Alcohol: Is There a Healthy Way to Drink?

By Maya Shetty, BS

“Salud!” If you’ve ever raised a glass to your health, you’re not alone. For decades, many have believed that minimal alcohol consumption is potentially beneficial for your health. However, not every researcher would agree. A growing body of evidence reveals health concerns about alcohol use, making it crucial to understand the spectrum from harmless to harmful levels of consumption to keep your body healthy. 

“Alcohol will impact everyone’s health differently,” says Douglas Noordsy, MD, Clinical Professor of Psychiatry at Stanford University School of Medicine and Assistant Director of Stanford Lifestyle Medicine. “Rather than a daily habit, drinking alcohol should be seen as an indulgence, something you have once in a while to celebrate.”

Experts have conflicting views regarding how much alcohol carries risks. Some believe that drinking in moderation is safe, while others believe that even light drinking can cause harm.

“While many believe light to moderate alcohol intake is safe and even healthy, this reality is far from true,” states Cindy Kin, MD, a colorectal surgeon and Associate Professor of Surgery at Stanford University. “In fact, no level of alcohol can be considered beneficial for our health.”

Isn’t One Glass of Red Wine Good for the Heart?

“Studies have gone back and forth, with some suggesting potential cardiovascular benefits of light drinking, while others point to increased risk of cancer and liver disease even when consumed at low intake levels. As a result, many are confused about headlines proclaiming alcohol as either good or bad for health,” says Dr. Noordsy.

The origin of this belief traces back to the 1980s, rooted in a concept known as The French Paradox–the observation that despite consuming a diet high in saturated fat, France had a low incidence of heart disease. Researchers of the era decided that this unexpected trend was attributed to the widespread consumption of wine in the region. This correlation led to extensive research into wine and the identification of polyphenols, thought to be responsible for wine’s apparent cardioprotective potential. 

Since then, numerous observational studies have claimed that light to moderate wine intake has beneficial effects. “However, these studies overlooked some crucial factors,” says Dr. Kin. While early observations indicated poorer cardiovascular outcomes for non-drinkers than for moderate drinkers, researchers overlooked that many non-drinkers abstained due to existing health conditions that led to overall poorer health outcomes. Additionally, those self-identified as light drinkers were more likely to lead healthier lifestyles overall. This oversight has fostered a misleading impression that associates better cardiovascular outcomes with light drinking, falsely implicating alcohol as the causal factor. As a result, enjoying a glass or two of wine a day has become widely accepted as a  healthy habit. 

While red wine contains antioxidants like resveratrol, found in grape skins as well as in peanuts, dark chocolate, and blueberries, which might have heart-healthy benefits like reducing cholesterol and lowering blood pressure, the quantities are often misunderstood. To achieve the levels of resveratrol observed beneficial in mice studies, one would need to consume an impractical amount of red wine—somewhere between a hundred to a thousand glasses daily. Thus, while the idea of resveratrol’s benefits is enticing, the practical reality makes it an unrealistic source for therapeutic effects.

How Much Alcohol is Too Much?

Many people believe alcohol becomes a concern only when consumed excessively. “Excessive alcohol use” is defined as exceeding the US Dietary Guidelines’ recommendations, which advise males to limit themselves to two drinks per day and females to one drink per day, on average. Two-thirds of adult drinkers report drinking above this level at least once a month.

However, a growing body of recent research shows that even modest quantities of alcohol can be harmful to our health. Such consistent findings have prompted the World Health Organization to assert that “when it comes to alcohol consumption, there is no safe amount that does not affect health.”

The main issue with alcohol is that it enters the bloodstream and quickly spreads throughout the entire body (especially when consumed without food). Unlike most substances, alcohol is both water- and fat-soluble, allowing it to permeate nearly every cell and tissue, including the highly secure blood-brain barrier that protects our central nervous system. 

While the liver does most of the alcohol metabolism, other organs also process alcohol, such as the kidneys and lungs. As our organs work to break it down into a usable fuel source, acetaldehyde is produced, which is toxic due to its ability to damage and kill cells indiscriminately. As acetaldehyde enters the brain, it causes a disruption in our neural circuitry that creates the sensation of “tipsiness” associated with alcohol. And, the more “tipsy” one feels, the greater the amount of toxic acetaldehyde in the blood.

Rather than following strict guidelines about how much to drink, Dr. Noordsy recommends that individuals take note of their personal perceptions of intoxication and pace themselves accordingly. He recommends using the feeling of being “tipsy” as the signal to slow down or stop drinking. “The ‘tipsy’ feeling is the indicator that blood alcohol levels have risen to the point that you’re starting to put your health at risk. And the more ‘tipsy’ you become, the higher the risk,” states Dr. Noordsy. “If you’re having alcohol with food, your blood alcohol level won’t be as high as compared to having drinks by themselves. So, if you’re enjoying a glass of wine as part of your meal, that’s a very different thing than drinking in a way that’s leading to the feeling of intoxication.”

Health Concerns Linked to Alcohol Use

Recent data from the World Health Organization reveals that each year, alcohol contributes to three million deaths globally and accounts for 5.1 percent of the worldwide burden of disease and injury. Alcohol’s detrimental effects span more than 200 disease and injury conditions, encompassing everything from alcohol dependence and liver cirrhosis to a range of non-communicable diseases (such as heart disease, cancer, chronic respiratory disease, and diabetes) and mental health disorders.

Liver Disease

Acetaldehyde, a derivative of alcohol metabolism, inflicts significant harm on the body’s cells, especially within the liver. Given the liver’s primary role in detoxifying our bloodstream, it bears the brunt of the detrimental effects of alcohol metabolism. This continual strain can result in the buildup of fat, chronic inflammation, and potentially irreversible damage to the liver. 

A study analyzing the livers of 3,649 participants discovered a concerning correlation: as daily alcohol intake increased, so did the accumulation of fat in the liver. Alarmingly, no identifiable threshold existed below which these harmful effects were absent, suggesting that even individuals who consume alcohol in minimal amounts are not immune to the accumulation of liver fat.

Fat accumulation hinders the liver’s vital metabolic functions, including blood sugar regulation, cholesterol processing, and nutrient absorption. It also increases the risk of inflammation around the liver, known as alcoholic hepatitis. 

“The good news is that abstaining entirely from alcohol can reverse these changes, however, continuing to drink alcohol can lead to irreversible damage, scarring, liver dysfunction, and in advanced cases, liver failure,” states Dr. Kin. “This is especially concerning because fatty liver often presents no early symptoms, with individuals potentially unaware until it advances or results in serious complications.”

Another important consideration is that people who have non-alcoholic fatty liver disease, caused by obesity and other metabolic syndromes, have a much higher risk of developing alcoholic liver disease. 

“This means that even small amounts of alcohol will cause the same level of alcohol-related liver disease (fibrosis, cirrhosis, etc.) as would larger amounts of alcohol consumed by someone without underlying fatty liver,” explains Dr. Kin. “Therefore, people who are already dealing with metabolic diseases should be extra cautious around alcohol because their livers are working extra hard already.”

Cancer

Alcohol is designated as a carcinogen by the International Agency for Research on Cancer due to its association with higher risk for many common cancers.

Alcohol increases cancer risk specifically in areas it is in close contact with, such as the mouth, pharynx, and digestive tract. It also has carcinogenic effects throughout other parts of the body,” states Dr. Kin.

Underlying its harmful effects, chronic inflammation from alcohol consumption elevates cell turnover, heightening DNA mutation risks. Additionally, alcohol is believed to promote tumor growth while inhibiting tumor-suppressive molecules.

In 2017, the European Union reported nearly 23,000 cancer cases tied to light to moderate alcohol use, with half attributed to female breast cancers. Even at levels as low as three drinks per week on average, there is a slight but measurable increase in breast cancer risk. Notably, raising daily alcohol intake by just 10 grams—equivalent to what’s in a standard beer or wine—escalates the risk of breast cancer by 10 percent.

Cardiovascular Health

Despite popular belief, alcohol consumption, regardless of the amount, is linked to an increased risk of cardiovascular disease. A comprehensive study of 371,463 individuals found that as alcohol consumption increased, so did the risks of conditions like hypertension and coronary artery disease. Light alcohol intake (less than 8.4 drinks per week) led to a minimal but noticeable increase in cardiovascular risk. Researchers also found that when accounting for various lifestyle factors, the perceived protective benefits of modest alcohol intake against cardiovascular risks diminished significantly.

There are numerous reasons hypothesized for these detrimental effects, especially surrounding the metabolic effects of alcohol. “Alcohol offers no nutritional benefits; it’s essentially empty calories that are consumed on top of the calories required by your body. On top of this, alcohol interrupts the body’s regular metabolic functions. As the body prioritizes removing this toxic substance, it compromises processes like nutrient absorption and fat metabolism. This disruption promotes the storage of visceral fat, the harmful fat surrounding organs,” explains Dr. Kin. “This fat increases inflammation and poses significant risks, especially around the heart.”

Hormone Imbalance

Alcohol consumption raises estrogen levels in both males and females by increasing the activity of the enzyme responsible for converting androgens to estrogen. This accelerated conversion can lead to issues like gynecomastia (enlarged breasts in males), decreased libido, and increased fat accumulation. Additionally, consistent alcohol exposure can reduce testosterone levels over time, which is associated with reduced libido, fatigue, decreased bone density and muscle mass, and potential fertility issues in both males and females.

Additionally, regular alcohol consumption of more than 3.5 drinks per week for males and 2.6 drinks per week for females can cause chronic changes and reduced control of the hypothalamic-pituitary-adrenal axis. This disturbance may lead to an increase of the stress hormone cortisol released throughout the day.

Microbiome Issues

Alcohol also disrupts the gut microbiome by killing beneficial bacteria and other essential microbes. Additionally, alcohol’s pro-inflammatory properties trigger the release of inflammatory cytokines, causing gut inflammation and making the intestinal lining more permeable. This increased permeability can allow undigested food particles to enter the bloodstream. Over time, chronic alcohol consumption can further imbalance the gut microbiome, promoting bacterial overgrowth and dysbiosis. These disruptions can trigger immune responses, increasing susceptibility to food intolerances.

Brain Health

When alcohol is consumed, it enters the brain and suppresses neural networks involved in memory formation and storage. Through chronic consumption, this disruption can have permanent effects. A study involving over 36,000 middle-aged adults revealed that even moderate drinkers, consuming one to two drinks per day on average, displayed thinning of the neocortex and other brain regions, indicating neuron loss. This research also found that increased alcohol consumption correlates with diminished brain volume and reduced gray matter, which are the areas of the brain highly concentrated with neurons. As alcohol intake rose, so did the severity of these detrimental effects. 

Fortunately, for most casual drinkers, abstaining from alcohol for two to six months can reverse damage to the prefrontal cortex and neural circuitry. However, chronic users may only experience partial recovery and might endure lasting effects.

“As alcohol consumption increases, so does one’s risk of cognitive decline and dementia,” states Dr. Noordsy.

Mental Health

As anxiety and depression continue to rise in the US, alcohol use also increases as individuals self-medicate to reduce stress. Also, the nightly glass of wine may cause more stress the following day since it impairs cognitive and physical performance, reducing one’s ability to cope. “During the pandemic, we observed a startling rise in cases of alcohol-induced hepatitis, indicating a growing reliance on alcohol as a coping mechanism,” says Dr. Kin. 

One study, however, showed that light to moderate alcohol consumption may be beneficial to mental health by offering short-term relief by reducing stress signals in the brain. Although Dr. Noordsy acknowledges this study, he states that “learning to manage stress through physical exercise, mind-body and mindfulness practices can lead to safer and likely more effective mediation of impacts of stress than relying on alcohol use.” 

Is There a Healthy Way to Consume Alcohol?

Given the extensive research on the detrimental health effects of alcohol, both Dr. Kin and Dr. Noordsy recommend abstaining from alcohol, or at least drinking very rarely, if one is experiencing or has a family history of liver disease, cancer, cardiovascular disease, hormone imbalances, gut microbiome issues, dementia, or mental health disorders, including addiction.

The precise amount of alcohol that is harmful is difficult for experts to confirm because it’s different for each person. Therefore, when it comes to alcohol and health, Dr. Noordsy recommends a balanced, personalized approach keeping in mind one’s individual risk factors and health goals.

“While heavy, regular consumption is linked to health problems, an occasional drink with meals may pose little risk for most adults,” says Dr. Noordsy. “However, individuals with personal or family histories of certain cancers or other conditions may need to be more careful with alcohol intake. We put thought into our nutrition and exercise habits, and we need to be just as thoughtful about the role that alcohol plays in our lives and make informed decisions regarding how much is the right amount for ourselves.”

Although less inclined to recommend light alcohol consumption, Dr. Kin acknowledges that it is an ingrained part of people’s social and cultural lives, similar to many other things that individuals consume that do not contribute to health. So, she encourages individuals to reframe their mindset around alcohol. 

“Rather than viewing alcohol as a daily routine, consider it a treat reserved for special occasions or celebrations, much like enjoying a slice of birthday cake,” she says.

 

Protein Needs for Adults 50+

By Sharon Brock, MEd, MS

 

Key Take-Aways:

  • For adults aged 50+, we recommend consuming 1.2  – 1.6 grams of protein/kg of body weight per day (0.54 – 0.72 grams/pound body weight per day). For a 165-pound adult, this translates to roughly 90 – 120 grams of protein per day.
  • To build muscle past the age of 50, we need to eat enough protein AND do weight training, and consume 30 – 35 grams of protein within two hours of the workout.
  • Due to anabolic resistance, which increases as we age, it’s recommended to increase protein intake per meal to roughly 30 – 35 grams.
  • Here is a detailed list of the protein content of various foods.

 

While looking at the menu at your favorite café and deciding whether to add salmon to your salad, it’s important to remember that we should strive to eat protein with every meal for optimal health. Protein is found in animal products, such as meat, fish, eggs, and dairy, as well as beans, tofu, nuts, and many vegetables. In your daily life, protein is the milk in your coffee, the eggs and cheese in your omelet, the chicken and beans in your burrito, and the handful of almonds as your afternoon snack.

Protein is essential for a multitude of functions in the body. Not only does protein support the building of our muscle mass, it helps the body repair tissues and cells, makes immunoglobulins and antibodies to fight infection, and drives metabolic reactions like digestion for energy production. It also makes up hormones, like insulin, provides structure in the body, such as bone and collagen, balances fluids and pH, as well as transports nutrients throughout the body, like blood sugar and cholesterol.

“It’s important to learn about protein and make sure we are eating enough because it’s a major building block of our bodies,” said Marily Oppezzo, PhD, MS, RDN, DipACLM, Nutrition Scientist and Head of the Stanford Lifestyle Medicine Nutrition Pillar. “We need to eat enough protein every single day to get the essential nutrients necessary for optimal health and functioning.”

How Much Protein Do You Need Every Day?

The federal guideline for individuals aged 19 and older is 0.8 grams of protein per kilogram of body weight. For a 165-pound adult, this translates to roughly 60 grams of protein per day (equivalent to consuming an 8oz salmon fillet and a handful of almonds). Many nutrition experts, however, believe this amount is too low, especially for those over 50.

“There is a growing body of evidence, particularly by researcher Stuart Phillips, that shows health benefits of consuming higher amounts of protein as we age, including slowing down age-related loss of muscle mass,” says Dr. Oppezzo. “There’s a difference between just surviving and thriving. For those over 50, I’d recommend between 1.2 grams / kg of body weight to 1.6 grams / kg of body weight, which is roughly double the federal recommendation.”

A recent study recommended that adults aged 18 to 30 consume 0.8 – 0.93 grams of protein per kilogram of body weight, with an increase of 0.85 to 0.96 grams / kg after the age of 30. For those over 65, another study recommended 1.2 – 2.0 grams / kg of body weight per day.

Dr. Oppezzo says that eating protein is not sufficient for building muscle—we must also strength train as we age. Researchers from this study recommend a protein intake higher than 1.6 grams / kg of body weight per day combined with resistance training to improve muscle strength. “Protein is important, but strength training is THE most important way to prevent age-related muscle loss, and it’s important to consume around 30 grams of protein within a couple of hours after working out,” she says. “First, give your body a reason to get stronger and build muscle (lifting weights), then give it enough materials (consuming protein) to build.”

Why Do We Need More Protein as We Age?

Starting around age 30, our body goes into maintenance mode, and our muscle mass starts to decline roughly one to two percent per year. And, as we age, the rate of decline increases by three to 10 percent per decade. Once we reach our 60s and beyond, the accumulated decline of muscle mass can increase the risk of falling, bone fractures, hospitalization, and earlier death, making the topic of protein consumption relevant to longevity.

“As we get older, we move less, and we eat less, and if we are not paying attention to our activity level and protein consumption, we can become frail,” says Dr. Oppezzo. “This becomes more important as we age because we become more anabolic resistant. Anabolic resistance is basically a reduced stimulation of muscle protein synthesis to a given dose of protein—it’s like you need to speak louder (more protein) for your muscles to hear (grow).”

Over the last ten years, there have been many studies on anabolic resistance. One study measured the amount of muscle synthesis between men aged ~22 and men aged ~71. The researchers gave each group a meal containing 20 grams of protein and then tested the degree of muscle synthesis. In the same sitting, both groups ate an additional 20 grams of protein, followed by a second test of muscle synthesis.

For the ~22 aged men, there was no difference in muscle synthesis between eating 20 or 40 grams of protein in one sitting. But for the ~71 aged men, their muscles were unresponsive to 20 grams of protein; they needed 40 grams. Specifically, the ~71-year-old group needed 0.4 grams / kg of body weight per meal, whereas the ~22  year-old-group only needed 0.2 grams / kg of body weight.

“The men in their 70s needed more than 20 grams of protein at a time to get their muscles to listen,” says Dr. Oppezzo. “Though they didn’t do this same elegant study in women, I imagine it is the same.”

Since protein consumption supports just about every function in the body, the body will utilize the amino acids where they are needed, such as the functioning of the brain, liver, immune system, or gastrointestinal tract. Unfortunately, maintaining muscle strength can be last on that list. Therefore, individuals over 50 need to consume enough protein to maintain the healthy functioning of their organs and keep their muscles strong.

“Within a meal, we must eat enough protein to wake up our muscles and say, ‘you have enough protein and calories to build,’ but in older adults, maybe the body is instead going to use that protein for energy or to support another function,” says Dr. Oppezzo. “I think muscle growth is a bit like remodeling your kitchen. You don’t remodel your kitchen if you can’t afford your utility bill. And, I think—as we age—the remodelers require more up-front cash.”

How Much Protein Do We Need Per Meal?

One study shows that there is no “upper limit” to the amount of protein we should eat in terms of our muscles’ ability to utilize it. However, Dr. Oppezzo suggests that we still spread out our protein throughout three meals a day.

Eating 20 grams of protein per meal might be enough if you’re 25 years old, but for those aged 50 or above, Dr. Oppezzo recommends 0.4 grams / kg of body weight per meal (which translates to 30 grams of protein per meal for a person who is 165 pounds).

Dr. Oppezzo says there are occasions when individuals may need to eat more towards the 1.6 grams / kg of body weight end of the range, such as competitive athletes or those recovering from an infection, hospitalization, or surgery. She also urges people who are intermittent fasting or on a very low-calorie or restrictive diet to make sure they are still consuming adequate protein.

“If we don’t eat enough protein during the day, where do we get our amino acids from? From our muscles!” exclaims Dr. Oppezzo. “I wouldn’t panic about a single day, but it’s not a great long-term plan.”

What are the Best Sources of Protein?

Luckily, every food has some protein in it! And most would agree that getting protein from a whole food source is always better than getting it from a powder. Whole foods have many other nutrients that are part of the package, and since we chew, swallow, and digest whole food at a specific rate, protein-rich foods enter the body more naturally than powders.

If you need to supplement with a protein powder, Dr. Oppezzo recommends whey protein or pea protein (vegan option). The most important amino acid needed to build muscle is leucine, which is found in high quantities in whey and milk. Researchers from this study found that leucine enhanced muscle protein synthesis in women aged 65 to 75, suggesting that older women should ensure that leucine is part of their protein intake.

“Although my mom, who is in her 70s, exercises every day, I’ve tried to supplement her activity by emphasizing eating enough protein every day and lifting weights weekly to keep her strong,” says Dr. Oppezzo. “I’m passionate about getting this information out there. It can help many people in their 50s and beyond maintain optimal health and live their best lives as they age.”

 

Practice of the Month: Make Your Own Balanced Bowl

By Carly Smith, BS, MPH(c) 

Making a bowl that has a mix of veggies, protein, grains, and fats can ensure you’re eating a meal that has balanced nutrition. While the specific ingredients can be changed to fit your personal preferences, below is the basic structure Nutrition Scientist Marily Oppezzo, PhD uses to create her own bowls:

1. Make your bowl half vegetables:

  • Either raw or cooked, make vegetables the base of your bowl. While the exact measurement will depend on the size of your bowl, you can aim for roughly 1 – 2 cups of veggies.

2. Add your preferred protein:

  • On top of your vegetables, add about ½ cup chicken, fish, tofu, or beans of choice.

3. Throw in some salad greens:

  • In addition to your vegetables, throw in about 2 – 3 cups of your favorite leafy greens. This is a great way to increase the volume of your bowl without losing control of the total amount of calories.

4. Be wary of dressings:

  • Limit dressings and vinaigrettes to only 2 – 3 tablespoons as the primary ingredient is often sugar. As an alternative to traditional dressing, try adding some salsa or a drizzle of olive oil with some lemon.

5. Personalize your bowl:

  • This is the fun part! You can control the flavor of your bowl by topping it with fresh herbs, fruit, whole grains, avocado, and/or a handful of nuts and seeds. You may also want to add a scoop of pickled veggies or 1-2 hard-boiled eggs.

With time, creating your favorite bowl mixtures will become intuitive. Until then, we have prepared a graphic that you can screenshot or print to help you plan your bowls.

How to Enter: “Make Your Own Balanced Bowl” Contest!

-> Create your own Balanced Bowl

-> Write the title of your bowl (which includes your name, like “Sharon’s Super Salmon Bowl”) on an index card

-> Take a birds-eye-view photo of your bowl and title

-> Post the photo to your Instagram and/or Facebook page or story

-> Tag your photo @StanfordLifestyleMedicine

(Alternatively, you may email the photo to [email protected] to enter the       contest)

-> We will feature all the bowls on our Instagram and Facebook stories and select the BEST BOWL during the week leading up to the Super Bowl!

 

Lifestyle Medicine Physician Works with Veterans to Improve Nutrition

By Carly Smith, BS, MPH(c) 

MOVE! is a weight management program offered to veterans by the U.S. Department of Veterans Affairs (VA). The program includes science-backed curriculum and practices adapted from the VA’s Whole Health program, an interdisciplinary and patient-centered program that empowers veterans to take control of their own health and wellbeing. 

“Research shows that nutrition is often more influential for weight loss than exercise,” says Stanford Lifestyle Medicine expert Robert Oh, MD, MPH, and Chief, Well-being Officer (CWO) at the Palo Alto VA. “A lot of things matter for weight loss and two big influences are diet and stress management, which is why we include the Whole Health educational model into our MOVE! program.”

“People may come for weight loss, but they stay when they realize how involved and influential the program can be for them to change their whole life,” says Michelle Truong-Leikauf, MS, RD, and MOVE! Program Coordinator. 

A Holistic Weight-Management Program

“Although the program is designed for weight loss, we look at the person holistically and focus on the aspects of health and weight loss that people can actually control and what they want to focus on,” says Dr. Oh, at the Palo Alto VA.

The MOVE! Program offers nutrition, fitness, and lifestyle medicine courses to veterans (both in-person and virtually) for comprehensive weight management. The program coordinates with health coaches and physicians to meet with veterans individually and in small groups to address their specific health needs.

“The program is really complex operationally, but the quality of care offered benefits from our team of experts all dedicated to one mission: giving people the best shot at success at reaching their goals,” says Truong-Leikauf. “Removing judgment and creating an environment that encourages people to talk about their concerns, their power, and the actions they have the power to take gives us the ability to meet people where they are at.”

The MOVE! program utilizes a tailored, person-centered approach that prioritizes sustainable lifestyle changes, giving the veterans a sense of control in their own health plan. While weight is the main measurement, healthy behaviors and goal setting are emphasized to produce continuous results in people’s lives and diets. 

“MOVE! emphasizes the same pillars of health as Stanford Lifestyle Medicine for people to focus on,” says Dr. Oh. “Weight is our measurement, but our health coach team works with the veterans to keep their actions going. So, even if people are not seeing results on the scale, they can see real changes in their diets and other established healthy habits to be proud of.”

Resources Available for Everyone

Although the MOVE! program is only available for veterans receiving care at the VA, their website has an abundance of resources freely available to all. Resources include episodes of the Fresh Focus Podcast, which discusses nutrition for veterans; the MOVE!11 Getting Started Questionnaire, which helps summarize one’s current health status; guided recipe videos and cookbooks approved by the VA Nutrition team, and much more. There are also educational resources to learn more about Whole Health’s “Circle of Health” model and testimonies from veterans describing how the MOVE! Program helped guide their weight loss journeys.

Circle of Health

Veteran Testimonials

On the MOVE! program website, people are greeted with hundreds of success stories and testimonials from Veterans that have chosen to share how the program impacted their lives. Dennis Pecorella shared that after years of trying different diet methods, he was matched with a MOVE! program dietician who made nutrition information easier to understand and incorporate into his life. With her help, he was able to create his own sustainable diet plan.

“MOVE! has not only led me to weight loss, but better health overall,” says Pecorella. “I take less medication, try to walk two miles every day, and always eat my vegetables!” 

Peter Johnke’s primary goal in the MOVE! program was to make eating and dieting a more mindful activity. With the help of the MOVE! team, Peter learned to consistently track his food and beverage intake for an entire year and continues to do so. This helped him gain more control over his diet and learn when to best incorporate healthier options. 

“If you are in a place that you need to change…the MOVE! program will help you to help yourself!” says Johnke. “Do your due diligence! Take care of yourself!” 

 

Meal Prep Ideas for Busy People

By Carly Smith, BS, MPH(c) 

So, you want to start meal prepping in 2024? Perhaps this is related to a larger goal to lose weight, eat cleaner, or meet your nutritional goals. To set yourself up for success, you have bought a container for each day of the week and started to plan your week-by-week meals. Maybe you’re planning to make the Sunday morning farmers market and subsequent wash, chop, and prep of your vegetables part of this new-you routine?

Once we begin to break down this resolution, we can see that it is composed of many smaller action steps, which many people may not have the time to do. Busy schedules often do not mix well with New Year’s resolutions that require a lot of time and effort.

Stanford Lifestyle Medicine’s head of the Healthful Nutrition pillar, Marily Oppezzo, PhD, MS shares that you only need to make a few adjustments to your meal prep plans to set you up for success!

“For the New Years’ resolutions, you can have your aspirational goal, but start with the side quests that lead up to that lofty goal in the end,” says Dr. Oppezzo. “Even if your first goal is to eat just one vegetable today, you are learning consistency and making progress. Incorporating one healthy habit a day based on your situation helps you feel successful and see that little accomplishments build up with time.”

3 Meal Prep Tips

“Realistically, not everyone has three hours every Sunday to dedicate to meal prep,” says Dr. Oppezzo, Registered Dietitian with 20+ years of experience in nutritional coaching. “If you have the time, that is great, but I encourage people to always have a back-up plan for when they don’t. Instead of ditching your resolution, rely on pre-cut vegetables, frozen vegetables, and bagged salads and add them wherever you can during the week.”

1. Frozen IS Fresh

Many of us succumb to the belief that frozen fruit and vegetables are not fresh, but oftentimes they are just as fresh, if not more, than those bought in the produce aisle or at the farmer’s market. You may prefer to buy fresh produce, but frozen produce is a great option when trying to make healthy meals in a pinch. Since these fruits and vegetables are frozen and preserved upon harvest, they will still maintain their day-one freshness once cooked.

2. Drawers of Doom

Dr. Oppezzo recommends avoiding the “drawer of doom”, or the drawer in the refrigerator that you toss all your veggies in. It is common to forget about these items once they are discarded into a drawer, especially during a busy morning or when you’re tired after a long day at the office. Instead, Dr. Oppezzo recommends keeping your healthy options on display so that they can help remind you of your nutrition goals. Throw your fruits and veggies into transparent containers and keep them within view on the shelf, rather than the drawer of doom. You can put all your less-than-healthy options in this drawer since you’ll grab for these items anyways.

3. You Know You

Perhaps the most important part of your meal-prep regimen is to be realistic with yourself. You know your schedule, abilities, and preferences the best. Your meal prep practices can adjust to match the time that you have available each week. If you have a free Sunday, you can spend more time preparing your meals for the busy week ahead. If you’re catching up on life on Sunday, perhaps you could opt for making a larger batch of quinoa or brown rice between activities to have on hand throughout the next few days. If you only have time for a quick trip to the grocery store on Sunday, shopping for convenient but still healthy options is just as good of an option if it helps you stick to your nutrition goals.

Dr. Oppezzo recommends grabbing a few microwavable grains and your preferred pre-cut, frozen produce to greatly cut down on cook time. Having these convenient staples can help keep healthy meals a viable option when spending an hour to cook a healthy meal is not realistic. The goal is to make meal prep easy, convenient, and consistent, rather than being overly repetitive or overly strict and giving up by the end of February.

“It is not so much about how psychologically committed you are, but more about what your life is like right now,” says Dr. Oppezzo. “Once you have mapped out your availability, you know how to best adjust your behaviors to keep with your resolutions using the time that you actually have.”

 

A Day of Meals to Keep You and Your Colon Healthy

By Cindy Kin, MD, MS, FACS

Our TeamDr. Cindy Kin is a colorectal surgeon, Associate Professor of Surgery at Stanford University, and a member of the Stanford Lifestyle Medicine Healthful Nutrition Pillar. She is also an active researcher focusing on the role of prehabilitation in mitigating surgery complications and exploring the application of “wearables” in both pre- and post-operative recovery. After completing her undergraduate education at Harvard University, she received her medical school degree at Columbia. She subsequently attended Stanford University for general surgery residency training and Cleveland Clinic for her colon and rectal surgery residency training. Following this, she returned to Stanford University to complete a master’s degree in health services research. Dr. Kin is passionate about increasing awareness of the profound influence of lifestyle medicine on surgical outcomes and actively advocates for its seamless integration into patient care.

As a colorectal surgeon, I’ve witnessed firsthand the undeniable connection between a well-balanced diet and overall health. In my clinic, the dietary patterns of my patients are pivotal factors impacting both their recovery from colorectal issues and the prevention of future complications. This commitment to balanced nutrition not only shapes my professional perspective but also influences how I approach nourishment within my own household. As a working mom of two young kids, I am always looking for simple, flexible, and healthy meals that allow the kids to exercise some choice. In this blog, I will share some of my favorites.

Breakfast: Overnight Oats

  1. Overnight oats have endless variations. The basic formula is 1 part oats + 1.5 parts water or milk of choice (I use soy or almond milk). You can also use yogurt for a portion of the liquid.
  2. Toss in a spoonful of chia seeds and a bit of sweetener like honey or agave, if desired. 
  3. Shake it up and leave it covered overnight in the fridge.
  4. The next morning, you can add whatever toppings you happen to have–fruit, seeds, nuts, nut butter, cocoa powder, chocolate chips, coconut shreds. I have found that if the kids get to pick their toppings, they’re more likely to eat them! (Also, whatever they don’t eat for breakfast is included in their snack box for school).

Low-Prep Lunch: Yuba Noodle Salad

  1. To create this quick and easy lunch, cut the yuba (tofu skin) into strips, and voilà, you have high-protein, high-fiber noodles that you don’t have to cook, but are delicious when lightly sautéed. 
  2. Make a sauce using whatever is in the fridge. I usually use a combination of tahini, miso, peanut butter, and rice vinegar. 
  3. Toss everything together with some veggies, such as cucumbers and carrots.

More-Prep Lunch: Chickpea Salad Sandwich

The garden veggie chickpea salad sandwich recipe from Peas and Crayons is a game-changer! For a slightly healthier twist, I swapped out the mayo for tahini dressing and it was delicious. 

Dinner: Rainbow Wraps (or as my kids call it, “Rainbow Dinner”)

  1. Mix a couple spoons of black rice (“forbidden rice”) into brown rice, and it comes out a lovely purple hue. 
  2. Cut up some red peppers, orange carrots, and green zucchini.
  3. Make crispy tofu yellow by tearing up chunks of firm tofu and tossing with turmeric, arrowroot starch, nutritional yeast, and garlic powder. Air fry the tofu for 10 minutes at 390oF.
  4. Blue is the hardest color to make, but for those rainbow purists out there, steep some butterfly pea flower tea and pour a bit of it over firm tofu strips while sautéeing them.
  5. Place the rainbow of prepared ingredients onto nori seaweed sheets and let everyone make their own wrap.
  6. Serve with dipping sauce such as miso or ponzu sauce, or whatever you have around!

Dessert: Brownies (high fiber and no added sugar–no way!)

I love this simple brownie mousse cake recipe from Feasting on Fruit that uses a few simple ingredients, such as dates, almond butter, and cacao powder– I make just the brownie cake part, without the mousse layer–it’s good on its own and super easy! 

For more information about the influence of diet on colorectal health, read our blog post titled The Impact of the Western Diet on Diverticulitis.

Health for the Holidays: Transforming Traditional Recipes with Expert Guidance

By Maya Shetty, BS

This blog is part of our Gratitude & Reflection newsletter. If you like this content, sign up here to receive our monthly newsletter!

As the holiday season approaches, many of us eagerly anticipate the joyous moments of togetherness, gift-giving, and, of course, indulging in mouthwatering dishes that have become synonymous with holiday celebrations. Whether it’s grandma’s famous pecan pie or Aunt Sally’s stuffing, these cherished holiday recipes bring with them a comforting sense of nostalgia that warms our hearts. However, there’s no denying that the generous spreads served during the holidays can take a toll on our health.

The good news is that you don’t have to sacrifice taste and tradition to make your holiday feasts healthier. In fact, we at Stanford Lifestyle Medicine believe it’s possible to transform your beloved recipes into delicious versions that nourish your body.

We also recognize the significance of celebrating the season with the foods we love. Our mission is to bridge the gap between these two priorities, demonstrating that health-conscious recipes can not only reduce sugar, cut down on saturated fats, and enhance nutritional value but also deliver flavors that rival the indulgent classics.

In this blog, we will provide you with expert insights, trusted recipes, and innovative ingredient swaps that will empower you to make healthy choices while still savoring the essence of the season.

Holiday Recipe Recommendations from a Physician Chef

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Dr. Carlie Arbaugh is a Stanford surgical resident, chef, and member of our Healthful Nutrition Pillar. After graduating from Cornell University with a BS in Human Biology, Health and Society she attended medical school at Stanford School of Medicine and gained professional certifications in Plant-Based Nutrition and Culinary Arts. Dr. Arbaugh firmly believes that food plays a fundamental role in our health, community, and culture. This passion drives her commitment to exploring the harmonious blend of deliciousness and nutritiousness in our food choices. Delve deeper into Dr. Arbaugh’s expertise as she shares her recipe recommendations and ingredient swaps for the upcoming holiday season.

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Stuffed Mushrooms

“For the past two holiday seasons, I’ve been whipping up a delightful dish that everyone has loved – stuffed mushrooms,” says Dr. Arbaugh. “Whether served as an appetizer or a side, it’s a naturally vegetarian gem, with the flexibility to go fully vegan. What’s more, it’s a breeze to prepare, requiring just a handful of simple ingredients.”

Dr. Arbaugh follows the New York Times Cooking recipe, making a healthy tweak by swapping out the butter for vegan butter or olive oil.

“In general, mushrooms stand as a healthful, naturally plant-based meat alternative, thanks to their ability to deliver that irresistible umami flavor!” she emphasizes.

Quinoa Stuffing

Dr. Arbaugh also recommends swapping traditional stuffing for quinoa stuffing. 

“It’s a nice whole grain alternative to stuffing made with bread (especially white bread) and you can boost the nutritional value and flavor by adding seasonal veggies, nuts, and dried fruits,” she states.

There are numerous recipes out there, including the nutrient-rich and fiber-packed creation found on Allrecipes.

Roasted Vegetables

“A simple way to add more plants to your holiday spread is by roasting some seasonal vegetables with a sprinkle of spices and herbs,” says Dr. Arbaugh.

A go-to favorite for Dr. Arbaugh is roasted butternut squash, like this example by Well Plated. Tossed with maple syrup, cinnamon, and rosemary, this recipe is infused with holiday flavor.

Seasonal Fruit Crisp

Seasonal fruit crisps and crumbles are another holiday favorite of Dr. Arbaugh. “Crisps and crumbles are a wonderful holiday dessert as they are primarily fresh fruit and use less flour, butter, eggs, and sugar than you would find in a cake or cookie,” she states.

When possible, Dr. Arbaugh recommends choosing fruits and vegetables that are in season. “Many people don’t actually know what is truly in season because so many of our grocery stores provide a lot of the same produce year-round and transport it in from other geographic locations,” she states. “Seasonal produce is often harvested at its peak ripeness, ensuring maximum nutrient content and flavor.”

Seasonal produce can vary across different regions of the US due to the range in climates. There are many online resources that can be used to track this information. For Bay Area residents, Dr. Arbaugh recommends the San Francisco Environment Department website.


Plant-Based Recipes From a Stanford Food Researcher

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Jessica Hope, MSN, NP is a passionate advocate of plant-based diets, an impactful nutrition researcher at Stanford University, and integral member of our Healthful Nutrition Pillar. After studying at Princeton University, she gained her master’s at Vanderbilt University School of Nursing and became a nurse practitioner for the abortion clinic at Planned Parenthood in San Mateo. She went on to conduct nutrition research at the Stanford Prevention Research Center, the Division of Immunology & Rheumatology, and now at the Humane & Sustainable Food Lab where she serves as the research coordinator. Continue reading to discover Hope’s expert tips on crafting a more plant-based holiday spread.

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Hope’s Family Recipe for Mashed Potatoes

Hope’s mashed potato recipe, a cherished family favorite each year, stands out for its ease and health-conscious approach. “This simple recipe is not only beginner-friendly but prioritizes health,” she says.“These are great leftovers, too, so I always make as much as I can fit into my biggest pot.” 

Hope also recommends mashing the potatoes by hand using a real potato masher for the best results. “To enhance the nutritional content and minimize the impact on blood sugar levels, try leaving the potato skins on as they add fiber and contribute to a more interesting texture and flavor,” she says. 

Ingredients

  • Golden/yellow organic potatoes
  • Unsweetened organic soy milk (I prefer Silk brand)
  • Salt
  • Organic Earth Balance butter (either sticks or whipped is fine)
  • Freshly ground pepper, optional
  • Fresh organic parsley, finely chopped, optional, for garnish

Directions

  1. Use a sharp knife to cut the larger potatoes into 6 pieces and the smaller ones into quarters. Put as many as you want to cook (my Aunt Emily’s recommendation was 2 potatoes per person) into a heavy pot. Then add enough water to just barely cover the top layer of potatoes. Bring to a boil. After it starts boiling, put a lid on the pot and turn the heat down to a lively simmer.
  2. Gather your other ingredients, and recruit someone with strong arms (in our family, my son is the designated masher). You’ll have enough time to set the table and/or get started on another dish.
  3. Keep an eye on the potatoes. You want to cook them until they are very tender when poked with a fork, but not so long that they start to fall apart. When they reach that point, drain out the water.
  4. Keep the potatoes in that same hot pot on the stove, but with the heat turned off. Immediately add Earth Balance butter. The amount is up to you; imagine how much butter you’d want on a small potato and then multiply that by the number of potatoes you used. Immediately begin mashing. After a minute, add only enough milk to moisten the potatoes so that they are easier to mash. Add a little salt, and pepper if using. After mashing for a while, it’s fine to add a little more milk if necessary to get the consistency you like.
  5. Once the potatoes are fairly smooth, taste to see if they need more butter, salt, or pepper. After transfering to a pretty serving bowl, top with a tiny bit of chopped parsley if desired. Enjoy!

The only caution Hope has with this vegan recipe is related to one ingredient—Earth Balance vegan butter. “While it is a healthier alternative to cow’s butter because it contains zero cholesterol and only half as much saturated fat, it is still equally high in calories and is not a whole food,” she says. 

Healthy Sweet Potato Swaps

Hope recommends using your go-to sweet potato recipes as a starting point for incorporating healthy ingredient swaps.

“Most sweet potato dishes can smoothly transition to whole-food plant-based versions that still maintain the flavor of your family’s traditional holiday recipe,” she states.

Explore Hope’s suggestions below for ingredient swaps that can seamlessly replace traditional components.

* To make homemade flax eggs, Hope recommends using the recipe from Minimalist Baker.

Pumpkin Pie Cups

Hope enthusiastically endorses the dessert creations by Feasting on Fruit, especially their six-ingredient pumpkin pie cups. The almond flour crust caters to a grain-free lifestyle, and the sweet potato and pumpkin provide fiber and beta-carotene. Additionally, the simplicity of the recipe ensures a hassle-free preparation while maintaining a focus on wholesome ingredients. 

More Resources

For more recipe inspiration, Hope recommends the three-course vegan and gluten-free holiday menu from Oh She Glows.

 

Potential Risks to Skipping Breakfast

By Carly Smith, BS, MPH(c) 

Potential Risks to Skipping Breakfast

Many people know the saying, “Breakfast is the most important meal of the day” yet fasting until noon (one type of intermittent fasting) has become popular and mainstream. While it may be beneficial for some, Stanford Lifestyle Medicine physicians and researchers caution new fasters and want to highlight some important considerations for those thinking about skipping breakfast.

“Limiting the time frame that calories are consumed has become a popular dietary strategy to improve health and aid in weight management. Fasting until noon is one of these popular strategies,” says Jonathan Bonnet, MD, MPH Stanford Lifestyle Medicine Physician. “For some, this may work well, however, the preponderance of evidence suggests that weight loss is modest and no more beneficial than overall caloric restriction.”

Side Effects of Skipping Breakfast

Delaying the first meal of the day until noon falls into the category of time-restricted eating. Although this eating pattern may help someone reduce their overall caloric intake, it may also lead to disruptive changes to their circadian rhythm, which could negatively affect sleep, as well as insulin sensitivity and glucose uptake.

In a recent review, researchers discussed the potential impacts of skipping morning-time breakfast. The review reported associations between skipping breakfast and an increased risk of developing obesity or type 2 diabetes. These studies primarily focused on the short-term effects of introducing the morning fasting behavior into one’s routine, however, the long-term effects of habitually fasting until noon are still being studied.

Feeding the Circadian Rhythm

Eating breakfast early in the morning is one signal that influences the genetic pathways underlying the circadian oscillations in the gut, which are critical for predicting daily energy levels and jump-starting metabolism. Thus, skipping breakfast could weaken the signaling of these clock genes and could be one reason why some people that fast until noon experience higher hunger levels throughout the day.

 “Skipping breakfast impacts numerous circadian signals within the body that may be suboptimal,” says Dr. Bonnet. “If someone wanted to try a time-restricted approach, they may experience more benefits from having an earlier eating window (to include a more substantial breakfast) with limited late-night food consumption.”

While research is still trying to understand how impactful these circadian changes are long-term, it is possible that irregular or inadequate fueling of the body may negatively affect one’s body weight, glucose metabolism, and overall health. Thus, it may be more beneficial for one’s health to prioritize consistently eating meals at the same time every day.

“From a circadian perspective, regularity is key,” says Jamie Zeitzer, PhD, Stanford University Professor and member of the Stanford Lifestyle Medicine Sleep team. “The circadian system anticipates signals, like food intake, at certain times of the day and synchronizes gut activity in response.”

Not All Fasting is Bad

Fasting until noon is just one type of eating pattern and not all types of fasting have negative health effects. There are other forms of intermittent fasting that are currently being studied in longevity science due to their ability to build resilience to stress and diseases. For individuals facing obesity and related chronic diseases, time-restricted eating approaches (that maintain the morning fasting window), have not been shown to be significantly more beneficial for weight loss than those following overall caloric restriction methods.

“For those with weight-related cardiometabolic conditions like Type 2 Diabetes, most forms of weight loss can improve their condition,” says Dr. Bonnet. “Finding a way to create a sustainable caloric deficit to lose weight is a challenge, so if some variant of intermittent fasting works for them, it may be the key to start improving their overall health.”

Anyone considering any form of intermittent fasting or time-restricted eating should consult with their physician to make sure that it is the healthiest decision for them both physically and mentally.

 

The Impact of the Western Diet on Diverticulitis

By Maya Shetty, BS

Recognizing the vital connection between colorectal health and diet has never been more important, given the escalating prevalence of colorectal diseases in Western societies. According to Cindy Kin, MD, MS, a colorectal surgeon at Stanford, many of these conditions are preventable and are linked to the dietary patterns we develop early in life.

“Many people in the US have a chronically low fiber diet high in inflammatory foods beginning in childhood that leads to microbiome dysbiosis, as well as actual structural changes to the gastrointestinal tract,” says Dr. Kin. “Over time, this leads to numerous colorectal diseases, some of which are irreversible and require surgery.” 

One specific condition that has seen a significant increase in prevalence in the last 50 years is diverticulosis, characterized by the formation of irreversible outpouchings in the colon. This condition affects approximately one in three individuals aged 50-59 and virtually everyone over the age of 90 in the US.

Diverticulosis itself does not cause symptoms, and most patients only find out about them when they have a colonoscopy. However, anyone with these diverticular outpouchings is at risk of developing diverticulitis, a painful disease triggered by perforations in one or more diverticula. Diverticulitis may range in severity from mild to severe and life-threatening, depending on the size of the perforation. A tiny pinhole perforation that seals itself quickly might cause a little pain and inflammation that can be treated with oral antibiotics. On the other end of the spectrum, a larger perforation that leaks air and stool into the surrounding abdominal cavity can make someone so sick that they would need to have emergency surgery.  

“Three to five million people get some sort of treatment for diverticulitis per year in the US,” says Dr. Kin, “A proportion of those people need surgery, making diverticulitis one of the most common reasons for colon surgery.”

The Growing Prevalence of Diverticulitis in the US

Diverticulosis became a known problem in the US in the early 1900s, coinciding with major technological advancements, such as fertilizers, preservatives, and factory farming. These advancements caused significant changes in the American diet. Regular consumption of high-fiber, farm-fresh whole foods was replaced by processed foods lacking in essential nutrients. Diets also became increasingly saturated with meats, fats, and sugars, replacing fruits, vegetables, and whole grains. As our diets followed this trend and became more “Westernized,” cases of diverticulitis significantly increased. 

This US-specific increase in diverticulitis is in stark contrast to the nearly negligible incidence found in regions of the world where diets are rich in fiber. In Asian countries, where the diet is becoming more influenced by Western culture, we observe a rising incidence of diverticulitis in the last 30 years. “Diverticulitis is almost entirely a disease of our Westernized diet, low in fiber and high in ultra-processed foods and saturated fat,” says Dr. Kin.

What to Eat (and Not to Eat) to Reduce the Risk of Diverticulitis

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Fiber

Dietary fiber, found in various forms in vegetables, legumes, and whole grains play a critical role in maintaining soft, easily eliminable stool. Conversely, diets lacking in fiber often lead to hard smaller-caliber stools and constipation, prompting the colon to work extra hard to move it through. Years of  sustained high pressure within the colon is thought to be the root cause of diverticulosis, the presence of outpouchings in the wall of the colon. These outpouchings, or diverticula, form as the colon is squeezing so hard that it pushes out a portion of its own wall. The diverticula are weaker than the rest of the colon wall, and are more prone to bleeding and perforations. Research has consistently demonstrated that diets rich in fiber are strongly associated with a reduced risk of developing diverticular disease.

For many years, the widespread recommendation for those with diverticular disease was to avoid nuts, seeds, and popcorn due to the perceived risk of these foods getting trapped in the diverticular outpouchings. However, research suggests this is not the case and eating these foods may actually reduce one’s risk of developing diverticular disease due to their fiber content. “In all my years operating on diverticulitis, I have never seen a popcorn kernel or a sunflower seed poking out of a diverticulum causing a perforation, yet patients continue to steer clear of these fiber-rich foods due to this persistent diet myth,” says Dr. Kin.

Dr. Kin’s recommended daily fiber intake for women is 30-35 grams and 35-40 grams for men. While there are numerous fiber supplements available to help reach this daily goal, Dr. Kin recommends getting your fiber from dietary sources because foods that naturally contain fiber offer a multitude of advantages that extend beyond digestive health, such as lowering cholesterol and weight management to lower the risk of heart disease, stroke, diabetes, and other chronic diseases.

“If your body is not used to a high-fiber diet, gradually add fiber into your daily meals to allow your body to adjust over a couple weeks,” cautions Dr. Kin. “For most people, the gassiness that can happen with eating more fiber will get better pretty quickly, so don’t give up! A little gas upfront for a lifetime of colon health is a small price to pay.”

Processed Foods

Processed foods often lack the essential dietary fiber that whole unprocessed foods naturally provide. Additionally, the overconsumption of refined sugars and saturated fats in processed foods has been associated with several adverse health effects, including changes in gut microbiota composition and an increased risk of inflammation within the gastrointestinal tract. These factors can further exacerbate the risk of diverticular disease development.

Red Meats

Diets high in red meat are linked to diverticulitis, with a large-scale study finding the risk increasing by 18 percent for every additional serving of processed red meat. Red meat is associated with inflammation within several internal organs, and excessive consumption over time has numerous health consequences, including deteriorating colorectal health.

To prevent diverticulitis and several other colorectal diseases, Dr. Kin highly recommends “adopting a whole food, plant-based diet for its exceptional combination of high fiber content and nutrient-dense antioxidant  properties.”

 

In a Pickle? Unveiling Gut-Friendly Pickles for Your Health

By Maya Shetty, BS

By now, most people have heard about the extensive health benefits fermented foods provide. Fermented foods have become increasingly popular as research continues to reveal that their high concentration of probiotics can improve gut health, boost immunity, and enhance digestion.

“Pickles are fun, tangy, potentially health-promoting ways of eating cucumbers,” according to Dr. Marily Oppezzo, PhD, MS, Head of the Lifestyle Medicine Nutrition Pillar.

However, Dr. Oppezzo cautions that even though the beloved snack of pickles are thought to be fermented, not all of them are, hence, they don’t all have the health benefits. 

Determining whether a particular pickle brand is fermented or not can pose a challenge. In this blog, we will delve into the various pickle varieties, offer guidance on spotting fermented options at grocery stores, and highlight recommended brands to seek out.

How to Choose a Healthy Pickle?

Dr. Oppezzo says that all pickles are a healthy snack, whether they are found on the shelf of the grocery store or in the refrigerated section. However, if you’re looking for a pickle to support gut health, you’ll have to select from the pickles in the refrigerated aisle.

“The pickles that are beneficial for your gut health are the fermented ones, made by brining them in salt rather than vinegar,” says Dr. Oppezzo. “While vinegar pickling is a common method, true fermentation in brine enriches them with beneficial probiotics for your gut. How can you spot these live bacteria-packed pickles? Check out the refrigerated section of your grocery store, as they won’t be found on the regular shelf.”

As Dr. Oppezzo mentioned, pickles essentially fall into just two primary categories: pickled pickles and fermented pickles.

  • Pickled pickles (aka vinegar pickled) are produced using, as you might have already guessed, vinegar. The vinegar kills all bacteria, including the bacteria beneficial to one’s gut. This process effectively sterilizes the pickles and allows them to shelf-stable. Therefore, these pickles are found unrefrigerated in the grocery store.
  • Fermented pickles are produced using brine and go through a natural fermentation process involving bacteria that is inherent within cucumbers. These pickles contain beneficial bacteria for the gut known as probiotics, as long as they have not undergone pasteurization. The pasteurization process, which involves heat, effectively eradicates probiotics from pickles.

So, what you want to look for are unpasteurized fermented pickles, which can be found in the refrigerated section of grocery stores, often in the cheese section. It is always good to double-check the label as well. If vinegar or pasteurized is indicated on the label, chances are probiotics are absent. Instead, look for these terms on the label: “fermented,” “unpasteurized,” , “live cultures”, and/or “probiotic”. Another sign that pickles are naturally fermented are the presence of bubbles on the surface of the brining liquid – a by-product of live bacteria at work.

Dr. Oppezzo also recommends prospective buyers to “spend some time reading labels and look for ‘added sugar’ on the label to be sure you aren’t accidentally getting sugar through your pickles.”

Why are Fermented Pickles Healthier?

Probiotics Support the Microbiome

Fermented foods have a variety of health benefits due to their high concentration of probiotics, 

or beneficial microorganisms aka the “good” bacteria. The microbiome within one’s gut helps to digest food, absorb nutrients, synthesize vitamins, and regulate one’s immune system. Research consistently demonstrates that healthy, stable microbiomes that are high in diversity and beneficial microbes  are shown to reduce chronic inflammation, weight gain, and disease.

Nutritional Benefits

Fermented pickles offer a range of nutritional benefits due to the diverse array of compounds they contain. These include antioxidants like flavonoids and phenols, which fight inflammation and protect cells from oxidative stress. The pickling process may also enhance the bioavailability of these antioxidants. Additionally, pickles contain a high concentration of vitamins and minerals, specifically vitamin K, vitamin C, vitamin A, calcium, and potassium. 

Immune Benefits

Vegetables that undergo the fermentation process typically produce natural substances such as alkyl catechols. Alkyl catechols activate a defense pathway that shields against various chronic diseases linked to oxidative stress. These substances may also boost the activity of cell defense pathways that protect our body from cancer and neurodegeneration.

Be Careful of the Sodium!

Despite all these potential health benefits, pickles are not the perfect snack.

“One major downside of pickles is their high salt content,” Dr. Oppezzo cautions. “A single pickle can contain over two-thirds of the recommended daily sodium intake for an average adult. Excessive sodium can be detrimental to overall health, thus it is important to eat pickles in moderation. If you are going to have them and are watching your salt, eat after you’ve sweat a lot due to exercise or a sauna.”