Disease and Condition

WATER

Water is second only to oxygen for human life. It makes up 65–75% of the body and every cell requires water to perform its essential functions. Water maintains system equilibrium, lubricates, flushes, and hydrates the body. It also regulates body temperature and transports needed nutrients to where they are needed throughout the body. When the body has enough water, fluid and sodium retention decrease, hormone function improves and the liver is able to break down and release more fat into the system for energy. At this point, hunger is less and weight loss can occur.

Plain water is the best way to replace lost body fluids. Other good choices are unsweetened fruit juices and vegetable juices without added sodium (salt). Experts use the “eight 8 ounce glasses of water” rule of thumb to let people know how much water a person needs to drink under normal conditions. How much water you actually need depends on your weight, level of activity, the temperature and humidity level, and your food diet. If you eat plenty of water dense foods like fruits and vegetables your need to drink water could be reduced. Fruits and vegetables and their juices contain a lot of water, but also usable nutrients for the body. Many are high in vitamins, minerals, and fiber necessary for good nutrition. Diuretics, such as caffeinated beverages and alcohol cause your body to expel water so you need to drink more water to compensate. When you feel thirsty, you are already starting to dehydrate. Try to avoid this situation by drinking water on a regular basis and before activities begin.

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WATER AND WEIGHT LOSS: In a diet/weight loss plan it is important to drink water because

Initial weight loss is largely due to loss of water, and you need to replace lost water to avoid dehydration.
The process of burning calories and temperature regulation requires an adequate supply of water in order to function efficiently; dehydration slows the fat burning process and can lead to heat exhaustion or stroke.
Burning calories creates toxins and water plays the vital role of flushing these toxins from your system.
Dehydration causes a reduction in blood volume which lowers the available oxygen to your muscles which will make you feel tired.
Water helps maintain muscle tone by assisting in their ability to contract and helps lubricate the joints. Proper hydration helps reduce muscle and joint soreness during and after exercising.
Water alone has no calories or nutrients, so water alone is not very filling. But, drinking water with a meal will make you feel full sooner so that you may eat less.
A healthy weight loss program includes a high fiber intake. Fiber is important to certain body functions, but without plenty of water, it can lead to constipation.

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Calories
The theory of the human body taking in calories and using them for energy or storing them for future use is pretty simple. If a person takes in fewer calories than are needed to meet energy demands, no storage will take place and weight loss will occur. Vice versa, if a person takes in more calories than are needed to meet energy demands, storage will take place and weight gain will occur. With this in mind, a person only needs to know how many calories are needed to meet their energy demands and they should be able to control their weight. Let us take a look at energy demands.

The demand for fuel fluctuates, but it never falls below a fundamental rate that keeps our body functioning at its most basic level. This is called our basal metabolic rate. This base rate supplies energy for functions such as pumping blood throughout the body and breathing. Energy is also needed to maintain brain function and to supply the trillions of cells in our body with energy to perform their specific functions as well as to generate the heat that we need to stay warm. These are our basic, involuntary, and unstoppable energy demands. The human body also expends energy in digesting and assimilating food. Generally this is about 10% of an average person’s caloric intake each day. There are also energy demands created by voluntary activities that we choose to do each day, like exercise, work, housework, play, etc. Most people think that these activities use a lot more calories for fuel than they actually do. Here are some examples of voluntary activities and the associated calorie burn.
Calories used per minute (approximate)
1 calorie - sitting reading, knitting, talking
3 calories - walking 2 mph, washing dishes
5 calories - swimming leisurely, vacuuming, slow dancing
7 calories - sawing with a handsaw, mowing the lawn with push mower
9 calories - cross country skiing, aggressive basketball, fast dancing
11 calories - playing racquetball, running 7 mph, jumping rope (125 time/min.)

So our total energy needs are basically a combination of basal metabolism, voluntary activities and the digestion and assimilation of food. Together they constitute an unending energy drain. A good rule of thumb is that basal metabolism is about 65% of our calorie burn, voluntary activity is about 25% and food digestion is about 10% of our energy demand.

There are about 3500 calories in a pound of body fat. This means that one must create a 3500 calorie deficit to lose one pound of body fat. Simple math tells us that a 500 calorie per day reduction for 7 days equals 3500 calories or one pound. Good choices for reduced calorie nutrition plans include nutrient dense foods with a high content of water and fiber such as grains, vegetables, and fruits. Their high bulk, relative to their calories, makes them good weight reducing food choices. On the other hand, a person could choose to increase their voluntary activity level (eg. Exercise) by 500 calories per day and in 7 days get the same results. Generally, people are advised to try a combination of reduced calories and increased activity levels to promote weight loss. In that scenario, a healthier outcome can be achieved and success is more likely because positive behavior habits are incorporated into a person’s lifestyle.

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Aids to Weight Control
Because emotions can effect how much and what we eat, influencing the emotions can be an important factor in weight reduction plans. The theory looks good on paper, but sometimes it is not that simple to “eat less and exercise more.” There are many deep rooted psychological, familial, ethnic, and societal roadblocks that cause people to have mixed feelings about their weight and mixed views of themselves. There have been efforts to find practical short term ways to deal with weight loss. These efforts generally fall into three broad categories.

Group Support
This method uses the pressure of the group to help or push members to deal with their weight issues. Principles of dieting and nutrition may be taught to these groups in varying degrees. The approval/disapproval power of a group of like minded peers and the sharing of common problems is an important part of this method. Paying to be in these types of groups is sometimes a motivation to be successful. In a recent Consumer Reports study, ‘Weight Watchers’ with its varied menus and support meetings provided the best chance to lose weight and keep it off in these types of programs. The report said that those who attended meetings and followed the plan were more likely to still be on track after one year or more.

Restricting Choices
This category is designed to restrict a dieter’s choices. It can be severely regimented as to what to eat and when, with strict meal plans and no variety or choices. These plans work fairly well in the short term for most dieters because there is no danger of overeating when there are no decisions to make about what to eat and how much to eat. Most of us will tend to overeat when given a lot of choices. Many people who are overweight are more prone to external cues. The message to these types of dieters is that the key to weight control is a matter of controlling the number and kind of food choices. In the Consumer Reports study mentioned earlier, “Slim Fast” products received high marks based on ease of preparation and nutritional balance. For people who need to control their food choices, users of these products were more likely to stick with the program and lose weight.

Behavior Modification
The focus of this type of approach to dieting is to increase awareness of the act of eating. Eating behavior modification refers to a special kind of training using various techniques to alter eating habits – to make eating a more conscious act not a blind unthinking behavior. A basic feature of these types of programs is journaling or keeping food diaries with times and food amounts written down for analysis. The aim is to teach awareness of a person’s eating habits so that adjustments can be made based on eating times and situations or locations that cause poor eating behavior. In terms of long term success, some programs that use behavior modification techniques have achieved better results than other methods.



The Bottom Line
People who want to lose weight in a nutritionally and medically sound way must accept the truth that they have to eat fewer calories and/or exercise more. Weight loss of about one pound per week is reasonable, considering the fact that the aim is to lose excess body fat, which requires a calorie deficit of 3500 calories per week. The best reducing plan is one that includes at least moderate physical activity, a food plan that is nutritionally adequate, and behavior modification techniques to change eating and exercise habits so that long term weight control is possible.

Mouth care
Daily care
Children should brush their teeth and gums with fluoride toothpaste and a soft bristle toothbrush every morning and night. You may need to help your child do this. When the toothbrush bristles get stiff or bent, you should replace your child’s toothbrush about every three months.
Use dental floss only if you are familiar with the procedure. Check with your doctor or nurse for the times when it is OK to floss.
If your child’s mouth feels dry, he or she can rinse with salt water solution of ¼ teaspoon salt mixed in one glass of lukewarm water. Do not use drugstore mouthwash. Avoid all mouthwash with alcohol, since it dries the mouth.
For dry lips, use a lanolin ointment or Nature’s Second Skin® to moisten, not Vaseline.
To lessen the mouth sores, which may occur during chemotherapy or radiation therapy, have your child rinse with Peridex® after each morning and evening brushing. One to two teaspoons are swished in the mouth for 30 seconds then spit out. Peridex® can change the way food tastes. Ask you doctor or dentist about Peridex®.
After your child brushes his or her teeth, examine the mouth area. Your hands should be clean when you do this. Look for these things:
• Lips should be smooth and moist.
• Tongue should be moist, smooth and pink with no coating.
• Floor of the mouth should be moist and pink.
• Open the mouth as wide as possible. Check the roof of the mouth and sides of the cheeks; they should be moist, pink and free of spots or patches.
• Teeth should be white and free of film, soft debris or crusts.
This exam is an important part of daily care. If you see red or white spots or patches, sores, or if your child’s tongue looks furry or coated, call your doctor or nurse coordinator.
Your child needs to brush his or her teeth after eating sweets. If a brush is not available, help your child swish and swallow with lukewarm water three to four times. Try to avoid frequent sweet snacks, especially sticky or chewy candy, raisins, fruit rolls and hard candies.
Snacks that are less likely to cause cavities include cheese, carrots, fresh fruit, popcorn, crackers, pretzels, chips, and artificially sweetened candy, gum and sodas.

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Toddlers and preschoolers
When the first tooth is visible, begin cleaning your child’s teeth and gums after each feeding. Clean using a water-moistened gauze wrapped around your finger. Examine your child’s mouth at this time. As soon as your child has several baby teeth, you should brush your child’s teeth two times a day.
If your child tends to swallow toothpaste, do not use it. Use plain water instead.
After your child takes sweetened medicine (liquid or pill), help your child rinse his or her mouth with water.
If your child takes a bottle to bed, fill it only with water. Do not send your child to bed with formula, juice or milk, since this can cause tooth decay. If your child cries, try giving him or her a clean pacifier instead of a bottle.

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Mild mouth irritation
The dentist or doctor needs to examine your child’s mouth. The following are signs of a mild mouth irritation:
• Red, shiny gums and mouth lining that can include white patches
• Gums look swollen
• A burning feeling or tenderness in the mouth, but no sores can be seen
• Tongue may be coated, red, dry or swollen
The dentist or doctor will ask you to help your child:
• Eat bland foods, such as mashed potatoes or fruit-flavored gelatin. Avoid acidic, fried or hard crusty foods that may irritate your child’s mouth.
• Rinse with salt-soda solution as often as every two hours when awake. You can make your own solution, using this recipe:
~ 1/2 teaspoon salt
~ 1/4 teaspoon soda
~ 8 ounces water
• Twice a day: If dried mucus or food is present, rinse the mouth first with 1 tablespoon of Peroxyl® mixed with 1 tablespoon lukewarm water, or use a soft toothbrush dipped in Peroxyl®. Then rinse the mouth well with the salt-soda solution or plain water.
*DO NOT use Peroxyl® as a mouth rinse more than three days in a row.
• Remove a coating on the tongue by brushing or scraping this area twice a day. Scraping may be done with a tongue blade, plastic spoon or special “scraper.” Then rinse mouth well with the salt-soda solution or plain water.

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• Relieve mouth pain by swishing 1 teaspoon ST-37 solution mixed with 1 teaspoon plain water for 1 minute, then spit it out. Your child should do this 15 minutes before eating and as needed.
Moderate mouth sores
The dentist or doctor needs to examine your child’s mouth. With moderate mouth sores your child will have pain in these areas during eating and swallowing.
The dentist or your doctor will ask you to help your child:
• Eat bland foods, such as mashed potatoes or fruit-flavored gelatin.
• Clean teeth and gums using a soft toothbrush. Dip the toothbrush in a mixture of 1 tablespoon Peroxyl® mixed with 1 tablespoon of plain water. Then your child can rinse with a large mouthful of salt-soda solution. If the Peroxyl® causes a burning feeling in the mouth, increase the amount of lukewarm water.
You can decrease your child’s mouth pain, depending on the amount of sores, by doing the following:
• For a few tiny sores, place KANKA® solution on a cotton swab and touch the sore mouth areas. Your child may complain of a burning feeling for a few seconds, but then the pain should get better. Help your child with this treatment three times a day.
• For many or large mouth sores, help your child swish and spit 1 to 2 teaspoons of Ulcer-Ease® solution in the mouth. Your child should hold the solution in his or her mouth for 30 seconds or longer before spitting it out. Help your child with this treatment four times a day.

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Dry mouth
• Rinse with salt-soda solution every two hours or as needed. You can find a recipe for making your own solution under “Mild mouth irritation.”
• Moist foods like fruit-flavored gelatin, gravy or a sauce will help swallowing.
• Artificial saliva may be ordered by the dentist or doctor or Moi-Stir® swabsticks may be used sev­eral times a day.
• Moisten lips with lanolin ointment. One brand name for this ointment is Nature’s Second Skin®.
• Chew sugar-free gum.

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Dry, cracked, crusty lips
Clean every two hours with a clean washcloth soaked with salt-soda solution. Pat dry with another clean cloth and apply lanolin ointment. Do not use petroleum jelly or lip balms, because they can dry out the lips even more.

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Low platelet count
• Gently brush teeth and gums with a soft toothbrush. Dip the toothbrush in a solution of 1 table­spoon Peroxyl® mixed with 5 tablespoons of water. You may also use a moist washcloth wrapped around a finger.
• Rinse with the salt-soda solution.
• If your child has cracking at the corners of his or her mouth, it could mean that your child has a yeast infection. Ask your doctor or nurse coordinator about a special ointment you can use.
If you have any questions or concerns, please speak with your child’s doctor or nurse coordinator.

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Adapted with permission from St. Jude Children’s Research Hospital. Revised 9/03
UC Davis Cancer Center 12/06
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