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. 

Getting Good GUT Flora: The “Pres” and “Pros” of GI Bacteria

Getting Good GUT Flora: The “Pres” and “Pros” of GI Bacteria
By Laura Cipullo, RD, CDE, CEDRD, CDN and the Laura Cipullo Whole Nutrition Services Team

 

Photo Credit: ninacoco via Compfight cc
Photo Credit: ninacoco via Compfight cc

We all hear a great deal about probiotics and their amazing gastrointestinal benefits, but what are the exact benefits and do probiotics need prebiotics to be effective? In honor of Irritable Bowel Syndrome Month, EALM will help you with the “pres” and “pros” of getting good gut flora.

 

There are prebiotics and probiotics. Prebiotics are natural, non-digestible carbohydrates (insoluble fiber). They include “fructo-oligosaccharides (FOS) such as inulin and galacto-oligosaccharides (GOS).”1 They are “selectively fermented ingredients that allow specific changes in the gastrointestinal microflora that benefit the health of the host.”2 They are “good bacteria promoters” and “may even enhance calcium absorption” per registered dietitian Jackie Newgent, RDN, CDN, as reported on the eatright website. “Foods naturally with prebiotics include bananas, onions, garlic, leeks, asparagus, artichokes, soybeans and whole-wheat foods.”1 Foods such as yogurt, and specifically brands like Maia yogurt (a favorite of Ilisa Nussbaum, RDN, CDN at Yale-New Haven Hospital), are adding the good bacteria promoters allowing you to get both the prebiotic and probiotic in one serving. Foods or supplements with both prebiotics and probiotics are called synbiotics.2

 

Probiotics are “gut-dwelling bacteria that keep pathogens (harmful microorganisms) in check, aid digestion and nutrient absorption, and contribute to immune function.”3 Bacteria such as Lactobacillus rhamnosus GG, L. reuteri, bifidobacteria and certain strains of L. casei or the L. acidophilus-group are used in probiotic food, particularly fermented milk products.2 Think kefir and yogurt.

 

These probiotics work on the prebiotics. So it’s suggested that one eat plain yogurt (which is fermented and contains live bacteria) with wheat berries and or bananas (foods that contain indigestible carbohydrates) or a yogurt containing prebiotics and probiotics (an easy option for those on the go). One of the best sources of probiotics is yogurt, of course, because it contains lactobacillus and or bifidobacteria. Other probiotic food sources include sauerkraut, miso soup, kimchi, fermented soft cheeses (like Gouda) and even sourdough bread. The common feature of all these foods is fermentation, a process that produces probiotics.4

 

 

The 7 Pros of Probiotics5

1. Diarrhea

  • Probiotic therapy, specifically with Lactobacillus GG, is well supported by research for treating diarrhea.3
  • Prevention and/or reduction of duration and complaints of rotavirus-induced or antibiotic-associated diarrhea as well as alleviation of complaints due to lactose intolerance.4

 

2. Crohn’s disease and irritable bowel syndrome (IBS)

  • Studies suggest that certain probiotics may help maintain remission of ulcerative colitis and prevent relapse of Crohn’s disease.3
  • Prevention and alleviation of unspecific and irregular complaints of the gastrointestinal tracts in healthy people.

 

3. Cancer Promoting Enzymes

  • Reduction of the concentration of cancer-promoting enzymes and/or putrefactive (bacterial) metabolites in the gut.

 

4. Inflammation

  • Beneficial effects on microbial aberrancies, inflammation and other complaints in connection with inflammatory diseases of the gastrointestinal tract, Helicobacter pylori infection or bacterial overgrowth.

 

5. Constipation

  • Normalization of passing stool and stool consistency in subjects suffering from obstipation or an irritable colon.

 

6. Allergies

  • Prevention or alleviation of allergies and atopic diseases in infants.

 

7. Colds and Infections

  • Prevention of respiratory tract infections (common cold, influenza) and other infectious diseases as well as treatment of urogenital infections.

 

Photo courtesy of Maia Yogurt
Photo courtesy of Maia Yogurt

Whether you are trying to prevent the common cold, or manage IBS, prebiotics, probiotics and synbiotics are worthy of consideration. You are probably already eating these foods and don’t even know it. If you need assistance, eating yogurt daily would be a very easy way to make your gut happy.

 

Happy GUT Meals

  • Whole-wheat pasta with artichokes, asparagus and olives.
  • Sourdough pizza crust topped with Munster cheese, onions, garlic and, of course, tomato sauce.
  • Salmon in a Greek yogurt sauce served with grilled asparagus.

    

Happy GUT Snacks

  • Maia yogurt with wheat germ.
  • Greek yogurt with bananas, figs and almonds.
  • Sourdough bread with black bean spread.

 

Happy GUT Sides

  • Kimchi with roasted soybeans.
  • Sauerkraut with onions.

 

 

References:

  1. Academy of Nutrition and Dietetics. Prebiotics and Probiotics: The Dynamic Duo. 2013. Available at: http://www.eatright.org/Public/content.aspx?id=6442477443. Accessed April 7, 2014.
  2. de Vrese, M, Schrezenmeir, J. Probiotics, prebiotics, and synbiotics. Adv Biochem Eng Biotechnol. 2008; 111:1-66.
  3. The Harvard Medical School Family Health Guide. Health Benefits of Taking Probiotics. 2005. Available at: http://www.health.harvard.edu/fhg/updates/update0905c.shtml. Accessed April 7, 2014.
  4. WebMD. Probiotics and Prebiotics: Ask the Nutritionist. Available at: http://www.webmd.com/vitamins-and-supplements/nutrition-vitamins-11/probiotics. Accessed April 7, 2014.
  5. Peters, BA, Neet, KE. Regulatory properties of yeast hexokinase PII. Metal specificity, nucleotide specificity, and buffer effects. J Biol Chem. 1977;252(15):5345-9.