mild deficiencies according to cronometer

[Todd Allen]

I've been tracking my diet with cronometer for several weeks.  I'm not being terribly precise as I haven't been weighing my food.   Even if I wanted to it would be challenging as my wife has somewhat adopted my diet in that I'm preparing food mornings and evenings that we share.

 

I've been averaging about 1800 calories per day and hitting most of the targets.  A couple such as D and B12 I come up very short but I am taking supplements.  My most concerning deficiency that I'm not supplementing is Folate.  It's rare I hit 400 ug, 300 ug is roughly my average.  I'm not eating bread or other processed foods so I'm not getting anything fortified with folic acid.  Also, I'm not eating legumes which appear to be one of the richest natural sources of folate.  I've upped my consumption of greens such as spinach, kale, etc. but don't want to eat as much as needed to get the full amount of folate out of concern of excessive oxalic acid and goitrogens.  I'm inclined to start taking supplemental folate either as folic acid or perhaps as 5-MTHF.  The supplements start at 400 mcg which is more than I need.  Should I take it daily or does it average out ok if taken less frequently?

 

I also regularly come up ~15% short on calcium, potassium, zinc and ~50% short on sodium.  My calcium and potassium both come up high normal in blood tests.  Zinc is considered a needed substrate for testosterone and that also comes up high in blood tests.  My blood pressure has been coming down but is still not ideal so I suspect being on the low side for sodium is ok?  Or should one add enough table salt to hit the target?

[Dean Pomerleau]

Todd,

 

I've been averaging about 1800 calories per day and hitting most of the targets.

 

How fast are you losing weight these days? 1800kcal / day seems on the low side for someone who has your risk for pathological muscle loss. 

 

 I've upped my consumption of greens such as spinach, kale, etc. but don't want to eat as much as needed to get the full amount of folate out of concern of excessive oxalic acid and goitrogens. 

 

Do you have a history of kidney stones or thyroid issues? Even if you do, it's not at all clear that a diet with enough leafy vegetables to meet your folate needs increases risk of either. See this review for kidney stones & diet [1]. In fact, a diet high in fruits and vegetables may actually be protective, at least against kidney stones, due to its high levels of potassium, magnesium and citrate. Regarding goitrogens in vegetables (particularly cruciferous veggies like broccoli, cauliflower, brussel sprouts etc.) I too wouldn't worry about it, especially if you don't have a history of thyroid problems. See this post for discussion of a 25 year "one rat" experiment with cauliflower. Many of us have been eating a ton of foods high in both oxalates & isothiocyanates (the potentially goitrogenic compounds in cruciferous veggies) for any years, without stone formation or thyroid problems.

 

More info on cruciferous veggies and thyroid function, from the conclusion of [2]:

 

The consumption of typical serving sizes of raw, commercial B. oleracae and B. rapa varieties (i.e., broccoli, Chinese cabbage, bok choy, broccoli rabe) correspond to progoitrin- and thiocyanate-generating indole glucosinolate exposures at concentrations far lower than those likely to impair thyroid function. In contrast, excessive consumption (e.g., >1 kg/d for several months) of raw Russian/Siberian kale of the species B. napus, some collards, and Brussels sprouts, all of which have high progoitrin concentrations and thus can decrease iodine uptake into the thyroid to affect the synthesis of thyroid hormone, should be avoided.

 

In other words, you'd need to eat over a kilogram (2.2 lbs) of the cruciferous veggies with the highest levels of goitrogenic compounds for it to be considered "excessive" and therefore unwise for thyroid health. It only takes 200g of spinach (or 300g of collards) to get the RDI of folate, that is only about 1/10th the intake (> 1kg/day) where it could be an issue.

 

My blood pressure has been coming down but is still not ideal so I suspect being on the low side for sodium is ok?  Or should one add enough table salt to hit the target?

 

I've been doing just fine on less than 50% of the DRI for sodium (~1000 mg/day) for many years. A healthy body is amazingly well-adapted to retaining sodium on a low sodium diet. But having said that, you don't need to be obsessive about keeping salt low (below the DRI of 2400 mg/day) either.

 

--Dean

 

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[1] Arch Ital Urol Androl. 2015 Jul 7;87(2):105-20. doi: 10.4081/aiua.2015.2.105.

 

Dietary treatment of urinary risk factors for renal stone formation. A review of 

CLU Working Group.

 

Prezioso D(1), Strazzullo P, Lotti T, Bianchi G, Borghi L, Caione P, Carini M,

Caudarella R, Ferraro M, Gambaro G, Gelosa M, Guttilla A, Illiano E, Martino M,

Meschi T, Messa P, Miano R, Napodano G, Nouvenne A, Rendina D, Rocco F, Rosa M,

Sanseverino R, Salerno A, Spatafora S, Tasca A, Ticinesi A, Travaglini F,

Trinchieri A, Vespasiani G, Zattoni F; CLU Working Group.

 

Author information: 

(1)Università Federico II Napoli. dprezioso@libero.it.

 

Erratum in

    Arch Ital Urol Androl. 2016 Mar;88(1):76. Ferraro, Manuel [added].

 

Free full text: http://www.pagepressjournals.org/index.php/aiua/article/view/aiua.2015.2.105/4756

 

OBJECTIVE: Diet interventions may reduce the risk of urinary stone formation and 

its recurrence, but there is no conclusive consensus in the literature regarding 

the effectiveness of dietary interventions and recommendations about specific

diets for patients with urinary calculi. The aim of this study was to review the 

studies reporting the effects of different dietary interventions for the

modification of urinary risk factors in patients with urinary stone disease.

MATERIALS AND METHODS: A systematic search of the Pubmed database literature up

to July 1, 2014 for studies on dietary treatment of urinary risk factors for

urinary stone formation was conducted according to a methodology developed a

priori. Studies were screened by titles and abstracts for eligibility. Data were 

extracted using a standardized form and the quality of evidence was assessed.

RESULTS: Evidence from the selected studies were used to form evidence-based

guideline statements. In the absence of sufficient evidence, additional

statements were developed as expert opinions.

CONCLUSIONS: General measures: Each patient with nephrolithiasis should undertake

appropriate evaluation according to the knowledge of the calculus composition.

Regardless of the underlying cause of the stone disease, a mainstay of

conservative management is the forced increase in fluid intake to achieve a daily

urine output of 2 liters. HYPERCALCIURIA: Dietary calcium restriction is not

recommended for stone formers with nephrolithiasis. Diets with a calcium content 

≥ 1 g/day (and low protein-low sodium) could be protective against the risk of

stone formation in hypercalciuric stone forming adults. Moderate dietary salt

restriction is useful in limiting urinary calcium excretion and thus may be

helpful for primary and secondary prevention of nephrolithiasis. A low-normal

protein intake decrease calciuria and could be useful in stone prevention and

preservation of bone mass. Omega-3 fatty acids and bran of different origin

decreases calciuria, but their impact on the urinary stone risk profile is

uncertain. Sports beverage do not affect the urinary stone risk profile.

HYPEROXALURIA: A diet low in oxalate and/or a calcium intake normal to high

(800-1200 mg/day for adults) reduce the urinary excretion of oxalate, conversely 

a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A 

restriction in protein intake may reduce the urinary excretion of oxalate

although a vegetarian diet may lead to an increase in urinary oxalate. Adding

bran to a diet low in oxalate cancels its effect of reducing urinary oxalate.

Conversely, the addition of supplements of fruit and vegetables to a mixed diet

does not involve an increased excretion of oxalate in the urine. The intake of

pyridoxine reduces the excretion of oxalate. HYPERURICOSURIA: In patients with

renal calcium stones the decrease of the urinary excretion of uric acid after

restriction of dietary protein and purine is suggested although not clearly

demonstrated. HYPOCITRATURIA: The administration of alkaline-citrates salts is

recommended for the medical treatment of renal stone-formers with hypocitraturia,

although compliance to this treatment is limited by gastrointestinal side effects

and costs. Increased intake of fruit and vegetables (excluding those with high

oxalate content) increases citrate excretion and involves a significant

protection against the risk of stone formation. Citrus (lemons, oranges,

grapefruit, and lime) and non citrus fruits (melon) are natural sources of

dietary citrate, and several studies have shown the potential of these fruits

and/or their juices in raising urine citrate levels.

CHILDREN: There are enought basis to advice an adequate fluid intake also in

children. Moderate dietary salt restriction and implementation of potassium

intake are useful in limiting urinary calcium excretion whereas dietary calcium

restriction is not recommended for children with nephrolithiasis. It seems

reasonable to advice a balanced consumption of fruit and vegetables and a low

consumption of chocolate and cola according to general nutritional guidelines,

although no studies have assessed in pediatric stone formers the effect of fruit 

and vegetables supplementation on urinary citrate and the effects of chocolate

and cola restriction on urinary oxalate in pediatric stone formers. Despite the

low level of scientific evidence, a low-protein (< 20 g/day) low-salt (< 2 g/day)

diet with high hydration (> 3 liters/day) is strongly advised in children with

cystinuria. ELDERLY: In older patients dietary counseling for renal stone

prevention has to consider some particular aspects of aging. A restriction of

sodium intake in association with a higher intake of potassium, magnesium and

citrate is advisable in order to reduce urinary risk factors for stone formation 

but also to prevent the loss of bone mass and the incidence of hypertension,

although more hemodynamic sensitivity to sodium intake and decreased renal

function of the elderly have to be considered. A diet rich in calcium (1200

mg/day) is useful to maintain skeletal wellness and to prevent kidney stones

although an higher supplementation could involve an increase of risk for both the

formation of kidney stones and cardiovascular diseases. A lower content of animal

protein in association to an higher intake of plant products decrease the acid

load and the excretion of uric acid has no particular contraindications in the

elderly patients, although overall nutritional status has to be preserved.

 

DOI: 10.4081/aiua.2015.2.105 

PMID: 26150027

 

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[2] Nutr Rev. 2016 Apr;74(4):248-58. doi: 10.1093/nutrit/nuv110. Epub 2016 Mar 5.

 

Concentrations of thiocyanate and goitrin in human plasma, their precursor

concentrations in brassica vegetables, and associated potential risk for

hypothyroidism.

 

Felker P(1), Bunch R(2), Leung AM(2).

 

Author information: 

(1)P. Felker and R. Bunch are with the D'Arrigo Bros. Co., of California,

Salinas, California, USA. A.M. Leung is with the Division of Endocrinology, VA

Greater Los Angeles Healthcare System, Los Angeles, California, and the Division 

of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles,

California, USA. Peter.Felker@darrigo.com. (2)P. Felker and R. Bunch are with the

D'Arrigo Bros. Co., of California, Salinas, California, USA. A.M. Leung is with

the Division of Endocrinology, VA Greater Los Angeles Healthcare System, Los

Angeles, California, and the Division of Endocrinology, David Geffen School of

Medicine at UCLA, Los Angeles, California, USA.

 

Full text: http://sci-hub.cc/10.1093/nutrit/nuv110

 

Brassica vegetables are common components of the diet and have beneficial as well

as potentially adverse health effects. Following enzymatic breakdown, some

glucosinolates in brassica vegetables produce sulforaphane, phenethyl, and

indolylic isothiocyanates that possess anticarcinogenic activity. In contrast,

progoitrin and indolylic glucosinolates degrade to goitrin and thiocyanate,

respectively, and may decrease thyroid hormone production. Radioiodine uptake to 

the thyroid is inhibited by 194 μmol of goitrin, but not by 77 μmol of goitrin.

Collards, Brussels sprouts, and some Russian kale (Brassica napus) contain

sufficient goitrin to potentially decrease iodine uptake by the thyroid. However,

turnip tops, commercial broccoli, broccoli rabe, and kale belonging to Brassica

oleracae contain less than 10 μmol of goitrin per 100-g serving and can be

considered of minimal risk. Using sulforaphane plasma levels following

glucoraphanin ingestion as a surrogate for thiocyanate plasma concentrations

after indole glucosinolate ingestion, the maximum thiocyanate contribution from

indole glucosinolate degradation is estimated to be 10 μM, which is significantly

lower than background plasma thiocyanate concentrations (40-69 μM). Thiocyanate

generated from consumption of indole glucosinolate can be assumed to have minimal

adverse risks for thyroid health.

 

© The Author(s) 2016. Published by Oxford University Press on behalf of the

International Life Sciences Institute. All rights reserved. For Permissions,

please e-mail: journals.permissions@oup.com.

 

DOI: 10.1093/nutrit/nuv110 

PMCID: PMC4892312 [Available on 2017-04-01]

PMID: 26946249

[Todd Allen]

Dean, I've roughly lost 5 lbs in the last 4 weeks.  When I was averaging 2000 calories per day I was losing a little less than 1 lb / week so I cut back the calories to get back on track.  I've found tracking weight a little fuzzy.  My scale reads to the half pound and probably isn't that accurate and day to day my weight can fluctuate by about a pound due to hydration & speed of bowels, etc.

 

My performance gains exercise wise have been improving giving me some confidence this pace of weight loss is reasonable.  I'll probably tweak the calories back up soon but I've been very comfortable eating at my current level.

 

Both my mother and my older brother have had kidney stones.  I haven't had one yet and would like to keep it that way.  However, I have been eating a lot more spinach and other greens than either of them for a long time (they both eat SAD) so maybe it's not as big an issue as I feared.

[Todd Allen]

I bought a gram precision kitchen scale and weighed my food yesterday.  I previously said I wasn't going to be weighing my food and I don't plan on making it a daily habit.  But I'm glad I did it as I was underestimating the quantity of greens I was eating by almost half.  Yesterday's folate was 173% by CRONOMETER and I ate roughly the same as before when I was coming up with a deficit.