Have you found your “bliss point”? It’s not what you might think.



Obesity is all around us, and surveys reveal that more and more of us are endangering our future health through poor diet and lack of exercise.  It is our responsibility to control our appetites and activity.  Right?  Well, new information suggests that other forces are also at work. 

In the February 20 New York Times magazine, Michael Moss wrote about his research involving junk food, as part of an soon-to-be published book, “Salt Sugar Fat: How the Food Giants Hooked Us”.  Mr. Moss has uncovered some fascinating tactics used by food manufacturers to keep us hitting the snack aisle. 

  • Bliss point – optimizing each component in a product that the consumer likes to create the highest level of craving,  keeping the food good enough to want to eat, but not so good that you tire of the food.
  • Stomach share – how much each brand can dominate the market versus their competitors.
  • Sensory-specific satiety – design foods that taste good, but avoid any single distinct flavor that would tell you to stop eating.
  • Mouth feel – the positive interaction of food with the mouth in terms of moisture and texture (think chips).
  • Sweet range – the range of acceptable taste that may allow manufacturer to adjust costly ingredients to the lowest acceptable level in order to reduce cost
  • Vanishing caloric density  – ability of food to dissolve or shrink while eating, giving you the impression that you are eating less (Cheetos?)

Each of these factors is considered in the design and marketing of snack foods.  In this way, convenience foods like Lunchables end up including nearly a full day’s maximum amounts of fat, sodium and sugar.  Yogurt, which used to be considered a health food, has become a dessert given the amount of added sugar in each serving. 

For information about healthy eating, visit Student Health Services.  Our providers can advise you and refer you to nutrition services for further assistance. 

Roger Miller, MD  (OSU Student Health)

Why You Eat More Than You Think

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Is this your day?  Overslept for 9 AM class; jumped out of bed, threw on some clothes, brushed teeth and ran out the door to class.  Sat in class until 10:18 and ran to next class at 10:30.  Had a break from 1:00 until 1:30.  Grabbed lunch to go at Market Place.  Wanted to get the salad but had to take it to class so picked the Tuna melt, bag of chips and a diet pop (tuna is healthy, right!).  Ate lunch in class, which ended at 2:30.  Ran home to change- had to be at work at Buffalo Wild Wings by 5PM.  Worked from 5 until 11:00PM. At work, scarfed down some wings and fries and sipped on diet coke throughout the night.  Got home at 11:30, exhausted and starving and too hyped up to go to bed.  Relaxed on the couch with laptop (Facebook, emails). Scoured the refrigerator and found a yogurt.  Ate that first since it’s healthy and you’re trying to lose some of the 20 pounds you have gained in the past year.  Spied the leftover pasta from Noodles and Co. and finished it off while watching the episode of Lost you had taped but it’s OK since you haven’t eaten much all day. Went to bed at 2AM.

This type of routine is not an untypical schedule for many OSU students.  We have become the “Masters of Multi-tasking”, because there is always too much to do.  Unfortunately, this does not always serve us well when it comes to our relationship with food.  Often we are not “in the moment” with our food (or with many other things as well).  This lack of mindfulness prevents us from being aware of our body’s natural signals for hunger and fullness.  It is important to realize that we all came into world normal, intuitive eaters.  Babies are experts at eating; they cry when they’re hungry and they stop eating when they’re full.  They eat exactly what they need to grow and be healthy.  They do not count carbs, protein, fat or calories.  They just eat!

Our body’s natural systems would continue to manage our eating and meet our body’s needs if modern society did not mess with them.  Arbitrary schedules are set up that interfere with intuitive eating and we are constantly bombarded with external versus internal food cues. No wonder we “mess up.”

So what is “Mindful Eating” and how can you re-learn this healthy approach to eating?  Mindfulness is deliberately paying attention to how, what, where and when you eat in a non-judgmental way.  It is using all of your senses – seeing, hearing, tasting and feeling – when you eat.  I call it “yoga with food” – it requires eating without distractions (no TV, Computer, work, studying) in a calm environment, and it requires practice. 

Here are some guidelines to help you implement mindful eating in your life and some web sites with good information that will start you on the path to more natural, intuitive eating.

  • Make eating consistently a priority and give yourself permission to eat. Eat breakfast within 30 minutes of waking and pay attention to hunger cues-usually about every four hours.
  • Keep a food intake diary for a week noting what, where, and when you eat and how you feel when eating.
  • Eat sitting down without distractions, preferably in a calm environment.
  • Turn off the television, computer, or other distracting electronic devices. Music is fine.
  • Eat at a table if possible-not on the couch, easy chair, car or bed.
  • Try not to work or study while eating
  • Slow down! Practice putting down your fork or sandwich between bites. Time a typical meal and add 5 minutes the next time you eat. Enjoy the texture and flavor of the food. Pay attention to your body’s signal of fullness or satiety.
  • Eat when you feel comfortably hungry (not starved) and stop when you are comfortably full (not stuffed).
  • Be aware of emotional triggers for eating-a “craving” is often the result of emotional need.

Remember, food is not the enemy!  There is no such thing as perfect eating, but eating mindfully will make it more pleasurable and satisfying.

If you would like to discuss mindful eating, or any other nutritional questions you may have, call to make an appointment with the Student Health Center’s Registered Dieticians.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Center For Mindful Eating

“Mindless Eating”

“Eating mindfully”

My doctor said that my vitamin D level is low. Is that really bad?


It’s well established that Vitamin D is important in the regulation of the body’s calcium levels and bone development.  If people don’t get enough, they are at risk of diseases like rickets and osteoporosis.  But researchers have more recently discovered that vitamin D receptors are found on almost all tissues of the body.  This has caused a “boom” in vitamin D research; scientists are investigating its role in everything from heart disease and diabetes to depression, cancer and the common cold. 

You get Vitamin D in two ways: by consuming it in foods or supplements, and by making it in your skin when sunlight hits it.  Vitamin D doesn’t occur naturally in a lot of foods – unless you’re a really big fan of cod liver oil or mackerel, you wouldn’t get nearly enough – so many foods are fortified with it.  Almost all of the milk sold in the U.S. is fortified with Vitamin D, as are many cereals, juices and yogurts. 

This time of year in Columbus ain’t exactly the most Vitamin D friendly environment – the sun seems to head south for the winter – so it’s not unusual for people around here to have a low Vitamin D level.  But what does that really mean?  How low is too low?  And does having a low Vitamin D level increase your risk for depression, high blood pressure, the flu?  We don’t know for sure.  There’s even a lot of debate going on right now about whether or not the current cut off for a “normal” Vitamin D level is too high and that a lot of people are being told they have a deficiency when they really don’t. 

That being said, people build up the majority of their bone density during their twenties so it wouldn’t hurt to take a daily adult multi-vitamin containing around 600 IU of Vitamin D to help prevent osteoporosis later in life.  It’s also a good idea to get some regular sunlight exposure whenever you can; even if it’s cold, it’ll turn on your skin’s Vitamin D factory.  But don’t overdo it – taking too much (over 4000 IU) can cause damage to the heart, blood vessels and kidneys.  And excessive uv radiation exposure can damage your skin and put you at risk for really bad things.   

The National Institutes of Health has a great site about Vitamin D supplements, and the Mayo Clinic also provides a lot of good information.  And of course, you can always make an appointment to see us if you’re worried about your Vitamin D level.   

John A. Vaughn, MD
Student Health Services
The Ohio State University

Everything you need to know about fish oil supplements


Ever since researchers discovered that Greenland Eskimos had really low rates of heart disease because of all of the fish they ate, fish oil has been a hot topic.  And once supplement manufacturers realized they could bottle and sell it, fish oil really took off. 

So let’s dish about fish – here’s everything you need to know about fish oil supplements.      

What conditions does fish oil really help?

It’s been proven that the Omega-3 fatty acids in fish oil – eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid – prevent heart disease, improve cholesterol by reducing triglyceride levels, and prevent heart attacks, stroke, and death in people who already have heart disease. 

While Dr. Google will tell you that fish oil will cure rheumatoid arthritis, high blood pressure, depression, bipolar disorder, menstrual pain, and certain kidney problems, there isn’t a lot of good evidence to back that up at this point.

Is taking a fish oil supplement the same as eating fish?

Obviously, the best way to consume fish oil is to eat oily fish.  The American Heart Association (AHA) recommends at least two servings per week for cardiovascular health.  A serving is 3 ounces (the size of a deck of cards, or ¾ of a cup).  So if you can afford, prepare and stomach salmon a couple times per week, you can skip the fish oil capsules.

How much fish oil supplement should you take?

A good target intake is between 250 and 500 mg per day of EPA + DHA.  You could get that in a daily 1 gram fish oil supplement, which contains between 200 and 800 mg of EPA + DHA, depending on the formulation and manufacturer.   

Do fish oil capsules have side effects?

The most common side effects are nausea, heartburn, a fishy aftertaste, and burping.  Taking them with food or refrigerating them helps a lot, but some brands can’t be refrigerated so be sure to check with your pharmacist.  In general, fish oil capsules have an “expiration date” of about 90 days after opening a new bottle.  Capsules with a very strong or spoiled smell should be thrown away.

Can you get mercury poisoning from taking fish oil supplements?

There’s been a lot of concern lately about mercury contamination in the world’s fish supply.  In general, this is more of a concern for pregnant women and young children, but it’s always a good idea to pay attention to what you’re eating.  Fish known to be low in mercury include shrimp, canned light tuna (not albacore), salmon, pollock, and catfish. 

Fish oil capsules are generally low in mercury and other pollutants.  But to be safe, only buy products with the “USP Verified Mark” on the label; these have been tested and found to contain acceptable levels of mercury.    

Jason Goodman, PharmD, RPh
Student Health Services
The Ohio State University

How much are you willing to pay per pound to lose weight?


The Food and Drug Administration (FDA) recently approved two new medications for weight loss.

Qsymia, is actually a combination of two older drugs – topiramate (Topamax), an anticonvulsant that helps increase satisfaction after eating, and phentermine, a psychostimulant and appetite suppressant. Using Qsymia combined with diet and exercise for a year led to an average weight loss of 8.4% of total body weight, or about 20 pounds.   

Qsymia is a controlled medication because it has a potential for addiction. Like other psychostimulants (think Adderall and Ritalin), it can cause a fast heart rate and a tingling sensation in the limbs. Other side effects include memory impairment and decreased concentration. Topiramate can cause birth defects as well.   

Belviq, is an entirely new class of medication called a serotonin 2C agonist.  It helps patients feel full sooner and eat less. Belviq was even less effective than Qsymia in helping with weight loss; it led to an average annual decrease of just 5% of total body weight, or about 7 pounds. The side effects from Belviq are minimal, but because older serotonin agents were associated with heart problems, everyone is keeping a close eye on it. 

Information about cost is hard to pin down exactly, but the best guesstimates are that Qysimia will cost about $6 a day and Belviq $8 a day.   

This made me wonder if we should approach these medicines as if they were in a refrigerator case at the grocery store and ask ourselves, “What am I paying per pound?”

When you look at it this way, these two new wonder drugs don’t look so great. Qsymia will run you about $109/pound of weight lost while Belviq will cost you about $417/pound.

To give you an idea of how that compares to other methods that have been around for a while:

  • Weight Watchers = $ 97/pound
  • Nutrisystem = $130/pound
  • Jenny Craig = $131-237.56/pound
  • Weight loss surgery = $235 – 400/pound
  • Diet and exercise = $0/pound!

As you can see, none of them are cheap, and the only one that doesn’t cost you any money costs you a little more in time and effort.  Unfortunately, it’s the only one that really works.  In fact, it’s the main ingredient in those super expensive drugs we’re talking about.  Read that description again – “using Qsymia combined with diet and exercise led to weight loss…”  The problem with diet pills is that not only do you gain the weight back as soon as you stop taking them, but without diet and exercise, they barely make a dent in your waistline.

Because of all of this – the cost, the side effects, the potential for addiction and the lack of any proven long-term benefit – we don’t even prescribe these medicines at the Student Health Center. We’d rather work with you one on one and help you take advantage of the resources available to you here at Ohio State.    

At Student Health Services, we can offer a “well person” exam with any indicated laboratory tests and refer you to one of our registered dieticians. Dining services offers some great online resources to help you keep tabs on your nutritional intake and Rec Sports has many facilities and programs to help you participate in any kind of exercise that you are interested in. 

We want you to succeed at getting to and maintaining your optimal healthy weight. As soon as it is as easy as taking a pill, we’ll let you know.  In the mean time, we’re here to help you do it the right way.

Jo Hanna Friend D’Epiro, PA-C, MPH
Student Health Services
The Ohio State University

How Healthy are Healthy Foods?

photo: ehow.com

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A recent WebMD report cited 23 “Food Frauds” that are suggested by advertising as being healthy food choices, but really contain lots of hidden bad stuff:

  • extra calories
  • fats
  • sugar
  • salt

or, they are just misleading:

  • 2% milk does not mean 2% of the fat in whole milk, but actually about 50%
  • “Zero trans-fat” may not truly mean there is no trans-fat in the food

Here are some of their list of frauds – are any of these on your menu for today?

  1. Fresh Smoothies
  2. Energy Bars
  3. Chicken Burrito
  4. Sugar-free Drinks
  5. 2% Milk
  6. Turkey Hot Dogs
  7. Low-fat Granola
  8. Added Omega 3
  9. Iced Tea
  10. Trans-fat Free Foods

Want to learn more about your diet and healthy food choices?  Both Student Health Services and the OSU Student Wellness Center have nutritionists on staff to assist you. 

Healthy Eating!

Roger Miller, MD (OSU Student Health Services)

Source: WedMD (Copyright ©2009, WebMD, LLC. All rights reserved)

Save a Million Hearts!

Million Hearts - Sodium?

Think you will have a heart attack or stroke in the next five years?  Well, of course, at 50, my chances are a lot greater than yours.  But even young adults can be at risk.  Is your cholesterol elevated?  How about your blood pressure? Do you smoke? 

Visit this link to try out a risk calculator for yourself

Ok, maybe you are reading this in the RPAC, after your intense daily workout, your pleasing weigh-in, and your fruit-n-bran smoothie.  If you are already doing the things you should, maybe you can spread the word to the people you care about.  (Think – Mom, Dad, Grandpa, Aunt, Neighbor, Friend):

Launched by the U.S. Department of Health and Human Services with several key partners, Million Hearts aims to prevent 1 million heart attacks and strokes over the next five years.

The first goal is to empower Americans to make healthy choices such as preventing tobacco use and reducing sodium and “trans” fat consumption. This can reduce the number of people who need medical treatment such as blood pressure or cholesterol medications to prevent heart attacks and strokes.

The second goal is improving care for people who do need treatment by encouraging a targeted focus on the “ABCS

  • Aspirin for people at risk,
  • Blood pressure control,
  • Cholesterol management and
  • Smoking cessation

These four items address the major risk factors for cardiovascular disease and can help to prevent heart attacks and strokes.  

If you want to learn more about your health and your heart attack and stroke risk, stop in at the Student Wellness Center, or come see us at Student Health.  We have the expertise and are here on campus for you. 

Students First!

Roger Miller, MD  (OSU Student Health Services)

Check your calendar, Groundhog!


Jogging with tunes

Courtesy cksinfo.com

 February 2.  Your New Year’s resolution is officially 33 days old.  How are you doing?  Did you decide to

  • Eat healthier?
  • Stop smoking?
  • Get more exercise?
  • Party less?
  • Finally address your moodiness and depression?

One challenge of a New Year’s resolution is that it is so permanent.  If you stop smoking on January 1, only to catch yourself with a cigarette on the 3rd, all is lost.  So, how can you make this more productive and less discouraging? 

Well, if the universe can be committed to fair or foul weather for a few weeks by the emergence of a groundhog from its hole, what say you?  Can you set a short term goal for the next 6 weeks? 

Healthy eating – Can you add another fruit and vegetable to your daily diet each of the next 6 weeks? Remember, while fresh fruits and veggies have a lot of health benefits, you can also get some of these servings from microwave soups, packaged fruit bars, etc., that may be a bit easier to carry around campus.

Smokers – how about setting March 15 as your planned stop date?  Between now and then, look at your smoking habits, try to wean yourself down on the number of cigarettes used every day, and consider a visit to Student Wellness or the Health Center to talk to a professional about the health benefits. 

Exercise – Are you a couch potato?  Try starting with a twenty-minute walk tonight.  Over the next 6 weeks, see if you can progress to 30 minutes of activity that gets your heart beating a little faster, and do it at least 5 days of the week. 

Alcohol – We all know that alcohol should be used legally and in moderation.  If you occasionally cross the line, try this trick – when you go out, see if you can limit yourself to no more than one alcoholic drink each hour. If you meet your goal, then slip a five-dollar bill into your piggy bank when you get home.  At the end of six weeks, see how many “Abes” you have accumulated.

Depression – The National College Health Assessment reports that more than one in four college students is suffering from depression, but only of third of them have consulted a healthcare professional.  Did you know that in six weeks of treatment, either with medicines, counseling, or both, you can see significant improvements? 

6 weeks.  Enough time to get out there and let the sun shine on your new healthier lifestyle?  Or maybe you want to just stay in your dark, wet, wormy hole in the ground?  It’s your decision.  Will you risk seeing your shadow?

Happy Winter!

Roger Miller, MD (OSU Student Health Services)

Don’t lose your cookies

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Ever run though the kitchen when your mom or dad or grandparent was whipping up a batch of cookies, and grab a finger-ful of raw cookie dough from the bowl?  Very sugary, very smooth, maybe a chocolate chip or two – yummy.  Sound like fun?  But, you were always warned that the raw eggs will make you sick. 

Well, beware.  The New York Times Health section recently ran an article looking at disease outbreaks associated with uncooked cookie batter, and came up with an interesting suspicion – maybe the concern is not limited to raw eggs.  Researchers studied packaged cookie dough, which uses pasteurized eggs, and still found that infections were occurring.  The source?  They suspect that flour may be the source, as it was the only raw ingredient that went into the mix. 

Further research will be needed to know if this is true, but the bottom line is that if you buy food that is intended to be cooked or baked before you eat it, then you should avoid eating it raw.  A simple solution, so long as you can keep your fingers out of the mixing bowl.

Stomach upset?  Come in to Student Health Services, our healthcare team can help.

Healthy eating!

Roger Miller, MD (OSU Student Health Services)

Trouble losing weight? You might have a caloric handicap.


I recently came across an interesting blog post on NPR called Losing Weight: A Battle Against Fat and Biology.  You should check it out – it brings up an interesting concept called a “caloric handicap” that helps explain why it so hard to lose weight and even harder to keep it off once you do.

Basically, the premise is that your body fights your attempt to lose weight.  Weight loss always comes down to taking in less calories than you expend.  The problem is that once you go into a state of less coming in than going out, your body takes that as a sign that starvation is on the way and starts sending out hormones to not only slow down your metabolism but increase your appetite.  (Unfortunately, these systems developed at a time when starvation was a real possibility – if our early ancestors had fast food drive throughs and 1400 calorie Frappa-lattes, we’d all be better off right now.)

So, to use NPR’s example, a person who weighs 230 pounds and loses 30 pounds cannot eat as much as someone who has always weighed 200 pounds.  The difference in the number of calories that the dieter can eat vs. the number that the naturally thinner person can is that dieter’s caloric handicap – and it can be up to 500 calories a day.

None of this information makes it easier to drop those pounds and keep them off, but at least it lets you know that it isn’t just a matter of will power – so give yourself a break.  The other take home point is that exercise is the key – no matter what type of diet you do, without a good 30-60 minutes of exercise per day, it most likely won’t last. 

So hit the RPAC, park farther away from your building, take the stairs, do whatever you can to burn those calories.  I know it’s a lot easier said than done, but you gotta keep trying.  If you ever need help, come in and talk to our nutritionists – they can give you some great advice.

John A. Vaughn, MD
Student Health Services
The Ohio State University