Eating Out With Food Allergies

As someone who has multiple food allergies/intolerances, I know from personal experience that restaurants can be tricky.  When you have to avoid a number of common ingredients, eating out makes one anxious

Parents of children with food allergies are understandably more comfortable eating their meals at home.  When they control the ingredients they can be sure their kids are safe.  However, there are a number of strategies that can make eating out safer for both children and adults with food allergies.

There was a poster presented at the American College of Allergy, Asthma and Immunology annual meeting this week in Washington State.  Researchers at University Hospitals Rainbow Babies’ and Children’s Hospital explored strategies used to avoid allergic reactions in restaurants.

They found that those who had never had a reaction used more safety strategies than those who had had reactions.  Once a person had an allergic reaction, they tended to increase their use of safety strategies.  This makes sense, right?  Anyone who has had an allergic reaction is pretty motivated to avoid another one!

The allergens people reported included the most common ones like peanuts, tree nuts, dairy, wheat, eggs and soy.  85% of the participants were children, they were split evenly male-female, and most were white.

Safety strategies varied widely.  The most common strategies included

  • Talking to wait staff, manager and chef about allergies
  • Checking menus and ingredients on the restaurant website, if possible
  • Choosing restaurants that are allergy-friendly or have a low chance of contamination
  • Ordering meals with simple ingredients
  • Double checking with wait staff after food arrives

The researchers found that the more different strategies were used, the less likely reactions were.  They also advised that whenever eating out, those who have food allergies should always bring an EpiPen or similar treatment with them in case of a reaction.

I know from my own experience that eating out with food allergies can be tough.  However, if you or your family member has food allergies, you don’t have to give up restaurant foods.  Simple strategies can make eating at restaurants safer and more enjoyable!

QUESTION:  Do you or a family member have a food allergy?  What strategies do you use to make eating out safer?

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Just What Are Supplements FOR?

My new student and I were talking in the office the other day.  She was surprised (and all my students are, actually) at how often I talk to patients about nutrition.  Usually without my patients really WANTING to hear my opinions about nutrition, LOL!

So we got to talking about the question, “What are supplements for?”  This is something I don’t think I’ve ever put in so many words before.

We know our diets stink.  People eat too much meat, too much junk food, too much sugar.  We don’t get enough whole fresh foods.  Even if we did get all our servings of fruits and veggies (and I try really hard) our foods aren’t as nutritious as they were in the past.

This decrease in the nutrition content of food is generally because of changes in farming practices and because we tend to get our food from far away.  We get peaches from Chile instead of from Georgia.  We get apples from Washington State instead of from local orchards.  And we want to eat apples in June when they haven’t been harvested in over 6 months.

So one of the main reasons I advocate supplementation is to make up for gaps in our diet.  A good quality, comprehensive multivitamin (and yes, Shaklee’s Vita Lea is the best on the market, the one I use and recommend) goes a long way to filling in for days when our diets aren’t the best, or when the food we eat has lost nutrition due to storage and processing.

Other than a multivitamin, what other supplements do we take to make up gaps in our diet?  People under stress tend to use up the B vitamins more quickly.  People who suffer with migraines tend to have gene mutations which make them need more B vitamins.  More than half of us don’t get enough magnesium in the diet.  We eat way too much omega 6 oil, so omega 3 fats from fish oil supplements can help correct that.  And of course nearly everyone needs a vitamin D supplement especially in winter.

These supplements as mentioned above are used from a Functional Medicine approach.  This means we give the body what it needs to function properly, and avoid poisoning it!  Supplements used in this way are generally very safe, and very few side effects.

Giving the body what it needs doesn’t just refer to food.  This includes fresh clean water, plenty of rest and quality sleep.  Practicing our faith and getting fresh air and sunshine, exercise, and time with those we love are “nutrients” as well.  The word “nutrient” comes from the same root as “nurture.”  When we nourish ourselves properly we will be healthier!

And poisons or toxins include pesticides, alcohol and excess sugar but can also include excess stress.  Negative self-talk is toxic.  Smoking, recreational drugs and artificial food ingredients are other examples of things we should avoid in order for our bodies, minds and spirits to be as healthy as possible.

How else can supplements be used?  Supplements can also be used as drugs.  Some examples are St. John’s wort for depression, milk thistle for liver disorders, and red yeast rice for high cholesterol.  These supplements are considered botanical drugs.  They have risks just like pharmaceutical drugs do.  The risks tend to be lower, but the effectiveness is lower as well.  Some supplements can be used either way.  For instance, magnesium in high doses is a very effective laxative and is used for bowel prep before colonoscopy.

How can you tell the difference between a supplement used for a functional medicine purpose and one used as a drug?  It’s pretty simple actually.  Is the nutrient or supplement found in food, and can one be deficient in it?  One can be deficient in magnesium, but there’s no such thing as a milk thistle or St. John’s wort deficiency.

I’d like to use a very current controversy to illustrate the difference.  Right now there are a lot of supplement companies starting to market krill oil as a “better fish oil.”  Early research suggests that the main omega 3 fatty acids in both krill oil and fish oil are better absorbed from krill oil and may influence cholesterol and glucose metabolism in favorable ways when compared to fish oil.

The problem is that krill isn’t food for humans.  We have little or no idea what a safe dose of krill oil would be, or what the long-term effect may be.  There are no studies showing how krill oil supplements affect heart risk or any other health risk in humans.  Fish oil supplements are generally made from edible fish like sardines, tuna or salmon.

So fish oil is a functional medicine supplement, made from a human food that most of us don’t get enough of to balance out the oodles of omega-6 fatty acids in our diets.  Krill oil is not a human food, containing a form of omega-3 fatty acids not clearly understood.  I would therefore classify krill oil as a drug, one that’s not well understood.  Certainly not well enough to recommend regular use.

Before someone recommends a supplement to you, think to yourself whether that supplement is meant to fill a gap in your diet and provide nutrients your body needs to function well.  If not, it is a drug.  Make sure you understand the risks and benefits, because there are always risks with drugs, whether they come from nature or from a factory.  Often the ones that come from the factory are safer because they’re better understood and better studied.

QUESTION: Have you ever thought before about the question “What are supplements for?”  What do you think now?

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Weight Loss Reduces Breast Cancer Risk

Are you tired of me talking about weight loss yet?  LOL!  I just came across yet another reason for women to lose and maintain their weight after menopause.  Weight loss reduces breast cancer risk!

There was an study recently published in Cancer that looked at breast cancer risk in women who gained weight, maintained their weight and lost weight after menopause.  The authors found that weight loss of at least 5% body weight after menopause did significantly decrease the risk of breast cancer over the 11 year follow up period.

In this study, women lost an average of 19 pounds.  While not a small amount of weight, it isn’t a crazy amount either.  They were able to maintain their weight loss for the most part too.

We know that breast cancer risk is higher in women who are overweight and obese.  Since over 1/3 of women in the United States are obese, this is a significant risk factor for breast cancer in this country.  According to NHANES survey data from 2013-2014, 40.4% of women in the US are obese.

Let’s do some math.  Approximately how many American women are obese?  In 2010 (according to census data) there were just under 157 million female Americans.  53.2 million were over 50, and 40.4% are obese.  That’s 21.5 million obese female Americans over age 50.  (Since we’re talking about breast cancer I want to focus on the population most at risk, and the study focused on women after menopause.)

In the study just published in Cancer, they found that 5.09% of women who maintained their weight got breast cancer, and 4.27% of the women who lost at least 5% of their body weight got breast cancer.  That’s an absolute risk reduction (ARR) of 0.82%.  This translates to a Number Needed to Treat (NNT) of 122.  (Remember that NNT = 1 / ARR)  This also assumes that the breast cancer risk reduction was caused by the weight loss.

If 122 obese women have to lose at least 5% of their body weight (and maintain that loss) to prevent one case of breast cancer…

That is over 176,000 women that could be spared breast cancer over approximately a 10-year time frame.  With about 266,000 women diagnosed every year with breast cancer, that’s a 7% reduction.

Will you be one of the women who suffers a potentially preventable case of breast cancer?  Now that you know weight loss reduces breast cancer risk, will you make sure to lose weight and get closer to your ideal body weight?  Your heart, your liver, your brain, your pancreas, your joints, your back, and even your breasts will thank you!

QUESTION: Do the numbers in this article surprise you?

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Surgery Type Matters In Cervical Cancer

Cervical cancer screening is a routine part of women’s health care.  I do Pap tests and HPV screens every week to check for this problem.  Luckily I rarely make a cancer diagnosis (although abnormal Pap tests are fairly common).

Cervical cancer is one of the most common cancers in women worldwide, with over half a million cases diagnosed per year.  About 13,000 new cases are expected to be diagnosed in the US in 2018.  Approximately 4000 American women will die of cervical cancer this year, according to the American Cancer Society.  Women are most commonly diagnosed in their 30s and 40s, but it can happen in women over age 65 as well.

It’s important to realize that this disease is more common in black and Hispanic women, but much less likely to occur in women who get regular screening.  Cervical cancer is preventable with vaccination, regular screening and treatment of abnormal cells found on Pap tests.

Once a diagnosis of cervical cancer is made, surgery is the most effective treatment.  Hysterectomy and removal of lymph nodes in the pelvis is necessary.  What hasn’t been understood until recently is whether the TYPE of hysterectomy mattered.

In this country, most surgery that CAN be done in a minimally invasive way IS done in that fashion.  Laparoscopic and robot-assisted surgeries are associated with less pain, shorter recovery, less blood loss and less risk of infection.  However, recently it has been found that these minimally invasive surgical techniques are actually associated with a HIGHER death rate from cervical cancer.

Two articles (1, 2) published in the New England Journal of Medicine this week showed that open abdominal hysterectomy was much better as far as survival goes than laparoscopic or robot-assisted hysterectomy for cervical cancer.  The number needed to harm in one study was 19 which is really low.  This means for every 19 patients who were treated with a minimally invasive rather than open procedure, one went on to die of cervical cancer who would have survived with the open procedure. In the other study the number needed to harm was 26.

I have two take-home points from this frankly shocking finding.  First, if you know anyone with cervical cancer make sure they know a “keyhole surgery” approach is not as safe as an open procedure.  We can’t assume that an operation that’s right for one condition (like gallbladder removal and appendectomy) is the best for all problems.

The second point is that there needs to be more research done on minimally invasive surgery in cancer patients.  There must be some reason for the difference.  Neither of these studies really addressed WHY there is such a difference between open and minimally invasive operations for cervical cancer.  There are any number of possibilities.  Minimally invasive surgery is as safe for uterine cancer as an open procedure, for instance.

Could it be because cervical cancer is caused by a viral infection?  Or because affected  lymph nodes in cervical cancer are smaller or more subtle or harder to see through the laparoscope?  I really don’t know, and clearly no one else does either.

But with less pain, shorter recovery time, less bleeding and less risk of infection, minimally-invasive surgery is best IF scientists can figure out how to make it safer for cervical cancer patients.  That would be the best result of all.

QUESTION: Do you know anyone who has or had cervical cancer?  What was their experience like?

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