Sourdough – Safe for Gluten Sensitivity?

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There’s something special about sourdough bread. Made through a slow process that begins with simple ingredients, warm water and flour, yeast and bacteria feast on the flour’s carbohydrate, producing carbon dioxide gas and bubbles that expand the dough. Each batch may tastes a little different depending on the flour and water used as well as the environment the starter is made in. My favorite sourdough bread, the kind that is made over the course of several days, has an alluring pungent, slightly sour taste. This long fermentation process leads to more complex flavors while also creating bread that is easier for those with gluten sensitivity to digest. I shared the science behind sourdough in this segment on Fox TV:

What is Gluten?

Gluten’s stretchy fibers give dough it’s rubberband-like elasticity allowing it to stretch when pizza dough is tossed in the air like a frisbee. Gluten-rich dough traps air and water during the baking process so bread rises with delicate ease, producing light and fluffy baked goods. Without wheat (and therefore gluten, which is produced when wheat flour is mixed with water), gluten free items require a blend of flours, starches and additives yet they still can’t replicate the texture of gluten-containing baked goods.

In people with celiac disease, an autoimmune digestive disease, repeated exposure to gluten damages villi, fingerlike projections in the small intestine that help us absorb nutrients from food. Over time, a decrease in nutrient absorption can lead to anemia, osteoporosis, miscarriages and other complications. The University of Chicago Celiac Disease Center website lists over 300 symptoms associated with celiac disease though anemia is the most common symptom in adults. The only available treatment is a strict gluten free diet – which helps reverse intestinal damage over time. Gluten sensitivity is not an autoimmune disease but instead a vague medical condition without a uniform definition or diagnostic test at this time. People with gluten sensitivity report various symptoms triggered by the ingestion of gluten-containing foods including abdominal pain, bloating, and constipation or diarrhea. Though gluten sensitivity is real, someone who thinks they have sensitivity may actually be reacting to something other than gluten (another protein or the starches – see below under Is it the Gluten?)

Sourdough bread

The Science behind Sourdough

Standard yeast leads to a fast fermentation process. This ramps up production speed and it is also foolproof so companies can produce batches of bread at warp speed. Sourdough bread is made slowly, over time, letting the yeast work it’s magic to deliver an array of flavors as well as bread that is easier to digest. In one study, sourdough bread made with selected sourdough lactobacilli and long-time fermentation resulted in bread with gluten levels of 12 parts per million (ppm), which qualifies for gluten-free (anything below to 20 ppm is gluten free). A long fermentation process allows bacteria and yeast adequate time to feed on proteins and starches breaking them down into more digestible parts. Yet sourdough also boasts a lower glycemic index than many other types of bread (including white bread) and therefore it doesn’t lead to a quick spike in blood sugar levels.

In 2011, a small study conducted in Italy tried giving volunteers with celiac disease a small amount of specially prepared sourdough bread. The bread was fermented until the gluten was broken down to more easily digestible parts. The subjects in the study reacted well to the sourdough, with no changes in intestinal villi and no detectable antibodies typically found when a celiac disease patient eats a gluten containing food. According to the study authors, the bread “was not toxic to patients with celiac disease.”

In another study, conducted over 60 days, baked goods made from hydrolyzed wheat flour, manufactured with sourdough lactobacilli and fungal proteases, was not toxic to patients with celiac disease. Though these studies are groundbreaking, it is far too soon for celiac disease patients to try this at home. For sourdough bread to be an option for those with celiac disease, a uniform production process would need to be established to ensure the end product is gluten-free.

For those with Gluten Sensitivity, Is it Really the Gluten?

Some people may experience bloating and flatulence in response to FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). FODMAPs are a type of carbohydrates that are not well absorbed in the small intestine and are present in bread along with a number of other foods (other grains, some vegetables and fruits). In some people the problem may be FODMAPs, not gluten. The long fermentation process reduces FODMAPs.

How to Make Sourdough at Home

Sourdough starter begins with flour and water that sits for several days while being fed intermittently with both flour and water allowing bacteria (lactobacilli) and yeast to grow and multiply creating live cultures. These microorganisms are what makes the dough ferment similar to the way milk ferments to become yogurt. Check out these recipes to make your own sourdough bread: Healthy Aperture, the Perfect Loaf.

If you run into problems making sourdough check out this page for troubleshooting.

 

 

Meal Planning Made Easy

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salmon with veggies

If you don’t have the luxury of eating in a cafeteria with a variety of options each day, it makes sense to plan your meals ahead of time. Doing so will save you time and money. If saving money doesn’t entice you, consider this: eating at home can help you lose weight. A study published in the Journal of the Academy of Nutrition and Dietetics found the average meal at 360 restaurant dinner meals examined contained 1,200 calories. If you choose to dine at an American, Italian or Chinese restaurant, that meal may cost you a whopping 1,495 calories. Don’t worry, I have no intention of having you replicate the instagram photos from fitness buffs who eat perfectly portioned bland-looking chicken, broccoli and brown rice twice a day, every day. Instead, I am an advocate for taste, variety, and better nutrition. Here are the 4 steps you should take to start planning better-for-you meals ahead of time:

1 – Take Inventory

Go through your cabinets, refrigerator and freezer at least once per month and throw out anything that is past it’s expiration date, freezer burned, molded, and stale or smells bad (smell your cooking oil too and if it doesn’t smell normal, toss it). Half-eaten anything that is more than a day old? Trash. This is also a great time to take inventory of what you have on hand.

2 – Stock Your Kitchen

After taking inventory, decide what you need (sticking to your grocery list will save you from impulse buys you don’t need after looking at your grocery store circular). Essential foods include shelf stable, refrigerator and frozen foods. I like the option of preparing a meal in 5 minutes or less. Frozen and canned items allow me to do this.

Shelf Stable:

  • Beans, lentils and legumes (tip: some lentils can be soaked for just 40 minutes and added to a wide variety of dishes from salads to spouse, stews and grain-based dishes)
  • Bread
  • Canned vegetables, beans, fish and chicken
  • Condiments including chicken, beef or vegetable broth, mustard, hot sauce and any other commonly used condiments
  • Cooking oil – get good quality cooking oil. Pay more for a brand you trust. Olive oil is the most adulterated food on the market so you do get what you pay for.
  • Nutrition bars
  • Nuts, nut butters and seeds (all can be refrigerated; opened nut butters should be refrigerated)
  • Popcorn, whole grain snacks
  • Protein powder
  • Rice, pasta, whole grains, cereals and other similar foods. Grab a few options that you can make in a just a few minutes including couscous. Also, vary your rice, pasta and whole grains – look for black, red or purple rice, bean pastas and more.
  • Soups (boxed, bagged or in cans)
  • Spices & seasonings (including salt and pepper). If you don’t use these regularly get dried spices or refrigerated spices in squeezable tubes.
  • Ziploc bags – these will come in very handy if you travel (always pack food and supplements to go)!

Fresh:

  • Dairy (milk, yogurt, cheese)
  • Eggs (consider egg substitutes for their shelf life)
  • Fresh vegetables and fruits
  • Fish, poultry, meat

Frozen:

  • Fish, poultry, meat
  • Fruit
  • Vegetables

3 – Menu Planning

There are a number of ways you can approach menu planning but one of the easiest ways is to center your meals around the protein rich foods you plan on eating. So for instance, if you choose chicken, lean ground beef and fish, you can center 7 meals on those three proteins. Or, if your week is hectic and you are very busy, you can plan meals around protein-rich foods that take just minutes to prepare such as canned tuna, eggs and rotisserie chicken.

After you pick your protein rich foods, decide on recipes or quick prep meals. You might want to do this by determining what perishable foods you have on hand and need to use. So, let’s say you have mushrooms in the refrigerator and chicken defrosting. If you don’t feel like eating chicken Marsala but you aren’t sure what else you can make with a little flavor, type these words in Google to get other meal ideas “chicken, mushrooms, recipe, quick, easy.” (Also check out Cookinglight.com’s “5 Ingredient Cookbook, Fresh Food Fast”)

After determining which meals you are eating each day of the week, write a shopping list by figuring out any extras you may need to buy and what staple foods you are out of. Be flexible with your list depending on the season and sale prices. Shopping in season often means you will not only get the best looking produce but you will save money too. So for instance, if your recipe calls for sweet potatoes but butternut squash is a steal – go for the squash.  When you make your shopping list, you can do it on an app, in the notes section on your phone, or the old fashioned way with pen and paper. I make mine in the order of the grocery store I am shopping in so I can cross items off one by one without having to scan the entire list to make sure I’m not forgetting something before I move onto the next section of the store.

If the weekly circular tempts you with sugary cereals, cookies and candies on sale, don’t pick it up. You won’t miss out on a bargain because you’ll figure out which healthy foods are on sale when you look for the items on your list – all stores flag these items for you.

Quick sample meal ideas:

  • Rotisserie chicken, 10 minute brown rice (or thawed and microwave brown rice from your freezer), frozen veggies
  • Rotisserie chicken wraps with hummus (spread the hummus on first) and any crunch veggies you desire (shopped carrots, cucumbers etc.)
  • Whole-wheat pasta, spaghetti sauce and frozen turkey meatballs with added veggies such as cooked (or steamed) mushrooms, squash, zucchini
  • Whole wheat pasta, canned tuna, light cream of mushroom soup (either made into a casserole and baked along with frozen peas, ½ cup milk and chopped onions at 400ºF for 20 minutes or you can heat up the soup and mix the ingredients together and eat it.
  • Canned tuna, light mayo, chopped celery and onions for a tuna sandwich.
  • Grilled salmon drizzled with lemon, asparagus and a sweet potato.

4 – Storing and Packing

You can freeze almost any food and reheat it easily. Even brown rice – just cook it, let it cool completely and portion it into zip-loc bags (make sure no air is in the bag) for later. Two important things to remember when freezing foods – freeze them in airtight containers and label them so you know what you made and when it was frozen. The longer you leave food in the freezer the greater the likelihood of texture and taste changes over time (sometimes resulting in freezer burn). Foods that freeze well include:

  • Breads
  • Canned foods (once out of the can of course)
  • Casseroles (keep in mind that mayonnaise and other cream sauces do not freeze well)
  • Egg whites (raw)
  • Grains, cooked
  • Granola (homemade or store bought)
  • Herbs, fresh
  • Nuts, seeds (these should not be kept opened on shelves for long periods of time as they can go rancid)
  • Cheese – some types freeze better than others
  • Fish, poultry, meat (raw meat and poultry freezes better than cooked meat and poultry because of moisture lost during cooking).
  • Fruit, though this must be completely dry and frozen in portions (unless you want it stuck together in big clumps). The texture may change so fresh fruit that is frozen may be best used when blended in shakes.
  • Sauces
  • Soups, stews, stock
  • Yogurt – if you want to eat it frozen. If it defrosts the consistency isn’t so great.

Thaw food in the refrigerator, a microwave or immersed in cold water only (in a leak proof plastic bag submerged in the water that should be changed every 30 minutes), not out on countertops or in kitchen sinks.

Recommended Freezer Storage Time (for quality only, frozen food is safe indefinitely if left frozen).

Food Months
Bacon and Sausage 1 – 2
Casseroles 2 – 3
Egg whites or egg substitutes 12
Frozen dinners 3 – 4
Ham, hotdogs, lunchmeats 1 – 2
Meat, uncooked roasts 4 – 12
Meat, uncooked steaks or chops 4 – 12
Meat, uncooked ground 3 – 4
Meat, cooked 2 – 3
Poultry, uncooked whole 12
Poultry, uncooked parts 9
Poultry, cooked 4
Soups and stews 2 – 3
Wild game, uncooked 8 – 12

See, that wasn’t so tough! Get started planning, preparing and cooking right away. If there are a limited number of dishes you feel comfortable cooking, check out quick and easy cookbooks or resources on line. Each time you try a new recipe you’ll expand your horizons and taste buds and also be able to prepare a wider variety of meals on the fly in the future.

References
USDA. Freezing and Food Safety. http://www.fsis.usda.gov/factsheets/focus_on_freezing/

 

Do Carbohydrates Make You Fat?

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When I was in college I would often eat 3-4 bagels per day (free from the cafeteria and portable), along with cream of wheat in the morning, fruit and/or starchy veggies at lunch, heaping quantities of brown rice at dinner, and a bowl (or two) of Raisin Bran with milk after dinner. I wasn’t on an all carbohydrate diet, I ate all of this in addition to regular meals . As a cross country runner, I was just plain hungry. Despite my high carb diet, my body fat via underwater weighing (the benefit of being an exercise physiology student) was very low, as in elite distance runner low. So when I hear people suggest carbohydrates are a surefire path to obesity for everyone, I shake my head and think “no, clearly they are not.”

Carbohydrates have taken a hit in recent years because 1) they taste good and are therefore easy to overeat (Which one tastes better: a jumbo size blueberry muffin or grilled chicken breast?) and 2) carbohydrates stimulate the release of insulin from our pancreas, a hormone that increases carbohydrate (in the form of sugar) uptake by muscle and fat cells while also suppressing the breakdown of fat tissue. Sounds like a double whammy right? It definitely can be if you chronically overeat. But, if you only eat the amount of calories you need each day or less than you need over time, you’ll maintain or even lose weight (in the absence of Type 2 diabetes or insulin resistance). And that is why the weight loss research shows that over time higher carbohydrate diets result in similar weight loss as low carbohydrate diets in healthy individuals. However, there are two big caveats to this “total calories” approach to weight loss:

1) If you don’t eat enough protein each day (and I recommend a minimum of 30 grams of protein at breakfast, lunch and dinner) – 0.55 – 0.91 grams per pound of body weight per day, you will lose a good bit of muscle during weight loss.

2) If you have insulin resistance, PCOS or Type 2 diabetes, a lower carbohydrate diet combined with exercise is the most effective way to take off weight (work with your MD to adjust any glucose lowering medications or insulin you are on based on your change in diet and/or drop in weight).

If you want to read more on this topic including the design of an exciting upcoming study, check out this thorough overview I wrote for FitnessRx.

In the meantime, remember there is no one perfect diet for all people. Are there times I ask my clients to cut down on their intake of carbs (particularly the junk food carbs)? Yes, absolutely. But, I take their overall diet, goals and what they will realistically do into account. And you should too. Because adherence, the ability to stick with a diet program, is the biggest factor that will predict weight loss success. So don’t jump on your neighbor’s diet detox 2 shakes-per-day bandwagon or let yourself be dragged to Weight Watchers meetings while kicking and screaming.  Instead, take into account your current food intake (what do you like to eat?), lifestyle, cooking skills, medical history, diet history and physical activity and come up with a plan that works for you.

The Great Gluten Debate

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Get two passionate Italian scientists in the room and you are in for a show. If the nitty gritty details about mucosal villous atrophy sound about as exciting as reading a manual on how to fix your vacuum cleaner, at least you’ll be entertained by the Cramer Mad Money Style voice inflections, common pop culture references and overly expressive hands gestures that put a non-verbal exclamation point on every sentence!!! The Great Gluten Debate Face-off between two world renown scientists, Stefano Guandalini, MD  from the University of Chicago Celiac Disease Center and Alessio Fasano, MD from the University of Maryland Center for Celiac Research did not disappoint.

Fasano said two things must be present for you to have celiac disease, an autoimmune digestive disease: you have the gene and you consume the trigger (gluten). Celiac disease is under diagnosed – there are many people who have it yet they have no idea that they have celiac disease. Fasano said 3 million people likely have celiac disease but less than 5% have been diagnosed. Some of the symptoms he spouted off at warp speed include:

  • anemia and fatigue – by far the most common symptoms in adults
  • delayed puberty
  • dermatitis herpetiformis
  • short stature
  • dental enamel hypoplasia

A comprehensive list of Celiac disease symptoms is available here.

Initial screening tests often include a celiac panel including a test for Immunoglobulin A, which is 90-98% sensitive and 94-97% specific for celiac disease (sensitivity means this test returns an accurate result in about 90-98% of patients screened).

Gluten is in all forms of wheat including spelt, kamut, malt, couscous, bulgar, triticale, einkorn and faro while rye and barley are related grains. Think of gluten like a long beaded necklace. According to Dr. Fasano, some of the beads (gliadin) stand out and create problems. In a person with celiac disease, the gliadin “beads” are the toxic part of gluten. Celiacs can tolerate a miniscule amount of gluten in their diet, about 10 milligrams. How much is 10 milligrams? Flip over the back of a multivitamin and take a peek at how many milligrams of each vitamin and mineral are packed into that pill or tablet and you’ll see 10 milligrams is next to nothing. Though there are about 400 new gluten free products introduced into the marketplace every year, navigating the maize of avoiding gluten can be a challenge for a number of reasons including cross contamination (French fries cooked in the same oil with anything breaded for example) and food service personnel may not understand how to keep gluten free meals completely separate from regular gluten-containing dishes. Distilled vinegar is gluten free, vinegar that isn’t distilled probably isn’t. Oats are only gluten free if they are processed, handled and packaged in a gluten free facility (otherwise, each step of the way they can be contaminated with gluten). Fasano said Triumph Dining books and apps are very helpful for people who need to navigate gluten-free grocery shopping, cooking and eating out at restaurants.

So, aside from the sheer entertainment value the biggest difference in opinion between Fasano and Guandalini was about grain intake in the normal, non-celiac disease population. Fasano said “modern wheat is a chronic poison,” and “grains are not good for us.” He also mentioned that the Paleo diet is intrinsically gluten free (all Cross Fitters are slapping high fives right about now saying “I knew it!”). Guandalini believes those without celiac disease can easily enjoy their wheat and other grains without a problem. And, he takes his own advice devouring the most delicious Italian bread and gnocchi Chicago has to offer.