Ginger Hultin – Food & Nutrition Magazine

Nutrition for People with Lung Cancer

Ginger Hultin — Fri, 27 May 2022 16:35:47 +0000

Lung cancer is the third most common cancer in the country and is the leading cause of cancer-related death worldwide. Over the past 20 years, lung cancer rates in the U.S. — as well as the death rate — have been declining and the five-year survival expectancy is trending up. However, data collected from 2012 to 2018 shows lung cancer has a much lower survival rate for people in the U.S. (22.9%) compared to five-year survival estimates for other types of cancers, such as “female breast cancer” (90.6%) or cancer of the prostate (96.8%). That being said, survival rates vary based on stage of diagnosis with better rates for those with early diagnosis and localized disease (cancer has not spread) and much lower rates for advanced disease.

There are two main types of lung cancer: non-small cell lung cancer, or NSCLC, and small cell lung cancer, or SCLC. NSCLC includes large cell and squamous cell carcinomas and adenocarcinoma and accounts for 80% to 85% of lung cancers. Accounting for 10% to 15% of all lung cancers, SCLC also is called “oat cell cancer” and tends to grow and spread faster than NSCLC. Other subtypes of NSCLC, such as adenosquamous and sarcomatoid carcinomas, are much less common.

Lung Cancer Risk Factors

While a reduction in tobacco smoking is one reason for positive changes in lung cancer rates, there are many other risk factors including exposure to secondhand smoke; use of beta-carotene supplements by heavy smokers; family history of lung cancer; HIV/AIDS infection; and environmental risk factors such as radiation therapy, imaging tests including CT scans and radon exposure.

Although supplementing with beta carotene is a risk factor for people who smoke, there is evidence that eating more foods containing carotenoids can help decrease lung cancer risk. Studies have shown an inverse relationship between the consumption of a combination of fruit and vegetables and a lower risk of lung cancer. The same protective relationship has been associated with higher fruit intake, but studies evaluating vegetable consumption have yielded inconsistent results. Other research shows that a traditional Mediterranean dietary pattern may lower risk of developing lung cancer and that foods containing isoflavones may decrease risk in people who have never smoked. Limited research suggests those who are physically active may have a decreased risk of lung cancer.

Role of RDNs

Since both diet and physical activity may play a role in decreasing the risk of lung cancer, registered dietitian nutritionists can guide patients and clients regarding interventions and advice related to food, nutrition, dietary supplements and lifestyle factors. RDNs are critical members of the interdisciplinary cancer health care team and should assess patients with lung cancer diagnoses for malnutrition. Evidence has shown positive outcomes when RDNs provide medical nutrition therapy to adult cancer patients who are undergoing chemotherapy or radiation treatment. Nutritional interventions — especially during treatment — are key, and RDNs play a crucial role in helping to manage any potential side effects.

According to Dolores D. Guest, PhD, RD, a research assistant professor in the department of internal medicine’s division of epidemiology, biostatistics and preventive medicine at the University of New Mexico School of Medicine and director of the Behavioral Measurement and Population Science Shared Resource at the UNM Comprehensive Cancer Center, the location or type of lung cancer could cause several abnormalities and syndromes such as hypercalcemia, anemia, Cushing’s syndrome and others that need nutritional intervention. “It’s not uncommon for one thing to be resolved and another to appear,” Guest says. “Working with an RDN throughout treatment is very important for these patients.”

Oncology dietitian Tricia Cox, MS, RD, CNSC, LD, who works at Baylor Scott & White Medical Center in Dallas, Texas, explains that in her oncology research, many RDNs may have to focus their time on patients with head and neck cancer or esophageal tumors. The research Cox has helped to conduct shows RDNs are often understaffed in outpatient oncology settings and many of them must focus on the most critically ill patients. “While this is good for [critically ill] patients, RDNs are often unable to adequately see all of the patients who need to be seen,” she says. “This could include patients with lung cancer.”

While other members of the medical team serve critical roles, an RDN is qualified to understand the science of lung cancer and how treatment interplays with nutritional status. “RDNs are trained to be able to mitigate these effects in a very personal way, providing individualized advice so patients can make both incremental and overall improvements,” Guest says. Her research shows that the key role RDNs serve in treating high nutrition-risk cancer patients, such as those with lung cancer, is more appreciated by fellow oncology team members than ever before. “Oncologists and nurses really value and have come to rely on RDNs to be the experts when it comes to assessing and working with patients to meet their nutritional needs.”

Assessing Nutrition and Nutrient Needs

About 45% to 69% of people with lung cancer experience malnutrition, which is associated with reduced quality of life, increased symptom severity and shorter survival rates. Concurrent chemotherapy and radiation, radiation to the esophageal region and being classified with stage 3 or 4 cancer all increase the risk of malnutrition. Evidence supports using the Malnutrition Screening Tool to assess for malnutrition(undernutrition) in adults; the Academy and the American Society for Parenteral and Enteral Nutrition have released a joint consensus statement that serves as a guide for assessing malnutrition (undernutrition) in adults who may be at risk.

Guest emphasizes that malnutrition screening is crucial for people with lung cancer and should be conducted at diagnosis and at regular intervals using validated instruments without modifications. The Malnutrition Screening Tool and the Patient-Generated Subjective Global Assessment are both recognized by the Academy’s Evidence Analysis Library as being valid and reliable tools for “identifying malnutrition risk in adult oncology patients” and within inpatient and outpatient settings. “Nutrition issues that are addressed proactively — not reactively — set the patient up for the best possible outcome,” Guest says.

Nutrition therapy for people who have undergone treatment, such as radio or chemotherapies, is critical. Published in 2021, a systematic review of 25 studies suggests that taste function can be impaired as early as three weeks into radiotherapy treatment and can remain impaired for three to 24 months after treatment. For people undergoing chemotherapy, impaired taste function varied and was less predictable, according to the authors, and could occur within days of treatment. A few studies also included patient reports of experiencing reduced appetite and dietary intake.

In general, nutrient needs per day for those with lung cancer can range from 25 to 30 calories per kilogram of body weight and 1 to 1.5 grams of protein per kilogram of body weight. RDNs should complete ongoing nutrition assessments for patients or clients with lung cancer throughout treatment and adjust calorie and protein recommendations as needed. Pay close attention to symptoms that may impact nutrition, such as early satiety, nausea and vomiting, diarrhea or constipation, and oral problems such as altered taste, pain, dysphagia, dry mouth, problems chewing or mouth sores, as these can reduce the patient’s ability to meet nutrition needs.

Dietary Strategies

Because people with lung cancer are at an increased risk of malnutrition, RDNs can help patients and clients maintain body weight and protect lean body mass.

“Lung cancer is often diagnosed at a later stage,” Guest says. Weight loss is very common for these patients, and it can occur or be exacerbated by factors such as the location of the tumor, metastasis or treatments including surgery, radiation and chemotherapy and immunotherapy medications. “RDNs work with these patients and their caretakers or families to mitigate the effect of malnutrition on their bodies, which can help them withstand long-term treatment and improve medical outcomes and quality of life.”

Preventing severe loss of muscle mass, or sarcopenia, is a top priority. Studies have shown 47% to 61% of patients already have sarcopenia before they start chemotherapy or chemoradiation therapy, respectively, for lung cancer. Additionally, sarcopenia increases adverse outcomes and mortality rates in those with cancer and is a hallmark of cancer cachexia, which is a multifactorial syndrome often associated with reduced food intake, systemic inflammation, and catabolic metabolism characterized by weight loss greater than 5% in the past six months (not related to simple starvation) or a body mass index under 20 with any degree of weight loss more than 2%, or muscle wasting consistent with sarcopenia (as indicated by the appendicular skeletal muscle index) and any degree of weight loss more than 2%. Nutrition for any patient with cancer cachexia increases up to 35 calories per kilogram of body weight per day and up to 2.5 grams of protein per kilogram of body weight per day.

Research shows nutritional counseling can help increase food intake in people with cancer-related weight loss. Some data also shows patients who followed nutrition counseling advice while being treated for head and neck cancer experienced better health outcomes such as increased muscle mass and survival rates. Unfortunately, some studies have shown that only 50% to 61% of patients who receive nutritional counseling are able or willing to follow an RDN’s advice due to a multitude of barriers. A recent study that included “dietitian-identified barriers” for patients with advanced forms of cancer and cachexia revealed that non-symptom related barriers — such as restrictions from a prior medical diagnosis, conflicting nutrition information or lack of motivation — were cited as barriers more often than those associated with symptoms.

In one study of 310 patients with lung cancer, those with better nutritional status had better emotional and social functioning as well as less severe symptoms including fatigue, nausea, vomiting, pain, dyspnea, loss of appetite, coughing, mouth or tongue pain, difficulty swallowing and hair loss. The most significant differences between the patients with normal nutritional status compared to the patients at risk of malnutrition or considered to be malnourished (based on the Mini Nutritional Assessment questionnaire) were improvements in insomnia, diarrhea, shortness of breath, tingling in the hands or feet, and chest, arm or shoulder pain.

For people identified as at risk of or diagnosed with malnutrition, RDNs can provide education on dietary strategies such as encouraging meals and snacks dense in calories and protein and ways to meet vitamin and mineral needs. Small, frequent meals and snacks can be helpful if appetite or intake is poor. Because many patients undergoing treatment for lung cancer may have trouble swallowing or have pain in the esophagus, texture modification may be needed.

Depending on the type of treatment, tube feeding or, in some cases, parenteral nutrition may be needed. Parenteral nutrition can be used if the gastrointestinal tract is not functioning or is not accessible, such as with a blockage in the digestive tract. Artificial nutrition in the form of enteral nutrition may be warranted if a patient isn’t able to meet their needs through diet alone. Enteral nutrition should be strongly considered if the patient is unable to eat food for a week or longer or if they only meet 60% or less of their needs through food for more than two weeks. It also should be considered if the patient is malnourished and has poor oral intake. For patients with other types of cancer (such as gastrointestinal), evidence shows nutrition interventions including modified oral diets and parenteral and enteral nutrition have the potential to not only improve outcomes, but also generate millions of dollars in cost savings annually.

Dietary Supplements

Especially for those at risk for malnutrition and not meeting nutrient needs through food, it is wise to educate patients on appropriate and safe use of dietary supplements when warranted.

Omega-3 Fatty Acids

Omega-3 fatty acid supplementation may be helpful in maintaining weight and muscle mass, especially for those with advanced NSCLC undergoing chemotherapy. Potential benefits of omega-3 fatty acid supplements for those with lung cancer may include reduced inflammation and less severity of chemotherapy-induced oral and esophageal mucositis. However, more research is needed. Additional benefits include a potential reduction of peripheral neuropathy from chemotherapy drugs or increased effects/clinical benefits of other medications used in cancer treatment.

Possible Risks of Antioxidant Supplements

Research has shown that taking beta-carotene supplements increases the risk of lung cancer in people who smoke, especially one or more packs per day. Risk is further compounded in people who smoke and drink one or more alcoholic beverages per day.

Results from animal studies show that supplementing with N-acetylcysteine, or NAC, accelerates tumor progression, but more research is needed to support these findings in humans. Other studies indicate that both NAC and antioxidant vitamin E may promote cancer metastasis because they reduce the natural reactive oxygen species that cancer cells produce, which opens a path to tumor progression. This has been shown in both human and mouse lung cancer cell study models

Also, antioxidants may reduce enzyme activity designed to promote apoptosis (the process of programmed cell death). Conversely, some research on NAC based on in vitro studies with bromelain and gastrointestinal cancer cells indicates NAC may be used to enhance the cytotoxic effects of chemotherapy drugs while protecting host tissues from the drugs’ toxicity. However, supplements that contain NAC are technically illegal at this time due to being excluded from the Federal Food, Drug, and Cosmetic Act’s definition of a dietary supplement. NAC is available as a prescription drug, and the U.S. Food and Drug Administration is evaluating whether certain NAC-containing products can be lawfully marketed as dietary supplements in the future. The Natural Medicines database by TRC Healthcare also indicates NAC is currently “considered an unlawful ingredient in dietary supplements” and is “likely ineffective” for lung cancer.

The Vital Role of RDNs on the Cancer Care Team

RDNs working with lung cancer patients can provide nutritional counseling, supplement guidance and lifestyle modification suggestions to help improve outcomes. New research and analysis published in two articles in the February 2021 Journal of the Academy of Nutrition and Dietetics highlight the role nutrition may play in cancer risk and treatment, as well as the barriers cancer survivors face in maintaining a healthful diet.

According to one of the articles, American adult lung cancer survivors with obesity (ages 30 to 64 and current smokers) had a diet quality score that was significantly lower compared to the reference group, based on data from the National Health and Nutrition Examination Surveys from 2005 through 2016. In the study, adherence to the 2015-2020 Dietary Guidelines for Americans — specifically the dietary recommendations for whole grains, greens and beans, sodium and fatty acid — had “less than 50% of the maximum possible scores” based on the Healthy Eating Index 2015, which is a measure of diet quality. RDNs play an important role in providing nutrition education so cancer survivors can better meet these guidelines.

References

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Creamy Mushroom Soup

Ginger Hultin — Fri, 27 May 2022 13:36:12 +0000

Creamy Mushroom Soup

This dairy-free twist on a classic is just as creamy as the traditional version. The secret ingredient is cooked whole oats, blended until smooth.

See more “A Bowl for Every Belly” recipes!

Developed by Ginger Hultin, MS, RD, LDN

Ingredients

1 tablespoon grapeseed oil
1 large yellow onion, chopped
3 cloves garlic, minced
16 ounces crimini mushrooms, quartered or chopped
1 teaspoon salt
5½ cups low-sodium vegetable stock
⅔ cup old-fashioned rolled oats
2 tablespoons white miso paste
½ teaspoon black pepper
¼ cup fresh parsley, chopped

Directions

Heat oil in a large soup pot over medium-high heat. Sauté onion 2 to 3 minutes or until translucent.
Add garlic, mushrooms and salt, reduce heat to medium and cook 4 to 5 minutes, stirring occasionally.
Add stock and oats, cover and simmer for 8 minutes.
Place miso and pepper in a large blender.* After soup has cooled slightly, pour into blender. Puree 45 seconds to 1 minute or until completely smooth. Garnish with parsley. Serves 5.

Cooking Note

Boiling miso can destroy its probiotic properties. Be sure the soup is warm, but not boiling, as you add it to the blender.

Nutrition Information

SERVING SIZE: 1½ cups

CALORIES 130; TOTAL FAT 4g; SAT. FAT 1g; CHOL. 0mg; SODIUM 884mg; CARB. 20g; FIBER 4g; SUGARS 6g; PROTEIN 5g; POTASSIUM N/A; PHOSPHORUS N/A

Note: Nutrition information for potassium and phosphorus in low-sodium vegetable stock not available.

Vegan Corn Chowder with Potatoes and Basil

Ginger Hultin — Fri, 28 Jan 2022 11:00:02 +0000

Who doesn’t love a light yet creamy corn chowder? This soup is perfect for all seasons, but is especially delightful during the cold and frigid winter months.

Vegan Corn Chowder with Potatoes and Basil

Ingredients:

3 tablespoons vegan butter, divided (or olive oil)
1 large yellow onion (finely diced)
1 bay leaf
¼ teaspoon dried thyme
1 inch large leek (the white part plus the green sliced into thin rounds)
1 pound medium yellow potatoes (peeled and diced, about 3)
1 quart vegetable stock
4 cups corn kernels
1 ½ teaspoon salt
2 branches fresh basil (plucked and stems reserved, about 8 leaves)
1 teaspoon freshly ground pepper
1 large yellow bell pepper, diced
1 cup unsweetened soy milk

Instructions:

Melt 2 tablespoons vegan butter in a soup pot and add the onion, bay leaf, thyme and leek. Cook over low heat until the onion is soft, about 10 to 12 minutes, stirring occasionally. Add the potatoes, vegetable stock, and 1 ½ teaspoons salt and bring to a boil. Lower the heat and simmer, partially covered, until the potatoes are tender, about 20 minutes. While the soup is simmering, sauté the pepper in the remaining tablespoon of vegan butter in a small skillet until tender, about 10 minutes.

Use an immersion blender on about ¼ the pot of soup, blending some of it but not the majority. Add the corn and soy milk. Simmer until the soup is heated through and the corn is tender, about 5 minutes. Add the peppers to the soup then serve with thinly sliced basil leaves and black pepper.

Why Celebrate Vegetarian Awareness Month?

Ginger Hultin — Wed, 13 Oct 2021 10:00:20 +0000

From Meatless Monday to consumer questions about vegetarianism for children, general health or medical conditions, and an ever-increasing rate of veggie-based foods on menus at restaurants, hospitals and facilities, dietitians need to feel comfortable working with this type of cuisine. Whether already committed or veggie-curious, join the celebration of Vegetarian Awareness Month, which kicked off with World Vegetarian Day on October 1^st, and ends with World Vegan Day on November 1^st of each year.

Reasons to celebrate Vegetarian Awareness Month, even for non-vegetarians

Taste! Vegetarian meals are delicious, fast and easy. Meatless food is far from boring; experimenting with antioxidant-rich herbs, spices and sauces for flavor can be fun for chefs and families alike.

Meatless Monday has gained national and worldwide attention. Your facility may ask you to help institute this practice into its menu plan. Gaining knowledge about meatless meals can help save money and time and increase dietary micronutrients and fiber for your clients or coworkers.

Save money. Studies show that plant-based dietary patterns could cost less money. Animal protein has been assessed as more expensive than plant-based foods. An additional savings could come from the many health benefits of plant-based diets and reducing money spent on medical care.

Vegetarian diets are statistically higher in fiber. Though 25-34 grams of fiber per day is recommended, the typical American consumes only 12-15 grams. Increasing whole grains, legumes and fresh produce can easily help achieve the goal. For example, a pound of beef contains zero grams of fiber, but just one cup of lentils has 16 grams.

A love of animals — in the U.S., billions of animals are slaughtered for human consumption each year. Help protect animals by going vegetarian during October.

Respect for the environment and sustainability. From water protection to soil and air quality, raising animals uses more natural resources than growing plants. Studies show that plant-based diets are more environmentally sustainable than those rich in animal foods.

Health! Studies show that vegetarian diets are statistically higher in vitamins A, B2, C and E, beta carotene, calcium and folate than non-vegetarian diets. There is also recent research that indicates vegetarians experience a significantly lower overall incidence of cancer and a lower cholesterol and blood pressure than non-vegetarians. This dietary pattern is linked to reduced risk of ischemic heart disease and type 2 diabetes as well.

Additional resources to help dietitians and their clients incorporate a vegetarian lifestyle:

Academy of Nutrition and Dietetics, Vegetarian and Special Diets

Fruits and Veggies For Better Health

Meatless Monday Recipe Files

Vegetarian Resource Group

Happy Cow (for finding vegetarian and vegan restaurants)

Blackberry Oat Crisp

Ginger Hultin — Fri, 27 Aug 2021 10:00:22 +0000

Blackberries hang heavy from their thorny vines here in the Pacific Northwest during the late summer months. They bop you on the head as you walk down the sidewalk, snag your shirt as they reach out from rockeries, and make hiking on forest trails a bit more complex as you gently pinch the vine to move it out of your way. If you don’t live in Seattle like me, perhaps you have other types of local fruit growing that you can make into a dessert. And if it’s the wrong time of year altogether, the great news is that this Blackberry Oat Crisp is so versatile that it can be made with frozen berries, too!

Classic crisps and crumbles are heavy on the saturated fat (butter) and sugar. When I was comparing recipes and assessing how I’d create my own oat crisp, I was really shocked by the amount of added sugar. All berries contain a nice amount of added sweetness, naturally, so why are we dumping sugar all over them and covering their complex sweet-tart flavor? I cut the sugar more than in half and, after making this recipe several times now, I’ve never found it to be anything less than perfectly balanced.

The Berries

Blackberries are ideal for this blackberry oat crisp, but you can really use any type of berry that you want. I like blackberries because of their sweet-tart taste and their size. They are a bit firmer and so they have a nice texture when compared to raspberries. That being said, use raspberries if you have them – fresh are my favorite. Feel free to slice strawberries or cherries and use those. Blueberries work very well, too and I actually dump in some frozen if I need to bulk up my blackberry mixture in the Blackberry Oat Crisp. You really can’t go wrong!

The Topping

You can so easily make this topping vegan by using vegan-butter substitute. You could mix it up by adding in chopped nuts for more texture and healthy fats. You can add or subtract the number and amount of spices.

If you’re gluten-free, make sure to get gluten-free labeled oats. Though oats are naturally gluten-free they can get contaminated by being processed in facilities that also process flour. You can easily use a gluten-free flour blend instead of regular flour like it calls for in the recipe. Going gluten-free in this recipe won’t change the texture or flavor at all.

Blackberry Oat Crisp

Ingredients:

1 teaspoon coconut oil
4 cups fresh blackberries frozen are ok; can sub other types of berries
¼ cup sugar
⅓ cup flour
½ cup rolled oats
2 tablespoons brown sugar
¼ cup butter softened
¼ teaspoon cinnamon
¼ teaspoon ground nutmeg
¼ teaspoon ground ginger
½ teaspoon freshly grated lemon peel

Instructions:

Preheat the oven to 350°F. Grease an 8-inch-by-8-inch baking dish with coconut oil.

Add the berries to a medium mixing bowl and sprinkle them with sugar. Gently fold to coat the berries and let them sit in the sugar while you prepare the oat mixture.

In another medium mixing bowl, combine the flour, oats, brown sugar, butter, cinnamon, nutmeg, ginger and lemon peel. The mixture will be crumbly.

Pour the berries into the prepared dish, scraping any additional sugar on top of the mixture. Spread the oat mixture evenly on top of the berries then bake the crisp for 35 to 40 minutes until its lightly browned and the berries are bubbling and soft. Set the crisp on a cooling rack and serve warm.

What to Know about Polycystic Ovary Syndrome (PCOS)

Ginger Hultin — Mon, 23 Aug 2021 14:27:25 +0000

Known as polycystic ovary syndrome or polycystic ovarian syndrome, PCOS is the most common endocrine disorder in females of reproductive age. Once thought of as a gynecological condition, emerging research and guidelines present PCOS as a multisystem disorder requiring a multidisciplinary approach to treatment. While PCOS affects between 3% and 21% of all women and adolescents around the world, one report estimates that 50% to 75% of those with PCOS do not know they have it.

“Many of my clients come to me already diagnosed with PCOS but share a similar story of years with symptoms managed by birth control or completely dismissed,” says Olivia Wagner, MS, RDN, LDN, IFNCP, owner of Chicago-based Liv Nourished, which offers functional women’s nutrition for PCOS and irregular or missing periods.

PCOS symptoms can present differently. Many people with PCOS experience irregular menstrual cycles, ovarian cysts or increased follicle count on the ovaries (diagnosed via ultrasound) and hirsutism (increased body and facial hair growth more characteristic in males). Up to 80% of those with PCOS experience excess androgen levels, which lead to hirsutism, acne and changes in hair growth patterns. Half of those with PCOS experience overweight or obesity.

Women with PCOS are at an increased risk of infertility (15 times more likely), Type 2 diabetes (4 times more likely) and insulin resistance, cardiovascular disease, certain types of cancer, eating disorders and mental health conditions including depression and anxiety. An estimated 50% of people with PCOS will develop metabolic syndrome.

Diagnosing PCOS

Several organizations have published recommendations for PCOS over the years, including in 1990, when the first international conference was held at the National Institutes of Health. Here, initial diagnostic criteria for PCOS were developed and used until 2003, when a group of experts created the Rotterdam criteria. According to these criteria, two of three clinical findings must be present for a physician to diagnose PCOS: ovulatory dysfunction, polycystic ovaries and an excess of androgen hormones. In 2018, as a result of a collaboration among 37 international organizations in 71 countries, an International Evidence-Based Guideline for the Assessment and Management of PCOS was released. It presents 166 recommendations and practice points for clinicians and dedicates a chapter to lifestyle interventions for women with PCOS. It is unknown how many U.S. physicians have adopted this guideline.

Some RDNs believe the traditional criteria used by physicians to diagnose PCOS can have limitations. Melissa Groves Azzaro, RDN, LD, owner of The Hormone Dietitian LLC and author of A Balanced Approach to PCOS explains, “Rotterdam is definitely flawed — ovaries can appear polycystic for several reasons, including puberty, hypothalamic amenorrhea and after going off hormonal birth control.”

Wagner supports the new international guidelines, which she says support aspects of the Rotterdam criteria “but also recommend tighter diagnostic criteria requiring both hyperandrogenism and irregular cycles. The newer guidelines are more specific regarding how ultrasounds are used and interpreted.”

Because of the potential reductions in quality of life and comorbidities such as CVD, Type 2 diabetes and reproductive problems, the scientific community has focused on PCOS diagnosis and treatment in adolescents. Some pediatric guidelines indicate PCOS diagnosis in adolescents cannot be made until two years post-menarche, while others, including the new international guideline, suggest adolescents should be assessed as at-risk if they experience menstrual irregularity after just one year. In 2019, a group under the International Consortium of Pediatric Endocrinology created an update of recommendations specifically for adolescents.

New research funded by the NIH suggests there may be distinct subtypes of PCOS, which could provide insight into diagnosis and treatment in the future. The study included an analysis of hormonal and anthropometric data and the genes of close to 900 individuals diagnosed with PCOS based on NIH and Rotterdam criteria. These preliminary findings were based solely on cases in the U.S. and individuals of European ancestry.

Weight-Related Concerns

Studies surveying people with PCOS show weight management and difficulty losing weight are their foremost concerns. The primary intervention for PCOS has been advice to lose weight to lessen the effects of insulin resistance that often accompanies the condition. Even modest weight loss (5% to 10% of initial body weight) can reduce PCOS symptoms, decrease androgen production, increase fertility and improve both insulin sensitivity and ovulatory function.

Amy Plano, RD, CDE, MS, CDN, owner of The PCOS Dietitian and author of Treating PCOS with the DASH Diet: Empower the Warrior from Within, describes her approach to weight loss: “There is so much research backing the benefits of even modest changes in weight for this population from a symptom standpoint. So, weight loss — when warranted — is a no-brainer. Looking at the big picture is most important. I help women lose weight so they can qualify for in vitro fertilization and accomplish their dream of having a family.”

Wagner takes an approach that de-emphasizes weight loss as a focus but finds many of the changes she works with clients on ultimately lead to a reduction in weight, if appropriate and a goal of the client. “In my practice, I prioritize features like blood sugar balance, anti-inflammatory diet modifications and addressing other imbalances that could be adding to inflammation and overall expression of PCOS,” she says. “As a result of these shifts, weight loss is typical. We know that fat loss improves insulin resistance and estrogen metabolism, and improved insulin resistance also improves testosterone levels. Weight loss and fat loss can be supportive, but for me, it is a secondary goal in overall treatment.”

However, people with PCOS may have trouble losing weight because of metabolic changes associated with the condition. Also, studies show people with PCOS experience food cravings, increased appetite, impaired impulse control and body dissatisfaction. This may worsen the likelihood of disordered eating and mental health problems. “PCOS is a lifelong condition, so any changes we recommend have to be sustainable,” Azzaro says. “It is also important to remember that the incidence for disordered eating is exponentially higher in people with PCOS and restrictive diets are not the answer.”

Studies have shown that people with PCOS have higher rates of and higher odds of moderate and severe depression and anxiety. Research on the incidence of eating disorders in the PCOS population has found an increased prevalence of binge eating behavior. Women with bulimia nervosa and binge eating disorder are more likely to have PCOS symptoms and polycystic ovaries; more research is needed to better understand a possible association between eating disorders and PCOS.

A cross-sectional study in Australia found that disordered eating — but not eating disorders — was more prevalent in women with PCOS compared to the control group. Researchers concluded that health care professionals should screen all women with PCOS for disordered eating patterns.

The new international guideline states that all health care professionals should be aware of the increased prevalence of eating disorders and disordered eating that may be associated with PCOS. The guideline also says people with PCOS can experience benefits in body composition and metabolic status separate from weight loss. Azzaro agrees and says, “I question whether it was the weight loss itself or the behaviors that led to the weight loss that actually impacted symptoms and markers. I think a lot of doctors don’t acknowledge how damaging it is to tell women with PCOS to ‘just lose weight,’ given the context of hormonal imbalances that make weight loss more difficult, such as insulin resistance, high androgens, high cortisol and DHEA, and inflammation.

Treating PCOS

Most clinical guidelines suggest lifestyle modifications can serve as the first line of treatment for PCOS. Pharmacological treatment also is available and often includes combined oral contraceptive pills or anti-androgen medications for those with irregular menstrual cycles and high androgen levels, metformin for blood sugar management and insulin resistance, and ovulation induction medications for those with infertility related to PCOS.

Limited studies suggest dietary modifications, physical activity and behavioral therapy delivered by a multidisciplinary team that includes a registered dietitian nutritionist and health psychologist may yield better success with weight loss, patient satisfaction and continuing to seek care with their provider for PCOS management. However, a survey-based study of 722 women with PCOS found less than 10% of participants reported working with an RDN.

Plano agrees with taking a multidisciplinary approach and does so in her practice. “PCOS is multifactorial and impacts so many different systems in the body. It is not just a hormone issue,” she says. “Having a strong referral team in place is absolutely critical. I work closely with therapists, marriage and family counselors, endocrinologists, dermatologists and OB/GYNs.” Azzaro says a multidisciplinary approach is “absolutely integral. It takes a village. In fact, one of the things I like most about the [international guideline] is that it highlights the need for people with PCOS to have a full support team, including primary care, gynecology, endocrinology, diabetes care, dietitians, mental health professionals, personal trainers, estheticians and more.”

Dietary interventions
Plano explains her approach to personalizing the diet for clients with PCOS: “First I look at improvements in quality, then I work on decreasing the caloric intake, if necessary. I don’t cut out any food groups but instead do my best to help them gradually scale back the quantity of carbohydrates they consume. I like to aim for 40% or fewer total calories coming from carbohydrates. I elevate the protein to promote satiety and encourage heart-healthy fats.

The international guideline offers dietary intervention recommendations for women with PCOS, which include a focus on balanced dietary approaches tailored for food preference, flexibility and individual needs. While the dietary interventions list an energy deficit of 30% (or 500 to 750 calories per day) as a consideration for those with excess weight, they also state that all women, regardless of age, should follow general healthful eating principles. The guideline also says weight-related stigma, self-esteem and body image need to be taken into consideration. All health care professionals should be respectful and considerate when approaching discussions about weight, seek permission before taking weight measurements and focus on the emotional well-being of patients and clients.

An important strategy for treating people with PCOS is creating a dietary plan to help reduce insulin resistance. Published in 2013, a systematic review of five studies found that, although several diets (monounsaturated fat-enriched, low-glycemic index, low-carbohydrate, high protein) yielded various health benefits, it was ultimately weight loss that seemed to improve PCOS symptoms the most, regardless of the diet’s composition. These researchers pointed to reducing total caloric intake rather than adjusting individual aspects within a dietary pattern.

A more recent systematic review of 19 clinical trials showed that diet can significantly improve insulin resistance and body composition for people with PCOS. Specifically, the Dietary Approaches to Stop Hypertension diet and eating patterns that created a 500-calorie deficit performed best. Researchers found that a longer duration of these dietary interventions yielded more improvements in insulin resistance and body composition.

Macronutrient modification including low-glycemic or low-carbohydrate diets have limited evidence for effectiveness in treating PCOS. One small study from 2005 examining the use of a ketogenic diet for six months saw significant improvements in weight, hormonal profiles and fertility. Other studies, including a systematic review, have shown that reductions in carbohydrate consumption (from 55% to 41% of total energy intake, in some studies) improved the metabolic effects of PCOS. All these studies are small and have limitations, so more research is needed to understand whether carbohydrate restriction or reduction could be beneficial for people with PCOS.

Surveys about health-related knowledge, beliefs and self-efficacy of women with PCOS, compared to a control group, found those with PCOS perceived fewer benefits from healthy lifestyle behaviors such as diet and exercise in relation to weight gain, and only 47% of the PCOS group reported attempting to follow an overall balanced diet. “When it comes to dietary support for PCOS, my approach is a whole-food diet focused around blood sugar stability, high plant-based fiber and inclusion of macronutrient-balanced and anti-inflammatory meals while addressing any individual root imbalances with food as medicine,” Wagner says.

Exercise interventions
Exercise guidelines for women with PCOS are similar to those without. Adolescents should aim for 60 minutes or more of physical activity per day with strength training three times per week, and adults should get 150 minutes per week of moderate-intensity activity or 75 minutes of vigorous activity (or a combination of both) and two non-consecutive days of strength training activities. The international guideline for PCOS suggests activity be performed in 10-minute or longer bouts and that patients and clients take 10,000 steps per day. Recommendations for those aiming for modest weight loss or focusing on weight regain prevention are 250 minutes per week of moderate-intensity activity or 150 minutes of vigorous activity (or a combination of both) and two non-consecutive days of strengthening activities.

In a systematic review and meta-analysis about exercise for managing PCOS, effects from exercise included statistically significant benefits to fasting insulin, insulin resistance markers, total and low-density lipoprotein cholesterol and triglycerides. The greatest improvements were seen in study participants with overweight or obesity. However, the authors cautioned about interpreting the findings due to study limitations including low-quality evidence.

One systematic review and meta-analysis found that when assessing exercise duration (ranging from six to 26 weeks), exercise intensity mattered more than quantity for health outcomes, including increases in V0₂ peak (used to assess a person’s physical activity limits, this is the highest value of oxygen rate attained during a high-intensity exercise test), reduced insulin resistance markers and reduced waist circumference. The greatest benefit was seen in vigorous-intensity exercise either alone or combined with a dietary plan, advice or guidance.

Behavioral therapy interventions
A review of evidence included in the new international guideline for PCOS indicated behavioral interventions yielded better outcomes in weight management for adolescents than compared to a placebo group, as well as when used in combination with dietary and exercise interventions. One study showed that adolescents who received behavioral interventions from a multidisciplinary care team with an RDN, health psychologist, gynecologist and endocrinologist experienced enhanced weight loss when combined with dietary consultations.

Role of RDNs

There are proven benefits to people with PCOS receiving early access to an RDN. While studies show a multidisciplinary approach to PCOS treatment yields the best outcomes, they also highlight barriers to including RDNs in the care team, including insurance reimbursement and financial limitations for patients and clients, lack of referrals for nutrition education and lack of knowledge of PCOS and the potential benefit of lifestyle interventions. Studies show knowledge gaps in health care professionals can lead to delays in diagnosing and caring for people with PCOS and to patients and clients seeking less qualified or low-quality information online for support. RDNs working with populations at risk for PCOS should stay abreast of current research.

When approaching weight management for people with PCOS, RDNs should consider emotional well-being, individual dietary and lifestyle preferences, and unique, cultural and socioeconomic values or needs. Using a patient-centered approach that is weight-inclusive is important when working with people with PCOS. Plano supports this approach and adds, “No matter what the dietary protocol, the individual and their food preferences and lifestyle are paramount. Working around my guidelines is second to the client’s personal needs.”

Wagner also supports personalized care and holistic support. “I find that establishing an empowered mindset toward their health is essential for best outcomes,” she says. “With a focus on inclusion versus exclusion and empowering them in their diet and lifestyle, it is easier to adopt daily practices that they truly feel aligned with that are going to support their health with PCOS long-term.”

References

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Dokras A, Stener-Victorin E, Yildiz B, et al. Androgen Excess-Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Sterile. 2018;109(5):888-99.
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Fresh Herb Soup with Orzo

Ginger Hultin — Fri, 16 Jul 2021 10:00:50 +0000

Are you looking for plant-based recipes that are also a good source of protein? This soup recipe delivers on both. Packed with plant-based protein from creamy cannellini beans, this fresh herb soup with orzo has a bright, savory flavor. I love one-pot recipes that are easy to make. This soup recipe is no different, making it a great meal prep option for weekday lunches or dinners.

A lot of my clients associate soup with winter and I hear things like, “I stop making soup when the weather gets warmer.” But you’re not stuck with chilled soups like gazpacho outside of fall and winter. By utilizing fresh herbs, you can bring soup into the spring and summer with vibrant flavors. When you don’t have the fresh stuff, use dried for a more savory, earthy taste that really is perfect for colder weather.

Luckily, this recipe does not require much prep ahead of time. Even though there is some chopping and slicing involved, as long as you have a sharp knife on hand, you’ll be good to go. If you don’t have a Dutch oven, any large pot will do. Part of what makes this recipe so easy is that it utilizes ingredients you probably already have hanging around like canned beans, olive oil and onions.

My purpose as a registered dietitian nutritionist is to make getting into the kitchen easier and fun. Set some time aside in your week to whip this soup up and be sure to make it simpler by using canned beans, boxed broth and even pre-chopped onion (yes – that comes frozen). This can be an incredibly quick and easy recipe.

Fresh Herb Soup with Orzo

Ingredients:

2 tablespoons extra-virgin olive oil
1 medium yellow onion, finely chopped (about 2 cups)
½ teaspoon salt
½ teaspoon black pepper
½ cup dry white wine
1½ cup uncooked orzo
3 tablespoons finely chopped fresh flat-leaf parsley stems
1½ cup finely chopped parsley
2 cloves garlic, minced
1 teaspoon crushed red pepper flakes
8 cups low-sodium vegetable stock
1 15-ounce can cannellini or white beans, drained and rinsed
½ cup finely chopped fresh chives
¼ cup finely chopped fresh tarragon
2 tablespoons finely grated pecorino Romano cheese, for garnish

Instructions:

Heat the oil in a medium Dutch oven or soup pot over medium heat.

Add the onion, salt and black pepper and cook, stirring occasionally, until softened, about 8 to 10 minutes. Add the wine and cook, stirring occasionally, until the liquid has almost completely reduced, 4 to 5 minutes.

Add the parsley stems, garlic and crushed red pepper and cook, stirring constantly, until fragrant, 2 to 4 minutes. Add the broth and bring it to a boil over medium-high heat then reduce to medium-low and cook the orzo, stirring occasionally, 8 to 10 minutes until it’s softened.

Reduce the heat to low and stir in the cannellini beans, cooking until they’re heated through, about 2 minutes. Remove the soup from heat.

Stir in the chives, tarragon and parsley leaves. Add any additional salt or pepper as needed per your taste and, if you’re not following a vegan diet, garnish with pecorino Romano and serving hot.

A Complex Connection: How the Foods You Eat May Influence Mood and Depression

Ginger Hultin — Mon, 21 Jun 2021 20:36:20 +0000

There is evidence that depression, ranging from mild to major depressive disorder, or MDD, may be influenced by a person’s diet — and vice versa. MDD is associated with chronic diseases such as heart disease, arthritis and diabetes, as well as high risk of disability and suicide.

Depressive symptoms can include lack of motivation, fatigue, feelings of overwhelm and worthlessness or guilt, sadness or abnormal negative mood, the inability to feel pleasure, problems sleeping or sleeping too much and negative self-cognition. Depression is commonly treated with antidepressant medications and/or psychotherapy, though research shows physical activity and social support also can be helpful.

Depression has many potential causes including biochemical factors, such as neurotransmitter activity and the gut microbiome, genetics, social and environmental factors, and even personality. A complex condition, depression likely stems from multiple origins.

Research on Diet Quality and Depression
While a poor diet may be associated with risk of depression, studies are still assessing whether quality of diet causes depression or worsens existing symptoms. Dietary patterns that have been examined and are thought to influence risk of depression include those high in ultra-processed foods, saturated fat (including high-fat dairy or fried foods), processed meat, refined grains and added sugars including sugar-sweetened beverages.

In a study of 139 children and adolescents with MDD, researchers found those with MDD reported eating fewer healthful foods than those without MDD. The authors inferred that it’s possible MDD leads to a less healthful diet, but also that less healthful dietary behaviors may lead to more depressive symptoms.

Other studies have shown that dietary patterns with high consumption of less processed foods including fruits, vegetables, whole grains, legumes, nuts, seeds and fish are inversely associated with risk of depression. Eating patterns including vegetarian and vegan, Mediterranean, traditional Japanese and Nordic diet have been studied, with positive outcomes. An analysis of 4,349 adults’ self-reported health and 24-hour food recall data from the Korea National Health and Nutrition Examination Survey found reduced depression rates with increased consumption of fruits and vegetables. A review of 12,062 Taiwanese Buddhists found participants who followed a vegetarian dietary pattern had lower incidence of depressive disorders than non-vegetarians; however, contradictory findings also have been observed.

Researchers suspect the benefits of a healthful diet relative to depression risk could be attributed to factors including improvements in vascular health, lower levels of LDL cholesterol, lower inflammatory levels, less oxidative stress, improvements in neurotransmitters serotonin and norepinephrine or improvements in the gut microbiome.

Dietary Intervention
Preliminary research shows dietary intervention by a registered dietitian nutritionist may be helpful for people with depression. A 12-week randomized controlled trial of dietary improvement for 67 adults with major depression — which included either seven 60-minute sessions by a clinical RDN or social support in addition to dietary changes based on a modified Mediterranean diet model — found those who received dietary education support from an RDN experienced significantly greater improvement in depressive symptoms than the control group.

In this study, the dietary intervention pattern included whole grains, vegetables, fruit, legumes, low-fat unsweetened dairy products, raw unsalted nuts, fish and moderate lean red meat, chicken, eggs and olive oil. Additionally, participants were instructed to eat according to their hunger and to reduce consumption of refined cereal, fried food, fast food, processed meat and sugar-sweetened beverages. They also were instructed not to have more than two alcoholic drinks per day and, if they did drink alcohol, it should be red wine and consumed with meals. For those who completed the trial, more than 32% (10 participants) achieved remission of symptoms, compared to 8% (2 participants) in the control group.

Food Insecurity and Depressive Symptoms
Food insecurity can lead to inadequate intake of nutrients, which can affect mental health and depression and increase risk for chronic disease, especially among women in the United States. Studies also show that food access issues are linked to depression. One cross-sectional study of 372 older adults found those with food insecurity had less ability to care for themselves and, in turn, had higher depressive symptoms, as well as poorer diets.

Exploring Individual Nutrients
Although specific nutrients have been studied as treatment for MDD, research findings have been mixed and inconclusive. Some research suggests consuming more of certain nutrients such as B vitamins, magnesium, vitamin D, zinc and omega-3 fatty acids may help reduce depressive symptoms. However, research isn’t yet clear on whether individual nutrients may be able to reduce risk of depression or improve symptoms in people experiencing depression or anxiety. Most studies indicate that more research is needed.

B vitamins
A systematic review and meta-analysis of B-vitamin supplementation and its effects on depressive symptoms, anxiety and stress found that, while there may be a potential benefit to mood in people reporting high levels of stress, it was not beneficial for healthy people or those at risk of mood disorders. Researchers concluded that supplementation may benefit those who are at risk because of either poor nutrient status or stress. A large cross-sectional, population-based study using validated surveys to assess dietary intake of B vitamins and psychological health in Iranian adults found a beneficial effect from a higher intake of biotin and lower odds of anxiety, depression and stress, after adjusting for several confounding factors. An inverse relationship also was observed with vitamin B₆ and the risk of stress. While the results were promising and suggested other B vitamins also may have an influence, researchers stated randomized, controlled trials are needed for further study.

Omega-3s
Omega-3 fatty acids have been shown to upregulate neurogenesis, the process of new neuron development in adults, which can have a protective effect. An inverse relationship has been noted between eating more fish and lower risk of depression. Some studies have shown improvements in depressive symptoms with omega-3 fatty acid supplements, especially when used with antidepressant medications; other studies have found that any benefit may be small and not clinically significant. Natural Medicines database by TRC Healthcare lists eicosapentaenoic acid, or EPA, supplementation as possibly effective for those with MDD. However, it states that docosahexaenoic acid, or DHA, does not appear to improve any type of depression. In studies, 1 to 6 grams of omega-3 fatty acids EPA and DHA per day have been used, but the duration has varied from several weeks to months.

Vitamin D
Evidence suggests adequate vitamin D intake may help protect the brain from experiencing low dopamine and serotonin levels, which is why correcting vitamin D deficiency may be beneficial for those diagnosed with depression. While there is some evidence of an association between low levels of vitamin D and depression, the National Institutes of Health explains that results of vitamin D and depression research are based on observational studies rather than clinical trials — like many studies on diet as it relates to depression. The Natural Medicines database indicates there is insufficient evidence to rate vitamin D’s effectiveness in treating depression and that it doesn’t seem to help with prevention.

Zinc
Especially when combined with antidepressant medications, zinc supplementation has shown potential to be helpful, but more research is needed to better understand why. Higher consumption of zinc has been associated with a 28% lower risk of depression, and researchers indicate that it shows promise as an adjunct therapy. Studies have used 7 to 25 milligrams of zinc supplements daily for up to 12 weeks.

In general, while some of these nutrients show potential benefits, research findings are very mixed, and many benefits are seen when used with antidepressant medications.

Considerations for Medication Interactions with Food or Dietary Supplements

According to NHANES data and based on medical expenditures for antidepressant and antipsychotic medications, the use of medication for depression in the U.S. has been increasing. Antipsychotics and lithium are common treatments that have important dietary considerations.

Side effects of antidepressants can include gastrointestinal symptoms such as nausea; weight gain and increased appetite; sexual problems and decreased sexual desire; fatigue and low energy; or sleep disturbances including increased sleepiness or insomnia.

Dietary Supplements and Herbals
In February, the U.S. Food and Drug Administration warned of 10 companies illegally selling dietary supplements that claimed to treat depression and other mental health disorders. The warning states that any dietary supplements that claim to cure, treat, prevent or mitigate depression are considered unapproved new drugs and are potentially harmful.

In studies, some herbal supplements have demonstrated positive effects on depressive symptoms, but each case has considerations ranging from lack of conclusive evidence to drug-nutrient interactions that should be taken seriously.

When compared to a placebo, St. John’s wort extract has shown positive effects on mood, reduced insomnia related to depression and decreased anxiety symptoms. Although clinical guidelines from the American College of Physicians and NIH both note that St. John’s wort can be equally effective — and better tolerated — as some antidepressant medications in the treatment of mild to moderate depression, there are many challenges and considerations. These include assessing standardization of supplement dosing and significant, even life-threatening, drug-nutrient interactions such as potentially major interactions with antidepressants, contraceptive drugs, certain immunosuppressant medications and moderate interactions with cytochrome P450 substrates.

A class of herbs used to help the body adjust to physical and psychological stressors, adaptogens such as rhodiola, saffron and ginseng, among others, have been studied in the treatment and management of depression. Studies show that adaptogens may help improve sleep, including insomnia; balance and decrease the release of stress hormones including cortisol; and lessen symptoms of mild to moderate depression. However, given the wide range of types of adaptogenic herbs, limited studies and potential for drug-nutrient interactions, RDNs should use caution with advising the use of adaptogenic herbs and should work with the patient’s or client’s health care team to assess whether adaptogens could be used as adjunctive therapy.

Sleep, Stress Reduction and Physical Activity
While nutrition may play a role in the prevention and treatment of depression, some lifestyle factors also can make a difference. Some studies show a connection between sleep and depression, especially with insomnia. Depression disorders are associated with both reduced sleep duration and quality.

One of the most consistent findings about depression is that stressful life events can predict its onset. The ways in which people think about or process stress, how they regulate their emotional response to stress and how their bodies physically respond to stress can make a difference in whether a person will become depressed and how severely.

Studies show a benefit from stress reduction techniques, specifically mindfulness-based stress reduction, or MBSR. This eight-week program utilizes mindfulness meditation and other strategies that have led to significant reductions in depressive symptoms in several populations.

According to a systematic review of eight meta-analyses, there is evidence that exercise may help decrease symptoms of depression in the general population, regardless of age. Both aerobic and resistance training appear to help reduce symptoms. For MDD treatment specifically, the most common exercise prescription for adults is 60 minutes of moderate-intensity activity three times per week over a period of 24 weeks. Some of the reasons this may be effective occur in the brain, in both the hippocampus and prefrontal cortex, where it can help benefit mental health. The 2018 Physical Activity Guidelines for Americans lists regular physical activity as having a positive effect on health, including brain health and conditions that affect cognition such as depression and anxiety.

Role of RDNs
Nutrition and dietetics practitioners can play a vital role for patients or clients with depression, including MDD, but they need to have proper training and multidisciplinary support for the complex needs of people with these conditions. RDNs can use the Academy of Nutrition and Dietetics: Revised 2018 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Mental Health and Addictions to build knowledge and expand their practice in these specialty areas.

Another resource from the Academy is the Guidance Regarding the Recommendation and Sale of Dietary Supplements. RDNs can educate patients or clients on the safety and efficacy of dietary supplements commonly used to help treat depression, as well as the potential for medications and supplements to interact with foods and nutrients. It is important for RDNs to work with the patient’s health care team to assess the best intervention for managing interactions. RDNs also can assess for potential nutrient deficiencies that could impact mental health and educate patients or clients on how to meet their nutrient needs through food.

In general, RDNs should take a holistic approach to supporting patients or clients experiencing depression. If and when possible, provide dietary education and emphasize the importance of physical activity, adequate sleep and stress reduction. Educate patients or clients about the connection between stress and depression and, when needed, refer them for individual or group therapy, counseling or MBSR support. Consider connections between food insecurity and a person’s ability to manage self-care, nutritional status and risk of depression. And screen for clinical malnutrition in anyone with a mental health condition.

References

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Konstantinos F, Heun R. The effects of Rhodiola Rosea supplementation on depression, anxiety and mood–A Systematic Review. Global Psychiatry. 2020;3(1):72-82.
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Cooking Veggies in the NuWave Brio Digital Air Fryer

Ginger Hultin — Mon, 17 May 2021 10:00:18 +0000

Product reviewed: NuWave Brio Digital Air Fryer

I’ve always been a little jealous of my colleagues and clients getting creative with their air fryers; I hadn’t yet invested in this kitchen gadget. I heard a lot of stories about how versatile these machines are and how they make the best crispy tofu and delicious veggies, but I was just sticking to baking and steaming… until I got the NuWave Brio Digital Air Fryer.

When the air fryer arrived, I realized this is a large kitchen appliance (17-by-15.25-by-22.5 inches). I have the 15.5-quart capacity, which has several different levels for various racks. It also comes with a rotisserie, so it’s definitely large enough to cook an entire chicken. If you need something smaller, the machine is also available in 14-, 10-, 6-, 4.5- and 3-quart options. Choose the best capacity for your needs! The cooking range is 100 to 400 degrees Fahrenheit and offers options to air fry, broil, roast, grill, sear or dehydrate food. Honestly, if you had limited equipment, you could cook most foods in this machine.

Getting the NuWave Brio Digital Air Fryer ready to use took some work. I had to unpack and wash several pieces: numerous racks, the rotisserie, a metal basket and a variety of instruction booklets and list of preset cooking options. The instructions said to handwash each piece and also wipe the machine out with a wet cloth, which took time. I wish the pieces were safe to put in the dishwasher. After deeper search online, I found that many of the accessories could be washed on the top rack of a dishwasher, but the instructions provided do say to wash by hand.

I wanted to jump right in and use the air fryer. Some of the recipes in the book looked intriguing, but I quickly realized that this machine wasn’t like a microwave or multi-cooker. I was going to have to read the instruction booklet carefully before using it. Poring through the instructions and navigating the digital touchscreen were more challenging than I thought they would be. This is certainly not an intuitive machine. Trying to figure out which rack to use, which position to put it on within the air fryer, how and when to use the preheat function and what setting to push for a given recipe is still taking time, though I have made several items in the machine.

That being said, and even though it’s not the easiest tool I use in the kitchen, I’m really enjoying the NuWave Brio Digital Air Fryer. I made spicy vegan cauliflower bites, crispy tofu and even French toast and everything turned out great. I like that I can cut down on some of the fat I use in cooking and that I can get a crisp texture that I’m unable to produce any other way in my kitchen. I can definitely see this machine turning someone into a tofu lover or get them eating more vegetables.

I’m enjoying the NuWave Brio Digital Air Fryer in my regular, full kitchen, but it also would be a great appliance to have in a dorm room, small apartment or RV, allowing for variety in recipes without needing an oven, stove and microwave. This air fryer really does it all — you just need to be patient and good at reading instructions.

Seeking Immune Support

Ginger Hultin — Wed, 17 Feb 2021 22:48:36 +0000

Explore trends in consumer behavior, functional foods and supplements since the start of the COVID-19 pandemic.

The human immune system consists of two major components: the innate and acquired immune systems. A person is born with an innate immune system as their first line of defense. This includes factors such as skin integrity, mucosal membranes and immune cells including natural killer cells, or NK. The acquired immune system, also called the adaptive immune system, includes T- and B-cells, which help the body develop an immune “memory” when exposed to viruses or immunizations.

Individual nutrient intake, including some vitamins and minerals, can affect the immune system by supporting healthy physical barriers in the skin and mucosal membranes, or by impacting the gut microbiome, innate immune system macrophage function (white blood cells that kill microorganisms) and adaptive immunity via T- and B-cell function. Certain nutrient inadequacies may impair the immune response, and micronutrients including vitamins A, C, D, E, B₆, B₁₂ and folate and the minerals iron and zinc influence all aspects of the immune system.

Data from the 2005–2016 National Health and Nutrition Examination Surveys revealed many Americans who are 19 or older may have usual intakes below the estimated average requirement of vitamins A, C, D and E, as well as zinc, from foods. Information from the National Institutes of Health’s Office of Dietary Supplements indicates that while nutrients including vitamins C, D and E and minerals such as zinc do help support immune function, the primary goal should be to prevent deficiency rather than taking more than the recommended amounts.

Nutrients, the Immune System and COVID-19
There is some evidence that the immune system is influenced by nutritional status and that malnutrition does increase risk of admission to the intensive care unit and mortality from COVID-19. However, less is known about the potential preventative benefits of individual nutrients on viral infections, including COVID-19. Developed by a panel of experts, the NIH’s report on treatment guidelines for COVID-19 includes information about zinc and vitamins C and D as adjunctive therapies, but much of that data is based on supplements rather than functional foods. The guidelines for vitamins C and D state that there is currently not enough data to recommend for or against their use in preventing or treating COVID-19. In the case of zinc, the data is lacking for or against its use as a treatment; however, the panel recommends against its use as a supplement in amounts above the recommended dietary allowance in the prevention of COVID-19, unless it is being administered during a clinical trial. A scoping review by the Academy’s Evidence Analysis Center found a lack of evidence regarding the efficacy of additional micronutrients or conditional amino acids such as glutamine or arginine in reducing the severity of disease in people infected with COVID-19.

Currently, there are no specific nutritional guidelines for those who have or are at risk for COVID-19. Medical nutrition therapy guidelines say registered dietitian nutritionists should provide care for those infected with COVID-19 to help optimize nutritional status and prevent malnutrition including screening for food insecurity and helping provide budget-friendly food options, when appropriate.

Market Trends for Functional Foods and Immune Support
Consumer sales for functional foods with proclaimed “immune-supporting” ingredients such as vitamin C, vitamin D, elderberry, beta-glucan, probiotics and antioxidant polyphenols have increased greatly since the COVID-19 pandemic began in 2020. This trend led to increased product claims — some illegal — such as statements about disease treatment.

Projections suggest global immunity-focused functional foods will grow by $170 billion between 2019 and 2023, reaching $1 trillion. Market research studies show that consumers are especially interested in foods rich in vitamins C and D, specifically due to fears of COVID-19.

A 2020 consumer market report revealed that 31 percent of consumers are taking more supplements as a result of the pandemic and 29 percent are consuming more functional foods and beverages, including fortified or enriched products, and increasing consumption of healthful foods such as whole grains, fruits, vegetables, plain bottled water and fruit or vegetable juices. When asked why they were increasing use of supplements and functional foods, their reasons included immunity, increased energy, general illness prevention and for digestion and microbiome support.

Regulatory Policies and Oversight
A study examining the term “immune boosting” on Instagram during the COVID-19 pandemic found that between April 15 and May 15, 2020, the use of the hashtag #immunebooster increased more than 46 percent. Researchers warn that, given the lack of evidence that specific products can enhance the immune system for protection against COVID-19, using these types of terms can be misleading to consumers.

The U.S. Food and Drug Administration and Federal Trade Commission have been addressing product label claims as they relate to the immune system and specific diseases such as COVID-19. Companies are not allowed to claim their product prevents, treats or alleviates signs or symptoms of COVID-19. Additional guidance provided by industry experts includes that companies should not make anti-inflammatory or anti-viral claims. This advice extends to social media, blogs, websites and product representatives or influencers.

Additionally, these experts advise companies and individuals to use caution with terms such as “boost,” “build,” “defend,” “therapeutic” or “protect” in regard to the immune system, and instead can claim immune or general health support. Further advice includes taking caution with using the hashtags #coronavirus or #COVID19 when referencing a product or health claim.

Potential Dangers of Supplemental Functional Foods
Many foods are functional in that they provide energy, protein or other nutrients to the body. Although there is no specific legal definition in the U.S., working definitions for functional foods have been used in the past by several organizations, including the Academy of Nutrition and Dietetics. According to the “Position of the Academy of Nutrition and Dietetics: Functional Foods,” published in 2013 and now retired, “the term functional foods is defined as whole foods along with fortified, enriched, or enhanced foods that have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis at effective levels based on significant standards of evidence.” Because many functional foods are fortified or enriched with nutrients beyond the recommended amounts, there is a risk of consuming more than the Dietary Reference Intakes of many nutrients, which could be problematic. For example, people who exceed the Tolerable Upper Intake Level for vitamin E (1,000 milligrams per day for adults) may experience an increased risk of bleeding or hemorrhagic stroke. Supplementing can be problematic as well. For instance, vitamin E supplements can interact with medications including anticoagulants and statins. Chronic intakes of supplemental zinc in high amounts can impair copper absorption, alter iron function and even reduce immune function — the opposite effect desired by many people taking additional zinc.

A Look at Labeling Regulations

Types of claims that may appear on food and supplement labels, as permitted for use by the FDA:

Nutrient content

Structure/function

Authorized health

Qualified health

Nutrient content claims relate to the amount that is declared based on established criteria. For example, the FDA regulates terms used in nutrient content claims, including antioxidant claims, such as “high,” “good source” and “more.” For individual nutrients, the use of “high potency” can be used when an individual vitamin or mineral is at 100 percent or more of the Reference Daily Intake (per reference amount customarily consumed).

Structure/function claims focus on how a nutrient may influence the structure or function of the human body. On supplements, packaging will indicate, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.” This is not required on conventional foods.

Authorized health claims are based on “significant scientific agreement” and address the relationship between a food or a food component and a health condition or a risk for it. Qualified health claims are supported by less evidence and must include a disclaimer stating such.

The FDA regulates claims that affect a disease, including if it protects against a disease or affects signs and symptoms. Further, the FDA regulatory guidance explains that implied disease claims, depending on the context, could include words such as “promote,” “regulate,” “stimulate,” “support,” “maintain” or “lower.” In these cases, the FDA warns that caution should be used with the words “diagnose,” “cure,” “treat” or “prevent,” since these terms are associated with disease claims and require FDA approval in the case of drug products or must follow guidance for health claims if used on foods.

Role of the RDN
Registered dietitian nutritionists should be mindful of language used in education materials, blogs, websites and social media posts, as well as know what can and can’t be said about potentially immune-protecting foods or nutrients. Use caution with phrases such as “immune boosting,” which studies suggest could be fueling the spread of misinformation and misleading consumers.

Patients or clients may ask RDNs questions about functional foods and products to support the immune system or general health during the COVID-19 pandemic and beyond. Aside from conducting a nutrition assessment for potential micronutrient deficiencies, RDNs can take a whole foods approach, explaining how to obtain nutrients from food and when supplements may be needed, as indicated in the “Position of the Academy of Nutrition and Dietetics: Micronutrient Supplementation.” This position paper guides nutrition professionals to stay abreast of research regarding the efficacy of supplements and to educate and guide consumers on the appropriate and safe use of micronutrient supplements.

Nutrition professionals can refer to the Academy’s “Guidance Regarding the Recommendation and Sale of Dietary Supplements” for more information about regulatory, legal and ethical considerations and the “Scope and Standards for the RDNs and NDTRs Collection” in the Journal of the Academy of Nutrition and Dietetics.

For patients or clients interested in ways to protect their immune response, RDNs can share evidence-based guidance on lifestyle factors including recommendations for sleep, exercise and alcohol consumption. Studies show a direct connection between sleep and immunity, protecting both immune system maintenance and response when sleep is achieved in adequate amounts.

Research on how regular (three to five days per week, 20- to 60-minute sessions), moderate-intensity exercise modulates immunity shows promise for benefiting several aspects of the immune response. For adults who are of legal age and choose to drink alcohol, the 2020-2025 Dietary Guidelines for Americans specify a limit of one drink or less in a day for women and two drinks or less in a day for men on days alcohol is consumed. This can be an important piece of guidance given evidence that chronic, heavy alcohol intake can reduce immunity to both viral and bacterial infections.

RDNs are well-positioned to educate consumers on all aspects of dietary and lifestyle factors that help achieve optimal immune function.

References

Chick J. Alcohol and COVID-19. Alcohol Alcohol. 2020;55(4):341-342.
COVID-19 Treatment Guidelines. The National Institutes of Health website. Updated January 14, 2021. Accessed January 14, 2021.
Crowe K, Francis C. Position of the Academy of Nutrition and Dietetics: Functional Foods. J Acad Nutr Diet. 2013;113(8):1096-103.
Dietary Supplement Labeling Guide: Chapter VI. Claim. Food and Drug Administration website. Published April 2005. Accessed January 14, 2021.
Galanakis C, Aldawoud T, Rizou M, Rowan N, Ibrahim S. Food ingredients and active compounds against the Coronavirus disease (COVID-19) pandemic: a comprehensive review. Foods. 2020;9(11):1701.
Grebow J. Making Immune Health Claims in the Time of COVID-19. Be Careful. Nutritional Outlook website. Accessed February 15, 2021.
Handu D, Moloney L, Rozga M, Cheng F. Malnutrition Care during the COVID-19 Pandemic: Considerations for Registered Dietitian Nutritionists Evidence Analysis Center. J Acad Nutr Diet. 2020.
High Demand In The Immunity Boosting Food Products Market As Result Of Covid-19, As Per The Business Research Company’s Immunity Boosting Food Products Market Global Report 2020. Globe Newswire website. Published November 3, 2020. Accessed January 14, 2021.
Lerner A, Neidhöfer S, Matthias T. The gut microbiome feelings of the brain: a perspective for non-microbiologists. Microorganisms. 2017 Dec;5(4):66.
Marra M, Bailey R. Position of the Academy of Nutrition and Dietetics: micronutrient supplementation. J Acad Nutr Diet. 2018 Nov;118(11):2162-73.
Ono B, Souza J. Sleep and immunity in times of COVID-19. Revista da Associação Médica Brasileira. 2020;66:143-7.
Peregrin T. Guidance Regarding the Recommendation and Sale of Dietary Supplements. J Acad Nutr Diet. 2020 Jul;120(7):1216-9.
Rachul C, Marcon A, Collins B, Caulfield T. COVID-19 and “immune boosting” on the internet: a content analysis of Google search results. BMJ Open. 2020 Oct 1;10(10):e040989.
Reider C, Chung R, Devarshi P, Grant R, Hazels S. Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005–2016 NHANES. Nutrients. 2020 Jun;12(6):1735.
Rozga M, Cheng F, Moloney L, Handu D. Effects of micronutrients or conditional amino acids on COVID-19-related outcomes: an evidence analysis center scoping review. J Acad Nutr Diet. 2020.
Small Entity Compliance Guide on Structure/Function Claims. Food and Drug Administration website. Published January 2002. Accessed January 14, 2021.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020.
Venter C, Eyerich S, Sarin T, Klatt KC. Nutrition and the Immune System: A Complicated Tango. Nutrients. 2020;12(3):818.
Vitamin E. National Institutes of Health website. Updated November 20, 2020. Accessed January 20, 2021.
Wagner D, Marcon A, Caulfield T. “Immune Boosting” in the time of COVID: selling immunity on Instagram. Allergy Asthma Clin Immunol. 2020 Dec;16(1):1-5.
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Yousfi N, Bragazzi N, Briki W, Zmijewski P, Chamari K. The COVID-19 pandemic: how to maintain a healthy immune system during the lockdown–a multidisciplinary approach with special focus on athletes. Bio sport. 2020;37(3):211.
Zinc. National Institutes of Health website. Updated July 15, 2020. Accessed January 20, 2021.

The Business of Personalized Supplements: Exploring the Difference Between Precision Medicine and Targeted Online Marketing

Ginger Hultin — Mon, 21 Dec 2020 18:23:20 +0000

Precision medicine, an individualized treatment and prevention strategy based on a person’s genetics, lifestyle and environment, is becoming increasingly attractive to consumers who no longer wish to be treated like an “average patient” and want a more personalized approach. In 2015, the U.S. Precision Medicine Initiative was launched to improve health and treatment of disease through genomic data in both clinical and public health practices and to better understand how to best provide tailored treatment. Since then, there has been a rise in direct-to-consumer, or DTC, testing options that give individuals information that may help them make more informed health decisions. This includes an ever-growing selection of personalized multivitamins and other supplements largely marketed online through social media, as well as some television, radio and print advertising.

Some reports estimate that more than 50 percent of U.S. adults use some type of dietary supplement, two-thirds of which are multivitamins or multiminerals. As of December 2020, an online search for personalized multivitamins yields nearly 400 million results, many featuring companies that offer delivery of custom supplement packets. Consumers can take an online quiz and order supplement packets directly from their favorite brand. Because of this, patients may no longer see a need to visit their physician for a blood test or a registered dietitian nutritionist for recommendations on treating vitamin or mineral deficiencies.

However, there’s still a place for RDNs in the realm of personalized nutrition, particularly in the provision of individualized nutrition advice. Current data suggests DTC tests, particularly genetic tests, yield better outcomes related to behavior change when interpreted by a qualified provider, rather than when data are provided without explanation. Experts warn that personalized recommendations, including dietary supplement advice based on results from genomic testing should be backed by high-quality research, in addition to considering possible ethical implications. For RDNs, this means using an evidence-based approach in accordance with the professional Code of Ethics to expertly guide patients or clients.

The Rise of DTC Testing
DTC tests can analyze health parameters by obtaining genetic material, blood, saliva, urine or microbiome and stool samples without any involvement of a health care provider. The validity of DTC test claims are reviewed by the U.S. Food and Drug Administration when results are deemed “moderate- to high-risk” medical information, such as carrier screening or tests that indicate genetic health risks; however, general tests for wellness, non-medical or “low-risk” medical purposes, such as ancestry tests or tests that predict athletic ability, are not reviewed. The Federal Trade Commission notes that both the FDA and Centers for Disease Control and Prevention have issued warnings about DTC tests, stating that some lack scientific validity, should be handled in certified and registered laboratories and may require interpretation by a health care practitioner.

DTC tests are not only available online; some are now sold in pharmacies. An editorial article in Expert Review of Precision Medicine and Drug Development describes a scenario where a consumer can walk into a chain drugstore, pick out which blood tests they want, have a phlebotomist draw blood and then be emailed results. Although they are not yet selling personalized supplements based on the results, the article describes several states that now offer ways for consumers to choose and order their own labs without any guidance from a physician.

Trends in Online Supplement Marketing
Many consumers discover online supplements through targeted ads on social media. Many companies offer a free assessment quiz that consumers can take to determine what supplements may be useful based on questions about age, sex, activity level, health goals, dietary patterns and more. Other companies sell DTC testing kits and base recommendations on those results.

After the patient or client has their supplement recommendations, they can enroll in a monthly delivery program to receive individual packets of vitamins, minerals and other supplements. Some monthly programs can cost upwards of $50 and many charge an additional fee for shipping — a significant price for many consumers. An important consideration is client privacy in regard to HIPAA-protected health information being shared on a potentially non-secure platform, such as social media or an online quiz. Some companies may ask about health conditions or other information that is sensitive and should be protected.

Doctors, RDNs and other health care providers are not dominant voices in the online marketing of supplements. Rather, research suggests social media “influencers” play a large role. Influencers often promote regimented diets and exercise routines aimed at achieving a certain body image, all driven by the visual aspect of the social media platform.

How companies are promoting dietary supplements online also has been questioned. Research on internet marketing of omega-3 supplements, for example, found that in the cardioprotective category, risk reduction claims and structure or function claims were made more often than an FDA disclaimer was used. (According to law, if a dietary supplement includes such a claim, it must include a disclaimer stating the FDA did not evaluate it.) Although warnings were made more available to consumers, many of the websites analyzed did not offer information about adverse effects. Researchers suggest that internet marketing is leading to significant increases in both the sale and consumption of dietary supplements.

Appropriateness of Supplement Usage
According to the Academy of Nutrition and Dietetics Micronutrient Supplementation Position Paper, “micronutrient supplements are warranted when requirements are not being met through the diet alone.” The Scientific Report of the 2020 Dietary Guidelines Advisory Committee found that Americans age 1 and older generally do not get enough vitamin D, calcium, potassium and dietary fiber from their diets. Certain populations may be at higher risk for insufficient amounts of nutrients such as iron for infants, children, adolescent girls, and premenopausal and pregnant or lactating women. If a person’s DTC test reveals a low iron or vitamin D level, their doctor or RDN could help guide them to further testing and appropriate supplementation. Through this process, patients and clients could feel more empowered to improve their health.

Conversely, there are risks of exceeding the recommended dietary allowances for nutrients through supplementation. Excess amounts of vitamin D are toxic and can cause hypercalcemia (too much calcium in the blood), hypercalciuria (too much calcium in the urine) and renal failure. Iron supplementation exceeding 20 milligrams per kilogram in adults can cause gastric upset and constipation, impair zinc absorption and, at doses higher than 60 milligrams per kilogram, cause iron overdose, organ failure and even death. Some nutrients interact with medications or other supplements. Even at supplement intake within the RDAs, iron supplementation could reduce the absorption of certain medications, such as levodopa and levothyroxine, or the concurrent use of proton pump inhibitors could reduce iron and vitamin B₁₂ absorption.

Some common supplements, such as probiotics, digestive enzymes and herbs, do not have RDAs. Therefore, it is important for patients and clients to discuss the safety and appropriateness of supplementation with a health care provider to understand the potential benefits and dangers. Research should be assessed to understand a safe duration for taking a particular supplement; some supplements may not have been studied for long-term use or may have potential negative effects or interactions over time.

A final consideration for consumers is how dietary supplements are regulated in the United States. While supplements must follow labeling and marketing regulations required by the Dietary Supplement Health and Education Act of 1994, FDA and FTC, they are presumed to be safe and do not require the FDA’s review for safety or effectiveness before they are marketed or sold to consumers. However, supplements sometimes contain higher or lower levels of ingredients listed on the label or contain ingredients other than what is listed. RDNs can help educate consumers about supplement quality and regulation, encouraging extra protection by looking for brands that pay for third-party certification. The same is true with DTC tests in terms of encouraging patients or clients to evaluate any claims that are made regarding the test or its results.

The Role of the RDN
RDNs are uniquely qualified to educate and inform their patients or clients about dietary supplements, helping them weigh the pros and cons of investing in personalized supplements and evaluating whether the supplements are necessary and safe.

When patients or clients have questions about personalized multivitamins, supplements or DTC testing, approach them with an open mind and curiosity. Use open-ended questions to guide the conversation and learn why they are interested in supplementation or where they may have knowledge gaps about obtaining nutrients through a balanced diet. In addition to sharing FDA advice, RDNs can encourage patients or clients to discuss DTC test results with their health care provider and to avoid making dietary or health changes based on these tests without the guidance of a health care provider. RDNs also may need to educate themselves, as well as their patients or clients, about the accuracy and validity of specific tests and their relevance to a patient’s or client’s overall health status.

Ways that RDNs can support patients or clients include taking an individualized approach to their health, educating in a food-first manner and referring more testing if the patient or client may need to exceed the RDAs due to a nutrient deficiency, health condition, stage of life or other circumstance. Although patients and clients have more access than ever to personalized information online, they still need to partner with their RDN for safe and relevant supplement use and dietary information for optimal health. The area of personalized supplements and how DTC testing influences consumer health continues to grow, and RDNs will need to stay informed of updated research and resources.

References

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Eichner A, Coyles J, Fedoruk M, et al. Essential features of third-party certification programs for dietary supplements: A consensus statement. Curr. Sports Med. Rep. 2019;18(5):178-82.
Genomics. Healthy People 2020 website. Accessed November 12, 2020.
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Guest N, Horne J, Vanderhout S, El-Sohemy A. Sport nutrigenomics: Personalized nutrition for athletic performance. Front. Nutr. 2019;6:8.
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Horne J, Madill J, O’Connor C, Shelley J, Gilliland J. A systematic review of genetic testing and lifestyle behaviour change: are we using high-quality genetic interventions and considering behaviour change theory? Lifestyle genomics. 2018;11(1):49-63.
Iron Fact Sheet for Professionals. National Institutes of Health Office of Dietary Supplements website. Updated October 9, 2020. Accessed December 11, 2020.
Marra M, Bailey R. Position of the Academy of Nutrition and Dietetics: micronutrient supplementation. J Acad Nutr Diet. 2018;118(11):2162-73.
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Rozga M, Latulippe ME, Steiber A. Advancements in Personalized Nutrition Technologies: Guiding Principles for Registered Dietitian Nutritionists. J Acad Nutr Diet. 2020;120(6):1074-1085.
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Vitamin D Fact Sheet for Professionals. National Institutes of Health Office of Dietary Supplements website. Updated February 28, 2020. Accessed November 20, 2020.

Pretty, Petite Salt and Pepper Grinder Set

Ginger Hultin — Mon, 16 Nov 2020 11:00:53 +0000

Product reviewed: Eparé Mini Salt & Pepper Grinder Set

Hiking, camping and traveling nationally in vans and RVs is one of the hottest COVID-19 trends. With it comes an uptick in interest in cooking outdoors. Eco-friendly gear is increasingly important to consumers, so reusable, miniature options for seasoning foods — like the Eparé Mini Salt and Pepper Grinder Set — are especially handy. If you’re on the hunt for a way to make healthful eating while socializing outdoors easier and more delicious, this salt and pepper grinder set is for you.

Chic with a simple design, the Eparé grinders feature a clear glass base and a black handle on the pepper and a white one for the salt. They come with a small stand made of no-scratch acrylic for durability. The adjustable ceramic grinding mechanism is easy to adjust: Turn the cap of each grinder to the left for larger, coarser pieces or to the right for finer granules. The grinders are quite petite (3.5 inches tall and 1.2 inches in diameter) and weigh 2 ounces yet hold 0.3 ounces of salt and pepper each, so they’re ideal for on-the-go cooking, camping and picnics or for small living spaces such as apartments, dorm rooms or studio kitchens.

These salt and pepper grinders are ready to use as soon as you open the packaging. They come with simple care instructions indicating you can simply wash them with soap and warm water, then put them to use immediately.

Because the Eparé Mini Salt and Pepper Grinder Set is made of clear glass, it could be fun to use pink Himalayan sea salt or rainbow peppercorns inside to add an interesting and unexpected color to your seasoning.

I would definitely recommend this as a gift for a friend who loves hiking, backpacking or who eats on the go a lot. Consider using the set for flights during which you may need a little extra seasoning on your food, or if you’re going to be serving meals outdoors and want a simple way to add a pinch of salt and pepper to the food as a garnish.

Salt and Pepper Pumpkin Seeds

Ginger Hultin — Wed, 21 Oct 2020 10:00:59 +0000

Halloween is one of my favorite holidays aside from Thanksgiving and New Year’s. Every year I pick out my costume and get ready for pumpkin carving. I’ve also been known to have some fun pumpkin carving parties where I serve my famous apple cider bourbon punch and we all go to town making creative pumpkin sculptures.

This year, I saved the seeds from my pumpkin and needed a simple, easy way to bake them so I could still be with my guests. It’s so fun to make a recipe like this the night-of so people can enjoy the snack. If you want to take it to the next level, have containers ready to go so you can send salt and pepper pumpkin seeds home with folks. The best thing about this recipe is that it’s a simple base for you to build on. Add in other fun ingredients that make the flavor pop!

Getting the Seeds

The hard part here is carving the pumpkin. First grab a big bowl. Cut a circle around the top of the stem and carefully remove it and slice off any seeds on that part and put it in your bowl. After that, take a large metal spoon and start scraping the inside of the pumpkin, loosening the insides where the seeds are. Once the insides have fallen to the bottom of the pumpkin, scoop it out with the spoon (or even your hands) and place it in the bowl. Do that until all the insides are completely scrapped out and the pumpkin is hollow.

Then hand-pick your seeds from the bowl and place them into a smaller bowl. Your fingers are the very best way to loosen the slippery seeds from the fruit strands. Pluck them out and run your hands down the strings to loosen the seeds. Once you’ve got most of them, put them in a strainer and use your hands to wash off all the pumpkin gunk. They may still be a little sticky but that’s ok if they’re relatively clean.

Salt and Pepper Pumpkin Seeds

Serves 6

Ingredients

1 to 2 cups fresh pumpkin seeds (rinsed)

1 to 2 teaspoons dairy or vegan butter (melted)

⅛ teaspoon salt

½ teaspoon freshly ground pepper

¼ teaspoon chili powder

Instructions

Preheat oven to 300°F. In a medium mixing bowl, combine seeds, melted butter or butter substitute, salt and pepper and chili powder. Spread seed mixture on a parchment lined baking pan and cook for 20 to 30 minutes, stirring occasionally until toasty brown but not burned! Remove from oven and serve warm.

Healthy Egg Bites Made Easy

Ginger Hultin — Mon, 10 Aug 2020 10:00:06 +0000

Product reviewed: Hamilton Beach Egg Bites Maker

The other day, I made egg bites in muffin tins and it didn’t turn out well. My tins were ruined because, though I used oil in the bottom, the egg stuck and no amount of scraping and washing could clean them. I ordered silicone muffin tin liners, which worked better. When I saw the Hamilton Beach Egg Bites Maker, I knew I had to try it.

This small and simple machine has four pieces: the base, a cup for measuring and pouring water, the two egg mold cups and the lid. At 4.6-by-8.0-by-5.69 inches, it doesn’t take up a lot of counter space and can easily be stored in a cabinet. Every part except the base is dishwasher-safe. Cooking time is indicated by two lights on the front of the machine — a green one and a red one — so there’s no need to worry about mastering a timer or other settings.

Using this egg bite maker is extremely simple. Whisk together two eggs and season them however you want, whether simply with a dash of salt and pepper or with added cheese, vegetables, protein and other herbs and spices. The instruction manual also has recipe ideas.

The Egg Bites Maker uses a steam process to cook the eggs. Use the included measuring cup to fill the base of the machine with water, then pour your egg mixture into the two cups, close the lid and plug it in. The red light will come on, indicating you shouldn’t open the lid while it cooks. The egg bites cook in about eight to 10 minutes, at which time the green light illuminates, indicating the bites are ready. Unplug the machine, then carefully open the lid. A little steam will come out, but it doesn’t seem dangerous or too hot. The egg bites pop out very easily, even without using oil in the tins.

Since this product cooks with hot steam, use caution around kids. Pre-teen or teenage children could use it to make their own breakfast or snack, but they should be educated about the steam and its potential to cause burns if the tool is not used correctly.

I can see myself using the Egg Bites Maker in the future for a (safe and socially distant) brunch or breakfast with friends. Families and those who want to cook batches in advance would need to keep the machine running for a while to cook enough eggs. It would be great to have a machine with more cooking tins, but luckily this one cooks quickly.

I would absolutely recommend this product to a client who needed an easy way to make breakfast or snacks. Since it’s so easy and quick to use, you could pour the eggs in while you’re getting ready for work or school, then pop them out onto a plate to grab and go. Plus, it’s a wonderful way to make high-protein egg bites without added fat, for those looking to cut back on butter or oil, and an easy way to add vegetables, herbs and spices into the diet.

Adrenal Fatigue

Ginger Hultin — Mon, 06 Jan 2020 15:04:04 +0000

Understand this controversial concept and why some experts say we shouldn’t slam it.

Coined in 1998, the phrase “adrenal fatigue” is used by some health care practitioners — typically in integrative and functional medicine — to refer to a collection of symptoms including fatigue and other general complaints, some of which mimic signs of adrenal diseases, syndromes and medical conditions.

A 2016 systemic review of adrenal fatigue literature, published in the journal BMC Endocrine Disorders, analyzed 58 studies that attempted to test for adrenal fatigue. Testing used in most studies included direct awakening cortisol, cortisol awakening response and salivary cortisol rhythm. Researchers found conflicting results and concluded there is no firm evidence that the condition exists; however, they also noted several limitations to the review, including heterogeneity of study design plus many study designs’ descriptive nature, the poor quality of the assessment of fatigue and the use of unsubstantiated methodology for cortisol assessment.

While no one disputes the existence of patients’ symptoms, many researchers and medical organizations, including the Mayo Clinic and Endocrine Society, have determined that adrenal fatigue is not a single condition or syndrome. Further, they have expressed concern with the lack of standardized language — which can sometimes include “burnout” or “burnout syndrome” — as well as the lack of clinical evidence to support testing.

However, many of those critics advise against telling patients that adrenal fatigue is a myth or that it doesn’t exist. Rather than fixating on a label, experts encourage practitioners to take patients’ complaints and symptoms seriously and investigate potential causes and treatments.

The Concept of Adrenal Fatigue
Symptoms associated with “adrenal fatigue” include fatigue, unexplained weight loss, low blood pressure and lightheadedness, darkening of the skin, loss of body hair, body aches, hormone imbalance, poor digestion, trouble falling asleep or waking up, reliance on caffeine to stay awake during the day, a lowered immune system and slow recovery from illness, inability to concentrate and a reduced ability to cope with stress.

The theory is that chronic physical or psychological stress creates subclinical adrenal dysfunction. (By definition, subclinical means not severe enough to be readily detectable or present definite symptoms.) This is due to a high burden on the adrenal glands to produce high levels of hormones long-term, namely cortisol, ultimately causing chronically low cortisol levels. In other words, the adrenal glands can’t keep up with the patient’s constant state of stress.

Adrenal Conditions

Although there are many known diseases and conditions that affect the adrenal glands, most are rare:

Addison’s Disease
Primary adrenal insufficiency caused by insufficient steroid hormone production despite adequate adrenocorticotropic hormone (ACTH) levels. Low ACTH hormone levels are caused by a problem with the pituitary gland and are considered secondary adrenal insufficiency. Symptoms include fatigue, loss of appetite, low blood pressure, nausea and vomiting, dysregulation of blood glucose, darkening of the skin on the face and neck, and problems regulating stress management.

Adrenal Insufficiency
This disorder includes Addison’s disease and occurs when the adrenal glands do not make enough cortisol. Potential causes include stopping a steroid medication suddenly or an autoimmune disease. Symptoms include fatigue, muscle weakness, loss of appetite and abdominal pain.

Adrenal Crisis (AC)
A life-threatening condition requiring treatment with glucocorticoids, AC is caused by chronic adrenal insufficiency, Addison’s disease, tumors and severe infection or sepsis. Symptoms include abdominal pain, confusion or loss of consciousness, dehydration, fatigue and weakness, headache, fever and loss of appetite.

Cushing’s Syndrome
This is when there is too much cortisol in the blood stream due to exogenous sources such as steroids, or endogenous reasons, including an adrenal or pituitary gland tumor. Symptoms include weight gain, depression, muscle loss and weakness.

Primary Hyperaldosteronism
A condition in which the adrenal glands produce too much of the hormone aldosterone (causing hypertension and low blood potassium levels), it can be caused by hyperactivity in one or both adrenal glands, sometimes related to an adrenal tumor. Symptoms include high blood pressure, fatigue, headache, muscle weakness, low potassium levels and numbness.

Proponents say adrenal fatigue is a mild form of adrenal dysfunction. It’s also known as “subclinical adrenal insufficiency,” “adrenal stress,” “adrenal exhaustion,” “adrenal burnout” and “adrenal imbalance.” However, adrenal fatigue is not an accepted medical diagnosis

It’s important to understand the difference between adrenal insufficiency (a diagnosis that is recognized by the Endocrine Society) and adrenal fatigue. Some of the symptoms overlap, such as fatigue, low blood pressure and weight loss, while others do not. People with adrenal insufficiency often experience joint pain, nausea, vomiting, diarrhea and dry skin in addition to fatigue. Adrenal insufficiency is diagnosable by a physician through ACTH Stimulation and Insulin-Induced Hypoglycemia tests.

However, there are no scientifically validated tests to assess whether a patient is experiencing altered hormone levels that could indicate subclinical adrenal dysfunction. Tests that attempt to do so include any combination of salivary cortisol tests, DHEA-Sulfate serum test, thyroid hormone tests and a nonvalidated survey.

Proposed interventions for adrenal fatigue include moderate exercise, a balanced diet that supports proper blood sugar regulation, adequate sleep, and stress relief and management techniques. Some practitioners also recommend supplements, including B-vitamins, dehydroepiandrosterone (DHEA) and adaptogenic herbs or adaptogens — a collection of compounds used to stimulate non-specific resistance against physical, environmental and emotional stressors.

Other Potential Explanations
Critics of the adrenal fatigue concept believe its hallmark symptom, fatigue, may be related to other diseases or the presence of long-term stressors. For example, conditions that may mimic symptoms of adrenal fatigue include anemia, thyroid disease, growth hormone deficiency, depression, fibromyalgia and menopause, among others.

When clients or patients arrive with questions about adrenal fatigue, registered dietitian nutritionists can start by exploring symptoms, medical history and lifestyle factors during the nutrition assessment. Being aware of the different types of adrenal diseases (see sidebar) is important, as is referring back to their primary care provider if further medical testing is warranted.

In a 2018 commentary in the journal Endocrine Practice, one physician recommended patients who are concerned about “adrenal fatigue” undergo testing for adrenal disease. If the results are negative, they should seek lifestyle approaches to improve stress and promote wellness.

RDNs can educate clients and patients on the importance of stress management, a healthful diet and physical activity. And for those taking or considering supplements, RDNs can reinforce the importance of finding products that are third-party tested for safety, in addition to reviewing other medications, supplements and medical conditions for potential interactions.

Practicing patient-centered care is an important part of any therapeutic relationship — and it’s important to meet people who are seeking help with an open mind.

References

Adaptogens. Natural Medicine’s Database website. Updated April 10, 2019. Accessed November 12, 2019.
Adrenal Insufficiency and Addison’s Disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Accessed November 12, 2019.
Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr. 2016;16(1):48.
Harvey C. Holistic Performance Institute Position Stand: Adrenal Fatigue. J Holist Perform. 2017:1920.
Iwasaku M, Shinzawa M, Tanaka S, Kimachi K, Kawakami K. Clinical characteristics of adrenal crisis in adult population with and without predisposing chronic adrenal insufficiency: a retrospective cohort study. BMC Endocr. 2017;17(1):58.
Kampmeyer D, Lehnert H, Moenig H, Haas CS, Harbeck B. A strong need for improving the education of physicians on glucocorticoid replacement treatment in adrenal insufficiency: an interdisciplinary and multicentre evaluation. Eur J Intern Med. 2019;33:13-5.
Liao L, He Y, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chinese Medicine. 2018;13(1):57.
Mahan K, Raymond L. Krause’s Food and the Nutrition Care Process. 14th ed. St Louis, MO:Elsevier; 2017.
Mullur R. Making a Difference in Adrenal Fatigue. Endocrine Practice. 2018;24(12):1103-5. Nippoldt, T. Adrenal Fatigue: What causes it? Mayo Clinic website. Published April 12, 2017. Accessed November 30, 2019.
Noland D, Raj S. Academy of Nutrition and Dietetics: Revised 2019 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition in Integrative and Functional Medicine. J Acad Nutr Diet. 2019;119(6):1019-36.
Seaborg E. The Myth of Adrenal Fatigue. Endocrine News website. Published September 2017. Accessed November 30, 2019.

Easy Vegan Chocolate Mousse

Ginger Hultin — Fri, 20 Dec 2019 11:00:46 +0000

I originally made this dessert for Valentine’s day. We were having a dinner party and I needed a rich dessert to pair with a lavish meal. Wanting something a little lighter, I decided to use silken tofu as the base for this vegan chocolate mousse. It’s full of antioxidants, packed with protein and has a rich consistency that whips up perfectly — soft tofu is a wonderful foundation.

This recipe is perfect for all seasons. It would be wonderful for a birthday dessert, for the holidays or for a party. No one would ever know that this is a vegan dessert, but it is perfect for anyone with food allergies, so long as they are OK with soy.

I whipped this vegan chocolate mousse up in my blender in a matter of minutes. It’s one of the simplest desserts you could make. Serve it in ramekins, small decorative bowls or martini glasses. I used mini mason jars. Garnish with whatever you prefer: chopped nuts, sprinkles, berries, coconut, cocoa powder, etc.

Easy Vegan Chocolate Mousse

Serves 4

Ingredients

1 pound package silken tofu (drained of excess liquid)

⅛ cup unsweetened almond, oat or soymilk

3 to 4 tablespoons pure maple syrup

1 teaspoon pure vanilla extract

½ cup baking cocoa

Unsweetened shredded coconut or your favorite sprinkles as a garnish

Instructions

Combine all ingredients (except garnish) in a blender or food processor and blend until completely smooth and creamy.

Place ½ cup servings into a small container (try mason jars, ceramic ramekins or martini glasses) and refrigerate for a minimum of 4 hours or overnight.

Garnish with cocoa powder, shredded coconut, dried or frozen chopped fruit or colorful sprinkles if desired.

Spicy Green Butternut Squash Chickpea Enchiladas

Ginger Hultin — Wed, 20 Nov 2019 11:00:14 +0000

Hearty for anytime of the year, this dish reminds me of fall with warm spices and seasonal squash. Enchiladas are often loaded with cheese, meat and salty sauce but you can make them healthier by packing in the veggies and minimizing cheese to get the most vitamins, minerals, antioxidants and fiber possible. Beans add a nice protein balance in addition to the whole wheat tortillas, so you get that satiating feeling to keep you full for hours.

This enchilada recipe is full of spice so make sure to cut down on the chili powder if you need to mellow them out or use sour cream as a garnish at the end to cut it. Avocados are another option to cut the spice and a heart healthy fat that always pairs well with Mexican-inspired meals.

These Spicy Green Butternut Squash Chickpea Enchiladas feature conveniently prepared whole foods like canned beans, frozen butternut squash chunks and frozen corn. Simple ingredients to have on hand, affordable and quick to prepare, look for these types of unprocessed foods that come in a form that makes cooking easier. Did you know that frozen fruits and vegetables have the same nutrient quality as fresh produce? Frozen produce is flash frozen right after it is harvested, maintaining their nutritional value. I never hesitate to use frozen foods; they’re a big part of my shopping list and my meal prep.

Keep in mind that Spicy Green Butternut Squash Chickpea Enchiladas are excellent for freezing or leftovers, be sure to whip up a batch for your lunch or dinner this week.

Spicy Green Butternut Squash Chickpea Enchiladas

Ingredients:

1 Tablespoon olive oil

1 medium yellow onion, diced

3 cups of peeled, diced butternut squash (frozen variety for simplicity)

1 ½ cups frozen corn

15– ounce can chickpeas, drained and rinsed

8– ounce can diced green chilies, un-drained

2 teaspoons cumin

1 Tablespoon chili powder

½ teaspoon kosher salt

½ teaspoon freshly ground black pepper

2 cups salsa verde

8– ounces Colby or Monterey jack cheese, shredded finely

8 6-inch whole wheat or soft corn flour tortillas

⅓ cup cilantro, chopped

Instructions:

Preheat oven to 350°F.

Lightly coat a large sauté pan with olive oil over medium heat. Add onion and cook until softened, 1-2 minutes.

Add frozen butternut squash and corn, sautéing for 3-5 minutes.

Add beans, green chilies, cumin, chili powder, salt, and pepper, cook for an additional 3 minutes, stirring often.

In a 12×9 glass baking dish, spread one cup of the salsa verde evenly on the bottom.

Fill each tortilla with about ½ cup of filling, add 2 Tablespoons of shredded cheese, roll tightly and place seam-down in the baking dish. Repeat for the remaining tortillas.

When all enchiladas are in the dish, top immediately with the remaining salsa to prevent cracking and sprinkle with remaining cheese.

Cover with foil and bake for 20 minutes, until the cheese is melted, remove the foil for the last 5 minutes and let cook until lightly browned.

Let cool for 5 minutes and serve with cilantro garnish.

Simple Pumpkin Hummus

Ginger Hultin — Wed, 06 Nov 2019 11:00:01 +0000

To make this simple pumpkin hummus, you literally throw all the ingredients into a blender, pulse it and serve. It makes perfect leftovers for the rest of your busy week and it’s a beautiful color to serve at an autumn celebration or as a pre-Thanksgiving snack.

Chickpeas make the base of this traditional dish and they’re packed with filling fiber and protein to power your day. Plant-protein is swiftly replacing many meat items as the go-to choice for so many reasons including environmental reasons, animal welfare benefits and positive health outcomes in humans. All the ingredients contain health-promoting properties!

I hope you enjoy this simple pumpkin hummus. In a sea of pumpkin spice, sweet coffee drinks, breads, muffins and desserts, you can enjoy this season’s flavor in a lighter, slightly more savory way with this recipe.

Simple Pumpkin Hummus

Serves 3

Ingredients

1 (15 oz) can chickpeas, rinsed and drained

1 ½ cups pumpkin purée

¼ cup tahini paste

1 medium lemon, juiced

2–3 cloves garlic, minced

½ teaspoon ground cumin

¾ teaspoon salt

¼ cup cold water

Instructions

Combine chickpeas, pumpkin, tahini, lemon, garlic, cumin, salt and cold water in a food processor or high speed blender. Add additional water for desired consistency.

Top with additional cumin if desired and serve with fresh veggies or crackers.

Green Tea Frozen Yogurt Breakfast Cups

Ginger Hultin — Mon, 06 May 2019 10:00:26 +0000

What are you eating for breakfast these days? Same old thing? I make time for breakfast every single day of the year even if I’m running out the door. But breakfast is an easy meal to get into a rut, creating the same thing over and over. That’s where green tea frozen yogurt breakfast cups come in! A frozen on-the-go treat, it’s not a muffin, it’s not a smoothie, it’s not a cup of yogurt but it does travel well. High in protein, low in sugar, packed with antioxidants and a little punch of caffeine, these little breakfast cups are perfect before a morning workout or on your commute. They also make a great snack later in the day because they’re sweetened naturally (with banana) so no danger of a sugar crash.

I’ll be honest, I liked the green tea frozen yogurt breakfast cups more than my husband did. He said that they taste like a frozen ice pop… which they do. I thought they were great but if something this chilly sounds strange to you as a breakfast meal, tuck this recipe away until summertime when a cool breakfast will be perfect.

Tips for Making Breakfast a Priority in the Morning

Don’t eat so late at night! Your body needs to break the fast so if you have only been without food for 4 to 5 hours, then of course you won’t be hungry early in the day. A lot of folks I talk to eat dinner later than they want or they snack late into the night so no wonder they don’t feel hungry when they get up a few hours later. Let your body do its thing and take a break from eating at night so you’re hungry in the morning.

Eat non-breakfast food. A common complaint is that my clients don’t like traditional breakfast foods. If you prefer savory food, feel free to heat up leftovers for breakfast, make some soup or eat a sandwich instead. Who says you have to stick to eggs and pancakes?

Be active in the morning. It’s hard… so hard when the weather is cold and dark but once you get into the habit of going to the gym or even taking a walk in the morning, you may find yourself becoming deeply committed. Fueling before morning workouts is key or I’m dragging so I have extra motivation to eat something light like green tea frozen yogurt breakfast cups so I can lift weights better.

Eat something…even a little something. Breakfast is a habit that you can form even if you aren’t naturally inclined to eat when you get up. Start with a bite or two of something that you enjoy and work up from there. The very act of eating gets digestive processes going so regularly preparing your body to expect food in the morning is important. It might take a few days or weeks but you’ll get there.

Green Tea Frozen Yogurt Breakfast Cups

Serves 4

Ingredients

12 ounces Greek yogurt (I like vanilla best; aim for a low-sugar variety)

1 frozen banana

2 teaspoons matcha green tea powder

2 to 4 tablespoons unsweetened vanilla almond or soy milk

⅛ cup shredded unsweetened coconut flakes

Instructions

In a food processor or blender, pulse all ingredients yogurt, banana, matcha and milk until completely smooth.

Line a 12-cup muffin tin with paper cups and spray with cooking spray.

Pour yogurt mixture into muffin tin, distributing equally among all 12 cups.

Sprinkle with coconut flakes and freeze 2 hours or more until completely set.

To remove them, use a butter knife to gently slide down into the tin and pop them out.

Fresh Herb Frittata

Ginger Hultin — Fri, 01 Mar 2019 14:55:04 +0000

Inspired by kuku sabzi, an herb-heavy egg dish traditionally served for Persian New Year, this version uses less oil and is baked instead of fried.

SERVINGS: 6
SERVING SIZE: 1 piece (70 grams)
PREP TIME: 20 minutes
COOKING TIME: 18 minutes

Ingredients

3 tablespoons (45 milliliters) grapeseed oil, divided

½ cup yellow onion, thinly sliced

2 teaspoons minced garlic

1½ cups chopped fresh cilantro

1½ cups chopped fresh flat leaf parsley

1 cup chopped fresh dill (woody stems removed)

½ teaspoon freshly ground black pepper

½ teaspoon ground turmeric

5 eggs, beaten

1 teaspoon baking powder

½ teaspoon kosher salt

1 tablespoon pomegranate arils

Instructions

Preheat oven to 400°F (204°C).

Trace a 9-inch round cake pan on parchment paper, then cut to create a piece that fits in the bottom of the pan.

In a sauté pan, heat 1 tablespoon oil, then add onions and cook 3 to 4 minutes, until soft.

Add garlic and cook for 1 minute.

Add cilantro, parsley and dill and cook 1 to 2 minutes until wilted.

Transfer mixture to a large mixing bowl and stir in pepper and turmeric.

Set aside to cool slightly, about 5 minutes.

Add eggs, baking powder and salt and stir to combine.

Brush pan with remaining 2 tablespoons oil (on parchment and up the sides), then pour in the egg mixture.

Bake 18 to 20 minutes,or until internal temperature reaches 160°F (71°C), then remove and place on a cooling rack.

Use a butter knife to loosen the edges of the frittata, then place a plate on top of the pan and gently flip to remove the frittata.

Flip back over using another large plate or serving dish.

Cut into 6 pieces, garnish with pomegranate arils and serve warm.

NUTRITION PER SERVING: 124 calories, 10g total fat, 2g saturated fat, 134mg cholesterol, 332mg sodium, 4g carbohydrate, 1g fiber, 1g sugar, 5g protein, 199mg potassium, 106mg phosphorus