Food Intolerance, What is Real and What is Not

It seems like everyone is gluten free these days. Is gluten bad for us? What about wheat and other grains? I’ve heard of food sensitivity blood tests…should I get tested? Every day I have 1 or 2 patients ask me these same questions. It is time to set the record straight…

Food intolerance is real. Foods that irritate your body and cannot be properly digested are a food intolerance. They range from person to person, with symptoms mild to severe. Nausea, stomach pain, diarrhea, vomiting, gas, bloating, cramps, heartburn, headache, irritability, and nervousness are the most common signs someone has a food insensitivity/intolerance.

Food allergies are not as common but symptoms can be similar. The largest difference is that food allergies involve the immune system and are life threatening. The body produces immunoglobulin E (IgE) which circulates throughout the blood and releases histamines once exposed to an allergen. People with allergies may begin to feel itchy, experience gi distress, or even have difficulty breathing. If you have a true food allergy, having a blood test will reveal IgE antibodies. It is very important for people with food allergies to avoid foods that they are allergic to.

Food intolerance does not involve the immune system and are not life threatening. People with food intolerance may need to avoid trigger food to prevent the unwanted symptoms they experience. There are many different food substances that cause intolerance; the most common are lactose, preservatives and additives, tyramine, and gluten. In recent years food sensitivity blood tests have surfaced claiming to identify food intolerance and help you avoid your trigger foods. 

Are food sensitivity blood tests valid?

Food sensitivity/intolerance tests seek out the presence of IgG and IgA antibodies to identify reactions to various foods. Some people who receive test results and eliminate identified foods do believe the test helped them. The American Academy of Allergy, Asthma, and Immunology’s position is that the tests do not have clinical relevance, are not validated, lack sufficient quality control, and should not be performed. These blood tests produce an unacceptably high false positive rate and are not accurate enough to diagnose food intolerance. Also the presence of IgG antibodies to foods may not necessarily mean intolerance but could be related to foods you eat often or ate recently. Research also shows elevated IgG antibodies have been related to childhood allergies that were outgrown as a child becomes an adult (such as an egg allergy), indicating increased tolerance to the food not an increased intolerance.

At this time the best method of identifying food intolerance is through an elimination diet. This diet removes foods and slowly reintroduces them one at a time over several weeks while keeping close track of your symptoms. A dietitian can help assist you with an elimination diet to help ensure your success.

The bottom line is food sensitivity testing may have worked for some people, but the evidence-based research backing up the findings are not there. If you have received test results and have eliminated foods based solely on this recommendation, you may try slowly adding back in these foods and see if you experience any side effects. If you are currently suffering from food intolerance and you do not know which foods are causing you distress, working with an allergist and dietitian and trying an elimination diet may help bring you relief.

What about gluten?  

Gluten is a protein found in wheat, rye, and barley responsible for triggering an immune response in about 1% of the American population who suffers from a condition called Celiac Disease. Symptoms include diarrhea, anemia, pain, skin rash, and malabsorption. People with Celiac Disease must avoid gluten to prevent nutritional deficiencies. Some people may suffer from an intolerance to gluten, which does not trigger an immune response, and avoiding foods with gluten may help them feel better.

Gluten is deemed safe to consume and there is no reason to avoid it unless you experience symptoms and avoiding gluten resolves your discomfort. Currently gluten-free products are booming and many people perceive a gluten-free lifestyle to be healthier-this is not always the case. Many whole grains that contain gluten are rich in vitamins, minerals, and fiber that gluten free products may be lacking. Also gluten free products may be higher in fat, sugar, and salt to improve taste. The bottom line is avoiding gluten does not make you any healthier than eating gluten. The majority of people tolerate gluten and it is safe to eat. Some people may experience intolerance and avoiding gluten helps relieve their symptoms. 

What about wheat and other grains?

Wheat is one of the most common allergies among children. It involves an immune response and production of antibodies after exposure to several different proteins found in wheat. With Celiac Disease only one protein, gluten, causes an immune response. Avoiding wheat is essential for people with wheat allergies, particularly hidden sources of wheat such as in condiments and beer. Intolerance to wheat and other grains does exist, and just like other intolerance's it does not trigger an immune response. Starting an elimination diet to pinpoint what specifically is causing your symptoms is the most effective way to manage food intolerance.

Food allergies and food intolerance can be difficult to manage. Working with your registered dietitian to find a well balanced diet that works for you can help. Grains are an excellent source of nutrients and energy; they belong in every healthy diet in moderation.

Garcinia Cambogia

Garcinia Cambogia has come into the spotlight as a “proven fat loss therapy.” It is derived from the Garcinia fruit, which looks like a small pumpkin and is native to Indonesia. The fruit is used as food throughout Southeast Asia and has a sour taste. The rinds are also used in some recipes in southern India and contain a large amount of Hydroxycitric Acid, the active ingredient in several diet supplements including Garcinia Cambogia.

As a supplement, Garcinia Cambogia claims to burn fat, block new fat, offset hunger to prevent overeating, and help you crave healthier foods. It is believed Hydroxycitric Acid may also boosts serotonin levels to help prevent emotional eating.

Popular weight loss supplement Hydroxycut recalled its product in 2009 after reports of muscle damage, liver problems, and seizures with the main active ingredient being Hydroxycitric Acid. Further investigation never directly tied the side effects to Hydroxycitric Acid and while Hydroxycut no longer uses it, it is still in many other weight loss supplements. 

The majority of legitimate scientific research studies on Hydroxycitric Acid and weight loss were carried out on animals. Studies involving humans received criticism for being poorly designed and producing questionable conclusions. A study in 1998 published in the Journal of the American Medical Association found no evidence of Hydroxycitric Acid to produce significant weight loss effects. A systemic review of several dietary supplements for weight loss was published in 2004 in the American Journal of Clinical Nutrition stating none of the over the counter weight loss aids analyzed produced significant weight loss effects, including Garcinia Cambogia. The only exception was Ephedra containing supplements which had significant risk of adverse effects and are considered potentially dangerous substances.

A study in 2010 published in the Journal of Obesity found some significant weight loss regarding Hydroxycitric Acid, but the clinical relevance was uncertain. They also found GI side effects to be twice as high in the Hydroxycitric Acid group; other side effects were nausea and headache. WebMD states it is possibly ineffective as a weight loss supplement, with some evidence it may increase satiety and help people eat less.

WebMD also states the supplement is possibly safe for most people when used in short duration. Use over 12 weeks has need been studied and the long-term effects are unknown. Pregnant and breastfeeding women should not use Garcinia Cambogia or any supplement with Hydroxycitric Acid.

Overall it looks like research and proof that Garcinia Cambogia is a safe and effective weight loss supplement just isn't there. In reality the true secret to weight loss does not come in a bottle...it comes from living a healthy active lifestyle.

Nuts for nuts

Heart healthy and nutrient dense, nuts pack a lot of power under a tiny shell. Eating a small handful everyday can be part of a healthy diet as well as help stave off hunger. Some people have the impression that nuts are very high in calories and fat, and may lead to weight gain. The high amount of quality nutrients makes nuts a healthy source of calories and keeping portion size to 1oz will minimize caloric intake to about 160-190 calories. Also the primary fat in nuts is unsaturated healthy fat, which has excellent health benefits.  

Numerous studies show people who eat nuts regularly can lower their LDL (bad) cholesterol levels and lower their risk of heart disease. It appears consuming unsaturated fatty acids helps to lower bad cholesterol in the blood. Many nuts also contain ALA omega-3 fatty acids which may act as an anti-inflammatory, increase memory, reduce risk of cardiac death, reduce triglyceride levels, and improve blood pressure.

Nuts are a great source of fiber which promotes a healthy digestive tract, can help lower cholesterol, and helps you feel full longer.

Protein is abundant in nuts and can be a great combination with whole grains to make a complete protein….think almond butter on some whole grain crackers.

High in antioxidants, nuts range in the types and amounts each contain, but most are rich in vitamin E which may prevent the formation of plaque in your arteries.

Some nuts, such as peanuts, almonds, and macadamia nuts contain plant sterols. Sterols help block cholesterol absorption to reduce blood cholesterol levels up to 10%.

L-arginine is a type of amino acid found in nuts and many other protein sources. L-arginine helps blood vessels to become more flexible, more dilated to improve blood flow helps reduce the risk of blood clots. 

Weight loss can even be promoted through regular nut consumption. Several studies indicate people lost more weight eating nuts than those who did not.

When it comes to your nut selection avoid nuts roasted in oil which may contain hydrogenated or partially hydrogenated fats. Instead eat them raw or dry roasted with as little added salt and sugar as possible. If it is candy coated, contains chocolate, or has lots of added ingredients, chances are it should be considered candy and not a health food. I like to recommend eating a variety of nuts to enjoy the health benefits and flavors each has to offer. Below are some facts on the most popular nuts and how they benefit your health.

Walnuts: Top rated when it comes to heart health. They are the highest in ALA omega-3 fatty acids and nearly twice the amount of antioxidants when compared to other common nuts. 1 oz is 14 shelled halves, 190 calories.

Peanuts: Technically this is a legume, like peas and beans, and is one of the highest in protein compared to other common nuts. Peanuts are also very high in folate which is very important for pregnant women. Peanuts are also high in niacin and anti-oxidants such as vitamin E, p-coumaric acid, and resveratrol (which is also found in wine). 1 oz is 28 peanuts, 170 calories.

Pistachios: One of the highest in monounsaturated fatty acids when compared to other common nuts. Buying them with the shell on may help people with portion size and hunger control. This nut is also high in vitamin E, carotenoids, antioxidants, and B-vitamins. 1 oz is 49 pistachios, 160 calories.

Almonds: Low in calories and almost equal in protein to peanuts. Almonds are high in monounsaturated fatty acids as well as vitamin E. 1 oz is 22 almonds, 160 calories.

Cashews: Least amount of fat compared to other common nuts. Cashews are high in selenium and a flavonoid called Xeaxanthin which is important for eye health. 1 oz is 16-18 cashews, 160 calories.

Macadamias and Pecans: While very tasty these nuts are higher in saturated fat, are the highest in calories, and have the lowest amount of protein when compared to other common nuts. No need to avoid these, nut having them on occasion instead of everyday would be a healthier choice.

Heart Healthy Marinara Sauce

Tomatoes are an excellent source of vitamin A, C, E, and lycopene. Lycopene is a carotenoid pigment that acts as an antioxidant. Unlike most nutrients, lycopene increases in concentration when cooked and processed. Cooking tomatoes and serving it with some fat, such as olive oil, greatly increases its bioavailability and absorption into the blood stream. Among the many health benefits of consuming tomatoes, such as reduced risk of cancer and heart disease, no research has proven its effectiveness. Regardless, tomatoes are considered to be one of the world's most healthiest foods and enjoying it on a regular basis is encouraged. Below is a recipe for my favorite Heart Health Marinara Sauce...Enjoy!


Ingredients:
1 Tbs Olive Oil
1/2 Yellow Onion, Minced
2 Garlic Cloves, Minced
28 Ounce Can of Organic No Added Salt Whole Tomatoes
Handful of Fresh Basil

Directions:
Heat olive oil in a large saucepan. Add the onions and garlic; sauté until onions are transparent and tender. Add the can of tomatoes and use a spoon to crush the whole tomatoes. Toss in a few pieces of torn basil and stir occasionally until sauce is hot and begins to thicken, about 12 minutes. Before serving add some additional fresh basil and optional sprinkle of low fat cheese.

For added health benefits I used a pasta that includes a 1/2 serving of vegetables in each serving of pasta.

We stopped eating salt.....but are we getting enough iodine?

So you stopped cooking with salt and avoid eating salty foods like it's the plague. Reducing salt has been a hot topic, promoting reduced risk of high blood pressure, stroke, heart attach, atherosclerosis, and even some cancers. According to the CDC, Americans consume 3,436 mg of sodium daily which is far too high for good health. The American Heart Association recommends we consume less than 1500 mg of sodium daily....that's about 1/2 teaspoon of salt. Our bodies need about 180-500 mg of sodium to sustain life, far below the American Heart Association's recommendations making it easy to meet our minimum sodium needs. With such low sodium intake, are we getting enough iodine too?

Iodine is an essential mineral needed for the production of thyroid hormone which controls our metabolism. A deficiency in iodine can lead to a slowed metabolism, goiter, infertility, even improper bone development, brain development, and mental retardation in a growing fetus. In the 1920's the United States began adding iodine to table salt in order to prevent iodine deficiency. Today an iodine deficiency is very rare in the United States. Our bodies need about 150 micrograms daily, 220 micrograms for pregnant women, and 290 micrograms for breastfeeding women. 1/2 teaspoon of iodized salt has about 200 micrograms, 1 baked potato with the skin has about 60 micrograms, and 1 cup of milk has about 56 micrograms.

Research does show about 75-90% of the salt Americans consume comes from processed foods that do not contain iodized salt. Cutting back on processed foods is a great start to remove sodium from your diet without worrying about cutting out too much iodine. If you currently use sea salt look for brands that are also fortified with iodine to help increase your intake, and use it sparingly like regular table salt. You can also receive iodine from other food sources such as wild fish and shellfish, milk, cheese, yogurt, eggs, and vegetables grown in iodine-rich soil. Many multivitamins also contain iodine too. The American Thyroid Association recommends women of childbearing age, especially when pregnant and breastfeeding, supplement 150 micrograms of iodine daily; this is generally found in prenatal vitamins. It is always important to discuss supplements with you physician prior to taking them.

Americans are very unlikely to become iodine deficient when eating a well balanced diet. Restricting sodium could increase the risk of iodine deficiency, however many health benefits of reducing sodium far outweigh a high sodium diet. Cooking with minimal amounts of iodized salt, focusing on wild seafood, consuming adequate amounts of dairy and vegetables, and considering a multivitamin supplement with iodine can help reduce iodine deficiency risks.

To all my triathletes, marathoners, endurance athletes and heavy sweaters....these guidelines apply to the general population and do not address the likely need for you to supplement extra sodium in your diet. Replacing losses from sweat, especially in hot weather is critical. Not consuming adequate sodium and can lead to very serious health complications. If you exercise beyond 1 hour, sweat excessively, or have salt streaks on your body you will need additional sodium in your diet. Work with your physician and sports dietitian to determine your sodium needs and if adding a salt supplement is warranted during your training.

Can Too Little Fat be Harmful?

A coworker of mine explained they were giving their diet a complete overhaul for the New Year. Starting today they would be limiting their fat intake to 10% of their diet and consuming mostly fruit and vegetables. While I am a HUGE advocate for eating whole foods and lots of fruits and veggies...restricting fats isn't as helpful as some people think.

Fats have a bad reputation; eating too much can lead to weight gain, clogged arteries, heart disease, diabetes, even cancer. We are constantly being told to decrease our fat consumption. But is it possible to eat too little fat to stay healthy?

Fat protects our internal organs by providing cushioning from trauma and stress. It is an insulator and helps our body stay warm. Fat is the largest energy reserve in our body and gives us energy especially during long endurance events. Fat transports fat soluble vitamins (A, D, E, and K) from the digestive tract into our bodies and to our cells for utilization. It is essential to form hormones needed to regulate bodily processes. Fat keeps us feeling full and satisfied from a meal. Fat also wraps around nerves within the body and brain to help send electrical messages and maintain cellular communication.

Our bodies can make some fat from the carbohydrates and protein we eat, but we cannot make two essential fatty acids that are necessary for good health. The essential fats are called omega-3 and omega-6 fatty acids. These fats help regulate blood pressure, reduce inflammation, promote healthy blood clotting, increase immunity, protect the heart, are needed for growth and development, and possibly increase cognitive function and memory. These unsaturated healthy fats should make up the majority of our diet. They can be found in nuts, seeds, soybeans/tofu, fish, shellfish, whole grains, nut butters, sunflower oil, canola oil, soybean oil, and olive oil.

Saturated fats and trans fats are typically considered the "bad" fats found in meat, whole milk, and baked goods. Believe it or not our bodies do need a small amount of saturated fat to work properly. The American Heart Association recommends limiting saturated fat to less than 7% of total calories. Most healthy fats such as nuts, avocado, and olive oil do contain a small amount of saturated fat so it is easy to obtain some in your diet.

The American Heart Association recommends limiting total fat intake to less than 25-35% of total calories, obtaining most from unsaturated sources. If you are sticking to a 2000 calorie diet that is about 3-5 Tbs of fat daily. That does not just include cooking oils and salad dressings. That total includes any fat found within the food you eat. Most breads, some vegetables (like avocados), dairy, eggs, fish, and meat contain fat to contribute to your daily total.

With the start of the New Year focus on healthy eating habits on a day to day basis, and try to avoid extreme diets that limit essential nutrients. Eating plenty of whole grains, fruits, vegetables, fish, nuts, seeds, and beans can help promote a healthy lifestyle and optimal health.

Low Calorie Snacks

Low Calorie Snacks

Healthy snacking can aid in weight loss by keeping your metabolism running high. Snacks help add extra nutrients into your diet, keep your blood sugar steady, and your energy levels elevated. The key is to select snacks that will fill you up without adding lots of calories. Plenty of fruits, vegetables, and whole grains are high in fiber to add bulk without the added calories.
 

·       Apple and glass of skim milk

·       1 cup Edamame

·       3 cups light popcorn

·       1 packet oatmeal (low sugar)

·       1 cup baby carrots with 2 Tbs hummus

·       1 cup sliced melon (or berries) with 2 Tbs plain nonfat yogurt mixed with 1tsp honey

·       ½ cup low fat cottage cheese with 4oz crushed pineapple

·       1 ounce mixed nuts

·       4 stalks of celery filled with low fat cottage cheese mixed with dill and chopped scallions

·       2 cups salad sprayed with lemon juice and ground pepper

·       8oz low fat Greek yogurt with flaxseed

·       1 cup vegetable sticks with 1 Tbs salsa, nonfat Ranch dressing, or 1/3 cup hummus

·       1 cup low sodium chicken, tomato, or vegetable soup

·       2 rice cakes with 1 Tbs peanut butter

·       5 whole wheat crackers with ¾ oz low fat cheese or ½ cup tuna

·       1 cup steamed vegetables