 I was not taught much about intuitive eating in my Nutrition program. It is a concept I have wrangled with myself for years. The idea is that if we listen to our bodies and trust our hunger signals, we will naturally eat the right amount of food and choose a balanced healthy diet. Intuitive eating is different from dieting in that it is not about weight, though it may lead one to their natural stable weight. Intuitive eating is different from mindful eating (although not incompatible with it) in that it focuses more on when, what, and how much to eat while mindful eating is a way of eating that keeps you present and aware. Intuitive eating is how an infant knows to cry when it is hungry and stop feeding when it is full, yet for most adults, being able to eat intuitively is an advanced practice. Many of us were raised in an environment in which were required to eat foods we didn't like or didn't want. Conversely, foods such as desserts were given as a reward for clearing the plate, or withheld as a form of punishment. Or consider that a child not being offered enough food to become full on a regular basis, creating a constant sense of hunger, might overeat given the opportunity. In addition to feeding experiences during our formative years, in this country we are constantly exposed to food advertisements and other forms of media messaging that are designed to stimulate our senses and provoke our interest in foods regardless of whether or not we feel hungry. It is no wonder that at some point during childhood, many individuals lost their instinctive ability to manage their hunger based on biological signals alone. One of the biggest tenets of intuitive eating is that no foods should be restricted. If you are someone who “watches what they eat”, there are two distinct ways you might react to this notion. The first, utter excitement - nothing is off limits! Great! I can eat ice cream and potato chips all day long in the name of intuitive eating! The second, stifling fear - I will eat nothing but ice cream and potato chips. I will gain 100 pounds. I will never want to eat a vegetable again. I will have no energy and my health will decline. The result for many people is that their actions reflect one or the other end of this spectrum; they binge with abandon, or they restrict mercilessly. A lot of people end up somewhere between the poles, but with a tendency to overeat or restrict. Intuitive eating however, is something different than finding the exact mid-point between the extremes. It requires getting off the continuum and really listening to your body along with having access to plentiful resources and the ability to prepare or provide nutritious foods for oneself at the time when the need arises. Like I said, it is an advanced practice. Although intuitive eating is the gold standard, I sometimes question whether it is realistic for everyone. In the world we live in, if we didn’t feel like we had to eat vegetables for our health, would we ever be drawn to them? You could go months without even seeing one if you didn’t want to. Whereas fast food and junk food are hard to escape – even if we don’t eat them, we encounter them everywhere. Our environment shapes our impulses and our tastes and preferences. It can be hard to sense your own intuitive messages through the noise of advertising and information alongside a blunted inner awareness. If we have adapted to an unhealthy style of eating, we made need to change deeply ingrained habits before we can expect our intuition to lead us onto a healthy path.  Some other obstacles to effective intuitive eating may include:
Other issues might need to be addressed before one has the facility or sensitivity to tackle the challenge of eating intuitively and be successful. That doesn't mean don't try. However, if you are someone who has been eating poorly for a very long time, or if you struggle with disordered eating, it could be necessary to change some habits, even if it does not feel intuitive at first, just to get to a more neutral place. There are also circumstances in which eating intuitively would be contraindicated. For example, a diabetic needs to monitor what they eat, and although their body will send signals if blood sugars are too low or high, it is far better to keep glucose levels balanced before they reach the stage of causing a physical reaction. There are other medical conditions that may require people to eat at certain times or choose specific foods for health reasons alone. Intuitive eating is best practiced by those that are otherwise healthy, both physically and mentally. So, should intuitive eating be encouraged? Is it worth undertaking? Well, it does beat many of the alternatives (bingeing, dieting, extreme eating practices). Listening to your body and relying on hunger and fullness cues to know when and how much to eat is brilliant, but as a dietitian, I think it is also valuable to understand that there are health benefits to be gained from including whole foods such as fruits and vegetables and whole grains in your diet. It may take some intentional work to incorporate healthful foods into your life before your body will begin to “intuitively” want them. You may need to become less reliant on processed foods so that you can break their addictive hold on you. Eating behaviors rooted in stress or emotion may not be resolved without addressing the underlying issues. Thus, it would not be a bad idea to find someone to work with to help you navigate the path so you can avoid mistaking impulse for intuition and restriction for restraint. “Trusting your gut” is a great idea, but you may need to train your gut a bit first.  My name is Lorelei Sturm. Some of you may know me as a yoga instructor with Chicago’s Neighborhood Fitness Centers. I am also a Registered Dietitian with a Master’s degree in Nutrition. CNF is committed to helping its members lead healthier lives by encouraging wellness and a healthy lifestyle in addition to fitness. So, what burning nutrition questions do you have? Let me know in the comments below.
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 It seems like everyone has heard of the ketogenic diet (aka “keto”). A polarizing topic, some people swear by it, and some see it as just another fad. During my recent dietetic internship, I met a woman who was morbidly obese wondering if she should try keto to lose weight. Her history included an abdominal surgery, after which her gut had never been the same. She had digestive issues that sometimes put her in the position of having to sprint to the restroom - not an easy feat for an individual of her size. My “gut” reaction was that the keto diet wouldn’t be right for her: high fat and low fiber are not the usual recommendation for GI issues. But as a student and an intern, I wanted to learn more before making a recommendation. If you don’t know about the keto diet, I don’t know where you’ve been – certainly not on YouTube watching weight loss videos. The ketogenic diet is a pattern of eating that is high in fat, moderate in protein (NOTE: the keto diet is NOT a high protein diet as many believe), and low in carbohydrates compared to the traditional dietary recommendations. It was initially prescribed as a diet for patients with epilepsy and intractable seizures. There is a significant body of research demonstrating the diet’s effectiveness for this population. The way keto works is that the body, deprived of glucose, starts to use fats or lipids for energy. Ketone bodies are a product of this pathway and can travel through the bloodstream and be utilized for energy by all the body’s cells and organs. Even the brain can adapt to using ketones rather than glucose as an energy source. It is this adjustment in metabolism that appears to be behind its effectiveness in preventing seizures. Due to its noted ability to alter brain metabolism, the ketogenic diet is being investigated as a possible therapy for autism, Alzheimer’s disease and other degenerative brain conditions, even migraines. But the possibilities do not end there! Could the keto diet be useful for diabetics who are not able to effectively handle large quantities of glucose in the bloodstream? How about in cancer – cancer cells thrive on glucose, but may not be able to use ketones for energy. And yes, the keto diet has been shown to promote weight loss in some individuals. But here’s the deal: there has been little research done on the ketogenic diet. We don’t know for sure that it doesn’t work, but we can’t yet verify that it does either.  I spent a day with two dietitians who work with kids with epilepsy and their families utilizing the keto diet to minimize their symptoms. It really does work – not in all patients, and it doesn’t cure the disease, but it can dramatically improve overall quality of life by reducing seizure frequency, sometimes halting seizure activity altogether. The clinical version of this diet is pretty extreme and doesn’t look anything like what a regular person might eat. Between 75 and 90% of calories come from fat, which means lots of heavy whipping cream, butter, and oils. Total protein and carbohydrates combined make up, at the most, 25% of total daily intake. (again, the ketogenic diet is not a high protein diet) It is important that these ratios are maintained for the body to stay in ketosis. Ketosis is a state in which fat is being used for fuel and ketones are being produced. It can be checked by measuring for ketones either in the blood or in the urine. These kids are monitored very closely, not only for the presence of ketones, but for some of the potential side effects of the diet. Keto side effects: CONSTIPATION. Unsurprisingly, it is the most common side effect considering fiber, which can keep us regular, is found in carbohydrate foods. Given the choice between seizures and constipation, putting up with this side effect is probably preferable, especially since it can be managed with medications like Miralax. If you’re just trying keto for kicks, constipation may be a deal-breaker. ACIDOSIS. Ketones are acidic and a person in ketosis does have slightly more acidic blood. If the pH drops too low, it can become a problem, especially for the kidneys. With monitoring, acidosis can generally be prevented and treated. OF NOTE: ketosis is different from diabetic ketoacidosis – an acute condition that occurs in diabetics when their body is unable to take up glucose in the blood due to insufficient insulin creating an emergency situation. ALSO OF NOTE: a high protein diet can be hard on the kidneys because proteins create nitrogenous wastes the kidneys have to excrete. Since the keto diet is not a high protein diet, it is not necessarily bad for the kidneys, unless acidosis occurs. NON-COMPLIANCE. Not really a side-effect so much as a downside of taking on a diet that is super hard to do. Kids in the keto clinic have their menus created, calibrated, and regularly adjusted by registered dietitians who specialize in this work. Parents of children with epilepsy are generally very motivated to stick with it for the welfare of their child. Lay people who just want to try keto likely won’t have these advantages or access to an RD. They are not monitored to ensure they are in ketosis but not acidosis. Non-compliance is actually one of the biggest reasons there isn’t a ton of useful scientific data available regarding its effectiveness for other conditions – study subjects find it extremely challenging to get it right. HIGH CHOLESTEROL? I assumed that a high fat diet, particularly one that includes quantities of saturated fat (butter, cream, eggs, cheese, etc) would lead to high cholesterol, which is a risk factor for cardiovascular disease. As it turns out, blood lipid levels rise initially in people beginning a ketogenic diet, but studies have demonstrated that they normalize after a few months. Which means that going on this diet to solve one problem (epilepsy) does not mean another one (heart disease) will be created down the road. Unexpectedly, not a side effect after all – if the diet is done right. I asked the dietitians I joined for their opinion on the lady I had met as an intern. One of them claimed that, in her experience, she had not found the diet to be contraindicated for anyone. She maintained that in such a case, helping a patient to lose weight rapidly might supersede other conditions. I was surprised. I think of keto as being quite controversial, even frowned upon, particularly in the nutrition community, but as mentioned, some people are hard core believers, and many have good reason to be.  A study published in 2018 by Mohorko et al demonstrates keto’s effectiveness in promoting weight loss, along with several other positive findings, and it is not alone in suggesting this diet may help combat obesity. But there are lots of weight loss diets out there. Is keto somehow better, or is it just another version of the same old concept – eat fewer calories and burn more? And fat is higher in calories per gram than carbs or protein, so how is anyone able to get away with eating mostly fat? Why it works – the theories: FEWER CALORIES CONSUMED. Restricting carbohydrates and limiting protein means most people run out of options and end up eating less. FAT IS SATIATING. People on the diet eat less because they get full more quickly. KETOSIS IS AN ENTIRELY DIFFERENT TYPE OF METABOLISM. It could be that being in ketosis and using fat for fuel somehow burns more calories than our usual glucose based metabolism. Or maybe ketosis, which depresses insulin levels, affects other hunger hormones and reduces appetite. Or maybe…you name it - speculation here is what has really caught people's interest. Unfortunately, not enough research has been done to definitively establish why ketosis causes certain effects. So what’s the take away? Well, everyone would love keto to magically solve the obesity epidemic, put an end to metabolic syndrome, knock out Alzheimer’s, and cure cancer for good measure. And who knows, someday we may all regret that we ever recommended brown rice over eating butter with a spoon. But at this point, high quality evidence of keto’s therapeutic effects beyond seizure control is still pending, and studies on the long-term effects of the diet are sorely lacking. Individuals trying the diet on their own should be warned about the challenges they might face. Ketosis takes time to establish and adjust to, but can be instantly derailed by consumption of too much carbohydrate, or even protein, which our body is capable of breaking down to glucose. You can't cheat on this diet without undermining it completely! Are people on keto actually measuring their ketone levels? If not, they don’t know if they’re in ketosis or not, and if they’re not, they’re basically just eating a high fat diet, which has serious health risks. A balanced diet full of vegetables and fruits, low-fat proteins, whole grains, and a moderate amount of fat is still the general recommendation for most folks. Boring, I know. I wonder if keto hasn’t taken off simply because it is new and different. People get excited by the idea that fat is back after having been shunned from plates a couple decades ago. So what would I say to the woman from the top of this story if I could meet her again now? I think I would talk to her in depth about the pros and cons of the keto diet. Let her decide, and then provide as much assistance as possible with whatever decision she made. If keto was her call, I would help her do it right, monitor levels, and keep track of progress. But I would not oversell it. It is uncharted territory, and though it may be exciting to go to the extreme and embark upon a journey into the unknown, when it comes to health, maybe playing it safe and boring isn’t such a bad idea.  My name is Lorelei Sturm. Some of you may know me as a yoga instructor with Chicago’s Neighborhood Fitness Centers. I am also a Registered Dietitian with a Master’s degree in Nutrition. CNF is committed to helping its members lead healthier lives by encouraging wellness and a healthy lifestyle in addition to fitness. So, what burning nutrition questions do you have? Let me know in the comments below. REFERENCES:
Barry D, Ellul S, Watters L, Lee D, Haluska R Jr, White R. The ketogenic diet in disease and development. Int J Dev Neurosci. 2018 Aug;68:53-58. Gershuni VM, Yan SL, Medici V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep. 2018;7(3):97–106. Kraeuter AK, Guest PC, Sarnyai Z. The Therapeutic Potential of Ketogenic Diet Throughout Life: Focus on Metabolic, Neurodevelopmental and Neurodegenerative Disorders. Adv Exp Med Biol. 2019;1178:77-101. Mohorko N, Černelič-Bizjak M, Poklar-Vatovec T, Grom G, Kenig S, Petelin A, Jenko-Pražnikar Z. Weight loss, improved physical performance, cognitive function, eating behavior, and metabolic profile in a 12-week ketogenic diet in obese adults. Nutr Res. 2019 Feb;62:64-77.  If you are reading this blog, you are likely someone who is concerned about your health. You understand that exercise and a healthy diet can help prevent disease and maybe even lead to a longer life. You may not follow all the practices that you know are good for you, but fruits and vegetables are not a foreign concept. You probably also know that highly processed foods such as snacks made from refined grains and sugars are not ideal choices for anyone, even if they find their way into your grocery cart every once in a while because they taste good and nobody’s perfect. It is not news to you that processed foods tend to be high in calories and sodium, devoid of dietary fiber, loaded with preservatives and chemical agents, and lacking in overall nutritional quality compared to whole foods. Big manufacturers of chips and cookies and cereals and sodas and candy are making lots of money despite the understanding that a diet based on such foods could lead to obesity and worse. These foods do not exist in nature, it’s not as if they have always been around, so why is it that this industry has grown and continues to thrive in the face of all that is wrong with it? Many conscious choices have occurred along the way to putting these foods on the shelves of grocery stores, drug stores, and in vending machines. There are neighborhoods in every city in which these sorts of foods represent the majority of what is available to eat within a significant radius. How did it come to be, and why do processed foods continue to have so much real estate despite their known contribution to poor health? Suffice it to say, there is a lot to this story, and I won’t be able to cover it all here. But I want to start with the idea that, although we may see processed foods as a scourge on society, the story didn’t start as a bad one. Yes, these products are too easily accessible. Sure, these products are strangely affordable, considering more work and energy goes into processing a food than serving it in its whole form. But the initial reasons behind them are actually pretty positive and despite their current ill repute, there was a time at which they undoubtedly saved lives. Not terribly long ago (think the Great Depression) starvation in the US was not uncommon. Of course people still go hungry today, but in many ways obesity has replaced starvation in our country. Those in poor economic situations are no longer without food, rather they have access to affordable edible products that provide plenty of energy as calories. The current US food system is able to package and distribute shelf-stable sustenance to ensure that the vast majority of people are able to eat enough to stay alive and then some. Granted, these provisions tend to be deficient in actual nutrition, which can lead to overeating. A body deprived of necessary vitamins and minerals will continue to feel hungry, even if it has taken in enough calories. Additionally, poor nutrition can lead to poor development in children, including mental development. Interestingly, obesity and malnutrition can co-exist in one person, but actual death by starvation is much more rare these days because food here is plentiful. Another thing that our current food system deserves some credit for is preventing deficiencies of specific nutrients. When grains such as rice and corn were first processed, deficiencies in B-vitamins such as Thiamin and Niacin became common, leading to some pretty scary diseases. You may also know that lack of Folic Acid, which is a B-vitamin found in some fruits and vegetables, can lead to birth defects if a pregnant mother is deficient. To solve these problems, processed foods such as cereals and white bread have been manufactured to contain sufficient quantities of these key nutrients to prevent deficiencies. While eating whole foods could easily remedy these ills, for those for whom whole foods are not an option, fortification and enrichment have stepped in lessen the damage done by processing foods in the first place (clearly some irony here, but nevertheless…) Mass producing and processing foods began for the sake of public health and overall food security. Therefore, much of what goes into making your bag of cheese puffs is subsidized by the US government. If you think about it, it’s hard to imagine the cost of growing, processing, producing, packaging, distributing, shipping, storing, and finally selling a bag of chips is covered in the $1.59 you pay for it. Unfortunately, aside from very few crops (think commodities like corn, wheat, soy) everything else that is grown is considered a specialty crop. Prices on items like fruits and vegetables are therefore higher. Store owners take more risk in stocking them if they don’t know they will sell quickly because they can spoil. So system-wide, healthy foods have some big disadvantages compared to processed foods. As a dietitian, my priority is to encourage people to eat the foods that are going to be most beneficial to their health. However, the environment we live in and the giant systems that make up our food supply do not make it easy. Everything around us from the convenience store on the corner to the fast food chain down the block to the commercials we see on TV steer us toward making choices that simply aren’t good for us. Depending on where you live, you may have to go out of your way to find a better option. Lack of nutrition education means that many may not even realize that those foods aren’t good for them. The end result is that processed foods have taken over many people’s diets in a big way, which reinforces the system that generates them. And though the measures taken to prevent children in this country from starving in the first half of the 20th century worked, we are now dealing with the opposite problem, which may be equally deadly, but harder to solve. If we could simply imagine a better structure for getting nourishing foods to people and snap our fingers and make it happen, that would be fantastic. But the economics behind what now exists is a huge hurdle to overcome and companies making money are not going to spend any time convincing people that junk food isn’t good for them. So what can we do? One step is to acknowledge the true costs of processed foods, not only the government subsidies which ultimately come from the pockets of taxpayers, but also the rising healthcare costs associated with diseases that might be preventable if eating habits shifted nationwide. We can also be conscientious about the reality that our food environment does not support healthy living; this is most true in communities that are economically challenged.  On a personal level, if you are in the position of being able to make better choices, knowing what they are and having access to alternatives, you are lucky, but that doesn’t mean it is easy. You may have to be willing to think critically, even in the face of compelling advertising. Use some creativity when planning meals and snacks rather than just opting for what is convenient. Start thinking in terms of quality rather than quantity when you place value on a food item. If it is within your means, find ways to support local growers and smaller food producers who use fewer resources and deliver higher quality end products. I don’t have all the answers, but I think it’s important to have some understanding of the problem so we can at least be asking the right questions. Thoughts? Leave them in the comments below.  My name is Lorelei Sturm. Some of you may know me as a yoga instructor with Chicago’s Neighborhood Fitness Centers. I am also a Registered Dietitian with a Master’s degree in Nutrition. CNF is committed to helping its members lead healthier lives by encouraging wellness and a healthy lifestyle in addition to fitness. So, what burning nutrition questions do you have? Let me know in the comments below.
 I grew up in the Midwest with plenty of dairy and meat in my diet. We ate ham and cheese sandwiches for lunch and hot dishes at dinner containing tuna or ground beef and often Velveeta cheese. Drinking milk was required at every meal. Pepperoni was a critical pizza ingredient and a burger from a fast food restaurant was an exciting treat. I knew these foods came from animals, but as a kid, I didn’t overthink it. I ate what I was fed and what I thought tasted good. As I got a bit older, I became an animal lover. I was perhaps a little awkwardly obsessed with cats and ended up with a subscription to a magazine on the subject. This subscription resulted in my being added to mailing lists from many animal welfare organizations, and I started to get their mailings. As a 10 or 11 year old, I didn’t get much mail, so I would pour over brochures describing in great detail the suffering imposed on animals in the food industry, the cosmetics industry, and more. I started to feel a little uncomfortable about eating meat, but I lived at home and didn’t know any vegetarians. Shortly before moving away to go to college, I decided I would become vegetarian at that point. With a new environment and more choices in my own control, it seemed the perfect opportunity to re-invent my eating habits. Rarely do such decisions result in a lasting impact, but for me, it did. I had sausage and pepperoni pizza the night before I left for college and have not (intentionally) eaten any meat since. Every vegetarian or vegan probably has their own origin story. Some may have ups and downs, some may involve very different reasons, but generally, becoming plant-based is a conscious choice that goes against the norm, even though more and more people are opting out of animal products these days. For me, not eating meat was an ethical decision. Some people don’t eat meat because it is against their religious beliefs. I have heard of kids who don’t eat meat because they just don’t like it and refuse to eat it from a very young age. Environmental considerations factor into the decision for people who are concerned with sustainability as well as feeding a growing world population. Methane emissions from livestock make a significant contribution to greenhouse gas production. I remember learning in college that you could feed 10 times as many people if you grew grain for people to eat rather than grain for cows to eat. There are certainly other reasons people may site for going veg, but these are some of the big ones. And then we get to health. Are vegetarian (meatless) and vegan (no meat, eggs, dairy) and plant-based diets healthier than diets that include meat? I think it’s pretty safe to say that most vegetarian diets are healthier than the current standard American diet. And although some people still gasp from fear that I am going to waste away when I tell them I don’t eat meat, it’s been very well established that vegetarian diets are healthful. But are they MORE healthful, and if so, why? The answers here are not as clear-cut as one might wish, but I will try to provide some insight from the point of view of a dietitian/nutritionist. There have been a bunch of long-term studies done tracking lifestyle habits and health outcomes of individuals. One common finding is that people who eat vegetarian and vegan diets tend to be leaner and have a lower incidence of certain diseases. This finding does require some interpretation. When looking at large studies, things tend to get averaged out, which is really good in a study, because it means that one extreme result will not throw everything off. But it also means, that not everyone in a study looks like the average study result. Some vegans may fare very poorly, and some meat eaters might be extremely healthy, but ON AVERAGE, those that skip the meat do better. The “standard American diet”, which includes fatty meats and added fats along with refined carbohydrates and excess sodium while lacking whole grains, fruits, and vegetables, has been blamed for the obesity epidemic and many lifestyle related diseases. However, other patterns of eating that incorporate foods of animal origin, such as fish, eggs, and lean meats, AND ALSO include nutritious plants and grains may be healthful diets. On the other hand, just because a diet does not contain animal products does not mean that it is healthy. You could subsist on potato chips, Oreos, and Coke and still call yourself a vegan. A low-quality vegetarian or vegan diet made up of mostly processed grains, sugary foods, and refined fats may not be any better than the standard American diet, though most people choosing to avoid animal products have a healthier bent. It is much harder to answer the question as to whether a healthy vegetarian or vegan diet is better than a healthy diet that includes some meat.  Which brings us to the Plant-Based Diet. Strictly speaking, plant-based could just mean any food that is not animal in origin. Yet, the term generally refers to a diet that is BASED on whole foods that come from plants such as fruits, vegetables, whole grains, legumes (like beans), and whole nuts and seeds. Specific definitions of this concept vary. Some people define a plant-based diet as one that is strictly vegan. Some plant-based purists reject any refined or processed plant-derived foods such as flours or oils. Others are more lenient and allow for small amounts of healthy whole food animal products to be included. Whereas the terms vegetarian and vegan focus on what they don’t include - meat and animal products, the emphasis of plant-based eating is on what it DOES include – lots of plants! In my view, one can call themselves plant BASED, without eliminating anything, if the bulk of the diet is made up of whole plant foods. Just what is it about plant-based diets that might make them more healthful, preventing disease and perhaps improving longevity? Meat and dairy and eggs do contain saturated fat, which has been linked to increased risk for heart disease. Red meats and processed meats have been shown to contribute to oxidative stress. Eliminating these foods may give one a leg up. But it probably has a lot to do with what these diets DO include, rather than simply what they don’t. If one is not eating animal products, but still needs to eat the same number of calories as someone who is, they’ll necessarily be eating more plant-based foods in total than a meat-eater. If those foods consist of whole grains, legumes, fruits, vegetables, and healthy fats, they will be consuming a lot of fiber and nutrient dense foods providing all essential vitamins and minerals in sufficient quantities. Here are some other fun facts:
 So the message is eat more plants! Surprise. I did not have to get a Master’s in Nutrition to know that most people don’t eat as many fruits and vegetables as they know they should. The reasons are undoubtedly many and varied from dislike to lack of access. Some people believe a plant-based diet is more expensive than an omnivorous one, which may be true if you don’t cook, but whole plant foods are almost always cheaper than meat pound for pound at the grocery store. There’s also the misguided idea that eating organic produce is so important that if you can’t afford organic, you should skip it altogether. You will have to deal with your own demons if you are rationalizing avoiding fruits and vegetables entirely – you know who you are. But is it important to go full-on plant-based for your health? If your only reason for considering eliminating meat is health, it may be a great decision, but you will get no guarantees. My personal advice (although I’d love it if everyone became a vegetarian) is to exercise moderation when eating meat. I know people don’t like the term “moderation”. It sounds vague and wishy-washy and we want clearer parameters to work with. I wish the science was clearer here, but it rarely has definitive answers to seemingly simple nutrition questions: If non-meat eaters tend to be healthier than meat-eaters, does that mean I will be healthier if I stop eating meat? Maybe – it depends. What if I only eat meat one time a week – is my risk higher than if I never eat it? I don’t know. Does a plant-based diet need to be perfect to be effective, because if I know I can’t do it perfectly, maybe I shouldn’t even try at all! And that is where we end up if we need all or nothing answers. Moderation actually might be essential, simply because it is sustainable. Moderation is the expression that suggests do the best you can, but cut yourself a little slack.  My name is Lorelei Sturm. Some of you may know me as a yoga instructor with Chicago’s Neighborhood Fitness Centers. I am also a Registered Dietitian with a Master’s degree in Nutrition. CNF is committed to helping its members lead healthier lives by encouraging wellness and a healthy lifestyle in addition to fitness. So, what burning nutrition questions do you have? Let me know in the comments below.
  I'm Lorelei the resident dietitian with Chicago’s Neighborhood Fitness Centers. Some of you may know me as a yoga instructor, which I am, but I also have a Master’s degree in Nutrition. CNF is committed to helping its members lead healthier lives by encouraging wellness and a healthy lifestyle in addition to fitness. Let me know if you have any nutrition questions in the comments below.  I like to get my workouts done in the morning. It helps to wake me up, I don’t have to worry about fitting it in later, and I feel like I’ve already got one thing checked off my list before the day has really even started. But I’m not always sure whether I should work-out on an empty stomach or eat a little something to fuel the activity. Admittedly, the choice to eat or not eat before or after exercise and what types of food to choose is a matter of personal preference. If what you are doing feels right for your body, then there may be no reason to adjust your habits. But if you are looking to improve performance or are not happy with your current routine or are just getting started and would like a suggestion, here are a few things to consider. Our bodies can use 2 fuel sources for energy during exercise: carbohydrate and fat. We burn a combination of the two throughout the day, but in general, fat is burned when we are just sitting around or doing low-intensity activity and carbs fuel more intense exercise. Fortunately, our bodies store both of these macronutrients, which is why we can move even if we haven’t eaten for a while. We know all about the fat stores in our bodies, but did you know that we store carbs too? Glucose (the main carbohydrate building block) is stored in our muscles as glycogen, which is just a bunch of glucose molecules linked together. We also store some glycogen in our liver, which can be released back to our bloodstream as needed, such as when we are sleeping so our blood sugars don’t drop too low. The glycogen in our muscles can’t go back into the bloodstream, but the muscles can break it down to use for energy themselves. The amount of glycogen stored in muscles is directly related to how long it takes for a muscle to get fatigued. If you’ve ever heard of carbohydrate loading, the premise is that a week or several days before an event, athletes train their muscles to store more glycogen, so that while they are actually performing, the muscles have enough energy to sustain the exercise for a longer period of time. However, normal glycogen stores can generally fuel exercise of 60 to 90 minutes with no problem. When our muscles run out of glycogen, they have to rely on glucose coming from the bloodstream, so if your workout is more than an hour, you may need to eat something so those muscles don’t run out of steam.  If I am just jogging for 45 minutes at moderate intensity at the beginning of the day, I don’t need to eat ahead of time because the muscles should have enough glycogen to keep my legs moving that long, right? Honestly, I do it all the time, and I’m fine, however if you haven’t eaten since the night before, your liver glycogen is depleted. With no food coming in, your blood sugar level could be low. Low blood sugar means not enough fuel for the brain, which can cause you to feel tired and lightheaded and can interfere with running for reasons other than muscle fatigue. Therefore, eating a little bit of carbohydrate food, like a banana, or fruit, or toast could be helpful. I hear you’re supposed to do yoga on an empty stomach – is that true? As a yoga instructor, I admit to feeling uncomfortable during class if I have eaten a meal too recently. Yoga involves moving your body in lots of different ways. Laying on your belly, twisting, and back bending don’t feel good with a full stomach. However, if you are doing a vigorous practice and haven’t eaten in many hours, low blood sugar could put you at risk of losing your balance or passing out. It’s important in yoga as well as other forms of exercise to balance comfort with safety. You don’t have to eat a lot to perk up your blood sugar – just half a granola bar or a small orange is plenty. When it comes to running, the motion of it can shake things up inside, so eat something easy to digest, low in fiber and fat, both of which can slow digestion. If you’re going for a bike ride, you might be able to eat a heavier or larger meal since your belly will remain relatively stable during the ride. On the flip side, if you are doing a Tabata workout or sprint drills, very high intensity exercise can pull blood flow to muscles and away from the digestive system. Anything you eat may not be able to digest at all causing GI issues as it sits in your stomach.  When I am exercising, I’d kinda like to burn some of that stored fat for fuel. Do I have to have used up all of my glycogen first? Maybe it would be better to eat fewer carbs so that I don’t have a lot of glycogen to start with and my muscles have to use fat. Some studies have looked at this idea to see if a low-carb high-fat diet might cause the body to use more fat stores during exercise, and it kinda works, mainly because you give the body no choice. But turns out that performance fueled by fat rather than carbohydrate is not improved at all, and there are some other negative side effects to a high fat diet. In reality, the type of energy you burn has more to do with the type of exercise you are doing than the type of food in your diet. As I mentioned earlier, we tend to burn more fat with lower intensity exercise such as walking, though the lower intensity also means we burn fewer total calories. Ultimately, creating a calorie deficit each day will burn fat in the long run, whether you are actually burning it during your exercise session or not. Okay, but what about a gym training session that involves mostly resistance exercise? Should I do anything different? Muscles are made of protein, so if you’re breaking them down in training, you want them to rebuild. Eating protein before a workout may provide a ready supply of amino acids to replete muscles as they break down. However, you still need carb to actually fuel the muscles, and eating too much protein only causes the body to use it as a fuel source, which is inefficient. So having a small meal or snack that is balanced in carb and protein and low in fat is the standard recommendation. After a workout, think about trying to replace what you have broken down or used up in the exercise. If you’ve used up your muscle glycogen stores, you need carbohydrate to replete them. If you’ve broken down muscle (which can happen during any exercise in which you are bearing your body weight), some protein can help rebuild it. Chocolate milk is often suggested as the perfect post-workout snack because it offers proteins (casein and whey) as well as carbohydrates (lactose from the dairy and likely sucrose as a sweetener). Here are a few other easy post-exercise options:
Athletes training to improve performance may need to be much more deliberate about meal composition and timing. But even if you are a recreational exerciser, eating intentionally before and after a workout may help you to get the most out of it. If you’re going to put in the time, fueling properly could assist you in feeling energized during activity, leading to improved results. And refueling afterwards can support your recovery, helping you to feel great the rest of the day as well.  My name is Lorelei Sturm. Some of you may know me as a yoga instructor with Chicago’s Neighborhood Fitness Centers. I am also a Registered Dietitian with a Master’s degree in Nutrition. CNF is committed to helping its members lead healthier lives by encouraging wellness and a healthy lifestyle in addition to fitness. So, what burning nutrition questions do you have? Let me know in the comments below.
 They say low-fat is where it’s at. Fat-free is even better. Omit ALL glycerides, And you’ll look great in that tight sweater. Low-carb’s the way, is what they say. Eschew all foods with starches. So skip the bun and French fries When you patronize the arches.
 They warn that gluten makes you ill And causes stomach pains. Take one more step, just to be safe, And go against all grains. For low BP, no MSG Or salt should touch your dish. Though pesticides may taint your greens, And mercury your fish. Garlic makes your breath stink. Legumes will give you gas. Tea has tannins, so does wine. Don’t pour them in your glass!  And eggs have high cholesterol. (Cholesterol is bad) Meat’s full of saturated fat. Plus, killing pigs is sad. Dairy is a nightmare Full of hormones and cow tears. Beware antibiotics! No milk can calm your fears.  Soy increases estrogen. Most corn is GMO. There must be something wrong with peas, But what, they don’t yet know. I’m paranoid, so I avoid All foods they say might stun me. I am the queen of eating clean, But I am really hungry! Lorelei Sturm If you can relate, you are not alone. When it comes to advice about health and nutrition, there is SOOO much information out there, easily accessible via internet. Much of it is delivered passionately with a rigid point of view and tons of reasons why what THEY SAY is right and everyone else is wrong. It is impossible to believe and follow everything all at the same time, but also difficult to ignore advice and suggestions that sound really convincing. Here are a few questions to ask yourself when offered nutrition advice:
If you have a hard time distinguishing practical, down to earth recommendations from bogus or simply trendy ones, don’t go online! Ask your doctor, or better yet, a qualified dietitian. Doctors can and will give dietary advice, but most get very little nutrition training in medical school. And look, you probably already know there is no magic bullet when it comes to losing weight or building muscle or living a longer healthier life. It’s a process of making sensible choices over time.  My name is Lorelei Sturm. Some of you may know me as a yoga instructor with Chicago’s Neighborhood Fitness Centers. I am also a Registered Dietitian with a Master’s degree in Nutrition. CNF is committed to helping its members lead healthier lives by encouraging wellness and a healthy lifestyle in addition to fitness. So, what burning nutrition questions do you have? Let me know in the comments below.
 This coronavirus doesn’t appear to be going away anytime soon, and despite masks and distancing, it seems likely that a high percentage of people may eventually be exposed to it. There may be a vaccine someday, hopefully some drugs and treatments will help with symptoms and keep people from dying. But is there anything that we should be doing nutritionally to keep us from getting really sick? Some medical experts are actually looking into certain micronutrients such as Vitamins C and D and Zinc, so I wanted to share with you my thoughts as a dietitian based on the science.
Many of us have been brought up thinking that Vitamin C can help treat the common cold, leading us to stock up on OJ and EmergenC when we get the sniffles. Studies have actually shown that though people who regularly supplement with Vitamin C may experience fewer days of cold symptoms, they are not less likely to catch a cold, and taking Vitamin C when you first notice symptoms does little or nothing to reduce the length or severity of the illness(1). But it’s pretty ingrained in our belief system, so no wonder many store shelves have been emptied of Vitamin C supplements this season. Zinc is a similar story – lots of people think it helps, but the science isn’t super supportive of that idea. Coronavirus is different from a cold or the flu though, so research is currently being done to see if either could play a role in supporting immunity to keep people healthier. We’ll see! Vitamin D seems a little more promising at this point. Vitamin D is mainly responsible for maintaining blood calcium levels in the body, but it does a bunch of other things as well, including supporting the immune system and preventing inflammation. Some studies have been done in the past to see if taking Vitamin D might keep people from developing the flu with mixed results(2). However, D has specifically been shown to protect against acute respiratory infections, which is noteworthy considering COVID-19 seems to be attacking people’s respiratory systems. Our bodies can make Vitamin D when our skin is exposed to sunlight, which is historically how we have met our D needs. Interestingly, most flus including COVID-19 begin to spread during winter months when there is less sunlight. People’s ability to make Vitamin D from sunlight declines with age, so lots of older individuals have low Vitamin D levels, and older individuals also tend to be more at risk for bad outcomes with COVID-19. These parallels could be purely coincidental, but again, researchers want to know if there might be an actual relationship between Vitamin D levels and susceptibility to the virus. I looked up a few recent studies to understand what the thinking is, and here is what I found:
**correlation does not equal causation The bottom line for these studies is that more studies need to be done. It’s not that they don’t have anything to show for themselves, but usually it is something like “hey, this is what might be happening, let’s come up with a better study to really test this idea.” COVID-19 is very new, so randomized clinical trials (the gold standard), which could test whether or not increasing vitamin D intake could actually benefit infected patients, just haven’t happened yet. However, according to one research team, “Vitamin D has already been shown to protect against acute respiratory infections and it was shown to be safe. It should be advisable to perform dedicated studies about vitamin D levels in COVID-19 patients with different degrees of disease severity(5).” So, we don’t know yet if Vitamin D is going to be any help in the fight against COVID-19, but Vitamin D is a nutrient of concern, pandemic or not. You need to get about 15 minutes per day of full sun exposure on your arms to meet the recommendation for Vitamin D for most people, which doesn’t sound like much, but nowadays we work inside or live in climates where there is little sunlight during winter months or slather on sunscreen to block harmful UV rays. Few people get enough vitamin D from sun exposure, especially during winter months. There are not a lot of food sources of this important vitamin. It is found in fish, egg yolks, liver, fortified dairy products, and irradiated mushrooms, but it’s hard to eat enough of these foods to get adequate D. For example, one egg has less than 10% of what a typical healthy person needs in a day, and some people may need more. Dietitians generally recommend getting vitamins and minerals through food rather than taking a supplement, but considering the above, supplementing may be necessary for some of us. If you can get a blood test to learn your Vitamin D levels, I would recommend finding out if you are okay, but the reality is, many people fall short of the mark. Here are few things to think about for yourself:
One of the recent studies I read about D and COVID-19 recommended people who are at risk get their vitamin D levels up by taking 10,000 IU (International Units) per day for a few weeks, and then going down to 5000 IU for a while. However, the tolerable upper level (TUL) for the vitamin is currently set at 4000 IU. Although doses up to 10,000 IU have not shown any negative effects, you don’t want to risk getting too much D! Its toxic effects are bad including calcification of organs. Dosing needs to be tested further to establish safe and practical guidelines. There are a couple additional points worth making:
So what does it all mean? Well, don’t get too excited about Vitamin D being the coronavirus hero, but it is something we should be addressing for our overall health anyway. If you choose to supplement, do some research rather than relying on labels when choosing a brand and a dosage. Personally, I had my blood tested a while ago, and my levels were a little low, so I get a bit of sun when I can and supplement above the RDA, but below the TUL. Done right, supplementing with Vitamin D won’t hurt us, and it might give us a leg up should we get exposed to COVID-19. Bummer that it took a terrible virus to get us to start paying more attention to Vitamin D. Here are some resources I used, in case you are interested:
My name is Lorelei Sturm. Some of you may know me as a yoga instructor with Chicago’s Neighborhood Fitness Centers. I am also a Registered Dietitian with a Master’s degree in Nutrition. CNF is committed to helping its members lead healthier lives by encouraging wellness and a healthy lifestyle in addition to fitness. Let me know if you have any nutrition questions in the comments below. 
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