Pittsburgh Dietitian | Case Specific Nutrition™

Embracing Positive Body Image: Your Guide to Confidence

September 25, 2023

by amwadenutrition@gmail.com with No Comment Blog Posts Pittsburgh Dietitian

Points By: Devon Kroesché, MS RDN LDN

Chilly evening air, the sunset, and crispy leaves signal that fall is just around the corner. It’s an exciting time to slow down and create lasting memories. However, the pressure to attain an idealized body image can sometimes overshadow these moments. This fall, let’s commit to prioritizing our well-being and nurturing a positive body image through every season. Here are some of our best tips to assist you in doing just that!

Dress for Comfort, Not Conformity

As seasons change, the pressure to conform to certain fashion trends can intensify. However, remember that your comfort and confidence should be your priority. Opt for clothes that fit well and make you feel good. Say goodbye to the days of constantly adjusting ill-fitting clothing or outfits that make you feel self-conscious. Choose pieces that highlight your favorite features and allow you to enjoy activities without distraction.

Limit Mirror Time

Mirrors can be both friend and foe when it comes to body image. While they can be helpful for a quick outfit check, spending too much time scrutinizing yourself can lead to self-criticism. Instead of getting dressed in front of a mirror, opt for a quick glance and then shift your focus elsewhere. Remember, the goal is to feel confident and at ease in your own skin, rather than hyperfixating on perceived flaws.

Shift the Conversation

Group gatherings often lead to discussions about bodies, diets, and weight loss goals. It’s crucial to redirect these conversations toward more positive and enriching topics. When someone starts talking about wanting to change their body size, pivot the discussion by asking about their plans, upcoming adventures, or hobbies they’re excited about. By steering the conversation away from body-centered topics, you’ll create an environment that values experiences over appearance.

Embrace Body Diversity

Every body is unique, and that’s what makes us all special. It’s easy to fall into the trap of comparing ourselves to others, especially in the era of social media. However, remember that your body is your own, and its worth isn’t determined by its similarity to someone else’s. Celebrate the beauty of diversity by appreciating the variety of shapes and sizes that exist.

Celebrate Your Body’s Abilities

Your body is an incredible instrument capable of so much more than just looking a certain way. Shift your focus from appearance to functionality by acknowledging what your body can do. Instead of fixating on how your body looks while you jog, concentrate on the fact that your body enables you to engage in an activity you enjoy. Whether it’s swimming, hiking, dancing, or simply enjoying a leisurely walk, embrace the gratitude for your body’s abilities.

Let’s prioritize self-love and body positivity. Embrace each season by choosing comfortable clothing, limiting mirror time, shifting conversations, embracing body diversity, and celebrating your body’s abilities. Remember, your body is your companion on your adventures, so treat it with kindness, appreciation, and the care it deserves.

If you would like to speak to a dietitian at Case Specific about this topic, reach out to us at scheduling@casespecificnutrition.com

The Vital Role of the Liver: Metabolism and Detoxification

September 19, 2023

by amwadenutrition@gmail.com with No Comment Blog Posts Pittsburgh Dietitian

Points by: Andrew Wade, MS, RDN, LDN, CSSD

The liver is a remarkable organ that plays a central role in maintaining the body’s overall health and well-being. It serves as both a powerhouse for metabolism and the central protector against harmful substances. The liver processes energy, breaks down nutrients, and detoxifies the body from potentially harmful compounds. In this blog post, we will delve into the functions of the liver, explore its relationship with energy metabolism and detoxification, and highlight the role of supplements in supporting liver health.

Metabolism: The Liver’s Energy Processing Hub

The liver’s metabolism function can be compared to a car engine that converts the food we eat into energy. It breaks down carbohydrates and fats, two primary energy sources, into forms that can be readily utilized by the body. This process, known as metabolism, is essential for maintaining energy levels, supporting physical activity, and sustaining various bodily functions.

Carbohydrates and fats are broken down into simpler molecules through a series of biochemical reactions. The liver stores glucose as glycogen, releasing it into the bloodstream when energy demand rises. This mechanism helps stabilize blood sugar levels, ensuring a steady supply of energy to the body’s cells as needed.

Detoxification: The Liver’s Natural Defense System

Another crucial role of the liver is detoxification, a process that involves filtering out harmful substances and chemicals from the bloodstream. This includes medications, dietary metabolites, environmental toxins, and various waste products. Think of the liver as the body’s own detox center, working to neutralize and eliminate potentially harmful compounds.

The liver achieves detoxification through a series of enzymatic reactions that convert toxins into less harmful substances. These substances are then excreted through bile or the kidneys, preventing their accumulation in the body. This detoxification process is vital for maintaining overall health and preventing damage to organs and tissues.

The Liver’s Complex Processes: Micronutrients and Enzymes

The liver’s many functions rely on a diverse range of nutrients and enzymes. Micronutrients, such as vitamins, minerals, and antioxidants, are essential for supporting the liver’s various processes. These nutrients act as cofactors, facilitating enzymatic reactions and ensuring the execution of metabolic and detoxification functions.

Enzymes are catalysts that drive biochemical reactions in the body. The liver utilizes enzymes to break down nutrients, convert toxins, and facilitate various metabolic pathways. Proper enzyme function is crucial for maintaining liver health and overall well-being. The ALT and AST on a lab panel ordered by your doctor are the most common liver enzymes. When these levels rise, it means the liver is processing more or working harder than normal. If there is an obvious reason why (illness, medication use, alcohol intake etc), a temporary spike is to be expected. If these levels are very high (above 80) or consistently high with no obvious reason, your medical team will want to investigate potential liver stressors or diagnoses.

Supplements: Enhancing Liver Health

Supplements can play a valuable role in supporting liver health, especially when the body’s nutrient levels are deficient. Vitamins, minerals, and antioxidants are integral to the liver’s metabolic and detoxification processes. When the body lacks these essential nutrients, supplementation can help bridge the gap and optimize liver function.

For instance, Milk Thistle, enriched with the active compound Silymarin, has been shown to boost liver health. Silymarin enhances cytochrome P450 activity and supports enzyme function, leading to reduced inflammation and the neutralization of free radicals. Studies have indicated that Milk Thistle supplementation can lower liver enzyme levels in individuals with acute and chronic liver conditions. A daily dosage of 250-350mg has demonstrated safety and efficacy in supporting liver health.

N-Acetyl-Cysteine (NAC) and Glutathione are potent antioxidants that also play a pivotal role in reducing the burden on the liver. These antioxidants help neutralize harmful compounds, reduce oxidative stress, and support detoxification processes. Dosages of 200-600mg of NAC and Glutathione have been found to be safe and effective in promoting optimal liver function.

The Synergy of Supplements and Diet

While supplements can be beneficial, they are most effective when integrated into a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. A diet abundant in produce provides the necessary vitamins, minerals, and antioxidants that work with supplements to support the liver’s functions.

Hydration also plays a critical role in maintaining liver health. Staying consistently hydrated ensures optimal blood flow and aids in the transport of nutrients and waste products, facilitating the liver’s detoxification processes.

The liver’s role as the center of metabolism and detoxification is fundamental for overall health. Its ability to process energy, break down nutrients, and filter out harmful substances is required for maintaining bodily functions. Supplements, when used strategically and in conjunction with a nutrient-rich diet and proper hydration, can complement the liver’s natural processes and promote optimal liver health. By understanding the liver’s intricate functions and providing it with the necessary support, we can take proactive steps toward maintaining our health and well-being.

Tofu + Zucchini Stew

September 11, 2023

by amwadenutrition@gmail.com with No Comment Pittsburgh Dietitian Recipes

Written by: Ava Elliott, MS, RD

Are you starting to be in the mood for a big bowl of stew or soup? Me too, thanks to this preview of fall weather in Pittsburgh. The following recipe is adapted from Food & Wine and is a cozy, spicy dish to add some tofu and veggies to your weeknight rotation. Tofu is a high source of plant-based protein packed with all nine essential amino acids our bodies needs through food. It also provides other nutrients like calcium and potassium to nourish your body and support bone health.

What You’ll Need:

16 oz firm tofu
5 cups water
1 clove minced garlic
2 cups napa cabbage, shredded
1 zucchini, cut
1 white onion, diced
4 scallions, cut
1 tbsp bonito flakes
1/2 tsp oyster sauce
3 tbsp fermented soybean paste
3 tbsp Korean chili paste
2 tsp gochugaru
2 tsp minced ginger
1 ½ tsp salt
1 tsp sesame oil
Serve with white rice and kimchi

What To Do:

Simmer 5 cups water over medium heat in Dutch oven.
While water is simmering, cut and drain tofu (half block) and set aside. Add bonito flakes and oyster sauce and simmer for 7-8 minutes.
Add fermented soybean paste, Korean chili paste, gochugaru, ginger, and garlic. Stir for about a minute or until paste dissolves.
Chop tofu in bite-sized pieces. Also cut zucchini into thin slices, or as desired.
Increase heat to medium-high heat and add in tofu, cabbage, zucchini, and onion and cook uncovered for about 4 minutes. Add in scallions and salt and cook until vegetables are cooked through.
Serve with rice and kimchi and drizzle sesame oil and enjoy!

Please share a picture with us on social media if you make this delicious recipe @CaseSpecificNutrition. Have you seen Case Specific Meal Prep’s new site? If you are running out of time to cook, check out the delicious dietitian-approved meals and get rewards for referring a friend! You can always schedule an appointment with a registered dietitian by emailing us!

The Fern

August 29, 2023

by amwadenutrition@gmail.com with No Comment Blog Posts Pittsburgh Dietitian

Written by: Andrew Wade, MS, RDN, LDN, CSSD

In honor of our 10 year anniversary, we want to explain the meaning behind our logo–the fern. We are beyond thrilled to celebrate 10 years and want to thank you all for being a part of this journey!

I have been asked many times what the meaning of the ‘fern thing’ is. To this I usually say the symbol means many things, and has a long and decorated history in my life. Here is my attempt to explain the traditional meaning of the symbol, as well as its significance in my life.

My logo is called ‘AYA’, and it is the Adinkra symbol of the fern. The word aya can mean ‘I am not afraid of you’ or ‘I am independent of you.’ It is the symbol of endurance and resourcefulness. According to the Adinkra dictionary: “The fern is a hardy plant that can grow in difficult places. An individual who wears this symbol suggests he has endured many adversities and outlasted much difficulty.” It is 1 of 53 original Adinkra symbols created by the Akan people, an ethnic group native to Ghana and the Ivory Coast in West Africa. The symbols were used to convey wisdom, aspects of life, or the environment. Traditionally, this symbol was worn or displayed by individuals who were defiant in times of difficulty, displayed hardness and perseverance, and were known for their independence and resourcefulness.

I originally found this symbol in my junior year of high school. I was instantly attracted to the image and what it meant. It became my computer background, and has remained there for inspiration ever since. I always planned to get it as a tattoo along with the runner that is now on my ankle. The runner was a symbol I drew in high school to commemorate and celebrate the impact running has in my life. The fern, on the other hand, just spoke to me. The idea of being independent, hard nosed, unshakeable; it stood for everything I aspired to be. I spent six years trying to decide when to get this tattoo. My procrastination revolved around the original definition, which clarifies aya is worn by those who have ‘outlasted much difficulty.’ To me, this symbol was a sign of wisdom, worn by those who had been through trying times. Though I have always worked hard, and have had my own list of adversity in life (as does everybody), I never felt I deserved to wear the symbol.

Finally my senior year of college came around, and I decided I wanted to get the tattoo to celebrate my graduation. As the plan progressed, I still felt that I hadn’t overcome enough adversity to wear this symbol. That’s when it hit me. I have always been attracted to the symbol because it is an ideal I aspire to maintain throughout my life. My desire to constantly move forward, tendency to seek independence, and remain resilient in hard times, are all traits I work very hard to prioritize. These traits are present, and with life’s experiences, can be built upon. This epiphany helped me identify how I affiliated with the symbol.

It also realized that the AYA represented the lessons my grandparents instilled upon me. This symbol represents my grandparents, and the life they lived. I decided to get this tattoo after I graduated, but added my grandparent’s initials, RLW, underneath it. When I got the tattoo, my grandfather’s health was deteriorating quickly. I was happy to be able to show it to him before he passed away, so he could see my visual representation of the magnitude of his influence.

In the summer of 2013, just over a year later, I sat in my grandfather’s chair, filing the paperwork for my newly formed company. My need for a business symbol was instantly a non-issue. The AYA, which has come to represent so much in my life, is truly representative of the challenge I present to all my clients. No matter what the obstacle is, whether physical, emotional, perceived or real, you can overcome it. Standing tall in the face of adversity is what my grandparents did, it’s what I was raised to do, and it is what I know all of my clients can do.

Beet Fries

August 14, 2023

by amwadenutrition@gmail.com with No Comment Pittsburgh Dietitian Recipes

Written by: Ava Elliott, MS, RD

Are you familiar with nitrates? Beets are rich in nitrates. They can enhance performance with exercise and improve muscle contraction with oxygen consumption.¹ Consuming beets provides antioxidants that have anti-inflammatory properties to help decrease blood pressure² and help prevent strokes and atherosclerosis. Beets also are packed with vitamins and minerals like vitamin A, potassium, and folate³ to help your immune system, vision, and body functions. Are you excited to add them to your dietary pattern yet? See the fun recipe below!

Tip: Use disposable gloves when handling beets to prevent staining of your hands.

What You’ll Need:

2 large beets (choose red, yellow, or Chioggia beets for color!)
¼ cup feta, crumbled
1 Tbsp oregano, chopped
1 Tbsp parsley, chopped
1 Tbsp olive oil
¼ tsp Kosher salt
¼ tsp pepper
1 tsp lemon zest
Sprigs of mint for garnish

What To Do:

Peel beets and cut into ½ in-thick strips. Toss with olive oil, salt, and pepper while air fryer preheats for 5 minutes to 400°F.
Cook the beets in an air fryer for about 15-20 minutes or until golden and crispy. Flip so all sides get cooked well.
In a small bowl, mix feta, oregano, parsley, and lemon to pour over the cooked beets. Garnish with mint and enjoy!

Do you need some quick and delicious meals because you are too busy to cook this week? Visit Case Specific Meal Prep! If you’d like to schedule an appointment with one of our Case dietitians to chat about more recipes or your nutrition concerns, email scheduling@casespecificnutrition.com!

References:

Gallardo EJ, Coggan AR. What Is in Your Beet Juice? Nitrate and Nitrite Content of Beet Juice Products Marketed to Athletes. Int J Sport Nutr Exerc Metab. 2019; 29(4): 345-349. doi: 10.1123/ijsnem.2018-0223
Williamson L. Give me a beet: Why this root vegetable should be on your plate. American Heart Association. Published February 22, 2023. Accessed August 14, 2023. https://www.heart.org/en/news/2023/02/22/give-me-a-beet-why-this-root-vegetable-should-be-on-your-plate
FoodDate Central. Beets, raw. U.S. Department of Agriculture. Published April 1, 2019. Accessed August 14, 2023. https://fdc.nal.usda.gov/fdc-app.html#/food-details/169145/nutrients

The RD2B

July 31, 2023

by amwadenutrition@gmail.com with No Comment Blog Posts Pittsburgh Dietitian

Written by: Ava Elliott, MS, RD & Anna Jacobs, Dietetic Student & Marketing Intern

What is a Registered Dietitian? An RD or RDN is a credentialed healthcare professional that is an expert in all things nutrition-related. They provide the highest quality of care using evidence-based science and research. To become an RD, one must complete the school requirements, obtain a master’s degree (in 2024 it will be required), complete a dietetic internship with at least 1000 supervised hours of experiential learning, and pass the national examination.

Ava’s Experience:

I graduated in April from the University of Pittsburgh’s Dietitian Nutritionist Program with my master’s degree in Nutrition and Dietetics. I took my RD exam earlier this month and I am officially an RD!

My tips while going through school are to stay organized and show yourself grace and compassion. There is a lot you will be learning, and using pretty colored pens and highlighters for your planner, notes, post-its, etc. is the key to success. Once everything is organized you can focus on learning! I entered Pitt’s program as a sophomore in college and learned so much through classes like nutrient metabolism, pathophysiology, ethics, medical nutrition therapy, functional nutrition, and so many more! I recommend being a teaching assistant (TA) for a class if you can, to gain perspective from the professor’s point of view and sharpen your own leadership skills. Additionally, take any and every opportunity related to nutrition to gain experience and start to figure out your interest areas. During your dietetic internship, keep an open mind and remain curious. Sometimes you will feel slightly stressed because you will have a lot on your plate, but that is where you can show yourself compassion and take one day at a time, doing the best you can each day with productive work. During the year of your internship, you will learn SO much and even some things you dislike. All the opportunities are important to gain perspective and grow as a future professional.

When it comes to studying for the RD exam I recommend remaining organized and practicing self-compassion. I used Jean Innman’s study materials and made a schedule for myself to study six out of seven days a week for a month. I also kept a study log to keep myself accountable and track how many hours I studied during the month. Take care of yourself, allow yourself breaks, and find a way to be your own cheerleader. During the actual exam, I recommend staying confident and reading each question carefully. Trust in your knowledge and critical thinking skills! You spend a lot of time learning about nutrition before even taking the exam and you will know more than you think!

Anna’s Experience:

Hi! I’m Anna. I am currently studying to become an RDN! I will be a senior in college this fall, entering my 2nd year of Pitt’s Dietitian Nutritionist Program. Being one year into the program has already taught me so much about not only nutrition, but healthcare in general. No two classes are the same, even though they are all (mostly) nutrition-based! You are always learning something new!

If I had to give advice to any prospective dietetic students I would say believe in yourself! If you have a passion for this topic then you will have a great time learning about it. You and your peers will all go through it together and while it may be challenging it will also be incredibly fascinating! You’ll learn more than ever before and you’ll quickly find out how fun it is to implement into your everyday life. Additionally, don’t be afraid to ask questions! If you are entering a program you will be surrounded by tons of knowledgeable faculty. They will be more than willing to share their experiences and contacts with you! If there is an area of the field you’d like to learn more about, or a place you’d like to shadow, just ask! More times than not they want you to gain that experience and learn more about what you like and dislike in the field. You can do it!

By far, my favorite part of the program has to be the people. Most of my classes are with the same group of my peers. We’ve all become good friends and really enjoy learning together. There is always someone to study with, to ask questions, and to hang out with at the end of a long day! Additionally, the professors have all been wonderful. Each of them has great stories to share and expertise that you only get from a career in dietetics! I feel really lucky!

If you’re a prospective dietetic student and would like to chat, join us on Wednesday, August 2 for a Q&A on our Instagram!

Baked Oatmeal

June 27, 2023

by amwadenutrition@gmail.com with No Comment Pittsburgh Dietitian Recipes

Written by: Ava Elliott, Marketing Intern & Future Dietitian

Reviewed by: Devon Kroesché, MS, RDN, LDN

One of the best meal prep to give you a great energy boost in the morning while saving time will be this chocolatey baked oatmeal. If you love oatmeal like I do and want to switch up your recipe, try baking it! What is nice is that you can customize your flavor profile. I am going to share a banana chocolate chip recipe because I’m a chocoholic.

What You’ll Need:

2 cups old-fashioned rolled oats
1 large egg
3 medium bananas, mashed
~2 cups milk (I use oat)
¼ cup chocolate chips
1 ½ tsp cinnamon
½ tsp baking powder
½ tsp salt
1 tsp vanilla extract

What To Do:

Preheat oven to 375 degrees and prep a 9×9 baking dish while you prepare your ingredients.
Combine oats, egg, milk, banana, and vanilla in a mixing bowl and stir well.
Next add in cinnamon, baking powder, salt, and chocolate chips and stir well. Transfer to baking dish.
Bake for about 40 minutes (make sure center is cooked through).
Cool for 15 minutes before enjoying.
Keep in fridge for breakfasts or snacks for the next few days.

What is so great about baked oatmeal is you can start your day with benefits from a whole grain; including fiber and vitamins and minerals to boost your morning energy. (Read more about carbs here.) Adding fruit or yogurt with your baked oatmeal can add extra vitamins and protein from the Greek yogurt. This meal is a balance of nutrients to satisfy your hunger.

Share with us on social media by tagging @CaseSpecificNutrition on Instagram or Facebook. If you’d like to schedule an appointment with one of our dietitians, please email Scheduling@CaseSpecificNutrition.com.

Your Favorite Macro: Protein

June 12, 2023

by amwadenutrition@gmail.com with No Comment Blog Posts Pittsburgh Dietitian

Written by: Jesse Cook, Dietetic Intern

Reviewed by: Madison Frye, MS, RDN, LDN

What Is Protein?

The Greek term for protein, Proteos, refers to “taking first place” and was given to reflect the importance of this macronutrient back in the 1800s. Proteins are found throughout our entire body with over 40% in skeletal muscle, 25% in our organs, and the rest within our skin and blood. Proteins are composed of amino acids, which are the building blocks for many functions in our body. Many people associate protein with muscle growth, but proteins are also key components of our immune system, hormone signaling, digestive enzyme production, structural development, and influence satiety.¹

The Basics of Protein

Proteins are broken into two main categories of complete and incomplete proteins.

Complete protein – contains all our indispensable or essential amino acids in the amounts roughly needed by humans. Indispensable amino acids, discussed below in more detail, cannot be synthesized by our bodies and must come from our diet. This source of protein is primarily found in animal sources such as meat, fish, poultry, dairy, eggs, etc. The exception to this is gelatin, which is of animal origin, but lacks the amino acids tryptophan and collagens.¹

Incomplete protein – lacks some indispensable or essential amino acids needed by humans. These are primarily found in plant food such as nuts, seeds, vegetables, grains, legumes, and lentils. The exception to this is soy and quinoa, which are complete proteins.¹ Additionally, it is important to remember that incomplete does not mean they’re of no use, but just have limiting amino acid profiles. We will discuss this more in the “Animal and Plant Proteins” section.

What are Amino Acids?

Amino Acids (AA’s) are the building blocks of protein. When amino acids begin to bond together into linear chains, they are called polymers. As polymers bond together, they become polypeptides. As the various polypeptide shapes and sizes are formed, they bond together and are referred to as proteins. There are a total of 20 amino acids that directly code with human genetics, each provide unique benefits in the body. These amino acids are categorized into three groups: essential, non-essential, and conditionally essential.

Essential (indispensable) – can only be obtained via diet (our body cannot make these!) There are 9 in total.
Non-essential – can be made by our body. There are 11 in total.
- Conditionally essential – normally our body can make these, but in weakened states, our body cannot make sufficient amounts. 7 of the 11 non-essentials fall into this category.

For our body to absorb protein, we must first break the polypeptide bonds down into smaller amino acid molecules. This process occurs in the stomach via stomach acid (HCl) and protein specific enzymes, known as protease. The absorption of any protein is done through our interstitial brush border (along the small intestine) via facilitative diffusion or active transport. However, large bonds are unable to be absorbed. This means that when we eat something, our body must break it down into tiny molecules and then build it again once absorbed.

Specific Amino Acid Benefits/Examples

Each amino acid has a unique and pivotal role in our bodily functions. Discussed below are only a few of the 20 amino acids, each with unique functions. It is important to recognize that amino acids are the building blocks to every protein found in the human body. In order to improve our quality of life, a well-balanced diet that includes a variety of amino acids should be consumed.

Valine, Isoleucine, Leucine (BCAAs)

Valine, Isoleucine, and Leucine are referred to as Branch-Chain Amino Acids (BCAA’s) due to the structure of their molecule. These are essential amino acids. Each of these amino acids, especially leucine, are well known for their benefits relating to Muscle Protein Synthesis (MPS), inhibiting Muscle Protein Breakdown (MPB), lean muscle growth, muscle recovery, and reducing muscle fatigue/soreness.²

*BCAAs are found most abundantly in red meat, chicken, eggs, fish, dairy products, legumes, nuts, grains, and seeds.

Tryptophan

Serotonin, melatonin, and other neurotransmitters are derivates of tryptophan. This essential amino acid is responsible for many functions that allow us to thrive! Serotonin regulates our mood, fights anxiety, improves our sleep, impacts our pain perception, improves thermoregulation, and regulates our blood pressure. Melatonin plays a large part in our circadian rhythm and sleep. As we age natural melatonin production diminishes, resulting in difficulty sleeping.¹

*Tryptophan is found most abundantly in salmon, chicken, turkey, eggs, spinach, seeds, nuts, soy, and dairy products.

Glutamine

Glutamine is one of the most abundant free AA’s in the body and is responsible for many metabolic processes. Our bodies store large amounts of Glutamine, so it can be readily used. This conditionally essential amino acid is referred to as “glucogenic,” meaning that if and when needed, will readily convert into glucose (energy), via a process called gluconeogenesis. Glutamine is also essential in the production/replication of leukocytes (white bloods cells that fight infection). Additionally, glutamine may be recommended in someone who has increased intestinal permeability (commonly referred to as “Leaky Gut”), as it plays a significant role in healing the lining of our gut.¹

*Glutamine is found most abundantly in chicken, fish, cabbage, spinach, dairy, tofu, lentils, and beans.

Roles of protein in body

Muscle Growth – Proteins are the building blocks of all muscle. Adequate intake of all essential amino acids alongside total protein intake is vital for muscle development, maintenance, and repair. Muscle growth occurs when MPS is stimulated, generally via resistance training. Without adequate protein, the rate of MPB will surpass that of MPS, and ultimately net in a loss of muscle. An important note, after the age of 30, our lean mass is estimated to decrease 3-8% per decade.² So, promoting the development and maintenance of lean muscle mass is something everyone should consider!

Immune System Function – Antibodies, also known as immunoglobulins (IgG, IgM, IgA, IgD, an IgE), are large proteins used by our immune system to target and neutralize antigens (foreign pathogens such as bacteria and viruses).¹

Hormone Signaling – Hormones are chemical signals released by our endocrine cells. These signals control a wide variety of physiological processes including growth, metabolism, reproduction, and many others. Some hormones (such as steroid hormones) are lipid based and others are protein based (such as peptide hormones).¹

A great example of peptide hormones is insulin. When blood glucose rises (after a meal) our cells within our pancreas release insulin into the bloodstream. The insulin then binds to cells within the liver, skeletal muscle, adipose tissue, brain, and other areas the glucose can be used. Resulting in blood sugar returning to normal levels.

Digestive Enzymes – Enzymes comprised of proteins are designed to help speed up chemical reactions in our body. The digestive enzymes amylase, lipase, and protease are the three most common digestive enzymes. These specific enzymes are found throughout our gastrointestinal system with the purpose of breaking down macronutrients (carbohydrate, lipids, and protein) into their smallest forms they can be absorbed and used.¹

Structural Development – Proteins are the foundation for many structures in our body. Collagen, elastin, and keratin are the three well-known structural proteins.

Collagen makes up 35% of the body’s total protein. Its purpose is to improve the elasticity and firmness of our skin, ligaments, tendons, and bone density.¹

Elastin is found in nearly every tissue of the body, helping maintain the structural integrity even when stretched.¹

Keratin gives our hair, skin, and nails their strength and structure! This type of protein has sulfur-rich amino acids (cysteine) that make it less prone to damage and tearing.¹

Satiety – Protein is considered the most filling macronutrient. This is because ghrelin and leptin, our hunger and fullness hormones, are more impacted by foods that are more filling and digested slower.

Ghrelin, a peptide hormone, increases our drive to eat as levels rise. This hormone is released by our stomach when it is empty. Improving our regulation of ghrelin commonly results in less overeating.¹

Leptin, a peptide hormone, increases as we eat satiating foods and promotes the feeling of fullness. This hormone is released by white adipose tissue and inhibits ghrelin release. ¹

Ensuring that each meal contains protein is very beneficial for hunger/fullness regulation. However, this is only a piece of the puzzle as protein should always be part of a balanced meal! (do NOT skip the carbs, they are essential also!!!).

Protein Intake

Protein and AA’s needs vary depending on the age, size, activity, and physiological state of the person. The Recommended Dietary Allowance (RDA) for protein in adults is currently set at .8g/kg/d. This, however, is outdated in all populations.¹

General Recommendation for Health

A recommendation of 1.2g/kg/d for active individuals seeking to maximize their general health. The benefits of protein discussed above cannot occur if adequate amounts are not obtained through the diet. For reference, someone who weighs 68 kg (150 lbs.) should consume a minimum of 82g of protein per day. This, however, is a generalized guideline and varies depending on the individual.

65+ Years Old

1.2g/kg/d is the minimum recommendation for those over 65 years of age that wish to promote muscle growth, maintain current muscle mass, and improve bone health. As we age, our lean muscle mass declines. It is important to maintain an ideal protein intake to help support this (and to consider introducing some resistance training).¹

Endurance training

Protein intake is put on the back burner for endurance athletes as their primary source of energy is carbohydrates. However, without adequate dietary protein intake, our bodies are unable to keep up with MPB that occurs during extended periods of vigorous exercise. The quantity of protein needed for endurance athletes varies depending on the training intensity and duration. The current recommendation for protein intake is 1.2-1.4 g/kg/d for muscle maintenance but is best individualized for each athlete via a registered dietitian!²

Resistance training

A common misconception within the fitness community is the more protein consumed, the more muscle growth occurs. This is a massive oversimplification and lacks truth to it. There is, however, truth to larger individuals requiring more protein than smaller individuals. This leaves the question of how much protein is best to maximize muscle protein synthesis. Current recommendations for promoting hypertrophy are set at 1.6-2.0 g/kg/d.² In those who are attempting to maximize their lean mass development you may have heard “1 gram per pound”. This is overkill. 1.6-2.0g/kg/d is the highest amount you will need under normal circumstances (.7-.9g/lb/d.). The upper end of this recommendation is generally for those in extreme sports such as bodybuilding contest preparation. Talk to a Registered Dietitian to figure out what is best for you and your goals.

Protein Timing

This discussion has been heavily debated in the fitness industry. The bottom line is that total protein intake, spread throughout the day, trumps everything else. This is because amino acids circulate through our blood steam for hours after a meal. However, if you are looking to maximize your muscle mass having a well-balanced meal with at least 3g leucine, 10g essential amino acids, 20g of protein, and 40g carbohydrates within 2-3 hours of resistance training may be beneficial. This is because our mTOR pathway (the pathway responsible for anabolic signaling) increases after resistance training and amino acids ingestion. ¹

Animal and Plant Proteins

There is an ongoing battle between animal and plant protein that is best answered through understanding amino acid content. At face value, most plant products lack one or more of the essential amino acids making them an incomplete protein and animal products are mostly complete proteins. However, this does not mean animal products are superior to plant products.

Let’s use a basic example to understand why this does not matter if we understand amino acid content! Beans lack the essential amino acid methionine but have high amounts of the essential amino acid lysine making it an incomplete protein. Rice is also an incomplete protein but contains high amounts of methionine and lacks lysine. When we pair these incomplete proteins together the meal becomes complete as all the essential amino acids can be found in adequate amounts. *Similar to this is pita and hummus!

While most animal products tend to be complete proteins and plant products tend to be incomplete protein, this doesn’t make one better than the other. All that matters is those who prefer to avoid animal products must be more diligent with their daily protein intake and balanced amino acid profiles. The only argument that can be truly made is it is more convenient to get your protein through animal products.

No Tolerable Upper Intake

To date, no adverse consequences have been identified from high-protein diets. For those without specific requirements advised by a doctor or Registered Dietitian, increasing your protein intake has no negative consequences! Concerns have been raised relating to increased risk of dehydration and negative effects on the kidneys and bones, but these do not have evidence to support or truth behind them. Dehydration is not a result of excretion of urea (and other nitrogenous waste) from protein catabolism. Additionally, a systematic review on renal function and high protein intake (up to 35% intake) concluded there were no negative outcomes. It has also been found that at least 1.2g/kg/d of protein should be considered to maximize bone health (alongside calcium, vitamin D, and other nutrients).^1,2

References:

Gropper SS, Carr TP, Smith JL. Advanced Nutrition and Human Metabolism. Cengage Learning; 2021.
Karpinski C, Rosenbloom C. Sports Nutrition: A Handbook for Professionals. Academy of Nutrition and Dietetics; 2017.

If you would like to schedule an appointment with one of our dietitians to discuss more about protein or how to incorporate it into a balanced diet, please email scheduling@casespecificnutrition.com!

Grilled Salmon

May 29, 2023

by amwadenutrition@gmail.com with No Comment Pittsburgh Dietitian Recipes

Written by: Ava Elliott, Marketing Intern and Future Dietitian

Reviewed by: Devon Kroesché, MS, RDN, LDN

Happy Memorial Day! We want to share this recipe with you to throw on the grill or share with friends and loved ones. Salmon is a great source of protein that also provides our bodies with healthful fats like omega-3 fatty acids that are vital to play many roles in your body. Salmon also gives us other vitamins like B12 and vitamin D. Vitamin B12 nourishes the brain and nervous system while also helping create DNA. Vitamin D helps with calcium and phosphorus absorption and also boosts our mood. Being outside this weekend in the sun and eating a sweet and spicy grilled salmon will be a combo for happiness and nourishment!

What You’ll Need:

2 Tbsp hot sauce
1 Tbsp Dijon mustard
1 Tbsp light mayo
1 Tbsp brown sugar
1 tsp smoked paprika
¼ tsp cayenne pepper
¼ tsp ground ginger
Kosher salt, to taste
Black pepper, to taste
½ small red onion, sliced thinly
4, 4-5 oz salmon filets

What To Do:

Preheat the grill and in a small bowl, mix hot sauce, brown sugar, paprika, cayenne, and ginger.
In a larger bowl mix the mustard, mayo and spices to make sauce for the salmon.
Lay the salmon on the grill with salt and pepper sprinkled on top. Grill with skin-side up for about 3 minutes.
Flip the salmon and brush with sauce. Cook for about 12-15 more minutes until it reaches 145 degrees. Brush the salmon with the sauce every few minutes.
Once the filets are cooked through and glazed, serve and enjoy!

Have a great holiday weekend and if you make this recipe and want to tag us on social media @CaseSpecificNutrition, we would love to see your dish! Please email Scheduling@CaseSpecificNutrition.com to make an appointment with one of our dietitians to talk about more recipes and your health goals. If you do not have time to cook this week, consider ordering from Case Specific Meal Prep!

Can Athletes Eat Intuitively?

May 15, 2023

by amwadenutrition@gmail.com with No Comment Blog Posts Pittsburgh Dietitian

Written by: Devon Kroesché, MS, RDN, LDN

I am the CSN Lead Dietitian at our Robinson office and the Director of Marketing. Last weekend, I ran in the Pittsburgh marathon. During my marathon training for my last race in November, the Philadelphia marathon, I implemented principles of intuitive eating (IE) into my training program. I want to share how I accomplished this training method and if it is possible and/or recommended for other athletes

First, you may be familiar with IE, but let’s define it. Intuitive eating is not just eating without tracking or following a meal plan, but rather it is a weight-neutral framework that focuses on internal cues (aka listening to your body) and learning how to respond to these cues without explicit “rules.” It focuses on nourishing your body properly rather than restricting it to the constraints of a certain diet or caloric intake. It is a practice that incorporates elements of mindfulness as well as what is sometimes referred to as “gentle nutrition” to determine your body’s energy needs.

You may be wondering if you should incorporate this way of living into your life. It is a powerful mindset that can help you achieve freedom surrounding food and nutrition. For example, just as having an understanding of your own unique energy needs and how to meet them is an essential skill for properly fueling as an athlete (or as a person in general), knowing how to tune in to your body’s natural hunger and fullness cues is absolutely critical skill in being a “healthy eater” long term. The reality is you are not always going to know the exact calories in what you’re eating, and energy needs estimates are just that, estimates. The best way to know if you’re meeting your specific energy needs is paying attention to your body: how it is performing, how are your energy levels, possibly looking at weight trends, etc. It can also be helpful for people who are trying to develop a better relationship with food, and for whom monitoring their intake closely is not helpful for them at this stage of their journey. They have been hyper-aware of their dietary intake and are trying to distance themselves from that mindset.

Can an athlete practice IE? Yes, but I wouldn’t necessarily dive head first into this. As a dietitian, I like to make sure my athletes have an in-depth understanding of their energy needs and how to meet them properly. First, I want to make sure my clients understood how much they need to eat (that might include knowing about calories or it might not, depending on the client and the level of appropriateness). Secondly, I want them to know their hydration needs, electrolyte needs, protein needs, carbohydrate needs, etc. I also want them to be able to tell me how they can effectively meet their needs through food. I want my athletes to be aware of where they can find the nutrients they need through food. For example, tell me good sources of carbs, protein, salt, and others for training and fueling. Personally, a bagel with peanut butter, a banana, and skim milk is an adequate breakfast for me.

Once an athlete has a good foundational knowledge of nutrition and they are confident they have been appropriately fueling, we can transition into a less-focused approach. They can move away from tracking or following a close plan, and start listening to their bodies while keeping some of those foundational principles front of mind. For example, maybe they deviate away from a PB bagel with a banana and skim milk and instead do overnight oats with fruit, nuts or seeds, and greek yogurt because they know it offers comparable benefits. It is IMPORTANT TO NOTE: we should be implementing intuitive eating throughout the entire process. I’ll share a story with you. I had an athlete whose energy levels felt better when he ate a lower carb lunch as long as he met his carbohydrate needs over the course of the day. The high carb lunch was making him feel sluggish in the afternoon, a fairly common phenomenon especially if you work a desk job. So we adjusted his plan accordingly to meet his energy needs.

You may also be wondering some of the limitations of IE as an athlete and that is valid. One thing that can occur with exercise is decreased appetite. Intense exercise results in increases in leptin sensitivity; leptin is a metabolic hormone that helps your body sense fullness. People who are very active tend to be highly leptin sensitive, meaning their body will sense they are full quite quickly and more effectively compared to more sedentary people, putting them at higher risk for undereating. Athletes have very high energy needs and sometimes their body’s cues might not be able to account for this increased need. You may need to time your nutrition in a specific way that might not be in line with your body’s natural cues. For example, you might need high amounts of quick-digesting carbs before a workout even if you are not necessarily hungry for that at the moment. Athletes that are aiming to be in an energy surplus (in order to gain strength or size) may not be able to eat enough if they rely on hunger/fullness cues alone. The same thinking applies to those who are trying to lean out for their sport. Although, IE is not applicable in this instance as it goes against the IE framework of being a weight-neutral approach to eating. Some athletes – like marathon runners – may have to undergo carb loading. Nobody is going to intuitively eat enough carbs for an optimized carb load. It often takes planning an intention and a registered dietitian can help you with this journey.

I want to share my journey of marathon training while practicing IE with you. At first, I wasn’t using an IE approach. I sat down and planned my training, calculated my energy needs, and cross referenced it with Andrew, founder of CSN. I realized I wasn’t eating enough and increased my intake which led to me performing better. Then, I tracked my food intake for a few weeks to make sure I was meeting my needs. I also paid attention to how my body reacted to this fueling. Was I getting gassed during runs? I also paid attention to my hydration, sleep, stress levels, and other aspects of recovery. Once I had a good idea of exactly how much I needed to eat throughout my day and my week, I stopped tracking my food. I prioritized eating around the same times, every 3 hours or so, and prioritized carbs at every meal. I made sure most of the time my plate was filled up with at least 50% carbohydrates, mostly from high quality sources like sweet potatoes, bananas, oats, beans, and whole grain breads.

I challenged my inner food police. As a dietitian, I tended to stray away from quick digesting carbohydrates and ultra-processed foods. During training I realized that these foods are okay in limited amounts, and actually quite convenient when it comes to things like carb loading. I bought my favorite breakfast cereal, fruity pebbles, and had a bowl every night before a long run to top off my glycogen stores. I also incorporated foods like poptarts, rice krispy treats, and gummy worms on runs as quick-digesting carbs. I would need some quick sugar anyway, and I figured why not get it from some of my favorite foods rather than relying on less appetizing energy gels (nothing against them of course). I recognized the limitations of my intuitive eating during my training, especially when it came to carb loading for my race or for a long run. I ate slightly past fullness, and ate more frequently than I would have done intuitively.

I learned training for an endurance event like a marathon IS possible without having to track everything you’re eating. In fact, leaning into your body’s natural cravings can even enhance your performance. Often, I craved salt several hours after a run. Scientifically, this made sense because of the salt lost from sweat. I incorporated a salty snack that both satisfied that craving and helped replenish my electrolytes in a way I enjoyed. Eating intuitively, made fueling more FUN. I got to enjoy foods I don’t usually eat as often and challenge my unconscious food rules and be more flexible with my diet. I was way more in touch with my body than I ever have been. I learned to push myself out of my comfort zone and proved to myself that I can do hard things. No matter how you plan to approach your training, you will have to iterate along the way. Be willing to be flexible. If you want to take this approach to fueling for your sport, WORK WITH A DIETITIAN by emailing scheduling@casespecificnutrition.com. Even if you yourself are a dietitian!