4/27/17 Less Is More 

Irritable bowel syndrome (IBS) is a gastro intestinal disorder of function. Unlike celiac (gluten intolerance) disease, Crohn’s disease, or colitis, IBS is not the result of abnormalities or damage to the G.I. track. Instead it results from changes in the normal way the large intestine works, despite the digestive system appearing normal.

Unfortunately the cause of this malady is not well understood but we know that stress and dietary habits are usually contributory. Additionally, heredity, allergies, abnormal amounts of bacteria growing in the large intestine, infections, increased intestinal sensitivity and a high-stress lifestyle are all associated with the disorder. Generally symptoms include a cluster of chronic pain/discomfort in the abdomen and changes from usual bowel movement patterns.
Women are more frequently afflicted by (IBS) with a 2 to 2.5 times greater incidence then men. Women also have gender specific symptoms. For many, healthy dietary and lifestyle changes (including stress reduction) manage the symptoms effectively. But in some cases, medication is recommended. The lack of clarity of cause makes treatment more of a challenge and very much necessitates individualized care.

IBS treatment is based upon symptoms. Therefore no “one-size-fits-all” therapy is recommended. The best personalized management starts with identifying the triggers, and then reducing them as much as possible. Starting with an elimination diet is recommended. Elimination diets remove all suspected trigger foods for 2-3 weeks with a gradual adding back of one food at a time, as tolerated.

Often problematic foods include dairy products with lactose (milk sugar), large meals, high fat foods, and several food additives (i.e., MSG, sulfites, sugar-free sweeteners). Carbonated beverages can cause increased gas production and further exacerbate irritation and prolonged discomfort. Caffeine and alcohol consumption and cigarette smoking, all gastro-intestinal stimulators, are additional culprits identified. Stringent documentation of one’s intake and discomfort responses can be very beneficial to the prevention of painful response episodes.

The health and vitality of the GI track is fundamental to normalizing its functionality. Consensus from Academy Nutrition and Dietetics, NIH, and Mayo Clinic reflect the following dietary recommendations for IBS patients:

• Avoid or minimize high-gas foods such as broccoli, cauliflower, cabbage, and beans as well as carbonated beverages.

• Avoid chewing gum or drinking liquids through a straw, to reduce swallowing air, which causes more gas.

• Minimize consumption of fried or other high-fat foods.
• Reduce meal size to reduce cramping and/or diarrhea, and eat smaller, more frequent meals instead.

• Minimize consumption of foods high in lactose, such as milk, ice cream, and soft cheeses, especially if lactose intolerance is suspected. Use hard cheeses, lactose-free milk, lactose-free ice cream and low-lactose or lactose-free yogurt or kefir, with less lactose than other dairy products, may be more easily tolerated.


Water is key to life

It’s summer and we know we need more water, right! Well yes! Most scientists will tell you that our bodies are 60+ percent water (including the fluids in our cells, our tissues/ organs, our blood and our plasma). That makes water the most important nutrient that we consume for our health.

We use it progressively throughout our day, in all of the body’s activities. Understanding this should cue us to drink in increments, gradually all day and not wait for our thirst to motivate us. Our individual needs vary based upon our age, sex, body type and our ability to sweat, and the intensity of activity we are participating in. This time of year when summer sports are enticing us, proper hydration is especially critical.

The USGS (US Geological Survey) quotes Dr. Jeffrey Utz, of Allegheny University, as saying “different people have different percentages of their bodies made up of water. Babies have the most, being born at about 78 percent. By one year of age, that amount drops to about 65 percent. In adult men, about 60 percent of their bodies are water. However, fat tissue does not have as much water as lean tissue. In adult women, fat makes up more of the body than men, so they have about 55 percent of their bodies made of water.”

A different perspective on water’s focal point as our most important nutrient comes from others. They assert that it is water plus the many solute components contained in the water that are the critical nutrients for our sustenance.

So what does this mean and who is right? Both perspectives are valid, especially when one looks at what the body’s “water” is made up of and the comprehensive functions it serves to support our health.

Our total body “water” is not H2O alone, it also contains multiple solutes including sodium potassium, calcium and magnesium, chloride bicarbonate, phosphate, proteins and other critical nutrients. Its multiple functions include promoting growth, development and maintenance of all body tissues, generating hormones and neurotransmitters, and regulating our body temperature, forming our saliva to aid in digestion, keeping our tissues (such as the mouth, eyes and noise) moist, lubricating our joints, cushioning and protecting our body organ and tissues, helping to promote regular illumination thus preventing constipation, supporting kidney and liver flushing of waste products, facilitating metabolism and carrying nutrients and oxygen around the body to the body.

There are some extreme risks to inadequate hydration. Insufficient fluid intake can lower your physical and mental performance, causing headaches, lethargy, mood changes, weakness tiredness, confusion, hallucinations and slow response times. Continued challenges include dry nasal passages, dry or cracked lips, dark-colored urine, increased risk of kidney stones, and salivary gland function.

Eventually dehydration leads to the end of urination and subsequent failure of the kidneys, resulting in the body’s inability to remove toxic waste products. In extreme cases, dehydration may result in death.

The wise choice to avoid this potential health emergency is prevention. That means consuming adequate water. And that means what? According to the Mayo Clinic: “We must replenish the loses from breathing, perspiration, urination and bowel movements.” The Institute of Medicine determined that an adequate intake (AI) for men is roughly about 13 cups (3 liters) of total beverages a day. The AI for women is about 9 cups (2.2 liters) of total beverages a day.

It’s not always easy or convenient to drink all of that water. Good news is that one can get about 20 percent of the water needed through foods we eat. Fluids obtained this way have the advantages of slowed excretion through urination, significant when traveling or doing other activities that preclude immediate availability of the facilities.

Some great hydrating foods, because they are at least 90 percent water by weight include: cucumbers (96.7), grapefruit (90.5), iceberg lettuce (95.6), celery (95.4), tomatoes (94.5), spinach (91.4), radishes (95.3), green peppers (93.9), cauliflower (92.1), watermelon (98.0), star fruit (91.4), strawberries (91.0), broccoli (90.7), baby carrots (90.4), and cantaloupe (90.2). Further bonus is that they add additional nourishment of vitamins, minerals and antioxidants with few calories.

A word of caution using other beverages for hydration! Sports drinks, coffee, tea, and other various flavored waters may contain caffeine and other added stimulants that can be instead dehydrating. Worse, some may even cause insomnia, tremors, tachycardia, heart palpitations, and upset stomach, vomiting and abdominal pain, hypo-kalemia, hallucinations, increased intracranial pressure, cerebral edema, stroke, paralysis, altered consciousness, rigidity, seizures, arrhythmias, and death. Be thoughtful in choosing these beverages or allowing you children to consume them. Read labels carefully and discuss safety of consumption with your PCP and Registered Dietitian Nutritionist.

Qualified advice supports the best possible health outcomes.

As always, for the health of it ...


Nutrition notes for the teen mom

Yes, a healthy diet during pregnancy is vital to the optimum growth and development of the baby. Adequate nutrient intake during this time is of equal importance for mom’s well being, especially if she is a teen. A teen mom’s own growth and development necessitates high nutrient requirements. The addition of pregnancy significantly compounds these needs.

Getting early prenatal care to include a personalized nutritional plan decreases the health risks and supports a healthy outcome for mom and baby. Of note: The most frequent complications for pregnant teens under age 15 who are not receiving prenatal care include a low iron levels in the blood (anemia), high blood pressure and preterm labor. Babies born to teen mothers are more likely to be born prematurely and have a low birth weight.

Individual needs vary by person. Current eating patterns including specific food exclusions/preferences (eg: vegetarianism) and state of health should be assessed to create the optimum pregnancy eating strategy. Recommendations should consider maternal’s age, weight, state of health (to include chronic illness or metabolic conditions eg.: gestational diabetes, hypertension, pre-eclampsia, gastrointestinal disorders, eating disorders, food intolerances or allergies, etc.) activity level, individual metabolic rates and assessed appropriate weight gain for best pregnancy outcomes.

General guidelines from the American College of Gynecology and Obstetrics (ACOG) recommend nutrient and caloric levels with increased protein, iron, calcium, and folic acid intake individualized to mom and baby’s needs.

Step 1 for any teen is taking a thorough review and assessment of their usual dietary intake and quality. This can reveal what deficits exist. Frequently at-risk micronutrients include vitamins A, B6, B12, Folate C and D, Choline, Docosahexaenoic Acid (DHA), Iodine, Iron, Zinc. In the first trimester increased protein is particularly important. Increasing calories, including healthy fats to 200-300/per day is recommended in the 2 nd and 3 rd trimesters and while breast feeding. Step 2 is embracing the reality that dietary intake directly relates to the health of the womb and fetus. Step 3 is taking responsibility for consuming all necessary nutrients daily, in support of the best pregnancy outcomes possible.

The National Academy of Sciences Engineering and Medicine have established Dietary Reference intakes for pregnancy in age 18 or less and a detailed list can be found at The highlights of nutrients of greatest concern are as follows: Water: 3 liters(quarts)/day, Vitamin A:2500 IU/day, Vitamin B:1.9mg/day, Vitamin B12 : 2.6mcg/day, Folate: 600mg/day, * higher recommendations for women with a history of any neural tube defects, Vitamin C: 80 mg/day, Iron: 27mg/day, Zn: 12mg/day Carbohydrates 175 gms/day, Protein: 70-80gms/day, and Fiber: 28gms/day. A healthy diet based predominantly on vegetables, fruits, beans, legumes and nuts complemented with adequate protein, dairy and healthy fats will supply these vitamins, minerals, anti-oxidants, bio-flavinoids, essential fats, and fiber. However to meet all of these requirements most Peri-natal Care Providers recommend daily use of a prenatal vitamin, check with your provider for your personal recommendations.

Some other concerns during pregnancy relating to nutrition:

Food cravings during pregnancy: The cause remains unknown but it is usually resolved by the end of the 1st trimester. Craving non-food items (PICA) should be discussed immediately with your health care provider.


Don't Overlook Nutrition

Priming your health prior to any surgical procedure, including plastic surgery, significantly promotes best recovery outcomes. Inadequate nutritional status prior to surgery can increase the risk of surgical complications and infections and delay post surgical healing.

Surgery is a stress to the body, causing metabolic and physiologic responses such as inflammation, depleted nutrient stores and possibly impaired immune responses. The amount and degree of impact of stress is individualized and influenced by one’s state of health at the time.

People having chronic medical conditions, cancer, or any immuno-suppressing disease processes, a loss of more than 5 percent of weight in the last one to three months, a BMI of less than 18.5, or steroid use, require a personalized prescribed pre-surgical nutrition regimen. So consult your surgeon and dietitian. Adhering to a healthy eating pattern, exercise and sleep routine for at least several weeks pre-operatively is the smart choice. Also significant research has verified the impact of adequate post-operative nutrition intake in optimizing healing.

Research based general nutrition recommendations before and after surgery include:

• Adequate hydration. Water is 60 percent of an adult body’s composition. It vitally serves as a necessary fluid in the cells and tissues. Water supports digestion and movement of all nutrients and excretion of wastes. It enables better wound healing by supporting increased blood volume, mediating body temperature, and facilitating wound drainage. Studies show that when patients are well hydrated, they report less pain and nausea after surgery. Intake of two quarts of water daily is recommended.

• Sufficient dietary protein (critical to wound healing) ensures new growth and repair of cells, for post-operative tissue repair, good blood circulation, and appropriate immune function. Protein deficiencies can present serious problems and stimulate breakdown of body muscle to be used as a resource. Protein’s building blocks are called amino acids. Ten of these amino acids are essential, meaning they have to be consumed as the body cannot make them.

Two very important amino acids paramount to good healing are arginine and glutamine. Arginine- and glutamine-rich foods include red meat, fish, poultry, wheat germ, grains, nuts and seeds, and dairy products. Glutamine is also amply available in pork and turkey beans, milk, raw spinach, cabbage and parsley. Good sources for protein generally include meat, poultry, fish, dairy, eggs, tofu, soybeans, nuts and grains.

• Extra Vitamin A and C, Coenzyme Q10 and the mineral Zinc support increased cell and tissue development along with antioxidant and immune functions to promotes healing. Vitamin E plays a significant part in important anti-oxidant activity, especially in the skin. Vitamins A and C are plentiful in spinach, kale, carrots, bell peppers, sweet potatoes, grapefruit, cantaloupe, and strawberries. Zinc is easily gotten from red meat, and poultry as well as in many sea foods. Coenzyme Q10 (CoQ10), similar to a vitamin, is used by cells to produce energy, and is found mostly in fish, and meat.

• Glucosamine, familiar to many for its joint health promotion, appears to be another important nutrient in wound healing and promotes the development of cells that make hyaluronic acid. Hyaluronic acid is a type of carbohydrate the body makes to hydrate, lubricate, and support cell structure, increasing the reliability of wound healing. Foods rich in Hyaluronic acid include skin, bones and connective tissues of animals, particularly chicken, apples, tomatoes, avocados, strawberries, beets, spinach, sweet potatoes, green peas, carrots, pineapples, pumpkin seeds, soy, shark cartilage, and the shells of shellfish.

• Sufficient and healthy essential fat intake should not be over looked. Essential fats are important in restoring body structure and function after surgery. They supply concentrated calories, transport fat-soluble vitamins (A, D, E, K) to cells, and fortifying every cell wall. Good dietary fats come from fish, nuts, flaxseed, avocado, olives, vegetable oils, eggs, dairy products, and meat. Grape seed extract supports Vitamin C movement into cells, improves cell membrane strength and decreases swelling and scarring. Avoid the inflammatory saturated and trans fats found in fried and processed foods.

• Regularly taken pro-biotics can support good bacteria in the bowels and counter the often prescribed postoperative antibiotic therapy side effects of nausea, gas, bloating, constipation and general discomfort.

Also helpful post operatively: the anti-inflammatory monounsaturated foods like extra virgin olive oil, avocados, tart/sour cherries and blueberries. Bromelain is an anti-inflammatory proteolytic enzyme has been demonstrated to significantly reduce swelling and bruising post-operatively. Arnica Montana, an anti-inflammatory herb, functions to enhance blood flow to injured tissues to reduce swelling and pain. Check with your surgeon for dosing on both.

There are some precautions regarding dietary supplements pre-surgery. Some can cause post-surgical bleeding, worsen inflammation, raise blood pressure, or alter blood sugar levels. This list includes but is not limited to: diet pills or herb blends designed to control appetite, Vitamin E, Chromium, Garlic, Ginger, Ginkgo, Goldenseal, Flaxseed, Fish oil, Echinacea, Licorice, Saw Palmetto, Ephedra, Ginseng, Feverfew, Kava-Kava, St. John’s Wort and Valerian Root.

Generally, quitting all herbal supplements three weeks prior to planned surgical procedures is advised. As a precaution, before your procedure, discuss all supplements being taken with your surgeon.

To ensure nutritional adequacy before and after surgery, anyone on a Medical Nutrition Therapy regimen for an ongoing medical condition should consult with their doctor and/or registered dietitian. Qualified advice supports the best possible patient outcomes.

As always, for the health of it...


For Your Heart's Sake

OK ladies, this is about you. Heart disease is the number one cause of death in women! Stroke is close behind as the third offender. Empowering yourself, by understanding the risk factors, can decrease your chances of becoming a victim of both.

The Office on Women’s Health, U.S. Department of Health and Human Services, reports that the more risk factors a person has, the higher their chances of getting these diseases. Risk factors related to age, race, ethnicity and family history are beyond our control. The good news is that there are other substantial risks that we can significantly manage. For example, high blood pressure, abnormal cholesterol, diabetes, excess weight, smoking, inadequate sleep and physical inactivity are related to lifestyle choices. Taking personal responsibility and adhering to a healthy eating pattern, exercising regularly, sleeping adequately, and quitting smoking are the key strategies to decreasing the potential of heart disease mortality.

Personalizing one’s heart health strategy begins with assessing one’s current state of health. Heart healthy eating plan recommendations then depend on whether it is prevention or treatment that is needed.

For those who do not have heart disease and are looking to reduce their chances of developing it, The National Heart, Lung, and Blood Institute’s Heart Healthy diet recommendations are sound advice. These include whole unprocessed food meals, snacks with plenty of vegetables, a focus on whole grains, about 8 ounces a week of fish high in omega-3 fatty acids, skinless poultry, 95 percent lean meats, eggs, nuts, seeds, and soy products.

Legumes/beans and foods containing high levels of monounsaturated and polyunsaturated fats that help lower LDL blood cholesterol levels are recommended. Emphasis is on oils instead of solid fats, and fat-free or low-fat dairy. Finally limits on sodium, saturated and trans fats, added sugars, and alcohol are additional key points. A heart-healthy diet is low in sodium, saturated fat, trans-fat, LDL cholesterol and refined sugars and high in nutrients.

The Mediterranean-style diet proven to decrease cardiovascular disease closely approximates these recommendations. It specifically focuses on the use of Olive oil, more fish including shell fish, alcohol in moderation and very limited meat, cheese and sweets. The other research documented diet that reduces cardio vascular events is quite a bit more stringent. This regimen is The Dean Ornish Diet, a strict vegetarian, very low fat (10 percent) regimen and difficult for many to follow.

In the case of established heart disease calling for treatment, the Dash Diet (in the case of high blood pressure) or the TLC Diet (where LDL cholesterol is high) both created by NIH are highly recommended.

The DASH eating plan (Dietary Approaches to Stop Hypertension) is recommended for individuals with high blood pressure or hypertension. High blood pressure and “bad” LDL cholesterol can lead to heart disease and stroke in time. The DASH diet is a lifelong approach to healthy eating and encourages reduced sodium, eating a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium.

The DASH diet emphasizes vegetables, fruit and low-fat dairy foods, and moderate amounts of whole grains, beans, fish, poultry and nuts. It is low in saturated fat, cholesterol and total fat. Sweets, added sugars and beverages containing sugar are restricted. In addition to the standard DASH diet, there is also a lower sodium version of the diet.

The TLC diet is focused on cholesterol reduction because too much LDL (bad) cholesterol circulating in the blood can infiltrate into the inner walls of arteries, including those to the heart and brain. Together with other substances it can form a thick, hard deposit (plaque) that can narrow the arteries, reducing their flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result.

Specific recommendations include: total fat intake equaling 25-35 percent of total calories, saturated fat less than 7 percent of total calories, polyunsaturated fat up to 10 percent of total calories, monounsaturated fat up to 20 percent of total calories, avoidance of trans fat (high in processed foods), carbohydrate soluble fiber equaling 50 percent to 60 percent of total calories, at least 10 to 25 grams a day of protein (approximately 15 percent of total calories), and less than 200 mg of cholesterol a day.

Total daily calorie intake should be balanced with what’s burned to reach and stay at a healthy weight. At least 30 minutes of a moderate intensity physical activity, such as brisk walking, on most, preferably all, days of the week is recommended as well. More vigorous activities are associated with more benefits.

All heart healthy regimens do include recommendations for regular aerobic exercise, involving the large muscle groups. Aerobic activities include brisk walking, cycling, swimming, jumping rope and jogging. If walking is the exercise of choice, use the pedometer goal of 10,000 steps a day. Before beginning an exercise routine, check with your primary care provider for best personal strategies.

All heart healthy regimens recommend regular aerobic exercise as detailed above. Before beginning an exercise routine, check with your primary care provider for the best personal strategies.

Remember ladies, you can choose to be healthy. Taking care of yourself isn’t being selfish. It’s insurance that you will be able to take care of those you love for a long time!

As always, for the health of it...


The Keys to Better Uterine Health

This vital pear shaped organ has several monumental functions. Initially it is provides structural support for the bladder, bowel, pelvic bones and organs while separating the bladder and the bowels. Subsequently and very importantly, it is the site of fertilization for the embryo.

Eventually that embryo becomes a baby and the uterus is its home until delivery. Uterine health is born of a healthy lifestyle, just like any organ in the body. Eating the necessary nutrients supports proper cell formation for a good beginning. Its long-term vitality requires a continuum. The best continuous strategy is working to limit hormonal imbalances and injury to the uterine wall, as well as good nutrient intake and regular exercise.

Nutrition has a key part to play in reducing hormone imbalances, supporting a healthy uterine lining, and some say even in preventing fibroid growth or at least its progression.

There is abundant current research substantiating the relationship between eating a whole food diet, balancing hormones, and maintaining a healthy uterine lining. Whole food diets are a regimen rich in the vital building blocks of required vitamins, minerals, and healthy fats. This regimen supports normal uterine processes including normal hormone balances.

Low nutrient diets can increase inflammation and disrupt the hormonal system. These diets are high in sugar, trans-fats, growth hormones, antibiotics pesticides and bisphenol A.

The January 2011 issue of Fertility and Sterility and the December 2011 issue of the American Journal of Clinical Nutrition respectively reported that Vitamin D inhibited the growth of cells involved in uterine fibroid growth and that fruit and retinol (pre–vitamin A) also contributed to reduced risk of fibroid development.

Caloric intake that achieves and maintains normal weight is a good goal to aim for. Also, consuming adequate amounts of fiber (25-35 grams per day) will help remove excessive estrogen, wastes, and toxins from the body. Beans, legumes, vegetables, fruits, and whole grains are great sources of dietary fiber.

Focus on vegetables for calcium, potassium, magnesium and vitamins. Legumes, cabbage, bok choy and broccoli can slow the progress of fibroid tumor growth as they are rich in phyto-estrogens, which compete with the body's estrogen and support their elimination.

Kale, spinach, collard greens and stinging nettles help to maintain the alkaline balance of the uterus, and provide minerals that optimize nervous system function. Their folic acid supports a uterus ready to create a healthy baby.

Fruits, rich in vitamin C and bioflavonoids, can also support normalizing estrogen levels. Bioflavonoids prevent ovarian cancer and aid in keeping the reproductive system healthy.

Dairy products like yogurt, cheese, milk and butter are rich in calcium and vitamin D. Calcium helps to keep your bones healthy, and as mentioned above vitamin D plays a vital role in reducing uterine fibroids.

Green tea is an antioxidant powerhouse and supports fibroid reduction as well.

Cold water fish, such as mackerel and salmon, are rich in omega-3 essential fatty acids. Those fatty acids help to reduce the production of prostaglandin, a hormone-like compound that can cause severe contraction of the uterus. Severe contractions can actually lead to a mal-positioned uterus. These fish also supply levels of protein necessary for healthy tissue growth and sustenance.

Lemons, rich in vitamin C, can help to boost the immune system. Improving the immunity of the uterus enhances its ability to ward off bacteria and prevent infections. Another plus with Vitamin C is that it increases the bioavailability of the iron. This is especially helpful when using plant foods as a principle iron resource. Hail to the vegetarians!

Seeds and nuts provide healthy fats for optimal production of hormones. Almonds, flaxseeds and cashew nuts are rich in omega-3 fatty acids and good (HDL) cholesterol. The omega-3 fatty acids help in eliminating fibroids and also prevent uterine cancer. It also prevents the birth of a premature baby or a low weight full-term baby.

Being mindful and limiting alcohol and caffeine is a good idea as they add to the liver's work load, reducing its ability to metabolize excess estrogen. And then of course there are the multiple benefits of exercise to consider. Exercise profoundly boosts circulation of blood through the entire body, including the uterus and fosters an improved immune system.

There is extensive documentation that athletic women have less instances of fibroid tumors than women who are inactive. For personalized support, contact your PCP and Registered Dietitian Nutritionist.

As always, for the health of it...;

Melanie Ajanwachuku, B.S., R.D.N.,CDE, is a nutritional consultant in the High Desert.


Nutrients Can Play Key Role in a Successful Outcome in Surgery

Optimizing nutrient intake everyday significantly supports a better prepared body should surgery be necessary or even one's choice. Whether an emergency or a scheduled "elective" surgical procedure, physical, emotional and psychological stress is to be expected.

Surgery is a stress to the body that causes metabolic and physiologic responses including inflammation, depleted nutrient stores and possibly impaired immune responses. The degree of the stress and how it manifests is very much an individual matter and influenced by one's state of health at the time. A compromised state of health due to chronic illness or disease process, a loss of more than 5 percent of one's weight in the last one to three months, a BMI of less than 18.5, use of steroids, having cancer, or any immuno-suppressing disease processes can all effect outcomes.

A pre-surgical nutrition regimen warrants a personalized assessment and regimen. Inadequate nutritional status prior to surgery can increase the risk of surgical complications and infections and it can delay post surgical healing. To ensure nutritional adequacy pre and post surgery, anyone on a Medical Nutrition Therapy regimen for an ongoing medical condition should consult with their doctor and/or Registered Dietitian. Qualified advice supports the best possible patient outcomes.

For the most part we understand that eating healthfully means consistently getting adequate calories, protein, carbohydrates, healthy fats, vitamins, minerals, fiber and water to meet ones personal needs. Following healthy eating patterns for even a few short weeks pre-surgery can improve one's immune system. A strong immune system protects against infection that can result from surgery, and each of the multiple stages of healing after surgery requires increased nutrients.

Extra Vitamin A and C and the mineral zinc are necessary to support increased cell and tissue development along with antioxidant and immune function which promotes healing. Vitamin E plays a significant part in important anti-oxidant activity especially in the skin. Vitamins A and C are plentiful in spinach, kale, carrots, bell peppers, sweet potatoes, grapefruit, cantaloupe and strawberries. Zinc is easily gotten from red meat and poultry as well as in many sea foods.

Glucosamine, a nutrient more familiar to most for its joint health promotion, appears to be another important nutrient in wound healing and promotes the development of cells that make hyaluronic acid. Hyaluronic acid is a type of carbohydrate the body makes to hydrate, lubricate and support cell structure, increasing the reliability of wound healing. Foods rich in Hyaluronic acid include skin, bones and connective tissues of animals, particularly chicken; apples, tomatoes, avocados, strawberries, beets, spinach, sweet potatoes, green peas, carrots, pineapples, pumpkin seeds, soy, shark cartilage, and the shells of shellfish.

Taking supplements is quite common today as more people believe they foster wellness. However, there are some precautions regarding dietary supplements pre-surgery due to their enhanced ability to cause post-surgical bleeding, worsen inflammation, raise blood pressure, or alter blood sugar levels. This list includes but is not limited to: diet pills or herb blends designed to control appetite, Vitamin E, chromium, garlic, ginger, ginkgo, goldenseal, flaxseed, fish oil, echinacea, licorice, saw palmetto, ephedra, ginseng, feverfew, kava-kava, St. John's Wort and valerian root. Generally quitting all herbal supplements three weeks prior to planned surgical procedures is advised. As a precaution, before your procedure, discuss all supplements being taken with your surgeon.

Pre-surgery caloric intake should be based upon assessed need. Choosing caloric reduction for weight loss prior to surgery should be discussed with your surgeon. Adequate dietary protein (critical to wound healing) ensures growth and repair of cells, good blood circulation, and appropriate immune function. Protein deficiencies present a serious problem and can stimulate breakdown of body muscle to be used as a resource. Essential amino acids (protein building blocks) have to be consumed as the body cannot make them.

Two very important amino acids paramount to good healing are arginine and glutamine. Arginine and glutamine rich foods include red meat, fish, poultry, wheat germ, grains, nuts and seeds, and dairy products. Glutamine is also amply available in pork and turkey, beans, milk, raw spinach, cabbage and parsley. Good sources for protein generally include meat, poultry, fish, dairy, eggs, tofu, soybeans, nuts and grains.

Sufficient and healthy essential fat intake is important in restoring body structure and function after surgery. Fats supply concentrated calories, transport fat-soluble vitamins (A, D, E, K) to cells, and fortify every cell wall. Choice dietary fats come from fish, nuts, flaxseed, avocado, olives, vegetable oils, eggs, dairy products and meat.

Hydration before and after surgery is very important. Water is 60 percent of an adult body's composition and serves as a necessary fluid in the cells and tissues. Water supports digestion and movement of all nutrients, excretion of wastes, increased blood volume, better wound healing, and supports mediating body temperature and wound drainage. Studies show that when patients are well hydrated, they report less pain and nausea after surgery.

Finally, healing after surgery is also better in a fit body. Ongoing research has demonstrated that wounds heal more quickly in individuals who exercise regularly, especially in adults 55 and older. Exercise supports improved blood flow and speeds oxygen to the healing sites. In fit individuals, collagen formation and white blood cell activity are enhanced and bacteria development inhibited. Remember before beginning or resuming an exercise routine after surgery, check with your primary care provider and surgeon for appropriate strategies.

As always, for the health of it...;


Gestational diabetes: Disease can be managed, but now affects 9.2% of pregnant Americans

OK, you have been diagnosed with gestational diabetes. Don't panic, get informed. The numbers are significant, and warrant attention. According to the Center for Disease Control and Prevention, the prevalence may be as high as 9.2 percent of pregnancies, and is higher in women of minority groups, women of Hispanic, African, Asian, Native American, and Pacific Island ancestry.

The good news is that most women with gestational diabetes go on to have a successful pregnancy and to deliver a healthy baby. Remember if ever there is a time to be informed about and follow a healthy diet this is that time. The mother's health and the baby's normal development depend on it!

So what is gestational diabetes? According to the NIH - National Institute of Diabetes and Digestive and Kidney Diseases, it is a type of diabetes that develops only during pregnancy and usually disappears after delivery. Screening for occurrence for women without known risk is recommended between 24-28 weeks of pregnancy. Where there is clear risk, screening should be at the first prenatal doctor visit.

Focus for mother and baby when gestational diabetes is diagnosed is consistent, carefully management of blood sugars. Uncontrolled blood sugar levels heighten problems during the gestation term for mother and baby. Increased probability of a C-section delivery and even fetal death either before or shortly after birth are extreme complications of gestational diabetes.

Specific pregnancy concerns and complications in gestational diabetes for the baby include: excessive growth and high birth weight, respiratory distress, low blood sugar and seizures immediately after delivery, and a higher risk of developing obesity and type 2 diabetes later in life.

For the mother health issues can include high blood pressure and preeclampsia, and development of diabetes in the future. A healthy diet, appropriate weight gain (as recommended by the PCP) and moderate exercise significantly decreases pregnancy risks. Achieving normal body weight after delivery with consistent exercise decreases lifetime risks.

So let's get to it, what's to be done to avoid non-desirable outcomes and have the best pregnancy and delivery possible? General recommendations for managing gestational diabetes (G.D.) and successful delivery are good meal planning, adequate physical activity, and, in some cases, medication and blood sugar monitoring to support controlled blood sugar.

It is important to be meet with a registered dietitian to have nutritional needs assessed and a personalized meal plan designed. This should include calculating the amount of carbohydrates needed at meals and snacks, and instruction on how to count carbohydrates. Carbohydrate counting is of significant importance to controll blood sugar, as carbohydrates raise blood sugar rapidly. Additionally, the meal plan should be well-balanced, with consistent meal and snack timing. Include a variety of nutrients, limit caffeine and avoid alcohol all together. It is well intended to repeat that normalizing blood sugar in pregnancy and controlling weight gain improves maternal and fetal outcomes.

Individualized meal plan strategies should at least distribute one's food intake between three meals and often include two or three snacks each day. Overeating at one time can cause blood sugar spikes and skipping meals can lead to uncomfortable lows and inconsistent nutrient resources for mom and baby. Balancing food groups at each meal/snack supports more consistent blood sugar. Carbohydrate foods are found in the bread and starch group, the fruit group (high in natural sugars but better than juices because they are high in fiber), and even in milk (high in calcium). Portion control is paramount.

Breakfast still the most important meal of the day! Blood sugar can be difficult to control in the morning, when normal fluctuations in hormone levels occur. Refined cereals mean lots of carbohydrate and along with fruits and milk may result in post-breakfast blood sugar level increases. A better outcome is achieved when breakfast includes carbohydrate plus protein, and it is often better tolerated.

All meals and snacks should strictly limit sweets and desserts! Cakes, cookies, candies and pastries tend to have excessive amounts of carbohydrates. These foods often contain large amounts of fat and offer very little in terms of nutrition. Additionally, avoid all regular sodas and sugar-sweetened beverages.

Read food labels to identify less obvious names for sugars added to foods including but not limited to: Honey or syrup, raw sugar, barley malt, beet sugar, brown sugar, sucrose, buttered syrup, cane-juice crystals, cane sugar, caramel, carob syrup, corn syrup, corn syrup solids, date sugar, dextran, dextrose, fructose, high fructose corn syrup, glucose, invert sugar, malt syrup, molasses, malto-dextrin, and turbinado sugar. Consult with your dietitian regarding the use of artificial sweeteners.

Gestational diabetes is seemingly a woman's issue but it is more! The circumstances and outcomes of one's pregnancy affect everyone in the family and ultimately the total society. Healthy babies contribute to the well being of the society so healthy management of gestational diabetes is important to us all.

As always, for the health of it...;


Eating and Cancer: Healthy Diet Can Reduce Risk of Breast Cancer

The appropriate nutrition approach in the matter of breast cancer is a synergistic focus! Weight control, exercise and healthy food choices need consistent address, whether it’s for breast cancer prevention, treatment or recovery.

The link between nutrition and breast cancer has been well studied. We have scientifically substantiated diet and exercise recommendations to support reduced breast cancer risk. Clearly and concisely the American Cancer Society (ACS) recommends: getting regular physical activity of at least 30 minutes a day, five days per week, maintaining a healthy weight throughout life, eating a healthy diet rich in fruits, whole grains and vegetables (including 2.5 cups of fruits and vegetables daily), and limiting alcoholic beverages to no more than one drink daily for women, two for men. Note that one drink is equal to 12 ounces of beer, one ounce of liquor or four ounces of wine.

It is the scope of this article to address risk reduction and prevention for breast cancer. Recommendations for a specific nutrition plan during treatment phases should be personalized with your treating physician/practitioner and registered dietitian/nutritionist.

General consensus for the best cancer prevention diet is a plant-based eating plan. This eating regimen includes whole plant foods including fruits, vegetables, legumes, grains, nuts and seeds as opposed to their processed byproducts. Variations of the diet add dairy foods and or eggs. However, concerns for dairy products containing recombinant bovine growth hormone (rBGH), which has been implicated in cancer promotion, have led to recommendations for reducing heavy intake.

Providing the essential nutrients of carbohydrates, protein, healthy fats and water, plant diets supply disease-fighting phyto-nutrients and phyto-chemicals. Concentrated in the skins of many fruits and vegetables, these nutrients give these foods their color, hue, scent, and flavor.

Researchers at New York University found that women who had higher blood carotenoid levels have significantly smaller risk of breast cancer than women with lower levels. Carotenoid-containing foods are yellow and orange in color and include carrots, sweet potatoes, kale, spinach, turnip and mustard greens, watermelon and tomatoes.

Grapefruits, oranges, and citrus fruits contain monoterpenes. Monoterpenes are credited with cancer prevention by carrying carcinogens out of the body. Red grapes and berries contain bioflavonoids (antioxidants that help to prevent cancer), resveratrol (which inhibits cancer cell growth) and ellagic acid (which appears to slow the growth of tumors).

Tomatoes, watermelon, pink grapefruit, and red bell peppers are rich in the phytochemical lycopene, a powerful antioxidant credited with stopping breast cancer cells from growing. Cruciferous vegetables, especially broccoli, Brussels sprouts, cauliflower and cabbage, have sulfur-containing agents called indoles. They help eliminate excess estrogen from the body and thus the growth of breast cancer. Omega 3 fatty acids (flax seeds, flax oil, raw walnuts and fish) are credited with reducing the inflammatory process, improving immune function, and reducing breast cancer risk. Plant fiber binds harmful carcinogenic substances in the intestines, which aids carrying them out of the body.

Green tea contains cancer-fighting substances called epigallo catechin gallate (ECGC). These substances reduce free radicals and cancer promotion. Additionally, according to the American Institute of Cancer Research, plant phyto-nutrients and phyto-chemicals have the potential to stimulate the immune system. This stimulation can block substances that we eat, drink and breathe from causing cancer. Other bonuses they provide include reducing the kind of inflammation that makes cancer growth more likely, preventing DNA damage, assisting with DNA repair, reducing oxidative damage to cells that can spark cancer, slowing the growth rate of cancer cells, and triggering damaged cells to commit suicide before they can reproduce.

Maintaining a weight within normal ranges will reduce the incidence and reoccurrence of breast cancer. Obesity, especially in postmenopausal women, increases the risk of breast cancer. According to the NIH National Cancer Institute, weight gain during adult life (most often from about age 18 to between the ages of 50 and 60) has been consistently associated with increased risk of breast cancer after menopause. Healthy weight is generally considered having a BMI between 18.5 and 24.9. Overweight is assessed at a BMI between 25 and 29.9. Obesity is classified as a BMI greater than 30. Excess muscle mass can influence BMI, so another criteria defining healthier weight is waist circumference less than 35 for women and 40 for men (there are some variations for Asian populations).

Weight management and control is a complex task that can be affected by multiple variables. One’s state of physical and mental health, medication use, genetics, family history, lifestyle choices, sleep patterns, and environment can be factors. Some of these we have more control of than others.

Mindful eating strategies with thoughtful, purposefully selected food choices can support improved outcomes for weight management. Success is better achieved pursuing a multi-step strategy. Some well-established eating tips for weight control include a focus and commitment to eating more vegetables, fruits, lean protein, whole grains and fluid-filled foods such as broth-based soups (which support more stable blood sugar levels and a feeling of fullness). Also, limiting beverages that are high in sugar such as juice and soda is advisable, since they do not contribute to satiety.

Knowing ones daily caloric requirement and gradually and consistently adjusting intake to support and maintain a healthy weight is key. Exercise is an equal partner to weight management and breast cancer risk reduction. Existing evidence shows a decreasing risk of breast cancer as the frequency and duration of physical activity increase. Most studies suggest that 30 to 60 minutes per day of moderate- to high-intensity physical activity is associated with a reduction in breast cancer risk (according to the NIH, National Cancer Institute).

While the preceding are general recommendations, discuss your personal nutritional concerns, dietary restrictions and potential food drug interactions with your Registered Dietitian Nutritionist (R.D.N.), doctor or primary care provider.

As always, for the health of it…

Melanie Ajanwachuku, B.S., R.D.N., CDE, is CEO and president of A Dietitians' Exchange in Apple Valley.


Eating to ease pain: You can choose an anti-inflammatory diet

Had surgery, having pain? Not a bad time to look at your diet. Whether it’s the acute pain post operation or the chronic pain of ongoing injury or illness, your dietary choices could make a difference.

We know that trauma or injury, including surgery, causes acute (immediate) inflammation. The site of the injury becomes heated, appears red and swollen, becomes painful and there may be some loss of function. Critically this response is the immune system’s initiation of the healing process. What follows is an increase of blood flow to the affected area and provision of nourishment. Progressive chemical reactions result in the removal of damaged cells and the repair and rejuvenation of the area.

So, this healthy inflammation stops the process of injury and supports recovery. But chronic inappropriate inflammation is destructive and promotes disease and aging. It is better to choose an anti-inflammatory eating plan, and lifestyle to bolster medical pain management and ultimately support less pain.

So what is this rescue diet? Abundant research suggests that the Mediterranean diet with a variety of fresh foods and careful restriction of manufactured, processed and refined food stuffs is the step in the right direction.

The anti-inflammatory and protective properties of the Mediterranean diet according to the National Center for Biotechnological Information (, are linked to the large presence of omega-3 polyunsaturated fatty acids, vitamins, and especially the constituents of extra virgin olive oil. Oleic acid, phenolic compounds olecanthal, is a new recently discovered molecule with natural anti-inflammatory properties.

The basics of this plan embraces eating primarily a plant based regimen, including fruits and vegetables, whole grains, legumes/beans (all helpful in promoting healthy bowel function, often suppressed by post-surgical pain meds) and nuts (rich in Omega-3 fatty acids that fight pain and inflammation in the body). Additionally it replaces butter with healthy fats such as olive oil (rich in antioxidant poly-phenols that help reduce common pain-causing mechanism in the body).

The plan encourages using herbs and spices instead of salt to flavor foods, limiting red meat to no more than a few times a month, eating fish (especially salmon, mackerel and herring with Omega-3s which convert in the body into hormone-like substances that decrease inflammation and pain), and eating poultry at least twice a week. Enjoying meals with family and friends, drinking red wine in moderation (or Concord grapes) and getting plenty of exercise are always good ideas as well.

Now as to some specific as to the “why” these good choices make a difference. High on the list would be: pineapples (rich in the anti-bruising and swelling enzyme: bromeline), apples, red onions, citrus fruits, leafy greens, and capers (high in quercetin, a plant flavanoid with anti-oxidant and anti-inflammatory properties to speed pain relief).

Other valuable players include red grapes, all the dark berries and peanuts which contain anti-inflammatory benefits from resveratrol and vitamin C; and to be equally appreciated are the tart cherries (not sweet cherries) whose anti-inflammatory and antioxidant properties act as natural NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen and aspirin).

Additional helpers include some well recognized spices including ginger, which reduces pain-causing prostaglandin levels in the body much like ibuprofen does; turmeric, a bright yellow spice, which research has been shown to be a more effective anti-inflammatory than steroid medications when dealing with acute inflammation; also celery and celery seeds, with more than 20 anti-inflammatory compounds including a substance called apigenin, very powerful in its anti-inflammatory action.

Neither the anti-inflammatory diet nor these specific foods and spices are offered or suggested as replacements for the pharmacologic pain prescriptions recommended by one’s doctor. They are discussed as adjuncts and definitely encouraged over the highly refined, processed, manufactured diet so commonly consumed today. Consider this eating regimen as the basis of a health producing pain reduction lifestyle choice.
Don’t forget adequate hydration! Water is 60 percent of an adult body’s composition and supports digestion, movement of nutrients to the sites they are required and excretion of wastes. Additionally, water is fundamental to supplying increased blood volume, mediating body temperature and facilitating wound drainage. Studies show that well hydrated patients have less pain and nausea after surgery.

Finally, a “Fit Body” experiences less pain, acute and chronic. Consult the 2015-2020 Physical Activity Guidelines for Americans and get started on your own personal fitness program. Remember before beginning any exercise routine check with your primary care provider for guidance.
While the preceding are general recommendations, discuss your personal nutritional concerns, dietary restrictions and potential food drug interactions with your doctor, primary care provider and Registered Dietitian Nutritionist (R.D.N.).

As always, for the health of it.


Clean Eating: Concept is User-Friendly Nutrition Prescription

Clean eating, the concept, was originally introduced with the natural health food movement of the 1960s. By the mid-1990s large grocery chains (spurred by the huge growth of health food chains) began to come on board with the offering of more “natural food products” with fewer additives and preservatives. Today by virtue of online access and social media it has become a popular mainstream movement; definitely a 2016 trend.

Clean eating is a consensus-based, conscious grounded eating style and not a scientifically designed eating protocol. There are general principles of this dietary movement that can be considered well meaning, for example when they encourage awareness and choice of a healthy eating pattern and lifestyle. “Clean eating” is not so much a reference to removing what is on food. Instead the focus is on consuming healthful whole foods, closer to their natural state, unrefined and not processed. The general tenets of the plan are within keeping with the 2015 UD Dietary guidelines and the research-substantiated Mediterranean and Dash Diets.

As a movement, clean eating is subject to interpretation variances by nutrition professionals and the general public. Some of the more strict interpretations are unnecessary and can be unhealthy. However, in its essence this movement is predominantly about eating a high quality natural diet that supports a healthier stronger body. The movement includes regular exercise and supports respect to the preservation of our environment.
The highlights and best practices of clean eating include eating whole foods in as close to their natural, unprocessed state as possible. An easily relatable example is eating whole fruit instead of consuming its juice. Choosing organic produce, or at least fruits and vegetables, from a local regional farmer’s market. Simply put, getting food closer to where it grows. Farmers markets are increasing their presence in many communities, including our own High Desert.

Significant intake of these whole plant foods anchor this eating strategy. Foods with added sugars or other sweeteners, artificial or natural, salts, preservatives, flavors, colors, hormones, antibiotics, GMOs and other unnatural add-ons are discouraged. Further focus is on low-fat dairy products without fillers, and whole grains of all varieties including but not limited to: Soft red, hard red, and durum wheat and wheat kernels, barley, buckwheat, couscous, millet, rolled and steel cut oats, rye, spelt, amaranth, quinoa and corn.

When beef is consumed, the choice of grass fed, pastured raised beef, in reduced portions (3-4 ounces per meal) is the suggested choice. Lean poultry and fish are also encouraged but cured meats should be avoided. Small frequent meals (5-6 per day), including breakfast that supports appetite control with stable insulin levels and better metabolism to discourage excess fat storage, are emphasized.

Healthy fats (mono unsaturated and poly unsaturated) from foods such as avocados, whole eggs, walnuts, seeds, full-fat Greek yogurt and grass-fed butter, are included to provide for hormone balance and the anti-inflammatory process that helps fight disease development.
Food preparation recommendations lean to healthier choices of baking and steaming, while avoiding frying foods.

Of course, home preparation yields the healthy advantage of choosing ingredients in keeping with best nutrition practices.

Including children in meal preparation offers teachable moments demonstrating nutritious meal preparation and supports quality family time. Repeated consumption of nutritious foods retrains taste buds to enjoy what the body needs. This is the best strategy to encourage less junk food consumption and makes the choice of healthier eating more natural.

From this dietitian’s perspective, with a women’s health and wellness concern being so much about good nutrition and regular exercise, the best of the clean eating momentum should be one’s focus. Progression toward meeting one's specific nutrient needs and achieving a healthy active lifestyle should be the goal. Caution should be taken to not succumb to the undue pressure of an exclusive, restrictive eating regimen.
Wellness eating should not cause stress. It is advantageous to gradually incorporate good food habits, read labels and seek to understand the ingredient list to support better food choices. Eating regular portioned, controlled meals from a variety of whole sustainable foods, choosing locally grown produce in season, eating high fiber, and including unsweetened beverages can go a long way to contribute to sensible embrace of clean eating.

The occasional consumption of a processed food or a meal eaten out does not doom one to ill health. A long-term commitment to foods that nourish the body are what make a healthy lifestyle and give a validity to following the clean eating movement.

As always, for the health of it…


Healthy Skin Starts From What We Eat and What We Absorb

Skin, health and beauty starts from the inside out. That’s because, while we hear that we are what we eat, really we are what we digest and absorb. This applies to the integrity of every organ in the body, including our skin.

Our skin is a giant protective covering organ with three layers. It is responsible for multiple critical operations and functions in the body. Skin serves as the body’s first line of defense preventing pathogens such as bacteria, viruses, and other foreign substances from entering the body. Our skin helps regulate body temperature and serves to facilitate communication from the environment through nerve endings. These nerve endings in our skin afford us our sensations of touch, temperature and pain. Skin produces and stores cholecalciferol or vitamin D, in its bottom 2 two layers. This important nutrient facilitates bone integrity, cell growth, cancer prevention and immune functions. In order for skin to excel at its multiple responsibilities it needs to be healthy. Healthy skin is largely a reflective of its composition, thus what we eat and absorb matters.

Skin cells have a rapid cell cycle where production of new cells and replacement of old cells only takes 28 days. Nutrients critical to healthy cell formation and maintenance include macro nutrients such as protein, complex carbo-hydrates, healthy fats: poly and monounsaturated fats, and omega 3 fatty acids and of course water. Adequacy of these nutrients is specific to each individual. Determining one’s requirements and meeting them is the first step to promoting healthy skin. The micro nutrients like vitamins, minerals, and anti-oxidants are also big players in the healthy growth and development of all body tissues. This being said the overall health of the digestive track including its absorption of nutrients and elimination of wastes is pertinent to great skin. Both of these functions support optimized cell structure, function and flow. So what should we focus on in our diet?

Pro-biotic foods that promote a healthy gut lining and good nutrient absorption include: plain yogurt, Kefir, Sauerkraut, Microalgae (spirulina, chorella, and blue-green algae), Miso Soup, pickles (very salty, limit for those with high blood pressure), Tempeh, Kimchi (An Asian form of pickled sauerkraut), kimchi ( is an extremely spicy and sour fermented cabbage), and Kombucha Tea. Knowing your personal food tolerances and dietary restrictions based upon your health is important when choosing which of these to consume. Consulting with a dietitian regarding potential side effects is recommended.

Not surprisingly, plenty of vegetables and fruits (naturally rich in anti-oxidants, bio-flavinoids, vitamins, minerals, fiber and water) aid in cell formation and preservation. Vitamin A ( found in salmon, fish oil carrots, spinach, and broccoli) and Zinc ( found in turkey, almonds, Brazil nuts, and wheat germ) supports strong cell growth, vitality and integrity. Antioxidants such as vitamin E (found in sweet potatoes, nuts, olive oil, sunflower seeds, avocados, broccoli, and leafy green vegetables ) and vitamin C ( found in oranges, lemons, grapefruit, papaya, Guava, bell peppers of all colors, grapefruit juice, strawberries, pineapple, and tomatoes) protect cell membranes from UV light damage. This of course is a key process, in the preservation of skin cells. Selenium ( found in wheat germ, tuna, salmon, garlic, Brazil nuts, eggs, and brown rice) has antioxidant properties that help protect skin’s elasticity. Selenium protects skin cells from the damage caused by free radicals and reduces the risk of death by squamous cell cancers.

Including a good complement of healthy fats and anti-inflammatory foods supports cell preservation. The omega-3 fatty acids rich foods like wild salmon, sardines, fortified eggs, and walnuts support this end. Serving to keep the outer layer of skin strong and intact, these foods will support keeping external toxins and pollutants stay out.

Adequate hydration is not to be under estimated. Water is the most important nutrient we consume. At 70 percent of our body composition it is critical to digestion and absorption of nutrients, so thus it’s critical to skin health. General recommendations are to drink at least 1/3 to ½ your body weight in ounces daily.

Equally important is to limit the skin destroyers : refined sugars including white bread, baked goods and other sugary desserts. Finally optimizing skin health comes from a synergy of eating well, exercising and managing stress. Exercise promotes cleansing. It improves circulation and the bringing of nutrients to cells while carrying away wastes. It reduces the impact of our daily stresses, and supports elimination. Make it a part of your daily routine for your best skin ever!

As always for the health of it…


Vitamin D and Tea Rescuers for PFD!

Reported incidence of pelvic floor dysfunction, (PFD), among American women ranges from 25 to 50 %. This broad variance is a result of the lack of reporting of this problem, by many victims. At either end of this range, clearly the quality of life for a significant number of women is being impacted. Improper functioning of the muscles in the pelvic floor, also known as pelvic floor dysfunction can be a severely painful, and life altering condition .

Poor muscle strength in any part of the body can create havoc on our structure and functionality. The pelvic region is no exception. The pelvic floor is made up of a group of muscles that support the bladder and uterus in women, the prostate and bladder in men, and the rectum for both. Normal contracting and relaxing of these muscles allows for natural control of bowel and bladder movements. With PFD there can be bladder control problems, bowel control problems, and pelvic organ prolapse.  This dysfunction can result in constipation (as much as 5% of the adult population in the U.S.), irritable bowel syndrome (IBS), interstitial cystitis (I.C.), urinary frequency, painful urination, pelvic muscle spasms, lower back pain that cannot be explained by other causes, ongoing pain in the pelvic region, genitals, or rectum, and pain for women during intercourse.

So where’s the involvement of nutrition in all of this?  Very notably the relationship between Vitamin D deficit and PFD is well documented. (Obstet Gynecol. 2010 Apr;115(4):795-803  and  research by the National Health & Nutrition Examination Survey (NHANES) April 2010).    Insufficiency of vitamin D is strongly associated with muscle weakness; adequacy has been demonstrated to increase the skeletal muscles supporting the pelvic floor. Vitamin D is a fat soluble vitamin and not naturally present in many foods. The sources are not commonly consumed in the standard American diet. It is available in supplemental forms and produced in the body with sun exposure (ultraviolet rays from the sun) to the skin.  Additional conversions in the liver and kidney change this important nutrient to an active form, enabling it’s many functions including bone and muscle growth and sustenance.  Food Rich sources of Vitamin D include Cod Liver oil, swordfish, salmon tuna, fortified milk, yogurt, juice and orange juice. The RDA for women to age 69 is 600 IU, and at 70+ recommendations are 800 IU.

            There are actually a group of nutrients involved in muscle development, strength and integrity. Sufficient high quality protein intake is important for the development, tone, and sustenance of all muscle tissue including the pelvic floor muscles.  Additionally important are: Vitamin C, found in all fruits and vegetables. Vitamin C is responsible for the health of the blood vessels, which convey oxygen and nutrients  to the muscles. The B vitamins including B1 (thiamin), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B7 (biotin), and B12 (cobalamin), are each essential for protein metabolism and energy production, healthy nerves and breaking down fat and carbs for energy to build muscles. Great sources include whole grains, eggs, lean meats, legumes, nuts, leafy greens, and fortified cereals.  Importantly  B12 is only found in animal sources, possibly requiring supplementation for vegans.  Vitamin E is an antioxidant  that helps preserve cell membranes from oxidative stress and supports muscle sustenance. Food rich sources include mustard greens,swiss chard, spinach kale and collard greens, nuts, tropical fruit,red bell peppers,broccoli plant oils, whole wheat. Omega 3s, the fatty acids found in fish oils and nuts enhance the effects of muscle integrity by increasing blood flow to the muscles, reducing muscle protein breakdown.  Calcium and vitamin D are two of the most important nutrients for bone and muscle health. Calcium can be found in dairy products, leafy green vegetables, almonds and calcium-fortified foods and juices. Vitamin D helps the body absorb calcium.  Zinc is required to support muscle development and helps regulate protein function, as do magnesium and phosphorus. Zinc is found in red meat, seafood, eggs, milk, legumes and whole grains. Phosphorus is supplied by meat, seafood, grains, legumes, nuts, dairy products and eggs. Magnesium is plentiful in spinach, nuts, legumes, and whole grains.  Fluid especially water,  makes up 70% of muscle tissue and is critical for muscle synthesis.

            Not a great water drinker?  Here’s an option : A recent study funded by the National Institutes of Health National Center Complementary and Alternative Medicine examined the effect of tea on muscles.  They discovered that the polyphenols in tea reduce inflammation and cell break down from oxidative stress.  This contributed to reduced muscle and bone deterioration and even improved their strength. So take a break, or better yet prevent one and have your tea time! 

Other specific dietary interventions are specific to the disorder being experienced.   In the instance of bowel irregularities, be it constipation or IBS, focus should be on adequate hydration and fiber intake.  Adequate fluid to support normal bowel movements means getting plenty to drink. Drinking eight 8-ounce glasses of liquid a day may help prevent constipation. Water is a good choice. Drinks with caffeine, alcohol, milk, or carbonation should be avoided if they trigger diarrhea. Eating the right amount of fiber. Fiber can help with diarrhea and constipation. Fiber is found in fruits, vegetables, whole grains, and beans. Fiber supplements sold in a pharmacy or in a health food store are another common source of fiber to treat fecal incontinence. The Academy of Nutrition and Dietetics recommends consuming 20 to 35 grams of fiber a day for adults.  American adults consume only 15 grams a day on average. Fiber should be added to the diet slowly to avoid bloating. Good sources of high fiber include flax seed beans, kiwi, berries, pears, plums, apples, popcorn, nuts, seeds, whole grains, broccoli , prunes, and dried fruits.  A good regimen to follow includes an evening dose of fiber supplement with a morning routine of mild physical activity; a hot, preferably caffeinated beverage; and, possibly, a fiber cereal followed by another cup of a hot beverage — all within 45 minutes of waking. 

In the case of Interstitial Cystitis, extensive dietary intervention and meal plan formatting has been developed by Julie Beyer, M.A, R.D.N.’s I.C. diet.  Her plan, focuses on alcohol and caffeine, avoidance of trigger foods, including spices, carbonated waters, processed and smoked meats, acidic fruit and vegetables, and many grains and dairy products.  Adherence to her plan has yielded extensive positive results for many sufferers.

Finally, strive for healthy weight management:  Research reveals that overweight women also have a greater chance of having at least one pelvic disorder. Prevalence was 15.1% for underweight/normal weight, 26.3% for overweight women, and 30.4% for obese women. Limit stimulants including caffienated beverages, soda (particularly diet),  alcoholic beverages, citrus fruits and juices, cranberry juice, tomato products, soy, artificial sweeteners, hot peppers, and spicy foods. Decrease your stress and increase your strength with appropriate exercise.  Good choices include, pilates, yoga and Kegel exercises.  Consulting with a Registered Dietitian Nutritionist is highly recommended for personalizing an optimum nutrition for the best outcomes and management. 

As always for the health of it… Melanie Ajanwachuku, B.S., R.D.N., CDE | Medical Nutrition Therapy Consultant serving the High Desert


The Alcohol Impact

 In April the U.S.Dept Health and Human Services‘s  National Health observanceis on  : Alcohol Awareness

“Even in small amounts, alcohol affects women differently than men. In some ways, heavy drinking is riskier for women than it is for men.“ This is according to the collaborative publication by  The U.S.Deptartment of Health and Human Services, National Institutes of Health, National Institutes of Health Alcohol on Abuse and Alcoholism 

“ Alcohol  a Women‘s Health Issue“.

All for good reasons, The U.S. Dietary Guidelines for Americans recommends that individuals who do not drink alcohol should not start drinking for any reason.  Further the guidelines advise that women restrict their intake to 1 drink per day.   One alcoholic drink-equivalent is described as containing 14 g (0.6 fl oz) of pure alcohol.  Beverages that are one alcoholic drink-equivalent include 12 fluid ounces of regular beer (5% alcohol), 5 fluid ounces of wine (12% alcohol), or 1.5 fluid ounces of 80 proof distilled spirits (40% alcohol). 

So why so much concern for limiting a woman’s alcohol intake, you ask?  Research tells us that a woman’s smaller body structure and distinct metabolism generally leads to more absorption of alcohol with longer break down time then men.  This means drinking equal amounts, a woman will have higher alcohol levels in their blood than a man, with more immediate, and longer lasting effects. This disadvantage also makes it more likely that drinking will cause long-term health problems in women than men.

And….. then there is this association between drinking alcohol and developing breast cancer. Women who consume about one drink per day have a 10 percent higher chance of developing breast cancer than women who do not drink at all. That risk rises another 10 percent for every extra drink they have per day. Cancer of the breast, mouth, throat, esophagus, liver, and colon are all health concerns for women who consume excess alcohol.

Women who drink are more likely to develop alcoholic hepatitis (liver inflammation) than men who drink the same amount of alcohol. Alcoholic hepatitis can lead to cirrhosis, according to the CDC. Chronic heavy drinking is a leading cause of heart disease. Among heavy drinkers, women are more susceptible to alcohol-related heart disease than men, even though women drink less alcohol over a lifetime than men.

Any drinking during pregnancy is risky. A pregnant woman who drinks heavily puts her fetus at risk for learning and behavioral problems along with abnormal facial features. Even moderate drinking during pregnancy can cause problems. Drinking during pregnancy may also increase the risk for preterm labor. 

Alcohol significantly affects the processing and use of most nutrients we consume. Thus by doing so, it affects our wellbeing.  Our body’s basic needs for growth, repair, maintenance and disease prevention are dependent on essential nutrients: proteins, carbohydrates, fats, water, vitamins and minerals. Alcohol consumption alters the lining of our digestive tracts which diminishes our physical ability to absorb those vital nutrients. Additionally, alcohol inhibits the secretion of digestive enzymes which interferes with normal digestion, storage, use, and excretion of nutrients.

Vitamins and minerals (micro nutrients) are catalysts they work together with the macro nutrients: protein, carbohydrate, and fats to support our functionality. This impact can be extensive just to name a few examples:  Folate, a water soluble B vitamin is highly affected by alcohol consumption. A deficiency of this nutrient can alter the cells lining the small intestine and impair absorption of water, glucose, sodium, and additional folate.  This a dangerous cycle that can lead to decreased energy, fatigue, and impaired judgment and other functions. 

Other possible compromises include (but are not limited to) a reduced ability to repair the body and fight diseases.  Alcohol intake at above recommended limits can create deficiencies of Vitamins A, C, D, E, K, and all of the B vitamins. Inadequacy of Vitamin K, necessary for blood clotting, can cause delayed clotting and excess bleeding. Deficiencies of other vitamins involved in brain function can cause severe nerve damage. Decreased liver storage of vitamin A and D, can lead to night vision and wound healing problems.  Vitamin D deficiency is associated with softening of the bones (e.g. : rickets in children and osteomalacia in adults). Additional health risks include cancer, cardiovascular disease, autoimmune diseases, infections, cognitive disorders, and/or mortality. 

Mineral deficiencies are equally problematic and impactful with excess alcohol intake. Calcium, magnesium, iron and zinc deficiencies can occur.  These nutrients are already limited and at risk for most Americans.    Consuming the standard  American , highly processed diet can lead to  a variety of medical consequences including calcium and magnesium related bone disease, zinc-related night blindness and skin lesions, and Iron deficiency anemia.

So in support of controlled imbibing, think easy and progressive changes. Knowledge is power!  Pick and align with the strategy that best suits you. Be mindful and assess your habits. Note how much and how often you are drinking.

Set personal goals.  Be honest with yourself and track your intake, if you are consuming alcohol every day, plan on skipping a day per week. Now that you know what a standard drink is, stick to the “serving size”.  Measure, when you pour at home, and ask when you drink out.  Create your own pace, drink non-alcoholic beverages between and after you hit your limit.  Dilute your drink with as much water as possible and always rehydrate after drinking.  Avoid drinking on an empty stomach, eating while drinking should help to slow you down.  The less often and smaller quantity that you drink will help give you that relaxation alcohol affords you with a smaller volume.  Develop alternate de-stressors and “triggers” if you drink to relax. Think of substituting fun relationship times and activities for that non-alcoholic relaxing “high”.  Don’t let others push you to drink when you really don’t want to.  Be in charge of your health and wellbeing!

Knowledge is power and can support your best intake.


Besides Eating Chocolate, What's A Girl To Do?

Heart disease is the number one cause of death in women; stroke is close behind at the number 3 position. To take charge and be empowered to decrease our chances of being victims, we need to know our risk factors. No surprise, nutrition and lifestyle play a large role in preventing and treating of several causes and types heart disease. We can and should adopt healthy eating and living strategies that reduce our risk and improve our chances of optimal heart function and health.

OK, so what do we need to know and what should we target to support good heart health and disease prevention? The Office on Women’s Health U.S. Department of Health and Human Services tells us that risk factors are conditions, habits, family history, and other factors that make one more likely to develop certain heart diseases.

The more risk factors one has, the higher one’s chances are of getting these diseases. There are risk factors that we do not control, for example, race and ethnicity and family history. However, the good news is that there are risk factors we do have some control over. High blood pressure, abnormal cholesterol, diabetes, overweight and physical inactivity are within our power to change and are all very much related to what we eat and how much we move!

Choosing the appropriate personalized heart heath strategy requires consideration of one’s state of health. In that vein the National Heart, Lung, and Blood Institute suggests three heart healthy eating plans. Each is geared to address one's status and needs, whether the need is prevention versus treatment.

On the side of prevention The Heart Healthy Diet is for those who do not have heart disease and want to support healthy blood cholesterol and blood pressure levels. Unhealthy cholesterol levels as well as high blood pressure can in time lead to heart disease. A heart-healthy diet is low sodium, low saturated fat, trans fat, cholesterol and refined sugars while at the same time being high in nutrients. Heart healthy eating guidelines indicate that these foods should be eaten most of the time:

— Fruits and vegetables: at least half of the plate should be fruits and vegetables; they are rich in antioxidants, which have been proven to lower your risk for heart disease.

— Whole grains: at least half of one’s grains should be whole grains. Whole grains include: whole wheat, whole oats, oatmeal, whole-grain corn, brown rice, wild rice, whole rye, whole-grain barley, buckwheat, bulgur, millet, sorghum.

— Fat-free or low-fat dairy products: including milk, calcium-fortified soy drinks (soy milk), cheese, yogurt, and other milk products.

— Seafood, skinless poultry, lean meats, beans, eggs, and unsalted nuts.

Once treatment is deemed necessary, for those with unhealthy blood cholesterol levels, the Therapeutic Lifestyle Changes (TLC) Diet is recommended. When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, cholesterol can form a thick, hard deposit called plaque. Plaque can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result.

The TLC diet calls for:

— Less than 7 percent of daily calories from saturated fat

— Less than 200 mg a day of cholesterol

— 25–35 percent of daily calories from total fat (includes saturated fat calories)

Diet options for more LDL lowering: 2 grams per day of plant stanols or sterols, which occur naturally in small amounts in many plants. Those used in food products are taken from soybean and tall pine-tree oils. When combined with a small amount of canola oil, the product is used in various foods. As with soluble fiber, plant stanols and sterols help block the absorption of cholesterol from the digestive tract. This process helps to lower LDL without affecting HDL (good cholesterol) or triglycerides. Studies show that a daily intake of about 2 grams of stanols or sterols reduces LDL cholesterol by about 5-15 percent, often within weeks.

— Eating 10–25 grams per day of soluble fiber

— Eating only enough calories to reach or maintain a healthy weight

— Getting at least 30 minutes of a moderate intensity physical activity, such as brisk walking, on most, and preferably all, days of the week. More vigorous activities are associated with more benefits. Exercise should be aerobic, involving the large muscle groups. Aerobic activities include brisk walking, cycling, swimming, jumping rope and jogging. If walking is the exercise of choice, use the pedometer goal of 10,000 steps a day. Consult your doctor before starting any exercise program.

Another treatment diet, the Dietary Approaches to Stop Hypertension (DASH) eating plan, is recommended for individuals with high blood pressure, or hypertension. Hypertension can raise the risk of heart disease and stroke. The DASH diet is a lifelong healthy eating plan that recommends decreasing sodium intake and eating a variety of foods rich in nutrients to help lower blood pressure.

Potassium, calcium and magnesium are key in this process. The DASH diet emphasizes vegetables, fruit and low-fat dairy foods. Also recommended are moderate amounts of whole grains, fish, poultry and nuts. It is low in saturated fat, cholesterol and total fat. In addition to the standard DASH diet, there is also a lower sodium version of the diet.

— Grains: 6 to 8 servings a day: Grains include bread, cereal, rice and pasta. Focus on whole grains because they have more fiber and nutrients than do refined grains.

— Vegetables: 4 to 5 servings a day: Tomatoes, carrots, broccoli, sweet potatoes, greens and other vegetables are full of fiber, vitamins, and minerals such as potassium and magnesium.

— Fruits: 4 to 5 servings a day: Like vegetables, they're packed with fiber, potassium and magnesium and are typically low in fat — exceptions include avocados and coconuts.

— Dairy: 2 to 3 servings a day: Low fat milk, yogurt, cheese and other dairy products are major sources of calcium, vitamin D and magnesium

— Lean meat, poultry and fish: 6 or fewer servings a day: Meat can be a rich source of protein, B vitamins, iron and zinc.

— Nuts, seeds and legumes: 4 to 5 servings a week. Good sources of magnesium, potassium and protein, healthy types of fat — monounsaturated fat and omega-3 fatty acids, fiber and phyto-chemicals. Phyto-chemicals are plant compounds that may protect against some cancers and cardiovascular disease.

— Fats and oils: 2 to 3 servings a day. Helps your body absorb essential vitamins and helps your body's immune system. The DASH diet strives for a healthy balance by limiting total fat to 27 percent or less of daily calories from fat. Focus is on consuming the healthier monounsaturated fats. Saturated fat and trans fat are the main dietary culprits in raising your blood cholesterol and increasing your risk of coronary artery disease. DASH helps keep your daily saturated fat to less than 6 percent of your total calories.

— Sweets: 5 servings or fewer a week

Our Hearts, our health, our choice! Eat well, indulge in moderation (and maybe just 1.5 ounces of dark chocolate with 70 percent+ cocoa, 2-3 days a week) move more, and don’t forget to manage your stress. It helps to get the amount of sleep you need to wake up feeling refreshed. Take time each day to relax and unwind. Take charge by prioritizing your health and well-being!
As always for the health of it…

Melanie Ajanwachuku, B.S., R.D.N., CDE, is a medical nutrition therapy consultant serving the High Desert.