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How Many Calories Do I Need? And Other Questions From The Boys & Girls Clubs Fit Family Challenge

This year’s finalists for the Boys & Girls Clubs’ Fit Family Challenge are about to be announced. I’ve had the privilege of acting as nutrition coach for the semi-finalist families, and have had fantastic interactions with them about common nutrition questions. In my continuing Q&A series, I thought I’d share some of our email conversations:

Q: How many calories do I need per day, and how many should I eat to lose weight?

I like to use this Mayo Clinic calculator to get a rough estimate of daily caloric needs.   If you enter your height, weight, age, and activity level it will tell you approximately how many calories/day you need to maintain your weight. To lose one pound a week, you need to subtract 500 calories/day from that number. So, for example if the calculator suggests that you need 2000 calories/day – you should follow a 1500 calorie/day diet to lose 1 pound a week. Studies have shown that people who drop more than 500 calories below their daily maintenance needs have a hard time sticking to their diet. You may feel weak, trembly, and irritable if you cut down too low too fast. You will have to play with the amount a little bit since the calculator is not exact – if you don’t see the scale moving when you cut out 500/day, then you have to wonder if you’re counting calories correctly or perhaps if you have to go a little bit lower still. Unfortunately, the “reward” for losing weight is that you have to permanently eat less when you are at your desired goal because there is less of you to feed!

Q: What do you think about sports drinks? Do my kids need them when running races?

As far as sports drinks are concerned, their benefits are often over-hyped and exaggerated. That being said, I believe they do have a role in hydration during endurance sports like long distance running. When you do strenuous exercise for long periods of time (over 1 hour of effort) you lose a lot of body salt and minerals (electrolytes) in your sweat. It’s important to replace certain key electrolytes so your body doesn’t become depleted and begin to cramp. This is more likely to happen to folks running very long distances, such as marathons and triathlons. However, if it’s hot during your race, you could be at risk for dehydration and electrolyte loss as well.

Regular Gatorade (made by Pepsi Co.) has water, sugar, sodium, and potassium in it. Powerade (made by Coca Cola) has water, sugar, sodium, potassium and B vitamins. Powerade has a little bit higher sugar concentration, which could be an advantage on a long run. Both are reasonable choices for hydration during a race.

The rough rule of thumb is to take in 6-12 oz of fluid for every 20 minutes of running. Water is sufficient for runs that last less than an hour. Sports drinks (or adding electrolyte gels/chomps to water) are helpful if your run will last longer than an hour. It’s better to sip the water slowly at regular intervals than to dry to gulp it all down at one time. You may feel nauseated or have a “sloshy stomach” feeling if you don’t spread out your hydration.

Sports drinks can be quite expensive – and you can easily create your own at home. The World Health Organization has a simple recipe for rehydration fluids, and I found this (probably slightly tastier) version on a blog site.

Outside of endurance sports, I don’t see a physiologic need for sports drinks (with the exception of extreme sweating in hot weather or during illness with vomiting and diarrhea) – they can add unnecessary calories to your diet.

Q: Should I cut down the amount of salt in my diet?

Not necessarily. Too little salt, as well as too much salt, have both been shown to be unhealthy. If you’re eating a lot of fast food, you’re probably getting too much salt. If you cook for yourself and focus on fruits and veggies, whole grains, and lean protein you may not need to cut back. Unless you have a kidney problem or very high blood pressure, salt is generally not dangerous for you. About 2.5g of salt/day (roughly a teaspoon full) is optimal, but for most people up to 4g/day probably won’t hurt (and at least one study suggests that heart disease risk doesn’t increase until the daily intake of salt exceeds 7g/day).

The Truth About Weight Gain

Consuming excess calories increases body fat, regardless of how many calories come from protein. High-protein diets do affect energy expenditure and storage of lean body mass, just not body fat storage.

To evaluate the effects of overconsumption of low-, normal-, and high-protein diets on weight gain, researchers conducted a single-blind, randomized controlled trial of 25 healthy, weight-stable adults in an inpatient metabolic unit in Baton Rouge, La. Patients were ages 18 to 35 with a body mass index between 19 and 30. The study was headed by George A. Bray, MD, MACP.

After consuming a weight-stabilizing diet for 13 to 25 days, participants were randomized to diets containing 5% of energy from protein (low protein), 15% (normal protein) or 25% (high protein). Only the kitchen staff who supervised participants while they were eating knew the assignments. There was no prescribed exercise, and alcohol and caffeine were restricted.

Patients were Read more »

*This blog post was originally published at ACP Internist*

Do Artificial Sweeteners Actually Promote Weight Gain?

When sugar-free beverages first became available, I was skeptical that they could really taste as good as “the real thing.” I quickly changed my mind. In fact, it seemed to me that the sugar-free versions actually tasted better than “the real thing.”

It seemed like a no-brainer. Sugar-free beverages had no calories and tasted better—maybe there is such a thing as a free lunch. Obviously, many people who also wanted to lose weight made the same switch. Were we right about artificial sweeteners?

Although short-term studies suggest that switching from sugar to no-calorie sweeteners can help, other research suggests it may actually promote weight gain. Writing in the December 2011 Harvard Health Letter, noted obesity researcher Dr. David Ludwig explores the possible connection between sugar substitutes and weight gain.

The FDA has approved six calorie-free sweeteners: acesulfame, aspartame, neotame, saccharin, Stevia, and sucralose. They are Read more »

*This blog post was originally published at Harvard Health Blog*

How To Lower Your Cholesterol

Your doctor has just informed you that you have “hyperlipidemia” — or high cholesterol. She’s mentioning lipid-lowering drugs (statins), but you said you want to try some things on your own first. She agrees and will recheck your blood levels in three months. What are you going to do?

The advice is all over the map and your Google searches come up with various supplements and diets that are confusing and overwhelming. Here are some specific recommendations, based on evidence, that can help you lower your cholesterol. Read more »

*This blog post was originally published at EverythingHealth*

Which Diet Fits Your Genes?

Why do some diets work better than others? Why can your best friend lose 10 pounds with a low-carb diet and your weight just hovers? Why can some people eat just about everything and still stay skinny?

It’s all in the genes. 

Mindy Dopler Nelson, Ph.D., of Stanford University reported the results of her study at the American Heart Associate Conference. She found that a single nuceotide polymorphism caused women to loose five times as much weight on the Atkins diet compared with women who didn’t have the gene. Read more »

*This blog post was originally published at EverythingHealth*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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