By Dr. Ed Hendricks on August 13, 2009
The following went out to all staff at the Center for Weight Management today. In view of the intense interest in the Swine Flu I’m posting it here for our patients and others. Please post your questions and comments.
Swine Flu or H1N1 Influenza:
Classes at Granite Bay High School started on Monday, August 10, 2009. Yesterday parents of students were notified that “Swine Flu” had been diagnosed in three students on the second day of classes. The H1N1 flu is now among us and we should be prepared to deal with it among our patients, our staff and our families.
A visit to CDC web pages today yielded the following information. “When the novel H1N1 flu outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the novel H1N1 flu outbreak, including the numbers of confirmed and probable cases of disease. From April 15, 2009 to July 24, 2009, states reported a total of 43,771 confirmed and probable cases of novel influenza A (H1N1) infection. Of these cases reported, 5,011 people were hospitalized and 302 people died.” The mortality rate during that time was 0.7% and the hospitalization rate 11%. A mortality rate of 0.7% means about 7 persons die out of 1,000 infected. This mortality rate is lower than usual for an influenza epidemic but these data are for summer months when the mortality rate is typically lower.
Of interest is the “secondary attack rate” meaning the rate of infection following close contact with an infected person at home, at work or at school. The CDC reports “a secondary attack rate in household contacts for acute-respiratory-illness (ARI) was 18 % to 19% and 8% to 12% for influenza-like-illness (ILI). ARI is defined as two or more of the following four symptoms: fever, cough, sore throat, and rhinorrhea (runny nose). ILI is defined as fever and cough or sore throat. In general, these household secondary attack rates are slightly lower than what occurs in seasonal influenza.” The secondary attack rate in the household can be lowered by the use of antiviral medications for the infected family member to reduce viral shedding. Secondary infection rates can also be reduced by treating contacts with an antiviral drug as discussed below.
Also of interest is that obesity may be a risk factor for flu complications.
Prevention: What can one do to avoid this flu? Wash your hands often, avoid infected persons if possible, get the vaccine as soon as it becomes available, and take vitamin D. More information about vitamin D is written below.
Symptoms: The symptoms of H1N1 flu virus in people are similar to the symptoms of seasonal flu, although vomiting and diarrhea has been reported more commonly with H1N1 flu infection than is typical for seasonal flu. Symptoms include fever (93%), cough (83%), shortness of breath (54%), fatigue/weakness (40%), chills (37%) and myalgias (muscle soreness) (36%).
Treatment: The swine flu or H1N1 influenza virus is sensitive or susceptible to the neuraminidase inhibitor antiviral medications, zanamivir (Relenza Inhalation Powder) and oseltamivir (Tamiflu). It is resistant to the adamantane antiviral medications, amantadine (Symmetrel) and rimantadine (Flumadine). For treatment and prophylaxis to be effective it should be initiated as soon as possible after exposure. If time lapse between exposure and therapy or prophylaxis was 2 or more days, choose Relenza over Tamiflu. Each Relenza prescription comes with an inhalation device – no special inhalation equipment is necessary.
Relenza Inhalation Powder treatment for adults & children ≥ 7 years infected with H1N1 influenza: 10 mg (two 5mg inhalations) twice daily for 5 days. Relenza prophylaxis if exposed to an infected person: 10 mg (two 5mg inhalations) daily for up to 10 to 28 days.
Tamiflu treatment for adults and adolescents ≥ 13 years infected with H1N1 influenza: 75 mg twice daily for 5 days. Tamiflu prophylaxis if exposed to an infected person: 75 mg daily for 10 days to 6 weeks.
As the recommendations indicate, either of these drugs can be used for prophylaxis during an epidemic for any patient or member of their family even in the absence of known exposure. At this point in the emerging epidemic we should not hesitate to write prescriptions for either drug if any patient requests them. I plan to prescribe Tamiflu for my family and hold it for use if needed. Later on in the epidemic the drugs may be hard to find or unobtainable.
Vitamin D3:
Vitamin D is an extremely important defense mechanism against influenza. Although definitive randomized placebo controlled clinical trials (RCTs) have not been reported, there is anecdotal evidence and limited trial evidence strongly suggesting that taking supplementary vitamin D is protective and reduces both the risk of influenza infection and the risk of complications if infection does occur. Vitamin D can be used as a supplementary, experimental treatment for and prophylaxis against influenza – it should not be used as the only agent in treatment or prophylaxis.
Vitamin D is toxic only in high doses taken for long periods of time. Rather than wait for definitive evidence from RCTs I make the following recommendations. These recommendations are adapted after those of John J. Cannell, M.D. of the Vitamin D Council. Patients should be informed that their other physicians probably would disagree with these recommendations. since knowledge of the importance of Vitamin D supplementation is not stressed in mainstream medicine.
As a daily routine in the absence of flu symptoms or exposure:
1. Every adult should take one 5,000 I.U. vitamin D capsule daily.
2. Children should take one 1,000 I.U. vitamin D capsule daily for each 25 pounds of weight. Thus a child weighing 75 pounds should take 3 capsules, etc.
If exposed to the flu I recommend increasing the vitamin D dose as follows:
1. Adults and adolescents should take one 50,000 I.U. capsule daily for 10 days. If re-exposed during the 10 days add another 10 days. (Don’t continue this dose indefinitely since this dose can produce vitamin D toxicity, but only after several months).
2. Children should take 10,000 I.U. per 25 pounds body weight for 10 days. If re-exposed during the 10 days add another 10 days. (Don’t continue this dose indefinitely since this dose can produce vitamin D toxicity, but only after several months).
If influenza symptoms develop, I recommend increasing the vitamin D intake as follows:
Adults, adolescents, and children should take 2,000 I.U. per Kg body weight per day for 7 days.
Examples for different weights:
Vitamin D dose for a 250 pound patient
Dose = 250 lb X 1 Kg/2.2 lb X 2,000 I.U./1 Kg = 236,367 I.U.
I’d round up to 250,000 I.U. or five 50,000 I.U. capsules per day for 7 days.
Dose = 200 lb X 1 Kg/2.2 lb X 2,000 I.U./1 Kg = 181,182I.U.
I’d round up to 200,000 I.U. or four 50,000 I.U. capsules per day for 7 days.
Vitamin D dose for a 85pound patient
Dose = 85 lb X 1 Kg/2.2 lb X 2,000 I.U./1 Kg = 72,272 I.U.
The 50,000 I.U. dose of vitamin D is a prescription and must be prescribed and dispensed by a physician or other practitioner. Practitioners should explain carefully such prescriptions to the patient (or to a parent if it is for a child or adolescent.) Since these high doses of vitamin D can lead to toxicity if continued for too long we do not sell the 50,000 I.U. vitamin D capsules as an over-the-counter supplement. Practitioners should document these prescriptions and the instructions and cautions in the patient record.
Patients should be informed that vitamin D alone is not sufficient treatment for influenza and this too should be documented in the record.
By Paula Hendricks - Nutritionist on August 5, 2009
PRODUCTS & SPECIALS
· Protein Special of the Month: Just in time for back to school lunches – Crisp n’ Crunch bars are on sale, both the Cinnamon Crunch and Fudge Graham. Each flavor has 15 grams of protein and 5 grams of fiber. These filling bars make great snacks or meals for all ages. On sale for $10.80 (box of 7 bars). Regular price – $12.00
· Supplement Special of the Month: Pro-Flora Probiotics #30 – Special Price of $17.10 + tax. What are probiotics and should you be taking them? Read more about the benefits of supplementing with probiotics below or download the Late Summer 2009 handout on our website blog under Did You Know.
· Just Released – Our 20th Anniversary Key Diet Book: Purchase our latest Key Diet Book today for yourself or for friends and family. The new version has up-to-date information on the best way to eat for long term health and wellness and new tips on exercise and motivation. $14.95 + tax.
· Get Motivated and Come with a Friend or Family Member: Ask us about our discounted Prepaid Buddy Office Visits. We offer packages of 4 or 12 visits.
FROM THE NUTRITIONIST
· Recipe of the Month – Chicken Tostadas for Four! Our family loves to eat Mexican food, especially chicken tostadas. They are really tasty when you use fresh Pasilla chilies. Each serving has 30+ grams of protein. Pick up a copy in the office today or go to our website and download the recipe. Enjoy!
· Did You Know? – The Benefits of Probiotic Supplements and Probiotic Yogurt Intake. Research studies suggest eating probiotic-containing yogurt or supplementing with probiotics stimulates a beneficial immune response, improving the body’s ability to ward off infections. Maintaining a healthy immune system is extremely important today because of the prevalence of antibiotic-resistant bacterial strains and the emergence of new viral strains such as swine flu…. Read more about the benefits of probiotics – pick up the latest Did You Know? hand-out in the office today or download it from our website posted under our blog.
· Want your Kids to Succeed Physically and Academically in School? It’s that time of the year again – school schedules, getting to bed earlier, the morning rush, purchasing back to school supplies, and signing up for school sports. And most importantly, sending the kids off to school with a nutritionally sound breakfast and healthy lunch to help them succeed both physically and academically. Scientists show that good nutrition improves mental and physical abilities. In fact, multiple studies have shown that kids who skip breakfast are more likely to eat more during the day, have a higher body mass index, score poorly on tests, and be less physically active. Help your kids succeed in school and in life by providing them with sound nutritional guidelines at an early age. Be an example. Breakfast is the more important meal of the day. Start it with a good protein meal.
Get organized by planning ahead. If morning time is too rushed, plan or prepare both breakfast and lunch the night before. Have your kids help with the process. Skip the cereal and milk and serve up some eggs with chopped ham and cheese, make a yogurt smoothie with high-protein Greek-style yogurt, or a low-carb burrito. Make a healthy breakfast casserole, and divide into serving sizes that can be quickly heated for breakfast. For lunch ideas, pick up a copy of our Lunch Choices for Kids hand-out at the office. Want something quick, easy and healthy? Take advantage of our special pricing on Crisp n’ Crunch bars for breakfast or lunch. Kids also like the Chocolate and Vanilla Wafers, BBQ Cruncho’s, and the Ready-to-Drinks and Shake-n-Go’s.
Know anyone who would be interested or would benefit from our Monthly Newsletter, Recipes of the Month, or Did You Know handouts? If you do, have them sign up for our monthly email newsletter. All they need to do is send us an email through our website and request we add them to our newsletter. Or if you receive the newsletter, you can forward them the email link. Share health with those you love.
By Paula Hendricks - Nutritionist on August 5, 2009
Chicken Tostadas with Sour Cream Taco Sauce – Serves Four
Our family loves Mexican food, especially chicken tostadas with a little spice. We do make these with a low-carb flour tortilla but you can top the ingredients over some refried beans, a corn tortilla or for those of you on the VLCD, over shredded lettuce. Each tostada has approximately 40 grams of protein per serving with the tortilla (no beans).
Ingredients:
- Four 4-ounce chicken breasts, boneless
- 2 whole lemons
- 2 garlic cloves, minced
- One package taco seasoning
- 1 cup reduced fat Mexican-style cheese, shredded
- One small avocado, diced
- One 8 oz can Ortega chiles, diced (or 2 fresh roasted Pasilla chilies, seeds removed)
- One head Romaine lettuce, shredded
- Four low-carb tortillas, Mission brand, fajita-size
- Jalapeno peppers, sliced
- 1/2 cup fresh cilantro leaves
- 1/2 cup light sour cream
- Salsa for garnish
- Optional – one cup refried beans
Instructions:
1. Marinate chicken breasts in one whole lemon juice, garlic, and 3/4 of the package of the taco seasoning for about 30 minutes.
2. If using fresh chilies, broil in the oven or roast on grill until the skin becomes black. Cool and peel.
3. Cook chicken in a non-stick skillet for about 10 minutes, 5 minutes on each side, until cooked.
4. While chicken is cooking, wash and shred the lettuce, dice the avocado, dice the roasted chilies, slice the other lemon for garnish, and chop cilantro.
5. Mix the sour cream with the remaining taco seasoning. Keep chilled.
6. When chicken if cooked, removed from pan and slice each breast into long strips (or dice if desired).
7. Heat the tortillas and beans (if using).
Assembly:
Place a tortilla on each plate. Add 1/4 cup of beans to each tortilla. Next, add the lettuce, chilies, avocado, sliced chicken, jalapeno and cilantro. Sprinkle 1/4 cup of cheese and drizzle a little sour cream over each tostada. Serve with a side of salsa. Enjoy.
By Paula Hendricks - Nutritionist on August 5, 2009
Benefits of Probiotic Yogurt Intake and Probiotic Supplementation
People have been consuming yogurt for centuries as a curative for many gastrointestinal problems and inflammatory conditions. It has also been a diet staple in the Middle East, Russia, and many European countries as it provides a complete protein and is a good calcium source. Not until the 20th century did yogurt begin to gain popularity for its health benefits when consumed – most notably from the live bacteria (active cultures) found in high quality yogurts, also known as probiotics, meaning “for life.”
Research studies suggest eating probiotic-containing yogurt or taking probiotic supplements stimulates a beneficial immune response, improving the body’s ability to ward off infections. Maintaining a healthy immune system is extremely important today because of the prevalence of antibiotic-resistant bacterial strains and the emergence of new viral strains such as swine flu.
Other benefits of probiotics include the relief of symptoms of irritable bowel disease and associated diarrhea, relief from constipation, and promotion of the growth of beneficial bacteria which reduces yeast and other infections. Because of the numerous benefits from probiotics, we recommend you make yogurt consumption or probiotic supplementation part of your daily diet.
Caution! Not all yogurts contain probiotics. You must look on the yogurt container label to make sure it states “Contains live active cultures.” In addition, we recommend consuming only Greek-style yogurt which is low in carbohydrates and high in protein. Greek-style yogurt contains twice as much protein and 400 mg more calcium than milk, cup for cup. If you or your family is consuming milk for a good protein, calcium, vitamin D or probiotic source, we recommend you replace your milk intake with Greek-style yogurt, either non-fat or low-fat.
Adults should not drink milk. Milk (breast or formula) is for babies and adults have no need for it. There are many other ways to consume protein, calcium, and vitamin D than from milk intake. Milk from cows is higher in sugar than protein and many adults have difficulty digesting the lactose (sugar) in milk and may not even be aware of the symptoms. Symptoms include bloating, allergies, asthma, constipation, and diarrhea. Although yogurt is made from milk, the active cultures blended with milk turn the lactose into lactic acid which promotes friendly bacterial growth in the intestines without the digestive problems associated with milk intake.
Caution! Not all yogurts are a high quality food. Most popular brand-name yogurts contain high amounts of added sugar, up to 6 teaspoons per cup, typically do not contain probiotics, are not a good protein source (less than 6 grams of protein from milk per cup), and are basically a high sugar dessert. Next time you go to the grocery store, pick up a container of Yoplait, Dannon, Activa, or Gogurt (2 grams of protein) and check out the ingredients list. You will likely find sugar listed as the second ingredient.
If you don’t care for the taste of yogurt but want to benefit from the probiotics, we recommend using our nutritional supplement, Pro-Flora Concentrate, which contains six live active cultures, and is formulated to survive stomach acids and promote a good balance of friendly bacteria in the intestines. For those of you with chronic intestinal problems or are taking an antibiotic, we recommended you consume high quality probiotic yogurt and supplement with probiotics as well.
On the back page, I have put together a few yogurt recipes for you to try. They are tasty, simple to prepare and will provide you with some alternate high-protein serving choices. Experiment and enjoy.
By Paula Hendricks, BS, Nutritionist
Some recommended yogurt brands: Trader Joe’s Greek Style Nonfat Plain Yogurt; Fage Total Nonfat Greek Strained Yogurt; and Stonyfield Farms’ Oikos Organic Greek Yogurt. Always check the container label to assure you are getting the right type of yogurt.
Recipes
Chilled Cucumber &Yogurt Soup– single serving size (OK on the VLCD)
Ingredients: 1 cup non-fat Greek-style yogurt (about 20 grams of protein)
1/2 cup finely chopped cucumber or more
½ minced garlic clove
Salt and pepper to taste
1 teaspoon extra virgin olive oil to drizzle on top
Dried mint (or dill) to sprinkle on top, about 1/4 teaspoon
Directions: Mix first four ingredients together. Put in blender and blend for 30 seconds. If you like it thinner, add more cucumber. Pour in a soup bowl and drizzle olive oil on top and sprinkle with mint. You can also prepare it without blending.
Yogurt Creamed Spinach – single serving size (OK on the VLCD)
Ingredients: 1 cup non-fat Greek-style yogurt (about 20 grams of protein)
4 cups packed fresh spinach, chopped
1 teaspoon extra virgin olive oil
½ minced garlic clove
Salt and pepper
Italian seasoning, about 1/2 teaspoon
Directions: Cook spinach in a microwave-safe bowl for about 2-3 minutes. Drain excess juice. Add the remaining ingredients and mix well. Eat warm.
Plain Yogurt with Sweetener – try mixing a packet of non-nutritive sweetener, 1 teaspoon of fruit-only jam, a dash of flavored extract, or sugar-free syrup into one cup of Greek-style yogurt.
Yogurt and Berry Smoothie – single serving size (OK on the LCD or MD)
Ingredients: 1 and 1/2 cups non-fat Greek-style yogurt (about 30 grams of protein)
8 ice cubes
10 raspberries
1/5 of a medium banana, slightly green
2 packets non-nutritive sweetener (Stevia, Truvia or Splenda) or more if needed
Directions: Place all items in a blender and blend until all ice is crushed. Pour in glass and drink.
Dips and Dressings:
Creamed Horseradish Dip – mix 2 T. plain yogurt with 1 T. prepared horseradish and 1/2 tsp. garlic salt.
Ranch Dressing – mix 1 cup Greek-style plain yogurt, 1 cup buttermilk, 1/2 packet Hidden Valley Ranch dressing or mix together garlic salt, dill, and Worcestershire seasoning for your own taste. Chill.
Contact our non–surgical weight loss clinic, which serves Sacramento, Roseville, and surrounding areas, to schedule an appointment.
2310 Professional Dr., St. 200
Roseville, California 95661
Phone:916.773.1191
Fax: 916.773.0498
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2621 Capitol Ave.
Sacramento, California 95816
Phone: 916.551.1999
Fax: 916.551.1998
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