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Intermittent Fasting: Feast or Famine

Updated on Jun 30, 2022 | Diet and Nutrition, Your Health

Reclaiming the health of western society may require matching our diet and lifestyle to those that our bodies and minds evolved for, notes Julie Devinsky, RD, an inpatient dietitian of the Department of Clinical Nutrition at The Mount Sinai Hospital.

Julie Devinsky, RD

Before the modern age, we ate to survive. Our bodies and metabolism were more opportunistic and adaptive to what was intermittently available. There was no such thing as breakfast, lunch, or dinner. For most of human history, it was a mix of scavenging, gathering plants, and hunting. Diets varied by season, differing enormously across climates. At times, it was feast or famine.

Intermittent fasting—a term for prolonged cycles between eating and fasting—aims to mimic what early humans experienced by interrupting the regular flow of calories into our bodies.

Because intermittent fasts can be considered more of an eating pattern, rather than a diet, they may be more beneficial and can be used to complement a low-fat, low-carbohydrate, plant-based, or high-fat animal-based diet. However, this pattern works best for a very disciplined person and may not be realistic for many American lifestyles.

There are three types of intermittent fasting: the 5:2 method, alternate-day fasting, and time-restricted fasting.

The 5:2 method involves eating normally for five days and fasting for two. On fasting days, roughly 500 calories are consumed. Based on an archetypal “hunter-gatherer” diet, the proposed benefits of the 5:2 diet are based on the premise that fasting increases insulin sensitivity and decreases leptin levels. A hallmark of the fasting phase of this diet is mobilizing fatty acids and ketosis, a process in which the body uses fat rather than glucose for energy. Glucose is stored in the liver as glycogen, which runs out after about 10-12 hours (without exercise), forcing the body to burn fat.
Alternate-day fasting (ADF) requires eating no more than 500 calories every other day. In an October 2010 study published in the International Journal of Obesity, approximately 100 obese women on a ADF diet lost an average of 13 pounds over six months with reductions in cholesterol, blood pressure, triglycerides, and insulin. The mechanism of high-fat alternate-day fasting is inducing ketosis similar to the 5:2 regimen. Even lower-fat ADF diets were shown to be effective for weight loss. Further, the dropout rate in the ADF study was only 10-20 percent, which is considerably lower than other diet trials. Interestingly, researchers found that on the non-fasting days, participants ate less than expected. Instead of “feasting” to make up for the fasting days, participants only ate 10-15 percent more than baseline.

The time-restricted feeding diet requires that the entire day’s worth of calories be consumed over six to eight hours and the remaining 16-18 hours are to be spent fasting. Research is limited, but preliminary studies suggest this diet may lower cancer risk and help with weight maintenance.

The jury is still out on fasting diets. Initially, many experience a two- to three-week adjustment period where symptoms often include fatigue and nausea. The long-term effects remain to be seen. Fasting may slow metabolism and cause persistent fatigue while some studies show marked changes in weight, blood glucose, insulin sensitivity, and lipid profiles.

These regimens are not for everyone, especially those with diabetes, pregnant and breastfeeding women, people taking certain medications, or those with serious medical conditions. However, in this age of escalating obesity and when the failure of “dieting” is commonplace, intermittent fasting may be useful as part of a weight loss regimen.

The Big Fat Myth: Can Fat Be ‘Good?’

Updated on Jun 30, 2022 | Diet and Nutrition, Your Health

A low-fat diet was once touted as the best for weight loss and optimal health. Groceries stocked low-fat foods on the shelves and everyone avoided fat like the plague. Unfortunately, the low-fat diet trend did America a great disservice. In fact, obesity rates in the United States have consistently climbed. Adena Neglia, MS, RDN, CDN, Senior Dietitian at The Mount Sinai Hospital, explains why fat is not the enemy and how to incorporate ‘good fat’ into your diet.

Do fatty foods make you fat?

Let’s clear up a common misconception: Fat does not make you fat. We gain weight when we eat in excess of our needs, whether the excess comes from protein, carbohydrates, or fats. From a weight management standpoint, fat makes food taste good. When we eat it, we feel more satiated and wind up craving and eating less food later on. In fact, getting adequate amounts of healthy fats in your diet may make managing your weight easier. From a health and wellness standpoint, fat is needed to help our bodies absorb certain fat-soluble vitamins, including vitamins A, D, E, and K. In the brain, fat stimulates the creation of new brain cells and improves our memory. Fat is critical for reproductive health in men and women because it is used to both produce and balance our hormones.

What is a ‘good’ fat?

As with any macronutrient, quality matters. Healthy sources of fat include avocados, olive oil, nuts, seeds, grass-fed beef, and fatty fish. Incorporate healthy fat into your diet by mashing avocado on toast or pureeing it into a sauce for zucchini noodles. Drizzle olive oil on vegetables to roast them or use as a dressing with lemon on a salad. Add chopped nuts to yogurt and oatmeal or eat them as a snack by themselves.

So, what fat do I need to limit or avoid?

Trans fat. Found in most processed and packaged foods—such as cake, cookies, chips, and crackers—it can be hidden on the nutrition label as “partially hydrogenated oils.” This kind of fat is terrible for our hearts. Not only does it raise your LDL (“bad”) cholesterol, but it also lowers your HDL (“good”) cholesterol. In 2013, the U.S. Food and Drug Administration (FDA) specifically designated partially hydrogenated oils as no longer “generally recognized as safe.”

How can I avoid trans fat?

Choose whole food sources and check your labels for lurking trans fat. Here’s a list from the FDA of foods that contain trans fat.

What’s so bad about low-fat food?

When companies start to take fat out of their products, they often replace it with sugar to compensate for the taste. We now know that increased sugar intake contributes to obesity, heart disease, diabetes, and cancer. Food additives, emulsifiers, and stabilizers are also added to mimic the texture and mouthfeel of fat. Many people are under the impression that they can eat more of these foods because the low-fat label makes it “healthy.” As it turns out, these low-fat products often do more harm to our health than good.

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What Should You Eat if You Have IBD?

Updated on Jun 30, 2022 | Your Health

Laura Manning, a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai.

Inflammatory Bowel Diseases (IBD) such as Crohn’s disease and ulcerative colitis are believed to be caused by a combination of your genetic predisposition and changes in the microorganisms in your gut.

These disorders are on the rise in industrialized regions like North America and Western Europe, forcing scientists to reconsider the role of modern diets in the development and management of these diseases. Indeed, our gut bacteria look quite a bit different from our ancestors’ as we eat more and more processed foods to help us keep up with our busy lives and to allow us to prepare foods quicker and easier.

In this Q&A, Laura Manning, a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai, offers some advice on what you should eat if you have IBD and the possible connection to a related condition, Irritable Bowel Syndrome (IBS).

The good news is that in academic medical centers around the world, including the Mount Sinai Health System, studies are examining the link between IBD and a variety of diets, including low FODMAP, which can help, she says.

Can food choice decrease your risk for IBD?

Studies show that certain dietary patterns may put people at greater risk for IBD. For example, a low-fiber, high-fat diet may increase inflammation and cause disease relapses. This is typical of a diet with a lot of processed foods. In contrast, a diet high in soluble fibers, fruits, and vegetables and low in saturated fat may be beneficial to our microbiome and have anti-inflammatory properties.

How can eating the right foods help treat IBD?

In addition to conventional medication focused on modifying the immune-inflammatory pathways in the gastrointestinal (GI) tract, diet can play an essential role in the management of IBD, especially for patients with a lot of unpleasant GI symptoms such as diarrhea, bowel urgency, and abdominal cramps. Unfortunately, there is not enough scientific evidence to suggest that there is a “silver bullet” diet for IBD or a single diet approach that can take someone with IBD from a very severe flare-up all the way down to remission (i.e. no signs of inflammation at all).

What are FODMAPS?

FODMAP is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. Foods that are high in FODMAPs include fruits, honey, high fructose corn syrup, lactose from dairy products, and some vegetables and cereals. These are hard to digest sugars that pass through the small intestine without being properly broken down by enzymes. Once these sugars reach the colon, they cause more water to enter the intestine, which leads to potential unpleasant side effects such as pain, bloating, and diarrhea. Also, bacteria ferment (think of brewing beer), and the residual FODMAPs give off gas. You can learn more from this video.

How can a low FODMAP diet help?

There is very strong evidence showing the benefits of the low FODMAP diet for managing symptoms in patients with Irritable Bowel Syndrome (IBS), a much more common disorder of gut-brain dysregulation with many of the same symptoms as IBD. We are now seeing that the diet can help manage symptoms in patients with IBD as well, especially when patients are in remission.

A person with IBD often can be technically in remission (a healed intestinal tract) but continue to experience symptoms that mimic an IBD flare-up. This is known as IBD with IBS overlay and it is extremely common, affecting 40-60 percent of IBD patients. High FODMAP foods can trigger IBS symptoms in people with IBD and make them feel like they are experiencing a flare-up. In fact, in a recent study, the low FODMAP diet was shown to lower symptoms like gas, bloating, diarrhea, nausea, and fatigue in patients with IBD.

What can I eat to help manage my symptoms?

The most common question patients with IBD ask me is “what can I eat?” My goal is to help patients find ways to eat that will allow them to manage symptoms and feel like they are in control. That’s where the low FODMAP diet becomes so useful. A FODMAP elimination and reintroduction process can be a life-changing tool for IBD patients to identify the triggers that add to their daily stress.

We know food alone does not cause IBD, but many patients will begin to notice “trigger foods” that increase their symptoms of gas, bloating, and diarrhea. The best way to identify your trigger foods is to simply keep a journal of what you eat. Note if there are changes that occur in our bowel function when certain foods are eaten more than others.

Are there resources to help me follow this diet?

The low FODMAP diet is complicated, and it can be tough to stick with it. We’ve found that Epicured, a meal delivery service that I work closely with, is an easy, go-to option for many of my patients. There are lots of other resources out there too, from mobile apps to support services. You’re not alone in this.

Any other advice?

Don’t get frustrated. What works for one person with IBD may not work for another. This is one of the many challenges I face as a dietitian working with patients at the Feinstein IBD Center at Mount Sinai. Having worked with patients with IBD for more than 15 years, I have seen many different diet therapies work and fail, and I must tailor suggestions to each individual. You can also get more information from the Crohn’s & Colitis Foundation.

Food is a very important topic because it evokes a lot of emotion in people. People with IBD must carefully think about what to eat and the timing of their meals. If I can offer suggestions that help ease this stress, then I can successfully improve their nutrition, allow people to eat comfortably at work and at gatherings and lessen anxiety that commonly accompanies mealtime. Food is a large part of our culture as well as a basic human need, and patients with IBD welcome guidance to help manage their disease and lead the healthiest life they can.

Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai. You can make an appointment at the Feinstein IBD Clinical Center or contact the office at 212. 241. 8100. For exceptional low FODMAP, IBD-friendly prepared meals delivered right to your door, check Epicured’s menu.

Thyroid Center Offers Cohesive Care and Expert Referrals at a Single Site

May 21, 2018 | Featured, MSBI, Your Health

Maria Brito, MD, Director of the Mount Sinai Thyroid Center at Union Square, and Terry F. Davies, MD, Co-Director.

The Mount Sinai Thyroid Center at Union Square is a valuable new resource for patients with thyroid disorders, as well as physicians seeking referrals for complex cases. The Center is unique in gathering a wide array of services in one ambulatory facility.

“This collaborative center includes Endocrinology, Endocrine Surgery, Head and Neck Surgery, Pathology, and Radiology,” says Director Maria Brito, MD, Assistant Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai. “I don’t think there is another thyroid center in Manhattan that has all of these services in one single building.” The Center is still expanding and will be joined by a Diabetes and Endocrine Center at Mount Sinai Union Square within the next year.

One goal of the Thyroid Center is to simplify care. “It is one-stop shopping, which is what we all want when we go to the doctor,” says the Center’s Co-Director, Terry F. Davies, MD, the Florence and Theodore Baumritter Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai. “If your physician says you need to see another specialist, it’s nice if he or she is in the next room. Y

ou can have your interview with the specialist and the surgeon; you can have a biopsy; you can have a sonogram; and you can have your blood tests, all in the same visit.”

New patients will be offered an appointment within 72 hours, Dr. Davies says, addressing a frequent complaint in medical care— having to wait weeks for an appointment.

Five endocrinologists and five surgeons are active in the Center, including leaders in their fields, Dr. Davies says, such as William B. Inabnet III, MD, Chair of Surgery, Mount Sinai Beth Israel, and Professor of Surgery at the Icahn School of Medicine; and Mark L. Urken, MD, Professor of Otolaryngology at the Icahn School of Medicine. For appropriate patients, “remote access” thyroidectomy can be offered, in which the thyroid is removed through incisions in the armpit or the mouth, leaving no visible scar on the neck. For certain patients with recurrent cysts, nodules, and some thyroid cancer recurrences, Dr. Brito and her colleague Michael A. Via, MD, Assistant Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine, offer a minimally invasive option, ethanol ablation, in which an alcohol solution is injected into these lesions, causing reabsorption or destruction.

Additionally, the Center is the national headquarters of the Thyroid, Head & Neck Cancer (THANC) Foundation, founded by Dr. Urken. The nation’s largest private funder of research for these cancers, THANC administers the Thyroid Cancer Care Collaborative, a data registry in which physicians can record important data about their thyroid cancer patients, enabling them to share clinical information with their patients as well as de-identified data with other physicians and researchers.

The Center’s physicians work closely with peers across the Mount Sinai Health System. For example, “we meet twice a month for the thyroid tumor board, in which surgeons and physicians discuss difficult cases,” says Dr. Davies, a leading physician-scientist in autoimmune thyroid disease who has been funded continuously for 35 years by the National Institutes of Health. Sharing knowledge among peers is a top priority of the Center, which is an important referral destination for primary care doctors seeking to consult with endocrinologists, and for endocrinologists seeking to collaborate with surgeons.

“We think this is definitely an appropriate place for second, third, or fourth opinions,” Dr. Brito says. “But it is very important for both primary care doctors and specialists to know that we expect to collaborate with them. They will not lose their patient to the Center, instead, they will gain a colleague.”

What Causes High Levels of Calcium in the Blood?

May 14, 2018 | Ear Nose Throat, Your Health

Though many people take calcium supplements and eat calcium-rich foods, elevated calcium levels can be too much of a good thing. Mike Yao, MD, Associate Professor of Otolaryngology, explains how your high calcium levels might actually be signs of hyperparathyroidism.

Many of the body’s organs need calcium to be at a specific level to function properly. Calcium levels that are too high or too low can affect the function of the muscles, bones, heart, and brain.

Blood calcium levels are often too high due to abnormal growth of one of the parathyroid glands, a condition called hyperparathyroidism. The effects of high calcium levels can dramatically decrease your quality of life. For example, elevated calcium levels can worsen the quality of sleep and increase anxiety, depression, fatigue, and bone pain. High calcium levels can also decrease concentration, learning, and memory.

Fortunately, high calcium due to hyperparathyroidism is easily treatable with minor surgery.

How do I know if my high calcium level is due to hyperparathyroidism?

A simple blood test to check your parathyroid and calcium levels will confirm a diagnosis. Only hyperparathyroidism will cause the calcium and parathyroid blood levels to be elevated at the same time. Calcium testing is often a part of routine yearly blood tests for adults. High calcium levels are suspicious for this disease and should lead to further testing for hyperparathyroidism.

What can be done if I am diagnosed with hyperparathyroidism?

Hyperparathyroidism is caused by the abnormal growth of one or more of the parathyroid glands. In approximately 85 percent of cases, only one gland is abnormal. Minor surgery to remove the abnormal gland cures the disease. This short, outpatient procedure is completed in less than an hour through a one-inch long incision in the neck. If there is more than one abnormal gland, all abnormal glands are removed through the same incision. Typically, the surgery is not very painful. More than half of our patients do not take any pain medication and most return to work within a week.

Is there a medication I can take instead of undergoing surgery?

Patients reluctant to undergo surgery often ask about alternatives. However, surgery is the only treatment for primary hyperparathyroidism; there is no medication which eliminates the condition. Some endocrinologists will prescribe cinacalcet—a calcium reducer—to lower the calcium level in patients with hyperparathyroidism who are reluctant to have surgery. Yet, for most patients, cinacalcet causes existing problems to worsen. If prescribed, the drug needs to be taken forever to maintain the lower calcium level, and makes patients susceptible to bone loss and osteoporosis. For primary hyperparathyroidism, it may be safer to do nothing than to take cinacalcet. However, the drug can be useful for secondary hyperparathyroidism, a parathyroid disease that only happens in patients with kidney failure.

If your calcium levels are 10 or higher, visit the Center for Thyroid and Parathyroid Diseases for a hyperparathyroidism evaluation.

Mike Yao, MD, is a board certified, fellowship-trained head and neck surgeon at Mount Sinai’s Head and Neck Institute and Center for Thyroid and Parathyroid Diseases. He treats all stages of thyroid diseases and cancers of the head and neck. His practices are located at The Mount Sinai Hospital, Mount Sinai Queens, and Mount Sinai Doctors Westchester.

What is the parathyroid?

The parathyroid are four small glands located behind the thyroid in the neck. These glands are essential in regulating calcium levels throughout your body. Calcium is an essential mineral. It is important for strong bones, teeth, and muscle function.

Mount Sinai at Home Coordinates and Innovates Home-Based Care

May 8, 2018 | Featured, Your Health

Mount Sinai at Home leaders, from left, Operations Director Alexander Mandl; Albert L. Siu, MD; and Clinical Director Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine.

The Mount Sinai Health System recently launched Mount Sinai at Home, an innovative enterprise with two key components: a service line of programs across the Health System that care for patients in their own homes, and a research arm, the Institute for Care Innovations at Home.

“Mount Sinai at Home’s programs will align closely with the Health System’s population health strategies and advance our capacity to serve communities beyond our hospitals,” says Director Albert L. Siu, MD, Professor and Chair Emeritus of Geriatrics and Palliative Medicine. Treating patients in familiar and convenient environments can improve communication, coordination, and continuity of care, and reduce the risk of admission and readmission.

“This all started with Mount Sinai Visiting Doctors, which was founded in 1995 and gave us an opportunity to create the Mobile Acute Care Team (MACT),” Dr. Siu says. “When MACT started out in 2014, it was just Hospitalization at Home, but very quickly our teams found more ways to support our patients and our Health System, so we created services such as Rehabilitation at Home for care after hospitalization.” MACT, which was founded with a $9.6 million Health Care Innovation Award from the federal Centers for Medicare and Medicaid Services, has been a success, treating 750 patients so far. Its name presented a challenge, Dr. Siu says, since “MACT was not particularly descriptive from the point of view of patients.” As all of its home-based programs grew, the Health System saw a need to coordinate them and to find a new, unified name.

The result is Mount Sinai at Home, which is also headed by Clinical Director Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine, who was Director of Mount Sinai Visiting Doctors and Clinical Director of MACT; and Operations Director Alexander Mandl. Mount Sinai at Home will provide “operational, financial, legal, logistical, and clinical” support for home-based care across the Health System, Mr. Mandl says. Its clinical programs are:

Mount Sinai Visiting Doctors, providing primary care for homebound patients, who are usually very frail and elderly;
Pediatric Visiting Doctors and Complex Care Program, for young patients, such as children with chronic illnesses or infants who have just left neonatal intensive care;
Hospitalization at Home, for patients with a condition that might otherwise call for hospitalization, such as acute pneumonia; and
Rehabilitation at Home, for patients who need care that might otherwise be provided at an inpatient rehabilitation center.

In March 2017, Frederick Ballen became the 500th patient of the Mobile Acute Care Team—now part of Mount Sinai at Home. He was treated at his home in Manhattan by Caitlin Pelan, RN, left, and Joanna Jimenez-Mejia, NP.

These programs will continue to function in collaboration with the Departments of Medicine, Geriatrics and Palliative Medicine, and Pediatrics. Over time, other efforts and collaborations may be added, such as a palliative care program that is now part of a clinical trial led by R. Sean Morrison, MD, the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine. In the program, a team of nurses, community health workers, social workers, nurse practitioners, and physicians provide care and support to seriously ill patients at home. “If it is successful, we hope to keep this as a clinical program,” Dr. DeCherrie says. Another study led by Dr. Morrison, on the cost-effectiveness of palliative care, was recently published in the Journal of the American Medical Association Internal Medicine.

Mount Sinai at Home also created a payment model for Hospitalization at Home that in September became the first to be approved by Medicare’s Physician-Focused Payment Model Technical Advisory Committee. “When it is implemented, it will be a model that hospitals around the country can use,” Dr. DeCherrie says.

The Mount Sinai Health System has long been a leader in palliative care, geriatrics, and health care at home. “We already have the largest academic house-call program in the country—Visiting Doctors—and our Hospitalization at Home program is already the largest in the country,” Dr. DeCherrie says. “To put it all together under one service line, that is very different and very new.”

What’s so bad about low-fat food?

What is the parathyroid?

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