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It occurred to me that I share a lot of information about nutrition, the body, and integrative healing practices in Inner Workings, and yet my readers may not know how I got started or much about my clinic. Let me introduce myself! In Wellness, Mary Virginia Who I Am Hello! I’m Mary Virginia. 😀 I am a clinical integrative nutritionist who owns Coffman Integrative Nutrition. My areas of expertise include mental health nutrition (especially anxiety, depression, ADHD), brain health, gut health, metabolic health, thyroid health, and stress resilience. Many years ago I had my first baby, and I nursed her. As she grew and began to eat solid foods, it occurred to me that if breast milk was important for her growing body, then surely the rest of the food I chose for her was also important. Thus was born my first fascination with nutrition and health. Later my third child developed chronic sinus infections as an offshoot of H1N1 (bird flu). As the one year anniversary of her monthly antibiotics approached, the importance of gut health was starting to be all over the news. I was beside myself that her microbiome was continually being wiped out and she would suffer long term health consequences. That’s what really kicked off my research, and boy did I learn a lot on my own about the effects of nutrition on the body! My reading opened my eyes to gut health and inflammation and how they interact with mental health. I was hooked. This information built on my Master of Social Work, where I majored in Interpersonal Relations (i.e. therapy). Moreover, I was able to help her overcome those awful sinus infections. 🥳 I elected to pursue a Master of Science in Human Nutrition, earned the Certified Nutrition Specialist designation, and here I am now with my own clinical practice in Atlanta, Georgia! What I Do What many don’t really realize is that clinical nutrition is health care, not a sideline alternative path to health. It’s an expansion of standard care that uses the body itself to heal. In fact, much of Western medicine is “disease care.” You get sick, and medicine is applied to stop the specific sickness. This is really important, and I am grateful for the advances in medicine that help so many people heal. However, it’s narrow in scope and often creates a domino effect of other illnesses. Clinical integrative nutrition, also called functional nutrition, uses a different lens than seeing just a small fraction of the body. We really practice “health care.” That is, we identify the root contributors to your body’s illnesses, observe all the systems of your body and the environments that influence them, and then align with your body’s own healing mechanisms. This does not necessarily exclude medication, although it often turns out that medication is not necessary or is reduced. Certified Nutrition Specialists (CNS) coordinate with our clients’ doctors so that they really experience the fullest possible care. My work takes a multidisciplinary approach. I use food, supplements, lifestyle choices, and coaching (behavior and mindset/perspective shifts) to support my clients in both prevention of illness and healing from being sick. I practice medical nutrition therapy (in states where I am legally allowed to practice), which uses these methods to manage and heal from chronic health conditions, such as autoimmune diseases, metabolic illness, digestive health issues, and emotional dysregulation. Pointedly, my clients are all individuals with unique life experiences and preferences. I provide personalized nutrition and coaching care so that my recommended interventions feel authentic and accessible to my clients. Doctors Don’t Talk About This What I have learned is that many symptoms are manifestations of underlying dysfunctions that we can address. For example, there is an ongoing conversation in America about people in larger bodies. Being in a higher weight body is described by itself as an illness. However, it’s typically not, even if reducing weight appears to solve health issues. Weight status is the cart, not the horse. I see weight increase as only one symptom of one or more root cause: hormone shifts, the gut microbiome/digestion, metabolic issues, medication, fatigue tied to autoimmunity, mental health status, stress, generational or personal trauma, mindset, genetic predisposition, sleep deprivation, behaviors tied to any of these, or other things. It’s a data point, but it’s not an end in itself. Anxiety and depression are at epidemic levels now. While the conversations about environmental triggers (e.g. cell phones, social media) are worthy and salient, I can identify a number of points of dysregulation in the body that can be treated with great success. For example, people who are low in vitamin B6 and zinc are more prone to panic attacks. High stress depletes certain B vitamins and indicates a need for higher antioxidant intake, such as vitamin C and colorful, phytonutrient-rich foods. I wrote a whole article on the vagus nerve and nervous system regulation because of its importance to mood, focus, and cognition. Hypothyroid has an impact not just on metabolism, but also on mood and digestion. Cortisol rises or dips at the wrong time of day will create persistent over- or under-stimulation and symptoms of anxiety or depression, including overstimulation or fatigue. ADHD and anxiety have a strong Venn diagram of symptom overlap. Allergies (food and environmental) trigger anxiety and depression symptoms. There is a loop between poor digestion, nervous system dysregulation, and anxiety that we label Irritable Bowel Syndrome. And the gut microbiome is a key player in mood status and brain health. I address all of these and other root causes, and my clients report feeling so much more even keeled and well. Genes are one of the most fascinating contributors to health status. I use a test by 3X4 Genetics that identifies your individual genetic blueprint on how your body is designed to interact with nutrients and lifestyle, such as exercise. Knowing your genes means that we can craft an integrative nutrition care plan that is specifically tailored to allow your body to function optimally. We can lower risks for potential future health problems and support you now to have your best health and energy. Picture Yourself in Session With Me Our first clinical session is a comprehensive intake. Before our 90 minute session, I will send you several forms to complete: Health & Social History (Intake Questionnaire) Nutrition Focused Physical Exam Medical Symptom Questionnaire Wellness Questionnaire HIPAA Notice of Privacy Practice Release of Protected Health Information I also request that you upload your most recent lab results and provide any unique information that lets me understand your situation better. As part of this initial evaluation, I will review your medications for drug-nutrient interactions and delve into what your signs and symptoms indicate about your nutritional status. We meet for a long initial session because I really want to know your story and your experience. Between the data on your forms and our conversation, I develop a timeline of your illness or health status and define the triggers and mediators that influence it. This is your body, and you are the expert of it. I will reflect back what I hear from you to confirm that I fully understand. At the end of it I might make initial recommendations or lay out the first steps of the path that will move you toward better health. For example, it might be wise to pursue more data, such as updated standard blood work or functional testing, which might be a stool panel, a urine test called an organic acids test, or other specialized tests, such as 3X4 Genetics. Follow-up sessions are designed to move you toward the health outcome you envision. Typically we will meet for an hour. This time might include my interpretation of labs and root causes of symptoms, education on food plans and choices, recommendations for supplements and my reasoning for offering them, education on the relationship between different bodily systems, presentations on the influence on your health of sleep, movement, time in nature, the vagus nerve, circadian rhythm, and more, and/or training in lifestyle practices that will support your body’s optimal functioning. This is also a time when you can ask questions, bring up new information, or participate in coaching to help you decide how to proceed. May I Ask a Favor? Inner Workings goes out to all of my former and current clients, as well as people simply interested in the role of nutrition and behavior choices on our health. It is humbling to work with such amazing people! I truly have the best job in the world and I am grateful for each of you.
Along those lines, I have a couple of favors to ask:
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A reader asked me to talk about “the link between the gut biome and mental health/brain function.” Since this is such a key component of my work, I was surprised I had only touched on it along the way and never dug in! Well, Greg, here you go! Thanks for the question! In Wellness, Mary Virginia In functional medicine and nutrition, we take a systems approach to get to the root causes of disease and dysfunction. One of the biggest contributors to all kinds of illness is an unhealthy digestive tract and microbiome (you’ll remember I talked about this here). It’s every bit the same for mental and brain health. Bring this into your own personal life. How is your mood when you have heartburn, indigestion, diarrhea, or constipation? What happens to your energy? Your sleep? Do you find you’re grumpier? More anxious? Do you battle brain fog or forgetfulness? What happens to your ability to focus or process information? I’ll walk you through the connection between inflammation, the gut microbiome, the gut’s nervous system, and brain and mental health. The upshot is that digestive health, mood, and brain health are inextricably intertwined. Immune System About 70% of our immune system can be found lining the walls of our gut. Healthy gut wall barriers and the immune system work to protect us from most of what travels through (viruses, bacteria, random junk, and other pathogens) that could make us sick. A healthy digestive tract maintains a strict gatekeeping process that serves to allow only safe and useful things, like nutrients, inside the body. This is important as the digestive tracts itself starts and ends with access points outside of the body (i.e. the mouth and anus respectively). We’re Looking at You, Inflammation Inflammation is the first step taken by the immune system. The five characteristics are: redness, swelling, heat, and loss of function. Swelling is the part that makes space between cells so that the metaphorical EMT’s can get through. These are chemicals that battle infection and repair damage. The cells of our digestive tract are only one layer deep. They are tightly bound together to keep stuff that’s inside the tube from slipping between them into the bloodstream. They are also covered with a thick protective layer of mucus to keep the cells from being damaged. A poorly maintained digestive tract begins to break down. Cells become fragile. The mucosal layer starts to become thin. So the immune system ramps up inflammation to treat the damage. When that happens, the cells are no longer tightly bound. You may have heard this called “leaky gut.” Molecules that should stay in the digestive tract slip between the cells into the bloodstream. The immune system throughout the body identifies these as invaders, and creates more inflammation. Note also that chronic stress undermines digestion and triggers inflammation. Poor digestion alone creates a continual stress response in the body, which is its own merry-go-round with gut health, mood, and brain health. I wrote about the role of stress resilience and mood here. Blood Brain Barrier Leaky gut also risks a leaky blood brain barrier (BBB), which is the brain’s protective layer. It’s different from the digestive tract, but serves a similar protective purpose and is also only one cell deep. “Invading” molecules travel in the bloodstream from the gut to the BBB, which triggers an immune reaction and a leaky BBB. This allows the cascade of inflammation to reach the brain. Many psychiatric disorders are associated with inflammation in the brain. For example, depression has long been associated with it. An inflamed gut and a compromised microbiome are also contributors to blood sugar dysregulation. Persistent blood sugar dysregulation is a primary foundation of diabetes, heart disease, vascular dementia, and Alzheimer’s disease. It all starts in the gut. An important answer to preventing inflammation in the gut is assuring a healthy gut microbiome. You’ll learn all about that in a bit. But first, let me tie in the nervous systems. Two Brains, One Integrated Response You know about the Central Nervous System (CNS), which consists of the brain and spinal cord. Perhaps you also are aware that the digestive tract has its own nervous system, called the Enteric Nervous System (ENS). It can also be found embedded in the walls along the entire digestive tract. The CNS and the ENS are connected to each other through the vagus nerve (the vagus nerve is so cool! You can read about it here), and that is a primary way that the gut communicates to the brain. What very few people know is that the ENS (gut) almost completely mirrors the CNS (brain) with the neurotransmitters (electrical messengers) it produces. Familiar neurotransmitters are the mood related chemicals called serotonin and dopamine. Low levels of these are associated with depression, agitation, irritation/anger, lack of motivation, sleep disruptions, issues with focus and attention, and more. Here’s the kicker: the ENS produces about 90% of the body’s entire pool of serotonin and an only slightly lower percentage of dopamine, as well as other lesser known, but important, mood chemicals. That is, it’s your gut that’s keeping your mood steady. Here’s another astonishing example: Parkinson’s disease starts in the gut. It begins with a protein that gets folded wrong in the ENS. Here’s the really wild part: each misfolded protein teaches the next proteins like it to fold the wrong way. The misfolded proteins travel up the vagus nerve into the part of the brain that controls motion, retraining every next protein in the chain reaction to fold and act differently. This is the trigger for Parkinson’s disease. Beneficial Bugs We all agree that we want to encourage a balanced mood and maintain brain health by reducing inflammation and bolstering neurotransmitter production. I see nodding heads in my audience. Luckily, there’s a single strategy that addresses all of this, and it’s all wrapped up in the gut microbiome. Our five pound collection of bacteria and other microbes in our gut microbiome really do a lot for us when we tend to it. People compare it to a garden, and it’s really true. We want to crowd out and “weed” the microbes that are only in it for themselves (selfish beasties) and nourish those that maintain their healthy living space by supporting the health of their human host. Certain types of bacteria are well known for their role in partnering with the immune system and healing the cells, the tight junctions between them, and rebuilding the protective mucosal layer. And what these thrive on is fiber from our food. Well nourished “good” bacteria proliferate (like tribbles. Star Trek fans?), and they produce a critical nutrient for the cells called short chain fatty acids (SCFA). So imagine. Now you have healthy, robust, tightly bound cells in the digestive tract walls. The mucosal layer is constantly maintained (the old, worn out mucus is literally eaten by some bacteria while other bacteria encourage the production of fresh new mucus. It sounds gross, but we really want this). Out of this blossoms a reduction in inflammation in the digestive tract, which leads to less inflammation in the body overall, and the blood brain barrier and brain reap the benefit. Fun Fact: All of this makes a difference to allergy sufferers, too. When you think about it, allergies are just another form of inflammation caused by something the body considers to be an invader. But Wait, There’s More! Short chain fatty acids also transport through the cells to the enteric nervous system, which is the source of those beautiful mood supportive neurotransmitters. The presence of SCFA’s triggers the release of serotonin and dopamine. These actually travel up the vagus nerve, attaching to serotonin and dopamine receptors across the body before reaching the brain (it’s actually a chain reaction of neurotransmitter production, not just some from the gut). Good mood is a full body experience. You know a quick way to deliver short chain fatty acids to the gut? A piece of buttered whole grain toast! Butter contains the SCFA called butyrate. The carbs in the bread give energy to the cells (also a mood booster), and the fiber in the whole grains feed those lovely SCFA-producing bacteria. An Apple a Day… Prebiotic fibers like inulin & pectin are amazing fiber food for beneficial bacteria. When you learned as a child that an apple a day keeps the doctor away, it’s because apples contain pectin (well, and a bunch of vitamins). When we chew the apple thoroughly (or cook it), pectin is released. It lands in the colon and is consumed by the good bacteria of the microbiome. Pectin is found in most fruits and vegetables. Among fruit, apples, peaches, oranges, grapefruits, apricots, lemons, and tomatoes contain the highest concentration. Rich vegetable sources are carrots and potatoes. The best legume source is peas. Inulin is also easy to find. It’s rich in asparagus, bananas, garlic and onions. Other sources include burdock, chicory (used in salads), dandelion root, Jerusalem artichokes, and leeks. The upshot is that fiber and probiotic foods are the darlings of gut health (again, read more here). Variety in food choice leads to better health from every angle, and that includes fiber sources. Choose from a wide range of whole, colorful vegetables, whole grains, whole fruits, legumes, beans, nuts, and seeds. Also look to probiotic-rich food sources, like yogurt, sauerkraut, kimchi, kombucha, and real pickles (not the kind made with vinegar). Anti-Inflammatory and High Fiber All the Way! I have already written about a food plan/guide that supports a healthy overall immune response and digestion, so I will refer you to this article so you can read all about it! And check out the antioxidant and anti-inflammatory roles of phytonutrients in colorful vegetables and fruit in this article.
Inner Workings has broken down the benefits and myths around both proteins and fats. Now we’re putting the spotlight on one of the most discussed, and often condemned, of all of the macronutrients: Carbohydrates. Do carbs deserve their bad reputation? Well, let’s go find out! In wellness, Mary Virginia But Before We Dive In… There’s a whisper in my ear, “Psst…wait - what’s a macronutrient?” Macro = large. A macronutrient is a major molecule in food that we need routinely in larger quantities in order to build our bodies and create energy. In contrast, a micronutrient is also an element in food that our bodies require, but only in very small amounts. Vitamins and minerals are micronutrients. There are three official macronutrients: protein, fat, and carbohydrate. While I’m boiling down carbs in this newsletter, these three really work in synchronicity in the body. As I often say, our bodies are intricate and complex. Ok, So What is a Carbohydrate? People can pretty easily identify a protein or a fat. But lots of people seem to be confused about carbohydrates. How many times have I heard, “But I had some chicken!” Carbs are made up of chains of sugar, and now you know the source of their supposedly bad reputation. When you understand them, though, you’ll see that they totally earn their macronutrient street cred. There are three foundational single sugar molecules (aka monosaccharides) that define a carbohydrate-rich food: glucose, fructose, and galactose. These combine to create disaccharides (which occurs when two sugar molecules bond together), which form many of the sugars we recognize:
Fuel Your Body Here’s what makes carbohydrates an important tool in our food toolbox. Our mitochondria - the powerhouses of the cell! - are designed by nature to use glucose as their #1 fuel source. In fact, this is so true that our bodies will actually transform other sugars and even fats and proteins into glucose so the mitochondria have a steady supply to power them. When we eat foods with carbs, we first use the glucose that enters our bloodstream to make energy. That’s why we feel so much better after we eat! Then, once our energy needs are met, our body stores some leftover glucose molecules in the liver and muscles as a back up. (Stored glucose is used later in three major ways: overnight to fuel our brain; to fuel our muscles when we’ve used up the ready glucose in our blood; and to fuel our whole bodies between meals when we’ve used up the glucose from our prior meal. That’s about when you’ll start to feel hungry.) If there is any left after that, then glucose is turned into fatty acids and stored in adipose tissue (body fat). This right here is why many people think carbohydrates = weight gain. It’s so important to understand the prior steps in the process and then work from there to meet your individual needs for this necessary macronutrient. Finally, and critically, our brains use about 20% of our daily energy, and brains really, really prefer glucose as their primary fuel. Most people’s bodies function best when 45%-65% of their daily caloric intake is sourced from carbohydrate-rich foods. That’s about 225 to 325 grams of carbohydrate daily. The higher end of that is likely best for people who burn a lot of energy daily, such as professional athletes or those who work in very physically or mentally demanding jobs. Obviously what makes one person feel best may not be right for someone else, so like other macronutrients, the right amount for you will be personal. The amount also could change in response to specific health conditions and/or therapeutic food plans (e.g. for brain and mental health). Simple vs. Complex Carbs Simple carbs are made from sugars that are already broken down into their most basic components - that is, simple carbs are short sugar chains, like sucrose, lactose, and maltose. Because they are already so small, they are very easily and rapidly absorbed through the small intestine into the bloodstream. Simple, right? Examples of foods that contain simple carbs: table sugar; sodas; juices; refined flours; baked goods (cookies, cakes, pies, crackers, bagels, pancakes, etc.); pasta; white rice; fruit filling in yogurt; potato chips; desserts, candy, and sweets; honey; agave; maple syrup; etc. Key to understanding simple carbs is that they are so easily absorbed into the bloodstream. This can be useful when our energy is really flagging and we absolutely need something to get us from here to there. High performing athletes, like marathon runners, need the ready energy of simple carbs before, during, and after their races to keep up their strength and stamina. Nevertheless, for the average Joe and Josephine, our bodies are not well designed to handle repeated swift spikes in blood sugar that arrive with consuming simple carbs often (occasionally having them won’t cause issues). Blood vessels like glucose best when it’s just passing through. Complex carbs, on the other hand, are found in foods in their most whole form (which are also more nutrient dense). The chains of sugars in complex carbs are long and - you got it - complex. They are also full of fiber, a type of complex carb that is consumed by our gut bacteria, sweeps out debris in our digestive tract, or is used to create bulk and softness in our stool. Between the complexity of the sugar chains and the fiber, these foods digest more slowly. This means that the sugars are released only bit by bit into the bloodstream - time release energy, if you will. Examples of foods with complex carbs include: whole grains (oats, brown rice, wheat, millet, amaranth, corn, etc.); starchy and non-starchy vegetables; whole fruit; beans and legumes; nuts and seeds (including quinoa, though their carbs are mostly as fiber). Try this experiment: take a bite of raw carrot and chew it really thoroughly. Maybe even close your eyes so you can focus on flavor. Can you taste the carrot getting sweeter and sweeter? That’s the sugars being broken down into their more simple forms. Where will you not find carbs? Meats, poultry, fish, or shellfish or any cooking or food prep oil. Good Carbs vs Bad Carbs I’m going to share something you may struggle to believe. There’s no such thing as a “good” or “bad” carb. I see you shaking your head in disbelief. This is a new perspective for a lot of folks who have experienced a diet-culture mindset. Remember, food has no moral value. It can’t be good or bad: it only exists as a practical tool for physiological and biochemical building blocks, fuel, and pleasure. It’s up to you to decide how and when you use that tool. For example, there’s not a thing wrong with choosing foods with simple carbs simply because you enjoy them. We bond and celebrate over many of these delightful sweets. What is a birthday without cake? My personal favorite ways to round out a meal are with a square or two of chocolate or a Mexican wedding cookie! Sugar is a natural taste preference for humans. Carb-rich foods from hunter-gatherer days to now have assured our bodies have the energy we need to live our lives. I follow an Instagram account called jennthedietitian. She captures neutrality around food so well!! I hope you will absorb my version of her message: “Some foods that taste good give us more vitamins and minerals. Others give us more joy and pleasure. Both are good for us.” Low Carb Diets Remember the primary role of carbohydrates? Energy production. When we persistently eat poorly designed low carb food plans, odds are that we will begin to drag. Those who eat low and very low carb food plans often end up on my office doorstep with fatigue, lethargy, brain fog, poor focus and attention, anxiety, depression, disrupted sleep, stubborn fat accumulation, and more. If we don’t consume enough carbs or fat (see my newsletter on fats), or if overall the body is not getting enough food, then it begins to break down protein, i.e. your muscles, to make the missing glucose, which in turn makes you weaker. And also, remember how much your brain loves glucose (have you seen the Ryan Gosling meme on this?) Many commercial weight loss plans are guilty of recommending long bouts of inadequate food intake overall to promote weight loss. Many people on these diets begin to lose muscle and strength along with shrinking fat. In case you’re new here, I am not a fan. High Carb Diets The flip side of the coin is when we have too much glucose in the blood repeatedly, often, and for too long. Blood glucose dysregulation ultimately triggers illnesses such as insulin resistance, diabetes, imbalanced cholesterol, cardiovascular diseases, mood disorders (anxiety, depression), and sleep disturbances, and can even contribute significantly to brain diseases, such as Alzheimers and vascular dementia. It’s very easy to have too much glucose in the blood when food choices are consistently overly high in carbs, especially simple carbs, compared to the other macronutrients and fiber. Normally a well-oiled machine, too much easy carb energy really messes with how our bodies manage our blood glucose levels. The Sweet Spot (haha - see what I did there?) At this point you may be wondering how to use carb-rich foods so that you have the Goldilocks amount that keeps you feeling great.
Ten bucks says you are confused about how to include fats and oils healthfully in your food choices. Am I right? Folks of a certain age especially grew up being hammered with the “necessity” of eating low or no fat foods in order to have healthy arteries. And it just ain’t so. Let's talk about it! In Wellness, Mary Virginia Fats and Your Body Believe it or not, oils and fats are hugely important to how your body functions. These are some reasons your body will be glad you ate them:
I bet you have questions... Fat Makes You Fat, Right? Nope. In fact, balanced well with protein, complex carbohydrates, and fiber in a food plan using foods that have no or limited processing, health supportive fats and oils very much support the size your body wants to be. In the 1950’s a physiologist named Ancel Keys brought scientists together to perform a huge research program called the Seven Countries Study on the effects of diet on cardiovascular health and longevity. Yadayadayada…the results got limited interpretation by folks not part of the study, so our understanding devolved into a highly oversimplified popular belief that dietary fat was bad for you, i.e. it made you fat and clogged your arteries. By the 1970’s, as growing commercial food manufacturers began to crowd grocery store shelves, low- and no- fat products dominated the market based on this misunderstanding. Anyone remember Snackwells? The rich flavor of fats was replaced by the thin flavor of sweet. We found ourselves increasing our carbohydrate and sugar intake to support taste satisfaction and energy levels. Our bodies don’t know what to do with such an excess of foods that spike blood sugar. This shift in our food messed with our metabolism, cardiovascular health, and waistline. Dietary fats and oils contain 9 calories per gram, compared to 4 calories per gram in carbohydrates and protein. Typically the fats we eat are first utilized for all of the health benefits described at the start of this article, including our energy production. Only then is any excess stored as adipose tissue (aka, fat). But then there’s this: Picture yourself eating a higher fat meal - a drizzle of olive oil on your veg, a pat of butter on your sweet potato, some delicious chicken thighs... How well do the flavors satisfy your palate? How quickly do you feel full? How long do you feel full afterward? Fat/oil (along with protein and fiber) is very slow to digest, and therefore meals that include some fat/oil satiate us more quickly and keep us feeling full longer than low fat meals. It adds flavor and enhances mouthfeel, which increases our pleasure. While fat/oil might have more calories per gram, we tend to eat relatively small amounts of it (many fewer grams) in proportion to the rest of our food. Its long-lasting satiating effect leaves us feeling nourished until it’s time for our next meal. Well-managed moderate to higher fat food plans may have the effect of reducing adipose tissue (fat stores), even without pursuing ketogenesis (where fat is actively used for energy in place of glucose). Getting the balance right is imperative, so work with a nutritionist, most especially if you choose a ketogenic food plan. Note that for most people, ketogenesis is best used short term therapeutically, not as a full time forever way of eating. Adipose tissue accumulation (getting fat) or sustainably making the body smaller is not at all straightforward - it’s never, ever as easy as “calories in, calories out.” Don’t let anyone persuade you of that. It’s a total lie. The nutrient density of our foods, stress resilience, generational and personal trauma, hormone status, health status, digestion, medications, life stage, movement, sleep, mood, and the body’s natural preference all intricately contribute to body size way beyond merely the number of calories. Frankly, not eating enough calories can ultimately lead to a bigger body. This is where learning how to read your body and eat intuitively proves crucial. What’s the Deal with Saturated Fat? I remember years ago when my brother sent me a New York Times article that declared that saturated fat was safe to eat. “Now what am I supposed to do?” he lamented. This was news to him—and to a lot of people! Back to the popular understanding, everyone “knows” that saturated fat will cause a rise in total cholesterol and “bad” LDL cholesterol. What a relief to find out, then, that daily dietary saturated fat from healthy sources is not only unlikely to affect your arteries, but can contribute to better health? Check out this recent “well-done randomized controlled trial” (per Dariush Mozafarrian of Tufts University) from the University of Cambridge that describes that both butter and coconut oil do not cause the “bad” LDL cholesterol to rise and does increase good “HDL” cholesterol. The data for saturated fat and cardiovascular health is so interesting. For example, I provide this list of standard blood work to consider when you want a deep dive into your health status and risks. On that list are several tests for types of cholesterol. It turns out that including some saturated fat may have a beneficial effect on certain types of cholesterol (e.g., see LP(a) on that list). The upshot? Balance and food choices are key. Most interesting to me is that how our individual health responds to saturated fat has a strong genetic component. There are those who really do need to reduce saturated fat intake in order to protect their blood vessel, heart, and brain health. And there are those who actually need to increase their saturated fat intake. This can be determined by a 3x4 Genetics test (my code is MCOF001 when you register your kit. I can interpret your results and support you to better health using them). Here’s your reminder that good quality saturated fat in the diet also supports cellular health, mitochondrial health, and brain health. Ghee and butter even contribute to the health of your intestinal wall and a better mood. That doesn’t mean you should eat a vat of butter every day! But some saturated fat daily via real, whole food is health supportive for most people. Where will you find saturated fats? Butter & ghee, coconut oil, MCT oil, full-fat dairy (milk, cream, ice cream, sour cream, cheese), processed & cured meats (bacon, sausage), fried foods, meat (beef, pork), poultry dark meat, processed snack foods, and baked goods & pastries. Some of these have strong inflammatory effects, so eat the following rarely: processed/cured meats, fried foods, fatty cuts of meat, sugary foods, processed snack foods, and baked goods & pastries. Surely You Have Nothing Nice to Say About Trans Fats You’re right. I don’t. And don’t call me Shirley. By now we are all aware that trans fats cause damage: heart disease, cancer, diabetes, allergy, and more. These are a type of unsaturated fatty acid that absolutely clogs arteries and causes nearly 300,000 deaths annually. Unlike saturated fats, there is no healthy level of trans fats. That said, if you have a healthy body and you eat them very rarely (movie popcorn? potato chips? crackers?) your body will be able to clear them. Avoid them, though, if you have a higher risk or a disease diagnosis. Trans fats are found in industrially made products, such as margarine, shortening, fried foods, and many commercial baked goods and snack foods. One way to ID it on a label is to look for partially hydrogenated oil (PHO). What About Cholesterol in Food? Normally consumed amounts of dietary cholesterol, like what’s found in eggs, shellfish, or red meat will not cause your bodily cholesterol levels to rise. Cholesterol balance and heart health risk are most affected by: refined carbohydrates and sugars (i.e. blood sugar status); oils that contribute to inflammation (see below); high intake of saturated fats; digestive health (esp. constipation); and hugely affected by stress - both physical and mental. There can also be a familial (genetic) risk of high cholesterol that is also still not affected by dietary cholesterol. Hormone changes that come with age also increase bodily cholesterol. Sex hormones are made from the cholesterol made by your liver, so when that stops then cholesterol rises. There is some evidence that well balanced higher cholesterol levels are actually brain protective as we age. Should We Lean into Poly- & Mono- Unsaturated Fats? I won’t argue with you about the value of these flexible unsaturated fatty acids. They do indeed support healthier blood vessels, less sticky blood, and lower LDL and triglycerides. The place to be cautious, though, is with some cooking oils that are touted for their supposed heart-healthy benefits because they are high in polyunsaturated fats, such as soy, corn, canola, safflower, sunflower, and “vegetable” oils. These highly refined seed oils are deodorized and bleached to promote shelf life, stripping away all other potential nutritional benefits. Moreover, they are high in inflammatory omega-6 fatty acids. A diet that is rich in these oils will contribute to poor health. Ideally we’d consume a ratio of 1:1 omega-6 to omega-3 (anti-inflammatory) fatty acids via food, fats, and oils. However, Americans eat more like a 10:1 ratio! This contributes to the chronic inflammation that we see in heart disease, arthritis, depression and other mood disorders, gut disease, brain diseases, and other illnesses. → The most health-promoting cooking oil sources of poly- and monounsaturated fats are found in extra virgin olive oil and avocado oil. ← Scroll to the bottom of the newsletter for a primer on reaching this 1:1 ratio! Whew! That Was A Lot to Take In Many of my clients are surprised to learn that I actually encourage them to include oils and fats in their cooking! Given the health benefits and pleasures of good quality oils and fats, I would be doing them a disservice by not promoting them. One aside: if you don’t feel well when you eat fats and oils, you may have trouble digesting them. There are several possible reasons, from a sluggish gall bladder to no gall bladder to low digestive enzymes or stomach acid. Your friendly clinical nutritionist (me!) can help you digest them well again. I hope you’ll save this newsletter for reference, check out the fats & oils primer below, and please reach out with your questions! How to Include Healthy Fats & Achieve the 1:1 Ratio Cook at home most of the time
We can’t swing a short stick these days without bumping into something in the news or an advertisement about the gut microbiome. There’s probiotic this and prebiotic that. What does it all mean? And do we really need them? I thought I’d bring some clarity to the conversation about supplements for the microbiome to help you out. After all, our digestive tract carries about 70% of our immune system and all the same neurotransmitters as the brain, making this a pretty important topic to understand. What is the Gut Microbiome, Anyway? Our health and our digestion really lean on a healthy gut microbiome. So what is that? The gut microbiome is literally the collection of microbes - bacteria, viruses, fungi, and other infinitesimally small living organisms - that make a home in our digestive tract, especially in the large intestine. In total, this microbial collection can weigh up to five pounds. Our whole bodies, especially our guts, are populated with these microorganisms as we travel through the birth canal and then encounter the outside world (fun fact: babies born by c-section have different, sometimes less robust, microbiomes than those by vaginal birth). Here’s one terrific short article I used for reference. The Microbiome Keeps Us Healthy → It works symbiotically with its human host (when it’s in balance). In fact, there are bacteria that really go all out to keep us healthy: making certain B vitamins and vitamin K; maintaining the mucosal layer that protects the lining of the digestive tract; regulating our immune system; and helping us digest our food. I learned recently that bacteria even metabolize drugs we take before we absorb them, which may critically inform how well they work. → It directs our food choices and hunger and satiety cues. Literally, if you find yourself really wanting a certain food, it’s probably because a portion of your gut microbiome is asking for more of something so that group can live and grow. The microbiome composition has an effect on fat accumulation as well. → It helps us prevent or heal from everything from the common cold to cancer. → It also assures things run smoothly, i.e. comfortable, easy to pass stools. Don’t come at me! Stool quality tells me so much about what’s happening in there. → It plays a key role in mood balance, mental health, and brain function. Anywhere from 80% to 90% of serotonin and 50% of dopamine is produced along the gut’s nervous system. They require production of short chain fatty acids by bacteria in the gut microbiome to underpin their synthesis and release. The gut produces all of the same neurotransmitters that the brain does, and a healthy microbiome vitally supports a balanced mood, mental wellness, and brain health. So you can see that we want to take good care of it! The Big Picture TBH, the microbiome is like outer space or the ocean. There’s a lot we know, and there’s even more still to find out. While research has parsed out many specific benefits and health risks of various genera and species of bacteria, we’re still working on the best way to use, increase, or reduce the right organisms to support our health. Complicating it even further, there are different strains of the same bacteria. Sometimes a specific strain is well studied, but others in the species aren’t as well understood. But that’s ok! What we do know is hugely helpful and has allowed clinicians like me to use supplements and food to nourish the garden of a healthy microbiome. Here are the categories of products we use and what they do. Probiotics Probiotics are beneficial (pro-) bacteria (biotics) known to exist across the body, especially in the digestive tract, vagina, and mouth, that actively support our health - they are “pro-” human. They primarily can be found in two broad groups: live bacteria or spore-based bacteria. Live bacteria fall into the genera of lactobacillus and bifidobacterium. When you read the label of a probiotic container, you’ll see names like L. acidophilus, or B. infantis. Live bacteria in supplements must be properly encapsulated so they can withstand stomach acid and be stored carefully to maintain their live status before consumption. Many commercial products have to be refrigerated, but there are brands that offer convenient and reliable shelf-stable containers. These good bugs will hang around in the gut for about two weeks once you stop the supplement. They are amazing to support the body through healing (like traveler’s diarrhea or IBS/IBD) and can play an important role in therapeutic interventions. There’s one I really love to use for overcoming yeast infections! However, if you want them to proliferate so that they colonize your gut (yes, you want that), you’ll need to increase your prebiotic fiber intake, which I discuss below. Health promoting bacteria also can be found in traditionally fermented foods like yogurt, sour cream, kefir, kombucha, miso (refrigerated only), sauerkraut, kimchi, and real pickles (fermented, not with vinegar). Interestingly, most of these contain prebiotic fibers that help the bacteria in the food establish themselves in the gut. Real food is the best way to populate and perpetuate a variety of good bacteria in your gut. Spore-based bacteria or spore-based organisms (SBO) are typically sourced from soil and are species of the genus bacillus, such as B. clausii or B. subtilis. Here’s a terrific description of SBOs. Once upon a time we did not use antibacterial cleaners, antibiotics, pesticides, or herbicides, or scrub everything clean, and our food and water carried these important bacteria into our bodies. Playing in the dirt, with other people, and with our pets also transfers them to us. Another reason gardening is good for you! SBOs are hearty souls and can withstand harsh environments, like stomach acid, and can’t be killed by antibiotics. When they reach the large intestine, they blossom and multiply, permanently colonizing the gut. They actively refurbish the cells and mucosal layer of the intestinal tract and promote the increase of other beneficial bacteria that we can’t consume in food or supplements. S. boulardii: I would be remiss in not mentioning one of the best tools in my toolkit, a yeast-based probiotic called Saccharomyces boulardii. It’s terrific to treat diarrhea, including preventing or stopping antibiotic-triggered diarrhea. Like SBOs, it won’t be destroyed by antibiotics. It offers many of the same health benefits of other probiotic strains, and treatment for Helicobacter pylori infection is more effective when S. boulardii is given at the same time as the antibiotics. When you work with a practitioner, they might choose specific probiotic species to help you heal from a particular health condition. However, we also choose products with variety. This allows us to cover the waterfront, assuring that there’s a good balance of health promoting bacteria being introduced. Prebiotics Prebiotics are fibers mostly in the carbohydrate categories of fructooligosaccharides (FOS), inulin, and galactooligosaccharides (GOS). Big words! These are types of indigestible fibers made from chains of tightly bound sugars. Because only bacteria can digest them, they are sometimes used in sugar substitutes because they provide a sweet flavor without causing a spike in blood sugar. Prebiotic fibers feed and nourish beneficial bacteria. Their benefit comes from the fact that they are fermentable, and it is out of this fermentation process that we receive the health benefits. We see how they support our health by the increase in Bifidobacteria and Lactobacilli, better calcium absorption, lower protein fermentation (ultimately less gas and better BMs!), fewer pathogenic bacteria, lower allergies and risk of developing them, a healthier gut lining, a better lipid profile (cholesterol), and improvement in our immune functioning. Prebiotics help create an overall anti-inflammatory environment in the body. We can deliciously provide prebiotic fibers with foods especially rich in them: chicory root, dandelion greens, Jerusalem artichoke, onions, leeks, asparagus, avocado, bananas (the less ripe ones), barley, oats, apples, cocoa, flaxseeds, jicama, wheat bran, and seaweed. All fibrous foods, though, will support a healthy microbiome: whole grains, vegetables, fruits, nuts, and seeds are all great sources of fiber. There’s also inulin in some new brands of carbonated soft drinks. Some people see a difference in their bowel habits when they drink these, but the amount of the inulin is honestly pretty meager. There are better sources, but no harm in enjoying these drinks! Be aware that some people overdo a prebiotic supplement or foods and find themselves with uncomfortable gas and bloating. Their guts are unused to so much fiber! Definitely increase prebiotics and all fiber gradually to allow your system to grow into being able to utilize it. If you find you still have symptoms, it’s time to talk to a clinical nutritionist. Phytochemicals This is an area of research that is still developing, honestly. That said, what we’re learning is still very cool and encouraging: “Phytochemicals are non-nutrient biologically active plant components that can modify the composition of gut microflora through selective stimulation of proliferation or inhibition of certain microbial communities in the intestine.” (read the article here). That is to say, the more you eat the colorful rainbow of plant-based foods, the more complex and richly health-promoting your microbiome will be. Questions I Get About Taking Probiotics Should everyone be taking a pre- or probiotic supplement?
Not in my opinion. While supplements are really useful for therapeutic purposes and sometimes for prevention (e.g. traveler’s diarrhea), they also cost $$$. I make probiotic recommendations when I can see their therapeutic value, but I don’t just tell everyone to take them. It’s much more effective over the long haul to serve your microbiome with probiotic-, fiber-, and phytonutrient-rich foods and to attend to your stress, sleep, and movement. How would I know if I should be taking one? On your own it may be hard to know for sure. That said, if you were digesting your food well and feeling pretty good, and then something triggered a bout of digestive difficulties, a multistrain probiotic with some prebiotic fiber added (a combo product called a “synbiotic”) could be just the OTC ticket to help you recover. Go for it if you develop a yeast infection. Yeast will show up in your vagina or penis, mouth, as jock itch and athlete’s foot, and even under finger and toe nails. If it’s in those places, then it’s almost for sure in the digestive tract. A probiotic that is designed for vaginal health and S. boulardii (see above) can crowd out the yeast and help reestablish balance, either alone or in conjunction with antifungal medications. Clinically I thoroughly assess my clients to determine whether certain bacterial strains or blends will support the desired health status. However, if the symptoms are complicated or not resolving, I like to ask my clients for a stool panel so I can really target the imbalances. How do I know which product to buy? If you aren’t willing to or can’t go through an assessment and/or just really feel like taking a probiotic is right for you, keep these things in mind:
Yes, there can be too much, but really only under specific circumstances. Most people with average health concerns are safe with following package directions. Always ask your doctor before taking a probiotic if you have an exceptional health condition. One time I recommend you not take a probiotic is if there is any chance you have small intestinal bacterial overgrowth (SIBO) - please get tested. The overgrowth needs to be treated, which can be done with a very targeted antibiotic from your GI doc and/or a really effective herbal program from your clinical nutritionist. Most of the time, it’s really an issue of diminishing returns. You’ll be spending a bunch of money to be doing something you could be doing with your delicious food choices instead. When my clients return from their relaxing summer vacations, they tell me about how their digestion, mood, energy, cravings, and sleep all improved, and they feel so much better. This is yet another reminder of how critical it is to my clients’ healing, health, and overall well-being that they quite literally feel safe in their bodies, or know how to get there. Psychological and emotional safety give our bodies time to heal and then thrive. This is some of my favorite stuff! We’re learning how to harness our own nervous systems to help our mental and physical health. The body communicates a veritable firehose of information about the status of the body to the brain, which informs both our health and our mood. So I’ll tell you all about that firehose, called the vagus nerve. Then I’ll give you a useful theory about how our bodies orient toward or away from feeling safe. Finally, I’m going to share some super accessible practices that use this theory to help you heal both physically and emotionally. The Vagus Nerve The vagus nerve is a “wandering nerve” known as cranial nerve X (ten in Roman numerals) that starts in the brain and “wanders” through the body. The other eleven cranial nerves serve the five senses and the movements of the head and neck, like our facial, eye, and neck muscles, and the tongue - even things like saliva production. The vagus nerve is in constant bidirectional communication with the other cranial nerves, the heart, the organs, and the digestive tract. A whopping 80% of the vagus nerve’s communication is from the body up to the brain. When you have an instinctive gut feeling, feel stimulated (excitement? anxiety?), or feel the heart’s intuition and emotion, your brain automatically translates that feeling into a response. The same messaging and responding happens when there’s something occurring in the body, like relaxation or stress, slow/strong or rapid heart beat, or good or poor digestion. That’s the vagus nerve sensing what’s happening in your body and sending a message to your brain: “This is what’s going on and we are safe (or not safe).” The brain assigns that message a meaning, creates a story to explain it, and instantly sets you up with thoughts, words to describe your experience, and actions. The action might be movement, like smiling or hitting something; an emotion, like joy, anger, or depression; or a biochemical or physiological process, like an immune response, sleepiness, hunger, or thirst. The upshot is that the body-mind is enmeshed in tightly designed programming to seek, support, protect, and defend our health and safety. And the vagus nerve is our key. There’s so much to know about how the vagus nerve allows the gut, the organs, the heart, and the brain to talk to each other! Do some exploring in this informative, succinct article about the many physiological roles of the vagus nerve. The quality of the bidirectional messages between brain and body through the vagus nerve directly influences our health. Persistent messages of “danger” result in increased risks of colds/viruses, digestive woes, heart disease, high or low blood pressure, blood sugar imbalances, metabolic diseases (diabetes, cholesterol, arteries)…even mood disorders, focus/attention issues, sleeplessness, sexual dysfunction, and cancer. Understanding this allows integrative practitioners to bring to bear both nutrition and non-nutrition healing practices. There’s This Theory … And it has a name: Polyvagal Theory. It was conceived by Dr. Stephen Porges in 1994 (you can learn about him here). Understanding it allows us to create tools that retrain our bodies to reorient toward safety, and therefore better physical and mental health. As the brain interprets and reacts to nervous system communications, it does it based on one of two broad, overarching messages that help it direct the body’s responses. The first message is safety, during which it allows the body to heal, rest, and renew itself. The second is when we feel unsafe, which is all about defense and protection. Polyvagal Theory offers up the visual of a ladder, and each rung is whatever is primarily being communicated to the body and brain through the vagus nerve. Whichever rung is the top rung becomes the dominant, prevailing response. There are three rungs on this theoretical ladder:
Sympathetic: When we’re in danger, our brains and bodies typically prompt us into action. We are prepped to turn and battle the danger or turn the other way and run. Fight or flight is a highly stimulated stress response, and it is directed by the sympathetic nervous system. If the sympathetic branch is the top rung, we will be anxious and overwhelmed. Dorsal Branch: However, sometimes when we’re in danger we feel trapped, unable to run or fight even though we don’t feel safe. Polyvagal Theory says there’s a branch of the vagus nerve called the dorsal branch, which essentially shuts us down, like a possum playing dead. In an acute situation, a human might actually faint, and over a somewhat longer span that person might become sad, unmotivated, sluggish, etc. If the dorsal branch is the top rung, we will be depressed and unable to engage. Ventral Branch: The ventral branch shepherds us to safety without feeling overstimulated or shut down, even in the face of something that we might see as dangerous. It is the essence of resilience and widens our Window of Tolerance. It borrows energy, focus, and clarity from the sympathetic nervous system and relaxation from the dorsal branch. That is to say, we feel like we have the mental space, ability, and confidence to make good decisions and act in our own and others’ best interest. This can be described as flow. We’re in the moment. We can identify, absorb, and act on good information for a positive outcome, or hit the ball right in the sweet spot, or make our best work presentation, or ace the test. Importantly, both consciously and unconsciously we are better equipped to protect and defend our health and well-being while simultaneously cultivating our ability to heal and renew. A body-mind that primarily has ventral dominance will be healthier - physically, mentally, emotionally, and even in spirit. (Please seek proper professional support if you suffer from a mental or physical illness). Practices: The Ventral Branch is Yours for the Taking The beauty of it all is that we can train our bodies to attune to a dominant ventral response, even if right now our emotional, psychological, and environmental triggers typically lead directly to stress, anxiety, or depression. Physical and mental resilience, more balanced emotions, focus/attention, improved cognition and memory, and flow are within reach with some accessible practices. We can use cranial nerve X - the vagus nerve - to reorient our bodies to safety by using other cranial nerves and our lungs to communicate with it. The more we practice any combination of the exercises you’ll find below, the more resilient we become. And there you go! This issue ends with suggestions for practices that can help you build resilience in the face of hard things. Practice them away from your triggers as training. That way your body will automatically respond when you choose to use them during the hard stuff. When our body feels safe, our mind, emotions, and health follow suit, fostering a state of balance, well-being, and peace. Check out the exercises below! Breath Work Of all the autonomic processes that we can’t control, we can control our breath. We only breathe deeply when we’re safe. Intentional breathing engages the stretch receptors of our lungs, which sends a signal through the vagus nerve to the brain that the body is safe. It also increases heart rate variability. Box Breathing: Breathe in for a slow count of four, pause for a slow count of four, release the breath for a slow count of four, pause for a slow count of four. Repeat at least three times. 4-5-6 Breathing: Breathe in for a slow count of four. Pause at the top for a slow count of five. Release for a slow count of six. Pause for a couple of seconds and repeat at least three times. Once this is familiar, increase to 5-6-7 breathing, then 6-7-8 breathing. Engaging Cranial Nerves Eyes Dr. Porges’ Basic Exercise:
Ears
Smell Take in the odor of real lavender or rosemary, which are especially calming. Perhaps grow them in your garden or kitchen window for easy access. Vocal Cords Gargle with water three or four times in a row. Repeat as many times as you’re comfortable. Sing! Sing hymns, showtunes, etc. or along with your favorite songs as loudly as practical. Hum to engage the vocal cords. Choose one that also resonates in the chest. Touch
Hug and be hugged by someone you consider safe for at least 10 seconds. Hold hands. Get a back rub or massage. Rub your hands up and down your own arms and/or legs. Snuggle with your pet. I recently finished my training so that I can add Health and Wellness Coaching to my clinical nutrition practice. It got me thinking outside of the box in some really stellar ways. For example, what we say about our choices and behavior really makes a difference to our ultimate health and wellness outcomes in ways we might not expect. In this issue I take you through a couple of reflections and mindset exercises, similar to something I might do in a coaching session. By the end, I hope you’ll be able to answer this question: What would happen for your path to wellness if you made small tweaks to your language? Let’s explore. Defining Your Health Everyone has their own worries, experiences, and aspirations about their health. Some are more about physical health, and some are more about mental/emotional health. You might be interested in prevention of illness, or you might actively have an illness that you’d like to ameliorate or cure. Or both! Here are a couple of questions, then, along those lines:
I’ll wait. You Know What You Ought to Do? Read over what you wrote. How many times did you use the word “should”? How about the words, “I have to” or “I need to” or similar? Or if you didn’t write it, you may have thought it. Say one of those sentences out loud. No, really. Give it a shot. How do you feel after doing that? What are your internal sensations? What happens around your heart area? What’s the status of your mood? What’s the feeling in your gut? I’ll take a stab at what might have happened. You read aloud a sentence that started with, “I need to ….” Or maybe it was, “To [reach this health outcome], I have to ….” Your mood soured a little. Doubt and resistance began to whisper in your thoughts. Your heart area tightened, and maybe you got a teensy funny feeling in your tummy. I could be wrong about this. Please (honestly), let me know about what happened for you. Restriction, Deprivation and Resistance It’s not just teenagers that don’t like being told what to do. None of us do. When we are told rigidly how it’s gonna be, regardless of who says it or the reason, we immediately feel forced outside of our sense of comfort and safety, and even the comfort of our very selves. It makes us feel different from other people. “Should, need to, have to, ought to, and must” are words that delineate right and wrong. If we’re not doing the thing we “must” do, then we perceive ourselves as in the wrong. People who are wrong generally tend to feel unwelcome. Right away, we’re going to stick out our jaw, cross our arms over our chests, and feel defensive. Rigid right/wrong, black and white thinking is a real set up. Once we’ve bought into it, we begin to spread that kind of language all over in the most judgmental fashion. Our behavior and the things we choose (foods, movement, how we spend our time, ways of being, etc.) start being called “good” or “bad,” e.g. Oreos are a “bad” food and vegetables are a “good" food. (FYI, food has no morality. It just exists). Or we’ve got “bad habits.” What we’re secretly telling ourselves is that we are bad people when we don’t follow these rigid rules of right and wrong choices. “Oh, I’m being good today. I’m only eating a salad.” Or, “Ugh, I was so bad - I ate the donuts in the break room.” At this point many people start to restrict food or over-exercise to try to rebalance to “being good”, or they label themselves with negative words and whip themselves with negative thoughts because they’ve “been bad.” Or maybe they come to feel really stuck - at a loss and sad. The thing is, the more we tell ourselves that we “should” do something we see as health promoting or “shouldn’t” do something we see as undermining our health, the more we resist the change! Restricting and depriving ourselves just creates a longing for the thing we “can’t” have. But when we do have it, we’re morally inferior - or “bad.” Then we judge ourselves (or feel judged) for having no discipline. Another hot take is that when we “should” do something, and we’re not doing it, then a barrier grows up and the behavior starts to feel out of reach. We find ourselves toggling between the idea that we are either “bad” or “a failure.” That kind of negativity destroys motivation. Maybe, though, we have a real vision for how we want to feel in our bodies and haven’t figured out how to get there yet. We might be quietly curious about shifts in our choices that feel both intriguing and daunting. For example, perhaps there’s a pleasant way to move our bodies so that we improve our heart health or bone strength. We wonder about making our meals more nutrient dense. Balancing blood sugar could keep us from following our family history of diabetes and heart disease, but so far getting started seems overwhelming. What if - stick with me here - using different language could open the door? Reframe Please go back to your list of things that you believe would help you reach your goals. What are the ones that you truly feel called to do? Or maybe there’s low hanging fruit you hope someday to start? Or even ones you resist? Rewrite one or more of them, starting with one of these phrases:
I have written about this concept of “choosing toward” before. Open, positive language reduces barriers and invites a sense of true self-efficacy and a desire to develop competency. No one is telling you to do any of these things, not even you. It’s valid to say you don’t want to, or don’t choose to, or you’re not excited. When you do choose something you “want” or “get” to do, you have the opportunity to make it entirely yours and to blossom into who and how you want to be. You Get to Design Your World When you make a choice to release rigid language about how you might get to where you want to go, you’ll find that possibilities open right up. It turns out there is not only one food plan or exercise regimen or length of time between meals or supplement. The influencers don’t have any idea what’s right for you after all. But you do. Knowledge is power because it reveals all of your options, not because it locks you in. Once you can envision what it will be like to have the health status you long for, you get to choose how to get there. And who knows? You might even find yourself saying, “I’m excited to …” participate in some behavior you previously couldn’t imagine being yours. So what’s your preference? Where would you like to experiment? And what does authentic health really mean to you? Bonus Tip! You may have noticed my subtle use of the word “yet” above. Sneaky, aren’t I? When we look at something we aren’t doing, but that we want to be doing, and then add the word “yet” to it, all of a sudden the pressure is off and the thing we hope for becomes possible again. When we use the word “yet,” we can then think about what we might want to do to get to that outcome we envision.
Here are some examples:
Writing about bowel habits last newsletter got me thinking about how many people misunderstand stomach acid. No, really! Look at drug store shelves and you’ll see great numbers of products designed to help you control it. But is that what you really need to feel good? To answer that question for yourself, you’ll definitely want to understand stomach acid before you take your next heartburn medication. The Irony of It All There is a real irony to heartburn, reflux, and GERD (gastroesophageal reflux disease). The symptoms of low stomach acid are surprisingly similar to those of high stomach acid. They create a burning sensation in the chest and meals that repeat all the way up in the throat. Doctors and regular folks alike too often conclude that there must be too much acid in the stomach. Hydrochloric Acid: The Friend You Never Knew You Needed Technically, stomach acid is actually hydrochloric acid, or HCl. HCl is a popular corrosive acid used for laboratory, industrial, and manufacturing purposes, and can even be found highly diluted in some household cleaning products as muriatic acid. HCl (aka stomach acid) is also naturally released by the parietal cells of the stomach lining as part of our digestion when we eat food. We first break down food mechanically (chewing, massaging by the stomach muscles) and then chemically via HCl in the stomach. The big surprise is that the vast majority of people (I’ll grant you - not all) who suffer from reflux actually have too little stomach acid. We need enough of it for proper digestion. Think of what HCl does: it’s an acid that dissolves food into a semi-liquid so it can be moved easily into the small intestine where nutrients are absorbed. HCl keeps food moving. Along with dissolving food, the increase in stomach acid triggers the release of pepsin, an enzyme that breaks down protein, and intrinsic factor, which separates vitamin B12 from animal proteins. 💡 Lightbulb Moment: low stomach acid is one key reason why elderly people tend to eat too little protein (poor digestion makes it uncomfortable to eat more than a little) and to become anemic due to low vitamin B12 and iron. You can figure out what happens when someone has low stomach acid! First it prevents food from being broken down well or quickly. Food then sits in the stomach, keeping you feeling full and uncomfortable. Undigested food can begin to ferment, and that’s when post-meal discomfort really starts to kick in. You might start to burp, feel bloated, and/or develop heartburn. This is what’s happening: the incompletely digested food puts pressure on your esophagus (specifically, the lower esophageal sphincter, or LES), causing that chunky mush to push its way back up, carrying some HCl with it. That combo irritates the esophagus and creates the burning sensation associated with reflux or heartburn. Did you know that the irritation and inflammation of the esophagus can travel all the way up, getting as far as your sinuses? It can be a source of increased mucus formation, leading to coughing and even sinus infections! All because there’s not enough stomach acid. Who is at risk of low HCl? Almost anyone can have low stomach acid. Most commonly it affects:
Problems with Stomach Acid Suppressing Meds It’s the norm for people who experience reflux or heartburn to reach for over the counter acid suppressing medicines, like proton pump inhibitors (omeprazole) or H2 blockers (e.g. Pepcid). Doctors also prescribe these medications when their patients report the symptoms. Obviously we want pain relief! However, many of my clients have taken these drugs for long stretches or indefinitely. As a result, they suffer from multiple nutrient insufficiencies, which contribute to a cascade of health conditions. Short term use - say, 1-2 weeks - does not increase these risks. Always talk to your doctor before discontinuing any prescribed medication. That said, a clinical nutritionist can coordinate with your doctor, assess your digestion and health conditions, and devise a personalized healing plan. So, what to do? Luckily, under normal circumstances there are a number of approaches to help alleviate reflux and heartburn. Since it’s pretty likely that those symptoms are due to low stomach acid, these interventions are designed to increase HCl rather than suppress it.
You might also be surprised at how your bowel habits improve when your stomach acid is on point. Et Voilá! There you have it! Stomach acid is the unsung hero of digestion. Now you know. I’d really love to hear your thoughts on this (and any other!) topic! Feel free to respond to this email. While you’re at it, send me your questions on other topics of integrative nutrition. I genuinely want to hear from you!  Many of my clients have something in common: trouble with pooping. Yep. We’re going there! You might find some surprises and insights as you read. So many people have no idea what’s normal and healthy. Let’s talk about it. What’s Normal for You?
Digesting food takes a lot of steps. When something about the process isn’t working right, that’s when bowel symptoms above show up. Briefly and oversimplified, here’s what happens with digestion when you eat:
Potty Talk I’m always surprised when clients tell me they poop normally - every two or three days. Y’all, that’s constipation! Our bodies are built like a flowing stream. Food goes in. The body does its thing. Stool forms as un-digestible stuff and waste products build up in the colon. And then we release it. Every single day - sometimes two or three times. It should look like a sausage (with or without cracks), happen at a fairly routine time, not be overly urgent, and be easily and completely passed. It should not be particularly stinky. No, really. And it should mostly be brown. If it’s regularly a different color, consult a practitioner. So check out one of my favorite diagnostic tools, the Bristol Stool Chart:  Types 1 and 2: Typically constipation is easy to address by increasing our fiber and fluid intake. Did you know that we are designed to consume 25-30 grams of fiber daily in food? Most Americans only get about 15 grams. Fiber also absorbs water, making stools comfortable and easy to pass. If increasing fiber and fluid intake isn’t quite enough to relieve constipation, we can explore supplements, like magnesium citrate or magnesium oxide. I usually don’t use magnesium oxide because the molecule is large and poorly absorbed, so the person won’t get the additional benefit of the magnesium itself. Other magnesium formulations typically don’t affect stool quality or frequency. Life experiences can also lead to constipation. Stress in particular can shut down (or overstimulate) that flow. More below. Why do we care about constipation? When stool sits in the colon too long, the body begins to reabsorb certain elements that are supposed to depart the body. For example, that water that makes it easy to pass? It can be reabsorbed into the bloodstream, drying out the stool and exacerbating the constipation. Hormones and cholesterol can also be reabsorbed, which can mess with the levels of these in your body. Remember: flowing stream. Out with the old, in with the new. Type 5: An added bonus to fiber is that it gives an all important bulk to our stool so that it becomes more sausage-like and comfortable. Types 6 and 7: There are a number of potential contributors to loose, watery, urgent stools. It can be as simple as eating something that doesn’t agree with you, and once your body has a chance to heal, stool returns to normal. Food allergies, intolerances, and sensitivities can trigger inflammation in the gut lining. When that happens, it’s very similar to eating something that doesn’t agree with you. Up to 70% of your immune system lines your intestinal tract. If it senses a danger, it will cause water to enter the bowel and trigger the nerves to stimulate movement to wash that danger right out! Interestingly, how healthy your digestive tract is defines to a great degree whether you will have a food intolerance or sensitivity. Once the lining is healed and functioning properly, most foods stop being such a trigger. Illnesses from the common cold to cancer can cause inflammation everywhere, including in the intestines. Some medications - either prescribed or OTC - can lead to inflammation and loose stools. Talk to your doctor about prescriptions if your stools change. OTC meds like ibuprofen, naproxen sodium, and acetaminophen all can damage the lining of your gut and create inflammation. Whether you have enough stomach acid (hydrochloric acid, or HCl) to kill pathogenic viruses and bacteria can be super important. For example, Helicobacter pylori is the cause of stomach ulcers, and it can’t take hold if there is adequate stomach acid. H. pylori also inhibits production of more stomach acid so it can proliferate. As food becomes poorly digested due to lack of HCl, it enters the intestinal tract in particles that are big enough to cause irritation. The inflammation of the stomach lining can travel up and down the gut. These and other microbes can lead to inflammation, low grade (or sharp!) pain, and issues with stool. And back to fiber! It is the primary fuel source for all kinds of symbiotic beneficial bacteria that support our gut and, frankly, our overall health. Pathogenic bacteria and yeast relish refined flour and sugars because these help them multiply. When we eat low fiber in our meals, the “bad” bacteria can grow in number while the symbiotic bacteria languish. And there you have it: inflammation thrives. Unfortunately, once there is a big imbalance (called dysbiosis) in these various bacteria, sometimes we need to eat a low fiber diet for a while before adding it back in. Those with Inflammatory Bowel Diseases, diverticulitis, and small intestine bacterial overgrowth (SIBO) might follow specific low fiber food plans while the flare heals. Work with a qualified CNS (after checking with your doctor) to design a healing plan and prevent future flares. Mood & Bowel Habits There is a strong connection between anxiety, depression, high stress lives and bowel habits. An inflamed gut lining will send signals to the body and brain that something’s not right - the body must be in danger - and this can affect mood status and resilience significantly. Conversely, anxiety, depression, and stress are mood states that integrate the body’s protective mechanism known as “fight, flight, or freeze.” When we enter that protective state, what’s happening with our poop either becomes urgent (diarrhea: get rid of it fast so we can run) or completely shut down (constipation: we don’t have time for that). Gut bacteria status also influences how much the protective state affects the bowel. This cycle is known as Irritable Bowel Syndrome (IBS). It can show up as persistent diarrhea or constipation, or even alternate between the two. The issues of IBS can ultimately result in more significant gut health issues over time. The good news is that clinical integrative nutrition practitioners have accessible ways to stop the cycle and normalize stools. Examples of these can be found here where we Cultivate the Pause, and here, where we discuss stress resilience. Upshot The upshot is that a lot of people take for granted that what’s happening in the bathroom is a normal part of life when it really isn’t! Bowel habits are key participants in your overall health status - don’t ignore them!
Medical Nutrition Therapy (using food and supplements) and lifestyle practices can heal the intestinal lining, improve your digestion, and make your stools a consistent Bristol 3 or 4. I can predict right now that when that happens several other health items you assume are part of life (or aging!) will also heal. We are headed into the warm months, which are the height of colorful food variety. After the heavy topic on genetics in my last newsletter, I thought we’d take on some lighter fare! Here’s some info on what you actually get out of those amazingly delicious fresh fruits and veggies, and be sure to check out my Coffman family approved recipes to help you use them! Happy summer, y’all! Lush, leafy plants grow heavy with their flowers and fruits as they reach toward the summer sun’s life-giving rays. Small community farmers across the country glory in the beautiful rainbow of colors reflected in the produce they grow in these warmer months, including red radishes, orange carrots, yellow corn, green basil, white onions, and blueberries. Many of these seasonal foods are available at local farms and markets — and pro tip: the color of the fruit or vegetable we eat is a clue to the nutrition found inside of it! This is great news as we shape our food choices to match the health we want to cultivate. The CDC reports that an estimated 129 million people in the U.S. live with pre-existing health conditions and chronic illness, like heart disease, hypertension, or diabetes. Even more of us live with niggling issues we may not think of as related to our physical health, like constipation or diarrhea, brain fog, or low grade anxiety. Fresh fruits and vegetables can help prevent and improve both the chronic diseases and the less obvious health issues. They also support our immune systems against viruses and bacteria. In fact, when we eat a variety of vegetables, fruits, and herbs, we consume nutrients that our bodies need to survive: vitamins, minerals, protein, carbohydrates, fats, fiber, and water. All of these nutrients give us energy, run our cells, and build our bodies so that we can move, think, work, play, and even manage our emotions. When we don’t have enough, our bodies don’t work well, we become low on energy, and we’re more likely to get sick. If you want a deeper dive into eating nutrient dense foods, read this past CIN newsletter. Snacking on Sunshine So where do the vivid colors in our produce come from? The answer lies in phytonutrients (‘phyto’ like Fido, but with a ‘t’), a part of the plant that fights off bugs and diseases while interacting with the sun to generate color. Phytonutrients are responsible for the red found in strawberries, the green in broccoli, and even the brown and white in cauliflower, onions, and mushrooms. While there’s still a lot about phytonutrients that we don’t know, research clearly shows that they are invaluable to keeping us healthy and often to helping us heal when we’re sick. Here’s what you need to know:
Your Summer Cheat Sheet Click through the slideshow below to learn how each color of the rainbow directly supports your good health! Remember: the more vegetables, fruit, herbs, and spices you eat, the healthier you are likely to be! Be sure to download your (FREE)! "Eat the Rainbow" Guide! A handy printable guide that clearly identifies the benefits of each color group so that you can choose the ingredients to create vibrant, delicious, and nutrient-packed meals. Download it now! |
AuthorI am Mary Virginia Coffman (I go by “Mary Virginia”), a clinical nutritionist who focuses on mental health, digestive health, metabolic health, and nervous system regulation. My unique combination of clinical interventions, education, and coaching will help you feel well in body, mind, and spirit. Archives
October 2024
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