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!


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
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
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.
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.
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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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.

Car accident

How Safe is Your Car in a Car Accident?

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.

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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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.

Confronting Lyme Disease

So how exactly did I get diagnosed with Lyme disease, and what did I do? Well, like I said in the last article, I was bitten by a tick in 2011, which resulted in swollen lymph nodes 2 months later. I never saw the connection. I spent the next 3 years with migrating pains in my knees, low back, neck, and especially my left shoulder. And I got sick, severely sick, A LOT! Like, I had to go to Urgent Care twice a month to get prednisone and antibiotics, just so I could breathe. So when people say they’ve suffered with an illness, I can definitely relate! However, I must admit, I was a little in denial about how bad I really was. I mean, how could I have something terrible wrong with me? I didn’t get sick right after the tick bit me, and it wasn’t a deer tick, it was a dog tick that bit me. Those didn’t carry Lyme disease did they? All the doctors did not even approach the Lyme disease diagnosis with me, so how could they all be wrong?

Well, in 2014, after being sick for like the 10th time that winter, I went to the MD (actually, I saw a Certified Nurse Practitioner, which was actually a blessing, she was very open with me), with my wife, who also mentioned that in addition to being sick all of the time, I had migrating joint pains. So she says “why don’t we run a Lyme panel, and autoimmune panel on you?” I figured, why not? I knew that lab tests were notoriously inaccurate, but what the heck?

A couple of days later, I got back my test results. Guess what? I came back for autoimmune disease, and an “equivocal” Lyme test. What did that mean? In the words of the CRNP “even though we’re not sure if you have it, or what’s wrong, we’re going to treat you for Lyme disease. Do us a favor, when you find out how to treat Lyme disease, let us know, because we don’t know much about it”. Then a strange thing happened. I was scared, but at the same time, I knew that this was my challenge to find and eradicate Lyme disease in my own body (and help many others in the process). I took the antibiotics (two of them, for a month), just so that I could see if they would cure Lyme disease. They did not in my case. In fact, they made it worse. So at the end of treating Lyme disease medically, this is what I did.

1. I admitted that I had Lyme disease.

2. I became 100% determined to beat Lyme disease, mostly by myself, with a little help from my teachers.

3. I promised myself that I would do whatever it takes to beat Lyme disease once and for all, even if it meant that I had to give up things, or change the way I lived.

4. I put myself in charge of eradicating this disease.

5. I took it as a personal mission to help as many people with Lyme disease as possible.

This is the mind set you need to beat Lyme disease. It was necessary for me to confront the problem, and take responsibility for its defeat. Without that, I would have been relying on others, who didn’t have my problem.

Next week I’ll go into all of the symptoms I had associated with my Lyme’s disease.

Approaching Lyme Disease

One thing I sometimes get asked about is Lyme disease, or, more specifically, do I treat Lyme disease.  The short answer is that no, I don’t treat Lyme disease.  However, I can tell you that I have a lot of success helping people that have Lyme disease get over it.  What’s the difference?  Well, let me tell you my own story with Lyme disease, and hopefully that’ll shed some light on the situation.

I was never a very healthy child.  I grew up suffering with allergies and asthma, for which I had to almost constantly take medication for.  I was always sick.  I remember when I was 14, during the winter, I had some kind of bronchitis that lasted the whole winter.  It was so bad that I had that “seal cough”, the one that’s really loud, and sounds horrible.  I used to use it to annoy the teachers in school (they couldn’t tell me to stop, it sounded like I was hacking up a lung!).  The doctors were stumped, couldn’t do anything about it, luckily, it “went away”, meaning the symptoms went away.  Two years later, I developed “trench mouth”, an infection of my gums, where they cracked and bled continually for a week.  I couldn’t eat for a week (I consumed only soup).  It’s important to note that I got trench mouth not from poor hygiene, I brushed thoroughly twice a day, but that I got it from a poor immune system. When I was 17, after a particularly stressful event, I developed Ulcerative Colitis.  I lost 20 pounds in a matter of weeks from that one.  When I was 21, I went to Mexico, where I picked up Salmonellosis, which almost killed me.  So now that you know my past history of severe illness, why did I tell you all of this?  Because I wanted to let you know that I, like many of my patients, have an underlying cause.  What’s that common thread from all of the above problems?  My immune system stinks (as does my father’s and brother’s immune system, I like to blame my parents for this!  JK!).

Following my Salmonellosis diagnosis, I really got into nutritional studies.  The salmonella poisoning had left me with digestive issues, and chronic, debilitating low back pain, that chiropractic could not help at all.  I went through this for 2 and ½ years.  It was only by cutting out grains, and sugar, that I regained my health quickly.  Not only did my digestive issues and pain totally clear up, but I also lost 40 pounds of fat!  Hot dog!

So how did I go about developing full blown Lyme disease?  Well, like most of my patients, I started slacking with my diet, letting in grains, and sugars, slowly but surely over time.  I didn’t have the worst diet, but it certainly wasn’t the best.  I was under stress with some personal upheaval in my life.  Then, one day Laura and I went camping in the woods in the spring of 2011.  I remember it was very cold, below freezing, and my Chihuahua Taquito kept on hogging my sleeping bag and blankets, as was his style.  When I awoke in the morning, I felt something weird on my back, and when I asked Laura to take a look, she said “you’ve got a tick sticking out of you!”, and pulled it out.  I thought nothing of it, I was tired, but otherwise felt fine.  But a couple of weeks later, I felt some pain in my left armpit.  When I lifted it up, I was horrified.  I had a huge, purple swollen lymph node.  The purple part was about 6” wide.  I had no idea what it was, as this was now about 2 months after our camping trip.  As I had not had the Advanced Clinical Training in Nutrition Response Testing, I also was not able to test and see if it was Lyme disease.  Gradually, the initial swelling subsided, but this would not be the last time I would see it…

So let’s recap.  From this history, we can see that:

  1. I have a genetically weak immune system
  2. I have an intolerance to grains and sugar (compounding my immune system problems)
  3. I’ve had a lot of stress in my life (who hasn’t! this is important to note though)
  4. I have a history of a tick bite
  5. I have a history of exposure to Mercury (wait a second! How did I fail to mention that before?  While in chiropractic school, I broke a thermometer, and absorbed some of the mercury into my wedding ring.  It actually turned to a silver color, before turning back to gold.  My body absorbed the mercury from the ring.  I also had mercury amalgams).

All of this created the perfect storm, like so many other of my patients.  Tune in next week to see the long and drawn out road I had to take to fix myself (and how it taught me about what so many of my patients are going through!)

See you next week!

~Dr. Sheehan

Hidden Hyper Organs

I’ve been seeing a lot of Hidden Hyper Organs lately in my nutritional counseling practice. So I wanted to provide an explanation  of this phenomenon.

Hidden Hyper Organs are a non-medical phenomenon that we observe within the realm of Nutrition Response Testing. Typically the person comes in with a relatively easy-to-handle health concern…or at least it looks that way on the surface. They may have fatigue from the beginning (or it can develop later). They might have digestive issues. Or maybe some hormonal-type issues (like hot flashes). Often there’s a sense of anxiety or the feeling they want to jump out of their own skin. These people are often highly functional…they have learned to just keep going in spite of their bothersome symptoms.

There is no clear indicator right away that a person has a Hidden Hyper Organ. What happens is that they respond only marginally if at all to the appropriate standard Nutrition Response Testing program. Visit after visit it will appear that there is layer after layer of issues to clear away and the person will just not progress. This is a frustrating situation for both the patient and also for the practitioner! We are used to hitting the nail on the head quickly and then just monitoring people as they continue to improve. Lack of improvement is sometimes a clear indicator that there is some hidden situation that we need to uncover.

I recently have seen some dramatic Hidden Hyper Organ cases. One gentleman recently was suffering from the symptoms of panic attacks. In spite of my best efforts he was not improving. His symptoms were actually getting worse. He was having trouble sleeping and his breathing was becoming labored. Finally around visit 7 I checked him for Hidden Hyper Organs and I found his brain was completely exhausted! His brain was testing fine on the surface, but when placed under stress his “brain energy” was just on overload! Like the organ was saying “I got nothing” and was running on fumes. After I handled that situation with the appropriate nutritional support, the next visit he was calm. He was fine! The panic had left him. Now he is just getting better. Those are amazing results!

I have a theory that people with a Hidden Hyper Organ situation are on their way to a crash. It’s like we’re heading off the person developing a severe condition or disease. Many of these people have had several lab tests that have all come back normal. I always say “Thank God they didn’t find anything. That gives us time to fix this before they do find something.” Here is a list of severe chronic diseases you could be diagnosed with. Believe me, you want to solve your health problems before they turn in to one of these.

Nutrition Response Testing and Designed Clinical Nutrition provide safe, effective relief for many health problems, safely and naturally. Could you be a candidate for Nutrition Response Testing? Contact our office at (717) 392-6606 to schedule an initial evaluation or reserve your space at our New Patient Event.

Caffeine Blues

I have been historically a big fan of caffeine: in fact about two years ago I wrote a very popular blog about coffee. I was explaining how to make your coffee “Bulletproof”. Now maybe you’ve heard of the “Bulletproof” blog. This blog (and online store) is geared toward helping people achieve their full potential–to get the most out of every area of their life. This is a purpose I can get behind…so check it out. And I love coffee. I have drunk a cup a day for years.

Here are a few of the different ways I have enjoyed my coffee:

  1. drip
  2. Fresh ground French press
  3. Espresso machine
  4. with coconut oil blended in
  5. with butter blended in
  6. “Bulletproof”
  7. with coconut oil and butter blended in
  8. with heavy cream
  9. with milk and sugar free caramel syrup
  10. with half and half, when traveling
  11. black (only when absolutely necessary)

You get the picture. For many years (probably about 10) I have looked forward to my daily coffee. I can remember going to sleep at night and saying to myself “I can’t wait for the morning when I can have my delicious cup of coffee.” Yes, it was true love.

But recently I decided to give it up. Last week, in fact. I have been one week free of coffee. Now why on earth would I decide to make such a batty move?

Well it all has to do with my thyroid and adrenals. Because I am personally what you would call (and we in our office call) a thyroid and adrenal case. It’s not that I have any sort of disease–it’s more that those organs are a little weak and tend toward imbalance from time to time. Especially when I’m under stress. It’s not that my life is terribly stressful, it’s more that I work a lot and demand a lot of myself, and I have to be “on” a lot, which demands that my thyroid and adrenals work harder than usual.

The other thing about thyroids, and from time to time my thyroid too, is that they can become imbalanced in sort of an unusual way. Not quite hypo–you’ve probably heard a lot about hypo-thyroid situations, and not quite hyper (maybe you’ve heard about hyper-thyroids as well). But it’s like the thyroid goes a bit out of whack and wavers between hypo and hyper, which correlates symptomatically to up and down emotions and fluctuations of energy levels as well. This is not a medical condition, it’s just something that we have observed with stressed-out thyroids. Nutrition Response Testing is the only way to identify this sensitive situation. These thyroids need extra special care in the form of nutritional support, stress reduction, and yes–reducing the use of stimulants such as caffeine.

So from time to time I feel a little tired out or a bit keyed-up…I have my husband check my thyroid. My thyroid health is something I’ve been working on using stress reduction, diet and supplementation, but the piece I’ve been missing is reducing the stimulants. This is why I took the plunge and decided to cut out the coffee.

The first few days were rough. I tried to make up for the coffee withdrawal by drinking lots of black tea and mate, but I was still feeling exhausted and foggy. But now I can gladly say now that I’m over the hump, and I’m going to cut my caffeine back little by little from here. And my energy is better! Somehow that one little cup of coffee a day was not serving me. But by golly, am I glad coffee was there for me when I needed it.

So don’t panic and assume that you need to cut out coffee. I almost never recommend that my clients cut it out. But certain people might benefit. Here is a great article by Chris Kresser on coffee:  “Coffee is good for you–unless it’s not.”


Here’s my diet log for the last few days:

Monday 10/31/16

7AM: black tea with milk (4)

8:30 AM: chicken with cabbage, onion and guacamole

11:00 AM: SP Berry bar (21)

2:30 PM: 1/2 c pecans (3), pumpkin seeds (1), chicken salad, homemade chai with rooibos and pu-erh tea

8:00 PM: sweet potato with butter (10), 1/2 diet coke, rooibos chai with milk and 1 tsp honey (10)

Carb total for Monday: 54 g

Tuesday 11/1/16

7:00 AM: homemade chai with mate and milk (4), chicken meatballs, black tea

1:30 PM: 1/2 SF chocolate bar (4), gluten free egg, cheese and bacon sandwich (34), mixed nuts (5), apple snitz (10), green tea

6:00 PM: potato chips (36), 1 diet coke

7:00 PM: mixed nuts (5), carrots (3), green tea with milk and stevia (4)

Carb total for Tuesday: 105

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