Archive for December, 2018

Carbohydrate tolerance is a gray area. The amount of carbohydrates that works for one person’s metabolism doesn’t always serve another’s. In the past decade, I’ve seen a growing number of patients who for years have limited sugary foods and swapped out refined carbohydrates for whole grain products, sweet potatoes, and fresh fruit. Yet they are overweight or have surges of fatigue, foggy-headedness, or cravings. Sometimes they don’t carry any extra pounds but have worryingly high levels of blood sugar. It’s not unusual for these issues to come on late in life; their response to a diet they used to do well on has suddenly shifted.

Why this happens is a topic of robust debate in nutritional circles. It’s likely a combination of factors: a genetic predisposition combined with a sedentary, stressful, and sleep-deprived lifestyle; decades of processed foods and medications that have altered the microbiome; or even (unfortunately) overconsuming the healthy-seeming multigrain breads, bananas, and beans, which all turn to sugar in the blood. All this can lower your personal “set point” for tolerating carbohydrates so that your blood sugars don’t fall back to normal within two hours of eating as they should. Instead, they stay elevated, going beyond what the cells can handle, and eventually this triggers a chain of effects that lead to insulin resistance, the precursor to high blood pressure, heart disease, diabetes, obesity, possibly Alzheimer’s disease, and even some cancers. The 2017 National Diabetes Statistics report found that an estimated 50 percent of Americans have either diabetes or pre-diabetes and that many are unaware of this fact.

Taking your blood sugar seriously is nothing to sneeze at. When carb intolerance is at play, your body is telling you to get stricter with your intake. To follow a low-carb diet, nix all sugars and reduce complex carbs dramatically, replacing them with plenty of nonstarchy vegetables and generous amounts of fat. In addition, take sleep seriously, work on repairing the gut, and increase the amount of movement you do. The low-carb diet, along with these other fundamental improvements, can often help restore order where there was previously metabolic chaos. To catalyze real metabolic change in cases of significant weight gain or diabetes, it may be warranted to take the low-carb approach to its ultimate extreme: the ketogenic protocol.

There is another, more accurate way to learn your personal carb set point. Use a glucose monitor to measure the impact of a range of carbohydrate-rich foods on your blood sugar. Twice after eating, at the one-hour and two-hour marks, you can get snapshots of how your body metabolizes starches like grains, beans, and potatoes. If this level of detective work speaks to you, try the protocol outlined in Robb Wolf’s book Wired to Eat. His program of dietary change, basic blood work, and a seven-day carb test can help you zero in on your set point and your level of insulin resistance.

Photo: Jackelin Slack

So are you carbohydrate intolerant? Start by answering these questions.

  1. Are you overweight?
  2. Do you feel fatigued much of the time, especially after eating a carb-heavy meal?
  3. Do you lead a largely sedentary life?
  4. Do you feel like your appetite is out of control?
  5. Do you frequently crave sweets or starchy foods like bread, pasta, potatoes, or beans?
  6. Do you feel lightheaded and dizzy when you get hungry?
  7. Is your blood sugar in the upper ranges of “normal” or beyond?
  8. Are you struggling with brain fog, anxiety, depression, skin problems, joint pain, aching muscles, hormonal issues, and/or sleep problems?
  9. Optional: If you’ve had blood work done recently, look at your hemoglobin A1c levels. This provides a snapshot of your average blood sugar levels over the last three months. Has your diet been clear of sugary foods, yet the number is still above 5.5?

If you answered yes to one or more questions, try 14 days of cutting out of your diet all grains, legumes (beans and peas), starchy vegetables (carrots, corn, potatoes, squash, sweet potatoes, yams), and fruit. (In case it’s not obvious, sugary foods; natural sweeteners like honey, maple syrup, and agave; and most packaged drinks should be removed completely.) After day 14, revisit questions 2, 5, 6, and 8. If you have experienced a marked change in your symptoms, you may have discovered your own carbohydrate intolerance.

So I’m carb intolerant: Now what?

Take heart! Healthy low-carb diets can improve blood pressure and help you lose weight, have fewer sugar cravings, and feel less driven by hunger. Skin and digestion often improve, as well as triglycerides (a form of blood lipids) and blood sugar and insulin markers.

Follow all the advice in this section—then tweak your diet slightly using the suggestions that follow:

  1. No sugars or refined carbohydrates. Increase the amount of leafy and cruciferous vegetables at each meal, and dramatically or completely decrease complex carbs like starchy vegetables; grains, beans, and legumes; and “pseudo-grains” like quinoa and buckwheat. Maximum two or three portions of these complex carbs per week.
  2. Be more generous than you think you should be with “good” fats like avocados and extra-virgin olive oil.
  3. Limit dairy: It’s high in carbs.
  4. Eat low-sugar fresh or frozen fruit only: fresh berries, citrus fruits, green apples, maximum two or three times a week.
  5. Go very light on the alcohol: And if you do drink, go for the lowest-carb options. Pure spirits like whiskey, vodka, and tequila are carb-free, and dry wine is better than beer. Avoid sweet drinks and mixers, which may contain a lot of sugar.
  6. Pay attention to the effects of starchy foods when you eat them.

Your tolerance can rise and fall depending on how much you exercised, how well you slept, how stressed you are, and so on. There’s nothing a doctor can give you that is more valuable than this personal awareness. If you find that you handle whole-food complex carbs quite well, I still advise that you keep them to a reasonable amount, picking from the low- and medium-count foods described above. If you are using carb-counting devices, know this: Conventional dietary recommendations suggest a limit of 225 grams per day. That’s too high: Stay under 150 grams a day maximum, and preferably under 100 grams.



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Image by Leandro Crespi / Stocksy

When it comes to keeping your pearly whites, well, pearly white, you probably think you know the drill. Foods like tomatoes, coffee, and wine are notorious for staining teeth while products like brightening toothpaste and white strips claim to reverse it (and so the cycle continues).

But the biggest influence on the whiteness of your teeth is actually already in your mouth: the oral microbiome. Much like the all-important gut microbiome, the oral microbiome is a complex microbial community made up of beneficial bacteria and other organisms (six to 10 billion of them, in fact), explains biologic dentist Dr. Gerry Curatola, DDS, author of The Mouth-Body Connection. A healthy oral microbiome helps remineralize teeth, transports oxygen molecules to your gums, carries waste products away from your gums, keeps bad breath at bay, and, yes, influences how white your teeth appear.

How the oral microbiome keeps your teeth white.

It does this in two main ways. First, “when the oral microbiome is healthy, it’s a thin, clear, odorless protective film,” says Curatola. “But when that oral microbiome is out of balance, it’s a thick, sticky, smelly film that you wake up with on your teeth in the morning.” This thick film is stain-absorbing, so your teeth are more prone to the staining effects of what you eat and drink.

The oral microbiome also influences how white your teeth are through its role in maintaining healthy enamel. When the oral microbiome is in balance, “that film is transporting ionic minerals from saliva, like calcium and phosphorus, to the surfaces of your enamel so they re-mineralize,” says Curatola. And thicker, stronger enamel means whiter teeth. “Think of the enamel as a piece of glass that goes over your teeth: The thicker the enamel, the frostier the glass, the whiter your teeth,” he explains.

On the other hand, if you have thin, translucent enamel, the dentin (or the yellow part of the tooth) is closer to the surface, making your teeth appear duller. Ironically, thin enamel also makes your teeth even more sensitive to whitening treatments since the dentin (which is connected to the pulp, where the nerve is) isn’t as protected by the enamel.

How to restore your oral microbiome for whiter teeth.

There are a few ways to restore an out-of-whack oral microbiome for whiter teeth. First, Curatola warns against products that strip the mouth of its good bacteria, like detergent toothpaste and alcohol mouthwash (if it says something like “kills germs” or “kills bacteria,” it’s probably a no-go on his list).

Even some holistic health practices can harm the oral microbiome, like coconut oil pulling and using charcoal toothpaste. Common ingredients in natural toothpastes such as tea tree oil and xylitol also disrupt the balance, so keep an eye out for those. Lifestyle habits also play a role in the health of the oral microbiome. When it comes to nutrition, opt for alkalizing, anti-inflammatory, and antioxidant-rich foods, says Curatola. This helps prevent an acidic environment in the mouth, so acid-loving bacteria that disrupts the oral microbiome won’t be able to thrive.

Exercise is also important since staying active promotes healthy circulation and boosts the immune system, he says. Finally, focus on stress management. “When you’re stressed, your saliva dries up, you grind your teeth, and you do a lot of other unhealthy things [that affect your mouth,]” says Curatola.

In fact, these practices are important for overall wellness, too—limiting toxic chemicals, eating well, exercising, and managing stress have major health payoffs, including rebalancing the oral microbiome. And while the benefits of restoring the good bacteria in your mouth go beyond the surface of your teeth, a whiter, brighter smile is a nice bonus.


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High cholesterol? Add these healthy foods to your diet to lower your numbers naturally.

Have high cholesterol? You’re not alone. The problem affects some 95 million Americans, according to Centers for Disease Control and Prevention, and has been linked to serious health conditions, from heart disease to diabetes.

Cholesterol is a waxy, fatty substance found in your cells. Your liver makes it naturally, but it’s also found in animal foods like meat and dairy products. Your body needs some cholesterol to function, but getting more than you need, which can happen from eating too many cholesterol-rich foods, causes plaque to form in the arteries that could lead to dangerous blood-flow blockages.

“High cholesterol is a top risk factor for heart attacks, strokes, and poor circulation,” says Omar Ali, MD, intervention cardiologist at Detroit Medical Center Harper University Hospital. Ideally, this is what healthy cholesterol numbers look like, according to the National Institues of Health:

Adult women (age 20+)

  •  Total cholesterol: 125 to 200 mg/dL
  •  LDL cholesterol: Less than 100 mg/dL
  •  HDL cholesterol: 50 mg/dL or higher

Adult men (age 20+)

  •  Total cholesterol: 125 to 200 mg/dL
  •  LDL cholesterol: Less than 100 mg/dL
  •  HDL cholesterol: 40 mg/dL or higher

Medications like statins can help you get there, though most experts recommend trying to make healthy lifestyle changes first. “I always advise people to try and lower their cholesterol through diet and exercise,” says Jennifer Haythe, MD, co-director of the Women’s Center for Cardiovascular Health at New York-Presbyterian.

Cutting back on high-cholesterol foods—like fried foods, sugary desserts, and fatty meats—is a start, but you also need to eat more of the fare that can help lower your cholesterol naturally. Here, 10 picks to add to your grocery list.


Overnight oats with blueberries and bananas, with white and black background

Getting 5 to 10 grams of soluble fiber daily could help lower LDL cholesterol (the “bad” cholesterol that can build up in your arteries) by as much as 11 points, according to the National Lipid Association. The roughage isn’t well absorbed by your intestine, so it binds to cholesterol in the blood and helps remove it from the body, Dr. Haythe explains. And oats are a top source, delivering around 2 grams of soluble fiber per half-cup cooked.

Try it: These tasty overnight oats recipes will save you tons of time during busy mornings. Simply prep them the night before and enjoy a fiber-rich breakfast the next day.

Fatty fish

honey spiced salmon with quinoa

Aim to eat at least two 3.5-ounce servings of fatty fish like salmon, mackerel, tuna, trout, or herring per week, recommends the American Heart Association. The omega-3 fatty acids found in these swimmers can help improve your triglycerides—a type of cholesterol-like fat found in the blood that can cause your arteries to become hard or thick.

Try it: This honey-spiced salmon with quinoa is loaded with protein and fiber—and takes just 35 minutes to make! If tuna is your go-to, try this tuna salad recipe that subs out mayo for protein-rich Greek yogurt.


assorted nuts

Regular consumption of tree nuts like walnutsalmonds, and pistachios is tied to lower levels of total cholesterol, LDL cholesterol and triglycerides, found an American Journal of Clinical Nutrition review of 61 studies. “This is likely because they contain unsaturated fats, omega-3 fatty acids, fiber, vitamin E, and plant sterols,” Dr. Haythe explains. Just watch your portions, since nuts are high in calories. A small handful or two tablespoons of nut butter is all you need, says Dr. Haythe.

Try it: Top your salads, oatmeal, and stir-fry with nuts for extra crunch.

Green tea

Green tea

A Japanese study of more than 40,000 adults found that those who drank more than five cups of green tea daily were 26 percent less likely to die from a heart attack or stroke compared to folks who rarely sipped the stuff. Experts suspect that’s because the grassy brew is rich in catechins, a family of flavonoids that have been shown to thwart the production of cholesterol as well as block it from being absorbed.

Try it: Drink it straight—or amp up the flavor of your brew with this iced lemon and ginger green tea recipe.

Beans and legumes

Cooked legumes and vegetables in a bowl

Having a daily half-cup serving of beans or legumes could lower your LDL cholesterol by an average of 5 percent in just six weeks, according to a review of 26 studies. Like oats, beans are packed with soluble fiber that helps sweep cholesterol out of the bloodstream, Dr. Ali explains. Hummus, anyone?

Try it: Add beans to your tacos, salads, and soups for extra plant-based protein and fiber. You can add your favorites to this vegetable chili for a hearty dinner.

Dark chocolate

dark chocolate

Who says treats can’t also be good for you? In a British study, participants who sipped a cocoa drink twice daily for a month lowered their LDL cholesterol and raised their HDL cholesterol (the “good” cholesterol that helps prevent plaque from building up in your arteries). Chalk it up to dark chocolate’s flavonoids, beneficial compounds that have an antioxidant effect. Just stick with chocolate that’s 70 percent cocoa or higher—it contains more antioxidants and less sugar than the lower percentage stuff.

Try it: Sprinkle a serving of dark chocolate over your oats or eat on its own with a cup of tea as a post-dinner sweet treat.

Safflower oil

Oil pouring and dripping to the spoon

This neutral-flavored oil is rich in phytosterols—cholesterol-blocking plant compounds that could lower your LDL cholesterol by as much as 14 percent, according to the Cleveland Clinic. In fact, regular consumption of safflower oil is tied to lower total cholesterol and LDL cholesterol compared to regular consumption of olive oil, according to a recent Journal of Lipid Research review.

Try it: Safflower oil has a mild flavor and high smoke point, making it easy to cook with. Drizzle over your favorite veggies before roasting or use it in a DIY salad dressing.


Kale Salad

The leafy veggie (along with cousins collard and mustard greens) has been shown to bind to bile acid. What good does that do, exactly? “That helps the liver burn more fat, which in turn lowers cholesterol,” Dr. Ali says. For the biggest benefit, opt for lightly cooked greens over raw ones. Steaming in particular seems to boost bile acid binding, research shows.

Try it: Beyond using kale as a salad base, you can throw it into your stir-frysauté with eggs, or add into soup.


Toast with avocado and cress

Thanks to their fiber and monounsaturated fat, avocados could help lower your total cholesterol by 18 points, your LDL cholesterol by 16 points, and your triglycerides by 27 points, suggests an analysis of 10 studies. The key is using them in place of foods containing less healthy fats, like saturated fat. Think sliced avocado instead of mayo on a sandwich, or diced avocado rather than cheese in a burrito bowl.

Try it: We all love avocado toast and guacamole, but if you want to get creative, they make a creamy (and satiating) base for smoothies.


Red Apple

Having one every day really might help keep the (heart) doctor away. Apples are one of the best sources of pectin, a type of fiber that’s been shown to lower levels of LDL cholesterol. They’re also chock-full of antioxidants like polyphenols, which an Ohio State University study found can help keep LDL cholesterol from oxidizing, which can cause arteries to become inflamed and clogged.

Try it: Enjoy as a snack or whip up a batch of these apple oatmeal muffins for a grab-and-go breakfast in the morning.


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