We had a great event focused around the DICAS application and in dietetic internships in general. If you missed it, here are some important dates for information sessions for a few of the in-state dietetic internship programs.
Attached is also some information from the presentation itself. Hope you find it helpful!
Tri-County Health Department
Nov. 20th, 2018 1:30-3:30pm
January 9th, 2019 1:30-3:30pm
Children's Hospital Colorado
Info session: January 4, 2019 2-4pm
University of Northern Colorado (distance DI)
Virtual info session via Zoom: November 5th, 5pm
Metro State (second round ISSP)
DICAS Combined PPT 2018.pdf
DICAS Overview Handout 2018.pdf
Interview and Internship Prep Handout Final.pdf
The House Agriculture Committee was unable to come to an agreement regarding The Farm Bill on March 21, 2018. Collin Peterson, the ranking member, has paused negotiations that would benefit the Supplemental Nutrition Assistance Program. As members of the dietetic community, this gives us an extended opportunity to reach out to legislators and verbalize what is important to us!
Our recommendation is to send Collin Peterson an email or phone call to tell him what matters to us. To contact Congressman Peterson, check out his website.
The AND has four priorities for 2018 Farm Bill. When you are voicing your concern to politicians, make sure to consider these points:
For an introduction on the Farm Bill, please see this post.
Write By: James Fazzio, RD
If you have ever dabbled in the world of entrepreneurship, you probably recognize this classic scenario:
Come up with a “brilliant” business idea
Research the heck out of how to make it happen
Run into roadblocks, get frustrated
Go back to what you were doing
As a newbie nutrition entrepreneur, trust me when I say there are no shortage of ideas. In fact the problem for most of us is the complete opposite - having too many ideas but not being able to properly execute on them regularly. We want to help everyone, do everything, be on every social media platform and say yes to every opportunity that comes our way. Sooner or later though, that tends to result in burn out and minimal forward progress. It may feel like you are doing a million things, but doing zero things really well. Can you relate?
Asking for help
This is where mastermind groups come in. In case you are unfamiliar, a mastermind group is basically a group of 3-5 people who all have a similar goal and join forces in the name of support, accountability and exchanging ideas. Groups typically meet weekly, bi-weekly, or monthly and check in on wins and losses with one another among other predetermined things like action items and program launches. It’s a great motivator to stay on top of your goals. After all, who wants to report back to the group the following month with “yeah, I didn’t get around to that”?
Since joining up with two other local biz-minded RDNs, I’ve made more progress in a few months than I did in the previous year and I know I have the group to thank for that. Each month we meet virtually and have really candid discussions on what’s going well, and what could be going better. There are two other professionals with experience unique from our own that are then available and willing to problem-solve as a group.
Want to start a mastermind? Do this first.
If you are interested in building your own mastermind, make sure you have a general goal or business plan in place first. Since everyone has a limited amount of time, you’ll want to have a clear vision going in so the meetings are mutually beneficial for everyone (as opposed to using the time to help one member create an initial game plan).
Once you are ready to get started, you’ll want to join forces with others who are at about the same level as you. Set expectations at the beginning and be sure to have a structured agenda to keep things moving. Dietitians are passionate folks and could chat about all things food and nutrition for hours if there was time for it. You can meet in-person, via phone or video chat, just make sure you stay consistent!
Interested in learning more?
If you have specific questions about initiating or managing your first mastermind group, I would be happy to talk more about my experience. Connect with me for details on an upcoming opportunity for nutrition entrepreneurs who want to join/start their own mastermind group - I can help you get started!
Leanne Ray, MS, RDN is the owner of Leanne Ray Nutrition, through which she offers 1:1 virtual health/wellness coaching, in-person cooking lessons, and nutrition writing and recipe development services. Check out her food blog for simple, plant-powered recipes that even the busiest of people can manage in addition to relatable, science-based articles.
A recent study showed a relationship between sleep and clothing size, suggesting that insufficient sleep can add more than an inch to your waist. And if you sleep more, your clothing size may go down.
How does sleep change your weight and body composition? The answer is hormones. When you don't sleep enough, the regulation of hormones that manage hunger and satiety is disrupted. When hormones aren't properly regulated, you may struggle to make good food choices.
Sleep deprivation can affect hormones related to weight regulation and hunger. When you're sleep deprived, production of ghrelin (the hunger hormone) is increased, and leptin (the satiety hormone) is decreased.
This imbalance suggests to your brain that you may be more hungry and less satisfied than you really are. It encourages consumption of more calories, and a greater potential to make poor nutritional choices.
Sleep deprivation can also disrupt the regulation of cortisol and insulin, other hormones that can influence nutrition and weight gain. Cortisol is a stress hormone that conserves energy as fat reserves so that you can use it as fuel throughout the day. Insulin regulates your body's ability to process food into energy.
Making good decisions can be difficult when you're tired. It's tough to stick to a diet, and you may be more likely to indulge in junk food. One study indicates that people who are sleep deprived are more likely to eat high carb snacks and snack late at night than those who sleep enough.
In another study, people who sleep less than five hours each night are more likely to consume more calories, less water, and more carbohydrates overall. Additionally, acute sleep deprivation may make you more likely to purchase more caloric food, and in larger quantities, so you may set yourself up for failure later even when you're well rested just by having that food available.
When you sleep well, you're in a better position to make good food choices. But sleeping well doesn't always come easily. Follow these tips to improve the quality and quantity of your sleep:
Written by: Selina Hall. Selina is an expert on sleep health and wellness for BestMattressReviews.com. She believes that sleep is one of the most important pillars of health. Selina lives in Portland, Oregon. She sleeps best under a handmade quilt passed down from her great-grandmother.
It’s important to understand that the Farm Bill has a major impact on our entire nation’s food system. What farmers grow, how food prices are set, and how much funding goes into programs like Supplemental Nutrition Assistance Program (SNAP) as well as other food and nutrition research projects is determined through the Farm Bill.
What is the Farm Bill?
The Farm Bill is an in-depth legislation (body of laws), that governs an array of agricultural and food programs and is addressed approximately every five years. The 357-page Agricultural Act of 2014 contains 12 titles and indirectly affects every American in the U.S. It is also one of the most expensive pieces of legislation Congress addresses.
Since its introduction in the 1930’s, the main goal has been to keep food prices fair for farmers and consumers, ensure an adequate food supply, and protect and sustain the country’s natural resources.
A look at the current titles under the Agricultural Act of 2014
Title I: Commodities: covers payments to farmers who grow widely-produced corps crop, such as wheat, corn, soybeans, peanuts, rice and even livestock, during unforeseen circumstances like natural disasters, weather, over-production, and price fluctuations.
Title II: Conservation: covers programs that help farmers conserve vital natural resources such as healthy soil, lean water and wildlife habitat.
Title III: Trade: covers trade exports and international food aid programs.
Title IV: Nutrition: covers nutrition assistance for low-income households through programs like Supplemental Nutrition Assistance Program (SNAP) and several other smaller programs.
Title V: Credit: covers direct government loans to farmers and ranchers especially for beginner farmers and small family farms.
Title VI: Rural Development: covers rural business and community development programs.
Title VII: Research and Extension Title: covers farming and food research, education and extension programs to help farmers become more efficient, innovative and productive.
Title VIII: Forestry: covers forestry management programs.
Title IX: Energy: covers the opportunities and development of farm and community renewable energy and bio-based manufacturing to reduce our nation’s dependence on foreign oil.
Title X: Horticulture: covers speciality crops like fruits, vegetables, tree nuts and nursery crops including farmers market and local food programs.
Title XI: Crop Insurance: covers the subsidies and improvements of the Federal Crop Insurance Program.
Title XII: Miscellaneous: covers additional programs for the limited-resource and socially disadvantaged farmers as well as others that do not fit into a category.
The Academy of Nutrition and Dietetics was actively involved in the reauthorization of the Farm Bill in 2014 and will continue to work with Congress to advance a Farm Bill that maintains the integrity of nutrition assistance programs, ensures vital nutrition education and nutrition research, and enhance access to healthful food.
Registered dietitians can advance nutrition, food and health legislation by educating their federal Representatives on the urgency of funding nutrition prevention programs that combat childhood obesity, reduce health disparities in low socio-economic communities and help lower the incidence of diabetes.
We will continue to follow the progression of the Farm Bill for 2018, and share any important information that may affect us from a nutrition standpoint.
To learn more about what the Academy of Nutrition and Dietetics has to say, click here.
More resources on the Farm Bill from the USDA can be found here and here.
Consumers are increasingly interested in where their food comes from and how it’s being produced, and they’re coming to registered dietitians with their questions. In order to equip you to better answer those questions, this blog will take you on a journey to tell the story of milk from farm to table. Because, after all, as a mom and registered dietitian working on behalf of the dairy farm families in Colorado, Wyoming and Montana, I want you to feel good about milk – how it’s produced, its freshness and simplicity, and the story that connects your glass of milk with the local dairy farm families who produce it.
On the Farm
There are many moving parts on a dairy farm, from facility management, to herd health, to feeding dairy cows, to sanitation in the milking parlor, all of which ultimately affect the bottom line – the quantity and quality of milk produced.
Cows are milked two to three times each day with specialized milking equipment that milks the cows and pumps that milk directly from the cow to a refrigerated storage tank, where it is quickly cooled to preserve freshness and safety. It is important to note that milk never touches human hands – just one of the many food safety measures in place.
Animal welfare is a top priority for dairy farmers because healthy cows produce high quality milk. For that reason, dairy cows receive regular veterinary care, including periodic check-ups, preventative vaccinations and prompt treatment of illness. It is important to note that dairy cows are not routinely treated with antibiotics. Just as you’d only treat a sick child with antibiotics under the supervision of a doctor, dairy farmers care for their cows in a similar manner. When an illness requires that a cow be treated, antibiotics are administered according to strict Food and Drug Administration guidelines, the cow is milked separate from the milking herd, and her milk does not enter the food supply.
At the Processing Plant
Fresh milk is driven from the dairy farm to a local dairy processing plant in an insulated, sealed tanker truck. You’ve probably seen one on the highway – it’s similar to a giant thermos on wheels.
Prior to leaving the farm, and upon arrival at the processing plant, every tanker load of milk is tested for antibiotics. In the extremely rare event that milk tests positive, it is disposed of immediately and never reaches the public.
Once the milk is unloaded from the tanker truck, it is homogenized, pasteurized and packaged into bottles or cartons. Pasteurization is a process of heating raw milk at a high enough temperature for a sufficient length of time to destroy bacteria which can cause serious illnesses. Traditional pasteurization heats the milk to 161 degrees Fahrenheit for a minimum of 15 seconds while ultra-high temperature pasteurization heats the milk to 280 degrees Fahrenheit for a minimum of 1 to 2 seconds. Both methods ensure the milk is safe to drink and neither affects milk’s nutritive value.
Distribution companies pick up milk and other dairy products in refrigerated trucks from the local processing plants and deliver them to grocery stores, convenience markets, gas stations, schools and other retail outlets.
For 80 percent of Colorado’s milk, the journey from farm to plant is 40 miles or less, and in most instances, the milk you buy in your grocery store was harvested on farm less than 2 days (48 hours) prior. Now that’s local!
Regardless of whether your choice in dairy is influenced by taste or nutrition, you too can feel good about milk, cheese and yogurt as part of a balanced diet. In fact, milk is a nutritional bargain at less than 25 cents per 8-ounce glass, on a gallon basis. Especially when you think of all the liquid assets inside! Milk provides great taste plus 9 essential nutrients – it’s how nature does wellness.
Need some help decoding the dairy aisle, check out this recent blog on the topic.
Do you want to learn more about each step in the process of getting milk from farm to table? We’ve got you covered…
Written by Jenna Allen, MS, RDN, Registered Dietitian with the Western Dairy Association. If you have specific questions or you’re interested in visiting a dairy farm, please e-mail firstname.lastname@example.org. For more tips and healthy recipes visit www.westerndairyassociation.org.
If you have ever had a lengthy conversation with me, chances are you’ve heard me start a story with “I was listening to a podcast…” I would like to blame the fact that I have been commuting via public transit, which gives me ample time, but I just like podcasts the way some people like sportsing. So I figured I would share some reviews of the podcasts that fellow RD/Ns or RD2Bes may enjoy. These are in no particular order, though I tried to group them into categories. Also, I know this is just scratching the surface of great podcasts, so I'd love to hear which ones you'd add to the list!
The Pod: The Sporkful
Who it’s for: The official tagline is “it’s not for foodies, it’s for eaters.” I think it’s for people who eat food and also enjoy being entertained.
Who it’s for: The official tagline is “it’s not for foodies, it’s for eaters.” I think it’s for people who eat food and also enjoy being entertained.
Description: Hosted by Dan Pashman, this podcast explores some of the most important questions like: Is a wrap a sandwich? Should the cheese on a cheeseburger face up or down? What shape constitutes a slice of pizza? Simple questions…sure…but Dan has obviously put a lot of thought into answering to these types of questions and he shares his view on food in the most amusing way possible. He also investigates much more serious issues, and some of my favorite episodes are those surrounding food and culture.
He also interviews a wide variety of people to get their perspective on life and how food fits into it, some notable mentions being: Rachel Maddow on perfecting cocktails, Guy Fieri’s rise to fame and food philosophy (I know…Guy Fieri…but this episode is actually pretty interesting), and Lucy Dahl (Roald Dahl’s daughter) on how whimsical food was growing up.
Get Started: I recommend starting with a 4-part series, called “Your Mom’s Food,” which investigates the way food and culture is passed down from parents to children or clashes when two people from different backgrounds decide to be in a relationship. Part 1: http://www.sporkful.com/your-moms-food-pt-1-what-dumplings-mandu-cant-fix/
The Pod: Gastropod
Who it’s for: Anyone who has 45 minutes to hear about the science and history of food. And snails.
Description: This podcast tells some really interesting tales about some of the lesser-known science and history of our food. Sometimes they take a deep dive into a specific ingredient, like vinegar or marshmallow fluff, and other times they take a look at broader topics like fraudulent foods or the world’s first theme park devoted entirely to Italian food. Either way, I guarantee you will learn something. Like did you know that the reason chicken is so popular today is all thanks to Jewish people in New York City? (Found in the episode “The Birds and The Bugs”).
Get Started: One episode that stands out for me is “Lunch Gets Schooled,” which looks at this history of school lunch in the U.S. with some comparisons to other countries. Part of the conversation turns to why school lunch plays an important role in gender equality, something that I had never considered. https://gastropod.com/lunch-gets-schooled/
The Pod: Nutrition Matters with Paige Smathers, RDN, CD
Who it’s for: Probably everyone, but especially those looking “to explore what really matters in nutrition and health with a sensitive and realistic approach.”
Description: Okay I confess: I haven’t listened to much of this podcast. I was going to feature a different podcast by an RDN (I felt like it was important to represent our people), but I honestly didn’t love that one and I recently discovered this one. One thing that caught my attention was that, early in the first episode I listened to, she called out the fact that there is no such thing as a perfect diet, and focusing on achieving that either leads to the feeling of failure or puts you on the path to disordered eating. This podcast seems to really focus on the counseling side of nutrition, and I am really excited to listen to more episodes. Looking through the list of episodes, there are many topics on intuitive eating, healthy at every size, body image, and finding the appropriate balance with nutrition.
Get Started: Really anywhere you want, we’re starting this one together!
The Pod: Mastering Nutrition with Chris Masterjohn
Who it’s for: Students. And people studying for certification exams. Or people who really want an in depth explanation of the biochemical and physiological aspects of nutrition science.
Description: This is certainly not my relaxing, light-rail listening podcast (though if it’s yours, more power to you). A large part of the reason why I have subscribed to this podcast is for the notifications when new episodes are available. This podcast really delves into the science of nutrition – as it should, the host has his PhD in Nutritional Science – so if the topic is interesting, or something I know little about, I try to listen when I can. Fortunately, most of the episodes are 8-15 minutes long, so if there is a particular area that you want help with you can take a quick break from your day and try to really understand it.
Get Started: Browse the episode titles and see which ones catch your eye!
The Pod: Only Human
Who it’s for: People interested in hearing really cool stories about the human body or health care (both the patient and provider perspectives).
Description: This podcast covers a very broad range of topics, all of which somehow relate back to our health because “every body has a story.” You’ll hear stories about a young woman who finds out that she’s pregnant while she’s planning treatment for newly diagnosed breast cancer, what it’s like to be a Christian physician who chooses to provide safe abortions in the south, how opera singing can help people on the autism spectrum, and how an OKCupid date between a young woman with type 1 diabetes and a programmer lead to the development of an artificial pancreas that started as a DIY project.
Get Started: You almost can’t go wrong with any of these episodes, but a few that stand out are “Doctor Stories: The Patient I’ll Never Forget,” “Who Are You Calling Inspiring?” and of course “The Robot Vacuum Ate My Pancreas.”
The Pod: Charting Pediatrics
Who it’s for: In the context of this blog post, mostly RDs interested in clinical pediatrics. But I can definitely see how episodes would apply to WIC RDs or (for the nutrition-related episodes) everyone.
Description: This is a relatively new podcast out of Children’s Hospital Colorado, and each episode they interview a specialist about a topic with the general goal of informing primary care physicians what to look for, test for, when to make referrals, and how the condition is managed. While not every episode is nutrition-adjacent, there have been quite a few that are. So far, this has included: constipation management, ingested foreign bodies, breastfeeding management, vaccinations and motivational interviewing, food allergies, neonatal jaundice, and adolescent bariatric surgery. These episodes typically last 20-30 minutes, and while the overall conversation can be formulaic at times, I am always highly engaged in the episodes.
Get Started: Despite not being nutrition related, two of the episodes that stand out for me are an Update in Teen Reproductive Health and International Adoption Medicine.
The Pod: NPR’s Up First
Who it’s for: Everyone!
Description: I am a very firm believer that politics affects us all and thus it is our job to stay informed, especially in today’s political climate. I know not everyone enjoys keeping up with these stories, which is why Up First is great. Every weekday morning this podcast is released to provide a 10-15 minute take on the news of the day. Seriously, you can finish listening to the podcast in the time it takes to make your coffee in the morning (and since we’re in Colorado it’s always posted by the time I wake up for work).
Get Started: Today! Or if you’re reading this on a weekend go ahead and subscribe and start on Monday. https://www.npr.org/podcasts/510318/up-first
The Pod: NPR Politics Podcast
Who it’s for: Again, everyone, but especially those looking for a deeper dive into the political stories of the week.
Description: This podcast typically has episode released twice per week, with each episode generally lasting between 30-45 minutes. On Tuesdays the episodes catch you up to the news that happened over the weekend, and sometimes take deeper dives into specific hot topics in politics. Then on Thursdays the team does a weekly roundup of the week’s news, and always end with talking about what each member can’t let go from the week’s news, politics or otherwise. And during times when the week’s news just can’t be contained in two episodes, or when the breaking news is so big, they sometimes release additional episodes to discuss these topics. The team is always very well researched and entertaining, after a while it sounds like you’re listening to your group of friends.
Get Started: With the most recent episode. https://www.npr.org/podcasts/510310/npr-politics-podcast
Written By: Sara Scheler, RDN
I attended a lecture at the Colorado Society for Parenteral and Enteral Nutrition (CSPEN) nutrition support symposium in September, where Carrie Schimmelpfenning, RDN at Denver Health’s ACUTE eating disorder center, provided information regarding severely malnourished eating disorder patients. Carrie shared an overview of ACUTE, a review of common eating disorders, and nutrition therapy recommendations for critically ill eating disorder patients. The following is a summary of Carrie’s informative presentation.
ACUTE is an inpatient medical stabilization program for eating disorder patients—the only one if its kind in the country. Admission criteria includes weighing <70% of IBW, having a BMI <15, severe medical complications from an eating disorder, and/or needing to safely detox from laxative or diuretic abuse. ACUTE accepts male and female patients 17 years of age and older. Patients are seen 5 days/week by internal medicine doctors, registered dietitians, psychologists, psychiatrist, occupational therapists, physical therapists and speech therapists. They receive customized, daily meal plans and receive 24/7 observation for their first week. The goals of ACUTE are: to nourish the body with calories (the ultimate goal is a 2-3 pound per week weight gain), correct micronutrient/macronutrient deficiencies, empower clients to choose for themselves, provide nutrition education, and reduce disordered eating behavior.
Anorexia nervosa (AN)affects 0.9% of women and 0.1% of men nationwide. It has the highest mortality rate of any psychiatric disorder. The average recovery from anorexia nervosa is seven years; about 30% of patients never fully recover. Anorexia nervosa occurs when genetic predisposition meets an environmental trigger (abuse, social, trauma, etc.). The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines anorexia nervosa as:
AN patients are categorized into one of two subtypes. Restricting anorexia nervosa involves severely restricted PO intake; these patients have not binged and purged in the past three months. A patient who has binged and purged in the past three months is characterized as binge-purge subtype. Patients can move back and forth between the two subtypes.
Bulimia Nervosa is characterized by recurrent episodes of binge eating (once per week or more), and recurrent compensatory behavior in order to prevent weight gain (laxatives, vomiting, diuretics and/or exercise). Bulimic patients typically present with a healthy BMI.
ARFID (avoidant-restrictive food intake disorder) is a newer ED diagnosis, in which patients chronically fail to meet appropriate nutritional and/or energy needs. Food avoidance in ARFID can be related to sensory issues (taste/texture avoidance) or a fear-based experience (Carrie shared that one of her patients choked on food when he was young and had a fear of eating related to that incident). ARFID patients typically present with significant weight loss, nutritional deficiencies, dependence on enteral nutrition and/or oral nutrition supplements, and abnormal psychosocial functioning due to their condition.
Carrie highlighted a few medical complications that are common among ED patients in detail:
Patients are at risk for refeeding syndrome if they weigh <70% of their IBW, have been NPO for 7-10 days, and/or experience >10% weight loss in the past 2-3 months. Refeeding syndrome is characterized by a metabolic shift of utilizing fat for energy to utilizing carbohydrates for energy. Hypophosphatemia, hypomagnesemia, hypokalemia and edema are classic signs of refeeding syndrome. Thiamine deficiency is also common, as carbohydrate metabolism requires thiamine.
Cardiac complications are common among eating disorder patients, as a starved body utilizes muscles in the heart for energy. Phosphorous depletion and edema exacerbate cardiac complications in AN patients.
Superior mesenteric artery syndrome occurs when the fat pad surrounding the duodenum disintegrates and compresses, causing nausea, vomiting, abdominal distention, diarrhea and abdominal pain. Nutrition therapy for this condition include an all-liquid diet (milk, ice cream, oral nutrition supplements, pudding, ice cream, etc.) until the patient can tolerate whole foods.
Fifty percent of anorexia nervosa patients have hepatitis, and it is common for AN patients to have AST and ALT values 2-3 times higher than normal. Refeeding hepatitis looks similar to fatty liver, where the liver enlarges. Nutrition therapy for refeeding hepatitis includes reducing carbohydrate intake to <45% of total calories and holding or reducing caloric intake until liver enzymes stabilize.
About 50% of AN patients experience gastroparesis. In this condition, the gastrointestinal tract slows during starvation, in order to absorb nutrients completely. Eating disorder patients may feel their disorder is reinforced by their GI symptoms, as any PO intake causes abdominal pain, bloating and discomfort. Carrie tells her patients “the only way out of this is through it.” A return to proper digestion will come in time, provided the GI tract is utilized. Nutrition therapy for gastroparesis in eating disorder patients involves small, frequent, low-fiber meals. A low-fat diet is typically recommended for gastroparesis, as fat increases gastric emptying time, however, Carrie still recommends 25% of her patients’ calories come from fat, as it is very difficult to meet energy goals with a low-fat diet. A patient would have to consume a high volume of low-fat foods in order to meet energy needs, and it is unrealistic to expect eating disorder patients to consume high-volumes of food.
Some ACUTE patients are on nutrition support, though Carrie explained that TPN is not recommended unless the case is very severe. Patients can manipulate their PICC line and harm themselves; they also need to feel their GI tract being utilized, in order to work toward a full recovery. Carrie recommends a post-pyloric NG tube if enteral nutrition is required. Some of her patients take nocturnal feeds, or are willing to accept a bedtime oral nutrition supplement instead. Hearing the machine pumping at night, Carrie explained, causes a great deal of anxiety for patients, so she is often able to bargain with them to accept a supplement and stay off nutrition support. Carrie recommends starting on a 1.2 kcal/ml formula and transitioning to a 2 kcal/ml formula, to decrease total volume.
“Almost all medical complications associated with eating disorders can be resolved with consistent nutrition and full weight restoration,” Carrie said. This is particularly exciting for dietitians, as our main goal is to provide adequate nutrition to restore patients to their full, healthy capacity.
Carrie discussed the “therapeutic relationship” dietitians have with ED patients: her job is to establish trust, establish autonomy and boundaries, provide acceptance, normalize patients’ experiences, struggles and thoughts, and remain open and curious when patients resist.
ACUTE admission line: 1-844-649-8844
Thanks to MSU Denver students, Shawn Portwood and Alicia Wildman for contributing this article
The human digestive tract is an amazing organ system, it helps us break down food, absorb nutrients, and provides over 70% of our immune functions and that’s just from the bacteria found in our intestines.1 The bacteria, or biota, located within are so unique, one might even call them our own digestive finger print. So, how can we eat this holiday season to feed these critters and optimize how they work for us?
First a background, there are two major classes of bacteria found in our gastrointestinal tract (GIT). These include Firmicutes and Bacteroidetes, trust me there’s way more but that’s a topic for another day.i, 2 These two classes play very different roles in utilizing the foods we eat, each special in their own ways. So let’s dive in!
Firmicutes get a bad rap in the gut biota. When this phylum of bacteria is in a higher proportional ratio to Bacteroidetes, it has been shown to create a dysbacteriosis of the gut. In other words, if you have too many Firmicutes and your gut colony is out of whack then you have a potentially higher risk for gaining weight. This was demonstrated in a Ukraine study in which stool samples were collected and bacterial content was sequenced. Participants were grouped into categories by BMI and tests revealed the Firmicutes colonized at a higher percentage rate as BMI increased.3 Also, a mouse study that was published in Nature took gene sequencing samples from overweight ob/ob mice and their lean +/+, ob/+ littermates. In a similar breakdown to human biota, ~90% of the bacteria were in the two mentioned phyla – Firmicutes and Bacteroidetes. In the obese mice, there was a 50% higher abundance of the Firmicutes species over Bacteroidetes and the inverse held true in the lean mice. 4
Studies show that once you have established whom the ALPHA bacterial phyla is, which is dictated through early childhood development and dietary intake, how you retain caloric density gets sorted one way or another by the Bacteroidetes or Firmicutes. 5 If Firmicutes tend to be favored in your gut fight club than you have a much higher tendency to retain and absorb broken down fats, carbs and proteins that are turned into Short Chain Fatty Acids (SCFA) to be used as energy. The mechanism at play here is the microbes suppressing the host’s fasting-induced adipocyte factor, and by suppressing this enzymatic reaction more triglycerides end up in adipocytes.6 So, if you have a ton of these overachieving bugs you will retain too much stored energy and doing that for years on end may lead to negative health outcomes such as obesity. So what foods tend to feed your colony of Firmicutes? There is some research that shows these little bugs thrive in people with a diet that is high in both fats and sugars (The Standard American Diet aka SAD!).
Foods of plant origin contain fiber, something we simply cannot get from meat, eggs, or milk. The vegetables, fruits, grains, and seeds we eat all contain a variety of fibers. Some are digestible by our own bodies and some are indigestible. For the fibers our bodies cannot break down, we rely on the bacteria in our GIT to lend us a hand. Bacteroidetes have the special ability to break down glycans or huge links of carbs that we would not otherwise be able to use. 7 The indigestible fiber we get from our diet not only feed these bacteria and keeps them in working order, but the by-products of this breakdown feed the cells in our GIT and keep our digestion in working order.ii This phyla is also known to produce SCFA but to a lesser degree than that of the Firmicutes. For this reason, Bacteroidetes are considered the “lean” biota.i, ii
Bacteroidetes also have the ability to break down yeast that we get from food most notably found in bread, wine, and beer. This is so awesome because yeast is known to have a protective layer covering its cells that makes it nearly impossible to break down without the help of our little bacterial friends. Certain sub groups of Bacteroidetes have the skills necessary to break down the side chains and backbone structure supporting the shell around these yeast cells and keep them from proliferating in the GIT. 8 Essentially, filling your plate with more fruits and veggies can keep other bugs in check.
One of the coolest things about this class of bacteria is that it can thrive in environments within and outside of the body and tends to be found on the fiber known as hemicellulose found in plants.vii This means, the more plant sources of food we consume the greater the amount of Bacteroidetes that make it into our bodies and the better we can utilize nutrients from these types of foods. These bugs contain a strong ability to adapt to a varied diet, and rely on a mix of items on your plate.
Now for the holiday cheer! If you are thinking, “Darn! I can’t drink any egg nog because it’s high in sugars AND fats,” or, “what about those cookies made with butter?” Relax! This is the time of the year to enjoy time with friends, family and loved ones. So, enjoy the cookies and egg nog. Just try to focus on nourishing the Bacteroidetes at the majority of your meals this season to ensure they are fully fed, equipped and ready to wage war on keeping a symbiotic balance with their nemesis: the Firmicutes. Then once the party begins, indulge a bit because remember we are ALL one happy family, and that includes the Firmicutes! We just don’t want too many of them hanging around into the New Year!
To feed your Firmicutes make sure to load your plate with:
For bulking your Bacteroidetes take an extra helping of:
1. Walsh, C. J., Guinane, C. M., O'Toole, P. W., Cotter, P. D. (2014), Beneficial
modulation of the gut microbiota, FEBS Letters, 588, doi:
2. Parnell, J. A., & Reimer, R. A. (2012). Prebiotic fibres dose-dependently increase satiety hormones and alter bacteroidetes and firmicutes in lean and obese JCR:LA-cp rats. The British Journal of Nutrition, 107(4), 601-13. doi:http://dx.doi.org.aurarialibrary.idm.oclc.org/10.1017/S0007114511003163
3. Koliada, A., Syzenko, G., Moseiko, V., et. al. (2017). Association between body mass index and Firmicutes/Bacteroidetes ratio in an adult Ukrainian population. BMC Microbiology, 17, 120. http://doi.org/10.1186/s12866-017-1027-1
4. Turnbaugh, P., Ley, R., Mahowald, M. et. al. (2006). An obesity-associated gut microbiomewith increased capacity for energy harvest. Nature 444, 1027–103. doi:10.1038/nature05414
5. Mariat, D., Firmesse, O., Levenez, F., et. al. (2009). The Firmicutes/Bacteroidetes ratio of the human microbiota changes with age. BMC Microbiology 2009 9:123. https://doi.org/10.1186/1471-2180-9-123
6. Million, M., Lagier, J.C., Yahav, D., Paul, M. (2013). Gut bacterial microbiota and obesity. Clin Microbiol Infect 2013; 19: 305–313. doi: 10.1111/1469-0691.12172
7. Martens, E., Koropatkin, N., Smith, T., Gordon, J. (2009). Complex Glycan Catabolism by the Human Gut Microbiota: The Bacteroidetes Sus-like Paradigm. The Journal of Biological Chemistry 284, 24673-24677. doi: 10.1074/jbc.R109.022848
8. Cuskin, F., Lowe, E., Temple, M. (2015). Human gut Bacteroidetes can utilize yeast mannan through a selfish mechanism. Nature 2015 Jan 8; 517(7533): 165-169. doi: 10.1038/nature13995
Alicia Wildman is a senior at Metropolitan State University of Denver about to complete her BSc in Human Nutrition and Dietetics. She plans to apply for a few distance internships for the Spring 2018 match and after becoming a Registered Dietitian, go on to pursue a Master’s and PhD. in biochemistry. She hopes to use her education to expand future research on the science of food. In her free time she enjoys hiking, yoga, and art as great stress relievers.
Shawn Portwood is a senior at Metro State University of Denver pursuing his BSc in Dietetics with a minor in biology and emphasis in microbiology. His long term plans are to obtain his RD credentials as well as pursue a PhD in nutritional biology to research the microbiome. He is also a certified personal trainer (NASM CPT) and corrective exercise specialist (NASM CES). In his free time, he loves reading, training for endurance races and is obsessed with Star Wars.
Written by: Sara Scheler, RDN
The alkaline, or acid-ash diet, has been gaining traction as the new, “best” way to eat. Proponents of this diet claim that high acidity causes our bodies to steal minerals from our bones and organs. They
the advocate a decreased intake of minerals that create acidic ash, namely phosphate, chloride and sulfur, to restore our body’s pH back to its normal range. Foods are rated on a scale based on their Potential Renal Acid Load (PRAL), a calculation of the acidic ash they create when consumed (Cl + Po4 + SO4 – Na – K – Ca – Mg). High PRAL foods are to be avoided. Meat, fish, eggs, dairy, alcohol, wheat and yeast are the biggest offenders. Low PRAL foods are to be consumed daily—leafy greens, sea vegetables, some fruits, most vegetables and sprouted seeds. Neutral PRAL foods (fruits, nuts, some grains and legumes) are to be used occasionally in the diet (see Supplement 1).
These concepts are not new; H.C. Sherman created the first list of acidic and basic foods in 1912 when scientists began to investigate the functional properties of food8. Popularity of this diet has grown in recent years. As with most fad diets, there are numerous blogs devoted to the alkaline eating pattern. Some alkaline diet gurus, such as the Alkaline Sisters Julie and Yvonne, describe their results as dramatic weight reduction, relief from chronic back pain and total body healing2. Others claim the diet protects from sarcopenia, improves immune function, prevents cancer, increases vitamin absorption and combats mineral deficiency1. Chiropractic and clinical nutrition celebrity Dr. Josh Axe claims that chronic disease will not occur in bodies with balanced pH levels.
pH and Mineral Balance in a Healthy Human Body
Of course, these claims rest on the assumption that our body cannot regulate pH effectively on its own. In most cases, our renal and respiratory systems are proficient at maintaining healthy pH levels. If phosphate levels rise in the blood, bone resorption occurs. Osteoclasts break down bone and release calcium, which acts as a buffer to neutralize the phosphate. Alkaline diet followers maintain that this breakdown process depletes our bones of minerals and leads to osteoporosis. However, current medical research shows that this is not the case. In a meta-analysis of the alkaline diet, researchers concluded that the pH of urine was not related to an increase in bone damage or fractures4.
The alkaline diet also maintains that phosphate intake causes calcium excretion and subsequently osteoporosis. However, in all studies reviewed, phosphate intake was found to increase levels of bone calcium and increase acid excretion4. A meta-analysis of these studies concludes, “Dietary advice that dairy products, meats and grains are detrimental to bone health due to “acidic” phosphate content needs reassessment. There is no evidence that higher phosphate intakes are detrimental to bone health.”4 Neither dietary phosphate nor supplements reduced the amount of excreted calcium, as presumed by the alkaline diet4.
Dr. Axe claims that calcium in dairy products causes acidity and calcium loss, leading to osteoporosis1. Most practitioners in the medical and nutrition worlds know that dietary calcium has a protective effect against osteoporosis, and regular calcium intake is recommended for all individuals, especially children, adults and pregnant or nursing mothers5. The body regulates calcium absorption and excretion to prevent our bones from deteriorating. When calcium levels are low, the parathyroid hormone increases calcium excretion from bones, while also increasing calcium resorption and absorption to rebuild the bone structure. A healthy human body will regulate its own calcium levels, rather than steal from our bones as Dr. Axe suggests.
Some studies indicate that an acidic diet can increase urinary calcium excretion, however, researchers note that urinary excretion is not an effective measure of the body’s calcium status4. Urinary calcium does not provide a good picture of calcium balance because this mineral is absorbed, secreted and lost in various ways throughout the body4. Many studies that support the alkaline diet consider urinary calcium excretion as the only measurable aspect of acid balance, while studies that consider whole body calcium balance do not support the diet’s hypotheses4. The biochemistry behind the alkaline diet is based on limited studies that consider urinary calcium excretion as proof that an acidic diet causes osteoporosis. A meta-analysis of calcium balance studies found no connection between acidic food intake and calcium loss or osteoporosis, further squelching this diet’s credibility4.
Practicality of the Alkaline Diet
The alkaline diet may have minor benefits during anaerobic exercise. A study of 10 participants found that a low-acid diet increased anaerobic exercise performance, as compared to a high-acid diet3. Participants who consumed 6-8 cups of vegetables, four cups of fruit, and low-acid seeds and plant fats for four days performed 21% better on an anaerobic exercise test (running on a treadmill) than those who consumed large quantities of meat, dairy and grains for four days prior3. Participants who followed the low acid diet consumed 60 grams of protein per day, while the high-acid participants consumed 110 grams per day3. Current recommendations for endurance athletes are 1.2-1.7 grams of protein per kilogram of body weight per day (70-100 grams per day for someone of my size, for example). The low-acid diet in this study would not provide enough protein to maintain athletic performance and muscle structure. It would not provide enough calcium, either; the Academy of Nutrition and Dietetics recommends 1000mg of calcium per day for adults5. The low-acid diet in this trial provided just 556mg per day.
A sample from the Alkaline for Life® 30-day meal plan provides just 1280 calories, 67 grams of protein and 610mg calcium. Alkaline for Life® meal plans focus on balancing acidic and alkaline foods at each meal, so dairy, meat and eggs are allowed in small amounts. Even with this modified alkaline diet, the meal plans do not provide enough nutrients to maintain weight in any healthy adult, much less an athlete. It would be difficult to maintain micro and macronutrient requirements while adhering to an alkaline diet, and almost impossible if adhering to a strict alkaline diet and avoiding all animal-based proteins.
A strict alkaline diet is vegan by nature. Research indicates that vegan diets can cause nutrient deficiencies6. Recently, the German Nutrition Society published a position paper stating that a vegan diet is not suitable for children, adolescents, or pregnant or nursing women7. Researchers cited vitamin B12 as the most notable deficiency but Omega-3, vitamin D, riboflavin, protein and mineral deficiencies are also commonly seen with vegan diets7. The alkaline diet recommends avoidance of meats, grains and dairy products, all of which contain bone-protecting protein, calcium and vitamin D. Strict alkaline diet followers are certainly at risk for developing nutrient deficiencies.
Clinical Significance and Implications for Practice
The principles of the alkaline diet are used clinically in two ways. Sodium bicarbonate is used to correct blood imbalances and improve growth rates in children with metabolic acidosis, and the higher pH level that results from an alkaline diet can make some chemotherapeutic agents more effective4. For healthy individuals, however, an alkaline diet does not have the benefits that its followers proclaim. Though some studies suggest that a low-acid diet can moderately increase exercise endurance, the diet is low in calories, protein and calcium, expensive, time-consuming and impractical to maintain. Furthermore, a strict alkaline diet poses serious risks of vitamin and mineral deficiencies. The limited and inconsistent research that supports this diet is certainly not enough to warrant recommendation of its use. I would not recommend an alkaline diet, as it would be difficult to maintain any level of athletic performance and avoid deficiencies with a diet devoid of animal, egg and dairy-based proteins. A minor increase in performance, based off the small cohort and very short duration found in one study does not transcend the risks this diet poses to long-term health.
As with all fad diets, it is important to investigate the biochemistry behind its claims and evaluate whether or not diet’s suggestions align with physiological fact; in the case of the alkaline diet, they do not.
Supplement 1: Alkaline Food Chart. Source: Alkaline Sister (web)
Accessed September 2016 from: Alkaline Food Chart
Celery with 1 tsp almond butter
½ baked sweet potato with butter and cinnamon
Beets and Greens
1. Alkaline diet: the key to longevity and fighting chronic disease? Dr. Axe Web site. https://draxe.com/alkaline-diet/. Accessed August 29, 2016.
2. Alkaline sister: my story. Alkaline Sister Web site. http://www.alkalinesisters.com/sisters-blog/. Published 2009. Accessed September 1, 2016.
3. Caciano C, Inman C, Gockel-Blessing E, Weiss E. Effects of dietary acid load on exercise metabolism and anaerobic exercise performance. Journ. Sports Sci and Med. 2015; 14, 364-371.
4. Fenton T, Lyon A, Eliasziw M, Tough S, Hanley D. Phosphate decreases urine calcium and increases calcium balance: a meta-analysis of the osteoporosis acid-ash diet hypothesis. Nutr Journ. 2009; 8-41.
5. Mahan L, Escott-Stump S, Raymond J. Krause’s food and the nutrition care process. 13th ed. St. Louis, MO: Elsevier; 2012.
6. Mądry E, Lisowska A, Grebowiec P, Walkowiak J. The impact of vegan diet on B-12 status in healthy omnivores: a five-year prospective study. Acta. Sci. Pol. 2012; 209-213.
7. Richter M, Boeing H, Grünewald-Funk D, Heseker H, Kroke A, Leschik-Bonnet E, Oberritter H, Strohm D, Watzl B for the German Nutrition Society (DGE) (2016) Vegan diet. Position of the German Nutrition Society (DGE). Ernahrungs Umschau 63(04): 92– 102.
8. Sherman H, Gettler A. The balance of acid-forming and base-forming elements in foods and its relation to ammonia metabolism. Columbia University; 1912; 205.
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