Spaghetti Squash with Red Sauce

Ingredients

4 medium boneless/skinless chicken thighs, chopped
1/4 cup of mushrooms
1/2 cup chopped broccoli rabe
1/2 cup chopped onion
1 medium tomato, chopped
1 medium spaghetti squash
1 yellow sweet pepper, chopped
1 1/2 tbsp olive oil
6 oz can of tomato sauce or 1 large tomato

Instructions

Place a little bit of water in a microwave-safe pie dish.  Place spaghetti squash in dish and stab with a fork all the way around.  Cook on high for 15 minutes, rotate it 1/3 of the way and cook for 7 minutes, and rotate it the rest of the way and cook for 7 more minutes.  Feel squash each time you rotate it, if it's soft it's done.  Take out of microwave, let cool, drain water, and cut in half length-wise.  Take out seeds and guts and scrape the inside with a fork, it should come out the texture of spaghetti. Heat a cast iron skillet on medium high and add olive oil.  Once the oil heats, brown the chicken and then add the rest of the vegetables minus the tomatoes and tomato sauce.  Cook until vegetables are tender, then add tomato and sauce and cook for 5 more minutes.  Serve over spaghetti squash.

Nutrition info

Serves2
483 cals
24g fat
36g carbs
8g fiber
35g protein
1413mg potassium
1039mg sodium

Plantain Chips

Ingredients

1 medium Plantain, as green as possible(Yellow plantains won't slice well)
1 1/2 tbsp coconut oil
Approximately 1/2 tsp of garlic powder

Instructions

Preheat oven to 425 degrees.  Peel plantain by cutting off both ends, scoring length wise, and removing peel.  Slice plantain in to discs with a mandolin slicer to about 1/8 of an inch.  Heat up coconut oil and pour over plantains in a dish, sprinkle with garlic powder.  Space discs out on a cookie sheet and bake at 425 degrees for 7-9 minutes. Remove when browned on edges and salt to taste.  Serve with spicy mustard.

Nutrition info

Serves 1
234 cals
10g fat
38g carbs
3g fiber
1g protein
555mg potassium
121mg sodium including 4 tsp of mustard, more if you add salt

Sausage, Peppers, and Fingerling Potatoes

Ingredients

5 large hot sausage links
1 large onion
1 green pepper
2 red peppers
24 oz fingerling potatoes
6 oz can of tomato sauce or 1 large tomato

Instructions

Slice onions and peppers and slice fingerling potatoes in half lengthwise.  Slice sausage in to 1-2 inch lengths and brown in a cast iron skillet.  Place all ingredients in a crockpot and cook on low for 5-6 hours.

Nutrition info

Serves 3
461 cals
12g fat
60g carbs
7g fiber
30g protein
1776mg potassium
1123mg sodium

Sausage and Brussel Sprout Hash

Over the next few weeks I'm going to be putting up some of my go-to recipes.  This week we start with my favorite breakfast: Sausage and Brussel Sprout Hash.

Ingredients

2 slices of bacon
2 small breakfast sausage links (Pork or chicken)
2 large brussel sprouts
1 large carrot (7" long)
1 parsnip (9" long)
1 large sweet pepper
Oregano, basil, savory and marjoram to taste

Instructions

Shred all vegetables in a food processor.  Slice bacon length-wise and cut in to small squares.  Place chopped up bacon in a cast iron skillet on low heat.  Shred all vegetables in a food processor.  Chop sausage in to bits and place in skillet once bacon begins to get crispy.  When sausage is browned season pan with spices, heavily with oregano and lightly with basil, savory, and marjoram.  Stir seasonings in oil and let heat up for a minute or two.  Dump shredded vegetables in to skillet and stir well until meat, veggies, and spices are mixed well.  Increase heat to Medium-Low and cover for 10-15 minutes.  Uncover and stir occasionally for another 10 minutes.  It's done when the vegetables are just short of mushy.

Nutrition info

Serves 1
406 calories
21g of fat
38g of carbs/9g of fiber
19g of protein
1168mg potassium
908mg sodium

Does gluten sensitivity exist?

Last week, articles took the internet ablaze questioning whether gluten sensitivity exists.  Multiple articles written by multiple people claimed gluten sensitivity doesn't exist, including this one titled, Researchers who provided key evidence for gluten sensitivity have now thoroughly shown that it doesn't exist.  These articles take a look at a study published last year that had some very interesting findings, they just didn't find that gluten sensitivity doesn't exist.  In fact, it found the opposite, that it does exist.  However, the study raises questions on those who see improvements in GI symptoms on a gluten free diet.  Those findings are:

• Gluten may not be the primary trigger in grains that induces GI symptoms in susceptible individuals
• Most of the people who improve on a gluten free diet may be responding to reduced FODMAPS and not less gluten
• Gluten sensitivity is poorly defined and the criteria for diagnosis is terribly inaccurate

Let's take a look at the study to see what we can pull from it.  The study happened in 2 parts.  In the first part, the authors followed 37 people with non-celiac gluten sensitivity(NCGS) and IBS but not Celiac disease through 3 different diets that followed 2 weeks of reduced FODMAP intake.  FODMAPs are fermentable carbohydrates that humans cannot digest but resident bacteria in the digestive tract can.  The 3 diets contained either gluten only, gluten and whey, and whey only and each person underwent each diet for 1 week.  They tested the subjects for intestinal inflammation and immune system activation as well as a subjective assessment of fatigue.  In this part of the study, gluten specific effects were found in 3(8%) of the participants, and symptoms improved during reduced FODMAP intake but worsened when gluten OR whey were introduced in subjects.

In the second part of the study, 22 subjects were given diets that increased FODMAP intake and included either gluten, whey, or no additional protein for 3 days and subjectively assessed for GI symptoms.  All subjects received all 3 diets.  This part of the study found that GI symptoms increased by similar levels in all groups with no specific response to gluten.  However, there was an order effect which means that the order that a person received each diet had an effect on the results.  In other words, people who received the diet with gluten first all had similar results to one another but different results than people who had whey or no gluten first.

So what does this study show?  First off, this study supports the notion that NCGS exists, but that only a small number of people who respond positively to a gluten free diet are responding to lower gluten exposure.  Instead, they may be responding to a reduction in FODMAP intake.  But what does that mean?

First off, NCGS is poorly defined.  To be diagnosed with NCGS you simply have to have symptoms of gluten sensitivity, not have celiac disease, and see an improvement in your symptoms with a gluten free diet.  So anyone who has IBS or other GI problems who responds positively to removing gluten qualifies.  There are 2 problems with this.  The first problem is that a gluten free diet can mean many things.  For some people it means removing grain-based foods, for others it means removing the gluten from grain-based foods.

If the culprit is specifically gluten, either one should work.  The problem is, if it's not gluten and as this study suggests FODMAPS that are the problem for most people with GI symptoms, removing grain-based foods would be a successful approach while consuming grain-based foods with the gluten removed would have little effect since they would still contain FODMAPs.  But why are FODMAPs a problem?  The answer potentially lies in something called small intestinal bacterial overgrowth, or SIBO.

SIBO is a condition where bacteria overgrow in to the small intestine.  While the large intestine houses a large number of bacteria, the small intestine houses far fewer in comparison.  When an excessive amount of this bacteria begins to take up residence in the small intestine, people experience the same IBS symptoms associated with NCGS.  In fact, some studies put the number of people with IBS who also have SIBO at approximately 80%(1, 2).  Furthermore, those who eradicate SIBO see dramatic improvements in their symptoms(2).  While there is a simple test for SIBO, the authors of the study did not test for it.  This is ironic since FODMAPS should exacerbate SIBO and IBS symptoms by providing substrate for bacteria that make their way in to the small intestine to ferment, causing bloating and gas.

The second problem that was not tackled directly in this study was gluten sensitivity that presents with symptoms outside of the GI tract.  Though gluten sensitivity and Celiac disease are both associated with GI symptoms, Celiac disease presents itself most typically with symptoms outside of the GI tract(3) and gluten sensitivity often presents itself with neurological symptoms and no GI symptoms(4).  The brain is one of the most common sites for symptoms related to gluten sensitivity including headaches, brain fog, vertigo, and more(3).  This study only looked at people with symptoms of IBS and suspected gluten sensitivity and left out people who may fit the criteria of gluten sensitivity with no GI symptoms.  So people who see relief from vertigo, headaches, rashes, or any other manifestation of NCGS without IBS were not included in this study so the results don't pertain to them.

So what can we pull from this study?  In the majority of people with symptoms of IBS and self-diagnosed gluten sensitivity, their GI symptoms may be caused by FODMAPS and not gluten.  This does not rule out that they are sensitive to gluten as gluten sensitivity can present itself with symptoms outside of the GI tract, and it certainly doesn't rule out the existence of gluten sensitivity in the population since the study showed 8% of the subjects had gluten specific effects.  The good news here is that a large chunk of people who think they are sensitive to gluten may have SIBO which is something that can be improved with a low FODMAP diet.

On the other side of the coin, people who eat a gluten free diet that contains grain-based foods with the gluten removed who still experience GI symptoms may want to look at reducing FODMAP intake as well.  Dropping grains altogether as well as legumes and a few other fruits and vegetables for a brief period, as is seen in the specific carbohydrate diet, may fix the problem if SIBO is the culprit.  Once the issue is fixed, a normal diet can resume.

Conclusion

Most of these articles professing that NCGS doesn't exist are sensationalizing the research that they use to try and support their preconceived notion.  This study showed that most people who have self-diagnosed themselves with NCGS based on symptoms of IBS are not experiencing GI symptoms due to gluten.  This is backed up by a study published earlier this year that found that only 1 in 4 people who self-diagnosed themselves with NCGS fit the criteria for diagnosis(5).  Oddly the author of the article mentioned at the beginning of this blog took that as evidence that gluten sensitivity doesn't exist, which isn't the case.  It doesn't surprise me that most people who self-diagnose themselves with gluten sensitivity don't have it.  I'd imagine most people who self-diagnose themselves with aggressive colon cancer on WebMD don't have that either.

If you learn anything from this study, it's that you should see a doctor rather than self-diagnose yourself with anything.  Another thing you should pick up from the hoopla surrounding these articles based on a study is that the authors are trying to get clicks, they're not trying to be accurate.  The title Gluten sensitivity doesn't exist is likely to grab more attention than Gluten sensitivity exists but maybe less than we thought because it will grab the attention of both people who have already decided it doesn't exist and people who have benefited from a gluten free diet.  More clicks equals more $$$.  It doesn't help that so few people even check the sources these authors cite in their work.

The final thing you should take home is that we are in the embryonic stages of gluten research, a knee jerk reaction based on a few bloggers' incorrect opinion of a study that didn't show what they say it showed isn't going to change the science.  All it does is give you an incorrect opinion that goes against what the research and MDs working in this field are seeing on a day to day basis.  Spreading it on social media without checking that it's accurate only increases the confusion and doesn't do a service to anyone.

As the research progresses I'm sure there will be further refinement since the criteria for diagnosis is so crude.  This means that some people who are undertaking a gluten free diet may learn that gluten isn't a problem and their issue may be a much simpler fix that will allow them to eat foods they thought weren't right for them.  I don't see how that's a bad thing, even if you don't want to eat gluten regularly I don't see why having the option is something you should preoccupy yourself with.  On the flip side, if you don't believe gluten sensitivity exists, why not pick up some peer reviewed journals and read them?  The internet isn't peer reviewed so any yahoo with a computer can print something and send it out to cyberspace, I'm living proof of that.  :)

Confused about gluten?  The dude who is the go to guy on gluten research just wrote a book that I referenced in this article and it clears up a lot of the confusion about the research.  Take a look...

Gluten Freedom by Dr. Alessio Fasano

Understanding stress: Adaptation to stress

In my last blog I discussed the autonomic nervous system and how the 2 primary branches within it, the sympathetic and parasympathetic branches, prepare the body to deal with stress.  The sympathetic branch acts to mobilize resources to deal with a stressor while the parasympathetic branch works to help the body recover from a stressor so that it can be prepared when the next one comes.  The 2 branches work in concert with one another, albeit in antagonistic fashion, to make sure you are prepared with whatever the environment has to throw at you.  In this blog we will go over the effects of chronic stress and things you may be doing in your life that can exacerbate stress.

To help explain how the animals, including humans, adapt to stress, Dr. Hans Selye developed the general adaptation syndrome seen below.

This figure depicts the 3 phases of adaptation to stress and how an individual's resistance to stress changes over time.  In the first phase, Alarm Reaction, a stressor is experienced and the initial reaction is a decreased resistance to stress.  This is because the stressor startles the person experiencing stress, but this changes very quickly, in the blink of an eye.  In an instant, the sympathetic branch swings in to action to prepare the individual to deal with the stressor leading in to the second phase, Resistance.

During the Resistance phase, the individual has an increased resistance to stress as the sympathetic branch places them on high alert.  If the stress ends before resources are depleted, the parasympathetic branch will begin to swing in to action to help the person recover the resources used during the resistance phase.  You don't typically run in to problems unless the stress is unabating.  Eventually, if the stress is not resolved, the individual will enter the exhaustion phase which leaves them at a reduced ability to deal with stress.  This is where they are forced in to a parasympathetic state.

Now, given the name General Adaptation Syndrome, you may be able to figure out that this is the way the body responds to all stress.  In other words, even if you are able to defeat one stressor, all of the other stress that you are under can still force you in to the exhaustion phase.  In addition, whether the stress is physical or psychological is irrelevant, this same process occurs whether you are fighting off a lion or fretting over whether you can make your mortgage. This system is optimized to work with stress being experienced intermittently, it doesn't work so well when stress is chronic and never-ending.

Given what we know about the 2 branches of the autonomic nervous system and looking at the General Adaptation Syndrome, you can see that being in a sympathetic state day in and day out is not a good place to be.  Eventually your resistance to stress will tank and the slightest stress will set you off and force you back in to the exhaustion phase until you accumulate enough resources to deal with another stressor.  Since the pressures of work and life tend to accumulate very easily, it becomes important to make sure you take the time to incorporate some activities that activate the parasympathetic branch of the autonomic nervous system to help your body recover from the rigors of daily life.

Most people are familiar with the benefits of exercise so they often undertake programs such as weight training, distance running, or some other physically demanding activity to keep healthy.  The problem is, these activities are sympathetic branch activities so they add to sympathetic activity.  There are countless benefits to exercise, so I'm not suggesting you avoid it.  What you should do is incorporate other activities such as yoga, stretching, massage, foam rolling, meditation, or even steam room/sauna heat therapies that increase parasympathetic nervous system activity to help you manage your stress by increasing your stress resistance.

Other lifestyle factors can also have a big impact on your ability to deal with stress via the autonomic nervous system.  Sleep is crucial to helping your body recover from and deal with the stress of everyday life.  One not so obvious activity may also have a pretty significant impact on your ability to deal with stress: Reducing sedentary time.

While you may think of sitting down as a parasympathetic activity, which it is, the issue is actually a little more complicated than that.  While you want to incorporate parasympathetic activities to help you deal with stress, your perception of stress is equally important.  Recent research in inactivity physiology has identified changes in the brain that are associated with a sedentary lifestyle.

In studies done in rats, researchers have shown that high levels of sedentary behavior lead to changes in the brain in an area important to the regulation of sympathetic nervous system activity, the rostral ventrolateral medulla(RVLM)(1).  High levels of inactivity are associated with increased branching of neurons in the RVLM that increase sympathetic nervous system activity(2).  This increased branching of nerves would theoretically increase sympathetic nervous system activity for a given stressor and likely lower the threshold at which sympathetic nervous system activity is increased leading lower stress resistance and a shorter time to the exhaustion phase.

This shows that the relationship between stress and health is not about keeping stress as low as possible, but more about experiencing a sweet spot for stress that is neither too low nor too high.  This means that you want to balance activities between sympathetic and parasympathetic activity dominant, not drop sympathetic activities as low as possible while increasing parasympathetic activities as high as possible. This means that most people will have to increase parasympathetic activities such as yoga and meditation while reducing stressful activities through stress management and potentially even reducing intense exercise in Type A personalities, but not always.  The important concept to grasp here is to find balance between the two.

Understanding stress: The autonomic nervous system

Over the last 2 blogs I have gone over stress and how it affects the body.  Stress is one of those things that many people have heard about and few understand.  Over the course of the next couple of blogs I will break down how stress is handled and things that we do in our lives that can lead to mismanagement of stress.  First, to get a better understanding of how stress affects the body, it's important to understand a part of your peripheral nervous system that controls mostly involuntary functions such as heart rate, breathing rate, bood pressure and digestion called the autonomic nervous system.

Autonomic Nervous System 101

The autonomic nervous system is the control center of your vital organs.  It helps prepare the body for the environment it 's in by directing resources to the most pressing needs.  It does this through it's three branches: The sympathetic, parasympathetic, and enteric branches.  It used to be broken down in to the sympathetic and parasympathetic branches until it was learned that the enteric branch, which controls the digestive system, can function without assistance from the parasympathetic branch.  Since we know very little about the specifics of the enteric branch outside of how it's controlled by the sympathetic and parasympathetic branches, we'll simply consider those 2 branches.

The sympathetic branch of the autonomic nervous system is also referred to as fight or flight.  When sympathetic nervous system activity increases it diverts blood flow to muscles and away from the organs of digestion, increases heart rate and blood pressure to increases oxygen to muscles, and mobilizes energy for use to either fight or flee a stressor.  The parasympathetic nervous system directs blood flow away from muscles and towards the organs of digestion while decreasing heart rate and blood pressure.  The parasympathetic nervous system is referred to as rest and digest.  The picture below shows the primary functions of each branch.

Looking at this figure, it would be easy to think of the 2 branches as being antagonistic to one another, but that isn't the whole story.  While the effects of increased activity of each system is antagonistic of the other, they are actually complementary to one another in the grand scheme of things.  While fight or flight allows you to battle a stressor in the environment, rest and digest allows you to recover from that stressor and be prepared for the next.  In this way, proper function of one branch is dependent on proper function of the other.


The sympathetic and parasympathetic branches also have other effects throughout the body, but they are much more nuanced.  During the initial stages of increased sympathetic nervous system activity, the immune system is enhanced, but if sympathetic nervous system activity is increased chronically, it has a depressive effect on the immune system.  This is thought to be one of the processes underlying the increased inflammation found in the metabolic syndrome and heart disease.  In the reproductive system, increased parasympathetic activity promotes erection while increased parasympathetic activity induces orgasm.

At any time, most people are at varying degrees of both sympathetic and parasympathetic activity.  The autonomic nervous system doesn't function in an on/off manner; when sympathetic nervous system increases it doesn't completely shut off parasympathetic activity.  Instead, they are both typically activated to some degree with increased sympathetic activity typically causing a decrease in parasympathetic activity and vice versa.  Under extreme circumstances in either direction, one can  basically be forced in to the other due to dysregulation in the system.  In other words, if someone is under constant, unabating stress that is never recovered from due to poor parasympathetic "tone", they will be forced in to a long term parasympathetic state.  In converse, someone who completely removes stress and physical activity from their life is likely to see a lowered threshold for activating the sympathetic nervous system.  In other words, things that pose a minor threat are handled as major ones.

Conclusion

The autonomic nervous system is comprised of three branches with opposing, but complementary, functions that allow us to adapt to the environment we are in.  Increased sympathetic activity prepares the body to respond to a stressor while increased parasympathetic activity helps the body recover from it.  Under normal circumstances, the sympathetic and parasympathetic nervous systems work together to help you respond to the world you live in.  Under extreme conditions, the autonomic nervous system can become dysregulated making the individual's response to the environment exaggerated and maladaptive.

In my next blog I will go over how lifestyle factors can contribute to dysfunction in the autonomic nervous system.