Dieting, celiac disease, and healthy eating: Q&A with experts

[Music] you [Music] hello and welcome to the University of Chicago Medicine at the forefront live or excited host these programs to allow you to interact with our experts use Chicago 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 Schuchman and Laurie well said both our registered dieticians they’ll be speaking with us about healthy living and diet let’s just start off with the two of you telling us a little bit about yourselves and your areas of expertise and interest 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 Stockman I’m also one of the registered dietitians within the department of gastroenterology with Laurie 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 it’s 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 and 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 like weight management as well as a variety of other disorders as well I always mentioned 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 if you’re embarking on any kind of a diet out you know that’s out of the ordinary it’s probably good idea to see a physician before you do that just to make sure you don’t exasperate any kind of bus 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 test run and in advance so that you know if there’s any areas of concern and reasons to stop or continue adhering with the diet okay 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 you know we usually have patients void some foods if they if they suspect things such as dairy might bother them or things such as gluten again unfortunately with regards to 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 and I again any kind of new diet you want to try it’s you know the questions that that I have in my mind because you see a lot of fad diets a lot of diets where people say I only drink coffee and you know 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 if it’s specifically solely based on one food group I would also avoid it like a 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 it be Tottie’s detox diet so the concept behind a detox diet is that it can eliminate toxins from your body and so for a lot of people they use these detox diets to jumpstart their weight loss because they believe it can help cleanse some toxins from the diet from the body however there’s minimal research to support that these diets actually do that for your body and your body actually has a built in mechanisms for detoxing itself and those are your kidney and your liver so any detoxing of medications or toxins or anything you ingest your kidney and your liver are gonna be respond forgetting that juice cleanses we’ve heard about that healthy not it’s kind of long the same lines I would imagine exactly so I also agree what Courtney said so especially the 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 that in juices so I’m 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 or looking at weight loss it’s not you know they may they may be looking for healthy options for other things as well but weight loss is what they’re what they’re thinking of what are the keys to successful weight loss and we’ll start with you on this one so there’s so many different keys to it so I think definitely making sure sleep hygiene because oftentimes many of our patients are getting very little sleep throughout the night so sometimes that can cause I’m 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 you know 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’re getting adequate amount of fluid as well especially water and non-caloric fluids 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 jumpstart your weight loss sustainable exercise is super important so aiming for 150 minutes of some form of physical activity per week so that 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 a 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 gonna be you know 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 a an exercise routine that you might not be able to stick with now you mentioned sleep hygiene which i think is a facet subject because a lot of us don’t get enough sleep I know that’s something that that I struggle with and I think a lot of folks do what exactly is sleep hygiene and let’s let’s kind of delve into some of the details what what do people need to do to get to have a good sleep hygiene great question so I think making sure you find some time to relax before you go to bed and not just have your phone and your tablet out or your computer screen out right before you go to bed because that can definitely affect your sleep 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 um just usually say try to eat stop eating two or 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 2:00 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 too to help ensure that you’re getting a good night’s rest 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 at the 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 them 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 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 on that one I hadn’t heard before I’ve just always hear the eight cups of water a day or you know whatever but that’s that’s interesting so and caffeinated beverages not a good idea as you said yeah it’s not me something that actually is going to contribute to the hydration 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 you know 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 waters well the flavor it you know it’s funny it’s whenever we we talk about things like this it always gets back to kind of keeping it basic and simple and going with what’s natural and what we’ve been doing for thousands and thousands of years so water is the the best bet I we already answered the next question how much water should a person have is fiber essential to weight loss that would be a another one absolutely so uh 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 fifteen 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 gonna get back to our sleep 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 is a good thing to take and if it will help so I would say definitely you know advise you know get the advice of your doctor you can try melatonin it is you know a supplement that’s just over-the-counter and I would start with just a small the smallest dose and see how you react to it okay amy has a question for us she says do you recommend a whole food plant-based diet to your patients so I mean definitely what I recommend to patients is really looking at the diet and saying okay I want to eat more things that I joke that say rot and go back so again I used to say eat things around the perimeter of the grocery store but often time that has the you know fried foods the bakery and all those other kinds of things so I’d 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 of plant proteins as well as animal proteins you know I think they have changed the way grocery stores are set up okay in the past few years because I do remember hearing that shop the perimeter of the store and that’s changed so much 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 I 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 this one’s interesting to me because my my 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 it’s not a good idea my son so let’s talk a little bit about that he’s I think that’s a good thing to educate people absolutely so typically in our clinic we don’t recommend going under 1200 calories um 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 registered dieticians they can do labs because that is a very low calorie diet is 800 calories but we usually say 1200 try 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 when it’s hard hard to meet all your vitamin mineral needs when you’re less than 1200 calories per day which is why the Academy of Nutrition and Dietetics does kind of make that as our lowest cutoff for weight loss um 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 gonna result in less weight loss we were talking a minute ago about the it’s a fiber what are good sources of fiber so yeah plant-based yeah these 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 gonna have a good amount of the fiber and they’re whole grains beans and lentils are also great sources as well for fiber is there a specific amount you should eat so typically for females about 25 for males it’s up to 30 38 I think it’s the as the cutoff for males so again as Courtney mentioned trying to aim for you know 5 to 7 grams of fiber at least per sir per meal to really get into that 25 at least 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 you see or 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 I up 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 these down and absorb them might be you know less than what they were produced at before so that can cause some problems for other people exquisitely sensitive when you reintroduce those foods back yeah yeah that makes sense you know you’re you know used to things I’ve got another question from a viewer I’ve heard that controlling blood sugar can AB essential be essential for weight loss practically speaking how does someone control their blood sugar is it cutting out processed sugar or is it 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 carb hydrates you do want to be mindful of fiber when it comes to carbohydrates the fiber will be very helpful for the blood sugar 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 the dietician or you’re on the chronologiste about the specific carbohydrate goals you should be shooting for also along those lines keeping in mind added sugars are gonna 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 are also forms of added sugar but often people think those are a healthier alternative I’m gonna mispronounce this person’s name and I apologize in advance but we have a question from I believe it’s Kat o ka do I’m not sure how to pronounce that but what are your thoughts aren’t 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 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 and 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 some day or there’s some days that you’re not consuming any calories and then there’s other ones where you’re only consuming food during an 8 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 gonna do for a week it’s probably not gonna be beneficial for a weight loss make 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 with blood tests because you can only detect celiac disease in the blood if you have gluten 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 I’ll have us 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 two celiac yes 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 the outside of celiac disease that we know at this time I think the main thing is just to make sure that they they are taking a multivitamin because you can also become deficient a lot of these grains that are gluten free are not fortified yeah and that’s that’s kind of along the same lines if somebody wants to go vegan or very strict vegetarian they they need to possibly look at their vitamin intake and obviously protein as well absolutely and meet with the dietitian 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 vitamins and minerals that are essential for you know weight loss and other things next question how do I care for a child or 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 could 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 it’s that it’s that sensitive yes it is very good that’s 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 and particularly where they lose 20 pounds 30 pounds they get where they want to be and then they struggle to stay in that 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 dogs back you don’t regularly so all of a sudden if you notice your weights creeping up and you haven’t entered any food logs you have no idea where calorie intake is now that’s a good thing to revisit or how frequently you are 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 that weight loss now speaking of the the weight loss there are a lot of fad diets out there and Nathaniel has a question for us and he asked are there certain fad diets out there that you would recommend people avoid so when I saw on Facebook today was the egg diet so well 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 yeah so a Heather has questions you recommend vitamin supplements are there should people be taking these on a regular basis it’s case-by-case basis I think we have 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 it’s across the board we don’t read 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 checking with your doctor they can draw some different vitam labs or mineral labs that you may be deficient in and really most individuals if you’re eating a overall normal diet you shouldn’t be too deficient in vitamins and Merrill’s 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 you know a dietitian or a physician can help recommend the appropriate dosage Debra has question for us thoughts on alternative sweeteners that don’t cause GI issues so specifically looking for ones that don’t some of those issues I think that’s what she’s getting in 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 to read the food label very closely because some of the stevia’s that are sold on the market container with retal which is a sugar alcohol that can cause some GI distress great now here’s one that 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 is all you’ve got and you know there are a lot of times we’re in the car and you look for someplace to eat and you’re in a hurry what what do you do 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 menus so you can kind of see what your options are well load up on vegetables vegetables are typically an option at all restaurants and fast food places so you know you can always get foods that are in like the grilled form so instead of getting a fried chicken breast may be getting your grilled chicken sandwich and having like a side salad instead of the french fries with that and yeah I think it’s just you know buyer beware when you do that because sometimes you even see the salads and some of the restaurants that will have more calories and then exactly you know the other thing I’m curious about I know there a lot of apps out there for your phones or whatever that their calorie counters and that you can enter your which what you eat and sort of thing are those helpful do you think absolutely I think they are a lot of our patients really finds me helpful yeah 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 Fitness Pal um 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 you know 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 were their calories at during the day right well I think we’re about out of time you guys were fantastic thank you had 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 you Chicago medicines weight management program please visit our website at you Chicago Medicine org slash weight – management or call eight eight eight eight two four zero two hundred it’s a bond on the screen right there thanks again for watching at the forefront live and we’ll have a great week


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