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Ask the Nutritionist

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 Meritus Health offers “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 dietitians from the Meritus Diabetes Education and Meritus Medical Center will answer questions on nutrition and how it affects your health. Get the information you need by asking your own questions or by reading their 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!

Ask The Nutritionist

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Q & A

How soon after I stop taking Warfarin, can I start to eat green leafy vegetables again?

Start leafy greens immediately, in fact, they would be appropriate even when taking warfarin. When on warfarin the intake of foods high in vitamin K like leafy greens should be limited and the amount consistent from day to day. It is not necessary to eliminate them from one's diet, rather keep the intake of high vitamin K foods consistent from day to day.

Does pickled asparagus have less nutritional value?

Pickled asparagus doesn’t necessarily have less nutritional value than regular asparagus; however it is much higher in sodium, making it a less healthy choice. Either way, asparagus is high in vitamins A and C and is also a good source of fiber.

All of the meal plans and diet pills I read about are for type 2 diabetics. Is there anything out there for me?

I'm type 1 diabetic. I was diagnosed at age 30 and now I'm 35-years old. I'm on an insulin pump. My body mass index is in the ideal range, but at the high end. I would love to lose about 15 to 20 lb., but nobody will give me advice on what diets are safe. In the past (before I was diagnosed) it seemed like the Atkins diet and eating no carbs helped me shed pounds. But now, I don't know what to do. Every time I exercise vigorously I end up with a blood glucose level in the thirties. Help. All of the meal plans and diet pills I read about are for type 2 diabetics. Is there anything out there for me?

For sustainable weight loss, I would focus on lifestyle changes rather than going on a diet. Particularly with type 1 diabetes, some diets could even become dangerous if they don’t give you the nutrition you need to maintain healthy blood glucose levels. Lifestyle changes such as exercise (which you’ve mentioned), increasing vegetable and fruit intake, and logging food intake are a good start. The American Diabetes Association has a great tool called My Food Advisor that you may find helpful as well. Visit their website at: http://www.diabetes.org/food-and-fitness.

As for the exercise, I would check your blood sugar both before and after exercise and record them to see if there are any trends based on type of exercise, time of day, etc. Often, diabetics need a snack that includes approximately 15 grams of carbohydrates prior to exercise to help keep their blood sugar up. Another option is to consult your physician about making insulin adjustments for exercise.

I would suggest consulting with a registered dietitian who can create a safe, effective meal plan for weight loss based on your individual caloric and carbohydrate needs.

My friend was in the hospital for a pulmonary embolism and the doctor wants him to cut back on sodium, cholesterol, and carbohydrates. What should he be eating?

To reduce sodium in the diet, there are several steps someone can take. First, they should get rid of their table salt shaker and avoid using salt when cooking. Another step is to limit packaged processed foods such as chips, pastries, boxed dinners, bologna, hot dogs, etc. Choosing fresh or frozen vegetables over canned is another step. When reading food labels, look for items with less than 500 mg of sodium per serving.

For cholesterol, watching portions of meat and dairy is important. Choose leaner cuts of meat and cut or drain off any fat. Buy only low fat cheese and milk. Finally, avoid fried foods, packaged pastries and cookies, and mayonnaise.

Is there a liquid diet that someone can live on for life?

If so, what is it? Can someone live on a liquid diet for life, if they drink meal replacement drinks like SlimFast, Carnation Breakfast Essentials, Ensure, Boost or Special K protein shakes?

Unless someone has a medical necessity to be on liquid nutrition (such as those with swallowing problems or head and neck cancer), it is generally not recommended by nutrition professionals to follow such a regimen "for life." Meal replacements such as those listed above cannot provide adequate amounts of fiber and are not meant to be a sole source of nutrition for prolonged periods of time. Some weight management programs involve meal replacement beverages but it is recommended that anyone considering them should make sure the program is medically supervised and their physician is aware

My child is overweight for his age, as well as blind and autistic. He is on a specific calorie diet plan. He loves chocolate milkshakes. What is a good rule for a special treat for him to have a milkshake? One time a week?

Simply put, one time per week. If he is on a specific calorie diet plan and you know the calories in the milkshake, it can be exchanged for a food with similar calorie content.

What do you think of probiotics?

When I think of probiotics, I think of foods that are alive. Probiotics refer to the healthy or favorable bacteria that inhabit our digestive tract. Fermented and aged foods including yogurt, sourdough starters, and sauerkraut are traditional sources of probiotics. I make yogurt and have a sourdough starter in my refrigerator that I have been using to make bread weekly for the past three years. I have a strong bias toward foods that are less processed, close to their natural source, and alive.

There is more and more evidence coming out all the time on ways probiotics support health, but precautions may be appropriate for some people. Go to the NIH National Center for Complementary and Alternative Medicine website ( nccam.nih.gov) and search for probiotics. You will get a good overview of current findings related to the health benefits of probiotics.

What should a person with partial bowel obstruction eat? What symptoms should I call my doctor about?

I have been on a low fiber and low residue diet for two months now. I read on one website the list of low residue diet information with this note: "special considerations: if a low fiber or low residue diet results in abdominal cramps or discomfort, notify the dietitian or physician immediately." I really want to know why. What harm does this diet cause in the long run? My primary care doctor does not know the answer. What should a person with partial bowel obstruction eat? What symptoms should I call my doctor about?

The special considerations you mention for a low residue diet most likely pertain to changes in bowel function, such as constipation which can cause cramps or abdominal discomfort. A low fiber or low residue diet is recommended with a person with a partial bowel obstruction. It may be helpful to keep a record of foods you eat in case you need to discuss your symptoms with your doctor or dietitian. Also, do not overeat, remember to chew foods well, eat small portions more often, and keep well hydrated by drinking six to eight cups of fluid per day.

I take potassium chloride, a B-12 shot, daily women's vitamin, calcium+D, and vitamin D3. Is there any other thing I need to change?

I am a forty-six-year-old female that had a Roux-en-Y gastric bypass in October 2008. I lost approximately 169 lbs and have maintained a weight loss of 154 lbs. Recently I was diagnosed with kidney stones and was told to start a low oxalate diet. I eat between four and six ounces per meal with protein being my major part of my diet. I shoot for between forty and sixty grams of protein a day. I also eat and drink low-fat or no-fat milk, cheese, and yogurt every day. The urologist wants a max of 1,200 milligrams of calcium per day. I was told to take two calcium supplements a day plus my daily vitamin has 325 milligrams of calcium. I stopped eating nuts, am limiting my peanut butter, and have stopped eating baked beans. Most of my diet is chicken, fish, low-fat cheese, cooked veggies, lean beef, eggs, milk, and water. I take potassium chloride, a B-12 shot, daily women's vitamin, calcium+D, and vitamin D3. Is there any other thing I need to change?

The only things I would add would be to be sure to keep well hydrated (up to nine cups of fluid per day and drink thirty minutes before or after meals), limit vitamin C to less than 2,000 mg per day, and take your calcium with meals.

What is the right amount of protein in grams per day that I should be consuming?

I am a forty-year-old female who was recently diagnosed with follicular lymphoma. I would like to maintain a vegan diet. I weigh around 125 lb., and have concerns about getting enough protein from nuts, seeds, beans, legumes, tempeh, and soy. What is the right amount of protein in grams per day that I should be consuming? Also, can you offer any other advice for nutrition concerns for cancer patients going through chemotherapy?

Based on your weight and assuming a body mass index (BMI) in the normal range (20-25) the RDA for protein would be approximately 45-55 grams per day. This is not difficult to do if you eat enough calories to maintain body weight. The most important thing is to eat a wide variety of foods including legumes, whole grains, seeds, and nuts. One concern with anyone undergoing chemotherapy is loss of appetite or inability to keep foods down. When adequate intake is questioned, use of protein supplements may be advised. It’s important to have a consultation with a registered dietitian to review your individual nutrition needs.

What should I be doing to lose weight, when all these traditional methods are not working?

I am post menopausal. I have tried every diet and fitness regimen I can think of, to the point of injury, and cannot lose weight. I am obese by the BMI standard. My thyroid was recently checked and came back normal. What should I be doing to lose weight, when all these traditional methods are not working?

Hormonal changes associated with menopause reduce caloric needs. This means to lose weight you must eat less and exercise more. To quantify the amount eaten, keep a food journal. Avoid drinking calories, be sure to measure portion sizes, and eat regularly throughout the day to prevent excess hunger and overeating. When you get into a stable eating routine that is aided by a journal, eating less becomes a lifestyle rather than a diet. Sounds like you are committed to making changes, hang in there!

I eat a good healthy breakfast, light lunch, light dinner, and snack on fruits-1,200 calories per day. I am still gaining weight! Can you offer any advice?

I am a forty-eight-year-old female, five foot two inches tall, 144lb., and in menopause. I work out at least five to six times a week. I swim three days a week and on other days do the elliptical machine for 30 min. I also alternate my muscle strengthening. I eat a good healthy breakfast, light lunch, light dinner, and snack on fruits-1,200 calories per day. I am still gaining weight! Can you offer any advice?

Are you sure about your intake? Are you measuring portions and keeping a journal? Based on your weight, activity and calories, I would expect weight loss (your intake is approximately 18 calories per kilogram of body weight, which is 30% less than I would predict to maintain your current weight). Try keeping a journal and measure portions.

Is sea salt a better option?

My husband has high blood pressure, and loves salt. Is sea salt a better option?
No, it is the sodium in salt that affects blood pressure. The sodium content of both options is the same.

What is the daily requirement of iron for a twenty-five-year-old female?

The daily requirement or dietary reference intake (DRI) is 18 milligrams per day. For a complete list of all DRIs go to the USDA Web site at www.fnic.nal.usda.gov/nal.

Do you have any favorite cookbooks that have great recipes, but are healthy and tasty with a focus on vegetables and minimizing fat?

Hey Tim! I enjoy your blog. Do you have any favorite cookbooks that have great recipes, but are healthy and tasty with a focus on vegetables and minimizing fat? Thanks and keep up the good work!
Thanks for the nice words. I use cookbooks to find cooking techniques, especially when it comes to vegetable cooking. Once you become comfortable with a few basic vegetable cooking techniques, choice of vegetables becomes a matter of preference. Some examples I look for may include roasting, sauté, braising, and altering texture using purée or grating. One very basic book I use often is The Fannie Farmer Cookbook edited by Marion Cunningham.

Is it okay to eat four raw eggs along with 1500 mg of vitamin C each day?

Is it okay to eat four raw eggs along with 1500 mg of vitamin C each day? Will it cause any harm?
It may be harmful to eat raw eggs because of the risk of consuming salmonella, a common cause of food poisoning. The recommended intake of vitamin C for adults is 75-90 mg per day, with the upper safe limit being 2000 mg per day.

What is the problem and what can I take since I need protein for body building?

Since I work out often, I drink a lot of whey protein. This was fine until recently. Now when I take it, my hemorrhoids are irritated and burn. I tried the vegetable protein only to get the same unpleasant result. What is the problem and what can I take since I need protein for body building?
There are many good food sources for protein, including eggs, meat, fish, and legumes. The legumes are also a good source of fiber, which may be lacking in your diet and contributing to your elimination issues. You may want to contact a registered dietitian to review your whole diet to balance your fiber and protein needs.

Am I a good candidate for prescription weight loss medicine?

I am thirty-seven and I weigh 209 lbs and am 5'7". I have what they call an apple shape. My BMI is 32. Am I a good candidate for prescription weight loss medicine? I have tried everything to get rid of my belly fat, but nothing works.
I certainly can’t assess your weight loss prescription needs over the Internet, so you should speak with your doctor about prescription weight loss options. Keep a food diary or use an online calorie calculator to get an idea of your caloric intake. Also, track your activity. You should be getting 150 minutes per week of exercise. Bring all of this information to your doctor and consider your options.

I have been diagnosed with gastroparesis and also have diverticulitis. The diets have conflicting recommendations. Do you have any advice?

Your case can be confusing, as are other complicated conditions when nutrition advice can be conflicting. You would be best advised by a registered dietitian with access to your full medical history. The primary conflict when providing nutrition advice for these conditions would be fiber intake. A good general recommendation would be to limit fiber and seek advice from a registered dietitian.

What is a typical day like for a nutritionist?

A nutritionist may mean different things for different people. A registered dietitian is a nutritionist who may work in a hospital or outpatient nutrition practice. He may also work as an independent consultant for sports teams or nursing homes. An individual may be a nutritionist and not a registered dietitian. Nutritionists may write for newspapers or blogs, work in a health food store, or consult with individuals. I don’t think one can describe a typical day for a nutritionist, but go to www.eatright.org to get information on becoming a registered dietitian, and compare this with other information on nutritionists who practice with other backgrounds.

I saw claims on the Internet that whole wheat products, whole grain cereals, and orange juice will release insulin in your body and cause your body to store fat. Are these claims true?

I saw claims on the Internet that whole wheat products, whole grain cereals, and orange juice will release insulin in your body and cause your body to store fat. It recommended that we should eat sprouted bread, rice millet, quinoa, and sweet potatoes. With fats, we should eat real butter, eggs, olive oil, raw nuts, and coconut oils. I stopped using regular Coffeemate because the coconut oil in it caused weight gain. I've never heard of whole wheat and orange juice causing your insulin to rise, which causes fat to stay. I am confused. Are these claims true?
Wow, what a mouthful! Insulin is released by your pancreas when you eat carbohydrate foods; this is normal and needed to utilize the energy we get from these foods. Excess production of insulin and overeating can cause excess fat storage. As for fats, they contain many calories, which can lead to weight gain. And you mentioned lots of fats that have various effects on our health. When eaten in moderation, all can be healthful. Go to the American Diabetes Association, the American Dietetic Association, or www.mypyramid.gov and you will find lots of good information to help you understand these questions better.

I'm a thirty-eight-year-old male recovering from a heart attack. What would a healthy sodium intake be?

The recommended amount would be 1,500-2,300 mg each day.

Is there a difference between the amount of fiber found in cooked food compared to dry or uncooked foods?

Fiber may be lost when preparing foods, such as peeling an apple. Some fiber may also break down during the cooking process. There may be some difference, but it may be related to the concentration of food when it is cooked, not the loss of fiber.

Hello! I was just wondering what your recommendations are for omega 9 (oleic acid)?

Oleic acid and omega 9 are monounsaturated fatty acids that provide some health benefit. These fatty acids can be made by our bodies from omega 3 and omega 6 fatty acids, which means they are not essential to include in one’s diet. Examples of foods high in monounsaturated fats include vegetable oils such as olive oil, canola oil, peanut oil, sunflower oil, and sesame oil. Other sources include avocados, peanut butter, and many nuts and seeds. These fats help to lower the “bad” LDL cholesterol, and raise the “good” HDL cholesterol. They also support our immune system, have antioxidant properties, and taste good.

I have symptoms of low thyroid; Are there some vitamins I can take to help my symptoms?

I have all the symptoms of low thyroid: weight gain, thinning hair, low energy, dry skin, brittle nails, no sex drive, and an inability to sleep. The doctor tells me my thyroid is in the normal range, but I feel awful. Are there some vitamins I can take to help my symptoms?

You sound very uncomfortable and may want to go back to your doctor to discuss your vitamin status. Some of the symptoms you mention may be related to low vitamin D. A multi-vitamin may help ensure one gets the recommended amount of vitamins needed to maintain health. You may also want to discuss your sleeping issues in more detail; lack of sleep can be related to weight gain too.

My question is, at what times should I eat?

I work a seven-day rotation which includes seven days of the day shift, one day off, then seven days of the evening shift, then one and one-half days off, then seven days of the midnight shift followed by four days off. My question is, at what times should I eat?

Your schedule is a challenge. I don’t know a time you “should” eat, but creating an eating pattern that will help you function well at work and not interfere with your sleep would be helpful. You may also have social concerns to consider, such as eating with family members. Use trial and error, keep a food journal, and note how you feel to guide you in this process. Planning will be needed to get the food you need when you need it.

I have to watch my carbs, how do I do that?

I just found out I have type 2 diabetes. I have to watch my carbs, and I don’t have a clue how to do that. For example, I see on a package there are 24 carbs and only 2 servings. How do I calculate the carbs from that?

Each serving contains 24 carbs. If you eat both servings you get 48 carbs. More information on reading the food label can be found at the FDA Web site.

I am currently taking vitamins and supplements daily, I need to know if its okay to take these together.

I am currently taking vitamins and supplements daily, and I just need to know if it is okay to take these all together: green tea 100mg, ginko biloba 120mg, omega-3 fish oil 1200mg, and calcium 600mg with vitamin D 400iu. I’m also considering adding Sam-e Made.
Check with the manufacturer for instructions on when to take each vitamin/supplement, as well as possible interactions.

I think I am addicted to food, will a therapist help?

I am a fifty-one-year-old obese woman who doesn't seem to be able to diet and stick to exercise. I think I might need therapy to get myself in a healthy place and find out why I am addicted to food. Do you think that will help?

Yes, change can be challenging, and checking in with a therapist may be very helpful.

I eat between 1200 and 1500 calories and day and exercise, how am I gaining weight?

I am a twenty-five-year-old woman. I am five foot seven and weigh 174 pounds. I eat 1200 to 1500 calories daily and I exercise between forty five and ninety minutes a day. I don’t feel hungry or crave anything after I eat. I am eating healthy things such as salmon and plenty of fresh vegetables. I read online that 1200 calories is not enough and will eventually slow my metabolism. This worries me a lot. I don’t want to lose the weight just to gain it back. I feel that I can keep this up even after I lose the weight but I just want to know if it is okay to do this plan.
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Hi, I’m a five-foot-five, 140-pound female. At my lowest weight last summer (125 lb.) I was eating and exercising healthfully (lost fifty pounds over three years). After a five-pound gain about eight months ago, I added a second cardio workout most days to halt the gain. However, all other factors seemingly the same, I have gained another ten pounds, even though I’m working out harder. I eat healthfully: lean meats, egg whites, oatmeal, whole grains, and a TON of veggies. I work out six days a week and figure my calories burned through exercise are around 700 per day. During the week, I eat 1300 to 1450 calories a day, and on the weekends it is more like 2000 to 2200 a day. I understand my routine could be considered maintenance, but how come I cannot get rid of the fifteen pounds even though I am working harder than when I was 125 pounds?
The calorie levels in both cases above seem reasonable. It may be helpful to confirm the caloric count to see if they are accurate. There are many good calorie calculators on line. Another consideration is body composition, i.e. the percentage of body fat and muscle. Try to locate someone to check your body fat; some health clubs have bioelectrical impedance scales that do this. You may also want to measure your chest, waist, hips, thighs, and upper arm and keep a log, rechecking both the body fat and measurements once a week. With all of these goes time. Give your body time to adjust to changes you have made with diet and exercise. On the medical side, hypothyroidism can result in a ten- to fifteen-pound weight gain, and some medications can cause weight gain. Discuss these issues with your physician.

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