Irritable bowel syndrome, or IBS, is a class of disorders involving gut-brain interaction that affects up to 1 in 10 Americans. Diagnostic criteria includes abdominal pain at least once per week on average over the past three months associated with changes in stool frequency or form. Symptoms affect the large and small intestines and typically include periodic or chronic bloating, diarrhea, constipation, gassiness, and cramping.The cause of IBS is unknown, however genetics, allergies, infection, lifestyle, and gut microbiota may contribute to IBS and stress and certain foods may trigger symptoms. The large intestine has nerves that communicate with the brain, so stress can stimulate intestinal spasms resulting in pain and discomfort. Specific foods can initiate episodes of IBS, and many people with IBS notice that symptoms worsen after consuming high-fat foods or large meals.

Until recently, the medical advice provided to patients with IBS was to reduce stress and eat more fiber. Research has indicated that IBS can be managed with a focus on diet composition and eating habits, possibly with the assistance of medications, probiotics, and stress management. Consider the following modifications to your diet to provide relief from IBS and prevent future flare-ups.

• Consume small, frequent meals to ease the volume of food in the intestinal tract.
• Eat on a regular schedule to help regulate bowel movement. 
• Consume adequate fluid to help move foods through the intestine.
• Eat high-fiber foods, such as whole vegetables and fruits, beans, and whole grains (e.g., brown rice, rolled oats, whole-grain bread and pasta).
• Limit alcohol and caffeine, as both can stimulate the intestines and cause diarrhea. Note that beverages containing sugar alcohols can also stimulate diarrhea and carbonated drinks produce gas.
• A diet low in fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (low-FODMAP) guided by a registered dietitian may help alleviate symptoms of IBS. FODMAPs are short-chain carbohydrates found in a variety of foods that are sometimes poorly absorbed in the gut. FODMAPs are fermented by gut bacteria and pull additional water into the intestine.

If you suspect you have IBS, be aware that additional testing may be needed if you observe blood in stool, unintended weight loss, or anemia. It is generally not necessary to test for food allergies/sensitivities unless reproducible symptoms exist. Blood tests to evaluate C-reactive protein levels and fecal lactoferrin are helpful to rule out inflammatory bowel diseases and celiac disease. Don’t allow IBS symptoms to interfere with your quality of life - a registered dietitian can help you identify triggers and learn how to manage symptoms.

According to the Center for Disease Control and Prevention, nutrient dense foods are those that provide an average of 10% or more daily value per 100 calories of 17 nutrients, including potassium, protein, fiber, iron and calcium. While there are numerous fruits and vegetables that are nutrient dense, there are some in particular that are best in the summertime because they also happen to be very hydrating. Citrus fruits and berries are excellent choices for summer snacking. According to CDC’s nutrient density approach, the healthiest of them all is the strawberry, with a nutrient density score of 17.6. According to the FDA, strawberries have more vitamin C than any citrus fruit, and are also rich in potassium and fiber. As an added bonus, strawberries are a good source of flavonoids, a group of phytonutrients linked to reduced risk of diabetes, heart disease, and some cancers. Strawberries are about 92% water, a proportion similar to that of watermelon; and, because of their electrolyte content, strawberries are an ideal source of hydration on warm days. If you aren’t a fan of eating a portion of plain fresh strawberries, the flavor of strawberries is delicious when sliced pieces are added to your ice water. There are also many healthy summer recipes, both sweet and savory, that contain strawberries, such as the Caprese Salad with Strawberries recipe below!
 
Refreshing Caprese Salad with Strawberries
2 pounds fresh strawberries, stemmed and halved
2 cups bite-sized fresh mozzarella balls (Bocconcini), drained and halved
2 tablespoons extra virgin olive oil
1/3 cup balsamic vinegar
3-4 fresh basil leaves, finely diced
Salt, pepper to taste
In medium sized bowl, toss strawberries and mozzarella balls with olive oil. Season mixture with salt and pepper. Add basil and toss again. Drizzle balsamic syrup over and around salad. Grind more pepper on top and serve.
 
References:

1. Di Noia J. Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach. Preventing Chronic Disease. 2014;11:E95.
2. Odriozola-Serrano, I., Soliva-Fortuny, R., & Martín-Belloso, O. (2008). Phenolic acids, flavonoids, vitamin C and antioxidant capacity of strawberry juices processed by high-intensity pulsed electric fields or heat treatments. European Food Research and Technology, 228(2), 239-248.
3. Arnoldi, A. (Ed.). (2004). Functional foods, cardiovascular disease and diabetes. Elsevier.
4. National Nutrient Database for Standard Reference, Release 28 slightly revised May, 2016, Software v.2.6.1.

A healthy diet takes planning, time, and effort. Having the right foods available when you need them is important for dancers with limited time and intense training schedules. Here are some nutritious food staples recommended for every dancers' kitchen.

1. Fresh fruit - incorporate variety by choosing in-season produce
2. Rolled oats - cooked oatmeal, overnight oats, or blended into a smoothie, oats provide energy, fiber, and B-vitamins.
3. Nut or seed butter - spread on whole-grain bread, rice cakes, or bananas for a source of healthy fat and protein.
4. Greek yogurt - enjoy with fruit, nuts and seeds, or granola as a versatile source of protein and calcium.
5. Lean protein - cooked fish, chicken, or turkey, canned tuna or salmon, and eggs are simple to incorporate into meals. Just pair lean protein with whole grains and vegetables for a complete meal.

Stress is a physiological condition associated with disorders of the nervous, endocrine, and immune systems. Uncovering natural remedies to combat stress continues to be a significant area of scientific research. In traditional Chinese Medicine known as Ayurveda, consumption of adaptogenic herbs is common practice to improve the body’s ability to adjust to exposures such as extreme temperatures, loud noise, strenuous physical exertion, chemical pollutants, and to help maintain cognitive function, blood glucose, lipid levels and blood pressure. Adaptogens are naturally occurring plant compounds or extracts known to exhibit protection against stress, fatigue, anxiety, and depression. According to Selye’s theory (Selye, 1950) the stress response and general adaptation syndrome includes three phases: alarm, resistance, and exhaustion. Recent pharmacological studies of individual adaptogens provide rationale to their effects at the molecular level, indicating several mechanisms of action that help the body maintain equilibrium. However, adaptogens supposedly act non-specifically, and may activate certain energy-producing chemical receptors and deactivate others to prevent overreaction to stress messengers. Combinations of adaptogenic plants may offer unique effects due to their synergistic interactions in organisms which are not achieved by isolated extracts or supplements of individual adaptogens.

The chemical compounds known as adaptogens are typically phenolics or triterpenoids. Phenolics are structurally similar to catecholamines, which activate the stress system in the early stages of stress response. Triterpenoids resemble the corticosteroids that act as stress hormones in deactivation of the stress system. Adaptogens often are included alone or in combinations in bottled beverages, herbal teas, smoothies, plant-based protein powders, and supplements. The following are adaptogens that have demonstrated beneficial health effects:

• Holy Basil
• Turmeric
• Ashwagandha
• Ginseng
• Rhodiola

Stress is a part of daily life, and many lifestyle factors, including diet, sleep, physical activity, and mental health practices such as meditation, yoga, Pilates, and deep breathing influence stress management. Although adaptogens may be a promising complementary therapy for stress, future research is needed to evaluate the complex potential of these herbal extracts and their possible effects on human health and longevity. As with all dietary supplements, the FDA advises that consumers consult with a qualified health care professional before taking any botanical or herbal supplement. It is important to be aware that adaptogens aren’t safe for everyone, as they may interfere with certain medications, and their use is contraindicated in pregnant and breastfeeding women because botanicals may alter hormone levels.
References:
Enyeart JA, Liu H, Enyeart JJ. Curcumin inhibits ACTH- and angiotensin II-stimulated cortisol secretion and Ca(v)3.2 current. J Nat Prod. 2009;72(8):1533-1537. 
Jamshidi N, Cohen MM. The clinical efficacy and safety of tulsi in humans: a systematic review of the literature. Evid Based Complement Alternat Med. 2017;2017:9217567. 
Lee S, Rhee DK. Effects of ginseng on stress-related depression, anxiety, and the hypothalamic-pituitary-adrenal axis. J Ginseng Res. 2017;41(4):589-594.
Liao, L. Y., He, Y. F., Li, L., Meng, H., Dong, Y. M., Yi, F., & Xiao, P. G. (2018). A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chinese medicine, 13, 57. https://doi.org/10.1186/s13020-018-0214-9.
Panossian, A., & Wikman, G. (2010). Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel, Switzerland), 3(1), 188–224. https://doi.org/10.3390/ph301018
Selye H.  Stress. Acta Medical Publisher; Montreal, Canada: 1950.

Anemia is a common blood disorder in which the body lacks adequate red blood cells to carry oxygen to tissues. The reduced oxygen delivery results in fatigue and weakness, and can severely interfere with exercise capacity and performance. Causes of anemia include inadequate dietary intake, poor absorption of nutrients,  blood disorders, or lack of red blood cell production from the bone marrow. Nutritional anemias are usually detected with blood tests that assess the size and number of red blood cells.
Symptoms of anemia include:

• Weakness
• Shortness of breath 
• Chest pain
• Dizziness
• Irregular heartbeat
• Pounding in the ears
• Headache
• Pale or yellow skin​

        Certain nutrients play an important role in the function and integrity of red blood cells. Iron-deficiency anemia is the most common nutritional anemia and not only decreases athletic performance, but also impairs immune function and results in physiologic dysfunction. Hemoglobin is an iron-rich protein in red blood cells that attaches to oxygen and carries it to body tissues. When iron stores are inadequate, hemoglobin levels become too low to transport sufficient oxygen, resulting in iron-deficiency anemia. Most often, dietary choices explain most of a negative iron balance, but it is also possible that a higher iron turnover rate occurs due to intense exercise. Diagnosis of anemia is confirmed by a blood test indicating a hemoglobin value less than 13.5 gm/dl in men or less than 12.0 g/dl in women. 
        Iron is important at any age, but particularly during stages of rapid growth. The high demands of dance training make dancers susceptible to iron deficiency because iron is lost in sweat. Menstruating females are at additionally elevated risk of developing anemia. The average adolescent should consume 6-8 mg of iron each day and dancers and athletes should aim for 9-12 mg per day to help distribute additional oxygen to working muscles and account for any iron that is lost through sweat. 
        The second and third most common nutritional anemias are related to folate and vitamin B12. Vitamin B12 deficiency anemia is unique in that it causes neurological problems and can take years of inadequate supply before symptoms develop. Inadequate levels of B12 are sometimes caused by poor absorption due to a lack of intrinsic factor (the protein that transports B12 to its absorption site in the gut) or a stomach disease. Folate deficiency manifests quickly and is typically a result of a poor diet or alcohol abuse. Folate needs are approximately 200-400 mcg/day and needs increase to 500-800 mcg/day during pregnancy and breastfeeding. Deficiencies of copper, zinc, and vitamins C, A, and B6 can also contribute to anemias.
        Eating a balanced diet can help you avoid both iron and vitamin-deficiency anemias. There are two kinds of iron found in foods. Iron that is found in animal products (e.g., beef, chicken, eggs)  is called heme iron, and the body can absorb 15-18% of heme iron. In contrast, the body only absorbs approximately 5% of non-heme iron, which is found in plant foods such as grains, dark leafy greens, dried fruits, and nuts. Vitamin B-12  is found in meat and dairy. Citrus, green leafy vegetables and legumes are rich in folic acid. A daily multivitamin can also help fill in any gaps in nutrient intakes from food and help prevent nutritional anemias. Be aware that iron supplements can result in toxic levels of the mineral and should only be used if instructed by a physician.
References:
John Beard, Brian Tobin, Iron status and exercise, The American Journal of Clinical Nutrition, Volume 72, Issue 2, August 2000, Pages 594S–597S, https://doi.org/10.1093/ajcn/72.2.594S

Faramarz Naeim, Chapter 23 - Disorder of Red Blood Cells: Anemias, Editor(s): Faramarz Naeim, P. Nagesh Rao, Wayne W. Grody, Hematopathology, Academic Press, 2008, Pages 529-565, ISBN 9780123706072, https://doi.org/10.1016/B978-0-12-370607-2.00023-5.

Inflammation is the body’s normal response to promote healing when the body is fighting infection related to injury, wounds, allergens, toxins, or infection. Typical signs of inflammation include swelling, pain, and redness. In contrast, signs of inflammation may not be apparent with chronic inflammation. Chronic inflammation is typically caused by excess body fat or immune dysfunction. While acute inflammation promotes healing, chronic inflammation can result in DNA damage and increase cancer risk.

Despite the numerous “anti-inflammatory diets” promoted online, research is barely emerging in regards to diet and inflammation. So far, scientific studies indicate that consuming a variety of nutritious foods may help reduce inflammation and keep chronic inflammation at bay. Foods that enhance immune function are also important in fighting inflammation. Here is what we know thus far about foods and inflammation:

• Fruits and vegetables provide phytonutrients with potential anti-inflammatory properties.
• Healthy omega-3 fatty acids and monounsaturated fats promote anti-inflammatory pathways.
• A diet high in saturated fat may increase inflammation; trans fats may also be inflammatory.
• Animal studies indicate that dark chocolate, green tea, red wine, turmeric and ginger may reduce inflammation.

However, these findings have not been observed in humans and it is unknown how much and how often these foods must be eaten to provide benefits. 

​Tips for reducing inflammation:

• Include fruits and vegetables with every meal.
• Consider eating a variety of protein sources, including fish, tofu, legumes, and low-fat dairy.
• Choose monounsaturated fats including olive, canola, safflower, sunflower, peanut and avocado oils. Eat omega-3 rich foods like salmon, walnuts, flaxseed and chia seeds. Avoid partially hydrogenated oils and high amounts of saturated fat.
• Choose whole grains such as quinoa, brown rice, millet, and bulgur.

In addition to a healthy diet, inflammation can be reduced by getting adequate sleep, remaining physically active most days of the week, and maintaining a healthy weight.

The autumn season is upon us, bringing cooler temperatures, holiday traditions, and countless hours of Nutcracker rehearsal. For dancers, this time of year can be busier than ever, contributing to fatigue and susceptibility to illness. Good nutrition is especially important in the months ahead to keep you healthy through the season. We hope an easy and nourishing recipe idea will help - this complete meal can be prepared ahead, is portable, and delicious.

Ingredients:

• 1 medium head of cauliflower
• 1 medium yellow onion, diced
• 3 Tbsp extra virgin olive oil
• 2 tsp minced garlic
• 1 Tbsp finely  grated ginger
• 1 tsp salt
• 1 Tbsp curry powder
• 3 cups cooked or canned chickpeas, drained and rinsed well
• 1/2 cup finely chopped cilantro leaves and stems
• 6 large whole wheat tortillas

      Garlic Yogurt Sauce

• 1 cup low-fat plain Greek yogurt
• 1 tsp garlic powder
• 1 Tbsp lemon juice

1. Chop or break cauliflower into large chunks.
2. Place cauliflower chunks onto a microwave safe plate with 2 Tbsp water and microwave on high for 5 to 7 minutes until tender. 
3. Mash cauliflower with a potato masher. Set aside to cool
4. Add olive oil to a large pot, then add the onions and sauté for 5-7 minutes, until brown. Add the ginger and garlic and sauté for a minute more.
5. Reduce the heat to medium, and then add the salt and curry powder and sauté for one minute.
6. Add the mashed cauliflower, chickpeas, and cilantro and stir well, cooking for 3-5 minutes. Remove from heat, and let cool slightly.
7. To make the garlic yogurt, whisk together Greek yogurt, garlic, lemon juice, and add salt and pepper to taste.
8. Spoon about 1/6th of the filling into the center of each tortilla. Fold one side over towards the center, fold the edges in, and roll up like a burrito. Serve with garlic yogurt sauce if desired.