At The Forefront Live: Healthy Eating

[THEME MUSIC] Hello, and welcome to the University of Chicago Medicine At The Forefront Live. We're excited to host these programs to allow you to interact with our experts. UChicago Medicine has some of the leading researchers and scientists in the world who are working for the betterment of your health. So get your questions ready, and we'll answer as many as possible over the next half hour. And we want to remind our viewers that our program today is not designed to take the place of a medical consultation with your physician.

Joining us today is Courtney Schuchmann and Lori Welstead. Both are registered dietitians. They'll be speaking with us about healthy living and diet. And let's just start off with the two of you telling us a little bit about yourselves and your areas of expertise and interest.

Hi. I'm Lori Welstead. I'm a registered dietitian in the GI section at the University of Chicago Medicine. And I see a variety of patients with GI disorders as well as diseases, including inflammatory bowel disease, celiac disease. We also see a lot of patients for weight management as well.

Hi. I'm Courtney Schuchmann. I'm also one of the registered dietitians within the Department of Gastroenterology, with Lori as well. So I also see a lot of the IBD and GI patients as well as a lot of weight management. And then one of my areas of expertise is ketogenic, which I think we'll get into a little bit as well.

Great, great. Now I want to remind everyone, as you watch you can ask our experts questions that are of interest to you. So get typing. We'll try to answer as many as we possibly can.

Let's get right to the questions. We have a couple of questions that were sent in in advance. So let's start with those. Kathleen asks, do you have thoughts on a ketogenic diet?

So as mentioned, this is one of my areas of expertise and specialty. I've done some research in the diet. So the ketogenic diet actually was initially developed for the treatment of epilepsy. It's been used for ages. It is very effective for treating seizure frequency and severity.

However, recently it's gained a lot of popularity for weight management as well as a variety of other disorders as well. I always mention, if you're interested in the ketogenic diet to speak with your physician just because there are some areas and disorders that you want to confront in advance, just to make sure that it is a safe diet to follow.

And I imagine if you're embarking on any kind of a diet that's out of the ordinary, it's probably a good idea to see a physician before you do that, just to make sure you don't exasperate any kind of situation you might have.

Exactly. And with a ketogenic diet, or any very restrictive diet, you want to make sure that you talk to your physician and have the appropriate labs and tests drawn in advance so that you know if there's any areas of concern and reasons to stop or continue adhering with the diet.

OK, Jennifer has a question. And that's, what are the best diets to follow or foods to avoid for inflammation? Don't really know what inflammation she's talking about. But see if you guys can answer that one.

So it depends on-- we usually have patients avoid some foods if they suspect things such as dairy might bother them, or things such as gluten. Again, unfortunately with regards inflammatory issues, sometimes a Mediterranean diet could be helpful. But there's not much to suggest a specific diet will help just for inflammation.

And again, any kind of new diet you want to try, you know, the questions that I have in my mind-- because you see a lot of fad diets, and a lot of diets where people say, oh, only drink coffee, and things like that. How do you know if a new diet will be safe? And how do you know if it might not be?

So I typically say, if it's a diet that says, restrict very large food groups, be cautious with following a diet along those lines just because it can be lacking appropriate vitamins and minerals, as well as some other nutrients. Also, on the other spectrum, I say it's specifically solely based on one food group, I would also avoid it, like the carrot diet or the hard boiled egg diet, just because you're eliminating almost everything outside of those food groups which could be dangerous.

What's a detox diet?

So, the concept behind a detox diet is that it can eliminate toxins from your body. So for a lot of people, they use these detox diets to jump start their weight loss because they believe it can help cleanse some toxins from the body. However, there is minimal research to support that these diets actually do that for your body. Your body actually has built in mechanisms for detoxing itself, and those are your kidneys and your liver. So any detoxing of medications or toxins or anything you ingest, your kidney and your liver are going to be responsible for doing that.

Juice cleanses, we've heard about that. Healthy, not? It's kind of along the same lines, I would imagine.

Yes, exactly. So I also agree, like Courtney said. So especially with juice diets, a lot of times when people are juicing they're using a lot of fruits. And that is a very high amount of sugar that's in the juices.

So sure, it would be fine to do a little bit of juice, but doing more vegetable juices. But doing a complete juice cleanse could certainly cause some weight loss. But you would likely gain the weight back pretty soon after you're eating normal foods again.

So, I think most of the people that probably are watching this, or writing questions in, are looking at weight loss. They may be looking for healthy options for other things as well, but weight loss is what they're thinking of. What are the keys to successful weight loss? And we'll start with you on this one.

So, there are so many different keys to it. So I think, definitely making sure of sleep hygiene, because oftentimes, many of our patients are getting very little sleep throughout the night. So sometimes that can cause an increase in cortisol, one of the stress hormones, if you're not getting adequate sleep.

I think eating frequently throughout the day. So oftentimes a lot of our patients struggle with eating. They eat just once a day and say, I'm really having a hard time losing weight. So that can really make your metabolism sluggish. Making sure you get an adequate amount of fluid as well, especially water and non-caloric fluids. Courtney, I'm sure you--

Exercise, also, is a key component. So as much as you can do with diet alone, and there's a ton of changes you can make that can initiate and jump start your weight loss, sustainable exercise is super important. So aiming for 150 minutes of some form of physical activity per week. So it kind of boils down to like 30 minutes five days a week or a little bit less than an hour three to four times a week.

Try and find something you enjoy. So, you know, Zumba is a nice option for some people. Going for a daily walk after dinner can be a sustainable change. But something that you actually enjoy and you can sustain long term.

And that's, I think, an excellent point. It doesn't have to-- you know, when people think of exercise I think sometimes they get a little overwhelmed because they think they're going to the gym and they're going to be really working out hard. A walk is good exercise.

Exactly. And if that's something you can stick to, I think that's more important than going headfirst into an exercise routine that you might not be able to stick with.

Now, you mentioned sleep hygiene, which I think is a fascinating subject because a lot of us don't get enough sleep. I know that's something that I struggle with and I think a lot of folks do. What exactly is sleep hygiene? And let's kind of delve into some of the details. What do people need to do to have good sleep hygiene?

That's a great question. So, I think making sure you find some time to relax before you go to bed and not just have your phone or your tablet out, or your computer screen out, right before you go to bed because that can definitely affect your sleep routine. Making sure you aren't eating too close before bed because that could also be a negative impact on how you sleep if you go to bed with a really heavy stomach. So usually we say, try to stop eating two to three hours before you go to bed. Usually I say your bed should be to sleep rather than having the TV on and all those other things.

Be cautious with caffeine, too, in the afternoon. So for a lot of people that have trouble with sleeping, having coffee or caffeinated beverage in the afternoon can make it a lot more difficult to sleep at night. Create the right environment with, you know, room darkening curtains can be a good option to help ensure that you're getting a good night's rest.

Yes.

We want to remind our viewers that we are taking questions live. So if you have any questions for our experts, please just type them in on your screen and we'll get to them as quickly as we possibly can. So, fluid intake, let's talk a little bit about that. Is that important if you're trying to lose weight?

Absolutely. So oftentimes you may think that you are hungry but you're oftentimes thirsty. So usually we recommend about a half an ounce per pound of weight of water. And remembering that caffeinated beverages are not going to be something that hydrates you.

Half an ounce per pound? And that one I hadn't heard before. I just always hear the eight cups of water a day, or you know, whatever. But that's interesting. And caffeinated beverages, not a good idea, as you say.

Yeah. It's not going to be something that actually is going to contribute to the hydration. It can dehydrate you a little bit.

So water, obviously that's probably the best thing to drink. What are other good ideas?

So, water, you can add other things to the water to give it some sweetness, whether it's real fruit, whether it be lemon, lime, orange, grapefruit, cucumber slices. You could also add some non-sugar containing things onto the water as well to flavor it.

You know, it's funny. Whenever we talk about things like this, it always gets back to kind of keep it basic and simple and going with what's natural and what we've been doing for thousands and thousands of years. So, water's the best bet. We already answered the next question, how much water should a person have? Is fiber essential to weight loss? That would be another one.

Absolutely.

Absolutely. So, fiber is really important for weight loss just because fiber is one of those nutrients that can actually help keep you full and satisfied after your meal. So aiming to incorporate some type of fiber-- you know, I typically say about five grams of fiber per meal is a good starting place. That kind of breaks down to 15 grams of fiber from your meals and then some snacks with some fiber gets you somewhere close to that 25 to 30 grams of fiber recommendation per day.

So again, fruits, vegetables, whole grains, are all great sources of fiber. And those are going to help fill you up after meals. They're low in calories and they can help you sustain your weight loss in the long term as well.

And we have a question from a viewer who says that they struggle with sleep as well. We're going to get back to our sleep. And I think that's something that's probably on top of a lot of folks' minds. They get a prescription from their physician, but they also want to know if melatonin is a good thing to take and if it will help.

So I would say definitely get the advice of your doctor. You can try melatonin. It is a supplement that's just over-the-counter. And I would start with just the smallest dose and see how you react to it.

Amy has a question for us. She says, do you recommend a whole food plant based diet for your patients?

So I mean, definitely what I recommend to patients is really looking at the diet and saying, OK, I want to eat more things that, I joke, that say, rot and go bad. So again, I used to say eat things around the perimeter of the grocery store. But often times that has the fried foods, the bakery, and all those other kinds of things.

So I say, yes, definitely eating a good portion of your diet being plant based. And I also think, too, so if you are getting animal products it is good to have that balance. So plant proteins as well as animal proteins.

Yeah, I think they have changed the way grocery stores are set up over the past few years, because I do remember hearing that, shop the perimeter of the store. And that's changed so much.

Mm-hm.

So, question from Louis. Do pain medications cause issues with weight loss?

So again, talk to your physician about this. It's very specific to what kind of medications you're on. There are a variety of different medications, pain related medications as well as some other medications, that people often do take that can impact your metabolism and can make it a little bit more difficult to lose weight. Some of them can also impact your sleep habits which again, can kind of boil down to some difficulty with weight loss. So it's very specific to the specific medication. And bringing it up to your physician if that's a concern, or you recently started a medication and now you're having some difficulty with your weight, that could be something that needs to be discussed with your doctor.

Have a question from Ashley. I know if you don't eat enough it can make it harder to lose weight. Is there a kind of a minimal recommendation of how much you can eat? And this one's interesting to me because I have a family member who was talking about losing weight and his goal was to try to eat 500 calories or less a day which I suggested is not a good idea-- my son. So let's talk a little bit about that, because I think that's a good thing to educate people.

Oh, absolutely. So typically in our clinic we don't recommend going under 1,200 calories. Typically, again, you could be on a medically supervised weight program and do about 800. But that would be something you would want to see your physician very often, or a registered dietitian, so they can do labs because that is a very low calorie diet, is 800 calories. But we usually say 1,200. Trying not to go below that when you're trying to lose weight because yes, if you are eating too little, that could actually make your metabolism a little more sluggish and affect the goal of weight loss.

And it's hard to meet all your vitamin and mineral needs when you're less than 1,200 calories per day, which is why the Academy of Nutrition and Dietetics does make that as our lowest cutoff for weight loss. Also, we do see often when patients cut their calories really, really low, it is a lot harder to lose weight. And it might just be that you're not getting enough energy to burn calories throughout the day. So you're feeling sluggish, you're not moving as much, which is going to result in less weight loss.

We were talking a minute ago about the importance of fiber. What are good sources of fiber?

So yeah--

Plant based foods.

Yeah, plant based foods. So again, with regard to fruits, berries are one of the highest sources of fiber. Again, all fruits and vegetables, the skins, the seeds are going to have a good amount of the fiber. And there, whole grains, beans and lentils are also great sources as well for fiber, nuts and seeds.

Is there a specific amount you should eat?

So typically for females about 25, for males it's up to 30--

38.

--I think is the cutoff for males. So again, as Courtney mentioned, trying to aim for five to seven grams of fiber at least per meal to really get into that 25, at least, grams of fiber per day.

This next one is interesting to me because I've heard this one before. I don't know if it's true or not. If you change your diet, can that cause food sensitivities?

So myself personally, I have seen some people come in and say they've eliminated dairy from their diet. And when they go to reintroduce it into their diet they do have some sensitivities to these foods that they don't remember having before. Same thing with gluten based foods. Often they add these foods back into their diet and they notice that they have some GI discomfort and intolerance to them. It could just be that the enzymes that your body produces to help metabolize these and break things down and absorb them might be less than what they were produced at before, so that can cause some problems for other people.

I think you are exquisitely sensitive when you reintroduce those foods back, yeah.

Yeah. That makes sense. You're not used to things. I've got another question from a viewer. I've heard that controlling blood sugar can be essential for weight loss. Practically speaking, how does someone control their blood sugar? Is it cutting out processed sugar? Or is there more to it than that?

So we definitely say to cut out all the processed sugars, and then to be very mindful of the overall carbohydrate content of the diet. So that would be, even from things that are even whole grains, you still want to be mindful of the portion of those whole grains because that could still add up. So it's the total carbohydrates whether it be from fruits, starchy vegetables, peas, corn, and potatoes, again the whole grains.

Even things like beans-- beans are a great source of protein but they also do have carbohydrates. You do want to be mindful of fiber when it comes to carbohydrates. The fiber will be very helpful for the blood sugar. Courtney, you have anything else to say?

Well, and also keep in mind if you have diabetes or anything along those lines where you're on insulin or medications that are specific to the amount of carbohydrates that you're consuming, make sure you meet and discuss with a dietitian or your endocrinologist about the specific carbohydrate goals you should be shooting for. Also along those lines, keeping in mind added sugars are going to be one of the first things that you should try and cut back on. Often people tell me that they cut out table sugar. However, it's also important to keep in mind things like honey and agave. They are also forms of added sugar. But often people think those are a healthier alternative. OK, I'm

Going to mispronounce this person's name and I apologize in advance. But we have a question from, I believe it's Kado. K-A-D-O, I'm not sure how to pronounce that. But, what are your thoughts on intermittent fasting? And that's, again, something that I've heard many times, seen it on the internet. People will fast for a day and then-- is that a good way to do this, though?

Yes. Go ahead.

There is a lot of research to suggest that it can help with some weight loss, especially right now there's a lot of up and coming research studies that are showing that it can be beneficial for weight loss. There's a bunch of different types of intermittent fasting. So there's some where you're less than 500 calories a few days a week. There are some days that you're not consuming any calories. And then there's other ones where you're only consuming food during an eight to 10 hour period of time. So there's a bunch of different versions of intermittent fasting. And again, it's what is sustainable? So if it's something that you're only going to do for a week, it's probably not going to be beneficial for weight loss.

Yeah, makes sense. So Celiac Awareness Day is Thursday, September 13th. So of course, we probably want to discuss that just a bit. And we do have a question already that is along the same lines. If my stomach feels better when I don't eat gluten does that mean that I have celiac disease?

Not necessarily. So what we do recommend if someone does suspect that they have symptoms after consuming gluten, is to get tested for celiac disease. And it's a simple blood test just to rule it out. Because once you do go gluten free, it makes a little bit more of a challenge to actually determine if you do have celiac disease--

Interesting.

--with the blood test, because you can only detect celiac disease in the blood if you have gluten in your system. Now, oftentimes patients may feel better doing a little bit more gluten free of a diet. And it's because of something called FODMAPs, which are different kinds of fermentable carbohydrates.

Now, wheat, rye, and barley, which are the grains that contain gluten, are in that same category as things such as brussels sprouts, cabbage, onion, garlic, which for a lot of individuals they might find they are more gassy after those foods. So the wheat, rye, and barley are in that same category. So we suspect it's more of a carbohydrate issue that causes gas and bloating, versus something with celiac disease.

Interesting. And that was the next question, is there any benefit to a gluten free diet if you don't have celiac disease? And some folks have said that, that they feel better after going gluten free even though they're not diagnosed as celiac.

Yeah, so unfortunately we don't have any evidence to say that there's going to be any other improvement, besides symptoms. Now again, if someone has a better quality of life on a gluten free diet, that's fine, that's great. But again, there's no other added benefits to going gluten free outside of celiac disease that we know at this time. I think the main thing is just to make sure that they are taking a multivitamin, because you can also become deficient. A lot of these grains that are gluten free or not fortified.

Yeah. And that's kind of along the same lines of, if somebody wants to go vegan or very strict vegetarian they need to possibly look at their vitamin intake and obviously protein as well.

Absolutely.

Absolutely. And meet with a dietitials so that you have an understanding of which foods have proteins, which ones have the vitamins and minerals, because often if you're going vegan and just eating chips and salsa, you're missing out on a lot of the protein and the vitamins and minerals that are essential for weight loss and other things.

Next question, how do I care for a child or a loved one that suffers from celiac disease?

So I think making it as celiac friendly in the household. So making sure there are some separate things. So making sure they have a separate toaster, a separate strainer for their pasta, even cleaning vegetables because that can be often cross-contaminated. Even things such as cutting boards and some of the utensils in the house to make sure that there are some separate things for that individual with celiac disease.

Interesting. So it's that sensitive?

Yes it is.

That's great to know. Now, here's kind of the million dollar question. So, you've achieved your desired weight loss. How do you maintain it? What are some good tips to-- you know, because I think a lot of people do go on some of these crash diets in particular where they lose 20 pounds, 30 pounds. They get where they want to be, and then they struggle to stay in that neighborhood.

Yeah. I do know that a lot of people do look at that goal weight as their finish line. And once they've achieved it, they kind of go back to those eating habits that got them into the predicament that they were in in the first place. So I actually have a patient that once told me that she wrote down everything she did to achieve her weight loss. And that's something she revisits frequently to help her stay on track.

So things like keeping food logs regularly. So all of a sudden if you notice your weight's creeping up and you haven't entered any food logs, you have no idea where your calorie intake is now, that's a good thing to revisit, or how frequently you were exercising before. So kind of implementing some of those changes you made to achieve that goal weight, those are going to be just as important to sustain that weight loss.

Now, speaking of the weight loss, there are a lot of fad diets out there. Nathaniel has a question for us. And he asks, are there certain fat diets out there that you would recommend people avoid?

So, one I saw on Facebook today was the egg diet. So while eggs are awesome, great source of vitamins, minerals, healthy fat, protein, it's definitely not something you can adhere to long term. But you're also missing all of the vitamins, minerals from fruits and vegetables and grains. You're also missing a lot of fiber. So staying on a diet like that in the long term can result in some constipation as well, which is a concern for a lot of people that are trying to lose weight if you're feeling bloated all the time from not having bowel movement.

So, Heather has a question. Do you recommend vitamin supplements? Should people be taking these on a regular basis? Is it case by case basis? You know, I think we, again, we all look at vitamins and supplements and I think we worry, a lot of times-- I know I do-- if I'm getting the proper nutrition.

Across the board, we don't necessarily recommend that everyone takes all sorts of supplements and vitamins. Specifically for celiac disease I do recommend taking a multivitamin with minerals. Also, if you are concerned about having any kind of deficiencies possibly check with your doctor. They can draw some different vitamin labs or mineral labs that you may be deficient in. And really, most individuals, if you're eating an overall normal diet, you shouldn't be too deficient in vitamins and minerals.

But yeah, If you're following like a vegan or a vegetarian diet, you definitely want to see if some of those labs should be checked because there could be areas that you're missing out on such as calcium or vitamin D that a dietitian or a physician can help recommend the appropriate dosage.

Deborah has a question for us, thoughts on alternative sweeteners that don't cause GI issues? Ooh.

So, specifically looking for ones that don't cause some of those issues?

I think that's what she's getting at, yeah.

So, Stevia is one that we often recommend in clinic. It's a plant based sweetener. It's not a sugar alcohol, which sugar alcohols are some of those ones that can cause some GI distress. However, keep in mind, read the food label very closely because some of the Stevias that are sold on the market contain erythritol, which is a sugar alcohol that can cause some GI distress.

Great. Now here's one that I like because unfortunately I do travel quite a bit and I am on the go a lot. Healthy eating options when fast food is all you've got. There are a lot of times when you're in the car and you look for someplace to eat and you're in a hurry. What do you do?

Let's see. So I mean, I would say, you know, be mindful. If you can possibly look on something like Calorie King, or looking on their menu ahead of time to kind of gauge your options, because oftentimes you might think one entree might be the healthier option. But if you don't really know the nutrition facts that might be the highest calorie option on the menu. So I usually recommend looking ahead of time at that menu so you can kind of see what your options are.

And load up on vegetables. Vegetables are typically an option at all restaurants and fast food places. So you can always get foods that are in the grilled form. So instead of getting a fried chicken breast, maybe getting a grilled chicken sandwich and having like a side salad instead of the french fries with it.

And yeah, I think it's just buyer beware when you do that, because sometimes you can see the salads in some of the restaurants that will have more calories than--

Yes.

Exactly, than the burgers.

--the hamburger.

Yes, so definitely be careful.

Watch those toppings.

The other thing I'm curious about, and I know there are a lot of apps out there for your phones or whatever that are calorie counters and that you can enter what you eat and that sort of thing. Are those helpful, do you think?

Absolutely.

I think they are. A lot of our patients really find to be helpful.

So what would you recommend for people? Just is it, you just go through and you make sure you enter everything you eat during the day, exercise, things like that?

Yes.

So, we often use my MyFitnessPal. It's one that you can actually input your recipes into as well, which is nice. So if you're eating the same salad every day, rather than entering every ingredient for that salad into your food log it's kind of nice because you can put the recipe in and just add it and it takes five seconds out of your day. Other people, it's easier to just write it down on paper throughout the day and maybe enter it at the end of the night so that they can get a feel for where where their calories at during the day?

Great. Well, I think we're about out of time. You guys were fantastic.

Thank you.

You did a great job. That is all the time we have today. I want to thank Courtney and Lori for appearing on At The Forefront Live. If you want more information about UChicago Medicine's weight management program, please visit our website site at uchicagomedicine.org/weight-management, or call 888-824-0200. It's at the bottom of the screen right there. You can see it. Thanks again for watching At The Forefront Live and have a great week.