Thanks for being patient with me as I navigate the land of the computer-less. I’m still on the hunt for a new Surface Pro.
Meanwhile, I finished my anti-inflammatory diet on Monday. I was telling my husband that this has to be in the top two for the most enjoyable eating style I’ve tried (tied with carb counting). You can still eat most anything, and it truly makes a difference for me to mentally focus on getting in good stuff rather than cutting out “forbidden” foods (like when I was on Paleo).
I can’t say that I felt much different necessarily, with the exception of one noticeable thing. Plug your ears if it weirds you out guys, but when the natural disaster occurred this month, my normally 4-6 level cramps were easily only 1-3. I’ve noticed before that there is a connection between my hydration/diet and my cramps, but this was pretty dang sweet.
Eating an anti-inflammatory diet was mildly restrictive, but largely enjoyable. I didn’t mind adding chia seeds and avocado to stuff and including lots of spices – they add tons of flavor and keep food interesting! Overall, anti-inflammatory is one of my favorite eating styles to date. I will blog more soon about the specific types of conditions/people that can benefit from eating this way. In the meantime, enjoy your Father’s Day weekend!
Sorry for the delay in posting – I’ve been experiencing technical difficulties. And by “technical difficulties” I mean that my work tablet took a brief swim and is now resting in a pan of rice. 🙁 Pray for dry insides!
Anyhoo, as you may know, eating out and eating well can be a challenge. My favorite mantra for eating out:
You can make a “bad” choice just about everywhere, you can make a “good” choice pretty much anywhere, but you can always make the best choice for where you are.
Life happens. Food is a (wonderful!) part of life. By all means, eat out and enjoy it! Making choices when eating out depends a lot on how frequently you eat out. If you mostly cook at home and eat out once or twice a month or only on special occasions, ignore this post. Go out on your date night, anniversary, or family fun night and enjoy it. Don’t worry about this – it’s not a big enough portion of your whole eating picture to matter that much. I’m not advocating an all-out binge, but you should order what you want and move on.
On the other hand, if eating out is more frequent for you – maybe you travel or life is just busy – the story is different. You will have to tailor your eating out for your health goals if you ever hope to meet them. If you’re hoping to eat well with an eye towards decreasing inflammation, here are some tips from my experiences in the last few weeks:
Asian
We’ve eaten Asian food out twice since I started anti-inflammatory. Once we went to a new (to us) local Asian fusion restaurant that essentially offers a Subway-style, build-your-own sushi wrap, bowl, or salad. When eating out along these lines, choose foods without too much carbohydrate and get lots of veggies. Choose fish (especially salmon) – it’s high in anti-inflammatory omega-3s! If you’re up for spicy, add in brightly-colored spicy sauces, but go easy on those with sugar like teriyaki or sweet chili sauce. The seaweed in sushi is loaded with antioxidants too. I really wanted a sushi wrap so I asked for a light layer of rice, got miso soup on the side, and only ate half of the wrap.
Another day we went to a Korean restaurant. This one was easy – I love bibimbap! If you aren’t familiar, it’s a crackly, delicious cauldron of rice, tons of veggies, a meat of your choice, and an egg. I chose chicken and added loads of the optional veggie add-ins at the table (especially kimchi, which not only has colorful spices but also contains probiotics). Again, I saved half for later.
Italian
This one was tricky because (by far) my favorite type of Italian food is pasta, and most pasta dishes are just that – a giant plate of carbohydrates with a creamy, buttery inflammatory sauce. Hmph. I had to do a little finagling for this one. I decided I would still get pasta but choose a lean meat, an olive-oil based vinaigrette sauce, and lots of colorful vegetables. In this case, I picked a seafood pasta (to up the omega-3s) with tomatoes, onions, and asparagus. To prevent eating too many carbs I only ate half (are you noticing a pattern?). A vegetable-based sauce (like marinara) would have worked nicely too. Watch out for too much cheese or the absurd amount of delicious carbohydrates like breadsticks with pasta, pasta, and more pasta!
If you weren’t so much a pasta person, a salad with Italian vinaigrette or a chicken breast with marinara sauce could be a less inflammatory choice.
Seafood
A friend’s birthday dinner took us to a seafood restaurant. Seafood is anti-inflammatory as long as it’s not covered in butter or alfredo sauce (darn it), so you can choose a fillet of salmon or whitefish with veggies and a starch any time. I opted for a cioppino – basically seafood stewed in a tomato-based sauce with herbs and spices. High in antioxidants and omega-3s! It came with one slice of bread (plus in the spirit of full disclosure, I ate a slice of sourdough as an appetizer too). I skipped a drink and opted for water instead. Since my entree wasn’t inflammatory and it was delicious and reasonably portioned, I ate the whole thing!
Indian
We didn’t actually go out to an Indian restaurant in the last three weeks, but it could be a great place to go for an anti-inflammatory meal because of all of the beautiful spices they use! Keep your rice/naan portion reasonable, choose a sauce that is brightly-colored but not creamy, like curry, and get a brightly-colored veggie for a side (like palak paneer). This is a great opportunity to go meatless and choose a lentil- or garbanzo-based dish as well!
As I’ve continued with anti-inflammatory eating, I’ve frequently found myself at BBQs – summer is starting! Depending on the context, anti-inflammatory eating can be tricky at BBQs because there may not be very many options, other people are bringing the foods, and sometimes the sides are just junk food. Tough anti-inflammatory noogies for Becki.
.
So, I’ve had to be creative: eat small at the BBQ and fill in the gaps with fruits or veggies at home after or bring a fruit or veggie to the BBQ.
Fruit has become my go-to anti-inflammatory snack, and that is fine with me. I’m sprinkling chia seeds on nearly any edible object that will allow it and using lots and lots of spices, which is so fun! I’ve really enjoyed the food I’ve been eating and it’s anything but bland. The anti-inflammatory diet definitely makes for colorful, visually pleasing, and delicious healthful eating.
Depending on who you ask, you might find anti-inflammatory recommendations that encourage complete elimination of sugar and carbohydrates to decrease inflammation. This reasoning is often used as support for a keto diet ____. As is frequently the case, though, those recommendations are likely unnecessary extremes and everything is case-by-case. For one thing, you can probably achieve the anti-inflammatory benefits you’re looking for while still including well chosen, nutrient dense complex carbohydrates. Secondly, why over-restrict if we can still enjoy some tasty treats in moderation? That’s how we balance meeting health goals and living a life we love! So what does the research actually say about carbs and inflammation?
Multiple studies have linked consumption of concentrated sugar and simple carbohydrate consumption with increased levels of inflammation.1-2 A long time ago I talked in this post about what happens when we eat carbs and how we break them down into blood sugar to use as fuel. Those fuels are stuck in the blood until insulin comes around to let them in to our cells. Research draws a strong link between chronic inflammation and insulin resistance.3 This is a vicious cycle because insulin resistance means that blood sugars get stuck in the blood without a way out, causing fat storage and inflammation.4 Stored fat then produces inflammatory factors which make insulin resistance worse! Not fair.
Focus on eating more complex carbohydrates than simple carbohydrates like sugar. What does that mean? Well, complex carbohydrates are long chains of sugars that take much longer to digest, break down, and enter our blood, thus making our blood sugar much more stable (and preventing inflammation from blood sugar spikes). Simple carbohydrates are individual sugars or tiny chains of sugars that break down very quickly and enter the blood rapidly, causing a sharp spike in blood sugar that is inflammatory. Complex carbohydrates like whole grains, beans, and vegetables are connected with lower levels of inflammation.5 Same goes for high-fiber carbohydrates like fruit.
Avoid eating too much carbohydrate at once.Just like with diabetes, the key to preventing carbohydrate-induced inflammation is keeping the blood sugar from going too high. Eating controlled amounts of carbohydrate throughout the day can help keep your energy up and your inflammation down.
You’d have to be living in a mole hole to not have heard of the ketogenic diet. Everyone knows someone who’s on it. What everyone wants to know is whether or not keto is safe and effective. Does the keto diet work for weight loss? Is it dangerous? Is the keto diet nutritionally balanced? Is it easy to follow? There is SO much to say about keto so I’m going to make this post a quick overview. I’ll make more in-depth posts about these topics along the way (with a lot more references), so check back for more info!
What does the research say about the keto diet?
Research about the effectiveness of the keto diet (or similar low carb, high fat diets) for weight management is somewhat mixed. Most of the time, keto-like diets are successful at causing weight loss.1-2 Unfortunately, the research also indicates that the success of keeping that weight off long term (1 year or more) is low (and no better than with other types of diets).3-5
Research on keto’s effects on other health markers (cholesterol, blood glucose, insulin, inflammation, etc) is also mixed. Some studies show the keto diet improves cholesterol markers, others demonstrate that it makes them worse.1,6 Research on inflammation is once again, annoyingly, unclear and conflicting.6-7 For the most part, blood glucose and insulin levels do tend to improve1,6, likely because carbohydrates (and therefore the need for insulin) are largely a non-factor in a ketogenic diet.
With all of the conflicting information, it’s no wonder everyone is so confused about the keto diet. In a future post, I will go much more in-depth about what the research says and what conclusions we can pull from it.
Is the keto diet dangerous?
This answer is a little convoluted (you’re shocked, I know). Short-to-moderate length studies looking to evaluate the safety of the ketogenic diet have mostly unearthed no dangerous results (other than those mentioned above).1 However, few of those studies have looked at the long-term effects of the ketogenic diet (or similar very low carb diets) on metabolism.2,8 By far and away, my largest caution with the keto diet is its long-term effects on metabolism. This is also the main reason I do not recommend the keto diet for my clients and I am not following the keto diet during this feature.
Eating so few carbs mimics a “famine” situation, causing your body to rely more on its body fat stores than on blood glucose. So far, that sounds great, right? But your body expects this to be temporary (think caveman days – in Spring/Summer, the carbs will come back!). After a while, if carbohydrates don’t increase, your body resorts to a more sustainable long-term plan. Your body knows it can’t keep burning through the fat stores – it would rather slow down metabolism and try to preserve its fat stores as much as possible. This nearly always leads to fatigue, brain fog, feeling cold, and a weight loss plateau. Often at this point people become frustrated with the lack of results and begin to eat more carbohydrate. Your body is jazzed – “Spring/Summer is here! We survived! Boy, that was a long one. Next time, we will be even more prepared for Winter.” Translation: we will store more fat. These shifts are backed by documented hormonal changes in mice and humans,4,8-9 and are linked with the weight regain mentioned earlier.
The take-home message: In the long run, very low carb diets like keto teach your body how to store fat more effectively.
Is the keto diet nutritionally balanced?
The answer is a big it depends. I would venture to say that the average keto diet is not nutritionally balanced. I would follow that up by saying that it is possible to eat a nutritionally balanced keto diet, but it takes a lot of intention. Here are some of the nutritional weaknesses I see in keto diets:
Fiber – Fiber is a type of carbohydrate that composes the structure of certain plant-based foods. Since fiber doesn’t break down into blood glucose, it is not actually limited on the ketogenic diet and will not interfere with ketosis. At the same time, it comes in primarily carbohydrate foods, so the carb limitations often make it quite tricky to get enough fiber while avoiding other carbohydrates. It can be done with certain high-fiber foods such as nuts and seeds, avocados, and berries.
Vitamin C – While you can certainly get vitamin C from certain keto-friendly vegetables (hey, peppers!), a lot of the best vitamin C sources are fruits, which are very limited on a keto diet. You can definitely make a point to eat vitamin-C containing foods, but you have to make the point to do so.
Saturated fat – These are the types of fats that are primarily found in animal foods. Being a high-fat diet, unless someone is being very intentional in their food choices, a keto diet is typically quite high in saturated fats. While there are some debates around the appropriate recommendations for saturated fat,10 most keto-dieters I’ve talked with are eating WAY more than even some of the higher evidence-based recommendations. High saturated fat intakes are associated with high levels of cholesterol and increased occurrence of dementia.11-12 Keto dieters can buffer this impact by limiting intakes of high fat meats (sausage, bacon, ribs, hot dogs, etc) and dairy in favor of lean and grass-fed meats and reduced fat dairy. Focus on including a variety of plant-based fats like nuts, seeds, avocado, and olive oil.
Is the keto diet easy to follow?
This kind of depends (do you see a theme here? It seems nutrition rarely has a clear answer). Some people absolutely LOVE meat and veggies and aren’t so big on the carb-y stuff, and keto totally rocks their world. Others – most, if we’re honest – enjoy at least some carbohydrate foods (or the option to eat them without ruining ketosis) on a regular basis. With ketosis, it’s kind of an all-or-nothing thing. You either need to be in and mostly stay in ketosis or regularly meet your carbohydrate needs. Bouncing back and forth or riding the low-carb-but-not-quite-low-enough-for-ketosis train is generally not an enjoyable ride. Many clients complain about low energy, brain fog, fatigue, and weight fluctuations, particularly coming in and out of ketosis. Digestive disturbances come up frequently as well.
My average client finds keto to be a social and nutritional bummer, because it restricts a lot of foods – particularly delicious and commonly social foods. It can also be a challenge for some to consume enough fat to promote ketosis and meet caloric needs. I can’t even count how many clients and friends have followed keto for a few weeks or months, convinced it was going great, only to decide it was too restrictive and they weren’t enjoying their food quality of life or feeling their best. The same high dropout trend is commonly seen in studies about low-carbohydrate diets.3 When deciding about a diet, be sure to take the nutritional and safety factors into account as well as your personality, favorite foods, and family/friends.
Dashti, Hussein M et al. “Long-term effects of a ketogenic diet in obese patients.” Experimental and clinical cardiology vol. 9,3 (2004): 200-5.
David S Ludwig, The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed, The Journal of Nutrition, nxz308, https://doi.org/10.1093/jn/nxz308
Phelan, S., Wyatt, H., Nassery, S., DiBello, J., Fava, J.L., Hill, J.O. and Wing, R.R. (2007), Three‐Year Weight Change in Successful Weight Losers Who Lost Weight on a Low‐Carbohydrate Diet. Obesity, 15: 2470-2477. doi:10.1038/oby.2007.293
Cardillo, S., Seshadri, P., Iqbal, N. The effects of a Low Carbohydrate vs. Low Fat Diet on adipocytikines in severely obese adults: a three-year-follow-up on a randomized control trial. Eur Rev Med Pharmacol Sci vol. 10 (2006): 99-106.
Foster, G., et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med (2003); 348:2082-2090 DOI: 10.1056/NEJMoa022207.
Rosenbaum, M., et al. Glucose and lipid homeostasis and inflammation in humans following an isocaloric ketogenic diet. Obesity. 2019 Jun;27(6):971-981. doi: 10.1002/oby.22468. Epub 2019 May 8.
Shen, Y., Kapfhamer, D., Minnella, A.M. et al. Bioenergetic state regulates innate inflammatory responses through the transcriptional co-repressor CtBP. Nat Commun8, 624 (2017). https://doi.org/10.1038/s41467-017-00707-0
Goldberg, E.L., Shchukina, I., Asher, J.L. et al. Ketogenesis activates metabolically protective γδ T cells in visceral adipose tissue. Nat Metab2, 50–61 (2020). https://doi.org/10.1038/s42255-019-0160-6
Cooper, E. The Metabolic Storm: The science of your metabolism and how its making you fat. Seattle Performance Medicine. 2015. 2nd edition.
Enos, R., et al. Influence of dietary saturated fat content on adiposity, macrophage behavior, inflammation, and metabolism: composition matters.
Enos, R., et al. Influence of The Journal of Lipid Research. doi: 10.1194/jlr.M030700 (2013), 54, 152-163.
Barnard, N. D., Bunner, A. E., Agarwal, U. Saturated and trans fats and dementia: a systematic review. Neurobiology of Aging. Volume 35, Supplement 2 (2014) S65-S73. https://doi.org/10.1016/j.neurobiolaging.2014.02.030.
Week two of following the Mediterranean Diet is done and I’m learning a lot! The experiences I’m having help me provide tips to my clients for following a Mediterranean Diet.
What went well
This particularly week, grocery shopping was significantly cheaper than my normal grocery budget. I only spent $67 on groceries this week! Now, it’s pretty normal for my shopping trips to alternate from a more expensive “stock up” week to a cheaper “fill in” week (averaging $100 per week), so it’s likely that this next week’s shop will be quite a bit more expensive, but we’ll see. Regardless, I’m excited that the Mediterranean Diet is turning out to be so affordable so far!
My goal from last week was to try to increase plant-based proteins in my diet, and decrease fish intake a little. This is only because some Mediterranean Diet recommendations limit fish (others don’t) and I wanted to try not to go crazy with it since it seems to vary depending on the recommend-ers. Anyway, I succeeded! I swapped 7 servings of seafood last week for 4 this week, and 3 servings of legumes last week for 9 this week.
Challenges
One of my go-to proteins pre-Mediterranean diet was chicken, which is limited in the “white meat” category to twice weekly. That is significantly less than I’m used to…which is probably more like 5 times weekly (or more). I’ve found logistical ways to swap out chicken (mostly tuna, salmon, and beans), but I’m finding myself bored with these limited options since I’m having them so frequently. I need to work on incorporating more variety – there are other options, I just haven’t explored them as much as I could be yet.
The limited protein options I’ve been choosing has caused me, primarily out of boredom, to eat less protein overall. Since protein is very satisfying, this causes me to be hungrier overall and to be more likely to avoid eating when I’m hungry because I’m tired of my options. That isn’t very fun. As I mentioned, this limiting of my proteins is only partly due to the nature of the diet and partly due to my lack of effort in finding and using other protein options. I hope to remedy that in the upcoming week by picking up some hummus, pistachios, a different veggie breakfast sausage, and some tofu.
How I did
This week I did better on individual recommendations and succeeded in swapping seafood for more legumes. I also ate quite a bit more fruit (still within recommended ranges). I did, however, have two soul meals this week (celebrating my son getting his first job and enjoying some delicious nachos at a football game). These are not “cheat days,” by the way. They are living life, and living life is not cheating. These two meals threw off my count for days that I met recommendations.
Next week I’m going to focus on upping my veggie intake – it’s been low both weeks. I’m planning to get some snacking veggies and some hummus to up my protein and veggie munching next week.
Mediterranean Diet Goal*
Week #1
Week #2
# of days nutrition recommendations met
7
5
4
Grains (daily average)
3-6 servings
4 servings
4.5 servings
Potatoes (weekly)
≤3 servings
3 servings
2 servings
Legumes (weekly)
>2 servings
3 servings
9 servings
Dairy (daily average)
2 servings
2 servings
2 servings
Fruits (daily average)
2-6 servings
2.5 servings
5 servings
Vegetables (daily average)
4-6 servings
3 servings
3 servings
Olives/nuts/seeds (daily average)
1 serving
1 serving
1 serving
Eggs (weekly)
2-4 servings
3 servings
3 servings
Seafood (weekly)
>2 servings
7 servings
4 servings
Red meat (weekly)
<2 servings
1 serving
1 serving
White meat (weekly)
2 servings
2 servings
1 serving
Processed meat (weekly)
≤1 serving
1 serving
1 serving
Sweets (weekly)
≤2 servings
2 servings
2 servings
Weight change
-1 lb
0 lb
Grocery Budget Change
$0
-$33
In case you were wondering…
My digestive disturbances have resolved…thank you for asking.
That’s two weeks, folks! One to go and much more to learn…
*Based on the FDM recommendations I chose to follow. AHA and ACJN limit fish to “low to moderate” amounts.
Today marks the end of my first week on the Mediterranean Diet. My first impressions are that the Mediterranean Diet is heavy in fish and beans, nuts, seeds, grains, fruits, vegetables, and olive oil. Those things are all basically free-for-alls.* The diet includes a decent allotment of dairy products, and then some limited amounts of other animal-based proteins like chicken, beef, and pork.
Following the Mediterranean Diet was not a major struggle, but not entirely a walk in the park either. Read on to find out about my first week!
What went well
The biggest win of the week was the fact that I stayed within my grocery budget – I was very concerned about how expensive all that fish was going to be! It was so pleasantly surprising that groceries were comparable cost to my normal budget of $100 per week. Likely that was because the expensive seafood and the cheap beans in this diet balanced each other out.
I really enjoy fish and plant-based proteins so it wasn’t hard to eat those. I swapped my typical canned chicken for canned salmon to use on sandwiches and salad. I also learned a thing – canned salmon (at least the brand I bought) contains bones and skin! Who knew? Probably you – but not me (until last week). For breakfast proteins, I used Morningstar brand veggie sausage patties to avoid processed meat in the mornings. All that worked really well!
Challenges
The major challenge I faced this week was trying to navigate conflicting and/or vague recommendations from different sources. For example, the American Heart Association (AHA) and American Journal of Clinical Nutrition (AJCN) recommend low to moderate intake of fish, while the Mediterranean diet pyramid by the Fundación Dieta Mediterránea (FDM) recommends ≥2 servings of fish and seafood per week. The detailed guidelines from the FDM provided more specific guidance (which my type A brain appreciates), so I chose to follow those.
The AHA and AJCN also provide more generalized, less specific guidelines (e.g. low to moderate intake of fish and poultry). The Fundación Dieta Mediterránea gives very detailed recommendations in their Mediterranean Diet pyramid (e.g. <2 servings red meat per week). These types of differing messages are frequent sources for confusion for my clients. When you’re dealing with more generalized recommendations, you wonder “what does “low to moderate” mean, exactly?” When you have specific detailed guidelines, it can be difficult to count and keep track of them all. I struggled with this a bit, particularly since some of the recommendations are daily and others are weekly.
The detailed guidelines are a bit more restrictive than my typical diet in some areas. The biggest struggles were sweets and processed meat, believe it or not. Since there was no definition for these categories, I found myself wondering “what qualifies as a “sweet”? Obviously cookies, candy, etc. but what about beverages with added sugar, fruit juice, a few chocolate chips, a waffle with syrup?” I ended up deciding that I would only count dessert-like items in this category.
I had the same struggle with the “processed meat” category. Technically, all meat from the store is processed to a point…it’s been butchered and cut, sometimes seasoned, pressed or shaped, frozen, canned, etc. I assumed that any meat that has been ground and pressed with additives would count as processed meat – hot dogs, lunch meat, sausage, ham, etc. I did not include canned plain meats (chicken, salmon, tuna) as processed.
These two categories (sweets and processed meat) also proved most difficult for me to limit within the recommendations. Both of these things surprised me! I don’t generally consider myself a sweets person (I prefer salty all the way!), but limiting these to twice weekly was a challenge. The very first night I went to my grandma’s house for dinner and we ate ham (my processed meat for the week!) and dessert (one of my two sweets allotments for the week).
It was all totally worth it – it was made by my grandma, after all – but it was an early lesson in how quickly those allotments can go!
How I did
Following the Mediterranean Diet recommendations was a little tougher than I anticipated, partly because of the challenges mentioned above, but not extremely difficult.
The 2-4 egg per week, 2 servings dairy per day, and 2-3 servings fruit per day allotments pretty much reflect my typical intakes, so that wasn’t tough at all. I do pretty well with veggies in general, but I couldn’t quite average two servings per main meal.
Mediterranean Diet Goal*
Week #1
# of days nutrition recommendations met
7
5
Grains (daily average)
3-6 servings
4
Potatoes (weekly)
≤3 servings
3 servings
Legumes (weekly)
>2 servings
3 servings
Dairy (daily average)
2 servings
2 servings
Fruits (daily average)
2-6 servings
2.5 servings
Vegetables (daily average)
4-6 servings
3 servings
Olives/nuts/seeds (daily average)
1 serving
1 serving
Eggs (weekly)
2-4 servings
3 servings
Seafood (weekly)
>2 servings
7 servings
Red meat (weekly)
<2 servings
1 serving
White meat (weekly)
2 servings
2 servings
Processed meat (weekly)
≤1 serving
1 serving
Sweets (weekly)
≤2 servings
2 servings
Weight change
-1 lb
Grocery Budget Change
$0
Possibly TMI reality
Digestive disturbances. Normal with any diet change, but ever obnoxious. Let’s leave it at that.
All in all, my last week has gone pretty well. I’m looking to get a bit more organized and try to balance the seafood with more plant-based proteins this week since the AHA and ACJN recommendations are to moderate those also. Stay tuned!
*Based on the FDM recommendations I chose to follow. AHA and ACJN limit fish to “low to moderate” amounts.
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