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Nutrition Program

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Well-Being and Nutrition

October 2016: Gut Microbiome and Food Additives » |September 2016: Cognitive Behavioral Therapy » |August 2016: Probiotics - Food vs Supplements » |July 2016: Summer Fruits Without Digestive Distress? » |June 2016: Leaky Gut » | May 2016: Beans » |April 2016: Olive Oil » | March 2016: Dietary Tips for Sinusitis » | February 2016: Chocolate » | January 2016: New Year, More Compassionate You »

   

Vitamin D Winter

In Southern California, we are moving into what is known as a "vitamin D winter." This term describes the time of year when there is not enough UVB light to allow for vitamin D synthesis in the skin. Normally, vitamin D can be produced by the body with the aid of sunlight, in the form of UVB rays. These rays get absorbed by the skin and go through a complicated process involving the liver and kidneys to become stored and active vitamin D in the body.

Vitamin D winters occur above about 35 degrees North and South latitude. Dependent on location, vitamin D winters will occur for different amounts of time and at different times of the year. For Southern California, at a latitude of roughly 34 degrees North, the vitamin D winter is from November to early February. As you can imagine, this is a very short vitamin D winter compared to other parts of the country, such as Boston or Seattle, given their higher latitudes of 42 degrees North and 47 degrees North respectively.

With inadequate vitamin D synthesis occurring during this time of year, it is important to adequately supplement synthesis with vitamin D from foods or pills to guard against vitamin D deficiency. Ask your doctor about having your vitamin D level checked. The appropriate lab to check is 25(OH) vitamin D. Stored vitamin D is deficient below 20 ng/mL, insufficient between 20-30 ng/mL and ideal at 30-100 ng/mL. Always check with your doctor and dietitian about appropriate supplementation based on blood work.

The recommended intake of vitamin D is between 600-2000 IU per day. Consider the following food sources of vitamin D to load up on during vitamin D winter:

FOOD SOURCE PORTION AMOUNT VITAMIN D

1. Wild salmon - 3.5 oz - 980 IU
2. Farm raised salmon - 3.5 oz - 250 IU
3. Sun dried shitake mushrooms - 1 oz - 400-500 IU
4. Fortified milk - 1 cup - 100 IU
5. Fortified cereals - ¾ cup - 40 IU
6. Egg yolk - 1 - 20 IU

     
   

October 2016: Gut Microbiome and Food Additives

This past weekend I attended the gut microbiome conference in Huntington Beach, California. What a wonderful conference! One of the big nutritional take-aways was the potentially destructive nature of specific food additives on our gut microbiome (the healthy bacteria that live in our digestive tract). The two main food additives discussed were polysorbate 80 and carboxymethylcellulose.

Polysorbate 80 and carboxymethylcellulose are emulsifiers, meaning they help fat and water to mix (which they usually do not --- just try to mix cooking oil and water!). Both are found in foods such as chocolate bars, ice cream and condiments, giving these items a smooth and creamy appearance and mouth feel.

Preliminary research on mice has shown that these food additives can potentially promote inflammation in the gut as well as increase intestinal permeability (see June 2016: "I think I have Leaky Gut!" for more information). There was even research that the changes that occurred to the gut microbiome due to these food additives placed the test mice at higher risk for obesity, diabetes and metabolic syndrome.

My advice --- eat as close to the earth as possible. We are all going to eat processed foods on occasion, and these can be part of a healthy well-rounded diet, but try to make most of your meals from whole foods. Focus on whole grains, beans, legumes, nuts, seeds, vegetables, fruits, lean animal proteins and nonfat or low-fat dairy products if tolerated. And when you do consume packaged food, read the ingredients list carefully. Choose products with the fewest ingredients and where you recognize all ingredients used.

   

  
 

September 2016: A Few Thoughts on Cognitive Behavioral Therapy


I had the privilege of attending a seminar at the Beck Institute in Philadelphia, the birthplace of cognitive behavioral therapy, or CBT.
 
You might be wondering why I would choose to attend a seminar on mental health as a digestive health dietitian. You may remember my August 2015 tip on the brain gut connection, but just in case you missed it ... the brain gut connection is the near constant communication between two intricate systems of neurons known as the central and enteric nervous systems that connect the brain and the digestive tract. Stress signals can be transmitted from the brain to the gut and vice versa, leading to anxiety, depression, changes in mood, gas, bloating and altered bowel habits, such as seen in Irritable Bowel Syndrome (IBS). Stress is a part of being human, but when it leads to digestive distress, it needs to be investigated. This means that as a digestive health dietitian, I can't just focus on the gut! And several studies have shown that stress reduction therapies, such as mindfulness meditation, hypnosis and CBT can be an effective treatment tool for those with functional gut disorders such as IBS.
 
Here are some of the valuable lessons I learned:
  • CBT is a solution based therapy tool - focus is on what is happening now that is leading to certain behaviors or thoughts that lead to actions leading to symptoms; no discussions needed about childhood or familial issues
  • CBT is not long term - total number of sessions generally ranges between 10-22 and are meant to empower the patient to use skills acquired during sessions to be their own teacher/therapist out in the world
  • CBT gets at core beliefs and automatic thoughts to help unlock how we think and behave. It is truly fascinating and very useful
If interested in learning more about CBT and whether or not it might be useful for managing your digestive symptoms, we can help.
     
  
 

August 2016: Probiotics - Food vs Supplements

The normal human intestinal tract houses over 100 trillion live and active microorganisms. These intestinal bacteria are important for many body processes, including synthesizing vitamin K, defending against infection and bacterial overgrowth syndromes. Some studies even show they are important for maintaining healthy weight, creating a positive mood and staving off chronic disease. Poor dietary habits, emotional stress, lack of sleep, antibiotic overuse and environmental influences can all shift the amount, types and potency of our gut bacteria. Maintaining balance in the gut is necessary for optimal health.

Today's marketplace is littered with products claiming to aid digestion with the help of probiotics. But what is a probiotic and what is the best way to use probiotics to maintain balance in the gut? Probiotics are live, active bacteria that help reintroduce or change the current bacteria in the intestine. Probiotics are believed to help the digestive tract in two ways - direct aid to digestion and elevating our immune system (found primarily in the gut).

Probiotics are found naturally in many food sources including yogurt, kefir, kimchi, kombucha, sauerkraut, miso, tempeh and even sourdough bread. These foods, when eaten in moderation on a regular basis (daily to every 3 days) can be beneficial for reducing gut distress, bloating, gas, and regulate bowel habits as well as boosting the immune system. Probiotic rich foods have been utilized for thousands of years by numerous cultures and are a healthy, easy and tasty way to get your healthy bacteria.

If the probiotic rich foods are unappealing or unavailable, a supplement is a good alternative, but at this time do not house the same potency, variety or amount of bacteria as the natural food sources, so go for the foods whenever possible. 

     
  
   

July 2016: Enjoy Summer Fruits Without Digestive Distress

Summer evokes images of days at the beach, barbeques with family and friends and, my favorite part, lots of fresh fruit varieties.

In California, the varieties of fruit available this time of year is incredible ---- all types of berries (raspberries, blackberries, blueberries), avocado, watermelon, and stone fruits such as peaches, plums, pluots, cherries, nectarines and apricots. It is easy to go overboard when shopping at the grocery store or farmer's market, and even easier to overconsume --- eating whole punnets of blackberries or bags of cherries.

Unfortunately, this can lead to gas, bloating and loose stool. The reason for the digestive distress is due to certain sugars found in our favorite summertime fruits. FODMAPs are a set of sugars (fructans, galactans, fructose and polyols) that can be poorly digested and absorbed by the body, especially for some with irritable bowel syndrome (IBS). These sugars are found in the stone fruits, avocado, watermelon and blackberries - yikes!

A few tips for enjoying summer fruits without the gut distress:

  • Stick to 3 servings of fruits per day; a serving of fruit is equivalent to 1/2-3/4 cup berries, 1 medium sized stone fruit or 1 cup cubed watermelon
  • Only eat one serving of fruit at a time; more than one serving per meal could lead to symptoms
  • If you have IBS, or feel the summer fruits lead to digestive issues, instead of going for the stone fruits, blackberries or watermelons, try other melons such as cantaloupe or honeydew and berries such as raspberries and blueberries, which are still in season with lower digestive distress sugars
     
  
 

June 2016: "I Think I Have Leaky Gut"

Leaky gut ---- I am asked about this term by patients several times per week --- they were either diagnosed with it by an alternative practitioner, read about it on the internet, or were told by a family member or friend about it. So what is leaky gut and who has it?

Normally, the gut is lined with a layer of cells called the mucosa that acts as a protective barrier and selectively allows small molecules (water, nutrients, electrolytes) to pass through while keeping bacteria and other possibly harmful elements out. This selectivity is possible because of the space between the cells, called tight junctions, that when strong can mediate what is allowed through and what is kept out.

When the tight junctions become weak, they allow gases, bacteria and fluid to pass through, which can lead to symptoms such as diarrhea, gas, bloating and abdominal discomfort. Western medicine prefers to use the term intestinal permeability to describe this phenomenon.

Intestinal permeability is most likely to occur if the gut is damaged by some insult or trauma; bacterial or parasitic infection, chemotherapy/radiation, chronic stress, chronic digestive disease (celiac disease, IBS), or abuse of alcohol or NSAIDs.  It is also possible that those with autoimmune conditions are at greater likelihood for intestinal permeability, especially if the condition is not well managed.

At this time, there are no good diagnostic tools for intestinal permeability. If you think you have intestinal permeability, or leaky gut, make sure to talk with your gastroenterologist and meet with a specializing dietitian to discuss possible treatment plans. 

     
  
   

May 2016: Beans Beans the Musical Fruit!

We all heard this classic kid song during our childhood and may wonder, what is it about beans that cause so much gas?!?

Beans contain sugars called galactans (galacto-oligosaccharides or GOS). This sugar molecule is made up of chains of a smaller sugar called galactose. This chain of sugars needs to be broken apart in order to be absorbed and utilized by the body. Normally, sugars are broken down by an enzyme, which acts like a tiny scissor, cutting the bonds that hold sugars together. Unfortunately, the human body does not make the enzyme needed to break down the galactan molecule.

When the body is unable to break a sugar down, it will send it undigested all the way to the large intestine where it can be ushered out of the body as part of the stool. However, our large intestine is filled with trillions of healthy bacteria that do have the ability to break down, or ferment, the galactan molecules. This fermentation causes gas production.

A few tips for eating beans without the toot!

  • Use canned - as opposed to the dry varieties, canned beans have a reduced amount of GOS. This is due to the fact that GOS is water-soluble, meaning this sugar loves water. The GOS leaves the bean and migrates into the water, making the water syrupy. Make sure to dump out all of the water and rinse the beans carefully before using.
  • Try soaking your dry beans - again, GOS loves water! My favorite technique is to place 1 cup of dry beans in a glass bowl with 2 cups water and leave on the countertop overnight; dump the water out in the morning and replace with fresh water and leave for another 6-8 hours; dump the water once more, add fresh water and cook.
  • Take an enzyme pill - many enzymes on the market contain alpha-galactasidase, the tiny scissor that cuts apart the galactan molecule into individual galactose sugars. This allows for absorption and utilization by the body, so no gas!
     
  
   

April 2016: Olive Oil --- My Not-So-Secret Passion

I admit it, I'm addicted to good olive oil! I research and savor it the way some savor a fine bouquet of wine or extra decadent chocolate. I go to olive oil tasting events, try every kind I can get my hands on to see if it is smooth, tangy, spicy, pungent, floral, thin or rich.

Olive oil has been a staple of the Mediterranean diet for centuries. This region of the world has lower risks for many diseases including heart disease, cognitive diseases and high blood pressure. Some of this benefit is believed to be due to the high phytonutrient or antioxidant properties of the olives. For instance, olive oil contains, just to name a few:

  • Squalene - a protective antioxidant that helps to fights skin cancer
  • Oleuropein/Oleocanthal - helps with blood flow and reduces inflammation in the heart
  • Quercetin - anti-cancer compound also found in onions

Olive oil has long been touted for its health benefits, but something not fully understood is why getting a quality bottle of olive oil is so important to getting those health benefits. There have been several media outlets reporting on less than top quality olive oils coming into the USA. How can you ensure you are getting a good bottle? Here are a few tips to get you started:

  • Choose extra-virgin and unfiltered whenever possible - filtering can remove up to 50% of the health benefits from the oil
  • Choose bottles that are dark - clear bottles allow in light which can harm the delicate bionutrients; so can heat, oxygen and changes in pH, so cook at low temperatures
  • Look for the words "early harvest" on the label as well as " processed within hours of harvesting" - early harvest equates to higher nutrient profile and if the olives are pressed within a few hours of harvesting the quality of the end product should be higher 

Watch a video with Emeran A. Mayer, MD, PhD, Director of the G Oppenheimer Center for Neurobiology of Stress and Resilience, on the Health Promoting Effects of the Mediterranean Diet and Olive Oil »

     
  
   

March 2016: Dietary Tips for Sinusitis

Spring is just around the corner --- blooming trees and pollen in the air. For millions, this equates to inflamed sinuses, better known as sinusitis. For those who suffer from sinusitis, symptoms can include cough, headaches, runny nose, stuffy nose, facial pressure or pain, fatigue, and even dental pain.

There are lots of anti-histamines and anti-allergy medications on the market, but what can you do nutritionally to help decrease symptoms? Try out some of these tips: 

  • Did you know that spices and herbs such as ginger, onion, garlic and cayenne contain active compounds that can help decrease post-nasal drip, reduce nasal congestion and improve the flow of mucus making your sinuses less inflamed! Add garlic, onion and cayenne pepper to food or make a cup of ginger tea to help soothe aching sinuses.
  • Vitamin C is an antioxidant and natural anti-histamine. Vitamin C is found naturally in lots of fruits and vegetables including bell peppers, guava, mango and kale. Supplements are also available over the counter. Aim for 500-1500 mg Vitamin C daily.
  • Curcumin, the active compound in turmeric root, and EGCG, the antioxidant found in green tea, have both been found to decreased mucous secretions, leading to less runny noses. There are several teas on the market today with both turmeric and green tea in a variety of flavors. Pick some up the next time you are at the grocery store.  

Above all, stay hydrated! Dehydration will only make facial pain and headaches worse. Simple rule of thumb --- to figure out your hydration needs, multiply your body weight in kilograms (1kg = 2.2 lbs) by 35 to find out the number of liters fluid to drink daily.

     
  
   

February 2016: Chocolate

As February is the month of love, flowers and, most notably, chocolate, I thought it would be fun to discuss some of the pros and cons of this beloved sweet treat.

Chocolate, termed the "food of the gods," has been around for over 4000 years, first enjoyed as a bitter beverage by Olmec, Mayan and Aztec cultures in Mexico. Cocoa was introduced to the Western world by the Spanish Conquistadors in the 1500s where sugar was added, leading to the first incantation of our current chocolate beverages, bars and confections.

We know chocolate is delicious, but is it nutritious? The answer is yes and no. Cocoa contains several beneficial properties, most notably catechins. Catechins are a form of flavonol, or antioxidant, that are proven to reduce cardiovascular disease by decreasing plaque buildup in the arteries. Another notable compound in chocolate is anandamide. This fatty acid only occurs naturally in one other plant source, cannabis. Ever wonder why chocolate was so pleasurable and addictive? Now you know!

The cons of chocolate - since cocoa on its own is very bitter, lots of refined sugar is added when making chocolate to increase palatability. Other ingredients such as milk, preservatives and additives increase calories and fat and decrease the health benefits of chocolate.

To get the most from your chocolate, think darker and moderation. Look for chocolate bars with 72% or higher cocoa content (higher cocoa generally equals less added sugar and hopefully higher catechin content) and eat no more than 1-2 squares daily.

     
  
   

January 2016: New Year, More Compassionate You

New Year's Eve, a night of parties, staying up all night long and, most importantly, New Year's resolutions --- "I will start going to the gym 5 nights a week"; "I will not eat more than 1200 calories per day"; "I will lose those last pesky 5 pounds."

Resolutions by nature are demanding and commanding. "A firm decision to do or not to do something" says the dictionary when you look up the word. When we obligate ourselves to something, as with a firm resolution, the spirit and joy of the task is depleted. This can lead to feelings of worry, anxiety and, eventually, to giving up.

How about instead of making New Year's resolutions, we make New Year's intentions? The word intention means "an aim or plan; the healing process of a wound." When we create space for change there is an element of self-compassion, of believing in one's self that comes through.

Instead of "I will start going to the gym 5 nights a week," the compassionate intention version might be "May I start to work out this year in a way that is right for this body and that makes me feel strong." For "I will not eat more than 1200 calories per day," one could instead make the intention to "be mindful of the food I consume and listen to my body cues as to when I need food to quell hunger vs. when I am trying to fill an emotional need." And finally, instead of "I will lose those last pesky 5 pounds," "may I do activities and eat nourishing food that sustains my body without overindulging."

Once you have your New Year's intentions, creating a game plan for each task feels like a fun adventure instead of a chore or duty. Have fun with it! Sign up for a dance class you always wanted to try or purchase a cookbook that inspires you to make more dishes at home. Let your New Year's intentions create an opportunity for cultivating compassion.

     
  

 

 

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