1. What is the ketogenic diet?
Low in carbohydrates with moderate protein and high in fat, a ketogenic diet prompts the body to burn fat for energy rather than glucose, which leads to the production of ketone bodies—molecules that can be used as a source of fuel. A typical ketogenic diet consists of ~70% fat, 20% protein, and 10% carbohydrates. Though this can vary slightly depending on the individual, this diet is specifically designed to induce nutritional ketosis.
2. What is ketosis?
When ketone bodies accumulate in the bloodstream (>0.5 mmol/L) due to low glucose availability, they cause a metabolic state called ketosis. The most efficient approach to induce nutritional ketosis is to lower dietary carbohydrate intake while increasing fat intake. This reduction in carbohydrate intake helps the body shift toward a state that promotes the breakdown of fats (from the diet and your body) to produce ketone bodies and enter ketosis.
3. How does the ketogenic diet differ from a paleo diet, Mediterranean, Atkins?
One diet does not fit all—the best diet is the one that you can stick with for long-term. As a lifestyle modification, it should be closely monitored and modified as needed.

​4. What is intermittent fasting? How is this beneficial for someone on ketogenic diet?
Intermittent fasting (IF) limits the eating window to just a few hours a day. However, during this window, one simply eats to feel full. This practice allows the body to increase the amount of food intake at one time, and induce adaptive metabolic changes. There are many different variations of intermittent fasting,and many different reasons for doing so. Some people may experience mental clarity and focus as well as using intermittent fasting to get over a plateau.
5. What are ketones? How are they produced?
Ketone bodies production in the liver is a natural process when the body increases the use of fat as the main source of fuel. This occurs during a fasting state and/or prolonged exercise, or when dietary carbohydrates are very low. There are three endogenous ketone bodies. These are acetone, acetoacetate and beta-hydroxybutyrate (βHB).
When following a ketogenic diet, your brain, as well as other organs and tissues, depend on ketones as an energy source. Ketones can be measured in the blood, breath and urine, and measuring can be helpful when following a ketogenic diet or program to ensure that the desired level of ketosis is reached and maintained.
6. What is keto-adaptation? How long does it take to adapt?
Keto-adaptation is the process the body goes through during the ketogenic diet as it switches to using fat as an energy source rather than glucose. The length of time varies for individuals, but typically starts a few days after being on a ketogenic diet. Within a week to two weeks, many people report positive effects of keto-adaptation, and studies have shown that signs of keto-adaptation (such as increase in fat oxidation) occur within this time-frame.
7. What are exogenous ketones vs. endogenous ketones? Are there benefits to taking exogenous ketones?
Exogenous ketones are ketone bodies in either mineral or ester forms that can be ingested as a nutritional supplement, producing acute elevations in circulating ketone levels. Nutritional ketosis resulting from adherence to a ketogenic diet is often referred to as endogenous ketosis in contrast to peripheral ketosis induced by supplementation, referred to as exogenous ketosis.
8. Which patients or individuals would be excluded or not advised to follow a ketogenic diet?
While the ketogenic program can benefit a wide array of patients, it may not be suitable for patients with possible inborn metabolic disorders (CPTI or II deficiency; β-oxidation defects [LCAD, MCAD, SCAD]; and pyruvate carboxylase deficiency). Caution should also be used in patients with the following conditions:

• Type 1 Diabetes (diabetic ketoacidosis (a mixture of high blood glucose with high KB levels) can result in acidosis)
• Kidney disease (the ketogenic diet has not been studied in people with impaired kidney function)
• Liver disease

9. Is it safe long term? How long should a patient be on the ketogenic diet?
Depending on the health goals, the practitioner may recommend a specific time period for the patient to be on the ketogenic diet. There are many people and cultures that go into ketosis and stay there for a long period of time without any negative effects.
10. Can someone just dabble in keto for a few days/weeks? Can they still get benefits?
While there is evidence to support the long-term use of ketogenic diets without serious side effects, there are also benefits to just doing a cyclical ketogenic diet. We encourage patients to stay on the ketogenic program for a period of 6-12 weeks as it takes some time for the body to be “keto-adapted” and for them to start seeing results.
  11. During the keto-adaptation process, which noticeable changes are expected and what is the “keto flu”?
During the keto-adaptation process, many people may experience symptoms of the “keto flu”. These symptoms occur because the body, being used to utilizing carbohydrates as main source of energy, is going through a metabolic shift to burn fat instead. Some people describe this as a feeling of withdrawal. Symptoms one may experience include feeling drowsy, achy, nauseous, dizzy, and irritable. Some may even experience cramping, stomach pains, and muscle soreness.
 12. How long do these symptoms last?
It varies for the individual, but the keto flu lasts typically a week or less for the average person and not everyone experiences the keto flu. However, below are some anecdotal ways to mitigate symptoms of the keto flu. Increase electrolyte intake, but avoid those electrolyte sports drinks with high sugar.

• Drink more water
• Eat more quality fat
• Take an exogenous ketone supplement
• Increase in exercise
• Get plenty of sleep

 13. How should a patient measure whether they have achieved ketosis?
Ketones can be measured in a variety of ways via a breath meter, urine strips, or a blood meter. The blood meter is the most accurate way to measure the levels of ketones (primarily βHB) in the body. However, this method is more invasive than others, and can also be significantly more expensive. Your healthcare practitioner can advise you on commercially available blood meters to test ketone levels by looking at circulating levels of βHB measured in millimolar (mmol/L) units.
14. What levels should be achieved (millimolars)?
While variable among individuals, βHB ranges >0.5mmol are considered the beginning of the range of nutritional ketosis and a range at which clinical benefits (for example to body weight management) have been described. Work is ongoing to understand the optimal range of circulating ketones for different outcomes.

​15. Why is it important to incorporate as we age?
The healthy young brain relies solely on glucose to obtain energy for its functional and structural needs. During healthy aging, brain glucose uptake is 10-15% lower and can be up to 35% lower in certain brain areas in neurological disorders such as Alzheimer’s Disease. In contrast, brain uptake of ketones appears to still be normal in the brains of Alzheimer’s disease patients. A common misconception is that the brain can only use glucose. Ketone bodies are the only alternative source of energy for the brain as it cannot utilize free fatty acids (FFAs). Both rodent and human studies have shown increase uptake of ketone bodies by the brain following peripheral infusion of ketones, prolonged fasting, or a ketogenic diet. They observed that up to 70% of brain’s energy demands were provided by ketone bodies available in circulation (blood) and taken up by the brain.
16. Why is it used for weight loss?
Ketogenic diets that are rich in fat and low in carbohydrate induce a decrease in blood sugar and insulin levels. A reduction of circulating insulin levels causes an increase in the metabolism of fatty acids (increased lipolysis-the breakdown of lipids) from adipose tissues for utilization as energy. The liver uses FFA derived from dietary source and release from adipose tissue to oxidize and generate ketone bodies in order to meet the energy demand. Ketone bodies in circulation provide a stable source of fuel for the body and the brain, thereby sparing the need to break down muscle protein into glucose as energy supplies. A ketogenic diet encourages the burning of body fat as fuel, as well as inducing satiety between meals. Additionally, a ketogenic diet may help suppress appetite and reduce cravings.
17. Why is it used to prevent cognitive decline?
With a ketogenic diet, the brain utilizes ketone bodies instead of glucose as its primary fuel source. This switch can help encourage more nerve growth factors and synaptic connections between brain cells, and result in increased mental alertness, sharper focus, and improved cognitive capabilities.
 18. Why is it used for diabetes?
Studies have shown that low-carbohydrate diets help support insulin metabolism in the body. This is because the absence of carbohydrates in the diet can reduce circulating insulin concentrations and contribute to glucose control.
 19. Will this affect cholesterol? Isn’t this diet is too high in fat for weight loss or CVD patients?
The ketogenic diet, as many diets, can positively influence body weight and cardiometabolic health and potentially improve dyslipidemia. Ketogenic diets are by design high in fat, and the type of fat is an important consideration as is the overall quality of the foods eaten within the diet. In terms of cholesterol levels, although there are studies to show that total cholesterol and total LDL cholesterol may increase on a ketogenic diets, more detailed analysis of cholesterol profile has shown the following:

•  Increase the concentrations of HDL cholesterol more than low-fat, high-carb diets
•  Lead to higher levels of HDL cholesterol
• Decrease LDL particle concentration (LDL-P) and increase the size of LDL cholesterol
• Decrease the amount of harmful VLDL cholesterol in the blood1

As with any diet, there is variability in how people respond. It is recommended that the practitioner monitor biomarkers of health including blood lipid profile, blood pressure, inflammation, insulin signaling, blood glucose parameters, waist circumference, lean body mass.
20. Why do athletes use it?
Low-carbohydrate, high-fat and ketogenic diets are increasingly adopted by athletes for body composition and sports performance enhancements. There is not one diet that fits all or perhaps most. The literature on ketogenic diets in athletes is limited but variable with some studies showing no negative impact and others suggesting that a ketogenic approach may not be ideal. As the science evolves in this area, current thinking is that the health status of the individual athlete and type of exercise (endurance vs high intensity) they are performing is important. For example, a ketogenic approach has been discussed as being beneficial for those participating in endurance activities, or for those who need to increase power-to-weight ratio, however specific studies in these areas are currently lacking.
21. Isn’t glucose needed for energy for workouts?
Carbohydrates only go so far to sustain energy throughout the day, and especially during a workout. In ketosis, your body uses fat as fuel instead of glucose, to provide the brain with a consistent supply of the ketone bodies necessary to sustain physical performance.
22. Isn’t this diet too low in protein for my patients with sarcopenia or who are athletic?
Studies show that low carbohydrate ketogenic diet is effective in body weight reduction without inducing lean body mass loss, preventing the risk of sarcopenia. Consumption of approximately 25–30 grams of high-quality protein per meal maximally is recommended to stimulate muscle protein synthesis and slow sarcopenic muscle loss. 
23. Doesn’t the brain need glucose to function?
A common misconception is that the brain can only use glucose. Ketone bodies are the only alternative source of energy for the brain as it cannot utilize FFAs. Both rodent and human studies have shown increase uptake of ketone bodies by the brain following peripheral infusion of ketones, prolonged fasting, or a ketogenic diet. They observed that up to 70% of the brain’s energy demands can be provided by ketone bodies available in circulation (blood) and taken up by the brain.
24. Will insulin resistant patients need to be on this diet the rest of their lives?
Modifying lifestyle behaviour including weight-loss and exercise are considered to be methods in restoring the ability of tissues to properly respond to insulin. Although a ketogenic diet with low carbohydrate intake can effectively improve insulin sensitivity, the duration of diet for which these patients should be on is of healthcare practitioner’s decision. As the patient makes other important diet and lifestyle changes and maintains these healthy behaviours, it may be possible to re-introduce dietary carbohydrates (with a focus on lower glycemic index/load sources) which may be tolerated with improved insulin sensitivity.
25. Isn’t this diet too acidic?
Diabetic ketoacidosis happens when extremely high levels of ketone bodies are presented in the blood (normally > 5 mM). Therefore, the blood can turn more acidic. However, during nutritional ketosis you might experience a small, transient decrease in serum bicarbonate in conjunction with mild ketosis which can be minimized by increasing electrolyte intake. Hence the need for following this dietary approach under the supervision of a healthcare practitioner and for periodic monitoring of biological parameters is recommended.
 26. Do I have to restrict calories on the ketogenic diet in order to lose weight or just follow the macronutrient plan? What about if I am not trying to lose weight but just want to follow the keto diet?
A caloric deficit will allow your body to mobilize stored fat deposits for energy utilization. If weight loss is not a goal, there is no need for caloric deficit and you can still get the benefits associated with the keto-adapted state of nutritional ketosis.

27. I can’t recommend this diet because less than 25g of CHO’s would be impossible for my patients to adhere to.
The exact amount of carbohydrate intake to reach nutritional ketosis requires an individual assessment as several parameters need to be taken into account (gender, age, physical activity, insulin sensitivity, among others). Hence, the need for following this dietary approach under the supervision of a healthcare practitioner and for periodic monitoring of biological parameters (see question 19) is recommended. A carbohydrate intake of less than but close to 50 grams per day is acceptable for some individuals to reach a state of nutritional ketosis.
28. How do I count the carbs allowed per day? Are fibre included – do these count towards the total carbs allowed per day?
When following a ketogenic diet, it is important to consider the individual when determining the total amount of carbohydrates per day. Several factors will influence the ‘carb tolerance’ of an individual, such as gender, age, physical activity and insulin sensitivity among others. As a general recommendation, you will want to start with total carbohydrates intake below 50 grams per day. This number can be reassessed after the first two weeks to optimize your individual threshold for carbohydrate intake and maximize the benefits from reaching a state of keto-adaptation.

Please let us know if we can provide any further information
*References available
​
Kind regards
The Amipro | Metagenics Team

Eat, drink, and be merry—and still feel good on January 1? If you make it a priority, you can enjoy the holidays without sabotaging your health and waistline. All you need are some realistic goals, thoughtful planning, and smart choices. Check out these 10 tips for healthy holiday eating to be ready for an energetic 2019.

1. Begin with the end in mind.
   What are your health goals for the holiday season? Envision how you want to look and feel on January 1st. Commit to it. Write it down. Post it. Own it. Research shows that writing down goals significantly increases your chance of meeting a goal.1 However, be realistic that this may not be the ideal time to try to lose weight or start a new exercise program in order to get there.
2. Have a plan.
   When you go to a holiday gathering, you likely already make plans for transportation, for childcare, for gifts, etc. So add an eating and drinking plan to the list. Without a plan, you’re more likely to make indiscriminate choices and overindulge. And if you know that you won’t be happy without a piece of your neighbor’s pie, then plan to have it and enjoy it—guilt-free! Just be mindful of how you define a special occasion and favorite treats. Remember, not every event in November and December is a special event.
3. Don’t skip meals, especially breakfast.
   Many people routinely skip meals, especially breakfast, in the belief that the missing calories help their waistline.2 But it doesn’t work that way. In fact, people who skip breakfast regularly tend to have a higher body mass index and report more hunger and food cravings throughout the day than those who eat breakfast.3
4. Go colorful.
   Eat colorful fruits and vegetables throughout each day. This provides an ongoing supply of phytonutrients, potent plant chemicals that help offset oxidative stress from holiday indulgences. In doing so, they leave your body’s detoxification and immune systems in better shape for the new year.
5. Plan to drink…plenty of water.
   Drink up! Enjoy plenty of sparkling or still water before and during holiday events. Besides providing hydration, keeping your skin party-ready, water helps fill you up and occupy your hands. According to a three-month research study, people who drank about 2 cups of water an hour before eating consumed fewer calories, helping them lose 44% more weight than those who didn’t.4 Adding a slice of lemon or lime makes it more festive.
6. Don’t go hungry.
   Bolster your holiday eating plans by consuming a light, nutritious snack an hour before your event. For example, have a serving of fruit or a protein-rich food. Yogurt or a healthy salad, in particular, has been show to manage hunger and reduce intake at the next meal.5,6
7. Portion control: The portion makes the poison.
   Indeed, holiday eats tend to be calorically dense and heavy on the carbohydrates. So, in addition to using a smaller plate and filling half of it with nonstarchy vegetables, be mindful of portion control. Try the American Institute of Cancer Research’s portion quiz7 to test your portion size smarts. And if you’re making or bringing dessert, cut it into small portions. For example, slice a pie into twelve pieces instead of eight. Your guests can always have seconds if they are so inclined.
8. Do a buffet drive-by─then go last.
   Before you even pick up a plate, look at all your options. Then let others help themselves first. It’s easier to restrain yourself if the buffet isn’t quite Instagram-ready.
9. Skip the deep-fried wontons (and other high-AGE foods) to look better in January.
   Many holiday foods contain compounds known as advanced glycated end-products, or AGEs. Accumulation of these harmful compounds can affect all of our cells and is linked to the development or worsening of many diseases, such as cardiovascular and Alzheimer’s. In addition, like their acronym, they are associated with premature aging. Specifically in skin cells, AGEs can build up in connective tissue, promoting stiffness and loss of elasticity.8,9 Think wrinkles.So avoid high-AGE foods. These include:
   • Sugary items such as candy, cookies, cakes, soda, and pastries
   • Processed foods, including packaged meats and cheese
   • High-fat (especially red) meats
   • Deep-fried and broiled foods
10. Bring the holiday healthiness.
    Always offer to bring a healthy dish to a gathering. Besides being a helpful guest, you’ll be assured that there is something nourishing you can enjoy. Buy one premade if it will reduce your holiday stress. Be sure to add festive garnishes, such as toasted, chopped nuts or dried cranberries. Ideally, bring a vegetable or fruit-based dish, as nutrient-dense dishes are harder to find at holiday gatherings. Here are some healthy holiday swap ideas.
    • Mashed potatoes: Mash the potatoes with chicken broth and roasted garlic or garlic powder rather than whole milk and butter. Let guests add butter to their own portions.
    • Cauliflower mash: In addition to being much healthier than typical mashed potatoes, these can be made in advance and won’t turn into culinary cement. Try the basic recipe, or try dressing it up with a citrus version.
    • Stuffing: Swap out some of the bread with dried fruits and herbs to make it lighter and phytonutrient-rich. For gluten-free stuffing, consider making cornbread with organic cornmeal.
    • Cranberry sauce: It’s a condiment, not a dessert. So avoid the high-fructose corn syrup in the canned versions and make your own. This recipe includes citrus and pomegranate to deliver an antioxidant-packed bright color and flavor without relying on a lot of added sugar.
    • Turkey: True, the darker meat has more fat than the white meat. But whether you pick light or dark meat, remove the skin to save 11 grams of saturated fat per 3 oz. serving, and most holiday servings are bigger than that.
    • Gravy: Refrigerate, then skim off the hard fat before rewarming, then serving. This habit removes nearly 500 calories of fat per cup.

REFERENCES

1. Domincan.eduhttps://www.dominican.edu/academics/lae/undergraduate-programs/psych/faculty/assets-gail-matthews/researchsummary2.pdf Accessed November 29, 2017.
2. Nicklas, TA, Myers, L, Reger, C, et al. (1998) Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa, Louisiana: ethnic and gender contrasts. J Am Diet Assoc. 98: 1432–1438.
3. Cho E. Dietrich M, Brown CJP, Clark CA, et al. The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III). J Am Coll Nutr 2003:22(4):296-302.
4. Dennis EA, Dengo AL, Comber DL, et al. Water consumption increases weight loss during a hypocaloric diet intervention in middle-aged and older adults. Obesity. 2010;18(2):300-307. doi:10.1038/oby.2009.235.
5. Tremblay A, Doyon C, Sanchez M. Impact of yogurt on appetite control, energy balance, and body composition. Nutr Rev 2015; 73 (suppl_1): 23-27. doi: 10.1093/nutrit/nuv015.
6. B J Rolls. L S Roe, J S Meengs. Salad and satiety: energy density and portion size of a first-course salad affect energy intake at lunch. J Am Diet Assoc. 2004 Oct;104(10):1570-6.
7. American Institute for Cancer Research. Holiday Portion Quiz. http://www.aicr.org/enews/2017/11-november/enews-holiday-portion-quiz.htmlAccessed November 29, 2017.
8. Lee EJ, Kim JY, Oh SH. Advanced glycation end products (AGEs) promote melanogenesis through receptor for AGEs. Scientific Reports. 2016;6:27848. doi:10.1038/srep27848.
9. http://www.todaysdietitian.com/newarchives/030314p10.shtml Accessed Nov. 28, 2017.

You can’t beat the “meal in a cup” convenience of a smoothie or shake. A smoothie or a shake also provides built-in portion control, which can be so helpful. However, whether it’s Instagram-ready or a basic powder-water combo, your beverage should do more than just fill you up on the way out the door. So check out these seven smoothie upgrades—and become a shake master in the process.

1. Powders—start smart. Choose your powder wisely, as it’s the foundation of your shake. Expect more from a powder than just a pleasing flavor, texture, and adequate protein. It should also deliver the essential vitamins and minerals—in the most bioavailable forms that your body needs—without the artificial flavors, colors, preservatives, and GMOs it can do without. Of course, many individuals may also desire a gluten- and dairy-free formulation. Look for products from a GMP-certified manufacturer. Good Manufacturing Practices (GMP) certification is your assurance of product quality and your best strategy for reducing exposure to contamination, heavy metals, or inactive ingredients.
2. Liquids—keep ’em cold. For best taste, always mix your powder with a chilled liquid. Add ice!
3. Variety is the spice of life. Change it up! Luckily, base powders come in a wide variety of flavors. Likewise, experiment with dairy or dairy alternative beverages for different tastes and textures. Make a change now and then to avoid “flavor fatigue.”
4. Get creative and enhance nutrition with add-ins!

• Increase fiber and satiety by adding fruit to your shake. Berries (ideally organic) in particular will give an antioxidant boost. If you don’t regularly eat much fruit, this is an easy way to get a serving of fruit each day. For convenience and cost savings, use frozen fruit. Add it to a blender with or instead of ice.
• Bring on the nonstarchy vegetables, especially greens, such as kale or spinach or even fresh herbs! If you want your drink to have more volume, fiber-rich nonstarchy vegetables will fill you up with few added calories. Try adding as much as two cups of vegetables. Bonus: It’s a great way to clean out your crisper and reduce food waste!
• Nuts and seeds. Add a serving of seeds to your shake for extra flavor and texture. Almonds, almond butter, and walnuts, as well as unsweetened, shredded coconut all work very well. Chia seeds and ground flaxseed act like natural thickeners and add fiber as well as omega-3 fatty acids.
• Herbs, spices, & more. Try some of these combinations or even try mixing powder flavors.
  • Chocolate-flavored shake powders: carob, cacao, powdered cinnamon, or fresh mint
  • Vanilla-flavored shake powders: vanilla extract, cilantro, cardamom, cinnamon, or nutmeg
  • Fruit-flavored shake powders: fresh lemon or lime juice or fresh grated ginger

1. Shaker, blender, or high-speed blender? Bottom line: Use whichever is most convenient for you. Here’s a run-down of the pros and cons.

• Shaker cups = convenience. However, if you want to add fruits or vegetables, a blender is a must.
• High-speed blenders. Vitamix, Blend-Tecs, Ninjas, etc., can process just about any fruits, vegetables, or other add-ins into a relatively smooth shake. But you’ll pay a price premium for their powerful motors.
• Standard blenders. Any kitchen blender will work just fine. However, a produce-dense shake may end up a little chunkier, more like a “chewie” than a smoothie. While that might not be ideal for Instagram, it’s great for your digestive system! Chewing stimulates a cascade of digestive processes, such as the secretion of digestive enzymes and bicarbonate into the lumen of the small intestines.

1. Go easy on the blending. For best texture, blend fruits, vegetables, ice, or other add-ins, with the liquid first. Then, add the powder and briefly blend again for no more than 20-30 seconds.
2. Don’t delay. For the freshest taste and texture, enjoy drinks made with preservative-free powders within 20 minutes of preparation.

What’s your favorite shake combination? Share a picture or description!

About Maribeth EvezichMaribeth Evezich, MS, RD is a functional nutrition and therapeutic lifestyle consultant. Maribeth is also a graduate of Bastyr University and the Natural Gourmet Institute. Whether she is in her kitchen experimenting, at her computer researching, or behind the lens of her camera, she is on a mission to inspire others to love whole foods. as much as she does. She lives in Seattle and is the founder of Lifestyle Medicine Consulting, LLC and the culinary nutrition blog, Whole Foods Explorer. Maribeth Evezich is a paid consultant and guest writer for Metagenics.

The holidays involve taking time off work, travelling to see family, and picking out thoughtful gifts. For many, the final months of the year also require careful planning to stay in shape. According to a number of studies, including research from The New England Journal of Medicine, the average person gains one to two pounds between Thanksgiving and New Year’s Day.1
Fortunately, awareness and creativity will help you keep the momentum going on your fitness regimen. Consider the following workout tips to stay in shape over the holidays.
1: Make the airport your personal gym.Occupy your time at the airport by taking a long walk through the terminal. Use your phone to keep track of your steps—the ground you can cover may surprise you!
Engaging in light activity even for five minutes helps to increase your blood flow and heart rate, so make use of long wait times at the airport by pacing around at the gate. You can log thousands of steps before you board your plane. Celebrate the holidays in style by keeping active amid the chaos of air travel.
2: Stretch in your seat on the plane or in the car.Research reveals that you burn up to 30% more calories standing up than when you’re seated.2 If you’ve booked a long flight for the holidays, you probably know that getting up to stretch your legs isn’t always feasible. (The same goes for driving. While you should plan to stop at a gas station and get your blood flowing every few hours, extenuating circumstances—say, an impending December blizzard—might make this difficult.)
However, you can still stretch during transit. Does this sound counter intuitive? It’s actually quite simple. If you are seated in a small space, there are plenty of ways you can work your muscles. Consider the following exercises:

• Start in an upright position and then push your back into your seat and engage your core. Make a conscious effort to flex your abdominals.
• Gently roll your wrists and ankles. Do this in both directions for optimal results.
• Place a book between your knees and squeeze your thighs to work your legs, core, and hip abductors.
• Ball your hands into fists, place them on both armrests, and lift yourself gently out of your seat. This is a fantastic exercise for lengthy car and plane rides—as long as you’re not the one behind the wheel.

3: Challenge yourself to park far away at the mall.Are you planning to purchase holiday gifts at your local shopping center? Walking around the mall is a fantastic winter workout, and you can get started as soon as you pull into the parking lot. Rather than circling around in search of a spot near the entrance, deliberately seek a parking space at the back of the lot.
Go into this knowing that parking far is your choice. Those extra steps will add up, and the fresh air will do you good. Another benefit of parking far from the entrance is that you will no longer need to stress about snagging the perfect space.
4: Take advantage of slow times at the office.If your workload is lighter during the holidays, enjoy your downtime at the office. Step outside every few hours to stretch your legs and recharge. Go for a long walk during your lunch break. You could even encourage your colleagues to bundle up and join you for a walking meeting. This time of year is ideal for building healthy habits on the job.
5: Register for a holiday race.From Turkey Trots to Reindeer Runs, there is no shortage of 5 km and 10 km races around the holidays. Take your workout routine to the next level by registering for your local Jingle Bell Jog. There’s no need to fret if you’re not in running shape—many people sign up for these events with the aim of simply getting in the holiday spirit, and they still manage to break a sweat by walking the course.
These tips will help you maintain a workout routine during the holidays. In addition to working out regularly, make sure to relax and get enough sleep during this busy time of year.
References:

1. Jack A. Yanovski, M.D., Ph.D., Susan Z. Yanovski, M.D., Kara N. Sovik, B.S., Tuc T. Nguyen, M.S., Patrick M. O’Neil, Ph.D., and Nancy G. Sebring, M.Ed., R.D. N Engl J Med 23 March 2000; 342:861-867 DOI: 10.1056/NEJM200003233421206.
2. Julie Corliss, “Too much sitting linked to heart disease, diabetes, premature death,” Harvard Health Blog, 22 January 2015, https://www.health.harvard.edu/blog/much-sitting-linked-heart-disease-diabetes-premature-death-201501227618

You probably know about probiotics. They’re the tiny, “friendly” bugs that support a balanced and healthy gut. What you may not know is that their benefits go well beyond gut health!*
Your body is full of both good and bad bacteria, and when this delicate bacterial balance is out of whack, probiotics may be your most powerful ally to help restore your intestinal ecosystem.*
Before adding a probiotic to your daily routine, it’s important to consider the following factors:
​

1. There are multiple sources. Whether through yogurt, fermented foods (e.g., kombucha and kefir), or supplements, there are ways to recolonize your gut with good bacteria. However, it’s important to note that not all these sources are equally reliable. Make sure you choose a probiotic source that is strain-identified with clinically demonstrated benefits.*
2. They contribute to your microbial flora. The microbiome is the genetic material of all microbes—bacteria, fungi, protozoa, and viruses—that live on and inside the human body. The bacteria that contribute to your microbiome are essential to your health, development, immune function, and nutritional status.*
3. 70% of the immune system is found in your gut. Oftentimes, a gut imbalance can lead to other kinds of health concerns. Probiotics can help support a healthy immune system.*
4. Probiotics influence more than just gut health. And this list runs long. Good bacteria can positively influence nasal, sinus, and respiratory health; immune system health; gastrointestinal health; your ability to absorb nutrients; digestive comfort; vaginal and urogenital health; and weight management.*

​

With all the benefits probiotics have to offer, there are many reasons to consider probiotic supplementation. Talk to your healthcare practitioner today about which probiotic formula may be best for you.
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

What’s Eating You?
Feeling overly tired, bloated, or achy? When dealing with these often stress-related concerns, there are a few questions you should ask yourself: Am I eating well? Am I getting enough sleep? Do I drink enough water and get enough exercise?
A healthy body handles daily stress better while an unhealthy lifestyle and daily stress can contribute to a deeper issue—chronic inflammation.
Inflammation is the body’s natural response to fighting off potential health threats, but unhealthy lifestyle choices can stunt the resolution of your immune response. In fact, chronic low-grade inflammation is often related to common chronic illnesses. But here’s the good news: There are a few ways you can help resolve your body’s inflammation response—starting today!

1. Ditch That Diet
Unfortunately, many of us do not receive our fair share of nutrients from food. You may feel tired and overworked, and rather than taking the time to prepare a healthy, well-balanced meal, you may often resort to convenient inflammatory trigger foods that are lacking in nutrients: refined starches, high-fat and processed red meats, fried foods, dairy, etc. These may cause an activation of the innate immune system and lead to excessive production of pro-inflammatory cytokines.
It’s time to break the cycle by incorporating anti-inflammatory foods into your day. A Mediterranean-style diet, for example, typically has a high ratio of monounsaturated fatty acids as compared to saturated fats, and more omega-3 to omega-6 polyunsaturated fatty acids. It’s also rich in fresh fruits, vegetables, legumes, and whole grains, which have shown anti-inflammatory effects in observational and intervention studies.

2. Stay Hydrated
This one is obvious. It’s always important to drink enough water throughout the day and ensure you are properly hydrated. Water makes up a large percentage of our bodies to keep all our physiological systems working together smoothly, and it helps flush out toxins and unwanted chemicals we may pick up from the environment.
Tip: Bored with plain water? Add in fresh fruit slices to liven up your H2O. Antioxidant-packed green tea is also great for afternoon sipping.
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3. Put Stress to Rest
In our fast-paced modern culture, you may find yourself working too much and not getting enough rest. The initial stress response can be positive, but when left unchecked, it can lead to chronic stress and become pro-inflammatory. This is when getting extra sleep, practising yoga, or taking on leisurely activities you love can make a world of difference.
Catching those Zs at night is especially important because it’s your body’s time to rest and recharge. Lack of sleep can make you feel sluggish, unmotivated, and irritable, which only compounds a  stress problem; and increased stress disturbs the quality of your sleep. Research has also linked higher levels of inflammatory proteins to getting fewer hours of sleep at night.
In addition to getting proper rest, taking time to move and exercising are helpful stress relievers, as they release “feel-good” endorphins and can reduce your body’s levels of adrenaline and cortisol (stress hormones).
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It’s never too late to make positive life changes!Eating a nutrient-rich diet, ensuring proper hydration, and taking time for relaxation, exercise, and healthy sleep habits are some simple ways you can support your body’s best health today.

For the one out of six Americans sleeping less than seven hours per night, a sleep debt may feel “normal.”1 But, similar to a financial debt, the real cost may not be immediately apparent and can be damaging with time.

Sleep debt is costly for your body, even a few nights of insufficient sleep can leave you sleepy, with slower reaction times, foggy thinking, overall decreased performance, and, perhaps, a less than sunny disposition. Less noticeable is the disruption that may happen silently inside of our body: The effects of long-term sleep deprivation can possibly lead to negative health consequences.

Weekend catch-up sleep: does it work?Extra weekend shut-eye is a coveted treasure for the sleep-deprived. While we know it makes us feel better, can those extra hours of sleep reverse the health risks of a sleep-poor Monday-Friday?

Catch-up sleep and weight gain Studies have found a consistent link between sleep deficiency and weight gain—even over a very short time frame.2 In fact, when it comes to weight, every hour of sleep counts—not only for weight gain but also preventing it. In a study of over 2,000 participants, those who slept longer on the weekends, nearly two hours longer on average, had a significantly lower body mass index (BMI) than those who didn’t. Further, every extra hour of weekend catch-up sleep was associated with a significantly lower body mass.3

Strategies to help you get—and stay—out of sleep debt, so short-term, catch-up sleep can be helpful for paying back your sleep debt. But it shouldn’t be your only strategy. In addition to eliminating lifestyle-related sleep issues (over scheduling, limiting caffeine and electronics before bed, room temperature and darkness, etc.), you may want to consider dietary supplements that help support relaxation and healthy sleep.*

Some ingredients that can help support rest and relaxation include:

• Magnesium bis-glycinate--Magnesium may help relieve muscle tension related to stress and help support nervous system health. However, while abundant in green, leafy vegetables, magnesium is often lacking in the Standard American Diet. Further, it can be depleted by stress. So, magnesium deficiency in not uncommon. The bis-glycinate form enhances magnesium absorption and intestinal tolerance.*
• Taurine--Taurine is a sulfur-containing amino acid that is abundant in the central nervous system, and it may play a role in regulating the brain’s chemical environment.  Laboratory evidence suggests that taurine may influence GABA metabolism.Gamma-aminobutyric acid (GABA) is a neurotransmitter that has a calming, relaxing influence.*
• Folate and vitamin B12--These vitamins are co factors for neurotransmitter production, including serotonin. Serotonin is associated with mood, sleep, and relaxation.*
• Vitamin B6--This vitamin helps the body convert glutamate (a stimulatory neurotransmitter) into GABA, which can support a calm and relaxed state.*
• Melatonin--Produced and released by the pineal gland, melatonin helps regulate sleep, waking, and the body’s circadian rhythm (or time clock).* Changing time zones, evening shift work, and bright light exposure during desired sleep times can all inhibit melatonin release and potentially disrupt sleep patterns.*
• Sleep-friendly botanicals--Extracts of passionflower, hops, valerian, and Chinese skullcap provide added support for relaxation and a sense of calm.*

There are a number of specialised formulas that contain the above ingredients which can help you relax and relieve occasional sleeplessness.* Talk to your healthcare practitioner to determine which options are best for your individual needs.
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*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

1. National Sleep Foundation. National Sleep Foundation Recommends New Sleep Time. https://sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times Accessed 7.19.17.
2. Spaeth AM; Dinges DF; Goel N. Effects of experimental sleep restriction on weight gain, caloric intake, and meal timing in healthy adults. SLEEP 2013;36(7):981-990.
3. Hee-Jin Im, MD, MMSc, Shin-Hye Baek, MD, MMSc, Min Kyung Chu, MD, PhD, Kwang Ik Yang, MD, PhD, Won-Joo Kim, MD, PhD, Seong-Ho Park, MD, PhD, Robert J. Thomas, MD, MMSc, Chang-Ho Yun, MD, PhD; Association Between Weekend Catch-up Sleep and Lower Body Mass: Population-Based Study. Sleep 2017; 40 (7): zsx089. doi: 10.1093/sleep/zsx089

You try to eat well to feel good and stay healthy. While it’s optimal to get your nutritional needs from the foods you eat, it’s not always possible. There is conflicting information out there on the benefits of supplements, but the Dietary Guidelines for Americans 2015-20201 say that supplements may be useful for providing the nutrients you may be lacking from diet alone.
Still on the fence? Consider these top five reasons to add a multivitamin to your daily regimen.

1. Healthy ageing. As we get older, our bodies have a harder time absorbing nutrients from food. The National Institute on Ageing notes that starting around age 50, people begin to require increased amounts of certain vitamins and minerals.1 In fact, according to a study published in the June 2009 issue of the American Journal of Clinical Nutrition, researchers found that taking a daily multivitamin & mineral supplement may help improve micro nutrient deficiencies associated with ageing.3†
2. Making up for eliminated food groups. While some people have to cut certain foods like nuts or gluten out of their diets due to allergies, many eliminate particular foods or food groups from their diet voluntarily. This can cause vitamin deficiencies that would be helped with a multivitamin.
   Trying a Paleo diet? You might risk a shortage of calcium or vitamin D by eliminating dairy or grains. Cutting back on red meat? A multivitamin will replace the iron and B12 you would normally get from diet.†
3. Getting the RDAs you’re not getting from food. You’ve probably heard that the typical Western diet doesn’t include nearly enough daily fruits and vegetables. As part of that, you don’t always get the vitamins those natural foods supply. Supplementing with a multivitamin containing phytonutrients from fruit- and vegetable-derived ingredients may help. In addition, it’s important to keep in mind that RDA levels are set to prevent nutrient deficiencies. But there’s a wide range between taking enough vitamin C to avoid scurvy and the optimal amount you can benefit from.†
4. Getting that extra energy to get through the day. In today’s “go-go-go” society, one of the top complaints is a general lack of energy. Instead of reaching for that third cup of coffee, remember that your cells require certain vitamins and minerals to power your busy life; especially if you’re not getting a full eight hours of sleep or eating a balanced diet, a multivitamin can help provide the nutrients you need to feel energetic throughout the day.4
5. Managing stress. Daily life stressing you out? You’re not alone. But vitamins and micro nutrients play a significant biochemical role in improving your brain’s cognitive processes, and studies have shown that a daily multivitamin—particularly one with high doses of B vitamins—can help to reduce stress and support a healthy mood.5†

Ready to add a daily multivitamin to your diet? Be sure to check with your healthcare practitioner to see if he or she has a recommendation and to ensure that any medications you’re currently on won’t interfere with their effectiveness.
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†These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.References:

1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
2. National Institute on Ageing, Dietary Supplements. https://www.nia.nih.gov/health/publication/dietary-supplements#should
3. Qun X, et al. Am J Clin Nutr 2009; 89:1857–63. Multivitamin use and telomere length in women.
4. Bailey RL; et al. JAMA Intern Med. 2013; 173(5):355-361. Why US Adults Use Dietary Supplements.
5. Stough et al. Nutrition Journal 2014, 13:122. Reducing occupational stress with a B-vitamin focused intervention: a randomised clinical trial: study protocol.

If you’re trying to maintain a healthy weight, counting sheep may be as important as counting the carbs on your plate or weight repetitions at the gym. Because, while physical activity and a balanced diet are key factors, sleep may be the most overlooked aspect of your weight management plan.

Can you sleep your way to your dream body? Perhaps not. But if you are sleep deprived, more sleep may help you reach your weight goals. Here’s what you need to know about the sleep-weight connection.

Are you sleep deprived? The National Sleep Foundation recommends seven to nine hours of sleep per night for adults 24-64, slightly more for younger adults and a bit less for those older.1 But due to electronic gadget lights, chronic stress, habitual caffeine, shift-work, and many other reasons, few folks get their target rack time. In fact, according to the Centers for Disease Control, insufficient sleep is a public health problem2 with serious concerns for our productivity, safety, and health—including your waistline.

It’s not just when you’re sleep deprived and find yourself battling the bulge, you’re in good company. Studies have found consistency in the sleep-weight connection; sleep deficiency is linked to weight gain. The largest study of its kind involved over 200 participants and simulated a sleep-restricted workweek. It compared the effects of restricting sleep to only four hours per night compared to unrestricted sleep, up to ten hours per night.3 After only five days, the sleep-restricted subjects had gained about 2 pounds. In contrast, the control group, allowed to sleep for up to 10 hours a night, gained virtually no weight.

If sleep restriction can cause you to gain two pounds in just five days, what can happen on the scale long-term?A lot, according to women tracked for 16 years in The Nurses’ Health Study. Women reporting six hours of sleep per night were 12% more likely to gain at least 30 pounds during the study compared to the women who slept seven hours per night. But those women who were even more sleep deprived, reporting no more than five hours per night, were 28% more likely to gain at least 30 pounds during that same period!4 Apparently, with the sleep-weight connection, every hour counts.

How does less sleep = less svelte? There are several underlying factors behind the sleep-weight connection. But a common thread is our own chemistry, which almost seems to revolt when restorative sleep is intentionally or unintentionally withheld. It’s you against them—and it’s not a fair fight.

Getting to know your hunger chemistry. There’s more than your sensation of fullness and stomach-brain communication involved. Rather, when it comes to hunger regulation and sleep, we have several chemical messengers at play. And when it gets complicated between you and the sandman, those messengers are not on your side. So get to know them:

• Ghrelin: When ghrelin, known as the “hunger hormone,” is released from the stomach, it sends your brain a “feed me” signal. It signals not only when to eat, but also when to switch from burning calories to storing them as fat. Ghrelin naturally decreases after a meal and remains lower while you sleep, when caloric needs are less. But less sleep means more ghrelin.
• Leptin: The opposite of ghrelin, leptin is known as the “satiety hormone,” as it plays a crucial role in appetite and weight control. Released from fat cells, leptin crosses the blood-brain barrier and signals, ‘‘We’re good here. Put the fork down.” It also stimulates fat burning to create energy. Leptin levels naturally increase after a meal and remain elevated while you sleep, until you awaken and your metabolism increases. But less sleep means less leptin. Making things even tricker, sometimes leptin is secreted, but the brain’s not getting its signals. Think boy who cried wolf. This situation, known as “leptin resistance” can mean there is an underlying insulin resistance, a sign of disordered blood sugar metabolism, which puts you at risk for obesity and metabolic syndrome. While research on how to reverse leptin resistance is limited, animal studies show that an unbalanced diet can cause leptin resistance.5 So a dietary approach to reducing the underlying insulin resistance is a logical start.

As you can see, proper balance of ghrelin and leptin is very sleep-dependent. And for the caveman, perhaps these hormones were key to survival during the shorter, sleep-heavy but food-poor days of winter. They also played a part in the ability to capitalise on the longer, lighter sleep and more food-abundant days the rest of the year.
Today, our sleep-deprived bodies are prone to having too much ghrelin and not enough leptin. The result is that the body doesn’t feel satiated, thinks it’s hungry, and needs more calories—and squirrels away those calories for the long winter. In short, ghrelin and leptin kept the caveman alive, but they may be making you heavy.

• Endocannabinoids: “It’s 1 AM, and I’m craving a salad,” said no one ever. If you’ve ever experienced sleepiness munchies, blame it on endocannabinoids. Sound vaguely familiar? Endocannanbinoids are the endogenous version of the cannabinoids in marijuana—our bodies can generate a very close facsimile of the previously illegally (in some states) induced substance. Endocannabinoids bind to the same receptors in the brain, fat cells, muscles, and elsewhere, causing a similar appetite-inducing effect as cannabis.6 Further, the endocannabinoid system interacts with your dopamine and opioid pathways, driving not just hunger, but according to some studies cravings for high-carb and high-fat.7 You want cookies. Now. Resistance is pretty much futile.

What to do?
That depends. There are two main reasons behind sleep deprivation. Either you have a sleep hygiene issue (trouble falling asleep or staying asleep), or you have a scheduling issue, in that your lifestyle is interfering with adequate sleep.

For sleep hygiene issues, the typical recommendations always merit consideration: limiting caffeine, avoiding blue light before bed, creating a cool and dark environment, etc. But, when you have a scheduling challenge, getting adequate sleep requires some lifestyle restructuring. It’s worth the time to re-engineer your schedule to slowly go to bed earlier or rise later to increase your sleep time. But in the meantime, can you catch up on sleep on the weekends?

Weekend catch-up sleep: Is it a real thing?Of course, you can get extra sleep on the weekend. But can it potentially reverse your Monday-Friday sleep deprivation? Perhaps. In a study of over 2,000 people participants, those who slept longer on the weekends, nearly two hours longer on average, had a significantly lower body mass index (BMI) than those who didn’t. Further, it appears that the sleep:BMI relationship was dose-dependent in that every extra hour of weekend catch-up sleep was associated with a significantly lower body mass.8 So catch-up sleep can indeed be a good strategy. That is, if your overall average sleep for the week puts you out of the red and into the black, as in you’ve paid back your sleep debt. 

Sleep more. Weigh less. Not convinced? Sleep on it…
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1. National Sleep Foundation. National Sleep Foundation Recommends New Sleep Time. https://sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times Accessed 7.19.17.
2. Center for Disease Control. Insufficient Sleep is a Public Health Problem. https://www.cdc.gov/features/dssleep/index.html#ReferencesAccessed 7.19.17
3. Spaeth AM; Dinges DF; Goel N. Effects of experimental sleep restriction on weight gain, caloric intake, and meal timing in healthy adults. SLEEP 2013;36(7):981-990.
4. Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB. Association between Reduced Sleep and Weight Gain in Women. American journal of epidemiology. 2006;164(10):947-954. doi:10.1093/aje/kwj280.
5. Vasselli JR, Scarpace PJ, Harris RB, et al. Dietary Components in the Development of Leptin Resistance, Reviews from ASN EB 2012, Adv Nutr March 2013 4 2): 164-175; doi:10.3945/an.112.003152.
6. Hanlon EC, Tasali E, Leproult R, Stuhr KL, Doncheck E, de Wit H, Hillard CJ, Van Cauter E. Sleep restriction enhances the daily rhythm of circulating levels of endocannabinoid 2-arachidonoylglycerol. SLEEP 2016;39(3):653–664.
7. De Luca MA, Solinas M, Bimpisidis Z, Goldberg SR, et al. Cannabinoid facilitation of behavioral and biochemical hedonic taste responses. Neuropharmacology. 2011;63:161–8.
8. Hee-Jin Im, MD, MMSc, Shin-Hye Baek, MD, MMSc, Min Kyung Chu, MD, PhD, Kwang Ik Yang, MD, PhD, Won-Joo Kim, MD, PhD, Seong-Ho Park, MD, PhD, Robert J. Thomas, MD, MMSc, Chang-Ho Yun, MD, PhD; Association Between Weekend Catch-up Sleep and Lower Body Mass: Population-Based Study. Sleep 2017; 40 (7): zsx089. doi: 10.1093/sleep/zsx089

According to data from a recent study published in the Journal of the American Medical Association (JAMA), the more plant protein consumed, the lower your risk for mortality.1 This remains true even for those with unhealthy lifestyle habits, such as heavy drinking, obesity, physical inactivity, or smoking.
The study takeaway?
Look for ways to reduce the number of calories you consume daily from red meat and eggs. Substituting just 3% of daily calories derived from these animal proteins with plant protein was found to be associated with a 10% lower risk of death.
How does this translate to our forks?
Very easily! No major dietary overhauls are required to gain these life-extending benefits. For example, if you consume 2,000 calories daily, you would only need to swap out 60 calories. That’s just 15 grams of protein each day.
We’ve put together some delicious examples of plant protein meals.
Plant Protein Swaps:Breakfast

• Oatmeal with flax seed and almond butter
• Granola with nuts and seeds
• Tofu scramble with 1/3 avocado

Lunch

• Hummus with pita
• Black beans and brown rice
• Nut butter sandwich on whole wheat bread

Dinner

• Lentil soup
• Vegetarian chili over brown rice or bulgur
• Vegetable stir-fry with tofu over brown rice or bulgur
• Tempeh—try grilled or grated and use in tacos or pasta sauce

Make it spicy—every day!
According to a recent study published in the British Medical Journal (BMJ), spicy food could help you to live longer.2
A seven-year Chinese health study examined spicy food intake of over 20,000 lives and revealed a reduced risk of total mortality, as well as death due to cancer, ischemic heart diseases, and respiratory diseases (independent of other risk factors).
Compared with eating spicy food less than once a week, eating it once or twice a week resulted in a 10% reduced overall risk for death. But eating spicy food six to seven times a week reduced the risk by 14%.

1. Song M, Fung TT, Hu FB, et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Intern Med. Published online August 01, 2016. doi:10.1001/jamainternmed.2016.4182.
2. Lv Jun, Qi Lu, Yu Canqing, Yang Ling, Guo Yu, Chen Yiping et al. Consumption of spicy foods and total and cause specific mortality: population based cohort study BMJ 2015; 351 :h3942