Sarah-Kate Rems, NP
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What to Order at the Italian Restaurant

8/31/2017

 
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Italian food is one of the most beloved foods across the world - and for good reason! It is based on using super fresh ingredients with plenty of olive oil and herbs. However, Italian food is also known for its heavy pasta and cream based dishes which are definitely not helpful for staying healthy and fit. As with any restaurant, it is all about making the right choices and choosing the dishes that will fuel your body and not work against you.

Here is how to order healthy at an Italian restaurant:

Appetizer:
  • Minestrone soup - This soup is broth based with lots of vegetables, and tends to pack a ton of flavor with not a lot of calories. Soup is great to start with because the liquid will fill up space in your stomach, meaning less chance of overeating later.
  • Charcuterie - This is a mix of different meats which makes this a high protein and high fat appetizer and will make you feel satisfied and help to fill you up a bit before the main course.
  • Antipasto - This is a mix of meats, cheese, vegetables, and olive oil, and  is a great high protein and high fat starter.
  • Carpaccio - Another high protein, high fat appetizer, this consists of thin slices of raw fish with olive oil.
  • Roasted vegetables - Super fresh vegetables are a staple of Italian food, starting with vegetables will give you some fiber to fill you up a bit before the main course.
  • Caprese salad - This salad is traditionally composed of tomatoes, basil and mozzarella which is great high fat starter. Eating high fat to start will prevent you from overeating at the main dish. Note: If dairy tends to upset your stomach, you should probably skip the mozzarella because this type of cheese is typically harder to digest due to the higher lactose content.
  • Grilled calamari - Aka squid, calamari is a another great protein choice, just make sure to get grilled and not fried or crusted.
Main as Pasta: Choose pasta only if you are if you are looking for a high carb meal, such as after heavy exercise or a carb-refeed day. Otherwise, pasta in general is not a good choice for your waist-line. 
  • Pasta primavera - This dish is made with lots of vegetables and the sauce is usually olive oil based with tomato.
  • Spaghetti with pesto - If you are really craving a fatty pasta with more of flavor profile than just plain olive oil, get it with pesto rather than cream. Pesto is made with basil, garlic, olive oil and pine nuts, and is much better for you than heavy cream based sauces such as with Alfredo.
Main as Low Carb:
  • Pollo alla Diavola - This is typically roasted chicken with vegetables, olive oil, and herbs -  can't get much healthier than that! Just ask to make sure it is not battered or crusted
  • Soup and salad - When in doubt, go for a soup and salad from the appetizer menu. The soup will fill you up along with the fiber from the salad. Add protein to the salad and use olive oil as the salad dressing - most Italian restaurants should have great olive oil.
  • Fish - There will likely be salmon or Branzino on the menu, any grilled or baked fish with a side of vegetables is a perfect order. 
Drink:
  • Red wine - Go for dry red wine (dry means low in sugar) such as Pinot Noir, Cabernet Sauvignon, and Merlot.
  • Dry white wine - This is great with light meals such as salad or fish. Order a dry white wine such as Sauvignon Blanc .
  • ​Scotch or whiskey on the rocks - If you are not a wine drinker, go for one of these which tend to pair well with heavier meals and will be low in calories when served on the rocks or water.

​SK

How To Stay Healthy While Eating Out At Brunch

8/28/2017

 
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Who doesn’t love brunch? Just because you are eating healthy doesn’t mean you have to skip your weekly brunch with friends! It’s all about making the right choices so that you can enjoy a meal outside of your kitchen once and a while.

Here are the best choices for brunch that you should be able to find one or more of on any brunch menu:

Appetizer:
  • Bowl of fruit - Go for the melon and/or berries which have the lowest sugar. Fruits with the greatest amount of sugar include tropical fruits such as banana, pineapple, mango - go easy on these tropical fruits.
Main:
  • Eggs benedict - Request for some greens to serve as the “bun” for the eggs and skip the english muffin. Also ask for hollandaise on the side - restaurants typically smother your eggs in so much hollandaise that you can't even taste the rest of the meal. Take back the control and ask for this on the side.
  • Egg omelette - With lots of veggies. Again skip the breakfast potatoes or toast. If you are extra hungry then add some more fat in the form of avocado, guacamole, or cheese, or consider adding another protein like ground turkey if this is an option.
  • Egg white omelette - If you are not feeling egg yolks, this is also a great option. Ask to have it made with lots of veggies and hold the breakfast potatoes. Egg whites have zero fat so consider bulking them up with healthy fat such as avocado, guacamole, or cheese (if you can tolerate).
  • Scrambled eggs - With lots of veggies. Depending how hungry you are, you could consider adding avocado, guacamole, or cheese for some extra fat or another serving of protein such as turkey. Note: be weary of sausage or bacon which are processed meats and may also have had sugar added to them.
  • Eggs - When in doubt, order a side of 3-4 eggs. Poached is best because the eggs are cooked in water without any added oil.
  • Oatmeal - PLAIN. No added raisins/maple syrup/brown sugar/honey/agave etc. Berries are ok. This is your choice only if you are really craving something carby or sweet, and if you are between this and ordering the stack of pancakes. Add some cinnamon on top to blunt the blood sugar increase that comes with eating carbs.
Drink:
  • Prosecco - Mimosas are over-rated. Why waste any of that tiny flute space on some high sugar syrupy, over-processed orange juice? Prosecco has enough sweetness in itself, but if you must, ask for just a splash of OJ.
  • Dry white wine - “dry” is code for low sugar. Under all circumstances go for the drier wines such as sauvignon blanc and chardonnay. Stay away from riesling or white zinfandel tend to basically be grape juice.
  • Dry rose - Rose in general is pretty sweet. so a dry rose may be hard to find, but still worth asking if the restaurant has one available.

SK

Ketones: Burn Your Own Fat For Fuel

8/27/2017

 
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Have you ever heard of a ketogenic diet? A ketogenic diet means your body is using ketones for energy production rather than sugar. Ketones are an alternative fuel source for the body, and are produced when eating a high fat and low carbohydrate diet. This type of diet is called "ketogenic" because your body is in a state of "ketosis" meaning fueled by ketones rather than sugar (aka glucose). 

9 Reasons why you want your body to be fueled by ketones instead of sugar:


1. You literally burn your own fat for energy
Your body can run on either glucose or ketones. Which would you choose? Well, when you look at what this actually means: Glucose is produced from the breakdown of glycogen (strings of glucose), this means you are burning glycogen to produce fuel for your body. Ketones on the other hand are produced from the breakdown of fat (fatty acids), this means you are literally burning your own fat stores to produce energy. You can make ketones from eating very low carb (sub 50 net carbs), fasting, or consuming a product that can induce or supply ketones (such as MCT oil).

2. No more “Hangry”
You know that feeling when are so starving that every little thing is irritating, and you need to eat right. NOW? Terrible feeling right? Blame the carbs! After a blood sugar spike from eating carbs, this will trigger insulin whose job is to get that sugar out of your blood as fast as it can (because sugar in your blood is toxic and inflammatory), resulting in an even lower blood sugar than you started with. Low blood sugar (aka hypoglycemia) is that terrible anxiousness you are feeling. No bueno! And how do you make that feeling go away the fastest? Eating sugar. And the vicious cycle continues.

Fat is the only macronutrient that won't raise blood sugar, and therefore won't spike insulin. Yes, that means protein can also raise blood sugar when eaten in excess. That is why a ketogenic diet favors a higher fat and moderate protein intake.


3. Ketones favor less mental stress
The presence of ketones increases the production of the primary calm inducing neurotransmitter, GABA, while at the same time decreasing the primary stress inducing neurotransmitter, Glutamate. Ketones do this by assisting in the conversion of glutamate to GABA in the brain, thereby favoring a more calming state. Increasing the activity of GABA is essentially what most anti-anxiety medications aim to do as well - pretty cool you can get the same effects by just changing your diet! 

4. Ketones favor a more focused state
For the same reason ketones favor calmed brain activity, they also favor a more alert and focused state. As stated above, more GABA compared to glutamate in the brain favors a less stressed state, meaning there is less “noise” in the brain, allowing for greater focus and mental clarity.  This is why medium chain triglycerides (MCT) are marketed as a product that can increase focus and cognition - because they give the body ketones that can be used for fuel without having to be in actual ketosis from eating low carb.

5. Ketones are a more efficient source of energy
Ketones and glucose are both used as fuel by mitochondria to produce energy (aka ATP) - mitochondria are the part of a cell that takes fuel (either glucose or ketones) and manufactures energy from it. When comparing the output of energy produced from the use of ketones vs. glucose, more energy is produced when using ketones, thereby making it a more efficient fuel source. The presence of ketones also up-regulates the amount of mitochondria in cells, so more mitochondria means more energy produced. This is another reason for the improved focus and mental clarity seen with a ketogenic diet. 

6. Ketones act as antioxidants
Research has found that ketones act as antioxidants because they protect against oxidative damage from free radicals. When ketones are used to produce energy (by mitochondria) this process does not cause the release of free radicals, as does glucose when it is used to produce energy. Free radicals aka oxidative damage cause damage to cells and aid in the development of chronic disease, cancer, cognitive decline and other brain diseases, and aging. 

7. Ketones may prevent cancer growth
Compared to normal cells, cancer cells metabolize a much greater amount of glucose meaning they need more glucose to thrive. Cancer cells may preferentially use sugar to fuel their growth and proliferation, and research has shown that they may not be able to use ketones as fuel. Research has also shown greater response to chemotherapy when in a fasting state inducing ketosis. There is more research needed in this area, but ketones as a preventative measure for cancer is looking very promising! 

8. Greater absorption of nutrients
Major vitamin, antioxidants, and other nutrients need to be taken with fat to be able to be absorbed. This includes Vitamin D, Vitamin E, lycopene and beta-carotene such as in tomatoes, and the B vitamins.  Making sure you are taking in plenty of fats will ensure you are getting the most out of your food and supplements.  

9. Ketones are neuro-protective
Fueling the brain with ketones has shown to help with brain disorders such as seizures, brain cancer, Parkinson's Disease,  traumatic brain injury (TBI), and Alzheimer's Disease. There is a widely cited case of a physician who put her husband on a ketogenic diet as treatment of Alzheimer's disease and he improved within a couple of months. More research is needed on the direct effect of ketones for the prevention of diseases that affect the brain, but so far its looking very optimistic!

Side note: Ketones can supply up to 70% of the energy needed by the brain. It is true that your brain requires some glucose to function, but 
glucose can come from protein, it does not have to come from carbohydrates. It is a misconception that carbohydrates are necessary in your diet - they are not. Protein and fat are the two macronutrients your body definitely needs to manufacture all of the necessary components of the body.

SK

Note: all works cited can be found in the hyperlinks 

How To Choose A Protein Bar

8/24/2017

 
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Figuring out how to choose a healthy protein bar can be very tricky and I get the question all of the time about how to choose a good one. I always advise reaching for whole food first, but sometimes when you are desperate and starving, having a protein bar on hand can be great. However, most protein bars are full of chemicals and sugar and are no better (or might be worse) than eating a candy bar, yikes! 

Here is a cheat sheet of how to choose a healthy protein bar:

Sugar
Look for a bar with less than 5 grams of sugar (ideally 0-2 grams), and definitely do not grab a bar that has anything over 12 grams of sugar. Even if the label says something like "sweetened with dried fruit" or "natural sugars" bottom line is that sugar is sugar, certain types of sugar may be a little less bad for you, but sugar by any name is still not good for you.


Net carbs
Ideally there will be less than 10 grams of net carbs in the bar - lower the better. Net carbs are the carbs that impact your blood sugar, more sugar in your blood means greater insulin response, and greater insulin response means greater amount of sugar funneled into your fat cells (insulin is the fat storing hormone). You can calculate net carbs by subtracting the total fiber from the total carbohydrates listed. This is because your body does not process calories from fiber and they will not raise your blood sugar.


Protein
Look for a bar with plenty of protein because this is what is going to help to keep you full and help to keep your muscle mass. Protein is the hardest macronutrient for your body to breakdown, meaning it will take longer to be digested which will keep you fuller longer, AND you will burn calories just from the digestion of protein (because it takes energy to break it down). Aim for at least 15 grams of protein in the bar.


Fiber
More fiber the better, this should be at least over 5 grams. As discussed above, fiber is not absorbed by the body but your body will still work very hard to try and break it down! This means digestion is slowed down when you eat fiber (keeping you fuller longer) and more calories lost from the energy your body puts in to trying to break down fiber.


Fat
Fat will help to keep you full and satisfied because it takes a longer time to digest and will not raise your blood sugar at all - meaning no insulin response, yay! It will also make the bar taste better - be weary of any "fat free" protein bar, this usually means there is added sugar to make it taste better. Aim for at least a couple grams of fat.

Ingredients
This might be the most important aspect of the protein bar because most bars are full of chemicals which can throw off hormones and may even cause you to gain weight. Ideally there will be under 10 ingredients on the list, you will be able to pronounce all of the ingredients, there will be no chemical names, and all ingredients will be from whole food source such as almonds or coconut. 

​Good luck!

SK




Crucial Tips You Should Be Doing To Save Your Skin From Sun Damage

8/17/2017

 
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You should be wearing sunscreen every. single. day. to prevent damage of your skin - everybody knows that. But here are some more tips and recommendations that you may not have heard and to keep in mind every time you are exposing your skin to the sun.

Here are 11 tips to help you stay safe in the sun:


1. Apply sunscreen before getting dressed
This will prevent you from missing areas that were semi-covered by your clothing or undergarments, and also gives the sunscreen time to sink in - most sunscreens needs 30 minutes or more to sink in to give you optimal coverage.

2. Sunscreen spray should be sprayed a maximum of 4-6 inches from your skin  
You want to make sure you are getting concentrated sunscreen on your skin, spraying from farther distances means less sunscreen on your skin and more lost in the air.

3. Rub in sunscreen after spraying
Your skin should have an even sheen after spraying and you need to make sure to rub this in  to ensure coverage - don't miss this crucial last step!

4. Wear sunscreen of at least 15 SPF and no more than 50 SPF
Don't worry, you will still get some color even if you are wearing sunscreen at this level. Studies have shown that SPF above 50 really doesn't give you much more protection - but will cost your more money - so no need to go above this.

5. Wear clothes 
Clothing
 is your first line of defense. Clothing does not give you 100% protection but it still definitely helps protect your skin from damaging sun rays.

6. Wear a hat
The best would be a wide-brimmed (3-inch or greater) hat to give your face complete coverage, but even a baseball cap will help, just be sure to always apply sunscreen to your ears and nose.

7. Wear sunglasses
Sun rays can damage the eyes, eyelids, and the thin skin directly surrounding your eyes. It is important to protect your eyes year-round because even overcast sky can be harmful and cause damage to the eyes. Your best choice includes large frames that wrap around to prevent light penetrating from all angles.


8. Zinc oxide
This is the safest and most effective sunscreen agent because it sits on top of the skin and provides full spectrum coverage by reflecting UVA and UVB rays away from the skin. Another great thing about zinc oxide is that it starts working immediately once applied - no need to wait for it to sink in like chemical sunscreens. Look for the zinc oxide percentage to be over 10%, the greater percentage means greater the coverage.
​

9. Reapply sunscreen
This means after getting out of the ocean or pool, toweling off, after exercise where you are breaking a sweat, and/or every 1.5 to 2 hours. This is especially true of chemical sunscreens, zinc oxide will give you a little more leeway, but regardless you need to make sure you reapply if you are directly in the sun.

10. Aim for shade 10am-4pm
The suns rays are the strongest between 10am and 4pm, so good idea to stay in the shade during this time - along with wearing your protective garments and sunscreen :)

11. Your body needs  a shot-glass full of sunscreen
Most individuals do not apply enough sunscreen to fully protect their body and face. At least a shot-glass, or two tablespoons, of sunscreen is needed for adequate coverage.

SK

What You Should Know Before Starting a Keto Diet

8/10/2017

 
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A ketogenic diet means that most of your calories are coming from fat, you are eating a moderate amount of protein, and keeping carbs low - around 50 grams net carbs. In my opinion, when done correctly this type of diet is best for controlling and preventing chronic disease - most notably diabetes and obesity - and can make you feel awesome! Note: I advocate for a little more protein and a little more carbs than the traditional hardcore ketogenic diet (i.e. carbs under 20 grams) and I am a proponent of a cyclical ketogenic diet which means carb refeeding 1-2 days per week - more on this below and in a future post. 

Here are some things to know before starting a ketogenic diet:

1. You need to increase your salt intake
When you are in ketosis your body will rapidly be shedding electrolytes, most notably sodium, from your kidneys. Unless you have a medical condition by which you are forbidden to eat salt, add sea salt or Pink Himalayan Salt to your meals, and opt for bouillon balls and/or bone broth as other ways to get salt into your body.

2. You need to increase your fluid intake
Water follows sodium, so as your kidneys are shedding off more sodium you are going to lose more water as well. Carbohydrates also hold onto water, so eating less carbs means less water stored in your body, and that you need to increase your water intake. Shoot for 2-3 liters of fluid per day at least.


3. Don’t eat too much protein
It’s hard to eat too much protein, but it is still good to know that yes, you can have too much. Too much protein can cause your body to convert the excess amino acids to sugar, and sugar triggers the release of insulin (fat storage hormone) which can lead to fat gain. A rough estimate of how much protein you should be getting is 0.7-1.0 grams per pound of body weight. More protein is needed for an individual who exercises hard daily, because more amino acids will be needed to repair the muscle that has been broken down.

4. 
Expect the keto "flu"
As your body switches from sugar burning to fat burning for fuel this can cause what is known as the “keto flu.” It means you may feel lethargic, foggy, and run-down. Do not worry - this will not last long but does happen when switching to this type of diet.

5. Stick to healthy fats
Ketosis does require most of your calories to come from fat, that being said, you want to stick to the good non-processed, grass-fed, natural fats. These include eggs, fatty fish, coconut oil, olive oil, full-fat dairy, avocado, and nuts. Things to definitely avoid include processed meats and processed cheeses.

6. 
Consider increasing carbs one or two days a week
I am a huge fan of a cyclical ketogenic diet which means you are increasing your carbs 1-2 days per week, or having a "carb-refeed." Individuals working out hard everyday or few days a week will burn through their glycogen stores faster, and may need to increase their carbs twice a week or more. The hormone leptin which helps to regulate appetite, can also become low on a ketogenic diet and is boosted up when you eat carbs. Women are especially susceptible to leptin changes and should definitely be re-feeding carbs 1-2 days a week at least. Probably the only group of individuals who may not see a benefit from increasing carbs once a week are men who do zero exercise - which hopefully fits the description of no one reading this because exercise is great for your body and mind! 

7. You might develop dry eyes
This happens when you are eating very low carbs for a long time because tear production requires some glucose. This symptom actually happened to me long before I understood a keto diet could cause this, and can be very irritating and even lead to more severe eye problems. When your eyes are getting very dry this may mean you need to up your carbs a little more daily, and increase the number of days you do a carb-refeed.

Look for an upcoming most where I will go over all the benefits of a cyclical ketogenic diet :)

SK

The Herbs & Spices You Should Be Using

8/3/2017

 
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Herbs and spices are a great way to bring out the flavors in a dish without adding unwanted sugar or carbs. They are also great way to enhance the antioxidant, vitamin, and mineral profile of your meal. To get the greatest benefits, always use high quality, organic, fresh or dried herbs and spices and avoid storing in a hot or damp place.

Here is a list of my top 10 favorite herbs and spices:

1. Turmeric
This spice has strong anti-inflammatory and antioxidant power, and is best served with savory dishes such as with vegetables, fats, and proteins.

2. Paprika
This spice is rich in antioxidants and vitamins and is best served with savory dishes such as with vegetables, fats, and proteins.

3. Pink Himalayan Salt
Unlike common table salt which is heavily processed and devoid of nutrients, this type of salt is very low processed and also contains up to 84 different trace minerals. This can be used to bring out flavors in both sweet and savory dishes.

4. Cayenne
Capsaicin is the active ingredient that gives this spice its spiceness and is best served with savory dishes such as with vegetables or protein.

5. Cinnamon
This spice helps to keep blood sugar normal and can even blunt blood sugar spikes when added to carbohydrate meals. For this reason, this spice is great for preventing Type 2 Diabetes or for those with Type 2 Diabetes. Cinnamon can be used with both sweet and savory dishes.

6. Dried red pepper flakes
This spice contains polyphenols which are antioxidants that combat cellular damage and in effect may lower your risk of certain cancers. The “hotness” of this spice may help rev your metabolism. This spice is best used with savory dishes such as with vegetables, fats, and proteins.

7. Stevia
Stevia is an herb that comes from the leaves of a plant and is a natural (or near natural) sweetener. This is the only sweetener that I recommend because it has been studied extensively and so far has shown to have no ill effects to the body. It has also shown to not cause blood sugar spike after eating - which happens after eating sugar or certain other sweeteners. Check the label before buying and make sure there are no added ingredients or processing steps listed.

8. Basil
This herb has anti-inflammatory, antioxidant, and antibacterial properties. It is quite versatile and is well paired with savory dishes as well as fruits such as berries, melon, and tomato.

9. Rosemary
This herb is anti-inflammatory and may boost alertness and improve memory. It is best used with savory dishes such as with fish and poultry.

10. Oregano ​
This herb has both strong antibacterial and anti-inflammatory properties, and has shown to be possibly helpful for menstrual cramps, bloating, and preventing or treating mild respiratory infections.

SK    ​
Note: all references are cited within the hyperlinks 

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