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Ask the dietitian! Sandra Frank answers YOUR questions. To submit your question, fill out the form here.
The information presented here is not a substitute for professional medical advice. You should consult a physician in all matters relating to your health, and in respect to any symptoms that may require diagnosis or medical attention.
Dec. 17, 2009
Q. My cardiologist wants me to eat a diet low in carbs for my heart health. My gastroenterologist wants me to eat a "low residue" diet. I have IBS and GERD and despite a Fundaplication procedure a number of years ago, I have a lot of trouble with my digestive tract.
Each diet that I've been given is diametrically opposed to the other - I don't know what to eat anymore. I've gained several pounds trying to balance these two problems. I'm generally thin, small boned, and wear a size 6. When I gain weight it goes straight to belly fat. I am a young 72.
Can you help me figure out what to eat?! -- Madlyn Reynolds of Coral Springs
A. It's not easy for a person with multiple diagnoses and doctors to come up with a treatment plan unless everyone communicates with each other.
You mentioned your cardiologist recommended a low carbohydrate diet. What is your diagnosis? Traditional diets for heart patients are usually high in carbohydrates, low in fat with a moderate amount of protein. Sheryl Lozicki, a registered dietitian states, "the exception is high triglyceride levels, where a doctor may recommend cutting back on carbohydrates."
Your gastroenterologist wants you to eat a "low residue" diet related to Irritable Bowel Syndrome (IBS) and Gastroesophageal reflux disease (GERD).
The diet for IBS is personal in that each individual responds differently to various types of food. However, there are some foods which may aggravate the symptoms by creating a lot of gas or by stimulating the activity in your gut.
You said each diet is diametrically opposed to the other. Let's look at the similarities and make some recommendations.
1. Keep a journal and note any foods that cause you discomfort. 2. Eat 6 smaller meals spread throughout the day. Do not lay down after eating 3. Limit foods high in fat. Avoid fried foods. 4. When you use added fat, use fats high in monounsaturated fats, such as in olive and peanut oil. 5. Eat more fish. Fish is a good source of protein and other nutrients. It also contains omega-3 fatty acids. 6. Avoid Caffeine, found in coffee or tea 7. Avoid Alcohol 8. Read the ingredient label and limit foods high in fructose, found in foods such as soda or may occur naturally in some fruits. You may have similar symptoms of bloating and diarrhea with foods containing sorbitol or xylitol, sweeteners used in candies and gum. 9. Some foods may create gas and bloating, such as beans, cabbage, broccoli, cauliflower, brussel sprouts, legumes, peas, soybeans, onions and bagels. These foods should be avoided. 10. Eat cooked vegetables and fruits you can tolerate. 11. Use white bread, instead of whole wheat. 12. Reduce salt intake. 13. Exercise. 14. Be sure to stay adequately hydrated. Drink water. 15. Avoid gaining weight.
It is important you speak with both physicians. They may recommend you work with a registered dietitian to help plan balanced meals.
IBS and GERD can be extremely painful. I hope you are feeling better soon.
Dec. 2, 2009
Q. I used to enjoy baking during the holidays, but I've put on weight and it seems like all my friends are watching their weight. Can you recommend healthy and/or tasty holiday gifts? -- Corrie of Coral Springs
A. Holiday baskets are a great gift and if you enjoy being creative there are many healthy items you can put in a basket or even in a holiday mug. Here are some ideas to create the perfect gift that shows you care.
Food. Purchase single serving packages. The calories listed below are an average, so it is important to read the label. Calorie amounts will vary from manufacturers.
Pretzels, single serve, 1 ounce = 100 calories Popcorn, air-Popped, 1 cup = 31 calories Apricot, dried, 1/4 cup = 100 calories Pineapple, dried, 1/4 cup = 140 calories Apple, dried, 1/4 cup = 55 calories Shortbread Cookies, rite bites sandies, 1 pouch = 100 calories Almonds, roasted, 1 package, 3/4 ounce = 130 calories Fresh Fruit, sealed to extend shelf life, 4 ounces = 70 calories Hot Cocoa, sugar-free, 1 pouch = 50 calories Candy cane, 1 cane, 1/2 ounce = 55 calories
Books. There are numerous books on healthy cooking or exercise that would be a wonderful addition to the holiday basket.
DVD or CD. An exercise DVD will help shed any extra pounds. A music or relaxation CD will rid you of stress.
Other Items. Scented candle, body lotion, gift certificate for a massage, kitchen gadgets and the list can be as long as your imagination.
Have a happy and healthy holiday.
Nov. 11, 2009
Q. I went to the doctor and was told my cholesterol and triglyceride levels were high. What foods should I avoid and what can I eat? -- Carl Ross of Port St. Lucie
A. Use this list of foods and heart healthy substitutes help you make better choices:
Instead of whipped cream Choose chilled evaporated skim milk, whipped
Instead of Whole milk or 2% milk Choose Skim milk or 1% milk
Instead of Cheese, (American, Cheddar, Swiss) Choose Cheeses with 5 or less grams of fat per ounce. Terms used: reduced-fat, low-fat or fat-free. Reduced-fat is easier to substitute when cooking
Instead of Mozzarella cheese Choose Part-skim mozzarella cheese
Instead of Sour cream, regular Choose Non-fat, light, or low fat sour cream or plain yogurt.
Instead of Salad Dressing Choose Reduced-fat, cholesterol free, low fat, or fat free dressings or lemon juice, vinegar, or mustard. Reduce the amount required in the recipe.
Instead of One whole egg Choose Two egg whites or 1/4 cup egg substitute
Instead of Gravy Choose Gravies made with broth and thickened with flour/cornstarch
Instead of Bologna, salami, or corned beef Choose Lean ham, low fat cold cuts, sliced turkey breast
Instead of Short ribs Choose Grilled or baked salmon, grilled lean beef tenderloin
Instead of Beef, pork, veal, lamb Choose Lean cuts trimmed of all visible fat, or substitute with chicken or turkey without the skin.
Instead of Ground beef Choose Ground turkey or lean ground beef
Instead of Cakes or pastries for desserts Choose Angel food cake, fruit, gelatin
Instead of Chocolate chips or nuts Choose Raisins or dried fruit
Nov. 9, 2009
Q. How long can you keep frozen food if the power goes out?
A. The United States Department of Agriculture under the food safety and inspection services provides guidelines on how to handle frozen food when there is a power outage.
The amount of food in the freezer will affect how long it will stay frozen as long as the door is kept shut. A freezer full of food will keep about two days and half-full freezer will last about a day. When the power goes out separate the meat and poultry from the other food items and store on a low shelf. This is done to prevent the food juices from dripping onto other foods, if thawing begins. Then group other foods together as close as possible so they remain cold.
You may want to use bags of ice or dry ice until the power is restored. Make sure you have a food thermometer available and keep track of the temperature.
Check the condition and temperature of the foods when the power comes back on. If the food is partially frozen, ice crystals visible and the food temperature is 40F or less then it is safe to refreeze or use. Throw away all foods warmer than 40F for more than two hours. Dispose of foods contaminated by meat or poultry juices. Discard melted or soft ice cream due to quality.
Q. With Halloween coming up, I would like to give out treats that are fun and healthy. What do you recommend?
A. With the increase in obesity among children today, the last thing they need is empty calories. Below are lists of healthy Halloween treats and Non-edible Halloween Ideas. Remember to purchase only prepackaged foods.
Healthy Halloween Treats: Box of raisins Juice boxes Popcorn Pretzels Trail Mix Fruit and Nut Mix Granola Bars Prepackaged Cheese and Crackers 100 Calorie snack packs
Non-edible Halloween Ideas: Stickers Crayons Coloring Books Play-Doh Bubbles Chalk Temporary tattoos Card Games Bouncing balls Hand stamps Frisbee Glow or Inspirational rubber bracelets Yo-yo's
Q. Since I'm a very picky eater (I dislike most vegetables), I've never been able to follow any specific diet.I have since heard that matching certain foods together as a meal will actually burn fat/calories.Is this true and, if so, can you tell me what goes together to accomplish this? âLynn Kelly, Fort Lauderdale
A. The matching of foods in order to burn fat and/or calories has not been verified. But there are food combinations that can help you lose weight and/or increase absorption of nutrients.
Variety of foods. The best food combinations include fruits, vegetables, breads and starches, fats, meat and milk. A milk allergy may prevent you from consuming dairy products. Include other foods rich in calcium and the B vitamins if you have a milk allergy.
Try soup: Consume a low-fat soup, a large salad with fat-free dressing or a 1/2 grapefruit before you eat your main meal. This will slow down your eating and curb your appetite.
Increase absorption: Drinking orange juice with an iron supplement will increase your absorption of iron from the foods you already eat.
Q. I am taking a diuretic. How do I keep from depleting my sodium? Thank you for your help. â- Arnold Portnoy, Boynton Beach
A. Diuretics are prescribed for high blood pressure, congestive heart failure and other conditions in which there is swelling or fluid retention.
They increase the loss of water and salt from the body through the urine. Usually a low-sodium diet is prescribed when you are taking a diuretic. This diet does not eliminate all of the sodium; it just reduces it to a safe level.
As long as you follow a prescribed food plan and do not abuse the diuretics, you should be consuming an adequate amount of sodium to prevent depletion. If you are still concerned about your sodium level, contact your physician and ask to have tests done to check your levels.
Some symptoms of sodium depletion include nausea, abdominal cramping and/or vomiting; headache, swelling (edema), muscle weakness, tremor, disorientation and slow breathing.
Q. With the countless number of weight loss programs and fad diets on the market today, what do you consider as being tried and true method to effective and permanent weight loss? -- Linda Christopher, Coral Springs
A. There are over 20 million weight control sites on the Internet. Some of these offer programs that are excellent, and others are dangerous or useless. If any program or method promises a quick, permanent weight loss of 10 pounds or more overnight or within a week, you can eliminate it and save yourself time and money.
You should avoid buying any diet pills or dietary supplements online. Unless you know the company is reputable, there are limited safeguards against contamination.
An effective weight control program should include the following factors:
1. A weight loss and a weight maintenance phase.
2. Encourage the use of a food diary or journal to keep a record of intake, activities and feelings.
3. Provide lessons on motivation and the advantages of having a positive attitude.
4. Information on how to use portion control.
5. Strategies for planning ahead.
6. Physical activities.
7. A variety of foods, either through a food plan or prepackaged foods.
The factors listed above are from my personal research of people who lost weight and successfully kept it off. These are the top seven "Success Factors." The participants in the study used over 17 different weight loss programs to achieve their goal weight. This made it impossible to determine whether a specific program was better than another.
Choose a plan that meets your lifestyle. Are you a person who would prefer prepackaged foods or going to the market and creating your own menus? Shop around for a weight control program that includes the "Success Factors".
Q. How do I fool my metabolism? For five weeks I stopped having my usual two scotches before dinner. I also increased my aerobic workout to burn 50 percent more calories. In addition, I had diverticulitis and ate only soup for four days, during this period. Net result no weight change. My metabolism seems to be able to figure out what changes I make and works against it. -- John Nugent, Fort Lauderdale
A. Your metabolism cannot be fooled, but you can work with your metabolism to lose weight successfully. You mentioned a few factors that may affect your weight, such as alcohol consumption, aerobic workout, diverticulitis and no weight loss in five weeks.
Alcohol and diverticulitis do not go together, and you should avoid all alcohol when you have a flare up.
There are many factors affecting one's weight loss. You seem to be aware of the benefits of exercise, but what are you eating and how often do you exercise? Are you retaining fluids?
In order to lose weight, calories consumed must be less than calories needed for weight maintenance. Keep a food journal. Check to make sure you are not eating more than you think.
Q. I need to restrict my intake of potassium. I have been diagnosed with high potassium. I want to find out the potassium milligrams in one cup of cooked whole-wheat pasta. -- Sonia Spivack, Boca Raton
A. Potassium is a mineral that helps maintain the normal function of the heart and nervous system. Deficient and excess intake of potassium can cause health problems. Make sure to monitor your blood potassium levels so they are within the normal range.
One cup of cooked whole-wheat pasta contains about 61.6 milligrams potassium.
The following foods are considered high in potassium: Bananas, oranges, apricots, avocadoes, strawberries, raisins, prunes, mangoes, papayas, potatoes, pears, plantains, tomatoes, cantaloupe, lima beans, cucumbers, cabbage, cauliflower, chard, bell peppers, eggplant, squash, Brussels sprouts, turmeric, parsley, spinach, broccoli, tuna, halibut and oat bran.
In addition, if you use a salt substitute, read the label and make sure potassium is not the mineral replacing the sodium.
Q. I have recurring UTI's and bladder infections. The doctor put me on antibiotics but it doesn't help much. People tell me they take Azo cranberry tablets daily for urinary health. Do you recommend that? Are they high in sugar? -- Linda Versil, Coconut Creek
A. When I put Azo cranberry in the search engine there were 459,000 results, mostly from sellers. I noticed a disclaimer on all the ads, "The FDA has not reviewed this product for safety or effectiveness." Looking further I found additional information from the Food and Drug Administration (FDA) and AMA.
1. Cranberry has not been approved by the FDA to diagnose, treat, cure or prevent any disease. It should not be substituted for prescription medications.
2. Cranberry has not been studied by the FDA for safety, effectiveness, or contamination. All potential risks and/or advantages of cranberry are not known.
3. There are no regulated manufacturing standards for Azo cranberry. Some dietary supplements have been found to be contaminated with toxic metals or other drugs due to lack of regulations. When purchasing a supplement make sure it is a reliable source.
4. One Azo cranberry tablet has 3 calories with a minimal amount of sugar. Different brands may have different amounts of sugar. Read the label.
Research shows cranberry juice may reduce the risk of getting a urinary tract infection (UTI). However, the research does not prove cranberry juice can treat a UTI.
Cranberry juice is defined as a drink, not a medicine. The medical testing applied to drugs does not apply to a drink. One study estimated at least 10 ounces of cranberry juice per day may be a preventative amount. If watching calories or sugar there are sugar-free cranberry juices that may include similar preventative benefits.
Antibiotics are the first choice of treatment for bladder infections. The type of antibiotic the doctor prescribes depends upon the bacteria found in the urine.
Women with recurrent UTIs can take steps to prevent and treat infections. The tips include:
1. Drink plenty of fluids.
2. Self care.
3. Avoid coffee, soft drinks with caffeine, citrus juices and alcohol.
4. Avoid spicy foods until the infection has cleared up.
5. Take your medicine as prescribed by your physician.
If antibiotics and self care does not work, the physician may refer you to an urologist for other treatments.
Based on the information I reviewed, I would not recommend the use of Azo cranberry tablets. More research is necessary that includes food and drug interactions, effectiveness, dosage, side effects and contamination.
Q. I have an 82 years young patient who has Alzheimer's. My concern is she does not swallow her food when she eats, she chews and chews the food then spits it out. A couple of months ago this same eating behavior was happening I took her to do a swallow test and was told the condition was caused by acid reflux and was told to give her a acid reducer tablet for 14 days which I did, and her appetite returned to normal.
However this time I have now been giving her the acid reducing tablet for over two weeks, and there is no change in her eating. So I was wondering if you have any knowledge of this condition and could offer some helpful advice. She does not even swallow soft food such as cream potatoes, grits or oatmeal, and also as soon as she sees any kind of food she atomically feels full and has no appetite. -- Karen Gilz, Miramar
A. Your patient needs to see a physician as soon as possible. From what you have described, another swallowing evaluation will most likely be ordered. This test is usually preformed by a speech therapist to determine a patient's ability to swallow.
Various consistencies of foods are used in the test.
Swallowing disorders are common, especially in the elderly. If the swallowing problem goes untreated this can cause dehydration, weight loss, choking, and malnutrition.
Q. I have diabetes, as well as high cholesterol. I take medication for both. I'm not sure what type of food plan would be best to follow. Sugar-free/low sugar products seem to have more fat. Low fat/fat free products seem to have more sugar. I would love to find a food plan with a daily menu of proper foods. Any suggestions? -- M. DeForest, Sunrise
A. I'm glad to see you are reading the labels. You are right there are some sugar-free foods high in fat and some fat-free foods high in sugar. It can become confusing trying to put together a healthy menu.
The American Diabetes Association states that following a healthful meal plan is one of the best things you can do for your heart and recommends the following lifestyle changes to help improve your cholesterol level:
Don't skip meals, eat at the same time each day and take your medicine.
Be sure to limit:
Saturated fats found in packaged foods, red meats, whole-milk dairy products, egg yolks and shellfish. Read food labels and try to keep saturated fat to less than 7 percent of your daily total calories.
Total fat. Most foods should have 3 grams or less per serving; meats and cheeses, 5 grams or less. Keep total fat intake between 25 and 35 percent of calories.
Limit your dietary intake of cholesterol to less than 200 milligrams per day. Foods high in cholesterol include egg yolks, whole-milk dairy products, poultry, shellfish and meat.
Trans fats found in shortenings, hydrogenated oils, deep-fried foods, margarines and many packaged foods.
Liver and organ meats.
Add to your diet:
Fat-free and low-fat versions of dairy products, dressings and other foods (be sure the fat is not replaced by carbohydrates).
Fish, beans, chicken without skin and extra-lean cuts of red meat. Buy tuna packed in water, not oil.
Prepare foods using low-fat methods, such as baking, boiling, poaching, sauteing, roasting or grilling. Cook with no-stick cooking sprays. Steam or microwave vegetables.
Monounsaturated fats such as canola, avocado and olive oils.
The amount of fiber you consume by eating whole grains, fruits, vegetables, oats, barley, beans, chickpeas, seeds and dried peas. Your goal should be 20 to 30 grams fiber per day.
Plant stanols and sterols found in the cholesterol-lowering spreads in the refrigerated/margarine section of your grocery store.
Foods rich in omega-3 fatty acids, such as salmon, mackerel, lake trout, herring, sardines, albacore tuna, flaxseed, soybean oils and walnuts.
Exercise and maintain a healthy weight
The American Diabetes Association offers a free "What Can I Eat" booklet by calling 800-DIABETES or emailing AskADA@diabetes.org. Or visit There also is a section on their website MyFoodAdvisor to help with diabetes management, tracking what you eat and meal planning.
Wendy Petusevsky R.D., LD, CDE is a Diabetes Educator at Holy Cross Hospital. She states "It is best to have a meal plan designed by a dietitian who will take into consideration your weight, medications, lab values (including cholesterol), activity levels and food preferences. To find a dietitian who specializes in diabetes, you can call your local hospital or the Diabetes Association in your area."
Q. How much caffeine is in a 3-ounce espresso and an 8-ounce cup of coffee? -- Moe Schneider, Boynton Beach
The amount of caffeine varies in different brands and blends but here are some generaltities:
A double shot (3 ounces) of espresso contains between 58 and 185 milligrams caffeine.
An 8-ounce drip coffee contains 115 to 175 milligrams caffeine.
An 8-ounce brewed coffee contains 80 to 135 milligrams caffeine.
Q. How many calories should I be eating a day as a pregnant woman. I'm 5-feet 2-inches and 145 pounds and in my fifth month of pregnancy. -- Joy Oglesby, Fort Lauderdale
A. The number of calories you need depends on factors such as your height, activity level and whether or not you are over or under your ideal body weight.
Pregnant women need an additional 100 calories in the first trimester and 300 calories in the second and third trimesters. Monitor your weight gain and adjust your calories as needed.
General weight-gain recommendations are listed below and refer to pre-pregnancy weight and women expecting only one baby:
If you are underweight, it is recommended you gain about 27 to 40 pounds.
If you are normal weight, it is recommended you gain about 25 to 35 pounds.
If you are overweight, it is recommended you gain about 15 to 25 pounds.
If you are obese, it is recommended you gain about 15 pounds.
Women carrying twins should plan to gain about 35 to 44 pounds.
Excess weight gain from eating too many calories can increase your risk for gestational diabetes and high blood pressure. This can put both you and your baby's health at risk.
Restricting calories and weight gain can result in a baby with a low birth weight and nutritional deficiencies. Babies who are born weighing less than 5 1/2 pounds are at greater risk for developing difficulties and illnesses than babies who weigh more
This is a list of healthy food choices that have about 300 calories:
1 cup of non-fat fruit yogurt and a medium orange or apple.
1 slice whole-wheat toast with 2 tablespoons peanut butter
1 cup raisin bran cereal with 1 cup nonfat milk and a small banana
3 ounces chicken breast and 1/2 cup sweet potatoes
1/2 cup low-fat ice cream with 1 small banana and 1 cup strawberries
Should you have any further questions about your specific caloric needs, be sure to seek advice from your primary care provider or a registered dietitian. The Florida WIC Program offers free nutrition information for Women, Infants, and Children. This article addresses the foods for a healthy mother and baby.
Q. My doctor put me on a low-fat/low-sodium diet, but I love Chinese food. Can you tell me what I can eat, and what I should avoid? --Marilyn Ross, Boca Raton, Fla.
A. Ask the chef to omit the MSG and cut down on the cornstarch, sugar, salt and oil. Avoid anything fried (rice or crispy noodles included) or laced with sweet-and-sour sauce; egg dishes or soups; avoid duck and limit beef, pork and pickled foods; or excess soy sauce.
Order plain steamed rice; boiled, steamed or stir-fried vegetables; moderate portions of simple prepared fish and shellfish; non-fried tofu; skinless poultry and the filling of egg rolls.
Try this: Chicken and broccoli made without MSG or cornstarch.
Q. What does "light" mean on a nutrition label?-- Samantha Curtiss, Scranton, Penn.
A. The Food and Drug Administration regulates the use of descriptive words on nutrition labels.A food product claiming to be "light" must adhere to one of the following FDA definitions:
1. The food is at least one-third fewer calories per serving than a comparison food.
2. The food contains no more than half the fat per serving of a comparison food.
3. The food contains no more than half the salt per serving of a comparison food.
4. Light can still be used to describe other properties like color or texture as long as the label makes the distinction clear (for example, "light brown sugar" or "light and fluffy").
Q. What foods are high in iron? -- Fran Resnick, Deerfield Beach, Fla.
A. Excellent food sources of iron are clams, oysters, mussels and liver from chicken, beef and pork. Good sources are beef, shrimp, sardines and turkey.
Iron sources for vegetarians include iron-fortified breakfast cereals, spinach, kidney beans, black-eyed peas, lentils, turnip greens, molasses, whole-wheat breads, peas and some dried fruits (dried apricots, prunes, raisins).
Eating foods rich in vitamin C at the same time you eat iron-rich foods will help increase iron absorption. These foods are rich in vitamin C (ascorbic acid): oranges, orange juice, cantaloupe, strawberries, grapefruit, broccoli, tomatoes, tomato juice, potatoes, and green and red bell peppers.
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