Whole Foods – Nicole Holovach | Dietitian Nutritionist

Milk & Dairy in Context

I’ve been putting off writing about this topic for a while because we’re currently in a period of time where milk and dairy products are vilified foods. I’m a big proponent of the idea that ALL foods have pros and cons, and I think milk and dairy products have way more pros than cons. The inability to digest milk and dairy products is often due to additives, quality, and a person’s gut health and metabolic rate, rather than milk and dairy products being “bad foods.”

Thankfully, my intern, Nosheen Hayat, was up to the challenge! Nosheen is a dietetic intern at the National Institutes of Health and a Gates Millennium Scholar. She received her Masters of Public Health degree from the University of Michigan. She runs a private practice Hayat Nutrition in Gaithersburg, MD. I am grateful to her for tackling this tough, but timely blog post. Enjoy!

Many people (particularly in the vegan circles) make the argument that humans are the only mammals that drink another mammal’s milk and thus, it is an “unnatural” behavior. However, humans are also at the top of the food chain and the only mammals on earth that drive cars, cook their food, and use technology.

Dairy consumption has been a human practice for at least 8,000 years. In many cultures, milk is regarded as an important food and used to make butter, cheese, yogurt, and kefir.

Despite a long history of dairy being an integral component of the human diet, it has recently been vilified and alternatives such as almond, rice, and soy milk have become popular. One reason why dairy is considered an “unhealthy” food is due to its saturated fat content. Many publications since the 1950s have linked saturated fat with increased risk for heart disease; however, more recent publications are showing this may no longer be the case. Research now shows that saturated fat may not be associated with an increased incidence of cardiovascular events (1).

Milk consumption is associated with reduced risk for a number of diseases, including childhood obesity, type 2 diabetes, cardiovascular disease, stroke, colorectal cancer, bladder cancer, gastric cancer, and breast cancer; research also shows a positive effect on bone mineral density (2). While humans have been drinking milk for thousands of years, drinking plant-based milk is a new phenomenon and its consequences on health are yet unknown.

Not only is milk cheap and easily accessible for most individuals, it is also a rich source of magnesium, potassium, selenium, vitamins A, B, D, and K. It is a naturally balanced food—containing 87% water, 5% sugar (lactose), ~3.5% protein, and ~4% fat.

However, not all milk and dairy is created equal.

Grass-fed, Organic vs. Conventionally Farmed Milk

Grass-fed milk comes from cows that are allowed to graze on pasture for most of the year rather than being fed a processed diet (i.e. genetically-modified corn and soy). This method of farming creates an environment for happy, healthy cows. Grass-fed milk has a lower omega-6 to omega-3 ratio, which is important for good health and reducing inflammation in the body (3). It also has higher amounts of conjugated linoleic acids (CLA), which are associated with reduced risk for cardiovascular disease (3).

Purchasing organic milk can reduce the amount of pesticides in your milk and guarantee that the feed provided to the cows is not genetically modified. However, it does not imply that the cows your milk comes from are allowed to graze on pasture or be unconfined.

Conventionally farmed milk typically comes from cows that are fed a processed diet, consisting of soybean, corn, and other grains as well as antibiotics. Additionally, these cows are not allowed to graze on pasture and live in very unsanitary and stressful conditions.

Homogenization of Milk

The purpose of homogenization is to ensure that the fat or cream of the milk does not separate from the liquid. This is done by forcing the fat molecules through small holes or mesh at high pressure. One problem with homogenized milk includes the breakdown of casein micelles, which result in calcium phosphate soaps that can irritate the gut lining and decrease the bioavailability of calcium and phosphorus found in milk (4).

Homogenization can also introduce oxygen into the milk product, which can cause excess bloating and gas when it interacts with the bacteria in the gut of individuals with gastrointestinal issues. Lastly, homogenization can inactivate a protein called lactoferrin, which exhibits anti-bacterial properties by binding up iron and reducing its access to gut bacteria (5).

Opt for a non-homogenized milk, if possible. However, if you can’t get access to a non-homogenized milk, it’s no reason to avoid milk! Homogenized milk is still a great source of protein, minerals, and vitamins.

Pasteurization of Milk

When milk is pasteurized, it is heated to a specific temperature for a length of time and then cooled immediately. The temperatures and length of time vary based on type of pasteurization. Heat treatment is used to destroy potentially pathogenic bacteria; however, it can also inactive enzymes and reduce the percentage of nutrients found in milk.

Unpasteurized or raw milk is not heat-treated. However, raw milk is illegal in most states and difficult to find. If you live in a state that allows the sale of raw milk (i.e. California), it is important to visit the sourcing farm and see their practices to ensure cleanliness of their operations and proper care of their farm animals.

Low-pasteurized milk is heated in small batches at a lower temperature but longer period of time than regular pasteurized milk—to 145ºF for 30 minutes.

Regular pasteurized milk is heated to a temperature of 161ºF for about 15 seconds and then cooled immediately.

Ultra-pasteurized milk is heated to a minimum of 280ºF for at least two seconds. The higher temperatures kill more bacteria and ensure longer shelf-life of milk processed with ultra-pasteurization.

Pasteurization can reduce the amount of immune-modulating proteins in milk, such as lactoferrin; it can inactivate enzymes and reduce the amount of vitamin C, B6, iron, manganese, and copper (4). Ultra-pasteurization further reduces the vitamin and mineral content of the milk, cause formation of lactulose (a laxative) through lactose isomerization and Maillard reaction products, which can reduce the bioavailability of proteins and minerals in milk (4, 6).

While low pasteurization to no pasteurization is the best option, it can differ person to person depending on their digestive health. Individuals struggling with digestive issues may have symptoms of bloating, gas, and abdominal pain when drinking raw milk. These individuals may do better with a pasteurized or ultra-pasteurized milk product. Or vice versa, these same individuals may do better on raw milk or low-pasteurized milk. It is important for you to look out for symptoms after drinking milk to see if the type of milk you’re drinking is working for you.

Context of Drinking Milk

Now that we’ve discussed what to consider when purchasing milk, let’s talk about the different physiological contexts of drinking milk.

Many people cannot drink milk due to lactose intolerance, which occurs when not enough lactase (a digestive enzyme that breaks down the sugar lactose) is produced. Often times, a lack of lactase production is considered “unfixable,” however, underlying issues such as hypothyroidism or a low metabolic rate can be the root cause of a lactose intolerance. Digestive enzymes and stomach acid production decreases in a hypo-metabolic state, not only because the body is now in a stress response state and shunts resources away from the rest and digest system, but also because a slower metabolic rate requires less caloric intake and therefore, less inputs to the digestive system are needed (7).

Lactose intolerance can also present itself as a symptom of underlying gastrointestinal issues, such as small intestinal bacterial overgrowth (SIBO) or irritable bowel syndrome (IBS) (8). Microbiota dysbiosis usually occurs when there is an imbalance in the number of good to bad bacteria. Good bacteria thrive off of sugars and produce useful byproducts, such as acetic acid and butyric acid, which are subsequently absorbed into the bloodstream or used to activate thyroid hormone in the gastrointestinal tract. However, bad bacteria produce an excess amount of gas, which presents itself as flatulence and bloating, when they have access to sugar molecules (i.e. dairy sugar lactose, a disaccharide). And they subsequently suppress the growth of good bacteria by reducing their access to nutrients as well as over-proliferating.

For individuals who may struggle with gastrointestinal issues, you can reduce the likelihood of bloating, gas, and pain with drinking milk by opting for warm over cold milk. The optimal temperature for digestive enzymes is 98.6 degrees. When we drink cold milk, we reduce the temperature of our digestive tract and reduce the effectiveness of enzymes responsible for digesting our food.

It’s also important to note that individuals who have lower metabolic rates are likely unable to convert the amino acid tryptophan in milk to a B vitamin called niacin. In individuals with high metabolic rate, tryptophan is easily converted to niacin, which is used to break down carbohydrates, protein, and fats from our meals, support liver and digestive function, and much more (9). Eating a balanced meal prior to drinking milk ensures that the tryptophan in milk is converted to niacin, as opposed to the stress hormones serotonin and melatonin (10).

Milk is a balanced food with many nutrients that can be used to support good health. For people with low metabolic rate and gastrointestinal issues, it can be difficult to consume milk. Addressing the metabolic rate and GI issues almost always results in better digestibility of milk and therefore, increased access to a great source of nutrients.

Cheese

Cheese, like milk, is a great source of nutrients. However, the problem with cheese is the excess ingredients manufacturers add to them, such as whey protein, gums, carrageenan, enzymes, GMO cultures, food coloring, and “natural” or artificial flavoring. These additives can make it difficult to digest the cheese products, which is why it’s important to look for a cheese with the least number of ingredients (9).

For example, when searching for organic ricotta cheese, look for a brand that only has skim milk, salt, and vinegar on the ingredients list. Also, look for cheeses that have animal rennet as opposed to enzymes or other types of rennet, which can be allergenic. Many European imports still make cheese the traditional way with animal rennet.

Yogurt

Individuals who struggle with hypoglycemia, a sluggish liver, or are hypo-metabolic should eat yogurt (and other fermented foods) in small quantities. Lactic acid from yogurt, when absorbed, can cause a stressful response in the body by forcing the liver to use its glycogen stores for energy to convert the lactic acid into glucose.

When consuming yogurt, choose a low-fat Greek option, which will be lower in lactic acid (because it has been strained); will have less additives; and more calcium and protein.

References

July 26, 2018/by admin

Blog, Food, Stress, Thyroid, Uncategorized, Whole Foods

Cholesterol Through a Metabolism Lens

Did you hear? The latest version of the U.S. Dietary Guidelines, released earlier this year, has removed the recommended limit on cholesterol in the diet. Cholesterol is no longer a nutrient of concern. While most of us in the nutrition world have known for a long time that cholesterol in the diet does not affect risk for heart disease, we also know that it sometimes takes a while for policy to catch up with science.

So if cholesterol in food doesn’t cause high cholesterol, what does? While some might blame saturated fat and fructose (the latest fad), I’m going to dive in and explain to you a more in-depth, big picture view of cholesterol labs and your health.

The most important thing to know is that is that cholesterol isn’t this bad-for-you-you substance that it’s made out to be. Most people think, the lower your cholesterol, the better. If you could just get it down to zero you’d be in great shape! However, cholesterol is absolutely vital to the proper function of the human body. Your body makes cholesterol, regardless of your dietary intake, for good reason. If you had no cholesterol in your body, you would be dead! It plays an important role in digestion, Vitamin D status, hormone production and balance, and many other human body processes.

You also need to know that high cholesterol isn’t a diagnosis. It’s a symptom. Just because you have high cholesterol, doesn’t mean anything bad will happen! The words ‘high cholesterol’ inspire a feeling of dread as something akin to a death sentence. The mainstream narrative on cholesterol is that arteries are like pipes and cholesterol is like gunk. The pipes get clogged up with cholesterol, and then you have a heart attack. This is a powerful image, but it’s not accurate at all. First of all, at least half of all people who suffer a heart attack have normal cholesterol levels (1, 2). Second of all, after age 65, high cholesterol is associated with health and longevity (3). Third, plaques that “clog” arteries are actually made up of calcium and oxidized LDL particles (think rancid – more on that later), and they form under the artery wall (4). So get that vision of “clogged arteries” out of your head, and if you are a health professional, quit using those test tubes full of fat to scare people at health fairs!

Instead of looking at your high cholesterol labs with a sense of doom, let’s look at how cholesterol levels in the blood rise and when it becomes a problem.

One of the basic functions of cholesterol is to stabilize the mitochondria (the energy powerhouse of the cell), preventing their destruction by stress. Anytime you’re under a stressful situation, cholesterol rises as a protective response to the stressor. Yes, you read that right: cholesterol is a protective substance! Stress also lowers intracellular magnesium, which also causes cholesterol production to increase, since magnesium regulates the enzyme that makes cholesterol (5). Stress can be anything from psychological stress like that from jobs, family, money, etc., to physiological stress like skipping meals, not getting enough sleep, and eating poorly.

In youth and those with high metabolisms (good thyroid output AND uptake of thyroid hormone by cells), cholesterol is converted inside cells into pregnenolone, DHEA, testosterone, progesterone, and other important protective hormones. You cannot make these hormones without cholesterol!

Cells need two things to make the conversion: Vitamin A in its active form and thyroid hormone. As humans get older, their ability to convert beta carotene into active Vitamin A decreases, most Americans don’t eat much active Vitamin A in their diet, and metabolism decreases. In fact, up until about 40 years ago, high cholesterol was diagnostic of hypothyroidism, and routinely treated with supplemental thyroid hormones.

So high cholesterol is a problem because you’re not making youthful, protective hormones. But it’s also a problem because cholesterol oxidizes if it hangs around in the blood stream long enough, losing its protective functions. The cholesterol — or more accurately, the lipoproteins like LDL that are carrying cholesterol — get damaged by oxidation, and then the immune system’s response to that oxidative process is what causes the buildup of plaque and then ultimately the rupture of plaque and heart attack.

So the real question everyone should be asking when it comes to atherosclerosis and heart disease is: “what causes LDL to oxidize?”

There are three main ways oxidized cholesterol builds up in your bloodstream (6):

eating commercially fried foods, such as fried chicken and French fries
eating excess polyunsaturated fatty acids, which are found in vegetable oils, packaged food and restaurant food
cigarette smoking

Your doctor, and most dietitians for that matter, will tell you that polyunsaturated fats from refined vegetable oils, margarine, nuts, seeds, and other plant foods lower your cholesterol. And they’re right! But given what you just learned about cholesterol, do you really think lowering your body’s protective production of cholesterol is a good idea?! Within this framework, the effect of polyunsaturated fats is the same as the effect from statins, which come along with nasty side effects. I hope after reading this, you’ll start to understand physiologically why statins have the side effects they do, and why they’re not very helpful for most people (7).

A note about Paleo diets and fructose. Paleo bloggers and gurus have been pretty hard on fructose recently, blaming carbs and sugar for raising cholesterol. “Quit sugar and watch your cholesterol plummet!” Yup, also watch your libido and energy tank from lack of fuel for the liver and brain. Don’t fall for the low-carb trap when trying to lower your cholesterol. Fructose has pretty much been absolved of any wrongdoing in my book (8, 9).

If you have high cholesterol and your doctor is concerned, here is what I would advise:

Ask your doctor for a cholesterol particle size test (LDL-P). Small LDL particles are more likely to oxidize and form plaques under the artery walls (10).
Know your calcium status. One of my favorite things about Mineral Analysis, is the crucial information on tissue calcium it gives me. Coronary calcium scans will also give you good information about your tissue calcium buildup (4).
Have your thyroid status checked. This involves more than a TSH test! Blood lab work, including TSH, will tell you if your thyroid gland is producing enough thyroid hormone, but tells you nothing about your cells’ ability to use it. Broda Barnes was an American physician who was able to reduce heart disease incidence in his almost 2,000 patients by 90 percent. He used basal body temperature first thing in the morning as an indicator for thyroid uptake. Anything less than 97.8 degrees was considered functionally hypothyroid (11).

If you want to lower your cholesterol in a physiologically-sound way, that ensures proper body function for years to come:

Make sure your diet has plenty of sources of active Vitamin A. Eggs, liver, and grass-fed dairy are examples. Hmmm, imagine that….all potent sources of cholesterol! It’s like nature has a plan or something…
Make sure your diet has plenty of Vitamin K2, active Vitamin K. K2 is a calcium director and can remove calcium buildup from the arteries (12). It’s found in, again, eggs, liver, and grass-fed dairy. This is sounding more and more like a French diet. It’s not genes or the wine protecting them from heart disease (13).
Eat plenty of potassium-rich foods, like fruits and vegetables (14). You are likely not eating enough.
Eat more magnesium and supplement if needed. Cooked dark leafy greens and organic dark chocolate are good sources. Magnesium is also absorbed topically through the skin.
Destress!
Focus on all the things that improve thyroid uptake by cells: get enough calories, protein, carbohydrates, potassium and other minerals, good estrogen metabolism, and good liver function – AKA all the things I work on with clients!

July 25, 2016/1 Comment/by admin

Blog, Pregnancy, Uncategorized, Whole Foods

Killer Calcium?

I’ve been thinking a lot about calcium lately. Our bodies need this mineral to build and maintain bones and teeth. Calcium also helps with blood clotting, muscle function, and regulation of the heart’s rhythm.

We’ve had it hammered home since we were in grade school that increasing calcium intake will prevent osteoporosis, the weakening of bones. We’ve been told to take calcium supplements if we don’t get enough calcium in our diet.

Yet, we have a very high calcium intake in the U.S. and also high osteoporosis rates, plus, calcium supplements are linked to heart disease (1). What gives?

It has to do with calcification, calcium buildup in the body’s tissues. Along with reduced metabolic rate, calcification is a hallmark sign of aging.

Examples of calcification:

Atherosclerosis: calcification of blood vessels
Osteoarthritis: calcification of joints
Tartar: calcification on the teeth
Gallstones/kidney stones: caused by calcium deposits
Infertility: sometimes caused by endometrial calcification
Alzheimer’s: evidence is mounting brain calcification contributes
And so many more!

When you consume calcium, regardless of if through food or supplements, you hope it will be deposited in the bones and teeth, right? Well without a critical vitamin in your diet to direct calcium, it often winds up in the body’s tissues instead. So you could conceivably have a high dietary calcium intake or take calcium supplements, and still wind up with osteoporosis and heart disease to boot. Sucks, right?

So what’s this critical vitamin? Vitamin K2, not to be confused with the Vitamin K1 that is found in dark leafy greens. K1’s main role is in blood clotting, while K2’s main role is calcium metabolism. K2 activates certain proteins that guide calcium into bones and teeth where it belongs. And even cooler? K2 will activate other proteins that sweep calcium OUT of other tissues where it is potentially harmful. So you could potentially REVERSE heart disease just by getting enough of this crucial vitamin (2).

Other potential benefits? Better teeth. Weston A. Price (3) was a dentist who embarked on an medical anthropology trip around the world in the 1930’s to study how diet and lifestyle affected dental health. He found cultures with straight, beautiful, healthy teeth and deduced what they had in common. He has been called the “Charles Darwin of Nutrition,” since much of what he discovered looks at how food and food quality affect health in general. If you haven’t read his 1939 book, “Nutrition and Physical Degeneration,” a nutrition classic in my opinion, pick it up for the photos alone! Anyways, Price is credited with discovering Vitamin K2, although at the time, he had no idea what it was. He called it Activator X.

He realized that humans are capable of thriving on very diverse diets. However, he did find one thing in common: they all ate some amount of animal-derived fat-soluble vitamins. Even the near-vegetarian groups ate insects or small animals that were rich in pre-formed Vitamin A, Vitamin D, and what we now know is Vitamin K2. And here’s the kicker for my fertility clients: many of the foods high in these nutrients were fed preferentially to pregnant or reproductive-age women in the groups he studied.

Depending upon your current understanding of fats and the causes of heart disease (see here and here), you either will be pleasantly surprised or horrified by the list of foods high in Vitamin K2:

Butter from grass-fed cows
Organ meats
Shellfish
Fish eggs
Cheese from grass-fed cows
Natto (a fermented soybean popular in Japan)

Butter from grass-fed cows vs butter from the grocery store

Now, think about the French Diet and the above list of foods. Health experts have been talking about the “French Paradox” for years – the confusion over France’s rich, fatty diet and their low heart disease rates. What if the French Paradox isn’t such a paradox after all? What if it’s not the red wine that’s protecting them, but all the foie gras, quality cheese, and butter?

Now think about the Japanese diet. What if it’s not the green tea that’s protecting them from cancer and heart disease, but all the fish eggs and natto?

Previous thinking on Vitamin K2 was that our gut bacteria can make what we need from Vitamin K1. Does the typical American’s damaged gut do this? Who knows. I’ve seen evidence for and against the claim that we get enough from eating dark leafy greens.

But logically, when I think about the modern American diet, our current rate of disease, and compare it to someplace like France that has loads of K2 in their diet, it makes sense to me to eat more foods with K2.

As a side note, my latest obsession in my nutrition practice is mineral analysis. I find it most useful for determining tissue calcification. I would say that about 80 percent of my clients have high calcium levels in their tissues and would benefit from more K2 in their diet, either from foods or supplements, to help “sweep” it out of tissues. For those few who actually do need more calcium, K2 would also be beneficial in guiding that extra calcium into bones and teeth.

I see lots of potential in Vitamin K2 and I think you’re going to be hearing a lot more about it in the future. Vitamin K2 has potential benefits for nearly every major health concern of our time. K2 might be the ‘missing link’ that explains many of our modern health woes.

So eat your pastured dairy, organs, fish eggs, and shellfish! And if you have arterial calcification, as determined by a heart scan, or tissue calcification as determined by mineral analysis, you may want to consider supplementing with additional K2 (also called menaquinone-4 and menatetrenone).

For more information on Vitamin K2, “Vitamin K2 and the Calcium Paradox,” by Kate Rheaume-Bleue, is a great place to start.

1. https://well.blogs.nytimes.com/2013/04/08/thinking-twice-about-calcium-supplements-2/

2. http://wholehealthsource.blogspot.com/2008/11/can-vitamin-k2-reverse-arterial.html

3. Trolls: I am not a lacky for the Weston A. Price Foundation. Stop trying to label me. I’m anti-dogma and support many different types of diets.

July 31, 2014/3 Comments/by admin

Blog, Uncategorized, Whole Foods

The Whole Picture

When I was a health conscious teenager drinking skim milk, I remember I used to look at my grandmother drinking whole milk with a bit of self righteousness.

“Doesn’t she know any better?” I would wonder. “Whole milk is full of saturated fat and cholesterol!”

My, how times have changed! These days, I enjoy full-fat dairy, and I’m much more likely to tell my clients to drink whole milk, rather than skim or 1%. Especially my fertility clients!

Why the 180? Eating full-fat dairy fits into my “eat real food” philosophy. This philosophy has been cultivated year after year, the more I study food and nutrition. And it’s reinforced year after year, as new research emerges that shows the foods my grandmother ate may be healthiest for us after all. Butter and whole eggs have both seen a healthy renaissance recently. Now it looks like whole milk may see a similar revival.

Consider two recent studies that conclude the consumption of whole-fat dairy is associated with reduced body fat. In a study published last year in the Scandinavian Journal of Primary Health Care, middle-aged men who consumed high-fat milk, butter, and cream were significantly less likely to become obese over a period of 12 years compared with men who never or rarely ate high-fat dairy. (1)

In another paper, published last year in the European Journal of Nutrition, researchers reviewed 16 other studies and concluded that the evidence does not show that high-fat dairy foods contribute to obesity or heart disease. In most of the studies, high-fat dairy was actually associated with a lower risk of obesity! (2)

Moreover, full-fat dairy has been a recommendation for women trying to get pregnant since 2007, when research from the Nurses Health Study showed intake of high-fat dairy foods may decrease the risk of anovulatory infertility.

How can this be? Well, the fat in whole milk can curb appetite and slow the release of sugar into the bloodstream, reducing the amount that can be stored as fat. Also, fat-free dairy products can potentially disrupt hormone balance, an important factor in fertility and weight. The process of removing fat from whole milk removes estrogen and progesterone, which are bound to the fat. This leaves behind higher portions of androgens, insulin-like growth factor one (IGF-1), prolactin, and male hormones in the watery layer, therefore causing an imbalance. (3)

So does that mean you can go on an ice cream and cheese-eating bender? Not quite! It means you can stop feeling guilty if you keep whole milk in the house for the kids and you drink it too. It means you can enjoy the 2% Greek yogurt, instead of the 0%. It means cheddar and apples can be a balanced afternoon snack. Incorporate modest amounts, 1-2 servings, of full-fat dairy into your diet, even if you’re trying to lose weight. And let your grandmother tell you, “I told you so!”

1. http://www.ncbi.nlm.nih.gov/pubmed/23320900

2. http://www.ncbi.nlm.nih.gov/pubmed/22810464

3. Victoria Maizes, “Be Fruitful.”

March 28, 2014/3 Comments/by admin