Go with your Gut   –   GI Distress from a different perspective

Ilana Katz MS, RD, CSSD

Since a big part of my work with athletes involves reducing the risk of Gastrointestinal (GI) distress I thought a different perspective of the GI environment and how to nurture it would be rather informative.  The organisms and their metabolic processes themselves, the majority of which live in the colon, are referred to as microbiome and they dramatically effect human health in general, not just for athletism. The microbiome is made up of trillions of microorganisms ranging between bacteria, fungi, viruses, and others., all of which impact the immune system.

The microbiome multitasks between maintenance of immunity, digestion, hormonal and nutrient balance by:

  • maintaining optimal gut flora (by fighting pathogens and embracing working microorganisms)
  • activates anti-inflammatory responses1
  • uptake of hormones2
  • detoxifies environmental negatives (such as drugs, chemicals, unnatural “food” items eg. artificial sweetener, sugar alcohols, etc.)1
  • synthesizes essential nutrients (particular to the gut are biotin, folate and vitamin K)1.

Inflammation and digestion, and most other functions mentioned above, differs greatly between individuals, and is mostly influenced by stress, age, past infections (antibodies), gender (and within gender experience of natural birth, breast feeding, etc.), medications, lifestyle habits (smoking, alcohol, etc.). and most importantly, diet3.

It is thus safe to say that almost every chronic (and probably acute too) inflammatory response is affected by changes in the microorganism composition of the gut. There is no blueprint for an ideal breakdown of gut microbiome but the diversity of the microorganisms has shown an increase in symbiosis – the mutually beneficial relationship between them.

Lower level symbiosis results from higher than necessary caloric intake, highly processed foods, saturated fat, refined sugar, and soda (chemicals) whereas microbial diversity and therefore increased likelihood of positive symbiosis result from dietary intakes such as coffee, tea, red wine, fruits and vegetables, nuts and buttermilk.4   Stress would be the biggest contributor to low diversity and reduced symbiosis as well as high triglycerides, irritable bowel symptoms (diarrhea) and intestinal inflammation.5

In research on dietary effects of microbiome, the summary states that eating plant-based foods and nuts are related to reduced bowel inflammation and aid in healthy cholesterol management5.  The typical American diet of low earth based nutrients, high saturated fats, high refined sugars and high in processed animal proteins negatively reduces gut microbial diversity, symbiosis and overall gut health.

So what is it about the earthy foods that assist in a positive microbiome? Simply, the content of fiber. Why? Because although fiber is the undigestible carbohydrate for humans it provides the gut microorganisms with essential “food” for them to produce enzymes. These enzymes in turn, breakdown these undigested carbohydrates in process of fermentation.6 Fermentations’ end-product is butyrate, the preferred food-source for cells in the large intestines. The healthier cells are then able to maintain the intestinal wall health, reducing risk of other major chronic disease states such as colon cancer, colitis and Chron’s disease.

Why then are people with a diagnosis of inflammatory bowel diseases (IBD) like Chron’s and colitis advised to keep their diet lower in fiber?  It may be a case of which came first, their dysbiotic colons, or the fact that fibrous foods can cause abdominal pain, bloating, cramping, diarrhea, and obstructions.7   Symptoms of IBD could then be reduced by limiting fiber however the vicious circle of health impacted colon and dysbios will ensue. It is therefore in the best interest of a person struggling with GI distress to seek professional help within the dietetic realm to work on tolerance of fiber. Because GI distress should not mean a low fibrous diet, dietitians will often teach such patients to increase fiber progressively, maintain excellent hydration processes and learn new techniques such as juicing, blending, other cooking methods to pre-breakdown tough fibrous skins of earthy produce, and removing completely undigestible seeds.

So far, I have focused mostly on the digestion of fibrous carbohydrates. But when talking about microbial flora it is important to consider that some undigested animal protein lands up in the colon too. Unlike plant based proteins, the fermentation of animal protein does not result in butyrate and the formation of healthy enzymes, instead they are fermented by colonic bacteria and produce potential toxins such as ammonia, and hydrogen sulfide.8    These toxins inhibit butyrate formation that would otherwise protect the colon lining from harmful entry of microbial invasion. The toxic gases thus increase inflammation responses further risk GI distress and chronic bowel diseases.  Not only do they inhibit the growth of anti-inflammatory bacteria, but they also support the growth of pro-inflammatory bacteria3.  Furthermore, hydrogen sulfate results in foul smelling gas, a common side effect of high protein, low fibrous diets. From a dietetic standpoint, if the diet is high in meat, by simply adding a variety of colorful, and fibrous vegetables could reduce the protein fermentation.

In summary, whether you are an athlete looking to reduce the risk of gastrointestinal distress while training/racing, or an individual wanting to reduce irritable bowel syndrome, or just an individual trying to keep the gut healthy, diet is the major factor determining microbiome make-up. The best diet for a healthy flora in the colon is simply a whole food diet with a variety of non-processed macronutrients (fibrous carbohydrates, lean protein and unsaturated fat), favoring plant-based more than animal proteins, non-excessive alcohol (favoring red wine) and the elimination of refined and processed sugars, artificial sweeteners and sodas.


  1. Gut Microbiome for health. http://www.gutmicrobiomeforhealth.com/en/about-gut-microbiome-info/
  2. Camilleri MD., Serotonin in the Gastrointestinal Tract. Curr Opin Endocrinol Diabetes Obes. 2009 Feb; 16(1):53-59.
  3. Brown K, et al. Diet-induced dysbiosis of the intestinal microbiome and effects on disease. Nutrients. 2012;4:1095-1119.
  4. Conlon MA, Bird AR. The impact of diet and lifestyle on gut microbiota and human health. 2015;7:17-44.
  5. Zhernakova A, et al. Population-based metagenomics analysis reveals markers for microbiome composition. Science. 2016;565-569.
  6. Rose DJ, et al. Influence of dietary fiber on inflammatory bowel disease and colon cancer: importance of of fermentation patterns. Nutr Rev. 2007:65:51-62.
  7. Limdi et al. Dietary practices and beliefs in patients with IBD. Inflamm Bowel Dis. 2016:22:164-172.
  8. Yao CK., etal. Insights into colonic protein fermentation and its health implications. Ailment Pharmoco ther. 2016;43:181-196.

Beat the Heat with a Watermelon Treat

Watermelon – not just for seed spitting.

Not only is watermelon is a favorite summer food selection and barbeque closer, it is equally beneficial to health. The antioxidant lycopene is a chemical found in plants that gives certain foods (watermelon, tomatoes, red grapefruit, and guava) their red color.

Part of the large class of plant compounds called carotenoids, which help protect and preserve body cells from oxidation and damage, lycopene may reduce one’s risk of various cancers, particularly prostate cancer. Watermelon is also a good source of antioxidants, that work towards preventing heart disease, lowering cholesterol.



Choose a firm, symmetrical fruit that is free of bruises, cuts, and dents. Pick up the melon, it should feel heavy. (A good watermelon is 92% water.) The underside should have a creamy yellow spot where the melon sat on the ground and ripened in the sun.

Watermelon-Strawberry Smoothie

(16 oz serving)

  • 1 cup seeded watermelon, diced
  • ¾ cup lemon sorbet or sherbet
  • 8 frozen whole strawberries
  • 1 tablespoon lemon juice
  • 4 cubes of ice
  • 1 cup water

Place all ingredients in a blender. Blend until smooth.
(cals; 224, carbs: 50g carbs, 4g fiber (net carbs = 46g (mostly natural sugar: fructose), 2g pro, 0 g fat.

Watermelon Sorbet

1 seedless watermelon (peeled and cubed)

1. Arrange the watermelon cubes in an even layer on a baking sheet and freeze until the watermelon is solid, about 2 hours.

2. In a blender, puree watermelon cubes until smooth

3.  Put the puree in loaf pans or dish, packing it down as you add more on top.

4. Freeze until the sorbet is scoopable, 1 to 2 hours more.

5. To serve, scoop the sorbet into dishes and eat immediately.

watermelon sorbet

Watermelon Parfait

(2 servings)

  • ½ cup low fat granola
  • 1 cup seedless watermelon, cut into small chunks
  • 2 cups of low fat vanilla yogurt
  • 1 sliced banana, sliced
  • ¼ cup of Almond slivers

In 2 tall glasses layer ½ of each of the granola, watermelon, yogurt and banana
Repeat layers with the other half of the ingredients.
Garnish with slivered almonds.
(cals per serve: 230 cals, 4g fat, 9g pro, 35g carbs, 5 g fiber)

watermelon kids

Hyponatremia: Signs, Symptoms and Warnings

Ilana Katz MS, RD, CSSD

Hyponatremia tends to be mostly associated with athletes who participate in long duration sports such as marathons and triathlons. Endurance athletes taking in water during training or an event can develop hyponatremia, a potentially life threatening condition that occurs when sodium levels drop to a dangerous low in the blood stream (below 135 mmol/L (of blood). Early symptoms may include nausea, drowsiness, confusion, headache and fatigue. These can quickly progress to seizures, coma and death if not resolved in time. Importantly, athletes are not the only population that needs to be aware of this deadly phenomenon.

Dilution of sodium can result, as mentioned, from over-drinking, but also from water retention (often a side effect of various medications). Sodium can be lost in various ways other than dilution which include urination, perspiration and gastrointestinal distress (vomiting/diarrhea). Furthermore certain medical conditions such as congestive disease, kidney dysfunction and ineffective ant-diuretic hormones are known causes.

Since hyponatremia has usually been associated with endurance sports, those who engage are much more well-informed than in the past, and emergency staff who treat athletic stress conditions are also far better educated to recognize and manage symptoms, and even play a role in prevention. The sports medicine community has been helpful in raising awareness about risks and signs of over-hydration. However, with obvious evidence that there are many other populations at risk for hyponatremia, it is vital to recognize these so that all health care professionals are on the leading edge of avoidance and if necessary, acute care.

Some examples of patients who may be eligible for high alert:

  • Psychiatric patients with a syndrome known as psychogenic polydipsia, meaning they drink excessive amounts of water..
  • Multi-pharmocological patients (especially elderly). Why, well because many medications have potential risks.
    • Diuretics deplete electrolytes, including sodium
    • Antidepressants increase level of antidiuretic hormone
  • Patients being administered intravenous hypotonic fluids: hypotonic fluids contain a lower concentration of sodium than blood and thus excessive quantities at high entry rate can dilute sodium.
  • Tube fed patients: proper fluid levels and electrolyte balance must be continuously monitored and orders adjusted based on results of consistent blood work.

There is also the all controversial sodium debate to consider. Researchers and health practitioners often have opposing arguments as to whether dietary sodium should always be strictly conserved. While lowering sodium is unarguably beneficial for those already diagnosed with hypertension (high blood pressure), increasingly conservative recommendations for the average population is often contested. The argument being that too little sodium can lead to other health problems, the main one being hyponatremia. Interestingly, the dietetic community are in agreement that avoidance of dietary sodium is unlikely to cause hyponatremia. Even a very low sodium diet of 500 – 1000 mg/day should maintain adequate levels under normal circumstances. It is the complexity of what defines “normal circumstances.”

In summary, with regards to controlling appropriate levels of sodium in the blood and avoidance of hyponatremia, not only athletes should be aware of hyponatremic signs and symptoms. For those with a normal blood pressure, eating patterns and water intake should be developed based on clinical judgement, guidelines and scientific evidence.

glass of ice blue




How to Keep a Food Journal

The number one complaint about keeping a food journal is that it is too much work for your busy schedule or that it makes you think more about food. Both of these are probably true. In the beginning, however, driving a car was a lot of effort. Eventually it became second nature and now you can probably drive while eating. By using either of these tools you can also update your food journal while in your car. (not while driving of course )

Keeping a food journal will help you improve your eating habits. No doubt about it. You can’t manage what you can’t measure. It is an old management adage that is just as meaningful to your weight control. Unless you measure something you don’t know if it is getting better or worse. If we are going to be able to help you with your weight management, we need to be able to see what you are eating and when you are eating it. SO.. we are going to do this thing, let’s make it as easy and fun as possible.

There are various apps on-line that regulate your fitness and food journal. They typically let you track what you eat with a few clicks – almost no data entry and record your workouts in minutes. Some examples are FitBit, MyNetDiary, Livestrong, MyFitnessPal, etc.

TweetWhatYouEat  is another on-line food journal – stripped down to the bare necessities.  If you use Twitter, this is incredibly easy to use.  You sign up with the service and then, using your Twitter account, send a direct message every time  you eat something.   Like this:

DM TWYE 2 eggs, spinach, olive oil

That’s it.  When you go to your TWYE diary, you will see a list of everything you entered.  The calorie counts are “crowdsourced”,  meaning that other users have given “2 eggs” a calorie count and TWYE uses that in your calculation.  If you don’t like the calorie count they used you can edit it.   TweetWhatYouEat gives you a total for the day.

You can use either of these services to send  food logs to your nutrition clinicians, or merely just for self accountability.

If you use Twitter, feel free to follow me on Twitter for our latest tips @ilanakatz.  I try to post neat stuff to share with  Twitter friends frequently.  Or of course Facebook too “Optimal Nutrition for Life – by Ilana”.


Did you know that May is Mental Health Month

No matter if you or someone you know struggles with mental illness, proper nutrition and exercise can boost your mood!

If you’re looking to increase your energy, decrease your stress, alleviate anxiety, or up your spirits, you might want to give some of these a try:

  • Oily fish (example: Mackerel): contain vitamin D which increases serotonin to boost your mood.
  • Pumpkin and sunflower seeds: rich in omega-3-fatty acids and essential nutrients which can help to reduce symptoms of Depression and Insomnia.
  • Vanilla ice cream: contains phosphorus that can help increase the libido in some.
  • Bananas: contain tryptophan which works with serotonin. It also contains potassium, which we may need when stressed, and B6 that helps to regulate sugar levels.
  •  Dark chocolate: causes the brain to release feel-good endorphins and serotonin.
  •  Pasta: contains carbohydrates that increase the production of serotonin.
  • Cheese: contains tryptophan and calcium, needed to manufacture the sleep-regulating hormone melatonin.
  •  Green, leafy vegetables: contain folic acid. A deficiency of folic acid can result in symptoms of Depression.
  •  Coffee: boosts the metabolism, increases alertness, and can activate the pleasure controls in the brain.
  • Spicy food: causes the body to release endorphins in response the capsaicin, also known as the spiciness, of say hot tamales.
  •  Wine: in moderation, may promote a feeling of happiness and lower blood pressure.

Interesting tidbit:

A study in Spain over  the course of 11 years found that those who ate the most trans fats were  48% more likely to develop depression. To avoid trans-fats, you will want to look for “trans-fat free” products and those that do not contain “partially hydrogenated” in the ingredients list.

Water: insufficient amounts of water, or dehydration, can lead to fatigue, headaches, and memory loss.


Nutrients that are beneficial to mental health disorders:

  •  Amino acids
  •  Antioxidants
  •  Essential Fatty Acids
  •  Omega-3 and Omega-6 Fatty Acids
  •  Vitamins and Minerals: Vitamins B6, B12, folic acid, vitamin D, vitamin C, and vitamin E.

The Art of Mindful Eating

What is it?

Mindful eating is a stress relieving technique or meditative practice that allows you to use all of your senses to enjoy the food you are consuming.

What are the benefits?

    • Can decrease the amount of mindless eating a person does which, in turn, possibly reduces the number of calories taken in. When people eat mindlessly, they often snack without realizing how much they have actually consumed.
    • It allows the person to truly enjoy their food resulting in an overall sense of satisfaction that may not be found when eating quickly or on-the-go
  •  It also allows the body time to make the brain aware of how full you are. It takes the digestive tract approximately 20 minutes to tell the brain that you are full so you stop eating when satisfied.

How is it done?

  • Savor your food and pay attention to the various flavors of the ingredients
  • Analyze the textures of your meal: crunchy or creamy? Dry or juicy?
  • Meditate on the food. When outside thoughts enter, identify them and then return to the enjoyment of your food.
  • Listen to your body. Pay attention to when you are no longer hungry and other sensations or tension within your body.


                           Fitness Corner

Not only can nutrients help boost your mood but so can exercise through various methods:

  • Releases endorphins that produce a feel-good emotion which is why you may have heard of the term ‘runner’s high’.
  • Reduces immune system overreactions.
  •  Increases body temperature which can calm some individuals.
  •  Boosts self-confidence.
  • Acts as a distraction from worry and negative feelings and creates a positive outlet for such emotions.
  • Exercising at the proper time of day for the individual can result in improved sleep.
  •  It is considered an effective treatment for mild to moderate Depression.

How can you add more exercise into your life?

  • Walk with someone or join a group fitness class. Both of these options, and others, allow for additional mental health bonuses- a social network.
  • Have fun and be creative dancing- at a club, taking lessons, or a fun fitness class like the latest trend known as Zumba.
  • Even decluttering your house can reap benefits for both your body and mind. Housework and yard work burn calories and can lift your spirits.

Recipe of the Month:

An Uplifting Feast

Using the ingredients mentioned above, consider trying this meal, remembering to use all of your senses for a mindful experience.

 Spicy Pasta             


  • 3 tablespoons olive oil
  • garlic cloves, minced
  • 1/4 teaspoon crushed red pepper flakes
  • 1 pound common white mushrooms, thinly sliced
  • 1 1/2 cups canned crushed tomatoes or tomato puree
  • 1 jar of Arrabbiata pasta sauce, use as desired
  • 1/8 teaspoon dried rosemary crumbled
  • 1/2 teaspoon salt
  • 1 pound linguine
  • Grated Parmesan cheese to taste


Bring a large quantity of water to a boil in a stockpot.  To make the sauce, heat the olive oil in a medium-size saucepan over medium heat. Add the garlic and crushed red pepper flakes, and cook 30 seconds. Optional: use Arrabbiata pasta sauce instead of making or if you desire additional sauce. Stir in the mushrooms and cook until brown and juicy, about 10 minutes. Mix in the tomatoes, rosemary, and salt, and cook, stirring often, for 10 minutes. If the sauce begins to splatter during cooking, lower the heat to medium-low. Keep the sauce warm while cooking the linguine.

Drop the linguine into the boiling water and cook until al dente. Taste one along the way to avoid overcooking it. Drain thoroughly in a colander and return to the pot. Pour on the sauce and toss. Serve with a light sprinkling of Parmesan cheese.


Grilled Salmon Salad         


  • 5 tablespoons extra-virgin olive oil
  • 1 salmon fillet
  • Salt and freshly ground black pepper
  • 1 cup mixed greens
  • 1/4 cup grape tomatoes
  • 2 tablespoons dried cherries
  • 2 tablespoons pine nuts
  • 5 small broccoli florets
  • Handful of blueberries
  • 2 tablespoons champagne vinegar
  • 1 teaspoon chopped fresh chives
  • 1 slice bread, brushed with olive oil and toasted, for serving


Heat 1 tablespoon olive oil in a skillet over medium-high heat. Sprinkle the salmon with salt and pepper. Add the salmon to the hot skillet and cook for 7 minutes on each side. Remove from the heat.

Combine the mixed greens, tomatoes, dried cherries, pine nuts, broccoli and blueberries together in a bowl. Whisk together the remaining 4 tablespoons olive oil, vinegar and chives. Season with salt and pepper and pour half over the salad. Place the salmon on top of the salad and pour over the remaining dressing. Serve with toasted bread on the side.

This recipe was created by a contestant during a cooking competition. The Food Network Kitchens have not tested it for home use, therefore, we cannot make any representation as to the results.

Dessert: Ice Cream with Bananas and Chocolate   


½ cup low, fat vanilla ice cream

1 tsp chocolate sauce

½ banana


Slice ½ banana into small pieces. Heat chocolate sauce as desired. Pour chocolate sauce over banana slices and ice cream. Enjoy!