Amanda Laird, Writer & Nutritionist - The Building Blocks for An Anti-Inflammatory Diet
Patient Awareness Day 2019: HEALTHY MIND & HAPPY PELVIS
Living Your Best Life With Endo
March 10, 2019 (8am - 5pm)
Einhorn Auditorium, Lenox Hill Hospital, New York City
Thank you so much and thank you, everybody. Good morning, I'm so excited to be today. I feel like I need to disclose before I get started that I do not have endometriosis. However, I'm a fierce advocate and ally for those suffering from this disease. We heard the statistics here this morning. As somebody who's a feminist and an advocate for women's rights, I really do see this as a feminist issue. As part of my work, I'm happy to include endometriosis education and advocacy in that.
A little bit about me. Pardon? Oh, perfect. A little bit about me. I'm a registered, holistic nutritionist. I specialize in hormonal and menstrual health. Back when I first started out as a baby nutritionist, just getting started, I was very passionate about hormones and menstruation and I really wanted to help people have better periods. However, I found that I really struggled to get my nutrition business off the ground because number one, periods were such a taboo topic, that people didn't want to share my blog posts or talk to me. I wasn't giving talks on periods even three or four years ago.
The other piece is that people didn't know that periods aren't supposed to be painful. It's just something that we are taught that periods, that's just the way it is. They're painful and we know that there's a genetic link with things like endometriosis. So, if your mom, your sister, or your family members have painful periods, you're not ever going to question that there's another way.
In 2017, I decided I wanted to start creating and facilitating conversations, changing the narrative around menstrual health, and I launched the Heavy Flow Podcast, which is my podcast all about periods. We talk about reproductive health, all kinds of things related to that. I just published my book, 'Heavy Flow: Breaking the Curse of Menstruation', which is a companion to the podcast. It came out in Canada in February. It's not out in the U.S., but I did bring some for you today. So, they are out on the front table.
Let's talk a little bit about diet and endo. As you've heard this morning, we do know that inflammation is a factor in endometriosis. The good news is, is that what we eat can help to increase or lower our inflammation load. When we have fewer prostaglandins, these are the compounds in our body that contribute to inflammation, we might experience less pain, less symptoms of endometriosis. What we eat can have a profound effect on our day-to-day feeling, how we feel all day today, and, of course, our menstrual cycles and our endo symptoms.
Now, as a holistic nutritionist, food is a lot of what I talk about, however, it's not the only thing. Before we talk about some key foods that might be helpful, I wanted to lay out some guiding principles. Number one, nutrition is a tool but it's not your silver bullet. I hate to be the bearer of bad news. It's good to get it out right off the start, but as my colleague, Jessica Murnane, said when she was on my podcast, "When you have endo, no amount of green juice is going to stop that bitch from coming back." It's just one thing in your toolkit that can help you manage your symptoms, but changing your diet is unlikely to cure your endometriosis.
We also need to understand what is going to work for you. What I'm not going to talk about today is the endo diet. I have some guiding principles, I have some key foods, but we really need to get to know ourselves and what's working for us because there's no one-size-fits-all solution. That goes for everybody, but as we hear this morning, every person who has endometriosis has a different disease. You might have different symptoms and I was really excited to hear about the genetic markers turning things on and off in different people. Certainly, that's a great way to start exploring food and figuring out what works for you.
Oh, it's down here. I also want to assure you that what you do most of the time matters more than once in a while. When it comes to making changes to our diet, it's easy to get overwhelmed with the choices. Is it gluten-free? Is it dairy-free? Is it low FODMAP, anti-inflammatory? Food is such a pleasure and us humans, we get to eat for pleasure, which is wonderful and it should be something that we enjoy. When we're making changes to our diet, that doesn't necessarily mean that we're never going to get to have pizza or birthday cake again. Doing that once in a while isn't going to undo all the hard work that you are basing your diet on every day.
Last, but certainly not least, as a nutritionist, food is important, but what I have learned in my own life with my clients and when I was researching my book, I came across some studies that actually show that stress can negate the benefits of healthy food. If you are chronically stressed, your overstimulated, even if you were to have a perfect diet, if you're super stressed out, it's going to negate the benefits of that food. One of the reasons as well why I don't prescribe or I don't recommend a very prescriptive, rigid diet is because that can be stressful and now you're just canceling out the benefits of your healthy food.
With that in mind, let's talk a little bit about some of the key foods for building an anti-inflammatory diet. Number one, I always recommend a plant-based diet. What plant-based means to me is not necessarily that you're a vegetarian, but that the majority of the food that you are eating comes from plants, so natural, fresh, whole foods as much as possible. I'm willing to bet that looking at this list of healthy foods, there's no surprises up here. We all know that we should be eating lots of fresh fruits and vegetables, whole, intact grains. That's things like brown rice, quinoa, millet, beans, legumes, nuts, seeds, and fat as well, which we'll talk a little bit about in more depth.
Then, once you covered off your bases, building the majority of your diet with plants, then you can decide how much, if any, animal protein you want to include. You need to find out what makes you feel great. I don't thrive on a vegetarian diet. I only know that from being a vegetarian for 13 years and feeling like garbage. Perhaps, that's not you. You need to find that sweet spot between what makes you feel great physically and also aligns with your ethical and environmental concerns 'cause that's also an issue when it comes to eating meat.
As long as the majority of what you're eating is plants, I think you're in good shape. Some of the great players are leafy greens. All of our moms told us to eat our greens and that was for a reason because these really are superfoods. I love leafy greens. I think that they're delicious. They're versatile and they're so many of them that you can eat them three times a day and you don't necessarily have to just be eating kale or spinach all the time. Leafy greens are just packed with nutrients, minerals, vitamins, fiber. They have a little bit of protein in them and they're very anti-inflammatory as well. We want to be eating lots of leafy greens in abundance.
In the morning, you can through them into a smoothie. You can saute them. Of course, you can eat a salad. There's lots of things you can do. I always recommend having some raw and also some cooked because, as we cook our greens, the nutrient profile changes a little bit. We want to be mixing it up and certainly, if you have a lot of GI symptoms, sometimes too much raw food or too much roughage can actually irritate your gut more, which is not what we want. Lightly cooking our food and our veggies can help mitigate some of that. Kale, spinach, arugula, Romaine lettuce, collars, beet greens, Swiss chard, anything that is green. We want to be eating lots every day.
Another piece of any type of hormonal, menstrual issues is supporting our liver. Our liver does lots of jobs. Two of these jobs include metabolizing hormones and also detoxing. There's lots of things that we can do or lots of things that we can eat that's going to help stimulate our liver and keep that part of our body healthy. The key here is the bitter the better. Anything that is a little bit bitter is going to stimulate your liver. Broccoli, cauliflower, cabbage, lemons, limes, grapefruits, bitter greens like radicchio, endive, and beets are also fantastic for our livers. We want to be eating these every day.
Fiber is another important factor in anti-inflammatory and also supporting hormones as well. Again, if you have a lot of GI symptoms, we don't want to be going overboard with fiber, but it is important that we are getting sources of fiber into our daily diet. Of course, fruits and vegetables are a great source. Any fruits and veggies that we're eating is going to have lots of fiber in it. Beans and legumes, so any types of beans or lentils are fantastic for fiber. Of course, whole grains as well. Whatever floats your boat on that front. We have oatmeal, brown rice, millet, amaranth, quinoa. They're all great sources of fiber.
Last on this list, but certainly not least, is fats. It wasn't that long ago that low fat was the diet craze. We were afraid of fat. We were afraid that fat was going to make us fat. Now, we know that we actually need fat to function. It's an essential nutrient in our body and there's some evidence that we're seeing now that omega-3 is specifically helpful in reducing inflammation. Getting omega-3s into our diet. Hemp seeds, chia seeds, walnuts are great sources of omega-3s and so are fatty fish. If you like fish, fish agrees with you, then any fatty fish will be loaded with these omegas and anti-inflammatory properties.
You just have to remember the acronym SMASH. That stands for sardines, mackerel, anchovies, salmon, and herring. Those are some of the top fatty anti-inflammatory fish. Avocados, also great source of fat. This is one area that I also would recommend a supplement. We don't necessarily all like fish. Fish can be expensive or inaccessible to fresh fish. So, a supplement, either a fish oil supplement of a vegan omega-3 supplement can be very helpful to make sure that you're getting the fat that you need.
Now, some bonus blocks. When it comes to building your anti-inflammatory diet, those categories that I just went through, that would be your foundation. Then, a few bonus things that you can pile on top that are superfood or flavor boosters that are going to help with the inflammation. Certainly, I'm sure you've heard that turmeric is a fantastic anti-inflammatory property. We can cook with this. We can get a powdered turmeric or we can get the actual turmeric root and use that in our cooking or smoothies. You can also get a supplement as well. Ginger, garlic, again, anti-inflammatory, delicious. So, we want to be using this in our food as much as possible.
Bone broth is fantastic for GI issues. It has lots of nutrients, collagen, things that can help to tame an inflamed gut lining if you have a lot of GI issues. Fermented foods as well are a key in this diet. That can be anything from kombucha to kimchi to sauerkraut. If you look up the fermented foods Wikipedia article, the list of fermented foods is pages and pages long. Almost every culture around the world has some type of fermented food and it can be a bit of a learning curve to get used to fermented foods. Start with a little bit, work up from there and if you don't like one, try another. Because there's lots of options out there. Another popular food that's getting trendier every day is mushrooms. Medicinal mushrooms, dried mushrooms, things like shiitakes, portobello mushrooms, Chinese mushrooms are all fantastic and can help support your inflammation as well.
Those are just a few building blocks to help you start exploring what foods are going to help you manage your symptoms and make you feel great. I have much more in my book which is available at the front and I'm also happy to take a couple of questions 'cause we have about four minutes left.
Have you tried [inaudible 00:16:12] yet?
Yes. I have. I don't like the mushroom coffee one, but there's a mushroom hot chocolate, which I do like and it's from Four Sigmatic Foods. Comes in a little packet. You can just mix it up with hot water, hot milk, or dairy-free milk. I find that the hot chocolate one is a little less earthy. Yeah.
Yeah, yeah. Yes. Hi.
I just learned that my endo impacted my kidneys and a number of things that you think are great, spinach and avocados, are actually really ... Oh, hi there. I learned that many things that are wonderful for you in general like spinach, avocados, and stuff is actually really bad if you have kidney issues. You have to take some of the very healthy things with a grain of salt because if your endo impacts kidneys, then a lot of these things don't actually work and potentially can cause damage because their levels of potassium and things like [crosstalk 00:17:17].
That's why the number one guiding principle is you need to figure out what works for you. I think that that test that we were talking about earlier, the genetic test, which can give you some more information about how endo is showing up in your body, is a great place to start because then you can make decisions around food like that. Yeah, that's why I don't have the endo diet, right? Yeah. Yeah, that's a great point. Thanks for sharing.
[inaudible 00:17:57]. Hi, I was just wondering if there's anything that you see like patients come to you or out in the media that is advertised as healthy or anti-inflammatory and you actually feel like it's not. The there any misconceptions or myths that we should know about?
Well, apples don't make a lot of health claims. A lot of the foods that are heavily marketed, that are packaged, that get a lot of press, have a lot of advertising and marketing dollars behind them where they're trying to get in front of you to say, "Hey, this is the miracle food." Certainly, in the last couple of years, everything is kale, everything is turmeric, and now, we're seeing everything is mushrooms. My guiding principles for that would be beware of trends in marketing and if something has a label where they can put a big yellow sticker that says, "Anti-inflammatory, superfood," that is usually a red flag for me. If you really just stick to whole foods, natural foods, sticking to the perimeter of your grocery store where you're shopping for fresh fruits and veggies, then that's the best place to start I would say. Yeah.
I have a question. I struggle with my diet all the time. I can't control my will and I just can't. However, when I think of patients, I can understand their dilemma. Scientifically, really, endo inflammation's a unique inflammation. It's really a lot of weird places in the body that circulation is less. Who wrote the most scientific anti-inflammatory? I'm sure you did some research on this. Is there any source that scientifically people really focus on what is anti-inflammatory, how this is working, which cells are they really trigger or work through? Do you have any explanation to this crowd? You know ...
I feel like that's beyond the scope of my research as a nutritionist. I should also point out that when I was in school as a holistic nutritionist studying, we never talked about endometriosis as inflammation. It was a bullet point on a dot when we're talking about reproductive health. It wasn't until I finished school and I took a secondary course about hormonal health and then dove into reading independently that I even discovered the link between inflammation and endometriosis. I don't have a specific answer.
In general, for patients, it is true the outer layer of the bowels are involved. That is where the inflammation scarring takes place, especially in the lower part of the abdomen. The bowels, because of adhesions and some minute changes that happens the way Doctor Redwine has always stressed, diagnosed very early diseases, in that every little implant or every little disease focus has a surrounding many fibrosus around. That is translated into the bowel, whatever organ it's sitting on as a noxious, a terrible signal and it interferes with its function. Any diet that really soothens that flow easy would probably, potentially has a better result of digesting and pushing it out.
Constipation is a major symptom. Diarrhea, constipation, that gas, bloating, and also painful bowel movements, these are things that should not be taken lightly when it overlaps with the period, particularly. The message is right there for the crowd. Thank you very much.
Hi, how much do you feel contributes to the inflammation in terms of organics and non-organics because of how our food is grown and all of the pesticides? I try to stick to an organic diet 'cause I notice a huge difference in foods that are non-organic in terms of inflammation.
Yeah, that's a great question. I recognize that there is a benefit to organic food, but I don't want that to be a barrier to access. I have first let's eat vegetables and then once we're eating vegetables, then we can graduate to organic. If I was to put up a slide that said, "Let's eat organic food," you can still buy organic junk food at Whole Foods. I really want people to focus first on those real foods. That's going to have, I think, an impact to begin with.
The question is, how does organic food fit, which ... I think I might have to wrap it up so we can talk a little bit. I would say let's eat vegetables first and then if we can afford organic food, then go for it. Yeah, yeah.
Well, thank you for that.