I’ve already been asked this question by three clients this year, so I figured it’s probably a good topic for a post!

Question: How can I detox from all of my holiday eating?

Answer:

The term “detox” is actually misleading, since if your kidneys and liver are functioning properly, it’s not likely that your body is accumulating toxins. They do a pretty good job of keeping those at bay! However, after a couple weeks of holiday partying you’re probably not feeling your best. Common complaints include:

• Swelling/rapid weight gain – When you eat more sodium than your body is used to, the sodium binds with water in your body and causes you to retain a bit of extra water weight.
• Inflammation – High intakes of sugar, alcohol, and certain types of fat (that like to come out at parties) are inflammatory. Not to mention we tend to eat more of the foods that our individual bodies just “don’t agree with” at holiday times. This can lead you with a dose of extra inflammation for a bit afterward.
• Headache – This is likely to due either to hangover, inflammation, or dehydration (or a combo).
• Digestive…um…disturbances – These can vary across the spectrum from constipation to diarrhea to gas and bloating. This is usually related to eating foods that your normal collection of gut bacteria are not used to. They aren’t prepared for it and have a hard time helping you digest. Thus, disturbances.
• Low energy – Sugar crashes, the effects of alcohol, and lack of vitamins and minerals can leave you feeling sluggish.
• Heartburn – This one can be caused by eating more food overall, or specifically more fat, sugar, alcohol, or high-acid foods.
• Guilt – I gotta throw this one in here, since many people feel badly about their actions after holiday eating

The good news is, most of this is temporary. If you go back to your usual routine you’ll probably feel normal again after a few days or a week. If you want to speed up the process, here are some tips to feel your best as soon as possible after the holidays.

1. Hydrate – The number one thing you can do to resolve most of the issues above is to hydrate. Drinking water, tea, and black coffee can help to flush out extra sodium, which in turn can help resolve water retention. Seems backwards, but it’s true. Hydration can also help with digestion, energy, and headaches. Aim for 100 oz of fluid per day for a couple of days. Bonus: Green tea is loaded with anti-inflammatory antioxidants, so it’s a great option.
2. Get 4-5 fruit and vegetable servings per day – Water content in produce helps with hydration, and the antioxidant vitamins and minerals in these nutritious goodies fight inflammation and should get your energy back on track.
3. Go easy on sodium – Extra sodium is causing that buildup of fluid and contributing to dehydration at the same time. Steering clear of high-sodium foods like processed meats, canned/boxed foods, or restaurant meals for a couple of days can help kill the bloat.
4. Be active – Moving your body helps reduce inflammation and promote healthy digestion and circulation (that gets the water weight out quicker)!
5. Don’t beat yourself up – Easier said than done when our diet-crazed culture is coming at ya swinging, particularly at the start of the year. Do. Not. Feel. Bad. For. Enjoying. Food. You are under absolutely no obligation to dwell on your holiday eating behavior. If you feel physically bad, make a few healthful choices today and head in a direction that makes you feel good. There is absolutely no worth in kicking yourself for enjoying your holidays. In fact, I encourage it! What is a healthy life for if not to be enjoyed?

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Many of my clients wonder if they have a problem with food, because they find themselves craving sugar or bingeing on snacks or treats, especially at nighttime. There are several steps you can take to identify or overcome food addiction. The first and most important thing is to determine what causes your food cravings. Determining the cause will help you discover whether or not you have a food addiction or if there is another potential cause for your food cravings.

How to Determine what triggers your cravings

Check in with your intakes 

Most of the time, cravings are a response to a need for fuel. Many of my clients get cravings in the evenings, especially for sweets or salty snacks, because they are undereating either carbohydrates or calories throughout the day. More than half of my clients who are trying to lose weight are actually undereating, so honestly assess the possibility that you might be over-restricting. Common symptoms include low energy, poor sleep (or sleeping too much), brain fog, fatigue, memory issues, and food cravings, especially cravings for carbohydrates or sugar.

If you aren’t sure (most of my clients assume they need to eat less than they actually should), find a Registered Dietitian to help you know how much you should actually eat. For reference, most adult clients should be eating more than 1400 calories and well over 100 grams of carbohydrate daily (even if you’re trying to lose weight or if you have diabetes). Calorie tracking apps and online calculators are often inaccurate.

Assess your emotions

If you are certain you are meeting your body’s nutritional needs and you still struggle with a compulsion to eat unhealthful foods on a regular basis, try looking at your emotions. The second most common cause of food cravings has to do with dopamine, a neurotransmitter in the brain that makes us feel content. Negative emotions are usually paired with low dopamine. The brain sees low dopamine as a problem that needs to be fixed and will often go hunting for a way to raise it. Eating delicious food is a quick way to get a rush of dopamine, so often our brains go straight to the fridge to fix the problem. Your brain doesn’t care if you eat ice cream, it wants dopamine. Ask yourself if you are experiencing a negative emotion. Boredom, loneliness, stress, anxiety, and depression are common culprits.

If so, the first line of attack is to try to raise dopamine in a way that doesn’t involve food. You can do this by turning to an activity that you truly enjoy. Calling a friend, doing a crossword, going for a walk, or reading a book are examples of activities my clients have used. The key is that you enjoy it – otherwise it doesn’t raise your dopamine!

Sometimes you don’t have the time to do an alternative activity, so the next line of attack is to try to find a healthier food option. Craving salty snacks? Go for a couple handfuls of tortilla chips with salsa,  pretzels, or whole grain chips or crackers (Sun Chips and Triscuits are great options). Sweet tooth calling out to you? Try frozen grapes,  graham crackers, or berries with vanilla yogurt or whipped topping.

Finally, if you know that a healthier activity or alternative will not do the trick, it’s not a failure. The best thing you can do is try to moderate the amount of food you eat. Three to four bites of a desired food can cause the peak amount of dopamine response within the following 10-15 minutes. The take-home message? Rather than eat continually until your dopamine peaks and you feel better, try to savor that tasty food for 3-4 bites then wait 10-15 minutes. After that, reassess to see if you still feel like you need more.

Seek an outside opinion

If you have evaluated the above topics and are still struggling to get to the root of your food cravings, it could be possible that you have a food addiction. Evaluation for food addiction is still in its early stages. Researchers from Yale University have created a food addiction scale but the scoring system is complex and it is not widely used. For now, the best method is to meet with a Registered Dietitian and a Licensed Mental Health Counselor. Since food addiction by nature exhibits crossover between mental health and food habits, each professional can have valuable perspective. If it turns out that you do have addictive food behaviors, a holistic treatment plan will involve them both as well.

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I hear this from clients all the time: “It doesn’t matter what I do! My weight goes up and down and up and down. I’ll lose a few pounds and then I’ll gain two back and I just want to give up.”

Ahhh the scale…a mean mistress. It’s a rare person who has not noticed that, whether trying to lose weight or not, his or her number on the scale tends to fluctuate. This is true for just about everyone for a variety of reasons.

If you’ve been tracking my goal-getting journey, you know that one of my goals was to get back to my normal body weight by losing 7 lbs. If you haven’t been following along, well…now you know. So the first 4-5 came off in the first month or so. After that, things slowed to a screeching halt and began climbing…1 pound, 2 pounds, 3 pounds. I was sticking with my nutrition and workout goals for the most part, but it was still climbing.

How could this be, you ask? It’s actually very common. Read on and I’ll run you through a few reasons that your weight is not the “end all, be all”…or even necessarily a good way to measure your overall progress. It’s part of the equation, and it is certainly linked to health outcomes, but it does not warrant or deserve the intense focus we tend to put on it. Here are 7 reasons your weight may fluctuate that have nothing to do with eating too much or not exercising enough:

1. Time of the day – Believe it or not our weight changes, sometimes pretty significantly, throughout the day. During the day we retain some of the water we consume, so we tend to weigh the most at the end of the day and the least first thing in the morning after we’ve used the bathroom. I have a pretty small frame and depending on the day I’ve clocked as high as a 4-5 pound difference from morning to evening.
   
   
2. Hydration – Along the same lines as #1, the amount of water we drink during the day can affect our weights. On a day where we are sweating heavily or not drinking enough fluids, we will weigh less than a day where we are adequately hydrated.
3. Bathroom/food status – Gross but true. If you haven’t had a bowel movement in 1-2 days, your bowels may contain at least a couple of pounds (sometimes more!) of fecal material. Your bladder can hold anywhere from .5 to 1.5 lbs of urine as well.
4. Menstruation – Sorry ladies, but it can’t be helped. Most women retain at least an extra pound or two of fluid during menstruation.
5. Fluid retention/swelling – This can be caused by many different things, but in healthy people it is most commonly due to high sodium intakes. Have you ever noticed that your pants don’t fit quite right or your fingers look like sausages the day after the Superbowl party? Sodium and water are friends, so when we eat a lot of sodium, our body hangs on to extra water for a day or two.
   
   
6. Stress – In general, stress tends to make our bodies want to gain fat. Stress management is a very key component of overall health.
7. Muscle/fat – Most of us have heard the adage, “Muscle weighs more than fat.” It’s true, and it’s also true that if you start a new exercise program you will be gaining some muscle as you lose fat so progress can be tricky to track. Be careful with this one though, because you usually won’t be gaining enough muscle to really affect your weight for the first month or two of a new exercise program.

For these reasons, I try to encourage (and beg and plead) clients to focus on their overall health and fitness, their habits, and how they feel, as well as assessments like weight, circumference, or body fat to assess their overall progress. Given the things listed above, going up a pound or a few every so often is normal and should be expected. Don’t let it stress you out or discourage you! If you feel like you’re likely to quit on improving your health if the scale goes up, I have a strong recommendation for you – don’t get on the scale!

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Oftentimes I will have patients with diabetes whose blood sugars are high, and they think, logically, that if they eat very few (or no) carbohydrates, that will help. Unfortunately, they are working against themselves, and here’s why:

The body has what I like to refer to as a savings account of glucose in the liver. When the cells in the body aren’t getting the glucose they need for energy (like when someone skips a meal or when their cells are resistant to insulin), they start complaining all over the body trying to get someone to fix their problem. Word gets to the liver that the cells are starving and he wants to help. The trouble is, liver is a busy guy. He’s got many, many jobs. I often joke that managing this savings account is his “side gig.” He’s not particularly good at it.

In people with diabetes, liver sometimes starts dumping glucose from his savings account into the blood when he doesn’t really need to, and then once he has started…he doesn’t know when to stop. He just keeps pouring and pouring sugar into the blood and before you know it, this poor person who is trying their darnedest to avoid eating carbs in order to get their blood sugars down has a sky-high blood sugar because they haven’t eaten!

It’s the most frustrating thing in the world because it’s totally backwards to what we would naturally think.

Moral of the story: don’t skip meals, and don’t over-restrict carbohydrates! It’s just as important to eat enough as it is to not eat too much to manage blood sugars in diabetes (side note: that’s true for weight loss as well!).

Bonus sub-moral of the story: If you have something frustrating going on with your blood sugars or your weight that you can’t explain, seek out a Registered Dietitian or a Certified Diabetes Educator to help explain all the funky things that your body might be doing without your realizing it! You don’t have to be frustrated and helpless. You can be empowered to better understand your body!

What a great question. I get asked about sugar alternatives all the time and it is one of the more frustrating areas of nutrition for me.

As a dietitian, I am held to practice evidence-based nutrition, which means providing recommendations to patients based on the information that research provides. The tricky part with research is that, darn it, it doesn’t always agree with itself. One study will say something is fine, another will say it will cause you cancer (a great reason not to change your eating habits based on one single news clip, health news article, or Dr. Oz show).

We are only as good as the research that we have, and when it comes to sugar alternatives, I don’t feel that what we have is great. We have a lot of research in some areas, and not as much in others, but I struggle with the research we have because some of it is funded by industries that have a financial stake in the results (think sugar companies or artificial sweetener companies) and the methods aren’t always great assessments of real-life application.

So what I end up giving my patients is the information that we do have on all of their choices, and advise them to make a personal decision. Here is what we have so far:

Artificial sweeteners like sucralose (Splenda®), aspartame (Equal®, Nutrasweet), and saccharin (Sweet‘N Low®)

• Pros: Do not raise blood sugar significantly (1, 2) do not provide calories. (3, 4)
• Cons: Do not occur naturally, some have an unpleasant aftertaste, sucralose may worsen insulin resistance. (5)
• What is unclear: conflicting research on whether artificial sweeteners may increase hunger (the first two references say it does, the latter four found it did not) (6, 7, 8, 9, 10, 11), aspartame has been linked to increased occurrence of cancer, though in the spirit of full disclosure the methods of this study have been debated. (12)

Stevia (Truvia®)

• Pros: Does not raise blood sugar, provide calories, or increase hunger (13), some researchers claim it may have anti-hypertensive, anti-inflammatory, and anti-carcinogenic benefits (14), comes from a leaf that grows naturally.
• Cons: The safety of consuming stevia in large amounts has not been well-studied, though preliminary reviews have considered it safe (15).

Agave Nectar

• • Pros: May have a lower glucose and insulin response than sugar and cause less weight gain than sugar (16), occurs naturally.

• • Cons: Provides calories, raises blood sugar and can lead to insulin spikes in large amounts, causes inflammation, contains high levels of fructose which may increase BP (17) and worsen insulin sensitivity (18).

Honey

• • Pros: Unprocessed raw local honey is generally easy to find (albeit expensive), has higher antioxidant content than other sweeteners including sugar (19), occurs naturally.

• • Cons: Provides calories, raises blood sugar and can lead to insulin spikes in large amounts, causes inflammation.

Sugar (including raw sugar/turbinado sugar, cane sugar, and brown sugar)

• Pros: Tasty – that’s about it. Raw sugar and brown sugar have slightly more antioxidants than refined sugar (19).
• Cons: Provides calories, raises blood sugar and can lead to insulin spikes in large amounts, causes inflammation, offers empty calories without micronutrient value (20).

So there you have it. It’s unfortunately not as simple as “which is the best sweetener to use?” Your goals, personal convictions, and body all play in to that choice.

Other tips: work on decreasing your use of sweetening agents in general, and don’t put all your sweetener eggs in one basket. In other words, moderate. Small amounts of a few different kinds of sweeteners in your diet is less likely to cause the damage that might occur from getting all your sweetening from one particular source.

Sources (Yes, I know – lazy, linked sources without full citations):

1. http://care.diabetesjournals.org/content/19/9/1004.short
2. http://www.sciencedirect.com/science/article/pii/S0002822303013646
3. http://ajcn.nutrition.org/content/51/6/963.short
4. http://www.sciencedirect.com/science/article/pii/S0273230009000786
5. http://www.healio.com/endocrinology/obesity/news/online/%7Bd976c2ee-06ee-425f-b1eb-aa3b6cbc2891%7D/non-nutritive-sweetener-effects-may-contribute-to-insulin-resistance-in-consumers-with-obesity
6. http://agris.fao.org/agris-search/search.do?recordID=US8466072
7. https://www.researchgate.net/profile/Jacquie_Lavin/publication/14185276_Lavin_JH_French_SJ_Read_NW._The_effect_of_sucrose-_and_aspartame-sweetened_drinks_on_energy_intake_hunger_and_food_choice_of_female_moderately_restrained_eaters._Int_J_Obes_Relat_Metab_Disord_21_37-42/links/541c1ece0cf241a65a0bb530.pdf
8. http://www.sciencedirect.com/science/article/pii/S0195666310000826
9. http://www.sciencedirect.com/science/article/pii/0031938490902542
10. http://www.sciencedirect.com/science/article/pii/003193849090350D
11. http://www.sciencedirect.com/science/article/pii/0031938488902077
12. http://www.jstor.org/stable/4626891?seq=1#page_scan_tab_contents, http://jnen.oxfordjournals.org/content/55/11/1115.abstract
13. http://www.sciencedirect.com/science/article/pii/S0195666310000826
14. http://www.academicjournals.org/article/article1386344782_Gupta%20et%20al.pdf
15. http://www.sciencedirect.com/science/article/pii/S1572599502800394
16. http://online.liebertpub.com/doi/abs/10.1089/jmf.2013.0162
17. http://hyper.ahajournals.org/content/10/5/512.short
18. http://www.sciencedirect.com/science/article/pii/0026049580900414
19. http://www.sciencedirect.com/science/article/pii/S0002822308018919
20. Gropper, S. A. S., Smith, J. L., & Groff, J. L. (2009). Advanced nutrition and human metabolism. Australia: Wadsworth/Cengage Learning.

No matter how you say it, it’s serious. Diabetes is common and can wreak havoc on someone’s body, so I’m more than happy to spend some time focusing on this condition and how to manage blood sugars by counting carbohydrates.

For anyone who is looking for a review of what carbohydrates are or what they do in the body, check out this post. Carbs are the numero uno focus when it comes to managing diabetes and reducing risk of complications.

To understand how diabetes works, let’s go back to the house/insulin key/sugar explanation I wrote about here. Check it out because my upcoming explanation will likely not make sense if you’re not in on the metaphor. Let’s also bring my highly sophisticated representative drawing back for a second look:

 In people with diabetes, the sugar people are not able to get into the house, causing a buildup of sugar people in the streets. They get crowded and angry and start flipping cars, breaking windows, and rioting all over the place. It makes for a pretty hostile environment.

This buildup of sugar people in the streets typically happens for one of three reasons:

1. The person has an autoimmune condition that prevents the body from being able to make insulin keys at all. This is called Type 1 diabetes.
2. The person’s locks are all rusty and take a long time to open. While the lock and key are fumbling around, sugar people build up in the street. This happens for a variety of reasons including genetics, obesity, stress, and inflammation, among others. This is called Type 2 diabetes.
3. The person’s locks are temporarily rusty because of the effects of hormones associated with pregnancy. This is called Gestational diabetes and most of the time it goes away after the baby is delivered, though it does increase a woman’s risk of having type 2 diabetes later in life.

In order to keep there from being too many angry sugar people in the blood, nutrition recommendations include portioning total amounts of carbohydrates eaten at one time. In other words, we send sugar people into the street single file all polite-like rather than stampeding en masse. That is why, in support of my patients and anyone with diabetes, I will be counting and moderating intake of carbohydrates at each meal and snack starting on Monday. We’ll also be going over more specifics about what types of foods are carbohydrates.

There are several other things we can do to help keep the sugar people from building up and rioting – look for more info in upcoming posts!

The paleo diet in and of itself is not a “high-fat, low-carbohydrate” diet; however, many people utilize paleo thinking as a method of achieving a low-carbohydrate way of eating. The paleo meal plan I’m currently using is based on that method. One of the premises of high-fat, low-carbohydrate is that your body enters into a state of ketosis. That means that your body is switching fuels from using primarily carbohydrate to mainly fat.

Remember in this post when I talked about how your body breaks down carbohydrates to use for energy? Well, here begins chapter 2: After your body turns the carbohydrates into glucose and your cells pick up the glucose, a bunch of active little proteins called enzymes start changing the glucose by adding and taking away chemical bonds. At the end, the glucose is converted to something called Acetyl CoA which then goes on into another process known as the TCA cycle (or Kreb’s cycle, or citric acid cycle, but that’s neither here nor there). This nifty little pathway is the major energy factory in your body. In fact, my metabolism textbook* says that “over 90% of the energy released from food is estimated to occur as a result of TCA cycle oxidation.” Basically, it’s where carbs, fats, and proteins all go to die. They are broken down until there is just water, carbon dioxide, and energy left. Pretty cool, huh?

Since Paleo is considered a high-fat diet, I’ll start with fat. After making its way into the cells, the fatty acids undergo a conversion to (guess what?) acetyl CoA. That molecule then has two possible destinations: it can either go through the TCA cycle just like the former glucose molecules do, or in the presence of extra acetyl CoA the liver can convert it into something called ketones. Ketones can then travel throughout the body to other tissues where they are actually converted back into acetyl CoA and used for energy there.

Starting Wednesday morning (paleo day #3), I started having hot flashes, brain fog, nausea, lightheadedness, and a mild headache. All of these are symptoms described by paleo-diet promoters as the “low-carb flu”. Others complain of such maladies as muscle soreness, extreme fatigue, poor sleep, and digestive disturbances. Doesn’t that just sound like a barrel of monkeys?

Anyway, these ailments are due mostly to chemical shifts in my body (that are super complicated) and the adjustment from using well-oiled glucose burning machinery to my dusty, rusty fat/ketone users. Most of my symptoms have gone away by now, but I now have a bad taste in my mouth (all the time) and occasional hot flashes. My next quest is to investigate the long-term implications of this way of eating and how it affects the body over time. Here goes nothing!

*Gropper, Smith, and Groff. Advanced Nutrition and Human Metabolism. 2009. 5th edition. Wadsworth, Cengage Learning. Belmont, CA.

UPDATE (3/1/14): A friend of mine made a good point that prompted me to edit the original post. I had originally referred to the paleo diet as a high-fat, low-carbohydrate diet, but paleo in and of itself is not “high-anything” or “low-anything.” If one wanted to not eat a low carbohydrate diet and still be paleo, he or she could eat loads of fruit, for example. In my case, the meal plan I chose only included fruit 3 times in the first week, so I have ended up on a high, fat low carbohydrate diet though paleo would not necessarily require that. I updated the post above to reflect this.