Answers to the Most Commonly Asked Nutrition Questions

Jodi Citrin, MS, RD, President, Citrition, LLC


What to Eat Before a Workout
Do you eat lunch and then wait to eat again until dinner? Do you also try to squeeze a workout in-between? If so, you are not alone. The problem -- if you eat lunch and then don’t eat for another 6 to 8 hours until dinner, your body is running on empty.
Food is your body’s fuel and your body needs it to function. And, if you want it to function well enough to do physical activity, you need to eat. Although we can store some food, the amount of food stored in our muscles only lasts a few hours.  So, it’s normal to be hungry every 3 to 5 hours. If you’re not eating anything after lunch and going to the gym on your way home from work, it’s expected that you would be hungry.
Yet, despite this hunger, many of us ignore it and try to exercise without eating. We think it’s okay to keeping pushing our body to workout without feeding it. In order to maximize your workouts and maintain lean body mass you must feed your body. Starving yourself or holding out to eat until dinner means you’ll be fatigued while exercising which means you’ll get fewer benefits out of your workout. What’s the chance you’ll push yourself the extra ½ mile or do that extra set if your stomach is grumbling and all you’re thinking about is food? 
The solution -- have a small snack to hold yourself over until dinner. This will also give you enough energy so that you can have a great workout and not feel sluggish. Generally, a snack should be about 150 – 200 calories depending on your age, sex and physical activity level. Men generally need more calories than women, so it would be normal for a snack for a male to be more caloric than that for a female.  However, having a “snack” of 500 calories is not a good idea which means grabbing a few cookies from the conference room is not the solution.
Eating 500 calories is more like a meal and could make you feel ill during a workout, particularly if you are doing cardio. Carbohydrates are the main source of energy for your body so you need them to function, and especially to work out. About 50 – 60% of your total calories should come from carbohydrates.  Most people only think of bread and pasta as carbohydrates, but carbohydrates include: cereals, grains, fruits, vegetables and dairy products. 
When carbohydrates are broken down in your body, they are broken into glucose which your body can quickly use for energy. The type of snack you should eat depends on when you are eating it relative to when you are exercising. It should almost always include some type of carbohydrate. If you are eating a few hours before working out, you should opt for a balanced snack or one that includes foods from different food groups.
That means eating carbohydrates with a fat or carbohydrates with a protein.  Some examples of good snacks are: whole wheat crackers with cheese, nuts with dried fruit or turkey slices with lettuce. If, on the other hand, you are eating shortly before working out, i.e. on the way to the gym, you want a snack that is high in carbohydrates, but low in fat and protein. It’s also essential to choose easily digestible carbohydrates, not those high in fiber like whole wheat crackers. (Fiber is really important for good health, but not a good snack before a work out.
The fiber takes a long time to digest and can lead to bloating during workouts.) Instead, choose foods such as an english muffin, a few saltines, a low-fat yogurt, a banana or an apple.  These foods are easy to digest and will give your body the energy it needs to exercise. It is best to eat at least a half hour before you work out so you have time to digest the food. It’s also important to avoid anything really sweet or sugary before working out.
The sugar gets digested very quickly and can give you a stomach ache when you are exercising. Snacks such as candy, sweetened cereal, or even many of the protein/granola bars are too high in sugar to be a good pre-exercise snack. If your workout isn’t at the end of the day, but rather first thing in the morning, it is also important to have a small snack before you work out. Likely you have not had anything to eat in at least 8 – 12 hours since the night before.
As previously mentioned, exercising takes energy and without food, or fuel, it is nearly impossible for your body to effectively do any. Although you may feel like you are able to workout, you will not be getting the same results as if you were to eat something. If you are going to the gym in the morning before work, it’s unlikely that you will get up a half hour before you exercise to eat something.  So, opt for something small that can be digested quickly, such as a banana or 6 oz of juice.
Also, be sure to drink plenty of water as you likely have gone many hours without hydrating your body.  Remember, our bodies are very efficient and can make the best of what we provide them. But, if you want to maximize your workouts, drink plenty of water and have a small snack before going to the gym whether in the morning or at the end of your day.  Sugar – Natural vs Added and the Effect on Working Out
Carbohydrates are our body’s main source of energy. Each gram of carbohydrates provides four calories.  There are two types of carbohydrates - complex carbohydrates and simple carbohydrates – and a balanced diet should include nutritious sources of both. Starch such as potatoes or bread are complex carbohydrates whereas sugar such as that found in fruit and candy are simple carbohydrates.  When starch is digested in our bodies, it is broken down into simple carbohydrates or sugar.
It is common knowledge that sugar is in cookies, candies, soda and cakes, but sugar shows up in a lot of other unexpected places. Although sugar may not cause hyperactivity as once thought, it does cause dental caries and excess weight gain. There are two types of sugar: natural and added. Natural sugars are sugars that are part of a food.
For example, fructose is a sugar that is naturally found in fruit and lactose is a sugar naturally found in milk. These sugars are healthy and should be part of a balanced diet. Sugars that are added to foods, usually processed foods, are the sugars that need to be limited. Added sugar is found in soda, sweetened beverages, ice cream, cereal, cakes, cookies, candy and many other packaged foods.
Our body does not know the difference between added sugar and natural sugar. It merely recognizes that you have given it sugar. However, natural sugar found in foods such as fruits is usually found with vitamins, minerals, phytochemicals and other nutrients. Most foods with added sugar contribute little or no additional nutrients. Individuals who eat foods with added sugar often replace nutritious foods with these high sugar foods.  Therefore, it is important to limit added sugar to about 10% of your total calories for the day.
For someone eating a 2,000 calorie diet, that means only 200 calories should come from added sugar. For young children, who often need less than this number of calories, the number of calories that can come from added sugar is even fewer.  Keep in mind that most sweetened drinks such as soda, flavored juice drinks and sweetened iced tea, provide that many calories in only one beverage. So, it’s easy to overdo the sugar if you are consuming a lot of packaged foods and beverages. How can you know if you’re getting too much sugar? By reading the food label. You can look at the ingredient list as well as the nutrition facts panel to check if the food has too much sugar. 
If sugar is in the first three ingredients of a food, the food has too much sugar. Be aware that sugar can be disguised as many other names. Watch out for names like high fructose corn syrup, honey, sucrose, fructose, glucose, dextrose, maltose, lactose, confectioner’s sugar and maple syrup turbinado sugar. All of these are alternative names for sugar.  Therefore, if any of these are in the first three ingredients, the food is also too high in sugar.
The other way to check if a food has too much sugar is to check the nutrition facts label. If a food has more than 8 grams of sugar per serving (check under carbohydrates), the food contains too much sugar. Keep in mind that four grams of sugar is equal to one teaspoon. To limit your sugar intake, or the sugar intake of your children, limit your intake of foods with added sugars or try switching to low-sugar versions of foods.
Be aware of some common places for hidden sugar -- juice, granola bars, yogurt and cereal.  Although most people are aware that cake is not healthy, these other foods are often assumed to always be healthy. However, if they are versions that are loaded with sugar, that can compromise how nutritious they really are. If juice does not say 100% fruit juice, it is not. Many juices are only 10% juice. The rest is sugar water.
Some of these juices have more sugar than an equivalent amount of soda.  If you’re serving juice, make sure it says 100% fruit juice. Keep in mind that most juice flavors that are flavors you’ve never heard of, such as kiwi-strawberry, are not 100% juice.  Also, watch the sugar content in cereal. Even cereals that appear to be “healthy” cereals are often loaded with sugar. Watch out for yogurt coatings and fruit pieces (other than raisins) which can significantly increase the sugar content of the cereal.    
Artificial sweeteners are another option for decreasing sugar intake.  Artificial sweeteners such as Splenda are considered safe to use, but should still be used in moderation.  Avoid replacing all sugar with artificial sweeteners. Too much of this is not healthy either.  Some researchers suggest that frequent use of artificial sweeteners may cause increased cravings for sweets. So, keep this in mind when switching to foods that are artificially sweetened.
Limiting high sugar foods such as candy, cookies and even some meal bars is not only important for health reasons, but also important for working out.  Eating foods high in sugar before working out can cause cramping. Even fruits should be consumed at least a half hour before working out so that you have time to digest. The best way to limit added sugar in your diet is to eat foods closest to their natural states such as fresh fruits and vegetables, fish, chicken, milk, nuts etc. Limit your consumption of processed foods to limit your intake of added sugar. By doing this, you will also most likely end up eating a healthier diet.
Calculating Protein Needs Many individuals mistakenly believe that it’s not only okay, but really healthy to eat as much protein as you want. The confusion is due in part to the abundance of low-carbohydrate diets pushing protein – bacon, eggs, cheese… - at every meal, snack and in-between.  However, eating too much protein can cause serious liver and kidney problems. If you are training for an endurance event, such as a marathon or Iron Man competition, you do need extra protein, but only a small amount more.
In this case, about 15% of your calories for the day should come from protein. This is in comparison to someone who isn’t training who only needs about 10% of their calories from protein. To put this in more tangible terms, for an athlete consuming a 2,000 calorie diet, 15% of your calories would work out to be 300 calories from protein. 
Three hundred calories from protein is equivalent to 75 grams of protein. (1 gram of protein = 4 calories). It’s important to keep in mind that most people in the United States consume significantly more protein than they need -- that is more than 15% of their calories come from protein sources. So, how much do you need? Most women need about 60 to 75 grams of protein whereas most men need 75+. You can also figure out your approximate protein needs with the following calculation:
1. Convert your weight in pounds to kilograms by dividing it by 2.2.
2. Multiply your weight in kilograms by .8
3. Multiply your weight in kilograms by 1
4. This gives you a range of how many grams of protein you need
Ex. 140 pound woman
140/2.2 = 63.6 kg
63.6 * .8 = 51 grams
63.6 * 1 = 64 grams
This woman would need 51 – 64 grams of protein each day.
Protein is found in animal products such as meat, fish, poultry and eggs. It is also found in soy products, dairy products, nuts, grains and even vegetables. For example, you could get 52 grams of protein just from a chicken sandwich: 6 oz chicken (42 grams), 2 slices whole wheat bread (2 grams), 1 oz cheese (8 grams). For someone who needs 75 grams of protein a day, that sandwich would provide almost 70% of the protein needs for the day. Or, in the case of the woman in the example above, this could be all of her protein needs for the day. 
Protein has many important functions.  It is essential for building muscle, forming enzymes, hormones, and antibodies, maintaining acid-base balance, maintaining fluid and electrolyte balance, for growth and for energy.  Animal sources are the best source of protein as they are complete proteins. That means they contain all the essential amino acids that we need. Essential amino acids are amino acids we cannot produce in our body, but can only get from our diet.
Examples of complete proteins are: meat, fish, poultry, eggs and milk. Protein that comes from plant sources such as bread, rice, nuts or beans are incomplete proteins. They are missing at least one essential amino acid. In order to get all the essential amino acids you need, you must eat another different incomplete protein.  These two sources then complement each other providing all the essential amino acids. 
An example of how to properly combine proteins would be to eat rice and beans. It was previously believed that you needed to eat the two foods in the same meal, but it is now accepted that as long as you eat the foods in the same day you will get the benefits of a complete protein. Vegetarians must be aware of eating a wide variety of plant based foods to ensure that they are getting all the essential amino acids. 
Vegetarian athletes must be even more aware because of the increased protein needs.  Most individuals who eat animal products will consume an adequate amount of protein if they are eating a balanced diet.  The bottom line – it isn’t necessary to get protein from shakes if you are eating a healthy, balanced diet. One meal with animal protein could provide almost your entire protein needs for the day as seen above. 
Supplements – What you Need and What is a Waste of Money
There is a huge market for supplements today.  Most nearly every problem one can think of has a supplement claiming to cure that problem.  What most people don’t know is that there are different regulations for supplements than for medications and food. “Under the Dietary Supplement Health and Education Act of 1994, the dietary supplement manufacturer is responsible for ensuring that a dietary supplement is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market.” (Office of Dietary Supplements)
In other words, supplements can make any claims they want about the health benefits they provide. Not only does that mean the claim may not be true, but the supplement could actually be harmful. Supplements do not get removed from the market until there have been many reports of problems as in the case with Ephedra. For most adults, taking a multivitamin can be beneficial and help ensure that you are getting all of the vitamins and minerals you need.
For many Americans, calcium and vitamin D supplements are also beneficial as it is common to not get enough of either of these through diet. The amount of calcium and Vitamin D that adults need increases as you age.  Therefore, older individuals and those individuals with little exposure to sunlight can benefit from a Vitamin D supplement. A calcium supplement can also be very important for individuals who are lactose intolerant or do not consume dairy products. (read below about calcium to see the exact amount of calcium required for different age groups)
Supplements have also become very popular for preventing heart disease due to the number of individuals suffering from it. Since current health recommendations suggest that eating fatty fish at least two times a week provides enough omega-3 fatty acids to decrease the risk of heart disease, fish oil supplements have become very popular. Studies have shown mixed results from taking these supplements. Fish oil supplements may lower triglycerides (a positive effect), but may increase total and LDL cholesterol which increases the risk of heart disease.
The benefits from eating fish and taking a supplement are different which is why it is always best to get something from its natural source rather than from a supplement. Often it is a combination of nutrients and phytochemicals in the foods that lead to the health benefits, not a single nutrient extracted from the food.  If you do not like fish, you can still get omega-3 fatty acids from many other sources such as omega-3 eggs, walnuts, canola oil and wheat germ. 
For those individuals who are trying to lower their risk of heart disease by lowering cholesterol, Metamucil and phytosterols are supplements that have been shown to be effective.1,2  On the contrary, antioxidants, garlic, isoflavones, guggul and tocotrienols supplements have been shown to have no effect on lowering cholesterol. 1,2 Supplements are also essential during pregnancy. Studies have shown that taking a prenatal vitamin benefits most babies except in rare circumstances. The diets of many American women are deficient in some of the nutrients that a developing fetus needs most. To ensure an adequate supply of these nutrients, women are encouraged to take a prenatal vitamin throughout pregnancy and often post-pregnancy if they are breastfeeding.
Other individuals who could benefit from supplements are those individuals with chronic diseases, individuals suffering from eating disorders, individuals on severely restrictive diets, individuals from families without enough food, individuals who avoid certain food groups and individuals following a vegetarian diet. Always discuss any supplements you are taking with your doctor.  For more detailed information on specific supplements, visit the Office of Dietary Supplements at http://dietary-supplements.info.nih.gov/index.aspx.
Calcium for building muscle and losing weight. Calcium is essential for many functions in the body. It helps build and maintain bone, teeth and muscle tissue and it regulates heartbeat, muscle action, nerve function and blood clotting. Eating a diet high in calcium can also help lower blood pressure. Some research suggests it may also help relieve PMS symptoms as well as burn fat.
Calcium is an abundant mineral found in many sources throughout nature. Good sources of calcium are dairy products such as milk, yogurt and cheese. Pudding, ice cream and frozen yogurt can also often provide a good source of calcium. Calcium is not only found in dairy products, but in other foods as well.  For individuals who are lactose intolerant, there are many other ways to get calcium. Some good sources include calcium fortified orange juice, calcium fortified soy milk, beans, almonds, tofu and dark green vegetables. The exact amount of calcium needed by individuals is not known, but the daily recommendations are as follows:
9 – 18 years old 1300 mg
19 – 50 1000 mg
50+ 1200 mg
For individuals who are unable to get enough calcium from the diet, there are also many varieties of supplements. Some possible supplement sources are calcium pills, Viactiv or tums, although there are many others.  Calcium is best absorbed if taken in 500 mg doses, rather than one 1000 mg dose. It is therefore best to take two doses of calcium – one in the morning and one in the evening – if you are taking supplements.
One hot new topic of debate is over whether dairy can promote weight loss.  The dairy industry has quickly taken advantage of this theory, promoting that 3 servings of dairy a day can help with weight loss. However, research has been minimal and results have been conflicting.  Two studies conducted on obese individuals showed that dairy can be beneficial for weight loss when combined with caloric restriction in obese individuals.3,4  However, another study in overweight and obese individuals showed that a diet abundant in dairy products did not aid in weight loss.5 Whether dairy can promote weight loss is not known for sure, but what is known is that the benefits of dairy are many.
Dairy is a great source of calcium (as well as Vitamin D) which has many functions in the body.  Some suggest that dairy may also curb appetite, so it can make a great snack.  Until more is known about the effects of calcium on weight loss, do not assume that you will lose weight by eating 3 servings of dairy a day.  But, do know that you can get many other health benefits from eating your dairy (see above).  Also, because of calcium’s role in regulating muscle action and tissue, it is essential for building muscle, another great incentive to include it in your diet.
So, for all of you weight lifting protein fanatics out there, don’t forget about calcium. Calcium is also essential for building and maintaining muscle mass. And, because dairy products are also a good source of protein you can get really get bang for your buck with them!
With a list of functions as numerous as calcium has, go ahead --- drink or eat up. But, make sure to consume low-fat or nonfat dairy products.  Whole milk and full-fat dairy products are high in saturated fat, the fat associated with increased risk of heart disease, as well as cholesterol and calories. So, if you do want to lose weight, low-fat and nonfat products are a great option for getting your dairy products without overdoing it on the calories and fat. And, remember that weight loss is based on caloric intake and expenditure. The only way to lose weight is to eat less, burn more calories or ideally, both. 
Jodi Citrin, MS, RD is the President of Citrition, LLC, a cutting-edge private nutrition counseling practice based in New York City specializing in healthy eating and weight loss. Her NYC-based practice attracts clients across the country including models, news anchors and celebrities. In addition to private counseling, Jodi is often asked to speak at corporations, non-profit organizations, hospitals and universities throughout the tri-state area.  Jodi is also a co-author of the upcoming book The Little Black Apron: A Bachelorette’s Cookbook (Adams Media, 2007).
For more information, go to www.citrition.com or call 212.535.1795.
References
1. Schardt D.  The heart of the matter.  Nutrition Action.  2004 Apr;31(3):8-11.
2. Castro IA, Barroso LP, Sinnecker P. Functional foods for coronary heart disease risk reduction: a meta-analysis using a multivariate approach. Am J Clin Nutr. 2005 Jul;82(1):32-40. 
3. Zemel MB, Richards J, Mathis S, Milstead A, Gebhardt L, Silva E. Dairy augmentation of total and central fat loss in obese subjects.  Int J Obes (Lond). 2005 Apr;29(4):391-397.
4. Zemel MB, Thompson W, Milstead A, Morris K, Campbell P. Calcium and dairy acceleration of weight and fat loss during energy restriction in obese adults. Obes Res. 2004 Apr;12(4):582-590.
5. Harvey-Berino J, Gold BC, Lauber R, Starinski A. The impact of calcium and dairy product consumption on weight loss.  Obes Res. 2005 Oct;13(10):1720-1726.