The EALM Blog Shelf

While Laura Cipullo and the Laura Cipullo Whole Nutrition Team work on some new and exciting projects, you may notice less posts on the Eating and Living Moderately Blog. We have created a “blog shelf” below to keep you entertained and educated. Get caught up on the latest nutrition education by clicking on each year below. We will send you nutrition updates, but we will not be inundating your mailboxes on a weekly basis. If you want weekly “love” and inspiration, subscribe to our Mom Dishes It Out blog for weekly posts and recipes. Mom Dishes It Out provides expert advice from mom Registered Dietitians and mom Speech Pathologists on the “how to” of health promotion!

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The EALM Blog Shelf

Please feel free to peruse our posts organized by year below. Or take a look at the categories listed at the bottom of the page to find a post in the desired.

2015

2014

2013

2012

2011

2010

Is “Gluten Free” for Your Family?: Autism and Gluten, Casein Free

*This post was originally published on the Bitsy’s Brainfood Blog. To see the original please click here.

Photo Credit: Whatsername? via Compfight cc
Photo Credit: Whatsername? via Compfight cc

Is “Gluten Free” for Your Family: Autism and Gluten, Casein Free
By Laura Cipullo, RD, CDE, CEDRD, and Mom

There aren’t too many quality research studies reporting on the gluten-free diet and its efficacy for children with autism spectrum disorders. However, you definitely hear the media and parents supporting it. The latest solid research a.k.a. randomized double-blind study only had fifteen children with ASD. This particular study from 2006 looked at the effects of the gluten-free, casein-free diet on autistic symptoms and urinary peptide levels. Surprisingly, there were no statistically significant results, still leaving the need for more research and many parents without answers. When reading the overall research, it seems parents may notice behavioral changes but nothing consistent across the board and nothing significant enough to make the recommendation to follow this diet.

However, when you keep reading, the association between ASD and GI (gastrointestinal) complaints is quite clear. Adverse GI symptoms such as diarrhea and abdominal pain are reported from 9 to 91 percent in different study populations1. The cause of these GI problems is unclear, but it appears to relate partially to abnormal carbohydrate digestion1 and abnormal gut flora possibly due to excessive use of oral antibiotics2. If gut flora is a concern, probiotics may help decrease ASD symptoms.

As parents wait for more information, many are willing to try the variety of diets that promise decreased symptoms. Like any child, a child with ASD is an individual and may/may not respond to dietary changes. It could be like many other foods—there are intolerances or sensitivities not recognizable as food allergies. There are many questions for parents to ask themselves and/or their child’s team. Weigh the pros and cons and decide what you think is best for your child.

– See more at the Bitsy’s Brainfood Blog.

 

References:

1. Williams, B. L., M. Hornig, T. Buie, M. L. Bauman, M. Cho Paik, et al. “Impaired Carbohydrate Digestion and Transport and Mucosal Dysbiosis in the Intestines of Children with Autism and Gastrointestinal Disturbances.” PLoS ONE 6, no. 9 (2011): e24585. doi:10.1371/journal.pone.0024585.

2. Adams, et al. “Gastrointestinal Flora and Gastrointestinal Status in Children with Autism–Comparisons to Typical Children and Correlation with Autism Severity.” BMC Gastroenterology 11, no. 22 (2011). doi:10.1186/1471-230X-11-22

FODMAPS: A Look at their Role in Managing IBS

FODMAPS: A Look at their Role in Managing IBS
By Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team

 

Can you recall the last time you felt bloated, gassy, abdominal cramping, diarrhea or constipation? For most people, these symptoms are mild and once in a blue moon, but for people with Irritable Bowel Syndrome (IBS), there is no cure for this gut disorder and these symptoms are chronic issues that can disrupt the quality of life. The great news is that you can help manage your symptoms through nutrition!

Photo Credit: visualpanic via Compfight cc
Photo Credit: visualpanic via Compfight cc

When people think of gut symptoms like those mentioned above, one of the most common suggestions is limiting irritating food triggers like caffeine, alcohol, and fatty foods, as well as increasing fiber intake and fluid intake. However, when dealing with IBS, since these gut symptoms are broad and can vary from person to person, managing them with a one-size-fits all approach is not ideal. While there are various treatment suggestions for those suffering from IBS, following a low-FODMAP diet is the new nutrition therapy approach in town that has the potential to manage symptoms in most people with IBS.

 

Last month, we were fortunate enough to attend the Nutrition Grand Rounds at New York-Presbyterian Hospital to learn more about FODMAPs and their potential benefits in the treatment of IBS. The presentation featured two speakers Dr. Julie Khlevner, M.D., an expert in pediatric gastroenterology who oversees the new Pediatric Gastrointestinal Motility Center at NewYork-Presbyterian/Morgan Stanley Children’s Hospital, and Patsy Catsos, MS, RD, LD, author of the book IBS – Free at Last!. While Dr. Khlevner and Patsy both discussed treatment options for people with IBS, each speaker touched on very different areas and treatment options. Dr. Khlevner explained the process of testing, diagnosing and treatment in children and young adults. In terms of treatment options, Dr. Khlevner suggested keeping a food log, keeping an eye on trigger foods, taking probiotics, as well as IBS hypnotherapy. Patsy educated the audience on a food-based approach to treating IBS and the potential benefits of this dietary therapy.

 

Patsy Catsos explained dietitians play a starring role in the management of IBS. A high fiber intake has been a common recommendation for treating IBS symptom management, however, research has found that few people find the increased fiber to be helpful. Thankfully the use of FODMAPs has been becoming increasingly popular in the management of IBS symptoms and with a relief in symptoms. In fact, evidence has shown a FODMAP-elimination diet to reduce symptoms in 3 out of 4 people with IBS1.

 

 

What is IBS?

To start, lets give a background on Irritable Bowel Syndrome. IBS is classified as a Functional Gastrointestinal (bowel) Disorder and can consist of a variety of symptoms. Dr. Khlevner explained the symptoms as the “ABCs of IBS” –

 

  • Abdominal pain or discomfort
  • Bloating, flatulence
  • Change in bowel habit
    • Stool urgency or straining
    • Incomplete evacuation

 

These symptoms often greatly impact a patient’s quality of life, especially in children and adolescents. Treatment for IBS can vary greatly per patient; however, common treatment options can include the use of probiotics, increased fiber intake, pharmacological interventions, psychological therapy, and lifestyle and dietary modifications.

 

 

What is a FODMAP?

FODMAPs are short-chain carbohydrates that tend to be malabsorbed in people with IBS and can trigger or exacerbate symptoms. FODMAP is an acronym that stands for:

Fermentable (Produce Gas)
Oligosaccharides (Fructans and Galacto-oligosaccharides)
Disaccharides (Lactose)
Monosaccharides (Fructose)
And
Polyols (Sorbitol and Mannitol)

 

How do FODMAPs affect IBS?

The origination of IBS symptoms can, too, be caused by a number of factors, some including, chemicals found in packaged foods, such as nitrates or sulfites, as well as FODMAPs. The ingestion of FODMAPs are not the cause of IBS, rather what can trigger the troublesome symptoms like abdominal pain or bloating. Patsy spoke about the use of FODMAP elimination trials in patients with IBS. This idea behind FODMAPs is that when people with IBS consume sugars that their body can’t properly breakdown, it contributes to their symptoms. The FODMAP approach includes a 1-2 week elimination of all FODMAPs, which Patsy called the Elimination Phase. The FODMAPs are then reintroduced into the diet one at a time to allow for proper monitoring of the patient’s tolerance. It can help you determine which sugars you may be sensitive to, and what foods to limit in quantity or what foods to avoid altogether.

 

Photo Credit: La Grande Farmers' Market via Compfight cc
Photo Credit: La Grande Farmers’ Market via Compfight cc

Where are FODMAPs Found?1

Oligosaccharides

  • Fructans, galactooligosaccharides (GOS), and inulin
  • Found in foods like:
    • Vegetables: artichokes, asparagus, broccoli, Brussels sprouts, onions, garlic
    • Grains: wheat and rye
    • Fruits: watermelon

Disaccharides

  • Lactose
  • Found in:
    • Milk, yogurt, ice cream

Monosaccharides

  • Fructose
  • Found in:
    • Fruits: apples, pears, peaches, mangoes, watermelon, dried fruit, and fruit juices
    • Sweeteners: honey, agave nectar and high-fructose corn syrup
    • Alcohol: sherry and port wine

Polyols

  • Found in:
    • Fruits: apples, apricots, blackberries, cherries, nectarines, pears, peaches, plums, prunes, and watermelon
    • Vegetables: cauliflower, button mushrooms, and snow peas
    • Sweeteners: sorbitol, mannitol, xylitol, maltitol, and isomalt (often found in sugar-free products like gum, mints, cough drops, and medications)

 

Important to Note:

Many foods contain FODMAPs and they may be very hard to avoid. You’ll likely find hundreds of food lists and suggestions of foods to avoid, which can lead to both confusion and restriction. Because of this, it’s very important to understand that the FODMAPs approach is not recommended for everyone to follow and is certainly not a weight loss diet or a cleanse, but a nutrition therapy that has the potential to help people with IBS figure out what foods trigger symptoms (…because let’s face it, constant bloating and gas isn’t fun for anyone or anyone around you!). If you’re still unsure about how to treat or manage your IBS symptoms, speak with your doctor, your dietitian, and/or check out the resources below:

 

 

 

  • And yes, there is an app for that! The research team at Monash recently launched a smartphone application: The Low FODMAP Diet. The app provides a list of hundreds of foods using traffic light signals i.e., (Red = Avoid and Green = Eat without fear) and according to serving sizes since smaller portions may be better tolerated.

 

 

 

References:

1. Scarlata K. The FODMAPS Approach – minimize consumption of fermentable carbs to manage functional gut disorder symptoms. Today’s Dietitian Website. Available at: http://www.todaysdietitian.com/newarchives/072710p30.shtml. Published August, 2010. Accessed April 16, 2014. 

Navigating the Gluten-Free Aisle: A Guide to GF Shopping

Navigating the Gluten-Free Aisle: A Guide to Gluten-Free Shopping
By Lindsay Marr and the Laura Cipullo Whole Nutrition Services Team

Photo Credit: Whatsername? via Compfight cc
Photo Credit: Whatsername? via Compfight cc

The gluten-free world can be daunting, especially for a newly diagnosed celiac or gluten-intolerant. Navigating the aisles of the grocery store can seem even scarier. Thankfully, there are more gluten-free options in stores and the labeling laws are becoming stricter, making gluten-free shopping less of a matter of chance. We took to the grocery stores to try and help ease the confusion and offer you a list of some healthful gluten-free tips.

 

You may remember we wrote about the new gluten-free labels this past summer and touched on the different aspects of the gluten-free diet in the fall. To touch base, the FDA has decided to consider foods with no more than 20ppm (parts per million) of gluten as gluten-free. But, what does 20ppm mean, you ask?  20ppm is the least amount of gluten that can be found in foods via reliable scientific analysis testing. It is also the level that meets many other countries’ standards for safety.

 

Can you trust a gluten-free label?

With the new FDA rulings, you can expect food companies to be more cautious in their labeling. In fact, we may even see a few gluten-free products come off the shelves, as some manufacturers may not want to go through the trouble of abiding by the FDA’s gluten-free rulings. If you feel uneasy before the August 2014 deadline, you can look for two seals on packages to assure the products you’re buying are gluten-free.

Screen shot 2014-04-06 at 10.34.22 AM
This image was used with the permission of The Gluten Intolerance Group.

Gluten-Free Certification Organization (GFCO): The GFCO is currently the leading gluten-free certification program in the world. It is an independent organization that verifies the “quality, integrity, and purity of products” and certifies gluten-free products to no more than 10 PPM.
Click here for the label.
CSA (Celiac Sprue Association): The CSA seal is given to products that have undergone a review and testing of ingredients to ensure the product is free of wheat, rye, barley and oats.

 

Which gluten-free products should I choose? 

Gluten free food companies are making efforts to make their food products more healthy by adding fiber, using brown rice flour instead of white rice flour and some are even using gluten free grains like buckwheat for this first ingredient. EALM was quite impressed to see these changes. However, some food labels noted the addition of added fibers like inulin, which is a non-digestible form of fiber that can cause gas.

 

Photo Credit: Caden Crawford via Compfight cc
Photo Credit: Caden Crawford via Compfight cc

Let’s Go Shopping!

When searching for the gluten-free foods with the most nutrition, we recommend using the following tips:

 

  1. Always double check!
    • Be sure to read the ingredients list for potential gluten, even if the product boasts a GF label or seal of approval from the organizations mentioned above. Food products and manufacturing practices change often and some companies even use the GF seals fraudulently. So, be aware and read those ingredients!
  2. Read the ingredients to educate yourself on which product is more nutrient dense!
    • When searching for healthier GF packaged goods look for nutrient-dense flours like quinoa, garbanzo bean, and brown rice. Also watch where these items are listed within the ingredient lists – ideally they are listed in ingredients one through five.
  3. Look for natural fiber!
    • As mentioned before, many high-fiber GF foods contain added carbohydrates like inulin or psyllium husk. While these carbs add fiber without affecting the texture or taste of the food, they can result in gas production (not so comfy for sensitive stomachs). Look for products that are naturally gluten-free, like corn meal or certified gluten-free oats. When in doubt, you can increase your fruit and vegetable intake for a boost of fiber, too.
  4. When in doubt…
    • Tap into some resources! There are a number of apps, subscription services, and organizations that keep consumers updated on all news relating to gluten-free. Take a look at our list below that will help you be a GF detective.

 

GF DETECTIVE Resources:

Celiac Disease Foundation

  • The CDF offers numerous resources for those affected by Celiac Disease, including a list of GF medications and supplements, tips for managing the holidays, as well as the latest research and gluten-free news.

 

Celiac Sprue Association

  • The CSA’s website offers a host of resources for those with Celiac and gluten intolerance. With lists of restaurants, recipes, and information on GF labeling, you are sure to find great information on all things gluten-free.

 

Gluten Free Watchdog

  • This handy monthly subscription is run by registered dietitian, Tricia Thompson, and for only $4.99 per month, you can have access to the latest in gluten free news and product testing results.

 

Gluten Intolerance Group

  • The GIG offers an annual membership with perks including access to food and medical information, educational programs, events, and even summer camps for children with gluten-sensitivities.

 

National Foundation for Celiac Awareness (Celiac Central)

  • The NFCA offers a list of GF manufacturers, keeps readers updated on GF news, and provides free webinars for readers. This is a great site when looking for GF news and information.