Healthy eating is an important factor when it comes to your overall well-being. But these days it isn’t easy to find the time to learn about nutrition. That’s why Washington County Hospital and Robinwood Endocrinology now offer “Ask the Nutritionist,” an easy way for you to get answers to your nutrition questions and find out about dietary issues that are important to you.

Periodically, registered dietitian Tim Higgins will answer questions on nutrition and how it affects your health. Get the information you need by asking your own questions or by reading Tim’s responses to others. “Ask the Nutritionist” makes it a little easier to get the info you need to stay on the right track—one bite-sized question at a time.

Click here to submit a question!

Latest questions

I have type 2 diabetes. What percentage of carbs should be in my daily diet?
The American Diabetes Association recommends that 40% to 50% of calories come from carbohydrates.

Two years ago I had gastric bypass. I have lost a great amount of weight (138 lb) and I am very happy with my results; the only problem is now I have an awful time growing my nails and hair. I do take an iron pill daily (low iron), MSM, and a multivitamin. Do you have any other suggestions to help me out? A friend of mine suggested taking a prenatal vitamin—it that wise?
Hair loss is common following gastric bypass surgery. This tends to be a temporary effect and may resolve when nutrition intake and weight stabilize. Your multivitamin should be meeting your basic vitamin needs.

Has there been any reliable study so far which proves nutrition can help children who are predisposed to anxiety and panic? Can you give any advice from your end in such cases?  Is supplementation really effective?
Good nutrition may help but not cure anxiety. Carbohydrate-rich meals, milk, bananas, poultry, cheese, and nuts may help increase serotonin and have a calming effect. High-fiber choices are best. Small frequent meals throughout the day may prevent low blood sugar, which may cause anxiety or panic. Be sure to provide plenty of fluids and be sure to avoid caffeine.

Are there any foods that are better for people with hypothyroidism? I crave sugar. Since I was diagnosed I went from two candy bars a year to eating three to four a week. Is there something that can give you energy or help with the craving that is less damaging to my midsection?
Be sure to take a multivitamin to make up for vitamins not absorbed; zinc and copper are also needed by the thyroid. A diet with adequate calories may help prevent cravings, and use high-fiber snacks such as vegetables and fruits to satisfy your hunger.

Previous questions

When I take a multivitamin it seems to upset my stomach. Is this normal? I have heard that it could be that the levels of vitamins or minerals in my body might already be good and I might not need a supplement. Is this true?
An intolerance to vitamins is not uncommon. You may want to speak to your pharmacist about other options.

Is it true that our bodies will show symptoms or signs if we are deficient in a particular vitamin and/or mineral? For example, my mother claims that leg cramps are caused by a lack of potassium in the diet. Is she correct, and if so, how much of each vitamin and mineral do we need on a daily basis?
Severe vitamin deficiencies will certainly show signs and symptoms. Leg cramps could be caused by low potassium or may indicate other medical problems. This should be reported to your doctor.

Do pickles have any nutritional value?
They have more culinary or sensory value than nutritional value. The amount of one nutrient, sodium, may be high, so anyone on a sodium restriction diet should use moderation.

For my diet I'm using the “old exchange list” (which consists of rice and pasta=1/2 cup) in addition to the revised list. Each day I get 6 proteins, 4 starches, 3 fruits, 2 veggies, 2 milks, and 2 fats. Sometimes I replace the 4th starch with a 4-oz. apple. My total intake is 1200 calories per day. Is this a good plan?
Your plan sounds good in general; whether or not it is good for you depends on your goals. Go to mypyramid.gov to figure our a good diet based on your needs.

How should I count sugar alcohols when on a low-carb diet? What are “net carbs” and should I trust that number?
When looking at the Nutrition Facts label, total carbohydrates include dietary fiber, sugars, sugar alcohols, and other carbohydrates. Fiber and sugar alcohols are indigestible or partially digestible.

Net carbs are calculated by subtracting both of these from total carbohydrates. Depending on how conservative you want to be in figuring your carbohydrate intake, you can either use net carbs, or subtract one half of the sugar alcohol and all or half of the fiber from the total carbohydrates. Given that the DRI (dietary reference intake) for carbohydrates is 130 grams per day, the impact of how one counts these carbohydrates will not be very significant. For further information on DRIs go to the USDA’s food and nutrition Web site.

Is Weight Watchers a good program for a Type 2 diabetic?
Weight Watchers has a new Flex Plan that can work well for persons with diabetes. You will need to know basic carbohydrate counting as the Weight Watchers plan uses points, not total carbs.

Should people eat breakfast even when they’re not hungry?
No, not necessarily. Skipping a meal on occasion may not be the worst thing for most of us. This becomes a different issue when medication enters the picture, especially for those with diabetes. If lack of hunger persists or if one loses weight, then these could indicate other health issues to discuss with your doctor.

How does metabolism work in the body and what is its purpose? I’ve heard that the higher it is, the better it is for people trying to lose weight. Is this true?
Metabolism is an all-encompassing term that relates to many body functions, including digesting food, building tissue, and energy transfer. Increasing one’s metabolism can help one lose weight. Muscle is metabolically active tissue, so increasing exercise helps stimulate muscles to expend energy which can aid weight loss.

I am seventy years old and have a very difficult time losing weight. I exercise (stationary bike) several miles a day, lift hand weights, and do light exercises, and my weight seems to be at a standstill. I have been taking Topral XL 50mg daily as prescribed by my cardiologist since 2001 and continue to fight the battle of the bulge. I had a stent applied at that time as well. I also try to eat healthy.
Sounds like you are on a good track. You may want to journal your food intake to watch how much you are eating. All that exercise may be offset by increased food intake.

I’ve read that tumeric is good for cell repair. Will incorporating this into my diet delay the onset of macular degeneration?
I don’t know of any association between tumeric and macular degeneration. A diet rich in fruits, vegetables, and whole grains will provide antioxidants and omega-three fatty acids which support good eye health.

What vitamins should be taken while on a diet?
A good over-the-counter multiple vitamin will cover all your needs for most diets. Very low calorie, restricted diets should be done under the supervision of a doctor who can order blood tests to check essential vitamin levels.

How long could it take me to see some results from my exercise and calorie counting? I have been doing cardio exercise five times a week and weight training twice a week for six weeks now, and I have gained eight pounds and gone up one pant size.
How long depends on the intensity of your exercise and the total calories you take in. If you are gaining weight around your waist, I would suspect you are eating too many calories.

I am diabetic, and it seems like there is no rhyme or reason to my blood sugar being high. What foods are the worst to eat? (I mean besides the obvious, like soda, candy, and sugar.)
High blood sugar is related to the total amount of carbohydrate eaten. At Robinwood Endocrinology, we teach patients how to count the number of grams of carbohydrate that are in foods to help them eat a consistent amount of carbohydrate throughout the day. People who have diabetes can eat most foods, being careful with the amount of those obvious ones you mentioned. Generally speaking, the more refined the carbohydrate, the worse the effect will be.

What can I eat that will help lower my cholesterol?
Fiber, approximately twenty-five grams per day, will help lower cholesterol. High-fiber foods include whole grains, beans, fruits, and vegetables. Nuts, like walnuts and almonds, not only help lower total cholesterol, they contain good fats that help raise the good, or HDL cholesterol. Go to mypyramid.gov for some dietary tips.

Are there any long-term health effects of drinking diet sodas in moderation?
No. Within moderation, there should be no problem. The acceptable daily intake (ADI) of artificial sweeteners is set for all diet sodas. You can go online and search for the ADI of individual products, or they can be reviewed at the Food and Drug Administration (FDA) Web site. However, any time you’re going to have more than three to six servings of any type of sweetener during the day, you should be asking yourself, what other foods have I eaten that contain sugar substitutes, and why consume so many of these products?

I avoid sugar as much as possible, so I drink water with flavor packets made with Splenda. Out of all the sugar substitutes, is Splenda the least of all the evils?
The data for that would be based upon the FDA’s acceptable daily intake (ADI) for Splenda and how much Splenda is in the individual product you’re drinking. To answer that question, you should look up the individual product. But the FDA has recognized all of the artificial sweeteners as safe, even for pregnant women. That said, if someone is eating three to six packets of those a day, I would be asking, as stated previously, what other foods the person has eaten that contain sugar substitutes, and why consume so many of these foods?

Is Splenda a good sugar substitute for diabetics? How does it affect a diabetic who uses it on a regular basis?
It’s an acceptable sweetener, and it is safe to use it within reason and stay within the acceptable daily intake (ADI). But it does not affect blood sugar.

My spouse is a Type I diabetic who watches his carb intake. As a spouse who is not a diabetic should I myself be watching/counting carbs or calories?
When someone counts carbs or limits carbs, they’re also counting calories, because carbohydrates have four calories per gram. So if you’re going to eat 300 grams of carbohydrates a day versus 200, obviously you’re going to get a reduction in calories which could help you to lose weight.

The reason people with Type I diabetes watch carbohydrate intake is because they have to match it with their insulin. The recommended carbohydrate intake is anywhere from 50% to 60% of total calories. Someone with diabetes may have a better tolerance of somewhere between 40% and 50%. The reason they’re doing that is to keep their sugar correct.

If someone doesn’t have diabetes, they don’t have to worry about their blood sugar. But they should be worried about total calories in general, and they should also be looking at the percent of calories from carbohydrates during the whole day. That information is on the food label. If you look at a food label you’ll see total carbohydrates, which will give you a percentage figure. That percentage figure is based upon the percent of carbohydrates in that food, based on 300 grams of carbohydrates per day. That’s the recommended intake that’s used on the food label.

What are some good tips to lower blood pressure for someone who doesn't like reducing salt, and likes fast food?
Just because you like something, you can’t do whatever you want. I may have a broken foot and I may love to run, but that doesn’t mean I can! As far as blood pressure and salt, there are a couple of things to consider. Number one, people in general do not know how much salt and sodium they eat. So the first thing you would need to look at is how much sodium you eat in a day. The recommended level is 2,400 milligrams of sodium in a day. Now some fast foods may have as many as 1,200 milligrams in one serving, half of your sodium intake for the day. So if you didn’t get a lot of sodium from other foods during the day, that could work. The other thing is reading labels and understanding how much sodium that you are getting. And if you are trying to lower blood pressure, sodium may not be the only thing that you need to look at. You may need to look at your total calories, how much you weigh, and how much exercise you’re getting—those other things as well.

I heard that eating flax seeds or drinking flax seed oil can prevent cancer, heart attack, stroke, alleviate allergies, and even help with weight loss. Is there any truth to this? And if so, how should I take them, should I get the seeds and crush them, buy them in pill form, or drink teaspoons of the oil? Please advise.
Eating flax seeds is good. Flax seeds are a good source of fiber; that’s why they’ve been associated with a lower risk of heart attack (because they will reduce cholesterol) and also weight loss. Flax seeds also have very good fats in them called omega-3 fatty acids which help to raise good cholesterol and also help to prevent cancer.

They can be eaten many ways. If they’re ground up you’re probably going to get more benefit from them than if they’re whole, because if they’re whole, they may just go right through you. If they’re ground up, your body is more likely to be able to use them. Basically I just try to incorporate them into my diet. So if you’re eating oatmeal or if you’re making bread, add ground flax seeds.

How can you avoid fish loaded with dioxins? What other foods are high in dioxins?Dioxins are a toxin, of course. We as a country have gotten a lot better with our waterways and ridding them of dioxins; however, they’re still there. Certain fish have more dioxins than others. The higher up in the food chain a fish is, the more likely it may have dioxins, especially if part of the fish’s life cycle is in rivers, such as salmon.
For example, sharks eat other fish, so they have a higher concentration of dioxins, mercury and those types of elements than trout or crab. If you go to the Environmental Protection Agency (EPA) Web site (www.epa.gov/ncea/dioxin.htm) and look at dioxins, you’ll get tons of information and also some very interesting statistics on how much dioxins have been reduced. Foods other than fish can have dioxins if they have been exposed to them, so it really depends on where they are. I would go to the EPA Web site if you are concerned about anything in our area.

How many meals a day should be eaten to increase one’s metabolism?
That’s an interesting question, and it’s actually somewhat controversial. There’s been a lot of research done to try to answer that question, and the results are not confirming that the number of meals that one eats affects the metabolic rate. There have been some studies that show it does affect metabolism; there have been other studies that don’t show it. The main thing that will affect one’s metabolism is exercise. However, the more one splits up meals during the day, the more likely it is they’ll get a better balance of intake, not overeat, and in the end have fewer calories. One of the biggest things that I see when people come in to see me—especially people who have problems with weight—is that they’re not eating regular meals, especially breakfast. Many times they’re eating late at night, and lots of food. If you don’t eat breakfast, the body wants to catch up. You end up eating the wrong things (that have more calories), and you overeat.

Where can I attend a seminar regarding diabetes?
It depends—do you want to just learn about diabetes, or do you want to learn how to care for your diabetes? For patient care, we have programs monthly at Robinwood Endocrinology. If you go to the American Diabetes Association Web site (www.diabetes.org), there are opportunities for lectures and seminars all over the country.

I found a strange spotted mushroom in the woods. Is it okay to eat it?
Big NO, because even experienced mycologists—people who study mushrooms—have made errors in identifying mushrooms. Many poisonous ones can be very similar to the edible ones. In fact, there was an example on Long Island where a mycologist got and ate a wrong mushroom. This was an expert, so it can happen.

Now, lots of people in this area do mushroom hunt for morels. I don’t know how many varieties looks similar to morels, but there are many varieties of edible mushrooms and there are many poisonous ones that are very similar. So it’s a big “no” without knowing what you’re doing.

Are diet sodas an acceptable substitute for water or tea?
I would not characterize diet soda as a substitute for water. Water is the best fluid to hydrate with. Having some diet soda is fine but not to substitute for water; it’s the same thing with tea. As far as your total fluid intake, you can count the tea and you can count the diet soda, but it should not be in lieu of drinking water.

There's a new diet out called the “eat clean” diet. The basic idea of the
diet is to avoid processed foods. Do processed foods really lead to
weight gain, and if so, why?
It’s really a matter of excess calories. Any excess foods will cause weight gain. Whether processed foods are really causative of it more than others, no. I don’t believe in banning foods. I tend to go for simpler, non-processed foods; but that doesn’t mean you can’t eat processed foods. Really, it’s a matter of total calories more than whether it’s processed or not processed, as far as weight gain.

I've heard that soy converts to estrogen when it enters the body. Does
this mean that it is harmful for men? Can it interfere with testosterone
levels?
Soy products contain something called phytoestrogens, and phytoestrogens can mimic or have an estrogen-like reaction in the body, and it can interfere with some hormone reaction in both men and women. However, there are no studies that really point out specifically how severe that problem is. Also, soy products have been shown to help lower cholesterol, so they do have health benefits. Like any food, if they’re part of a mixed diet and there’s plenty of variety in the diet, there should not be an issue.  

If I drink nothing but meal replacement shakes, is there anything that I
would be missing out of my diet? Would there be any adverse health effects
to eating nothing but meal replacement shakes for a long period of time?
That depends on the replacement shake. We have a program here called HMR, and these meal replacement products were formulated with added vitamins and minerals and they’re used under the supervision of health educators, and in some case medical supervision, to actually deal with these types of issues. So anything that involves meal replacements for a long period of time should be done under the oversight of a nutritionist or medical professional.