The Gut/Body Connection: Four Key Ingredients

Word is getting out that gut health is important to our entire body. But for many folks hearing all the talk about the gut-brain connection, gut-autoimmune connection etc. etc., the dots are still fuzzy.  My intention with this post is to hopefully give you that “a ha” moment in understanding some basic concepts about the GI tract’s intimate connection to the rest of the body.  

I’m a visual person and I learn best by seeing what I’m learning. Isn’t a picture worth what, oh, a thousand words?  For some of us, it's worth even more. When I give powerpoint presentations, my powerpoints have lots of colorful images. And usually, the attendees are quite appreciative.  Although some people are wordsmiths and love to read, proportionally, the portion of the brain devoted to word processing is much smaller than the portion devoted to processing images. So, for most of us, pictures really are worth a thousand or so words.

So, let's talk about the gut—body connection--here's the nutshell version. Food contains nutrients, right, and phytochemicals that benefit the body. But if we take a closer look, the quality of the food we eat impacts our health, in part because of the food's intimate proximity to the GI tract as it takes its ride from mouth to anus.

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Here are the important parts to remember:  The GI tract houses over 70 % of our immune cells. 

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Combine this with a partially permeable membrane in the small and large intestine,

plus the direct entry of the liver’s portal circulation into the small and large intestine;


and you have three big reasons why the quality of our diet can be the difference between health and disease: immune cells, permeable membrane, and the circulatory system.  Keep in mind, the gut mucosal membrane is supposed to be permeable—in part, it helps us absorb nutrients but trouble can start when the membrane becomes excessively permeable.

Add the vast microorganism community who live throughout our gut and now we have the potential for many, many interfaces. The balance of these microorganisms probably orchestrates much of the activity throughout our body. The quantity and type of organisms depend on their location, function and ph of the organ they live in. Many factors can disrupt this microflora balance. 

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For all of my clients, regardless of the reason for their appointment, I show them an enlarged, colorful image of the GI tract and explain these “ basics” and the intimate connection between our immune system and circulatory system. It usually leaves an impression-and an initial understanding of why all the fuss about gut health. 

Is it any wonder now why the body can have a negative response to certain ingredients in processed foods and even to certain ingredients in healthy foods?  Let’s face it, all processed foods contain some “foreign ingredients” to the body.  Food additives, thickeners etc.-- ingredients that the FDA generally recognize as safe are not “natural” to the gut. They did not exist hundreds of years ago when it was just man and the land. I don’t think evolutionary man’s GI tract was made to consume these ingredients over and over. When we do, there is always the possibility that they could trigger a “reaction”  or intolerance with enough exposure, depending on the health of the individual. The body has a tremendous ability to "filter" out many unfavorables, but it does have a threshold depending on our genes and amount of exposure before the cup runneth over.

My gut microbiome interest has taken me on a journey throughout the body but the gut-body connection most under the radar, despite perhaps having the greatest research, comparatively, is the gut-heart connection.  The gut microbiome affects our cardiovascular health you say?  Remember, direct access to our circulation and our liver widely opens the door to diabetes, fatty liver disease--anywhere our vessels may lead.


Yes, there is a bit more to it.  No doubt, the body is complex, but understanding this basic set up in the gut- with its large number of immune cells, permeable membrane, access to the portal circulation, and immense presence of microorganisms makes it easier to connect the gut to our heart, brain, immune system and virtually every system in our body.

Four key ingredients to the Gut/Body connection

  • Large presence of immune cells

  • Permeable membrane

  • Access to portal circulation

  • Microorganisms



Make It A Mediterrean New Year

 Int. J. Mol. Sci. 2014, 15, 11678-11699; doi:10.3390/ijms150711678

Int. J. Mol. Sci. 2014, 15, 11678-11699; doi:10.3390/ijms150711678

You may have heard of the Mediterranean diet (MD)…..yes?  If you are a registered dietitian, you’d have to be deep in hibernation not to be aware of this famous diet.  It’s been around much longer than even I’ve been around in health care—over 25 years. A PubMed search on the Mediterranean diet pulls up over 5,000 related research articles.  By no coincidence, over the years my practice focus has moved towards digestive and cardiovascular health. I believe these two systems are related. A healthy gut microbiome helps maintain an integral gut lining that prevents toxins and inflammation from occurring elsewhere in the body—particularly, the cardiovascular system and its extensive vessel network. Yes, our body parts are connected. 

We’ve known for many years that the MD has cardiovascular benefits.  Historically, the research shows these benefits are related to the nutrient dense and phytonutrient dense foods, such as polyphenols in berries and omega fats in fish and their anti-inflammatory effects in the body. Now, in the last decade research shows that these benefits may stem from the positive effects these compounds have on the gut microbiome—which in turn has many orchestrated effects in the body.  

The biggest variable to the MD is how much of these diverse foods do you eat?  Shall I eat more nuts or more chocolate--tough choices. Probably for many, the choice should be a more consistent intake of fruits and vegetables.  I prefer to modify amounts depending on your needs and a little common sense.  For example, do you want to eat fewer dense carbs-- sure, limit grains to 1-2 servings/day.  Gluten-free—sure, eat more legumes or potatoes for denser carb sources.  Red meat is allowed but fish and chicken preferred. Chocolate —of course.  Alcohol—yes too, in moderation.  I tend to be a grey zone kind of person with food—you know, find a modified version that works for you—because we know one size never fits all.  There always needs to be some tweaking. The main point of the Mediterrean diet is fruits, veggies, good fats, fermentable and resistant fibers and high-quality protein sources. You can even manage a low-fodmap version, if necessary.  Here are ten reasons to head south —and eat a little more MD like.

1.  Protects your gut microbiome.  This may be the most profound effect of the Mediterranean diet.

2. More polyphenols in foods such as berries and chocolate—which, BTW, helps your gut microbiome.

3.  Fats are ok—thank goodnes—healthy fats that is— especially olive oil.  Olive oil is rich in monounsaturated fat, which may help your gut microbiome.  The MD is not a low-fat diet. Some studies showing up to 40-45% of calories. More research needs to now focus on the influence of the diet and health of the animal—i.e. grass-fed animal fat. 

4.  Lower your cancer risk, especially breast and colon.

5.  Lower your blood sugar, blood pressure, triglycerides/cholesterol and your weight.

6.  More resistant starch and varied fibers, which help your gut microbiome. Depending on your gut health and gut microbiome, your tolerance to these foods will vary. 

7.  Enjoy chocolate, wine and all nuts —pecans, walnuts, almonds, cashews, pistachios, Brazil--in moderation.  Cheers. 

8.  Provides high-quality protein sources, including dairy, fish, poultry and meat.  You determine how much of each you need.  Generally, protein requirements are .8- 2 grams/kg Ideal body weight, depending on health and activity level.

9. Few foods are completely restricted, except processed foods and excessive sugar (dream on).  

10. Great flavors.  The MD tastes good.  What's not to like about berries, nuts, chocolate, wine and even a little cheese.

11.  I could go on—oh, did I say it lowers your heart and diabetes risk?

The Mediterranean diet is about diversity. A diverse selection of foods that offer diverse nutrients and phytonutrients lending to a healthy and diverse gut-microbiome.









Chocolat 33%, 55%, 72%, 88% 

By Cindy Carroll, RD, RN, IFNCP


33 %, 55 %, 72 %, 88 %    These percentages could represent nearly anything in life—but for those of you who have any affection for chocolate, you might recognize them as the percentage of cacao by weight listed on chocolate containing foods.  Chocolate research has exploded in the last decade and the food industry is jumping on board, wanting to show that their products have some amount of this esteemed ingredient, cacao, pronounced "ca-cow".  I thought I knew a little something about chocolate but as with so many topics in nutrition, once you dive in and investigate there is always so much more. The chocolate industry and science is complicated….losts of rules and variables. Before we get to the heart of chocolate’s benefits, let’s look at some basics.

Cacao beans are the fermented seeds from the dried cocao plant. Cacao powder is the solids of cocao beans minus the natural fats (cocoa butter).  Chocolate is catagorized by the content of cacao by weight in the forms of liquor, powder and cacao butter. Dark is referred to as semisweet and extra dark as bittersweet, although the ratio of cocoa butter to solids may vary, usually ranging from 70-99 % cacao solids. White chocolate actually contains no cacao solids, just milk, cocoa butter and sugar.  Milk chocolate must contain a certain percentage of milk.  The greater the cacao solids, generally the less sugar and more bitter taste. Which products may be labeled "dark chocolate" and “milk chocolate” vary by country and government and industry standards.

Thanks Mom!

Chocolate and I go way back—probably to the womb because my mom loved chocolate too. She lived to be 94—didn’t let a day go by without eating something chocolate—peppermint patties, chocolate bars, chocolate ice cream.  She really loved just straight chocolate and I can remember my Dad indulging her now and again with a “surprise” large Hershey chocolate bar and hiding it in the refrigerator for her to find. So, of course growing up with all of that chocolate in the air, it was only natural for me to partake. Chocolate ice cream was my favorite indulgent. Back then I didn’t worry too much about calories—life was good, just me and my bowl of premium Hood ice cream watching the Wizard of Oz. 

So, it’s always good when life-long patterns of anything end up actually having some redeeming qualities. Research is showing that all of the cocoa beans I’ve consumed over the years may be quite beneficial but as in anything in life, they also come with a few risks. Let’s get the risks out of the way and save the best for last.


The combination of chocolate and sugar together is a no brainer for manufacturers….it is in part, what keeps us going back for more.  Also, depending on the percent cacao, there may be higher sugar in the chocolate itself. Read the label to see how many grams of total sugar are in the product. Generally, the more cacao solids and cacao fat, the less sugar, however, a manufacturer can add any amount of sugar or sweetener into the mix.  On a positive note, I’ve seen many clients better manage their “sweet tooth”  by enjoying the bitter taste of dark chocolate. For some with sensitive GIs, cocoa may be irritating and the more milk in the chocolate, the greater the lactose and potential fodmap content. According to Monash university, a 30 gram portion of dark chocolate is considered low fodmap, which is about 2 tablespoons of semi sweet morsels, 1 heaping tablespoon of cacao powder or 5 small squares.


Cadmium is an unwanted heavy metal found in cacao.  It is also a carcinogen, can weaken bones and be toxic to the liver. Smoking and high risk occupations are the greatest risk for inhaling cadmium but otherwise, food is our greatest source for non-smokers. Strict vegans have higher cadmium blood levels than non-vegans. Certified organic plants/foods does not eliminate or reduce cadium risk.   But don’t panic, although, minimizing total exposure of cadium is of course better, it is the absorption of any heavy metal that is important. Many factors affect absorption including other heavy metals in the diet such as calcium, magnesium and iron, which compete with cadmium and may help decrease its absorption. Also, cadmium in plants contain fiber and phytates, which may also interfere with cadium’s absorption. Research shows people who are vegetarian, although may have a greater cadmium intake may also have decreased absorption because of the antioxidants and phytates in those same plants. Overall, nutritional status is a more important determinant of cadmium uptake into the body than is the actual amount of cadmium ingested.

For the Good of Chocolate  



Back in the day—in my early chocolate years, I didn’t have a clue about polyphenols or flavanols. I just loved the flavor and feel of chocolate in my mouth. From a nutrition perspective, dark chocholate is relatively low in sugar, high in fiber—but the true benefits probably lie in the polyphenols. Polyphenols are a large class of phytonutrients that research has been studying for decades. Flavonoids are a large subgroup of polyphenols. Flavonoids include flavanols, flavonols and proanthocyanins--(who made these up?)  There are thought to be over 6,000 flavonoids in plants.   Other foods high in flavonoids include berries, teas, and wine.

Gut Microbiome and Flavanols- Prebiotic Effect

The numerous health benefits associated with flavanols in cocoa may be attributed to their prebiotic effect on our gut bacteria, thereby affecting the growth of certain gut organisms. Research shows that polyphenols in foods have a "give and take" effect on our gut microbiome. Almost like they know they are living together in tight quarters —“Hey, you help me out and I’ll help you”.  The microbes convert polyphenols into their beneficial metabolites or byproducts, and in turn the polyphenols influence the composition of the gut bugs, probably by inhibiting more troublesome bacteria and stimulating beneficial bacteria. One of the first studies to demonstrate this with cacao, compared the consumption of a low cocoa drink, to a high cocoa drink. In a four week period, the high cocoa drink significantly increased the bifidobacteria and lactobacillus bacteria, while also significantly decreasing clostridia counts. Other positive changes included significant reductions in plasma triglycerides and C-reactive protein.   

The benefits of chocolate are thought to stem primarily from the cocoa flavanols, especially the epicatechins but other compounds in chocolate such as caffeine and threobromine also have effects and need more research. Some of the research is conflicting but the studies are growing in number. Here is a glimmer into some of the benefits from flavanols.


Decreased blood pressure and lipids are among the potential cardiovascular benefits seen in populations who consume chocolate. The Flaviola Health Study applied the Framingham heart study risk scores to healthy people without CVS and showed that flavanol intake improved blood vessel function, lipids and blood pressure. The study predicted a significant lowering of 10-year risk for CHD.  Similar findings have been found in studies with people with CVD risk.

Blood glucose

Eight clinical trials have demonstrated daily cocoa flavanol intake between 200-600 mg/day significantly decreased fasting blood glucose, fasting insulin and HOMA-IR in people with CVD risk factors. There is some suggestion that higher intakes- more than 600 mg/day may raise blood glucose, possibly because of an association with threobromine in cocoa. Threobromine when given 500 mg/day has been associated with elevated blood glucose. I would not avoid dark chocolate for fear of it elevating your blood sugar, unless you are consuming high sugar choices and large, daily amounts. Also, we know based on other gut microbiota research that each person’s gut flora is unique in determinig their response to carbohydrates and food in the diet.

Atrial fibrilliation

Atrial fibrilliation (a fib) is one of the most common heart arrthymias and has the potential for serious consequences such as stroke.  A 13.5 year study in Denmark showed the risk of a fib decreased significantly in proportion to the chocolate consumed, with 2-6 servings per week giving the greatest, 20 % reduction of atrial fibrilliation.


A small study showed that people with peripheral vascular disease were able to walk 15% further than normal when they consumed 40 grams of dark chocolate, greater 85 % cacoa within two hours of exercise .


Research suggests that flavanols are able to cross the blood brain barrior and reach brain  cells.    In a 2-month, double blind study (CoCoA study) with 90 elderly people without cognitive problems, those who drank the high flavanol had the greatest improvement in specific cognition markers, particularly processing speed but also improvements in insulin resistance and blood pressure.

Clincal studies suggest the following intakes of flavanols for health purposes


  • Cardiovascular health:  200-900 mg/day
  • Blood sugar/insulin improvement 200-600- mg/day
  • Memory/cognitive function 500-900 mg/day
  • Skin elsasticity/wrinkles 320 mg/day

Food products differ but here is a rough estimate of chocolate serving size needed to meet 200 mg flavanols.   

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Cocoa powders generally contain more cadium per weight than solid chocolate. Aim to eat the lowest cadium per weight of flavanols. Endangered Species and Baker’s unsweetened chocolate bar had of the lowest cadium for high flavanol ratio and Trader Joes Dark chocolate Lover’s Bar 85% had a high cadmium for flavanols ratio.  For more information, see Consumerlab’s latest reveiw on chocolate.

Would you like epicatechins or flavanol concentration on future food labels---or  TMI?   Flavanols, splavanols.....I'm still eating my chocolate.

Your GI Bugs and Your Blood Sugar

Diabetes and heart disease are two peas in a pod.  You can’t have diabetes without some cardiac risk and likely if you have heart disease, you may have some level of insulin dysregulation. The future of cardiovascular health may be in Individualizing your carb and food intake to align with your poop and your blood sugar. By eating the carbohydrates and diet that best match the organisms in your stool---you may be able to better control your blood sugar.  Fun, huh!  And not everyone's choice of carbs will be the same--because we don't all have the same organisms in our gut.  A piece of bread may raise one person's blood sugar but not someone elses because their gut flora is different.

The gut microbiome and their metabolites impact nearly every aspect of our biology.  Such metabolites or byproducts include butyrate, histamine, tryptophan and serotonin, to name just a few.  We don't even know all of the metabolites our gut microbiota produce but their consequences probably depend on their amount and location. The cardiovascular impacts go somewhat under the radar.  Even the relationship of diabetes and heart health is under the radar.  If you watch any television, you've seen the commercial where a "diabetes expert" asks random people on the street if they realize that diabetes raises heart disease risk? The street actors are shocked to learn this connection between diabetes and the heart. This isn't new information in medicine but the average person doesn't recognize it.  Not that TV commercials should dictate your health choices, but this time the message is valuable.

A recent study in Cell Science demonstrates this association of our blood sugars with the organisms in our stool and the foods in our diet. Using a sophisticated algorithm, this 800-person cohort suscessfully predicted the foods that will best maintain a healthy blood sugar.  The key components of the study include measuring blood glucose using a 24-hour glucometer, examining the organisms in the participants stool, and looking at other lifestyle factors. They validated their findings in a smaller 100-person cohort.  Individualized diets made by RDs in the study based on this data were able to consistently predict and manage blood sugar response more accurately than traditional dietary blood sugar interventions.  


Whoa--let me rephrase that. Food choices or diets created by RDs in the study that were based on the person's microorgansms better controlled blood sugar than conventional diabetes guidelines.  Although DayTwo's research certainly points out individual response to food because of the microbiota--the body lives and thrives on optimal nutrition.  DayTwo's research doesn't claim to know how to change your microbiota or claim that the foods that keep your blood glucose normal are necessarily healthy.  But they did use registered dietitians in the study to create healthy meal plans. You still need to see the big nutritional picture. 

Blood sugar regulation is a reflection of our metabolism.  An elevated blood sugar carries increased risk for lots of things--insulin resistance, diabetes, heart disease, metabolic syndrome, fatty liver disease and even brain health. Recognizing this association of CVD risk, blood sugar and our gut microbiome may give us more options for prevention and treatment. We want to maintain a healthy blood sugar with healthy foods--and manipulating the gut microbiota via healthy foods, prebiotics and probiotics is the direction this research is leading. The biotech world is moving fast on this. Here is a sample of what's out there:  Vedanta Biosciences has created a probiotic drug that they describe as "bacterial consortia therapeutics"  which targets immune response.  Most research on probiotic supplements and CVD suggest that any reduced cardiac risk is a result of some kind of immune modulation. Vedanta drug goes a step further--here is a description from their website of what their drugs aim to do:  "Unlike fecal transplants, which require use of donors and are an inherently variable procedure, bacterial consortia therapeutics are defined drug compositions produced from clonally isolated bacteria that can trigger targeted immune responses.  And unlike reductionistic approaches such as single strain probiotics, they can robustly shift the gut ecosystem."   Yes, a mouthful description but this is where medicine is headed and it is becoming a competitive space.   

Several other companies including Viome and Vibrant Wellness claim that their sophisticated technology will more accurately identify your gut organisms and their metabolites, which will reduce your health risks depending on your symptoms and medical history. I believe this research is all good, though is in its infancy.  We are in somewhat uncharted territory here, not fully knowing the consequences of robustly and intentionally shifting the gut ecosystem or even exactly knowing what our individual gut microbiome is made of or the interactions with our unique genetic makeup. 

Our fast paced life, abundant medications/drugs and western diet has already shifted the gut microbiome of many people to a not so healthy place.  The one thing you can control is the food you eat. Everything you eat affects your gut microbiome-carbs, protein, fat, alcohol --even artificial sugars.  We all should be striving to eat a balance of vegetables, fruits, whole grains, legumes, nuts/seeds, animal proteins and fats-- but the amounts and types will be different for each of us. We are all susceptible to changes in blood glucose management--even thin, lean people.  Health can change for a variety of reasons. 


What keeps blood sugars in a healthy range?

1.   Eating a low- moderate carbohydrate diet with adequate protein, healthy fats and adequate, varied fibers.

2.  Maintaining a healthy gut microbiota.

3.  Avoiding belly or visceral body fat gain.

3.  Exercising:  aerobic and resistance training.

4.  Staying healthy: avoiding colds, flus, stomach bugs, autoimmune problems.

5.   Managing your medications.

6.  Managing stress.

7.  Getitng adequate sleep

Stay tuned ---personal diet prescriptions and the gut microbiome will be a routine part of future health care.




What is your motion meter?  Are you a "mover"--  in pertual motion, barely able to sit through a movie?  Or do  you amble through the day, with much of it anchored to a chair? The “movers”, the people who can't sit still are burning more NEAT calories than those of you who prefer and do sit still.  NEAT (non-exercise activity thermogenesis) are those calories burned doing non-exercise related physical activity.  We all know a “mover”-maybe it’s a child or that “naturally” thin, fidgety friend.  Despite the benefits of our hi-tech world, computers have changed our motion meters. If you are a tradesperson, ER nurse or MD, chances are you are burning far more NEAT calories than a computer programmer or anyone with a desk job.

How important is NEAT? 

Research suggests that NEAT can account for more calories burned during the day than regular, moderate exercise, even greater than 50 % of our total energy expenditure in some major “movers”. When you compare "movers" with people who find a way of avoiding physical movement, the "movers"  burn significantly more calories. Obese people sit 2.5 hours more per day than non-obese people, burning 350 fewer calories-- about the same amount of calories burned in a 3-mile walk. We need regular exercise for the cardiovascular and mental health benefits but the calories burned in moderate exercise 3-5x/week for 30-60 minutes are limited to ~ 200-500 calories per session--not bad, but an active NEAT day can burn well over 500 and up to 2000 calories for those major movers.

James Levine, MD, an endocrinologist at the Mayo Clinic is a pioneer in the field of metabolism and NEAT research.  He has transformed a whole wing at the Mayo clinic putting into practice his research findings including: utilizing higher workstations to facilitate more standing and perpetual reminders for people to avoid “chairs”.  Dr. Levine’s research is compelling!  Overall, movers have greater advantages on metabolism over non-movers. All movement is helpful and cumulative towards calories burned in a given day. Standing burns more calories than sitting and sitting without other movement carries a whole world of risk; not just musculoskeletal but metabolic risk, changing our metabolism at a cellular level, affecting how we burn calories. In chronic “sitters”, research shows the enzyme lipoprotein lipase(LPL) begins to “turn off’.  LPL breaks down triglyceride fat in our blood. Less LPL increases weight gain and cardiovascular risks.  

My nutrition practice has a focus on digestive, cardiovascular health and weight control.  My clients and I break down the steps needed to change their lifestyle--I call it "building a health you".  Research is rapidly demonstrating that these two areas of our health- digestion and heart health are closely related. Our gut microbiome influences our cardiovascular health--who knew right?!  So, what does NEAT have to do with our gut?  Actually, these days I wonder if there is anything in the body that the gut microbiome doesn't affect?  We all know physical activity is important but the motivation to move is a bit trickier.  Everyone’s genes, biochemistry and gut microflora is unique and therefore ability to gain or lose weight may differ. Some gut organisms are responsible for "energy extraction", making us-the host, more energy efficient. Unfortunately, not the kind of efficiency we want--unless we are in a famine. Energy efficiency makes us good at storing fat. To compound this, a gut dysbiosis may contribute to insulin resistance-- a metabolic state where our pancreas makes too much insulin --trying to keep our blood sugars normal and the insulin receptors on our cells lose sensitivity to the insulin we do produce.  Insulin resistance is a risky metabolic place to be that can make us fatter.  Insulin resistance is also associated with leptin resistance, a hormone made by our fat cells.  When leptin becomes imbalanced, not only can it increase the drive to eat, but also increase that desire to be anchored to a chair. Research is showing that exercise affects these gut microbes through a variety of pathways.   Yup- these organisms  get involved with many, many pathways in the body. Since we must co-exist with these critters, we might as well have them working on our behalf--whose body is it anyway?  And although they are affected by many factors--- diet may exert the greatest influence.  Eating a healthy diet and regular exercise are two of the most important lifestyle factors to maintaining a healthy balance of microbes in your gut--which in turn make it easier to up that motion meter

Walk--even ten minutes at time. 

My clients seek my consultation for a variety of reasons. We talk about NEAT at nearly every appointment. In particular, they appreciate learning that calories burned during movement is cumulative, so short bouts of movement count--especially if you move again and again--and add up your daily movement.  Boost YOUR NEAT calories by sitting less and moving more, particularly walking, whether it's sweeping your floor, dancing to a song on the radio, or walking around your house. Try walking whenever you are on the phone, especially if it's a social call that may require less other attention.  Please don’t underestimate NEAT's impact on your metabolism. Your waistline and gut microflora will thank you!

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The Hidden World of Spinal Leaks

It's funny the twists and turns your life and your career can take. As a digestive and cardiovascular health specialist, my research and consulting calls for a particular focus on intestinal permeability.  Impaired permeability is sometimes called, "leaky gut".   Back in 1999, my body had a different kind of leakiness going on and last year I posted my story about my csf leak. I received many emails from people around the world grateful for raising awareness and I suspect just knowing that they were not alone. This year thanks to the persistance of Pennsylvania Senator John P. Blake and the CSF Leak Foundation—Feb 26th thru March 4th 2017  was marked the first SPINAL CSF LEAK AWARENESS WEEK  Landmarks across North America shone purple for #leakweek

Being in the medical profession, I consult with clients every week who tell me their medical stories-many of them IBS related and many who feel like they’ve lost their way, because the medical community does not validate their condition.  Validation is as important as healing —because not only do you feel heard, but then it puts some ownership on the medical community to learn, because isn’t that why we entered medicine?  My friend and colleague, Kate Scarlata is part of the #IBelieveYourStory campaign to raise awareness about IBS, a functional digestive disorder.  Please visit Kate's website for more information on how to share your IBS story.   And while you are on Kate's site, check out our workshop on the gut microbiome and chronic disease. RNs and RDs will earn 6 CEUs/contact hours. You will learn how these microbes operate inside of us.

Here is my csf leak story again— in part, it is about instincts and knowing that you know your body best--regardless of the condition.

Seventeen years ago this month I developed a spinal csf leak from an epidural lumbar puncture that put me out of commission for nearly five years.  A chronically protruded lumbar disc that was resistant to PT, along with the urging of my physician and physical therapist, reluctantly, pushed me to have two epidural steroid shots in my back.  In theory, the shots would reduce the inflammation, and allow my disc to heal.  My instincts were very leary about this procedure--but compared to surgery, an epidural shot seemed easy. Ultimately, my pain made the decision. The procedure takes about 15 minutes, several doctors told me that they give these shots, “all the time”, and with a little luck my back would be feeling better.  

Every day, hundreds of doctors poke needles into the sacred spinal canal for various reasons and more often than not, the procedure goes flawlessly and the purpose of the test is achieved. But more often than perhaps many physicians realize, a spinal headache can develop that does not always heal in the timely manner that the medical establishment believes. 


Many horrible conditions that this seemingly benign procedure can do to you are listed in the disclaimer.  I distinctly remember my doctor saying, “Don’t worry about the headache, it almost never happens”.  I received two shots, five weeks apart (they are usually given in a series of three). And truthfully, the actual shot is a piece of cake. The first shot helped my back pain, but within a week I started developing headaches. Not debilitating headaches, but for someone with miminal headache history—they were attention getting.  Since my back was feeling better, I cautiously started light exercise. But the headache thing worried me.  I even began to believe I had a brain tumor because my right foot also became somewhat floppy….better known as “foot drop” (a hallmark sign that a nerve has been brushed).   Walking required a conscious effort to lift my foot.  

Most physicians have never heard of spinal headaches lasting longer than a few weeks and as it turns out the “almost never” statement by my doctor regarding their existence is not quite accurate. Though the numbers vary, up to as much as 30- 40 % of people experience a spinal headache after a lumbar puncture---pregnant woman after child birth being among the most frequent victims.  

Sitting on the exam table at 9:00 am, waiting to receive my second shot, I asked the doc and his nurse if my first shot was the cause of my headache.  And here in lies my greatest concern with this condition. My physician, who was working at one of the three most prestigious hospitals in Boston said to me, “spinal headaches never last five weeks and it would be the worst headache of your life—not to worry”.  My doctor was absolutely convinced my headaches were unrelated to the shots….so before I could say, “spinal leak”, I was agreeing to have another one, which proved to be the proverbial last straw to my already existing spinal headache’s back. Though hindsight frequently looks different, had my doctor been up-to-date on the literature, and recognized the range and degree of symptoms, I would never have received the second shot. Yes, I made the choice to have the shot, but he was not informed enough to make his medical choice. Had I followed my own instincts, I would have never had the shot.


Soon after the second shot my headaches took an obvious turn for the worst.  They became pressure-like and standing became a great feat. My husband compared it to having “a baby grand” on my head, and I sort of likened it to G-forces, pulling my head down.   A csf leak truly makes you believe that your brain is being sucked right down your neck—it is not your garden variety headache. I then entered a world of spinal leaks that would have physicians doubting my symptoms but also scratching their heads as to why a seemingly healthy, active, young woman could no longer stand up. I spent the next three years in bed with multiple cranial neuropathies, tremendous nausea, double vision, arm weakness and pain, ear fullness and the cardiovascular changes that still linger—arrthmyias and low blood pressure. I couldn’t get out of my own way.  Need-less-to say, spinal headaches can flip families upside down—my two sons were three and five at the time—emotionally, it was the worst part of the whole experience.

Csf fluid literally protects our brains from hitting our skulls with even the slightest movement . Picture a ball in a bucket of water. When a hole punctures the dura, csf leaks out.  Since the spinal canal is an open system to the brain, the brain is acutely affected by this leaking.  Unfortunately, it doesn’t take much csf leakage to start a headache. Standing for any length of time is impossible. Depending on how large the leak and how long it lasts, the brain actually begins to sink in the skull—simple physics. Talk about the ultimate body part you do not want sagging.  At its worst, this sagging brain phenomenon can cause a subarachnoid bleed, put you into a coma, or kill you.  If a spinal leak hole doesn’t heal, it transitions into a condition called, intracranial hypotension…a broader term but still implying too little csf for the brain.

Headache 2.jpg
 Yikes--G-Force type feeling when your Brain has too little CSF.

Yikes--G-Force type feeling when your Brain has too little CSF.

Throughout this time I had the recommended blood patches —three of them —all unsuccessful.  A blood patch takes your own blood and inserts it like an epidural shot into the level of back that has the leak, temporarily clotting the hole and hopefully jump-starting healing. Except for lying in the back of our car to medical appointments, traveling was nearly impossible. By year three I could tolerate sitting in the car to make it to a neurologist in NYC,  who to this day I hold so much gratitude because in a matter of thirty seconds after looking at my MRI and confirming my “brain sag”, she validated my whole condition—something no one else seemed to be able to do. I wasn’t crazy. I’ve decided reading an MRI is as much a speciality as any medical discipline.  Her advice  was to forgo any more needle poking in my back and wait it out.  I did--and eventually, I healed--mostly.   Seventeen years later, I am much better -still 24/7 head pressure and limitations with exercise but no comparison to the life I was living.  I was able to go back to work and nursing school. In part my experience is what accelerated my interest in functional medicine and a more whole-biology approach to our health.  Each day, I hold much gratitude for every step my body allows me to take.

Regarding csf leaks, my hope is that with better imaging small leaks will be more easily detected--even just to validate the condition. And that epidural steroid shots are not encouraged for back pain because they are a very short term bandaid. Before receiving any kind of lumbar puncture to minimize leaking, be sure your doctor is savvy regarding techniques and needle sizes. Perhaps, most importantly —for the medical community to recognize the signs of a csf leak—they don't always start out as the worst headache of your life. We each travel our own medical road in life.  Don't be afraid to listen to your instincts.  You, the owner of your body know it best!   




Tom Brady's diet and other Patriot stuff.

The Appeal of Football

As a sports nutritionist, I've always loved watching athleticism.  Football requires a lot of athleticism but now, finally,  I am getting the whole strategy thing with football.  I realize men have long appreciated this aspect of the game.  Years ago, I admit,  while watching a football game I only really watched the player with the ball, seems logical right?  Not that I didn't realize the other guys were important too, but I was a little clueless to the pieces of the whole. After so many years of watching a successfull footbal team with our New England Patriots, I’ve become just as intrigued with the strategy of the game and the lengths of preparedness that the sport requires.  

I get that not everyone is a football fan, though here in New England if you weren’t one before Tom Brady’s arrival, it’s pretty hard not to be at least a casual observer. Concussions and NFL/Roger Goodell non-sense aside, there is a method to football madness. Yes, the banging each other up is distressing to me. It’s a tough sport to appreciate unless you begin to understand that the devils in the details. And the Patriots have practiced these details at a record setting level every week for seventeen years. The Patriot documentary, Do Your Job, illustrates this the best. Malcom Butler's last second interception that led to their Super Bowl win in 2015 was a result of months of team and individual preparedness that put him in that exact spot to catch that ball.  

Success makes others curious. The Patriots' success is unique and at a caliber that doesn’t happen by chance. Any "system" is only as good as the intellect, mindfulness, emotions, motivation athleticism etc. etc. of the people in it.  Personally, I admire the Patriot work ethic, their respect for their opponent and the sense of humility they carry for themselves, despite their greatness.  New England fans who watch them every week know this well. Any industry or individual could apply and learn from these same principles.

Brady's Diet

Frequently, I hear and read the media poke fun at Brady’s diet, questioning if it is too extreme or does he really feed his kids this stuff?   I mean really, who eats avocado ice cream?  Well, I eat avocados and avocado ice cream and avocado pudding.  Avocados are actually a versatile fruit—high in healthy fats and if you don’t have trouble digesting them and like them—then eat them. Actually, research shows that avocados--one a day- may reduce LDL cholesterol— but I digress.

I’ve never met Tom Brady, nor do I know exactly what he eats—only what I hear and read.  In my humble opinion, his diet seems to suit him.  It appears to be working and at the age of 39, an age where almost all of his competitors are on the decline, what's to argue?  Every person's body is unique and has different needs. The growing body of science supports many principles that Brady applies to his diet.  It's impossible to list here all the benefits that a balanced, nutrient dense diet provides--but less inflammation is one big payoff. Less inflammation especially in the gut leads to less inflammation elsewhere. The trick is to match what works for you. 

The pluses of Brady’s diet: 

1. Abundance of vegetables.

Veggies are arguably the best form of carbohydrates because of their high nutrient value per mass of carb calories. Overall, they promote less insulin response while containing nutrients that help improve insulin senstivity.  The recommended servings of vegetables and fruits are 5-11/day to acquire the many and varied phytonutrients that vegetables contain--including various fibers. Phytonutrients, have positive, some even pharmocological effects working synergistically within the body. For vegetables to provide these benefits, we have to eat them. Looking at them doesn’t give the same effect. Brady avoids certain vegetables (nightshades) which may or not be necessay for everyone.  Of course if your diet is 100 % veggies then you will be missing out on certain nutrients.

2.  Adequate protein.

Brady is not a strict vegan (which I tend to discourage especially for athletes).  From what I hear, he eats occaisonal beef, chicken and wild fish.  I suspect he is meeting his individual protein needs or he would not be able to heal and repair at his level.

3. Whole high quality vs. processd food.

Brady eats high quality, grass fed, no added hormones meat, poultry and wild fish, organic, high quality fats, organic produce; and minimally processed other foods. Yes, this requies a few more dollars to execute but this should be a no-brainer why this is a better practice than the standard, processed American diet.  Why would you not want to provide these foods to your children if you are able?  

4. Limits dairy and sugar. 

Dairy has positive attributes for many people but the sugar lactose may cause GI distress for some and the protein casein may aggravate certain GI and autoimmune conditions.  For Brady, limiting dairy does not see to be an issue.  For the majority of people, there is no down side to eating a diet low in sugar. 

Extreme or just SAD acceptance?

Brady’s diet seems extreme to many people only because for the last forty plus years, we’ve lived in an America flooded by sugar and processed foods (standard American diet--SAD) at every street corner.  Ironically, the NFL has done their part in promoting these foods.  We've come to live and believe that these foods are not just the norm for our existance but are acceptable.   I have two sons in their twenties and despite their leaness, my insulin alarm goes off and I cringe a bit when they eat lots of sugar, drink lots of lemonade/juices or “carbo load”. Few people can handle “low nutrient, carbo loading" day in and day out, even athletes.  Insulin is a powerful hormone that when constantly secreted, carries risks, even when our blood sugars remain normal. Most people especially children eat far more refined carbs than their little bodies need. Unfortunately, everyone is susceptible to our processed food environment.  No person's body lean or overweight and especially growing needs chemical additives, excessive animal hormones, glyphosphaes, trans fats etc. We are learning that these foods probably change the microbes in our gut, causing an imbalance that lead to other problems--i.e. inflammation.  I call the internet the wild west--but it has helped push the interest in nutrition, as well as help the public become more aware of better resources.  The research in many areas is exploding, especially the gut microbiome--but we still have a ways to go.

Last year at a press conference Brady in his humble but passionate way, disbaraged the standard American diet SAD—especially sweetened cereals and the plethora of sugar sources.  Amazingly, in the following weeks, I read some in the media and public criticizing him, saying he shouldn’t be telling people how to eat.  People—-we can’t have it both ways!  If we want these larger than life sports figures to be role models —because our kids do pay attention to them—then we must be open to the positive moments and information that they share. 

A few weeks ago, a local radio broadcaster here in Boston (WEEI), Gerry Callahan asked Brady if it’s a burden for him to follow his diet. Brady's response, echoed a little of the Patriot’s, "Do your job" motto—that taking care of his body is part of his job, but also that it becomes a personal preference and a natural part of your life.  I suspect Brady wonders how the rest of America doesn’t think it’s a burden to eat the SAD.  And if you feel better, why would you not continue?

As a nutritionist, I do this for a living and I know it’s not easy for people to make changes, however, we should be thanking Tom Brady for calling attention to the unhealthy foods that are every day accessible to our children’s growing bodies. And if you don’t think it matters, take a look at the chronic disease statistics (especially obesity, diabetes and pre-diabetes and autoimmunity).  They are staggering-- and especially for children and so much of it is preventable!  I’ve been seeing these people as patients for over 25 years.  Brady doesn’t impose his personal eating patterns on anyone but I would challenge every person to impose a little, "Do your job" on their own body.  Eat a few more vegetables and a little less sugar.  It's your choice to take care of yourself--or not.  Your body will talk to you and let you know if it’s working.  Learn what works for you!








Twelve Tips for Smart Holiday Eating

Steeped in tradition of eggnog, pecan pie, and pumpkin lattes, the holidays are here.  Many Americans are fearful of these celebrated months-fearful of the damage that they may do to their waistlines.  Take solace in the fact that true body fat loss or gain occurs over time, not in one day—and barely in one week. However, you can do damage--especially in one month. 

If your lifestyle includes regular exercise and mostly nutrient dense, whole, unprocessed foods, without excessive carbs, the extra flavors of the holidays don’t have to wreak havoc with your body.  Yes, that may seem like a big “if”.

Perhaps, the biggest damage one can do over the holidays is regarding their behavior--getting your mindset out of sync. For many people, hunger cues are thrown off in their body because of metabolic dysfunction, including changes in hormones, insulin, leptin and ghrelin.  This holiday,  help your hormones maintain better function by not flipping that switch; you know---the all or nothing switch--when you say, I'll start January 2.  Keep the course with your healthy patterns--just be cautious.  One key strategy to surviving these weeks and making it to Jan 1 without a 10 plus weight gain is portion control—boring portion control.   Calorie and carb overload  of low nutrient and processed foods that our body can more easily store as fat is what causes fat gain, especially if you don’t keep to your exercise regime.  Be your own person and don't succumb to peer pressure-- do what's right for you! (Tip #3).   The good part is that no food is really off limits during the holiday.  But do yourself a favor and go for quality.  Choose, smaller amounts of tasty, high quality foods.

Perhaps the easiest behavior you can do throughout the holidays is to keep exercising. The metabolic adaptions and mood benefits your body gains from regular exercise give you a profound advantage compared to not exercising. Not exercising through the holidays is like walking through the jungle without a machete. There are no guarantees of protection but at least you give yourself a fighting chance. Plus, maintaining exercise makes for one less New Year’s resolution.

Try These 12 Survival Tips For A Healthy Holiday Season

1. Be realistic about your expectations.  Don’t strive for weight loss, but try to avoid weight gain (unless needed). Aim for maintenance.

2. Prioritize your tastes. Instead of eating everything, indulge in small portions of foods that you may not eat often and ones that you truly enjoy.  Usually, the first few bites of a food provide the most pleasure. Yes, there are exceptions but when trying to control portions–really savor those first few bites and then be done. The latter bites usually contribute more to GI distress.

3. Careful of peer pressure.  Don’t eat just because everyone else is eating-unless of course you’re seated at someone’s dinner table, who has labored for hours. Make your own choices and be your own person.

4.  Avoid the feast or famine mentality, especially on party days.  Saving calories for the big feast will only make you hungrier and risk overeating. However, avoid grazing. Our GI tracts like to have some rest time between eating—at least 90 minutes.  And some research suggests fat burning occurs better when we are not constantly feeding ourselves.

5. Return to healthy eating for the meals and days between your parties and holidays. Avoid all or nothing mentality i.e.  Diet starts January 2.

6. Beware of marketing tricks that tempt the consumer. Those holiday bags of chocolates/candy with colorful wrapping seem enticing but taste no different and are no less available than in the “off” season.

7.  Do maintain enjoyable traditions.  No need to replace every heirloom recipe, with something that barely resembles it.  Go for quality ingredients.

8.   Make a meal of appetizers and desserts. Shrimp cocktail or stuffed mushrooms, veggies and small slice of pumpkin pie is a nutrient dense meal. 

9.  Preserve Protein.  Aim for  2-6 oz at all meals.  Protein protects us in many ways, including weight management. Don’t skimp through the holidays.

10.  Limit alcohol. Alcohol not only lowers inhibitions but it can be high in calories and leave you dehydrated. 

11.  Count all liquid calories.  Calories in beverages can easily exceed your daily requirements.  Dilute drinks with club soda or seltzer or add  lots of real lemon or lime. Even diluted, hot apple cider is tasty.

12.  Focus on fitness. Keep your sights on your exercise goals and not the cheese dip.  Studies show that people make better food choices on the days that they exercise.

Merry Christmas and Happy and Safe Holidays to All!


Holiday Cheer

Use this chart to help choose liquids wisely.

Beverage                               Calories

Mixed drink, 5-1/2 fl. oz                                              160 

Rum, gin, vodka, whiskey: 90% proof, 1 oz                110

“After dinner liquor” 2 oz                                           240

Coffee liquer drink (4 oz cream and 1 oz. liquor)      392

White wine, a4 oz                                                       80

Red wine, 4 oz                                                            85

Eggnog, 4 fl oz                                                           170

Eggnog with 1 oz alcohol                                           268

Beer, 12 oz                                                                 146

Lite beer, 12 oz                                                          100

Nonalcoholic beer, 12 oz                                          60-100

Spakling cooler, 12 fl. oz                                           215

Hot apple cider, 8 oz                                                 128

Tonic water, 12 oz                                                      125

regular soda, 12 oz                                                  150-190

Club Soda and diet soda, 8 oz                                   0

The Wonders of the Teenage Boy Metabolism--and the value of "clean eating".

In deciding on the topic for my first blog post two years ago, I opted to write about my two sons--who are now  22 and 20.  The oldest has since graduated from college and has been home for the summer —can you say, “more trips to the grocery store”.  I decided to re-post that first blog here with a few changes, including-- the value of teaching our young, lean adults about "clean eating", a term that can rub some in the nutrition industry the wrong way, but non-the-less, might I argue, a simplistic term that still holds much value.

With so much written about obesity and overweight, not so much is mentioned these days about the sacred few people out there who needn't worry about calorie quantity.  Both of my sons are tall, lean, calorie burning machines. I’m in awe of their metabolisms, really.  I vaguely remember having a similar ability to burn such calories at their age, but as boys they certainly surpass me--at times you can nearly see the smoke coming off of them. To watch them eat after exercise is truly to witness human chemical combustion and food's primary role— as an energy and nutrient source. I'd insert a photo of them here but they declined…..sorry!  As I watch us become such an energy efficient society, struggling to lose weight, I know many would pay a pretty penny for even just one day of eating like them.  

The health benefits of being lean are thought to far surpass those of being overweight.  Right now, in their lives, (knock, knock) both are blessed with good metabolisms--in terms of leaness. But many factors can influence weight control.  Though my kids at times may believe that having a nutritionist and nurse as a mom is the bane of their existence, more and more days occur when they ask me, “Mom, is this okay to eat?" or even text me a nutrition question. I actually get weak in the knees when this happens and all is right with the world. Though I have faith that their own “ah ha” nutrition moments will contine to come in time, my mentality as their mother is still to “nourish” them, striving to help them meet their high daily calorie needs—and at the same time, giving them the tools to nourish themselves--healthfully—a.k.a. learn to cook, prepare a meal, grocery shop, read labels and care about what's in their food and how it is grown. Cooking, at the least is a matter of survival and at its best becomes an art of survival.  Teaching your kids to cook is the gift that keeps on giving and they can turn it into their own art.  


Over the years, I've challenged my boys to expand their taste buds, especially with fruits and veggies. A bowl of berries is a familiar site on our kitchen counter and various dark leafy greens, carrots, broccoli, cherry tomatoes, sweet potatoes are staples at most meals.  Also, despite their leaness, my insulin alarm goes off and I cringe a bit when my sons eat lots of sugar, drink lots of lemonade/juices or “carbo load”.  Few people can handle “carbo loading" day in and day out, even athletes. All carbohydrates require insulin to be metabolized. Insulin is a powerful hormone that when constantly secreted, carries risks, even when our blood sugars remain normal. And everything seems to go back to that gut microbiome-certain organisms probably influence how we secrete insulin. 

But back  to "clean eating".  If I had one of those pretty pennies for every time I was told, "You are so lucky that you and your kids don't have to worry about what you eat!"--- I'd have a pile of pretty pennies.  Hmmm--if only that were so---my day might just consist of--chocolate ice cream for breakfast, french fries for lunch and a cheeseburger for dinner--I kid you not!  Oh, if only!   Unfortunately, everyone is susceptible to our processed food and toxic environment, even thin/lean folks.  To me, clean eating is a term that really just means eating whole foods grown and processed with the least extra "stuff" to produce the most nutrient dense foods that will protect the body, not harm it.  No person’s body, lean or overweight, especially growing, needs pesticides, chemical additives, excessive animal hormones, glyphosates, or trans fats, to name just a few.  

Despite the lack of worry regarding overweight, food quality and nutrients are huge on my mind when I shop for my kids. I try to buy foods that will deliver taste and nutrients, with few extra bad stuff.  As medicine better understands the biological changes that occur after any given food or product slides down our "gullet" or after our lungs breath in any number of toxins or our skin (an organ BTW, with access to our bloodstream) absorbs the many topical products that we slather on it every day---the notion of body burden makes perfect sense.  Perhaps the most important research that has put an exclamation point to understanding the impact food has on our health and immunity is that regarding gut mucosal permeability, starting with celiac disease.  Now we know that gut permeability is not a far out concept, made up by "holistic practitioners".  Gut permeability can be measured in the body and excess gut permeability, particularly if left unchecked may well lead to a long list of symptoms and chronic diseases.  Add to that, an individual's own genetic make up and the vast land of gut organsims modulating these changes and wow---yes, that term "clean eating" seems like a simple concept that makes sense to me--certainly at least most the time.

Our young adults, finding that first job and setting up house will be challenged, however, to eat "clean" on a daily basis.  Some may be more motivated then others but for all of them, unless they have a hefty cash flow, will have to budget their food dollars. Unfortunately, the foods with the most ingredients, cost the least.  I teach my kids and my clients that there are benefits to buying certain organic foods, grass fed beef etc. even if they can only afford it 1-2x/month; its better than nothing.  Over time, they can increase the frequency, if their budget allows. It all goes to that body burden concept.

Despite their cavalier approach to calories, lessons can be learned from my lean sons. I seldom see either of them overeat to discomfort.  And although one eats rather quickly and the other more slowly, both stop eating when they are content, often times leaving food on their plate. So, although they sometimes consume crazy amounts of food, they stop eating when their internal cues speak....a skill many adults lose because of carbohydrate addictions and metabolism malfunction.  Although your carefree calorie days may be behind you, the teenage boy metabolism is a metabolic moment in time to watch and enjoy and - no matter your leaness everyone can benefit from a little "clean eating".

So, what does a nutritionist pass out on Halloween?  Truth be told, back in the day, yes, my kids trick or treated with pillow cases full of candy, as did I.  If Halloween candy doesn’t give you an appreciation for what our body has to detoxify, then I don’t know what will.  The best we can teach our young kids about Halloween is to safely enjoy the festivities, practice moderation, and of course--enjoy the chocolate.  I pass out a few different, full size chocolate bars and try to encourage the eager little hands to take just one. Happy Halloween!



Seven Reasons To Test For Celiac before Going Gluten Free.

Every week in my private practice I meet people who are eating a gluten free diet. Eating a gluten free diet can be a healthy eating style for many people--I eat gluten free.  However, understand your reasons for doing so and consider testing for celiac disease first.

1. You might have celiac disease.

Sounds obvious, yes, but I’ve seen many a client shocked to find out that they have celiac. Their reasons for going gluten free are because they think it might help some other condition-which it might. If you do have celiac disease, however, you need to know.  Knowing may offer more health insurance benefits and more directed care.  Celiac disease increases your risk for lymphoma and other conditions including autoimmune thyroiditis, rheumatoid arthritis and type one diabetes— strictly following a gluten free diet is essential.  

2. Give your family members a heads up! 

If you have celiac disease this information is helpful for direct family members so that they can decide if they want to be tested. Direct relatives and even first cousins have a greater risk than the general public, who do not have family members with celiac.  Give your family, the courtesy of this family history.

3. Celiac looks different in different people.

Celiac disease has a broad presentation. People with celiac may have few GI symptoms or many GI symptoms including constipation or diarrhea. They may be obese, thin, athletic, sedentary.  Please don’t assume that you do or do not have celiac unless you have a blood test and ultimately a biopsy of the small intestine.  Also, a negative blood test does not mean a negative biopsy and vice versa.  Aim for both to be negative.

4. Mostly gluten free isn’t enough. 

If you do have celiac but you don’t know that you do and you’ve been living “mostly” gluten free, consider that a “bite of cookie” here and there or cross contamination from shared cutting boards, toasters and utensils can be enough gluten to keep antibodies elevated. Elevated antibodies indicates inflammation of that small intestinal mucosal lining; thereby possibly compromising immune function. 

5. Celiac doesn’t occur overnight.

Keep in mind, small intestinal damage as demonstrated by a positive blood test— reflects the later evolution of celiac.  The damage may be occurring even without your awareness.  How many people are we missing at earlier stages of celiac?  

6. You could be celiac negative at age thirty and then celiac positive at age forty. 

One negative celiac test does not make for a life long negative test. If you have the gene for celiac, you could test positive at another time because various life events may trigger the epigenetic influence of the gene, including pregnancy, antibiotic use, stress, “a GI bug or illness”.  Plus, if you were tested more than ten years ago, the tests may not be as accurate as they are today. 

7. You don’t want to do a gluten challenge. 

What’s a gluten challenge?  If you’ve been eating gluten free and then decide, hmm, maybe I should know for sure if I have celiac disease, unfortunately, the more accurate way to test for celiac is to expose yourself to exactly what's causing you harm.  You need to eat gluten-- a gluten challenge.  Some people breeze through a gluten challenge but others find it challenging. A gluten challenge requires eating roughly three grams of gluten- about the equivalent of two slices of wheat bread per day for about 4-6 weeks.  If you have been gluten free for months and it turns out that you do have celiac—or you just feel better from eating gluten free, then you’re small intestine will not be happy will this re-introduction of gluten.  Some people may test positive for celiac with less gluten and in less time, so check with your physician and a knowledgable nutritionist.  One way out of a gluten challenge if you’ve been living gluten free and decide it’s time to know for sure is to test for the celiac gene— HLA-DQ2 and HLA-DQ8. If you test negative, chances are that you don’t have celiac and do not need to do the gluten challenge.  But, if you do have the gene then work with a knowledgeable nutritionist and physician about either undergoing a gluten challenge before you are tested or making the executive, personal decision of how gluten will fit into your life.

Of note,  I am a big proponent of gluten free. The more I study this protein, the more I believe that it is a tough protein to digest and it probably affects more people’s gut barrier function then we know--making the rest of the body vulnerable. If you have an auto-immune disease or are suspect, consider going gluten free, even if your only evidence is a positive anti-nuclear antibody (ANA). ANA is a general autoimmune antibody, not specific to any one disease--but it should not be positive.  If an autoimmune disease is in progress, more specific auto immune antibodies can lag a decade behind symptoms before they become positive. 



Gluten proteins stimulate the release of zonulin in everyone—not just people with celiac.  Zonulin is a protein that can change those tight junction connections in our mucosal cells that influence its permeability. With the right scenario—genes, infection, medication, diet etc. those tight juctions may be more vulnerable to remaining open.  However, that does not mean everyone who does not have celiac or non-celiac gluten intolerance needs to eat gluten free. It becomes a choice.  But keep in mind, many gluten containing processed foods also promote high blood sugars and a greater need for the pancreas to secrete insulin. Also, other naturally gluten free foods including oatmeal, quinoa, fruits and vegetables help promote healthy organisms in the gut including the bifidabacterium.  

On a different note--keep in mind, FODMAPs are sugars and they behave differently in the gut vs gluten, which is a protein.  Both can compromise gut integrity but they do so by different means. Ultimately, we want to eat a range of healthy FODMAP containing foods because they feed and breed a healthy gut flora. But if you are in the throes of IBS or other gut issue, a lower FODMAP diet can help reduce symptoms until you are able heal and hopefully tolerate more.

If you do not have celiac but wonder about non-celiac gluten sensitivity, you can also test for additional gluten and wheat antibodies.  We are just beginning to understand the vast land of wheat. Many labs test for additional wheat antibodies; Cyrex Labs and Vibrant Wellness both have comprehensive wheat protein panels and intestinal permeability markers.

So, the next time someone—anyone suggests that you try eating gluten free—consider the end game—how long you are going to do it. If it’s just for a week and you have full intentions of returning gluten to your life, then forgo the celiac test. But, if you are at all considering going gluten free because you don’t feel well, regardless of the reason, be tested for celiac disease first.  


Challenge Your Taste Buds

What’s your favorite food?  Hmmm—favorite you say.  What exactly do you mean by favorite?  Do you mean what food makes you feel good- physically well after eating it, nourished or satisfied?  Or, do you mean what food do you just plain looove to eat, unable to stop, such as pasta, chips, chocolate chip cookies or ice cream?  Some foods for some people trigger addictive signals in their gut and brain making it hard to stop eating that food (without proper training and other diet/nutrient adjustments.)  For those with GI-belly issues, a favorite food could simply be a food that just doesn’t rock the boat.

For many people visions of their favorite food sit precariously on the periphery of their mind, sometimes all day.  At a moment of stress or emotional or physical weakness—boom, there it is —mocha chocolate chip ice cream, mysteriously making its way into their mouth.


My clients complete a lifestyle questionnaire in which I ask them to identify their favorite food(s).  Although a big part of my counseling focuses on figuring out the nutrients, foods, and supplements that will help you heal, for many of my clients I also focus on behaviors around food. We all have certain food behaviors that are influenced by a variety of factors in our life and how we are raised by our families. One food behavior which I believe has exponential benefit is simply challenging your tastebuds. 

You know the kids whose total diet repertoire is all of four foods, often all white in color?   No reds, blues, or greens — you may have been one of these children or have a child who is one. Some of these kids grow up to be adults with the same white, restricted taste buds-resistant to trying new tastes, new consistencies or new colors.  Sometimes other medical issues are contributing factors.  For many children, however, once they start socializing with friends and other families, often their food horizons expand.

When I ask a client if there are any foods that they don’t like— a great answer is always, “no- I love everything”.  I know that person will have an easier time of food experimenting.  Of course, the proverbial "sweet tooth" is perhaps one love that is healthier not to have but challenging your tastebuds even helps to conquer that too. 

Eating a variety of flavors means Nutrient Density.

Trying new tastes and combinations of ingredients in foods that you wouldn’t necessarily seek out by yourself has tremendous emotional and nutritional benefit. When we combine tastes that might not seem like they work together, we’re satisfying different sensory stimuli, usually leaving us more satisfied physically and mentally after a meal- less likely to be looking for more. Usually these contrasting flavors means more nutrient density. And eating a varied diet contributes to a healthy diversified gut flora. 

Try These Four Tips To Challenge Your Taste Buds.

1.  Combine consistencies.

Add a sliced, crunchy apple to a plate of leafy greens or top off a salad with a few walnuts, almond slices and or pumpkin or sunflowers seeds.

2. Combine sweet and bitter foods or sweet and sour foods.

Add pomegranate seeds or dried fruit to brussel sprouts, greens or broccoli or add a sour pickle or sauerkraut to a meal or use fermented kefir as a salad dressing.

3. Spice it up. 

Spices contain phytonutrients, chemicals that benefit that body and a little can go a long way.  Add cinnamon or ginger to cereals, grains, or smoothies or add cayenne pepper or turmeric to vegetable and meat dishes or  just sprinkle good old fashioned black pepper on veggies and other dishes of your choice.


4. Work at your food. 

Foods that slide down just a bit too easily, sometimes leave us looking for more. Foods such as yogurt or smoothies do better when they are lower in sugar and higher in nutrients. So, thicken up your smoothies for more consistency with berries, chia seeds, yogurt or kefir.  Also, a salad with a crunchy fruit and slices of protein that require thoughtful chewing, not only help the process of digestion so that nutrients can be fully utilized in the gut, but they also provide more time to process and enjoy the contrast of flavors.

Finally, challenging your taste buds can lead to a sort of “deconditioning”  towards our sweet callings. Sweet cravings stem from a variety of factors but by challenging them with other flavors, you may notice that they are not at your beckon, sweet call. My observations from years of working with clients, is that those people who eat a variety of healthy foods, especially a variety of vegetables at most meals are not owned by their sweets. Sweets are still enjoyable but not a necessity.  

So, what does a nutritionist pass out on Halloween?  Truth be told, back in the day, yes, my kids trick or treated with pillow cases full of candy, as did I.  If Halloween candy doesn’t give you an appreciation for what our body has to detoxify, I don’t know what will.  The best thing I think we can teach our young kids about Halloween is to safely enjoy the festivities, practice moderation, and of course--enjoy the chocolate.  I pass out a few different, full size chocolate bars and try to encourage the eager little hands to take just one. Happy Halloween!


Decisions, Decisions!


Happy New Year to everyone. Each new year brings decisions and change for many folks.  For others it may bring the status quo, which may or not be a good thing. Usually, the process of taking down my Christmas decorations gets me thinking more about the New Year and transitions— and what I will be doing differently in 2016 that will help attain my personals goals.  How will I improve my business, how will I optimize quality time with family and friends etc. What am I doing wrong?  What am I doing right?  I’ve always believed no decision is a decision in itself—which doesn’t mean no decision makes the topic go away.  Quite the contrary—often no decision leaves a person quite discontent. Going forward with a particular change or going forward with no change is a choice.  Ahhh—life and the tricky ways in which our minds approach choices.


My career allows me the opportunity to work with people in their efforts to make changes.  Lifestyle choices that affect our health including changing your diet, exercising, stopping smoking or reducing alcohol etc, often also affect other big changes such as career changes, relationship changes and vice versa.  All of these changes first require acknowledgment of the need to change. A change may be as small as adding some protein to your breakfast, walking every day for as little as 15 minutes, flossing your teeth, calling that friend more often, cleaning the kitchen before going to bed, taking your vitamin D supplement, writing more blog posts, or bigger changes such as finally addressing that fifty pound weight gain or a dead end career or unfulfilling relationships.

This isn’t a post about how to change but just to start thinking about how you approach change and decisions. And maybe even just thinking about it will prod you towards taking steps to make the important changes you desire. The big changes inevitably require smaller changes —and you may not even be aware that you’re making them. Sometimes, however, people finally become so fed up—they just go for it.  It’s curious to me that human behavior usually dictates that people reach a really low point before initiating change. How low do you go?  How do you approach your decisions?  

Being pro-active is not easy for many of us. It’s important not to underestimate the value of small change. Small changes can have huge positive impact. I see the benefits every day in my own life and the life of my clients. What doesn’t feel so great is the burden we bear or the weight we carry of indecisiveness. Indecisiveness is part of procrastination and can lead to feelings of inadequacy or helplessness—because you are not taking a stand one way or another. My wish for you in 2016 is to consider how you approach decisions in your life.  Become more decisive about your choices, become more proactive—big or small.


One change that I’m making in my practice is giving my clients more options for obtaining informative lab tests. Lab tests provide us with information about our body’s biomarkers.  Many tests can be provided by your physician, however some physician offices will only provide them for certain conditions or within a certain time period.  Individuals are able to purchase many lab tests on their own through certain labs.  Of course, interpretation of results is important too.  But getting the information is the first step.

So—what is a biomarker? Our bodies talk to us by giving us a variety of information. Biomarkers are measurements of substances that are indications of health and disease. These biomarkers reveal quite a bit about our state of health. They may be nutrients, hormones, neurotransmitters, organisms or break down products of metabolism. We can test for these biomarkers in the blood, urine and saliva.  Medicine is learning better about the best biomarkers for measuring thyroid function, detecting inflammation, cardiovascular health etc. Health occurs on a continuum. Disease doesn’t just happen overnight and by keeping track of certain biomarkers may help you stay better a head of the sick curve and if you do become ill better understand the pathways that are being affected to help get you well.

More information is not necessarily better but it’s important to test the biomarkers that give you the best value.  As a nutritionist, I appreciate that nutrients are involved with nearly every pathway in the body and influence so many processes.

Two quick examples:

Vitamin D is a nutrient and a hormone that is best tested in our blood, so far we believe, anyway. We have D receptors throughout our body and we know it’s involved with probably every system in the body.  I recommend people have their blood levels checked at least every other year, preferably yearly and if too low or too high, then to check every 3-6months until optimal levels are achieved.  

Vitamin B-12 is a nutrient that may not be as accurately measured in the blood.  B-12 has many functions in the body including DNA synthesis, normal functioning of the brain and nervous system, as well as being a cofactor for many reactions. Blood levels  don’t give you the best measurement of whether vitamin B-12 is getting inside your cell to be optimally utilized.  Normal to high blood levels don’t rule out a deficiency.  True deficiency is better measured by a substance called methylmalonic acid —aprecursor to vitamin B-12, found either in your blood or in your urine. High levels of methylmalonic acid are quite sensitive for B-12 deficiencies, though less so in the elderly.

For more information about a nutrition evaluation or acquiring tests contact

Happy and Healthy 2016

Happy, Healthy and Hopeful

Private Practice Duo Team-Up to Get People Healthy, Happy and Hopeful!


Did you know?—- that the brain is intimately connected to the GI tract via the vagus nerve?  The GI system has a complex network of blood vessels and nerves that allow the gut to communicate with the brain.  This network is called theenteric nervous system or you may have heard of it referred to as the “second brain”.  The organisms that live in your gut intimately communicate with the brain via this network.  Research in the gut microbiome is exploding–how these bugs keep us healthy – and how any changes in them effect our health–and brain health. Nutrition is no longer about just preventing nutrient deficiencies—nutrition is about protecting your own unique DNA and gut microbiome–allowing your body, brain and mind to thrive.

Understanding these connections and interrelationships in the body, I am thrilled to share with you a recent addition to my office, Diane Pascucci RN, MS, M.Ed. BC-PMHCNS.  Diane is a clinical nurse mental health specialist with expertise in helping clients with mood disorders, ADHD, learning disabilities, HSP, chronic illness, acute illness, grief and grieving, palliative care, loss and trauma, and relationship concerns – all with a supportive, compassionate, non-judgmental regard for the mind/body connection.

Back in the day— our emotional and mental health– was thought of as separate from the rest of our body–as if  there is some sort of wall separating our brain from our body.  Of course, any chronic disease, trauma or unfortunate event in one’s life can be challenging for any person. However, now we know that a healthy lifestyle, healthy foods, and a support system can tremendously benefit our brain health and coping skills, no matter what the challenge may be.

Diane has many years of experience working with individuals who have anxiety and depression, learning disabilities, ADHD, chronic illness, sadness, and confusion. She also has years of experience working with individuals grieving the pain of significant losses. She has worked in school systems, universities, hospitals, clinics and private practice. She has experience as a learning specialist working with students with LD, ADHD, and social needs at both the high school and university level. She understands the mind/body interrrelationship, given her expertise as a psychiatric clinical specialist liaison nurse in the hospital setting.

Diane enjoys seeing the progress and transformation clients make.   She appreciates seeing the big picture – looking at life from her clients’ perspective with all their respective experiences. Clients may not always arrive with a clear idea of what they need – only knowing that something needs to change.  Sometimes all that is needed for a motivated individual to improve their quality of life is the empathy and compassion of a seasoned professional.

Diane and I confer about clients in a spirit of collaboration with the client’s consent.  Our goal for every client is to help him/her achieve optimal functioning: physiologically, psychologically, emotionally, socially and spiritually.