The Importance of Food & Symptom Tracking
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Kara Wada, MD: Welcome back to this second episode of our amazing mini series here on the Becoming Immune Confident podcast, the show where we dive deep into the science of living a vibrant, energy filled life, free from the fog of inflammation. I'm your host, Dr. Kara Wada, and I'm joined today by my friend and colleague, Jenifer Tharani, who is an autoimmune dietitian. She's the autoimmune dietitian if we're getting, you know, specific about things. And today we're here to empower you with the knowledge, insights, and personal stories you need to reclaim your health and vitality.
The value of Food and Symptom Tracking
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Kara Wada, MD: And in today's episode, we're exploring the importance of food and symptom tracking, something that was really critical in my own journey to becoming immune confident.
So today we are going to dive in and talk about food and symptom journaling or tracking. I would love to learn, you know, from your perspective, Jen, how does food journaling help expose foods that may be a problem for someone who is trying to sort out like what to do with their diet.
Jenifer Tharani: Absolutely. Because it's like, you know, an awareness tool, right? Like it's anything in life. Awareness comes before action, right? Like we can be thinking about doing some things, but our brain is constantly, I know you say chatterbox. It's like constantly going on and on and on, right? So it's hard to like compartmentalize until we put things on paper. And then food and symptom journal like the name suggests is like food, relationship to symptom.
Now, I want to remind the audience is that it's not like, "Oh I eat red meat and that is bad for me. So I need to eliminate it a hundred percent." What I find in my practice is possibly, even if you eat an ounce of red meat every time, once a week, you probably start having joint pain. That is a huge possibility. However, when we do the food and symptom journal, we also see that was it that day that it rained? And was it that day you had a really big presentation at work and that you were very stressed? Was it on the same day you stayed up late night to prepare for the presentation? Was it also the same day that you missed your lunch because you were really busy? Or maybe you ate a sandwich with deli meat and cheese. Again, both of them can be high in sodium. And then in the evening, you picked up dinner from restaurant, which was again high in sodium and probably saturated fat. So was it a cumulative effect of the entire day of eating and the entire day of chronic stress and lack of self care and lack of sleep that may have led to you to believe that every time I eat red meat is when I start having joint pain?
Because it's very easy for us to connect one dot, right? Like too many dots, it's hard to connect, right? So every time and in the back of your head, subconsciously you heard that, "Oh, red meat is bad for me. Red meat causes inflammation. So red meat is the culprit, right?"
So with the Food and Symptom Journal, it's also not one day. It's a lot of data that clients will give me, right? A portion sizes, brands, what preservatives, stabilizers, et cetera, or in the brands of the product that they're eating, how much fiber is coming from their meals. Like so many, so many dots that, you know, need to be connected. So I feel like to answer your question and to summarize, like, how does food journaling expose personal food triggers that may be overlooked is through this, right?
Like, okay, I see that you're constantly skipping a midday snack and you're ravenously hungry at dinner and you're eating a sugary snack right before dinner and you're having poor quality sleep, right? So that's how it kind of helps me take a bird's eye view and then dive into the data and help with that connection.
Kara Wada, MD: I think it's so critical, you know, going back to that idea that this is a mindfulness tool too.
Avoiding the pitfalls of strict elimination diets
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Kara Wada, MD: And I've increasingly been talking to my patients about that is, in particular, I've been seeing a lot of patients in the last few months that have suspected mast cell disorders and are worried about the role, for instance, of histamine.
Histamine is not only created in our body, but it's also found in our food. And so they will wonder, "Okay, if I cut down on the amount of histamine in my food, will that result in less symptoms?" And the case is sometimes maybe, and yet also we want to avoid limiting our diet and you know, getting to that point where in the worst case scenario, I see people who have maybe three or five safe foods. And we know that that is a big problem, too.
So maybe you can explain a little bit about you know, what are the downsides of doing an elimination diet, which might have some more kind of, um strict boundaries to stay within. But you know, what are some of the worries or problems that can come about with that?
The Evidence Provided by the Food & Symptom Journal
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Jenifer Tharani: So I always ask myself, right, like, whenever I am kind of looking at any elimination diet protocol, I'm asking myself, how much evidence is there, right? Like research evidence.
And then how much evidence do I have from the Food and Symptom Journal to really, really say that, okay, this big spectrum evidence of elimination, does this apply to your case, right?
So just taking your particular example, when we were working together, you had done autoimmune protocol and had eliminated a lot of grains. And then when we did the Food and Symptom Journal, we realize that oatmeal wasn't a culprit, right? Like it's such a good source of soluble fiber. And so the downsides of elimination can be is that let's say you are doing a vegan diet, right? And you're not being very mindful of excessively processed vegan products that you're buying from the grocery store because if you're on a vegan diet, or even like a gluten free diet for that matter, the minimally processed, the one ingredient whole foods, if you're on that kind of a really vigilant diet, which again, because of lack of time, it could be impossible to do, right?
Like everything fresh, do such a very like very like a specific grocery haul, right? Like it's very hard. So the downsides are it doesn't provide very much flexibility. It creates more food fear where it's not necessary and then also is like it can create more inflammation in your body because over time you're not realizing that you're getting a lot of the inflammatory ingredients in the vegan processed cheese, in vegan processed, I don't know, protein, right? If it's not one ingredient whole food based. Or even there are research studies in like gluten free diet where the gluten free diet, if it's not gluten free whole foods based diet, it's very highly likely that the patient's inflammatory markers increase because they haven't taken educated themselves on proper anti inflammatory gluten free diet, right? Because we already also know is gut microbiome, the diversity is affected. A lot of clients have Irritable Bowel Syndrome. You did have that as well.
Kara Wada, MD: Yeah.
Jenifer Tharani: We don't know, right? Like if the disturbed gut microbiome came first, or if it was, you know, the next step after the autoimmune diagnosis, or even like experiencing autoimmune illness symptoms.
So lack of fiber can be a huge, huge problem because if you're not feeding these gut bacteria, They're not able to produce anti inflammatory short chain fatty acids. They're deprived of the food that they need, right? The antioxidants, the anti inflammatories that are absorbed in our gut microbiome are not absorbed. And also if we are eliminating a lot of foods without realizing that we are not adding in specific nutrients like iron, B12, Omega 3s, we can become deficient of the nutrients that are basic building blocks for us and that can exacerbate energy issues, fatigue, brain fog, right? Like inflammation in our body. And also, it's very overwhelming and can stretch you very thin, right? And not sustainable. I'm all about sustainability. I'm like, ask yourself, are you going to be doing this one year later? Are you going to be happy about this?
Because it's always like, I did this, I saw results. I stopped doing this, I stopped seeing results, right? So we need a more individualized plan that is sustainable so you continue to see results and you're not excruciatingly eliminating the foods that are not really necessary that may have needed for your next door neighbor, but maybe not for you.
Kara's personal experience with food intolerances
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Kara Wada, MD: Yeah. I think it's important to like, and I'll share a personal example, you know, our, our body's responses to different foods will change over time. You know, this is a little less common in true food allergy. So we don't see adults outgrow true food allergy as often. It can happen rarely, but when it comes to sensitivities or intolerances, a lot of that is impacted by our gut health and our microbiome health. And if you are able to improve that health over time, you can see your body's ability to tolerate foods improve. And so an example I will occasionally share, you know, if the circumstances are right with patients is after I had Charlotte, she's my oldest, there was a period of time where she, you know, she was an infant, so I was postpartum. In hindsight, I am pretty certain there was Sjogren's or, you know, going on in the background. I had significant flare up of my IBS, which of course I didn't actually have diagnosed because I didn't actually see a doctor. That's a story for another day.
But there was a period of time when anytime I would eat eggs, that weren't fully cooked, I would end up in excruciating pain. Knowing what I know now and knowing kind of the symptoms I was having, I'm pretty convinced I had something called FPIES to eggs, which we'll have to cover on another day. It's a type of food allergy that you can't detect with testing. but you know, with repeated exposures, you see the same constellation of symptoms. And so, you know, kind of following, putting my detective hat on, I now kind of recognize that I think that's what was going on.
Interestingly, it is around that time that I decided to experiment with a more plant forward style of eating. As Charlotte started to eat solid foods, she really liked eating beans. She could pick them up and that was a fun food for her to get some iron and some protein. So we're eating a lot more vegetarian, vegan style. And so certainly was getting more of those plants. We started subscribing to a community supported agriculture, like a veggie box every week.
And I started to learn how to cook more from scratch and to make different veggies that I had never eaten before. And with time, I was able to eat eggs again, and now I can eat eggs without a problem.
And so I think, you know, of course that's our, my N of 1, but you will see this with different intolerances too, that things can change and evolve. Our microbiome is constantly changing to the point where we see significant changes, even in as short as 30 hours after dietary change. And I think that's where ongoing tracking can be helpful.
Making food tracking sustainable long-term
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Kara Wada, MD: I'd love to hear if you have any tips on how people can make tracking more sustainable for the longterm.
Jenifer Tharani: First of all, I want to make a comment on what your response was is also you focus so much on addition versus like getting your mind focused on elimination of eggs, right? And getting like really stuck up on that elimination versus you're like very much focused on let me bring in more of the anti inflammatory food compounds components in my diet, right? And that's such a eye opener. It's like, "Oh you probably even didn't think about that, but you're like, okay now I have like fiber in my diet, right?"
Kara Wada, MD: Yeah.
Jenifer Tharani: So much more fiber and I'm meeting my fiber needs because we don't necessarily meet our fiber needs even on, you know, on an American diet, right? So now to answer your next question about sustainability is honestly, you don't even need to track for the rest of your life.
Kara Wada, MD: Love it.
Jenifer Tharani: That's the truth, right? I always will ask my clients to track for like first three weeks when they join the program because that's like, that just gives them good time to get out of that perfectionism or sometimes for some people they are so busy that the first week is just like getting used to the journal, really like tracking a little bit here and there and then going over that learning curve, right?
Like you may have tracked in MyFitnessPal or here, there. But the Food and Symptom Journal is a little different tool. So there is a learning curve. And a lot of times, you know, you may not like the fact that you have to journal, right? So there's always that opportunity that I offer to clients is like you can also do photo food journaling. That's fine, too. Um, a lot of my clients do that, my private clients. Um, however, so in short period of time we collect so much data and that is like the time where you really have to commit to the process, right? Now, next time you pull out your journal is like you're like, "Hey Jen, I've gained 10 pounds. I want to come back and I want to work with you."
I'm like, "Okay, things may have changed. Let's do the journal again." Or you're doing a, you're doing great. You're, overall, you know, living a very anti inflammatory lifestyle. You have flares here and there. But now you're in a big flare, right? Like it came out of nowhere. You're still doing the same things. Then that would be the time again to pull out your journal and start recording because there may be some blind spots, right? Maybe you got busy. Maybe you're a new mom. Maybe you started a new exercise routine and your personal trainer told you to have more protein and now you're like eating this vegan protein powder, which has a ton of fiber, ton of everything that your digestive system is not tolerating. And because of that, it could lead to joint pain. There is connection, right?
Like if your digestion is not great, it can cause that inflammation and spread in your body parts. And so joint pain is big. Brain fog is big because of that. So you see like how I'm like talking about different things that interconnected that you may not have thought about and so that's when you need to pull out your journal again, start recording. If you can, figure out your own patterns. But if you want help, Kara and I are always here to help you. So, yeah, that's how you make it sustainable. You just don't necessarily have to do that every single day of the rest of your life.
Kara Wada, MD: I love that. And that's how I've been using it clinically with my patients since we work together. It's kind of this tune up of, "Okay. Where are things now?" Things are okay, you know, and then you come back to it when you need it.
I think was so helpful for me was having that unbiased person, that person being you. You know, taking a look and pointing out some things that for me I didn't want to notice, which we joke about, like, um, for me was cheese. Like, I grew up five minutes from the Wisconsin border. Cheese is like its own food group in the Midwest. Cheddar cheese, nacho cheese, parmesan cheese, I love it all. And yet, it's also pretty high in saturated fat and it was something that was a pretty significant part of my diet or off and on over the years. And for a while, I had cut it out completely. And I think as a rebound, you know, kind of said heck with it, started eating a whole bunch more. And, you know, it really goes back to this idea that you kind of started off with, which is balance, you know, not depriving yourself, coming from the place of abundance and what can I add.
So that I don't need to eat a quarter of a block of cheddar, I can have a delicious, reasonable sized portion of cheddar along with an apple and maybe, you know, some carrots and hummus and whatever else that's going to help build a well rounded anti inflammatory meal or snack.
Jenifer Tharani: Yeah, that reminds me how my intern at the time, Kia, who has rheumatoid arthritis, helped me develop this amazing resource. Like, we have amazing resources throughout the program, but this one resource every client loves and swears by and has it stuck on their fridge.
Five questions to ask yourself when building an anti inflammatory meal. And it doesn't say, "Ask yourself what you should eliminate." It says, "Ask yourself what you can add to build."
So like Kara said, it's like, what other anti inflammatory components you can add along with cheese to kind of take away that edge of high sodium, high saturated fat in the cheese that can cause inflammation. But also adding more can reduce the portion size of the inflammatory food because now you have other foods that are also satisfying and flavorful and it's lunchtime and I'm salivating because I'm like really feeling hungry now that we are talking all about foods.
Building anti-inflammatory meals through addition
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Kara Wada, MD: I think that is a great place to hit pause because we're gonna talk a lot more about that tool and the role of meal planning next week. So make sure if you haven't subscribed that you are subscribed so you don't miss out when that drops next week. And maybe think about inviting a friend or two to listen as well.
We really love sharing, you know, what we've learned together and with our clients and from the science with this community and really bringing, you know, this paradigm shift of, you know, what I have seen in wellness culture is essentially diet culture that's like a wolf in sheep's clothing. And really kind of turning that on its upside down where we are coming from this place of love, of abundance, of nourishing our body. And in doing so really helping us learn how to trust our bodies again, trust our immune system again.
Embracing Simplicity and Sustainability in Nutrition
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Jenifer Tharani: Yeah, that's why I changed my Instagram handle to Minimalist Autoimmune Nutrition because it's all about simplicity over complexity, right? Like we want to chase something that is hard to achieve. And it's also so wired in our culture. It's like, if it's hard to achieve, if you have to do hard work, then only it's worth it, right?
And the same can actually linger in our personal lives. And when it comes to diet and nutrition it's like, we feel like we're achieving something when we are restricting more and we are succeeding at restricting, right? So it's all about progression over perfection and simplicity over complexity.
Kara Wada, MD: Well, thank you to all of our listeners for tuning in to another episode of the Becoming Immune Confident podcast. We hope that you found today's topic of food and symptom tracking both inspiring and informative, providing you with the tools and motivation you need on your health journey. And remember, if you're ready to take the next step towards becoming immune confident, our Jumpstart Program is here to guide you.
We've designed this program with you in mind, focusing on simple, sustainable and science supported symptoms to combat inflammation. And enhance your wellbeing.
Jenifer Tharani: Yes, absolutely. Like, don't forget to secure your spot on the early bird wait list for the Becoming Immune Confident Jumpstart Program. The enrollment opens April 11th through 14th with exclusive access and a special discount for early birds. This is your opportunity to join a community of women just like you looking to reclaim their vibrant selves.
Kara Wada, MD: So hop on over to www.immuneconfident.com and add your name to the wait list. And thank you for sharing your time with us today. We're here to support you every step of the way. And so until next time, keep striving for that vibrant health and clarity that's just around the corner. Get on the wait list now over at immuneconfident.com and let's embark on this transformative journey together. And make sure to subscribe so you don't miss next week's episode where Jen and I discuss anti inflammatory meal planning made easy. Talk to you later.
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