Author Archives: jslyter

Fish Oil and Heart Disease – Beware


Pick up a bottle of Omega 3 fish oil and you will read that it supports heart health, and may reduce the risk of coronary heart disease.  What it does not tell you is that it can elevate your low density lipoprotein or LDL, which is referred to as the bad cholesterol.  What is does improve is your triglyceride.  To better understand this let’s look at both fats.

Cholesterol is  waxy, odorless lipid (fat) made by the liver that is an essential part of cell walls and nerves.  It also plays an important role in body functions such as digestion, and hormone production.  In addition to being produced by the body, cholesterol comes from animal foods that we eat to include meat, poultry, eggs, fish, and diary products.  Eating too much saturated fat therefore increases cholesterol.  The guideline for total cholesterol level in healthy adults is less than 200mg/dl.

Triglyceride is a fatty substance referred to as a lipid.  It is the fat that is carried in the blood from the food we eat.  Most of the fats we eat, including butter, margarine and oils, are in triglyceride form.  Excess calories, alcohol or sugar in the body are converted into triglycerides and stored in fat cells throughout the body.  The liver packages cholesterol with triglycerides and proteins as lipoproteins and transports it to sites throughout the body .  An elevated triglyceride level increases the risk of heart disease.  The guideline for a normal triglyceride level in healthy adults is less than 150 mg/dl.

The American Heart Association (AHA) does not recommend drug treatment to reach a normal triglyceride level.  Instead, for those trying to lower their triglycerides, lifestyle changes such as diet, weight loss and physical activity are encouraged.  That’s because triglycerides usually respond well to dietary and lifestyle changes.  The AHA recommends Heart-healthy polyunsaturated and monounsaturated fats found in oily fish as well as in flax seeds, walnuts and omega-3 eggs.  For those who need to lower their triglycerides the physician may order omega 3 capsules.  One should not take more than 4gms per day without a physicians care since it can increase the LDL

If you are taking omega 3 capsules for a healthy heart know what your heart status is.  If you have family history or told you have elevated triglyceride then omega 3 is right for you. On the other hand, if you have elevated cholesterol stop the fish oil and focus on other dietary measures.  Increase your soluble fiber since it forms a gel which binds some cholesterol in the small intestine and takes it out of the body.  The next time you are at the vitamin cottage ask about plant sterols.  It is a plant compound with chemical structures similar to that of cholesterol.  Interestingly because phytosterols so closely resemble cholesterol they can actually block food-based cholesterol from being absorbed into the blood stream.  The result is both phytosterols and dietary cholesterol end up excreted in waste matter.  Taking 0.8gms twice a day will decrease both LDL and total cholesterol. Your best options is to select foods with plant sterols added such as in orange juice and vegetable oil spreads,  otherwise to get 0.8gm naturally would require an excessive intake of  food items such as 12 cups of broccoli, 70 carrots or 26 oranges.

Written by Joanne Slyter, MBA, RD Westminster, CO



Having Gestational Diabetes Is Not A Sentence To Type 2 Diabetes

78484693Did you ever get diagnosed with gestational diabetes during your pregnancy and felt like a black cloud was placed over you? Were you told you have a likely chance of acquiring Type 2 diabetes?  Did you feel helpless waiting for doom and gloom?  Erase all that script from your mind – ALL IS NOT LOST!  According to studies conducted at the Department of Food Science and Nutrition, Laval University, Quebec City, Canada results of their study suggest  you can do something to prevent it!!  It’s called taking “preventive measures”.

Preventive measures involves examining your physical activity, dietary habits, and breastfeeding.  The goals for each are as follow: exercise a minimum of 150 minutes/week, eat a healthy diet, and breastfeed > 6 months.  For each addition of one preventive measure practice results in 30% less chance of having a body mass index (BMI) >25, 34% less chance of a waist circumference >.88cm, and 33% less chance of insulin sensitiviy <9.69.   (Gestational diabetes need not necessarily lead to T2D, if interventions are put in place)

You may wonder what a BMI, waist circumference or breast feeding  has to do with preventing diabetes.  The answer is fat!  Excess fat interferes with the muscle’s ability to use insulin. The key aspect of type 2 diabetes is Insulin Resistance, which  is the diminished ability of cells to respond to the action of insulin in the transporting of glucose from the blood stream into muscle. By managing your weight, and waistline you are assuring your body less chances of lower insulin sensitivity.  The benefit with breastfeeding is women who nurse may lose the weight gained in pregnancy faster, and more likely to
be true if she nurses for longer than 6 months.

For guidelines on a healthy diet go to

Signed by Joanne Slyter, Registered Dietitian, Westminster, CO




So What Do Kim Kardashian, Miley Cyrus and Bill O’Reilly Have In Common?

All three celebrities are sharing their so-called secret to good health and weight management.  They are claiming that avoiding wheat  or gluten is the diet of choice.  The question that comes to mind is if they understand just how restrictive a wheat or gluten free diet really is.  Wheat is one of three grains that contain the storage protein, more specifically called prolamin, that is considered toxic to those with celiac disease.  The other grains are rye and barley with oats to a lesser extent.

When avoiding rye, barley, and/or wheat  there are other ingredients that must be considered as well to make it a true wheat or gluten free diet. Triticale, for example, is a cereal grain that is a cross between wheat and rye;  farina,  bulgur,  couscous, graham, semolina, durum, bulgur, kamut, kasha, matzo meal, spelt, and tabouli are made from wheat or are a type of wheat.  Be aware that many ‘Wheat-free” foods are made from varieties of wheat such as kamut and spelt, but wheat-free does not mean gluten free. Tabouli is a salad usually made with bulgur wheat or couscous which are not gluten-free, but can also be made with guinoa which is gluten-free.

While the presence of gluten is evident in baked goods and pasta, it is often a hidden ingredient in many other items.   Candy to include hard candy, chocolates and licorice may contain barley malt flavoring and or wheat flour. Flavored coffees and teas may also contain barley malt flavoring.  Prepared meats may contain fillers made from wheat, and seasonings added may contain hydrolyzed wheat protein, wheat flour or wheat starch.

Alcholic beverages must also be considered.  Unfortunately beer, ale and lagers contain the mixture of barley, hops, and yeast that are only fermented and not distilled like other spirits.  The distillation process  allows those with true celiac to imbibe.

Although learning to eliminate gluten from the diet can be very challenging, emphasis on the nutritional quality of the gluten-free diet is frequently overlooked.  There are ten nutrients which have been found deficient in studies of individuals on the gluten-free diet.  These include calories, thiamine, riboflavin, niacin, pyridoxine, cobalamin, folate, iron, calcium and fiber.  Deficiencies of these nutrients can lead to anemia and bone deficiencies.  The gluten free foods are fortified with the same nutrients added to gluten containing products, but versus switching over to gluten-free bread and cereal many opt to avoid.  As a result, they bring on other problems not to mention a bad case of constipation from a lack of adequate fiber.

Decreased calorie intake is the primary cause for successful weight loss in this diet but it is the same cause for all other so-called fad diets.  (Keep in mind that the gluten free and wheat free diet are not fad diets meant for weight loss but are medically required for those with specific nutritional issues and physician prescribed ) There is nothing wrong with eating wheat and other gluten containing foods for those who do not have  a chronic autoimmune intestinal disorder or allergy.  The thing to always question before  embarking on any weight loss diet is if it requires avoidance of specific food items or food group.  The avoidance of the  item may cause more harm than good.  Primary cause for successful weight loss is portion control.  Eat the proper amount of all foods to make it balanced with nutrients and within the determined calorie level to assure a safe weight loss.  Keep in mind that exercise plays a big part in weight loss as well.

Signature by Joanne Slyter, registered dietitian, in Westminster, CO



Bet You Can’t Eat Just One!

To improve your blood pressure reading, eating less sodium is on top of the list.  In my previous blog I mentioned that The Dietary Approaches to Stop Hypertension, referred to as DASH, encourages you to  reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure.  Let’s look at this in more detail.

Sodium is a major component of table salt.  Our craving for salt is actually learned, and as such, can be unlearned.  If we cut back on our salt intake, the desire for salt will gradually decrease.   The American Heart Association  recommends to limit your intake to 1500 mg daily.  This can be a real challenge because food manufacturers add so much sodium to processed foods.  We need some sodium, but it is present in our foods as they are picked from the field because it is in the soil.  Most foods have some sodium even before they are processed, and that is OK, since it is enough to supply what we need but not enough to cause health problems.  It is the canned and processed foods that are the problem. If we cut out table salt, we only reduce our sodium intake by about 15%. Your best bet is to find items which state, “No Added Salt” on the label. You can also read the nutrition facts label.

The % Daily Value section on the food label tells you the percent of each nutrient in a single serving, in terms of the daily recommended amount. As a guide, if you want to consume less of a nutrient (such as saturated fat, cholesterol or sodium), choose foods with a lower % Daily Value of 5 percent or less. If you want to consume more of a nutrient (such as fiber), seek foods with a higher % Daily Value of 20 percent or more.

The typical sodium intake in our society is around 4000 – 5000mg/day.  As previously stated, the American Heart Association recommends cutting back to 1500mg to be heart healthy.  There are several steps you can take to reach that level.  Buy varieties of food with no added salt.  Rinse regular canned foods under running water to help reduce salt.  Skip items with added sauces.   Avoid food items that have been cured, smoked, processed, brined, or pickled since all have been prepared in salt.  For luncheon meats its better to cook fresh meat and slice up versus deli meats.  Cheese is high in salt so use sparingly. Be aware of products with the word sodium or salt in it such as monosodium glutamate, celery salt, onion salt, and garlic salt.  Use powders instead such as garlic powder. There are no limits on herbs and spices. There are also seasoning mixes with no salt you can try, like Mrs. Dash, which comes in various flavors.

So where is your level of sodium intake?  See if you can change your craving for salt by following the above recommendations for a month.  You may surprise yourself and suddenly decide salty chips are toooo salty and unappealing.

Signature by Joanne Slyter, registered dietitian who focuses her practice on nutrition consulting and coaching


I Don’t Know Why I have High Blood Pressure

In my previous blogs I looked at elevated HDL and triglyceride as risk factors for heart disease.  Both of these can be elevated due to eating behavior and weight, but family history can also be a detriment.  The next risk factor I want to focus on is high blood pressure.

A high blood pressure is defined as 140/90 or higher.  It is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. The Dietary Approaches to Stop Hypertension, referred to as DASH, encourages you to  reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium.   Lifestyle changes such as losing weight if your body mass index is above 25, moderate alcohol consumption which is defined as no more than 1 glass per day for women and 2 glasses per day for men,  limit saturated fats, add more fiber in your diet, manage stress,  avoid smoking,  and exercise regularly will also lower your blood pressure and can improve your overall health. With exercise, take it slow at first with just 10 to 15 minutes a day and gradually increase the time and intensity of your activity.  Choose something you enjoy and can stick with, such as walking, swimming, or bike riding, and make it a daily habit.

In my next few blogs I will look at each of these life style changes in more detail. What do you see may be affecting your blood pressure?

Signature by Joanne Slyter, registered dietitian with nutrition consulting and coaching practice located in Westminster CO



Triglycerides Need More Attention

There is always something on TV or in the newspaper talking about cholesterol and the need to lower it to prevent heart disease, but why doesn’t the triglyceride get the same attention? An elevated triglyceride is just as much a risk factor, and is even an indicator for other possible medical problems such as diabetes or pancreatitis.  So why not put warning signs on foods that could help lower this fatty substance known as a lipid in your blood?  The basic answer is that too much of anything we consume is converted into triglyceride, and therefore it’s simply not what we eat that counts.

Triglyceride is the fat that is carried in the blood from the food we eat. Most of the fats we eat, including butter, margarine and oils, are in triglyceride form. Excess calories, alcohol or sugar in the body are converted into triglycerides and stored in fat cells throughout the body. The liver packages cholesterol with triglycerides and proteins as lipoproteins and transports it to sites throughout the body.  An elevated triglyceride level increases the risk of heart disease.  The guideline for a normal triglyceride level in healthy adults is less than 150 mg/dl

To turn an elevated triglyceride around is not simply avoiding types of fats  ( important for lowering elevated cholesterol) but the amount of fat, protein, and carbohydrates (sugar) you consume.  This implies  watching your calories, lose weight if greater than 25 body mass index,  ( To check your body mass index look on the right-hand column for Resource Tools and click on Body Mass Index Calculator), and exercise to help control weight.

Being overweight places extra stress on your body in a variety of ways.    Control the calories you consume to take action in managing your weight.  It takes 3500 calories to equal 1 pound (lb) of body fat. Cutting back just 500 calories/day can promote a 1 lb weight loss/week. What does 500 calories look like? A 20-fluid-ounce bottle of regular cola plus one regular-sized candy bar equals approximately 500 calories.   If you are overweight, just losing 5%-10% of your weight can significantly reduce your Triglyceride!  For weight management, the key  is assuring that your daily caloric intake does not exceed the amount of calories you burn off per day.

A Heart Healthy Diet is the most recommended program to follow.  It is not a diet but  a way of eating that is appropriate for anyone older than 2 years of age. A heart-healthy diet is low in saturated fat, trans fat, and dietary cholesterol and full of fruits, vegetables, legumes like dry beans and peas, nuts, whole grain foods, and fish (preferably fatty at least two times per week) at an appropriate level of calories to help reduce triglycerides and LDL cholesterol level.

The American Heart Association (AHA) also recommends including oils and foods rich in alpha-linolenic acid such as flaxseed, canola, and soybean oils, walnuts and omega 3 eggs.  The AHA does not recommend drug treatment to reach a normal triglyceride level.  For those who need to lower their triglycerides, your physician may order omega 3 capsules.   It is important to know that taking more than 4 gm should be done only under a physician’s care since it can increase the Low Density Lipoprotein or LDL, which is referred to as the bad cholesterol, in some people as well as cause excessive bleeding. The LDL should therefore be monitored on a monthly basis.

Limit alcohol intake.  Even small amounts can lead to large changes in plasma triglyceride levels.  Drinking more than three drinks a day has a direct toxic effect on the heart. Heavy drinking, particularly over time, can damage the heart and lead to high blood pressure, alcoholic cardiomyopathy (enlarged and weakened heart), congestive heart failure, and stroke. Heavy drinking puts more fat into the circulation in your body, raising your triglyceride level. That is why doctors will tell you, “If you don’t drink, don’t start.”   Moderate drinking is defined as no more than one drink/day for a woman and two drinks/day for a man.   One drink is equal to 12 fluid oz of beer or wine cooler, 5 fl oz wine, or 1.5fl oz of 80 proof liquor.

Exercise is a necessary component for weight management and overall health.  Take it slow at first with just 10 to 15 minutes a day and gradually increase the time and intensity of your activity.  Choose something you enjoy and can stick with, such as walking, swimming, or bike riding, and make it a daily habit.  Also, add motion to every aspect of your day, but gradually so it won’t seem like much effort at all.  This is particularly helpful for people who aren’t used to exercising, for those with a body mass index above 30, or those with medical conditions.  Some suggestions are taking the stairs versus elevator, parking farther away, getting off the bus a few stops early, and walking instead of driving.

If you have family history of heart disease or diabetes keeping your triglyceride level down is vital.  If you notice it  is going up, review the checklist to see what you need to change:

  • Body Mass index >25
  • Eating excess calories especially sweetened dessert items
  • Alcohol intake not in moderation
  • Minimum exercise

It’s possible that your elevated triglyceride is hereditary and may require pharmacological therapy, but this is always the last step if lifestyle changes with weight management, diet and exercise do not work.  Don’t wait for the doctor to tell you what to do, but make changes now!!

Signature by Joanne Slyter, registered dietitian living in Westminster, Colorado who does nutrition consulting and coaching




Drink the Wine

I love life and only makes sense for me to do what I can to keep my chances  down of suffering and dying from cardiovascular disease and even cancer.  There are certain things beyond ones control that will put you at a higher risk, so first be aware of where you are starting out.  If you knew that your chances were few to none by following the 7 step guidelines from the American Heart Association, would you be prudent or risky with your health and life?

Before delving into what you can do, let’s first evaluate the risk factors that you have no control over.  Do you have family history of heart disease? You may be one whose genetic chemistry prevails you to have elevated cholesterol, low high density lipoprotein (HDL), elevated triglycerides,or elevated blood pressure which will not improve under the best of cardiovascular health behavior.

For this blog, let’s start by looking at cholesterol and HDL.  Your HDL, which  is called the “good” cholesterol, removes the bad cholesterol (LDL) from the arteries thus preventing plaque buildup that damages vessel walls and ultimately blocking blood flow. The goal for HDL is 40-50 for men and 50-60 for women.  HDL is not directly affected by watching the amount of fat you eat, but  by the kind of fat you eat, exercise, weight loss, quitting smoking, and moderate alcohol (wine) consumption.

Choose healthier fats.  This means avoiding saturated fat and trans fats, and consuming more monounsaturated and polyunsaturated fats.  Saturated fat is contained in animal products with the exception of tropical fats – palm, palm kernel and coconut oil.  These fats are usually added to bakery products and some candies.  Trans fats is a man-made fat which helps to increase the shelf life of foods.  Look for the words partially hydrogenated or hydrogenated oils on the label.   Monounsaturated and polyunsaturated fats — found in olive, peanut and canola oils — tend to improve HDL’s anti-inflammatory abilities.

Get more physical activity. Within two months of starting, frequent aerobic exercise can increase HDL cholesterol by about 5 percent in otherwise healthy sedentary adults. Your best bet for increasing HDL cholesterol is to exercise briskly for 30 minutes, five times a week. Examples of brisk, aerobic exercise include walking, running, cycling, swimming, playing basketball, raking leaves — anything that increases your heart rate. You can also break up your daily activity into three 10 minute segments if you’re having difficulty finding time to exercise.

Lose weight. Extra pounds take a toll on HDL cholesterol. If you’re overweight, losing even a few pounds can improve your HDL level. According to the Mayo Clinic,” for every 6 pounds (2.7 kilograms) you lose, your HDL may increase by 1 mg/dL (0.03 mmol/L).”

Don’t smokeIf you smoke, quit. The Mayo Clinic also states, “Quitting smoking can increase your HDL cholesterol by up to 10 percent.”

Enjoy a glass of red wine in the evening.  We can thank the French for this discovery.  The French paradox is wondering how a society that eats delicious creamy pastries, has cheese for a whole course at dinner, and a buttery croissant… sometimes with butter, perhaps with a bit of cheese or meat sausage, as a regular breakfast item, have less clogged arteries and are less obese than Americans or Brits.  For years this has been attributed to red wines “health benefits.”  According the the American Chemical Society, red wine specifically contain the compounds catechins and resveratrol called polyphenols that have antioxidant or anticancer properties, and saponins.  Resveratrol is thought to block cholesterol oxidation by its antioxidant action and saponins are believed to work by binding to and preventing the absorption of cholesterol.   Keep in mind, drinking a glass of wine can be good for you, but drinking more has its own health effects that can more than counteract the benefits of the wine.

Following all of these steps to improve you HDL is a prudent move , but if these changes don’t increase your HDL level, don’t beat yourself up.  Look into  your  family history of heart attacks and strokes and it may be that your low lab value is a familial issue.  You can’t remove the family genes but continue the lifestyle changes and discuss your concerns with your doctor or other health care professionals.  If needed, medications may be prescribed to help increase your HDL level.

In my next blog I will focus on elevated triglycerides, and what specific steps  you can take to improve it.

Signature Joanne Slyter, dietitian, Westminster, CO




Vit D3 is the New Vit D

From the newsletter of the Vitamin D Council:
Vit D has been taking center stage over the past few years with the discoveries of its positive affects on the elderly maintaining balance to reported lower stress fracture risk among adolescents involved in high-impact activity.

Vitamin D, known as the “sunshine vitamin” is found in a limited number of foods such as fatty fish, fish oils and egg yolk and is added to milk and margarine.  Some yogurt and yogurt-based beverages may also be fortified with vitamin D, however, other dairy products including cheese, ice cream, ice milk and frozen yogurt are not fortified foods.  It can also be produced naturally by the body when the skin is exposed to sunlight.  While it is possible for a healthy person under the age of 50 to get the currently recommended amounts of vitamin D from the diet, it is more difficult for someone over 50 years of age to meet their recommendations.

For those found to be deficient in Vitamin D many doctors prescribe it, with instructions to take one capsule every week, or every two weeks, or even one capsule per month. Up until the last few years, only one vitamin D2 , which is less potent and effective, has been available for prescription.   Vitamin D3 has now come on board and is available by prescription!

Bio-Tech Pharmacal has partnered with distributors to make 50,000 IU D3 available for thousands of US drug stores. Unless your doctor writes “Drisdol, do not substitute,” your pharmacist can give you human vitamin D, not plant vitamin D.

If you’re a medical professional, contact your local pharmacy to request they stock the product. If you’re a pharmacist, order the product and begin substituting Drisdol prescriptions now. If you’re a patient, tell your pharmacy today and make sure you start taking D3, not D2. The list of distributors and the information they need to know, is below.

The reasons to switch are as follow:

  • Vitamin D3 is the type of vitamin D the human body produces in response to sun exposure. Vitamin D2 supplements are produced by irradiating fungus.
  • Research has shown that the body prefers vitamin D3 over D2 when both forms are readily available in the body (Heaney 2011)
  • Research has shown that vitamin D3 is more efficacious in reducing mortality risk than D2 (Bjelakovic 2011). Research has also shown than vitamin D3 is more efficacious in reducing the risk of fractures and falls than D2 (Bischoff-Ferrari 2009).

I recommend if 50,000 IU is going to be prescribed, have it noted to   take weekly, which equates to 7,000 IU/day. Once every two weeks might do the trick (equivalent to 3,500 IU/day). Once a month is not enough  (equivalent to 1670 IU/day).

The list of distributors are as follow:

Bio-Tech D-3-50 (50,000IU)
NDC# 53191036201
Domestic Distributors

McKesson Drug Company
Cardinal Health
Emerson Ecologics
Dakota Drug
HD Smith Wholesale Drug Company
Gulf South Medical Supply
Smith Drug Company
National Drug Source

Signature  Joanne Slyter, dietitian Westminster, CO


Can I Snack on a Chocolate Bar?

Snacking use to be  required if a diabetic was on insulin, otherwise they were expected to eat only three meals a day.  Thank goodness rules have changed.  It was finally determined that the diabetic needs to control their diabetes and not have the disease control their lives.  So what are the new rules for snacking?

  1. Snacking for Type II is not required.  If you generally snack then continue since your body is adjusted to that eating pattern.
  2. Protein use to be required with  snacks to slow down the absorption of sugar into the blood stream, but now determined no longer necessary.  Carbohydrates (CHO) only or simple CHO snacks such as fruit are acceptable.
  3. For Type 1 diabetes, snacking is usually not necessary.  If you decide to snack and it isn’t your usual routine then begin with 1 unit of short-acting insulin for every 15 grams (gm) of CHO eaten.  Assess your insulin needs based on your blood glucose response.
  4. A bedtime snack is warranted if:
  • taking Ultra Lente or NPH at dinner
  • exercise during the day
  • have a history of nocturnal hypoglycemia
  • hypoglycemic at bedtime.

So what about the chocolate bar?  Carbohydrate counting meal planning allows for any food item.  Read the food label to determine how many CHO is in a serving.  A 2oz Snicker Bar has 35 gms CHO equal to 2 CHO choices (1choice=15gms CHO), but has 271 kcal and 14 gm of fat = to 2 slices of bread and 3 pats of butter!  Instead of having your usual snack of graham crackers and a glass of milk in the evening you can replace it with the candy bar, but beware of the calories and fat!!  Fat and protein do not affect the blood sugar but it can play havoc on the waistline if you aren’t paying attention.

So how do you like to snack?

Signature   Joanne Slyter, dietitian, in Westminster, CO





Poor Hydration Will Affect Exercise Performance


Congratulations if you are continuing on with your New Year resolution to exercise on a regular basis.  If you notice there are days where your performance is not up to par, yet you can’t relate it to anything in particular, it may be inadequate hydration.  Thirst drive is not stimulated until 1-2% water loss—therefore, exercise enthusiasts probably train in a state of hypohydration most times.  When given free access to fluids, subjects tend to consume only about ½ of the fluid they lost through sweat.

Water is the largest single constituent of the human body and is essential for cellular homeostasis and life. Total water intake includes drinking water, water in beverages, and water that is part of food. Although a low intake of total water has been associated with some chronic diseases, this evidence is insufficient to establish water intake recommendations as a means to reduce the risk of chronic diseases. Instead, an Adequate Intake (AI) for total water is set to prevent deleterious, primarily acute, effects of dehydration, which include metabolic and functional abnormalities.

The primary indicator of hydration status is plasma or serum osmolality, but not a realistic option unless you have access to a lab.   Because normal hydration can be maintained over a wide range of water intakes, the AI for total water (from a combination of drinking water, beverages, and food) is set based on the median total water intake from U.S. survey data. The AI for total water intake for young men and women (ages 19 to 30 years) is 3.7 L and 2.7 L per day, respectively. Fluids (drinking water and beverages) provided 3.0 L (101 fluid oz; ≈ 13 cups) and 2.2 L (74 fluid oz; ≈ 9 cups) per day for 19- to 30-year-old men and women, respectively, representing approximately 81 percent of total water intake in the U.S. survey.

Dehydration refers to an imbalance in fluid dynamics when fluid intake does not replenish water loss from either hyper hydrated or normally hydrated states. It impairs physical work capacity, physiologic function, and  predisposes one to heat injury when exercising in a hot environment   So what’s the best way to increase voluntary fluid intake?   Fluids should be cool…not cold.   Sodium in the drink (.5-.7 g/L) will stimulate the thirst response.  Thirst is triggered by a decrease in plasma volume and an increase in plasma sodium.  Consumption of plain water may remove the osmotic drive to drink.  Studies show that sports drinks are consumed at 2 times the rate of water.   Sodium though does not enhance fluid absorption because the amount in the beverage is miniscule compared to the amount of Na in the bloodstream. Palatability is a big factor.

There appears to be little physiologic need to replace electrolytes during a single exercise session of moderate duration (eg, less than 3 to 4 hours), particularly if sodium was present in the previous meal. However, including sodium in amounts between 0.5 and 0.7 g/L is recommended during exercise lasting longer than 1 hour because it may enhance palatability and the drive to drink, therefore increasing the amount of fluid consumed.    It should be noted that this amount of sodium exceeds that typically available in commercial beverages. Including sodium in fluid replacement beverages may also help prevent hyponatremia in susceptible people.  Although most athletes who drink more fluid than they lose as sweat simply excrete the excess fluid as urine, in some people it is retained . If the fluid contains sodium, it could help prevent the dilution of serum sodium levels, thereby decreasing the risk of hyponatremia. Limiting fluid intake so that it does not exceed sweat rate can also decrease risk of hyponatremia.

Colder air contains less moisture than air at warmer temperature, particularly at higher altitudes. Greater fluid volumes leave the respiratory passages as the incoming cold, dry air becomes fully humidified and warmed to body temperature. Cold stress also increases urine production, which adds to total-body fluid loss.

So what is an appropriate amount of fluid to consume?  You can easily calculate your hydration needs based on your sweat rate.

Sweat Rate:

  • Wt before exercise = 176#
  • Wt post exercise = 174#
  • Difference = 2# X 16 oz. (32 oz)
  • Fluids consumed during exercise = 70 oz.
  • Total fluids used during exercise =  102 oz.
  • Fluids used/hours of activity (102 oz/2hr)
  • Sweat Rate = 51 oz/hour

Hydrating based on sweat rate:

  • Drink every 10-12 min  10 oz – 5X/hr
  • Drink every 15 min  13 oz – 4X/hr
  • Drink every 20 min  17 oz – 3X/hr

In most cases athletes do not consume enough fluids during exercise to balance fluid losses, and thus complete their exercise sessions dehydrated to some extent. Consuming up to 150% of the weight lost during an exercise session may be necessary to cover losses in sweat plus obligatory urine production. Including sodium either in or with fluids consumed postexercise reduces the diuresis that occurs when only plain water is ingested . Sodium also helps the rehydration process by maintaining plasma osmolality and thereby the desire to drink. Because most commercial sport drinks do not contain enough sodium to optimize postexercise fluid replacement, athletes can rehydrate in conjunction with a sodium-containing meal.   High-sodium items include soups, pickles, cheeses, processed meats, pizza, pretzels, and popcorn. Use of condiments such as soy sauce and ketchup, as well as salting food at the table, also increase sodium intake

The overall take home message is to  monitor your hydration status.  Check the following:
  • Urine color- the lighter the better
  • Sweat rate
  • Pre-exercise :  16-24 ounces fluid prior to 2-3 hours prior to work out
  • During exercise:  6-12 ounces fluid every 15-20 minutes
  • Post-exercise:  24 ounces per pound lost
  • Possible inclusion of sodium foods or sports drink

In addition to increasing fluid intake 24 hours before strenuous exercise in the heat, it is recommend to consume 400 to 600 mL (13-20 oz) of cool water about 20 minutes before exercise.

Caution with hyperhydration.  There was one documented case at Ft. Benning, GA when a Soldier from Alaska drank 10+ canteens of water the evening prior to hyperhydrate and he ended up with severe hyponatriemia resulting in the Soldiers death.

Good luck with continuing your pursuit of a new you for the new year.

Signature  Joanne Slyter, dietitian, Westminster, CO   Interest in sports nutrition