Author name: laura@lauracipullo.com

Navigating the Holidays While in Recovery: A Compassionate Guide By Paige Mandel MS, RD, CDN Adapted from Balance Webinar “Holiday & Recovery: Your Guide to Navigating the Holidays and Recovery” hosted by VP of Admissions & Clinical Services Danielle Levitine, MS BC-DMT LCAT CED-CAT and Dietitian Quinn Haisley, MS, RD. Recorded Webinar & discussion linked here   Why Are The Holidays Difficult to Navigate While in Recovery? The holidays typically mean being around an abundance of food and potential food triggers Diet and food talk increase during the holiday season Challenging interactions with family Heightened stress can increase the urge to rely on unhelpful behaviors   The Before: How to Prepare Identify your needs Set your goal Ex: I will complete my meal plan today List out potential trigger points What resources do you have to navigate these potential triggers? Create, review and communication your plan with your team of providers Reach out to someone at the event who you can share your holiday recovery plan with   Set your mentality Be compassionate with yourself Give yourself permission to enjoy the moment Set expectations that feel good Set boundaries with your family members ahead of time Examples: Please don’t make comments on other people’s appearance during this holiday I am really looking forward to getting together for the holidays! To make it as enjoyable as possible for me I’d rather we don’t talk about weight or food Allow yourself to say no Focus on gratitude Prepare for things that are going to be out of your control such as food choices and preparation style   Action steps Prepare your self-soothing toolbox Wear comfortable clothing Schedule your meals and snacks Do your favorite self-care activities Gather inspiration of why recovery is worth it to you to have handy Plan fun activities before and holiday events to help keep a positive focus and balance i.e. ice skating, baking cookies with family, massages Set reminders on your phone to check in with yourself throughout the day Make sure your recovery plan is accessible and ready to go   During the Event: Follow your meal plan Aim to eat regular meals and snacks throughout the entire day If you can, pack snacks if you know you will be away from home for a long period of time. However, don’t use this to replace fear foods with safe foods Enjoy variety! Approach food with curiosity Look for your early warning signs that can lead to unhelpful behaviors such as spike in feeling body dissatisfaction Avoid making body judgements Set boundaries or walk away from any conversation regarding body talk If you have strong urges Reach out to your support person who you feel safe and comfortable talking to, someone in your corner Utilize your tool box Have a supportive exit strategy in case you feel overwhelmed   After the event: Defining your exit strategy What to prepare for Can you be alone after the event? Do you want someone to be with you? Do you have adequate support? What positive activities can be supportive? Volunteer Schedule session with team Journal Self-care

Navigating PCOS with a Weight-Neutral Approach By Rebecca Jaspan, MPH, RD, CDN, CDCES Edited By Laura Cipullo, RD, CDCED, CEDRD-S Polycystic Ovarian Syndrome, or PCOS, is an endocrine disorder that occurs in 4%-20% of women of reproductive age1.  It is characterized by imbalances in androgens, progesterone, and insulin.  Due to these hormonal imbalances, women may experience a wide variety of symptoms including fatigue, hirsutism or unwanted hair growth, hair loss, difficulty losing weight, irregular or painful periods, acne, mood disorders, and diabetes or heart disease.  In order to be diagnosed with PCOS, you must meet two out three criteria including presence of ovarian cysts, abnormal or irregular periods, and high levels of androgens detected through blood work2. When women are first diagnosed with PCOS, many are told to lose weight without any advice or instruction for how to do this.  They may also not be given other treatment options beyond weight loss and birth control to regulate their periods.  Through early attempts at decreasing calories and increasing exercise, many women may see some temporary improvement in symptoms, but become frustrated at not seeing any movement on the scale. In PCOS, women experience hyperinsulinemia, an overproduction of the hormone insulin that is used to move sugar from our blood into our cells to be used for energy.  This causes insulin resistance and contributes to maintenance of high levels of androgens, inflammation, and metabolic syndrome3.  Insulin resistance leads to inaccurate hunger and fullness cues, increased carbohydrate cravings, and an altered metabolism.  Consequential restricting of calories and or carbohydrates, in attempt to lose weight can increase these cravings and further affect metabolic function. It is understandable that women diagnosed with PCOS may end up feeling discouraged and confused. Research shows there is evidence for non-diet strategies for PCOS management, meaning you can still improve your PCOS symptoms without focusing on weight loss.  In one study, exercise was associated with reduced insulin resistance independent of weight change4.  There is also evidence that shows adhering to a low glycemic-index diet had its greatest improvements on insulin resistance and menstrual irregularity5. There are several ways to manage PCOS other than losing weight.  There are many changes you can make in your diet and lifestyle to improve your symptoms.  First, it is important to eat enough calories for a healthy metabolism (known as basal metabolic rate) and eat your meals and snacks evenly throughout the day in a balanced manner. Eating a “consistent carbohydrate diet” helps to maintain blood sugar levels, preventing any major spikes of insulin.  Next, you will want to focus on having a balanced plate, or including a protein, carbohydrate, and fat at each meal and two out of the three macronutrients at snack time.  Fat and protein help stabilize blood sugars, increase levels of fullness and satisfaction. Finally, choosing high fiber carbohydrates (aka complex carbs), such as beans, whole grains, and vegetables, is helpful for insulin resistance.  Fiber helps food digest slower in the body, slowing the release of glucose into the bloodstream.  You can absolutely still include refined grains and sugar in your diet but in small amounts throughout the day, rather than all at once. Balance higher fiber foods with refined grains and pairing those foods with a leaner protein and plant fat. Beyond diet, there are a number of lifestyle factors to consider in managing PCOS.  Chronic stress plays a major role in inflammation in the body, increasing cortisol and insulin levels6.  Our bodies are meant to withstand temporary amounts of stress, but chronic stress wreaks havoc on our hormones and mental health.  If you have PCOS, make sure you find some outlets for that stress- reaching out to a loved one for support, therapy, meditation, or listening to music.  Additionally, research shows effectiveness of movement in improving reproductive function, regulating periods, and improving insulin sensitivity in women with PCOS7.  Incorporating movement such as walking, yoga, biking, or light strength training can be helpful for improving symptoms. If you have PCOS, be sure to talk to a dietitian on our team at Laura Cipullo Whole Nutrition.  We take a holistic approach to provide specific recommendations for your lifestyle so you can feel confident managing your symptoms. We encourage you to focus on your health rather than weight. References Deswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J Hum Reprod Sci. 2020;13(4):261-271. doi:10.4103/jhrs.JHRS_95_18 https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?. Fertil Steril. 2012;97(1):18-22. doi:10.1016/j.fertnstert.2011.11.036 Woodward A, Klonizakis M, Broom D. Exercise and Polycystic Ovary Syndrome. Adv Exp Med Biol. 2020;1228:123-136. doi:10.1007/978-981-15-1792-1_8 Hutchison SK, Stepto NK, Harrison CL, Moran LJ, Strauss BJ, Teede HJ. Effects of exercise on insulin resistance and body composition in overweight and obese women with and without polycystic ovary syndrome. J Clin Endocrinol Metab. 2011;96(1):E48-E56. doi:10.1210/jc.2010-0828 https://www.sciencedaily.com/releases/2012/04/120402162546.htm Marsh KA, Steinbeck KS, Atkinson FS, Petocz P, Brand-Miller JC. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am J Clin Nutr. 2010;92(1):83-92. doi:10.3945/ajcn.2010.29261

Navigating Eating in College: Dorm/Apt Grocery Staples By Paige Mandel, MS RD CDN In Part One of this blog series, we learned first what normal eating looks like, and then how to address the what and when of eating while away in college. A recap in short, “normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food, and your feelings”1. If you missed our last post, you can find it here. This post, part two, will touch on another way to tackle the what of eating, but also how to navigate some of the where. An obstacle I often hear from college students is that there either is “no time for” or “no good place for” a quick meal or snack throughout the day. While the dining hall is usually the gold standard for meals on many campuses, fostering social meal time with friends, it is not always the most convenient to your schedule. Knowing what food you could have on hand for those early morning classes, late study nights, or days spent out and about on campus, is essential to navigating eating in college. Set yourself up for success, to be well equipped when that early sign of hunger strikes. Honoring your hunger at this early point not only keeps you from getting hangry, but also keep your blood sugar levels stable. This helps to teach your body and mind that food is not scarce and is always coming shortly, training your nervous system to keep anxiety at bay. Pro tip: be prepared. Refrigerator space is frequently limited, whether that is due to college dorm appliances or shared spaces with roommates, therefore you must learn to be strategic with what you fill it with. Secondly, grocery stores are not always easy to get to and from without a car, so filling your fridge, freezer and pantry with items that have an extended shelf life is also something to think about. Pro tip: if a grocery store is not accessible for you, consider looking into grocery delivery services such as Instacart, Fresh Direct or Amazon Fresh to see if online orders are available in your area. Fridge Staples: Eggs (can buy pre-cooked hard boiled if you don’t have cooking appliances) Yogurt Milk String Cheese Cottage Cheese Hummus Avocado Veggies: i.e. carrots, cucumbers etc. Freezer Staples: Amy’s Frozen Meals/Microwavable Meals Bell & Evans or Applegate Chicken Nuggets Pre-cooked Chicken Strips Frozen Veggie Medley Pantry Staples: Oatmeal Peanut Butter or Almond Butter Jelly Individual Pack Nuts and/or Trail Mix (especially helpful to pack for class/on-the-go) Fruit: i.e. apples, bananas, oranges (don’t need to be refrigerated) Dried Fruit Pretzels/Crackers Popcorn Cereal/Granola Kind Bars/Granola Bars Bread/Bagels/English Muffins Minute Rice Annie’s Mac & Cheese Pasta (if cooking appliances are available) Jerky Microwavable Soup These staples are some ideas to help you get started into stocking your fridge, freezer and pantry to whip up balanced meals or snacks at home or pack for on-the-go between classes, study hours, etc. Many questions are asked from college students learning to navigate eating in their different environments, and will continue to be answered throughout this series – Navigating Eating in College. If you have any topics you would like to know more about, or would like to schedule an individual session to get your personal questions answered and needs met – email me at paige@lauracipullo.com

Fall in Love with Fall Snacks By Rebecca Jaspan, MPH, RD, CDN, CDCES   It is finally feeling like Fall in the Northeast.  The air is getting cold and crisp and the sweaters and ready to make their way out of the closet.  It also has me craving all the Fall flavors- pumpkin, apple, cinnamon, and more.  I love enjoying these flavors all day long, so I try incorporating them into easy and delicious snacks.   Fall foods are packed with nutrition as well.  Pumpkin and winter squashes are a great source of Vitamin A, an antioxidant that also helps the body fight infections.  The seeds of the pumpkin are also a nutrition powerhouse, containing healthy fats and magnesium, important for forming and maintaining healthy bones.  Warm Fall spices such as cinnamon and nutmeg contain antioxidants, help reduce blood pressure, and relieve digestive discomfort.  Lastly, fruits such as apples and pears in peak season during these months are a good source of fiber, specifically pectin, which nourishes bacteria in your gut.   Here are some of my favorite and fun Fall snacks you can enjoy all October and November long.   Butternut squash toast   We all have a can of pumpkin puree in our pantries, but have you ever tried butternut squash puree?  I love it in breads, as a pasta sauce, and yogurt as a twist on pumpkin.  And the leftover is a perfect, sweet spread for toast.  I like combining the puree with Greek yogurt, nuts, and seeds for protein and fat to create a simple and satisfying snack.   Apple chips with Greek yogurt and cinnamon   Have you gone apple picking and have so many apples you don’t know what to do with them all?  Try making apple chips for a sweet and crunchy snack paired with Greek yogurt.  They are so easy to make with just two ingredients.  First core your apples and slice them into very thin rounds, about 1/8 inch thick.  Spread them in a single layer on a baking sheet and sprinkle with cinnamon.  Bake them in a 200 degree oven for 1 to 1 ½ hours until the apples are crispy.  Add them to Greek yogurt or dip in peanut butter and sprinkle on more cinnamon!   Kettle corn, nuts, and M&Ms mix   The smell of kettle corn always reminds of going to the pumpkin patch as a kid.  And the sticky texture goes perfectly with crunchy nuts and chocolate.  I like to mix and match whatever I have around the house, from peanuts to pecans or cashews.  Don’t have M&Ms?  Any leftover Halloween candy goes great in this mix!   Baked pear with yogurt   Unpopular opinion: pears are better than apples.  And baked pears stuffed with creamy yogurt are the perfect Fall treat.  Cut a pear in half and scoop out the seeds.  Bake the halves in a 350 degree oven for about 10-15 minutes, until they become soft.  Scoop vanilla yogurt into the center and top with granola, pumpkin seeds, or chocolate chips!   Chocolate chip pumpkin bread with peanut butter   Who doesn’t love a cinnamon-y pumpkin bread in the Fall?  I love baking multiple batches and keeping loaves in the freezer for easy breakfasts and snacks.  A slice alone usually doesn’t fill me, but adding a smear of peanut butter gives it more staying power for a filling and satisfying snack.          

Starting Your Mindfulness Practice: Five Key Steps By Rebecca Jaspan, MPH, RD, CDN, CDCES   The term “mindfulness” gets thrown around a lot these days, but what does it actually mean to practice mindfulness?  The dictionary definition of mindfulness is “the quality or state of being conscious or aware of something” or “a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations.”  With so many distractions in our lives, from work or school demands to social media, it is challenging to practice mindfulness.  However, bringing mindfulness into your daily life has significant effects on your health.  Chronic stress and anxiety can lead to depression, burnout, substance abuse, insomnia, and hopelessness.  Dedicating even just one minute a day to a mindful practice can decrease your risk of negative health effects and help you to start feeling better.   At Laura Cipullo Whole Nutrition, we firmly believe in the practice of mindfulness in eating disorder treatment and strive to help our clients use strategies in their road to recovery.  Here are five ways you can begin practicing mindfulness.   Be gentle with yourself   We all have negative thoughts, but attempting not to think about them doesn’t help.  In fact, trying not to think about a thought makes it even stronger.  According to Dr. Andrea Bonior, licensed clinical psychologist, it is our response to our thoughts, worry, and stress that help or hurt us.  Rather than tell yourself to stop thinking about something and maybe get angry with yourself for having the thought in the first place, try to notice your thought in a gentle and non-judgmental way.  Speak kindly to yourself and the thought may become less powerful.   Be curious and nonjudgmental   Practice being an active observer of your thoughts.  If you notice yourself ruminating over something specific, get curious about why.  Ask yourself “I seem to be thinking about that a lot today, what’s going on that might be causing this?”.  When we separate ourselves from our thoughts and observe them, it is called “cognitive defusion”, because we are literally de-fusing from our thoughts.  Bringing curiosity and loving kindness to your thoughts can decrease depression and anxiety.   Engage with the present moment   Bring awareness to your breath and notice it without trying to change anything.  Notice how you feel in the present moment.  How does your chair feel beneath you?  Is the temperature in the room warm or cool?  Ask yoursel questions like to bring your awareness back to the present.  This may cause you to feel uncomfortable or feel the difficult emotions.  It is important to sit in your discomfort and learn to tolerate it.  When we consistently avoid discomfort, we teach ourselves that we can’t handle it, and this moves us further away from presence and mindfulness.  We need to allow ourselves to feel and manage uncomfortable emotions and tell ourselves we can handle it.   Be aware of your bodily sensations.   We tend to mask or hide our stress and anxiety when actually it can be really helpful to notice and label what you are feeling in your body during a stress response.  Oftentimes, when we begin to panic, we are responding to and interpreting whatever is going on in the body as a threat.  The next time you notice yourself starting to get anxious or panic, notice your heart rate, your breathing, your sweaty palms.  Try to label these sensations in a curious and non-judgmental voice and maybe even write them down.   Bring awareness to your thoughts and feelings   Research shows that labeling our thoughts and feelings makes them more manageable.  Try to acknowledge your thoughts as just thoughts.  Put the phrase “I am having the thought that…” in front of your distressing thought and notice how that changes your feelings.  Remember that just because you are having a thought does not making it automatically true and you have the ability to challenge the thought.

Hashimoto’s Thyroiditis: Which style of eating is best for you? By Rebecca Jaspan, MPH, RD, CDN, CDCES   Have you been recently diagnosed with Hashimoto’s thyroiditis?  If you’ve gone to “Dr. Google,” you might be overwhelmed with mountains of information; everything from different foods to avoid to the dozens of supplements you should take.  Some of this information might even be contradicting itself. I would assume you’re not even sure where to begin.  To start, close “Dr. Google” and talk to your registered dietitian, who can help you make an individualized plan that works for your symptoms and lifestyle.   There are a number of diets recommended for Hashimoto’s.  While research is limited in telling us the best go-to intervention, it is known that diet and lifestyle modifications are a key way to reduce symptoms along with medication prescribed by your endocrinologist.  These changes help reduce inflammation, slow or prevent further thyroid damage, and manage blood sugar and cholesterol levels1.   So, what diet is best for Hashimoto’s?  Some research recommends cutting out gluten or dairy.  Others find symptom relief from a plant-based, anti-inflammatory diet.  And some individuals follow the Autoimmune Protocol Diet, which is a strict elimination diet followed by phased reintroduction of foods.  Everyone responds differently based on their symptoms, so it’s best to talk with your doctor and registered dietitian to figure out what might be best for you.  Let’s take a deeper dive into some of these eating patterns.   Many individuals find symptom relief when they eliminate dairy and gluten from their diet. There is a high prevalence of lactose intolerance and sensitivity to milk protein in individuals with Hashimoto’s2.  When dairy is consumed, the immune system activates and leads to increased inflammation.  One study showed decreased TSH levels in patients who avoided lactose2.  Studies show symptoms relief from following a gluten-free diet as well.  Due to an increased risk of celiac disease with Hashimoto’s, it is advised that all patients with Hashimoto’s are screened for celiac disease3.  This association may be explained by low selenium and vitamin D due to malabsorption3.  A study investigating the efficacy of a gluten-free diet in 34 women with Hashimoto’s found that a gluten-free diet reduced thyroid antibodies and increased vitamin D and concluded that a gluten-free diet may show clinical benefits for patients with Hashimoto’s3.   As inflammation is a driving force of Hashimoto’s, increasing intake of anti-inflammatory foods may be helpful to relieve symptoms.  A study with 218 women with Hashimoto’s showed decreased oxidative stress in those who ate fruits and vegetables more frequently4.  Additionally, a significant positive association was shown between anti-inflammatory plant oil consumption and T3 levels in patients with Hashimoto’s5.  Another study showed decreased serum thyroid autoantibodies with increased consumption fatty fish intake6.   Finally, the Autoimmune Protocol Diet was designed for people with autoimmune diseases.  It involves phased elimination and reintroduction of foods such as grains, dairy, nightshade vegetables, added sugar, coffee, legumes, eggs, alcohol, nuts, and seeds.  In a study with 16 women with Hashimoto’s disease, the AIP diet showed decreased levels of C-reactive protein, an inflammatory marker, and increased quality of life7.   The diet for Hashimoto’s is extremely individualized and may involve a series of trial and error.  Be sure to work with your registered dietitian to find what style of eating works best for your body and symptoms.    

Navigating Eating in College: Where Do I Start? By Paige Mandel, MS RD CDN   Whether you’re the new kid on the block as a freshman, or gearing up for your final semesters as a senior, you are in the driver’s seat for almost all of your food decisions. For many, this may be very different from what you’re accustomed to at home. Historically, you may be used to what Ellyn Satter has coined as the “Division of Responsibility” in Feeding. This outlines that to nurture a positive feeding relationship the parents are responsible for the what, when and where of feeding, and the child does the how much and whether of eating1. So what happens once you go off to college?   This is a big fear for many current and soon-to-be college students, amongst many new decisions you have to make. Navigating your way, being the little fish in a big pond, can come with many challenges, obstacles and opportunities to finding your authentic self. It is important that your body is adequately fueled to guide your journey.   Therefore, let’s start at the very beginning.  Whether this is the first time you are learning how to feed yourself or relearning to eat in order to heal your own relationship with food, understanding what normal eating may look like this:   Step One. “Normal Eating is: Going to the table hungry and eating until you are satisfied Being able to choose food you like and to eat it and truly get enough of it- not just stopping because you think you should Being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food Sometimes giving yourself permission to eat because you are happy, sad, or bored, or just because it feels good Mostly three meals a day—or four or five – or it can be choosing to munch along the way Leaving some cookies on the plate because you know you can have some again tomorrow, or eating more now because they taste so wonderful Overeating at times—feeling stuffed and uncomfortable. And it can be underrating at times and wishing you had more Trusting your body to make up for your mistakes in eating Takes up some of your time and attention but keeps its place as only one important area of your life In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food, and your feelings”1.   Step Two. Next, you need to develop an understanding what makes up a balanced and nourishing meal or snack to keep you energized, satisfied and sated throughout your busy day. This will help cover the what of eating. A balanced meal has 3 main components, otherwise known as the 3 macronutrients: protein, carbohydrate, and fat2.   Why Carbohydrates? Carbohydrates are the body’s main and most efficient source of energy. What is considered a carb? Bread, pasta, cookies, cakes, pastries, fruits, vegetables (emphasis on the starchy veg such as potatoes, sweet potatoes, corn, peas, butternut squash), beans, legumes, rice   Why Proteins? Proteins are the primary component of muscle and essential for the formation of all cells and repair of all tissues of the body. Protein also helps to keep us full between meals. What is considered a protein? Eggs, chicken, turkey, seafood, beef, pork, lamb, yogurt, tofu, beans, nuts, nut butters, cheeses   Why Fat? Fats support organ and tissue structure and function as well as aid in the absorption of fat soluble nutrients. Dietary fat is essential for growth and brain development as well as blood pressure, heart rate and nervous system regulation. Fat is known as the “satiety” nutrient (along with protein) to keep us feeling sated, giving our meals “staying power” What is considered a fat? Avocado, olives, olive oil, canola oil, chia seeds, flax seeds, hemp seeds, pumpkin seeds, nuts, hummus, butter, whole fat milk, cheeses   Step 3 Now is the time to create a flexible meal structure for yourself3, relative to your schedule, access to food and social life. This will help cover the when of eating. This could look like breakfast, morning snack, lunch, afternoon snack, dinner, evening snack, or on some days can look like snack, breakfast, lunch, snack , snack, dinner, or any combination of meals and snacks. The goal is to aim to fuel and refuel your body every 3-4 hours to keep your energy stable and to teach your body that food is always accessible. This also prevents you from becoming too hungry or hangry, often leading to mindless eating, overeating or disconnection from your body’s innate hunger/fullness cues.   What about the dining hall? What should I have in my dorm/apartment?  What about late night eating? What if I need to pull an all-nighter for an exam? How do I know how much to eat? Am I eating too much/too little? What about exercise?   All of these questions are common from college students, and will continue to be answered throughout this series – Navigating Eating in College. If you have any topics you would like to know more about, or would like to schedule an individual session to get your personal questions answered and needs met – email me at paige@lauracipullo.com   References: Satter E. Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook. Kelcy Press; 2008. Myers, MPH, RD, LDN, CEDRD, FAND ES, Caperton-Kilburn, MS, RDN, CSSD, CEDRD, LDN, FAND C. WINNING THE WAR WITHIN. Cipullo, RD L. The Women’s Health Body Clock Diet.  

Hashimoto’s Thyroiditis: Managing Symptoms Through Diet and Lifestyle By Rebecca Jaspan, MPH, RD, CDN, CDCES The thyroid, a butterfly-shaped organ located at the front of the neck, is small but mighty.  The 2-inch gland is a major part of the endocrine system and affects almost every organ in the body.  It is responsible for regulating fat and carbohydrate metabolism, respiration, body temperature, brain development, cholesterol levels, the cardiovascular and nervous system, blood calcium levels, menstrual cycles, skin integrity, and so much more1.  Thyroid gland issues are fairly common in the United States with 27 million people affected with one of many thyroid abnormalities2.  Any issue with the thyroid gland puts someone at risk for cardiovascular disease, diabetes, and other metabolic disruptions.  The good news is that management with medication, diet and lifestyle changes under the guidance of a registered dietitian can provide the opportunity for the best quality of life. The most common thyroid condition is hypothyroidism, which is when the thyroid gland is under-active.  Hypothyroidism is typically caused by an autoimmune disease known as Hashimoto’s thyroiditis.  The body recognizes its’ own tissues as an invader and attacks its’ organ.  This causes the thyroid to release inadequate amounts of thyroid hormone to keep the body systems functioning properly2.  Consequently resulting in a slower metabolism, fatigue, dry skin and hair, slow heart rate, shortness of breath, constipation, menstrual irregularities, and many other symptoms3.  Hashimoto’s is largely caused by genetics and is associated with other autoimmune disorders as well such as type 1 diabetes, rheumatoid arthritis, and celiac disease4. If you feel that you are experiencing any symptoms of Hashimoto’s, it is important to see an endocrinologist who can diagnose your condition, and help develop a treatment plan with regards to mediation.  Your endocrinologist may have a RD in their office or you can seek the help of a RD, CDCES to help you develop easy diet modifications to manage symptoms, provide education regarding dietary supplements, and share tools and or exercises to decrease stress levels. Diet and lifestyle modifications are key to reducing symptoms and preventing further complications of Hashimoto’s.  Changes to reduce inflammation are ideal, but the focus should be on what to include rather than what to exclude.  It is important to be recognize any existing or history of disordered eating or even an eating disorder. Please share this with your medical doctor and dietitian, as some dietary modifications can seemingly feel restrictive.  Research does show an association between autoimmune diseases and the development of eating disorders5.  An experienced eating disorders dietitian known as a certified eating disorders specialist can guide you through these nutritional and lifestyle changes in a way that feels safe and inclusive. Addition of monounsaturated fats and omega 3 fatty acids such as fatty fish, avocado, nuts, seeds, and olive oil are helpful for reducing inflammation, slowing and preventing further thyroid damage3.  Due to the relationship between inflammation and the microbiome, taking a probiotic supplement may help improve the quality of the gut microbiota6.  Many individuals experience improvement in symptoms when following the Autoimmune Protocol Diet, which is an elimination diet that helps figure out which foods are harmful for the thyroid and which can be resumed.  This may require the individual to avoid gluten, dairy, and certain vegetables3.  Specific nutrients of concern are iodine, iron, selenium, zinc, magnesium, and Vitamin D which may require supplementation and a focus on foods high in these nutrients6.  Regular lab/blood tests ordered by your doctor in combination with nutrition sessions will ensure you maintain adequate levels of these nutrients. While a diagnosis of an autoimmune condition may be scary and the medical and nutrition management may seem daunting, finding a team with an endocrinologist and a RD, CDCES, CEDS you can trust will help you feel more at ease.  Here at Laura Cipullo Whole Nutrition, we are passionate about working with you collaboratively to help you manage your diagnosis of Hashimoto’s with realistic meal plans/structures, easy recipes, and supplement recommendations so you can feel calm and confident. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000;160(4):526-534. https://www.todaysdietitian.com/newarchives/070112p40.shtml https://www.healthline.com/nutrition/hashimoto-diet#diagnosis-symptoms Bethesda, MD: National Endocrine and Metabolic Diseases Information Service, US Dept of Health and Human Services; 2012. NIH Publication No. 12–6180. https://www.webmd.com/mental-health/eating-disorders/news/20140912/autoimmune-diseases-eating-disorders Ihnatowicz P, Drywień M, Wątor P, Wojsiat J. The importance of nutritional factors and dietary management of Hashimoto’s thyroiditis. Ann Agric Environ Med. 2020 Jun 19;27(2):184-193. doi: 10.26444/aaem/112331. Epub 2019 Oct 2. PMID: 32588591.

It’s that time of the year again where we start preparing for the Jewish holidays.