 oz. (23 nuts / 75 mg.
Carbohydrates are macronutrients that provide us with energy, in the form of calories. They are the primary fuel source for cells in the brain and bloodstream, and muscles rely on a steady supply of carbohydrates to support physical activity. Think about trying to run a car without gas, carbohydrates are the body’s fuel source.
Types of Carbohydrates
Carbohydrates can be broken down into two major categories:
1. Sugars or simple carbohydrates:
Simple carbohydrates are 1 or 2 sugars that are bonded together and easily broken down in digestion. Examples include fructose (fruit sugar), lactose (milk sugar), and sucrose (table sugar). All carbohydrates, except fiber, are converted into glucose, which is a monosaccharide or single sugar, and used as the energy source for all cells in the body. Simple carbohydrates provide a faster release of energy, but it doesn’t last very long so you’ll be hungry sooner.
2. Complex carbohydrates:
Complex carbohydrates are larger molecules that consist of many hundreds or even thousands of sugars bonded together. They are not digested as quickly as simple carbohydrates, especially when fiber is present. The result is a slower release of sugar into the bloodstream with a less dramatic rise (and then fall) in blood sugar. This provides a slower release of energy that lasts longer, keeping you fuller longer.
Do You Need to Eat Carbohydrates?
The short answer is yes. Carbohydrates are cells’ main source of energy as well as the best source of many nutrients that the body needs, including the majority of the B vitamins, minerals (such as calcium-remember that dairy contains carbohydrates in the form of milk sugar), phytochemicals (disease fighting substances found in fruits and vegetables), and fiber (which helps protect against colon cancer, heart disease, and diabetes).
What Foods and Beverages Contain Carbohydrates?
• Dairy products
• Grains, grain products, and starches
• Sugars and sweets
Do Carbohydrates Cause Weight Gain?
Weight gain is caused by any food or food group eaten in excess. Carbohydrates are no exception. However, some of the higher fiber carbohydrate foods can actually assist with reducing caloric intake because they are more filling and therefore you may eat fewer calories. Be careful when increasing the fiber content of your diet, as increasing it too quickly can lead to gastric upset (bloating, gas, diarrhea even constipation). While more processed carbohydrates, such as cakes, cookies, and refined grain products, provide little more than a calorie source and are not very filling.
Does It Matter What Kind of Carbohydrates I Eat?
Yes, not all carbohydrates are created equal. The more heavily processed a carbohydrate, technically the more digested it already is, so it’s easily converted to sugar upon eating. This goes without saying for foods that are sugars such as candy, desserts etc.
Foods that are less processed require more chewing, and so it takes longer to eat those foods and allows for more awareness of fullness, which may help you eat less. Ideally, choose “whole” foods; starches such as barley, whole grains, sweet potatoes and brown rice, more often than the processed ones. Avoid products with too much “added fiber”, like those that contain inulin, a fiber source that is not found naturally in most foods, and often causes gas and discomfort.
Does It Matter When I Eat Carbohydrates?
Timing is everything. Think about the natural flow of your blood sugar – low in the morning upon getting up, then typically higher throughout the day depending on how much carbohydrate we eat. If our sugar is low in the morning it would make the most sense to have more carbohydrates at the earlier meals (breakfast and lunch), thereby supporting our blood sugar needs in the morning and afternoon. Unfortunately, many of us eat the bulk of our carbohydrates later in the day or the evening, when we’re well past the most active part of the day, and don’t need the energy. Excessive carbohydrates in the form of sugars, in particular, may lead to weight /fat gain. Ideally, keep the carbs lower at dinner by eating unlimited vegetables and having a smaller portion of fruit and/or starch, and eat larger amounts of lean protein and healthy fats.
Dietary Approaches to Stop Hyperextension
What you eat can help manage your blood pressure. Research shows that high blood pressure (hypertension) can be lowered by making lifestyle changes including following the DASH (Dietary Approaches to Stop Hypertension) eating plan.
What is high blood pressure?
Blood pressure readings higher than 140/90 are considered high. Take note that both set of numbers matter, however the lower number (diastolic) is more indicative of hypertension. The top number (systolic) is readily influenced by anxiety or nervousness which is why a medical provider may have you sit and wait before retaking a reading.
Prehypertension is defined as a blood pressure reading between 120/80 and 139/89
High blood pressure increases the amount of work your heart has to do and can lead to heart and kidney disease as well as other circulatory problems.
Steps you can take to help lower your blood pressure:
• Follow a nutritious/balanced eating plan, such as DASH which would include watching your salt (sodium) intake
• Maintain a healthy weight for you
• Be moderately active- about 150 minutes per week
• Be moderate with your intake of alcohol
• Take any medications as prescribed by your health care provider
What is the DASH Eating Plan?
This is a heart healthy style of eating which is rich in key nutrients that are associated with lowering blood pressure. These nutrients include potassium, magnesium, calcium, protein and fiber. It is lower in sodium, simple sugars and saturated and trans fats.
For most people a DASH diet style of eating is more about what you should include in your diet than what you need to restrict.
Servings Per Day*
1 Serving is equal to:
What each Group Provides
(whole grains are recommended)
1 slice of bread
¾ c dry cereal
½ cup cooked rice, pasta or other grain
Whole wheat bread, crackers
Whole wheat pasta
Whole grain cereal
Quinoa, brown or wild rice, barley
Good source of energy and fiber
1 cup raw leafy vegetable
½ c cut up raw vegetable or cooked vegetable
Broccoli, carrots, collards, green beans, peas, kale, spinach, potato, lima beans, squash, sweet potato, tomato
Rich in Potassium, magnesium and fiber
1 medium whole fruit
¼ c dried fruit
½ c fresh or frozen or canned fruit (in its own juice)
½ c fresh fruit juice
Apples, apricots, bananas, dates, grapes, grapefruit, oranges, kiwi, mangoes, melons, berries, raisins, peaches, pineapple, cherries, tangerines or clementines
Rich in potassium, magnesium and fiber
Low fat dairy
1 cup of milk or yogurt
1.5 ounces cheese
Skim or low fat milk or yogurt. Part skim or reduced fat cheese
Major source of calcium and protein
Lean, meats, poultry and fish
1 oz cooked, meat, poultry or fish
Select lean meats. Broiled, roasted, grilled or poached. Remove excess fat and skin on poultry
Rich source of protein and magnesium
Nuts, seeds and legumes
3-5 per week
1/3 c or 1.5 ounces nuts
2 Tbsp of nut butter
2 Tbsp or ½ ounce seeds
½ c cooked legumes
Almonds, hazelnuts, peanuts, walnuts, sunflower or pumpkin seeds, peanut or almond butter, kidney beans, lentils, split peas, black beans, chick peas.
Rich in energy, magnesium, protein and fiber
Fats and oils
1 tsp butter or soft margarine
1 tsp vegetable oil
1 Tbsp Mayonnaise
1 Tbsp full fat salad dressing
1 ounce or 1/5 medium avocado
Soft margarine (trans fat free), vegetable oil such as olive, canola or safflower, avocado
Fats are anti-inflammatory foods and are a good energy source
1500-2300 mg per day
Based on your doctors recommendations
Up to a maximum 1 tsp salt (remember sodium is hidden in other foods so you have to count that too)
Choose fresh or frozen fruits and vegetables over canned (rinse canned foods if you need to use them)
Reduce intake of smoked, cured or processed meats
Avoid visible salt like you see on pretzels, chips or crackers
*Number of servings is determined by your energy needs to maintain a healthy weight for you. See a dietitian if you are not sure how much of each food group you need
- Make gradual changes over a period of weeks (this is a higher fiber diet, if you add too much too quickly you may become bloated or gassy- gradual change is better)
- Choose one or two things to start with and build from there
- Add a serving of fruit or vegetables to each meal to start
- Include two or more vegetarian meals per week
- If you don’t normally consume dairy, add it in slowly (no more than one serving per day at first. If you have a hard time tolerating milk sugars consider lactose free products.
- Check with your doctor before starting a new exercise routine and take it slowly if you have not been exercising regularly
Dietary Assessment “Red” Flags
“I want to gain weight” – although this sounds promising, it’s often more to appease others’ wishes, than actually desiring to gain weight. Follow with, “can you describe to me what you’ve done to try to gain weight?”
“I eat “healthy” – please have them define what that means for them as this usually means “high volume” eating – lots of fruits and vegetables, but relatively low calorie intake. If starches; grains, pasta, potatoes, are missing then they’re most likely restricting. This would apply to fat and sugar as well.
“I’m a picky eater” – very convenient way to restrict. Even picky eaters can maintain a healthy weight.
“I’ve become vegetarian, vegan or gluten free in the last year”. – another convenient way to restrict. I often follow this up with, “can you share with me what may have prompted your decision to do this”. If answer is I want to be healthier, could be they want to lose weight.
“I’ve tried to gain weight but can’t” – this usually means that they haven’t really tried or that they really don’t know how to do that – although most people could figure that out.
Diet recall – when asking them to give you an example of what they might eat in a 24 hour period of time:
• Shows very little fat, very few starches and lots of fruit and vegetables.
• Meals, snacks are often not well balanced – just an apple or just a piece of string cheese rather than combining the protein and the carbohydrates.
• “I don’t snack” or don’t like to snack – often too “messy” for someone that is rather controlling or is afraid that a snack might turn in to a binge so I like to ask why, to see what reasoning they have. Snacks can be very helpful if done well.
• Compensation/guilt talk – “I usually don’t eat the next morning if I have had a large dinner the night before”
“I exercise a lot and just can’t keep up with my food” – there should be no reason that one can’t maintain or even gain weight with a lot of exercise, although yes, it is challenging. But again, often an excuse for not maintaining weight.
Possible physical signs that they are not eating enough?
Recent weight loss – this alone is not necessarily a sign of an eating disorder. Many things may contribute to this such as untreated depression or anxiety, needs to be followed up on.
Low energy/tired during the day – could be a sign of low energy intake, iron or vitamin D insufficiency, any of which can increase symptoms of depression or anxiety.
Feeling cold all the time – could point to lower metabolic rate related to low energy intake or low iron levels.
Dizzy when you stand up – may point to low blood sugar or low blood pressure related to low energy intake or low fluid intake.
Thinking about food all the time – hunger, obsessive thoughts, restriction.
Irregular or absent periods – insufficient, consistent energy intake (perhaps low fat or protein intake), over exercising.
Low pulse/heart Rate – insufficient energy intake (it is not a sign of an athletic heart in these clients). Often the only sign of significant restriction. Lab work is often normal.
New or unexplained GI upset or constipation – usually a sign of the body slowing down and reduced peristalsis due to significant energy restriction. These symptoms often make restriction worse as clients try to manipulate diet to find relief.
• Eating differently when alone then when with others.
• Not eating with others, avoiding social situations around food.
• History of strong family criticism about weight or body shape.
• Having a parent that has not recovered from their own “eating issue”. Usually presents as a parent that is overly obsessed with “fitness” or “weight”.
• Overweight as a child with strong history of dieting and weight loss now fear of gaining.
Revive Your Love of Food
Do more than eat, Savor!
Do more than nibble, Taste!
Do more than consume, Enjoy!
Do more than feed, Nourish!
Do more than munch,
Ever thought you could change the way you eat without changing what you eat?
Mindful eating is a practice that focuses on how we eat, rather than what we eat, as a means of eating more healthfully.
What does it mean to be mindful?
Mindful eating simply means paying attention to our food as we are eating it. When we slow down to savor each bite, and focus on the taste, sound, sight, smell and feel of our food, we can determine our level of satisfaction without judgment. We are also more likely to realize when we have had enough and stop eating when we are satisfied rather than when we are over-full.
There is a misconception that healthy eating requires us to feel deprived. But mindful eating actually asks us to focus more on the pleasure of eating.
Mindful eating as a way of life
Unlike dieting mindful eating is sustainable. It is a way of life. When we eat mindfully, we increase both our happiness and our health as they relate to our eating. In this sense, mindful eating benefits both our mental and physical health.
Tips for eating mindfully
Sit down. If you eat while standing up or while on–the–go, chances are you are not paying attention to what you are putting in your mouth. It is important to sit down to eat a meal or snack, so we actually remember it.
Don’t multitask. Focus on your food, and your food only, during a meal or snack. Watching TV, checking emails, and even heated discussions will distract you from your food. Before you know it, your plate (or the chip bag) will be empty, leaving you wanting more. You’ll feel much more satisfied (sooner) if you give your food your undivided attention.
Savor each bite, one at a time. Put one bite of food into your mouth at a time. Take the time to taste that bite of food, and finish swallowing before taking your next bite. Slowing down helps your brain catch up to your stomach, thereby helping you sense your level of satisfaction sooner.
Put down your fork. Pause between each bite to allow yourself time to chew and taste your food.
Drink water. Having a sip of water between each bite may help you to slow down.
Try new foods. If you find yourself mindlessly eating the same foods over and over again, try mixing it up a little bit. When you try a new food, you are more likely to eat mindfully. You will experience new flavors and textures, which will help you pay more attention.
How to Navigate Emotional Eating
It’s been a long day and you’ve eaten well. Regardless, you find yourself looking for a snack but not quite sure why? One reason may have to do with food being medicinal. You might notice, albeit after the fact, that food temporarily soothes those feelings of anxiety, tension or other emotions you might not know what to do with – the act of procrastination being one of those.*
Things to ask yourself before reaching in the cabinet when not hungry:
- Were my meals balanced today? Was there protein and healthy fat at my meals?
- Or, have I been too rigid/restrictive and now I am craving sugar/fat/salty foods?
- Have I had enough water today?
- How am I feeling? Name the emotions. Am I stressed, lonely, upset?
- For females, is it getting close to that time of the month?
- Sleep: are your short on the Zzz’s? Aim for 7-9 hours.
- Is there some area of my life that seems out of control and so I am turning to food?
Ok, so what do you do now?
If mindless munching is a problem, plan some set snacks for yourself while studying make sure to portion out how much you’ll eat in order to avoid mindless eating.
When you do eat, sit at a table and use a plate or bowl instead of eating out of your hands or the bag to increase awareness.
If aiming for weight loss/weight management, reach for protein rich foods (string cheese, deli meat, Greek yogurt) after dinner to curb the cravings.
Make yourself some hot herbal tea or decaf coffee (milk and a bit of sugar or hot cocoa mix) to sip on while studying.
The Food-Mood Connection
Hunger alerts us to when we need to eat. If hunger is not something you are familiar with, take some time to try to identify symptoms associated with “eating time”. Have you noticed that you have a headache, feel light headed, harder time concentrating or maybe you hear you stomach growl.
Going too long without eating or limiting your intake may be contributing to anxious feelings. When you eat in this way, your blood sugar drops and this can literally make you feel shaky and nervous. If you ignore your hunger cues for too long your body will try to get your attention in a different way, causing an internal sense of unease.
We recommend eating within one hour of waking up (this does not have to be a large meal). Include a food higher in protein (eggs, yogurt, milk, nuts or nut butters) which will help stabilize blood sugar levels.
Eat regular meals throughout the day. Try not to go more than 4-5 hours without eating or blood sugars will begin to fall again.
Don’t restrict your carbohydrate intake
Limiting your intake of carbohydrates prevents efficient uptake of serotonin (the brain chemical or -neurotransmitter) which helps promote calming feelings.
Choose your carbohydrates wisely, whole grains, fruits, vegetables, dairy foods like milk and yogurt, as well as legumes are all healthy sources of carbohydrate.
Dehydration can contribute to anxious feelings and feeling anxious can contribute to dehydration, so be sure you are drinking plenty of fluids.
The “What to do instead of eating” List
(put it on your fridge/cabinet to remind you in times of desperation)
• Be OK to sit with your emotions. Use the emotions list on the right to help you identify your feelings.
• Get up and walk around. GO outside for some fresh air if possible.
• Workout and workup a sweat. Endorphins are released when you exercise and can soothe you in the same matter that foods does. (not more than once per day)
• Start a hobby or resume an old one
• Call a friend.
• Hug someone.
• Paint your nails or toes or both.
• Take a nap. Take a hot shower/bath.
• Make yourself laugh (Jimmy Fallon anybody?) Journal
• Cut yourself some slack. Sometimes it is necessary to call it quits for the night and go to bed, or skip your workout if it is going to make your more stressed and lead to compensatory eating later in the evening.
• Set a timer for 20 min before reaching for food. If you are still hungry, have a portioned amount (in a bowl, on plate, while seated).
List of Emotions
Demeaned Disappointed Discouraged
Manipulated Misunderstood Neglected
Oppressed Overburdened Overwhelmed
* Emotional eating can be a sign of a bigger problem. Resources are available for you at Duke including CAPS 919-660-1000 and Duke Student Health 919-681-9355
Given all the news about our cholesterol, and needing to lower it, one would think that we shouldn't have any. However, that's not true at all. Our bodies require cholesterol. Cholesterol is needed for the production of hormones and important for maintaining healthy cell membranes. High cholesterol may be the result of an elevated LDL ("bad cholesterol") or elevated HDL ("good cholesterol") or a combination of both. High triglycerides, along with elevated cholesterol may increase your risk of heart disease.
- LDL (low density lipoprotein) transports cholesterol throughout the body. In high amounts, LDL deposits cholesterol on the walls of arteries. This contributes to plaque formation, which narrows arteries and can interfere with blood flow.
- HDL (high density lipoprotein) carries excess cholesterol back to the liver, where it can be degraded. This is why low levels of HDL increase risk of heart disease and high HDL is considered protective. Smoking significantly decreases your HDL, thereby increasing your risk of heart disease.
- The fat we eat travels through our bloodstream as triglycerides. Triglycerides can be used by cells as energy or stored in the body as fat. High triglycerides may contribute to thickening and hardening of arteries.
There are several factors that contribute to high total cholesterol, including genetics. The good news is you can help to lower your cholesterol by what you do and what you eat!
What you do:
Get enough sleep!
Inadequate sleep can alter your hunger, food preferences and weight! Getting enough sleep is a lifestyle change that can help to improve your cholesterol.
Physical activity is not just about weight loss. Remaining active has a host of benefits that protect our heart health. Exercise improves circulation, blood flow and mood. Exercise can also increase your HDL (“good” cholesterol) and reduce your triglycerides.
What you eat:
For many years, the thought was that saturated fat was the worst nutrient for cholesterol. The truth is: saturated fats and cholesterol that we eat may not directly impact or increase our cholesterol levels. Refined carbohydrates and sugar are actually more harmful. Here’s how you can improve your diet and total cholesterol.
Quality not quantity.
Focus on an overall healthful diet pattern that is higher in fruits, vegetables and healthy fats, and lower in refined sugars and processed foods.
What about fats?
Fats can be saturated, unsaturated or trans. These all refer to their chemical structure, but there are easy ways to differentiate between fats.
- Saturated fats are usually solid at room temperature - think butter or lard. Research shows that saturated fats are actually neutral when it comes to heart health, and do not directly increase total cholesterol.
- Unsaturated fats are usually liquid at room temperature - think oils, like olive oil, canola oil and peanut oil. These are the healthiest fats.
- Trans fats are made as a result of the chemical processing of food. They increase LDL - so you should avoid these! (Trans fat is also naturally found in dairy, but these are not of concern.) Trans fats in products like margarine, vegetable shortening or pastries should be avoided.
Which fats are healthy?
All fats are healthy but watch for a nice balance of these. Unsaturated fats(which include the Omega 3 fats) are protective when it comes to heart health. You can incorporate these by having more of your fat intake come from plant based oils (e.g. olive oil, canola oil), other plant based sources include walnuts, chia seeds, or Brussel sprouts. Sources from fish include salmon, mackerel, albacore tuna, sardines.
What can’t I eat?
Remember - quality not quantity. Focus on increasing your whole grains, vegetables, beans, cheese and yogurt. The foods you should reduce include sugars, processed meats (e.g. bacon, hot dogs, smoked or cured red meats) and high sodium foods (e.g. canned foods, chips, frozen foods and entrees).
Focus on these:
Moderation with these:
(e.g. bacon, sausage, ham)
High sodium foods
(e.g. canned foods, chips, frozen foods and entrees)
(e.g. white breads and flours, white rice)
(e.g. soda, candy, and pastries)
What Can Cause Fatigue?
When asked about fatigue, most people might think of not getting enough sleep. Although adequate sleep is absolutely instrumental in ensuring optimal energy levels, there are other factors that might contribute to fatigue as well.
Hydration, Hydration, Hydration
Fatigue can be a symptom of dehydration. Since our bodies are made up of mostly water, and we have no way to “store” water, remind yourself that you’ll need plenty of fluids to feel your best. If exercising outdoors, take into consideration the elements. heat, humidity and length of time exposed to the sun and cold, all of which increase your need for fluids. Fluid needs will vary greatly from one person to the next, but for most 6-8 eight ounces glasses is a good start. Although fluid tolerance depends on many things, well hydrated individuals do find that they have to pee at least 2-3 times per day and have almost clear to pale yellow colored urine. If you find that you need to go less often, perhaps you are somewhat dehydrated.
Vitamin/Mineral Deficiencyor Other Medical Condition
Chronic fatigue that does not seem togo away regardless of how much you sleep, should be evaluated by your health care provider. Schedule an appointment with a clinician at Student Health to rule out the possibility of avitamin/mineral deficiency, such as iron, or other health issue. More often than not there is an easy fix.
You Aren’t Eating Enough
• If you are working out, make sure that you are giving your body enough fuel to do so. Sometimes we forget that when we ask the body to do more, we need to give it “slightly” more energy.
• If you’re trying to lose weight, make sure you haven’t decreased your intake too much, resulting in an overly slowed metabolism, and make you feel sluggish. If you are making changes to your diet check in with a Student Health Dietitian for the best recommendations. Although any decrease in eating can lower your metabolism, cutting back too much, can stall the metabolism.
Too Many Sugary Carbohydrates
Simple sugars are broken down and stored very quickly. Consumption of a lot sweets (especially on an empty stomach or in place of meals) i.e. chocolate, Swedish fish, gummy bears, bin candy, and cookies can cause a very rapid rise in blood sugar. Consumption of a lot of refined flours; pizza, bread, muffins, donuts etc. may have the same effect. The immediate response is a feeling of energy. However, within an hour, this feeling is often replaced with fatigue, as the blood sugar has been effectively stored by that time. You may wish to consider setting up an appointment with one of the dietitians at Student Health to help you develop strategies for eating for sustained energy.
Not Enough Sleep
• As much as you may not be able to get 8 hours per night, do the best you can to get at least 7 hours whenever possible.
• Insure the quality of your sleep. Try not to eat or drink alcohol within 2 hours before going to bed. Don’t workout before going to bed since exercise can make you feel energetic, which is not what you want if you’re trying to sleep. It’s best to limit caffeine to before lunch.
• Don’t use food to give you energy when lack of sleep is the problem. Often, people eat to help them stay awake, which doesn’t work. Try to listen to what your body is asking for and get some rest.
If it’s more than feeling tired - accompanied by sadness, loss of appetite or lack of motivation, you may be suffering from some depressive symptoms. Contact Counseling and Psychological Services (CAPS) for a meeting to help assess what might be going on.
Sometimes stress can be a good thing. It can help motivate us to get a job done. However, stress shouldn’t be ongoing or overwhelming. At those times, stress can be exhausting. When the prospect of getting anything done seems so overwhelming that you can’t get anything done, then things have gotten out of control. Is it because you are the type to say “yes” to everything? You need to assess your priorities and learn to say “no.” This will help decrease your stress considerably. Saying “no” does not mean that you don’t care or that you are letting someone down. It simply means that you don’t have the time right now. It’s important to respect your own limits and take care of yourself. This can be energizing in and of itself.
For help with stress management contact CAPS (Counseling and Psychological Services) or DuWell (Duke Wellness Center)
Inadequate Time For Recovering From injury
One mistake that many people can make, is trying to get into a normal routine too quickly after recovering from surgery, illness or injury. The body takes time to heal, so don’t be too quick to rush back. This can increase the feelings of fatigue and make the recovery process longer.
What is Fiber?
Dietary fiber is the non-digestible part of plants that form the support structures of leaves, stems, and seeds. Dietary fiber is found in minimally processed fruits, vegetables, legumes, and whole grain products. There are two types of fiber: soluble and insoluble. Both are important to overall health, and most fiber-rich foods contain a mixture of both, although they are not usually differentiated on food labels. Dietary Fiber plus Functional Fiber equals Total Fiber, as listed on a Nutrition Facts food label.
The recommended daily amount of fiber is 25 grams for women and 38 grams for men. After age 50, your daily fiber needs drop to 21 grams for women and 30 grams for men.
Benefits of a High Fiber Diet:
• May help decrease cholesterol levels.
• Stabilizes insulin and blood sugar levels.
• Increases feeling of fullness, which may help with weight management.
• Bulks stools and improves stool motility, promoting regular bowel movements (when consumed with enough fluid).
• Provides vitamins, minerals and other healthy, disease-fighting nutrients called phytochemicals.
• Decreases risk of colon cancer, Type 2 diabetes, and heart disease.
What about Fiber supplements?
Fiber rich foods include whole grains, fruits, and vegetables, which also are high in vitamins, minerals, and phytochemicals. Ideally, one should strive to get adequate amounts of fiber from food. However, physiological limitations may limit the quantity of food one can eat. Over-the-counter, natural fiber supplements can be used when the diet is not providing enough fiber. These supplements do not cause any type of dependency, the way prescription or stimulant laxatives can.
How do I increase fiber in my diet?
• Increase fiber in your diet slowly to avoid stomach discomfort.
• Make half your grains whole grains.
• Try to eat fruit and /or vegetables with each meal and snack.
• Choose foods with at least 3 grams of fiber per serving.
• Increase fiber in meat dishes by adding beans and vegetables.
• Add fiber to dairy products by adding fruit, nuts, seeds, or cereal to yogurt.
• Choose raw fruits and vegetables over juice and canned fruits
Good Sources of Fiber:
Food / Amount / Fiber (grams)
Apple w/skin / 1 medium / 4
Avocado / 1/2 / 9
Banana / 1 medium / 2
Pear with skin / Large / 7
Strawberries / 1 cup whole / 3
Blueberries / 1 cup / 4
Dried Figs / 2 / 4
Dried prunes / 4 / 4
Orange / 1 medium / 3
Raspberries / 1 cup / 8
Baked Sweet potato w/skin / 1/2 medium / 2
Cooked Spinach or other cooked leafy greens / 1 cup / 4-5
Raw carrots / 1 medium / 2
Broccoli, Cauliflower or Brussels Sprouts, cooked / 1 cup / 5-6
Brown Rice / 1/2 cup / 2
Bran (wheat or oat) / 1oz / 12
Whole Wheat Bread / 1 slice / 5-6
Whole grains (barley, quinoa) / 1 cup / 3
Oatmeal / 3/4 cup / 3
Beans/legumes (in general) / 1 cup / 14
Bran cereal / 1 cup / 10-14
Garbanzo beans / 1 cup / 11
Add Pasta(whole wheat) / 1cup / 6
Lentils / 1 cup / 11-14
Breakfast cereal / Look for minimum of 5g/serving
Almonds / 1oz / 4
Surviving the Cold & Flu Season
Worried that you’ll get sick? Strengthen your immune system with a little self care: Balanced eating, regular sleep, physical activity, and stress reduction can help keep you on the right track.
Balance Your Plate
• Keep your gut bacteria healthy! Think of those “bugs” as natural barriers to and fighters of infection. Feed them well by including lots of whole grains, veggies, fruit and some fermented foods (think Yogurt, Kim Chee, Kefir, Sauerkraut, Tempeh).http://ow.ly/GMmq300zMJ0
• Fruits and vegetables also provide: vitamins, minerals, phytochemicals and antioxidants that work together to keep you healthy and fight disease and infection.
• Don’t forget the Omega-3 fatty acids that are found in fish, nuts and flax seed oil which help stimulate immune activity of our white blood cells. These little guys literally eat up germs!
Catch Some Zzzzs
• Getting adequate sleep (7-9 hours per night) improves your immune system and decreases your susceptibility to contagious illness like colds and flu.
• Did you know that regular, moderate intensity exercise and a well balanced diet makes us less susceptible to upper respiratory infections and colds?
• Exercise is also a great way to relieve stress! 30-60 minutes on 4-6 days of the week is plenty. If you over exercise both in frequency and intensity, you’re likely to become fatigued and MORE vulnerable to bacteria and illness.
• If you’re getting sick, don’t exercise – let your body rest.
Wash Your Hands
• This is the most important thing you can do to prevent getting sick. Make sure to wash your hands after using the bathroom or sneezing and before meals.
• Use hand sanitizer if your hands aren’t visibly dirty. If you can see the dirt, it’s best to wash those germs down the sink with soap and water.
Lessen Your Stress
• When you’re stressed out you may find that you sleep less and eat poorly, which can ultimately lead to fatigue and illness. Address your stress when it happens. Find ways to relax that work for you and take time for your self.
Getting sick is never fun, but if you do get sick take time to relax and recover. Make taking care of yourself a priority and you may lessen the severity of your illness or avoid getting sick all together!
And, if you do get sick, take the time to rest and recover otherwise you’ll just be sick longer.
FODMAPs are carbohydrates (sugars) found in foods that can be poorly absorbed in the intestines leading to gas, bloating, diarrhea, and constipation. A low FODMAP diet may be useful in management of irritable bowel disease.
This type of diet can be difficult to follow if you are unable to cook your own food. Make sure to consult with a Registered Dietitian Nutritionist (RDN) to help plan nutritionally balanced meals/snacks while following a low FODMAP diet.
There are many other nutrition factors to pay attention to before beginning a low FODMAP diet. An RDN can help tease out this information and make finding a solution to your gastrointestinal complaints a little easier.
How do I follow a low FODMAP diet?
FODMAP intolerance is about the “dose” of food. Unlike celiac disease, where gluten can no longer be consumed because of an autoimmune response, many individuals can tolerate some or all FODMAPs in different quantities.
Typically one removes all FODMAPs foods, from the diet, for 4-6 weeks to see if symptoms improve. Because this can be quite challenging, we suggest starting with removing the more obvious perpetrators such as dairy, broccoli, cauliflower and some of the higher fiber vegetables. If symptoms improve, nothing else needs to be done. If not, more foods would need to be eliminates.
A low FODMAP diet is not nutritionally adequate and is not intended to be followed for a long period of time.
• Have you been tested for celiac disease or other gastrointestinal disorders? If these tests were negative try to eliminate all FODMAPs for 4-6 weeks using the food lists provided on the back of this sheet.
• Systematically add FODMAPs back into your diet one group at a time over one week in order to test for sensitivity and monitor symptoms.
• At the end of the food-challenge phase, you will have your list of “safe foods” that will likely include some but not all of the FODMAPs in varying quantities.
Foods Suitable on a Low FODMAP Diet
• Banana, blueberry, boysenberry, cantaloupe, cranberry, durian, grape, grapefruit, honeydew melon, kiwifruit, lemon, lime, mandarinorange, passion fruit, pawpaw, raspberry, rhubarb, star anise, strawberry, tangelo
• Note: if fruit is dried, eat in small quantities
• Alfalfa, bamboo shoots, bean shoots, Bok Choy, carrot, celery, choko, Choy sum, endive, ginger, green beans, lettuce, olives, parsnips, potato, pumpkin, red capsicum (bell pepper), silver beet, spinach, squash, swede, sweet potato, taro, tomato, turnip, yam, zucchini
• Herbs: basil, chili, coriander, ginger, lemongrass, marjoram, mint, oregano, parsley, rosemary, thyme
• Gluten-free bread cereal products
• Bread: 100% spelt bread
• Other: arrowroot, millet, psyllium, quinoa, sorghum, tapioca
• Milk: lactose-free milk, oat milk, rice milk, soy milk (check for additives)
• Cheeses: hard cheese, brie, camembert
• Yogurt: lactose-free varieties
• Ice-cream substitutes: gelato, sorbet
• Butter substitutes: olive oil
• Sweeteners: sugar/sucrose (in small quantities), glucose, artificial sweeteners not ending in ‘-ol’
• Honey substitutes: golden or maple syrup (in small quantities), molasses and treacle
Elimination: Foods Containing FODMAPs
• Fruit: apple, mango, Asian pear, pear, canned fruit in natural juice, watermelon
• Sweeteners: fructose, high fructose corn syrup
• Large total fructose dose: concentrated fruit sources, large servings of fruit, dried fruit, fruit juice
• Honey: corn syrup, fruisana
• Milk: cow milk, goat milk, sheep milk, custard, ice cream, yogurt
• Vegetables: artichoke, asparagus, beetroot, broccoli, Brussels sprouts, cabbage, eggplant, fennel, garlic, leek, okra, onion (all), shallots, spring onion
• Cereals: wheat and rye in large amounts. Ex: bread, crackers, cookies, couscous, pasta
• Fruit: custard apple, persimmon, watermelon
• Miscellaneous: chicory, dandelion, inulin, pistachio
• Legumes: baked beans, chickpeas, kidney beans, black beans, lentils, soy beans
• Fruit: apple, apricot, avocado, blackberry, cherry, longon, lychee, Asian pear, nectarine, peach, pear, plum, prune, watermelon
• Vegetables: cauliflower, green capsicum (bell pepper), mushroom, sweet corn
• Sweeteners: sorbitol (420), mannitol (421), isomalt (953), maltitol (965), xylitol (967)
Adopted from IBS Self Help and Support Group
A Duke Student’s Guide to Gluten Friendly Dining at Duke
Think it’s difficult to find gluten-friendly options on campus? Think again! As a student following a Gluten Free dairy free diet I have found that there are a variety of nutritious and delicious options at many Duke Dining locations.
Duke Dining does its best to insure that cross-contact of gluten-containing ingredients are limited. Additionally they provide extensive training on allergen safe food preparation and service to all of our employees.
While there are no certified gluten-free dining establishments, they make every effort to insure that your food is prepared in ways that minimize the risk of cross contact.
I have found that the following food options are safe for gluten-sensitive individuals. These items are made without gluten-containing ingredients.
I strongly encourage you to communicate with the chef, manager and server when ordering so that they can take the necessary precautions when preparing and serving your food.
Bella Union & Dolce Vita
• Garden Salad
• Cobb Salad
• Fresh Fruit
• Mixed Berries
• Chickpea Edamame
• Tomato Mozzarella
• Black Bean Salad
• Mango Salsa
• Gluten Friendly Buckwheat Crepes
• Turkey Havarti Panini
• Roasted Potato Salad
• Chicken Salad
• Tuna Salad
• Kale Caesar Salad
• Beet and Goat Cheese Salad
• Garden Salad
• Garden Chicken Salad
• Roasted Vegetable
• Grilled Chicken Garden
• Tuna Garden Salad
• Salmon Garden Salad
• Chicken Caesar Salad
• Gluten-Friendly Pancakes (add chocolate chips, bananas, strawberries, or blueberries)
• Eggs Your Way (sub gluten-free toast)
• Chicken Tikka Masala
• Grilled Chicken Sandwich ( On Gluten-Free Bun)
• Garden of Edens Salad
Café De Novo
• Chicken Pita request gluten-free Bread
• Chicken, Egg, Tuna Salad Platter (replace baguette crisp w/ GF toast)
The Devil’s Krafthouse
• Sweet Potato Tots
• Chicken Tenders
• Nachos (chicken or beef)
• Tortilla Chips and Salsa/Queso Dip
• French Fries
• Southwest Chopped Salad
• Caesar Salad
• Greek Salad
• Grilled Cheese Sandwich (ask for GF bread)
• All meats
• Cottage Cheese
• Curried Carrots
• Egg Casserole
• Fruit Salad/Whole Fruit
• Garden Salad
• Hardboiled Egg
• Home Fries
• Lentil Soup
• Lentil Stew
• Tomato Basil Soup
• Veggie Curry
• Veggie Soup
• Veggie Stew
• Basil Chicken Pesto Pasta (w/ Gluten Free Noodles)
• Gluten-Free Spaghetti and Meatballs (w/o Meatballs)
• Customize Your Own Mini Pizza (w/ Gluten Free Crust)
• Roasted Chicken
• BBQ Chicken
• BBQ Ribs
• Lamo Salto
• Jerk Chicken
• Pernil Pork
• Turkey Pozole Soup
• Beef Stew
• Chicken-Lime Soup
• Kimchi Slaw
• Green Beans/Tomatoes
• Creamed Corn
• Maple-Roasted Brussel Sprouts
• Jasmine Rice
• Buttermilk Mashed Potatoes
Joe Van Gogh
• Yogurt And Granola
• Chocolate Truffle Cookie
• Coconut Macaroon
• Big Spoon Bars
• Taos Bars
• Jp’s Pastries
• Fruit Parfaits
• Traditional and Build-Your-Own Pizza Pies (w/ Gluten Free Crust)
• Steamed Broccoli
• Homemade Chili
• Chicken, Kale, & Sweet Potato Soup
• Santa Fe Black Bean Soup
• Hot Lava Cake
• Pesto Chicken Ciabatta with Gluten Free Bread instead
• Feta Mediterranean Salad without croutons
• Garden salad without croutons
• Goat cheese salad without croutons
• Walnut Gorgonzola Salad without croutons
• Grilled Chicken or Cajun Grilled Chicken
• Grilled or Cajun Salmon
• Grilled or Cajun Whitefish
• Sauteed or Cajun Shrimp
• Scoop of Chicken Salad
• Grilled Portabello
• Grilled Hamburger
• Any of these items can be made into a sandwich with gluten free Bread
All items on the Sitar Indian Cuisine menu are gluten-friendly except for the Naan and the Samosas.
• Strawberry Banana
• Tropical Pineapple
• Tropical Mango
• Berry Banana
• Peach Popper
• Strawberry Sonata
• Mango Melody
• Berry Medley Hibiscus
• Coffee Chillers
• Strawberry Energizer
• Pomegranate Protector
• Super Berry Flower Power
• Super PB Cup
• Simple Green
• Citrus Mango Greens
• Mango Berry Remix
• Smooth Berry Swirl
• Pineapple Point
• Mango Melange
• Peach Perfect
• Peach On The Beach
• Raspberry Jammin
• Tropical Acai Blues
• Strawberry Swag
• Mango Mojo
• Acai-Blueberry Blast
• Mango Metabolizer
• PB&J Hunger Zero
• Vegan Green
• Apple Ginger Kale
*all yogurt flavors are gluten-free with the exception of:
• NY Cheesecake
• Banana Cream Pie
• Slam Dunk
• Cake Batter
• Mint Cookie
• Pumpkin Pie
• Red Velvet
Saladelia Cafe at Perkins and Sanford
• GF Turkey Havarti
• Beet Salad
• Andean Black Bean
• Chicken Salad
• Green Beans
• Mediterranean Eggplant
• Mozzarella Tomato
• Quinoa Salad
• Red Pepper Hummus
• Roasted Vegetable
• S. West Beans and Rice
• Albacore Tuna Salad
• Chicken Caesar Salad
• Beet and Goat Cheese Salad
• Garden Salad
• Garden Chicken Salad
• Greek Salad
• Grilled Chicken Garden
• Tuna Garden Salad
• Salmon Garden Salad
• Grilled Salmon Steak
• Country Ham
• Collard Greens
• Green Beans
• Potato Salad
• Baked Polenta
• Potato Gratin
• Shepard’s Pie
• Chick Pea Stew
• Smoked Cauliflower Steaks
• Baked Sweet Potato
• Roasted Cauliflower Salad
• Grilled Local Squash Salad
• Avocado Salad
• Local Watermelon Salad
• Black Eyed Peas
• Smoked Sweet Potato Salad
• Hummus Salad
• Baba Ganoush
• Assorted Fresh Fruit
• Winter Kale Salad
• Mixed Greens Salad
• Spinach Salad
• Wild Salmon Bowl
• Tex Mex Bowl
• Quinoa Bowl
• Chicken Avocado BLT
• Blue Devil Club
• Turkey and Chipotle Gouda
• TK Chicken Salad
• Any of these items can be made into a sandwich with gluten free bread
• Chef Salad
• Cobb Salad
• Spinach and Goat Cheese Salad
• Tuna Over Tomato
• Mediterranean Salad with Chicken
• Fresh Fruit Salad
• Greek Salad
• Chic Pea Salad
• Gluten-Friendly Brownie
• Any sandwich on regular menu can be made with gluten free bread
Other venues will have gluten friendly options as well and many menu items can be made without gluten containing ingredients, ask a chef or manager.
Menus may be subject to change – ask a chef or manager if you have questions
Balanced Eating at Duke
If you are a college freshman, living on your own and making all of your own decisions about the food you eat may be a new experience for you. Fortunately here at Duke you have a wide variety of nutritious and delicious options available to you.
Here are some basic guidelines to help you get started.
Become familiar with available dining options. Check out the dining website (https://studentaffairs.duke.edu/dining) where cafes on campus post menus and information about the foods they serve.
Don’t skip meals.
Your schedule may seem impossibly busy and you may be tempted to sleep in or skip lunch—DON’T! Not only does your body need fuel but so does your brain; studies show that students who skip breakfast don’t perform as well academically. Additionally skipping meals is likely to lead to over eating later in the day. So if you can’t make a meal, look for balanced “grab and go” options available at many cafes on campus or keep a supply of healthy snacks handy in your room and carry some along with you.
Balanced Snack Ideas:
• Cereal and milk − aim for a cereal with at least 3 grams of fiber and a few grams of protein per serving. Top with some nuts or seeds for a boost of protein and healthy fat.
• Instant oatmeal − Ideally plain and add your own fruit and nuts/seeds.
• Peanut butter and whole grain crackers
• Granola bar − aim for one that has some protein and fiber to keep you satisfied longer (a good rule of thumb is at least 5 grams of protein and 3 grams of fiber). Choose chocolate covered bars less often, and ideally not at breakfast.
• Hummus and veggies or whole grain crackers
• String cheese and fruit
• Yogurt and granola
• Nuts and dried fruit or fresh fruit
• Trail mix − ideally make your own, store bought versions can be high in salt and added sugars depending on what’s in them.
Balance Your Plate at Meals.
Have a serving of good quality protein (eggs, tofu, meat, poultry, dairy, beans or fish), some fruit and/or veggies and a grain. Balancing your plate will keep your meals and snacks nutritious and your weight in the right range for you. For more information: http://ow.ly/vDYf300wXu6
Become Familiar with the Layout of your Café.
Know what is typically available at the various stations and mix and match to make a balanced meal you will enjoy eating. For example say you want the grilled chicken from the grill but don’t want a bun - you can take your plate to the stir fry station and get some brown rice and veggies to create a balanced plate.
Vegetarian or Vegan?
The majority of campus cafes offers a very good variety of vegetarian and vegan options. At the Marketplace you will find an entire hot line which offers both a vegetarian and vegan option at all meals.
Special Dietary Needs.
Let a manager at your café know. Most special dietary needs can be managed by talking to the manager. You can contact Toni Apadula RDN, LDN, CEDRD at 919-613-1218 if you have concerns.
Late Night Eating.
Don’t deny yourself food if you are craving it, but don’t over do it either. Balanced eating is about being flexible and enjoying all the foods you love in moderation. It is okay to eat a piece or two of pizza at night or a small serving of dessert once in awhile, but for the most part try to opt for a balanced snack that includes some protein, like those previously listed.
You can always opt to speak with one of your Student Health Dietitians if you find you still have questions. Call 919-681-9355 to set up a free consultation.
Acid Reflux - Heart Burn
Acid reflux is the term used to describe stomach acid entering the esophagus, which may or may not cause a burning sensation in the middle of the chest behind the breast bone. If it burns, it is refered to as “heart burn”. Some people are more prone to this than others, in particular individuals that may produce more stomach acid. Untreated, this can cause erosion of the esophageal tissue, which can be problematic. Stress can trigger the release of more stomach acid so you may notice it more during those times.
In addition, the following foods or behaviors may trigger these uncomfortable events.
• Citrus foods or drinks
• Acidic foods such as vinegar, tomatoes, tomato sauce, and spicy foods
• Fried foods
• Large meals – a very full stomach
• Lying flat after eating
• Chewing gum – in particular peppermint (not just in gum)
• Aspirin or aspirin containing products such as Pepto Bismal™ - which is often taken to help reduce stomach acid
• Motrin™ or Ibuprofen based medications
If “heart burn” is occasional and felt mostly when consuming these foods, limit consumption of these foods. Also try to eat small, well balanced meals rather than larger meals. If laying down after eating, make sure to prop up the upper body slightly so as not to lay flat and, if possible, try to allow a good hour to digest your food before laying down.
Over-the-counter medications such as TUMS™ (calcium carbonate) will help neutralize the acid and give relatively quick relief. You may also wish to try Mylanta™, or its generic counterpart – which is a liquid containing magnesium, that helps coat the esophagus and stomach and also provides relief.
If heart burn is more regular, on a daily basis, then you may wish to consult with your medical provider to see if you are better suited for medications that might have a longer impact. Some signs of regular acid reflux are a regular dry cough when you a aren’t sick or feeling as though you need to clear your throat often.
Given that stress can really trigger acid release, learning to manage stress can be incredibly helpful. You may choose to consult with someone in Wellness or CAPS to discuss stress management.
How to Help a Friend
Be Mindful of Time and Space
When you sit down to share your concerns make sure you are not rushing; leave plenty of time to talk or just to be with one another. Also consider timing; if emotions are running high for either of you (ie you just had an argument) it wouldn’t be a good time to have this talk. You want to be sure to make this a meaningful and productive conversation.
Be mindful of space. Find a quiet, safe space without a lot of distractions.
Be Honest and Compassionate
Be straight forward and honest but empathic as well. This can be a tricky balance to find. One way you can do this is by relying on this tool:
Make an observation, express your concern and ask a question.
Make an objective observation - (this is not an accusation or an assumption) “I’ve noticed that you seem really tired a lot”, or “We miss you on Thursday nights for our dinner, you never seem to be able to make it anymore” or note observable physical changes
Express Your Concerns - “I’m worried that you are not taking care of yourself” or if you know the person or know about previous struggles they may have had you can be straight forward “I’m concerned you may be struggling with eating issues”- use this only if you know the person pretty well.
Ask a Question – this makes it a dialogue and puts the ball in their court so they can be heard too.
“I have noticed you are losing weight, I am concerned about you, how can I help?”
“I have noticed you are going to the bathroom after every meal, I am worried you may be sick, can you help me understand what’s going on?”
(If you know the person well and you know they have struggled you could come out and say) “I have noticed you are going to the bathroom after every meal. I am worried you may be purging (or relapsing), can you help me understand what is going on?”
Barriers to Getting Help
Shame and Stigma - Individuals struggling with eating disorders carry a tremendous amount of shame and self-blame. They know that what they are doing is not “logical” or “healthy” but cannot make themselves stop and are therefore ashamed of their behavior. They often, also feel that it’s “their” problem and don’t reach out for help. Eating disorders thrive in isolation.
Studies show that people with eating disorders are likely to be blamed for their disorder or it may be seen as attention seeking. It’s important to know that an eating disorder is not a lifestyle choice
They may be concerned that they will be asked to leave school – which may be the case at times, depending on the severity of their illness, but there are also other options.
They may lack insight. They might not see their behavior as problematic or they may minimize the problem
Come prepared with a plan - Know where you can go to get them help on campus. You have asked how you can help and they may not know. If you have a plan in place you can say - “You can talk to someone at CAPS, here’s how you can contact them. I will go with you or make the call if you like.”
Things to Remember
• They may not want to talk or they may deny there is a problem.
• They will likely be unhappy with this conversation and can become angry at your implication.
• They may avoid you in the future as they are worried that you might be “on to them”.
• You are not alone, you can ask for help. Let them know that you are so concerned that you are going to let someone else know (your RC or Duke Reach) - this is not a threat it’s done compassionately and for the right reasons.
• Take care of yourself! Ask for help!
• Counseling and Psychological Services 919-660-1000
• Duke Reach 919-681-2455 email@example.com https://studentaffairs.duke.edu/dukereach1
• Duke Student Health 919-681-9355
• Duke Student Health Nutrition Services 919-613-1218 or 919- 613-7486
• Women’s Center 919-684-3897
Happy Holiday Eating Tips
Don’t Party Hungry
Eat a light balanced snack such as fruit and yogurt, cereal and milk, soup, or half sandwich about an hour before heading out to a party.
Navigate the Buffet
Fill your plate with half veggies and fruits, add lean proteins such as seafood and lean meats or poultry. Choose smaller portions of pastas and breads. Once you have filled your plate move away from the buffet table and enjoy some conversation.
Balance Your Plate
Don’t try to cut out the holiday treats— choose small portions and balance your plate with fruit and vegetables.
Don’t Avoid Your Holiday Favorites
Enjoy your favorite holiday foods by eating slowly and savoring these special treats. An occasional indulgence won’t hurt if you don’t let it become a pattern at every meal.
Moderation with Alcohol
Remember that alcohol supplies a significant number of calories—go easy on eggnog, beer, mixed drinks, punches etc. In addition, it can lower our resolve to moderate our eating. If you choose to drink, drink slowly and alternate with a non alcoholic drink. Never drink and drive—always designate a driver.
Don’t skip meals early in the day in anticipation of what you may eat later; hunger and alcohol guarantee an overeating experience.
Even when things get hectic, take time for yourself to move your body daily.Try to exercise in the morning before events of the day and time get the better of you.
We all love the holiday season and being around family and friends, but sometimes this can get stressful. Try not to comfort yourself with food, look for other ways to manage stress; take a walk, phone a friend or just find a quiet place to be for a few minutes.
Holidays are about friends, family and good food. Remember these tips, but don’t over think food—focus on the conversation and time spent with loved ones.
Irritable Bowel Syndrome
Irritable Bowel Syndrome (IBS) is a disorder of the gastrointestinal tract that causes a variety of abdominal symptoms including; gas, bloating, cramping, diarrhea and/or constipation, and change in bowel habits. It usually occurs in people under the age of 45. Most people can relate the onset of their IBS to major life stressors or changes such as: academic pressures, moving or starting a new school, death of a loved one, etc. Some people first notice their symptoms after abdominal surgery or shortly after recovering from a gastrointestinal infection. Certain foods may also trigger onset of symptoms for an individual who is sensitive (sensitivity to foods varies from individual to individual).
What is the Cause of IBS?
The cause is unknown, but stress, abnormal contraction of the intestines and diet may all be contributory.
If you are experiencing any of the above symptoms, check with your physician to rule out any other problems and for a definitive diagnosis.
How is IBS Treated?
IBS is generally best managed through a combination of lifestyle changes which include stress reduction and medication. Treatment is based upon the severity of symptoms and the individual’s response.
Stress Reduction may include: medication, massage therapy, yoga, relaxation therapy and cognitive behavioral therapy (CBT) (see a CAPS counselor for more information on CBT and stress management).
- Eating small frequent meals, chewing your food well and eating in a relaxed environment will help aid in digestion.
- Eat slowly so that you avoid swallowing a lot of air which can increase the bloated/gassy feeling.
- To prevent constipation and stimulate development of healthy microbiota (good bacteria) in the gut, include fiber from a variety of natural sources including fruits, vegetables, whole grains, oats and beans. The goal is roughly 25-30 grams of fiber per day. Increase fiber intake slowly to avoid abdominal discomfort.
- Drink more fluids to help combat constipation.
- Avoid any food that irritates or causes gas.
- If you are lactose intolerant, avoid standard milk products; look for Lactaid products or use Lactaid caplets or drops with dairy.
- Individuals will vary according to their tolerance of one food over another, but some find caffeine, fat, alcoholic beverages, spicy foods, foods with added fiber like chicory or inulin and sorbitol (and other sugar alcohols found in lite foods)—worsen symptoms.
- Regular exercise helps relieve stress and stimulates normal contraction of your gastrointestinal tract.
- Some may find that following a low FODMAP diet for a short period of time helps with symptoms. We do not recommend that you follow this type of diet unless you are under the care of a doctor or dietitian.*
Medications, if indicated, will be managed by your healthcare provider.
They may include
- Antidiarrheal medication for the treatment of diarrhea predominant symptoms.
- Antispasmodic medication for the treatment of gas and bloating.
- Antidepressant medication which is used to treat pain and bloating.
- Ask your health care provider if a FODMAP diet is appropriate for you.
The body needs iron to carry oxygen through your bloodstream to give you energy. If you don’t have enough iron in your diet you may feel weak or fatigued because oxygen cannot reach your tissues and organs at the rate you demand energy.
The most common causes of iron deficiency are:
Blood loss - When you lose blood you lose iron as well. If you don’t have enough iron stored to make up for the loss deficiency occurs.
Poor diet - When you don’t regularly eat foods that are high in iron (or are fortified with iron), and you don’t take an iron supplement, you’re more likely to develop iron-deficiency anemia. People following vegetarian or vegan diets are at greater risk for iron deficiency anemia. Needs are also higher for those who regularly perform vigorous activity and in times of rapid growth such as adolescence and pregnancy.
Inability to absorb enough iron -
Even if you have enough iron in your diet, your body may not be able to absorb it. Only about 10-15% of the iron consumed is actually absorbed. The RDA accounts for the low rate of absorption. Causes of poor absorption include: disease of the GI tract, gastric surgery, taking too many antacids.
How much iron do I need?
Recommended daily amount (RDA) of iron:
Men: 10 mg
Women: 15 mg
Signs of Iron Deficiency:
Anemia, fatigue, paleness of the skin, headaches, brittle nails decreased immunity, and decreased intellectual and/or physical performance.
Iron poisoning can occur if large amounts are ingested in a short period of time. Iron toxicity can cause damage to organs, and even death in young children.
What about iron supplements?
While it is preferable to meet iron needs through dietary intake, there are cases where it may be necessary to take a supplement. Before starting an iron supplement, consider a multivitamin that contains the necessary amount of iron. Schedule an appointment with a provider to assess whether this is sufficient or if you need to move to an iron supplement. If there has been a deficiency diagnosed, supplements can be in pill or liquid form. Iron supplements can cause nausea, when taken on an empty stomach, and/or constipation.
Two Types of Iron:
• Heme iron is found in meat, poultry, and fish. Heme iron is easier for your body to absorb than non-heme iron.
• Non-heme iron is more easily absorbed when consumed with a vitamin C source such as non-calcium fortified fruit juices, dark greens, kiwi, bell pepper, strawberries, citrus fruits and tomato products or with an iron rich animal source. Some foods; bran, coffee, milk, and tea, can hinder iron absorption when consumed at the same time as the iron rich food.
Good Sources of Iron:
Food / Serving Size / Iron Content (mg.)
Heme Iron Sources
Beef Liver / 3 oz. / 5.8
Lean Sirloin / 3 oz. / 2.9
Lean Broiled Ground Beef / 3 oz. / 1.8
Skinless Chicken (Dark) / 3 oz. / 1.1
Skinless Chicken (Light) / 3 oz. / 1.0
Pork, Lean, Roasted / 3 oz. / 1.0
Salmon, tuna, halibut or haddock / 3 oz. / 0.8
Non-Heme Iron Sources
Fortified Cereal / 1 cup / 4.5 - 18
Pumpkin Seeds / 1 oz. / 4.25
Soybean Nuts / 1/2 cup / 4.0
Black Strap Molasses / 1 tbsp / 3.5
Lentils, boiled / 1/2 cup / 3.3
Boiled Spinach / 1/2 cup / 3.2
Prune Juice / 8 oz. / 3
Tofu (raw, firm) / 1/2 cup / 3
Red Kidney Beans / 1/2 cup / 2.6
Refried Beans / 1/2 cup / 2
Peanuts, roasted almonds, walnuts, pecans, cashews or pistachios / 1 oz. / .7
The Microbiota is the name given to the trillions of microrganisms that inhabit the intestines, skin, mouth, and the vaginal tract.
Most of these microrganisms (100 trillion) are found in the intestines (“gut flora”), and serve to:
• Protect the intestine from overgrowth of “bad” bacteria, and inhibit the growth of others such as E.coli that can cause infections.
• Synthesize vitamins and proteins
• Help with digestion and absorption
• Stimulate immune function
• Produce serotonin, a crucial neurotransmitter
An imbalance in species of bacteria (Dysbiosis), may be associated with:
• Metabolic syndrome
• Inflammatory bowel diseases
• Irritable bowel syndrome
• Type 1 diabetes
• Celiac disease
• Autoimmune disease
How can we restore balance?
• Adequate sleep
• Stress management
• Avoid unnecessary antibiotic usage
• Eat regular, nutritionally balanced meals throughout the day
• Speak with your healthcare provider about taking pre- or probiotics
Can I just take a probiotic and be fine?
Not really. The probiotics on the market are our best guess at which strains confer health benefits as shown in the literature. The most important thing is to feed your gut flora prebiotics, which are the fuel for the probiotics. So if you eat a diet lacking fiber, fruits/veggies, and whole grains, your intestinal bacteria will not have enough fuel.
What else can I do to keep my gut microbiota healthy?
• Check your Vitamin D status
• Consume foods high in omega 3 fatty acids EPA/DHA, aim for salmon other fatty fish 2 times per week.
• As an alternative to fish, you can take an Omega-3 supplement Nordic Naturals Ultimate Omega-3 capsules.
• Eat fermented foods like Kefir, sauerkraut or Kim Chee
• Lower sugar/highly refined food intake.Increase your fiber from veggies, fruits, intact whole grains (quinoa, brown rice, amaranth, etc) as opposed to energy bars, protein bars, whole grain snacks, or refined grain bread products.
• Avoid sugar alcohols, (Sorbitol, Mannitol and Xylitol) “diet” products like diet soda, sugar free ice cream, sugar free yogurt, and sugar free/lower sugar protein bars.
• Avoid inflammatory fats (margarine, trans fats) and excessive saturated fats (bacon, visibly fatty meats, etc). Eggs are encouraged, and use olive oil, avocado, walnuts, flax, and 2% dairy products for your fat sources.
What can I do to support my microbiota after taking antibiotics?
• Reinoculate the gut: Consume probiotic and prebiotic rich foods at every meal as possible.Focus on soluble fiber from potatoes, starchy vegetables, and peeled fruits
• Large quantities of insoluble fiber can irritate the gut right after antibiotic usage.
• Choose cooked vegetables over raw vegetables and consume them in a smaller amount.
Consider a probiotic supplement for 6-8 weeks
• For Diarrhea look for blends that contain, bacteria strains Lactobacillus rhamnosus, Lactobacillus reuteri, and Saccharomyces boulardii, although other strains might also be useful.
Cook with spices:
• Tumeric (Curry)
• Rosemary (Italian)
• Oregano (Italian)
• Cinnamon (Oatmeal)
Where can I find these foods on campus?
Most vendors on campus will provide the listed foods on this handout.
· Leaks and onions
· Nuts, dry roasted
· Fiber-rich fruits (pears, berries, apples, slightly green bananas)
· Fibrous plants (Brussel sprouts, broccoli, spinach, kale, greens)
· Oat bran
· Kimchi, Miso
· Sauerkraut refrigerated
· Yogurt Fage Greek 2%, Chobani
· Kefir (low sugar)
· Low sugar Kombucha
· Brined olives
· Pickles (refrigerated only)
· Greens (spinach, kale, collards, arugula, watercress)
· Whole peas, snow peas, snap peas
· Green beans
· Kernel corn
· Bell peppers
· Onions, shallots, leaks, scallions, garlic
· Cabbage, bok choy, Brussel sprouts
· Broccoli, cauliflower
· Winter squash (butternut, acorn, Kabocha, pumpkin)
· Summer squash, peeled
· Starchy tubers
· Taro root
Polycystic Ovary Syndrome (PCOS)
What is it?
PCOS is a condition that leads to an imbalance in female sex hormones. It can affect a women’s menstrual cycle, ability to have children, hormones, heart, blood vessels and appearance. Its name comes from cysts that may form around a woman’s ovaries that look like a ‘string of pearls’. The cause of PCOS is unknown, but genetics seem to play a role.
What are the symptoms?
Common symptoms include irregular or missed periods, hirsutism (hair growth on the face, chest, stomach, around the nipples, back, thumbs or toes), infertility due to lack of ovulation, decreased breast size, acne, thinning of scalp hair, and acanthosis nigricans (dark or thick skin markings and creases around the armpits, groin, neck, and breasts). While some women experience rapid weight gain (usually around the waist and experience difficultly losing weight) with PCOS Its important to know that women of all weight ranges and body sizes can suffer from PCOS. Women may also experience a rapid gain in muscle mass and size due to higher levels of testosterone.
How is it diagnosed?
There is not a single test for PCOS, but rather a number of steps that a doctor can take to diagnosis the condition. The first step is to assess your medical history, including menstrual periods as well as presence of unwanted hair growth, acne, thinning hair and sudden changes in weight. A physical examination which may include a pelvic exam can identify if ovaries are swollen or enlarged due to the presence of cysts. Blood tests check the amount of the hormone androgen in your blood as the condition is characterized by hyperandrogenism (excess levels of male hormones). Glucose and insulin testing may be done as well as checking cholesterol and other lipids. Finally, a vaginal ultrasound can detect the presence of cysts on your ovaries.
Conditions that are association with PCOS include:
• Increased risk for endometrial cancer
• Obstructive sleep apnea
• Cardiovascular risk factors, including hypertension, hyperlipidemia, insulin resistance a type 2 diabetes and metabolic syndrome.
How is it treated?
• Physical Activity Regular, varied physical activity 4-5x/a minimum 150 minutes of activity per week. 90 minutes or three 30 minute sessions of aerobic activity 60 minutes or two 30 minute sessions of strength or resistance training
• Dietary Intervention Reduce carbohydrate intake to 35-40% of calories. Take a look at what type of carbohydrate you are eating, while increasing the overall amount of protein you are eat. Focus on whole grains vs. refined
• Increase fiber intake- a suggested range is about 25 grams pr day (talk to your dietitian about how to do this)
- Protein intake 15-30% of calories
- Increase intake of lean protein foods with most meals and snacks
Fat should be 35-45% of calories each day Focus on monounsaturated and polyunsaturated fatty acids. Be sure to include some healthy fats into your diet
- Eat every 3-5 hours
- Vitamin D supplement of 1,000 IU daily
- Supplementation of iron if stores are low
- Fish oil and a combination of d-chiro and myoinositol (see your dietitian to discuss)
Other supplements that may need to be considered include zinc and magnesium, discuss supplements with your doctor or dietitian as everyone’s needs are individual
• Medication Hormonal contraception to induce regular periods, may help with acne Spironolactone-effective for hirsutism and alopecia Metformin-lowers insulin levels, may help with weight management, decreases testosterone levels, induces ovulation, improves lipid profile and lowers blood pressure
• Regular lab tests Women with PCOS often have altered lab values Regular lab work can make deficiencies known so that they can be corrected
- Many women with PCOS have low iron stores as well as vitamin D
- Control Chronic Inflammation in the body (chronic inflammation can increase insulin levels which will make PCOS harder to manageAvoid yo yo dieting which increases increase inflammation
• Manage stress. Increase intake of healthy fats, fruits, vegetables and whole grains. Avoid excess intake of simple sugars
• Psychological support. Depression can be associated with PCOS, be sure to check in with a therapist if you or other notice a change in your mood Managing anxiety or stress can be a useful addition to treatment
Eating for Yoga & Pilates
Before Working Out
Purpose: Provides energy to workout
Timing: 1-2 hours before
Hydration: Drink plenty of water throughout the day, and ~8 fluid ounces 30 mins. before workout
Nutrient Composition: Easily digestible carbohydrates with some protein
• Banana with peanut butter
• Oatmeal with fruit
• Small bowl of cereal with milk
• Whole wheat crackers and cheese stick
After Working Out
Purpose: Builds muscle
Timing: 15-45 minutes after
Hydration: Drink ~ 8 fluid ounces post-workout and plenty of fluid the rest of the day
Nutrient Composition: Protein with some carbohydrate
• Small package of dried fruit and nut trail mix
• Greek yogurt with fruit or granola
• Carrots with hummus
• Turkey deli meat with a few whole wheat crackers
Positive self-talk isn’t about where you are or where you’ve been, it’s about where you’re going.” —Anonymous
How we talk to ourselves can be a reflection of how we feel about ourselves. If words are judgmental or constantly portray disapproval: should have done better, should have known that, can’t believe I did that, we begin to feel less capable, less confidant and that can slowly erode our self esteem. Although we often believe that chronically pushing ourselves and not ‘settling’ so to speak may be incentive to make us work harder, the truth is that it really just wears us down. When we don’t believe in ourselves it’s much more difficult to move forward, instead we spend a lot of time looking at where we’ve been and what we could have changed.
The Harsh Self Critic
• Critical – critiquing
• Easily distracted
• Past and future oriented
– “I should have done better!”
– “I can’t believe I ate that!”
– “Anyone can lose a few pounds so what’s the matter with me?”
– “I don’t have any self control”– how pitiful is that?
The Empowered Self
• Non-verbal – mindful
• Fully focused on the present
• At ease
– “I had a difficult day today, so I can understand why food is a bit more trying.”
– “Today may not have gone as planned but I’ll focus on that tomorrow.”
– “I know I’m doing a good job with activity so not worried about the number not moving on the scale.”
– “Right now I'm feeling a lot of stress, so backing away from the focus on food, may be a good idea.”
Words to limit or avoid using for empowerment – these words infer that one is doing something for someone else or to please someone else.
– “I should not have eaten that cake, that really blew the day for me.”
– “I’m always so good at staying on top of things,”
– “I never thought that I would have trouble with this.”
– “I’m must be losing control to have let myself get to this point”
Ideally use words that portray a self-interest
W want, would like
– “I want to lose a few pounds because it’s so much easier for me to move around. There are a lot fewer aches and pains.”
– “I enjoy being outdoors so can’t wait to go on my walk this morning.”
– “It’s my desire to feel good physically and so I’m choosing to cut back on some portions and/or make other choices in my diet. I desire to be more mindful of what I eat so that I can really enjoy my food and not feel rushed.”
And of course granting permission.“I give myself permission to….”
...sleep in because I was up very late last night and sleep is important too.
...enjoy food without guilt.
...move my body even if I am not an athlete or in perfect shape.
Protein — The Muscular Nutrient
Protein has always been the least controversial macronutrient and yet there are many misconceptions surrounding it. Often, it is believed, especially by athletes and body builders, that eating more protein bulks you up. While it is true that in order to build new muscle you need more protein, you also need to increase resistance training, which requires additional carbohydrates for energy. Ideally the carbohydrates should be a combination of whole grains, pastas, beans, starchy vegetables and fruits and certainly an occasional sweet treat if so desired.
How much protein?
• Many factors determine protein needs: activity level, type, duration, intensity as well as frequency of the activity, gender, age, health goals and current health status.
• The protein RDA (Recommended Dietary Allowance) for healthy adults is 0.8 g/kg body weight, daily, but can range from 1.0 to 2.0 grams/kg/body weight for athletes, which usually accounts for 10-15% of total calories. Caution: more is not necessarily better.
Body Weight / Protein Range Recommendations
Pounds Kilograms Normal RDA (.8 g/kg) 1.3 g/kg 1.6 g/kg
110 50 40g 65g 80g
130 60 48g 78g 96g
155 70 56g 91g 112g
175 80 72g 104g 144g
200 90 80g 117g 160g
1.2-1.7 g/kg for power athletes (strength or speed)
1.2-1.4 g/kg for endurance athletes
Common Protein Values
Here are general guidelines that can be used to determine protein value of foods. Notice that a “combination” of foods can easily allow you to meet your daily needs.
• Medium Density Protein Foods (3-7 grams/serving) Vegetables, Bread, Rice, Cereal
• High Density Protein Foods (.8-30 grams/serving) Meat, Poultry, Fish, Soy Food, Eggs, Nuts, Milk, Yogurt, Cheese, Peanut Butter
What about protein supplements?
When possible you should strive to get the protein you need from the diet. Although you can go and buy amino acids (protein building blocks) at the local store, protein from food provides us with many other nutrients versus just supplementing protein alone. The sample meals below show that how you can easily reach higher levels of protein through the diet.
• This diet, although not completely balanced, would be an example of a relatively high protein diet, and would not be intended to be followed by everyone.
• 2 hardboiled eggs (12g)
• yogurt (6-10g) and fruit
• 2 slice whole wheat toast with butter (6g)
• orange juice
• 6 oz tuna sandwich with mayonnaise or other dressing (48g)
• 1 pint of skim milk (16g)
• 7 oz roasted chicken (49g)
• 1 cup cooked vegetables (2g)
• 2/3 cup rice (6g)
• 1 cup skim milk (12g)
Add a 1/2 cup snack of nuts (12g) and a soy protein bar (10g), and you have a total of 183 grams of protein. The RDA for an athlete weighing 200 pounds is only 160 grams. As you can see, a balanced diet will give you all the protein you need even if you are a world-class athlete.
More recent research has shown the benefits of having milk or chocolate milk post workout (20 grams of protein) due to it’s unique combination of whey and casein (whey works quickly and casein is a bit more slow acting) to help with cellular repair. Both of these types of protein are found in dairy products.
Athlete’s appetites may be impacted by intensity and/or duration of their workouts thereby impacting their desire to eat. Drinking nutrients/calories is sometimes easier than eating, so protein shakes may be considered a good alternative in these types of circumstances.
How to Catch More Zzzz’s
Sleep can be tough to come by as a busy student. However, getting the right amount of good quality sleep is essential to promote optimal health as well as both physical and mental performance.
Seven to nine hours of sleep is recommended although nine is optimal.
Why We Need Good Sleep:
• Promotes healthy brain function
• Heals and repairs your heart and blood vessels
• Maintains a healthy balance of hormones
• Maintains blood sugar levels
• Supports healthy growth and development
• Controls immune function
• Improves memory
What Happens if You Don’t Sleep?
Sleep is crucial to optimal brain functioning, thinking, and learning. Too little sleep can make concentrating difficult and impair problem solving. It can also interfere with memory. Adequate sleep allows your body to consolidate the information you are exposed to throughout the day. If those 7-9 hours are not achieved you might not be learning to your full potential. Lack of sleep has also been associated with an increase in appetite. This can lead to unwanted changes in weight and other detrimental health issues in the future.
Tips for a Good Night’s Sleep
• Create a healthy sleep environment. Try to remove bright lights, loud noises, or anything else that may keep you awake.
• Shut off electronics at least 30 minutes before bed. The blue light disrupts melatonin production, an essential sleep regulating hormone.
• Relax a bit before you climb into bed. Find an activity that you find calming. Try a warm bath, reading a book, try some deep breathing or meditation.
• Stick to a sleep schedule. Go to bed and wake up at the same time each day, even on the weekends.
• Stop drinking alcohol at least 3 hours before you go to bed, and if you choose to drink alcohol limit intake to 1-2 drinks per hour and 4 or fewer drinks on any one occasion. Any more than this may interfere with your sleep cycle.
• Exercise: 20-30 minutes is all it takes. Try to do this 5-6 hours before you go to bed to allow your body to unwind from the workout.
• If you are a caffeine consumer, try to eliminate consumption after 2 P.M. The effects of caffeine can take up to 8 hours to wear off.
• If you need to nap, shoot for curling up and snoozing earlier in the day and limit to no more than 45 minutes
• Check out more tips here: https://studentaffairs.duke.edu/sites/default/files/u110/Sleep.pdf
What About Snacking Before Bed?
Here’s the deal: it’s perfectly okay to enjoy a little something if you find yourself hungry after dinner.
First look to your previous meals and ask yourself if they were balanced with protein, carbohydrate, and healthy fat. Have you had enough water? Are you short on sleep experiencing the fatigue munchies? If you took care of the above, or need to fuel muscle recovery:
• Try to snack at least two hours before bed. Allowing time for digestion is important to avoid any reflux.
• A small bedtime snack may help you sleep better if you have not had enough to eat during the day. If you are hungry before you fall asleep your body might wake you up in the hopes that you fuel it.
• Choose a snack that is a combination of protein and carbohydrate. This combination will help control blood sugar.
If you are trying to build muscle choose an option with casein like milk, cheese or Greek yogurt. It is long lasting and takes longer to digest.
What Should I Avoid Before Bed?
• Caffeine. Consuming caffeine later in the day or before bed could keep you awake and interfere with sleep.
• Large, heavy meals. A big meal right before bed can lead to reflux.
Night Time Snack Ideas
• A cheese stick and a few crackers
• Whole grain toast with nut butter
• A piece of fruit and one serving of nuts
• One glass of low fat milk or chocolate milk
• Cottage cheese with fruit
• Hummus with raw veggies
• Hardboiled egg and a few crackers
• Oatmeal with milk
• Cheese and a few pretzels
• Fruit with nut butter
• Lean lunch meat with cheese and a slice of whole grain bread
Smart snacking means eating foods that provide sustained energy for getting you through your busy day. In order to do this, combine foods that contain carbohydrates for quick energy, and protein which helps you maintain energy levels and keeps you feeling full longer.
*** Healthy fats are an important part of a healthy diet and are found in some of these protein/carbohydrate choices.
Choose a food from the Carbohydrate column and one from the Protein column and create your own smart snack. Be creative and have fun!
Some Examples of How to Pair Up
• Nuts — Dried Fruit (Trail Mix)
• Apple — String Cheese
• Hummus — Veggies
– What ever your snack choices may be, remember to fuel up regularly about every 4 hours, and “don’t skip out” on meals.
• Energy bars, look for lower sugar varieties and that have ideally a two to one ratio of carbohydrates to protein. (If you need two snacks in a day, try another option with this instead of two energy bars for better balance.)
• High fiber cereal; (those that have 5 or more grams per serving) is a good option, but limit to 1.5 cups, with skim or low fat milk or yogurt.
• Trail mix – A serving of higher fiber cereal, a handful of nuts and a handful of dried fruit.
• Canned soups – ideally ones such as Minestrone, chicken noodle, vegetable, bean and not the heavier cream soups.
• Raw vegetables with hummus or yogurt based dip. Great way to get the vegetables!
• Fruit and cheese (a serving of cheese is about the size of four dice stacked).
• Serving of whole grain crackers and string cheese – string cheese is easy because it is transportable.
• Greek yogurt 2% with cereal or fruit.
• Instant oatmeal – stay with the lower sugar flavors, made with milk and a small handful of nuts.
• Turkey, chicken or ham sandwich on whole wheat bread, with lettuce, tomato, onion, mustard or a small amount of mayonnaise.
• Peanut butter and jelly sandwich – whole wheat bread and Peanut butter (about a golf ball size), or cashew butter or any nut butter – yes even Nutella and no more than two tablespoons to a light spread of jelly.
- Apple, Apple sauce, Banana
- Any that you enjoy & are readily available
- Raisins, apricots, prunes, bananas, craisins, your choice.
- Raw: green, red or yellow peppers, carrots, cucumbers, celery, radishes just to name a few. Cooked; green beans, carrots, peas, corn for example.
- Whole grain crackers
- Whole grain bread
- Whole grain cereal
- Pita chips
- Granola bar – preferably one with some fiber
- Graham crackers
- Cereal – make your own trail mix- whole grain cereal, dried fruit and nuts or seeds
- Low fat Milk, flavored, regular or soy
- String cheese
- Cottage cheese
- Eggs, egg whites, egg beaters or egg substitutes
- Peanut butter or other nut butters such as almond butter or soy nut butter
- Nuts and Seeds
- Bean based soups – carbs. and protein in one
- Edamame (soy beans)
- Beef or Chicken jerky
- Lean sandwich fillings such as turkey, chicken, ham, roast beef
- Tuna (packed in oil or water)
Nutrition for Sobriety
Substance abuse, whether through alcohol or drugs, can cause real, measurable damage to your body. Healthy eating can make your recovery easier, help heal the damage caused by abuse, and prevent relapse.
How Alcohol & Drug Abuse Impacts Nutrition
• Drug use affects absorption and metabolism of several essential vitamins and minerals.
• Alcohol interferes with the metabolism of most vitamins and with the absorption of many nutrients, which can lead to deficiencies in your body.
• Alcohol stimulates excretion of both calcium and magnesium, which may increase risk for stroke and hypertension (high blood pressure).
• Smoking cigarettes lowers levels of vitamin C and other antioxidants, which protect the body from harm at the cellular level.
Meal Planning Tips and Recommended Foods
Low blood sugar can cause cravings which increase risk for relapse. Avoid low blood sugar by focusing on balanced meals – including carbohydrates, protein, and fats in every meal to help raise and maintain your blood sugar. Other suggestions include:
1. Planning ahead.
Plan where you will eat your meals each day – and aim for healthier options on campus, such as looking for the “Balance Your Plate” logo at The Great Hall or Market Place, Student Special at the Refectory, or a thin crust pizza at The Loop.
2. Eating breakfast.
A meal every morning will help regulate your blood sugar levels and boost metabolism. Aim to balance your plate by including a source of carbohydrate, such as toast or other bread product, potatoes, or hot or cold cereal;, fat, such as cheese, butter, egg yolk, nuts and nut butter;, and protein, such as eggs, yogurt, nuts, nut butter, meat, and cottage cheese. For example, whole wheat toast with two eggs over easy is a quick and easy balanced meal.
3. Eating frequent meals and snacks.
Plan regular meals and healthful snacks to eat - no more than 4 hours apart. Eating every 3 to 4 hours is a great way to keep your moods stable. Pack healthy snacks while on campus, such as granola bars, string cheese, nuts, whole grain crackers, and fruits and veggies.
4. Staying hydrated.
Drink several glasses of water daily to stay hydrated and help you feel alert. Caffeinated beverages should not account for more than one or two cups of coffee or tea per day. No energy drinks.
5. Enjoying meals with friends.
Socialization is an important part of recovery. Make sure to plan to meet your friends at your favorite dining location on campus.
Try to limit
1. Foods and drinks with caffeine (such as coffee, tea, cola).
If you have chosen to quit smoking or drinking, be aware that caffeine can increase anxiety, decrease your appetite, and keep you awake at night. Too much caffeine can increase cravings for alcohol and/or drugs. For some people, any caffeine can create a problem. Others can handle a moderate amount (1 to 2 cups of coffee per day).
2. Too much sugar.
Sugar (in candy, cola, and desserts) can make you moody and anxious. If you consume sugar, try to balance it in a meal or healthy snack that includes protein, such as nuts or nut butter, trail mix, or yogurt. This will lessen the effects.
3. Too much fast food.
High-fat fast food such as pizza, french fries, and fried food, can make you tired and moody.
High complex carbohydrates
(beans, whole grains, pasta)
· Stabilized blood sugar
· High in B vitamins
· Provides sufficient energy
· Increases serotonin (a messenger in the body that produces the “happy feeling”)
(chicken, meat, fish, dairy, nuts and seeds, soy)
· Helps physical healing
· Increases Dopamine (a messenger in the body that helps control the brain’s reward and pleasure centers)
· Correlated with longer abstinence
Moderate healthy fat
(olive oil, avocado, nuts, seeds, milled or crushed flax seed or flax seed oil)
· Lowers cholesterol
· Correlated with longer abstinence
· Improves satiety (fullness)
3-5 meals/snacks per day
· Stabilizes blood sugar
· Minimizes cravings
· Match eating to metabolism
· Prevent excessive fat storage
High intake of nutrient dense foods
(those high in vitamins and minerals, such as fruits and vegetables, whole grains)
· Increase vitamins and minerals
· Increase neurotransmitters, such as dopamine and serotonin
· Increase serotonin
Limit (1-2 cups) caffeine
(coffee, tea, cola)
· Decrease anxiety
· Increase cognitive functioning
(at least 60 ounces per day)
· Helps detoxification
· Increases endorphins, metabolism, lean body mass, circulation
Shake the Salt Habit
Sodium is a major mineral, serving many important functions in the body. In a sports venue you may be familiar with hearing it referred to as one of many important electrolytes. While the AHA recommendations are lower, trying to limit your intake to no more than 2300 mg per day* (or about 1 tsp table salt) is a very reasonable goal. Most Americans consume around 3400 mg sodium per day, far exceeding recommended amounts. For most healthy young people this is not a significant concern. However some people have medical conditions that require them to be more moderate with their sodium consumption. Excessive sodium intake, especially in the form of table salt (sodium chloride) has been linked to high blood pressure, strokes, heart attacks and kidney failure.
Most Sodium Comes from Processed & Restaurant Foods
Due to technological developments, salt, once used mainly as a preservative, is no longer needed exclusively for that purpose. However, salt is a wonderful, cheap, flavor enhancer and also prolongs shelf life and so is used freely by processed food manufacturers and chefs. Over the last 30 - 40 years our consumption of processed foods and dining out options have increased along with our ability to afford these foods; hence our sodium intake has increased dramatically.
How do we reduce our sodium intake? A taste for salt is acquired over time so cut back gradually.
1. Put away the salt shaker at the table and reduce your sodium intake by an average of 6%.
2. Begin replacing processed foods with fresh fruits and vegetables. These foods are almost sodium free and also provide other vitamins and minerals that contribute towards good health.
3. Most chain restaurants provide nutrition information online. Familiarize yourself with your options before hand to ensure that you choose a lower sodium option.
4. Read all packaged food labels. If a serving has more than 400 mg of sodium or perhaps 600 mg or higher for an entrée, consider looking for another option. Keep in mind that the information on the label is based on one serving and you may consume more than one serving – make sure to do the math. Don’t forget to look for sodium-containing compounds such as: MSG, baking soda, baking powder, disodium phosphate, sodium alginate, sodium nitrate or nitrite. Be a savvy shopper.
5. Stick to foods that are in a form closest to how they were grown. For example, Fresh vegetables, frozen vegetables, canned vegetables. Fresh tomatoes, canned tomatoes, tomato sauce—the more processed the more salt.
6. Don’t be afraid to order your sauce or salad dressing on the side in a restaurant. Ask your server to recommend lower sodium options and/or season your food yourself.
Food / Sodium content (mg.)
3 oz Bagel with 2 Tbsp Cream Cheese - 670 mg
Subway Roast Chicken Sandwich on Wheat - 828 mg
1 oz Lays Potato Chips - 180 mg
12” Hand Tossed Domino’s Pepperoni Pizza - 4000 mg
Jimmy John’s Italian Club - 2165 mg
McDonald’s Southwest Salad With Grilled Chicken and Low fat Balsamic Dressing - 1690 mg
Low Fat Triscuit crackers 1 oz - 160 mg
Low Sodium Triscuit crackers 1 oz - 50 mg
½ cup cooked lentils no salt added - 2 mg
1 cup raw spinach - 24 mg
Medium banana - 1 mg
½ cup brown rice - 5 mg
3 oz roast chicken breast no skin - 64 mg
Fiber-How Much is Too Much?
Dietary Fiber is the indigestible parts of plants and Functional Fiber is fiber that is added to processed foods in the form of non-digestible carbohydrates.
A diet high in fiber has many health benefits, including decreased cholesterol levels, insulin and blood sugar stability. While it’s recommended that young women eat 25 grams of fiber a day and young men aim for 38 grams per day, more than this can lead to negative effects. Just because some is good, does not always mean that more is better!
Signs You’re Consuming Too Much Fiber:
• Gastrointestinal distress, which may include bloating, gas, constipation, cramping and/or diarrhea.
• Decrease in appetite or early satiety. (fullness)
• Inability to consume enough energy due to high volume meals resulting in weight loss or lack of weight/muscle gain.
Negative Effects of Fiber:
• Fiber can bind minerals such as calcium, magnesium, iron and zinc, which limits absorption of these micronutrients.
• Intestinal blockage is rare but serious and occurs when individuals eat too much fiber and do not consume enough fluid.
Where is Fiber Found?
• Fruit and vegetables
• Whole grains such as brown rice, quinoa, whole wheat bread, cereal.
• Beans and legumes.
• Nuts and seeds, including chia and flax seeds.
• As an added ingredient (look for inulin, chicory root, maltodextrin, polydextrose, soy hulls, oat fiber, sorghum fiber, beet fiber, corn fiber, soy fiber or guar gum) in protein or granola bars or other foods labeled as “High Fiber”.
Feeling Too Full?
If you’re experiencing bloating or any other side effect from too much fiber in your diet, here’s how to reduce the discomfort:
• Remove added fiber products from your diet. The fiber found in products like high fiber cereal bars is more upsetting to your GI system than naturally occurring dietary fiber.
• Take a look at your meals. If each of the options are high in fiber, how about choosing a lower fiber option for either a grain or protein?
• Choose cooked instead of raw vegetables.
• Skip foods that increase bloating, such as sugar free gum, cough drops and candy.
How Could I Possibly Eat More than 50 Grams a Day?
1 cup oatmeal - 8 g
2 T almonds - 1 g
2 T raisins - 1 g
1.5 T chia seeds - 3 g
Turkey Sandwich— 2 slices whole grain bread - 8 g
1 slice of tomato, 2 leaves of romaine - 1 g
1 cup baby carrots - 3 g
1 apple - 3 g
High Fiber Cereal Bar - 9 g
1 cup of lentils - 16 g
1 cup of quinoa - 6 g
1 cup of cooked kale - 3 g
2 cups of popcorn - 2 g
Total: 64 g