Feel the (Not So Good) Burn

Oh so many people have heart burn. It is also known as GERD, which stands for gastroesopohageal reflux disease. That is simply a more clinical name for chronic acid from the stomach that backs up into the esophagus. It technically does not have any relation to the function of your heart, but for some people the pain is situated in the center of your chest and can easily be confused with chest pain associated with cardiac complications. Other symptoms of heart burn can include a dry cough, problems swallowing or feeling that there is something stuck in your throat, hoarseness, sore throat and juicy burps that contain regurgitated food in liquid form that is very sour.

At some point everyone experiences acid reflux, but most people do not truly understand its cause. Acid reflux actually occurs when the band at the bottom of your esophagus (known as the lower esophageal sphincter or LES) cannot stay closed. When the LES is open highly acidic content from the stomach can move back up into the esophagus where it does not belong. So how do we manage acid reflux without using medications that have unwanted side effects and lead to other digestive disturbances?
Grateful Guts top 10 tips for lifestyle changes to manage acid reflux:
  1.  Work with a registered dietitian nutritionist, like yours truly, to complete a short elimination program to determine which foods may be considered triggers. Often we become de-sensitized to signs of dis-ease because these symptoms have become so common. Know that a common symptom does not mean it is normal function. The best example of this was a client who went through an elimination and re-introduction program with me in order to identify the cause of gas, bloating and abdominal pain. Interestingly though the first thing she noticed was that her persistent dry cough disappeared when she eliminated gluten. It returned when she tried to reintroduce gluten-containing foods. She had not even considered her persistent dry cough as a sign of dis-ease because she was so used to having it. Not until it was gone did she notice how it affected her quality of life.
  2. Eat real food! Shocking that I would say such a thing. Most real food, consumed in a form that is as close to its natural source as possible, is going to be lower in acidity and therefore will not be trigger foods. These real foods include whole muscle meat products from grass-fed, free-range, sustainably raised animals, as well as fruits and vegetables and wonderfully gelatinous bone broth. I also recommend avoiding all dairy products (milk, yogurt and cheeses), along with gluten containing foods (barley, wheat, rye, soy sauce, processed lunch meats, most convenience foods and products containing modified food starch and maltodextrins). This is where #1 is important. People like me can really help with this part.

  3.  Get exercise that strengthens your muscles. Try yoga, Pilates and functional movement training.  Cardio exercise like walking, swimming or riding your bike are helpful in maintaining good heart health, but these forms of exercise are not as effective for maintaining muscle tone (think diaphragm) as strength training.
  4. Eat slowly. Put down your eating utensil between bites and do not pick it up again you have swallowed the first one. It takes approximately 20 minutes for your body to recognize that you are full. If you are still eating when you start to feel full, then you have over eaten. You will continue to feel full for at least another 20-30 minutes. Remember that overeating creates excess pressure in the stomach, which can prevent the LES from closing thereby causing the acid to back up into the esophagus…ouch! If you slow down the speed at which you eat, then your brain can keep up with your body and you will be able to recognize when the physical sensation of hunger is gone. That is when you should stop eating.
  5. CHEW your food. Do not just chomp and swallow. Help your stomach work more efficiently by actually chewing. Chewing breaks down your food into tiny particles. The acid in your stomach continues breaking down those tiny particles into their most basic forms. If the particles are still too big when they hit your stomach, then the chemical breakdown from the acid can create gas, in your stomach, increases the pressure in your stomach and can prevent your LES from closing.  Gas in your stomach escapes as a burp. Have you ever noticed that the faster you eat the more you burp?
  6. Eat more frequently throughout the day, but consume smaller quantities in one sitting. This is important so that you do not overeat. I feel like a broken record now. Eating smaller portions will prevent you from overeating. And once again overeating creates excessive pressure in your stomach and prevents the LES from closing…sigh.
  7. Avoid ALL sodas and any carbonated beverages. Carbonation is a gas. Gas inside your stomach can create pressure…you get my point. Also sodas and chemically created beverages made in a lab or factory contain a lot of sugar and A LOT of acid. Don’t put extra acid in if you do not want to feel it come back up.
  8. Stop drinking alcohol and stop smoking. These damage your health, including your GI tract. Enough said.

     
  9.  Consume your last meal at least three (3) hours before lying down. Myth, eating too close to bedtime makes you gain weight. Fact, eating too close to bed can cause acid reflux.

     
  10.  Sleep with the head of your bed at a 30 degree angle. OK not every person needs to actually measure the incline of the head of their bed, but know that sleeping at an incline can help keep the stomach acid from moving up into the esophagus.
To understand why these are my top 10 tips, let’s do a quick anatomy/physiology review. The gastrointestinal tract (GI tract) is technically a one-way street. It starts when you put solid and liquid items in your mouth. Mechanical digestion occurs through the act of chewing and your tongue in needed to move the food back to your throat so that it can be swallowed. Once swallowed it moves down a tube called the esophagus, hence the E in GERD. At the bottom of the esophagus is the stomach. The LES is the band where the esophagus and stomach join. In this same general vicinity is a sheet of muscle that runs horizontally across our upper abdomen known as the diaphragm. This muscle is important for breathing and it helps maintain closure of the LES, thereby preventing stomach acid from sloshing upward into the esophagus. Now let’s understand part of the physiology of the GI tracts. The environment inside the stomach is very acidic. It contains hydrochloric acid (HCL), which is important for chemically digesting nutrients, especially protein. HCL can also activate other digestive enzymes in the small intestines needed for absorbing nutrient. There are cells inside the stomach that create a protective lining in the stomach that prevents acid from causing damage. There are no such cells in the esophagus, which is why we often feel a burning sensation when stomach contents back up.

So, the burning question is what prevents the LES from closing all the way? Unfortunately there could be many explanations for this. For example obesity, pregnancy and overeating can cause excess pressure in the stomach that prevents the LES from closing. Occasionally older adults can develop a hiatal hernia, that occurs when the top of the stomach protrudes into your chest. When this happens the LES is above the diaphragm and therefore no longer has the musculature support that helps keep it closed. Lifestyle factors such as smoking, alcohol and caffeine consumption can cause damage throughout the GI tract, including weakening the LES and causing heartburn. There are also some medications that can weaken the LES. Anecdotally I have had clients with food intolerances experience heartburn after eating an offending food, and I attribute this experience to inflammation occurring within the GI tract that temporarily prevents LES closure.
Regardless of the cause, the pain associated GERD is exacerbated by highly acidic foods like alcohol, caffeine, soda (regular and diet…don’t even get me started…there will be an entire blog post dedicated to the syrupy, bubbly poison), tomato and citrus based products and even chocolate. Other triggers can be foods that create acid when they are digested, such as dairy products and simple sugars, especially those that are refined and added to processed foods. And of course there are those pesky food intolerances which can be both a cause the LES dysfunction and can be a trigger that can create excess acid.
Treating heartburn is often multi-factorial, and being the crunchy-not quite hippie-let’s try a natural approach-kind of girl, I prefer to start with lifestyle changes rather than medication…and here is why. More often than not, too much acid is not the actual problem; rather the problem is that the acid from the stomach is simply in the wrong spot. We want acid so that we can actually digest our food, especially protein. We also need acid to activate other digestive enzymes in the small intestines to aid in nutrient absorption, especially calcium, magnesium and vitamin B12. Problems associated with not digesting or absorbing nutrients properly cause many of the side effects listed in the fine print of these medications, which interestingly enough are also symptoms of irritable bowel syndrome (IBS) – bloating, gas, abdominal pain and diarrhea.

There are a number of natural remedies such as DGL (licorice) and slippery elm, along with other supplements that complimentary healthcare practitioners recommend for symptom management.  While I truly believe these can be very helpful when used appropriately, it is important to work with a qualified practitioner to ensure the appropriate use of such remedies.

I could probably write an entire dissertation on this topic, but I think we have covered enough for now. If you have questions, then please leave them in the comments. And once again cheers from my cup of gelatinous bone broth to yours.
Resources:

Keeping It Real

Six years ago I had the brilliant idea to start a blog and share my wealth of nutrition and fitness knowledge. A quick review of the handful of posts on what was originally Living Inside Out serves as a testament to how much I have changed. The one professional constant through the years has been my passion for nutrition and wellness. All other aspects of my professional life look drastically different, and for that I am forever grateful. 

“So,” you ask, “what has changed in the last six years?” And to that I respond, “absolutely everything.” I quit a very rewarding job to change careers and complete a master’s degree in nutrition, built and then left a successful personal training practice, competed in a half-iron man competition, moved across the state of Indiana, became a registered dietitian, started working as a clinical dietitian and taught nutrition classes for the hospitality program at a community college. 

From a nutrition perspective I went from a MyPlate, USDA junkie who believed that whole grains and Greek yogurt improved my health, to the current version of my real self. Now I embrace real food from farms and vendors that are as close to my home as possible. Most meals include grass-fed, pasture-raised animal products for protein, plenty of fat for flavor and fullness, along with an abundance of colorful vegetables and a few fruits as my primary carbohydrate sources. I know that dairy gives me zits and grains whack out my insulin response. I avoid products with food labels and  added sugars.  I buy organic when possible, and believe that consuming food as close to its natural source tastes the best and provides the best nutrition. 

You are invited to peruse earlier blog posts, gain a better understanding of where I began this professional journey, then stay tuned for what will be a wonderful journey filled with all of the deliciousness in life that makes us feel good…so cheers from my cup of gelatinous bone broth to yours.

Another Win for Team Muffin!

During the spring semester in a food science class, my lab partner and I did a research project on fat replacers.  The purpose of our research was to find fat replacers that could be used to make some of our favorite baked goods a little healthier.    We were SUCCESSFUL when using both pureed pumpkin and pureed banana (using baby food to control for consistency) to replace the oil, butter or shortening in muffins.  The results showed that using these fat replacers decreased calories and fat, while increasing fiber content.  Needless to say we were pleased with our results.

I’ve always loved cooking with pureed pumpkin, so I decided to test another recipe in my own kitchen. This time I used a standard cornbread recipe from Better Homes and Gardens, 11th Edition (p. 117 for those of you following along at home).  The nutrition facts per serving from the original recipe:

  • 222 calories
  • 9 g total fat (2 g sat fat)
  • 56 mg cholesterol
  • 301 mg sodium
  • 29 g carb
  • 1 g fiber
  • 6 g protein

My modified recipe substituted whole wheat flour for the all-purpose flour and a 1:1 replacement of pureed pumping for the cooking oil or shortening.  The nutrition facts per serving from this recipe (as analyzed using www.thedailyplate.com):

  • 135 calories
  • 2 g total fat (0 g sat fat)
  • 42 mg cholesterol
  • 315 mg sodium
  • 24 g carb
  • 5 g fiber
  • 4 g protein
Here is how I made my new and improved cornbread:
  • 1 cup whole wheat flour
  • 1 cup cornmeal
  • 3 tablespoons sugar
  • 1 tablespoon baking powder
  • 1/2 teaspoon salt
  • 2 beaten eggs (add 2 extra tablespoons of pumpkin if you want to make this egg-free)
  • 1 cup milk (or milk alternative i.e. soy, almond, hemp or coconut milk)
  • 1/4 cup pureed pumpkin
Pre-heat oven to 425 degrees.
Grease a 9x9x92 baking pan.
In a medium mixing bowl combine the dry ingredients and make a well in the center.
In another bowl combine the wet ingredients, including the pumpkin.
Add the wet ingredients to the dry, and incorporate until the dry ingredients are just moistened.
Spoon batter into the prepared pan and bake for 20-25 minutes.  Cool on a wire rack
Serves 9

Favorite Things List

So I haven’t completely shed the super woman cape.  I have the good fortunate of bringing new clients.  They provide me with so much inspiration.  Unfortunately I have not removed anything else from my calendar, so once again I find myself with too much to do and not enough time to do it.  Instead of stressing out this time though I plan to fall back on a few of my favorite things.  I honor the time I can spend reveling in each of these, even it is only for 5 minutes in the day.

  • I love early mornings.  A new day always offers fresh perspectives.
  • My favorite ways to relieve stress are to practice yoga, enjoy a good cup of coffee (current flavor is coconut), read an interesting book and talk to friends (morning commute conversations and FaceTime are lifesavers right now).
  • Nothing can get me motivated like doing my own strength workout so that I recognize just how much power I really have.
  • Riding my electric blue Electra cruiser never feels like work, even when I am riding to the gym to go to work to teach a class or see clients.
  • When I finally admit that my body and brain are at capacity a good massage helps put me back together.
I must thank everyone who is a part of my life and contributes to my favorite things list.  

Sweat and Soul Food

It has been outrageously hot this summer, and I love it!  Admittedly though, the heat is not for everyone.  There have even been a few days recently when it has been too hot for me to stay active outside.  Despite my indoor workouts (at home and in the gym) I am usually a sweaty mess in need of some seriously good food.  Here is one of my favorite 30 minute, at-home workouts and dinner option.

3-2-1 Yoga Workout
Time: 30 minutes
Equipment: stopwatch and mat
Workout design:
There are 5 circuits in this workout.  Each circuit begins with 3 minutes of sun salutations, then two minutes of one a pose, and one minute of a reflection pose.

  • 3 minutes: sun salutations
  • 2 minutes: poses
    1. crescent lunge (1 minute each side)
    2. warrior II (1 minute each side)
    3. chair pose with prayer twist (1 minute each side)
    4. bridge pose 
    5. side plank pose (1 minute each side)
  • 1 minute: reflection
    1. forward fold
    2. mountain pose
    3. forward fold
    4. cobblers pose
    5. corpse pose

This is very simple, but not necessarily easy.  For my fellow yogis, let your breath lead you through the entire workout.  You can definitely get into a moving meditation with this.  Even if yoga is not your workout of choice, google the exercises listed above and give it a try.  Think of it as a new version of a core interval challenge.

Dinner
Disclaimer: I am not a chef or a recipe developer.  I eye-ball a lot of measurements and adjust seasoning to taste.  I will share with you the basics of the meal, and then turn the power of creation over to you.  Enjoy!

Bacon wrapped asparagus (makes 2 servings)

  • evenly divide 1 bunch of asparagus into 4
  • wrap each asparagus bundle with 1 slice of bacon
  • sprinkle with garlic powder, salt and pepper
  • bake or grill until the bacon is your desired crispness

Rice pilaf (makes 2 servings)

  • in a large microwavable bowl chop 1 clove of garlic and 1/4 cup of onion, then microwave in 1 teaspoon of oil for 1 minute
  • add a packet of 10-minute, boil-in-bag brown rice to the onions, garlic and oil, then add the recommended amount of liquid according to the package instructions
  • use some sort of stock (vegetable or chicken) to add extra flavor to the rice

1/2 cup fresh pine apple chunks

Total nutrient value of this meal (calculated using www.thedailyplate.com):
465 calories, 14 g fat, 25 mg cholesterol, 401 mg sodium, 70 g carbohydrates, 9 g fiber, 18 g protein, 28 g sugar

My Favorite Mode of Transportation

Many people think that weight loss and/or weight management occurs in a vacuum, eat less or exercise more and weight comes off…then what?  Generally the weight comes back because often people do not make lifestyle modifications that become part of their everyday living.  One reason is because some people just don’t like to workout.  Another reason is that people don’t perceive themselves to have enough time for lifestyle modifications.  The good news though is that there are endless opportunities to incorporate healthy activities into a lifestyle.  Lifestyle activity involves increasing the number of calories used each day simply by moving more doing the activities that normally occur.  For example taking stairs instead of the elevator or parking your car as far away from the door as possible.  Studies have shown that incorporating lifestyle activity helps manage weight over a longer period of time than just programmed activity.  This summer my favorite mode of transportation is my electric blue cruiser.  I just can’t help but smile every time I get on it, and it never feels like a workout…just pure fun.

Leading by Example

It’s been so long since posting anything new.  In the last year a lot life changed occurred, and the entire time this blog has been lingering in my mind.  I’ve almost posted a gazillion different time, but something that I couldn’t quite put my finger on was holding me back.  One of my favorite authors, Debbie Ford, might respond to that comment by asking, “well if you did know what was holding you backs what would it be?”  So right now my answer to her is, time, stress, school, commuting, meeting the expectations of 400 other people, etc, etc, etc, and being ashamed for going so long without posting.  I wondered if I would actually have anything profound to say while in survival mode – 19 credit hours, 8-10 hours commuting each week, working as a personal trainer and trying to spend some time with my family and friends.  I didn’t even fit into my own schedule.

I know I’m not the only one who has been in this state.  The causes of survival mode craziness may be different for each person, but certainly you can or have related to that feeling at one time in you rife.  In fact it is one of the primary reasons that people don’t eat well, stay active or take care of themselves.  We’re all too busy doing other things and taking care of other people that we never make it to the top of our own priority list.

So here I am still busy, but ready to shed the Super Woman cape and admit that I cannot always do it all all the time.  Since I love reading things that are interesting and relative to me, since I love cooking, eating and anything related to food and since I love staying really active, I’m going to redirect my efforts with future blog posts to demonstrate how happy, healthy and active are attainable even in the midst of chaos.  I’d like to keep it simple, just leading by example.

On Track and In Shape

By now the gym is a little less crowded than it was this time last month.  Most of those New Year’s resolutions have been broken and a few people are even sinking into the winter blues.  You on the other hand are equipped to to stay on track and in shape.

The Winter 2011 American College of Sports Medicine Fit Society Pages reiterate what we all have heard so many times, “Exercise provides an effective natural boost to both mood and health.”  Exercise, mood and your overall fitness level provide you with a win-win-win situation.  Exercising releases feel good hormones to keep your spirits lifted and your energy high.  It is also increases your metabolism, thus increasing the amount of calories burned during and after a workout, helping you manage your weight, get stronger and stay healthier.

While you may not be a winter warrior willing to brave icy streets and sub-zero wind chills for a good workout, there are plenty of options to keep you on track and in shape.

  1. Break up workouts
    Aim for at least 30 minutes of moderate to intense exercise each day, but instead of doing it all at once break it up into 10 minutes bouts performed 3 times in the day.  Do your first 10 minutes when you wake up in the morning to jump start your day.  Peform your next 10 minutes of exercise after lunch to prevent the mid-afternoon lag and keep you sharp for the second half of your work day.  Finish your last 10 minutes of exercise between the time you get out of work and have dinner. 
    • Jump rope
    • Climb stairs (at home or in the office)
    • Lunge up and down a long hallway
    • Shadow box
    • Dance vigorously to your favorite songs 
  2. Vary your activities
    Elevating your heart rate is key to a good workout.  You can burn just as many calories performing effective resistance training activities as you can burn performing cardiovascular activities like walking or biking.  Consider alternating resistance training workouts with cardiovascular workouts every other day.  This will prevent your body from adapting to your workouts as quickly, which prevents you from reaching the dreaded plateau.  Varying your activities will also help you stay engaged and keep you from getting bored.
  3. Buy a workout DVD, download a workout video or stream your favorite meditation
    Using guides such as your favorite celebrity’s butt blasting exercises or participating in the latest fitness craze in the comfort of your own home is a good way to ensure that you are getting an effective workout.  It takes the guessing out of what to do next since each exercise, set and repetition are provided to you in an easy to follow format.  All you have to do is pay attention and move with it.
  4. Grab a partner
    Finding a workout buddy is one of the best strategies to keep you on track.  Your buddy will hold you accountable for showing up to your workouts and will motivate you on the days when you are feeling down.
  5. Make the time
    The only way to stay on track and in shape is to make time.  You might be the busiest parent on earth, juggling a job, the kids, your spouse and running an almost perfect house with a white picket fence and the friendliest family pet, but remember that you cannot be the best person to care for everyone and everything depending on you if you do not even take care of yourself.  Bottom line…make the time…
    • Block time in your calendar just like you would for a business meeting or doctor’s appointment.
    • Multi task.  If you the only time you have to workout is during the 30 minutes you take to watch the news, then perform some kind of cardiovascular activity during the broadcast (jump rope, jumping jacks, marching in place etc) and perform resistance excercises during the commercials (push ups, squats, lunges etc).