Dr. Bernstein diet and beyond

I'd like to respond to some of the feedback we've been receiving about the topic of carbohydrates and their place in your diet. I'm not a dietitian, so I've consulted with Jennifer Nelson, M.S., R.D., a Mayo Clinic dietitian, who says, "The American Diabetes Association generally recommends that around 50 percent of the calories in your diet come from carbohydrates — preferably healthy carbohydrates such as vegetables, whole grains and fresh fruit. Lean proteins or fat-free dairy and healthy fats should make up the rest of the calories."

The Dr. Bernstein diet, which has been mentioned in some comments, is low-carbohydrate and calorie restrictive. In some cases, it proposes limiting calories to 800 to 1350 a day. The program also includes behavior modification, education and vitamins and mineral supplements. People with diabetes who follow the Dr. Bernstein diet are required to do intensive management of their diabetes, including blood glucose testing five to eight times a day. The main function of Dr. Bernstein's diet for those who have diabetes is to maintain constant, near-normal blood glucose levels — desirable for anyone with diabetes. Good glucose control can reduce or prevent the chronic complications of diabetes such as nerve damage, kidney damage, eye disease and heart disease risks.

When carbohydrates are reduced, you must make up the difference in fat and proteins. Consuming total daily calories at an amount needed to maintain a healthy weight is key and, over the long run, is probably more important than diet composition.

Can good glucose control be achieved on a traditional diet? It most certainly can. Good glucose control involves paying close attention to the balancing act of healthy eating, insulin use (and diabetes medications, if required), exercise and blood glucose monitoring.

Good diabetes management takes self-direction and work, no matter how it's achieved.

According to Jennifer Nelson, M.S., R.D., "The bottom line is to find a healthy eating plan that works for you lifelong."

Thanks, Jennifer. And, I hope you all have a good week.

Regards,
Nancy

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Know your blood glucose target range

Wow, what a tremendous response to the new diabetes blog. You are showing the huge impact diabetes has on an individual's life, family, community, and society as a whole.

Peggy and I would like to thank all of you for sharing your stories about living with diabetes. As you all know, diabetes is a complex issue and there are many facets involved in managing and living with the disease.

In viewing the comments, we would like to thank you for sharing your personal experiences, challenges, burdens, and successes. This is your opportunity to share information and tips, and Peggy and I plan on choosing a couple items each week to respond to.

This week I would like to talk about the blood glucose target range. What should it be? A normal fasting blood glucose target range for an individual without diabetes is 70-100 mg/dL (3.9-5.6 mmol/L). The American Diabetes Association recommends a fasting plasma glucose level of 70–130 mg/dL (3.9-7.2 mmol/L) and after meals less than 180 mg/dL (10 mmol/L).

Individuals with hypoglycemic unawareness (limited or no awareness of low blood glucose symptoms) may require a lower target range. Your healthcare provider may personalize your blood glucose target for specific medical conditions. Blood glucose targets should be in a healthy range to prevent diabetes complications, but also keep you safe from serious low blood glucoses.

Remember, blood glucose targets are targets. Diabetes is a balancing acting and blood glucoses will fluctuate; even sharpshooters don't hit the bull's-eye every time.

Once again, thank you. Keep the comments coming. We will try to address some of your concerns in the upcoming weeks.

- Nancy

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Focus is essential for success

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

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What's OK to eat after gallbladder removal?

I just got a phone call from a retired Mayo Clinic doctor asking why we don't have a gallbladder removal diet. He went on to explain that he'd had a very uncomfortable and embarrassing incident after eating a large meal that contained lots of fat. My response was that there isn't a set diet people should follow after gallbladder removal because the guidelines depend on the individual.

It's helpful to know a little background: The gallbladder collects bile, a fluid that is produced by the liver, and releases it when you eat to aid the breakdown and absorption of fat. Between meals, bile collects in the gallbladder and is concentrated. When the gallbladder is removed, bile is less concentrated and it drains continuously into the intestine. This affects digestion of fat and fat-soluble vitamins. How much of a problem it is varies from person to person. With time, the body often adjusts and becomes better at digesting fatty foods.

The amount of fat eaten at one time also factors into the equation. Smaller amounts of fat are easier to digest. On the other hand, large amounts can remain undigested and cause gas, bloating and diarrhea.

Although I don't have a specific gallbladder removal diet to recommend, I can offer general advice for avoiding problems after you've had your gallbladder removed:

Eat smaller, more frequent meals. This may ensure a better mix with available bile. Include small amounts of lean protein, such as poultry, fish and nonfat dairy, at every meal, along with vegetables, fruit and whole grains.Go easy on fat. Avoid high-fat foods, fried and greasy foods, and fatty sauces and gravies. Instead, choose nonfat or low-fat foods. Read labels and look for foods with 3 grams of fat or less a serving.Gradually increase the fiber in your diet. This can help normalize bowel movements by reducing incidents of diarrhea or constipation. However, it can also make gas and cramping worse. The best approach is to slowly increase the amount of fiber in your diet over a period of weeks.Be aware that after gallbladder surgery some people find that the following are difficult to digest: caffeinated beverages and dairy products.

Talk with your doctor if your symptoms are severe, don't diminish, continue over time or if you lose weight and become weak.

I'd like to hear from anyone who has had gallbladder surgery — do you have problems — or are you able to eat almost everything? Any advice you can share?

- Jennifer

blog index References Barrett K. Gastrointestinal Physiology. http://www.accessmedicine.com/content.aspx?aID=2306279&searchStr=gallbladder#2306279. Accessed July 6, 2011.Nutrition Care Manual: Gallbladder disease process and meal plan. American Dietetic Association. http://nutritioncaremanual.org/content.cfm?ncm_content_id=81517 Accessed July 6, 2011.Fisher M, et al. Diarrhoea after laparoscopic cholecystectomy: Incidence and main determinants. ANZ Journal of Surgery. 2008;78: 482.Surawicz CM. Mechanisms of diarrhea. Current Gastroenterology Reports. 2010;12:  236.

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Remember 3 numbers for safely cooking meat

No matter the season, food safety should always be on the menu. And that means using a thermometer to judge when meat and poultry are fully cooked. But remembering the appropriate meat cooking temperature can be challenging. Well, that just got a bit easier.

The U.S. Department of Agriculture recently revised the recommended internal cooking temperatures for all whole cuts of meat. Now you just have to remember three numbers:

145 F for whole cuts, such as ribs, roasts, chops and steaks, of beef, pork, lamb and fish160 F for ground versions of the above165 F for all poultry

Be sure to cook foods to these recommended temperatures. Check the temperature by putting the thermometer into the thickest part of the meat. Don't rely on looks. Appearance is not a safe indicator of doneness.

When a whole cut of meat reaches the right temperature, remove it from the heat but continue to watch the thermometer to ensure it's at or above the minimum temperature for at least 3 minutes. The temperature may continue to rise — this is normal.

Leave the thermometer in the meat until you see the temperature start to cool. This will preserve some of the moisture in the meat while still allowing enough time to kill or reduce the bacteria always present on meat.

You might wonder if higher temperatures are better, but that's not necessarily the case. By using the temperatures above, you can be safe and still keep food moist and juicy.

To your health,

Katherine

blog index References USDA revises recommended cooking temperature for all whole cuts of meat, including pork, to 145 F U.S. Department of Health and Human Services. http://www.fsis.usda.gov/News_&_Events/NR_052411_01/index.asp. Accessed June 29, 2011.

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Weight loss after pregnancy: Tips from a specialist

Are you looking forward to getting on the scale after your baby is born? You might hope that you've literally worked your butt off having the baby.

At first, you'll lose weight simply from the delivery of the baby and the placenta — as well as loss of amniotic fluid and blood. Within the next few weeks, you might also lose weight from all the fluid that used to be in your feet and ankles. Then weight loss is likely to slow down. Still, you're not stuck with pregnancy weight gain for life.

It might seem counterintuitive, but to take off those excess pounds it's important to eat regular meals after the baby is born. Even though you might be busier — and more tired — than you bargained for, be careful to eat healthy meals and snacks. It's also important to make conscious choices about what — and how much — you eat. Be aware of what you're eating and really think about it before you pop it in your mouth.

Another important part of pregnancy weight loss is physical activity. You might think I'm crazy to expect you to find time for exercise when you can't find time for sleep — but every bit helps. Make sure you have your health care provider's OK, then start out slowly. You might be surprised by how much better you feel after a 10-minute walk. Add a few minutes to your walk every day. Better yet, invite your partner or other new moms to join you.

Believe it or not, sleep counts in your weight loss plan, too. When you're exhausted, it's harder to feel positive about yourself — and make smart choices about food and exercise.

So get some sleep, think about ways to include physical activity in your daily routine, and be thoughtful about what you eat. Remember, it took an entire pregnancy to gain the weight and it'll take time to lose it. Be kind to yourself in the process.

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Exercise your right to say no

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255)Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

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Your energy is limited, spend it wisely

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

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Aging athletes show you can't outrun time

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

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Orthorexia — Healthy eating gone awry

Everyone can benefit by paying more attention to choosing healthy foods, right?

For the most part, yes. However, a small number of people seem to become obsessed with the "perfect diet." These individuals fixate on eating foods that make them feel pure and healthy — to the extent that they avoid foods with any: 

Artificial colors, flavors or preservativesPesticides, genetic modificationUnhealthy fat, sugar or added salt

For some people with orthorexia:

Preparation techniques must result in "clean food," meaning it's been washed multiple times, cooked to ensure no bacteria and minimally handled.Eating out is out of the question because it's important to avoid food that they don't buy and prepare.

The term "orthorexia" has been used to describe this disorder. It comes from the Greek words "orthos," meaning straight or proper, and "orexia," meaning appetite. According to experts including Dr. Steven Bratman, the doctor who first described and named this disorder, what tips the balance from being committed to healthy eating and having orthorexia is the extreme limitation and obsession in food selection. Orthorexics find themselves being unable to take part in everyday activities. They isolate themselves and often become intolerant of other people's views about food and health.

Studies have looked to at whether this disorder is more common in groups more likely to have a keen interest in a healthy diet, such as medical residents, dietitians, students in nutrition, fitness club members and those in the performing arts (ballet, symphony orchestra and opera singers). Each of the professions studied showed some incidence. However, the studies were unable to determine if the incidence was higher than that in the general population.

Health professionals have proposed that orthorexia be officially recognized as a new mental disorder. Currently it remains controversial and grouped with other not yet accepted disorders such as night eating syndrome, muscle dysmorphia (obsession with muscle building) and emetophobia (constant fear of vomiting).

Whether it's recognized as a true medical problem or not is beside the point. It's important to seek professional help when striving for a healthy diet becomes an overwhelming drive that takes over. Orthorexia that features obsessive compulsive behaviors can be effectively treated with medication and cognitive behavioral therapy by a trained therapist.

blog index References Bartrina JA. Orthorexia or when a healthy diet becomes an obsession. ALAN. 2007;57(4):313.What is orthorexia? Journal of the American Dietetic Association. 2005;105(10):1510.Bosi ATB, Derya C, Guler C. Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine. Appetite. 2007;49(3): 661.Kinzel JF, et al. Orthorexia nervosa in dietitians. Psychotherapy and Psychosomatics. 2006;76(6):395.Korinth A, et al. Eating behaviour and eating disorders in students of nutrition sciences. Public health Nutrition. 13(1): 32-37. 2009.Eriksson L, et al. Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scandinavian Journal of Medicine and Science in Sports. 2008;18(3):389.Aksoydan E, et al. Prevalence of orthorexia nervosa among Turkish performance artists. Eating and Weight disorders-Studies on Anorexia, Bulimia and Obesity. 2009;14(1):33.Vandereycken W. Media hype, diagnostic fad or genuine disorder? Professionals' opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emetophobia. Eating Disorders. 2011;19(2):145.

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Caregiver navigates her way to transforming life

Recently I received a message from a woman I admire deeply whom I'll call Rose. She wrote:

"Two years ago we discovered that Charlie (my husband with dementia) could no longer navigate our canoe. I stormed, stomped and basically had a meltdown when it was apparent that our canoeing was over. I felt robbed.

"Then, our son taught me how to navigate. Charlie, however, no longer felt safe in the canoe. So I decided to get a one-person kayak. In some way, I felt like I was betraying Charlie. I tried to get past that.

"Today, I 'soloed' in my new kayak. Charlie helped me launch it in calm waters tonight. I was scared, but with his encouragement and support, I managed."

Rose writes, as many of you have as well, that caregiving brings with it guilt, anger, loss and even resentment. And her story of the two-person canoe turned solo kayak may be reflective of the way many caregivers experience changes in their life and in their relationship.

The story speaks of Rose letting go of something pleasurable she and Charlie shared. The story exposes the loss of the way things used to be. Charlie may still be there for Rose, yet, in some ways he no longer is.

Moreover though, I think Rose's story is about opportunity.

I believe that Rose has begun to open up to new possibilities and discover qualities about herself not fully recognized until now. Rose is finding joy and meaning in her life in fresh ways and maybe most importantly, giving herself permission to do so.

Like Rose, each of you has the opportunity to transform your loss and discover untapped wells of internal strength and inner resources. Through caregiving you can receive a new awareness of your abilities and a renewed sense of identity. This awareness can build self confidence about the future and about what is possible for you — even infusing a sense of courage.

Often this transformation begins to unfold when caregivers focus on what they can change and begin accepting what they can't. Rose can't change the disease her husband has or the way it alters their partnership. Rose can love Charlie unconditionally and paddle her solo kayak with renewed vision and possibility.

"Some changes look negative on the surface but you will soon realize that space is being created in your life for something new to emerge."

- Eckhart Tolle

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Sorting out the evidence for antidepressants

In the July 9 New York Times, Dr. Peter Kramer wrote a piece titled, "In Defense of Antidepressants". It seems ironic that such an article is needed, given the substantial evidence that antidepressants have helped millions of people. However, there continues to be a confusing, academic argument about some of the studies of antidepressants.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

Dr. Kramer is a gifted psychiatrist. He achieved national recognition 18 years ago when he wrote the book "Listening to Prozac". He made his patients come to life for the reader. I read the book and was impressed by how many people he had helped to find their way forward by combining sensitive psychotherapy and appropriate use of one of the earliest serotonin reuptake inhibitors, Prozac.

While his recent article takes on a difficult topic, I was pleased that the paper published it. While some of the details are too esoteric for most readers to follow, the balance of evidence clearly demonstrates that antidepressants work. That's also the conclusion of the FDA and is the experience of many people who have recovered from a serious depression.

Of course, as has been discussed at great lengths on this blog, not all antidepressants work for everyone. Additionally, for some of you, the side effects can be intolerable. Despite millions of dollars of research, the process of finding the right antidepressant is still a difficult one.

While some new tools, such as pharmacogenomic testing, make this process somewhat more rational, it's clear that the search for a better antidepressant must continue and that research designed to identify which people will respond to which medication should have a high funding priority from the National Institute of Health.

One type of study that Dr. Kramer discusses is particularly interesting and rarely considered. These are "maintenance studies". In his article, Dr. Kramer refers to a large study of 4,410 patients who initially had a good response to an antidepressant. The study was designed to focus on the question of how long to continue treatment. The study also wanted to examine the possibility that some patients may respond to treatment as a consequence of other factors besides their medication.

In this study, after successful treatment, half of the patients were switched to a placebo and the remainder continued to receive their active antidepressant. The participants didn't know if they were still getting their antidepressant or had been switched to a sugar pill. In many ways, this is a tough study to volunteer to be in. However, the results were clear. About 70 percent of those who were switched to the placebo relapsed, while most who remained on their medication didn't relapse.

This finding strongly suggests that simply believing that you're taking your antidepressant is not sufficient to maintain a good response. This result makes good sense and supports the importance of staying on a medication that's working.

A link to Dr. Kramer's article can be found in the Resources tab above.

Please share your thoughts.

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Tips for cancer survivors dealing with financial burden

The financial burden for cancer survivors is significant. In a recent study, more than 30 percent of people living with cancer said they had practical concerns regarding financial issues. On top of monthly or yearly insurance premiums, extra costs such as co-pays, medication (chemotherapy or treatment) expenses, travel costs and lost wages are all part of the equation as you deal with a cancer diagnosis, treatment and survivorship.

Some practical ideas that may help as you navigate your way through these issues include:

Talk with your health care team on an ongoing basis about treatment costs. If they recommend a new medication or prescription — ask about your out-of-pocket costs. Many times, your cancer treatment center's business office and pharmacy can give you an estimate of costs before hand.Meet with a social worker to review potential financial resources available to you. This might include charity care, prescription assistance programs, gas cards, low cost (or no cost lodging) and other resources.Call the American Cancer Society (1-800-227-2345) to connect with resources that are available to you as a cancer survivor. If you are unable to work because of your cancer diagnosis; talk with your employer to plan for medical leave, or call the Social Security office (1-800-772-1213) to discuss your options for disability benefits.

Feel free to share ideas, pearls of wisdom and any resources that you have found helpful.

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What can be done to improve America's health?

Although America provides some of the world's best health care and spent over $2.5 trillion for health in 2009, it still ranks below many countries in life expectancy, infant mortality and other key health indicators. For this reason, the U.S. Surgeon General and multiple federal agencies came together to create the National Prevention and Health Promotion Strategy, which was released in June of this year. The strategy calls on leaders in state and local communities, businesses, nonprofit groups and individuals to commit to healthy initiatives.

It's no surprise that healthy eating is one of the priority initiatives. We know that eating healthy can reduce risk of the most common, deadly medical problems including heart disease, high blood pressure, diabetes, osteoporosis and several types of cancer — many related to obesity. Eating healthy requires more than providing people with information — it needs to be supported by an infrastructure that makes healthy foods available, affordable and safe.

In keeping with the current economic atmosphere, the strategy includes no new funding and very few mandates. Here are examples of how it's supposed to work.

The federal government will:

Ensure that foods in federal programs (like school lunches) meet the standards set in the 2010 Dietary Guidelines for Americans.Improve agricultural and food safety policies to align with the dietary guidelines.Develop voluntary guidelines for foods marketed to children (for example in TV commercials), monitor and report on industry activities.

State and local governments will:

Use grants and zoning to attract full-service grocery stores and farmers markets to underserved areas, aka "food deserts."Discourage businesses that serve unhealthy foods around schools.

Schools, businesses and employers will:

Make healthy options and appropriate portion sizes the norm.Reduce sodium, saturated fats and added sugars in the foods served.Eliminate high-calorie, low-nutrition drinks and provide greater access to water.

Health care systems, insurers and health care providers will:

Assess dietary patterns (quality and quantity of food eaten) and provide appropriate care for obesity.

Communities and individuals will:

Lead and expand programs such as community gardens that bring healthy, locally grown foods to schools and businesses.Eat less by avoiding oversized portions.Exercise more.

What changes are you seeing happen that support healthy eating — in your community? In your health system? At work or in your schools? In your local and state governments? What are you doing?

To your health,

Jennifer

blog index References The National Prevention Strategy: America's Plan for Better Health and Wellness. http://www.healthcare.gov/center/councils/nphpphc/strategy/report.pdf. Accessed July 25, 2011.

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Alzheimer's caregivers can love more by caring less

Getting my hair colored has become one of my most pleasurable events — and not so much because I hope covering my gray helps me look 10 years younger. It's more about the joy I feel while sitting in the chair for two uninterrupted hours of dozing off and paging through magazines I just can't bring myself to buy at the grocery store — "Us Weekly," "People," "OK! Magazine".

At today's salon visit, I came upon an article in "O, The Oprah Magazine" that got me thinking about you, the readers of my blog. The article, written by Martha Beck, is titled, "How to Love More by Caring Less."

In the article, Martha Beck describes the concept that loving without caring is a useful approach. I was intrigued by this idea and wondered if it translated in any way to the turbulent nature of loving and caring for a person with Alzheimer's. I realize, though, that it's the "without caring" that probably seems illogical to many of us.

As Alzheimer's caregivers, many of you would probably say that to care for someone means to prepare meals, assist with feeding, dressing and personal hygiene, manage medications, orchestrate appointments and so on. But Beck would say that care can also mean being weighed down by cares.

In my experience, Alzheimer's caregivers are often invested physically and emotionally in the caring around day to day tasks and the challenging behaviors their loved ones with the disease can exhibit. Common behaviors in a person with Alzheimer's can include agitation, apathy, delusions, paranoia, and sleep problems to name some. And caregivers care that their loved one is confused, agitated or unable to sleep.

For many Alzheimer's caregivers, when they care, emotions such as worry, frustration, guilt and agitation are often an unwelcome outcome of caring — and that, I believe, is when unconditional love can get buried. Beck writes, "Unlike 'caring', the word love has no such range of meaning: Love is pure acceptance." So, to love, maybe we do need to care less.

As I read the article, I contemplated if Alzheimer's caregivers can find a way to "un-care" about challenging behaviors their loved ones exhibit and care less about day to day caregiving. I'm not saying that caregivers should be complacent in their responsibilities, I'm just saying that by caring less, there's limited emotional investment in the results of caregiving tasks or the behaviors of the person with the disease.

If we accept Beck's idea that it's possible to love more if we care less, then I guess we can all stop trying so hard and breathe a bit of relief, right? And if you don't buy into her idea, then may I suggest you make an appointment soon to spend a couple hours sitting in a chair at the hair salon — no doubt, a simple way to love (yourself) more.

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Cancer survivors practice the art of helping others

Mentor, navigator, advocate ... these are just a few of the people that you may have been touched by as a cancer survivor.

Most times, the people who fill these roles have faced cancer on a personal level as well. They've walked in your shoes and may have similar experiences to share. The art of caring, listening and supporting is so valuable.

Helping others make it through the experience of living with cancer is an incredible gift. They help you navigate your way through diagnosis, treatment and the time after treatment ends, which can be the hardest period.

People in these roles often want to give back by providing support and guidance to others who may be just at the beginning of their cancer experience. This is an empowering experience where the person helping oftentimes gets back as much as they give. For the person receiving the support, it's just so good to be with someone who knows exactly how they're feeling.

At Mayo Clinic Cancer Center, we are so fortunate to have American Cancer Society Navigators and volunteer survivors who work in the Cancer Education Center, Pink Ribbon Mentors who support breast cancer survivors, a strong group of men who organize the Prostate Cancer Support Group, as well as countless other advocates and community support.

Please share stories of how you've been touched by people in these supportive roles. Whether you were on the giving or receiving end, both are equally important!

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Weight gain: Inevitable as you age?

Is weight gain with age inevitable? It can seem that way when your weight climbs despite dieting and even exercising. Indeed, a recent study suggests that a range of lifestyle choices — not just the number of calories in your diet — influence your weight as you age.

The study included more than 100,000 men and women who were in good health and not obese. Their weight, diet and lifestyle habits were tracked for up to 20 years. The pounds seemed to creep on, with an average weight gain of slightly less than 2 pounds every 4 years.

What surprised researchers was that specific foods were independently associated with more weight gain:

Potato chipsPotatoes Unprocessed red meatsProcessed meats

On the other hand, eating more of some foods — vegetables, nuts, fruits and whole grains — was associated with less weight gain.

Liquid calories were another culprit. Alcoholic beverages and fruit juices were associated with a small but gradual increase in weight. Sugar-sweetened beverages were a major contributor to weight gain.

Lifestyle factors also influenced weight gain. Not surprisingly, physical activity was important to weight control. So was limiting TV time. Sleep also factored in. Weight gain was lowest among people who slept 6 to 8 hours a night and was higher among those who slept less than 6 hours or more than 8 hours.

Do any of these findings surprise you? Motivate you to change your habits? If so, how?

To your health,

Katherine

blog index References Mozaffarian D, et al. Changes in diet and lifestyle and long term weight gain in women and men. N Engl J Med. 2011;364:2392.

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Rewire your thinking

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

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Making positive change helps cancer survivors

Last year, we had a blog discussion on "How cancer changes you" and so many of you wrote in to share your experiences. With this post, I want to delve deeper into the positive side. I realize it might be asking a lot to do this; however, while having cancer is a generally negative occurrence, some positive things may come from it.

I'll share a story of a woman I met who was diagnosed with breast cancer. After her initial treatment, she decided to reduce her work schedule and pursue her love for painting. She traveled to places she loved and created incredible watercolor paintings reflecting on the beauty of each place.

She stayed active in her work life, but was able to balance it with her dream of painting again. She told me she wouldn't have done this if it hadn't been for her cancer diagnosis. Previous to her diagnosis, she was extremely focused on her career and had put her love for painting on hold.

I'm sure this story isn't unique. Many of you have made positive changes in your life because of your cancer diagnosis. I've heard so many stories of love, courage and strength. At times, it's hard to be positive, as having cancer isn't exactly easy and the physical feelings of the body usually have a strong influence on the mind and outlook.

I would love to hear about your personal experiences. How did you transform the negative to positive? How did this experience change your life?

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Pregnancy and you: Pregnancy weight gain — Know the factors

A prenatal visit can be a joyful experience. You get to listen to your baby's heartbeat, and you're reassured about your baby's well-being and your own health. Still, you might dread getting on the scale. You might wonder why you never weigh the same on the scale at the office as the scale at home — or if the scale will reveal your dietary indiscretions.

Why the focus on pregnancy weight gain? The risk of pregnancy complications is higher in the upper and lower extremes of weight gain. If you gain too much weight during pregnancy, it can be challenging to lose the excess pounds afterward — and those pounds have the potential to stay with you for a lifetime.

Your health care provider will give you an idea of the amount of weight gain that's ideal for you and your baby. Generally, the amount of weight you're encouraged to gain depends on your pre-pregnancy weight:

Underweight (BMI less than 18.5): 28 to 40 pounds (about 13 to 18 kilograms)Normal weight (BMI 18.5 to 24.9): 25 to 35 pounds (about 11 to 16 kilograms)Overweight (BMI 25 to 29.9): 15 to 25 pounds (about 7 to 11 kilograms)Obese (BMI 30 or more): 11 to 20 pounds (about 5 to 9 kilograms)

So what should you do if you realize you're gaining too much weight? Start by forgiving yourself. Then look at the past few weeks to see if you can pinpoint any major contributing factors to your pregnancy weight gain. Brainstorm ways to deal with those issues. Remember, it might be easier to curb excess weight gain during pregnancy than it is to lose the pounds after pregnancy.

Likewise, what should you do if you're not gaining enough weight? My advice is the same. Look back on your eating habits and consider what you can learn. Remember that sometimes changing to a healthier diet can cause weight loss.

If you find you're having trouble managing your pregnancy weight, ask your health care provider for a referral to a nutritionist or dietitian. Also remember that weight gain is just one part of your pregnancy. Don't let the scale ruin the joy and excitement of pregnancy.

What are your strategies for gaining a healthy amount of weight during pregnancy? What are your struggles? Share your stories so that we can learn from each other.

blog index References Committee to Reexamine IOM Pregnancy Weight Guidelines, Food and Nutrition Board, and Board on Children, Youth and Families. Weight gain during pregnancy: Reexamining the guidelines. Institute of Medicine and National Research Council. http://www.nap.edu. Accessed June 29, 2011.

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