What You Eat Matters

Shiva: My name is Shiva Mozaffarian and in a recent episode #196 we spoke with dermatologist Dr. Ronald Prussick about the impact of nutrition on psoriasis and psoriatic arthritis. Today I’m here to discuss tips for eating healthy with registered and licensed dietitian and wellness coach, Brittany Link from Advice for Eating based in Houston, TX. Her nutrition focus is on wellness, weight loss, healthy cooking, and disease prevention with an interest in specific diets that include vegan and vegetarian, gluten, grain, or dairy-free, and anti-inflammatory needs. In fact, Brittany addressed celiac disease in a previous episode of Psound Bytes #121. Brittany has a passion for cooking and uses her passion to help others discover healthy habits that become a lifestyle.

Welcome Brittany! It’s so good to have you back on Psound Bytes™ today! So given your background we’re hoping you can provide some healthy eating tips for the psoriasis and psoriatic arthritis community. But first, let’s start with a basic question – from your perspective as a dietitian, can what we eat improve or make chronic, systemic inflammation worse?

Brittany: Hi Shiva, thank you so much for having me back. I'm excited to be here. Yes, absolutely, what we eat can definitely improve or make our inflammation worse. So there are certain foods that we have seen can actually cause inflammation in the body and then there are specific foods that will actually fight inflammation in the body. So what we eat does have a big impact on our overall inflammation. So some of the things that we can eat that will help to fight inflammation are gonna be as many whole single-ingredient foods as you can. So those fruits and vegetables, the whole real thing, not the dried or the fruit leathers, but the real deal, fresh fruits, and vegetables. That's where you're gonna get most of your antioxidants and your vitamins and minerals, which are all gonna help to fight inflammation. Omega-3 rich foods are a really good way to help fight inflammation as well. So seafood is highest in those Omega-3’s. But some plant-based sources are like hemp seeds, chia seeds. Actually, spirulina is a very good source as well. And then probiotic-rich foods that help keep our gut in fighting order, so things like sauerkraut, yogurt, kefir are all gonna be really good options to help fight inflammation as well. And then foods that cause inflammation in the body are those highly processed foods. So foods that have a lot of added sugar, artificial sweeteners, fried foods, beverages that are sugar-sweetened or have those artificial sweeteners in them, processed meats, and then things like trans fats as well.

Shiva: Wow, that's quite the list! And Brittany, isn’t it true that how you prepare the food is equally as important as what types of food you eat? Do you have any tips on the best way to prepare foods?

Brittany: Yes. So you're absolutely right. And there are a few things to consider here. So there's how you're cooking a food and then the type of fat that you're cooking it in. So when you're cooking meats and proteins, especially one thing we wanna consider is how high we're heating them. So if you cook a meat or a protein at too high of a heat. So, for instance, if you're deep frying or even sometimes when you're grilling or broiling and it's a very high heat, then it can increase the production of these harmful compounds that are known as advanced glycation end products. These actually, if they're in high levels in our blood and our tissues can trigger an inflammatory response. So cooking your meats and your proteins at a lower heat by simmering them or steaming them, even braising meats will be a lot healthier if you do that on an everyday basis versus eating those meats and proteins at really high cooking temperatures. And then in the same kind of idea, but with a different ingredient, is when we're cooking at high heat, we also want to make sure that we're using the appropriate fats. So when you're cooking something at a higher heat, you want to use a fat or an oil that has a higher smoke point. So what we found is that heating oils past their smoke point has been linked to the formation of carcinogens. So if you are occasionally eating something that is cooked at a higher heat, making sure you're using something that has a higher smoke point. For instance, my favorite would be avocado oil. If you're cooking something at a lower heat point, that's somewhere where you would wanna use something like olive oil, extra virgin olive oil. But if you're roasting something above 400 degrees in your oven, olive oil, even though it is very healthy, isn't actually gonna be the best choice in that instance. So making sure that you're not cooking your meats and proteins in too high of heat, but also what you're cooking them in is important.

Shiva: That’s great information. So by high heat, you're indicating 400 degrees or higher. But does that also apply to grilling?

Brittany: Yes, exactly. And so that doesn't mean that you can't ever do it, but you don't wanna consistently be cooking your meats and your proteins at a high heat on a daily basis. So grilling is OK and turning the heat down on the grill a little bit, but just making sure that you aren't only cooking your meats at those high temperatures all of the time.

Shiva: So once in a while is OK. Good to know. So I’m curious, what is the right combination of protein, carbohydrates and fat, and as you know a lot of people tend to eat mostly carbs and our heaviest meal at the end of the day. Is there a specific time frame that works better?

Brittany: Great question. So first answering your question about what the kind of right combination is. Now, this is of course gonna change based on who you are, what kind of activity level you have, what your disease state is. So very active athlete is gonna need more carbohydrates than someone who is a little bit more sedentary. So carbohydrates, our body’s most immediate source of energy, meaning we're able to digest them most quickly, and those carbohydrates are what give us the energy to get up, get dressed, and move around throughout the day. If you're an athlete to work harder in your training or run further. So carbohydrates are important to have in our diet. But the amount you have is gonna vary or the amount you need is gonna vary based on your activity level as well as how well your body is able to digest those carbohydrates. So, people who have certain conditions like diabetes or polycystic ovaries, their bodies aren't able to digest and process carbohydrates in the same way, so they may need less carbohydrates. But a rule of thumb or the standard American diet calls for about 50% of your calories coming from carbohydrates, 20% coming from protein, and about 30% of our calories coming from fats. Now I said earlier that carbohydrates are your body's most immediate source of energy. So with that in mind, I typically recommend that people make sure that they're getting their carbohydrates in throughout the day and earlier in the day when they're actually gonna be able to utilize them and burn through them. I have a lot of people who come in to see me who want to do a lower-carb diet. And what I find the main mistake a lot of people make when they do that is they have no carbs at breakfast and then they have a pretty low carbohydrate lunch. And then by the end of the day, they're hungry. They haven't had a lot of fiber to help keep them full. That's when they start to overdo it on the carbohydrates and have a really high-carb afternoon and evening. So we actually wanna flip-flop that. You wanna give your body more of that immediate source of energy earlier. So I always say I always want some sort of carbohydrate, ideally a high-fiber carbohydrate at breakfast and lunch and potentially a snack if you're having it. And then if there is a meal that you wanna go lower in carbohydrates or even skip some of the carbohydrate, then dinner is the time to do it before you go lay down and rest and aren't really gonna be burning through those carbs in the same way as you would earlier in the day.

Shiva: That makes sense. You mentioned processed foods earlier, which we know tend to be pro-inflammatory. What ingredients might someone watch out for on labels for prepared or processed foods?

Brittany: Good question. Labels are something we focus on a lot, and we even do grocery store tours where we walk people through the grocery store and go through labels together because labels can be so confusing and there's so many different words and terms. Some of the main things that I tell people to look out for are added sugars, and what's nice is nowadays they actually tell you how many added sugars, not just total sugars, are in an ingredient. Artificial sweeteners are something I tell people to look for, sodium nitrate, transfats, partially hydrogenated oils, any artificial colors or flavors. And then I also tell people to look for carrageenan as well.

Shiva: What is a carrageenan?

Brittany: So it is something that is plant-based and it's often used to bind things. So you'll see it in like almond milk often to make it a little bit creamier. But we're actually finding that it can cause bloat in a lot of people when mixed with stomach acid.

Shiva: I haven’t heard of that before. So you mentioned added sugars. What are some of the aliases for sugar on food labels? I've heard there are over 50 names for added sugars in prepared foods.

Brittany: Yes, unfortunately, there are so many different names, it can be hard to keep track of them all. I even sometimes can get tricked a little bit. So the main thing I do recommend you do now is look on the label to see how many added sugars there are. But ideally, you wanna know what names sugar can fall under. A few just to go over them, (I'm not gonna name all 50) but dextrose, fructose, fruit juice concentrates, glucose, high fructose corn syrup, maltose, malt syrup, raw sugar, sucrose, sugar syrup, cane sugar, evaporated cane juice, barley malt, agave nectar, rice syrup, molasses. So the list goes on. Anything with syrup is likely gonna be a sugar. And then like I said, if you can really look on the nutrition facts label and see how many grams of added sugar are in the product that you're looking at.

Shiva: And what is the general recommendation for the amount of added sugar someone should have in a day?

Brittany: So the American Heart Association recommends 6 teaspoons of added sugar for women and nine teaspoons for men, which is an equivalent of about 25 grams a day for women and 36 grams a day for men. Now keep in mind, total sugar in terms of grams that we typically recommend here at Advice for Eating per day is about 60 grams, but this includes sugar from fruit as well. So you do wanna be trying to get most of your sugar in the day from natural sources like lactose which you'll see in in dairy products and fruits as well. So trying to get most of that from that 60-gram total from natural sources.

Shiva: So given what we've spoken about so far, do you think people in the US need to adjust their eating patterns, and if yes, what easy adjustments can be made? You've mentioned a few already.

Brittany: Yes, definitely. We are definitely one of the countries that I think has more of those refined foods, packaged products, fast food. So I think that most people could use a little bit of an improvement in their diets and what I like to start out by doing instead of telling people, they need to stop eating this or take this out of their diet, I really like to encourage people to add in more of the good for you ingredients. So I try to focus on having people start by aiming to get at least three servings of vegetables and two to three servings of fruit a day. Again, those whole food, real fruits and vegetables, not the dried or the fruit leathers or anything like that. And then adding to that the ultimate goal is to try to make half your plate at lunch and dinner vegetables. So filling up on those whole food ingredients is gonna help to fill you up and leave less room for some of those less healthy ingredients. The other thing that I really encourage people to do is increase their water intake. This is gonna leave less room for those sugar-sweetened beverages, the sodas, but water also helps to give you more energy and make you feel more full. So just incorporating those fresh whole foods and increasing your water should help to reduce the intake of a lot of those packaged sugar-sweetened products. But those are the things that we're trying to consume less of.

Shiva: So it sounds like eating a rainbow is kind of an accurate approach to eating.

Brittany: Yes, absolutely. So that's something I focus on with my clients of every age. In fact, I have a 3-year-old son, and getting him to eat vegetables sometimes, like most children, can be a little bit of a struggle. And one of the first things I do to try to encourage him to eat more new foods is at the end of the day before dinner time we go through the actual colors of the rainbow and talk about what foods he's eaten that hit each color. So what have you eaten today that's red and then that gives him an opportunity to see food in a different way. But for us as adults, even a yellow bell pepper is gonna have a little bit different nutrition profile than a red bell pepper. So getting in as many of those colors as you can is gonna be the best way to get as many vitamins and minerals, and antioxidants in as you can, which is what really helps to fight those diseases and keep you healthy, active, and young and all of those things.

Shiva: So Brittany, you previously mentioned fiber. We know fiber helps maintain digestive health and reduces risk for metabolic diseases and heart disease. There's also evidence that gut health is associated with skin and joint inflammation, which is key to the psoriatic disease community. What is the recommended daily amount of fiber and what tips can you offer to help improve fiber intake? How does the five-to-one rule work here?

Brittany: So the goal for women is about 25 grams of fiber a day and for men about 30. Now, of course, this varies again slightly based on who you are and your health state, but that's a general rule of thumb. And so I just spoke about trying to make half your plate vegetables. Trying to get three servings of vegetables and two to three servings of fruit in a day. That's gonna be one of the best ways that you can increase your fiber intake are those fresh fruits and vegetables. Aside from that, when you can, choosing the whole grain products. So whole wheat, whole brown rice, quinoa, beans are gonna be an amazing source of fiber. So black beans, chickpeas, lentils are gonna be great. And then adding things like chia seeds or flax seeds to your oatmeal or your yogurt, or on top of even salads or bowls are gonna be a great way to really boost your fiber to the next level. And then those flax and chia seeds are also a good plant-based source of those anti-inflammatory omega-3 fats that we talked about earlier as well. So they kind of have a 2 for one. When you're talking about the five-to-one rule, that's gonna be for package products. And so really what the rule is saying is that you wanna take the total carbohydrates of a product when you look at the label and then divide it by the total fiber in the product. If that number is 5 or less, it passes the test and you can go ahead and put that food item in your cart. If the total number is more than five then it has quote un quote failed the test and you should put it back on the shelf. So just helping you to choose the more high fiber options when you're buying stuff that's packaged at the grocery store.

Shiva: OK, I love the five-to-one fiber rule. It’s super helpful. So do you have any other tips for shopping or stocking the kitchen? What are your favorite items to have on hand for cooking?

Brittany: Yes, whenever I talk about grocery shopping, I always recommend that as much as you can stay to the outer perimeter of the store. This is where the most fresh and healthy products are going to be. That's really what you want to stock your cart with. And then when you are going into the center aisles, I always recommend you go in with a list or a plan. So if you wanna peruse and try new products, do it in that outer aisle section where you can try a new fruit or a new vegetable, and then try not to just go into those center aisles without some sort of idea of or plan of what you're gonna get because that's where you can get tripped up on new, less healthy products. In terms of things that I like to have on hand, I always try to keep in my fridge and my freezer fresh fruits and vegetables, as well as frozen fruits and vegetables. Frozen fruits and vegetables can be a really great way to keep things on hand that might go bad quickly as well as foods that might not necessarily be in season in the moment. As long as you're getting them frozen just as is without some sort of syrup or sauce or anything, they can actually sometimes be healthier and more nutrient dense than the fresh fruits or vegetables that have been traveling really far to get to you, and they just make life a little bit easier. I always try to have some sort of fresh or even frozen protein options so I always have some frozen chicken breasts, some frozen ground turkey then I can just defrost it when I need. Same with some fish. I'll always have eggs in the fridge and then those whole grains that we talked about, those high-fiber foods. I tend to like to have things like beans and canned low sodium beans is totally fine, and then some whole grain products like corn tortillas. I'll even buy frozen precooked brown rice or quinoa. You can make so many things with just those ingredients and some spices, lemons, olive oil. From those ingredients that I just listed, you could make tacos, you could make bowls, you could make a quick stir fry. So really trying to use those things like I said that you get on those outer aisles as well as the freezer section.

Shiva: Brittany, we need to hire you as our personal shopper!

Brittany: [laughing] I would love it.

Shiva: And what about smart snack ideas for mid-afternoon or after dinner? What foods should be avoided?

Brittany: Good question. So a lot of people think having a snack is something that they should avoid doing and there are times and places where you might not actually need a snack, but having a planned healthy snack can actually be really a good idea. So I typically recommend if it's been longer than four hours since your last meal, then you should have a snack. Because that's going to help your blood sugar from dropping too low. And when our blood sugar drops too low, that tends to be when we get cravings and overeat at the next meal. So a snack can actually be a good thing. Now, if you're really hungry and you're eating a snack like an hour after your last meal, then you wanna consider 'Am I actually hungry or is this a craving? Am I bored or am I thirsty?' A lot of us mistake thirst for hunger. So making sure that you've drank enough water if you're getting hungry pretty soon after a meal. The other thing to think about if you're getting hungry pretty soon after a meal is whether or not that meal was balanced. So what we really wanna focus on when we're balancing meals, but especially snacks, kind of my rule is I never want you to just eat a carbohydrate alone by itself. So we talked earlier about carbohydrates being your body's most immediate source of energy, and the reason they are is because they digest the most quickly and they raise our blood sugar the highest. So if you eat and it tends to typically be a snack, but someone may just have a bowl of pasta or something, if you eat a snack or a meal, that is just pretty much carbohydrates alone. What's gonna happen is they're gonna digest really quickly. They're gonna spike our blood sugar, and then it's gonna come crashing back down pretty quickly which is when you would get hungry soon after a meal, or pretty soon after a snack. So what I always recommend is that if you are gonna have some sort of carbohydrate, then you always pair it with a protein or a fat. Instead of just having fruit as a snack, having fruit with some yogurt or with some cheese or some nuts or some peanut butter. So something to help balance that carbohydrate so that it lasts you a little longer and it prevents your blood sugar from dropping too low.

Shiva: Thank you so much for those tips Brittany and I know we’re almost at time here but I have to ask since you have a passion for cooking, what’s your favorite dish to prepare?

Brittany: That's hard because I like trying new foods all the time, but I think it would either be chicken piccata. Years ago I started modifying recipes and there's a recipe from one of the Canyon Ranch cookbooks which it takes typical foods and makes them healthier and then I just adapted that recipe a little bit more. But I love that that flavor of the salty and the lemony of chicken piccata and so this is just a little bit of a healthier version of that. It's satisfying, but also light. So that or Shakshuka is my other favorite. It is kind of like a tomato pepper stew that you then cook eggs into. It's a good brunch or breakfast recipe that actually incorporates quite a few vegetables as well. The Ottolenghi Shakshuka recipe is the best.

Shiva: Well, thank you. I can’t wait to give it a try and thank you so much for being here with us today. It was such a pleasure having you back and you provided such helpful information and tips to help guide our food choices. Do you have any final comments you'd like to share with our listeners today?

Brittany: If I can recommend anything, it's just to try to slowly increase your fruit and vegetable and water intake and then go from there. Thank you so much for having me.

Shiva: Thank you Brittany for such words of wisdom for eating healthy. I’m so glad you were able to come back for today’s discussion. For our listeners, if you would like to receive additional healthy eating tips, contact our Patient Navigation Center for a free healthy eating guide by calling (800) 723-9166 or by emailing education@psoriasis.org. You can also check the episode website page at psoriasis.org/watch-and-listen for a copy of the chicken piccata recipe Brittany mentioned. And finally, thank you to our sponsors who provided support on behalf of this program activity through unrestricted educational grants: Bristol Myers Squibb, Janssen, and UCB.

What You Eat Matters

Psound Bytes™ Transcript: Episode 198

Release date: Tuesday, June 27, 2022

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