Friday, October 27, 2017

6 Reassuring Facts About Lice That Every Parent Needs

It’s time we say the two little words that no parent wants to hear—flu season. The time of year when temperatures go down and the germ count goes up. Together, this dangerous duo makes nearly impossible for your child to avoid getting sick.

Now, for all those parents out there who know the flu-season drill, you’ve probably already stocked up on vitamin C, cough drops and tissues. Unfortunately, though, you may be overlooking one tiny thing—head lice.

Just thinking about lice can make the most level-headed parent feel overwhelmed—and itchy. Just remember, if your head starts to feel itchy while reading this, it doesn’t mean you have lice.

So, what is it about lice that makes it so revolting? Well, the many myths, stigmas and misinformation out there may have something to do with it. That isn’t to say that having lice is easy or fun, but it may not be quite as bad as what you’re imagining.

Let’s get the record straight with lice. Here are 6 reassuring facts about lice that you need in your life:

Contracting head lice is common. Head lice have been around for millions of years and it’s unlikely that they’ll disappear anytime soon. Outbreaks affect people all over the world, so if your child ends up getting them, you’re in good company.

Lice aren’t dangerous. While they may cause itching and difficulty sleeping, head lice are relatively harmless and cannot transmit disease.

Lice only move by crawling. They cannot jump, fly or swim. Unlike fleas, the only way to contract head lice is by having one hook onto your hair through physical contact. They are also very slow, most lice only move about four inches per minute.

Contracting lice has nothing to do with hygiene. While there is often a stigma associated with lice as resulting from poor hygiene, in reality they actually tend to prefer clean hair.

Pets cannot carry lice. Head lice have evolved to only thrive with a human host; pet blood is too warm for them. So you can continue cuddling with your furry companions guilt-free.

Lice cannot live alone in your home. While you may feel the need to disinfect every surface of your house after an outbreak, the reality is that head lice don’t live long without a human host to sustain them.

My child has lice, now what?

The first step is to remain calm. Lice can be controlled with medicated shampoo and a lice comb. While there are some medications available over the counter, a primary care provider can prescribe more efficient alternatives. At the new GMC Primary Care & Specialty Center-Suwanee you can work with knowledgeable experts who utilize the latest in treatment options to get rid of this pesky parasite—for good. That way, you can get back to enjoying time with your family without any involuntary itching.

Wednesday, October 25, 2017


Fun fact – fiber is only present in plant foods. 

Everywhere you read about adding more fiber to your diet! Why is there so much fuss about fiber? Well, the main reason is preventing constipation and good bowel function; the other reason is prevention of numerous diseases.

Many of my clients suffer from constipation. Their solution? Medication. They don’t quite understand that food is the better solution. Unfortunately laxatives lead to a lazy bowel. In order to retrain the bowel to function properly, gradually increase fiber-containing foods. It’s as easy as that. The result is comfortable and regular bowel movements – nice topic.

Constipation is known as the “silent disease” as no one wants to talk about it. It’s embarrassing and everyone thinks they’re the only one with this problem. However, it is common and serious. One myth is that you need to have a bowel movement every day. This is not so. You can have a bowel movement every third day and not be constipated, if the bowel movement is soft and easy to dispel. Constipation means your bowel movement is hard and painful to eliminate.

In most cases, your bowel movements follow your eating pattern. On days that your food quantities are smaller, your bowel movements will be less in quantity and less frequent. After large meals, especially those high in fiber, your stools will be larger and your bowel movements more frequent. By increasing your fiber intake, you are taking the first step towards maintaining a healthy bowel.

There are other factors that influence regularity. Do you drink enough fluids, exercise frequently and make time to go to the restroom? If you delay a bowel movement, water is absorbed from the feces, making the feces difficult to move. Some clients are so busy that I have to remind them, “When you have to go, you have to go!”


Besides providing the joy of regular bowel movements, fiber has other benefits. High-fiber intake is linked to a lowered incidence of intestinal disorders, cancer, heart disease, hypertension, high cholesterol, gallstones, diabetes and obesity. Isn’t taking preventive measures, like increasing the fiber in your diet, better than illness, uncomfortable treatment and expensive medication? Buy your fiber foods now!


Fiber is present in grains, legumes, fruit and vegetables, not in animal products. Also in packaged foods - read the “Dietary Fiber” content on the Nutrition Facts panel. For example, with cereal, look for 4 grams of fiber per serving. Be sure to check the serving size. Some cereals have it listed as ½ cup, others 1- ½ cups.

I like to mix a weeks supply of four cereals plus dried cranberries and sunflower seeds in a container, for a different taste and texture every day. The cereals range from little fiber (1 g per 1/3 cup) to a very high source of fiber (11 g per 1/3 cup). Using mainly the latter, I’m ensured approximately 8 g fiber for a ½ cup of mixed cereal. By adding 1% milk and ½ banana, my breakfast consists of a hearty intake of fiber (in cereal, cranberries and seeds); calcium, vitamin D and riboflavin (in milk); potassium and a little vitamin C (in the banana); and a multi-vitamin supplement (in fortified cereals.)

Aim for 25 g of fiber per day for health and comfort reasons. On average, we consume less than 15 g of fiber per day. There is plenty of room for improvement. With any increase in your fiber intake, remember to increase your intake of fluids. Fiber absorbs fluid, which makes feces soft. Without fluids, the fiber can bulk up in the colon and cause an obstruction. Usually increased fiber intake increases thirst.


There are two types of fiber: soluble and insoluble. The soluble fiber helps lower blood cholesterol and glucose levels, and insoluble fiber aids regularity. Sources are:

Soluble: oat bran, oatmeal, legumes, fruits, vegetables
Insoluble: wheat bran, cereals, whole grain bread, fruit vegetables

Add to your shopping list:
• High fiber cereals (containing at least 4 g fiber per serving)
• Whole-wheat breads and rolls
• Whole-wheat pasta
• Brown rice
• Legumes (canned or dried beans, peas and lentils)
• Plenty of vegetables (fresh, frozen and canned)
• Plenty of fruits and fruit juice with pulp


A client and her sixteen-year-old daughter stayed with a vegetarian. On the second day, the teenager had such terrible cramps in her abdomen; she had to be taken to the hospital. The teen’s worried mother suspected appendicitis. En route, the teenager started passing gas. When they arrived at the hospital, the bloating, pain, and discomfort subsided and she needed the washroom. Needless to say, she felt fine afterwards. Her problem? She had never had so much fiber in her diet in such a short time. Her bowel was not used to the overload, and had reacted accordingly.

Another concern, you will notice when you increase your fiber intake - an increase in gas production. Gas may cause discomfort and lead to complaints from family members and friends. I eat less of my favorite multi-bean stew before going to a movie. When alone, I take a chance with a larger portion. You will also need to balance your bean intake with social activities.

- Minimum intake of 25 g fiber per day
- Drink plenty of fluids
- Exercise for at least half an hour every day
- Relax
- Take time to go to the bathroom


Food: grams fiber 

½ cup high-fiber cereal: 8
1-cup 1% milk: 0
½ banana: 1.5

1-cup pea soup: 5.5
1 whole-wheat roll: 4
2 slices turkey breast (2 oz): 0
1 Tbsp light mayonnaise: 0
Lettuce, tomato and cucumber salad: 2
1 tsp extra light olive oil: 0
1 apple with skin: 3.5

1 sesame seed bagel: 3
1 Tbsp light cream cheese: 0

4 oz salmon: 0
½ cup brown rice: 2.5
2 tbsp light sour cream: 0
½ cup carrots: 2.5
½ cup broccoli: 2
1-cup strawberries: 4 

1 low fat yogurt: 0
Total: 38.5 g fiber for the day

Do you see how easy it is to get enough fiber in your day? Even if you eliminate the pea soup, a vegetable and a fruit, you can still consume enough fiber in one day. A bonus is these foods contain numerous other nutrients such as vitamins, minerals and antioxidants that are important in the prevention of many diseases.

Where you get into trouble is when you are rushed for time. You skip breakfast and pick up a bran muffin (2.5 g fiber) and coffee on the way to work. At lunch you grab an egg sandwich (2 g fiber). In the afternoon, it’s four chocolate chip cookies (1 g fiber) that are always in the office kitchen. On the way home you buy a hamburger (2 g fiber) and fries (1 g fiber). You might as well include a chocolate (0 g fiber); after all, you’ve had a hard day - a total of 8.5 g fiber. With the national average intake of 11 g fiber per day, your day is really looking bad.

By “preaching” fiber-rich foods, I’m not trying to force tasteless cardboard chips on you. I want you to eat delicious fruit, the crispiest vegetables, the freshest breads and the crunchiest cereals. In particular, always have low fat, high fiber, tasty foods in your home and office, and ready to eat.

The immediate benefit of increased fiber intake is regular bowel movements. The long-term benefits include lower cholesterol levels, better diabetes control and perhaps a lower body weight. Eat more fiber and Feel Fantastic!

Cheat Days: Yay Or Nay?

Most of us do what we can to be healthy. For some this means exercising regularly and eating a balanced diet, for others it means getting 7 to 9 hours of sleep and drinking water. Whatever form your healthy habits take, one thing remains the same—it’s all about making it work long term.

So, what’s the secret to making it last? Enjoying all of your favorite treats—cookies, candy and ice cream—oh my! While you wouldn’t normally think of these foods as diet-friendly, they can be if you enjoy them during designated nutritional splurges. That’s right; we’re talking about cheat days.

The concept is simple enough; you follow your healthful diet for a majority of the week. Then, for one day only, you cut lose and let yourself indulge in all of your favorite foods. That can’t be healthy, though, can it?

Because there’s still a fair amount of debate about the potential benefits and drawbacks of cheat days, there’s no clear answer. So, to help you decide if cheat days are right for you, here’s a quick look at the physical—and psychological—pros and cons.

Let’s get physical

Pros: Recent studies have shown that periodic cheat days may help to restore your body’s level of the hormone, leptin. As an important part of your metabolic process, leptin helps support energy and regulate hunger signals. Oh, and let’s not forget that higher levels of leptin also help to boost your metabolism, but only for a 24-hour window after overeating.

Cons: Keep in mind that a cheat day here and there isn’t necessarily bad news, but consistently binging can cause some notable physical changes, including:

·         Stomach stretching. While your stomach can technically stretch to fit 4 liters of food, its average is closer to 1 liter (the size of a Moe’s burrito). If you consistently overeat, your stomach may remain stretched, requiring more food to feel full.
·         Decreased insulin sensitivity. Your body relies on insulin, a compound produced by the pancreas, to process and absorb blood sugar. If insulin sensitivity is reduced, this means it takes more and more insulin to get the job done. Over time, this can lead to diabetes. What’s even scarier, is just one day of binging can decrease insulin sensitivity.
·         Disrupted circadian rhythm. After indulging in an extra-large meal, your circadian rhythm, which regulates the timing of both eating and sleeping, may be thrown off for the next several days. This will leave you feeling extra hungry and extra tired.
Be Mindful

Pros:You may remember hearing about leptin for its many physical benefits, but the good news doesn’t stop there. It also provides psychological benefits, too. For instance, higher amounts of leptin have been linked to increased motivation, libido and dopamine levels.

Cheat days can also help individuals satisfy their cravings in a manageable way. Instead of giving up on dieting all together, individuals have an outlet to indulge periodically, while still maintaining a healthy diet overall.

Cons: As noted above, overeating can cause a spike in dopamine levels, which is the neurotransmitter that controls your pleasure and reward systems. Moving forward, your body will associate those good feelings with unhealthy foods and overeating.  

Also, when binging on delicious foods (aka those high in fat and sugar) the hormone gherlin, which stimulates appetite, becomes elevated and stays elevated, which keeps you wanting more and more—and more.

A Healthy Dose of Dieting

The foods we eat have the power to make us look and feel our very best, but they can also leave us feeling tired, sluggish and uncomfortable. Gwinnett Medical Center’s Nutrition and Weight Management program offers access to the experts and resources you need to make better food choices for your unique health needs. Our registered dietitians will help guide you through nutrition consultationsDiet by Design, as well as metabolic testing—all of which will make a positive difference in your overall health.

Tuesday, October 24, 2017


Studies show there are no benefits to taking supplements, and there may be harm. (Added 2017)

I’ve always been careful with recommending supplements, as the results of studies change over time. A new study finds that high doses of folic acid may increase the risk of developing precancerous colon polyp growths. Previous studies showed diets low in folic acid led to a higher risk of colon cancer.

Last month, a study linked heavy vitamin E use to fatal prostate cancer, and other research has shown beta-carotene pills can heighten smokers’ risk of lung cancer.

“I take vitamin C every day,” boasts a gentleman at my luncheon table. “I believe it’s good for me.” I ask him how much he’s taking. He doesn’t know. But he takes two to three pills. This is so common - someone believes something is good for him or her - they heard it somewhere - so they buy it but they don’t know how much they should take.

Billions of dollars are spent on nutrient supplements of all kinds each year. According to the Office of Dietary Supplements, in 2005 dietary supplement sales in the US approached 21.3 billion dollars.

Most of the supplements are going to those who need them the least. The people who buy the supplements are the well-to-do healthy population, not the malnourished population who really do need them.


Everyone is looking for the “magic pill.” False advertising appeal to their insecurities. Messages such as “vitamins in fruits are destroyed when transported,” “a balanced diet is insufficient to maintain health,” “if you’re feeling tired, you lack....” and “when under stress you need extra nutrients.” If you buy into these, you may become another victim of the supplement industry.

With the craze for mega-dosing, it’s important that you know what you’re doing. A “little is good,” so you might assume a “lot is better.” This is not the case and can be downright dangerous. Don’t play games with supplements! (Even the scientific community is struggling to find the right amounts of nutrients that will improve health with no harmful side effects.) Instead use your knowledge to consume a variety of nutritious foods.

For example if you think you don’t have time to prepare vegetables, time yourself. It takes 15 seconds to open a bottle, take out a beta-carotene tablet, pour water and swallow the pill. Peeling a fresh and crunchy carrot takes only 20 seconds and you get so much more value. The carrot will not only supply you with beta-carotene, but hundreds of protective nutrients like other carotenoids, vitamin C and fiber. These substances in the carrot will supply many health benefits, so why limit yourself to only one?

Vitamin C - the perennial “flavor”’ of the month? - From 500 mg to 3000 mg and more. Who cares? It’s supposed to be good for us isn’t it? Next month it’s vitamin E. Again the public doesn’t know the amounts to be taken or why they should take it. With osteoporosis in the news, you self-prescribe calcium and vitamin D. What about ginseng and bee pollen? They’re hot in the media from time to time. I have clients who have brought in bags filled with 20 supplements. Many have overlapping nutrients, many don’t have ingredients listed, and many have very strange ingredients. What are the functions of the various ingredients? They can’t remember, although they sounded good at the time.

No one knows for sure if supplements are necessary. If they are, which ones and how much? Will there be toxic side effects at a later stage? Who knows? We can only work with what we know now. I prefer to be cautious. Eat well, and supplement only for certain conditions, and then under the care of a dietitian or physician.


Most people don’t feel any different when they take supplements. But some take certain supplements and say they feel different. This may be the “placebo effect” working on them. In other words if you believe it makes a difference, it will. If the supplements are not harmful, I don’t object. But, if the total intake of some of the nutrients is excessive, I warn my clients that they can continue at their own risk, or slowly decrease their supplement intake, eventually stopping altogether. Remember, the contents of these supplements are present in nutritious foods, a more enjoyable way to get all your nutrients.

Some supplements, such as vitamin C, taken in large doses should be weaned slowly so that the body adjusts to absorbing vitamin C from food. This takes time due to the deprivation of its usual overload from supplements. Under these circumstances, scurvy can occur. Again, seek professional help.

With regard to pain and arthritis, studies with glucosamine chondriotin supplements found that some people feel better after three months, others had no change in pain. There are also quality issues, some supplements contain less than claimed or no chondroitin at all, some are good quality. Visit for product reviews – well worth your investment.

Studies on chromium supplements have seemed positive. If your diet does not contain whole wheat bread and cereals, peanuts, prunes, apples, mushrooms, oysters or wine each week, speak to your dietitian.


A supplement salesperson once claimed, “Zinc is an essential vitamin you should take.” When I told her that zinc is not a vitamin, it’s a mineral, she said it’s not important, so long as we know it’s essential. She also told me that my clients should take supplements to prevent cancer. If I don’t recommend them, she insinuated, I’m contributing to their future ill health. As it turned out, she’d “studied” nutrition from a sales book on supplements. Wow, what kind of super salesman wrote that book? Unfortunately, she was passing on false information to her customers, who probably didn’t know better. It gave me pause to wonder what else she didn’t know that she was convincing the public to believe!

High-powered people from multi-level marketing companies are out there selling supplements to their friends. These unnecessary supplements are more expensive than those in drugstores. Salespeople who boast about their large commission sell them to you. Fortunately, most of my clients, who have bought these, forget to take them.

I’ve been approached to endorse, or sell, their products but have declined. I would lose my professional status were I to do so. Dietitians may only recommend supplements if they are necessary. We certainly cannot sell them. The Nutrition Division of a local Public Health Department has been so concerned about pyramid sales or “network marketing”, that they have issued a pamphlet entitled “Caveat Emptor - Buyer Beware.” This issue warns the public about nutrition quackery, of which many of these supplement salespeople are guilty.


Don’t feel you have to ingest grape seed extract, spirulina and echinacea to be healthy. I don’t consume them either. Our desire for perfect health compels us to seek products to replace our deficiencies. When we enter a health food store, a plethora of mixtures; herbs, seeds, powders and bars that seem to contain the precise remedy for our ailment confront us. With the claims to decrease aging, people are popping pills at an alarming rate. The prospect of lowering stress and preventing heart disease is naturally compelling, but without a sound scientific basis, you could be harming yourself.

My advice is to buy real foods, such as vegetables, fruits and whole grain products that are bursting with essential nutrients. The only time I go to a health food store is for interesting types of rice, seeds, herbs and spices. They’re quite expensive, but complement certain dishes. So if price is not an issue, buy interesting foods - not pills - at these stores.


Before I plan any program with a client, I ask the following questions to assess their overall health:
• Are you taking supplements? Thankfully, most say no. But some are not certain if they should. I assure them that I’ll balance their food intake so that supplements can be avoided, unless necessary.
• If they say yes, I ask which supplements and what are the quantities taken? Most of my clients don’t know what is in each tablet or the amounts of vitamins and minerals they’re consuming.
• I then ask who recommended them? Many can’t remember - if they do, it’s either a relative, friend or health food supplier. It’s seldom a health professional.
• Why are you taking them? The answers vary: “It’s meant to be good for me,” “I heard our food supply lacks vitamins,” “for energy,” etc.
• Since taking the supplements, do you notice any difference in your condition? “No, but I’ll just finish these anyway,” “I think I’m feeling better, but I switched to a high fiber diet as well,” and more of the same.
• If a doctor has recommended a multi-vitamin and mineral tablet for a specific condition, for example, for pregnant women, I feel comfortable going along with this.


“This is a ‘natural’ not a ‘synthetic’ type,” - Clive says smugly. How can he tell if it’s true? They look alike. And there’s no regulation at all to define “natural.” “Natural” is used to describe anything and everything. It does and always has meant nothing. In actual fact there’s no difference, except perhaps in price. The body can’t tell the difference.

If you are determined to take a supplement despite my advice, take the lowest dose and the cheapest all-purpose one. A better investment in health and education, and possibly cost saving, is to see a dietitian who helps you plan a healthy, nutritious eating program.


Supplements are regarded by the consumer as a food, not as a drug. But overdosing can occur. The dangers of toxicity far outweigh the hope for miracle effects. I need proof that a supplement is necessary for everyone before I recommend it across the board or even take it myself!

Pregnant women in particular need to be careful about self-prescribing supplements. The effects of vitamin megadoses on pregnant women can result in birth defects. More than 1 to 2 grams Vitamin C per day can destroy some vitamin B12 , cause stomach inflammation, diarrhea, over absorption of iron, oxalate kidney stones and possibly “rebound” scurvy.

Keep supplements away from children. Megadoses of vitamins and minerals are potentially harmful to children, damaging their livers and in some cases causing death.

Watch for other possible problems. The toxic effects of too much vitamin B3 can lead to liver damage, B6 leads to nerve damage, zinc leads to both copper deficiency and weakening of the immune system, and excess magnesium causes diarrhea. We have yet to discover all the toxic effects from overdosing.


Vitamins are organic compounds that are needed in small amounts in the diet for use in important metabolic reactions in the body. They promote growth, development and maintenance of the body. They promote good vision, form normal blood cells, create strong bones and teeth, and ensure the proper function of the heart and nervous system. They do not supply calories. They are found in minute quantities in animal and plant foods. The following is up-to-date information on the most popular vitamins being sold today:


Vitamin A is always present in a general multivitamin tablet. Excess intake as a supplement can be toxic so only take it under medical supervision. Beta-carotene is a precursor of Vitamin A and is present in dark colored fruits and vegetables. Picture spinach, carrots, tomatoes, broccoli, and green beans on your plate - plenty of color.

On rare occasions I’ve seen excessive consumption of carrots, up to ten carrots per day, in eating disordered clients, resulting in yellowing of the skin, particularly the palms of the hands.


Despite the Recommended Nutrient Intake for vitamin C being 60 mg per day, doses of over 500 mg per day have become very popular. “Since I’ve been taking vitamin C I haven’t caught a cold.” There is no scientific proof, to date, that this is true. But perhaps if you “believe” that vitamin C can stop colds, the placebo effect may spring into action. Besides, if you’re so concerned about catching a cold, you may already be taking good care of yourself and eating in a healthy manner. One research project did show that vitamin C taken when you already have a cold, can decrease the length of time of the cold. But then again, another study showed that exercise could decrease the length of time that you have a cold from ten days to five days. (Perhaps exercise is a better bet.)

You’re going to read somewhere that heavy smokers and drinkers should increase their vitamin C intake. Maintaining an unhealthy lifestyle as it stands is bad enough. It certainly doesn’t help you to supplement with vitamins. Instead, have an extra fruit a day.

Be warned: too much vitamin C appears to destroy vitamin B12, cause diarrhea, flushing, rapid heartbeat and kidney damage in children. Keep kids away from them!


The rumors of vitamin E are much more exciting! For example: “Vitamin E improves your sex life dramatically” - unfortunately no proof. “Vitamin E slows down the aging process” - again no proof. “Vitamin E slows down the onset of heart disease and cancer” - not in recent studies. Rather include wheat germ, fruits, vegetables, vegetable oils and nuts in your diet.

Vitamin E is a fat-soluble vitamin and is not easily eliminated from our bodies so supplement intake can be toxic. The recommended intake is 8 - 10 mg per day. Excess intake - more than 250 mg per day (400 I.U.), can cause nausea, weakness, headache, diarrhea and fatigue. A recent study has shown earlier deaths as well. Scary thoughts!


Vitamin D is essential for bone strength because it aids in calcium absorption. You can get it from food and a little sun. If it’s winter, be sure to include milk, eggs, canned salmon with bones, sardines, cheese, fortified margarine and fortified breakfast cereals. The RDA is 400 – 600 IU/day. A study found that higher daily doses of vitamin D—in the range of 700 to 800 IU—may reduce the risk of bone fracture by approximately 25%.

High intakes of vitamin D (from supplements) are toxic, leading to kidney stones, kidney failure, muscle weakness, excessive bleeding, bone weakness and overgrowth of bone.


Fortunately it is easy for us to get an adequate intake of vitamin B12, as it is present in all animal foods. I have heard of people injecting themselves with this vitamin for extra energy - how bizarre. Fatigue in healthy people is usually not due to the deficiency of this vitamin. It could be lack of sleep, hunger, overeating, iron deficiency and many other more obvious reasons. Only vegans, people who have chosen not to consume any animal products, need a vitamin B12 fortified food or supplement. Vegans should see a dietitian for a balanced healthy diet.


Minerals are present in organic and inorganic compounds and are essential for good health. Similar to vitamins, we need very small quantities of these nutrients for our body to function. The best way to get them is from food.


“Cows don’t drink milk after weaning, so why should we?” was the opening question asked of me by an obnoxious (but funny and likable) radio host. My reply was, “if you want to compare yourself to a cow, eat grass.” It’s illogical to compare a cow’s eating habits to ours. Cows have four stomachs with different enzymes to digest grass.

A lifetime intake of sufficient calcium is essential. We’ve all seen women and men practically bent over double with a humped back, and heard of elderly people falling and easily breaking their bones. This is due to osteoporosis, a crippling disease that causes bones to become porous and brittle due to loss of bone material. The incidence of osteoporosis is higher with women (25 - 30%) than men (12 - 15%) and bone fracture rates, which cost us millions of dollars annually, are related to calcium intake. If women over 65 receive adequate calcium intake, their bone loss is reduced by 12 to 25% over 2 years. So add up your calcium intake in your diet, and adjust where necessary.

As 99% of body calcium is found in our bones, this mineral is essential to keep our bones healthy and strong. Milk (including skim milk and 1% milk) is the best food source of calcium. (Notice that milk is enriched with vitamin D, which is essential for calcium absorption.) Other dairy products such as cheese and yogurt are equally good sources of calcium. Choose the low fat options - they contain no less calcium than the high fat types.

Research work has found that bone strength is increased until the age of 35 years. After that, calcium absorption is decreased.

Calcium is also present in other well-known foods. Although certain compounds (oxalates) in spinach and sweet potatoes, and other compounds (phytates) in legumes and grains reduce the availability of calcium in these foods, don’t be shy of eating them.

If you are a vegan and don’t drink milk, there are other sources of calcium equal to 1 cup of milk that can be chosen. Broccoli (8 cups), oranges (6), almonds (2/3 cup) or calcium-enriched tofu (1 cup) are all good sources. Unfortunately, I find it hard to get children to consume large quantities of broccoli, almonds and tofu at the best of times. Be very careful if you decide to have your children adopt this lifestyle.

“I didn’t manage to drink any milk or eat any yogurt or cheese today, I’d better take a calcium supplement.” Missing one meal or missing one food on a day is not cause for concern. Your food intake needs to be considered over a week and over a lifetime, not every meal in every day.

Be careful when prescribing a calcium supplement for yourself. Preferably, don’t supplement with bone meal or dolomite as these may contain lead. Over supplementing can lead to decreased absorption of iron and zinc as well as kidney stones.


There are two matters about this mineral that affect my female clients. Firstly, lack of energy due to anemia (lack of iron in the blood) and too much iron due to iron supplementation that causes constipation.

“I’m always tired. I was once diagnosed as anemic.” - say a few of my female clients. If lack of sleep is not the cause, they are often not eating foods high in iron. Certain foods enhance the absorption of iron such as meat, poultry, fish and vitamin C rich fruits and vegetables. Certain foods decrease the absorption of iron, such as oxalates in spinach, phytates in whole grains and ingredients in tea, coffee, bran and legumes. So even if tea is decaffeinated, it still contains tannin, and excess decreases the absorption of iron.

Iron deficiency is more common with women than men. It occurs in approximately 15% of women due to increased requirements for menstruation and pregnancy. Women are also inclined to eat less meat, either for “diet” or ethical reasons. Of course if they are athletes as well, they need sufficient iron to achieve peak performance. The result of an insufficient iron intake is weakness and shortness of breath, which may impair their work and activity performance. These people are frequently pale, have a poor appetite and an increased risk of infection.

Many of my clients are unaware of the fact that an iron supplement may cause constipation. Certainly, don’t prescribe it for yourself. If you have a blood test and discover that you have an iron deficiency, the physician will recommend the amount you need or, preferably, refer you to a dietitian who can make sure the amount you take is adjusted to suit your diet, increasing fiber and fluids and becoming more active to counteract the constipating effect.

Iron-rich foods from animal products (meat, liver, sausages and turkey) are better absorbed than from plant products (dried fruits, cereals, pasta, dark green vegetables and legumes). The good news is that, if you want to limit your meat intake, small portions of meat, poultry or fish, as well as foods rich in vitamin C (fruits and vegetables) increase the absorption of iron from plant foods. For example, add vegetables to iron enriched pasta or bean soup.

For children, iron is essential for rapid growth. Among teenagers it has become trendy to avoid beef. However, they replace meat with doughnuts and muffins - creating an iron deficiency. Teenage girls undergo a rapid growth phase, start menstruating and many go “on a diet” - three reasons that could lead to iron deficiency. If you decide to prescribe an iron supplement for your teenager, be aware that the toxic effects of excess iron intake include damage to the liver, pancreas, heart or immune system, hemorrhaging, decreased absorption of copper and even death. You’ll notice a warning on supplements, particularly high iron supplements, to keep from children. If they must take supplements, only a little is necessary.


In the 1940’s, when my dad started losing his hair, he heard that liver stopped baldness so he ate liver every day for six months. It didn’t help; he continued to lose his hair.

I’m not sure why, but zinc is a mineral everyone goes crazy supplementing from time to time. It seems that salespeople can always find something about you that needs improvement and say zinc can do it. But, as with other metals, ingesting too much can cause side effects such as vomiting, cramps and diarrhea. These symptoms, however, will subside once you stop taking it.

Rather, ensure that you are eating good sources of zinc, such as beef, lamb, pork, liver, the dark meat of chicken and/or whole-grain cereals, legumes, peanuts and peanut butter. You don’t have to have one of these foods in every meal, every day. Some days you’ll have plenty - cereal, a peanut butter sandwich and a hamburger. Other days you’ll have less. Deficiencies are rare - only vegetarian and low-protein diets can be low in zinc.


Should you take supplements? Not before an individual assessment of your diet by a dietitian. Don’t go to someone who sells supplements.

There are certain circumstances when I would consider supplementation. Women who are pregnant, vegans, lactose-intolerant people, osteoporotic women and men and people in a high-risk category for heart disease or cancer might need supplements, and then only if they run a risk of deficiencies in their diet. All the vitamins in the world won’t help if you have an unhealthy lifestyle.

If you intend to eat badly, or are insecure about your health, take a general, multi-purpose, tablet with less than 150% RDA for all nutrients. Just one. And a cheap one.

Monday, October 23, 2017

5 Common Breast Conditions That Aren't Cancer

If you hear the dreaded news that you have a breast abnormality, it’s hard to stop yourself from jumping to conclusion that it’s cancer. After all, what else could it be?

Well, chances are, your abnormality is actually the result of a common benign breast condition. And you aren’t alone. In fact, experts believe that most women will experience a non-cancerous breast condition at some point. While these conditions aren’t life-threatening on their own, some of them can increase your risk of breast cancer over time.

So, just because they aren’t dangerous conditions doesn’t mean that you don’t need to worry about them. Unfortunately, because many of these conditions share the same symptoms, or may not show any symptoms at all, it’s essential to have the help of a specialist to detect it and treat it.

Here are several deceiving conditions that your mammogram may detect:

1.    Hyperplasia

Hyperplasia is a condition in which there is an overgrowth of cells in the ducts or lobules of the breast. This overgrowth is commonly referred to as proliferation. There are two types of hyperplasia – typical and atypical. While both increase your chances of breast cancer, people with atypical hyperplasia have a greater risk. While hyperplasia doesn’t typically cause lumps, it can show up on a mammogram and must be diagnosed through a biopsy.

2.    Cysts

Cysts are sacs filled with fluid and are quite common, particularly in premenopausal women. They are almost always benign and do not increase the chance of breast cancer. While most are too small to feel, larger cysts can feel like lumps in a self-exam. Cysts can often be diagnosed through a simple ultrasound, but some may need to be biopsied to determine whether they are cancerous or not.  

3.    Intraductal Papillomas

Intraductal papillomas are small tumors that grow within the milk duct and can cause clear or bloody discharge from the nipple. They often resemble warts and can be felt as a small lump that sometimes causes pain. They can be removed with surgery and only increase chances for breast cancer if there are abnormal cells or further complications.

4.    Sclerosing Adenosis

Sclerosing adensosis is a condition where the lobules are enlarged, often resulting in several lumps in the breast. Because of the abnormal shape, it is often mistaken as breast cancer during mammograms. A biopsy may be needed to determine if it is cancerous. There is no treatment needed for sclerosing adenosis, and it is not thought to increase chances of developing breast cancer.

5.    Mastitis

Mastitis is the condition that results from breast inflammation typically caused by infection. It most commonly affects women who are breastfeeding but this is not always the case. Mastitis causes swelling, increased blood flow, redness and can be painful. It can be easily diagnosed during a basic breast exam. Inflammatory breast cancer can be mistaken as mastitis, so if conditions do not improve after a week of antibiotics, further testing may be needed to determine it is in fact cancer.  

So how do you know the difference?

As you can see, there are many breast conditions that may not necessarily be cancer – and they all share many of the same symptoms. It’s best to talk to an expert if you experience anything out of the ordinary during a routine self-examination. Gwinnett Medical Group Primary Care can work with you to stay on top of your health through all phases of care. For additional breast services, the extensive Gwinnett Breast Program is designed to guide and care for patients and their families throughout the process of screening, diagnosis, treatment and recovery from breast cancer and other breast conditions.


Do we really need to drink 8 cups of water every day? Plus coffee, tea, milk, juice and soda? What about caffeine and alcohol? How much is good or bad? 


Water is actually needed to carry essential nutrients for the healthy working of the body and makes up 50-70% of the weight of the human body. Even teeth have a water content of 5%. Water is also responsible for functions including temperature regulation and the lubrication of joints.


The magic number is 8. Why must we drink 8 cups of water a day? What if we drink 7, or if we overindulge and drink 9? What are the harmful effects? If we are to drink eight glasses of water per day, plus other beverages, how much time will be spent going to the bathroom?

According to the Institute of Medicine’s Dietary Reference Intakes, fluid intake comes from all beverages consumed, from water to drinks containing caffeine, soup, fruits, vegetables and even meat, and recommends 9 cups/day for women and 13 cups/day for men. When it comes to actual water and flavored water, intake is closer to 5 cups/day for women.

The Panel on Water and Electrolytes at the Institute of Medicine devised daily recommendations as follows:

Water - 20 to 50 oz
Unsweetened tea and coffee - 0 - 40 oz with less than 400 mg caffeine
Low-fat milk, skim milk, soy beverages - 0 - 16 oz
Noncalorically sweetened beverages (diet sodas) - 0 to 32 oz
100% fruit juices - 0 to 8 oz
Sodas and fruit drinks - 0 to 8 oz

My advice is to drink enough to prevent the onset of thirst - the first sign of dehydration. The second sign is dark colored urine with a strong odor, similar to your first urination in the morning. If this is the case, drink more fluids as dehydration leads to muscle weakness and fatigue.


What kind of water is the next question? Can we trust tap water? For that matter, can we trust bottled water? You’ll be pleased to know that any water is fine. Bottled water is not more healthful, more “natural,” or purer than tap water from most municipal systems. If you don’t like the chlorine taste of your water, use a filter. Chlorine is used to disinfect drinking water to prevent deadly illnesses like typhoid and cholera.


Fluid intake needs to be increased under the following circumstances:
1. In the elderly, the thirst mechanism is not very sensitive, so they purposefully need to increase their fluid intake beyond the feeling of pure thirst.
2. With vomiting or diarrhea, dehydration can occur. Small sips of liquid, as much as can be tolerated, are recommended during and after these bouts.
3. With heat exhaustion from hot weather.
4. With prolonged exercise or strenuous sports that may blunt the thirst response.


No! With fashionable coffee houses at every street corner, don’t miss out on any fun! Many a curious eye is turned when, as a dietitian, I order caffeinated coffee. 

According to a Norwegian study, up to five cups of coffee a day may reduce heart disease, Parkinson's and Alzheimer's. However, these benefits are negated with more than five cups a day. 

This doesn't mean you have to force yourself to drink 5 cups of coffee a day. There are many foods and beverages that can help reduce diseases.

This means, if you're having 2 or 3 cups of coffee a day, that's okay. And I'm talking about 8 oz cups, not super-sizing 16 oz cups!

Caffeine is a stimulant found in coffee, tea, colas, and chocolate. The recommended maximum daily intake is 450 mg caffeine per day. My recommendation is a maximum of three cups coffee, three cups tea, and three cans of diet pop per day. With the following checklist, you can calculate your caffeine intake:

Coffee (6 oz.) 
 - decaffeinated 2 
 - instant 60
- drip, brewed 105 
- espresso 100
- cappuccino 100 
Tea (6 oz.) 36 
 Chocolate Milk (8 oz.) 8 
Cola Drink (12 oz.) 45
Milk chocolate bar (2 oz) 20
Dark chocolate bar (2 oz) 37
Medications 60 - 200

It is not essential to have caffeine in the diet and moderate caffeine intake is not associated with any health risk. Unfortunately some of my clients drink ten 8 oz. cups of coffee per day which is certainly excessive.
A child's caffeine consumption should be closely monitored. Although caffeine is safe to consume in moderation, it may negatively affect a child's nutrition, replacing nutrient-dense foods such as milk. Restriction may be necessary for a hyperactive child as caffeine is a stimulant.
Pregnant women, and people with coronary heart disease or peptic ulcers may be advised by their health care provider to restrict or avoid consuming caffeine.

Many drugs will interact with caffeine. Consult with your health care provider or pharmacist.According to a 

This doesn't mean you have to force yourself to drink 5 cups of coffee a day. There are many foods and beverages that can help reduce diseases.

This means, if you're having 2 or 3 cups of coffee a day, that's okay. And I'm talking about 8 oz cups, not super-sizing 16 oz cups!


After a busy day, meeting friends for a drink is great fun and good for you, drinking too much is bad! According to the US Dietary Guidelines for Americans 2005, females can have up to 1 drink per day, men can have up to 2 drinks per day.

1 bottle (12 oz.) beer - 5% alcohol 135 - 150
1 bottle “light” beer - 4% alcohol 100
1 bottle “extra light” beer - 2% alcohol 60
1 glass wine (5 oz.), 11% alcohol 100
1 shot (1 1/2 oz.) liquor - rye, gin, rum or scotch 100
Gin and tonic (7 1/2 oz. cocktail) 170
Liqueurs (1 1/2 oz.) 185


Studies indicate that alcohol abuse causes approximately 10% of cancer deaths. We also know the distressing results of drinking and driving, and drinking and family violence. However, there are diet-related reasons to limit alcohol intake:


1. Alcohol is high in calories - alcohol supplies seven calories per gram and no other nutrients. 
2. Alcohol blocks the ability to burn fat for energy, resulting in 30% less energy coming from fat. Delays in burning fat in our bodies are not a good idea.
3. Watch alcohol quantity - an “extra light” beer contains 2% alcohol, that is, 3% less than regular beer. Switch from beer to “extra light” beer, but do not increase quantities.
4. Alcohol is usually accompanied by fat snacks - the food served with drinks often consists of ribs, chicken wings, nachos and chips - fat fixes!


Alcohol decreases willpower: “I used to find that I could eat healthy all day, but in the evening I blew my diet by drinking too much wine and then overeating. Now I drink sodas for most of the evening or alternate alcoholic and non-alcoholic drinks. I enjoy myself much more because I’m in control.” 

Drink water when you’re thirsty, and alcohol for the taste. This way you will enjoy your drinks more. 


When drinking alcohol, drink more water, especially before going to bed. Although alcohol makes you fall asleep quickly, you’ll wake up in the night feeling thirsty and restless. Cut back and sleep well.


Alcohol is expensive. If you’re on a budget, cut back on this beverage. Don’t make the excuse that fruits and vegetables are expensive this season, and then choose alcohol regularly. Get things into perspective.



The French have a low incidence of heart disease yet eat heart-attack producing saturated fats from cream, butter and beef, and they smoke. Why? Perhaps it’s because they eat small portions, maintain a healthy body weight and walk a lot. Or is it because they drink red wine?

If red wine is the answer, the amount of red wine consumed with meals should be one to two glasses per day. This doesn’t mean you should start drinking wine if you’re not a drinker, or increasing your red wine intake if you are.


“Please don’t take away my occasional glass of wine.” - a plea from Vanessa. She doesn’t consider herself a drinker, but likes to have one or two glasses of wine socially. She wanted to know if she does have wine, which foods should she eliminate.

I told Vanessa to keep track of her alcohol intake. If it is indeed only the amount that she remembers, then it’s fine. Drinking alcohol on occasion does not mean eliminating other foods. It is important to form habits that you can live with, not restrict yourself and decrease your quality of life,

1. Drink water when thirsty. 
2. Sip alcoholic drinks slowly. 
3. Dilute your drinks with club or diet soda. 
4. If you don’t feel like an alcoholic drink, have an orange or tomato juice, tonic water or club soda. 
5. Drink what you want to drink, not what is expected of you. 

6. Limit your alcohol intake to one or two servings and save money!

Sunday, October 22, 2017


My book on a cereal box. I think I was the first dietitian to be on a cereal box:)

“I want to make healthy choices at the grocery store,” you say to yourself. Picking up a box of crackers and looking at the ingredient list, you see many words you don’t understand.

They are not even pronounceable. What are they? Are they necessary? Are they harmful? You want to know!


Which additives are safe? Usually these additives with long names are at the end of the “Ingredient” list, so we know that the amount in the package is very little. But, if so, why are they used?


Additives are regulated according to up-to-date research results. Food additives must be shown to be safe before they can be introduced into the food supply. Chemicals are usually tested on their ability to cause cancer.

BHT (butylated hydroxytoluene), for example, is necessary to retard rancidity in oils so that our product doesn’t spoil. Some cereal boxes even state that, “BHT is added to packaging to help preserve freshness.” Most products don’t tell you anything. Of course, we wouldn’t buy a product that isn’t fresh. Therefore, the small amount of BHT added to a product will ensure freshness. Further research has shown that BHT may block the action of a large group of chemicals that cause cancer. Some scientists think they are partly responsible for the decline in stomach cancer among Americans.

Despite all the news and warnings about contaminated produce, the American food supply is among the safest in the world.


Also colorants, pesticides, antibiotics and hormones - all regulated by the FDA. The amounts, types and uses must conform to strict rules. On the other side, food manufacturers pay for these additives so the less used the better for them financially. Moreover, realizing that consumers are demanding fewer additives, they are continuously working to supply foods that contain less unpronounceable words in the Ingredient List.

Additives are not added to products to confuse us, but to improve taste, shelf life, and texture. We will, after all, only buy a food if it’s yummy and looks attractive. If additives were not in the products, our food would spoil. If the food is spoiled we won’t eat it. If you hear shrill claims such as “Additives will cause cancer when you’re old,” ignore them. Use your common sense. If preservatives were not added to foods, we wouldn’t live long enough to worry about diseases. We would all starve to death when young.


Under the Federal Food, Drug, and Cosmetic Act (the Act), FDA is responsible for evaluating the safety and approving the use of food additives and color additives. In addition, FDA currently reviews petitions to affirm that substances used in food are generally recognized as safe (GRAS).


Fringe groups continuously warn consumers that the food supply is harmful. The members of these groups usually have no academic background in nutrition. They are very often misinformed and have a general distrust of anything governmental. Logically, their claims are flawed. Why would government agencies dupe consumers by condoning a harmful ingredient and then eat the same foods as we do? It would mean they’re poisoning themselves. Or do they have a secret cache of non-preserved foods hidden somewhere?

The link between pesticides and cancer deaths are controversial. The food industry is continuously researching new ways to decrease the use of pesticides, yet you’ll hear that fruits and vegetables should not be eaten because of possible negative effects. Fruits and vegetables have preventive effects on many cancers, which overwhelm any hazard from detectable pesticide residues. However, always wash fruits and vegetables before eating them.


Few foods are given a break by the “alternative” nutritionists. By the way, “nutritionist” is not a protected title. Anyone can call herself or himself a nutritionist. If you are looking for nutrition advice from an expert, check that the individual is a Registered Dietitian (RD). The American Dietetic Association’s website, can find you one in your area. Dietitians are a regulated health profession and have to conform to high standards of education and conduct.


“I choose ‘natural’ foods whenever I can.” This I hear this all the time. What does “natural” mean? Perhaps it means that fewer additives are used with the product, but since there is no regulation to govern this, can we believe it?

If my clients consume “natural” foods, I do mention that these foods may be more expensive and have a shorter shelf life than the regular product, but I don’t discourage them if they prefer the taste.


Organic foods have become increasingly popular with chefs and consumers. “Organic” refers to the process of growing fruits, vegetables and grains without the use of chemicals or pesticides. Organically grown plants have a shorter shelf life and less uniformity than plants that have undergone chemical treatments. As you can imagine, to grow produce without fertilizing or using pesticides is expensive, because disease and pests can ruin crops. If you can afford organic foods, then by all means try them. The taste may be better and you’ll be supporting environment friendly farming practices.


“I only choose foods without MSG.”

What is MSG? MSG (mono-sodium glutamate) is a flavor enhancer, and is used mainly in Chinese soups and sauces. Because a few people have problems such as headaches or tingling sensations (known as the Chinese Restaurant Syndrome) when consuming foods containing MSG, this additive has become most unpopular.

In one research project, people were given foods with MSG for a certain time period and then foods without MSG for the same amount of time. They weren’t told that the foods in the second period did not contain MSG. The number of people who developed headaches was the same for both, with or without MSG. Once again, the placebo effect, showing that perhaps if you believe MSG is in the dish, you’ll develop the headache whether the substance is present in the food or not.

The World Health Organization (WHO) researchers have concluded that the consumption of MSG, even in large amounts, is not harmful. Yet we see advertised regularly that certain foods do not contain MSG, as if it does create a problem when in food. This is group-fear and belief. I have seen quoted in numerous nutrition articles that from one to 25 percent of people are sensitive to MSG. Although the claims may sound logical, they are classic examples of off-balance conclusions and selectivity of research. The result is mass hysteria and “NO MSG” signs wherever you go. My suggestion is, don’t worry about MSG unless you show definite symptoms of a bad reaction to the substance.


Do you think you consume too many non-nutritive (artificial or non-caloric) sweeteners? They are found in many products such as soda, gum, sweets and tabletop sachets. Through my years in practice, I have not yet found anyone who comes near to the maximum amount allowable, so your consumption is probably okay. To me, obesity is a really big problem. If the use of sweeteners help people satisfy their sweet tooth and keep them away from high calorie foods, that is good.

Before a sweetener is approved, it goes through several levels of intense scrutiny. Research work is submitted to a panel of health experts who decided what is healthy after they finish their analysis of the research. Ultimately, their goal is to protect consumers and keep them healthy.

Aspartame, better know as NutraSweet, can be used for the whole family. You will find the characteristic twirly logo on many foods and beverages. However, individuals with a rare genetic disease called phenylketonuria must avoid aspartame.

Sucralose was approved for use and can be found in many foods and beverages, as well as in tabletop sachets. It’s called Splenda. It took more than 15 years and over 140 safety and environmental studies to confirm that sucralose is safe.

Will you lose weight if you use sweetener instead of sugar? Not really, because people tend to think they can eat more of other foods when they use sweetener. How many times have you seen a friend order a chocolate mousse cake and then use a sweetener in his coffee to compensate? He may consume less calories in your coffee - maybe 20 calories less - but the dessert will contain 450 calories. You can’t really compare the two, can you?

Using a sweetener does inhibit my desire for sweet foods. I put sweeteners in my coffee and tea. I use diet soda, “diet” hot chocolate and low calorie jellies. Psychologically I haven’t lost control, and yet have satisfied my sweet tooth. Sweeteners play an important role in my diet and that of my clients.


“I put honey in my tea. I don’t touch sugar,” boasted a friend. He was surprised to hear that honey has no benefits over sugar, neither in nutritive nor in caloric value. Use it if you like it, but don’t look for special health advantages in it. This is not the only misconception. The two most common questions I am asked about sugar are:

Should I avoid sugar?

No, sugar adds flavor and variety to the diet. It is not harmful per se. Sugar does not cause obesity, diabetes or heart disease. However, it does supply calories, so it needs to be limited to small quantities, together with other foods, if you want to lose weight. Many people avoid high-fiber cereals that contain sugar. If the cereal tastes terrible, you won’t eat it, so it has to be sweetened slightly.

Where sugar can be harmful is in the consumption of “sticky” products such as toffees, dried fruit and sweet baked goods. Foods that lodge on or between the teeth provide more time for bacteria in the mouth to produce tooth-decaying acid. Follow meals with foods that will not promote tooth decay, such as sugarless gum, sugarless beverages, peanuts or cheese.

I love sweet things and would find it hard to deprive anyone of this delicious sensation. My advice is that you simply limit the amount to times when you really feel like something sweet.

How do I know if sugar is added to a product?

As with additives, sugar claims are regulated. If a product says no sugar added, it means precisely that - no sugar is added to the product. However, the product itself may contain sugar, so it does not mean sugar-free. Moreover, the product does not necessarily have to contain sucrose (table sugar); it may contain other sugars such as honey, glucose, fructose, which supply the same amount of calories as sugar.

Sugar alcohols may be listed such as maltitol, zylitol or sorbitol, which are not absorbed well by the body so supply slightly less calories per gram than table sugar. Sugar alcohols have a laxative effect in large amounts. My clients have been surprised when they discover the reason for their loose stools. Any substance with “-ose” or “-ol,” at the end of it is a type of sugar. So no sugar added does not mean calorie free.

For a ½-cup serving of canned sliced peaches (in juice - no sugar added), the sugar content is 12 g. For canned sliced peaches in light syrup, the sugar content is 16 g, a slight increase. The difference in calorie content is 16 calories (sugar supplies 4 calories per gram, 4 x 4 = 16). As you can consume 1500 to 2500 calories per day, depending on your sex, size and activity, 20 calories is not going to make a big difference. Choose the one you like the most, but keep to the serving size of half a cup!


The FDA sets sodium guidelines. Healthy American adults should reduce their sodium intake to no more than 2300 milligrams per day. This is about 1 teaspoon of sodium chloride.

For lower-salt living:
• Choose fresh, frozen or canned food items without added salts.
• Select unsalted nuts or seeds, dried beans, peas and lentils.
• Avoid adding salt and canned vegetables to homemade dishes.
• Select unsalted, fat-free broths, bouillons or soups.
• Select fat-free (skim) or low-fat milk; low-sodium, low-fat cheese, low-fat yogurt.
• When dining out, be specific about what you want and how you want it prepared. Ask for your dish to be prepared without salt.
• Learn to use spices and herbs to enhance the taste of your food.
• Don’t throw salt on your food before you taste it. Always taste your food first, and if you really need more salt, add it sparingly - that’s the rule.

However, it’s not the salt you sprinkle on your food that’s the biggest problem. Far more salt is used when cooking and in chips, pretzels, popcorn, cheese, crackers, canned/dehydrated soups and ready-made dinners.

Salt labeling:
• Sodium-free -- less than 5 milligrams of sodium per serving
• Very low-sodium -- 35 milligrams or less per serving
• Low-sodium -- 140 milligrams or less per serving
• Reduced sodium -- usual sodium level is reduced by 25%
• Unsalted, no salt added or without added salt -- made without the salt that's normally used, but still contains the sodium that's a natural part of the food itself
The FDA and USDA state that a food that has the claim "healthy" must not exceed 360 mg sodium per reference amount. "Meal type" products must not exceed 480 mg sodium per reference amount.

Salt claims and content can be found on products such as cracker packets, margarine tubs, canned soups and cereal boxes. The salt content of fresh meat, poultry, eggs and fish does not have to be labeled, as they are quite low in salt. But beware of processed meats, which also don’t need labeling, but can be very high in salt.

Why do I need to lower my salt intake?

A high salt intake is linked to high blood pressure, certain cancers, kidney stones and osteoporosis. So we should aim for moderation in everything, which means lower intake of salt and salty foods. We eat far too much of it - approximately 6,000 mg sodium per day. Replace high-salt foods with fresh fruits and vegetables, and grains.

“I avoid soda because I heard it’s high in salt”

Soda contains approximately 20 mg sodium per can, which is certainly not high. Rather decrease your sodium intake from some of the following foods you consume every day:

French fries, 1 regular : 120 mg sodium
Potato chips, 15: 160 mg sodium
Ketchup, 1 Tbs: 205 mg sodium
Cheese, cheddar, 1-½ oz: 265 mg sodium
Bread, 2 slices: 300 mg sodium
Vegetable juice cocktail, canned, ½ cup: 450 mg sodium
Nuts, salted, ½ cup: 460 mg sodium
Pretzels, 1 oz: 540 mg sodium
Tomato sauce, ½ cup: 620 mg sodium
Rice: white, long grain, 1 cup, cooked with salt: 780 mg sodium
Rice: white, long grain, 1 cup, cooked without salt: 4 mg sodium
Pickle, dill, 1 large: 830 mg sodium
Pizza, 1 slice with meat, cheese, vegetables: 900 mg sodium
Cheeseburger, 1 regular with the works: 975 mg sodium
Soup: canned chicken noodle, 1 cup : 1100 mg sodium
TV chicken dinner, 1 regular: 1030 mg sodium
Salt, 1 tsp: 2300 mg sodium

With the recommended maximum daily intake of 2,300 mg sodium per day, it easily adds up. Calculate your total sodium intake for a typical day. Make a plan to lower it if necessary.

For lower salt cooking, replace salt with herbs, spices, lemon juice, vinegar, salt substitutes, garlic powder, fresh garlic, onion powder and fresh onion.