There are so many Genetic Testing companies now. Since the completion of the Human Genome project, businesses have been in a rush to enter the market promises the most accurate information to date. For years I have scoured the Genetic Testing sites in search of a program that provided insightful information, was clear about what we can draw from it, and did not attempt to over reach the application to the general population. In my opinion, Genetic Testing will start every nutrition consult in the next decade. As of right now it remains too expensive, and in many cases, the research is still very weak, and requires more substantiation. Genetic Direction is by far the best Genetic Report I have found. After I completed my training with them, and went through the studies they used to come to their conclusions, I was excited to call them the first Genetic Test offered by Case Specific Nutrition™!
As a Dietitian, I take clinical evidence very seriously. That is why their 8 pages of transparent links to research for each of their categories peaked my interest. Not only are they making it easy for professionals to interpret, they are quick to highlight when there are limits to the research. This makes this information useful, while not being misleading.
I like how user-friendly the information is. It breaks down the results, and what that means to the individual. I can take the information farther from there and use it to customize eating and exercise recommendations. That said, the 84 page document customers buy has a ton of information they can interpret and apply!
I am very excited by this program! It is the first of its kind to impress me. From the information provided, I can better gauge whether a person benefits more from a carb focused or fat focused diet, how high their protein intake should be, what micro nutrients might be missing (we then test for those), and what type of exercise will be the most effective for fat loss, muscle growth, and changes to blood glucose and cholesterol levels!
We are currently performing the test on clients at our Shadyside and Penn Hills office. The cost is $350, with results in less than 2 weeks! Unfortunately insurance does not cover it yet, but hopefully one day this will be an inexpensive step in all our Case Specific Consults!
For more information please contact Andrew Wade, MS, RDN, LDN at email@example.com or 412-593-2049!
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Thus far in my blogs, I have discussed endurance activity using carbohydrate as the primary fuel source. In the last three weeks we outlined the protocol for pre, during and post workout fueling. While our body does prioritize carbohydrate as the primary fuel source for activity and brain function, many endurance athletes agree that carb-centered fueling is both frustrating and time consuming. In recent years, the ketogenic diet has emerged as a popular choice among extreme endurance athletes for a couple key reasons. Today’s post will discuss an introduction to ketogenic dieting, what it means, the potential benefits, as well as potential concerns and obstacles. This post will not discuss the physiology of the process in detail. For those interested in a greater level of detail, I have posted links to some of my favorite resources on ketogenic dieting.
Simply stated, the ketogenic diet is built for those interested in running on fat. As mentioned repeatedly in this blog, our body will use carbohydrates for activity first when they are available. Since they are such a common part of our diet, many go through life never considering another way to eat. But what happens when our body has no carbohydrate stores left, and none are in the diet? Our body adapts to use a fuel that is always available, fat. When the body has no carbohydrate, and does not have enough protein to make carbohydrate from, the body will begin to adopt fatty acids as the primary energy source. Metabolism of fat in the body produces a group of compounds called ketones, which can be used by all systems in our body, including the brain. As I may have eluded to above, it takes quite a bit of time to enter ketosis, and is not done without resistance from the body. Once in ketosis, most people report a return in energy and mental clarity, and our body runs on ketones without any significant problems.
The application and interest in this diet with runners is fairly straightforward. The average person has enough carbohydrate stored to fuel activity for approximately 2hrs, or 15 miles (give or take 10 miles). To compare, the same person has enough fat to fuel activity for 500-700miles. We reserve and store fat very efficiently, and can readily use it when needed. As you reflect on the pre-, during- and post- training protocols from the last 3 weeks, it becomes obvious that our body does not have a great deal of carbohydrate stores. You are constantly taking in glucose from food during the entire training and event to keep stores available. Runners on the ketogenic diet don’t use carbohydrate, and therefore do not have to eat anything before or during their event unless they choose to (except water and electrolytes). For an avid athlete running long distances on a regular basis, this has a great deal of appeal. It becomes more enticing when they learn that not only are feedings surrounding exercise optional, there is no need to time meals or eat every 3 hours. Since your body is not using sugar, no insulin is being produced, and blood sugar levels are stabilized by a compound called glycerol, which is abundant as a result of breaking down triglycerides into fatty acids for oxidation. With no need to manage blood glucose, and muscle glycogen out of the conversation, keto-dieters can eat when they please with no impact on performance.
In addition to endurance athletes, this diet has potential application with individuals who have compromised glucose utilization. For pre-diabetics, non-insulin dependent diabetics, and others deemed insulin resistant, the ketogenic diet has the potential to serve as an alternative to carb management and medication. As noted above, the body does not use insulin, and blood glucose is maintained with glycerol. Instead of trying to manage the compromised system, many diabetics are choosing a different energy path, one that “skips using what is broken”. In the short-term this seems to have success in many individuals. Unfortunately, we have never witnessed individuals in our culture and time maintain ketosis for a life time. More research and time is needed to better understand what the long-term effects of this diet are. My personal interest lies within extreme endurance athletes and diabetics. Extreme endurance athletes are often training so intensely their body must rely on an enormous amount of sugar, which strains the pancreas. Any organ used in this fashion will wear down over time. Just from observation I have noticed many endurance athletes in their 60’s are pre-diabetic. Low body fat, great muscle mass, but struggling with this issue despite it all. What if instead of demanding such constant insulin production, they were able to use fat. While fat also demands function from the pancreas, the amount of fat needed for caloric balance is less than half that of carbohydrate. All of this is speculation, but I look forward to watching this area of science grow.
At this point it seems like this diet would have great application to the populations discussed. With all this potential, what is the catch? Why isn’t everyone doing this? Are there any concerns? While there is a tremendous amount of potential, there are certainly a number of issues that complicate the ketogenic diet as a viable option for many individuals.
The first obstacle for most is the transition into ketosis. Our body does not like to switch to fat as our primary fuel source. Traditionally this switch implied starvation. Our body stores energy very efficiently, and body fat is meant to be a reserve kept for dire circumstances. As our body reaches the end of its carbohydrate reserves, most experience extreme fatigue, dizziness, headaches, changes in bowel regularity and consistency, shakiness, muscle cramping, disruptions in sleep, a temporary dip in thyroid hormones, and even an increase in kidney stone formation. That long list of symptoms is intimidating to type let alone experience, so it comes as no surprise many cannot handle this during training, working and activities of daily life. It is important to note that these are temporary, often lasting from 1-3 weeks depending on rate of carbohydrate depletion.
Once in ketosis, the biggest issue becomes the sustainability of the diet. Maintaining nutritional ketosis for extended periods is a very different diet than we are used to, and does not resemble most other low carb diets. Carbohydrate intake is supposed to be nonexistent, so it is essentially restricted to the 2.5 cups of dark green, non-starchy vegetables per day, and 1-2 servings of nuts. The rest of the diet is protein and fat. The most difficult part of this plan is the protein limitation. As mentioned before excess protein will be turned into carbohydrate, so protein has a restriction in ketosis, which is the main way this diet differs from an Atkins or South Beach. This results in a plan that has a lot more fat than protein, which means foods that are exclusively fat must take a leading role. Things such as grass-fed butter, vegetable oils, coconut oil and MCT oil are often consumed at every meal. An example meal plan for a 5’9” 155lb male triathlete is below:
Example Day: 2400 kcal 200g Fat 120g Protein 30g CHO
Meal 1: (60g Fat, 30g Protein)
4 slices Bacon (14g Fat, 12g Protein) Pan fried in 1 Tbsp Coconut Oil (14g Fat)
*Use ¾ teaspoon of Himalayan Sea Salt with food daily (Sodium and trace minerals)
*Use ¾ teaspoon of Salt Substitute with food daily (Potassium)
*Drink 130 ounces of fluids daily before accounting for exercise
Notice how much pure fat there is in the diet? While some enjoy it, others find it unappealing and cannot stick with it. In addition to fat as a barrier, vitamins and minerals pose a problem. Many of our micronutrients come from fruits, vegetables, dairy and grains. While we can do our best to maximize some of them in the 2 servings of vegetables and serving of nuts, we are still left without adequate micronutrients. To achieve balance many keto-dieters will use bone broth. It is very hard to assure adequate intake with broth, so supplements are commonly used. As noted above, this individual used unsweetened almond milk as a calcium supplement, salt for sodium, and salt substitute for potassium. This individual also consumes a mineral and vitamin complex that is spread throughout the day to maximize absorption and provide key vitamins and minerals that are lacking.
While quite a few websites now boast recipes and options for keto-dieters, many people still struggle with the lack of variety, and miss certain foods. As a Dietitian, my job is to help people maximize their health. For me, health is a balance of quality and quantity of life. It varies for most individuals, and that is our right. The clients I have who maintain the ketogenic diet are those who do not have strong social and emotional ties to food. While in many ways this is a positive attribute, it is a rare one in our culture. The ability to look at food as simply “energy to perform and sustain life”, will usually result in successful ketosis, but may also restrict certain social ties to food that many would argue impact quality of life.
A large barrier in the world of performance is application to certain athletes. While many view the ability to fuel on fat through endurance races as an advantage, there is one lingering disadvantage. Our body’s anaerobic systems, the energy systems that function when there is not enough oxygen, are exclusively reliant on carbohydrate. In simpler terms this means that when you are exerting yourself at maximum intensity, you rely exclusively on carbohydrate for fuel. In ketogenic dieting, there is no carb, so there is no true max performance. Endurance athletes are rarely concerned with this, as their push to the finish is often not going to be at max performance, but many athletes rely on anaerobic systems to compete. Sprinters and those athletes who rely on short bursts of high intensity will not see a performance benefit from this diet. Most of the studies investigating performance in ketosis note an increase in perceived rate of exertion, and an inability to reach max effort (White 2007), meaning they felt like they were working harder compared to when they were eating carbs for the same intensity, and they were unable to achieve max intensity. This is why the diet is most popular in endurance sports and why Lebron James only went “low-carb” in his offseason.
Aside from the daily life and performance concerns that many will find discouraging, we also have a lack of vision for the long-term impact of the diet on health. There are quite a few personal testimonials of individuals feeling great at a healthy body weight with encouraging clinical indicators of health for 5 and even 10 years in ketosis. This is quite encouraging, but we need much longer and better controlled trials. While it is true that diets with too much carbohydrate, particularly refined and processed carbs, can cause a host of problems in very little time, we have abundant data proving a eucaloric diet containing carbohydrate is able to propel humans well into their 80’s and 90’s with similar values. The inflammation and metabolic disturbances linked to carbohydrate largely stem from excessive intake and a large calorie surplus. It is much more difficult to over consume calories on the ketogenic diet, but there are still potential issues only time will tell us. As a practitioner, I am most concerned with the long-term impact of a high fat diet on the digestive tract and accessory organs. We know too much sugar wears on our pancreas and causes insulin resistance. Is it possible that a diet with high levels of fat will wear in our production of pancreatic lipase and lead to pancreatitis? I am also concerned with the effects on the gallbladder, liver and our lymphatic system. Finally, while short-term observations suggest no adverse effects on lipid profile, we simply do not know the long-term impact on lipid levels or the cardiovascular system.
Overall, it becomes clear that while this diet has great promise in certain populations, there are severe barriers to sustainability, as well as large gaps in our understanding of the long-term impact on the body. Until more research is presented, the scope of this diet is fairly limited. Personally, I am most excited about the potential application in non-insulin dependent diabetics, as well as in ultra-endurance athletes during their training and competitive seasons. For the general population I still promote the idea of carbohydrate management as opposed to elimination, but there is always a need for Case Specific Nutrition™!
Below are some links to the most comprehensive materials I know of. Much of the research on ketogenic dieting and performance was done by Dr. Jeff Volek & Dr. Stephen D. Phinney, and can be accessed at.
Dr. Peter Attia is a fascinating man with a great understanding of the physiology and potential in ketogenic dieting. For a great explanation of how our body runs on fat, I recommend his post “Keto 101”
For any other questions or concerns, fell free to contact me at casespecificnutrition.com or Pittsburgh-dietitian.com
You’re busy. Each day you find yourself more heavily invested in life with higher expectations and more responsibilities. Stress is an ever-present factor, and with it, sometimes life seems to get in the way of truly living. This cycle is far too common in our society. It is the same cycle that leads to sedentary behavior and poor eating habits. From these habits come the sacrifice of health and what Jack Lalanne considered the most fundamental American tragedy. People are living longer but less able to participate in the activities they love. Said another way, life is measured in quantity not quality. The average lifespan is 85, but who cares when a majority of adults stop doing what they love by 60? There needs to be acknowledgement of the difference between living and existing. It is easier than one might think to invest in a life that favors living. All you need is a little attention to lifestyle.
Step 1: Change the Mindset
On January 1st, a large percent of the American population starts a ‘diet’. The overwhelming failure that often results is directly related to the terminology. A ‘diet’ has become a term to characterize a miserable and temporary action. That mindset sets you up to fail. Those who succeed are more interested in implementing ‘healthy lifestyle changes’. These are factors that can become routine for the rest of your life. The ability to customize and prioritize your diet, and create effective lifestyle changes, is best accomplished by working with a Registered Dietitian. Not only are they nutrition experts, they are trained to help you set and realize your goals. The best part is I know a local Private Practice Registered Dietitian if you need a referral!
Step 2: Find what works for YOU
A similar problem and solution exists with fitness goals. Instead of setting the goal of going to the gym 5 days per week, realize the ultimate goal of increased physical activity. Physical activity is a broad term with many outlets. Some people enjoy going to the gym for a formal workout 5-6 days per week, but that is the exception to the norm. Most people are unlikely to go to the gym that often for extended periods of time. Life gets in the way. This is when you need to explore areas of grey. Commit to a gym, but do so in a way that fits your schedule. 3 days per week at the gym for 45 minutes is manageable with any schedule, and with the help of a personal trainer or exercise physiologist, it can be enjoyable and rewarding. In addition to your gym membership, commit to participating in the physical activity you enjoy, or learning new ways of physical activity. Sports, recreation, and at home fitness options are available and easily at your disposal with the help of a personal trainer.
Step 3: Choose the Platform
Find a place designed to help you achieve a balance of physical, mental, emotional, and spiritual priorities. This place will become the platform through which attention to lifestyle occurs. Use punching bags to spare your stress away; swish a game winning basket at your weekly basketball league; climb through your thoughts on a climbing wall; run away from health complications on the treadmill or at a local park; set a personal record on a lift; find the yoga tape that leaves you feeling flexible and at ease; see the results on your waistline with improved confidence and mental clarity. Everybody exercises differently, the key is to find what you want to do to improve your health and keep you accountable. Meet with a trainer, attend a local group exercise class, schedule a consultation with a Dietitian- Network!
Step 4: Figure out what you want to be doing at 65-75-85?
Nutrition and exercise regimens have had extreme makeovers in the last 15 years. Personalized health programs are now adaptable to fit your needs. The age of chicken and green beans alongside 60 minutes on an inclined treadmill for weight loss is dead. To look good and feel great you don’t need to live in a gym. You don’t need to be a chef or nutritionist. You definitely don’t need to go on biggest loser. I have many clients who lose more than a pound of fat a week amongst their busy schedules. They don’t spend two hours a day in the gym training, and they definitely don’t have to sacrifice good food and flavor. All they did is complete these 4 steps, and pay a little more Attention to Lifestyle.
Feel free to send me an email or visit my blog, pittsburgh-dietitian.com, to learn more about how you can begin paying better Attention to Lifestyle!
A colleague of mine once observed that efficiency is reduced when there are “too many chiefs and not enough Indians”. That remark correlates with my current view of the health industry. The health industry is a mess. Thanks to extremely transparent access in all media, everyone is a health expert. Personal trainers, doctors, chiropractors, physical therapists, nurses, and dietitians all offer professional services that occasionally step into the realm of the one another. When the education, experience, and application are relevant there is nothing wrong with this coverage. A problem arises when an expert decides to branch into a new area without the proper education or ability. This is one of the most direct causes of contradicting recommendations, which creates a medium for overwhelming confusion and misinformation.
Compile all the opinions of actual health professionals; with the now rampant stream of conscious the general population provides and you have a disaster. Every weight loss and success story now has a blog and a social media following based on the accepted premise that because a person accomplishes a personal goal they are an expert source. The ramifications of everything mentioned can be observed in the polarity of perception regarding a “Healthy” diet in the United States. If you read my last blog you know I use that word with hesitation, and with a personally clarified meaning. From low-carb to low fat, with gluten-free, anti-dairy, paleo, liquid diets, and flexible dieting (among others) adding to the spectrum, it is quite clear we can’t seem to agree on what is best for health.
Part of the problem is that many diets are intended for certain groups or people with specific fitness and wellness goals. The other fault is we live in a media driven society, which as a whole does very little to accurately communicate actual clinical evidence. Most of the diets listed above have research to back their use in certain populations and instances. More often than not, this research is not generalizable to the entire population. Said another way, it won’t benefit everyone. Unless you have a complete understanding of the human body and intricacies that lie within diet, it is difficult to recognize this.
As a health professional how do I help the masses understand that one study doesn’t mean recommendations should change? How can I communicate that no diet fad has application to all people? Here is my attempt. For the general population, a healthy diet is not a result of eliminating a single ingredient from food. It is not a result of eliminating entire nutrient categories (low-fat, low-carb). It is definitely not a result of eliminating entire food groups. None of these commonly chosen paths are the definition of health, nor do they translate into a long-term benefit. Your diet should be something you invest in for the long haul. The long-term investment comes from a diet that has what I call the lifestyle triad: balance, moderation and variety.
I would argue balance is the single most fundamental ideal in the pursuit of a healthy lifestyle. In many ways, the decision to seek balance is what drives the implementation of moderation and variety. Realize that too much or too little of anything usually has consequences. Too many calories, too much fat, carbohydrate or protein, to few vegetables, water balance, fiber intake, micronutrient intake; virtually everything about our diet has a spectrum with the correct amount sitting somewhere in the middle. How do we ensure this balance? Through moderation and variety of course! Eating excessive amounts of anything will have consequences (some more severe than others). Eating too much of the same thing leaves your body feeling deprived and starved of many nutrients. A diet that looks at true portions, rotates different foods, and acknowledges the various motivations to eat, is a diet that demonstrates long-term application and satisfaction.
“Balance is the single most fundamental ideal in the pursuit of a healthy lifestyle”
Aside from dietary intake, the lifestyle triad has application in almost everything. When we speak of longevity, or maximized quantity AND quality of life, we see that it generally comes from investing in the pursuit of balance, moderation and variety. For example, just as too many calories can lead to health complications, so can too much cardiovascular exercise. Yes you read that correctly. There is emerging evidence that too much running often shortens lifespan, just like too much sedentary behavior does (it’s a bell curve). Even exercise requires the lifestyle triad. Extreme athletes are just that, extreme. While we often look at professional athletes as the image of health, that may be quite skewed dependant on your definition of health. While there is no doubt they are specimens of physical conditioning, they often struggle with the longest endurance event: longevity. If you take the concepts of balance, moderation and variety, and begin to implement them into your daily activities, you will find they have application to everything you do. Since I began practicing the lifestyle triad, those close to me have observed an increase in self-confidence, improved ability to manage stress, a surge of optimism, an increase in vegetable intake, alteration of exercise habits, improved ability to enjoy food socially, and a generalized happiness that is consistent in my career and social life. All I can say is it is worth a try!
IIFYM, acronym for ‘If It Fits Your Macro’s’, is a trending simplified diet format that has increased in popularity recently. Any why wouldn’t it? A concept that says as long as you meet your daily calorie, fat, protein, carbohydrate and fiber goals, it doesn’t matter what you eat. This core foundation allows consumers to fit their favorite ‘unhealthy’ foods into a weight loss plan. Bodybuilders and fitness enthusiasts have been the group most attracted to this ideal, and understandably so. After years of broccoli, brown rice and chicken breast every meal, this group of fitness enthusiasts were more than happy to replace their broccoli and brown rice for Cinnamon Toast Crunch and an Eggo.
I will start by saying there are some very real benefits of the IIFYM concept. Most importantly it helps teach people that weight loss doesn’t have to mean eating bland foods or following a strict regimented diet. It simplifies it to the realization that weight loss is nothing more than consuming fewer calories than your body needs. This is a fundamental stepping-stone I work with my clients to understand. Many people have predetermined notions of what starting a diet means, most of which are incorrect.
The other lesson IIFYM diet teaches is moderation. Instead of the traditional ‘restrict yourself until you finally cave then binge plan’, IIFYM teaches you things like pizza or ice cream in moderation don’t have to ruin a diet. As long as you account for what you are consuming and you meet your daily goals, weight loss will happen.
The portion of IIFYM that nutrition professionals struggle with is nutrition status. While this plan does well to account for the macronutrients and fiber, it does not take into account micronutrients and most importantly, the concepts of functional nutrition. A simplified description of functional nutrition is the relationship between nutrients, the environment, and the genetics of an individual. Everyday the list of functional foods known to contain vital vitamins, minerals, antioxidants and other bioactive substances, grows and becomes better understood. Since the completion of the human genome project, the area of nutritional genomics and epigenetics has identified nutrients that have a direct effect on the expression of genes that cause or prevent inflammation, metabolic disorders, cancers, and other chronic disease. What does that mean for us? Well first off it means we have a lot to learn. Most importantly to this article, it means the correct foods are more important than previously thought. Herein lies the problem with IIFYM. While it is a great introductory method for weight loss, it does nothing to educate people about the importance of the food they eat. It treats food as simply energy, when in fact it is so much more. Bodybuilders would be intrigued to know that while brown rice and broccoli aren’t as appealing as a portion of ice cream after a workout, the contents of the first choice are known to have a positive impact on liver enzyme production, cholesterol, blood glucose, elimination of carcinogens, and antioxidant properties, not to mention the vitamin, mineral and electrolyte content. There is so much more to food than just energy and fiber, and I want to make sure everyone knows that.
I personally use IIFYM. When I am at a special social gathering or visiting family for theholidays I use the concepts to target my macros without focus on the functional nutrition of the foods I am eating. This concept has allowed me to become less restrictive. A couple chicken wings or some pizza with friends no longer mentally strains me. That being said, it is not my daily practice. Ultimately it is vital that vegetables, whole grains, fruits, and lean meats make it into your diet most of the time.
As usual I talked (or typed) too much. This article, and my point, can be summed up in far less words: use IIFYM as a piece of your adaptable healthy lifestyle plan to help you achieve the goals of BALANCE, MODERATION, and VARIETY.
Vitamin D has been a major topic of discussion recently. Over the past 5 years this vitamin has been the focus of many scientific communities. While some of the areas of impact need more research, there is quite a bit of promise from repeated data, which makes the case for increasing daily Vitamin D intake.
A General Background
Vitamin D is a fat-soluble vitamin that is produced in the body when the skin is exposed to UV rays. It is also available in low levels from some foods. Vitamin D in foods has two common forms, D2 and D3. D2, or ergocalciferol, is a fungus or yeast derived product that is created when certain fungi or plants are exposed to UV light. D3, or cholecalciferol, is what our skin, as well as the skin of other animals produce when exposed to UVB light. It can be produced synthetically and added to foods or produced as a supplement. Once in the blood stream, Vitamin D is transported to the kidneys, where it becomes Calcitriol, the biologically active form of vitamin D.
Why should I care?
Vitamin D has many functions in the body, many of which are well established and understood. Calcitriol (active Vitamin D) circulates as a hormone in the blood and regulates the concentrations of calcium and phosphate. This helps promote important processes, such as bone growth and remodeling. Calcitriol also has an effect on immune function and neuromuscular function.
The most well-known link to vitamin D is its role in the prevention of rickets, a bone disease in children. This was discovered in 1922, and the addition of vitamin D to dairy in the 1930’s virtually eliminated rickets from the United States. For years, the levels of adequate consumption for Vitamin D (%DV, RDA, DRI), easily attained by three servings of dairy daily, have been based on the prevention of rickets. Recently however, studies have emerged suggesting that an increased serum vitamin D level beyond the levels currently recommended, can translate to reduced incidence of many diseases and disorders, which are noted in the chart below:
There are many notable areas of research. The most established is still bone health. Rickets in children, and reduction of fall risk, fractures and low bone mineral density in late adults and elderly, especially women, are the most significant. In addition to bone health, deficiency of vitamin D has been linked to higher risk of viral infections. Low levels are also associated with gestational diabetes, pre-eclampsia and low birth weight in pregnant women.
Multiple Sclerosis (MS)
Vitamin D has shown great potential in Multiple Sclerosis. Prevention and management of Multiple Sclerosis, as well as some other autoimmune disorders, are the main areas of the newest research. The study of nutritional genomics is working to better establish this link. Initially, it was observed that the farther away from the equator you get, there is an increase in both vitamin D deficient persons (less sunlight), and incidence of Multiple Sclerosis.
The most popular theory is vitamin D deficiency is an environmental trigger that turns a gene coding for MS ‘on’. With this theory, increasing vitamin D consumption and raising serum levels would succeed in turning the gene ‘off’. More studies are needed, but multiple have been done and some show very promising results.
The map is from an article titled ‘Time for more vitamin D’, which appeared in the September 2008 issue of Havrad Women’s Health Watch. The article and this image discuss the difficulty obtaining enough vitamin D from sunlight and diet. The grey area on the map shows latitudes above 37 degrees north, where very little vitamin D is synthesized, except in the summer months. People who live in these areas are at relatively greater risk for vitamin D deficiency. The article can also be found on the Harvard Harvard Health Publications website, or by clicking the picture! Some other good articles on Multiple Sclerosis and Vitamin can be found in the following links:
Ever notice that the months of January-March often leave people feeling depressed. My Dad always says that February is the worst month and he would be happy to see it missing from the calendar. Are you someone who just goes through the motions when it’s snowing and overcast? Seasonal Affective Disorder (SAD) is another area of promising research for vitamin D intervention. Though the link between vitamin D and depression is not fully understood, it is established that low serum levels of vitamin D are linked with depression. It is also understood that a lack of vitamin d in the blood makes you more likely to develop depression, and taking a vitamin D supplement can improve symptoms of depression. There is direct evidence that the prevalence of SAD, the most appropriate acronym ever, is most concentrated in areas with the most extreme weather changes.
As suggested earlier, our primary source of vitamin D is what we make ourselves. Vitamin D3 is synthesized from cholesterol in the body, when an adequate UVB exposure exists. Ideal scenarios include 15 minutes of daily sun exposure to approximately 40% of the total body during the middle of the day to synthesize 10,000-25,000IU. That’s easy enough right? (Not.) In reality, this is a very real problem. First, most people work indoors during peak hours of sunlight. This instantly reduces chances of exposure to evenings, weekends and vacations. To make matters worse sunscreen, the vacationers best friend, reduces vitamin D synthesis (SPF 15 reduces vitamin D synthesis up to 98%). Then you consider location and seasonality. If you live in the Northeast United States like me, chances are there are 4-6 months each year that are cloudy and cold. Not only are you inside mostly, when you do go out, your entire body is covered with clothing. We live in a world that greatly reduces our ability to synthesize vitamin D. All of these factors become quite the D-ilemma (pun intended).
There are very few foods that are a great source of vitamin D. Currently, our best sources are dairy products that have added D3, fish that have some naturally occurring D3, or in mushrooms that have been UVB irradiated for enhanced vitamin D2 content.
How much am I getting from my diet?
o Dairy is fortified with D3 (30% DV = 120IU)
o Cod Liver Oil (1390IU/15mL)
o Catfish: 425IU/3-4oz
o Salmon: 360IU/3-4oz
o Tuna canned in oil: 235IU/can
o Whole egg: 20IU/60g egg
Portabella exposed to UV light: 420-525IU/100g
Current studies suggest vitamin D3 is better utilized in the body, which makes sense since it is what we can synthesize. D3 binds better to receptors, which ultimately leads to a more effective raise and maintenance of serum levels. In addition to being better utilized, it is more shelf-stable and has a longer half-life. Since there is no real price difference between D2 and D3 on the shelf, I would recommend Vitamin D3 to those looking to increase consumption. Attention Vegetarians! Vitamin D3 is from animal sources. If representatives at supplement companies tell you it is synthetic, it is still likely a product with ingredients of animal origin that were processed synthetically.
How much do I need?
The amount of vitamin D a person needs is another ‘Case Specific’ value. It varies based on sun exposure, diet, genetics, gender, age, activity level, along with many other factors. The best way to know is to get your serum 25(OH)D level checked.
The current ‘normal range’ for serum 25(OH)D is 30-100ng/mL. As the chart above notes, levels above 20ng/mL are what virtually eliminated rickets. That is what a typical person will have if they consume 3 servings of dairy daily. An additional reference to the chart suggests there are benefits from serum concentrations as high as 55ng/mL. A lot of those values are either extrapolated or very preliminary research, but show great promise. Since this test has a standard deviation (potential error) of 10ng/mL, I would recommend at least getting your levels above 40ng/mL. Levels above 50ng/mL are what I strive for, and what I would recommend to my clients. To do this, there is a generic formula for quick reference.
Generally, 100IU of D3 will raise serum 25(OH)D approximately 1ng/mL.
So for someone with a vitamin D level of 25ng/mL, to get to 45ng/mL, you would need approximately 2,000IU in addition to your current lifestyle’s consumption and sun exposure. I would like to repeat that this is formula is not fact or scientifically proven. It is more of a general reference tool to help gauge a starting point.
For those concerned with over consumption, serum levels above 150ng/mL have been associated with negative effects. The Vitamin D Council often notes that there are no issues associated with a serum level around 70ng/mL, so if there is potential benefit why not? I personally supplement 2,000IU in the summer, when I am outdoors running frequently, and 3,500IU in the winter when I am bundled up and bogged down by the Pittsburgh winters. These amounts are in addition to what I consume from dairy, eggs, and other dietary staples.
Talk to your doctor about getting your serum 25(OH)D levels checked. Ask to know the value, not just the generic ‘you are fine’. If you are below 40ng/mL, I would still recommend getting at least an addition 1,000IU of daily D3. If you are deficient (below 30ng/mL), many doctors will write a prescription for a weekly 50,000IU D2 supplement. This is an unnecessary prescription. Not only do I advise clients to buy D3 instead of D2, Vitamin D can be purchased in a much cheaper, daily dose at any supplement store, website, or chain store that carries supplements. Let your doctor know you will instead buy a D3 supplement (2,000IU-5,000IU are very easy to find), and would like to retest in 3 months.
Support of Recommendations
Compared to the DRI of 600 IU for adults set by the IOM and Food and Nutrition Board, the levels I am referencing seem high. The Vitamin D Council, an organization solely focused on Vitamin D research would suggest otherwise:
As you can see, the Vitamin D Council actually recommends 5,000IU per day. They also work to convince the FNB and IOM to increase the Tolerable Upper Limit (TUL) from 4,000IU to 10,000IU. This request is heavily based on the evidence that our bodies synthesize around 10,000IU daily from proper sun exposure without issue of toxicity. I am a great supporter of this council and their devotion to research and health. I also have a great deal of respect for the Endocrine Society. According to their documentation, the average adult will need around 1,500-2,000IU per day to receive the full benefit of vitamin D. Supplementing more than that should be based on individualized serum results, or done by those who wish to supplement with the hopes of receiving benefits hypothesized in very new research.
1. My recommendations are based on the areas I feel are well established. Those are the areas I discussed in greater length. Many of the links and charts I provided may discuss information or topics I feel need more data are not ready for application to populations yet. Remember moderation, balance, and variety rule the day.
2. If I had to pick one vitamin for the general population to supplement, it would be vitamin D. It is the only vitamin I supplement daily.
3. Get your Serum 25(OH)D levels checked immediately, 3 months later to track progress.
4. Levels are typically at their lowest in March, due to the lack of sunlight experienced since approximately November. If you wish to know you low and high throughout the year, March and September (respectively) are the best times.
5. Increase your dose in the winter months, or in periods when you have further reduced sun exposure. Decrease supplemented dose in time periods when you are getting more sun exposure.
6. Stay updated on the latest research using myself or the Vitamin D council website for reference. Vitamin D is being studied intensely. Current areas in need of more research will be updated frequently. This topic is one that will be updated constantly.
4. Gloth III F.M., Alam W., Hollis B. J Nutr Healthy Aging. 1999;3(1):5-7. ‘Vitamin D vs Broad Spectrum Phototherapy in the Treatment of Seasonal Affective Disorder. http://www.ncbi.nlm.nih.gov/pubmed/10888476.
5. Harvard Health Publications: Harvard Medical School. ‘Time for more Vitamin D’. http://www.health.harvard.edu/newsweek/time-for-more-vitamin-d.htm. September 2008.
6. Mark A. Moyard, MD, MPH. Medscape Multispecialty. Dermatology Nursing. 2009;21(1). ‘Vitamin D: A Rapid Review’. http://www.medscape.com/viewarticle/589256.
7. National Institutes of Health: Office of Dietary Supplements. ‘Dietary Supplement Fact Sheet: Vitamin D’. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. 2011.
9. Runia T.F., Hop W.C., de Rijke Y.B., et al. Neurology. 2012 Jul 17;79(3):261-266. ‘Lower serum vitamin D levels are associated with a higher relapse risk in multiple sclerosis. http://www.ncbi.nlm.nih.gov/pubmed/22700811.
10. Vitamin D Council. ‘Depression’. http://www.vitamindcouncil.org/health-conditions/depression/. June 2013.
11. Vitamin D Council. ‘Multiple Sclerosis’. http://www.vitamindcouncil.org/health-conditions/multiple-sclerosis/. March 2013.
12. Vitamin D Council. http://www.vitamindcouncil.org/. 2013.
13. The Endocrine Society. https://www.endocrine.org/. 2013.
I don’t know about you, but I am a creature of habit. I like routine. Don’t get me wrong, spontaneity has its place in my life, but when it comes to most daily activities, I like to have a plan. This can mean different things to different people. Some like to have the same schedule Monday-Friday. Personally, I like each day of my week to have variety, but I like the variety to be planned. What I do on Monday is likely not the same as on Tuesday, but my Mondays are all very similar. With this schedule, instead of having a daily routine, I have a weekly routine. Some people, especially those in health care (yes I’m talking to you nurses) have a biweekly or completely unpredictable routines.
There are pros and cons to all of the lifestyles above. A daily routine tends to become monotonous relatively quickly, but is great for planning and accountability. Alternatively, weekly, biweekly, or unpredictable routines do keep the mind better stimulated, but can also be difficult to manage at times. The more variety in your day equates to more decisions, and ultimately a need for better planning. Factors such as these need to be considered, especially when health and wellness is a priority in your life.
I have multiple clients with daily, weekly, and unpredictable routines. When it comes to meal planning, a daily routine is by far the easiest. The meals times, workouts, and activity schedule is predictable. For clients in need of education, this is the easiest schedule to have, as it reduces the need for adaptation.
For those with weekly schedules, they have to learn to adapt to daily change. Most psychologists agree that it takes approximately 19-21 days to create a habit or routine. What happens if the routine is only performed once per week? The idea of mental adjustment is very crucial. The key is gradual adjustments in planned areas. Over time, the pieces of the plan come together to form a complete and optimized routine with daily variety.
Then we have the unpredictable schedules. Some of the more common jobs include nurses, doctors, small business owners, sales positions, and a variety of jobs that require frequent travel. For this group, it is often impossible to settle into a complete routine. There is likely some consistencies while at home, or in the office, but that may only account for 3 days per week. The rest of the week often consists of travel to different states or countries, airports, hotels, restaurants, and a great variety in level of activity and time to plan. For someone trying to lose weight, build muscle, manage diabetes, or focus on healthy lifestyle choices, this poses a tremendous challenge. When challenges such as these present themselves, the key to maintaining a successful healthy lifestyle plan is to NEVER get stuck.
Since not everyone spends their time becoming a walking nutrition facts list, or automated calorie calculator, there are many tools and strategies that can be used to help control the unpredictable. Technology has become a huge asset for many. Apps like the My Fit Pal, Calorie Counter, and many others can be reference lists for nutrition facts, and can help you track your days caloric intake with macronutrient distribution, and even estimate your caloric needs. Though these apps do not replace the knowledge and customization offered by a Registered Dietitian, it can be helpful, especially if used in combination with personalized consulting services (email me for more information!).
Thanks to the dramatic increase in demand for transparency by consumers, eating healthy on the go is no longer the burden it was in years passed. All restaurants with more than 20 locations, particularly commercial fast-food chains, are required to have nutrition facts available. This is a huge asset for people who are stuck with limited options. Many fast-food chains offer grilled chicken, salads with light dressing, and wheat grain options. This makes it possible to eat fast food with attention to calories consumed, as well as macronutrient distribution and nutrient density. I always tell my clients, I don’t care where you are eating, there is always the opportunity to get a grilled chicken salad with no cheese, and lite italian dressing. This option may not be necessary for everyone, but the take home message is there is no longer an excuse for unhealthy choices.
One of my most heavily utilized strategies is constant accessibility to smart snacks. Throughout my education, I have worked in environments with limited time to eat, limited access to the foods I want to eat, and in positions with very unpredictable days. Throughout all of these environments, my constant access to smart snacks is what helped me maintain my goals. Snacks will of course vary based on your individual goals, but many of the following items are ideal for use.
If you looked in my briefcase and gym bag, you will find the following:
A shaker bottle with 3 scoops of my ‘Daily Whey’ protein powder in a ziploc bag
An apple pie Quest Bar
A jar of Smucker’s Natural Creamy Peanut Butter
A light string cheese
Two rice cakes
A ziploc bag of almonds
A small organic apple
A bag of baby carrots
a 6oz container of plain greek yogurt
All of these items are quick, convenient, easy to eat, easy to store, and most importantly delicious! There are many other options that exist, but I find that these key items cover my bases. If I am on the go, I can select any one of these items to eat in less than 1 minute. I choose what I eat based on the type of activity I will perform. If I am stuck without food and will be sedentary, my need for carbohydrates is only for mental function. With those needs in mind, the combination of an apple and a light string cheese provides some much needed brain power, along with some protein and a couple vitamins and minerals worth mentioning. I will openly admit my briefcase always has a couple scoops of protein and a quest bar in it. This isn’t because I affiliate with the common misconception that I will wither away without a steady stream of protein; its because they are simply formulated and versatile products with a reasonable shelf life, and they store at room temperature. These items allow me to fulfill my protein requirements, and they leave me satisfied when I need a meal and can’t readily access anything. These items have saved me on numerous occasions throughout my education, and are a fundamental reason for my ability to never get stuck.
If you have never had a Quest Protein Bars, I would recommend trying one. Not only are they high in protein and fiber, they are delicious. My favorite is the Apple Pie flavor. It has 5g of unsaturated fat, 20g of protein, and only 6g of non-fibrous carbohydrate. Of these carbohydrates, the sugar is mainly from dried apples. I prefer sucralose (splenda) over sugar alcohol, which is another reason I prefer this flavor. I love how short the ingredient list is, especially for a prepackaged protein bar! They have many flavors, some with no sugar alcohols, some with no artificial sweetener. They have options for every taste palette! If you click the Quest Bar link on this page, you will be directed to the Quest Bar Page. You can select to purchase single bars or full 12 ct. boxes from them. Enjoy!
Also, don’t forget to try a tub of Case Specific Nutrition™ ‘Daily Whey’. Not only can this powder sit in a shaker waiting to save you from hunger, it can also be used in recipes that are easy to make and even easier to eat! Subscribe to my page and receive 6 recipes that you can make using Daily Whey!
What are the snacks you use to never get stuck? All comments and ideas are welcome!
Andrew Wade, RDN, LDN
Registered Dietitian, Smart Snacker