Dietary Considerations - Carolina Total Wellness

March 17, 2023March 19, 2023

How to Talk About Food

Erica Nelson, MSPH, NBC-HWC

Here, at Carolina Total Wellness, we often recommend dietary adjustments to treat a wide variety of symptoms. Many of our patients come to us for guidance, asking ‘What is the healthiest diet?’ And the truth is, the ‘healthiest diet’ is unique to the person eating it.

One patient may get itchy and congested when they eat and need to reduce or eliminate foods that may increase or contain histamines like leftovers and peanuts. Another patient may have intestinal permeability and need to eliminate identified sensitives to gluten, oats and eggs. Yet another may be concerned about their family history of Alzheimer’s disease or cancer and need to make a variety of other adjustments.

Regardless of health status and dietary needs, most of us prefer sharing meals with our friends, family and coworkers over dining alone. Sometimes even a simple lunch can be a source of concern when a well-meaning aunt or friend asks about your ‘crazy diet.’

Over and over again, patients tell me that eating with their families is a barrier to successfully making the adjustments necessary to improve their health. Here are some strategies to enjoy eating the food that nourishes your body with the people that nourish your soul (and even some people that don’t):

Know your why. Get clear on why you are making the changes. And practice your responses ahead of time. When you know exactly what you are trying to accomplish with your food, it is easier to make good choices and much harder for someone else to convince you otherwise.

Have a short ‘elevator pitch’ prepared. Something like, ‘I wasn’t feeling my best recently and, after talking to my doctor, I am focused on eating foods that nourish my body and soul like (name a few key foods you’re enjoying eating.)’ And then mention a positive outcome like. ‘You wouldn’t believe how much better I am sleeping!’

Have at least one person fully in your corner. As part of your preparation for making these changes, make sure you talk to a trusted friend or partner that will be your support-person when the going gets tough. No matter how committed you are to health changes, there will be days when you don’t get enough rest or you have a bad day at the office. On these days, even strong-willed, prepared ‘you’ can have a tough time remembering your ‘why’ and the ‘Can’t you have just one bite?’ question may be coming from inside your own head. On these days, call this person and tell them that you are considering deviating from your plan.

Project confidence. Add a big smile to your ‘No thank you’ and you’re less likely to get pushback or hear ‘Can’t you have just one?’ Know your restaurant order before you go and say it confidently. ‘I’ll have the burger, no bun, no cheese, extra lettuce and the spinach salad on the side, please.’

“Girl (or boy,) stop apologizing.” Rachel Hollis made this phrase famous with her book by the same name. She was right, though. There is no need to apologize for doing what is right for your health and/or sanity. Try replacing ‘I’m sorry’ with ‘Thank you.’ For example, instead of ‘I’m sorry to inconvenience you,’ try ‘Thank you for accommodating for my gluten/dairy/egg/sugar sensitivity.’

Boundaries. Some people have no trouble with the sentence ‘no.’ But for many, it is easier to please the people around you and silently suffer your own consequences later. This can be exhausting and lead to difficulty knowing what you wanted in the first place. Know where your line is and don’t let anyone tempt you to cross it. Remember that everything you say ‘yes’ to is a ‘no’ to something else.

It is okay to make inappropriate people uncomfortable. If, for example, someone makes a comment about your body composition or fertility, it is not only okay to make them uncomfortable, but also brave and good. Saying ‘That’s inappropriate’ could keep them from bestowing their judgement on another undeserving person.

The health coaches at Carolina Total Wellness are here to support you in your personalized health care journey.

Your Partner In Health,

Erica Nelson, MSPH, NBC-HWC

February 14, 2023March 9, 2023

Chocolate: The Good, The Bad, and The Ugly

Frances Meredith, MD

For many Valentine’s Day brings with it thoughts of chocolate. February is both American Heart Month and National Chocolate Lovers Month, a brilliant combination as the nutrients within chocolate can help to improve heart health. Let’s dig into the good, the bad, and the ugly of chocolate.

Dark chocolate is rich in polyphenols, specifically flavonoids, the substances that have a wide range of health benefits. These include lowering blood pressure, improving the function of our vascular endothelium (the inner walls of our arteries), protecting skin against sun damage, improving blood flow to the brain, and reducing the risk of cardiovascular damage. Dark chocolate has also been proven to help with mood. These benefits come from chocolate’s ability to promote production of the vasodilator Nitric Oxide as well as the anandamide within, a cannabinoid compound (like CBD) that binds to receptors in the brain to alter mood and brain activity. In addition, methylxanthine compounds, such as theobromine and caffeine, are powerful antioxidants. Remember that these are stimulants as well and should be kept far from your bedtime.

As milk chocolate has a much higher sugar content and lower flavonoid content, dark chocolate, at least 70%, is the best choice. Know that white chocolate has no flavonoids, and hot chocolate mixes have very low amounts. As even dark chocolate has sugar, limiting daily intake to 1 oz of at least 70% dark chocolate is the best choice.

There is however, a DARK side to chocolate: heavy metals. Lead and cadmium have been known for many years to be elevated in chocolate. Consumer reports has recently reported their results of batch metals testing of multiple brands of chocolate. They have confirmed levels of metals in many brands of chocolate that exceed California Proposition 65 standards, specifically for lead and cadmium. These metals are associated with multiple health issues in both children and adults. The risk is highest for young children and pregnant women as metals have a negative effect on brain development and IQ. However, even outside this patient population, accumulation of metals in the body can cause a wide range of health conditions including kidney damage, elevated blood pressure, immune and hormonal disruption, and central nervous system dysfunction.

Now why would metals be in our chocolate? For cadmium, the cacao plant absorbs the metals from the soil and levels accumulate in the beans. Lead, however, gets in after harvesting, with levels rising as the beans dry and are processed. Highest levels are found on the outside of the bean, consistent with environmental contamination.

So…. should we give up chocolate? My vote is a resounding NO! The “Yum” and “Aaaaah” response to chocolate are undeniable, and the health benefits are substantial and backed by science. The Consumer Reports study gives us guidance as to which brands of dark chocolate are lowest in metals. See the report for details where one bar each from Mast, Tatza, and Valrhona, and two bars from Ghirardelli have relative low levels of both cadmium and lead

https://www.consumerreports.org/health/food-safety/lead-and-cadmium-in-dark-chocolate-a8480295550/

From the Functional Medicine perspective, food is medicine. But the devil is in the details where purity, dose and timing make it medicine or poison. Choose your brand wisely, be moderate in your amount, and time your chocolate well away from your bedtime. And most of all: ENJOY!

Your partner in health,
Frances T Meredith, MD

January 4, 2023March 19, 2023

CGM’s

Sara Yadlowsky, FMHC

Many of us have too much glucose (blood sugar) in our system and are not aware of it. Glucose enters our bloodstream mainly through the sweet or starchy foods we eat. The conventional medicine community has taught for many years that unless you are diabetic or pre-diabetic your blood sugar levels are not important. However, more recent, cutting-edge science and the increased use of continuous glucose monitors (CGM’s) have proven that everyone needs to pay more attention to glucose levels. A CGM is a small device that attaches to the back of your arm and monitors blood glucose on a continuous basis. You can obtain a CGM through a prescription or purchase one online through websites such as Signos, Veri and Nutrisense. I wore a CGM for several weeks recently and found it very informative in understanding how my food choices affect my blood sugar levels. For example, I realized how breaking my fast with a low carb meal was very helpful in avoiding the spike that can occur after fasting for 16 hours.

Symptoms of uncontrolled glucose can include fatigue, food cravings and brain fog. Long term effects of uncontrolled glucose can include hormonal dysfunction, acne, wrinkles and infertility. Over time the development of type 2 diabetes, cancer, dementia, PCOS and heart disease can occur.

There are several easy modifications you can make to your diet that flatten the glucose curve that occurs after eating. These modifications include:

Eating fiber first. Have your vegetables before your protein and/or starch.
Ingesting apple cider vinegar before eating carbs
Avoiding sugar on an empty stomach. Have it after a meal instead.
Getting some type of movement in after eating a meal high in carbs. A walk or even just some air squats will do.

There is a new book out about blood glucose called The Glucose Revolution written by Jessie Inchauspe. The author goes into depth about the huge impact glucose has on our health. She then presents several ways to control our blood sugar more effectively. The book also includes tips on how to handle cravings, better choices in alcohol and how to read ingredient labels.

Jessie Inchauspe has an Instagram account (glucosegoddess) that continues the education on controlling glucose and gives lots of actional advice. This may help provide you with some motivation to jump start a healthier lifestyle in 2023. Our health coaches and physicians at Carolina Total Wellness are also always available to provide you with personalized advice on improved blood sugar control.

In health,
Sara Yadlowsky, FMHC

September 30, 2022November 28, 2022

Fall Detox

Susan Denny, MD, MPH

Hello Fall! It’s Time to Detox!

While consistent Fall weather arrives a little later in our area than the Autumnal Equinox, the lower temperatures and falling humidity have thankfully begun to emerge. This is one of my favorite times of year and one in which I reflect on the past year and look forward to the year ahead. In many cultures this changing of seasons is a time for celebration and reflection. It is also a great time for detoxification to help cleanse our bodies of unwanted toxins and prepare ourselves for the year ahead.

I have completed many different detoxification regimens over the years but one of the easiest and most effective ones I have tried is the Mung Bean Detox. This simple detox was shared with me by one of my favorite local chiropractors, Dr. Thomas Mitchell. Dr. Mitchell practices Ayurvedic medicine as well as chiropractic medicine at Mitchell Chiropractic Healing Center in Raleigh. The following information, instructions and recipes are from Dr. Mitchell and his wife, Lisa.

If you have questions about whether or not this diet or another detoxification program is right for you, please contact us at Carolina Total Wellness.

Yours in health,

Susan Denny, MD, MPH

The Fall Detox Plan:
By: Tom Mitchell, DC

Detoxification is one of the pillars of Ayurveda, the ancient medical system of India that is more than 5,000 years old. Whole mung beans are a legume that is common in Asia but is also widely available now in the US. Whole (green) mung beans. Whole mung beans have a scraping action, which supports the detoxification process. More specifically, they cleanse the colon, liver, kidneys, and lymph system. Mung beans are also much easier to digest than other legumes such as lentils and hard beans, which include pintos, black beans, and chickpeas.

The Benefits of a Mung Soup Food Plan

Improved digestion
Reduced inflammation
Pain reduction
Strengthened metabolism and weight loss
Improved energy, enthusiasm, and stamina
Reduced congestion
Greater mental clarity
You never go hungry!

Many patients lose 6 to 8 pounds in one week. Follow-up labs often show measurable improvement in cholesterol, triglycerides, and blood sugar/insulin resistance. Many patients experience lowered blood pressure as a result of the program.

The Food Plan

The simplest form of the food plan is to make a pot of Mung Soup daily cooked with vegetables right in the same pot. You can make this dish in a standard pot, standard pressure cooker or Instant Pot. Eat this food for five to seven days, at least two times a day (lunch and dinner) but preferably three times. (If you don’t enjoy a savory breakfast, it’s fine to have some organic cooked oatmeal, but not the instant variety.) Focus on easy-to-digest foods such as squashes and greens of all kinds. A little bit of green beans and a little sweet potato is also fine. A small amount of white basmati rice is considered better for a detox than brown rice; just eat enough to complete the protein of the beans and ensure that you feel adequately fed.

During the detox it is essential to avoid gluten, dairy, and refined sugar as well as all animal foods. The major emphasis is staying on a plant-based diet (except for the use of ghee, clarified butter). Plant-based meals are easier to digest, which supports the detoxification process. We also recommend that you avoid inflammatory vegetables such as nightshades (tomatoes, eggplant, peppers, chilies, white potatoes) and gassy vegetables such as the cruciferous vegetables and okra.

For people who can make a little extra time to cook—and who want a more diversified diet—we offer some delicious vegetable soup and side dish recipes to complement the mung soup. You can make Quick Sauteed Asparagus in about 5 minutes, or a luscious Asparagus Soup with leeks and fresh tarragon. One of our favorites is a Vegan Collards recipe with smoky salt. You will find all these recipes on Lisa’s Sacred & Delicious Blog. You can also buy a copy of her cookbook Sacred & Delicious: A Modern Ayurvedic Cookbook, with 108 gluten-free recipes at Amazon, only available today in Kindle (reprint date TBA). The book won five national book industry awards in 2019. You can sign up for Lisa’s blog to receive new recipes at www.sacredanddelicious.com/blog.

June 3, 2022August 2, 2022

Health Coaching

Erica Nelson, MSPH, NBC-HWC

The legendary basketball coach, John Wooden once said, “A good coach can change a game. A great coach can change a life.” At Carolina Total Wellness, our coaches help our patients change their lives every day.Every patient at Carolina Total Wellness that sees a doctor or physician assistant is paired with a health coach. Some patients may also choose to work solely with a health coach to achieve their dietary and lifestyle goals. This article will help you know what to expect when you work with a health coach.

Here are 3 key aspects of the health coaching experience at Carolina Total Wellness:

The Space Between
Health coaches hold space for you to pause… and decide how you want to respond to your circumstances. The world today is a seemingly relentless onslaught of stimulation, and it can feel like there is an urgency to react to all of that stimulation.

George Mumford, meditation coach to Michael Jordan, LeBron James, Kobe Bryant and other world-class athletes offers another way, ‘Think about the eye of a hurricane.’ He says, ‘No matter how intense the storm or what’s swept up in its gale-force winds, that calm, blue center is always there. We all have this quiet center within us.’ Your CTW coach will help you respond from that quiet center within, rather than reacting from the chaos of the storm.

In our office, health coaches hold space for you to make sense of what is going on in your world and in your body and decide how you want to respond. Health coaches always honor the fact that you are the expert on your own life and display unconditional positive regard for you and whatever lifestyle decisions you choose. They pay attention to what matters to you and may offer suggestions for adjustments that fit into your life.

Translator
The science of the body and its systems are the physician’s expertise. Science of behavior change is the coach’s expertise. Our coaches help you translate medical science you discuss with your doctor or PA into evidence-based behavioral change strategies to optimize your health. When you combine the medical knowledge of our physicians and PA with your coach’s expertise in the science of motivation, habits, and change, many of the barriers to experiencing health fall away.

Each of the coaches at CTW has at least a bachelor’s degree from an accredited university and training in coaching from either the Functional Medicine Coaching Academy or Duke University. Some of them also have master’s degrees and other specialized training in nutrition, exercise, counseling, and other relevant fields. Unless otherwise specified, CTW coaches are not registered dietitians, licensed mental health professionals or certified fitness professionals.

Guide
In the words of Michael Jordan, ‘A coach is someone that sees beyond your limits and guides you to greatness!’ CTW coaches come to the table with empathy for whatever you are facing and feeling and confidence in your ability to overcome. Each coach has faced their own struggles in life and knows what it is like to work hard to overcome. However, coaches never replace you as the expert on you; they serve as your guide on your journey to health. Coaches can help you understand all the different ways you can try intermittent fasting or yoga or what, exactly, is ‘glycemic index.’ Maybe our most important job, though, is to help you get very clear on your vision of the healthiest version of you. Once you decide where it is you want to go, coaches provide education, support and accountability to knock down any stumbling blocks that may come up along the way.

Call us today to schedule your appointment with one of our health coaches.

Erica Nelson, MSPH, NBC-HWC

February 4, 2022February 4, 2022

LENTILS “THE POOR MAN’S MEAT”

Didem Miraloglu, MD, MS

January 6, 2022January 6, 2022

Food and Mood

Blair Cuneo, PA-C

I think about many things this time of the year with seasons changing and holidays approaching. As a functional medicine provider, I consider how changing landscapes not only affect my patient’s physical health, but also their emotional health. This landscape or “environment” of less direct sunlight, more time indoors, increased celebratory food and drink and increased holiday stress has a major impact on mental health for many of us.

Our relationship with food is complex, as is our body’s response to our culinary selections. We hope that our bodies can effectively digest food and absorb its nutritious content, but how do we know if it doesn’t? We hope the foods we are eating are contributing to healthy neurotransmitter production, healthy immune system messaging, but what does it feel like if that’s not the case?

You’d think that your stomach would definitely let you know if any of the above was amiss, but consider this: approximately 30% of us will have a gastrointestinal/gut symptom if there are imbalances in digestion or immune activation, while the majority of us will have a “beyond the gut” symptom first, such as headaches, mood changes, sleep disruptions, fatigue and pain. Thus, the majority of people may not be thinking of a direct relationship between green bean casserole and their anxious or sad days.

Several things need to happen when we eat a meal. First, we need to be in a “rest and digest” state. This signals to the body it’s time to produce digestive acids, enzymes and bile to sterilize the food, break it down and absorb it well. Next, we need healthy proteins that can be broken down by these digestive supports to become the basic amino acids that our body will use as the building blocks to create neurotransmitters like dopamine and serotonin. Neurotransmitters are signaling molecules, providing communication between nerves. The balance of neurotransmitter production, absorption and clearance, affects mental and physical health. Further, this building of neurotransmitters requires cofactors of several micronutrients like zinc, vitamin B6, magnesium and vitamin D.

To cap things off, there can be immune system reactions to foods, allergies and/or sensitivities that are contributing to inflammatory messaging that starts in the gut, but travels “beyond the gut”, affecting our emotional state.

In my practice, I regularly see low levels these cofactors, low levels of digestive enzymes and gastric acid, high stress and of course, the daily challenge in regularly making healthy eating and drinking choices.

In order for a body and mind to be healthy, each of these areas needs to be considered, evaluated and addressed.

While there are objective tests available for providers to check your nutrient and digestive status, there are also excellent lifestyle supports to begin making a shift in your wellness today.

-Eat at regular intervals. It is less stressful for the body when it knows it can count on you to feed it. This also helps the timing of the digestive acids/enzymes release where there are patterns in meal timing.

-Whole foods. Limit processed foods. Head to the refrigerator, before you head to the pantry. Each meal should contain a protein, small amount of fat, and colorful fruits and vegetables.

-Mindful eating, not distracted eating. Try to avoid multitasking while eating. As often as you can, eat at a table, focused on your food and the company that you share. Look, smell, taste and chew well! Even the process of chewing is signaling release of enzymes.

-Connect with your healthcare provider to review your micronutrient and vitamin status. You might discuss multivitamin, magnesium and/or zinc supports and also test your vitamin D to help assign dosing recommendations.

Remember, Food can be medicine! Make sure you use it wisely!

Your Partner in Health!

Blair Cuneo, PA-C

November 15, 2021November 28, 2022

5 Strategies For Stress Eating

Stress eating occurs when we eat in response to a stress signal instead of a hunger signal. It is reaching for food to calm our nerves, soothe our sadness, chase away boredom or buffer against other emotions we are uncomfortable with.

When we stress eat we are usually reaching for sugary and/or salty foods. It’s often food we eat with our hands. Hand to mouth eating frequently occurs without much awareness or mindfulness.

Tips to Help Decrease Stress Eating:

1) Being Body Aware – This means getting in touch with your body. Get back into your body, get grounded, get centered. Are you truly hungry? Pay attention to what sensations are going on in your body. Has your heart rate increased? Do you have butterflies in your stomach? Are you feeling fragmented and disassociated in your body? Feeling out of sync between body and mind?

You can bring yourself back to center by concentrating on your breath. Put one hand on your chest and one on your belly and breathe in deeply. Is the breath going to the upper chest area or the belly? You want the breath to go into the low belly. By doing this you engage the parasympathetic system (aka rest and digest) and reduce the sympathetic system (aka fight or flight).

2) Exercise your emotional muscle – Emotions are energy in motion. Don’t be afraid to show your emotions. We need to let emotions flow and we need to express them. When we don’t do this we “eat our emotions” with food. Emotional eaters tend to eat foods that are nutrient poor (junk food) instead of nutrient rich (veggies, fruits, healthy fats, lean proteins).

Keep a check on your feelings. One way to do this is to check in with family and friends. Be real about your emotions as this allows others to feel comfortable to open up with you as well. Journaling is also a great tool for expressing your emotions.

3) Developing alternatives – Rather than engaging in stress eating come up with alternatives. Make a list of 5 things that you can do instead of eat when you are not really hungry but are craving food due to emotions. Some ideas: call a friend, physical movement, journaling, nap, read a good book, organize a drawer in your kitchen or bathroom.

4) Having healthy foods available – If you can’t fight the urge to eat, make the best choices with the cravings you have. Ideas: avocado for someone who craves fat, fruit for someone that craves sugar, cacao powder in water for someone who craves chocolate, olives for someone who craves salt.

5) Fueling your body with real food – Be sure you are getting lots of nutrients so you are not vulnerable to the effects of stress. Food modulates our mood and if we stick with whole unprocessed foods our mood will be better and we won’t feel as stressed.

Your Partner In Health!
Sara Yadlowsky, FMHC

August 29, 2021August 29, 2021

A Guide To Grilling Food

February 25, 2021August 28, 2021

Top 5 Heart Healthy Fats

1. Butter

It is a very common fat that everybody has (or should have from now on) in their fridge. As opposed to industrial trans fat, which increases the the risk of heart disease, the trans-rumenic acid called conjugated linoleic acid (CLA) is thought to decrease the risk for cardiovescular disease. CLA along with other natural trans fats as well as vitamin K2 are abundantly found in grass-fed meat and dairy products, which is why butter is a great source to maintain cardiovescular health and to prevent heart attacks.

2. Coconut Oil

Coconut oil currently has gained in popularity for all kinds of health remedies and benefits. The hype is justified and it definitely belongs in the kitchen and on this list! First of all, coconut oil is one of the best oils to cook with as it is with more than 90% almost entirely saturated. Its chemical structure stands out to other fats and oils in our diet, which has a significant effect on the body and the heart. Coconut oil is composed of a special type of saturated fat called medium chain triglyceride (MCT). This structure makes the oil special because the vast majority of fats and oils we consume are composed of long-chain fatty acids (LCFA). In fact, both the saturated and unsaturated fat found in meat, eggs, milk, and plants consist of LCFA.

That means that most of the western world gets way too much of these fats and not enough of the MCFA’s that are found in coconut oil.

Why does that matter? Because of its shorter chemical composition, MCFA’s are absorbed with ease without requiring pancreatic enzymes to break them down. This means less work for the pancreas and the fatty acids can go directly to the liver from where they go into the mitochondrias and are immediately utilized for energy. The best part is that coconut oil makes our heart happy by protecting it from heart disease as well as lowering the risk of atherosclerosis.

3. Duck Fat

Just like butter, duck fat is packed with the favorable CLA’s and natural trans fat that were found, in animal studies, to prevent fatty streaks and plaque formation in the arteries of rodents by changing macrophage lipid metabolism.

Another statistic, however, shows that the same effect seems to apply for humans as well. According to the World Health Organization’s Multinational Monitoring of Trends and Determinants, in the United States, of every 100,000 middle-aged men, 315 die of heart attacks each year. However, in the Gascony region, where duck liver is a steady part of the diet, this rate is only 80 per 100,000. A great statistic for the consumption of duck fat and the relation to a healthier heart!

4. Leaf Lard

This fat is a highly popular fat in the kitchen of every celebrity cook. For good reason! Lard is a very stable fat which makes it an excellent choice for frying. Morover, it has a higher smoking point than other fats therefore it is excellent for cooking in general. It is gained from the visceral fat deposit that surrounds the kidney and loin and because of its little pork flavor, leaf lard is considered the highest grade of lard.

Nutritionally speaking, lard is composed of more than twice the monosaturated fat and nearly one-fourth the saturated fat than butter. In addition to that, it is also low in omega-6 fatty acids, known to promote inflammation, which is good news for a healthy heart.

5. Ghee

Ghee, a great fat for cooking, taste, and cardiovescular health. It is made from butter, however, the milk solids and impurities are removed, which makes it consumer friendly for everybody, including people who are lactose or casein intolerant.

Just like coconut oil, it is composed of medium chain fatty acids (MCFA), which are directly absorbed to the liver and burned as energy. Besides of being a fabulous energy source, it contributes to a healthy heart as it protects the arteries from hardening. A study from 2010 found that people in India, where ghee is originated from and thus has the highest population of consumers, had fewer cases of heart disease than our western world.

Category: Dietary Considerations

How to Talk About Food

Chocolate: The Good, The Bad, and The Ugly

CGM’s

Fall Detox

Health Coaching

LENTILS “THE POOR MAN’S MEAT”

Food and Mood

5 Strategies For Stress Eating

A Guide To Grilling Food

Top 5 Heart Healthy Fats

Functional Medicine

Allergy Testing & Drops

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