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Phytoestrogens for Menopausal Women

Posted by James on 07/09/2018 | Comment

Menopausal women experience a hormonal imbalance which can lead to a number of different clinical syndromes and disorders (1). Menopause is characterized by a decrease in estrogen, which triggers uncomfortable symptoms such as hot flushes, night sweats, sleep disturbances, vaginal dryness (2), and an increased risk of osteoporosis (3).

Estrogen is a hormone that is naturally produced by your body and plays an important role in managing your reproductive system, protecting your bones, and helping your skin heal. Phytoestrogens on the other hand are produced by plants but are functionally similar to estrogen (2). When we eat foods with phytoestrogens, our bodies may respond as if our own estrogen were present.

Although phytoestrogens can easily be found in legumes, such as soybeans, chickpeas, alfalfa and red clover (4), most American women fail to consume these food items in adequate amounts. Meanwhile, Asian women incorporate higher amounts of phytoestrogen-rich foods into their diet and experience menopausal symptoms less frequently than American women (2,5). Could this absence of symptoms be a coincidence—or could this be due to their phytoestrogen-rich diet?

Various research studies have focused on phytoestrogens as a safe and effective treatment for menopausal symptoms. One study investigated the effects of Femarelle—a natural medication that contains a variety of phytoestrogens derived from tofu— on 631 Spanish menopausal or perimenopausal women. After 4 weeks, 80.7% of patients reported that their hot flushes were ‘better’ or ‘much better’. With that being said, the authors of this study concluded that treatment with Femarelle resulted in a “significant reduction in the number and intensity of hot flushes in postmenopausal women, especially in those with frequent symptoms, and these effects were observed within the first month of treatment,” (3).

Aside from this prospective study, several systematic reviews have also been published related to phytoestrogens and menopausal symptom relief—all of which found a reduction in the frequency or severity of hot flashes in menopausal women (2,5,6).

Although estrogen- and progestogen-based hormone therapy are commonly used as a first treatment option for menopause symptom relief, these treatments have numerous risks (3). According to the Women’s Health Initiative, hormone replacement therapy as a means for alleviating symptoms related

to menopause can increase the risk of stroke and venous thromboembolism, which can inadvertently lead to breast cancer or a heart attack (2).

Instead of hormone replacement therapy, menopausal symptom relief can be treated with a phytoestrogen-rich diet and/or dietary supplementation. If you would like to incorporate phytoestrogens into your diet, here are three Registered Dietitian-approved tofu recipes…

Food, Pleasure, and Health’s Baked Tofu Fries                                            

Wellness Simplified’s Crispy Tofu Meatballs                                                 

The Conscious Dietitian’s Tofu Salad Bowl with Glory Bowl Dressing          

…OR if tofu doesn’t do it for you,

try Femarelle Recharge from epic4health.com.


(1) Rosic S, Kendic S, Rosic M. Phytoestrogens impact on menopausal symptomatology. Materia Socio-Medica. 2013; 25(2): 98.

(2) Chen M, Lin C, Liu C. Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric. 2015; 18(2): 260-269.

(3) Sánchez-Borrego R, Mendoza N, Llaneza P, Sánchez-Borrego R. A prospective study of DT56a (Femarelle®) for the treatment of menopause symptoms. Climacteric. 2015; 18(6): 813-816.

(4) Eden JA. Phytoestrogens for menopausal symptoms: A review. Maturitas. 2012; 72(2): 157-159.

(5) Lagari VS, Levis S. Phytoestrogens for menopausal bone loss and climacteric symptoms. The Journal of Steroid Biochemistry and Molecular Biology. 2014; 139: 294-301.

(6) Roberts H, Lethaby A. Phytoestrogens for menopausal vasomotor symptoms: A Cochrane review summary. Maturitas. 2014; 78(2): 79-81.

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

What does L-theanine have to do with ADHD?

Posted by James on 06/23/2018 | Comment

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders among children—many of whom have trouble paying attention, controlling impulsive behaviors, or being overly active (1).

It is estimated that 5% of US children have ADHD, with 6.1 million in 2016 (2).

The rise of ADHD in young children ages 2-5 is particularly alarming, as rates more than doubled from 2007 to 2012 (2).

Oftentimes, ADHD occurs with other disorders and conditions, such as depression, autism spectrum disorder, and Tourette Syndrome. In 2016 alone, 75% US children with ADHD had at least one other mental, emotional, or behavioral disorder (2).

Causes of ADHD

The cause(s) and risk factors for ADHD are unknown, despite the common, yet inaccurate, belief that ADHD is caused by consuming too much sugar, watching too much television, parenting, or social and environmental factors. However, there is strong enough evidence to show that genetics plays an important role. Other possible causes and risk factors include brain injury, alcohol and tobacco use during pregnancy, premature delivery, and low birth weight (1).

Signs and symptoms

Although most children typically have trouble focusing, children with ADHD have trouble outgrowing such behaviors (1).

A child with ADHD might:

  • daydream a lot
  • forget or lose things a lot
  • squirm or fidget
  • talk too much
  • make careless mistakes or take unnecessary risks
  • have a hard time resisting temptation
  • have trouble taking turns
  • have difficulty getting along with others (1)

Treatment for ADHD   

Treatment for ADHD can include behavior therapy and/or medication. For children 6 years of age and older, the American Academy of Pediatrics recommends both behavior therapy and medication. For younger children under the age of 6 with ADHD, behavior therapy is recommended as the first line of treatment, before medication is introduced (2).

However, every child is unique and may take to a particular treatment differently. With that being said, it is important that treatments are closely monitored (1).

What about L-theanine?

L-theanine is a water-soluble amino acid known to promote a “relaxed, yet alert, feeling at rest” (3). Aside from its ability to reduce stress, anxiety, and blood pressure, L-theanine may also be effective in the treatment of ADHD.

Evidence-based research has shown a variety of benefits from taking L-theanine. It has been shown to have a calming effect when people are under physical and psychological stress, enhance attentional capacity and mental clarity, and improve overall cognitive performance. It has also been found to improve simple reaction time, speed of numeric working memory, word recognition, and accuracy of sentence verification.

A 2011 randomized controlled clinical trial investigated the efficacy and safety of L-theanine as an aid to improving sleep quality among 98 boys, ages 8-12, who have been formally diagnosed with ADHD. Participants consumed two chewable tablets of L-theanine twice daily, totaling 400 mg/day for six weeks. After collecting and analyzing the data, the authors concluded that 400 mg/day of L-theanine is safe and effective in improving some aspects of sleep quality in boys diagnosed with ADHD (4).

Managing ADHD

Although being healthy is important for all children, it is particularly important for children with ADHD. Having a healthy lifestyle can help children deal with symptoms relating to ADHD. According to the Centers for Disease Control and Prevention, healthy behaviors for children with ADHD include:

  • Eating a healthful diet centered on fruits, vegetables, whole grains, legumes, lean protein sources, and nuts and seeds
  • Participating in physical activity for at least 60 minutes each day
  • Limiting screen time from TVs, computers, phones, etc.
  • Getting the recommended amount of sleep each night based on age (1)



(1) Attention-Deficit/Hyperactivity Disorder (ADHD): General Information. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/facts.html. Updated May 31, 2017. Accessed June 22, 2018.

(2) Attention-Deficit/Hyperactivity Disorder (ADHD): Data & Statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/data.html. Updated March 20, 2018. Accessed June 22, 2018.

(3) Owen GN, Parnell H, De Bruin EA, and Rycroft JA. The combined effects of L-theanine and caffeine on cognitive performance and mood. Nutritional Neuroscience. 2008; 11(4), 193-198.

(4) Lyon MR. The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): A randomized, double-blind, placebo-controlled clinical trial. Alternative medicine review. 2011; 16: 348-354.

Barrett JR, Tracy DK, Giaroli G. To Sleep or Not To Sleep: A Systematic Review of the Literature of Pharmacological Treatments of Insomnia in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. Journal of Child and Adolescent Psychopharmacology. 2013; 23(10) :640-647.

Giesbrecht T, Rycroft JA, Rowson MJ, De Bruin EA. The combination of L-theanine and caffeine improves cognitive performance and increases subjective alertness. Nutritional Neuroscience. 2010; 13(6), 283-290.

Millichap JG, Yee MM. The Diet Factor in Attention-Deficit/Hyperactivity Disorder. Pediatrics. 2012; 129(2): 330-337

Rucklidge JJ, Frampton CM, Gorman B, Boggis A. Vitamin–mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. British Journal of Psychiatry. 2014; 204(4): 306-315.

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

OMeGa-3 Fatty Acids

Posted by James on 06/23/2018 | Comment

Omega-3 fatty acids are essential fatty acids, vital for normal body functioning. The three most important types are alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These essential fatty acids have an array of health benefits and are considered by many investigators to be beneficial in the prevention or treatment of several diseases, such as heart disease, non-alcoholic fatty liver disease, Alzheimer’s disease, inflammatory disease, eye disease, and bone disease. Other health benefits of omega-3 fatty acids include…

1. Reducing waist circumference
2. Maintaining healthy skin
3. Lowering the risk of cancer
4. Encouraging early growth and development
5. Reducing the risk of childhood asthma and allergies

…and the list goes on and on and on…

Although omega-3 fatty acids are popularly known for their heart-healthy benefits, growing evidence suggests they can also serve as a potential treatment for major depressive disorder. Taking a closer look at omega-3 supplementation in pediatric populations, multiple randomized controlled trials suggest its positive role on children and adolescents with mood disorders, such as depression or bipolar disorder, or on children at ultra-high-risk for psychosis. Key findings are highlighted below:

1. Decreased impairment in executive functioning* was associated with omega-3 supplementation in youth with mood disorders (Vesco, 2018)
2. Data suggests a lower dietary intake with omega-3 polyunsaturated fatty acids in those with depression (Sweene, 2011)
3. n-6 to n-3 polyunsaturated fatty acid ratio is associated with an increased risk for mood disorders in young people exhibiting an ultra-high-risk for psychosis (Berger, 2017)
4. Combined psychoeducational psychotherapy** and omega-3 supplementation is a promising treatment for co-occurring behavior symptoms in youth with depression (Young, 2016)

* Executive functions are a set of cognitive processes that are necessary for the cognitive control of behavior
**Psychoeducational psychotherapy is an evidence-based therapeutic intervention often associated with serious mental illness

Excellent sources of omega-3 fatty acids include salmon, trout, sardines, anchovies, herring, Pacific oysters, Atlantic and Pacific mackerel, algae, and krill.

Excellent sources of omega-3 fatty acids include salmon, trout, sardines, anchovies, herring, Pacific oysters, Atlantic and Pacific mackerel, algae, and krill.

Recipe Alert! If you are looking for a summery, savory, salmon recipe, try Chili Lime Salmon with Peach Salsa from The Real Food Dietitians.

Aside from seafood, other sources of omega-3 fatty acids include:

1. Certain plant and nut oils
2. Flax, chia, hemp seeds
3. Walnuts
4. Wheat germ
5. Fortified foods such as certain brands of eggs, yogurt, juices, milk, soy beverages, and infant formulas

While we’d love have a perfectly balanced diet, sometimes life gets in the way and we need help to get the nutrients our bodies need. This is where supplements can make a huge difference.

Although seafood is an excellent source of omega-3, not everyone loves seafood, or gets enough of it in their diet. A great alternative, or in addition, to seafood, is omega-3 supplementation. It is important to find a high quality, potent omega-3 supplement—and unlike many other omega-3 supplements, Health Thru Nutrition’s Highly Purified Omega 3 Premium Fish Oil offers such potency and purity our bodies need.


Cornu C, Mercier C, Ginhoux, T et al. A double-blind placebo-controlled randomised trial of omega-3 supplementation in children with moderate ADHD symptoms. Eur Child Adolesc Psychiatry 2018; 27: 377-384.

Berger ME, Smesny S, Kim S-W, et al. Omega-6 to omega-3 polyunsaturated fatty acid ratio and subsequent mood disorders in young people with at-risk mental states: a 7-year longitudinal study. Translational Psychiatry 2017; 7(8).

Young A. Psychoeducational Psychotherapy and Omega-3 Supplementation Improve Co-Occurring Behavioral Problems in Youth with Depression: Results from a Pilot RCT. Journal of abnormal child psychology 2017; 45: 1025-1037.

Vesco AT, Lehmann J, Gracious BL, Arnold LE, Young AS, Fristad MA. Omega-3 Supplementation for Psychotic Mania and Comorbid Anxiety in Children. Journal of Child and Adolescent Psychopharmacology 2015; 25(7): 526-534.

Lopresti AL. A review of nutrient treatments for paediatric depression. Journal of Affective Disorders (2015); 181: 24-32.

Swenne I, Rosling A, Tengblad S, Vessby B. Omega‐3 polyunsaturated essential fatty acids are associated with depression in adolescents with eating disorders and weight loss. Acta Paediatrica 2011; 100: 1610-1615.

Mocking RJ, Harmsen I, Assies J, Koeter MW, Ruhé HG, Schene AH. Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry 2016.

Appleton KM, Sallis HM, Perry R, Ness AR, Churchill R. ω-3 Fatty acids for major depressive disorder in adults: an abridged Cochrane review. BMJ Open 2016; 7(1).

Appleton KM, Sallis HM, Perry R, Ness AR, Churchill R. Omega-3 fatty acids for depression in adults. Conchrane Database Syst Rev 2015; 11.

Vesco AT, Young AS, Arnold LE, Fristad, MA. Omega-3 supplementation associated with improved parent-rated executive function in youth with mood disorders: secondary analyses of the omega 3 and therapy (OATS) trials. J Child Psychol Psychiatr 2018; 59(6): 628-636.

Stonehouse W, Conlon CA, Podd J, Hill SR, Minihane AM, Haskell C, Kennedy D. DHA supplementation improved both memory and reaction time in healthy young adults: a randomized controlled trial, The American Journal of Clinical Nutrition 2013; 97(5): 1134-1143.

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

The Mitochondrial Cocktail

Posted by James on 06/07/2018 | Comment

As many of us have learned in science class, mitochondria are often referred to as the powerhouse of the cell because of their role in energy production. When mitochondria become dysfunctional, energy production comes to a grand halt. This dysfunction is often a result of a mitochondrial disease or disorder, including “autism, Parkinson’s disease, Alzheimer’s disease, muscular dystrophy, Lou Gehrig’s disease, diabetes, and cancer,” (1). According to the Cleveland Clinic, one in 5,000 individuals has mitochondrial disease and approximately 1,000 to 4,000 US children are born with this disease every year.

Current treatments for mitochondrial diseases rely on alleviating the severity of the symptoms rather than eliminating them. A common intervention for symptom relief is exercise. However, symptom relief for more serious forms of mitochondrial disease requires a more intensive intervention (2).

A common strategy is the so-called “mitochondrial cocktail”, a mixture of vitamins and supplements, designed to counteract mitochondrial dysfunction. Common “ingredients” of a “mitochondrial cocktail” include L-carnitine, Coenzyme Q10, riboflavin, and thiamine (2).

Coenzyme Q10 is a vitamin-like powerful antioxidant nutrient naturally found in every cell in our body. It is necessary for the production of cellular energy, which is essential for every single process of life. Ubiquinol is the active, antioxidant, form of Coenzyme Q10. It shuttles and delivers electrons to oxygen to assist in energy production.

Not only can Coenzyme Q10 be beneficial in those who with mitochondrial disease, but also can be beneficial in those who are chronically fatigued, over the age of 40, or in those who exercise often.

Coenzyme Q10, as an energy producer, has also been shown to promote cardiovascular health, due to the heart’s high energy demands.

Furthermore, numerous scientific studies have indicated the need for Coenzyme Q10-containing supplements for prevention and successful treatment of disorders associated with the gums—or other supporting structures of the teeth. A majority of patients with periodontal disease have a Coenzyme Q10 deficiency. Scientific evidence suggests the “extraordinary” healing power of Coenzyme Q10 supplements on periodontal disease. An adequate supply of Coenzyme Q10 ensures efficient energy production and tissue oxygenation for the healing and repair of periodontal tissue. Health experts believe that Coenzyme Q10 supplementation can be used for the treatment of periodontitis, by itself, or in combination with traditional non-surgical periodontal therapy.

Supplementation for Coenzyme Q10 can be found at epic4health in the form of H2Q—a Bioenhanced Coenzyme Q10 for enhanced dissolution and easier absorption. In fact, H2Q promotes absorption up to 8 times over standard Coenzyme Q10! Once Coenzyme Q10 is absorbed, it is released into the the bloodstream where cellular uptake occurs.

In addition to H2Q, Health Thru Nutrition recently debuted Cellurex—a unique formulation of red spinach extract leaves, pyrroloquinoline quinone, Coenzyme Q10, L-Arginine, and epicatechin. Together, these ingredients may have a beneficial effect on a variety diseases and conditions related to mitochondrial dysfunction.

For more information, visit epic4health.


(1) Mitochondrial Diseases. Cleveland Clinic. https://my.clevelandclinic.org/health/ diseases/ 15612-mitochondrial-diseases Accessed June 7, 2018.

(2) Slone J, Gui B, Huang T. The current landscape for the treatment of mitochondrial disorders. Journal of Genetics and Genomic 2018; 45(2): 71-77


Posted by James on 06/07/2018 | Comment

Do you suffer from chronic gastrointestinal pain and discomfort? If so, a low-FODMAP diet may be just what you need.

Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal (GI) disorder characterized by
abdominal pain or discomfort, and changes in bowel movement patterns and defecation (1, 2).

There are four IBS subtypes, including IBS + diarrhea, IBS + constipation, mixed IBS and unsubtyped IBS, with IBS + diarrhea being the most common. The physiological mechanism differs depending on subtype. IBS can be attributed to visceral hypersensitivity, altered brain-gut signaling, immune dysregulation, microbiota, and psychosocial factors (1).

IBS-related symptom relief can often be found through modifying dietary fiber intake and restricting potential triggers such as caffeine, alcohol, and fat. However, a new dietary approach, known as the low-FODMAP diet, has been proven to relieve pain and discomfort in patients with IBS (1).

With annual IBS-related healthcare costs up to $1.66 billion, the low-FODMAP diet may prove to be an affordable and symptom-relieving solution (1). This diet “produces gastrointestinal symptom relief by reducing the fermentable load on the colon, in order to reduce gas production and luminal distension” (2).

FODMAP stands for Fermentable Oligosaccharide, Disaccharide, Monosaccharide, And Polyol. These short-chain fermentable carbohydrates increase small intestinal water volume and colonic gas production, which induces GI symptoms in those with IBS (1).

In addition to a low-FODMAP diet, patients with IBS have found yoga to be helpful in symptom relief. A 2018 randomized controlled trial investigated the effect of a yoga-based intervention versus a low-FODMAP diet on 59 patients with IBS. Although there was no statistically significant difference between groups, there was a statistically significant difference within each group. In other words, both yoga and a low-FODMAP diet were equally beneficial in reducing GI symptoms (2).

Research has also compared a high- and low-FODMAP diet in athletes with a history of nonclinical exercise-associated GI symptoms. Compared to the athletes on the high-FODMAP diet, athletes on the low-FODMAP diet had significantly lower GI symptoms including flatulence, urge to defecate, loose stool, and diarrhea (3).

Similar randomized controlled trials examined the effects of a low-FODMAP diet on patients with IBS and found significant reductions in symptom relief (4, 5, 6), In addition to symptom relief, two additional studies found an improved quality of life in participants assigned to a low-FODMAP diet (7, 8).

Although the low-FODMAP diet brings symptomatic relief to those with IBS, starting this diet can be daunting. Similar to most diets, a low-FODMAP diet is restrictive in nature. You can say goodbye to lactose-containing products, a range of fruit high in fructose, wheat-based products, onions and garlic, and fruits with pits (3).

To guide you through this process, a registered dietitian can help you 1) eliminate FODMAPs from your diet and 2) monitor your symptoms while gradually adding FODMAPs back into your diet.

To learn more about the low-FODMAP diet, visit Harvard Health Publishing.


(1) Staudacher HM, Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut. 2017; 66(8): 1517-1527.

(2) Schumann D, Langhorst J, Dobos G, Cramer H. Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2018; 47(2): 203-211.

(3) Lis DM, Stellingwerff T, Kitic CM, Fell JW, Ahuja KD. Low FODMAP: A Preliminary Strategy to Reduce Gastrointestinal Distress in Athletes. Med Sci Sports Exerc. 2018; 50(1): 116-123.

(4) Staudacher HM, Lomer MCE, Farquharson FM, Louis P, Fava F, Franciosi E, Scholz M, Tuohy KM, Lindsay JO, Irving PM, Whelan K. A Diet Low in FODMAPs Reduces Symptoms in Patients With Irritable Bowel Syndrome and A Probiotic Restores Bifidobacterium Species: A Randomized Controlled Trial. Gastroenterology. 2017; 153(4): 936-947.

(5) McIntosh K, Reed DE, Schneider T, Dang F, Keshteli AH, De Palma G, Madsen K, Bercik P, Vanner S. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut. 2017; 66(7): 1241-1251.

(6) Böhn L, Störsrud S, Liljebo T, Collin L, Lindfors P, Törnblom H, Simrén M. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015; 149(6): 1399-1407.

(7) Harvie RM, Chisholm AW, Bisanz JE, Burton JP, Herbison P, Schultz K, Schultz M. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World J Gastroenterol. 2017; 23(25): 4632-4643.

(8) Pedersen N, Ankersen DV, Felding M, Wachmann H, Végh Z, Molzen L, Burisch J, Andersen JR, Munkholm P. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease. World J Gastroenterol. 2017; 23(18): 3356-3366.


Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

Type 3 Diabetes?

Posted by James on 06/07/2018 | Comment

With a greater life expectancy and an increased prevalence of type 2 diabetes, the prevalence of dementia is expected to rise (1). In order to understand the commonalities of Alzheimer’s disease and diabetes, we must have a better handle on their definitions.

Alzheimer’s disease is a progressive degenerative disease of the brain in which brain cells stop functioning, lose connections with other brain cells, and eventually die. The damage initially appears to take place in the hippocampus, the part of the brain essential in forming memories.

On the other hand, type 2 diabetes is characterized by high levels of blood glucose due to inadequate insulin production and/or insulin resistance. Insulin resistance is the inability of cells to respond to the action of insulin in transporting glucose from the bloodstream into muscle and other tissues.

So, what do they have in common?

A study of the Mayo Clinic Alzheimer Disease Patient Registry reported that greater than 80% of Alzheimer’s disease patients exhibit type 2 diabetes or abnormal blood glucose levels. Furthermore, a 2018 publication discovered that individuals with type 2 diabetes are twice as likely to develop dementia (2). These findings suggest the possibility of a linkage between the processes responsible for loss of brain and pancreatic B-cells in these disorders (3).

Growing evidence has shown similarities between Alzheimer’s disease and type 2 diabetes. Both diseases present insulin resistance and impaired insulin signaling. Alzheimer’s disease has even been deemed as an “insulin-resistant brain state”. Furthermore, both diseases experience apoptosis, inflammation, oxidative stress, mitochondrial dysfunction, and amyloid deposition (Figure 1).

Mediterranean Diet and Cognition

A mediterranean diet emphasizes fruits, vegetables, nuts, whole grains and olive oil while limiting red meat and other saturated fats, refined sugars and processed foods. Research has focused much of its attention on determining whether a Mediterranean diet, supplemented with olive oil or nuts, influences cognitive function.

In particular, a 4-year, parallel-group randomized clinical trial investigated 334 cognitively healthy volunteers with a mean age of 67 and concluded that a Mediterranean diet is associated with improved cognitive function. Participants belonging to the Mediterranean diet scored better on tests assessing immediate and delayed episodic verbal memory, attention, visuomotor speed, and cognitive flexibility (4).

A similarly designed study investigated 522 participants at high vascular risk with a mean age of 75. Compared to the control, participants belonging to the mediterranean diet scored significantly higher on neuropsychological tests evaluating orientation to time and place, registration, attention and calculation, recall, language, and visual construction (5).

Nutrition for Treatment and Prevention of Type 2 Diabetes and Alzheimer’s Disease

Say “yes” to unsaturated fats and “no” to saturated and trans fats.
Look for foods high in fiber such as…

  • Vegetables
  • Legumes, nuts and seeds
  • Whole grains
  • Fruits


Increase your intake of vegetables, legumes, fruits, and whole grains.
Incorporate foods with anti-inflammatory properties such as…

  • Tomatoes
  • Olive oil
  • Green leafy vegetables
  • Nuts
  • Fatty fish
  • Fruit


Ensure adequate intake of the following vitamins and minerals:

  • Calcium
  • Potassium
  • Magnesium
  • Vitamin A
  • Vitamin C
  • Vitamin E
  • Vitamin B12
  • Vitamin K


Obtain omega 3 fatty acids from…

  • Makeral
  • Salmon
  • Cod liver oil


For additional resources relating to type 2 diabetes and Alzheimer’s disease, visit www.diabetes.org and https://alz.org.


(1) Li X, Song D, Leng SX. Link between type 2 diabetes and Alzheimer’s disease: from epidemiology to mechanism and treatment. Clinical Interventions in Aging 2015; 10: 549-560.

(2) Silzer TK, Phillips NR. Etiology of type 2 diabetes and Alzheimer’s disease: Exploring the mitochondria. Mitochondrion 2018.

(3) Moreira PI. Sweet Mitochondria: A Shortcut to Alzheimer’s Disease. Journal of Alzheimer’s Disease 2018; 62: 1391-1401.

(4) Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, Torre R, Martinez-Gonzalez M, Martinez Lapiscina EH, Fito M, Perez-Heras A, Salas-Salvado J, Estruch R, Ros E. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA Intern Med 2015; 175(7): 1094-1103.

(5) Aridi YS, Walker JL, Wright OR. The Association between the Mediterranean Dietary Pattern and Cognitive Health: A Systematic Review. Nutrients 2017; 9(7): 674.

Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

Avocados for the Heart

Posted by James on 05/28/2018 | Comment

Although these versatile fruits are awfully expensive, avocados are deliciously smooth and LOADED with nutrients!

Vitamin C

To start, avocados contain vitamin C, an antioxidant that plays an important role in maintaining circulatory antioxidant protection and contributing to vascular health and arterial plaque stabilization. A 2009 review article suggests greatest cardiovascular disease protective effects on specific populations such as smokers, obese and overweight people, patients with elevated cholesterol, hypertension, or type 2 diabetes over 55 years of age (1).


Deficiencies in B-vitamins such as folate and vitamin B-6 may increase homocysteine levels, which could reduce vascular endothelial health and increase cardiovascular disease risk (2).

Unsaturated Fats

In addition to vitamin C and B-vitamins, avocados are a great source of protein, fiber, and healthy unsaturated fats. Avocados are fatty—and fat scares people! Yet, the author of The Secret Life of Fat explains, “Fat is not just fat.” Fat is an endocrine organ that produces hormones that are vital to our health. Our body needs fat and we possess many defense mechanisms to protect and hold on to it. So, even with its fat and all, avocados are not to be feared! In fact, their high fat and fiber content makes them exceedingly satiating—and if you are full, you are less likely to continue eating.

The Science

Several studies have shown promising benefits of an avocado-enriched diet on serum lipid concentrations (3, 4). A 2018 systematic review and meta-analysis concluded that avocado consumption increases serum HDL-cholesterol—often known as the “good” cholesterol due to its ability to metabolize and rid LDL-cholesterol and other harmful forms of lipids from the body (5).

However, in a 2013 randomized controlled parallel study, Park and colleagues found no significant impact of avocado consumption on serum HDL-cholesterol in type 2 diabetic patients. This study (2), in addition to a 2016 meta-analysis, also found a lowering effect on total cholesterol, LDL-cholesterol, and triglycerides by 15, 12, and 20 mg/dL respectively (6).

Lastly, a 2015 randomized controlled trial reported lowering effects of LDL-cholesterol and concluded that avocados have beneficial effects on cardio-metabolic risk factors that extend beyond their heart-healthy fatty acid profile” (3).

Avocados also have a diverse range of other nutrients and phytochemicals that may have beyond cholesterol vascular health benefits. In particular, avocado’s potassium and lutein may help promote normal blood pressure and help to control oxidative or inflammatory stress, respectively (7).


Nutritious and delicious, avocados can be added to your breakfast, lunch, dinner, or dessert. YES—dessert! Turn it into gelato or make yourself a creamy milkshake—the possibilities are endless.

For fun, easy, and tasty recipes see below:

Marisa Moore, MBA. RDN. LD. shares 4 ways to make the most of your avocado leftovers! Check out the recipes here.

4 Ways to Use Leftover Avocado

Looking for a guiltless dessert? Visit Rachael’s Good Eats for her avocado chocolate mousse recipe to satisfy your sweet tooth.

Avocado Chocolate Mousse

Add avocado to your next smoothie with this delicious recipe from Yummy Body Nutrition.

Pineapple Avocado Cilantro Summer Smoothie

(1) Honarbakhsh S., Schachter M. Vitamins and cardiovascular disease. Br. J. Nutr 2009; 101: 1113–1131.
(2) Antoniades C., Antonopoulos A. S., Tousoulis D., Marinou K., Stefanadis C. Homocysteine and coronary atherosclerosis: From folate fortification to the recent clinical. Eur. Heart J 2009; 30: 6–15.
(3) Wang L, Bordi PL, Fleming JA, Hill AM, Kris-Etherton PM. Effect of a Moderate Fat Diet With and Without Avocados on Lipoprotein Particle Number, Size and Subclasses in Overweight and Obese Adults: A Randomized, Controlled Trial. Journal of the American Heart Association 2015; 4(1).
(4) Park C, Cuypers LE, Sin A. Impact of Avocado Enriched Diet on Serum Lipids of Diabetic Patients. Journal of Cardiovascular Disease 2013; 1(1): 13-14.
(5) Mahmassani HA, Avendano EE, Raman G, Johnson EJ. Avocado consumption and risk factors for heart disease: a systematic review and meta-analysis. The American Journal of Clinical Nutrition 2018; 107(4): 523-536.
(6) Peou S, Milliard-Hasting B, Shah SA. Impact of avocado-enriched diets on plasma lipoproteins: A meta-analysis. Journal of Clinical Lipidology 2016; 10(1): 161-171.
(7) Dreher ML, Davenport AJ. Hass Avocado Composition and Potential Health Effects. Critical Reviews in Food Science and Nutrition 2013; 53: 738-750.

Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

Eat Sleep Move

Posted by James on 05/14/2018 | Comment

Do you suffer from obstructive sleep apnea? Are you tired during the day? In middle-aged adults, the prevalence of obstructive sleep apnea is estimated to be 4%-9%, although the condition is often undiagnosed and untreated (1).

What is it? “Obstructive sleep apnea is defined by the occurrence of daytime sleepiness, loud snoring, witnessed breathing interruption, or awakenings due to gasping or choking in the presence of at least 5 obstructive respiratory events per hour of sleep,” (1). The number of apnea or hypopnea events per hour of sleep reflects the Apnea– Hypopnea Index (AHI), which classifies the severity of obstructive sleep apnea. An AHI of 5-15 is mild, 15-30 is moderate, and > 30 events per hour characterize severe sleep apnea (1).

What are the risk factors? Risk factors for obstructive sleep apnea are dependent on gender, age, weight, neck girth, snoring, and frequent breathing pauses. With that being said, obstructive sleep apnea is a risk factor in itself for a number of chronic diseases, such as hypertension, diabetes, stroke, and cardiovascular disease (1).

Can your diet really help improve your quality of sleep?

Fat. A recent publication (1) examined dietary intake in patients with newly diagnosed obstructive sleep apnea. Of particular interest was the percentage of fat contributing to their total caloric intake. Participants with a BMI < 30 kg/m2 who received 35% or more energy from fat had significantly higher AHI than those with less than 35% energy from fat (P = .022). Among those with BMI ≥ 30 kg/m2, elevated fat intake was associated with a higher AHI although the difference is not significant.

Processed meats. Although not significant, the intake of processed meats was associated with sleep apnea (P = .056)

Dairy. Low-fat dairy was found to be significantly associated with less severity of sleep apnea in overweight participants.

Snacks. Consumption of snacks was associated with increased apnea in subjects with BMI < 30 kg/m2 (P = .016 but not in participants with BMI ≥ 30 kg/m2.

Key Takeaways (1).

1. In overweight patients, severity of sleep apnea was related to an increased intake of saturated fats

2. Intake of processed meats was associated with sleep apnea

3. Low-fat dairy was associated with a decreased severity of obstructive sleep apnea on presentation.

Tart cherries and kiwifruit. Additional research found an association between consumption of fruit, specifically tart cherries and kiwifruit, and enhanced sleep in individuals with sleep disorders. This association may be due to the presence of antioxidants in cherries, which help to reduce oxidative stress in patients with obstructive sleep apnea. It is also important to note the influence of consumption time and quantity on total sleep time and sleep efficacy. The consumption of 2 kiwifruits, 1 hour before bedtime enhanced the sleep of individuals with sleep disorders (2).

What are the dietary recommendations if I suffer from obstructive sleep apnea (1)?

1. Fat intake should be less than 10% total calories per day

2. Encourage the consumption monounsaturated “healthy” fats and limit saturated “unhealthy” fats

3. If dairy products are eaten, they should be of the low-fat variety.

What about exercise?

As a whole, the scientific literature indicates improved clinical outcomes for obstructive sleep apnea patients who are physically active. These improved clinical outcomes include a “reduction in disease severity and in daytime sleepiness, as well as an increase in sleep efficiency and in peak oxygen consumption, regardless of weight loss,” (3). Furthermore, exercise has been shown to improve AHI and cardiorespiratory fitness in patients with obstructive sleep apnea (4,5).

Obstructive sleep apnea has become quite common in the United States and, just as with any other disease state or condition, nutrition and exercise can play a significant role in improving clinical outcomes. If you are suffering from obstructive sleep apnea and are looking for a longer and better-quality sleep, try to reduce fat to < 10% of your daily caloric intake and take part in at least 150 minutes/week of moderate-intensity, or 75 minutes/week of vigorous-intensity aerobic physical activity.


(1) Bove C, Jain V, Younes N, Hynes M. What You Eat Could Affect Your Sleep: Dietary Findings in Patients With Newly Diagnosed Obstructive Sleep Apnea. American Journal of Lifestyle Medicine 2018;

(2) St-Onge MP, Mikic A, Pietrolungo CE. Effects of Diet on Sleep Quality. American Society for Nutrition 2016; 7: 938-949.

(3) de Andrade FM, Pedrosa RP. The role of physical exercise in obstructive sleep apnea. Jornal Brasileiro de Pneumologia 2016; 42(6): 457-464

(4) Aiello KD, Caughey WG, Nelluri B, Sharma A, Mookadam F, Mookadam M. Effect of exercise training on sleep apnea: A systematic review and meta-analysis. Respiratory Medicine 2016; 116: 85-92.

(5) Iftikhar IH, Kline CE, Youngstedt, SD. Effects of Exercise Training on Sleep Apnea: A Meta-analysis. Lung 2014; 192(1): 175-184.


Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

Nutrition for Two

Posted by James on 05/14/2018 | Comment

…for moms-to-be

With the endless supply of information on what you “should” and “shouldn’t” do while pregnant, it is no surprise moms-to-be feel overwhelmed.

As a highly motivated mom-to-be, you want to do everything right. You want to eat the right things, do the right exercises, read every single pregnancy book, and buy all the right things! But, when all is said and done, you are going to make mistakes—and that’s okay. No one expects you to be perfect or suddenly know all the “ins and outs” of a healthy pregnancy.

With that being said, here are some important nutrition recommendations that may help put your mind at ease.

Here are the nitty gritty, straight-to-the-point, evidence-based recommendations:

Let’s start with CALORIE RECOMMENDATIONS. Most reasonably active reproductive-age females need about 2,100 to 2,300 calories each day. During your 1st trimester, YOU DON’T NEED ADDITIONAL CALORIES!! Shocking, I know. Yet, for the 2nd and 3rd trimesters, aim to increase your calories by 340 and 450 calories/day, respectively.


Protein. Prior to pregnancy, women should consume about 50 g/day protein, and during the 2nd and 3rd trimester of pregnancy, women should consume an additional 25 g/day.

Fat. Pregnant women should consume daily at least 300 mg of DHA—which is an omega-3 fatty acid. Furthermore, pregnant women should eat a total of 8 to 12 ounces of fatty fish each week to obtain omega-3 fatty acids, iodine, iron and choline.

However, the FDA cautions pregnant women and parents about avoiding fish with high levels of mercury. For detailed information, visit Eating Fish: What Pregnant Women and Parents Should Know

Carbohydrates. Pregnant women should ingest at least 175 g/day.


NEXT, THE VITAMINS. How much vitamin A do I need? 2500 IU/day but no more than 10,000 IU/day. Vitamin A is important during pregnancy HOWEVER, too much vitamin A can be dangerous for you and your baby.

How about vitamin D? 600 IU/day


Folic Acid. For healthy, reproductive-age women, 400 mcg/day. For pregnant women without a prior neural tube defect, 600 mcg/day. For women with a prior neural tube defect, 4000 mcg/day.

Cobalamin. How much do I need? 2.4 mcg/day prior to pregnancy and 2.6 mcg/day during pregnancy.

Choline. How much do I need? At least 450 mg/day during pregnancy and 550 mg/day when nursing.

MINERALS, such as calcium, iron, and iodine, are also important for pregnant women.

How much calcium do I need? 1000 mg/day.

What about iron? 18 mg/day prior to pregnancy and 27 mg/day during pregnancy.

…and iodine? Pregnant and lactating women need at least 220 and 290 mcg/day, respectively.


A recent systematic review included 17 trials with 137,791 pregnant women who incorporated multiple-micronutrient supplementation into their diet. The authors concluded that “pregnant women who received multiple-micronutrient supplementation had fewer low birthweight babies and small-for-gestational-age babies than pregnant women who received only iron, with or without folic acid,” (1).

Additionally, authors of a review article on micronutrient supplementation and placental function suggest micronutrient supplementation to be a “cost effective, applicable, and safe method of improving pregnancy outcomes for millions of women across the globe,” (2). For additional AND reputable resources, visit the World Health Organization, Academy of Nutrition and Dietetics, Centers for Disease Control & Prevention, or the U.S. Food and Drug Administration.


(1) Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database of Systematic Reviews 2017.

(2) Richard K, Holland O, Landers K, Vanderlelie JJ, Hofstee P, Cuffe JSM, Perkins AV. Review: Effects of maternal micronutrient supplementation on placental function. Placenta. 2017; 54: 38-44.



Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University


Posted by James on 04/26/2018 | Comment

What is it?
You may be wondering, “What is kombucha?”. For starters, Kombucha is a recently popularized probiotic beverage consumed for its anti-inflammatory and antioxidant properties. Now you may be wondering, “What is a probiotic?”. The World Health Organization defines a probiotic as “live microorganisms which when administered in adequate amounts confer a health benefit on the host.”
For a product to be considered a probiotic, Lynne McFarland, an associate professor at the University of Washington explains, “…they have to be alive. They can be a bacteria or a yeast. They have to be used in an adequate dose, and they have to have some proven beneficial health effect.”

How is it made?
Kombucha derives from a process known as fermentation. So, before we continue on about Kombucha, let’s explore this antique method for extending the life and safety of food.

Kombucha fermentation is an aerobic process in which sugar and tea are converted, in the presence of a SCOBY, or a symbiotic colony of bacteria and yeast, to “a lightly carbonated, slightly sour, and refreshing drink, which is composed of several acids, 14 amino acids, vitamins, and some hydrolytic enzymes,” (1). Specifically, Kombucha contains the following vitamins and minerals: Vitamins B1, B2, B6, B12, and C
Minerals Copper, Iron, Manganese, Nickel, and Zinc (1)

Preferable conditions for kombucha fermentation
Fermentation is influenced by many factors such as time, temperature, and pH. Therefore, any changes in the fermentation condition may affect the final product. With that being said, below are general recommendations based on the finding of current literature (1).
Time: Average of 15 days
Temperature: Generally, between 22-30 degrees Celsius
pH: No lower than 3

The science
Research has been conducted to examine antimicrobial, antioxidant, anti-inflammatory, and anticarcinogenic properties of Kombucha (1). The findings of one particular study is highlighted below. However, further research is warranted to better understand the characterization of its active components and their evolution during fermentation.

Anti-inflammatory properties (2)
• Fermented beverages of oak effectively down-regulated the production of nitric oxide
• Pro-inflammatory cytokines (TNF-alpha and IL-6) in macrophages were stimulated with lipopolysaccharide.
• Phytochemical compounds, present in kombucha analogues from oak, decrease oxidative stress.

Make your own!
Visit The Kitchn, an online food magazine, at https://www.thekitchn.com/how-to-make-kombucha-tea-at-home-cooking-lessons-from-the-kitchn-173858 for help on how to make your very own Kombucha.


(1) Villarreal-Soto SA, Beaufort S, Bouajila J, Souchard JP, Taillandier P. Understanding Kombucha Tea Fermentation: A Review. Journal of Food Science. 2018; 83(3): 580-588.
(2) Vázquez-Cabral BD, Larrosa-Pérez M, Gallegos-Infante JA, Moreno-Jiménez MR, González-Laredo RF, Rutiaga-Quiñones JG, Gamboa-Gómez CI, Rocha-Guzmán NE. Oak kombucha protects against oxidative stress and inflammatory processes. Chemico-Biological Interactions. 2017; 272: 1-9.
(3) Chakravorty S. Kombucha tea fermentation: Microbial and biochemical dynamics. International Journal of Food Microbiology. 2016; 220: 63-72.


Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University