Weight Management and Health Status

Recently I have gotten a lot of inquiries related to weight loss. These questions have come from a variety of people with a variety of shapes and sizes. When I get these questions I inwardly cringe. Not because these people are being annoying or unrealistic, rather they have a misperception about weight.  Our current culture perceives skinny as healthy and fat is fraught with fear about how well our clothes fit and what the reflection in the mirror is going to show.


First, I would like to say that weight is a state of being. It is not a disease or health condition on its own. Weight is an outcome that occurs as a result of how our body responds to the input from foods, beverages, medications, skin care, unknown toxins that we breathe or otherwise ingest without knowing, stress and electromagnetic fields. If our body is unable to metabolize or process one or more of these inputs, then it adapts. If one of these inputs disrupts a particular system, like the endocrine, adrenal or reproductive system, then it adapts. Often that adaptation is to neutralize the excess or foreign substance and store it as subcutaneous tissue we call fat in an effort to prevent harm.


Second, weight can often be an outward reflection of our internal health or struggles. By managing a health conditions such as diabetes, adrenal dysregulation, thyroid dysfunction, gut dysbiosis, high blood pressure, depression/anxiety and even cancer, we will by default begin to shift our weight. As our health status improves, so will our ability to metabolize and process the inputs in a way that provides us energy and vitality, while effectively eliminating that which is not functional or useful. This is true on from both a physical and mental perspective.


In order to change the weight status there must be a change to one or more of the inputs. These inputs are behaviors. For example, consuming appropriate selections and preparation of carbohydrates, proteins and fats will aid in the management of diabetes, which will therefore better control insulin production and sensitivity, and ultimately aid in weight management for people with insulin resistance or type 2 diabetes. Consuming a protein-rich diet in the morning and shifting to a more complex carbohydrate diet in the evening with food intake about every 2-3 hours, while reducing strenuous activities, including high intensity workouts will be helpful in regulating adrenal function and stabilizing energy. Eliminating gluten and dairy, while transitioning away from processed foods high in sodium and preservatives can prevent flares from auto-immune disorders including thyroid dysfunction. Timing meals, correctly, increasing physical activity, eliminating toxic exposure to alcohol, plastics, pesticides and negative attitudes can drastically improve depression and anxiety.


We are not victims of our health or weight status, rather we are co-creators. This is not to place blame or make us feel badly about our current state of health and weight. It is a statement meant to empower us to make the changes and feel good enough to sustain behaviors that are supportive to a different state of health and weight that is more supportive to our well-being and longevity.


As I continue to reflect on how I respond to questions about weight loss and weight management, I realize that my personal practice as a dietitian is much more focused on health and well-being rather than the external manifestations of these behaviors. When asked about weight management, I in turn ask the questioner a series of questions that tune me into their clinical status. Here is what I mean:

  1. How many of hours of uninterrupted sleep do you get each night?
  2. How frequently do you get up each night to go to the bathroom?
  3. Do you wake up energized or feeling tired?
  4. Do you get tired at specific times during the day?
  5. What is your level of stress at home with family and friends, at work and within yourself?
  6. Do you suffer from acne or skin irritations (psoriasis, dry skin, oily skin, rough skin, itchiness or rashes)?
  7. How frequently do you have a bowel movement?
  8. What is the consistency or texture of your stool?
  9. Does your stool float or sink?
  10. Is your stool super smelly?
  11. How frequently do you get gas and is it painful?
  12. Do you feel bloated (with or without gas)?
  13. How frequently, if ever, do you suffer from heartburn?
  14. If you are a female of child-bearing years (still menstruating):
    • Do you have regular periods?
    • Do you suffer from PMS? If so, what occurs and in what time frame associated with your menstrual cycle?
    • Do you have a heavy flow throughout any part of your menstrual cycle?
  15. Do you eat processed foods more than fresh foods?
  16. Do you eat away from home more than you eat at home?
  17. Do you have distractions while you are eating (TV, computer, phone, work, stressful environment)?
  18. Do you eat or drink from plastic containers?
  19. How frequently do you consume alcohol and in what quantities?
  20. Do you ever feel shakey, disoriented or get headaches between meals?
  21. Have you previously been diagnosed with a chronic health condition or do you suffer from a regularly occurring illness (sinus infections, headaches, joint pain etc.)?
  22. Do you currently take medications, vitamins/minerals or other supplements?
  23. Have you taken medications for prolonged periods of time in the past?
  24. How much physical activity do you get daily (consider more than just exercise)?
  25. Have you had a recent, unintentional change in weight status?


The answers to these questions can all have an impact on weight management, and none of them really have to do with portion sizes, how many calories you consume or how many calories you burn off. While those issues might be a component to an overall eating pattern and nutrition lifestyle, they are not going to be the solution to weight management. Solutions to weight management with always come from changing the inputs. We can be healthy at any size, and that health, size and shape will change as we progress through life.


Need help with your health, then contact me. Want to lose weight, then be ready to answer a few questions and take a deeper look into your wellness.


Confessions of a Pregnant Dietitian with Constipation and Indigestion

Hey! Guess what I found this week? Energy…it is absolutely amazing. For the last two days I have been motivated and productive to actually do more than survive on my couch. My eyes feel like they are opening all the way.  I climbed the stairs at work more than I took the elevator. And, probably the most important, is that I feel like my brain is fully functioning. I can actually find words to make a complete sentence. Amaaazing (imagine me singing that word)!!!


At this point I am teetering between my first and second trimester. Like any good foodie I am tracking the progress of fetal development by using food comparisons. Baby H is approximately the size of a lemon (credible source pending). Its eyelids are closed, limbs have formed, the central nervous system is developing and its head is half the size of the rest of its body. (BTW, I have no qualms calling Baby H “It” right now because we do not know the gender and repeating Baby H 45 thousand time is exhausting…remember I have to keep my energy up for things like moving and making complete sentences.)


For me, the lemon comparison is very apropos. Generally, lemons are good for gut health. They aid in digestion and increase stomach acid needed to begin the digestion process before food contents actually reach the intestines for absorption. I however, am avoiding them like the plague right now.


Recently, I wrote an FB post about some of my pregnancy experiences, which included 3 points, all of which focused on my gut, and all of which I am attributing to the excess progesterone coursing through my body and keeping Baby H snug in the womb.


First, despite knowing a lot about gut health I continue on my own journey for the perfect poop.
Second, in light of point 1 I am having difficulties going number 2. (Is that too much information? I mean…we all poop, ideally daily, but no one ever wants to talk about it…except for me of course. My poor husband has to a get an update on my bowel habits daily right now. Some one should probably feel sorry for him.)
Third, complications with the lower end of my gut are not currently the only joys of pregnancy. I also have the pleasure of a new kind of indigestion. When the GI system slows down it can create constipation (hence points one and two) and/or indigestion (point 3). The longer it takes the stomach to empty its contents into the small intestines, then the more opportunity there is for those contents to move back up, causing that burning sensation in the middle and upper chest. It can also leave a sour taste in the mouth, cause a dry cough and generate some stinky burps that might taste like gross versions of your last meal.


A common misperception is that there is too much acid, and so many clinicians recommend an acid blocker or a PPI, proton pump inhibitor. Usually there is not too much acid though, rather there is acid is in the wrong spot. Using an acid blocker or PPI to manage these symptoms does not always solve the problem. Whether pregnant or not, many people find that acid blockers and PPIs do not work for them in the long run. This is because they neither prevent acidic stomach contents from getting in the wrong spot, nor do they help the stomach empty faster. In addition, acid blockers and PPI can prevent optimal digestion of protein, especially animal-based protein. It can also prevent absorption of many B vitamins.


In my opinion there are better ways to treat constipation and indigestion than using pills. My professional opinion and personal experiences are as follows:


For constipation or sluggish bowels:

  • Add more fiber. This is a helpful tip for those who have constipation without a chronic inflammatory bowel disorder (IBS/IBD, Crohn’s, ulcerative colitis). Soluble fiber attracts water and can make stools softer and bulkier, therefore easier to pass. Insoluble fiber can increase intestinal motility, which keeps things moving along at a more desirable pace. I recommend getting fiber from whole, real food sources, like most fruits and vegetables, and whole grain sources that do not include gluten. Whole grain sources like gluten-free oats, chia seeds, flaxseeds and quinoa (just to name a few). Say no to things like Fiber One bars, whole grain breads, granola and even popcorn.
  • Avoid foods that ferment in the belly. These can cause excess gas and bloating and are really stinky . Enough said. It is not comfortable, and for most people does not feel socially acceptable either. Avoiding these foods is only temporary until the gut starts functioning at a more normal pace, i.e. you have a bowel movement everyday. Some of these foods are lactose, gluten, beans, onions, garlic, avocados, cauliflower, asparagus, fruits with peels you eat (apples, pears, peaches), dried fruits, honey, agave nectar, alternative sweeteners, high fructose corn syrup and high concentrated sweets like juices and desserts. I like this handout from Stanford, https://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf
  • Drink water, a lot of it. Water is the body’s preferred solvent. It carries away waste and toxins and promotes regularity. Water helps breakdown food during the digestion process so that it can be absorbed. It also combines with fecal matter to make stools softer. (See the pattern here? Fiber and water combined are a powerful combination.) I have been drinking about 90-120 ounces of water per day.
  • Move! Physical activity also promotes gut motility. Gentle aerobic activities such as walking, riding a bike and swimming increase blood flow to organs, including the intestines. This increases contractions and stimulates digestive enzymes.
  • Add some magnesium citrate as a nutrition supplement. This supplement is available in a liquid or pill form. It increases water in the intestines and generally promotes a bowel movement within 30 minutes to 6 hours. Usually doses are less than 300 mg. My recommendation is to dose low and increase slow.


For indigestion:

  • Eat smaller meals more frequently throughout the day. Smaller meals put less burden on the stomach itself, which may be help prevent delayed gastric emptying. If you eat too much, to the point that you actually feel full, then your stomach has become distended. Stomach distension puts pressure on the valve between your esophagus and your stomach. If gastric contents cannot leave the stomach and move down into the small intestines in a timely manner, then it will move up into the esophagus causing heart burn.
  • Eat less fat. Despite my belief that fat is necessary for optimal health, when it comes to indigestion excess fat is not your friend. Fat naturally slows down gastric emptying. During normal digestion this is helpful to maintain satiety and keep us feeling full longer. Once again though, too much fat can exacerbate an already slow digestive tract. Remember that the longer food sits in the stomach, then the more opportunity for stomach contents to move up instead of down.
  • Avoid traditionally acidic foods to prevent an increase in acid production which only makes indigestion feel worse. This includes coffee, tea, citrus fruits, tomato products, caffeine, chocolate and spicy foods. Avoid dairy products too. Some feel that dairy is an antidote to indigestion, however it increases in acidity as it is digested. Lastly, avoid concentrated sweets (desserts, juices, sweetened beverages etc). Like dairy, sugary foods become more acidic as they breakdown. Why fuel the fire?
  • Avoid a few other foods too. Peppermint (tea, hard candies etc) is a relaxant. This means that it can also relax the valve between your esophagus and stomach, thus allowing stomach contents to move up instead of down. Avoid all carbonated beverages and alcohol. Carbonation increases gas, namely carbon dioxide, in the stomach. More gas in the stomach increases gastric distension and pressure on the valve between the esophagus and the stomach…I am starting to sound like a broken record.
  • Check out my previous blog post, Feel the (Not So Good) Burn


Here’s my week in review that incorporates my recommendations. Notice the simplicity of these meals. Nothing fancy, creamy, super smelly or spicy for this mama right now.

  • Breakfasts: 2 eggs scrambled in 1 teaspoon of coconut oil, 1 cup oatmeal chia cereal
  • Morning snack: 2 stalks celery with 2 tablespoons dairy-free ranch dressing
  • Lunches: Salad of romaine hearts and ½ bell pepper with 2 tablespoons of homemade vinegar and oil dressing, 1 cup of yellow cherry tomatoes (naturally lower in acidity), 3 ounces grass-fed beef burger or Italian sausage, 1 cup fresh strawberries
  • Afternoon snack: muscat grapes with ½ cup unsweetened coconut flakes
  • Dinner:
    • Grilled chicken leg, grilled zucchini
    • Grilled pork steak with steamed broccoli and boiled sweet potatoes seasoned with 1 teaspoon butter


Final thoughts. I have noticed that I can no longer tolerate highly processed snack foods. I find that these make the indigestion worse. The clinical professional in me speculates that these refined products breakdown faster than real food, and since they cannot leave the stomach because of delayed gastric emptying they create an even more acidic environment and make the indigestion feel worse as it moves upwards instead of down.


Alright…that is all for now. Let me know your thoughts and any other preggo tips and tricks you used. You can also leave your tips and tricks for managing your own GI issues.