Living with a chronic health condition can take a toll on our bodies mentally and physically. It can cause us to feel anxious and worry frequently. It can cause our muscles to tense and our digestion to be compromised. Some stress in our life is unavoidable and can even be beneficial to keep us motivated. But, what happens when the stress over a chronic health condition becomes it own health condition? We may begin to ruminate and follow a negative thought pattern that keeps us from feeling better. Knowing that you have some tools you can use in times of excessive worry can be helpful. For instance, challenge that anxious thought. Ask yourself if it is factual. If not, replace it with one that is. For example, if your thought is, I will never get better, ask yourself what evidence there is for that statement. Replace it with something more factual, such as my body doesn’t feel good right now. This can change the feeling from one of hopelessness to temporary discomfort. It can also change your actions from for example, endlessly researching your condition on the internet to moving your body in a way that allows the emotions to move. if physically able, you could take a walk outside or get out of your physical space.
Weight loss medications
The past few years have seen monumental growth in the use of weight loss medications. The GLP-1 class of medications is most prevalent now. It includes medications under the names of Ozempic, Wegovy, Mounjaro, and Zepbound which increase the production of a hormone called glucagon like peptide (GLP) that enhances satiety, regulates blood sugar, and promotes weight loss. GLP-1s were initially developed for individuals with diabetes, but given the significant weight loss side effect (up to 20%), certain GLP-1 medications can be offered to those with obesity. Insurance coverage and price is a limiting factor now to broader distribution, but this will likely change as the marketplace expands with more options.
It is promising to see more tools and research to help those who struggle with obesity and diabetes. Dietitians are poised to help individuals who are prescribed these medications maintain adequate nutrition. Because the medications can have a dramatic decrease on hunger levels, it is important to ensure an individual’s diet still contains the necessary macronutrients, vitamins and minerals to ensure good health. In addition, one of the common side effects can be constipation, so addressing dietary factors like fiber and fluid can be important to evaluate.
Stay tuned for more coming in the future of weight loss medications. Dietitians stand ready to help patients navigate the nutrition-related impacts.
Pre-diabetes
Pre-diabetes is a condition in which your body is not able to regulate your blood sugars to an optimal level. It is caused by a variety of factors, including excess body fat, inappropriate dietary intake, sedentary lifestyle, and even certain medications can worsen blood sugar control. Race and ethnicity can increase your risk, as being Asian, Hispanic or Black have higher rates of diabetes.
Pre-diabetes is commonly diagnosed using a test called Hemoglobin A1C ordered by your health care provider. A diagnosis of pre-diabetes is made when the result is between 5.7 and 6.4%. Knowing that you have it, is the first step in reversing it and preventing the progression to Type 2 diabetes. Simply monitoring it and not changing your diet, exercise or lifestyle will do nothing to prevent the progression to worsening diabetic control. Pre-diabetes in and of itself is a warning that your metabolic health needs work.
The first recommended intervention for pre-diabetes is lifestyle modification, which includes healthy eating (including carbohydrate intake adjustments), regular exercise, and moderate weight loss. Many individuals with pre-diabetes don’t know where to start. A dietitian can evaluate your diet and the type and quantity of carbohydrates that you are consuming and provide recommendations to start improving your blood glucose. Exercise is also important as it is a remarkable insulin sensitizer and helps to reduce blood sugars after meals.
Research on diabetes prevention programs has shown that losing 5-7% body weight and exercising 150 minutes per week can reduce the risk of developing diabetes by 58%. If there was a drug that performed as well as lifestyle change, it would be making headlines!
I work with clients daily who are empowered by this information that they can begin to make many changes on their own to improve their metabolic health. A pre-diabetes diagnosis is a warning sign to take notice of diet, physical activity and lifestyle factors to make a difference in your health!
Aligning your lifestyle with health goals
Occasionally when working with clients, we reach a roadblock where lifestyle factors are interfering with their ability to achieve their health goals. At this point, it is important to reflect on what components of your life are creating challenges in your health. Is the work schedule or perhaps a relationship dynamic working against your ability to make healthy food choices or be physically active? Is it an over-scheduled life with too many demands to keep up with or a social circle that encourages excess alcohol consumption?
Sometimes clients become frustrated and think that they are too weak or a failure for not achieving their health goals. However, this is not the case. Evaluating the whole scope of your life to figure out what’s working and what can be improved upon is an important exercise for everyone to do from time to time. It can be particularly invaluable when coming up against frequent obstacles to achieving health goals. Leading a self-directed life can sometimes bring about necessary changes that can be hard to make, but create positive change in the most meaningful areas of our life.
In health,
Leslie
The Power of Protein
Protein has a powerful effect on enhancing satiety when it is incorporated into a meal. A well balanced meal with adequate protein should keep you full and satisfied for at least 3 hours. A good range of protein intake to aim for at meals is about 20 grams. Keep in mind you would want to balance this with foods like vegetables, fruits, whole grains, and some healthy fat. The equivalent of 20 grams of protein is about 2 large eggs , 1 cup of Greek yogurt, 8 ounces firm tofu, 1 cup of legumes or 3 ounces of any animal protein. You would only need to eat one of these example foods to get 20 grams of protein! I often see clients eating a salad for lunch with lettuce, vegetables, a little cheese and some salad dressing. Not only does this meal have little protein, but it is simply not enough calories for your peak meal of the day. Add a hard-boiled eggs, some lentils or beans and a tablespoon or two of nuts. You could also add some cooked chicken breast or tuna fish. Protein can also help those who struggle with more food cravings or have fluctuating hormones such as during perimenopause that tend to increase hunger.
Sneaky Weight Gain Factors
Many times clients visit with me frustrated by a lack of losing weight despite making many healthy changes in their lifestyle. What I often uncover is that these clients are eating healthy diets, but that they have some items in their diet that are stalling more progress. Here’s a summary of the top 5 sneaky weight gain factors
Oil - All oils have 120 calories and 14 grams of fat. Yes, there are many healthy oils like olive oil and avocado oil, but if you are not measuring them, then you could be getting almost as many calories as in a can of soda. Whether you are cooking with oils or dressing your salad or vegetables, measure your oils. Often 1 teaspoon is more than enough to dress a salad (add some fresh lemon juice to it as well) or to roast a vegetable like sweet potato.
Supplements - Many of my clients take gummy or chewable multivitamins. If you are taking multiple sources of the chewable ones, they also have calories too. Add on to that immune boosting lozenges or syrups, and you could be tacking on 100 or more calories per day. Take a look at all your supplements especially those in powder or chewable form and total up the calories.
Nuts - I love recommending nuts to clients as a healthy add-on of anti-inflammatory fats. But, keep in mind that because nuts are mostly fat, they are also very calorie dense. A cup of nuts tips the scales at 800 calories. Nuts are a great topping for oatmeal or nuts. Or try a small handful paired with a serving of fruit. Remember to portion them out. Keep a 1/8 cup scoop in your nut container if you want to have a snack.
Sweetened plant based milks - Plant based milk like almond, oat, and coconut are all the rage now. They are a great alternative for those who are intolerant to dairy products. However, many of these products have several teaspoons of added sugar per serving. Look for a plain and unsweetened version.
Protein bars - There is an endless supply of bars on the market. Many of these are 200-300 calories in what would take only 5-7 bites to consume. While they can fit the bill when you need a quick, non-perishable snack, I encourage my clients to be cautious about their consumption when they are trying to lose weight. Choose fresh food more often than packaged good like protein bars. For example, a cup of berries and small handful of pumpkin seeds would be a better snack idea.
More on Fatigue causes
Fatigue is such a common issue my clients face, I thought I’d provide an additional update to my previous post.
Here is a list of some common areas that can lead to fatigue
-Low DHEA hormone (precursor to sex hormones and cortisol)
-Low cortisol (our bodies’ own steroid hormone; peak in the morning and lowers near bedtime)
-Low ferritin or iron
-Low copper or zinc
-Low magnesium
-Very low Vitamin D
-Inadequate hydrochloric acid production (leads to post-meal fatigue)
-Reactive hypoglycemia
There are other factors at play as well - sleep apnea and other sleep disorders, thyroid disease and other autoimmune disorders, mitochondrial dysfunction, depression and anxiety, and physical inactivity. Certain medications can also cause fatigue as a side effect.
Talk to your dietitian or medical provider about testing for these areas to get to the bottom of your fatigue.
Magnesium types and their uses
So you think you might need a magnesium supplement and you head to Amazon or a drugstore to find one and are bombarded by many different types. Here’s the low down on different forms.
Magnesium oxide - Works essentially like a laxative. Very little is absorbed into the cells. High dosage per pill usually around 500mg. Can cause loose stools. This is the cheapest form of magnesium.
Magnesium citrate - The preferred form of magnesium if you need a little help in the motility department. At higher dosages (>600mg), it works more like a laxative too.
Magnesium glycinate - This is a great type to take for anxiety, help with relaxation, deeper sleep and also to replete deficiencies. It generally doesn’t cause loose stools.
Magnesium threonate - This is a type of magnesium that cross the “blood-brain” barrier. This can also be a good type for repleting deficiencies and promoting a sense of calm. This is one of the most expensive forms of magnesium. The dosage per pill is usually small, around 50mg.
Magnesium is a mineral that people can easily become deficient in. Ask your doctor or dietitian to measure you blood levels and aim for the mid-point of the range. Foods like nuts and seeds are among the richest magnesium sources. You need extra magnesium during types of stress.
COVID-19 and Nutrition
COVID-19 has brought up new challenges for us all. Our eating behaviors and diets have also been affected. Some of my clients lament that they are eating more because they are bored and stressed. Others have less food available and are eating more canned and packaged foods due to longer shelf life. Even those with plenty of access to healthy food, may not have the time or energy to prepare due to juggling child care and work.
Do the best that you can. Buy frozen fruits and vegetables, when available. Try to eat some produce (fresh, frozen or even canned) several times per day. If you have to eat some packaged foods from time to time, your health will still be okay. Give yourself a break and make breakfast for dinner sometimes. [Think eggs with some veggies added, smoothies, grits or oatmeal.] Other easy and healthy meals are homemade pizza with some protein and lots of veggies (I like arugula with sun dried tomatoes and pesto), spaghetti squash with a hearty lentil or meat sauce, tuna salad over a bed of greens with some roasted sweet potatoes. Ensure you are eating regular meals so your hunger is well controlled. You will be less likely to reach for unhealthy foods when you are well nourished.
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.