What does Health Mean To You?

In counseling many different people over several years, I have noticed certain consistencies in how most people consider changes that impact their health.  Change is an interesting topic.  How many times have you thought, or even said out loud "I know what I need to do, I just don't do it"?  

Let's see if we can start to understand why....

First, change is hard.  Humans don't really like it very much, even though we know it happens and we live in a world of constant change.  We tend to be creatures of habit, we like what we like and we don't really like being asked to do something different.

Second, we always assess the payback equation.  What I mean by that is, in order to agree to change something, we want to know what we get out of it.  What is the "reward" I get, for experiencing the discomfort that comes along with changing something?  And it stands to reason, the more discomfort you might experience, the higher the reward you would expect, right?

Lastly, it turns out that  eating our absolute favorite foods, is a highly valued habit that we hold most dear.  It brings us happiness!  Happiness in this crazy world is a prize to be held on to tightly!  Unfortunately, it seems we are biologically pre-programed to adore salty, fatty and sweet foods.  In other words, I've never met a person yet who has made themselves sick on broccoli....but plenty of people who make their bodies sick all the time by eating too much bacon, cheese, ice cream, fried foods and sweets.

So the challenge to you today is....what is your Health worth to you?  If you could make some small changes, like reducing the amount of something you eat or swapping it for a similar but slightly healthier food, might that be worth it?

Do you think you'd be open to at least having that conversation?  Because I bet we could come up with a plan together that would make the change easier and the payback equation work for you.  Remember, we are not seeking perfection, we are just seeking balance and improving your overall health!

If this resonates with you, let me know!  I can help!

Recipe for ORIGINAL-style Vogel Bread

(US Measurements and Ingredients)

Vogel recipe take #2!  While my first recipe for Vogel Bread makes a wonderful bread in a bread machine, it still wasn't quite true to the original style of the very first type of Vogel bread on the market.  It is almost impossible to find that original, dense bread any more, especially in the US.  But after a LOT of experimentation I've developed a recipe, loosely based on Jim Lahey’s no knead bread, and it's producing a really wonderful loaf I wanted to share with you!  There are several very specific instructions here about times, temperatures etc.  Because of the unusual method, this recipe relies heavily on food science and the instructions should be followed carefully to ensure a successful result.  Note that the bulgur wheat must be soaked overnight, so plan ahead! ☺☺

Ingredients:
3/4c dry Bobs Red Mill Bulgur Wheat (replaces kibbled wheat in NZ recipe)
1tsp dry yeast
2c milk
1tsp sugar
1tsp salt
3c whole wheat flour
1.25 c white standard flour
3 tablespoons chia seed

First, soak the bulgur wheat in a large bowl of water overnight, then gently drain (but don't squish out the water in the grains...the recipe needs the moisture).

Warm milk and sugar until 100-115F (use kitchen thermometer), then stir in yeast and set aside for 10 minutes (the sugar just helps to activate the yeast; you could leave this out and wait longer for the yeast to activate).

Then add all remaining ingredients including drained bulgur to standing mixer bowl with bread paddle attachment, pour in milk/yeast mixture and turn mixer on low for 10 mins.   Let rest for 10mins, then knead again on low for 10 mins.

After this, grease a large bowl with olive oil or butter, tip dough into bowl (it will be much wetter/mushier and more delicate than a typical bread dough) and set aside somewhere warm to rise, with a wet kitchen towel draped over the top so the dough doesn't dry out.  It should double in size before the next step.  That typically takes 3-5 hrs.

Punch down the dough, divide into two loaves and place in greased bread loaf tins.  Place a damp kitchen towel over them again, and place in warm spot to rise.  Again, we want them to double in size  This typically takes another 2 hrs.

When ready, heat oven to 400F.  CAREFULLY cover each loaf tin with tin foil. It should be tightly attached to the tin so very little steam escapes, but lofty enough so the bread doesn't stick to it when it rises a bit more.  The reason for this is because this bread method produces a very wet dough, and the bread needs to be covered and initially cooked in a humid environment to allow the moisture in the center of the bread to escape, before it develops a crust.)

Cook bread covered with foil as stated above for 30 mins, then remove foil and cook another 15 minutes.

Tadaaaa!  Your bread is ready to eat!  Let it rest a while before cutting. 

Don't Fry It, Put it on White Bread and Cover it in Tartar Sauce.....

What are we talking about today?  You guessed it, fish!

There was an interested article from UT Southwestern recently, discussing the benefits of Omega 3 capsules to prevent heart attacks. Basically, we have been a little overzealous in thinking Omega 3's might help in this area.  A better idea that we know to be effective is to eat fish 2-3 times per week.  We know that a Mediterranean diet with plenty of veggies and fish is associated with a lower risk of heart disease.

This topic sometimes causes wrinkled noses and "I don't like it" responses.  And in honest truth, it is HARD to find good fish in Dallas, Texas.  We are a landlocked city and a LONG way from the coast, after all!

So let's get specific about what types of fish. Sorry folks, but, catfish, tilapia and shrimp, the mainstays of American restaurant menus, don't help you.  They contain negligible amounts of Omega 3.  They are low in fat so that's great, but they don't provide Omega 3's like Salmon, Mackerel, Trout, Tuna, Cod and Sardines do.

So where can you find fish in a palatable form in Dallas?  Here's my recommendations based on many many years of market testing! :)

1) By far, the best place to find good quality fish in the Dallas area is H-Mart.  Yes it might be a little overwhelming to you given the foreign language writing on labels and unusual (to Americans) Asian fruits and veggies, but I'm telling you from the bottom of my heart, it's worth a little adventure to get the best quality and best priced fish in town.  I can personally vouch for the fresh Cod, Salmon, Tuna, Mackerel and Snapper.  And if the product at the counter looks a little dodgy to you -- just ask if there is any fresh "in the back".  They are very proud of their fresh fish and will get you the freshest product they have!

2) Whole Foods is a good second choice option for fresh Salmon.  I typically won't buy any other fish there but it's possibly ok.

3) When in doubt and in desperation, always buy FROZEN.  I know, it might sound weird, but seriously folks we live a long way from the coast and there is NOTHING fresh about "fresh fish" in this town (except see 1).....they do it really well!).

4) No matter where you buy fish from, always check country of origin.  I recommend buying wild or farmed fish from USA, Canada, Australia or New Zealand.  I do not recommend buying ANY fish from any other places....the regulations for farming and antibiotic treatments are lax in most parts of the world and sea quality (given untreated sewage discharge) may be questionable.

5) Lastly, see post title. :)

That about covers it, but always feel free to contact me if you have any questions or concerns!

The End of the Low Fat Diet?

I am asked about fats a lot in my job at a heart hospital.

Lots of patients come in and tell me they were on the "see food and eat it" diet prior to their bypass surgery and their physicians told them they really need to consider cleaning up their diet.  But does that mean low fat?  Research points to the answer being "no", but it also doesn't mean we get to eat chocolate, cheese and coconut butter with reckless abandon.

A friend of mine and her intern posted a really great article on this topic here.  I encourage you to take a look!

As always, if you have any questions or would like some help figuring out your own dietary plan, feel free to contact me!

Salt/Sodium -- how much is too much?

I currently work at a heart hospital and I hear this question a LOT!

The American dietary guidelines for salt intake differ by age, but honestly,  for MOST adults, a daily "budget" of about 2000-3000mg/day is completely adequate.  The typical American diet contains too much salt; studies show the **typical** intake in the US is closer to 6000mg or more!!

CERTAINLY, as we age, particularly after about age 55, we ALL need to aim towards the 2000mg end -- the reason is, sodium has a tendency to increase blood pressure and therefore increase the work the heart and kidneys have to do. There is a really good (and short!) overview of the salt issue on the American Heart Association website.  They also have a pretty neat little "sodium tracker" here.

The unfortunate news for those tracking sodium intake, however, is that sodium is in many foods we eat.   I often say "anything in a box, package or can"....but that even means breakfast cereals, canned vegetables, breads, tortillas, crackers, cheese, deli meats, etc. and as these foods form the foundation of the typical american diet, it can be pretty overwhelming to figure out what to do.

I had a patient recently tell me that a low salt diet was "like licking glass"!!!  Salt is a mineral required for human life, so we don't want a NO sodium diet, just a LOW sodium diet.

So, what CAN you eat? As it turns out, fruits and vegetables (not canned, but fresh or frozen are fine), are almost completely salt free. Also, fresh lean meats such as salmon, tuna, fillet steak, chicken, turkey breast and so forth are also very low in sodium (as long as you don't add a bunch to it when cooking).

So I have two takeaway messages for you:

1) KNOW WHAT YOU ARE EATING. TURN THE PACKAGE AROUND AND READ YOUR LABELS.  If it has a label, it will tell you how much sodium it contains.  And guess what, if it doesn't have a label (eg, fresh meats, fish, fruits and veggies), it doesn't have an appreciable salt content.  Also look up the salt content of the foods you order at restaurants online -- most restarants use a LOT of salt, so it will help you recognize where your sodium intake is coming from.

2) SPEND YOUR 2000mg BUDGET.  You have a budget, so use it.  Humans need salt. and we like it too.  Just spend it wisely by referring to 1).  :)

Low salt does not mean low flavor....you just have to find other seasonings with herbs and spices to help season your food.  Feel free to share any favorite low sodium recipes below!

Helpful Cooking Tips for those with Chronic Illness

So very many of the people I work with are managing an underlying medical condition, which may cause pain, fatigue, weakness or difficulty standing for long periods of time.

I saw this really great article today and thought I would share it.  The article is written for those with Rheumatoid Arthritis, however the tips are great for anyone having difficulty cooking home meals.

We know that meals cooked at home tend to be lower in salt, fat and calories, so if you are working on getting your weight back to normal after the holidays, it is worth the extra effort to try to cook at home.

Kitchen Tips

If you need some help devising a personalized food plan, I would love to work with you!

Healthy, Sensible and Delicious!

Now that the holiday season has almost come to a close, I thought I would share a couple of concepts for getting back to regular food habits.

Get back to a healthy food routine

I encourage you to consider adopting a 3 meals-a-day routine.  Just like sleeping and waking, humans really do need to eat at least 3 times a day to function at our best.  And if your meals are more than 4-5 hours apart, consider adding a small snack, around 100-200 calories, to help bridge the gap to your next meal.

Deal with any small weight gain now

If you have gained a bit of weight over the holidays, it will be easier and quicker for you to deal with it immediately (read: start today!!), than wait until it's 5 or 10 pounds (or more) and several weeks worth of work.  Cut down your portion sizes, eliminate the treats, and move 30 minutes every day.  Repeat until you get back to the weight you like to maintain. :)

Find some healthy and yummy new recipes

Holiday food is so special because we tend to use ingredients we don't use all year round - lots of cream, butter, cheese, bacon....and so on.  Most of us cannot eat like this year-round and maintain a healthy weight.  So, find some new and yummy healthy recipes such as these ones below, to help you get back on track!

• American Institute for Cancer Research  - you can download these for free here
• Use MyPlate on Pinterest to help with portion sizing and here for recipe ideas
• The Food Network has some nice ideas too

Avoid Fad or Crash Diets

Studies show the majority of people who adopt a fad or crash diet gain all that weight back or MORE later.  Be kind to the body God gave you, realize that this is a journey, not a destination.  Gently adjust your habits (less calories, more exercise) until you get back to where you like to be.  It comes off the same way it went on...little bit, by little bit, by little bit.  So be patient and kind to yourself!

And contact me if you would like some personalized help and a one-on-one plan to acheive your goals!

Holiday Weight Gain

Well, it's that time of year again.  Those of us who on the one hand, love all those wonderful and special foods that only come around once a year during holiday season, but on the other hand, dread the inevitable holiday weight gain.  It's an age-old dilemma.  And with obesity rates in America at an all-time high, it's a battle with which so many of us struggle.

Given that the conventional wisdom of "eat less and exercise more" doesn't seem to be working, I went in search of some new and perhaps alternative, maybe even kooky, ways of managing this difficulty issue so fraught with feelings of guilt and failure.

Here are some things I found.  What the heck, what we are doing isn't working, so perhaps we could try something new this year? Lets take a look....


1)  Guilt and Food......two things that have absolutely NOTHING to do with each other! We inflict this on ourselves.  And while we're at it- punishing yourself for overeating, by eating more food....well....let's try to quit that habit too.  Listen to your self talk, own it, change it, repeat as needed. :)


2) Deprivation doesn't make you feel good, and eating until you feel uncomfortable with a belly ache really isn't fun either.  A friend of mine wrote this blog entry and I think it's great!

Hey Listen, you don't have to gain weight during the holidays.



3) On facebook, "Like" the Institute for the Psychology of Eating.  They publish some really interesting videos and while some of them may seem a little bit kooky, others of them ask questions that may help you gain a more healthful relationship with food. Here's an example I quite like.  Spiritual Lessons We can Learn from Weight

And lastly, if you do happen to gain a few pounds, see 1), follow 2) and 3) and deal with it as a little bump in the road.  This life is a journey, not a destination, after all!

If you have any tips that help you during this time, I'd love to hear from you!

Are You Hungry?

I've been meeting with a lot of people lately to help them with weight loss.  I guess January through Spring time is somewhat of the season of weight loss in this profession! 


It has reminded me that for humans, food is so much more than just an energy input.  We all have our own likes and dislikes based on taste preferences -- basically the "what we eat" side of the equation.  To some degree, we can categorize these into having a "sweet tooth", or loving salty foods, or disliking vegetables and so forth.  And as a Dietitian, we love to tell people what their plate should look like, or how much [insert food item here] they should have, etc.  And these are great life skills, but they don't really get to the root of the behavior change needed to alter a lifetime of poor food habits.


So it's important to focus on why we eat the things we do, and in this regard, I have found every individual to be completely unique.  One of the conversations that I think is the most helpful starts with the question, "do you ask yourself if you are hungry?". 


It's interesting to guide someone through the underlying emotions and habits around food.  Sometimes its centered around early family habits such as the requirement to eat everything on your plate "because there are starving kids in Africa...."...you all know how that goes!  Sometimes, food is used to sooth, comfort and calm.  And often in our culture it's used to celebrate!  It's important on your own journey not to judge these feelings, just to understand them.  With awareness, comes the ability to proactively make decisions, rather than being led by what you might interpret as "cravings".  Essentially, I help people engage the cognitive side of the brain, to gain back some oversight of food intake, instead of allowing these underlying feelings and habits drive everything.  Because in the conscious understanding of your own decisions, you can gain back control of a part of your life that may seem beyond your control.  And doesn't that feel comforting?  :)


If you would like my help on the journey to better eating, I'd be delighted to help you with a nutrition plan you can Live With!!

The New Gluten-free Fad

Gluten-free products are everywhere these days and it seems that going gluten-free is as much of a trend as the Atkin's Diet was in the 90's.  While there truly are some people who have a gluten allergy, they account for only 1% of the population.  What's up with the others, you ask?  In my experience it is true that some people have a gluten intolerance (not the same thing as an allergy) which may be relieved by avoiding gluten.  However, for the vast majority of people following a gluten-free diet, it's (erroneously) perceived as promoting health, vitality, disease avoidance and weight loss.  I've even seen gluten-free dog food!

Here is a great and concise article, consulting with some fellow Registered Dietitians, on the risks of gluten-free.  http://www.foxnews.com/health/2013/03/12/why-shouldnt-go-gluten-free/

Basically, I'm not really sure why you would sign yourself or your family members up for this new diet fad unless you really felt you had an allergy or severe intolerance.  Furthermore, if you really feel you have an allergy or severe intolerance, consult with a Registered Dietitian who can determine if a gluten-free diet will be of benefit to you and advise you on how to replace the nutrients you are eliminating with the gluten.

Great Recipes using The Plate Method

Just a quick post today!  When I teach people how to deploy better nutrition habits, I use what we call "The Plate Method" a LOT.  The USDA now uses it to replace the old "Food Pyramid" that you may be familiar with.  Nobody could ever quite figure out how to eat "in pyramid style" so it was an almost completely useless tool.  Now, we can use this visual plate to help us put the correct proportions of food on our plates!

Anyway, I found this really great Pinterest board of published recipes that conform to this new plate method approach and really wanted to share them with you -- Pinterest MyPlate Recipes

If you try any of them out, give me a shout...I'd love to hear what you thought of them!

The Grand New Years Weight Loss Goal....

Millions of us will make the weight loss pledge this New Years -- having felt the weight piling on through halloween, Thanksgiving, Christmas and New Years Eve, we find the idea of doing something about it in January so enticing!

Unfortunately, diets often put us in yo-yo weight loss mode, bouncing back and forth between weight highs and lows, with the highs getting higher over the years.  Crash diets and fad diets typically make this worse.

Instead of putting yourself on a diet, how about establishing new, healthy habits that will lead to weight loss and a healthier lifestyle?  I really enjoyed the post below from a fellow Dietitian and encourage you to read it!  In a nutshell;

Be Specific - set a realistic and attainable goal, such as "I will limit my soda intake to one per day", or "I will make half my plate vegetables for lunch and dinner every day".

Be Positive - don't beat yourself up!  Angels fly because they take themselves lightly.  :)

Nourition Blog

As Nour reminds us;

 "Do what you've always done, get what you've always got!"

What's a food industry to do?

The food industry and it's advertising techniques heavily influence what we buy and what our kids ask (demand??!) us to buy for them.  I saw this video on YouTube today and wanted to share it -- it's an excellent reminder to assess those messages carefully!

http://www.youtube.com/watch?v=-BdFkK-HufU&list=UUVNyZUMykNKrK70JC_Q1qug&index=1

Would you like some arsenic with your rice?

Recent headlines about levels of arsenic in rice have struck fear into the hearts of gluten-free diet followers everywhere!  A Consumer Reports study showed that both organic and inorganic arsenic compounds were quite high in several types of rice, particularly brown rice.  The gluten-free community tends to eat a LOT of rice, for example they may eat rice chex for breakfast, rice crackers as a snack, and rice or rice pasta for lunch and dinner.  Therefore, the gluten-free community is likely to be eating more arsenic than they realize, which is concerning as arsenic is potentially cancer promoting and may affect brain development and IQ in growing children.

There are no federal regulations for arsenic in food, so technically, no laws have been broken and we really don't even know that the levels are dangerously high, but it is an interesting finding and one which makes me inclined to remind all my patients that variety is key!  Furthermore, until more information is gathered about this issue (the FDA has a large study underway), there are a couple of things you should consider....but remember, don't panic and ban brown rice from your table!  Moderation is key.

What you need to know;

• Brown rice has higher levels of arsenic than white rice
• Rice from the US southern states is particularly high in inorganic arsenic, due to a pesticide that was used decades ago in the same region to protect cotton crops
• Consumer Reports recommends to cut back to just 2-3 serving per WEEK, with less for babies and children.
• Pregnant women, children and babies are at particular risk

What you should consider doing;

• Rinse your rice several times before cooking it
• Cook your rice with excess water and drain it off, similar to the way pasta is cooked.  Remember though, this also will discard many of the healthy minerals and vitamins from the rice
• Purchase rice grown in Thailand or India and avoid rice from the southern US (eg, Texmati brand)
• Vary your grains— use Millet, Sorghum, oats, quinoa, amaranth, buckwheat and cornmeal
• Consider adding vegetable-based starches back into your meal plans - potatoes and sweet potatoes, winter squash, corn, dried beans, peas, lentils

With moderation and variety you will reduce your exposure to the food-bourne issue du jour.  That's nutrition you can live with!

Reaching for a Soda? Think about this first!

There is a general undertone in the medical community at the moment regarding sugary drinks.  We all know that they provide absolutely no nutritional value at all, but why do we keep drinking them?  Well, you might say they taste good, we like the sweetness of them, they are refreshing, or we like them better than plain water.  Ok, fine.  But do you know that they have negative effects on your health?  And if you consider the graphic below, produced by a collaboration between many health groups, does it perhaps tilt your mental scales on the pros and cons a bit more towards moderation?  Of even ordinary old water?  That would be good.  :)

Walk for your Health

Today I'd like to focus on exercise.   Is your reaction a combination of "ugh", "I'm too busy" and visions of a sweaty Olivia Newton-John music video?  Never fear.

It turns out that all you have to do is walk.  Yep, just walk.  Ok, so it's nice if you like to workout more vigorously and whatnot.  But just walking is great.  Compared to doing nothing, walking 30 minutes a day cuts your risk of diseases like diabetes, cardiovascular disease, hypertension and cancer by 30-50%!

According to a new study in the British Medical Journal, physical inactivity causes at least 1 in 10 deaths, which puts it on par with smoking.  I also love this great picture from www.everybodywalk.com.... a great reminder that our health is so related to taking a little time for ourselves to WALK!

Some really good articles today!

Thought I would share these with you....I feel like I couldn't have written them better myself!!

First, an article on Fructose -- if you don't have time to read it, basically, it's not really the big enemy  -- but you have to use it in MODERATION.  In other words, 12 teaspoons of it in a sugary beverage (such as sodas or juice) is NOT moderation....  http://www.foodnavigator-usa.com/Science/Sugar-debate-Fructose-may-be-healthy-after-all

Second, a pretty good article on aging healthfully by focusing on your brain, bones and belly.  In a nutshell, eat fish because it's good for your brain, keep your calcium and Vitamin D intake in check, and get rid of as much belly fat as you can - exercise and a high fiber diet help!  http://www.miamiherald.com/2012/06/26/2867372/the-3-bs-of-healthy-aging-brains.html

Happy Summer!

Does Obesity Affect our Daytime Performance?

Well, if you believe some newly published, quite well designed studies, yes.

Sadly, there is now a body of evidence suggesting that obese children have poorer test scores, particularly girls and particularly in math.  This effect shows up as early as kindergarten and also predicts a lower likelihood of going on to college, even after correcting for such factors as parental education and income levels.  Is it unknown at this point whether this effect is caused by changes in mental function caused by the extra pounds themselves, or by something related to the obesity (e.g., self esteem, hesitance to ask questions in class, depression, etc)

Furthermore, in adults, a new study released at the annual meeting of the Associated Professional Sleep Societies indicates that the leading causes of daytime sleepiness are a) depression and b) obesity.  Sleepiness at work is associated with poorer work performance and an increase in work-related injuries.  Upon losing weight, these same individuals reported a reduction in daytime sleepiness.  A taboo topic in the professional world is the question as to whether obese individuals are discriminated against during the hiring process.  Sorry to say it, but studies like this indicate that it may well be warranted.

If you or a loved one are struggling with obesity, reach out for help.  There are lots of different approaches and many professionals out there who can help you!  Not the least of which, your friendly Registered Dietitian!

Regulation of the Big Gulp?

So there's a big kerfuffle brewing based on this  news story today.  Basically, to address the obesity epidemic, Mayor Bloomberg is proposing that sugared drinks in New York should only be sold in 16oz containers or less.  We do know that sugared drinks contribute around 50% of the calories consumed by our kids and indeed represent the highest calorie intake per day in the diet of the typical American.  And we also know that these excessive calories contribute to our expanding waist lines and massively increasing healthcare costs.

In an earlier post I also discussed the HBO documentary "The Weight of the Nation", in which we learned that 2/3s of us are overweight or obese and only 1/3 of us are maintaining a healthy weight.  So I guess Mayor Bloomberg is suggesting that we need a bit of extra help in trying to cut back on our caloric intake?!

I don't think that reducing the size of the portion does much to change someones behavior, however, one could argue that we have this huge (no pun intended!) problem and perhaps we do need some help.  I personally am a proponent of a sugar tax - basically, throw a 50c or so tax on sugared beverages and throw it in a Medicare "savings account" to try to alleviate the massive expense that happens when chronic excess weight gain remains unchecked over the decades, and then burdens the Medicare system.

On the other hand, some would say well, what about steaks?  Should we say you can only buy a 6oz ribeye?  Or perhaps you can only buy 2 slices of cheddar cheese?  Or maybe if you buy one lettuce you can only buy 6 tablespoons of full-fat salad dressing?  ....ummm...is this starting to sound a little COMMUNIST to anyone?

Thoughts?  Would love to hear them!

Glucosamine and Condroitin for Arthritis?

So the story goes that we have an elderly dog who suffered dreadfully from arthritic back legs, mostly in the winter. It was so bad that she really struggled to get herself out of bed, and her back legs moved together in one motion most of the time. Sometimes the poor thing was so sore, she would pick up one back leg and hop around on the other.

Our vet suggested we try glucosamine for dogs. After a few weeks, we were amazed at the progress! We now call this dear old dog "The amazing reverse aging dog" also known as "Benjamin Button"! You'd hardly know she suffers from arthritis at all and she now frequently accompanies us on long walks again too.

So we decided to look into this supplement to see if it would soothe our own aching joints. It turns out that while glucosamine often works incredibly well in dogs, it only works in about 50% of humans. Go figure. However, if you are suffering chronic joint pain, it's a fairly harmless supplement in terms of side effects and you have a 50/50 shot of it being useful!

You should look for a supplement that is certified as safe by the Consumer Lab - they are really good at sniffing out the stuff that isn't as labeled or is just flat dangerous. For example, they recently discovered that Whole Foods is selling a product that is heavily contaminated with lead!

Also, you should take the supplement for 2-3 months. If you see no improvement, you should cease taking the supplement as this would indicate you are in the unlucky 50% for whom this supplement provides no use.

Let me know what your experience has been with this supplement! I hope you have the same experience with it as our dear old dog!