Can Diet Calm an Anxious Mind?

foods to calm your nervesAnxiety. It’s a common ailment. When my clients list their medical history, anxiety is often on the list. It seems to be more prevalent than ever. Maybe we are now recognizing and diagnosing it more often, but it is not uncommon for a person of any age, even children, to report various levels of anxiety.

What is anxiety? Many confuse it with stress, but it’s actually more than that. Whereas stress is the body’s physical response in the moment to a situation, anxiety differs in that the physical response continues far after the situation is over. It is almost as if there is no switch to turn “off.” These physical responses can include increased blood pressure, excessive trembling or sweating, chest pains, insomnia, headaches, nausea, dizziness, muscle tension, constipation and/or diarrhea, indigestion, and even rashes or what feels like allergic reactions. The physical manifestations clearly can be many and may cause harm to one’s body over the long term.

The levels of anxiety can be varied as well. I am not a psychiatrist so I won’t get too far into this, but it can range from general anxiety all the way to obsessive-compulsive disorder (OCD) or post-traumatic stress syndrome (PTSD).

The first step to take if you feel you have anxiety is to talk with a mental health professional. That way you can find out where you are on the spectrum and hopefully even find out where the anxiety is stemming from.

Second, which is where I come in, is supporting your body through this process with proper diet. Studies have shown that specific foods can play a huge part in reducing overall anxiety and improving the body’s ability to cope and recover.

While a healthy, balanced diet is what we typically recommend, let’s break it down into specific foods you can choose to support your brain and mental health.

Foods to Calm Your Nerves

1. Foods high in B Vitamins: Many of the B vitamins are known to help with anxiety and mood. Some great choices include:

  • Green leafy vegetables (at least one large handful of raw greens daily is ideal!) Spinach, kale, chard, collard greens
  • Avocado
  • Citrus fruits
  • Beans, peas, lentils
  • Cruciferous veggies such as broccoli, cauliflower, Brussel sprouts
  • Beets
  • Bananas

2. Foods high in Omega 3 fatty acids: The Omega 3’s (DHA and EPA) we know are very beneficial for the brain and may do wonders for your mood. These are foods such as….

  • Seafood including wild caught salmon, mackerel, sardines, herring and anchovies
  • Plant sources with pre-cursors to DHA and EPA include flax seed, hemp hearts, chia seeds, walnuts
  • High-quality fish oil supplement

3. Fermented foods: Numerous studies have shown that our gut microbes talk to our brain. Crazy, isn’t it? Supporting a healthy gut environment, therefore, is an important consideration for our mental health. Fermented foods include:

  • Cultured dairy products, such as high-quality yogurt (few ingredients, low sugar), kefir, buttermilk, cultured butter
  • Sauerkraut
  • Kimchi
  • Kombucha
  • Pickles and other pickled veggies
  • Miso
  • Tempeh
  • Natto

4. Foods high in antioxidants: Inflammation can definitely put stress on our brains. Fight inflammation with antioxidants and other anti-inflammatory foods. Antioxidants, particularly anthocyanins, can also help increase the body’s production of dopamine.

  • Anthocyanins: blueberries, cherries, grapes, blackberries, pomegranates, red cabbage, purple asparagus
  • Vitamin C foods: Oranges, kiwis, strawberries, pineapple, mango
  • Others: goji berries, dark chocolate, herbs and spices (especially turmeric)!

5. Hydrate!: While not a food, keeping up good fluid intake is so important! Dehydration increases stress on the body which can only exacerbate anxiety. While straight up water is a great choice, teas can also have a very calming effect on the body. Aim for 8 cups per day and even more if sweating excessively.

Foods That May Stress an Already Anxious Mind

While eating more of certain foods can be helpful, we also need to cut out those foods that are increasing stress on your body. These are likely nothing new to you, but they are good reminders!

1. Caffeine

Not everyone reacts adversely to caffeine, but if you are one of those who do, caffeine can definitely raise your anxiety level. Try cutting it out for awhile to see how you respond. On a personal note, someone in my own family did this recently and it did wonders for their mood and overall stress level!

2. Sugar

No surprise here, but sugar increases inflammation, raises blood sugar, and overall is harmful for your brain. Dial it back and choose naturally sweetened foods like fruit instead.

3. Gluten

For some, gluten can be very inflammatory and therefore impact your mood and well-being. Try taking a gluten vacation for a couple of weeks and see how you feel.

4. Processed foods, especially fast food

Another no-brainer, but fast food and other highly processed foods are very low in actual nutrition and high in refined carbs, sugars and additives. Ditch the drive-through and seek out healthier alternatives.

5. Artificial sweeteners

A component of many processed foods, I single these out because they may be harmful to our guts and therefore impact brain health. Some of my clients have even reported headaches and other reactions from these sweet additives. Go for the natural sugar if forced to choose but in very small amounts.

6. Avoid any foods you are allergic or sensitive to

Some of you, knowingly or unknowingly, may be suffering from food sensitivity reactions. These reactions cause inflammation which can exacerbate stress and anxiety. If you aren’t sure which foods are causing you problems, an elimination diet can be a good first step. Seek guidance from an RD like myself to help tailor such a plan or dig deeper if the offending foods are elusive. For difficult cases, I like using MRT food sensitivity by Oxford Biomedical for decisive answers (www.nowleap.com).

 
Hopefully, this gives you a few specific food ideas to get started! Again I will reiterate that if you are struggling with anxiety, seek professional help. Don’t do this on your own. Along with expert advice, change up your diet to give your brain the support it needs!

 

Are diets one size fits all? Research suggests not all diets are created equal when it comes to your genes.

weight lossOnce again I’m pondering the research around “diets.” First of all, I hate the word diet. It implies some sort of rigorous eating plan that once completed, will solve all your health problems and somehow miraculously allow you to resume former habits. Or, it alludes to something you hop on/off a couple times per year in hopes of staving off weight gain.

Diet is actually defined as the foods a person or animal habitually eats. In that sense, the way we use diet is all wrong. For most, “diets” have a foreseeable end, whereas a diet in actuality is the way you eat most of the time.

There are numerous “diets” or ways of eating that are being publicized. Who hasn’t heard of the ketogenic diet by now? There is also paleo, Mediterranean, low carb, macrobiotic, vegetarian, vegan, etc.  All of these tout that their plan is the “way” everyone should eat. It can be extremely confusing. It’s like a pick your own adventure of diets.

Naturally, as a dietitian, everyone wants to know what I deem to be the BEST diet. Some are disappointed when I don’t provide a clear and firm response on the matter. You see, the reason I keep pondering various these diets is because I’ve seen through countless client encounters that many diets, as healthy as they might seem, just plain do not work for some people. I have had people come in, desperate for help, because the “healthy” diet they have followed to the “t” is producing no weight loss results, or even worse, causing increased lipid levels and reduced energy. What gives?

Recent research out of Texas A&M may provide some helpful results.1 They showed that that in mice fed various popular diets (Standard American, Ketogenic, Japanese, Atkins, etc ), they all responded differently, some positive and some negative. In other words, some mice showed positive improvements on particular plans while others actually got worse on the very same diet.

The key is genetics. The researchers in this study suspect that genetic variations cause our bodies to respond better or worse to various foods and styles of eating. For example, one mouse in particular did very poorly on the Japanese diet, surprisingly, while the rest stayed in good health. Also, most did poorly on the standard American diet (as expected) but some fared less poorly than others.

The take home message is that clearly, one diet does not fit all. A diet that improves the health of one person might worsen the health of another. So many out there want to promote and sell you the universal “ideal” diet, and yet it is becoming more clear that it does not exist. The role of genetics is only going to continue to become more prominent as we search for answers in the obesity epidemic and for conditions such as heart disease, diabetes, and hypertension.

Is your current diet not providing the results you had hoped? The good news is that there is a “right” diet out there for you. Maybe you need to stay more consistent with the one you are on, or maybe you need to change gears entirely. If you are unsure which way to go, consult a professional like myself to provide some guidance on steps forward. While we can’t know for sure which diet will be the golden ticket, we certainly can provide some objective advice to point you (hopefully!) in the right direction.

Last point. If you have failed at weight loss in the past despite carefully following popular diet plans that show amazing results for others, don’t count yourself a failure. Look at this research as hope. It validates that it may not be your efforts that have failed but that type of diet doesn’t work with your genetics. Keep exploring and keep trying!

https://www.sciencedaily.com/releases/2017/11/171130170236.htm

‘Tis the Time for Mindful Eating: Danielle’s 5 Key Tips to Surviving the Holiday Food Deluge

Oh yeah, here they come again, the holidays! It’s funny because it is a time we all look forward to and yet there is still this dread …. the dread of weeks of overeating and the unavoidable weight gain. For many it’s quite predictable. In fact, the average American gains 7-10 pounds during the months of November and December. But really, who can resist all those delectable holiday treats?

Many, on the other hand, never gain an extra pound over the holidays. I am usually one of those. “That’s because you are a dietitian and never enjoy food anyways” you say. “No way!” is what I say. I enjoy lots of foods. Lots of foods in moderation. “Ugh, the moderation word. So overused.” Yeah, I agree. But to a large extend it’s true. You can enjoy a wide variety of foods if you keep it in moderation. Over-indulge? No. Indulge a little? Yes.

Now, you might be already thinking, well that’s no fun. What’s the holidays if you can’t eat until your stomach is about to rip in two and you need to take an extended siesta on your grandfather’s lazy boy? I hear you. We all have traditions that we come to expect and almost crave during this time of year. For so many, over eating is one of them. As mentioned, we dread this season of overeating, but we also expect it and do it anyways. It’s like an unbreakable vicious cycle. How do we get out of candy land hell!

One of the first steps is to recognize the problem! The problem is that when we overeat, we constantly over-ride our natural hunger/fullness cues which eventually leads to dysfunction, to the point we can’t even tell when we are hungry and full anymore. We start to eat for pleasure or pain instead of physical need. This causes us to eat frequently and in portions much larger than we need.

What to do? This is where some basic mindful eating tips can come in super helpful. It may not change your life immediately, but trust me, over weeks and months you will slowly be more in tune with yourself and better able to nourish your body with what it needs, not with what your cravings tell you it wants.

Danielle’s 5 tips for surviving the holiday food deluge:

1. Recognize your weakness areas and where they are encountered.

Recognition is always the first step, isn’t it? You have to assess where your problem areas lie.  Is it sugar? All carbs? Salt? Large portions in general?  All of the above? Does the problem occur in the workplace? At home? At family gatherings? Late at night alone? All of the above. Think through the foods you just can’t stop eating and where you find them throughout the day. Write it down.

2. Make a daily and weekly plan.

Remember, most of the gradual weight gain comes from slight but cumulative overeating all through the holidays, not just on Thanksgiving and Christmas day. Make a plan for yourself so you have a rough idea of what you want to eat from day to day and stick to it. Having a plan liberates the mind to think about other more important things and even frees it from considering cravings, especially when you know, according to your “plan,” that they are not an option.

*If you need help making a plan for the holidays, come see me for ideas!

Going along with that, keep a diet journal as you go. Writing down what you eat, at least for a short period of time, increases your mindfulness around what you are eating and helps avoid random snacking. When you are forced to think more about what you eat, you tend to make better choices. So put pen to paper (or finger to phone) and keep track for a couple of weeks during the holidays.

3. DO NOT avoid all your favorite foods. That is probably the worst thing you can do, especially as you start something new. In my experience the more forbidden a food is, the more you want it. What I say is that all foods are allowed, but portions are controlled. That is the key. Make sure you enter it into the plan and stick to a defined portion. *Don’t forget, usually the first 1-3 bites of any food are the most satisfying. The word is enjoy, enjoy, enjoy. Enjoy the hell out of each bite. When that uber enjoyment ends, put down the fork. Save the rest for another day. I know it’s hard, but try it!

4. Keep up your physical activity! I can’t even tell you how many people let go of their exercise routines during this time because they are “too busy.” Oh no. That is not acceptable. We all have extra things we add to our daily itineraries because of holiday stuff, but slacking off on exercise is not one we can cut. Decreasing exercise can increase your risk for depression (especially if you are prone to it), decrease your willpower around food portions, and of course only add extra calories to your day because your aren’t burning those bad boys off. In fact, my advice is to INCREASE your exercise during the holidays! Make November and December your fittest months. You will not be regretting that come January when everyone else is hauling their sorry arse back to the gym!

5. Always load up on fruits and veggies.

Basically when in doubt, choose fruit and veg. These beauties are chocked full of vitamins, minerals, fiber and antioxidants ….all the things you need to counter act any unhealthy choices encountered over the holiday months. You are going to feel a lot better, and gain less weight, if you fill your plate with produce at each and every meal.

Bonus tip: Relieve stress however you can! Stress always makes eating worse (not to mention ruins our holiday spirit). Before the holidays hit, think thru right now what helps you melt away stress and make a plan to DO those things regularly. Read a book? Get together with a friend? Meditate or deep breathing? Yoga? A quick getaway? If the holidays stress you out, counteract it this year and get stress-relieving activities on the schedule!

Remember these tips as you move through these next weeks and months, and best of luck as you navigate another wonderful holiday season!

As always, if you need help with any of the above, please come talk to me! I’d love to help you make a holiday plan to make this time your healthiest yet!

Image courtesy of Serge Bertasius Photography at FreeDigitalPhotos.net

Skipping breakfast hardens your arteries? More reasons to charge up in the morning with a healthy (and preferably potassium-rich) meal!

According to a recent study in the Journal of the American College of Cardiology, those who skip breakfast are more likely to experience atherosclerosis, aka hardening of the arteries, than those who ate a daily, healthy meal in the morning. 1

The connection, it appears, is that those who are breakfast skippers tend to have more unhealthy diets and lifestyles than those who don’t. They found in the study that overall, those who opt to skip breakfast had poorer diets, were more likely to have high blood pressure or be overweight, and were more likely to smoke or consume alcohol in excess. All of these factors lead to an increased risk for atherosclerosis. Lack of breakfast is not the cause, per se, but an indicator of other health habits.

Now, when I read the study synopsis I was suddenly reminded of another study I recently perused. It linked low potassium intake with hardening of the arteries.2 I got to thinking. Does lack of a morning meal also mean less nutrient intake overall, and therefore decreased intake of critical nutrients for heart health?

Think about it. If you are skipping an entire meal, one that for most provides roughly one quarter to one third of a person’s daily calories and nutrients, wouldn’t this eventually have an impact on nutrient status (particularly potassium) and therefore one’s heart?

The daily recommended intake for potassium is 4,700 mg per day. This is easily achieved if the diet is full of fruits, vegetables, legumes, and dairy. This is hard to achieve if one lives on processed foods and is skipping meals. It seems, therefore, that skipping an important meal, one that has the potential to provide a good dose of nutrition, could be a serious problem. Now, if a person is very diligent with their diet the rest of the day and makes up those nutrients elsewhere, clearly this is less likely to be a problem. But let’s be honest: that is not most of us.

So while we thought the great breakfast debate had died down, evidently it has not. Here we have yet another reason to start your day off right. Eat your breakfast, and make sure it is healthy….for your heart’s sake.

Now that begs the question: what constitutes a healthy breakfast? Let’s dive into some potassium rich breakfast ideas to get you going in the morning:

  • Sweet potato hash and eggs
  • Greek yogurt with fruit and nuts
  • Protein shakes:
    • Add banana and/or berries
    • Add avocado
    • Mix with coconut water for a super potassium boost
  • Egg scramble with spinach, broccoli and onions
  • Avocado toast
  • Smoked salmon or lox on toast w/ fruit on the side (cantaloupe is a great choice!)

Hope those ideas get you started! Just remember, starting your morning with healthy foods straight away sets you up for a day of healthy eating. So eat something, even it is small, and get your day off to a good start. Your heart will thank you.

  1. https://www.sciencedaily.com/releases/2017/10/171002145635.htm
  2. https://www.sciencedaily.com/releases/2017/10/171005102712.htm

 

Image courtesy of KEKO64 at FreeDigitalPhotos.net

Can you fight your genes? The importance of healthy lifestyle factors in gene expression.

Genetics. It is a hot topic right now. Well, it has been a hot topic for quite some time, ever since the human gemone project was completed in 2003. We now have the ability to look at someone’s unique DNA and assess risk for a host of health conditions. In many cases, we do not even fully understand the impact of DNA aberrations as many abnormalities have not yet been well studied.

Genetics is also very hot in the nutrition world right now. Why? Because we now have advanced testing that can give us specific information related to how a person’s body responds to various inputs: diet, stress and the environment. We are also uncovering specific genes related to body weight, blood sugar control, brain health, autoimmune conditions, etc. 23andme.com, which you have likely heard of, is one of the leading companies in this arena right now providing raw genetic data to clients across the country.

While this information is useful (and believe me, it can be really, really useful), there is also the danger of believing our genes determine our destiny. It is a common belief that if you have genes for obesity, for example, that at some point you will become obese. That same can be said for alzheimers disease or celiac disease. The thinking is that if your genes point you in any one of these directions, there is nothing you can do to avoid the progression. Might as well eat that doughnut and sit on the couch a little longer because at the end of the day, what can you do to stop it?

Thankfully, that is not true! Lifestyle choices DO matter, and they matter critically when it comes to gene expression. The key point is this: just because you have “bad” genes does not mean that they will express. Take the person with genes for celiac disease. There are actually many people who have those genes and yet never get the disease. How can that be?

Well, in celiac disease, according to Dr. Alessio Fasano, you need three things for the celiac gene to turn “on.” You need to have the gene, obviously. You need to have gluten in the diet. And you need to have an environmental trigger. Ah, an outside trigger! That is one of the key ways genes express. Take a moment and think about what an outside or environmental trigger might be……..

Yep, likely you named a few. How about emotional stress? Physical stress (extremely hard labor, over-exercising)? Poor diet? Substance abuse? Illness? Fatigue/lack of sleep? Toxins?

That brings me to the latest study I read that hit home on this very fact. Lifestyle influences genes. Your genes do not determine your destiny….. necessarily.

The study, conducted in the UK, looked at genetic data and self-reported lifestyle choices from over 360,000 middle-aged subjects. Their primary interest was to see how various lifestyle factors affected the risk for obesity in people with genetic markers predisposing them to excess weight.1

When they analyzed their data, three points stood out. Those with a lower socioeconomic status showed an increased risk for obesity. Presumably this is due to poorer diet choices, increased stress, and other factors related to being low-income. Those with regular exercise showed a significant decrease in their risk for obesity, as well as those subjects with regular alcohol consumption. While clearly more studies need to be done, we can definitely start to see that certain lifestyle choices play a role in how genes express.

What is the take home message then? Drink more alcohol? No, sorry, this is not an article sponsored by Smirnoff. The main message is this: consider your lifestyle choices more than your genes.

Think of it like this, as I learned in a recent webinar by Dr. Ben Lynch. “Bad” genes suggest susceptibility, not cause. Knowing your genes allows you to understand where you are susceptible, but it does necessarily determine your fate. So, as much as you can, take your health into your own hands.

Don’t let anyone tell you diet doesn’t matter. Don’t let anyone tell you exercise doesn’t matter. Don’t let anyone tell you stress doesn’t matter. It all matters. Obviously no one can achieve perfection in any of these areas, but do what you can. It not only makes you feel better, but your genes feel better too!

If your lifestyle just isn’t up to par and you feel lost, please reach out! That is what dietitians are for! The focus of my job is food and healthy lifestyle and I have LOTS of pertinent information to share. Drop me a line!

1. https://www.sciencedaily.com/releases/2017/09/170906103749.htm

Hitting Home the Importance of Fiber

I know, you probably think you have heard enough about fiber over the years. Well guess what, you haven’t. We certainly talk a lot about fiber but Americans continue to eat less than is recommended. The average American maybe eats 15g of fiber per day, and we are supposed to get at least 25-38g (female vs male) in a 24-hr period. That might even be conservative given that fiber intake in other cultures can reach levels much higher.

Previously we have always hyped up fiber for its benefits in weight control, heart health, and digestion. It helps to keep us full, which decreases overall caloric intake, and fiber is associated with improved cholesterol and blood pressure. Fiber also bulks up stools and helps keep us regular. Clearly, it is an essential part of our diet.

But its importance is becoming even clearer as we delve deeper into the studies on the complex system of microbes living in our digestive tract, the “microbiome” as we call it. Study after study is showing that the type of microbes living within us either contribute to good health or detract from it, and studies also show that the types of foods we consume, particularly fiber, play a huge role in determining its overall influence.

For example, a recent study came out showing that walnuts might help support healthy flora in the gut.1 Rats given diets supplemented with walnuts showed an increase in the diversity of bacterial species in their guts over the non-supplemented animals. Walnuts acted as a pre-biotic food, feeding the beneficial bacteria and helping their colonies increase. While we have many known prebiotic foods already (I have handouts on these!), walnuts, at least to my knowledge, have never been on that list. Better get to adding it!

So yay, walnuts are good. But the thing is, as more of these studies are done, I think we will find that all fibrous foods are prebiotic to various extents. In fact, diversity of fiber is probably the key to optimal diversity of gut microbes. These one-off studies, while helpful no doubt, are to many people a simple suggestion to add a few more walnuts here or there, or whatever food the researchers are reporting on that week.

In reality, the take home message is that we need lots of fiber, every day, from whole foods sources, and we need to get rid of the non-fibrous, nutrient-empty foods that clog up our diet. A handful of walnuts in addition to your morning bagel and venti coffee is not going to cut it. We need to be intentional about the choices we make and ensure our meals are full of diversity and fiber.

What does this look like? I think that is the biggest hurdle for most. The grocery stores are not exactly helpful in this area as they seek to entice us with processed and “convenient” options, most of which are extremely low in fiber. Meals still can be quick, but you have to think ahead and make careful choices. To get you started, here are a few ideas:

Breakfast:

1. Yogurt bowl: Grass fed Greek yogurt with ¼ cup granola, 1 tbsp flax seed, 1 tbsp hemp hearts, ½ cup blueberries, ¼ cup chopped walnuts, 1 tbsp honey
2. Oatmeal: ¾ cup oatmeal with 1 tbsp flax seed, 1 tbsp hemp hearts, ½ cup berries, ¼ cup chopped walnuts or other nut, 1 tbsp honey or maple syrup. Alternatively, instead of oats, use cooked quinoa as your base and add same ingredients.
3. Egg scramble: 2 eggs, 1 cup diced mixed veggies, ¼ cup grated cheese, ½ banana on the side
4. Toast & Fruit: Piece of whole grain toast with 1 tbsp almond butter with apple slices or other fruit
5. Chia seed “pudding”: Chia seeds soaked in coconut milk, then add ingredients just as you would with the yogurt bowl
6. Breakfast smoothie: Milk of your choice, protein powder, frozen berries, 1 tbsp flax or chia, handful of spinach or kale, sweetener if needed (try stevia)
7. Egg “hash:” Take cooked kasha groats and top with egg cooked sunny side up, add black beans or baked sweet potato on the side.

Lunch/Dinner:

1. Sandwich: High fiber whole wheat bread with deli meat or PB&J.
2. Wrap: Whole wheat or gluten-free tortilla w/ hummus, leafy greens, deli meat
3. Soups: chicken/veggie, bean soup, etc
4. Stir-fries over quinoa or brown rice
5. Pasta using whole wheat noodles and meat/veggie sauce
6. Curries

Snacks:

1. Piece of fruit with handful of nuts
2. High fiber protein or granola bar
3. Kale chips
4. Homemade whole wheat or bran muffins
5. Veggies dipped in hummus or bean dip

See? So many options besides cereal or the morning pastry. A million more ideas instead of hamburgers or grab n’ go sandwich on white bread. You just have to be intentional. No, most often you cannot simply walk into a store or restaurant and find one of these options on your way into work. You have to plan ahead and do a little prep in advance.

Remember, health doesn’t just happen. You have to work at it. Anyone training their body for an athletic event knows this. It’s the same with your diet. YOU have to make it happen. So no more excuses about not having time or not being to find these things at your local Starbucks, ok?

Go to the grocery store after work and have these ideas ready to go. Pack along a cooler or other mode of food transport so you can take these things with you. Do not let others dictate what you eat for sake of convenience. Make it happen! Your body (and especially your gut microbes) will thank you.

1. https://www.sciencedaily.com/releases/2017/07/170728100832.htm

More Harm than Good? The Health Risks of Proton Pump Inhibitors

proton pump inhibitorAre you one of the millions of Americans currently taking a proton pump inhibitor (PPI) medication? If so, please read on. There are many health concerns coming to light regarding the use of PPIs, including this recent study (see link below), suggesting an increased risk of death with long term use. Yikes! It may be time to talk with your doctor to see if continuing with such a medication may cause more harm than good.

As you are likely aware already, PPIs are commonly prescribed for digestive concerns such as acid reflux (GERD) and ulcers. Common brand names include Prilosec (Omeprazole), Protonix (Pantoprazole), Prevacid (Lansoprazole), among many others. Their primary goal is to reduce the secretion of stomach acid, thereby decreasing GERD and/or allowing ulcerative tissue to heal. Once symptoms subside, the medication is intended to be gradually discontinued.

How do PPIs work? Well, the lining of your stomach contains cells called parietal cells. These cells, through a cascade of enzymatic reactions, make hydrogen ions. These hydrogen ions are then secreted into the stomach where they help form a mixture of hydrochloric acid, potassium chloride, and sodium chloride, aka stomach acid.  PPIs do their job by inactivating this enzyme sequence, hence far less hydrogen ions are pushed out into the stomach. The end result is less production of stomach acid. Less stomach acid means less reflux and less irritation of ulcers. Seems like a perfect solution.

But the problem is………we actually need stomach acid. Long term suppression can lead to a cascade of other health complications.

For starters, stomach acid helps break down proteins, a process called proteolysis. I think we all agree getting enough protein is important, and the acidity of our stomach helps make sure we can utilize what we eat.

Secondly, HCL helps improve the absorption of several key vitamins and minerals that our bodies need. Without stomach acid, many of these nutrients cannot be unbound from their protein carriers and/or transformed into their absorbable form; therefore absorption is impaired. Some of these include calcium, iron, magnesium, and B12.

Thirdly, HCL in the stomach acts as an important protective barrier against unwanted bacteria and helps maintain healthy flora in the intestines. Studies have found that PPI users have an increased risk for C Diff, Listeria, Salmonella, and other pathogenic bacteria which can not only cause illness but also long-term imbalances in the intestinal microbiome.

In light of this, it is not surprising that long term use of a potent acid-suppressing medication can have harmful effects in terms of nutrient status and overall digestion. Could the increased risk of death indicated in this recent study be linked to this? Possibly. Certainly causes one to pause and consider.

But there is more. Apart from decreasing stomach acidity and impairing digestion, PPIs have other equally and potentially more dangerous side effects that should not be overlooked.

One recent study found that PPIs interfere with an enzyme that supports nitric oxide (NO) production in the body. NO is an important compound for cardiovascular health; it allows dilation of the arteries and improves blood flow. Reduction in NO may contribute to cardiovascular complications in some people.

Other studies have shown increased damage to the kidneys with long term PPI use. While the mechanism is unclear, PPI use is linked to increased risk for chronic kidney disease and end-state renal disease.

Could these be linked to the increased risk of death found in the aforementioned study? More points to ponder.

The main point is this: PPIs were not intended for long-term use and their use does not come without risk. This recent study simply highlights that there are in fact risks and users need to be aware of these when making their medication decisions.

If you are using PPIs and have been doing so for quite some time, please talk to your doctor. Proton pump inhibitors are just a band-aid for a deeper medical issue. Ask your doctor to help you find the root cause. If they have no solution, talk to an integrative health specialist and keep searching. Take your health care into your own hands. This latest study should be a wake-up call to do just that.

If you and your doctor do decide to wean off the meds and you are curious about other ways to repair your digestion, I would love to talk with you. We can find a way for you to be symptom free…..naturally. Diet is a key component and I have many ideas to share!

What is Functional and Integrative Medicine?

integrative medicineThere are many of us nutrition professionals now aligning ourselves with Integrative Medicine. I consider myself in this group. Maybe you are asking yourself what exactly this is and most importantly, does it really matter?

To answer that question, let’s first address the area of conventional medicine. For some time now modern medicine has sought to treat the presenting symptoms. This might mean treating a fever or a cough, for example, or addressing pain or other discomforts. Sometimes this approach is entirely appropriate, however more often this approach misses the underlying cause and the person is never completely restored to health. Think of lingering health conditions such as acid reflux, chronic fatigue, and headaches, just to name a few. Drugs are often prescribed and the patient is sent on her way, but the symptoms persist if the drugs are discontinued.

Additionally, there is very little discussion with the patient as to how their condition came about. Unfortunately, and not the fault of our doctors, there is limited time available to spend with patients and so remedies must be delivered quickly. Without more in-depth dialogue there is little chance the practitioner even has the opportunity to see below the surface of what is really going on.

From a dietetic perspective, a conventional approach to diet intervention would be something like prescribing the same diet to everyone with the same disease. Everyone with heart disease would get guidance on the exact same heart healthy diet, for example, with no consideration given to their culture, preferences, cooking ability, or genetics. Similarly, a person seeking to lose weight would be advised on the same general diet as another without consideration given to what they’ve tried in the past or an understanding of what foods work or don’t work for them. These would be examples of conventional approaches.

Now let’s flip to the functional side. Functional practitioners are looking less at masking symptoms and more at how the body is functioning as a whole. They are attempting to uncover where the body is malfunctioning and how can we restore it to its normal, healthy state. Symptoms are just clues to lead us towards the underlying cause.

In addition to symptomatic clues and obviously a physical exam, if appropriate, functional medicine practitioners are also looking in-depth at a person’s unique health history to find more clues as to how and why the body is not functioning as it should. This means sitting down with someone for a significant length of time (often 45 min to an hour) and asking a series of pertinent questions to paint a picture of the person before them. What might seem off-topic to the patient is often valuable information to the practitioner, as random side notes about vacations, new pets, change of jobs, or significant loss can give further clues into a person’s current state of health. These are topics rarely discussed in the conventional model.

Additionally, if necessary, laboratory tests can be conducted to give further insight into treatment options. These might include not only standard blood work but also food allergy tests, digestive stool testing, hormone testing, etc.

The goal then, after this information is obtained, is to determine how to best gently nudge the body back into an optimum state. Pharmaceutical options are a last resort as we know these only mask symptoms and leave the original condition unresolved. Potential nutrient deficiencies are often addressed, exercise recommendations may be made, and stress reduction techniques might be employed as well. Some may go further and prescribe other treatment modalities such as massage, acupuncture or chiropractic care to complement their recommendations. Once initiated these treatment plans often need time. Patients do not develop chronic health conditions in a day or even a week. Likewise these treatments need weeks if not month to restore the body to proper function and balance.

So how does this model work for the dietitian? Thankfully, we already have the immense fortune of being able to sit down with someone for a good hour or more to delve into health and diet history. This gives us a solid place to start when it comes to tailored diet advice. While we are not credentialed to prescribe or “treat” per say,  this time allows us to get a full picture, both past and present, of what clients are dealing with; therefore we can devise and educate on an appropriate diet strategy. Often we suggest helpful supplements as well, especially where nutrient deficiencies are apparent. We can also advise on exercise and stress and provide additional referrals when needed.

While both modalities have their place, consider looking into functional medicine, especially if you have chronic conditions that the standard medical model is not effectively addressing. Remember, more medications is not necessarily the answer and in fact can lead to yet more symptoms that require more drugs. Believe me, I have clients in these predicaments and it’s a slippery slope.

So consider seeing a naturopath, a functional dietitian like myself or other holistic care providers for a more thorough look into your condition; or even consider it for another opinion. It just may be the nudge your body needs to finally heal and restore.

Of course, if you have questions or want to talk, please reach out! I have loads of referrals if you are looking for a qualified practitioner to meet your unique needs.

 

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

Smart Summer Snacking

healthy snackSummer is just about here….we in Seattle can feel it. It’s been a long winter. Finally the days are longer and we are getting outside. More importantly, many of us are planning trips, outings, picnics, etc. What do these things always involve? FOOD of course!

With all this movement out and about, eating healthfully can be tricky. Many of us end up snacking more than normal as we end up in different environments with less access to our typical go-to foods. The temptation to swing into a gas station mini-mart or fast food becomes all the more tempting. Unfortunately these places rarely have healthy options, and even when they do, who actually buys them? Be honest here.

The key to solve this problem? Planning! Plan, plan, plan. Did I say plan already?  You HAVE to plan ahead. Yeah, maybe it takes the spontaneity out of things, but there are plenty of other opportunities for exciting food adventures besides those you might encounter driving down I-90 or on a 5-hour plane ride. Plan some snacks, pack them with you, and stay healthy and energetic throughout your trip.

What to pack on the road? I’m glad you asked. Here are some simple, car-friendly and flight-friendly options to get you through until your next exciting meal can be enjoyed. These can also make great meal replacements in a pinch when no healthy meal options exist.

Nuts
Nuts are your friend. They pack a good deal of calories, so portion accordingly, but they also have healthy fats, fiber and protein. Pick your favorite and parcel into plastic baggies or just tote the whole darn bag and share with your travel mates.

Dried Fruit
Yeah, I know dried fruit has carbs. They have a lot of carbs. But they also have vitamins, minerals, fiber and antioxidants. If you portion them correctly you do not have to be afraid of dried fruit. It too is your friend and makes a great travel companion. They pair fantastically with nuts or other protein options.

Dried Vegetables/Legumes
Dried vegetables? Indeed, I have been seeing more dried veggie options in the stores these days. From kale chips to crispy beets to baked chickpeas, there are more savory dried options that are travel friendly. While some may contain oils and flavorings that might be less than ideal, we are still doing better than chips, candy and fast food, right?

Bars
Bars can be risky. I always hesitate and clarify when I recommend bars. Many are loaded with sugar and beefed up with cheap protein fillers and poor quality vitamins. That being said, there are actually some decent options out there with high quality ingredients and actual nutrition. What do I look for? First off I check the ingredients. Does the list run 4 lines long and contain many unpronounceable words? Put it back. For me, the less ingredients the better.

Also check the nutrient label. How’s the calorie count? Protein content? Fat? In a perfect world I’m looking for 200kcal or less (could be more if substituting for a meal), 8g of protein or more, and a fat content that does not seem obscene (less than 15g, perhaps?). Then I’m looking for simple, whole foods ingredients that I know are providing my body with nutrients and don’t require the manufacturer to add in a host of artificial vitamins to make sure it’s well balanced. I like to see nuts, seeds, grains, fruit, etc. Some might add whey or plant-based protein to pump up the total protein content, which I am fine with. Avoid soy protein isolate.

Now, there are a bazillion bar options out there and I am no expert on them all. I will list a few options I like here, but do realize this list is by no means exhaustive. If you find a bar that meets your personal criteria and you like it, go for it! Here are a few I’ve found that I will travel with in a pinch. I believe most of these avoid the common allergens as well so great options for those with food restrictions. Check out their sites for ingredients and places to purchase.

Rx Bar
https://www.rxbar.com/

Macro Bars
https://gomacro.com/shop/product-category/macrobarminis/

Epic Bars
https://epicbar.com/

Primal Kitchen
https://www.primalkitchen.com/products/almond-dark-chocolate-bars/

Pro Bar
http://theprobar.com/#2

And if you have the time, make some bars yourself! On my last trip overseas I planned ahead by making a batch of protein balls and packed them in my carry on. They made a great treat when the food cart came around and there were very few options I deemed acceptable to eat. Homemade gourmet for the win!

Hope these ideas help you plan more effectively for fun and sun this summer!

If you have your own go-to travel snack ideas, please share!

 

Image courtesy of SOMMAI at FreeDigitalPhotos.net

What is Pre-Diabetes?

prediabetesMost of us have heard plenty about Type 2 Diabetes. It is a serious condition causing abnormal elevations in blood glucose levels. Type 2 Diabetes now affects over 29 million Americans and is costing the healthcare system over $300 billion annually.

The cause of Type 2 Diabetes is multifactorial. A high BMI with an unhealthy diet is often the main culprit, but genetics may play a role as well.  Over time, diabetes leads to a host of other diseases, which is where the most considerable health damage is done. These include conditions such as neuropathies, heart disease, stroke, infections, and poor wound healing.

In terms of diagnosis, your doctor will sound the diabetes warning bell if you have an HbA1c above 6.5 and a fasting blood sugar over 125. Treatment often begins with drugs (Metformin is usually the first option) and diet and lifestyle recommendations.

But…..now more frequently we are hearing about what is termed Pre-Diabetes. Yikes, another type of diabetes? Well, sort of, but not exactly. Pre-diabetes is basically the beginning stages of blood sugar irregularities.  It is a critical point where we can catch people before they become full diabetic and in many cases even reverse the progression.  It is important that we all get a better understanding of this condition so we can combat the rising rates and healthcare costs of diabetes. To that end  let’s review the definition of pre-diabetes, the associated health risks, and effective preventative measures.

We already reviewed the diagnostic criteria for diabetes. For pre-diabetes, the ranges are just slightly lower. If your fasting blood sugar is running anywhere from 100-125 and your A1c comes back anywhere from 5.7 to 6.4, you will likely be labeled as pre-diabetic. This puts you at significant risk for diabetes within the next 4-10 years unless steps are taken to return your blood sugar to an ideal range.

This is where I would ask, if you happen to have them on hand or online, to go check your labs. Seriously, go check them! See where your fasting blood glucose is at and determine if you’ve had a recent A1c. The reason being? Many doctors are not diagnosing pre-diabetes. Studies have shown we have an under-diagnosis problem in this country when it comes to pre-diabetes. I’ve seen many clients in my office with pre-diabetic numbers and yet no one told them they were pre-diabetic. So yes, go check.

It is so valuable to know this information because pre-diabetes is EASY to treat with diet and lifestyle change. The studies show that diet and lifestyle are the number one way to reduce blood sugar numbers in pre-diabetic patients. Once you progress to full diabetes the chance of returning to normal blood glucose is much, much harder. NOW is the time to take action and correct.

If you are pre-diabetic and want to take steps now to avoid becoming diabietc, here are a few of the researched ways to get those numbers back under control.

DIET
Not surprisingly, diet of course is the primary area to address. From the research we see that that reducing carbohydrates helps immensely, as does decreasing overall calorie intake such that weight loss occurs. When diet and weight loss are tackled together, blood sugar begins going in the right direction as well. What kind of diet you ask? Multiple studies show the Mediterranean diet is a very helpful roadmap for an overall healthy diet. Thankfully multiple books, cookbooks, websites, and blogs have been devoted to this way of eating. Another similar approach is the anti-inflammatory diet. In both cases, think fruits, veggies, lean protein (especially fish), nuts, seeds and legumes…..you get the idea.

WEIGHT LOSS
As alluded to, weight loss is extremely important in normalizing blood glucose levels. In many studies they have found weight loss to be the most important factor in reducing diabetes risk. The theory is that being overweight increases inflammation in the body. Once the weight comes off and the inflammation subsides, blood glucose begins to return to normal. Of course diet is always interwoven with weight loss, so likely the diet plus the decrease in weight is working together. Whatever the cause, include modest weight loss in your plan and you should see results.

EXERCISE
Naturally we cannot talk about diet and weight loss without including exercise. Exercise helps support weight loss which we know improves blood glucose. Apart from helping with the weight, exercise also helps improve insulin sensitivity and increase metabolism, all of which help us clear sugar from the bloodstream more efficiently. It also supports a healthy heart and improves circulation, both of which are negatively impacted by high blood sugar.

DRUGS
In some cases, drugs are employed to help in the pre-diabetic state. If diet and lifestyle changes just aren’t working, or maybe you are at a place where you cannot implement these changes, doctors may prescribe drugs such as Metformin to support healthy blood glucose levels and slow the progression towards diabetes. Of course diet and lifestyle change remains paramount components, but drugs can often work in conjunction with other treatments when necessary.

SUPPLEMENTS
As you are likely well aware, there are many supplements on the market for diabetes. They are often marketed for pre-diabetes as well. Some of the ones you may have heard of include cinnamon, alpha lipoic acid, chromium and Omega 3’s. All of these have shown some promise in various studies conducted. While they can help support improved glycemic control, remember that diet and lifestyle changes are always the most important. Never rely on supplements as your primary means of blood glucose control.  They show modest results at best. Like medications, they can be helpful in conjunction with changes in diet, exercise and weight control.

Hopefully this review gave you a quick glimpse into pre-diabetes and a better understanding of where you stand in terms of blood sugar health. Like I mentioned, always review your labs and be keep tabs of where you are at. While doctors are very knowledgeable, sometimes they miss these early stages of disease where small changes now can lead to big decreases in risk later. Take control of your health and be on top of your numbers.

If you do find that you are pre-diabeteic, one of the best things you can do is talk to a Registered Dietitian! In fact, a recent study conducted found that RD’s were more effective in delivering health information to diabetics than other types of practitioners, resulting in greater improvement in diabetic markers over a 12-month period. What makes our job so great is that we get to sit down with clients one-on-one for up to an hour, really drilling down on each person’s unique diet and situation. We customize the plan to fit the client instead of forcing people to adhere to some standard regimen on a piece of paper. As the research shows, this results in better compliance and bigger changes in blood glucose.

So….along with knowing your numbers, know a dietitian! Get some support if you are looking to navigate new changes in your diet and overall health! That’s what I’m here for.