Category: Nutrition

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Nutrition

Gluten-free Diets without Celiac Disease: Yay or Nay?

Flaxseed crackers on plate with blue pattern

In general, the majority of people are just fine eating grains with gluten Gluten makes great bread. They don’t need a gluten-free diet.

People who avoid gluten tend to actually have poorer intake of some nutrients. For this reason, I generally say that if you don’t have celiac disease, you can eat food with gluten in it.

However. There are always exceptions. Sometimes, these reasons explicitly require avoiding gluten (a protein in wheat, barley, and rye). In other cases, the recommendation focuses on limiting the carbohydrate type found in wheat.

A few people have to avoid the protein found in wheat– so they may eat gluten-free foods (which are free of wheat).

Why Not to Argue with Someone Following a Gluten-free Diet

  1. Dermatitis herpetiformis. This is actually a skin rash that links to celiac disease, so if someone has this rash, they must completely avoid gluten. They need a gluten-free diet.
  2. FODMAP sensitivity (specifically, to fructans). These are the people who can get away with a few bites of someone’s pasta, or a taste of pie. They get unpleasant gut sensations (I’ll spare you the details) but there is no known damage to the gut.
  3. Eosinophilic esophagitis. In this condition, people often have to entirely avoid several foods, including 100% of all wheat, due to food allergies that affect their esophagus.
  4. Non-celiac gluten sensitivity. This has been controversial, but more research is suggesting that this condition is not in anyone’s head. It is in their gut. The severity of their symptoms seems to vary.
  5. Fructose malabsorption. This is rarely diagnosed, but some people following a diet to limit fructose find avoid wheat is helpful. As such, given the recent popularity of “gluten-free,” they may look for gluten-free options.
  6. Small Intestine Bacterial Overgrowth. Sounds uncomfortable, doesn’t it? It is. Many people with chronic SIBO feel better when avoiding or severely limited wheat (related to the FODMAPs, again). This one damages the gut, quite a bit.
  7. Autoimmune conditions. While systematic research does not support widespread adoption, it could help people with certain conditions or those who have “silent” celiac disease. This study shows how screening for celiac disease is important in one condition.

Don’t Get Too Excited– A GF Diet Is NOT a Panacea

If there isn’t a medical condition, a gluten-free diet can actually be harmful.

Why?

Many of the substitutes people eat are lower in important nutrients- like magnesium and folate. Further, those food may not be fortified or enriched the way foods made with wheat are.

Notably, someone with several of the conditions above can test negative for them when they are faithfully following a GF diet. It is vital to complete a medical evaluation prior to beginning a gluten-free diet if there is any concern about possible celiac disease or EoE.

May is Celiac Disease Awareness Month.

How to Eat Well on a Gluten-Free Diet

Much of the advice is similar to general nutrition guidance. Eat the rainbow! Go whole (GF) grain! Choose leaner meats. Season with herbs, spices, and acids.

To escape that issue of lower nutrient intake, pick whole foods. An example:

  • nuts, yogurt, and fruit for breakfast;
  • vegetable and chicken stew for lunch;
  • boiled egg, string cheese, and sugar snap peas for a snack;
  • a quinoa, kale, and chickpea salad for supper.

Fortunately, many cuisines have entirely or nearly gluten-free options (for example, many Indian and Vietnamese dishes are naturally gluten-free). Starting with these can help people beginning a gluten-free diet feel like they have access to delicious, flavorful food.

The next step is to get more adventurous. Take a favorite pancake recipe and learn to adapt it, using the basic “What to eat” and “What to avoid” lists.

Start using those lists, until you are fluent. Check in with a Registered Dietitian for a brief intro to the lists and practice reading labels.

Beyond the basic eat/don’t eat food lists, the key elements to learn about are:

  1. Cross-contamination.
  2. Sources of fiber (that work for you).
  3. Nutrient-rich options for grains.
  4. How to manage travel.
  5. Eating out.
  6. How to handle holidays/special occasions.

So, yay or nay?

It depends.

If there is a medical reason requiring a gluten-free diet, yay.

If there is a medical reason suggesting a gluten-free diet, yay. But only after confirming no concurrent celiac disease (or other concerns) through testing.

If there is a medical reason suggesting a low wheat diet, I recommend a low wheat diet (often including gluten free items). Barley and rye may still be fine, so keep enjoying those!

If it’s just for curiosity or weight loss, then nay.

Resources

Celiac Disease Foundation

APFED

FODMAP Everyday

Small Intestinal Bacterial Overgrowth: A Comprehensive Review

Got more questions? Get in touch!

Categories
Nutrition

Five Easy Ways to Move With Joy

Two People Kayaking
Find Joyful Ways to Move

Sometimes, exercise can seem like yet another assignment. An obligation, a duty. However, the key to sticking with regular physical activity for physical and mental wellness is finding joy in your moves.

Here are five easy ways to move with joy.

trail photo

Don’t Grin and Bear it– Grin and Laugh About it


1. Volunteer in community clean-ups.

From city parks and local schools to National Parks and beaches, volunteers move trees, put out mulch, pick up trash, and create new amenities. They move while socializing and serving their communities.

Many towns have garden clubs or groups who maintain some garden beds, too. Plant and mulch away!

2. Attend a dance or join a dance group.

From salsa and contra to clogging and ballet, there’s a variety of dance out there for you. Shimmy, shake, tap, twirl, and laugh your way to fitness.

Have you ever heard of Morris dancing? No? Then you officially haven’t tried everything.

3. Take up drumming.

Really. You might want to offer your neighbors some earplugs, though. The more conventional exercise class just uses the drumsticks, not the drum.

Watch this demo of a beginner cardio drumming class.

4. Go skipping! Perhaps take a break and play frisbee.

Skipping is a vigorous activity, per the CDC. The intensity of frisbee would depend on how much time you spend walking, standing, and running.

5. Try kayaking.

Kayaking engages quite a few muscles but also offers the option of a relaxing ride (in some types of water).

Many state parks, and some larger city or town parks, rent kayaks for reasonable prices. Make sure you stay within the area for the appropriate difficulty level.

Put On Your Shoes: Get Started Building New Habits

While pop culture says you can start a new habits in three weeks, that’s not long enough for most people. You might need two weeks, or even six months.

However long it takes you to establish habits, make a plan. Write it down. Tell someone. And return to your plan to adjust it to fit your life.

Remember your reasons for moving joyfully.

If what you are doing now isn’t working for you, take time to figure out what could help you. Maybe you need moral support; maybe you need to find an activity that fits into your life more effectively (adjusting for pain, mobility, time, preferences, etc.).

Ask for help from a professional, if appropriate. Many health coaches, personal trainers*, and nutritionists work with clients on physical activity. A physical therapist may be appropriate for some people.

Have fun! And share the joy!

*I encourage people to work with certified exercise professionals when they are learning correct exercise form to avoid injury. However, if they are looking for assistance with setting goals, developing behavioral strategies that work for them, and/or moral support, working with a coach or RD may work well.

Categories
Nutrition

5 Key Nutrition Questions that Everyone with Kidney Stones Should Ask

blue mug

The pain of kidney stones is said to be worse than labor– but nutrition for kidney stones can help.  Knowing about just a few possible strategies can help you ask key nutrition questions when you talk to your health care providers.

Surface of a kidney stone

Microcrystals cluster together to form a spiky, painful stone. 

Nutrition for kidney stone resolution

Stay hydrated.  The stone precipitates when you start to get dehydrated– and it will grow. 

Ask: How much water should I be drinking each day to help the stone(s) pass?

Use your diet to alter the acidity of your urine.  Depending on the type of kidney stone, having more acidic urine or more alkaline urine can help manage kidney stones growth. Sometimes, drinking orange juice or eating certain foods can help.

Ask: Do I have acidic stones or alkaline stones?  Can I eat or drink anything to help keep them from getting bigger?

Nutrition for kidney stone prevention

Staying hydrated– all the time– helps.  This also means drinking extra with additional heat, exercise, illness, or other factors that might make you sweat or lose more water.

Ask: What are my goals for drinking beverages?  What beverages can I count toward that goal?

Maintain sufficient calcium intake.  At one point, patients were advised to limit calcium intake.  Research has since shown that sufficient calcium intake helps prevent kidney stone formation.

Ask: How much calcium per day do I need?  Can I count supplements?

Limit other compounds.  For example, extra vitamin C, high levels of oxalate, or certain medications can contribute to kidney stones.  Be sure to tell your doctor about everything you take.  

Ask: Should I stop any supplements?  What are my goals for maximum daily intake of [substance]?


Should I stop taking any of my vitamins?


In the future: exciting possible kidney stone treatments on the horizon

Look for more research to help us figure out how to help your microbiome process oxalate, so your kidneys don’t have to.  Early research shows that a particular species of bacteria found in some people’s colon helps remove oxalate through the colon, preventing absorption from the diet into the bloodstream.

Your Future: How to Avoid Kidney Stones

You know kidney stones hurt– so much pain you might end up in the emergency room. And they can lead to dangerous infections.

Taking action. Ask your health care team these questions. Print them now.

You can take steps to avoid that pain– so you can get back to the things that are important to you.

(And, seriously, drink those fluids. All the beverages!)

Resources

Need help with fluid intake? Read this booklet for ideas and then track your intake in the chart.

Want to learn more about oxalate? Read the previous post to learn more about a low oxalate diet and why I think you, as a patient, should be given more information to make informed decisions.

Want to learn more about kidney function and different types of kidney stones? Take a look at the in-depth kidney stone guide available at University of Chicago.

Categories
Nutrition

Why Low Oxalate Diet Handouts May Be Giving You Too Little Information (And What To Do About It)

Bowl of berries with wood sorrel

Low oxalate diet handouts often fail to help people maintain the sustaining change they need to make to avoid future kidney stones.  Why? 

Skillet with vegetables being cooked

Because the handouts lead to the feeling of unreasonable constraint.  They make it difficult to eat while traveling, hard to eat at family meals, and contradict the nutrition advice people are receiving elsewhere (for example, eat whole grains!).

Sometimes, these handouts can make it seem impossible to eat well.   Keep reading to learn how different information can make it easier to manage a low oxalate diet in the real world.

What is a low oxalate diet?

A low oxalate diet reduces the amount of a chemical—oxalate– commonly found in foods by limiting certain foods.  Oxalate is an organic compound made up of two carbon atoms and four oxygen atoms.

Most people eat around 200 mg of oxalate per day without any problems.  However, some people need to limit oxalate intake to 50 mg, or 100 mg, per day to help manage a medical condition. Knowing that target level is helpful for patients.

What foods do you avoid on a low oxalate diet?

Part of the reason it is so hard to follow a low oxalate diet is that oxalate is found in many foods. For example, whole grains like buckwheat, grits, and brown rice contain oxalates; vegetables like sweet potatoes, spinach, and beets are quite high in oxalates; fruits like figs and gooseberries are also rich in oxalates; and even peanuts and lentils provide high levels of oxalates.

Whole grain cereal and strawberries

Whole Grains + Strawberries = Oxalates

Who follows a low oxalate diet?

Most often, these are people who have had calcium oxalate kidney stones several times.  Low oxalate diets are widely recommended; however, some research suggests that using other strategies should be the first line approach.  Some of these will be reviewed in the next post—stay tuned!

People who are at high risk of kidney stones because they have malabsorption—such as someone who is losing weight quickly after bariatric surgery or who has gastrointestinal diseases like Crohn’s disease—may wish to consider a low oxalate diet.  In these patients, low oxalate diets are effective at preventing kidney stones. 

More recently, there’s some research suggesting that some people with cystic fibrosis and autism have higher levels of oxalate in their blood that people without those conditions.  

They may have a form of primary hyperoxaluria—a condition where they are unable to process the molecule normally.  In general, anyone with primary hyperoxaluria should follow a low to moderate oxalate diet to stay healthy.

Occasionally, I will recommend that someone who has anemia try temporarily limiting some of the high oxalate foods at meals when they take an iron supplement.  Oxalate impairs iron absorption, so avoiding high oxalate foods like tea, coffee, and spinach when they take their iron supplement can help.

What do low oxalate diet handouts say?

Low oxalate diet handouts tend to plop commonly eaten foods into a few categories.  For example:

  • “No oxalates”
  • “Low oxalate”
  • “Moderate oxalate”
  • “High oxalate”

These four categories are broad and may or may not include the foods a client commonly eats.

In other words, they don’t list specific levels of oxalate.  For example, many handouts will include foods with 50 mg and 11 mg in the same category. 

If you are trying to eat less than 50 mg per day, it is helpful to have a sense of whether a food might have 15 mg or 45 mg.  Because you’d probably avoid the 45 mg food but maybe you’d eat the 15 mg food once or twice a week, right? 

Designing the handout with these vague categories way means food is simplified to “I can’t eat leafy greens except for lettuce.”  The handout does suggest that– because leaf lettuce is the only low oxalate green.  But when you look at specific levels of oxalates in other leafy greens, you can find kale at 2 mg per cup, mustard greens at 4 mg per cup, and collards at 10 mg per cup.  Now, bok choy and broccoli are down there at 1-2 mg per cup.

Why aren’t specific oxalate levels of foods commonly given to patients on low oxalate diets?

There’s likely two reasons.

First, there’s the assumption that people will be overwhelmed.  I don’t believe this– we nutritionists (dietitians) walk people through rather complicated schemes for managing diabetes. 

Mostly, people do just fine with numbers and some basic math.  Sometimes someone doesn’t want to, or has a limitation making it too hard to manage those approaches.  Then, they use a simpler option.

Second, the data for precise oxalate levels is a little wishy-washy.  Specific varieties of some foods can have different oxalate levels.  So, there is variation in the scientific data.  And—as happens with science—this data has changed over times.  For example, the level for strawberries has decreased.


Is there a way to empower patients to make their own decisions more easily?

Precise people many find this mentally challenging to accept these values for oxalates as reasonable approximations.  Nonetheless, I argue we need to give people the option of using this information.  We use imperfect information often (that food label data? Could be off by 5%, easily, and may actually be off by 10-15%).  

If the consequence is people avoiding healthful “Moderate” or “High” oxalate foods that have 3 mg or 11 mg per serving, we should ask ourselves:

  • Is it necessary to limit the diet this extensively?
  • Is there a way to empower patients to make their own decisions more easily?

First, for most patients, it is not necessary to limit the diet that much. In fact, there may be negative consequences to limiting the diet extensively.   Second, we can provide patients with more information easily.

This is possible because we do have reasonable, if imperfect, data. The consequences of using slightly imperfect data here are low; likely less than limiting a diet to avoid important foods like dark green vegetables, berries, and nuts for a lifetime.

Omelet over cooked collard greens
Collard greens have about 10 mg of oxalates per cup.

Caveat: Limiting one’s diet for a shorter period is occasionally important, even necessary. Always talk to your health care provider about starting and stopping special diets.

A Better Handout for Low Oxalate Diets

A low oxalate diet handout that truly empowers patients is customized.  It enables them (you) to make decisions based on the amount of oxalates in the foods they (you) eat, or provides alternatives.  It also focuses on frequency of consumption rather than categories of oxalate levels. 

I use one that has some commonly eaten foods in each category.  It also space for writing in the foods the patient normally eats. Key information:

  • food names with serving sizes
  • recommended frequency of intake (these are maximums—“up to daily” or “up to once a week”)
  • actual oxalate levels of the foods
  • patient’s individual recommended oxalate cap per day or week
  • space to note fluid intake or other secondary target.

Research suggests that clients do best if they have a few strategies to focus on rather than a long list.  If a low oxalate diet is one of them, I prefer to also offer the reminder of a second target in the same place.

Alternatives to a Low Oxalate Diet

Consistently following a low oxalate diet is challenging for some people.  If you are eating food that is prepared for you, such as meals at work, delivered hot lunches or family meals where you aren’t involved in meal planning, you may find following a low oxalate diet does not work for you.

However, particularly if you are following a low oxalate diet due to kidney stones, there are other options!  Avoiding a few simple items (coffee, tea, chocolate, and nuts) may work for you.  Read the next post to find out what questions to ask about kidney stones and nutrition.

Walnut halves in a pan

Nuts are mostly high in oxalates.

If you are following a low oxalate diet due to hyperoxaluria, it’s vital to figure out what will work for you.  This is where talking to your health care team and a registered dietitian can help get you on track with the support you need to succeed.

What You Can Do About Low Oxalate Diet Handouts

If you are on a low oxalate diet:

  • Discuss how limited you feel in your diet with your health care provider.
  • Ask for a referral to a dietitian with experience with low oxalate diets (often, these are general practice dietitian who receive referrals from urology clinics or those who work with patients with autism).
  • Watch for the next post with key questions to see if there are other nutrition concerns related to kidney stones that your health care provider can answer. 

If you provide patient care:

  • Review your handout.  Consider revising it or emailing me (stephanie.bostic@gmail.com) for permission to use mine.
  • Work specific oxalate levels of foods that patients eat regularly into your counseling.  
  • Write in specific values that are relevant to that patient.
  • Print or save the Harvard Excel Spreadsheet with oxalate levels and serving sizes for your reference. Try using the oxalate database, too.

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In Summary

  • Oxalates are found in many foods. The amounts of oxalates may vary notably between similar foods.
  • A low oxalate diet may not be best nutrition strategy for someone with kidney stones. Other people may benefit from it.
  • Information can empower people who must follow a low oxalate diet, so they can eat a wider variety of foods.

Still have questions? Get in touch!

Categories
Nutrition

How to Get in Touch with Your Body in 5 Minutes

Empty plate with knife and fork

Just a few minutes a day can help you get in touch with your body.  Keep reading for two simple exercises that will help you learn to understand the signals your body sends you in just five minutes a day.

The Purpose of Mindfulness in Nutrition

How much of your day do you spend looking at screen or focused on a task?  In contrast, how much of your day do you spend focused on the sensations your body is sending to your mind?  Many people ignore too many of those signals.

Recognizing those signals is key to helping you understand how to feed yourself.

Doing this exercise is a simple step toward accepting and acting on feedback from inside your body.  When you struggle to judge your body’s response to the way you eat, it’s tough to figure out if changes in eating are helping you.

Goal of the Getting in Touch with Your Body

The goal is to feel what is happening inside your body, from your nose and your mouth to your bladder and colon.  There are no right or wrong answers– just sensations.  Accepting the sensations without judgement is the goal.

For example, right now, I feel a bit of heaviness in my right ear (allergies to the cat…).  My mouth feels dry, a little scratchy toward the throat.

Exercise #1: The Nose and Lungs

  1. Close your eyes and pay attention to how your nose and ears feel.
  2. Describe it to yourself.
  3. Breathe in and out, relaxing for 3-5 breaths. Imagine you are following the air in and out.
  4. Move your attention down and pay attention to how your lungs and diaphragm feel.
  5. Describe it to yourself, as you breath in and out for another 3-5 breaths.

Exercise #2: The Mouth and Stomach

  1. Close your eyes and pay attention how your mouth feels.
  2. Describe it to yourself.
  3. Breathe in and out, clearing your mind and relaxing for 3-5 breaths.
  4. Move your attention down your throat, to your stomach.
  5. Describe how your stomach feels, as you breathe in and out for another 3-5 breaths.
  6. Rate how full your stomach is on a scale of 1-10 (4 is comfortable hunger; 7 is comfortably full).

When Should You Do These?

Start with exercise #1 when you have a chair and a few moments.  After you are comfortable with the first exercise, move onto the second exercise.

Try the second exercise at different times of day.  See how the sensations differ.  How do you feel after you exercise?  Is it different when it’s cold outside?

When you are ready, check out the resources below.  Begin paying attention to how you feel when you eat different foods– do some help you feel better more than others?

Still have questions?  Send in a Reader Q & A Submission!

Resources

UCLA Mindfulness Awareness Research Center: Free guided meditations as well as online courses and information on the research related to mindfulness.

How to Be Mindful with a Snack: Ready to connect this practice to food?  Try a snack.

Center for Mindful Eating’s Free Recordings: Begin a consistent practice– with plenty of options to see what works for you.

Categories
Digestive

What to Eat for Chronic Constipation

Image of bathroom focused on toilet tank with toilet paper and shelves

So, what if you’ve tried the low FODMAPs diet?  What if you don’t have IBS with diarrhea?  There are other options.  Today, let’s look at another option for people who struggle with chronic constipation.

celery
Is Adding Fiber Actually the Answer?

Low Fiber Diet for IBS

This diet goes against the classic recommendation– fiber!  Add more fiber, you’ve been told.  But then it didn’t work (for you– it does work for some people).  This is the direct opposite.  Eliminate the fiber.

A few years ago, a few research studies about chronic constipation were published that trialed no fiber or low fiber diet (<10 grams) for chronic constipation. It worked pretty well for the participants who managed to stay on the diet.  Many of them had the constipation resolve, or at least improve.  (See one 2012 publication here.)

What can I eat on a low fiber diet for constipation?

This involves eliminating many of the foods that we’ve been taught are healthy, like whole grains and beans. It’s a big change for many people. Here are some examples of what to eat and what to avoid.

Eat:

  • white rice, white pasta, and white bread
  • fruit and vegetable juice without the pulp
  • strained vegetable soups
  • meat, poultry, and eggs
  • milk, yogurt, and cheese.

Avoid:

  • fruits and vegetables with skins or seeds
  • beans
  • whole grains
  • nuts and seeds.

What does that mean long term?

Like the low FODMAPs option, the goal is to stabilize symptoms and work on liberalizing your diet to include more fruits, vegetables, and nuts.  High fiber foods like beans may or may not start constipation– but avoiding all potential foods with fiber over a longer time means you miss out on key nutrients.  Personalizing the way you eat is essential to staying healthy over a lifetime.

Why don’t more people talk about this?

Many people with constipation do respond well to adding soluble fiber.   Fewer people seem to respond well to insoluble fiber, like bran.  Constipation has different causes, so different types of chronic constipation seem to respond to different nutrition approaches.

Other people end up working with medications, stress reduction, biofeedback, or other methods.  Staying on a low fiber diet long-term can lead to nutrient deficiencies, though, so it’s advisable to work with your health care providers.

Could this work for me?

It’s always wise to chat with dietary changes with your health care providers, especially major changes.  Start the conversation if you think it might be an option at your next appointment.

Still have questions?

Contact me to request a short call to discuss how I can help you feel better.  If I can’t help, I’ll refer you to someone else who hopefully can.

 

Categories
Digestive

How to Manage Acid Reflux Symptoms with Nutrition

Pepperoni pizza

First, talk to your doctor about your symptoms.  Consistent acid reflux can be a sign of more serious problems than over-indulging in pizza. But after that– there are also some choices you make with your fork that can help or harm you.

What is acid reflux?

In short, your stomach has a little valve at the top.  Normally, it closes pretty tightly after you finish swallowing.  Sometimes, it doesn’t.  When it doesn’t, the food and acid found in your stomach can be pushed back up into the esophagus.  Your esophagus isn’t designed to tolerate that acid, so it can be damaged (which hurts!).

A certain pattern of severe acid reflux is called GERD, gastroesophageal reflux disorder.  Gastroenterologists usually diagnose and manage this condition.

How can nutrition help with acid reflux or GERD?

So why does overindulging in a wing, pizza, and beer night lead to reflux symptoms?  First, the spicy sauces with wings are a trigger.  Second, the tomato sauce can be a trigger.  Third, alcohol is a likely culprit.  Finally, a large meal later in the day often leads to night-time symptoms.

Several basic steps can help manage acid reflux symptoms.

  1.  Avoid alcohol.  At least most of the time– it relaxes that little valve, so it opens more easily.
  2. Reduce or avoid caffeine.
  3. Eat several smaller meals instead of one large meal.  For example, instead of a large lunch, eat a morning snack, a light lunch, and an afternoon snack.
  4. Avoid eating for four hours before bed, if possible.
  5. Limit irritating foods.

Often, the first four steps are enough to manage symptoms most of the time.  Other people have to limit trigger foods and add in some lifestyle changes (like stress management or changes in the way they sleep) to help.

Do you know what foods trigger your symptoms?

Keep reading to learn about some possible culprits.

Foods that can trigger acid reflux

Occasionally, even after making basic changes to how they eat, people may find that some additional foods still lead to symptoms. Some common problem foods include:

  • Tomatoes and tomato-based sauces
  • Chili peppers and hot sauces
  • Peppermint candies and gums
  • Carbonated beverages
  • Chocolate
  • Fried food
  • Garlic and/or onions.

If you don’t experience symptoms after consuming one of these foods, there is no reason to avoid it.  But if you are experiencing symptoms after eating, it may be helpful to consider whether one of these (or another) food may be the culprit.  A dietitian can help you figure which foods are problems.

When there are many irritating foods, or someone continues to have symptoms often, I refer them to their doctor or gastroenterologist for evaluation.  It’s important to manage frequent acid reflux (called GERD) which can damage the esophagus.  In rare cases, GERD even leads to a type of pre-cancer called Barrett’s esophagus.

Stay in Touch!

 

Categories
Digestive

Got IBS? Here’s How to Fix It with a Low FODMAPs Diet

Array of colorful vegetables with text overlay "Eating Approaches for IBS Symptoms"
Do you know which vegetables are higher in FODMAPs?

 

Array of colorful vegetables with text overlay "Eating Approaches for IBS Symptoms"
Do you know which vegetables are higher in FODMAPs?

Eating for IBS can be a puzzle because your response to a slice of apple can be completely different from another person’s response to a slice of apple. So, figuring out what works for you can be tough without a plan to help.

If you’re considering using food to manage your symptoms, the popular low FODMAPs diet for IBS is a plan that is often successful.

Low FODMAPs & IBS

Low FODMAPs is popular because it works for many (but not all) people with IBS.  People on a low FODMAPs diet who experience improvements in symptoms often have more problems with pain, diarrhea and/or bloating than constipation.

What is the low FODMAPs diet?

A low FODMAPs diet reduces the amount of specific types of carbohydrates.  These carbohydrates are not digested well by some people who have symptoms related to IBS.  When they aren’t digested in the small intestine, the carbohydrate molecules travel into the colon. The extra molecules draw water into the colon while also giving the microbes in your colon supplies to chow down and throw a little party.  Their party, and that extra water, leads to the diarrhea and/or bloating.  (Some people have gas, too.)

Comparison: This is like lactose intolerance.  The same process happens to other carbohydrates, too.

By avoided or reducing certain foods, the low FODMAPs diet limits those carbohydrates.  For example, apples and mushrooms contain specific carbohydrates that could be an issue. Sweet potatoes can be a problem when you eat a larger portion.

How does it work in terms of food?

Being successful at the low FODMAPs diet involves knowing what you are eating and tracking your symptoms.  So, what helps you find out if and how well it works for you? The most rigorous approach is to eat as few FODMAPs as possible (eliminating foods like onion, beans, and apples).  After that, you then slowly add them back in.

To be successful, it helps if you:

  • learn about the different types of high FODMAPs carbohydrates in different foods you like to eat
  • read labels
  • eat basic (non-processed) foods
  • log foods
  • log symptoms.

Other options include eliminating just one or two groups at a time to see if symptoms improve.  Most people see some improvement in two to four weeks but six weeks may be needed.

The goal is to figure out how many different foods you tolerate so you can eat as many foods as possible without annoying symptoms. Sometimes, just having smaller portions mean you can eat some slightly troublesome foods. For example, many people can eat a mini apple but not a large apple. Other people find they can have one or two high FODMAPs foods per day but not five or six foods.

Feeling confused? Watch this short video that uses a great analogy!

How many people improve?

The estimate from research studies suggests that most people with more diarrhea respond well to a low FODMAPs diet– about 2/3 to 3/4 experience fewer symptoms during and after trying the diet.  Most of those people are able to return to eating higher FODMAPs foods once they understand what their body tolerates.

Is it for you?

If you know you react to some foods, check out a list of high FODMAPs foods here. If there’s a food on that list, you may want to consider this option (check with your gastroenterologist, just to be safe).

Stay in touch!

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Categories
Nutrition

What NOT to Eat (on the MIND diet)

Chocolate covered fruit

Last week, I posted the delicious part: what to eat for brain health.  When it includes delicious foods like pecans and raspberries, who’s complaining?

The flip side is that while there are just a handful of foods to eat daily on the MIND diet, there are also a few foods to minimize too.  Fortunately, this a relaxed diet: you can enjoy them sometimes, just not always. Keys to success: avoid deprivation, chose high quality treats (and you determine quality), and truly savor the ones you choose.

Foods to Limit on the Mind Diet

  1. Cheese: once a week or less.Chocolate covered fruit
  2. Butter: less than 1 tablespoon per day.
  3. Red meat: less than four servings per week.
  4. Desserts and sweets:  less than four servings per week.
  5. Fried and/or fast food: less than once a week.

What to Eat Instead

Try substituting nuts for cheese.  Nuts add a nice savory kick to salad; if they are toasted, they also have a nice crunch.  Olive oil can add richness to sauces.  Combining olive oil, herbs, and nuts creates delicious pesto-like sauces that can substitute for cheese toppings.

Butter is often the easiest to trade– switch to olive oil.  If you need butter on your toast, blend softened butter and olive oil.  If you refrigerate the mixture, it will be firm enough to spread on different foods.

Red meat is also a relatively easy one to trade.  Try both combining red meat with poultry (such as a half turkey, half beef meatloaf) and shifting your weekly menus to dishes without red meat, like those featuring fish or legumes.  Cuisines from around the world offer lots of options, from a vegetarian Indian curry to a Brazilian feijoada.

Quick tip: the hashtag for #MeatlessMonday can often be a source of inspiration.

Skipping the fast food takes planning.  I know I tend to eat fast food most when traveling, or when my plans for the day go askew.  The simplest option is to have a back-up plan: where can you go instead?  Is there a convenience store that carries some healthier options?  Is there a grocery store with a salad bar or deli?  Packing food on days when you might be kept away later is also an option.  Making your own snack packs in a mini-cooler with options like hardboiled eggs, raw vegetables, sliced fruit, nuts, and perhaps whole grain crackers is affordable and delicious.

Going un-fried: let’s order it baked, broiled, grilled, sautéed, simmered, or stewed.  Pull out the stops on marinades if you miss the flavor, or add a pesto for richness.  Looking for crisp?  Try some celery or run baked items under the broiler to add a touch more crispness.

Desserts and sweets: if you have a sweet tooth, this one can be tough.  Those tips at the top may be helpful– chose your favorites, not the stale doughnuts at work (unless your favorite is the stale doughnut at work). Be selective and then take the time to appreciate those decadent sweets.  On other days, try dressing up fruit.  Sliced nectarines with a little lemon zest or orange slices with cinnamon are more interesting than a whole piece of fruit. Occasionally, even a little melted dark chocolate can add some excitement!

Practice: Place a chocolate chip on your tongue.  Hold it there until it melts.  Write down a description of the flavors and textures you experienced as it melted.

Need some help?

Get in touch— let’s set up a workshop for a group you’re in, or a one-on-one consultation.  Let me know how I can help you meet your goals!

Categories
Nutrition

What’s the MIND Diet Again?

Raspberries and wild herbs

Last week, I gave a quick workshop on the MIND diet: a Mediterranean-style pattern of eating that is linked to lower risk of Alzheimer’s disease and delayed cognitive impairment.  We’re talking delaying cognitive impairment by seven years if you eat this way, so it can help quite a bit.

It’s pretty simple: eat some foods often and eat others less often.  The more consistently you do, the better your chances of getting the full benefits.  However, even people who only followed about half the recommendations had better cognition as they aged.  Read on to learn more about what eat to age better.

What to eat

These are your basic foods– you can eat more of any of them and add other foods to round out your meals.  Because you will need additional food.

  • Fish: once a week
  • Nuts: five times a week
  • Poultry: twice a week
  • Beans and lentils: three servings a week
  • Dark green leafy vegetables: six times a week
  • Other vegetables: once a day
  • Whole grains: three servings a day
  • Olive oil: use it as your main source of fat
  • Berries: two servings a week
  • Wine: one glass per day (only one glass)

Let’s break this down and chat about the individual foods.

How to eat MIND Diet foods

Fish: Any type of fish or seafood counts, from tuna to shrimp to cod.  For the best overall health benefits, try to eat one serving of fattier fish like tuna, salmon, or sardines each week.  Broil or grill for an entrée, make into a salad, or try sashimi or sushi.

Nuts: Choose any kind of nut or seed that you like.  Variety is helpful– walnuts, almonds, flaxseeds, hempseeds, pecans, Brazil nuts, hazelnuts, chia seeds, cashews… plenty of options!  Add them to salads, cereal, yogurt, pancakes, muffins, or have as a snack.

Poultry: This is usually pretty easy. Chicken and turkey are typically on menus and easy to find in grocery stores.  Roast, grill, stew, or make into soup.

Beans and lentils: You may like them but perhaps you’re not in the routine of eating them.  Try chickpeas or kidney beans on a salad, dahl with an Indian meal, lentil soup, hummus, refried beans, black bean soup, or use white beans as the base of a dip instead of sour cream.

Dark green leafy vegetables: There are plenty of options!  Try broccoli, spinach, kale, collard greens, turnip greens, bok choi, gai lan, or beet greens.  Grill baby bok choi with a little sesame oil, toss chopped broccoli into omelets, or make spinach an ingredient in scrambled eggs. I adore dinosaur kale in soup.

Other vegetables: Even more options.  Try raw, roasted, grilled, stir-fried, steamed, or any other way you might enjoy it.  Seasonal options often have the best flavor and quality– like snow peas in the spring and winter squash in the autumn.

Whole grains: Look for options with little or no added salt and sugar.  For example, oatmeal, whole grain pasta, bulgur, corn tortillas, popcorn, kasha, and brown rice are all options for whole grains.  With breads and cold cereals, check the ingredient labels to ensure you are buying 100% whole grain options.

Olive oil: Select 100% olive oil.  I prefer extra virgin olive oil for salad dressings and gentle cooking.  For very high heat (450 degrees Fahrenheit and above), I’ll switch to something that tolerate more heat.

Berries: Choose the ones you like!  Off-season, the quality of frozen is likely higher.

Wine: If you like to drink responsibly, and don’t have any other health reasons to avoid alcohol, a glass of wine with dinner may be helpful.  However, if you have any reasons to avoid alcohol (for example, a family history of breast cancer, addiction, or medications that don’t allow alcohol consumption), try some red grapes for dessert instead.

What if I can’t eat….

Then don’t!  The only exception is that I will suggest vegetarians/vegans who are not allergic to fish and shellfish consider a fish oil or krill supplement, as their ethics permit. However, it’s not essential.

Try to eat more of another, similar food group instead.  So, for example, if you can’t eat beans, eat more nuts and/or whole grains.  If you don’t eat poultry, substitute beans and lentils.

Your brain gets healthier when you consistently eat even just some of these foods. In other words, if you can only follow 8/10 of the guidelines for what to eat, then you are still getting at least half the benefits, if not more. Still have questions?  Get in touch.

Coming up next week: What not to eat

Resources

Research Article: MIND Diet Associated with Reduced Incidence of Alzheimer’s Disease

Book: Diet for the MIND by Martha Clare Morris

Book: The MIND Diet by Maggie Moon

*Amazon links are Amazon Affiliate links.