Are you getting enough fiber?

Nutrition therapy for constipation in healthy people is soluble and insoluble fiber, as well as fluids. (IBS patients consult with your physician or RD prior to initiating as it could lead to more discomfort) Fiber is also known as the roughage or bulk of the plant that your body can’t digest or absorb. Most Americans only consume half the recommended amount of fiber, which is about 14 g for every 1000 calories consumed. Adult women should consume 25 grams of fiber, and men 38 grams, children from 19-25 grams of fiber. 

Soluble (fermentable) fiber foods dissolve in water and sources include fruits, barley, legumes, oats, oat-bran, and vegetables such as cucumbers and carrots. Soluble fiber attracts water and forms a gel, which slows down digestion. This can slow down the absorption of sugar in your bloodstream to help maintain stable blood sugar levels and help prevent type 2 diabetes. Diets high in fiber can reduce cholesterol by 2-3% and LDL cholesterol by up to 7%. Fiber binds with bile acid, while not undesirable themselves, require the body to use up more cholesterol to replace them, hence improving blood lipids.  

Insoluble (nonfermentable) fiber foods do not dissolve in water and sources are from whole wheat products, wheat and corn bran, and vegetables such as cauliflower, green beans, and skins of root vegetables. Insoluble fibers help “keep you regular” because the food absorbs water and passes through the GI tract relatively intact, which speeds up the passage of food and waste through your gut. 

The other added benefit I like is that it makes me feel fuller in my meal, so it can help cut down overall caloric intake. If you currently don’t take in a lot of fiber, beware to jump right in, rather you should look to increase about 5 grams every 3 days. There are cases where an overload of fiber causes constipation, gas and bloating, and possibly diverticulosis, which are "weak spots or pockets" in the wall of the colon. Conversely, getting too much may cause loose stools or diarrhea. Excess fiber may bind to iron, zinc, calcium, and magnesium and decrease their absorption.

How to get more fiber in your diet:

Add bran or powdered fiber to your smoothies, or the fiber sprinkles that you can add to almost all foods because it dissolves in liquids and soft foods. There are also many fiber food sources, and the top rich ones include: beans, bran cereal, split peas, brown rice, lentils, artichoke, sweet potato, edamame, whole wheat bread, Asian pear, raspberries, prunes, oatmeal, corn, banana, and avocado.

Where I can get 2 grams of fiber:

Apple-1 small, Orange-1 small, Banana-1 small, Peach-1 medium, Strawberries- ½ cup, Pear ½ small, Cherries-10 large, Plums- 2 small, whole-what bread 1 slice, All Bran- 1 Tbsp., Rye bread 1 slice, Corn flakes 2/3 cup, oatmeal dry 3 Tbsp., Shredded wheat ½ biscuit, Wheat bran 1 tsp., Grape-nuts 3 Tbsp., Puffed wheat 1 1/3 cup, Broccoli ½ stalk, Lettuce 2 cups raw, Brussels sprouts 4, Green beans ½ cup, Carrots 2/3 cup, Potato 2-inch diameter, Celery 1 cup, Tomato 1 raw, Corn on the cob 2 inch, Baked beans canned 2 Tbsp.

Tips:

• Start your day with whole grains. Look for whole-grain cereal or oatmeal with 3 or more grams of fiber per serving. 
• Try whole-grain bread and crackers
• Include fruits like apples or pears (both leave skin on) with peanut butter as your afternoon snack, or add raspberries, blueberries, strawberries, or blackberries on top of your fluffy pancakes or in cereal. 
• Add flaxseed for fiber. The seed of the flax plant can be an excellent source of fiber, providing 2.8 grams per tablespoon of whole seeds. Flaxseed is often used as a laxative, but studies have shown that it also may help reduce cholesterol levels and decrease hot flashes. 
• Add high fiber veggies like artichoke hearts and corn in your pastas, or include beets, celery, raw broccoli to your mixed salads or soups.
• Adding beans to your tacos or rice dishes, eating veggie chili versus meat-based, or spread hummus (chickpea puree) on your sandwich instead of mayo.
• Drink plenty of water throughout the day.

You can read more on fiber at http://www.mayoclinic.com/health/fiber/NU00033  and see more fiber-rich recipes at on http://www.foodnetwork.com/recipe-collections/high-fiber/index.html. 

Screen this too!

October we recognize Breast Cancer Awareness month. I love seeing the husky NFL players with flashes of pink on their uniforms in support to raise awareness for women to get their mammograms and to support research cure funding. March is Colon Cancer Awareness month (blue is our color). I run the Colon Cancer Awareness 15k and support their charity awareness, but we can only do better to raise the awareness about colorectal cancer and getting colonoscopy screening. It’s not March, but since we are thinking about breasts, lets think about our bottoms. As the Colon Cancer Alliance says “Think Pink. Go Blue. Screen this too.” 

Colorectal cancer is cancer of the colon or rectum. In the US, it is the 3^rd most common cancer in adults and is also the 2^nd most common cause of cancer death. This year, over 142,000 people will be diagnosed with colorectal cancer and an estimated 50,800 will die of the disease.

Factors that increase the risk of colorectal cancer include family history, long-term presence of IBD, familial polyposis, adenomatous polyps, and several dietary components. Polyps are considered precursors of colon cancers. Patterns of dietary practices may be more predictive of the risk of developing colorectal cancer. These factors include increased meat, fat, and alcohol intake. Obesity is a major risk.

Protective:

Adequate intake of Vitamin D, folate, calcium, plant based foods, high fiber grains, omega-3 fatty acids can be beneficial in prevention as well as the use of aspirin. Nonsteroidal anti-inflammatory agents have also been shown to help prevent colon cancer, but benefit of long term use needs to be weighed against the increased risk of developing stomach or intestinal ulcers as well as major gastrointestinal bleeding. The use of prebiotics and probiotics reduces toxic and genotoxic compounds that may contribute to carcinogenesis, and regular use should be considered for digestive health. Regular exercise as well as limitation of alcohol is also a good preventative strategy.  

Colonoscopy screening:

This procedure involves the physician inserting a flexible tube with a camera (scope) on the end into the rectum and advancing the scope around the colon. The physician applies air to fully inflate the colon while withdrawing the scope back through and at same time looks at the video images from the scope searching for polyps (pre-cancerous growths) in the colon. If polyps are seen, they would also be removed at the same time by biopsy forceps or a cutting wire that is looped over the polyp. All samples are then sent to a pathologist determine potential cancer risk. The polyps will either be benign or pre-cancerous. These results will in turn determine the appropriate timing for a repeat exam. The timing can be 6 months-10 years (average is 5 years) for a repeat exam, and this can vary depending on personal and family risk factors, the size of the polyp, the pathology of the polyp and the quality of the cleaning preparation of the colon.

More than 90% of all colorectal cancers are found in people who are 50 and older. For this reason, the American Cancer Society recommends you start getting checked for this cancer when you are 50. People who are at a higher risk for colorectal cancer—such as those who have colon or rectal cancer in their families—may need to begin testing when they are younger. You should ask your primary doctor or your gastroenterologist the appropriate time to get started.

You can read up further on www.coloncancer.org or www.ccalliance.com

Runner’s GI distress

It’s almost time for THE marathon in NYC. If you lived here in the city, you can’t miss the hordes of runners in Central Park and West Side highway getting their training miles in these last few months, or the over 40,000 marathon runners who take over the boroughs the first weekend of November.

I want to discuss three uncomfortable and slightly embarrassing GI issues a long-distance runner may have or will face.

Runner’s trots

‘Runner’s trots’ is a friendlier name for runner’s diarrhea that affects distance runners by an urgent need for a bowel movement mid-run. The cause is controversial, one theory is the enzyme that is known to increase peristalsis (the food-pulsing of the large intestine). Another potential etiology is bowel ischemia, the process where the body shunts blood to running legs and away from the digestive organs, causing them to reject what they can’t digest. Diet is also a common cause. Runner’s diarrhea will clear up from several hours to a few days after running. As the case with diarrhea of any cause, electrolytes and fluids will need to be replaced. These tips might be useful for you: Cut down on eating the night before the race from 5pm on, except for something light (toast) or pretzels. Avoid fat,  high fiber foods (fruit, vegetables, legumes) and caffeine. I try to eat basic and bland (no Indian food, no seafood). I like quinoa and a few slices of turkey breast or homemade pasta with very little tomato sauce and French bread. Drink plenty of water (close to 64 ounces). Choose foods that are naturally constipating such as bananas, plain bagels, rice, oatmeal, and pasta. For the day of the race, get your breakfast in as soon as you wake up to allow at least 2 hours of digestion. I like small portions of either a slice of bread and peanut butter or 1/4 of a plain bagel with Gatorade to drink. Make sure you aren’t eating anything that’s “new” to your body, I had a friend who tried a new carbohydrate gel during our half marathon that didn’t agree with her. Make sure to sample out your gels, blocks, or sports drinks ahead of time to determine the best fit for you.

Hemorrhoids

Hemorrhoids or ‘roids are painful or swollen internal or external varicose veins in the rectum. The internal ones can bleed a lot, and the external are seen and extremely painful. It is common for runners to get hemorrhoids, just like the common patients who get them (obesity, pregnancy, older age). Dehydration and long exercise can lead to constipation, so it is important to drink plenty of water leading up to your running, and after to refuel. You may want to run with a Camelback or a water bottle during your run, especially on hot or humid days to assure hydration. Eat enough fiber (beans, fruits, broccoli, oat and wheat bran) or a fiber supplement (Metamucil). Also try to avoid straining or spending too much time on the toilet with bowel movements, as this increases your risk of hemorrhoids. If you are a toilet reader, stop now before it is too late! Hemorrhoids can be treated by surgery or by an outpatient banding procedure in a GI office. Trying over the counter meds such as Preparation H and soaking in a warm bathtub once or twice a day can also alleviate them.

Runner’s colitis

Runners colitis is associated with Ischemic colitis. This is a medical condition where inflammation and injury of the large intestine results from inadequate blood supply, usually due to dehydration and limited blood flow to the intestines during intense exercise. The symptoms may include mild to severe cramping, diarrhea, nausea, and bleeding. The bloody diarrhea is the intestine sloughing off its’ inflamed lining. Patients are usually treated with IV fluids, pain medicine and bowel rest, so no food or water by mouth until the symptoms resolve. Those with severe ischemia can develop complications such as sepsis, intestinal gangrene, or bowel perforation and may require more aggressive interventions such as surgery.

I personally have experienced runner’s colitis and it is very painful. I finished a half marathon in 1:37, and I’ve never been so sick. The amount of blood that came out of me was extreme and nothing made me feel better for 24 hours. I made a poor decision to compensate my late night party the prior evening by taking an Adderall before my race to wake me up. I found out later from my GI doc that I basically shut my lower organs down during the 90 minutes. I was surprised there are not more cases of this reported, but it could also be summed up as dehydration (which is effect of Adderall).

While running is a great exercise for our body and our minds, we should be mindful that long endurance running requires us to pay extra attention to nutritional preparation and hydration.

Happy running and good luck marathon runners.  





(That's me puffing through the finish of a half-marathon)




Further readings:
  http://www.mayoclinic.com/health/ischemic-colitis/DS00794
http://www.hindawi.com/crim/gastrointestinal.medicine/2012/356895/

On gluten and wheat

Celiac disease, gluten, gluten sensitivity, and wheat allergy

Last week at bookclub, the conversation turned to adopting a gluten free diet. My one girlfriend tried it out last year to see if it would help her then GI problem. (She actually ended up having a parasite from traveling to India). She told us she wanted to give it a try again to help with her fogginess and current GI issues. Of the group there were so many questions on gluten vs. wheat vs. Celiac disease vs. allergies. I broke this down in three segments:

Celiac disease

One out of every 133 people in the US has celiac disease. People with Celiac disease (CD) are food sensitive, not allergic, and these patients can’t consume the protein gluten because it causes their body to generate an autoimmune response that causes damage to the villi in the intestine. Over time the reaction wears down the villi that line the walls of your intestine called villous atrophy. Damage to the villi impairs absorption of nutrients from food. Digestive problems are more common in infants and young children, which may include chronic diarrhea, vomiting, constipation, weight loss, and addition symptoms of growth retardation, ADHD, headaches, and skin rashes. Adults may experience the same digestive symptoms and are more likely to experience different extra-intestinal manifestations of the disease including: unexplained iron-deficiency anemia, fatigue, bone or joint pain, arthritis, numbness or tingling sensations in the extremities, depression, bone loss, infertility, canker sores in the mouth. The diagnosis involves blood tests for gluten antibodies and a small bowel biopsy to access gut damage. The only treatment is a gluten free diet, so patients must avoid wheat, rye, barley, triticale (a cross between wheat and rye), and sometimes oats if cross-contaminated.

Fortunately, grocery stores and restaurants are becoming more accommodating to these patients. I've been to so many groceries that have half of an aisle dedicated to gluten-free products including gluten free beers, and on many restaurant menus, I now see several gluten free options including gluten free pasta and pizza.

 Celiac disease: condition that damages the lining of the SI and prevents it from absorbing nutrients from food that is a reaction from wheat, barley, rye.

Foods to avoid: wheat, barley, rye, triticale, sometimes oats.  

Foods to enjoy, all plain: meat, fish, rice, fruits, vegetables, beans, corn, white/brown/wild rice, nuts and seeds

Sub for wheat: potato, rice, soy, amaranth, quinoa, buckwheat, bean flour

Hidden: sharing the toaster, medications, chapstick, makeup, lotion, shampoo 

Gluten free drinks to order at the bar: Wine, Brandy, Champagne, Gin, Cognanc, Tequila. I read these drinks are safe according to their website, Bourbon Makers Mark, gluten free vodkas including Ciroc, Titos, and Chopin.  

Non-celiac gluten sensitivity

This is less of a diagnosis but more of a description of the patient who does not have the immune response and intestinal changes characteristic of CD but still experiences certain nonspecific symptoms oftentimes seen with CD. There is still research developing, but it hasn’t been established what causes gluten sensitivity. It has been confirmed that certain genetic mutations present in CD are not seen in these patients. Gluten sensitivity symptoms include: nausea, abdominal cramping, bloating, gas, or diarrhea after ingesting gluten, rashes, brain fog, headaches, depression, joint pain, and numbness in extremities. Patients visiting their GI doctors will be administered a celiac disease testing to first rule out CD.  They may choose to still follow a gluten-free diet to see if this helps with their complaints. Patients should be generally advised against following a gluten free diet without having a workup to exclude or confirm CD, because there may be an underlying medical condition where gluten free is not the treatment. 

Gluten sensitivity or gluten intolerance: a reaction to gluten but is not associated with the intestinal damage that characterizes celiac disease.

Patient may choose to follow a gluten-free diet after ruling out CD from GI doctor. 

Wheat allergy

Celiac disease or gluten sensitivity is not a wheat allergy. A wheat allergy generates an allergy-causing antibody to proteins found in wheat. Celiac disease is a reaction to one particular protein, the gluten, which causes an abnormal immune system response in the small intestine. A wheat allergy is common in children and tends to resolve by adulthood. Symptoms include swelling, itching, irritation of the mouth or throat, hives or rash on skin, cramps, nausea, vomiting, and difficult breathing. Blood testing can also be performed to screen for this particular allergy, however, a skin test is a more sensitive diagnostic tool used to confirm wheat allergies.

Wheat allergy: allergy-causing antibody to proteins found in wheat

Mostly found in children and grown out of by adult age.

Wheat free alternatives: Amaranth, barley, buckwheat, chickpea, corn, lentil, millet, oats, quinoa, rice, tapioca.

About 20% of children are also allergic to other grains. It is important to ask your doctor if foods containing barley, oats, and rye are safe to enjoy

Sources: Dr. Patrick Saitta, Gastroenterologist with Concorde Medical Group, NYC

http://www.celiac.com/categories/Allergy-vs.-Intolerance-%252d-What-is-the-Difference%3F/