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Increasing Fiber Intake

So… the doctor told you to increase your fiber intake? Well, you are in the right place! I'll be the first to admit that getting 25-35 grams of fiber in one day can be difficult, but that doesn't mean it's impossible! Fiber is interesting because humans do not have digestive enzymes to break it down as we do for fat, protein, and simple carbohydrates. Fiber is considered a "non-digestible" carbohydrate. However, there is something that can break down the fiber we eat - microbes! Oh, and do these microbes impact our overall health. So now when a doctor recommends you increase fiber intake, you know what they mean is to feed your microbes so "they" can help you stay regular and improve GI health. 

What has fiber? PLANTS. Fruits, vegetables, legumes, grains, nuts, and seeds.

Fun fact: Did you know our ancestors likely ate around 100 grams of fiber per day? They ate a variety of plant foods in large quantities. 

Why is fiber important? 

• Help regulate your digestion and improve GI health
• Regulate bowel movements
• Provides pre-biotics for a healthy microbiome
• Lower the risk of several forms of cancer, including colon cancer
• Improve cholesterol and blood pressure
• Help you feel full so that you eat less
• Reduce the risk of heart disease and type 2 diabetes

4 Tips to Increase Your Daily Fiber Intake

1. Add 1 cup of beans or lentils to your meal 

2. Cover half of your plate with vegetables (raw or cooked)

3. Choose a whole-grain as your carbohydrate serving (barley, brown rice, quinoa, oats) 

4. Eat dessert! And add a serving of fruit 

High Fiber Diet 1-day Example

Meal 1: Oatmeal - 7 grams of fiber

- 1/2 cup of rolled oats (2g)

- 1 cup of milk alternative (coconut, almond, oat)

- 1/2 cup berries (2g)

- 1 oz walnuts (3g)

Meal 2: Mediterranean Salad - 19 grams of fiber

- 1 cup of cooked lentils (15 g)

- 1 cup Bruschetta Sauce

- 1 onion diced (2 g) 

- 1 cup of feta cheese 

- 1 cup of spinach (2g)

Meal 3: Salmon and Veggie Dinner - 6 grams of fiber 

- 4 ounces of salmon 

- 1 cup of lightly cooked vegetables (4g)

- 1/2 baked potato (with skin) (2g)

Dessert: Chia Seed Pudding - 12 grams of fiber 

• 1 oz (2 TBSP) of chia seeds (10 g)
• 1/2 cup of almond milk 
• 1 tsp of honey 
• Top with strawberries (2 g)

Total: 44 grams of fiber

The above meal plan is the ultimate goal. I don't expect anyone to get to 40+ grams of fiber overnight. If you currently eat less than 15 grams of fiber daily, introduce it slowly. Try increasing your intake by 2-3 grams per day. For example, if you usually eat 5 grams of fiber, try getting 8 grams on your first day and go from there.

Please remember when you increase fiber in your diet, it is essential to increase your water intake as well. The two go hand in hand. Recommended MINIMUM: 65 oz water daily. Exact recommendations vary depending on your size and gender: 80-100 oz. 

If you have further questions or would like an individualized nutrition plan, visit the "Work With Me" tab.

Nutra Narratives Podcast

I am so excited to share that I was on a podcast! My dear mentor (and now colleague) started her podcast back in December 2019. This was my FIRST time on a podcast, and it was great fun.

Dr. Noval's Nutra Narratives Podcast takes the listener on a journey into the lives of dietitians and dietetic students. Each story is different. Each one is inspiring to the max.

Here I share my story.

Confession. After my mom listened to it, she called me to obviously tell me how much she loved it. And she also mentioned that she did urge me to get 8 hours of sleep each night. So I would like to give her credit for that. I didn't listen to her because... you know... when you're in your early twenties, you think you know everything!

I highly recommend anyone who is interested in becoming a dietitian (or any dietitian that is interested in pursuing a different direction in their career) to listen and subscribe to this podcast.

Nutra Narratives Podcast by Dr. JeJe Noval

6 Must-Read Books for a Healthy 2020

I commute about 10 hours a week. I know, I'm "crazy". Driving is a part-time job for me. What's even crazier is that I don't mind the commute anymore. I got into audiobooks pretty early on in my commuting life (and overcame road rage - mental health is important too!). I've read more books over the last 1.5 years than I have in my whole life. Reading a book (or listening to one) is my favorite way to learn about a novel idea. Podcasts and YouTube videos are great but sometimes have too much fluff, in my opinion.

Books about nutrition, health, and longevity obviously hold a special place in my heart (since I'm a dietitian and all I do at work is think about nutrition). I would like to share the books I've stumbled upon that have changed my personal eating habits and the direction of my career.

The Six Must-Read Books for a Healthy 2020 
1. The Obesity Code by Dr. Jason Fung 
This book changed my life! I began intermittent fasting about 6 months before I read this book but I hadn't fully understood why I had lost weight and kept it off after starting the 16/8 time-restricted eating regimen. This book goes into the details of why insulin is the culprit to weight gain.

2. The Longevity Solution by Dr. James DiNicolantionio and Dr. Jason Fung
This book is filled with valuable information on the components of living a long, healthful life.  And it includes pictures and mechanisms. Dietitians love mechanisms. I read this book as a hard copy (not on Audible). One of my favorite books on longevity.

3. Food - What the Heck Should I Eat? by Dr. Mark Hyman 
This book goes through the different food groups and debunks myths. Many foods are deemed "healthy" or "bad for you" - Dr. Hyman reveals the truth. Although Dr. Mark Hyman can sound a little arrogant at times and has put down dietitians and nutritionists, he still presents valuable information on food. I agree with most of his claims.

4. The Good Gut by Dr. Justin and Erica Sonnenburg 
This married couple is at the forefront of microbiome research. They have become a trustworthy source for emerging scientific information regarding the world of bacteria within us. A majority of my patients have gastrointestinal health problems and  I found this book helpful in understanding a large component to gut health: the microbiome. This book gives the overused Hippocrates quote even more momentum.
“All Disease Begins in The Gut.” - Hippocrates.

5. The Circadian Code by Dr. Satchin Panda
Dr. Panda produces a lot of research on intermittent fasting and health outcomes. I follow his work closely because he is at the forefront of research. This book provides information on understanding your internal clock: Circadian Rhythm. It's SO much more than just a sleep/wake clock.

6. The Longevity Diet by Dr. Valter Longo 
This book provides information on Fasting-Mimicking Diet (FMD) and nutrition recommendations for living a long, healthy life. If prolonged fasting is difficult for you, FMD can be considered an alternative. This book dives into plant-based nutrition and limiting your animal product consumption which has all been shown in longevity research to increase lifespan.

Remember, the authors do NOT know it all. You should always be skeptical of new information and conduct further research on your own. It is important to read these books if you are a healthcare professional (and especially if you are a dietitian or RD2B) because patients/clients may ask you about the claims in these books. Utilize critical thinking when processing new ideas from books. I found all 6 of these books helpful in bettering my health and the health of my patients.

Leaky Gut - The Case Against Gluten

I've looked into "leaky gut" on multiple occasions during my first year working closely with GI patients. I remember after consulting my 3rd patient that had an extensive list of food allergies/sensitivities, I had to investigate what was going on. WHY are these patients positive for ALL 6 of the common food allergens? And also, why are they not presenting with traditional allergen symptoms (anaphylaxis, itching)? In my investigation, I soon stumbled upon a possible cause: increased intestinal permeability AKA Leaky Gut Syndrome. What I found at that time was that something was causing the tight-junctions between intestinal cells to break down. Without tight-junctions, gaps would form between cells allowing for food particles to enter the bloodstream only to result in immune system response. Immune response to a food = "allergy".

I concluded that I would have to circle around to this conundrum at a later time. But for the time being, I had to recommend the only studied diet for this food allergy/sensitivity condition: The Six Food Elimination Diet. The six food allergens are milk, egg, wheat, soy, fish/shellfish, and peanuts/tree nuts. As you can imagine, compliance with this diet is low.

Besides food allergies/sensitivities, other symptoms of Leaky Gut Syndrome include: 

• Diarrhea
• Malabsorption (which can lead to nutritional deficiencies) 
• Poor immune system
• Fatigue
• Skin Rashes
• Food Cravings 

Fast forward to this past week. After a short discussion with my colleagues about gluten, I revisited the connection between gluten and leaky gut. I've never really taken a side for or against a gluten-free diet (except for celiac patients), until now. 

Remember that something was breaking down the tight-junctions causing "leaky gut"? Well zonulin, an inflammatory protein, is the master regulator of inter-cellular tight-junctions. In other words, it regulates "leakiness" by opening and closing the spaces between intestinal cells. 

The next question I had was: What increases zonulin?

GLUTEN. Gluten stimulates zonulin release! Also, lectins do as well, but we usually cook foods high in lectins, which disables the action of the lectins (please eat your beans!). Another stimulus for zonulin release is bacteria - harmful bacteria. If your digestive tract senses harmful bacteria, zonulin will break down the tight-junctions, allowing water to enter the colon to flush the body of the bacteria. For all of us that have experienced food poisoning knows what I mean... DIARRHEA.

This picture below demonstrates how gluten disrupts intestinal permeability. 
Gluten --> Increases Zonulin --> Zonulin widens the tight-junctions --> flow of food particles enter the blood via the gaps between the intestinal cells --> Autoimmune response to these food molecules (which should normally not be there) --> Inflammation and irritation of the GI tract --> Patient presents positive for food allergies/sensitivities 

So should we all be following a gluten-free diet? No, but a gluten-free diet should be considered for those with GI symptoms such as diarrhea, constipation, and bloating. A therapeutic elimination diet would be beneficial in giving the GI tract a break from the gastric irritant gluten. See below for directions on how to do an elimination diet properly. It's also important to slowly increase prebiotic fiber which will help improve the health of your microbiome (the world of bacteria inside of your GI tract). 

If you suspect leaky gut or some gut imbalance, please see your doctor. Could you benefit from removing gluten from your diet? Yes. Do you need to eliminate gluten forever? No, but you should consume anything processed (such as wheat) in moderation.

Can probiotics help? Possibly! Studies suggest that specific strains may improve tight-junctions. There isn't enough research to solidify this claim, but a high-quality probiotic supplement in combination with increase prebiotic fibers is the best place to start to improve overall gastrointestinal health. Two probiotic supplement brands I trust are Metagenics and Garden of Life. 

Side Note: NSAIDs, such as ibuprofen and aspirin, can also increase intestinal permeability. But that is for another discussion. I highly recommend limiting the use of NSAIDs as they have been shown to damage the gastrointestinal tract.

30-Day Elimination Diet 

Step 1: Remove Gluten for 30 days 

Gluten is found in A LOT of commonly eaten foods. Luckily there are plenty of gluten-free options at the grocery store. Once you understand what foods have gluten (wheat, barley, rye, some oats), adjust your mindset to thinking about what you CAN eat. It will make the process much easier. 

Note other names for wheat: durum, einkorn, emmer, kamut, spelt 

Step 2: Think about the foods you CAN eat 

Fresh, whole foods are the way to go. Fruits, vegetables, lentils/beans are a MUST to include because they contain fiber. Fiber is essential to healing the gut and building up a healthful microbiome. Other foods to include are eggs, fish and grass-fed beef, free-range chicken (QUALITY MATTERS when it comes to animal products). It would also be beneficial to include a dietary probiotic such as yogurt or kefir (non-dairy is okay as long as it has the live-cultures). 

What about the carbohydrates?! Well, rice will likely become your friend. And gluten-free oatmeal. Other gluten-free options include quinoa, corn, and millet. 

Step 3: Reinoculate 

It's time to build up that microbiome. It's important to include both prebiotics and probiotics. If you do not like fermented foods, I recommend getting a probiotic supplement. Prebiotic fibers include strawberries, bananas (the greener the better), oats, artichokes, asparagus, garlic, onions, and leeks. 

Step 4: Asses how you are feeling 

If you are still experiencing gastrointestinal issues, I recommend seeing a gastroenterologist so they may rule out any serious GI condition. 

For more information, visit the Mayo Clinic for a good article on Gluten-Free Diet. 

Taylor Swift Themed Birthday Party

So being the big Swiftie I am, after the release of Taylor Swift's new album Lover, I had to throw that in with the mix of my birthday party theme: Boho, iridescent, Lover.

Flower Crown Making Station 

Photo Booth with Polaroid Camera 

Floor Seating Boho 

Lover Album inspired drink menu

Dessert Table

Ultimate Charcuterie Board Table

"Oh, 25 years old"

Want to recreate the drink menu?

Drink Menu Holder - 3 Pack 

I used all three. 1. Alcoholic drink menu 2. Non-alcoholic drink menu 3. Photobooth Sign

A Message to the Body Shamers

A Message to the Body Shamers out there (including healthcare professionals, family, friends, and strangers):

Hi, I'm Tatiana. I'm your [insert relationship: patient/child/friend/spouse]'s dietitian. My patient has told me about you and your comments during our appointment. They expressed feeling hurt, shame, and/or embarrassment about their weight due to your remark. I understand that you are trying to help, perhaps even motivate them. I must inform you that body-shaming does all harm and no good. Weight loss is NOT easy. Healthful, permanent weight loss is a colossal obstacle, especially when my patient is struggling with body image (which is 90% of my patients). 

To The Healthcare Professional: 

My patient was told to lose weight at your medical clinic (likely because their BMI was above 30). The patient brought back the already-known information to our nutrition session. "The doctor said I need to lose weight. I should reduce calories and exercise more." What you didn't know: My patient was too embarrassed to tell you that they are already in the process of making healthful lifestyle changes.

I ask you to change your approach. Before you go on preaching the ineffective calorie-in/calorie-out method for weight loss, ASK your patient what lifestyle changes he/she has already made (don't even bring up their weight). They may ask you for some additional advice, sensing a safe, open environment. If you don't have time to discuss weight loss, ask if they have ever met with a dietitian. If not, write a referral. If yes, don't worry, they are likely in good hands. 

To The Parents:

Never ever, ever use the F-word (fat) in front of my patient. Don't even use that word to describe yourself or another person. You may think it's helpful to remind them about their weight and health, but to be the bearer of bad news, it does not motivate them whatsoever. In fact, it hinders their progress in practicing positive body image. Did you know that positive body image is associated with weight loss? Probably not. We live in a shame-filled society. The least you could do is avoid adding on to that shame. You play a role in my patient's success. Words are powerful. Shame is real and dangerous. I discuss this reality with them during our sessions together, in a safe, non-judgemental environment. Please, do your best to create this same environment at home. Be encouraging and tell them the positive truth: Your daughter/son is making progress and they are enough just the way they are. 

To The Stranger:

Take a moment to think about the pain and hurt you have experienced in your life (if you deny hurt/sadness, then you may be a psychopath or have alexithymia: unable to feel emotions). You are NOT the only one who experiences bad days. Every person you come in contact with is struggling with something (death of a loved one, relationship problems, negative body image, etc.). I would think that judging my patient would be the last thing on your mind. However, sometimes you forget the reality of normal life struggle and embarrass my patient. Perhaps you assumed that my patient doesn't give a flying f**k about their health (which your body language and look gave away). You may have looked at the items in their grocery cart in a disapproving manner. You may have even avoided looking at them in the eye, pretending they weren't there. 

I ask you to treat every person you meet with kindness. Make eye contact and smile. Acknowledge their existence! You do not know what they are going through. Your smile could ignite my patient's will to continue the process of gaining health.

To The Friend:

The type of relationship you have with my patient is crucial to their success. I hope you have an honest, real relationship. I hope he/she can come to you for comfort and reassurance. Allow my patient to talk aloud and honestly about his/her body image. Let them excitedly share their progress on making healthful lifestyle changes. Please, avoid talking about fad diets and losing 10 lbs in a week with him/her. The diet mentality doesn't work. Dieting doesn't work. Calling yourself fat doesn't work. Buying into the billion-dollar industry is just helping the enemy. 

To The Intentional Body Shamers:

I can see right through you without even looking at you. There's insecurity that lives deep within you. I highly recommend looking at yourself before you cast any stones at my patient. My patient has been fixing the damage you've done during our sessions together. If you are interested in bettering yourself so you may be kinder to others, I recommend reading The Gifts of Imperfection by Brene Brown.

We live in a sick, diet-culture. Working closely with weight loss patients has opened my eyes to the psychological component of losing weight. 

From Psychology Today: "80% of U.S. women don’t like the way they look, 50% attribute it to weight and 34% of men are equally dissatisfied with themselves." 

Body shaming is cruel and cheap. Your words have deeply affected my patient and your [insert relationship]. You have created more obstacles on my patient's journey to lose weight. Do your part in making the world a better place by not giving in to the insecure, weak world we live in. Help me take down the diet culture by practicing positive body image and self-love. 

To My Patient:

I'm so sorry that you have experienced body-shaming from family, friends, and strangers. This is not your fault. I know you care about your health; After all, you've sought out help by seeing me. I have hope that you will succeed in making healthful lifestyle changes so that you may return to a natural weight. Do your best to question the diet culture and to loosen the tight chains around your mind. You are worthy now. Love your body now. It's a positive truth that your body has brought you this far in life, so be grateful. You can love your body AND make lifestyle changes at the same time. Respect yourself. And always remember what you CAN control. You may not be able to control the body-shamers. But you can control how you respond. Forgive and remind yourself of the positive truth.