As a physician assistant, I’ve seen first hand how the nutritional choices people make on a day-to-day basis are powerful enough to change lives. For example, certain foods may decrease the risk of certain cancers, while others can lower risk of cardiovascular disease. Still others can be used as adjunct treatment for mental health. Knowing which foods are right for you given your health history and wellness goals, empowers you take an empowered and active role  in your own health and wellness. 

The field of culinary medicine has been steadily growing in popularity. There are various programs throughout the country geared to educating practitioners how best to support and guide patients through the choices they face at the grocery story and during meal time. In 2019, Jessica completed her certification as a culinary medicine specialist from the Goldring Center for Culinary Medicine at Tulane University. culinarymedicine.org

Using this certification and more than 10+ of clinical practice as a physician assistant, Jessica educates and inspires individuals through her  SYSTEM/ NAME TBD.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739343/

https://culinarymedicine.org

You may have heard friends or colleagues state they are eating a “gluten free” diet … or have seen the entire grocery store sections or restaurant menus dedicated to gluten free items. And you may be wondering, ‘Should I be eating a gluten free diet’? 

Here is what you need to know. 

First, what heck is gluten? Gluten is a protein found in a variety of grains such as wheat or barley. Items that contain gluten include malt, breads, cakes, desserts, food thickeners or additives, protein bars, crackers, seasoning blends, condiments, and so

many others.  Gluten may even be present by cross contamination with gluten containing items on restaurant work surfaces and deep fryers. 

In my experience, elimination of gluten from the diet is usually due to one of two main reasons. First, in an effort to reduce or resolve symptoms someone may be experiencing. Or secondly, because there is a misunderstanding about gluten containing items and the effect they may have on weight gain or health status. I will explain both below in a little more detail and then offer some ways I can support you 

Reactions to gluten are very real. For some people, gluten may trigger symptoms of bloating, upset stomach, migraine headaches, and even as severe as intestinal damage in those who have Celiac disease. If you are experiencing any symptoms you may believe are related to gluten or are otherwise unexplained, you should seek medical attention as soon as possible. I have outlined three reactions you may experience to gluten below. 

If you are not experiencing symptoms, but rather, have chosen to eliminate or are considering eliminating gluten - keep reading. In my experience, the protein gluten has become synonymous with “processed food”. To that end, many people believe that items without gluten are better for overall wellness. Additionally, many people assume because it is gluten free, it is also free from carbohydrates, additives, or sugar. This is not the case! Let’s look at gluten free pasta as an example. Per cup of standard, wheat spaghetti, there is 200 calories, 1g fat, 42g cabs, 2g fiber, 2g sugar, and 7g of protein.  In the gluten free variety from the same company, where corn is used instead of wheat, there is 190 calories, 1g fat, 44g carbs, 2g fiber, 0 sugar, and 4g protein. You can see the nutrition profiles are quite similar. This tends to be similar with other gluten free items as well. Also, gluten free cookies, cakes, or snacks still contain refined fats and sugars. “Gluten free” does not necessarily equal “better for you”.  But, if you decide to switch from refined pasta and bread to a whole grain variety in an attempt to include

more whole foods in your diet - WONDERFUL! According to an article by Harvard Health, as compared to refined grains, whole grains provide more fiber, B vitamins, and antioxidants. 

Harvard Health has a great article: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/whole-grains/ . Remember to always discuss food choices with your health care

Three Common Gluten- Related Reactions:  

1. Celiac Disease - Celiac disease is an autoimmune disease. This means the body is triggered by gluten and creates an immune response directed toward one's own tissues. Celiac disease is the only known autoimmune disease with a known trigger.  Symptoms of celiac disease vary and present differently in many people. They include stomach pain, bloating, change in bowel movements, headaches, infertility, low nutrition, body aches, amongst others. For diagnosis, a serum blood test and a small bowel biopsy, which remains the most accurate form of diagnosis. Prolonged and untreated celiac disease can cause damage to the intestinal lining. Treatment is patient specific and may include nutrition supplementation and removing gluten from the diet. There are many trusted organizations, like Beyond Celiac, which have great resources and info pages. 
2. Wheat Allergy - A wheat allergy is an allergic reaction to the wheat proteins. This allergic reaction is histamine mediated, similar to other foods allergies like peanuts or shellfish. Treatment includes avoidance of wheat and similar to other allergies, may include carrying an epipen in the event there is allergen exposure. 
3. Non Celiac Gluten Sensitivity - This gluten reaction may be the most confusing of all! Some individuals report reactions when eating gluten but it isn't autoimmune or allergy mediated. We, as a medical community don't actually know why this is but have a few hypothesis. (1) It may be a symptoms of irritable or inflammatory bowel disease. (2) It could be a reaction to another ingredient in the food item. (3) It may be an intolerance to modern day wheat strains, that have been bread to serve the food markets, no the consumer, by being faster growing. (4) It could be from a shortened length of production of breads due quick rising yeast that don't allow gluten and other proteins to breakdown. (5) Added herbicides and pesticides.

practitioner before making any changes.

 Yes, absolutely ! Of course your individual choices should be discussed with your healthcare practitioner for your safety. To that end, here are a few tactics I use when eating at restaurants - whether for business or pleasure!

1. I make sure it isn’t my first meal of the day! Many people fast all day long in anticipation for the meal, then end up overindulging at dinner. Rather, I am sure to have breakfast and lunch and drink enough water throughout the day so I am not ravenous when I arrive at the restaurant. 
2. I limit alcohol consumption. For safety, 1-2 drinks per day for women and men respectively, is the limit we recommend as practitioners to otherwise health individuals over the age of 21 years. Anything more increases risk for disease or side effects. Additionally, alcohol limits your inhibitions, making it more difficult to listen to you body’s hunger and fullness cues. Always discuss how much alcohol consumption is right for your with your healthcare practitioner.
3. If I order an appetizer, I try to choose broth based soups, garden salads, or lean protein, like a seared ahi tuna. These items contain fiber, lean protein, vegetables, and antioxidants so it makes me feel good to know I am getting nutritious items! Additionally, veggies and soups have water that hydrate me and stave hunger pangs, so I can then enjoy my meal with my company and eat with more mindfulness and intention. 
4. I ask for olive oil and vinegar instead of dressing, which is often laden with processed oils, sodium, added sugar, or other preservatives and additives. I enjoy it just as much (I've been known to drink the vinegar at the bottom of the bowl at home!). If you prefer dressing, ask the restaurant to add your dressing on the side. Add 1-2 tbsp and toss together. Studies show when you toss the dressing into the salad, rather than dunking with each bite, overall you use less dressing! 
5. For my main meal, I often look for the main protein to be grilled, baked, broiled, or seared, as opposed to fried. If I am really wanting something fried - I go for it because it isn't something that I am eating on a regular basis. It’s all about moderation and feeling satisfied, not restricted, in my opinion.
6. Instead of mashed or creamed potatoes, I opt for a baked potato. I find the butter and cream added to previous preparations tends to sit ‘heavily’ in my belly and causes me some GI upset, which is a no-no at a business dinner! Instead, I love to eat carbohydrates in their whole food and add butter myself at the and salt at the table. It isn't about resurrection but rather knowing what makes me feel energized and satisfied! 
7. When dinner arrives, I remember mindful eating practices and I listen to my body. For me, the portions at restaurants are HUGE and way more than I can comfortably eat. So I generally eat half. If, after that, I listen to my body and still feel hungry, I will eat more. But usually, I feel satisfied and comfortable, so I wrap the other half to go. Then I have leftovers for lunch the next day!
8. After dinner, I like to enjoy a cup of coffee or tea. This ritual feels like a “close” to a meal. If I am craving something sweet, I often split a dessert with my table mates. Half of anything chocolate is good for my sweet tooth! If there isn't someone to split with or it's a professional meeting, I use the ‘eat half -listen to my body- eat or wrap the rest’ method just like with dinner. 
9. I never beat myself up. The thing is, life is LIFE! Of course, I try my best to make choices I know my physical body will love, but it is also important to indulge my mental health. No matter what I decide to eat, I eat it and MOVE ON. I don't ruminate about it or feel guilty. NO WAY! I am healthy, I feel good, and for me that is more than most people have. All I can do is my best. RIGHT?? RIGHT!

Definitely. Believe it or not, I encounter may people who complain about bloating. The tricky part is, though, that even though bloating is very common, it is not very specific. This means there are multiple causes for bloating, including potential fatal causes - keep reading!

I often recommend starting with a food diary. This exercise alone can sometimes help you tease out the cause for bloating. If you can't discern the cause on your own, then you will at least have some information to bring to a dietitian or healthcare practitioner. In the diary, it is important to log EVERYTHING; food intake, chewing gum, drinks, sleep, stress level, bowel movements - everything! All of this will be pertinent to figuring out the cause of the bloating. 

Some common food causes of bloating may be food intolerance or sensitivity, IBS, stress, irregular bowel movements, sleep disturbances, artificial sweeteners, menses, or eating processed foods.  Bloating may also be a sign of something more severe than food intolerance, like inflammatory bowel disease, liver disease, or even certain cancers. It is important never to brush off bloating as “no big deal”. If it is, in fact, no big deal, let a professional tell you so after a full evaluation and examination. SAFETY FIRST!