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Recently, I lost 4 inches off my waist, decreased my blood pressure, lost 5 pounds, became happier, and bonded with my wife, making one simple change in my life. What makes this significant, is that for the past 20 years, I’ve been exercising about four hours per week with weight training and sprinting, trying to spend as much time with Laura’s possible outside the office, keeping my carbohydrate intake as low possible, and overall trying to be as healthy as possible. But even with focusing on all these things, I was always battling with continued weight gain and gaining circumference. Then Laura talked to me about a study she read that said that the best way to lose belly fat was to do medium intensity cardio for 30 minutes, 5 days a week, and that she was going to test out this hypothesis for a class she had (she’s getting her masters in nutrition), and that she needed a guinea pig.
Here’s the link to a summary on the study: http://sweatscience.com/cardio-vs-weights-for-visceral-and-liver-fat/
I obliged. However, I hate running, and I wanted to spend time with Laura, so we decided to walk 4 miles, or 1 hour and 10 minutes, instead of running for 30 minutes, per day. We started walking four miles every morning. It’s one of the best decisions I’ve ever made, and it’s free!
Some people’s knee jerk reaction would be “but I don’t have time!” To them I would ask, what is your health and happiness worth to you? I’m actually very busy person, but what I did was wake up a little earlier, so that I could walk. I originally actually got the idea for doing this from one of my patients, who was having health problems such as weight gain, elevated budget blood pressure, gallbladder problems, and blood sugar problems. She told me that she started waking up one hour earlier in the morning so that she can walk for hour. She also said that she would walk half hour lunch, however I don’t think she does that anymore. To make a long story short, her blood pressure came down, she lost 30 pounds and she feels great.
If you want to try this experiment, try making a goal of walking 5 miles per week. Try walking 1 mile per day. With the ultimate goal of walking 20 miles a week. Just starting with 5 miles per week, you’ll find that it’s actually very easy to fit that in, and you’ll find out that the more you get used to it the more you can do at one time. Pretty soon you’ll be doing 2 miles a day, or about 10 miles a week then 3 miles a day, 15 miles a week until finally her 20 miles week. The reason why I say 5 miles a week or 1 mile a day is to allow for a day here or there of rain. On these days, I would recommend buying a stationary bike, you can get one on Craigslist for about 100 bucks, or a new one for 250 to peddle while you watch Netflix at home. It’s actually kind of fun.
So that covers how to do it, and how walking can affect your life positively. So why did I say that it helped me bond with my wife? Well here’s the thing, while we walk, we actually do we do a walking/talking kind of meditation and planning. We got this idea years ago from Tony Robbins and do it just about every time we walk. Here’s what we do. The first 15 minutes of walking, we give thanks for what we have in our lives. The next 15 minutes, we go over what our life plans are. The next 15 minutes, we go over what we want to do that day. Believe me, these three, 15 minute periods really help us to communicate our gratitude towards each other in our lives, plan out our day in our lives. It’s really helped us grow closer together as a couple, and we’re both much happier for it. If we walk for more than 45 minutes, which we usually do, the rest the time we just talk to each other about whatever we feel like.
I hope this blog encourages you to take action with exercise in life. Remember, you can just start with one mile day. I also encourage you to practice the 15 minutes of gratitude, 15 minutes of life planning, and 15 minutes of daily planning. If you don’t have somebody to walk with, you can always just say it out loud. There’s a lot of power of the spoken word, and positivity.
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?
|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!
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.
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,
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.
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).
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
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
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:
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
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.
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.
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
Don’t Delay care after a Car Accident
By Dr. Jennifer Green
The human body was not designed to handle the sudden impact and force that most automobile accidents can generate.Even a low-speed crash can cause lasting damage to the neck and back. In stressful situations, our bodies release adrenaline, dopamine and norepinephrine to cope with the shock and trauma that may mask the pain.
Being involved in an accident, even a minor one, causes some type of initial shock. Nobody is ever prepared to be in an accident, and even if you realize it’s going to happen and cannot prevent it, you are still pretty shocked right after it occurs. If you are not in immediate pain after your accident, it may not cross your mind to see a chiropractor. However, if you are injured and do not realize it, not being treated could hurt you in the long run. When you seek immediate chiropractic care after a motor vehicle collision, you could avoid years of chronic pain.
Not all car accident injuries are immediately apparent; the body will go into survival mode, releasing endorphins that mask your pain.Many accidents cause harm to the joints, ligaments, and other internal issues in the body which can lead to significant pain, reduced range of motion, and other future problems. One of the most common car accident injuries that may take 24 hours or more to present symptoms is whiplash.
Common symptoms of whiplash include blurred vision, neck stiffness, headaches, dizziness, and tingling in the extremities. When you see a chiropractor immediately following your accident, they will be able to diagnose and treat whiplash symptoms early on. This is the best way to avoid the worst of the pain and to have the injury resolved, so it does not linger into the future.
Chiropractors promote pain management without the use of addictive pain medications. By utilizing non-invasive chiropractic adjustments and corrective exercises to strengthen muscles, we are able to reduce pain from car accident injuries and promote the body’s natural ability to heal. Chiropractic adjustments help to realign the spine and joints, which reduces pain and promotes healing.
If you are in a car accident see a chiropractor to get you out of pain and help you heal properly. Through chiropractic care you can avoid the use of harmful painkillers, surgeries, and avoid future problems.
Foreman & Croft, Whiplash Injuries: Cervical Acceleration/Deceleration Syndrome, 3rd Ed., Lippincott Williams & Wilkins, 2002.
Woodward MN, Cook JC, Gargan MF, Bannister GC, “Chiropractic treatment of chronic Whiplash injuries,” J. of Injury, 1996, 27 (9): 643-5;
Khan S, Cook J, Gargan M, Bannister G, “A Symptomatic classification of whiplash injury and the implications for treatment,” J. Orthopedic Med. 1999, 21: 21-5.
Berglund, A, Alfredsson, L, Cassidy, JD, et.al., “The Association Between Exposure to a Rear-End Collision and Future Neck or Shoulder Pain: A Cohort Study,” J Clin. Epid., Vol. 53 (11), 11/2000.
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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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
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.
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.
How Safe is Your Car in a Car Accident?
By Jennifer Green
A car accident can happen – we know we need to wear seatbelts, it’s the law. It is widely accepted and documented, that with the introduction of mandatory seat belt laws, there is a reduction in deaths and serious injuries after motor vehicle crashes, but there is a significant INCREASE in neck sprains.
A seat belt actually increases pain in the soft tissues of the neck tissues after a car accident to remain. It does this by anchoring the body in place and thus allowing the head free.The sudden jerking motion of the head forces muscles and ligaments supporting the spine and head to move past their normal physiological limit and can overstretch or tear these structures. Additionally, the impact can force vertebrae out of their normal alignment causing the muscles to naturally spasm as a protective mechanism to limit your range of motion.
What about my headrest – isn’t it supposed to protect my neck in a car accident?
That is a great question, the headrest only protects your neck if your head it touching it or is close to it, you can check your headrest for something called Head-Restraint Geometry.
Head-Restraint Geometry has to do with how close or far the headrest of the vehicle, was located in relation to your head. More than two inches away from the head and the efficacy of head restraints drops off significantly. You can go to www.iihs.org (Insurance Institute for Highway Safety) to find out if your car’s headrest is properly aligned to protect you in an accident.
Navin F, Romilly D, “Investigation into Vehicle and Occupant Response Subjected to Low-Speed Rear Impacts,” SAE, 1989, 159-168;
Hirsch S, Hirsch P, Hiramoto H, et.al., “Whiplash Syndrome: Fact or Fiction?” Ortho. Clinics of North America 1988, 19 (4): 791-795;
Porter K, “Neck Sprains After Car Accident,” Brit. Med. Jour., 1989, 298 (973-974); Evans, R, “Some Observations on Whiplash Injuries,” Neurologic Clinics 1992, 10 (4): 975-997.
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.”
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.
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.
- 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.