Tuesday, February 7, 2012
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Nutritionally Fit

by Jeff Shilt, M.D.

Like most, I’ve had swings in my fitness and nutrition during my “triathlon” career. My initial entry into the sport just over a decade ago resulted in a 20-point increase in my healthy cholesterol (HDL) and weight loss of nearly 25 pounds. At that juncture in my life, I was training 10-12 hours a week and was very happy to participate as a “complete rather than compete athlete” in the North Carolina triathlon series. Triathlon represented a lifestyle that was fun and healthy, both attributes that I aspired after completing the 13 years of school and training to be orthopaedic surgeon.

Fast forward a decade and life changes found me this winter in a bit of a slump. After two shoulder surgeries in 12 months and the life stresses we all face, I found myself falling back into old habits... and the loss of the healthy lifestyle that previously rejuvenated me.

Determined to return to my baseline, I thought I would share the some of the events that triggered the demise and the nutritional guidelines that I’m using to get there.

Rationalizations lead the list of things that fostered my demise. Eating dessert after a huge business meeting this one time wouldn’t hurt turned into dessert at every meal; eating the snacks that the clinic staff would bring to work; changing my diet routines at home because it was “easier” to eat like my teenage daughters (no one should adopt the eating habits of their teenagers… your metabolism will never be there again), all the while telling myself it was okay to delay my return to good habits because of "X, Y, or Z."

Another challenge was that I was accustomed to putting in some big training weeks for a few years. This actually made it easier to rationalize poor food decisions. You know how it goes: "I just rode five hours… surely this Ho-Ho I’m eating will get burned off without difficulty," or, "I’ve created a big aerobic engine -- it will burn off whatever I put in it." With fewer training hours, these occasional habits become that more obvious on the waistline and in my lab results.

Another important factor is the combination that I’m using/consuming less calories and exercising less, thereby resulting in a lower resting basal metabolic rate (metabolism) (van Pelt, R.E., Dinneno, F.A., Seals, D.R., & Jones, P.P. [2001]). Though somewhat controversial if considered as an independently from the above, I’m a bit older as well. Therefore, each poor decision is magnified.

I often use an old adage that if you want to be something that most people aren’t, you must do what most people aren’t willing. As I return to good habits, repeating this little mantra makes things a bit easier.

So on to my nutritional guidelines. The United States government spends a great deal of money trying to figure out how to reduce costs, and in particular, healthcare costs (http://www.cdc.gov/obesity/causes/economics.html). Therefore the U.S. government has provided great resources determining ideal diets. The benefits of an improved diet on health and fitness are numerous and include:

  • Reducing the risk for stroke and other cardiovascular diseases
  • Reducing the risk for type 2 diabetes
  • Protecting against certain cancers, such as mouth, stomach, and colon-rectum cancer
  • Reducing the the risk of coronary artery disease
  • Decreasing bone loss and reduce the risk of developing kidney stone

Every five years, the USDA scrutinizes all of the scientific literature on issues relating to diet and physical activity to health promotion and chronic disease prevention were examined. This is the basis for my new diet plan (http://www.cnpp.usda.gov/DGAs2005Guidelines.htm).

The basics are:

  • Focus on fruits. Eat a variety of fruits -- fresh, frozen, canned or dried. For a 2,000-calorie diet, you need two cups of fruit each day.
  • Eat more orange and dark green vegetables such as carrots, sweet potatoes, broccoli and dark leafy greens. Include beans and peas such as pinto beans, kidney beans, split peas and lentils.
  • Consume calcium–rich foods. Consume three cups of low–fat or fat–free milk (or an equivalent amount of low–fat yogurt and/or low–fat cheese) every day. If you do not or cannot consume milk, choose lactose–free milk products and/or calcium–fortified foods and beverages.
  • Make half of your grains whole. Eat at least three ounces of whole–grain cereals, breads, crackers, rice or pasta every day. Look to see that grains such as wheat, rice, oats, or corn are referred to as "whole" in the list of ingredients.
  • Choose lean meats and poultry and then bake, broil, or grill them. Vary your protein choices with more fish, beans, peas, nuts and seeds.
  • Know the limits on fats, salt and sugars. Read the "Nutrition Facts" labels on foods. Look for foods that are low in saturated fats and trans fats. Choose and prepare foods and beverages with little salt and/or added sugars.

Optimizing Personal Health
When considering optimizing our personal health, one must look at our relative health risks and family history. Personally, three of my four grandparents either died of a stroke or had carotid endartectomy. Therefore, I have paid particular attention to addressing the modifiable risk factors for stroke:

  • High blood pressure
  • Cigarette smoking
  • Diabetes mellitus
  • Carotid or other artery disease
  • Atrial fibrillation
  • Other heart disease
  • Sickle cell disease
  • High blood cholesterol
  • Poor diet
  • Physical inactivity and obesity

I don’t smoke, have diabetes or heart disease, so the bulk of my emphasis is on reducing my cholesterol, improving my diet, and maintaining a healthy level of exercise.

In order to improve my cholesterol or lipid profile, I need to increase my HDL and lower my total cholesterol. I am raising my HDL through exercise and dietary changes that include increasing the amount of healthy fat in my diet. Foods high in DHA or EPA will raise HDL. Additionally, I need to reduce the intake of bad fats which include saturated or trans fats. I am trying to reach the ideal total cholesterol/HDL ratio, which is under 3.5 to 1.

My Plan
My overall plan has included identifying areas that are counterproductive to my goal of eating healthy.

  • Breakfast: This has been easy -- coffee with whole grain English muffin with almond butter and fruit preserve spread without added sugar.
  • Lunch: Very challenging -- avoid bad choices in surgeons lounge and plan ahead to take lunch from home
  • Dinner: Lucky here that some (not so) subtle suggestions to Erin led her to mastermind a fantastic new weekly dinner schedule that helps me reach my goals of increasing good fish intake (you can see my thought on fish selection here). In addition to meat choices, my wife has been great about increasing the amount of roasted carrots and asparagus in olive oil with salt and pepper or spinach or broccoli in olive oil/garlic/salt and pepper. On meatless night, I do a salad with avocados, lettuce, pinto beans, salsa, tomatoes, and no or very little dressing.
  • My weekly dinner breaks down to this:
    • Monday: Leftovers
    • Tuesday: Meatless
    • Wednesday: Fish
    • Thursday: Chicken
    • Friday: Fish
    • Saturday: Chicken
    • Sunday: Meat
  • Snacks: Another tough one -- eliminate all snacks except some roasted almonds, apples, and berries low in sugar (blackberries, raspberries).
  • Training nutrition: I’m not training long days or big hours, so I restrict myself to bananas and water with an occasional backup gel. I'll will use Infinit for nutrition on long days greater than three or four hours.

I hope you find some of this information useful in your life. Best of luck in making good nutrition choices.

P.S. For those interested, 12 pounds are gone with three remaining to get down to 2007 racing weight. Labs due next month for my biannual lab check… stay tuned.

References:

Jeff Shilt, M.D., is the Director of Pediatric Orthopaedics at St. Alphonsus Medical center in Boise, Idaho, where he also has an expanding endurance sports medicine practice. Jeff is a multiple-time Ironman Hawaii qualifier.