Caitlin Johnson, RD, CLT
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Fiber for Heart Health and Waistlines...

12/22/2016

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Most Americans don't eat anywhere near the amount of fiber they should. Let's change that! Fiber is critical for many organ systems from your heart to your bowels. It can help maintain healthy blood sugar levels and is great for weight loss efforts. It's actually pretty easy to add into your diet. Check out the suggestions below:

1. Eat more fruits and veggies! 
Try to add a piece of fruit to your breakfast routine, and choose fruit as an option for a morning snack. Make sure you inculde at least 1-2 vegetables in your lunch and evening meal. Eat the skins and peels of fruits and vegetables.

2. Choose whole grains whenever possible.
Look for "whole grains" on the packaging. If something says wheat flour, it isn;t the same as whole wheat flour. Choosing whole grains means that you get the whole or entire grain. You are getting the roughage in addition to the sweet tasty white carbohydrate parts we all love. It usually helps incorporate a fun nutty flavor.

3. Add legumes to your diet.
When making dishes look for opportunities to add in beans or lentils. I like to add black beans to enchiladas, garbanzo beans to shepards pie, kidney beans to italian soups, and hummus to sandwiches. 

4. Make my recipe below to add a natural fiber mix to your oatmeal or drink it in some luke warm water right before dinner. This fiber mix will help even out your blood sugar throughout the day, improve your bowel habits and help you feel more full. 

Natural Fiber Mix
Mix together equal parts of the following:
Ground Flax Seed
Ground Chia Seeds
Oat Bran
Psyllium Husk

Store in a tupperware, plastic bag or mason jar and keep in the fridge. It is good to limit the amount of air that touches (so a plastic bag is GREAT) it will limit oxidation frmo the ground flax seeds and chia seeds. I would start with just one teaspoon per day and gradually increase to two heaping tablespoons.

My favorite way to take this mix is in 6 oz of hot water about 10 minutes before dinner. I recommend having this drink right before dinner, it will help bind extra fats. It also will help you feel super full - this is great for portion control. 

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Bone Broth: Hype or Healthy, Super Food or Super Trend?

12/17/2016

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Saucy Saturday: Let’s Talk Bone Broth

Is this hype or truly healthy? Is it a super-food or a super-trend? Bone broth has had a place in the typical human diet for ages. It’s been in your grandma’s repertoire for health and healing and there is certainly something to be said regarding those tried and true methods to nurse us back to health. With modern scientific influence looking at components in food rather than the food as a whole item, we now know more about why certain foods (or rather, certain nutrients) are so good for us. I would conclude that bone broth is a super-food and though it is super trendy right now, it’s a bandwagon worth jumping on, and here is why:

  1. Joint Health and Joint Protection – Bone broth is one of the best sources of natural collagen. Collagen makes up bones, skin, cartilage, ligaments, tendons, and as we age we have more cumulative wear and tear on these joints. Gelatin is also in bone broth providing building blocks for strong bones and a soft cushion between them. The collagen and gelatin in bone broth is readily absorbable and a natural alternative to supplementation.
  2. Digestive and Gut Health- Bone broth provides this same gelatin to your intestinal cells. This is important for the gut lining to protect us and prevent development of food sensitivities. The collagen plays a huge part in the tissue that lines your GI tract.
  3. Supporting Immune Function – 80-85% of immune cells are located in the gut. Supporting the gut means supporting your immune system. The amino acids proline, glutamine and arginine help seal the openings in gut lining thereby supporting gut integrity. These amino acids are essential to a healthy body.
  4. Detox- Bone broth contains potassium and glycine. Both of which support cellular detox and liver detox. Glutathione is also in bone broth and lowers oxidative stress.
  5. Brain health, cardiovascular health, I could go on. The minerals and electrolytes in bone broth support most organ systems in the body.

Bone broth is very nourishing and tolerated by almost everyone. So how do you make it?

I like to save the carcass from a chicken or turkey in the freezer in a large ziplock bag until I am ready to make my broth. You don’t need to make it the same day/night or even the next day from the roast chicken you made. Save two carcasses even and make a large batch. I also like to save the extra nibs, bits and peels of vegetables over a few weeks. As I cook dinner I will store the carrot tops and ends of celery, ribs from bell peppers, etc and I throw them into a big zip lock back and let the collection grow. Once I have a nice collection of bones and vegetables I know I’m ready to start a batch of broth. 

You can also go talk to your butcher and get bones that may otherwise be thrown away. It is a super cheap way to source bones to make some broth. You can use beef, lamb, turkey, chicken, venison, fish, really most bones can make bone broth. It’s good if you can source some chicken feet and neck to increase the gelatin in the broth. But beware, adding a lot of chicken feet and forgetting you put them in the pot can make for a horror movie scene when you go to check on your broth. Okay let's get started:

1: Get out a large pot for the stovetop or uncover your crockpot. Place bones in to the pot or crockpot and cover with water. If you are making a lamb or beef broth, it’s nice to brown the meat/bones before starting the broth. Throw in the vegetables you would like to add (you can also add half way through cooking) Add some extra water over the bones, to allow for evaporation. Don't worry so much about how much meat, water and veggies, just get it in the pot and add some water. You can't mess this up.

2: Add two tablespoons of apple cider vinegar to water prior to cooking. This is so important to pull minerals and nutrients from the bones.

3: Bring the broth to a boil and then reduce to a low simmer for at least 6 hours. Skim the fat off the top as it rises. I recommend cooking for 16-20 hours for optimal nutrients. You can cook longer, many people say low and slow… however, if you cook too long you can have high levels of glutamate which is not optimal. So low and moderately slow.

4: Remove from heat and allow to cool slightly. Discard solids and strain the remainder through a colander, I also like to strain through a cheese cloth to get all the floaty bits out.

5: Let broth cool to room temperature, cover and chill. Use within a week or freeze for up to 3 months.

You can sip this broth, but I like to also use it to cook and incorporate in meals for my whole family (not everyone is willing to sip a mug of broth every day). I like to add the broth to cook my grains like quinoa, rice, barley, and spelt. I use it as a base for soup or to make a gravy. I use it in curries and noodle bowls like a pho knock off. 
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Hypothyroidism

12/16/2016

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The thyroid gland is a 2-inch butterfly shaped organ located at the front of the neck. This is often times the gland a physician is checking during an exam when they are touching your neck. It is small in size compared to other organs, however it is a major command center in terms of hormone health and metabolic health. It affects nearly every organ in the body. It helps to regular fat and carbohydrate metabolism, breathing, body temperature, brain development, blood calcium levels, menstrual cycles, skin, integrity, cholesterol levels, and MORE.

The thyroid gland is often one of the big players wreaking havoc in my patients’ bodies as an underactive thyroid has a profound impact on the ability to lose weight. It is an important organ to pay attention to as those with underactive thyroids are at an increased risk of heart disease and diabetes. 27 million americans have one form or another of thyroid disease. The most common condition being hypothyroidism, or an underactive thyroid. In the US this is most commonly caused by an autoimmune response known as Hashimoto’s disease. Essentially, your body creates antibodies that target the thyroid and decrease thyroid function significantly. Other conditions include hyperthyroidism (overactive), goiters (not enough iodine intake), or thyroid cancers. Since hypothyroidism is the most common we will focus on lifestyle and nutrition factors that can help an individual with hypothyroidism.

How do I know if I have an underactive thyroid?
This requires blood testing and is a diagnosis your physician will provide for you. Often physicians will check TSH (thyroid stimulating horomone), T3 and T4 levels. I always recommend a patient ask their physician to also check for the thyroid antibodies such as TPO antibody, Anti thyroid globulin antibodies and thyroid stimulating immunoglobulin. Often times if the thyroid is underperforming, there is a link to adrenal function so checking DHEA-S and cortisol levels is helpful. If your physician is ordering labs, ask them to include these adrenal markers as well.

What symptoms accompany an underactive thyroid?
  • Dry skin
  • Fatigue
  • Cold intolerance (chronically cold hands and feet)
  • Hair loss
  • Concentration problems
  • Constipation
  • Weight gain and difficulty with weight loss
  • Menorrhagia – painful menses
  • Elevated LDL cholesterol
  • Muscle cramps/weakness
  • Infertility
  • Depression

Potential causes of hypothyroidism
Inflammation that goes haywire causing an immune response that leads to an attack on your bodies own organ.
Poor diet
Leaky gut syndrome
Genetics
Pregnancy (causes postpartum thyroiditis)
Certain medication interactions
High levels of stress (persistent)
Toxic burden (heavy metals)

What medications will a physician prescribe?
Typically the first line of treatment is with a synthetic drug called synthroid. This supplies only T4. Many, many people are on this drug and see some benefits in symptoms and ability to lose weight, increased energy levels, etc. There are more “natural” forms of medication, the most popular is called Armour, it is sourced from porcine (pig) thyroid glands. It contains both T4 and T3 in a ratio more similar to what a human produces. It is worth asking your physician why they prescribe one over the other. Most will not even consider Armour. 

Lifestyle and diet are two of the biggest factors that contribute to healing your thyroid, and if healing it is no longer available, we can support it allowing the most optimal functioning.

Let’s consider lifestyle factors first.
SLEEP MORE, aim for at least 8 hours of sleep at night. I know this sounds like a lot, but your body needs it when your thyroid is underperforming. It will allow for optimal healing.
AVOID STIMULANTS, caffeine in any form is best to be avoided. If you can’t avoid it, I recommend choosing a green tea, so that you get the antioxidant benefits.
MOVE YOUR BODY, but not too much. Choose gentle exercise activities until your medication and stress levels are lowered. Try longer low impact walks or an activity like yoga.
Be patient with yourself and inform your family members what you are dealing with so they can be patient and understanding with you too.

Food and Nutrition
You can do a lot in terms of supporting your thyroid with the right food. Let’s get down to it.

AVOID EXCESS SUGAR. I am serious. Your body doesn’t need it, and your immune system most importantly, doesn’t need it. Cut out cakes, cookies, candy, soda, sugary coffee beverages, etc. A little maple syrup in the oatmeal is fine, but really, take this seriously. It’s the most important food choice to help you recover.

COOK CRUCIFEROUS VEGETABLES (goitrogenic foods). Your body needs iodine for optimal thyroid function, however these vegetables in the raw form have an incredible ability to block iodine from being absorbed. To combat that, cook these vegetables. Broccoli, Kale, Cauliflower, Brusell sprouts, Bok Choy, Kohlrabi, Mustard and Mustard greens, Cabbage. If you are one to add greens to your smoothie, choose something other than Kale, like spinach or arugula.

ADD SEA VEGETABLES OR NATURAL SEA SALT. This will help increase your mineral and iodine intake.

CHOOSE ORGANIC PRODUCE WHEN POSSIBLE. These have higher levels of trace minerals and significantly lower levels of pesticides, which are known endocrine disruptors.

INCORPORATE FOODS RICH IN TRACE MINERALS AND VITAMINS YOUR THRYOID NEEDS TO CREATE THRYOID HORMONE AND CONVERT FROM T4 to T3.
                ZINC: red meat, poultry, beans, nuts, seafood
                VIT E: liver, eggs, nuts, seeds, sweet potatoes and avocados
                B2, B3, B6: meat, seafood, green vegetables, mushrooms, eggs, almonds
                Selenium: brazil nuts
                Vit C: veggies and citrus

STICK TO WHOLE FOODS. Avoid processed foods as much as possible. Choose fruits and vegetables as snacks throughout the day with a handful of nuts.

What about supplementation?
There are some antioxidants that research has shown improve thyroid function, they include vit C, vit E, turmeric(curcumin) and glutathione. There is a place for supplementation with thyroid issues. However, it’s important to seek the help of a qualified professional. For instance, if you have Hashimoto’s you do not want to supplement with iodine, it can increase the rate of thyroid destruction. This is not the condition to play around with, I would not consult the vitamin clerk at your local healthfood store, speak with a physician or dietitian to get evidence based, proven solutions.
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If you suspect Hashimoto’s you most likely have leaky gut and would benefit from food sensitivity testing and an immunocalm diet. You would also consider as a first line of defense, decreasing gluten in your diet as it has been shown to affect hashimoto’s thyroiditis.
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Bacterial Dysbiosis

12/15/2016

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Yesterday I wrote about SIBO, small intestinal bacterial overgrowth. This occurs oftentimes alongside bacterial dysbiosis. Dysbiosis is an alteration of the body’s microbial community making a shift in the population when primarily good bacteria decreases and bad (or pathogenic) bacteria flourish. In simple terms you have less good and more bad. The balance is thrown off.

How can dysbiosis occur? Overuse of antibiotics, poor diets, excessive alcohol intake, overuse of NSAIDs(aspirin, Ibuprofen), and other lifestyle factors.

Many are more used to calling these instances of dysbiosis by the location of the bacterial community shift or the type of change that is taking place. For instance, we call a dysbiosis in the vaginal cavity a vaginal yeast infection. Or a local overgrowth of yeast in the mouth is called thrush. Other examples are SIBO (dysbiosis in the small intestine), vaginosis, and candida overgrowth.

If you have IBS, chronic bloating, distention and indigestion, celiac, crohn’s, colitis, GERD, obesity, food allergies or heart disease, you may have some intestinal dysbiosis.
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In order to assist in bringing a better balance to your intestines, eating a specific diet and reintroducing the best bacterial communities can improve the above symptoms/conditions. It is also important to take specific protocols for gut healing to avoid dysbiosis in the future. Taking glutamine for gut healing and nourishing yourself with bone broth, and decreasing sugar intake, especially in the form of soda and other liquid sugar can all help with keeping a balanced bacterial community.
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Small Intestinal Bacterial Overgrowth: SIBO

12/14/2016

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If you have gas, bloating, diarrhea and other uncomfortable symptoms in your gut, you may have SIBO. SIBO, which is pronounced “see-bo”, stands for Small Intestinal Bacterial Overgrowth. This develops when too many bacteria colonize in the small intestine. In a healthy colon (or large intestine) there should be 100 billion bacteria per milliliter but in your small intestine you should have less than 100,000 per milliliter. You can see a big difference between 100 billion and 100 thousand.

SIBO is uncomfortable, usually underdiagnosed and can cause damage to intestinal cells. There are estimates that more than 80% of people with IBS also have SIBO. Individuals with other digestive issues are more likely to have SIBO, conditions such as Celiac and Crohn’s Disease.

What symptoms are present along with SIBO:
  • Abdominal bloating and distention
  • Gas
  • Heartburn
  • GERD
  • Diarrhea (persistent)
  • Abdominal Pain

What brings SIBO on?
In a normal healthy intestine there are cleansing waves that take place between meals and snacks that sweep food through the small intestine into the large intestine. If these cleansing waves are compromised it can lead to more time for bacteria to colonize in the small intestine.

Other anatomical issues such as the valve between the small and large intestines becoming compromised and allowing bacteria to migrate from the large intestine back up to the small intestine.

Chronic inflammation leading to an underactive immune system. Most of the immune cells are located in the intestinal tract, if the immune system is compromised then it can not fight off invading unfriendly bacteria or manage concentrations of bacteria.
Insufficient stomach acid can lead to intestinal bacterial overgrowth. The pH of stomach acid kills acidophobic(or acid hating) bacteria. If the pH is higher than normal, it can lead to certain bacteria surviving that would have otherwise died in the stomach.

If SIBO persists, what else happens?
  • Vitamin and mineral deficiencies
  • Leaky Gut
  • Fatigue
  • Food sensitivities
  • Headaches
  • Skin problems
  • Inflammation
  • Autoimmune cascades

Many physicians will treat SIBO with antibiotics. This can be necessary depending on the amount of overgrowth. Other treatment options include diets that starve the bacteria. Diet options include: Specific Carbohydrate Diet, GAPS diet, or low FODMAP diet.

Working with a Functional and Integrative Dietitian can help as these diets are implemented. Preventing SIBO from returning is essential, correcting for vitamin and mineral deficiencies and healing the gut lining is very important. If you think you have SIBO, it is important to visit your physician and obtain testing for accurate diagnosis.

Here is tip #1 for preventing SIBO: Encourage cleansing waves in your intestine. Drink hot lemon water or take a shot of apple cider vinegar. You can do this before bed or after meals (just make sure to brush  your teeth after). It's also important to wait sufficient time between meals and snacks before eating again (at least 2 hours).
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8 Easy Ways to Support Digestion... that you can do anywhere- make sure you read to number 8, it's my favorite.

10/28/2016

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Tummy trouble got you down? Here are 6 simple ways able to assist your body in digesting a little more effortlessly.

1. Chew. Chew. Chew, and Chew Some More. Yes (my husband is smiling while reading this, because he is SO good at chewing each  bit of food, and the amount of chewing he does some times drives me a bit nutty, however, he is really doing something great for his body), digestion begins in the mouth and the chewing both mechanically breaks food apart leaving less work for your stomach (which doesn't have any teeth) but it also allows for ample exposure to saliva. Saliva is key to digestion and has enzymes, protein and bacteria in it taking some of the first most important steps in digestion. It's all there for a reason! Helpful Tip: Try slowing things down and counting out 10 actual connections between your upper and lower teeth (or 20 or 30 if you can) and see if that helps.

2. Take a digestive enzyme before a meal to help give your digestive capacity a boost! I personally like a very inexpensive pineapple or papaya enzyme from Trader Joes, but just about any health food store has digestive enzymes. Normally, when we eat, our body squirts out some enzymatic juices to help you break down the food that’s coming into your stomach and intestines. However, if your GI tract, pancreas or gall bladder are compromised, you might not be producing as much as you need.  Give this a try. Especially before very large meals- like a birthday supper or Thanksgiving..

3. Drink only about 4 ounces of a liquid with meals.  When large amounts of fluid are consumed with a meal it dilutes digestive enzymes, stomach acid, and other important cofactors that assist both in the food breakdown and maybe more importantly ABSORPTION. Try drinking it before the meal if you are super thirsty- but leave at least 15-20 minutes before eating. Allow for at least 60 minutes after a meal before drinking a large amount of liquid.

4. Take a probiotic.  These beneficial bacteria should be residing in your intestines. They aid in digestion of food, most especially fiber that makes it's way to the colon. Medications and stress can deplete our good bacterial supplies and allow for the bad bacteria to take over.  You can easily supplement or include fermented/cultured foods at every meal which contain probiotics: sauerkraut, kim chi, miso, tempeh, yogurt, kombucha, kefir are all great examples.

5.  Add more herbs and spices to your meals. Herbs and spices are included in the traditional dishes of almost every culture because of their ability to offer a touch of assistance to our digestion.   Parsley, ginger, cumin, cilantro, fennel, mint are all a few examples of items you can toss into just about anything that you are cooking.  They are known as “carminatives”  and help to stimulate the production of “bile” which helps break down fats. You can also try things like Dandelion,  Ginger,  Mint, or Fennel tea.  

6. Eat smaller more frequent meals. Not only will this aid in allowing your body to get the most out of everything you eat, you will be less tempted to over-eat or choose foods that are not as beneficial for your body, This alone will help improved digestion, by eating foods that are better for you.

 7.  Up your fruits and vegetables.  This is a good idea for almost everyone for so many different reasons. Why this aids in digestion is due to the fact that God so miraculously packed into most fruits and vegetables the exact enzymes needed to digest them. They are foods that are packed with self-eaters, giving your body a little break as you eat them from doing and producing all of the work. Amazing right?

 8.  Smile while you eat and be thankful.  A merry heart doth good like medicine. Think about the food you are eating and be grateful, think about the farmers that helped produce it, the rain it took to keep the fields hydrated, think about all that goes into making a meal, when it is prepared so lovingly for you. This may be the most important part of getting ready to eat. 

What do YOU do to support your digestion?  What has worked with tempering your tummy?  I'd love for you to comment and share! Thanks again for reading.

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Got Guts? What about LEAKY GUT?

10/26/2016

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​Leaky gut syndrome is gaining attention in both conventional medicine and alternative treatment modalities as more and more chronic inflammatory illnesses are plaguing Americans. I know that cooky aunt of yours or the self proclaimed health nut down the street have been talking about it for years, but what does the research, the current evidence have to say about the process? First of all, what is leaky gut syndrome? Is it as gross as it sounds? Yes! Most of us can’t stand the sight or smell of our own gut contents when they move from us to the toilet, can you imagine what these contents are doing as they leak out of your GI tract and into your body?

The lining of the GI tract, like our skin, is a barrier to the outside world, and it is one layer of cells thick. Thankfully, this lining is extremely good at blocking the bad and letting in the good. These cells sit very closely to one another and transport nutrients into the cells to be absorbed into the blood or lymph stream and distributed throughout the body. However, when contents of the GI tract can get IN BETWEEN the cells and access our blood and lymph systems, it can create havoc. You immune system at first will respond with local inflammation and mount a defense against the invaders, but after long term exposure your immune system can become “confused” and start mounting a defense against you and your body, your organ systems.
Physicians and the general public have long been resistant to the idea of leaky gut as an alternative medicine quack diagnosis, but if you take a search among medical research databases for the words “intestinal permeability” or “intestinal hyperpermeability” you will find hundreds upon hundreds of studies looking at just this: leaky guts.

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The symptoms leaky gut can cause include: fatigue, gas, bloating, joint and muscle aches and pains, skin rashes and confusion. The difficulty with these symptoms is that they can occur in many different diseases, making leaky gut syndrome all the more difficult to correctly diagnose. Among the published evidence the following specific medical conditions are associated with leaky gut syndrome: celiac disease, IBS, asthma, Crohn’s disease, Type 1 diabetes (late onset), rheumatoid arthritis, obesity-associated insulin resistance, migraines, food allergies/sensitivities, even cancer. In some of these conditions we have a chicken and egg scenario and we need more research to determine causality or just merely association. In others, we understand the increased gut permeability, or leaky gut starts an immune system cascade that affects very distant parts of the body, including the brain, joints as far away as hands and feet.


If you or a loved one experiences any of the above medical conditions, I know you are thinking: Is there a way to be tested for leaky gut syndrome? Yes, labs have the ability to do three different tests that assist in identifying how permeable our intestines are. They are all based upon ingestion of certain foods and then measuring ratios of these food contents in the urine. The idea is your body takes in the food, it makes it to the part of the GI tract that is compromised, then it will either pass between cells, into your blood, to your kidneys to be filtered and out through urine, OR your gut is okay, and it makes it out as a part of your stool.

Conventional and Alternative Treatments
There is absolutely no doubt in my mind about it, we need more research in this area. Many doctors will just slap your gut with a healthy dose of anti-inflammatory drugs, with no regard to the fact that NSAIDs have been implicated in causing increased intestinal permeability. However, working with a Dietitian (especially and functional and integrative medicine dietitian) provides a unique advantage to adjust diet to try and lessen symptoms, remove underlying roots of the problems, clear infections (Small Intestine Bacterial Overgrowth or SIBO) and institute patient specific interventions to heal the gut.

If you feel that you may have leaky gut the first recommendations I make are the following: Stop taking NSAIDs, decrease alcohol intake significantly, consider removing gluten from your diet for a time. The next step (though it can be expensive) is test for food immune reactions, so offending foods can be eliminated and your body can be given a chance to heal. As a specific elimination diet is implemented, then considering glutamine, zinc, gelatin, and probiotic supplementation and other gut healing protocols that are appropriate for the individual and their condition.

Making the paradigm switch to eating whole foods and removing processed foods from the diet will give your body an extreme advantage in avoiding a leaky gut. Why? Because all of the processed chemicals and highly refined foods can be inflammatory to the gut and soon when the gut is compromised when these foods make it to the blood before your body has a chance to rid them or break them down into smaller particles, it is likely your body will mount an extreme response to the chemicals contained in these foods. Whole foods taste good and are good for you. What do I mean when I talk about whole foods? Fruits, vegetables, whole grains, beans, nuts, seeds, choosing meat that has not been treated with hormones, responsibly sourced fish. 

Thanks for reading, please let me know if you feel you need assistance with this, I would be glad to set up an appointment with you.


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Heartburn Got You Down? Don't let it! Check out this article on changes you can make today.

10/25/2016

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GERD (GastroEsophageal Reflux Disease), or what most people call heart burn, ails at least 1 in 4 people in America. While it is a very uncomfortable condition with unpleasant sensations, it can have serious long lasting damage to your esophagus lining. Damage moves from irritation to scarring, constriction, ulcers, and can even lead to esophageal cancer. As a functional medicine dietitian, it is my firm belief that treating the root cause of the condition rather than taking pills forever to mask it will pay off down the road in improved health. Treatment of GERD can be achieved by proper nutrition, elimination of food agents that trigger GERD, changing lifestyle patterns, leveraging weight loss where indicated and choosing natural, healing supplements where needed. 

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The Science
In normal digestion, your food passes from your mouth to your esophagus ( a long thin passageway that connects from mouth to stomach) and from your esophagus to your stomach. And on down the hatch it continues. Connecting your esophagus and your stomach is a door, we call that door the lower esophageal sphincter (LES). After food passes through this door, it should close, to prevent food and stomach acid from flowing back up. Some medicines have a side effect of lowering LES function. Other than medicine, sometimes the LES just becomes weakened, or more relaxed that it should be. This can be do to chronic overeating and stretching of the stomach. And with the help of a new study, inflammation may play a major factor in this weakening, a larger role than previously imagined.  Because stomach acid is so acidic, it can be painful when it climbs back up touching tissue that wasn't created to withstand exposure to acid. Helping to remove inflammatory and painful triggers and giving the body a chance to lower inflammation, it can heal itself over time. 

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Conventional Treatment
Many medicines taken, even over the counter, block production of stomach acid. This follows the thought that less stomach acid, means less exposure when the LES is weak and opening. This can be very effective in relieving heartburn, however it just slaps a band-aid on the symptoms, and creates larger problems down the line. This is an interesting band-aid, because many sufferers of GERD have been found to create insufficient amounts of stomach acid to begin with. This leads to a theory, that less acid creates the problem of food sitting in the stomach for too long, increasing chances of back flow and heartburn. These medicines are a temporary fix for symptom management and have increased risk of conditions such as vitamin deficiencies, kidney disease, allergies, skin disorders, osteoporosis, heart attacks, GI infections and depression. I would vote we look for the cause of GERD and treat it, rather than only covering up the symptoms.

Causes
Smoking
Hernia
Overweight or Obesity
Consuming Large Meals
Eating Before Laying Down
High Stress Levels
Magnesium Deficiency
Food Sensitivities
SIBO - Small Intestinal Bacterial Overgrowth
Inflammation
Pregnancy (just due to baby pushing up on all your organs)

Some of these could be changed with simple lifestyle modifications. Treatment can include the following:

Treatment
  • Avoid the following foods that can weaken LES function:
           Fatty, Fried Foods, Chocolate, Coffee, Mint, Sugar, Alcohol, Onions
  • Avoid Esophageal Irritants for Symptom Management Until LES Heals
          Citrus fruits and juices, Garlic, Carbonated Drinks, Coffee, Spicy Foods,                            Tomato based products
  • Lower inflammation in your body:
           Cut out inflammatory foods: sugar, alcohol, processed foods, excess                              dairy
           Eat foods rich in anti-inflammatory factors: Fish, Fruit, Vegetables,                                 Healthy Fats (avocados, nuts, olives)
  • Eat smaller meals
  • Wear loose fitted clothes after meals that will not squeeze around the abdomen
  • Limit large meals before sleeping
  • Take a walk after eating your meals
  • Quit Smoking

If you have implemented all of the above and still experience mild GERD, supplements have been known to help. These are natural supplements that can assist the body to strengthen the LES or heal the esophageal lining. Licorice, Zinc Carnosine, L-Glutamine, Magnesium. 

With the above treatment options, lifestyle modifications and supplements, an individual can work towards healing their body rather than masking the symptoms with medicine that is not providing a long term solution. In time digestion can return to normal and the LES will be able to heal itself.

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Healing Your Gut: Glutamine the                         SUPER Amino Acid

10/24/2016

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Our gut is our bodies largest immune organ, it houses more inhabitants than your body has it's own cells, it helps us absorb all the necessary components for life including water, food, and vitamins, it is your bodies first access point for many invaders and houses the largest surface area of your body. Your gut is so, so, so vitally important- and having a healthy gut can assist in enjoying optimal wellness. We talk a lot about the microbiome that lives in our gut, however, we don't often talk about the cells that line our digestive tract, and the topic of today's blog is an important component of protein that these cells rely on: Glutamine.

Protein is made of amino acids, and glutamine is just one of twenty our bodies require. Glutamine, that amino acid from above is an important "food-stuff" for the cells of the gut lining. 20-30% of the bodies glutamine is used by these cells alone. It is an essential component for the maintenance of gut metabolism, and function especially during periods of trauma or when gut health is compromised. 

If an individual is lacking adequate glutamine they may experience fatigue, weakened immune system, and even chronic inflammation. When gut cells lack the necessary glutamine, cell function decreases, and our first line of defense (in terms of immunity) can become severely compromised. Glutamine supports essential healing processes and works to regenerate and repair the cells of the intestine. 

It is also an important amino acid used for removing toxins from our body - in this way it removes excess ammonia. It is also important in the production of a neurotransmitter known for calming effects on the body and mind in stressful situations (GABA). 

Conditions (or habits) that can compromise gut health and function include:
  • Smoking
  • Stress
  • Chronic inflammation
  • Overuse of antibiotics
  • Leaky gut
  • Environmental toxins
  • High levels of sugar intake
  • Consuming foods an individual is allergic/sensitive to

Since glutamine is so important, even if you are not experiencing one of the above listed conditions or habits it is important to make sure your body is provided enough glutamine. 

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Food sources of glutamine include:
Dairy - ricotta cheese, cottage cheese, yogurt
Meat- chicken, beef, pork
Fish
Beans/Legumes
Dark Leafy Greens - spinach, cabbage & parsley

You can buy glutamine as a supplement, If you walk into a healthfood store they will probably think you are trying to be a bodybuilder, that is why most people take glutamine. This amino acid won't bulk you up, instead it helps slow muscle catabolism (or breakdown), which is partly why it is so helpful for those intestinal cells. If you think that you would like to supplement with glutamine, all supplements are not created equal, and I recommend consulting your functional medicine dietitian (ME!) before adding it to your routine.

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Fiber- What Kind, How Much? WHY?

10/6/2016

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After my most recent post "Nourishing the Gut" a reader wrote in with the following question: so I have read some where that there are certain kinds of fiber that are more beneficial to gut guys. What's the deal with that? 

Let's take some time to talk more about fiber. Fiber is essential for optimal digestive health. It is recommended that we eat 25-30 grams of fiber per day however, the average American eats about 15 grams of fiber per day. That is an "F" in my book. And not F for Fiber, F for FAIL.

Fiber represents a group of carbohydrates or carbohydrate-containing compounds. We tend to classify fiber based on whether it is soluble in water. That is just a fancy way of saying, it absorbs water. Some fibers do, others done. Unlike most carbohydrates, fiber is not digested or absorbed in the small intestine. What does that mean? It means it makes it's way to your large intestine (also known as your colon) fairly intact. Why? Humans lack the digestive enzymes to properly break down fiber. Don't worry, we still need it. This just means, you aren't a cow, who can turn grass or hay into energy. 

Soluble vs. Insoluble

So soluble fiber and insoluble are both very important, they just each provide their own benefits. Soluble is the kind of fiber that decreases blood cholesterol levels, it provides bulk to stool - which is a good thing. This type of fiber is in apples, the pulp in oranges, foods like oats, and dry beans. 

Insoluble fiber remains VERY unchanged as it passes through your small intestine. It helps move contents through your guts. This type of fiber is what you find in the peels of fruits, like that apple from above, it's skin or peel is insoluble fiber. Insoluble fiber is in seeds, it is more often the type of fiber in vegetables and whole grain products, corn and brown rice. 
 
Fiber is a "prebiotic" food. That just means, it is a food source for the biome of bacteria in your gut. 

Okay, but the question above had to do with our gut guys, the friendly bacteria in our gut that we would like to support. The long and the short of it is this: the fibers that are more fermentable are the fibers these guys feast on. The few that are proven to be very preferential for the microbiome include: inulin (which occurs naturally in leeks, asparagus, chicory, garlic, onions, wheat, oats, and soybeans), oligofructose (bananas, onions, Jerusalem artichoke), galactooligosaccharides (which is found most beneficially in human breast milk, but can be found in dairy products and is often packaged as a prebiotic food right in yogurt). 

Here are a few sources of great foods with a mixture of two of the above fiber types that our "gut guys" love:

  • Chicory root: 41.6 g inulin, 22.9 g oligofructose
  • Jerusalem artichoke: 18.0 g inulin, 13.5 g oligofructose
  • Dandelion greens: 13.5 g inulin, 10.8 g oligofructose
  • Garlic: 12.5 g inulin, 5.0 g oligofructose
  • Leek: 6.5 g inulin, 5.2 g oligofructose
  • Asparagus: 2.5 g inulin, 2.5 g oligofructose
  • Wheat bran: 2.5 g inulin, 2.5 g oligofructose
  • Wheat flour, baked: 2.4 g inulin, 2.4 g oligofructose
  • Banana: 0.5 g inulin, 0.5 oligofructose
***THESE ARE PER 100 grams OF THESE FOODS

This is just a sampling. To keep things simple. It is important that we eat a wide variety of plant based foods to ensure we are giving our bodies adequate sources of fiber. When shopping for any type of bread, look at the fiber, if per serving it is less than 5 grams of fiber, don't waste your money. Eat 2-3 servings of fresh fruit per day, and eat 4-7 servings of vegetables (cooked and raw). Choose brown rice over white, choose whole grain pasta over white, choose cruciferous vegetables like broccoli, brussels sprouts, cabbage, cauliflower, collard greens, kale, turnips, and bok choy. Eating a wide variety of plant based fruits and vegetables will make sure you are eating the types of fiber the microbiome loves. 

WHY DOES THIS MATTER?
We carry around 3 pounds of gut bacteria in our body at any given time. That is as much as your brain weighs. You have GALT cells (gut associated lymphoid tissue) in the lining of your intestines that represents the largest mass of lymphoid tissue in the body, approximately 25% of the intestinal mucosa consists of lymph tissue. The immune responses that start in the gut have GREAT potential to affect all the areas of our body, and inflammation levels. These GALT cells feed primarily on short chained fatty acids, which is what you microbiome is turning the fiber you eat into.

Fiber + Gut Bugs = Short Chain Fatty Acids

Short Chain Fatty Acids + GALT cells = Healthy Immune Response

No wonder we in America are suffering from so many chronic, inflammatory diseases, and autoimmune diseases when we are getting an "F" when it comes to eating enough fiber.

​I will mention if anyone reading this has considered a low FODMAP diet due to IBD, consult your healthcare provider before increasing the fiber in your diet.

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    Caitlin Johnson is a dietitian, wife, lover of ice cream, chef wannabe, California-girl, Christian, liver eating, "food-avore." 

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