Monday, January 30, 2017

Eating for IBS: The FODMAP Diet

This is a re-post from a few years ago. This topic is getting continued interest so I thought I would re-visit it! 

            As a registered dietitian, I have been counseling patients with a variety of medical needs for years. The condition that has always left me empty handed when it comes to patient advice is irritable bowel syndrome (IBS). Most of our nutrition texts simply state “the patient has to figure out for themselves what foods they can and cannot tolerate”. Big help huh? Well, after a little searching, I found a little-known diet based on a little-know hypothesis that may help with IBS.

            First, a little background on IBS:

IBS is one of the most common disorders that doctors diagnose.

Ø  As many as 20% of Americans have IBS.
Ø  The good thing about IBS is that it is not a dangerous disease. There is no damage to the intestines with IBS and no risk of any long-term complications. Other intestinal diseases like celiac disease or Crohn’s disease where the intestine is actually physically damaged.
Ø  The bad thing is that IBS can wreck your life. People who have it experience bloating, abdominal discomfort, and can alternate between diarrhea and constipation. And there really isn’t a cure for it.
Ø  But the good news is that some people may respond well to a diet called the “Low FODMAP” diet.

           The idea behind it is that foods from 5 different groups tend to ferment in the intestine and contribute to the symptoms of people with IBS. The idea was developed and studied by an Australian nutritionist. While more research is needed to find out if it really works, it can’t hurt to try it. The foods are abbreviated by the acronym FODMAPS: Fermentable Oligo-, Di-, Mono-saccharides and Polyols. High FODMAP foods tend to ferment in your intestines and cause the symptoms of IBS. High FODMAP foods include prunes, apples, milk, watermelon, asparagus, avocado, corn, and wheat. But there are many more.

            You don’t have to completely eliminate all of the foods on the list – you may be able to handle some in small amounts. You may be more sensitive to some than others. So, if you are struggling with IBS, I recommend that you eliminate the FODMAP foods for several days to a week. If you find that your symptoms subside, then you can add back individual foods (one at a time) from the list to see which are more problematic for you. Obviously, keeping a detailed food record will be very important for sleuthing out the foods you need to ditch from your diet.

            I do recommend that you work with a registered dietitian to help you develop your own healthy, low FODMAP diet! You don’t need to simply eliminate all high FODMAP foods. In fact, cutting them all out could be bad for your diet. However, here is a list from Barbara Bolen, PhD, a leader in this research: 

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham 

Tuesday, January 17, 2017

Brain Food

The MIND diet was one of U.S. News and World’s top diet picks in last week’s big reveal of the best 2017 diets. Some studies show that following the MIND diet is associated with a lower risk of Alzheimer’s disease and better cognitive function.

How good is the research? The data is really preliminary – observational studies that can’t show cause and effect, just associations or correlations. So, what you’re reading is likely over-hyped. But what isn’t overhyped in nutrition news? However, if you’re interested in the MIND diet, it is a healthy, plant based diet that does not cut out large categories of foods. Even if it doesn’t live up to the hype, you could end up with benefits such as weight loss, heart health, and lower blood pressure because it is basically a combo of the Mediterranean diet and the DASH diet. These two diets have stronger research to support their benefits.

Let’s take a look at foods that supposedly give your brain a boost, and the foods you should limit.

Supposedly Brain Healthy Foods:

1.     Green Leafies (think kale, romaine lettuce, spinach) every day
2.     Other Vegetables – at least one a day in addition to the green leafies
3.     Berries – particularly blueberries and strawberries – a half cup several times a week
4.     Nuts & Seeds on most days
5.     Starchy Beans – every other day
6.     Olive Oil – use it as your primary cooking oil
7.      Whole Grains – like brown rice, whole grain breads and cereals – 3 servings a day
8.     Wine – a glass a day - but if you're a non-drinker, just             skip this one! 
9.    Fish at least once a week
10.  Poultry twice a week

Supposedly Brain Unhealthy Foods:
1.     Butter – less than one tablespoon a day
2.     Red Meat – 3 servings or fewer servings a week
3.     Cheese – fewer than 1 serving a week (undoable for cheese lovers and probably not             necessary to cut it out anyway)
4.     Fried Foods/Fast Foods – no more than once a week
5.     Sweets – 5 or fewer a week

Here’s a sample one day MIND meal plan:

3/4 cup bran flakes with ½ cup blueberries
1 slice whole grain toast with 2 tsp peanut butter

1/3 cup cashews
1 cup strawberries

      2 slices whole-wheat bread
3 ounces chicken
      1 teaspoon Dijon mustard
     1 cup romaine lettuce
     ½ cup raw vegetables
     1 tablespoon sunflower seeds
     Olive Oil Dressing


      1/2 cup romaine lettuce
1/2 cup baby spinach
1 tablespoon olive oil vinaigrette
3-ounce salmon cooked in olive oil
1/2 cup brown rice 
1/2 cup zucchini and asparagus spears
1 cup lima beans
5 ounces red wine

1/2 cup sliced almonds

Now, let me tell you what I don’t like about this diet.  Some of the restrictions are reasonable – others are not:

·For us cheese lovers, eating less than one ounce of cheese a week is crazy. And it’s probably not even necessary. And, yes, I have bit of a bias about cheese! I love it and will never give it up! 
·No mayo on your sandwich? For some that’s fine, others it’s not.
·I think the red meat guideline is pretty good – eating several servings a week is not too rigid.
·But I think with sweets, you can have a small amount every day to satisfy your sweet tooth. We should definitely limits sweets – but if you’re like me – I need a little chocolate every day!

So, here’s what I recommend. Start by focusing on the “brain healthy” foods like berries, nuts and seeds, olive oil, fish, and lots of green leafies. Find olive oil based salad dressing that you like or make your own and dress up your salad with nuts and seeds, tuna, chicken, and yes, a little cheese if you like it.  You don’t have to eat all your green leafies in salads. For instance, you can sautee spinach and kale in olive oil. Berries can be expensive – so look for frozen blueberries and strawberries and add them to yogurt or smoothies.  

Check out the U.S. News and World’s evaluation of this diet and many more:

Make sure you go to the “Expert Reviews” section for a good analysis of the claims the diets make.  

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham 

Thursday, December 1, 2016

Can You Guess the One Nutritional Supplement That Might Hold Off that Cold?

Did you guess vitamin C? It’s not surprising if you did, but you’d be wrong! While vitamin C has a reputation for cold prevention, the research just doesn’t hold up. The best research shows that zinc sulfate may lower your chances of getting a cold. It might also shorten the length of a cold and help you feel not quite as bad! While the evidence for zinc sulfate and colds is not conclusive, it does look pretty good. In a 2014 research review on cold prevention, researchers ranked taking zinc right up there with hand washing and hand sanitizer as “likely beneficial”.

Here’s what you need to know about safely taking zinc sulfate:

  • Taking 15 mg of zinc sulfate within 24 hours of the start of your cold may shorten the length and severity of your cold.
  • Taking 15 mg throughout the winter may lower your chances of a getting a cold.
  • Check with your doctor first before taking zinc.
  • Don’t use zinc in nasal spray. It can cause an irreversible loss of your sense of smell!
  • Don’t go over the 15 mg oral dose.

You should be able to find zinc sulfate supplements in most drug stores. Look for the “USP” (United States Pharmacopeia) mark as a guarantee of a quality supplement.

Source: Allan GM & Arroll B. Prevention and treatment of the common cold: making sense of the evidence. CMAJ 2014 Feb 18; 186(3): 190-199. 

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham

Sunday, November 20, 2016

Best Cranberry Recipe Ever

 This is a re-post from two years ago - but it's that time of the year!

Welcome to the greatest cranberry recipe ever. I made this for my family last Christmas and everybody loved it - even my 7 year old nephew. I've been making it for my own Thanksgiving dinners for years. One of the things I love most about it is how easy and "unmessy" it is. The most work-intensive part is chopping up the pears. I also love that you don't put the cranberries through a food mill - so it stays chunky and you keep the skins - where a lot of the nutrition lies. I love to eat this leftover for days after Thanksgiving. I treat it like dessert since I am not a fan of pumpkin pie. I cut the sugar to about 3/4 cup - a whole cup is a little too sweet for me. But if you like it sweeter, keep it in. Don't try to cut the sugar too much. Cranberries are very bitter on their own and need a lot of sugar! I skip the last two steps - the canning part - and just put it in the fridge and eat it for many days after the holiday meal!

Pear Cranberry Compote

Recipe type: PreservesSource:
Author: Marisa 
Prep time: 20 mins
Cook time: 1 hour 30 mins
Total time: 1 hour 50 mins
Serves/Yield: 2 pints

If you're planning your Thanksgiving menu already, this pear cranberry compote would complement the turkey quite nicely. Just skip the canning process and store jars in the refrigerator for up to ten days.
  • 3 pounds thin-skinned pears
  • 1 pint cranberries (approximately 8 ounces)
  • 1/4 cup orange juice
  • 1 cup sugar
  • 1 teaspoon cinnamon
  • 1/4 teaspoon freshly grated nutmeg
  1. Chop pears into small pieces. Place in a heavy-bottomed, non-reactive pot. Add cranberries and orange juice.
  2. Put a lid on the pot and place it over low heat. Cook until the pears are very, very soft and the cranberries have popped, about 1 hour.
  3. When the pears are soft, use a potato masher to break the fruit. Add the sugar, cinnamon and nutmeg and stir to combine.
  4. Raise temperature to medium-high heat and simmer, stirring constantly for 5-7 minutes, to help evaporate the liquid in the compote. When it has darkened in color and no longer looks watery, it is done.
  5. Funnel compote into prepared pint jars and process in a boiling water for 20 minutes. Be sure to read our post on Canning Basics if you have any questions.
  6. When time is up, place jars on a folded kitchen towel to cool. Once jars are cool, check seals and store in a cool, dark place.

 Enjoy the cranberries and have a Happy Thanksgiving! 

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham

Wednesday, October 12, 2016

Three Mental Traps That Sabotage Healthy Eating

These are three of the biggest mental traps I see people make when trying to eat healthy.
  • All or nothing thinking: This is the “perfect diet” trap – the “I’m either on a diet or I’m off a diet”. Perfection can lead to disordered eating or even a full-blown eating disorder. No one can maintain this kind of perfection. When you try to be perfect, you invariably mess up and “go off” your diet and feel bad about yourself. When you feel bad about yourself, you eat more. Do you see the cycle here? People with binge eating disorder and bulimia often started out as extreme dieters.
  • Dichotomous Thinking: This is the “good food, bad food trap”. No one food is going to kill you. Nor is any one food going to cure you. There are no magic foods and there are no evil foods. Of course some foods are healthier than others. And there are certainly foods you should limit. But barring a medical condition, no one food is unsafe in any amount. Sadly, even some pretty smart scientists have fallen into this trap – labeling sugar toxic or red meat a killer. It’s ridiculous – and it can be a dangerous precursor to binge eating.
  • The Self-Fulfilling Prophecy: If I eat one bite, I’ll eat the whole bag. I’ve had many clients fall into this trap. Many years ago, I had a client who came to me because her diet wasn’t working. Her diet forbade anything with sugar in it. She told me that one day she ate one Oreo cookie and then ate the whole bag. I asked her what she said to herself after eating that one cookie. She said: “I felt that eating that one cookie blew my whole diet, that I was a failure, and that I might as well just eat that whole bag”. One Oreo cookie has 40 calories. It doesn’t blow your whole diet. It’s fine, really. Eventually she learned that she could “eat just one” - and that one cookie doesn’t blow your whole diet.

You can avoid these traps by:
  • Including something you perceive as “bad” in your food choices every day. That’s right. Every. Day. Strive to be healthy but also strive for some imperfection. Don’t look at these foods as “treats” or “something special”. They should be normal parts of your diet in amounts that fit into your calorie needs.
  • Stop saying and thinking “I can’t eat that” or “I shouldn’t eat that”. Replace that with “do I really want that?” and if you do, then “I’ll just eat a small amount of that”.
  • Slow down and enjoy your food. Avoid eating on the run, in the car, or on the way to a meeting. That might lower your physical hunger, but it’s unlikely to satisfy the need to enjoy your food.
  • Watch out for inaccurate self-talk. One cookie or even one or two days of overeating doesn’t ruin your healthy diet. If you do overeat one day, do strive to make better choices the next day. But don’t try to make up for that day by being overly restrictive. You could end up in a cycle of overeating/starvation – and that can lead to disordered eating.

Follow me on twitter at @DrBethK

Beth Kitchin PhD RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham 

Friday, July 29, 2016

Lessons from Theranos: Why We Need Scientists and Skepticism

If you've been following the story of Theranos (as I have) you might find this "Viewpoint" piece by Dr. John Ioannidis interesting. It's published in this week's Journal of the American Medical Association and it's revealing. Here is my take: 

  • There were scientists and journalists who were wisely skeptical. They did their due diligence instead of leaping onto the runaway Theranos bandwagon. They raised red flags early on. However, few people picked up that part of the story.
  • Scientists are the ones who should be doing the science. Everybody loves a good "college dropout gets rich with big idea" story. But these folks are often entrepreneurs - like Steve Jobs, Bill Gates and of course, Elizabeth Holmes. Sadly, in Holmes' case, she and many of the people who flocked to her were not scientists. Her big idea of using a finger prick's worth of blood on which to run big bunches of lab tests needed scientists to develop and test the technology. Scientists need to go to school to learn to be scientists. And scientific data needs to be published in established medical journals and tested to see if it can be repeated. The process is slow and deliberate - not exactly the stuff of flashy, attention-grabbing headlines.
  • This is classic cart-before-the horse, sensationalized health reporting. It happens way too much and it needs to stop. The only people who can really stop it are good health and medical journalists who are able to combine healthy skepticism, the right sleuthing skills, and an understanding of how science works.
  • Dr. Ioannidis is an unsung hero in this story. His skeptical, sciency brain was able to quell the pull of the Silicon valley spotlight that hijacked so many journalists, politicians, and businessmen. He questions whether we even need more available testing when the bigger problem in medicine right now may be unnecessary testing.
But read the piece yourself - because it teaches us all something about how to think. 

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham

Monday, July 25, 2016

Eat Vegetables, Be Happy?

A New Study Suggests a Link Between Increasing Fruits & Vegetables and Higher Life-Satisfaction Points 

A lower risk of heart disease or some types of cancer 20 years from now may not motivate you to eat more fruits and vegetables. Sure, improved health and a lower chance of getting a chronic disease should inspire us to eat healthy. But for most of us, they don’t. But what if eating more fruits and vegetables actually made you feel happier? Now, before you get too excited, the study I’m going to tell you about cannot show cause and effect. But, it does suggest that eating more fruits and vegetables could improve your life satisfaction.

Researchers in Australia analyzed the food records of over 12,000 adults in 2007, 2009, and 2013. They also measured their life satisfaction during those same years. People who increased their servings of fruits and vegetables from zero to eight a day reported higher life-satisfaction scores. The increase in their scores was equal to how you would feel if you found a new job. People who did not eat more fruits and vegetables reported a decrease in life satisfaction. The researchers controlled for the participants’ income levels and personal circumstances.

So will eating more fruits and vegetables make you happier?
·         This study cannot show that eating more fruits and vegetables actually makes you happier.
·         It does show that there could be some sort of link between the two. But remember, the people who increased happiness ate a lot more fruits and vegetables. It was a huge increase.
·         There could have been other things in their lives that explained their increased happiness.

But don’t let that stop you from eating more fruits and vegetables. It could be that as we start to take better care of ourselves, we improve our outlook on life! We definitely need more data on this topic. But don’t let that stop you from pursuing happiness and health through better eating!

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham


Redzo Mujcic and Andrew J.Oswald.  Evolution of Well-Being and Happiness After Increases in Consumptionof Fruit and Vegetables. American Journal of Public Health: August 2016, Vol. 106, No. 8, pp. 1504-1510.doi: 10.2105/AJPH.2016.303260