Q: I am wondering how do I know how much protein to eat? I don’t eat meat; but I do have plant based protein powder. I am noticing that I am not progressing in my strength training; I’ve been stuck at the same dumbbell amounts for close to 5 weeks now.

A: Because you are losing weight and not gaining muscle mass, you may not be consuming enough calories to support your level of physical activity. If your body does not have enough calories to fuel exercise, it may break down muscle for energy. So perhaps an extra snack would help you to reach your goals. It’s important not to solely focus on the number on the scale. Increasing muscle mass may slow your weight loss, but this does not increase your risk of chronic disease.

The suggested amount of protein for increasing muscle mass is 1-1.2 grams of protein per kilogram of body weight. To determine your weight in kilograms, divide your weight in pounds by 2.2; then multiply that number by 1-1.2 to yield your protein target in grams. Timing is also important; you may try consuming 20-30 grams of protein after you finish your work out to increase muscle growth.

While it can be helpful to supplement with protein powders and bars, I recommend trying to get most of your protein from whole foods in combination with carbohydrates and healthy fats. Good sources of plant based protein include beans, legumes, peas, tofu, soy products, nuts, nut butters and seeds. Plant based protein foods offer other benefits too including vitamins, minerals, and fiber. Other vegetarian sources include dairy products such as milk, cheese, and yogurt. I hope these ideas help!

Q: I have recently been diagnosed with IBS and my Gastroenterologist suggest I try a low FODMAP diet to manage my symptoms. Could you help get me started with this?

A: Thank you for reaching out to us! First let’s start by explaining what a low FODMAP diet is. FODMAP stands for fermentable oligo-, di-, mono-saccharides and polyols. FODMAPs are a group of short-chain carbohydrates (a.k.a. sugars) which are poorly absorbed in the GI tract. Some people with IBS and other bowel disorders may not tolerate FODMAP containing foods and experience gas, bloating, stomach pain, nausea or fullness when FODMAPs are consumed. Research in the effectiveness of this diet is still limited but trialing a low FODMAP diet can help you to figure out which FODMAP containing foods might trigger your specific symptoms (constipation being one of them).

Consider the following approach to a low FODMAP diet:

• Step I: Remove high FODMAP foods from your diet and change them out for low FODMAP alternatives (see FODMAP food list below).
  • Follow this step for at least 2-6 weeks.
• Step II: If GI symptoms improved with Step I, you will slowly start to reintroduce high FODMAP foods to identify those foods which trigger your IBS symptoms. You want to introduce one food every three days, while keeping a detailed food and symptom diary.
  • This step can take 8-12 weeks.
  • If GI symptoms do not improve after Step I, this may mean you are not sensitive to FODMAP containing foods and you should speak with your gastroenterologist about other interventions to manage your IBS symptoms.
• Step III: This step is for lifelong maintenance. In this step remove only those high FODMAP foods which you identified in Step II as foods which trigger your IBS symptoms. Ideally you should include well tolerated high FODMAP foods into your diet as these foods also provide beneficial prebiotics and contribute to a healthy gut microbiome.

Implementing a low FODMAP diet can be confusing and hard to navigate. Consider asking your gastroenterologist for a referral to a dietitian to help advise you through this process. In the meantime the following resources can help you learn more about a low FODMAP diet:

• Monash University (creator of the low FODMAP diet, food list and phone app available)
• Books: The IBS Elimination Diet and Cookbook by Patsy Catsos, MS, RDN, LD

FODMAP Food List

Food Group	Recommended Foods (Low FODMAP)	Foods Not Recommended (High FODMAP)
Grains	Gluten-free grains: arrowroot, buckwheat flour, cornmeal, cornstarch, gluten-free flour blends, glutinous rice, ground rice, millet, oat bran, oatmeal, polenta, potato flour, quinoa, rice, rice bran, rice flour, sago, sorghum, tapioca, wild rice Cereals: baby rice cereal, cream of buckwheat, rice- or corn-based breakfast cereals, oatmeal, wheat-free, fruit free muesli Pasta and Noodles: rice noodles, rice vermicelli, gluten-free pasta Breads and Baked Goods: gluten-free breads, corn tortilla/taco shells, corn-based crackers, pretzels (½ cup), plain rice cakes/rice crackers, gluten-free cookies, gluten-free cakes/pastries, sourdough breads made of wheat or spelt	Barley, bulgur, chickpea flour (besan), couscous (wheat), durum, Kamut, lentil flour, multigrain flour, pea flour, rye, semolina, soy flour, triticale, wheat bran, wheat flour, wheat germ, wheat-based mixed-grain cereals, muesli, chicory root, inulin, noodles, pasta, spaetzle, gnocchi, bread, bread crumbs, cookies, cakes, croissants, muffins, pastries containing wheat/rye
Protein Foods	Unseasoned, tender, well-cooked poultry or fish; unseasoned beef or pork; Bacon Eggs Almonds (fewer than 10 nuts), hazelnuts (fewer than 10 nuts); macadamias, peanuts, pecans, pine nuts, walnuts Seeds (chia, pumpkin) 2 tablespoons smooth peanut butter Tofu, firm (drained); tempeh	Black-eyed peas, dried beans, chickpeas, or lentils Sausage (may contain onion and dehydrated vegetable powders) Soybeans Pistachios and cashews Fatty meats Fried meats
Dairy	Lactose-free milk Calcium-fortified rice milk; soy milk made from soybean extract (not whole soybeans) Most lactose-free yogurts and lactose-free kefir Lactose-free cottage cheese 2 tablespoons soft cheeses (cottage cheese or ricotta) 1 ounce hard, aged, or ripened cheeses (brie, camembert, feta) Lactose-free ice cream Sorbets made from suitable fruits and sweeteners	Buttermilk Chocolate milk Custard Milk (cow ’s, goat’s, sheep’s, condensed, evaporated) Sauces that are milk-based or cheese-based Soft cheeses (in amounts greater than ½ cup): cottage, ricotta Sour cream Soy milk (made from soybeans) Yogurt Ice cream
Vegetables	Alfalfa sprouts, bamboo shoots, bean sprouts, bell pepper, bok choy, broccoli, Brussels sprouts, cabbage (common or red), canned artichoke hearts (1 ounce), carrot, corn (½ cob), cucumber, eggplant, green beans, lettuce (butter, iceberg), olives, parsnip, potatoes, pumpkin, rutabagas, seaweed, sweet potato (½ cup), Swiss chard, spinach, scallion (green part only), squash (yellow, spaghetti), tomatoes, turnips, watercress, yams, zucchini	Artichokes, asparagus, cabbage (savoy), cauliflower, celery, garlic, leeks, mushrooms, onions (all), scallions (the part that is white), shallots, snow peas, sugar snap peas
Fruits	Bananas, blueberries, cantaloupe, dried cranberries (1 tablespoon), grapes, honeydew melon, kiwi, lemons, limes, mandarin oranges, oranges, passion fruit, papaya, pineapple, plantain, dried banana chips (no more than 10 chips), dried shredded coconut (less than ¼ cup), raspberries, star fruit, strawberries, tangelos, tangerines	Apples, applesauce apricots, Asian pears, avocados, blackberries, boysenberries, cherries, figs, mangoes, nectarines, peaches, pears, persimmon, plums, prunes, tamarillo, watermelon
Oils	Vegetable oils, garlic-infused oil, butter, ghee, lard, margarine (trans fat free)	None
Other	Beverages: Water, mineral water, soda water, sugar-sweetened soft drinks, tonic water, fruit juice (choose only juices made from fruits listed in the Fruits section of this table; limit to ½ cup). Orange juice (one 4-ounce glass freshly squeezed) or cranberry juice (4 ounces), most teas/coffees/alcohol Fresh Herbs: Basil, coriander, parsley, rosemary, thyme Spreads and Condiments: Jam (without high fructose corn syrup), marmalade (with appropriate ingredients and no high fructose corn syrup), mayonnaise, mustard, soy sauce, garlic-free sweet chili sauce or hot sauce, pickles/relish, soy sauce, tamari, vinegar Sweeteners: Sucrose (table sugar, cane sugar), including superfine sugar, confectioner’s sugar, brown sugar, raw sugar, glucose; maple syrup, molasses, artificial sweeteners not ending in “ol” (aspartame, saccharine, and stevia) Other: Baking powder, baking soda, cocoa, coconut, gelatin, salt, fresh and dried herbs and spices (not including garlic and onion powder), chives, ginger	Beverages: Apple, pear and mango juices; other fruit juices in amounts over ½ cup, made with high-fructose corn syrup (HCFS), fortified wines (sherry, port), chamomile tea, fennel tea, chicory-based drinks or coffee substitutes Spreads and Condiments: Chutneys, hummus, jellies, gravies made with onion, pickle, relish, salad dressing or sauces made with, salsa, stock, tomato paste Sweeteners: Agave nectar, artificial sweeteners (isomalt, mannitol, maltitol, sorbitol, xylitol) honey, corn syrup solids, fructose, fruit juice concentrate, high-fructose corn syrup, and polydextrose. Others: Bouillon cubes, garlic and onion powder

* Foods in bold are moderate in FODMAPs and portion size should be limited.

Source: Academy of Nutrition and Dietetics. Nutrition Care Manual. Low-FODMAP Nutrition Therapy. Accessed 11/30/2018.

 

Q: What are the best foods to eat if you have low vitamin D?

A: That is a great question, because getting an adequate amount of vitamin D is important for bone health, and it’s also vital for your immune system and cardiovascular function.

There are 3 ways to get vitamin D: sun exposure, food, and supplements. Your body can use sunlight to produce vitamin D, but the amount of sun exposure needed depends on your age, skin type, where you live relative to the equator, weather, and air pollution. Under certain conditions, just 10 minutes of exposure might be enough, but of course we always recommend sunscreen.

Dietitians generally promote “food first”, but there are very few foods that contain a significant amount of vitamin D. The recommended daily allowance (RDA) for vitamin D is 600 IU per day for adults up to age 70, and 800 IU for adults >70 years. A 3 oz. serving of salmon contains 447 IU, and 1 egg yolk contain 40 IU. Cow’s milk is fortified with vitamin D, and contains about 120 IU per cup. For many people, sunlight and dietary sources are not enough.

If you are vitamin D deficient, I recommend you check with your doctor before starting supplementation. It is possible to get too much, and vitamin D is fat soluble so your body cannot easily excrete the excess. Your doctor may wish to retest your vitamin D level after 3-6 months of supplementation to determine if your current dose is sufficient.

If you want to read more, check out this fact sheet from the National Institutes of Health.

 

Q: What foods can help control Ulcerative Colitis?

A: Diet recommendations for ulcerative colitis are based on whether you are actively experiencing symptoms. If you are in the midst of a flare up with symptoms such as diarrhea and abdominal cramping, a low fiber diet will be best tolerated. This includes foods such as:

• Refined grains such as white rice, white bread, and white pasta
• Well-cooked lean meats, scrambled eggs, and tofu
• Creamy nut butter
• Reduced fat cheese and other dairy products (lactose free if you are lactose intolerant)
• Well-cooked vegetables such as carrots and green beans; cooked potatoes without the skin
• Ripe bananas, applesauce, cantaloupe, and canned peaches

You should avoid higher fiber foods such as raw fruits and vegetables and whole grains, as these can further irritate your digestive tract.

When your symptoms have subsided for at least 2 weeks, you may try to incorporate 1-2 servings of a higher fiber foods in your diet each day. Be sure to monitor your symptoms closely and reduce the fiber if you experience any discomfort.

The foods which trigger UC symptoms are often unique to each individual, but you may wish to avoid foods which are spicy or high in saturated fat. Keeping a food journal can help to identify your trigger foods.

It is always recommended to drink plenty of fluids, and avoid caffeine and alcohol as these can exacerbate symptoms. You may find it easiest to tolerate smaller, more frequent meals.

Finally, I would recommend that you seek personalized advice from a Registered Dietitian. You may also find helpful resources on the Crohn’s and Colitis Foundation website.

 

Q: How does a carnivore diet affect/alter your microbiome?

A: Many studies have examined the relationship between diet, microbiome, and chronic disease.  A diet which contains high amounts of animal protein, and low amounts of fruits and vegetables is associated with less microbial diversity in the gut.  This decreased diversity may be associated with increased inflammation nd increased risk of infection.

In contrast, a Mediterranean style diet is associated with an increase in total bacteria in the gut, and associated with reduced levels of inflammation.  This diet focuses o vegetables, fruits, legumes, nuts, and olive oil, and moderate amounts of fish and chicken.  There is also evidence that changing your diet can alter your microbiome and decrease inflammation, although the research isn’t clear on the duration needed to significantly reduce the risk of chronic disease.

Research continues to support the fact that a heavily plant based diet is good for health!

References:

Mills, S., Stanton, C., Lane, J. A., Smith, G. J., & Ross, R. P. (2019). Precision Nutrition and the Microbiome, Part I: Current State of the Science. Nutrients, 11(4), 923. doi:10.3390/nu11040923

Singh, R. K., Chang, H. W., Yan, D., Lee, K. M., Ucmak, D., Wong, K., … Liao, W. (2017). Influence of diet on the gut microbiome and implications for human health. Journal of translational medicine, 15(1), 73. doi:10.1186/s12967-017-1175-y

 

Q: Do you have any advice for someone trying to start a vegetarian diet (eggs and dairy still in diet)? My concerns include eating to many carbs and also making sure I’m getting adequate protein and B12 intake.

A: Thank you so much for reaching out to us! For lacto-ovo vegetarians, we strongly encourage maintaining a healthy, balanced diet by eating a variety of fruits, vegetables, whole grains, legumes, nuts, seeds, eggs, and low-fat or fat-free milk and other dairy foods. Through proper meal planning, and by including a variety of foods in your diet, it is entirely possible to meet your protein and vitamin B12 needs as a vegetarian.

A general rule of thumb that helps a lot of people who are transitioning to a new diet is the MyPlate design.  Aim to fill ½ of your plate with fruits and vegetables, ¼ of your plate with protein, and ¼ of your plate with whole grains.  Protein foods can include eggs, dairy, and plant-based proteins such as beans and tofu.  Whole grains also contain some protein in addition to vitamins, minerals, and fiber.  The carbohydrates in starchy vegetables, fruit, and whole grains contain nutritional benefits and are a vital component of a healthy, balanced diet.  You also should eat some sources of healthy fat such as nuts, avocados, and olive oil.

Vitamin B12 is found in many of the foods listed above such as fortified breakfast cereals, eggs, and yogurt.  You can readily meet your vitamin B12 needs as well simply by eating a variety of vegetarian foods each day.

 

Q: Is there a good diet for perimenopause? The anxiety and mood swings specifically. 

Perimenopause features hormonal changes, such as a decline in estrogen which alters metabolism and fat storage. These changes make it more difficult to avoid unintentional weight gain.  Perimenopause may also be associated with other symptoms such as mood swings, as you noted.

Exercise is extremely important at this stage of life, to support weight management and preserve lean body mass. Both cardiovascular exercise and strength training are recommended. The CDC recommends 150 minutes per week of aerobic activity, and muscle strengthening activity at least 2 days per week.

There is no specific diet which alleviates the symptoms of perimenopause, but here are some tips which can help.

• Reduce added sugar – Added sugars are found not only in foods like cookies and other sweets, but also flavored yogurts, coffee beverages, and many convenience foods.
• Eat more fruits and vegetables – These foods have important nutrients including fiber, which will help you to stay satisfied and keep blood sugar stable.
• Get enough calcium – Women need 1000mg of calcium daily until age 50, and then the requirement increases to 1200mg. You may get enough in your diet with calcium rich foods such as milk, cheese, white beans, almonds, and spinach or you may want to consider a supplement.  ​

 

Q: I am considering the ketogenic diet, and would like your input.

The ketogenic diet has received a lot of media attention. This type of diet is very high in fat, and carbohydrates are restricted to usually <50g/day. In the short term, it is likely to produce rapid weight loss. However, there is limited evidence that this weight loss can be maintained, especially since it is difficult to remain compliant on the diet in the long term.

There are other health concerns associated with the ketogenic diet. The carbohydrate restriction essentially limits plant based foods including fruits and vegetables. The diet lacks fiber and vitamins, in addition to antioxidants and phytochemicals which reduce the risk of chronic disease.

There are risks associated with the diet including dehydration, constipation, and kidney stones. A diet high in fat, especially saturated fat, may increase the risk of heart disease.

Instead of the ketogenic diet, I recommend a diet high in plant based foods including fruits, vegetables, beans/legumes, and whole grains. To promote healthy weight loss, fill half your plate with non-starchy vegetables which will promote satiety and provide your body with a lot of beneficial nutrients.