Intermittent Fasting and Weight Loss: How to Use It to Lose It

Intermittent Fasting and Weight Loss: How to Use It to Lose It

  July 30, 2020    AVisenMD

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OBESITY is a chronic medical condition that cannot be just attributed to laziness or low motivation. It is often due to the lack of CONSISTENCY to follow a diet or exercise regimen. The most important question you need to ask yourself is 'Can I stick with this diet long-term?' Because even if it is the best diet, if you can't stay consistent, you can't receive its benefits.

Topics to be covered in this article:

• What causes weight gain

• The role of insulin and how it can be controlled

• Strategies of intermittent fasting

• What to eat and what to avoid

• Benefits and concerns of intermittent fasting
  

How Did it Originate?

Intermittent fasting is not a new concept; it has been used by our ancestors, initially as religious fasts, since the beginning of our existence. It has only recently been labeled as a diet that can enhance weight loss and provide other health benefits.

Why the Uncontrolled Eating and Weight Gain?

Because eating feels good! As simple as that. To make matters worse, food is literally available at every corner of nearly every street. Can you imagine any occasion where food, in some form, will NOT be present? It is there in celebrations, mourning, boredom, socializing, sadness. And, to speak scientifically, eating stimulates insulin production and release, which in turn stimulates hunger and the urge to eat more.

What is the Role of Insulin?

Insulin is a hormone that is released by the pancreas that regulates energy utilization. Food digestion leads to increase in blood sugar. Insulin rescues this sugar from the blood and stores it either in the form of glycogen, which is the temporary or short-term energy storage or in the form of fat, which is the long term energy storage. Constant ingestion of foods that cause sudden increase or spike in insulin levels can lead to insulin resistance over time. Insulin resistance, in basic terms, means that normal levels of insulin can no longer remove sugar from bloodstream, which causes the body to release more insulin in order to reduce blood sugar levels. Increased insulin, in turn, causes an increase in hunger, sugar cravings and fat storage.

How Can We Control Our Insulin Levels?

One of the best method is to reduce the frequency of eating, which is where intermittent fasting comes in. It is also important to reduce the intake of refined sugars and processed food items, and incorporate more of the healthy fats like fatty fish, olive oil, nuts and seeds, avocados. As a result, the hunger spikes will be controlled, which will minimize food intake and reduce and stabilize insulin levels. Intermittent fasting will essentially slow down or even shut off insulin production. In addition, it is vital to recognize to what degree certain foods stimulate insulin ( in order of highest to lowest): high fructose corn syrup (please avoid completely!), simple carbs like sugars and processed foods, complex carbs like whole grains, brown rice, high fiber, starchy veggies, and lastly, protein.

How Can You Intermittent Fast?

There are numerous ways but the two most common methods are: 1. 16-20 hour fasting with 4-8 hour eating window. 2. 5:2 fasting.

1. Consists of prolonged overnight fasting beginning from your sleep time. For example, if you have eaten at 7pm, you fast till 11am next morning, skipping breakfast.

2. 5:2 fasting means you eat regular diet for 5 days of the week and choose 2 non-consecutive days for prolonged fasting. Fasting in this case is usually for the entire 24 hour period.

What to Eat When You Are Not Fasting?

The primary goal here is to manipulate insulin. You should eat enough calories to maintain your weight and use a combination of any healthy dietary pattern you enjoy. Generally, half of your plate should be non-starchy veggies (broccoli, asparagus, bean sprouts etc.), one quarter should be lean protein (yogurt, beans, lean meat etc.), and one quarter should be grain foods (wheat, rice, oats etc.) or starchy veggies (potatoes, corn, pumpkin etc.).

Start your day with a high protein and a high healthy fat meal. Examples:

• Greek yogurt with nuts & chia seeds
• Egg frittata with veggies and cheese
• Masala Chai/Tea Latte made with unsweetened almond milk
• Avocado toast with low carb bread

(Note: For fasting days, restrict your calories to 1/4th of your daily requirement. Generally, that is between 300-500 calories per day.)

Why You Should Try Intermittent Fasting?

• Less fat storage and more fat utilization
• Reduced hunger and sugar cravings
• Reduction and remission of insulin resistance and type 2 diabetes
• Improvement of fatty liver
• Reduction in central adipose tissue (abdominal/belly fat)
• Reduction in progression of Alzheimer's Disease
  
• Reduced risk of cancer
• Improved cholesterol levels
• Improvement in sleep quality and energy levels
  

Concerns to be Mindful of:

• Constipation: restriction of food intake means less digestive movement, which can lead to constipation. Incorporate high fiber food items for relief.
  
• Dehydration: cutting back on eating naturally causes less water intake as well and when combined with vigorous exercising, it can lead to dehydration. Keep track and drink 8-10 glasses of water everyday.
• If you are diabetic and taking insulin: intermittent fasting can cause hypoglycemia (very low blood sugar level). Talk to your doctor or dietician before fasting.
  
• Pregnancy: intermittent fasting is not recommended during pregnancy.

There is no ONE best diet for weight loss. You really just have to choose a plan that suits you, meets your nutrition and weight loss goals and more importantly, a plan that you can remain CONSISTENT with for long-term. Always track your food intake, eat out less often (a restaurant take out meal is 1000-1100 calories), drink less calories (especially alcohol that is rich in calories and also increases appetite), and try to cook at home as much as possible where you have more control over the quality of the ingredients, the types of oils and salts you can choose from and best of all, something you can enjoy with your family. Step up to make a lifestyle change, not just a diet change!

References:

1. Lindsay Venn, registered dietician at Eastern Idaho Spine, Sports and Rehab Center

2. Copeman Healthcare Centre

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Pregnancy Care with Balanced Nutrition and Robust Immunity

Pregnancy Care with Balanced Nutrition and Robust Immunity

  July 28, 2020    AVisenMD

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Pregnancy is one of the most beautiful journeys you embark on. But the process of going through it for nine months can be challenging and daunting, both physically and emotionally. My aim in this article is to make the process a little easy for you by providing you with information on how you can maintain a health pregnancy through lifestyle modifications, dietary recommendations, proper nutritional balance and a robust immune system.

Objectives of this article:

1. How to manage your weight and eating patterns during pregnancy

2. What is Gestational Diabetes and how to minimize your risk

3. Why proper hydration is important and why not to over-hydrate yourself

4. Discussing the vital roles of calcium, magnesium, folate, iron and omega-3 fatty acids in pregnancy
   

5. How to maintain a robust immune system in pregnancy

6. What food items are essential to minimize during pregnancy

Weight Gain:

The amount of weight gained during pregnancy varies for everyone depending on how much the body weight was before pregnancy and what the eating pattern is throughout pregnancy. In general, the baby will weigh about 6 pounds, blood volume will increase by 60%, breasts will start getting enlarged for milk production. Therefore, for an average BMI, there is usually a weight gain of 25-35 pounds. It is also important to be mindful that being pregnant does not mean doubling the calorie intake - you only need about 300 calories extra per day for the developing fetus. Being overweight or obese is linked with gestational hypertension (high blood pressure throughout pregnancy) and gestational diabetes (high blood sugar levels throughout pregnancy). Stress is also a major contributor towards weight gain in pregnancy. Therefore, it is highly recommended to get rid of stressors and distractions and practice mindfulness. This will prevent you from overeating due to stress. Also, small frequent meals are advisable throughout the day as the uterus continues to grow. So, it is ideal to have small 5-6 meals per day along with regular exercise - start with low impact Pilates and prenatal yoga that will exercise your muscles and ligaments as your body prepares for child birth.

Gestational Diabetes:

During the first trimester, a blood work will be carried out to assess your HbA1c value for pre-diabetes and if the values are normal and there is no family history of diabetes, then you will not be tested for diabetes again till around 28 weeks of pregnancy. Otherwise, you may be tested earlier than 28 weeks. This test is a non-fasting test so you will be asked to have a high glucose drink and after one hour, your blood sugar levels will be tested. If the results show elevated blood sugar, then you will be asked to come back again later for a fasting test to determine your risk of gestational diabetes.

You can minimize the risk of developing gestational diabetes by avoiding packaged, processed and sugary food items. Try to consume high fiber foods, non-starchy vegetables, low glycemic index fruits like apples and berries, legumes, artichokes etc. Daily recommendation is to incorporate 25-35 grams of fiber in your diet. Overeating proteins can also shoot up your blood sugar levels. Therefore, it is recommended to have 2-3 servings of protein per day for a total of 10-20 grams. Best sources of proteins: lean meat, poultry and fish. Vegetarian protein options: chia seeds, hemp seeds, fermented soy beans, beans and legumes with rice. Please note that it is very important to supplement with vitamin B12 if you are a vegetarian (look at the supplement label and choose the methylated form of vitamin B12, which is methylcobalamin).

Hydration:

The general recommendation is to drink 8-10 glasses of water. Proper hydration is key in pregnancy as it provides relief in abdominal cramping, constipation and headaches. If you do not like the taste of plain water, you can add lemon and cucumber to make a refreshing drink. While hydration is important, over-hydrating yourself can prove to be unhealthy. The more you drink, the more you have to urinate, and every time you urinate, you lose minerals. That is why it is important to maintain a balance between hydration and essential minerals. To ensure that you have adequate amount of minerals in your system, it is highly recommended that you consume celtic sea salt, which has one of the highest amounts of trace minerals. Just sprinkle them on your veggies and fruits! Salt consumption in pregnancy is crucial because it helps in the maturation of the immune cells of the fetus, aids in the development of the brain cells and helps in maintaining adequate birth weight.

Calcium and Magnesium:

The leg cramps of pregnancy are usually a sign of mineral imbalance in the body, especially calcium and magnesium. Magnesium is extremely beneficial in calming the nervous system and the digestive tract. Both versions, magnesium glycinate as well as magnesium citrate, are easily absorbed into the system. Another strategy to reduce stress and calm down the nerves - epsom salt baths are highly useful. The minerals presents in these salts are very easily absorbed through the skin. You can mix magnesium flakes and soak them together for about 20 minutes before bathing. Alternatively, you can also choose to just soak your feet in epsom salt water, which will provide similar benefits. This method of mineral absorption through the skin is particularly beneficial if you have a sensitive digestive system and take antacids for heartburn as that can interfere with proper absorption of the minerals. Best food source of magnesium is dark chocolate (fun fact: magnesium deficiency causes dark chocolate cravings!). In regards to calcium, the best sources are broccoli, steamed green leafy vegetables (note that it is important to steam veggies to receive calcium from them as raw veggies have natural inhibitory enzymes that keep those minerals locked up and make them unavailable for absorption), sardines, sesame seeds. Calcium balance is not just a representation of how much calcium you are consuming but also of how much you are losing through urination. One of the main culprits of dietary calcium loss is the stress hormone cortisol. So, when your cortisol levels are elevated, there is an increased loss of calcium. Here it becomes even more important to practice mindfulness and reduce stress.

Folate:

It is one of the most important elements to add in your diet as soon as pregnancy has been confirmed. In fact, it is very common to start taking folic acid as early as 6 months before pregnancy. However, there is a lot of confusion between the terms 'folic acid' and 'folate'. Folic acid is the synthetic, cheap form of folate that is not found in nature. It is effective in preventing neural tube defects in pregnancy but it does not provide the additional benefits of folate, the natural version, which actually aids in the production of new cells. The methylated form of folate is best absorbed by the body. Look at the labels of your prenatal vitamins. You would want to look for 'methylfolate' or 'methyltetrahydrofolate'. Daily recommended amount is 800-900 micrograms coming from food and supplement combined. Best food source of folate is green leafy vegetables. Alternatively, you can also use the dehydrated greens powder that is equal to 3-5 servings of veggies.

Iron:

Your iron levels are checked once early in the pregnancy, around 10 weeks, and then again at 24 weeks. The reason for the recheck is the increase of blood volume, which can dilute the iron levels. The normal level in pregnancy is 11 or above of hemoglobin. Ferrous sulphate 325mg can either be acquired through prescription or taken over the counter. Note that this dose is taken every other day (not everyday) because it can lead to severe constipation. Also, taking iron with vitamin C boosts its absorption and beneficial effects. Ideally, if you take your prenatal vitamins early morning then it is recommended to take the iron later in the evening between meals. If iron is upsetting your stomach, another option is to take the liquid form of iron, which is more gentle on the digestive tract (search for 'Floradix' on Amazon). Best food sources of iron: red meat from a clean source, particularly liver, and seafood. Vegetarian alternatives are much more difficult to absorb into the body. Here it is crucial to reiterate the importance of incorporating vitamin C in your diet, especially if you are vegan/vegetarian to maximize iron absorption. Some plant-based options for iron are blackstrap molasses, cacao seeds and kale or collard green leafy vegetables. Another strategy is to cook in a cast iron skillet to incorporate more iron. Best sources of vitamin C are citrus fruits, berries and kiwi.

Omega-3 Fatty Acids:

Omega-3 fatty acids are essential nutrients, especially in early pregnancy when the vital organs of the baby are developing. Daily recommendation is 2-3 servings of fatty fish per week like salmon and herring. Docosahexaenoic Acid, or DHA, is the form that is readily absorbed by the developing fetus and is crucial till the first two years of life. Research has shown that DHA has a profound impact on mental acuity, visual acuity and hyperactive or irritable behaviors in children. A 'superfood' to mention here is cod liver oil, which is not only rich in DHA but also has high levels of fat soluble vitamins like vitamin A, which is converted to retinol, a beneficial element for skin and eyes and vitamin D, which boosts immunity. It is recommended to incorporate 400-600mg of cod liver oil in your diet, preferably cold pressed and minimally processed. Vegetarian/vegan options include microalgae, chia seeds and flax seeds. 

Immunity:

Pregnancy is an immunocompromised state where women tend to get sick more easily and remain sick for longer. Therefore, it is important to maintain a robust immune system. Stress has the largest impact on immunity - cortisol suppresses the immune system. You are encouraged to go out in nature, have a walk, get involved in activities that are enjoyable and have an adequate high-quality sleep. Not having proper sleep is the number one cause of decreased immunity (Read in detail here about the relationship between sleep, stress and nutrition). Additionally, there are three main nutritional stressors to be aware of. First is the sugar. Eight teaspoons of sugar has been shown to suppress the immune system for 5-7 hours! If you are craving sweet, opt for a fruit, which will curb the cravings and also provide you with healthy fibers. Alternatively, honey can be incorporated into the diet that has antiviral and antibacterial properties. Second enormous stressor is alcohol. No matter which type of alcoholic drink you take, it is processed as a toxin by the body. It slows down digestion and cognition and reduces the body's ability to burn fat. The third one is food sensitivities. Gluten or lactose intolerance, for example, will absolutely wear out the immune system (Read in detail here about food sensitivities and how you can navigate through them and maintain your nutritional balance successfully).

Natural strategies to boost immunity is adequate sleep and stress reduction through breathing exercises and meditation. Vitamin C is the nutrient that is used most readily by the adrenal glands that also process cortisol. Therefore, as cortisol levels increase, vitamin C consumption should also increase. Some food sources of vitamin C as mentioned earlier are citrus fruits, berries, kiwi, raw bell peppers, raw spinach. 1000mg of vitamin C is the daily recommendation that can be incorporated into the diet gradually beginning with 200mg. If vitamin C causes digestive discomfort, you can opt for the liposomal vitamin C, which is the liquid version of tiny nano particles that you hold under your tongue for 30 seconds and it gets absorbed directly into the bloodstream. Another important nutrient that boosts immunity is vitamin D and as mentioned previously, some sources are cod liver oil and mushrooms. Again, if vitamin D upsets your digestion, you can choose the liposomal version of it. Daily recommendation for vitamin D is upward of 2000 international units (IU) to 4000 IU for boosting immunity in pregnancy.

Last but not the least, our gut houses 70-80% of  the immune system in our body so it is crucial to maintain robust gut health. Best method to keep your digestive tract healthy is by consuming probiotics. Best food source to increase probiotic levels naturally is the intake of high fiber diet. Gut bacteria will ferment fibers, which will increase the strength and diversify the probiotic strains present in the gut. In case you are on antibiotics and absolutely need to take probiotic sources then the best recommendation is to incorporate soy-based or spore biotic for 90 days as they mimic nature more.

Foods to Minimize:

Although caffeine should ideally be avoided in pregnancy but it is safe to consume about 200mg of it per day. That equals to a large cup of coffee, a coca-cola and a piece of chocolate. The biggest risk with increased caffeine is miscarriage in the first trimester. Post that period, it is considered safe to consume caffeine.

It is absolutely important to avoid all types of uncooked food items like raw meat, eggs and fish and also unpasteurized milk and other dairy products.

Alcohol should also be refrained from throughout pregnancy but can be resumed gradually post pregnancy and it is advisable to take a glass of wine just before breastfeeding before alcohol is absorbed into your bloodstream.

Reference: UCSF Centering Pregnancy Program

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Are You Trying to Restrict Your Diet? Here's How You Can Navigate Through It Successfully.

Are You Trying to Restrict Your Diet? Here's How You Can Navigate Through It Successfully.

  July 26, 2020    AVisenMD

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Are you allergic to gluten or any other food item? Are you dealing with lactose intolerance? Are you trying to lose weight? Are you gripped by a medical condition? If you answered YES to any of the questions above, you most likely eat a RESTRICTIVE DIET.

The main objectives that I am going to cover in this blog are:

1. How and why restrictive diets can lead to significant nutrient gaps and reduce compliance

2. What is Food Phobia and how it relates to restrictive diets

3. How various milk sensitivities differ from each other and what dietary recommendations can be followed

4. How consumers can reduce their fear and incorporate a more diverse meal plan to tackle their food sensitivities

What are the Health Risks of a Restrictive Diet?

While restrictive diets are necessary in certain conditions such as in food allergies, lactose intolerance, weight loss plans and some medical conditions like diabetes and kidney disease, they do not come without their own health risks.

Restrictive diets can cause nutritional imbalance and  deficiencies, especially in those who are not closely monitoring their eating patterns with a health care professional or a nutritionist. Secondly, eating a restricted diet over long term generates fear, or is called 'FOOD PHOBIA', where a consumer is cautious and very fearful of eating something they have eliminated from their diet with the assumption that it will affect their health negatively. Food phobias very often lead to disordered eating pattern where a consumer will binge eat all the foods they ignored, followed by a strong guilt and reintroduction of the old restrictive diet. The more restricted a diet is the lesser the chances are of sticking with it. Consumers can become very resentful of eating, in general, which leads to poor health outcomes.

Children are at the greatest risk of developing nutritional deficiencies due to restrictive diets because they tend to have more allergies and food sensitivities. For example, if a child is experiencing abdominal discomfort, reflux or eczema, parents begin self-treatment at home by eliminating cow's milk entirely from the diet. Another common example is the weight loss diets that restrict calorie intake along with which many nutrients are excluded as well.

In a study that looked at various restrictive diets, like DASH diet and weight loss diets, where participants followed a 1500-2000 calorie diet, it was concluded that they were falling short on 15+ micronutrients like Vitamin E, Vitamin D, Iodine, Chromium etc.

What is the Impact of Restrictive Diet on Long-term Health?

• Restrictive diets that are not balanced can lead to nutrient gaps over long term
• Restrictive diets are a risk factor for abnormal eating patterns/eating disorders
• Restrictive diets reduce compliance and accelerate the disease process
• Example: A diabetic patient on a restrictive diet since long can all of a sudden binge eat due to craving, which will spike the blood sugar levels, worsening diabetes. 

Who is a Restrictive Eater?

• Someone who experiences pain or discomfort upon eating a food like bloating, fullness, gas, heartburn etc. These can be consumers who have food allergies or intolerances.
  
• Someone who is fearful to experience the symptoms again that have been relieved by eliminating certain foods. This includes those who are fearful of weight gain, who avoid all types of sugars (refined and natural), those with medical conditions.
• Someone who is under medical restrictions (those with high blood pressure, celiac disease, Irritate Bowel Syndrome (IBS), kidney disease etc.)
• Someone who has certain personal beliefs like following vegetarian or vegan diet, religious beliefs that eliminate certain food items, belief in fasting etc.
  

Food Allergies vs. Food Sensitivities:

Food allergy is an immune response by the body where smallest amounts of food items can trigger a severe immune reaction and therefore, these foods must be avoided under all circumstances. On the other hand, food sensitivity/intolerance is a reaction triggered by the digestive system in which small amount of food in a particular range can be eaten safely without uncomfortable symptoms.

What is an Elimination Diet?

Elimination diet is a method by which the exact source of food allergy or intolerance can be identified and successfully eliminated from the diet. The first phase is the 'Elimination Phase' where the consumer eliminates a wide range of food item that they believe could be causing the symptoms of gastrointestinal (GI) discomfort, bloating, reflux, heartburn etc. This leads to resolution of symptoms. The second phase is called the 'Reintroduction Phase' where eliminated food items are gradually added back into the diet over the time of weeks in small amounts while monitoring the recurrence of symptoms. Through this procedure, the exact cause of discomfort and symptoms are identified and only that food item is eliminated from the diet.

Navigating Through Dairy Sensitivities:

It is estimated that 65% of the human population has a reduced ability to digest lactose. However, many of these have just assumed they are lactose intolerant without any such medical diagnosis. Recent research suggests that much of the GI distress is caused by a type of milk protein, called BETA CASEIN, rather than the milk sugar, called LACTOSE. Therefore, eliminating all dairy items will relieve the symptoms but it will not determine whether it was beta casein or lactose that was causing the discomfort.

Understanding Beta Casein in Detail:

Roughly one-third of the protein content in milk is beta casein.This milk protein comes in two forms: A1 beta casein and A2 beta casein. Research suggests that the A2 beta casein protein is easier to digest, which may help minimize the gastric discomfort of dairy products.

               

A1 and A2 proteins differ in their structure at the amino acid position 67, where A1 is cleaved into a product that is harder to digest while A2 does not form this by-product and therefore, is easier to digest.

Is it Necessary to Avoid Dairy Products?

National Institute of Health has stated that dairy products provide us with essential nutrients that are difficult to obtain from low-dairy or dairy-free products. This is the main reason why some consumers do not stop consuming dairy even if it causes digestive discomfort. Before restricting all dairy products, it is important to differentiate whether the discomfort and associated symptoms are caused due to lactose intolerance or the difficulty in digesting the beta casein A1 protein.

How to Differentiate Between the Two Milk Sensitivities?

• Hydrogen Breath Test: Lactose intolerance is diagnosed using the 'Hydrogen Breath Test' in which the amount of hydrogen present in the breath is measured. Presence of higher than normal amount in presence of digestive discomfort is used to diagnose lactose intolerance. Basically, when sugars and carbohydrates are easily digested, they do not reach the distant colon. However, when these reach the colon in largely undigested forms, the bacteria present in the colon use them as their energy source and release hydrogen as a by-product. This hydrogen is then absorbed into the blood, which causes an increase in the hydrogen concentration in the breath.
  
• A2 Tolerance Test: For about a week, the consumer is required to eliminate all dairy products from their diet EXCEPT dairy products made ONLY with the A2 beta casein milk protein. Then, over the course of the next week, consumption of dairy products with A2 beta casein milk protein is gradually increased while tracking the tolerance level and any associated GI discomfort. For example, the consumer may begin with half a cup of milk, gradually increasing to 2 cups over the next week. At the end of the week, if no GI discomfort is noted, it can be concluded that the consumer has sensitivity to the A1 beta casein milk protein instead of being lactose intolerant. 

How Dietary Balance Can Be Achieved:

• When any sort of restrictive diet needs to be followed, a health professional or a nutritionist must be consulted to avoid significant nutrient gaps leading to nutritional deficiencies.
• In case of children, their feeding patterns and dietary habits must be monitored closely to ensure adequate nutritional gain for their level of growth and development.
• Healthcare professionals needs to change the direction of conversation with their clients from 'foods to avoid' toward 'food varieties that can be enjoyed' to avoid food resentment and abnormal eating patterns.
• After a thorough discussion with clients regarding their comfort level and properly addressing their food phobias, healthcare professionals should develop a plan to gradually introduce new food items to maximize variety and monitor and trace food sensitivity and intolerance to judge the necessity of appropriate alternatives to maintain proper nutrition.
  
• In case of food sensitivities, additional food sources must be identified to avoid nutrient deficits. For example, in case of gluten sensitivity, which restricts intake of whole grains and fiber, alternate gluten free food sources must be consumed to maximize fiber consumption. These food items can be fruits and vegetables, beans, lentils, brown rice, etc. In case of dairy insensitivity, which restricts the intake of adequate calcium, dairy products with only A2 milk protein may be an alternative.
  

Having a variety of foods incorporated in the daily diet plan not only ensures adequate nutritional balance but also enhances food enjoyment, promotes healthy eating and improves dietary compliance in cases of restrictive diets. Take time to think whether you are avoiding certain food items and what might be the reason behind it. If you have any dietary restrictions, how does it affect your enjoyment of eating? How likely are you to try new food items without hesitation? Let me know your thoughts and comments below!

References:

1.JaworskiM, Panczyk M, Śliwczyński AM, et al.A ten-year longitudinal study of prevalence of eating disorders in the general Polish type 2 diabetes population.Med Sci Monit. 2018;24:9204-9212.

2.WróblewskaB, Szyc AM, Markiewicz LH, Zakrzewska M, Ramoszko E.Increased prevalence of eating disorders as a biopsychosocial implication of food allergy.PLoS One. 2018;13(6):e0198607.

3.KirbyM, Danner E. Nutritional deficiencies in children on restricted diets. Pediatr Clin North Am.2009;56(5):1085-1103.

4.CaltonJB. Prevalence of micronutrient deficiency in popular diet plans.J Int Soc Sports Nutr. 2010;7:24.

5.Robbins KA, Uygungil B.Nutritional deficiencies and food allergy. J Allergy Clin Immunol Pract.2017;5(2):528-529.

6.JaworskiM, Panczyk M, Cedro M, Kucharska A.Adherence to dietary recommendations in diabetes mellitus: disease acceptance as a potential mediator. Patient Prefer Adherence. 2018;12:163-174.

7.Study finds that adherence to diet, not type of diet, more important factor for losing weight. ScienceDailywebsite. https://www.sciencedaily.com/releases/2005/01/050111122137.htm. Published January 14, 2005.

8.NelsonM, Ogden J. An exploration of food intolerance in the primary care setting: the general practitioner's experience. Soc Sci Med.2008;67(6):1038-1045.

9.US Department of Health and Human Services;US Department of Agriculture. Dietary Guidelines for Americans2015–2020: EighthEdition. https://health.gov/dietaryguidelines/2015/guidelines/. Published January 7, 2016.

10.He M,Sun J, Jiang ZQ, Yang YX. Effects of cow’s milk beta-casein variants on symptoms of milk intolerance in Chinese adults: a multicentre, randomised controlled study. Nutr J.2017;16(1):72.

11.Jianqin S, Leiming X, Lu X, Yelland GW, Ni J, Clarke AJ. Effects of milk containing only A2 beta casein versus milk containing both A1 and A2 beta casein proteins on gastrointestinal physiology, symptoms of discomfort, and cognitive behavior of people with self-reported intolerance to traditional cows’ milk. Nutr J.2016;15:35.

12.Asledottir T, Le T, Petrat-Melin B, Devold TG, Larsen LB, Vegarud GE. Identification of bioactive peptides and quantification of β-casomorphin-7 from bovine β-casein A1, A2 and I after ex vivo gastrointestinal digestion. IntDairy J.2017;71.

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