Monday, June 11, 2018

Food Recommendations In Summer Heat

I received an interesting question about whether or not a particular diet should be recommended in hot environments. I must confess that because I'm accustomed to air conditioning, I hadn't given it much thought recently. Significant research has been done on the eating habits of military personnel stationed in both very cold and very hot environments, and the findings are worthy of note.

First of all, humans eat much less when temperature rises above 90 degrees Fahrenheit, and most mammals stop eating at temperatures above 104 F. There is a natural tendency to select liquids over solids at high temperatures, and carbohydrates are consumed in smaller quantities in the heat.

In one study comparing calorie consumption between soldiers stationed in the arctic versus the tropics, it was noted that those living in cold environments consumed about 25% more calories per day.

There is evidence that being overweight can interfere with heat dissipation, and that women are more at risk for heat stroke than are men, if both are sedentary in a hot environment. This may be due to the higher average body fat percentages of women.

Although hot food may raise body temperature, the "thermogenic effect" of food at any temperature is more significant than its physical temperature when consumed. In other words, the body has to work to break down and digest food, and this action creates more heat than the heat of the food itself. One study suggested that certain mammals have a 1 degree increase in body temperature for up to 3 hours after a meal, for example.

The bottom line is that our natural tendency is to eat less when it's hot outside, and for most of us that's a perfectly natural and desirable phenomenon. Eating hot food in hot temperatures is rarely dangerous, though we may feel uncomfortable sitting down to a bowl of hot soup in the sweltering heat. As for what's healthy - the same diet recommendations hold year-round. The Mediterranean diet is one of my favorites and has significant research to back its benefits.

My main dietary considerations in the heat are:
  1. Food poisoning. Avoid leaving certain foods out in the heat for too long, lest they succumb to bacterial overgrowth. Summer buffets are a prime risk for food poisoning. The FDA recommends leaving food at room temperature for only 2 hours at a time, and being especially wary of "doggie bags" where saved food may be left unrefrigerated for too long. 
  2. Adequate fluid intake. Dehydration is more likely to occur in the heat (obviously) and so consuming foods with a high water content, and drinking plenty of liquids is very important. Please see my health tip about water consumption for more details. A general rule of thumb for daily fluid needs: About 15.5 cups (3.7 liters) of fluids for men; About 11.5 cups (2.7 liters) of fluids a day for women.
  3. Hidden calories. It's easy to forget that the fluids we drink can contain a lot of sugar, adding hundreds of unwanted calories to our daily totals. Be sure to fill up with water and low calorie fluids whenever possible. 4. Limit alcohol consumption. Again, when we are thirsty and dry it's easier to take in too much liquid in the form of sugary or alcoholic beverages. Alcohol does have a diuretic effect on the body. For every 200mL of beer, for example, our body produces an extra 120 mL of urine (a total of 320mL) due to complicated hormonal changes in fluid regulation that occur with alcohol consumption. In large quantities alcohol can paradoxically contribute to dehydration and hangovers.
When it's very hot outside and you do not have access to air conditioning, limiting/adjusting exercise is probably more important for your health (in avoiding heat stroke) than changing your food intake. In my next tip we'll discuss safe summer sport and exercise strategies.


If you have any questions about summer eating, please log into your account and send us your question. We are here to help.

Friday, June 1, 2018

Summer Skincare

If you're interested in minimizing facial wrinkles, limiting "age spots" and discolorations, and avoiding skin cancer, then you must take steps to protect yourself from the sun's ultraviolet (UV) radiation. After a long, dark winter, we all yearn to shed the sweatpants and sweaters and get outside into the sunshine. Just remember to protect your skin from harmful rays prior to dashing outdoors. It's important to do this consistently.

Getting a sunburn (defined as pinkness or redness from sun exposure - it doesn't have to blister or peel to qualify), just once every 2 years, can triple your risk of melanoma skin cancer. And for those who are already using skin-lightening creams (hydroquinone) to reduce prior sun damage, an entire month of cream application can be reversed in a single 15 minute, unprotected sun exposure.

The best ways to reduce your skin's DNA damage from sun exposure are:
  1. Avoid direct sun exposure when the UV rays are their most intense (10am-4pm).
  2. Choose to sit in shaded areas whenever possible.
  3. Wear sun-protective clothing. Some summer clothing manufacturers list the SPF (sun protection factor) on the label. Coolibar ( and REI ( are two companies that feature sun-protective fabrics, for example.
  4. Wear sunglasses with UV protective lenses and a wide-brimmed hat.
  5. Use high SPF, broad-spectrum sunscreens (>30 SPF). There are two kinds of sunscreens - chemical (which use a scattering mechanism to reduce UV exposure - benzophenone and octinoxate) and physical barriers (sun blocks, which usually contain one of two metals: zinc oxide or titanium dioxide, do not allow the rays to penetrate). Whenever possible, choose the block type of sun screen as it is more effective. These days there are many tinted block options that reduce the old fashioned "white lifeguard nose" appearance.
  6. Remember that the sun reflects off of water and snow, and UV rays are stronger at higher altitudes. Reflected rays can actually burn you under your chin, so don't forget to put sunscreen there.
  7. Re-apply your sun block every two hours or when you suspect that water or sweat may have removed them or reduced their efficacy.
  8. Remember to cover your scalp and ears - visors do not provide the kind of coverage that full hats can. Use sunblock on the ears if they remain uncovered. Ear skin is high risk for skin cancers because we often neglect to put sunscreen on them.
Besides sun damage, dehydration and heat stroke are concerns at high temperatures. For more information about these topics, please refer to my previous health tips about water intake and heat stroke.

I'll see you around in my white, SPF 50 turtleneck with a big hat and sunglasses and zinc-face this summer!


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Tuesday, May 29, 2018

Fibrocystic Breast Changes

Whether called fibrocystic breast "changes" or fibrocystic breast "disease", it's a problem that affects up to half of all women at some point during their lives.  Currently, most doctors just refer to women as having fibrocystic breasts, since it really isn't a disease at all.  Fibrocystic breasts are lumpy, thick, and tender, especially right before menstruation.  The condition primarily affects women between the ages of 30 and 50 and tends to become less of a problem after menopause.

Why do breasts develop fibrocystic changes? Fibrocystic breast changes are linked to the hormone production that occurs during the menstrual cycle. There is no proof that drinking caffeine, eating chocolate, or eating a high fat diet is primarily responsible for this condition.

What symptoms are associated with fibrocystic breasts?  Specific symptoms include breast soreness, swelling, and heaviness.  Generalized breast lumpiness occurs most commonly in the upper/outer aspect of the breast (the portion closest to the armpit). Symptoms are generally worse right before the menstrual period, and then improve after menstruation begins. Women who take hormone replacement therapy often have more symptoms, whereas, women who take birth controls pills have fewer symptoms.

Is it necessary to undergo testing for fibrocystic breasts?  In most cases, a history and physical examination that is consistent with fibrocystic breast changes, is adequate to make the diagnosis. If there are any worrisome lumps, such as those that persist through several cycles, a mammogram and/or ultrasound should be performed.  Any new lump in a post-menopausal woman requires evaluation, since this is unlikely to represent a fibrocystic change. In some cases, it may be necessary to obtain a sample (biopsy) of breast tissue with a needle or by surgery in order to make an accurate diagnosis and differentiate between a fibrocystic breast condition and breast cancer.

Is there a treatment for fibrocystic breasts?  Treatment may not be necessary if symptoms are absent or tolerable.  When painful, treatment is usually directed at the symptoms themselves, or at the hormonal changes that cause fibrocystic breasts.  Symptomatic treatment includes taking a non-prescription analgesic, such as acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Advil), use of heat or ice on the breast, and wearing a well-fitting bra.  In some women, particularly those with irregular periods, taking low-dose birth control pills may be of benefit. In post-menopausal women on hormone replacement therapy, taking a periodic "vacation" from estrogen each month is sometimes beneficial.

Can fibrocystic breast changes develop into cancer?  Fibrocystic changes pose no increased risk of developing cancer.  However, fibrocystic breast changes can make it more difficult to distinguish developing breast cancer from fibrocystic lumps. Additionally, mammograms to screen for breast cancer can be more difficult to interpret when fibrocystic changes are present. This can lead to the increased need for additional testing such as ultrasound or biopsies.

Are natural remedies available for treating or preventing fibrocystic breasts?  Certain "natural" treatments may work for some women, but none has been proven to help all women. These treatments include:
  • Caffeine avoidance, including chocolate, sodas, coffee, and tea.
  • Eating a low-fat diet, with fat constituting less than 15% of the day's total calories. 
  • Taking a vitamin E supplement
  • Using evening primrose oil, an oil that is high in gamma-linolenic acid.
Before taking any medication or supplement, particularly if you are on other medications or could be pregnant, it is best to talk with your doctor first.

Sources for article:
Fibrocystic Breasts from Mayo Clinic
Evening primrose oil for fibrocystic breasts from Cleveland Clinic Wellness
Fibrocystic Breast Disease from Medline Plus

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