The Clarification of Cachexia

By: Nikki Nies

Overconsumption of food is emphasized as the leading cause of obesity in the U.S.  However, the other end of the spectrum  of nutrition related problems, such as starvation and/or cancer cachexia are not equally advertised in the media.

How many people know what cachexia is? Truthfully?It’s understandable why the two terms could be confused.  Starvation is defined as the suffering caused by hunger.  Cachexia, aka paraneoplastic syndrome, is the progressive and extreme weight loss associated with certain chronic diseases (i.e. multiple sclerosis, type 1 diabetes, failure to thrive syndrome, heart failure, emphysema,cancer and/or HIV/AIDS).

Cachexia is caused by “tumor factors”, which are produced and secreted by the tumor.  It is dominated by catabolic metabolism, which is the breakdown of normal bodily processes.


  • Anorexia
  • Early satiety
  • Progressive and severe weight loss with >10%  in 6 months
  • Generalized wasting and weakness
  • Impaired immune function
  • Poor physical performance.

 It is present in more than 50% of those with advanced cancer and thought to contribute to 20% of cancer deaths.   Although diagnosis of cancer cachexia often comes after some time with cancer, it commonly leads to muscle wasting in the early stages of cancer.  Cancer cachexia is more common in those with stomach, lung or pancreatic cancer.

Cancer cachexic patients may have a harder time handling treatments, such as chemotherapy due to additional side effects and have a poorer prognosis.

The metabolic difference between starvation and cachexia are important to note and provide better insight into why the terms cachexia and starvation can not and should not be used interchangeably.

Starvation Cachexia
Mobilizes fat, spares skeletal muscle Mobilizes fat and skeletal muscle
Decreased Basal Metabolic Rate (BMR) Normal or increased BMR
Decreased liver size Increased liver size
Normal lipoprotein lipase (LPL) Decreased LPL activity
Decreased glucose turnover Normal or increased glucose turnover
Decreased protein breakdown Increased protein breakdown
Increased Cori Cycle activity
Increased synthesis of positive acute phase proteins

LPL is responsible for the cleavage of triacylglyercols into fatty acids and glycerol.

The evaluation of cachexia can be found by measuring one’s lean body mass, food intake diaries, BMI and blood tests that include (WBC count, serum albumin, uric acid and C-reactive protein).

The nutritional goal when treating cancer cachexia is the recommendation of nutrient through a variety of foods daily.  The goal is to preserve lean body mass, minimize nutrition related side effects and/or deficiencies and maximize quality of life.It is difficult to reverse cachexia,  but that doesn’t mean there’s no cause of concern.  The aim is to “stimulate” anabolic processes, which is muscle building while inhibiting catabolic processes, which are the actions that result in the breakdown of muscle.

It’s been found that the addition of supplements in the diet is not found to be effective, but the gradual increase of nutrients can benefit.  Some studies have found using fish oil or EPA, one of three fatty acids may decrease inflammatory markers.  In addition, endurance training exercise may decrease the decline of muscle mass and there are medications available (i.e. megace, thalidomide).




By: Nikki Nies

Sugar sweetened beverage (SSB) consumption is the largest contributing factor to childhood obesity.  SSB includes soda, fruit drinks, fruit juice, energy drinks, sports drinks, flavored milk and are the unnecessary consumption of added carbohydrates for flavoring.  High consumption of SSB increases risk for metabolic syndrome and chronic diseases, such as diabetes and cardiovascular disease.

Risk factors for increased consumption of SSB:

  •  Sedentary lifestyle: With increased sedentary activities such as TV watching and computer use comes mindless consumption of SSB; an increased opportunity to overeat and additional exposure to food advertisements
  •  Access at school: 68% of students consume SSB through vending machines, cafeteria and events in the classroom; Approximately 145 kcal could be saved by limiting intake of SSB at school; amount of SSB consumed is inversely related to the quality of SSB policies in schools
  •  Parental Influence:parents are “gatekeepers” of SSB consumption at home; children of lower educated mothers are 1.7 times more likely to consume SSB than those with higher educated mothers; parents are key players in the prevention and change of consumption of SSB
  • Ethic and Socioeconomic Disparities: Lower household income is independently associated with increased consumption of SSB; among children ages 6-11, Latino and black children have an increased overall consumption of SSB compared to white children of the same age

Negative Consequences:

  • Altered milk consumption: with increased consumption of SSB comes decreased consumption of milk; Kids who drink SSB instead of milk are missing out in vital nutrients such as Calcium and Vitamin D which can lead to bone disease later on; when available, two thirds of school children prefer flavored and sweetened milks instead plain low fat milk
  • Other food consumption:increased consumption of SSB leads to increased consumption of higher energy dense foods such as pizza, burgers, fried potatoes and snack foods; heavy consumers of SSB have an increased consumption of food, they also have a decreased consumption of non-sugar sweetened beverages such as milk and water

The risk factors and consequences of SSB are multifaceted.  By understanding why adults and children consume SSB in exorbitant amounts will provide great groundwork on how to best intervene and provide increased awareness on why people can’t stay away from sugar sweetened beverages.


1. Taber D, Chriqui J, Powell L, Chaloupka F. Banning all sugar-sweetened beverages in middle schools: Reduction of in-school access and purchasing but not overall consumption. Arch Pediatr Adolesc Med. 2012;166:256-262.
2. Kremers SPJ, van der Horst K, Brug J. Adolescent screen-viewing behaviour is associated with consumption of sugar-sweetened beverages: The role of habit strength and perceived parental norms. Appetite. 2007;48(3):345-350.
3. Wijtzes AI, Jansen W, Jansen PW, Jaddoe VWV, Hofman A, Raat H. Maternal educational level and preschool children’s consumption of high-calorie snacks and sugar-containing beverages: Mediation by the family food environment. Prev Med. 2013;57(5):607-612.
 4. Briefel R, Wilson A, Cabilli C, Dodd A. Reducing calories and added sugars by improving children’s beverage choices. Journal of the Academy of Nutrition and Dietetics. 2013;113(2):269-275.

5. Johnson D, Bruemmer B, Lund A, Evens C, Mar C. Impact of school district sugar-sweetened beverage policies on student beverage exposure and consumption in middle schools. Journal of Adolescent Health. 2009;45(3):S30-S37.
6. Bogart LM, Cowgill BO, Sharma AJ, et al. Parental and home environmental facilitators of sugar-sweetened beverage consumption among overweight and obese latino youth. Academic Pediatrics. 2013;13(4):348-355
7. Han E, Powell L. Consumption patterns of sugar sweetened beverages in the U.S. J Acad Nutr Die. 2013.
8. Beck AL, Patel A, Madsen K. Trends in sugar-sweetened beverage and 100% fruit juice consumption among california children. Academic Pediatrics. 2013;13(4):364-370.
9.Keller K, Kirzner J, Pietrobelli A, MP S, Faith M. Increased sweetened beverage intake is associated with reduced milk and calcium intake in 3- to 7-year-old children at multi-item laboratory lunche. J Am Diet Assoc. 2009;109(3):497-501
10. Mathias KC, Slining MM, Popkin BM. Foods and beverages associated with higher intake of sugar-sweetened beverages. Am J Prev Med. 2013;44(4):351-357.
11. Story M, Hannan P, Fulkerson J, et al. Bright start: Description and main outcomes from a group-randomized obesity prevention trial in american indian children. Obesity (Silver Spring). 2012.
12.Shapiro J, Bauer S, Hamer R, Kordy H, Ward D, Bulik C. Use of test messaging for monitoring sugar-sweetened beverages, physical activity, and screen time in children: a pilot study. J Nutr Educ Behav. 2008;40:385-391.

Benefits of Breastfeeding


By: Nikki Nies

One of the common first questions posed to new moms is bottle or nipple fed?  While breastfeeding may be initially thought as unrealistic for working mothers, those feeling detached or with hectic schedules, perhaps you need a little a more convincing.

 I’ve personally not given birth, but I can understand and empathize with the concept of wanting to provide the best for one’s children. The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists strongly recommend breastfeeding, as it’s one of the first, best acts of love a mother can give.

Benefits of Breastfeeding:

  • Provides ideal amount of nutrients–provides perfect mix of vitamins, protein and fat
  • More easily digested than infant formula
  • Breast milk contains antibodies, which can help fight off bacteria and/or viruses
  • Can satisfy baby’s emotional needs–best way to keep baby comfortable!
  • Protects against Crohn’s disease
  • Reduces risk of allergies and/or asthma 762_breastfeeding-poster
  • When exclusively breast fed for first 6 months, may decrease risk of ear infections, respiratory illnesses and/or bouts of diarrhea
  • Babies are less likely to be constipated
  • Most convenient method of feeding!
  • Breast milk composition provides newborn all the nutrients needed
  • May increase intelligence in the future
  • May need less trips to the hospital and/or doctor
  • Increases maternal bond with newborn
  • More likely for babies to to stay on target on growth charts
  • Plays a role in the prevention of sudden infant death syndrome (SIDS)
  • May lower future risk of diabetes, obesity and/or certain cancers
  • For mothers, reduces risk of breast and ovarian cancer, increases recovery from childbirth, reduces risk of osteoporosis, burns extra calories–>helps one lose more pregnancy weight faster
  • More environmentally friendly–less waste with formula cans and bottles
  • More budget friendly–with breastfeeding, one doesn’t have to worry about purchasing baby bottles, sterilizing and/or measuring formulas
  • Saves time!

Yes, every mother’s situation is different.  If your doctor states your baby needs to be bottle fed temporarily, of course, bottle feed.  But, if all’s clear, don’t knock breastfeeding until you’ve tried it.  Make sure to try different positions and compare notes with friends on some useful tips. Good luck!

Photo Credit: Fluffy Baby Shop and Ann elise in the big world


Fruits & Veggies–More Matters


By: Nikki Nies

Although, the USDA recommends Americans consume 9 servings of fruits and vegetables daily, it’s evident with the obesity epidemic not many are attaining said recommendations.  Gradual, small changes are better than no changes at all.  The UK established a 5 a Day Campaign, recommending 5 servings of fruits and vegetables, which the U.S. has adapted into their own program of Fruits & Veggies–More Matters.  Five servings derives from the World Health Organization (WHO)’s recommendation of consuming 400 g of vegetables daily.

Regular, varied consumption of fruits and vegetables are needed to ensure one is obtaining the necessary vitamins, minerals and fiber needed for growth and overall health.  Fruits and vegetables are low in fat and calories, may reduce risk of cardiovascular disease and cancer, lower cholesterol and high blood pressure.  This campaign stresses it’s easy to meet this challenge of 5 servings of fruits and vegetables since they come in many forms (i.e. frozen, fresh, canned, pureed or in juice form, etc).

Tips for easier success: basket-of-vegetables

  • Add fruits and vegetables into yogurt, soups, stir fry, smoothies and/or salads
  • Keep fruits and vegetables on hand as a snack (i.e. carrot or celery sticks, apples)
  • To stay budget friendly, buy in season and/or in bulk
  • When choosing canned fruits and vegetables, opt for those without added sugar or syrup
  • Drinking 1 glass (150 mL) of 100% unsweetened fruit juice counts as one portion of F&V
  • Make sure you’re eating fruits and vegetables with a balance of lean protein, whole grains, while limiting excess fat and sugar
  • Document what and how you’re eating fruits and vegetables to better know what methods work best for you
  • First in, first out (FIFO): use what’s oldest first, rotate stock to ensure freshness and reduce waste
  • Store frozen food at zero degrees F
  • Use frozen food within 6 months of purchase
  • Store canned goods at room temperature
  • Store dried goods in a cool, dark place
  • Use products by “use by” date

Warning, while yams, potatoes and plantains are vegetables, they’re considered a starchy vegetable and should not be counted to intake of fruit and vegetable intake.

Since fruits and vegetables can be cooked and served in numerous variations, you’re unlikely to become “sick” of eating such essential foods.  Only good things can come from eating fruits and vegetables, so, start cooking!



By: Nikki Nies MSG-Peter-Tsai-Photography

Many Chinese take out restaurants and menus clearly state their foods are not cooked with MSG.  While such restaurants have eliminated MSG from their food, monosodium glutamate (MSG) has not been completely eliminated from other food industries.

When I was researching MSG, I was shocked to hear how many products still contain MSG.  Well, what’s MSG? MSG is a flavor enhancer used in flavored crackers and chips, lunch meats, salad dressings, canned vegetables, tomatoes, cheeses, gravy mixes, hot dogs, seasoning salt, bouillon cubes, instant soups, meats and fast food.  It is composed of the amino acid, glutamic acid and is created through the fermentation of molasses, starch, sugar and/or sugar beets.

Although, MSG is Generally Recognized as Safe (GRAS) product, the MSG Symptom Complex has emerged in recent decades.  Negative Impacts of consumption of High MSG products:

  •  Headache
  •  Flushing
  • Facial pressure or tightness
  • Sweating
  • Chest pain
  • Heart Palpitations
  • Numbness
  • Nausea
  • Intense Thirst
  • Tingling in mouth
  • Ringing in ears
  • Dizziness
  • Weakness/Lethargy

A high MSG product is defined as anything that exceeds 3 g/1 teaspoon of MSG.

So, how can you decrease your risk of MSG Symptom Complex?  Look at the nutrition fact label AND ingredient list. MSG can also be listed “naturally” as hydrolyzed vegetable protein, autolyzed yeast, hydrolyzed yeast, yeast extract, soy extracts, and protein isolate.  While initially time consuming, you’ll get the hang of analyzing food products the more you become accustomed to reading labels.

Photo Credit: The Open Mind


Why is MSG hidden and masked in Food and Drug labels?

The Measuring Tape Movement

Original Image by Jamie via Flickr
Original Image by Jamie via Flickr

By: Nikki Nies

Everyone knows it’s not healthy to fixate on the numerical size you are.  The scale can only tell you your numerical weight.  When’s the last time you measured yourself with a measuring tape?

Critics state measuring oneself with a measuring tape weekly can provide a better indication of health and fluctuations better than a scale, as a scale is not a clear indicator of lean muscle. Not only can one zero in on the specific part of the body that has gained or lost weight, but by measuring waist, thighs upper arms and hips. Weekly measures of one’s waist can decrease abdominal obesity and long term chance of obesity.

“A quarter-pound fat loss may not register on the scale but could mean millimeters on a tape measure,” says Cynthia Sass, RD

As stated before, measuring waist to hip ratio is a better indicator of health than calculating BMI, which is calculated using one’s height and weight. It’s hoped with this new measuring method, one will be more focused on lowering risk of heart disease, cholesterol, blood pressure and overall health.

Tips for using Measuring tape:

Original Image by Adrian Clark via Flickr
Original Image by Adrian Clark via Flickr
  • Stand straight
  • Use a mirror
  • Stay relaxed
  • Wear thin clothing or nothing at all
  • Don’t exhale strongly or try to suck in your belly to make your waist appear smaller
  • When measuring waist, place measuring tape close to belly button
  • When measuring hips, place measuring tape around widest part of hips
  • Reference range: women should aim for a waist circumference less than 35 inches/88 centimeters; men should aim for less than 40 inches/102 centimeters when measured

If you don’t have a measuring tape in your house, it can be purchased pretty inexpensively at any local stores.  Decreasing your reliance on what the scale states can make a world of difference and hopefully increase your overall health!


The Stroke Belt


By: Nikki Nies

A culmination of factors raise concern for those located in the “Stroke Belt” region. The southeast region is composed of the the Stroke Belt, which refers to higher risk of heart disease and/or hypertension.  The term Stroke Belt started in the late 1950’s by epidemiologists compiled data showing a higher-than-average death rate from strokes.

The stereotypical consumption of fatty, fried foods is not the only culprit, but genetic, socioeconomic, cultural associations, lack of access to healthy food, and lack of physical activity contribute to the higher percentage of the overweight. It’s a shame MI and TN are limited in side walks since the thought of walking around the block isn’t easily supported. It’s no coincidence southern states are also tobacco producing states as well as smoking is more common in the south.With increased weight and higher blood pressure, significantly increases one’s risk of stroke.  The elderly, Native stroke-signsAmericans, African Americans and those with lower education levels are found to be more likely to be overweight.

It should not be overlooked there are some changes that have been put into place.  As of 2007, Mississippi created nutrition standards for schools lunches, Tennessee encourages schools to buy fresh ingredients from locally grown areas and Arkansas has a school BMI program, where screening results can be sent home to inform parents.  The impact of these implemented programs will take time, but I’m glad to see such changes have been gradually introduced.

As the 4th leading cause of death in the U.S., living in the Stroke Belt, which consists of Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee increases one’s risk of stroke.  It’s critical to know the warning signs of stroke, such as: sudden numbness or weakness of the face, arm, or leg—especially on one side of the body; sudden confusion or trouble speaking or understanding; sudden trouble seeing in one or both eye; sudden trouble walking, dizziness, or loss of balance or coordination and/or sudden severe headache with no known cause.

Although not all factors that contribute to being overweight, like genetics or ethnicity, but lifestyle changes can make a difference.  By lowering one’s blood pressure, cholesterol and weight and avoiding use of cigarettes, can help the situation and decrease chances of stroke.


The Weight of the Nation


By: Nikki Nies

The Weight of the Nation is a documentary created and produced by HBO.  This 4 part miniseries brings together health professionals, policy makers, researchers and partners that advocates of obesity strategies and solutions.
Although long, this documentary gives a good explanation of how we’ve gotten where we are now–with 2/3 of adults overweight.  The scary part, more and more children, America’s future, are overweight.


Meatless Mondays

Original Image by Megan Rascal via Flickr
Original Image by Megan Rascal via Flickr

By: Nikki Nies

The concept is not new, but the topic is never too old to talk about.  As the name of the day suggests, Meatless Mondays consists of eating an entire day without any meat.   There’s been a strong movement that has evolved and the impact has not gone unnoticed.

I had heard about Meatless Mondays a few years a go, but it never dawned me why Monday was chosen as the day to go meatless.  After looking on’s website, it makes sense.  The Western culture uses Mondays as a jump start for a fresh week and studies have shown people use Mondays as a new “beginning” for health and diet regimens,  to quit smoking or to make a doctor’s appointment.  Meatless Mondays sounds fitting to include in your calendar too, right?

If you’re still not convinced, let me share with you some of the benefits in participating in Meatless Mondays.


  • Can help prevent chronic conditions, such as cardiovascular diseases, cancer, obesity and/or diabetes
  • Can reduce one’s carbon foot print
  • Can save water and fossil fuel
  • Can extend one’s life–as eating red and processed meats are associated with increased risk of mortality
Original Image by Jennifer via Flickr
Original Image by Jennifer via Flickr

So, now you might be thinking, what’s a person to do without meat? Here’s some alternatives:

  • Tortellini Primavera
  • Tofu Parmigiana
  • Greek Orzo Stuffed Peppers
  • Tandoori Tofu
  • Red Curry with Vegetables
  • Spring Turnip Frittata

By eliminating meat from your daily Monday routine will not make you automatically healthier.  However, it is a small step in the right direction of a balanced, varied diet.  Today I’m making a huge salad and digging out my tofu.  What’s on your menu today?


More Than Meets the Eye


By: Nikki Nies

There’s an ongoing controversy if one can actually be addicted to food.  It sounds crazy right? People associate addiction with drugs or alcohol, but food?

In a recent journal article, Dr. Nora Volkow explained, food addiction is as real as drug or alcohol addiction. Both addictions impact the same neuronal mechanisms, decreasing D2 levels and the ability to resist temptation.  Brain dopamine pathways play a crucial role in the development of obesity as well as addiction, of any kind. Like drugs, sugary and fatty food activates the dopamine reward circuit and can create an addictive need of less nutrient dense foods.  Obese individuals have an increased activation in the reward and motivation circuits compared to healthy weight individuals.

Those skeptical of the role food addiction plays in the obesity epidemic believe more research is needed to better explain food as an addiction.  With a quantitative measure of the features of food versus drug addiction, there is only partial overlap.  But, that is like comparing a lemon and an orange.  Although they have a different external composition, they’re both classified as citrus fruits.  Same for drug and food addiction.  Externally, there appears to be limited similarities, but with a closer look, the brain’s response to either addiction is more similar than different.

Critics state one can’t be addicted to food as people don’t demonstrate conventional addictive qualities.1 Nonetheless, about 20% of those that do drugs are reported to be addicted, while 2/3 of Americans have trouble controlling their energy intake. 1 Another researcher, Ziuddeen argues people are set up to be obese since unhealthier foods are more in line with the lower SES income.  However, one has to look at overall picture. Why are unhealthier foods are more likely to be consumed? Does the composition of the food have addictive qualities? More than likely, yes.

It’s a harder addiction to help treat as one does not need drugs or alcohol to survive, but we need to eat food on a regular basis so there’s no “cleansing” of food out of our system to decrease the addiction. Food addiction should be taken seriously and treatment needs to be part of curbing obesity epidemic.

  1. Szalavitz M. Can food really be addictive? yes, says national drug expert. Time Web site. Published April 5, 2012. Updated 2012. Accessed November 2nd, 2013.