Gluten For Dummies: Real Tips From a Nutritionist

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“Gluten Free” is everywhere: supermarkets, magazines, and celebrity diets. Is it good for you? Does it have real health advantages? Can it help you lose weight and stay healthy? As a nutritionist to celebrities and professionals alike, I get these questions constantly. With all the hype, it’s easy to forget that there is an actual medical reason for cutting out the gluten.

What is gluten, anyway?

Gluten is a protein found in certain types of grain — wheat, rye, barley — that can cause an autoimmune reaction in in the small intestine, resulting in symptoms ranging from stomach pain to nutrient malabsorption. People that suffer from this are often diagnosed with celiac disease, which affects more than 3 million Americans nationwide. The most effective solution is a strict, gluten-free diet.

Just how many people can’t tolerate gluten?

A much wider audience is suffering from milder symptoms of gluten intolerance than previously realized — nearly 18 million Americans. Those with even the slightest bit of intolerance are turning their focus to gluten-free foods to alleviate these uncomfortable side effects.

Should I go gluten-free?

Stocking up on every food item that touts the “gluten-free” label seems like a no-brainer — but that’s not always the best-case scenario. Gluten binds foods like pretzels and cake together. Without it, food companies are forced to add extra fat and sugar to make up for the lack of texture and flavor. Hello, extra calories! Gluten-free foods can be quite expensive, too (bread at $6?). These products may be the remedy to your GI issues but could be causing a thickening waistline and a thinning wallet. My advice: Seek out foods that are naturally gluten-free, instead of trying to eat something that’s trying to be something it’s not.

5 gluten-free carbs that won’t break the bank or widen your waistline:

Oatmeal — I get this question all the time: “Is oatmeal gluten-free?” The answer is yes, naturally it is. That being said, oats are usually processed in food facilities that also contain wheat products so the chance of cross contamination is high.  However, there are companies that have isolated, specialized farms that produce gluten-free grains without this concern. Bob’s Red Mill has an entire line of oat products ranging from quick rolled or steel cut oats to GF oat flour. Pick your pleasure!

Polenta — This freshly-ground corn product actually yields a lot of options. Trader Joe’s offers an organic variety that works great as a substitute for pasta or used as a pie crust in an egg white and spinach quiche. Since polenta is gluten-free to start with, you won’t find any extra sugar or fat. A 1/4 tube serving is only 70 calories and provides two grams of protein.

Buckwheat — People usually group buckwheat into the cereal grain category, but it’s actually a fruit seed related to rhubarb and is packed with magnesium and phosphorous. Replace rice side dishes with buckwheat or add to soups instead of using noodles. Besides its hearty flavor, buckwheat satisfies hunger with six grams of protein and five grams of fiber per one cooked cup serving.

Wheat free tortillas — Going Gluten-free can make sandwiches and wraps difficult. Using a low calorie, wheat free tortilla makes an excellent substitution. French Meadow bakery uses tapioca starch and rice flour to make a delicious wrap at only 120 calories.

Amaranth — One of the lesser-known grains, amaranth contains more protein than wheat in a form that is more readily available to the body. When compared to other grains, it’s also the front runner in calcium, iron and an important amino acid called lysine.  You can find amaranth in one of my favorite fiber bars by Oskri.

Try all of these alternatives and see how gluten-free works for you. It might make you feel fuller, healthier, and refreshed. But don’t let it rule your life.

Got Non-Dairy Milk?

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Milk does the body good, but not if you’re one of the hundreds of thousands of individuals who are lactose intolerant and cannot handle dairy products without serious bouts of discomfort, bloating, flatulence and much more. Cow’s milk may be responsible for bringing us the “Got Milk?” ads showcasing some of the world’s most beautiful people sporting a milk-mustache, but it also has a multitude of health benefits and a large supply of crucial vitamins and minerals that do “do the body good”. Thanks to the high levels of vitamin D, calcium and vitamin K, milk is the spokes model for healthy and strong bones. But milk doesn’t stop there, its’ laundry list of vitamins and minerals makes it apparent that milk is beneficial to more than just bones. Some of the notable nutrients in milk are iodine, riboflavin, vitamin B12, vitamin A, omega-3 fatty acids (linoleic acid), phosphorus and protein. Clearly, milk is something everyone wants to enjoy and reap the benefits from, so when non-dairy milk alternatives starting showing up in our supermarkets, there was no doubt that new industry was born. Now, when you roam the diary aisle you are faced with more non-dairy milk alternatives that you can count and it can get quite confusing. First it’s a good idea to clear up any confusion surrounding the word “milk”. Milk is traditionally liquid that comes from a mammal used to feed its young, however it has now evolved to include the liquid that is pressed from any plant based sources as well, such as almonds, coconuts, hemp seeds, rice and soybeans, and is nutritionally superior to water. Now that we’ve cleared that up, it’s time to take them apart and find out what’s really in that “milk”.

Almond Milk: In general, almonds are a super-food and one of the best plant based sources for protein and vitamin E. They contain a bountiful amount of healthy and essential fats as well as fiber, calcium and iron, which make them a good candidate for a non-dairy milk. Almond milk is definitely your go-to if you are looking for a milk that doesn’t irritate your skin because it is shown to help with skin, protect against sun damage and possibly have anti-aging properties. My favorite brand of almond milk is Unsweetened Vanilla Almond breeze. With a low glycemic index, 23.5, this milk is ideal for diabetics or anyone looking to control their blood sugar after meals since it not only has half the calories of regular milk but has one-sixth the carbohydrates and sugar too. Almond Breeze is a certified peanut-free facility and almond milk is naturally gluten-free which makes it a good solution for individuals with known peanut allergies or have Celiac’s disease.

Coconut Milk: There are two kinds of coconut milks that people have become familiar with- the canned milk and the refrigerated coconut milk. The canned version of coconut milk is extremely high in fat and is commonly used for cooking and baking, as it’s an integral ingredient in Thai cuisine. The refrigerated coconut milk, is actually good if you want to lose weight because it is low in calories and sugar free. Studies are showing that this version of coconut milk may actually aid in weight loss. When your body metabolizes the coconut milk it may speed up your general metabolism allowing you to burn more calories. If you are looking for a good coconut milk, not canned, check out So Delicious Unsweetened Coconut Milk, they have plain and flavored varieties too.

Hemp Milk: Hemp milk is quickly becoming one of the more popular milk alternatives on the market. Made from hemp seed, it is shown to possibly help with memory because it is packed with omega-3 fatty acids. Since two-thirds of your brain is made up of fat, hemp milk’s omega-3’s provides the nutrients to help improve your memory and cognitive function. The omega-3s are also beneficial for your heart, making this a heart healthy product. Another problem the general public is facing with non-dairy milks is their flavor and texture; milk alternatives generally have a nutty taste or have a slightly thicker consistency. Hemp milk solves these problems with its more neutral taste and consistency, which most closely resembles that of cow’s milk. Other notable facts about hemp milk include that it has no known allergens, contains stearidonic acid (SDA) and gamma linolenic acid (GLA) which help convert the benefits of omega-3 and omega-6 fatty acids, it contains all 10 essential amino acids (building blocks of proteins), naturally cholesterol free and is eco-friendly because it uses less water to harvest and there are no pesticides. I love adding Living Harvest’s Unsweetened Original hemp milk to my cereal in the morning to ensure I get my brain in work mode.

Rice Milk: Rice milk is the new comer to the non-dairy milk drinks. Made from organically grown, non GMO brown rice, it is another great alternative to those who have dairy or nut allergies which restricts them from not only not having cow’s milk but almond, coconut and soy milk as well. Rice milk may also be a good option for individuals with kidney complications who are advised to go on low protein diets since rice milk has only 1 gram of protein per serving. With no saturated fat and naturally cholesterol free this is definitely a go to for individuals with heart disease or whose family has a history of heart disease. Some great brands to check out are Rice Dream and Rich Rice Milk.

Soy Milk: Soy milk is by far the most popular alternative to cow’s milk. Just be sure to check the ingredient label on your favorite soy milk product. We are becoming increasingly aware of the fact that many soy milks are not actually derived from the soy bean itself but rather isolate soy protein (ISP). The whole soy bean is what is actually nutritious and is a great source of protein, fiber, omega-3s and a multitude of vitamins and minerals. By using the whole bean you get more isoflavones which have been studied to have many beneficial effects including potentially supporting heart and bone health, minimizing menopausal symptoms and reducing the risk of some forms of cancer. The soybean protein is a complete plant based protein indicating that it contains all of the essential amino acids that we cannot produce ourselves. However, soy protein is one of the eight most common allergens so it is best to steer clear of this product unless you are not allergic to soy. Silk is one of the most reputable and well-known soy milk brands, and they have even come out with a new line of Light soy milk products that are sweetened with all-natural Stevia. All of Silk’s products are contain “no artificial colors, flavors or funny business”, are naturally cholesterol free and do not contain ISP. I love their Silk Light Original Soy Milk!

Just in case you still cant decide which one is right for you, here are the nutritional breakdowns of the “milks” we’ve discussed!

Sugar: Exposed as The Sweet Culprit for Obesity

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Doctors, nutritionists and researchers alike have all been searching for the culprit responsible for our current childhood and adult obesity epidemic, as well as the skyrocketing rates of nutrition related chronic diseases (i.e. diabetes, heart disease, cancer and metabolic syndrome). Finally, one well-known scientist, Robert Lustig, may have come up with a convincing and bittersweet answer: Sugar. Gary Taubes, author of Why We Get Fat: And What to Do About It and Good Calories, Bad Calories, covered Lustig’s convincing argument, research and lectures in a recent New York Time’s Magazine article Is Sugar Toxic?. Between Taubes’ nutrition background and eloquent writing style, and Lustig’s seemingly incontrovertible evidence and compelling public speaking abilities, you will most likely finish this article not only as a believer, but will also think twice before adding that spoonful of sugar to your next cup of coffee. While the evidence may not be conclusive just yet, Lustig and Taubes’ make one thing certain: sugar may be sweet but if cutting it out (or cutting down on its consumption) means a healthy, longer life, then count me in.

Salty Situation

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It’s that little bottle that sits on your table, counter or stovetop.

Maybe it’s from Tiffany’s, maybe it’s from the clearance aisle of Target – no matter where it’s from that shaker holds the same thing – salt. A staple in pretty much everyone’s diet, this ingredient masquerades as a simple table seasoning… but it’s actually the main player in American’s latest health battle.

When the “Dietary Guidelines for Americans 2010” comes out at the end of this year, it’s expected to recommend that even healthy folks consume no more than 1,500 mg of sodium daily. This is astronomically less than what was recommended even just five years ago in 2005. Also as part of her “Let’s Move” campaign, First Lady Michelle Obama has called for a salt cut out as well.

While1,500 mg might seem like a hefty serving… it’s just about the equivalent of a teaspoon. And just what dangers lurk in that microscopic serving? Besides the obvious increased water weight, excess salt can lead to high blood pressure and hypertension. Big problems from a little “seasoning.”

So cut it out!

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Pregnancy & Diabetes

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The nutritional needs of the pregnant woman with diabetes are similar to the pregnant woman who does not have diabetes. Taking into account weight, weight gain, appetite and blood glucose results, a dietitian can develop individualized meal guidelines with you. The goal of these meal planning guidelines is to help you maintain healthy blood glucose levels while providing adequate nutrition to both you and your baby. Pregnant women are encouraged to eat smaller and more frequent meals. This usually means 3 meals and 3 snacks for the woman with diabetes. The amount of food varies from woman to woman depending on her rate of weight gain.

Pregnancy will affect your insulin treatment plan. During the months of pregnancy, your body’s need for insulin will go up. This is especially true during the last three months of pregnancy. The need for more insulin is caused by hormones the placenta makes. The placenta makes hormones that help the baby grow. At the same time, these hormones block the action of the mother’s insulin. As a result, your insulin needs will increase.

A focus on the carbohydrate content of each meal and snack is important because of the effect it has on blood glucose. Timing of meals and snacks that contain carbohydrate is important to reduce the risk of hypoglycemia, which is a common problem in the first trimester.

Your dietitian will keep track of your weight gain. If you start pregnancy at a normal weight, expect to add between 25 to 35 pounds. Women who start pregnancy too thin need to gain more. If you are obese at the start of your pregnancy, work with your dietitian to limit your weight gain to about 15-25 pounds.

Some important facts:

  • Your calorie requirement will increase after the first trimester by about 300 calories a day over what you needed before you became pregnant.
  • You will need about 30 grams more of protein a day — that’s about the equivalent of one serving of meat or fish.
  • To maintain normal blood glucose levels, you’ll have to be sure to get enough carbohydrates in the morning.
  • Snacks will be important, and should probably include a complex carbohydrate (such as whole-grain bread) and a protein (such as meat or cheese).
  • It’s more important than ever not to skip meals or snacks, since that can lower blood glucose to dangerous levels. If you have trouble eating three large meals a day, split your daily food into six or eight smaller ones, regularly spaced and carefully planned.
  • Eat more starches such as bread, cereal, and starchy vegetables. Aim for six servings a day or more. For example, have cold cereal with nonfat milk or a bagel with a teaspoon of jelly for breakfast. Another starch-adding strategy is to add cooked black beans, corn or garbanzo beans to salads or casseroles.
  • Eat five fruits and vegetables every day. Have a piece of fruit or two as a snack, or add vegetables to chili, stir-fried dishes or stews. You can also pack raw vegetables for lunch or snacks.
  • Eat sugars and sweets in moderation. Include your favorite sweets in your diet once or twice a week at most. Split a dessert to satisfy your sweet tooth while reducing the sugar, fat and calories.

Healthy Snacks

  • 4 to 6 whole wheat crackers with a little low-fat cheese (<1 oz) or low-fat cottage cheese (1/4 cup)
  • 4 to 5 whole wheat crackers with a little peanut butter (< 2 tablespoons)
  • 3 cups of popcorn, air-popped, low-fat or no butter
  • 12 to 18 baked potato chips
  • one slice of whole wheat toast with melted low-fat cheese (< 1 oz)
  • 2 rice cakes
  • 1/2 whole wheat pita
  • 1/2 whole wheat English muffin
  • 1/2 cup fresh fruit
  • blended drink of 1/2 cup of low-fat milk and 1/4 cup of fresh fruit
  • 1/4 cup of regular pudding, or 1/2 cup of sugar-free pudding
  • 1/2 cup of regular or no-added-sugar ice cream
  • 1 cup of low-fat yogurt
  • 1/2 cup frozen yogurt, no sugar added
  • 1/4 cup sherbet or sorbet
  • 1 granola bar (Belly Bar, Larabar, Gnu Bar)
  • 3 cups of raw vegetables such as fresh broccoli, carrots, celery, or zucchini with 2 tablespoons of dip

Morning Sickness

How common is it?
Up to 70 percent of expectant mothers have nausea, sometimes with vomiting, early in pregnancy. Queasiness may be most noticeable in the morning, but it can occur at any time. Even if you aren’t nauseated, you may develop aversions to certain foods, such as coffee and meat, partly because of their odors. As long as you continue to eat a healthy diet and get all the nutrients you need, food aversions aren’t a cause for concern.

What causes it?
The exact cause is unclear, but pregnancy hormones that relax the stomach may play a role.

How long does it last?
It generally improves by the 13th or 14th week of pregnancy, but some women continue to feel queasy from time to time well into the second trimester.

How can you manage it?
Munch a few crackers before getting up in the morning.   Eat several small meals a day so that your stomach is never empty. Avoid anything that causes nausea.

Drink plenty of liquids, especially if you’ve been vomiting. Try crushed ice, fruit juice or frozen ice pops if water upsets your stomach.                                                                                                Try wearing a motion sickness band, which may relieve nausea by pressing on an acupressure point inside the wrist.

Try ginger, which has proved effective in combating morning sickness. Some ways to consume the spice include ginger soda or tea, gingersnaps or ginger in capsule form.

Constipation

How common is it?
Constipation affects at least half of all pregnant women.

What causes it?
An increase in the hormone progesterone, which slows the digestive process, is partly to blame. In addition, your colon absorbs more water, which tends to make stools harder and bowel movements more difficult.

How long does it last?
Infrequent, difficult-to-pass stool can be a problem any time during pregnancy, but it may be worst in the first 13 to 14 weeks.

How can you manage it?

  • Try to eat on a regular schedule.
  • Drink plenty of liquids — at least eight to 10 glasses a day.
  • Get some exercise every day.
  • Eat high-fiber fruits, vegetables and grains such as whole wheat and oatmeal.
  • Try fiber supplements, such as psyllium powder, Metamucil, Konsyl, Fiberall or Citrucel. Don’t take any other laxative without discussing it with your doctor.

Fatigue


How common is it?

Almost all women report increased fatigue and need for sleep in the first trimester.

What causes it?
To carry oxygen and nutrients to the fetus, your body produces extra blood and your heart works harder and faster. These early pregnancy changes make enormous demands on your circulatory system. During this time, you’re also producing higher levels of progesterone, which tends to make you sleepy. These may be factors producing the fatigue of early pregnancy.

How long does it last?
Fatigue usually subsides by the second trimester, but may return in the third trimester when carrying the extra weight of the baby may be tiring.

How can you manage it?

  • Rest. Take naps during the day or after work. If you need to go to bed at 7 p.m. to feel rested, do so. This is a symptom that has no solution other than sleep.
  • Avoid taking on extra responsibilities. Cut down on volunteer commitments and social events if they’re wearing you out.
  • Ask for the support you need. Get your partner or children to help out as much as possible.
  • Exercise regularly. Moderate exercise, such as walking for 30 minutes a day, can help you feel more alert and energetic.
  • Eat foods rich in iron and protein. Skimping on these nutrients can aggravate your fatigue. Foods rich in both iron and protein include red meat, seafood, poultry and eggs. Other good sources of iron include whole-grain or iron-fortified cereals, breads and pastas. ‘
  • Avoid stimulants. Avoid caffeine, which may be harmful in high doses. Any product marketed for relieving fatigue and enhancing wakefulness is unsafe in pregnancy.

Heartburn

How common is it?
More than half of all pregnant women get heartburn, an uncomfortable sensation caused by the backward flow of stomach acids into the esophagus, the tube that carries food from your mouth to your stomach.

What causes it?
Constipation, gas and heartburn are all effects of sluggish digestion, induced by pregnancy hormones. As pregnancy progresses, a second factor — the expansion of the uterus, which can push your stomach out of its normal position — also may contribute to heartburn.

How long does it last?
Heartburn can be a problem at any time during pregnancy, but may be most noticeable during the third trimester.

How can you manage it?

  • Eat several small meals instead of two or three large ones. No matter how small the meal, eat slowly.
  • Avoid common heartburn triggers, such as fried foods, alcohol, chocolate, peppermint, garlic and onion.
  • Drink plenty of fluids, especially water.
  • Avoid coffee. Both regular and decaffeinated coffee may worsen heartburn.
  • Stay up for two to three hours after your evening meal. If your heartburn comes on when you recline, raise the head of your bed four to six inches.
  • Talk to your physician about using antacids or other medications that relieve heartburn. These products can be used safely in pregnancy, but your physician should know which ones you take and how often you take them.

Why is tight control of your blood sugar important?
Blood sugar control is crucial not only to your health but to the health of your unborn child. If during the first six to eight weeks of your baby’s development — when your baby’s heart, lungs, kidneys and brain are being formed — your blood sugar is too high, your baby is at increased risk of birth defects. You could also have a miscarriage. A high level of acid in your blood (diabetic ketoacidosis) also can cause miscarriage.

Later in pregnancy, uncontrolled blood sugar can lead to premature birth or stillbirth. Excess blood sugar can cause your baby to grow larger than normal and make delivery more complicated. And in contrast to your own condition, your baby may be born with low blood sugar. Another possible complication is a yellowish skin color (jaundice) from a buildup of old blood cells that aren’t being cleared away fast enough by your baby’s liver. Fortunately, these conditions are easily treatable.

Your own risks from uncontrolled blood sugar during pregnancy include high blood pressure and a worsening of pre-existing diabetic complications, especially eye disease (retinopathy).

First trimester
During the first 10 to 12 weeks of your pregnancy, you’ll meet with your obstetrician regularly, perhaps every one to two weeks. This is the time that your baby’s organs are developing, so you want your blood sugar to be as close to normal as possible to prevent birth defects. Frequent blood sugar monitoring can help you do this. Because your body’s need for insulin may drop slightly during this time, it’s important to be alert to signs of low blood sugar.

Second Trimester
If you take insulin, expect your insulin requirements to rise gradually to about week 20 and then accelerate dramatically. Hormones made by the placenta to help your baby grow block the effect of your insulin, so you’ll need significantly more to compensate. At this stage of your pregnancy, it’s also important to see an eye specialist. Damage to the small blood vessels in your eyes can progress during pregnancy.

Third trimester
During the final three months of your pregnancy, your doctor will monitor you carefully. He or she will check for complications that can occur during the late stage of any pregnancy, such as high blood pressure, swollen ankles from fluid buildup and kidney problems. Your doctor may also recommend that you have your eyes examined again to check for eye damage.

If you’re on insulin, you’ll need to take a few precautio:

  • Be aware of the risk of hypoglycemia, and take a high-sugar snack along with you.
  • It may be necessary to eat small snacks between meals.
  • If you exercise right after a meal, have a snack after the exercise.
  • If you exercise two hours or more after a meal, eat the snack before the exercise.
  • One serving of fruit will maintain blood sugar for most short-term activities (about 30 minutes).
  • One serving of fruit plus a serving of starch will be enough for activities that last longer (an hour or more).
  • Don’t inject insulin into a part of the body that will be exercised; for example, if you’ll be walking, avoid injecting into your leg.

How will my diabetes affect my baby?

A common problem among diabetic women who are pregnant is a condition called “macrosomia,” which means “large body.” In other words, babies of diabetic women are apt to be considerably larger than others. The reason for this lies in the interchange of the mother’s blood with the fetus. If the mother’s blood has too much glucose, the baby’s pancreas will sense that and produce more insulin in an attempt to use the glucose. The baby then converts the extra glucose to fat. The combination of high blood glucose levels from the mother and high insulin levels in the baby results in large deposits of fat, causing the baby to grow excessively large.

Sometimes the baby gets too big to be delivered vaginally, and a cesarean delivery becomes necessary. Your doctor will be closely watching the size of your baby and planning the safest delivery for you and the baby.

Sometimes the baby of a diabetic mother will have very low blood sugar immediately after delivery. This occurs if the mother’s blood glucose levels have been high throughout the pregnancy, and especially if they were high in the 24 hours prior to delivery, causing the baby to have a high level of insulin in its circulation. After delivery the baby continues to have a high insulin level, but it no longer has the high level of sugar from its mother, so its glucose level drops quickly.

Your baby’s levels will be checked after birth and it may be necessary to give the baby glucose intravenously. Infants of mothers with diabetes may also have other chemical imbalances such as low serum calcium or magnesium levels. Your baby should receive special examinations and tests right after birth.

Irritable Bowel Syndrome & Your Diet

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What is Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a common medical disorder afflicting 10-20% of American adults, the majority being females. Formerly called “spastic colon”, IBS is characterized by a combination of varied symptoms that may include constipation, diarrhea, gas, bloating, and alteration in bowel habits.  Fatigue and headaches can accompany IBS symptoms and are often exacerbated by certain foods, stress and/or other irritants.  The abdominal pain or cramping can be a dull ache and, for some individuals, it can be intolerable and without relief. It can also lead to fatigue, irregular sleep habits, and in extreme cases, low-grade depression. There are three types of IBS. They include:

  • IBS with constipation. This comes with stomach pain and discomfort, bloating, abnormally delayed or infrequent bowel movement, or lumpy/hard stool.
  • IBS with diarrhea. This comes with stomach pain and discomfort, an urgent need to move your bowels, abnormally frequent bowel movements, or loose/watery stool or mucus in the stool.
  • IBS with alternating constipation and diarrhea.

Symptoms

  • Abdominal cramping
  • Gas
  • Constipation
  • Feeling of incomplete bowel movements
  • Diarrhea
  • Bloating, abdominal distention
  • Alternating diarrhea & constipation
  • Mucus in the stool

Treatment

Proper treatment for IBS will depend on the individual’s specific symptoms. Symptoms can often be lessened through diet, exercise and lifestyle changes. Evaluating one’s digestive history, stress level and diet is effective in determining an appropriate method of treatment. Physicians may also recommend prescription drugs in severe cases of constipation or diarrhea-prone IBS.

IBS and Diet

Certain dietary changes and adequate water consumption can help alleviate IBS symptoms.

IBS with constipation

Traditional therapies have included dietary fiber, especially for treatment of symptoms of constipation. Fiber decreases the transit time through the colon and decreases the pressure in the colon. If you suffer IBS with constipation, gradually introduce insoluble high-fiber foods into your diet.  Good sources of insoluble fiber include whole-grain bread and cereals, fruits, vegetables, and beans. Dried plums, prune juice, ground flaxseed, and water also help loosen bowels. High-fiber diets may cause gas and bloating, but these symptoms often go away within a few weeks. It is important to stay away from refined foods such as chips, cookies, and white rice as well as high fat foods.  These can slow the passage of stool.

IBS with diarrhea

In cases of diarrhea, it’s best to consume soluble, rather than insoluble, fiber as it has a longer transit-time leaving the digestive system. Good sources of the soluble fiber include oat bran, barley, the flesh of fruit (as opposed to the skin), and navy, pinto and lima beans.

Identifying Dietary Triggers

Identify trigger foods that aggravate IBS symptoms. Keep a symptom diary to help pinpoint the foods that lead to your IBS symptoms.  Below is a list of common IBS trigger foods and beverages.

  • Carbonated Drinks & Caffeine: Sodas, coffee, caffeinated as well as carbonated items can irritate the bowels and worsen diarrhea. Decaf coffee often has similar effects.
  • Dairy: Many individuals with IBS also suffer from lactose intolerance, which worsens symptoms. Choose reduced fat milk and milk products and eliminate high fat diary products.  If lactose intolerant, avoid milk and milk products all together. Yogurt is often an exception to the rule and provides beneficial ‘friendly’ bacteria to the gut.  Choose a natural or organic plain low-fat yogurt than does not contain artificial sweeteners.  Boost calcium intake by substituting fortified rice, oat or soy milks.  Goat’s milk is also known to be more easily digested.
  • Artificial Sweeteners & Fats: Sweeteners like sorbitol, malitol, and fructose used in diet sodas, sugarless gum, certain low-calorie products stimulate the bowels and can act as diuretics and/or exacerbate diarrhea.  Artificial fats such as Olestra causes digestion problems in many individuals, particularly IBS sufferers and should be avoided.
  • Gum chewing: Gum chewing can lead to swallowing air, which in turn may produce gas.
  • Fat & Fried Foods: Fat in any form (animal or vegetable) is a strong stimulus of colonic contractions after a meal, so fat intake should be decreased. That means most red meats, oils, butter, cream cheese, peanut butter, nuts, fried foods, avocados, coconut and cheese. Find substitutions for fat, such as using a nonstick pan and fat-free cooking spray. High-fat, red meat sources like beef, pork and lamb can be difficult to digest.  Choose more-easily digested lean protein sources such as chicken, turkey and fish. Fried foods augment symptoms and can cause painful cramping and bloating.
  • Chocolate, Candy, Sugary Foods – high sugar consumption can cause gas and bloating
  • Insoluble Fiber with Diarrhea – consuming too much insoluble fiber (commonly known as roughage, which passes through the body undigested) can be difficult and can be an irritant to those who suffer IBS with diarrhea.  Beans, legumes, wheat and oat bran, grains and certain raw fruits and vegetables can cause gas build-up and bloating.
  • Fiber for Constipation – Eating plenty of sources of dietary fiber including whole grains, high fiber cereal and crackers, vegetables and fruits often alleviates symptoms in individuals who have IBS with constipation. To increase fiber, try sprinkling a tablespoon of ground flax seeds on high-fiber cereals, in yogurt or salads.
  • Soy Products: Soy products including soybeans, tofu, items containing soy protein, etc can exacerbate bloating and gas (some individuals may be more sensitive than others).
  • Overeating, fast eating - Too much food and/or consuming food too fast in a single meal can set off IBS symptoms; opt for small, frequent meals and eat slowly, enjoy your meal.

Soothe Your Symptoms

  • Probiotics: Contain “friendly” bacteria that can stabilize the digestive tract.
  • Hydration: Adequate water intake throughout the day is important to maintain good digestive function.  Aim for 6-8 glasses a day.
  • Peppermint Tea: Peppermint acts as a calming agent to the intestinal system during spasms.
  • Relaxation Techniques: IBS is often triggered by stress, certain lifestyle changes may be beneficial.  Try practicing yoga or meditation, take time for yourself, read, write or do something you enjoy.

Gastroesphageal Reflux Disease & Your Diet

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What is GERD?

Gastroesophageal Reflux Disease, commonly know as GERD or ‘heartburn’, is a clinical condition characterized by a regurgitation of acid from the stomach into the esophagus. The backflow of acid is caused by a relaxation of the lower esophageal ‘gate’ or sphincter which ordinarily remains closed and serves to keep food on its normal digestive track, moving down into the stomach.   Refluxed acid can irritate and potentially damage the delicate lining on the inside of the esophagus. Many individuals experience gastroesophageal reflux at times, but an estimated 5 to 7% of the global population suffers reflux chronically.  Men and women between the ages of 45-64 most often are diagnosed with GERD, though the disorder can also affect younger populations.  Individuals with asthma, peptic ulcers, irritable bowel syndrome, developmental disabilities and sliding hiatal hernias are most susceptible to experiencing reflux.  Other factors including alcohol consumption, overweight, pregnancy and smoking can also contribute to GERD as well as certain foods and beverages.

Signs & Symptoms

Though GERD can sometimes present itself without any symptoms, most individuals frequently experience heartburn, an uncomfortable burning sensation behind the breastbone, most commonly occurring after a meal.  Such symptoms are often dismissed and GERD may remain undiagnosed for quite sometime, allowing the disease, in some cases, to cause significant medical problems.

  • Regurgitation of gastric juices
  • Asthma, coughing, intermittent wheezing
  • Chest pain, throat constriction
  • Vocal cord inflammation, hoarseness
  • Difficulty swallowing
  • Persistent heartburn, acid indigestion

Tips for Treatment

If your physician has diagnosed you with GERD, there are many treatment methods that may be combined with medication to help alleviate symptoms.

Positive Lifestyle Changes

  • If you are overweight, weight loss will help to relieve abdominal pressure
  • Relax at mealtimes, eat slowly to avoid  swallowing air and stomach distention
  • Eat small frequent meals and snacks throughout the day
  • Remain upright for 2 hours after meals, light walking often helps
  • Avoid eating for 2-3 hours before bed
  • Avoid wearing tight clothing around your abdomen such as tight jeans and elastic waist bands which can increase gastric pressure
  • Sleep with your head elevated
  • Stop smoking, tobacco products aid in relaxing the lower esophageal sphincter and can cause digestive problems

Helpful Dietary Changes

  • Avoid trigger foods such as: high-fat, fried foods, cream sauces, gravies, mayonnaise, fatty meats, pastries, nuts, potato chips, ice cream, butter and margarine
  • Avoid carminatives, foods that decrease lower esophageal pressure such as: chocolate, peppermint, regular and decaf coffee, pepper, onions, garlic, spearmint and alcohol
  • Avoid acidic foods such as:  carbonated beverages, tomato juice/sauce, pizza, spicy foods, and citrus fruits and juices
  • Do choose a low-fat, healthful diet rich in fresh fruits, vegetables, whole grains, and lean protein sources

Fiber & Diet

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What is fiber?

Fiber, also known as roughage or bulk, is a substance found only in plants, such as fruits, vegetables, and grains. The part of the plant fiber that you eat is called dietary fiber and is an important part of a healthy diet. Dietary fiber is made up of two main types: insoluble and soluble.

What is the difference between insoluble and soluble fiber?

Soluble fiber forms a gel when mixed with liquid, while insoluble fiber does not. Insoluble fiber passes through the digestive tract largely intact. Both types of fiber are important in the diet and provide benefits to the digestive system by helping to maintain regularity. Soluble fiber has some additional benefits to heart health.

  • Insoluble Fiber: Food sources include: vegetables, wheat bran, whole grains brown rice, fruits and legumes.
  • Soluble Fiber: Food sources include: barley, fruits, legumes, oats, oat bran, rye, seeds, and vegetables.

Health Benefits?

Fiber is thought to play a beneficial role in the prevention and management of heart disease, diabetes, appendicitis, diverticulosis, constipation, irritable bowl syndrome and colon cancer.   Fiber-rich foods are also found to aid in weight loss by promoting feelings of fullness and by displacing calorie-dense food items.

Best Sources of Fiber?

The best sources of fiber are whole grain products, raw or cooked fruits and vegetables and dried beans and peas. Refined or processed foods, such as fruit juice, white bread, pasta and non-whole-grain cereals, are lower in fiber content. This is because the refining process removes the outer coat (bran) from the grain, which lowers the fiber content. Additionally, removing the skin from fruits and vegetables decrease their fiber content.

Incorporating Fiber in Your Diet

  • Choose high fiber breakfast cereals (those that contain 5 or more grams of fiber per serving). Opt for cereals with bran or fiber in the name.
  • Switch to “whole grain” breads. These breads list whole wheat, whole-wheat flour or another whole grain as the first ingredient on the label. Ideally, look for one with at least 3grams of dietary fiber per serving.
  • Choose fresh fruit or vegetables rather than juice.
  • Eat the skin and membranes of cleaned fruits and vegetables.
  • An increase in fiber should be accompanied by an increase in water.
  • Eat less processed foods and more fresh ones.
  • It is better to get fiber from foods rather than fiber supplements as foods are more nutritious.

How much fiber is recommended?

The national dietary guidelines recommend 20-35 grams of fiber daily.  Dietary fiber have great health benefits, however, too much fiber too quickly can cause intestinal gas, abdominal bloating and cramping. Increase fiber gradually over a period of a few weeks.

Sources of Fiber

Fruits Serving size Total fiber (grams)
Raspberries ½ cup 4.6
Figs, dried 2 figs 4.6
Pear 1 pear 4.0
Strawberries 1 cup 3.8
Apple, with skin 1 large 3.7
Prunes, dried 5 3.0
Banana 1 medium 3.0
Watermelon 1 large slice 2.8
Orange 1 large 2.4
Raisins 1.5-ounce box 1.6
Grains, cereal & pasta Serving size Total fiber (grams)
Kashi Go Lean Cereal ¾ cup 10
Kellogg’s All Bran ½ cup 10
Thomas’ Light Multi Grain English Muffin 1 muffin 8
Spaghetti, whole-wheat 1 cup 5.6
Rice, brown, cooked ¾ cup 3.5
Oatmeal, cooked ¾ cup 3.0
Bread, rye 1 slice 1.9
Bread, whole-wheat 1 slice 1.9
Popcorn 1 cup 1.0
Veggies/Legumes Serving size Total fiber (grams)
Kidney Beans, cooked ½ cup 9.7
Split peas, cooked ½ cup 8.1
Lentils ½ cup 7.8
Spinach, cooked ½ cup 7.0
Chickpeas ½ cup 6.0
Corn on the cob 1 medium 5.0
Potato, baked with skin 1 medium 4.4
Broccoli, raw ½ cup 4.0
Zucchini, cooked ½ cup 3.0
Beets, cooked ½ cup 2.5
Brussels sprouts, cooked ½ cup 2.0
Asparagus, cooked ½ cup 1.7
Carrots, raw ½ cup 1.4

Diverticulosis & Your Diet

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What is diverticulosis?

Diverticulosis is the presence of weak areas or tiny pouches in the wall of the body’s intestine. Pouches generally appear in the lower part of the intestine known as the colon. The pouches, called diverticula, look like small protrusions or tiny balloons poking out of the side of the colon.

A diet high in fiber is known to be very beneficial in the prevention and treatment of diverticulosis.  Dietary fiber increases the movement of food through the digestive track, promoting regular bowel function and the reduction of abdominal pain and gas.  Fiber is most prevalent in raw, fresh fruits and vegetables, whole grain products, high fiber cereals and bran.  The daily recommended intake of dietary fiber is 20-35 grams for adults.  Introduce additional fiber into your diet slowly in order to avoid bloating, abdominal gas and diarrhea.

The list of foods below highlights foods you’ll want to incorporate into your diet, as well as those you should be cautious about consuming.  Drinking plenty of water throughout the day is also extremely helpful in promoting digestive function and helping food move through the intestine.

YES FOODS

NO FOODS

High fiber cereals (>6g fiber per serving): Fiber One, Kashi Go Lean, Kashi Good Friends, All Bran, 100% Bran Flakes, McCanns steel cut oatmeal, Kashi Go Lean hot cereal

Whole grain bread & rolls (>2g fiber per slice): whole wheat, oat bran, wheat bran, spelt, rye bread, bran muffins

Whole grains: millet, quinoa, brown rice, bulgur, buckwheat, whole wheat & spelt pasta, ground flaxseed meal, wheat germ

High fiber crackers: FiberRich, Wasa, Finn Crisps

Legumes: black beans, kidney beans, chickpeas, great northern & navy beans, lentils

Vegetables: raw vegetables/salads, cooked vegetables such as broccoli, cauliflower, Brussels sprouts, cabbage, spinach, kale, carrots, asparagus, green beans, turnips, parsnip, sweet potato (with skin)

Fruits: (raw or cooked, with skin) berries (raspberries, strawberries, blueberries), apples, pears, apricots dried fruit (1/3 cup), peaches, grapes, oranges, grapefruit, pineapple, banana

Nuts, coconut, crunchy peanut butter, popcorn

Dairy: low-fat plain yogurt, skim or low-fat milk, low-fat cheese, low-fat cottage cheese

Meats, Chicken, Fish: eggs, well-cooked or stewed lean beef, chicken or turkey breast, salmon, tuna, white-flesh flaky fish (cod, bass, flounder, sole, halibut)

Refined carbohydrates: white breads, focaccia, muffins, rolls, croissants, cookies, candy, chips, pastries, bagels, potatoes, french fries, white rice, pasta, pancakes, waffles

Cereals: low fiber cereals (<6g fiber per serving) Special K, Rice Krispies, Corn Flakes, sweetened sugary cereals – Honey Nut Cheerios, Frosted Flakes, etc.

Vegetables: mashed potatoes, vegetable juices

Fruits: canned fruits in heavy syrup, fruit juices

Celiac Disease and Gluten-Free Diet

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What is Celiac Disease?

Celiac disease is an autoimmune disorder in which the ingestion of gluten causes damage to the small intestine and often results in the malabsorption of nutrients.  Consistent, lifelong diet and nutrition therapy, specifically a gluten-free diet, is the only effective known treatment for celiac disease.

Signs & Symptoms

Individuals diagnosed with celiac disease often present with weight loss, chronic diarrhea or constipation, abdominal pain and cramping, gas, abdominal distention, anemia, lethargy, nutritional deficiencies.  Nearly 40% of those with celiac disease, however, don’t have any noticeable symptoms at all or may experience “silent” symptoms such as constipation, gastroesophageal reflux (GERD), osteopenia, and anemia.  Some common deficiencies that appear with celiac disease include anemia, osteoporosis/osteopenia, iron and folate deficiency, vitamin D/calcium deficiency, B vitamin deficiency.

Associated Autoimmune Disorders

Some disorders associated with celiac disease include dermatitis herpetiformis, type-I diabetes mellitus, thyroid disease, liver diseases, and lupus.

What is gluten & where is it found?

Gluten is a protein found in wheat, rye, barley, oats and other products as listed below.

YES FOODS

NO FOODS

Grains: rice (wild, brown, white, basmati, jasmine, red), risotto, corn, tapioca, chickpea flour, potato/potato flour, amaranth, quinoa, buckwheat, soba noodles, millet, soy (tofu), sorghum, arrowroot,  (all pastas, flours, breads, baked goods made from above grains are acceptable)Condiments: mustard, liquid aminos (substitute for soy sauce), vinegar (non-malt), herbs, single spices dried or fresh (i.e. Paprika, garlic powder, basil, chili powder etc.)

All fresh fruits, vegetables (raw or cooked, with skin)

Legumes: black beans, kidney beans, chickpeas, great northern & navy beans, lentils, hummus, edamame

Dairy: low-fat plain yogurt, skim or low-fat milk, low-fat cheese, low-fat cottage cheese

Meats, Chicken, Fish: all sources of lean-protein including tofu and soy products *avoid things “breaded, battered, fried”

Desserts/sweets: gluten-free baked goods; LEDA bars, Ghirardelli chocolate chips, Barbara’s Bakery, Mi-Del, Ener-G, Laura’s WholesomeJunkfood (www.lauraswholesomejunkfood.com), Smart Treat cookies (www.smarttreat.com), Kozy Shack puddings (chocolate, rice, tapioca), Newman’s Own Organics chocolate bars, Rice Dream & Soy Delicious ice creams, Stonyfield Farms Frozen Yogurt

Grains: wheat, rye, barley, oats, spelt, bulgur, farina, kamut, triticale, bran (wheat & oat), faro, semonlina, durum wheat (flours, breads, muffins, English muffins, cookies, cakes, oatmeal etc.) *some oats are acceptable if labeled as “uncontaminated”; be safe and steer clearCommon foods: pizza, pasta, cookies, crackers, doughnuts, ice cream cones, noodles, pretzels (unless made from gluten-free flours)*

Condiments: malt products & malt flavoring (made from barley) malt vinegar, teriyaki sauce, soy sauce, brown rice syrup (unless “Gluten-free”)

Alcohol: malt-based alcohols, beer, hard liquor (vodka, rum, whiskey, bourbon)

Processed Foods: processed cheese slices, modified food starch, hydrolyzed plant/vegetable protein, canned soup soups

Desserts/sweets: cake icing, cookies, cake flour

Items to beware of: (wash hands after use) play dough, paints, crayons, lipstick

Meats, Chicken, Fish: seitan (wheat protein), hydrolyzed vegetable protein (eg. HVP)  *avoid “breaded, battered, fried”

Questionable foods: sour cream, cottage cheese, seasoning blends, packaged rice and potatoes, carmel coloring

Hidden Sources of Gluten

Breading, coating mixes, breadcrumbs, croutons, Panko, stuffing, thickeners, communion wafers

Broth, soup bases, canned soups, marinades, gravies, sauces, bouillon cubes & powders

Buttermilk, butter flavoring (Molly McButter, I Can’t Believe it’s Butter Spray)

Candy – licorice, some chocolates

Processed Foods: imitation bacon and seafood, cold cuts, luncheon meats, hot dogs, processed cheese, frozen meals

Desserts/sweets: cake icing, cookies, cake flour

Flavored, sweetened rice and soy milks may contain barley or malt flavoring

National Support Organizations & Websites

Celiac Disease Center at Columbia University
www.celiacdeseasecenter.columbia.edu

Celiac Disease Foundation
818-990-2354
www.celiac.org

Gluten Intolerance Group of North America
877-CSA-4CSA
www.gluten.net

R.O.C.K (Raising Our Celiac Kids) (local chapters across the nation)
858-395-5421
www.celiackids.com

National Institute of Health
www.niddk.nih.gov/health/digest/pubs/celiac/index.htm

CSA/USA Inc.
www.csaceliacs.org

Gluten-Free Magazines

www.glutenfreeda.com

Living Without Magazine http://www.livingwithout.com/recipes_glutenfreebasics.htm

Finding Gluten-Free Products Online

www.glutino.com
www.glutenfree.com
www.glutenfreemall.com
www.glutenfreegourmet.com

www.wholefoodsmarket.com

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