56. Optimizing Immunity with Kristin Koskinen, RDN

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00:00
Kristin Koskinen
You can operate at a low level deficiency and still be operational, you don't know what's going to be too low. And we can test for certain things there's not necessarily to the best of my knowledge, there could be by now, but a specific immune panel that says you are in perfect shape or you need to do these. We have panels we can take and we can extrapolate information. But most people aren't having a broad sweep of blood work done and blood work and other work testing, metabolites, GI, health, that kind of thing, which include stool samples, urine samples, blood work regularly. I mean, they feel like they're getting a great workup if they get a Chem 20 and a CBC and maybe, gee, if we're really great, we've tacked a vitamin D on it. But I know a lot of people who have to fight dancers to get a vitamin D level. 

00:51
Kristin Koskinen
So we also don't want you to be lulled into a sense of, oh, I'm fine. And those lab levels, oftentimes they don't refer to you. They refer to general public, not hyper farming athletes or hypermobile people. They are not specific to these populations. So the interpretation of those labs should be made in context of your entire fishbowl, not just isolated. 

01:30
Jennifer Milner
Welcome back to the Bendy Bodies podcast, where we strive to improve well being, enhance performance, and optimize career longevity for every Bendy body. This is co host Jennifer Milner, here with the hypermobility MD linda Bluestein. 

01:44
Dr. Linda Bluestein
We are so glad that you are here to learn tips for living your best Bendy life. This information is for educational purposes only and is not a substitute for medical advice. 

01:54
Jennifer Milner
Our guest today is Kristen Koskinen, registered dietitian nutritionist, Bendy Bodies resident nutritionist, and specialist in nutrition for performance and hypermobility. Kristen, hello and welcome back to Bendy Bodies. 

02:06
Kristin Koskinen
Hello, thank you for having me. 

02:09
Dr. Linda Bluestein
We're so thrilled that you're here. 

02:11
Kristin Koskinen
Yes, we are. 

02:12
Jennifer Milner
Any excuse to be able to chat with Kristen. Exactly. So, Kristen, for our listeners who may not know who you are, may not be familiar with the work that you've done and heard the other podcasts we've done with you. Could you tell us a little bit about yourself? 

02:26
Kristin Koskinen
Sure. As you said, my name is Kristen Koskinen. I'm a registered dietitian nutritionist, and I work with dancers and hypermobile people to help them optimize their health and performance, help them to reach their goals with really translatable skills using food and nutrition. 

02:44
Jennifer Milner
Excellent. So part of us knows that everybody needs to eat healthy, everybody needs to eat good nutrition. Yada, yada. Then we also know that all the athletes and artists need to work really hard to take care of their instrument, especially because their body is their instrument. We're asking it to do really difficult things. But as we tie into our audience, why should Bendy artists specifically care about the immune system and nutrition in general? 

03:09
Kristin Koskinen
Sure. Well, the immune system is critical for everybody. It protects us from foreign organisms and substances. It's critical for our survival. And it's made up of a number of cells and organisms that require the nutrients that we get, ideally from food. Sometimes we need to bring in some supplementation for structure and function. And what we find is even mild nutrient deficiencies can set you up for illness. What we find for artistic athletes specifically, is they are under a lot of stress, so they have high physical demands and they often have high psychosocial and emotional demands too. And that all plays a role in what your needs are. So the body is complex and dynamic. So there's not one set of this is what you need all the time. It's really a moving target with regard to nutrients and your requirements. So we can set some general goals and we see general goals all over the place. 

04:12
Kristin Koskinen
Governments set goals here's the RDA, for example. And those can be starting points, but they may not be the ending points because what we know is there are a number of things that impact your needs. And if you are not meeting your physiologic needs, your body's going to be compromised, including your immunology. An example that I use, I don't know, somewhat frequently, is that of a fish bowl. So if you imagine a fishbowl and you've got a fish inside the fish bowl, if the water is dirty, throwing a lot of supplements at the fish may help it to deal with the dirty water, but it's really not going to solve things. So things that can dirty the water include stress, pollution, mold, toxicity, disease states, Lyme, anything underlying you may have, including some of the sidekicks that we have with hypermobility, all those things can impact things. 

05:08
Kristin Koskinen
Sleep. Have I mentioned stress, lack of sleep, what you're eating, what you're not eating, all those things impact that milieu. And so what we really need to do is keep in mind that nutrition isn't a component and it's an exceptionally important component, but it's not the only thing. And so it's really important to look, give a 360 look to your lifestyle, and all the inputs that you have with regard to how this impacts your health and your immunity. And when we look at what that entire package is for you, it may help to direct us in what your specific nutrient needs are. 

05:46
Jennifer Milner
Okay? So I'm just going to follow up on that because there's a lot of greatness in that. And I think I'm going to carry that goldfish image with me for a while. That's a really great image. But if someone is a bendy artist, I have lots of hypermobile dancers and they seem to feel the impact of their nutrition more on their bodies. And they're like, how come that person gets to eat whatever they want and how come I don't? So is there something about being hypermobile or having a connective tissue disorder. That means you have to be mindful of your nutrition in ways that other people don't. 

06:19
Kristin Koskinen
Yes. So for example, let's just be really simplistic and basic about hypermobility, right? So as basic as we can get it, you have connective tissue throughout your body and including your intestines. And so for some people with hypermobility, they may have difficulty with digestion and absorption. So that means that they may need to be more conscientious about getting more nutrients because they need to effectively hit the system harder with certain nutrients simply because their digestion and absorption is impacted, because of the structure matters and how things are able to operate. Another thing that we see in hypermobile people is they may struggle with dysautonomia or their digestion may be slower than other people. So they may struggle with getting enough food because they may notice they have fullness, they may not have peristalsis. That moves things along so that they get appropriate digestion and absorption. 

07:23
Kristin Koskinen
And if you're not you can eat food, that's definitely an important step one. But you also have to digest the food so that your body can absorb the nutrients. And that happens in a stepwise order. So if we're missing a step, if your TMJ is sore and you're not able to masticate the food, meaning chew it properly, incorporate the digestive enzymes from saliva, swallow it appropriately. Next step is the stomach where we have hydrochloric acid. If you have a nutrient deficiency, because days before you weren't able to get enough nutrients so that your body's producing adequate hydrochloric acid, you're not going to have that breakdown and then things aren't going to move along that can move to other issues that we see in the hypermobile community, which can include things like SIBO overgrowth, which will as we will talk about the microbiome and immunity. But that's something that can be really significant. 

08:18
Kristin Koskinen
So all these things roll in and there are a lot of complications. You may see if you have a histamine intolerance, if you have mast cell activation syndrome, your selection of foods may be different than what other people can eat because your body may tolerate them differently in different amounts. Not at all. Not right now, depending on what your stress level is. So those are all things that we really have to take into consideration that might make things different for you than from another dancer. 

08:49
Dr. Linda Bluestein
I love what you were saying about the gastric acid because I find in my patients and in my clients that things like gastroesophageal reflux is much more common, right? And sometimes people get put on proton pump inhibitors and then they never get taken off. So that's something that can also affect micronutrient levels. And often I feel like we have this kind of like black and white thinking gastric acid is bad because if. 

09:18
Kristin Koskinen
We had an issue with reflux absolutely we do. And we see proton pump inhibitors a lot. So we see them, whether it's part of an approach to address histamines, whether it's simply to, oh, there was some reflux, so we're just going to hit it with a papai, or if it's someone who's coming off an eating disorder and has some reflux for that. I see those dancers, so they can be young, put on a proton pump inhibitor and that all impacts that hydrochloric acid. If you do not have enough hydrochloric acid, bringing it back to immunity, you also aren't going to be killing organisms that hit your stomach that have been swept from the nasoesophageal pathways into the stomach. And that hydrochloric acid is there to kill bad stuff as well as optimize digestion. Something else that I see people do in terms of medication. So that's one medication we see. 

10:17
Kristin Koskinen
But if dancers decide they want to get more calcium and they take something like Tums for a calcium source, that also increases the PH of your stomach. And now we may, by bringing in this supplement, may compromise a whole lot of other things downstream from the stomach and you may or may not have even needed that calcium. Wow. 

10:40
Dr. Linda Bluestein
So it's really so complex. And as you always say, N equals one, right? So each person is definitely unique in terms of what if you're working one one with someone, right, you're going to give them very specific recommendations. But in general, we know that foods impact immunity a lot. So can you give us some kind of general guidelines or general information about how the foods we eat impact immunity? 

11:06
Kristin Koskinen
Sure. So, again, we're going to pull as a dietitian, I work with a lot of lenses. This might be a secondary to my intro. My lenses include the microscopic to what's going on at a biochemical level all the way out to satellite or telescopic level when we're looking at where you live on the planet and then everything in between. So all of these things matter. So sometimes we need to pull back the lens. There's a great tendency to want to narrow in and dial into individual nutrients and we want to look at one offs and give me the magic bullet and what can I control? And pills are controllable. We like that stuff because we'll hit it with a pill, we've signed off, we get the numbers where we want them, great. Maybe often not so great. So we're going to pull the lens out and look at the diet overall and what it does for the body. 

11:59
Kristin Koskinen
So the first thing I'm going to look at, and it may be surprising, but the first thing that I look at as a dietitian is protein. That's where we start, because all your cells require protein. The organs that produce the immune cells require protein. And sometimes we forget about that. We get caught up in the white blood cells and antibodies and things. But where are those things coming from? Are you making sure that your thymus is well supported as an organ? Is your bone marrow well supported as something that produces these things? How about your spleen? What's it looking like? All these things require protein. And when we look at protein one, you need to make sure you have enough to support the structures that produce the cells and the cells the production of the cells themselves. You got to have protein two, when you eat protein, it's not just about the protein. 

12:47
Kristin Koskinen
It's about the nutrients that come along with it. So if you're eating an adequate amount of protein and getting it from good sources, you're also going to be getting things like zinc and iron, which we need for the immune system. The marrow of your bone cells is important, and it requires iron. We know that when we see even a slight zinc deficit, we will see immune deficiency. So we want to start with protein. That's where I start. And looking at dancers, we start that as a range from needing someplace between 1.2 to maybe up to 2.5 grams/kg. That's going to depend on a lot of things, and we might get back to that. Fishbowl so if the dancer is injured, if you're coming in with an injury or any sort of other physiologic compromise, you're going to be toward the higher end of that goal. 

13:38
Kristin Koskinen
If you're eating a plant based diet, and by plant based, I'm going to limit that to, say, a vegan diet, though, there's no definition for plant based. But if you're eating a vegan diet or very limited amounts of animal foods, you're going to lean toward the 2.2 to 2.5 grams of protein simply because the protein and nutrients that come the protein and minerals specifically that come from plant foods are less bioavailable than those from animal sources. So if that's a dietary choice you choose to make, okay, but I don't want dancers to be confused to think eating a lot of plants and a variety of plants is good and converting that to eating only plants is best. It's not necessarily the case. So we start with protein. I'm going to stop there and see if there are some questions you have there. Before I move on to anything else. 

14:37
Dr. Linda Bluestein
I do want to clarify. When you're talking about 1.2 to 2.5, that's grams per kilogram, correct? 

14:42
Kristin Koskinen
Grams per kilogram. 

14:43
Dr. Linda Bluestein
And if you want to convert your weight from pounds to kilograms, you need to divide by 2.2. So anyone who's listening to this and they're like, well, what? 

14:52
Kristin Koskinen
Okay. Yeah. And that's a range, and it depends on a lot of things. And even within the same person, we may shift that range, depending on what you have going on. Where are you at in your season? Where are you at in your life stage? Are you male or female? There are a lot of things that go into calculating that and getting some estimates, but that's where I like to start. So we start there. And I really do, and I oftentimes do recommend I find that animal products can be very helpful because they are more bioavailable. And when we're looking at dancers, a lot of times the limitations we look at for artistic athletes are time, convenience, affordability. And if we kind of blend that over into the hypermobile world where we talk about spoons or the resources you have, we really need to marry. 

15:45
Kristin Koskinen
What are your resources? How much time do you have to prepare things and how much time do you have to eat things? How much time do you have to digest things? So if you're going vegan or strictly plant based, it takes a lot of food to get to those goal levels. Do you have the time to eat it? Do you have the time to prepare it? Those are really issues. Do you have the time to chew it? That's important. And sometimes when I'm working with dancers, I'm working with how many bites do we have between here and here? This is what we have. It's not ideal. We are working in completely unil circumstances and we're going to make it work, but they're not ideal circumstances to support health. So we have to be incredibly intentional. 

16:31
Jennifer Milner
So what you're describing is sort of the basic steps that you take with every new client that you get in and that you start working through for designing a healthy eating patterns. And as we speak specifically about the immune system, could you connect the dots for people who are listening between how you're eating and how you don't get a cold during nutcracker season? 

16:55
Kristin Koskinen
Right? 

16:55
Jennifer Milner
Because there are people out there, hopefully not our listeners, who think a calorie is a calorie. And as long as I'm fueling my energy levels, I'm good. And I know there was a doctor. 

17:04
Kristin Koskinen
Who famously gosh like 20 years ago. 

17:08
Jennifer Milner
Lived off of gas station food only for a month just to prove that calorie is a calorie. And he was alive and all that, but as he did that, I was thinking his body is now made of beef jerky and hohos and Cool Ranch Doritos. And what does his immune system look like? Right? So can you connect the dots for us between eating a healthy diet and being able to fight off that cold, not having a sprained ankle turned into a lingering tendinopathy link? Help us with that? 

17:36
Kristin Koskinen
Yeah. So the basics are you need to have a foundationally sound diet, and that sounds kind of boring and maybe you've heard it, but like this well balanced diet idea. But it's true. I think what too many dancers want to do is they're going to skate by and then, oh, I'll deal with it later. I'll come in with echinacea elderberry, oh, I've got zinc lozenges and all this stuff. Those may be helpful and they may be curative to a point or help with symptoms, but your best bet is to start strong and stay strong. We want to be really consistent. In some ways. I kind of feel like if you look at someone who is struggling on point, like they can't get over their box and it's because they are weak and they need to strengthen a certain set of muscles. Jen, that would be something you'd address, but they're dialed into the elastic. 

18:26
Kristin Koskinen
It's like your elastic is important, but that's not the driver of this problem. So what we want to start with is a well balanced diet. And as boring as that sounds, let's unpack what that looks like. So one, we got to make sure you're getting adequate protein. We covered that. Two, I actually want people to eat a lot of plant foods. And so plant foods include things that grow so legumes, vegetables, fruits, grains. These are all herbs. These all are plants, right? We want to eat a lot of those. They provide a lot of things. They provide carbohydrates, they provide fiber, they provide different kinds of fiber. I'm going to throw it's not really a plant, but we kind of think of mushrooms as a non animal source, so I'm just going to put that into that world too. They all provide different nutrients, including polyphenols, and different chemicals that support your health and well being. 

19:27
Kristin Koskinen
So the RDA doesn't have lists of these are the requirements for things like quercetin, luteolin, resveratol, but we know that they're important and getting them from Whole Foods matters. So I'm going to give you some food examples so you can see how this works. So when I'm recommending a diet, I want you to have a lot of variety. There's the kind of the thought of eat the rainbow, so eat lots of different colors. That's a good guideline. I suggest that dancers and anyone eat at least ten different plant foods per day. And that may sound like a lot, but it's really not. We can talk about some examples in a little bit, if that's helpful. But when you do this, you're going to get different fibers, you're going to get different nutrient profiles from each plant. You're also going to get different allotments of these plant chemicals that we're really just learning about. 

20:16
Kristin Koskinen
So here are some examples. I'm going to take an orange. So people see orange and they think vitamin C, there is vitamin C, and it's a great source of it. However, it's got a lot more going for it than just the vitamin C. When you eat that orange, you get vitamin C, you get fiber, you get folate, which is helpful for mood DNA, which you need to make sure that you're producing all these immune cells and so on. And if you look at eating the rootin or the pith of the orange that inside lining, it contains one of these phytochemicals called rootin, which is anti inflammatory. So a whole food diet means you don't have to shop at that grocery store when I type it in? No. It's eating whole foods and eating as much of the food as possible. When we shift that over to animal products, if you're going to eat an egg, I want you to eat the whole egg, including the yolk. 

21:09
Kristin Koskinen
The yolk will provide things like vitamin A, which we know is necessary for immune health. It can be a source of omega three fatty acids. It has choline, which helps with your neurologic health. So that's a whole food. When you're eating animal products, eating a variety of different animal products will provide different nutrient profiles. So protein isn't just protein. Getting it from a wide variety of sources helps to ensure you're meeting the wide needs you have and keeps us from narrowing into, oh, I'm just going to pop a zinc pill. When you eat a whole foods diet, the other side of that is that you got to eat food anyway. You're going to get energy, and it supplies your nutrient needs. And when we look at a lot of studies, they may isolate nutrients, which is fine, it's a way of studying. But our bodies are intended to eat food, not to hit supplements. 

22:06
Kristin Koskinen
Supplements are awesome. They can play a great role. But when you get your vitamin C from oranges, bell peppers, cauliflower, berries, and you're eating them in a balance of other nutrients. And the chance that you are going to create a nutrient deficit by overdoing one nutrient because you've created a competitive environment for absorption, is effectively nil the chance that you're going to end up with an overdose, which can be dangerous. It's hard to do, it's possible, and we can get there, but it's a challenge to get there. So if you're looking at a plate, typically I want to have we're going to start with that protein requirement that we talked about, and then we're going to fill in with colorful fruits and vegetables which provide the vitamins. Minerals and phytonutrients that help support the immune system as well as complex carbohydrates that come from starches and legumes and that kind of thing which provide energy as well as minerals and B vitamins that are important for supporting your performance as well as driving those immune functions. 

23:15
Jennifer Milner
So what I'm hearing from you is I liked what you mentioned at the beginning about how a lot of dancers will say, I'm just going to skate by right now and I'll deal with it later. And they start stocking up on their echinacea or their vitamin C supplements or whatever it is. And what I'm hearing is that it's very similar to dancers with injuries or any artist with injuries, right? And when it's something small, we don't pay attention to it. And then when it gets bigger, we deal with it. And so dancers always have their arnica gel or their body wraps or their salon paws or whatever to deal with it. When it gets to be a problem, and so for everybody who's listening, we need to deal with our nutrition, like our conditioning class, like our performance enhancement, not just I'm going to have chicken soup when I'm sick because it'll be great vitamins and it'll make me feel better. 

24:00
Jennifer Milner
Let's do that beforehand. So trying to plan nutrition is hard, I get that. But skating by on the skittles and the Red Bull is not going to be ideal. And maybe just that little bit of planning as Kristen was discussing, and as we've talked about before, will help us not need the Echinacea and the chicken soup and all of that kind of stuff. So I love that thought about let's just make it part of our maintenance, even though it seems invisible and we'd be fine without it. 

24:29
Kristin Koskinen
And I think that it's important to note that these things, you can operate at a low level deficiency and still be operational. You don't know what's going to be too low. And we can test for certain things there's not necessarily to the best of my knowledge there could be by now, but a specific immune panel that says you are in perfect shape or you need to do these. We have panels we can take and we can extrapolate information. But most people aren't having a broad sweep of blood work done and blood work and other work testing, metabolites, GI, health, that kind of thing, which include stool samples, urine samples, blood work regularly. I mean, they feel like they're getting a great workup if they get a Chem 20 and a CBC and maybe, gee, if we're really great, we've tacked a vitamin D on it. 

25:19
Kristin Koskinen
But I know a lot of people who have to fight dancers to get a vitamin D level. So we also don't want you to be lulled into a sense of, oh, I'm fine. And those lab levels, oftentimes they don't refer to you. They refer to general public, not high performing athletes or hypermobile people. They are not specific to these populations. So the interpretation of those labs should be made in context of your entire fishbowl, not just isolated. 

25:49
Dr. Linda Bluestein
So we're pretty sure we know the answer to this question, but are there any categorical absolute no's for healthy diet, like no fat, no sugar? I feel like we see a lot of things people are trying to oversimplify. What do you think about that? 

26:04
Kristin Koskinen
Yeah, okay. You know what? I'm really going to come out no hacks. Do not try to hack your system. Do not allow food manufacturers or influencers to come in to hack your system. So the things that I really say, I would like to say hard no to, but you may have to temper this because the world is the world. Sugar replacements, protein replacements, fat replacements, don't do it. Without exception. Every time we look at one of these ways to and almost all the time, they are to cut calories. And they are diet related, not health related. So don't kid yourself and don't let people I just was listening to a lecture about someone trying to push a fiber supplement because it could decrease calories. It could decrease sugar. Don't listen to this stuff. Without exception, every time these things come in, there is a risk. 

27:01
Kristin Koskinen
So, for example, let's talk about stevia. But it's a natural product. Well, stevia is known to decrease the MMC, the migrating motor complex of your intestines. So if you've slowed down the pace of your intestine, your intestinal tract, that GI motility. What we do is we set you up for infection, something called siba. We can now, the bacteria, even the good bacteria in your gut, have the opportunity if things aren't moving at the pace they're supposed to go in the direction they're supposed to go to, maybe move up into the small intestine where they do not belong. And this can cause a lifelong program problem. Fat substitutes were bad from the get go. They can cause nutrient deficiencies. They can cause anal leakage. I'll let you paint your own picture on that. But it's a fish bowl problem and protein replacements, too, because when you start messing and this is all the fake chicken nuggets, the fake burgers, they're touted as being a plant based, healthy, environmentally sound thing. 

28:08
Kristin Koskinen
A lot of that is up for debate. And I will tell you, in terms of health, they're heavily processed. They do not come with the same nutrient profiles as the original that they're mimicking do. You may feel really good about it, but you may not be getting the benefits that you think you are from these halo things. And so those are fake. I'm not a fan of fake food, and I'm not a fan of food that'll make you sick. So if something's been sitting on if you go to like a cast party or you're at a holiday event, if there's a buffet and you're concerned about the safety of that food, has it been kept hot? Like at the temperatures it's supposed to be kept hot at consistently, has it been kept cold? Don't eat it. Foodborne illness can wreck your gastrointestinal system. Number one, you can guess that you do not want to have food poisoning. 

29:03
Kristin Koskinen
That's what foodborne illnesses you don't want food poisoning because it's nasty, but it can also cause long term damage to the gut. So avoid that. Same with if you're at theater and you can't keep hot food hot or cold food cold. If your chipotle had to sit for a few hours, don't eat it. In these instances and this is where we need to talk about performance specific foods. Processed food is really helpful here. It's really helpful. You know why? It's shelf stable. It can give you energy when you are away from home. You may need that stuff. I use it and recommend it all the time. Why? Because it's a practical consideration that we need to look. At. We don't have spoons that say we have a chef that's there to prepare our meals while we're rehearsing, and that can give us the number of bites we can digest in the amounts we need right here, right now. 

30:01
Kristin Koskinen
So processed foods can be an absolute boon when you need them. When you're eating at home, I recommend you eat whole foods that as often as possible you're able, even simple foods. Food cooking doesn't have to be hard, but foods that you can make or prepare easily that are nourishing as minimally processed as possible. And we know that we are going to lean on processed foods and food products and sports drinks sometimes because they're necessary or they're performance enhancers, or they allow us to perform and keep up a pace because our demands exceed what we can do. Trying to eat whole foods. 

30:40
Jennifer Milner
Well, first, there were a lot of really great things in there. The discussion about food substitutes is an important one to have because a lot of us do like our hacks. Right. And you mentioned fat substitutions and all that. I remember very much a certain fat substitute, olestra, that was supposed to bind to and not be absorbed, right? So you couldn't absorb it. Somebody's like yay. So people were eating entire bags of potato chips because they were like, I won't get fat because I won't absorb the fat. And then they were having intestinal distress because of it, number one. But number two sorry, no pun intended. 

31:18
Kristin Koskinen
Number two. 

31:22
Jennifer Milner
Apparently I'm a 14 year old boy. Number two. One of the consequences that a lot of people didn't expect was people lost a lot of nutritional support in their body because there are fat soluble vitamins, right? A-D-E and K, I think, are the fat soluble vitamins. So if you're eating foods and you're eating that bag of fat free potato chips, all of a sudden those vitamins aren't being absorbed. So there's unintended consequences. At the same time, if people want to eat vegetarian and they want to have a veggie burger, I would encourage them to go to a really great local restaurant and get a really great portobello or black bean or some sort of amazing vegetarian style burger. And I think what you're referring to when you're talking about the protein substitute is like the frozen chicken nuggets or the fast food meat substitutes for burgers and things like that. 

32:17
Jennifer Milner
Yes. So it's about going and finding those whole foods still, right? It's saying, hey, sure, it says that it's plant based, but in this case, what does the cholesterol look like? What does this look like? 

32:27
Kristin Koskinen
All of that. 

32:28
Jennifer Milner
So that's an important distinction. 

32:30
Kristin Koskinen
Yeah, totally. And you can I mean, it's looking at things and it's how it's represented. And if you look at the list of things, it's massively processed, and the processing of that consumes environmental resources. So go in eyes wide open. Just really we want to be eyes wide open on this. And yeah, there are a lot of great depending on where you live. Some people may not have if you don't have access to a restaurant, that's okay. I have recipes that I give my plant based clients all the time. It can be soups and chilies and stews and patties that they can make on relatively quickly with affordable ingredients that they can freeze in advance. And then they can take them and have them and enjoy them when they want. And even if you can't have that at theater or the studio, you can have it ready when you get home because you have these really late come home times. 

33:24
Kristin Koskinen
So then if you need to pop it in the microwave, great. If it's something you could have had in a slow cooker or you can put in a pan, great. But there are definitely options. They may take a little bit of time and preparation, but really, they don't have to be difficult, they don't have to be complex. And they should be delicious. Yeah. 

33:42
Dr. Linda Bluestein
When I was a dancer, I know I was very focused on my weight and avoiding things. But what I like about this conversation is it's really focused on what you need to include. Right. So I think when you're talking about packaged and processed foods and performance nutrition, maybe if people pay more attention to the degree that they're able, what's on the label and what is this food providing for me? If you go in the store now, you can see a section, like a massive section on Fruit Roll up type things, right. And some of those things are some I guess not all packaged foods are created equal, I guess is what I'm trying to say. Right. Some of those things, they're going to provide calories, but not a whole lot else, whereas others will actually provide more benefits. So are there any particular guidelines for what people should or shouldn't be looking at when it comes to those kinds of things? 

34:36
Kristin Koskinen
I think okay, let's start with the mindset. We're going to start with the mindset of abundance versus scarcity. And weight loss is a scarcity mindset can't don't bad. We're going to start with abundance. What's going to fuel me? What looks good? If you're looking at labels and packaged or processed foods, it's going to vary. So it really depends on your needs and where we're going because there are sometimes like I recommend sports drinks to dancers, not to drink as a beverage all the time and at home, but we may use those strategically. I am not a fan of red dye number 40. I really don't like it. It has some bad effects and it can really negatively impact a lot of people. However, if you have a sports drink, if that's what you can have and you don't get migraines from red dye number 40, and it's going to get us through and you're not going to be under hydrated at a lack of electrolytes and missing sugar. 

35:32
Kristin Koskinen
You need to perform. We're going to take that as an exception. So planning out what you're going to do in advance can be really helpful, knowing what you need and what you might have. Sodium is one that I look at a lot, and people poo sodium, and I think we all know the value of sodium. So avoid products that say low on them. We don't want low. We don't want low sugar because low sugar usually means there's a sugar substitute in there, even if it's natural. If it's a sugar substitute, whether it's an artificial sweetener or something that's natural but highly processed, avoid it. If it says high fiber or if it says high, we want to look at that too, because they may have added something like Chickery or inulin, which may be okay, but it could give you massive intestinal distress, which we don't want. 

36:22
Kristin Koskinen
So fiber is good, but an inulin is coming in. And be cautious with that. We don't know if it's absolutely safe. It's not a, oh yeah, just throw that stuff at it. But manufacturers are putting it in because then they can pull back on sugar and they can pull back on other things when they put this food additive in. So if you see high fiber, if it's advertising the nutrient labels, be cautious. Anylen in chicory may mess with you. Anything sslphame K Saccharine stevia can mess with you. What else? If it says high protein, look at where the protein is coming from. Are they adding it in? And is it a source that is good for you or not? Sometimes they are, and sometimes it's great when we're in these specific situations, like, I need a packaged food, but be aware. 

37:11
Jennifer Milner
So basically eat whole foods, basically, right? Basically. Why are we trying? Like you said, you're not a big fan of hacks and to sort of beware of them, hacks can be great for diabetics people on very specific medical diets. Totally get that. But if it seems too good to be true, eat this whole package without eating any sugar, but it tastes like sugar, then that could be an issue. Speaking of sugar, with the holidays, there's a big emotional component to the holidays and food, and there are all those treats that we sort of emotional ties to that should probably be worked out with a shrink and how we deal with food and all of that stuff sometimes, right? But if we feel like this is the time to enjoy those special foods, what roles does sugar and alcohol have with the immune system? And how do we deal with that? 

38:05
Jennifer Milner
It's okay to eat it. It's okay to indulge in something if you want, but then we have to worry about using the words indulge or withhold. So how do we walk that fine line about eating healthy, allowing ourselves to have. It not feeling like we're walking some mental tightrope emotionally with our relationship with food and of course, the immune part of it, too. Ready, set, go. 

38:27
Kristin Koskinen
Yes. Okay. So again, we're going to pull the lens back, and ideally, we're going to pull back in time and we're going to go from what's your mindset? Is it scarcity or is it abundance? And so I work with dancers a lot. I use bentos as one of my tools. And one of the reasons I use bentos is it drives variety, which can be difficult for dancers because they tend to get very narrow and specific and limited. So they drive variety. They help with meeting a bunch of different needs. They're neat and tidy, they're structured. They meet so many dancer box check many dancer boxes. And one of the things that I have with my bentos and that I prescribe is hold space. But well, before we've come to the holidays, my dancers are accustomed to this idea of hold space. And hold space is reserved just for you. 

39:22
Kristin Koskinen
There's no judgment, there's no commentary. There's nothing. It's, what do you want? This is the stuff that nourishes your soul, that makes you feel good. And it is designated. It's important. We're setting it aside just for you. You choose what it is. So for some people, hold space is chocolate eminem skittles, a token to have a glass of wine after class if you're 21 or older. It could be a note, it could be playdoh, a toy. It can be anything. But it's intended that it can be reserved for foods. And I will say that the dance dietitians that I work with and respect, I know Rachel fine, and I enjoy a sweet every day. I don't know that there's a day that goes by, but I don't have something. It's just part of life, right? It feeds us in different ways sometimes it fuels us in great physiologic ways too. 

40:18
Kristin Koskinen
But when you come in with it's normal, we've normalized this as a community. And for you, we're not going to change the whole culture. But if you feel normalized and those people around your parents, your studio, your instructors, because you do this and they see you doing it all the day, there's no big deal. So now when we take that concept of hold space and we translate it to the holidays, there's not a big difference. Except now the hold space may be more emotionally tied, like, oh, this family recipe means so much to me. I have enjoyed this recipe since I was a child. Or this is something in my culture, this is cultural. We do this. And I feel a connection to this. And it is important for some people, it's just knowing it's there. For some people, just making the food and making sure that they follow through with, this is how my grandmother's hands have kneaded this dough or twisted this knot or whatever it is that's adequate. 

41:20
Kristin Koskinen
If for some reason, let's say, you're gluten intolerant or you just don't feel well, or you've got a performance and you know that hit of sugar at that particular moment isn't going to serve you, that's okay. You may want to save it for later or take it to have when you can enjoy it. Or maybe you can't enjoy it right now because of the way your health is working, but you can be there and be with it or create other ways to still enjoy it. Caveat just being around the food or saying, oh, I just like to look. 

41:49
Jennifer Milner
At the food or touch the food. 

41:51
Kristin Koskinen
Or make it for the other people can also be a sign of disordered eating. So take what I said, and if that's something that resonates with you, that may be something to unpack too. But there should be no pressure, and it really should be something that brings you joy. Joy is important. The artistic community seems to think you have to be in pain and somewhat crazy to be a good artist, and I'd like to dispel that. 

42:24
Dr. Linda Bluestein
And joy is a perfect lead in to alcohol, too. Could you just touch on that briefly? 

42:31
Kristin Koskinen
Yeah. So we know okay, alcohol is a depressant. We know that it's definitely something to take in moderation, if at all. Alcohol is a toxin, and it disinfects not to the degree that we can use it on surgical instruments. It's not concentrated enough, but it can sterilize and it can sterilize things in your microbiome. So be aware of that. And you really need to limit how much you have. There's been talk, and again, as we see things, as we watch science unfold, there was a lot of talk in the 90s about the benefits of alcohol and all these things in the Mediterranean diet and drinking wine. Well, was it the wine or was it the reservatol that came with the wine? Was it that people needed to manage their stress? And maybe going for a walk after dinner was a better idea than three glasses of wine with dinner. 

43:26
Kristin Koskinen
We know that there are definite negative consequences with alcohol. I want touch back to gun sugar, because I think this is important just with regard to where we're at is sugar. When we talk about sugar timing matters. Okay, so now we're going to get performance nutrition related. If you notice that you are grabbing, going for sugary sweets throughout the day, I want you to ask yourself why. Very often, if you are eating sugar throughout the day sweets, and this isn't vilification, this is curiosity. If you're eating them throughout the day, we want to ask why are you using it for an energy bump? Are you not eating enough? Are you not getting enough protein? If you notice that this is a behavior you have, we want to know why. Eating a lot of sugar or sugar consistently in the form of sweets or refined sweets can demonstrate when you're not getting enough energy overall and your brain needs glucose. 

44:22
Kristin Koskinen
And so it's saying, let's get it. You may not be getting enough protein. You may have a Dysbiosis that's say a candida overgrowth, which can drive sugar cravings. So we want to see, is that a problem? When I suggest sugar in that hold space, it's for a time to sit and to be enjoyed, not to nosh on over the course of the day. And the reason for that is we know that sugar, simple sugars, can tamp down the impact and health of white blood cells for a period up to maybe 5 hours. So if you're gnashing on sugar throughout the day, you're really hitting your immune system in a big way. So just like with alcohol, you've got a period of time where it's in your system before you've metabolized. It the same with sugar, it's there for a period of time and that's okay. 

45:20
Kristin Koskinen
And the body's resilient and it's going to be fine. Have the brownie, have the cookie, have the cake, whatever, and then be done and move on with everything else. You really need a lot of nutrients. And if you're eating a lot of simple sugars, you're also setting an ARSF up for a B vitamin deficiency because to metabolize that sugar requires B vitamins. So now you may find B vitamins are needed in the metabolic process of creating energy. So now if you've consumed all those B vitamins and you're not getting more in with whole foods like fruits, vegetables, whole grains and meats, now you may find you're fatigued again and it creates a cycle of demanding more of those. And if you're low on those B vitamins now, your immune system isn't just depressed because, hey, we've hit the neutrophils and slowed them down among other immune cells. 

46:14
Kristin Koskinen
But now we're at a B vitamin deficiency and it may be subclinical, meaning you're not presenting with it in ways that your physician is going to be like, wow, you must have a B twelve deficiency because you've got tremors and tingling and your neurologic system is out of whack. It can just be writing under the radar. 

46:34
Dr. Linda Bluestein
Those are such fabulous points. And I'm also thinking about how many people who are hypermobile have issues with their teeth and their gums. So if you're eating a lot of sugar all throughout the day, you're also really helping that bacteria to grow on your teeth and increasing your risk of gum disease, which increases your inflammation in your whole body, and that can increase your risk for chronic pain. And what I love about what you're saying is all of these things that you're saying are so beneficial if you're making better choices, they're also so beneficial for the whole body. It's like you're dealing with the root cause rather than just like you're saying take a pill or a supplement for this or this and then now you have to deal with the side effects of that. Anytime you can address the root cause, you're going to be so much better. 

47:18
Kristin Koskinen
Off than if you're just trying to. 

47:20
Dr. Linda Bluestein
Fix something after the fact. One of the things that you've brought up a couple of times and as our final topic, I wanted to just have you dive a little bit into is the microbiome. I know lots of people are like, oh, but I take Probiotics or I take prebiotic pills, or there's all kinds of products on the market now. And we know that the microbiome is super important for immunity. Can you give us a little microbiome pre Probiotic 101, what we should know about those in the immune system? 

47:49
Kristin Koskinen
Sure. Okay, so the microbiome plays a really big role and it includes linda, you just mentioned the mouth. So mouth, gut, skin, anywhere there's mucus, we're going to find it. And it's colonized by a lot of microorganisms, not just bacteria, but fungi and viruses and parasites. And so when we talk about usually we're talking about the gut. And so there's an interface and a conversation that goes on with these microscopic organisms and our own immune system and it's a two way dialogue and so it impacts our immune system and all kinds of things metabolism, neurologic, health, any number of things. For the most part, what we're talking about, it's in the intestines. So we want to make sure that we are feeding that. So we have something that we call commensal bacteria. Those are the good guys. And what we know, and there's a lot of information, but the more diverse that population is, the better. 

48:56
Kristin Koskinen
We want to have a wide variety. And people who eat a wide variety of foods tend to have a broader variety of microbiota. That's because they tend to like different foods. And their food stuffs for the most part come from fibers and plants and things that we don't digest. So eating a broad swath of plant foods, different herbs, different spices, different vegetables, different legumes, everything you eat that's different helps to support that diversity and feeds the good guys. And so part of what's going on is it's a game of balance. So we want to have balance in the body and there are going to be some things in there that can be damaging to us. But in simplistic terms, the good guys outnumber the bad guys. We're in good shape and we do know that specific strains do specific things. So before you take a Probiotic, you want to know if that's a strain you might want to check and see is that a strain that's appropriate for you? 

49:59
Kristin Koskinen
And if you struggle with IBS Bloating, any kind of GI symptoms, SIBO, you may want to resolve some other things before you go there. And it may or may not be a good idea. And that really goes with all supplements. So eating a broad variety of plant foods is important and I recommend it highly. If you can eat 100 different plant foods in a month, that could be a goal. And it doesn't have to be serving sizes. It can be I had a parsley plant growing and I had two parsley leaves. It doesn't have to be over the top. It really can be. Oh, I made chili and so I added celery and peppers and not just kidney beans, but black beans and white beans and look it and tomatoes and you're there, right? You're going to hit it in one dish. When I make chili, I add canned pumpkin and it's surprisingly good. 

50:54
Kristin Koskinen
You don't even taste it. And you get this food that otherwise seems to be relegated to pie twice a year, households, unless you're eating, unless you're making a bunch of pumpkin bread, and here we are, pumpkin season. But there are different things you can do. There are culinary ways that we can help bolster your diet to support that microbiome that tastes good. You can also obvious things are probiotic foods, so foods that are fermented, and if they're fermented, they need to be in the refrigerator section for them to work. If you're getting your sauerkraut off a shelf in the middle of the grocery store, then it's not going to be the same as the stuff you get off. So sauerkraut, kimchi, keffer, yogurt, miso are all examples, any kind of fermented, vegetable are all examples of ways to ingest these organisms that help support that work with us in a symbiotic relationship to help us with our health. 

51:53
Kristin Koskinen
And they are preferred and do a better job typically, than the supplements we take. If we can't get to that level, then a supplement can be important and helpful. And sometimes we may want to bring in specific strains of things to get specific outcomes. And that's the case with supplements. I'm going to give a plug on supplements here. Overall, you want to be specific, you want to be intentional. Just don't try things because you read about it in an article or your friends taking it or your favorite influencer mentioned it and mentioned all the benefits. We really want to be specific, which. 

52:30
Jennifer Milner
Goes back to the whole be careful where you get your information, right? We want to get our information. And this is a fantastic time to say everybody should follow you if they don't because you want to get your information from a dietitian, from somebody who has some sort of certification and not from the mom next door who started working for a pyramid group and now does coaching, who may not have the qualifications right for handing out nutritional advice. So that's a really important caveat. 

53:01
Kristin Koskinen
Yeah, it really is because here are some of the things that people don't know. So you can have a coaching certification and all these things and that's fantastic and there's definitely a role, but when we start looking at supplementation. You need to look at it like medicating. It's important because there can be distinct consequences. So, for example, a lot of dancers will start with and we saw this during the pandemic, people started hitting a lot of things really hard. Vitamin D, zinc, vitamin C were three big ones. So it's great. If you want to take vitamin D, get a baseline level. Let's see how much we need to give you. If you're going to take it, let's make sure you're getting enough. Right? And let's make sure we taper or get you where you need to be or find food and lifestyle changes that can help you support you in other guys. 

53:45
Kristin Koskinen
Before we just start dosing vitamin D. And if you're going to take it, hey, we want to make sure you're getting that with vitamin K two, because we can end up with some other problems if you don't. Do you need zinc? Well, let's look at it from a dietary source first so we make sure you don't overdo. Because if you get too much zinc and you're not balancing it with the right amount of copper, well, now you might not get enough copper. And the problem with that is copper deficiencies. Guess what? They lead to immune compromise, and they lead to collagen production compromise too. So when we get Hype on zinc, now we've created a deficit of copper. And if you already struggle with collagen production, you certainly don't want to throw another kink in the works with a nutrition deficit that you've created with nutrient competition in the intestine. 

54:34
Jennifer Milner
Yeah, that makes a lot of sense. And I know my doctor that I work with tests me regularly for my D levels. And she had said last year that she had, I think, five patients with vitamin D levels over 100, which is really high because she was seeing through the pandemic. People were like, oh, we need to and so people were just taking these doses and not if they didn't have someone doing regular blood work that they wouldn't see that. So it is really important to not just say, oh, I know it's getting to that season. Let's take a bunch of zinc, and I'm sure I will stay healthy. There's been so much information that you've given us here, not just on the immune system, but on nutrition in general. Was there anything that you wanted to cover that we didn't? And where can people find you? 

55:21
Kristin Koskinen
I think we need to have a part two, because the answer also very. 

55:26
Jennifer Milner
Much, so much more, right? 

55:28
Kristin Koskinen
So much. And people can find me. You can find me on my website, which is WW Dot Eatwellpros pros.com or Instagram, which is my name. Kristen. K-R-I-S-T-I-N underscore koskaden. K-O-S-K-I-N-E-N. Underscore RDN. And that's where you find me the most. Unless I'm hanging out with you guys. Yes. 

55:56
Jennifer Milner
Which is also true. Kristen is a team member of Bendy Bodies, so you will find her posting. And if enough people ask for it, maybe she will post her chili recipe with the pumpkin in it for us one time. Or maybe I'll just have to beg off camera, something like that. But that sounds delicious. Maybe we can get something like that from her. 

56:19
Kristin Koskinen
That's a great idea. Yeah, we'll take a poll. 

56:23
Jennifer Milner
I think all you need to know are our opinions and we say yes. 

56:27
Kristin Koskinen
If Jen wants it, we give it to her. 

56:29
Jennifer Milner
That's exactly right. We speak for all of the Bendy Bodies out there. We say we want this chili recipe. Well, you have been listening to Bendy Bodies with the Hypermobility MD. And our guest today was Kristen Koskinen RDN. Thank you so much for being here, Kristen, and for sharing your knowledge with us once again on our podcast. 

56:49
Kristin Koskinen
Thank you. 

56:50
Dr. Linda Bluestein
We got so much fabulous information. I know people are just going to love this episode and we really appreciate you taking the time to share your vast expertise with us. 

57:01
Kristin Koskinen
Thank you. It is always my pleasure. 

57:08
Jennifer Milner
Well, if you love what you learned, follow the Bendy Bodies podcast. To avoid missing future episodes. Screenshot this episode. Tagging us in your story so we can connect. Our website is WW bendibodies.org. You can follow us on Instagram @bendybodies. Leaving a review following the Bendy bodies podcast and sharing the podcast helps spread the word about hypermobility and associated conditions. This information is not intended to diagnose, treat, cure or prevent any disease. The information shared is for educational purposes only and is not a substitute for medical advice, diagnosis or treatment. Please refer to your local qualified health practitioner for all medical concerns. We will catch you next time on the Bendy Bodies podcast.