Should I Take Probiotics with Antibiotics?

I don’t get sick often but when I do, it hits me hard. I have a history with Strep throat, in particular, which means I end up taking an antibiotic. In the hospital, I have seen a young person (30 years or younger) have heart-related complications due to Strep; I do not treat it as if I would a virus that I would do my best to get over as naturally as possible.

When put on antibiotics, as a nutrition professional, I have to question the effectiveness of taking probiotics while taking antibiotics.   According to Harvard, “Since the mid-1990s, clinical studies have established that probiotic therapy can help treat several gastrointestinal ills, delay the development of allergies in children, and treat and prevent vaginal and urinary infections in women”. After all, a significant percentage of our immune function is related to the wall of our gut!

A recent meta-analysis did find a reduction in antibiotic-related side effects. With research such as this making an appearance, many food products being touted with having healthy probiotics, many health professionals encouraging patients to take probiotics, and few reported negative side effects to taking them, it’s easy to see why many would choose to take probiotic supplements with or without taking antibiotics.

Many foods, such as yogurt, kefir, and sauerkraut, contain probiotics; however, these may not contain enough or the right culture for every individual. If you’re a generally healthy individual and you don’t experience GI side effects from taking antibiotics, increasing your intake of foods that contain probiotics might be beneficial if you are inclined to do so. If you do suffer from side effects, such as diarrhea, from taking antibiotics, the meta-analysis above indicates that you might benefit from increasing your intake of probiotics and possibly reduce such side effects.

Ideal times for taking probiotics are to be considered, as well. It is generally recommended to wait 2 hours after taking the antibiotic before taking a probiotic. Due to gut pH, meal times, particularly breakfast, may be ideal for taking probiotics to ensure they reach the intestines to be most effective.  However, some individuals may not tolerate taking probiotics in the morning but tolerate taking their probiotics at dinner or in the evening with a snack. Certain antibiotics and probiotics must be taken separately; make sure to ask your provider about this. Probiotics are not recommended to be consumed with hot beverages.

Keep in mind, this is not medical advice; you should always check with your health provider before making changes to your diet, including taking supplements. Some people may have allergies or intolerances to certain probiotic cultures. Some individuals may benefit from a certain culture or variety of cultures depending on their individual gut flora. Price is something to consider and may not indicate quality of the product. The consumer market has many brands to choose from with few having clinical data to support their claims. While I do not recommend, or receive financial or other gains from/because of, a specific product, I will say that Florastor has some research behind it. I would, of course, recommend researching a particular product you are interested in.

As for me, I will increase my intake of probiotic foods that I regularly enjoy and continue to take my prenatal vitamin that includes a probiotic blend.

For more information on the study above and other probiotic information I referenced or reviewed for this post, please visit the links below:

Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea:  A Systematic Review and Meta-analysis

Harvard Family Health Guide: Health Benefits of Taking Probiotics

Dr. Weil: Probiotics

National Center for Complementary and Alternative Medicine

Nutritionally yours,

Julie Wallace, RDN, LDN

Disclaimer: All information here is for educational purposes only. Individuals should speak with their health providers regarding changes made to their diets and physical activity. Please visit eatright.org to find a dietitian who can assist you with dietary changes.

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Getting Your Plate in Shape: The Plate Method

It’s National Nutrition Month: Did you get your plate in shape?

 The idea of how to use your plate for portion control, balanced eating, and even diabetes management has been known as “The Plate Method”. One version, for example, is from Harvard (below). Another is “My Plate” from http://www.choosemyplate.gov/. Both are relatively similar and encourage you to balance your meals with healthy fats, lean proteins, and carbohydrates coming from vegetables and fruits.

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               The Plate Method can be a great starting point for anyone who wants to eat better, eat balanced meals, and not stress over counting calories.

If you’re considering this method, you will want to:

  • Make half of your plate non-starchy vegetables and a smaller portion/side of fruit.

  • Consider 1% or skim milk in place or higher fat milks if you want to watch your calories and fat intake.

  • Try to make at least half of your grains whole grains; consider ancient grains such as quinoa or amaranth for more variety.

  • Change up your protein sources to get a variety of nutrients. Consider salmon or tuna for their omega-3 fatty acids and maybe an addition of plant-based proteins for even more variety.

  • Consume foods and beverages with little or no added sugars. Even if you’re considering fruit juice, try to limit it to 4 ounces. Try to stick with water, which you can flavor or infuse with herbs and fruits. Consider tea and coffee, without too much added sweeteners or cream, instead of soda.

  • Keep an eye on your sodium intake and try to avoid adding salt to already prepared meals. Keep the table salt off the table and make it inconvenient. Try using herbs and spices for more flavor. Remember! If you prepare the food at home, you have more control over the amount of salt, fat, etc. that is used.

  • Choose foods with healthy fats over saturated and trans fats.

  • Eat for your needs. Try to only eat until full. Extra calories can lead to extra, unnecessary body weight.

  • Cook at home when possible. Cooking at home allows you to be in control of what goes on your plate and may help save you money.

  • When dining out:

    • consider looking at the menu online so you know what you should order

    • try to use the plate method, if possible. Select your lean protein, select your non-starchy vegetables, choose your starch in the form of starchy vegetables or grains, a side of fruit, and you’re on your way to a balanced meal.

    • consider asking the server to put half of your order in a to-go box before it arrives at your table

  • Keep track of what you eat throughout the day. There are many of free websites, phone apps, and inexpensive notebooks that will allow you to track your meals without adding up all the calories (but some may do it for you automatically, if you are interested in that).  Of course, using the plate method is simple and you don’t have to track all of your meals unless you feel that doing so might provide you with insight such as a food allergy/intolerance, unbalanced meals, or excessive calories.

  • When drinking alcoholic beverages, do so in moderation: 1 drink/day for women, 1-2/day for men are the general recommendations. What consists as a drink serving does vary depending on the alcoholic beverage your are drinking.

  • Be physically active.

Why Do I Encourage a Plate Method?

I think using the plate method makes meal planning easy. You can choose your lean protein choice, non-starchy vegetables, a side of fruit, and some fat in the form of olive oil for cooking, a little butter for flavor, or as dressing over a salad to create your recipes when at home or order these items from a menu when dining out without fretting over exact calories. If you try to follow the plate method and choose foods in their less processed forms and avoid excess sodium then eating a healthy, well balanced meal every meal each day can become simple.

You can download your own plate method worksheet here: http://platemethod.com/downloads.html

Test Your Nutrition Knowledge

A free basic nutrition quiz here: http://nutrition.about.com/library/blnutritionquiz.htm

Curious About a Nutrition Topic?

It’s National Nutrition Month 2014! That means, it’s time for me to celebrate being a dietitian and reach out to you all to help you achieve optimal health and longevity through nutrition with this short ‘post’.

As a RDN (Registered Dietitian Nutritionist), I spend most of the time of most of my days reading about nutrition, teaching others about nutrition, and thinking about food! I want to reach out to you, my readers, and find out what nutrition topics you are curious about! 

I’m a wealth of nutrition information so let me focus some of that towards something you’ve always wanted to ask a dietitian by commenting below with your topic or question. I won’t necessarily be able or willing to answer your questions directly or write a post about each topic but I will try to use some of them for future blog posts. 

 

Heart Health: Added Sugar linked to higher risk of Cardiovascular Disease (CVD)

Sweet sugar: we love it so much that some may say we are addicted to it. I, too, enjoy sweet treats, sauces, etc. However, the one thing I know for sure is that moderation is key. I think, however, the concept of moderation is ‘relative’ as many people ask questions like “What does moderation mean? How much fat, protein, carbohydrates, and sugar can I have if it’s in moderation?”.

I recently watched a talk by a woman whose very job it is to find historical clues and interpret what our ancestor’s diets were actually like. In her talk, she mentioned how many canes of sugar we consume nowadays and how impractical that would have been for our ancestors to actually sit there and chew on multiple sugar canes a day to consume how much sugar we eat so conveniently.

Today, sugar is everywhere. We do consume far more than our ancestors and like many other nutrients we probably consume too much of (or too little of), we are seeing increases in a variety of health issues. Of course, these aren’t all because of our diets- there are many factors such as physical activity, stress levels, inflammation, etc. that can affect our health.

But, back to sugar and heart disease. A recent analysis evaluating data from 25 years of information from the NHANES study found a 30% increase in CVD (cardiovascular disease) and added sugars.

*Added sugars do not include naturally occurring sugars found in fruit, for example. We are talking about the sugars added to foods to make them taste more appealing (which doesn’t just pertain to sweets but also items like salad dressings or savory dishes that need ‘balanced’ flavor and so on).

So, what is considered a moderate amount of added sugar? Well, that depends on who you ask. The Institute of Medicine recommends less than 25% of your total calories should come from added sugar (which would be approximately 500 kcals from sugar on a 2000 kcals diet). The World Health Organization recommends less than 10% of total kcals coming from added sugar (approximately 200 kcals on a 2,000 kcals diet). The American Heart Association recommends less than 5% (or 100 kcals) of total kcals for women’s diets and less than 7.5% (or 150 kcals) for men’s diets. And then there are many who say to avoid it completely, if possible.

If you are reading nutrition labels, you may want to use grams instead of calories when measuring sugar. One gram of sugar is approximately 4 kcals (to make math simple). Therefore, the AHA recommendations allows for up to 25 grams of added sugar for women and up to 38 grams of added sugar for men per day while the WHO recommendations allows for up to 50 grams of added sugar per day and the Institute of Medicine allows for up to 125 grams of added sugar per day (if based on the 2,000 kcals diet above).

Most people I know do not wish to count calories and measure grams of nutrients. This is completely understandable. I have often found that making simple changes such as cutting out soda/sweetened beverages, consuming sugars/carbohydrates from whole foods such as fruits and vegetables,  only lightly sweetening drinks such as tea/infused water, cutting back on dining out/fast food, making your own meals as much as possible, and using smaller portions for sweets or having a cheat day for a sweet treat are pretty effective in cutting back on added sugars and also help in weight loss for many people.

Of course, we are not all the same and recommendations are for the general public. If you have special concerns or medical conditions, you will want to speak to your personal health professionals regarding your dietary intake.

I’d love to hear your feedback!

Nutritionally yours,

Julie Wallace

February 2014: Chocolate and Strawberries

Chocolate: Sweetness without the Guilt!

Indulgently delicious, dark chocolate has many surprising health benefits:

  • May lower overall blood pressure
  • Can lower cholesterol
  • Contains serotonin which boosts mood
  • High in antioxidants
  • Flavanols found in chocolate may have other cardiovascular benefits such as improving circulation
  • The scent of chocolate can induce relaxation

In general, research does not appear to indicate that more is better- so enjoy chocolate in moderation. As little as 3 grams per day of dark chocolate (1 ounce of chocolate could easily have 30 grams alone) has been shown to have potential health benefits. Now you can celebrate Valentine’s Day guilt-free with a few pieces of decadent dark chocolate.

Recipe of the Month: Vanilla or Chocolate Coconut Mousse
Something delicious to dip your favorite fruit into.

Serves at least 4
• 1 can coconut milk
• ¼ cup cocoa powder (optional for chocolate mousse)
• ½ spoon pure vanilla extract
• Sweetener to taste

DIRECTIONS
1. Place the unopened can of coconut milk in the refrigerator overnight.
2. Remove from refrigerator in the morning, open can, and scrape the top solid layer into a mixing bowl. Do not place the thin liquid at the bottom of the can into the mixing bowl- instead consider using it for a smoothie or other recipe.
3. Whip the coconut cream (*you can purchase premade coconut cream in many stores and skip the above steps) with an electric mixer until it appears to have the consistency of of whipped cream.
4. Gently mix cocoa powder, vanilla extract, sweetener, or anything else you might enjoy, such as cinnamon, into the bowl until uniform during the mixing process. Do not over mix.
5. Pour over your favorite berries. For the data below, consider using 2 cups raw, halved strawberries:

Per serving: 1/4 ingredients used

Calories 128
Protein 2g
Total Fat 13g
Carbs 69g
Cholesterol 0mg
Sodium 8mg
Fiber 1g

Fitness Corner

According the online video titled 23 1/2 hours, if you walked or exercised just 30 minutes to 1 hour a day, you can gain some of these benefits:

  • Improves knee arthritis pain and ability to move
  • Can reduce progression of dementia and Alzheimer’s disease
  • Helps to manage diabetes
  • Reduces the number of hip fractures among post-menopausal women
  • Can decrease anxiety
  • Reduces depression
  • Can lower overall risk of premature death
  • Fights fatigue
  • Improves overall quality of life

Winter Garden Inspiration

It’s cold outside and there isn’t much green outside, even down here in the South, this time of year.

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However, when you just want to cozy up inside and have a hot bowl of soup, it can give you time to prepare for the Spring and Summer months; after all, there are bathing suits in the stores already!

I’ve been trying out a few different apps (Noom, Endomondo, and MyFitnessPal to name a few) to monitor my nutritional intake and my physical activity. I’ll post in the future about my reviews on those. Like many others, I take January to re-assess my needs and focus on my weaknesses (again, did I mention the bathing suits?!?!). I’ve stumbled upon a few free fitness websites I’d like to share if you’re getting ready for the warmer seasons like I am: Fitness Blender on Youtube and ToneItUp.com (which is really geared towards the female population but trust me, if you can look past all the girly marketing, there are some great workouts for anyone!). I don’t get anything from anyone to share these; I just like to share anything I come across that might be helpful (and especially if it’s free!).

I’ve been telling myself every morning my new mantra “Summer bodies are made in the winter”. So, I’ve changed some workout habits and as I have posted previously, I’ve been working to shift to a ‘clean eating’ lifestyle. Which brings me to two topics I want to share: 1. Clean eating recipes I will start to implement as I try them out and 2. Updates, occasionally, on my own garden in which I will include some form of nutritional tips to accompany those posts (recipes, what’s in season, tips on storing them, etc).

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To ensure I have a long growing season of delicious vegetables to eat, I had to start some seedlings, early, indoors.

Speaking of, let me introduce you to my favorite soup recipe during the winter months:

Cabbage & Garden Vegetable Soup

Ingredients:

  • 1 potato
  • 1 medium cabbage (we like red but green tastes delicious too)
  • Tomato paste to taste
  • 1 turnip
  • 3 medium carrots
  • 3 cups diced vegetables of choice
  • Salt and black pepper to taste.

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Directions:

  • Boil 2 quarts of water in a large pot. Add olive oil, as desired.
  • Peel potato. Dice it up and boil in 2 quarts of water until tender. Once tender, mash it up in the water, as desired.
  • Add tomato paste, salt, and black pepper to taste.
  • Dice up all vegetable, as desired (you might like chunky or smaller pieces), and put in pot of boiling water.
  • Add cabbage last, putting in as much as will fit. Let it boil down and add more, as able.
  • Add water, if needed.
  • Approximate cooking time is 1 – 1.5 hours. Taste broth and add seasonings as desired.

New Year, New Goals: Happy, Healthy 2014

January is Folic Acid Awareness Month.
  • Foods high in folate include leafy greens such as spinach, citrus fruit, dried beans, legumes, nuts, and enriched products.
  • Folic acid is important for women of child-bearing ages to protect against neural tube defects.
  • The recommended amount for women of child-bearing age is 400mcg of folic acid.  High doses may have negative health impacts. Remember! Moderation is key.

 

Happy New Year!

According to the US.gov website, each year the following resolutions are popular: drink less alcohol, get a better education or job, eat healthy food, get fit, lose weight, manage debt and stress, quit smoking, go green, save money, take a trip, and volunteer to help others. In a study published in the American Journal of Health, researchers at the University of Missouri found that, after looking at over 99,000 participants,  any method that utilizes recording and tracking activity and results significantly provided motivation for improvement.  No matter your personal resolutions, remember that you can make resolutions at any time- it doesn’t have to be January 1st– it can be today!

Resolutions: we all make them. To be successful, we need goals, or rather, SMART goals. SMART stands for specific, measureable, attainable, realistic, and timely. So, if you have a resolution or goal you want to accomplish, it’s time to take out a pen and paper and write it down.

  • Specific: Instead of saying “I want to get fit”, a specific goal would be something like “I will do 30 minutes of walking on Mondays, Wednesdays, and Fridays”. Being less vague will help you pinpoint what activities you can perform, with whom, and at what time or on what days, to be successful in accomplishing your goal.
  • Measurable: It’s important to have a starting point and a way to measure the results. For example: “I will start walking around the block every Monday, Wednesday, and Friday. In 1 week, if I have comfortably walked around the block on those days; I will walk around 2 blocks on Mondays, Wednesdays, and Fridays. I will continue to add blocks until I have walked for at least 30 minutes on Mondays, Wednesdays, and Fridays.” Or maybe, if you are trying to lose weight or tone up, you can measure your waistline, hips, and any other areas you are focusing on. At the end of each deadline, you will better be able to see results and decide if you need to make adjustments to your goal.
  • Attainable: It’s important to choose a goal that is attainable for your unique needs and desires. It can be easy to open up magazines, watch television, or hear from a friend about the latest health trend that is or isn’t working for someone else and want to jump in. The example I have used above may be attainable or easy for some and maybe only a starting point for others. You should consider your attitude about certain activities and motivation as some may enjoy walking while others enjoy running while others enjoy swimming while others prefer to lift weights or go to an aerobics class. If you don’t enjoy the activity, your chances of success could be much lower. The same can be said about your limitations; if you have a health condition that prevents certain activities, it is important to seek out those you enjoy and can perform without risk of hurting yourself.
  • Realistic: Goals need to be realistic or you are setting yourself up for failure. Instead of aiming for a radical change, you can plan small, attainable goals with reasonable deadlines that will allow you to reward your progress and motivate you to keep going. For example, if you’ve only ever enjoyed walking/jogging a few miles a day, it wouldn’t be wise to sign up for a marathon within a month. Instead, a more realistic goal for someone who walks/jogs for run, but who is considering a marathon at some point, could start off with smaller goals of running 1 mile, then 3, then 5 over months until, eventually, their goal of running a marathon can be achieved safely.
  • Timely: Your resolutions and goals need to have a timeline. Both the short-term goals and the long-term goal should have deadlines to measure your progress against. Without a sense of deadline, one can lose their motivation to ‘get fit someday’ when instead, they can eventually ‘walk 30 minutes a day on Mondays, Wednesdays, and Friday in 2 months’ or lose those stubborn 10 pounds in a few months.

Only you can decide your goal and how SMART it is going to be for you. To help you out, you can use a worksheet, such as the one below to better help you achieve your goals in 2014!

SMART GOALS

What do you want to achieve? Specifics:

  •   Who?
  •   What?
  •   Where?
  •   Why?
Measurable

  •   How much?
  •   How often?
  •   How many?
Is it achievable?   Why or why not? How important is   it to you to achieve this goal? Time

  •   By when do you   plan to complete your goal?