Nutrition
Gluten – what you need to know!
May 6, 2012 | 
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I’m sure that most of you have heard about gluten, or know someone who is gluten intolerant. But, what does ‘intolerant’ actually mean? Let’s start with the basics.
What is gluten?
Gluten is a protein found in grains and cereals such as wheat, barley, triticale, rye, etc. 
It provides elasticity to dough, allowing it to rise and take on its characteristic chewy, soft texture. It is also added as a thickener to many prepared foods such as imitation meats, sauces and gravies. Once you start looking for gluten – it’s everywhere!
Types gluten intolerance
1. Celiac Disease
- Celiac disease is an autoimmune condition, not an allergy or intolerance. The presence of gluten triggers the production of antibodies resulting in damage to the mucosa of the small intestine. This can result in loose stool (but not always), weight loss, fatigue and various nutrient deficiencies such as B12 and iron defeciency. Screening for celiac disease can be done through bloodwork, but can only be diagnosed with a biopsy of the small intestine.
- A new in-office/home test is now available, allowing for more convenient screening. The Biocard test can be purchased online, or at our office. During the month of May we will be offering the Biocard test at a reduced rate – $45.
- Gluten avoidance is mandatory for those with celiac disease, otherwise damage will continue to occur. Individuals with celiac disease must avoid all gluten-containing grains such as wheat, barley, rye, spelt and kamut.
2. Wheat allergy
- Wheat allergy is an IgE bound histamine reaction of the immune system.
- Unlike celiac disease, the reaction is usually only to wheat, so other grains (such as rye and barley) may be ok. Spelt and Kamut should also be avoided though as they are wheat relatives.
- Also unlike celiac diease, allergies are sometimes outgrown, so an allergic child may not become an allergic adult.
3. Wheat/Gluten Intolerance
- Symptoms of a wheat and/or gluten intolerance can vary quite a bit. Some people may experience digestive symptoms such as diarrhea, gas or constipation, but others may experience headaches, fatigue, anxiety or depression.
- Unlike celiac and wheat allergy, there is no reliable testing available to detect intolerance. The gold standard “test” is an elimination diet. By eliminating all wheat and/or gluten for a minimum of 3 weeks, intolerance can be ruled in or out based on the return of symptoms with a subsequent challenge. Often times, other foods are eliminated as well and the patient is put on a strict hypoallergenic diet. While not difficult per se, this diet does require a bit of planning and guidance, which an ND is qualified to provide.
More Information:
- Canadian Celiac Association
- http://www.celiac.com/
- About.Com – Info page on Celiac Disease/Wheat allergy
Posted in Celiac, Gluten, Gluten-Free, Naturopathic Medicine, Nutrition, Uncategorized, allergies | 
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Naturopathic Approach to Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome (IBS) is a functional disorder of the gastrointestinal tract leading to symptoms such as gas, bloating, constipation, and diarrhea. Symptoms can range from mild to debilitating. There is no lab test or exam that can be used to diagnose IBS because there are no changes in the tissues- IBS is a result of dysfunction in the digestive tract. While there are many things that can contribute to digestive dysfunction including stress, most patients that I treat with IBS have a combination of food sensitivities or intolerances and dysbiosis which is an imbalance of the healthy gut flora and the potentially harmful gut flora. Oftentimes, flooding the system with healthy bacteria or probiotics is enough to rebalance the flora but sometimes it is necessary to actively kill off the harmful bugs. If you have IBS, try keeping a food diary for 2-3 weeks to see if your symptoms get worse with a specific food. If they do, remove the food from your diet for at least 2 weeks and take a probiotic (kefir is a great food source) to see if you notice any improvement. Determining food sensitivities can often be tricky; your naturopathic doctor can help you figure out if you are reacting to any foods and can advise you on the best way to rebalance your gut flora.
Posted in Irritable Bowel Syndrome, Naturopathic Medicine, Nutrition, probiotics | 
Tags: Food Sensitivities | Comments Closed
Need a sugar fix? Thoughts on overcoming sugar addiction.
Think sugar isn’t addictive? Think again. A study conducted at Princeton University found that rats could indeed become addicted to sugar, and would display symptoms of withdrawal after a period of time without their “sugar fix”. And more concerning is that the researchers found that sugar acted as a gateway drug for the rats. What does this mean for our kids, who have more sugar in their diet than any other generation? Sugar stimulates the release of dopamine in the brain, just like other well known addictive substances such as cocaine and heroine. It really IS an addiction for some people.
But, isn’t sugar naturally found in foods? How can it be so bad for us?
Fruit contains naturally occurring fructose, which is very different than sucrose (table sugar) or even fructose added to foods during manufacturing. And, fructose from fruit (sometimes called levulose) is balanced out by the vitamins, minerals, fiber and enzymes naturally present in the fruit. When sucrose or fructose is added to foods, it’s often paired with refined white flours, colourings and flavourings. Not such a great combo. So, the two can’t really be compared.
If sugar is so bad, can I use sugar substitutes?
Artificial sweeteners are definitely out, as they still raise the threshold for sweetness which can trigger sugar cravings. And, they’re chemicals. Natural sweeteners like honey, coconut sugar and maple syrup are better, but still contain sugar. And agave nectar, which many people believe to be healthier, isn’t – it’s actually high in fructose and is heavily processed. So, while natural sweeteners are better than white table sugar, they still have the potential to cause harm. In other words, moderation is key.
Ok, I’m an addict – what do I do?
1. Start the day with a low-glycemic, protein rich breakfast. Resist the urge to have toast in the morning as high carbohydrate meals can trigger mid-morning slumps in blood sugar, resulting in the need for a “quick fix”
2. Avoid anything “white” – no white bread, rice, potatoes or crackers.
3. Protein at every meal. Protein, along with fat and fiber help to reduce the glycemic load of a meal, resulting in a more stable rise and fall of blood sugar levels.
While the above measures can help some people stave off their sugar cravings (or at least help get them under control), many others need to go cold turkey. In that case, a visit to an ND can help you formulate a plan. There are also a few key nutrients involved in blood sugar metabolism that can help. And, since dopamine receptors are involved in sugar addiction, some people need a lot of support, which an ND can provide.
Gluten-free resources
Gluten
Gluten is a protein found in wheat, barley, rye, triticale, and spelt. Because gluten binds ingredients together and helps baked goods to rise, it is commonly used in processed foods. Reactions to gluten vary from the extreme of celiac disease to mild digestive upset. While people with celiac disease or gluten allergies have to avoid all amounts of gluten including contamination from kitchen utensils and toasters, most people with gluten sensitivities can tolerate trace amounts up to about 1/8 tsp.
Common sources of gluten
bread
pasta
baked goods including cakes, biscuits, muffins, and cookies
cereal
crackers
pizza dough
tortilla wraps
breaded meats
beer
Gluten is often used as an additive in soups, broths, baking powder, spice mixes, soy sauce, gravy, sauces, marinades, and imitation seafood (especially crab).
What to look for on labels
If any of these ingredients are in a product, it contains gluten: flour, enriched flour, wheat, whole wheat, bran (unless from a gluten free source), barley, rye, triticale, spelt, bulgar, semolina, frumento, durum, kamut, graham, einkorn, farina, couscous, seitan, matzoh, matzah, matzo, malt (assume it is derived from barley unless otherwise specified) and gluten.
Naturally gluten free
Most foods are naturally gluten free including vegetables, fruit, beans, nuts, seeds, seafood, and poultry. There are a number of gluten free grains and starches that can be eaten on their own or used to make pasta, cereal, bread, and baked goods including:
Amaranth
Arrowroot
Buckwheat/kasha
Chickpeas/garbanzo beans
Corn
Millet
Potato
Quinoa
Rice (any variety including glutinous rice)
Tapioca
Teff
Although naturally gluten free, oats are often contaminated with gluten and may be an issue for some people.
Gluten free products
Fortunately gluten free products can be easily found at your local supermarket in the health food section. Farmers’ markets, health food stores and the Bulk Barn are also great resources. There are a wide range of breads, pastas, cereals, baked goods, crackers, baking supplies, and even pizza! Just remember that gluten free does not necessarily mean healthy- many products are based on starches (such as potato) which lack nutrients and fiber, and are loaded with sugar. Try to choose products with either a whole grain or a bean flour base. For baking purposes, you can buy mixes for pizza dough, bread, and desserts or simply purchase a gluten free all purpose flour and use your favorite recipes. You may need to add some xanthum or guar gum to the mix to help it bind and rise- check the label for directions.
Alcohol
Avoid beer, malt beverages, and cider that contains barley.
Gluten free options include gluten free beer, gin, rum, schnapps, tequila, vodka, whisky, wine, and Champagne.
Eating Out
Many restaurants offer either a gluten free menu (you may have to ask for it) or have gluten free (GF) indicated beside some of the menu options. Even if they do not specifically advertise it, if you can tolerate trace amounts of gluten you should be ok with a main course of protein (non-breaded meat, fish, etc.) with some vegetables and rice or potatoes. Salads are usually fine too- minus the croutons.
Resources
celiac.ca A comprehensive guide to going gluten free.
glutenfreegoddess.blogspot.com Fantastic recipes, especially for desserts.
celiackids.com Information on celiac disease, tips for educating caregivers, and meal suggestions.
theceliacscene.com Search Halifax to find local restaurants that have gluten free options.
schoolhouseglutenfreegourmet.com A local gluten free bakery that provides a number of local restaurants with gluten free bread. Search the “where to buy” section for a list of places with gluten free sandwich options.
www.urbanspoon.com/tn/235/1/27000/Atlantic-Provinces/Gluten-Free-Friendly/Halifax-restaurants Another listing of local gluten free friendly restaurants.
Getting baby (and parents!) ready for solids – a case for baby led weaning
If you’re at all familiar with my practice, you’ll know that I’m a huge advocate of baby led weaning (BLW). For the past year I’ve been offering workshops at Nurtured Products for Parenting and Fiddleheads Kids Shop in addition to counseling patients and families in my office on the ins and out of BLW for the past several years.
My interest in BLW was piqued after we my first daughter was born, 4.5 years ago. We had such success with it that we subsequently used it to introduce food to our twins, who are now almost 2! When asked about the benefits of BLW, I tend to be a little emphatic! I think it encourages family time at the table, requires less prep and care (don’t have to worry about running out of baby food!), introduces new flavours and tastes and encourages self-control. And, a recent study echoes these sentiments – kids weaned using BLW were leaner and enjoyed a greater variety of foods than those fed traditional purees.
What is BLW?
In a nutshell, BLW is a method of introducing solids that generally doesn’t involve purees or spoon feeding. By providing developmentally appropriate foods (right size and texture), spoon feeding becomes unnecessary as baby is capable of feeding him/herself! It’s quite amazing really. That’s not to say it has to be all or nothing, but it can be a stand-alone method of introducing “real” food to babies.
What’s wrong with rice cereal and purees?
Rice cereal is suggested as a “first food” because it is fortified with iron, and breastfed babies need a reliable source of iron by 6-9 months of age as the stores of iron they’d gotten from Mom will start to run out. But, if iron is the concern, why not offer great sources of iron such as meat and fish, both of which are recommended first foods? The other concern is that white rice, in particular, isn’t very nutritionally dense. We recommend a whole-grain diet for adults, why not babies? And finally, the other concern I have with rice cereal is that I often see babies suffering from terrible constipation, especially if they’re already receiving iron fortified formula. While not advocating BLW per se, Dr. Greene has launched a “White Out” campaign which encourages whole grains (vs. white rice cereal) as a first food. It’s a start!
Purees, if made from whole foods (ie just fruits and vegetables) are healthy. But, why not introduce baby to foods that the whole family is eating? BLW is cheap and easy compared to buying/preparing jarred foods! Purees were introduced at a time when infant feeding guidelines were recommending a much earlier introduction of solids foods (ie 3 months old). We know better now, and most babies are perfectly capable of feeding themselves by approximately 6 months of age. There’s nothing special about purees, and if baby is showing signs of readiness (able to sit up, loss of tongue thrust reflex, etc) then they can feed themselves!
But what about choking?
Gill Rapley, author of the ‘Baby Led Weaning‘ book sums it up nicely:
Many parents worry about babies choking. However, there is good reason to believe that babies are at less risk of choking if they are in control of what goes into their mouth than if they are spoon fed. This is because babies are not capable of intentionally moving food to the back of their throats until after they have developed the ability to chew. And they do not develop the ability to chew until after they have developed the ability to reach out and grab things. The ability to pick up very small things develops later still. Thus, a very young baby cannot easily put himself at risk because he cannot get small pieces of food into his mouth. Spoon feeding, by contrast, encourages the baby to suck the food straight to the back of his mouth, potentially making choking more likely.
It appears that a baby’s general development keeps pace with the development of his ability to manage food in his mouth, and to digest it. A baby who is struggling to get food into his mouth is probably not quite ready to eat it. It is important to resist the temptation to ‘help’ the baby in these circumstances since his own developmental abilities are what ensure that the transition to solid foods takes place at the right pace for him, while keeping the risk of choking to a minimum.
Tipping a baby backwards or lying him down to feed him solid foods is dangerous. A baby who is handling food should always be supported in an upright position. This ensures that food that he is not yet able to swallow, or does not wish to swallow, will fall forward out of his mouth.
Getting Started with BLW
Do your research! Read sites such as www.babyledweaning.com, and pick up a copy of Gill Rapley’s ‘Baby Led Weaning’. If you think BLW is right for you and your baby, join me for a workshop at Nurtured, or schedule a BLW consult in our Dartmouth office.
Here are a couple pictures of my kids loving food!
Tasty Gluten-Free Snacks
Tasty Gluten Free Snacks
One of my personal struggles is to fully commit to a gluten free diet. I have been pretty close for the last few years but it keeps sneaking in. I find snacks especially challenging- I can only handle so many almonds! One of my goals over the holidays was to find a few gluten free snacks that would suit my lifestyle and also be appealing to my 5 year old stepson- for me that means quick and easy to prepare, tasty, loaded with protein, and easy to eat on the playground. My New Year resolution is to commit to a gluten free diet- if that is something you are working on or if you are simply looking for some new snack ideas, I hope you enjoy these recipes.
Gluten Free Breakfast Bars
Ingredients:
- 1 ¼ cup almond flour
- ¼ tsp salt
- ¼ tsp baking soda (gluten free)
- ¼ cup olive oil
- ¼ cup maple syrup or honey
- 1 tsp vanilla extract
- ½ cup shredded coconut
- ½ cup pumpkin seeds, raw and unsalted
- ½ cup sunflower seeds, raw and unsalted
- ¼ cup almonds, whole or slivered
- ¼ cup raisins (optional)
Directions:
In a small bowl, combine almond flour, salt and baking soda. In a large bowl, combine olive oil, sweetener and vanilla. Stir dry ingredients into wet and mix in coconut, pumpkin seeds, sunflower seeds, almonds, and raisins. Grease an 8×8 baking dish with olive oil and press the dough into the baking dish. Bake at 350° for 20 minutes.
Dried Fruit and Nut Bites
Ingredients:
- 2 cups dried fruit of choice (I love the combination of apricots, cranberries and some coconut; if you prefer something sweeter, include 2-3 dates)
- 2 cups raw nuts and seeds of choice
- dash cinnamon
- pinch salt
- ~3 cups raw sesame seeds
Directions:
Pulse 2 cups of dried fruit in food processor and transfer to a bowl.
Pulse 2 cups of nuts and seeds until finely chopped.
Add nuts and seeds to dried fruit with a dash of cinnamon and pinch of salt.
Knead together and form 1 inch balls.
Roll each ball in raw sesame seeds.
Resolve to be healthy in 2012!
I love the holidays, but hate the expectations that come with the New Year. But, as my friend and colleague Dr. Jillian Murphy, ND points out, if we don’t take time to think about resolutions would we ever think about change and how to make ourselves better?
So, I thought I’d make things a bit easier for those of you who are hoping to make a resolution (or two) and need some help sticking with it! Here’s a quick list of small things that can make a big impact on your overall quality of life and health.
1. Take a multivitamin. This basic step is such a great insurance policy. A good quality supplement will be free of fillers, come in capsule form and ideally be taken in divided doses (ie. 2-3x/day). One-a-day vitamins are convenient, but you won’t absorb as much as you will from a multi-dose vitamin. And, if you have any concerns about the risks and benefits of a daily multi-vitamin, have a look through this report from the Harvard School of Public Health. It does a great job of explaining why you’re better off taking one!
2. Eat a reliable source of probiotics. Good bacteria like those found in fermented foods such as yogurt, kefir and saurkraut are proving to be more and more important to overall health than ever before. Not only are they involved in maintaining a healthy gut, they also play am important role in maintaining a healthy immune system. For example, a Cochrane Review found that those who took probiotics were less like to suffer with upper respiratory infections. These “good bacteria” are also important for those with autoimmune conditions, allergies and eczema. Diet should be sufficient to maintain a healthy population of gut bacteria, but you may need to supplement if you’ve taken antibiotics, recently travelled, take certain medications or have a GI illness. In these cases, we’re happy to help.
3. Eat your Greens! Yes, I know you’ve heard this before, but do you know why? Leafy green vegetables such as spinach, kale, swiss chard and the like are loaded with phytonutrients. Dark leafy greens are a rich source of vitamin C, K, E, and B, as well as iron, calcium (must be cooked), and fiber, which are essential for good health. Recent studies have shown that Vitamin K plays an important role in preventing osteoporosis, arthritis, diabetes, and atherosclerosis. Vitamin E has been shown to prevent skin cancer. Greens also contain beta carotene (converts to vitamin A), lutein, and zeaxanthin which are powerful antioxidants.
4. Get rid of “white food”. Most people know that white bread isn’t the best choice, but other white foods like white potato and white rice should also be limited. Choose sweet potato, brown rice, quinoa or millet more often! Insulin resistance is on the rise, and “white foods” should be a “less often” choice.
5. Have your Vitamin D status assessed. There’s a growing body of evidence about the role of vitamin D in maintaining health, and it’s very far reaching (read www.vitamindcouncil.org for more info. In Nova Scotia, the minimum level required to maintain bone health is 75 nmol/L, and I can’t tell you the number of patients I see with numbers well below that. If you haven’t had this simple blood test, ask your doctor to check it for you at your next appointment. And, if you are found to be deficient, touch base with us on how best to optimize your levels.
Hope 2012 is full of peace, health and wellness for you and your family!
Posted in Naturopathic Medicine, Nutrition, Uncategorized, Vitamin D, Wellness, probiotics | 1 Comment »
Practical Tips for Surviving the Holidays
Here we are, just 2 weeks away from Christmas Day. You are in good company if you find yourself surrounded by friends, food and fun. But, you may also find yourself run ragged, tired, stressed out and feeling out of control. Sound familiar? As we approach “the happiest time of the year”, it can be easy to get off track and fall away from the 80/20 rule, in food and in life! So, to keep yourself balanced here are some practical tips:
- Set boundaries. If you have to attend several functions (social or otherwise), plan to eat well before you go so that you don’t arrive hungry. And, decide which occasions are worth the treat, and which should be avoided.
- Remember that calories from alcohol can add up quickly, and that people tend to make poorer food choices after having a drink or two.
- Stick to the “real foods”. You’ll fare better by sticking to fruit and cheese, and staying away from other hors d’oeuvres that may be fried of cooked with a lot of fat, etc.
- If you’ve been invited to a party or gathering, offer to bring a healthy dish. At least you’ll be sure of one healthy option!
- To manage stress levels, avoid the temptation to load up on caffeine and sugar. The quick rise in blood sugar, and subsequent crash, can make things worse. Many people experience anxiety during the crash, which won’t help you feel more in control.
- Get 8 hours of sleep. Don’t skimp on sleep at this time of year. If you aren’t sleeping well, talk to us about options such as melatonin, inositol, or other herbs.
- B vitamins are especially important at this time of year, as they are used up quickly under stressful conditions. A B-Complex, along with a good multivitamin may be a good idea.
- Herbs such as licorice, eleuthrococcus and ashwaganda are known as adaptogenic herbs. Adaptogens are useful in times of stress, and may be helpful if you are having symptoms such as excessive fatigue, disordered sleep patterns, weight changes and/or difficulty coping with day-to-day stressors. Talk to us if you feel you may need adaptogenic support.
And, finally, remember that the holidays are meant to be a time of celebration and gathering. We wish you you and family peace and joy, and the best of health in 2012.
Osteoporosis and Diet – Beyond Calcium.
Just a few short years ago, the bulk of dietary recommendations for osteoporosis revolved around calcium. But, over the past number of years, new players have come onto the field and calcium is now taking somewhat of a backseat when it comes to importance.
Vitamin D
Vitamin D is the “sunshine vitamin”. While exposure to sunlight provides vitamin D, Canadians are at risk of seasonal vitamin D deficiency because winter sunlight in northern latitudes above 35º does not contain enough ultraviolet B for vitamin D production. Osteoporosis Canada’s new guidelines (July 2010) recommend daily supplements of 400 to 1000 IU for adults under age 50 without osteoporosis or conditions affecting vitamin D absorption. For adults over 50, supplements of between 800 and 2000 IU are recommended. I feel that everyone (especially those with osteoporosis) should have their vitamin D levels check (ask for 25-hydroxyvitamin D). This allows for individualized supplementation.
In my experience, most people in Nova Scotia need more than the recommended amounts to maintain optimal levels of vitamin D.
Magnesium
Magnesium is a very important mineral, and vitamin D’s most important cofactor. In fact, it has been shown that low levels of magnesium inhibit formation of the active form of Vitamin D.
Food sources of magnesium include:
- Halibut
- Spinach
- Squash
- Seeds, especially pumpkin and toasted sesame
- Beans, especially pinto and black
- Plantain, raw
- Nuts, especially Brazil nuts, almonds, peanuts
Magnesium oxide is the most common form of magnesium sold, but only about 4% is absorbed, making it ineffective at providing the body’s magnesium needs. Magnesium taurate, glycinate, citrate, and gluconate have demonstrated higher absorption and bioavailability. Magnesium malate and glycinate are considered by many to be even more effective supplemental forms.
Vitamin K
This vitamin, once only known for it’s role in blood clotting is thought to be as important as Vitamin D and Calcium in maintaining bone health. Unlike other fat-soluble nutrients, vitamin K is not stored in the body and must be received daily through diet or supplementation. In fact, research indicates one can become deficient in vitamin K in as little as 7 days. While there are 3 types of vitamin K, K2 is an important cofactor for Vitamin D.
Green leafy vegetables are the best source of vitamin K – another good reason to eat them!
Boron
Boron is a trace mineral, recently found to be important in bone health. It is found in many foods, but concentrated in:
- fresh fruits and vegetables
- nuts
- seeds
- honey
- dried prunes
So what about Calcium? Do I still need to take it?
Calcium is still a very important mineral in preventing and treating osteoporosis. However, most of the recent research seems to indicate that you can get too much of a good thing, and that less is more when it comes to calcium. A recent study, which analyzed data from the WHI (Women’s Health Initiative) found that women who started taking calcium and vitamin D had increased risk for heart attack and stroke. But, dietary sources of calcium aren’t a problem – so be sure to include good sources of calcium every day. And, discuss the need for calcium supplements with your ND or MD.
M. J. Bolland, A. Grey, A. Avenell, G. D. Gamble, I. R. Reid. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ, 2011; 342 (apr19 1): d2040 DOI: 10.1136/bmj.d2040
Posted in Naturopathic Medicine, Nutrition, Osteoporosis, Uncategorized, womens health | Comments Closed
Lunchbox Goodies: Healthy choices for back to school
We have the shiny new Spiderman lunch box all ready to go for the new year at school. The question is what to put in it. Finding healthy kid-friendly options is hard enough but add in a food restriction such as gluten free or dairy free (both of which we aspire to at home) and then things become challenging. Here are a few ideas to get you started.
The Basic:
I grew up taking a peanut butter and jam sandwich with some crackers and an apple. With a few substitutions this can still be a staple. Keep the apple (or another piece of fruit) and use rice crackers instead. It’s really only the sandwich that needs to be tweaked- try using gluten-free bread or brown rice wraps with almond butter (if your school allows nuts).
The Easy Vegetarian:
Rice crackers and hummus are a staple at our house. Add some fresh veggies to dip, too, and you have a complete meal. Just make sure to pack lots of hummus – at least 1/2 cup.
The Picnic:
We pack a little bit of everything to keep things interesting and use up the leftovers. Any source of protein will do (chicken, fish, tofu, etc.) with some cut veggies, crackers, nuts, and seeds. Just make sure to include an ice pack if using animal products or anything else you would refrigerate.