FRUITPHOBIA 
Fresh seasonal fruit is so delicious! There is nothing that compares to a bright red strawberry picked in the middle of June or a fresh papaya drizzled with lime juice when traveling in Hawaii. Especially in the hotter months, cooler water-rich foods like fruit are more often desired than a hot meal. 
 
Unfortunately, with the popularity of low carbohydrate diets many individuals are fearful of fruit. Many paleo and low carb diet advocates recommend sticking to only small amounts of low sugar fruits like berries stating that other fruit provide too much unnecessary sugar. I have had multiple patients in practice that are too afraid to eat more than a ½ cup of berries per day! 
 
I agree that it is important to reduce your intake of added refined sugars like high fructose corn syrup, maple syrup, honey, sugar, and other processed foods. However, this does not immediately place fruit into the same category. Although fruit does contain sugar (glucose and fructose), it is not found in the same concentration as high fructose corn syrup in sodas, pastries, pancake syrups, etc. For example, soda contains a sugar ratio of 60% fructose to 40% glucose. One 20 oz bottle of Coke contains roughly 36 grams of fructose. Now compare that to a banana, which contains 7 grams of fructose, or a medium sized apple with 13 grams fructose. When do you sit down and eat 7 bananas in one sitting? Never! Plus, that banana comes in a completely different package, rich in fiber, and made by nature.
 
However, this way of thinking can cause harm. You are not addicted to sugar if you enjoy fruit. Fruit is rich in easy to digest carbohydrates, antioxidant rich vitamins and minerals, gut healing fiber, and anti-inflammatory polyphenols. Plus, they are easy to throw into a bag and hit the road. Rather, if fruit is lacking in your diet you may be missing out on a lot of health benefits. 
 
REASONS WHY FRUIT ARE GOOD TO EAT

Fruit are Rich in Polyphenols: Polyphenols are plant compounds that are found most concentrated in the outer parts of plants. These chemical compounds have been studied in relation to their potent anti-inflammatory and antioxidant capacities. Each type of polyphenol has different health benefits. Therefore, it is important to consume a variety of unpeeled fruit (unless it's a melon or banana of course). Polyphenols have been shown to help:

• Reduce inflammation
• Prevent cancer, cardiovascular disease, and neurological disorders. 
• Fight infections
• Promote the growth of good gut bacteria. 

Fruit Are Rich in Soluble Fibers and Prebiotics:
Soluble fibers and prebiotic fibers help support the growth of good gut bacteria. When these fibers reach the large intestine, they are fermented by bacteria and produce short chain fatty acids which help fuel colon cells and prevent colon cancer. 

• Apples, oranges, and bananas are rich in soluble fiber. 

Fruit Are Rich in Vitamin C: Vitamin C is a nutrient that is very sensitive to heat, light, and air. Therefore, whole fruit become an excellent source of vitamin C. It is suggested that the current RDA for vitamin C is too low (75-90mg) and that we should be shooting for at least twice as much from whole foods. Especially if you are under a lot of stress, exercise a lot, or have an inflammatory condition, getting plenty of vitamin C is essential. 

• Excellent sources of vitamin C include: kiwis, oranges, papayas, strawberries, and pineapples.

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Fruit Are Easy to Digest Whole Food Carbohydrates for Active People:If you are on the go and active, especially in the summer months, then fruit can be a great way to fuel your activity. Generally, your carbohydrate intake increases with your amount of activity. If you are unsure what to pack to fuel a mountain bike ride, trail run, or hike, pack some fruit! It comes in its own protective barrier, and is easy to eat!

• Easy Fruit to Pack: Apple, Banana, Orange, Grapefruit,

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Fruit Can Help You Digest Protein: Some fruit contain unique enzymes that aid in digesting proteins and help reduce inflammation, support wound healing and relive constipation. You can even buy digestive enzymes in supplement stores made with these fruit enzymes. 

• Protein Digesting Fruit: papaya, pineapple, and kiwi.

 
SOME CONSIDERATIONS
Daily fruit consumption depends on the individual. Some can tolerate more than others due to activity levels and certain health conditions. For example, individuals with a fructose intolerance or severe gut imbalances may not do well with apples, pears, cherries, figs, and mangos. On the other hand, those that have metabolic disorders like diabetes and PCOS (polycystic ovarian syndrome) may have to stick to lower sugar fruits like kiwi and berries or pair their fruit with protein for better blood sugar balance. If you have any of these issues it may be best to work with a dietitian to help you find out what fruit and what portion is right for you. 
 
TAKEWAY
Don't fear fruit!! If you are a healthy individual, eating seasonal organic fruit to your liking can provide many health benefits and should not be avoided. I generally recommend 2 servings of fruit per day and adjust the types of fruit based on the individual needs of the patient.  

Many people have heard of vitamin D and understand its relationship to the sun. I often hear people say “soaking up my vitamin D”, when a nice, sunny day arrives. But is it really as simple as that? Of course not. Today I will clarify what vitamin D is, why you need to make sure you are getting enough, and how to make sure you are getting what you need. 
 
Vitamin D is a fat soluble vitamin with hormone like properties that is found naturally only in a few foods and can be synthesized in the skin from the sun’s UVB rays. It is commonly known for its facilitative role in bone health by increasing calcium absorption and for its role in improving seasonal affective disorder. However, many people do not know that it also is required for proper immune function, hormone health, cellular growth and development, and blood sugar and blood pressure regulation. That's a lot! Many studies have found an inverse relationship between vitamin D status and autoimmune disorders, diabetes, eczema, cancer, depression, and more. The current recommended dietary allowance (RDA) is set at 400IU per day for infants, 600IU per day for children and adults alike, and 800IU for the elderly. 
 
SOURCES OF VITAMIN D
 
Vitamin D from the Sun
The sun doesn’t give you vitamin D3, it merely starts a process. Upon the skin’s exposure to the sun’s UVB rays, pre-vitamin D3 is converted to inactive vitamin D3 (cholecalciferol). After conversion in the skin, cholecalciferol is quickly transported to the liver and then to the kidneys to be metabolized to active vitamin D3, also known as calcitriol. Therefore, if the liver or kidneys are not functioning properly, vitamin D status can be impaired. 
 
However, the darkness of your skin, the fat deposition underneath your skin, and the coverage on your skin (including sunscreen and clothing) all play a role into if and how much pre-vitamin D3 is converted to cholecalciferol. If you have darker skin tone, are elderly (less fat under skin), wear a protective clothing layer, or apply a sunscreen greater than 10 SPF you will have reduced or no vitamin D3 conversion. Furthermore, the time of year and time of day also play an important factor. In latitudes above 42 degrees North (or below 42 degrees South), there is inadequate UVB radiation to support vitamin D synthesis from mid-October to mid-March. Keep in mind Bellingham is at 48 degrees North. Plus, the best time for good UVB exposure is between 10am – 2pm. Therefore, if you are working an indoor job from 9am to 5pm, are fully clothed, and wear sunscreen on your face, then you will not synthesize any vitamin D. And if you think you will get some vitamin D when sitting in a sunny spot inside, think again. It doesn’t matter what time of year it is, or time of day, if you are sitting in front of a window, all UVB rays will be blocked and you will not synthesize any vitamin D.   
 
Nutritionist Tip: Get outside around noon for 15 minutes and expose your hands, arms, and face (without sunscreen) in the late Spring, Summer, and early Fall months to synthesize about 1000IU. Then you can layer on the sunscreen or seek shade. 
 
Vitamin D from Food
Vitamin D is only found naturally in very few foods including fatty fish like salmon and sardines (340IU per 3oz), eggs (40IU per egg), and liver (40IU per 3oz). Mushrooms, although advertised as a source of vitamin D, often do not provide much useable vitamin D unless the grower purposefully has exposed the mushrooms to UV light. One cup of sliced “unexposed” crimini mushrooms only provides 5IU, whereas the “exposed” provides around 400IU. Ask your grocer what kind they offer. However, there are other foods on the market that are fortified with vitamin D such as dairy and plant milks, orange juice, and some cereals, usually providing anywhere between 50-100IU per serving. 
 
Nutritionist Tip: Enjoy fatty seafood like salmon, UV “exposed” mushrooms, and fortified milk or non-dairy milks multiple times per week for substantial food sources of vitamin D. 
 
Vitamin D from Supplements
Vitamin D supplements can be found as vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol). Vitamin D2 is synthesized via UV irradiation of yeast, whereas D3 is synthesized via UV irradiation of lanolin. However, research studies have found that vitamin D2 may not be as effective in increasing active (calcitriol) vitamin D3 serum levels. Taking supplements is essential when adequate dietary intake and proper sun exposure are lacking. 
 
How Much to Supplement?
The optimal intake of vitamin D to support general health and wellbeing remains controversial. Researchers have found a U shaped curve regarding vitamin D status, indicating that both low and high vitamin D serum levels are correlated with disease development and progression. The Linus Pauling Institute recommends that generally healthy adults supplement with 2000IU of vitamin D3 daily. Some may need more or less depending on all the factors discussed previously. However, more is not always better! High dose vitamin D supplementation that is not monitored can lead to abnormally high serum calcium concentrations which can damage the kidneys and heart. Research suggests that daily intakes of less than 10,000IU per day in healthy individuals is very unlikely to result in toxicity.  
 
Nonetheless, it is best to test not guess! Work with a health care practitioner to check your vitamin D status 1-2x per year to get a feel for what your unique needs are. Research studies suggest that a serum vitamin D concentration between 40 ng/mL and 60 ng/mL is ideal. 
 
Nutritionist Tip: Supplement with 1000 - 2000IU per day and check your vitamin D levels annually to ensure a serum vitamin D between 40-60ng/mL. Make sure to check your multivitamin, as they often already contain some vitamin D.
 
RESOURCES FOR THE INSPIRED INDIVIDUAL
 Overall, low vitamin D status can impact your health in many ways. Unfortunately, testing vitamin D status is not as routine as it should be, especially here in the Pacific Northwest. Ensuring optimal vitamin D levels year round can help keep you feeling your best. Be an advocate for yourself and request vitamin D labs at your annual doctors visit or see the resources below for more helpful research, testing, guidelines, and applications. 

• Check out GrassRoots Health for more vitamin D information and research. They also provide vitamin D testing for $65. 
• Check out the free DMinder App to monitor your vitamin D status and local sun exposure. 
• Check out the Environmental Working Group “Guide to Sunscreen” for safe sunscreen products. 

 
Article References:
Krause’s Food & The Nutrition Care Process, 14thEdition. Pages: 1071-1072.
Linus Pauling Institute. Vitamin D. https://lpi.oregonstate.edu/mic/vitamins/vitamin-D#RDA
GrassrootsHealth. Resources. https://grassrootshealth.net/documentation/

If you suffer from seasonal (or chronic) allergies, the Spring and Summer months may be your least enjoyable time of the year. As the flowers bloom and the grasses grow, your ears, nose and eyes keep you inside. However, there are a few things you can do via diet that may help you enjoy the summer months once again and maybe even save some money on over-the counter anti-histamines down the road.
 
Eat a Whole Foods Diet:
By eliminating processed foods and eating a diet rich in quality grass-fed meats and wild caught seafood, fruits & vegetables, whole grains, beans and legumes, nuts and seeds your diet will help reduce inflammation and histamine production. The benefits don't stop there! Many people are sensitive to food additives such as sulfites, MSG, food coloring, and added sugars all of which may contribute to allergic symptoms. By switching to a whole foods diet like the Mediterranean Diet, Anti-Inflammatory Diet, Whole 30, or Paleo you will naturally reduce the consumption of these additives.
 
Dietitian Tip: No matter what whole foods based diet you choose aim for at least 6 servings of veggies per day and 2 servings of fruit. One serving is equal to: 1 cup of leafy greens, ½ cup hardy veggies, 1 cup diced melon or berries, and 1 medium piece of fruit. 
 
Increase Foods Rich in Magnesium & Calcium:
Did you know that more than two thirds of Americans consume less than recommended magnesium daily? Magnesium is a mineral that is required in over 300 enzymatic reactions including histamine metabolism. It is found in whole grains, beans and legumes, nuts and seeds, and leafy greens. Pumpkin seeds are one of the richest sources of magnesium. Other big super stars include quinoa, chia, flax, almonds, dark chocolate, oatmeal, and spinach. Aim to eat 3 servings of magnesium rich food daily to ensure adequate intakes. Furthermore, calcium has been found to have a regulatory role in histamine release as well. 
 
Dietitian Tip: Monitor your intake of calcium rich foods such as grass-fed dairy, sardines with bones, or calcium fortified nut milks to make sure you are getting close to 1000mg daily. You may also consider an additional magnesium supplement of 200mg of magnesium glycinate per day and note for improvement in symptoms. Discuss this with your health care provider.  
 
Increase Foods Rich in Vitamin C:  
Vitamin C helps prevent the release of histamine from mast cells. As with magnesium, many Americans are not getting adequate vitamin C via their diet. Foods rich in vitamin C include papaya, raw bell pepper and broccoli, strawberries, citrus fruit, and cantaloupe. Aim for at least 2 servings of vitamin C rich fruit or veggies per day. 
 
Dietitian Tip: Camu Camu is a supplemental powder and can be a great adjunct to a whole foods diet rich in fruits and vegetables. One teaspoon of Camu Camu powder provides ~680mg vitamin C (760%). I suggest mixing Camu Camu powder in smoothies or juices for best tolerance. 
 
Eat Fermented Foods:
Many research studies have looked at the effect of various probiotic strains in patients with chronic or seasonal allergies. In most studies, probiotics have been found to significantly reduce symptoms. This is not surprising as gut dysbiosis (imbalance of good and bad bacteria) can contribute to both environmental allergies (pollen, grass, dander, etc) and food sensitivities. Nancy’s yogurts and kefirs, Good Belly Shots and Drinks, and Kevita Probiotic Beverages all provide therapeutic probiotic strains via food. 
 
Dietitian Tip: Try a probiotic for 2-3 months to see if you note further improvement. Choose one with one or more of the following researched strains: Bifidobacterium longum BB536, L. salivarius PM A0006, Lactobacillus johnsonii EM1, or L. paracasei HF A00232. Discuss this with your health care provider for product suggestions. 
 
Enjoy Local Honey:
Most people have heard that raw local honey can help reduce seasonal allergies. Although there is not much research in this area, I have heard testimonials from patients and friends that they have found an improvement in their symptoms with the daily addition of raw local honey. The only study I was able to find did see a significant improvement in participants who consumed 1g/kg of honey daily for 4 weeks in addition to 10mg of loratadine (anti-histamine). To put this in perspective a 150lb individual would need to eat ~ 3 tablespoons of honey per day to get close to the study recommendations. So, if you like honey, adding a little to your tea, homemade salad dressings, or drizzled over plain yogurt,  will not hurt, and perhaps it will help!

Check Your Vitamin D Status: 
The prevalence of vitamin D deficiency is significantly higher in individuals with allergic rhinitis. In latitudes above 40 degrees North or South, vitamin D production via the sun is insufficient between the months of November through March. Also sunblock with an SPF factor of 10 reduces vitamin D production by 90%. Therefore, many individuals here in Bellingham are at an increased risk of vitamin D deficiency. 
 
Dietitian Tip: Ask your health care provider to test your vitamin D level annually and replace as needed. Aim for levels between 40-60 ng/mL. Linus Pauling Institute recommends that general healthy adults supplement with 2000IU daily.
 
Consider Food Elimination:
If you have done all of the above without good effect on symptoms, I suggest looking into possible food sensitivities as these are often related. Work with a trained dietitian or certified nutritionist to help guide you through a 4-6 week elimination diet excluding the most common symptom evoking foods including dairy and wheat/gluten. A more comprehensive elimination diet may be utilized if the elimination of gluten and dairy do no provide relief. 

When you look at the dairy shelves today there are many vegan options available. Usually, they are made from a nut or seed base. Lately, oat milk has been getting a lot of marketing press. But do these products really make the cut nutritionally speaking?? That is a great question! Making a smart choice can be really difficult if you do not know what to look for.  
 
Although plant based non-dairy products can be a helpful alternative if someone struggles with a lactose or milk protein intolerance, they are often not as nutrient dense as you may think they are. Plant based yogurts and milks are commonly low in protein and calcium and high in added sugars, thickeners, and gums. You have to be very careful when selecting a product to make sure you are not missing out on certain nutrients that you would otherwise get from dairy milk products.  
 
PROTEIN CONTENT vs SUGAR CONTENT
When comparing protein content most plant based milks and yogurts contain very little, usually about 1-3g per serving (unless it’s soy milk). On the other hand, 1 cup of regular milk or yogurt contains 8g of protein, while the Greek yogurt varieties contain up to 25g per cup! That is very significant when compared to their plant based counter parts. 
 
Unfortunately, both the plant and dairy based products are often sweetened with added sugars to increase palatability. This is more often true with plant based products because milk is naturally sweet from lactose. Even plain varieties of plant based yogurts often contain added sugar. If you combine this with their low protein content it is a recipe for increased blood sugar spikes and increased hunger shortly after consumption. 
 
Dietitian Tip: Choose a plant based product that contains more protein and less added sugar to help maintain satiety for a longer period of time and reduce blood sugar spikes. Plus, instead of adding more honey or maple syrup to plain yogurts or milks, pair them with fresh berries for a little high fiber sweetness and add a handful of nuts (or tablespoon nut butter)  to increase the protein, fat, and fiber for more blood sugar support and increased satiety. 
 
Plant Based Yogurts with HIGH protein and LOW Sugar:

1. Kite Hill Plain Greek Style Almond Yogurt: 13g protein, 0g added sugars, 0% calcium, 0% vitamin D
2. Nancy’s Plain Oatmilk Non Dairy Yogurt: 6g protein, 0g added sugars, 2% calcium, 0% vitamin D

 
Plant Based Milks with HIGH Protein and LOW Sugar:

1. Orgain  Organic Protein Almond Milk: 10g protein, 0g added sugars, 25% calcium, 25% vitamin D
2. Silk Protein Almond & Cashew: 10g protein, 2g added sugars, 30% calcium, 10% vitamin D
3. Westsoy Organic Unsweetened Soymilk: 9g protein, 0g added sugars, 0% calcium, 0% vitamin D

 
PROBIOTIC POTENTIAL
As with dairy products the probiotic action of most plant based yogurts is very minimal. By the time yogurts reach your plate the number of live cultures is limited. Tanginess or tingling is often the characteristic of live, active fermentation which indicates higher probiotic potential. If you make your own 24 hour yogurt at home, whether dairy or plant-based, it will yield a much higher probiotic count than store bought. 
 
Dietitian Tip: GT’s CocoYo provides a live probiotic punch. Be aware it is VERY tangy and tingly which is not everyone’s cup of tea. Lavva Yogurts also promote that they have 50 billion units per cup, but what strains is not indicated. Nancy’s Oatmilk yogurts is another great option because it contains researched probiotic strains that have been shown to provide health benefits. 
 
MICRONUTRIENTS OF CONCERN
Finally, if one must replace dairy products with their plant based alternatives due to intolerance or personal preference, one must consider what nutrients are being missed. Those of biggest concern are calcium, vitamin D, and iodine. 
 
Calcium:
With an average daily recommended intake of 1000-1200mg, calcium is one of the biggest concerns. As many people know, calcium is essential for bone health. It also plays a role in cell signaling including regulating blood pressure, insulin secretion, nerve impulse transmission, and muscle contraction to name a few. Some plant milks and yogurts are fortified with calcium. However, if you are not careful, you can easily select one that is not fortified or contains very little thereby increasing your risk of calcium deficiency. For example, 1 cup of dairy milk or yogurt contains between 300-400mg of calcium. If you replace your 1-2 cups of dairy milk or yogurt with a non-fortified plant based product you are missing out on a lot of your daily needs!
 
Dietitian Tip: Choose a plant based milk or yogurt that contains at least 20-25% of your daily value of calcium. Make sure to shake the milk container well prior to each use because the added calcium carbonate can settle at the bottom. 
 
Vitamin D: 
Vitamin D plays an important role in calcium absorption. Without adequate vitamin D individuals will not be able to obtain as much calcium from their diet. Since dairy is often fortified with vitamin D, it can be easy to lose out on this source of vitamin D if you switch to a plant based alternative. Unfortunately, in the Pacific Northwest you can only rely on the sun to provide vitamin D during the months of May through September. 
 
Dietitian Tip: Choose a plant based milk that is fortified with vitamin D and/or make sure your daily multivitamin provides 800IU of vitamin D3. 
 
Iodine: 
Finally, iodine is an essential nutrient for proper thyroid function and therefore directly effects metabolism. Dairy products are a main source of iodine in the American diet. Plant based milks and yogurts do not contain iodine. Keeping this in mind it is very important to replace iodine from other food sources including fish, seaweed, or iodized salt. 
 
Dietitian Tip: Sea Seasonings Dulse Granules or Eden’s Gomasio are fun ways to add a great source of iodine to your diet. If you don't like the flavor of seaweed, simply use iodized salt in cooking. 
 
CONCLUSION
It is really hard to find a non-dairy milk or yogurt that has it all; protein, low sugar content, and 20% or more of your calcium or vitamin D, and not to mention a flavor profile that you like. Even the new oat milk craze doesn’t match up with only 3g of protein per cup. The items below are close to meeting most specifications, but are not perfect. Therefore, it is important to be aware of what you are getting out of your non-dairy product. Is it protein, micronutrients, or live probiotics? Or is it simply because it tastes delicious? Just make sure to be smart to avoid missing out critical nutrients in the long run. 
 
Best All Around Choices:

1. Orgain Organic Protein Almond Milk: 10g protein, 0g added sugars, 25% calcium, 25% vitamin D
2. Silk Protein Almond & Cashew Milk: 10g protein, 2g added sugars, 30% calcium, 10% vitamin D
3. Oatly Oat Milk: 3g protein, 0g added sugars, 25% calcium, 20% vitamin D.
4. Nancy’s Oatmilk Yogurt: 6g protein, 0g added sugars, 2% calcium, 0% vitamin D
5. So Delicious Plain Cultured Coconut Milk: 0g protein, 7g added sugars, 40% calcium, 40% vitamin D
6. GT’s CocoYo Living Yogurt: 1g protein, 0g added sugars, 0% calcium, 0% vitamin D 

 
Dietitian Tip: If you have a favorite brand of non-dairy milk or yogurt and it is low in calcium consider stirring in 1/8th or ¼ teaspoon of KAL Bone Meal Powder per serving to increase the calcium content. 
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