Monthly Archives: June 2014

Appetite Awareness

Post by Diane Danchi, R.D., L.D.N. Diane is a Registered Dietitian at Rex Wellness Center of Cary and Rex Wellness Center of Knightdale.

Summer is here and many are faced with a desire to lose some weight for summer styles. For so many people, this is a common life theme and success this time may not mean a permanent change in weight. The common approach is to start skipping meals or restricting and depriving of specific foods. Sometimes this restriction and deprivation feels empowering, but it often leads to some kind of rebound eating or a full blown binge. Some may believe that they cannot lose weight unless they are totally miserable, which in turn is not sustainable.

063014_hunger2Learning how to key into your body’s true hunger and satiety is a balanced and effective approach which is helpful in weight management. We are trained from the time we are small children to ignore hunger and satiety signals, “eating for the kids in China,” being members of the “clean plate” club, being taught to never “waste” food regardless of the impact it has on our own “waist!” A new perspective on hunger and satiety could revamp your relationship with food and get your weight moving down.

There is great beauty and pleasure in eating when we are truly hungry. It means we have burned off all the fuel from the previous meal, our palate / taste buds are rejuvenated and ready to enjoy food, and it is the time food will taste best, giving us the most pleasure for the calories spent. This is the purpose of the Hunger Scale, a tool to call us back to eating when hungry and stopping when satisfied (never “full” or uncomfortable). Eat at “3” when your stomach is growling; stop at “7” when satisfied.

With the Hunger Scale as a guide, train yourself to eat regular meals and snacks at regular times. A meal should last at least 20 minutes (so your appetite control center has time to get the “we have fuel” message). If you eat faster, you will still be hungry after you eat the right amount of food and head for seconds. At the end of the meal you should be satisfied and always COMFORTABLE. Never eat to discomfort. That meal should get you 4-5 hours, then you are hungry for the next meal or snack.

063014_hunger3With the availability of food in our culture, we are constantly exposed to challenging food cues. Recognizing these cues and effective ways to deal with them can help greatly with weight management. Most of the time we should eat when hungry and stop when satisfied. If you see an advertisement, smell something cooking, are offered something with pressure, are with other people, get stressed, bored, angry or feel lonely, you might want to eat even though you aren’t hungry at all. “Is my stomach growling?” is the question to ask before grabbing that fork. If you are not hungry, learn to skip the eating event and wait until true hunger presents. Plan ahead to focus on something else like taking a walk, striking up a conversation with someone, playing an instrument, cleaning a closet, calling a friend, or planning your next vacation!

Experienced dieters will often create a list of foods to avoid when “dieting.” This eventually results in feelings of deprivation with a rebound binge-eating event, accompanied by guilt and frustration. Rather than restrict food, listen to your body. If the craving is strong, honor it in the smallest portion you can without guilt, then move on. This is a life strategy and is sustainable.

A couple more tools to help management appetite are fiber and water from whole grains, fruits, veggies. They both fill you up with no calories, and a high fiber meal takes longer to digest. Dehydration can make you think you are hungry when what you really need is fluid, so intentionally hydrating wards off “fuzzy hunger.”

There are lots of ways to honor yourself and manage weight through understanding your appetite, so use it to your advantage and don’t let your appetite be the saboteur of your health and weight management.



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Keep Bugs at Bay

If the warm temperatures and sunshine beckon you outdoors this summer, don’t let biting bugs drive you back inside. Wearing insect repellent is one way to help protect you and your loved ones from the bite of pesky — and sometimes dangerous — bugs.

Why repellent?

062414_bugtbite1Some mosquitoes and ticks transmit viruses or bacteria that may cause diseases like Lyme disease, West Nile virus and St. Louis encephalitis when they bite you. In addition to wearing long sleeves and long pants and avoiding bug-friendly habitats like tall grass and standing water, applying insect repellent to skin can keep bugs from landing on you. To choose the best repellent for you, consider the insects you’ll be exposed to, the length of protection you need and the active ingredient. The higher the concentration of the active ingredient, the longer the protection.

Active ingredients

The most common and effective active ingredient is DEET. An EPA data review in 1998 confirmed that when users follow product label instructions, DEET poses no health concerns to humans. Many products promise protection of about two and a half hours, depending on concentration. Experts suggest that a concentration higher than 30 percent offers no additional protection.

062414_bugtbite3Other EPA-approved active ingredients include picaridin and several plant-based oils. Picaridin may be as effective as DEET according to recent studies, but there is no data showing long-term safety results. Further research is needed to understand how well the active ingredient repels ticks, as well. Plant-based insect repellents are made from the essential oils of citronella, cedar, eucalyptus and soybeans, with oil of lemon eucalyptus being the most effective. These products may offer protection for up to two hours. There are also citronella-scented candles that you can put outside of your home to make sitting outdoors more enjoyable.

062414_bugtbite2Application safety

  • Always read the product label and follow the directions.
  • Use just enough to cover exposed skin. Do not apply under clothing.
  • Avoid applying on or near eyes, mouth, ears and open sores.
  • Do not spray directly to face or in an enclosed area.
  • Wash skin and clothing with soap and water once you return indoors.

If you do get a bug bite that needs to be treated, Rex Express Care Centers are the perfect place to go. Check out our list of locations to find the nearest Rex Express Care to your home.

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Recipe: Fruit Pizza

Are you a pizza lover? Add more fresh fruit to your day with this fruit-inspired dessert pizza.

Number of servings: 12


  • ½ cup margarine
  • ½ cup sugar
  • 1 teaspoon vanilla extract
  • 1 egg (large)
  • 1 teaspoon vanilla extract
  • 2 cups flour
  • 2 teaspoons baking powder
  • 8 ounces cream cheese, nonfat or light
  • ½ cup sugar
  • 1 cup strawberries, sliced (or kiwi, bananas, pears, peaches or blueberries)


  1. Preheat oven to 375° F.
  2. To make the crust: Cream margarine, sugar, vanilla and egg until light and fluffy.
  3. Add flour and baking powder, mixing well.
  4. Spread mixture about 1/8-inch thick on a pizza pan, baking sheet, or 9-inch by 13-inch pan.
  5. Bake for 10 to 12 minutes or until lightly browned. Cool.
  6. Mix together cream cheese and sugar. Spread on cooled cookie crust.
  7. Arrange fruit on top of pizza. Refrigerate until serving time.

Serves 12. Per serving: 240 calories, 8 g fat, 15 mg cholesterol, 310 mg sodium, 36 g total carbohydrate, 1 g fiber, 19 g sugar, 6 g protein, 8 percent vitamin A, 15 percent vitamin C, 10 percent calcium, 6 percent iron.

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Preventing Cardiac Arrest in Marathon Runners

060614_running1Post by Deepak Pasi, M.D., F.A.C.C., NC Heart & Vascular.

Cardiac arrest in marathon runners is a very uncommon event. However, occurrences at recent race events have heightened the awareness of this dramatic and unexpected tragedy.

060614_running2The chance of suffering cardiac arrest during marathons is about 1 in 184,000, and the likelihood of dying from the arrest is about 1 in 259,000. Men are more likely to be a victim than women. The good news is that the chance of surviving the arrest is higher than in the usual out-of-the-hospital cardiac arrest. The reason for the arrest is dependent on age. If one suffers cardiac arrest before the age of 35, usually it is related to a congenital defect (from birth) and hereditary diseases. After the age of 35, it is usually related to early coronary artery disease.

There are numerous congenital heart diseases that can cause cardiac arrest. Here are a few:

  • Hypertrophic Cardiomyopathy in which the muscular wall or septum between the two ventricles abnormally thickens.
  • Anomalous Coronary Anatomy in which one of the heart arteries originates from a different location.
  • Arrhythmogenic Right Ventricular Dysplasia (ARVD) in which the wall of the ventricle is replaced by fatty tissue.
  • Long QT syndrome: Prolongation of the QT interval on the EKG.

The only way to prevent the cardiac arrest from happening is to detect the abnormality before the event happens. The athlete should heed the symptoms and body warnings and seek medical attention promptly. It is wrong to be under the impression that because one is an athlete then he or she is invincible or saying that ‘I have a good diet and exercise a lot, so I cannot have a heart problem.’

060614_running3Look for the following:

  • chest pain, burning, ache or discomfort
  • palpitations
  • shortness of breath
  • dizziness
  • family history of heart problem or sudden death

One should see a physician should you have any of the above symptoms or if you have any unexplained symptoms or concerns. It is also important to participate in this activity only after adequate training. You should make sure you are well hydrated before and after the marathon. You should never push for completion of the marathon if you are having any of the above symptoms.

There is much controversy on how to prevent the incidence of cardiac arrest for marathon runners. One school of thought is that the marathon runner or athlete should undergo a complete evaluation by a physician which may include an electrocardiogram (EKG), echocardiogram (echo) and/or stress testing. Opponents of that thought suggest that it would be very expensive and we do not have the money or the resources. Most would agree to seek medical attention for above symptoms, as well as encourage athlete and physician education.

In the end, there are many preventable causes of cardiac arrest in athletes. The marathon runner should listen to his or her body and report any unusual symptoms instead of ignoring the body’s warnings. If you have any of the above mentioned symptoms or have risk factors, you should seek medical attention before starting or continuing the sport.



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