What I ate for a Day – Gluten Free, Dairy Free Edition

For those of you who follow Bordeaux Nutrition on Facebook you may have seen that Renee has spent the last two weeks traveling around France eating gluten-free and dairy-free. With that, and to relate to my last post, I decided to document a day of my eats following a gluten-free, dairy-free diet for the day. While I am not 100% free of either food category, I do try to avoid most dairy as I have found that I do have problems with it.  And as far as gluten, I have done 100% gluten free at times, but often just tend to limit my intake of it because I am including other foods.

I’ve always felt that it is important to not only be knowledgeable about different diets and dietary restrictions, but to also experience what it’s like to eat that way.  I like being able to recommend meals, snacks and products that fit each diet.  Here is what a gluten-free, dairy-free day looks like in my life:

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How to Eat Gluten-Free

For my last post of May I figured I’d stick with my celiac theme and do a little post on the gluten free diet. As with any diet I talk about, I like to emphasize all the things you CAN have, versus focusing on the restrictions.   Additionally I choose to promote more naturally gluten free foods and try to limit the processed foods that are typically “gluten-full” that have been made gluten-free.

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Thyroid Disorders and Celiac

As I mentioned in my last post, celiac disease has a strong link with many other autoimmune disorders. The most common type of autoimmune disorder I work with is thyroid disorders, so I thought it was appropriate to highlight the link between thyroid disorders and celiac disease this month.  An estimated 27 million people suffer from autoimmune thyroid disorders (ATD), and about half of those are undiagnosed.

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Celiac Disease…Are you 1 in 133?

May is Celiac Disease Awareness Month. Celiac disease is a genetic autoimmune disordered triggered by eating gluten, the protein found in wheat, rye and barley. When someone has celiac, ingesting gluten causes the immune system to respond and damage the villi of the small intestine. Villi are responsible for absorbing nutrients from food through the walls of the small intestine into the bloodstream. When villi are damaged and not working properly, a person becomes malnourished, no matter how much food one eats.

Celiac disease is genetic, meaning it runs in families.  Sometimes the disease is triggered—or becomes active for the first time—after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

In the past few years, celiac disease has gotten a lot more attention and the gluten free industry has exploded. Many people, including health care professionals, have brushed the gluten free diet off as a fad, but it should be taken much more seriously. It is estimated that 1 in 133 Americans, or about 1% of the population, has celiac disease. In individuals who have a first-degree relative—a parent, sibling, or child—diagnosed with celiac disease, the occurrence rate may be as high as 1 in 22. 83% of Americans who have celiac disease are undiagnosed or misdiagnosed with other conditions. Celiac disease goes undiagnosed or is misdiagnosed often because there are at least 300 documented symptoms and some people have no symptoms at all.

Symptoms of Celiac Disease

Great infographic from the Gluten Dude.com

The most common symptoms include:

  • bloating, gas and/or abdominal pain, IBS
  • hard to flush, bulky or loose stools
  • diarrhea or constipation
  • pale, foul-smelling, or fatty stools
  • fatigue
  • anemia
  • itchy skin rash
  • Dermatitis herpetiformis
  • tingling or numbness in hands and feet
  • discolored teeth or loss of enamel
  • canker sores
  • bone or joint pain
  • irritability or behavior changes
  • anxiety or depression
  • significant unexplained weight loss
  • poor weight gain
  • delayed growth/failure to thrive in children
  • missed menstrual periods
  • infertility or frequent miscarriages
  • fractures or thin bones, osteoporosis
  • migraines
  • seizures

Symptoms vary depending on a person’s age and the degree of damage to the small intestine. Celiac disease can also have no symptoms at all, leading many adults to have the disease for a decade or more before they are diagnosed. The longer a person goes undiagnosed and untreated, the greater the chance of developing long-term complications.

If you think you might have celiac, you can use this interactive checklist to identify your symptoms and check a print off to discuss with your doctor. http://www.celiaccentral.org/disease-symptoms-checklist/

Related Conditions

In addition to having several symptoms, celiac disease is also closely related to a number of other health conditions and autoimmune disorders. The following is a list of related disorders and the estimated percentage of patients with the disorder that have celiac.

  • Type 1 diabetes – 3-8%
  • Autoimmune thyroid disease — It has been shown in studies that the prevalence of celiac disease in patients with autoimmune thyroid disease is 4-15 times greater than that in the general population. 3.3-4.8% with Hashimotos thyroiditis and 4.5% with Grave’s disease. Stay tuned for an upcoming blog post dedicated to this connection alone.
  • Autoimmune liver disease. Celiac disease has been found in 5-10% of patients with liver diseases including autoimmune hepatitis, primary biliary cirrhosis, autoimmune cholangitis and primary sclerosing cholangitis.
  • Sjögren’s syndrome – 4.5-15%
  • Turner syndrome – 2-8%
  • Williams syndrome – 9.6%
  • Down syndrome – 5-10%
  • Juvenille idiopathic arthritis – 1.5% – 6.6%
  • Rheumatoid arthritis
  • Addison’s disease

Testing and Diagnosis

Blood Test

The first step is blood testing. Your doctor can order tests to measure you body’s response to gluten. Individuals with celiac with have higher than normal levels of specific autoantibodies—proteins that react against the body’s own cells or tissues—in their blood. These specific antibodies are anti-tissue transglutaminase antibodies (tTGA) and anti-endomysium antibodies (EMA). The blood tests will measure total IgA, IgA-tTg and IgA-EMA, high levels will indicate a positive celiac test. A person needs to be consuming gluten regularly at the time of testing for the results to be accurate.

Intestinal Biopsy

Blood tests are simple and helpful in diagnosing celiac disease, but they are not always accurate. False negatives and false positives are possible, so an endoscopy is needed to take a biopsy of the small intestine. The doctor will take several small samples, which are studied under a microscope to look for damage and inflammation due to celiac disease. It is recommended that the doctor take at least 4 duodenal samples, including at least 1 from the duodenal bulb, in order to obtain an accurate diagnosis.

Treatment

The only treatment for celiac disease is a completely gluten-free diet.  Eating just a small amount of gluten can damage the intestine. A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale and khorasan), rye, and barley. This means eliminating or finding substitutions for things like breads, pastas, and baked goods. There are many good substitutions like brown rice pasta, and baked goods made with flours from other grains, beans and nuts. I like to encouraged by patients to focus mostly on naturally gluten free foods like rice, potatoes, starchy vegetables, quinoa and other grains to replace the gluten-containing foods in their diets. Plain meats, fish, eggs, fruit and vegetables are all naturally gluten free. Working with a Registered Dietitian is the best way to ensure you are following a well-balanced, completely gluten free diet.

For more on celiac disease go to:

Celiac Central

National Institute of Diabetes and Digestive and Kidney Diseases – Celiac Disease

Celiac Disease Foundation

Celiac.com

Stay tuned for more on celiac disease and gluten free diets

Food Allergy Awareness Week

This week (May 10-16) is National Food Allergy Awareness Week. Food allergies and intolerance are hot topics and something I work with frequently. Food allergies seem to becoming more prevalent and the exact reasoning behind that is not known. According to the CDC food allergies in children rose 18% from 1997 to 2007. Adult onset allergies are also on the rise with at least 15% of people developing allergies after age 18. There are a lot of theories and hypotheses on why allergies develop that are currently being researched. There is still a lot of unknowns, but there is evidence supported recommendations for reducing overall risk of allergies in children.

What is a Food Allergy?

Food allergy is an abnormal response to a food, triggered by the body’s immune system. The “classic food allergy” reaction is an IgE reaction in which the body produces a specific type of antibody, called immunoglobulin E (IgE). The IgE antibodies bind to the food triggers and create an immune response.

The most common allergenic foods in infants and children are egg, milk, peanut, tree nuts such as walnuts, soy (primarily in infants) and wheat.  In adults, the most common foods that cause allergic reactions are the shellfish such as shrimp, crayfish, lobster, and crab, peanuts, tree nuts and fish such as salmon.

An allergic reaction to food can present as a number of different symptoms including:

  • Itching in your mouth or swelling
  • GI symptoms, such as vomiting, diarrhea, or abdominal cramps and pain
  • Hives or eczema
  • Tightening of the throat and trouble breathing
  • Drop in blood pressure

Oral allergy syndrome (OAS) is an allergy to certain raw fruits, vegetables, and/or nuts.  OAS is mainly associated with birch and ragweed pollen allergies, so people suffering from hay fever due to those allergies are susceptible to OAS.  Symptoms include an itchy, tingling sensation in the mouth, lips, and throat when the foods are eaten. More severe reaction can include swelling of the lips, tongue, and throat; watery, itchy eyes; runny nose; and sneezing. Cooking or processing breaks down the proteins in the fruits and vegetables that cause OAS, so most individuals are eat cooked or processed versions of the fruits and vegetables.

Oral Allergy: Plants, Foods That Cross-React

Exercise-induced food allergy is a type of reaction that is triggered by exercise after consuming the food. Exercise raises body temperature and triggers itching and light-headedness, hives may appear, and even anaphylaxis may develop. Crustacean shellfish, alcohol, tomatoes, cheese, and celery are common causes of exercise-induced food allergy reactions.

Food Protein-Induced Enterocolitis Syndrome (FPIES), also known as a delayed food allergy, is a severe condition in which an allergic reaction (typically vomiting and diarrhea) occurs hours after eating the trigger allergen. FPIES reactions are thought to involve cells of the immune system rather than IgE antibodies.

There is also food allergy associated chronic disease called Eosinophilic esophagitis (EoE). EoE is characterized by inflammation and accumulation of a specific type of immune cell, called an eosinophil, in the esophagus. Symptoms of EoE include nausea, vomiting, and abdominal pain after eating. A person may also have symptoms that resemble acid reflux from the stomach.

Is a Food Intolerance the same thing?

Food allergies and intolerance are not the same. A food allergy typically comes on suddenly, can be triggered by a small amount of food, happens every time you eat that food and can be deadly.

Food intolerance, on the other hand, usually comes on gradually, may not happen every time you eat the food or may depend on the amount eaten, and is not life threatening.

Lactose intolerance for example is a lack of the lactase enzyme that breaks down lactose, the sugar found in milk and milk products. Lactose intolerance is not a immune reaction and is not life threatening. People may have varying degrees of lactose intolerance and may be able to tolerate small amounts. Symptoms are usually GI problems such as gas, bloating, diarrhea or constipation. Gluten and other food intolerance are similar.

Other types of food intolerance include reactions to food additives like MSG and sulfites. Symptoms may include flushing, sensations of warmth, headache, chest discomfort, and breathing problems in people with asthma.

Possible Causes of Food Allergies

In Children

One possible cause is known as the hygiene hypothesis – the idea that lack of early childhood exposure to germs and infections depresses the immune system and makes children more susceptible to allergies.

Another possible cause is vitamin D deficiency. Studies have shown that as food allergy prevalence has increased, so has vitamin D deficiency. According to an article by the American Academy of Allergy, Asthma, and Immunology, areas further away from the equator have been shown to have higher rates of childhood food allergy-related hospital admissions, epinephrine autoinjector prescriptions, and peanut allergy (up to six times the risk) than areas closer to the equator. Season of birth (being born in autumn or winter when there is less UVR exposure) has also been associated with higher risk of anaphylaxis and food allergy.

A third, common theory, is that food allergy risk is affected by the gut microbiome, or the makeup of our intestinal bacteria. The diet of those in developed countries paired with the increased use the antibiotics and incidence of C-Sections is thought to have a big impact on the microbes in the gut. A study found that mice given antibiotics early in life were much more susceptible to peanut sensitization, the equivalent of the human peanut allergy. Researchers found that introducing certain healthy, naturally occurring bacteria reduced the sensitization. The hope is to research this in humans to see if supplementing/replacing beneficial gut bacteria would be an effective treatment for food allergies.

In Adults

Adult onset food allergies seem to be triggered by changes in the immune system. Whether it is the hormonal changes from pregnancy or menopause, or aging or co-morbid illnesses suppression of the immune system seems to increase risk for developing food allergies.

Risks for Food Allergies

  • 1st degree relative, if a parent has a food allergy, then the child is at increased risk
  • Eczema – 25% of children with food allergies have eczema
  • Other allergies, such as seasonal, environmental, or chemical

Reducing Food Allergy Risk in Children

A lot of research has been done on the effect of exposure to allergenic foods during pregnancy, breastfeeding and when introducing solid foods. During pregnancy and while breastfeeding, the mother should eat a balanced diet including all potentially allergenic foods (unless the mother herself has an allergy). There is no conclusive evidence that avoiding potentially allergenic foods will prevent a child from developing food allergies.

Babies should be breastfed exclusively for 4-6 months. A 2013 study, found that introducing solid foods before 17 weeks actually increased risk for developing food allergies. It is recommended that babies continue to breastfeed while introducing solids to receive the immunological factors in breast milk and educate their immune systems to further reduce risk. New foods should be introduced one at a time and parents should wait 2-3 days before trying another food. Parents should watch for diarrhea, rash, or vomiting as signs of a food allergy. Several studies have actually shown an increased risk of developing allergies when there is a delay in introduction of foods past 6 months.

Overall, there is still much research to be done to pinpoint why the prevalence of allergies has risen and what we can do to prevent or treat food allergies.

For more information on food allergies:

National Institute of Allergy and Infectious Diseases

American Academy of Allergy, Asthma & Immunology

Water — Drink Up!

The weather is finally starting to warm up which had me thinking about hydration. Hydration is something I always bring up with my patients and the majority of them are shocked at just how much fluid we need each day to stay properly hydrated.

Did you know that by the time you feel thirst, you are already dehydrated? Other signs of dehydration are:

  • Dry mouth
  • Fatigue/tiredness (suffering from the afternoon slump? Try a glass of water before a coffee or sugary snack)
  • Headache
  • Dry skin
  • Constipation
  • Low blood pressure
  • Dizziness

The general recommendation for fluid is to drink half your body weight in ounces. For example, if you weigh 140lbs you should drink about 70oz of water daily, which is 8 1/2 8oz glasses or 4 standard size water bottles.

Shocked by that number? Look at it this way. The average man’s body is about 60% water, while a woman’s is about 50%, so it makes since to aim for about that much water intake. When the body is not fully hydrated it is not working at full capacity. This is evident in the symptoms of dehydration. For instance, fatigue and headaches are very common signs of dehydration, well that’s because the brain and muscle are both 75% water. Skin is 72% water, hence why your skin suffers if you are chronically dehydrated.

If the numbers aren’t enough to convince you to drink enough water maybe some facts will.

  • Being well hydrated helps your mood, as dehydration can make you grumpy and your brain foggy
  • Research shows proper hydration may reduce the risk of colon, bladder and possibly breast cancer
  • Water provides lubrication and cushion for our joints, brain, spinal cord, and eyes. Water keeps cartilage soft and hydrated.
  • Water improves the color and texture of skin by helping build healthy new cells. Water, in the form of perspiration, also helps our body regulate temperature.
  • Water aids in digestion by being the basis of saliva which carries enzymes that start the breakdown of carbohydrates and protein. Water also dissolves soluble fiber and keeps you regular.
  • Water works to transport nutrients through our blood stream and functions in the liver, kidney, and intestines to excrete waste.
  • Staying hydrated can help you lose weight. We often mistake thirst for hunger. Hydrating may help suppress your appetite.

Don’t like plain water?

Have a hard time remembering to drink enough?

  • Start your day with a glass of water
  • Drink water with each meal and snack
  • Keep a water bottle or cup on your desk or with you all day at work
  • Set reminders on your phone or computer to drink every so often. There are even a few apps that will remind you. “Water Your Body” is available on iPhone and Android
  • Set goals to finish so much water by a certain time – i.e. I aim to finish one water bottle by lunch, then a second before I leave work for the day

Bottom line: Drink water and be happy and healthy

Want more on hydration? Check out Lauren’s blog.

Protein Supplements – How to Find One that Works for You

Thanks to everyone who read my last post! It sparked up some conversations and some questions. One thing a lot of clients and friends ask is “what do you recommend for a protein powder?”  When asked this I like to take a step back and ask “what are you using a protein supplement for?” The average person really does not need to add a protein shake to their day to day diet. If you are vegetarian, vegan, or just don’t like a lot of high protein foods, a protein shake might help you meet your protein needs better.  Additionally, extremely active people or endurance athletes, who have higher protein needs, can also benefit. But, in general, most people can get adequate protein from whole foods. The majority of people asking me about protein powders do not fall into the the groups of individuals mentioned. Most people are just looking for a quick meal or snack replacements. I, myself, even like having an option for a quick breakfast that has adequate protein, such as a smoothie. Out of my own curiosity, and in order to make a good recommendations, I set out to research and sample protein powders. My results were disappointing and lead me back to my gut feeling, that we should just stick with whole foods. Like usual though, I like to provide the information for you and let you decided what you’d like to choose.

Type of Protein

As I mentioned in my post about meal replacement shakes, I do not recommend soy or whey based proteins. Both soy and whey have controversy when it comes to health benefits and risks.  In addition, many people have sensitivities to soy or dairy, even if they haven’t figured that out to themselves yet. Better options for protein sources include pea and rice, egg white, and hemp.  A blend of rice and pea proteins are superior to either alone because neither pea nor rice include all essential amino acids.  Combining them provides all eight amino acids to form complete protein.  Pea and rice protein blends are good for many because they are vegan, non-GMO and include a lower risk for allergies.  Egg white protein is good because it is a complete protein, and minimally processed. Hemp protein is another great alternative that is an easily digestible complete protein. Hemp is a good source of magnesium, iron, zinc and fiber and contains the perfect 3:1 ratio of essential omega-3 to omega-6 fatty acids.  Hemp is also earth friendly and sustainable.

Sweeteners

DSCF1318

A sampling of the protein powders I’ve tried. All had an overbearing stevia taste.

The biggest issue I have with many of the protein powders I tried or looked at was that they contain stevia. Stevia is a zero calorie, natural sweetener and sugar substitute extracted from the leaves of the Stevia rebaudiana plant. It’s 200 times sweeter than sugar in the same concentration. It is “generally recognized as safe” by the FDA, but doesn’t come without possible side effects. I personally just can’t tolerate the taste of it. I find that in most protein powders it was bitter and overwhelming. Additionally, it makes me nauseous.  Nausea, upset stomach, bloating, and even allergic reactions are possible side effects. I’ve also heard from people that is gives them headaches. The photo above is a sampling of the different protein powders I tried with stevia. I couldn’t tolerate any of them. If you do not have an issue with stevia, the above brands are good choices otherwise. The only flavored protein powder I found without stevia is hemp protein. I’ve been using Trader Joe’s Organic Hemp Protein Powder in chocolate to supplement my breakfast smoothies and love it. I definitely has a nutty taste and grittier texture than most powders, but it tastes much better than every other type I’ve tried. DSCF1319If you’re looking for another plant based protein power without stevia, the options are Garden of Life RAW Protein or Sunwarrior Natural Protein Powders. Please leave a comment if you know another.

sunwarrior_protain_natural_2.2lbsindex

Whole Food Proteins (and fats!)

As I mentioned, most individuals don’t need a protein supplement, but it is important to include some sort of protein or fat in a meal replacement smoothie. I actually prefer to use real foods, since most protein powders provide more than enough protein — 20-30gm usually which is equivalent to 3-4oz of meat.  Data suggests that even for a post-workout meal/shake anything over 20gm of protein does not provide any additional benefits.

When using a smoothie as a meal replacement the exact protein amount is not critical, the more important factor is usually satiety. You may have noticed yourself if you make a smoothie with just milk or water and fruit it won’t keep you full for long.  Both protein and fat help with satiety because they are more slowly digested.  You can either add protein/fat to your smoothie, or eat it separately (i.e. a few nuts, an egg, etc).  Again, the exact amounts don’t necessarily matter, it’s more important to try to balance your calorie, protein and fat intake for the whole day. For example, if you don’t plan on having much meat that day, maybe an extra protein source with your smoothie would be good. Bottom line – it’s best to try to keep your total calories for a smoothie between 300 and 400 calories for a meal with 50% or less of those calories coming from carbohydrates. If using as a snack, try to stay around 200 calories. MyFitnessPal is a great tool for calculating the nutrition for your smoothies.

My go-to formula is usually 1 cup liquid + 1 cup fruit + 1 serving protein/fat + 1 cup greens. Here are some suggestions for healthy protein/fat smoothie add-ins.

smoothie add onsQUESTION FOR READERS

What is your favorite smoothie combination? What do you add for protein or fat in your smoothies?

Shake It Off – Facts about Shake and Meal Replacment Programs

You see it all over Facebook and Instagram, people you went to school with, co-workers, long lost family members – everywhere you look you see someone is raving about one of the latest meal replacement programs. It goes back as far as the 70’s with SlimFast, then the big craze of NutriSystem, Jenny Craig, the Special K diet, now it seems to be the shake programs– HerbaLife, Shakeology, Ideal Protein, Medifast, Advocare, the list goes on.

As a health professional it’s great to see so many people taking steps to better their health, yet at the same time I can’t help but cringe a little when I see people getting so enthralled in these programs and companies. There are numerous studies supporting that meal replacement programs are successful for weight loss and that some people are able to maintain their weight after discontinuing the programs. However, there are several things about these programs that I dislike.

As a dietitian a big part of my job is helping people manage their weight, but as a more alternative practitioner I go beyond the weight loss and focus on people developing healthy habits and eating good, wholesome, REAL FOOD. I strive to educate myself as much as possible about food and products on the market so that I can advise people on what is best for them. Knowledge is power, so I hope to educate you on these products, why they work, benefits and drawbacks, but do not intend to offend or bash any of these products or programs.

Why Meal Replacement Programs Work

Weight loss is often defined as a simple equation of calories in = less than calories out [although not always that simple]. When people use shakes or pre-packaged meals they lose weight by virtue of calorie control. If someone usually eats a burger and fries or even a 6” sub for lunch every day, then switches to a 200-300 calorie shake or meal they are going to create a calorie deficit. It makes sense that people have easier time controlling calorie intake when they are limited to a shake or pre-portioned meal vs having to control portions on their own.

People may also have greater success with these programs because of the ease and convenience. Eating a healthy balanced diet takes planning and prepping, a commitment many people looking to lose weight quickly aren’t ready to make.

Shakes and meal replacement programs can be a good kick start to weight loss and/or transition to a healthier lifestyle, but that leads me to the drawbacks of such programs…

Why I don’t Love Meal Replacement Programs

  • Short term success with no long term support
    These types of programs are not meant for long term use, and most people will eventually get tired of the same foods/shakes every day, the restricted diet, and cost. None of these programs are maintainable the way that healthy lifestyle changes are. It may be challenging at times, but eating a balanced real food diet allows for much more variety and flexibility. These shake programs don’t teach you how to navigate holidays and functions, they don’t teach you how to transition to normal foods again, they don’t demonstrate portion and calorie control beyond their products. Unfortunately, that means that many individuals fall back into their bad eating habits once they give up the shakes.
  • Highly processed, artificial ingredients including soy and/or dairy and sweeteners
    One thing I often tell my patients is “if you can’t read it, you probably shouldn’t eat it”. The ingredient lists for most shake powders are the length of a short novel. Even with two degrees in nutrition, I have to look some of them up. Many do have some good ingredients such as vitamins, minerals, fiber, and even probiotics, but a number of ingredients are not so great.herbalifeThe main ingredient in HerbaLife shakes, for example, is soy protein isolate. The safety, concerns, and benefits of soy have been long debated and are still controversial. Most data suggests that whole soy (i.e. edamame, tofu, tempeh, miso and natto) are safe and have beneficial health qualities. Processed soy, specifically soy protein isolates and concentrates, have been stripped of the beneficial nutrients soy has to offer and are usually made from genetically modified soy. The topic of soy could be a whole other blog topic, so for now I’ll leave you with a link briefly describing some of the concerns of processed soy including heavy metal contamination, pesticide exposure and hormone disruption. Additionally, if you have a pre-existing thyroid disorder and are on medication for it, soy can interfere with that medication, making it less effective. Bottom line, soy may or may not be detrimental to our health, but it is best to avoid large quantities of it so drinking 2 or more soy based shakes a day is not something I would recommend.shakeologyShakeology, on the other hand, gets most of its protein from whey. Whey protein supplement use in athletes has been researched widely and shows muscle building and even some weight loss benefits. However, consuming very high doses can cause some GI upset, nausea, headaches and fatigue. Whey is derived from dairy, so anyone with an allergy or sensitivity to dairy may have issues with whey to include inflammation and water retention, comprising of the immune system, worsening seasonal allergies, and more.

    Various meal replacements may also contain artificial sweeteners. Recent studies have linked artificial sweeteners to increased body mass and reduced ability to lose weight because they affect the body’s ability to gauge how many calories are being consumed. Some studies show that artificial sweeteners affect the brain by providing a sweet taste without any calories which can cause cravings for more sweet foods and drinks, which can add up to excess calories. This applies to natural zero calorie sweeteners, such as stevia, as well. You can read more about artificial sweeteners here.

    Another fun fact – “Consumer Reports” published a review of 15 different protein drinks and shakes in July 2010. Researchers found that every drink in the test was contaminated by arsenic, cadmium, lead or mercury. Those heavy metals when consumed in excess are toxic.

  • Pushes out REAL FOODS in our diet 

    The main reason I got into the nutrition field is for the love of food. I encourage my clients every day to consume as many whole foods as possible. I also put a huge emphasis on things in moderation (in case you couldn’t tell from my blog name). I have a huge sweet tooth, so I feel it is important to teach my clients how to fit in treats here and there…the real thing too, not some fake sugar or protein powder cake. I feel eating should be pleasurable experience. I find that most of these meal/shake programs place so much emphasis on use of their products (and duh, that’s how they make their money) that it pushes a lot of good, healthy foods out of the diet. It’s truly better to get your vitamins and antioxidants from whole fruits and vegetables then from powdered extract in a shake.Additionally, most of the disclaimers for these programs state “Consumers who use “such and such program” twice per day as part of a healthy lifestyle can generally expect to lose around 0.5 to 1 pound per week.” or something to that extent. Guess what — that’s normal healthy weight loss for any calorie reduction program. My average weight loss client sees that with whole food balanced diet and moderate exercise.

    Not only is the limit on real food a nutritional drawback, but a social one as well. This lack of education on how to include healthy foods, and make balanced choices impacts a person’s ability to manage social situations involving food. Our culture puts a lot of focus around food for holidays and other gatherings, it is important to learn how to balance this in a healthy way rather than feeling like you can’t partake. I want my clients to enjoy these situations rather than feeling they can’t attend, have to bring their own food, or will feel their progress is completely sabotaged by one meal. These programs do not provide that support.

Bottom Line

Meal replacement programs can provide the motivation and success that people want when managing their weight; however, I feel the drawbacks much outweigh the benefits. I believe it is certainly possible to fit in shakes as a healthy meal replacement (I do so myself), but would emphasize making them with whole foods as much as possible.

A good equation for a satisfying healthy shake or smoothie is:

1 cup liquid (almond, coconut, rice milk, water, coconut water) +
1 cup total fruit +
1 serving of fat or protein (1-2TB nut butter, coconut oil, flaxseeds, chia seeds, hemp seeds, ½ an avocado, or a plant or egg based protein powder) +
Optional vegetables/greens (kale, spinach, etc)

Some favorite combinations of mine are:

“Green Monkey” – 1 cup almond milk, ½ frozen banana, 1-2TB peanut butter, 1 cup spinach

“Blueberry Avocado Smoothie” – 1 cup liquid of choice, ½ avocado, ½ frozen banana, ½ cup frozen blueberries, 1 cup kale

“Chocolate Covered Cherry” – 1 cup almond milk, ½-1 serving plant based chocolate protein powder (I’ve been using Trader Joe’s Hemp Protein lately), 1TB almond butter, ½ cup frozen cherries, 1TB cocoa powder, 1 cup kale/spinach

Follow me on Instagram @jacqui_rd for more yummy meal/snack/smoothie ideas

Working with a dietitian can help you weed through the facts and myths about food and diet, figure out exactly what you need in terms of amounts of different types of food, and set you up with habits and strategies to maintain weight and a healthy lifestyle. The great thing is most insurance companies with cover nutrition therapy with a registered dietitian, many cover 100% with no cost to the patient, so seeing an RD with save you money too! Interested? Check us out at http://www.bordeauxnutrition.com or on Facebook.

Autism and Nutrition

April is Autism Awareness Month and April 2nd was World Autism Awareness Day. As of 2014, one in every 63 children is diagnosed with Autism Spectrum Disorder. More than 2 million people in the US and more than 10 million worldwide are affected by ASD.

ASD describes a grouping of various developmental disabilities. There are three main classifications of ASD – autistic disorder, Asperger’s syndrome, and pervasive developmental disorder, not otherwise specified, or atypical autism. Autistic disorder, the more classic form, includes significant delays in language, social, and communication skills. Autistic disorder patients may also have unusual behaviors or interests, and may have intellectual disabilities. Asperger’s syndrome is typically a milder form of autism that is characterized by delays in social and communication skills and unusual interests or behaviors. Many people with Asperger’s demonstrate a specific interest or hobby that encompasses most of their time. Asperger’s patients do not usually have language or intellectual delays or disabilities. Atypical autism individuals may demonstrate characteristics of classic autism or Asperger’s, but have fewer, milder symptoms or delays.

So you’re probably wondering what nutrition has to do with ASD. As research continues, many links are being found between ASD and nutrition, indicating that symptoms and what are thought to be co-morbidities of ASD may be treated with diet changes and nutrition supplements.

Autism and Digestive Disorders

Autism is identified primarily as a brain/mental disorder, but research suggests that as many as nine out of 10 individuals with ASD also suffer from gastrointestinal problems such as inflammatory bowel disease (IBD) and “leaky gut.” Symptoms of IBD include constipation, diarrhea, bloating, nausea and GERD, problems many people with ASD suffer from. Leaky gut occurs when the intestines become excessively permeable and leak their contents into the bloodstream. Theories suggest that many individuals with ASD may have trouble digesting gluten and dairy leading to undigested peptides gluteomorphin and caseomorphin leaking into the blood stream and crossing the blood-brain barrier. These peptides have an opiate effect on the brain thought to cause delays in social and language skills and withdrawn behaviors.  What this is like hypothetically is a child with ASD drinking a glass of milk which appears to have a calming effect at first, but it followed by a “withdrawal” and the problematic behaviors.

Gluten-Free, Dairy-Free Diet

A gluten-free, dairy-free diet may help to reduce some ASD symptoms. This means eliminating wheat, rye, barley and foods that may contain additives made with these grains, as well as all dairy products (milk, yogurt, cheese, butter, etc). It is important to work with a Registered Dietitian when doing an elimination diet to help guide you through it and prevent further nutrition deficiencies.

Probiotics and Healing the Gut

Before eliminating gluten and dairy, it is recommended to start a probiotic supplement to “clean up the gut”. The National Center for Complementary and Alternative Medicine defines probiotics as live microorganisms—usually bacteria, but they also can include microbes such as yeast—that people can ingest to increase the population of desirable bacteria in the gut.

A number of recent studies have compared the intestinal bacteria of children with ASD to healthy children and found altered levels, specifically a reduction in the bacteria that promote good intestinal health. One hypothesis is that a leaky gut may allow substances to pass into the bloodstream that harm the brain, so focusing on rebuilding the microbial ecosystem in the gut with protect against leakage of substances.

There are many probiotic supplements on the market. The key things to look for in a probiotic supplement is the number of colony forming units, CFU’s, and the number of strains of bacteria. Our gut contains 30-40 different strains of bacteria, so the more variety you can get in a supplement the better. It is recommended to find a probiotic with at least 10-20billion CFU and 7 or more strains of bacteria. It is best to work with an RD or other natural practitioner who can recommend the best option for you.

Omega-3’s

Many other nutritional supplements can help support individuals with ASD by strengthening the immune system and improving some symptoms. Omega-3’s, especially DHA (docosahexaenoic acid), play a huge role in brain development and neurological functioning. Studies have shown reductions in anxiety, aggression, hyperactivity and impulsivity with omega-3 supplementation in children with ASD. Longer attention spans, improved language development, reading and spelling skills have also been seen with supplementation of omega-3. The recommended daily dosage is 1.5g of total omega-3 (EPA and DHA). See my post here on how to choose a quality omega-3 supplement.

Vitamin D

Another key nutrient is vitamin D. Vitamin D deficiency is very common, and studies suggest there is a direct link between low vitamin D and ASD. Vitamin D is a fat soluble vitamin that regulates the immune system and reduces oxidative stress and inflammation. Some ASD symptoms may be improved with adequate vitamin D levels. Vitamin D levels can be easily tested with routine blood tests. Taking a vitamin D3 supplement with a specific dosage recommended by your doctor or RD can bring levels up within a few months. It is also believed that maternal vitamin D supplementation may reduce the risk of ASD. Research recommends pregnant and breast feeding women supplement 6000IU/day of vitamin D3.

Clearly, there is much research still to be done on the link between nutrition and Autism, but the research is promising.  Although we know that we cannot cure ASD with nutrition, the studies and case studies show that nutrition therapy and supplements have been helping in families and individuals with ASD in reducing symptoms.

Information obtained from:

Today’s Dietitian January 2013 Issue – Autism Spectrum Disorder — Research Suggests Good Nutrition May Manage Symptoms

Contemporary Pediatrics -Managing autism symptoms through nutrition

Scientific American – Gut Bacteria May Play a Role in Autism

Lurie Center for Autism: Omega-3 Fatty Acids

Vitamin D Council

Nutrition from the Sun

Vitamin D, “the sunshine vitamin”, is a fat-soluble vitamin that supports the body in many ways. Vitamin D maintains bone health, cardiovascular and immune systems, muscle function, blood pressure regulation, insulin production, and reduces inflammation and mood disorders.

Vitamin D naturally occurs in two forms, vitamin D2 (ergocalciferol) and D3 (cholecalciferol). Both forms are converted into a hormone when activated. D2 comes from plants or yeast steroids and is used in fortified foods such as milk, soy and breakfast cereals. D3 (cholecalciferol) is in animal sources including fatty fish and egg yolks and is produced by our bodies.

Vitamin D is unique from other vitamins and known as “the sunshine vitamin” because D3 is produced when the cholesterol in our skin absorbs UVB rays in sunlight. Those with adequate sun exposure may not require vitamin D supplementation; however folks in New England will never achieve optimal levels with sun exposure alone. Factors that impact vitamin D production include skin type, time of year, the amount of time spent in the sun, and the amount of skin exposed. According to the Vitamin D Council it is nearly impossible for New Englander’s to produce vitamin D from the sun in the winter, no matter their skin type.

The Vitamin D Council recommends minimum daily intake of 2,000 IUs vitamin D3. Since we know we do not get enough from the sun and it is unlikely our diet will provide the recommended amounts, most people can benefit from a supplement. It is important to choose a supplement containing vitamin D3, the active form which the body better absorbs and utilizes.

With the summer in full swing, try to boost your vitamin D levels by sitting outside during your lunch break or on the weekends for 10-30 minutes without sunscreen. Research shows moderate, frequent exposure is healthy, but overexposure increases risk of skin cancer, so make sure to cover up before you burn.

For more information on vitamin D, visit www.vitamindcouncil.org