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!

Are colon cleanse programs really necessary?
Colon cleansing may be necessary to treat constipation or to prepare for a colon procedure. Colon programs promoted for general health have been used in traditional medicine in India and China but I am not aware of any research that proves it to be necessary. Overuse of these programs can cause a dependency and prevent regular bowel movements. Some herbal or coffee enemas can cause harm by electrolyte imbalance. Colonic irrigation or pumping water into the colon can introduce pathogens if they are not properly sanitized and may even perforate the colon.

If you eat a lot of candy, does it eventually stick to the lining of your stomach?
No, it won’t stick to your stomach. If you eat too much candy it will increase your caloric intake, possibly increase your weight, and cause dental cavities.

My skin is starting to get white spots, my nails are really thin, and I lose a lot of hair. What should be my new daily diet?
These symptoms could be related to various medical or nutritional conditions. First you should consult your doctor. As for your diet, visit mypyramid.gov and review basic diet recommendations for a good start for a healthy diet.

The last few weeks I’ve been under a lot of stress, and I recently realized that I haven’t been eating as much as I used to eat. I have lost about four pounds—should I be worried?
I would recommend that you get help with your stress to reduce your overall health risks. A four-pound weight loss may not be serious unless you are very underweight to begin with. Try to eat regular meals with plenty of fresh fruits and vegetables. Work on your stress and remember exercise can be a wonderful stress reducer.

During my first pregnancy three years ago, I experienced an extreme amount of stress—my mother died, my best friend’s husband left her and her two kids and my family was her only local support system, we bought a home we quickly discovered we could not afford, and work stress was through the roof. I gained sixty to seventy pounds which I still haven’t lost. I had another child eleven months ago and gained fifteen to twenty pounds during that pregnancy. I lost that weight within about eight months. I have been following the “Neuropsychology for Weight Control” ideas for about two months now. I have been exercising forty-five to sixty minutes a day—moderate intensity—and focusing on my portion sizes and snacks as I tend toward healthy eating otherwise. I’m still nursing my daughter. I have lost about three pounds in this last two months. Should I get my thyroid and/or other hormone levels checked?
Your questions are similar to others that have been asked and answered previously. You are on the right track—exercise and focus on portion sizes seem to have helped you lose some weight over the last two months. Continue on this track, keep a food diary, and watch your fat intake (which should be about seventy grams per day for most breastfeeding mothers). Go to mypyramid.gov for more help with meal planning and diet analysis. As for your medical question, speak with your doctor about your thyroid; chances are he may have already run a thyroid screening test.

I have fibromyalgia and am currently going through a low period as the pain is debilitating and I am having a difficult time even getting around. I am also not able to get much sleep at night as the pain is so bad. I also suffer from hypothyroidism and take meds for that (.250 mg daily of Synthroid). I was also recently told I am prediabetic. I currently work full time and am finding it more and more difficult to get through my days. I have become extremely overweight due to all that has been dealt me. I would love to get on a good diet and exercise program but feel like I just don’t know where to start at this point. Walking at the moment is out of the question as it has become difficult for me to just go to a grocery store. Any info you can offer up to get me on the right track would be greatly appreciated.
You are asking the right question when you ask about how to get started on a good diet and exercise program. The symptoms you mention can be related to your hypothyroidism and once it is corrected you should see improvement, so hang in there. As to where to start? First step, find out where you are. Keep a food diary, list the foods and amounts you are eating. Find a dietitian in your area and bring this information to discuss your starting point. Discuss physical therapy options with your doctor—a trained therapist will help you develop an exercise routine appropriate for your condition. Exercise is very important, but getting hurt will negate benefits.

I just found out that I have high cholesterol. What can I do to lower it, and what could you suggest I do for exercise?
To treat high cholesterol, increase your fiber intake to twenty-five to thirty grams per day. Reduce all fat by using low-fat dairy (1% fat or skim), eating lean meats, avoiding fried foods, and reducing your weight to a healthy range BMI of twenty-five or less. You can also raise your good cholesterol by increasing exercise and including healthy fats in your diet, such as omega-3 (found in nuts, oily fish, and olive oil). Go to the National Institutes of Health Web site and review the National Cholesterol Education program guidelines at www.nhlbi.nih.gov/about/ncep.

My five-year-old daughter has been allergic to various foods. Since she was three months old, she has many food allergies with an extreme case of eczema. She is allergic to casein, soy, nuts, wheat, and egg white. Very recently she had high lead levels of twenty-one and we are working on that by giving her iron. I have tried every source possible to give her complete nutrition which consists of lentils, spinach, broccoli, avocados, carrots, orange juice, rice, and other fruits and vegetables. She looks very fatigued with dark circles. I have started giving her vitamins and iron supplements. I need to have information about nutritional yeast—how good or bad is it for her? I don’t want my daughter to experience any side effects so I’m desperately seeking help to find honest information on the value of this product.
Referring to nutritional yeast, I believe you mean brewer’s yeast, or baker’s yeast, which is often used as a source of B-complex vitamins, chromium, and selenium. The B-complex vitamins in brewer’s yeast include B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B9 (folic acid), and H or B7 (biotin). These vitamins help break down carbohydrates, fats, and proteins which provide the body with energy. They also support the nervous system, help maintain the muscles used for digestion, and keep skin, hair, eyes, mouth, and liver healthy. However, brewer’s yeast does not contain vitamin B12, an essential vitamin found in meat and dairy products. Vegetarians sometimes take brewer’s yeast and mistakenly believe that it provides B12, which can be lacking in their diet.
Given the extent of your daughter’s reactions to foods, I would suggest you see a dietitian to help with meal planning. I am not aware of data that indicates the safety of use of brewer’s yeast with children.

I have acid reflux disease. What should I eat?
Your question about acid reflux disease could involve many disorders related to the upper or lower gastrointestinal tract. This can be a very serious problem or one remedied by decreasing heartburn. Generally speaking, addressing excess body weight; reducing soft drinks, coffee, or tea; eating frequent small meals; remaining upright after meals; and avoiding food before bedtime all help to relieve gastric reflux. I would recommend you contact your physician to refer you to a registered dietitian to help you review your current food choices and help you make food choices that are appropriate for your condition.

Every day for the last two weeks, I’ve replaced one meal with this smoothie:
8 oz. water, 2 scoops protein powder (110 total calories), 3-4 strawberries, 1/4 beet, handful of fresh spinach, 1/4 cucumber, 1/2 medium carrot, less that 1/4 cup frozen blueberries, 1/2 banana, crushed ice, 1/2 container of light yogurt (40 total calories). This makes a large blender full and is so delicious that I drink every drop. There does not appear to be a lot of calories in this drink, and I eat pretty healthy throughout the day without snacking. I haven’t seen any weight loss and I have been walking/running four miles, three to four days a week. I am a forty-eight year-old female, five feet six inches tall, and I need to lose ten to fifteen pounds. Is my smoothie doing me in? Why haven’t I lost weight?
Sounds good. The smoothie isn’t doing you in. Journal your food intake, keep up the exercise, and let time help. Also note the scale will not change when the mass of fat in your body is replaced with an equal mass of muscle—we call this sculpting. The way your clothes fit may be a better indicator of fitness than your scale.

As a result of a meningioma (a tumor near the brain and spinal cord) that has affected  my pituitary gland, I have a low level of cortisol. To address my adrenal insufficiency and being overweight, I am looking for a food program or suggested foods that will not overly impact my adrenals or kidneys, as well as assist with a healthy approach to losing weight. Can you suggest an approach or recommend a food program to follow?
Adrenal insufficiency can cause many side effects ranging from hypoglycemia to high potassium. The recommendations that follow are for general care for nutrition concerns associated with adrenal insufficiency and should not be taken in place of medical supervision by your doctor. Most individuals with adrenal insufficiency do well with a high protein and moderate carbohydrate diet. Snacks can be used to prevent hypoglycemia (low blood sugar) between meals. Sodium and potassium intake should be kept to a level established by your doctor. Fluids should be encouraged as tolerated. Avoid skipping meals and avoid excess simple carbohydrates to reduce onset of hyperglycemia (high blood sugar).

For a few years I have maintained a severely restricted diet of about 800 calories a day, eating only a few times a day. I know that it is better for your metabolism to eat more frequently and more calories than that, but whenever I try to make the transition to a more reasonable diet I end up gaining weight. Have I done irreparable harm to my metabolism? I also work out five to six times each week and make clean and balanced eating choices.
As with the previous question, I wonder how accurate your numbers are. Very-low-calorie diets under 1,000 calories per day should be monitored medically. At this low intake you run the risk of nutrient deficiencies. Double check your numbers, inform your doctor about this low-calorie diet, and consider requesting a consult with a registered dietitian.

I am a six foot tall female, 245 lb., and twenty-nine-years-old. Weight is a big problem for me. I am used to getting 600 to 800 calories per day, but I read that I need 1,200 calories. I have done that for the past three weeks and have not lost any weight. Is it because my body is so used to the lower calories?
Getting 1,200 calories per day should result in weight loss for someone your size. I question the accuracy of your caloric intake. This can be confirmed by a registered dietitian’s review of your food diary. Stay with the 1,200 calories, carefully confirm your records, exercise, drink plenty of water, and the excess weight should come off.

What can I do to get my iron levels up without eating red meat? I eat lots of spinach but it does not seem to help.
Try increasing consumption of foods high in vitamin C such as oranges, tomatoes, broccoli, and cabbage. This may enhance the absorption of iron. Also, avoid high-fiber foods such as bran and soy products, which along with tea and coffee inhibit iron absorption.

I need help, please. I’m twenty-five years old and had a baby in October. I’m no longer breastfeeding and am looking to take off the fifty pounds I’m still carrying around from pregnancy. I have been strict for the last two weeks; I haven’t been following a specific diet, but I’ve been eating healthfully and about every three hours: apples, oatmeal, almonds, whole wheat breads and English muffins, peanut butter (sparingly), soy protein shakes, 1% milk, eggs, low-fat yogurt, bananas, Fiber One cereal, and granola bars) about 1,500 to 1,700 calories per day. I have heard that if you are on a very-low-calorie diet, once you start to eat normally again, you will just gain the weight back and your metabolism will slow. In addition I have been drinking nothing but water, about four water bottles a day (80 oz.) and I’ve done thirty to forty-five minutes of cardio exercise about three to four times per week and strength training twice in the last two weeks. I HAVE GAINED A POUND—what am doing wrong? My pants aren’t getting looser, so I’m not gaining muscle and losing fat. I’ve even been taking green tea supplement and Lipo 6 to help with energy since I’m not drinking caffeine anymore. I’ve done a ton of research and there is conflicting information everywhere. I’m thinking I need to do a cleanse or get my thyroid checked or something. Any information and help would be appreciated.
It’s hard to know what could be wrong. Your note has a frustrated tone and surely losing weight can be frustrating. You may want to confirm your estimates on your calorie intake. Keep a journal, check your figures with an online calculator, keep moving, and give yourself more time. Very-low-calorie diets, typically less than 800 calories per day, may lower one’s metabolism and should be done under medical supervision. Your estimated caloric intake is not very-low-calorie. Be careful with over-the-counter energy aids or weight loss claims associated with cleansing products—these will most likely be ineffective at best, and if overused create a potential for harm. Stick with the basics, whole grains, lots of fiber, plenty of fruits and vegetables, and low-fat dairy and meats. Keep moving and enjoy your expanded family!

 I am a vegetarian. What kind of multivitamin should I be taking? I have a high-stress job, and I’m not able to eat regular meals.
Vitamin B12 is recommended for some vegetarians depending on their actual dietary intake. Eating a variety of foods including fresh fruits and vegetables should provide all of the vitamins you need. Taking a multivitamin may be helpful but cannot be expected to replace a varied diet or skipped meals.

 I am a Type 1 diabetic who has cereal with whole milk every morning for breakfast and sometimes for dinner. I also eat cheese on everything. How can I be vitamin D deficient? Can insulin or other medications have this result with vitamin D? What would you recommend to bring this deficiency up to standards?
My concern about your question is your fat intake. This is something you may want to review at your next diabetes education visit. Vitamin D is naturally present in very few foods—even the milk you drink is fortified with vitamin D. Fatty fish, cod liver oil, and fortified foods are the major sources available. The best way to get the levels up to standard is by taking supplements. Depending on your level, your doctor may prescribe one for you. Also note, our bodies make vitamin D during the warm months of the year through sun exposure, but beware of extended sun exposure as a risk for skin cancers.

 Is it okay for a fifteen-year-old male to take weight gain and protein products?
I’m not sure what products you are referring to or what the fifteen-year-old eats during the day. I would favor foods, more foods if necessary, to gain weight. Make sure meals are not skipped, that he is active, and not losing any weight.
 
What’s your opinion on having nutritional snacks on high school campuses?
Healthy snacks could reinforce good snack choices, but I wonder why they are needed if the students eat at meal times and schools are appropriately funded.

I am eighteen years old and want to know the best way to lose ten pounds in a month or less?
Being overweight can lead to many health problems, however, quick weight loss may not be the answer. Increasing activity, decreasing portion sizes, and eating less fatty or sugar-laden foods will help with weight loss. Go to www.mypyramid.gov to find your body mass index (BMI) then set a goal to lose one to two pounds per week. Be sure to get at least five to seven servings of fruits and vegetables per day, and move more!

Why am I losing weight without trying?
There could be a number of medical issues associated with involuntary weight loss. If you have unintentionally lost 10% of your weight in the last three months, contact your physician.

I weigh 300 pounds. I am a compulsive overeater and when I say that I really mean it. I have recently been able to stop eating compulsively, by eating a normal breakfast and lunch and skipping dinner. Although it is working for me, I don't plan to do this forever. I want to reintroduce a healthy dinner once I reach a manageable weight. What do you think?
This may work for now but I wonder if you are eating a balanced diet and if you have any other medical issues. Skipping dinner may cause you to get hungry later in the evening and trigger overeating. I prefer to see a more regular eating pattern including dinner. Try eating smaller portions at meals and eating small high fiber snacks as needed. You may also benefit from taking a multivitamin.  Be sure to keep well hydrated by drinking up to eight cups of water per day. Check with your physician to be sure your diet is appropriate for your situation and make sure to get the okay to proceed with an exercise program. To achieve moderate, sustained weight loss, it is best to lose one to two pounds per week.           

 I would like to know if is okay to eat fruit mixed with flax seeds, and if it’s okay to drink soy milk. Is it true soy milk is bad for you?
Flax seeds are a good source of fiber and omega-3 fatty acids which help lower cholesterol and prevent some cancers. Whole flax seeds will not be digested well unless cooked, so try ground flax seed sprinkled on any food. Be sure to store ground flax seed in the refrigerator to prevent it from going rancid. As for soy milk, it is also a good food, but too much of anything is usually not good. Soy products may not be good for breast cancer survivors, or those with soy allergies or thyroid problems. These concerns should be addressed with your physician.
  
I need to gain some weight, as I’m very skinny. What should I do? 
Gaining weight can be more difficult than losing weight. Being underweight, which is classified as a BMI of less than eighteen, is associated with many health issues. This condition should be reviewed with your doctor to rule out any medical problems. To gain weight, add more calorie-dense foods or high fat foods to your diet. Make sure to choose sources that are lower in saturated fats, including nuts and olive or canola oils. Keep a food journal and go to www.mypyramid.gov to help you calculate your calorie needs and to tally your calorie intake.

I was just diagnosed with hypothyroidism. I am thirty-three years old and going through insemination treatments to get pregnant. I am taking 50 mg of Synthroid in the morning. The problem is I can't have anything that has calcium or iron for breakfast. What can I eat for breakfast?
You are correct to avoid supplements or foods with high amounts of calcium or iron when taking Synthroid. Choose low-fiber foods for breakfast and consider eating a smaller amount first thing in the morning and having a mid-morning snack to avoid possible interactions. You should be able to eat most foods, but avoid soy flour, walnuts, and high-fiber foods (more than five grams of fiber per serving).

What are the health benefits of green tea?
Green tea has been said to help lower cholesterol, reduce stroke, inhibit the growth of cancer cells, and add to an increased quality of life that may reduce stress. There is not much evidence to prove these effects (see the link below for background information and a summary of evidence-based research on green tea).  Drinking green tea, a natural beverage, is a good choice for a beverage, but one should see it as a health enhancer rather than a cure-all.
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-green_tea.html

What’s your opinion of the Oprah Acai diet?
I don’t know of an Acai diet. I went to Oprah’s Web site and saw she is distancing herself from promoting Acai products. The acai berry is very rich in antioxidants, as are other more common berries. Rather that looking for a silver bullet, eating a variety of fresh fruits and vegetables will meet one’s antioxidant needs.

Are there any foods or nutrients that help with allergy attacks and sinus infections?
A diet with plenty of fresh fruits and vegetables will provide vitamins, minerals, and other nutrients to support one’s immune status and reduce the effects of allergy attacks or sinus infections. I also like good, old-fashioned chicken soup to relieve an otherwise miserable condition.

My wife says that the combination of peas and mushrooms provides all nine essential amino acids. Are there other vegetable combinations that do the same?
This question points to days past when food combining was promoted by those on vegetarian diets to assure adequate protein status. Beans and grains combined provide all essential amino acids needed by our bodies. We have since come to understand that when one has adequate calories from a variety of foods, it is not necessary to worry about combining vegetables. We also have a source of amino acids from our protein pool supplied by recycling blood cells, the lining of our digestive tract, and other tissues replaced on a day-to-day basis.

I am thirteen weeks pregnant. I am lactose-intolerant and allergic to fish oils. I can’t seem to eat any kind of fish, or drink any kind of milk other than soy. What can I eat to still get the vitamins I need?
Eating a variety of foods other than milk and fish will provide all the vitamins you need.  Additionally taking a prenatal vitamin and calcium will ensure this.

I cannot take vitamin B because it makes me itch intensely. What could the problem be? It started several years ago; I had gallbladder surgery two years ago, but I still have the itching upon taking vitamins. Any help would be greatly appreciated.
The itch may be a sign of an allergic reaction. Stop taking the vitamin and see your doctor if the symptoms get worse. There may also be an inactive ingredient in the vitamin that’s making you itch; check with your pharmacist on other options available to you.

What is the maximum amount of sodium a person should consume a day?
The general recommended amount is between 1500 and 2400 milligrams (mg) per day. There are approximately 2400 mg sodium in a teaspoon of salt. That’s not much salt.
Most people get more than 70% of the salt they consume from processed foods. Too much sodium can lead to high blood pressure which, in turn, causes problems with one’s heart and kidneys and may lead to stroke. Become aware of how much you eat and reduce to aim towards the recommended range.

Does the number of calories in raw food change any if you cook it? Is it safe if I count calories content in raw food and assume it will be the same after cooking?
The caloric content of foods doesn’t change, but the volume or weight does change. Many meats will shrink 30% or weigh 30% less when cooked as compared to the raw weight. Some of this loss is caused by water loss or juices, including fat, that run out during cooking. Those juices contain calories! It is important to note if the calories reported for a food are based on the food being raw or cooked (ready to eat).

What kind of bread is healthier to eat, whole grain or wheat?
Whole grain bread, one that lists whole grain on the ingredient label, is better than one simply listed as wheat.

Do you miss any nutrition by drinking low-fat (1%) milk as opposed to whole milk? Do toddlers (fourteen months old) need whole milk rather than low-fat milk?
Toddlers under two years of age should have whole milk. Both 1% and whole milk are good sources of calcium and protein, and toddlers can use the extra calories provided by the higher fat content of whole milk.

I have no trouble getting vegetables in my diet—lovin’ my onions, peppers, zucchini, etc. But I really have trouble with fruits. Are there health/nutrient benefits that we get from fruits that are NOT available in my veggies??
Fruits and vegetables are good sources of vitamins, minerals, and fiber. These nutrients are also available in whole grains, and with a good multiple vitamin. The bottom line is more variety: five to seven fruit/vegetable servings per day.

What type of diet should a fifty-one-year-old man with diabetes, high cholesterol and high blood pressure follow?
Follow a diet that is low-fat, low-sodium, and has few concentrated sweets in processed carbohydrate foods like sugary drinks, pastries, cookies, and other sweets. Exercise and weight loss may also help your condition. Speak with your doctor to get a referral to see a dietitian to review a diet and exercise plan.

I just found out that my ferritin level is 4. Honestly, because of the meds I take, I have no appetite. I usually eat one small meal in the evenings and I don’t eat much meat. After doing some research I found out that the tannins in tea and coffee decrease iron absorption. Also, I guess I need to eat more meat. What other suggestions do you have for me?
Speak with your doctor about medications and other medical conditions that may be related to your low levels. Meats, eggs, whole grains, and other iron-enriched foods may help. If you eat these foods or take iron supplements, do so at least two hours after coffee and tea ingestion to maximize their effect.

What is the most common mistake people make when trying to lose weight?
The web is full of the most common mistakes people make; just search for “most common weight loss mistakes.” More importantly, focus on success, small success at first. Go to the National Weight Control Registry and read about successful weight losers.

I am a thirty-year-old African-American female. I have been yo-yo dieting off and on for about three years. I recently started a program of counting calories (no more than 1,600 per day) and working out with a personal trainer. I exercise six days a week, both cardio and weights. My weight loss is so slow that a lady who is seven years my elder has dropped double my weight. Do you think a cleanser would help now that I am on the right track with food and exercise? I also have issues with digestion and bowel movements; should I see an endocrinologist?
So many questions! It is hard to compare your weight loss to another person’s. The scale may not reflect sculpting changes or increased muscle mass. You may not be eating enough; more calories may help your metabolism. As to cleansers, no research I know of supports the efficacy of cleansers used as a weight loss tool. When dealing with other medical issues, talk with your physician to plan appropriate medical action or referrals. This discussion should include your vitamin status, which can be checked with blood tests.

Hi! My name’s William, and I have a fairly off-topic question, so I thank you in advance for your input! I’ve been a personal trainer and natural competitive bodybuilder for a few years now and owe all my success to proper nutrition. I’ve been highly interested in the field, and have picked up quite a bit of nutritional knowledge along the way. I’m looking to learn more and earn a holistic nutrition degree...I’ve found a school accredited by American Naturopathic Medical Certification and Accreditation Board. Would I be able to land a job after I graduate? Would most hospitals recognize this degree? Thank you!
William, it is nice to hear of your interest in nutrition, especially from your view as a body builder and athlete. The naturopathic/holistic track is interesting but will not be recognized by most healthcare institutions. Most will require registered dietitian certification, and a license issued by most but not all states in the U.S. Visit the web site of the American Dietetic Association (ADA) to get information on educational requirements, and visit the ADA practice group SCAN’s sports, cardiovascular, and wellness nutrition site (scandpg.org) to get more information on sports nutrition. Good luck with your search.

Who do nutritionists work with—what types of patients? Where do nutritionists work? What do nutritionists do? How can I become a nutritionist in the U.S.?
Nutritionists work in wellness, sports, inpatient/outpatient hospital settings, nursing homes, schools, prisons, the armed forces, industry, advertising, supermarkets, radio/TV/print media...and anywhere else one can capitalize on the need for information about food and health. Go out to the American Dietetic Association Web site to get information on career paths and the type of work nutritionists do.

I am a fifty-two-year-old Caucasian woman. I teach third grade, exercise sporadically (bad, I know), but eat a healthy diet of lean meats, fruits, and vegetables. I take vitamins, calcium, use flax seed…yet I am still forty pounds overweight. I know I need to increase my exercise and am working on that. My question is should I consider seeing an endocrinologist or a nutritionist?
This would be a good conversation to have with your doctor at your next checkup. A registered dietitan can be very helpful in assessing your current food intake and help you plan a weight loss diet.

I was recently diagnosed with pre-diabetes. Is there a Web site that you recommend I should go to for meal plans?
Yes, go to www.diabetes.org, www.dlife.com, or www.journeyforcontrol.com or do an online search for “diabetes meal plans.” Basically, you want to follow the same recommendations that someone with type 2 diabetes would follow,  including carbohydrate counting. All of these sites will provide information on this.

Is the crust on bread any more or less nutritious than the rest of it?
The crust is the same as the rest except for any coating such as an eggwash that may help the browning that is so attractive.

I am six months pregnant and recently diagnosed with gestational diabetes. I am on a low-carb diet and sometimes feel hungry in the mornings when my carbs are very limited. Is a whey protein drink okay to drink with my breakfast or morning snack as long as I stay within my carb limits?
Yes, but to be sure about the carbohydrate content, look at the food label.

I get cramps in my feet, calves, and thighs. What is the cause, and what can be done for it?
You would want to let your doctor know about this as it could be an indication of circulatory problems. Generally speaking, cramps can result from dehydration or a deficiency of minerals.

What is the best time to eat meals and snacks for someone who has diabetes and works the night shift?
Generally speaking, most people with diabetes do well if they eat every four to five hours, with snacks between. How often to snack and what to eat depend on the caloric content of their meals, their blood sugar levels, activity, and weight goals. Planning meals for night shift workers can be challenging, especially when considering meals on days off.

I do not always eat enough fruits and especially vegetables.  Is it okay to drink a low-sodium V8 each day? Does it help?
The V-8 will help provide vitamins and minerals but will not replace the benefit one gets from the fiber in fruits and vegetables.

If the liver controls the sugar in the body, what affect does Splenda have if you are a diabetic?
The liver has an effect on blood sugar, but carbohydrates in food also affect blood sugar. Splenda has no carbohydrates and does not affect blood sugar.

What are potential problems associated with taking supplements in lieu of a healthy diet?
A healthy, balanced diet can provide all of one's nutrient needs. Supplements may not be complete or may provide too much of some nutrients, which may have an unhealthy effect.

I have hypothyroidism, am on medication, and my blood work has been good for the most part of a year. Why can’t I lose ANY weight? And is there anything I can do to get it off? I’m 157 lb., 5'7" and forty-four years old. I would love to drop at least ten pounds. I also ride a stationary bike every day for 30 minutes and do some weight-lifting. Can you help me?
It sounds like you are doing well, exercising, and treating your condition. Your current BMI is just under 25, in the healthy range, and exercise may help increase your metabolic rate to help with weight loss. Try journaling your food intake and go to sparkpeople.com to calculate your caloric intake; by decreasing it by 200 to 300 calories you may see some more weight loss.

What foods can I eat if I have acid reflux, and what should I not eat?
First be sure to speak with your physician about any persistent acid reflux. Patients with reflux are encouraged to avoid late evening meals or lying down soon after meals. Losing excess weight, and avoiding clothes that fit tightly around the abdomen may also help.  Alcohol, soft drinks, coffee, and tea can aggravate reflux. Eat small portions of food that are low in fat and high in fiber. Avoid foods that may irritate the esophagus, such as citrus juices, tomatoes, and spicy foods, including pepper. Consider drinking fluids between meals.

If you eat fish late at night, will it interfere with your sleep?
This sounds fishy, I’d say it's okay as long as the fish is eaten on porpoise!

What are some foods to avoid on a gluten-free diet?
A gluten-free diet is given to patients with gluten intolerance or celiac disease. This includes foods that contain wheat, rye, barley, and oats.  The following organizations are good resources for information on celiac disease:
Gluten Intolerance Group - www.gluten.net
Celiac Disease Foundation - www.celiac.org
Celiac Sprue Association - www.csaceliacs.org
Canadian Celiac Association - www.celiac.ca
Celiac.com - www.celiac.com
National Digestive Diseases Information Clearinghouse - www.digestive.niddk.nih.gov/ddiseases/pubs/celiac

If I want to prevent getting diabetes, is avoiding sugar the best thing to do?
Avoiding sugar will not prevent diabetes. To stay healthy maintain a good weight, keep active, and review the U.S. Department of Health and Human Services’ Dietary Guidelines for Americans at www.hhs.gov.

What type of doctor would you see to have your vitamins and mineral count checked?
Laboratory tests for vitamins and minerals can be ordered by any qualified medical doctor.

What do these past four readings of “hair analysis mineral ratios” tell you regarding potential health problems? My past hair analysis test indicates…
Sorry, no comment! Research I have read concludes that the relationship between results of hair analysis with the levels of minerals/metals in body tissues is unreliable, so these readings cannot be considered good information for diagnosing health problems.

Are canned vegetables as good for you as fresh or frozen vegetables?
Canned vegetable processing tends to destroy some water-soluble vitamins and may have added sodium and sugar. Frozen vegetables may also cause vitamin breakdown, but both have the advantage of capturing most of vegetables’ nutritional value if they are processed immediately after harvesting. Interestingly, fresh vegetables held for a long time after harvesting may not be as vitamin-rich as frozen or canned ones. The bottom line is to include vegetables in your diet.

I am forty-one-year-old female who has always been in great shape. I had several things occur within the last two years: I had a baby at age thirty-nine, I had a tubal at the time of my child’s birth (via c-section…my third one), and I pulled the vitreous gel from my retina and cannot run anymore. The problem: I cannot seem to lose weight!! It’s like I have NO metabolism. I walk between two and five days per week for at least one hour, and I eat well ( no sugars, very little starches, portion control, etc.) yet I CANNOT get my weight down. I am currently 150 pounds and would like to lose at least 20 pounds. HELP!!! What can I do?
This sounds frustrating! As I mentioned in the previous answer, find out what your actual intake is versus your estimated caloric need. It may be that you need more exercise even if it is less intensive than running. When you mentioned your good eating, you didn’t mention your fat intake or consistency of eating. Avoid skipping meals and watch that fat intake.

It seems that I am always hungry. I was wondering if there were something that I can do to curb my appetite?
It may be helpful for you to keep a food diary to see how much you are actually eating. Go to mypyramid.gov to use their food analysis and compare your intake to the recommended caloric intake, which you can also calculate on the site.

I am forty-eight years old, a male, take vitamins, and eat “ok,” but for the last year or so I am not making it through the day. A wave of being very tired comes over me where my eyes will not stay open and I will have to nap for awhile just to make it until dinner. I have NO energy after work or on the weekend. I will be lucky to get out of bed at all. Plus the sex drive drove off for good it seems (been about eight months now). I do have hypothyroidism but my blood pressure is normal and so are my cholesterol levels. Could it still be maybe what I eat or don’t eat?
The symptoms you describe should be reviewed with your physician to assess issues that can contribute to fatigue, including sleep apnea and depression. Eating a variety of foods to maintain a healthy weight and a multivitamin can help.

Does meat have sugar in it?
No. There are three sources of calories in food: protein, fat, and carbohydrate. Sugar is a carbohydrate; the calories in meat are primarily from protein and fat with little or no carbohydrates.

What kind of food can people eat if they have a seizure disorder?
Controlling a seizure disorder may involve medications that could affect vitamin and mineral levels; however, there are some nutrients that can interfere with medications, and this should be discussed with your physician, pharmacist, or dietitian. Children are sometimes prescribed a ketogenic diet when medications are not effective. This diet, which is low in carbohydrates and higher in fat and protein, is used under medical supervision. Eating a variety of foods along with a multivitamin will help maintain adequate vitamin and mineral levels.

I have heard that nuts and beans are incomplete proteins. What does that mean? If it is true, is there anything that can be done to make them complete?
Proteins are molecules of amino acids. There are approximately two dozen amino acids in various combinations that make up proteins in our bodies. Eight of these are called essential amino acids we need to have in our diet, while the remaining nonessential amino acids can be produced as needed. Nuts, seeds, beans, and grains are sources of protein that may lack one or more of the essential amino acids. It is not necessary to make them complete as long as one eats enough calories to maintain a healthy weight.

I am required to take an iron pill each day. However, the iron pill makes me extremely sick.  Is there something else I can take or eat to supplement the iron pill (fruits, veggies, anything)?
Iron supplements can have side effects, including stomach cramping, diarrhea, etc. There are many types of iron supplements, so check with your pharmacist about alternative formulations. Iron taken on an empty stomach is most effective but may cause irritation. Try taking the supplement with foods or after meals. The downside to this recommendation is possible food-drug interactions. Again, your pharmacist will be a good resource for this information.

Can men take iron pills? I hear it is harmful to them.
Excess iron intake can be toxic for anyone. It is not recommended to supplement one’s diet with iron unless a deficiency has been diagnosed.

I am a 47-year-old female on thyroid medication. I have no energy and no appetite but still eat a healthy menu. I work night shift, so I eat an evening meal when I wake up and then cereal at 3:00 am and again when I arrive home around 9:00 pm. I haven’t lost one pound yet. This has been going on for two months. I will admit to cheating but not on a weekly basis. Where am I going wrong?
Sounds like a lot going on here! Thyroid condition, a varied schedule, night shift on work days, day shift on days off? It’s hard to know what you mean by healthy menu and whether or not you exercise. You may be best advised to see a dietitian to review your condition and develop a diet plan from there.

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.

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.