Saturday, February 21, 2009

Talking Sports Nutrition at University of Akron with Lonnie Lowery

Every time I fly on a plane, I get this song stuck in my head: "I'm leaving, on a jet plane. Don't know when I'll be back again.."

Well, except, in this case, I know when I'll be back.

Tomorrow, I'm flying to Ohio to speak at the University of Akron's sports nutrition event, on Monday Feb 23rd, entitled "New Directions in Sports Nutrition" . I'll be back Monday night.

I was invited by Lonnie Lowery, PhD, RD, who's a good friend and great colleague. I've known Lonnie now for 7 years (we met at Sports Nutrition Event in Chicago in 2002), and discovered we both have a secret love for the science of dietary fats. I guess it's not so secret anymore..... :)

The title of my talk is "Food, Exercise and Your Period". I'm touching on the serious and widespread condition known as the Female Athlete Triad. In my talk, I'm bringing more attention to the fact that athletic menstrual disturbances affect more than 5% of college women, with most of those women being college athletes.

The reason why menstrual problems are such a problem is because they are a sign of low estrogen, excess stress and energy deficiency. These issues then lead to other more serious problems such as low bone mass, increased risk of cardiovascular problems, and clinical eating disorders. All of these things are not what any woman needs, athlete or non-athlete.

Thus, making more women aware of this cluster of metabolic disturbances will help them to prevent it. And, it is highly preventable with an energy sustaining diet and proper stress management.

For more information on this topic, please visit this great site: The Female Athlete Triad Coalition

Also, if any of you are in the Akron area, try to attend the event if you can. It's on a Monday from 8 to 5pm on the UAkron campus.

Have a great week!

Tuesday, February 10, 2009

Diet and recovery following appendectomy

Hey Readers,

As you've come to learn, I'm slightly glued to my recent appendectomy. Well, today, a reader, Cecilia, posted this comment here, and I thought I'd share it with you all:

Hi Cass, I came out of hospital recently after three blind dates as my appendix ruptured, too bad the surgeons were ugly, obnoxious and married.

I had a dementia patient opposite me and a couple of antiques in my ward, it was a colourful 16 days to say nonetheless!

Could you tell me a little bit more about your diet and how its going? I'm having to do a bit of research on it myself and frankly do not know what to eat!

Rest well and don't do anything stupid! From the expert herself, Cecilia

Thanks Cecilia, I'm so sorry to hear that your appendix ruptured and that your doctors were not able to catch it in time. I hope this doesn't delay your travel plans too much (she's traveling around the world in 80 days! How cool is that? Will you take me with you, Cecilia??)

Anyhow, for me, this is what happened following my appendectomy:

I woke up from the surgery shaking like a cold dog in a winter storm. I also had spiked a fever of 105F! My gut still hurt just like it did prior to the surgery, but I hoped that would pass.

I slept pretty bad the whole night, but wanted to get out of there as soon as possible. Since I was determined not to pee in a bedpan, I made myself get out of bed, just hours after the surgery to use the toilet. I remember asking a nurse to help me out at about midnight and she thought I was crazy. Despite massive pain and absolutely no strength I made it up and to the potty.

The next day, I kept getting out of bed as often as I could until I could go home in the afternoon. I felt like hell and soooo bloated, but I wanted to recover fast. I ate first thing that morning, and had lunch that afternoon.

When I got home, all I wanted to do was do a #2, but nothing was happening. My gut looked so bloated, but nothing would come out. It stayed like all the way into late the next day. I took laxatives and everything else I could think of (magnesium), but nothing would move. I then had to resort to enemas, which was no fun.

This bloating and constipation lasted for three days, and then things started to move. I still stayed distended, but at least things were coming out.

Apparently bloating after surgery like this is common due to the retention of water in a previously inflamed area. It took a week to finally go away, but now I'm normal. So, if following your surgery, you look two months pregnant, don't be surprised.

For diet: I ate pretty normal right away. But, as I mentioned before, I started to follow a blood type diet plan. For me, this meant no red meat, tomatoes, cow's milk, oranges, vinegar, but plenty of poultry, fish, grains, pineapple, grapefruit, and vegetables. You can read more about that here:
The only thing I don't do is eat soy and nuts, which are supposed to be good for Type As. I'm allergic, so I eat the foods that I can tolerate and have been doing good.

I spoke with my homeopath after my surgery and he recommended tomato juice and soaked flax seeds to get things moving. Both actually did work initially, until I decided to avoid tomatoes and then just stuck with the flax.

Other dietary things I've done are to limit my whey protein intake as it's from a cow's product. Instead, I found goat's milk protein, which has almost the same protein content and use that to make smoothies with berries, hemp seeds and flax oil. I also take 6grams or more of fish oil per day and use glutamine to help the healing process (either drink it straight or in a smoothie)

For exercise: I was going crazy after the surgery and was actually in the gym by Tuesday morning (the surgery was Friday night). I did things such as pull-throughs, front squats, hip-pops, and some overhead pressing. I couldn't hold a plank or do bench press for the life of me, and even the front squats were a bit brutal. I was also quite sore when I got home. My PT friend Jonathan Fass was pretty mad at me for doing all this, but I'm a stubborn woman, and had to give it a go. Even still to this day, I'm weak in the core, and have issues doing lower flexion abdominal work. I also have little exercise tolerance. But, I've been working out as hard as I can about 4 days a week in the gym for about 45 mins to an hour each.

The best thing I've been doing is to do a lot of long walks with my dogs outside in the snow. It's a great workout and then I come home and do whatever core work my body will allow. This also helps me stay home so I can write my dissertation.

Anyhow, each person is going to be different. The best foods for me might not be the best for you. Listen to your body. If something gives you gas, makes you bloated, or makes you tired, it probably isn't the right thing for you. Try to stick to the most natural form of a food possible. The least amount of added ingredients, the better.

Drink lots of water and sugar-free fluids. If you're really "stuck" in the gut, try soaking 2 Tbsps of whole flaxseeds in water over night and drink it in the morning. It'll have you moving in a few hours :)

Hope this helps.

Friday, February 6, 2009

Appendicitis Hypothesis

(<--- Picture of my lovely new scar)

Following the removal of my appendix last week (an appendectomy), I was determined to understand why my appendix became inflamed.

Given that my diet is fairly well-balanced, and contains mostly fresh, organic, unprocessed, and minimally preserved foods, I was intrigued to know just what went wrong.

The surgery I had was not laproscopic, so I now have a new 2-inch incision below the right side of my belly button. The cut was also temporarily held together with staples (picture above of the actual incision on my belly), so I had to get them removed after 7-10 days. The visit with my doctor to do the removal was this past Tuesday, and it was then I asked him what caused my appendix to go crazy on me.

He explained that the cause was likely a fecal lith (a small stone-like ball of poop basically; the name is similar to gall stones which are correctly called chollithiasis). This ball could have formed for numerous reasons, but whatever caused it, the ball obstructed the opening of the appendix. Since there is only one way in or out of the appendix, the organ became upset, over-run by stagnet bacteria and then, Ta-da!, it turned into appendicitis. Since many doctors don't take the time to figure out what caused the appendicits, this is what they decide to be the most likely cause. In my case, they didn't try to figure it out either; the surgeon just saw dollar signs and his next vacation.

The appendix is one of those structures in our body that don't really have a purpose anymore. There may have been a role of it with out ancestors, but in today's age, it really does nothing for us at all.

One of my friends, Roland, sent me this message the other day regarding a hypothesized cause of appendicitis:

When I was a kid, I watched a show where they sent people out to the boonies to live like our ancestors might have. Tons of raw veggies, found grains and seeds, plus what meat they could hunt/catch. Several of them developed appendicitis. The theory was that the appendix once provided some enzyme or something to help with the additional fiber and tough to digest elements of our diets back then. No longer needed, the appendix has withered. The harsh diet triggered it to start producing, but at that tiny size, it's not up to the task and took a beating. Poor appendix...

This theory about the cause of appendicitis is very interesting. It does make logical sense, but in my case, with my high fiber diet, I should have developed this years ago. Not saying it's wrong, but maybe not so in my case.

The poop-stone theory does seem plausable. Due to all the fiber in my diet, my stools are well-formed. Thus, it would be easy for a small amount to become lodged in the opening of my appendix (yes, poop talk is both gross and cool, but we have to accept that it's a natural part of our lives... and should be everyday). However, in my scans of the literature on Pubmed and Web of Science, I've read that many pathologists don't feel that fecal obstruction or some other obstruction is the primary cause.

For example, this document by Carr NJ in the journal, Annals of Diagnostic Pathology, 2000, states:

Although acute appendicitis is frequent, it is subject to common misconceptions. Furthermore, there is little good evidence to support some of our beliefs. This report reviews the role of the anatomic pathologist in diagnosis when acute appendicitis is suspected clinically and discusses what is known of its pathology. The conclusions that can be legitimately drawn from the literature are emphasized. A classification is proposed that incorporates intraluminal inflammation, acute mucosal inflammation, acute mucosal and submucosal inflammation, suppurative (phlegmonous) appendicitis, gangrenous appendicitis, and periappendicitis, and the significance of each of these diagnoses is discussed. The etiology and pathogenesis of acute appendicitis is reviewed. Contrary to popular belief, the best evidence indicates that obstruction is unlikely to be the primary cause, at least in the majority of cases. Ancillary techniques in the diagnosis of appendicitis, including laparoscopy and peritoneal aspiration cytology, are discussed.

His discussion goes over the other more likely causes of appendicitis such as acute (sudden) inflammation in the middle of the colon, in the mucus membranes of the colon, in the membranes of the appendix, and deterioration of the walls of the appendix, among others.

Similarly, a 1983 article by Scandavian researchers stated:

The role of obstruction of the pathogenesis of acute appendicitis was studied by measuring the pressure in the appendix peroperatively in 33 patients undergoing appendectomy because of suspected acute appendicitis. The technique involved insertion of a fine needle via the apex into the lumen of the appendix and measurement of the hydrostatic pressure required to inject a saline solution. In all six patients with gangrenous appendix and in two patients with phlegmonous appendix there were signs of obstruction of the appendix lumen expressed as raised intraluminal pressure. In 19 patients found at operation to have phlegmonous appendix there were no signs of obstruction. The experimental data suggest that obstruction is not an important factor in the causation of acute appendicitis, but may develop as a result of the inflammatory process.

Other articles I read on this topic listed malrotation of the appendix as a cause, hernias or andominal wall defects as another cause, and then inflammation secondary to other bowel diseases like chrohn's and cholitis.

When the appendix is biopsied, the inflammation is often a result of bacterial overgrowth, and the most common bacteria is E.Coli. This bacteria lives in our bowels normally, so if they ever had a chance to overgrow in the appendix for whatever reason, this would send someone to the hospital.

Since I'm not an expert on the pathology of the appendix, and in the articles I read on the topic there was no clear answer, it doesn't seem that we (I) can assume one theory or diagnosis over another in any one case.

In my case, the cause may have been bacterial, leading to inflammation. I've been known to have bacterial imbalances that I've not been able to totally control or prevent. I do what I can to maintain a healthy flora in my gut, such as using high-qualtiy probiotics such as VLS#3, Align, and Saccromyces boullardii on a daily basis, obstaining from any alcohol and avoiding sugar. But, I'm not 100% balanced in this case.

My diet prior to the appendicitis may have also not been most ideal for preventing bacterial growth. Vinegar and vinegar-containing foods are often shown to encourage pathogenic bacterial growth in the gut. I'm known as a ketchup, mustard and salsa-aholic because I cover my food in these dressings (I used Carb One Ketchup though). I also love, love, love salads and use many vinegar and olive oil emulsions to dress them up. Thus, my addiction for these foods may have been my down fall.

As I spoke of earlier, as per my blood type (Type A), these foods are highly contradicted. I tried to abstain from them before, but they call my name. However, since the surgery and my attack, I've not used a drop of any. It's been a bit hard, but I'm getting used to it. I'm hoping this will help out my gut, and prevent anything else from arising.

Some people asked what evidence I have for Blood Type dieting, and I'll admit, there isn't really much out other. But, you can't prove everything in the lab, and with the loads of inaccurate and poorly run science investigations out there, it's hard to trust something just because it's published in a journal anyhow. Thus, I'm going with Blood Type dieting for the time being based on instinct. It feels right and it makes sense (for example, Type As are supposed to avoid bananas, oranges, and cow's dairy and those are two things I hate anyhow, but was experimenting before my appendicitis.). I'm not saying it's the end-all answer, but it can't hurt to give it a try. It contains all the nutrients I need to function properly, and I'm not omitting something my body needs essentially.

Overall, it's hard to completely accurately say what caused my appendicitis, or any of the millions of cases that occur each day (the surgeon who removed my appendix told me he removed three others that same day). It may be a function of the appendix not having the ability to keep up with our re-occuring high fiber intake, or it may be bacterial imbalances that are specific to each person. It may also just be obstruction. Whatever it is, I'm glad it's over with and hope others don't have the same thing happen. My recovery is still in progress... cut abdominal muscles don't heal fast enough :)

Sunday, February 1, 2009

Dietary Sabbatoge

Today it's Super Bowl Sunday, when most Americans (and some Canadians) sit down to hoards of high calorie food items washed down with beer or regular soda.

This whole event reminds me that almost every month in our country (America), our efforts to eat well and exercise regularly are sabbatoged by holidays, sporting events and parties.

Just think about it,

In the past 4 months, we've had the following food-centered activities to manage:

Halloween - either the trick-or-treating or the parties will get you

Thanksgiving - we all know the eating starts at 11am and doesn't stop all day

Christmas - from the baked goods to the gift-wrapped candies and chocolates to the Christmas dinner, we all know we're destined to put down some blubber

New Years Eve - the champagne and the late night eating doesn't do anyone's waist-line a favor

Super Bowl in January - wings, dips, cheeses, crackers, sausage, beer.... what more can you say?
Next month, we've got Valentine's day, centered around an evening meal at some over-priced restaurant, followed by something covered in chocolate.
The following month is St. Patty's Day rich in green beer, corned beef and hash (gross...) and green cookies or candies.

After that, there's Easter and we all know that means a basket full of chocolates followed by a morning brunch of some high-calorie casserole and bacon.
No wonder American's have a hard time maintaining a healthy weight. Some how along the line, the country (marketers...) decided that food had to be the center of each holiday and party event. And not even good food! It was high calorie, high-sugar and fat and totally low in nutrients. But why?
Can't we celebrate a holiday or special day without food? Or, if it's food, at least make it healthy and nutritious like hummus with fresh cut vegetables, all-natural turkey sausages and whole grain pilafs, like quinoa with parsley, olive oil and lemon juice? Then, pair this day with a group activity, like volleyball, soccer, baseball, mountain biking, hiking cross-country skiing, skating, etc. The possibilities are endless.
The bottom line is that we can enjoy holidays and events just like everyone else, but we should try to shift our focus from eating horrible foods to enjoying the day with friends, accompanied by healthy foods and a fun activity.
Change the way you celebrate and your belly will love you. You won't need a Flat Belly Diet or an Abs Diet either, you'll just constantly maintain a healthy weight and always enjoy being happy and active. It's not that hard and it can be done. Influence those around you to do the same, and they will figure out that it is good for them too.
Have a great day!