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What To Order At The Mexican Restaurant

7/27/2017

I get questions from patients all the time about how to eat at a restaurant without derailing their diet. Of course cooking your own food is best because you can control everything that goes into it (not to mention you save a lot of money!) but when you want to be social and go to dinner that’s ok too!

Here is what you should order when eating at a Mexican restaurant:

Appetizer:

Guacamole - Carve out 2-3 spoon fulls onto your plate and dig in or add some salsa on top. Guacamole is full of healthy fats with zero carbs and will keep you much better satisfied than a basket of chips.
Ceviche - This consists of raw fish (normally sushi grade) in citrus with maybe some diced tomatoes - you can’t get much healthier than that! This is a light, tasty, and low carb way to start your meal.

Main Course:

Fajitas - With lots of grilled vegetables, pico de gallo, and salsa as a topping to add flavor. Skip the rice and tortillas and see if they can substitute in extra veggies instead. If you are going to keep the beans go for black beans rather than refried because they have gone through less processing and contain more fiber. If you are low carb, skip the beans and ask for a side of avocado or guacamole instead.
Grilled chicken - With lots of vegetables. Skip the rice here as well, instead add add a side of avocado or black beans.
Grilled fish - With lots of vegetables. Skip the rice here as well. Top with salsa or consider adding a side of avocado or black beans.

Drink:

Tequila on the rocks - A shot of tequila has around 70 calories and will take a longer time to sip.
Skinny margarita - Tequila w/ soda and lime is great because you get the bubbles from the soda water and a hint of lime to pair with the tequila. This will also be easier to sip rather than a sugar bomb of a margarita - a margarita can have a whole days worth of sugar and calories!
Light beer - If you can’t see yourself not ordering a Mexican beer with your Mexican food, then go for a light version such as corona light.

Sarah-Kate Rems, NP
Co-founder, The Mindful Tech Lab - Check out all of our amazing apps to help improve your life here

How to Choose a Probiotic

7/20/2017

A healthy gut flora is incredibly important to prevent disease and to promote a healthy body. The bacteria in your gut work for you by killing off harmful invaders, help you to absorb nutrients, enhance your immune system, and help to digest your food. However, choosing the right probiotic is tricky because there are hundreds of different types of probiotics on the market and it can be difficult to know which one to choose.

Here is a list of 10 considerations when choosing a probiotic:

1. Probiotic must have at least 5 billion CFU
Your gut has literally trillions of bacteria and for a probiotic to make any sort of impact you need to find a probiotic that has billions of CFU (colony forming units - aka amount of bacteria). Don't look twice at a probiotic if it has anything less than"billions CFU" listed on the nutrition facts section.

2. Multiple strain or single strain probiotic?!
One good single strain is better than multiple strains that don’t do anything. The most important thing to consider when choosing a probiotic is what type of strain(s) it contains - good brands of probiotics will list the evidence showing their strain(s) of bacteria efficacy on their website.

3. If you are constipated
One strain in particular that has shown effective in numerous studies for reducing constipation is Bifidobacterium lactis. Other strains that may help with constipation include Lactobacillus rhamnosus, Bifidobacterium animalis, Bifidobacterium longum, and Lactobacillus plantarum.

4. If you have diarrhea or want to prevent traveler’s diarrhea
Strains that studies have shown to help with preventing diarrhea or traveler's diarrhea include Lactobacillus rhamnosus, Lactobacillus casei, and Saccharomyces boulardii.

5. If you want to lose weight
Probiotics that have shown to help you lose weight include species of Lactobacillus, specifically Lactobacillus rhamnosus and Lactobacillus gasseri. VSL# 3 is a probiotic in particular that may help with weight loss because it has been shown to promote satiety by increasing GLP-1 (satiety inducing hormone).

6. If you want to gain weight
Strains of Lactobacillus acidophilus have been shown to help you gain weight.

**Note** Before you go and throw away your probiotic that has L. acidophilus because you have been trying to lose weight, understand that there are many types of L. acidophilus and not all will necessarily promote weight gain.

7. If you are taking antibiotics
Antibiotics are sometimes necessary for large bacterial infections. Unfortunately, antibiotics will also kill off good bacteria which can lead to stomach upset and even weight gain and immune suppression. Start taking probiotics immediately when prescribed antibiotics and continue taking the probiotics for 2-3 weeks even after you have finished the course of antibiotics. Aim to take the probiotic a few hours from the antibiotic because there is the possibility of the antibiotic inactivating the probiotic - remember antibiotics kill bacteria and probiotics are bacteria.

8. If you have IBS
As of date, the best strains to treat IBS symptoms come from Bifidobacterium, particularly Bifidobacterium infantis. IBS can include alternating periods of bloating, constipation, diarrhea, gas, and stomach pain.

9. If you are prone to bacterial vaginosis
Bacterial vaginosis is often associated with low vaginal lactobacilli bacteria. Lactobacillus acidophilus and Lactobacillus rhamnosus are two strains that studies have shown to increase vaginal lactobacilli and decrease incidence of recurrent bacterial vaginosis.

10. If you get frequent urinary tract infections (UTIs)
Studies have shown that both Lactobacillus acidophilus and Lactobacillus rhamnosus can reduce and may prevent the incidence of UTIs. Studies have also shown that when antibiotics were taken with probiotics for treatment of an active UTI, treatment outcomes were better for those who took the probiotic.

Sarah-Kate Rems, NP
Co-founder, The Mindful Tech Lab - Check out all of our amazing apps to help improve your life here

IN With the Fat, OUT With the Carbs for a Healthy Heart

7/7/2017

Obesity, diabetes, and heart disease have skyrocketed and continue to increase since the government’s recommendation for low-fat diet for a healthy heart starting in the 1970s. When we take a closer look at the evidence connecting saturated fat and heart disease, the evidence presented is pretty weak, and more and more evidence is mounting and getting recognition against the long term belief that saturated fat intake leads to cardiovascular disease and death.

The low-fat mantra all started in the 1950s with a scientist named Ancel Keys. He performed a couple of highly flawed studies where he "cherry-picked" data to show that saturuated fat intake caused heart disease. The government and food industry locked onto this idea, despite data and numerous studies that have flooded in to debunk this theory. I highly recommend the books Eat Fat Get Thin by Mark Hyman, MD, and Why We Get Fat by Gary Taubes, for more information and citations of this.

Here are 5 reasons that saturated fats are not going to increase your risk for heart disease or death:

1. Low-fat diets are NOT effective at preventing heart disease
No study has been able to prove that a low fat diet will decrease risk of cardiovascular mortality. Plenty of studies show that saturated fat can increase total cholesterol, and then make the simplified conclusion that saturated fats lead to heart disease. But this is highly misleading because yes, saturated fat will increase total cholesterol because it increases HDL cholesterol (good cholesterol), as well as the good type of LDL cholesterol (more on this below); however, no study can show a direct link between saturated fat intake and cardiovascular related death. Again, there are more studies then I could ever reference, but here are a couple good ones:

In 2010, an analysis of 21 quality studies that looked at roughly 350,000 individuals up to a 21 year period found no risk of saturated fat intake with cardiovascular disease or stroke

And lastly, one of the largest and most expensive and long term clinical trials called the Women’s Health Inititiative(WHI) was meant to show the benefit of a low-fat diet for lowering cholesterol and heart disease. After eight yearsof this study, the women on low-fat diet had lowered their total and LDL cholesterol, however, there was no beneficial effect on heart disease, stroke, or cancer found from eating a low fat diet.

2. Fat increases your HDL cholesterol (good cholesterol)
Low HDL cholesterol has been found to be a far greater risk factor of having a heart attack than a high LDL cholesterol . When you replace fat in your diet (including saturated fat), with carbohydrate, this lowers your HDL cholesterol. A study by The New England Journal of Medicine explains that a low HDL cholesterol is a “biomarker for dietary carbohydrate.” Saturated fats have been shown to increase your HDL cholesterol (good cholesterol), and to have either no effect on your triglyceride cholesterol or to reduce this (another type of bad cholesterol).

In practice, when I get a patient's labs back and I see a low HDL cholesterol level with high triglycerides, this is an indicator to me that this individual is eating a high carb, low fat diet.

3. Fat increases large LDL particles (good type) and decrease small LDL particles (bad type)
Yes, to make things more confusing there are different types of LDL, large "fluffy" type (think cotton balls), small dense type (think rocks), and many other sizes in between. We want more of the large LDL particles to small dense LDL particles because the small dense LDL particles are much easier to lodge themselves into the walls of your arteries causing your arteries to narrow which leads to decreased blood flow (ie oxygen to your heart). These small dense LDL particles also are known to oxidize which leads to rancidity and inflammation in the blood vessels. Saturated fats will increase large LDL and decrease small LDL which in effect will cut your risk of heart disease.

4. Replacing saturated fats with carbohydrates increases bad cholesterol
This is more of a summary of the above, but I want to reiterate that replacing saturated fats for carbohydrates makes your cholesterol profile much worse. Carbohydrates have been shown to decrease your good HDL cholesterol while increasing small particle LDL bad cholesterol, as well as inceasing your triglyceride cholesterol. As mentioned above, heart disease is most associated with a low HDL cholesterol and high triglyceride cholesterol. LDL is a little harder to predict with heart disease because of the varying sizes and conflicting evidence.

5. Prevents "Diabesity"
Cutting back on fat almost enevitably means you are going to add carbohydrates to your diet, and high carbohydrate intake is what leads to diabetes as well as obesity - this is something that is not disputed. Obesity is a risk factor in itself for heart disease, as is diabetes, put these two major risk factos together and you are talking about a massive increase in your chance of cardiovascular disease (think heart attack).

Just as guidelines have changed in terms of cholesterol containing foods (in case you didn’t know, cholesterol containing foods do not raise bad cholesterol and this has finally been recognized by the American Heart Association (AHA) and the United States Department of Agriculture (USDA)) I have a hunch that there will be new guidelines for saturated fats in the near future.

Be sure to increase your intake of good saturated fats such as organic eggs, organic grass-fed beef, coconut oil, and dark chocolate.

Sarah-Kate Rems, NP
Co-founder, The Mindful Tech Lab - Check out all of our amazing apps to help improve your life here

What To Order At The Mexican Restaurant

How to Choose a Probiotic

IN With the Fat, OUT With the Carbs for a Healthy Heart

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