Digestion

Eating is just the first step in getting nutrients into your body.

Most of the protein, carbohydrate, and fat in a meal comes in pieces too large to pass through the lining of your intestines into your bloodstream, a process called absorption. While vitamins and minerals are already small, they’re often locked inside the food itself.

Digestion is the mechanical and chemical process that breaks food down so absorption can happen:

• Proteins are broken down into amino acids (and small chains of two or three amino acids)

• Carbohydrates are broken down into simple sugars, like glucose

• Fats are broken down mainly into fatty acids and monoglycerides

• Vitamins and minerals are freed from the food they’re bound in

Fiber is the exception here. While your body can’t digest it, the bacteria in your large intestine can and they turn it into compounds that help keep your gut healthy. More on that to come.

Digestive Tract vs. Digestive System:

• Digestive tract: the long, continuous “tube” where food enters, is digested and absorbed, and anything left over is pushed out.

• Digestive system: the digestive tract plus the organs that help with digestion, including the salivary glands, liver, gallbladder, and pancreas. The vagus nerve, a direct line between your brain and gut, helps control the whole process.

Mouth

Digestion begins before food even reaches your mouth. The sight, smell, and even the thought of food get your saliva and stomach acid flowing.

Chewing is mechanical digestion: each bite breaks food into smaller and smaller pieces.

As saliva mixes with food, an enzyme called amylase starts breaking down carbohydrates. This is chemical digestion. Digestive enzymes are like tiny scissors that “cut” long chains of nutrients into smaller bits, and more enzymes will join the digestive party soon.

Caring for your mouth and teeth is an underappreciated part of digestive health. Broken or missing teeth make chewing difficult, which may lead you to avoid harder-to-chew foods like veggies, nuts, and seeds, or to swallow them before they’re well chewed. That puts extra burden on the stomach and may cause digestive upset as poorly chewed food travels through the digestive tract.

On top of that, gum disease can increase inflammation throughout the body. It’s linked to a higher risk of heart disease, harder-to-control blood sugar, and slower healing.

Taking Care of Your Mouth

Fun fact: I once considered dental school. I didn’t go. So I’ll let Harvard Health be your guide to oral health.

Esophagus

After you swallow, food travels down the esophagus to the stomach, passing through a ring of muscle called the lower esophageal sphincter (LES). The LES acts like a valve: it opens to let food in, then closes tightly behind it. If the LES doesn’t close properly, or relaxes at the wrong time, stomach contents, including acid, can flow backward into the esophagus.

This is known as reflux. It’s one of the most common digestive complaints, and about 20% of US adults have GERD, its chronic form.

Reflux and GERD are more than just uncomfortable. Over time, untreated chronic reflux can lead to Barrett’s esophagus, a change in the lining of the esophagus that raises the risk of esophageal cancer.

Stomach

Chemical digestion really gets going in the stomach. Stomach acid kills potentially harmful pathogens and activates enzymes that break down protein, while the stomach’s muscular walls churn food into even smaller particles. The stomach then releases its contents, a little at a time, into the small intestine.

The stomach also plays a key role in absorbing vitamin B12. Stomach acid frees B12 from the food it’s bound to, and the stomach makes intrinsic factor, a protein that binds to B12 and is needed to absorb it later in the small intestine. This is why long-term use of acid-suppressing medication, or other changes to the stomach, can raise the risk of B12 deficiency.

The stomach also helps regulate hunger and fullness. As it fills, stretch receptors in the stomach wall signal fullness to the brain through the vagus nerve. When it’s empty, it releases ghrelin, the “hunger hormone.”¹.

Small Intestine

When partially digested food leaves the stomach, it enters the small intestine, where most digestion and absorption happen.

Remember, digestion is the mechanical and chemical process of breaking food down into tiny pieces so the body can absorb it. Absorption is the process of moving nutrients from the digestive system into the bloodstream, which delivers them throughout the body.

The small intestine has three sections: the duodenum, jejunum, and ileum (I still remember “DJI,” my memorization trick from college).

The liver, gallbladder, and pancreas all connect to the duodenum through small ducts, delivering more of the ingredients needed for chemical digestion.

• Bile is made in the liver, stored in the gallbladder, and released when you eat to emulsify dietary fat. Emulsifying breaks fat into smaller droplets so enzymes can digest it more easily.

  • Without a gallbladder, bile trickles into the intestine continuously instead of being released in a concentrated burst. This may cause loose stools and urgency after high-fat meals.

• Pancreatic enzymes digest carbohydrates (amylase), fats (lipase), and proteins (proteases). The pancreas also releases bicarbonate to neutralize stomach acid.

  • When the pancreas doesn’t make or deliver enough digestive enzymes, it’s called exocrine pancreatic insufficiency (EPI). It’s managed with pancreatic enzyme replacement therapy (PERT), taken with each meal and snack.

Conditions of the Small Intestine

Small Intestinal Bacterial Overgrowth (SIBO)

We all have health-promoting bacteria in our large intestine (more on the microbiome next time). But when too many bacteria build up in the small intestine, symptoms such as bloating, gas, diarrhea and/or constipation, abdominal pain, and nutrient deficiencies may occur. This is known as small intestinal bacterial overgrowth, or SIBO.

Many of these symptoms are “non-specific,” meaning they can have many causes, so SIBO isn’t diagnosed by symptoms alone. It’s diagnosed with a hydrogen and methane breath test and is typically treated with antibiotics.

SIBO often comes back, so preventing recurrence means addressing the underlying cause, such as slow gut motility, and being aware of dietary and supplement triggers (including probiotics!).

Celiac Disease:

Gluten sensitivity is more common than we once thought and has earned its own name: non-celiac gluten sensitivity. Celiac disease is different. It’s an autoimmune condition triggered by gluten, a protein found in wheat, barley, and rye.

Common symptoms include bloating, diarrhea, and/or constipation after eating gluten, though some people have few digestive symptoms at all. Over time, untreated celiac disease can lead to fatigue, anemia, bone loss, skin rashes, and weight loss.

Celiac disease is diagnosed with blood antibody tests and usually confirmed with an intestinal biopsy. Testing must happen while you’re still eating gluten, so don’t go gluten-free before you’re tested. The only treatment is a lifelong gluten-free diet.

Keep in mind that having one autoimmune condition raises the risk of others. With celiac disease, the most common are type 1 diabetes and autoimmune thyroid disease.

Food Intolerances

Food intolerances happen when the digestive system has trouble breaking down or absorbing a food. This may be due to a missing or inadequate enzyme (e.g., lactose intolerance) or poor absorption (like fructose or polyols). It is important to note, food intolerances are not food allergies:

Common Food Intolerances

• Lactose intolerance: not enough lactase enzyme to break down lactose (milk sugar).

• Fructose malabsorption: incomplete absorption of fructose (in fruit, honey, and high-fructose corn syrup).

• Polyol (sugar alcohol) sensitivity: sorbitol, mannitol, xylitol, and other “-ols,” found naturally in foods like peaches, plums, apricots, cherries, apples, pears, mushrooms, and cauliflower, and in many “sugar-free” products.

• FODMAPs: Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols are a group of carbohydrates that some people have trouble digesting (more on these below).

When undigested food components reach the large intestine, gas, bloating, and/or diarrhea may occur.

Large Intestine/Colon

“Large intestine” and “colon” are often used interchangeably, but technically the large intestine has three parts: the cecum (a pouch where the small intestine empties into the large intestine), the colon, and the rectum (where stool is stored until it passes out through the anus).

The colon is the longest part of the large intestine and has four continuous sections. The ascending colon travels up the right side of your abdomen, the transverse colon crosses from right to left, the descending colon travels down the left side, and the sigmoid colon is an S-shaped curve that leads to the rectum.

Microbiome

The microbiome has many jobs, including fermenting undigested fiber into short-chain fatty acids, supporting immune function, and producing vitamins (like vitamin K and several B vitamins, such as biotin and folate).

The microbiome is also an integral part of the “gut-brain axis,” a two-way communication network between the digestive tract and the brain.

We still have a lot to learn about the microbiome and all the ways it affects health. We don’t know exactly what makes up a healthy microbiome, or whether there’s even an ideal one. What we do know is that a diverse, balanced community seems to matter more than any single “good” microbe.

Prebiotics, Probiotics, & Postbiotics — oh my!

Talking about the microbiome inevitably brings up questions about the “biotics,” which refers to living things:

Probiotics: Food or Supplement?

If you read “probiotic” and think of a supplement, I don’t blame you. The claims on those bottles are enticing! (For more on navigating supplements, check out my Supplements 101 Health Guide.)

The truth is, we don’t know enough about most probiotics (which types, how much, which combinations, or for how long) to confidently recommend them for most conditions. There are exceptions, of course, such as using probiotic supplements to reduce the risk of antibiotic-associated diarrhea (there’s another “biotic” for ya).

For now, my recommendations for probiotic supplements are:

1. Food first. Include probiotic foods as often as possible (ideally daily), such as yogurt with live and active cultures, kefir, sauerkraut, kimchi, and kombucha. For sauerkraut and kimchi, choose refrigerated, unpasteurized versions, since heat processing kills the live microbes.

2. If you’re healthy, you probably don’t need a probiotic supplement.

3. If you’re interested in a probiotic for a health condition or digestive complaint, talk with your doctor. Feel free to share this resource on evidence-based probiotic use for various conditions with them.¹

4. If you do use a probiotic supplement, remember it’s usually meant for a specific purpose and time frame, not forever. My Supplements 101 Health Guide walks you through how to tell whether a supplement is working and when you no longer need it.1

Common Large Intestine Complaints

Poop, Stool, Bowel Movement, Feces, #2, Passing Gas, Tooting, Breaking Wind…

Talking about what comes out of our bodies makes most people squirm, which, in my opinion, is why we’ve invented so many names to get around the discomfort.

Yet what comes out of your body is an important sign of what’s going on inside it. So please get comfortable looking at your poop, talk with your healthcare team about anything that concerns you, and remember…Everyone Poops!

Clinicians use the Bristol Stool Chart (caution, there are visuals!) to describe stool consistency, so using the chart’s numbers is an easy way to talk poop without the awkwardness. Regardless, look at your poop! It tells you and your care team a lot.

Fiber

Even though our bodies can’t digest fiber, its trip through the digestive system still offers plenty of benefits. And let me tell you… those benefits go waaay beyond bowel regularity.

First, a quick review: fiber isn’t just one thing. Like vitamins and minerals, it’s a category, and it can be sorted in a few ways. The same fiber can even fit more than one category:

1. Solubility (what does the fiber do in water?)

Soluble Fibers

Soluble fibers dissolve in water and form a gel-like substance. This gel softens stool, slows digestion, and keeps you full longer. (Think of foods like oats and beans, which change when sitting in water.)

Insoluble Fibers

Insoluble fibers don’t dissolve in water. Instead, they add bulk and move through the digestive tract, supporting bowel regularity. (Think of foods like most vegetables and fruit skins, which don’t change when sitting in water.)

2. Fermentability (what does the microbiome do with it?)

Prebiotic Fibers

Prebiotics are fibers your body can’t digest but your gut bacteria can. When these bacteria ferment prebiotics, many of the byproducts are beneficial for health.

Prebiotic fibers are mostly soluble, but some insoluble fibers and resistant starch can also act as prebiotics. Examples include onion, garlic, leeks, and asparagus, which provide especially good fuel for those bacteria.

Resistant Starch

While not technically a fiber, resistant starch acts like a prebiotic fiber in the body. After potatoes, rice, and semolina pasta are cooked and cooled2, some of their starch is transformed into resistant starch. This is because it “resists” digestion in the small intestine and provides a food source for the microbiome. Plus, because less carbohydrate is absorbed, resistant starch has less impact on blood sugar.

3. Fiber-ish

FODMAPs

As the first word in the acronym implies, Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols (FODMAPs) are short-chain carbohydrates that are poorly absorbed in the small intestine and then fermented by gut bacteria. Here are examples of each FODMAP category:

• Oligosaccharides: wheat, onion, garlic, beans, and lentils

• Disaccharides: lactose in milk and other dairy products

• Monosaccharides: honey, apples, and mango

• Polyols: sugar alcohols in stone fruits and sugar-free products

As you can see, some FODMAPs are fibers, and some are not.

I include FODMAPs here because a “low FODMAP” diet is a relatively new intervention for IBS and has brought a ton of confusion along with it.

Most people can tolerate FODMAPs. If this is true for you, continue to enjoy! The byproducts of FODMAP fermentation by the microbiome have a growing list of health benefits.

However, for those with IBS, certain FODMAPs may cause gas, bloating, and discomfort. If this is you, please, please, please know this before you try a low FODMAP diet: it is meant to be a short-term elimination diet to help you identify IBS triggers, not a long-term super-strict diet.

Plus, it is complicated to implement on your own!

Frustratingly, many people are given a handout and told to “try a low FODMAP diet” without guidance or support. The patients who eventually make their way to me have either given up trying or have been on a diet so restrictive for so long that I am concerned about nutrient deficiencies.

So please, keep my fellow dietitians and ask for support if this is something you’d like to try.

The Benefits of Fiber

Keeps stools soft and regular

Ok, yes, fiber has been typecast as the poop nutrient, and for good reason! If you’ve never had trouble pooping, consider yourself lucky, because the ability to have easy bowel movements is something too many people take for granted.

Fiber helps you stay regular in a couple of ways. First, soluble fibers absorb water, keeping stool soft and easy to pass. Second, insoluble fibers increase the bulk moving through the digestive tract, which stimulates the muscles of the digestive system and keeps everything moving.

Supports satiety

Fiber-rich foods take longer to eat and add volume to your meals, helping you stay satisfied. The gel formed by the soluble fibers also slows how quickly food leaves the stomach. You can amplify this effect by pairing fiber-rich foods with lean proteins and healthy fats.

Manages blood sugar

The gel formed by soluble fiber slows how quickly carbohydrates are digested and absorbed, which helps prevent sharp spikes in blood sugar after eating. Over time, diets higher in fiber are linked to better blood sugar control and a lower risk of type 2 diabetes.

Lowers cholesterol

Soluble fibers, such as the beta-glucan in oats and the fiber in beans and psyllium, bind to bile acids in the digestive tract and carry them out of the body in stool. Your liver then pulls cholesterol from the blood to make more bile, which lowers circulating LDL cholesterol levels.

Decreases colorectal cancer risk

Higher fiber intake, especially from whole grains, is associated with a lower risk of colorectal cancer. This may be because fiber speeds the movement of stool through the colon, bulks and dilutes its contents, and feeds the microbiome.

Feeds your gut microbiome

The bacteria in your microbiome rely on fiber as their main fuel. When they ferment it, they produce short-chain fatty acids like butyrate, which support the health of the colon lining and may play a role in immune function and inflammation. A variety of fiber-rich plant foods supports a more diverse microbiome, which is why eating many different plants matters more than relying on a single source.

Comes with an entourage

Finally, fiber-rich foods are often packaged with other important nutrients: vitamins, minerals, phytochemicals. So eating those fruits, veggies, whole grains, nuts, seeds, and lentils brings a whole lot more than fiber to the party. Cheers!

Fiber in Common Foods

The truth is, most foods contain a mix of different fiber types, as you can see in the chart of common fiber-rich foods below. For most people, variety is key. Eating lots of different fiber-rich foods provides lots of different fiber types, which can contribute to the impressive list of benefits outlined above.

While many people can enjoy a wide range of fiber-rich foods, those with digestive problems may need to be a little more selective. If this is you, please work with your doctor, and potentially a gastroenterologist and dietitian, to determine whether changing the types or amounts of fiber you eat will help.

How Much Fiber Do You Need?

Most guidelines recommend about 25 grams of fiber per day for women and 38 grams per day for men. However, many experts agree that if tolerated, more may be better, and not only because of the fiber itself. It may also be because of the countless other nutrients in fiber-rich foods that work their magic together.

Unfortunately, most adults in the US get only about half of the minimum recommendation. If this is you, please take an extra look at the chart above. Adding an extra serving of fruit, beans, or nuts each day can go a long way toward getting the many benefits that fiber-rich foods provide.

But… easy does it. Adding too much fiber at once can cause gas and bloating, so start slow. Add a new fiber-rich food to your typical intake every few days to let your digestive system and microbiome adjust.

The Perfect Pairing

As you now know, soluble fiber works by absorbing fluid to form a gel that softens stool, increases satiety, and helps manage blood sugar and cholesterol levels.

Yet, this also means that the benefits of soluble fiber depend on having enough fluid to work.

Why is this? I like to think of soluble fiber as a kitchen sponge: dry and hard when left out on the counter but soft and pliable once it gets wet. Not enough fluid means dry, hard stools and sluggish digestion. Not fun.

How much

Several factors determine how much fluid an individual needs3, including gender, activity level, and medical conditions, among others.

Typical recommendations range from about 2.1 L per day for women to nearly 3 L per day for men. (For context, 2.1 L is about 9 cups or 71 oz, and 3 L is about 13 cups or 100 oz.)

I talk about fluid a lot with my patients, and I only recently realized that when I say “fluid,” many hear “water.” For those who aren’t big water drinkers, hearing they need over 2 L per day can be overwhelming!

The good news is that ALL FLUIDS COUNT. You heard that right. Water counts. Coffee counts. Tea counts. Milk counts. Carbonated beverages count. Heck, even juices and sugar-sweetened and artificially sweetened beverages count.

I say this to get their attention, and it usually works. Their facial expressions alone show me that they’re relieved they don’t have to force themselves to guzzle bottles of water.

Then I explain that, based on their situation, we may need to modify how much of that fluid comes from caffeine, sugar, carbonation, or whatever else. But the message doesn’t change: all fluids count! Stay tuned for a whole post dedicated to fluids and hydration!

When to be careful: Fiber isn’t one-size-fits-all.

• IBS: Some fibers ferment quickly and can trigger gas and bloating. Soluble, less fermentable fibers such as psyllium are often better tolerated than wheat bran. A dietitian can help you sort out what works.

• IBD (Crohn’s disease or ulcerative colitis): During a flare, or if you have a narrowed bowel, high-fiber foods may need to be limited. Follow your care team’s guidance.

• SIBO: Fermentable fibers, including prebiotics and high FODMAP foods, can feed bacteria in the small intestine and worsen gas and bloating. Tolerance varies a lot, so work with a dietitian to adjust types and amounts rather than cutting fiber across the board.

• Diverticulitis: During an active flare, your care team may recommend temporarily limiting fiber or following a clear liquid diet. Fiber is typically added back gradually once symptoms settle, so follow your care team’s guidance.

  • Diverticulosis: Having pouches in the colon wall is not a reason to avoid fiber. Higher fiber intake is linked to a lower risk of diverticulitis flare. The old advice to avoid nuts, seeds, and popcorn is not supported by current evidence.

• Bowel surgery, strictures, or swallowing problems: Ask your doctor before increasing fiber.

• Medications: Fiber can affect how some medications are absorbed, so ask your pharmacist about timing.

New bleeding, black stools, ongoing changes in bowel habits, or unexplained weight loss are worth a call to your doctor. These shouldn’t be treated with fiber alone.

The take-home

Fiber deserves its time in the spotlight. From digestive health to metabolic health to cardiovascular health, plant-based fiber-rich foods have so much to offer for many of us.

So go out there and enjoy! (slowly, of course 😉)

Leave a comment

Thanks for being here,

~Allison

This information is meant to inform and inspire and is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

Do you have a question? Leave it in the comments or email me at allison.mckeanyrd@gmail.com

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“What can I do to lower my triglycerides?”

• Triglycerides are a type of fat affected by much more than dietary fat intake. If you are trying to lower your triglyceride levels, here is a checklist to get you started:

  1. Limit or avoid alcohol.

  2. Limit highly processed carbohydrates, including:

     1. Beverages that contain carbohydrates/sugars — even “natural” beverages such as fruit juices.

     2. Added sugars, including refined sugars as well as “natural” options (see below). You can now find “added sugars” on the nutrition facts label. I typically recommend consuming no more than 25g of added sugar per day.

  3. Limit saturated fats:

     1. Saturated fats are fats primarily found in animal-based products. This includes fatty meats, poultry skin, butter, cheese, cream, etc.

        1. Exception #1: Fat coming from most fish is low in saturated fat.

        2. Exception #2: Fat from tropical oils (coconut, palm) also contains saturated fat, despite being plant-based.

“Is honey better than sugar?”

• Not really. Honey, maple syrup, agave, coconut sugar, and similar sweeteners are often marketed as “healthier,” but they raise blood sugar and triglycerides much like refined sugar.

  One advantage of honey or maple syrup is that their stronger flavor may allow you to use less, which can help reduce overall sugar intake. However, they should still be used in moderation.

“Is bread a highly processed carb?”

• It depends. All grain-based flours are made by grinding the whole grain, which breaks it down and makes the carbohydrate easier for your body to digest and absorb.

  If the flour is refined (like white flour), the fiber-rich bran and nutrient-dense germ are removed, leaving mostly the carbohydrate-rich center. This makes refined bread more processed and typically faster to raise blood sugar.

  So yes, most breads are processed to some degree. However, that doesn’t mean they can’t fit into a healthy diet. Whether and how they fit in depends on your overall eating pattern, metabolic health, activity level, and personal goals.

“Does gluten-free mean low carb?”

• Not necessarily. Gluten is a protein found in wheat, rye, and barley. When products are labeled gluten-free, they typically replace those grains with ingredients like rice flour, tapioca starch, potato starch, or cornstarch.

  While these alternatives are gluten-free, they are still carbohydrate-dense and can raise blood sugar, sometimes even more quickly than whole-grain, gluten-containing options. Gluten-free does not automatically mean lower in carbs or healthier overall.

Thanks for being here,

~Allison

Please remember that this information is meant to educate and inspire but is not medical advice - please consult your healthcare team to determine what is most appropriate for you.

Surprisingly, heart disease continues to be the leading cause of death for both men and women in the US,1even though we’ve learned so much about risk factors and both lifestyle and pharmaceutical management.

Heart disease, or more broadly, cardiovascular disease, encompasses several conditions that affect the heart muscle and/or the blood vessels that circulate blood throughout the body.

Blood delivers oxygen, nutrients, and immune cells and removes waste products that would otherwise be toxic.

Every cell in your body depends on adequate blood flow to survive.

In that sense, taking care of your cardiovascular health is taking care of your whole body's health.

Definitions:

The most common cardiovascular diseases include:

• Heart Attack: Sudden blockage of blood flow to the heart muscle.

• Stroke: A blocked or ruptured blood vessel in the brain.

• Coronary Artery Disease (CAD): Narrowing of arteries caused by the buildup of plaque (atherosclerosis).

• Heart Failure: Weakened heart muscle, which includes symptoms such as fluid accumulation (edema), fatigue, & shortness of breath.

• Peripheral artery disease (PAD): Narrowing of arteries and decreased circulation in the arms and legs.

• Arrhythmias: The heart beats too fast, too slow, or irregularly; Atrial Fibrillation (AFib) is the most common.

Risk Factors:

Cardiovascular disease risk factors include both non-modifiable and modifiable.

Non-Modifiable Risk Factors (Things we can’t change, but are important to be aware of):

• Age — Risk increases with age.

• Sex at birth — Men are at an increased risk earlier in life, and women are at increased risk postmenopause.

• Genetics / Family history — Especially for early heart disease in close relatives.

Modifiable Risk Factors (Things we can change):

• Smoking — Injures blood vessels, increases blood pressure, & increases risk of atherosclerosis.

• Nutrient intake — Excess salt, sugar, & unhealthy fats increase blood pressure, cholesterol, & inflammation that promotes atherosclerosis.

• Alcohol — Excessive intake raises blood pressure.

• Inactivity — Reduces blood circulation & weakens the heart muscle.

• Sleep — Poor sleep quantity & quality increases blood pressure, blood sugar, & inflammation.

• Stress — Chronic stress increases blood pressure & inflammation.

Evaluating Your Risk

Knowing where you stand on the following markers of heart health can help you prioritize lifestyle changes, monitor if interventions are effective, and help guide discussions with your healthcare team about the need for any medical management of your risk.

The following cardiovascular disease risk factors include the 2026 American Heart Association (AHA) & American College of Cardiology (ACC) updated cholesterol guidelines. You can read more about the 2026 guidelines here and listen to an overview here.

1. Goal Blood Pressure (BP): <120/80 mmHg — Chronically elevated blood pressure damages blood vessels throughout your body (heart, brain, kidneys, eyes, etc.).

   1. Follow these tips to ensure you are getting an accurate blood pressure reading at home or in the doctor’s office.

2. Goal Resting Heart Rate (RHR): <80 bpm — A higher resting heart rate strains the heart muscle over time, increasing blood pressure and increasing the risk of cardiovascular disease.

   1. Here is a step-by-step guide to measuring your resting heart rate.

3. Cholesterol is carried through the blood by lipoproteins (such as LDL and HDL). It is essential for building cell membranes and hormones, but elevated levels of certain types of lipoproteins can contribute to plaque buildup in arteries.

   1. While total cholesterol was initially thought to be a good marker for cardiovascular disease risk, we now know that different types of cholesterol provide a more nuanced assessment, with goal levels based on overall risk as calculated by the PREVENT™ online calculator:

      1. Goal Fasting LDL-Cholesterol:2 Less than 55mg/dL to less than 90 mg/dL.

      2. Goal Fasting Non-HDL-Cholesterol:3 Less than 85mg/dL to less than 100 mg/dL.

      3. Goal Fasting HDL-Cholesterol:4 Greater than 60 mg/dL.

4. Goal Fasting Apolipoprotein B (ApoB):5 Less than 55mg/dL to less than 90 mg/dL.

   1. ApoB is a protein found on all plaque-forming lipoproteins, providing a better indicator of cardiovascular disease risk than LDL-C alone.

5. Goal Lipoprotein(a) (Lp(a)):⁶ Less than 125 nmol/L or less than 50mg/dL.

   1. Lp(a) is a genetically determined type of LDL with an extra protein attached that is an independent risk factor for cardiovascular disease. New guidelines recommend that everyone should have this tested at least once in their life.

6. Goal Fasting Triglycerides (TG): Less than 100 mg/dL

   1. Elevated triglycerides contribute to plaque formation.

7. Goal Fasting Blood Glucose (FBG): Less than 90 mg/dL

   1. Chronically high blood glucose (aka “blood sugar”) damages the lining of blood vessels, resulting in inflammation that supports plaque formation and accumulation.

8. Goal Hemoglobin A1c (HbA1c): Less than 5.4 %

   1. A marker of long-term (~3 months) blood sugar levels.

9. Goal Fasting Insulin: Less than 5 µIU/mL

   1. Released by the pancreas in response to rising blood sugar levels; high fasting insulin is an early marker of poor blood sugar management, even if blood sugar levels are at goal.

10. Goal Homocysteine (Hcy): Less than 9-10 µmol/L, based on age.

    1. Elevated levels damage blood vessels and increase risk for plaque formation and blood clots.

11. Body Composition — Excess body fat, especially in the midsection (visceral fat), increases blood pressure, cholesterol, blood sugar, and inflammation.

    1. Although total body weight and Body Mass Index (BMI) reflect overall body weight, they do not account for the distribution of fat throughout the body.

    2. Assessment of visceral fat provides a more accurate indicator of cardiovascular disease risk:

       1. Goal Waist Circumference: Men <40”, Women <35”

          1. Use this guide to accurately measure your waist circumference at home.

       2. Goal Waist-to-Hip Ratio: Men <0.90, Women <0.85

          1. Here’s a handy ratio calculator.

Heart-Healthy Living

The American Heart Association has put together a list of eight lifestyle factors that contribute to cardiovascular health, including nutrition, sleep, exercise, not smoking, and managing cholesterol, blood pressure, blood sugar, and more.

Be sure to check out my health guides on , sleep, and the Insight into Health framework.

A Note on Heart-Healthy Eating

Heart-healthy eating centers on a Mediterranean-style pattern, rich in vegetables, fruits, whole grains, legumes, nuts, seeds, and healthy fats.

Learn much more about eating for your body, brain, and heart health in my nutrition health guide.

Oats are one heart-healthy food to highlight. Oats contain beta-glucan, a soluble fiber that has been found to lower LDL-C levels while also supporting stable blood sugar levels and reducing inflammation.

A couple of my favorite oat recipes to get you started6:

While food and beverage choices strongly influence overall cardiovascular health, it is important to understand that cholesterol levels, including LDL-C, ApoB, & Lp(a), are largely genetically determined.

This doesn’t mean, however, that what you eat doesn’t matter for your heart. Instead, it is important to recognize that some people may do everything they can to lower their cholesterol levels through lifestyle changes and still may need a little help from medications.

What heart health questions do you have?

Leave a comment

Thanks for being here,

~Allison

Why is it so challenging?

Besides all of the systemic issues often making healthy choices the harder choices (food prices, cost of health and mental healthcare, and more), some of it has to do with not having a good enough reason to make the harder choices in the first place.

Knowing what to do is often not enough.

Because, let’s face it, we all have a toddler inside of us who doesn’t want to be told what to do.

Which is why, when I’m meeting a patient for the first time, I take the time to ask them what their hopes and goals are.

I don’t settle for “I want to be healthier,” either. I want to understand, specifically, what being healthier looks like to them. This provides valuable information for both of us as we work to understand what is between them and their healthier self.

Finding Your Why

Health is so much more than a number. I rarely meet a patient who is motivated to exercise in order to lower their blood pressure or to eat less ice cream to see their A1c (marker of long term blood sugar levels) go down.

Sure, I’ve had individuals who are motivated by the numbers, but this is usually because they’ve experienced a family member become debilitated by uncontrolled diabetes or a they have had a friend suffer an unexpected heart attack. Yet, if you really think about it, even these examples are so much more than a number.

Insight into Health Framework

If starting to think about what being healthy means to you feels overwhelming, the Insight into Health framework was made for you.

Before jumping to the middle of the circle, which is the what to do, I urge a little patience.

Starting on the outside of the circle, ie figuring out why you want to be healthy in the first place, can go a long way to informing where to start.

I think about health falling into four main categories:

• Physical Health: How you feel and how well you take care of your body to prevent and/or manage chronic diseases.

• Functional Health: Your body’s ability to do what you want it to do.

• Cognitive Health: Ease of thinking, focusing, and remembering (check out my cognitive health guide here).

• Emotional Health: Being able to experience, express, and manage a range of emotions.

Each of these areas of health interacts, which means that improving one often improves the other. For example, I’ve worked with plenty of people who have worked to improve their functional health, which has led to improvements in their emotional health.

As you consider your own life and goals, ask yourself the following questions:

What areas of your health do you feel good about?

What might you want to change about your health?

In which areas of health are you hoping to see gains?

What aspects of health do you not want to lose?

There are no right answers here.

One person may think about what they need to stay functionally independent, while someone else may think about the things that bring them joy and good quality of life. Keep reading for more detailed examples.

Present & Future Health

If you were like my younger self, middle age and beyond seemed light-years away. It wasn’t until I’d lived those years that I experienced how quickly those years go by.

I can finally see into what is, hopefully, decades ahead of me, and I’ve come to appreciate that while getting older will come with changes to my body, ignoring those changes is not an option.

I’m choosing to follow the old addage, “if you don’t use it, you lose it,” which involves thinking about my health now and into the future.

By future, I’m talking about everything from next year to the next decade (or several).

If I want to swim later, I also need to swim now. Just keep swimming, as it goes.

One Step at a Time

Once you’ve come up with your working definition of health, it is time to take the first step (into the middle of the framework), which involves small things that you can do every day:

• Fuel: Feeding and hydrating yourself

• Fitness: Moving your body

• Sleep: Prioritizing and valuing sleep

• Connection: Finding belonging and an uplifting community

You may find that, just as different areas of health interact with one another, so too do the actions that support them. Better sleep may lead to better connections or more energy to move your body, for example.

Fuel

You can find more about fueling yourself here. Be on the lookout for a hydration health guide, coming soon!

Fitness

Until my fitness guide is ready, below are some basics to get you started.

Different types of fitness activities contribute to physical function. Incorporating each type of exercise throughout your day and week is important for all categories of health:

• Cardiovascular (“cardio”) activities include swimming, walking, jogging, biking, hiking, dancing, and more! They increase heart and breathing rates, supporting heart, lung, and brain health.

• Resistance training includes exercises such as body-weight exercises, resistance bands, hand weights, machine weights, Pilates, certain types of yoga, and more! The goal is to progressively challenge different muscles and muscle groups to enhance muscle mass, strength, and bone density.

• Balance practices such as yoga, tai chi, single-leg standing, walking backwards, and more! They require coordinating your body in space, reducing your risk of falling.

• Flexibility exercises, including yoga, Pilates, dynamic stretches, static stretches, and more! They promote muscle relaxation and lengthening, decreasing injury risk and pain.

Remember, it doesn’t have to feel like exercise. Make it fun and try new things. And even better? Make it a time of connection.

Connection:

Connection involves cultivating positive relationships with yourself and others:

• Self:

  • All too often, the thoughts that go through our heads are full of rumination about the past and worry about the future. While being hypervigilant used to be an important survival mechanism, you can pull your thoughts to the present by:

    • Narrowing in on what you can hear (Car engine? Bird? Washing machine?)

    • Feeling the sensations in your body (your feet on the ground, your seat in a chair, the silkiness of the water)

    • Naming what you see (tree, coffee cup, book).

• Others:

  • We need each other for our safety and survival. Connection and belonging are both key components of emotional health. Support your emotional health by:

    • Setting regular calls, walks, or coffee dates

    • Signing up for a class, book club, exercise class, or local organization

    • Volunteering

    • Saying “yes!” to new experiences

What Else?

Some astute readers may be wondering: what about the other words on the Insight into Health framework graphic?

Screening? Medical care? Therapeutics (medications & supplements)? Support?

These, too, are important in optimizing health. But, it’s when these factors are combined with fuel, fitness, sleep, & connection that things start to get exciting.

Leave a comment

Thanks for being here,

~Allison

By the time I became a Registed Dietitian (Nutritionist) in 2010, I had completed 7 years of schooling, including an undergraduate degree in biology and a graduate degree in nutrition science.

Ok, you might be thinking, you spent 7 years learning about “healthy eating?”

No…and yes. Nutrition is one of those terms that is thrown around without really grasping what it is referring to. Consider this:

There’s a lot there. Way more than just eating your broccoli, that’s for sure.

Let’s break it down.

Science

Nutrition is a science. Principles that I share are based on well-designed scientific studies. But science changes. When we learn better, we pivot, often leaving a generation of frustrated people in our wake. I get it. But I’d much rather admit when I got it wrong than dig my heels in the sand.

Nutrition is not a diet, a fad, a headline, or a supplement. Nor is it about perfection, restriction, or guilt. There is no one-size-fits-all here.

Nutrients

Nutrients include energy (Calories), macronutrients (protein, carbohydrate, fat), and micronutrients (vitamins, minerals, & phytonutrients). Much more on each of these in a moment.

Digestion

Digestion is the process of breaking down food using mechanical and chemical processes so that it can be absorbed. This occurs in the mouth, continues in the stomach, and really gets to business in the small intestine.

You may think about eating, even healthy eating, as what you put into your mouth. Yet, that’s just the first step. If you are to get the benefit of the nutrients you eat, digestion is is a key second step. It’sthe prep crew, if you will.

If digestion doesn’t happen well? That healthy food comes out the opposite direction than it came it…if you know what I mean. Not to mention the gas, bloating, and other symptoms that often accompany poor digestion.

Absorption

If eating is step one, and digestion is step two, the third step of absorption is the gateway to the rest of your body.

Absorption is the process of nutrients passing from your digestive tract into your bloodstream on a journey to the rest of your body.

Every cell, tissue, and organ system requires energy from food and nutrients that provide building blocks for growth, maintenance, and repair.

More on both digestion and absorption in my digestive health guide, coming soon!

Metabolism

Metabolism is about so much more than dictating your body weight. It is all of the processes and reactions within your body (the “orchestra”) that keep you alive.

Metabolism powers your heart, lungs, brain, muscles, & more. (Fun fact: The brain makes up ~2% of body weight but uses about 20% of energy at rest).

Metabolism builds, maintains, & breaks down muscle, bone, body fat, hormones, enzymes, & immune cells.

Metabolism helps manage blood sugar, facilitate nerve signaling, fluid & electrolyte balance, inflammation, body temperature, and cell, tissue, & organ repair.

In short, metabolism keeps you alive.

Murch more on metabolism in episodes #10-13 of the Insight into Health Podcast.

Nutrition Fads

I can’t talk about nutrition without addressing diet fads. Unfortunately, nutrition is all too often tied up with body weight and the desire to change it and control it. This, in turn, conjures up a sense of restriction, guilt, and shame.

See what I’m up against?!

Each macro has had its time in the spotlight. The 1980’s and 90’s were the low-fat days, the 2000’s brought around the stubborn low-carb craze, and we are currently in the midst of high-protein everything.

The tricky thing about these fads is that each is based on what I call “a nugget of truth.” A nugget that, unfortunately, gets blown out of proportion, overgeneralized, and loses its nuance.

So what are the nuggets of truth for each of these macro fads?

• Low-Fat:

  • Eating too much of some kinds of fat may increase your risk of heart disease, obesity, and other chronic diseases.

    • This doesn’t apply to all fats. Sure, not overdoing it on the butter, bacon, cheese, etc. is generally a good approach. Unfortunately, the low-fat trend also pulled down unsaturated fats like those found in fatty fish, nuts, seeds, avocados, and olive oil, etc., which may decrease risk of heart disease, some cancers, Alzheimer’s disease, and more.

• Low-Carb:

  • Frequently consuming food and drinks high in added sugars & highly processed flours (which replaced much of the fat in the low-fat days) is linked to increased weight, blood sugar, and other metabolic-associated diseases.

    • This doesn’t apply to all carbs (sound familiar?). High-quality, minimally processed carbs such as fruits, beans, and sweet potatoes have no business being associated with sodas, chips, or cookies.

• High-Protein:

  • I’ve been convinced that the RDA (Recommended Daily Allowance) for protein greatly underestimates how much protein most of us need, especially in midlife and beyond. Adequate protein can help maintain muscle mass (which decreases with age), promote satiety (feeling satisfied between meals), and manage blood sugar.

    • But, this doesn’t mean that eating high-protein chips, ice cream, and popcorn (yes, these are all real products) is the answer to our health goals.

Meal Planning Principles & Macronutrients

I don’t make meal plans for people, despite being asked for them all the time.

I’ve learned that even if I create what I think is the most amazing, delicious, and healthy meal plan, it is too subjective of a task for me to get it right for someone else (“oh, I don’t like avocado,” “I don’t know how to cook that,” “ugh, I can’t stand cottage cheese!”).

Instead, I’ve found that by teaching the principles I use to make a meal plan, not the meal plan itself, people are empowered and can make healthy eating their own.

Some overarching principles to keep in mind:

1. Meal planning needs to be realistic, sustainable, and enjoyable. If you love to spend 3 hours on a Sunday cooking meals for the week, great, go for it. If Sunday rolls around and meal prep is hovering over you like a black cloud of obligation, that’s probably not the right approach for you.

2. Use mostly “whole” foods and keep it simple. You don’t need to have gone to culinary school (I didn’t) or spend hours in the kitchen to eat healthy-ish, delicious meals. Simple is the key to making healthy eating realistic & sustainable. We’ve got lives to live, after all.

3. Put your food to work! By understanding how different macronutrients (protein, carbs, & fat) work in your body, you can manipulate how those macronutrients work to better meet your goals:

   1. Protein: Makes a meal more satisfying, promotes balanced blood sugar, and provides the building blocks for muscle growth & maintenance.

   2. Carbohydrates: Provide the energy you need to power your brain, heart, lungs, muscles, and more. “Single-ingredient” carbohydrates (see chart below) provide a slow, steady drip of energy between meals to help keep you alert and focused.

   3. Fats: Improve absorption of Vitamins A, D, E, and K, provide essential brain structure, and act as a secondary energy source.

   4. Fiber: While not really a macronutrient, the fiber found in veggies, beans, lentils, fruit, avocado, and nuts & seeds supports bowel function, blood sugar and cholesterol levels, and more.

Make it Your Own

If it sounds simple, it is. I’ve just walked you through the framework that I use with most of my patients. Understand what different macros do in your body, and then, depending on your needs and preferences, experiment with how changing the types, amounts, and pairings of different macros.

Use this simple chart to get you started. For most people, including a protein and a carb with each meal and snack is a good place to start, and if you can get a healthy fat and/or a starchy veggie in there too, awesome.

Micronutrients

If macronutrients (protein, carbs, and fat) provide the raw materials for the body to function, repair, and build, then micronutrients are the cofactors, aka “workers”, that get stuff done.

The energy from carbohydrates, for example, doesn’t just jump to work as soon as you swallow. After a complicated process of digestion and absorption, an even more complicated metabolic process turns it into energy for the cells:

Don’t worry, I won’t test you later. This dizzying diagram demonstrates that Vitamins B1, B2, B3, & B5 (in brown), as well as minerals iron & magnesium (in purple), are essential for carbohydrate metabolism.

Now, consider that this is only one part of carbohydrate metabolism!

Without enough vitamin and mineral cofactors, your health, energy, and function are impaired.

Inadequate Vitamin B1, for example, can cause a condition called beriberi (very rare in the US), which may cause fatigue, weakness, numbness, heart failure, fluid retention, memory impairment, confusion, irritability, and more.

This condition can be avoided by regularly consuming whole or enriched grains, nuts & seeds, and soy, and avoiding chronic alcohol abuse, which is the main risk factor for this deficiency in the US.

Below are two charts I put together to show why I included each group of foods on the macronutrient chart, above - they also provide a range of important micronutrients.

You won’t be tested on these charts, either. Full disclosure, I would probably fail the test, too.

After looking at this, though, I hope you can see that nuts & seeds, for example, are more than just trail mix. They are a secret source of more than half of the vitamins and minerals that your body needs to work at its best.

Well, there you have it, your nutrition primer.

What was your top takeaway?

Leave a comment

Thanks for being here,

~Allison

Please remember that this information is meant to educate and inspire but is not medical advice - please consult your healthcare team to determine what is most appropriate for you.

She would tell me the same stories and ask me the same questions.

She knew something was off. Yet, like her doctor at the time, I brushed it off:

“Grandma,” I said, “you need to focus so you don’t forget.”

Now, I feel awful about saying that. Placing blame on her probably did more harm than good.

It wasn’t a matter of focus at all. It was the first sign of Alzheimer’s disease.

Fast forward 8 years, and, because of one of those situations of being in the right place at the right time, I had the opportunity to work with a program for the Buck Institute for Research on Aging, which is just over the hill from where I live.

At the time, research was emerging that suggested that much of one’s risk for Alzheimer’s Disease is modifiable.

So I dove into the literature, and sure enough, there was hope after all.

I had the honor of developing a nutrition education curriculum and working one-on-one with patients and providers to use lifestyle (including nutrition) approaches to support their cognitive function.

The research and the hope have continued to grow. Alzheimer’s disease isn’t inevitable. Modifiable risk factors (meaning, things you can do something about) make up an estimated 45% of the risk for developing Alzheimer’s disease.

That isn’t a small number.

What is Cognitive Health?

Cognitive health is the ability to think clearly, learn, remember, and make decisions that support independent daily life and overall well-being. It encompasses several interconnected domains of brain function, including:

Yes, cognitive health includes memory, but it is waaaaaay more than memory.

It is identity. It is independence.

Is Cognitive Decline Inevitable?

For the most part, no.

A little slowing of processing speed — recalling a name, following fast conversations, for example — may be part of the brain aging process. But this certainly doesn’t steal identity or independence.

Anything more than mild processing speed changes is cause for investigation because it suggests there may be something in the brain disrupting how it functions.

In the case of Alzheimer’s disease, accumulation of amyloid-beta and tau-tangle proteins are thought to cause progressive cognitive decline.

Alzheimer’s Disease

Sometimes people use “dementia” and “Alzheimer’s disease” interchangably, but they are different.

Dementia is an umbrella term to refer to a number of neurodegenerative conditions that lead to cognitive decline. Alzheimer’s disease happens to be the most common form of dementia.

Alzheimer’s disease accounts for an estimated 60–80% of diagnosed dementias, making it by far the most studied and the primary focus of research on cognitive decline prevention.1

What have we learned?

Amazingly, typical Alzheimer’s disease isn’t something left to fate. Individual risk for this disease involves a combination of non-modifiable (things you can’t change) and modifiable (things you can change) risk factors.

Non-Modifiable Risk Factors:

• Age — Risk of chronic diseases, including Alzheimer’s disease, goes up with age.

• Biological sex2 — Women represent approximately two-thirds of all Alzheimer’s cases, which we are still trying to understand.

  • This difference is not fully explained by longer lifespan, and research is actively exploring the roles of estrogen/menopause, depression, reproductive history, and historically lower access to education and cognitively stimulating work.

• Genetics — The vast majority of Alzheimer’s genetic research has focused on the APOE gene3, which accounts for an estimated 20–25% of population-level risk. Importantly, APOE risk is not deterministic, meaning even the highest-risk combination does not guarantee developing the disease.

  • The APOE gene comes in three forms:

    • APOE-2 — associated with decreased risk of Alzheimer’s disease

    • APOE-3 — associated with neutral risk (neither increased nor decreased)

    • APOE-4 — associated with increased risk of Alzheimer’s disease

  • Since we each inherit two copies of the gene (one from each biological parent), the six possible combinations are:

    • APOE 2/2, 2/3, 3/3, 2/4, 3/4, 4/4

      • APOE 3/3 is the most common combination

      • APOE 3/4 increases risk approximately 2–3x compared to APOE 3/3

      • APOE 4/4 increases risk approximately 8–12x compared to APOE 3/3

What Does that Mean?

Ok, I know that went deep into the science for a moment. So let’s take a step back and put everything into perspective.

Understanding each risk factor is important information as you figure out where you are and what you need to do to influence what happens going forward.

When it comes to genetic risk, I know it can be scary, and some people would rather not know. That’s ok.

For me, I choose to look at genetic risk as a motivator. I want to know all the cards on the table so I can make my next move.

Even if my genetic risk is high, remember it is not guaranteed that the disease will develop.

This is an important distinction.

Modifiable Risk Factors:

Not long ago, an Alzheimer’s diagnosis came with little more than advice to “get your affairs in order.”

Those worried about their own risk had little guidance and even fewer concrete steps they could take to prevent the onset or progression of the disease.

I don’t blame science or medicine for this.

The brain is so complex. If back then we were in the infancy of understanding its complexities, then today we are mere adolescents.

Yet, the good news is that 2024 Lancet Commission report estimated that 45% of all dementia diagnoses are due to modifiable causes, meaning things that you can monitor and address with your healthcare team.

This is huge! Oh, and by the way, these factors aren’t just good for your brain, they are good for your whole body:

1. Level of education — While most research refers specifically to formal higher education, being a lifelong learner in any sense of the word can only help support your cognitive health. Take a class, join a book club, learn a language, pick up an instrument. Curiosity counts.

2. Traumatic brain injury (TBI) — Falls, car accidents, and sports are the leading causes of concussion and brain injury. While we can’t go back and change any history of brain injury, we can stay off of ladders, put handrails and anti-slip mats in the shower, and always wear seatbelts.

3. Elevated LDL-cholesterol — The adage “What is good for your heart is good for your brain” continues to hold true. It includes monitoring for and managing plaque-forming cholesterol. Talk with your doctor about whether the more aggressive LDL targets published recently apply to you.

4. High blood pressure (hypertension) — Working with your doctor to keep your blood pressure in a healthy range won’t just make them happy; it will protect your heart and brain.

5. Smoking — While smoking increases the risk of dementia, long-term cessation significantly lowers it. In fact, quitting in middle age or later and staying smoke-free may reduce dementia risk to that of a non-smoker after 8–10 years. It is never too late to quit.

6. Diabetes — Chronically high blood sugar damages the brain and may increase Alzheimer’s Disease-related pathology over time. Monitoring for and managing high blood sugar, prediabetes, and diabetes goes a long way in protecting your brain.

7. Excessive alcohol intake — “Excessive” is currently defined as more than 21 units of alcohol per week, compared to fewer than 14 units, with a 4–5oz glass of wine, 12oz beer, and 1–1.5oz of liquor each counting as one unit. That said, some research suggests there is “no safe level of alcohol consumption for dementia,” especially for women and those carrying the high-risk APOE-4 gene.

8. Obesity — The number on the scale is my least favorite health metric, for it is often more harmful (to mental health) than helpful. That said, excess body weight, particularly around the midsection, is associated with increased risk for several chronic diseases, including dementia. If this applies to you, focusing on the lifestyle and medical strategies covered here is a more meaningful and comprehensive place to start.

9. Physical inactivity — Any movement is better than no movement (and it isn’t too late to start!) was a primary takeaway from the Women’s Health Symposium I attended yesterday. In fact, physical activity may be the most important factor in protecting your cognitive health, with regular movement being the key.

10. Depression — Appropriately treating depression and other mental health challenges, especially in midlife, is an important step in protecting long-term brain health. Seek support, whether through therapy, medication, lifestyle changes, or a combination. Your brain health is worth it.

11. Social isolation — Humans are wired for connection, and the brain thrives on meaningful social engagement. Chronic loneliness and isolation have been shown to accelerate cognitive decline. Prioritize your relationships, stay involved in your community, and don’t underestimate the powerful protective effect of simply spending time with people you care about.

12. Hearing loss — Sensory input is essential for keeping the brain active and for maintaining and forming new brain cell connections. Untreated hearing loss not only reduces a critical sensory channel, but it is also often socially isolating, compounding the risk even further. Wear those hearing aids if you need them!

13. Vision loss — Untreated vision impairment can be socially isolating and may reduce engagement in cognitively stimulating activities such as reading, writing, and art. Stay current with regular eye exams, and let this be extra motivation to manage your blood sugar and blood pressure, both of which can also affect your vision.

14. Air Pollution — This risk factor is often considered a “social determinant of health,” meaning that people of lower socioeconomic status are more likely to work and live in communities with higher levels of air pollution. Relocating away from polluted areas is not a realistic option for most, but it is worth acknowledging that chronic exposure to this environmental factor does play a role in long-term brain health.

I suspect that this list of modifiable risk factors will continue to grow, providing us all more hope and agency for protecting our cognitive health.

Fueling Your MIND

Until about a decade ago, we had a hunch that the Mediterranean diet was good for the brain, but we didn’t have much good evidence to be sure.

That changed in 2015, when research on the MIND diet first made headlines¹. (Note: I prefer “approach” because I’m not a fan of the 4-letter “D” word).

What is the MIND “diet”?

MIND is an acronym (which, it turns out, encompasses another acronym “DASH” which stands for Dietary Approaches to Stop Hypertension):

Mediterranean-DASH

Intervention for

Neurodegenerative

Delay

In short, the MIND intervention combines the cognitive and cardiovascular benefits of Mediterranean eating with the cardiovascular benefits of the DASH plan.

Results of the 2015 study showed that after following 960 people for almost 5 years, those who consumed the recommended MIND foods most of the time showed slower cognitive decline.

In fact, these “most of the time” folks had cognitive function equivalent to being 7.5 years younger in age than those who ate MIND foods the least.

Importantly, perfection was NOT required to see benefit.

This is good news for all of us.

If you can incorporate the MIND foods into your routine a moderate 70-80% of the time, your brain gets the benefits.

Plus, the research doesn’t suggest that you have to give up the foods that you love.

Research from around the world has continued to support the MIND intervention for reducing the risk of dementia:²

MIND Foods

The MIND approach first focuses on foods to consume more regularly (a refreshing change from “diets” that start with what to avoid):

• Green leafy vegetables — daily

• Other types of vegetables — daily

• Berries — 2+ per week

• Nuts & Seeds — 5+ per week

• Olive oil — daily

• Whole grains — daily

• Fish — 1+ per week

• Beans — 3+ per week

• Poultry — 2+ per week

While participants in the MIND studies were also encouraged to decrease intake of butter, cheese, red meat, fried foods, and sweets, the focus on what to consume more of is likely the most important part.

“Neuro” Nutrition:

As you can see, the brain-healthy MIND foods are largely plant-based, meaning that they are rich sources of fiber, vitamins, minerals, and phytochemicals.

These components, along with ones we likely haven’t discovered yet, promote brain health by:

• Improving cardiovascular health — blood pressure & cholesterol

• Supporting metabolic health — blood sugar & inflammation

• Increases micronutrient intake — vitamins and minerals (including B-vitamins, choline, zinc, iron, magnesium, and more)

• Supporting neurotransmitter (brain cell) function — healthy proteins

• Supporting brain structure — healthy fats

• Providing reliable energy for the brain — healthy carbohydrates

• Fueling the microbiome — fiber

A note on alcohol

While a glass of wine daily was originally seen as a positive dietary addition in the 2015 MIND publication, we now believe there is no safe level of alcohol consumption for brain health.

Brain Healthy Eating = Healthy Eating

I often get new patients who come to me in a panic that they need a diet for their diabetes, high blood pressure, and cognitive health.

How will they manage it all!?!

The reassuring news is that brain-healthy eating is healthy eating. The MIND foods aren’t just good for your brain; they are good for your heart, your blood sugar, inflammation, cancer risk, and more.

Once again, the research points us to more plants, including fruits, vegetables, nuts, seeds, and grains.

No magic. Just real food.

Leave a comment

Thanks for being here,

~Allison

Please remember that this information is meant to educate and inspire but is not medical advice - please consult your healthcare team to determine what is most appropriate for you.

This is unfortunate because the most critical time for bone health is when many of us think we are invincible: our teenage years.

What exactly is bone?

While it is easy to picture bone as a solid structure, it contains an inner “spongy matrix” that resembles honeycomb, surrounded by a hard outer shell.

Nearly half of bone is made of protein (specifically collagen) in addition to minerals such as calcium and phosphorus.

Unlike hair and nails, bone is alive and constantly being remodeled, meaning it is in a constant state of being broken down and built back up. An estimated 10% of your skeleton is being turned over in this fashion every year!

Bone provides the obvious structure and foundation for movement, but also plays an essential role in mineral storage and blood cell production.

Bone Throughout the Lifespan

The rate of bone remodeling depends on several factors, one of the most important being the stage of life:

• Infancy and childhood: Bones are rapidly being built as part of the growth process.

• Adolescence: Nearly 40% of total bone mass is accumulated during this window.

• Early to late 20s: Peak bone mass is achieved.

• Around age 30: Most people begin losing 0.5–1.0% of bone per year.

• Menopause transition: For women, bone loss accelerates to 2–3% per year, as estrogen plays a protective role in bone health.

• 50s and beyond: Gradual bone loss continues, accompanied by an increased risk of fracture.

Why Peak Bone Mass Matters

Given the somewhat inevitable decline in bone mass over time, reaching maximum bone density in your 20s is a critical piece of lifelong bone health:

The challenge is that this bone-building window comes at a time when long-term health is rarely top of mind. Some of my most challenging nutrition conversations are with teenage audiences, as I try to find compelling ways to convince them that calcium-rich foods really are important.

While most of you reading this are likely beyond your peak bone-building years, there is still plenty you can do to slow bone density decline.

Bone Metabolism

Bone is alive and in a constant state of being broken down and rebuilt, a process known as remodeling. This complex cycle is fueled by nutrients and orchestrated by two key cells: osteoblasts and osteoclasts.

I know, I wish their names weren’t so similar either. Here’s how I remember them:

• OsteoBlasts — B for Builders (build bone)

• OsteoClasts — C for demolition Crew (break down bone)

During childhood, adolescence, and young adulthood, osteoblast activity dominates and bone mass increases. Starting around age 30, osteoclasts gradually outpace osteoblasts, and slow bone loss begins. In women, the loss of estrogen during and after the menopause transition accelerates this process by ramping up osteoclast activity.

Necessary Nutrients

If osteoblasts and osteoclasts are the construction and demolition crew, they rely on having access to supplies, delivery drivers, and apprentices. This is where vitamins and minerals come in.

• Calcium — the star building block of bone

• Vitamin D — required for calcium to be absorbed from your digestive system

• Vitamin K — the K2 directs that absorbed calcium to your bones (and not somewhere less helpful, like an artery)

• Zinc and Vitamin B12 — support the osteoblast builder cells

• Magnesium — supports Vitamin D

While it might be tempting to rush out and buy supplements to cover all of the above, a food-first approach is the ideal way to ensure your body gets the most out of these nutrients. Remember, our bodies weren’t designed to absorb 100% of what we need in a single swallow.

The following is a quick reference guide to the vitamins & minerals involved in bone health, how much most people need, common food sources, and some things to think about when it comes to supplementation. This list is not all-inclusive. Please remember to check with your healthcare team regarding your specific needs:

In my experience, the most commonly needed supplements for bone health are Vitamin D3 and K2, as both are difficult to obtain in meaningful amounts through food alone. Many supplements now conveniently combine them in a single pill.

I recommend basing Vitamin D3 dosing on blood test results (the 25-OH vitamin D test). If testing isn’t easily accessible, 1,000–2,000 IU of D3 daily is generally considered safe for most adults, but more is not always better, so testing is worth it.

Bone Fuel

Every process in your body requires energy. Energy that comes from food, which we call calories.

While calories often get a bad rap, energy is essential in fueling bone metabolism and is key to promoting healthy bones throughout life.

While consuming more calories than your body needs is a common concern, consuming an inadequate amount of calories (regardless of weight) also has risks. Inadequate energy intake increases the risk of low bone density, low muscle mass, as well as falls and fractures.

I’ve worked with many individuals who chronically underfuel themselves in an attempt to change the size of their body or to “get healthy.” Yet these often shortsighted attempts overlook the essential role of adequate energy for health, including bone health.

Protein Power

Protein is having its time in the spotlight. When it comes to bone health, adequate protein intake plays two important functions:

1. Provides the building blocks for bone collagen, which makes up roughly a third of bone mass.

2. Promotes building and maintenance of muscle mass, which acts as an important stimulus for bones to stay strong.

So how much protein do you need? That’s a hard question to answer for everyone reading this. As is the case with most health and nutrition topics, the amount you need is highly individualized and best calculated by a nutrition expert (dietitian!).

As a guideline, most adults benefit from starting with ~1.2 grams of protein per kilogram of body weight, using adjusted body weight for those with high body weight. (If you are thinking, “kilograms!?”, I hear ya. We are stuck in the metric system over here in healthcare…). This is ~0.54 grams of protein per pound of body weight.

Please remember that protein needs vary based on several factors, including age, activity level, and health status.1

Raising the Bar

Ok, we’ve gone through nutrition for bone health, but that is only half the story.

Your body responds to the demands you put on it, and bones are no different. If you don’t ask much of your bones, there is no reason to spend precious energy and resources to maintain them.

This is where resistance training comes in.2 When combined with adequate protein intake, resistance training builds and maintains muscle mass.

Because muscles connect to bone via tendons, the bigger, stronger, and more frequently those muscles are used, the more force the bone has to brace against. It is this demand that motivates your body to prioritize bone structure.

I’ve only recently started doing resistance training. If you are new to it, too, here are a few things to consider:

• Resistance training is any movement that challenges your muscles to work. You do not need a gym membership or a barbell to get started! Bodyweight exercises like squats, lunges, and knee pushups count, as do resistance bands, free weights, and more. Here is an online resource I recommend to many of my patients who aren’t sure where to start.

• To keep your bones motivated to stay strong, resistance training needs to be progressively more challenging. This means that as you gain strength, slowly increase the challenge by adding more resistance and/or trying different movements.

• The ultimate goal is 2–3 strength/resistance sessions per week that work all major muscle groups.

• Working with a professional to learn proper resistance training technique is well worth the investment to decrease the chance of injury.

Of course, check with your doctor first before starting a new exercise program, particularly if you have existing health conditions or known bone loss.

Prevention is the Best Medicine

Breaking a bone later in life can be serious and threaten independence, mobility, and, in certain cases, even increase the risk of death.

That being said, preventing a fall in the first place goes a long way toward protecting your bones and the rest of your body. Balance-focused activities such as tai chi, yoga, and single-leg exercises can help promote better balance, stability, and reaction time.

A few simple home modifications can prevent falls at any age: removing trip hazards like loose rugs and floor clutter, installing grab bars in the bathroom, and placing non-slip mats in the shower and on slippery floors. More home fall prevention tips here.

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Thanks for being her,

~Allison

Please remember that this information is meant to educate and inspire but is not medical advice - please consult your healthcare team to determine what is most appropriate for you.

You may be surprised that, as a Registered Dietitian, I sometimes talk about sleep before nutrition.

Chronically poor sleep increases the risk of nearly all areas of health:

What does “good” sleep even mean?

I define good sleep in terms of quantity (how much) and quality (how well).

• Quantity: Most adults regularly need 7-9 hours of sleep per night, ideally continuously.

  • To figure out how much sleep you need, go to bed (and to sleep) at the same time every night for a week and let yourself wake up naturally — no alarms, pets, or partners. You may sleep more than 9 hours the first night or two if you are in sleep debt. The amount of sleep you get on the 6th and 7th night is a good indicator of your natural sleep needs.

• Quality: How easily can you fall asleep? Do you typically stay asleep? If you wake up, how easy is it for you to fall back asleep? Do you feel refreshed in the hours after waking?

  • Sleep quality is subjective and difficult to evaluate outside of a sleep lab. Yet, it is probably the most important metric for an individual. Poor sleep quality (or the perception of it) affects how we think, how we feel, and how we show up for ourselves and others for the rest of the day.

What’s Your Chronotype?

I know this sounds like a Seventeen Magazine quiz, but stick with me here.

Chronotype refers to your preferred sleep timing, which is largely genetically determined. Think early bird (me) and night owl (my husband).

Note that chronotype is preferred, which is not necessarily consistent with the timing of your life responsibilities (work, school, etc.). This mismatch is a big driver of poor sleep quantity and quality.

Society has placed judgments on each end of the chronotype spectrum. As an early bird, I get teased for going to bed early, and many night owls are deemed “lazy” when they sleep in. Yet, there is no one best chronotype.

You likely already have an idea about your chronotype, but here is a quiz if you are curious (and no, not from Seventeen magazine).

To Track or Not to Track

I have learned to refine how I ask a patient about their sleep.

Instead of asking “How are you sleeping?”, which often gets the reflexive “good” response, I now ask “How do you describe your sleep?” The most common answers I get are “horrible” and “terrible” — words that speak volumes on their own.

Though more commonly, I am also hearing, “My phone says…”

While sleep trackers can certainly increase awareness about sleep duration and quality, there are some important factors to keep in mind to determine if they are right for you.

First, while sleep duration accuracy on common sleep-tracking devices continues to improve, they often have trouble evaluating the nuances of sleep stages (more on that next week).

Second, for some people, the use of sleep trackers may sabotage sleep because of the anxiety and obsession that come with data overwhelm. There is even a term for it: orthosomnia, which is the pursuit of perfect sleep data at the expense of actual sleep.

Third, the more we outsource how we feel to technology, the greater the risk we have of losing touch with… how we feel. And our bodies have a lot to tell us; it’s usually a matter of whether we listen.

That said, if using a sleep tracker helps you feel informed and empowered, keep using it.

If it leaves you lying awake wondering why your deep sleep percentage was low, it may be time to take a break.

How Does Sleep Happen?

1. Melatonin

I’m guessing you’ve heard of melatonin. It is the most common sleep supplement in the US.

Many people don’t realize that melatonin is naturally produced in our brains to help us fall asleep, yet it has little value in keeping us asleep.

Naturally produced melatonin is light-dependent, a system that evolved when sunrise, daylight, and sunset were the main drivers of our sleep-wake cycle.

The amount of light coming into our eyes directs melatonin production:

• As light increases (think sunrise), melatonin production goes down

• As light decreases (think sunset), melatonin production goes up

Disruptions to melatonin production because of artificial light exposure at night, such as lights in our homes and screens, and inadequate sunlight exposure during the day, are at the core of poor sleep for many.

2. Adenosine

Adenosine is the byproduct of energy metabolism (ATP for any biology folks out there). The longer you are awake, the more adenosine builds up in your brain. As the day goes on, adenosine slowly accumulates, which causes you to feel more tired. This is known as “sleep pressure.”

Getting a good night of sleep clears adenosine from the brain.

(Fun fact: Caffeine blocks your brain from recognizing that adenosine is there. That’s right, caffeine does not give you energy. It just tricks your body into not realizing how tired it is.)

Importantly, both adequate melatonin production and sleep pressure are required to fall asleep and stay asleep. Easier said than done, I know.

Your Hormones on Sleep

If you think that melatonin and adenosine are impressive/complicated/overwhelming…we are just getting started.

In Part 1 of this series, I shared that chronically poor sleep affects nearly every area of health: metabolic, cardiovascular, immune, mental, and more.

Why is that? How is sleep so powerful?

The answer has to do with more hormones. Hormones that follow sleep-wake cycles and are affected by poor sleep:

• Cortisol is the “alert” hormone that gradually decreases throughout the day and spikes in the early morning to prepare for wakefulness. Poor sleep confuses cortisol production, often resulting in high levels at night, making it difficult to fall and stay asleep, and low levels in the morning, making it difficult to feel awake.

• Leptin & Ghrelin are “appetite” hormones that play opposite roles. As leptin goes up after a meal, you feel full. On the other hand, ghrelin¹ levels make you feel increasingly hungry the longer it’s been since a meal.

• Insulin is the “energy shuttle” hormone, responsible for moving energy-rich blood glucose (blood “sugar”) from the bloodstream into the cells. Sleep deprivation makes insulin less effective, raising blood sugar and increasing the risk of Type 2 Diabetes and other metabolic-associated conditions.

• Growth Hormone is the “repair” hormone, released during sleep to stimulate tissue repair, immune health, and metabolism. Poor sleep can impair recovery and healing.

I could go on, but I’ll spare you.

Foundations of Good Sleep

• Morning sunlight — Even a few minutes of direct morning sunlight increases alertness by decreasing melatonin production and increasing alertness hormones. Set yourself up for an energized day and better sleep tonight.

  • Take your morning cup of coffee or tea on your porch, get out on a short walk with your furry friend, or simply step outside to hear the goings on.1

• Simulate sunset — Sleep doesn’t happen like a light switch. Give your system a head start by reducing light in your environment 1-2 hours before bed so that melatonin production has time to ramp up in time for bedtime.

  • Turn off bright overhead lights, use dimmer switches or lower wattage light bulbs, and create a bedtime routine that doesn’t rely on screens.

• Increase sleep pressure — Regular exercise helps promote that sleep pressure, establishes your circadian rhythm, and may decrease the stress and anxiety that often makes sleep difficult.

  • Try your favorite cardio and/or resistance activities earlier in the day for better sleep later that night. Relaxing practices such as restorative yoga and tai chi before bed may also be helpful.

• Consistency is key — There doesn’t appear to be one “right” time to go to bed. Instead, it may be dictated by your chronotype. Consistency may be more important than sleep timing because it supports your internal sleep system. Going to bed at vastly different times each day is akin to being chronically jetlagged.

  • Go to bed and wake up at the same time every day to mimic regularity in sunrise & sunset. If shifts to your sleep schedule are needed, do so in ~15-minute increments (for context: sunrise and sunset change by 1-3 minutes per day!).

Sleep & Your Senses

• Sight — In addition to leveraging the power of naturally produced melatonin by being exposed to sunlight early in the day, throughout the day, and by mimicking sunset ahead of bedtime, sleeping in complete darkness can help you stay asleep. Consider blackout curtains, eye masks, and other tricks to decrease even small sources of light in your sleeping environment.

• Sound — Sudden changes in noise from outside or inside your bedroom during sleep trigger your alertness reflex, making it difficult to fall back asleep. Decrease noise disruptions with white noise machines/apps or earplugs.

• Touch — Body temperature affects sleep, & natural decreases in body temperature at night promote good sleep. Amplify this effect by warming yourself up before bed (e.g., a bath, shower, or tea) to support sleepiness as you cool down. Sleep with the room temperature at least a few degrees cooler than it is during the day, if possible.

• Taste — Avoid caffeine (coffee, tea, soda) for 8 hours before bed to support sleep pressure. Finish eating 2-3 hours before getting into bed to improve digestion & decrease heartburn. Limit fluids for 2 hours before bed to prevent bathroom wakeups. While alcohol may appear to make it easier to fall asleep, alcohol actually disrupts deep sleep.

Other Factors to Consider

If you’re concerned about your sleep, energy levels, or health, please consult your doctor. Several medical conditions can be both symptoms and causes of poor sleep, including sleep apnea, restless leg, chronic pain, anxiety & related disorders, heartburn/reflux and other GI conditions, and any medical and/or medical cause of excessive nighttime urination.

Additionally, there are several other factors that I wasn’t able to cover in detail in this series, but I’ve linked to more information for the following sleep-related topics:

• Pets in the bed/bedroom

• Naps

• Shift work

• Travel/Jetlag

• Melatonin Supplements

• Insomnia

I hope this series has provided some helpful insights and, hopefully, some better nights of sleep for you!

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Thanks for being here,

~Allison

Please remember that this information is meant to educate and inspire but is not medical advice - please consult your healthcare team to determine what is most appropriate for you.

First, let’s define what we are talking about here, since “supplement” is used to refer to a grab bag of things.

For the purposes of this piece, I consider supplements to be any vitamin, mineral, herb, botanical extract, amino acid, enzyme, or microbial used for some supposed health benefit. For example:

• Vitamins: Vitamin D, Vitamin B12, biotin, multivitamins (usually more appropriately called multivitamin/multiminerals), etc.

• Minerals: Magnesium, calcium, iron, etc.

• Herbs: Ashwagandha, turmeric, ginger, etc.

• Botanical extracts: Berberine, green tea extract (EGCG), resveratrol, etc.

• Amino acids: Creatine, L-carnitine, glycine, etc.

• Enzymes: Digestive enzymes, lactase, CoQ10, etc.

• Microbial: Probiotics, Prebiotics, Postbiotics

Supplement Safety

Supplement oversight is essentially nonexistent.

While medications are regulated by the FDA, food products are regulated by the USDA, and a handful of other regulatory bodies keep tabs on consumer and product safety, the supplement industry is like an unsupervised teenager seeing how far they can go.

The Dietary Supplement Health and Education Act of 1994 (DSHEA) established that supplements do not need approval for safety or effectiveness before going to market. It stipulates that the FDA only gets involved to determine if a supplement is unsafe after it’s already for sale. Note: the burden of proof is on the FDA…

What’s A Consumer to Do?

The lack of supplement safety oversight results in three main safety concerns:

• Supplements may contain ingredients different from those listed on the label1

• Supplements may contain contaminants2

• Supplements may contain way more or way less of the stated active ingredient3

Looking for products that are third-party tested is currently the best way to choose safe supplements, including USP Verified, NSF, and ConsumerLab.

But, Wait! Too Good to be True?

While third-party organizations may test for safety and purity of supplements, they do not test to see if the supplement does what the company says it does.

This is important.

The only labeling requirement that DSHEA outlines is a phrase I’m almost certain you’ve seen if you’ve ever shopped for supplements:

While this statement really says it all, it is like the fine print that no one reads, understands, or pays attention to.

Every bottle of supplements tells us that they aren’t regulated.

Every bottle of supplements states that they aren’t meant to prevent or treat disease.

But does that stop us from believing otherwise? No.

And that is because labels can say just about anything other than “diagnose”, “treat”, “cure”, or “prevent.”

A label can’t say “prevents osteoporosis,” but it can say “supports bone health.”

A label can’t say “treats diabetes,” but it can say “helps maintain blood sugar levels.”

A label can’t say “prevents heart disease,” but it can say “supports healthy cholesterol levels.”

The fact that these claims are misleading is not a consumer problem. It is marketing getting at the heart of our hopes, worries, and desire for health. Heck, some sound tempting to me sometimes, and I study this stuff!

Pros & Cons

Supplements aren’t all good or all bad. There are certainly circumstances where supplementation may be needed. Yet, it is always important to remember that supplements aren’t risk free.

Pros:

• Nutrient deficiencies: The most common scenario in which I recommend supplementation is to address an identified nutrient deficiency. In fact, when it comes to vitamin & mineral supplementation, specifically, there doesn’t seem to be much benefit when there is no deficiency or insufficiency¹.

• Increased needs: Some people have increased needs for certain nutrients, which can be difficult to get through diet alone. During pregnancy, for example, research supports specific vitamin and mineral supplementation to protect the health of the mother and the growing baby.

• Digestive challenges: We get nutrients into the parts of our body that need them through eating food. That food is then digested into small enough pieces to be absorbed into the bloodstream and distributed throughout our body. Several digestion and absorption challenges may make this process ineffective, and supplementation can sometimes be part of the intervention.

• Inadequate intake: Whether because of necessary or chosen food restrictions (allergies, vegan, etc.), decreased appetite due to medication or illness, or even eating disorders, supplements can sometimes help fill nutrient intake gaps when food alone is not sufficient.

Cons:

• Risk of toxicity: More is not better, especially for supplements whose excesses are stored in our tissues instead of being excreted. I see this most commonly for Vitamins A, D, E, and K, which are fat-soluble, meaning that they require fat to be absorbed as well as stored, which gives two important pieces of information:

  • First, if you are taking a Vitamin D supplement, for example, you will absorb it more readily if you take it with a meal containing at least a little bit of healthy fat.

  • Second, if you overdo that Vitamin D supplement, excess will be stored in body fat, increasing the risk of Vitamin D toxicity. More is not better.

• Supplement interactions: Supplements are not benign. Even if you take a supplement because you need it and you choose a product that has been third-party tested, interactions between individual supplements and between supplements and medications are common, ex:

  • Supplement<>Supplement: Calcium blocks iron absorption, so taking both in supplement form at the same time reduces the amount of iron that gets into your body.

  • Supplement<>Medication: St. John’s Wort famously interferes with some birth control pills, making them less effective, and interacts with common antidepressant (SSRI) medications.

• Mask other deficiencies: Blindly taking supplements because you’ve heard they are healthy may mask a true deficiency, which can be incredibly dangerous. Taking folate or folic acid without monitoring, for example, may disguise a Vitamin B12 deficiency, which is associated with cognitive decline.

• Contamination risk: There is no pre-market regulation for supplement safety. This means that supplements may or may not have the ingredient(s) listed on the label, may have more or less than the amount on the label, and/or may have contaminants such as lead. Third-party testing is the best way to evaluate each of these risks.

• False sense of security: You can’t out-supplement a low-quality diet. Too often I see people who are spending loads of money on supplements only to be eating fast food, highly processed snacks, and other low nutrient quality foods. In this case, it is often best to save the money you spent on supplements to buy higher-quality food.

• Cost: The supplement industry is valued at $70 billion in the US alone, with the average US adult spending more than $500 a year on various supplements, with some spending way more. I’m not saying some supplements aren’t worth it, but being well-informed about supplements can protect your health and your bank account.

Are Supplements Right for You?

There are so many factors that go into deciding if a supplement is right for you. Below is the process I use when working with patients to decide if they may need to supplement, how much they may need, and for how long they may need it.

1. Test, Don’t Guess

I don’t use the “throw spaghetti at the wall” approach for supplements. Everyone has different needs, and taking something that you don’t need isn’t harmless.

Yes, Vitamin D, B12, and iron are important for all of us. But it doesn’t mean we all need to take them in pill form. Remember, supplements… supplement. We don’t need to fill a gap if there isn’t one.

Testing the status of vitamins and minerals in your body first to determine if a supplement is even needed is the place to start.

Now, it isn’t realistic to test the status of every vitamin and mineral. Nor would your doctor likely write that order. To figure out what nutrients to check, it is helpful to understand your risk:

• Dietary patterns at most risk of inadequate micronutrient intake:

  • Vegan: Vitamin B12, Vitamin D, Omega-3s, Iron, Zinc, Iodine, Calcium4

  • Vegetarian (eats dairy/eggs): Vitamin B12, Iron, Vitamin D, Omega-3s

  • Bariatric surgery post-op (ex: gastric bypass, gastric sleeve): Vitamin B12, Iron, Calcium, Folate, Thiamine (B1), Vitamins A, D, E, K

• Life stages at most risk of inadequate micronutrient levels:

  • Older Adults:Vitamin B12, Vitamin D, Calcium

  • Pregnant/Breastfeeding: Folate, Iron, Iodine, Choline, Omega-3

  • Heavy Menstruation: Iron

• Medical & lifestyle factors at most risk of inadequate micronutrient levels:

  • Limited sun exposure, darker skin: Vitamin D

  • Digestive conditions (Crohn’s, Ulcerative colitis, celiac): Vitamin B12, Iron, Folate, Vitamins A, D, E, & K

  • Excessive Alcohol Intake: Thiamine (B1), Folate, Vitamin B6, Magnesium

  • Smokers: Vitamin C

  • Certain medications:

    • Metformin: Vitamin B12

    • Stomach acid reducers (ex: omeprazole/Prilosec, famotidine/Pepcid): Vitamin B12, Magnesium, Calcium

    • Diuretics: Potassium, Magnesium

2. The Limits of “Within Normal Limits”

Pet peeve time.

Just about everyone has access to their lab results and can quickly scan them for anything outside the “green” range, which indicates the “normal” reference range.

How handy. So what’s the problem?

1. Most reference ranges aren’t standardized.

2. Reference ranges are typically set by the lab or lab equipment company.

3. Reference group populations vary.

4. “Normal” shows what is common in a reference group, not necessarily what is ideal for you.

All of this means that simply looking for values that are either in or out of range can mislead you — a value outside the range can cause undue concern, and a value within a given range can create a false sense of security.

Interpreting lab results involves appreciating the context of age, medical history, symptoms, genetics, goals, and more.

A deficiency is defined as a nutrient level outside the reference range and likely to cause signs and symptoms in most individuals.

An insufficiency/inadequacy is suboptimal nutrient status typically at the low end of a reference range, which may cause signs and symptoms in some individuals.

Both can cause symptoms. But it takes more than being in or out of the reference range to appreciate that.

I recently experienced a perfect example of this. I was feeling more fatigued and just not feeling like me. So I asked my doctor to test for anemia and low iron stores (more about how they differ here).

The most sensitive marker of iron stores, ferritin, was just inside the green reference range:

But wait, do you see that reference range? It is almost too large to make it meaningful.

So I didn’t have iron-deficiency anemia.

I didn’t have iron-deficiency without anemia, either.

But with my symptoms and my unique history, my doctor agreed that I had insufficient iron levels and an agreed-upon supplementation regimen was started.

3. “More” ≠ better

If you do need to supplement, don’t reach for the biggest dose you can find. Not only can your body not always absorb larger doses, but it may also cause side effects and even toxicity.

Let’s go back to my iron example. We now know that iron supplements are most effective and have the least side effects when taken every other day.5 More is not better.

Just because you can buy a 10,000IU Vitamin D3 supplement (typical doses are 2,000-4,000IU per day) or a 20mg melatonin supplement (I don’t typically recommend more than 5mg), doesn’t mean you should.

Please, please, please ask the questions to make sure you are supplementing only what you need and no more.

4. Happily Ever After?

The story does not end here. Periodically retesting nutrient status can let you know whether the amount you are taking is effective, the dose needs to be adjusted, or it can be stopped altogether.

While those following a vegan dietary pattern or who had bariatric surgery will likely need some level of supplement indefinitely, testing at least annually is recommended.

Many other supplements can be decreased or discontinued after a period of time, especially if the reason for the deficiency or insufficiency has been resolved.

In my case, my ferritin levels came back up nicely, but since I don’t eat red meat and I have other risk factors for iron insufficiency, I will continue to work with my doctor to create a plan to take my supplement less often and check my levels periodically.

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Thanks for being here,

~Allison

Please remember that this information is meant to educate and inspire but is not medical advice - please consult your healthcare team to determine what is most appropriate for you.