Gluten is the protein in wheat that has received much attention in the media lately. I get many questions on whether or not it is an option worth choosing.  I am thus dedicating this newsletter to some interesting facts, tips, recipes, and tid bits on gluten, to hopefully help each individual decide. It is a lifestyle choice, and it is not always simple!

“Should I Go Gluten Free?”

One of the latest trends is a gluten free diet with an increasing variety of GF products available in grocery stores and restaurants. However, does that mean you should cut gluten out of your diet? Whole grains are an important part of a balanced diet with many nutritional benefits yet more people are avoiding wheat, rye, barley, oats, and anything that doesn’t say gluten free on it. Gluten is a protein that provides elasticity in dough to give bread and other products a wonderful texture. So, why give that up?

It is currently only recommended to eliminate gluten from your diet if you have a gluten sensitivity/intolerance/allergy or Celiac disease. A gluten free diet can be restrictive in both choices and nutrients.  Some drawbacks of a gluten free diet include an imbalance of intestinal flora (the bacteria in your gut which protect or harm your GI tract, depending on the bacteria, and can also influence weight gain/loss), lethargy, vitamin B deficiencies, calcium deficiency, and other documented conditions. With that being said, there are a number of individuals who tout the benefits that they have personally experienced having cut out gluten from their diets such increased energy levels and weight loss. With any diet, it’s important to get adequate nutrients and calories and restrictive diets can be challenging in that aspect.

Gluten sensitivity and Celiac can be diagnosed in a variety of ways. Keeping a food diary that tracks your mood and symptoms as well as foods can help you and a health professional better assess if you do have any issues with consuming (or even touching) gluten products. Some individuals eliminate gluten from their diets during a short period of time, as well, to see if gluten causes unwanted symptoms when re-introduced to the diet. An important piece of information to remember when attempting to be diagnosed with a gluten sensitivity or Celiac often includes consuming gluten so the presence of it is in your system during testing, depending on the diagnostic tool.

If you’re avoiding gluten, you will want to check the ingredient  and nutritional labels for:

  • Certified Gluten Free
  • 100% Gluten Free
  • Wheat
  • Wheat gluten
  • Barley
  • Rye
  • Oats: do not necessarily contain gluten but many with a gluten sensitivity have trouble digesting oats as well.
  • Malt
  • Hydrolyzed vegetable protein

What can you eat instead?

  • Corn; including cereals and other corn-based products
  • Rice; including cereals and other rice-based products
  • Potatoes
  • Craving pasta? Consider using spaghetti squash instead
  • Wine is generally safe but check the ingredients to be sure
  • Eggs
  • Fish
  • Dairy
  • Meat
  • Fruit
  • Vegetables
  • Specialty, GF products



Fitness Corner: Yoga

Yoga, once a male-dominated practice, is being done by people of all ages, genders, at home, at the gym, and in the park. It has extraordinary benefits for the mind and the body. Would you consider trying it? If so, you will want to try out a variety of styles (some people love flow yoga while others love power yoga and others simply prefer a different style) and teachers as no one yoga instructor is like another.

The benefits?

Increases strength. That’s right- you can see some amazingly toned yoga bodies using their muscle strength to hold astounding poses.

Increases flexibility. Not only are certain muscles being strengthened during a pose, others are being lengthened.

Improves posture. Yoga poses focus on a straight back so lots of practice can make perfect!

Provides relaxation through meditative breathing. Now that’s a way to pack a punch- get in shape and get rid of stress at the same time!

Relaxation, proper breathing, increased muscle tone, movement that increases circulation, and other benefits of yoga also benefit the heart.

Yoga may also be beneficial for memory loss, concentration, and even IBS symptoms in some individuals.

Yoga is not to be treated like a race or performance. You go at your own pace. You choose your level of intensity and hold the pose as long as you comfortably can. If you are interested in trying yoga, fitness centers offer classes that may be beneficial to beginners as instructors can help make sure poses are done properly for your own safety. Want to try it for free? Consider a free video online from or to see if yoga is right for you.



Cinnamon Up Your Life
Cinnamon is a very common spice that has recently received a pat on the back because of its health benefits. There have been many studies discovering its effect on glucose metabolism, antiseptic powers against bacteria’s and fungi and even for improving brain function.
Some of the possible ways in which one can enjoy this power spice:
– Add a cinnamon stick to flavor your favorite tea
– Add to unsweetened applesauce, cereal or oatmeal
– Sprinkle on toast or add to butter or cream cheese
– Sprinkle on coffee, cocoa, fruit juices, and ciders
– Add cinnamon to your favorite baked goods
Remember after opening your cinnamon store it in a tight sealed container away from the light.


If you’re looking to add some different spices to your life, consider this recipe:

Recipe Corner: Curried Red Lentil Soup      (SERVES 6)

  • 1 cup hulled red lentils, rinsed in hot water
  • 4 1/2 cups nonfat vegetable stock
  • 2 Tbs. nonfat plain yogurt
  • 1 tsp. curry powder, or to taste
  • 1 tsp. grated fresh ginger, or to taste
  • 1/2 tsp. ground cumin, or to taste
  • 1/4 tsp. cayenne, or to taste
  • 1/2 tsp. onion powder, or to taste
  • Shredded coconut as garnish
  • Dried peanuts as garnish
  • Cilantro leaves as garnish
  • Diced red pepper as garnish
  • Chutney as garnish
  • Raisins as garnish


  1. Put lentils and vegetable stock in a large saucepan, and bring to a boil over medium-high heat. Reduce heat to medium, and cook for about 20 minutes, or until lentils are tender. Reduce heat to very low.
  2. Put 2 cups lentils and yogurt into blender and purée until smooth. Recombine with soup in pan, and stir in seasonings. Heat through, and serve, garnishing each portion as desired. 


Calories 130
Protein 8g
Carbs 25g
Sodium 520mg
Fiber 6g
Sugar 5g




  • 1   cup uncooked quinoa
  • 2   tablespoons fresh lemon juice2   tablespoons olive oil
  • 2  tablespoons chopped fresh basil
  • 1  can (15 oz) gluten-free garbanzo beans, drained, rinsed
  • 1  can (15.25 oz) whole kernel sweet corn, drained
  • 1  can (14.5 oz)  diced tomatoes, drained
  • 1  cup chopped red bell pepper
  • 1/2  cup crumbled goat cheese
  • 2 Tablespoons balsamic vinegar

Rinse quinoa under cold water 1 minute; drain. Cook quinoa as directed on package; drain. Cool completely, about 30 minutes.
Meanwhile, in small nonmetal bowl, place lemon juice, oil and basil; mix well. Set aside for dressing.
In large bowl, gently toss cooked quinoa, beans, corn, tomatoes, bell pepper. Pour dressing and balsamic vinegar over quinoa mixture; toss gently to coat. Serve immediately or refrigerate 1 to 2 hours before serving.
Just before serving, sprinkle with goat cheese. Garnish with basil leaves if desired.




How to Form Lifestyle Habits

Ilana Katz MS, RD, CSSD

Challenges are embraced, and once decided upon require the extra effort to ensure getting to the finish line. Does your resolve weaken before success? Do you risk stalling?  Do you focus on outcome instead of process? Do you consider yourself an “all-or-nothing” individual?  If you answer “yes” to either of these two questions, you may need to make more of your efforts habit-forming rather than forced.  Athletes who are consistent with good habits are the most successful.

Athletes, or anyone for that matter, sustain momentum by embracing small, frequent victories.  The all or nothing mentality tends to trigger disappointment time after time, because of interruptions and interferences beyond individual control  (for example, you backed your healthy, pre-planned lunch that fits into your new eating goals but at lunch time, you find someone stole it out the office fridge).

Successful habits worth forming:

  • Become a morning exerciser: after hours exercise more than often does not happen. Schedules change, family, social and work obligations shift constantly. Research has proven that people who make exercise first thing on the agenda get hooked on the feeling of accomplishment before the rest of the world wakes up. Furthermore, the morning workout  results in a rush of endorphins.  
  • How to make this routine: Progress from just a couple of mornings a week. Knowing you can “sleep in” some days, makes getting up on the days you have committed to, much easier. Routine includes the night before: Get to be early enough the night before ;  Lay out your gear (all of it, clothes, sweaters, fuel belts, water bottles, etc); set coffee machine on automatic (something to look forward to); put the alarm out of reach.
  • Become buddy accountable: find a partner in crime.  Nothing keeps you from pressing the snooze button knowing someone is relying on you.  Furthermore, having social time with your besties, while working out together makes it fun.
  • Be Patient:  All new behaviors can be out of your normal depth at first. Habits require resetting the body clock and planning for the time before they stick.
  • Eat more color: Nutrient packed fresh earthy food are not only low calories, but their high-quality carb sources power workouts and daily living. Their anti-oxidants and other micronutrients (vitamins and minerals) keep the metabolism working at its best.   How to make this routine  Don’t choke down the so-called superfoods just because they are super, rather make sure they are your super. Pick up the produce that you actually like and want to eat, even if it’s more expensive or not as much of a superfood as the well-known ones (like Kale, acai, beets, etc).  When you buy these foods, plan them into your meal plan, don’t just let them turn bad because you couldn’t find a recipe that calls for them. Smoothies are a great alternative.
  • Snack Smart: Trade high calorie snacks, like chips and candy, for high nutrient snacks, like fruit, vegetables and healthy fats. Some great examples are carrots and hummus, apples and nut butter, tuna on cucumber slices, edamame and egg whites scrambled in a cup.

  • Cook at home more often: research shows that two or more restaurant meals in a week can add up to an extra 5 pounds of body fat per year. Master some easy kitchen basics for starters, without needing to turn into a top chef. You will be amazed at how controlling your own food choices helps you feel in control of life stressors in general, including your budget (cooking at home is always cheaper!). Some easy ways to make this routine is to look for quick easy cooking videos online; gear up your kitchen with the basics (knifes, cutting boards, pots and pans, Tupperware, and common ingredients like herbs & spices, olive oil and salt & pepper).
  • Take time to research motivating recipes:  you can often find restaurant favorites in recipes online or at the very least, something similar. This way you will control the caloric and fat intake as you prepare your favorite dishes yourself. Plan time in your schedule to shop and go to the store with a list, stick to it.

  • Get enough sleep: Sleep may be the one thing that has the most impact on making challenging actions routine. Everything seems unreachable on a sleep deprive mind. Sleep allows the recharging organs, repairing muscles and releasing hormones for rebuild, strength and nerve connections.  Lack of sleep has been linked to every limitation you can think of (low energy, injury, moodiness, weight gain, dis-ease and disease, to name a few). Most adults require 7 – 8 hours every night. Easy ways to make this routine include declaring bed time sacred; unplug all electronics, prepare for “night time” ahead of time by dimming the lights, closing the curtains, put on PJs, stop eating, eliminate the caffeine
  • .
  • Eat breakfast everyday: glycogen, your first source of energy, gets used up during the night keeping your body functioning, so you are typically waking up on an empty tank. Breakfast is replenishment as well as setting the tone for a healthy day. Studies shows that breakfast eaters can accomplish optimal body composition easier than those that starve all morning. To make breakfast a habit, start off with something small, even if it’s just a piece of fruit and then begin to balance it out with some protein or good fat like a few almonds, nut butter, Greek yogurt. Think outside the box of traditional breakfast foods (anything is fair game, even leftover salmon and quinoa from last nights’ dinner).
  • Pre Prep meal plans and meals: – spend a low activity day preparing a weeks’ worth of food (particularly breakfasts0, from overnight oats, or using a slow cooker to cook once, eat multiple times.
  • Move More: Even athletes sit on their butts most of the day, especially those with day jobs. Making an effort to stand and walk during working hours reduces the risk of tight muscles, injuries, bad posture, weight gain, etc.  Making moving around a habit by keeping track with an activity monitor (such as pedometer, apple watch, fit bit, etc).  Use the tracker to look beyond daily goals of a set step count like never allow more than a two-hour period of sitting. Remind yourself by setting alarms on your phone or computer to stand and walk around the room at minimum. Some ideas are to stand and greet anyone that enters your office, pace while on the phone, hover in the back during a meeting (if appropriate of course).
  • Treat yourself to a rest/break day. Have a day in the week that you can look forward to. If you have developed a great habit of a consistent work out and eat well routine, find the pleasure in something you love as a treat. It helps to not indulge everyday, as well as provides the energy for constant motivation. A rest in the workout routine enhances recovery and reduces injury. A break in eating perfectly allows keeps the habit of a healthy lifestyle to stick. A great definition of “D.I.E.T” is Don’t Indulge Every Time

In conclusion:

Habits are brain behavior hacks. Make them ingrained and they will turn to auto-pilot mode.   Respect your “WHY.” Write it down and monitor and embrace the benefits. Schedule your “WHY.” Block time in your calendar for your new behavior. Blab about it by asking friends, family and supporters to hold you accountable and even go as far as join you in your quest for habits of success. And finally, make sure your surroundings support your efforts by removing triggers of your bad habits to make the new ones visible and possible.



Is your scale the boss of you? Really, are you allowing this unforgiving, inanimate demon to constantly determine your moods? I ask this of many clients almost daily, and believe it or not, I get a defensive nod, and a “yes, of course!” Why people? Jokes aside, I do understand why, since I too have known to be a slave to a scale. Oh yes, and shamefully, I too allow that scaly, dumb thing determine my self worth. But I am done… I am ready to give you all a break. I am offering a plea bargain here – trade the scale in!! Open your mind, soul and mood-swings to more up-to-date, smarter devices, such as yourself,  mirrors, and clothes. Hey, I am not turning in my food police badge here, and neither is this a journal entry from my deepest, darkest soul search. This here is my curtsey to ol’ faithful science and Ilanalogic (an emerging scientifically evidenced phenomenon). Are you ready for the mind boggle?


To be fair, before I totally dis the scaly dumby, I will offer some credit, where credit is due. It is good for one thing, and that one thing is the determinant of scientific concept called gravity. Gravity, yes, the force that pulls objects towards earth.  In other words, if you were to weigh yourself on the moon which has no gravitational forces, you will weigh approximately only 20% of your current earthly weight. Moving to the moon seems to be a good weight loss option then, right?  Wrong! You will take yourself with you. If you have diabetes, you will still have diabetes. If you have high cholesterol, you will still have high cholesterol, Your body fat, will be your body fat. Ahhhh, but your weight will be less…mmm… would you still want to live on the moon with the same body fat?  (Darn, I guess I am not moving to the moon after all). So does that put the scale in its place yet? Do you now realize that when you lose 10 lbs in a week, or gain 3 lbs in a day, what you are losing or gaining is not fat, but simple a gravitational pull to the earth? It is in my nature to further define this gravitational pull to the earth, so that we can finally send all our scales to the moon (rather than ourselves).


Definition of weight can be “Ilanalogically” broken down into 3 distinct matters: Undigested matter, body water, and muscle mass. I dare you to study these each individually to get on my bandwagon. Firstly UNDIGESTED MATTER, known to the layman as poop  (I am not shy, dietitians speak of this daily, it is what we do.)  Undigested matter is created from the food we eat, so if we eat less on a day here and there, we will weigh less on a day here and there, since less poop will be created. Yes, all those unanswered questions can be finally put to rest, you know the ones: “is it possible to lose 2 or 3 lbs  by tomorrow?” Sure it is, just eat less today than you usually do, and matter of factly, you will lose a gravitational pull of poop to the earth. It may even be 2 to 3 pounds less if you eat that much less. Your metabolism has not risen suddenly, your body composition is mmm status quo, and your health has not magically improved over night.

 I hear you… many of you are itching to point out that I do not typically eat that much to begin with, so cutting back by 2 or  3 lbs of digestive matter in one day is not quite possible, huh? Well this brings me to my second component, and that is WATER. Did you know that 60 – 70% of your whole being is water? When you eat, the absorptive matter is attached to water which is transferred in the body. Do not forget, everything has weight, and every particle of weight is a component of gravity, and our scales measure gravity, in this case water.  Did you know the word carbohydrate means “glycogen” (storage of carbs) plus “hydrate” (the 3 – 4 molecules of water attached to the carbs). Quite mind boggling, huh?  So eat less carbs, and the initial response by your body is weight loss, because there is an absence of water that would normally be in those carbs.  Now eat hardly any food, in other words a low calorie diet, or a diet that does not equate in calories to your needed calories to survive (your basal metabolic rate), and what do you think will happen? Your body will begin to use up the glycogen stores to the point of depletion, and once again you will lose weight !! Let me be clear – this is not fat loss! You have not magically raised your metabolism, you have not drastically improved your health, and your body fat is once again, status quo.


This brings me to the third component of weight, MUSCLE. Unfortunately, the greatest component of weight loss, particularly on too-low calorie diets, is muscle mass.  Too low calories causes deprivation of nutrients, carbs, protein and also vitamins and minerals necessary for an effective metabolism. I say unfortunate, because loss of muscle also means loss of your most metabolic active tissue. Loss of metabolic active tissue translates into training the body to store more fat.  You may very well ask why do you not burn more fat in a state of deprivation. Although this seems like the a logical step, fat cannot burn unless there are carbs present. The by-product of carbohydrate metabolism is the oxygen in which fat burns.  Depriving yourself of the right amount of carbs will shift the body into finding the most available energy source for survival, and that is muscle.  Once again, you are losing something that has a gravitational pull to the earth – weight !!  And again, you have not lost any fat, you have not improved either your metabolism or your health… in actual fact, you have trained your body to store fat, and are going further and further away from the original goal of health and fat loss.  Literally, it would be to a point of no return, since muscle mass, although the easiest tissue to lose, is the most difficult tissue to rebuild.


So now back to the original question of what is the value of the scale (unless you have already thrown it away, in which case, good for you!!) No longer are you going to scream with joy and accomplishment when your weight goes down in one day (sorry I took that illusion away), but neither are you going to tantrum in defeat, failure  and wonder “why why why!!

I hope I have somewhat eliminated the awe of a 2 – 4 lb weight shift from day to day.  Ilanasology should have explained the normalcy of this, and it has nothing to do with fat loss.  If you are still not convinced that the 4 lbs you gained overnight is not fat, then get out your calculator:  One pound of fat is 3500 calories. This means that to gain 4 lbs, you would have to eat 14 000 calories, and although some of you may snicker, I doubt that you ate that for dinner.  Similarly, if you are convinced that the 4lbs you lost within a day or two is because you have been a perfect angel on your eating plan, then again, get out your calculator.  Realistically it is viable to lose 1 – 2 lbs a week but a 10 lb fat loss in one week would equate to a 35 000 calorie reduction over the week. Not really rational, is it?

 So now that the technical stuff  has bogged you down, there is one simple take home focus, and that is that you can realistically lose 1 – 2 lbs of fat a week. With that said, if you are not willing to give up your dysfunctional relationship with the scale, at least consider “dating” the scale. And by that I mean, set up a date or two with the scale, play hard to get, keep your distance, and do not let that dumby become a mood swinger. Keep the scale at bay, and date night should be at max once a week. Well, maybe not date night, since the dumby is more effective in the morning. Weigh in at the same time and under same conditions on each date, meaning no clothes.  Always put yourself first! No really – YOU are your best critic for your success and continuous motivation. Look in the mirror,  pinch your firmer muscles for a reality check. Do you feel good. Are you feeling fit and healthy.  Get in touch with your feelings, since they are the real proof in the pudding (and no, not mmmm pudding). Are your rings slipping, is your skin feeling tighter, are your muscles shapely, and do your clothes feel loser.  You know when you are eating well, sleeping optimally, de-stressing. So never let your scale tell you any differently!




August Newsletter 2018

August 2018 Newsletter:

 This month’s hot topic to address is the benefits of consuming antioxidants. Many people have heard of antioxidants, but may not be aware of what it actually is and what it does for the body that makes them beneficial. Well, read on, and you will know all about antioxidants!

                            What in the heck are ANTIOXIDANTS??





An antioxidant is a dietary substance that can prevent damage to the cells in the body or repair damage that has already been done.

Damage can occur due to oxidation, which is the process of atoms loosing electrons and becoming “free radicals”. If atoms remain unstable due to the loss of an electron, they have the ability to make other atoms unstable, damaging or destroying cells. Free radicals may also be developed due to exposure to sunlight, radiation, pollution, and other toxic substances.

Antioxidants help by donating electrons to unstable atoms or by converting and excreting them out of the body. Research suggests that if the body undergoes oxidative stress, it may be the cause of the formation of medical and chronic conditions, such as cancer or heart disease.

Here’s an easy tip: Think of it antioxidants as being “against oxidation”.


Red Wine and Flavonoids





Flavonoids are water soluble molecules with antioxidant affects. They are derived from fruits, vegetables and wines. Flavonoids cause the body to reduce the oxidation of lipoproteins, especially LDL, the bad cholesterol. They also help raise HDL, which is the good cholesterol.

Consumption of flavonoids can assist in the reduction of both systolic and diastolic blood pressures, total cholesterol, and decrease stroke risks.

Many studies show that having 1 glass of red wine a day may decrease risk of coronary heart disease.

However, put your goals in perspective – Wine also has calories and may diminish ones results for weight loss. Furthermore, Red wine has also been shown to increase the risk of breast cancer.  You can get flavnoids from various other food sources with less calories, and less risk of breast cancer such as citrus fruits, berries, legumes and grapes.

Nutrients as Antioxidants:

Antioxidants are found in a variety of foods, including many fruits and vegetables, nuts, grains, and some meat, poultry and fish.

Antioxidant substances are found in foods containing Vitamin A, Vitamin C, Vitamin E, Selenium, and Beta-carotene. Here are examples of foods with these specific nutrients:

  • Vitamin E- Vegetable Oils, Nuts, Seeds, Soybeans, Wheat Germ.
  • Vitamin C- Many fruits and vegetables, grapefruit, oranges,  potatoes, broccoli, etc.
  • Vitamin A- carrots, spinach, mango, milk, margarine, fortified cereals
  • Beta carotene- red, orange, yellow, and deep-green foods


An Easy, Yummy Antioxidant Dessert:

All you need is fruit, brown rice cakes, and cool whip: Add 2 tablespoons of lite cool whip to one rice cake and top with ¼ cup sliced strawberries, ¼ cup blueberries, and ¼ cup raspberries.

Only 115 calories plus 9 grams whole grains

“In your body, the antioxidant process is similar to stopping an apple from browning. Once you cut an apple, it begins to brown, but if you dip it in orange juice, which contains vitamin C, it stays white.”- The American Dietetic Association


Research Suggests…

There are many studies that suggest that a high consumption of antioxidants can help reduce and delay chances of cancer development.

Antioxidants are powerful because they enhance the immune system. A strong immune system is vital for good health. Research is also concluding that antioxidants assist in the removal of precancerous cells, as well as inhibit the growth of tumors that may already be present.

By following a healthy diet, full of fruits and vegetables, you can help your body fight and prevent oxidation.

Antioxidants are vitally important for general healthy, but for athletes they may even have additional benefits

 Notes for Antioxidants and Performance.

This is an interesting concept, because it has been found that on the one hand, regular physical exercise enhances the antioxidant defense system and protects against exercise induced free radical damage. However, the level of intensity and duration also requires attention: Intense exercise, particularly in untrained individuals, overrides the defense system, resulting in increased free radical damage. Furthermore, endurance exercise increases oxygen utilization up to 20 times as compared to the resting state. Increased oxygen utilization means an increase in the generation of free radicals, with the concerning result of muscle and tissue damage.

Antioxidant supplementation has had increased awareness in the athletic community for these reasons.

Individual fitness level, intensity of exercise, and diet are among the factors determining the extent of exercise-induced free radical damage. This article focuses on how athletes can defend against the increased free radicals resulting from exercise and to determine the antioxidant supplementation that may be necessary.

Vitamin E, in particular, considered the strongest antioxidant, shows a clear protection against exercise-induced oxidative damage, . Vitamin E has also been shown to enhance recovery following intense exercise. There are some studies suggesting that vitamin C may also hasten recovery, as well, and decrease muscle soreness.

Furthermore, athletes adapting to high-altitude training (such as skiing or mountaineering), vitamin E might be a beneficial supplement because it did demonstrate reduced free radical damage and blood lactate levels in a placebo-controlled study on mountaineers.

· Your diet,  could be capable of providing the necessary components for an inherent antioxidant system. Eating 5 servings of fruit or vegetables per day along with a balanced exercise program will ensure this, but for many athletes that work out longer and stronger than the average Joe, supplementation is certainly worth considering.

· Weekend warriors should strongly consider a more balanced approach to exercise. Failing that, again, consider supplementation and be reasonable about knowing the product, its purity, its bioavailability. and its research

· For extremely demanding races (such as endurance events), or when adapting to high altitude, consider taking a vitamin E supplement (100 to 200 IU, approximately 10 times the RDA) per day for several weeks up to and following the race, as well as an overall variety of antioxidants (Juice plus is a product that comes to mind, which supplies all these added benefits within its highly respected brand).

· If you do supplement, read labels and follow instructions. Do not over-supplement.

· Remember that free radicals can be generated not just by exercise but also from smog and other environmental sources. Do not exercise in areas with significant air pollution.


Hyponatremia: Signs, Symptoms and Warnings

Ilana Katz MS, RD, CSSD

Hyponatremia tends to be mostly associated with athletes who participate in long duration sports such as marathons and triathlons. Endurance athletes taking in water during training or an event can develop hyponatremia, a potentially life threatening condition that occurs when sodium levels drop to a dangerous low in the blood stream (below 135 mmol/L (of blood). Early symptoms may include nausea, drowsiness, confusion, headache and fatigue. These can quickly progress to seizures, coma and death if not resolved in time. Importantly, athletes are not the only population that needs to be aware of this deadly phenomenon.

Dilution of sodium can result, as mentioned, from over-drinking, but also from water retention (often a side effect of various medications). Sodium can be lost in various ways other than dilution which include urination, perspiration and gastrointestinal distress (vomiting/diarrhea). Furthermore certain medical conditions such as congestive disease, kidney dysfunction and ineffective ant-diuretic hormones are known causes.

Since hyponatremia has usually been associated with endurance sports, those who engage are much more well-informed than in the past, and emergency staff who treat athletic stress conditions are also far better educated to recognize and manage symptoms, and even play a role in prevention. The sports medicine community has been helpful in raising awareness about risks and signs of over-hydration. However, with obvious evidence that there are many other populations at risk for hyponatremia, it is vital to recognize these so that all health care professionals are on the leading edge of avoidance and if necessary, acute care.

Some examples of patients who may be eligible for high alert:

  • Psychiatric patients with a syndrome known as psychogenic polydipsia, meaning they drink excessive amounts of water..
  • Multi-pharmocological patients (especially elderly). Why, well because many medications have potential risks.
    • Diuretics deplete electrolytes, including sodium
    • Antidepressants increase level of antidiuretic hormone
  • Patients being administered intravenous hypotonic fluids: hypotonic fluids contain a lower concentration of sodium than blood and thus excessive quantities at high entry rate can dilute sodium.
  • Tube fed patients: proper fluid levels and electrolyte balance must be continuously monitored and orders adjusted based on results of consistent blood work.

There is also the all controversial sodium debate to consider. Researchers and health practitioners often have opposing arguments as to whether dietary sodium should always be strictly conserved. While lowering sodium is unarguably beneficial for those already diagnosed with hypertension (high blood pressure), increasingly conservative recommendations for the average population is often contested. The argument being that too little sodium can lead to other health problems, the main one being hyponatremia. Interestingly, the dietetic community are in agreement that avoidance of dietary sodium is unlikely to cause hyponatremia. Even a very low sodium diet of 500 – 1000 mg/day should maintain adequate levels under normal circumstances. It is the complexity of what defines “normal circumstances.”

In summary, with regards to controlling appropriate levels of sodium in the blood and avoidance of hyponatremia, not only athletes should be aware of hyponatremic signs and symptoms. For those with a normal blood pressure, eating patterns and water intake should be developed based on clinical judgement, guidelines and scientific evidence.

glass of ice blue