Tuesday, March 19, 2013

Iron Status - Vegan Style

Here's a helpful guest post by Evelyn Pearce on achieving optimal iron status.

Some take homes:

  • Vegans can have optimal iron status
  • Iron from meat (heme-iron) might be a causative factor in the link between meat and many chronic  diseases
  • Being conscious about eating healthy whole plant foods usually means including an iron rich food at each meal
  • There are a few little food tricks that can boost iron absorption which might be important for some people... read on to learn more... 
Demystifying Iron: Why Vegans Can Have Optimal Iron Status
A vegan diet offers many health benefits. It is lower in calories and saturated fat, yet high in antioxidants, B vitamins, potassium and fiber, all of which reduces your risk of heart disease. There is also growing evidence that those who avoid or limit their intake of animal produce are less likely to develop diabetes and cancer. As all three medical conditions are highly prevalent in the United States and other industrialized countries, this can only be a good thing. While the advantages of a vegan diet for your health are well recognized, worries relating to potential nutritional deficiencies are one of the barriers standing in the way of more people adopting a completely plant-based diet.  It is true that you can develop particular vitamin and mineral deficiencies on a vegan diet, but equally this can occur if you eat meat or other animal produce. The key is ensuring you include the right balance of foods whichever dietary approach you choose to adopt.

The question of iron
However, when people hear you follow a vegan diet, one of the most common things they assume is that you must be anemic. It’s still a widely held belief that avoiding all animal produce will leave you deficient in iron. As any vegan with a good awareness of nutrition knows – which to be honest is a lot of us – there are a variety of plant sources of iron and obtaining adequate iron through our diet is easily achievable. We just need some forward planning, but then everyone should be putting thought into their meals irrespective of whether they eat meat or not.

Admittedly iron deficiency anemia is a relatively common in America, with figures showing that it affects around 9% of women under 50 years of age. It’s not a pleasant condition; you’re left extremely tired, as your blood is unable to carry sufficient oxygen, which makes even day to day activities difficult. However, research suggests that vegetarians are at no greater risk than non-vegetarians of developing this form of anemia. While less well studied in vegans, the National Institutes of Health doesn’t identify us as an at risk group for iron deficiency anemia. However, it does suggest we may need twice as much iron as meat eaters to prevent deficiency, though more on this point shortly.

Vegan source of iron
When relying solely on plant produce for iron, there are a number of key foods that provide this; though as a matter of following a vegan diet, they are probably included already. Pulses (peas, beans and lentils), wholegrain cereals and those which have been fortified with iron (which many are, so check the label), tofu, green leafy vegetables like kale, spinach and cabbage, dried fruit and seeds are the main providers. We should ideally be including at least one of these foods at each meal and consider the likes of cereal, dried fruit and seeds for snacks.

A matter of absorption
As hinted previously, the iron in plant-based foods is not as well absorbed as that from meat and fish, which is why we need to consume more iron to ensure our bodies receive sufficient. This relates to the fact that the iron present in the two sources is slightly different, with that found in animal produce more readily available to the body. However, we can take steps to increase our uptake of iron from plants.
  • It’s well-known that vitamin C increases absorption of iron by converting the iron in plant foods to the more favourable form, so a source of the vitamin should be included with meals. Good sources of vitamin C besides citrus fruits include berries, kiwis, peppers, tomatoes and green vegetables. 
  • Meanwhile the tannins and polyphenols found in tea and coffee make it more difficult for the body to take up iron if these are consumed near meal times; try to avoid them for an hour either side of meals to give your body a better chance of iron absorption. 
  • Phytates, which are found mainly in pulses and wholegrains, also reduce iron absorption. However, as these foods are also a source of iron, you should not avoid these in your diet, but instead concentrate more on increasing your vitamin C intake and avoiding tea and coffee near meals.
Health benefits of non-heme iron
Obtaining your iron from plant sources (known as non-heme iron) in contrast to that derived from animal flesh (heme iron) could be a healthier option according to research. There is increasing evidence that heme iron encourages production of free radicals - damaging substances that cause injury to cells and are implicated in the development of heart disease and cancer. This may explain why meat eaters have been shown by studies to have a higher risk of heart disease and bowel cancer than those who avoid it. Research also suggests that consuming heme iron increases the risk of developing diabetes; this condition of impaired glucose metabolism is certainly less common amongst vegetarians and vegans. As non-heme iron is less readily absorbed, it is unlikely that iron stores will accumulate; it is these high iron stores which have been linked to increased susceptibility to chronic diseases.

About the author:
Evelyn Pearce is a freelance writer and mother of two, who when not at her keyboard or minding the children, likes to take her German shepherd for a walk in the hills around her home in Red Oak, Iowa.

Sunday, March 3, 2013

Sleep Better - 4 Tips To Fall Asleep

Many people struggle to fall asleep. Having the odd sleepless night is not a big deal, but day after day of poor sleep can have a major impact on your health and sense of well-being. A patient of mine asked if I would post a few tips for those who struggle with sleep.

First, a caveat: there are many causes of insomnia. If this is a major struggle of yours, it's worth having a detailed clinical evaluation. For example, perhaps the main cause is Obstructive Sleep Apnea and the best treatment for your restless sleep is weight-loss and a CPAP breathing machine.

That said, irrespective of the cause, it's also worthwhile learning what factors you can control to improve your sleep.

Here are 4 sets of tips I find helpful:

Basic Sleep Hygiene

Many factors influence the ease at which you can fall asleep. You don't necessarily need to do all of these, but likely the more you do the better. You've probably heard some of this before:
  • Go to bed and waking at the same time each day is the best way to regulate your circadian rhythm
  • Make sure your bedroom is sufficiently dark and quiet
  • Sleep in a bed you find comfortable
  • Dim the lights as early as you can to allow melatonin levels to rise
  • Do something to relax before you go to bed, like meditate or have a hot bath/shower
  • Don't use your bed for anything other than sleeping and physical intimacy (there are exceptions, for example if you've conditioned yourself for decades to fall asleep after reading in bed) 
  • Understand your caffeine sensitivity: for most people caffeine after 3p or so will interfere with sleep (caffeine has an ~8 hour half life)
  • Alcohol can be sedating but it always worsens sleep quality. Some people can do fine with a drink or two, others need to avoid completely
  • Exercise daily - for me, this is the single most important thing I can do to guarantee a good nights sleep. Exercise increases sleep quality. Just be aware that intense exercise late at night can be activating and keep you up.

Advanced Sleep Hygiene

Turns out there are some new discoveries based on sleep physiology that offer even more insight into factors that help, some of which I learned at last years American College of Lifestyle Medicine meeting:
  • Being well hydrated: this enables your peripheral blood vessels to dilate (see below) without a large increase in heart rate. However, try to drink a lot during the day as if you drink a lot right before bed you might have to wake to urinate.
  • Be warm before you go to bed, but sleep in a cooler environment - to induce sleep your body dilates blood vessels to lower your body temperature. Presumably it won't be able to lower your temp much is you are already cold. So make sure your extremities (hands and feet) are warm before going to bed.
  • Many find the combination of black-out shades and a dawn-simulator light an effective combination for creating a dark sleep environment and having light wake you up.
  • Don't use a back-lit screen an hour before you go to bed (i.e. computer, ipad, smartphone, TV, etc.) as the blue light will decrease melatonin production.
  • If you nap in the afternoon, limit your naps to 30 minutes or less.

Advanced Sleep Hygiene for when you wake up in the middle of the night

  • Don't make the classic mistake of stressing about it. This will keep you up. Sleep quality is not significantly decreased by waking once or twice at night to pee. Avoid looking at the clock when you awake. 
  • Drink a cold glass of water - this will cool your body down (as above).

Sleep Induction Techniques

Most people have racing thoughts, worries, aches or pains that "prevent" them from falling asleep. Trying to force these thoughts, feelings or worries to stop only serves to activate your brain and make it even harder to fall asleep. Instead, some savvy clinicians have realized that diverting attention to a sleep-inducing concentration can be very effective.

I learned this technique from Richard Shane PhD - the idea is to mimic the sensation of falling asleep, which is universal in humans. Thus the term "falling" asleep. 
  1. Pick A Sleep Position. Find the most comfortable position you can to fall asleep and commit to staying in that position for 20 minutes without tossing and turning.
  2. Allow Your Tongue to Relax. Notice the position of the tongue? Is it pressing hard against the roof of your mouth? Allow it to relax a tiny bit and press less hard. You don’t need to move the tongue.
  3. Allow Your Throat to Relax. Notice if your throat is tight or open. Imagine the sensation of yawning or a relaxed neck and throat. You don’t need to move your throat. 
  4. With One Hand Over Your Heart, Notice a Falling Sensation of Your Chest When You Breath Out. Pay attention to falling in and down sensation as the chest wall cradles the heart space every time you breath out. Your breathe will often be shallow and will pause at the end as you are falling asleep. This is normal. You don’t need to change your breathing. Just pay attention to the falling sensation...and keep your attention there.
Wishing you all sweet dreams and restful sleep.