Lists, Uncategorized

How to reduce stress

“Reducing stress requires ACTIVE relaxation.” Dr. Mark Hyman’s book The UltraSimple Diet

He points out zoning out on the couch is not really relaxing. I know I usually feel worse after a long day of sitting!

Here’s his list of relaxing activities to truly de-stress.

  • Take an UltraBath (Dr Hyman’s 20 minute bath of lavender, epsom salt and baking soda)
  • Yoga
  • Meditation
  • Guided relaxation
  • Biofeedback and tools for improving heart rate variability
  • Massage or facial
  • Deep breathing
  • Stop rushing and give yourself more time
  • Observe natural beauty like a garden or the woods
  • Limit exposure to the news (I’ll add social media) and take a break from the world’s troubles
  • Limit exposure to people who make you feel bad

How do you actively de-stress?

Leave a comment below

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Nutrition and Pain Management

As a part of the Dietitians in Integrative and Functional Medicine practice group of the Academy of Nutrition and Dietetics, I receive a publication called “The Integrative RDN.”

The spring 2018 issue features an article by Nancy Cotter, MD about nutrition interventions in pain management! She notes that since a linear cause/ effect relationship cannot be drawn yet, it’s important to remember that if you are supporting the whole body then the body is able to heal and function as intended.

Dr. Cotter identified four areas; nutrient insufficiencies, inflammatory load, microbiome and overall eating patterns.

Nutrient Insufficiencies: 

  • Magnesium (400-600 mg/day)
  • Vitamin C (500 mg/day)
  • Alpha lipoic acid (600 mg/day with or without vitamin B12)
  • Not enough evidence, but may be helpful- Vitamins D and B complex

Inflammatory Load: 

  • Anti-inflammatory Diet
    • Fat balance
      • Omega 3 and omega 6 are both essential fatty acids and must be obtained in the diet
      • Since the pathways for omega 3 and omega 6 fatty acids use the same enzymes they must be balanced
    • Phytonutrients/spices
    • High fiber
      • Slow absorption of carbohydrates
      • Prebiotics to support good bacteria
    • Low glycemic load (reducing need for insulin and reduced rise in C-reactive protein)
    • Low to moderate animal protein (focus on grass-fed animals or cold-water fish)
    • Basic preparation (vs highly processed)

Gut Microbiome:

We are learning more and more about how our gut microbiome interacts with our food and affects multiple metabolic processes.

Eating Patterns: 

Diets such as Mediterranean, Okinawan and Kuna emphasize plants, fiber, low glycemic foods and high quality protein diets. Patients can expect results in 3 to 6 weeks after implementing anti-inflammatory diets.

 

Nutrition should be part of chronic pain care.

 

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Supporting the gut microbiome is the future

I subscribe to a few scientific journal review services. The best I’ve found is ScienceDaily- go check it out. 

Anyway, it seems like at least once a week there is another study published about gut health and our microbiome in relation to long term health and prevention of chronic disease.

Check this one out:

Fruit flies lifespan increased by 60% with reduction in chronic disease

They fed the flies probiotics (good bacteria) and an herbal supplement called triphala.

I have never seen triphala used before. It comes from Ayurvedic medicine (traditional medicine in India) and is a blend of three fruits; Amalaki (Emblica officinalis), Bibhitaki (Terminalia bellirica), and Haritaki (Terminalia chebula). It claims to be useful for many varied conditions; immune system, various digestive conditions, diabetes treatment and eye disease. None of these three fruits have been studied enough to confirm or deny safety or efficacy, but when used short term it seems there is likely safe, especially if consumed in amounts you could feasibly eat as food.

Just in case you were curious, the probiotics used were Lactobacillus plantarum NCIMB 8826 (Lp8826), Lactobacillus fermentum NCIMB 5221 (Lf5221) and Bifidobacteria longumspp. infantis NCIMB 702255 (Bi702255).

 

Citation:

McGill University. “Secret to longevity may lie in the microbiome and the gut: Experiments in fruit flies show increased lifespan thanks to a combination of probiotics and an herbal supplement.” ScienceDaily. ScienceDaily, 31 May 2018. <www.sciencedaily.com/releases/2018/05/180531114611.htm>

Link to full article

Always Hungry by David Ludwig, MD, PhD

Blogging through “Always Hungry” by Dr. David Ludwig (Part 2)

This is part 2 in a series summarizing and reviewing “Always Hungry” by David Ludwig, MD, PhD. It may help to start reading these posts in sequence starting with part 1.

***Summary***

Chapter 3: The Science (pg 34-49)

Dr. Ludwig makes the case against calorie counting as the best way to lose weight. He acknowledges it is A way, but not the only, nor the best way. “The problems isn’t with our calorie-counting abilities or self-control, but rather the current understanding of the cause of — and cure for — obesity.” (pg 36) He cites systematic reviews (where many similar studies are viewed together) that look at the calorie counting model with and without exercise or behavior change therapy/counseling.  He also notes that almost all of the weight participants may lose is regained.

This is due to biology. “When you eat fewer calories, the body becomes more efficient and burns fewer calories, even as your desire for extra calories heightens. … If we marshal a Herculean effort, stick to the diet, and stay active, metabolic rate will continue to fall, so we’ll need to cut calories even more drastically to keep losing weight.” (pg 37)

This maintaining of weight also works the other way too. In volunteers who are overfed naturally lose interest in food until they return to their “set point.” There is a great graphic on page 38 that shows this relationship. If body weight and energy expenditure are increased, hunger decreases so you are able to return to your set point. If the body weight is low, hunger is increased and energy expenditure decreased to allow for weight gain to set point. So, he reasons, the answer to weight loss must be in our fat cells themselves (not calorie manipulation).

“Adipose tissue is a highly specialized organ, cushioning vital organs, insulates against the cold, and as a “strategic calorie reserve to protect against starvation.” (pg 39)

At rest, one of every three calories is consumed by our brains. To our ancestors, having fat reserves meant the difference between life and death when famine, scarcity and crop failure came. A brain needs a constant supply of energy whether food is available or not.

What about calorie storage in our bodies?

Carbohydrate in the liver, 4 calories per gram

Protein, in muscles, 4 calories per gram

Fat, in adipose tissue, 9 calories per gram

Dr. Ludwig notes, fat cells are active and take in excess calories and release them as needed. He says they are part of chemical and neural messaging systems in metabolism and the immune system. Most notably, insulin.

Insulin is a hormone made in the pancreas. When you start eating, blood insulin levels rise and signal incoming macronutrients to enter body tissues (exiting the blood stream). Then, when blood insulin levels get low (a few hours after eating), stored fuels reenter the blood to be burned for energy. Research in human and animal models have shown that excess insulin leads to overeating and extra fat storage (even when the amount of calories consumed are controlled).

When we eat a meal with excess carbohydrate, especially refined carbs, the pancreas must produce even more insulin than normal to move the glucose into cells (and lower blood sugar). This causes even more glucose and fatty acids to enter fat cells (not available to the brain). The blood then runs out of calories faster making you more hungry sooner and since the fastest way to raise your blood sugar is carbs- that’s what you crave. Remember how important it is that the brain not run out of fuel? Being hungry is VERY stressful to your body because it’s literally trying not to die. Stress hormones (epinephrine and cortisol) enter the blood to access calories in the fat and liver. To conserve energy our metabolism slows down making weight loss difficult.

Let’s simplify a little (I have always liked lists). This is based on the graphic on page 45.

  1. Fat storage is increased by
    1. Processed carbohydrate increases insulin secretion
    2. Sleep deprivation
    3. Physical inactivity
    4. Stress
    5. Other dietary factors
  2. This causes decreased calories in the bloodstream
    1. This increases hunger and food cravings (increased energy intake)
    2. Decreased metabolism and fatigue (decreased energy expenditure)

Dr. Ludwig explains an experiment he conducted with teenage boys. After eating one of three breakfasts (fast carb, slow carb or balance protein/carb) the boys were allowed to eat as much as they wanted for lunch. Those who ate the balanced meal consumed 650 calories less if they ate an omelet and fruit vs instant oatmeal (fast carb). The fast carb group also had a larger rise in adrenaline at four hours after breakfast causing symptoms of low blood sugar.

Another study (pg 48) showed that consuming high fructose corn syrup vs uncooked corn starch activates a brain region called the nucleus accumbens– the reward center. This suggests if one activates this region when on a low calorie diet, temptation would be too much to overcome.

“Hunger is hard enough to fight under any circumstances, but once the nucleus accumbens joins in, it’s all over.” pg 48

***End Summary***

An interesting point that I hadn’t thought of this way before was that fat is not passive. It doesn’t just suck up extra calories, but interacts with the insulin and other messengers in the body.

I wonder how much other research exists surrounding how different carbohydrate sources are processed in the body. I know my body reacts differently to sugar in candy than it does to a breadstick.

I will finish chapter 3 in my next post.

Always Hungry by David Ludwig, MD, PhD

Blogging through “Always Hungry” by Dr. David Ludwig (Part 1)

I struggle to make time for the reading that I WANT to do but don’t HAVE to do. So, in the spirit of accountability, I’m going to blog through Dr. David Ludwig’s book “Always Hungry.” I’ll pick out tid bits and summarize each chapter and include my thoughts.

“Always Hungry” is a three stage diet book that explains why the conventional diet rules are not working for many people. The cover claims to conquer cravings, retrain your fat cells and lose weight permanently. Sounds too good to be true! Let’s hear him out.

***Summary***

Chapter 1: The Big Picture

This chapter explains why medical doctors usually know very little about nutrition. Most only have an afternoon of nutrition training during med school. In contrast, registered dietitians have 4 years of training, an intensive internship and a comprehensive registration exam (soon a master’s degree will also be required). Dr. Ludwig shares his own story as a medical doctor struggling with weight management.

The author begins to debunk the mantra “a calorie is a calorie” (meaning all calories are equal). It’s taking a long time for the diet industry to get on board with this claim. A 100-calorie snack pack vs 100 calories of nuts is a big difference metabolically. He then states,

“Overeating doesn’t make us fat. The process of becoming fat makes us overeat.”

Something has caused your fat cells to store more of your energy which makes your brain perceive starvation and decreases your metabolism in order to keep you alive. This accelerates your weight gain the next time you eat to curb your hunger. And the cycle continues. His solution is three fold; obey hunger/fullness cues, control your fat cells by eating in a way to reduce your insulin need and inflammation, and take care of your self through activity, sleep, and stress to avoid going back to where you were before.

Chapter 2: The Problem

This plan acknowledges that weight loss is not just a balancing act. You can’t simply ignore hunger and expect to lose weight. Dr. Ludwig asks questions about five areas usually targeted in the weight loss journey.

  1. He urges you to forget counting calories and focus on the quality of your food. A huge study (Women’s Health Initiative, n=50,000, for 8 years) showed only a 1 pound difference between low fat diet vs control groups and no difference in prevalence of chronic diseases.
  2. Increasing exercise does not work because your body automatically increases caloric demand to keep your weight stable. He briefly discusses “set point” here.
  3. Genetics cannot be the answer because the rise in obesity has happened too quickly to blame on changes to be generational.
  4. Has food become irresistible? Every nation has food considered to be delicacy. It’s hard to believe America leads the world in obesity because we have the most delicious diet.
  5. Lack of willpower? A study of 3,176 compared participants’s ratings on 4 personality traits and found limited relationship to weight, but significant relationships to demographics like age and gender.

Dr. Ludwig then takes a deep dive into “The approaching tsunami of obesity-related disease.” Beginning with prenatal programming and continuing through development as an obese child to an obese adult and the cycle continues. “In short, many factors may conspire to create a vicious intergenerational cycle of obesity that will increase human suffering and have catastrophic consequences to the U.S. economy in the next few decades.” (p. 31) He outlines the losses in human productivity and the healthcare costs associated with obesity and health issues.

This is why, on a personal and a societal level, it’s time for a change.

***End Summary***

It’s shocking to think about the effect my choices have on my children (especially all the cookies I ate while pregnant!!!) It’s hard for anyone to think long term. Making good choices is rarely satisfying in the moment; each good choice does, however, make it easier to make the next good choice and eventually they really add up to make something worthwhile. The consequences of procrastination affect you, your family, your productivity as a citizen and eventually, the whole world.

That’s big.

Lists, Uncategorized

7 Tips to Help Evaluate Nutrition Claims

Researchers are publishing new studies every day. Bloggers and the media know that we are all hungry for an exciting sound bite.

How do you know what to pay attention to and what to pass over?

  1. Consider the source. Does the article have citations to actual clinical research? Is it funded by a special interest group. Special interests do not mean the research is invalid but it may mean the interpretation is slanted. They may be less likely to publish unfavorable results. They may have even designed the study in such a way that the conclusions were most likely to look good for their industry. Let’s face it- that’s good business, but it’s not good science. Some believe government studies may have slanted results due to lobbying and support from food companies. I put greater faith in studies conducted by government organizations like NIH, CDC, WHO, major medical institutions like Mayo Clinic, Cleveland Clinic, and John’s Hopkins or universities like Tufts, Emory or University of Illinois Champagne- Urbana
  2. Consider the size. Find out how many subjects were in the study. Was it 10 to 30 people or more like several hundred? The larger the size, the more plausible it is to assume the results could translate to the general population. Studies that follow participants for a longer period of time are generally more accurate as well. This is especially true in weight loss studies since regaining weight is so common.
  3. Beware of over-reaching. Sometimes a person reporting on the study may oversimplify or overgeneralize the results of a study. It’s always best to review the research yourself before applying it in your life or practice. Additionally, is this a single study or are there multiple studies saying the same thing? Obviously, an idea has to start somewhere, but remember it’s hard to interpret a single puzzle piece without the context of the rest of the puzzle.
  4. Skipping citations. While browsing through the library and bookstore shelves I often see interesting looking books. When I begin to look through them though, there are no citations to support the author’s claims or conclusions. Perhaps the statements were written after considering research, but it’s a sign of sensationalism or sloppy research to skip citing sources.
  5. Fads and Celebrities. I get very suspicious when someone famous begins selling a nutrition program or product. While in the marketing world it’s always helpful to have a celebrity on your sales team, be sure there is real science behind the claim and a qualified  creating the program.
  6. Beware of health claims. There are very few health claims approved by the FDA. There is a HUGE loophole that allows creative advertisers to make you feel like a product is worth buying. As long as they don’t explicitly say the product prevents or treats a disease, companies do not have to provide evidence that what they are saying is true! Let me give you an example. I could sell you “all natural” cotton candy that “supports a healthy immune system” and this is not illegal. I cannot say my cotton candy “prevents the common cold.” If you are interesting in what the FDA does regulate click here.
  7. Verify before reposting. When you forward an email or repost an article, you are basically putting your stamp of approval on it (unless you are posting with a note that you disagree). You can check it out on snopes.com, urbanlegends.about.com or quackwatch.com. When you forward something untruthful, you promote the misinformation. Let’s be responsible friends.

If you are interested in getting notifications about new research there is an awesome subscription you should sign up for!! Go to http://www.ScienceDaily.com and sign up for email alerts for any area of science or medicine that you have interest.

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Can’t vs Don’t: Food Psychology

Think about the difference between these phrases

  • “I can’t eat chocolate”
  • “I don’t eat chocolate”

Stick with me here. Let’s try some word association.

Can’t = forbidden, fear of breaking a rule, being a disappointment, trying to follow a rule set by someone else

Don’t= choice, making an informed and conscious decision, based on a conviction you’ve made

Words have power, but you don’t have to give them power over you! This touches on a mantra of Katie Vigesaa, RD- food itself is amoral. Eating a type or amount of food that is not on your eating plan does not make you a bad person. Having an extra treat doesn’t mean you’re “being bad.” Following your plan and “eating right” doesn’t mean you’re a good person. You do not need to let food have any power over you. Research actually points to greater weight loss and wellness gains when subjects are relaxed about their lives and eating plans.

Try this in your own life. Next time you begin to say “can’t” switch it to “don’t.” It’s amazing how freeing this simple switch changes your attitude.

Now another topic that’s loosely related.

Food psychology is so interesting to me. Dr. Brian Wansink is a professor at Cornell and author of “Mindless Eating” and “Slim by Design.” His team measures how much popcorn people eat at the movies…. even if it’s stale. They looked at how many chicken wings people eat if wait staff removes the piles of bones verse if they leave the bones at the table. They investigate what death row last meals reveal about the inmates. Mindless Eating is an entertaining read. Slim by Design is on my “want to read” list!! 🙂

Check out Dr. Brian Wansink’s website

Lists

Cool Links

Produce converter: 

Have you ever needed to know how many stalks of celery are in a cup. How about how many cloves of garlic makes 2 tbsp. PRODUCE CONVERTER is a super helpful tool for anyone doing intensive meal planning and grocery guides.

Quack watch: 

A go-to for objective ANALYSIS OF ANY HEALTH CLAIM, fad or book. *Remember that even objective analysis can be shortsighted. Dr. Mark Hyman’s 2003 book “Ultraprevention” was listed as a quack. Later he became the medical director of the Cleveland Clinic’s Center for Functional Medicine.

Biochemical Pathways:

Julie Andrews sang “Let’s start at the very beginning. A very good place to start.” This link shows METABOLIC PATHWAYS in the body. It’s amazing how smart our bodies are! All of the back up routes! This is best viewed on a bigger screen. It’s like google maps for your metabolism! 🙂

Lists

Possible Topics List

I listen to the podcast “Stuff You Missed in History Class” and they always talk about their list of future topics  I thought I had better start my list too.

gut microbiome

MIND diet

insulin resistance

throid function

metabolism and fat cells

nutritional ketosis

saturated fat

dietary cholesterol

intermittent fasting

beta hydroxy beta buterate

 

Please leave your ideas for topics in the comments.

Lists

What’s your Motivation?

This is a list of experts and the reason they pursued nutrition**

Marion Nestle (author of “Food Politics” and “What to Eat”)-

Dr. Mark Hyman (author of “Eat Fat, Get Thin”)-

Dr. Jason Fung (author of “The Obesity Code”)-

Dr Rangan Chatterjee (author of “How to Make Disease Disappear”)- Infant had a seizure due to dangerously low calcium and vitamin D levels.

Michael Pollan (author of “In Defense of Food”)-

Jimmy Moore (author of “Livin’ La Vida Low Carb”)- Personal journey for weight loss

Max Lugavere (author of Genius Foods)- Mother’s struggle with early onset dementia

 

**Not necessarily recommending these authors or their works, but simply as a compilation of popular writers and influences in the nutrition field.

My original motivation- Mother told to eat gluten free to aid gallbladder function