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Monthly Insights

Nutrition 101: Understanding Why We Need ALL Foods (August 2017)

Due to the various trends floating around, it’s easy to be confused about what to eat. So many discussions tout the best “clean” foods or “super foods.” For someone that does not work in nutrition, it can be overwhelming to constantly learn about, and follow, these trends. A crash course in nutrition can be helpful in becoming a discerning consumer that eats for nourishment and health.

To begin, there are basic macro and micronutrients in our diet that are necessary to allow our body to work at the highest level.  Those macronutrients include carbohydrates, protein, fat, and water. Micronutrients include antioxidants, phytochemicals, minerals, and trace elements.


Carbohydrates are a huge point of discussion and there is a lot of misinformation out there. Carbohydrates areincredibly important, as they are the main fuel source that our body requires. Because of the diet industry’s treatment of carbohydrates as “the enemy,” people are often surprised when I tell them that our body requires 50-60% of their diet to be derived from them. Carbohydrates contain glucose, a simple sugar that provides our bodies with energy and allows our brain to work optimally. Our brains cannot store glucose like other parts of our body, therefore, we need to consume it consistently. Research shows that, at all times, 25% of all given circulating glucose is used by our brain.  Our muscles require carbohydrates to function properly as well.


To be clear on what a carbohydrate is, some common sources include, bread, rice, pasta, cereal, crackers, popcorn, starchy vegetables, beans, fruit, milk, desserts, and alcohol. 


Macronutrients, like carbohydrates, cannot assist the body and brain properly without the help of micronutrients. When a diet doesn’t include macronutrients, overtime we lose our ability to function at an ideal level. We begin to focus on food more, have “food swings,” obsess about what we are eating and not eating, become irritable and overall are unpleasant to be around.  Physically, our bodies are not working at their maximum potential. Our brain function is altered, gut function is delayed and basically our body is slowly deteriorating. When complete food groups are removed from one’s diet, vitamins and minerals that are necessary for proper functioning are missing. The macronutrients are a part of the micronutrients and the two must have one another to perform optimally.


To understand what our body goes through when we deprive it of the necessary micro and macronutrients, it’s important to understand what causes these cravings. Longer periods of deprivation and dieting lead to a faulty error with our body’s hunger signals.  When you are hungry, your brain releases a hormone called Neuropeptide Y (NPY), which then stimulates food intake, especially carbohydrate intake, since carbohydrates fuel our bodies. NPY is released in response to any time of fasting or food deprivation, from the extreme case of anorexia nervosa to normal fasting of going to bed and having breakfast the next morning.  When people don’t have any disordered eating, the NPY levels drop once they eat. For people who deprive themselves or restrict often, this will cause chronically elevated or increased NPY levels that don’t change the way they are supposed to.


Essentially, if you have been chronically dieting, limiting carbohydrates, or both, the body will produce larger amounts of NPY, leading you to crave the higher carbohydrate foods that your body needs for fuel.


Protein is important to help repair muscle and tissues. It also helps to rebuild cells, organs, and enzymes as well as to manage blood sugar.  In the media, there is so much attention on eating protein that our culture typically over consumes it. With eating disordered clients, it’s common to avoid protein or under-consume protein. When one does this, the body actually eats away at its own tissues to provide whatever nutrients or amino acids that it needs. Basically, we are eating ourselves for lunch, like a deleted scene from “Silence of the Lambs!” 


Some of the obvious signs that our body is failing or breaking down due to low levels of protein is lack of energy, hair loss, changes in skin texture or color, achy muscles, dental problems, nail breakage or fragility, osteopenia or osteoporosis and, of course mood changes and problems with concentration. An individual experiencing these symptoms would benefit from adding protein to their meals and snacks.


Now, to talk about an area of nutrition that is HUGELY misunderstood: FAT. I always like to say: “let fat be our friend.”  Many clients believe that eating fat will make them fat. This is a myth. There are many forms of fat. Whether one eats butter, salad dressing, avocado, nuts, hummus, olives, chia seeds, cream cheese, mayonnaise, olive oil, or the skin from their chicken, it’s important to add fat to our diet at all meals. Fat fills us up, allows us to feels satiated longer, allows us to not think about food, and is necessary to transport fat soluble vitamins in our body (vitamins D, A, K, and E). Fat also tastes good and delays the aging process. Without fats in our diet, our skin would shrivel up like a prune!  This process will occur over time and that individual will, at least, complain about always being cold, since their bodies are not working to optimally to warm them. Also, their organs are lacking the protection and cushion that fat provides. Additionally, having sufficient amounts of fat allows women’s menstruation to work optimally.


Fluid is, of course, important for hydration. Many people know hydration is important but do not think of all the bodily functions water is needed for such as saliva, tear drops, urine, blood, our digestive juices, and lymph, a fluid that runs through the lymphatic system and helps rid our bodies of toxins.  Our body fluids are dependent on water. Also, water is important to prevent constipation and for our electrolyte balance. It’s very common for clients to complain of headaches due to a suboptimal amount of electrolytes, as they may be consuming a lot of caffeine, which dehydrates their bodies, and/or they don’t drink much water to begin with.  Clients also state that water makes them feel full or they fluid load (drink too much water), flushing out the electrolytes from the body. Water is necessary to help remove waste in our body and manage our temperature control.


I like to help clients incorporate balance, variety, and moderation into their lives. For many this is not an easy to achieve, whether mentally or physically. Our society often spreads incorrect and backward information about food and nutrition. It can be difficult for one to properly fuel themselves with all of the misinformation they’ve had engrained into them. Having a basic understanding of what our micro and macronutrients do for our bodies has been my intent for you today. Having a basic knowledge of nutrition can be an important weapon to battle against any misinformation we’re told and to work toward a more balanced and healthy relationship with food.


I hope these brief descriptions of the micro and macro nutrients explain the reasons as to why we do not want to exclude any food or food group. The long term goal is to be able to have a variety of foods and to not have any fears with food.

Working “Play Food” Into Your Diet (July 2017)

The title may sound strange to you! After all, what is “play food,” and how can it help me? “Play Food” is a term that I use with my clients but it is also sometimes referred to as “fun food.” Diets teach us to deprive ourselves and not honor what we are craving. In return, we obsess about that food and feel wracked with guilt when we eventually eat it. Restricting in this manner can also result in more out-of-control binge cycles. As such, I like to teach clients to honor those “play food” cravings that they have touted as taboo.

There are many ideas on how to work “play food” into our diet. When I teach clients about this concept, I emphasize that it’s very important to be aware of their emotional status. What this means is if they are feeling, sad, anxious or overwhelmed,  they are more likely to over-consume their “play food,” for example ice cream.  Our feelings (negative or positive) can be so overwhelming and distracting that we become unaware of what emotion we are actually experiencing and why. Additionally, when a negative feeling is occurring it is not always possible to differentiate between our physical and emotional feelings of hunger.  For example, if we are anxious, we may perceive the physical feeling of anxiety as hunger. I like to suggest that one delay, or postpone, eating if they are feeling consumed by their emotions. This can allow the feeling to calm down and help the individual become better connected to their true emotions and hunger levels.

My philosophy is that it’s important to have some type of “play food” in our diet whenever we crave it. I don’t believe in “weekend only” or “saving up for it.” Placing rules around food often results from remaining entrenched in the diet mentality and shows a lack of surrender to giving up this mentality. Whenever we crave “play food,” it’s important to fulfill this craving and, in doing so, to move toward being an intuitive/attuned eater. Eating a food that we crave “unleashes” this food, lessening the power that it has over us and bringing it back to ourselves.

So, how do we work on the process of healthfully indulging our cravings and regaining the power food once had over?
I start by having clients make a list of their forbidden foods. We go through the list one by one. Continuing with ice cream as an example, I will then suggest that they keep three pints of ice cream in the house. This is important, as the client knows that this food is always there. I have suggested to the client to keep several on-hand so they know that they can eat it whenever they want. Clients are often reluctant to do this, as they are concerned about weight-gain. It is important to emphasize that weight should not be the focus, as it looks at the external. When legalizing “play foods,” the focus should be on processing what is really going on internally.

I also like to remind clients that forbidding themselves from eating a food, for example saying “I can never have that food again,” is more likely to lead to a binge. This is known as the “final supper” syndrome, when a client gorges themselves on a particular food, vowing that this is the last time they will allow themselves to eat it. During the step of bringing the forbidden food into the house, it is important the client knows that this is not for “one final binge” and that they can eat this food at any time.

When the client is able to experiment with eating the “play food,” questions like these come up:

  • What lead me to crave this food?
  • Did I have a meal that didn’t fully satisfy me beforehand?
  • Did I eat it because I wanted a different taste to end a meal?
  • Did I feel lonely?
  • Was I mad that I couldn’t say what I wanted to my teacher or boyfriend?

 

Or maybe I just wanted to eat ice cream. The food begins to separate from the emotions and simply becomes food again.

If ice cream is around all the time, we habituate eating it and it doesn’t seem so special. This is important to begin exploring so that eating a “forbidden” food is desensitized and doesn’t result in a binge.

When I start working with many of my clients, they don’t keep food, or much food, in their home, as they are afraid that they will be “out of control.” As we work through the process of allowing “play foods” in the house, we grow from considering one food to numerous others they have been depriving themselves of. We discuss what it would be like to keep some of their favorite foods stored at home and how they can learn to take charge over their food instead of their food being in charge of them. Having courage to keep food in the house is not easy, but it is something that can be worked toward gradually.

I also discuss the importance of eating foods of substance. For example, when a client has had a meal (i.e. a sandwich) they tend to be more likely to eat the food they crave without bingeing.  If clients make sure to nourish their body substantially, they will begin eating foods because they crave them and not simply because they are famished or it is there.

This can be a long and difficult process, as clients typically have multiple foods to work through. I successfully help clients with this on a daily basis and help them meet their goals of wanting to live fulfilling lives, getting rid of their fear of food, and dropping the obsession with diets and the scale. This is necessary to help clients work toward the path, of body positive and anti-diet options.

I am happy to be a resource for you during this process.

References:

  1. Matz, J., Frankel, E. (2014). Beyond the Shadow of a Diet - 2nd edition. Routledge.
  2. Matz, J., Frankel, E. (2006). Diet Survivors Handbook. Routledge.
  3. Tribole, E., Resch, E. (2012). Intuitive Eating – 3rd Edition. Griffin Publishing, USA.
The Fad of Drinking Charcoal…(June 2017)

Did the title catch you by surprise? No, you did not read it incorrectly! The latest fad in the health and nutrition sphere is, indeed, drinking charcoal. I first learned of this several months ago when a client told me that she bought a bottle of Charcoal Lemonade (www.juiceservedhere.com).  I had never heard of such a fad! My initial thoughts were: how long would this fad be around? What is the objective of this beverage? How safe is drinking charcoal? It is my job to understand nutrition fads and educate my clients on their true benefits, and drawbacks. Upon hearing of this new trend, I was surprised and skeptical and, obviously, felt I had to learn more.

I think it is important to make clear from the beginning that I do not believe in indulging in fads or “quick fixes.” Many of the clients and clinicians I work with can attest to the fact that I strongly believe that there are no shortcuts for drinking water or obtaining energy. I live my own life by this principal and recommend my clients do as well. As such, I also recommend against engaging in detoxes or cleanses. The trend of drinking charcoal has been recommended in Western medicine as just those, a way to “detox” our body from alcohol, metals or any other substance that one is trying to remove from their diet.  In my opinion, changing our relationship with food would be the ideal way to approach living a healthier and happier life. However, people may find it important to say they have tried the next “trend du jour.” What I think is important to emphasize is that education must always precede any dietary change. Therefore, I want to enable my readers with some information on this particular trend so that you can make evidence-based decisions regarding your health.

Let’s start with a discussion of how activated charcoal is created as well as how it works. Activated charcoal is produced by heating wood to high temperatures and then oxidizing it, resulting in almost pure carbon. The final product is a very large surface area that can absorb various chemicals to its surface. When ingested, the charcoal isn’t absorbed into the body; however, its remains in the gastrointestinal tract then help to prevent the absorption of toxic poisons or drugs.

This trend took on massive popularity when Gwyneth Paltrow mentioned charcoal lemonade on her website. The lemonade is made with alkali water and sweetened with cane sugar. Such simple ingredients, and yet it costs $8 just for one 15 oz. bottle. The site claims that the lemonade will remove toxins from foods that contain GMOs, preservatives and additives. This sounds helpful and appealing, however, registered dietitians are aware of the truth here: our bodies are able to get rid of these toxins on their own via the liver, kidneys, lymphatic system and skin. We don’t need a beverage to assist with this.  There is no scientific evidence to back up the claims that charcoal further assists the already natural bodily processes at play in getting rid of these toxins. 

Another problem I have found is that ingesting activated charcoal removes nutrients from our food, making it less nutritious. In 2004, the Journal of Food Quality published a study that looked into the effects of ingesting activated charcoal in conjunction with apple juice. The study showed that there was a reduced amount of vitamins absorbed from the juice, such as Vitamin C, Vitamin B6, Thiamine, and Biotin, when combined with activated charcoal.

As a nutrition therapist, I always like to understand the reasons my client is interested in trying something new. Nutrition trends can be particularly dangerous because they always assert that they are better than other trends because they are “all natural” and “work with the body.” Many people give into these trends because there doesn’t seem to be any harm in doing so. It is important to remember that the body is already an incredibly resilient and efficient machine. Much of what nutrition trends claim to do are already being done by your body every day. We must work hard to be conscious consumers and educate ourselves on the true benefits of these trends so that we don’t fall into expensive, unnecessary, and, sometimes, unhealthy nutrition habits.

References:

  1. www.webmd.com/vitamins-and-supplements/activated-charcoal-uses-risks, December 2016
  1. Kadakal C, Poyrazoglu ES, Artik N, NAS S. Effect of activated charcoal on water-soluble vitamin of apple juice. Journal of Food Quality. 2004; 27(2):171-180.
How to Break Free from the “Diet Mentality” (May 2017)

As we are in spring, there are messages everywhere reminding us that it’s time to “get in shape for summer,” “start working on our beach bodies,” and “lose all of that winter padding.” Our society has such an obsession with dieting that January is known as “National Dieting Month.” The constant push to have our bodies fit in with the societal ideal becomes even stronger as the weather warms, adding pressure to the thoughts that we need to change or “fix” our body.  This “diet mentality” can be very persuasive and tempting, as everyone exclaims that it “really works” and “changed their life” without touching on the reality of diet behaviors and the negative impacts they can have on your mental, emotional, and physical health.

Those that have hit “rock bottom” in the trenches of the diet world often realize, after gaining the weight back, that diets do not work. In fact, they may actually cause you to gain weight and, while they may improve our health short-term, and can do more damage to your health each time you engage in the dieting rollercoaster.

Has anyone ever noticed that, when we deprive ourselves of different foods and food groups, your caffeine consumption increases? Perhaps you are irritable, short-tempered, less likely to socialize and more tired than usual? This is because diets starve our brain of the various micro and macronutrients that we need, such as carbohydrates, proteins, and fats. Similarly, supplements do not provide the energy we need either! Dieting causes us to deprive ourselves of the nutrients we need most, all of which come from, you guessed it, “Vitamin F:” FOOD!

Diets also create disordered thinking, disordered eating, food rules and the fear of various foods and/or food groups. In this vain, they do more harm than good and these harmful behaviors can result in hair loss, nails breaking, excessively dry skin, and lack of menstruation, just to name a few. The diet industry, of course, does not mention these fun and seductive potential side-effects. With all of the negative impacts dieting can have, I think it’s important to offer some tips on how to avoid the diet culture and life a happier and healthier life.

To begin, stop reading any book or magazine that discusses how to change your body. Whether the article or book is focused on long or short-term change doesn’t matter, do not allow any space in your mind or life for publications that make you feel as if you need to change yourself.  Instead, immerse yourself in reading about travel, decorating, psychology, or cars, anything that you find interesting and inspiring. Don’t spend time reading things that involve changing your physique or provide food ideas that suggest making meals or snacks in a low-calorie manner. I am suggesting reading material that isn’t for a quick fix and, instead, feeding your mind with information about things that motivate and entertain you.

Next, learn to discuss topics with friends and co-workers that do not involve food or weight. People seem to make casual comments, either positive or negative, about other people’s bodies and what they do, or should, look like. Even when people are well-intentioned and believe they are referring to weight in a scientific manner, they can be misguided. For example, when people refer to other’s Body Mass Index (BMI). This is calculated by dividing one’s weight in kilograms by the square of one’s height in meters and is used as the standard determination of “fatness” for many doctors. However, BMI is an inaccurate measurement, as it doesn’t include various factors that contribute to weight and health including age, ethnicity, family genetics and years of dieting. BMI is not an indicator of health.  BMI is a comparison of height and weight tables.

Learn how to develop hobbies and interests that are intellectually stimulating. Perhaps you have always been interested in studying a foreign language or learning how to play a musical instrument. These are a couple of ideas that can allow us to feed our minds and strengthen our knowledge and understanding of the world around us, not be sucked into the idea of being on a new diet. Diets are expensive, short lived, a waste of money and are not a fun or worthwhile conversation to have.

It is also important to change our focus, putting energy toward taking care of ourselves and our bodies instead of berating ourselves and restricting our diet. When we take care of ourselves, inside and out, this can allow us to feel better about ourselves. Important aspects of self-care can include: getting enough sleep, focusing on our mental well-being, creating boundaries with people that deplete our energy, consciously choosing what fuel we want to eat that will provide sufficient energy, and learning how to be in touch with ourselves to see what type of intuitive movement, if any, we like. These can all go a long way in helping us to lead happier, healthier lives that revolve around consistent and true wellness instead of temporary, perceived, wellness

Focusing on the above areas can allow us to feel more confident about ourselves as people and forget about ever wanting to go on a diet. Learning to accept ourselves and not compare ourselves to anyone else is important, as well. When we begin to know, and like ourselves, we move closer to being able to accept ourselves. I want to emphasize that no one is perfect, attempting to achieve perfection through diet and exercise fads is a fool’s errand. The fad, and its results, are temporary but the harm it can cause to your mind and body can last much longer. It is important to invest in who we are as people, not what we look like. Our personality will continue to shine and glow as we know and love ourselves. It’s important to remember that people don’t see the flaws we obsess over that make us so hard on ourselves. The next time you ask  people what they like about you, I can assure you, it will be all character-related compliment , not your hair extensions, make up, or how many bicep curls you can do. Try to see yourself as your loved ones do, treat yourself as compassionately as you would treat your close friends, and love yourself unconditionally.

I hope this has given you some perspective on the many reasons to give up dieting. Forget the restrictions and the societal pressure to form yourself to an impossible ideal. Instead, use these tips to work on being kinder to yourself on this journey to being “freed” from the difficult and confusing messages that we hear in today’s society about food and body.

What is the Hype Behind Spirulina? (April 2017)

Have you bought a green drink at the juice bar that contains something called spirulina? Or a green powder that notes spirulina as a listed ingredient?  Perhaps your multivitamin includes spirulina, too. This concentrated blue-green algae is reported to have many health claims and seems to be in the press quite a bit lately. So, what’s the truth about this new fad?

There are many claims about spirulina’s potential health effects, some of which are more well-founded than others. For example, spirulina, reportedly, assists in detoxifying the body, can cure allergies by stopping the release of histamines, can assist in curing candida, and boosts the immune system by increasing production of antibodies, which fight disease.

There is a long laundry list of supposed vitamins and minerals contained in spirulina that may be leading to these impressive claims. Spirulina is said to contain B-Complex, beta carotene, Vitamin E, manganese, copper, selenium, zinc, iron, and the fatty acid called Gamma linolenic acid. Did you know that one ounce of spirulina, 4 tablespoons dried, provides 16 grams of protein as well as 60% of the daily value of riboflavin!? It also provides 44% of the daily value of iron and thiamin, 14% of the daily value of magnesium, and 11% of the daily value of potassium.

As impressive as these supposed benefits are, it is important to note that pregnant or breast feeding women should avoid taking spirulina due to the uncertainties in how it may impact them. Spirulina grows in ponds all over the world in such locations as Hawaii and China.  With this comes concerns about contamination with toxins and heavy metals. Whether you are pregnant or not, it is wise to select a company that has done third-party testing on their product. If a company has done so, it will have a quality assurance label on its packaging. 

Those on blood thinners are also recommended to avoid taking spirulina. Spirulina is contraindicated with these medications, meaning it is not advisable to use them simultaneously due to how spirulina may negatively impact the effectiveness of the drugs. For example, if one takes an antiplatelet or immunosuppressant drug (a medication that weakens the immune system), the effects of spirulina could negatively impact the dosage of the medication.

Additionally, those with Phenylketonuria (PKU) should not consume spirulina. PKU is a disease that causes a lack, or deficiency, of the enzyme needed to process an amino acid called Phenylalanine. A dangerous buildup of phenylalanine can develop when a person with PKU eats foods that are high in protein, such as milk, cheese, nuts, meat, or, you guessed it, spirulina.

It is also noted those with an autoimmune disease, such as rheumatoid arthritis, lupus, or multiple sclerosis, should avoid spirulina, as it could stimulate the immune system and make the disease and symptoms worse.

Spirulina contains a large amount of nucleic acids according to Beth Israel Deaconess Medical Center.  These substances produce uric acid and are related to DNA when they are metabolized. If too much uric acid builds up in the body, gout or kidney stones can develop. If you are susceptible to gout attacks or kidney stones, then spirulina may be harmful to you. To avoid excessive uric acid, Beth Israel Deaconess Medical Center suggest limiting the intake of spirulina to 50 grams per day.

Listed below are some medications that are speculated to cause drug-nutrient interactions if spirulina was consumed while taking these medications. These medications suppress the immune system and I would suggest one avoid taking spirulina if they are on the following medications:

  • Humira (Adalimumab)
  • Imuran (Azathioprine)
  • Neoral (Cyclosporine)
  • Ethanercept (Enbrel)
  • Infliximab (Remicade)
  • Leflunomide (Arava)
  • Methotrexate
  • Cellcept (Mycophenolate)

As spirulina is a relatively new supplement, there isn’t a lot of scientific information to confirm its benefits. Therefore, it is left up to you to educate yourself on its origin and impacts and decide if you believe it may be an effective addition to your daily life. Please be aware of the medical diagnosis that Spirulina, and all other supplements, are contraindicated for to make informed and healthy decisions so that you can live well and be well.

References:
Chamorro-Cevallos, G., Garduno-Siciliano, L., Barron B. L., Madrigal-Bujaidar, E., Cruz-Vega, D. E., Pages, N. Chemoprotective effect of spirulina (arthrospira) against cyclophosphamide-induced mutagenicity in mice. Food Chem Toxicol. 2008; 46 (2): 567-574.
Deng, R., Chow, T. J. Hypolipidemic, antioxidant, and anti-inflammatory activities of microalgae spirulina. Cardiovasc Ther. Aug 2010; 28 (4): 33-45.
Fetrow, C. W., Avila, J. R. Professional's Handbook of Complementary & Alternative Medicines. 1st ed. Springhouse, PA: Springhouse Corp., 1999.
Mazo, V. K., Gmoshinski, I.V., Zilova, I. S. Microalgae spirulina in human nutrition. Vopr Pitan. 2004; 73 (1): 45-53.
http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND

What does “Body Gratitude” mean to you? (March 2017)

Have you ever thought about thanking your body for everything that it does for you?

After carrying your groceries up the stairs or your purse on your shoulder? When standing on your feet at work or as you prepare a meal? Even simply allowing you to get out of bed in the morning or hug your loved ones.
These are all tasks that we take for granted. Every interaction, every feeling, every movement, occur because our bodies carry us through them. Sadly, when we are not happy with how our body looks, we focus on the negative instead of all the wonderful areas where our body allows us to succeed.

This type of attitude may not seem like a big deal, but maintaining it can cause larger problems. When we feel poorly, we eat to feel better. Left unchecked, these behaviors can often result in a binge and can become an ongoing issue.  Learning how to develop a positive body image, and developing body gratitude, will help one be conscious of the food choices that are made, and feel better regarding one’s self.  

One of the challenges that I see my clients experience is that they compare their bodies to friends, family members, or colleagues. All of our bodies are unique and are meant to be developed in a certain manner based on our genetic makeup. When we can learn to accept that our bodies have a place where they are naturally meant to be, it becomes easier to work on body gratitude. 

I like to discuss “Radical Acceptance” with clients to help them with this. This term was coined by Marsha M. Linehan, Ph.D., the creator of DBT (Dialectical Behavior Therapy). Radical Acceptance is broken down into the following: 1) Accept the reality of what it is, 2) Accept the situation that causes you pain, and 3) Accept that life is worth living, even with painful events in it.  An example of this that relates to body image would be: 1) My genetics mean that I have a specific body type that I can’t change, 2) It causes me pain that I am not able to change my body because I feel pressure to look a certain way, 3) My body may not be the societal ideal and it certainly isn’t perfect, but it gives me life and helps me to do amazing things that bring me joy, therefore, I am willing to learn how to give my body the respect it deserves. With this process of Radical Acceptance, comes a change based on the acceptance. Continuing with the above example, a decision based on acceptance of one’s genetic body type could result in a decision to stop dieting. With giving up dieting, I am no longer turning myself inside-out in an attempt to alter something I can’t change. Instead, I recognize my inability to change my genetic makeup, accept that my body is not merely decorative and should be appreciated for the abilities it provides me, and live my life without having to put my body through extreme measures. Practicing Radical Acceptance means working on accepting where one’s body is naturally and learning how to enjoy food without guilt or shame by eating the foods they truly enjoy and crave.

A common misconception about learning to accept one’s body is that it can open the door to potential loss of control. When we give ourselves permission to eat a food that we enjoy, and have been denied, there is a possibility that we may over eat it at first, and it is important to be aware of this. However, it worth noting that, eventually, the food won’t seem as special after as it’s being desensitized or made “legal”. This process can help the individual learn how to have more appreciation for what our body is capable to do. For example, my body is able to taste various foods and chew as this is a skill that I take for granted.  

Learning how to focus on the many areas our body provides for us can make a huge difference in making our value of our body internal, as opposed to purely valuing it for its external appearance. Sadly, our culture perpetuates the idea that we should base the worth of ourselves, and others, purely on physical appearance alone. Imagine the change it would make if, instead, people focused their self-worth and happiness on different facets of their lives, such as: “did I have a restful night’s sleep?” or “It’s amazing that my body was able to heal itself from the terrible cold I had.” These thoughts and questions lead to important realizations that shift the focus of our experience. For example, getting a restful night’s sleep may lead one to think: “I would like to thank my body for this peaceful night’s sleep.” Realizing that the body has mechanisms to heal itself and fight disease can help us to better appreciate the amazing machine it is. These are things that many of us do not think about, or that are often forgotten. What about carrying a full-term pregnancy or delivering a baby!? Our body is strong enough to create another human being! How remarkable is that!? For these reasons, and so many others, our body deserves love, respect, and appreciation.

To achieve this outlook, it’s also important to learn how to focus on the positive. I always like to tell clients: “fake it till you make it.” This is a quote that I take to heart, as I often see people saying so many negative and mean things to themselves that the thoughts eventually manifest into poor self-esteem and lack of self-worth. It is important to learn how to say something kind, loving and supportive to ourselves.  A great rule of thumb is to consider the following question when you find you are berating or talking down to yourself: “would I speak to my friend’s like this?” This question often reminds us to speak to ourselves as we would to all others we love. You wouldn’t remark on your friend’s body or call them names, so hold yourself and your self-talk to the same standard. Think of a time when your friend was beating themselves up emotionally and try to remember what you said to them. Most likely, you gushed about their wonderful attributes, their worth, and their talents and reminded them that their appearance does not make them who they are. Do the same for yourself. Shift the focus of your self-talk from the external to the internal, from the negative to the positive, from hate to love. Perhaps focus on one thing you like about yourself?  Maybe it’s a quality about your personality or a hobby you have? This is an important place to begin as we work on changing focus away from the external. This is about working from the inside and finding the strength to thank yourself and your body for allowing you to do everything that you do.

I’d like to end with one final word of advice, to get you started on this journey of Radical Acceptance and self-love: write a gratitude letter to your body. Thank your body for everything it has done for you thus far, list the amazing abilities it gives you, the experiences it has provided for you, the way it has carried and healed you. I know your relationship with your body may be complicated, as all relationships are, so make this letter an on-going project. When you find yourself shaming your body for its external appearance, come back to this letter, and this list. Continually remind yourself that your body is so much more than merely decorative, until that way-of thinking becomes habit.

The Mysterious Matcha Tea (February 2017)

In December, 2014 I went on my cycling trip in Southeast Asia.  During that trip, I noticed that there seemed to be a considerable amount of hype surrounding matcha tea, which is in the green tea family.  Not only is it the only tea that is produced and used in a powdered form, it is also considered the most potent tea in the world.  Its potency comes from the fact that the powder consists of the entire tea leaf, unlike other tea products, which are tea leaves infused into hot water then discarded.  Repeatedly hearing about this tea led me to write a monthly insight for all my tea connoisseur readers.

Let me begin with some interesting facts about this tea.  It originated in Japan by a Japanese Buddhist monk named Eisai who brought home the green tea leaves known as “matcha.”  This tea, commonly used as a ceremonial tea in Japan, is traditionally blended with a bamboo whisk and consumed from the Japanese drinking bowl known as a Chawan

However, matcha tea is no longer limited to the traditional use, traditional consumption, nor even only the Japanese market.  Today, we may find it in smoothies, boba drinks, and lattes, as well as an ingredient in sweet and savory recipes.

As a matter of fact, the use of matcha tea has actually become global, i.e., an individual can purchase these powders from tea purveyors all over the world.  Unfortunately, research suggests that the purity and quality might be compromised depending on where the processing took place.

As I have cycled through many different tea fields, where field owners provided information about their teas as well as the opportunities to taste them, I can say first hand that matcha tea’s flavor intensity varies from the production and the quality.

The cost of the final product is determined by whether it is   low grade powder with added sweeteners or pure matcha, which is bright green, the desired color for the end product.  Matcha exposed to oxygen may easily become compromised because it can become oxidized. Oxidation imparts a dull brownish-green color and a distinctive hay-like aroma, characteristics that indicate a low quality product.

The International Standards Organization’s (ISO) tea subcommittee has considered setting a standard for matcha and other green tea powders, an action similar to what the Food and Drug Administration (FDA) does for food in the United States.  I believe for every food industry it is important to have standards so the quality of the product does not vary a great deal and the consumer is not misled.  Because determining this standard is a work in progress, we will look for their completion and publication in the future.

Benefits of matcha are similar to other green teas relative to the antioxidant content.  Benefits of antioxidants include risk-reduction for certain forms of cancer and coronary artery disease.  It is interesting to note that one glass of matcha is equivalent to ten glasses of green tea in regards to the antioxidant content. I would say, therefore, that this tea is quite an antioxidant power house.  In addition, due to the caffeine content of the tea, it certainly may increase one’s ability to pay attention

On those days when the weather is brisk, treat yourself to matcha.  It would not only be soothing and comforting, it would also give you a substantial dose of health-promoting antioxidants while helping you stay awake and alert.

In the picture to the right, taken in 2014, my cycling friends and I experienced the Japanese Tea Ceremony in Japan.  We learned the history of matcha and what each special bowl or saucer used in the ceremony represents.

This picture (on the left) shows the “Chawan” aka: the Japanese drinking bowl, bamboo whisk, special saucer, and brewing container that the matcha tea is in.

References:

  1. https://en.wikipedia.org/wiki/Matcha
  2. http://www.drweil.com/diet-nutrition/nutrition/discover-matcha-tea/  
Eating Disorder Screening for Health Care Providers: What you see is not always what you get… (January 2017)

I hear this scenario all the time from clients: “my doctor has no idea that I have an eating disorder, since I don’t look like I have one,” or, “I have fallen back into my eating disorder and my doctor is not aware how to handle it.” For those familiar with the eating disorder and nutrition realm, the last statement can be surprising. When a client is referred to the registered dietitian nutritionist for constipation and bloat by the gastroenterologist, this would seem like an obvious referral, wouldn’t it?  Cases such as these, where eating disorders are going undetected and untreated by general practitioners, make clear the importance of medical professionals having an awareness of eating disorder behaviors and symptomology.

If a doctor is unaware that the patient has developed food rules, and that they have become afraid of food due to the gastrointestinal challenges that they have faced, there can be serious physical consequences. For example, in regard to the above scenario, as I begin to explore the client’s medical history on a deeper level, I often learn that he/she has lost a significant amount of weight (40 lbs.) and his/her body is in a place where it naturally is not meant to be. These physical symptoms are correlated with Refeeding Syndrome, which occurs as a result of reinstitution of nutrition to patients who are severely malnourished or starved. In regard to re-feeding syndrome, metabolic disturbances can occur as a result of the patient’s electrolytes being imbalanced, which increases cardiac workload and heart rate. Patients with refeeding syndrome can experience heart failure if their team is unaware of their eating disorder behaviors and, therefore, not monitoring their fluids, cardiac workload, and heart rate. A doctor that has not developed a knowledge and understanding of eating disorders may overlook these symptoms, to the detriment of a patient.

According to the National Eating Disorders Association (NEDA), an estimated 30 million Americans (20 million women and 10 million men) will experience an eating disorder at some point in their lives. Those who experience eating disorders are known for their silence. Most of these people don’t come forward to express their thoughts or experiences with their eating disorder. It’s only when they are working with a cohesive treatment team that he or she learns how to process their thoughts, create boundaries, and articulate what their needs are. A treatment team consists of a therapist, dietitian, internist or pediatrician, and psychiatrist, all of whom are trained in eating disorder treatment. Assembling such a team is no small feat and can be a challenge in-and-of-itself. The earlier that an individual obtains help by setting up a treatment team, the greater the clients chances are to be recovered on a physical and emotional level.

Early detection and intervention is key, as, too often, clients slip through the cracks due to the inherent secrecy and shame of their disease. This article will provide some screening strategies to help the medical community recognize common eating disorder symptoms and behaviors. I believe that all individuals in the medical community should have specific screening questions during their initial appointment and follow-up’s. Many of the medical practitioners that I work with have disclosed that they are limited on time or don’t feel comfortable bringing up these questions. These questions do not have to be invasive in order to provide key information. Some general questions which may feel less threatening for the clinician and the patient could include reviewing their typical diet and exercise regimen, how the clients feels about their body, if they have recently gained or lost weight in a certain time frame, and what a healthful diet looks like to them.

The reason that many clients are able to “trick” their medical team about their eating disorder is because they don’t “look sick.” Physically, they may be at a normal weight, or even overweight. Emotionally, they often don’t feel comfortable sharing the thoughts that go along with these behaviors with their doctor, especially since a large percentage of them are not trained in eating disorders. There are many societal misconceptions about eating disorders and how those experiencing them look and behave. These misconceptions can make it difficult for those who aren’t informed to identify the problem and know how to approach it when it arises.

For the above reasons, I always like to reiterate that weight changes are not the only screening criteria for an eating disorder. There are many other factors to assess. For example, missed menstrual cycles, low testosterone levels, elevated cortisol levels, thyroid issues and Endocrine abnormalities are all indicators that there is a possible problem. It is also important to be aware of the emotional symptomology involved with eating disorders, such as increased anxiety or feelings of depression. Many healthcare providers don’t realize that males also experience eating disorders, as it’s more common in females. As a result, male eating disorders are particularly undiagnosed. Other areas to be on the lookout for include: compulsive exercise, skipping meals, counting calories, wearing baggy clothes to hide one’s body, and preparing extensive meals and then choosing to skip them. Feeling dizzy and lightheaded are also very common due to being dehydrated and having hypoglycemia, which occurs when a patient has low blood sugar due to starving the brain of glucose.

Binge Eating Disorder is the number one eating disorder diagnosis, affecting 60% of women and 40% of men. This disorder has been acknowledged by the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) as well as by the American Psychiatric Association. However, despite its recognition as a serious disorder, and its prevalence, binge eating disorder is often overlooked due to a lack of awareness of its symptoms. Binge Eating Disorder is defined as binge eating a large amount of food in a short period of time. It is also described as three or more of the following: 1) Consuming a large amount of food, or more than what is normal for the individual, rapidly in a concentrated period of time, 2) Eating large amounts of food when not feeling physically hungry, 3) Eating until the individual reaches an uncomfortable level of fullness 4) Feeling shame, guilt, depression, and disgust with oneself. Additionally, the individual may eat alone, as they feel embarrassed about the quantity and/or kinds of food they are consuming.

A helpful screening tool that all healthcare clinicians can use in their screening process is the SCOFF questionnaire. 

These questions can be used with all patients:

S - Do you make yourself Sick because you eat until you feel uncomfortably full?
C - Do you worry you have lost Control over how much you eat?
O - Have you recently lost more than One stone (14 lbs. or 6.35 kilograms) in a three- month period?
F - Do you believe yourself to be Fat when others say you are too thin?
F - Would you say Food dominates your life?

An answer of “yes” to two or more questions would indicate a need for further questioning and a more comprehensive assessment. Internal medicine doctors often see clients who are at risk for eating disorders, since they see a large volume of patients with varying issues. Additionally, physicians who are specialists, such as gastroenterologists, gynecologists, cardiologists, endocrinologists and psychiatrists, may encounter these clients, since the individual is coming in for a specific issue that has developed secondarily due to the eating disorder. Should a patient answer “yes” to two (or more) of the SCOFF questions, practitioners should consider referring them to a mental health clinician and a registered dietitian who are trained in eating disorders so that the patient can access appropriate support.

Another screening test that healthcare clinicians may incorporate into their practice is the Eating Attitudes Test (EAT26). This is a self-report to determine if a client should be referred to an eating disorder specialist. The test is free, and online, with 26 statements, that the individual answers on a six point scale of “always”, “usually”, “often”, “sometimes”, “rarely”, or “never” in terms of thoughts or behaviors. An example of one of these statements would be: “I feel extremely guilty after eating.”  There are then six behavioral questions to be answered in regard to the past six months and this extensive questionnaire allows loved ones to see how an individual’s relationship with food may have changed in a negative manner.  The test shows that, if the individual scores 20 or higher, expert help with an eating disorder professional is necessary. This can help to make a clinician’s referral more official. It also helps to provide support for such a referral, as, often times, the client may be in denial about their disorder or it’s severity and believe they can make changes on their own.

When it comes to eating disorders, and their subsequent medical consequences, it is important to remain positive in remembering that they are treatable and that recovery is possible with the proper medical, nutritional, and psychological support. I encounter many clients that express dismay that their primary care physician wasn’t informed in eating disorder signs and symptoms, as they feel this would have made a big difference in their diagnosis and path to recovery. As such, it is important for healthcare clinicians, to develop knowledge, resources, and a skillset in this area so that those experiencing and eating disorder can receive the necessary referrals and appropriate treatment. I hope this article can allow all of us to become better educated friends and loved ones to those that are trying to have their message heard.


References

  1. www.nationaleatingdisorders.org
  2. Philip S. Mehler, M.D. and Arnold E. Anderson, M.D., Eating Disorder: A Guide to Medical Care and Complications, Second Edition (Baltimore, Maryland: The Johns Hopkins University Press, 2010), 64-65.
  3. Luck, A.J. et al. “The SCOFF Questionnaire and Clinical Interview for Eating Disorders in General Practice: Comparative Study,” British Medical Journal, (2002): 755-756.
  4. www.eat-26.com/form/index/php
  5. www.aedweb.org
Bone Mass Loss… An area that needs to be addressed in males, younger females and those in the change of life (December 2016)

How many times have you thought that osteoporosis is something that only older women get? We hear our moms, aunts, teachers and grandmothers speak about taking calcium supplements to minimize the chances of developing that condition, but probably never realize that habits during the teenager years could lead to later-in-life development of osteopenia (lower than normal peak bone density) or osteoporosis (bone disease in which too much bone tissue is lost, the body is producing too little bone tissue, or both).

As a certified eating disorder dietitian who specializes in eating disorders and medical conditions I see various types of clients in my practice. It is typical for me to see a male in his twenties with osteoporosis related to a history of an eating disorder, or a young woman in her thirties with osteopenia and osteoporosis resulting from years of dieting, smoking, and insufficient quantities of calcium in her diet.  Any of these life-style habits could cause bone loss in both men and women. This insight paper focuses on calcium intake across the lifespan including recommendations for the amounts of calcium to consume.  I will also address what can happen to the body when it does not receive the amount of calcium that it should. Other aspects of the lifestyle will be touched on as they impact the bone mass density of individuals.

The teenage years are a crucial time period for bone development. Teens are growing in height and their bone density (or thickness) continues to increase. Research shows that if peak bone mass is achieved during this stage of life, the chances of developing osteoporosis later in life are significantly reduced.  It is also important to note that dietary calcium enhances the rate of bone mineral development, i.e. increases bone mass by increasing the availability of the building blocks for bone tissue.

The recommended amount of calcium for teenagers is 1,300 mg/day. Forty-two percent of teenage boys and 13% of teenage girls consume the recommended amounts. But studies also show that teens consume significant amounts of soda, all of which contain phosphoric acid, a compound known to remove calcium from the bone.  Caffeine containing sodas, such as cola drinks, also remove calcium from the bones. Research further shows that teens who consume large amounts of soda usually consume small amounts of calcium. A recommendation I would give to parents would be to have calcium as well as vitamin D rich foods available at home. Vitamin D helps the body maximize the absorption of calcium from the foods that are consumed and utilize that calcium in the body.  Snack options to have on hand include yogurt, almond milk, edamame (soy beans), and cheese sticks. Dinner options could include sautéed spinach, broccoli, or other green vegetables. It is understood that during the teen years, kids are beginning to be less dependent on their parents and are likely to formulate their own meal/snack options, but having healthful choices available could help them in the long run.

When individuals are in their twenties, bone mass will increase but at a slower rate than during the previous decade.  When the twenty-something group begins to live on their own it is not unusual that behaviors evolve such as smoking, drinking, and making food choices that are different from what was available at home.  Drinking, smoking, and dieting (for weight loss) in young adults can lead to delayed damage such as bone mass loss later in life.  Restaurant options, fast food meals, and food choices available in college cafeterias may not be adequately balanced. The goal is to include some calcium/vitamin D rich foods in the diet and to develop a healthy relationship with food to reduce the risk of delayed problems such as bone mass loss.

The bone mass of the 30-something individual has typically reached its maximum level. At this life-stage, often found to include the beginning of a career, the primary goal needs to be to minimize losing bone mass rather than to build it. Long work hours frequently are accompanied by an increase in caffeine intake which has been found to facilitate the bone loss (aka: urinary calcium losses). The research states that in this age bracket insufficient amounts of vegetables and fruits are consumed.  My professional opinion is that as individuals work on getting established in their careers and personal lives, more meals are out at restaurants than at home, making awareness of nutrient content difficult.  In addition, they do not seem to be particularly focused on nutrient intake. It would be beneficial for many members of this age category to consider calcium supplementation. Supplementation is especially important when (a) the lifestyle includes consumption of more than 16 ounces of caffeine containing beverages per day, (b) food-intake lacks calcium-rich selections, and (c) very little weight bearing activities, such as Pilates and weight-lifting, are engaged in. Weight-bearing activities help preserve the density of bone tissue.

As you may have guessed bone mass continues to drop in the forties as most people do not keep up their weight bearing and aerobic activities, both of which impact overall bone health.  Examples of weight bearing activities are mentioned in the previous paragraph.   Aerobic activities include such things as cycling, swimming, and jogging.  Recommendations for individuals in their 30s carry over to the decade of the 40s.

Women in their fifties can expect accelerated bone mass loss once they have gone through menopause. For men bone mass had already begun to decrease after age thirty.  The calcium recommendation increases from 1,000 mg/day to 1,200 mg/day for both men and women who are in their 50s. It is ideal to obtain our calcium from food as some research questions whether or not calcium supplements slow down bone density loss during this stage of life. In addition, there is research that associates calcium supplements with increased risk of cardiovascular events in women and men over the age of 50.  Whether or not to take calcium supplements is a topic that is best discussed with your internist and your cardiologist.  My goal is to assist you in reducing the risk of your bone mass diminishing to the point that your skeletal structure resembles Swiss cheese.

In our senior population, age 60 and beyond, the bone density continues to drop gradually in men and steadily in postmenopausal women. As the total bone density decreases there is a high risk for fracture. In other words, as one ages the fracture risk increases. Did you know that 68% of men and 61% of women in their 60s do not meet their recommended daily intake amounts of calcium? Unfortunately, a decrease in protein consumption, often observed in older adults, also increases this risk for bone density loss. Evidence-based recommendations are challenging to make as the research about the nutritional needs for our senior population is not as prolific as it is for other age categories.  The good news is that we are seeing an increase in the research focusing on the nutritional needs for the senior population, which will help me make more specialized recommendations in the near future.

It is crucial that we all focus on calcium intake over the course of the lifespan while helping our family-members and friends do the same.  In addition, we must not forget the role vitamin D takes in helping our bodies use that calcium.  Even though vitamin D is known as the “sunshine vitamin” because our bodies manufacture it while we are exposed to sunshine, there is question as to whether or not we are able to manufacture enough to assure adequate bone health so supplementation might be advisable.  All that said, the goal is to avoid weak bones which can be deadly according to National Institutes of Health resources about osteoporosis and related bone diseases.  Knowing what to do to avoid that weakness is important no matter what age you are.

References:

  1. National Institutes of Health, https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
  2. American Academy of Orthopedic Surgeons, http://orthoinfo.aaos.org/topic.cfm?topic=a00127
  3. www.nationalinstituteofarthritisandmusculoskeletalandskindiseases.com
  4. Ross, A. Catherine, “Dietary Reference Intake for Calcium and Vitamin D, Washington DC, National Academies Press (US), 2011.
Hormones and Appetite… A Much Needed Discussion (November 2016)

How often have you wondered what role your hormones have relative to the food choices that you make, the quantities that you consume or even how your body’s make up has become what it is? These topics have been regular conversation pieces with clients at my office.

Since the focus of my practice is Intuitive Eating as well as Health at Every Size, the goal is to change my clients’ relationships with food, not to speak  about weight loss.  These approaches help clients explore what foods provide energy for them, make them feel empowered in their bodies and are also pleasurable to eat.  Many people believe that all foods we eat must have some nutritional benefit, but it is also important to have some fun or “ineffective” choices in our daily diets or we will feel deprived.  My goal in writing this article is to provide you with insight into recognizing that some of your genetically controlled hormones may impact your food choices as well as when you eat. 

Clients understand that embracing intuitive eating is a long journey to work on.  For many, embarking on this process begins with working on the “radical acceptance” of aspects of their lives which they are not able to change, e.g. what their genetics are. No one can be certain what his/her body makeup is naturally meant to be as dictated by genetics.  I like to begin educating clients, and my readers as well, by touching on the functions of several hormones, bodily aspects that are genetically controlled.

Leptin, which is also known as the satiety hormone, is secreted by fat cells to regulate energy metabolism and to signal the brainto suppress the appetite, i.e., decrease our food intake when we are satiated (full).  Research has shown that when someone is obese or has been chronically dieting, even though her/his leptin levels are high, leptin resistance is the reason the body is not registering the satiety signal.  Since that satiety signal does not register and energy metabolism is not adjusted, the obese person is likely to continue eating while the body is storing that food-energy (calories).  This leptin resistance is the reason an obese individual does not feel satiated.

The opposite of feeling satiated is being hungry. Ghrelin is the hormone in charge of hunger.  Ghrelin was discovered in 1999 and works on a cycle: it rises before meals and drops after meals. This occurs organically approximately every four hours.  This is the reason it is important to develop consistency with our eating schedules so we can avoid reaching extreme levels of hunger.  Ghrelin levels double before meals, which explains the high levels after the fasting that naturally occurs overnight.   It has been reported that if one sleeps two hours fewer than what the body needs the ghrelin levels will be high the next day, therefore, obtaining adequate rest is a key aspect of health and well-being. The ghrelin levels decrease to their lowest after meals.

Ghrelin is secreted in the gut but also signals the same cells in the brain as does leptin.  Stress and depression cause levels of ghrelin to increase, which can lead to emotional eating as a means of anxiety reduction.  It is important to note that this hormone does not build up in the blood stream but rather it works in the short term, i.e. within a few minutes or an hour.

Individuals with genetic disorders such as Prader-Willi syndrome seem to have high levels of ghrelin in their bodies, which can lead to extreme overeating because of the excessive hunger.  Research also shows that an individual may crave high fat and high sugar foods when this hormone is elevated.   

Many of us have heard of the word Dopamine, correct? This is the pleasure hormone.   Dopamine is correlated to food and mood. When we are sad, which can occur when dopamine level is low, often the tendency is to select foods that provide instant gratification or comfort. For example, macaroni-and-cheese not only can provide comfort but it also can take us back to a place that is positive and memorable. The food choices that are typically selected for comfort are usually associated with cravings and the pleasures provided by food.  “When a person is obese they have a blunted dopamine pathway from having the chronic exposure to highly palatable foods”, according to Heather Leidy, PhD, assistant professor of nutrition and exercise physiology at the University of Missouri in Columbia.  A “blunted dopamine pathway” would lead to low dopamine levels.

When we eat, dopamine rises and when we consume high fat foods and high sugar foods dopamine levels will rise also…but what about the impact of protein?  Leidy and her colleagues did a study in August 2014 comparing the satiety effects of high protein breakfasts (35 grams of protein) vs normal protein breakfasts (13 grams of protein) or skipping breakfast.   Their subjects were overweight and obese late-adolescent girls. The results indicated that the high protein breakfast reduced cravings, increased satiety after breakfast, and increased post-meal dopamine levels.  According to Leidy this was the first study that demonstrated dopamine increases when protein is consumed.  “Protein contains amino acids, several of which are building blocks of dopamine.”   It appears that increasing the protein consumption will increase the dopamine production. 

There is also research done by Leidy that shows increased satiety and reduced appetite occur when people of normal weight consume a high protein breakfast. 

By focusing on the three most widely known hormones (leptin, ghrelin, and dopamine), this article could be a pathway for future discussions about the variety of other appetite-regulating hormones that enhance communication between the brain and the gut.   

References:

  1. Diz-Chaves, Yolanda. “Ghrelin, Appetite Regulation, and Food Reward: Interaction with Chronic Stress.” International Journal of Peptides. 2011; 898450  
  2. Hoertel, Heather A., Will, Matthew.J., Leidy, Heather J. “A Randomized Crossover, Pilot Study Examining the Effects of Normal Protein vs High Protein Breakfast on Food Cravings and Reward Signals in Overweight/Obese ‘Breakfast Skipping,’ Late-adolescent Girls.” Nutrition Journal, 2014;13:80.
  3. Hillman, Jennifer. “Ghrelin Biology and Its Role in Weight-related Disorders.”  www.discoverymedicine.com, 2011. 
  4. Blum, Kenneth. “The Addictive Brain: All Roads Lead to Dopamine.”  http://colliersmagazine.com/article/addictive-brain-all-roads-lead-dopamine. (accessed April 24, 2015).
The Latest Coffee Trend… “The Bulletproof Diet” (October 2016)

Many months ago I was listening to a client describe to me how her husband adds grass-fed butter and coconut oil to his coffee, a combination which I thought was interesting. I had not realized that this was actually a trend until I overheard many weight-lifters at the gym discussing it. That led me to believe that this was a noteworthy topic for a monthly insight.

The creator of this diet/plan, David Asprey, who at one point weighed more than 300 pounds, claims in his book, The Bullet Proof Diet, that “using technology to change the environment internally and his body externally can help individuals take control of their body.” He goes on to report that he has spent more than 15 years and more than $300,000 changing his own biology.

In his book, Asprey claims that his research indicates that there are “bulletproof foods,” considered advantageous in a healthy eating plan, such as grass fed animal products, organic and pastured eggs (note: some people may say “eggs from free-range chickens), organic produce, extra virgin coconut oil, avoiding hydrogenated fats, avoiding dairy except ghee (clarified butter) and grass-fed butter. Conversely, he identifies and recommends avoiding what he refers to as “toxic” foods like grains, legumes, and some fruits (NOT considered toxic are berries, melons, citrus, peaches, tomatoes, lemons, and limes). By including bullet proof foods and avoiding toxic foods, an individual will lose weight, increase his or her energy, transform his/her body and mind and become smarter. These all sound like pretty strong claims to promise, don’t they?

Asprey’s regimen directs followers not to count calories but goes on to outline that 50-60% of the total caloric intake should be derived from fat, 20% derived from protein and 20-30% from vegetables. This recommendation seems to contradict itself because on the one hand he directs his followers not to count calories, but on the other, he says that his followers should consume certain percentages of calories from the primary nutrient categories. How can one do that without counting calories?

But let’s get back to the virtues of coffee as outlined by Asprey. His premise is that coffee accelerates fat loss, suppresses appetite, and increases not only energy but also the brain power of the individual following the plan. Another item to mention is that Mr. Asprey’s plan recommends that the fat that is used is only “grass fed butter”, coconut oil and ghee, aka clarified butter.

As a nutrition therapist dedicated to helping people heal their relationships with food I do not believe in rules of any sort, something which Asprey’s diet has an abundance of: limiting fruits, avoiding sugar and gluten, select only “grass fed butter” as he states it, and consuming pastured egg yolks, coconut oil, avocado oil, grass fed meats and bone marrow.

These requirements/limitations strike me as ones that will lead to a relatively unpalatable eating plan, therefore they run counter to my basic nutrition therapy premise: our food choices can and should taste good. Mr. Asprey provides no scientific evidence to support his claims. In addition, this registered dietitian views the guidelines of Asprey’s diet as another form of disordered eating because of the many food rules he imposes.

People should be able to enjoy having black coffee, lattes, espresso, mochas and all the fun coffee drinks available without having to face criticism about this highly desired hot (or cold) beverage. Consumption of coffee for many people is something that can be described as a basic part of their lives designed to accompany relaxation, reading the paper, and socializing.

At the end of the day, a healthful goal is to learn how to effectively evaluate our food choices by returning to basics. We should not have to worry about whether our food is “bulletproof” or “toxic.”

References: Asprey, David. The Bulletproof Diet. El Segundo, CA: Rodale Inc., 2014

“Why do I swell up?” Dehydration, edema, and the effects of purging (vomiting, laxatives, and/or diuretics)? (September 2016)

As a certified eating disorder registered dietitian, I often meet with clients who purge by vomiting, laxative abuse, and/or diuretic abuse. They have tons of problems with swelling and/or rapid weight gain. My colleague and friend Jennifer L. Gaudiani, MD, CEDS, formerly from the ACUTE Center for Eating Disorders at Denver Health and now the Founder of a new outpatient medical practice, the Gaudiani Clinic, is an amazing eating disorder physician who explains the biochemical processes that occur people stop purging.

Originally published on ACUTE Center for Eating Disorders at Denver Health and republished here with Dr. Jennifer Gaudiani’s permission.

As you all know—and hopefully the rest of the world understands better after National Eating Disorder Awareness Week—eating disorders come in all shapes and sizes. Those who purge—either through vomiting or laxative/diuretic abuse—might meet criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder, depending on a number of factors. What many doctors don’t know is the terrible struggle patients go through to stop purging. And I’m not talking about the emotional and mental struggle, which is hard enough! I’m talking about the medical struggle. Patients who purge chronically may find that when they stop purging…or reduce the frequency/amount of their purging…they immediately start to swell up with fluid. Their fingers become uncomfortably stiff, ankles and feet fill with fluid, body shape and size changes radically, and of course…the scale shows a very different number. This can happen JUST with cessation of purging…not to mention if you go to the emergency department and some well-meaning though woefully uninformed person (while they cheerfully make some comment about your size/weight) hooks you up to an IV and gives you a liter or two of fluids fast. BOOM, weight up, body radically changed.

Needless to say, this phenomenon makes my patients think, “Yep, I knew it. I’m ruined. I can never ever stop purging again.” And back we go to the behavior. I want to tell you why this happens and how to prevent it. I also want you to use this medical knowledge as ammunition against your eating disorder voice (former patients of mine: imagine me “talking” with my right hand near my right ear), because one of the beauties of the internal medicine of eating disorders is we can use the objective evidence of body suffering to combat denial and motivate recovery.

So here we go. When you chronically purge (vomiting, laxative abuse, diuretic abuse, or some combination), you get chronically dehydrated. In internal medicine speak, you’re actually volume depleted, which means that you have low levels of both salt and water in your bloodstream. As a result, your “cave girl brain” (I think of this as the subconscious part of your brain that’s been saving our bodies for years through all sorts of challenges) thinks…”I am dying of dehydration in the desert. If I’m lucky enough to find an oasis where there’s salt and water, I’d better have produced any hormone I can that will prevent me from peeing away these life-saving resources.” And that’s exactly what she does. She tells your adrenal glands (they are little triangular organs that sit on top of your kidneys) to over-produce aldosterone, a hormone that has two key functions in this setting. One, aldosterone truly keeps you from peeing away salt and water. So any salt/fluids you eat or drink when you’re not purging, or any IV fluids you get in the emergency room…they stay in your body. That’s actually a good thing at first. You are so dehydrated that your blood and tissues absolutely need the extra salt and water. It’s life-saving. But the body can produce so much extra aldosterone that it overshoots, and before you know it, that salt and water has squeezed out of your bloodstream and is setting in your fingers, ankles, etc. In rare cases, it can be so bad that the extra fluid (called edema) can go into your brain and lungs, which can be life-threatening. Two, aldosterone makes you lose potassium in the urine. Anyone who purges ever been told to increase/increase/increase their potassium supplement until it’s practically burning holes in your stomach? The reason it’s not “sticking” in your system and bringing low potassium levels up is because of aldosterone…even though your body desperately needs that potassium, you pee it away.

So basically, the act of chronically purging—of giving in to that drives to be totally empty, clean, etc.—actually sets you up for rapid and sometimes dangerous body changes due to edema. This process of high production of aldosterone is called Pseudo-Bartter Syndrome. Pseudo-Bartter Syndrome is responsible for that rapid swelling and the inability to get your potassium levels up. And given the underlying emotional drive to live dehydrated/dry/empty, my patients who purge are the least tolerant of the really fast body changes that occur when you stop purging. (This is a not-so-subtle plug…DON’T START purging…it’s no quick fix…it’s a miserable way to live.)

There is hope. On ACUTE we take care of patients of all shapes and sizes who purge, because there’s no one body size that says, “Hey, you’re sick enough for us,” especially when it comes to helping patients detox off purging. My rule of thumb—and I hesitate to even name numbers because I don’t want to invalidate anyone’s personal experience—is that if you’re using more than 10 laxatives a day, you probably need expert medical detox before you enter into residential treatment. (Eyebrows go up…”But I’m using that many and I’m not even close to planning on residential treatment”…Dr. G says you absolutely should be planning it.) The key lab value to give a clue whether you’re at risk for Pseudo-Bartter Syndrome is your bicarbonate (sometimes called the CO2 on your lab sheet)…if it’s above 30 for those who vomit/use diuretics, you almost certainly have Pseudo-Bartter syndrome. If it’s above 35 you should be in a hospital ASAP. If you use laxatives, the bicarb is trickier to interpret. By a nerdy mechanism that I will spare you the details of, diarrheal losses can push your bicarb down, so it’s not as good a marker. To get rid of Pseudo-Bartter Syndrome, first know that your body is NOT ruined, and that you CAN successfully stop purging.

Work with your team to do the following, pretty much all on the same week:

1. you must 100% stop purging. (Ha, you say, like that’s so easy. Where’d your magic wand? But yes, you have to decide…you can’t control your emotions, but you can control how you react to your emotions, and decide to be done purging.)

2. You must pharmacologically (that means with medicines) block your over-production of aldosterone. The right medicine for this is spironolactone, an old and tested very mild diuretic whose mechanism of action is direct blockade of aldosterone. 25 mg a day should do, but you may need more if you use laxatives.

3. You must gently rehydrate yourself. This is not the time to guzzle water. Imagine a bathtub that is on the brink of overflowing. Do you turn the taps full on? No. You might limit yourself to 2-3 liters of fluids a day and eat moderate amounts of sodium in your diet.

4. Toss the scale. This is good advice anyway with an eating disorder, but the fact is that you are running 5-15 pounds dehydrated all the time if you purge. So even if your body doesn’t overshoot and get edema, you will (appropriately) see changes in your body as it rehydrates. This is appropriate and normal and will need lots of support from your mental health professionals.

5. Stay on spironolactone (note: it causes increases in your blood potassium levels) for 2-4 weeks, depending on what your doctor recommends. After that, you are detoxed from purging and should no longer be at risk from edema.

I send you all wishes for recovery, living life instead of surviving it, and wellness.

Dr. G Jennifer L. Gaudiani, MD, CEDS Medical Director

ACUTE Center for Eating Disorders at Denver Health

Dr. Gaudiani is now in private outpatient practice having founded the Gaudiani Clinic, www.gaudianiclinic.com

I hope this article will educate you more about the process of swelling from purging, laxative and diuretic abuse. I also hope it will inspire you, your patient, loved one or friend to set up an eating disorder treatment team.

 

Pregnancy and Nuts: How does a mother’s eating nuts during pregnancy impact her child’s likelihood of developing an allergy to nuts? (August 2016)

(Note: for purposes of this monthly insight, “nuts” will be used to include peanuts and tree nuts unless specifically stated otherwise.)

In the United States, the incidence of nut allergies had more than tripled between 1997 and 2008 – from 0.4% to 1.4% of children in a survey reported in JAMA Pediatrics.  This realization may have been the catalyst for some very important subsequent research.

A February 2014 study conducted by Dr. Lindsay Frazer, M.D. from Dana-Farber Children’s Cancer Center in Boston and her team was reported in JAMA Pediatrics.  It found that the likelihood of children developing nut allergies was reduced owing to two factors: mothers are not allergic and mothers-to-be consumed nuts freely (5 or more times per week) during their pregnancies. 

Two other significant observations were made as well: the initial allergic reaction in children generally is observed the first time the nuts are consumed; if a child is allergic to peanuts, s/he also is likely to be allergic to tree nuts.

Dr. Ruchi Gupta, MD, MPH from Northwestern University Feinberg School of Medicine in Chicago explained that Dr. Frazer and her team revealed that non-allergic women need not restrict their nut consumption during or just prior to pregnancy. Also, the risk of nut allergy in children born to mothers who do not have nut allergies is low.  Further, early exposure of children to nuts increased the probability that they will tolerate nuts, i.e., the risk of childhood allergic reaction to nuts is reduced by early exposure to them.  Additional studies need to be done to see if the results will be duplicated.

There is no question that all nuts are great sources of the nutrients protein, fiber and folic acid, so pregnant women should not want to exclude them from their diets unless allergies are present.  Nut butters provide an alternative way to consume nuts before, during, and after pregnancy…enjoy.

References:
Gupta, R. “To Eat or Not to Eat What Foods Are Safe to Consume During Pregnancy?” JAMA Pediatrics 168, no. 3 (2014): 109-110.

Frazier, A. L, “Prospective Study of Peripregnancy Consumption of Peanuts or Tree Nuts by Mothers and the Risk of Peanut or Tree Nut Allergy in Their Offspring.” JAMA Pediatrics 168, no. 2 (2014): 156-162.

What does Intuitive Eating mean to you? (July 2016)

As a Nutrition Therapist who is a Certified Eating Disorder Registered Dietitian and a Certified Intuitive Eating Counselor the topic of “what does intuitive eating mean to you?” has been a popular topic of discussion with many of my clients.

The premise of Intuitive Eating (IE) is centered on learning to eat when you are hungry and stop when you are satisfied.  It is about choosing foods without guilt, shame or remorse. We encourage clients to eat with flexibility, variety, and adaptability depending on the circumstances in which they find themselves.  In other words, as nutrition therapists we promote learning how to “go with the flow” regarding food intake habits.

A misunderstanding that has developed among a number of clients who are trying to embrace this dietary approach is that IE denotes a “free for all.” They erroneously believe that being permitted to choose whatever they want, including some foods that traditionally have been thought of as forbidden, gives them license to satisfy hunger by eating, for example, donuts for all meals during the day. I have discovered that such a choice might be made not only because they are afraid those foods will be taken away but also because they are the foods that are actually craved.  Surprisingly enough, they also believe that energy they acquire from donuts and diet sodas is the same as that from chicken, zucchini and rice.  (Such is actually not the case, but that would be a topic for another discussion.) When they learn how to legalize their perceived-forbidden foods it becomes a natural tendency to include “play foods” (a much less threatening term than “forbidden foods”) in their diets while slowly and effectively transforming some of those cravings into foods with nutritional benefits. Remember...it is not uncommon to crave pizza for breakfast, lunch and dinner. Such a craving becomes stronger when the person believes s/he must be deprived of pizza and never eat it again.  Intuitive Eating helps a person control that craving while s/he acclimates to being satisfied by other choices made for the personal eating experience.

Some clients are prone to fall into food jags or eating the same food over and over for many meals very close together.  Jags can be characterized by eating pizza for a number of meals, then moving on to bagels all the time, then a period of time where protein foods are all that is consumed.  Like cravings, jags can be brought one due to the fear that a specific food may not be available in a food plan. 

Many of my clients focus so much on weight loss, that they lose the benefit of IE, which is to embrace patterns that lead to a feeling of well-being.  What I underscore with them is that the focus should be on becoming satisfied with their eating experiences.  When they combine being satisfied with their food, using fullness to signal the end of eating, and incorporating some of the “fun foods” in their eating habits, they are likely to reach the goal of feeling more energetic and healthier.

Discussions with my clients include learning how to be mindful and competent eaters.  They are guided into learning how to honor their food choices without feeling that deprivation must occur. We look at how to create food-intake balance while constantly performing self-checks for moods, cravings, appetites, hunger and fullness and the impact these things have on food choices.  The bottom line is that we all need the same thing: to learn how to be connected to ourselves and eat with our own best interests in mind.

The important part to remember is that it is ok to give yourself unconditional permission to eat what and when you want by using your body’s time clock, not that of your family or friends. Food should not be labelled as positive, negative, or forbidden.  There is no question that this can be a long journey often requiring the support of an appropriately trained registered dietitian, but the benefits of Intuitive Eating can be very rewarding because not only does it lead to being freed from chronic dieting or being obsessed with food but it also is a wonderful way to get in touch with yourself.

References:
Resch, Elyse and Evelyn Tribole. Intuitive Eating. New York: St. Martin’s Press, 2012.

The Popularity of Sprouted Greens (June 2016)

Several years ago on a Sunday morning I was at the farmers’ market when I had my first encounter with a sprouted-grain vendor.  My only experience with sprouted grains before the farmers’ market was seeing, at the end of a salad bar, what I would describe as the following: crunchy legumes with a little string that had a bitter taste.  As I was curious about what the vendor had to offer, he gave me an explanation about his various sprouted beans and sprouted legumes; I sampled several varieties of them. Finding some less bitter than others, I realized that not only could they be introduced into salads, but I could also add them to various stews, pastas, baked good and grain dishes as toppings.

The nutritional benefits of sprouts are the same as or better than legumes or grains that have not been sprouted; therefore, I decided it was important to research the reasons it would be wise to incorporate sprouted grains into our diet.  Sprouted grains have been shown to include more protein, folate, vitamin C, and soluble fiber than their non-sprouted counterparts.  In addition, because sprouts contain higher levels of amylase, therefore lower gluten content, sensitive individuals may find them easier to digest than the non-sprouted grains/legumes.

A Japanese study showed that sprouted brown rice may control blood sugar as well as lead to beneficial lipid profiles.  Another study demonstrated sprouting of grains for a limited period of time caused increased activities of hydrolytic enzymes in the human body. Such activity can result in the body’s enhanced ability to efficiently break down protein into essential amino acids, carbohydrates into total sugars, and fat molecules into their simplest forms.  All of these actions can be nutritionally beneficial.

Any grain can be sprouted as long as the germ and bran are intact, although the sprouting process varies among grains. Examples of grains that are commercially sprouted include farro, quinoa, amaranth, millet, black beans, mung beans, pinto beans and more. In commercial processing, grains generally are soaked, rinsed, drained and kept moist for sprouting. To sprout grains yourself it is recommended that you also “soak, rinse and drain.”  (Important note: for sprouting at home, purchase your grains, which are essentially seeds, in the natural food section of the grocery store, NOT the gardening store.)   Grains that are altered, pearled, or rolled will not sprout. 

Food safety is always a topic of concern. To reduce the risk of food poisoning sprouted grains are kept in a controlled environment with the temperature and humidity closely monitored because such conditions can stimulate the growth of harmful bacteria such as E. coli, Salmonella, and Listeria.  The equipment used must be sterilized and kept clean.  In spite of the precautions the commercial industry takes, for children, pregnant women, nursing women, the elderly and anyone with a suboptimal immune system it is recommended that sprouted grains are cooked before being consumed.  Sprouted grains are sold in natural foods stores in containers (rather than in bulk).  I always recommend rinsing them even if the package says they are prewashed.

Many people may just prefer to continue buying their sprouted grains in breads such as Ezekiel Bread or Alvarado Street Bread, in addition to sprouted English Muffins, tortillas, crackers and cereals. I think it is worthwhile to give sprouted grains themselves a try as they can add interest, texture, and a nutritional advantage to your food.  So go ahead and try them; you might be in for a pleasant culinary treat.

References:
Oldways Whole Grains Council, “Health Benefits of Sprouted Grains,” http://wholegrainscouncil.org/whole-grains-101/health-benefits-of-sprouted-grains

Hsu, TF, and others. “Effects of Pre-germinated Brown Rice on Blood Glucose and Lipid Levels in Free-living Patients with Impaired Fasting Glucose or Type 2 Diabetes,” Journal of Nutritional Science and Vitaminology, 54, no. 2 (2008):163-8

Chavan, J.K., Kadam, S.S., “Nutritional Improvement of Cereals by Sprouting,” Critical Reviews in Food Science and Nutrition, 28, no. 5 (1989): 401-37.

Gastric Bypass Surgery and Alcohol Consumption, Critical Information to Know (May 2016)

When we have surgery how often do we think about what our future will be like? Is consideration given to all of the trips to the doctor we will experience, how much happier we will be, and whether or not our requirements for our nutritional intake will be different?  When I see clients who experience various gastric procedures, many of them do not think about how their lives will be different nutritionally, socially, and physically. What many people also fail to consider is not only how their bodies’ absorption of various vitamins and minerals will be impacted, but also how alcohol consumption will need to be addressed.   Since alcohol consumption is a large part of the social life of many people it is critical to think about how the body is likely to react after gastric surgery.

According to a 2015 study at Washington University School of Medicine in St. Louis, women who have gastric bypass and lose weight metabolize alcohol faster in comparison to those who do not have gastric bypass. The study showed that post-bypass women who had consumed the equivalent of two drinks in a short period of time had blood alcohol levels (BAC) close to the levels found among women who had not had the surgery but had consumed four drinks.

The way alcohol is metabolized by the body changes according to Marta Yanina Pepino, Ph.D.  Dr. Pepino is an assistant professor of medicine of geriatrics and nutritional science at Washington University School of Medicine.  She is also a member of the team of researchers for the 2015 study mentioned above.  Although Pepino’s study focused on women, researchers suspect that men could have a similar outcome, i.e., changes in alcohol absorption likely are altered after gastric bypass surgery in men as well.

The subjects of Pepino’s study were 17 obese women who had had the Roux-en-Y gastric bypass surgery, the most common bariatric procedure.  The women were required to spend two days, one week apart, at Washington University Clinical Research Center. On one visit, each of the women was randomly given either the equivalent of two alcoholic drinks or two nonalcoholic drinks to consume within a 10-minute time period.  At the second appointment, each woman was given the beverage she had not received during the first visit. Blood alcohol content was measured and then a survey was used to assess their feelings of being intoxicated.

The women in the gastric bypass group had an average BMI of 30; the average BMI of the women who had not had the surgery was 44.  For the latter group, blood alcohol levels peaked approximately 25 minutes after they finished the alcohol, measuring 0.60g/L. Among the women who had had the surgery, blood alcohol levels peaked about 5 minutes after consumption, reaching 1.10g/L, which is much higher than the legal driving BAC limit of 0.80g/L. After two drinks, the blood alcohol content of the surgery group exceeded the legal driving limit for 30 minutes; however, the BAC levels in the other group never reached the legal limit.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), a sub-department of the National Institutes of Health, defines binge drinking as “a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours.” It was reasonable for the researchers to conclude, therefore, that the blood alcohol content in the surgery group met NIAAA’s criteria for binge drinking. It is also important to note that women who had the gastric bypass surgery can experience the result of alcohol consumption sooner and for longer periods of time when compared to women who did not have the surgery.

This is not the first study to examine how alcohol metabolism is altered after bariatric surgery.  It is important to note that the post-surgery women had only consumed the equivalent of two drinks, but they reacted as if they had consumed twice that amount.

Awareness of these results is not only important for yourself, but also for your loved ones and anyone that you know who will consider this surgery.

References:
1. Dryden, Jim, “Gastric Bypass Surgery Lowers Women’s Alcohol Tolerance”, Washington University School of Medicine, August 5, 2015. https://source.wustl.edu/2015/08/gastric-bypass-surgery-lowers-womens-alcohol-tolerance/

2.NIH-National Institute of Alcohol Abuse and alcoholism. “Drinking Levels Defined,” NIH: NIAAA, http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

3.Pepino, M.Y., and others. “Effect of Roux-en-Y Gastric Bypass Surgery: Converting 2 Alcoholic Drinks to 4,” JAMA Surgery.2015;150(11):1096-1098. doi:10.1001/jamasurg.2015.1884 http://archsurg.jamanetwork.com/article.aspx?articleid=2422337

The Fruits of Southeast Asia (April 2016)

As I had the opportunity to ride my bike in December through Bali and Thailand I was fortunate to not only experience unique and delicious cuisine but also exotic fruits.  I thought I would share with all of you the wonderful types and healthful benefits of these fruits.   When many of our day to day fruits are not accessible, it forces us to adapt to changes in our routines.   As you can imagine some of these fruits were strange looking and/or had unfamiliar aromas. Below I have listed my favorites.

  • Mangosteen

This fruit, a delicacy in its native habitat of tropical Asia, has resisted attempts to be grown abroad as the fruit does not travel well.  The edible flesh of the mangosteen contains tannins, also found in tea, which may slow blood clotting.  However, it is a great source of Vitamin C, and B-Vitamins in addition to Vitamin E.   It is very high in xanthones which are phytonutrients and the free radicals can help boost our immune system. There is much data that states having a variety of color in our diet due to the “free radicals” which are provided. Xanthones are a yellow pigment common to a variety of fruits and vegetables.  The high concentration of xanthones in mangosteen is the reason that we have seen attempts to produce this pigment in the form of supplements, such as powders and pills, in the United States. 

 

  • Rambutan

This fruit derives its name from the Malay word “rambut” meaning hair, which reflects the fruit’s unusual hairy appearance. The bright red shell is easily removed with the fingers to reveal the sweet translucent white flesh, which is comparable to the lychee. 

Rambutan also is a significant source of Vitamin C, but also can provide 13.8 to 31.2% of the amount of iron that we need each day.  In addition it is a sufficient source of phosphorous, which our bodies use to to remove the waste from our kidneys.

 

  • Snake Fruit (Salak)

Salak is a species of palm tree native to Indonesia.  It is a short stemmed thorned palm with leaves that grow up to 6 meters long. The fruit grow in clusters at the base of the tree, and are known as snake fruit due to the brown scaly skin.  Salak fruit is tear-drop shaped which, when peeled, resembles garlic cloves.  The taste is sweet and less acid than other fruits.  The fruit has a dry, crunchy consistency.

A significant nutritional component is beta carotene, a food pigment known to be good for our eyes’ night vision.  I suppose that explains why when I was eating salak throughout my trip the local people would always point to their eyes.  Also, it is believed that the fruit is great for the memory, so it has come to be known as “the Fruit of the Memory.”  It is a significant source of potassium and pectin but it also contains tannins.   Snake fruit can serve as an antidiarrheal agent.

Snake Fruit

 

  • Jackfruit

Jackfruit has recently become popular in the U.S. where it is being adopted into traditional dishes, such as tacos and rice bowls, as a meat substitute.  During my travels, I enjoyed eating it daily in the raw form.  It is a great source of potassium and vitamin A. This large, round fruit is prickly on the outside with a smooth interior flesh.  Raw jackfruit tastes to me like a less sweet version of mango with a kick somewhat like pineapple.  I imagine we are seeing prepackaged items in natural food stores using jackfruit in place of meat because it is so filling. It is becoming quite popular in the vegan/vegetarian community.

 

  • Dragon Fruit (Buah Naga)

Belonging to the cactus family, the dragon fruit has an unusual yet gorgeous exotic appearance. When one cuts through the skin the sweet flesh is revealed. The flesh, either white or fuscia in color, is consumed raw. Its texture is sometimes compared to the kiwi fruit due to the presence of edible black seeds.

Dragon Fruit, among the most nutritious of tropical fruits, contains many antioxidants, vitamin C, and calcium.  The pigment lycopene, which imparts the fuscia color, is wonderful for the eyes and can reduce the chances of prostate cancer.  Another nutrient class that dragon fruit contains is polyunsaturated fats, also found in sunflower seeds and pumpkin seeds.   Lastly, dragon fruit is an excellent source of iron because it meets 8 percent of the daily value. This fruit has the nickname “crazy fruit” because of the way it looks.

 

I was fortunate to be able to experience many other exotic fruits but I chose to highlight my favorites.  It was exciting to me to have a tutorial from our guides on the important information about these fruits:  when they grew, how to cut them, when they were ripe.   Of course, the best part was being able to eat them.  I hope each and every one of you has the pleasure of eating a fresh exotic South East Asian fruit.  Some of these products you might be able to find in ethnic (Asian) grocery stores or maybe even in Gelson’s or Bristol Farms.  Whoever you may find them, try them out.  It can be a fun and tasty experience for you as it was for me.

References:

  1. Lancaster, Angel.  “Vitamins in Mangosteen.” Livestrong.com, August 11, 2015.
  2. Wolf, Nicki. “Nutritional Content of the Rambutan Fruit.” Livestrong.com, June 23, 2015.
  3. www.salak. Wikipedia.com
  4. Purdue University.  “Jackfruit,” www.hort.purdue.edu.  January 2015.
  5. Corleone, Jill.  “Dragon Fruit Nutrition,” http://www.livestrong.com/article/81272-dragon-fruit-nutrition/, April 14, 2015.
Using the “Health at Every Size Approach” (HAES) in a Diet Focused World (March 2016)

As a nutrition therapist who specializes in the non-diet approach, in my private practice I have embraced a movement which is known as the Health at Every Size Approach or the HAES approach.  It is common in health care to hear our physicians speak to us about our weight, family history of hypertension, hypercholesterolemia or adult onset diabetes mellitus in addition to other medical concerns.  When people are overweight, we have been told that they are at a significant risk of developing these medical issues and that reduction in size can reduce the chances of developing these health problems. Of course, genetics plays a part in our health status as well.

What exactly is the HAES approach? Linda Bacon, Ph.D. is a San Francisco based psychologist who is a researcher and leading force within the HAES movement. She has explained that when people lose weight they are not always healthier. Her first book, Health at Every Size, reveals some evidence-based truths about weight. One myth that her book overturns is that “fat kills,” but the reality is that up to a point, overweight people live longer than “normal” weight people. Another myth she endeavors to dispel is the “lose weight, live longer” notion.  The truth is that no study has ever shown that weight loss prolongs life. As the cover of her book indicates, another myth is “anyone can lose weight if he or she tries.” The reality that Dr. Bacon has uncovered is that human biology dictates that most people regain the weight they lose, even if they continue the same fitness and diet program.

Many people tend to perceive that the HAES approach is a “free for all” meaning they can eat whatever they want.  Since following that thought can certainly be detrimental to health, it is important to work with a clinician that is trained in the HAES approach because someone who is not a HAES, non-diet approach clinician may have undesirable results.

The research has shown that many fad diets do not lead to sustained weight loss.  It is important to note, therefore, that self-acceptance promotes improved mental health and happiness which can lead to overall good health and well-being. Positive behavioral change is the goal of the HAES approach; the emphasis is not on weight loss.

HAES proponents also believe that obese people who are unhealthy may, in part, be unhealthy not because body fat in and of itself is unhealthy, but because years of repeated attempts to lose weight only to gain it back each time (a process referred to as “yo-yo dieting”) purportedly causes health issues. There could be various reasons why the individual is the size s/he is. Research has shown that having a BMI greater than 35 is associated with a higher death rate, compared with normal-weight individuals.  Having a BMI from 30 to 35, inclusively, had no greater risk of death, and being overweight with a BMI from 25 to 30, inclusively, was associated with a lower death rate compared with that of normal weight people.  It is also important to note that the degree of health risk may depend on where the body fat is located. Abdominal fat is associated with a greater health risk than fat on the hips and thighs.

This HAES approach has now been recognized and endorsed by The Academy of Nutrition for Eating Disorders, Binge Eating Disorder Association (BEDA), Eating Disorders Coalition for Research, Policy & Action, International Association of Eating of Eating Disorder Professional (IAEDP), and the National Eating Disorder Association (NEDA).

As a clinician, the challenging aspect that I am confronted with is how to satisfy my clients relative to the food choices they crave. The fundamental philosophy of the HAES approach overlaps to a great degree with the Intuitive Eating approach. Not all of my clients intuitively crave lentils, which would be an excellent choice in any approach.  Instead, many of them crave chips and cupcakes, choices that can be closely monitored. They also tell me they will intuitively eat their “fun foods” meaning that they are mindful of what they are eating.  Many clients may require some handholding during this journey such as checking in with a clinician who is knowledgeable in the HAES approach.  This process is about removing the judgement, guilt and shame from food so we can have Doritos and cupcakes with our lentils. To make achieving good health a successful venture, I always like to understand where my clients are in their respective journeys, meet them on that road, and walk along with them toward health and well-being.

 

References:
1. Bacon, Linda. Health at Every Size, Dallas, TX: Benbella Books, 2008.
2. Bacon, Linda, and Lucy Aphramor.  Body Respect: What Conventional Health Books, Leave Out, Get Wrong, or Just Plain Fail to Understand about Weight.  Dallas, TX: Benbella Books, 2014.

Kombucha Tea… Is This Processed Beverage Safe for Clients with a History of Addiction? (February 2016)

How often do you see someone walking down the street with one of those fermented drinks that are purchased at natural foods markets?  Kombucha tea (pronounced kom-BOO-cha) is a fermented beverage which has been around for centuries.  It is made with tea, sugar, bacteria, and yeast.  The producers of these drinks make many claims including that they may improve digestion, have anti-aging properties, and reduce the risk of cancer, but there is not much legitimate scientific data that would support these claims.

The tea is not complicated to make:  one would need what producers refer to as a “symbiotic colony of bacteria and yeast” (SCOBY) which resembles a mushroom and can be purchased online as part of a starter kit.  The tea can take 7-14 days to ferment, a temperature-dependent process.  The warmer the environment in which fermentation takes place, the faster the tea will become fermented.  However, according to the Mayo Clinic there are health risks when kombucha tea is made at home due to the bacteria that can grow in it when it is allowed to ferment for too long. 

As a consumer if you choose to make your own kombucha tea, be aware that SCOBY is vulnerable to mold therefore it is recommended that you discard it if mold growth is evident.  Also, if the tea that the SCOBY is being used to ferment shows signs of mold growth, it should be discarded as well.  That would seem logical, right?  It is also recommended that home-brewers sanitize the brewing containers between batches and store the kombucha away from direct sunlight to minimize the risk of contamination and the growth of health-threatening micro-organisms.

The Centers for Disease Control and Prevention (CDC) recommend that people limit their consumption of kombucha to 4 ounces per day.  This recommendation came about when older people became sick after consuming 12 ounces per day of very acidic kombucha, a finding which was published in the November 2013 edition of the Journal of Environmental Health.  Some people have died from home brewed kombucha and kombucha tea-like products.

Since kombucha tea is a fermented beverage, as are beer and wine, a very important issue which seems to come up with my clients who have a history of addiction and are recovering alcoholics is whether or not kombucha is a beverage they can drink.  According to the Alcohol and Tobacco Tax and Trade Bureau (TTB) a beverage can be sold as non-alcoholic if it contains less than 0.5 percent alcohol by volume (ABV).  Since not all kombucha beverages are created equally with respect to alcohol content, it is clear that only the kombucha that contains less than 0.5 percent ABV can be considered non-alcoholic by the TTB.

For commercially prepared kombucha the “primary fermentation” is a 5-30 day process, depending on the desired flavor of the end-product.  The sugary taste will decrease over time and the kombucha will become more vinegary. “Secondary fermentation” occurs when the liquid is bottled and then allowed time to develop the flavor and fizz.  During this phase, the ABV levels can climb as high as 2.5 percent.  In order to reach ABV levels in excess of 3 percent, the goal of some producers, the beverage must not only have grains added but must also be subjected to a third fermentation to produce what brewers call “kombucha ale” or “probiotic beer.”

In 2010, Whole Foods removed the tea from their shelves as some bottled kombucha contained over 0.5 percent alcohol. The TTB gave the producers of kombucha two choices: to become licensed as a “brewery/winery” or change the brewing process to bring the product to non-alcoholic levels.  Some companies choose to make both alcoholic and non-alcoholic kombucha.  For example, Synergy Kombucha differentiates their alcoholic beverage by their color-coded labels:  the black label indicates the beverage is for consumers who are 21 years of age and older.

The law states that if the beverage is more than 0.5 percent ABV, it is legally beer and must be labeled, sold, and treated as such.  Not even making kombucha tea at home is assurance of a non-alcoholic beverage because home brew kits usually produce a tea that is 0.5-1.5 percent ABV.  When all is said and done, for a person with a history of addiction and a goal of living a sober life, the choice seems evident.  Rather than take a chance with kombucha, that person should choose other non-alcoholic beverages … the only way to assure that s/he will remain 100 percent alcohol free.

References:
1. Nummer, BA. Kombucha brewing under the Food and Drug Administration model Food Code: risk analysis and processing guidance. J Environ Health. 2013;76(4):8-11.
2. Unexplained severe illness possibly associated with consumption of kombucha tea — Iowa 1995. Centers for Disease Control and Prevention website. http://www.cdc.gov/mmwr/preview/mmwrhtml/00039742.htm
3.www.webmd.com/.../ingredientmono-538-kombucha%20tea.as
4. www.muchies.vice.com/articles/recovering-alcoholics-shouldn’tdrinkkombucha

9 Common Mistakes Parents Make About Their Kid’s Weight (January 2016)

In the October 20, 2015 online newsletter of The Body is Not an Apology Website (TBINAA) Judith Matz, LCSW wrote a great article that I thought was very important to have in this monthly insight. In my daily career I am faced with parents who have unresolved issues with their body and food. I hope this article can help them begin to help the damage that has been caused.

Originally published on The Body Is Not An Apology and republished here with their permission.

When I see someone teaching kids to hate their bodies, I’m mad. I’ve spent the bulk of my career as a therapist helping adults to let go of body shame, and I know that the roots of this dissatisfaction often starts during childhood. A recent study of 111 girls revealed that by age 5, 50% of these kids had internalized the thin ideal.

Many of my clients have spent the decades since their childhood at war with their bodies and their appetites in search of thinness, a preoccupation that zaps their energy and interferes with living life fully. Kids who feel bad about their body size and start dieting are at about three times greater risk for binge eating, weight gain and other eating disorders compared to their non-dieting counterparts.

When a children’s book called Maggie Goes On A Diet came out a few years ago promoting a message of weight loss for young girls in order to be popular and successful, well that just crossed a new line for me. Teaching kids to hate their bodies and judge other people based on weight through a children’s story is just plain wrong. And telling kids that dieting is the way to become happier and healthier, when there is no scientific evidence to support long-term success is harmful to the very audience this book is intended for.

I did some research and was surprised to find that there’s a big gap in children’s literature on body image: very few books offer positive messages to teach kids how to feel strong and confident in their bodies. Illustrator Elizabeth Patch and I decided to collaborate on a story that would help kids reject body shame, learn that people naturally come in all shapes and sizes, and reaffirm the beauty and positivity of accepting who you are and following your dreams. We also hoped that adults would realize the harm caused by negative comments about weight, as well as the power they have to support kids in feeling good about their bodies.


Amanda’s Big Dream is the story of a girl who loves to skate and dreams of a solo in the Spring Ice Show. When her coach makes a comment about her weight, Amanda loses her confidence and quits. But with the help of her parents, doctor, and best friend, Amanda learns what it means to follow her dreams, at any size.
Helping kids feel good about their bodies in this fat-phobic culture isn’t easy, and we need to be able to talk about body size in an open and non-judgmental way. Children are like sponges! Not only will they be exposed to messages in the media and on the playground, as members of this weight shaming culture, parents often their own attitudes toward weight that are passed down – often unintentionally – to their children. While we can’t control all of the messages our children will receive, we can do our best to make sure we aren’t contributing to the negative ones.  Here are 9 common mistakes parents make about their kid’s weight and what we can do instead to ensure our children know that we will support them in the bodies they have right now!

1. Bashing your body.
Kids are born loving the bodies they have. Just watch them explore their fingers and toes as infants, and run, skip and jump as toddlers and preschoolers. They aren’t born thinking one size is better than another until the adults in their world tell them that thin is better than fat. Your child wants to admire you. If you stand in the mirror and make comments like, “These jeans make me look fat,” or “ I have to lose weight before I can wear a bathing suit,” your child will quickly get the message about what which bodies are worthy – and which ones are not.

Instead, imagine looking in the mirror and uttering the words, “I like the way this dress looks on me,” or “I feel beautiful.” What a beautiful message to pass down to your child
If you’ve always struggled with your body image, it may feel like quite a stretch talk positively about yourself, so start by trying to let go of the negative messages. But also consider that by speaking kindly about your body, your child will learn that positive feelings are not dependent on a particular weight. As you and your child stand in front of the mirror, celebrate what makes each of you special.

2. Promoting diet behavior
It’s become normal in our culture to say, “I can’t eat that – I’m on a diet.”  These words send out a message that depriving yourself of the foods you enjoy is a positive way to go about eating, and that weight loss trumps just about everything. Many kids are also told that they shouldn’t eat the cookie or pizza because it’s fattening. Children absorb the message that weight loss is a worthy goal, despite the fact that kids who diet are at greater risk of weight gain, binge eating, and other eating disorders, compared to their non-dieting counterparts.

Instead, don’t talk about your diet in front of your children—or better yet, don’t diet! Disconnect conversations about eating from any weight focus.

Adults often have their own issues with food and body image because they, too, have absorbed cultural messages that overvalue thinness. If you’re caught in the diet/binge cycle, seek out resources such as The Diet Survivors Handbook” 60 Lessons in Eating, Acceptance and Self-Care that can teach you to develop a healthy relationship with food: honoring your physical cues for hunger and fullness as you end the deprivation of dieting and choose from a wide variety of foods.

3. Laughing at fat jokes
Fat people continue to be the target of jokes. If you find humor at the expense of shaming another person about their size, kids will learn early that it’s okay to make fun of the higher weight child on the playground. And higher weight kids will get the message that their weight is a source of shame. Weight bullying is the number one type of bullying that takes place at schools, and participating in fat jokes gives permission to tease peers based on weight. It also teaches kids that, as adults, we believe its okay to single out a particular group based on physical characteristics that are different from us, a message that promotes an attitude of intolerance toward other human beings.

Instead, turn these jokes into a teachable moment to share your values about size diversity with your child.
Depending on the age of your kid(s), help them understand that these types of jokes are based on stereotypes, which make unfair assumptions about people who are fat. Teach them that jokes based on weight hurt people’s feelings and contribute to weight stigma. Everyone (including them!) deserves to be treated with respect. Humor is a wonderful outlet – share a joke that you find truly funny!

4. Referring to food as “good” and “bad”
There’s so much focus on “healthy” eating these days that it can be confusing for parents to know how to feed their children. Too much fat? Too many carbs? Gluten free? Paleo? Of course, it’s important for kids to have access to nutritious foods, just as it’s important for kids to eat foods that taste good. Too many children are becoming obsessed with healthy eating (which is often a disguise for diet behavior) and therefore aren’t learning how to eat all types of foods, which is an important skill. The flipside is that many kids will eat the “bad” foods when they’re away from you – whether they’re hungry for it or not.

Instead, teach your kids how to have a healthy relationship with food—instead of just eating “healthy” foods.
Help kids recognize and honor cues for hunger and satiation by providing a wide variety of food and letting them decide what and how much to eat. Talk about foods in a non-judgmental way. Children can learn that some foods are more nutritious and help their bodies grow strong; other foods are less nutritious but taste good. If you’re concerned about the connection between health and weight, read up on the Health At Every Size approach so that you can support your child’s health and well-being without a weight focus.

5. Treating children differently based on their size
 I know of kids who are required to exercise every day – while their sibling is not, and children who aren’t allowed to have dessert – while their siblings are. This type singling out fatter kids leads to feelings of shame that can – and do – last a lifetime.

Instead, decide what behaviors are age-appropriate for your children, and apply them equally to kids of all sizes (unless there is a specific health/mental health issue).
Whatever behaviors you value for you family, be consistent. Exceptions might include a child who needs to be dairy free due to lactose intolerance or a child diagnosed with an eating disorder that has a specific meal plan as part of treatment. The key is to take the pursuit of weight loss out of the equation.

6. Talking about exercise as a weight loss method
“I have to exercise because I ate too much” or “I need to work out more to lose weight” are typical comments people make these days. And the message we give to our kids? Exercise is punishment for eating the wrong foods, and the main reason to exercise is to change your body. This sets kids up to hook physical activity with being fat – or the fear of becoming fat – and interferes with children’s natural love of moving their bodies because it’s fun and feels good.

Instead, keep in mind that physical activity, appropriate for a person’s ability, can be a source of pleasure and/or fitness.
Participate in enjoyable activities with your children that involve moving your body (walking, swimming, playing catch, gardening, to name a few), and reflect back the joy they experience – as well as your own – when engaging in physical activity. Encourage kids of all sizes to participate in sports or activities that appeal to them.

7. Complimenting or commenting on other people’s weight
We’ve all heard (or even made) comments such as “You look great – have you lost weight?” or “I can’t believe how much weight s/he’s gained.” When our children hear these words, they learn what’s valued when it comes to body size. They also learn that it’s acceptable to judge other people’s bodies. If we tell kids that they look great because they have a thin build, what happens if they gain weight? And if a teen loses weight and we compliment him/her, what happens if the weight comes back? Commenting or complimenting people based on body size is a recipe for shame.

Instead, best to say nothing! If someone you know has lost weight and is looking for a compliment, consider saying something like “I’ve always valued our friendship no matter what size you’re at!”
We need to model for our kids that bodies (including theirs) are not up for discussion. If children want to talk about the topic of weight, create safe ways to have open and non-judgmental conversations that respect weight diversity. The Healthy Bodies Curriculum by Kathy Kater, LCSW is an excellent way to bring this issue into the classroom.

8. Focusing on your child’s weight
Ask anyone who was fat as a kid what the adults in their life said them about their bodies, and chances are you’ll hear things like, “You’d be so pretty if you lost weight,” or “No one will want to date you if you’re fat.” Shame is insidious, and we’re hurting kids when we give them the message that thinness is the only road to becoming happy and successful in this world.

Instead, focus on their character or accomplishments. If you make appearance-based comments, compliment the cute t-shirt, the new hairstyle, or even how strong they are when they help you bring in the groceries.
(If you have reason to suspect an eating disorder, including Binge Eating Disorder contact an organization such as NEDA, BEDA or ANAD for the best way to talk with your child.)

9. Missing the opportunity to see weight as one more aspect of diversity
Where did we ever get the idea that among human beings, there is only a very small window for the physical size of attractive and healthy bodies? Body size has a genetic base, and equating body size with health issues means that people often turn to unhealthy practices in order to try to change their physiology – a nearly impossible task that often leads to poorer health, getting caught in the diet-binge cycle, eating disorders, and a culture that reeks of weight stigma.

Instead, let your children know that, weight is a characteristic, not a behavior.
Just like they don’t get to decide how short or tall they’ll grow to be, or the color of their skin or eyes, they don’t get to choose their weight range. The current focus on helping kids celebrate diversity when it comes to race, religion, ethnicity, gender and sexuality must also extend to helping them understand the natural diversity of body size.

As we teach our kids to accept – and even embrace – the many differences among human beings in all areas, we need to include the diversity of body shape and size in our conversations and in our actions. If you find that you carry your own internalized weight stigma, you’re not alone. Remember to practice self-compassion as you work toward acceptance of others – and of yourself! Whether it’s building a positive body image on an individual level or working toward ending weight stigma on a cultural level, these are precious gifts to give our next generation of children.

As a nutrition therapist it is important to remind the parents that I work with, that our children our mirroring any message that we are giving off to them. With that being said it is important that we continue to work on our own relationship with food, to prevent disordered eating or an eating disorder in the future.

Resources:
For Kids:
Amanda’s Big Dream by Judith Matz
Your Body Is Awesome by Sigrun Danielsdottir

For Adults:
The Diet Survivor’s Handbook by Judith Matz and Ellen Frankel
Beyond a Shadow of a Diet by Judith Matz and Ellen Frankel
Health At Every Size by Linda Bacon
Body Respect by Linda Bacon

About Kids:
Healthy Bodies: Teaching Kids What They Need to Know by Kathy Kater
Your Child’s Weight: Helping Without Harming by Ellyn Satter
Helping Your Child with Extreme Picky Eating by Katja Rowell and Jenny McGlothlin
Raising an Intuitive Eater: What Works With Kids and Teens in Intuitive Eating by Evelyn Tribole and Elyse Resch

Judith Matz, LCSW is a Clinical Social Worker, author of Amanda’s Big Dream and co-author of The Diet Survivor’s Handbook (2006) and Beyond a Shadow of a Diet (2nd edition, 2014). Learn more at:
www.amandasbigdream.com 
www.judithmatz.com 
www.dietsurvivors.com 

Saturated Fat and Cardiovascular Disease…An Ongoing Conversation Piece (December 2015)

Coming from a cardiology background as a cardiac dietitian, I was trained back in the days when dietary trends followed the philosophies of Pritikin and Dr. Dean Ornish as ways to reduce the chances of developing coronary artery disease, to reverse heart disease, and also to keep one’s lipids at a healthful level.  Over the years the nutritional recommendations have changed and numerous fads have come and gone. 

Currently we are faced with the discussion of saturated fat: Is butter good for you? What about coconut oil? Ghee?  The journalist Mark Bittman first announced “butter is back” March 25, 2014 in The New York Times. Bittman’s article was related to the findings published in the Annals of Internal Medicine which was led by Rajiv Chowdhury, M.D., Ph.D. from the University of Cambridge. The review concluded that there was not enough supportive evidence for current cardiovascular guidelines to recommend high intake of polyunsaturated fatty acids and what the appropriate intake of saturated fats is; however, The Academy of Nutrition and Dietetics (AND) released its position paper on fatty acids for adults in January, 2014. It recommended that adults receive not more that 7-10% of total caloric intake from saturated fat. Americans currently consume more than 11% of their total calories from saturated fat, which, according to AND, is excessive.

The research that Chowdhury did was based on 27 randomized, controlled trials and 49 observational studies, which included more than 600,000 participants in 18 countries. The studies analyzed fatty acids circulating in the blood stream or being stored in fat tissue. The participants then completed a diet history questionnaire to assess fatty acid intake.  This didn’t affect the result of the study, but other experts, strongly disagree with the results.

Some experts assert that Chowdhury’s assessment is not accurate since he excluded a number of important studies, used incorrect information from other studies, and failed to mention some of the positive findings of Walter Willet M.D., DrPh, chair of the Department of Nutrition at Harvard School of Public Health, who had completed a small portion of the study. The analysis neglected to mention two important issues: the benefits from the omega- 3 and omega-6 polyunsaturated fats and also the benefits of replacing saturated fat with polyunsaturated fats.  These omissions were likely due to the aforementioned problems.

Currently we have a considerable amount of data that show how dietary saturated fat increases the blood levels of LDL cholesterol (bad cholesterol) and also increases the risk of coronary artery disease.  In addition, there is a significant amount of data that show that a high LDL in the blood stream can increase our risk of coronary artery disease.  Another problem with Chowdhury’s study is that participants share information about their food intake using a 24-hour dietary recall method.  Such a method does not give a broad sense of what their diets are like over a period of time.

Coconut Oil- A popular trend revisited
Coconut oil is a saturated fat and we know that it can raise our LDL cholesterol (bad cholesterol) but can also increase our HDL (good cholesterol).  It is 44% lauric acid and 16% myristic acid, both being hypercholesterolemic. The data are inconclusive whether coconut oil is better or worse for you than any other saturated fat. The reason that coconut oil is popular is because it contains medium chain triglyceride (MCT), eight- and ten-carbon chains.  These fats may be metabolized differently from other triglycerides so can, therefore, lead to less fat production in the body.   It is recommended to have coconut oil in the natural form as it will contain more of it beneficial fatty acids, which could otherwise, during processing, be destroyed.  

Important Considerations about Red Meat
It has been recommended that we limit red meat consumption due to the “artery clogging” saturated fats it contains.  On the other hand, a plus about red meat is that it contains oleic acid, the heart-healthy fatty acid which is also found in olive oil.  In addition, one third of the saturated fat in beef and pork is stearic acid, which is not thought to elevate our blood cholesterol levels.  The iron in red meat is known as “heme” iron and has proven to be efficiently used the body.  The vitamin B-12 and the mineral zinc are also nutritionally beneficial components of red meat.

Interesting Facts about Dairy Products
There has been quite a bit of evidence that full fat dairy is good for us due to the role fat plays in fertility and in reducing the risk of diabetes. In the August 2014 study of The Lancet Diabetes & Endocrinology the study followed 340,000 people across eight European countries and measured plasma levels of saturated fatty acids. The researchers found that fatty acid chains with an odd number of carbon atoms, especially C15:0 (pentadecanoic acid) and C17:0 (heptadecanoic acid) which are mostly in dairy products were linked to a lower chance of developing adult onset diabetes (type 2 diabetes). Even chain saturated fatty acids that were measured (myristic, palmitic, and stearic acid) were linked to an increased incidence of type 2 diabetes.

In an interview which followed the above study, Mozaffarian mentioned that more research needs to be done to conclude if odd chain saturated fatty acids have a direct correlation to reducing the risk of type 2 diabetes or if other ingredients are contributing to the results involving dairy products. He mentioned that probiotics or the fermentation of dairy products could receive some of the credit for the protective benefits.

Understanding Some Issues about LDL and HDL cholesterol…
I remember a few years ago watching an episode of CNN and seeing Dr. Sanjay Gupta discuss President Clinton after he had a heart attack. The goal of the episode was to educate the public about the most damaging type of LDL. What does that mean?  Most of us think there is only one kind of LDL and are not aware that there are several different types of LDL, some of which can be more detrimental to heart health than others.    These types are known as type-A and type-B.  Fortunately these types can be detected in specialized blood tests. People with a family history of hyperlipidemia and/or coronary artery disease might be well advised to discuss the need for this special blood test with their doctors.   I have been having these specialized labs done for a decade because of my family history.  It is an extra measure of precaution that gives me peace of mind.

It is important to know what type of LDL particles one has.  Overall, fewer LDL particles are better than having a larger number of particles.  We do not want the small, dense LDL, which is type B; the largest kind, type A, is the least harmful.   Some of the research suggests that consuming saturated fats instead of carbohydrates can reduce the number of small, dense LDL particles. This is not a helpful dietary change, but replacing saturated fat with unsaturated fats including the omega-3 and omega-6 are more effective choices.

It is also important to have a large buoyant HDL, the most protective one of which is a HDL2, according to Mark Houston, MD, MS, ABAARM, FACP, FAHA, FASH director of The Hypertension Institute of Nashville and author of What Your Doctor May Not Tell You about Heart Disease. There is one other type of HDL: small, dense HDL3 which is hypothesized to be the least protective against coronary artery disease. 

Dietary recommendations are always changing as the science of nutrition advances.  If you need to cut back on fats, consider filling that gap with carbohydrates, especially fibrous ones such as legumes, and whole grains -  black or brown rice, quinoa –  or yams.  Remember that small amounts of saturated fats are necessary for overall health and well-being making it unadvisable to remove them from the diet entirely.  Also, keep the major portion of fats in your diet as the unsaturated variety.  As a final thought, make sure your diet is one that has balance, includes a variety of foods, and you consume your choices in moderation.

 

References: 

  1. Bittman M. Butter is back. The New York Times website. http://www.nytimes.com/2014/03/26/opinion/bittman-butter-is-back.html. March 25, 2014. Accessed August 20, 2014.
  2. Vannice G, Rasmussen H. Position of the Academy of Nutrition and Dietetics: dietary fatty acids for healthy adults. J Acad Nutr Diet. 2014;114(1):136-153.
  3. DiNicolantonio JJ. The cardiometabolic consequences of replacing saturated fats with carbohydrates or omega-6 polyunsaturated fats: Do the dietary guidelines have it wrong? Open Heart. 2014;1. doi:10.1136/openhrt-2013-000032.
  4. Stearic acid: a unique saturated fat. National Cattleman's Beef Association website. http://www.beefnutrition.org/CMDocs/BeefNutrition/StearicAcid.pdf. Accessed August 22, 2014.
  5. Forouhi NG, Koulman A, Sharp SJ, et al. Differences in the prospective association between individual plasma phospholipid saturated fatty acids and incident type 2 diabetes: the EPIC-InterAct case-cohort study. Lancet Diabetes Endocronol. 2014; Epub. doi:10.1016/S2213-8587(14)70146-9.
  6. Mozaffarian D. Saturated fatty acids and type 2 diabetes: more evidence to re-invent dietary guidelines. Lancet Diabetes Endocronol. 2014; Epub. doi:10.1016/S2213-8587(14)70166-4.
  7. Katz DL, Meller S. Can we say what diet is best for health? Annu Rev Public Health. 2014;35:83-103
  8. Parlesak A, Eckoldt J, Winkler K, Bode CJ, Schäfer C. Intercorrelations of lipoprotein subfractions and their covariation with lifestyle factors in healthy men. J Clin Biochem Nutr. 2014;54(3):174-180.
  9. CNN.Com/Thelastheartattack/DrSanjaygupta/September 2011
Where Did You Learn “Fat Talk”? (November 2015)

Have you ever stepped away from yourself to listen to the manner in which you speak to yourself? Perhaps you hear your critical voice come out when you are getting dressed, or when you are eating a rich meal, or even when you choose to take the day off from being active.  For some of us there is a “voice,” that is not very kind, known as “fat talk.”

Where did we learn to speak in such a condescending and hurtful manner? It may have been from as far back as elementary school or more recently from our peers.  There is even the possibility that it is a result of the many hours we have spent with our parents. It is possible that our mothers dieted frequently resulting in the often-heard comments on thighs, butts, jiggling arms and other body parts with which they were dissatisfied.  It is likely that a dieting parent spoke of “good foods” and “bad foods” rather than exposing us to terms that would teach us how to legalize all foods into our diets.

Research shows that many of our parents have been so consumed with calories and diets that we end up learning their way of thinking about foods.  Sadly this way of thinking often times results in a lifetime of dieting, disordered eating  and perhaps an eating disorder such as anorexia nervosa, bulimia nervosa and/or binge eating disorder.  There probably is not a day that passes that we don’t hear someone discuss the latest diet s/he is on, what food or food group is being excluded from the diet, and what part of his/her body leads to dissatisfaction.  If we want our kids to love and respect themselves, we need to love and respect ourselves first so they can see how it's done.

If our “fat talk” is derived from that of our parents’ maybe it stems from the following: “At the birth of a baby, most parents will be relieved when genetic disorders, congenital conditions, and other issues resulting from problem genes are ruled out. If the baby has all his or her reflexes and ten fingers and toes, the child is perfect. So, why are a few extra pounds considered a genetic problem later on? The answer is unclear, but apparently the right genes are the solution” according to psychologist Stacey M. Rosenfeld, Ph.D and author of Does Every Woman have an Eating Disorder?  Dr. Rosenfeld’s book has many wonderful examples of the toxic language that parents use now and in the past that shape the thinking of current and future adults.

The Tri-Delta Sorority started Fat Talk Week which is an annual five-day body-image-awareness campaign typically held in October.  The purpose of the campaign is to educate participants about the damaging impact that pursuing the “thin ideal” and using “fat talk” has on women of all ages.  It also strives to promote a healthy lifestyle while inspiring women to change the way they think and feel about their bodies.

I think it’s a wonderful idea that college organizations have started to ban “fat talk” among their young-adult population; but how do we break this viscous cycle among other adults? I like to recommend to clients who have negative self-concepts to think the opposite of what they usually think about themselves. For example, I suggest to clients that they say something positive about themselves, even if they have difficulty believing it. Since we learn negative self-concepts from negative statements over time, it will take time to transform that negativity into positive thinking. It’s like the old saying goes: “Fake it ‘til you make it.”

If we lived in a different world -- one that neither displayed underage, underweight models as the beauty ideal nor fostered a culture of fear and rejection around weight gain-- then it might be easier to remove the fat talk. When we are influenced by parents who have been life-long dieters, plus media (print and tv/radio ads, journalism, and social media like Facebook) we are constantly reminded that “fat talk” seems to be endless and appearance and weight matter. 

So…why don’t we break a damaging cycle and begin to speak in positive ways about ourselves while practicing kindness to ourselves as well? I know that neither is easy to do, but such positive changes in behavior can begin to repair the damage that has been done.  And, you know what?  Before long you may actually begin liking yourself AND your body. Who knows?  In time, maybe you will become a positive role model for a friend, family member, co-worker or your own child.

References:

  1. http://bi3d.tridelta.org/ourinitiatives/fattalkfreeweek
  2. Rosenfeld, Stacey, Does Every Woman Have an Eating Disorder? Siena Moon Books, 2014. p. 37

 

Carrageenan: a natural ingredient but is it harmful? (October 2015)

Over the last several months I have had clients ask me about carrageenan.  They want to know what it is and what the possible risks of consuming it are.  When I was a student, my nutrition professors frequently said, “If you can’t pronounce it, it’s probably not a wise idea to eat it.”  Since carrageenan is not the easiest ingredient to pronounce, perhaps it is something to avoid; therefore, my article this month provides a brief overview of this frequently used food ingredient along with mention of a few problems associated with it.

We see carrageenan in quite a variety of foods: soy milk, processed cheeses, coconut milk, soups, frozen entrees, deli meats, and ice cream.  It is often found in low fat dairy products, to which it is added so we can get the feeling of fullness and the desirable mouth feel which the fat would normally provide.

Carrageenan is extracted from red seaweed that is found in the Atlantic Ocean.  As a gum, it thickens foods, including liquids. It can serve as a plant-based substitute for gelatin which, when added to a product, decreases the likelihood that the product’s ingredients will separate while increasing the product’s shelf-stability, i.e., the length of time the product can remain on the shelf while maintaining its original quality.  We often see carrageenan in products labeled “organic” or “natural”, terms which lead people to assume that it must be good for us.  It is not surprising, therefore, that many of the food products that we see in the natural food stores contain carrageenan.

Although some researchers claim that carrageenan may cause gastrointestinal distress, inflammatory problems or even Diabetes Mellitus, animal studies have produced mixed results.  Nevertheless, in 2008, a researcher petitioned the U.S. Food and Drug Administration (FDA) to reexamine its position that carrageenan is an additive that is safe for human consumption.  Many people who had experienced GI problems while choosing foods containing carrageenan reported that their symptoms disappeared and they felt better once they began to avoid foods that contained this seaweed extract.

Some manufacturers are voluntarily removing carrageenan from their products.  Europe has banned it from infant formulas entirely.

Since carrageenan will always be listed among the ingredients of the product that contains it, you can avoid it by scanning all food labels and simply not choosing those foods which contain it.  When carrageenan has been used in drinks, a label will always specify to “shake well” so the product does not separate.  This is one ingredient for which there are no tricky or hidden words used on the labels.

There is a petition available that enables interested parties to alert the FDA, a federal agency, that they object to having carrageenan in their foods.  By clicking on the link below (or copy/pasting it), you may sign that petition:

http://www.cornucopia.org/carrageenanfda/

References:

  1. www.cornucopia.org/wp-content/uploads/2013/02/Carrageenan-Report1.pdf
  2. www.drweil.com/drw/u/QAA401181/Is-Carrageenan-Safe.html
Menopause and Weight Gain… An Ongoing Conversation Piece amongst Women during the Fifth Chapter of Life (September 2015)

A number of times each week, women call my office with a lament that goes something like this:  “I work out regularly, eat well, haven’t changed my lifestyle, perceive that I am health conscious, and don’t understand why weight is increasing.”

I generally will say to the woman on the other end of the phone line, “How long have you noticed that your weight is increasing?” Basically all the woman can say is that her clothes are progressively fitting too tightly.  After a series of important questions that allow us to conclude that her thyroid hormonal output is normal, we decide that she is, in fact, going through menopause.  At that point, there is a perfect opportunity to explain to her about intuitive eating and the non-diet approach (the topic of a previous newsletter) but at this moment in time, we are addressing one of the expected outcomes of menopause…weight gain.

It is important to understand not only the hormonal shifts that take place during a woman’s menopausal years but also the ramifications of those shifts. It is common for women to be less active and work out with less intensity.  Some may be proud that they made it to the gym even though they were exhausted and lacked the drive to push as hard as they had done in the past.  In addition, it is common to have fluctuations in energy levels from day to day.  As aging women, we lose muscle mass, and develop achy joints.  Busy lives, variations in our choices of foods, and time constraints can put additional demands on our bodies leading to non-desirable results, one of which potentially is weight gain.

Did you know that during menopause, even some women who have healthy relationships with food may gain more than one pound per year?   It is true that our nutritional needs decrease as we age; we lose lean body mass as a result of fewer activities or decreased intensity of the activities we do engage in; there is a reduction in resting energy requirements.  Researchers say that a reduced energy need by as few as 10 calories per day can pave the way to an increase in our fat stores.   All of these factors, collectively, are the reason that I teach my clients how to become mindful and conscious eaters…not to eat out of boredom, mindless eating, or simply because the food tastes good.   We all need to listen to our bodies and eat accordingly.

In a study by Brown and colleagues with more than 8,000 Australian women between 45 and 55 years of age, researchers found that menopause, itself, was a risk factor for weight gain. Over the five years of this study these participants experienced an average weight gain of slightly more than one pound per year.   Other factors contributing to weight gain included quitting smoking, limited exercise, hysterectomies, and sedentary lifestyles.

In research by Blanck and colleagues the findings were that more than 18,500 postmenopausal women with an average weight gain of ten pounds over seven years, had lifestyles characterized by low activity and low recreational movement.  Animal studies have suggested that hormonal shifts such as decrease in estrogen, progesterone, and testosterone contribute to weight gain.  At this time, similar results have not been confirmed in human studies.  It is clear, therefore, that the research needs to continue.

When a client (or a possible client) inquires about what can be the cause of her weight gain, I become very excited about the potential to share the joy of the non-diet approach with her. I have found that many of the women I see had not made any changes in their lifestyles until they went through menopause.  The trend in my practice suggests that a lifestyle change does not come until a woman is dissatisfied with the direction her body seems to be heading, i.e. gaining weight.  (Note: Menopausal women often times develop increases in abdominal fat which can put them at a high risk for developing various diseases).

The bottom line is that commencement of menopause does not have to mean that a woman will gain a considerable amount of weight as long as she is aware of her lifestyle and asks herself these questions:  Am I active enough? Am I present when I eat? Am I eating too much? Am I satisfied after I eat? And likely one of the most important questions: Is it hunger that drives me to eat?

I hope this begins to clarify the confusion about how menopause might be a factor in weight gain. 

References:

  1. Blanck HM, McCullough ML, Patel AV, et al. Sedentary behavior, recreational physical activity, and 7-year weight gain among postmenopausal US women. Obesity. 2007;15(6):1578-1588.
  2. Brown WJ, Williams L, Ford JH, Ball K, Dobson AJ. Identifying the energy gap: magnitude and determinants of 5-year weight gain in mid age women. Obes Res. 2005;13(8):1431-1441.
  3. Davis SR, Castelo-Branco C, Chedraui P, et al. Understanding weight gain at menopause. Climacteric
    2012;15(5):419-429
  4. Lee IM, Djoussé L, Sesso HD, Wang L, Buring JE. Physical activity and weight gain prevention. JAMA. 2010;303(12):1173-1179.
  5. Panotopoulos G, Raison J, Ruiz JC, Guy-Grand B, Basdevant A. Weight gain at the time of menopause. Hum Reprod. 1997; 12(Suppl 1):126-133.
  6. Singh P, Haddad E, Knutsen S, Fraser G. The effect of menopause on the relation between weight gain and mortality among women. Menopause. 2001;8(5):314-320.

 

The Grain of Freekeh…(August 2015)

Have you seen the name freekeh (also referred to as farik) on various restaurant menus lately? Has it sparked your curiosity about what this new mystery grain is? As we explore the different grains to hit the restaurant circuit, I recap in my mind the various grains that have risen in popularity: first there was quinoa, then farro, now freekeh. Something that all three of these grains have in common is that they are high in both protein and fiber. But let’s take a closer look at this relatively new entry into the popular-grain market.

Freekeh (pronounced FREE-kuh), also known as “baby wheat,” originated in the Middle East and is native to Jordan, Syria, Lebanon, and Egypt. It was discovered about 2000 years ago when a village was attacked and its young wheat crop was set on fire. The villagers rubbed away the burnt layer of this young grain and cooked the remaining portion, which is now called freekeh.

Today, freekeh is a young, green wheat which is harvested during its peak nutritional state. After it has been harvested, freekeh is charred or roasted. This process not only enhances the flavor profile by imparting a smokiness to it, but it also protects the grain, as does the grain’s high moisture content. The texture can be described as crunchy accompanied by a flavor similar to rice and barley. This registered dietitian thinks it tastes like rice and kamut.

One-half cup of this nutritionally rich whole grain contains 160 calories, 32 grams of carbohydrate, 7 grams of fiber, and 6 grams of protein. Additionally, it is a great source of iron. Health promoting lutein and zeaxanthin, which contribute to the color of the grain, are naturally found in freekeh as are minerals important to our overall health: phosphorous, selenium, potassium, and magnesium. It is also speculated that freekeh may act as a prebiotic (good for gut health). This all serves to make freekeh a nutritional powerhouse but it is important to note that freekeh is not gluten-free. It is lower in gluten content than wheat because the gluten is not fully developed when freekeh is harvested.

Food stores such as Whole Foods, Sprouts, and Erewhon, all known for specializing in organic and natural foods, are stores in which this grain, relatively new to the American market, might be purchased. Of course, one can purchase freekeh online as well.

Freekeh is rather dense, so to cook 1 cup dry, you must use 2 ½ cups of the liquid of your choice; cook time should be 20-25 minutes or until the grain has reached a satisfactory consistency. The internet is a good source for recipes.

So why not give this relatively new entry to the market a try. I hope you are as satisfied with it as I am!

References:

  1. http://well.blogs.nytimes.com/2015/01/23/get-your-freekeh-on/?_r=0
  2. http://www.freekeh-foods.com/
  3. http://www.huffingtonpost.com/frances-largemanroth/best-supergrains_b_3824822.html
  4. http://www.todaysdietitian.com/newarchives/090114p46.shtml
What’s a Gut of a Guy or a Girl to do? Gastrointestinal Symptoms and Eating Disorders… (July 2015)

Any colleague specializing in eating disorders often hears their clients mention how they feel bloated. As a Nutrition Therapist, I like to dig deeper into this problem and ask a series of questions that help to illuminate what is going on like:

  1. Do you feel constipated?
  2. Do you experience heartburn?
  3. Flatulence/Gas?
  4. Dysphagia (swallowing difficulties)?
  5. Chewing problems?
  6. Anorectal Pain?

Although these are just some of the questions I ask my eating disorder clients, such gastrointestinal symptoms are rather common, especially when refeeding (the reintroducing of calories) is taking place.

Did you know that researchers from the University of Australia found that 98% of 101 female patients admitted to an eating disorder unit had the criteria for various gastrointestinal disorders? In addition, did you know that 50% of them had Irritable Bowel Syndrome (IBS)?


Sadly, many of our clients have various gastrointestinal symptoms, but are either embarrassed to discuss them. At the same time, they are not having the proper questions asked in order to help them reveal such problems during this difficult transition.
Did you know it is also common for female clients to have pelvic floor function?  Various OBGYN’s that I work with will diagnose the patient and send them to physical therapy. The challenge is that some of the treatment team members often are not aware that the patient currently has an eating disorder or had a previous history of an eating disorder. Pelvic floor dysfunction may also be a common cause of abdominal distention.


When the digestive symptom is severely damaged from purging, a peptic ulcer can develop. This is an area of the stomach or duodenal lining that becomes eroded by stomach acid. The result is significant pain whenever the client eats or drinks just about anything. If this is happening, your client needs immediate attention, especially if they are vomiting blood.


Research has shown that satiety and bloating are higher in patients who have eating disorders.  Patients with Irritable Bowel Syndrome (IBS) who have an eating disorder are more likely to develop psychological issues like anxiety, obsessive compulsive disorder (OCD) and other manifestations of disordered eating.  The longer the client remains entrenched in the depths of their eating disorder, the more likely they will develop motility issues – problems of digestion – because food will take longer to be digested. I have found that clients develop various food rules and phobias as a byproduct of this difficulty. Although many had rules to begin with, the difficulty often leads to an intensification of such rules.


A proven fact is that irregular eating patterns (i.e. restricting meals/food during the day, with binging at night, then adding carbonated beverages, chewing gum, and having caffeinated beverages with artificial sweeteners) exacerbates the bloat and negative symptoms that a client will experience. In addition, when laxatives/diuretics are incorporated in the disordered eating or eating disorder, a client will feel added gas and bloat as well.


Clients always ask me about our gut flora bacteria and what are the implications? Basically, when the eating disorder client has unpredictable eating times, gut flora bacteria that aid in digestion are impacted by the diet, the eating disorder symptoms, and gastrointestinal symptoms. Microflora are essential to healthy living because they break down many different food sources, produce a variety of important molecules that help mature the immune system, and support molecules that a human brain needs to function properly.


Chronic food restriction and disorderd eating patterns end up changing the production and life cycles of the gut flora, greatly effecting digestion. When clients ask me about probiotics , I recommend that they speak with their gastroenterologist if they are seeing such a doctor or find one to see. Some gastroenterologists are supportive of probiotics and others are not.
The good news is a client does not have to take such supplements because they can obtain probiotics in various food sources which we speak about during the “legalization of food” process.  The eating disorder research is now indicating that probiotics can improve the mood and behavior of the patient. Of course, food is the first course of treatment, but anything that supports that main challenge can be a welcome addition.


When I am working with an eating disorder client, we examine and adjust their fluid and fiber intake, frequency of binging and purging as well as looking at the other questions I noted above. When the majority of their food intake is fiber based, it is not surprising if they feel bloated and their stomachs feel unwell.


Chicory Root is a hidden source of fiber in yogurts, cereals, and crackers. Clients are often surprised to discover this about the foods they eat on a regular basis. We explore together what their safe foods are and what kind of meal plan would work for them to realize our “mutual goals” of restoring and maintaining their physical health and mental well-being.


It is important to make sure an eating disorder client is speaking about these gastrointestinal issues to their mental health practitioner. If they are not in therapy, I suggest that they start therapy and offer professional recommendations. This is the same as when I recommend a doctor like a gastroenterologist. It is important to know that I am a nutrition therapist and a certified eating therapist and professional boundaries need to be understood and respected. In order to provide the best multi-dimensional care possible to a client,  a team of diverse professionals is often required.

References:

  1. Bravo, Forsythe, Chew, Escaravage, Savignac, Dinan, Bienenstock & Cryan. 2011. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. PNAS http://dx.doi.org/10.1073/pnas.1102999108
  2. Hudson Jl, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61 (3);348-358.
Herbs, Spice and Not Everything Nice… (June, 2015)

How many times do you think this: It’s just an herb or a spice; I can consume it and it’s not a problem with my medication, because it’s natural? We think of natural as safe… not dangerous. Sometimes our doctors don’t have all the answers about interactions that occur among drugs, herbs, spices, and nutrients. A recent conversation with a client reminded me that ginger interferes with her blood thinner. That conversation led me to the idea that examining the interactions among substances we ingest would be a good topic for my monthly insight. I proceeded to consult my professional notes in addition to my current edition of the Food-Medication Interactions Handbook. My beloved late mentor, Christine Hamilton Smith, Ph.D., always made sure I had the latest copy as she was on the advisory board for this information-rich handbook. Below I have charted selected herbs/spices along with some of the medications with which they are known to have interactions. The third column addresses the possible concerns and/or complications resulting from these interactions.

This
herb/spice…

…if consumed
while taking
this/these medication(s)/drug(s)…

...could lead to this effect due to the potential interaction.

Cumin

Anticoagulant/Antiplatelet drugs such as aspirin, clopidogrel, warfarin, Plavix, Xarelto

Excessive bleeding

Antidiabetic drugs such as Metformin, Glimepiride, Glyburide, insulin & rosiglitazone

May have an additive effect and increase hypoglycemia

Rifampin

May increase the bioavailability and plasma levels of rifampin and increase the drug’s effects and adverse effects

Dill

Antidiabetic drugs such as glyburide, glimepiride, rosiglitazone, insulin

Lithium

Hypoglycemia (dangerous drop in blood sugar)

May reduce excretion and increase levels of lithium. Dill may have diuretic properties.

Anise

Contraceptive drugs

May increase the risk of bleeding

Estrogens

May interfere with drugs through competition for estrogen receptors

Tamoxifen

Might interfere with drug because of potential estrogenic effects

Black Pepper/White Pepper

Phenytoin

Piperine component in pepper may increase absorption, slow elimination & increase levels of drug

Propranolol

Piperine component in pepper may increase absorption & slow elimination of drug

Theophylline

Rifampin

 

Chemotherapeutic agents, antifungals, protease inhibitors, some calcium channel blocker, digoxin

 

May decrease drug levels

Piperine component in pepper may increase absorption & serum levels of drug

May Increase drug levels

Clove

Aspirin, Clopidogrel, Ticlopidine, Heparin, Warfarin, Xarelto

May increase the risk of bleeding

 

Cassia/Cinnamon

Antidiabetic drugs such as glyburide, insulin, metformin, rosiglitazone,& glimepiride

May lower blood glucose levels & have additive effects

Hepatotoxic drugs such as atorvastatin, fluvastatin, acarbose, gemfibrozil, niacin, tamoxifen , pravastatin

May cause hepatotoxicity

Saffron

Antihypertensive drugs such as enalapril, losartan, diltiazem, furosemide, &captopril may have additive effects& increase the risk of HTN

May have additive effects & increase risk of hypotension

 

May cause additive heart dilation effects

Turmeric

Anticoagulant/antiplatelet drugs such as aspirin, heparin, warfarin (Coumadin)clopidogrel, ticlopidine, dalteparin, enoxaparin, Xarelto

May decrease platelet aggregation & lead to increased risk of bleeding

Antidiabetic drugs such as glimepiride, glyburide, insulin, pioglitazone, rosiglitazone

May increase the risk of hypoglycemia

Rosemary

Tamoxifen

May inhibit platelet aggregation & increase risk of bruising & bleeding

Anticoagulant/antiplatelet drugs such as aspirin, clopidogrel, NSAIDS, ibuprofen, heparin, warfarin (Coumadin), Xarelto, naproxen, & enoxaparin may inhibit platelet aggregation & increase the risk of bruising & bleeding

May decrease the antiestrogenic effect of tamoxifen

Fennel

Ciprofloxacin

May reduce effectiveness of ciprofloxacin

Aspirin, heparin, Coumadin, Xarelto may increase the risk of bleeding

May increase the risk of bleeding

Cytochrome P450 3A4  (CYP3A4) substrates  drugs that may be affected by this system include calcium channel blockers, chemo agents, antifungals, glucocorticoids, & may inhibit CYP4A4 enzyme activity & increase levels of drugs metabolized by enzyme, increase drugs effect & adverse effects

May have estrogenic activity that could interfere with contraceptive drugs

Estrogens may interfere with hormone replacement therapy

May inhibit CYP3A4enzyme activity & increase of drugs metabolized by enzyme, increasing drugs effects & adverse effects

Tamoxifen

May interfere with hormone replacement therapy.  May decrease the antiestrogenic effect of tamoxifen

Ginger

Anticoagulant/antiplatelet drugs such as aspirin, clopidogrel, enoxaparin, warfarin, Xarelto

May increase risk of bleeding

Nifedipine

Inhibits platelet aggregation

Warfarin (aka: Coumadin)

May inhibit thromboxane synthetase & decrease platelet aggregation

Garlic

Aspirin, clopidogrel, enoxaparin (aka: Lovenox), warfarin, Xarelto

May increase prothrombin time (PT time). Might enhance the effects & adverse effects of anticoagulant & antiplatelet drugs

HTN drugs such as verapamil, diltiazem, felodipine, nifedipine,

May cause additive hypotensive effects

Contraceptive drugs

May decrease effectiveness of contraceptive drugs

Cyclosporine drugs

May decrease effectiveness of cyclosporine

Cytochrome P450 2E1 (CYP2E1) substrates drugs metabolized by CYP2E1 include acetaminophen, chlorzoxazone, ethanol, theophylline & some anesthetics

May inhibit CYP2E1 activity

Garlic

Cytochrome P450 3A4 (CPY3A4) substrate drugs that may be affected by this system include calcium channel blockers, chemo agents, antifungals, glucocorticoids, alfentanil

May induce activity of CYP3A4

Isoniazid

May reduce isoniazid levels

Non-nucleoside reverse transcriptase, or NNRTIs (antiretroviral drugs such as nevirapine, delavirdine, efavirenz)

May decrease plasma concentrations of protease inhibitor saquinavir & affect activity of CYP3A4

Saquinavir & possibly other protease inhibitors such as nelfinavir, ritonavir, amprenavir

May decrease concentrations of saquinavir, may affect activity of CYP3A4

Coumadin

May increase prothrombin time (PT time) and increase risk of bleeding

 licorice, plantain, uzara root, hawthorn & ginseng

Digoxin

Requires monitoring because herbs interfere with digoxin

Ginseng

Estrogens, corticosteroids

Interferes with estrogens & corticosteroids

Echinacea

immunosuppressants such as cyclosporine

Herb Interferes with these medications

St. John’s Wort & Saw Palmetto

Iron

May inhibit the absorption

Feverfew, garlic, ginkgo biloba, & ginseng

Coumadin (aka warfarin)

Interferes with these herbs; may alter bleeding time & should not be used.

 

The chart clearly shows that spices and herbs are much more interactive than we may have thought. Of course, they can interact with each other to create delicious dishes packed with wonderful flavors. But when we add prescribed or even some over-the-counter (OTC) medications to the equation the resulting interaction can be a serious threat to health.

If either you or your physician has any doubt about the safety of taking a prescribed or OTC medication with some of the herbs and spices you use routinely in your cuisine, take a little time to consult a reference. The accompanying chart is a good place to begin, but you can find considerably more information in the references below.

Here’s to a meal that is flavorful, delicious, and free of harmful interactions, Bon Appetite!

References

1. Pronsky, Z., Crowe, J. Food-Medication Interactions Handbook 17th Edition. Food-Medication Interactions.

2. Natural Medicines Comprehensive Data Base: http://naturaldatabase.therapeuticresearch.com/

How To Define Recovery From An Eating Disorder (May, 2015)

How will I know when I am "recovered" from an eating disorder? That's a question I frequently hear from clients who have embarked on a long journey to achieve a healthy relationship with food and a positive body image. There are many factors that need to be considered before a patient is recovered or "disease free." My colleague and friend, Dr. Edward P. Tyson, has written a wonderful article on the topic, recently published in The Renfrew Center Newsletter Perspectives. I am reprinting the article below with his permission. Dr. Tyson has specialized in the assessment and treatment of eating disorders for over 25 years.

For a patient to be recovered from an eating disorder, the following are essential considerations:

1. As a physician, I would answer this similarly to how I would declare someone “cancer-free”. That means no remnants of the disease exist in any aspect or are they likely to return and additional treatment is not considered worthwhile. The full treatment team has to agree that treatment for the eating disorder is no longer needed.

2. The patient must also agree that the eating disorder is no longer occupying any aspect of her or his life, be it physical, emotional, or social. This does not mean the patient cannot have other psychological or physical problems separate from the eating disorder.

3. Competent medical assessments must be done for much of the treatment phase, including at the end of treatment. This is probably the weakest link in most treatment teams as there are few physicians who are trained in medical care of eating disorders. But, it is still necessary to ensure safety and the status of “recovered”. I am not saying that just because I am a physician, but because the medical issues in eating disorders can be both dramatic and subtle any aspects that have the potential to rekindle the eating disorder need to be completely obliterated.

4. Incorporating exercise is a must as it is part of a healthy lifestyle. A recovered patient has learned to incorporate exercise and has done so in what the treatment team believes to be a balanced, appropriate manner. If the patient is a competitive or professional athlete, there is a consistent pattern that the increased demands of the sport have been met nutritionally, physically and emotionally.

5. There are no longer any precautions or restrictions in place, such as limited hours at work or school. Adaptation to those environments is complete.

6. The patient does not obsess about weight, food, exercise, or appearance and does not have distortions about “fat” on their body or about any aspect of their appearance. This, of course does not mean that they do not have fat or even a substantial amount of it. It is that they no longer have noticeable distortions about that fat or body appearance.

7. To be declared “disease free” or “eating disorder free”, the patient needs to be followed by the treatment team for approximately two years, during which time there has been no evidence of eating disorder behaviors or attitudes and the full demands of everyday life are being met. Having observed patients who remained well and eating disorder-free, two years represents a reasonable and appropriate period of time.

8. I do not include “being at “ideal” body weight.” That is because weight is such an individualized measure and no one can reliably predict exactly what weight is “ideal” for a given person (guess can be pretty reasonable, but this is about being recovered, not being better). Recovery is so much more than a measure of gravitational force.

Being recovered is much less about weight per se and more about what weigh now means to the sufferer. Other physical indicators are much more reliable, including vital signs and physical exam and these much indicate normalcy.

Finally, a patient must not be afraid of her or his own weight and must not refrain from getting weighed. S/he must be able to be weighted without trepidation and the number on the scale needs to be interpreted in an appropriate manner. For example, if a patient with an eating disorder also has congestive heart failure, an increase in weight may indicate excessive fluid buildup. The concern is not being too big or being overweight in the usual sense, but rather having a worsening medical issue.

9. For an illness as serious as an eating disorder to be eliminated from one’s existence, there needs there needs to be some powerful sense of gratitude, acceptance and perspective. When a patient declares to me, “The worst thing that ever happened to me is now the best thing that ever happened to me,” then I am highly confident that that person is unlikely to return to the eating disorder.

They stated, in so many words, that God had given them the eating disorder as a gift and without it they would never be in such a positive place as they are now.   “As hard as it was, I hate to think of where I’d be if I had not gone through my treatment and recovery. I never want to go back to that life again.” In short, my patients recognize that it took an eating disorder to push them to face the issues they had to face to have a happy, full life.

I believe Dr. Tyson all the aspects that must be addressed and worked on through the minimum two year period. From my experience the client who is recovered in a two year period has a supportive family, and makes recovery the top priority in his/her life.  Research shows those who do not prioritize take seven to ten years and the rest die.

Edward P. Tyson, MD has specialized in eating disorder treatment for over 25 years. He is the co-author of AED’s Medical Guide for Eating Disorders with a worldwide distribution of 100,000+ copies. He authored a chapter on medical assessment for “Eating Disorders-Bridging the Research-Practice Gap” and has developed legislation mandating insurance coverage for EDs in Texas.  A member of AED’s (Academy of Eating Disorder) Advisory Board and Austin Foundation for Eating Disorders, Dr. Tyson also teaches medical, nursing students, graduates and undergraduates at the University of Texas.

References

1. Tyson, Edward. “Perspectives” A Professional Journal of the Renfrew Center Foundation, summer 2014, 10-11.

2. www.eatingdisordersdoc.com

3. www.anred.com

AGEs Upon AGEs of Questions About Cooking and Carcinogens (April, 2015)

When it comes to making our favorite meals, many of us enjoy grilling, stewing, poaching, frying, roasting and broiling. These are just a few methods of cooking that are common in many homes, not to mention when dining out.

From our own blood sugar in our body, there is a natural chemical which is produced referred to as AGEs. AGEs stand for advanced glycation end products and is common in our diet when proteins or fats combine with sugars. This process is known as glycation. The problem is that having these in our diet increases our risk for medical problems. AGES can damage tissues, increase the chances of developing coronary artery disease, may increase the chances of developing insulin resistance in addition to type 2 diabetes and other medical problems.

AGEs form inside of our body when fats or proteins combine with sugars. This process is known as glycation as well. AGES also can be produced naturally in our body from our own blood sugar. Several studies have shown that people who have higher blood sugars or will have higher levels of naturally produced AGEs. What is important to know is that food preparation methods have a significant effect and can determine the amount of AGEs we ingest with a meal.

According to a study published in the Journal of the American Dietetic Association in June 2010 that compared the use of fruits, vegetables and whole grains, researchers found that preparing foods in a dry heat method led to low AGE levels after cooking. The study showed that meats high in protein and fat were most likely to form AGEs during cooking while using acidic ingredients such as vinegar and citrus juices produced the least amount of AGEs.

Studies show that people with either Type 1 or Type 2 diabetes who ate a meal that was high in AGEs increased signs of inflammation in their bodies. These compounds actually could damage structure and function of certain proteins in the human body. Such damage can lead to coronary artery disease. Researches have also found high levels of AGEs in the nerves of people with diabetes mellitus, and such high levels can play a direct role in the onset and worsening of diabetic neuropathy.

Given the above information, what should a consumer do with their food selection?

  1. First I would recommend choosing foods that are low in AGEs, including the following: Those include:
  2. Protein Rich Foods: legumes, tofu, eggs, fish, and poultry (listed from least to most). Red meat and cheese have the most.
  3. Grains: Boiled grains such as rice, quinoa, and hot cereal and sandwich breads are low in AGEs. When grains are cooked into crispy brown crackers or high fat cookies or sweetened with sugar, their AGE content can increase.
  4. Dairy: Milk and yogurt are low in AGEs, but when moisture is removed and the fat is concentrated (such as cheese, butter, and cheese) the AGE content increases). It is recommended to choose low fat or non -fat more often.
  5. Fats: Vegetable fats have lower AGEs than animal fats. Examples would include: olive oil, avocado, humus, nuts, and seeds.

I also would recommend cooking at low temperatures with lots of water. Examples of such cooking methods include: steaming, stewing, poaching and braising. Such methods will produce the fewest AGEs. When grilled meat products, it is recommended to marinate the meat in vinegar or a citrus juice, thus reducing the AGEs by up to half. This simple step will lower the health risks.

A final piece of advice: When you eat fried chicken or the crusty edges of banana bread, you are walking on thin ice. Both the fried skin and the crusty edges are examples of indicators that the cooking process has increased the amount of these potentially dangerous chemicals. By adding extra spices to food you can obtain the same taste desired while reducing the AGEs in your diet.

If you want to learn more or need a personal consultation, please feel free to contact Robyn L. Goldberg, RDN, CEDRD. I am here to support you and help foster a long-term healthy diet and lifestyle for you and your family.

References:

  1. Zanteson, Lori. “Advanced Glycation end Products.” Today’s Dietitian, Volume 16, No. 3 P. 10, March 2014.
  2. Uribarri, J., Woodruff, S.,Goodman S., Cai, W., Chen W., Vlassara H., Pyzik R., Young A., Striker G., (2010), Advanced Glycation End Products in Foods and a Practical Guide to Their Production in Their Diet, Journal of the Academy & Dietetics, 110 (6): 911-911.
To Weigh, or Not to Weigh: That Is the Question Intuitive Eating and Relearning How to Trust Your Body (March, 2015)

The weight loss industry teaches us that attention to the numbers on the scale is the primary way to be successful – or not – with regard to weight loss and management. Research has proven time and time again that this scale-driven approach increases disordered eating and obsessiveness about food and body image.

Currently, just as researchers are starting to ask whether or not counting calories is an effective approach to successful weight-loss/management, the scale-driven approach has been questioned. I am pleased to say that attention is currently being drawn to what is referred to as “intuitive eating.” This is also known as the “non-diet approach” because it promotes food selections based on the individual’s hunger and fullness signals, body acceptance, cravings, and even what sounds good to him/her. This approach is the philosophical basis of my practice.

Recently in the Journal of Academy of Nutrition and Dietetics, a review was published showing that by eliminating all food rules, the individuals in the study were able to maintain or lose weight. When the focus shifted to developing a healthy relationship with food, the individuals were able to have more positive moods, decreased anxiety and depression, increased self-esteem, and improvement in their overall body images. They also had a decrease in their total cholesterol as well as decreased LDL, the unhealthy type of cholesterol.

I will admit it is scary to give up the scale, however when I share with clients the findings of these various studies and their resulting benefits, often times my clients are motivated to make changes. For clients who are very attached to the scale, not only do we discuss how the scale has served them, but we also consider what they hope the scale will provide for them the next time they use it. The only clients that I “blind weigh” (meaning that I weigh them with their backs toward the scale so they can not see the numbers) are those who must be medically monitored.

While I discourage my clients from utilizing the scale, I help them learn how to work from within, i.e. intuitively. The example I like to present revolves around babies. When we were babies, we didn’t know anything about scales. We were permitted to eat when we were hungry and stop when we were satisfied. In other words, babies naturally listen to their bodies – they are intuitive about their eating.

By learning how to listen to what your body needs, you learn how to differentiate between physical hunger (based on the needs of the body) and emotional hunger (based on feelings). “Diets” impose rules with precise types and quantities of permissible foods while labeling foods as “good” or “bad.” Such regimentation can make the individual want to eat more. Guilt and shame increase if the “willpower” decreases leading the client to believe that he/she has failed.

My goal for my clients, therefore, is to put reliance on the scale on the back burner and learn how to fuel their bodies while relearning ways to find pleasure in eating for life-long benefits. So to weigh or not to weigh? I would bet we can arrive at the answer…intuitively.

References

1. Scritchfield, Rebecca. “Intuitive Eating and the Case for Not Weighing Yourself.” U.S. News 15 October 2014.

2. Schaefer, J., & Magruson, A. (2014), A Review of Interventions that Promote Eating by Internal Cues. Journal of the Academy & Dietetics, 114 (5), 734-760.

3. Beate, H., & Blechert, J., & Hautzinger., M., Matthias, E., & Herbert, C. (2012).Intuitive Eating is Associated with Interoceptive Sensitivity. Effects on Body Mass Index. Appetite, 58(1). 22-30.

4. Resch, Elyse and Evelyn Tribole. Intuitive Eating, New York: St. Martin’s Press, 2012.

BPA Safety for Women, Men & Children (February, 2015)

Over the last several months I have read various reports about BPA’s (Bisphenol A). This is an industrial chemical used to produce polycarbonate plastic that is a clear shatterproof plastic with epoxy resins. It is found in food and beverage cans, plastic containers, cash register receipts, some dental sealants, medical devices, composites, and other medical and plastic products. As a consumer, we thought that we were doing enough by changing our Tupperware, water bottles and food packaging, but that is not the case.

Did you know that exposure occurs when BPA leaches out into foods, particularly when foods are heated or washed with abrasive substances? It is estimated that approximately 93% of Americans age 6 and over are exposed to BPA. The FDA has declared BPA to be safe, although there are concerns about the chemical’s toxicity.

The FDA is in agreement with the National Toxicology Program (NTP) about the potential effects of BPA on the brain behavior and prostate gland in fetuses and in young children. A 2013 review in Reproductive Toxicology concluded that there was “a growing human literature correlating environmental BPA exposure to adverse effects in humans, along with laboratory studies in many species including primates, provides increasing support that environmental BPA exposure can be harmful to humans, especially in regards to behavioral and other effects in children.” There was also a review in Reviews of Environmental Contamination and Toxicology highlighting detrimental effects of BPA on male reproductive function during in utero exposure: including feminization of male fetuses, increased prostate size, and atrophy of the testes.

There is a study being done by the National Institute of Environmental Health Sciences and the FDA on the toxicity of BPA. The research is being done on the following areas: breast and prostate cancers, immune function, learning and behavior, ovarian function, urogenital abnormalities, brain and thyroid development, obesity and diabetes mellitus in addition to coronary artery disease. This study will be completed by 2015.

According to the NY Times article in September 2014, a series of tests revealed that BPA could damage developing ovaries. Jodi Flaws, a bioscientist at the University of Illinois, began testing a theory which concluded the above.

What is a health minded consumer to do? To begin with avoid all food containers, cups and dishes marked with the letters “PC” (which stands for polycarbonate or recycling label #7). Also in this category, are plastics that contain bisphenol-S (BPS), the primary chemical alternative to BPA, which may also have negative health effects. Secondly, I would suggest buying packed food choices in glass jars, or waxed cardboard cartons. Ceramic, glass, and stainless steel are a great way to store materials which can go into the freezer easily. Next, try buying fewer processed foods. Most processed foods at the grocery store come in plastic packaging. Also bring your own shopping bags which are reusable. Cotton ones are ideal. A great website is www.ecobags.com. Lastly, for toddlers Klean Kanteen makes a stainless steel BPS-BPA free cup for toddlers.

References

1. Blum, Deborah,” In Plastics and Cans, a Threat to Women”, NY Times.com, September 7, 2014.

2. http://www.forbes.com/sites/henrymiller/2014/03/12/fda-research-confirms-bpa-is-a-ok/

3. http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm064437.htm

What is Normal Eating? (January, 2015)

To begin 2015, I thought this topic would be a great one to discuss. So many of us have mixed ideas about what is normal eating?

Many of us have been on every diet, others have disordered eating with a variety of food rules, or maybe you are someone who is working on being in recovery from an eating disorder. There is no “formal definition” of normal eating, but I thought I would provide you with some tips that could help guide you on a positive pathway.
Remember that each of us are culturally unique and with habits that we have developed over time. I do believe that it is important to get support from an entire treatment team who specializes in body image issues and or eating disorders. By having this team, it will allow you to be closer to reach your goal of normal eating.

1. Eat when you are hungry.

Clients hear me say this all the time. The challenge is that each person has to go through their own journey to learn how to reconnect to their different levels of hunger. Often times people eat because the clock says it’s a certain time, or they have a social commitment, or because it’s convenient. When someone has anorexia nervosa, that individual has one of their body’s basic needs. By being on a meal plan in the beginning, they can retrain their body to learn how to reconnect to their different levels of hunger.

2. Stop eating when you are full.

I hear clients tell me that they don’t realize they are full until it’s too late.  Often times we are raised to clean our plate, or we are fast eaters.  We don’t realize the message from the stomach to our brain telling us we are full takes 20-40 minutes to arrive. 

3. Sometimes we will under eat.

There are days that we are rushed and don’t get to finish our meal. We bring food with us and don’t always have a chance to eat it.  Perhaps we are too full from a previous meal. Whatever the reason is, it is normal to under eat just like it is normal to overeat.  Under eating periodically happens and we trust that our body will make up for it at the next meal.

4. Sometimes you will overeat.

We all have circumstances that cause us to overeat. People tend to overeat in the following circumstances:   they are sad, bored, anxious or they are multitasking.  Sometimes the food tastes great and you just don’t want to stop. The key is to recognize this behavior and not allow it to become an ongoing pattern.    It’s important to not judge yourself, because this happens to everyone.  The way your body makes up for under eating, your body also makes up for overeating

5. Your eating is flexible.

Being flexible means that we can eat at different times, eat different foods, and of course different things.  Learning to not sweat the small stuff is important too.  Maybe snack foods become dinner or we pick up take out, and that’s fine too

6. Your don’t know or care about how many calories are in your food.

I always remind clients that our role is to not be a human calculator. People who have normal and healthy relationships with food do not count their calories, protein, carbohydrates and fat. They eat when they are hungry and stop when they are satisfied.  Those people would agree that in food pleasure is removed if they constantly compute the nutritional values of their food choices.

7. You spend a limited amount of time thinking about your food.

It is normal to think about what to put on your grocery list, or where you want to make a reservation for dinner, or what new restaurants are out there. Also, people who have healthy relationships with foods have an awareness of what help them feel their best.  If they have a medical condition, perhaps they have awareness about that too.  If you have thoughts that are beyond what is described, than it might be worthwhile to see a registered dietitian/therapist who specializes in food and body images issues.

8. You eat dessert and don’t feel guilty about it.

I always say to my clients that it is important to address our nutrition first, then to have some type of play food after. Dessert is play food. Let’s face it, how many meals can be salmon, brown rice and brussels sprouts? I am not saying that the play food has to be the most decadent item, but if we deny ourselves and feel guilty, then this can set us up to binge. When we legalize that “forbidden food”, you may find that it’s not a big deal to have it.

I hope you found that these eight tips describing normal eating helps to set you on a positive path!

Are Disposable Chopsticks Dangerous? Inquiring Minds would like to Know… (December, 2014)

How often do you order Chinese or Thai takeout?  What about picking up sushi from your favorite sushi restaurant or even from the grocery store? As you are taking your lunch or dinner out of the bag with the condiments, of course we have to make sure that the restaurant doesn’t forget the chopsticks.

Recently I have come across several articles that were somewhat distressing to me especially since I have traveled all through Asia, and I must say that this new information really grabbed my interest. I thought I must share this news with my clients and colleagues.

Did you know that to save Asia’s forest the disposable chopstick industry has been a hot commodity, but sadly environmentalists have not been happy with it for several reasons? First, China exported over 10,000 tons of chopsticks and it manufactures 80 billion pairs each year. From that, 20M trees mainly bamboo, poplar and birch are chopped down from forests where some are fast growing and some are not.

About a decade ago several universities in China had a BYOC (bring your own chopsticks movement). Few people paid attention, even when the government provided its support and put a 5% tax on throwaways. The factory price is about one-third of an American Cent, but people didn’t care.

The bigger issue is regarding the dangers pertaining to human health. The chemicals that are used to make disposable chopsticks use sulphur  to fumigate and kill mold with industrial hydrogen peroxide so they look  white, clean and have a nice presentation.  In addition, “Once they are beautified the chopsticks are dumped on the floor without sterilizing the sticks or plastic wrapping,” according to the Shanghai Youth Daily.

Lu Feung, an official from the Anji Quality and Technical Supervision bureau reports,  the factory price for disposable bamboo chopsticks is 0.02 yuan (much less than 1 US cent) so they must be  mass produced efficiently to ensure profit. A factory’s daily yield can be as much as 300,000 pairs.

Anji is a county that is known as the “hometown of bamboo”. Sadly its economy depends on these bamboo crops.  Since 2012 the local bureau has inspected the disposable chopsticks from more than 200 factories in Anji.

Some restaurants are trying to use reusable chopsticks. The sanitation is a concern for customers which makes complete sense. Electronic “smart chopsticks” are what is on the wave of the future. Some people say that will not be successful due to the contaminants that could be stuck in recycled oil. Also restaurant owners of cheap eateries may not be open to this concept.

What are other options for the consumer? Since I returned from Japan this summer I learned that sushi is considered “fast food”. We are not supposed to use chopsticks, as this is an Americanized approach. You may consider using your fingers. If you are not comfortable with this idea bring your own nice ceramic chopsticks to the restaurant or use a fork.
Also, for all other Asian cuisine, start using a fork at a restaurant or bring your own ceramic chopsticks.

Sayonara!

References
1. Shanghaidaily.com October 12, 2014
2. The Economist September 13, 2014
3. Naturalnews.com April 10, 2014
4. Chinadaily.com.cn February 28, 2014

Pregnancy and Eating Disorders… (November, 2014)

During my seventeen years of working with clients, many of them have seen me for pregnancy nutrition. Some clients see me for their relationship with food during their pregnancy. Those women are not just concerned about putting the best fuel in their body for their new addition, but they have struggled with body image for quite some time.

I have clients who are amazed that their bodies are changing and others that are not enjoying the transformation. These women do not want to honor what their bodies are craving, and feel ashamed that they have a belly, maybe hips and God forbid- a butt. The “unofficial” term that has been used with these women, who tend to restrict their food, is called “Pregorexia”. There has been such shame and stress for these women, whom I see as clients, who spend many days going to their reproductive endocrinologist working on becoming pregnant. This is a real problem and fortunately there is now an online support group in Orange Country by Maggie Baumann, MFT, CEDS. It is called “Lift the Shame Support Group”. She has teamed up with Timberline Knolls, a residential treatment center in Chicago.

Clients struggle to not only legalize foods, but to gain enough weight to have a healthy baby that does not have long term medical problems: such as seizures, irritability, and ADD. Mothers can of course have miscarriages, have uterine bleeding or have a seizure themselves. When I see clients in this challenging place we speak about how they would like to be a role model for their child and how important it is for them to have a team including a mental health practitioner, and a nutrition therapist to help them see that this is not the time to limit their caloric intake.

A wonderful resource to help all pre and post pregnant women includes: Does This Pregnancy Make Me Look Fat? By Clair Mysko and Magali Amadei. This book begins by having a pledge/contract in the beginning of the book stating that there is “no such thing as the perfect body or the perfect mommy”. My favorite commitment is: ”Work on developing a relationship with food that is about health, nourishment, and enjoyment; not deprivation, indulging, and punishment”.

The book does a great job highlighting women’s top fears pertaining to motherhood. “79% of the women who have body fears-weight gain, report this is their number one fear”. This is why Pregorexia manifests itself for many women who have either had a history of eating disorder before becoming pregnant or have never recovered from their eating disorder once they became pregnant. Statistics also reveal that 73% of pregnant women with body image issue and histories of eating disorders and disordered eating said they have not shared this history with their obstetrician or midwife.

Furthermore, 79% of mothers with body images and histories of eating disorders and disordered eating said they did not discuss this history with their obstetrician or midwife. What is a woman to do? Pregnant or non-pregnant, be open and honest with your medical care team, so they can help you find the proper care, during this challenging time. It is important to get help for your mind, body and soul. Namaste.

References
1. Does This Pregnancy Make me Look Fat? Clair Mysko & Magali Amadei
2. Mayo Clinic.com Pregorexia
3. USNEWS.com pregorexia February 25, 2014
4. www.Timberlineknolls.com

My Doctor Diagnosed me with Rhabdomyolysis… What is it? (October, 2014)

Do you hear friends discuss their intense boot camp workouts? Maybe they are thinking of starting Crossfit? Those P90X or Insanity infomercials have you motivated? You may want to think twice, especially if you are out of shape.

Rhabdomyolysis is also called “death of muscle cells” when a muscle is damaged under stress. It releases the protein myoglobin which is the protein that stores oxygen in the muscles, and is then released into the bloodstream. High levels of myoglobin can then damage kidney cells and cause renal (kidney) failure. Most people suffering from this have dark, red or cola colored urine which means they have myoglobin in the blood. The individual may also experience muscle weakness, fatigue, bruising and difficulty moving their joints.

This is not a new syndrome, but one not known to the average person. Causes may include extreme muscle strain from over exercise, crash injuries from an accident, drug or alcohol induced dehydration and also high doses of statins or corticosteroids.

I first heard about this when several of my clients shared with me their diagnosis after their HIIT (High Intensity Interval Training) regimen caused this to happen to them. Research shows that this type of interval training speeds up metabolism. According to American College of Sports Medicine’s “Worldwide Survey of Fitness Trends for 2014,” high-intensity interval training placed as the top fitness trend, despite warnings of many survey respondents about high injury rates.

I agree that intense exercise has many benefits, being a former collegiate tennis player and triathlete; but learning how to moderate activities and performing exercises correctly is very important. Improper training can only lead to injuries. Athletes at every skill level must learn skills to prevent this problem from developing. Of course, having sufficient nutrition and hydration are the key building blocks to an effective workout while drinking adequate water before, during and after which will help to flush out any myoglobin that is released from the muscles out of the kidneys. Also please don’t forget to stretch before and after.

References
1. WebMD.com - Rhabdomyolysis-Symptoms, Causes & Treatment
2. The Mayo Clinic-How do you know if you have Rhabdomyolysis from statin use?

How to Help Parents with Finicky Eaters… (September 2014)

I see many kids, tweens and teens. The topic has come up countless times: “What do I do with my kid who is a picky eater, without coming across as the food police?” I thought this would be a good topic to discuss as it important for parents to understand where their child is coming from.

On some level we are all particular with our food choices. We know what we like or dislike based on the familiarity of eating the same foods over and over. For kids, that may be ever more challenging when they have not been exposed to new foods or their parents are fussy eaters.

According to my colleague Ellyn Satter, MS RD who has written several books on eating competence for children she describes, “Eating Competence is not so much about food, as it is about the feelings and attitudes that surround eating”.

It is important for the parent to have a nonjudgmental attitude around food. If mom or dad is speaking to their child when they have struggles about food, then their child will pick up on that attitude and will not be open to try a new food. Removing words that involve any type of pressure such as “getting” is important as kids associate that with guilt, especially if they feel poorly after not being able to succeed.

When mom and dad are able to back off of the finicky eater and tell the child to select what they enjoy, the child becomes more relaxed and their feelings improve. It is necessary for the parent to do this for him/herself. The parent will want to take time to relax and work on legalizing the “forbidden food”, become a mindful and present eater, while learning how to connect to their self. During that time the shame will subside by eating that food. Also learning how to eat in public will help and your child will begin to see you as a role model.

If you are at a dinner party, it is ok to serve yourself as this can help you by neutralizing uncomfortable feelings. Select the food choices that are right for you and take more the food choices that you enjoy. When dining out, it is not ok to create a dish off the menu. This will enforce the behavior to your child that being finicky is acceptable. Eating off of someone else’s plate or drawing attention to your own eating refusal.

This is important to address within yourself as this will help your child in the future. This is allowing you as a parent that there is a problem that is being addressed. The long term goal is to feel positive about your relationship with food. Select from foods that are available and learn how to engage with people in a meal situation without feeling uncomfortable, which again will only help your child.

Current Trends Pertaining to Supplementation and Prostate Cancer Risk (August 2014)

What is a man supposed to do? Many men are trying to be proactive taking supplements to reduce their chances of developing prostate cancer due to aging, their family history, and are becoming more aware of prostate cancer from the data they have read.

A multicenter study led by the Fred Hutchinson Cancer Research Center has found that by taking a dose supplementation with both the trace element selenium and Vitamin E increase the risk of high-grade prostate cancer. This risk depends on a man’s selenium status before taking the supplements.

The results were published in the Journal of the National Cancer Institute, and are based on the Selenium and Vitamin E Cancer Prevention Trial (SELECT); a rigorously executed, randomized placebo- controlled trial conducted by SWOG cancer research cooperative group that  involved more than 35, 000 men.  The study went to determine whether taking high-dose vitamin E (400 IU/day) and/or selenium (200 mcg/day) supplements could protect men from prostate cancer.

The trial started in 2001 and was designed to last 12 years, but stopped in 2008 because it found no protective effect from selenium, and it was suggested that Vitamin E increased cancer risk. Men were still followed although the use of the study supplements stopped. After an additional two years, the men who took vitamin E had a significant 17% increased risk for developing prostate cancer.

When the study began there was some evidence that selenium supplementation wouldn’t benefit men who already had an adequate intake of the nutrient.   Researchers then measured the concentration of selenium in participants’ toenails and planned to test whether selenium supplementation would help only this group of men with low selenium levels at baseline. Instead, they found that taking selenium supplements increased the risk of high level cancer up to 91% among men with high selenium status at baseline.  When men took selenium levels that were already high their blood levels became toxic.

The study also showed that this subgroup of men also were at high risk for developing prostate cancer when taking vitamin E. Men with low selenium status who were baseline, found that vitamin E supplementation increased their total risk of prostate cancer by 63% and increased the risk of high level cancer by 111%. This concluded one of the original SELECT findings, which was that only men who received vitamin E plus a placebo pill, and not those who received both vitamin E and selenium, had an increased prostate cancer risk.  Selenium, whether from dietary sources or supplements, protected men from the harmful effects of vitamin E.

The bottom line is that the study showed no benefits to any of the men from either individual supplements being selenium or vitamin E, and for significant proportions of men in the study these supplements were harmful. There does not appear any risk by taking a multivitamin and these vitamins are included in a multivitamin which is not a problem.   There are ideal levels which can often be consumed from a healthful diet but either above or below the recommended amount could pose a potential risk according to the Fred Hutchinson Cancer Research Center.

Researchers at UCLA found that men with prostate cancer who ate a low fat diet and who took fish oil supplements had lower levels of anti-inflammatory substances in their blood as well as a cell progression score. This was in comparison to men who ate classic Western diet UCLA researchers concluded. Slowing down the cell cycle progression (CCP) is important as this may prevent prostate cancers to become more aggressive. Lead author William Aronson, MD from the Department of Urologic Oncology at the VA Medical Center in Los Angeles reports that “men who consumed a low fat diet and took fish oil had lower CCP scores”.

This study appeared in the online edition of Cancer Prevention Research which is a peer reviewed journal of the American Association for Cancer Research.

The study is a follow up to a study that Aronson and his team completed last year where the participants consumed a low fat diet with fish oil for four to six weeks before prostate removal.  The growth of cancer cells in human prostate cancer tissue were compared to a high fat Western diet.

In conclusion, as I say to my clients: learn how to eat in moderation instead of being extreme about anything, since we know that diet and trends are always changings. It’s nice to see what the science actually shows us.


What is ARFID? (July 2014)

In March 2014 I had the opportunity to attend ICED which is the International Conference on Eating Disorders. Out of the many sessions I was planning on attending this session was the one that I was most excited about. This session was presented by Rachel Bryant-Waugh who is one of the key individuals to come up with this new diagnosis.

ARFID is Avoidant-Restrictive Food Intake Disorder and this new term is currently in the most recent edition of the DSM-5. This eating disorder has replaced the term Feeding Disorder of Infancy or Early Childhood and it is not limited to children. ARFID is a diagnosis that can affect kids, adolescents and adults.

The way an individual is diagnosed would be by the following criteria: The client fails repeatedly with weight gain (usually a child is not moving forward on the growth grid), low weight or a significant weight loss over one month. Also the child may have a lack of interest in eating or is bothered by some sensory characteristics of food such as smell, taste, texture and appearance. The second way a person would be diagnosed is that the lack of intake of food interferes with some psychosocial development. The third way is the individual would have a nutritional deficiency such as being deficient in Zinc, Iron, and Vitamin B-12 just to name a few vitamins and minerals let alone protein. The final way an individual would be diagnosed is that the client would require an alternate feeding such as supplementing his/her diet with an enteral feeding (tube feeding) or oral nutritional supplement (Ensure/Orgain).

This diagnosis is not to be confused with anorexia nervosa as the individual does not have a body image issue or is scared about weight gain. The client does not have any weight or shape concerns. The problem is often due to some type of trauma such as the fear of choking or vomiting since this may have happened before. It is also seen that the client may have rumination disorder (regurgitate food).ARFID could certainly turn into anorexia nervosa but the two eating disorders are not the same. The best way to describe this eating disorder is it is associated by energy needs and nutritional needs.

Since this is an eating disorder it is recommended that this client be referred to a registered dietitian who can help address their nutritional needs, find foods that offer a safe texture, smell and consistency. Upon evaluation the client could possibly benefit from therapy during the process of restoring their nutritional status.

Finally it is important to point out that is does not matter what the client is eating, but that the client is eating to improve their nutritional status.

References:
1. ICED 2014 Rachel Bryant-Waugh
2. Bryant-Waugh, R., Markha, L. Kreipe, R. E., & Walsh B. T (2010). Feeding and Eating Disorders in Childhood. International Journal of Eating Disorders, 43: 98-111.

Arsenic in Baby Food and Rice: How safe are they? (June 2014)

As consumers, when we hear about arsenic in rice and baby food we automatically panic and start thinking: What will we feed our babies? I wrote an article in July 2013 and I wanted to write a follow up to that article about arsenic and now its possible effects on baby food.

To refresh your memory, there are two forms of arsenic that exist in the food supply: inorganic and organic. Inorganic is the dangerous toxic form. Research shows that the rice grown in the central states, such as Arkansas where 50% of our rice comes from in the US, has a higher concentration of pesticide. This is due to the higher amounts or arsenic due to the long history of arsenic containing pesticide sprayed on cotton crops in that region. Brown rice has higher arsenic content as opposed to white rice because the arsenic is absorbed in the outer brain and germ layers of the rice grains.

As an American parent we feed our babies cream of rice as the first solid food. I wouldn’t panic just yet, as rice is a main grain (or other food that babies eat.?) In 2012, Consumer Reports disclosed reports of an analysis of rice products which has rice cereals containing inorganic arsenic. These reports showed that the infant rice cereals had five times or more the level of inorganic arsenic found in alternative grains.

Other than cream of rice infants consume puffed rice, stage 2 dinners that include rice and cookies that have rice. Researchers concluded that infants could consume up to two to three servings of rice per day, which is an amount that equals to a cancer risk twice their acceptable level. Researchers recommend babies consume no more than one serving of infant rice cereal and alternate with grits, oatmeal, quinoa porridge, cream of buckwheat. These hot cereals have lower arsenic values. I also suggest this for my adult clients too.

The health effects of arsenic exposure are unknown. One study amongst US children found that for every ¼ cup increase in cooked rice there was a 14% increase in urinary arsenic concentration. The FDA recommends parents alternate rice with other grains as I mentioned above. Some of my personal favorites include sorghum, barley, and farro.

Lastly, concerned parents may want to limit brown rice syrup or rice syrup as the first ingredient even if it says organic. It is important to not say that these are “forbidden foods”, but to have variety in your child’s diet. We always go into panic mode when we hear something in the media and trying to diversify in the most important step.

References: 1. Consumer Reports, November (2012)
2. Rice Consumption & Urinary Arsenic Concentration in US Children, Environmental Healthy Perspectives. MA Davis, (2012)
3. Academy of Nutrition & Dietetics - Amy Jamieson-Petonic RD “ Brown Rice Syrup may want to be limited/avoided”.

Can the Amino Acid L-Carnitine Be Linked to Cardiac Health? (May 2014)

I see clients who bring their medicine cabinet in of supplements in review. Individuals either begin taking supplements as the internet/magazine has suggested as a good idea or to take these supplements after their internist’s recommendations. If you are taking supplement (s) this article will discuss the latest findings on the amino acid called L-carnitine.

The latest research indicates that by maintaining adequate levels of this amino acid then perhaps this will improve the health of the cardiac patient. Carnitine is found naturally in red meat and synthetically as an over the counter supplement. L-carnitine plays a significant role in blood glucose regulation, energy metabolism, in muscle tissue and in the heart’s myocardium. L-carnitine also helps transport long chain fatty acids across the mitochondrial membrane where they become a main factor in energy production which is then metabolized through beta-oxidation.

In the heart, L-carnitine becomes especially important as the myocardium prefers to oxidize long-chain fatty acids for energy. It also removes toxins, inhibits fatty acid accumulation during ischemic events, and prevents cardiac cell death.

Since L-carnitine is important in metabolic pathways, it is touted as a supplement to increase energy, promote weight loss as well as improve athletic performance. These claims have not been supported by clinical research studies. When L-carnitine is used as an ergogenic aid (sports performance enhancer) the research has been disappointing. The research shows that plasma levels increase with supplementation, the intramuscular concentration of L-carnitine doesn’t always increase, and performance isn’t consistently affected.

According to Janet Bond Brill, PhD, RD, LDN, author of Blood Pressure Down! L-carnitine is synthesized in the body from the amino acids lysine and methionine. As a result we don’t need to eat or take it in a supplement form. The average person gets adequate amounts of this amino acid in their diet alone.

Current Research is now reviewing whether the effects of L-carnitine supplementation are promising for the cardiac patient. The latest research shows that having adequate levels of this amino acid in the heart muscle can be beneficial to offer several protective benefits but the verdict is still out if it can effectively treat cardiac disease. Before taking any supplement on your own, I would always consult with your cardiologist or your primary care physician.

A meta-analysis review was done in the June issue of Mayo Clinic Proceedings which shows how a team of researchers evaluates L-carnitine on heart health. The research was done over the last 30 years evaluating 13 clinical trials including more than 3,600 cardiac patients all whom had a history of an acute MI (Myocardial Infarction). The researchers concluded that L-carnitine was safe, cost effective for cardiac patients and reduced mortality from all causes (27%), a decline in ventricular arrhythmias (65%), and a decrease in angina(40%). The research failed to show any correlation between supplemental L-carnitine and reoccurrence of an MI or heart failure.

The researchers also mentioned that this study was not conducted in an aggressive manner. This means that dietary changes were taken into consideration as well as different medications that were used than may have been recommended. It was recommended that further research be done for acute coronary syndrome than the dosage that was used.

It is speculated that the minimum dosage for the 13 trials of L-carnitine was 2 gm day, but the optimal amount is 6-9 gm/day. The exact dosage recommendation remains unclear.

With all of this positive news noted above there is also some conflicting evidence too. Although some people may have positive results with L-carnitine supplementation, it is important to note that a high dietary intake of L-carnitine has been linked with an increased risk of heart disease.

Red meat has been the food that elevated L-carnitine levels. According to Janet Bond Brill, PhD, RD, LDN “L-carnitine is metabolized by the intestinal microbiotia to trimethylamine-N-oxide, an atherogenic substance which increases risk of cardiovascular disease”.

Since this information is all new I would recommend obtaining your L-carnitine via supplementation vs. the dietary choices that I mentioned above. By having a diet that is high in red meat to obtain your L-carnitine research shows that it is not recommended for a variety of reasons.

References:

1. Janet Bond Brill, Ph.D, RD, LDN, Blood Pressure Down! (2013)
2. Oyanagi E, Yano H, Uchida M, Utsumi K, Sasaki J. Protective action of L-carnitine on mitochondrial function and structure against fatty acid stress. Biochemical & Biophysical
3. 3. McArdle WD, Katch Fl, Katch Vl. Sports and Exercise Nutrition, 4th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2012.
4. 4. Koeth RA, Wang Z, Levison BS, et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis, Natural Medicine Journal. 2013;19(5) 576-585.

Eating Disorders and the Aging Adult. How Adults often fall through the cracks with this diagnosis (April 2014)

Eating disorders do not discriminate against sex, cause, whether the person is predisposed, or their age. I have observed in my private practice that once an older adult is referred to me for his or her eating disorder they are at a stage of needing significant help.

Perhaps the doctor assumes the eating disorder was a disease that adolescents have or that the only eating disorders that they currently see are patients with binge eating disorder. By getting to know my clients on a very intimate level I have learned that many of their practitioners don’t always ask the correct questions which could be why the patient has gotten to where they are at today especially the older adult who has anorexia nervosa.

According to the June 2012 International Journal of Eating Disorders Cynthia Bulik, Ph.D reports that “13% of American women 50 years old or old experience symptoms of an eating disorder, 60% report that they have concerns about weight and shape which negatively affects their lives. Finally “70% of 50 year old women are trying to lose weight”.

Many of these aging adults have developed eating disorders due to depression, losing a spouse, becoming an empty nester, financial stressors and following a special diet throughout their life with now learning how to liberalize is a scary thought. For example one woman that I am seeing has been raised watching her cholesterol and now her M.D. asked her to forget about her cholesterol before he referred her to me and eat whatever fat she wanted with any quantities as this has been seen as a “forbidden food”. At the same time she has other food rules and is on medications that have altered her taste buds. She sees herself as fat.

What is one supposed to do? Both men and women who have eaten a certain way throughout their life and as their life has started to unravel, they have developed an eating disorder that has been the coping mechanism which has evolved. When client X has now reached perimenopause she has started to see her body change as well as other aspects of her life change (or certainly in other times of her life). I hear women share with me that they now develop hips, back fat and curves that they never had on their body before. This results in them often times developing food rules and the fear of food. According to my colleague Jessica Setnick, MS, RD, CEDRD she reports that “research shows that perimenopausal women have more eating disorders than premenopausal women”. “Boomers who make disparaging comments about aging have higher eating pathology than those who only engage in negative comments about weight”.

With aging men observing the need to lose weight or becoming addicted to exercise (since they appear rather health conscious) is often how the eating disorder begins. When the patient visits their primary care physician their vitals need to be assessed by identifying if his body temperature is warm enough, and his blood pressure is coming down excessively.

It is also important to identify if he is eating adequate calories. Also if the aging male has bulimia nervosa it is important to not discuss his weight as this can be a triggering mechanism for the patient whether they are overweight, normal weight or underweight.

These clients certainly require additional support not only from a registered dietitian who is skilled working with eating disorders but also seeking out the guidance/support of a psychologist or a therapist. It is important for him/her to have a team to get through this difficult time in his/her life. The registered dietitian can help facilitate a team for these patients to help work through these psychological challenges especially as some of these clients may have always had an eating disorder which just reappeared during these stressful times. As I mentioned before the client had a safe and routine way of eating throughout his/her life and now the individual has had some perceived loss, lack of purpose, or other stressful circumstance that has caused him/her to be required to liberalize their nutritional intake.

References:

1. ADA Pocket Guide to Eating Disorders by Jessica Setnick, MS, RD, CSSD
2. Food & Nutrition Magazine, “Eating Disorders: An Ageless Affliction” January/February 2014 (26/27).
3. Eating Disorders: Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders by the Academy for Eating Disorders Medical Care Standards Task Force.
4. Today’s Dietitian “Eating Disorders in Older Men- Research Indicates Prevalence May Be on the Rise” Mike Bassett, Vol 15, No. 10. P. 22

The Trend of Coconut Oil, Coconut Milk, Coconut Water… Are there benefits or is this “The Trend Du Jour?” (March 2014)

It is hard to not walk into a grocery store and avoid passing various products made with coconut. Whether it is milk, nondairy cheeses, ice cream, oil or we hear Dr. Oz speak about it I couldn’t help myself want to write about this proclaimed “superfood”. It claims to be a protecting agent against Alzheimer’s, speaks about promoting weight loss and we now see athletes drinking coconut water instead of sports drinks. What is all the hype about?

I wouldn’t be doing my job as a registered dietitian if I didn’t educate you on the type of fat that coconut contains. Coconut oil is 92% saturated fat. This is the artery clogging fat which is solid at room temperature. I know you are probably thinking how could this be true? Coconut is natural, falling from trees. Those are true facts.  For over 70 years research has shown the connection between saturated fats and heart disease. The thought has been that saturated fat increases the LDL (bad) cholesterol which will then cause inflammation in the body which then leads to heart disease.  A recent review in the American Journal of Clinical Nutrition (2010) has a theory that saturated fat may not be the culprit in heart disease. There is still much research and debate whether coconut oil may be harmful for your health.

This hypothesis could be derived from the fact that our American culture consumes large amount of saturated fats from meat, butter, eggs and dairy products which all contribute to inflammation. It’s a natural response to assume that saturated fats are not the ideal choice for us. Although coconut oil is high in saturated fat it is also high in a beneficial component known as medium chain triglycerides (MCT’s).  Some experts claim that the benefits of MCT’s outweigh the saturated fat that coconut contains.

Walter Willett, MD, DrPH, Chair Department of Nutrition at Harvard School of Public Health says” While coconut oil raises LDL, it boosts HDL cholesterol, the good kind, better than other fats. Research so far, though is limited, so we still don’t know how it affects heart disease. The ability to boost HDL makes it less bad, yet it’s not the best choice of fat overall for heart heath, as any fat that raises LDL should be limited.”

We might wonder about the claims for relieving Alzheimer’s symptoms? There is no proof on this topic but one theory is that ketones (spilling protein into the urine) may improve the quality of life for Alzheimer’s suffers.  Also the study pertaining to weight loss with coconut oil was used on MCT oil in comparison to olive oil. Once again there is limited evidence to prove that coconut oil can help one lose weight. It comes done to changing their relationship with food.
Coconut water is a great electrolyte replacement source. It does not contain saturated fat and has potassium and less sodium than other sports drinks. It can be used for greater than 60 minutes of any aerobic activity.

Finally there are more effective fats to cook with in place of coconut oil. Let extra virgin oil, canola oil and corn oil be your top oils to cook with. Baking and salad dressings options include: soybean, sesame, flaxseed oil and sunflower are great. Bon Appetite!

What is Orthorexia Nervosa? (February 2014)

We live in a culture that emphasizes eat “healthfully”, “unprocessed foods,” “whole grains”, perhaps gluten free if one has Celiac Disease or if you are gluten intolerant. We are told to eat fresh fruits and vegetables and yes they should be organic right? What about fat? Can I eat fat or should I avoid fat? Then we try to eat lean protein sources and we read about free range, grass fed, organic, or hormone free. I can go on and on about the different trends I hear clients talk to me about. They grow their own produce, won’t dine out unless it’s a vegan restaurant, or gluten free or better yet won’t serve their child anything that is not raw or vegan. Did I mention that they juice all their organic produce? This may sound innocent and healthy but it can turn out to be an “unhealthy obsession”.

Orthorexia Nervosa is a term that was introduced by Steven Bratman, M.D. who has a wonderful book called Healthfood Junkies: Orthorexia Nervosa the Obsession to Eat Healthful. As you are reading this you are probably thinking what is wrong with all of these areas to have in my diet? People with Orthorexia Nervosa become fixated on quality and purity. They become rigid, consumed with the amounts they are eating; and this way of eating takes the pleasure away from eating and can interfere with social eating with friends and family in the real world. Also eating this way can certainly make the person feel superior regarding knowledge and food choices in comparison to others since “they have read so much” and are often the experts even if they don’t have the credentials R.D. after their name.

You might ask as you are reading this, “Is Orthorexia Nervosa an eating disorder?” It is not in the DSMV but it has overlapping qualities similar to anorexia nervosa and bulimia nervosa such as calories and weight that eating disorder professionals in my field do use this term without hesitation.

Perhaps the question has entered your mind, “Do I know someone who has Orthorexia Nervosa?” Here are some questions to ask yourself to determine if they do:

*Will you not eat if the food is not “healthy” when out with family or friends? (If they can’t accommodate your needs)?

*Do you put yourself on a “nutritional pedestal” by eating the way you eat and wonder how others eat the foods that they do?

Are you constantly seeking out the perfect diet? If so, are you on the hunt for new recipes with those nutritious foods?

Do you feel shame when you stray from your “perfect diet”, or if something is not organic or gluten free?

Do you ever wish you could spend less time thinking and prepping food and just enjoy life?

Do you ever think about periodically eating and not worrying about the food quality?

As you can see, I can go on and on as people with Orthorexia Nervosa are not able to be intuitive eaters, or are rarely able to pay attention to hunger and fullness cues spontaneously. This person is often times isolated.

I am not saying that there is anything wrong with eating nutritious or “effective food choices”. When it takes over your life and your family’s life then it is a problem. You would never want it to take over life’s issues where you can’t enjoy your son’s birthday so that you won’t eat the pizza because it’s not raw or whole grain or whatever trend d’jour of the week you are following.

Hopefully by reading this article you will recommend help for that person or yourself.

References
Steven Bratman, MD “Healthfood Junkies” Orthorexia Nervosa”

Are Omega 3’s as Safe as We Think They Are? (January 2014)

A number of months ago there was a big headliner on CNN that taking Fish oil supplements could increase the prostate cancer in men. After this report came out many of my male clients, friends and family members began asking questions regarding this disturbing news. The research began and more information has started to unfold.

In the July 2013 Journal of National Cancer Institute scientists from the Fred Hutchinson Cancer Research Center Analyzed blood center of 834 men diagnosed with prostate cancer with a sample group of men (1, 393 that didn’t have cancer). The results showed these high levels of omega-3s put men at a 43 percent increased risk for developing prostate cancer. The researchers showed hypothesized that the omega-3 may promote oxidative stress instead of discourage which has been shown to be linked to cancer.

To play devil’s advocate omega 3’s are very effective in lowering blood pressure, lipid’s decreasing the rate of heart attacks, protecting from neurodegenerative diseases as well as depression. It has also been shown that fish oil can help with arthritis.

For the time being I would recommend eating your fish and taking a break from the supplement until more information comes out with having a variety of fish to reduction the chances of mercury and radiation. Atlantic fish is preferable and wild instead of eating the same type of fish daily as this can increase your chances of high levels of mercury.

Six Fun Things to Do with Your Scale! (December 2013)

Now that summer is over once and for all, have you surrendered to finally given up the scale? As you are well aware the scale psychologically can make you feel better or worse about yourself and your efforts with food. Here are some fun ideas of how you can have some closure with your scale for good.

  1. Make an art project out of your scale. In my office I have a client-made scale on display and it is one of the most beautiful scales I have seen. My client was ready to trust and listen to her body. What I mean, is that she took some of her “forbidden foods” and made a work of art. This one in particular has a donut glazed under where the number would be and the scale is painted hot pink and covered with wall paper. The borders are lined with cereal and candy which she used to binge on. It then has the word carbs painted above the donut. By decorating her scale, she received the necessary closure, to eat all carbohydrates without feeling like she has “blown it”.
  2. Put positive messages on the scale. This can only work on non-digital scales. This would also require you to take the scale apart so you can put some positive phrases in it. Examples would be “I love myself”, “I am amazing”, “I am fit”, “and I am beautiful”.
  3. Destroy it. Yes you heard me correctly destroy it. I have had clients throw it off the balcony of where they live which I probably wouldn’t recommend as this could be dangerous. This is nice closure as let’s face it you have had a love hate relationship with this part of your life and the scale has not reflected true behavioral changes. I can go on and on, but destroying it is a nice way to move forward.
  4. Donate it. It is a tax right off, so why not?
  5. Put a plant or tree on it. This could work as a nice stand in your home as sometimes those plants don’t get the right height that we want right?
  6. Have a funeral or a good bye ceremony. I know this sounds strange but you have to admit that the scale has served a purpose for you in life or it wouldn’t be a behavior that you would keep practicing. It is like a relationship that doesn’t work. It is nice to see how it has helped you during those challenging times, making easier to say goodbye. Maybe a friend who has some type of disordered eating, and who understands what you have been through can offer some support. It is just a thought.

These are the six ideas of how you can say adios to your scale for good. Hope this helps in your journey to being able to trust and listen to your body.

Eating Disorders and Gay Men… Is this a Stereotype? (November 2013)

The other month I wrote about how eating disorders are growing in the male community. I thought writing about how gay men are affected by eating disorders would be helpful since I see many gay teens and men. Often times expressing their sexuality via body dissatisfaction is their first step via eating disorder is the first way the client feels comfortable communicating that they are gay.

Some studies show that between 20% and 42% of eating disordered males are gay or bisexual. Did you know that 6% of our general male population is gay? There appears to be an unbalanced representation in the male eating disorder population. Furthermore, more than 15% of gay and bisexual men are struggling or have struggled with a body image issue or an eating disorder. It is certain that we are hearing more in research in and the media about men with eating disorders, but this population certainly deserves more attention in the research arena.

In the male gay community when looking at the majority of magazines and billboards the pictures that we see are photos (often times airbrushed) or an increasingly unattainable ideal. In many of my sessions when I was reading the various research articles that I have used as resources for this article I would ask my gay male clients how it makes them feel when they see these pictures? A very similar response of (from my single gay males) feeling competitive needing to look “perfect” cut, with lean ripped abs, defined chest muscles, arms and to be ready at any time to meet somebody. They also feel like living in a gay community that they are on display, having to look fit, sculpted. These clients would feel like they need to eat what they perceive is “perfect” or compulsively exercise to achieve the look that they desire.

In a study by Hospers and Jansen (2005) it was revealed that eating disorder behaviors evolved by body dissatisfaction. For gay males’ body dissatisfaction was influenced by their gay peers more strongly than for straight men. Men who are 30-40 years of age have a stronger increase of developing an eating disorder (particularly thinness, and dieting but not for bulimia) if they are single when trying to find a partner. Another area to take into consideration is the clients past. Often time’s trauma has an impact if they have an eating disorder. A study by Feldman and Meyer (2007) revealed that 53% of those men who shared that they are bisexual and 31% who disclosed that they are gay have a history of childhood sexual abuse. This study also showed a connection between childhood sexual abuse and the development of eating disorders with gay and bisexual males. It is important as a nutrition therapist to keep in mind if the client has an abuse history, since a body image issue may come up.

There are six primary stages that gay men go through when they come out to themselves and to others according to Vivienne Cass (1979). Briefly the gay male’s identity first begins with confusion, and then moves to identity comparison, tolerance, acceptance, pride, with the hope of identity synthesis. It is important to know where the eating disordered client minority is as this will be helpful for the practitioner when beginning to work with the client.

Lastly, for a client to share any of this information it is important for him to establish a relationship with him. He needs to know that he is in a safe non-judgmental environment and that you work as a team with whomever else he is seeing. If he doesn’t have a team, then as a nutrition therapist I for example will find the right people to help him. It is also important to remember that the work with this client may not always entail body image work, as it could be helping him with his feeling about being gay. Regardless he must feel confident with the environment that he is seeking treatment in.

References:
1. Anderson, A.E. (1999). Eating Disorder in Gay Males. Psychiatric Annals, 29, 206-212.
2. Brown, T.A., Keel, P.K. (2012). The Impact of Relationships on the Association Between Sexual Orientation and Disordered Eating in Men. International Journal of Eating Disorders, (45), 6, 792-799.
3. Carlat, D.J., Carmargo, C.A., & Herzog, D.B., (1997). Eating Disorders in Males: A report of 135 patients. American Journal of Psychiatry, 154 (8), 1127-1132.
4. Cass, V.C. (1979). Homosexuality Identity Formation: A theoretical model. Journal of Homosexualty, 4, 219-235.
5. Duncan, D. (2007). Out of the Closet into the Gym: Gay men and Body Image in Melbourne, Australia. The Journal of Men’s Studies, 15 (5), 331-346.
6. Feldman, M.B., & Meyer, I.H. (2007). Eating Disorders in Diverse Lesbian, Gay and Bisexual populations. International Journal of Eating Disorders, 40(3), 218-226.
7. Hospers, H.J., & Jansen, A. (2005). Why Homosexuality is a Risk Factor for Eating Disorders in Males. Journal of Social and Clinical Psychology, 24 (8), 1188-1201.
8. Seidman, S.N., & Rieder, R.O. (1994). A Review of Sexual Behavior in the United States. American Journal of Psychiatry, 151, 330-341.

What are Hemp Hearts and how does it compare nutritionally to Flax and Chia? (October 2013)

Let’s face it when we hear the term hemp whether it be seeds, powder any food or the bag for my yoga mat we think of the cannabis plant don’t we? Interestingly enough hemp foods have become rather popular and they can be nutritionally superior to other Omega 3 &6 fats that we consume.

Hemp foods are used as protein powders, oils and the one that I am going to discuss are Hemp Hearts. Hemp Hearts are great since they nutty, have a slight crunch and can be added to your favorite cereal, salad or yogurt. Sometimes I like to eat them straight from the bag or top a casserole or rice dish with them. They actually are similar in taste to almonds. For 3 tbsp. of hemp hearts we would consume 10 gm. of protein, 10 gm. Omega 3 & 6 fatty acids, and 3 gm. CHO. In comparison to Flax another one of my favorites based once again on 3 tbsp. this provides 5.5 gm. of protein, 4.5 gm. Omega 3 &6 gm. fatty acids and 9.5 gm. CHO. Lastly for Chia seeds the same quantity provide 6.3 gm. of protein, 8 gm. Omega 3 & 6 fatty acids and 12 gm. CHO.

All three in comparison are healthy fats for the heart and great for blood sugar stabilization as well as keeping us physically and emotionally content with meals. The nice part about the Hemp Hearts is that there is that crunch factor with the additionally protein so if you are tired of adding nuts to a meal for blood sugar stabilization this could be a new choice. Do not worry you will not fail any drug testing by consuming Hemp Hearts as there are under 10 parts per million which is confirmed by my favorite brand Manitoba Harvest. They sell it at Whole Foods or on Amazon.com

“Old Talk” vs. “Fat Talk” You Decide Can This Language Be Just as Toxic? (September 2013)

I couldn’t help myself but write an article on this topic as I hear the language that clients use in my office on a daily basis. We all hear our clients speaking in a negative and judgmental manner regarding their body and having various complaints about it. Then we hear bits and pieces about getting older which can be exciting and scary at the same time. I thought this topic would be appropriate as many statements pertaining to getting older mirror negative body image.

When we think of body dissatisfaction what comes to mind are body weight, size and shape. This can be in women and men. The latest research also shows this can also include how we look. As women we hear the analogy that as we age “we wilt just like a flower”or” let’s age gracefully”. I agree men have it better and easier from the aging standpoint than women do as aging does add character, but I still do have men clients that speak about “old talk” as they would about “fat talk”.

There was research done at Trinity University in San Antonio, TX and the University of the West in England. They both used questionnaires to assess “old talk” and “fat talk”, eating disorder pathology and body image disturbance among 914 women (sorry no guys done in this study) aged 18-87 in the US, AU, and the UK. The study concluded that women from all countries engage in “old talk” and “fat talk”. The study also showed that as women age the increase for “old talk” increases.

I think this study has not only opened my eyes as a conversation piece amongst colleagues but with clients. I will ask clients that when they recognize the purpose that their eating disorder has served for them the client will often times respond with not getting older as moving forward can represent that they are aging in their life. Getting older does not always mean that we are getting wiser. Also learning how to not bash ourselves for the time that we have spent engaging in our eating disorder is important to remember. I also let our client know that their eating disorder has helped them through many aspects through their life or they wouldn’t engage in it. Remember being kinder to yourself when you speak about getting older, as I have news for you: I am getting older, too!

References:
1.Becker, C.B., Diedrichs, P.C., Jankowski., &Werchan, C. (2013). I’m not Just Fat, I’m Old. Has the Study of Body Image Overlooked, “old talk?” Journal of Eating Disorders 2013, 1:6 doi:10.1186/2050-2974-1-6
2. www.nytimes.com/2013/02/28 Old booming/old talk-and fat talk

Men & Eating Disorders…A Growing Epidemic (August 2013)

I think our culture assumes that eating disorders are most common among women, especially young girls. This is not necessarily true. As an eating disorder specialist it is very common to have a conversation with another eating disorder professional in our industry and we can all agree that eating disorders amongst, men, boys and teens are certainly growing. I think the difference is that our society is hearing more about it. Of course the media is giving it more attention, whether it is a professional athlete, an actor or your everyday student. Eating disorders do not discriminate. They do not discriminate your age, sex, gender, or sex preference.

Over the last many years my practice has grown with men, boys and young men whom have eating disorders. When I use the title men this may include young boys with body image issues, teens who have full blown eating disorders such as anorexia nervosa, bulimia nervosa, compulsive exercise, binge eating disorder, engage in chewing and spitting or laxative/diuretic abuse. I also see men that engage in the behaviors listed above and that can partake in a combination of the behaviors listed above. Once again our culture often times identifies these behaviors to be only for young women but college age and middle age women can have eating disorders too and I work with them.

Did you know that in the U.S. it is estimated that 10 million males suffer from eating disorders? It is suspected that this this estimate is on the low end to the secret that is kept of the male not coming forward of having an eating disorder. It is thought that this percent is closer to 25%.

Shame is a significant part of not coming forward to having an eating disorder. As mentioned before our culture assumes that eating disorders are most commonly seen in women. Part of this shame is why we see men having their eating disorders come out in their activities. These activities can be body building, running, triathlon, wrestling, horse jockey, race car driver and the latest trend being mobile casino. It is also common that dual diagnosis (more than one addiction or disorder may occur at the same time) such as substance abuse or alcoholism which can take the place of food.

Also our culture tends to have the belief that men with eating disorders are gay. This is a myth. Sure this population may have eating disorders but it is not the case that everyone does. Individuals who are gay may be more prone to have an eating disorder. When a male is in pain they are in pain and males who are at higher risk of developing an eating disorder do not necessarily have a particular sexual orientation.

Men have many of the same concerns that women have pertaining to body image and my work as a nutrition therapist I work very hard at paying attention to what those concerns are. Although on the outside they may look different, the core elements of eating disorders are the same for both genders. It is important to identify the differences when I am sitting with males and to educate our society on these.

I always like to point out, don’t assume that when you see a male who looks very fit that he is very fit. Maybe he has exercise addiction? Maybe he limits fat and over consumes protein? Or when you see an overweight male that he lacks self-care. Maybe he is working on adding food into his diet after abusing laxatives, or maybe working on keeping food down after purging? Everyone has a different story but the key thing is being ready to be ready to want to develop a new and improved relationship with food.

References
1. Dramatic Rise in Men Diagnosed with Eating Disorders www.Huffingtonpost.co.uk
2. ‘Manorexia’ on the Rise: Men with Eating Disorders www.Huffingtonpost.com
3. Namedinc.org

Arsenic in Rice: An Update (July 2013)

Clients have brought up to me should they avoid rice? After watching the scare they heard about on the Dr. Oz show this has brought up ongoing conversation over these last few months that I wanted to address. Consumer Reports first made this an issue in September 2012 when it was released after a study released potentially dangerous levels of arsenic in domestic rice and called for the adoption of regulatory standard similar to those for drinking water.

Like many foods, rice is not bound by enforced arsenic standards, so Consumer Reports used stringent standards for arsenic in water set by New Jersey (0.005 part per billion). By this measurement, total arsenic (organic and inorganic) was discovered in many of the 62 rice products used as the test pool. Twenty-four of those products exceeded the New Jersey standard based on inorganic arsenic levels.

Inorganic arsenic is listed as a Group 1 carcinogen by the International Agency for Research on Cancer, an arm of the World Health Organization. Long-term exposure to high levels of this carcinogen is associated with higher rates of cancer.

Rice, which is grown in flooded areas, absorbs arsenic from soil and water. Seventy-five percent of U.S. domestic crops are grown in the south-central part of the country, an area with a high inorganic arsenic count in the soil. Many of these farms formerly grew cotton and used pesticides and fertilizers containing inorganic arsenic, which has remained in the soil.

These high levels are of particular concern for brown rice advocates. Brown rice, a healthy whole grain has been found to have higher levels of arsenic than white rice. This may be because arsenic is more concentrated in the outer layers of grain.

The Food and Drug Administration issued a response following the release of Consumer Reports’ study and call to action. The FDA did not support the call for regulation, but it did commission a study to determine whether more stringent regulations are necessary. Early results from the discovery phase of the FDA’s study have confirmed the arsenic levels found by Consumer Reports.

Based on data and current scientific studies, the FDA does not recommend that consumers change their consumption of rice at this time, but that people continue to consume a wide variety of grains. Upon completing expanded analysis of rice products, the FDA will determine whether to issue additional recommendations.

Resource: Adapted from March/April 2013 Food and NutritionMag.org (Publication from The Academy of Nutrition and Dietetics)

The Nutritional Benefits of Chia Seeds (June 2013)

Do you remember the commercial with the Chia Pet? I sure do. We are talking about the same seeds. Chia seeds have been around for a long time but seem to be the latest craze. They are an edible seed and come from an edible plant aka: Salvia hispanica. Chia seeds are incorporated into various products from crackers, breads, cereals, drinks, cookies and even marinades!

They contain Alpha-linolenic Acid (ALA) which is the plant form of omega-3 fatty acids which are in flax seeds. Chia seeds contain fiber, protein, antioxidants and what is so wonderful about them is that they last much longer than flax seeds without turning rancid. They also do not need to be ground to have their nutrients be made available to the body as flax seeds do. Chia seeds provide calcium, phosphorous, magnesium, copper, manganese, iron, niacin, zinc and molybdenum.

Chia can be added to cereal, yogurt, salads, and smoothies or added to baked goods. They have a unique sticky gelatinous coating when exposed to liquid. That is how ironically they would have that fuzzy chia pet coating.

There is limited evidence whether chia seeds can help to reduce LDL (“bad”) cholesterol and increase HDL (“good”) cholesterol. The review cites four clinical trials in humans one of which testing 25 grams of chia seeds consumed daily vs. placebo in 76 subjects over 12 weeks. They results showed that there were no significant benefits in weight loss or disease risk although blood levels of ALA were increased. It is too premature to see what chia seeds can do with helping one’s overall lipid panel but I have seen with clients by adding this food to their diet it can’t hurt their lipid values.

Overall by introducing Chia the individual will be adding fiber, healthy fat and many nutrients that they wouldn’t be having in their diet to begin with. It has a nutty taste and is very adaptable. You have nothing to lose by giving it a try.

Understanding SIBO (Small Intestine Bacteria Overgrowth) and the Dietary Management of it (May 2013)

How many of you are familiar with the term SIBO? I know clients bring this term up to me once they are diagnosed with it. SIBO which is also known as Small Intestine Bacteria Overgrowth affects can be responsible for up to the 84% of the IBS cases (Irritable Bowel Syndrome). Did you know that the human got flora has 10 times more bacteria than the body has cells?

Having too much bacteria (which should be located in the colon) can be overgrowing in the small intestines can lead to various digestive symptoms and nutritional deficiencies. The symptoms for SIBO and IBS are similar: flatulence, cramping, constipation and diarrhea, all of which can be frustrating. These gastrointestinal symptoms result from both the high osmotic activity and fermentation possibility of incompletely digested and unabsorbed carbohydrates present in the small intestines.

Both the gas and the produced by the intestinal fermentation and the water drawn through osmosis can contribute to bloating in SIBO clients. The type of gas produced by the bacteria has an impact on the motility on the intestines. Hydrogen producing clients are more likely to experience diarrhea, while the methane producers are more inclined to experience constipation.

Two-thirds of Celiac Disease Patients unresponsive to a gluten free diet and at least one quarter of acute flares in Crohn’s disease patients can be explained by SIBO. This chronic bacteria overgrowth can also be affiliated with headaches, joint pain, depression, hypothyroidism, diverticulitis, fatigue and other chronic conditions, according to Mark Pimentel, MD Director of the GI Motility Program at CSMC and author of A New IBS Solution.

Clients have measured the breath hydrogen and methane levels after giving patients a predetermined amount of Lactulose or glucose to diagnose SIBO. It is also important to know that positive breath tests for lactose, fructose and sorbitol can also indicate SIBO. Once the client is diagnosed antibiotics are given for treatment: (Neomycin & Rifaximin is the antibiotic of choice because 99.6% of it stays in the gut without being absorbed into the bloodstream), therefore reducing side effects and enhancing its efficacy within the gastrointestinal tract.

It is also important to note that clients may experience various nutritional deficiencies. These include having malabsorption induced by rapid intestinal transit time can lead to the loss of macro and micro nutrients. These include: omega-3 fatty acids, and fat soluble vitamins such as Vitamins D, A, K and E. Lastly it is important to point out that having excess bacteria in the small intestines can deconjugate bile acids and interfere with the absorption with the nutrients as well as Coenzyme Q-10 and Beta-Carotene. SIBO can reduce Vitamin B-12 levels and Iron levels which will increase the risk of anemia.

To make dietary changes is important. It is important to be mindful of foods that contain FODMAPs (fermentable olio-,di-,mono-saccharides and polyols) also can ferment in the small intestines and therefore may want to be limited if they induce symptoms in SIBO clients. To limit dairy, sugars, high residue starches and sugar is important. The client will notice an improvement in the bloating and normalization in bowel movements. The brush border will be in the process of being adequately healed to produce digestive enzymes again. It is important to meet with a registered dietitian who can customize meals options based on the necessary dietary changes that must be made.

It is important to spread meals out to eat every three to five hours. This will allow the cleaning process to take place in the gut (MMC) migrating motor complex. It is important to not snack and minimize stress, as Dr. Pimentel mentions in his book, the MMC is reduced by 70% if stress is decreased and can stop SIBO from returning.

References:

1. Pimentel, M. A New IBS Solution. Sherman Oaks, California: Health Point Press; 2005.

2. Siebecker A. Small intestine bacterial overgrowth: clinical strategies (webinar). September 17, 2011. Accessed September 25, 2012.

Supplements and Gluten, aka: wheat (April 2013)

Ever wonder if the supplements or medications you are taking contain gluten? I know this concern comes up with clients that I see who have Celiac Disease. Celiac Disease is intolerance to Gluten. Did you know that accidental gluten can be in certain drugs? Labeling gluten-containing ingredients isn’t medically required, and can be the inactive ingredient (fillers or binders). This would be considered a source of gluten (aka: wheat). It is important to review the ingredient list when the product is over the counter or if your prescription it is not listed ask the pharmacist to see the container that the supplement came out of.

An individual can also review the manufacture’s website for prescription medication if the pharmacist is not able to guide them. Key words to pay attention to include which means starch are: potato, tapioca, corn (these are ok) or wheat may not be identified. Also some tricky words which may be overlooked would include: pregelatinized starch, sodium starch, glycolate, dextrin, or dextrate. It is important to inquire if the above words contain wheat or are potato, corn or tapioca based. When in doubt have the pharmacist call the manufacturer to confirm if the medication/supplement contains gluten.

A book that I like to recommend to my clients with Celiac Disease that lists Gluten Free Supplements is Cecelia’s Marketplace Gluten Free Grocery Shopping Guide 2009-2010 by Matison & Matison. They do a great job of listing all gluten free supplements. Medications are individualized and must be checked out by each manufacturer. Also the website www.glutenfreedrugs.com lists many gluten free prescription drugs.

What is Diabulimia? (March 2013)

Have you heard this term before Diabulimia? It is an eating disorder merging individual with Type 1 diabetes (those on insulin) with bulimia. These patients must take insulin in order to metabolize glucose (sugar) and these patients will intentionally skip their doses of insulin or take less the amount of the prescribed dose of insulin in order to lose weight.

There isn’t much literature published about this eating disorder but it is suspected that this eating disorder occurs primarily in young women and adolescent girls. This doesn’t mean than men and other individuals who are on insulin can’t develop this type of eating disorder. People who have Type 1 diabetes are at risk for body image issues since weight gain often times occurs when they are taking insulin.

Diabulimia is considered very dangerous because it merges the complications from both diabetes and eating disorders. Also one study indicated that people who skip insulin doses are three times more likely to die as a result of diabetes than those who did not skip doses. Lastly, these clients are at risk from the long term complications from hyperglycemia (high blood sugar) such as neuropathy, cardiac disease, CVA’s (strokes) and blindness.

It is also important to mention that Diabulmia falls under the category “EDNOS” (eating disorder not otherwise specified) by the current diagnostic criteria, although many eating disorder professionals and medical professionals consider it to be a type of bulimia nervosa. Currently there is not a diagnostic criteria for diabulimia.

There are not many symptoms for diabulimia. The main symptom is hyperglycemia and of course the patient telling the practitioner that she/he is not taking their doses of insulin regularly due to the fears of weight gain. The skipped insulin dose could lead to diabetic ketoacidosis, which is a potentially life threatening medical condition. It can also be accompanied by other more common eating disorder symptoms such as the obsession with weight and body image. Patients can also experience binging too.

It is important that this patient seek treatment with an eating disorder treatment team in addition to their endocrinologist.

What is Red Raspberry Ketone? (February 2013)

As most of you know (if not all) I do not believe in diets. I have had a number of clients of over the months bring up the topic of Red Raspberry Ketone because they heard about it on Dr. Oz. This supplement claims to be a weight loss supplement.

Raspberry Ketone has the ability to increase the circulating levels of adiponectin. The is a hormone that is secreted from adipose tissue which plays a key role in fat and carbohydrate oxidation. It can also help with anti-inflamatory and antiatherogenic effects (reduce cholesterol from the cells). When there is a high level of adiponectin this is associated with a decreased risk of obesity, insulin resistance (aka: metabolic syndrome), and coronary artery disease.

Research has not been done on humans so as you would all agree the results in the laboratory could be very different then with the human race. The claims that are out all speculations, but I also want to mention that this supplement could interfere with blood thinners such as Coumadin and Plavix.

The claims in my opinion are that this is a diet pill which over time will show can not only be dangerous for those on certain medications, but of course is a temporary solution to changing your relationship with food.

My overall feelings about this supplement is to save your money and put it towards your vacation fund and surrender to “The Diet Mentality”.

The Female Athlete Triad (January 2013)

What is the Female Athlete Triad? Unless you are an athlete or a competitive you may have not heard this term before. This is a syndrome that is composed of three overlapping components. These are reduced bone mineral density, menstrual irregularity (menstrual dysfunction) and low energy availability.

Reduced bone mineral density reflects having a lower than be expected bone density for a patient of that age. A reduction in bone formation and an increase in bone resorption are responsible for the decrease in bone mineral density. There is also an increase in fracture risk which may affect an athlete later in her life.

Menstrual irregularity composes a large range of this triad including the luteal phase defects, oligomenorrhea, primary and secondary amenorrhea. The majority of the irregularity is considered to be secondary to a hypoestrogenic state following suppression of the hypothalamic-pituitary gonadal axis, possibly via leptin and resulting in a hypoestrogenic state.

Low energy availability refers to the energy consumed vs. the energy output. Whether this is intentional or not has a lot to do with the amount of exercise based on the amount of nutrition consumed. When the individual is consciously limiting their caloric intake, it may fall into the department of disordered eating, sporadic eating, to ultimately diagnosing an eating disorder. This disordered eating could be prevalent in sports that encourage a lean body or low body weight.

Management of the female is best addressed with a team approach (it would ideal to have all members or multiple members be experts in the eating disorder field). These members would include a physician), registered dietitian, a psychologist, a coach, parents, trainer, etc.

Prevention of the triad would be ideal. This would entail educating coaches, parents about what to say/not to say regarding food, body image and such as often times the sport/ coaches may bring on the eating disorder due to the pressure to look a certain way, to be faster if you could drop a few pounds, be fitter, etc.

It would be great if screening for the triad would be done for the sports examination. To check if the individual has amenorrhea and if they have had amenorrhea for more than six months or has a sustained stress fracture a bone density (DXA) scan should be obtained. In athletes, the ACSM (American College of Sports Medicine) recommends a BMD Z-Score less than 1.0 suggests further investigation.

An at risk athlete should be referred to an RD for nutritional recommendations. The nutritional goal is to prevent anabolism, increase her calcium intake and Vitamin D. Also her training regimen may have to be altered with reducing her exercise schedule.

The Female Triad effects all ages in athletics. Early screening is necessary to prevent any long term complications, with having a treatment team in development.

Monthly Insights (Prior to 2013)

Can Red Meat be as Heart-Healthy as Chicken or Fish?
When a recently published study regarding red meat announced that consumption can be as effective in reducing blood cholesterol (as much as a diet consuming chicken or fish), the media projected people eating hamburgers. It must be made clear that research was comparing lean red meat to poultry and fish, as well as the portion size (6 oz.) compared to a super sized burger, or thick sirloin steak. Beef provides one of the most concentrated forms of several nutrients including zinc, iron and B vitamins. To consume the same level of zinc, iron and B vitamins found in just one 3 oz cooked serving of beef, as adult would have to consume seven chicken breasts and eight chicken breasts respectively. Beef also contains its concentration of conjugated linoleic acid (CLA), which may have a variety of advantages including cancer protection, and selenium, a potentially powerful antioxidant. CLA is a unique fatty acid found in beef that exhibits powerful anticarcinogenic effects at relatively low dietary levels in animal studies. Studies have found that CLA can inhibit malignant melanoma, colorectal, lung, breast, ovarian, and liver cancers. The lowest cuts of beef and pork will often have “loin” or “round” in their names. For ground beef, choose a package that’s 90% or 95% lean.
3 oz Cooked Meat
calories
total fat (grams)
saturated fat (grams)
90% lean ground beef
169
9
4
beef eye of round
143
4
2
beef top loin
176
8
3
pork tenderloin
139
4
1
pork loin chop
172
7
3
veal loin
149
6
2
veal leg
128
3
1
skinless chicken breast
140
3
1
skinless chicken leg
162
7
2
skinless chicken thigh
178
9
3
flounder
62
1
0
halibut
119
3
0

Remember that having variety, taste and food quality, we should follow a diet that is heart healthy.

Diet and Diabetes

Diabetes and diet are always a topic of discussion, since most of us are acquainted with guidelines to avoid sugar. We experience the fear of the foods that may have to be given up. Understanding the NEW Guidelines is that not one food is restricted.

Our bodies do not care about the source of carbohydrate, rather than the total amount (in grams). Carbohydrates are a category of food that includes sugars and starches. Understanding the various forms is important in seeing why one’s body tolerates some forms better than others do.

Glucose is also known as a single sugar. This is the form that all of our food will be broken into at some point. Fructose is also a single sugar and is better known as fruit sugar. Sucrose is a double sugar. Glucose and fructose molecules hooked together make sucrose. This is also known as table sugar. Lactose which is also a double sugar, is made up of two simple sugars, glucose and galactose. This is also known as milk sugar. Finally there is starch which is hundreds of glucose molecules linked together. Common sources of starch are wheat (pasta, bagels, bread), corn and potatoes.

Upon food being broken down into glucose (the body’s main fuel), glucose enters the bloodstream and the level of glucose in your blood begins to rise. When an increase in glucose is sensed, the body sends a signal to your pancreas. The pancreas then makes insulin and sends it into the bloodstream. Insulin is like a key that allows blood glucose to cross from the bloodstream into the body’s cells. When the glucose is inside the cell, your body converts the glucose into energy. Therefore, insulin effectively lowers the level of blood glucose by letting glucose leave the bloodstream and go into the cells.

In people with diabetes, this system doesn’t work. This is why diet is very important in understanding how to better control the blood sugar. Having any source of carbohydrate that contains fiber will sustain blood sugar longer (fruit with skin, whole grains) compared to white flour refined starches. Also understanding the effects of the different fats in our diet can helpful, because our blood sugar can be better sustained with the right types of fats. Finally seeing how lean protein options can also benefit the control of blood sugar is important to understand.

People who have poor control of blood sugar can eventually cause damage to small blood vessels and complications in the heart, kidneys, eyes and nerves. This also increases the risk for heart disease two to four times and more than doubles the risk of a stroke.

In Summary an individual may want to learn how to optimize control of their blood sugar to prevent long term complications from diabetes mellitus in the future.

Eating for the Holidays

Are you uncertain what to eat over the holidays, since you have been unsuccessful being present when eating? Or are you unclear how to prepare tasty meals that won’t increase your cholesterol?

Healthy eating includes, healthy cooking. Included in this article are tips to decrease the overall caloric and fat content in meals. Planning creamy sauces and dips can be done the skinny way by using nonfat dairy products or using extra firm lite tofu. Tofu has the consistency that be implemented in desserts, puddings, whipped toppings, frostings, dips, dressings, and creamed sauces. Also soymilk and rice milk can be used in place of full fat or reduced fat dairy products.

De-fatting the turkey and stuffing are key components in serving lean poultry. While the bird is resting after being cooked, put the pan drippings in the freezer for 20 minutes and then remove the fat. Bake the stuffing in a casserole dish instead of in the turkey where it absorbs animal fat. Baste the turkey with broth instead of fatty drippings. Finally when preparing Matzo ball soup keeps removing the top layer of chicken fat from the broth.

Roasting your vegetables can enhance the flavor because it concentrates the natural sugars. Cut your veggies into wedges or strips, and sprinkle with fresh herbs and olive oil and bake at 400 degrees for 40 to 50 minutes. Remember that using canola oil instead of margarine, or extra-virgin olive oil for salad dressing would be heart healthy alternatives. It is important to keep in mind that using too much of a good thing can still contribute to the waistline.

When cooking meals, this can be a tempting time to sample meals that may lead to overeating. A key idea when preparing meals is to not begin when hungry. This will likely lead to over sampling of food. Keeping raw vegetables on hand is a handy alternative to curbing one’s appetite.

Dessert is always a hot topic over the holidays. Pies are commonly seen at various events. But why not try to be different this year and serve a fresh fruit cobbler!! Most of the fat and calories in the pie are in the crust, or the added butter mixed with the fruit.

A fresh fruit cobbler is satisfying to your sweet tooth and healthy too. Planning the appetizers for your party can be challenging. Some ideas include hummus (chick pea spread) with pita triangles, or a reduced fat cracker with your favorite low-fat spread. One can be extra creative by fooling their guests with soy cheese and crackers, or soy-veggie dogs wrapped. The traditional fruit kabobs with pineapple chunks, mango, strawberries and melon balls are always a hit.

Modify your traditional holiday menus and recipes to reduce fat, cholesterol and calories. For example:

Original Menu

Leaner Menu

3 oz roast duck
3 oz roast turkey breast
1/2 cup stuffing
1/2 cup rice pilaf
1/2 cup broccoli w/hollandaise sauce
1/2 cup broccoli with lemon juice
1/2 cup jellied cranberry sauce
1/2 cup fresh cranberry relish
1 medium crescent roll
1 fresh roll
1 slice pecan pie
1 slice pumpkin pie
Total Calories = 1205
Total Calories = 730
Total Fat = 55 grams
Total Fat = 21 grams

Click Here To View/Download Additional "Healthy" Holiday Recipes

Importance of a Diet Containing Carbohydrate, Protein, and Fat

Are you confused by the recommended quantities of Carbohydrate, Protein and fat that one should consume in their diet? This article will explain the specific requirements of each, the function and their sources.

CARBOHYDRATES

Carbohydrates are the main source of fuel in the body and are broken down to glucose for energy to the brain and all other cells in the body. They provide 4 kcal/gm, and aid in the metabolism of fat. They contain fiber, which aids in elimination, intestinal health, promotes a sense of fullness, and can regulate cholesterol and blood sugar. They are broken down and digested in one to three hours of consumption. American Heart Association recommends that one consumes 50 to 65% of their total caloric intake from carbohydrates, but newer recommendations include 45-60% of meals. If one were on the more active side, then the higher percentage would be consumed. Carbohydrates contain B vitamins, Vitamin E, Fiber and minerals such as chromium and Selenium. Excellent sources include: Whole grains, breads, cereals, pastas, rice’s, fruits, vegetables, *nonfat or low fat milk products, and *legumes. * contains carbohydrates and protein.

PROTEIN

Protein is also known as the building blocks of amino acids, which are needed for growth and repair of every cell in the body. Protein is needed to create antibodies (for immunity), hormones, red and white blood cells and enzymes as well as help maintain fluid balance in various parts of the body. Protein also provides essential amino acids that the body can’t manufacture on its own and is broken down within three to four hours of consumption. They also provide 4 kcal/gm. Recommendations had previously been 12-20% of the total caloric intake, but newer recommendations are 20-30% of meals. Protein provides B-6, B-12, Iron, Chromium, Selenium, Zinc and Copper. Lean sources include: skinless boneless poultry, fish, pork tenderloin, lean cuts of beef (eye round, top round, round tip, top sirloin, tenderloin), soy, egg whites.

FAT

Fat is our friend, not the enemy that it’s been portrayed out to be. Fat is the primary carrier of flavors in food, provide and store fat-soluble vitamins, A, D, E, and K, and is necessary for DNA synthesis. Fat is needed for temperature regulation, and supplies essential fatty acids necessary for healthy skin, hair and nails. Fat triggers us to feel full and stop eating. Fat provides 9 kcal/gm and recommendations are 20-30% of the total caloric intake. The three types include Saturated, Monounsaturated, and polyunsaturated fats. Saturated fat is the “bad” fat, solid at room temperature, and is animal based which can elevate one’s lipid panel. Butter, lard, cream cheese, creamy salad dressings, fat in poultry, meat and cheese and hydrogenated fats are ones to avoid. Mono- and Polyunsaturated fats are the “good” fats which are plant based and liquid at room temp. Examples include olive oil, canola oil, avocado, peanut butter, and cashews.

The above key nutrients are important for one to consume for optimal health, satisfaction with meals, and adequate intakes of vitamins and minerals. In a society that is obsessed with diets and dieting it is a struggle for the consumer to know which nutritional information is accurate.

Truth Regarding Low Carbohydrate Diets - How it Will Affect My Lipid Panel

An estimated 50-70 million Americans go on diets each year. Many of these same people will go on a diet the next year. And again the year after that. For many, this represents a cyclical pattern of yo-yo dieting that does our physical and emotional health little good.

The lowdown on carbohydrate-restricting diets has a rationale something like this: Eating carbohydrates increases blood sugar, which increases insulin secretion that causes excess insulin in bloodstream. This causes an increase in hunger, making you eat more, and increases the conversion of carbohydrates into fat. This then increases body fat.

Some parts of this rationale are fact, while others are fiction. FACT: Consuming carbohydrates will increase your blood sugar level, temporarily. This is a normal response to eating. An elevation in blood sugar will cause your pancreas to release more insulin into your blood stream. This too is normal. The insulin will help to bring blood sugar back into a normal range. In some instances, blood sugar and insulin will increase to abnormally high levels. Foods with a high-glycemic index will result in an exaggerated increase in blood sugar, and as a result, a higher than usual increase in insulin. People who are insulin resistant generally also will have an increased insulin response, regardless of blood sugar level.

FICTION: The exaggerated insulin response does not result in a significant conversion of carbohydrates into fat. Although, many animals- pigs and cattle, for example-fatten up quite easily on carbohydrates, humans have a very poor capacity for turning carbohydrates into fat. It is not primarily carbohydrates in your meals that get converted into body fat. The carbohydrates that you eat are, for the most part, either burned as fuel or stored in your muscles and liver for later use. It is the fat in your meal that gets converted into body fat.

Researchers at George Washington University Medical center and the National Institutes of Health placed 24 overweight men and women on the Atkins diet for eight weeks. Body weight was measured before and after, and blood samples were drawn and analyzed for cholesterol, free fatty acids, and uric acid. Conclusions of the Atkins diet may elevate total and LDL (bad) cholesterol, particularly in women. The diet also lowered HDL (good) cholesterol in women, as well as increase the ratio of bad to good cholesterol, especially in women. The nearly 50 percent increase in LDL/HDL cannot possibly be considered a good thing- regardless of weight loss. The Atkins diet also increased blood free fatty acid levels, which increases the risk of irregular heartbeat and diabetes. Furthermore, the increase of blood uric acid levels may be hazardous to joints and kidney function. This diet may result in weight loss over the course of a least eight weeks if strictly followed.

What should be considered is the actual amount of fat and protein consumed during the diet did not change all that much from their usual diet. In fact, total fat intake actually decreased a bit. The only major difference was that carbohydrates were virtually eliminated from the diet. So, one possible conclusion from this study is that the unfavorable cholesterol changes were due not to the relatively high-fat nature of the Atkins diet, but rather to the fact that the diet is low in carbohydrates. The study indicated an important role for dietary carbohydrates in cholesterol control.

To Be or Not to Be Vegetarian?

Much controversy has developed since the Dean Ornish Study that was published in the Journal of the American Medical Association (1998;280:2001-2007). People are confused with what they should eat if they have coronary artery disease. “Should I eat a high carbohydrate diet?” “A vegetarian diet?” or “maybe a high protein diet?”

The first thing that needs to be evaluated is that a lifestyle change needs to occur. No fad diet is the answer to resolving your lipid problem or heart disease. According to the American Heart Association guidelines, one can begin with a Step I or Step II diet. The Step II diet is the more stricter of the two and consists of no more than 30% calories from fat and no more than 7% of those calories from saturated fat.

Realistically, most people will not make radical changes in their diet to become a vegetarian. People will be more likely to eat vegetarian meals and increase their overall intake of vegetables and fish. But according to a response from the Ornish study, “if people make moderate changes they are likely to get worse. If they are willing to make bigger changes, they are likely to get better and better”. I believe decreasing your intake of saturated fats, and including more monounsaturated fats and polyunsaturated fats in moderation will decrease many weight and cholesterol levels and in opening blocked arteries. Method of food preparation is of high importance as well. Heart healthy methods such as baked, broiled, grilled, roasted, BBQ, and steamed are ways that we can acquire good tasting food, while cutting the fat.

Using the Non-Diet Approach for Treating Binge Eating Disorder (BED)

Many of us are familiar with the terms Anorexia Nervosa, and Bulimia, but the eating disorder, which is in the younger stages, is called Binge Eating Disorder (BED). This article will discuss the diagnostic features of BED and treatment using the non-diet approach.

Binge-Eating Disorder is classified as having binge episodes occur, usually among the overweight population on average a minimum of twice per week for a period of six months. The symptoms do not occur concurrently with Anorexia Nervosa or Bulimia.

BED is more prevalent among women compared to men, and one may have self-esteem issues relating to their body, relationships with others, with their job, and positive feelings about themselves. Some may have prevalence with Major Depressive Disorder, Personality Disorders, and Substance-Related Disorders.

Many individuals with this form of disordered eating have gone various routes with losing weight. These may include fad diets, pills, and feel they have tried everything except identifying their behavior. The non-diet approach teaches physical hunger vs. mouth hunger and does not focus on the result of weight loss. It focuses on improvements of self-concept and body image, and not classifying foods as good or bad (AKA: forbidden foods). Learning how to work on internal vs. external hunger cues and body dissatisfaction is a key part of the non-diet approach. Also being able to understand that it is the non-hunger eating that one is engaging in, NOT eating “bad” or (ineffective) foods that cause weight gain.

As one progresses towards this approach learning how to focus on eating in response to physical hunger and normalizing feelings about food are key areas. Also size acceptance is an area that one needs to identify with and having their goals be realistic per their bone structure. Also, each approach is very individualized, so one must work with a Registered Dietitian, who can tailor this approach per each specific lifestyle.

Long-term outcomes show that traditional weight-loss diet programs have not been successful because of psychiatric disorders. Cognitive behavior therapy (CBT), interpersonal psychotherapy (IPT) and antidepressant medications have been the routes most commonly used. By using the non-diet approach in conjunction with therapy, long-term results will be more promising than going the route of the “quick fix” to temporary weight reduction.

Using the Non-Diet Approach with the Addiction Patient (December 2012)

As we approach the holidays many individuals find that their addictions come to the surface. Whether they are dealing with relationship issues, work issues or whatever issue has led them to use and abuse many of you know I see people with body image issues/eating disorders whom also have drug and alcohol addictions.

I recently gave a talk on how I work with this population. I wanted to share a snap shot with how I address using the non-diet approach and the addiction patient. I always let the client know that the number one goal is for them to remain clean and sober. Everything else is secondary.

I have an acronym which is what I share with all of my addiction clients:

  • AA
  • BB
  • CC
  • DD
  • AA

Adjust attitude is what “AA” stands for. The client has to have their head be in the correct place before we even meet or anything we speak about won’t be very helpful. This brings up various myths they have centered on diets, carbohydrates, protein and fats. If the individual is not open then our session will not go very far. This tends to be a time that I clarify misconceptions they have which may allow them to be open to introducing some other foods into their diet.

I let the client know that I am working at the place that feels right for them. This is not about me.

BB

Begin biological eating. This is very scary for many people as they notice that they may feel hunger regularly since they are not using and abusing. We speak about how metabolism works and I will typically start them with Mechanical eating to help them reconnect to the internal wisdom that they were born with. Sometimes that individual experiences more “mouth hunger” due to the fact that when they are in meetings, or sitting in therapy/with their sponsor they can be triggered which may increase the desire to eat. We discuss how they know if it’s “real” hunger or not.

CC

Consider cravings can also be scary especially if the individual believes they are always craving a specific food such as chocolate! We discuss that after going through detox it is common to have more sweet tooth cravings and since this may happen it is important to have meals “real meals” not shakes or bars but three meals with two to three snacks per day all containing protein, carbohydrate and fat. If an individual doesn’t have enough fat they may notice that they are hungrier sooner or if there is a suboptimal amount of protein then they may notice that their sweet tooth craving is stronger. Also if the person is not eating carbohydrates chances are they will have a stronger sweet tooth craving too. I like to recommend high fiber whole grain complex carbohydrates as they will satiate the individual sooner and sustain them longer resulting in less searching for “play food”.

DD

Anyone who knows me or who has worked with me knows that I am not supportive of diets. Don’t Diet is what “DD” means. This comes down to being ready to being open to develop a whole new relationship with food. This will not be a quick fix and as I would tell any client substance/alcohol abuse of not they have to be in the right frame of mind and truly be at their bottom to want to change. I would imagine that they hear this from their sponsor or psychologist and it is the same with food. Wouldn’t it be nice to eat what you want without remorse or shame with feeling comfortable and confident in your body? Or to be able to make food choices freely without obsessing about calories, carbohydrates and/or fat? Learning how to get back to that place of being an intuitive eater is what “DD” is about.

These are just a few of the principles I take my clients through who have addictions/ eating disorders and disordered eating when they are ready to break away from the diet cycle.

Juicing: From Detoxing to weight loss, what is the hype? (November 2012)

Many people struggle to eat fruits and vegetables and it seems that the rage has increased beyond green powders to juice bars all over town. We hear the term “cold pressed” amongst others and it sounds very inviting to have that fresh squeezed kale, cucumber, lemon, parsley juice perhaps with a splash of apple as many of us can’t tolerate the straight vegetables.

The term juicing for many people may be synonymous with fasting where as I always emphasize to my clients it may be more physically satisfying and emotionally satisfying to have a solid meal than a liquid meal. Juicing can be great to “sneak” different types of produce into your diet that you would not ordinarily eat but to “detox” is unnecessary. Having a fresh juice is wonderful to work in especially if you see this as your only way to obtain variety in your produce intake.

Many people do not realize that by increasing their fruit and vegetable intake they may experience gas, bloat or diarrhea; well at least in the beginning. The other situation is that if you are on a blood thinner such as Coumadin or Plavix having large amounts of vitamin K foods (kale, spinach, rainbow chard, collard greens) may affect your protime if you do not consume on a regular basis.

For those of you that see me in my office or work with me professionally it is known that I like to help people learn how to develop a healthy relationship with food. I don’t believe detoxing, “juice diets” are long term approaches to help one change their outlook with food and I do not endorse them. I do however like to suggest everything within moderation and if you are craving juice fresh squeezed or not, to have it. On this same topic buying pasteurized juice drinks such as Odwalla, Naked Juice, Trader Joes, are great options because many of them do provide fiber and they will be more sustaining then a “cold pressed” or “expeller pressed” juice. Also all of the nutrients will still be there. They will not be lost.

For those of you that like to juice your own produce please make sure you wash your fruits and vegetables thoroughly before juicing it. Don’t forget that fresh juice can develop harmful bacteria faster than pasteurized juices, so it would be recommended to consume it immediately. You can always add yogurt (non-dairy options also: rice, almond, soy, goat, sheep, coconut) or milk (non-dairy options: rice, almond, soy, hemp, flax, coconut, potato).

Living in Southern California we can always take advantage of our wonderful produce. If it is difficult for you to consume it whole, remember you can always juice it, make a smoothie or go to one of the many fresh pressed juice shops around down.

Disney Characters are having a makeover via Barneys New York (October 2012)

Yes you heard it correctly through the title that The Walt Disney Company has teamed up with Barneys New York in preparation for mid-November and fashion week. When I first received this email towards the end of summer I was beside myself to think that characters that I have adored my entire childhood will appear in these new photos as having eating disorders or problematic body issues. That is visually what it looks like to me. Disney characters are being transformed into tall bony supermodels. Is this really necessary?

The theme is called “Electric Holiday” and the premise is supposed to be about fashion week and how Minnie Mouse has a fantasy in Paris with Mickey and other characters looking very trendy. If you examine the pictures of the characters more closely you might agree that it appears that they need to increase her calories if you ask me.

This doesn’t seem like a good idea for kids as kids begin to idealize characters at such a young age and want to be like the characters that they admire. They want to dress like their favorite idol, have hair like them, and of course have their body be like theirs too. I could go on with other areas that kids idealize but I do know that this topic has stirred up a hot topic amongst me and my colleagues.

Being a nutrition therapist who specializes in eating disorders and eating disorders I hear kids daily speak about their role models. Couldn’t Barney’s put some designer clothes on Mickey, Minnie and Goofy without changing their shape? Before you know it their food choices will be made public and kids will not be eating what they enjoy eating and they will feel like they need to diet. This will increase the shame and guilt when kids are eating their favorite foods since my favorite Disney Characters doesn’t eat that food. He or she only eats low fat and diet products. This isn’t a good message for kids. This will develop into future food and body image issues.

This is important for the public to be made aware of as there are websites that one may write how they feel about this new campaign. Google this topic and see the pictures for yourself.

Diet & Thyroid Health (September 2012)

I often times have clients ask me if there are food that can support their thyroid? This can be tricky as it is most important to have their endocrinologist or internist regulate their thyroid if the individual has hypothyroidism or hyperthyroidism.

The Thyroid Gland is described as a butterfly shaped gland about the size of a walnut which weighs less than an ounce, sits above the Adam’s apple and is part of the endocrine system. The thyroid gland uses dietary iodine to produce the hormones thyroxine and triiodothyronine, which is also known as T3 and T4. Thyroid hormones affect every cell in the body from protein synthesis and enzymatic activity to playing a critical role in the determination of energy expenditure. An overactive thyroid can result in weight loss and in some people excess bowel movements. An underactive thyroid gland which results in hypothyroidism may be associated with weight gain and frustration. I often times hear clients ask me if they should have their thyroid check due to their weight gain but it is actually their relationship with food when everything has checked out fine.

As many as 30 million Americans may be suffering from undiagnosed or misdiagnosed thyroid conditions. A particular concern is women who have a higher occurrence of thyroid disease than men and whose symptoms such as fatigue, weight gain, irregularity with bowel movements, menstrual irregularities, depression and anxiety are not diagnosed as thyroid disease. The most common cause of hyperthyroidism is Grave’s disease and Hashimotos Disease is the most common cause of hypothyroidism. Both are autoimmune diseases.

Cruciferous vegetables, sweet potatoes, and soyfoods contain goitrogens which interfere with thyroid hormone production or utilization. Goiter can be a response to an overactive or underactive thyroid gland. Unless there is an Iodine deficiency, these foods are of no clinical significance according to the Institute of Medicine. Goitrogens are inactivated by heating and cooking. The potential exception is millet. The nutritious gluten free grain may suppress thyroid function even with people who have adequate iodine intake. It may be wise to eat a different grain if a dietary recalls indicates frequent millet consumption.

Clients will also speak to me about their supplements and calcium intake. This is important to tie in with thyroid health. Calcium supplements have the potential to interfere with proper absorption of thyroid medications, so patients must consider the timing when taking both. It has been recommended that calcium supplements and thyroid medications are spread out by at least four hours. Also coffee and fiber supplements lower the absorption of thyroid medication, so patients should take them one hour apart. Also Chromium picolinate which is marketed for blood sugar and weight loss impairs the absorption of thyroid medication. If a patient chooses to take it they should take it three to four hours apart from their thyroid medication.

If the patient has hypothyroidism this would result in the patient pay closer attention to their hunger and fullness signals. This individual has noticed that they have the tendency to gain weight and since it really comes down to learning how to develop a healthy relationship with food, it is important that the patient does not feel like they are depriving themselves.

For the patient who has hyperthyroidism this patient most likely will feel hunger more often since metabolically they are burning off faster the nutrition they are taking in. Their energy needs are actually increased 50-60% in this condition and 10-30% in mild cases.

Overall the patient with a thyroid condition must have their thyroid regulated by their doctor before they address their nutrition and “joyful movement”.

Vitamin D and Screening for Kids (August 2012)

According to John Hopkins Children’s Center Vitamin D deficiency can be a problem year round, but because sun exposure is critical for Vitamin D synthesis and production, the winter months may further exacerbate what is now a recurrent problem.

Levels at or below 20 ng/mL are considered suboptimal. Levels below 15 ng/mL define deficiency and should be treated with supplementation.

Experts from Hopkins say that pediatricians should screen all children for risk factors and order blood tests for those that are high risk. Children at high risk for vitamin D deficiency include the following:

  • *those with vitamin D-poor diets
  • *obese children
  • *breast-fed infants because breast milk contains minimal vitamin D
  • *those with certain medical conditions including cystic fibrosis, IDDM & NIDDM and certain gastrointestinal disorders such as IBD which can interfere with absorption
  • *those with darker skin because darker skin synthesizes less vitamin D from sun exposure than lighter skin.

Several large scale studies have found that vitamin D deficiency is widespread- one in 10 US children is estimated to be deficient and that 60% of children have suboptimal levels of vitamin D. Prolonged and untreated vitamin D deficiency can affect multiple organs and functions, including bone growth and density, metabolism, the heart and immunity. It rarely causes symptoms that will go unnoticed.

Vitamin D deficiency in childhood can cause skeletal deformities, brittle bones, frequent fractures and lead to premature osteoporosis later in life. The positive news is that once detected, vitamin D deficiency usually can be corrected with high dose supplementation. The American Academy of Pediatrics recommends all breast fed infants receive supplemental 400 IUs daily until they’re weaned and start consuming vitamin D fortified formula or other foods. The recommended daily intake of vitamin D is 400 IUs for children younger than 1 year, and 600 IUs for those older than 1 year.

Food sources that are great sources of vitamin D include: sardines, egg yolks, vitamin D fortified orange juice, cereals, yogurt cheese and vitamin D fortified milk.

How Does Krill Oil Supplementation Compare to Fish Oil Supplements? (July 2012)

Obtaining our Omega-3-fatty acid intake tends to be easier than we think. One can take 1-2 gm of fish oil via supplements or consume several servings of fatty fish per week. What about Krill oil for n-3 fatty acids? This has become a hot topic lately.

N-3 fatty acids may include alpha-linolenic acid (ALA), which is mainly from plant sources, EPA and DHA which are from marine sources (fish and algae) as well as supplements. We typically fish oil supplements containing 180-300 mg EPA and 120-200 mg DHA per 2 capsules.

Krill oil has become the trend and people inquire where krill is from? Krill is the oil from shrimp-like crustacean that feeds off algae in the deep ocean waters which is a significant food source for animals high up on the food chain such as whales, seals and fish. Krill oil does contain both EPA and DHA, but does have a small amount than fish oil.

Patients have asked me if they can reduce their triglycerides with krill supplements. Consuming EPA/DHA supplements have been shown to reduce triglycerides (>200). Together, DHA and EPA are associated with lower risk of fatal cardiac events, and DHA is associated with lower risk of atrial fibrillation. EPA, but not DHA, is associated with lower risk of non-fatal risk cardiovascular events in some studies. Overall, the review noted, studies of EPA and DHA separately are relatively limited to date. The US Food and Drug Administration advice that no more than 3 gm of n-3 fatty acids per day be consumed as this may cause gastrointestinal symptoms.

The 2010 Dietary Guidelines for Americans average intake of seafood in the U.S. is approximately 3.5 oz./wk. the guidelines recommend increased consumption of two servings of fish per week (4 oz.=one serving) due to the range of nutrients fish provide in addition to DHA and EPA.

Since there is a lack of information regarding krill oil supplementation at this time it would be most effective to continue with omega-3 fatty acid supplementation until there is more evidence that this would be the way to go from a coronary artery disease perspective.

Protein Powders (June 2012)

Clients are always bringing their containers of protein powders into my office. They come in various varieties such as whey (dairy based), soy, eggs (usually from the whites), rice and then from peas or hemp. Before recommending a protein powder it is first important to assess if the individual actually needs one and next I always like to suggest that the individual chews their food instead of drinks it since we tend to get satiated sooner and satisfied longer when we are chewing instead of drinking our nutrition. I am going to discuss the various types of protein powders.

Dairy Based

Casein and whey protein are both derived from milk. Whey protein in the most common protein powder sold since it is easily absorbed and does help to build and maintain muscles. It is found in a concentrate or an isolate form. Whey protein isolates are readily available because it is less expensive and does contain 30%-85% protein. The whey protein isolates contain a minimum of 90% protein and provide 24 gm per ounce. The isolate form is more easily absorbed but is typically more expensive.

Casein is a milk protein isolate known as caseinate that provides 22 gm of protein per ounces and takes longer to digest than whey. A 2011 study in the American Journal of Clinical Nutrition found casein supplementation didn’t stimulate post workout muscle development as effectively as whey. Also, a 2007 study in Amino Acids found the combination of both casein and whey to be more effective in improving body composition and muscle strength.

Since Casein and whey are derived from milk they are not recommended for the individual who is lactose intolerant or who have milk allergies.

Soy Based

This protein powder is appropriate for the individual who is lactose intolerant, vegetarian, vegan or wants to limit their dairy intake. It is composed of soy flour. It is available as an isolate or a concentrate, although the isolate form is purer and more expensive and provides 15 gm protein per ounces. Studies have shown that soy protein helps to lower LDL cholesterol. Clients may express their concerns by consuming soy due to the estrogen like hormones that they contain, but studies have determines up to 60 gm of soy per day is safe.

Additional Varieties

Many of my clients are not familiar with other varieties of protein power. This is why I thought this next section was important. Of course there is the obvious of egg white protein powder which is free of saturated fat and cholesterol and is easily absorbed. It does contain 21 gm of protein per ounce. Next is rice protein which is derived from brown rice and contain 18 gm of protein per ounce. Pea protein contains 20 gm per ounce, while hemp protein provides 12 gm protein per ounce. Rice, pea, and hemp (these are all plant based powders) have essential amino acids added) and are effective for those with food allergies, limited diets and who are vegan/vegetarian. I will also mention that the above protein powders (pea, hemp) do have a harsh smell and the taste is acquired too. I would recommend adding fruit to your smoothie and a vanilla flavored beverage (almond, rice, and soymilk) to make it more tolerable if this is the one you select.

How much protein do we actually need?

The Recommended Dietary Allowance for protein is 0.8gm/kg of body weight. On average this amounts to 56 gm/day for men and 46 gm/day for women aged 19 and older. Most individuals can obtain this amount of protein from their diet alone and usually do not need to supplement with a protein powder. Typically protein powders/supplements aren’t needed for people who exercise a few times per week for an hour or less.

It is important to note that consuming too much protein can lead to dehydration and is contraindicated in those with renal issues. Side effects of large doses include: nausea, thirst, cramps, headache, bloating and upset stomach.

Milk…The Sports Drink? (April 2012)

New Research on milk suggests that it could be cheaper than and just as effective as other sports nutrition products. Can milk give up what we need to attain maximum performance?

Recovery

After your workout, your body is in a state of stress and needs adequate nourishment. Typically after exercise your body is dehydrated, insulin levels will be low, cortisol and other hormones will be high and your fuel stores (glycogen reserves) will be depleted. Your recovery nutrition should reverse all of the above to restore to a rehydrated refueled and recovered building state.

Milk Research

In 2004 US scientists from Virginia Tech published one of the first studies comparing the effects of milk and a carbohydrate electrolyte beverage, consumed in the immediate post workout period. The study compared 19 men consumed either milk or a carbohydrate or a carbohydrate electrolyte drink immediately following each workout, during a 10-week resistance training program. The authors concluded that the milk group tended to increase muscle mass but the gains were not significant. They suggested that more extensive training and supplementation would expand the trend for greater muscle mass in a milk group.

In 2007, Canadian scientists evaluated the long term consequences of milk, or soy protein, or carbohydrate on muscle mass after resistance training. Subjects trained five days a week for 12 weeks and were given beverages consisting of fat free milk, fat free soy protein, or a carbohydrate within an hour after the training sessions.

In the study there were no differences found in the strength development between the groups. The researchers determined that the type II muscle fiber increased in all groups; however it increased the most in the milk group. Muscle mass gains were significantly greater in the milk group when compared with both soy and control groups. They concluded that the consistent consumption or milk after strength training can promote greater muscle growth when combined with strength training.

Endurance and Hydration

The effects of milk have also been shown to aid recovery from endurance exercise. Scientists from Indiana University suggest that chocolate milk is an effective aid between two exhausting sessions of exercise.

In their study, non-endurance trained cyclists performed interval workouts followed by four hours of recovery and then another endurance trial to exhaustion. After the first exercise session, subjects consumed a post ride recovery beverage of either chocolate milk or carbohydrate or electrolytes. Time to exhaustion and total work were significantly greater for the chocolate milk compared to the carbohydrate electrolyte group. This indicates that in addition to promoting a greater muscle growth adaptation in a strength training group, a milk recovery drink can also improve performance on a subsequent endurance bout.

Research has also shown milk to be an effective rehydration drink. Subjects consuming milk with added sodium post training actually remained hydrated longer than when they consumed sports drinks or water.

Conclusion

Does this mean we should toss out our sports drinks? No! But it will allow those on a budget and individuals who want to consume adequate nutrition to be able to replete their muscle and tissue stores without breaking their wallet.

Binge Eating Disorder: The Most Common Eating Disorder (May 2012)

When it comes to the holidays and special occasions over-eating has become “normalized” as part of the American culture, but for those who struggle with binge eating disorder (BED) their relationship with food has evolved into a way of numbing out or escaping from reality usually dealing with unpleasant feelings.

According the Binge Eating Disorder Association (BEDA), BED is more common than anorexia nervosa (AN) or bulimia nervosa (BN). Did you know that BED occurs in 1 in 35 adults in the U.S.? This is equivalent to 3-5% of women (About 5 million) and 2% of men (3 million) who seek treatment.

Binge Eating Disorder is a set of behaviors that are used to protect and serve as coping mechanisms for the individual. These include having a large amount of food in a short period of time, often times being isolated and with high levels of shame, guilt and distress about binging in the first place. The disorder is not only rooted in genetics, but environmental factors may also play a role. Food is used to deal with stress, poor self-esteem, personal issues, weight issues and bullying. They can also coincide with un-treated and treated psychological issued such as depression, anxiety, bipolar, etc.

Binging often becomes an everyday occurrence/ritual with especially having increased discussion around “body talk”; holidays can increase the anxiety for the individual which are often seen as triggers.

BED will be recognized as a separate and distinct eating disorder in the DSM-V publication beginning 2013 as anorexia nervosa and bulimia nervosa have been recognized.

When an individual is focused on losing weight, recovery is not able to be sustained since the core issues are not being addressed. It is important to create a treatment team amongst a psychologist and a registered dietitian (also known as a nutrition therapist) (the client may be seeing a psychiatrist and of course their physician). A nutrition therapist is a registered dietitian (R.D.) who helps individuals work with their thoughts and feelings centered on food. They will help the individual create a road map and/or a meal plan in which they feel as if they are consuming their safe foods while being able to learn how to listen to their hunger and fullness cues. The client will also learn how to eliminate food rules, diets and counting calories with being able to address mindfulness and desires around food. He or she would ideally be able to use their intuition and knowledge to make food choices confidently and eat without experiencing shame.

Resources: www.bedaonline.com & www.something-fishy.org

What is the Role of the Parent and their Teen? (February 2012)

As your teenager starts exhibiting autonomy, parents will often times ask me how they can be involved with their teenager’s meals. This age group seems to “be forgotten” as infancy and early childhood parents receive so much direction pertaining to nutrition that this time in their children’s life tends to be skipped.

The first piece of advice I would provide would be to have regular meal times at your home. If you’re teen is not available then keep leftovers or a plate in the refrigerator for when they do arrive home. It is important for parents to ask questions and explore choices with their teens in a non-judgmental way regarding the types of foods they would like to have in the house.

Having a weekly family meal together is still a great expectation to have with your family as it shows that family time is important and this is a time to catch up. This is a time for conversation without television, texting, computers or other activities. This is not about placing judgment about what your teen is or isn’t eating. They are able to decide for themselves what they would like to eat based on the options that have been offered at that meal.

When food becomes a conflict in the house between the child and the parent then it is time to consult with a registered dietitian. It certainly has to come from the teen that they would like to see a registered dietitian instead of being an ultimatum.

Food for Thought…Fish (March 2012)

Fish can be a confusing topic; there is Dover Sole and Grey Sole then there is Atlantic salmon and Alaskan Salmon another example is Wild-caught striped bass and Striped bass. The main difference between two similar fish is the Atlantic Ocean, the Pacific Ocean or somewhere else tropic and exotic from around the world. We then think about wild and farm raised and become even more confused. Many of us are concerned for nutritional reasons as others are interested in the potential contaminants. It is difficult to know what we are actually getting from our fish.

Clients often ask me: “What is better farmed raised fish or wild fish?” I will explain the difference. Farmed raised fish are raised in controlled environments in “pens” with other fish and are fed with pellets of food. Wild fish live freely in an open body of water and feed on plants, fish and insects. Farmed raised fish are colored with PCB’s which is the red/orange color dye that gives the fish the color (salmon) which we are used to seeing them as. Farmed raised fish costs less and has a stronger flavor and is often times fattier.

Both kinds of fish have pollutants. Ocean fish do not contain the PCS’s or other antibiotics just like the farm raised fish do and may have fewer pesticides but farmed fish is better regulated from the stand point in pollution. Wild caught fish typically have higher levels of mercury as they are not in the controlled environment that farmed raised fish are in. The benefits outweigh the negatives about fish and the majority of fish do contain mercury. Typically larger fish have higher mercury levels. I like to recommend the mercury fish card from the Monterey Bay Aquarium Seafood Watch Program. It is wallet size and lists the fish which are more endangered but also lists the fish which are lowest and highest in mercury.

There is no right or wrong way to have fish as it is a matter of taste and your health concerns. To make your fish journey less complicated when you are at the grocery store of fish market here are a few simple questions to ask:

  • Where does this fish come from?
  • Has it been previously frozen?
  • Is the coloring natural or does it have PCB’s?
  • Is the fish wild or farmed raised?
  • What does the “organic” label mean?

Overall fish is a great source of omega-3 fatty acids and omega-6 fatty acids with having a variety is the key.

Eating All the Colors of the Rainbow (January 2012)

As a Registered Dietitian/Nutrition Therapist I have clients speaking about the number of servings of fruits and vegetables that are recommended. I like to respond by having them learn how to use their “healthy voice” and I say “you are not a human calculator”. My famous statement is “the more color the merrier”. Remember taking a multivitamin is like having life insurance; we have it with the hopes we will not need to utilize it.

It is known that the brightest colored produce provide the most nutrition, but I don’t think many of us know what these colors actually provide. That is what this article will be about.

RED / PURPLE / BLUE

These pigments are called anthocyanins and they give red, purple and blue produce their color and provide wonderful antioxidants in the body. They are known to reduce the risk of macular degeneration, certain types of cancer and stroke and are also known for promoting heart health. Examples of foods include: cherries, eggplant, purple cabbage contain fiber which keep you full. Blueberries, strawberries, pomegranate, red bell peppers and grapefruit have Vitamin C. Cranberries contain a compound with prevents bacteria from sticking to the bladder walls and helps to protect from urinary tract infections. Kidney beans, strawberries, beans and watermelon contain folic acid. Kidney beans also provide iron, protein and fiber. Mission Figs, cherries and tomatoes contain potassium which helps to reduce/regulate our blood pressure.

ORANGE / YELLOW

Nutrients in orange and yellow produce (zeaxanthin) include beta carotene which is converted to Vitamin A, potassium, Vitamin C, Folic Acid and bromelaine.

Oranges are the most popular Vitamin C fruit but also it is in mangoes, peaches, papaya, cantaloupe, sweet potatoes, and bell peppers. For folic acid, corn, carrots, and summer squash. Also bromelaine is a great enzyme found in pineapple which can help indigestions, reduce swelling and infection.

GREEN

Dark green leafy vegetables (the darker the better) would be great to have in our diet. They are packed with calcium, Vitamin A, and Vitamin K. People on blood thinners certainly may want to be mindful regarding their frequency of dark green leafy’s as these foods may be worked in their diet, but the key part is being consistent to not affect their protime (with Coumadin levels).

Cruciferous vegetables such as brussel sprouts and broccoli are high in vitamin A. Kiwis cabbage, string beans and broccoli are great sources of vitamin c. These green foods have a variety of nutrients and I would recommend mixing up the ones that are consumed to obtain a variety of vitamins and minerals.

Having white vegetables are very nutritious. I am not referring to having a plate of white processed foods. Bananas, cauliflower, mushrooms, turnips, garlic, onions, and cannelloni beans are great sources of potassium, vitamin C, fiber, and folic acid. Research shows that mushrooms are a great source of riboflavin and niacin (vitamin B-2) which may help you be satisfied and full.

The average person consumes the same 20-30 foods over and over again. If we broaden that intake then we would be increasing our vitamin and mineral intake as well as our antioxidant intake.

Why is Breakfast the Most Important Meal of the Day? (December 2011)

Did you know the reason why our mothers promoted breakfast? When you don’t eat a morning meal your body enters a prolonged fasting state. It then starts to believe that you will not be eating anytime soon. When you eventually eat lunch your body stores those calories as fat because it thinks that “I better save these calories for later”. Not only does this result in weight gain, but what you are doing to yourself is creating a chronically slow metabolism. When we break the fast we get our metabolism “revved up” which makes our metabolism stronger and we are able to power through the day.

Clients will mention that once they begin eating something for breakfast they feel hungry all day. This is often times related to what they are eating. If the individual is consuming a refined carbohydrate breakfast such as a pastry or cereal they will certainly feel hunger sooner as opposed to having a higher fiber cereal or adding protein and fat to that meal they will find that they are satiated longer and won’t be thinking about their hunger as soon. The good news is that if you feel your hunger you are in tune with your body and you know your metabolism is working.

The opposite is an individual who is not hungry for breakfast because once they arrived home from work or school the night before the individual may be eating until they go to sleep. The late night eaters may also state that they wake up starving. The overeating kicks insulin production into overdrive. If an individual doesn’t enter a “fasting” state overnight, they wake up just as their blood sugar drops. It doesn’t seem to matter that there was a binge the night before the individual needs food immediately!

Another reason to consume breakfast is that research shows that students do better in school. An individual is able to think more clearly, problem solve and also be more productive at work. Also eating helps with one’s fitness/physical performance as an athlete. People tend to have a healthier diet overall encompassing more fruit, vegetables and a larger variety of food choices when they consume breakfast.

Finally the key part to having breakfast is planning. Perhaps keeping string cheese at your office with some high fiber cereal bars is your quick on the run meal or giving your child a piece of whole wheat toast with almond butter and banana. Last night’s leftovers are always tasty. There are many frozen entrees that make breakfast food if you want breakfast options (eggs) and if you have the time adding Greek Yogurt or eggs to your hot cereal could always make the meal more satisfying.

Reassessing the Risks of Eating Fish during Pregnancy (November 2011)

Do you worry about eating fish during your pregnancy? What types of fish? How often? What kind? Also, how many ounces? Almost every pregnancy book devotes a chapter to nutrition as the key concept is eating a variety of foods. Many of these pregnancy books are not current on the latest recommendations.

Since 1994 the growing concern over the mercury content of fish caused the FDA to issue its first cautionary statement to women who were pregnant or were thinking about becoming pregnant, messages surrounding fish consumption have been cause for controversy. Historically, agencies such as the FDA, the Environmental Protection Agency, and the American Dietetic Association (ADA) have recommended that pregnant women limit their fish consumption to no more than 12 oz. per week of varieties low in mercury due to concerns over potential hazards to the developing fetus. Research demonstrates that because of these advisories, women have decreased their intake of fish and seafood while pregnant because of concerns about potential contaminants and the effect on their unborn children.

In 2010 the dietary guidelines changed, they recommended that women who are pregnant or breast feeding consume 8-12 oz. of fish and seafood low in mercury as part of a healthful diet. It has been emphasized that the fish be varied and that women avoid certain types (tuna, swordfish, tilefish, shark, and King mackerel) due to their high mercury content.

There are many reasons to add fish to the diet during pregnancy. One is that fish is a nutritional powerhouse. It contains higher concentrations of healthy fats, is lower in calories than many other protein sources and most importantly contains the omega-3 fatty acids such as EPA and DHA. One of the benefits of fatty fish consumption is that it supplies the DHA for a baby’s brain and eye development.

Safe fish and seafood are those high in EPA and DHA and low in mercury content. Examples include salmon, whitefish, mackerel, sardines, flounder, clams, shrimp, shad, canned light tuna and herring.

The FDA and ADA note that if local advisories determining the safety of fish in nearby lakes/rivers or coastal areas is not available it is recommended to consume up to 6 oz. of fish per week from local waters and no other fish for pregnant and breast feeding women.

Finally, any contaminant in fish or parasite (salmonella) can be killed by cooking the fish to 145 degrees or freezing the fish to -10 degrees F for seven days will kill parasites. It is always recommended to buy fish from a reputable source.

Women can still consume the recommended 200-300 mg DHA plus EPA daily taking a third to half tsp. per day of fish or an algae oil supplement.

What is Community Supported Agriculture? (October 2011)

Have you ever wondered what it would be like to receive a box with all local produce without actually picking your fruits and vegetables? Let alone to choose the ones that you “usually” buy each week?

Community Supported Agriculture (CSA) is a system that members purchase a subscription in return for a farmer to provide whatever size produce box you would like (it can be a mix of fruits/vegetables or all fruit or all easy to eat vegetables if you do not cook), and in return the farmer provides a box of produce during the growing season. Basically the individual is getting a share of the farm.

Some CSAs provide meat or cheese as well as homemade baked goods. They deliver to your home/office, have pick up locations, and some equire you to visit their farm. Some people join CSA to support farmers or to eat locally grown products. This is a great option if you do not have the time to attend a local farmers market each week. Another perk about joining a CSA is that it forces you to step out of the box (no pun intended!) as whatever produce is provided may not be your norm and the creative chef in you may evolve.

To find the right CSA for you check out www.localharvest.org to see the various options. See what each CSA offers during winter months as opposed to summer as well as if these farmers have your favorite items, especially if you are a picky eater. You will want to find out how long a farm’s been running a CSA (longer isn’t always better, but it does mean the major rough edges have been worked through) and whether the farm grows all of the produce you’ll be receiving or it if includes items by other farms. You do not have to be a gourmet cook to join, but it is a nice way to add more color and wholesomeness to your diet.

Two CSA’s that I like are www.farmfreshtoyou.com and www.mygoodlifeorganics.com.

They offer great quality and stand behind their products. In the meantime, enjoy what is in season!

What is the Balanced Diet? (September 2011)

Clients come to my office asking me what is a balanced diet? We hear this phrase so often and I believe before I explain what this means, it is important for me to define what is balanced eating. Balanced eating is eating when you are hungry in combination of what your body needs. It is eating two, three, four, or five meals per day and actually listening to the amount of food that your body needs. It is not feeling obligated to count our servings of fruit, vegetables, grains, proteins, fat and “play food” in our diet. A balanced diet truly has some of everything in it. Do not worry if you miss something in your diet one day, as you will not develop scurvy or anemia for not eating a specific food a day or two. In this article I will list various foods that would be great to work into one’s overall regimen, however the key piece to take away from this is to make it a lifestyle!

Whole Grains

In previous months, I have shared with you some cutting edge grains that contain tremendous amounts of fiber, B vitamins and magnesium as well as iron. Whole grains do not have to be boring, and there is life beyond brown rice. Have you ever tried kasha? What about amaranth? quinoa? Or barley? The key to substituting white carbohydrates or refined starches is to perhaps mix whole grains with white rice to introduce a new taste to your palate.

Milk

Some of us do not consume milk or other dairy products such as yogurt or cheese and if that is the case there are non-dairy alternatives. The reason dairy products are recommended are due to the amounts of calcium and Vitamin D that are provided. We then hear that we should reduce our dairy intake due to the saturated fat. We can certainly consume low fat or nonfat milk/yogurt, cheeses which all still have the same nutritional benefits.

Fish

Seafood has been recommended due to the omega-3 fatty acids. It has healthy fat which protects the heart and is a great protein source. The key factor here is to vary the fish that is consumed.

Of course the obvious is to work in plenty of fruits, and vegetables. These foods are important as our potassium intake will be increased especially when we eat asparagus, potatoes and tomatoes and all the great fall fruit such as apricots, mango and pineapple. Potassium is important to consume as our culture consumes almost double the amount of sodium we need in a given day. A nice benefit about potassium is that it can blunt the effects of sodium and lower blood pressure.

It is important to honor those emotional cravings too. When your tongue says I am craving something sweet such as chocolate, have it. The same thing goes for when you are aware that you would like something salty (and chips sound good), be conscious and have them. This will help in the legalization of working in everything into our diet.

Here is an example of a balanced diet:

Breakfast:

  • 5.5oz. low fat Greek Yogurt
  • Small banana
  • ½ c Grape Nuts
  • 4 Strips Turkey Bacon
  • 6 oz. low sodium V-8 Juice
  • 1 cup Green Tea with 1% milk

Lunch:

  • 1 cup split pea soup
  • ½ turkey sandwich on whole wheat bread with 3 oz. turkey with 1 tbsp. humus
  • Side salad with vinaigrette
  • Small apple with 1 tbsp. almond butter

Dinner:

  • 1 cup soba noodles tossed with 3oz. turkey
  • 1 cup roasted broccoli with 1 tbsp. peanut oil
  • Side salad with 2 tbsp. Chinese Chicken Salad Dressing
  • ½ cup Frozen yogurt
What is Night Eating Syndrome (NES)? (August 2011)

I will often have clients share with me how mindful they are with their food during the day and then once they arrive home, their eating challenges begin. I will typically ask them have they ever explored that they are so busy during the day that food is used as fuel and that they eat to relax/unwind in the evening? The answer usually comes up as yes! You find yourself experiencing Night Eating Syndrome (NES).

Symptoms of Night Eating Syndrome include: having little or no appetite for breakfast, having recurrent awakening from sleep requiring eating to fall back asleep and lastly when an individual eats during the night and may be able to fall asleep again unless he/she eats. NES is defined as someone who consumes at least a third of their total caloric intake after dinner and then wakes up multiple times, usually two to three times per week (or more) at night to eat. This order is being spoken about more and more but typically has but kept quiet due to the embarrassment and shame. It is common for the individual to not recall what they ate but to state that they remember that they did eat by seeing empty containers/wrappers the following morning or crumbs of food.

Stress can of course trigger NES whether it is the individual’s job, marriage/relationship, job or just out of habit. It is often stated that is it difficult to treat, but like any habit, practice and repetition of trying new alternative behaviors is necessary. It is also important to have a treatment team consist of a psychologist to help you assess what is causing stress in your life, a registered dietitian who can help provide you with food and behavioral goals and perhaps a psychiatrist if the psychologist thinks an SSRI (a selective serotonin reuptake inhibitor) may be appropriate for you.

What can I do if I am struggling with NES?

  • Within an hour to an hour and a half put something in your body, to get your metabolism moving. It is important to eat at least three meals per day to help normalize your meals and meal times.
  • Incorporate some type of “joyful movement” as this will not only help you feel better about yourself but movement helps to increase the rate of our metabolism and regulate the circuits in our body to want to eat at regular meals times for you.
  • Keep a sleep journal and a food journal (wake yourself up to record what is going on during the time you find yourself eating).

This will be helpful for not only yourself but your team to detect any patterns and check in with any behavioral patterns that are going on.

Remember that you have developed your habits and behaviors over many years and that they will not be broken over short term. The first step is recognizing that there is a problem that needs to be addressed and that you are seeking help for it. Accepting and owning that you have a problem is part of the work that needs to take place and sticking with working at it is well worth it if the behavior is not benefitting you the way you would like.

Is There Research to Support The Benefits of Coconut Oil? (July 2011)

Coconut Oil has been marketed on websites and magazines promoting all types of health benefits. Coming from a cardiology background I can’t help but read these claims, being aware of the high saturated fat content. According to the Natural Medicines Database, there is insufficient evidence to rate the effectiveness for the claims that have made. These include: weight loss, reducing cholesterol, improvements with diabetes, Crohn’s disease, chronic fatigue, and irritable bowel syndrome and thyroid conditions.

Similar to other tropical oils (palm, palm kernel, cocoa butter and cotton seed) coconut oil is high in saturated fatty acids, specifically lauric acid and myristic acid. Lauric acid and myristic acid have a greater total cholesterol raising effect than the palmitic acid found mainly in meat and dairy products, in comparison to stearic acid which is also found in meat and dairy products has a neutral effect on total, low density lipoprotein (LDL), or high density lipoprotein (HDL) cholesterol. Lauric acid, but not myristic or palmitic acid, decreases the total to HDL cholesterol. Foods contain mixtures of saturated fatty acids, therefore selecting foods on individual saturated fatty acid content is not recommended.

The American Dietetic Association’s Nutrition Care Manual provides current recommendations for disorders of lipid metabolism:

  • Limit intake of saturated fat, Trans fat, and cholesterol.
  • Consume adequate energy to maintain or achieve appropriate weight.
  • Replace saturated fat with monounsaturated or polyunsaturated fat.
  • Increase intake of n-3 fatty acids, fiber (especially soluble fiber), vegetables, and fruits

The effect of saturated fat in the diet is likely to continue and the topic of coconut oil will remain controversial. The evidence based 2010 Dietary Guidelines for Americans (DGA) recognized that the TYPES of fatty acids consumed are more important than is the total amount of fat in the diet. The DGA also mentioned the calories from solid fats are consumed in excess by Americans and they do not contribute to overall nutrient adequacy. According to the DGA, no more than 5-15% of calories from solid fats can reasonably by most people.

To be able to answer clients’ questions and concerns regarding coconut oil requires the nutrition therapist to remain current on trends and research on this matter.

What is our Set Point? (June 2011)

Our set point seems to come up in discussion with clients and I thought this month’s topic would discuss how it works with also clarifying any misconceptions.

Many bodily functions are automatically regulated to maintain a genetically defined balance for optimal functioning and wellbeing. We cannot control them. They operate by a genetic gauge, regulator or thermostat which turns the mechanism on or off to maintain the required functioning. This is called our “set point”.

There are some automatically regulated body functions such as heart rate, breathing, blood cell count, body fluid contents, body temperature, hormone regulation, reproductive cycles, body fat deposition and blood glucose levels. They are not limited to these.

Set point is the body’s weight which is regulated by an automatic regulator which genetically determines the amount of body fat that the body needs to function optimally. This automatic regulator of body fat determines the “set point” weight range. The body will actively strive to achieve your genetically determined “set point” weight in order to provide the body with adequate body fat and maintain optimal functioning. Your actions, thoughts and behaviors are ultimately connected to this automatically regulated need to maintain this weight range. The body, without your consent or permission will strive to maintain the genetically required amount of body fat and weight by altering metabolism, intensity of hunger and food thoughts.

Truths about Set Point, Weight & Genetics:

  • The amount and distribution of body fat is genetically predetermined (regulated).
  • Some people are genetically predisposed to gaining weight easier than others.
  • The body does not distinguish between weight loss from dieting and starvation and moves to sustain life by increasing fat stores. Chronic dieting tends to push the set point upward.
  • When your weight goes below the lower end of the range there is a substantial increase in the time spent thinking about food, weight and hunger.
  • Sustained periods of eating beyond physiological needs along with prolonged weight gain will raise the set point.
  • Set point regulation can be effected by drugs, dietary changes, exercise and age.
  • Weight gains and losses are not direct indications of body fat storage.

Truths about the Body’s Regulatory Functioning Ranges:

  • There is a range in which the body functions optimally.
  • We are all unique and the optimal ranges for our bodily functions are unique to us. Normal is a relative term.
  • The actual point or number may fluctuate within the rage, as a result of many factors, (stress, illness, pregnancy, drugs, medication, environment, depression), but the range remains constant over long periods of the life cycle.
  • The degree of fluctuation varies from individual to individual.
  • The size of the range varies from individual to individual.

Achieving relaxed eating and body wellness requires that we:

  1. Accept that the body fights to maintain a certain percentage of body fat.
  2. Accept that body fat is essential to produce regular menstrual periods, immune function and mineral deposition.
  3. Accept our family weight history and genetic predisposition and potential.
  4. Acknowledge the amount of total conscious time spent thinking food, weight, hunger and the resulting burden.
  5. Accept the connection between our physiological weight and our food-weight related behaviors.
  6. Accept our genetically determined physiological weight.
Four Popular Protein Myths (May 2011)

As a registered dietitian, it is very important keep up with diet trends. We are now in the “protein is the answer to everything” phase. We have gone through phases regarding carbohydrates and of course fat. This month’s article will demystify four popular protein myths.

Protein can’t get stored as body fat:

Protein is one of the building blocks of the body, but when you eat more protein then your body needs for maintenance and repair work, the excess goes straight to your fat cells. People forget that protein has calories.

Protein Fuels muscle:

When an athlete reduces his/her intake of carbs and eats too much protein, their body is forced to torch protein for fuel. A side effect of this imbalance is the buildup of nitrogen, part of protein molecule that can’t be burned which isn’t an issue when protein is used for repair and maintenance. Excess nitrogen contributes to an acidic state that triggers the breakdown of muscle mass, the exact opposite of the desired effect.

Plant protein doesn’t count:

Soy protein provides the same level of quality an animal protein as it contains all of the amino acids needed to put protein to work to maintain or build muscle. Don’t underestimate its value. Choosing edamame, tempeh or Quorn or another vegetarian option can be an effective muscle building strategy. You will meet your protein needs without any difficulty.

Protein is the most important nutrient for building muscle: According to a Tufts University study, fruits and vegetables play an important role in building and maintaining muscle. Their conclusion: Adults with the highest potassium intakes, found primarily in produce, retain 3.6 more pounds of lean tissue. Potassium protects muscle because one of its key roles is to buffer acids in the body, which can deteriorate your hard earned triceps. By balancing pH, potassium keeps muscle where it belongs.

Why do kids diet? (April 2011)

Many times kids diet as they have been restricted from an early age or they have poor body image. As a result, they lack the ability to self regulate their food based on their internal cues or hunger, fullness and appetite levels.

When they get out on their own, the kids turn to a way to manage. Dieting seems to be the only way they figure things out; by regulating what they are eating and how much of it.

What to do about it? It is important to raise your child to be a competent eater. Get help in storing confidence if you find it doesn’t reappear on its own. Kids assume that dieting is apart of being a grown up. Since many adults are unhappy with their own bodies they are constantly striving to be thinner. As a parent a very important goal is have your own healthy body image and not have any foods bias/rules. The bottom line is do not restrict or diet!

Children may diet because their coach of the sport they play tells them that they will be faster if they lose weight. This destructive advice creates a strong impression on the child.

What to do about it? Tell your child and the coach that weight loss is certainly not appropriate. Have a talk with your child before she/he begins and weight conscious sports (gymnastics, ice skating, wrestling, ballet). Make it clear to both your child and the coach that your child’s involvement is dependent on having a healthy relationship with food.

Children's friends diet. It’s trendy.

What to do about it? Teach your child to be a competent eater with learning how to eat when they are hungry and stop when they are satiated. Teach your child about their internal regulators so they will not when they have had enough to eat or if they are eating mindlessly. DON’T KEEP YOURSELF ON A DIET AND DON”T BE CRITICAL OF YOUR OWN BODY. As a parent do not collude with the dieting trend.

What to do about it? Encourage your child to hang in there and let him or her know that you are doing your part as a parent by providing the food and the child is doing his job of eating. His internal regulator will allow his body to be the shape that it is naturally meant to be.

What to do about it? Be clear about your own struggle. Be ready to listen, ask questions, DO NOT BE CRITICAL, and do not try to fix it. Reassure your child that they are beautiful just they way they are.

For monthly tips a great newsletter to get is by my colleague Ellyn Satter, MS RD whom parts of this article were derived from her last newsletter. Her website is www.ellynsatter.com

Helping Your Kids with Their Nutrition without Harming Them (March 2011)

I have been working with many kids, adolescence and teenagers with eating disorders or disordered eating which often times is a result of what our parents, media, or the medical community will say about food.

My practice has been growing helping parents learn the proper phrasing to support their kids food choices and behaviors without passing judgment and allowing their bodies to grow the way that it should for them.

By restricting any food or passing judgment to your child this will guarantee that they will develop some type of eating disorder or disordered eating.

The parent is responsible for putting the food on the table or as my colleague and eating specialist Ellyn Satter, MS, RD phrases beautifully “The parent is responsible for what, when and where; the child for how much and whether.

This is very important to follow with stepping back and watching your kids with providing support, structure and opportunities.

Are you FIBERLESS when eating Gluten free? (February 2011)

Since Celiac Disease is a specialty in my private practice, consuming fiber seems to be a topic that comes up sooner or later. Many gluten free foods are made with starches and or refines flours which are lower in fiber. This can be challenging to meet the Dietary Reference Intake (DRI) of 20-35 grams per day.

What is dietary fiber? Dietary fiber is the part of the whole grains, fruits, vegetables, legumes (dried beans, peas and lentils) nuts and seeds that cannot be broken down by the human digestive system. Although fiber is not readily digested, it plays an important role in the body, particularly through its effects on the digestive system. Fiber helps to maintain regular bowel movements. A high fiber diet can also play a role in the prevention of certain chronic diseases such as coronary artery disease, diabetes, colon cancer and diverticular disease.

Consuming adequate fiber is especially important for people with Celiac Disease. Many newly diagnosed individuals may have symptoms of diarrhea due to malabsorption caused by gluten damaging the absorptive surface of the small intestine. However, once a gluten free diet is initiated, the intestinal tract begins to heal and the malabsorption and diarrhea eventually resolve. It is noted that some individuals have constipation when they are initially diagnosed which may become worse on a gluten free diet (choosing food sources that do not contain fiber).

Here are some tips to increase your fiber intake:

  • Choose a variety of high-fiber gluten free foods on a regular basis.
  • Mix various grains into your salads such as buckwheat, quinoa, millet, wild rice or teff.
  • Add flaxseed meal, rice bran, rice polish or mesquite flour to pancakes, hot cereal or baked goods.
  • Make soups with various legumes, such as lentils, black beans, cannelloni beans or split peas.
  • Mix flax seed meal into smoothies, yogurt, cottage cheese or apple sauce.
  • Add cooked uncontaminated oats that are gluten free, buckwheat, quinoa, sorghum or wild rice to a rice pilaf recipe.
  • Eat whole fruits and vegetables instead of drinking fruit juice.

These ideas will help you meet your fiber intake. Being creative and open minded may also broaden your palate too.

What is the Anti-Inflammatory Diet? (January 2011)

Inflammation is a set of symptoms that include pain, swelling, heat and redness of an affected organ tissue. It is the natural way the body’s immune system responds to attack, infection, or injury. Recently, there has been discussion regarding another form of inflammation that is not aligned with pain and if referred to the literature as chronic low-grade inflammation or “silent inflammation”. The links between diet, inflammatory processes, and disease are the topics of intense current research. A number of diseases, particularly chronic diseases later in life, such as heart disease, diabetes, arthritis, Alzheimer’s disease and certain cancers, are thought to be connected to chronic low-grade inflammation. The research to support specific interventions for the different medical conditions regarding inflammation is still lacking. The diet plan or the “perfect diet” for chronic low grade inflammation is still unclear.

While each of the many diets has its own specific and unique guidelines, the basic concept for following an anti-inflammatory diet is the same. That is the belief that constant or out-of control inflammation in the body leads to ill health, and that eating to avoid constant inflammation promotes better health and can ward off disease. Specifics vary from diet to diet, but in general anti-inflammatory diet suggests:

  • eat plenty of fruits and vegetables;
  • eat a good source of n-3 fatty acids, such as fish or fish oil supplements and walnuts;
  • eat plenty of whole grains such as brown rice and bulgur wheat;
  • eat lean protein sources such as chicken: cut back on red meat and full-fat dairy foods;
  • minimize saturated and trans fats;
  • avoided refined foods and processed foods;
  • consume alcohol in moderation: and
  • add a variety of spices, especially ginger and curry.

Is the anti-inflammatory diet the latest diet fad, or will time prove it to be part of a healthy lifestyle? Until more evidence based research is completed, following the general principles of the 2010 Dietary Guidelines Advisory Committee Report should be encouraged. The diet recommends that accumulating evidence documents that certain dietary patterns consumed around the world are associated with beneficial health outcomes.

Reprinted by the American Dietetic Association Journal, October 2010

Does Inulin Have the Same Health Benefits as Soluble Dietary Fiber? (December 2010)

As we have seen inulin has been added to yogurts, breads and cereal bars as the form of chicory root extract.

Fiber has been classified as soluble and insoluble. Psyllium, oat bran, barley bran contain mainly soluble fiber which have health claims to decrease the risk of heart disease. Wheat bran and flax seed meal and other insoluble fibers are typically linked to laxative effects, yet scientific support that insoluble fibers lower blood cholesterol, whereas insoluble fibers increase stool size. These are the two terms that fiber has been distinguished by.

Different fibers have different function, and inulin unlike the water soluble fibers included in the Food and Drug Administration health claims for soluble fiber, does not seem to significantly decrease serum cholesterol, although some research suggests it may possibly be effective in reducing serum triglyceride. The ingestion of insulin may also result in a small increase in fecal bulk and stool frequency. Data for prebiotic activity associated with inulin have also been published. Additional studies on isolated fibers like inulin will help identify the physiological effect of the variety of biological compounds that fall under the definitions of fiber.

Source: Bonnema AL, Kolberg LW, Thomas W, Slavin JL. Gastrointestinal tolerance of chicory inulin products. J Am Diet Assoc. 2010; 110: 865-868

Why do I have a stomach ache? (November 2010)

According to a study, some people may have gastrointestinal problems after coming too much INULIN, a plant fiber that is often used in processed foods to increase fiber content. Most of the study’s subjects experienced only minor problems such as gas, bloating, and stomach cramps and rumbling. But the authors say some people can’t tolerate much inulin, which is most often sourced from chicory root. Look for chicory root extract in a product’s ingredients to know if its fiber comes from inulin.

Source: Journal of the American Dietetic Association, June 2010

Choose Truly “Microwave Safe” Containers (October 2010)

I thought I would write another month on containers as what we put in our bodies is very important but the containers and how it is utilized is also very important too.

Did you know that “microwave safe” plastic can leach chemicals into your food? It is so important that we change to these alternatives instead. Microwave safe containers have been shown to leach BISPHENOL A. It is important to use either glass or ceramic bowls for heating foods in microwave oven. Heating plastics can make chemicals used in their manufacturing to leach in your food.

Laboratory studies with rats indicate that exposures to BPS, especially during prenatal through adolescence, predispose an individual to increased risk for developing breast cancer. Most grocery stores sell Pyrex, or other glass storage containers that are easy to heat, allow you to freeze, thaw and heat even in the microwave safely for many years without danger. When you do microwave your food, in one of the above containers, cover the food with a piece of parchment paper, or other non-dyed, non bleached paper product. Or just put a ceramic plate on top as a cover.

Be Wise with Plastics (September 2010)

Plastics seem to be everywhere these days as they are cost effective and convenient. After watching an episode recently on CNN on cookware and plastics with Sanjay Gupta, M.D. I have researched my cookware and plastic situation more closely.

The thing certainly is to reduce our plastics. Look for natural alternatives such as solid wood, bamboo, glass, stainless steel. Also look for items with less or no plastic packaging. If you do buy plastic try to purchase those which can be recycled (yogurt container)

The most common plastic containers have a resin code in a chasing arrow symbol which is often located at the bottom of the product. I will go through the types of plastics that we should try to minimize in our lives/diet.

3 PVC (Polyvinyl Chloride, aka Vinyl)

Common Uses: Condiment Bottles, Cling Wrap, teething rings, toys, shower curtains.

Concerns: Can leach lead and phthalates among other things. Can also off-gas toxic chemical

6 PS (Polystyrene, aka Styrofoam):

Common uses: Meat Trays, foam food containers & cups

Concerns: Can leach carcinogenic styrene and estrogenic alklphenols

7 Others, this is a catch-all category, which includes:

PC (Polycarbonate): Avoid-Can leach Bisphenol-A (BPA). It also includes ABS (Acrylonitrile Butadiene Styrene), SAN Styrene Acrylonitrile, Acrylic, and Polyamide. These plastics can be a safer option because they are typically very durable and resistant to high heat resulting in less leaching. Their drawbacks are that they are not typically recyclable and some need additional safety research. New plant based, biodegradable plastics like PLA (Polylactic Acid) also fall into the #7 category.

There are other plastics that we can look at as well but the ones to toss in your Tupperware would most definitely include #3,#6, and #7.

To reduce calories, eat slowly… (August 2010)

In a study of April 2010, scientists found that when a group of subjects were given an identical serving of ice cream on different occasions, they released more hormones that made them feel full when they ate it in 30 minutes instead of 5. The scientists took blood samples and measured insulin and gut hormones before, during and after eating. They found that two hormones that signal feelings of satiety, or fullness-glucagon-like peptide-1 and peptide YY-showed a more pronounced response in the slow condition.

Ultimately, that leads to eating less, as another study published in The Journal of the American Dietetic Association suggested in 2008. In that study, subjects reported greater satiety and consumed roughly 10 percent fewer calories when they ate a slow pace compared with times when they gobbled down their food. In another study of 3,000 people in the British Medical Journal, those who reported eating quickly and eating until full had triple the risk of being overweight compared with others.

In other words, experts say, it can’t hurt to slow down and savor your meals.

THE BOTTOM LINE

Eating at a slower pace may increase fullness and reduce calorie intake.

Reprinted from NY Times May 2010

Why have I heard of the grain Bulgur? (July 2010)

This question is asked to me at least weekly by a client when I recommend this grain. I explain to people that bulgur is what is in the delicious Middle Eastern dish tabouli.

Bulgur is a type of cracked wheat kernel that has been precooked and dried. The grain is light and tan in color, slightly chewy with a mild flavor which can work well in many dishes and salads.

Bulgur is a great source of fiber 8 grams per cup with close to 6 grams of protein. It cooks fast (in a sauce pan double the liquid to the grain once you have rinsed it) and for extra flavor sautéed onion and using chicken broth or the broth of your choice works great!

What is this grain Buckwheat? (June 2010)

Many of us that are not afraid of complex carbohydrates, and have become educated on the importance of having them in our diet, tend to eat the same one’s over and over.

I thought I would enlighten you with all of the high fiber types of whole grain types of complex carbohydrates that contain many nutrients.

Some of us are familiar with buckwheat in the form of a pancake. It is actually known as a “pseudo cereal” that is part of the rhubarb family. It also gives Japanese soba noodles their wheat taste as well as French porridge kasha that same flavor too.

Buckwheat has high amino acid content, has 230 milligrams of potassium and 6 grams of protein per cup. It is also gluten free, another grain that is supportive for those with Celiacs Disease (a gluten intolerance).

The next time you bake muffins, or cook pancakes, substitute half of your recipe’s whole wheat flour with buckwheat flour. You will notice that you are satisfied sooner and sustained longer.

The Wonder Grain of Quinoa (May 2010)

Many of you do not know how to pronounced (KEENWAH). This super grain is derived from the Incas and happens to be a staple in the South American Diet. This is the only grain that contains all nine essential amino acids which makes it a complete protein. It is also gluten free so those individuals who have Celiacs Disease or are sensitive to wheat would benefit from this grain. Quinoa packs about eight grams of protein per cup.

This grain is easy to prepare. If you know how to make rice then you are on your way to quinoa. Just add some sautéed greens to it or your protein source the way you would with rice. The great part of the preparation is that in the US most of the quinoa has been prewashed to avoid the inconvenient step of the additional rinse so that part is unnecessary. It could also be used as a substitution of bread crumbs in a dish.

Bon Appetite!

Exercise and our Appetite (April 2010)

Does exercise increase our appetite significantly that post-workout binge eating quickly replaces the burned off calories? Not necessarily, as a study finds that exercise can make people hungry, but meals after a trip to the gym are more satisfying which leads to eating less. Overweight and obese participants exercised for 12 weeks in a laboratory setting, with a goal of expending 2,500 calories per week. After each session, breakfast was served. While participants reported their overall hunger increased as they shed pounds, they felt more satisfied after a meal than they had by the same sized meals at the study’s start, no matter how much weight they lost. This may be just one more way exercise helps people lose weight and keep it off: by making the bodies feel full with less. Researchers speculate that exercise may intensify the body’s natural system of regulating appetite and lead to the increased sense of fulfillment.

Source: American Journal of Clinical Nutrition, October 2009

Spice your meals up with Spices and Herbs! (March 2010)

Did you know that ½ tsp. of ground cinnamon has as many antioxidants as ½ cup of raspberries? Or ½ tsp. of oregano leaves has as many antioxidants as 3 cups of fresh spinach?

Studies show that antioxidants provide a range of benefits including supporting our immune system. They also play a role in reducing inflammation, which is increasingly recognized as a first step in chronic diseases.

The following seven spices have been known as the ”Super Spices”. Listed below is a snapshot of what these spices could do for you.

Spice/Herb Research Focus
Cinnamon Blood Sugar Regulation
Ginger Gastrointestinal symptoms, muscle pain
Oregano Inhibit bacterial growth, inflammation
Red Peppers Satiety and metabolic rate
Rosemary Inhibit inflammation, cognitive function
Thyme Reduce cell damage caused by free radicals
Turmeric (yellow curry) Inflammation, heart health, cognitive function
High-Carb Diets Improve Mood (February 2010)

There seems to always be the controversy regarding a high carb diet or a high protein diet for weight loss. I don’t believe in diets, rather than helping my clients change their relationship with food.

I can’t deny research studies that come out, so I thought this months article would be about a study that was out a few months ago.

Australian researchers have concluded that people who were on low carb diets were in worse moods. The high carb diet and high protein diet both lost an average of 30 pounds, which was slightly more than in studies of this type. Maintaining the low carb diet seemed to be a problem long term, which caused a change in one’s mood.

It is speculated that mood change could be biological (makes sense to me-they are lacking energy). A low carb diet can cause a drop in levels of the brain chemical serotonin. Low serotonin levels are linked to depression.

It also seems likely if one is depressed they can gain they weight back and emotionally overeat.

The bottom line is high carb diets are better for one’s mood and it is better to not diet and learn how to eat when we are hungry and stop when we have had enough with honoring what we are in the mood for.

Source: LA Times November 10, 2009

Walk it off! (January 2010)

You can reduce the effect of a post-meal blood glucose spike by taking a after walk. In a small study, researchers at Old Dominion University in Virginia found that participants’ post meal blood glucose reading was lower when they took a 20-minute stroll after than when they walked before eating.

Source: Journal of the American Medical Directors Association, July, 2009

Help! The gingerbread man is calling my name…(December 2009)

You make it through Thanksgiving and now arrive at work and we are in the midst of December. Your clients and colleagues are sending thank you goodie baskets to the office as well as bringing the leftovers from their home that they do not want. How do you manage during this difficult time?

Contrary to popular belief most people gain five to ten pounds from Thanksgiving through new Years. During adult lives the average weight gain is 0.4-1.8 pounds per year. The reality of what the weight gain is over the holidays is about one pound. That is minimal in the big picture but the problem is more that it is not lost over the year and more importantly the individual has never addressed their relationship with food.

Here are some tips to help you and your clients stay above water over this challenging time:

1. Do not go to a party hungry.

I always recommend to my clients treating the day as normally as possible without skipping a meal. It is helpful to even have a snack before the event so then one may take an inventory of all the possible options and be able to check in with their hunger level before they unconsciously start making a plate of food.

2. Bring some type of treat to the office if the treats that are in the office are trigger foods.

Some of us say I can have one piece of that brownie, but before you know it, you have broken off many pieces of that brownie and that brownie has eaten you, instead of you eating that brownie. I think many foods may be a trigger food, especially if you have not made peace with that food and learned how to legalize it. Perhaps taking that treat in its entirety, sitting down with it and just focusing on eating that treat without any distraction would be a way to work it in. Remember one food is not a deal maker or deal breaker.

3. Have what you truly want

I believe emotional satisfaction is equally as important as physical satisfaction. If you are saying “I am not eating carbs” and you find your self just eating sliced turkey and roasted brussel sprouts (which can get boring) you may find yourself “picking” when you are cleaning up the kitchen, or “sneaking” a piece of pumpkin pie, instead of just giving yourself permission to have it in the first place.

4. Do not skip a meal

When one does not overeat, we tend digest our food in a 3-4 hour duration. If we have regular eating intervals, then we will create a stronger working metabolism. This will allow us, to stop and pause when eating to assess how hungry we are, are we satisfied or eating just to eat? These are some of the questions that are important to begin asking oneself.

These tips are a handful of many to allow you to coast through the holidays. I am happy to work with any of you for more support or your patients. Have a healthy holiday and New Year!

Are you having a Snack Attack? (November 2009)

Commercials do sell products, which is bad news when so many TV ads are for unhealthy foods. Researchers found that kids ages 7 to 11 ate 45 percent more while watching a half-hour cartoon interspersed with ads for food than those who watched the same cartoon with ads featuring non-food items. Another experiment showed that adults ate more while watching TV shows with snack food ads than those with ads promoting healthful foods or good nutrition.

Source: Health Psychology, July 2009

What is Agave Nectar? (October 2009)

I hear clients share with me how they add Agave Nectar to their tea, cereal, and fruit or use it in baking, but is it any better than sugar?

Agave Nectar is somewhat sweeter than sugar, so use between a quarter and an eighth less agave nectar than if you were cooking with regular sugar. The lighter, golden version tastes syrupy while the darker, amber variety has a more intense has a more intense honey flavor.

Agave nectar is not carbohydrate or calorie free; it has the same amount of calories and carbs as sugar. But since it’s a food with a low glycemic index the syrup won’t raise your blood glucose levels as much as sugar or honey does. Plus, it’s sweeter than sugar, so you’ll use less.

Sweetening with agave nectar is easy to do is you’re adding it to a hot beverage. When you are baking it becomes more complicated when you start baking with the syrup. To adjust a recipe, replace each cup of sugar with two-thirds to three-quarters cups of agave nectar, and then reduce all other liquids in the recipe by a quarter. Lower your oven temperature by 25 degrees to prevent burning, and shorten the cooking time on cookies by 3 to 5 minutes and cakes 7 to 10 minutes.

Agave can still elevate one’s blood sugar if you have diabetes, so it may not be any better than sugar, as the various sweeteners (honey, sugar, agave, high fructose corn syrup, cane sugar) are still glucose in the end (aka: sugar).

Facts on Sugar (September 2009)

Did you know there are 142 pounds of added sugar and sweeteners that the average American eats per year?

Did you know that there are 16 calories in a teaspoon of sugar?

Did you know there are 26 numbers of different sweeteners on the market, including artificial ones?

Did you know there are 30 teaspoons of added sugars and sweeteners the average American eats per Day?

Clarifying Myths about Sugar (August 2009)

In my private practice about 40% of my clients have diabetes. It seems to be a misconception that eating sugar or having a craving for sweet foods is what has caused their blood sugar problem.

One of the hallmarks of the disease is elevated blood sugar, so many people assume what they are eating has contributed to diabetes. Sugar does not literally go from mouth to bloodstream. The exact trigger for diabetes isn’t well understood, but genetic and lifestyle factors- such as being overweight and sedentary appear to play key roles.

The truth about diabetes is that staying at a healthy weight lowers your diabetes risk regardless of how much sugar you eat. This does not mean go out and eat sugar rich foods if you have the tendency to have elevated blood sugar.

Another myth is that eating sugar causes one to break out or cause wrinkles. Eating a lot of sugary foods can trigger chronic low level inflammation throughout your body, which sends the aging process into overdrive. Sugar’s inflammatory effects create free radicals which wear down elastin, another skin saving protein.

Pack your diet with produce, herbs, spices, oregano, cinnamon, ginger and turmeric. They all have antioxidant properties and fight wrinkles.

Many people believe eating sugar will make them fat which are false. In fact eating too many calories can cause ones weight too increase, whether they come from brownies or broccoli? When was the last time you overate broccoli? Sugary foods tends to be high calorie and easy to overeat. They cause a spike in blood sugar; follow by a sudden drop that can leave you feeling depleted and hungry.

The facts about sugar are that if you limit less than 10 percent of your daily calories to added sugar that is great! What that would look like is the following: If you ate 1,800 calories that is 180 calories from sugar or 11 ¼ teaspoons.

What is the Best Produce to Buy Organic? (July 2009)

To buy or not buy organic, that is the question. Produce are the foods that can contain trace levels of pesticides. According to the FDA’s pesticide Residue Monitoring Program, which collects and tests random samples of domestic and imported foods, fruits and vegetables it is known that they have 54.9 percent of fruit and 23.8 percent of vegetables. Studies have shown certain types of produce are consistently high in pesticide levels, which may make varieties a suitable alternative.

Organic produce cannot be genetically modified, irradiated, or cloned. They must be grown or produced without chemical pesticides or fertilizers, and in livestock without the use of antibiotics or hormones.

The recommended produce to buy organic include: strawberries, cherries, apples, grapes, nectarines, peaches, spinach, celery, carrots, lettuce (all varieties), bell peppers, and potatoes.

Eating to Burn Fat (June 2009)

Research has shown that bodies of overweight people don’t burn fat as efficiently as those of thin people, but a new study found that eating high-protein breakfast and lunch may level the playing field. Protein-packed meals seemed to boost the fat-burning capacity in obese individuals. The opposite effect was seen in lean people, in whom fat storage was more likely after a high-protein meal. Source: Nutrition and Dietetics, December 2008

The Truth about Probiotics (May 2009)

You have probably seen the word on containers of yogurt, but what exactly are probiotics? They are “good” bacteria that aid digestion and help us aid fight off “bad” bacteria that cause illness. A few probiotic enhanced food products may settle the occasional stomachache. A reputable website which tells the consumer which supplements are reputable is: www.consumerlab.com. I share this website with all of my clients and check to see if the supplements that they are taking contain what they claim since the FDA does not regulate supplements and anyone can put one out. I subscribe to this service as they will not disclose everything to the consumer if one wanted to check it out.

A probiotic may be beneficial if you are on an antibiotic. Taking probiotics can help replace whatever “good” bacteria that have been wiped out by the drug and prevent diarrhea (a common side effect). A recent study from Johns Hopkins Bloomberg School of Public Health, in Baltimore, revealed that taking probiotics reduces antibiotic related diarrhea by 52% compared with placebo pills.

When traveling to an unfamiliar place, probiotics can ward off uncomfortable reactions from food and water that may not agree with your system.

Probiotics can also be helpful for those suffering with IBS. Research has shown that probiotics, along with drugs, may provide extra relief to those with this chronic condition.

What is the difference between “Sugar Free” and “Sugar Alcohols”? Are there better choices than food sweetened with sugar? (April 2009)

Sugar alcohols (also called polyols) such as sorbitol, polydextrose, isomalt, and hydrogenated starch hydrolysates are not technically sugar, but they provide sweetness in foods just as sugars do.

Sugar alcohols are only partially absorbed in the small intestine, so they supply only about half the calories as equal amounts of regular sugar while sometimes causing diarrhea, especially in children. On the other hand, sugar alcohols also do not raise blood glucose levels as much as equal amounts of sugar, and as a result they’re often used in foods advertised to people with diabetes.

However, in the amounts that are likely to be used in a serving of food, sugar alcohols may not make much of a difference and may offer little benefit over sugar in some foods. You must really read nutrition labels to find out. For example two sugar free Oreo cookies (also one serving) sweetened with sugar alcohol contain the same amount: 16 grams of carbohydrate and 107 calories.

As you can see, it is important to read nutrition labels and compare the carbohydrate and calorie content of foods sweetened with sugar alcohols with those of their counterparts that contain regular sugar. If you find there isn’t much of a difference, you may want to select the food based on your personal taste. Just don’t forget to compare the serving sizes.

The Incredible Cranberry (March 2009)

Cranberries have a lot more to offer than holiday tradition, Diane McKay, Ph.D, a nutrition expert at Tuft University in Boston, says preliminary studies suggest phytonutrients, including antioxidants, in cranberry products may improve heart health by helping to:

  • Increase HDL (good) cholesterol
  • Lower LDL (bad) and total cholesterol
  • Minimize plaque in your arteries
  • Limit the formation of blood clots (a stroke risk)
  • Improve the functioning of cells lining arteries, which helps control blood pressure and minimize atherosclerosis

McKay recently reviewed several cranberry studies, including some financed by Ocean Spray. She said most studies are conducted with low-calorie cranberry juice or powder, so the benefits of cranberry sauce, a holiday favorite, aren’t proven. It is recommended to make your own cranberry sauce so then you can control the sugar content and the calories.

When Fruit and Meds Don't Mix (February 2009)

If you want to get rid of a sinus infection, don’t wash those antibiotics with a glass of juice. Researchers from Canada’s University of Western Ontario found that orange, grapefruit and apple juices can decrease the effectiveness of certain medicines, such as those for allergies (antihistamines), high blood pressure (beta-blockers), and infections (antibiotics). “These juices contain compounds that prevent the transport of drugs into the bloodstream,” says study author David Bailey, Ph.D. Grapefruit juice may also prevent enzymes from metabolizing the medication, increasing the side effects. To stay safe, swallow your medicine with water and wait four hours before opening a juice carton.

Fuller Fat

Researchers at the University of California, Irvine, have discovered why avocados, nuts and olive oil are more filling than other foods. Their unsaturated fats trigger the release of a compound called oleoylethanolamide (OEA) in our small intestine, activating a brain circuit that makes us feel more satisfied for longer.

What is the Latest on the Consumption of Nuts, Seeds and Corn in Diverticular Disease? (January 2009)

People with Diverticulitis have been recommended to avoid nuts, seeds and popcorn for years. Research currently shows that consuming nuts and popcorn twice per week appeared to have a protective effect against diverticulitis, report researchers in the August 27, 2008 issue of Journal of the American Medical Association. Researchers analyzed the self reported data of 47,228 men from the Health Professionals Follow-Up Study (1986-2004) who were free from diverticular disease, cancer, and inflammatory bowel disease at baseline. Overall 27% reported eating nuts at least twice a week, while 15% consumed corn and popcorn. During 18 years of follow-up, there were 801 new cases of diverticulitis and 383 new cases of diverticular bleeding. The bottom line was that nut, corn, seed and popcorn consumption was not associated with an increased of new diverticulitis or diverticular complications. In fact, the men with the highest intake of nuts had a 20% lower risk of developing the disease compared to men with the lowest intake. In addition, the guidelines state that the seeds in tomatoes, zucchini, cucumbers, strawberries and raspberries, as well as poppy seeds are generally considered safe.

Healthier Holiday Traditions (December 2008)
Traditional Dish Typically Made With Instead Try
Sweet Potatoes butter & brown sugar orange juice & ginger
Stuffing butter/sausage smoked low-fat sausage, wild mushrooms
Brussels sprouts bacon/bacon fat vinaigrette dressing
Tossed Salad cheese, bacon, mayo-based dressing mustard greens, romaine vinegar based dressings
Cranberry sauce lots of sugar reduce the sugar, add walnuts & raisins or dried blueberries
Cookies butter, eggs, chocolate meringue cookies made with egg whites
Soy and Male Fertility (November 2008)

Men who eat soy have fewer sperm than those who don’t, according to a new study. Soy foods such as tofu, soy milk and some veggie burgers have been shown to have many dietary benefits. But they happen to be high in isoflavones, a dietary compound that can act like estrogen. This is one reason soy is a suspected male infertility agent. The association was stronger for overweight and obese men with sperm counts on the higher end of the spectrum. Some previous studies have failed to find this link between isoflavones and sperm quantity. But, according to the authors, this is the largest human study to date. Source: Human Reproduction, July 23, 2008.

The Battle of the Berries (November 2008)

Every week there seems to be a new berry aiming to have the status as the one with the most antioxidants, the chemical compounds that protect the body against cell-damaging, disease causing free radicals. The latest challenger is Acai. To see how some popular berries compare, check out their antioxidant scores below.

Berry Serving size Antioxidant Score (ORAC)
Acai (frozen) ½ cup (1 pack) About 10, 000
Blueberries (fresh/frozen) 1 cup 9,697
Cranberries (frozen) 1 cup 9,584
Blackberries (fresh/frozen) 1 cup 7,700
Raspberries (fresh/frozen) 1 cup 6,005
Strawberries (fresh/frozen) 1 cup 5,151
What about the new “Superfood” Acai Berry? (October 2008)

The Brazilian Acai berry is only one of the “Super Berry” family that includes pomegranate, goji berry (aka: wolfberry), mangosteen and the Chilean macqui berry. The first qualification is that the berry must be an exotic “berry type” fruit (cranberry, blueberry, bilberry, raspberries, strawberry are not members).

The Acai berry may have higher phenolic antioxidant content than a blueberry there is no scientific evidence that there are more health benefits to had by this alone. Many acai containing products make extraordinary, yet unsubstantiated claims, protected by fine print: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.” One 500-milligram tablet for example claims that the berry can help to enrich the vitality of your body and soul.”

Acai is also rich in polyunsaturated fats, which makes it higher in calories than most North American fruits, and contains fiber, vitamin E, calcium, copper, potassium and magnesium. Because it is shipped from abroad, finding whole acai fruit is rare in the United States; it usually comes in the form of juice, blended with other tropical juices.

Many of my clients have asked me about Mona-vie a juice containing 19 fruits including acai. It is sold through multi-level marketing companies. One can purchase any acai juice as this Mona-vie juice is quite expensive $40 for a 750 milliliter bottle and pretty caloric. If you are interested in incorporating this superfood into your diet any acai juice can be added but limiting it to a 4-6 ounce serving would be recommended.

The Truth Behind Water Bottle Health (September 2008)

Drinking water from your reusable water bottle you felt virtuous. Then came the news: A study from the National Toxicology Program warned that bisphenol A (BPA), a chemical found in hard plastic called polycarbonate (look for a number 7 inside the recycling symbol), was linked to precancerous tumors and hormonal changes. BPA is most often found in water bottles, baby bottles, food containers, and the lining of metal cans. “Even in low doses, BPA, has an estrogen-like effect on the body,” says Scott Belcher, Ph.D, as associate professor of pharmacology at the University of Cincinnati. Play it safe by opting for glass, polypropylene, or aluminum bottles, like those made by Sigg (mysigg.com).

Shape Magazine August, 2008

Does Splenda Contain Chlorine and is it Unhealthy? (August 2008)

It is true that Splenda is made using Chlorine, which sounds scary, but the sugar industry warns that you are actually “eating chlorine” when consuming sucralose, the chemical sold as Splenda. Plain sugar is transformed into sucralose by substituting three chlorine atoms for hydrogen, creating a substance that is not digested by the body, so it’s effectively calorie free and that’s 600 times sweeter than sugar. There is no evidence that the chlorine atoms in sucralose are any more dangerous than they are in, say sodium chloride (ordinary salt). Before giving sucralose the OK, the US Food and Drug Administration reviewed more than 110 human and animal studies demonstrating its safety.

Leafy Greens Cut Lung Cancer Risk by 50% (July 2008)

Spanish researchers report that a daily serving of green leafy vegetables rich in flavonoids and vitamins A and C, may cut your risk of lung cancer in half. But don’t think you can just pop a pill and get the same protective benefit: In a second new study, University of Washington scientists founds that people taking vitamin supplements were just as likely to develop lung cancer as those not taking vitamins. In fact, in smokers, certain vitamins actually increased the risk of developing the disease.

Fruit showed no protective benefit against lung cancer, regardless of the level of consumption.

Omega- 3's Fight Parkinson’s (June 2008)

Parkinson’s is a degenerative disease affecting speech and motor skills. A study by researchers at Universite Laval in Quebec City, Canada, showed that a diet high in omega- 3 fatty acids (found in salmon and flaxseed) may protect against and slow down the progression of this illness, while a diet high in omega-6 fatty acids (found in foods like vegetable oils and animal fats) may create a fertile environment for Parkinson’s. You should get a four-to-one ratio of omega-6s to omega-3s, but Westerners consume a whopping 10 to 20 times more omega-6s than omega-3s. So, try switching up that steak once or twice per week for wild Alaskan salmon, skipping fried foods and veggie oil based spreads, and adding flaxseed or flaxseed oil to your daily yogurt or smoothie to boost omega-3 counts.

Good News About Whole Grains (May 2008)

Getting two or more serving of whole grains every day may cut your risk of pancreatic cancer by about 40 percent, according to a study by researchers at the University of California, San Francisco. On the flip side, people who ate two or more servings of donuts every week had an increased risk of this cancer.

What is Inulin? (April 2008)

Inulin has been added to various foods lately. Clients have been asking me about it in my private practice and I thought it would be great to discuss what it is. Inulin is a type of soluble fiber that acts as a prebiotic, feeding the good bacteria in your gut. It can add bulk to many foods without contributing many calories (less than 1.5 per gram), manufactures have started using it to replace some of the sugar and fat in products like yogurt, cookies and granola. Not only could inulin help you increase the amount of calcium, magnesium, and iron your body absorbs, it also may help lower your cholesterol levels, according to a study published in the Journal of Nutrition. If you decide to try new foods with inulin (which could be listed on a label as chicory root), introduce them slowly, as some people have reported mild abdominal discomfort.

Tomato Products Reduce LDL Cholesterol by 13% (March 2008)

The British Journal of Nutrition published a study focusing on 21 healthy volunteer with normal cholesterol readings. They consumed a tomato free diet for the first three weeks, then a three week “high tomato” diet that included 30 milligrams of ketchup and 400 milliliters of tomato juice daily. That is about two tablespoons of ketchup and one and two-third cups of tomato juice.

The subjects’ cholesterol levels were then re-measured and found to have dropped significantly; total cholesterol level fell nearly 6% on average. The LDL cholesterol dropped decreased nearly 13%.

Go Three for Omega 3! (February 2008)

Did you know there are three types of Omega 3-Fatty Acids?

EPA (Eicosapentaeonic acid): This is the most abundant in seafood and fish oil concentrates. Research suggests that this omega 3 fat has anti-inflammatory effects, and according to a new study in Atherosclerosis, helps to prevent fatty plaques from building up in arteries.

DHA (Docosahexaenoic acid): This is found is seafood, breast milk and added to fortified foods (yogurt, eggs). This omega-3, which concentrates in the brain, has been associated with higher IQ scores in children whose mothers consumed plenty of it during pregnancy.

ALA (Alpha-linolenic acid): found in plants, most abundant in flaxseed, walnuts, canola oil. Most that you eat is burned for calories but some is transformed into the other two omega-3s.

Fish and the safety of it (January 2008)

Adult women should aim for roughly seven grams of EPA and DHA from fish per week. Here is a list of the different kinds of seafood that provide one gram per day. The websites that will keep you current on the safety of fish and whether it is safe to eat your favorite fish are the following websites: www.fishonline.org www.oceansalive.org www.seafoodchoices.com

Fish (3 oz. cooked) Omega-3s EPA/DH (g) Fish (3 oz. cooked) Omega-3s EPA/DH (g)
Mackerel, Atlantic 2.2 Mahi Mahi 0.1
Halibut 0.5 Sea Bass 0.7
Herring 1.8 Tilapia 0.2
Crab, Blue 0.5 Tuna, canned, white 0.7
Salmon, Atlantic 1.7 Salmon, Chinook 1.5
Lobster, Spiny 0.5 Salmon, Sockeye 1.2
Oysters 0.4 Salmon, Canned Pink 1.0
Tuna, Fresh or frozen 0.4 Shark 0.9
Tuna, canned, light 0.3 Shrimp 0.3
Trout 0.8 Catfish 0.2
Haddock 0.2 Swordfish 0.7
Mussels 0.7 Cod 0.1
Chocoholics time to celebrate! (December 2007)

Research shows that hot cocoa packs more of an antioxidant punch than green tea, black tea, or red wine. However, typical cocoa mixes use a treated form of cocoa that has fewer antioxidants. Look for gourmet mixes with natural (untreated) cocoa, or make your own with store-bought natural cocoa, stevia and milk.

Dark chocolate has been shown to reduce blood pressure slightly so it may actually be healthy for your heart. Don’t gorge though. The study’s participants ate about 30 calories worth each day which is the amount found in 1 ½ Special Dark Hershey’s Kisses.

What about Probiotics? (November 2007)

Probiotics help stave off urinary tract infections and keep your digestive system smiling, which helps to reduce and prevent constipation, diarrhea and bloating. In a study out of Finland, women who consumed dairy products containing probiotic bacteria three or more times a week were about 80 percent less likely to be diagnosed with a UTI in last five years than those who did so less than once a week. The probiotics may hinder the growth of E. Coli in the urinary tract, reducing the risk of infection.

Look for a brand of yogurt that contains cultures beyond the two needed for fermentation process Lactobacillus (L.) bulgaricus and Strepotococcus thermophilus. Those that have reported stomach soothing benefits include Bifidus regularis (exclusive to Dannon Activia), L.reuteri (only in Stonyfield Farm Yogurts), and L.Acidolphis (in Yoplait and several other national brands). New technology means that probiotics may be added to shelf stable products like cereal and energy bars, but be wary about claims of cultures in frozen yogurt, as probiotics may not survive the heating process very well.

The Goji Berry – also known as the “Longevity Fruit” (October 2007)

This fruit has been part of Chinese medicine for centuries. It is also known as wolfberries. Gojiberries have been used for dry skin, muscle strength, nosebleeds, irritability, back pain, low sexual function, liver and kidney disorders, macular degeneration, cancer and blood disorders. The most popular use is as an anti-aging supplement. Goji Berry is a dried fruit which researchers have theorized can help reduce blood sugar and cholesterol levels. There are active ingredients in the root bark and in the goji berries themselves that may help do this.

Medicinally, Goji berry can be prepared as a tincture, 3-4 tablespoons per daily, or as a tea. They are relatively safe and no person should consume more than 10-30 grams of Goji fruit per day due to the high content of selenium which can be toxic. Pregnant or lactating women should not consume foods consume foods containing Goji berries.

Trans Fats (aka: Hydrogenated) and Saturated Fats (September 2007)

The new label changes that occurred last January, 2007, regarding saturated fats and Trans fats, are still not completely clear. Below is a great link on the American Heart Association "Face the Fat" website which explains why Trans Fats (aka: “Hydrogenated Fats”) and saturated fats should be avoided. You'll find it here: BADFATSBROTHERS

Making Cauliflower More Colorful (August 2007)

You might be getting your beta-carotine from cauliflower-orange colored cauliflower. Scientists from the USDA’s Agricultural Research Service at Cornell University recently pinpointed and duplicated the gene-dubbed “Or,” as in “orange”-that cues the vegetable to produce beta-carotene. Switching “on” the gene not only boosts the level of beta-carotene, but also turns cauliflower from the familiar white to a carrot-like orange.

You body can use dietary beta-carotene to make vitamin A, a nutrient many Americans don’t get enough of from food.

Starbucks Slims Down (July 2007)

Your morning latte’ just got a bit lighter-at least, if you get your java fix at Starbucks, the nation’s largest coffeehouse chain.

The company announced that by the end of the year it will replace whole milk with 2% milk in espresso concoctions at all its North American outlets. Customers can still request whole milk, but the reduced-fat option will now be the default for all Starbucks drinks. Think twice, though, before bucking the low-fat trend: A 16-ounce “grade” latte’ beverage made with whole milk packs 260 calories, compared to 190 calories in the new 2%-milk version.

Of course, if you really want to cut calories and fat, you could opt for an “Americano” coffee instead-no milk and no sugar means zero calories and zero fat.

How to Grill Wisely (June 2007)

Some studies show that people who frequently eat grilled or broiled muscle meats (red meat, poultry and fish) have higher rates of colorectal and breast cancers. Researchers have identified carcinogens that develop while meat cooks over flames and high heat. There substances are known are heterocyclic aromatic amines (HAAs and HCAs).

By themselves, HCAs are not carcinogenic. But digestive enzymes in our bodies turn them into a potential problem. Tips to help reduce any potential problems would include marinated for at least 30 minutes first. Research shows that marinating may reduce the amount of HCAs. Don’t use the same marinade for sauce, because it will have harmful bacteria from raw meat.

Also remember to choose lean cuts of meat, with cutting any visible fat, cover the grill with punctured aluminum foil and turn the meat with tongs or a spatula. Grill for less time by partially pre-cooking the meat, poultry or fish in the oven or microwave. Then briefly grill if for flavor. Also avoid charring by flipping meat frequently frequently and cooking at a lower temperature. If it does char, cut away the blackened parts before eating.

Finally grill veggie burgers, tofu, vegetables, and fruits which don’t produce carcinogens when grilled.

The Anti-Cancer Fighters of Berries (May 2007)

One of the main families of phytochemicals in berries is phenols. As we age, our system becomes less reactive to deal with reactive molecules called free radicals. They cause oxidative stress. Berries have large amounts of plant compounds called phenols and good antioxidant properties.

Phenols fight cancer on several levels. Last November, California scientists founds that extract from cranberries, blackberries, black raspberries, blueberries, red raspberries, and strawberries inhibited growth and stimulated death of human oral, prostate and colon cancer cells in test tube studies. It is recommended to consume three to four half cup servings of berries per week of berries which may boost your diet protective ability.

Fatty Fish Consumption Associated With Lower Risk of Kidney Cancer in Women (April 2007)

Preliminary research suggests that higher consumption of fatty fish in women is linked with a lower of renal cell carcinoma, a common form of kidney cancer according to a recent issue of The Journal of the American Medical Association.

Fatty fish such as salmon, herring, sardines, and mackerel have 20-30 times the amount of DHA, EPA; Omega-3 polyunsaturated fatty acids have been reported to slow cancer development. These fish also have three to five times higher vitamin D content than lean fish.

What about the Pomegranate? (Mar 2007)

This fruit has been growing in popularity from, juices, to ice creams, to chicken sausages, to chewing gum to and chocolate truffles. Statistics show that 200 new pomegranate products entered the market place in 2005.

Studies focus on the antioxidant qualities. Pomegranates contain high levels of polyphenols which are the antioxidants responsible for anti-inflammatory, anticancer and antiathersclerotic properties. The main polyphenols found in the fruit include Ellagic acid, Ellagitannins, and Punicalagin. Punicalagin may be responsible for 50% of the powerful antioxidant properties in the juice. Most of the benefit is derived from the specific juice preparation, and consumption of the fruit would not contain the same benefits.

Having a daily dose of 8 ounces of Pomegranate juice per day would be recommended to achieve high amounts of antioxidants as well reduction in total cholesterol and LDL, The ratios of LDL to HDL and total/HDL cholesterol may improve. Pomegranates have been shown to help with skin repair as we may see more beauty products containing this wonder fruit.

More Evidence to Eat Variety (Feb 2007)

When it comes to eating fruits and vegetables a new study has found that eating a little of a lot may provide more health benefits than focusing on specific foods, even if those foods contain potent antioxidants. The August edition of the Journal of Nutrition found that a wide variety of fruits and vegetables significantly reduced DNA oxidative damage, while a diet focusing on a few fruits and vegetables did not.

Discover Your Stomach Signals (Jan 2007)

As the New Year has approached us, I like to suggest to my client’s reasonable goals that they may set for themselves instead of creating rigid food rules. Unfortunately just telling yourself to eat when you are hungry and stop when you are full is not that helpful. “Appetite Monitoring” would be a more efficient approach than food monitoring.

Food monitoring is often used as a weight loss strategy, but appetite monitoring is more effective in getting one to focus on what is happening when you eat. This shifts from the focus of what foods you should or shouldn’t eat.

Appetite ratings or levels are based on how you feel, so there is no right or wrong way of doing this as this may feel different at first. This approach will help one get on the normal eating path, regardless of why you have been having difficulties with food.

Tips for the Holidays (Dec 2006)

The holidays can be a challenging time centered on treats and cocktails. Here are some strategies that can make this time more tolerable: First, if going to a party, have a snack beforehand to take the edge off and may result in avoiding the appetizers altogether, or allow one to be mindful of when and why they are eating.

Next, when cocktails are served, alternate with sparkling water or have a low calorie juice with sparkling water to slow down the intake of alcohol.

When buffets are the option, walking the table to see all of the options before starting to fill up the plate will help make wise food choices. Remember, keeping your joyful movement in the picture is important, as one can maintain their weight during this time. Finally, having a limit to the number of treats that one consumes daily is necessary, as well as being conscious when eating them. This will allow one to fully enjoy what they are eating.

Facts about Cranberries (Nov 2006)

Cranberries may help prevent heart disease and some forms of cancer. Other studies show that cranberries may be beneficial in preventing gum disease and stomach ulcers. The now proven scientific evidence shows that cranberries may prevent disease causing bacteria from sticking to the walls of the urinary tract.

The latest study examines the potential interaction of cranberry and warfarin (aka: Coumadin). Previous case reports have suggested cranberry beverages interfere with the anticoagulant medication, researches from UCLA found that one cup of cranberry juice daily had no effect on blood clotting time in males subjects on warfarin.

Risk of vision loss is linked to Carbohydrate Quality (Oct 2006)

The risk for Age-Related Macular Degeneration is one of the leading causes of vision loss in older adults. The Nurses Health Study showed that the total amount of carbohydrate consumed over a ten year period with looking at the glycemic index (a measure of the dietary quality of dietary carbohydrates). Foods with a high glycemic index such as white bread of French fries are broken down into sugar much faster than those that contain fiber (lentils, or yams) which are low glycemic.

Women who consumed those high glycemic foods had a greater risk of developing signs of age-related macular degeneration, compared to have a diet that is lower glycemic index. The bottom line is the type of carbohydrate is important instead of the amount.

The truth behind Microwaved Foods (Sep 2006)

Did you know that it is more important to pay attention to the plastic that one uses to cover their food in the microwave instead of the microwave setting? Look for plastic wrap that specifically says “microwave safe”, then do not let the plastic wrap touch the food during microwaving, advises the US Department of Agriculture’s “Food Safety Facts”. Microwave-safe plastic wraps, wax paper, cooking bags, parchment paper and white microwave-safe paper towels should all be safe to use. It is also important to know that plastic storage containers such as margarine tubs, take-out containers, whipped-topping bowls and other one time use containers should not be used in microwaves ovens. Finally remember that one should never use thin plastic storage bags, brown paper or plastic grocery bags, newspaper or aluminum foil in the microwave oven.

Trying to drop pounds? Try minimizing your intake of red meat in your diet. (August 2006)

After evaluating the diet and health data of 56,000 Swedish women, Tufts researchers found the meat eaters were significantly more likely to be overweight than their vegetarian peers.

If a lower weight isn’t incentive enough to go greener, how about a longer life? Another study published in the American Journal of Clinical Nutrition found that a low meat intake was associated with a 3.6 increase in life expectancy.

Eat to beat PMS (July 2006)

Diet can provide defense against the bloating, cramps, mood swings and symptoms of PMS. Here is a list of foods to help promote natural relief:

  • Magnesium - Too little could aggravate mood swings. Sources include: soybeans, cooked spinach, Brazil nuts, and oats.
  • Calcium - Try nonfat dairy, broccoli and kale. In one study, women who consumed the most calcium had 30% lower risk of PMS.
  • Chamomile Tea - May help relieve muscle spasms, according to a study from Britain researchers.
  • Vitamin E - May hinder chemicals that cause menstrual cramps. Sources include: almonds, sunflower seeds and red bell peppers.
  • Caffeine - Some studies show cutting down on caffeine intake can help reduce symptoms of PMS.
Immunity Superfoods (June 2006)

Vitamins A, C, & E, antioxidants, zinc are all important defenders against germs, viruses and infection. See how to obtain the most of these nutrients from your diet!

Red Bell Pepper- Provides about 260% of your daily vitamin C needs helping to enhance white blood cell function. Red bell peppers are one of the few vegetables sources of Vitamin E, which in addition to slowing the effects of aging, also boosts immunity.

Butternut Squash- One cup of cooked butternut squash provides 127% of daily vitamin A needs. The same serving provides over 33% of daily vitamin C plus vitamin E, which shields immune cells from free radicals and may boost production of bacteria dusting white blood cells.

Spinach- Loaded with a variety of antioxidants that helps shield immune cells from environmental damage and boosts production of bacteria-dusting white blood cells. Other antioxidants include pomegranates, blueberries, kidney beans and dried plums.

Cantaloupe- One fourth cantaloupe provides 110% of daily vitamin C which some research has linked to shorter duration and milder severity of cold symptoms by lowering levels of histamine- a chemical responsible for congestion and stuffiness. Also, provides 50% of daily Vitamin A.

Soybeans-Contain the mineral zinc, which supports synthesis of nucleic acids essential for cell repair. Some studies show zinc may reduce duration of cold symptoms. Other healthy zinc sources include oysters, crab and white beans.

Papaya-Research comparing 40 different fruits for the RDA of nine vitamins plus potassium and fiber rates papayas first-but it’s also a top source of vitamin C which research shows, plus a good source of vitamin A, which helps maintain the skin and mucosal cells lining airways and digestive tracts.

Where our Diets Fall Short (May 2006)
The five most glaring deficiencies are potassium, vitamin E, magnesium, Vitamin A, and Fiber.

Potassium

Helps maintain already normal blood pressure needed for muscle contractions and may promote bone health. Top Sources; Potatoes, Beans, Bananas, Kiwis

Vitamin E

A potent antioxidant that may slow the effects of aging and help bolster the immune system. Top Sources: Almonds, Sunflower Seeds, Red Bell Peppers, Chicory Greens

Magnesium

Supports bone and heart health. Top Sources: Soy, Oats, Brazil Nuts, Spinach

Vitamin A

Promotes healthy skin, eyesight and immune function. Top Sources: Sweet Potatoes, Butternut Squash, Carrots, Kale

Fiber

May help maintain healthy cholesterol levels and can help reduce hunger. Top Sources: Beans, Oats, Raspberries, Blackberries

Coffee, Nuts, Eggs, Red Wine (April 2006)

Experts used to believe that coffee could cause hypertension and heart disease.

In the 1990’s refused the link with heart attacks; a 2002 Johns Hopkins study found that, while male drinkers had higher blood pressure than nondrinkers, coffee was not a major factor. Recent studies suggest that coffee may help ward off Parkinson’s and diabetes, pregnant women may want to limit their intake.

Nuts

Most fat in nuts is “good”, unsaturated fat that when combined with nuts’ fiber and antioxidants- could lower risk of heart disease. Recent studies- including 1998 Harvard research on women eating 5 oz. of nuts a week- have solidified the connection. Cut bad fats; substitute in several ounces of nuts each week.

Eggs

For decades, doctors believed that cholesterol-laden eggs were a major contributor to heart disease; in the 80’s, Americans started to limit their intake.

A ’99 analysis by Harvard scientists found that eating up to one egg a day didn’t increase the risk of heart disease or stroke in healthy people. Other studies have suggested that eggs don’t raise cholesterol levels appreciably. Experts say eggs are fine in moderation.

Red Wine

In the early ‘90’s, red wine, which contains compounds like resveratrol, was thought to be especially good for heart health. But a 1996 Harvard study of beer, wine and spirits showed that drinking any alcoholic beverage in moderation, not just red wine, can be linked to lower rates of heart disease.

Now experts say that 1-2 glasses a day may lower the risk of heart attack, but caution against starting to drink for health benefits alone.

Protein Makes You Feel Fuller (Dec 2005)

Latest research has shown (American Journal of Clinical Nutrition) protein suppresses the appetite. The added protein in foods replaces the “carbs”, as the reducing of carbohydrates is not the answer.

Dr. David Weigle, University of Washington School of Medicine, put volunteers on three different eating regimens. Results showed protein is more satiating than fat. Previous studies indicated that protein is more satiating than carbohydrates. This may mean increasing the consumption of lean protein sources and low-fat dairy products may encourage people to eat fewer calories and promote weight loss.

Remember, it is important to not reduce the intake of fruits, vegetables and whole grains. Scientists do not understand why protein makes you feel fuller than other foods. A European trial, the DiOGenes (Diet, Obesity, and Genes) project, will investigate the effect of a high-protein diet for a much longer time than the University of Washington study, one year, on a larger group of 1,500-3,000 subjects.

What’s the Right Message on Chocolate? (Nov 2005)

Chocolate is high in calories and saturated fats. Some studies suggest that one of the primary fatty acids in chocolate, stearic acid, does not elevate blood cholesterol to the same extent as other saturated fatty acids and may even reduce it.

It is important to remember that overindulging in chocolate will lead to weight gain and its attendant increase in cardiovascular disease risk. To reduce calories is important to remember so one does not put on weight.

Having three ounces of dark chocolate per week will not only increase the flavonols in your diet (also found in fruits, vegetables, red wine and tea), but will reduce the LDL (bad cholesterol) an average of 13.3%. Other benefits would include a reduction in those with essential hypertension and an improvement in insulin sensitivity (how the body uses insulin).