Traveling Abroad With Gout

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Anyone who suffers with gout knows how frustratingly painful it can be. This may prove to be especially true for people who are passionate travelers that don’t like their trip to be burdened by the physical symptoms that gout may affect them with.

How does gout occur?  Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as red meat, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose). Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling. Including or omitting certain foods while traveling may be helpful in controlling symptoms. In addition, if you have issues with weight management or poorly-controlled Type 2 diabetes, meet with a Registered Dietitian Nutrition (RDN) before you embark on your journey, to help you get your diet in good control.

When it comes to foods that could help symptoms, it is generally recommended to follow a healthful diet full of whole grains, fruits and vegetables, and limited in animal protein, such as meat, fish, and chicken. Alcohol should be avoided or limited within individual tolerance. Other foods to avoid include organ and glandular meats including liver, kidney, and sweetbread (thyroid gland and pancreas); certain seafoods including anchovies, sardines, mussels, scallops and  mackerel. The beer, seafood, and organ and glandular meats have potential to increase the production of  uric acid. Coffee, in moderation, along with low fat dairy  (cheese, milk and yogurt) may help reduce gout symptoms. By being a little strategic while exploring different countries, you can use food to help minimize your symptoms in the efforts to optimize your European adventure! Below are breakdowns of “To Eat and Not To Eat” in the following countries.

FRANCE:

To Eat: Available and popular fruits and vegetables: Artichokes, pears, apples, asparagus, strawberries, fennel, chard, and grapes. Look for them in ratatouille and fresh salads When sampling cheese in a courtyard patio, ask for breads that are whole grain or at least multi-grain so you can include some fiber in your late-afternoon snack. Having that quintessential cappuccino could also prove to be beneficial.

Not To Eat:  A very important dish to avoid is unfortunately a very typical French food: pate’ de fois gras, which is duck liver pate’. Liver is an organ meat that should be avoided when attempting to limit uric acid production in the body. Avoid the aforementioned seafood as well. In the efforts to reduce your intake of saturated fats, try to keep from indulging in one of France’s buttery, creamy sauces more than once a day.

SPAIN:

To Eat: Common vegetables include piquillo peppers, tomatoes, potatoes, zucchini, onions, eggplant, spinach, cabbage, cucumbers, and mushrooms. You can find them in stews, soups, and paella. Fruit is a typical dessert in Spain, and popular fruits include apples, oranges, grapes, cherries, dates, and figs. Spain is home to some of the best olive oil in the world. Embrace dietary fat sources from this olive oil in lieu of butter or butter-based sauces.

Not To Eat:  Avoid seafood paella, or have a very small amount, as it tends to have mussels and different seafood sources. The ingredients are mixed in and bite-sized, so it’s not always easy to identify the seafood the paella is prepared with. Stick to the vegetable paella –-I promise it’s just as good! Popular seafood in Spain that should be minimized: anchovies, sardines, and mussels

ITALY

To Eat: Vegetables are such a staple in Italian cuisine. Popular ones include tomatoes, onions, bell peppers, eggplants, cabbage, zucchini, artichokes, broccoli, and leafy greens. They are very easy to find in pasta dishes, risottos, pizzas, or in salads, soups and/or antipasti (appetizers). To consume more fiber in the efforts to stay energized and regular, ask for your pizza or bread to be made with whole wheat flour. Italians also eat fruit regularly for dessert, including grapes, berries, citrus fruits, and figs. Fish is a large commodity here, maintaining Italy as one of the base countries in the esteemed healthy fish-focused Mediterranean Diet. There are still plenty of fish you can enjoy here, including swordfish, cod, salmon, crab, and squid. You can find fish everywhere – alone as a grilled or baked entrée, or mixed in with stews and pasta dishes.

To Not Eat: The biggest off-limit foods in Italy are the following seafood: anchovies, sardines, and mussels.

If you minimize the foods high in purine, you may find that you can enjoy your time abroad to the fullest. Bon voyage!

Lisa Stollman, MA, RDN, CDE, CDN was recently honored as the 2015 Outstanding Dietitian of the Year by the New York Academy of Nutrition and Dietetics. She loves traveling the world and experiencing new foods, cultures and people. Lisa is the author of the ebook The Trim Traveler: How to Eat Healthy and Stay Fit While Traveling Abroad (Nirvana Press 2014) and The Teen Eating Manifesto: The Ten Essential Steps to Losing Weight, Looking Great and Getting Healthy (Nirvana Press 2012).. Lisa maintains a nutrition practice in NYC and Huntington, Long Island where she specializes in weight management, diabetes and travel nutrition. Lisa is also the CEO of Eat Well Restaurant Nutrition where she collaborates with chefs to get healthy dishes on the menu. For more info on Lisa, visit here. Special thanks to Samantha Marks, BS, DTR for her contributions to this blog post.

5 Tips For Eating Less Sugar

Silver scoop of sugar, spilling onto blue surface.

For most of us when we get a craving, it’s for sugar. Whether for a quick “pick-me-up,” a mid-afternoon treat, a late-night indulgence or –yep– that time of the month, something sweet surely makes the top of the list! Even at birth, babies prefer the taste of sweet over any other. Why does this happen? Sugar stimulates the release of the body’s “feel good chemical” serotonin, which calms and relaxes us. However, after eating the bag of jelly beans, this feeling of immense pleasure quickly plummets as your insulin level increases and hustles the sugar into your cells, ultimately dropping your blood sugar. And then the craving rebounds, and you want more sugar! If you are one of these people who constantly craves sweets, you may want to consider how often you indulge. Think about it. We have all heard people say “I’m just not a dessert person.” This is because they don’t regularly eat sweets. On the contrary, those who are “regular sugar-cravers” consume more than their fair share. Simply put, the more you eat, the more you crave. The problem with sugar is not when you have an occasional sweet food, but when you eat excessive sugar. And that is easy to do as sugar is added to many processed foods, including bread, yogurt, juices, cereals and sauces.

FYI: According to a report from the 2005–10 NHANES (National Health and Nutrition Examination Survey), Americans eat about 20 teaspoons of added sugar a day . Teens and men consume the most added sugars. Average daily consumption for men: 21 teaspoons,  boys: 23 teaspoons, women: 14 teaspoons, , girls:  18 teaspoons. The American Heart Association recommends limiting added sugar to about 6 teaspoons per day for children and women and 9 teaspoons per day for men.

Next time you pick up a candy bar, pay attention to how you feel after you eat it. How is your energy level? Are you truly satisfied or still hungry? Are you craving more? When trying to adapt to a healthy way of eating, it can be a “real eye-opener” if you just take a few minutes to observe how your body feels and the cues it’s providing. So what can you do to satisfy your sweet tooth without overdoing the sugar? Have no fear! Your sugar cravings can be controlled. The key is to be mindful when choosing sweets. Have a variety of go-to sweet snacks that won’t break the calorie bank. When you have a craving for sweets, sometimes you can find ways to not give in. Going for a walk, a relaxing cup of Chai tea or picking up a good book can take your mind off the need for a sweet. But when that fails, you need a backup plan!

Here are a list of suggestion to help you stay in control while feeding your sweet tooth:

1. Choose fruit. The healthiest “hands-down” sweet food is fruit. If a sweet dish of pineapple, strawberries, mango, or other fruit will do the trick, this is truly the best choice. You will get a nice burst of energy, but due to the fiber your blood sugar will be more stable and not drop quickly. Keeping fresh or frozen fruit always available is a great way to feed your sweet tooth and stay on track with your healthy eating routine.

2. Keep to your meal routine. Eating every three to five hours throughout the day will help keep your blood sugar stable and decrease your urge for the sweet stuff. Enjoying a serving of fruit with each meal will further decrease your sweet tooth and keep you energized.

3. Combine your sweet with a healthy protein, such as nuts or low fat cheese, or complex carbohydrate, such as fruit or whole grain cereal to avoid the spikes and plummets that leave you wanting more. Maybe fresh fruit by itself doesn’t do the trick! But what if it’s dipped in chocolate? YUM!! Buy a bag of chocolate chips (milk chocolate or dark–whatever your preference!) Cut up a cup of your favorite fruit. Measure out 2 tablespoons of chocolate chips (which is 130 calories) and microwave it for 30 seconds. Sit down at the table and dip the fruit into the chocolate. Or make a trail mix with 1/2 cup Multigrain Cheerios, 1 tbsp. chocolate chips and 1 Tbsp. chopped walnuts. Very delicious and under 220 calories!

4. Feed your craving! Enjoy what you crave, instead of denying yourself. Just try to keep to a sensible portion and eat it slowly! Its smart to limit snacks/treats to 200 – 250 calories. If you feel the strong desire for a candy bar or M&Ms, go for the small size but always read the label. The small package of M&Ms is 250 calories. If you keep them in freezer, you may find that even just a small handful of frozen chocolate will make you quite happy! Better yet, go for a KIND bar. These bars have several chocolate varieties, weigh in at 200 calories each, are a good source of fiber and only 1 teaspoon of sugar. Try to feed your craving with something that will satisfy you so you don’t continue eating. Try a small handful of nuts mixed with a tablespoon of chocolate chips. Or a sweet granola bar with an apple or small banana.

5. Go out and move. When you feel a sugar craving coming on, put on your sneakers and go out for a walk. Doing something else that will relax you may take your mind off the craving. Or, if it’s late at night, sip a cup of soothing chamomile tea with a teaspoon of honey or sugar to feed your sweet tooth and relax.

Lisa Stollman, MA, RDN, CDE, CDN was recently honored as the 2015 Outstanding Dietitian of the Year by the New York Academy of Nutrition and Dietetics. She loves traveling the world and experiencing new foods and cultures. Lisa is the author of the ebook The Trim Traveler: How to Eat Healthy and Stay Fit While Traveling Abroad (Nirvana Press 2014) and The Teen Eating Manifesto: The Ten Essential Steps to Losing Weight, Looking Great and Getting Healthy (Nirvana Press 2012).. Lisa maintains a nutrition practice in NYC and Huntington, Long Island where she specializes in weight management, diabetes and travel nutrition. Lisa is also the CEO of Eat Well Restaurant Nutrition where she collaborates with chefs to get healthy dishes on the menu. For more info on Lisa, visit here.