Questions and Answers

Q: Can you offer tips for maintaining a very low-sodium diet?

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: Much of the salt in our diets comes from eating out frequently and consuming packaged and prepared foods. As our dietary habits have changed over the last several decades, the number of people diagnosed with high blood pressure has increased. Reducing the amount of sodium in the diet and losing weight are among the most effective lifestyle changes available to treat this chronic condition.

Sodium is an essential nutrient, but the amount required per day is minimal. Many health organizations recommend limiting the sodium in your daily diet to no more than 2,300 mg—the amount in one teaspoon of salt. Some Americans consume much more than that.

In addition to its preservative properties, salt makes foods taste better to many people. That may make adhering to a low-sodium diet difficult. However, the preference for salty foods is not innate. Infants younger than 4 months don't like salty tastes. Although it's difficult, you can retrain your senses to prefer a less salty taste.

The best way to maintain a low-sodium diet is to adhere strictly for a few months. This gives the body a chance to develop a new, lower set point for sodium.

Here are a few tips for reducing salt in your diet:

• Choose fresh, unprocessed foods that provide strong flavors either by themselves or with added spices. Such foods include sweet fruits and highly spiced meats and vegetables.

• Banish the salt shaker from your kitchen.

• Avoid low-sodium versions of packaged foods for about three months. Choosing low-sodium versions of favorite packaged foods during the adjustment period may cause disappointment and frustration with the diet.

• At restaurants, select low-sodium appetizers such as fruit cups and green salads with oil and vinegar, and ask for baked or broiled entrees to be made without added salt.

After a few months of adhering to a low-sodium diet, you will be pleased to find many highly salted items you may have enjoyed before are now too salty.

These guidelines work well for sodium intakes above 1,500 mg. Below this level, special foods, such as low-sodium milk, breads and fats, are required. If you need to follow a very low-sodium diet, you should consult a registered dietitian.

Posted 7/1/2009

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: The good news is that very low-calorie diets, also known as weight cycling, do not reduce metabolic rates for the long term. This means your body will continue to use energy (calories) at the same rate it always has. You should not gain additional weight as long as you do not exceed your calorie needs.

If you have reached your goal weight, you can determine your calorie needs by multiplying 30 times your weight in kilograms (1 kilogram equals 2.2 pounds). For example, if you weigh 120 pounds, you would multiple 54.5 times 30 to determine that you need 1,635 calories per day. If you exercise heavily, you can consume more calories; if you are sedentary, you need fewer calories.

Regular exercise will help in your effort to maintain your weight loss. Muscle burns calories faster than fat. The 2005 Dietary Guidelines recommend healthy women who want to manage body weight and prevent gradual unhealthy weight gain engage in 60 minutes of moderate to vigorous aerobic exercise on most or all days of the week while not exceeding caloric intake requirements.

As you increase your calorie intake gradually to the desired daily level, make sure you eat a variety of foods from all the food groups. Include plenty of fresh fruits, vegetables, and lean meats or vegetable proteins, and limit the amounts of added fats and sugars.

Posted 7/1/2009

Q: Are there affordable ways to integrate more organic foods in my diet?

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: Organic has come a long way, baby. Fifteen years ago, most organic foods were found only in specialty stores and associated with people following alternative lifestyles. Many supermarkets today display organic produce alongside conventionally grown fruits and vegetables, with the organic products usually commanding a higher price than the similar conventional foodstuffs.

What makes a food organic, and why does it command a higher price? And is it really healthier? "The principal guidelines for organic production are to use materials and practices that enhance the ecological balance of natural systems. Organic agriculture practices cannot ensure that products are completely free of residues; however, methods are used to minimize pollution from air, soil and water," according to the U.S. Department of Agriculture (USDA).

Uniform national standards for the term organic were established under the Organic Foods Production Act (OFPA) in 1990. This act established the USDA National Organic Program, which oversees the production, handling and processing of organically grown agricultural products. Agricultural products are labeled based on the percentage of organic ingredients they contain.

Foods can be labeled organic in three tiers: "100 percent organic" foods are made from only organic ingredients and processing aids; "organic" foods are derived from 95 percent organically produced ingredients; and foods "made with organic ingredients" have at least 70 percent organic ingredients and are made without the aid of sewage sludge or ionizing radiation. Foods labeled "100 percent organic" or "organic" can display the USDA organic seal.

Organic foods do not have any additional nutritional benefit, although they may be healthier because they do not contain the levels of pesticides found in conventionally grown products. In addition, because they reduce the toll taken by conventional agricultural methods on the soil and water, they may provide overall ecological benefit for the planet.

If you buy organic foods in your local supermarket you may be paying more than you have to. With a little research and a willingness to explore, you can often find organic foods that won't break the pocketbook. Whether you choose to buy organic or not, buying in season and in bulk can often reduce costs. Freezing and canning excess fruits and vegetables are good ways of extending the life of foods and saving money. If you buy in your local supermarket for convenience, find out if the store brand has an organic version. The store brand is usually less expensive than other brands.

In addition, farmers' markets, co-ops and buying clubs often have organic foods available at discounted rates. If your town has a community farm, you may be able purchase a share and receive locally grown produce. The Organic Consumers Association provides information on organic and "green" businesses.

To find out more about organic agriculture, visit the USDA's guide to Sustainable Agriculture Organizations and Information Providers and How to Go Organic.com.

Can't afford to eat all organic? Start with these items. Plus, simple tips for budget shopping.

Reference:
USDA National Agricultural Library. www.nal.usda.gov/afsic/pubs/ofp/ofp.shtml.

Posted 5/6/2009

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: The gallbladder, a small organ under the liver, is the storage tank for bile. Bile helps the digestion of fat in the diet. When you eat a meal containing fat, bile moves from the gallbladder through the common bile duct into the intestine. There it helps emulsify the fat and prepare it for transport and storage.

Once you have your gallbladder removed, the liver takes over the role of providing bile for digestion. For the initial period after surgery, you may find that you have more frequent, looser stools, but this should clear up in a short time. Although it is not required as a prophylactic, moderating the fat in the diet and reducing the saturated fat in your diet can be helpful in avoiding weight gain and cardiovascular problems.

Posted 5/6/2009

Q: Are there specific strategies for keeping your thyroid in check?

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: The short answer to your question is no. However, many thyroid diseases, such as Graves' disease (hyperthyroidism) and Hashimoto's thyroiditis (hypothyroidism) have a genetic component, and research into the whys and hows of thyroid disease is ongoing.

The thyroid gland is a small double-lobed gland located at the base of the neck. Despite its small size, the thyroid gland is the powerhouse of metabolism. The two hormones the gland produces-tetraiodothyronine (T4) and triiodothyronine (T3)-help regulate temperature control, growth and metabolism. The body controls how much thyroid hormone is released by a feedback mechanism involving two other glands: the pituitary and the hypothalamus. When circulating thyroid hormone is low, the hypothalamus releases thyroid releasing hormone (TRH), which causes the pituitary to release thyroid stimulating hormone (TSH). TSH acts on the thyroid gland to increase production of T3 and T4.

In order for T3 and T4 to function properly, the body must have an adequate supply of iodine. In some areas, such as parts of the United States, parts of Canada and the Swiss Alps, the soil and water do not contain adequate amounts of iodine to prevent goiter (enlargement of the thyroid), so foods such as salt are fortified with iodine. If the supply of iodine is inadequate, the TSH causes the thyroid gland to swell in size to better capture more iodine.

Currently, the best method for keeping your thyroid in check is to recognize the symptoms of both hypothyroidism and hyperthyroidism and see your doctor if you notice such symptoms. Avoiding excess amounts of iodine is important if you have an autoimmune thyroid condition, such as Graves'.

Symptoms of hypothyroidism:

• weak, slow heart beat
• muscular weakness and constant fatigue
• sensitivity to cold
• thick, puffy skin
• slowed mental processes and poor memory
• constipation
• goiter

Symptoms of hyperthyroidism:

• rapid, forceful heartbeat
• tremor
• muscular weakness
• restlessness, anxiety and sleeplessness
• profuse sweating and heat intolerance
• diarrhea
• eye changes
• goiter

Posted 1/8/2009

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: The answer from a practical standpoint is it is better not to. Fish allergies tend to be severe, often causing anaphylaxis, a serious allergic reaction that can cause constriction of the airway with difficulty breathing. Allergies are due to protein molecules, so theoretically if a fish oil capsule had no traces of fish protein, taking the oil would be fine. There have been some clinical studies where pure fish oil capsules do not trigger an allergic reaction. However, since the FDA does not regulate dietary supplements, it is difficult to know precisely what is in them. And, despite its purity, the prescription formulation of fish oil, called Lovaza, recommends caution when prescribing for people with fish sensitivities.

Although fish is usually an easy food product to avoid since its presence must be identified on a label, it is important for people with fish allergies to be aware that restaurants may use the same oils to fry fish as they do French fries. The Food Allergy and Anaphylaxis Network, www.foodallergy.org, as well as a visit to a registered dietitian can help individuals with the difficulties of managing food allergies.

Posted 1/8/2009

Q: I've been told I have irritable bowel syndrome, mostly stress-related, but are there certain foods I should consume more of and others I should stay away from?

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: Irritable bowel syndrome (IBS) is what is known as a functional digestive disorder. Although there is nothing wrong with the structure of the gastrointestinal organs, they don't work together to move waste products efficiently through the bowel. When you have an irritable bowel, you may suffer from symptoms such as gas, diarrhea, constipation, cramping, bloating and abdominal pain. Having a bowel movement may relieve symptoms.

At this time, there is no cure for irritable bowel syndrome, but there are a variety of things that can help improve or relieve symptoms. Reducing stress in your life and medications can help bring IBS under better control. You should discuss the use of medications with your health care provider.

Diet can also improve symptoms. Gradually increasing the amount of fiber in your diet until you reach 25 to 30 grams a day and eating smaller meals more frequently throughout the day can make the stools softer and relieve constipation. It is important to include enough fluid as you increase your fiber intake or you can make constipation worse. While there is no "standard diet" for IBS, trying some or all of these suggestions may help you feel better.

In addition, you may want to try cutting down on the following foods:

• fatty foods
• chocolate
• alcohol
• caffeine
• milk products

Since IBS can wax and wane, and individuals respond differently to foods, you may find you're able to eat some of these foods without problems at one time and find them difficult to digest at another. If milk products bother you, be sure to include another source of calcium in your diet.

Posted 11/3/2008

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: The oils found in cold-water fatty fish are prized for their beneficial effects on the heart and circulatory systems. Research indicates that marine-derived omega-3 fatty acids have the ability to reduce cardiac arrhythmias and triglyceride levels and decrease the risk of cells sticking together and forming a clot. Experts recommend the general public consume between .3 to .5 grams per day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). This means you should eat two servings of fatty fish per week.

If you do not like fish or cannot eat it or you have a need for higher levels of omega-3s to treat a specific condition, fish oil capsules are a practical alternative. In addition, as our oceans become more and more polluted with the byproducts of our industry, heavy metal contamination of marine life is a real threat to certain populations, such as children and pregnant women.

Fish oil supplements do not appear to have the same contamination problems as fish. A study in the January 2005 issue of the Archives of Pathology and Laboratory Medicine found that fish oil supplements contained very few contaminants. That study tested the brands Omega Brite, Nordic Ultimate, Sundown, Kirkland and CVS. Consumerlabs.com has also tested a variety of fish oil supplements and found that they met safe levels for mercury and PCS.

Most fish oil in supplements has been purified using methods such as molecular distillation to ensure that the oil products do not contain significant levels of environmental toxins. When buying a supplement, look for a product's verification that it meets the environmental protection agency's (EPA's) allowable limits for contaminants.

Posted 11/3/2008

Q: As I'm getting older, I am becoming more concerned with bone health. Are there certain foods I can eat to fend off weakened bones?

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: Nutrition is an important part of building and maintaining bone health. Bone is made of collagen and a complex of the minerals calcium and phosphate that provide strength to the collagen framework. Up to age 30, it is possible to continue to add new bone. However, once we pass over this bridge, our ability to accrue new bone mass stops. During the early stages of menopause, a woman's bone mass declines steeply; in the first five to seven years after menopause you can lose up to 20 percent of your bone mass. The greater your bone mass before menopause, the better your chances of avoiding fractures after menopause.

Although your genes are largely responsible for determining your peak bone mass, what you eat, the amount you eat, and the type of exercise you do can have a significant effect. The two major nutrients needed to maintain healthy bones are calcium and vitamin D. In addition, sodium, potassium and possibly protein play roles in maintaining bone health.

Over 99 percent of the body's calcium is stored in the bone. Depending on your age, you will need 1,000 to 1,200 milligrams of calcium a day. Foods high in calcium include dairy products, certain leafy green vegetables, calcium-treated tofu products and sardines with bones. Calcium is also added to some juices and fruit drinks. If you do not consume adequate amounts of calcium from food, supplements containing calcium carbonate or calcium citrate are available. You should not exceed 2,500 milligrams of calcium per day from all sources.

Vitamin D helps metabolize calcium. New research shows that the amount of vitamin D we need may be more than previously thought. Food sources of vitamin D are limited. Some sources include fatty fish, cod liver oil, egg yolks, fortified milk and other fortified foods. Vitamin D can also be generated by getting out in the midday sun for 15 minutes at least twice a week. In northern climates during the winter, the sunshine is not adequate to generate vitamin D, and most health care providers suggest supplementation if you don't regularly consume fortified milk products. Recommendations for vitamin D intake are 200 units from ages 19 to 50, 400 units from ages 50 to 70, and 600 units over age 70.

Excess sodium intake, low potassium intake and, more controversially, excess protein intake have been shown to increase calcium excretion. These negative effects are reduced when individuals consume adequate calcium. Avoiding foods containing large amounts of sodium, such as canned products, frozen dinners, chips and highly salted condiments, can help reduce sodium intake. To ensure that you are getting your potassium for the day, eat five or more servings of a variety of fruits and vegetables.

Posted 9/4/2008

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: You are not alone. Many women put on weight during the years leading up to and during menopause. At the rate of a pound per year, women can add anywhere from six to 12 additional pounds during this time. And, as you may have noticed, the additional pounds tend not to be spread evenly over the body. Before menopause, women tend to add weight in a pear distribution on the hips and thighs. During menopause this changes to more of an apple distribution around the midsection.

The causes for the weight gain are not completely understood. Hormone changes seem to play a role. During menopause the ovaries stop producing estrogen. The body seeks to maintain estrogen levels by looking for additional sources. One source is fat cells. Although not proven, declining estrogen levels may predispose the body to convert calories into fat cells. In addition, testosterone levels decline during menopause. Testosterone helps create muscle. If you do not exercise to maintain muscle mass, the reduced testosterone levels can lead to increased fat cell mass and reduced muscle mass. Since muscle burns more calories than fat, weight gain often results.

Unfortunately, there are no magic foods or nutrients that can turn the tide on weight gain. As we get older we tend to eat more and move less. Together, these two behaviors lead to weight gain. Often without realizing it, we gain a pound or so each year. It is important to follow a low-fat diet containing fruits, vegetables, whole grains and lean sources of protein; reduce excess calories from extras; and practice both aerobic exercise and strength training. This can help stop weight gain and loss of muscle mass.

You may find that you hit a plateau with your diet and exercise program. If so, make an appointment with a dietitian or exercise physiologist who can review what you are doing and make suggestions to get you back on track.

Posted 9/4/2008

Q: I'm a new mom, and I've been breastfeeding for three months. When is a good time to make the transition from breast milk to food? What are the best foods to start with?

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: For the first four months of life, breast milk will supply all of an infant's needs. After this time an infant's requirement for iron exceeds the amount that is provided by breast milk. This is the time to introduce iron-fortified baby cereal.

The first step is to determine if your infant is ready for solid foods. If your infant is able to keep her head upright when sitting and is able to swallow when food is placed on the tongue, then she is ready for solid food. Try baby rice cereal first, since it is the least allergenic. Two to four tablespoons twice a day is recommended, with a small amount of breast milk added. Don't be discouraged if your baby refuses the food—babies often require a number of attempts before a food is accepted. Remember, your baby has only been drinking milk for her whole life and has to get used to the texture of food.

The type and amount of baby cereal can be increased once the rice cereal is tolerated. At about six months, strained fruits and vegetables can be added. To make sure your child tolerates the food, offer only one new fruit or vegetable at a time over a period of a few days. This way if a reaction occurs, you will know which food is the culprit. Additional food groups are added at 8, 10 and 12 months. You should discuss any concerns you have about feeding your child with your pediatrician. In addition, a basic infant feeding guide is available online from the WIC Web site at: www.nal.usda.gov/wicworks/Sharing_Center/gallery/wic_fam10.htm or in a handy pamphlet from the International Food Information Council ific.org/publications/brochures/solidsbroch.cfm

Posted 7/5/2008

Q: My three-year-old won't eat any vegetables. How can I incorporate some into her diet in a fun, yummy way?

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: Modeling good behavior can make a distinct impression on a child: if your child sees you avoiding vegetables, he will certainly notice. So, set a good example, and eat all of your vegetables!

Even if your child appears to hate vegetables, continue to offer them at meals. Often foods refused at one time will be accepted later on. Raw vegetables are a great way to get kids to eat healthfully, and toddlers often prefer the texture and taste of raw vegetables over cooked. You can also dress those veggies up with low-fat yogurt, salsa, applesauce or guacamole, and see if your child prefers them that way.

Including vegetables as part of a casserole, stew or soup can be a great way to work vegetables into his or her diet. Putting veggies on "fun" foods like pizza or grilled cheese are also great ways to integrate vegetables into your child's diet. As a last resort, play a game using a variety of raw fruits and vegetables. For example, make funny faces using chopped fruits and vegetables and let him choose which parts of the face he wants to eat first.

Remember, do not become anxious—most toddlers get the nutrition they need even if they are picky. Keep offering and feel secure in the knowledge that a few days without vegetables won't be a calamity.

The USDA Food and Nutrition Information Center provides information on healthy eating for infants, toddlers and children and links to other reliable health and nutrition sites.

Posted 7/5/2008

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?

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 body—this 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?

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?

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?

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!

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?

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?

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?

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?

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?

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?

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?

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?

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?

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:

• Medline Plus: www.nlm.nih.gov/medlineplus/druginfo/herb_All.html
• Food and Nutrition Information Center: www.nal.usda.gov/fnic/etext/ds_herbinfo.html
• National Center for Complementary and Alternative Medicine: http://nccam.nih.gov
• Office of Dietary Supplements: http://dietary-supplements.info.nih.gov

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?

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:

• American Institute of Cancer Research: www.aicr.org
• American Cancer Society: www.cancer.org

Posted 1/1/2007

Q: What does an eating plan for a pregnant woman look like?

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:

• USDA Food and Nutrition Information Center Lifecycle Nutrition: http://fnic.nal.usda.gov
• U.S. Centers for Disease Control and Prevention (CDC): www.cdc.gov/ncbddd/bd/abc.htm

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.

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

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?

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 prevents your body from absorbing fat. It can interfere with the absorption of fat-soluble vitamins, and cause diarrhea and abdominal pain. Neither medication is considered high risk for developing a dependence, although care should be taken in those with a history of drug or alcohol abuse.

There are several new drugs in clinical trials, many of which work by stimulating or suppressing the body's own hormones. Whether they turn out to be effective and safe long term is a question for the future. There are also numerous over-the-counter supplements and remedies that claim to induce weight loss. Most are appetite suppressants or diuretics of one sort or another. None have been found to be effective long term and some, like ephedra, which is now banned, have been linked to serious side effects.

Some issues to think about before considering a weight loss medication:

1. Your degree of overweight: weight loss medications are usually prescribed for people with a body mass index (BMI) over 27 who have additional complications, such as diabetes; or for those with BMIs over 30 without complications. BMI is a measure of weight status: people with BMIs from 25 to 29.9 are considered overweight; those with BMIs of 30 and above are considered obese.
2. Your degree of success with other weight loss programs or methods.
3. Your ability to comply with taking the medications and making long-term lifestyle changes.

Weight loss is a serious, long-term endeavor. You should always discuss the various options with your health care provider or consult a registered dietitian.
Posted 9/1/2006

Q: Does caffeine affect diverticulitis? Should certain foods be avoided?

Nora Saul, M.S, R.D., L.D.N., C.D.E.

A: Diverticulosis and diverticulitis are two common conditions that are often confused. Although diverticula can occur anywhere in the gastrointestinal tract, the colon is the most common site. Diverticula are outpockets or pouches that form in the lining of the colon. These outpockets are thought to form due to high colonic pressures needed to move hard, dense stool through the colon. Diverticular disease is much more common in Western nations where fiber intake is significantly less than in developing countries. Diverticulitis occurs when the outpockets become inflamed. Abdominal pain, infection, fever and pain may result. Diverticulitis can also lead to bleeding, perforations or tears, or blockages. If the infection spreads into the abdominal cavity, the wall of the abdomen may become infected and inflamed, a condition called peritonitis. Peritonitis requires immediate surgery to repair the abdominal cavity and remove any damaged parts of the colon.

Interestingly, the dietary treatment for the two diseases represents opposite sides of the same coin. While the bowel is healing from a bout of diverticulitis, a low-fiber diet is often prescribed. This diet limits intake of raw fruits and vegetables, whole grain bread and cereals, nuts, seeds and legumes. Fiber intake is usually limited to less than 10-15 grams per day.

Once the infection has cleared, fiber is gradually reintroduced into the diet until a goal of 20-35 grams of fiber is reached. The foods that were once limited for diverticulitis are now encouraged. Some physicians still recommend that nuts and seeds be avoided but this is controversial. As fiber intake is increased, it is important to drink enough fluid to prevent constipation.

Caffeine has many effects in the body, including stimulating the central nervous system, which, if over stimulated, can lead to restlessness, anxiety, irritability and sleeplessness; increasing free fatty acid release from fatty tissue; and increasing urination. In addition, if ingested in high amounts (more than 600 milligrams of caffeine per day, the amount found in three to seven cups of coffee), nausea, vomiting or diarrhea can occur in some people. Caffeine also interacts with certain antibiotics, increasing the length of time the caffeine remains in the body. So, although you don't need to stop caffeine altogether while on a diet for diverticulitis, it's a good idea to avoid taking in too much while your bowel is healing.
Posted 9/1/2006

Q: How much is too much of a vitamin or mineral to ingest before it becomes toxic? I eat at least six to seven servings of fruit and vegetables every day, including spinach almost daily. Am I at risk for vitamin A or iron toxicity?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

A: Kudos to you for eating six to seven servings of fruit and vegetables each day! Because food contains small amounts of vitamin A, it is unlikely that you are exceeding the Daily Value (DV) of 3,000 IU (International Units) in a day. The Tolerable Upper Level (TUL) of vitamin A—that is, the most you can take without worrying about any adverse effects—is 10,000 IU. Foods rich in vitamin A are orange, red and yellow fruits and vegetables, such as carrots, sweet potatoes, tomatoes and cantaloupe; and green leafy vegetables, such as spinach and broccoli.

Iron is more complicated because there is no amount that's right (or wrong) for everyone. Premenopausal women need 18 milligrams (mg) of iron each day, whereas postmenopausal women need only about 10 mg of iron daily. The TUL for iron is 45 mg in a day. Foods rich in iron are red meat, fish, poultry, eggs, legumes and fortified cereals.

Knowing the acceptable intake of each of these nutrients, along with reading labels and/or using some of the resources below, can help guide you further.

• National Institutes of Health, Office of Dietary Supplements Fact Sheets
• USDA's Food and Nutrition Information Center
• MedlinePlus: Vitamins
  Posted 7/5/2006

Q: I've been curious about cleansing fasts since a friend of mine did one last year. A doctor supervised his over a two-week period. Is it necessary to seek a doctor's guidance before starting one of these juicing fasts? What do I need to know to get started?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

A: It is absolutely necessary to seek a physician's help if you plan on doing a cleansing fast. I do not recommend anyone use this method for cleansing or weight loss. There are more negatives to juice fasting than positives, including these potential side effects: hunger, weakness, bad breath, cankers, colds, viruses, blackouts, diarrhea, headaches, nausea, fatigue, insomnia, dehydration, irregular heartbeat and the slowing down of one's metabolic rate.

There's no solid evidence that fasting of any kind removes toxins from the body. Furthermore, fasting for weight loss purposes is merely a temporary fix; once you go off the fast, any weight lost will be regained. People who have diabetes, cancer, kidney disease, liver disease, and who take prescription medications should not fast. Pregnant and nursing women, along with infants and children, should not fast either.
Posted 7/5/2006

Q: I share information I receive from NWHRC with several of my friends, one of whom would like to gain weight. She has breast cancer and finished her last chemotherapy treatment one month ago. I typically send articles about eating right and weight loss, but she wanted information on weight gain. Do you have any helpful tips I can pass along to her regarding gaining weight in a healthy way?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

A: Chemotherapy drugs can interfere with one's ability to eat. The type of chemotherapy drugs and how they are taken influences the type of side effects someone experiences. Weight loss is a common side effect.

Some helpful tips:

• Eat small meals or snacks every one to two hours.
• Avoid drinking liquids with meals to keep from feeling full early (unless needed for swallowing).
• Drink fruit juices or low-fat milk in place of some of the water that you drink.
• Cook foods with healthy oils, such as canola or olive oil, and don't be afraid to add a trans-fat-free margarine or regular salad dressing to your foods.
• Add avocado and olives to your salads.
• Ask your health care professional about medications to help relieve any side effects, such as nausea or pain.
• Set a pretty table to create a pleasant eating environment.
• Keep some high-protein, high-calorie snacks on hand.
  • Sprinkle seeds or nuts on desserts, such as fruit, pudding or custard, as well as on vegetables, salads and pasta. Spread natural peanut butter or nut butters on whole grain toast.
  • Make a trail mix with dried fruit and a variety of natural nuts-it's portable and handy when away from home.
  • Use fortified milk* (or evaporated milk) for cooking in place of water when making cereal or cream soups; also use it for mashed potatoes or puddings.
  • Make a smoothie: mix four ounces of fortified milk with a package of Carnation Instant Breakfast, fruit and four ounces of low-fat, Greek-style yogurt.

*Fortified milk can be consumed by itself or used in cooking to add protein and calories. Recipe: Blend one quart of low-fat milk and one cup of nonfat dry milk. Chill for at least six hours. It can also be made with buttermilk and dry buttermilk.

Some free, reputable resources:

• American Cancer Society: 1-800-ACS-2345 or www.cancer.org

• American Institute for Cancer Research: 1-800-843-8114 or www.aicr.org
  Posted 5/1/2006

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Women who are at risk for developing gestational diabetes are those who may be overweight before becoming pregnant; have a family history of diabetes; are over the age of 25; have previously given birth to a large (over nine pounds) baby; or have had gestational diabetes in a previous pregnancy.

Screening for gestational diabetes is generally done between the 24th and 28th weeks of pregnancy and requires an oral glucose tolerance test. (Be sure to ask your health care professional about this test). This test involves drinking a liquid that contains glucose, which causes blood glucose levels to rise within 30 to 60 minutes. A blood sample is taken from a vein in your arm about 30 minutes after drinking the solution. The blood test measures how the glucose solution was processed by the body. If your test results are not normal, you will have a similar test that requires you to fast beforehand. If this second test shows abnormal results, you have gestational diabetes.

The good news is that gestational diabetes is treatable! Most women have healthy pregnancies and healthy babies when they take the steps to control their condition. Meal planning, physical activity (be sure to check with your health care professional before starting any kind of exercise program) and home blood glucose monitoring are the cornerstones of therapy for women who have gestational diabetes. And because women who have had gestational diabetes are at a higher risk for developing Type 2 diabetes later in life, it's important to continue with healthy lifestyle habits.

The following are reputable sources for more information:

• American Diabetes Association: www.diabetes.org

• National Institute of Child Health and Human Development (NICHD): Call 1-800-370-2943 for a free booklet, Am I at Risk for Gestational Diabetes? Or access at www.nichd.nih.gov

• The March of Dimes: www.marchofdimes.com
  Posted 5/1/2006

Q: I take 1,000 mg of calcium each day in two pills. Since I drink milk with my breakfast, is it best to take those calcium pills with lunch, then again with dinner for best absorption? I have osteopenia so I'm trying to get the most calcium I can. Can I just take a calcium pill with some fruit at my morning coffee break at work?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

It is best to get calcium from food, but to meet calcium needs many women need to take a supplement. Calcium from supplements is best absorbed when taken in doses of 500 mg or less because the amount of calcium absorbed decreases as the amount of calcium in the supplement increases. So you should aim to take one 500 mg pill of calcium with a vitamin D supplement midday and the other 500 mg pill in the evening for optimal absorption. Your calcium supplement should also contain vitamin D, which is a vitamin necessary for calcium absorption. Be sure to check the label for the amount of elemental calcium, as this is the amount of calcium actually in the supplement. The type of calcium in your pill will determine if you need to take it with food or not. Calcium supplements that contain calcium carbonate, for example, may be best absorbed with food because stomach acid is present. Calcium citrate, another effective calcium source, can be taken at anytime, with or without food.
Posted 3/1/2006

Q: I have two sons (ages 6 and 10) whose diets sorely lack in fruits and vegetables. I try to show a good example by eating a variety of fruits and vegetables, but the best results from my boys are a rarely eaten apple, or nibbling at mashed potatoes or a few ears of corn. What can I do?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Q: Two years ago I became a vegetarian. I do eat eggs and dairy. I'm finding it challenging to understand how to eat a balanced diet and have put on lots of weight. Is there anywhere I can get a simple vegetarian diet plan to lose weight and stay healthy? A simple plan that tells me what to eat on a day-to-day basis over a week or a month, how to cook it (recipes) and what quantities. I would like a diet plan like the ones that are so readily available to meat eaters.

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

American Dietetic Association
Phone: (800) 877-1600
Web site: www.eatright.com

The Vegetarian Resource Group
Phone: (410) 366-8343
Web site: www.vrg.org

American Diabetes Association
Phone: (800) 342-2383
Web site: www.diabetes.org
Recommended reading for meals: Month of Meals: Vegetarian Pleasures by American Diabetes Association
Posted 1/4/2006

Q: Is the skin on fish bad for you like the skin on chicken?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Fish fat, which takes the form of oils, contains a certain type of fat, known as omega-3s. Omega-3s have anti-clotting properties and thus may be protective against heart disease and high blood pressure. Research suggests that the higher amount of fat in fish, the greater the cardiovascular benefit.

The skin of the chicken contains most of the saturated fat, whereas not much is known about the nutritional value of the skin on fish, as most people tend not to eat the skin and most fish come with the skin removed. Although the skin on fish may be healthy to eat, pregnant women, children and the elderly should avoid eating the skin on fish since contaminants (PCBs, mercury) may be present.
Posted 1/4/2006

Q: I have had a few bouts of diverticulitis and have to be careful about what I eat. High-fiber foods cause me to have a lot of gas and gassy bowel movements. If I put vegetables in a blender and mix until they are like soup, will my body process them in the same way as if they were whole? In other words, will they cause as much gas and discomfort? Would it make a difference if they were cooked or raw when I blend them?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

When the pouches become infected or inflamed, the condition is called diverticulitis. Increasing the amount of fiber in the diet may reduce symptoms of diverticulosis and prevent complications such as diverticulitis. Fiber keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily.

People differ in the amounts and types of foods they can eat. First, be sure to increase your intake of fiber gradually. Eating too many high-fiber foods at one time can cause gassiness. Unless you're having a bout of diverticulitis, you should be eating high-fiber foods every day. Regular intake of fiber will help your digestive tract get used to the fiber and you'll probably find that your gassiness will subside. However, if certain foods cause gas and abdominal pain, then processing or cooking the food to reduce the work of the digestive track is helpful and may cause less gas and discomfort. Generally, cooking before blending the foods would be best. You might also try taking an over-the-counter enzyme supplement, such as Beano®, with your meals to help lessen gas. Decisions about diet should be made based on what works best for each person. Keeping a food diary may help identify individual foods in your diet that cause discomfort.
Posted 11/1/2005

Q: I have been reading about conjugated linoleic acid and its benefits. It seems that the results are good in animals, but as far as I've found, no substantiated positive tests in humans. Have you heard otherwise?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Q: I had bariatric surgery four months ago. I eat lots of protein, but my hair is falling out, and I don't have room for vegetables and fruit. However, I do take a liquid vitamin and calcium. What type of foods should I be eating?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Although you are eating many foods high in protein, you may need a protein supplement to help you meet the daily requirement and stave off hair loss. Along with protein, however, it is critical to eat foods and take a multivitamin high in all of the essential vitamins and minerals, particularly zinc. Zinc is needed for normal cell growth and repair, therefore is a crucial nutrient for healthy hair. Food sources of zinc include lean beef, fish, soybeans, wheat germ and whole-grain foods. It's also important to limit your intake of foods high in fat and sugar. Foods high in fat and sugar are not very nutritious and may cause unpleasant symptoms, such as dizziness, nausea and diarrhea. If you find it difficult to eat a varied diet, consult a dietitian for more personalized advice. A dietitian can help you plan healthy, tasty meals appropriate for your condition.
Posted 9/15/2005

Q: I've read that drinking coffee reduces the risk for type 2 diabetes. Is there any truth to that?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Q: I recently attended a heart healthy screening event and was told that having one glass of red wine per day can reduce the risk of heart disease in women by 30 percent. But I have a family history of breast cancer and have heard conflicting information about an increase in risk for breast cancer when alcohol is consumed. Is the benefit worth the risk for me?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Health benefits of red wine are related to one of its nonalcoholic components, called resveratrol. Resveratrol is a type of polyphenol (a natural antioxidant), found in the skin and seeds of grapes used to make wine and is especially prevalent in raspberries, peanuts and other plants. The alcohol merely serves as a vehicle for which to get the antioxidant. However, you don't have to be a wine drinker to reap the benefits of resveratrol-this polyphenol is also found in a variety of fruits, vegetables and even tea.

In weighing the risk to benefit ratio of one drink of red wine per day for heart health versus breast cancer risk, start by talking it over with your healthcare provider. Then, try taking a more holistic view of foods in general. If wine is off-limits for you, don't worry, any antioxidants found in foods are thought to work synergistically and offer protection against disease. What you can do is eat a colorful abundance of vegetables and fruits every day to get the widest possible range of antioxidants and other nutrients that can help to fight both cancer and heart disease.
Posted 7/1/2005

Q: What is the difference among different vitamin C supplements? How do they compare to each other and to whole foods, such as oranges?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Vitamin C deficiency can cause dry hair and skin, bleeding gums, decreased wound healing and bruising. A more serious, severe deficiency can lead to scurvy, but this is uncommon; however it can occur in malnourished individuals, and those with increased vitamin C requirements, such as pregnant and breastfeeding women and infants receiving unsupplemented milk diets.

The Orange Route
The recommended daily intake of vitamin C for women older than 18 is 75 milligrams (mg)/day. Women who smoke need even more vitamin C - 110 mg/day. And women who are breastfeeding need closer to 95 mg/day. The best way to meet the daily vitamin C requirement is by eating a healthy, balanced diet that is rich in fruits and vegetables. Some of the best sources of vitamin C include green and red peppers, citrus fruits and juices, berries, tomatoes, broccoli, leafy green vegetables, sweet and white potatoes and cantaloupe. The following are rich sources of vitamin C that are easy to incorporate into your daily diet:

When Fruit Isn't Enough
Taking a vitamin supplement may be a healthful option if you can't meet the recommended vitamin C intake through diet alone. Vitamin C supplements come in two basic forms: ascorbic acid and ascorbate. Although ascorbic acid is the most inexpensive and standard form of vitamin C, many people find it to be too acidic. Supplements made with ascorbate, on the other hand, are more expensive, but are better tolerated because the ascorbate is attached to minerals, such as sodium, calcium or magnesium. Despite the cost, you may get more bang for your buck with ascorbate-containing supplements because they are also good sources of minerals, such as calcium.

Ester-C
Ester-C is a more costly, yet innovative form of vitamin C. In addition to calcium ascorbate, this product also contains other vitamin C metabolites. Manufacturers of such products suggest the added metabolites help the body absorb the vitamin C and keep the vitamin C in the cells longer. Beware, however, these claims are made by the manufacturers and have not been substantiated by scientific data.

No matter how you meet your vitamin C requirement, you should not consume more than 2000 mg/day. High doses can lead to stomach upset, kidney stones and severe diarrhea.
Posted 7/1/2005

Q: I can't always find or afford fresh vegetables like spinach or Swiss chard, let alone have the time to cook them. Can I get the same nutritional benefits if I eat frozen varieties of these vegetables?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

To the Plate
A small percentage of certain nutrients that are susceptible to heat, such as vitamin C, folate and thiamin, are lost during the flash-freezing process. However, unless you eat them raw, the same nutrient loss occurs when cooking fresh vegetables. Whether you are preparing frozen or fresh vegetables, the way in which they are cooked is key to maintaining nutrient content. Vegetables of any type that are boiled in a large amount of water for a long time lose a lot of nutrients, compared to those that are steamed or microwaved.

Helpful tips:

• Keep frozen vegetables no longer than six months
• 
  
• Do not thaw frozen vegetables before cooking
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• Cook for a short amount of time
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• Steam or microwave in as little an amount of water as possible
• 
  
• Use cooking utensils made from glass, stainless steel, aluminum or enamel (helps preserve vitamin content when cooking)
• 
  Posted 5/1/2005

Q: Now they're saying that we need to eat less than 300 mg of cholesterol daily. Does that mean I should cut out red meat? I've read that eating too much fish isn't healthy either.

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Lean, red meat actually has about the same amount of cholesterol as chicken and fish, yet it usually contains more saturated fat. For this reason, be sure to limit your intake of saturated fat -- found in animal products and tropical oils (like palm and coconut oil), and trans fat -- found in processed foods and many store-bought baked goods. They raise low-density lipoprotein (LDL), or "bad" cholesterol more so than eating foods high in dietary cholesterol, such as egg yolks. Rest assured that you don't need to totally eliminate red meat from your diet, but you should try to limit intake to 6 ounces per week.

You can also take these simple steps:

• Choose lean cuts of meat, such as loin or round, and remove skin from chicken and turkey.
• Include a variety of fish in your diet: Fish is a great source of protein as it is low in fat and high in beneficial, heart-healthy omega-3 fatty acids. It is best to eat a variety of fish. However, some types are high in mercury, and this is especially a concern for pregnant women. If you're pregnant, avoid shark, swordfish, king mackerel and tilefish, and limit fish consumption to 12 ounces per week.
• Eat more egg whites and egg substitutes. Limit egg yolks to two per week if you already have or are at risk for heart disease.
• Choose luncheon meats that are 95 percent fat-free, such as lean ham and turkey breast.
• Select low-fat or part-skim cheeses, as well as low-fat cottage cheese. Low-fat cheeses have no more than 3 grams of fat per serving.
• Be creative with meat substitutes: Choose a variety of dried beans and peas, such as kidney, lima, soy, pinto, navy and black beans, peas, chickpeas and black-eyed peas, lentils and vegetarian baked beans. Beans and peas are a great, high fiber and high protein addition to soups and salads. Also, experiment with tofu and soy-based foods, including soy burgers and soy hotdogs.
  Posted 3/1/2005

Q: I travel for work a lot, flying back and forth between different time zones. Are there any foods I should avoid or eat that will help me with jetlag?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Although the effects of jet lag vary among travelers, almost everyone experiences some symptoms. Physical differences among travelers require varying strategies for jet lag management. Recommendations often emphasize plenty of sleep, proper nutrition and sometimes the use of medication.

Avoiding factors that contribute to jet lag may be the best defense. Because sleep-wake disturbance is the most widely felt jet lag symptom, being well rested before travel can help the body cope with the inevitable change in time zone. Therefore, it is helpful to avoid alcohol, caffeine and nicotine, which are associated with restless sleep.

A few tips that may protect you from jet lag:

• Drink lots of water to prevent dehydration.
• Limit or eliminate alcoholic beverages and drinks containing caffeine (coffee, tea, cola), which can contribute to dehydration and cause restless sleep.
• Don't eat everything that comes your way. Gases (including those in your digestive tract!) expand at high altitudes. You may need to loosen your belt a notch or two by the time you arrive.
• For some people, eating a high-protein meal that is low in calories before travel helps prevent jet lag. For example, eating a light meal of baked or broiled chicken, with some steamed vegetables may be a better choice than a heavy pasta meal, which is high in carbohydrates.
• Move around as much as possible during the flight. This improves circulation, moving nutrients and waste through the body and aiding elimination.
• If you fly at night, try to get some sleep on the plane. Use the complimentary earplugs and blindfold. Purchase an inflatable travel pillow.
• A short-acting sleeping pill may help you snooze on the plane and adjust to a new time zone at your destination. However, talk to your health care professional before you take sleeping pills, as some can have disagreeable side effects.
• Talk to your health care professional about taking melatonin (a hormone that helps regulate the sleep cycle) to help prevent jetlag. Studies show that some people are able to prevent jetlag, or lessen its severity, by taking melatonin.
• Switch to the local time as soon as you arrive. A cold shower or quick swim can give you an extra energy boost.
• Consider a stopover along the way, or schedule a day to rest when you arrive.
  Posted 3/1/2005

Q: I love fried foods -- fried chicken, french fries and such. Do I have to cut them out completely to protect myself from heart disease?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

French fries, fried chicken, donuts, cookies, chips and other snack foods usually contain partially hydrogenated oils, or trans fats, along with saturated fat. In fact, nearly all fried or baked goods contain some trans fats. Trans fats tend to raise total cholesterol and LDL ("bad") cholesterol levels, and lower HDL ("good") cholesterol levels, all of which contribute to an increased risk for heart disease. One way to ensure heart healthy eating is to eliminate trans fats as much as possible from your diet. Take advantage of food companies and restaurants that are beginning to tout their use of "trans-fat-free" products and cooking methods. Or look for the next best things to your favorite foods, such as baked french fries or breaded chicken. Note of caution: Trans-fat-free does not mean calorie free! Maintaining a healthy body weight, eating a diet high in fiber and low in trans and saturated fats, and getting regular physical activity is the best way to ensure heart health.
Posted 2/1/2005

Q: Is it true that drinking tea can cut your risk of heart disease? Are there other foods I should eat to protect my heart?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

A note regarding new Guidelines to a Healthier Heart:
With a greater understanding of the relationship between diet and health, nutrition and medical experts crafted the new 2005 Dietary Guidelines for Americans. These are evidenced-based guidelines to help improve health and reduce the risk of chronic disease. These guidelines should serve as the basis for heart-healthy eating and meal planning. The guidelines emphasize reduced calorie intake and increased physical activity -- calories in should not exceed calories out (calories burned).

A few of the heart healthy recommendations include:

• Eat more fruits and vegetables
• Eat more whole grains and fewer processed carbohydrates like cookies and candy
• Choose low-fat or non-fat dairy products
• Choose poly- and mono-unsaturated fats whenever possible (found in fish, nuts, and vegetable oils), and avoid saturated and trans fats (found in many store-bought baked goods, fried foods and some margarines).
  Posted 2/1/2005

Q: I really appreciate the information in your newsletter. Could you please write about nutrition and working the night shift? I am a registered nurse, and I am having difficulty adjusting my diet from days to nights. Thank you in advance for the information.

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Often women who work the night shift might have breakfast before getting off duty and before returning home to sleep. Some may even exercise before going home, which would make breakfast even more important to eat. The other option is to eat breakfast right when you get home, before going to sleep.

Aim to eat lunch later in the day during some brief waking periods; consider something light like a sandwich on whole grain bread or a homemade roll-up or a piece of fresh fruit with a yogurt. If you tend to sleep for most of the day, then you might plan an early evening dinner and bring leftovers for a "lunch" or a "brown bag" lunch for work with a fruit, some pretzels or a yogurt for snacking.

With the holidays approaching and the onslaught of treats (and goodness knows, people love to shower nurses with treats during these times), healthy eating can be a challenge for all of us. So having snacks handy can minimize overindulgence with treats. Lastly, try to limit the amount of caffeine-containing beverages that you drink during your shift, such as regular coffee, tea and cola, as well as greasy, fatty foods, as they can disrupt your sleep patterns.
Posted 12/1/2004

Q: I have a family member who's coming to our house for the holidays. She's diabetic. Is there anything I should keep in mind when planning meals?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Some tips for the holidays:

• Serve foods, such as fruit, nuts in the shell, or a fresh vegetable tray with light spreadable cheeses or dips, to be enjoyed whenever guests need to eat. Certain diabetes medications may require a person to eat a snack sooner than the meal can be served.

• When planning your menu, provide a balance of carbohydrate, protein and fat. The Thanksgiving meal is a good example: roasted white meat turkey, baked sweet potato, plenty of greens and perhaps a fruit cup for a starter. You might add a tossed salad as an option (even if it isn't a traditional part of the holiday meal).

• Serve food family style or buffet-style so guests can choose their selections and control portion sizes. People with diabetes generally are advised to fill most of their plate with vegetables, whole grains and unsweetened fruits, with smaller portions of low-fat dairy products and lean protein foods, and very small amounts, if any, of alcohol-containing, high-fat or high-sugar foods.

• Provide a choice of low-sugar, low-fat desserts. For example, substitute artificial sweeteners for part or all of the sugar used in recipes. Using artificial sweeteners will decrease the carbohydrate content of the food, allowing your guests to eat more carbohydrates during the rest of their meal.

• Use 1/3 less sugar in your recipes. Serve pumpkin or apple pie since each has fewer calories and carbohydrates than pecan pie.

• Serve a variety of sugar-free beverages, including water. Another option is a spritzer, which can be made with seltzer water, a splash of cranberry juice and lime. If your guest would prefer wine, offer a wine spritzer.

• Limit added fats such as butter, oil, cream or cheese to your food preparation. Use nonfat milk or low fat milk in recipes; evaporated skim milk is a good substitute for cream. Provide reduced fat cream cheese, sour cream, mayonnaise, salad dressings or other toppings as choices. Fat-free dips are a good alternative. Serve sauces and gravies in separate bowls and let people choose the amount to add to food.

• Ask your guest if there are any particular "favorite" holiday foods that she usually eats and try to have one or two available for her.

• Finally, consider asking your guest when she usually eats her meals, and, if possible, think about adapting your meal schedule to better accommodate hers.
  Posted 12/1/2004

Q: I just found out that I have type 2 diabetes, and I don't know what to eat. I love brownies! Does this mean I can't eat them any more?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Until 1994 it was commonly believed that people with diabetes should avoid all desserts and sweets. Today, the message is different. Most people with diabetes can eat foods containing sugar as long as the total amount of carbohydrates for that meal or snack is consistent, and foods high in added sugars are added within the context of healthy eating. But this does not mean that you can eat desserts and not worry. Cookies, pastries, ice cream and cakes should be eaten less often due to their high calorie and fat content and low nutritional value.

But sugar is not the only type of carbohydrate you need to control. The body will digest all carbohydrate foods to glucose. The carbohydrate food groups are the starches (rice, pasta, bread, cereal), starchy vegetables (potatoes, corn, peas), fruits (canned, fresh, dried), dairy (yogurt, milk) and sweets such as cookies, cake and candy. The amount of food you eat is directly related to your blood glucose. When you eat more carbohydrates than your body can handle, your blood glucose may rise higher than expected.

Checking your blood glucose two hours after you eat gives you an indication of how the carbohydrate foods you ate affect your blood glucose. If you ate too many carbohydrates, take a walk to help your body burn the extra calories and to help lower your blood glucose level.

Choose food high in fiber more often, such as whole grains, beans, fresh fruit and vegetables. It is important to eat healthy foods, watch portion sizes, exercise and lose weight if you need to.

One meal planning approach that people with diabetes can use to help manage their blood glucose is the carbohydrate counting method. Carbohydrate counting is a method of calculating the grams of carbohydrates or number of carbohydrate servings you eat at meals and snacks. Counting carbohydrates helps create flexibility in your meal plan so you can include a variety of foods. If you want to know how many carbohydrates you should eat in a day, see a registered dietitian or diabetes educator to help create an individualized plan that will work for you.
Posted 10/1/2004

Q: I have type 2 diabetes and I know it is important for me to lose weight, but how do I start?

Jo-Anne M. Rizzotto, M.Ed, R.D., L.D.N., C.D.E.

Choose a variety of healthy foods like vegetables, fresh fruits, whole grains (wheat, oats, bran and barley), beans and low-fat meat, poultry and dairy. Eat fish two to three times per week and pick heart-healthy fats, such as olive or canola oils and nuts and seeds, rather than saturated fats such as butter, stick margarines or shortening.

Managing your weight also means you need to pay attention to how much and how often you eat. Everything today has become oversized, or what we call "portion distortion." So it is now easier to overeat because we've lost sight of what constitutes a portion. Until you visit with your registered dietitian, stick to standard portions sizes listed on the food labels.

Do not skip meals or eat so little during the day that you allow yourself to become super-hungry by nighttime. When you don't eat well-balanced meals during the day, or forgo them entirely, you'll end up so famished that you're far more likely to binge. A reliable way to keep your appetite from getting out of control is to incorporate good sources of protein into your meals. Examples include sliced turkey, chicken breast and seafood.

Some tips for helping with your weight loss efforts:

• Preplan and prepare meals and snacks ahead of time. This helps when you are too tired to cook and can keep you on track.

• Shop from a list, and shop when you are not hungry.

• Eat slowly so your brain can get the message when you've become full.

• Eat more vegetables. Cover half of your plate with greens. Take seconds of vegetables or salad instead of more meat and potatoes.

• Choose high-fiber foods, such as multi-grain breads, high-fiber cereals, fresh fruits and vegetables.

• Snack sensibly, such as raw vegetables with salsa.

• Choose smaller servings, get to know what a serving size is, weigh and measure portions if necessary.

• Cut back on carbohydrates. Studies show that individuals eat too many carbohydrates, so reducing portion size should help with weight loss and better blood glucose control. But remember that portion sizes of all foods, not just carbohydrate foods, should be controlled.

• Find support. Seek out some type of group support, such as a meeting or an online chat group.

• Keep a food diary. Writing down what you eat, when you eat, how much you eat and why you eat can help you make changes that lead to weight loss.

• Engage in some type of physical activity most days of the week. Physical activity is crucial to weight loss efforts.

Finally, work with a registered dietitian or diabetes educator to establish a meal plan, which is a guide that tells you how much and what types of food to eat at meals and snack times. Together, you can design a meal plan that's right for you and includes foods that you enjoy.
Posted 10/1/2004