NIFS Healthy Living Blog

Let’s be real: a health journey is not always linear and not always easy. Sometimes it can be overwhelming and mucky. What do you do? Where do you start? What if you backslid and need to get back on track? There is so much to health, right? If you try to fix it all at once, you might become overwhelmed and at a greater risk of failure.

Small Actions That Will Have a Big Impact on Your Health

Start with the things that seem small but make the most impact on your health.In this blog I identify five areas that will give you the biggest results for your efforts. Spoiler alert: none require silly supplements, tummy wraps, or popular diets such as Keto or Paleo.

Get 7–8 hours of sleep each night.

Sleep is our body's cheat code for restoration, rebuilding, and recovery from all of the sources of stress. You can eat all the nutritious foods in the world and exercise for hours, but if you are not sleeping, hormone imbalance starts working against you and halts your physical goals.

Fun Fact: A study at UC San Francisco found that those who sleep less than 5 hours are 4.5 times more likely to develop the common cold compared to those who sleep 7 hours. So hit the hay and keep infection at bay! Your body will thank you later.

Manage stress and mental health.

We all have stress. It’s important to manage the stress instead of using negative coping mechanisms, such as overeating, sleeping all day, isolating ourselves, and falling into the “I can’t change this” trap.

YOU CAN CHANGE THIS. You can get through this, and you can manage the stress in your life. Coping has its place in the health cycle, but ultimately, we want to shift into the “stress management” part of the cycle sooner rather than later. Coping is when we put up with the stress, live with it, and accept that it’s just the way it is (nothing can “lessen” the stress). Managing stress is when we try to lessen the stress by adjusting our thoughts and actions; we find a way to make it better. Examples include music, therapy, exercise, time management, making lists, saying “no,” nature, yoga, meditation, stepping away from toxic relationships, and doing a hobby.

Start dialing in on your nutrition.

What we eat fuels our physical, mental, emotional, and social health. Because of this, nutrition can get a bit complicated sometimes. So, start with small but significant changes and build from there. My suggestion is to start by practicing the 80/20 rule and having a consistent meal pattern.

So what does 80/20 mean? We all know it’s important to eat nutritious, whole foods. But what about those foods we love that aren't necessarily the best for our physical health but are good for our mental and social health (such as sweets, chips, pizza, eating out with friends, holiday food, etc.)? It’s unrealistic to cut these foods and events out of our lives—let’s be real, we have all tried this and failed. It's time to find a balance, one that will still keep you on track for hitting your health and fitness goals.

Here are the #dEATS: 80% of your food intake should be from nutritious, whole foods such as fruits, vegetables, lean proteins, legumes, whole grains, and high-quality dairy (if you’re not lactose intolerant). The other 20% of intake (calorie intake) should be from the foods you love and can't live without, but maybe aren't the greatest for your physical health. Use this 20% when going out with friends once a week, enjoying a sweet treat every other day, or grabbing a small bag of chips to compliment your chicken sandwich.

If you have a calorie goal, track these calories and make them part of your regimen to meet your daily caloric goal. If you do not have a calorie goal, practice portion control. Regardless, be sure to have a consistent meal pattern (3 meals and 2 snacks daily). Remember, there is more to health than just our physical bodies. The two other realms of health are mental and social. Food plays a big role in all three realms that make up health. Therefore, you must have a food plan that meets the needs of all three.

Increase your daily steps or non-exercise activity.

Get up and moving. I know it’s hard to do this, especially for those with desk jobs. But take a 10–15-minute break to walk in place, stretch, and do some deskercise. If you can get out and take a walk with some coworkers during the day or your family at night, do that! This gets your body moving and your metabolism going. You may be surprised at what some extra movement does for your mental and physical health.

Exercise 150–300 minutes per week.

Aside from trying to move throughout your day, plan to exercise 150–300 minutes each week. This exercise should be moderate to high-intensity. Be sure to consult a personal trainer if you are unsure what is best for you. Find something you enjoy and start there.

Incorporate Changes to Your Routine and Then Build on It

These are some starting points. Pick a few and get started. Do not overcomplicate this. No, you do not need a fad diet. No, you do not need a ton of supplements. No, you do not need to overcomplicate the timing of meals or workouts. These BIG FIVE are some of the most important things you can do to improve your health. What you need is to find a routine with all five of these points and build consistency over time. Once these become a part of your everyday life, you can dig deeper into other things, such as supplements, meal timing, and specific exercise movements.

As always, NIFS professionals are here to help! Reach out if you need help implementing any of these big 5 health improvements.

This blog was written by Sabrina Goshen, NIFS Registered Dietitian. To learn more about the NIFS bloggers, click here.

Cranberries and cranberry-derived products are commonly used as a remedy for urinary tract infections, especially among women. Cranberries contain proanthocyanidins (PACs), specifically A type (PAC-A). It is argued that this component of cranberries fights and prevents UTIs, just as an antibiotic would. However, there is much controversy on this topic.

Clinical Trials and Studies on Cranberry for UTIs

Freire Gde C. completed a large review of 24 studies totaling 4,473 participants. In the research, there was minimal evidence suggesting that cranberry products prevented UTIs. Within those studies, cranberry juice decreased the number of UTIs in women who had recurring UTIs; however, the studies that showed a significant efficacy were small trials. When studies grew in size, the difference between the placebo groups and the cranberry groups shrank.

Furthermore, a Stapleton AE et al study completed a randomized control trial of 176 participants, of whom 120 were taking cranberry juice and 56 were given the placebo over the course of 168 days. The adherence to instruction was similar between both groups (91.8% and 90.3%). However, cranberry juice did not significantly reduce UTIs.

The Maki KC et al study argues that cranberry juice intake does indeed lower the number of UTI episodes in women with a UTI history. In their RCT, 185 women were given 240-mL cranberry juice each day for 24 weeks, while 188 women were given the placebo. The cranberry group had 39 UTIs, while the placebo group had 67 UTIs. This makes the differences significant, meaning cranberry juice did indeed work.

So, why do some trials show significance while others do not? Occhipinti A et al¹ suggests this is due to the lack of authentication of cranberry products used (some are not really cranberry-derived). Thus, the products used do not contain PACs-A, which are what scientists claim fight the UTI. In their study, they authenticated and measured the PCAs-A in the cranberry product given. They gave one group a cranberry product with 36 mg PACs-A two times daily and another group with the same number of participants a product with no PACs (placebo). After 7 days, a significant difference in colony forming unit/mL counts (via urine cultures) was found between the placebo and the PACs-A group. The PACs-A group had significantly fewer colonies. The argument here is that for cranberry products to work, the cranberry product must be carefully authenticated to ensure that it indeed contains PACs-A, which is a component typically lost in processing.

The argument here is that for cranberry products to work, the cranberry product must be carefully authenticated to ensure that it indeed contains PACs-A, which is a component typically lost in processing.

Drug Interactions, Additive Effects and Side Effects

Lexicomp, a drug database used by medical professionals, still advises people to monitor cranberry intake while taking warfarin; however, there is little research to suggest the two adversely interact. Since cranberry juice is acidic, it is important to avoid drinking it within 2 hours of taking erythromycin, a common antibiotic, because it will decrease metabolism of the drug.

Common side effects of cranberry are nausea, vomiting, tightness in the chest, itching, cough, swelling of the face or lips, seizures, GI upset, and loose stools.

The Clinical Bottom Line

There is little evidence that suggests cranberry products decrease UTIs, mainly because the PACs-A have been lost in the processing. Although people are welcome to use cranberry-derived products, I would warn about the GI upset that can occur with excessive use, the cost of cranberry tablets, lack of authentication of the products, and added sugar content in the juices. Because of the lack of evidence, I would not advise individuals to spend their money on cranberry tablets. I would also argue that the risks associated with added sugars in the juices outweigh the small chance of preventing a UTI. If you insist on using cranberry for UTIs, be sure that it contains the bioactive PACs-A.

Further Research Is Needed

Much of the research done to prove cranberry juices and products prevent UTIs fails to address the authentication of the products used, and whether they even contain the bioactive PACs-A. I think further research should include authentication of the products used. If they do that, they may see that cranberry can indeed reduce and treat UTIs.

This blog was written by Sabrina Goshen, NIFS Registered Dietitian. To learn more about the NIFS bloggers, click here.

Healthcare providers and scientists are all working diligently to find ways to prevent, treat, and cure COVID-19. Many of us are eager for answers and probably getting tired of not knowing what to believe. One of the hot topics floating around is about Vitamin D’s role in preventing COVID-19. Can Vitamin D really protect us against COVID-19 or at least lessen the effects? Let’s take a look.

The Role of Vitamin D

Vitamin D serves many purposes in the body, the most commonly known purpose being assisting calcium absorption and bone mineralization for good bone health. It is less well known that Vitamin D plays an essential role in immunologic function—keeping your immune system strong. Vitamin D inhibits both B cell and T cell (lymphocyte) proliferation/rapid increase, affects T cell maturation, and facilitates the induction of T regulatory cells. It also helps regulate monocytes production of inflammatory markers and inhibits dendritic cell (DC) differentiation and maturation. All of this leads to a decreased production of inflammatory markers and an increase in anti-inflammatory markers. In short, it has an anti-inflammatory role.

Vitamin D and COVID

Now that you understand the role of Vitamin D in immune support, let’s look at the link between that and COVID-19. When healthcare providers check your Vitamin D levels, they request a lab called 25-hydroxyvitamin d. This is the circulating Vitamin D in your body. Ideally, we want to see that number be at least 30 ng/dL. In theory, having enough circulating Vitamin D should reduce complications by preventing the “cytokine storm” that providers are seeing in response to COVID-19 infection. The cytokine storm is when the level of inflammatory proteins rapidly rises to dangerously high levels. It is what leads to complications such as ARDS, myocarditis, and acute renal and heart failure, especially in those elderly patients with previous cardiovascular comorbidity. Researchers have started requesting this lab from patients with COVID-19.

Study Shows Decreased Risk for Adverse Affects

One cross-sectional study of 235 individuals showed that patients with at least 30 ng/dL had a significantly decreased risk for adverse effects, such as hypoxia (low oxygen levels), death of individuals over 40, and unconsciousness. Serum C-reactive protein (an inflammatory marker) was lower and lymphocyte percentage was higher in Vitamin D–sufficient COVID-19 patients. In the study, 67.2% of the 235 COVID patients had Vitamin D levels less than 30 ng/dL. The study saw no significant difference in hospitalization duration, ICU admissions, Acute Respiratory Distress Syndrome (ARDS), and intubation between insufficient and adequate Vitamin D levels.

Similarly, a study showed Vitamin D levels were significantly lower in COVID patients with severe symptoms than those with mild symptoms or no COVID at all. Of the symptomatic patients, 54 were admitted to the ICU due to ARDS—all of whom had lower Vitamin D levels than the patients not needing the ICU. Sadly, 19 patients died, and again they found that these patients had lower Vitamin D levels than the ones who survived.

Another Study Finds Lower Levels of Vitamin D in Hospitalized Patients

A study of 216 COVID-19 patients and 197 population-based controls saw significantly lower levels of Vitamin D in the patients hospitalized due to COVID-19 than the controls (of similar age and sex), which lines up with the previous studies. On the contrary, they did not find a relationship between severity of infection and Vitamin D levels like the other studies found.

Study Finds People with Vitamin D Deficiency More Likely to Test Positive

Another study of 489 patients found that those with Vitamin D deficiency (<20 ng/dL) were 1.77 times more likely to test positive for COVID-19 than those with sufficient Vitamin D levels. The study above by Hernandez et al supports this finding, showing that 82.2% of COVID-19 cases were deficient in Vitamin D compared to the population-based controls, where only 47.2% were deficient (which is significant).

Correlation Is Not Causation

Something to note: These studies are observational studies. Thus, we cannot determine a cause-and-effect relationship between vitamin D deficiency and COVID-19 infection outcomes. Correlation is not synonymous with causation. So, while these results are important and useful, we must be careful to not go as far as saying, “Vitamin D can protect me from COVID-19 or lessen the impact if I get sick with COVID-19.”

Further research is being conducted since we do have strong observational support that suggests low Vitamin D levels may favor respiratory dysfunction and even death in those with COVID-19. Several Randomized Control Trials are in process. Many are trialing high-dose Vitamin D in those with COVID-19, such as the registered study by University Hospital in Angers (France). One has already concluded, but it was small with only 50 hospitalized patients being given a high dose of Vitamin D (calcifediol) and 26 not given a high dose of Vitamin D. Only 1 of the 50 high-dosed patients needed ICU treatment, whereas 13 of the 26 not given Vitamin D needed ICU treatment. 

Vitamin D Recommendations

Let me be real clear: You do not need to start taking a megadose of Vitamin D! Doing so can actually lead to toxic effects because it is a fat-soluble vitamin. The goal is to prevent deficiency to help keep your immune system strong.

I do suggest reflecting on your Vitamin D intake and exposure. Do you get out in the sun 10–30 minutes several times weekly? Sun exposure is less common in the winter, which hints at why more people are Vitamin D deficient in the winter months. When the sun’s UV rays hit our skin, Vitamin D3 (cholecalciferol) synthesis can occur. Do you eat Vitamin D–rich sources? If not, start to add some foods that are rich in Vitamin D. This will help you reach the RDA of 600 IU for young adults under 70 years old and 800 IU for adults older than 70 years old.

Here are some Vitamin D–rich foods:

• Trout, rainbow, cooked (3 oz = 648 IU)
• Pink salmon, cooked (3 oz = 444 IU)
• Halibut, Atlantic or Pacific, cooked (3 oz = 196 IU)
• Portobello mushrooms (1/2 cup = 316 IU)
• Canned tuna (3 oz = 228 IU)
• Milk, whole, 1%, 2%, and nonfat (1 cup = 115–128 IU)
• Yogurt, various types and flavors (8 oz = 80–120 IU)
• Soy milk (1 cup = 116 IU)
• Orange juice, fortified (1 cup = 100 IU)
• Eggs (1 large = 44 IU)

If getting your RDA by eating these foods is not realistic for you, I would suggest a Vitamin D3 (cholecalciferol) supplement to help increase your intake. A Registered Dietitian can help you adapt your nutrition regimen to meet Vitamin D requirements.

Finally, speak with your healthcare provider. They can always request that your 25-hydroxyvitamin d (circulating Vitamin D in your body) lab be checked. If you’re found to be deficient, you may require larger doses for treatment.

The Bottom Line

We do have strong observational support that suggests low Vitamin D levels may favor respiratory dysfunction and even death in those with COVID-19. However, we simply do not have enough strong data to conclude that Vitamin D sufficiency can treat or prevent COVID-19 infection until Randomized Control Trials are complete.

In the meantime, the best thing to do is continue to stay healthy (or improve your health) and keep your immune systems strong, which includes eating enough Vitamin D or having adequate Vitamin D exposure.

As always, please reach out to a NIFS Registered Dietitian for any nutrition support you need.

This blog was written by Sabrina Goshen, NIFS Registered Dietitian. To learn more about the NIFS bloggers, click here.

• “I am going to eat a salad because I’m on a diet.”
• “I am going to eat a salad to clean my pipes.”
• “I am going to eat a salad because that’s the only way I know how to eat my veggies.”
• “I am going to eat a salad because I hear that’s how I can be healthy.”

Come on. We've all heard this before—from friends, from coworkers, and possibly from our own mouths. I swear, salads are easily the most famous “diet food.” Why is that? Do we really have to eat salads to lose weight, clean out our “pipes,” or be healthy? In this blog I break down each of these claims and then talk about ways to improve your veggie game!

“I am going to eat a salad because I’m on a diet.”

This is usually said when someone is trying to lose weight or be “super healthy.” First, to lose weight, it is widely understood that we must burn more calories than we eat. Thus, we try to minimize our calories to lose the weight. Second, people think that if they eliminate all “processed foods,” they will automatically become healthy. The idea behind salads is that they’re “healthy,” “low-calorie,” and blah blah blah.

Guess what? Salads can quickly turn into a high-calorie snack or meal and become full of unhealthy saturated fats and sodium. For example, let’s look at the Southwest Avocado Chicken Salad from Wendy’s. Sounds healthy, right? They even market this salad as healthy. A full salad has 530 calories with 34 grams of fat, only 15 grams of carbs, 43 grams of protein, and 1060mg of sodium. First off, that’s not a big salad for all those calories—which will make maintaining a caloric deficit (for weight loss) difficult. Finding foods that can be eaten in large volumes for lower calories tends to help satiety during weight loss attempts. Also, 34 grams of fat is a lot for one meal. The RDA for a full day is 44–77 grams for someone eating 2,000 calories. Now look at the sodium: 1060 mg of sodium is close to half of the RDA for sodium. Yikes. Hey, at least the salad has protein. They got that part right.

In addition, health is not just about physical well-being. Salads, if built correctly, can most certainly offer physical benefits. But health includes mental and social well-being too. Think for a moment. Does the salad taste good? Am I satisfied? Can I keep this up forever? Am I happy with this? If the answer is “no,” consider a different approach. Any change you make should be one that is sustainable for life. In the midst of making these changes, you must evaluate your physical, mental, and social health at all times. How can you improve one part of well-being without sacrificing another? Finding that balance is the key to SUSTAINABLE, healthful lifestyle changes, which ultimately leads to lifelong results.

“I am going to eat a salad to clean my pipes.”

Fiber does wonderful things. There are two types of fiber: soluble and insoluble. Soluble fiber is found in oats, beans, peas, berries, apples, plums, and sweet potatoes—all of which can be found in salads. This type of fiber helps absorb water, which adds bulk to stools. There is also insoluble fiber, which helps to get things moving in the GI system, thus helping to relieve constipation. Insoluble fiber is typically found in whole grains, the skins of fruit, skins of beans, seeds, spinach, carrots, cucumbers, lettuce, celery, zucchini, and tomatoes. These foods are even more common in salads, which gives you a hint as to why having a bowel movement after eating salad is not uncommon.

Fruits and vegetables, particularly lettuce, have high water content. It’s no secret that water assists in the digestion process. In this case, fiber works best when it absorbs water. This makes your stool soft and bulky.

“I am going to eat a salad because that’s the only way I know how to eat my veggies.”

This is valid. Vegetables can be super boring. Finding new ways to enjoy veggies can be a challenge. However, there are ways to eat veggies without having to eat a salad. Raw veggies with dip, grilled, steamed, and roasted are all ways to have veggies. Do not skimp on the spices and seasonings, such as garlic powder, onion powder, cumin, Italian seasoning, and ginger. I promise that makes the veggies taste 100,000 times better.

“I am going to eat a salad because I hear that’s how I can be healthy.”

Read above. I think you got the point.

Bottom line: You do not need a salad to be healthy, lose weight, or clean your pipes. If you like salads, eat them! But be careful of the added fats that tend to sneak into salads. If you do not like salads, find another way to eat your vegetables. Roasted, steamed, raw, and grilled are all yummy ways to eat veggies. Check out my recipe page for more ways to cook veggies. Remember, it’s important to like and enjoy the foods you eat.

This blog was written by Sabrina Goshen, Registered Dietitian. To learn more about the NIFS bloggers, click here.

As winter approaches, don’t let it discourage you from reaching your full potential and goals you’ve set for yourself. Continue to use exercise and strength training to keep your body healthy.

Keep Setting Fitness Goals

Continue to set goals; goal-setting will help you stay the course. Setting goals gives you purpose and meaning, and a reason to come to the gym. Set small goals and watch them turn into big ones. If you feel you’re plateauing, get a personal trainer to help you push past your threshold. They will keep you accountable as well as push you to new heights in your fitness journey.

Focus on Nutrition and Healthy Eating

Use the cold months to really focus on your nutrition. Winter months can lead to more relaxation since outside activities are not as prevalent. Keeping good nutritional habits will help you achieve your goals. If you need help with nutrition, utilize a dietitian to help you find the right foods to eat. Meal prepping and eating real foods will be key during the winter months—not getting set on carryout food and outside dining. Although every once in a while it’s okay to eat restaurant food, you want to focus on eating clean and getting proper nutrients into your body. Especially now during COVID-19, you want to make sure you’re staying as healthy as possible.

Maintain Safe Practices in the Pandemic

Speaking of the pandemic, continue to practice safe distancing while out in public. That way, you’ll keep your family safe and those around you. Try to minimize large gatherings. If you have to be with friends and family, make sure everyone does the proper things to keep everyone healthy and safe, including wearing masks. Use your best judgment while out and in social gatherings. Continue to wash your hands and sanitize equipment and any object that has been touched or will be touched.

Stay Busy and Keep Planning

Find new hobbies. If you’re able to get outdoors, enjoy that time with family and friends. If you’re not fortunate enough to be able to be outdoors due to the cold weather, find indoor activities to pass the time, but keep yourself busy. Don’t let the winter months bring you down. Continue to plan daily to attack the day and stay motivated. Stay busy and stay healthy!

This blog was written by Michael Blume, MS, SCCC; Athletic Performance Coach. To learn more about the NIFS bloggers, click here.

There’s always an assumption that fitness professionals work out 2 hours a day, 7 days a week. They eat healthy all day long and never have any junk food. Basically people think that we are perfect and never make mistakes. I have been in the health and fitness industry for more than 10 years now and I can honestly say that couldn’t be further from the truth.

Now, before anyone thinks I’m ratting out other trainers or telling you all we don’t practice what we preach, let me explain.

We Are Actually Humans, Too!

I know it’s hard to believe, but we are human; we make mistakes, we have cheat days, we indulge a little, and we even skip workouts from time to time.

Take a look at a conversation I had with one of our trainers at NIFS:

Ashley: How often do you work out?

Lauren: About 5 days a week.

Ashley: How long do you work out for?

Lauren: Anywhere from 30 to 90 minutes. If it’s conditioning, it’s much less.

Ashley: Do you have cheat days? Exercise or nutrition?

Lauren: I try to have cheat meals or situations. I try not to have it be the whole day. In the past, I would have cheat days, but they would turn into a stream of days. So I basically try to allow myself to have something sweet occasionally, so that I don’t fall way off the rail. And there are days where I fail at that, but that’s the goal.

We Aren’t Perfect in the Kitchen

I know this might come as a shock to some of you, but the truth of the matter is, we aren’t perfect when we eat, either. As if the world and our lives aren’t filled with striving for perfection as it is, why would we want to make the kitchen another stressful place?

I say all that to tell you this: it’s okay if you have a little extra of something one day. It’s okay if you have that piece of cake when you are celebrating yourself or someone special. It’s okay to have a “cheat meal.” It’s okay to NOT BE PERFECT.

If it happens, don’t beat yourself up about it. Be aware of it; Learn from it; and move on! The next snack, meal, and day will be better because you came out of the previous situation aware and stronger.

Tips for Staying on Track

Consider the following tips to help you take it easy on yourself, but also keep yourself motivated to stay on track.

Use a Planner

If you are someone who needs to stick to a schedule, plan it out. Write down your meals for the week, plan your schedule around when you can work out, and write down the day and time you will be able to work out. Keep on a schedule!

Provide Rationale

Understanding your “WHY” should be your biggest motivator. I encourage you to write down your reasons why you want to eat healthy and exercise, and keep it someplace where you will see it and can refer back to it for a motivational reboot.

Build Accountability

There is strength in numbers! Try creating more accountability. Tell family, friends, or coworkers about your goals. If you’re out to lunch with them, they can help remind you of what your goals are. They may even join in with you, and you will have created a community that’s trying to become healthier!

***

We would absolutely love to see you at our fitness center and set up an appointment with you. There are so many tools to assist in your training, nutrition, weight loss, and strength training goals! We aren’t perfect people, but we do have the tools for greatness and want to share them with you.

This blog was written by Ashley Duncan, NIFS Program and Weight Loss Coordinator. To learn more about the NIFS bloggers, click here.

Coenzyme Q10, also known as ubiquinone, is a commonly used supplement by those with cardiovascular risks and disease, and especially those using statins. CoQ10 acts as a carrier in our cells to assist in oxygen utilization.  It also assists enzymes in the mitochondria. This allows the production of energy in a cycle referred to as the Krebs Cycle, and hints at why the mitochondria are the “powerhouse of the cell.” Some believe that those with heart failure have a buildup of reactive oxygen species (ROS), which can lead to adverse effects. Furthermore, they suggest CoQ10 antioxidant properties can combat the buildup of ROS. Additionally, CoQ10 is thought to balance calcium-dependent ion channels within the heart, which is critical for heart function. As far as supplementation with statins goes, people are led to believe that supplementing CoQ10 is essential because statins block the pathway that leads to CoQ10 production.

Researchers looked into these claims. Some found many studies that showed CoQ10 had no clear effect on how much blood the heart was able to pump (left heart ejection fraction), and other studies were inconclusive with poor research design. On the other hand, a Large study (a meta-analysis of clinical trials) revealed that those who supplemented CoQ10 had lower risk of death and increased exercise capacity, but no correlation between CoQ10 and how much blood the heart was able to pump. Lastly, another study observed those with heart failure receiving medical therapy. In addition to medical therapy, some of the participants received a placebo and some received Coenzyme Q10. Although the concentration of CoQ10 in the blood serum increased dramatically, those patients saw no greater effect in ejection fraction, peak oxygen consumption, and exercise duration. 

Drug Interactions and Additive Effects

CoQ10 has been known to interact with Vitamin K Antagonists, such as warfarin, a commonly prescribed drug in cardiovascular disease cases. Some cases have shown that CoQ10 blocks the anti–blood clotting (aka anticoagulant) effect of Vitamin K Antagonists, especially warfarin, which can lead to fatal blood clotting (according to Lexi-Drugs Online). On the other hand, some studies have shown that CoQ10 has done the complete opposite to Vitamin K Antagonists and actually enhanced the anti-blood-clotting effect, which leads to excessive bleeding.

Side Effects

Some side effects reported include severe gastrointestinal (GI) bleeding, allergic reactions, headaches, vomiting, urine discoloration, and abdominal pain.

Further Research

Much of the research that shows a positive outcome when supplementing CoQ10 had small trial groups (not enough people). The number of participants in the trials, known as sample size, is too small for the evidence to be conclusive. Moving forward, is it possible to get a bigger sample size that can give conclusive results? As of now, many are torn on this topic.

The Clinical Bottom Line

There is not enough evidence to support the use of CoQ10 for treating heart failure or even lessening the risk of muscle weakness (myopathy) in those taking statins. Until more research emerges, I would suggest those with cardiovascular disease not take CoQ10, especially if they are taking a Vitamin K Antagonist. If you are torn about taking CoQ10, consider speaking with your Primary Care Provider and Registered Dietitian to see if it's right for you.

This blog was written by Sabrina Goshen, NIFS Registered Dietitian. To learn more about the NIFS bloggers, click here.

“Take a probiotic; it helps with your gut.” We have all heard it from friends, doctors, and Registered Dietitians. Is it really that simple, though? It is no secret that probiotics really do help with a variety of gastrointestinal (GI) issues. However, did you know that there are specific strains of probiotics that help with specific symptoms, and while one strain may help with one GI symptom, it may not help with another? Not all probiotics are created equal, and not all supplements labeled “probiotic” will yield health benefits.

What Are Probiotics and Prebiotics?

Probiotics are live microorganisms (tiny living things), mainly bacteria and sometimes yeast, and are intended to have health benefits when ingested. They are similar to the helpful microorganisms naturally found in the gut. Probiotics are found in supplements and fermented foods, such as Greek yogurt with added Lactobacillus and Bifidobacterium, kombucha, tempeh, kefir, and sauerkraut.

Do not confuse these with prebiotics, which are the food source for the “good” bacteria in our GI tract. Prebiotics are “a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal microflora that confers benefits upon the host’s well-being and health.” They are carbohydrate compounds, primarily oligosaccharides, that withstand digestion in the GI tract and reach the colon where they then are fermented by the gut microflora, helping the good bacteria to grow. In short, they fall under the categories of soluble fiber and fermentable fiber. This is important, because even if you are taking a probiotic or eating foods rich in probiotics, you may not be receiving the maximum amount of benefits if you are not eating enough prebiotics (soluble and fermentable fiber). Foods rich in prebiotics include green bananas, onion, garlic, asparagus, artichokes, and leeks.

How Do Probiotics Work?

The human GI tract is colonized by many microorganisms, such as bacteria, viruses, fungi, archaea, and protozoa. The totality of these organisms is known as the gut microbiota, microbiome, or intestinal microflora and can affect the health and disease state of a human. Probiotics typically work in the GI tract to alter the intestinal microflora, adding good bacteria to the microbiome. The mechanism of action depends heavily on the species and strains because different species and strains have different effects. Some of the known mechanisms include the following:

• Inhibit the growth of some pathogens (microorganisms causing disease or sickness).
• Help with vitamin synthesis (B vitamins and vitamin K).
• Increase absorption of protein.
• Reinforce the gut barrier, keeping food and other GI contents from leaking into the bloodstream.
• Neutralize toxins.
• Lower the pH in the colon, which could help speed up stool for those who are constipated.
• Replenish good bacteria after taking antibiotics, which may help resolve diarrhea from antibiotics.

Probiotics and Gut Health

The gut microbiota is the center of much current research. Researchers are suggesting that an imbalance in the gut microbiota could lead to several health issues including immune dysfunction, infection, obesity, and GI problems. The imbalance can come from medical conditions, stress, and antibiotic usage (which destroys bad and good bacteria).

Using a probiotic to restore balance has been shown to alleviate symptom persistence in irritable bowel syndrome (IBS) by 21% using both single-strain and multiple-strain supplements, with the mixtures being most effective. Studies also found symptom relief in ulcerative colitis, reduction in acute diarrhea duration and frequency, and lower risk of diarrhea from antibiotic use by 51% or clostridium difficile infection.

A healthy gut with plenty of good bacteria has also been shown to improve the immune system, combat inflammation, and potentially reduce bad cholesterol (total and LDL cholesterol).

Picking Probiotic Supplements

Remember, not all probiotic strains and species are created equal. Trying to figure out exactly what strain, species, and genus of probiotic will work for you and your needs can be tedious, because there are thousands upon thousands of variations. It may take some trial and error to finally find a probiotic that meets your needs.

The good news is that both Lactobacillus and Bifidobacterium are the most studied probiotic genera. There are several studies of strains from these two genera that have produced positive results. Below is a list of conditions with the genus and strain of probiotic that has shown promise in helping with the condition.

• Acute diarrhea: Lactobacillus paracasei or Lactobacillus rhamnosus or Saccharomyces boulardii
• Antibiotic-associated diarrhea: Lactobacillus casei, Lactobacillus bulgaricus, Lactobacillus acidophilus, Lactobacillus rhamnosus
• Overall symptoms of IBS: Bifidobacterium bifidum, Escherichia coli
• Abdominal pain: Bacillus coagulans, Bifidobacterium bifidum, Lactobacillus plantarum
• Bloating/distention: Bifidobacterium animalis, Bifidobacterium bifidum, Lactobacillus reuteri
• Constipation: Bacillus coagulans, Bifidobacterium animalis, Oligofructose (prebiotics)
• Lactose maldigestion: yogurt with Lactobacillus delbruecki susp bulgaricus and Strepococcus thermophilus
• High Cholesterol and LDL: Lactobacillus acidophilus, a mixture of Lactobacillus acidophilus and Bifidobacterium lactis, Lactobacillus plantarum (more research is needed here)

If you are struggling with GI symptoms and considering a probiotic supplement, it is important to talk this over with your Registered Dietitian (RD) and primary care provider. They can help to identify the correct genus, strain, species, and dose you need.

Feed Your Gut

For those healthy individuals, you most likely do not need a probiotic supplement. If you really want to help your gut, follow these tips:

• Eat foods rich in probiotics. When seeking foods with probiotics, the product must have active and live bacterial culture and indicate that on the label. A good rule of thumb is at least 1 billion colony-forming units or 1 billion CFUs, containing the genus Lactobacillus, Bifidobacterium, or Saccharomyces boulardii. Probiotic-rich examples include Greek yogurt, kombucha, tempeh, kefir, and sauerkraut. Be sure to check the label for the specific genus of probiotics(s) in the products, as they will differ. Also note that the starter cultures in Greek yogurt are Streptococcus thermophilus and Lactobacillus bulgaricus, but these are often destroyed by our stomach acid and offer no benefits. Get the Greek yogurt brands that add extra bacteria to the starter cultures (check the label).
  
• Feed your probiotics with prebiotics to help the probiotics multiply in your microbiome.
• Sleep at least 7–8 hours each night.
• Maintain a healthy weight and body fat percentage.
• Manage stress.
• Balance your diet, keeping it loaded with fruits, veggies, lean proteins, fiber, and whole grains.

As always, reach out to the NIFS Registered Dietitian for nutrition help, including nutrition management of gut-related issues. We are here for you.

This blog was written by Sabrina Goshen, NIFS Registered Dietitian. To learn more about the NIFS bloggers, click here.

Dietary supplement usage is reaching an all-time high. The 2019 Consumer Survey on Dietary Supplements revealed that 77% of Americans consume supplements. This is a dramatic increase from the 53% reported by the NHANES in 2010. Americans are spending $38.8 billion a year on supplements, with more than 85,000 supplements on the market. Reasons for consumption are widespread, ranging from athletes hoping to boost performance to people who need more Vitamin D for bone health.

With the rise in supplement usage, it is important to be an informed consumer. While there are numerous reasons for this, one of the biggest is that supplements are loosely regulated by the FDA, meaning labels may not display what is truly in the supplement. Also, claims marketed about the benefits of a supplement may be false because companies are not required to obtain authorization from the FDA prior to making such nutritional support claims.

How can you know whether what you’re taking is safe and effective? Let’s dive in!

What Is a "Dietary Supplement?"

According to the Dietary Supplement Health and Education Act of 1994 (DSHEA), a dietary supplement means “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following ingredients:

• Vitamin
• Mineral
• Herb or other botanical
• Amino acid
• A dietary supplement used by man to supplement the diet by increasing dietary intake
• A concentrate, metabolite, constituent, extract, or combination of any ingredient described in the above.”

Are Dietary Supplements Regulated? Can Supplements Be Trusted?

Technically, yes, supplements are regulated by the FDA under the DSHEA. However, there are loopholes to consider:

1. The FDA does not inspect products before they are sold, nor do they require registration unless the supplement contains a new ingredient not yet on the market.
2. The only formulation standard is the Current Good Manufacturing Practice (GMP); however, 2013 report by the FDA revealed that 70% of inspected manufacturers were in violation of GMPs. Not all products even get inspected after being on the market. The FDA states the manufacturer is responsible for ensuring safety and quality, but clearly some manufacturers are doing a poor job, and the FDA is only catching some.
3. Nutrition supplements may not claim to diagnose, cure, prevent, or treat diseases. Sure enough, some manufacturers have managed to ignore this. A 2003 study found that 81% of 338 herbal supplement retail websites made one or more health claims, and 55% claimed to diagnose, cure, prevent, or treat specific diseases.

What Can You Do to Be Safe When Taking Supplements?

Blind trust in supplements is unwarranted; however, there are steps you can take to ensure your safety while taking them.

• Check the label for a stamp indicating third-party verification. Independent third parties are hired by manufacturers to thoroughly test products, ensuring accuracy of ingredients, potency, and amounts; absence of toxic compounds; and production in compliance with FDA GMPs. Credible third parties include NSF International and US Pharmacopeia (USP).
• Athletes: look for the NSF Certified for Sport stamp. The USA Doping Agency (USADA) has recognized this program as best suited to assist athletes in choosing supplements that do not contain banned substances for sports.
• Download the NSF International App. It shows which products are NSF approved—right at your fingertips anytime, anywhere.
• Check out the Dietary Supplement Fact Sheets published by the National Institutes of Health: Office of Dietary Supplements. This government agency has quick fact sheets about a variety of dietary supplements, including vitamins, minerals, probiotics, botanicals and herbs, and more.

Speak with a Registered Dietitian for supplement guidance and which supplements may (or may not) be right for you. NIFS Registered Dietitians are available to help you!

This blog was written by Sabrina Goshen, NIFS Registered Dietitian. To learn more about the NIFS bloggers, click here.