Self-care Tips for PMS Relief

woman holding umbrella PMS


Cramps. Bloating. Fatigue. Insomnia. Mood swings. Diarrhea. Breast pain. For millions of women, these unpleasant symptoms are a monthly occurrence.

For some, the physical and psychological symptoms during the premenstrual phase are minor annoyances. But for others, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) symptoms put a damper on their work and academic performance, relationships, and body image.[1]

Fortunately, there’s a lot women can do to support healthy, happy periods with lifestyle medicine and self-care.

Nutrition for PMS

Because women with PMS have higher levels of inflammation than those who don’t, a great place to start for PMS relief is adopting an anti-inflammatory diet.[2] [3]

By extinguishing inflammation, anti-inflammatory foods could reduce symptoms.

Some anti-inflammatory foods to weave into meals and snacks are:

  • cold-water fish
  • colorful fruits and vegetables
  • green and herbal teas
  • olive oil and olives
  • nuts and seeds (especially flaxseed)
  • herbs, spices, and citrus zest (especially ginger)

In addition to their anti-inflammatory properties, flaxseed and ginger boast impressive scientific and traditional wisdom to back their ability to improve PMS. [4] [5] [6] [7] [8]

Taking about 3 teaspoons of ground flaxseeds has been shown to reduce breast tenderness in pre-menstruating women. Doses of 1.5 – 4 teaspoons of powdered ginger can be taken before the start of a woman’s period and continued well into her period or started on day one of her cycle to relieve menstrual cramps, nausea, and emotional symptoms.[9]

Supplemental calcium also has strong clinical research to support its use.[10] In research, doses of 1000-1336 mg/day have been given for up to three menstrual cycles.

While the research has focused on the effect of calcium supplements on PMS, it’s always a good idea to aim to get enough calcium from foods like collard greens, beans, and canned fish with the bones.

Remember, nutrition isn’t the only tool we have at our disposal. Stress management techniques and aromatherapy can also make a woman’s premenstrual experience more pleasant.

Stress Management for PMS

Since psychological stress makes premenstrual symptoms worse, reducing stress and building resilience may improve PMS.[11]

There are tons of tried and true ways to manage stress. The important thing is to find techniques that fit a woman’s interests and schedule.

Here are a few options to try:

  • Shinrin Yoku/ Forest Bathing
  • Journaling
  • Spending time with family, friends, or pets
  • Meditation
  • Yoga

Aromatherapy for PMS

The pain reducing, stress buffering, and mood altering properties of essential oils can help manage symptoms like muscle and joint pain, insomnia, and mood disturbances.

Lavender oil seems to hold special promise [12] [13]. It can be used in massage oils, diluted and applied directly to achy areas, or inhaled.

Though lifestyle and integrative medicine can improve premenstrual symptoms, physical and mental symptoms should always be discussed with and investigated by a primary care provider or gynecologist. They could be a sign of more serious concerns like endometriosis, fibroids, depression, or PCOS.

What lifestyle or self-care strategies do you most often recommend for improvement of PMS?  Please share in the comments section below.

Want to learn more about integrative and functional nutrition topics like this? Check out our Archived Webinars!

Kendra TolbertKendra Tolbert MS, RDN, CDN, CLC is registered dietitian, certified aromatherapist, and certified lactation counselor specializing in women’s health. Her website, Live Fertile, is packed with fertility, pregnancy, and women’s health wellness information. She currently lives in Alexandria, VA where she can usually be found taking a yoga or belly dance class.

Nutrition’s Role in Detoxification: Not just another “fad diet”



The word “detox” is one that has generated a lot of controversy over the years due to many unhealthy and scientifically unsound “fads” that have been promoted by the media. Popular detox diets have included the “Master Cleanse”, also known as the lemonade diet, and various forms of juice cleanses. While these diets do succeed in eliminating unhealthy and processed “junk foods” and may induce short term weight loss, they often deprive the body of vital nutrients necessary for proper detoxification and are not recommended by most Registered Dietitians or other health professionals.

What is detoxification?

Detoxification is a biochemical process in which the body rids itself of toxins from both the environment and those produced within the body (endotoxins). The human body is naturally designed to detox with help from organs such as the lungs, kidneys, skin and liver and does so through processes including urination, bowel movements, sweating, and breathing.

However, despite this innate ability to detox, the body can get into a state of toxic overload, or “oxidative stress”, which occurs when the amount of toxic exposure surpasses the body’s ability to detoxify. When this happens, studies have shown that chronic diseases such as diabetes, atherosclerosis, cancer, cardiovascular disease, and chronic inflammation can occur. One of the biggest contributors to a toxic overload for the average American is consuming the Standard American Diet that is lacking in key nutrients to support proper detoxification.  Other contributors to this overwhelming toxic load include repeated exposure to pollution, tobacco smoke, pesticides, pharmaceutical drugs, heavy metals and many man-made chemicals found everyday household items. Fortunately, proper nutrition and lifestyle factors can help to both prevent this oxidative stress and aid in proper detoxification processes.

Dietary compounds to support detoxification

  • Antioxidants: True to their name, foods high in antioxidants help scavenge free radicals and reduce the damaging effects of toxins. Foods high in antioxidants include berries, nuts and seeds, leafy green and orange vegetables, coffee, tea, dark chocolate and many spices such as cinnamon.
  • B vitamins: B vitamins are required for the biochemical detoxification pathway that occurs in the liver and without them the liver’s ability to detox is compromised. Some foods rich in B vitamins include whole grains, beans, poultry, dairy, eggs, and many fruits and vegetables.
  • Glutathione: Also necessary for the detoxification pathway in the liver, glutathione is a protein made up of the amino acids cysteine, glycine, and glutamic acid. It also serves as a powerful antioxidant. Consuming foods like whey protein and sulfur rich vegetables (broccoli, cabbage, kale, Brussels sprouts, garlic, onions, etc.) are two ways to boost glutathione levels in the body.
  • Fiber: Both soluble and insoluble fiber help promote regular production of bowel movements, which is a major way the body excretes toxins.
  • High quality protein: Protein provides amino acids, which are necessary for the liver’s detoxification pathway. High quality protein foods include organic meat, fish, poultry, eggs, dairy and soy.
  • Curcumin: Curcumin, the active constituent in the spice turmeric, has shown protective effects towards the gallbladder in promoting bile flow, another method of detoxification.

Lifestyle factors to reduce toxic exposure

  • Avoidance of following the Standard American Diet (SAD), which includes high amounts of refined sugar, refined fours, artificial ingredients, inflammatory fats and preservatives. Instead, aim to consume a diet rich in fruits, vegetables, anti-inflammatory fats, and high quality protein.
  • Reduce exposure to pesticides by choosing organic produce whenever possible, specifically of the Dirty Dozen.
  • Reduce exposure to man-made chemicals found in plastics, cleaning products, hygiene products, and many other everyday use items. This can be done by storing food and beverages in glass containers and purchasing cleaning and hygiene products that are made from naturally derived ingredients whenever possible.
  • Reduce exposure to cigarette smoke and polluted air.


While it’s true that the body is naturally designed to detox, following a diet and lifestyle plan that will reduce toxic exposure and aid detoxification may help treat and prevent the conditions associated with toxin buildup. However, rather than thinking of detoxification as a short-term fad diet, viewing it as an everyday lifestyle can help promote longer term and more sustainable health improvements. Working with a Registered Dietitian can help identify sources of toxins in the diet and create an individualized plan to help reduce exposure and promote proper detoxification in the body.

What are your thoughts on detox diets? Feel free to share your comments below.

For more on detox, check out our Archived Webinars, including “Why Detox? Tips and Tools for Guiding Your Patients towards a Healthy Liver” presented by Mary Purdy, MS, RDN.  We’ll also be hosting a Twitter Chat on August 29, 2017 at 8PM ET on “Decoding Detox”, and we’d love for you to join the conversation.

Joanna FoleyJoanna Foley, RD, has been practicing since 2014 and has worked as both a clinical dietitian and, more recently, a renal dietitian. She is passionate about promoting behavior changes that lead to a healthier, higher quality of life using food as medicine. Joanna enjoys experimenting with new recipes, traveling and running half marathons. Connect with her on Instagram (@joannafoleyrd), Facebook, LinkedIn and Pinterest.


Yoga and meditation for healthier aging

yoga and meditation

Yoga, meditation, and aging

Yoga and meditation have become popular forms of exercise and relaxation, and we continue to learn about even more benefits beyond fitness. Of the people who practice yoga in the US, 21% are over the age of 60. This is the second most popular group of yogis, falling behind the age group 30-39 who comprise 23% of the yoga practitioners. This is important because the aging population faces an increased risk for many conditions and diseases, such as heart disease, diabetes, anxiety, cognitive impairment, loss of balance, and increased respiratory issues.

In nursing homes, we see many residents with Alzheimer’s dementia, incidence of falls, and respiratory insufficiency, such as COPD. Many people will spend thousands of dollars on nursing home care including physical, occupational, and speech therapy as well as medication to correct or improve these physical and cognitive declines. Much of the research surrounding disease management is reactive, treating the disease once it occurs. However, a balanced, healthy diet and active lifestyle is beneficial for overall health and can be preventative or at least slow down the progression of many of the above conditions. Yoga and meditation can also have beneficial effects on many conditions in the aging population.

Health benefits of yoga and meditation

New research has shown that practicing yoga and meditation may help with conditions such as attention span, memory, respiratory status, neurogenerative diseases, and cellular aging  in older adults. Studies have shown that meditation reduces certain risk factors for Alzheimer’s, such as high cholesterol and high blood pressure. Since these are also risk factors for heart disease, America’s leading cause of death, incorporating meditation into a healthy lifestyle may pack more benefits than you think. One study also found that in older participants, mindful meditation improved the thickness of the prefrontal cortex, important in the role of decision making and memory. Yoga can significantly improve pulmonary volumes and respiratory muscle strength in older women as well as balance and mobility. Many of the yoga studies included an 8-12 week yoga program, and many of the meditation studies included meditation for 15-20 minutes twice daily.

Getting started

While the research is growing and more studies are needed, incorporating yoga and meditation into one’s daily or weekly lifestyle can have preventative effects in regards to developing Alzheimer’s dementia and respiratory diseases. Finding a yoga studio in today’s world is easier than ever. If joining a yoga or meditation class feels too intimidating, you can always turn to your smartphone to find an app that will lead you through a peaceful flow at home (App: Down Dog), or guide you through a meditation sequence (App: Headspace) before heading off to dreamland.

How are you incorporating yoga or meditation into your own lifestyle or nutrition practice?  We’d love to hear from you in the comments below.

For more on information, check out our other posts on Mind Body Practices.

Olivia MiddletonOlivia Middleton MS, RD, LD is a registered dietitian enjoying life in Atlanta, Ga. She is currently employed with Ethica, a long-term care and rehabilitation organization, as a regional consulting dietitian. Olivia studied Dietetics at University of Georgia and proceeded to complete the coordinated program for her dietetic internship and Masters in Nutrition at Georgia State University. Passionate about educating individuals regarding healthy lifestyles and being a support system for all patients/clients she interacts with. Outside of her working life, Olivia enjoys hiking, trying new restaurants & recipes, staying active at her fitness studio, and simply enjoying the outdoors.

Tart Cherry Juice: More than nature’s sleep aid

Tart Cherry Juice Smoothie

Potential Benefits

Tart cherry juice has received a lot of praise in the scientific community for its health qualities in the prevention of chronic diseases and as a natural sleep aid. This juice is packed with antioxidants that have been shown to decrease the incidence of cancer, diabetes, heart disease, and other chronic inflammatory conditions. Also tart cherry juice may impact muscle repair and sports injuries in the athletic community.


Tart cherries naturally contain a high amount of anthocyanins, a color pigment and powerful antioxidant. Anthocyanins can help improve circulation, decrease the presence of free radicals that cause cellular and vascular damage, and improve nerve function, which is why this juice is much more than a sleep aid.

A Natural Sleep Aid

Insomnia is a debilitating condition that affects more than 30% of the population at some point in their lives. Insomnia not only affects a person’s ability to fall and stay asleep but can affect many aspects of their lives. Many prescription and over-the-counter sleep aids are known to have potential harmful side effects as well as drug nutrient interactions that may lead to more harm than good. Therefore, recommending tart cherry juice as a natural sleep aid may help patients stay clear of potentially harmful side effects and drug dependency.

To help with sleep duration and quality, it is recommended that a person drink 1-2 servings of tart cherry juice per day. Researchers of one study found that drinking two servings of this juice, one in the morning and one in the afternoon, significantly improved sleep duration and sleep quality in subjects.

Getting regular good quality sleep is important for both physical and mental health and may impact weight gain and the onset of chronic conditions.  Sleep health is an integral part of a person’s overall well-being and health and should not be overlooked during counseling sessions.

Tart Cherry Juice

Recipe: Tart Cherry Juice Smoothie

Prep Time: 5 minutes

Yield: 3 servings


  • 1 cup tart cherry juice
  • 1 medium banana
  • ½ cup vanilla almond milk
  • ½ cup frozen blueberries
  • 1-2 Tbsp honey or maple syrup (optional)
  1. Add all ingredients into a blender and blend until smooth.

Nutrition Facts:

Serving: 6 oz

137 calories, 1g fat, 32g carbohydrate (16g sugar, 2g fiber), 1g protein, 54 mg sodium

Morgan GiannattasioMorgan Giannattasio is an outpatient Registered Dietitian in Raleigh, North Carolina. She received her Bachelor’s degree in dietetics from SUNY Oneonta and went on to receive her Master’s degree in nutrition from Meredith College in Raleigh, NC. In her spare time, Morgan enjoys going to the beach with her dog and family.

From the Chair: Why I Love the Heck out of Grocery Shopping

Healthy Grocery Shopping

I adore grocery shopping. One of my ideal Saturday night plans is lingering amidst the lemons, ambling around the apples, perusing the pickles and zoning out by the zucchini. Shopping for food is more like a hobby than a chore.  It’s like a little trip to a food museum, and on a Saturday night, I don’t have to rush.  I don’t have to get back to anything except for…the rest of Saturday night.

Normally on a quick weeknight shop, I have to stay on the route, focused and predictable, purchasing the necessities: kale, lemons, garlic, cilantro, quinoa, carrots, sweet potatoes, apples, oranges, almonds and sunflower seeds, cans of chick peas and black beans, tortillas, and don’t forget the salsa, yells my husband, Keith. (Or the coconut milk!)  I have the list down pat in my head. I know what we need for a typical week of meals so that we’ve got enough balance, bounty, color, fiber, sweet, sour, plain and fancy….but…. Saturday night at the Pacific Central Food Coop in Seattle, the world is mine. I can spend time reading labels and comparing ingredients, (wow, this brand has guar gum while this one uses carrageenan), discover new products, (There are 19 different brands of mustard!), sneak a taste of something in the bulk bin, (what exactly is in those gritty little chunks of brown marbled nuttiness?) look at products in the freezer that I’ve never seen (frozen chicken gizzards?  Eek!).

It’s an adventure and I get to take something home afterwards!  That doesn’t happen at a museum.  You cannot actually remove anything from a museum without causing a pretty big ruckus. (Trust me, my mom touched a painting once in a museum in New York City and almost got escorted out by a guard.) But grocery stores let you both touch and take items, historical and modern, out of the building and into the comfort of your own pantry where you can put them on display for your family members and guests, who can look at them and then devour them.

I am also at home in a grocery store. I appreciate the comforting familiarity of what I see as I stroll: my favorite box of flax seed crackers peeking at me from the shelf.  I remember those, my tummy chimes.  And now, look, they come in new flavors.  “Rosemary”!  Heavenly!  “Savory”? Well, I’ll be damned.  “Cinnamon Raisin”! Un-heard of!  Crackers with cinnamon and raisin in them.  Who thinks of these creative combinations?

Mary PurdyI clip coupons as a warm up: my grocery shopping foreplay.  I don’t care if it’s 35 cents, goshdarnitt, I’m determined to spend less than I did at the last trip.  I get high off of savings.  When I start flipping through those little coupon books and realize I have already save $3 and haven’t even started putting things in my basket, my heart rate starts rising (not in the “your Aunt Thelma has high blood pressure” kind of way, but rather in the “I just won the raffle prize” kind of way).  It’s like I am suddenly holding a 3 dollar bill in my hand, which makes me feel powerful, not because 3 dollar bills don’t exist, but because that was $3 that I got paid for no other reason than I picked up a little booklet of coupons and looked through it.  As I hand over the flimsy 2 by 2 paper cut-out to the cashier, I have this gratifying sensation that I just got something for nothing.   Basically, someone just gave me 65 cents to help me buy a jalapeno hummus that I was going to buy anyway.  I scour the aisles for sales (more savings!) – denoted by a bright orange sign – and grab those items off the shelves with extra spirit.  And I’m not too proud to say that yes, I wait for the sales and then buy several tubs/bags/cartons of that item.  Bam!  Just saved (or made) four dollars and 98 cents. And it’s not going to take me all that long to go through those 4 cartons of almond milk.

On Saturday evenings at my local store, the patrons seem to fall into three categories: 

The First: The market lovin’ foodie folks, coupons peeking out of their pockets, (hello, moi) taking the time to choose the perfect tomato, studying labels and relishing in a chocolate-covered coconut chunk they snuck from the bulk bin. (Yes, that would be me again).

The Second: Couples on a dinner-making date buying the ingredients for their meal – the older ones quibbling, the newer ones trying to be as agreeable as possible – “Um, sure!  I’m fine with any of the different types of pasta.  You choose!”.  We all know that’s not true.  I have been that person and found myself very disappointed with penne when what I really wanted were spirals – the naturally superior choice.

And the Third: The solo shopper, shoulders slightly hunched, staring blankly at the ice cream in the freezer section.  I have also been in category number three on nights when a Mint Galactica Coconut Bliss Ice Cream appears to have the utmost of potential to solve the world’s problems – or at least put them on pause for a moment.  Our current political turmoil immediately seems insignificant when ladling a scoop of Salted Caramel Chocolate Chunk directly onto your tongue.

I don’t want to give the impression that I don’t still have the occasional crazy Saturday night out smoking hookahs and going to a hard rock concert.  I do.  (Minus the hookah, and ok, exchange “hard rock” for “singer songwriter” at an intimate tavern on a quiet street in a quaint part of town.) But I have learned to find delight (or perhaps accept the delight that I naturally feel) in a simple evening of mingling with the miso paste at the community market. I am as comfortable in a grocery store surrounded by leeks, lemons and legumes as I am at home with my books, bed and bathtub.  When you feel connected to food, spending precious time with it feels less like a chore and more like a gift that offers both culture, entertainment and experiential learning – especially when you partake of as much “secret sampling” as I do.

Do you have a favorite grocery shopping experience?  Share in our comment section below.

To dig a little deeper, you may want to check out our Archived Webinars including Culinary Nutrition: from science to plate or The Cancer-Fighting Kitchen in the Members-Only section of our website.

Mary Purdy, MS, RDN, works at the Scientific Wellness company, Arivale, in Seattle, as Clinical Training Lead and Coach providing nutrition and lifestyle counseling to clients using personalized genetic data and functional labs to help them improve their health. Before that she was in private practice for 8 years. She was adjunct professor at Bastyr University for three years and spent five years as a clinical supervisor at their teaching clinic The Bastyr Center for Natural Health. She taught an online module on therapeutic diets with the IFNA Academy and has provided numerous webinars and workshops for nutrition professionals and the public. She has been interviewed on Seattle’s Public Radio and on local Seattle TV, and quoted in numerous magazines and websites including Prevention, Today’s Dietitian, Experience Life, and Natural Health. She has served on the DIFM board for several years as Communications Chair and is the Past President of the Greater Seattle Dietetic Association. She also co-authored the Diet Appendix for The Anti-Inflammatory Diet chapter for the 14th ed. of Krause’s Food & The Nutrition Care Process and is the host of the online web series and podcast, “Mary’s Nutrition Show.”

4 Things to Know About the “New Gluten”: Lectins

legumes lectins

By now, most of us are aware of the growing trend of going gluten-free. More recently, a “lectin-free” diet is being promoted. This diet suggests that we should avoid whole grains, legumes, seeds, nightshade vegetables (tomatoes, eggplant, potatoes, etc.), out-of-season fruit, dairy and eggs. You may be thinking, “what can you eat?”. While some people truly need an avoidance diet for specific conditions, any diet that eliminates so many nutrient-rich foods should be critically and fully explored before jumping on the bandwagon.

Here are 4 things you should know about lectins:

1. Lectins are a type of protein, which exists in many different forms and have many different functions, both good and bad.

Lectins are a group of proteins that bind to carbohydrates and exist in most plants. They can have both beneficial and harmful effects. Lectins are naturally used by plants to protect themselves from predators and cause unpleasant symptoms to deter those predators. They also exist in the human body and function as a helpful member of our immune system. The harmful effects of lectins have been the focus of the lectin-free diet.

 2. Some lectins are toxic, such as in raw or undercooked kidney beans, but proper cooking reduces this toxicity significantly.

Many lectins in our diet are harmless because they are denatured during cooking... Click To Tweet

Many lectins in our diet are harmless because they are denatured during cooking and broken down by our digestive system. Eating raw or undercooked legumes (beans, lentils, etc.) can cause symptoms such as vomiting and diarrhea, but when was the last time you had raw beans? The reason uncooked lectins are more dangerous is because they are very stable to proteases in the body. When cooked, they are more easily digested by these proteases. According to this study, most, if not all, lectins can be removed by boiling beans for 30 minutes. Soaking beans will also help remove lectins, but they should still be boiled for 30 minutes when cooking. Canned beans also have very low lectin levels due to the canning process.

Grains contain lectins, but we also boil our grains before eating them. Other ways to reduce lectin levels in foods include fermenting and sprouting – another great reason to eat those delicious probiotic-rich foods! Steaming and cooking vegetables also reduces lectin levels, if you are concerned about the lectin contents of these foods.


 3. Proponents of a “lectin-free” diet claim that lectins may cause digestive issues, leaky gut, bloating, nausea, gas and diarrhea, but the cited study (Peumans & Van Damme, 1995) only states that these effects occur in humans when consuming raw or undercooked beans.

First, these symptoms could be caused by a variety of reasons, not just lectins. Second, the research that this is based on is from 1995 and only mentions the harmful effects of lectins on human consumption only when consuming raw or undercooked beans. Another study states that foods with high concentrations of lectins, such as beans, cereal, grains, seeds, nuts and potatoes, could be harmful if consumed in excess if uncooked or improperly cooked. The effects of consumption include nutritional deficiencies due to their anti-nutrient properties and immune reactions. Again, this is regarding consumption in excess and of uncooked or improperly cooked foods.

 4. The majority of lectin studies have been conducted in isolated lectins rather than real food and on animals or in test tubes, not people.

In addition to this, research has also shown beneficial effects of lectins due to their antimicrobial, anticancer and immune system properties. A fair amount of research is currently showing that plant lectins may be a potential tool against cancers, especially digestive cancers. Because of this, it’s difficult to know how various types of lectins affect the human body after they are cooked and digested from real foods. Many of the high lectin foods, such as cereals and whole grain products, have also been shown to significantly reduce the risk of type 2 diabetes, cardiovascular disease, cancers, and help with long term weight management. These benefits of high lectin foods are better established than the effects of lectins after cooking in humans.

Conclusion –

While lectins do exist in many of the foods we eat and some do have toxic effects, most of these effects are eliminated by proper cooking and are safe for consumption in normal amounts. Legumes and whole grains are rich sources of B vitamins, iron and fiber while vegetables and fruits are powerhouses for a wide variety of micronutrients. Although avoidance diets may be necessary for some people with specific conditions, they may not be the best for the general public. If you are seriously considering an avoidance diet, it’s always best to consult with a Registered Dietitian to avoid any nutrient deficiencies, which could cause a multitude of other problems.


What are your thoughts on the rise of lectin-free diets?  Please share in the comments below.

Anna Pashkova, ACSM EP-C is a medical dietetics student in the coordinated master’s degree program at The Ohio State University. Anna earned her bachelor’s degree in Exercise Science at Gardner-Webb University where she also played volleyball and found her passion for food and nutrition. Her interests include plant-based nutrition, using food as medicine, nutrigenomics and food sustainability. In her free time, Anna enjoys trying new recipes and local food restaurants, practicing yoga, playing volleyball and finding the best local coffee shops in every town.

Nutrition for Chronic Fatigue Syndrome


Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) affects millions of Americans and has devastating symptoms. However, it is poorly understood, and effective treatments have not been established. Despite this, there is good news on the horizon. Research is elucidating several of the underlying pathologies, including dysfunctions of the mitochondria, the intestinal barrier, the gut microbiome, and the immune system. Based on this research, it is clear that ME/CFS is a complex disease that requires a multifaceted treatment approach, and there are a variety of nutrition interventions that may be useful for improving care.

What is ME/CFS?

ME/CFS is found in all ages and demographics. It affects many systems of the body and has a wide range of symptoms. It is commonly triggered by a bacterial, viral, or parasitic infection. Other possible triggers include chemical exposure, physical trauma, and psychological trauma, although sometimes there is no apparent trigger.

According to the Canadian Consensus Criteria, a diagnosis can be made based on four primary symptoms:

  • Debilitating fatigue that is not explained by other factors, and lasts for at least six months.
  • Post-exertional malaise and fatigue after any type of exertion, whether mental or physical.
  • Sleep dysfunction, unrefreshing sleep.
  • Pain such as muscle pain, joint pain, and headaches,

as well as:

  • Cognitive/neurological dysfunction
  • Autonomic nervous system dysfunction
  • Neuroendocrine dysfunction
  • Immune dysfunction

Underlying Pathologies

Research is currently focused on three major areas of underlying dysfunction: mitochondrial, gastrointestinal, and immunological. Let’s take a closer look at each.

Mitochondrial dysfunction

  • The inability of the mitochondria to produce energy is key to the fatigue seen in ME/CFS. Research has shown that ME/CFS patients have metabolic abnormalities that are associated with a hypometabolic state, impaired glycolysis, and increased oxidative and nitrosative stress. Specific biomarkers of mitochondrial dysfunction include altered levels of CoQ10, NAD, L-carnitine, amino acid metabolites, phospholipids, and lactate. However, there is not one universal metabolic biomarker for the disease.

Gastrointestinal dysfunction

Immune dysfunction

  • Immune system dysregulation involves both under- and over-activation. The immune patterns are not specific to ME/CFS, but key features include flu-like symptoms, an imbalance of Th1 and Th2 immunity, low natural killer cells, changes to cytokine activation, elevated viral antibodies, and elevated autoantibodies.

Nutrition Interventions

There is currently no established treatment for ME/CFS, and efforts to find treatments have not been successful. Thus, current care is focused on management of symptoms. However, research suggests several targets for nutritional interventions, as follows:

Address overall diet and nutritional deficiencies.

  • It may be impossible for patients to access, prepare, or even eat food. Therefore, patient and caregivers may need guidance on accessible food options.
  • Due to poor overall diet quality, increased needs, and/or malabsorption due to GI disorders, a multivitamin and other supplements may be warranted. Possible recommendations include nutrients involved in mitochondrial and immune function such as B vitamins, selenium, zinc, and magnesium. Some studies have shown that CoQ10 and NADH may help improve symptoms. When adding supplements, it is recommended to “start low, and go slow”.

Improve gut health and reduce oxidative stress.

  • A 2008 study found that improving the mucosal gut barrier and reducing oxidative stress reduced symptoms of ME/CFS. For 10-14 months, participants were put on a “leaky gut diet” that was dairy-free, gluten-free, and low-carb. They also took antioxidant substances such as L-carnitine, CoQ10, lipoic acid, and N-acetyl cysteine, as well as substances to support the gut barrier, such as glutamine. Twenty-four out of 41 patients showed either significant improvement or remission, with better results in those who were younger and who had had the disease for a shorter period of time. Improvements in symptoms were paralleled by improved markers of gut barrier function and inflammation.

Support mitochondrial function.

  • A study published in 2013 showed promising results from a protocol focused on supporting mitochondrial function. The protocol includes eating a paleo-inspired diet, getting adequate sleep, taking selected nutritional supplements, and balancing activity and rest. This was a study of patients at a private practice, and not a strictly controlled trial. Yet, they found that all 30 patients who followed the protocol significantly improved in both symptoms and mitochondrial markers, and these 30 patients were some of the more severely ill ones.

Moving Forward

There is a need for more research into ME/CFS, as well as a need for a shift in focus. It is straightforward to study one mechanism or nutrient at a time, but it is impossible to do randomized, controlled trials of treatments that are multifaceted and individualized. Yet, this is exactly what complex chronic diseases require.

The successful interventions mentioned above are linked by their comprehensive approach – they address diet, supplements, and lifestyle, they are tailored to the patient, and they last a year or more. Nutritional approaches like these are powerful because they can address the root causes of disease, even if the causes are not clearly understood. Treatments that consider the many features and pathologies of ME/CFS as part of an integrated system hold the most promise for improving care.


What nutritional interventions have worked best in the care of your clients with ME/CFS? We’d love to hear from you in the comments below.

Ready to learn more about integrative and functional nutrition? Check out the Certificate of Training Program in Integrative and Functional Nutrition.

Janie JacobyJanie Jacoby is a graduate student in Nutrition and Dietetics at Colorado State University. She is passionate about functional and integrative medicine, and is founder and president of the CSU student organization Holistic Health Alliance. She also works for the CSU Extension Office, where she writes and develops nutrition education materials. When not working, Janie can often be found concocting something in the kitchen, practicing yoga, or hiking and camping in beautiful Colorado. Her sporadic blog posts can be found at

Why One DIFM RD Recommends a Plant-based Diet

Monique Richard MS, RDN, LDN (left) and PPOD Speaker with Alyssa Luning RD (right)

Congratulations to DIFM Member, Alyssa Luning, who won the 2017 Plant-based Prevention of Disease (PPOD) essay contest! Learn why Alyssa recommends the plant-based diet and about her own transformative health experience on a plant-based diet. Thank you for your contribution, Alyssa!

A Plant-based Diet: My story —

For the last three years, I have been working as a bariatric dietitian. I have seen people do incredible things for the sake of their health, some would say, even “extreme.” I love the empowerment. People become motivated that they have the tools to change their direction in health, and they really do blast off. What has always brought me the most joy, has been seeing people resolve type 2 diabetes. The weight loss is great, but when I see people walk further and further from disease and closer to their improved quality of life, I am all smiles. However, the improved quality of life does not always sustain. Researchers, scientists, doctors, and RDs alike are flailing at the concept of weight regain, bariatric revisions, and continued complications with hypertension, hyperlipidemia, and unfortunately, reappearance of their type 2 diabetes.

My own dietary adventure began with influences coming from many places over the years, but ultimately, I landed in the health benefits of a plant based diet (Social media handle: The Little Green Pea – imagine my surprise when I saw the title of this conference). As a young professional in the world of nutrition, my main theme was to always attempt to try to help people to find their own path to overall optimum health through food. I knew my way would not be the way of others, as to each their own, and considered the way I chose to eat truly personal. As I became more and more familiar with the plant-based community of health professionals and enthusiasts, I was taken away. Essylstein, Cambell, Greger, Rich Roll, the list got longer. Then along came Dr. Garth Davis who wrote the book, Proteinaholic. This was it. The game changer.

I so related with his story that I became angry. I was frustrated, confused, and just about at a loss of words. My concept of providing optimal nutritional care became so cloudy that I could not decipher how to approach patients any longer. I was also overworked, stressed, and depressed. The only thing I could do was “mozy on,” and continue to teach patients willing to change their own bodies for the benefit of an improved life without disease by the approach of weight loss surgery, while also knowing their efforts are at risk for being in vain. Without an individual willing to change everything, they would not be successful in the long term. I would tell people this over and over during our sessions, but still felt as though I had red tape to tell them what exactly would improve their rate of success and decrease risk of weight regain, improve their success in their efforts to improve their quality of life for many disease states, and how to empower them to potentially avoid surgery (if medically appropriate). I was told the purpose of my position was, “to get them to surgery.” So that’s all I did. Backed into a corner, I need this job…my student debt is over 50k!

Within our healthcare system there is almost a laughable push to “preventative medicine.” Preventative in the sense of colonoscopies, mastectomies, and Lipitor for those with only a “family history” of heart disease and an LDL of 103. Revisions after revisions. Weight regain after weight regain. Reflux. Traumatic band revisions. I shudder with the knowledge of what could have been prevented. I started to run out of words to say, staring blankly at patients as they expressed their frustrations to me- “I know what to do, but I just don’t do it!” This was driving me crazy. As a dietitian, all I wanted to do was provide people resources, research, and information to better their lives & improve their health, but instead I was backed into a corner of being their psychotherapist. I felt useless, since I am indeed, not a therapist. Why is it that insurance will pay for the surgery but not for the psychotherapy?! Without the ability or the clarity to say what I truly understood to be true at the time about a plant based diet to be able to be a tool to help them, I felt even worse.

I remember asking my father, “If you really loved me and my sister, could you please stop drinking?” I was 11 when he died. I was informed well on alcoholism my whole life. I was strong in knowing that there was nothing I could do – he had a disease. This disease was addiction. Addiction is something we have been taught is something that can be battled and won, like cancer. So, I was under this impression that my dad fought the good fight, and eventually it took control, and even though he loved me and my family that the disease was too strong. I felt as though this was rational.

Flash forward to age 25, I was treated for PTSD & Substance abuse. Determined to do whatever I could do not feel like a piece of trash, I participated as much as possible. One session was titled a “mock 12-step.” I thought it would be interesting to see what my dad had gone through. Within the first few moments I was in tears. How could a program like this exist- so supportive- so caring, and so real- that if someone wanted to get better, that they couldn’t latch onto this life-line? I got home and immediately talked to my mother. “If all this was available, why didn’t he get better?” I was devastated that he was unable to use the tools discussed to still be alive to be here today. My mother’s response was something that shook me. “He never stayed.”

A plant based diet is a tool to help prevent disease. - Alyssa Luning RD Click To Tweet A plant based diet is a tool to help prevent disease. People can take it or leave it, but it is not fair that it is not known as a tool that is available (like 12 step). Dietitians and health professionals need to be liberated and empowered with the strength in the research. We need to stand strong and remain consistent and clear. It should be absolutely known, if indeed you want to recover, if indeed you want to avoid progression of disease- if you want to say, “hey you know what, I will do ANYTHING to NOT go down this path,” Then GRAB THIS TOOL, because IT WORKS. If you cannot grab it, check yourself for self-love and evaluate depression with a therapist. This EXTREME measure, relative to bariatric surgery, is a kick in the rear end. It is hard. It is weird. And yes, it can be socially awkward. But you know what it won’t be? As expensive as your think. It won’t taste like sticks. It won’t be lack luster, boring, or bland. The more people, family, friends, and community support you have, the more strength you will have in the change to become permanent method of REVERSING HEART DISEASE, type 2 diabetes, and depending on the individual, remaining in remission of cancer, dementia, and other autoimmune diseases. Oh yes, yes and we cannot forget – obesity.

We’d love to hear how you’re incorporating plant-based diet practices in your work or life.  Let us know about them in the comments below.  Also, stay tuned for future award opportunities by joining DIFM.  Learn more here.

Adaptogens: Can they improve the body’s response to stress?

Similar to how nutrition may be a preventative measure for chronic disease, Traditional Chinese Medicine (TCM) and Ayurvedic Medicine may be methods to help protect the body from ailments. TCM and Ayurveda have many facets of preventive care, one of them being the use of adaptogens.

Adaptogens provide the ability to adapt to psychological and physical stress and help prevent the development of stress-related diseases. Studies demonstrate that adaptogens work upon the hypothalamic pituitary adrenal axis and inhibit or decrease circulating levels of nitric oxide and cortisol. Prescribed by an herbalist, adaptogens can be taken orally through capsules and tinctures. They can also come whole or in powder form to be used in cooking. For example, they may be boiled whole to make broths or mixed as a powder into dishes or drinks.


A·dapt·o·gen: A class of non-toxic herbs that improve your body’s response to stress.

Stress and our health

A little stress in life isn’t a bad thing. Studies show that acute stress can improve memory and minimize the chances of getting sick in the short-term. However, when our body is constantly exposed to stress, it can decrease our body’s ability to return to homeostasis, leading to health issues such as hypertension, insulin resistance, and obesity.

Common adaptogens

The list of adaptogens used in TCM and Ayurveda is quite lengthy. Some of the most common and better researched are:

Panax Ginseng, also known as Korean ginseng, should not to be confused with American or Siberian ginseng. This root can be steamed or sun-dried. The steamed version is known as red ginseng and the sun-dried version is known as white ginseng. The different processing can produce different physical effects. However, generally speaking, this adaptogen can be used to lower blood sugar, lower cholesterol, anxiolytic, immunomodulating, and decrease the body’s stress in those with cardiovascular issues.

Withania Somnifera, more commonly known as ashwagandha, is typically used in Ayurveda. Ashwagandha is known to provide vitality, may assist in improving libido, may be used as a sleep aid for insomnia, and, like ginseng, can be an immunomodulant and anxiolytic. While this adaptogen can be sedative, it can also be taken in the morning for those with anxiety to help calm nerves.

Ocimum tenuiflorum, known as tulsi or holy basil, widely used in the Ayurvedic tradition for medicinal and spiritual practices. This adaptogenic herb has many uses, such as combating metabolic stress and helping to alleviate anxiety and depression. Religiously, Tulsi is planted in one’s home to purify the surroundings, and its wood or seeds are used to make malas, a string of beads used to help focus the mind in meditation.

The future of adaptogens

Even though adaptogens have been used for centuries in the Eastern world, limited research studies have been conducted on humans. With the Western world catching up, we should expect to see more evidence emerge about the benefits of adaptogens and their ability to normalize stress. With more evidence and information being presented in the media, our clients may be coming to us with questions.

Are your clients asking about adaptogens?  Which ones do they ask about most frequently?

To learn more about adaptogens and Ayurveda, you may want to check out our Archived Webinars titled Foundations of Herbal Medicine: Getting to Know Herbs and Can the Wisdom of Ayurveda Complement Modern Dietetics? in the Members-Only section of our website. Not a DIFM Member? Learn more here and join today!

Stacy Leung, RDN, CDN, CLC believes changing your health starts with learning, understanding, and seeking support from those you trust. Moonlighting as a yoga instructor, she focuses on using mindfulness and functional nutrition to help her clients reach their goal. She enjoys traveling, immersing herself in other cultures, and baking cookies. You can learn more about her at .

Farmers’ Market Fare

It’s that time of year again! Farmers’ markets are in full swing, making it easy to purchase local produce, eat seasonally, and support local producers. Although individual market seasons may vary depending on your location, farmers’ markets are generally open from mid-spring to the end of summer.

Benefits of Farmers’ Markets

Why bother to buy local?

  • Eating locally gives us the chance to eat seasonally. This means our produce is picked at its peak harvest time. Oftentimes, foods are more flavorful compared to conventional store bought produce, which can be kept in cold-storage for up to 9-12 months.
  • Eating locally supports small businesses and increases social interaction between patrons/producers. Purchasing local food keeps profits within your community and increases likelihood of re-investment among the local population.
  • Eating locally allows us to control the amounts of pesticides/chemical additives we consume. Talk to your local producers about what kinds and the amounts of pesticides they use.

Nutrition Education & Farmers’ Markets

Farmers markets have the potential to serve as opportunities for nutrition education and increase access to fruit/vegetables, particularly in limited resource communities. However, few research studies have investigated the effects of implementing a farmers’ market education program on nutrition-related parameters.

Examining the Evidence

McCann and colleagues conducted the Willingness to Try (WTT) program at farmers’ markets to increase elementary school age children’s willingness to taste fruit/vegetables. Children’s readiness to try fruit/vegetables was recorded prior to tasting, after tasting, and 2 days after tasting. Researchers observed a decrease in willingness to try the 8 fruits/vegetables offered among the children directly after tasting. However, two days after tasting, children’s readiness to taste the offered fruits/vegetables increased.

Norman et al. investigated the effects of the Power of Produce (PoP) Club on children’s attitudes and fruit/vegetable intake. The Power of Produce Club was designed as a farmers’ market incentive program to engage both children and their parents. After participating in the program, 75% of parents stated their children help them choose which produce to purchase at farmers’ markets. About half (51%) of participants said their children were willing to try more fruits/vegetables at home. 41% of parents responded that their children were eating more fruits/vegetable at home.

Ernzen et al. discussed the opportunities for registered dietitians to develop “sound nutrition messages focused on sustainable living” at farmers’ markets. By collaborating with other health-care organizations, registered dietitians, and community partners, registered dietitians can educate farmers’ market patrons via tools such as: food samples, recipe cards, interactive display boards, and cookbooks.

Currently underway, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Fresh Start Randomized Control Trial is examining whether web-based nutrition education held at farmers’ markets could encourage fruit/vegetable purchases and intake among WIC participants. Baseline data was published in 2016 in the Journal of the Academy of Nutrition and Dietetics.

Get Involved

As registered dietitians/healthcare professionals, we have a unique opportunity to introduce evidence-based nutrition education at farmers’ markets. Contact your local community farmers’ market director and volunteer to host an “Ask a Registered Dietitian” table, cooking demonstration, or children’s fruit/vegetable tasting. To locate a farmers’ market near you, visit Farmers’ Market Directory.

Mary White, MS, RD, LD is a registered dietitian residing in Travelers Rest, SC.  She is currently a PRN clinical dietitian at Pelham Medical Center.  Mary studied Food Science at Clemson University and proceeded to complete her dietetic internship at Texas A&M-Kingsville University.  Passionate about nutrition counseling and children’s programming, she volunteers with community organizations to promote sustainable dietary changes and nutrition education activities. In her spare time, Mary enjoys yoga, cooking, kayaking, and cuddling with her dog, Maggie.