Welcome to Swmdda's Corner, a space used to discuss current topics and happenings with the dietetics community
By Alyssa PumfordAs dietitians and health care providers, we have the responsibility and moral obligation to give every patient, no matter their background, the health care they need and deserve. A minority population that health care providers may not be familiar with or comfortable treating is the lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) community. The LGBTQ+ community comprises 4.5% of the US population, and 4% of Michigan’s population. [1] To better understand this minority group, it is important to be aware of some common terminology: [2]
-Lesbian: a woman who is sexually attracted to other women. -Gay: Being sexually attracted to people of the same gender. -Bisexual: Being sexually attracted to both men and women. Sometimes used to describe people who are sexually attracted to people of all genders, including non-binary genders. -Transgender: A person who has a gender identity or gender expression that differs from their assigned sex. -Queer: Refers to a variety of sexual identities and gender identities that are anything other than straight and cisgender. -Cisgender: Relating to a person whose sense of personal identity and gender corresponds with their birth sex. -Binary: The classification of gender as either male or female. -Nonbinary: People whose gender does not fit neatly into male or female and may be on a continuum. Because the LGBTQ+ community is a minority group, its members often face discrimination, social inequality, and stigma on a daily basis. [3] Collectively experiencing these things is often associated with poorer mental and physical health, such as high rates of depression, anxiety, eating disorders, substance abuse, and suicide. [4] Minority stress is unique because it adds stress on top of the general life stressors. Minority stress is not just individual, but can come from social processes, institutions, and structures, which have profound effects on health and wellbeing. [5] When minorities face constant social inequality and micro-aggressions, internalization occurs where individuals may develop shame, guilt, and self-hatred related to their identity, which leads to negative mental and physical health outcomes. [5] Many LGBTQ+ patients feel the health care they are receiving is inadequate, and some have ceased to seek medical care at all due to stigma/homophobia from health care providers, lack of access to culturally and orientation-appropriate medical services, and heightened concerns about confidentiality. [3] Although many patients hide their identity during treatment to reduce these problems, the ones who disclose it are often ignored or treated disrespectfully by the health care providers. [6, 7, 8] Additionally, many patients feel that common medical treatments are ineffective because they are not tailored to their needs. For instance, a study examined the treatment experiences of transgender individuals with eating disorders. [8] A traditional treatment plan for eating disorders typically involves a “positive body image” approach. However, this approach does not work for transgender patients since they typically use eating disorders to control unwanted aspects of their body structure (e.g. using starvation to eliminate curves, body fat, or menstruation), and insisting these aspects of their body are ‘okay’ or ‘normal’ only serves to worsen the body dysphoria they are experiencing. A way to remedy health disparities the LGBTQ+ population faces is by learning about prevalent nutrition-related problems each part of the community faces. It is important, however, to not assume disordered eating or other risky behaviors are present in all patients who identify as part of the LGBTQ+ community. [7] LESBIAN/BISEXUAL (SEXUAL MINORITY) WOMEN Research shows that sexual minority women (SMW) are more likely to be overweight or obese compared to heterosexual women. [9, 10] A metanalysis found 67% of the studies reported significantly higher rates of overweight and obesity in SMW versus heterosexual women. [10] Although there is not enough research showing any physical activity or nutritional intake differences for SMW versus heterosexual women, there is research on SMW having high rates of binge-eating disorder, depression, and alcohol and drug abuse, which could lead to a greater body mass. [7] Gender expression and lesbian subculture may also play a role in greater body mass because this subculture has more flexible norms about the female body. [11] SMW’s gender expression ranges widely on a masculinity/femininity continuum, and studies have shown that butch-identified SMW have a greater waist-to-hip ratio than femme-identified or heterosexual women, and that butch SMW tend to prefer and value larger body size. [11] This may lead butch lesbians to feel less pressure to conform to societal standards of thinness and feel more satisfied with greater weight. The most effective interventions to promote healthy behaviors for SMW include therapeutic all-women groups, where SMW feel safe and understood. [12] Also, focusing on healthy behavioral changes rather than weight loss as the primary goal is more effective for producing positive health outcomes. GAY/BISEXUAL (SEXUAL MINORITY) MEN Problems with body image are common among sexual minority men (SMM), and SMM are more likely to be at risk for developing an eating disorder versus heterosexual men. [9,13] SMM represent 5% of the total male population, but among males who have eating disorders, 42% identify as gay. [14] SMM reported being significantly more likely to have fasted, vomited, or taken laxatives/diet pills to control their weight in the last 30 days. [14] Several studies indicate that gay male subculture, with its emphasis on muscularity and leanness, influences SMM’s perceived discrepancy between their current and ideal body shapes, which could lead to disordered eating and being overly concerned or obsessed with muscle mass. [11,15] Like sexual minority women, SMM have gender roles that lie on a continuum, and men with “feminine” gender roles have a higher prevalence of eating disorders than men with “masculine” and “androgynous” roles. [14] As with sexual minority women, effective interventions include all-male therapeutic groups where they feel safe to talk about and work through their experiences. Topics should center on issues unique to SMM, like excessive exercise, media, and societal pressures, and the unique dynamic of male depression and shame. [14] TRANSGENDER PEOPLE Transgender people are particularly vulnerable to body dissatisfaction due to gender dysphoria, which puts them more at risk than any other sexual or gender demographic for restrictive eating, binge eating/purging, and misuse of diet pills and laxatives to help achieve a more masculine or feminine body image. [16,17] The prevalence of eating disorders in the transgender community is even higher than that of heterosexual females, which historically has been accepted as the highest-risk population for disordered eating. [18] Many transgender patients hide their identity during treatment because of anticipation of dismissal, mistreatment, disrespect, and the need to educate the provider about transgender health issues in order to receive appropriate care; all of which hinders their treatment and discourages them from disclosing their identity going forward. [17] Medical providers need to take transgender individuals’ identity seriously and create a care plan that is different from cisgender plans in order to have the best health outcomes. Several studies have pointed to decreased risk of eating disorders among transgender people when medical transition has been initiated (e.g., cross-sex hormone therapy and/or gender affirming surgery). [16,17] Having the intervention include initiating medical transition decreases body dissatisfaction and helps alleviate eating disorder symptoms in transgender individuals. HOW DIETITIANS CAN ENSURE INCLUSIVE PATIENT-CENTERED CARE FOR THE LGBTQ+ COMMUNITY It is imperative dietitians and health care providers adopt culturally competent, gender-affirming practices to ensure inclusive patient-centered care. One way to do this is to become aware of your conscious or unconscious biases, and work to dismantle them. Taking the Harvard Implicit Bias Test under the topic of “Sexuality” may be enlightening. In a 2009 survey, LGBTQ individuals in the United States and Canada were asked to rank a list of qualities they found important in health care providers. [19] Respondents ranked equal and fair treatment as one of the most important qualities, alongside competence, respect, and honesty. Becoming competent includes simply asking questions directly to the patient about how they identify, their preferred pronouns, and their beliefs rather than making assumptions. Additionally, respecting that self-concept by using those pronouns is equally important to build a strong patient-provider relationship. Creating office forms that do not assume gender/sexual identity is also a way to make the environment more inclusive, along with posting LGBTQ-friendly signage, brochures, and reading material in the waiting room. Seeking education of local and national resources for LGBTQ+ patients, such as support groups, hotlines, programs, and organizations is important to show support. Finally, refer LGBTQ+ patients to competent providers if you are uncomfortable counseling them. LGBTQ+ RESOURCES OutFront Kalamazoo: https://www.outfrontkzoo.org/ Kalamazoo County LGBTQ Resources: https://www.kalcounty.com/aaa/lgbtq.htm National LGBT Health Education Center: https://www.lgbthealtheducation.org/ GLMA: Health Professionals Advancing LGBTQ Equality: http://www.glma.org/ Human Rights Campaign: https://www.hrc.org/ Sources
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By Alyssa PumfordIt appears yoga isn’t just for hippies anymore. According to the Yoga Alliance, approximately 36 million Americans are attempting to find their inner zen through yoga, and for good reason. [1] Committed yogis claim that the practice of yoga has the ability to raise quality of life in areas such as fitness, stress relief, mental clarity, and spiritual growth. [2] Yoga has been present since 3000 B.C., and because it emphasizes individualization in practice, many variations have sprung outside of its traditional roots. However, all approaches to yoga have a main focus on harmonizing the mind and the body. [3] The word itself is derived from the Sanskrit root “Yuj”, meaning “to join” or “to unite.” [3] Although there are countless types of yoga practiced all over the world, the most common variations include: [4]
There is much anecdotal evidence that yoga, no matter the type, positively impacts the entire health and wellbeing of individuals who practice it. Therefore, it could prove to be a useful tool for healthcare providers, especially dietitians, to recommend to patients. But what does the science have to say? The Science Behind Yoga Mental Health
Physical Health
Implications for RDs and the Bottom Line: Although there is some evidence that yoga may be beneficial to practitioners, many questions remain. The biological mechanisms of how yoga improves stress and overall well-being are still unknown. In most studies, it seems that subjective measures of perceived stress are used the most, but evidence of biological measures of stress (SNS and HPA axis regulation) seems to be lacking. [8] The studies that do test for biological measures mostly test salivary cortisol which may not always be reliable, since there are many external factors that can raise or reduce cortisol (i.e. consuming beverages or a low or high pH, various drugs or medications, the cortisol awakening response depending on circadian rhythms, etc.). [8] Additionally, the populations studied are mostly small sample sizes that are white and female, so diversity in participants in future studies is needed. Also, standardization of the type of yoga used is necessary for more reliable research; many studies did not specify this, or just stated it was “hatha” yoga, which could be interpreted in many ways. Despite some of the unanswered questions, there are some common themes in the research. It is not just the physical act of performing yoga that seemed to positively impact practitioners’ overall well-being, but the combination of many yogic elements—meditation, breathwork, and posing. Mindfulness is a key concept used in dietetic counseling to encourage patients to make healthier food choices and reduce mindless emotional eating. In most of the studies mentioned above, yoga appeared to reduce stress, increase mindfulness, and therefore increase healthier behaviors. Additionally, longevity and consistency in practice seem to be the most effective in improving overall mental and physical health. Because of these themes, yoga may still be a powerful tool for dietitians to recommend to patients who want to improve their relationship with food using mindfulness techniques. It could also be recommended to those who struggle with self-compassion, want to develop sustainable mechanisms for coping with stress, have eating disorders, or desire alternatives to traditional exercise or gyms. It is important to note that yoga is very inclusive—it can be done by almost anyone, at any intensity level, at any age, and anywhere (see below for resources). All can benefit from yoga’s therapeutic effects. "Yoga is about clearing away whatever is in us that prevents our living in the most full and whole way. With yoga, we become aware of how and where we are restricted — in body, mind, and heart — and how gradually to open and release these blockages. As these blockages are cleared, our energy is freed. We start to feel more harmonious, more at one with ourselves. Our lives begin to flow — or we begin to flow more in our lives.” Yoga Sources
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By Alyssa PumfordIt’s a wonderful thing for dietitians, foodies and residents alike that Kalamazoo is progressive when it comes to fresh food and sustainability. The city has an abundance of delicious local restaurants, cafes and bakeries in the downtown area, as well as a booming farmers’ market chock-full of fresh and interesting produce. Many of its restaurants, such as Principle and Food Dance, use local items in their menus. Although most restaurants, retailers and institutions would like to source their ingredients from local farms, some choose not to because of challenges related to consistency, food safety, lack of labor to handle unprocessed produce and meat, as well as unfamiliarity with the local food system. Enter ValleyHub, housed inside the Kalamazoo Valley Community College (KVCC) Food Innovation Center. One of ValleyHub’s main goals is to eliminate some of these barriers by connecting farmers and institutions (i.e. restaurants, hospitals, grocers, cafes, etc.) and making local purchasing the easy choice. ValleyHub grows specialty items on site and aggregates fresh produce from local farms. To make procurement even easier for institutional buyers, ValleyHub has the facilities to process the produce (wash, peel, chop, and freeze) and package it. Along with produce, it also sells meats, eggs and locally produced packaged products. Essentially, the hub is trying to help institutional buyers link up with local farmers, and for farmers to sell and distribute to more clients than they could on their own.  This is the area where most of the food processing takes place- produce is washed, peeled, chopped, and packaged. Barriers to eating fresh, local produce exist not only for institutions, but also for the average consumer. ValleyHub is attempting to tackle that problem head on by also functioning as an educational facility for students and community members. Classes in which anyone can enroll (and all quite affordable) include mushroom cultivating, rain gardening, beekeeping, urban homesteading, and container gardening, just to name a few. ValleyHub is hoping these classes can provide more members of the community with the foundation to eventually become skilled in these areas, which in turn will empower them to pursue food initiatives in Kalamazoo. ValleyHub’s Current Dietitian, Hristina Petrovska Hristina Petrovska is a registered dietitian who has taken on the complex role of coordinating the intersection of food systems, community, sustainability, and education at ValleyHub. When asked about her role at ValleyHub, it is evident Hristina is passionate about supporting the hub’s mission to further sustainable food practices and continue making strides in getting farm-fresh food into the hands of the community.  Hristina with vertical growing tables that contain greens from seed to plant. She greeted me in the lobby of the hub and began the tour with an innovative rotary garden bursting with lush, green lettuce. “A lot of the growing systems we have here are for demonstration purposes; this rotary garden takes up very little space and you could even put it in a basement because it has its own light source,” Hristina explains. “The greenspace the plants are plugged into fills up with water once a day, and the plants soak by rotation. This model is an efficient way to conserve space, light and water resources and could be a great addition in a school, educational facility, or really anywhere.”  Model of what a rotary garden looks like. Hristina leads us into the next area where seeds are planted in coco fiber and allowed to germinate, after which they are moved to the vertical growing tables, the greenhouse, or outside in spring and summer. Students are encouraged to use their creativity and try new things in this space.
Next stop is the greenhouse, where a blue-colored tank filled with water and fish greets us at the entrance. “This is an aquaponics growing system,” Hristina clarifies. “Aquaponics is the combination term of ‘aquaculture,’ which is raising fish, and ‘hydroponics’ which is raising plants in water. In this system, the water from the fish tanks is fed to the plants, where the by-products are broken down initially to nitrites, and subsequently into nitrates that are utilized by the plants as nutrients. Then the water is recirculated back to the fish tanks.” The type of fish maintained in the tank was also carefully chosen to ensure productivity in the greenhouse and usefulness to the culinary program. “The fish raised in these tanks is tilapia. The culinary students get to prepare the fish when full size is reached,” says Hristina.  This small tank can accommodate about 30 tilapia. This close, warm environment mimics what tilapia prefer in their natural habitats. We walk through a few rows of vivid green plants that are mostly specialty herbs. “Over here, there’s Thai basil, oregano, parsley, lemongrass, and nasturtium flowers,” Hristina points out. “We want to be able to offer culturally diverse food to the community while keeping it local. Also in this area, we’re experimenting with growing a papaya plant, gingerroot and turmeric.”  Papaya, turmeric, pineapple, and much more are being grown in the greenhouse. As we return to the hub, Hristina describes that in the spring and summer, the space outside of the greenhouse is used to grow additional plants, including some for educational purposes. “In that corner,” Hristina points, “I use that area as an outdoor classroom. A lot of times we work with organizations like the YMCA, and various summer camps, to put on educational activities for the kids.” It is very apparent that no space or energy is wasted, and every opportunity to educate members of the community is seized at ValleyHub.
Food Initiatives Led by Hristina and Future Dietitians “The next exciting initiative that we are working on with a team of colleagues is the Valley Food Share,” Hristina discloses, “and the project is supposed to be a way to fight food insecurity among college students.” The idea is to provide a weekly box that will have ingredients to make two or three healthy meals with recipes included. The boxes will be assembled at the Food Innovation Center and ingredients will be gathered from the farmers, Kalamazoo Loaves & Fishes, and donations. Who are the people assisting to make this happen? Hristina answers, “This has been a multi-departmental initiative at the college, and there are many components to it, however, for deciding on what actually goes in the box, I have gotten a lot of help from WMU dietetics students who have been volunteering with me for the past two semesters. I really enjoy working with students, and I love being around their enthusiasm.” The Valley Food Share will be available to any current KVCC students on a weekly basis at alternating locations, Texas Township Campus and Anna Whitten Hall in downtown Kalamazoo. So how can Southwest Michigan RDs include resources from the ValleyHub and Food Innovation Center into their practice? Hristina says, “RDs are the ones who directly work with members of the community, and often know what barriers to healthy food people are experiencing. I am envisioning a collaborative relationship with dietitians, other health professionals, as well as food service industries in finding out ways in which we can collaboratively support our communities. RDs can share with patients the lists of community classes available at KVCC, and they can also make recommendations to food service departments about locally sourcing.” It is clear that ValleyHub is not only working hard to bridge the gap between farmer and consumer, but that it is also pursuing a mission that dietitians hold near and dear to their hearts—helping reshape the community’s food environment through education and improved access to healthy, locally sourced foods. By Stephanie Forstall, B.S.The probiotic supplement industry is worth billions of dollars, and sales continue to rise every year. Although most people consider probiotics to be safe and effective, the evidence to support their health benefits is inconclusive.1 There are two general reasons why the verdict is still out on the efficacy of probiotics: inadequate regulations [2] and low-quality experimental studies. [1] Probiotics are classified as food supplements, which are regulated differently than pharmaceutical drugs. With pharmaceutical agents, regulatory authorities make sure the product is safe to use as directed and works to treat the condition for which it is intended. On the other hand, food supplements are not tested for safety, efficacy, or quality before being put on the market. [2] Probiotics are generally checked by regulatory agencies to ensure the labels do not claim to prevent or treat specific medical conditions. For example, manufacturers can legally claim that probiotics support the digestive system or immune function. They cannot, however, claim to treat specific digestive or immune system disorders such as diverticulitis or Crohn’s disease. Without regulations to confirm the safety, efficacy, and quality of probiotics, consumers and health care professionals cannot be certain that the products will work for a particular condition or even match the ingredients that are listed on the label.
Secondly, the bulk of the evidence used to support the benefits of probiotic supplementation comes from studies with major problems with their methodology, which include small sample sizes; measuring secondary outcomes that are irrelevant to the efficacy of probiotics; and failing to specify methods of randomization, account for participant withdrawals, follow a double-blind procedure, and check the viability of the bacteria and concentration in the tested probiotic. [1] In addition, no study has yet examined the functionality of the microbiome after a dose of probiotics. The majority of studies look at stool samples, which was recently found to be an inaccurate way to determine whether the probiotics have successfully colonized the GI tract. [3] Two studies published in the journal, Cell, made discoveries that will change the way researchers and health care professionals think about evaluating and prescribing probiotics. The first study examined stool samples and the results of invasive techniques used to evaluate the microbiome of the GI tract of 15 healthy volunteers before, during, and after the use of a placebo or an 11-strain, commercially-available probiotic. The results showed that the bacteria found in the stool samples did not match the bacteria found in the GI tract. The study also suggested that probiotic colonization depends on the host’s original microbiome in various locations of the GI tract and its susceptibility to the strains of bacteria in the supplement. [3] In other words, the colonization of the probiotic was found to be highly variable in each participant, which suggests a single probiotic is not going to promote the same outcomes for every patient. The second study published in Cell looked at the rate at which the microbiome returned to normal after a week-long course of a broad-spectrum antibiotic in 21 healthy volunteers. The study participants were then assigned to one of three treatment groups: an 11-strain probiotic, an autologous fecal microbiome transplantation (aFMT), or no treatment. The results showed that the aFMT group had the fastest rate of microbiome reconstitution. The group without treatment recovered after a few weeks. Additionally, the reconstitution of the microbiome in the probiotic group was delayed for at least 5 months after the discontinuation of the supplement. [4] Why are these two studies important? Although they contained small sample sizes and did not aim to evaluate the efficacy of probiotics, [3] they suggest that the current methods of evaluating the colonization of probiotics likely lead to inaccurate conclusions. They also show that it might not be beneficial to recommend the same probiotic supplement to every patient because the unique composition of the host’s original microbiome appears to influence which strains in the probiotic are able to colonize the GI tract. At worst, one of the studies shows that the use of probiotics after a course of antibiotics could contribute to antibiotic-associated diarrhea and Clostridium difficile infections. [4] Two more studies recently published in The New England Journal of Medicine found that probiotics do not prevent the progression of moderate-to-severe gastroenteritis in children. [1,5] The first study was a randomized, double-blind, placebo-controlled trial with nearly 900 participants who were admitted to an emergency department (ED) for acute gastroenteritis. The study participants were given a five-day course of a two-strain probiotic containing Lactobacillus rhamnosus and L. helveticus two times per day or a placebo. It was found that the probiotic group did not have significantly better outcomes than the placebo group after 14 days. [5] The second study was also a randomized, double-blind, placebo-controlled trial with almost 1,000 preschool-aged participants who were admitted to EDs for acute gastroenteritis, and they were assigned to either a single-strain probiotic containing L. rhamnosus or placebo for five days. It was also determined that the probiotic treatment did not result in better outcomes for the group that received it. [1] These two studies are important because the results challenge the current recommendations for probiotics in children with acute gastroenteritis. [1,5] One of the studies also mentioned the failure of other large trials to produce significant positive outcomes in adults with Clostridium difficile infections or antibiotic-associated diarrhea, pre-term infants with necrotizing enterocolitis, and symptoms of pharyngitis in a wide range of ages. [1] So, where does this leave RDs when it comes to making recommendations for probiotic supplements? Since dietetics is a science-based health care profession, dietitians should consult the most recent research before recommending any loosely regulated supplement. RDs need to avoid promoting treatments that are not backed by sound science in order to receive the same respect as other health care practitioners. It is important for RDs to showcase why their professional education and training sets them apart from “certified nutritionists,” and one way to do that is to protect the health of patients (and their wallets) by waiting to see if additional rigorous studies will support the use of probiotic supplements as an effective treatment for certain medical conditions and the promotion of general health and wellness. References
By Anja Grommons, MA, RDNIn practice, patients will frequently paint a picture of their idea of a healthful diet, which is often contradictory, restrictive, and interwoven with the misinformation of diet culture. Their food beliefs are at times distorted, and their intakes are unbalanced with a maldistribution of macronutrients. Think back to the 1970s and ‘80s when the low-fat trend emerged and took the food companies and consumers by storm. Fast forward to now: fat is “back,” protein is on a pedestal, and carbohydrates are the enemy. Food confusion is a common topic seen in practice and it appears that much of the population is affected (1). With the help of the media and its convincing misinformation, people are often looking for a quick fix or answer to their rather complex nutrition problems or questions. While we’ve been bombarded with sub-par research that promotes the current diet trends, the truth is, a healthful diet consists of balance. But what is balance?
The Institute of Medicine (IOM) created the Acceptable Macronutrient Distribution Ranges (AMDR), which recommends consumption of 45 to 65 percent of calories from carbohydrates, 10 to 35 percent from protein, and 20 to 35 percent from fat. Additional recommendations include limiting saturated fat and added sugar while aiming for foods rich in dietary fiber. With “balance” defined, how does the Standard American Diet (SAD) measure up? For one, when comparing what we are eating to what we should be eating, our fiber intake is certainly not meeting the mark. In fact, fewer than 3% of Americans meet the minimum fiber recommendations (2). Dietary fiber is an indigestible form of carbohydrate that can help with weight control and gastrointestinal health. High fiber foods include fruits, vegetables, whole grains, and legumes, which the SAD is lacking (3). If Americans aren’t eating enough fiber, what is making it to the table? Interestingly enough, total carbohydrate intakes are within the recommendations of the AMDR, but they likely stem from low-fiber, highly processed sources. Similarly, Americans are meeting their protein and fat needs, but due to the consumption of animal-based sources, especially cheese (3), saturated fat intake exceeds its mark (4). It’s not exactly the public’s fault; nutrition can be a confusing topic to navigate. Just thumb through a health and fitness magazine; see any ads for fruits and vegetables? Didn’t think so. Instead you will find advertisements promoting foods already over-consumed, like dairy and animal-based products. In knowing where the SAD is falling short and what is being overconsumed, what exactly should Americans be focusing on? Glad you asked. Research has indicated that a vegetarian eating plan most closely resembles that of the dietary recommendations (5). What better way to remedy the fiber deficit while promoting adequate protein and reduced saturated fat intake than by shifting the focus to a plant-based diet? A diet rich in fruits, vegetables, whole grains, and legumes provides the aforementioned redistribution of macronutrients and can provide a plethora of antioxidants, phytonutrients, vitamins, and minerals, all necessary for growth and development. A plant-based diet has shown to be effective in the prevention and treatment of type 2 diabetes (6), overweight (7), coronary artery disease (8), and cancer (9), some of the most devastating and expensive chronic conditions in the U.S. A plant-based diet also packs a strong benefit for the environment and provides a more compassionate lifestyle benefiting all living beings. It may provide an improved relationship and understanding with food as well. Many testimonials exist on the latter (10), which of course are subjective and therefore a limitation of research, but nonetheless a potential valuable benefit of a plant-based diet. If you are interested in adapting to a plant-based diet, you should understand that there is no one-size-fits-all approach. A great transition may include focusing on plant-based alternatives to some of your favorite recipes or products, such as bean-based taco fillings instead of the beef-based variety, or a pulsed chickpea salad rather than egg salad in sandwiches or lettuce cups. A plant-based diet should still be modeled after the recommendations of the Dietary Guidelines and the MyPlate method may be employed to minimize the guess work of meal planning. In fact, vegan registered dietitians Ginny Messina (11) and Julieanna Hever (12) have created vegan adaptations of the standard plate. If recipes are your thing, check out some of my favorite vegan recipe resources, including Minimalist Baker (13), Forks Over Knives (14), and Bosh (15). As with all dietary changes, small steps are key, and evidence-based guidelines, along with tasty recipe resources, are imperative for navigating the transition. So, what will be your first step? About Anja: Anja is a registered dietitian providing nutrition education in the Patient-Centered Medical Home setting. Captivated by the benefits of plant-based nutrition, she has researched and personally followed a plant-based, vegan lifestyle for many years. After finishing graduate school, Anja completed the T. Colin Campbell Plant Based Nutrition Certification through eCornell and has continued to build upon that knowledge base to write personally and professionally on the benefits of plant-based living. Sources:
By Alyssa Pumford
 As chronic diseases continue to rise across the United States, patients are beginning to demand more holistic approaches rather than popping pills to heal themselves. As we know, inflammation underlies most chronic diseases and conditions, such as autoimmune disease, inflammatory bowel disease (IBD), type 2 diabetes, arthritis, cardiovascular disease (CVD), cancer and chronic pain. Although there is no standardized anti-inflammatory diet, there are foods that are thought to either reduce or increase inflammation. Educating patients about what these foods are and how to incorporate them into their diet may help reduce their symptoms. But before diving into that, let’s review the science! Pathophysiology of inflammation: Inflammatory conditions (e.g. infection, acute illness, trauma, toxins, diseases, physical stress) trigger the acute immune response to release eicosanoids and cytokines, which mobilize nutrients required to synthesize positive acute-phase reactants and leukocytes. [1] Cytokines (specifically IL-1beta, TNF-alpha, IL-6) increase the breakdown of muscle protein to meet the demand for energy during the inflammatory response. [1] Tissue injury results in declining values of serum albumin, prealbumin and transferrin (also known as negative acute-phase reactants). As the body begins to heal itself, a negative feedback cycle occurs, and inflammation ceases. If these mechanisms of acute inflammation fail to resist infection or heal an injury, chronic inflammation ensues. [2] Various nutrients in foods have been shown to reduce inflammatory markers. [1] Anti-inflammatory foods are high in fiber and have a low glycemic index, and typically include omega-3 fatty acids, antioxidants and polyphenols, and prebiotics and probiotics. -Omega-3 FA: Foods that have polyunsaturated fatty acids omega-3 DHA and EPA reduce the production of cytokines. [2] Sources include fatty fish, such as salmon, sardines, mackerel and oysters. Plant foods such as walnuts, chia seeds, flaxseeds and hempseeds contain omega-3 ALA, but DHA and EPA seem to be more effective in lowering inflammation. In general, replacing saturated and trans fat with polyunsaturated and monounsaturated fat reduces markers of inflammation (EAL Grade 1). [3] - Antioxidants and polyphenols in plant foods: Antioxidants help fight free radical damage to cells and reduce production of C-reactive protein and histamine. [1] Polyphenols are phytochemicals in plants that have shown anti-inflammatory effects. Although most plant foods contain these anti-inflammatory properties, fruits and vegetables that seem to contain the most include cruciferous vegetables, onions, garlic, berries, citrus fruits, pomegranates and cherries. [1] Spices and herbs such as turmeric, ginger, rosemary, cinnamon, red chili powder, and black pepper contain antioxidants and polyphenols that prevent free radical formation. [4] -Pre and probiotics for a happy gut: Although more research on the microbiome is needed, there is some evidence that supports consuming pre and probiotics for a healthy gut ecology, which in turn reduces inflammation. [1] For prebiotics, plant foods containing inulin and oligofructose are preferred because both can be fermented by the gut and promote growth of “good” bacteria. Prebiotic sources are bananas, asparagus, onion, garlic, chicory and artichokes. Probiotics are the actual bacteria themselves and can be found in fermented foods such as miso, sauerkraut, yogurt, kimchi, kefir, tempeh and kombucha. -High fiber and low glycemic foods: Refined carbohydrates, such as products with white flour, cakes, pastries, white rice, flour tortillas and pasta, have a higher glycemic load, which when consumed lead to higher post-prandial glucose and insulin levels, and can cause inflammation (which is unfortunate, since refined carbs are so delicious!). These refined carbs also tend to have little fiber as well. Carbohydrates high in fiber tend to have a low glycemic load, with the greatest protection from c-reactive protein seen at a total fiber level above 22 grams per day. [5] Foods high in fiber should be introduced slowly to reduce possible gastrointestinal distress. Of course, every person is unique and has different tolerances which need to be accounted for. Food journaling with symptoms are needed to discover these intolerances. Common intolerances include dairy, wheat, eggs, veggies from the nightshade group, and artificial flavors and sweeteners. Also, sleep hygiene is incredibly important; 7-8 hours of sleep per night is optimal for anti-inflammatory effects. The bottom line:
Check out the recipe below for an easy and delicious way to incorporate anti-inflammatory spices into a beverage! ANTI-INFLAMMATORY GOLDEN MILK * Serving size: 2 Ingredients:
Instructions:
*Adapted from Minimalist Baker Sources
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