Category: Nutrition

  • Testing for Vitamin B12 Deficiency 

    Testing for Vitamin B12 Deficiency 

    Many doctors mistakenly rely on serum B12 levels in the blood to test for vitamin B12 deficiency.

    There were two cases of young, strictly vegetarian individuals with no known vascular risk factors. One suffered a stroke, and the other had multiple strokes. Why? Most probably because they weren’t taking vitamin B12 supplements, which leads to high homocysteine levels, which can attack our arteries.

    So, those eating plant-based who fail to supplement with B12 may increase their risk of both heart disease and stroke. However, as you can see in the graph below and at 0:47 in my video How to Test for Functional Vitamin B12 Deficiency, vegetarians have so many heart disease risk factor benefits that they are still at lower risk overall, but this may help explain why vegetarians were found to have more stroke. This disparity would presumably disappear with adequate B12 supplementation, and the benefit of lower heart disease risk would grow even larger.

    Compared with non-vegetarians, vegetarians enjoy myriad other advantages, such as better cholesterol, blood pressure, blood sugars, and obesity rates. But, what about that stroke study? Even among studies that have shown benefits, “the effect was not as pronounced as expected, which may be a result of poor vitamin B12 status due to a vegetarian diet. Vitamin B12 deficiency may negate the cardiovascular disease prevention benefits of vegetarian diets. To further reduce the risk of cardiovascular disease, vegetarians should be advised to use vitamin B12 supplements.” 

    How can you determine your B12 status? By the time you’re symptomatic with B12 deficiency, it’s too late. And, initially, the symptoms can be so subtle that you might even miss them. What’s more, you develop metabolic vitamin B12 deficiency well before you develop a clinical deficiency, so there’s “a missed opportunity to prevent dementia and stroke” when you have enough B12 to avoid deficiency symptoms, but not enough to keep your homocysteine in check. “Underdiagnosis of this condition results largely from a failure to understand that a normal serum [blood level] B12 may not reflect an adequate functional B12 status.” The levels of B12 in our blood do not always represent the levels of B12 in our cells. We can have severe functional deficiency of B12 even though our blood levels are normal or even high.

    “Most physicians tend to assume that if the serum B12 is ‘normal,’ there is no problem,” but, within the lower range of normal, 30 percent of patients could have metabolic B12 deficiency, with high homocysteine levels. 

    Directly measuring levels of methylmalonic acid (MMA) or homocysteine is a “more accurate reflection of vitamin B12 functional statuses.” Methylmalonic acid can be checked with a simple urine test; you’re looking for less than a value of 4 micrograms per milligram of creatinine. “Elevated MMA is a specific marker of vitamin B12 deficiency while Hcy [homocysteine] rises in both vitamin B12 and folate deficiencies.” So, “metabolic B12 deficiency is strictly defined by elevation of MMA levels or by elevation of Hcy in folate-replete individuals,” that is, in those getting enough folate. Even without eating beans and greens, which are packed with folate, folic acid is added to the flour supply by law, so, these days, high homocysteine levels may be mostly a B12 problem. Ideally, you’re looking for a homocysteine level in your blood down in the single digits.

    Measured this way, “the prevalence of subclinical functional vitamin B12 deficiency is dramatically higher than previously assumed…” We’re talking about 10 to 40 percent of the general population, more than 40 percent of vegetarians, and the majority of vegans who aren’t scrupulous about getting their B12. Some suggest that those on plant-based diets should check their vitamin B12 status every year, but you shouldn’t need to if you’re adequately supplementing. 

    There are rare cases of vitamin B12 deficiency that can’t be picked up on any test, so it’s better to just make sure you’re getting enough.

    If you do get your homocysteine tested and it’s still too high, up in the double digits despite B12 supplementation and eating beans and greens, I have a suggestion for you in the final videos of this series, which we’ll turn to next with: Should Vegetarians Take Creatine to Normalize Homocysteine? and The Efficacy and Safety of Creatine for High Homocysteine.

    How did we end up here? To watch the full series if you haven’t yet, check the related posts below. 



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  • Are you getting enough protein?

    Are you getting enough protein?

    What’s included:
    Why protein is important
    ✓ 
    Food source vs protein content
    ✓ 
    Table to estimate protein intake

    The patient resources are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances.  The patient resources are for your information only, and we advise that you exercise your own judgment before deciding to use the information provided. Professional medical advice should be obtained before taking action.  Please see here for terms and conditions.

    Please note that all of our resources must be used in full and are unable to be personalised or customised.

     

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  • What About Vegan Junk Food and Vegetarians’ Stroke Risk? 

    What About Vegan Junk Food and Vegetarians’ Stroke Risk? 

    Just because you’re eating a vegetarian or vegan diet doesn’t mean you’re eating healthfully.

    “Plant-Based Diets Are Associated with a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults”: This study of a diverse sample of 12,000 Americans found that “progressively increasing the intake of plant foods by reducing the intake of animal foods is associated with benefits on cardiovascular health and mortality.” Still, regarding plant-based diets for cardiovascular disease prevention, “all plant foods are not created equal.” As you can see in the graph below and at 0:40 in my video Vegetarians and Stroke Risk Factors: Vegan Junk Food?, a British study found higher stroke risk in vegetarians. Were they just eating a lot of vegan junk food? 

    “Any diet devoid of animal food sources can be claimed to be a vegetarian [or vegan] diet; thus, it is important to determine” what is being eaten. One of the first things I look at when I’m trying to see how serious a population is about healthy eating is something that is undeniably, uncontroversially bad: soda, aka liquid candy. Anyone drinking straight sugar water doesn’t have health on top of mind.

    A large study was conducted of plant-based eaters in the United States, where people tend to cut down on meat for health reasons far more than for ethics, as you can see in the graph below and at 1:20 in my video.

    Researchers found that flexitarians drink fewer sugary beverages than regular meat eaters, as do pescatarians, vegetarians, and vegans, as you can see below and at 1:30.

    However, in the study from the United Kingdom where the increased stroke risk in vegetarians was found and where people are more likely to go veg or vegan for ethical reasons, researchers found that pescatarians drink less soda, but the vegetarians and vegans drink more, as shown in the graph below and at 1:44. 

    I’m not saying that’s why they had more strokes; it might just give us an idea of how healthfully they were eating. In the UK study, the vegetarian and vegan men and women ate about the same amounts of desserts, cookies, and chocolate, as you can see in the graph below and at 1:53. 

    They also consumed about the same total sugar, as shown below and at 2:02. 

    In the U.S. study, the average non-vegetarian is nearly obese, the vegetarians are a little overweight, and the vegans were the only ideal weight group. In this analysis of the UK study, however, everyone was about the same weight. The meat eaters were lighter than the vegans, as you can see below, and at 2:19 in my video. The EPIC-Oxford study seems to have attracted a particularly “health-conscious” group of meat eaters weighing substantially less than the general population. 

    Let’s look at some specific stroke-related nutrients. Dietary fiber appears to be beneficial for the prevention of cardiovascular disease, including stroke, and it seems the more, the better, as you can see in the graph below and at 2:43 in my video

    Based on studies of nearly half a million men and women, there doesn’t seem to be any upper threshold of benefit—so, again, “the more, the better.” At more than 25 grams of soluble fiber and 47 grams of insoluble dietary fiber, you can start seeing a significant drop in associated stroke risk. So, one could consider these values “as the minimal recommendable daily intake of soluble and insoluble fiber…to prevent stroke at a population level.” That’s what you see in people eating diets centered around minimally processed plant foods. Dean Ornish, M.D., got up around there with his whole food, plant-based diet. It might not be as much as we were designed to eat, based on the analyses of fossilized feces, but that’s about where we might expect significantly lower stroke risk, as shown below and at 3:25 in my video

    How much were the UK vegetarians getting? 22.1 grams. Now, in the UK, they measure fiber a little differently, so it may be closer to 30 grams, but that’s still not the optimal level for stroke prevention. It’s so little fiber that the vegetarians and vegans only beat out the meat eaters by about one or two bowel movements a week, as you can see below and at 3:48 in my video, suggesting the non-meat eaters were eating lots of processed foods. 

    The vegetarians were only eating about half a serving more of fruits and vegetables. Intake is thought to reduce stroke risk in part because of their potassium content, but the UK vegetarians at higher stroke risk were eating so few greens and beans that they couldn’t even match the meat eaters. The vegetarians (and the meat eaters) weren’t even reaching the recommended minimum daily potassium intake of 4,700 mg a day.

    What about sodium? “The vast majority of the available evidence indicates that elevated salt intake is associated with higher stroke risk…” There is practically a straight-line increase in the risk of dying from a stroke, the more salt you eat, as you can see in the graph below and at 4:29 in my video

    Even just lowering sodium intake by a tiny fraction every year could prevent tens of thousands of fatal strokes. “Reducing Sodium Intake to Prevent Stroke: Time for Action, Not Hesitation” was the title of the paper, but the UK vegetarians and vegans appeared to be hesitating, as did the other dietary groups. “All groups exceeded the advised less than 2400 mg daily sodium intake”—and that didn’t even account for salt added to the table! The American Heart Association recommends less than 1,500 mg a day. So, they were all eating a lot of processed foods. It’s no wonder the vegetarians’ blood pressures were only one or two points lower. High blood pressure is perhaps “the single most important potentially modifiable risk factor for stroke.” 

    What evidence do I have that the vegetarians’ and vegans’ stroke risk would go down if they ate more healthfully? Well, in rural Africa, where they were able to nail the fiber intake that our bodies were designed to get by eating so many whole, healthy plant foods—including fruits, vegetables, grains, greens, beans, and protein almost entirely from plant sources—not only was heart disease, our number one killer, “almost non-existent,” but so was stroke. It only surged up from nowhere “with the introduction of salt and refined foods” to their diet. 

    “It is notable that stroke and senile dementia appear to be virtually absent in Kitava, an Oceanic culture [near Australia] whose quasi-vegan traditional diet is very low in salt and very rich in potassium.” They ate fish a few times a week, but the other 95 percent or so of their diet was made up of vegetables, fruits, corn, and beans. They had an apparent absence of stroke, even despite their ridiculously high rates of smoking, 76 percent of men and 80 percent of women. We evolved by eating as little as less than an eighth of a teaspoon of salt a day, and our daily potassium consumption is thought to have been as high as 10,000 mg or so. We went from an unsalted, whole-food diet to eating salty, processed foods depleted of potassium whether we eat meat or not. 

    Caldwell Esselstyn at the Cleveland Clinic tried putting about 200 patients with established cardiovascular disease on a whole food, plant-based diet. Of the 177 who stuck with the diet, only a single patient went on to have a stroke in the subsequent few years, compared to a hundred-fold greater rate of adverse events, including multiple strokes and deaths in those who strayed from the diet. “This is not vegetarianism,” Esselstyn explains. Vegetarians can eat a lot of less-than-ideal foods, “such as milk, cream, butter, cheese, ice cream, and eggs. This new paradigm is exclusively plant-based nutrition.” 

    This entire train of thought—that the reason typical vegetarians don’t have better stroke statistics is because they’re not eating particularly stellar diets—may explain why they don’t have significantly lower stroke rates. However, it still doesn’t explain why they may have higher stroke rates. Even if they’re eating similarly crappy, salty, processed diets, at least they aren’t eating meat, which we know increases stroke risk. There must be something about vegetarian diets that so increases stroke risk that it offsets their inherent advantages. We’ll continue our hunt for the answer next. 

    From a medical standpoint, labels like vegan and vegetarian just tell me what you don’t eat. It’s like identifying yourself as a “No-Twinkie-tarian.” You don’t eat Twinkies? Great, but what’s the rest of your diet like? 

    What are the healthiest foods? Check out my Daily Dozen.

    To catch up on the rest of this series, see related posts below. 



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  • 10 ways to get more protein

    10 ways to get more protein

    What’s included:
    10 tips for eating more protein

    The patient resources are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances.  The patient resources are for your information only, and we advise that you exercise your own judgment before deciding to use the information provided. Professional medical advice should be obtained before taking action.  Please see here for terms and conditions.

    Please note that all of our resources must be used in full and are unable to be personalised or customised.

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  • What About Homocysteine, Vitamin B12, and Vegetarians’ Stroke Risk? 

    What About Homocysteine, Vitamin B12, and Vegetarians’ Stroke Risk? 

    Not taking vitamin B12 supplements or regularly eating B12-fortified foods may explain the higher stroke risk found among vegetarians.

    Leonardo da Vinci had a stroke. Might his vegetarian diet have been to blame? “His stroke…may have been related to an increase in homocysteine level because of the long duration of his vegetarian diet.” A suboptimal intake of vitamin B12 is common in those eating plant-based diets (unless they take B12 supplements or regularly eat B12-fortified foods) and can lead to an increased level of homocysteine in the blood, which “is accepted as an important risk factor for stroke.”

    “Accepted” may be overstating it as there is still “a great controversy” surrounding the connection between homocysteine and stroke risk. But, as you can see in the graph below and at 0:57 in my video Vegetarians and Stroke Risk Factors: Vitamin B12 and Homocysteine?, those with higher homocysteine levels do seem to have more atherosclerosis in the carotid arteries that lead up to the brain, compared to those with single-digit homocysteine levels, and they also seem to be at higher risk for clotting ischemic strokes in observational studies and, more recently, bleeding hemorrhagic strokes, as well as increased risk of dying from cardiovascular disease and all causes put together. 

    Even more convincing are the genetic data. About 10 percent of the population has a gene that increases homocysteine levels by about 2 points, and they appear to have significantly higher odds of having a stroke. Most convincing would be randomized, double-blind, placebo-controlled trials to prove that lowering homocysteine with B vitamins can lower strokes, and, indeed, that appears to be the case for clotting strokes: Strokes with homocysteine-lowering interventions were more than five times as likely to reduce stroke compared with placebo.

    Ironically, one of the arguments against the role of homocysteine in strokes is that, “assuming that vegetarians have lower vitamin B12 concentrations than meat-eaters and that low vitamin B12 concentrations cause ischaemic stroke, then the incidence of stroke should be increased among vegetarians…but this is not the case.” However, it has never been studied until now.

    As you can see in the graph below and at 2:16 in my video, the EPIC-Oxford study researchers found that vegetarians do appear to be at higher risk.

    And no wonder, as about a quarter of the vegetarians and nearly three-quarters of the vegans studied were vitamin B12-depleted or B12-deficient, as you can see below and at 2:23, and that resulted in extraordinarily high homocysteine levels.

    Why was there so much B12 deficiency? Because only a small minority were taking a dedicated B12 supplement. And, unlike in the United States, B12 fortification of organic foods isn’t allowed in the United Kingdom. So, while U.S. soymilk and other products may be fortified with B12, UK products may not. We don’t see the same problem among U.S. vegans in the Adventist study, presumably because of the B12 fortification of commonly eaten foods in the United States. It may be no coincidence that the only study I was able to find that showed a significantly lower stroke mortality risk among vegetarians was an Adventist study.

    Start eating strictly plant-based without B12-fortified foods or supplements, and B12 deficiency can develop. However, that was only for those not eating sufficient foods fortified with B12. Those eating plant-based who weren’t careful about getting a regular reliable source of B12 had lower B12 levels and, consequently, higher homocysteine levels, as you can see below and at 3:27 in my video.

    The only way to prove vitamin B12 deficiency is a risk factor for cardiovascular disease in vegetarians is to put it to the test. When researchers measured the amount of atherosclerosis in the carotid arteries, the main arteries supplying the brain, “no significant difference” was found between vegetarians and nonvegetarians. They both looked just as bad even though vegetarians tend to have better risk factors, such as lower cholesterol and blood pressure. The researchers suggest that B12 deficiency plays a role, but how do they know? Some measures of artery function weren’t any better either. Again, they surmised that vitamin B12 deficiency was overwhelming the natural plant-based benefits. “The beneficial effects of vegetarian diets on lipids and blood glucose [cholesterol and blood sugars] need to be advocated, and efforts to correct vitamin B12 deficiency in vegetarian diets can never be overestimated.”

    Sometimes vegetarians did even worse. Worse artery wall thickness and worse artery wall function, “raising concern, for the first time, about the vascular health of vegetarians”—more than a decade before the new stroke study. Yes, their B12 was low, and, yes, their homocysteine was high, “suggest[ing] that vitamin B12 deficiency in vegetarians might have adverse effects on their vascular health.” What we need, though, is an interventional study, where participants are given B12 to see if that fixes it, and here we go. The title of this double-blind, placebo-controlled, randomized crossover study gives it away: “Vitamin B-12 Supplementation Improves Arterial Function in Vegetarians with Subnormal Vitamin B-12 Status.” So, compromised vitamin B12 status among those eating more plant-based diets due to not taking B12 supplements or regularly eating vitamin B12-fortified foods may explain the higher stroke risk found among vegetarians.

    Unfortunately, many vegetarians resist taking vitamin B12 supplements due to “misconceptions,” like “hold[ing] on to the old myth that deficiency of this vitamin is rare and occurs only in a small proportion of vegans.” “A common mistake is to think that the presence of dairy products and eggs in the diet, as in LOV [a lacto-ovo vegetarian diet], can still ensure a proper intake [of B12]…despite excluding animal flesh.”

    Now that we may have nailed the cause, maybe “future studies with vegetarians should focus on identifying ways to convince vegetarians to take vitamin B12 supplements to prevent a deficiency routinely.” 

    I have updated my recommendation for B12 supplementation. I now suggest at least 2,000 mcg (µg) of cyanocobalamin once weekly, ideally as a chewable, sublingual, or liquid supplement taken on an empty stomach, or at least 50 mcg daily of supplemental cyanocobalamin. (You needn’t worry about taking too much.) You can also have servings of B12-fortified foods three times a day (at each meal), each containing at least 190% of the Daily Value listed on the nutrition facts label. (Based on the new labeling mandate that started on January 1, 2020, the target is 4.5 mcg three times a day.) Please note, though, that those older than the age of 65 have only one option: to take 1,000 micrograms a day. 

    We started this series on what to eat and not eat for stroke prevention, and whether vegetarians really have a higher stroke risk. Check related posts for the last few videos that looked at specific factors.

    Stay tuned for: 



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  • PCOS, endometriosis and nutrition | Dietitian Connection

    PCOS, endometriosis and nutrition | Dietitian Connection


    Through her award-winning virtual private practice, dietitian Stefanie Valakas has supported over 1000 women globally with nutrition strategies for reproductive health. In this episode, we explore Stef’s professional and personal journey towards finding her niche in women’s health, and why she is so passionate about helping women prepare for pregnancy and/or manage PCOS and endometriosis symptoms. Stef also shares her passion for keeping up-to-date with the latest science and highlights why an anti-inflammatory diet is an essential tool in a dietitian’s toolkit for women’s health.

    Hosted by Brooke Delfino

    Biography

    Stefanie Valakas is an expert certified fertility and pregnancy dietitian & nutritionist and founder of award-wining virtual practice, The Dietologist. Stefanie and her team of fertility and pregnancy dietitians are dedicated to excellence in nutrition for reproductive health concerns, fertility and pregnancy. Her passion for nutrition in this space has grown from her experience helping her clients online from around the world and also through her own personal experiences of navigating a diagnosis of endometriosis. Stef believes every hopeful parent should be armed with tools and knowledge to support their own reproductive health and set up their future children for a healthy future. Outside of her clinical work, Stefanie is a consultant to food industry and also mentors fellow dietitians inside her mentorship group, Fertility Friendly Dietitians.

    In this episode, we discuss:

    • The latest research in PCOS and endometriosis
    • Effective nutrition strategies dietitians can implement with their clients
    • Specific foods and nutrients to focus on
    • Key factors dietitians need to consider when creating personalised nutrition care plans


    Additional resources

    Connect with Stef at thedietologist.com.au or on Instagram @the_dietologist


    The content, products and/or services referred to in this episode are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see here for terms and conditions.


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  • Menopause Weight Gain: What Actually Works

    Menopause Weight Gain: What Actually Works

    Reviewed by Helen Kollias, PhD and Brian St. Pierre, MS, RD


    At some point in my mid-40s, the scale started climbing.

    A pound or two turned into five, then 10, then 20.

    It seemed as if I was doing all the right things: Eating less, moving more, rinse, repeat. Yet, the harder I worked, the less the scale seemed to respond.

    Had perimenopause destroyed my metabolism?

    It sure felt like it.

    However, after asking my doctor to run a series of tests, I learned that my metabolism was, in fact, fine. Instead, like the vast majority of midlife women, the true causes of my weight gain stemmed from several subtle issues that I would have sworn, at the time, didn’t apply to me.

    If, like me, you or your client are currently stuck in what feels like an eat less, gain more cycle, this article is here to help.

    In this story, you’ll discover:

    • Several reasons women gain weight at midlife that have nothing to do with a “slower metabolism”
    • Why intense exercise and strict diets can backfire after menopause
    • 11 crafty ways to get a handle on midlife weight gain

    First, what is menopause?

    Many women refer to midlife hot flashes and inconsistent menstruation as “being in menopause” or “menopausal.”

    However, menopause isn’t a phase as much as a transitional moment that separates menstruation from non-menstruation.

    Once you’ve gone 12 consecutive months without a period, you’ve reached menopause. For most people, that moment arrives somewhere between ages 46 and 56.

    The hot-and-dewy months and years leading up to that 12th missed period are technically known as “perimenopause.” 

    Perimenopause means “around menopause.”

    Some people refer to this time as the menopause transition. This is when estrogen levels fluctuate. Menstrual cycles lengthen and shorten and, at times, disappear, only to return a few months later. For many people, this marks the beginning of symptoms like hot flashes, sleep issues, vaginal dryness, mood changes, and, yes, creeping weight gain.

    (For a thorough overview of the many changes that can happen during this time, read: ‘What’s happening to my body!?’ 6 lifestyle strategies to try after menopause)

    How much weight do women gain during menopause?

    Many women think of menopause and weight gain the same way many young parents think of two-year-olds and tantrums: Inevitable.

    However, not all women gain weight during the menopause transition, explains Helen Kollias, PhD, who is an expert on physiology and molecular biology, and a science advisor at Precision Nutrition and Girls Gone Strong.

    On average, in the West, women gain four to six pounds during the three-and-a-half years of perimenopause, or about one to two pounds a year.1 2

    That’s double the rate of weight gain in pre-menopausal women, though it’s roughly the same amount men gain at midlife, notes Dr. Kollias.

    In other words, the menopause transition may not be solely to blame for those extra pounds on the scale. Aging may play a significant role, as we explore below.

    The real reasons the scale climbs

    Several factors conspire to add pounds to your frame during the menopause transition.

    ✅ You’re not sleeping as well.

    Maybe this sounds familiar: You wake repeatedly with sweat pooling under your breasts and sheets that are uncomfortably damp (or soaked).

    Even if you don’t have night sweats, plenty of other issues might keep you awake.

    First, there’s worry—over aging parents, teenagers with car keys, money needed to replace that leaking roof, some strange bodily sensation you’re worried might be cancer, the colonoscopy or mammogram you don’t want to schedule but also don’t not want to schedule, the sex you’re not having, and so many others.

    Plus, if you’re like me and you have osteoarthritis in multiple joints, your body hurts. Or your skin might itch. Or your legs are restless. Or you’re bloated.3 4 5 6

    My point: Problems that make sleep uncomfortable can multiply with age.

    Because of this, I’ll sometimes wake four or more times a night, as the red sections of this readout from my smartwatch show.

    Screenshot of a sleep tracking app's data for one night of sleep. The data shows the user was in bed for 9 hours and 25 minutes, but only asleep for 6 hours and 12 minutes, showing poor sleep efficiency

    These bad nights often set up a vicious cycle:

    The following day, I feel as if I’m two inhales away from death. So, I keep myself going with caffeine, which makes the next night just as bad or worse.

    Lack of sleep indirectly adds pounds to your frame in several ways:

    • When you’re sleep-deprived, it’s harder to cope with negative emotions, which may mean you turn to food for solace.
    • In addition, your decision-making gets compromised, so it’s harder to choose an apple when a chocolate chip cookie is also available.
    • Plus, sleep deprivation intensify both appetite and cravings (which we’ll discuss more in the next section)

    (Want to get a handle on some of the sleep challenges unique to this transition? Check out: How menopause affects sleep, and what you can do about it)

    ✅ You’re hungry, and not for celery.

    True story: When I was in my early 30s, someone once told me about her intense cravings, and I thought, “Cravings? What are those exactly?”

    (Don’t hate me.)

    Those days now feel foreign to me. Post-menopause, I spend most of my morning wondering how soon I can eat lunch, what I might have for lunch, whether it’s okay to have a snack now, and, if so, what it should be.

    After lunch, I go on to spend the afternoon thinking about dinner.

    It’s as if my appetite never flips off.

    For the longest time, I thought something was wrong with my brain or metabolism.

    It didn’t occur to me that the increased hunger, appetite, and cravings likely stemmed from my repeated awakenings each night.

    Until I checked out the research.

    In one study, people who were sleep-deprived reported higher levels of hunger and a stronger desire to eat. When provided access to snacks, they consumed twice as much fat compared to days when they weren’t sleep-deprived.7

    In another study, when healthy, young study participants slept four hours a night, they consumed 350 more calories the following day.8

    The annoying cycle of weight and food preoccupation

    Hormonal transitions (puberty, pregnancy, menopause) often cause changes to women’s body shape and size.

    Sometimes that’s welcome (“Ooh, a butt!”) and sometimes it’s not (“Darn, a butt!”).

    Some women—like me—don’t worry too much about their weight or body shape. Then, we gain unexpected (and unwanted) pounds, and with that, a new (also unwanted) preoccupation with the scale.

    Many women also find that as they try to get a handle on the scale, their preoccupation with food may (frustratingly and paradoxically!) shoot upwards—especially if they turn to restrictive diets or food rules for a solution. 

    Interestingly, this preoccupation with food can occur whether or not someone is actually reducing their calorie intake. In other words, this phenomenon can happen when someone just thinks about reducing their food intake.

    The phenomenon has a name: It’s called cognitive dietary restraint (CDR), and it can create a frustrating cycle of body image dissatisfaction, food preoccupation, and stress. 

    In one study, people who used a low-carb, intermittent fasting protocol to lose weight reported more frequent episodes of binge eating and more intense food cravings.9 

    In another study, postmenopausal women who scored high in CDR excreted more of the stress hormone cortisol than women who scored lower in this measure.10 Higher levels of CDR in pre- and postmenopausal women were even associated with shorter telomeres, a sign of accelerated aging.11

    All this to say, leaning too hard into self-criticism and extreme dieting can backfire. Which is why the strategies we suggest later in this article focus more on adding more nutritious, appetite-regulating foods, and prioritizing things like mindfulness and movement. 

    With these approaches, you’ll be less likely to feel deprived, and more likely to feel satisfied—and hopefully, empowered.

    ✅ You’re moving less.

    As humans age, we develop chronic low-grade inflammation and weakened immune function. When combined with the crummy sleep we mentioned earlier, along with other biological changes, this can interfere with the body’s ability to recover from intense exercise.

    The result: If you do too many vigorous workouts too close together, you’ll start to feel run down, sore, and unmotivated.12 13 14

    Other issues that crop up around midlife can also interfere with movement, like chronic injuries or joint pain.

    (A personal example: Due to osteoarthritis in my feet and spine, I switched from running to walking. This is easier on my body, but isn’t as efficient at burning calories.)

    Finally, due to those pesky time-sucks known as full-time jobs and caregiving responsibilities, you might not be as active in your 40s and 50s as you were during your 20s. Plus, over the past few decades, multiple inventions (hello, binge-watching) have conspired to keep people on the couch and off our feet.

    So, can you blame your hormones for anything?

    Other than messing with your sleep which, in turn, messes with your appetite and energy levels, fluctuating estrogen and progesterone likely aren’t behind your extra pounds—at least, not directly.

    If they were, menopause hormone therapy would help people stop or reverse weight gain. (It doesn’t.15)

    However, shifting hormonal levels are responsible for where those extra pounds appear on your body. As estrogen levels drop, body fat tends to migrate away from the thighs and hips and toward the abdomen, even if you don’t gain weight

    Old tactics may stop working after menopause

    The “Rocky” weight loss method was my go-to when I was younger.

    Whenever I wanted to drop a few pounds, I imagined I was a character in one of those “couch potato gets super fit” movies.

    In addition to walking and running, I embraced the sweat-til-you-vomit workout du jour. (Remember Tae Bo?) I also cut out foods, food groups, or entire macronutrients. A couple of times a week, I skipped lunch or dinner.

    It worked.

    Until, of course, it didn’t.

    Now, whenever I push too hard in the gym, I either get injured or feel so unbelievably tired that I must take four days off from all forms of movement. If I try to do anything extreme with my diet, I eventually eat every crunchy or sweet thing I can find, including stale crackers.

    For these reasons, after midlife and beyond, the countermeasures for weight gain aren’t strict diets (looking at you, intermittent fasting) or barfy workouts.

    Instead, to limit weight gain after menopause, you need to get wise about finding ways to tip calorie balance in your favor without triggering overpowering hunger, cravings, and fatigue.

    Regardless of age or stage, fundamental nutrition and fitness strategies still apply—and work.

    What changes after menopause is how you tackle these fundamentals.

    Experiment your way to better results

    The best menopause plan will look different for each person.

    That’s why experiments are so important.

    Precision Nutrition coaches often use experiments to help clients discover essential clues about what they need (and don’t need) to reach their goals. Based on the results you get from each experiment, you can make tiny tweaks, test them, and decide whether they work for you—until you find something that does work for you.

    How to run an experiment

    Health experiments are no different from the scientific method you learned about in middle school.

    • Choose a question to answer, such as, “Would I feel less munchy at night if I ate a protein-rich snack every afternoon?”
    • Run an experiment to test your question. In the above example, you’d track your hunger and cravings before adding the snack—to get a baseline—and then continue to track them for a couple weeks after adding the snack.
    • Assess what you learned. Did your ratings of hunger and cravings drop? Remain the same? Go up? What about your actual nighttime food consumption? This information can help you determine your next steps.

    Below are 11 experiments worth trying during and after menopause. We’ve separated them into three categories: sleep, hunger, and energy.

    (And if those 11 options aren’t enough, we’ve got more ideas here: Three diet experiments that can change your eating habits)

    Experiments for improved sleep

    Below, you’ll find a mere smidge of the many sleep tweaks you can try and test. For more ideas on potential sleep experiments, check out our 14-day-sleep plan and story about cognitive behavior therapy for insomnia.

    Experiment #1: Reset your body’s circadian clock

    As you age, your body starts to behave like an old clock that continually runs slow.

    Even if you used to be a morning person, you might wake groggy, as if your body doesn’t know it’s morning. Or, your body might tell you “time for bed” at weird times, like the middle of the afternoon. Then, after spending several hours fighting the urge to nod off during work meetings, you find that, when it actually is bedtime, you’re staring at the ceiling in the dark.

    This is why it’s helpful to experiment with zeitgebers, which are environmental and behavioral time cues that help to set your body’s internal circadian clock.

    These experiments might include the following:

    • Get up at the same time every day, regardless of how you slept the night before.
    • Spend 10-20 minutes in the sunlight as soon as possible after you wake.
    • Take a cold shower at the same time each morning or a hot shower or bath at the same time each evening.
    • Get outside frequently during the day, especially whenever you feel sleepy.
    • Exercise at the same time daily. Try first thing in the morning or 4 to 6 hours before bed. Bonus points if you do it outdoors.
    • Eat meals, especially breakfast, at the same time every day.

    Experiment #2: Remove “I’m uncomfortable” from your sleep vocabulary

    How you run this experiment will depend on what’s causing discomfort. We’ve listed a few possibilities below.

    • If you tend to wake feeling uncomfortably hot: Experiment with cooling technology. This might range from the very affordable, such as turning the thermostat a degree or two cooler or using a fan, to the more expensive, such as cooling electric mattress pads.
    • If you wake feeling bloated: If you’re constipated, try some prunes, a small daily serving of beans, a little psyllium fiber, or just extra water to get things moving. Or, you might try consuming a smaller meal or avoiding fatty foods in the evening.
    • If an uncomfortable “I need to move” sensation creeps into your legs at night: Talk to your doctor about restless legs syndrome, a condition that tends to worsen with age and/or iron deficiency. A physician may also give you ideas to cope if itchy skin or joint pain is keeping you up.

    Experiment #3: Time caffeine strategically

    We know we’re almost picking a fight with this suggestion. However, it’s worth investigating, especially if you consume caffeine in the afternoon or evening.

    If you’re like most people, it will take your body about five hours to clear half the caffeine from your system. That means about half of your 4 p.m. latte is still energizing your system at 9 p.m.

    But here’s the thing: Some people metabolize caffeine much more slowly than others, taking roughly twice as long to clear it from their bloodstream.16

    Interestingly, even if you had no issues with caffeine when you were younger, you might have issues now, as caffeine clearance tends to slow over time.17

    To see if caffeine is a problem, you’ve got a couple of options.

    • Try slowly shifting your consumption earlier by 30 to 60 minutes. (If you usually have your last coffee at 4 p.m., cut yourself off at 3 p.m., then 2 p.m., then 1 p.m., then noon.)
    • Switch to a lower caffeine source. (Try a bean blend that’s half decaffeinated. Or, you could switch to a lower-caffeine beverage such as green tea or maté.)

    (Yet more solutions to common problems: The five top reasons you can’t sleep)

    Experiments to reign in hunger

    The tactics below likely won’t surprise you. After all, they form the bedrock for solid nutrition and good overall health.

    However, before you disregard them with a “been there, done that!” consider: How many of the below are you actually doing consistently?

    Experiment #1: Add a protein serving

    It may seem counterintuitive to add a serving of food to your meals when you’re trying to eat less.

    However, this one tactic may help reign in appetite and hunger.

    Protein takes longer to digest than does carbohydrate or fat, so it helps you feel full and satisfied for longer.

    In addition, you may find, as I did, that you’re not consuming anywhere near as much protein as you think. (Find out how much you need here: ‘How much protein should I eat?’ Choose the right amount for fat loss, muscle, and health)

    Try one or both of the following:

    • Consume at least 1 to 2 portions of lean protein at every single meal
    • Prioritize snacks that contain protein—hard-boiled eggs, turkey sausage links, Greek yogurt, cottage cheese—instead sweets or chips.

    Experiment #2: Choose high-fiber carbohydrates over lower-fiber ones

    Fibrous plant foods can help fill you up with fewer calories.

    To see the difference, you might monitor how you feel after consuming a near-zero-fiber food, such as your favorite assortment of snack chips. The following day, when it’s time for the same snack or side dish, opt for something with more fiber, such as roasted nuts, a side of beans, a salad, or a piece of fruit. Notice how the fiber-rich option affects your appetite and hunger for the next few hours.

    Another experiment worth trying: Include one to two portions of produce with every meal you consume. Track your sensations of hunger to see if they make a dent.

    Experiment #3: Log between-meal indulgences

    You may be reaching for more snacky foods and beverages than you realize.

    These foods don’t need to be 100 percent off-limits; you just want to be intentional about your consumption and portion sizes.

    For a couple of weeks, keep track of alcohol, sweets, and treats that you eat between intentional meals and snacks.

    Review your notes at the end of each day to see if these more impulsive or less mindful eating episodes align with your memory of what and how much you consumed.

    Experiment #4: Move after meals

    Increased inflammation coupled with decreased muscle mass, among other factors, leads many people to become more insulin-resistant with age.18 Cells don’t respond as readily to the hormone, which means more glucose stays in the bloodstream rather than entering cells that can use it for energy.

    Through a complex set of mechanisms, this can drive up hunger and overall appetite.

    Consuming protein- and fiber-rich meals will help, as we mentioned earlier.

    So will movement. Walking for as little as two minutes after meals can help your body process the carbohydrates you consumed, improving blood sugar levels, finds research.19 20

    In addition, by removing yourself from your kitchen, you create a habit that helps to psychologically shift you away from “eating” and over to “the kitchen is closed.”

    Experiments for more energy

    To address midlife brain fog and fatigue, you’ll want to do all you can to encourage good sleep. In addition, see if the below suggestions make a difference.

    Experiment #1: Prioritize strength training over intense cardio

    This was a hard lesson for me because I love intense cardio.

    However, now in my 50s, if I try to fit in two weekly strength training sessions and two weekly spin sessions, I feel drugged—as if someone spiked my coffee with tranquilizers.

    When my Precision Nutrition health coach suggested I dial back on the cardio for a couple of weeks, I won’t lie. I thought about firing her.

    But then I took her advice and rediscovered what it felt like to be alert.

    Don’t get me wrong: I still do cardio. But I’m smart about it. I now know that I can’t do everything, at peak intensity, and expect to feel rested and alert daily. There’s a balance.

    Strength training is increasingly important at midlife to protect bone strength and maintain muscle mass. Aim for at least two weekly sessions. Then, fit in cardio around those sessions.

    If you feel worn out, experiment with doing low- or moderate-intensity cardio (like brisk walking, slow cycling, or swimming) over higher-intensity cardio (like an hour-long spin class).

    Or, if you love higher intensities, keep doing them, but shorten your duration.

    Or, just save those vigorous sessions for when you got great sleep the night before.

    Experiment #2: Try active recovery

    Active recovery can help increase blood circulation and the removal of waste products that may have built up in your muscles during intense exercise sessions.21

    This can include light activities such as walking, swimming, yoga, or stretching. You can also try massage, foam rolling, or a long, hot bath.

    Experiment #3: Consider creatine

    Lots of folks think of creatine monohydrate as something people take to get jacked.

    However, more and more evidence points to creatine’s benefits for people in midlife and beyond.

    The supplement may be especially helpful for muscle recovery.

    In research that pooled the data from 23 studies, study participants who took creatine experienced fewer indicators of muscle damage 48 to 90 hours after intense training than participants who didn’t supplement.22

    The supplement may also help you to think clearly, especially after a bad night of sleep, finds other research.23

    Finally, by promoting cellular energy throughout the body (including the brain), creatine may help to blunt fatigue and boost mood.24 25

    A daily dose of three to five grams works for most people.

    The winning midlife mindset

    There’s one final experiment that I want to tell you about.

    It has to do with embracing a mindset of acceptance.

    Think back to other difficult phases of your life. For me, parenting an infant with colic comes to mind. Gosh, I was so tired back then that I likely would have forked over my entire 401k in exchange for one solid night of sleep.

    However, I knew that the stage was temporary. That knowledge helped to keep me going.

    Midlife can be similar.

    You likely won’t weigh at 55 what you did at 25. That’s okay. However, the night sweats, brain fog, and fatigue are all fleeting. You will eventually establish a new normal.

    In the meantime, see if you can accept that your body may look and feel different now. Shift your focus away from trying to look and feel like your younger self and toward consistently embracing new behaviors that will help you age with strength, vitality, and contentment.

    After all, you have much more control over your behavior than the number on the scale.

    References

    Click here to view the information sources referenced in this article.

    If you’re a coach, or you want to be…

    You can help people build sustainable nutrition and lifestyle habits that will significantly improve their physical and mental health—while you make a great living doing what you love. We’ll show you how.

    If you’d like to learn more, consider the PN Level 1 Nutrition Coaching Certification.

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  • El rol de la dieta y los suplementos nutricionales durante COVID-19 – The Nutrition Source

    El rol de la dieta y los suplementos nutricionales durante COVID-19 – The Nutrition Source

    Multivitamins in the palm of a hand

    El distanciamiento social y el lavado de manos son los métodos más eficaces y comprobados para reducir el riesgo y la propagación de la enfermedad del coronavirus (COVID-19). Sin embargo, junto con preguntas generales sobre cómo comprar y preparar alimentos de forma segura (discutidos aquí), muchos se preguntan sobre el rol específico de la dieta y la nutrición durante esta pandemia. Para entender más sobre la relación entre la nutrición y la inmunidad, y la evidencia que existe sobre el estado nutricional, la suplementación y la infección, hablamos con Dr. Wafaie Fawzi, Dr. Walter Willett, y el estudiante doctoral, Dr. Ibraheem Abioye. A medida que se disponga de más información sobre este tema, revisaremos con nuestros expertos para proveer actualizaciones adicionales. (Última actualización: 4.14.20)


    ¿Pueden resumir brevemente la relación entre nutrición e inmunidad? 

    Hemos sabido durante mucho tiempo que la nutrición está estrechamente relacionada con la inmunidad y con el riesgo y gravedad de infecciones. Los individuos mal nutridos tienen un mayor riesgo de diversas infecciones bacterianas y virales, entre otras. Por el contrario, las infecciones crónicas o severas conducen a trastornos nutricionales o empeoran el estado nutricional de las personas afectadas. Por lo tanto, es imperativo que todos prestemos atención a nuestra dieta y estado nutricional durante la actual pandemia de COVID-19. Además, el curso clínico de la enfermedad de COVID-19 tiende a ser más grave entre las personas mayores y entre las personas con enfermedades crónicas, como la diabetes, la hipertensión, y el cáncer, que están parcialmente relacionados con la nutrición. [1] Aunque todavía no se dispone de datos, las co-infecciones, como el VIH/SIDA, también pueden estar asociadas con resultados más graves, y una nutrición óptima desempeña un rol importante en el mantenimiento de la salud entre las personas con tales infecciones.

    Ciertamente, consumir dietas de buena calidad siempre es deseable, y esto es particularmente importante durante la pandemia de COVID-19. Una dieta saludable, como se muestra en El Plato Para Comer Saludable, hace hincapié en las frutas, verduras, cereales integrales, legumbres y nueces, el consumo moderado de pescado, alimentos lácteos y aves, y la ingesta limitada de carne roja y procesada, carbohidratos refinados, y azúcar. Las grasas añadidas deben ser principalmente aceites líquidos como de oliva, canola, o el aceite de soja.  Dicha dieta proporcionará cantidades adecuadas de macronutrientes saludables y minerales y vitaminas esenciales. Comer proteínas, grasas y carbohidratos de alta calidad puede ayudar a mantener un peso saludable y un buen estado metabólico; este no es un momento para dietas altamente restrictivas. Si alguien desarrolla una infección COVID-19, es importante comer lo suficiente de estas calorías saludables para prevenir la pérdida de peso no intencional. Las cantidades adecuadas de minerales y vitaminas proporcionadas por una dieta saludable ayudan a asegurar un número suficiente de células del sistema inmune y de anticuerpos, los cuales son importantes a medida que el cuerpo desarrolle una respuesta a las infecciones.

    Aunque no tenemos datos sobre factores nutricionales en relación al riesgo y la gravedad de COVID-19, ¿cuáles son algunos ejemplos de evidencia que existe sobre nutrición e infección que serían importante considerar?

    Hay muchos estudios que evalúan la ingesta de nutrientes específicos en relación con otras infecciones. Para dar algunos ejemplos:

    • El zinc es un componente presente en muchas enzimas y factores de transcripción en las células de todo el cuerpo, y los niveles inadecuados de zinc limitan la capacidad del individuo para desarrollar una respuesta inmune adecuada a las [2] Múltiples meta-análisis y análisis agrupados de estudios clínicos aleatorizados han demostrado que la suplementación oral con zinc reduce la tasa de incidencia de infecciones agudas del tracto respiratorio en un 35%, acorta la duración de los síntomas similares a la gripe en aproximadamente 2 días, y mejora la tasa de recuperación. [3,4]. Estos estudios se llevaron a cabo en los Estados Unidos, así como en múltiples países de ingresos bajos y medianos como India, Sudáfrica, y Perú. La dosis de zinc en estos estudios varió de 20 mg/semana a 92 mg/día. La dosis no parece ser el principal promotor de la eficacia de la suplementación con zinc.
    • La vitamina C es un cofactor de muchas Mejora la función de muchas enzimas en todo el cuerpo manteniendo sus iones metálicos en la forma reducida. También actúa como un antioxidante, limitando la inflamación y el daño del tejido asociado con las respuestas inmunológicas. [5] Se han llevado a cabo estudios clínicos aleatorizados en soldados, jóvenes y personas mayores en los Estados Unidos, la Unión Soviética, el Reino Unido y Japón que evalúan la eficacia de la vitamina C. En estos estudios, se demostró que la suplementación con vitamina C reduce significativamente la incidencia de infecciones del tracto respiratorio. [6] También se ha estudiado la eficacia de la vitamina C en pacientes hospitalizados en los Estados Unidos, Egipto e Irán, admitidos por una amplia variedad de condiciones incluyendo sepsis, complicaciones postoperatorias, quemaduras, contusiones pulmonares, y condiciones cardíacas. [7] Se demostró que la vitamina C reduce la duración de la estancia en la unidad de cuidados intensivos y la necesidad de ventilación mecánica en estos pacientes. [8] La dosis de vitamina C varió de 1-3 g/día, y la dosis no parece ser el principal promotor de la eficacia. Las dosis de vitamina C por encima de 2 g/día deben evitarse fuera de atención médica.
    • La evidencia de varios estudios clínicos y estudios agrupados muestra que la suplementación con vitamina D reduce las probabilidades de desarrollar infecciones agudas del tracto respiratorio (la mayoría de las cuales se asume que se deben a viruses) en un 12% a un 75%. [9-12] Estos estudios incluyeron tanto la gripe estacional como la gripe pandémica causada por el virus H1N1 en el El efecto benéfico de la suplementación se observó en pacientes de todas las edades, y en personas con enfermedades crónicas pre-existentes. [13] Entre los infectados, los síntomas de la gripe fueron menores y la recuperación fue más temprana si habían recibido una dosis de vitamina D superior a 1,000 UI. [14] Los beneficios fueron relativamente mayores en individuos con deficiencia de vitamina D que en aquellos con niveles adecuados de vitamina D.
    • Los adultos mayores tienden a ser deficientes de estos micronutrientes, y por lo tanto pueden obtener el mayor beneficio de la suplementación. [15,16]

    Ustedes mencionan que una nutrición adecuada juega un rol importante en mantener la salud en personas con infecciones como VIH/SIDA. ¿Podrían comentar algo más al respecto?

    Muchas infecciones agudas del tracto respiratorio suelen ser más severas en personas que viven con VIH/SIDA y otras deficiencias inmunológicas [17], y los esfuerzos para monitorear COVID-19 en estas poblaciones son importantes. La nutrición también juega un papel importante en esta categoría de personas. En primer lugar, la infección por VIH y la malnutrición tienden a coexistir. Conforme progresa la enfermedad, muchas personas que viven con VIH tienden a tener desnutrición. Algunos medicamentos para el VIH también pueden provocar enfermedades metabólicas. En segundo lugar, en personas con infección por VIH, un estado nutricional bajo y deficiencias de micronutrimentos empeoran la enfermedad por VIH y aumentan el riesgo de fallas en el tratamiento y muerte. Antes de que surgiera la terapia antirretroviral, los estudios demostraban que personas viviendo con VIH con dietas de alta calidad y mejor estado nutricional tendían a vivir por más tiempo y tenían menos complicaciones. Era menos probable que tuvieran anemia y tenían un conteo más alto de células CD4 (el conteo de células blancas sanguíneas que combaten la infección). Estudios clínicos aleatorizados y grandes estudios prospectivos en África y Asia han demostrado que el uso de multivitamínicos conduce a menos muertes y disminuye notablemente la progresión de la enfermedad [18-20]. Los resultados de estos estudios fueron consistentes sin importar si las personas infectadas con VIH recibían terapia antirretroviral o no. En los Estados Unidos, el consumo adecuado de vitaminas y minerales estaba asociado de igual manera a una reducción de la progresión de la enfermedad por VIH y mortalidad [21]. Por ello, una dieta de buena calidad y suplementación con multivitamínicos pueden contribuir a reducir el riesgo de infección por COVID-19 en personas con VIH y enfermedades similares.

    ¿Existe un papel para los suplementos nutricionales en la pandemia de COVID-19? 

    Las encuestas dietéticas en Estados Unidos y en otros lugares muestran que la mayoría de las personas están consumiendo dietas que no cumplen con las recomendaciones nacionales- a menudo debido a la disponibilidad o precio- y dichas dietas pueden no proveer cantidades óptimas de vitaminas y minerales esenciales. Actualmente, es probable que la pandemia de COVID-19 ponga a muchos individuos en riesgo de inseguridad alimentaria y dificulte aún más el consumo de una dieta saludable. Esto se vuelve cada vez más probable si las estrategias para reducir la infección no consideran esfuerzos para garantizar la distribución y acceso efectivos de suministros esenciales, o si la pandemia afecta la productividad del sector agrícola.

    Aunque no estamos al tanto de información de calidad sobre los efectos de suplementos nutricionales en el riesgo o gravedad de COVID-19, la evidencia existente indica que suplementos de varios nutrimentos puede reducir el riesgo o la gravedad de algunas infecciones virales, especialmente en personas con fuentes dietéticas inadecuadas. Por lo tanto, es prudente sugerir que se evite el consumo inadecuado de minerales y vitaminas, y los suplementos pueden ayudar a corregir esta situación. Algunos puntos importantes:

    • Tomar un suplemento multivitamínico o multi-mineral estándar (RDA, recomendación diaria, por sus siglas en inglés) como una medida de seguridad nutricional es razonable. Estos suplementos son relativamente accesibles (un suministro para 6 meses debe costar menos de 40 dólares) y es una forma conveniente de llenar y mantener las reservas de micronutrimentos.
    • Es especialmente importante mantener niveles adecuados de vitamina D. La vitamina D se produce normalmente en nuestra piel cuando se expone a la luz del sol, y durante el final del invierno y primavera los niveles de vitamina D en la sangre tienen a ser bajos debido a poca exposición solar. Permanecer en el interior reducirá aún más los niveles en sangre. Aunque en este momento no tenemos evidencia de que los suplementos de vitamina D reduzcan la gravedad de COVID-19, podrían hacerlo, especialmente en personas que tengan niveles bajos. Debido a que generalmente el costo de los análisis de sangre es mayor que el costo de los suplementos (y no es apropiado mientras nuestro sistema de salud está siendo sobre utilizado), y debido a que hay otros beneficios de mantener adecuados niveles de vitamina D, es razonable que la mayoría de las personas considere tomar suplementos de vitamina D.
        • Muchos de los suplementos multivitamínicos/multi-minerales que están comúnmente disponibles contienen 1000 o 2000 UI de vitamina D, lo cual es un buen objetivo.
        • Personas con piel más oscura (que tienden a tener niveles más bajos debido a que la melanina de su piel bloquea la luz ultravioleta) pueden necesitar más vitamina D; hasta 4000 UI diarias se considera seguro.
      • Si no hay suplementos de vitamina D disponibles, una opción es aprovechar un poco de la luz solar, que ahora está empezando a ser suficientemente intensa como para producir vitamina D. Exponga la mayor cantidad de piel posible durante el mediodía y comience con periodos cortos, teniendo mucho cuidado de evitar quemaduras. Quince minutos pueden producir una gran cantidad de vitamina D en piel clara; periodos 3 ó 4 veces más largos puede que se necesiten para piel oscura. Tenga en cuenta que esto es una guía a corto plazo debido a la disponibilidad limitada de suplementos de vitamina D durante la pandemia actual; y no es aconsejable a largo plazo. Dado que la exposición al sol puede contribuir al cáncer de piel, en general es importante evitar la exposición excesiva al sol o el uso de camas de bronceado.
    • En este momento, suplementos con mega dosis (mucha más cantidad que la recomendación diaria o RDA) no parecen estar justificados, y pueden resultar dañinos ocasionalmente.
    • Evite cualquier suplemento que promueva declaraciones de salud exageradas. En este momento, la Administración de Alimentos y Medicamentos de Estados Unidos (FDA, por sus siglas en inglés) ha estado monitoreando y advirtiendo a las compañías que ofrecen productos fraudulentos que pretenden prevenir, diagnosticar, tratar o curar COVID-19.
    • Los suplementos nutricionales no deben considerarse sustitutos de una dieta adecuada, debido a que ningún suplemento contiene todos los beneficios que brindan los alimentos saludables.

    Asistencia de traducción provista por Andrea López-Cepero, PhD, Ana Maafs, MEd, y Josiemer Mattei, PhD, MPH (Translation assistance provided by Andrea López-Cepero, PhD, Ana Maafs, MEd, and Josiemer Mattei, PhD, MPH).

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  • What About Animal Protein and Vegetarians’ Stroke Risk? 

    What About Animal Protein and Vegetarians’ Stroke Risk? 

    Might animal protein-induced increases in the cancer-promoting growth hormone IGF-1 help promote brain artery integrity? 

    In 2014, a study on stroke risk and dietary protein found that greater intake was associated with lower stroke risk and, further, that the animal protein appeared particularly protective. Might that help explain why, as shown in the graph below and at 0:31 in my video Vegetarians and Stroke Risk Factors: Animal Protein?, vegetarians were recently found to have a higher stroke rate than meat eaters?

    Animal protein consumption increases the levels of a cancer-promoting growth hormone in the body known as IGF-1, insulin-like growth factor 1, which “accelerates the progression of precancerous changes to invasive lesions.” High blood concentrations are associated with increased risks of breast, colorectal, lung, and prostate cancers, potentially explaining the association between dairy milk intake and prostate cancer risk, for example. However, there are also IGF-1 receptors on blood vessels, so perhaps IGF-1 promotes cancer and brain artery integrity.

    People who have strokes appear to have lower blood levels of IGF-1, but it could just be a consequence of the stroke rather than the cause. There weren’t any prospective studies over time until 2017 when researchers found that, indeed, higher IGF-1 levels were linked to a lower risk of stroke—but is it cause and effect? In mice, the answer seems to be yes, and in a petri dish, IGF-1 appears to boost the production of elastin, a stretchy protein that helps keep our arteries elastic. As you can see in the graph below and at 1:41 in my video, higher IGF-1 levels are associated with less artery stiffness, but people with acromegaly, like Andre the Giant, those with excessive levels of growth hormones like IGF-1, do not appear to have lower stroke rates, and a more recent study of dietary protein intake and risk of stroke that looked at a dozen studies of more than half a million people (compared to only seven studies with a quarter million in the previous analysis), found no association between dietary protein intake and the risk of stroke. If anything, dietary plant protein intake may decrease the risk of stroke. 

    However, those with high blood pressure who have low IGF-1 levels do appear to be at increased risk of developing atherosclerosis, which is the thickening of the artery walls leading up to the brain, but no such association was found in people with normal blood pressure. So, there may be “a cautionary lesson for vegans” here. Yes, a whole food, plant-based diet “can down-regulate IGF-1 activity” and may slow the human aging process, not to mention reduce the risk of some of the common cancers that plague the Western world. But, “perhaps the ‘take-home’ lesson should be that people who undertake to down-regulate IGF-1 activity [by cutting down on animal protein intake] as a pro-longevity measure should take particular care to control their blood pressure and preserve their cerebrovascular health [the health of the arteries in their brain] – in particular, they should keep salt intake relatively low while insuring an ample intake of potassium” to keep their blood pressures down. So, that means avoiding processed foods and avoiding added salt, and, in terms of potassium-rich foods, eating beans, sweet potatoes, and dark-green leafy vegetables. 

    Might this explain the higher stroke risk found among vegetarians? No—because dairy and egg whites are animal proteins, too. Only vegans have lower IGF-1 levels in both men and women, so low levels of IGF-1 can’t explain why higher rates of stroke were found in vegetarians. Then what is it? I think the best explanation for the mystery is something called homocysteine, which I cover next. 

    If you aren’t familiar with IGF-1, my videos Flashback Friday: Animal Protein Compared to Cigarette Smoking and How Not to Die from Cancer are good primers. 

    Beyond eating a plant-based diet, how else can we lower our blood pressure? Check out the chapter of hypertension in my book How Not to Die at your local public library. 

    This is the eighth video in a 12-part series on vegetarians’ stroke risk. If you missed any of the previous ones, check out the related posts below.

    Coming up, we turn to what I think is actually going on:



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  • Protein-packed sample meal plan | Dietitian Connection

    Protein-packed sample meal plan | Dietitian Connection

    What’s included:
    Example of a high-protein day of eating

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