A Treatise on Processed Foods

Nutritional Analysis and Discussion of a Popular “Diet” Energy Drink Or
A Treatise on Processed Foods

By Laura Sheehan

April 8, 2018
In working with my clients, my approach as a nutritionist is generally toward recommending people consume more fresh foods in their whole form while at the same time reducing their intake of processed and refined foods. I let people pick the worst offenders on their own and find something better to replace it with. I try to avoid giving long-winded lectures on food quality because people can get lost in minutiae. What good is it, for example, to cut your beloved fried chicken out of your diet (at least partially a whole food), when you are still consuming large quantities of soda (not a whole food by any stretch)? Even worse, people will give up eating egg yolks for fear of cholesterol (they are a wonderful whole food!!), but continue eating candy bars with abandon (not even close to a whole food). These types of behaviors are the result of patchy information given by the media most people pay attention to, which cause them to lose sight of the forest for the trees.

So I get a little perturbed when people ask me “What do you think of such-and-such a product?” My responses are: is it highly processed? Does it have a lot of sugar? Tsk! You should be able to answer this! After a little bit of time working with me, people know better than to ask me these types of questions. Even so, just yesterday a long-time client asked me: “I’m not a coffee drinker, so what do you think about this XYZ energy drink to get me started in the morning?” I cringed, of course. The drink in question is a chemical cocktail with a lot of isolated and processed vitamin-y sounding ingredients. I thought, “just drink the coffee! It comes from a ground up bean, for heaven’s sakes.” But I couldn’t really tell her to do that, so I recommended she try out maté instead. At least maté comes from a tree and not a laboratory or factory.

And yet, in the world of nutrition, the in-depth discussion of the negative effects of processed foods and the (almost unknowable) effects that their completely un-natural hodge-podge of ingredients will have when combined in your body, becomes inevitable. Some of you may be surprised (although you should not really be that surprised, as I am human too) that I consume processed foods. Just today I found myself drinking a refreshing can of peach-tea flavored Monster Rehab.

The reasons I bought it: I was at Wal-Mart, it was late, Keith and I were very tired and I saw that there were only 3g of sugar per serving along with plenty of caffeine. With my recent opening of a new office, working full-time in the old office, and studying for my Master’s in Nutrition, this beverage seemed to be more of a necessity than a luxury. Plus, I have consumed this drink before and I like the taste.

So now I am challenged to answer some questions for myself: is Monster Rehab healthy? What are all these ingredients (and I count 25) for? What will happen to me when I drink this, either positive or negative?

I WILL NOT, and I repeat, WILL NOT engage in this type of exercise at length again. I hope you get the point. Processed foods are unhealthy, period. So after this, further yakking about it will not be helpful, just redundant.

Or will it?

Ingredient Purpose/Function Healthy/Unhealthy?
Filtered Water Provides liquid. Dilutes contents to make drinkable. Generally accepted as a necessity for life17. Can be toxic in large amounts.
Black Tea Solids Provides a “tea-like” aroma Black tea has potential health benefits15 but there is no mention if the tea “solids” might have the same benefits as the tea itself.
Glucose Sweetener1, part of the “Monster Rehab Energy Blend” A naturally occurring source of energy14. There are only 2 grams of glucose per serving.
Peach Juice Concentrate Flavoring, Possibly a coloring1 In general, fruits are high in beneficial phytochemicals16. It is unclear how much of the nutrients will remain when the peach is consumed in this form.
Taurine Part of the “Monster Rehab Energy Blend”, nutrient, also a flavoring agent9 Taurine in a non-essential amino acid with a wide arra of actions in the body9.
Citric Acid Preservative1 A normal metabolite in the body, being part of the Citric Acid Cycle. Not dangerous to humans.5
Sodium Citrate Emulsion stabilizer, buffer4 Not dangerous to humans. Has been used as a systemic alkalizer and to alkalize the urine.5
Phosphoric Acid Flavoring, acidulant (give a sharp taste to foods)6 Can be toxic irritant or corrosive at high concentrations (not found as a food additive)6.
Magnesium Lactate Source of dietary Magnesium10 Magnesium is a necessary mineral nutrient which performs many important functions within the body17.
Calcium Lactate Pentahydrate Source of Calcium. Also a flavoring agent11 Lactic acid is a naturally occurring substance in the human body so it is of no safety concern11.
Caffeine Part of the “Monster Rehab Energy Blend” Reports vary as to the effects of caffeine. Some states it is not a safety concern at normal levels of consumption12. May cause spontaneous abortion in certain pregnant populations when consumed in large amounts 12. Caffeine has also ben shown to decrease insulin sensitivity13.
Mono-potassium Phosphate Acidity regulatory, sequestrate (improves the quality and stability of a food; a preservative)7 May cause calcium loss when consumed in excess8. Luckily, there is plenty of calcium added to this drink, so, not to worry.
Potassium Sorbate Preservative1 Recognized as safe by the FDA1. Causes genotoxic effects in lymphocytes in vitro22.
Sodium Benzoate Preservatice1 Recognized as safe by the FDA1. However, a college student drinking this may report increased symptoms of ADHD23
Acesulfame Potassium Sweetener1 Recognized safe by the FDA1. Has been found to alter the gut microbiome and cause obesity and reduced insulin sensitivity in mice24.
Sucralose Sweetener1 Recognized as safe by the FDA1. Contributes to liver inflammation in mice25.
Concentrated Coconut Water Flavoring? Source of electrolytes? Coconut is a type of fruit and contains fiber and nutrients in its whole form16.
Natural Flavors Adds a specific flavor1 Industry re-evaluates the safety of these flavorings every 10 years, so trust them, there are no human safety concerns21
Niacinamide (Vit B3) Nutrient1 Necessary in energy metabolism18
Salt Used widely to flavor foods26. Recognized as safe by the FDA26 Sodium in an essential nutrient and is a critical electrolyte in regulating body fluids17.
D-calcium Pantohenate (Vit B5) Nutrient18 B-Vitamin important in macro-nutrient metabolism18.
Gum Arabic Thickener, emulsifier, or stabilizer2 As a dietary fiber. Gum Arabic may help reduce adiposity in type II diabetics27.
Ester Gum Keeps oil in suspension in water, emulsifier3 FDA agrees more studies are needed to fully ascertain its safety; however extremely large amounts are needed to show toxicity in lab animals3.
Inositol Part of the “Monster Rehab Energy Blend” A naturally occurring sugar in cell-membranes; important in cell signaling potential chemopreventive effects20.
L-Carnitine L-Tartrate Part of the “Monster Rehab Energy Blend” Active in fatty acid metabolism19. Possible antioxidant and chemeprotective activities19
Pyridoxine Hydrochloride (Vit B6) Nutrient18 Supports protein and carbohydrate metabolism, synthesis of red blood cells, synthesis of neurotransmitters18
Acai Fruit Extract To add a “superfruit pucnch” Has antioxidants; has been shown to reduce oxidative stress in men29>.
Goji Berry Extract To add a “superfruit punch” Used in Traditional Chinese Medicine, the goji berry contains lots of interesting chemical compounds and has potential health benefits28.
Cyanocobalamin (Vit B12) Nutrient18 Performs several complex, important functions within the body18.

So, after going through all that, what conclusions can we draw? Should anyone be drinking Monster Rehab? Some sources cite the dangers of energy drinks in general30 and even really, really, bad dangers of diet energy drinks specifically31. Not to say anything at all about the potential problems with synthetic nutrients32! Therefore I am forced to say that the answer is, “it depends.” It depends on how much you are drinking, your stage of life, if you have any medical conditions, what other foods you are consuming regularly, whether you are male or female, whether you are pregnant or breastfeeding, the circumstances of your life, etc. Whether you can or should consume these drinks also depends on a multitude of factors of which neither you nor I are aware, since not all the science has been done.
Can you see why I hate these types of questions? It makes me feel like a failure as a nutritionist if I can’t give you a “thumbs up/down” for a particular processed food item within five seconds. But how should I know? I could spend 12 hours researching that one item and all its little ingredients and still not get to the meat of whether it’s safe or good. Tell you what, why don’t YOU do the research, and tell ME whether you think it’s okay for you. Or better yet, just focus on a variety of whole, unprocessed, unrefined, natural, fresh foods in your diet. Humankind has survived for at least millennia on whole foods. Keep the processed foods to a minimum. You will be assured of their safety if you are barely consuming them. And it will save us both a lot of stress and aggravation!

References

1. Overview of Food Ingredients, Additives & Colors. Food and Drug Administration Web site. Published November 2004. Revised April 2010. https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm094211.htm Accessed April 8, 2018

2. Sec. 172.780 Acacia (gum arabic). CFR – Code of Federal Regulations Title 21. U. S. Food & Drug Administration Web Site. Revised April 10, 2017. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=172.780 Accessed April 8, 2018

3. Glycerol Ester of Wood Rosin. IPCS INCHEM Web Site. http://www.inchem.org/documents/jecfa/jecmono/v35je05.htm Accessed April 8, 2018.

4. Trisodium Citrate. IPCS INCHEM Web Site. Published March 9, 2003. http://www.inchem.org/documents/jecfa/jeceval/jec_2346.htm Accessed April 8, 2018.

5.Citric Acid and its Calcium, Potassium and Sodium Salts. IPCS INCHEM Web site. http://www.inchem.org/documents/jecfa/jecmono/v05je24.htm Accessed April 8, 2018.

6. UKPID Monograph: Phosphoric Acid. IPCS INCHEM Web Site. http://www.inchem.org/documents/ukpids/ukpids/ukpid73.htm Accessed April 8, 2018.

7. Potassium Phosphate, Monobasic. PubChem: Open Chemistry Database Web site. Published March 27, 2005. Updated April 7, 2018. https://pubchem.ncbi.nlm.nih.gov/compound/Potassium_dihydrogen_phosphate#section=Storage-Conditions Accessed April 8, 2018.

8. Phosphoric Acid and Phosphate Salts. IPCS INCHEM Web Site. http://www.inchem.org/documents/jecfa/jecmono/v17je22.htm Accessed April 8, 2018.

9. Taurine. PubChem: Open Chemistry Database Web site. Published September 16, 2004. Updated April 7, 2018. https://pubchem.ncbi.nlm.nih.gov/compound/1123#section=Top Accessed April 8, 2018.

10 Magnesium Lactate. PubChem Open Chemistry Database Web site. Published May 4, 2006. Updated April 7, 2018. https://pubchem.ncbi.nlm.nih.gov/compound/6536825#section=Top
Accessed April 8, 2018.

11. Safety Evaluation of Certain Food Additives and Contaminants: Aliphatic Acyclic Diols, Triols and Related Substances. IPCS INCHEM Web site. http://www.inchem.org/documents/jecfa/jecmono/v48je16.htm#2.0 Accessed April 8, 2018.

12. Cafeine. IPCS INCHEM Web Site. Published March, 2002. http://www.inchem.org/documents/sids/sids/CAFEINE.pdf Accessed April 8, 2018.

13. Keijzers GB, Galan BED, Tack CJ, Smits P. Caffeine Can Decrease Insulin Sensitivity in Humans. Diabetes Care. 2002;25(2):364-369. doi:10.2337/diacare.25.2.364.

14. alpha-D-Glucopyranose. PubChem Open Chemistry Database Web Site. Published September 16, 2004. Updated April 7, 2018. https://pubchem.ncbi.nlm.nih.gov/compound/79025#section=Top Accessed April 8, 2018.

15. Yang CS, Landau JM. Effects of Tea Consumption on Nutrition and Health. The Journal of
Nutrition. 2000;130(10):2409-2412. doi:10.1093/jn/130.10.2409.

16. Brown A. Fruits. In: Understanding Food Principle and Preparation. 5th ed. Stamford, CT:
Cengage Learning; 2015: 300-326.

17. Insel P. Ross D. McMahon K. Bernstein M. Water and Major Minerals. In: Nutrition. 6th ed.
Burlington, MA: Jones & Bartlett Learning; 2017: 464-501.

18. Insel P. Ross D. McMahon K. Bernstein M. Water-Soluble Vitamins. In: Nutrition. 6th ed.
Burlington, MA: Jones & Bartlett Learning; 2017: 427-463.

19. NCI Drug Dictionary: L-Carnitine L-Tartrate. National Cancer Insitute Web site.
https://www.cancer.gov/publications/dictionaries/cancer-drug/def/l-carnitine-l-tartrate
Accessed April 8, 2018.

20. NCI Drug Dictionary: Inositol. National Cancer Institute Web site.
https://www.cancer.gov/publications/dictionaries/cancer-drug/def/inositol Accessed April 8,
2018.

21. Smith RL, Cohen SM, Doull J, Feron VJ, Goodman JI, Marnett LJ, Munro IC, Portoghese PS,
Waddell WJ, Wagner BM, Adams TB. Criteria for the safety evaluation of flavoring substances.
Food and Chemical Toxicology. 2005;43(8):1141-1177. doi:10.1016/j.fct.2004.11.012.

22. Mamur S, Yüzbaşıoğlu D, Ünal F, Yılmaz S. Does potassium sorbate induce genotoxic or
mutagenic effects in lymphocytes? Toxicology in Vitro. 2010;24(3):790-794.
doi:10.1016/j.tiv.2009.12.021.

23. Beezhold BL, Johnston CS, Nochta KA. Sodium Benzoate–Rich Beverage Consumption is
Associated With Increased Reporting of ADHD Symptoms in College Students. Journal of
Attention Disorders. 2012;18(3):236-241. doi:10.1177/1087054712443156.

24. Bian X, Chi L, Gao B, Tu P, Ru H, Lu K. The artificial sweetener acesulfame potassium affects
the gut microbiome and body weight gain in CD-1 mice. Plos One. 2017;12(6).
doi:10.1371/journal.pone.0178426.

25. Aitbaev KA, Murkamilov IT, Fomin VV. Liver diseases: The pathogenetic role of the gut microbiome and the potential of treatment for its modulation. Terapevticheskii arkhiv. 2017;89(8):120. doi:10.17116/terarkh2017898120-128.

26. Sodium Chloride. PubChem: Open Chemistry Database. Published March 25, 2005. Updated
April 7, 2018. https://pubchem.ncbi.nlm.nih.gov/compound/5234#section=Top Accessed April
8, 2018.

27. Babiker R, Elmusharaf K, Keogh MB, Saeed AM. Effect of Gum Arabic (Acacia Senegal) supplementation on visceral adiposity index (VAI) and blood pressure in patients with type 2 diabetes mellitus as indicators of cardiovascular disease (CVD): a randomized and placebo-controlled clinical trial. Lipids in Health and Disease. 2018;17(1). doi:10.1186/s12944-018-0711-y.

28. Bucheli P, Gao Q, Redgwell R, et al. Biomolecular and Clinical Aspects of Chinese Wolfberry. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 14. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92756/

29. Alqurashi R, Galante L, Rowland I, Spencer J, Commane D; Consumption of a flavonoid-rich açai meal is associated with acute improvements in vascular function and a reduction in total oxidative status in healthy overweight men, The American Journal of Clinical Nutrition, Volume 2016: 104(5); 1227–1235. https://doi.org/10.3945/ajcn.115.128728

30. Breda JOJ, Whiting SH, Encarnacão R, Norberg S, Jones R, Reinap M, Jewell J. Energy Drink Consumption in Europe: A Review of the Risks, Adverse Health Effects, and Policy Options to Respond. Frontiers in Public Health. 2014;2. doi:10.3389/fpubh.2014.00134.

31. Harb JN, Taylor ZA, Khullar V, Sattari M. Rare cause of acute hepatitis: a common energy
drink. BMJ Case Reports. January 2016. doi:10.1136/bcr-2016-216612.

32. The Effect of Imbalance in the “Filtrate Fraction” of the Vitamin B Complex in Dogs. Science. March 14, 1941: 261.

Nutritional Consulting for a Hypothetical Client with GI Issues

Nutritional Consulting for a Hypothetical Client with GI Issues

By Laura Sheehan

March 19, 2018
My client Mrs. Green has come to me for help with her GI issues. Her symptoms include diarrhea, constipation, and recent unintended weight loss. She works full-time as a social worker and is also working on her master’s degree. She and her husband cook some of their meals and she also buys ready-made food at a gourmet shop.
Mrs. Green is wondering whether she might have IBS but based on her food record it appears she has already determined that she has it. Her consumption of fiber is very high. Fiber is a commonly recommended treatment for IBS by physicians1. But Mrs. Green may be consuming too much, or the wrong types of fiber2. I would suggest that she start to limit all types of fiber in her diet (i.e. beans, wheat berries), at least until her symptoms improve. I would also have her examine her continuing consumption of Metamucil and Colace, especially since she is currently not constipated. If she would agree to cutting them out or at least reducing them, we could see how that would affect her symptoms.
Another possible cause of her bowel issues is Lexapro. I do not know how long she has been taking it and I would attempt to get this information from her, especially because both diarrhea and constipation are listed as “common side-effects” of the drug3. If the bowel issues seem to have begun relatively concurrent or subsequent to her taking Lexapro, I would suggest that she talk to her doctor about potentially switching medications for her depression and anxiety.
My biggest concern about Mrs. Green is that she might be gluten-intolerant. Her reliance on gluten-containing foods is evident from her Food Frequency Questionnaire and 24 Hour Recall. Considering that cutting out gluten could help her IBS symptoms4, I will focus on this in the next section.
Mrs. Green appears to be an overall health-conscious eater. Among her favorite foods, she lists fish, salads, vegetables and fruits. Most of her foods appear to be fresh and not processed. Even the foods she buys pre-prepared at the gourmet shop look like they are made from scratch. This is good.
I am recommending that Mrs. Green do a trial of a gluten-free diet. I do not think this will be difficult for her as she will not have to change her current food selection habits very much. She will need to learn to replace gluten-containing foods in her diet with gluten-free options. It is likely that her gourmet food shop has gluten-free food selections that are prepared fresh and not processed. For example, instead of buying wheatberry salad, she could buy quinoa or buckwheat salad (although it would be better to buy tuna salad since I would like her to cut back on the fiber). Gluten-free foods are usually more expensive but this will likely not be an issue for her considering her demographic.
In order to increase the chance of compliance, I will try to transition Mrs. Green slowly to gluten-free. From her 24 Hour Recall, it looks like she consumes a gluten-containing food three times daily. I will work with her over time to reduce this to two servings a day and then gradually to zero servings. This should be relatively easy to do since she is motivated to make the necessary changes, and will be especially motivating for her if she sees changes in her symptoms.
The seed pizza is a favorite of Mrs. Green’s and for this reason I will provide an alternative gluten-free recipe for her. Here is the original recipe:
Seed Pizza
Ingredients:
1 13- to 14-oz. pkg. refrigerated whole-wheat pizza dough
2 Tablespoons shelled pumpkin seeds, plain sesame seeds, and black sesame seeds
2 Tablespoons toasted pine nuts
3 cloves of roasted garlic
3 ounces of fresh mozzarella, cubed
½ tsp. red pepper flakes
1 tsp. olive oil
Directions:
Preheat oven to 425 degrees. Lightly grease a large baking sheet. Unroll pizza dough onto a lightly floured surface. Using your hands, shape dough into a 12×9-inch rectangle. Brush the pizza dough with the roasted garlic. Sprinkle with seeds and pine nuts and lightly sprinkle with salt and red pepper flakes. Sprinkle cubed mozzarella evenly over pizza. Drizzle olive oil over pizza. Bake for 8 to 10 minutes or until cheese is completely melted. Cut and serve.
Gluten-free modification:
Substitute a pre-packaged gluten-free pizza dough for the whole-wheat pizza dough in the recipe.
The gluten-free pizza dough should taste similar to the whole wheat pizza dough. In keeping with my philosophy of not changing too many things at once, I am making a relatively simple change in the recipe. I love the idea of a homemade cauliflower crust, but that would be a lot more work and Mrs. Green is already busy and stressed. Keeping the changes simple and straightforward will increase compliance. Plus Mrs. Green will get to keep the “crunch” she enjoys in her pizza.
Nutritionally, the whole-wheat and gluten-free pizza crusts are quite similar, at least from a macro-nutrient perspective5,6. According to the nutrition information supplied by the manufacturer5,6, each crust has about 150 kcal per serving and comparable amounts of carbohydrate (about 31 g/serving). Both recipes are low in fat and protein. There is only a small amount of fiber (2g) in each pizza crust.
Once I’ve made headway with Mrs. Green in cutting out dietary gluten, I would then assist her in eliminating refined sugars from her diet in the context of her overall carbohydrate consumption7. The degree to which I would eliminate the sugars depends on her response to the changes she will have made thus far.
In conclusion, I will work with Mrs. Green over a series of consultations to systematically identify and alter potential issues with her diet that are contributing to her symptoms. I will help her transition to a gluten-free diet and rule out issues with her fiber and laxative intake. I will also encourage her to examine potential unwanted side-effects of the Lexapro she is taking with her doctor.
References
1. El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (Review). International Journal of Molecular Medicine. 2017;40(3):607-613. doi:10.3892/ijmm.2017.3072.
2. Talley N. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. Yearbook of Gastroenterology. 2010;2010:46-47. doi:10.1016/s0739-5930(10)79444-7.
3. Lexapro Side Effects by Likelihood and Severity. WebMD Web Site. https://www.webmd.com/drugs/2/drug-63990/lexapro-oral/details/list-sideeffects Accessed March 18, 2018
4. Vazquez–Roque MI, Camilleri M, Smyrk T, Murray JA, Marietta E, Oneill J, Carlson P, Lamsam J, Janzow D, Eckert D, Burton D, Zinsmeister AR. A Controlled Trial of Gluten-Free Diet in Patients With Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function. Gastroenterology. 2013;144(5). doi:10.1053/j.gastro.2013.01.049.
5. Whole Wheat Pizza Dough. Amazon.com Web Site. https://www.amazon.com/Rossi-Pasta-Whole-Wheat-Pizza/dp/B002R6X1K6/ref=sr_1_4_a_it/144-8432636-3933151?ie=UTF8&qid=1521421843&sr=8-4&keywords=whole+wheat+pizza+crust
Accessed March 18, 2018.

6. Schar Gluten-Free Pizza Crusts. Thrive Market Web Site. https://thrivemarket.com/p/schar-gluten-free-pizza-crusts?utm_source=connexity&utm_medium=pla Accessed March 18, 2018.
7. Goldstein R, Braverman D, Stankiewicz H. Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints. IMAJ. 2000; 2(8): 583-587. http://europepmc.org/abstract/med/10979349

Hypothetical Case Study #1 Obesity and Metabolic Syndrome

Hypothetical Case Study #1: An Approach to Obesity and Metabolic Syndrome

By Laura Sheehan

I am going to discuss my hypothetical client Marilyn. Marilyn has come to me for nutritional help, with the goal of making dietary modifications to get off her medications. She is 65 years old and obese.

Multiple definitions for Metabolic Syndrome (MetS) have evolved over the past two decades 1. The most recent and applicable definition to my clinical practice is the NCEP ATP III (2005 revision). In order to be diagnosed with MetS, my imaginary client Marilyn would need to meet three of the following five criteria: abdominal obesity (waist circumference >35 inches in women), high triglycerides (≥ 150 mg/dl), low HDL cholesterol (< 50 mg/dl in women), high blood pressure (≥ 130/≥ 85 mmHg), and high fasting glucose (≥ 110 mg/dl). According to these criteria, Marilyn fits all the criteria for MetS. She has obesity, type II diabetes with a fasting glucose of 190 mg/dl, hypertension (180/90 mmHg), high triglycerides (202 mg/dl), and low HDL cholesterol (40 mg/dl).

Insulin resistance has been proposed as the common thread linking the symptoms of MetS 2. In response to diminished sensitivity to circulating insulin, the pancreas produces more and more of this necessary hormone, and the result is high levels of glucose and insulin in the blood. These elevated levels of insulin and glucose are damaging to the body and are associated with a myriad of negative health effects, especially cardiovascular disease and diabetes mellitus, with its complications of increased susceptibility to infection, diabetic retinopathy, cataracts, and chronic renal disease3. To help Marilyn, I will need to focus on reversing her insulin resistance and MetS. I will need to provide guidelines to make her body more insulin sensitive.

Several metrics will help me to monitor Marilyn’s progress towards her goals of increasing her insulin sensitivity and getting off her medications. I will try to regulate Marilyn’s measurements toward normal. Her waist circumference should be progressively decreasing to below 35 inches, her fasting glucose toward normal (80-100 mg/100ml), her triglycerides toward normal (70-110 mg/dl), HDL cholesterol increasing toward ≥ 55 mg/dl4, and blood pressure toward normal (120/80 mmHg).

Although there is quite a bit of debate in the literature, simple biochemistry indicates that MetS and insulin resistance are effects of too much sugar in the diet. It makes sense that I would consider recommending changes to Marilyn’s carbohydrate consumption. Lowering the overall glycemic index of carbohydrates in Marilyn’s diet could be successful5, but It would be simpler in practice to reduce Marilyn’s total carbohydrate intake6. Both approaches could be successful in reducing waist circumference and hyperlipidemia. A carbohydrate restricted diet combined with added soluble fiber could increase HDL and decrease LDL levels78.

Within Marilyn’s carbohydrate-restricted diet, I will emphasize that she avoid processed sugars and focus on complex carbohydrates in their whole form. Processed sugars, especially high-fructose corn syrup, have been shown to contribute to MetS by increasing the deposition of fat in the liver9. I will also stress increasing soluble fiber as the literature suggests a benefit to lipid profiles7. After implementing these changes, provided Marilyn can stick to her diet long enough, she should see improvements in her MetS criteria and be able to visit her family doctor for a medication review.

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References

1. Huang PL. A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms. 2009;2(5-6):231-237. doi:10.1242/dmm.001180.

2. Reaven G. 1988 Banting Lecture: role of insulin resistance in human disease. Diabetes 1988; 37: 1595-1607.

3. Hall J. Insulin, Glucagon, and Diabetes Mellitus. In: Hall J. Guyton and Hall Textbook of Medical Physiology. Philadelphia, PA: Saunders Elsevier, 2011: 939-954.

4. Weatherby D, Ferguson S. Blood Chemistry and CBC Analysis: Clinical Laboratory Testing from a Functional Perspective. Jacksonville, OR: Bear Mountain Publishing, 2002.

5. Finley CE, Barlow CE. Glycemic Index, Glycemic Load, and Prevalence of the Metabolic Syndrome in the Cooper Center Longitudinal Study. Journal of the American Dietetic Association. 2010;110(12):1820-1829. doi:10.1016/j.jada.2010.09.016.

6. Volek JS, Phinney SD. Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids. 2008;44(4):297-309. doi:10.1007/s11745-008-3274-2.

7. Wood RJ, Fernandez ML. Effects of a carbohydrate-restricted diet with and without supplemental soluble fiber on plasma low-density lipoprotein cholesterol and other clinical markers of cardiovascular risk. Metabolism. 2007;56(1):58-67. doi:10.1016/j.metabol.2006.08.021.

8. Yancy WS, Westman EC. A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss. Archives of Internal Medicine. 2010;170(2):136. doi:10.1001/archinternmed.2009.492.

9. Havel P. Dietary Fructose: Implications for Dysregulation of Energy Homeostasis and Lipid/Carbohydrate Metabolism. Nutrition Reviews 2005; 63(5): 133-157.

Carbohydrate Diets in Clinical Nutritional Practice

Carbohydrate Diets in Clinical Nutritional Practice

By Laura Sheehan

I have been using low-carbohydrate diets in my nutritional consulting practice for three years. The results have typically been very good. For the most part, people lose weight, reduce inflammation, improve their digestive function and have better energy. I don’t have a one-size-fits-all diet that I recommend but help people to reduce their carbs to a reasonable level where they start to feel better. This level is different for everyone. People that have severe metabolic issues such as diabetes, heart disease, or obesity, I would recommend that they go even lower carbohydrate. When these people follow a ketogenic diet, they have reversed diabetes and lowered inflammatory blood markers. I do not believe everyone needs to go keto to be healthy however (many nutritionists are espousing this right now).

Some of the most dramatic “low-carb successes” I have witnessed have been Alzheimer’s clients. There have not been very many of them, I admit. But when they do choose to agree to follow a very low carbohydrate (no more than 30 grams of carbohydrates a day) and high fat diet, I have observed amazing results. People that didn’t seem quite “all-there” in the room with you suddenly begin to look you in the eye and engage you in meaningful conversation. It stays that way as long as people are willing to keep the ketogenic diet going. I can immediately tell if they have indulged in sugar when I meet with them.

What would account for this observed effect? A study1 showed that ketone bodies are protective of hippocampal neurons in vitro that have been exposed to a a fragment of amyloid protein, Aβ1–42, a substance found to produce a deficit similar to Alzheimer’s disease.

I have come across many different viewpoints on low carbohydrate diets and their effect on health. The scientific data are mixed2. I personally believe that human beings can be healthy and eat a vast array of different types of diets. What I am looking to do in my practice is to balance out the incredible over-consumption of sugar that most of my clients are guilty of. To this end, a continuum of different lower-carbohydrate diets appears to be useful. Even though the scientific debate is clearly not settled, I believe I have been helping people get healthier, lose weight, and feel better on lower-carbohydrate diets.

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1. Kashiwaya Y, Takeshima T. d-β-Hydroxybutyrate protects neurons in models of Alzheimer’s and Parkinson’s disease. Proc Natl Acad Sci U S A. 2000 May 9; 97(10): 5440–5444.
2. Nordmann AJ, Nordmann A. Effects of Low-Carbohydrate vs Low-Fat Diets on Weight Loss and Cardiovascular Risk Factors. Archives of Internal Medicine. 2006;166(3):285. doi:10.1001/archinte.166.3.285.

Soy beans

Let’s Take a Closer Look at Soy

Let’s Take a Closer Look at Soy

By Laura Sheehan

I was a vegetarian for 20 years and consumed more than my fair share of soybean-based foods. I drank soy milk and ate tofu almost every day. I didn’t have a well-researched reason for doing this. Soy was just available, and from what I heard it was a complete protein, so great, give me lots of soy. I became a very good tofu cook and learned to love the taste of soy milk. Over time, I heard more and more about soy foods. I can’t remember the exact timeline, but I started seeing commercials touting the benefits of soy on TV. I began to see tofu for sale at the regular grocery store. Wow! I thought. They are catching up! So, from the age of 14 until about 34 I practically wallowed in soy. My ears didn’t fall off, nor did I develop a thyroid condition (that I knew of).

This assignment is causing me to reflect on how I feel about soy. Firstly, not being vegetarian anymore, I pretty much don’t care if I never see it again. I’ll eat it occasionally if I go out to eat at an Asian Restaurant (which I practically never do–too many carbs). I also avoid soy milk like the plague because I have heard it’s bad for your thyroid. Are all the terrible things about soy (which I admit I have bought into) true? Let me examine some of my current assumptions one by one, and see if they hold up to the evidence. I consulted Mark Messina’s 2016 review 1 to help me sift through some of the research. I realize with these reviews it is still possible for the authors to cherry-pick the research they like and explain away the research they don’t like. In any case, I would need to thoroughly examine all the studies in a pro- and an anti-review and compare the relative merit of both to truly reach a satisfying conclusion. I will attempt to begin this process here.

Assumption #1: Soy is bad for your thyroid. Messina1 made a very clear point that neither soy foods nor isoflavones have been shown harmful to humans. It was interesting to me that he noted that soy’s negative effects on the thyroid are demonstrated only in vitro or in experimental animals such as rats1. Conversely, one study 2 suggested that soy formula increased the risk of autoimmune thyroid disease in children. Messina did not address this concern.

Assumption #2: Soy is estrogenic and for that reason will mess up your hormones. Doerge’s and Sheehan’s review 3 suggests that this is true. They cite many rat studies, which to Messina may not be necessarily applicable to humans. A 2011 study 4 correlated serum isoflavone concentrations with precocious puberty in Korean girls. Although Messina cited another study 5 done in the United States that contradicted the Korean study, I don’t feel he explained the Korean study away adequately enough, and I still have concerns about the estrogenic effects of soy isoflavones.

Assumption #3: Soy should be fermented if you’re going to eat it at all; never consume isolated soy products.There seems to be a lack of evidence to either or affirm or refute my assumption here. Messina indicates that the isoflavone profile is somehow altered in fermented soy, although he does not discuss the potential health effects of this1. An interesting study from 2010 6 examined the correlation of fermented soy food consumption and lower rates of Type II diabetes among Asian groups. It just makes sense that eating a food the way people traditionally prepared it (that is in this case, fermented) would be healthier. But clear evidence is lacking.

Interesting Incidental Finding: Consumption of soy is protective against breast cancer! 7 This definitely makes me feel better.

In conclusion, from this brief examination I would say soy is neither the nutritional savior that it’s touted to be by the soy industry, and neither is it the nutritional demon that the Weston A. Price people would have you believe. That leaves me pretty ambivalent about soy. There are a lot of other much more important nutritional problems to tackle (like eating too much refined sugar and carbs). I’ve only got limited time with a client and rarely is too much soy, or lack of soy, the problem. So I don’t talk about soy, and most of the time people don’t ask me about it. In one of the rare situations where I have a “soy discussion” with a client, I would have them steer clear of too much industrially processed soy (since it’s pretty much all industrially processed) and focus on whole, traditionally prepared fermented soy foods. This is my general philosophy about pretty much any food, so it can’t do any harm that I can see to extend that philosophy to soy. And since unsweetened soy milk doesn’t really taste very good, I would recommend something like unsweetened homemade cashew milk instead for a dairy intolerant person who absolutely required a milk substitute.
When it comes right down to it, here’s what I believe about soy, and what I would likely tell a client: “There’s a lot of controversy around soy, so it’s probably not a good idea to eat too much soy.”

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References

1. Messina M. Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature. Nutrients. 2016;8(12):754. doi:10.3390/nu8120754.

2. Fort P, Moses N, Fasano M. Breast and soy-formula feedings in early infancy and the prevalence of autoimmune thyroid disease in children. Journal of the American College of Nutrition. 1990;9(2):164-167. doi:10.1080/07315724.1990.10720366.

3. Doerge DR, Sheehan DM. Goitrogenic and Estrogenic Activity of Soy Isoflavones. Environmental Health Perspectives. 2002;110(s3):349-353. doi:10.1289/ehp.02110s3349.

4. Kim J, Kim S. High serum isoflavone concentrations are associated with the risk of precocious puberty in Korean girls. Clinical Endocrinology. 2011;75(6):831-835. doi:10.1111/j.1365-2265.2011.04127.x.

5. Segovia-Siapco G., Pribis P., Messina M., Oda K., Sabate J. Is soy intake related to age at onset of menarche? A cross-sectional study among adolescents with a wide range of soy food consumption. Nutr. J. 2014;13:54. doi: 10.1186/1475-2891-13-54.

6. Kwon DY, Daily JW. Antidiabetic effects of fermented soybean products on type 2 diabetes. Nutrition Research. 2010;30(1):1-13. doi:10.1016/j.nutres.2009.11.004.

7. Lu L-J, Nayeem F. Adolescent and adult soy food intake and breast cancer risk: results from the Shanghai Womens Health Study. Breast Diseases: A Year Book Quarterly. 2010;21(2):120-122. doi:10.1016/s1043-321x(10)79512-6.

sugar

Effect of Carbohydrate Intake on Depression

Effect of Carbohydrate Intake on Depression

By Laura Sheehan

I was never formally diagnosed with depression and I have never taken depression medication, but I can attest to the effect that altering my carbohydrate intake had on my depression symptoms. In short, I am cured of my symptoms when I avoid refined white sugar, and my symptoms return when I begin to consume refined white sugar again.

Research by Akbaraly et al.1 concluded that a processed-food based diet is associated with increased risk for depression while a whole food based diet is protective. In another older study 2, nondepressed individuals were found to consume more protein relative to carbohydrates, but in depressed individuals, it was the other way around.

So does this mean that high carbohydrate diets are associated in general with increased risk for depression? Recent research has revealed that depression is more a result of systemic inflammation than a chemical deficiency in the brain.3 Because of the inflammatory effect of high blood glucose 4, one can conclude that eating too much sugar and carbohydrates cause depression.

Many nutrition textbooks state that carbohydrate intake should be no lower than 50-100 grams per day. 5 It is my clinical experience that lowering carbohydrate intake in general to these levels can have a positive impact on mood and help individuals with depression.

References

    • 1. Akbaraly TN, Brunner EJ. Dietary pattern and depressive symptoms in middle age. British Journal of Psychiatry. 2009;195(05):408-413. doi:10.1192/bjp.bp.108.058925.
    2. Christensen L, Somers S. Comparison of nutrient intake among depressed and nondepressed individuals. International Journal of Eating Disorders. 1996;20(1):105-109. doi:10.1002/(sici)1098-108x(199607)20:1<105::aid-eat12>3.0.co;2-3.
    3. Leonard B, Maes M. Mechanistic explanations how cell-mediated immune activation, inflammation and oxidative and nitrosative stress pathways and their sequels and concomitants play a role in the pathophysiology of unipolar depression. Neuroscience & Biobehavioral Reviews. 2012;36(2):764-785. doi:10.1016/j.neubiorev.2011.12.005.
    4. Dandona P, Ghanim H. A. Insulin infusion suppresses while glucose infusion induces Toll-like receptors and high-mobility group-B1 protein expression in mononuclear cells of type 1 diabetes patients. American Journal of Physiology-Endocrinology and Metabolism. 2013;304(8). doi:10.1152/ajpendo.00566.2012.
    5. Insel P, Ross D. Carbohydrates. In: Nutrition. 6th ed. Burlington, MA. Jones & Bartlett Learning; 2016: 138-171.

What You Need to Know About Heartburn

Heartburn is a common complaint we see. Here’s what you need to know about how to help with heartburn.

Here are somethings you need to know about heartburn:

1. The person has to get down their refined food.
To distress the digestive tract and liver. Especially flour and grain products as well as sugars. If you’re not a real athlete, then you need to get your carb count down to about 70 per day. All that extra sugar and processed carbs will be tough on the digestive tract and it’s also difficult for the liver to process. And the liver is very important in handling heartburn.

2. Identifying and handling any kind of food intolerance.
The top ones we see are grains, refined sugars, and pasteurized dairy. Even if people don’t show up with these problems initially in the testing, it’ll tend to show up down the road. It’s better to cut them out.

3. Check all the digestive organs, to see which one is not responding properly using NRT.
The main ones you’ll see with heartburn is liver and gallbladder problems, not stomach. This is because we consume processed carbohydrates that are very toxic to your liver.

4. Supplements for the liver include:
Livaplex. For the gallbladder we mainly use Choline, AF Betafood, and Cholacol.

5. The second most common organ you see come up with heart burn is the stomach.
You’re going to use the acid and enzyme point in NRT protocol. With the acid point, use Zypan or D-Diges supplements. For the enzyme point we use Mulitzyme and Lactenz. If it’s bad enough and the person is not getting better, you can also text for Gastrex and Okra Pepsin E3 which will put out the fire in the stomach

6. The 3rd most common organ seen in Heartburn is the large intestine.
This is because when you don’t digest your food it goes down into the large intestine and ferments there which puts a lot of pressure on the kidney to detoxify which contributes to heart burn. If a person is constipated enough, the food can’t come down and it’ll stay in the stomach too long and cause heartburn,

7. Supplements to take for constipation are first Fenco and choline for liver and large intestine drainage.
If these don’t work you look at Colax.

8. If there is no constipation then you’re looking at a bowel flora problem.
Which then you’d use Zymex, Lactic Acid Yeast, Lact-Enz, Spanish Black Radish, Garlic, Pro Symbiotic, and Gut Flora Complex.
If you handle the three main causes of refined carb intake, food sensitivities, organ dysfunction, and proper supplementation, then in 95% of cases with heartburn will be about 95% better in about a month or two.

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3 Types of Excercise

3 Types of Exercises

One of the most common questions I get when consulting with a patient about getting them healthy again is “what type of exercises should I do?”  I usually tell them “the best exercise for you is the one that you will do.”  While that’s the long and short of it, that’s usually not enough of an answer for people, so let’s break this down.

Let’s talk about 3 general types of exercise.

  1. High intensity exercise-30 min/wk,
    1. Pros-
      • raises fat burning hormones
      • builds muscle
      • sensitizes insulin, and
      • burns fat post exercise (post-exercise oxygen consumption).
    2. Cons-
      • raises stress hormones (may be too much for those already under stress or tired)
      • difficult
      • may be injury producing if not done properly (you must do this type of exercise properly!).
    3. Example Exercise Types
      • sprinting (running, cycling, or swimming)
      • certain types of weightlifting
      • Crossfit
  2. Moderate intensity exercises-1 .5-3 hrs./wk
    1. Pros
      • good for “getting in shape”
      • not too difficult
      • usually “fun”(games such as tennis, soccer, and hockey, as well as “leisure” exercise, such as the more difficult types of yoga, jogging, and weightlifting fall into this category)
      • not as high of a risk of injury
      • does not raise stress hormones too much
      • sensitizes insulin
      • builds muscle
      • Burns calories (and potentially fat).
    2. Cons
      • takes 1 ½ to 3 hours per week.
    3. Example Exercise Types
      • Tennis,
      • Soccer
      • Hockey
      • “Leisure” exercise, such as the more difficult types of yoga, jogging, and weightlifting

      3. Low-intensity exercises-5 hrs./wk

      1. Pros-
        • lowered stress hormones to burn fat
        • very gentle, very low risk of injury
        • you don’t need a partner
        • you don’t need to go to the gym
        • inexpensive
      2. Cons-
        • May be limited by weather (walking, jogging, and biking)
        • Not much, if any post-exercise calorie and fat burning
        • You need to do a lot to benefit from it
      3. Example Exercise Types-
        • Walking
        • Jogging
        • Biking
        • Yoga
        • Swimming

There you have it, the three general groups of exercise.  You can mix and match these, in fact, that’s probably the best way to do them.  For example, you could work out with weights for 1 hour, 3 days per week, and take a leisurely walk for a ½ hour each morning to get in your high intensity, moderate intensity, and low-intensity exercise.

Or you could go to a yoga class 3 days per week, for 1 hours per session, and maybe lift weights 2 days per week, for 1 hour per session.  Like I said, the most important thing is that you actually pick an exercise that you will do consistently.

I hate vegetables. Help!

What do I do if I hate vegetables?  I know I have to eat them for better health, but they don’t taste that great, and boring!

Listen, I know what it’s like to know that I need to eat more veggies, but I don’t have the time to cook them, or even eat them in the quantities they’re needed in.  So I found this great tip by Dr. Eric Berg.  Basically, you make your veggies into a smoothie.  I thought it sounded pretty gross when I first heard of it, but I’ve got to say, I drink them just about every day now!  It’s all about how you prepare them. Here’s the ingredients list:

  1. 1-2 cups Berries (you should stick to lower sugar berries such as blueberries, strawberries, raspberries, and blackberries)
  2. Kale-the amount can vary. I use 4-6 cups of kale and squish it down, but it you’re giving this to a child, they may insist on a little less.  Go with however much you want.  I like to use kale, because overall, it’s one of the highest nutrient vegetables, but you can use another veggie or veggies if you like.
  3. Protein powder-this is totally optional. I use it because it makes my shakes taste good, and I exercise every day.  As a shameless self-promo, I use my own protein powder I designed because it has no sugar, has all natural flavors and sweeteners, and kids love it!
  4. Sweetener-you can add a little stevia if you like, but it’s totally up to you.
  5. Some coconut milk or an avocado-1/4 cup of coconut milk (the type that comes in the can), or a cup of coconut milk from the carton, or an avocado go a long way in making it much creamier and palatable. As an added bonus, they also add fat to help balance your blood sugar and hormones, and if you add avocado, you’ll get a ton of potassium-win!

Now here’s the trick.  You blend it for a couple of minutes, usually 2 minutes will do. If you don’t blend it well enough, it’s all chunky and nasty.  Drink a portion of it when you blend it, and you can save the rest for later.

There you go, that’s it!  A quick way to get in a day’s vegetables, which even kids will love!  Feel free to check out our Pinterest page: we try to pin a lot of smoothie recipes there that we’ve found.

 

 

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Feeling Stopped Up?

Most people know that regular bowel function is imperative for proper detoxification of the body and disease prevention. Sometimes, though, we forget the little things that help with constipation.

Here they are:

  1. Are you drinking enough water? People need about half their weight in ounces per day of water i.e.: a 160 pound woman needs about 80 ounces water. You’ll need extra if you drink diuretics such as coffee. Adequate water intake helps with bowel function, kidney function, and lubricates the joints. Drink your prescribed amount of water for about 2 weeks to see the full effect.  Some people say they don’t like water. This is a sign that your body is not detoxifying correctly- all the more reason to drink water! Adding a little lemon juice to the water usually makes it more palatable to drink.
  2. Are you eating enough fiber? To make sure you are eating enough fiber, eat 2 servings of fruit and 3 servings of veggies per day. This amounts to 2 medium size salads, and 2 apples for snacks, or the equivalent. Raw or cooked veggies are fine.
  3. When these steps fail, try eating 3-6 soaked prunes each morning. Just take 3-6 organic, unsulfured prunes, put them in a bowl, and cover them with water the night before. Eat them in the morning.

When these steps fail, it means there is another underlying cause of your constipation. A correctly performed Nutrition Response Testing exam will find the underlying cause.