Dieting, celiac disease, and healthy eating: Q&A with experts

[THEME MUSIC] Hello, and welcome to the
University of Chicago Medicine At The Forefront Live. We're excited to host
these programs to allow you to interact with our experts. UChicago Medicine has some
of the leading researchers and scientists in
the world who are working for the
betterment of your health. So get your questions
ready, and we'll answer as many as possible
over the next half hour. And we want to remind our
viewers that our program today is not designed
to take the place of a medical consultation
with your physician. Joining us today is Courtney
Schuchmann and Lori Welstead. Both are registered dietitians. They'll be speaking with us
about healthy living and diet. And let's just start off with
the two of you telling us a little bit about yourselves
and your areas of expertise and interest.

Hi. I'm Lori Welstead. I'm a registered dietitian
in the GI section at the University
of Chicago Medicine. And I see a variety of
patients with GI disorders as well as diseases, including
inflammatory bowel disease, celiac disease. We also see a lot of patients
for weight management as well. Hi. I'm Courtney Schuchmann. I'm also one of the
registered dietitians within the Department of
Gastroenterology, with Lori as well. So I also see a lot of
the IBD and GI patients as well as a lot of
weight management. And then one of my
areas of expertise is ketogenic, which I think
we'll get into a little bit as well. Great, great. Now I want to remind
everyone, as you watch you can ask our
experts questions that are of interest to you.

So get typing. We'll try to answer as
many as we possibly can. Let's get right
to the questions. We have a couple of questions
that were sent in in advance. So let's start with those. Kathleen asks, do you have
thoughts on a ketogenic diet? So as mentioned, this
is one of my areas of expertise and specialty. I've done some
research in the diet. So the ketogenic diet
actually was initially developed for the
treatment of epilepsy. It's been used for ages. It is very effective for
treating seizure frequency and severity. However, recently it's
gained a lot of popularity for weight management as well
as a variety of other disorders as well.

I always mention, if you're
interested in the ketogenic diet to speak with
your physician just because there are some
areas and disorders that you want to confront
in advance, just to make sure that it is
a safe diet to follow. And I imagine if
you're embarking on any kind of a diet
that's out of the ordinary, it's probably a good idea to
see a physician before you do that, just to make
sure you don't exasperate any kind of situation
you might have. Exactly. And with a ketogenic diet,
or any very restrictive diet, you want to make sure that
you talk to your physician and have the appropriate labs
and tests drawn in advance so that you know if there's any
areas of concern and reasons to stop or continue
adhering with the diet. OK, Jennifer has a question. And that's, what are the
best diets to follow or foods to avoid for inflammation? Don't really know
what inflammation she's talking about.

But see if you guys
can answer that one. So it depends on– we usually have patients avoid
some foods if they suspect things such as dairy
might bother them, or things such as gluten. Again, unfortunately with
regards inflammatory issues, sometimes a Mediterranean
diet could be helpful. But there's not much to suggest
a specific diet will help just for inflammation. And again, any kind of
new diet you want to try, you know, the questions
that I have in my mind– because you see a lot of fad
diets, and a lot of diets where people say, oh, only drink
coffee, and things like that. How do you know if a
new diet will be safe? And how do you know
if it might not be? So I typically say,
if it's a diet that says, restrict very
large food groups, be cautious with following
a diet along those lines just because it can be
lacking appropriate vitamins and minerals, as well
as some other nutrients.

Also, on the other spectrum,
I say it's specifically solely based on
one food group, I would also avoid it,
like the carrot diet or the hard boiled egg
diet, just because you're eliminating almost everything
outside of those food groups which could be dangerous. What's a detox diet? So, the concept
behind a detox diet is that it can eliminate
toxins from your body. So for a lot of people,
they use these detox diets to jump start their
weight loss because they believe it can help cleanse
some toxins from the body. However, there is
minimal research to support that these diets
actually do that for your body.

Your body actually has built in
mechanisms for detoxing itself, and those are your
kidneys and your liver. So any detoxing of
medications or toxins or anything you ingest,
your kidney and your liver are going to be
responsible for doing that. Juice cleanses, we've
heard about that. Healthy, not? It's kind of along the same
lines, I would imagine. Yes, exactly. So I also agree,
like Courtney said. So especially with
juice diets, a lot of times when people are juicing
they're using a lot of fruits. And that is a very high amount
of sugar that's in the juices. So sure, it would be fine
to do a little bit of juice, but doing more vegetable juices. But doing a complete
juice cleanse could certainly cause
some weight loss. But you would likely
gain the weight back pretty soon after you're
eating normal foods again.

So, I think most of the
people that probably are watching this, or
writing questions in, are looking at weight loss. They may be looking for healthy
options for other things as well, but weight loss is
what they're thinking of. What are the keys to
successful weight loss? And we'll start with
you on this one. So, there are so many
different keys to it. So I think, definitely
making sure of sleep hygiene, because oftentimes,
many of our patients are getting very little
sleep throughout the night. So sometimes that
can cause an increase in cortisol, one of
the stress hormones, if you're not getting
adequate sleep.

I think eating frequently
throughout the day. So oftentimes a lot of our
patients struggle with eating. They eat just once
a day and say, I'm really having a
hard time losing weight. So that can really make
your metabolism sluggish. Making sure you get an
adequate amount of fluid as well, especially water
and non-caloric fluids. Courtney, I'm sure you– Exercise, also, is
a key component. So as much as you can
do with diet alone, and there's a ton of changes
you can make that can initiate and jump start your weight
loss, sustainable exercise is super important.

So aiming for 150
minutes of some form of physical activity per week. So it kind of boils down to
like 30 minutes five days a week or a little bit less than
an hour three to four times a week. Try and find
something you enjoy. So, you know, Zumba is a
nice option for some people. Going for a daily
walk after dinner can be a sustainable change. But something that
you actually enjoy and you can sustain long term. And that's, I think,
an excellent point. It doesn't have to– you know,
when people think of exercise I think sometimes they get a
little overwhelmed because they think they're going to
the gym and they're going to be really working out hard.

A walk is good exercise. Exactly. And if that's something
you can stick to, I think that's more important
than going headfirst into an exercise routine
that you might not be able to stick with. Now, you mentioned sleep
hygiene, which I think is a fascinating subject
because a lot of us don't get enough sleep. I know that's something
that I struggle with and I think a lot of folks do. What exactly is sleep hygiene? And let's kind of delve
into some of the details. What do people need to do
to have good sleep hygiene? That's a great question. So, I think making sure you find
some time to relax before you go to bed and not
just have your phone or your tablet out, or
your computer screen out, right before you go to bed
because that can definitely affect your sleep routine. Making sure you aren't
eating too close before bed because that could also be
a negative impact on how you sleep if you go to bed
with a really heavy stomach. So usually we say, try to
stop eating two to three hours before you go to bed.

Usually I say your
bed should be to sleep rather than having the TV on
and all those other things. Be cautious with caffeine,
too, in the afternoon. So for a lot of people that
have trouble with sleeping, having coffee or caffeinated
beverage in the afternoon can make it a lot more
difficult to sleep at night. Create the right
environment with, you know, room
darkening curtains can be a good option to
help ensure that you're getting a good night's rest. Yes. We want to remind our viewers
that we are taking questions live. So if you have any
questions for our experts, please just type them
in on your screen and we'll get to them as
quickly as we possibly can. So, fluid intake, let's talk
a little bit about that. Is that important if you're
trying to lose weight? Absolutely. So oftentimes you may
think that you are hungry but you're oftentimes thirsty. So usually we
recommend about a half an ounce per pound
of weight of water.

And remembering that
caffeinated beverages are not going to be
something that hydrates you. Half an ounce per pound? And that one I
hadn't heard before. I just always hear the
eight cups of water a day, or you know, whatever. But that's interesting. And caffeinated beverages,
not a good idea, as you say. Yeah. It's not going to be something
that actually is going to contribute to the hydration. It can dehydrate
you a little bit. So water, obviously
that's probably the best thing to drink. What are other good ideas? So, water, you can
add other things to the water to give it
some sweetness, whether it's real fruit, whether it be
lemon, lime, orange, grapefruit, cucumber slices. You could also
add some non-sugar containing things onto the
water as well to flavor it.

You know, it's funny. Whenever we talk about
things like this, it always gets back
to kind of keep it basic and simple and
going with what's natural and what we've been
doing for thousands and thousands of years. So, water's the best bet. We already answered the
next question, how much water should a person have? Is fiber essential
to weight loss? That would be another one. Absolutely. Absolutely. So, fiber is really
important for weight loss just because fiber is one
of those nutrients that can actually help keep you full
and satisfied after your meal. So aiming to incorporate some
type of fiber– you know, I typically say about five
grams of fiber per meal is a good starting place. That kind of breaks down to 15
grams of fiber from your meals and then some snacks
with some fiber gets you somewhere close
to that 25 to 30 grams of fiber recommendation per day.

So again, fruits,
vegetables, whole grains, are all great sources of fiber. And those are going to help
fill you up after meals. They're low in
calories and they can help you sustain your weight
loss in the long term as well. And we have a
question from a viewer who says that they struggle
with sleep as well. We're going to get
back to our sleep. And I think that's something
that's probably on top of a lot of folks' minds. They get a prescription
from their physician, but they also want to know
if melatonin is a good thing to take and if it will help. So I would say definitely get
the advice of your doctor. You can try melatonin. It is a supplement that's
just over-the-counter. And I would start with
just the smallest dose and see how you react to it. Amy has a question for us. She says, do you recommend
a whole food plant based diet for your patients? So I mean, definitely
what I recommend to patients is really looking
at the diet and saying, OK, I want to eat more things
that, I joke, that say, rot and go bad.

So again, I used
to say eat things around the perimeter
of the grocery store. But often times that has
the fried foods, the bakery, and all those other
kinds of things. So I say, yes, definitely
eating a good portion of your diet being plant based. And I also think, too, so if you
are getting animal products it is good to have that balance. So plant proteins as
well as animal proteins. Yeah, I think they have changed
the way grocery stores are set up over the past
few years, because I do remember hearing that, shop
the perimeter of the store. And that's changed so much. Mm-hm. So, question from Louis. Do pain medications cause
issues with weight loss? So again, talk to your
physician about this. It's very specific to what
kind of medications you're on. There are a variety of
different medications, pain related medications as
well as some other medications, that people often do take that
can impact your metabolism and can make it a little bit
more difficult to lose weight.

Some of them can also
impact your sleep habits which again, can
kind of boil down to some difficulty
with weight loss. So it's very specific to
the specific medication. And bringing it up to your
physician if that's a concern, or you recently
started a medication and now you're having some
difficulty with your weight, that could be something
that needs to be discussed with your doctor. Have a question from Ashley. I know if you don't
eat enough it can make it harder to lose weight. Is there a kind of a
minimal recommendation of how much you can eat? And this one's interesting
to me because I have a family member who was
talking about losing weight and his goal was to try to
eat 500 calories or less a day which I suggested
is not a good idea– my son. So let's talk a
little bit about that, because I think that's a
good thing to educate people. Oh, absolutely. So typically in our
clinic we don't recommend going under 1,200 calories. Typically, again, you could
be on a medically supervised weight program and do about 800. But that would be
something you would want to see your
physician very often, or a registered
dietitian, so they can do labs because that
is a very low calorie diet, is 800 calories.

But we usually say 1,200. Trying not to go below that when
you're trying to lose weight because yes, if you
are eating too little, that could actually
make your metabolism a little more sluggish and
affect the goal of weight loss. And it's hard to meet all
your vitamin and mineral needs when you're less than 1,200
calories per day, which is why the Academy of
Nutrition and Dietetics does make that as our lowest
cutoff for weight loss. Also, we do see often when
patients cut their calories really, really low, it is a
lot harder to lose weight.

And it might just
be that you're not getting enough energy to burn
calories throughout the day. So you're feeling
sluggish, you're not moving as much,
which is going to result in less weight loss. We were talking a minute ago
about the importance of fiber. What are good sources of fiber? So yeah– Plant based foods. Yeah, plant based foods.

So again, with regard
to fruits, berries are one of the highest
sources of fiber. Again, all fruits
and vegetables, the skins, the seeds
are going to have a good amount of the fiber. And there, whole grains,
beans and lentils are also great sources as well
for fiber, nuts and seeds. Is there a specific
amount you should eat? So typically for females about
25, for males it's up to 30– 38. –I think is the
cutoff for males. So again, as Courtney
mentioned, trying to aim for five to seven grams
of fiber at least per meal to really get into that 25, at
least, grams of fiber per day. This next one is
interesting to me because I've heard
this one before.

apple norms size standards

I don't know if
it's true or not. If you change your diet, can
that cause food sensitivities? So myself personally, I have
seen some people come in and say they've eliminated
dairy from their diet. And when they go to
reintroduce it into their diet they do have some
sensitivities to these foods that they don't
remember having before. Same thing with
gluten based foods. Often they add these
foods back into their diet and they notice that they
have some GI discomfort and intolerance to them. It could just be that the
enzymes that your body produces to help metabolize these and
break things down and absorb them might be less than what
they were produced at before, so that can cause some
problems for other people. I think you are exquisitely
sensitive when you reintroduce those foods back, yeah. Yeah.

That makes sense. You're not used to things. I've got another
question from a viewer. I've heard that
controlling blood sugar can be essential for weight loss. Practically speaking,
how does someone control their blood sugar? Is it cutting out
processed sugar? Or is there more
to it than that? So we definitely say to cut
out all the processed sugars, and then to be very mindful
of the overall carbohydrate content of the diet.

So that would be,
even from things that are even whole
grains, you still want to be mindful of the
portion of those whole grains because that could still add up. So it's the total
carbohydrates whether it be from fruits, starchy
vegetables, peas, corn, and potatoes, again
the whole grains. Even things like beans– beans are a great
source of protein but they also do
have carbohydrates. You do want to be
mindful of fiber when it comes to carbohydrates. The fiber will be very
helpful for the blood sugar. Courtney, you have
anything else to say? Well, and also keep in mind if
you have diabetes or anything along those lines where you're
on insulin or medications that are specific to the
amount of carbohydrates that you're consuming, make
sure you meet and discuss with a dietitian or
your endocrinologist about the specific
carbohydrate goals you should be shooting for.

Also along those
lines, keeping in mind added sugars are going to
be one of the first things that you should try
and cut back on. Often people tell me that
they cut out table sugar. However, it's also important to
keep in mind things like honey and agave. They are also forms
of added sugar. But often people think those
are a healthier alternative. OK, I'm Going to mispronounce
this person's name and I apologize in advance. But we have a question
from, I believe it's Kado. K-A-D-O, I'm not sure
how to pronounce that.

But, what are your thoughts
on intermittent fasting? And that's, again, something
that I've heard many times, seen it on the internet. People will fast
for a day and then– is that a good way
to do this, though? Yes. Go ahead. There is a lot of
research to suggest that it can help with
some weight loss, especially right now
there's a lot of up and coming research studies
that are showing that it can be beneficial for weight loss. There's a bunch of different
types of intermittent fasting. So there's some where you're
less than 500 calories a few days a week.

There are some days that you're
not consuming any calories. And then there's
other ones where you're only consuming
food during an eight to 10 hour period of time. So there's a bunch
of different versions of intermittent fasting. And again, it's
what is sustainable? So if it's something that you're
only going to do for a week, it's probably not going to be
beneficial for weight loss.

Yeah, makes sense. So Celiac Awareness Day is
Thursday, September 13th. So of course, we probably want
to discuss that just a bit. And we do have a
question already that is along the same lines. If my stomach feels better
when I don't eat gluten does that mean that I
have celiac disease? Not necessarily. So what we do recommend
if someone does suspect that they have symptoms
after consuming gluten, is to get tested
for celiac disease. And it's a simple blood
test just to rule it out. Because once you
do go gluten free, it makes a little bit more of a
challenge to actually determine if you do have celiac disease– Interesting.

–with the blood test,
because you can only detect celiac
disease in the blood if you have gluten
in your system. Now, oftentimes
patients may feel better doing a little bit more
gluten free of a diet. And it's because of
something called FODMAPs, which are different kinds of
fermentable carbohydrates. Now, wheat, rye,
and barley, which are the grains that
contain gluten, are in that same
category as things such as brussels sprouts,
cabbage, onion, garlic, which for a lot of
individuals they might find they are more
gassy after those foods. So the wheat, rye, and barley
are in that same category. So we suspect it's more of
a carbohydrate issue that causes gas and bloating, versus
something with celiac disease. Interesting. And that was the next
question, is there any benefit to a
gluten free diet if you don't have
celiac disease? And some folks have said
that, that they feel better after going gluten free
even though they're not diagnosed as celiac. Yeah, so unfortunately we
don't have any evidence to say that there's going
to be any other improvement, besides symptoms.

Now again, if
someone has a better quality of life on a gluten
free diet, that's fine, that's great. But again, there's no
other added benefits to going gluten free
outside of celiac disease that we know at this time. I think the main thing
is just to make sure that they are taking
a multivitamin, because you can also
become deficient. A lot of these grains that are
gluten free or not fortified. Yeah. And that's kind of
along the same lines of, if somebody wants to go vegan
or very strict vegetarian they need to possibly look
at their vitamin intake and obviously protein as well. Absolutely. Absolutely. And meet with a dietitials so
that you have an understanding of which foods have proteins,
which ones have the vitamins and minerals, because often
if you're going vegan and just eating chips and salsa,
you're missing out on a lot of the protein and
the vitamins and minerals that are essential for weight
loss and other things.

Next question, how do I care
for a child or a loved one that suffers from celiac disease? So I think making it as celiac
friendly in the household. So making sure there are
some separate things. So making sure they
have a separate toaster, a separate strainer
for their pasta, even cleaning
vegetables because that can be often cross-contaminated. Even things such as cutting
boards and some of the utensils in the house to
make sure that there are some separate things
for that individual with celiac disease. Interesting. So it's that sensitive? Yes it is. That's great to know. Now, here's kind of the
million dollar question. So, you've achieved your
desired weight loss. How do you maintain it? What are some good
tips to– you know, because I think a lot of people
do go on some of these crash diets in particular where they
lose 20 pounds, 30 pounds.

They get where they
want to be, and then they struggle to stay
in that neighborhood. Yeah. I do know that a lot of people
do look at that goal weight as their finish line. And once they've
achieved it, they kind of go back to
those eating habits that got them into
the predicament that they were in
in the first place. So I actually have a
patient that once told me that she wrote
down everything she did to achieve her weight loss. And that's something
she revisits frequently to help her stay on track. So things like keeping
food logs regularly. So all of a sudden if you
notice your weight's creeping up and you haven't
entered any food logs, you have no idea where
your calorie intake is now, that's a good thing to
revisit, or how frequently you were exercising before. So kind of implementing
some of those changes you made to
achieve that goal weight, those are going to be just
as important to sustain that weight loss.

Now, speaking of
the weight loss, there are a lot of
fad diets out there. Nathaniel has a question for us. And he asks, are there
certain fat diets out there that you would
recommend people avoid? So, one I saw on Facebook
today was the egg diet. So while eggs are awesome, great
source of vitamins, minerals, healthy fat, protein, it's
definitely not something you can adhere to long term.

But you're also missing all
of the vitamins, minerals from fruits and
vegetables and grains. You're also missing
a lot of fiber. So staying on a diet like
that in the long term can result in some
constipation as well, which is a concern for
a lot of people that are trying to lose weight
if you're feeling bloated all the time from not
having bowel movement. So, Heather has a question. Do you recommend
vitamin supplements? Should people be taking
these on a regular basis? Is it case by case basis? You know, I think
we, again, we all look at vitamins and
supplements and I think we worry, a lot of times– I know I do– if I'm getting
the proper nutrition.

Across the board,
we don't necessarily recommend that everyone takes
all sorts of supplements and vitamins. Specifically for
celiac disease I do recommend taking a
multivitamin with minerals. Also, if you are concerned about
having any kind of deficiencies possibly check with your doctor. They can draw some different
vitamin labs or mineral labs that you may be deficient in. And really, most
individuals, if you're eating an overall
normal diet, you shouldn't be too deficient
in vitamins and minerals.

But yeah, If you're following
like a vegan or a vegetarian diet, you definitely want
to see if some of those labs should be checked because there
could be areas that you're missing out on such as
calcium or vitamin D that a dietitian or a
physician can help recommend the appropriate dosage. Deborah has a question
for us, thoughts on alternative sweeteners
that don't cause GI issues? Ooh. So, specifically
looking for ones that don't cause
some of those issues? I think that's what
she's getting at, yeah. So, Stevia is one that we
often recommend in clinic. It's a plant based sweetener. It's not a sugar alcohol,
which sugar alcohols are some of those ones that
can cause some GI distress.

However, keep in mind,
read the food label very closely because
some of the Stevias that are sold on the
market contain erythritol, which is a sugar alcohol that
can cause some GI distress. Great. Now here's one that I like
because unfortunately I do travel quite a bit
and I am on the go a lot. Healthy eating options when
fast food is all you've got. There are a lot of times
when you're in the car and you look for someplace
to eat and you're in a hurry. What do you do? Let's see. So I mean, I would say,
you know, be mindful. If you can possibly
look on something like Calorie King, or looking
on their menu ahead of time to kind of gauge your options,
because oftentimes you might think one entree might
be the healthier option. But if you don't really
know the nutrition facts that might be the highest
calorie option on the menu. So I usually recommend looking
ahead of time at that menu so you can kind of see
what your options are.

And load up on vegetables. Vegetables are
typically an option at all restaurants
and fast food places. So you can always get foods
that are in the grilled form. So instead of getting
a fried chicken breast, maybe getting a grilled
chicken sandwich and having like a
side salad instead of the french fries with it. And yeah, I think it's just
buyer beware when you do that, because sometimes you
can see the salads in some of the restaurants that
will have more calories than– Yes. Exactly, than the burgers. –the hamburger. Yes, so definitely be careful. Watch those toppings. The other thing
I'm curious about, and I know there are a lot of
apps out there for your phones or whatever that
are calorie counters and that you can enter what
you eat and that sort of thing. Are those helpful, do you think? Absolutely. I think they are. A lot of our patients
really find to be helpful. So what would you
recommend for people? Just is it, you just
go through and you make sure you enter
everything you eat during the day,
exercise, things like that? Yes.

So, we often use
my MyFitnessPal. It's one that you can
actually input your recipes into as well, which is nice. So if you're eating the
same salad every day, rather than entering every
ingredient for that salad into your food log
it's kind of nice because you can put the
recipe in and just add it and it takes five
seconds out of your day. Other people, it's easier
to just write it down on paper throughout
the day and maybe enter it at the end of
the night so that they can get a feel for where
where their calories at during the day? Great. Well, I think we're
about out of time. You guys were fantastic. Thank you. You did a great job. That is all the
time we have today. I want to thank Courtney
and Lori for appearing on At The Forefront Live. If you want more
information about UChicago Medicine's weight
management program, please visit our website site
at uchicagomedicine.org/weight management, or
call 888-824-0200.

It's at the bottom of
the screen right there. You can see it. Thanks again for watching
At The Forefront Live and have a great week.

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