Tips for Healthier Grilling

Grilling is the hallmark of summer and food. In addition to bringing people together, it gets us away from the hot oven in the kitchen and into the outdoors. It can also help us slow down, add variety to our diet, and give us new flavors to enjoy. We need to be careful, though. Grilling can make some foods more inflammatory to our bodies. However, there are steps you take to help you get the best nutrition from your outdoor fire.  

Why could grilling be a risk to your food and your health? Advance Glycation End products (AGE’s) are compounds that are produced when sugars combine with certain proteins or fats. These can form inside our body or in the food we consume. Manufacturing techniques of sugary or highly processed foods contribute to AGEs, but cooking methods that use high heat to brown or char foods, such as grilling, roasting, and broiling, have the largest impact on the amount of AGEs we consume. Also, AGE’s can accumulate in our body over time and contribute to inflammation, which increases our risk of insulin resistance and type-2 diabetes. Learning to avoid AGE’s can lower our diabetes risk and help improve insulin sensitivity.

---

Use the following tips to enjoy your next cookout and optimize your health:

1. Choose lean cuts of meat and trim any visible fat so that less fat drips during cooking.

2. Marinate meat before you grill. Research suggests that citrus, vinegars, cider, herbs and vegetable oils can reduce the formation of AGE’s. Sugar can increase AGE’s, so avoid marinades that have significant amounts of added sugar.

3. Try precooking meat in the oven and finish on the grill to lessen the exposure and risk.

4. Use lower heat by waiting for the coals to burn less hot or by turning down the gas.

5. Raise the grill rack farther from the heat.

6. Bigger is NOT better.  Grill thinner cuts of meat to reduce cooking time.

7. Go vegetarian. When veggie burgers, tofu and vegetables are grilled, there is little or no formation of AGE's.

8. Stay up-wind from grills to avoid breathing in smoke, which also carries health risks. No smoke is good smoke.

9. Use an untreated cedar plank for fish.  It’s always good to have a buffer between your food and the heat source.

10. Choose grass-fed meats which provide extra cancer-fighting Vitamin E (from grass), Conjugated Linoleic Acid and Omega-3 fats while being lower in inflammatory Omega-6 fats.

11. Never eat charred or blackened meat.

12. Eat foods rich in antioxidants with your grilled meats. Research shows topping a hamburger with avocado or other anti-oxidant rich veggies helps reduce AGE’s inflammatory effect.

GRILLED TUNA WITH MARINATED ARTICHOKES

How to make fresh fruit sorbet and other summer treats

These hot summer days may have you screaming for ice cream. I hear you. In my opinion summer is not complete without a few icy treats. Luckily, there are ways to indulge in “ice cream” that still honor our health.

For those of us avoiding dairy and watching our sugar intake we have a few options including sorbets, granitas and ice creams made with non-dairy “milks.”

A Primer on types of frozen treats

Sorbet is a French word for sherbet. It is any frozen dessert that does not contain dairy or eggs. (What Americans traditionally call sherbet is a dairy containing frozen dessert that has less milk or cream than traditional ice cream.)

Granita (Italian) or granité (French) is coarse-textured ice water that does not contain milk or dairy products and traditionally has less sweetener than sorbet.

Gelato (Italian ice cream) is a custard-based ice cream, typically made with more eggs and milk and less cream than French ice cream.

Traditional ice cream is a frozen dessert containing milk or cream, sweetener, and flavorings.

Guidelines for sorbet and granita preparation

Master Recipe for Sorbet:

1. Freeze 3-4 cups peeled, pitted, and chopped fruit in a single layer until firm (try peaches, plums, cherries, berries, pineapple, kiwi or combinations).

2. In a food processor, combine the frozen fruit pieces with 6 tablespoons maple or agave syrup, 2 tablespoons lemon or lime juice, and 1-3 teaspoons of alcohol* like vodka, mezcal, bourbon, rum, etc. until smooth. You can adjust the amount of sweetener as needed depending on the ripeness and sweetness of your fruit. Non-nutritive sweeteners like monk fruit, erythritol and stevia can be used.

3. Serve right away or freeze in a silicone container or loaf pan lined with parchment.

*The alcohol is optional, but it does help ensure a smooth consistency and prevents your sorbet from freezing rock solid. If you omit the alcohol, increase the sweetener to about 1/2 cup total to help keep your sorbet scoop-able.

Master Recipe for Granita:

1. Make a simple syrup by simmering 2 1⁄2 cups water and 1 3⁄4 cups sugar. Use about one cup of this syrup with about 3 pounds of fruit. Blend ingredients to a consistency that will thinly coat a spoon.

2. Freeze the granita in a shallow, rectangular container with a tight-fitting lid. Check granita occasionally (every 30-60 minutes or so) and scrape with a spatula, ice cream scoop, or fork as it freezes. Most granitas need to freeze about 24 hours.

Tips to keep in mind:

• Cold dulls flavor, therefore over flavor and over sweeten before freezing.

• Alcohol does not freeze; it adds creaminess to frozen treats (but too much prevents freezing). Adding a small amount of high proof alcohol can make your final product smooth and less “icy.”

• Sugar also helps prevents ice crystals. You can substitute monk fruit or erythritol for the sweetener, but your final product may be icier (but still delicious).

• Incorporate your solids when the treat is almost set. Don't add in chocolate chips, nuts, drizzles, etc. to the mixture while it is still a liquid.

• Store your ice treat properly. Keep them sealed in your freezer.

---

WATERMELON GRANITA

Yield: About 3 cups

Ingredients:
3 cups watermelon (about 1 pounds), seeded and cut into chunks
1⁄4 cup lime juice (about 4 small limes)
3 Tablespoons agave syrup or maple syrup
Pinch sea salt
Mint sprigs for garnish

Directions:

1. Process the watermelon, lime juice, sweetener, and salt in the blender. Strain out the excess pulp with a nut bag strainer or 2 layers of moistened cheesecloth.

2. Transfer the watermelon juice to a shallow, rectangular dish. (Ideally the juice should be about 1/4 inch up the side of the pan.)

3. Transfer the mixture to the freezer for about 1 hour.

4. Remove the pan from the freezer and use a fork to scrape any ice crystals that have formed on the side or bottom of pan. Return the pan to the freezer and repeat the scraping every 30 minutes for 3-4 hours.

5. Once the mixture is thoroughly frozen, scrape once more with a fork and returning the granita to “dry” in the freezer for another half hour before serving.

6. Garnish the granita with mint sprigs and serve.

---

POMEGRANATE GRANITA

Yield: 1 pint

Ingredients:
2 cups pomegranate juice
1/2 cup orange juice (about 2 oranges)
2 teaspoons sugar, coconut sugar or maple crystals

Directions:

1. In a saucepan over low heat, simmer the pomegranate and orange juices with the sweetener until the crystals dissolve.

2. Pour the mixture into a rectangular pan and transfer it to the freezer for about 1 hour. (The mixture should be about 1⁄4 inch up the side of pan.)

3. Remove the pan from the freezer and use a fork to scrape any ice crystals that have formed on the side or bottom of pan. Return the mixture to the freezer and repeat scraping every 30 minutes for 3-4 hours.

4. Once the mixture is thoroughly frozen, scrape once more with a fork and returning the granita to “dry” in the freezer for another half hour before serving.

---

STRAWBERRY SORBET

Yield: about 3 cups

Ingredients:
2 pints strawberries, stemmed and rinsed
1⁄2 cup maple syrup
2 tablespoons agave syrup
2 tablespoons balsamic vinegar
Pinch sea salt
Pinch freshly ground black pepper
2 tablespoons chopped basil leaves

Directions:

1. In a blender, puree the strawberries, maple syrup, agave syrup, and balsamic vinegar until smooth. Transfer the mixture to a medium bowl and whisk in salt, pepper, and basil.

2. Transfer the mixture to an ice cream machine and freeze according to its directions. Once the mixture has thickened, transfer it to a silicone container or loaf pan lined with parchment. Freeze for forty minutes to one hour or until the sorbet firms to scoop-able consistency.

---

Mint Chocolate Coconut Ice Cream

Yields: about 1 quart

Ingredients:
2 cans full fat organic coconut milk, chilled
1/3 cup raw honey, agave, or maple syrup
1 teaspoon peppermint extract or more to taste
1/2 cup chocolate chips or chopped dark chocolate, coarsely chopped and melted

Directions:

1. Blend the coconut milk, sweetener, and extract in a blender until smooth.

2. Transfer the coconut milk mixture to an ice cream maker and follow the manufacturer's instructions for ice cream.

3. While the mixture is churning, melt the chocolate carefully in the microwave or in a double boiler on the stove top.

4. Once the coconut mixture has thickened, transfer 1/3 to a silicone container or loaf pan lined with parchment. Drizzle 1/3 the melted chocolate over the ice cream. Continue to layer the ice cream and chocolate drizzle in the pan until all the ingredients are transferred. (Alternately, you can add the chopped, un-melted chocolate pieces to the mixture when it has started to thicken. In this case the chocolate will be in larger chunks and not thin, Stracciatella-like pieces.)

5. Freeze the ice cream for 1-2 hours before serving or until the ice cream has firmed to scoop-able consistency.

No ice cream machine? No problem. Check out this post by food-blogger David Lebovitz for tips on how to make ice cream without a machine.

(This blog post is not sponsored by any manufacturer. However, at no cost to you, Relish Health may receive a commission on purchases made through an Amazon link.)

TIPS TO MAKE YOUR HOLIDAY COOKIES MORE HEALTHY
HOW TO REPLACE BUTTER WHEN BAKING
A PRIMER ON GLUTEN-FREE FLOURS

The Ultimate Blood Sugar Test: Understanding your A1c

At Relish Health, a hemoglobin A1c (HbA1c or A1c) is a routine lab. It measures the extent to which hemoglobin in the blood has been affected (“glycosylated”) by blood sugar. Optimizing blood sugar balance is important for controlling inflammation and promoting longevity. With over 100 million Americans living with diabetes or pre-diabetes and millions more with suboptimal blood sugar balance, having a clear picture of your blood sugar levels is crucial.

What Is Diabetes And Prediabetes?

Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel. For the development of the disease, there are primarily two interrelated problems at work. Your pancreas does not produce enough insulin — a hormone that regulates the movement of sugar into your cells — and cells respond poorly to insulin and take in less sugar. These insulin management concerns can start to occur years or decades before a formal diagnosis of diabetes.

Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. The CDC estimates that more than 1 in 3— American adults have prediabetes with more than 80% unaware of their condition.

How Is Diabetes And Prediabetes Diagnosis?

There are several ways to diagnose diabetes. Each way usually needs to be repeated on a second day to confirm the diagnosis.

Measuring A1C:

The A1C test measures your average blood glucose for the past two to three months. The advantages of being diagnosed this way are that you don't have to fast or drink anything.
Your A1C test result is given in percentages. The higher the percentage, the higher your blood sugar levels have been:

• A normal A1C level is below 5.7%

• Prediabetes is diagnosed if the level is between 5.7 to 6.4%. Having prediabetes is a risk factor for getting type 2 diabetes.

• Type 2 diabetes is diagnoses if a level is above 6.5%

Fasting Plasma Glucose (FPG):

This test checks your fasting blood glucose levels. Fasting means not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.
A fasting glucose is only designed to measure glucose levels during the fasting period. It does not give a full picture of how a person’s body is handling sugar over a period of days or weeks. It does not provide any predictive insight into trends toward diabetes, prediabetes or other blood sugar handling issues. Fasting glucose levels can be highly affected by factors completely outside of diet such as poor sleep the night before or high stress levels.

• Normal Fasting Glucose: less than 100 mg/dl

• Prediabetes: 100 mg/dl to 125 mg/dl

• Diabetes: 126 mg/dl or higher

Oral Glucose Tolerance Test (OGTT):

The OGTT is a two-hour test that checks your blood glucose levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.

• Normal OGTT: Two-hour blood glucose less than 140 mg/dl blood

• Prediabetes: Two-hour blood glucose of 140 to 199 mg/dl

• Diabetes: Two-hour blood glucose of greater than or equal to 200 mg/dl

Random Plasma Glucose Test:

This test is a blood check at any time of the day when you have diabetes symptoms. Diabetes is diagnosed at a blood glucose of greater than or equal to 200 mg/dl.

What Are Optimal Glucose Levels?

In functional medicine, we are always looking beyond “normal” when it comes to lab marker ranges. When interpreting labs, “normal” does not necessarily equate to optimal if you are interested in preventing disease.

Optimal/Functional A1c Ranges:

• Optimal Range for A1c: less than 5.3%

• Less than Optimal/Pre-diabetic stage: A1c 5.4-6.0% (Your lab will call this “normal” but, in functional medicine we consider this a concerning zone.)

• Sub-optimal: Any A1c above 6.0% reveals a problem with blood sugar control.

In functional medicine, and at Relish Health, we want to catch blood sugar issues as early on as possible. The A1c test offers us a window into your last 8-10 weeks of blood sugar balance. It gives us clues into how sugars may be affecting your cells and tissues and can predict if you may progress to having diabetes. Prediction is key to prevention when it comes to disease. 

Health Effects of Chronically High A1c

The consequences of sub-optimal blood sugar balance over time include an increased risk of:

• Certain cancers

• Cardiovascular disease including elevated blood pressure, increased risk of heart attacks and strokes, and even impotence

• Diabetes

• Increased annual brain shrinkage and risk for cognitive decline

What Causes A High A1c?

It is tempting to place all the blame for a high A1c levels on too much sugar in the diet. In reality, there are many lifestyle factors that can directly affect your A1c levels such as:

• Sleep issues. Sleep deprivation is a leading causal factor behind blood sugar imbalances.

• Stress. Chronic stress can trigger excessive stress hormones that raise blood sugar and can create insulin resistance.

• Too many carbs, or too many of the “wrong” carbs. Excessive consumption of sugar and refined carbohydrates can trigger blood sugar imbalances. However, not all carbs will hurt you. “Good carbs” like those found in moderate amounts of whole fruits, vegetables and even sweet potatoes or white potatoes with the skins-on can be included in a healthy diet.

• Artificial sweeteners. Artificial sweeteners like aspartame, sucralose and saccharin have recently been shown to affect blood sugar and insulin levels.

• Not enough muscle mass and lack of exercise. Muscle helps your body regulate blood sugar. If you have a low lean muscle mass due to lack of exercise this could contribute to higher A1c levels.

Ways to Lower your A1c Levels

Relish Health can help you develop a personalized plan, but in general you can lower your A1c levels by:

• Reducing your intake of refined carbs and sugar. Minimize consumption of pastries, bagels, breads, pastas, cereals, and candy. Focus on eating non-starchy vegetables, proteins, fats, and small amounts of whole grains, fruits, and starchy veggies like sweet potatoes or beets.

• Increase your protein intake. Protein helps stabilize blood sugar while increasing satiety. Aim to have a small amount of lean animal or plant-based protein at every meal and snack. Relish Health can help you determine your protein needs with body composition analysis.

• Exercise regularly. Focus on exercises that build muscle mass. High intensity interval training (HIIT), weight training, yoga, and other weight-bearing exercises are excellent choices.

• Manage stress. This is one of the most profound things you can do to impact your blood sugar levels. Stress managing activities include exercising, listening to music, journaling, spending time with friends, laughing, meditation, spending time in nature and limiting your screen time.

• Optimize your sleep. Aim for 7.5-9 hours of sleep a night. Sleeping less may cause your blood sugar balance to suffer.

How Often Should You Check Your A1c?

Physicians typically recommend patients with type 2 diabetes check their A1c every three to six months to ensure adequate treatment. At Relish Health, we believe in the same vigilance to make sure that your lifestyle changes are giving you the results you want. If your A1c level falls in the concerning zone, we will recommend you check your A1c progress at least every 6 months.

If your A1c level is currently at an optimal level, we recommend checking your A1c once a year or every other year as part of routine preventative care. Many lifestyle choices over time can influence insulin resistance and blood sugar imbalances. Knowing your A1c level empowers you to manage your blood sugar balance proactively before it ever has the chance to become disease.

Tips for Reducing Sugar in your diet

IMPROVE YOUR SLEEP, IMPROVE YOUR HEALTH

TESTING Routinely ordered at Relish HEalth

Peach Melon Gazpacho

Local, tree ripened peaches are one of my favorite foods. In the late mid-western summer, they happen to be bountiful along with sweet melons and mellow cucumbers. These beauties are easy to pick up at your local farmer’s market or grocery. One benefit of deliberately eating locally and seasonally is that you are more likely to eat a wide variety of foods resulting in a greater diversity of phytonutrients vital for health and chronic disease prevention. The shorter the distance food needs to travel to reach you, the fresher and more flavorful it will be.

I hope you enjoy this recipe that combines the best of late summer fruits.

---

Peach Melon Jalapeño Gazpacho

Gazpacho is a Spanish-style soup often made from tomatoes and other vegetables and spices. This recipe is a liberal interpretation of the delicious chilled soup. The cucumbers, jalapeños and cilantro add balance and contrast to the sweet fruits, while the lemon and salt enhance all the flavors.

Peach Melon Jalapeño Gazpacho

Makes approximately 3 cups (6 servings)
Author: Erica Leazenby, MD
Time: 10 minutes

Ingredients:

• 2 peaches, peeled and pit removed

• 1/2 medium cantaloupe melon, rind and seeds removed; cut in large cubes

• 1 medium cucumber, peeled and seeds removed

• 1-2 medium jalapeño, seeds and ribs removed

• 2-4 tablespoons fresh lemon juice (1-2 small lemons)

• 1/4 cup raw cashews, soaked in water for 1 hour then drained

• Generous pinch of salt

• Garnish: Cilantro leaves and fruity olive oil

Directions:

1. Combine all the soup ingredients in a blender until smooth. Fruits can vary in sweetness and heat. Adjust the amount of lemon juice and salt to taste to balance the the fruit and veggie mixture.

2. Store the soup in the fridge, but allow the mixture to come close to room temperature before serving.

3. Garnish with a few cilantro leaves and a drizzle of high quality olive oil.

Understanding the Gut-Skin Connection: Fixing your Gut May Fix Your Skin

The human body is home to ecosystems of bacteria, yeast, viruses and other organisms that inhabit different regions of our body. These ecosystems are often collectively called the microbiome. While specific species and strains of organisms vary based on location in the body, imbalances of organisms in any given site play a role in the health of the body as a whole. The microbiome is a key regulator for the immune system. Hence, imbalances (also called dysbiosis) of these organisms are associated with an altered immune response, promoting inflammation in potentially multiple areas of the body. (1) A dysbiosis can occur if there are too many “bad” species, not enough “good” species, or not enough diversity of species.

The skin is the largest and most external barrier of the body with the outer environment. It is richly perfused with immune cells and heavily colonized by microbial cells. These microbes help train the body’s immune cells and help determine overall well-being. The skin has a unique microbiome that is distinct from the gut microbiome, yet scientists are learning that there is a strong bidirectional relationship between the health of these two areas of the body. The relationship is often termed the “gut-skin axis.” Skin conditions including rosacea, acne, psoriasis, atopic dermatitis, skin aging and others are often associated with altered gut microbiome health.

The gut and skin connection

The intestinal tract houses a diverse collection of bacteria, fungi, and protozoa. Many of these microorganisms are essential for metabolic and immune function. An imbalance in this microbiome can result in a breakdown of gut barrier function resulting in antigenic food proteins and bacteria components entering the body’s circulation to trigger inflammation. This inflammation can affect many organs, including the skin.

Adult Acne Vulgaris

Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Acne can be described as whiteheads, blackheads, pimples or deep cysts. Cystic acne is linked to the health of the skin’s microbiome, in particular the balance of a bacteria called Cutibacterium acnes. In a diverse, balanced skin microbiome, this bacterium is involved in maintaining a healthy complexion. However, if there is loss of the skin microbial diversity, this bacteria can also trigger cystic acne. The microbial imbalance can lead to the activation of the immune system and a chronic inflammatory condition like acne. (2) Like in the gut, the health of the skin microbiome influences the release of chemicals triggering inflammation. Optimizing both the gut microbiome and skin microbiome are important stratagies to resolve acne by controlling inflammation both at the skin level and whole body level.

Rosacea

Rosacea is a common, chronic inflammatory skin condition that causes flushing, visible blood vessels and small, pus-filled bumps on the face. The exact cause of rosacea is debated and likely related to multiple factors. Like acne, the skin microbiome and its associated inflammatory effects plays a role in rosacea's etiology. There are also numerous studies connecting rosacea to gastrointestinal disorders including celiac disease, inflammatory bowel disease, irritable bowel syndrome, Helicobacter pylori infection and small bowel bacterial overgrowth.(3) Conventional treatment of rosacea often involves managing symptoms. Identifying and addressing potential associated gut-related illnesses is an effective tool to help support rosacea management.

Eczema

Eczema, also called atopic dermatitis, is a chronic condition that makes skin red and itchy. It is common in children but can occur at any age. Atopic dermatitis tends to flare periodically and is often associated with asthma or allergies. Atopic dermatitis is the most common inflammatory skin disease affecting 7% of adults and 15% of children.(1)

Studies have shown that atopic dermatitis is associated with lower gut microbiome diversity, lower levels of beneficial species, such as Bacteroidetes, Akkermansia, and Bifidobacterium in the gut, and higher amounts of harmful bacteria species including Staphylococcus aureus on the skin.(1) The intestinal microbiome modulates the body’s immune system and inflammatory responses and thus may play a role in the development of eczema and its treatment. Targeted probiotics can play a role in prevention and treatment of this disease.(4)

Psoriasis

Psoriasis is an inflammatory, autoimmune skin disease that causes a rash with itchy, scaly patches, most commonly on the knees, elbows, trunk and scalp. The illness is associated with an intimate interplay between genetic susceptibility, lifestyle, and environment. People with psoriasis have an increased risk to develop intestinal immune disorders, such as inflammatory bowel disease like ulcerative colitis and celiac disease.(1) A growing body of evidence highlights that intestinal dysbiosis is associated with the development of psoriasis.(5) One study showed that malabsorption of nutrients in the gut was more prevalent among patients with psoriasis. Celiac disease, bacterial overgrowth, parasitic infestations and eosinophilic gastroenteritis could be possible causes of malabsorption in these patients.(6) Addressing associated gut conditions may play a role in management of symptoms.

Skin Aging

Skin aging is associated with multiple degenerative processes including oxidation and inflammation. Multiple factors including diet, UV exposure, and environment play a role in the regulation of the aging process. New research shows that healthier diets are linked to fewer signs of skin aging.(7) Additionally, oral probiotics may play a role in regulating skin aging through influences on the gut-skin axis. In a study published in 2015, the oral probiotic Lactobacillus plantarum HY7714 was shown to improve skin hydration, skin elasticity and UV related skin changes.(8)

Skin Care may need to Start with Gut Care

Optimizing the gut microbiome has a role in addressing skin disorders. The following strategies can improve the microbiome:

• Eat better. The microbiome is influence by the food we eat. Beneficial bacteria thrive on fiber that comes from eating a variety of vegetables regularly. The growth of unfavorable bacteria is influenced by sugar, saturated fats and a lack of fiber/vegetables in the diet. To optimize your microbiome, avoid refined sugar and saturated fats like those found in sodas, breakfast cereals, candies, cakes, red meat (limit to 1 or 2 servings a week to prevent overconsumption) and what is commonly referred to as “junk food”.

• Use antibiotics wisely. Antibiotic treatment is necessary from time to time. However antibiotics can significantly lower microbiome diversity and the quantity of beneficial bacteria.(9) When prescribed an antibiotic, ask your health care provider if it is truly necessary. Speak with your provider about using prebiotics and probiotics to support the microbiome after the antibiotic use.

• Repair the gut flora. In addition to a fiber-rich diet, probiotics may play a role in optimizing gut function. Probiotic science is in its infancy, but there is research suggesting that certain strains may benefit certain medical conditions. Speak with your health care provider for probiotic recommendations that may best suit your medical needs.

• Identify other ways to care for your digestive system, such as repairing the wall of the small intestine which may have been irritated by a poor diet, poor digestion, medications or stress. Identifying food sensitivities, restoring nutritional deficiencies and eating adequate nutrients to support healing are important.

Many of the interventions above can be easily implemented without need for laboratory tests. There are no specific gastrointestinal lab markers that are known to directly cause skin issues. However, assessments of the GI system may reveal abnormalities indirectly impacting skin health. Relish Health relies on multiple tools such as stool microbiome testing, breath tests and food sensitivity tests to understand the health of the gut-skin axis and develop targeted interventions to address gut and skin conditions.

TESTING, TESTING... WHICH ONES MIGHT BE RIGHT FOR YOU?

References:

1. De Pessemier B, Grine L, Debaere M, Maes A, Paetzold B, Callewaert C. Gut–Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions Microorganisms. 2021 Feb; 9(2): 353. doi: 10.3390/microorganisms9020353

2. Dréno B,. Pécastaings S, Corvec S, Veraldi S, Khammari S, Roques C. Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol 2018 Jun;32 Suppl 2:5-14. doi: 10.1111/jdv.15043.

3. Daou H, Paradiso M, Hennessy K, Seminario-Vidal L. Rosacea and the Microbiome: A Systematic Review. Dermatol Ther. 2021 Feb;11(1):1-12. doi: 10.1007/s13555-020-00460-1.Epub 2020 Nov 10.

4. Fiocchi A, Pawankar R, Cuello-Garcia C, et. al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics World Allergy Organ J. 2015; 8(1): 4. Published online 2015 Jan 27. doi: 10.1186/s40413-015-0055-2

5. Sikora M, Stec A, Chrabaszcz M, Knot A, Waskiel-Burnat A, Rakowska A, Olszewską M, Rudnicka L. Gut Microbiome in Psoriasis: An Updated Review. Pathogens. 2020 Jun; 9(6): 463. Published online 2020 Jun 12. doi: 10.3390/pathogens9060463

6. Ojetti V, De Simone C, Sanchez J, Capizzi R, Migneco A, Guerriero C, Cazzato A, Gasbarrini G, Pierluigi A, Gasbarrini A. Malabsorption in psoriatic patients: cause or consequence? Scand J Gastroenterol. 2006 Nov;41(11):1267-71.

   doi: 10.1080/00365520600633529.

7. Katta R, Sanchez A, Tantry E. An Anti-Wrinkle Diet: Nutritional Strategies to Combat Oxidation, Inflammation and Glycation. Skin Therapy Lett. 2020 Mar;25(2):3-7.

8. Lee, D. E. et al. (2015) “Clinical Evidence of Effects of Lactobacillus plantarum HY7714 on Skin Aging: A Randomized, Double Blind, Placebo-Controlled Study,” Journal of Microbiology and Biotechnology. Journal of Microbiology and Biotechnology. https://doi.org/10.4014/jmb.1509.09021

9. Ramirez J. Guarner F, Fernandez, L, Maruy A, Sdepanian V, Cohen H. Antibiotics as Major Disruptors of Gut Microbiota. Front. Cell. Infect. Microbiol., 24 November 2020 | https://doi.org/10.3389/fcimb.2020.572912

10. Stubbe C. The Gut Microbiome in Dermatology. Anti-aging Medical News. Spring 2022. p76-80.

Advice for Staying Regular When You Travel

I believe travel is an important part of life. It expands our understanding of the world around us which makes us better humans. Meeting new people, seeing amazing beauty, having special time with loved ones and trying new foods can be transformative. Unfortunately, there can be a side effect. If you get constipated when you travel, you are not alone. Disrupting our regular routine, changing time zones and eating that new food can be hard on our gut health. Try some of these strategies to help you worry less and have more adventure. 

Focus on fiber and bring (organic) prunes.

Fiber is magic for constipation. Fiber is the indigestible component of food that adds bulk to our stool. Traveling can make it challenging to eat your daily fiber minimum. Bringing fiber supplements along for the ride can make your journey easier. Prunes are a great option. They travel easy and make a sweet snack on the go. Many people only need three to four to maintain a regular bowel movement. Other great options include chia seeds to add to smoothies, psyllium husk or ground flaxseed. Berries are also rich in fiber and antioxidants. 

Stay hydrated.

Dehydration can be a big culprit contributing to constipation. Travel with a favorite refillable water bottle and aim to drink half your body weight in ounces of water. 

Drink something warm.

The warm beverage with or without caffeine can trigger motility. Regular or herbal tea, hot water or coffee are all great options. A small amount of caffeine such as a cup of coffee or espresso may be helpful for resetting the gut and getting things moving. If drinking caffeine, enjoy the cup in the morning so that it does not interfere with your sleep and melatonin production. 

Take magnesium.

Magnesium is a mineral found abundantly in the body and involved in many different enzymatic reactions in the body. There are several different types of magnesium, but in particular magnesium citrate is a safe laxative. I recommend that people start with one capsule per night and increase every one-three nights by one capsule until they get soft stools once or twice per day.

Even with a combination of these tips, some people still feel “off” while traveling. That’s ok. Give yourself a day or two to recover. However, if constipation is a regular occurrence there may be something more significant for you to address. Schedule an appointment with Relish Health and let's figure it out together. 

The Scoop on Choosing a Protein Powder

Protein is an important nutrient for our health. Proteins are made of small molecules called “amino acids” that serve as the building blocks for nearly every tissue and chemical in our body. Having an adequate dietary source is important to help control weight and muscle mass, balance blood sugar and prevent cravings, and appropriately drive metabolism. The daily intake of protein in an adult should be about 1 gram per kilogram of lean body weight however, your protein needs can vary based on your metabolic health, activity level and other medical conditions.

Adding a scoop of protein powder to a smoothie can be a quick and easy way to boost protein consumption. But, not all protein powders are created equal. Consider these options when selecting your product:

Whey

Source: Whey is a protein components in cow’s milk.
Pro: Whey is highly bioavailable, meaning it can be easily used by your body.
Con: Cow’s milk is a common gut irritant that causes low grade systemic inflammation for many people without them ever realizing it.
Good for you if: You are an athlete and want more lean muscle mass. You tolerate dairy well. You get it from a good source (organic, grass-fed, minimal ingredients, no thickeners, no sweeteners).

Casein

Source: Casein is also a protein in cow’s milk.
Pro: Casein is also easily used by the body.
Con: Casein can cause allergic reactions or upset stomach for those with dairy sensitivity. It also takes longer to digest than whey.
Good for you if: You are an athlete and want more lean muscle mass. You tolerate dairy well. You get it from a good source (organic, grass-fed, minimal ingredients, no thickeners, no sweeteners).

Beef Isolate Protein

Source: Various cuts of beef
Pro: Beef protein isolate is an animal source of protein that is not derived from milk. It is an excellent source of essential and collagen specific amino acids.
Con: The quality of the protein may be dependent on the cut of beef processed. Beef isolate protein is not as bioavailable as whey protein. It has a very specific taste and may clump together or not fully dissolve in liquid.
Good for you if: You want to avoid dairy, legumes and grains or are dairy sensitive. You get it from a good source (organic, grass-fed, minimal ingredients, no thickeners, no sweeteners).

Soy

Source: Soybean plant
Pro: Soy is a plant-based protein that is an alternative for those with dairy allergies or sensitivities. Soy is one of few plant foods that offers a full profile of amino acids that our bodies need.
Con: Research suggests that some soy consumption is safe, however, some still worry about the hormone-like compounds that soy contains.
Good for you if: You are vegan. You tolerate legumes. You get it from a good source (organic, minimal ingredients, no thickeners, no sweeteners).

Pea Protein

Source: Plants; usually yellow peas.
Pro: Pea protein is considered hypoallergenic meaning it is unlikely to cause an allergic reaction or food sensitivity.
Con: Peas do not contain the full spectrum of amino acids.
Good for you if: You are vegan. You mix it into other blends of protein (e.g. hemp or rice) to get all the necessary amino acids. You tolerate legumes. You get it from a good source (organic, minimal ingredients, no thickeners, no sweeteners).

Rice Protein

Source: Rice
Pro: Rice is also hypoallergenic, plus it may have an extra dose of B vitamins and fiber.
Con: Rice contains a small amount of carbs.
Good for you if: You are vegan. You are not paleo. You mix it into other blends of protein (e.g. hemp or pea) or nuts and seeds to get all the essential amino acids. You tolerate grains. You get it from a good, high-quality source (organic, minimal ingredients, no thickeners, no sweeteners).

Hemp

Source: Hemp seeds (from the cannabis plant)
Pro: Hemp is hypoallergenic and is a source of complete protein. Hemp has all the 9 essential amino acids and contains an extra dose of omegas.
Con: Hemp is the least bioavailable of the lot, meaning your body doesn’t absorb and use it as well as other sources. 
Good for you if: You are vegan. You are paleo. You get it from a good, high-quality source (organic, minimal ingredients, no thickeners, no sweeteners).

Collagen

Source: Animal connective tissue, often bovine hide or wild-caught white fish (marine collagen)
Pro: Collagen can be good for skin and joint health.
Con: Collagen is often considered a beauty product and comes with a lot of hype. Many label promises are not proven. Collagen is not a complete protein. It only contains 8 of the 9 essential amino acids. These amino acids are not equally balanced, as the ratio is skewed towards glycine, proline, and hydroxyproline.
Good for you if: You are not vegan. You are paleo. You don’t mind spending a bit extra to get the good stuff. You get it from a good, high-quality source (organic, grass-fed, minimal ingredients, no thickeners, no sweeteners).

Spirulina

Source: Blue-green algae
Pro: Spirulina is a complete protein plus gives extra minerals and antioxidants.
Con: It is hard to know where it comes from.
Good for you if: You are vegan. You are paleo. You tolerate chlorophyll-containing drinks. You get it from a good, high-quality source (organic, minimal ingredients, no thickeners, no sweeteners).

And the winner?
In my opinion, a mixture of rice and pea protein is the winning combo. The combination makes up the full spectrum of essential amino acids, while being plant-based, and free of common irritants like casein, lactose, gluten, or soy.

One final note of caution: unfortunately, the FDA does not regulate protein powders, so you have no way of knowing what’s actually in them. Do your homework to make sure you’re getting protein powder from a trusted source. Ensure your protein powder is free of added sugars and artificial coloring or preservatives. Ideally, it will be certified by a third party stating it is low in heavy metals. 

Curious about how much protein you needs? Relish Health can help you determine your protein need.

DETERMINE YOUR PERSONAL PROTEIN NEEDS WITH BODY COMPOSITION ANALYSIS AT RELISH HEALTH

BUILDING A BETTER SMOOTHIE AND DR. LEAZENBY’S FAVORITE RECIPE

Garam Masala Roasted Salmon with Spice Grapes

Garam Masala Roasted Salmon with Spice Grapes

Garam Masala is a popular spice blend used in Indian cooking. It usually includes cinnamon, cardamom, cloves, cumin, coriander, nutmeg, and peppercorns, but the ratio and spices used will vary from region to region and household to household. The combination of spices delivers the warm flavors found in most seasonal baked goods, with just a touch of intrigue from citrusy, earthy cumin and coriander.

A good garam masala recipe has a mix of sweet, hot, and savory ingredients. Cumin, coriander, and bay leaf provide savory notes. Cinnamon and clove provide sweetness. Black peppercorns provide heat while cardamom, fennel, and nutmeg provide fragrance. In addition to flavor, spices provide potent anti-inflammatory phytonutrients to make your meal more nutritious.

Author: Erica Leazenby, MD
Serves: 4
Time: 25 minutes

Ingredients:

Garam Masala Roasted Salmon with Spiced Grapes and Winter Salad with Roasted Squash, Shallots, and Pomegranate Vinaigrette

4 5-6 ounce wild-caught Salmon filets
1 teaspoon garam masala (store-bought or homemade)
1-2 tablespoon olive oil, divided
1 tablespoon ghee (or more olive oil)
1 cup red seedless grapes, sliced in quarters
1 teaspoon cinnamon
¼ cup balsamic vinegar
Salt to taste

Directions:

1. Preheat the oven to 350 degrees. (Use 325 degrees if using a convection oven). 

2. Heat a large cast iron skillet or other oven-safe skillet over medium heat. Brush each salmon with olive oil and season with salt and garam masala. 

3. Place the salmon skin side up in the skillet. Sear for 4 minutes. Flip the salmon and place the skillet in the oven. Bake until the salmon is medium rare or approximately 120-125 degrees. (Estimate a total cook time of 10 minutes per inch thickness.)

4. While the salmon bakes, heat a second smaller skillet over medium heat. Add 1 tablespoon of olive oil, the ghee, cinnamon and grapes. Sauté the grapes until they are hot and starting to soften, approximately 3-5 minutes. Season gently with a pinch of salt. Deglaze the pan with the balsamic vinegar. 

5. Serve the salmon on a bed of grapes. Drizzle the pan sauce over the salmon prior to serving. 

---

Garam Masala 

Author: Erica Leazenby, MD
Makes: Approximately 1/3 cup
Time: 10 minutes

Ingredients:

8 grams coriander seeds
8 grams cumin seeds
4 grams green cardamom pods
2 grams cloves
2 grams peppercorns
1 gram Ceylon cinnamon (approx. ½ stick)
2 grams fennel seeds
2 medium dried bay leaves
½ gram nutmeg (approx. ¼ small nutmeg)
1/8-1/4 star anise (optional)

Directions:

1. Inspect your spices for dust, mold, or impurities while pre-heating a pan over low heat. 

2. Gently toast the spices to enhance their flavor. I recommend toasting each spice individually or toasting similarly sized spices together. Toast each spice for 30-60 seconds or until they start to become fragrant. Place the toasted spices on a plate to cool completely.

3. Grind the spices together in a clean coffee or spice grinder.

4. Store in an airtight glass container. 

Rainbow Pad Thai Salad with Chicken Satay

Rainbow Pad Thai Salad with Chicken Satay

Serves: 3-4
Adapted from Oh She Glows and NomNomPaleo

Ingredients:

For the dressing and dipping sauce:

• 1 garlic clove, grated

• 1/4 cup almond butter, peanut butter or sunbutter

• 2 tablespoons fresh lime juice

• 2 tablespoons coconut aminos or low-sodium tamari

• 2 tablespoons water

• 1/2 tablespoon toasted sesame oil

• 1 teaspoon freshly grated ginger

• Optional: 2 teaspoon Maple syrup (omit to make Whole30 compliant)

For the salad:

• 1 medium zucchini, julienned or spiraled

• 2 large carrots, julienned

• 1 red pepper, thinly sliced

• 1 cup thinly sliced red cabbage

• 3/4 cup shelled edamame (omit to make Whole30 compliant)

• 3 green onions, thinly sliced

• 1 tablespoon hemp seeds

• 1 teaspoon sesame seeds

For the chicken:

• 1½ pounds boneless and skinless chicken breasts, sliced in 1/2 inch strips

• Wooden skewers, soaked in water 30 minutes prior to use

• ½ cup full-fat coconut milk

• 1 tablespoon Thai red curry paste

• 1 large Medjool date, pitted and finely chopped

• 3 garlic cloves, peeled and roughly chopped

• 2 tablespoons Red Boat fish sauce

• ½ teaspoon ground turmeric

 Directions:

1. Prepare the marinade: Combine the coconut milk, curry paste, date, garlic, fish sauce and turmeric in a large bowl. You can blend the ingredients in a blender if you prefer a smoother finished product. Add the chicken to the marinade and refrigerate up to 12 hours.

2. Prep vegetables. Add the zucchini, carrots, pepper, and cabbage into one or two large bowls. Toss to combine.

3. Prepare the chicken: Using one strip of chicken at a time, carefully skewer the meat on the pre-soaked wooden skewers. Skewer the meat in an accordion-like fashion ensuring that the meat is roughly the same thickness on each skewer. This will ensure that the meat cooks evenly. Grill the chicken over high heat for 3-5 minutes per side or until the chicken is cooked through. The skewers can also be roasted in a 425 degree oven (400 degree convection) for approximately 10 minutes or until cooked through. Broil for an additional 1-2 minutes for additional color if desired.

4. Prepare the dressing: While the chicken is cooking, prepare the dressing/satay sauce by combine all the ingredients in a small glass jar. Whisk to combine. The dressing will thicken as it sits.

5. To serve, toss the veggies with the dressing. Top with chicken and garnish with green onion, hemp seeds, and sesame seeds.

Slow Cooker Salsa Verde Chicken

This spicy, saucy chicken takes almost no time to prep in the morning and only 5 minutes to finish before eating. This meal can be enjoyed as a simple, satisfying, low-carb stew, but it can be adapted to make tacos, taco bowls, enchilada filling, tamale filling or even soup if desired.

Adjust the the level of heat to your taste by selecting mild or hot jarred salsas. If you want even more spice, substitute a hotter pepper for the jalapeño or use hot canned green chiles instead of mild ones.

---

Slow Cooker Salsa Verde Chicken

Adapted from NYT cooking by Sarah DiGregorio
Serves: 4 servings
Time: 5 to 6 hours

INGREDIENTS

1 1⁄2 pounds boneless, skinless chicken thighs
1 1⁄2 cups jarred salsa verde
1 (4-ounce) can chopped mild green chiles
8 garlic cloves, finely chopped
1-2 jalapeño, stemmed, seeded and diced
1 teaspoon garlic powder
1 teaspoon onion powder
1 teaspoon ground cumin
3 scallions (green and white parts), thinly sliced
1 small bunch cilantro, leaves and tender stems finely chopped (about 1 heaping cup)
Kosher salt, to taste
Fresh lime juice, to taste
Any combination of rice, cauliflower rice, tortillas, pepitas, cashew cream, diced avocado and crushed tortilla chips for garnish.

DIRECTIONS:

1. Combine the chicken thighs, salsa verde, green chiles, chopped garlic, jalapeño, garlic powder, onion powder and cumin in a 6- to 8-quart slow cooker. Stir to evenly combine. Don’t add salt; jarred salsas are often high in sodium. Cook on low until the chicken is tender and the flavors are blended, 4 to 5 hours. (If you will be away for 8 hours or more, set the cook time for 4 hours on low and set the slow cooker auto-switch to warm for the remaining time.)

2. Use two forks to coarsely shred the chicken. Just before serving add the scallions and cilantro; stir to combine. Season to taste with salt and lime juice. Serve with desired accompaniments.

Adaptation:

Salsa Verde Soup

• 1/2 batch Salsa Verde chicken

• 1 quart chicken stock or more for desired consistency

• 1 can black beans, drained and rinsed

• 1 cup frozen sweet corn

• Avocado, green onions, cilantro and/or tortilla chips to garnish

Salsa Verde Bowl

• Salsa Verde Chicken

• Romaine lettuce, chopped

• Guacamole

• Rice or cauliflower rice

• Diced tomatoes

• Salsa and hot sauce

• Cilantro

*Make this dish Whole30 compliant by avoiding rice, beans, corn and tortilla chips. Read labels to ensure your salsa and hot sauce do not contain added sweetener.

Simple Arugula Citrus Breakfast Salad

The perfect breakfast is low in sugar and contains protein, healthy fats and plenty of fiber. The combination of these macronutrients ensures that our blood sugars are stable helping to keep us appropriately fueled for our day. Give this simple salad a try. The citrus provides sweetness and acidity to balance the bitter greens. I like to serve this salad with a piece protein to round out the meal.

---

Simple Arugula Citrus Breakfast Salad

Arugula with grapefruit and breakfast sausage

Ingredients:

• 1 orange or grapefruit, peeled and sliced

• 1 large handful baby arugula

• 1 generous drizzle extra-virgin olive oil

• Pinch salt

• 1/4-1/2 avocado, diced

Directions:

• Combine all the ingredients in a medium bowl and toss. Gently stir in avocado.

Sheet-Pan Roasted Fish With Sweet Peppers

This quick and easy dinner strikes all the right notes. Sweet, caramelized peppers with salty olives and garlicky parsley dressing that nicely complement the mild, flaky fish. The gorgeous colors of this sheet pan are a feast for the eyes.

This dish is versatile and can be made with many types of mild, white fish like cod, trout, tilapia or flounder, or even shrimp, though you may have to adjust the roasting time to accommodate the different options. The thicker the fillets, the longer they will take to cook.

Seafood not your thing? Try roasting the peppers and olives with the dressing per the instructions and topping them on pan-seared chicken cutlets.

---

Sheet-Pan Roasted Fish With Sweet Peppers

Adapted from Melissa Clark at NYT Cooking
Serves: 3 to 4 servings
Time: 40 minutes

INGREDIENTS

1 tsp dried thyme
1 1⁄2 pounds white fish fillets like lake trout, tilapia, cod or hike
Sea salt and black pepper
3 large bell peppers, preferably 1 red, 1 orange and 1 yellow, thinly sliced
4 1⁄2 tablespoons extra-virgin olive oil, plus more for drizzling
1⁄4 cup pitted and sliced, Kalamata, green or black olives (or a combination)
1 teaspoon sherry or red wine vinegar, plus more to taste
1 garlic clove, grated
1 cup loosely packed Italian parsley leaves, chopped

DIRECTIONS:

Not a fish fan, try using chicken cutlets instead.

1. Preheat oven to 400 degrees.

2. Season fish all over with salt and pepper and sprinkle with 1/2 tsp thyme leaves. Let rest at room temperature while you prepare the peppers.

3. Spread peppers on a rimmed sheet pan, and toss with 1 1/2 tablespoons oil, 1/2 teaspoon salt and the black pepper to taste. Top peppers with the remaining thyme. Roast, tossing occasionally, until peppers are softened and golden at the edges, about 15 to 20 minutes.

4. Increase oven temperature to 500 degrees. Push peppers to the edges of the pan, clearing a space in the center. Lay fish out on that empty space and drizzle with oil. Scatter olives over the top of fish and peppers. Continue roasting the pan until the fish turns opaque and is just cooked through, about 6 to 10 minutes depending on the thickness of the fish.

5. While the fish roasts, make a vinaigrette by combining the vinegar, garlic and a pinch of salt in a bowl. Whisk in the remaining 3 tablespoons olive oil, then whisk in the parsley. Taste and add more salt or vinegar, or both, if needed. Serve fish and peppers drizzled with vinaigrette.

6. Serve with roasted potatoes, rice, cauliflower rice or side salad.

Lifestyle Tips to Ease Your Anxiety and Improve your Mental Health

If you find yourself in a frequent state of excessive uneasiness or apprehension, you may be experiencing an anxiety disorder. Often anxiety is felt emotionally—like feeling dread, overwhelmed or panicked, but occasionally these emotions are accompanied with physiologically symptoms like breathlessness, heart racing, sweating, chest pain or discomfort. If these sensations sound familiar to you, know that you are not be alone. Anxiety disorders are one of the most common mental illness in the United States and affects nearly 1 in 5 people at any given time.  

Freud believed anxiety reflected inner emotional conflict, but now we have a more biologic understanding of anxiety. Research demonstrates that anxiety results from the interplay of many factors including genetics, diet, environmental exposures, chronic illnesses and social and emotional well-being.  If we want to quiet the anxiety in our mind, we need an approach that supports each of these factors. 

Consider the following lifestyle tips for addressing anxiety:

START HERE

1. Eat an anti-inflammatory diet. Our mental health is an extension of our overall health. If our body is inflamed or deficient in nutrients, then your mental health will suffer. Food is the most important environmental factor when it comes to repairing your brain and keeping your body healthy. Eating well is an act of radical self-love. It unfortunately doesn’t come cheap, and often requires immense effort, but if you’re looking for the keys to the kingdom of feeling good, then look right in front of you on your plate.

   An anti-inflammatory diet focuses on nutrient-dense, unprocessed, whole, real food. It includes an abundance of vegetables; well-sourced meat, fish, and poultry, fermented foods, nuts and seeds; fruit; and plenty of healthy fats such as olive oil, avocado, coconut oil, and fatty fish. What is not present is sugar, refined carbs (i.e., bread, crackers, pasta, cookies, even seemingly healthy vegan or gluten-free replacement foods), and inflammatory oils, such as canola oil.

   Research from the new and exciting field of nutritional psychiatry is demonstrating the power of food to influence our mood. Check out these great resources for more details:

   • This Is Your Brain on Food: An Indispensable Guide to the Surprising Foods that Fight Depression, Anxiety, PTSD, OCD, ADHD, and More by Uma Naidoo

   • Brain Changer: The Good Mental Health Diet by Felice Jacka

   • Eat to beat Depression and Anxiety: Nourish Your Way to Better Mental Health in Six Weeks by Drew Ramsey

2. Actively manage stress. Our response to stress is regulated by a complex set of interactions between two parts of our brain—the hypothalamus and the pituitary glands and the adrenal glands. This subsystem of the body is often called the HPA axis. It is responsible for triggering the release of hormones needed to respond to stress. In pathologic anxiety, this HPA axis may become dysregulated. The normal cues to turn off the production of stress hormones are missed, and you may be left feeling stressed despite the threat being gone. Taking proactive steps to manage stress can help keep the HPA axis healthy. Activities like meditation and yoga are well documented to help relieve anxiety and depression. These not your cup of tea? Try other reflective practices like journaling, making music or even coloring mandalas. The trick is to find a practice that resonates and make it happen. Check out these resources to get started:

   • Relaxation apps: Headspace, Calm, The Tapping solution, Heartmath

   • The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel Van Der Kolk

3. Prioritize sleep. Lack of sleep activates the stress circuit and inhibits our relaxation. Our modern life often keeps us up and plugged into our devices much later than we should be. The circadian rhythm of the human body works best when we fall asleep approximately three hours after sunset and wake with the sunrise. Try going to bed by 10 pm every night. Avoid blue light emitted from devices that can suppress your production of sleep promoting melatonin. Exposure yourself to bright light in the morning by opening the curtains, going for a walk or sitting with a lightbox. Check out these resources to get started:

   • Lightbox from Amazon

   • Blue light blocking glasses from Amazon

   • Why We Sleep: Unlocking the Power of Sleep and Dreams by Matthew Walker

4. Exercise regularly. Exercise alone is a powerful tool to treat anxiety. In as little as 10 days it can make a dramatic difference. The best exercise is the one you enjoy and will faithfully complete, but studies suggest that resistance training may have a slight advantage over aerobic exercise at reducing anxiety.

ADVANCED PROTOCOL

Start with the basics, but if anxiety is still problematic further evaluation and more targeted treatment may be needed. 

1. Get a medical evaluation. Imbalances of hormones (thyroid, insulin, estrogen/progesterone, etc.) blood sugar problems, nutrient deficiencies, untreated infections and toxic exposure may be contributing to your poor mood. A comprehensive discussion and laboratory evaluation with your physician are important. 

2. Monitor your Heart Rate Variability (HRV). HRV is the measure of the variation in time between each heartbeat. It is regulated by a primitive part of our nervous system called the autonomic nervous system (ANS). If a person is in a fight-or-flight mode, the variation between heartbeats is low. If one is in a more relaxed state, the variation between beats is high. The healthier our ANS the faster we can switch gears between fight-and-flight and relaxation, showing more resilience and flexibility. 

   HRV can be easily monitored and improved. There are a number of tracking devices and training apps available on the market that are specifically designed to help address anxiety. For more information check out heartmath.com, Oura ring, and Elite HRV to get started. 

3. Try tapping. Emotional freedom technique (aka tapping or psychological acupressure) is an alternative treatment for physical pain and emotional distress. It has been extensively investigated for anxiety and has been shown to dramatically improve symptoms. Similar to acupuncture, tapping focuses on the meridian points—or energy hot spots based on Chinese medicine. Tapping is easy to learn and can be completed anywhere with no side effects. Learn more here. 

4. Consider medication and/or supplements. Optimizing lifestyle is always the best place to start addressing anxiety. However, there is a place and time to add targeted supplements and medication. If the above strategies are not providing adequate relief or more urgent relief is needed, talk to your physician about making a treatment plan. 

If you’ve been feeling anxious, I hope you’re able to put some (or all) of these practices into place. I always recommend being in care with a good mental health provider to help you see your blind spots and give you support, but I’m hopeful that most people can heal their anxiety without medications and the side effects that often come with them.

If you’re experiencing depression or anxiety and need support, please call the National Depressive/Manic-Depressive Association Crisis Call Center’s 24-hour hotline at 1-800-273-8255.

The Perfect Shrub Mocktail

How is your Dry January going? I am finding that sparkling water with lime is very refreshing with dinner. On the weekends I am enjoying some delicious “mocktails” made with fruit and vinegar. The sweet, slightly acidic and pungent flavors feel celebratory while still being mostly virtuous for my health (hello sugar, I’m still watching you.)

Drinking vinegars are often called “shrubs.” The word "shrub" refers to a cocktail or soft drink made by mixing a vinegar syrup with spirits, water or carbonated water. The history of shrubs dates back to medicinal cordials in the middle ages. In colonial America, shrubs were created as a way to preserve berries and other fruits for the off-season.

Shrubs are incredibly easy to make. They can be made by infusing vinegar with fruits, herbs or spices or by simply mixing fruit juice with vinegar.

How to make a shrub

There are two strategies for making shrubs, a hot process and a cold process. The cold process can be used with any fruit, but is ideal for fruits that you rarely cook, like melons or citrus. The hot process involves making a simple syrup while helping the fruit breakdown with heat. The heat process is ideal for fruits that you would simmer to make jam, think berries, peaches or rhubarb.

Hot Processed Shrub:

1. Make a simple syrup by combining equal parts sweetener and water in a medium saucepan over low heat. Stir the mixture until the sweetener is completely dissolved. 

2. Add your clean and sliced fruit to the simple syrup. Bring the syrup-fruit mixture to a low simmer until the syrup has started to thicken and the fruit has started to lose it’s shape.

3.  Combine the fruit mixture with an approximately equal amount of vinegar. Start with ½ of the estimated vinegar needed and slowly add it to the fruit syrup. Taste the mixture as you go so that you get a shrub that is just sharp enough for you.

4. Strain the mixture and discard the fruit (or use it as a base for a vinaigrette or marinade).

5. Store the shrub in a jar in the fridge.

Cold Processed Shrub:

1. Place your clean and sliced fruit in a bowl. Toss it with the sweetener. Gently mash the fruit.

2. Let this mixture sit for 2 days in the refrigerator to macerate. Stir the mixture periodically.

3. After 2 days, strain the mixture into a measuring cup and discard the fruit (or use it as a base for a vinaigrette or marinade).

4. Combine the syrup with an approximately equal amount of vinegar. Start with ½ of the estimated vinegar needed and slowly add it to the fruit syrup. Taste the mixture as you go so that you get a shrub that is just sharp enough for you.

5. Store the shrub in a jar in the fridge.

---

Choosing your ingredients

Shrubs are a matter of ratio. Finding the balance between sweet and tart is often a 1:1:1 ratio of fruit, sugar, and vinegar, however, feel free to let your palate fine tune this ratio. Here is a good place to start:

For the heated process:  
1 pound chopped fruit
1 cup sweetener
1 cup water 
1 cup vinegar

For the cold process:
1 pound chopped fruit
2 cups sweetener
2 cups vinegar

Each method should yield about 3 cups of shrub syrup, which will keep in the fridge for weeks. Feel free to adjust the recipe dependent upon the amount of fruit you have. I find shrubs are a great way to use up the bits of fruit I have on hand that may be past their prime. 

Shrubs are incredibly versatile. They are a great way to embrace seasonal fruits like strawberries in the spring; peaches, fennel, berries, and watermelon in the summer, or apples, citrus, and pomegranates in the fall/winter. You are not limited to fruit in your shrub. Grated fresh ginger, fresh herbs, like rosemary or thyme, or spices, like cardamom pods, bay leaves, cinnamon or star anise, can be added to either the simple syrup (hot process) or the sugar-fruit mixture (cold process).

Choosing your vinegar

There is a dizzying number of vinegars available in the groceries these days. Most vinegars will work in shrubs but think about how your fruit will pair with the flavor of the vinegar you select. I prefer to use vinegars that are more “delicate” in flavor rather than plain white vinegar, which is too intensely sharp in my opinion. Unpasteurized apple cider vinegar is the one I use most, but white or red wine vinegar, rice vinegar, or Champagne vinegar also work well. Balsamic vinegar is slightly sweet and adds an amazing depth of flavor, but you only need a splash. It mixes well with cider or wine vinegar for balance in a recipe.

The Sweetener

White sugar is the traditional choice for making a shrub. It’s neutral flavor is ideal to pair with the fruit. Brown sugar, honey or maple syrup can be used, but will add another element of flavor. I personally like to use a natural, non-nutritive sweetener like monk fruit or erythritol. These are not traditional ingredients to use in a shrub, but they do allow me to minimize my sugar intake and keep control of my blood sugars without significantly changing the flavor. 

Below is a list of fruit, spice and vinegar flavor combinations to consider using for your next shrub complements of food52.com:

Pomegranate + peppercorn + white sugar + red wine vinegar
Pear + star anise + brown sugar + white wine vinegar
Red plum + cardamom + brown sugar + white wine vinegar
Peach + cardamom pods + honey + cider vinegar
Strawberries + white sugar + red wine vinegar and a splash of balsamic vinegar
Blueberries + thinly sliced ginger + cider vinegar
Nectarine + peppercorn + brown sugar + white wine vinegar

---

Cheers! Using your shrub

Now that you have your shrub prepared you can make mocktails, vinaigrettes or even marinades with this culinary wonder. 

Mocktail: Fill a tall glass with ice, pour in a splash of shrub, and top it off with sparkling water. Give it a gentle stir to incorporate the shrub. Garnish as desired. 

Vinaigrette: A vinaigrette is traditionally 2 parts olive oil to 1 part vinegar. Substitute part of your go-to vinegar with the shrub when making your next dressing. Add a pinch of salt, a few turns of fresh ground pepper and a small dollop of Dijon mustard for an amazing way to elevate your next salad.

Marinade: Mix the shrub with avocado oil, salt, pepper and additional herbs and spices (think garlic, onions, rosemary, etc.) and allow your fish, chicken or beef to tenderize while soaking up the shrub flavor.

---

Fennel shrub mocktail

Ingredients:
2 tablespoons fennel juice
1.5 tablespoons champagne vinegar
1-2 tablespoons sweetener (I use monk fruit but sugar is traditional.)
8 oz sparkling water

Directions:

1. Juice the stems and bulb of a fennel using a juicer machine.

2. Mix the juice, vinegar and sweetener until the sweetener is dissolved.

3. Top with sparkling water and ice.

4. Garnish with fennel fronds and enjoy.

---

TIPS FOR DRY JANUARY SUCCESS
ELDERBERRY SHRUB
ELDERBERRY SYRUP RECIPE

---

(This blog post is not sponsored by any manufacturer. However, at no cost to you, Relish Health may receive a commission on purchases made through an Amazon link.)

Tips for Dry January Success

If you are taking a month off from drinking alcohol, you are not alone. Going “dry” for the month of January is on trend. “Dry January” has become a robust movement that started in 2012 from a public health initiative in the UK. Now millions of people around the globe are expected to abstain from alcohol this month.

Wondering if this is for you? The research shows that pushing the reset button on drinking after the holidays can benefit everyone, not just heavy drinkers. All types of drinking patterns, from light (1-6 drinks per week) to heavy (3 or more drinks in one day or more than 7 per week for women; more than 4 drinks in one day or more than 14 per week for men), report short-term improvements in deeper sleep, better food choices, improved lab markers, and even weight loss.

Why do Dry January?

Everyone can benefit from reevaluating their relationship with alcohol. Being alcohol-free for 31 days reminded us that we don’t need alcohol to have fun, relax, or socialize. Additionally, we strengthen our skills needed to manage our drinking. That means that for the rest of the year we are better able to make decisions about when we drink and how much, so we can avoid slipping into drinking more than we really want. In fact, a University of Sussex study showed that 70% of people who took part in Dry January were still drinking less six months later, especially if they use the Try Dry app developed by Alcohol Change UK. Other short term perks like better sleep, more energy, healthier skin, and sharper concentration seem to persist past the 31-day dry challenge too. And, even those who fell short of abstaining the entire month were drinking less after 6 months. 

In another study from the UK, researchers confirmed the old adage that avoiding alcohol gives our liver a break. The participants of the study saw improved liver enzymes even when they kept their eating, smoking, and/or exercise habits the same. The study participants also enjoyed reductions in weight, blood pressure, insulin resistance, and cancer-related growth factors.

---

Dry January Benefits:

What you'll notice Quickly(1):

70% of people sleep better
86% of people save money
65% of people notice generally improved health

Short-term medical benefits(2):

Reduced diabetes risk
Improve blood pressure (BP)
Lower cholesterol
Reduced level of cancer-related proteins in the blood
Improved liver function tests

Long-term benefits:

Alcohol is linked with more than 60 health conditions including liver disease, high blood pressure, depression and seven types of cancer. Cutting back on alcohol long-term reduces your risk of developing these conditions.

---

Tips to improve your success completing a 31-day alcohol free challenge:

Fennel Shrub Mocktail (Click here for the recipe.)

• Find a substitute non-alcoholic drink. For social situations, or when you crave a cocktail after a long day, reach for alcohol-free beverages like sparkling water, kombucha, or virgin beverages (non-alcoholic versions of alcoholic drinks.) There are many new and delicious non-alcoholic options on the market these days. I personally like to make a mocktails by combining sparkling water (love my soda stream) with a splash of bitters and an herb or citrus garnish. Experiment with a variety of bitters for fun flavors and combinations.

  Non-alcoholic beer or wine is also an option, but some brands still contain up to 0.5% alcohol by volume, so check the label. Sugar is often added to these beverages to improve the taste, so try to choose ones that are low in sugar. 

  “Shrubs” also make excellent alternative to alcohol. Shrubs are sweetened vinegar based syrups that can be mixed with sparkling water. They can be fruity, spicy or herbaceous with a kick from the vinegar. I like to use apple cider vinegar because it has health benefits on its own.

• Avoid temptations. Keep alcohol out of your house. When you are invited to someone’s home, bring your favorite non-alcoholic drinks with you to share.

• Create a support group. Let friends and family know about your intentions and encourage them to keep you accountable. Better yet, enlist someone to do the challenge with you.

• Use the Try Dry app. This free app is sponsored by the non-profit Alcohol Change UK. It helps you track your drinking, set personal goals, and offers motivational information like calories and money saved from not drinking. It’s aimed at cutting back on or cutting out alcohol, depending on your choices. Use of the app has been shown to double your success of completing a dry month challenge.

• Don’t give up. If you slip up, don't feel guilty. Tomorrow is a fresh start.

Warning:

Stopping drinking suddenly can be very dangerous, and can even kill you, if you are dependent on alcohol. If, after a period of drinking, you experience any of the following symptoms, you may be dependent on alcohol and you should NOT suddenly stop drinking completely: seizures, hand tremors, sweating, visual hallucinations, depression, anxiety or insomnia. You can still take control of your drinking. Speak to your health care provider to get help for you to reduce your drinking safely. 

---

References:
1. Alcohol Change UK. Accessed 1/7/2022.
2. Mehta G, et al. BMJ Open 2018;8:e020673. doi:10.1136/bmjopen-2017-020673
3. Thinking of trying Dry January? Steps for success. Harvard Health Publisher. Accessed 1/7/2022.

HOW ABOUT A “QUARANTINI?”
FIRE CIDER MOCKTAIL RECIPE
ELDERBERRY SHRUB MOCKTAIL RECIPE

House-cured Salmon

Gravlax is a Northern European dish that refers to salmon cured with sugar, salt and dill. It is traditionally served as part of a smorgasbord with a mustard sauce. Because this salmon dish is simple to prepare it makes an elegant and impressive treat for guests, but also provides an easy way to add brain and heart healthy omega- 3 fats to everyday meals and snacks.  

---

 House-cured Gravlax

Gravlax served on a GF cracker with vegan cream cheese and garnished with tart, sweet apple, mustard seed, fennel frond and green onion

Author: Erica Leazenby, MD
Yield: 3⁄4 pound 
Time: 15 minutes hands and 72 hours resting time

Ingredients: 

• 1 pound salmon fillet, boneless (Use the freshest and highest quality you can find. I like to use a center cut that is even thickness.)

• 1 cup sea salt


• 1 cup sugar


• 3-4 grinds of fresh pepper

• 2-3 sprigs of dill, stemmed, washed


• 4-5 basil leaves, washed and torn in pieces


• 1/4 red onion, sliced thin
 (or 1 small shallot)

• 1/2 lemon, sliced thin


 Directions:

1. Line a shallow dish with plastic wrap. Place the salmon skin side down on the plastic. 

2. In a bowl mix all remaining ingredients. 


3. Place mixture directly over the salmon, packing the ingredients down on to the salmon. 


4. Wrap the salmon tightly in plastic and refrigerate. This will take 3 days to complete. At the end of each day drain any liquid that has been extracted from the salmon. If necessary, add another cup of 1/4 cup of sugar and sea salt mixture to salmon. 


5. On the last day, rinse off the salmon. The color of flesh should have darkened and the texture of the meat should be more firm. 


6. Slice salmon thin on a bias leaving the skin behind.

Note: This salmon is excellent on toast paired with vegan cream cheese, red onion, mustard and capers or for a sweeter twist, pare with apples, vegan cream cheese and sweet mustard. It is also delicious scrambled with eggs or added to a salad for an omega-3 rich protein source. 

Mix the salt, sugar, herbs, lemon and onion well.

Salmon at 24 hours. Drain any liquid that accumulated in the dish.

Use the freshest, high quality salmon available to you.

Salmon at 48 hours. Drain any liquid that accumulated in the dish.

Pack the curing mixture on the flesh of the salmon.

Rinse the salmon after 72 hours.

Wrap the salmon to hold the curing mixture in place. Refrigerate.

Slice the gravlax thin and enjoy.

More Salmon Recipes:

SPICE RUBBED SALMON
PEACH AGRODOLCE SAUCE
ROASTED SALMON WITH LEMON WALNUT RELISH

How to Navigate the Holidays While Practicing a Low-Carb Lifestyle

Over the traditional holiday season it can become stressful and challenging to keep to a keto or low-carb meal plan. Here are a few tips for staying on plan and navigating the holidays:

• "Staying on plan" means you have a plan to follow. Remind yourself of the goals you set, the lifestyle commitment you made to yourself and the reasons behind your plan. There is no gain by going back to high-carb foods.

• If your friends or family are pushing you to eat high carb foods, you can acknowledge their request and redirect the conversation. "Thanks! I've been working hard, and feel really great. Go ahead, and I'll have some of this . . . (low carb alternative).

• Bring your own low-carb dishes to share at the table.

• If you feel ill, tired or are not feeling well, choose bone broth, tea or warm water for comfort foods. Sometimes fasting brings relief while letting your digestion rest.

• Manage stress with relaxation techniques like taking a walk, meditating or exercising. Limit alcohol and avoid overeating (particularly high-carb foods) when stress hits.

• Plan and celebrate your favorite traditions that are not related to food or look for low-carb versions of your favorite seasonal dishes.

• Overcome the winter blues with a walk or an activity that provides extra daylight or exposure to bright lighting. Music, dancing, walking, and connecting with others can all help.

• If you choose to go off plan, jump back on as soon as you can! Go very low carb for at least 2-3 days. Drink water and bone broth. Plan to eat 3 low-carb meals a day until your hunger is back in check.

Be kind to yourself. Surround yourself with good options to enjoy and you will navigate the holidays healthier.

5 STEPS TO REDUCE YOUR SUGAR INTAKE

Tips to Make Your Holiday Cookies More Wholesome

My first memories in the kitchen involve making holiday cookies to share with friends and family. As a functional medicine physician and chef, I’ve learned a few tips to make my holiday baking traditions more health supportive. For me, the perfect cookie is baked with minimally-processed ingredients, yet has crispy, lightly golden edges with rich flavor and just the right amount of sweetness. Here are some easy substitutions you can do at home this holiday season to bring a bit more nutrition to your favorite cookie recipes:

• Start with the best ingredients. Of course, the quality of the finished product is only as good as the ingredients you start with. Aim to use fresh organic ingredients when possible. The holiday baking season is a great time to take inventory of the products in your pantry. Check their expiration dates and check that dried spices have not become rancid with age. Try swapping sea salt for iodized table salt and use aluminum-free baking soda. Minimize artificial ingredients that may be found in imitation extracts and food colorings.

• Replace and reduce sugar. Cookies are a treat. As a general rule, minimizing sugar in our daily routine is important for our health, but life is meant to be celebrated especially at the holidays. There are ways to cut back on sugar yet still have a tasty show-stopping cookie. Instead of icing your sugar cookies, sprinkle with nuts, orange zest, dried flowers (I love crushed rose petals), seeds or drizzle with dark chocolate. Sugar adds moisture to cookies, but you can often decrease the sugar in a recipe (up to about 25%) with little compromise. Experiment with your favorite cookie recipe. You can add in a splash of your favorite extract like vanilla, almond or lemon for a sweet confectionary flavor. Natural nonnutritive sweeteners like monk fruit, erythritol or stevia can also be used as alternatives to granulated sugar. I like Lakanto brand monk fruit sweetener. It can easily be used to replace some of the sugar in a recipe. Beware, however, cookies using alternative sweeteners may become dry faster than their regular sugar sweetened counterparts.

• Upgrade your egg. Using a pasture-raised egg offers a slight nutritional advantage over a conventional egg. If you wish to make vegan cookies, replace each egg with 1/4 cup unsweetened applesauce, 1/4 mashed banana or with a flax egg. Applesauce works well in cakey cookies like snickerdoodles. For chewy recipes try the flax egg. For a flax egg mix 1 tablespoon ground flaxseed with 3 tablespoons warm water for each egg (up to two in a recipe). Let the mixture sit until cool before adding to your wet ingredients.

• Add some fiber. Change up your white flour for whole-wheat pastry flour as a cup-for-cup substitution. Whole wheat flour is made from the whole grain, so it contains more fiber and minerals. Whole wheat bread flour has a high protein content and will yield a tough finished cookie. Using whole-wheat flour in place of all-purpose flour gives your cookies about four times the amount of fiber in every batch.

• Mind the gluten. Gluten sensitivity is increasingly common. Luckily there are numerous alternative baking mixes available. I love to bake with almond flour and enjoy recipes from the Sweet Laurel Cookbook. You can also make your own alternative flour mix. Here is a recipe from my culinary alma mater, The Natural Gourmet Institute: try mixing 2 cups white rice flour with 2/3 cup potato starch and 1/3 cup tapioca starch. Treat this blend like it is all-purpose flour. You can also store it in an air-tight container.

• Mind the quality of your fats. Steer clear of ingredients that contain partially hydrogenated oil (or trans fats), like margarine and vegetable shortening. If you use butter, aim to buy organic cultured butter, which contains probiotics and no antibiotics. If you have a dairy sensitivity or wish to make vegan cookies, consider swapping butter or margarine for coconut oil. For every stick (1/2 cup) of butter, use 5 tablespoons coconut oil plus 3 tablespoons coconut cream. Use this for recipes that require creaming the butter and sugar together, like sugar cookies and shortbread. 

• Chocolate is your friend. There is always a bit of trial and error when experimenting with recipes. If your cookies are good but a bit less than perfect, try dipping or drizzling them with melted chocolate. When it comes to chocolate, the darker the better. Dark chocolate is loaded with antioxidants.

 A PRIMER ON GLUTEN-FREE FLOURS
HOW TO REPLACE BUTTER WHEN BAKING

Relish Health is Five!

Guess who’s five. Relish Health!

Starting a business has always been a dream of mine. Taking the plunge to leave the conventional practice of medicine felt scary and a bit crazy; but fast forward five years and I question how I could do anything else. 

Relish Health is my opportunity to practice root cause medicine. It has created space for me to really listen to your stories to find clues to your health, partner in your recovery, and become the healer I always dreamed to be. 

To all the people who have trusted me with their care, thank you. For future friends and patients, I look forward to journeying together toward better health. 

Mention this post in your next Relish Health visit for a code to join a future Relish Health virtual cooking class for free to help me celebrate.

Relish Health Gift Guide 2021

It is that season! I’ve pulled together some of my favorite health-enhancing gift ideas, and hope this guide gives inspiration, relieves shopping frenzy, and enables you and your loved ones to savor the season.

---

Books I enjoy:

The pandemic gave me extra time to read this past year and it also gave authors extra space to be creative. There are many new, great books on the market this year. Here are a few I enjoy:

For the gluten and dairy free baker in your life

This is an encouraging reminder how the “everyday” can be sacred and celebrated

Beautiful recipes to nourish your brain

Tips for women wanting to follow a low carb lifestyle

AMAZING resource for anyone wanting to understand and improve hormone balance

Fun musings from an episcopal minister about food, faith and the art of a proper dinner party

---

Green Kitchen Gadgets:

For the nespresso lovers in your life

For the nespresso lovers in your life

Freeze your soup or stock in perfect portions

---

Gifts for better mood:

Everyone with a brain should know how to properly feed it

Research suggests that “Dawn Simulators” significantly reduce the symptoms of seasonal affective disorder

Full spectrum light to chase away the winter blues (Learn more about treating Seasonal Affective Disorder)

---

Some gifts never go out of style.
Check out the gift guides from 2018, 2019, and 2020.

---

(This blog post is not sponsored by any manufacturer. However, at no cost to you, Relish Health may receive a commission on purchases made through an Amazon link.)