Nutrition & Fatigue

One of the most common symptoms clients ask me about if fatigue. Is there a nutritional cause for my fatigue?

In many cases, nutrition can be a factor in fatigue. Some of the lab work that can be helpful to evaluate include iron, hemoglobin and ferritin (stored iron). Having iron deficient blood or low stores of iron can contribute to fatigue. If an individual expresses significant fatigue after eating, I would assess for low hydrochloric acid (inadequate acid to breakdown protein based foods), reactive hypoglycemia, and appropriate macronutrient balance to avoid sugar crashes after eating.

A comprehensive vitamin-mineral panel that tests all vitamins, minerals, antioxidants and amino acids can also be very helpful in determining what an individual’s body needs or is having trouble acquiring from food. Certain genetic mutations, such as the MTHFR gene, would limit a individual from absorbing non-methylated forms of Vitamin B-6, B-12, and folate/folic acid.

Other factors not related to nutrition are also important to consider: quality and quantity of sleep, impact of medications on fatigue and thyroid function.

Best food to eat for weight loss

There are no magic foods that by themselves cause weight loss (sorry to disappoint you in this blog). However, there are foods that have high nutrient density and low calorie density that can assist with weight loss when incorporated more frequently into the diet. By swapping out convenience and processed foods with these nutrient dense foods, you will feel more satisfied and your cells will be nourished.

1. Greens - (rich in calcium, Vitamin K) collards, kale, spinach, swiss chard, arugula, mustard greens, beet greens

2. Berries - (high antioxidant status, Vitamin C) blueberries, strawberries, raspberries, blackberries, cranberries

3. Cold water fatty fish - (anti-inflammatory, omega-3 fatty acids) wild salmon, trout, tuna, sardines, herring

4. Orange/yellow/red produce - (rich in antioxidant beta carotene or lycopene) - butternut squash, pumpkin, red peppers, cantaloupe, carrots

5. Whole grains - (rich in B-vitamins, magnesium and fiber) - oats, quinoa, brown rice, millet, teff, buckwheat

Forever FODMAP??

Clients often ask me if they will be on a FODMAP diet forever. The FODMAP diet an extensive elimination diet that is used to help determine IBS triggers. It is also used to manage the unpleasant symptoms associated with Small Intestinal Bacterial Overgrowth (SIBO) and prevent the recurrence of this condition. The diet is generally followed for 1-3 months in it’s strictest form. Depending on the client’s symptoms, the dietitian will help the client understand when and how to liberalize the diet. In my experience, my clients have been able to liberalize their diet and find their own personal tolerance level for trigger foods. It is very rewarding to be able to give food categories back to client’s diet and not experience any unpleasant symptoms.

Leaky gut...what is it and how do I fix it?

Leaky gut is a general term that describes compromised gut integrity with increased intestinal permeability. There are a variety of factors that can contribute to leaky gut including bacterial or fungal infections, medications, alcohol and conditions such as celiac disease. When the gut junctions become compromised food components are allowed to exit outside of the digestive tract. This can contribute to the development of autoimmune conditions as well as what clients often perceive as being highly sensitive to many foods. Nutrient deficiencies are commonplace when leaky gut occurs.

The path to healing leaky gut lies in determining the underlying cause. Once the offending agents are removed, the path to healing can begin. Diet and healing supplements are key to allowing the gut to heal and allow nutrients to be adequately absorbed. A registered dietitian trained in the field of gastrointestinal nutrition can help guide the client toward the right food and supplement choices to heal a leaky gut.

Nutritional deficiencies from elimination diets

I work extensively with clients who have tried numerous diet to help heal their body, including Paleo, low FODMAP, elemental, Bi-Phasic and GAPS. it is my job as their dietitian to help determine what diet is right for their body and will give them the nutrients to heal while controlling symptoms. I always remind my clients that just because these diets exist doesn't mean they are right for every person. Case in point, with the popularity of the Paleo diet, I have seen numerous nutritional deficiencies that cause these patients to get worse, not better. After running an extensive micronutrient test, we can determine where their nutrition gaps are and add the necessary food and supplements to get their body back to a good place. Most elimination diet are needed only in the short-term; problems usually result when they are continued for long periods of time. Work with an experienced health professional to find the eating style that works for you and doesn't further deplete your nutrients.

The downside of almond milk

I frequently recommend plant based milks to my clients due to lactose intolerance or milk protein allergies and sensitivities. It has become such a commonplace milk that almost every cafe offer it as an option in coffee or smoothies. Is almond milk as good as it seems? To start with, almond milk that you buy in the supermarket is mainly water. Most of the almond solids are strained out. If the almond solids were kept in the milk, it would be very gritty, thick and high in fat. Check out the fat content of almond milk and you will see it is very low in fat (usually <2g fat). In addition, it is very low in protein. At my child's daycare, they allow almond milk as a protein substitute for cow's milk. When in actuality, this is a low protein food. It is okay to have a low protein almond milk as long as you are getting adequate protein elsewhere. One of my biggest issues with MANY of the big almond milks is how much CALCIUM CARBONATE they add to the product. If you have ever seen commercials from the almond milk companies advertising that their product has as much calcium and sometimes more as cow's milk, that is because they are adding it in the form of a supplement called calcium carbonate. This form of calcium is cheap and fairly concentrated. 1 cup ranges from 350-450mg of calcium for most brands. Too much of this calcium can be a bad thing contributing to calcium based kidney stones and more commonly constipation and bloating. So, if you are drinking more than 2 cups of almond milk per day, you may want to switch to a brand that uses a less concentrated (and less constipating) form of calcium called tricalcium phosphate. Speak to your dietitian for more recommendations. In the meantime, remember that the best source of calcium doesn't come from the "milk" aisle, it comes from dark green/leafy vegetables (kale, collards, swiss chard, broccoli, mustard greens) and foods like almonds (better to eat the almonds), sesame seeds, and even oranges.

Glucose or lactulose breath test for SIBO?

A breath test is used to detect the presence of hydrogen or methane-dominant bacteria in the small intestine. The test is conducted by having the patient drink a solution of glucose or lactulose and then breathe into test tubes over a period of 3 hours. The difference in substrate, glucose or lactulose, is that they detect bacterial growth in different areas of the small intestine. Glucose is a sugar that is fermented in the upper (proximal) part of the small intestine; while lactulose is fermented in the lower (distal) part of the small intestine. In my practice, I prefer to do combination glucose and lactulose testing to ensure that the test is highly accurate and avoids any false negatives due to the limitations of using only one test.

Packing gluten free school lunches

As the school year ramps up again, that means packing lunches for the kiddos. Here are some of my favorite healthy options.

-Greek yogurt with chopped nuts and added fruit

-Homemade chicken salad with gluten free crackers

-Rice and lentils with turmeric and butter/margarine (if heating an option)

-Bento box - turkey breast slices, raw veggies, hummus, grapes or apple slices, nuts 

-Cottage cheese with pineapple and chopped nuts

-Gluten free wrap with almond butter and jelly

-Rice noodle salad with sliced peppers, green onions, tofu chunks and peanuts

Kudos Starbucks! You did gluten free right!

Many restaurants offer gluten free menu items. However, it's not uncommon to see fine print indicating the risk of cross-contamination. Starbucks began offering a gluten free breakfast sandwich that is sealed in a package and heated that way so there is no cross-contamination. It is also quite tasty! I think that the 2 slices of Canadian bacon is a little much...one would suffice. Would love to see more gluten free options like this!

Kudos Starbucks! Celiacs thank you for the safe gluten free offering!

Enzyme for gluten cross-contamination??

AN-PEP (Aspergillus niger-prolyl endoprotease enzyme) is an enzyme that is unique in that it works in the stomach where the environment is acidic. In research studies, this enzyme has been shown to break down gluten in the stomach of gluten sensitive individuals who were fed a porridge with wheat containing cookies added. While these studies did not test gluten degradation in people with celiac disease, this enzyme may offer some promise in reducing symptoms caused by accidental cross-contaminations such as in a restaurant. It does not allow a celiac to eat gluten intentionally, but this early research suggests that it may degrade accidental gluten in very small amounts and therefore reduce or eliminate the problematic symptoms caused by accidental gluten contamination. I encourage anyone with celiac disease to consult with a health professional to determine if an enzyme make be helpful in maintaining their gluten free diet.

Metagenics currently offers a product called SpectaZyme Gluten Digest that contains AN-PEP similar to what was used in the studies.