Expert Q&A:
All Your Nutrition
Questions Answered
With Katherine Andrew, MPH, RD, LDN
Crissy Fishbane:
Katherine is one of our HER Experts and we are so grateful to her for joining us today.
Katherine Andrew is a Registered Dietician Nutritionist with a Master’s Degree in Public Health with over 15 years of experience in Community Public Health and Private Nutrition Counseling. Her work experience includes individual and group health counseling, interactive workshops, food systems consulting, non-profit program development and management, and safe skin care advocacy and promotion.
Katherine is a “jack of all trades” and she approaches each client individually to help create a realistic and sustainable plan. Thank you so much for being here!
We ask that if you have questions, to pop them into the chat box.
Macronutrients & Carbohydrates
Participant Question:
What are the appropriate macro percentages for weight loss?
Katherine Andrew:
Thanks for the question!
Unfortunately, I’m not going to give you a very fun answer (laughing). It’s all over the place. There’s a lot of different ways that we can get there. I hate that I can’t answer that question directly.
I tend to find that a lot of different things work for different people and it really depends on how much you’re moving, your hormones etc. It’s not the calories in and calories out or macros in, macros out but more about a holistic consideration of all the different parts of your body. As well as the quality and the types of foods you’re taking in.
Crissy:
Katherine, would you dive in just a bit to carbs? I know that low carb diets are a big thing right now. How many carbs should we be consuming? Are they bad?
Katherine:
Sure! The first thing about your last question, “Are they bad?” I don’t think anything is bad. There are very few foods, if any that I would classify as bad. I think that question in itself is a good one to challenge. The example I often use is, we would often order a second or third cocktail if we were out with our friends and no one would bat and eye, right? Would anyone look at you strange? However, if you were to say, “I’ll have a third donut” your friends would probably all look at you a little funny.
So, I think that the bad and good is the first thing that we have to eliminate in terms of labeling foods. Including categories! Carbs are necessary. We need them. Even on a Keto diet, which is a very low carb diet, you still need some amount of carbohydrates for your brain to function. What’s interesting is that that demand goes up the more that we move, and the more that our brains and our hormones work.
We have a higher demand for carbs, especially as women because we have ovaries and active thyroid glands. We have a lot of stress in our lives generally as moms. The other factor is the movement, which tends to vary from female to female.
We need carbs for our brain and for a lot of our hormones to work properly. So, I don’t think that super low carb tends to work for a lot of my female clients. Anecdotally, I’ve seen a few women do great on Keto, but for the most part I think the low carb trend has harmed more women than it has helped and I’m finding a lot of women moving to higher carb diets and feeling amazing.
I think that when we created this fear around a whole group of foods, we did ourselves a disservice when it comes to carbs.
Are there any other questions about carbs? I saw someone ask about diabetics, which is a great question.
What I would say for that is the same for all of us…the key for carbs is not necessarily how little or how high they are but how consistent they are. With diabetics, that’s especially important because your body is a little more sensitive to carbs. It can go high or go low faster than someone who doesn’t have diabetes. All of us need to work on managing our blood sugar. That’s a common cause that leads to anxiety, that leads to a lot of challenges to women especially. It is also especially true for diabetics.
So, I would say that it’s not so much about going “low carb” or going “high carb” but more so about having a consistent amount of carbs throughout the day.
I often work with people on having a handful or two handfuls of carbs at every meal, so that you have some sort of measurement in your mind to keep consistent throughout the day. Instead of having meals where we have pasta, wine and dessert and then a salad with no carbs, is probably the more challenging situation.
Intermittent Fasting
Participant Question:
Intermittent fasting, good or bad?
Katherine:
(Laughing) It depends. There’s a lot of those answers. I don’t know what the question would be so I could have an absolute.
Intermittent fasting is a great one to talk about. I like to think about fasting as an extra stressor on your body. Similar to doing a hard workout. Let’s think of a HIIT (high intensity interval training) workout. For someone who was truly exhausted and burnt out because my baby has had me up, doing a HIIT workout is actually going to make it worse on my body. It’s going to exhaust my body even further and I’m not going to be able to reap the benefits.
Whereas I’m optimally rested and restored, I’ve got the time and the space to do a hard workout then that might be awesome for my body. So, it can go either way and the same is true for intermittent fasting.
If someone has slept well and their hormones are not overly stressed, then that fasting can be used in a good way for your body. Whereas, if you are at the peak of your stress already then fasting is going to tip that bucket and make it such that your body feels like it’s in a famine. So, we want the fasting to be used beneficially, so it would depend on the person as to whether they could do it or not.
I don’t love for anyone, especially women to fast everyday. I like to see some days when you’re getting earlier meals in the day. I do think metabolically it’s better for our bodies to fast through dinner, if we were really to get nit picky about what would be best from a weight loss perspective, for example because that’s more in line with nocturnal and diurnal rhythms. That’s not often convenient for our lives.
I think fasting can be used if someone is at a place where they are healthy enough to use it as an opportunity and not as a damage to their body.
Cindi Michaelson:
Why would someone want to do Intermittent Fasting?
Katherine:
One reason is that it can be helpful for your digestion. It sounds technical, but we talk a lot about the window of digestion and for all the processes that happen when we are fasting. There is actually a rhythm that goes through our digestive tract that’s only on when we are not eating.
There are good things that happen, it’s called autophagy, where there is a whole process that our cells “clean up themselves” when we aren’t eating. Some of those things only happen when we aren’t eating or after meals, not during the digestive time. It’s helpful to have some amount of fasting every day but the window can change from person to person depending on how much that’s going to be useful or not.
I think that the "bad" and "good" is the first thing that we have to eliminate in terms of labeling foods. Including categories! Carbs are necessary. We have a higher demand for carbs, especially as women because we have ovaries and active thyroid glands. We need carbs for our brain and for a lot of our hormones to work properly.
Sources of Protein
Crissy:
We have a question on protein powders and collagen powder. Are they a safe way to get more protein in versus meats, eggs etc.?
Katherine:
I think protein and collagen powders can be really useful especially for convenience. I generally like for people to chew most of their foods. So, that’s the only down side in some cases. When we trick ourselves by drinking, we don’t register the same way as we do when we chew. We don’t produce digestive enzymes, so certainly, that is one downside but other than that, having protein powders to make smoothies for breakfast or for lunch could be a good option for some people. They are also just a great way to add protein to your day if you can’t get enough in through meat, eggs etc.
A lot of times they are just convenient. You don’t have to prepare them in the same way that you do meat or fish. There are some questions around heavy metals in protein powders, so I don’t want to miss mentioning that. You want to make sure you’re getting a high quality protein powder. They are popular enough on the market that you’re seeing more and more pop up and there isn’t much regulation around those. Making sure that it is a certified product, with high reviews, and that you could get some information around sourcing would be important.
Any time they are taking a protein and they are concentrating it down, they are doing a lot of work to that protein so you want to make sure the quality is high with the protein power and especially the collagen powder that comes straight from an animal.
Crissy:
Is there a safe way to get more protein in versus meats and eggs?
Katherine:
If you’re asking other ways to get protein, there are certainly a lot. I think of seafood, including shellfish as the healthiest food on the planet if it’s high quality. We get a lot of great nutrients from those without the down side, again assuming it’s a wild product.
You get plenty of protein from dairy if someone can tolerate that. I don’t love for people to use dairy for all three meals in a day, but that is certainly one that you can use in addition to other types of proteins.
Eggs are fabulous. Especially for women in their fertile years because of their high levels of choline and B vitamins.
As a former vegan, I have no problems with meat either. So again, it comes back to the quality of the meat and making sure you’re sourcing the best meat you can. I don’t think that we need to eat as much meat as we do as a culture, but I do think there can be meat in someone’s diet and still be very healthy.
Eating Breakfast & Hormones
Crissy:
There has been some debate about breakfast being the most important meal or not a necessary meal. Are there certain guidelines to follow such as, should we focus on more protein earlier in the day?
Katherine:
Sometimes when we create rules, we shoot ourselves in the foot. I don’t love this idea that, “you have to eat breakfast every day.” To me, that’s just another rule that puts us into these black and white boxes. If I have someone who is not very hungry in the morning and is not working out in the morning then I don’t mind them skipping breakfast in the morning. What I don’t like to see is someone who wakes up hungry and talks themselves out of eating just for the sake of skipping breakfast in terms of the fasting.
In terms of the value of eating breakfast, there are mixed reports. Research shows us that yes, most of the time it is easier to have a healthy lifestyle when you’re eating breakfast. A lot of that I think has to do with rhythms and routines. Day and night, and actually helping people start their day on a healthy note. So I think breakfast can be a healthy way to optimize the nutrients that you’re getting in. I don’t think it’s necessary and I don’t think it’s “the best meal of the day.” Again, anecdotally I do find that especially women feel like they eat better throughout the day when they start with a healthier breakfast. So, when we start with less sweet and sugary breakfast then I do find that women have an easier time focusing on savory meals throughout the day.
We have all had the days when we start with something sweet and then all day you want something sweet. I think there’s a little bit of that that goes into breakfast as well but then there’s certainly days where that makes sense for someone as well.
Cindi:
Katherine, I had read that, for women in particular, the hormone cortisol is highest in the morning so that’s why it’s best for us to actually eat breakfast. Is that accurate?
Katherine:
Yes and No. The hormone cortisol is our primary stress hormone and is what helps us respond to stress, so we want it. Like estrogen, we sometimes tend to vilify it. It’s not a bad hormone. We don’t want it to be excessive but we don’t want it to be absent.
It does tend to peak about two hours after we wake up. We want to see that natural rhythm and eating breakfast can help it peak appropriately. That’s why sometimes you’ll see the recommendation to eat breakfast within two hours of waking up, especially if you have problems with what used to be called adrenal fatigue or HPA Axis dysregulation would be the more appropriate term. To support your adrenals and to support your body NOT feeling like it’s in a famine, eating breakfast within two hours of waking is really helpful for that sake, for sure.
Crissy
We have a question asking you to speak more about hormones and dairy in particular. The participant is curious about your experience as a vegan.
Katherine:
Two different questions there. I think hormones in dairy are a big problem. I think we have thankfully, within the last 5-10 years started to clean up what we are doing with dairy and not inject them with all kinds of hormones. So, at least now there is more regulation. Dairy is one of the top products I recommend to get organic for the sack of getting less hormones. That doesn’t mean that it’s absent but it does mean less.
No dairy product is going to have hormones in it, to be clear. They aren’t floating around. It’s what the cow is actually injected with and that can infuse into the milk. I do think it has led to earlier puberty, kids with larger breasts, development happening faster, and in some cases stronger. Hormones in dairy is a challenge and I think it does matter when it comes to quality for that.
As far as a former vegan, what happened with me is that I was under-eating because I was going vegan as one way to manipulate my diet. We could call it disordered eating, if you will. I think sometimes a sideways way to get there, is that people will go vegan to restrict calories because you do find a lot of vegan foods, salads/vegetables etc. can be lower in calories. That was not exactly my intention but I was also destroying my gut in the process by eating a lot of grains and legumes, dairy and gluten. These aren’t bad in themselves but for me, it ended up hurting my gut health. So, for me it wasn’t a great fit. I have a lot of vegan clients who are thriving. It is not necessarily a bad thing for people, I want to make that clear. It just wasn’t the best fit for me.
Sometimes it’s harder when it comes to weight loss or harder when it comes to gut health when becoming vegan because you are eating a lot of high fiber foods but it’s not the case for everyone.
Fruit & Vegetables and Observation Logs
Participant Question:
What about protein powder for weight loss?
Katherine:
I guess I would say the same things I said before about protein powder. There’s no magic bullet to weight loss. I don’t think protein powder equates to weight loss. To the point I made earlier about chewing. Sometimes when we drink a meal it doesn’t really register the same elements of satisfaction and satiety. We then end up eating more in the long run. Or feel like we are being super restrictive by drinking protein powder drinks all day.
I don’t see it as a long term solution for sustainable health. It certainly can be part of a healthy diet.
Crissy:
Do you see any merit or value to such tactics as food logs, counting calories and other avenues like that?
Katherine:
That’s a great question. Yes and No. There is a time and a place for people to track macros, especially to see where the breakdown in composition of your foods is coming from and to understand what’s in certain foods.
There’s not a lot of value in old school diets but sometimes people do learn about certain foods and there is some benefit. Typically what happens however is we get WAY too focused on numbers and it becomes a game of black and white.
How many of you have had the experience of, you either win or you lose. There’s no way when using a calorie tracker to be in between. You’re either meeting that number goal or you’re not. Or your below it. Oftentimes people will become disconnected from their bodies because they are so focused on the numbers. I don’t like them in the sense that they disconnect us from noticing how food makes us feel.
What I use instead with my clients is what I call an “observation log.” Ultimately we may still look at calories and macros but what we are really starting with is, “Does this food keep me full? When I eat these combinations of food does it keep me full? When I add a little more fat, does it work better than when I add a little more carbs?” Then we end up getting to a different place that is reliant on your preferences and your body versus what a computer produced for you.
Participant Question:
Full disclosure I’m an intermittent fasting convert. My husband and I have been doing it for almost a year and I don’t see myself ever going back to eating three meals a day. However, I get nowhere near the daily serving of fruits and vegetables mainly because there are just fewer opportunities to eat them. How important is it to get the recommended servings of fruits and veggies everyday?
Katherine:
Great question and I love that you are enjoying fasting. So, you are one of those people that can do it and feel great. I probably fast twice a week. I do it on my rest days through breakfast and it feels great on those days. Depending on when you workout and your hormones etc. I think that it can be a good fit.
The challenge is sometimes getting enough food in. Just like you said, for some people its the amount of food. They can’t get enough food in to manage their stress levels and activity levels. For other people veggies really take a hit. When we look at the recommended USDA servings of fruits and veggies, it is 9 servings per day. Which is pretty high. I’m not sure how many of us are getting that. I get that on a good day because I’m eating a lot of them. If we are looking at that number then I’m not sure you need to get that much everyday.
I would look more at the type of fruits and veggies you’re getting. Are you getting high quality and high nutrient value polyphenol. Are we reaching your nutrient goals? When I talk about that I’m referring more to micronutrients, not macronutrients. By that I mean, vitamin C and all your vitamin B’s. Different types of nutrients that you are getting by what you’re eating. If you’re still getting there, then great! I don’t mind that you’re not at the recommended number.
Then looking at the composition of your meals. If you’re just eating two meals per day, what does that look like and how do we get more vegetables in those meals. I’ve seen plenty of people that can get to that fruit and vegetable number in two meals per day. It would be more a matter of working with you on which vegetables can we focus on to get the best bang for your buck.
Are some fruits and veggies better than others?
Back to the black and white thinking, I don’t want to answer yes but at the same time…yes. If you’re only going to eat one fruit or one vegetable every day then there are some that are better nutritionally than others. For most of us, hopefully overall it balances it out. We aren’t just choosing one thing. Even then, we can get into thinking, “I have to eat kale everyday. It’s the best vegetable ever.” Well, kale makes me feel awful. So, really trying to figure the best vegetables for you may not be the best vegetables for someone else. There are vegetables (we’ve all seen the rankings) that have higher density when it comes to nutrients and micronutrients. I don’t necessarily rely heavily on those.
I think another piece of vegetables is, they bring color to our plate which usually makes the plate more appealing. Visually it looks better when there is more color. Vegetables also provide a lot of texture. A lot of times it’s good to look at the value of vegetables beyond the nutrients. I think it’s a great question to ask when we are looking at vegetables, not only is this the most nutritious vegetable but is this going to bring crunch to the meal that is otherwise mild, or add spice, or however we are using those vegetables to enhance the meal.
Multivitamins
Crissy:
Do you in general think that women take a daily multivitamin?
Katherine:
I used to be anti supplements and I’ve come full circle. I do think that a lot of our soils are pretty depleted in many nutrients. Magnesium is one. I think we burn through all of our vitamin B’s pretty heavily when it comes to stress and also for anyone on birth control.
I guess my answer would be that most women would probably feel better on some form of supplement whether it’s a multi or a B complex and some C, I’m not sure depending on that person. It would matter what they are eating. It’s not necessary but I do think it’s pretty hard to get all the micronutrients through our current food system.
Cindi:
Katherine, do you recommend if women are going to start taking (or are currently taking) a multivitamin, for it to be food sourced or can they be synthetic? Does it matter?
Katherine:
I actually don’t have a stance on that. I recommend both. I have some companies that I work with that I think have very high quality synthetic vitamins and sometimes there’s certain forms that they really can’t extract from plants and foods. Certainly, the food based multi’s are going to be closer to what our bodies would be able to extract from foods. It depends on the person and their goals.
Sometimes we need something a little more potent, and the synthetic ones work great for that.
I personally take a synthetic version and feel amazing on them. I don’t think there is one or the other. I’m sure there are people that feel strongly about that. I do not. I care more about the quality about the vitamin itself and the company that it comes from and the validity of the actual ingredients.
Crissy:
Katherine, we are so grateful for you being here. Will you please let all the moms know where they can reach you if they would like to speak with you further?
Katherine:
www.katherineandrew.com is my website and I have my Instagram account.
I have a huge Pinterest account that would be a great resource for anyone.
I do take insurance. For most Blue Cross members it’s 100% covered even if you have a high deductible plan, you will likely have no payment due for me. So that’s a great resource for moms to know that you can get nutrition covered that way.
I also take United and Cigna. Certainly, out of pocket as well or HSA card.
As you’ve heard me say, so much of nutrition is pretty individual even though we would love for it to be generalized. It really matters that we work together and get more of those details out.
Katherine is a Registered Dietician Nutritionist with a Master’s Degree in Public Health with over 15 years of experience in Community Public Health and Private Nutrition Counseling. Her work experience includes individual and group health counseling, interactive workshops, food systems consulting, non-profit program development and management, and safe skin care advocacy and promotion. Gut health, food sensitivities, hormones, family food dynamics, and intuitive eating are a few of Katherine’s passions and specialties.
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