Questions and Answers
Q: Since I've gotten pregnant, I've heard a lot about gestational diabetes. Can you tell me what the risk factors are for this condition? Are there any preventive measures I can take?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Gestational diabetes is a condition that occurs during pregnancy, usually towards the end of the 2nd trimester. During pregnancy, fluctuating hormones cause insulin resistance in a woman's bodythis means that the insulin that the pancreas produces is not used as efficiently as it normally should be. If you have a genetic predisposition to diabetes, and this predisposition is combined with fluctuating pregnancy hormones, it can sometimes cause gestational diabetes.
Those at risk for developing gestational diabetes are people who are older than 25, are overweight, sedentary, have a family history of gestational diabetes, or have had the condition in previous pregnancies, those carrying multiple fetuses, or those who have delivered a baby weighing nine pounds or more. Practical tips for decreasing your risk for gestational diabetes are the same as those for type 2 diabetes: keep your weight in a healthy range prior to conception, avoid excessive weight gain during pregnancy, and remain physically active. If you were not physically active prior to becoming pregnant, talk with your healthcare provider about the right level of exercise for you during pregnancy.
Gestational diabetes typically resolves itself after the baby is delivered, and as your weight, activity, and hormone levels return to normal. However, people who have had gestational diabetes are at an increased risk for developing type 2 diabetes within ten years of giving birth unless you make significant lifestyle changes.
Posted 5/5/2008
Q: I am 74 years old and suffer from many health conditions, including osteoarthritis and peripheral neuropathy. I eat lots of fruits and veggies, but for some reason my edema keeps getting worse. My doctor tells me to just live with it. Can you offer any suggestions?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Edema is characterized by fluid accumulation in the body. While there are many different causes and numerous strategies to treat the condition, reducing sodium intake can often help. Sodium holds on to fluid in the body and the more sodium you consume, the greater the fluid retention. In addition to reducing your sodium intake, you might also try adding foods that are rich in potassium, which can help increase the amount of sodium you urinate out. However, if you take a medication that increases blood potassium, you must be careful about your potassium consumption. Of course, it is always prudent to inquire with your health care provider before starting a high potassium diet.
Even though you are eating fruits and vegetables, there may be other foods in your diet that are high in sodium. For example, processed foods, frozen dinners, packaged rice, mixed noodles, chips and many condiments are high in sodium. Even cheese, breakfast breads and cereals, as well as canned vegetables, can contribute to elevated sodium levels. By reading the Nutrition Facts Label on packaged foods you can determine if a product will fit into a low sodium diet. Most health professionals recommend keeping sodium intake under 2300 mg per day, but check with your healthcare provider to see what your individual goals are.
In addition to the aforementioned causes of elevated sodium levels, some people also have poor venous return, which means that fluid accumulates in the lower extremities. Keeping your legs elevated and wearing supportive hosiery can mitigate the effects of this condition.
If you find the condition onerous, or if it worsens, you might discuss the use of a mild diuretic with your physician.
Posted 5/5/2008
Q: When choosing a brand of yogurt, is it better to opt for one that is higher in calories and has more protein or fiber, or something lower in calories?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: It depends on what you're hoping to obtain, nutritionally speaking, from your choice of yogurt. The best-tasting yogurt with the fewest calories and fat that has the most calcium would be my choice. Yogurt is a good source of calcium but does not naturally contain fiber. If you don't get calcium from other food sources such as other dairy products, tofu processed with calcium sulfate, salmon or sardines with bones, then you need to consider yogurt for its calcium content. If you're already getting fiber in your diet from other sources such as fruits, vegetables, whole grains and legumes, then whether or not the yogurt has fiber is not as important.
Posted 3/3/2008
Q: Can I take my calcium (1,200 mg) together with other medications? Can I take my calcium with coffee?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Calcium, along with adequate vitamin D, promotes maintenance of strong bones and teeth. It also facilitates muscle contraction and nerve conduction. Consuming adequate calcium daily can help reduce the risk of osteoporosis. Adult women require between 1,000 and 1,200 mg each day.
Caffeine has a small negative effect on calcium retention. If milk is used in coffee, retention of calcium is decreased. However, if you have a high caffeine intake and do not consume adequate calcium, then the effect of taking your calcium supplement with coffee can be exacerbated.
Calcium can influence the way your body absorbs other medications when taken together. For example, calcium should not be taken with tetracycline because the calcium can bind to the tetracycline and make it unavailable to your body, so it wouldn't be used effectively. If you take multiple medications with your calcium supplement, talk with your health care provider about possible interactions.
Posted 3/3/2008
Q: I've just entered my second trimester and my doctor is concerned that I've already gained too much weight. How can I eat well and give my baby all the nutrients it needs without adding on too much extra weight? And, please don't ask me to give up dessert!
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: In women who are normal weight before pregnancy a weight gain of 26 to 35 pounds during pregnancy is ideal. An increase of approximately 300 calories a day above usual calorie intake starting in the second trimester is recommended to meet the increased energy demands of pregnancy. Energy needs in the first trimester approximate those of non-pregnant females. Health care providers usually look for a weight gain of approximately 1 to 1.5 lbs per week starting in the second trimester. Excessive maternal weight gain is associated with pregnancy induced hypertension and gestational diabetes among other complications. If you have already gained excessive weight, your goal should be to slow the rate of weigh gain, but not to lose weight.
The best way to avoid excessive weight gain during pregnancy is to choose nutrient dense foods (those supplying many nutrients at reasonable calorie levels). A good way to look at food needs for pregnancy is to think in terms of food groups. An adequate diet for pregnancy would include 7 ounces from the protein group (meat and meat substitutes), 3 servings of milk products 7 servings of grain products, 5 servings of fruits and vegetables, and 3 servings of fat. Although getting adequate servings from all the food groups might sound challenging, most serving sizes are quite modest. A serving of fruit and vegetables is just ½ cup or 1 tennis ball size piece; ½ cup cooked grains or 1 slice of bread is a serving from the grain group, a teaspoon provides a serving of fat and 7 ounces of meat for the whole day is only the size of a chicken breast. It is the choices you make from each category that will determine whether you meet or exceed your calorie needs. For example, 8 oz. of skim milk is 90 calories, whereas 8 oz. of whole milk is 150 calories. Although there is no need to give up dessert, you may want to consider the type and frequency of the desserts you have. A slice of angel food cake with strawberries provides 160 calories, while a slice of chocolate cake is 340 calories.
Exercise can also play a helpful role in reducing excessive weight gain as well as facilitating labor (when it's time!), reducing the risk of gestational diabetes and relieving stress. Continuing a pre-pregnancy exercise program during pregnancy can help reduce fat and facilitate a quicker return to pre-pregnancy weight. If you are starting an exercise program for the first time during pregnancy it is best to discuss your plans with your healthcare provider before you begin. Exercises such as walking, swimming and bicycling are all good choices.
Posted 1/2/2008
Q: I just turned 59 and with the big 6-0 on the horizon I've started exercising and trying to take better care of myself (better late than never, right?). Are there any super-foods a gal like me should begin adding to her diet to help keep my mind sharp and my body strong?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: It is never too late to get into better physical and mental shape—and kudos to you for getting making an effort! As the body ages, our needs increase for some nutrients and decrease for others. While energy requirements often decline with age due to lower metabolic rate and decreased physical activity, protein needs may increase. This is especially true of older adults with chronic illnesses. Choose protein sources that are low in fat and saturated fat such as fish, poultry and soy. In addition, older adults need more dietary vitamin D, calcium, and Vitamin B6.
Although there are no diet-related magic bullets to prevent the aging process, getting a good dose of antioxidants from the colorful (green, orange and red) fruits and vegetables (try for 5-9 servings a day); phytoestrogens and fiber from whole grains and legumes (6-8 servings a day); adequate calcium and vitamin D from low fat dairy (3 servings) and a modest amount of healthful fat; both omega-3s from fatty fish and monounsaturated fats from nuts and seeds is a good way to keep your body healthy for the long run. Although getting adequate servings from all the food groups might sound challenging, most serving sizes are quite modest. A serving of fruit and vegetables is just ½ cup or 1 tennis ball size piece; ½ cup cooked grains or 1 slice of bread is a serving from the grain group, a teaspoon provides a serving of fat and 7 ounces of meat for the whole day is only the size of a chicken breast. Consuming two, 4 oz. servings of fatty fish per week will provide the recommended 1 gram omega-3 fatty acids. It is the choices you make from each category that will determine whether you meet or exceed your calorie needs. For example, 8 oz. of skim milk is 90 calories, whereas 8 oz. of whole milk is 150 calories. If you do not drink milk and live in a northern climate, taking a vitamin D supplement with calcium is a good idea.
Posted 1/2/2008
Q: What is the best way to take folic acid: All at once or scattered throughout the day? I would like to take 800 micrograms (0.8 milligrams) daily. In addition to supplements, what foods should I eat that are high in folic acid?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Folic acid, also known as folate or folacin, is probably best known as the vitamin that prevents neural tube defects such as spina bifida during pregnancy. It plays an important role in the development of a fetus, particularly synthesis of DNA, which is essential for protein production and the transfer of the genetic material of cells. Without adequate folate, the proteins in cells that make up the fetal nerves, spinal cord and brain may not form properly, which leads to neural tube defects, such as spina bifida ("cleft spine"). Deficiencies of folate have also been associated with some cancers and as a risk factor for atherosclerosis (clogging of the arteries). Because it is so important for women of childbearing age to get the recommended amounts of folate before they become pregnant, the federal government mandated the folate fortification of grains and cereal products.
Although widely distributed in the American food supply, folate is highly sensitive to heat and light and food processing methods. Furthermore, much of the folate found in food is in a form poorly absorbed by the body. Supplements and foods fortified with folate, such as ready-to-eat cereals, are better absorbed. Supplements can be taken once daily, at any time of day.
The recommended intake of folate for adults is 400 micrograms per day and for pregnant women 600 micrograms. An example of a selection of foods that, together, would give you the recommended value of folate is: 1 cup spinach, 1 cup broccoli, 1 cup orange juice and 1 cup lentils. Just one serving of fortified breakfast cereal has 400 micrograms. Furthermore, all wheat, rice and corn grown in the United States is fortified with folic acid. In addition to eating fortified grain products, leafy green vegetables, nuts, beans, citrus fruits and liver are all good sources of folate.
Folate is not generally toxic at high levels, although excessive intake of folate can mask vitamin B12 deficiency, which may lead to neurological problems. It is very difficult to reach a toxic level of folate from unfortified foods alone.
Posted 9/1/2007
Q: I was recently diagnosed with type 2 diabetes. I've been told to follow a 1,500-calorie per day diet. What does a typical 1,500-calorie diet for a person with diabetes look like?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Typically, a 1,500-calorie diet is prescribed for weight loss. For someone with diabetes, the carbohydrates in the diet should be spread out over the day to avoid spikes in blood glucose (sugar) levels. Most of your carbohydrate selections should be those that are digested slowly—high-fiber foods, such as whole fruit, whole grain breads and cereals. Your fat choices should come from mono- and poly-unsaturated fats such as olive oil and nuts. How many servings of each category of food is in your meal plan will be based on the minimal requirements for a healthy diet, the amount of carbohydrate you can tolerate based on your blood glucose levels and your personal preferences. An example of such a diet is: six servings starch, two servings fruit, four servings fat, three servings vegetables, six servings protein and two servings milk. A sample menu based on this plan is:
Breakfast: 1/2 cup oatmeal, 1 slice bread with 1 teaspoon margarine, 1 small peach, 1 cup black coffee
Lunch: Turkey sandwich with 2 ounces turkey, 1 teaspoon mayonnaise, 2 slices tomato and lettuce; 1 cup 1% milk; 1 cup salad greens with shredded carrots and tomato, 1 tablespoon oil and vinegar; 1 cup flavored non-caloric water.
Snack: 1 cup berries
Dinner: 4 ounces grilled salmon with mustard, 2/3 cup brown rice with 1 tablespoon chopped almonds, 1 cup steamed broccoli with 1 teaspoon margarine
Snack: 1 light yogurt
There are many menus that would fit this pattern, and a meal plan should be individualized to the person who will be following it. My best advice would be to make an appointment with your health care provider or a registered dietitian and together come up with a meal plan you can follow for the long-term.
Posted 9/1/2007
Q: I have chronic constipation, which is probably from the medication I have to take for severe arthritis and a fractured spine. Regular use of over-the-counter laxatives results in nausea. Prescription laxatives haven't helped. High-fiber diet and activity aren't enough to prevent it. What can I do?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Bowel habits differ, and it is not necessary to have a bowel movement every day. However, lack of a bowel movement beyond a 72-hour period or straining generally indicates a problem. Constipation is often a side effect of many medications, especially narcotics. Increasing fiber and fluids is always a good first step. Make sure you are getting at least 14 grams of fiber for every 1,000 calories or are eating a minimum of 25 grams of fiber per day. It isn't difficult to consume 25 grams of fiber with a little effort. For example, you might have a cereal with at least five grams of fiber per serving at breakfast with a serving of fruit; a sandwich on whole wheat bread with a pear for lunch and a cup of broccoli with a baked potato as part of your dinner, ending with a snack of a handful of nuts. Beans and peas, high-fiber cereals, fruits, vegetables and nuts all add fiber to the diet. When increasing fiber in the diet, it is also important to drink adequate amounts of fluid, or large amounts of fiber can have the opposite effect causing more constipation. Try for at least 64 ounces of fluid a day and make sure that most of these fluids are decaffeinated.
Inactivity and poor bowel habits (ignoring the signal to have a bowel movement) can also contribute to constipation. Get regular exercise, if possible, and be sensitive to your body's signals.
Sometimes changing the bacterial environment of the gastrointestinal tract can help relieve constipation. Although the evidence is not definitive, many people have found that using a probiotic (bacteria that is beneficial to the body) aids in establishing an intestinal environment that promotes regularity. Probiotics can be purchased separately as a supplement or in yogurt and some milk drinks. There are a number of these products on the market. Look for those containing live cultures of bifidus. To be effective, products must contain at least a certain number of organisms. Ask your pharmacist for a product recommendation.
Finally, there are times when lifestyle management is not sufficient. In this case, your health care provider may suggest you follow a bowel regimen including non-stimulating laxatives with suppositories and enemas. Adequate follow-up and evaluation are important because persistent use of stimulating laxatives can lead to dependency and mineral imbalances in the body.
Posted 7/1/2007
Q: My teenage stepdaughter is eating a protein bar for breakfast and Special K cereal for lunch and dinner. We are worried that this is not enough food. What should we do?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: The teenage years are often ones of experimentation and testing limits, and short-term diet stints are usually not harmful. However, severely limiting the diet to one or two food groups on a regular basis, or cutting calories drastically can deprive the body of needed nutrients for growth and health. Eating properly, in addition to getting enough sleep, can make a difference in school and in after-school activities. The longer the deprivation, the greater the risk of long-term consequences such as damage to vital organs.
During the teenage years, the body is rapidly growing and adding bone and muscle. Adequate calories and protein are needed to provide building materials for this growth. One simple way of determining the impact of your stepdaughter's diet on her health is rapid changes in her weight. Rapidly weight loss, especially if she is not overweight, would be an indication for concern. In addition, many teenage diets lack adequate sources of calcium and iron. Calcium intake in the teenage years is one important determination of future bone health. And extra iron is needed to sustain the increased muscle mass and replenishes losses from menstruation.
Each of the food groups—meats or vegetarian proteins, dairy, fruits, vegetables, healthful fats and grains—contributes different nutrients. Taking a vitamin supplement cannot replace the variety of healthful components found in food. Two bowls of cereal and a protein bar would not provide the minimum levels of all the needed nutrients.
It is important to find out why your stepdaughter has decided to diet. If you feel comfortable talking with your stepdaughter, you should discuss her reason for limiting her food intake. Is she perhaps trying to lose weight? Does she want to follow a vegetarian diet? Is she simply following the latest fad? Or is her choice of diet a method of exerting control? See if she would be willing to explore more healthful ways of achieving her goals. Seek assistance from your health care provider.
The Center for Young Women's Health (www.youngwomenshealth.org) is a trustworthy, online resource that discusses a range of teenage health and wellness issues that you and your stepdaughter may find useful.
Posted 7/1/2007
Q: I have hypoglycemia and have to eat every two hours or so. I've been gaining a lot of weight even though I eat mostly healthy foods—fresh fruits, vegetables and grains. How can I control my weight when I have to eat so much, so often?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Eating more frequently is one strategy used to avoid low blood glucose (sugar) for people with hypoglycemia. Hypoglycemia can be associated with diabetes, as well as many other health conditions. Hypoglycemia itself is not a disease, but rather an indication of a health problem, so make sure you're working with your health care provider to identify the cause. In the meantime, an eating plan based on fresh fruits, vegetables, whole grains, lean protein sources and heart-healthy fats can help you achieve a healthful diet and reduce your symptoms of hypoglycemia. However, maintaining a reasonable weight while eating more frequently often requires a conscious effort to be aware of portion sizes. Although your frequency of meals has increased, the size of your meals should decrease. Combinations of one to two servings (15 to 30 grams) of healthy carbohydrate choices paired with one to two servings of lean low-calorie protein is all it takes. For example, a slice of whole grain bread and two ounces of tuna packed in water with sliced tomato is less than 150 calories. Make sure you are also choosing low-calorie beverages because fluids such as fruit juices, sodas and even milk can add a considerable amount of calories to your eating plan. And don't forget regular exercise, which will help with both weight loss and maintenance.
Posted 5/1/2007
Q: I work a 7 p.m. to 7 a.m. shift and am trying to lose a lot of weight (about 100 pounds). My body is fairly well adjusted to this schedule, but are there some foods that I should avoid because of my schedule?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Congratulations on your decision to get in better shape. The body is able to metabolize food at any time of day, so there aren't any foods you need to avoid due to your schedule. However, you want to make sure you eat a variety of foods from each food group, choosing those that are low in fat and high in fiber as often as possible. Skip the high-fat, empty calorie goodies that often accompany an overnight shift, such as doughnuts, pastries or pizza. Instead, bring healthy snacks to work, including fresh fruit, nonfat or low-fat yogurt and whole grain crackers. Also, make sure you eat at least three meals a day; avoid skipping meals because of your schedule. Going too long without eating can lead to a drop in your metabolism and may cause you to overeat later on. And don't forget to fit in some physical activity. Because you are trying to lose a substantial amount of weight, it's wise to meet with a registered dietitian who can help you work out an eating and activity plan to lose the weight safely. Best of luck.
Posted 5/1/2007
Q: Weight gain is one of the side effects of the medication I take for a chronic condition. The extra 15 pounds I've packed on has really affected my life. I want to lose weight but have trouble controlling my appetite. What can I do to limit this constant desire for food that accompanies use of the medication?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Constant hunger can make it very difficult to limit your food intake. There are basically two lifestyle approaches to this problem, which work best if used together. For both approaches you must follow a sensible plan for weight loss and not starve yourself by either skipping meals or by reducing your calories so you are unable to meet your body's basic needs.
With this in mind, when hunger hits you, the first approach is to wait it out. Hunger generally comes in cycles. If you can focus your mind on another activity for 15 or 20 minutes when hunger strikes initially, the craving will pass. In other words, you need an activity, such as going for a walk or talking to a friend on the phone, to provide a distraction and take your mind off food. You might also ask yourself if you're truly hungry, or if you're eating for other reasons, such as stress, anxiety or boredom, for example.
The second approach is to eat foods that are nutrient dense without being high in calories. Foods high in fiber, especially fresh vegetables, fit into this category. Recent research also shows that meals that contain some protein and a small amount of healthful fat can reduce hunger. Both protein and fat take longer to digest than carbohydrates. Adding lean protein (fish, skinless poultry, loin cuts of red meat and vegetarian sources of protein such as soy and dried beans) and small quantities of healthful fats, such as nuts, to your meals can help you stay full longer. In addition, some studies show that drinking hot beverages, such as a cup of tea or a cup of vegetable broth, can fill you up and take the edge off your hunger.
There are also some prescription medications that reduce appetite. Ask your health care provider if these are options for you. Finally, don't forget about regular physical activity. Physical activity can help you burn calories, curb your appetite and improve your overall health.
Posted 3/1/2007
Q: I've been hearing a lot about "hoodia" lately. Is it safe to use for weight loss?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Hoodia gordonii is a flowering plant found in southern Africa. The Bushman of South Africa, also known as the San, have traditionally used the plant for treating indigestion and small infections. In 1977, the South African Council isolated the appetite suppressant factor in the Hoodia plant and named it P57. Unfortunately, Hoodia, as either a weight loss drug or supplement, is not ready for prime time. A pharmaceutical company abandoned trying to develop P57 into a weight loss drug due to manufacturing problems. Hoodia is still available as a component in some supplements, diet bars and shakes, although most of the Hoodia supplements and products currently on the market don't contain the active ingredient, P57. There isn't good research regarding Hoodia's effectiveness, and there is some concern as to its safety. In addition, there are no clear-cut guidelines regarding safe and effective doses.
Although not glamorous, the tried and true approaches of following a healthful eating plan and getting regular exercise are more likely to produce results. There are also some drugs approved by the U.S. Food and Drug Administration (FDA) to help people with weight loss. Your health care provider is the best person to guide you in this area.
For more information about herbal products, visit:
Posted 3/1/2007
Q: I finished chemotherapy for estrogen receptor positive (ER-positive) breast cancer this past April. I take tamoxifen and have been advised by my doctor to avoid foods that contain estrogen. Although avoiding all estrogens in foods is probably impossible, I would still like to know what are some common foods with high amounts of estrogen or phytoestrogens, such as soy, flax and wild yams, that I should avoid?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: You are certainly on the right track. The goal for people who have had breast cancer and/or are taking tamoxifen is to avoid a diet high in phytoestrogens, but not to avoid all sources, as more than 300 foods have been found to contain some level of these substances. Depending on the source (both food or supplement) and its preparation, the phytoestrogen content of similar products can vary widely. Phytoestrogens are naturally-occurring substances found in plants that can either mimic the actions of estrogen in the body or work against the body's estrogen. Because phytoestrogens can cause tissue growth, women who have had breast cancer are cautioned against ingesting large amounts of these compounds. Additionally, studies have found that genistein, a type of phytoestrogen, prevented the tumor suppressive action of tamoxifen.
There are three classes of phyoestrogens:
- Isoflavonoids, found in legumes, with soybeans being the major dietary source of this compound.
- Lignans, found in cereal bran, beans, fruits and vegetables, with flaxseed having the highest amount.
- Coumestan, found in peas, pinto and lima beans, with alfalfa and clover sprouts having the highest amounts.
Wild yam, by the way, is not related to sweet potatoes or yams that we often eat in the United States. The root of the wild yam is used to make supplements that some women take to treat menopausal symptoms or osteoporosis, but there's no evidence that it's effective. Always talk to your health care provider before taking any supplement. You should definitely avoid taking phytoestrogen-based supplements, such as soy isoflavones or black cohosh. Also, reduce your intake of soy products (e.g., tofu, miso, tempeh, soymilk), flaxseed, alfalfa and clover to keep your phytoestrogen intake close to the United States average, which is considered quite low.
More information on diet and cancer prevention and therapy can be found at:
Posted 1/1/2007
Q: What does an eating plan for a pregnant woman look like?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Interestingly, it looks similar to a healthy eating plan for an adult woman who isn't pregnant, just with more calories and special attention to certain vitamins and minerals. During pregnancy women should eat plenty of fresh fruits and vegetables, whole grain products, lean meats or meat substitutes and lowfat dairy foods. Foods with little nutritional value, such as sweets and fats, should be consumed sparingly. You should also drink plenty of fluids, although avoid drinking alcohol, and limit caffeinated beverages. During the second and third trimesters of pregnancy your body and the baby's body are growing so you need about 300 more calories and about 10 extra grams of protein each day. In addition, you need additional iron, calcium, zinc, folic acid and B6 for your baby's growth.
Because it is important to get enough folic acid in the months before you conceive, your diet should contain plenty of foods with naturally occurring folate, such as orange juice, green leafy vegetables, beans, peanuts, broccoli, asparagus, peas and lentils. To make sure you meet your vitamin and mineral needs, your health care provider will likely prescribe a prenatal multivitamin. Protein, calorie and calcium requirements can easily be met from food sources. By having three servings from the milk group, four servings from the vegetable group, two to three servings from the fruit group, two to three servings from the meat or meat substitutes group, and seven to nine servings from the bread/grain group, you will be on your way to a nutritionally healthy pregnancy.
These recommendations are for healthy adult women. Teenagers and women with special needs should contact their provider or a registered dietitian for specific advice.
The following Web sites provide additional information on pregnancy and nutrition:
Posted 1/1/2007
Q: Can you recommend foods appropriate for someone on a yeast and mold-free diet? I do not eat potatoes, corn or eggs.
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: I am assuming that you are allergic or intolerant to mold and yeast. Carefully following a diet for a food allergy/intolerance can be a daunting task. For some food allergies completely eliminating one or two foods is all that is necessary to remain symptom free; other food allergies require a large investment of time, energy and know-how to identify and avoid problem ingredients and still plan both a nutritionally sound and appealing diet.
A food allergy is caused by the body's immune system inappropriately reacting to a protein molecule in a usually harmless food. Food allergies can develop at any time and a person may become sensitized to a previously tolerated food.
Both molds and yeast are types of fungi that are pervasive in our environment. While it's not possible to totally avoid exposure to mold, you can reduce your risk of having an allergic reaction by avoiding cheese, mushrooms, vinegar, beer and wine, pickled and smoked meats, dried fruits, peanuts and peanut-containing products.
At this time a clear link between yeast and medical symptoms in the healthy adult has not been proven. However, for those who want to reduce the amount of yeast in their diet, avoiding items such as alcohol, vinegar-containing foods, breads and pastries made with yeasts and commercially prepared foods such as soups, sauces and salad dressing is recommended.
Fresh meats, vegetables, fruits and certain unprocessed grains would form the basis of the diet. Since both mold and yeast are found in many foods, contacting a registered dietitian, who has experience with food allergies and intolerances, is the best way to plan an appropriate diet.
The following organizations provide information and referrals for people suffering from food allergies and intolerances:
American Academy of Allergy, Asthma, and Immunology
www.aaaai.org
American College of Allergy, Asthma, and Immunology
www.acaai.org
Food Allergy Network
www.foodallergy.org
American Dietetic Association
www.eatright.org
Posted 11/1/2006
Q: Sometimes I have to grab a sweater after eating a meal because I am literally freezing. What causes this?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Our core body temperature stays relatively constant, ranging from about 98 degrees to 100 degrees, depending on the air temperature. The body dissipates heat by sweating and tries to generate heat by shivering. Body part, individual tolerance, length of exposure and intactness of the skin, actual environmental temperature and humidity affect the body's tolerance to heat and cold. In addition, people with neurological problems often have distorted temperature perception. When you have an infection or traumatic injury, your body temperature will rise. Too low a body temperature can occur due to cold exposure, certain types of infections, hypothyroidism and diabetes.
Although I do not have a specific answer to your question, I can hazard a guess. The temperature of the foods themselves affects our feelings of hot and cold. For example, we may feel cold after eating ice cream. During digestion blood is directed away from the muscles and tissues and toward the digestive system. If you were physically active before eating your meal, which generates heat, and then stopped and ate, the combination of heat lost due to digestion and the loss of blood flow to the skin may cause you to feel cold.
Posted 11/1/2006
Q: Are there any diet pills or weight loss supplements that one can use without becoming addicted?
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| Nora Saul, M.S, R.D., L.D.N., C.D.E. |
A: Overweight and obesity are serious conditions associated with a number of chronic health problems. More than two-thirds of the American adult population are considered overweight or obese.
The cornerstone of successful weight loss involves lifestyle changes, such as eating a healthful, high-fiber, lower-calorie diet, being physically active, and behavior modification. In addition, there are several prescription medications that can augment the benefits of these lifestyle changes. Like many medications, weight loss drugs do have side effects and these effects are sustained only for the time the medication is used.
The two medications approved by the U.S. Food and Drug Administration (FDA) for long-term weight loss are sibutramine (Meridia) and orlistat (Xenical). Meridia works by tricking the brain into making you feel full quickly. It can cause increased blood pressure, headache, dry mouth and constipation. Xenical |
