Benefits of Omega-3 Fatty Acids: What Does the Latest Research Indicate?

   August 07, 2020      

 

 Omega-3 fatty acids fall under the category of polyunsaturated fats. Polyunsaturated means it remains liquid at room temperature. These fats are primarily marine and plant-based. On the other hand, the saturated fats are solid at room temperature, primarily coming from an animal source.

There are 3 types of omega-3 fatty acids: Alpha-lenoic acid (ALA), Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA). Out of these, ALA is an essential nutrient, which must be taken from the diet. ALA then breaks down into EPA and DHA. However, this conversion rate is quite low and therefore, it is recommended to incorporate EPA and DHA from diet and supplements.

 

To be discussed in this article:

  • Benefits of omega-3 fatty acids in heart health

  • Benefits of omega-3 fatty acids in brain health

  • Benefits of omega-3 fatty acids in eye health

  • Benefits of omega-3 fatty acids in prenatal health 

  • How to get the adequate amounts of omega-3 fatty acids

 

Benefits of Omega-3 Fatty Acid in Heart Health:

Regular intake of omega-3 fatty acids is directly linked with significant reduction in coronary heart disease and sudden cardiac arrest. It also helps lower triglyceride levels by maintaining healthy blood vessels with adequate blood pressure control. 

  • A Study of Cardiovascular Events in Diabetes: 1 gram per day of omega-3 fatty acids lead to a 18% reduction in risk of heart-related deaths.
  • Reduction of Cardiovascular Events with EPA- Intervention Trial: 4 gram per day of EPA combined with statin medication lead to a 25% decrease of cardiac-related events. 
  • Vitamin D and Omega-3 Trial: 1 gram per day of omega-3 fatty acid supplement reduced the risk of heart attacks by 28%.

 

Benefits of Omega-3 Fatty Acids in Brain Health:

DHA is found in a high concentration in brain tissue. Adequate omega-3 fatty acid supplement improves cognition and memory and reduces cognitive decline with increasing age. There is a growing body of research in psychology that supports the benefits of omega-3s in mental health conditions like Attention-Deficit Hyperactive Disorder (ADHD), Major Depressive Disorder (MDD), Bipolar Disorder, Schizophrenia and Anxiety Disorders. 

  • International Society for Nutritional Psychiatry Research: Omega-3 fatty acids can be combined with the regular medical treatment of MDD, as they have been proven to be both safe and effective in reducing the severity of MDD when taken with regular antidepressants. The most effective EPA to DHA ratio in this case is >2:1. 
  • Use of Omega-3s in traumatic brain injury: single dose of 3000mg of EPA+DHA given 3 times a day for the first week, for a maximum of 9000mg per day. For the second week, one dose 2 times per day for a maximum of 6000mg per day. Beyond that, one dose daily for maintenance, for a maximum of 3000mg per day. 

 

Benefits of Omega-3 Fatty Acids in Eye Health:

 Just like in the brain, DHA is highly concentrated in the eye tissue, especially in the retina. DHA plays a critical role in the development of eyes during pregnancy. Deficiency of omega-3s can be associated with dry eyes, and age-related vision problems, called macular degeneration.

 

Benefits of Omega-3 Fatty Acids in Prenatal Health:

Omega-3 fatty acids play a vital role in the development of a fetus brain and eyes. Brain development is linked with an increase in functionality of the brain parts that are involved in handling attention and physical movements. The development of the eyes is linked with an increase in visual acuity and increased functionality of photo-receptors, or the ability to see in minimal light and differentiate between specific colours. 

  • American Academy of Pediatrics: Omega-3 supplement should begin while the mother is pregnant and should continue for the child's first 2 years of life (1000 days) as the effects of omega-3s are crucial for the neurodevelopment and long-term mental health of the child. 
  • Effects of Omega-3 fatty acid on pregnancy: A study has shown that an adequate omega-3 fatty acid supplement in pregnancy leads to a massive 42% risk reduction of preterm birth before 34 weeks, 11% risk reduction of preterm birth before 37 weeks and a 10% risk reduction of a baby born with low birth weight (less than 5.5lbs).

 

How to Get the "Super Nutrient" Omega-3 Fatty Acids:

While the daily recommendation is 250mg of EPA+DHA, new research is beginning to show that we might need more than that. It has been concluded that while the general population is taking adequate amounts of ALA in their diets, the level of EPA and DHA is very, very low (the good stuff that we actually need!).

  • Start with knowing your needs of omega-3s: A simple blood test can be easily carried out at home, similar to diabetics checking blood sugar levels at home on a strip. This sample can then be sent to the lab to measure the level of omega-3 fatty acids in your body: low level corresponds to anything below 4%, intermediate is between 4-8%, and a desirable level of omega-3s should be between 8-12%.
  • 8 ounces of seafood per week (2-3 servings per week) provides an average of 250mg EPA+DHA per day. Include fatty fish like salmon and herring.
  • When you are grocery shopping, look for food items that are especially fortified with omega-3 fatty acids.
  • Omega-3 fatty acid supplements: fish oil gels, flavoured gummies, liquid syrup, like cod liver oil, that can be given to children. Check the supplement label for the serving size and the amount of EPA+DHA present (listed separately). As a general rule, the sum of EPA+DHA should equal to at least 900mg.
  • Options of vegetarians/vegans: marine microalgae, chia seeds, flax seeds, walnuts, soy beans are some of the options. 
It is best to take omega-3 fatty acids from multiple resources for a more balanced nutrition. 

 

Omega-3 fatty acids sit at the top of the list of those nutrients that have gained immense popularity in recent times and rightfully so, as more emerging research data support the benefits on fetus development, heart health, brain health and eye health, covering all age groups of the population, beginning from pregnancy. What is your requirement of omega-3 fatty acid intake? And how do you make sure you are getting enough of that good stuff? Leave your comments below and let me know!


References:

 1. Essential fatty acids. Oregon State University,Linus Pauling Institute, Micronutrient Information Center website.https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids. Updated May 2019.

 2.Fatty acids and cholesterol subcommittee. US Department of Agriculture, Nutrition Evidence Systematic Review website. https://nesr.usda.gov/fatty-acids-and-cholesterol-subcommittee.

3.EslickGD, Howe PR, Smith C, Priest R, Bensoussan A. Benefits of fish oil supplementation in hyperlipidemia: a systematic review and meta-analysis. Int J Cardiol. 2009;136(1):4-16. 

4.Nestel P, Shige H, Pomeroy S, Cehun M, Abbey M, Raederstorff D. The n-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid increase systemic arterial compliance in humans. Am J Clin Nutr. 2002;76(2):326-330. 

5.Miller PE, Van Elswyk M, Alexander DD. Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and blood pressure: a meta-analysis of randomized controlled trials. Am J Hypertens. 2014;27(7):885-896. 

6.Bowman L, Mafham M, Wallendszus K, et al.; ASCEND Study Collaborative Group. Effects of n-3 fatty acid supplements in diabetes mellitus. N Engl J Med. 2018;379(16):1540-1550. 

7.Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380(1):11-22.

 8.Manson JE, Cook NR, Lee IM, et al. Marine n-3 fatty acids and prevention of cardiovasculardisease and cancer. N Engl J Med. 2019;380(1):23-32. 

9.Chang JP, Su KP, Mondelli V, Pariante CM.Omega-3 polyunsaturated fatty acids in youths with attention deficit hyperactivity disorder: a systematic review and meta-analysis of clinical trials and biological studies.Neuropsychopharmacology. 2018;43(3):534-545. 

10.Lin PY, Huang SY, Su KP.A meta-analytic review of polyunsaturated fatty acid compositions in patients with depression.Biol Psychiatry. 2010;68(2):140-147. 

11.McNamaraRK,WelgeJA.Meta-analysis of erythrocyte polyunsaturated fatty acids biostatus in bipolar disorder.Bipolar Disord. 2016;18(3):300-306.

12.van der Kamp WJ, Klomp DW, Kahn RS, Luijten PR, Hulshoff Pol HE.A meta-analysis of the polyunsaturated fatty acid composition of erythrocyte membranes in schizophrenia.Schizophr Res. 2012;141(2-3):153-161. 

13.Gupta A Summerville G, Senter C.Treatment of acute sports-related concussion.Curr Rev Musculoskelet Med. 2019;12(2):117-123. 

14.Guu TW, Mischoulon D, Sarris J, et al.InternationalSociety for Nutritional Psychiatry Research practice guidelines for omega-3 fatty acids in the treatment of major depressive disorder.Psychother Psychosom. 2019;88(5):263-273.

15.Omega-3 protocol for brain health. Brain Health Education and Research Institutewebsite.http://www.brainhealtheducation.org/omega-3-protocol/. 

16.Schwarzenberg SJ, Georgieff MK; Committee on Nutrition. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics.2018;141(2):e20173716. 

17.AbdelhamidAS, BrownTJ, BrainardJS, et al. Omega‐3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev.2020;3:CD003177. 

18.Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes forenergy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids.https://www.nal.usda.gov/sites/default/files/fnic_uploads/energy_full_report.pdf. Published 2005. 

19.US Department of Health and Human Services. 2015–2020 Dietary Guidelines for Americans. 8th Edition. https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/table-of-contents/.Published January 7, 2016. 

20.US Department of Agriculture, Agricultural Research Service. What We Eat in America, NHANES 2015-2016: table 1. Nutrient intakes from food and beverages: mean amounts consumed per individual, by gender and age, in the United States,2015-2016. https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/1516/Table_1_NIN_GEN_15.pdf.

21.Hu Y, Hu FB,Manson JE. Marine omega-3 supplementation and cardiovascular disease: an updated meta-analysis of 13 randomized controlled trials involving 127477 participants. J Am Heart Assoc. 2019;8(19):e013543.  

22.Makrides M, Best K, Yelland L,et al.A randomized trial of prenatal n-3 fatty acid supplementation and preterm delivery.N Engl J Med.2019;381(11):1035-1045. 

23.Simmonds LA, Sullivan TR, Skubisz M,et al. Omega-3 fatty acid supplementation in pregnancy-baseline omega-3 status and early preterm birth: exploratory analysis of a randomized controlled trial [published online February 8, 2020]. BJOG.doi:10.1111/1471‐0528.16168.


 

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at August 07, 2020 5 Comments

Polycystic Ovary Syndrome Part II: Nutritional Strategies of Management

   August 03, 2020      

Dietary management of Polycystic Ovary Syndrome (PCOS) should focus on weight loss and modification in insulin levels.

In this article:

  • Ketogenic diets and insulin management

  • Mediterranean diet and risk reduction of metabolic syndrome and type 2 diabetes

  • Polyphenols and their role in blood sugar levels

  • Curcumin and its properties

  • Role of omega-3 fatty acids

  • Coenzyme Q10 health benefits

  • Most powerful antioxidants

  • Relationship between gut health and PCOS



Ketogenic Diets

Insulin signalling is key in the management of insulin resistance that gives rise to metabolic syndrome and type 2 diabetes. Research has shown that low-carb ketogenic diets have resulted in greater improvement of blood sugar levels in obese patients with type 2 diabetes. Additional benefits of these diets include better hormonal control, significant weight loss and improvement of fatty liver disease.

Mediterranean Diet

Mediterranean diet is composed of cereals, nuts, legumes, vegetables, fruits with significant use of extra virgin olive oil. This food composition enhances the intake of complex carbs like fiber & whole grains, minerals like selenium, iron, potassium, magnesium & calcium, vegetable proteins & polyphenols, which are micronutrients present in plant-based foods. All these together lead to better control of blood sugar levels & aim at reducing the blood pressure. The unsaturated fatty acids of healthy oils and polyphenols together work to increase HDL (good cholesterol) and decrease chronic inflammation. These effects lead to lower cholesterol and triglyceride levels and reduced fat storage, which significantly reduces the risk of metabolic syndrome and type 2 diabetes.

Polyphenols:

A research study comprising of 1133 subjects has shown that the consumption of green tea lead to decreased fasting glucose and HbA1c levels. Eleven other studies on 388 subjects have concluded that the consumption of resveratrol (plant-based polyphenol that is a strong antioxidant) significantly reduced fasting glucose, insulin, HbA1c levels in the diabetic population.
(Read the effects of green tea on sleep and stress: What is the Relationship Between Sleep, Stress and Nutrition?)

Curcumin:

Curcumin has long been known for its strong anti-inflammatory and antioxidant properties and has been widely practiced since ancient times in Indian Ayurvedic medicine. Turmeric contains roughly 10% curcuminoids that are a potent combination of curcumin, demethoxycurcumin, bis-demethoxycurcumin.In a 30-day research trial, daily supplementation with 400mg curcumin in healthy individuals lead to reduced brain aging, lowered triglyceride levels, reduced stress levels, improved liver function and an increase in antioxidant enzymes.

Omega-3 Fatty Acids:

Two comprehensive studies have shown that taking 1200-1500mg of omega-3 fatty acids over the period of 2-6 months significantly reduced free testosterone levels and lead to a better hormonal control of PCOS in obese and non-obese women. Long-term effects included lower insulin resistance, blood glucose and triglyceride levels. Other equally significant benefits of omega-3 fatty acids are: improved symptoms of chronic depression, lower inflammatory markers in blood, low cortisol (stress hormone) levels and increased brain function.

Coenzyme Q10 (CoQ10):

 In a clinical trial conducted on 60 women with PCOS that were given 100mg CoQ10 for 12 weeks, it was concluded that CoQ10 supplementation significantly reduced blood glucose levels with well-controlled insulin levels and reduced cholesterol levels with enhanced heart health.

Strong antioxidants to include in diet:

  • Vitamins A, C, D, E
  • Alpha-lipoic acid
  • Polyphenols
  • Selenium
  • Copper
  • Magnesium
  • Zinc
Antioxidants stabilize free radicals and essentially stop their damaging effects on cells and their metabolic activities. They further support detoxification, reduce fatigue and tiredness, boost mental health and are very important elements for proper functioning of the nervous system.

Gut Health:

In humans, around 90% of gut bacteria are represented by two major strains: Firmicutes (60-80%) and Bacteriodetes (15-30%). In obese women with PCOS, this ratio is imbalanced with a reduced microbial diversity. This imbalance and compromised gut health is linked with increased risk of type 2 diabetes in PCOS. Other risk factors include inflammatory bowel disease, irritable bowel syndrome, celiac disease, colorectal cancer, gut-brain axis disorders like depression, anxiety, chronic pain, fatigue, and compromised immune system (gut houses around 80% of the total immune system). In order to improve gut health, it is recommended to: increase fiber content in diet, which is naturally fermented in the gut that strengthens and diversifies gut bacteria; increase natural prebiotic intake in forms of cereals, fruits and vegetables; incorporate fermented foods like sauerkraut, kimchi, yogurt, kefir.


The nutritional strategies mentioned above are interventions that can be used in combination to synergistically enhance the health benefits while significantly reducing the health risk factors and hormonal disturbances associated with PCOS. Targeting multiple health factors with the combination of diverse nutrients mentioned above eases the challenging task of clinical management of PCOS.

Leave your thoughts and concerns in the comment section below and connect with me.




References:
1. DiSilvestro et al. Diverse effects of a low dose supplement of lipidated currcumin in healthy middle aged people. Nutr J. 2012. 11(79). doi: 10.1186/1475-2891-11-79.
2. Gholnari et al. The effects of coenzyme Q10 supplementation on glucose metabolism, lipid profiles, inflammation, and oxidative stress in patients with diabetic nephropathy: A randomized, double-blind, placebo-controlled trial. J Am Coll Nutr. 2018. 37(3):188-193.
3. Gokalp et al. Efficacy of omega-3 in the treatment of polycystic ovary syndrome. Journal of Obstetrics and Gynecology 2012. 33:289-291.
4. Liu et al. Effect of green tea on glucose control and insulin sensitivity: a meta-analysis of 17 randomized  controlled trials. Am J Clin Nutr. 2013. 98(2):340-348.
5. Liu et al. Effect of resveratrol on glucose control and insulin sensitivity: a meta-analysis of 11 randomized  controlled trials. Al J Clin Nutr. 2014. 99(6):1510-1519.
6. Mohammadi et al. Effects of omega-3 fatty acids supplementation on serum adiponectin levels and some metabolic risk factors in women with polycystic ovary syndrome. Asia Pac J Clin Nutr 2012. 21(4): 511-518.
7. Salas-Salvado et al. Protective Effects of the Mediterranean Diet on Type  Diabetes and Metabolic Syndrome. The Journal of Nutrition 2016. 146(4): 920S-927S.
8. Dr. Nina Bailey, PhD. Igennus Healthcare Nutrition.

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   13 Comments

at August 03, 2020 13 Comments

Intermittent Fasting and Weight Loss: How to Use It to Lose It

   July 30, 2020      




OBESITY is a chronic medical condition that cannot be just attributed to laziness or low motivation. It is often due to the lack of CONSISTENCY to follow a diet or exercise regimen. The most important question you need to ask yourself is 'Can I stick with this diet long-term?' Because even if it is the best diet, if you can't stay consistent, you can't receive its benefits.

Topics to be covered in this article:

  • What causes weight gain

  • The role of insulin and how it can be controlled

  • Strategies of intermittent fasting

  • What to eat and what to avoid

  • Benefits and concerns of intermittent fasting


How Did it Originate?

Intermittent fasting is not a new concept; it has been used by our ancestors, initially as religious fasts, since the beginning of our existence. It has only recently been labeled as a diet that can enhance weight loss and provide other health benefits.

Why the Uncontrolled Eating and Weight Gain?

Because eating feels good! As simple as that. To make matters worse, food is literally available at every corner of nearly every street. Can you imagine any occasion where food, in some form, will NOT be present? It is there in celebrations, mourning, boredom, socializing, sadness. And, to speak scientifically, eating stimulates insulin production and release, which in turn stimulates hunger and the urge to eat more.

What is the Role of Insulin?

Insulin is a hormone that is released by the pancreas that regulates energy utilization. Food digestion leads to increase in blood sugar. Insulin rescues this sugar from the blood and stores it either in the form of glycogen, which is the temporary or short-term energy storage or in the form of fat, which is the long term energy storage. Constant ingestion of foods that cause sudden increase or spike in insulin levels can lead to insulin resistance over time. Insulin resistance, in basic terms, means that normal levels of insulin can no longer remove sugar from bloodstream, which causes the body to release more insulin in order to reduce blood sugar levels. Increased insulin, in turn, causes an increase in hunger, sugar cravings and fat storage.

How Can We Control Our Insulin Levels?

One of the best method is to reduce the frequency of eating, which is where intermittent fasting comes in. It is also important to reduce the intake of refined sugars and processed food items, and incorporate more of the healthy fats like fatty fish, olive oil, nuts and seeds, avocados. As a result, the hunger spikes will be controlled, which will minimize food intake and reduce and stabilize insulin levels. Intermittent fasting will essentially slow down or even shut off insulin production. In addition, it is vital to recognize to what degree certain foods stimulate insulin ( in order of highest to lowest): high fructose corn syrup (please avoid completely!), simple carbs like sugars and processed foods, complex carbs like whole grains, brown rice, high fiber, starchy veggies, and lastly, protein.

How Can You Intermittent Fast?

There are numerous ways but the two most common methods are: 1. 16-20 hour fasting with 4-8 hour eating window. 2. 5:2 fasting.
1. Consists of prolonged overnight fasting beginning from your sleep time. For example, if you have eaten at 7pm, you fast till 11am next morning, skipping breakfast.
2. 5:2 fasting means you eat regular diet for 5 days of the week and choose 2 non-consecutive days for prolonged fasting. Fasting in this case is usually for the entire 24 hour period.

What to Eat When You Are Not Fasting?

The primary goal here is to manipulate insulin. You should eat enough calories to maintain your weight and use a combination of any healthy dietary pattern you enjoy. Generally, half of your plate should be non-starchy veggies (broccoli, asparagus, bean sprouts etc.), one quarter should be lean protein (yogurt, beans, lean meat etc.), and one quarter should be grain foods (wheat, rice, oats etc.) or starchy veggies (potatoes, corn, pumpkin etc.).
Start your day with a high protein and a high healthy fat meal. Examples:
  • Greek yogurt with nuts & chia seeds
  • Egg frittata with veggies and cheese
  • Masala Chai/Tea Latte made with unsweetened almond milk
  • Avocado toast with low carb bread
(Note: For fasting days, restrict your calories to 1/4th of your daily requirement. Generally, that is between 300-500 calories per day.)

Why You Should Try Intermittent Fasting?

  • Less fat storage and more fat utilization
  • Reduced hunger and sugar cravings
  • Reduction and remission of insulin resistance and type 2 diabetes
  • Improvement of fatty liver
  • Reduction in central adipose tissue (abdominal/belly fat)
  • Reduction in progression of Alzheimer's Disease
  • Reduced risk of cancer
  • Improved cholesterol levels
  • Improvement in sleep quality and energy levels

Concerns to be Mindful of:

  • Constipation: restriction of food intake means less digestive movement, which can lead to constipation. Incorporate high fiber food items for relief.
  • Dehydration: cutting back on eating naturally causes less water intake as well and when combined with vigorous exercising, it can lead to dehydration. Keep track and drink 8-10 glasses of water everyday.
  • If you are diabetic and taking insulin: intermittent fasting can cause hypoglycemia (very low blood sugar level). Talk to your doctor or dietician before fasting.
  • Pregnancy: intermittent fasting is not recommended during pregnancy.
There is no ONE best diet for weight loss. You really just have to choose a plan that suits you, meets your nutrition and weight loss goals and more importantly, a plan that you can remain CONSISTENT with for long-term. Always track your food intake, eat out less often (a restaurant take out meal is 1000-1100 calories), drink less calories (especially alcohol that is rich in calories and also increases appetite), and try to cook at home as much as possible where you have more control over the quality of the ingredients, the types of oils and salts you can choose from and best of all, something you can enjoy with your family. Step up to make a lifestyle change, not just a diet change!


References:
1. Lindsay Venn, registered dietician at Eastern Idaho Spine, Sports and Rehab Center
2. Copeman Healthcare Centre



  

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at July 30, 2020 5 Comments

Are You Trying to Restrict Your Diet? Here's How You Can Navigate Through It Successfully.

   July 26, 2020      

Are you allergic to gluten or any other food item? Are you dealing with lactose intolerance? Are you trying to lose weight? Are you gripped by a medical condition? If you answered YES to any of the questions above, you most likely eat a RESTRICTIVE DIET.


The main objectives that I am going to cover in this blog are:

  1. How and why restrictive diets can lead to significant nutrient gaps and reduce compliance

  2. What is Food Phobia and how it relates to restrictive diets

  3. How various milk sensitivities differ from each other and what dietary recommendations can be followed

  4. How consumers can reduce their fear and incorporate a more diverse meal plan to tackle their food sensitivities


What are the Health Risks of a Restrictive Diet?

While restrictive diets are necessary in certain conditions such as in food allergies, lactose intolerance, weight loss plans and some medical conditions like diabetes and kidney disease, they do not come without their own health risks.
Restrictive diets can cause nutritional imbalance and  deficiencies, especially in those who are not closely monitoring their eating patterns with a health care professional or a nutritionist. Secondly, eating a restricted diet over long term generates fear, or is called 'FOOD PHOBIA', where a consumer is cautious and very fearful of eating something they have eliminated from their diet with the assumption that it will affect their health negatively. Food phobias very often lead to disordered eating pattern where a consumer will binge eat all the foods they ignored, followed by a strong guilt and reintroduction of the old restrictive diet. The more restricted a diet is the lesser the chances are of sticking with it. Consumers can become very resentful of eating, in general, which leads to poor health outcomes.
Children are at the greatest risk of developing nutritional deficiencies due to restrictive diets because they tend to have more allergies and food sensitivities. For example, if a child is experiencing abdominal discomfort, reflux or eczema, parents begin self-treatment at home by eliminating cow's milk entirely from the diet. Another common example is the weight loss diets that restrict calorie intake along with which many nutrients are excluded as well.
In a study that looked at various restrictive diets, like DASH diet and weight loss diets, where participants followed a 1500-2000 calorie diet, it was concluded that they were falling short on 15+ micronutrients like Vitamin E, Vitamin D, Iodine, Chromium etc.


What is the Impact of Restrictive Diet on Long-term Health?

  • Restrictive diets that are not balanced can lead to nutrient gaps over long term
  • Restrictive diets are a risk factor for abnormal eating patterns/eating disorders
  • Restrictive diets reduce compliance and accelerate the disease process
    • Example: A diabetic patient on a restrictive diet since long can all of a sudden binge eat due to craving, which will spike the blood sugar levels, worsening diabetes. 


Who is a Restrictive Eater?

  • Someone who experiences pain or discomfort upon eating a food like bloating, fullness, gas, heartburn etc. These can be consumers who have food allergies or intolerances.
  • Someone who is fearful to experience the symptoms again that have been relieved by eliminating certain foods. This includes those who are fearful of weight gain, who avoid all types of sugars (refined and natural), those with medical conditions.
  • Someone who is under medical restrictions (those with high blood pressure, celiac disease, Irritate Bowel Syndrome (IBS), kidney disease etc.)
  • Someone who has certain personal beliefs like following vegetarian or vegan diet, religious beliefs that eliminate certain food items, belief in fasting etc.


Food Allergies vs. Food Sensitivities:

Food allergy is an immune response by the body where smallest amounts of food items can trigger a severe immune reaction and therefore, these foods must be avoided under all circumstances. On the other hand, food sensitivity/intolerance is a reaction triggered by the digestive system in which small amount of food in a particular range can be eaten safely without uncomfortable symptoms.

What is an Elimination Diet?

Elimination diet is a method by which the exact source of food allergy or intolerance can be identified and successfully eliminated from the diet. The first phase is the 'Elimination Phase' where the consumer eliminates a wide range of food item that they believe could be causing the symptoms of gastrointestinal (GI) discomfort, bloating, reflux, heartburn etc. This leads to resolution of symptoms. The second phase is called the 'Reintroduction Phase' where eliminated food items are gradually added back into the diet over the time of weeks in small amounts while monitoring the recurrence of symptoms. Through this procedure, the exact cause of discomfort and symptoms are identified and only that food item is eliminated from the diet.

Navigating Through Dairy Sensitivities:

It is estimated that 65% of the human population has a reduced ability to digest lactose. However, many of these have just assumed they are lactose intolerant without any such medical diagnosis. Recent research suggests that much of the GI distress is caused by a type of milk protein, called BETA CASEIN, rather than the milk sugar, called LACTOSE. Therefore, eliminating all dairy items will relieve the symptoms but it will not determine whether it was beta casein or lactose that was causing the discomfort.

Understanding Beta Casein in Detail:

Roughly one-third of the protein content in milk is beta casein.This milk protein comes in two forms: A1 beta casein and A2 beta casein. Research suggests that the A2 beta casein protein is easier to digest, which may help minimize the gastric discomfort of dairy products.

               

A1 and A2 proteins differ in their structure at the amino acid position 67, where A1 is cleaved into a product that is harder to digest while A2 does not form this by-product and therefore, is easier to digest.

Is it Necessary to Avoid Dairy Products?

National Institute of Health has stated that dairy products provide us with essential nutrients that are difficult to obtain from low-dairy or dairy-free products. This is the main reason why some consumers do not stop consuming dairy even if it causes digestive discomfort. Before restricting all dairy products, it is important to differentiate whether the discomfort and associated symptoms are caused due to lactose intolerance or the difficulty in digesting the beta casein A1 protein.

How to Differentiate Between the Two Milk Sensitivities?

  • Hydrogen Breath Test: Lactose intolerance is diagnosed using the 'Hydrogen Breath Test' in which the amount of hydrogen present in the breath is measured. Presence of higher than normal amount in presence of digestive discomfort is used to diagnose lactose intolerance. Basically, when sugars and carbohydrates are easily digested, they do not reach the distant colon. However, when these reach the colon in largely undigested forms, the bacteria present in the colon use them as their energy source and release hydrogen as a by-product. This hydrogen is then absorbed into the blood, which causes an increase in the hydrogen concentration in the breath.
  • A2 Tolerance Test: For about a week, the consumer is required to eliminate all dairy products from their diet EXCEPT dairy products made ONLY with the A2 beta casein milk protein. Then, over the course of the next week, consumption of dairy products with A2 beta casein milk protein is gradually increased while tracking the tolerance level and any associated GI discomfort. For example, the consumer may begin with half a cup of milk, gradually increasing to 2 cups over the next week. At the end of the week, if no GI discomfort is noted, it can be concluded that the consumer has sensitivity to the A1 beta casein milk protein instead of being lactose intolerant. 


How Dietary Balance Can Be Achieved:

  • When any sort of restrictive diet needs to be followed, a health professional or a nutritionist must be consulted to avoid significant nutrient gaps leading to nutritional deficiencies.
  • In case of children, their feeding patterns and dietary habits must be monitored closely to ensure adequate nutritional gain for their level of growth and development.
  • Healthcare professionals needs to change the direction of conversation with their clients from 'foods to avoid' toward 'food varieties that can be enjoyed' to avoid food resentment and abnormal eating patterns.
  • After a thorough discussion with clients regarding their comfort level and properly addressing their food phobias, healthcare professionals should develop a plan to gradually introduce new food items to maximize variety and monitor and trace food sensitivity and intolerance to judge the necessity of appropriate alternatives to maintain proper nutrition.
  • In case of food sensitivities, additional food sources must be identified to avoid nutrient deficits. For example, in case of gluten sensitivity, which restricts intake of whole grains and fiber, alternate gluten free food sources must be consumed to maximize fiber consumption. These food items can be fruits and vegetables, beans, lentils, brown rice, etc. In case of dairy insensitivity, which restricts the intake of adequate calcium, dairy products with only A2 milk protein may be an alternative.

Having a variety of foods incorporated in the daily diet plan not only ensures adequate nutritional balance but also enhances food enjoyment, promotes healthy eating and improves dietary compliance in cases of restrictive diets. Take time to think whether you are avoiding certain food items and what might be the reason behind it. If you have any dietary restrictions, how does it affect your enjoyment of eating? How likely are you to try new food items without hesitation? Let me know your thoughts and comments below!


References:
1.JaworskiM, Panczyk M, Śliwczyński AM, et al.A ten-year longitudinal study of prevalence of eating disorders in the general Polish type 2 diabetes population.Med Sci Monit. 2018;24:9204-9212.
2.WróblewskaB, Szyc AM, Markiewicz LH, Zakrzewska M, Ramoszko E.Increased prevalence of eating disorders as a biopsychosocial implication of food allergy.PLoS One. 2018;13(6):e0198607.
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