Integrative Nutrition

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diabetes, gut microbiome, healthy aging, holistic nutrition, integrative nutrition, obesity, prediabetes, registered dietitian nutritionist, The Diabetes Solution, wellness

These days, I often identify myself as an integrative nutritionist.  But just what does that mean?  Technically, many give the words integrative and holistic two different definitions. Integrative suggests the melding of different cultures and belief systems, blending traditional Western medicine with Chinese herbal medicine or acupuncture, for example. And holistic is used to denote an approach that says you cannot separate mind and body and the most productive way to help a patient is to look at all aspects of their being. Both of these imply an alternative approach. For me, these two concepts come together as one under the term integrative, a practice that is simply more practical and productive. Of course you capture more of the picture with a wider lens.

When I assess a patient, I try to learn what constitutes the root causes of her or his problem. It is rarely just one thing or another, a physical matter or a more subtle lifestyle or emotional issue. Most commonly, both physical and psychic or lifestyle issues are linked. Think about diabetes and prediabetes, for example. Elevated blood sugar and the long-term damage it causes is one of the biggest health problems plaguing our country at the moment. About 29 million adults, more than 9% of the population, has diabetes, and roughly 86 million suffer from its precursor, prediabetes.  In the majority of cases, these disease states are associated with obesity. Well, along with diet and exercise, stress and lack of sleep have been proven to affect weight gain.  Is it holistic if I ask a patient about the stress in their life?  Or the quality of their sleep?  No, it’s just part of good nutrition counseling. That’s why my new book coming out in November, The Diabetes Solution, written with Dr. Jorge E. Rodriguez, has large sections on stress reduction, improving sleep, and making sure you get enough physical activity to improve your health in addition to all the medical information you will ever need and a sumptuous dietary plan with 100 recipes. Forgive the plug; I worked on that book for a very long time. and it will be an excellent aid to anyone wishing to lower their blood sugar.

I think of integrative nutrition also as pushing the forefront of evidence-based medicine. By that, we mean science that has been shown to be effective or true in studies solid enough to be published in journals reviewed by other professional experts. Often it takes years for information that has been proven by research to enter standard practice, because not everyone reads the latest medical and nutrition journals, and organizations–not to speak of the government–are extremely slow to change, partly because of bureaucracy and partly because of appropriate caution. The Swiss doctor I worked with, Dr. Thomas Rau, lectured me almost a decade ago about the gut microbiome and the tremendous importance of nourishing our good gut bacteria with proper nutrition. That’s a model I’ve followed since I began my practice, even though it’s only become “fashionable” in the past couple of years. And as I’ve learned both in my practice and in my own life, this sort of integrative nutrition practice is powerful and effective.

On the other hand, sometimes integrative, alternative and holistic are used as titles without being backed up with enough training and knowledge. My dog could call himself a holistic nutritionist. There are no regulating bodies or state licensing agencies as there are for registered dietitians. Good nutrition practice is not magic. If you want to improve your health or want to make sure you are practicing the best form of wellness to ensure healthy aging, I hope you’ll look for a registered dietitian nutritionist ( a newer name for an RD who specializes in nutrition), preferably one with an MS or MPH in their credentials, which denotes a masters degree,  entailing years of extra scientific study.  And given my biases, I suggest you ask them if they have an integrative approach and if so, give it a chance. You’ll be amazed at the power of proper individualized nutrition.

 

 

 

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The Diabetes Solution

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blood sugar control, diabetes, prediabtes, type 2 diabetes

Some people may have noticed I have not posted in a very long time. That is because I simply am not a natural-born blogger. A million years ago, I learned to cook by working my way through both volumes of Julia Child’s “Mastering the Art of French Cooking,” but it would never have occurred to me to publicize that fact. More acts were private in those days. And there was no way of boasting when she came to my house to do Thanksgiving with wild turkey for “Good Morning America,” especially precious to me because she said on the air how much she loved my book “Cooking from a Country Farmhouse.”

So during the past year or so I neglected to document online all the work I have done on my next book with Dr. Jorge E. Rodriguez: “The Diabetes Solution. Together, we’ve put together a volume that addresses everything you need to know to reverse prediabetes or control and alleviate type 2 diabetes. I’ve come up with a structured eating plan that once mastered, makes it easy for anyone to lower their blood sugar, losing the extra weight they need to shed in the process. It’s based on the successful eating plans I’ve used in my private practice, which is so very gratifying.

So I hope you’ll look for “The Diabetes Solution” when it comes out in November, published by Ten Speed Press. In the meantime, future posts will give you a preview about managing diabetes as well as other chronic inflammatory diseases through the right way of eating and other lifestyle choices. Please stay tuned.

Prediabetes

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blood sugar, diabetes, integrative, Metformin, pre-diabetes

As high blood sugar becomes more of a national obsession–partly associated with our obesity epidemic, partly linked to our typical Western diet–the term pre-diabetes is being used more frequently. Prediabetes indicates fasting blood sugar over 100 but below 126 (or glycosylated hemoglobin above 5.7 but below 6.5), above which the diagnosis would indicate diabetes.  It is estimated that close to 80 million American adults fall into the pre-diabetic category.

One might wonder if “prediabetes” is comparable to being a little bit pregnant?  Happily, it is not, because while many people diagnosed with prediabetes go on to develop the full-blown disease, the condition is reversible with diet and physical activity. A landmark controlled trial proved that proper diet and regular exercise combined with intensive coaching beat out even the prescription drug Metformin in lowering blood sugar to normal levels.

Reversing the disease before it becomes full blown is important, because diabetes is a disease best treated before it starts or in its earliest, preliminary stage. Once blood sugar regularly rises above 126, it is much harder and often impossible to “cure” the disease  though progression can be largely halted and complications prevented with a lifetime regimen of one or more drugs.

High blood sugar is a much more complicated issue than it often appears in the media. Treating pre-diabetes immediately is important because capillary damage, which usually affects the retina in the eyes and the kidneys first, is silent and painless, and it occurs far earlier than was previously thought. So does neurological damage, which results in the tingling in the bottom of the feet, which many people with high blood sugar experience.

As an integrative practitioner, I counsel very effectively for diet and physical activity.   And I always prefer lifestyle changes over pharmaceuticals when possible. But recent studies have convinced me that this early damage to the microvascular system, which is irreversible, warrants medical treatment immediately.  Then as you work to lower your blood sugar through appropriate dietary practices and increased exercise, you can taper off and hopefully discontinue the drugs if you are successful. The two approaches work best in tandem.

Lest I sound too conservative, in my next post, I’ll discuss insulin sensitivity and a couple of natural non prescription supplements, which have proven helpful in dealing with pre-diabetes and diabetes.

Call Me “Prof”

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Food, food science nutrition, Gillings School of Global Public Health, Susan Wyler, Triangle Nutritional Wellness, UNC at Chapel Hill, UNC-CH

What a thrill to announce I’ve been invited to join the faculty of the University of North Carolina at Chapel Hill as an Adjunct Instructor in Nutrition at the Gillings School of Global Public Health. Starting in January, I’ll be teaching a graduate course in Food Science. Being invited back to my alma mater means so much to me because of what the university gave to me. The academic scientific education and rigorous clinical training in nutrition and public health provided  a robust and multi-faceted toolbox to use in treating my patients. To have so much to draw upon has imparted both confidence and competence in my practice at Triangle Nutritional Wellness.

Whether it’s been the effectiveness of my weight-loss program or complicated medical nutrition therapy for complex chronic ills, the combination of evidence-based information, the holistic approach I learned from Dr.Thomas Rau, and my extensive professional culinary knowledge have served me–and my clients–well. It’s no accident that UNC at Chapel Hill is ranked as highly as it is.

If I can inspire even a few students the way the amazing Amanda Holliday, Clinical Assistant Professor and Director of the Dietetics Programs, who was my advisor and teacher, inspired me, it will be an achievement. I look forward to pairing academia with my clinical nutrition practice.

Talking Health, Wellness and Food with Chapelboro’s “SideDish”

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Chapelboro.com, Deborah Miller, health, SideDish, wellness

This weekend I had the great pleasure of being interviewed by Deborah Miller on her show, “SideDish” on WCHL radio in Chapel Hill, North Carolina.  Deborah is a fabulous full-of-life individual who gets up-close and personal with area chefs, cooking teachers and food and wine experts, and she has a gift for drawing out the best in everybody. I guess I qualified as a cross-over, having been a food and wine expert and now following my passion for nutrition. We talk about my clinical practice, which emphasizes delicious natural foods as the path to good health, and offer several great seasonal recipes for fresh corn and tomatoes.

To listen to my interview with Deborah on her show, SideDish” please visit http://chapelboro.com/pages/13454906.phpI would like to give Deborah and her team a very big, “Thank You,” for having me on “SideDish” this past weekend!

Why I Hate Superfoods

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antioxidants, cancer, diabetes, fiber, glycemic index, heart disease, minerals, obesity, superfoods, vitamins

Well, “hate” is too strong a word. Let’s just say I find the word distasteful and not helpful when it comes to instilling an understanding of how to eat to promote healthy aging and prevent chronic ills like cancer, diabetes, obesity and heart disease.  You see, most lists of superfoods are innocuous.  The foods themselves are usually low in saturated fat and glycemic index and high in vitamins, minerals, antioxidants and fiber—all nutrients that have been associated with better health.

The problem is that the very term superfood reinforces the same mindset that suggests you can simply swallow a pill and make everything bad go away.  People who jump at superfood lists glom onto a particular food and eat it everyday: blueberries, walnuts, kale, salmon, acai berries…whatever, thinking that one ingredient will provide the magic bullet to cure all.

Researchers have tried the same approach, and it’s failed every time.  They’ve extracted particular nutrients that seem to have preventive powers from foods—folate, vitamin E, vitamin A—and done clinical trials where they give these supplements to see if they reduce incidence of cancer or heart disease. In many instances, trials have had to be stopped because they saw damage occurring along the way.  Too much of some single vitamins may be as harmful as too much. Or there may be nutrients we have yet to discover in vegetables, fruits and whole grains. Or it may be that it’s the combinations of foods we eat that are so helpful.

A truly healthy diet must include a wide variety of vegetables, fruits and whole grains everyday.  If you follow my blog, I’ll offer recipes that are creative and delicious, and that make healthy eating a delight.  Not a single superfood, but a collection of them that together will put powerful nutrition tools in your hands.

I did it!

Hard to believe that almost exactly 4 years ago, I was preparing  to leave my 1869 farmhouse in rural Pennsylvania, where we had filmed Thanksgiving for “Good Morning America” with Julia Child,  to make the biggest change of my life.  After a very long and happy career as a cookbook author and food editor, most notably at Food & Wine magazine,  I was leaving my home, friends, and livelihood, life as I knew it, to venture south into foreign territory–Chapel Hill, North Carolina. There I would spend an entire year taking the science courses required just to qualify for application to the combined program at the University of North Carolina at Chapel Hill, which would earn me a Master’s Degree in Public Health and all preparation for certification as a registered dietitian.  I needed inorganic chemistry, organic chemistry, human physiology, microbiology, introduction to psychology, sociology, nutrition, and biochemistry.  This for an English Major from the University of Chicago…  And there was no guarantee I’d be accepted. I even had to take the GREs!

Now I have my Master’s Degree in Public Health, with a Major in Nutrition, and am a fully accredited Registered Dietitian and Licensed Nutritionist. I practice medical nutrition therapy for chronic diseases and dietary counseling at my new company, Triangle Nutritional Wellness, which is located at Chapel Hill Doctors Integrative Health Center in Chapel Hill, NC. I use the latest evidence-based approaches to wellness, many of which I learned from my integrative work with Dr. Thomas Rau, when we collaborated on The Swiss Secret to Optimal Health.