The Anti-Inflammatory Diet

I had the opportunity to attend a program at Duke Integrative Medicine last week focused on Decoding the Anti-Inflammatory Diet. Before we move on from the topic of nutrition, I thought I would share a few highlights from this program that may be helpful on your healthy eating journey.

Inflammation: acute vs. chronic

 You’ve probably heard or read about eating a diet that reduces chronic inflammation in the body, but why is this so important? As you may know, there are two types of inflammation: acute and chronic. Acute inflammation is the immune system’s natural response to heal an injury or fight an infection – and it’s a good thing. It’s meant to be short-term and stop after the injury or infection is gone. However, research has shown that many of us are now subject to chronic, or ongoing, inflammation that is linked to several preventable chronic diseases such as heart disease, diabetes and Alzheimer’s disease. One example of how this works: if you have fat build up in the walls of your heart’s arteries, the body responds by sending inflammatory chemicals, as it sees this as an “injury” to the heart. This ongoing inflammatory response could trigger a blood clot that causes a heart attack or stroke.

Why diet matters

You may be wondering what food has to do with inflammation and chronic diseases. We now know that diet plays a critical role –  the types of food you eat affect how much inflammation you have.  There are some foods that can cause this inflammatory response (“prooxidants”) and some foods that help prevent it (“antioxidants”). The recommendations are probably not surprising, and my goal is to offer an overview of the general recommendations about what foods to eat and which to avoid if you want to reduce chronic inflammation in your body.

Basic recommendations of an Anti-Inflammatory Diet

  • Eat whole foods which are minimally processed before purchase. Once again, we are back to the advice that if it comes in a box or bag and has more than five or so ingredients on the label, it’s best to put it back on the shelf and keep shopping. Keep reading to learn more about which whole foods are best for reducing chronic inflammation in the body.

 

  • Choose a wide variety of colorful fruits and vegetables. You have probably heard the expression “eat the rainbow” meaning select fruits and veggies from all the color families, from red to violet (don’t forget white too). The reason behind this approach is each color provides particular nutrients that help your body function at its best. For example, orange-hued fruits and veggies offer plenty of beta-carotene, a powerful antioxidant, plus vitamin A and often vitamin C. These nutrients help with eyesight, immune function and healthy skin. Choices include butternut squash, oranges, carrots, mangoes, pumpkins, sweet potato, and cantaloupe. Click here for more examples of how to eat the rainbow.

 

  • Choose whole grains over refined grains, including non-wheat grains. This may be one of the most challenging changes for most people as it means limiting foods made with refined grains such as white bread, white rice, cookies and cakes, and replacing them with healthier options such as whole wheat bread and brown rice. Whole grains are rich in antioxidants, B vitamins and they are high in fiber, which is great for digestion and regularity. There are many choices when it comes to whole grains, so if you cannot or prefer not to eat wheat or gluten, you can select grains such as quinoa, millet, whole oats, or buckwheat.

 

  • Rethink your protein sources. If you choose to eat meat, opt for fatty fish such as Wild Alaskan salmon; organic, grass-fed lean meats; or skinless poultry from organic, cage-free chickens. If you eat eggs, choose omega-3-enriched eggs or organic eggs from free-range chickens. However, not all protein has to come from animal sources. Consider replacing some meat options with plant-based proteins including beans, nuts and seeds. Some examples include black beans, chickpeas, black-eyed peas and lentils (note: you can use canned versions, just drain and rinse them before use). Beans are rich in folic acid, magnesium, potassium and soluble fiber. You can eat them either whole or pureed into spreads like hummus.

 

  • Eat foods rich in essential fatty acids. Did you know there are certain fatty acids, needed for cell membrane integrity and chemical transport, that your body cannot make on its own? These include the omega-3 and omega-6 dietary fats. Each of these has a number of health benefits for your body. However, it’s important to get the right balance of omega-3 and omega-6 fatty acids in your diet as an imbalance may contribute to a number of chronic diseases. Although omega-6 fatty acids have many helpful benefits, they also have some prooxidant or pro-inflammatory effects; thus, the need to limit them in our diet. The recommended ratio of omega-6 to omega-3 fatty acids in the diet is 4:1 or less. However, for most of us that ratio is between 10:1 and 50:1, so we need to try to reduce our omega-6 intake and increase our omega-3 intake. Below are some examples of each:

 

  • The best source of omega-3 fatty acids is oily fish, such as salmon, mackerel, sardines, and anchovies. If you cannot or prefer not to eat fish, alternative sources include chia seeds, walnuts, and flaxseeds – or you can take a fish oil supplement.

 

  • The most common sources of omega-6 fats are refined vegetable oils, such as soybean and corn, and foods cooked in those vegetable oils. In addition, these fats are found in foods like mayonnaise, walnuts, sunflower seeds, almonds and cashew nuts. You may now see why the standard American diet contains more omega-6 than omega-3 fatty acids.

 

Before moving on from fats, let’s take a moment to discuss the “bad” fats that you want to reduce or preferably eliminate from your diet due to their harmful effects. There are two types of fat that should be eaten sparingly: saturated and trans fatty acids (or trans fats). Both can raise cholesterol levels, clog arteries, and increase the risk for heart disease.  Saturated fats are found in animal products (e.g., meat, poultry skin, butter, and eggs) and in vegetable fats that are liquid at room temperature, such as coconut and palm oils. Trans fats are used extensively in frying, baked goods, cookies, icings, crackers, packaged snack foods, microwave popcorn, and some margarines. Bottom line: you want to reduce your intake of these two types of fat as much as possible in favor of the healthier fats discussed above.

Some of you may be wondering where dairy products fit into this diet. We discussed some dairy products such as eggs and butter. In general, the recommendation is to limit whole-fat dairy products, and choose high-quality natural cheeses, such as Swiss or Parmesan, and yogurt (just be careful of products with high sugar content). When it comes to dairy products, this is one area where you may want to listen to your body and how it handles dairy products. For some, dairy can have inflammatory effects particularly in the gastrointestinal area and/or in the sinuses. If that is the case, consider dairy alternatives such as milk and cheeses made with soy, or almond.

I hope this information helps take some of the mystery out of the anti-inflammatory diet. If you believe your current diet needs improvement based on these recommendations, just remember that you can succeed by taking small steps, one at a time. You don’t have to completely revamp your entire diet overnight. Start with one recommendation and choose one small change you can make this week. Good luck!

Nutrition – Part 2 – How to Eat

In the last post about nutrition, I discussed some of the general recommendations around what kinds of foods to eat to promote or maintain good health. Today we are going to look at the topic of nutrition from another angle, one that I believe is equally as important – how to eat to maintain a healthy weight and stay healthy.

Weight loss/weight management is a heavily debated topic, and one that is also very popular based on the number of books, websites, and programs that exist to help individuals on this journey. Again, my goal with this post is to provide general guidelines that are supported by sound research that can help if you are struggling to maintain a healthy weight. As some of the latest science has revealed, there are several surprising factors that play into whether someone can lose weight and keep it off. There is no “one size fits all” approach and what works for one person may not work for someone else. The researchers also concluded that it can take multiple tries to figure out what works for you. My hope is that you’ll find one or two solid strategies that fit your needs and lead to success.

 The Dieting Paradox

 It is probably no longer a shocking fact to hear that 71% of American adults are overweight. A 2017 study found that obesity now drives more early preventable deaths in the U.S. than smoking. This has fueled a weight-loss industry worth $66.3 billion, selling everything from diet pills to meal plans to fancy gym memberships. And yet more and more research is demonstrating that traditional dieting, such as cutting calories or restricting certain kinds of foods, DOES NOT WORK.

There is a body of research dating back to World War II around dieting and the ensuing cycle of losing weight and regaining weight (sometimes more than was lost). The impact of this “yo-yo dieting” is to ratchet up the baseline weight even higher, beyond the individual’s original weight. Researchers at UCLA conducted a meta-analysis of 31 long-term studies on the effectiveness of dieting. They concluded that dieting is a consistent predictor of weight gain – up to 2/3rds of people regained more weight than they lost. So yes, dieting can actually put you at risk of gaining weight. Let that sink in for a minute.

There are neurological, hormonal and metabolic changes that occur when you engage in dieting behaviors and/or lose weight. For example, your metabolism slows down when you lose weight, but researchers have found that if you gain some or all of that weight back, your metabolism does not increase accordingly. So, the bottom line is, unfortunately, that biology is working against you when you diet.

A mindful approach – changing your relationship with food

So, what is the good news, you ask? There is another way! It is a slower, but more sustainable approach to weight management. You’ve probably heard the advice that in order to be successful at losing weight and keeping it off, you can’t succeed with short-term fixes – you have to make lifestyle changes that are sustainable over time. This is solid advice and the basis for what many have now coined “mindful eating.” This approach is not about making external changes such as restricting calories, but rather adopting an inner-oriented process where you tune into your mind and body for cues about hunger and eating.

Changing eating behavior is difficult because it is an automatic behavior that we’ve been doing for decades. How many of you have experienced eating on “autopilot” – when you intend to just have a handful of chips and next thing you know, the bag is empty? And you can’t remember eating them all? Mindful eating is about disengaging this autopilot and bringing awareness and intention to the act of eating. It takes time and practice to be mindful, but by learning to tune into your body, noticing hunger and fullness signals and the way food really tastes, you can radically change your experience of eating.

Some helpful tips, tools and resources

 As you have probably figured out, mindful eating is rooted in the practice of mindfulness. I touched upon mindfulness in my post highlighting the various areas of the Wheel of Health, and we will explore it further in a future post. Mindfulness is about paying attention on purpose, in the present moment and without judgment. Building a mindfulness practice in general will help you eat more mindfully. For now, we will focus on some basic strategies you can explore and adopt to help move you along your path to mindful eating.

  • Be present at meals – stop and focus on eating when you eat. Turn off the TV, put down the newspaper, book or phone, sit down at the table. Slowing down and being present while eating can prevent overeating, eating unhealthy foods, and help you tune into your body’s hunger and fullness signals. This may be a challenge if you are used to eating on the run or multitasking while you eat. If so, start small – try it for one meal and notice how it feels when you give yourself permission to simply be present and eat.

 

  • Stop judging – judgment plays a powerful role for people trying to change their eating habits and/or lose weight. We often turn a simple fact (“I ate the whole pint of ice cream in one sitting!”) into a condemnation of ourselves (“I have no willpower and will never lose weight”).  Being mindful can help break through this “all or nothing” thinking and the failure-shame-avoidance spiral that is common in weight loss (“I pigged out at the buffet. I have no willpower – it’s useless, I’ll never be able to lose weight so I might as well quit trying.”)  Rest assured, this is not about letting yourself off the hook or making excuses for less than optimal choices. As you increase awareness and cease to judge, you will learn to shift course before or while engaging in the unhealthy choice or habit; it actually allows for accountability.

 

  • Be kind to yourself – compassion will get you further than punishment. Think about a baby learning to walk. He is bound to stumble and fall, but do his parents judge or criticize him and tell him he’ll never learn to walk? No, they respond with love and encouragement to keep trying. We need to do the same for ourselves. This can be difficult as our society tends to favor finding the problem and focusing on what needs fixing. This works sometimes but not always. We also find it easier to treat others with compassion but not ourselves. If you had a friend struggling to lose weight and she shared her difficulties and setbacks, you most likely would empathize and encourage her to keep working toward her goal. Why not extend that same kindness to yourself?

If all of this seems a bit overwhelming, it may help to start by trying a simple tool that you can use anytime, anywhere. It is called the Hunger-Fullness Scale and it helps you tune into your body’s natural signals around the need to eat or stop eating. Here is one example that you can use.

hunger-fullness-scale-e1506543610976.png
Sample Hunger-Fullness Scale

Before you eat, pause for a moment to assess where you are on the scale in terms of hunger or fullness. The recommendation is to eat when you are moderately hungry (around a 2-2.5 on the scale) and to stop eating at the first sign or signal of moderate fullness (around a 5-5.5). As you may be aware, it takes about 20 minutes for your stomach to signal to your brain that you are full or starting to get full. Thus, slowing your pace of eating can also help you tune into signals of fullness, as will using this scale after you begin eating and when you finish your meal.

If you are interested in learning more about mindful eating, there are a number of excellent resources available on the topic. Two of my favorite books are “The Mindful Diet” by Ruth Q. Wolever and Beth Reardon and “Savor: Mindful Eating, Mindful Life” by Thich Nhat Hanh and Lilian Cheung. In addition, there is an excellent website called The Center for Mindful Eating.

Learning to eat mindfully is a process and a journey, but I believe you will find it is worth the effort. Start small, explore and see what works best for you – one bite at a time.

 

 

Nutrition – Part 1: What to eat

Ahh, nutrition – probably one of the most debated areas on the Wheel of Health. There is so much that can be written about eating a “healthy diet” but given that the recommendations seem to change daily, where does one start? Eggs are bad for you. Whoops, now they’re good for you! Eat low fat foods. Nope, now you need healthy fats. No wonder so many people are confused and frustrated – and therefore, reach for the quickest, most convenient thing they can eat regardless of its nutritional value. Who has time to figure it out, right?

Let me start by stating that I do not have a degree in nutrition and I am not a registered or licensed dietician so I will not be dispensing any specific dietary advice. My goal with this post is to help weed through much of the conflicting information out there and present some basic guidelines that most of the experts do agree on when it comes to the food we put in our bodies. I am of the firm belief that everybody – and every BODY – is unique and thus, what works for one person will not work for someone else. The bottom line is choosing foods that nourish and strengthen your body and mind.

What the experts say

It’s probably no surprise that even the experts can’t agree on what specific diet is best for us. However, in a review of the health benefits of many popular diets (think low fat, low carb, vegan, Mediterranean, paleo and so on), there were a few general patterns that rose to the top. In a nutshell, they include:

  • Eat minimally processed foods direct from nature
  • Eat mostly plants
  • If eating animal foods, choose ones that were raised on plant foods

(Of note, the authors point out that these dietary guidelines are beneficial not just to humans, but other species as well as the environment around us. A win-win-win if you are equally concerned about animal welfare as well as the impact of farming on the earth.) The well-known author/journalist Michael Pollan wasn’t too far off when he summed it up in seven words: “Eat food, not too much, mostly plants.” And to clarify, he meant eat real food like vegetables, fruits, whole grains, fish and lean meat. Or as he so simply states it: Don’t eat anything your great-grandmother wouldn’t recognize as food.

Some small steps to get started

I know what you’re probably thinking – easier said than done, especially if you work full-time, have a family to take care of and don’t want to (or can’t) spend hours focused on planning and preparing healthy meals! The good news is that it does not have to be hard. There is a plethora of resources available for anyone who is looking for a little help in this arena. I have listed a few of my personal favorites near the bottom of this post, but here are a few simple guidelines to help you get started:

  • Reduce the amount of processed foods you eat, which is pretty much anything that comes in a box or package with a food label on it. And if that food label has more than 5 ingredients or a bunch of ingredients you can’t pronounce, put it back on the shelf.

 

  • One way to help reduce the amount of processed foods you eat is to avoid the middle aisles at the grocery store as that is where most processed foods are found. You may already be familiar with the advice to shop the perimeter of the store, where most of the fresh foods are located (e.g., produce, fresh meats). Good advice and a great place to start.

 

  • Many of us could benefit from increasing our fruit and vegetable intake. Both the USDA MyPlate and the Harvard Healthy Eating Plate recommend that half your plate at meals consist of healthy fruits and vegetables (unfortunately, potatoes and French fries don’t count). There are so many choices when it comes to produce – experiment and find what works best for you, whether it is munching on raw veggies as a snack, drinking a fruit smoothie for breakfast, or adding a salad of leafy dark greens as a mainstay of your lunch and dinner. Even the pickiest of eaters can find a few fruits and veggies that they like.

Resources to help you take a deeper dive

As someone who is responsible for the bulk of meal planning and grocery shopping for my family, I understand that it may feel daunting to figure out how to put these recommendations into action. Thus, I have compiled a few resources that have really helped me in this arena. As I mentioned earlier, everyone is different so these may or may not work for you, but I pass them along as food for thought (pun intended).

There are many books and websites out there related to the “real food” movement, but one of my favorites is 100 Days of Real Food by Lisa Leake (the website and the related cookbooks). The reason it resonates with me is because it is a real family that made a pledge to reduce – or actually, eliminate – the amount of processed foods they ate and they were successful, even with two young children. My family has not yet taken the plunge to completely eliminate processed foods, but we have been inspired to reduce the processed foods in our diet and cook and eat more real, whole foods. I have one of Lisa’s cookbooks, which has many simple, healthy recipes (a key for me as I am not all that confident in the kitchen). Her website is also chock full of healthy recipes and meal plans for those who need a little extra help in the kitchen.

Given that my family’s quest to eat a truly healthy diet is still a work in progress, and we stumble from time to time with less than optimal choices, I have found comfort in the “good-better-best” approach when it comes to decisions about what to eat. I am not sure who gets credit for this principle, but I found a neat infographic on the Weed ‘Em and Reap website. In essence, this approach is about “doing the best you can with what you have” – which is all we can really ask, right? Maybe you’ll never live in the “best” column, but if you can make some small changes that bump you from bad to good or good to better in a couple of the food areas, that is reason to celebrate. Every little bit helps.

Finally, if you feel overwhelmed by the time and effort you think it might take to implement changes in your diet and seek a supportive community to help you on this journey, you may want to look into The New School Kitchen, or NSK as we members like to call it. The New School Kitchen is an interactive, video-based monthly membership program designed to help you “rock your cooking and eating without hating your family or life” as owner/creator Ryanna Battiste describes it. I have been a member since NSK was launched in August 2016 and it has been a huge help with meal planning and meal preparation centered around eating tasty, healthy real food. Members have access to everything from meal planning tips to healthy recipes to cooking demonstration videos. There is also a private Facebook group where members can ask questions, share resources and support one another along this real food journey. Most recently, the NSK has added the option of working with a health coach either individually or as a group. The beauty of the NSK is that it is self-paced – you determine when and how to engage and work at whatever pace suits your needs. Membership is only $21/month and you can cancel your subscription at any time.

(Note: In the spirit of full disclosure, Ryanna is a fellow Certified Integrative Health Coach – we did our training together at Duke Integrative Medicine. However, I am not getting compensated to promote NSK – in fact, she doesn’t even know that I am mentioning her business in this blog post. I hired Ryanna as my coach a couple of years ago when I decided to work on reducing dairy in my diet after years of suspecting that I had an intolerance. I can personally vouch for her integrity, wisdom and professionalism as a health coach. She is an amazing woman and to me, has created one of the most innovative approaches to healthy eating with The New School Kitchen. She is also just a ton of fun to watch in her videos as she’s not afraid to be real and share the ups and downs of her own real food journey.)

Whew, that was a lot to cover! Next time, we’ll move beyond what to eat and focus on how to eat – mindful eating, one of my favorite subjects!

 

The Wheel of Health and Your Optimal Health Journey

wheel2-878x1024Today I’d like to share an overview of the Duke Integrative Medicine Wheel of Health (WOH). This wheel provides a framework for creating your personalized health plan – and a map of your optimal health journey. We will explore the various parts of the wheel in-depth in subsequent posts, but for now, let’s look at the big picture.

The WOH represents the whole picture of your health and wellbeing. It is a multidimensional, whole person approach that considers body, mind and spirit. As you can see, it does not focus on just physical health. It goes beyond managing disease and instead emphasizes optimizing health.

Dimensions of the Wheel

You

At the center of the wheel is YOU, because health coaching is a person-centered process. Your health journey is driven by your values, goals and desires. As a coach, I won’t tell you what to do or not to do – you get to decide based on your priorities and what works for you.

Mindful Awareness

Surrounding the center of the wheel is Mindful Awareness. The concept of mindfulness – paying attention on purpose, in the present moment, and non-judgmentally – is a powerful tool and resource for behavior change.  Being more present and aware of what is happening to you and in you can help you respond to changes in your life in a more proactive, engaged way.

Self-Care

The green ring in the wheel represents the seven areas of self-care. People often focus their efforts here when making changes to their health behaviors. Evaluating your current and desired states in each of these areas can help you create a healthier life. These include:

Movement, Exercise and Rest – This area addresses physical activity, whether it be formal exercise (for example, running 30 minutes a day) or general activities of daily living (such as cleaning the house or grocery shopping). Just as important, it also incorporates the need for adequate rest (good sleep is vital!) and relaxation or “down time”.

Nutrition – In a nutshell, eating a balanced, healthy diet that fuels and nourishes your body and mind. There is no specific diet that is recommended. There are some key healthy eating strategies that we’ll discuss in a future post, but it is also based on what works for your body.

Personal and Professional Development –  It is helpful to assess where you are with personal, career or life goals, particularly at times of transition or milestones. These may include work-life balance, financial goals, and personal growth that will support optimal wellbeing. Regular assessment of your goals can reinforce healthy behavior choices.

Physical Environment – Studies have suggested that your surroundings at work and home can impact your health, either positively or negatively. Exposure to light, noise or toxins in your home or work space can have a major impact on how you feel physically and emotionally. On the other hand, a supportive, nurturing physical environment can enhance your sense of peace and wellness.

Relationships and Communication – Research demonstrates that positive relationships built on open, respectful communication with family, friends and colleagues can have a beneficial impact on your health. Identify those relationships in your life that fuel you and those that drain you. In doing so, you can invest in your positive connections and minimize or re-evaluate those relationships that don’t serve you.

Spirituality – This area is about finding purpose and meaning in something larger than oneself. For some people, it may include a religious affiliation. For others, it may be a connection to nature or the arts. Although the definition of spirituality is very personal in nature, the role that it plays in your life can transform your health.

Mind-Body Connection – This area relates back to the inner ring of Mindful Awareness. It focuses on mind-body practices that can help you be more present. Techniques include things that activate the body’s relaxation and healing response, like breathing practices, meditation, yoga, or guided imagery.

Professional Care

It is important to seek routine preventive medical care such as an annual physical exam, recommended cancer screenings (e.g., mammogram, colonoscopy) and vaccinations. In addition, you can supplement your usual medical care with complementary approaches such as acupuncture, massage, hypnosis or energy work. A primary goal of Integrative Medicine is to remove the distinction between conventional and complementary approaches and create one integrated approach to health care. In this model, patients and their providers work together to determine the most effective, evidence-based personalized health plan to achieve life-long wellbeing.