Feeding Your Immune System Takes Guts! How’s Yours?

One nutrition trend that peaked everyone’s interest in 2020 was “immune-boosting foods”. Understandable, too, with COVID-19 keeping the entire world terrified and “sheltering in place”. Outside the home, people were running scared about getting COVID from any place they went for necessities and from everything they touched.

Marketers got right on the fears, emphasizing on their products’ labels and in their ads how their food or supplement “boosted” immunity. They know fear is a great motivator, always has been.

Gut-Level Immunity

Taking good care of your immune system though, means taking care of your gut — vaccine or no vaccine.  Why? The gut, especially the colon, is the nerve center of the immune system. Indeed, 90% of our immune system is located in the gut, so taking good care of your gut also serves your immune system quite well.

The gut is loaded with bacteria though, both good and bad types. The right foods can nurture the good gut organisms and minimize the bad ones that work against us. A few definitions first:

  • PRObiotics: These are live, “good” bacteria that are already in fermented foods we eat.
  • PREbiotics: Fancy term for plant fiber. Since we can’t digest it, it passes through to our colons, where it becomes food for healthy bacteria, helping them grow and proliferate.

Examples of Probiotic Foods

  Yogurt: Look for “live & active cultures” on the label.

To “cut-to-the-chase” and get good bacteria right into your gut immediately, eat foods that already have good bacteria, the PRObiotic foods. Look for “live and active cultures: on food labels to make sure the food contains enough good bugs to actually matter. Some excellent ones:

  • Yogurt
  • Kefir
  • Kombucha
  • Tempeh (fermented soybeans and often includes some whole grains)
  • Miso – another type of fermented soybean, usually seen as a paste. Adds great flavor to soups and foods like salad dressings.
  • Kimchi (this is high in sodium, so not ideal for everyone)
  • Miso (fermented soybean paste)
  • Sauerkraut (another high-sodium choice)
  • Some cheeses – but the bacteria in cheese has to survive the aging process. Some that do: mozzarella, cheddar. Have another look at cottage cheese. It can have probiotics too, if the label says, “contains live and active cultures”.

Examples of Prebiotic Foods

These don’t have bacteria, but they have lots of good fiber to FEED the good guys in your gut and help grow more. These take the longer-term approach, but these are also foods that healthful diets need anyway, so forge ahead. Some great ones are:

  • All fruits and vegetables. Yes, all of them, so eat the ones you like, preferably one or more at each meal. Raw ones will have more fiber, but don’t obsess about this.
  • All beans – kidney beans, pink beans, the ever-loving garbanzo, and my personal favorite: elephant beans from Greece.
  • Peas and lentils. Beans are actually a vegetable, but they’re also loaded with protein and get placed into many food groups. Doesn’t matter, get some beans on most days, please.
  • Whole grain bread and cereals.
  • Brown rice, wild rice.
  • “Ancient grains” like quinoa, teff, and spelt.

Refined grains don’t have much fiber, so eat whole grains whenever you have the option. Whole grain cereal is super-easy now, as most of the “big name” cereals have at least half their grains as whole grains. Some pastas are made with partial whole grains, so they’re another source.

Can Pre- & Probiotic Foods “Boost” Your Immune System?

Yes and no. A vaccine is really the only way to truly “boost” the immune system and produce antibodies. Moreover, you don’t WANT a supercharged immune system – that results in over-recognizing substances as harmful agents when they really aren’t. It’s what happens in auto-immune disorders, where the body turns on itself, causing inflammatory responses that shouldn’t be there.

Immune SUPPORT should be the goal, and the foods listed above can help.

The Science Behind The Food: HOW Pre- and Probiotics Work

A just-published review of clinical trials of probiotics and fermented foods found that these directly influenced certain circulating immunoglobulins (Ig), especially salivary secretion of IgA, one of the blood proteins your body makes to help fight disease.

Beyond the immune system, prebiotics have been shown to have metabolic and health benefits.  This scientific review acknowledged, “The prebiotic effect has been shown to associate with modulation of biomarkers and activity(ies) of the immune system.” The authors specifically noted evidence supporting a healthy gut in modulating conditions such as type 2 diabetes and Metabolic Syndrome.

Cut To The Chase Takeaway

Evidence is building: probiotic foods and foods with prebiotic fiber have a positive influence on our health, including our immune systems.  They’re also delicious, and there are lots of options to enjoy.  

Know MSG & You’ll Never “No MSG”!

NO:TE: I’ve partnered with The Glutamate Association for many years, but this post is strictly my own – all based on science and any views are my own.

I love dispelling food myths. There’s so much “fear of food”, and how food myths get started is as varied as the myths themselves.  

No food or ingredient illustrates this better than monosodium glutamate, or MSG. Based on a physician’s single letter to the editor of a medical journal, back in 1969, noting symptoms after having eaten in a Chinese restaurant.  Of the possible causes he suggested, the only one that stuck was MSG: Chinese Restaurant Syndrome was born and went viral immediately – WAY before the internet! 

MSG had been used for decades with no reported issues, but suddenly fear of MSG dominated and all hell broke loose, launching dozens of research studies on the effects of MSG. 

Bottom line, years of clinical studies showed nothing: no connection to headaches, palpitations or any of the symptoms attributed to MSG.  A new website, knowMSG.com is loaded with the facts — and lots of delicious recipes (including for the dishes you see here), demonstrating what MSG can do to enhance the flavor of healthful food. 

MSG Is Simple: 2 Components

It’s just sodium and glutamate, and we have BOTH in our bodies at all times. Sodium is an electrolyte that’s critical for numerous body processes, including the nervous system, heart and circulatory function, every organ needs sodium. Yes, we get too much, but MSG can actually help there. Keep reading.

Glutamate, or glutamic acid, is an amino acid, one of the building blocks of protein. Glutamate is in all protein foods, but we don’t need to get it from protein because our bodies MAKE IT THEMSELVES – to the tune of about 50 grams a day. That’s why it’s not an “essential” amino acid. It’s far more than you’d ever get from eating anything with MSG.

True Or False: “Umami” = Glutamate

TRUE!  Chefs speak about “umami”, the fifth taste, and it’s what every chef wants more of in food, that intensity of flavor that makes food of all cuisines so delicious. Parmesan cheese, tomatoes, mushrooms, anchovies, seaweed, beef, even broccoli — they’re they’re all NATURALLY loaded with glutamate, giving them a savory umami taste.

It’s always been in breast milk, too.  Human breast milk has 10 times more free glutamate than cow’s milk — maybe to make it appealing to infants, so they’ll feed more readily?  

10 Reasons Why This Nutritionist Likes MSG:

  1. It’s simple, just 2 components, sodium and glutamate. 
  2. Glutamate has many roles in the body, but mostly fuels the functions of our digestive and immune systems – that’s why 95% if it is in our gut.
  3. Virtually ALL credible research shows no ill effects from MSG.
  4. Safety of MSG is backed by science, and confirmed by all global regulatory bodies. MSG is safe, period.
  5. It’s LOWER in sodium than salt! Gram-for-gram, it has 62% less sodium than sodium chloride (the familiar salt used in cooking).
  6. By swapping half a recipe’s salt for MSG, you intensify flavor BETTER but also lower the sodium. Lower sodium, but enhanced taste — I like “win-wins”.
  7. Glutamate is in many foods I don’t want to live without: parmesan cheese, tomatoes, eggplant, mushrooms, and many more. These foods are loved my many cultures for their unique flavor, and glutamate is an important part of that flavor.
  8. Nearly everyone needs to eat more vegetables.  MSG can help us get there by amping up the flavor of those veggies.  Another win-win.
  9. MSG is derived from plants, and made through fermentation – much like the process to produce beef, soy sauce or vinegar. What’s fermented? Usually starch from corn, or molasses from sugar cane or sugar beets.
  10. Glutamate = “umami”.  Umami is the 5th taste that all chefs aim for, and is a critical component of the umami taste. Research suggests having umami-rich broth before meals may even help promote healthful food choices and eating behaviors in people at risk for obesity. 

Cut to the Chase Take-Away

It’s time to swap food myths for food FACTS.  With MSG, the facts TASTE better and are better for us — there’s that win-win again!

Comfort Food Alert! 3 Top Nutritionists Share Theirs (No Kale Here!)

If there were EVER a time when we want comfort food, it’s now.  Sure, we want nutrition, but “in these challenging times” (getting overused!), we want what we know will make us feel better, even if just for a while.

What makes a food a “comfort food”? 

There’s no single comfort food; everyone has their own.  They can be specific (“my mother’s meatloaf”) but can also be a category of foods: “any kind of cheese.” 

How a food becomes a “comfort food” is as diverse as each person.  Registered dietitian-nutritionists (RDNs) like comfort food, too, so I asked some registered dietitian-nutritionists what their fave comfort foods are, and their responses might surprise you: 

Leslie Bonci has an arsenal of comfort foods.  “To me, comfort food is sense-surround with eye appeal, aroma, flavor and texture,” she said.  Her comfort foods range from spicy chili with crushed tortillas, to a bowl of pasta fagioli with crispy onions on top, or a season-specific pumpkin pie with a gingersnap-orange zest crust. 

Any time of year she’s up for sharp cheese, crispbread, pickles and grapes.  I’d bet the feature photo (courtesy of  Aliona Gumeniuk) would be VERY comfortable for Bonci!

Nicole Rodriguez believes whatever food you like can be worked into your healthy eating style (Go Nicole!).  “When I think comfort food, it has to be something unfailingly satisfying.  And for me, that’s a cheeseburger!  Combining beef, dairy, grains, and maybe just a smidge of vegetables (pickles and ketchup count, don’t they?), this American classic never fails to please.” 

Rodriguez doesn’t leave home for her comfort food, either.   “Instead of it being a restaurant indulgence, I prepare them at home with a side of roasted vegetables or a salad.”  She also has a hack for keeping the indulgence in check by keeping it all about the cheeseburger, not the fries.  “The fries have become an unnecessary afterthought.”   

 

Comfort Food Brings Memories

All of Barbara Baron’s comfort foods take her back to childhood and her Italian heritage, and family food experiences.  Like Bonci, Baron has several comfort foods.  “Shucking FRESH cranberry beans in their shells/pods and preparing them with green beans, garlic, olive oil and tomato sauce, as every good Italian dish starts.” 

That healthy “Holy Trinity” of garlic, EVOO, and tomato sauce pop up in the Swiss chard her mother made, “adding some cubed end chunks of Parmesan, if they were around.”  She loved how the cheese would remain firm on the inside but melted on the outside and she looked for these specially.  “It was like finding Waldo amid the Swiss Chard,” she said. 

Baron can go more indulgent for comfort food, too, noting, “Great family gatherings of making homemade potato gnocchi with my grandmother. When I see them on the restaurant menu it brings a smile to my face and a flood of memories of making these in my grandmother’s kitchen with my aunts and uncle.  It was a full-blown family affair!”

 

Eating For Comfort: What Does the Research Say?

Readers of this column know I like evidence.  Is there a health or emotional benefits from eating your comfort food? 

The evidence suggests some people get more benefit from comfort food than others do.  This paper reviewed the research on comfort food and concluded that people scoring higher on tests of emotional eating were more likely to find immediate benefit from comfort food.  Not surprising, but it’s normal to sometimes find yourself eating to feel better or cope with some stresses of life.  Most of us do that at least once in a while. 

No Comfort Food?  It Happens!

Not everyone heads to food when they need some TLC.  Some people do just the opposite – they turn away from food when stressed.  There seems to be a gender difference also. This study found that women experiencing stressful events such as the deaths of family or friends, relocation, or job changes are more likely to gain weight and see increases in body mass index (BMI).

This doesn’t mean that men don’t get stressed from life events, only that they may be less likely to head to food as a coping mechanism.  

Cut-To-The-Chase Takeaway

The effect of comfort food is immediate, but not long-lasting.  If you find yourself overdoing the comfort food, it’s time to cultivate other ways to cope with everyday stress.    Developing “non-food” interests that give us satisfaction, is a must.  Physical activity gets those brain endorphins hopping too, making us feel a little (or a lot) better and more able to handle what comes our way (and burns off some of those comfort calories!), but hobbies, a hot bath, or spending some time playing with your pet are other examples.  Especially in “these challenging times” have as many varied ways as you can to push that comfort button.

Post-Halloween! Where to Cut Back on Sugar – And Where NOT To!

Every diet, whether faddish or sensible, recommends cutting back on sugar.  Even if your weight is fine, sugar reduction is top-of-mind when you’re talking about strategies to improve your diet and health.

The World Health Organization recommends cutting sugar to 10% of calories, but strongly encourages no more than 5%.  The 2020 US Dietary Guidelines Advisory Committee’s recent recommendations were to keep added sugar calories to a max of 6% of total calories. 

What The Heck Does “6% Of Total Calories” Look Like? 

Using a 2000-calorie “reference diet”, which is just an average amount of calories needed by the “average person” (and that’s an average of men’s and women’s needs, so very general), it means added sugar would be limited to 6% of 2000 calories, or 120 calories a day.  Looked at in grams, it’s about 30 grams of added sugar, just a tad over one ounce!

That’s a modest amount, compared to the 93 grams – about 372 calories – that the “average” person eats each day now.  It adds up to 75 pounds of sugar in a year – more than triple what is recommended.

It’s Not All Bad

On the plus side, we’re eating less than we have in 20 years.  A recent analysis from the Pew Research Institute found that, in 1999, “each person consumed an average of 90.2 pounds of added caloric sweeteners a year,” or about 449 calories a day. 

A decline of 75 sugar calories a day is great, but we have a long way to go to meet up with current recommendations.

Where Are Our 93 Grams/day Of Sugar Coming From?

Media will have you believing that added sugar is everywhere, in our cereals, yogurt, even in condiments like ketchup and, salad dressing.  But the vast majority of our added sugar comes from 2 sources: sugary drinks, and empty-calorie sweets.  Let’s look at the data

Beverages  47%
Snacks/Sweets 31%
Grains 8%
Mixed Dishes 6%
Dairy (milk/yogurt/kefir) 4%
Condiments 2%
Vegetables 1%
Fruit Juice 1%

 

How “Empty” Is Your Diet?

Some quick math tells us that calories from beverages like soda, powdered drink mixes, fruit-flavored drinks, and sports and energy drinks along with sweets like pastries and candy add up to 78% of our added sugar calories.  These are all “empty-calories” because they deliver just calories, and few, if any, nutrients, even if they’re homemade and really taste good.  Note: 100% fruit juice has no added sugar, so isn’t included here.

We can also see that 22% of added sugar calories are coming from other foods, including dairy, grains, fruits and veggies, and mixed dishes (think a little added sugar to the sauce in the frozen lasagna, that sort of thing).

Getting Cultured & Grainy

The breakfast cereal you worry about?  The sugar in your yogurt?  The chocolate milk your kids And many of us adults) like? These are in the grains and dairy groups and here’s why probably don’t need to be concerned with the added sugar here:

  1. These foods are loaded with nutrients, and
  2. These food categories are providing only 12% of the added sugars in most diets.

That 12% is important.  It means that, of our 75 grams of daily added sugar, only 12%, or about 9 grams, is coming from those foods. 

Added Sugar: Cutting Back Is Easier Than You Think

A little more math: 22% of the 93 grams of average daily added sugar intake amounts to 21 grams/84 calories.  That’s even less than the 30 grams/120 calories recommended by the US Dietary Guidelines Advisory Committee!

If you choose to “spend” your 120 calories of added sugar each day on foods like whole-grain sweetened cereal and/or fat-free yogurt, you won’t hear a word from this nutritionist.  Indeed, a little added sugar can help drive consumption of nutrient-rich foods.  Personally, I favor Greek yogurt because it’s higher in protein, and usually has even less added sugar.  That’s quibbling though.  The choice is yours. 

As for where to spend those leftover other 9 grams of added sugar, followers of CutToTheChaseNutrition.com know of my fondness for dark chocolate.  An ounce of 70% chocolate will have about 9 grams of added sugar.  Done. And happy!   

 

 

 

A REALLY Plant-Based Meal — With Beef!

When people tell me “I don’t eat meat, I’m plant-based,” the implication is that plant-based diets can’t include meat, poultry, or fish.

They can!  “Plant-based” means only that a majority of the diet comes from plants.  Period.  That said, being “plant-based” tells nothing about the QUALITY of someone’s diet.  You can eat nothing but candy and soda and have a “plant-based diet.”  You can live on nothing but kale — a terrific food and all-plant — but both diets would be unbalanced.

Balanced: The Size That Matters  

If you want to eat a plant-based diet but also include meat, what’s the right portion?

Less than you think.  Figure 3- to 4-oz. of meat, poultry, or fish are definitely enough protein in any meal, because this amount provides about 28 grams of protein.  You’ll have several more grams from the grains, starches, and vegetables that balance the meal, bringing you well over the 30 grams of protein for the meal.  That’s definitely enough protein!

Why?  Because the body can’t utilize more than 30-35 grams at a time, so any extra will just be converted to energy or, if the meal has too many calories, stored in fat tissue.

This huge platter has 4-oz. of ribeye. It served one, and is not vegan, but TOTALLY plant-based!

I’m an omnivore, but I’m also a huge fan of produce (seriously, I can’t get enough veggies and fruit).  The sliced ribeye in the platter you see at the right was exactly 4-oz., half the weight of the ribeye.  It’s one way we make an expensive cut of beef go farther — as it should.  It also leaves plenty of space on your plate for the other foods we like and need and that balance the meal.

Being a Plant-Based Omnivore

I like simple and easy meals, but they have to taste good.  Here’s how I made this dish.  It’s a “guide” and it’s quite adaptable:

  • Take an 8-oz. ribeye, grill or fry it (I used a grill pan) to medium doneness (internal temperature of 145°F ). Let it rest for about 10 minutes.
  • Combine all the fresh veggies you like in a large bowl. Include a little fruit if you like (we do). This one is a platter of lettuce, cucumbers, tomatoes, corn, and red pears.
  • Divide the salad among two platters.
  • Slice the ribeye into 1/4″ slices and put half the slices on each of the two platters.
  • Add a fresh herb (optional, but if they’re on hand, add them). I topped the platter with julienned broad-leaf thyme because it grows like a weed on my windowsill, but fresh mint or basil is just as delicious.
  • A teaspoon of grated Parmesan adds umami.
  • Drizzle with EVOO and balsamic vinegar, or your favorite dressing, but please don’t drown it. You want the flavors of the ingredients to shine through.

All the produce here came from our local farmers market this time, but use whatever you have.  It’s easy to substitute leftover chicken, deboned, or grilled fish.  Salmon works especially well, but I’ve also done this with canned salmon and sardines.  (Laugh if you must, but both are loaded with omega-3s, inexpensive, and great to have in the pantry!  I like them packed in water.)  

This simple recipe is just a template, but there are dozens more chef-developed, delicious recipes at: beefitswhatsfordinner.com.  The Mediterranean Beef & Salad Pita in the featured photo is one of them.  Takes 30 minutes and uses budget-friendly 80% lean  ground beef, or go even leaner with 95% ground beef.  Adapt it with your own touches! 

More Than Ever, We Need “Polypills” & “Activity Snacks”

Even “BC” (before COVID), much of the world was pretty sedentary, and our new “pandemic lifestyles” haven’t helped. Now a new WHO report says worldwide levels of physical activity have been flat for nearly 20 years. This varies by country, but globally about 1 in 3 women and 1 in 4 men, are not meeting guidelines for adequate activity.

What’s “Adequate Physical Activity”?

This is defined as 150 minutes of moderate-intensity activity (think brisk walking) per week, OR 75 minutes of vigorous-intensity activity per week (whatever has you huffing).

The WHO report was sobering. Sedentary lifestyles may be how our lives evolved in modern-day society, but they aren’t what we are built for. Still, such physical inactivity is a big negative on our health.

The Reasons We Don’t “Exercise”

I’ve used all of these over the years, so if they sound familiar, you’re not alone:

  • Gym memberships are expensive (and possibly still closed).
  • I’m not seeing changes I expected to my body.
  • I don’t know “the right way” to exercise. I don’t have the right shoes.
  • I’m too busy and stressed out.
  • It’s too cold/hot.

Add in family responsibilities and any physical limitations and the list seems endless.

Revving Back Up: Let’s Ask A Pro

I decided to call on an internationally respected colleague, Chris Rosenbloom, nutrition professor emerita at Georgia State University, and author of Food & Fitness After 50 about ways to encourage us to be more active.
Dr. Rosenbloom knows the benefits of better fitness, but says communicating it well is key. “When we talk about ‘exercise’, some people are turned off but when put it in terms of ‘activity’, it can be more palatable.”

Rosenbloom also has the same feelings about “exercise” as everyone else. “I know for me, when I use an exercise bike in the gym I can’t wait for the timer to go off and be done with it, but when I ride my bike outside I can go forever.” Rosenbloom encourages everyone to do what they like to do. “Dancing, gardening, walking the dog, riding bikes…all of those are more fun than an hour of high intensity exercise in a gym.”

If you’re more home-based now, she advises checking into some great sites for online fitness classes. Among her favorites are FitnessBlender.com (totally free!) and, for older folks, Silver Sneakers (often free with Medicare plans).

The Value to YOU

Even a little strength training makes everyday tasks SO much easier!

 

It’s OK to make all the health benefits of activity secondary: focus on fitness that’s meaningful to you. Rosenbloom calls this “functional fitness” – having the ability to do things you like to do without being hindered by fatigue from weaker muscles. She’s encourages at least some strength training. “You can see the results very quickly…admire that bicep and it can keep you motivated to continue to lift weights!” Lugging those groceries gets easier, too.

“Sometimes it is hard to get to an exercise class, take that walk, or turn on the video,” Rosenbloom said, but keep your eye on the payoff. “I’ve never, ever said to myself, ‘Wow, I’m sorry I worked out.’” Instead, she gets a lift from a sense of accomplishment, “and that makes me feel good,” she noted.

Rosenbloom is spot-on – I’m always happier afterwards. My own motivation to be active daily is two-fold: it busts stress and really lifts my mood. If I don’t have time for the full exercise routine, then I just do what I have time for.

“Activity snacks”

Being active doesn’t have to be a huge time commitment to bring big bennies, Rosenbloom says. “Be active in 10-minute increments throughout the day.” Tied to your computer all day? She favors “activity snacks.” “Take 5 or 10 minutes every hour to do easy things like walk up and down the stairs, use therabands for bicep curls, do some walking lunges, or simply stretch in a forward fold.

I like this. It’s not just “being active” but also “less sedentary”. Doing those little things during the day also helps prevent muscle stiffness.

Taking a “Polypill”?

Yes, daily, or as often as you can.  Exercise is not only medicine, it’s a medication that has innumerable benefits, what Rosenbloom calls a “polypill”.  “It has many benefits that no prescription medicine can match,” she says, including physically, mentally, and even socially. “Activity helps in so many ways.”

This post dedicated to Diane Likas Ayoob, January 5, 1928 – September 21, 2020, who firmly believed in the polypill of physical activity.

Obese? Canadian Docs Say It’s About Health, Not The Scale

I’ve worked with so many overweight and obese adults and children whose weight was seriously impacting their health: diabetes, hypertension, back and joint pain, the works.  But not all overweight people experience these problems.   Some overweight patients have told me they’re happy with their weight and don’t feel hindered by it.   

As a health professional, I know and see the risks of having too much weight.  But what about the overweight person who has normal blood pressure and lab values, a good quality of life, generally feels good.  They ask, “do I still need to lose weight?”

Not necessarily, say the doctors of Obesity Canada.  The Canadian Adult Obesity Clinical Practice Guidelines (CPGs), a two-year effort by the Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons, was authored by over 60 physicians.  They reviewed over 500 published studies and a formed a consensus of both clinical and scientific issues related to weight gain.

These guidelines focus on health & quality of life,                      not “ideal weight”, as goals.

Why I Like These Guidelines

They state the facts:  Obesity is a complex chronic disease that predisposes a person to many disease conditions, including:

  • Hypertension
  • Type 2 diabetes
  • Gout
  • Non-alcoholic fatty liver disease
  • Numerous cancers: colon, kidney, post-menopausal breast, esophagus

They also admit that the causes of obesity are multi-faceted, and can include genetics, individual behavior, metabolic factors, and the person’s living environment impact a person’s weight.  I’d add social factors to this as well.

BUT – and this is just as important – they emphasized that managing it is not all about the number on the scale!  It’s just as much about overall health, quality of life, and lifespan.  Bravo!

One Size Fits ONE!

These guidelines push personalized treatment.  It’s the INDIVIDUAL’s journey, not the physician’s.  Yes, the medical pieces are important.  You can’t advise which road to take if you don’t know where you are.  After that however, being effective takes more: meeting each person where they are at that point in time, how they live, and what their own goals are.  That may include not wanting intervention right then. 

All hands on deck!

These docs admit they can’t do it alone.  Obesity has many causes and therefore needs many components of treatment and a multidisciplinary approach: 

  • Medical nutrition therapy (MNT): Eureka! The physicians of Canada recognize that personalized counseling from a registered dietitian-nutritionist (RDN) is critical!  It’s evidence-based but individually focused.   
  • Exercise: 30-60 minutes of “vigorous” activity on most days. No worries here – remember everything is individualized.
  • Use all appropriate tools: medication, if needed, referrals for cognitive behavioral therapy, even psychotherapy if needed, and bariatric surgery as a last resort.

It’s “Best Weight” Not “Ideal Weight”

“Ideal weight” may be an unrealistic goal for many, especially if they’ve been overweight for years.  That’s OK.  The goal should be better HEALTH first, and whatever weight you are when you’re doing healthy behaviors – whatever weight that is. 

Silver lining: Even losing 3-5% of initial body weight reduces your health risks.  Just do what you can. 

  QUALITY of life is everything!

Cut-To-The-Chase Takeaway

These CPGs don’t give permission to disregard the pursuit of healthy behaviors and lifestyles.  They focus on YOUR best health.  That means striking that sweet spot between doing what you need to do and not leaving out what you most enjoy.  It’s not the same for everyone, so have a chat with your doctor.   The goal is better health, and better QUALITY OF LIFE.  Obsession with the scale isn’t healthy! 

COVID-19 Got You Depressed? Could Probiotics Help?

Whether COVID-19 has you sheltering-in-place, quarantining, or just frustrated by not being able to have your usual life, lots of people seem a little down in the dumps, grumpy, and yes,  even “depressed”.  The “life sucks now” feelings are real, but different from true clinical depression, which can happen for no observable reason. 

Could “Bacteria” Improve Mood?

The right kind of bacteria – probiotics – just might help truly depressed people, even those who on antidepressant medication.  This just-published study reviewed clinical research on the impact probiotic supplements had on people formally diagnosed with clinical depression.  

Probiotics are what give Greek (& regular) yogurt that tangy taste. 

Probiotics are live healthy bacteria, found in cultured foods like yogurt, kimchi, and kefir.  These are different from PRE-biotics, which are various types of dietary fiber found in fruits, vegetables, grains, nuts, and beans.  Prebiotic fiber feeds the growth of probiotic bacteria in the gut.  

What The Results Showed

In the 7 studies that met the criteria for inclusion in the review, all found that probiotic supplementation “demonstrated a significant, quantitatively evident, decrease/improvement of symptoms and/or biochemically relevant measures of anxiety and/or depression for probiotic or combined prebiotic– probiotic use.”  Whether the studies used one strain of probiotics or multiple strains, the results showed improvement in reducing depression symptoms. 

Moreover, in one of the studies that also measured “quality of life”, it increased with supplementation but returned to baseline 8 weeks after the supplementation stopped.

Why Probiotics Helped

If something works, I always want to know WHY, and this paper suggests a mechanism for how probiotics might help depression.

The gut is known to be the center of our immune system, and when probiotics have been found to be useful, as they have with conditions like ulcerative colitis, it’s often because of their ability to reduce inflammation by suppressing the production of some annoying substances, called “cytokines”. 

The gut also is known to connect with the brain via the “gut-brain axis”, part of the central nervous system, so “food and mood”, or the notion that what’s happening in one’s GI tract could impact one’s emotional state has weight behind it.

The “Fine Print” 

It would be great to learn that just by having some yogurt, your mood would soar, but alas, reality must be acknowledged.  These studies looked at persons with diagnosed, measurable depression.  Those who got the probiotic supplements seemed to become less depressed, but those supplements contained higher doses of probiotics than you’d get from a cup of yogurt. 

Tempeh is made from fermented soybeans & contains lots of probiotics, plus protein & fiber!

Probiotic foods and supplements may not be useful mood-boosters if you’re just having a down day, but there are plenty of reasons to eat foods that naturally contain probiotic bacteria, like these:

  • Yogurt, including Greek yogurt
  • Kefir
  • Kombucha
  • Tempeh
  • Miso
  • Kimchi

Look for “Live and Active Cultures” on yogurt and kefir labels, to be sure they contain useful amounts of probiotics. 

“Live & active cultures” guarantees a high amount of probiotic bacteria.

These being dairy foods, they also have a whole lot of essential nutrients we need, especially calcium and potassium, to help fill gaps in most people’s diets.

The main ingredient in kimchi is cabbage, and it’s fermented soybeans in tempeh, so they both have PRE-biotic fiber, too.  Heads up, if you’re sodium-sensitive: Miso and Kimchi can be loaded with sodium.  

Is there a down side to getting probiotic bacteria?   So far, there doesn’t seem to be, especially if you get them from food.  Getting some probiotics daily though, gives you the most benefit, and the study found this as well: depression returned when the probiotics stopped. 

Even if probiotic foods don’t lift your mood, you can definitely feel good about adding some healthy foods to your eating style!

Food Is Medicine…But Some Restrictions Apply

Did Hippocrates really say, “Let food be thy medicine and medicine be thy food”?  Probably not, but he often gets the credit for it.  At any rate, using food for medicinal purposes has been done for years, by your doctor or registered dietitian-nutritionist (RDN), or maybe grandma.  It’s also been the stuff of quackery and unproven hypotheses forever.  Elderberries, anyone?  They’re a good food, but there is no evidence they’ll cure COVID.  And we speak today of food, not supplements.

Quackery aside, here are some foods that have been used to treat various conditions:

  • Chicken soup! From Dr. Grandma, given for colds, flu, and “anytime you don’t feel good.” 
  • Prunes – the original “laxative.”
  • Milk – to calm an acid stomach.
  • Coffee and tea – both contain caffeine to jumpstart the morning (bonus: they’re both loaded with antioxidants)

These foods helped in acute conditions, but taking the next step, could food actually be “prescribed”, like medicine, to treat chronic conditions, such as heart disease, diabetes, hypertension, and stroke?  These diseases may not be diet-caused, but they’re all definitely diet-influenced. We know that eating an unbalanced diet long-term can eventually take a toll on health.  It’s also clear that a lifelong healthful diet reduces your risk for chronic conditions.

Credits: Junan Sonin, Sarah Kaiser, CC 2.0
https://www.flickr.com/photos/juhansonin/14406031184/in/photostream/

 

But…A “Prescribed Diet”?

By definition, it’s a diet that’s personalized for YOU with YOUR chronic condition.  Just as a medical diagnosis can require specific medication, diet-influenced chronic conditions require specific “diet prescriptions”. 

The idea of prescribed diets is gaining traction, because of emerging evidence that such diets can improve health outcomes AND lower health costs. 

This 2019 study looked at whether medically tailored meals for chronically ill persons would impact admissions to hospitals and skilled nursing facilities.  The meals were delivered in “ready-to-eat” form to persons with a variety of chronic conditions who also had various environmental or other barriers (social, income, inability to shop or cook for themselves), placing them at nutritional risk.  The meals were customized to the medical needs of each person, but also incorporated food preferences whenever possible.  

Results?  Huge.

After two years, those who received the medically tailored meals experienced:

  • Nearly HALF the hospital admissions.
  • 72% FEWER admissions to nursing facilities
  • Health care costs reduced by 16%.

Delivering tailored meals is costly, and not everyone needs or wants that approach.  In addition to medically tailored meals, a recent analysis in the British Medical Journal also noted other programs that take a broader approach in order to have a wider reach:

Medically Tailored Groceries

These are for people with chronic diseases like diabetes and cardiovascular disease, who can prepare their own food, but are food insecure.  Specific groceries items are customized by a nutrition professional, usually an RDN, and picked up by patients at a central location, such as a clinic or community center.

The results? 

  • Better adherence to medication.
  • Better blood glucose control in diabetics.
  • Better intake of fruits and vegetables, lower medical costs!

Photo credit: pxfuel.com

Produce Prescriptions

 

Sounds gimmicky but it’s solid.  Healthcare providers distribute vouchers or debit cards for free or discounted produce to food insecure persons with chronic conditions.  They redeem the vouchers at any store that accepts them.

The results? 

  • Better blood glucose control in diabetics.
  • Reduced excess weight, fewer antibiotics in children.
  • Better consumption of fruits and vegetables.

The “Catch”

Most of the research on prescribed diets isn’t very granular, so we don’t know exactly what’s producing these improvements.  Is it the total food package?  Individual foods?  Was it just because they were able to get, and eat, more fruits and vegetables?  Or more nutrient-rich protein foods? 

These unknowns can be problematic, because it opens the door for all manner of charlatans and quacks to tell you they “know” what foods you need to eat to prevent or treat these conditions.  In these programs, food was given out directly or vouchers were provided that limited purchases to the intended foods.  

What if you’re food secure but still have these chronic conditions, what are YOUR options for a ”prescribed diet”?

Credit: Nick Youngson CC BY-SA 3.0 Alpha Stock Images

Medical nutrition therapy (MNT) is your best option, and it’s provided by an RDN – not a trainer, coach, or “wellness expert”.  MNT from an RDN customize your dietary plans, focusing on YOUR foods for YOUR needs, taking into account your food preferences, your food culture, and food budget.  It’s not a new skill for RDNs – it’s exactly what they’ve ALWAYS done, and they have more training in the field than anyone.  Bonus: most insurance plans cover some amount of MNT.

When a Pharmacist Talks With a Registered Dietitian/Nutritionist….

Dr. Jessica Nouhavandi, PharmD, co-founder and co-CEO of Culver City-based Honeybee Health, asked me recently what it’s like to think like a registered dietitian/nutritionist, and a little about my approach to nutrition, food, and eating.  

When did you first start working as a registered dietician (RD)? 

I have been an RD since 1980, so I’m now 40 years in! I was in graduate school back then, working on my doctorate and working part-time as a “relief” dietitian, so I’d fill in on weekends and when they needed someone during the week. It was great because, as a relief, I’d be experiencing all the different hospital units: oncology, cardiac ICU, pediatrics, the works.  

What inspired you to become an RD? 

Nutrition science was my undergraduate degree. I always enjoyed learning how the body worked, and the more I learned about how truly complex it is, the more fascinated I became.  Plus, in a nutrition curriculum, you also learn about food science, not just nutrition. Food science focuses on food before you eat it. Nutrition is what happens once you put it into your mouth.  

How would you say your approach differs from other RDs? 

My approach has definitely evolved over the years, because I keep learning, but also because nutrition is such an evolving science. I came up in a health care setting where the patient was the focus, not the statistics. My kids and families aren’t often “typical,” or they wouldn’t be in our clinic. I always felt I had to dig a little deeper with my patients and their family lives, to see what might be contributing to the child’s nutrition issues. 

There is the “cut-and-dry” approach that focuses mostly on educating people about what to eat and what a balanced diet is. However, just focusing on education doesn’t cut it any longer. It’s about motivating people to make changes. The combination of education WITH motivation can have much more of an impact than education alone.

You have a strong background in pediatrics, including working with children with special needs. Could you please elaborate on your “meet them where they live” approach to working with these children and their caregivers on nutritional issues?

When it comes to changing diets and eating behaviors, you have to remember you’re treating the child AND the caregiver. Caregivers need to know they don’t have to make huge food and eating changes all at once. I also tell them how long they should expect things to take. For a child with autism who eats 5 foods, parents need to know that he may never eat the same way as everyone else, but if he can accept at least two or three foods in each group, that’s enough.  Even that may take a year, and the only thing they need to really do is be patient and be consistent. It’s about baby steps towards improving, not big leaps to perfection. It’s about helping meet the child’s nutrient needs and also helping the caregiver feel he/she is doing their best.

What other chronic illnesses can benefit from particular diets? Can you please elaborate on one example? 

Many kids with ADHD are on medication to help them focus at school and do their best academically. When medication is prescribed, it’s often quite helpful, but there are side effects, the most common being a poor appetite. For these kids, it’s so important to get a solid breakfast into them every day. It might be the only thing they eat until dinner, so it must do double duty if possible, with calories, protein, and micronutrients. Most importantly, I stress that, once it becomes routine, it’s much easier—it’s a learning process. 

You talk about myth-busting when it comes to nutrition. The spread of misinformation has been a big issue with COVID-19 as well. What changes would you like to see to the way health information is shared online? 

One very popular online thing is “immune boosters.” Foods and supplements may “support” the immune system, but only a vaccine will actually boost immunity. That’s what it’s designed to do.  All nutrients “support” immunity, but support is such a vague term that it’s almost meaningless.

There is so much “junk science” online that credible sources get diluted or even lost. Please, follow your doctor’s or medical professional’s advice. It’s easy to get sucked in by celebrities, sports players, or others with high profiles, who talk about what they do, but it’s a huge risk.  Hydroxychloroquine is a perfect example. People are desperate for a COVID-19 cure and this just won’t do it. And anything described as a “miracle” food or supplement should be passed by.  Period.  

Can you please “cut to the chase” and give us your top 5 pieces of advice for anyone struggling to live a healthier lifestyle during these tumultuous times?

Comfort food is perfectly understandable for the short term, but we’re in this for the long haul and we need to get back on track.  Here are some great ways to get started:

  • Protein matters! It comes in plant and animal forms, and unless you’re a vegan, get it from both animal and plant sources. Every meal, every day. 
  • MOVE! It’s absolutely safe to go outside and walk or be otherwise physically active. In fact, you should if you can as long as you wear a mask and keep your distance from others. If the benefits of physical activity were derived from a drug, it would be the most demanded drug ever. It’s not in pharmacies though, it’s in your shoes. Use them.
  • Best diet? Maybe it’s a screen diet. Cut it off at least an hour before bedtime and give yourself permission to do nothing. The world will spin without you and still be there in the morning. You’ll have missed nothing and improved your chance for better sleep.
  • Sleep is medicine, in my book, so for most people, no eating at least 2 hours before bedtime. You’ll have a better quality, deeper sleep when your digestive system isn’t working so hard breaking down food.  
  • Yes, fruit and vegetables are critically important, and there’s no substitute for them nutritionally. Frozen and canned are fine (canned beans should be in every pantry) and they last, but include fresh when you can, too. Summer fruit is unbeatable. Aim for at least 2 cups a day, total, but the more the better.

Anything else you’d like to add?

One thing people ask me about is if I’m a vegetarian or vegan. I’m neither. I eat everything and I don’t like wasting food. That said, people think you have to be strict about being vegan or vegetarian but you don’t. That’s a self-imposed thing, but being a “flexitarian” is perfectly fine.  Or just being an omnivore who sometimes eats vegan or vegetarian meals. It doesn’t have to be either/or. And I’m just glad dark chocolate fits all the above eating styles.

Dr. Jessica Nouhavandi, PharmD is the co-founder and co-CEO of Culver City-based Honeybee Health. Dr. Nouhavandi combines ethics, patient care and passion to create the ultimate patient experience. She earned her bachelor’s degree in bioethics and became a Doctor in Pharmacy from Western University of Health Sciences in 2011. Dr. Nouhavandi left her traditional retail pharmacy to start her own accredited online pharmacy, Honeybee Health, once she realized she could dramatically reduce medication costs for patients by cutting out industry middlemen such as insurance companies and pharmacy benefit managers. Honeybee Health now provides direct access to affordable, high-quality prescription medications to patients—without the need for insurance or coupons. You can read more about her and her company at www.honeybeehealth.com.