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Summer Safety Tips

June 2, 2014 by  
Filed under Uncategorized

SUmmer Safety Tipsby Mommy MD Guides blogger Shilpa Amin-Shah, MD

Family safety is a priority regardless of the season, but the summer gives us more reason to emphasize simple measures to keep out of harm’s way.

  • Pool Safety: Be sure to swim only where there are lifeguards or adult supervision. Always use life jackets during water activities and when near open bodies of water such as the oceans, rivers, and lakes. Never leave your children unattended around water. Maintain barriers such as fences and locks to keep children away from unattended pool areas.
  • Food Safety: Summertime is often associated with outdoor barbecues and picnics. Mayonnaise, milk, eggs, meat, poultry, and seafood should not be kept at room temperature for more than an hour or two (one hour max if it’s hotter than 90 degrees outside). Be sure to thoroughly wash all raw fruits and vegetables. If you are traveling with food, be sure to use plenty of ice packs and ice to keep food cool.
  • Bug Safety: The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend an insect repellent that contains 10 to 30 percent DEET for children two months old or older. The DEET percentage represents how long it’s effective: Ten percent will provide protection up to two hours, while 30 percent will cover you up to five hours. Do not apply DEET to face or hands. DEET is effective in preventing insect-related diseases such as Lyme disease and West Nile Virus. For a greener approach to bug busting, organic mosquito repellents are available in most pharmacies.
  • Sun Safety: Make sure you apply sunscreen before leaving the house. The American Cancer Society recommends wearing SPF 15. Stay in the shade as much as possible during the sun’s peak hours between 10 am and 4 pm. Make sure to re-apply sunscreen every one to two hours when swimming or if you are excessively sweating. Wear protective clothing, a hat, and sunglasses.
  • Heat Safety: Limit time outdoors when the weather is extremely hot and humid. If you do not have air conditioning in your home, go to public places that do, such as shopping malls, libraries, and grocery stores. Avoid hot, enclosed places, such as cars. Wear light-colored and lightweight clothing, and drink plenty of water before and during your time outdoors. Heat stress in children and adults can lead to serious health issues very quickly. The very young and the very old are at most risk for heat exhaustion because of their inability to handle high temperatures. If you are taking the kids to the playground, check the temperature of the playground equipment because it can get very hot and could burn your child.

Eight Signs of Heat Overexposure

  1. Rapid heartbeat
  2. Headache
  3. Fatigue
  4. Nausea and vomiting
  5. Excessive sweating (However, if heat stroke sets in, the body can no longer compensate and may stop sweating.)
  6. Muscle cramps
  7. Dark-colored urine
  8. Fainting, confusion, dizziness, or disorientation

Six Tips for Overcoming Heat Stroke

  1. Move the person out of the sun and into a cool area. An air-conditioned area is ideal, but moving someone into the shade will also help.
  2. Remove any heavy or tight clothing.
  3. Give the person cool water to drink.
  4. Mist the skin to help keep him or her cool.
  5. Apply ice to his or her neck or armpits.
  6. Immerse the body in cool water, either at a swimming pool or in a bathtub.

If these measures do not cool the person off in 30 minutes, call 9-1-1 and go to your nearest emergency room.

Shilpa Amin-Shah, MD is a mom of two young children and a physician at eMedical Offices in Berkeley Heights and an attending emergency physician at Saint Barnabas Medical Center in Livingston. She received a bachelor’s degree from Rosemont College in Rosemont, Pa., and her medical degree from SUNY Downstate, Brooklyn, NY. She completed the Jacobi/Montefiore Emergency Medicine Residency Program at Albert Einstein College of Medicine and served as chief resident.

Anti Flat-Belly Foods

April 15, 2014 by  
Filed under Uncategorized

by Mommy MD Guide Ayala Laufer-Cahana, MD

Does the food we eat affect our body composition? Let’s start with the obvious: Caloric surplus makes you gain weight—too many calories in and too few out, and fat accumulates; reverse the equation, and weight is shed.

But here’s an intriguing question: Can the type of food we eat cause fat to accumulate preferentially in the belly? Do diet choices affect how much muscle we build? It’s an important matter, because belly fat isn’t just an aesthetic issue; fat around abdominal organs behaves like a big endocrine gland, affecting insulin resistance and heart health, while fat elsewhere has fewer health implications.

The fat you eat and the fat you store

A double-blind study published in Diabetes, led by Ulf Risérus from Uppsala University in Sweden, looked at what overeating saturated fat versus polyunsaturated fat* does to fat deposits.

Thirty-nine adults of normal weight gained weight on muffins for 7 weeks. They were assigned to eat 750 calories above their normal intake, in muffins made with either polyunsaturated fat (sunflower oil) or saturated fat (palm oil). The researchers chose a plant-based saturated fat (rather than butter, for example) in order to avoid confounding cholesterol effects, and because it’s a popular ingredient in the food industry. Except for the type of fat, the muffins had an identical nutrition profile (similar in sugar, protein, etc.).

As expected, 7 weeks of three extra muffins a day resulted in weight gain—both groups gained about 1.6 kg or 3.5 pounds.

But the extra fat, measured by MRI scans, was stored in different body locations. The saturated fat group stored twice the amount of fat in the abdomen and had significantly larger stores in the liver. The polyunsaturated fat group spread the extra weight in more favorable ways, and had a nearly three-fold increase in muscle mass. Bottom line, in this small study, saturated fat caused more weight to accumulate as fat, and that fat accumulated preferentially in the liver and around internal organs. While participants gained just as much weight on the polyunsaturated fat muffins, they gained more of it in lean, muscle tissue, and less in metabolically active abdominal fat.

Sugar belly

This new study connects saturated fats with preferential belly fat. It is a small study, of short duration, and I’d be curious to see if studies in other populations confirm saturated fat as a fat-belly food.

The food item many people associate with a bulging abdomen is beer, but the beer belly has little scientific support. Soda belly, on the other hand, might be for real.

A study from the University of California at Davis showed that drinking 25 percent of daily calories (which is quite a lot) in fructose for 10 weeks caused belly fat accumulation—and increased triglycerides, cholesterol, and insulin resistance. A recent study found that even moderate consumption of sugary drinks led to measurable undesirable effects after just 3 weeks: Belly fat accumulated, fasting glucose levels and inflammation markers rose, and the lipid profile changed when volunteers drank what amounted to just one can of soda a day.

Another study in the journal Obesity, following 800 people, found that drinking sugary drinks was associated with significantly more belly fat and wider waistlines.

A study in the American Journal of Clinical Nutrition adds to that body of evidence with a 6-month study in which a small group of overweight people were assigned to drink cola, skim milk, diet cola, or water, while fat distribution and metabolic markers were monitored. The total caloric intake didn’t differ between the participants, and all the participants gained just about the same amount of weight (almost 3 pounds). On the other hand, the amount of fat in the liver, abdominal organs, and muscle increased significantly in the regular soda group, while it remained unchanged in the other study groups. Blood pressure and triglycerides also rose among the soda drinkers.

A calorie is a calorie when it comes to weight, but not when it comes to health, and these studies suggest that there are indeed foods that make you fat in all the wrong places.

*Most foods contain a combination of fats. Saturated fats are typically solid at room temperature, and include fats that come from animal sources: meat, dairy, and poultry and also from tropical oils such as palm and coconut. Unsaturated fats are liquid at room temperature, and include monounsaturated fats—olive oil and almonds are rich sources—and polyunsaturated fats, which are typical of soybean, corn, and safflower oil, fatty fish such as salmon, walnuts, and seeds such as flax, hemp, and sesame.

Current nutrition understanding is that total fat in the diet isn’t the issue; the type of fat and the total calories we consume is. Present-day recommendations include limiting saturated fats, eliminating trans fats, and choosing foods with monounsaturated and polyunsaturated fats.

Ayala Laufer-Cahana, MD, is a pediatrician, mother, artist, serious home cook, and founder of Herbal Water Inc., in Wynnewood, PA.

Eat Slowly to Eat Less (and 7 Tips on How To)

March 8, 2014 by  
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by Mommy MD Guide Ayala Laufer-Cahana, MD

When I eat out (which isn’t very often), an appetizer and a few bites into the entrée are enough to make me full, and I am not one of these people with small appetites. They say it takes 20 minutes for our brain to register satiety, and the customary interlude between courses in restaurants and dining in company slows me down, which does the trick for me.

Unfortunately, I manage to eat slowly only when I’m with others.

Is this just my subjective feeling, or is there solid evidence to back the common weight-control advice to take your time with your meal?

Longer meal, fewer calories

A study reported in the British Medical Journal showed that the odds of being overweight were three times greater for people who reported eating quickly and until full than for people who ate slowly and stopped eating before they felt stuffed. There are several other studies that gather self-reported eating rates, which can be unreliable.

A study in the American Journal of Clinical Nutrition showed that when volunteers took large bites, rather than smaller ones, they ate about 100 calories more of chocolate custard. This kind of interventional study actually puts people in a test-meal environment, and empirically tests the rate of eating and the quantities consumed. Studies such as this have shown mixed results.

A new study in the Journal of the Academy of Nutrition and Dietetics also took the experimental approach. The researchers recruited 35 normal weight and 35 overweight and obese volunteers and fed them two meals of what most of the participants thought was delicious pasta with vegetables (many participants asked for the recipe). One of the meals was eaten quickly, while during the other, people were asked to take small bites, chew thoroughly, and put the spoon down between bites, with the slow meal lasting about 13 minutes longer.

Slow eating affected normal-weight people more than it did overweight participants: The normal-weight slow eaters shaved an average 88 calories compared with their fast-paced meal. For overweight volunteers, the difference was smaller: just 58 calories, which was not statistically significant. Everyone drank more water with the slow meal (water was offered freely at all occasions). An interesting finding was that overweight and obese participants ate less in both the slow and the fast meals compared with the normal-weight participants. This is not the first study that observes that overweight people consume less than expected when eating with peers—they might be self-conscious when eating in public, and that might affect the results of such studies.

Both groups reported they were less hungry an hour after the slow meal compared with the fast one.

7 tips for slow(er) eating

Most of the evidence suggests that the rate at which we eat affects how much we eat. So here are seven tips to help you eat more slowly and mindfully:

1. Eat with company: This is important on so many levels. My daughter is a super-slow eater; I try to pace myself to her rhythm (but just can’t manage it).

2. Small courses: You don’t have to prepare several courses. You can serve yourself a small amount of the one course you prepared, take a short break, and then decide if you’re going for seconds.

3. Sit at a table: When you eat on the go, in front of the computer (my vice), or over the sink (my husband’s favorite spot), you can hardly take your time. Eating on your feet definitely doesn’t make it go to your hips or thighs, but overeating deposits fat everywhere.

4. Chew: I don’t suggest you count to the 32 suggested by The Great Masticator. That would interfere with tip #1, but keeping the food in your mouth a bit longer, and not swallowing it whole, is a good idea.

5. Put down your fork between bites: or your spoon, or your chopsticks, or even your pizza, sandwich, or apple.

6. Solids are better: Food that’s ready to swallow goes down way too fast. Avoid liquid calories, and foods that are so processed that neither your hands nor your mouth have any work to do. The more fiber in your food, the more chewing it requires.

7. Drink: Sipping water with your meal forces you to slow down, and at the same time, distends your stomach, sending satiety signals to your brain.

Oh, there’s also an app for slow eating, and even a fork that vibrates in your mouth if your bites are too frequent. These, too, interfere with tip #1, which at least for me, is the most important of all.

Dr. Ayala is a pediatrician, mother, artist, serious home cook, and founder of Herbal Water Inc., in Wynnewood, PA.

Battling the Bathing Suit Blues?

March 5, 2014 by  
Filed under J.Bright

By Jennifer Bright

As I sit in my home office, wearing comfy sweats and slippers, the thought of putting on—worse yet, trying on—bathing suits terrifies me. I’ve tried to maintain my weight this winter, but the fitting-room mirror is likely to tell a different story.

Here are some terrific weight-loss tips that doctors who are also mothers use themselves. These women are so super busy that if a tip works for them, it’s bound to be good. I discovered these tips—and hundreds more—while interviewing for the new book The Mommy MD Guide to Losing Weight and Feeling Great.

“I recently created my own diet. I call it VEGLY. I eat as many servings of vegetables, eggs, grapefruit, lean meats or Lean Cuisines, and yogurt as I want. If I stick with that all day, I earn a treat: a glass of beer or wine or a small dessert. I’ve lost six pounds so far!” —Amy Baxter, MD, a mom of three, the CEO of Buzzy4Shots.com, and the director of emergency research, Scottish Rite, of Children’s Healthcare of Atlanta, in Georgia.

“After my son was born, I worked with a personal trainer. He gave me a simple piece of advice that has really helped: Don’t eat any carbs after 7 pm. I try not to eat at all after 7 pm, but if I do, I’ll have something high in protein, such as a piece of cheese or a hardboiled egg.” —Shilpa Amin-Shah, MD, a mom of two and an emergency physician and director of the recruiting team at Emergency Medical Associates in Livingston, NJ.

“I have a very long commute. Because of this, I ‘live’ in my truck several days a week, driving to and from some rather isolated areas in the Appalachian Mountains. Sometimes, after a hard day of working and driving, I’m almost tempted to pick up a slice of pizza and a bag of chips at a gas station on the way home. A trick I use to eat properly on the run is what I call my “cooler diet.” I put everything I want to eat for the day in a nice, roomy cooler. If it’s not in the cooler, I don’t get to eat it—no questions. So that means I don’t get to eat the chocolate that’s everywhere around me at work, or the yummy-looking cream-filled doughnuts that one of the nurses brings in from the doughnut shop for breakfast. I pack my cooler the night before work with lots and lots of whole and nutritious foods and beverages—apples, pears, oranges, and cut-up veggies with low-fat dip. A couple of bottles of water and some unsweetened tea. A container of yogurt, some string cheese, and a bag full of nutritious trail mix. A box of low-fat granola cereal. I pack as much food as I can fit into my cooler. The only rule I have is that the food I pack must contribute to my overall good health and support a healthy weight.” —Rallie McAllister, MD, MPH, a mom of three, a family physician, and the coauthor of The Mommy MD Guide to Pregnancy and Birth, in Lexington, Kentucky.

“Want to ‘lose’ 10 pounds in an instant? Sit up straight, pull your shoulders down and back, and arch your back to get ‘cheerleader butt.’ By pulling your shoulders down, your neck looks thinner, and with a C-curve in your lower back, your thighs and tummy look thinner. Voilà, you’ll look 10 pounds slimmer.” —Jennifer Hanes, DO, a mom of two, an emergency physician who’s board certified in integrative medicine, and the author of The Princess Plan: Shrink Your Waist, Expand Your Beauty, in Austin, TX.

About the author: Jennifer Bright is a mom of two, cofounder of www.mommymdguides.com and coauthor of the Mommy MD Guides books, including The Mommy MD Guide to Losing Weight and Feeling Great.

Maine Pumpkin Spice Bread

December 5, 2013 by  
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by Mommy MD Guide Jennifer A. Gardner, MD

There are so many great versions of pumpkin bread, but this one is truly delicious. Just the right amount of sweetness and spice. This bread is actually moister and more delicious the next day, so it’s a great make-ahead recipe. This recipe will make 2 loaves, 4 mini-loaves, or 24 muffins, and freezes exceptionally well as loaves or individual slices.

One 15-ounce can pumpkin puree (not pumpkin pie filling, which has added spices)

4 large eggs, room temperature

1 cup vegetable oil (such as Smart Balance or canola)

2/3 cup water

2 teaspoons vanilla extract

2 cups granulated sugar

1 cup packed brown sugar

3½ cups all-purpose flour

2 teaspoons baking soda

1½ teaspoons salt

1 teaspoon ground nutmeg

1 teaspoon ground cinnamon

¼–½ teaspoon ground ginger

½ teaspoon ground cloves

  1. Preheat the oven to 350°F and grease/flour two 9- x 5-inch loaf pans (glass pans work best).
  2. In a large bowl, mix the pumpkin, eggs, oil, water, vanilla, and sugar.
  3. In a medium bowl, mix the remaining ingredients with a whisk, making sure there are no lumps.
  4. Add the dry ingredients to the wet ingredients, and stir with a wooden spoon until just blended. Do not overmix!
  5. Bake on the center rack for approximately 60 minutes (it may take longer), until a toothpick inserted in the middle comes out clean with no batter or crumbs. Watch that the top does not begin to burn (if it starts to brown, gently lay a piece of foil over the pan.)
  6. Place 2 large sheets of aluminum foil onto the counter. Allow the loaves to cool in the pans for 5 to 10 minutes, run a knife around the edges to loosen, then invert onto a large dish or chopping board. Immediately invert onto the aluminum foil. After 10 minutes, wrap it in foil if you like moist bread, or wait until it’s cool to the touch if you prefer drier bread.
  • For a healthier, but still delicious bread: Replace up to half of the all-purpose flour with white whole wheat flour. Substitute ½ cup oil with ½ cup applesauce. Reduce the sugar to 2 cups.
  • If you like nuts, add ½ to 1 cup chopped nuts.
  • If you like raisins, add ½ cup (I like golden raisins in this recipe). Dried cranberries work well, too!
  • This recipe can be doubled by using the 29-ounce can of pumpkin puree and doubling all other ingredients.
  • If you don’t have all of the spices, you can substitute 2½ teaspoons of pumpkin pie spice.

Dr. Gardner is a mom of a three-year-old son, a pediatrician, and the founder of an online child wellness and weight management company, HealthyKidsCompany.com, in Washington, DC.

Want to read more blogs by Mommy MD Guide Jennifer A. Gardner, MD? Here’s her recent blog about Halloween safety tips.

Does It Matter Which Fruit You Eat?

December 2, 2013 by  
Filed under Uncategorized

by Mommy MD Guide Ayala Laufer-Cahana, MD

Every decent guide for healthy eating encourages us to eat more fruits and veggies. Why? An abundance of fruits and veggies has been associated with lower risk of a whole range of conditions, from hypertension, to diabetes, cancer, heart disease, and metabolic syndrome.

Up-to-date guidelines don’t just encourage us to eat more plants; they suggest we eat a rainbow, they urge us to eat a variety of fruits and veggies. The latest superfruit trend has also hyped several supposedly high performers from the plant kingdom, touting their assumed powers above other humble, non-exotic varieties.

Does fruit choice matter? Should we eat what we like, what’s affordable and available, or should we carefully select specific, health-promoting fruit?

Two new studies, just published, address this question. Let’s take a look.

Quantity or Quality?

When it comes to reducing the risk of type 2 diabetes, some fruits are better than others, concludes a study in the British Medical Journal. The researchers pooled the findings of three large studies, following the diets and diseases of 185,000 people over 12 years. About 12,000 people developed diabetes during that time, and while people who ate more fruit also usually made other healthy lifestyle choices (such as exercise and eating fewer calories), after controlling for all these, the researchers found that specific whole fruits, especially blueberries, apples, and grapes, were associated with lower risk of diabetes, while other fruit, such as strawberries and cantaloupe, less so.

Fruit juice, though, didn’t confer the same protection. Greater fruit juice consumption was linked with greater risk of diabetes.

The other study, published in the American Journal of Clinical Nutrition, looked at fruit variety and coronary heart disease. This study followed a cohort of about 120,000 people for more than 20 years, during which about 6,000 developed heart disease. After controlling for other variables, this study found that the quantity of fruit was more important than the variety. The people who ate the most fruits and vegetables had a 17 percent lower risk of ischemic heart disease. But quantity aside, some fruits and veggies, such as citrus fruit and green leafy veggies seemed to matter more—as long as quantity was maintained.

Superfoods and Miracle Foods and Plain Old Apples

A miracle, by definition, is something that happens very rarely (if at all). But nowadays, superfruits and miracle foods are ‘discovered’ weekly, and incorporated into processed foods and plastered with health claims promising eternal life.

Plants are very clever biochemical machines; it seems like there are many more mysteries within their cell walls that we have yet to discover, and the more research we do, the more benefits we find. (The opposite can be said of the Western, processed diet; the more we explore its effect, the more harm we find.) Not to take away from acai, blueberry, and chia, most fruits and veggies, once studied, become super. The love-of-my-kitchen tomato was thought to be poisonous and evil, but is now a superfood because we discovered its health-promoting lycopene.

It very well might be that certain fruits’ and veggies’ benefits are more targeted to certain conditions, but since our understanding of this is still limited, I’d stick to a simple plan: Eat more fruits and veggies and aim for variety, any variety. As long as you don’t confuse whole fruit with fruit juice, and don’t consider potatoes and corn a major veggie, I think you’ll be okay. Diet as a whole affects health—profoundly—but eating the latest fad miracle fruit, sensationalized by the media, is not likely to make much of a difference. Sorry, but shortcuts are improbable.

Bear in mind, superfruit is a marketing—not a scientific—term, invented by the food industry for the sole purpose of selling products.

Here’s my prediction: the fruits and veggies you like and eat anyway might have their moment of fame, and be rebranded as superfruit once studied, and you’ll be able to say you believed in them all along.


Dr. Ayala is a pediatrician, mother, artist, serious home cook, and founder of Herbal Water Inc., in Wynnewood, PA. Dr. Ayala is known for her extensive knowledge of nutrition and food, as well as her practical approach to improving health and preventing obesity and disease.

Want to read more blogs by Mommy MD Guide Ayala Laufer-Cahana, MD? Here’s her recent blog about salt.

Looking for a Great Read?

November 8, 2013 by  
Filed under J.Bright

By Mommy MD Guides blogger Jennifer Bright

Our friend Nonnie Jules has published a new novel—Daydream’s Daughter, Nightmare’s Friend—and we want to help her to get the word out!



“She was one horrible mess. Always looking over her shoulder, avoiding becoming too friendly with the neighbors, never letting her kids out of her sight for fear of human monsters lurking around corners, waiting to cause them harm. That anxiety stemmed from her own childhood memories. Always fearing that someone would recognize her face, she kept to herself and didn’t go out much. And when she did, no matter the season, she wore some kind of hat or covering on her head, enough to shield her face. HE had done this to her even though he was dead now.

Walter never understood why she was such a loner, avoiding people as much as she could, and just being extremely anti-social outside of the house. Houston was originally her home, not his, yet she didn’t even want her own family and friends to know that she had returned. The only person she found herself able to really open up with was him. And although she tried to make him feel otherwise, he knew that there was still a huge wall up that even he would never be able to see over or climb.

Marisa had a secret, and if it was ever discovered, it could cost her her life and her freedom.”



“I couldn’t put this book down! Every chapter that I read kept me on the edge of my seat, excited about what was to come in the next chapter. I want more…so I hope there’s a sequel! Lifetime Television…watch out for DAYDREAM’S DAUGHTER, NIGHTMARE’S FRIEND. You’re going to want to turn this script into a movie!” —P.J. Soemer, book lover






Nonnie’s Book Store

Also on Amazon

Answers about Vitamin D

September 24, 2013 by  
Filed under Uncategorized

by Mommy MD Guide Sonali Ruder, DO

Q: I was recently diagnosed with vitamin D deficiency. How can I get more vitamin D, and are there any foods that I should be eating?

—Lyz from N.Y.

A: This is a great question because vitamin D deficiency has become more prevalent in recent years. Just last year, the National Center for Health Statistics published data showing that 33 percent of Americans were at risk of vitamin D deficiency or inadequacy based on serum blood levels. Vitamin D is sometimes referred to as the “sunshine vitamin” because our bodies make vitamin D naturally from sun exposure to the skin. Exposure to ultraviolet rays specifically triggers the conversion of cholesterol in the skin to vitamin D3, a form of vitamin D. We’ve all been taught to use sunscreen to prevent the harmful effects of exposure to UV rays, but all of this sunscreen use has led to another problem—vitamin D deficiency. Sunscreen blocks the absorption of UV rays; correctly applied sunscreen reduces our ability to absorb vitamin D by more than 90 percent.

Most of us recognize vitamin D as being important for bone growth, which it is. Vitamin D aids in the absorption of calcium, helping to form and maintain strong bones. When you don’t get enough vitamin D, it puts you at risk for diseases such as rickets in children and osteomalacia in adults. That’s why the government started fortifying milk with vitamin D in the 1930s—rickets was a major health problem at the time. But vitamin D is not just important for healthy bones—it actually has several other important functions in the body, including maintaining a healthy immune system and modulating proper cell growth. Recent studies have linked vitamin D deficiency to cardiovascular disease, osteoporosis, autoimmune disease, and several types of cancer.

So how much vitamin D do we need? Currently there is a lot of scientific debate over what the optimal amount of vitamin D is. The official Recommended Dietary Allowance (RDA) in adults is 600 International Units (IU) per day and 800 IU for those over age 70. But many groups including Harvard’s School of Public Health are recommending much larger amounts based on the most current research.

What are the best ways to get an adequate amount of vitamin D? The best way is through exposure to sunlight. Just 10 to 15 minutes of sunlight exposure can provide 3,000 to 20,000 IU! The problem is that the amount of vitamin D that we get from sun exposure varies considerably, depending on several factors, including geographic latitude and skin color. Sunlight is generally weaker in northern latitudes, leading to less vitamin D synthesis. Also, people with darker skin tones generally need a lot more sun exposure to synthesize vitamin D because melanin reduces the skin’s ability to produce vitamin D from sunlight. Of course, it is also important to protect your skin from the harmful effects of sun exposure, which leads to millions of cases of skin cancer every year in the U.S.

To further complicate the issue, there are relatively few natural food sources of vitamin D. The best sources are fatty fish such as salmon, tuna, sardines, and mackerel. Canned fish generally has more vitamin D than fresh. Small amounts of vitamin D are also found in egg yolks, beef liver, and some cheeses. In fact, a new analysis done by the USDA found that eggs contain 64 percent more vitamin D than the last time they were analyzed by the government in 2002. This increase is probably due to changes in the diet of chickens by egg producers. In addition to natural food sources, many cereals, milk, and dairy products are also fortified with vitamin D. The U.S. also mandates the fortification of infant formula with vitamin D. Mushrooms also can be a source, especially if treated with UV rays during growth. Here are some specific levels taken from the N.Y. State DOH website:

Natural Sources:

Herring: 1,383 IU per 3 ounces

Salmon, canned: 530 IU per 3 ounces

Cod liver oil: 450 IU per teaspoon

Mackerel: 306 IU per 3 ounces

Oysters: 272 IU per 3 ounces

Shiitake mushrooms, dried: 249 IU per 4

Sardines, Atlantic, canned in oil: 203 IU per ½ cup

Tuna, canned in oil: 200 IU per 3 ounces

Large egg: 41 IU (new data)


Fortified Sources:

Tofu: 120 IU per 1/5 block

Cow’s milk: 100 IU per 8 ounces

Soymilk: 100 IU per 8 ounces

Orange juice: 100 IU per 8 ounces

Cereal: 40 IU per serving

If you are concerned that you are still not getting enough vitamin D through sun exposure and food sources, you can always take a vitamin supplement. Most multivitamins provide about 400 IU of vitamin D.

So what’s the take-home message with vitamin D? Vitamin D is very important for the body, and the more we learn about it, the more true this seems to be. If you’re concerned about vitamin D deficiency, consult your physician and get tested. Try to get brief periods of sun exposure daily, but after 5 to 15 minutes, make sure you apply sunscreen. To get the rest of your daily needs, incorporate natural food sources into your diet and, if needed, add a vitamin supplement.

Dr. Ruder is a mom of a two-month-old daughter, an emergency physician at Coral Springs Medical Center near Fort Lauderdale, FL, and a recipe developer and blogger at TheFoodiePhysician.com.

Want to read more blogs by Sonali Ruder, DO? Here’s her recent blog about the importance of eating breakfast.

Brace Yourselves: Cold and Flu Season Is Just around the Corner

September 18, 2013 by  
Filed under Uncategorized

by Mommy MD Guide Jennifer Gardner, MD

The autumn color show arrives soon, but with it comes the misery of cold and flu season. Both illnesses are caused by viruses that spread quickly from October through May, but the flu is typically much worse and lasts much longer than the common cold.

For some, flu means a respiratory illness so powerful that it keeps you in bed for a week or more. For others, it can mean a hospital visit. And for the most unfortunate, it can mean death, so prevention efforts must be taken seriously. Those at highest risk are young children, adults older than 50, and individuals with a chronic illness or weakened immune system.

The flu virus changes each year, so even if you’ve been exposed to it before or received a previous vaccination against it, you are still at risk for flu this season.

How Do You Tell the Difference between a Cold and the Flu?

Cold: Gradual onset (over days) of symptoms including hacking (productive) cough, sneezing, runny nose, nasal congestion, sore throat, and excess mucus production. (Fatigue, headaches, and body aches are rare with colds and, if present, are only mild.)

Complications: ear infection, sinus congestion, or sinus infection

Flu: More abrupt onset (over hours) of the same symptoms, but also high fever (lasting several days), chills, dry (unproductive) cough, severe headache, body aches, weakness, extreme fatigue, vomiting, diarrhea, chest pain, and chest congestion. Sneezing, stuffy nose, and sore throat are rare.

Complications: bronchitis or pneumonia

Can You Treat the Cold or Flu with Antibiotics?

NO. Each is caused by a virus, which is not killed or affected by antibiotics. Once you catch the flu, your best option is to monitor the symptoms and treat them with the tools available—antiviral flu medications can help, but these are best taken within 48 hours of onset. Check with your physician to make sure that these medications are suitable for individual members of your family.

Soup, plenty of fluids including warm tea with honey, over-the-counter cold medicine, humidifiers, saline nasal sprays (for congestion and stuffiness), salt water gargle (for sore throat), cough drops, and rest provide the remaining tools. Never give a child medications containing aspirin. Always check cold medications for acetaminophen (Tylenol) before giving additional Tylenol for fever.

What Doesn’t Work?

  • Antihistamines (these treat the runny nose, watery eyes, and sneezing associated with allergies, but have the exact opposite effect with cold and flu symptoms by drying out mucous membranes)
  • Nasal decongestant (temporary relief followed by worsened rebound congestion)
  • Cough medicine (Most are not particularly effective unless they contain codeine. I recommend that you let kids cough to expectorate mucus unless it is preventing sleep.)
  • Not eating (Turns out the old adage “starve a cold, feed a fever” is not sage advice!)

Should I Stay or Should I Go?


GO to School or Work

FEVER (child should have no fever for at least 24 hours without a fever-reducer before returning to school) NO FEVER (less than 99.6º oral) or mild   fever in a child who is otherwise active (less than 101º oral)
Productive, deep, or uncontrollable cough Nonproductive cough
Sore throat (very painful, difficulty swallowing) Mild sore throat
Less than 24 hours on antibiotics (if prescribed) More than 24 hours on antibiotics (if prescribed)
Thick, green or yellow nasal discharge Mild runny nose
Moderate to extreme fatigue Active or just mild fatigue
Flu Mild common cold
Vomiting or diarrhea


Remember, if you send your child to school with mild symptoms, be sure to send along hand sanitizer with instructions to use frequently, especially after coughing, sneezing, or handling a tissue. Your child should also be reminded to cough into the crux of the elbow, not the hands.

Prevention Is the Best Medicine!

The flu virus spreads many ways: directly by coughing, sneezing, or personal contact and indirectly by touching something harboring the virus and then touching your eyes, mouth, or nose. Viruses can remain infectious for more than 2 hours on surfaces such as phones, doorknobs, water fountain nozzles, desks, and tables!

Below are some proven methods for avoiding the flu virus.

  1. Wash hands regularly: Washing hands regularly and keeping hands clean is one of the best ways to avoid catching the flu and transmitting the virus. Make sure to have everyone in the house wash his or her hands for at least 20 seconds (the time it takes to sing Happy Birthday twice). Sanitizing hand wipes and gels work well too.
  2. Avoid touching eyes, nose, and mouth: Cold and flu viruses are often spread through contact with these mucous membranes. Kids do this much more frequently than adults, so keep an eye on them.
  3. Use the crook of your elbow to cover coughs or sneezes: After using a tissue, throw it away, and wash your hands as soon as possible. This applies to everyone in the house.
  4. Don’t go to school or work sick: Whenever possible, stay home, and keep your kids at home until symptoms are gone for at least 24 hours.
  5. Clean work and home surfaces regularly: Computer keyboards, books, binders, desktops, phones, and pens can all harbor 21,000 germs per square inch. Compare this with a toilet that contains 49 per square inch. Keep some disinfectant wipes around to eliminate these infectious agents on a regular basis. Have your kids take sanitizing gels or wipes with them to school.
  6. Get flu shots for you and your kids: Flu vaccine is typically available between October and December, the earlier the better. Contact your healthcare provider to determine if you and your kids should get a shot. If so, you may be able to get it at some pharmacies.
  7. Stay healthy: Get your needed sleep (at least 7 hours), eat healthy amounts of fruits and vegetables, drink plenty of fluids (60 ounces of water per day is recommended), limit your stress, and stay physically active.

What If a Classmate Appears Sick?

Unfortunately, there is little to do if it does not violate school policy. But I recommend that you teach your child to walk away from someone who is coughing or sneezing (most viral organisms do not travel more than 3 feet), and provide sanitizing alcohol for your child to use frequently.

You can also teach your child to wipe surfaces with alcohol wipes or gels during the cold and flu season (desks, lunch tables, computers, borrowed pens). And of course, being up to date on all immunizations (flu, whooping cough, measles) can give you piece of mind.

Dr. Gardner is a mom of a three-year-old son, a pediatrician, and the founder of an online child wellness and weight management company, HealthyKidsCompany.com, in Washington, DC.

Want to read more blogs by Mommy MD Guide Jennifer Gardner, MD? Here’s her recent blog about making sure your kids eat healthy meals at school.

Breakfast is the Most Important Meal of the Day

September 12, 2013 by  
Filed under Uncategorized

by Mommy MD Guide Sonali Ruder, DO

We’ve all heard the old adage, “Breakfast is the most important meal of the day,” but how many of us really follow it? On weekdays, I’m usually rushing out the door with only a cup of coffee to sustain me until lunchtime, by which time, I’m usually starving. Of course, I’ve always heard about how important eating a good breakfast is, but I never really thought it was a realistic goal for my lifestyle.
So why is it important to eat a nutritious breakfast? Studies show that people who eat a good breakfast end up eating fewer calories throughout the rest of the day. Eating a good breakfast keeps you feeling fuller longer so that you will avoid overeating later in the day. Although you may think that skipping breakfast will help you lose weight by cutting calories, it actually increases your risk of obesity. Eating breakfast boosts your metabolism, which makes you burn more calories throughout the morning rather than storing them.

Eating breakfast also helps boost your intake of important nutrients such as vitamins and minerals. People who eat breakfast are more likely to eat a healthier diet overall, including less fat and cholesterol, which is good for your heart and helps to maintain a healthy weight. Also, eating breakfast gives you more energy, which translates into increased concentration and productivity throughout the morning.
So what exactly constitutes a healthy breakfast? A good breakfast includes a balance of complex carbohydrates with protein, fiber, and just a small amount of fat. This combination will keep you feeling full for many hours as opposed to the high-carbohydrate breakfasts that we sometimes grab in a rush, such as muffins, bagels, and sugary cereals. These foods give you a short burst of energy, but in no time, you’ll be left feeling tired and hungry all over again. These are the components you want to include in your breakfast:

• Whole grains
• Lean proteins
• Low-fat dairy or soy products
• Fruits and vegetables

If you include foods from all of these categories in your meal, you will be eating a healthy, well-balanced breakfast. Need some examples? Here are some specific examples of healthy breakfast ideas that are quick and easy to prepare:

• Bowl of whole-grain cereal (watch the sugar content) with berries and skim or soy milk
• Whole-grain toast with peanut butter and sliced apples
• Whole-grain waffle topped with almond butter and sliced strawberries or banana
• Bowl of oatmeal with fresh or dried fruit and/or chopped nuts (apples, walnuts, and cinnamon are a great combination; another good combo is blueberries and almonds)
• Whole-grain toast with low-fat cottage cheese and sliced peaches or pineapple
• Parfait made with layers of fat-free Greek yogurt, fresh fruit, and chopped nuts or whole grain cereal
• Smoothie made with strawberries, blueberries, bananas, fat-free yogurt, and flaxseed
• Whole wheat pita topped with low-fat cottage cheese or part-skim ricotta cheese and sliced tomatoes; serve with fresh fruit or a glass of fruit juice on the side
• Whole-grain English muffin with lean ham or turkey, reduced-fat cheese, and sliced tomato
• Homemade breakfast burritos (see recipe below)

My Jump-Start Your Day Breakfast Burritos are a hearty and nutritious meal to jump-start your day and set you on the right path for healthy eating all day long. And the best part is that if you’re not a morning person, you can prepare a whole batch of them ahead of time and freeze them. Then when you want to eat one, you just unwrap, pop it in the microwave, and take it to go!

Jump-Start Your Day Breakfast Burritos
Makes 6 burritos
2 teaspoons olive oil
1 small yellow onion, chopped
1 red bell pepper, chopped
Kosher salt and black pepper
1 cup canned black beans, drained and rinsed
1 teaspoon chili powder
6 whole eggs plus 6 egg whites
½ cup shredded reduced fat Cheddar cheese
6 (9-inch) whole grain wraps (I used La Tortilla Factory Smart Delicious Whole Grain Soft Wraps)
¾ cup salsa
¼ cup sliced scallions
Hot sauce (optional)

Heat the oil in a large nonstick skillet over medium heat. Add the onion and pepper to the skillet and season them with salt and pepper. Cook, stirring occasionally, until softened, for 7 to 8 minutes. Stir in the beans and chili powder, and cook for 2 to 3 minutes until heated through. Pour the contents of the skillet into a bowl and set aside. Wipe the skillet clean.
Whisk the eggs and egg whites together in a large bowl along with ½ teaspoon salt and ¼ teaspoon black pepper. Spray the skillet with nonstick cooking spray and heat over medium heat. Add the eggs and cook them, stirring occasionally, until soft curds form. Stir in the cheese and cook 1 minute until melted. Remove from the heat.
Spread each tortilla with equal amounts of the veggie/bean mixture and top with the scrambled eggs. Spread 2 tablespoons salsa, some sliced scallions and hot sauce (if using) on top. Roll the tortillas up burrito style—fold the side closest to you over the filling, then fold both sides in toward the center and roll up. Serve alone or with reduced-fat sour cream, if desired.
If not eating right away, wrap each burrito in plastic wrap or aluminum foil and freeze. To reheat, unwrap and microwave until warm, about 2 minutes, turning over halfway through. For a crispier wrapping, heat in the microwave, then bake in a 450° oven for 5 to 10 minutes.

Dr. Ruder is a mom of a two-month-old daughter, an emergency physician at Coral Springs Medical Center near Fort Lauderdale, FL, and a recipe developer and blogger at TheFoodiePhysician.com.

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The information on MommyMDGuides.com is not intended to replace the diagnosis, treatment, and services of a physician. Always consult your physician or child care expert if you have any questions concerning your family's health. For severe or life-threatening conditions, seek immediate medical attention.