A: I love this sort of question because it lets me discuss how science works.

Dear Dr. Gourmet,

Q: I understand that vinegar may help lower blood sugar levels. Will lemon juice be just as helpful?

A: I love this sort of question because it lets me discuss how science works.

I have been skeptical about patients who come in and tell me that they are taking vinegar for their health. This is usually apple cider vinegar and it just seemed silly to me but I have also felt that this is like so many supplements – probably not harmful but probably not helpful. However, it appears that this “silly” idea may have some merit. Diabetes, Vinegar and Lemon Juice

Q: With total vitamin K set at 80-120 micrograms, how do you calculate this? Is it as adding up the amounts in different foods and their quantity, or are there factors for what the body can metabolize vs. input?

My wife unexpectedly had to get a pacemaker this past weekend. No symptoms, only a preop ECG, then an echo, and the Holter confirmed Bradycardia and AF. A cath ruled out any other problems except SSS. This has been a real stressful week, as she is just 51. We are trying to read everything we can, but there are many contradictions in opinions; I felt like you would be a great source, since you know both sides of the issue.

Our cardiologist is a great guy and we both trust him (I used him first), but he said you had to quit this and that, but most of those are the things that we used to trim up our waist lines and get “fit”. My wife now wonders about that one. We are ordering your cookbook and list, but I would like to know the answer to my questions. I think consistency is more important than what you eat that contains vitamin K.

A: There are factors other than simply the amount of Vitamin K you consume that can have an effect on its availability in the blood stream. For instance, many of the bacteria in your intestines create Vitamin K and taking antibiotics that change the balance of those organisms can have an effect on Coumadin (warfarin).Which is more important: amount or consistency?

Q: Are we eating too many high oxalic acid foods?

The available information on oxalic acid is confusing and varies with every source. According to one source our regular breakfast (oatmeal, dried figs, blueberries, wheat germ, flaxseed, and soy milk), our favorite dinner vegetables (spinach, beets, okra, and beans), and our regular snacks (almonds, peanuts, and berries) ALL contain high levels of oxalic acid.

Aside from the danger of getting kidney stones, most sources are undecided about the effect of high levels of Oxalate in one’s diet. Some say that it prevents absorption of calcium, iron, and other minerals but the extent of this problem is uncertain.

A: For most folks high oxalic foods are not an issue. There are some people who are prone to calcium oxalate kidney stones and there’s a feeling that limiting foods high in oxalate might help with treatment. The general recommendation for those people is no more than 50 mg of oxalic acid per day. Oxalates in the Diet

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

Dear Dr. Gourmet,

Q: I am currently caring for my dad who uses Coumadin and is diabetic. I am looking for menus/recipes with regards to his conditions. Menus would be helpful, as I work during the day.

A: We now know that the Mediterranean style diet is the best diet for diabetics. Here’s an article on the newest evidence on the best diet for type 2 diabetics.

All of the recipes on the Dr. Gourmet website are based on Mediterranean style diet principles. There are hundreds of Coumadin (warfarin) safe recipes at DrGourmet.com, and each recipe is labeled as to whether it is safe for Coumadin users, those with GERD, those who are lactose-intolerant or allergic to wheat gluten. Diabetes and Coumadin (warfarin)

Q: Some cakes need up to 8 eggs… Can half of them be replaced with starch and will there be a big difference in taste?

A: Reducing the amount of eggs in baking can be a challenge. One can’t really simply eliminate eggs from a recipe and replace it with another ingredient and expect the same result. This is not so much a matter of changing the taste of the cake or muffin but the texture. Eggs in Baking

Q: My 15 year old daughter just had surgery for a kidney stone. Her maternal grandfather suffered with these all his life, so we feel it is hereditary. It is unusual for such a young girl to have a kidney stone. She runs cross country and we also feel she has hydrated enough on a daily basis. The doctor told us to reduce her protein intake as her stone was a uric acid stone. What types of things should be cut out of her diet? Do you have recipes that are low protein for a lifestyle change?

A: There are a number of types of kidney stones and it is not unusual for children to have them. They are the most common type of kidney stone in kids. This is one of the better articles on the web that can help you understand how the stones form:http://www.emedicine.com/ped/topic2361.htm

Diet can also play a role and reducing the amount of proteins that are high in purines is key to avoiding more stones. This is the same sort of diet that those with gout will follow (gout is also caused by high levels of uric acid in the blood stream). This is not all proteins and since your daughter is an athlete it’s important that you make sure that she gets enough protein. Kidney Stone Prevention

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions – over 500 questions already answered!

A: No, it doesn’t appear that there are [...]]]> Dear Dr. Gourmet,

Q: I presume from your comments on Pradaxa that all the dietary restrictions for those taking Coumadin would also apply to someone using Pradaxa. Is that correct?

A: No, it doesn’t appear that there are any interactions of food with Pradaxa (dabigatran) as there are with Coumadin (warfarin). For those taking this new medication there won’t be concerns over consuming foods high in Vitamin K. Likewise, there are fewer interactions with other medications. You can read more information online.

Keep in mind that as of now this medication is only approved for certain types of atrial fibrillation. Check with your physician to see if this medication might be right for you.

Q: Is sushi high in cholesterol?

A: Sushi in general should not be high in cholesterol. The fish used does contain cholesterol. For instance, a 1/2 ounce piece of tuna that would be served in a typical nigiri sushi contains about 7 milligrams (mg) of cholesterol. Salmon and other fatty fish served at sushi bars like mackerel, eel and abalone can be higher in cholesterol in the range of 10 – 15 mg per piece. Sushi and Cholesterol

Q: I was told to go on a low salt diet. Are the salt substitutes a good alternative, or are they just as bad for you?

A: There are a lot of different salt substitutes on the market, and you can find these in the same aisle as the spices and the salt. Most of them use forms of potassium that do a fair job at mimicking how sodium binds to the salt taste buds. There are also some herb preparations that call themselves salt replacements but they usually rely on lemon, which can help. Salt Substitutes

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions – over 500 questions already answered!

A: Two fantastic books deal with this [...]]]> Dear Dr. Gourmet,

Q: I’m undergoing chemotherapy for B cell lymphoma. Are there any tasty recipes you can recommend that are high in calories to help stop the weight loss?

A: Two fantastic books deal with this issue. My favorite is Healthy Eating During Chemotherapy.

The book has great background information and each of the recipe sections is broken down by food textures and temperatures to help users through each phase of chemotherapy. Eating During Chemotherapy

Q: I have read in a couple of places that scrambled eggs are not good for you. One site said that by scrambling them, the cholesterol will oxidize. I love scrambled eggs so I hope this is not true.

A: The idea that oxidization of dietary cholesterol might be an issue comes from a number of sources. The problem is that none of these has been specifically linked to scrambled eggs. Scrambled Eggs and Oxidized Cholesterol

Q: I have been looking at your amazing website. I just want to know – I normally have a glass of hot water and lemon juice in the morning. Would this affect my INR level, since I take my warfarin the night before?

A: This should not be a problem, especially if it is something you do on a consistent basis. Read more Ask Dr. Gourmet questions about Coumadin (warfarin).

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions – over 500 questions already answered!

His diet recommendations counter many items in the Mediterranean Diet. See this excerpt from [...]]]> Dear Dr. Gourmet,

Q: I just read CNN’s latest article highlighting Dr. Caldwell Esselstyn Jr.’s plant-based diet to prevent heart attacks and reverse heart disease.

His diet recommendations counter many items in the Mediterranean Diet. See this excerpt from his website and please clarify! Now I’m really unsure what to eat. Fish? No fish? Nuts, no nuts? Olive oil, or no oils whatsoever? No avocados?

A: It has long since been proven that the type of diet that Dr. Esselstyn advocates is not substantially more beneficial for you than the Mediterranean Diet. The science is based partly on research that looks at vegetarian diets and partly on Dean Ornish’s work. In fact, due to the extreme nature of the low fat regime, it may actually be more harmful.

Is this healthier than the Mediterranean diet? Probably not. The research is clear that extremely low fat diets do not prevent heart disease. The Heart Attack Proof Diet

Q: I am concerned about the accuracy of the Vitamin K information in the foods you report on your website to Coumadin takers. You report that pistachios have 0mcg of Vitamin K, but on the USDA website and several other dietician and hospital websites, it shows that pistachios do have Vitamin K. Specifically, from the USDA, “Nuts, pistachio nuts, dry roasted, with salt added,” 1 ounce (47 nuts) has 3.7mcg of Vitamin K. I think this is very important because if someone thinks there is none in a food, then they might eat several throughout a day or week thinking they are a “safe” food, but then wonder why their INRs cannot balance.

A: Sometimes the information from the USDA web site can be challenging and it is key to make sure one is looking carefully at the choice of ingredient – comparing apples to apples and not apples to oranges. USDA Information and Vitamin K Information Accuracy

Q: Is the product Vitamin Water Zero a hoax or does it have some redeeming value?

A: My opinion is that this is a scam. There’s no reason to take multivitamins except in some very specific cases and there’s no health benefit proven from drinking vitamins.

Here’s the statement released in mid-June 2010 as part of the new dietary guidelines for Americans.

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions – over 500 questions already answered!

A: There [...]]]> Dear Dr. Gourmet,

Q: My husband’s borderline diabetes is compounded with a high potassium count. This makes it very difficult to maintain a Mediterranean diet. Do you have recipes or advice for this particular problem?

A: There can be a number of reasons for high potassium levels in the blood. With diabetes issues, changes in kidney function and medications are the two most common reasons and it’s important to make sure that these and other causes have been fully evaluated.

Depending on the recommendations of your physician, limiting foods that are high in potassium is the first step. High Potassium and Diabetes

Q: There seems to be growing evidence that horse chestnut is good for veins, with EBSCO adding that benefits may include “sealing leaking capillaries, improving the elastic strength of veins, preventing the release of enzymes (known as glycosaminoglycan hydrolases) that break down collagen and open holes in capillary walls, decreasing inflammation, and blocking other various physiological events that lead to vein damage.” Several studies have tested it for chronic venous insufficiency and varicose veins.

I have mild to moderate post-thrombotic syndrome and don’t want it to get any worse. However, I’m on Coumadin for life (or until they come out with better alternatives). Is it possible to take horse chestnut while on Coumadin? Like many drugs, there are warnings the combo could increase bleeding risks.

A: There has been some evidence for horse chestnut being beneficial for vein conditions such as venous insufficiency. Here isan abstract from 2002.

Q: Please help! My boyfriend is 51. He works outside and leaves very early in the morning. He has a regimen for breakfast and lunch that he wants to be healthful but quick, with breakfast holding him til lunch. He makes oatmeal every morning. However, in an effort to add protein he adds one pre-cooked Jimmie Dean Sausage patty to it. He also eats Oscar Mayer Deli-Fresh Smoked Turkey lunch meat for lunch. Every day. Six days a week. I’m concerned about the cumulative effects of that processed meat day after day, year after year. Is there a more healthful protein alternative he could add to his oatmeal? Are my concerns warranted?

A: There is great evidence that combining a good quality carbohydrate such as oatmeal with some protein in the morning can really help with staving off hunger through the morning. The choice of sausage is, however, a very poor protein source.

The same is true for lunch. By having a sandwich with whole wheat bread and combining it with a quality protein source it’s clear from research that satisfaction is better sustained throughout the afternoon. The choice of processed turkey is a poor one. Better Protein Choices

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions – over 500 questions already answered!

A: In the [...]]]> Dear Dr. Gourmet,

Q: I have heard from doctors or nurses that if you are prediabetic you are really a diabetic. Or if you are taking metaformin that you are diabetic. Is that true?

A: In the last few years the criteria for diagnosing diabetes has become much more stringent. This is because we know now that even modest elevations in blood sugars can have a devastating effect in the long term. Presently, the diagnosis is made when the morning fasting blood sugar is greater than 126 mg/dL.

We are, however, concerned when fasting blood sugars are consistently greater than 100 mg/dL. Likewise, those with fasting blood sugars that are higher than 110 mg/dL are considered by some to be “prediabetic.” Prediabetes

Q: First of all, thank you for your fantastic warfarin meals and recipes. I have been on this for about 8 wks now. Have lost about 23 lbs and my warfarin doses have actually changed from 47 1/2 to 37 1/2 per week. It is so seldom that I actually see recipes directed at warfarin users, especially the salads. I do still have one question. I eat the blueberry muffins and also include blueberries and blackberries in my alloted fruits per week. Is this safe or are the berries considered off limits for regular servings of fruit? It seems like I have seen questions or articles in favor of both. Thank You.

A: Wow! We’re really excited for you here at Dr. Gourmet World Headquarters. It’s always great to hear about weight loss such as yours and that you like the recipes!

Blackberries and blueberries do have higher amounts of Vitamin K than some fruits, but in an amount might be considered as moderate and not off limits. Each has around 28 micrograms of Vitamin K per cup.

At the same time we know that these berries are great choices for a lot of reasons, including their high proportion of great quality vitamins and antioxidants. Eating Blueberries and Blackberries on Coumadin (warfarin)

Q: I attended a health seminar where you mentioned how important it is to reduce the sodium and not have more than the daily recommended value. You gave a few examples of the amount of sodium in some fast food and chain restaurant meals and how the daily maximum could quickly be reached. If I do have these items will drinking extra water counteract the increase in sodium?

A: This is a great question.

There may be a slight effect but, sadly, drinking more water won’t likely offset a high sodium diet very much. The regulation of water volume as well as sodium, potassium and other electrolytes in the body is quite an elegant mechanism. The kidneys are quite efficient at holding on to electrolytes and filtering water. Water and High Sodium Foods

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions – over 500 questions already answered!

You can always check to see if your question, or [...]]]>

We’ve had a lot of new subscribers recently (welcome!), and I thought it might be helpful for us to share a few of our “greatest hits” or most frequently-asked questions on a variety of topics.

You can always check to see if your question, or a similar one, has already been answered by visiting the Ask Dr. Gourmet section on our web site.

Coumadin

Q: How much Vitamin K is in…?

A: There’s an easy way to find out about the nutrition content of any food. Just use the USDA National Nutrient Database. By entering an ingredient and following the steps, this web site will report the complete nutritional values of any ingredient and many prepared foods. The Vitamin K content is the last listing at the bottom of the Vitamins section. If it is not there, the food or ingredient that you searched on doesn’t contain enough Vitamin K to be reported.

Q: Can I use nutritional supplements while on Coumadin? What about acai juice / berries / Mona Vie or Resveratrol?

Q: Should you avoid cranberry juice on Coumadin (warfarin)?

Browse all Ask Dr. Gourmet Questions about Coumadin (warfarin).

Weight Loss / The Dr. Gourmet Diet Plan

Q: Is Body Mass Index accurate for everyone?

Q: Is cutting down on carbohydrates a healthy way to lose weight?

Q: Is there any cost involved in The Dr. Gourmet Diet Plan or the Dr. Gourmet web site?

Q: How can I lose weight if I can’t exercise?

Browse all Ask Dr. Gourmet Questions about Weight Loss and The Dr. Gourmet Diet Plan.

Miscellanous

Q: Should I be concerned about the level of mercury in the fish I eat?

Q: Does sea salt have less sodium in it than regular salt?

Q: Would adding baking soda to chili to make it GERD-friendly ruin the taste of the chili?

Q: Do you have diet plans for those with Type 2 diabetes?

Q: Are seeds really a problem for those with diverticulitis?

Browse all Ask Dr. Gourmet Questions about Health Conditions.

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions – over 500 questions already answered!

Dear Dr. Gourmet,

Q: Is there a substitute for red wine? Perhaps grape juice made from grapes rather than concentrate? I do not drink alcohol at all and would not do so even for the benefits of red wine.

A: There is good evidence that drinking grape juice has many of the same benefits as drinking red wine. The antioxidant polyphenols in red grape juice have been shown to have positive effects on cholesterol in the same way as red wine. Is Grape Juice a Substitute for Red Wine?

Q: I have just finished reviewing The Dr. Gourmet Diet Plan. I am considered obese, 50 pounds over my ideal weight, as is my husband. I also have two children, 5 & 6 1/2. How can I adjust these servings to accommodate their growing bodies so that I am making one main meal each evening or is it necessary?

A: The average 5 to 8 year-old needs about 40 calories per pound of weight, or 1,800 – 1,900 calories per day. Activity is going to have a lot to do with this, however. If your child is less active, they might need only 1,400 calories, and if they are very active, they will need more.

Most dieticians recommend more than just three meals per day for kids. A good strategy is to use the 1,500 calorie level as a guide and then supplement with nutritious snacks for your children when they are active. This means that your kids can eat the same healthy diet as you with adjustments for healthy snacks. Can My Kids Participate Safely in The Dr. Gourmet Diet Plan?

Q: My husband has been on warfarin for almost 15 years, and eats a huge salad each day. His Coumadin rarely needs to be regulated other than the dose he is currently on. I have become very concerned that the medication dose could be lowered if he stops eating the salads each day.

I serve all the K no no’s regularly. Should I stop? He was told years ago that since greens are a regular part of his diet he should continue eating as always.

A: While limiting Vitamin K is one strategy for keeping the INR stable while taking Coumadin® (warfarin), being consistent is just as important.

By having a salad every day, your husband is getting the same amount of Vitamin K every day from the greens, so the intake is consistent. This allows your husband’s doctor to adjust his Coumadin dose relative to that stable intake of Vitamin K. This is a great way to get healthy greens and take Coumadin at the same time. As long as his salad consumption is uniform he should continue to do as well as he has in the last 15 years. Keeping Your Dosage Stable

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You can now pre-order my new book, Just Tell Me What To Eat!: The Delicious 6-Week Weight Loss Plan for the Real World. This is a 6 week plan that I’ve built over the last decade of working with patients to help them lose weight and improve their health. The program includes 6 weeks of menus, with recipes and all the information that you need to transform your health.

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I use raw milk [...]]]> Dear Dr. Gourmet,

Q: I have celiac disease, and I keep reading that celiacs should stay away from dairy because it promotes inflammation. But dairy has always been one of my main “foods.”

I use raw milk (from a friend’s “pet” cow) and make my own kefir, yogurt, butter and cheese in addition to just drinking it.

Is raw milk as bad for celiacs as processed milk? Also, would I need to stay away from yogurt and kefir? (I cannot take probiotics in capsule form.)

A: There is some research that indicates many celiac patients may be intolerant of diary products. There is, however, more than one explanation for this. Celiac Disease and Lactose Intolerance

Q: I have had all the clinical signs of hypothyroid for decades but my “numbers” are always within “normal” range. I’ve heard a lot over the years about use of natural thyroid supplements and now iodine but only if it contains iodide (see the following link). Should I try this supplement?

A: As you may know, I don’t often comment on supplements. There are not many that are necessary and taking supplements has, in some cases, been associated with poorer health outcomes.

The supplement that is described on the page you pointed me to is iodide. As with many such supplements, the science is faulty and the use of high doses of iodide can be a problem. Thyroid Supplements

Q: I have been on Coumadin for 3 yrs since having a heart valve replacement. Lately, I am sleepy all the time. Seems like I can’t watch a movie or work on the computer without falling asleep. I think I am low on iron, but what can I do about eating foods rich in iron without it affecting the Coumadin?

A: While most people think of spinach and other greens as being high in iron, there are a lot of other great choices. Here’s a list of foods that are high in iron.

Note that there’s only a few items on this list that are high in Vitamin K.

If you believe that you are iron deficient, call your doctor and make an appointment today. He or she would want to know if you are not feeling well while taking Coumadin. Being iron deficient can be a sign of blood loss and for those on Coumadin we are very concerned about such things. Call now.

Also can I [...]]]> Dear Dr. Gourmet,

Q: I want to know if Fiber One cereal from General Mills is OK to eat when you have gout. I need to eat it every day because I have Diverticulosis.

Also can I eat microwave kettle corn popcorn with gout?

A: Cereals such as Fiber One shouldn’t be a problem for your gout. We know that the main issue where food will affect uric acid levels are those ingredients higher in protein, especially ones that contain more purines. Gout and Grains

Q: I work a lot, and am not thrilled with cooking. I’ve been thinking of trying the Nutrisystem plan. Would that be safe if I’m on Coumadin?

A: I get questions pretty frequently about the safety of prepared meals for those taking Coumadin (warfarin). This is a challenging issue and one that I don’t have a definitive answer for (but read on anyway).

As you may know from reading information on DrGourmet.com there are two approaches to consumption of Vitamin K containing foods when taking Coumadin. One is to eat about the same amount of Vitamin K containing foods each day. This can be challenging for many as there’s a wide variation between kale or other such greens (very high in Vitamin K) and carrots or iceberg lettuce (lower in Vitamin K). The other option is to eliminate all foods that are very high in Vitamin K. Coumadin, Convenience Foods and Nutrisystem

Q: My doctor suspects I might have metabolic syndrome. She advised me to lose weight, which I am in the process of doing: 11 pounds so far. Is there a particular diet that would be better for me, i.e., diabetic diet, Mediterranean diet? Are there any foods I ned to cut out forever? One article I read said not to eat corn, butter beans, beets, and anything white.

A: I love this question because recently there is excellent research to prove that the optimum diet for metabolic syndrome is Mediterranean style diet. This is a recent article that reinforces the conclusions from the last 20 years of research. Diet for Metabolic Syndrome

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

A: When creating our lists for Vitamin K content we reviewed many sources. We looked at the recommended [...]]]> Dear Dr. Gourmet,

Q: What are the ranges of mcg of vitamin K for low, medium, and high classifications?

A: When creating our lists for Vitamin K content we reviewed many sources. We looked at the recommended daily allowance (RDA) of Vitamin K as well as a grouping of ingredients by amounts. Low, Medium, and High Vitamin K

Q: Your website is terrific. My husband is a heart patient (bypasses, heart failure and atrial fibrilation plus Type 2 diabetes), so I turn to your website often. I have Type 2 diabetes and grew up in a Greek (Mediterranean) home with veggies, fruits, and very little meat. I have tried to maintain this in my own home and would like your advice as to how you rate some of the Mediterranean recipes that are in the more popular Greek Cuisine cookbooks. I would like to go on your diet plan because we could also lose about 20 pounds apiece, but I find it difficult to switch to more American-style foods such as are in your diet plan. Can you advise me?

A: Certainly, Greek cuisine is the foundation of Mediterranean style diet. If I have a choice of any restaurant, it would almost always be Greek. The challenge for the recipes in popular cookbooks is that the meals will often contain more calories than needed — great ingredients but just too much of them. This is true whether the cookbook is Greek or some other cuisine. Evaluating Greek Recipes

Q: I have a labral tear and I’m contemplating arthroscopic hip surgery, a relatively new procedure. I have read on the “Men’s Health” forum about the risks of this surgery and also about using foods such as greens and omega 3, 6 and 9s to repair cartilage. Is there any truth to the eating greens will cause hip cartilage to repair or re-grow? Does glucosamine/chondroitine work?

A: This is another example of claims made on the internet without much good science to back it up.

There have been some research studies that show improved function in those with arthritis when they consume a healthy diet. A variety of nutrients have been looked at including various fats (Omega-3 and Omega-6), antioxidants, vitamins and minerals. Cartilage-Supporting Supplements

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

A: I don’t normally answer questions not related to diet and [...]]]> Dear Dr. Gourmet,

Q: Any comments about the new drug that has just been approved by the FDA and supposedly will take Warfarin’s place – Pradaxa?

A: I don’t normally answer questions not related to diet and nutrition, but many of our readers are Coumadin (warfarin) users so I will make an exception.

This medication has been approved by the FDA only for prevention of stroke in patients with atrial fibrillation. Dabigatran has been on the market for some time in Europe. I actually had a few patients in the clinical trials before approval (they did well, by the way). It was shown to be slightly more effective than warfarin and slightly lower risk of major bleeding and hemorrhagic stroke. Pradaxa

Q: I was very interested in your article: Hot Chocolate for High Blood Pressure? as I drink hot chocolate after taking innulin every evening at bedtime. I note you state “not hot chocolate mix” and I wonder why this is? I use Nestle Carnation Light brand made with water and this has 45 calories. Skim milk would add 60 calories but this stuff tastes so good I don’t need to use milk.

A: I put this cautionary statement in the conclusion because many hot chocolate products have very little actual cocoa in them. They will often be milk powder combined with artificial chocolate or cocoa flavorings. Because the study was done with real cocoa products, simply saying “hot chocolate” might not offer the same benefit.

Q: I am watching my glucose numbers. Should I be more concerned about a food’s glycemic index or the amount of fiber in a food? It seems that a food with a good amount of fiber also has a higher glycemic index.

A: This is a fantastic question. There has been a lot of good research about the impact of a higher fiber diet on helping control blood sugars. We have less information about the impact of glycemic index (GI) on diet and diabetics but what we have is getting better. One study in 2008 compared a low glycemic index diet with a high cereal fiber diet and the diabetics on the low GI diet did slightly better. Fiber vs. Glycemic Index

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

Dear Dr. Gourmet,

Q: I drink one cup of green tea daily. I am wondering if taking green tea capsules would give me much more of the health benefits of green tea. Is one cup daily enough to improve blood sugar levels?

A: Green tea does appear to be good for you. There’s no great evidence that green tea can help control blood sugar. In fact, a recent research article showed that drinking green tea with breakfast had no effect on blood sugars up to two hours later. Green Tea

Q: I was plagued with Gout for a while until I discovered and began taking Cherry Fruit Extract. I had no flareups while on that.

But now I’m on Coumadin (Warfarin), and was told to stay off Cherry Fruit Extract, along with CoQ10 and Vit C. What are your thoughts on me going back to Cherry Fruit Extract while on Coumadin?

A: I am glad that your physician told you to not take these supplements. He or she was right to tell you that.

There is no evidence that cherry fruit extract helps with gout. There is some evidence that eating cherries decreases plasma urate levels. A good study in The Journal of Nutrition investigated this in 2003. While this is good evidence, there is no reliable evidence to support that eating cherries prevents gout (only that there are lower urate levels). Gout, Coumadin and Cherry Fruit Extract

Q: My boyfriend’s mother suffers with Crohn’s Disease (although fortunately she is not needing medication at the moment). She has started to take Linseed oil after hearing it may help with her symptoms. She adds a couple of tablespoons a day to yoghurt, cereal etc.

She has asked whether there are any bad effects of taking Linseed and what the evidence is for its use. My initial feeling is that as she feels it is having a positive effect, it doesn’t matter whether it is placebo or not but was wondering whether you had any information and thoughts about it?

A: There have been some reports that healthy oils such as fish oil and flax seed (linseed) oil might have benefit in those with Crohn’s Disease. That evidence is not all that great and there is no recommendation at this time for people with Inflammatory Bowel Disease to take such supplements. Crohn’s Disease and Linseed (Flaxseed) Oil

A: I love this question. Even though Dr. Gourmet is about food I believe that exercise is key to being healthy.

Dear Dr. Gourmet,

Q: Can you lower your cholesterol without exercising?

A: I love this question. Even though Dr. Gourmet is about food I believe that exercise is key to being healthy.

You can certainly lower your cholesterol without exercise. The research shows this to be the case. That said, you will do better to exercise regularly. Regular activity has clearly been shown to help lower your total cholesterol, improve the HDL (good) cholesterol and lower LDL (bad) cholesterol. Cholesterol and Exercise

Q: I wondered if there’s too much of a good thing: can salmon more than 4 times per week raise cholesterol levels or otherwise pose risks? Is there an upper limit? I’m referring to canned Pacific salmon, mackerel, or sardines.

I’m a lacto vegetarian, am likely deficient in omega-3 and omega-6 fatty acids, and don’t have qualms incorporating fish into my diet – just wondered about an upper limit.

A: Salmon is a safer choice as are mackerel and sardines. All three are higher in Omega-3 fatty acids and there’s less risk of contamination with mercury or other industrial pollutants than some other fish. A 3 1/2 ounce serving of each of these choices comes in at about 1,000 mg of Omega-3 fats but not more than 0.5 parts per million of mercury. Too much fish?

Q: I have had four attacks of AFib in the past 3 years, so I am on Coumadin. I have read many of your postings on Coumadin and caffeine and Coumadin and cranberries. Caffeine probably does not cause AFib but if one has had AFib attacks will Caffeine bring on another attack?

Regarding cranberries, all of the data I have seen relates to cranberry juice. Would the same opinion that there is no credible evidence that moderate intake of juice affects Coumadin therapy apply to cranberries in a salad or other recipe or eaten alone? I would think they are more potent than the juice.

A: I don’t see that there’s evidence one way or the other about whether caffeine will provoke further episodes of atrial fibrillation in those who have already had issues. The evidence we have about the lack of a link comes from large epidemiologic trials. These have not shown any association between caffeine and heart rhythm problems. However, the only way for us to know for certain would be to perform a randomized, prospective trial where one group with atrial fibrillation drinks coffee and the other doesn’t. Comparing the two would offer us definitive evidence. Coumadin, A-Fib, Cranberries and Caffeine

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

A: My opinion is that this is a scam. There’s no reason to take multivitamins except in some very specific cases and there’s no [...]]]> Q: Is the product Vitamin Water Zero a hoax or does it have some redeeming value?

A: My opinion is that this is a scam. There’s no reason to take multivitamins except in some very specific cases and there’s no health benefit proven from drinking vitamins.

Here’s the statement released in mid-June 2010 as part of the new dietary guidelines for Americans: Vitamins

Q: Is there more vitamin K in raw blueberries or in cooked blueberries, such as in pie filling?

A: One cup of raw blueberries is a little higher in Vitamin K than other fruits at 29 micrograms (mcg). According to the USDA, a cup of canned blueberries in heavy syrup has only 16 mcg of Vitamin K. This is likely because some of that cup contains syrup and sugar (the blueberries in syrup come in at 225 calories and the cup of raw fruit is only 84 calories). Raw vs. Cooked Blueberries

Q: In our household we have members with high blood pressure, high cholesterol, type 2 diabetes, reflux, and Coumadin use. Your Real World Diet program sounded like a custom combination could be made to cover all of us. However, the diabetic, high cholesterol, and high blood pressure diets are not choices. . . . What would you suggest we do? Your website could be a lifesaver for all of us.

A: We now know that the most effective diet for all three of the issues you mention is a Mediterranean style diet. There is tremendous research to show that eating this way can effectively treat diabetes, high cholesterol and high blood pressure. All of the recipes on the Dr. Gourmet web site are based on Mediterranean diet principles and translate them to more familiar American recipes for you. You can read about this by using The Real World Diet Coaching program, a collection of brief essays on how to eat healthy.

You are correct that a lot of folks who have these sorts of problems also have other challenges like acid reflux or are taking Coumadin (warfarin). This is why we have tagged every recipe to let you know how a dish might affect other conditions. We have set up The Real World Diet planner to create two week meal plans for all the members of your household. Diets for Multiple Conditions

Q: Thank you for your informative article about multivitamin use and breast cancer.I just started taking multivitamins a week ago because I am vegan, live in the Pacific Northwest, and am trying to conceive so I need B12, vitamin D, and folic acid. Would you say that I could interpret this new study to say that I should toss the multivitamins and just take individual supplements for those ingredients I listed above? I would really appreciate your input in this matter as I have PCOS and Endometriosis and therefore have an abundance of estrogen which would seem to place me in higher risk according to this study.

On a side note, are you familiar with the work of Dr. Neal Barnard and his studies on vegan diets and reducing or eliminating diabetes? I read his book and am curious to hear from a nutritionally informed physician (sadly, there are few to call upon) on his validity within the medical community.

A: In a case such as yours it would be good to consult with your Obstetrician about which are the best vitamins to take. You are correct that making sure to get enough folate and Vitamin B12 is both important for women of childbearing age but especially so for you, since you are a vegan. This is the sort of case that the new guidelines speak to. Vegans, Vitamins and Pregnancy

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

A: While cranberry juice is safe with Coumadin (warfarin), [...]]]> Q: There is information about cranberry juice interacting with Coumadin (warfarin), however, I would like to request information about the interaction of grapefruit with Coumadin (warfarin) and if it is contraindicated.

A: While cranberry juice is safe with Coumadin (warfarin), grapefruit and grapefruit juice is most definitely contraindicated (to be avoided) – not only with Coumadin but with many other medications. Cranberries, Grapefruit and Coumadin (warfarin)

A: It is a myth [...]]]> Q: I have a terrible sweet tooth and my blood sugar is normal. I’m otherwise healthy and have no blood pressure problems. Can too many sweets cause me to become diabetic? Should I be concerned?

A: It is a myth that eating too much sugar causes diabetes.

There are a lot of factors that go into whether one will develop diabetes. Type I, or juvenile diabetes, occurs when the cells in the pancreas stop producing insulin. Type II diabetes generally happens as folks age, primarily in those that are overweight. It can arise in those of normal weight, but either way the reason seems to be that the body doesn’t use insulin properly. Diabetes and Sweets

Q: I have just been put on Coumadin after having aortic valve replacement. I cannot find out if raspberries have a large amount of Vitamin K in them. Can you answer for me? Thank you.

A: A cup of raspberries contains about 10 micrograms (mcg) of Vitamin K. That would be considered a low amount and safe for Coumadin® (warfarin). In fact, pretty much all fruits are going to be safe for you. You can check that using the lists on this page: Coumadin (Warfarin) Diet Information

Q: My blood sugar has been creeping upwards and I’ve been cautioned against eating white sugar, white breads, and white rice. Is honey OK, and what fruits are permissible?

A: It’s great that you are working at making changes. For those with higher blood sugars avoiding processed foods and foods with a lot of sugar is key. The examples you give of table sugar, white bread and white rice are a good start. Working at getting more fiber in your diet by having whole wheat bread, brown rice, whole wheat pasta, beans and veggies will help control your weight and your blood sugar.

While honey is somewhat sweeter than sugar, both are still sweeteners. Better Choices to Control Blood Sugars

Do any safe, cleansing agents get rid of pesticides on food? What solid research [...]]]> Q: I am concerned about pesticides on foods. How does one avoid the “dirty dozen” and protect infants and children, while still eating a balanced diet?

Do any safe, cleansing agents get rid of pesticides on food? What solid research indicates that the “washes” work?

A: This is a challenging question and I will admit that over the last few years I have personally been moving more and more toward consuming organic products. There is clear evidence that consuming organic products leads to a decrease in pesticide consumption. One great study was published in 2006 with researchers measuring pesticide exposure in 23 children by looking for pesticide metabolites in their urine. Pesticides

Q: How much Vitamin K is in chicken liver?

A: Chicken liver doesn’t contain any Vitamin K.

You can find out the amount of Vitamin K in over 700 foods with our Supplement: Vitamin K Levels In Common Foods.Click here to purchase the supplement ($4.95) and download right now.

Q: I am a 54 year old woman who had cervical cancer back in 1987 when I had my hysterectomy. I still have both ovaries, but was also told that I shouldn’t take estrogen due to the fact that I’ve had cancer in the past.

I love soy products and I was wondering if there is a limit to how much I should intake before it can cause a medical problem, if any.

A: I have searched the literature and have not found any conclusive research that links consumption of soy products with cervical cancer. For some time it was felt that there might be a link between soy consumption and breast cancer. The most recent evidence says that this is not the case, and that soy products don’t promote breast cancer. Soy and Cancer

A: Sure. Both of these are going [...]]]> Q: I am now taking Coumadin and just learning what’s okay and not okay. Is it okay to include the combination of fresh ginger and fresh garlic in stir-fry cooking?

A: Sure. Both of these are going to be safe and a great addition to your stir-frys.

You can find out the nutritional content of any ingredient by logging into The Real World Diet and clicking the Recipe Box tab. You will find a database with over 7,000 ingredients and their Vitamin K content.

The menu planner also helps you track your daily Vitamin K intake along with calories and other nutrients. Click the Food Diary tab.

A: There’s no evidence at all that resveratrol is beneficial. None, nada, zip. There is [...]]]> Q: I have been hearing a lot about the positive affects of Resveratrol. Could I take that supplement along with Coumadin (warfarin)?

A: There’s no evidence at all that resveratrol is beneficial. None, nada, zip. There is some research that indicates foods containing resveratrol may offer benefit but that’s not conclusive. Coumadin and Resveratrol

Q: I need to watch my blood sugar and I am also on Coumadin. Stevia seems to potentially be a good sugar substitute, but since it’s made from green leaves, I am wondering if there is any Vitamin K content in it?

A: I reached out to many of the makers of stevia and received only one reply from the folks at ZSweet. Here is their response.

A: I checked with the folks at Blue Diamond Almonds and they tell me that there’s no Vitamin K in their Almond Breeze [...]]]> Q: I know there is no Vitamin K in almonds, but what about almond milk?

A: I checked with the folks at Blue Diamond Almonds and they tell me that there’s no Vitamin K in their Almond Breeze products.

A: Both of these fishes would [...]]]> Q: My husband is on Coumadin (warfarin), is diabetic, has hypertension, gout and arthritis. His favorite food is sashimi (tuna and salmon); is it okay for him to eat it?

A: Both of these fishes would be fine for him to eat. Here are some links to other questions about sushi: Sushi, Cholesterol, Sodium and More

Q: Can I take the PGX or PolyGlycopleX, a water soluble plant fibre, along with my Coumadin (warfarin)?

Q: I’ve been checking the internet [...]]]> Two related questions came in from two different readers:

Q: Can I take the PGX or PolyGlycopleX, a water soluble plant fibre, along with my Coumadin (warfarin)?

Q: I’ve been checking the internet for some low-fat crock pot recipes, and one website kept mentioning Miracle Noodles. Have you ever heard of them? They seem harmless enough, so I thought I might try some, but I wanted to check with you first.

A: This is not the first time that I have been asked about these products. In addition to many brand names, such as PGX and PolyGlycoplex, you’ll also find a related product that folks eat, Glucomannan. This is a calorie free starch that’s generally used as a thickener, as well as in a host of nutritional supplements, but is also made into calorie free noodles such as the Miracle Noodles. PGX, PolyGlycopleX, Glucomannan, etc.

I love this spin on chicken satay with the ginger. It gives it a fresh, light flavor. The peanut sauce with the addition of cilantro is rich but soft and [...]]]> Ginger Chicken Satay with Peanut Sauce

I love this spin on chicken satay with the ginger. It gives it a fresh, light flavor. The peanut sauce with the addition of cilantro is rich but soft and light enough for those with acid reflux.

This recipe is gluten-free, lactose-free and low in sodium. It is safe for those on Coumadin (warfarin) as well as those with GERD / Acid Reflux.

Beef Tips in Brown Gravy | GERD / Acid Reflux Friendly Version

This is a recipe that I remember from my childhood. I am not sure how my mother made it but I can remember the taste and this is it. A rich umami flavor from the caramelized mushrooms and onions combine with the beef for that great comfort food flavor. Perfect for a cold winter’s night.

This recipe is safe for Coumadin users, low in sodium and lactose-free. Those with gluten allergies should use gluten-free pasta in this dish.

There’s another stuffed pepper recipe on the Dr. Gourmet web site. It’s a vegetarian side dish, and I love it. This one is the traditional ground beef and rice that [...]]]>

Stuffed Peppers | Coumadin Safe Version

There’s another stuffed pepper recipe on the Dr. Gourmet web site. It’s a vegetarian side dish, and I love it. This one is the traditional ground beef and rice that I had when I was growing up. Most recipes call for white rice, but the brown rice is not only healthier but gives the dish a great nutty flavor. As with white rice, the brown rice needs to be slightly undercooked so that it’s not overcooked in the oven.

This recipe is gluten-free, lactose-free and low in sodium. Those with GERD / Acid Reflux should avoid it.

Quick Chicken Noodle Soup | Coumadin Safe Version

(Almost) everybody loves Chicken Noodle Soup. There’s just not a much better meal and if you are getting yours from a can, this is the easy compromise. It does take a little longer than opening a can, but the reward is so great! This recipe is all of about 10 minutes active cooking time and it’s oh, so worth it with true chicken flavor.

Cooking the noodles separately is key. It allows you to keep the soup from becoming cloudy with the starch from the noodles and to precisely cook them ’til they are just done. Add them to the soup with the fresh parsley at the last minute for that fresh, fresh flavor.

This recipe is low in sodium (salt) and lactose-free. It is gluten-free provided you use gluten-free pasta. There is onion in it, but the onion is cooked long enough that those with GERD / Acid Reflux should be able to tolerate it.

Timothy S. Harlan, M.D.
Dr. Gourmet

There are a number of reasons why you should make a healthy breakfast part of your life. When you consider that you had dinner at [...]]]> It looks like your mother was right (she knew it all along). Breakfast may just be the most important meal of the day.

There are a number of reasons why you should make a healthy breakfast part of your life. When you consider that you had dinner at 6:00 or 7:00 the night before and you might get up for breakfast at 6:00 A.M. you have already gone about 12 hours without eating. By not having breakfast and waiting until your “coffee break” or lunch adds even more time. By the time you get around to eating it could be that your body has been starving for as long as 18 hours.

It’s well established that such long periods of starvation will lower your metabolism. The body essentially slows itself to hold onto stored calories and this can have an effect how easy it is for you to lose weight. At the same time, the research shows those who are overweight consume a larger portion of their daily calories before noon instead later in the day have an easier time losing weight.

The type of breakfast makes a difference in how easy it is to lose weight. In one research study participants who ate cereals, quickbreads (like banana bread or zucchini bread) or muffins had a lower Body Mass Index (BMI) when compared to those having meat and eggs. (The meat and egg eaters tended to eat more calories, which makes sense.) Having whole grain and cooked cereals fared better for folks than ready to eat cereals or muffins. (JACN 2003, 22: 296-302)

Studies have also shown that those who skip breakfast have a higher BMI. Likewise, there’s good research showing that breakfast eaters with a lower Body Mass Index are more likely to eat their meals more regularly throughout the day. (AJCN l992;55:645-5l) Similarly those eating early in the day are less likely to snack during the day. When those who do have breakfast have snacks they tend to snack more sensibly.

Eating breakfast regularly even helps with improving cholesterol profiles. In one study women who didn’t eat breakfast have higher total cholesterol and LDL (bad) cholesterol. Those women also had developed problems in how their insulin responds to eating. Such changes in insulin response are now clearly linked to heart disease and diabetes. (AJCN 2005;81:388-96)

Researchers looking at data from the large long-term Physician’s Health Study found that those eating breakfast cereal had lower rates of heart failure. Those who had two servings of high-fiber cereal per week had a reduced risk of heart failure of almost 20%. (Arch Int Med 2007;167:2080-2085)

Studies go on and on to reinforce the importance of breakfast as being the most important meal of the day. Start with a high fiber cereal, whole grain toast, muffins or quickbreads and you’ll be satisfied and less likely to eat more during the day.

So your mom was right (and probably about more than just breakfast). Eat breakfast and get your day started right!

What’s a healthy breakfast? Here are some guidelines.

A: The Dr. Gourmet recipes, books and [...]]]> Q: I am taking Coumadin and also have type 2 diabetes. Is your book, The Quality Calorie Diet for Coumadin Users, compatible with a healthy diabetic diet?

A: The Dr. Gourmet recipes, books and The Real World Diet planner are all based on a Mediterranean style diet. We know now that this is the most effective diet for diabetics, especially Type II diabetics. Here’s the link to information about diabetes on the Dr. Gourmet web site: Diabetes

Dear Dr. Gourmet,

Q: I have “Short-gut syndrome” caused by a blood clot thrown to the mesenteric artery in my large intestine. My cardio doctor has put me on warfarin. I have a list of foods showing the value of vitamin K in those foods.

My question: Is there a daily allowance of vitamin K that I can safely intake without affecting the warfarin?

A: There are a lot of resources on the Dr. Gourmet website for those who are on Coumadin (warfarin). You can get answers to many questions here: Warfarin FAQ

Here’s one example that is the answer to your question: Daily Intake of Vitamin K

Q: Your wonderful site was recommended to me by my doctor. So far, after two weeks of dutifully following your Quality Calorie Diet menus, I have lost 3 kgs [about 6.7 pounds] and my husband has lost 6.5 kgs [about 14 pounds]. I plan on visiting family this summer and will leave my lovely husband to fend for himself for three weeks and he doesn’t cook. I would like to make ahead some recipes that will freeze well, so he can continue on his diet while I am gone. He is on Warfarin, so please keep that in mind.

A: Congratulations on the progress both of you have made! A lot of us work hard here at Dr. Gourmet and having you lose weight means a lot to us.

The challenge of going away and cooking three weeks of meals is not all that difficult. While that is 21 meals, certainly cooking recipes with more servings and eating leftovers is one of the best approaches. For the first week…

Q: In an attempt to control my Parkinsonism my doctor has prescribed Azilect. I have been told to avoid tyramine-rich foods. I have a preliminary list. Where can I get more information? For instance, herring is on the list. Is tyramine a naturally occurring substance in herring or is it in the way herring is generally processed? Also what about andouille sausage?

A: Here’s a link to get you started: http://www.drgourmet.com/askdrgourmet/tyramine.shtml

It is the aging and curing process with meats and the pickling process with fish that leads to the higher tyramine levels. The process of preserving is what leads to the higher tyramine levels.

Unfortunately, there’s no definitive list of foods and their tyramine levels.

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

I [...]]]>

Dear Dr. Gourmet,

Q: I am trying to better my diet and eat healthier. I see that you say we should be eating fish or seafood 3 times a week. I don’t like fish or seafood, I can’t eat it.

I pretty much eat chicken and wheat pasta and vegetables. I eat some red meat on occasion. I do take Omega 3 pills every day, so that should help with the health benefits of eating fish.

How many times a week I should eat chicken?

A: This is a great question. We have folks that are allergic to fish or shellfish and there are those like you who simply don’t like fish. The research does show that using fish oil capsules may be almost as good as having fish 3 days a week, so using these is a good idea. The rule of thumb….

Q: I signed up for The Quality Calorie Diet today and do not seem able to get a menu. I requested “vegetarian” and within the list of foods I do not like I listed goat cheese. The menu I received includes an item requiring chicken stock and another includes goat cheese. How I can get this straightened out?

A: With the Vegetarian option all the recipes that the software chooses will work well using vegetable stock instead of chicken stock. We have modified recipes to reflect this.

The Vegetarian option in the Quality Calorie Diet Plan doesn’t yet offer the ability to eliminate ingredients. A good option….

Q: My mom is on warfarin and I have gone through your listing regarding the vitamin K content in foods but for some reason, orange peppers are not listed. Can you help me out? My mother eats the yellow peppers because their vitamin K level is zero and I would like her to have some variety.

A: Yellow, red and orange peppers have a very low amount of Vitamin K and should be safe for those taking Coumadin (warfarin).

Q: Where can I go to get my percentage of body fat measured and compared to my muscle mass?

A: There are a number of different ways to measure body fat. Most use calipers to look at various areas of the body including the chest, abdomen, thigh, arms, hips and back. Many folks can help you with measuring the percentage of body fat. Measuring Body Fat

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

You can always check to see if your question, [...]]]> We’ve had a lot of new subscribers recently (welcome!), and I thought it might be helpful for us to share a few of our “greatest hits” or most frequently-asked questions on a variety of topics.

You can always check to see if your question, or a similar one, has already been answered by checking our main Ask Dr. Gourmet page.

Coumadin

Q: How much Vitamin K is in…?

A: There’s an easy way to find out about the nutrition content of any food. Just use the USDA National Nutrient Database. By entering an ingredient and following the steps this website will report the complete nutritional values of any ingredient and many prepared foods. The Vitamin K content is the last listing at the bottom of the Vitamins section. If it is not there, the food or ingredient that you searched on doesn’t contain enough Vitamin K to be reported.

Q: Can I use nutritional supplements while on Coumadin? What about acai juice / berries / Mona Vie or Resveratrol?

Q: Should you avoid cranberry juice on Coumadin (warfarin)?

Weight Loss / The Quality Calorie Diet

Q: Is Body Mass Index accurate for everyone?

Q: Is cutting down on carbohydrates a healthy way to lose weight?

Q: Is there any cost involved in The Quality Calorie Diet (formerly My eatTHISdiet) or the Dr. Gourmet website?

Q: How can I lose weight if I can’t exercise?

Miscellanous

Q: Should I be concerned about the level of mercury in the fish I eat?

Q: Does sea salt have less sodium in it than regular salt?

Q: Would adding baking soda to chili to make it GERD-friendly ruin the taste of the chili?

Q: Do you have diet plans for those with Type 2 diabetes?

Q: Are seeds really a problem for those with diverticulitis?

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

A: I often have patients ask me if they can smoke. My [...]]]>

Dear Dr. Gourmet,

Q: Can you still smoke when taking Coumadin? Does smoking hinder Coumadin from working in your body? My husband is on Coumadin, and started smoking again.

A: I often have patients ask me if they can smoke. My reply is usually pretty sarcastic: “You can do anything you want, but smoking is going to kill you.”

OK, sarcasm aside, the answer to your question is that we don’t know for sure. There are conflicting reports in the literature, with some saying that smoking more will decrease the INR. There are isolated case reports as well of this but so far no definitive evidence. Other reports have shown no difference. Coumadin and Smoking

Q: Good fresh tomatoes are not always available. Can I substitute canned tomatoes for fresh on the Coumadin diet?

A: For almost any recipe you’ll find that canned tomatoes work fantastic.

I keep both sizes on hand, including the 15 ounce and 28 ounce cans. A 15 ounce can is about 1 1/2 cups of tomatoes and that’s equivalent to around 3 small tomatoes. There are a lot of great brands on the market, but some do have added salt and often added ingredients like basil, garlic or oregano so check the label.

Q: For the last couple years I have been feeding my family ground turkey in all recipes that call for ground beef. After a friend made a comment that the ground turkey wasn’t always better for you I checked the labels. The 85/15 turkey is not as healthy as the 90/10 ground beef from a calorie and fat comparison. In fact, the ground turkey had a lot more calories and fat.

So now I am wondering if we should be eating the lean ground beef (90/10 or higher) instead of the ground turkey. I have tried the ground turkey that is 90/10 and it does not have much flavor. Is there a benefit to eating ground turkey over ground beef? We only eat ground turkey once or twice a week.

A: I use both ground turkey and ground beef in recipes. Most of the time I do this for flavor and not as much for health reasons. In some dishes I like the more mellow flavor of the turkey vs. beef.

Ground turkey can be leaner but it depends on what you purchase and where it comes from. There’s a wide variety of results when I look at different packages. Ground Turkey vs. Ground Beef: Which is Better?

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

A: There is some [...]]]>

Dear Dr. Gourmet,

Q: Do you have any advice for a supplement for lowering cholesterol without liver damage? I heard that CoQ10 with red yeast rice does damage to the liver. Is there an effective, safer supplement?

A: There is some evidence that red rice yeast does lower cholesterol. It is not clear if this effect helps prevent heart attack as do eating a healthy diet and some pharmaceutical medications on the market. It appears to be fairly safe. Here’s a great review: CoQ10 with Red Yeast Rice

Q: Can you tell me how much Vitamin K is in Spring Mix salad mix? Yes, I am on Coumadin.

A: Since spring mix has no real meaning it would be one to be careful with. There could be any of a number of lettuces or cabbages in it that are very high in Vitamin K.

Q: I have a question about Sai-fun noodles used in Asian cooking. My husband calls them “slimy noodles,” but I think they are also called cellophane noodles. Since they are made of mung beans, do they count as a carb or a vegetable?

A: Saifun noodles are often called cellophane noodles. They are produced from flour made from mung beans. As such they are considered a carbohydrate. According to the USDA database…. Saifun Noodles

Q: Does it make any difference what kind of pot you cook hard boiled eggs in – aluminum, stainless steel, etc.?

A: The type of pot should not make much difference. The main concern would be if you used a heavier pot that might hold heat better. The water would remain at a higher temperature and possibly be a little overcooked. Making Hard Boiled Eggs

Q: How long does it take for the odor of baking soda mixed into chili last? Will it ruin the taste of the chili?

A: I have not tried this technique in chili but will try this soon. The experiment with using baking soda in the tomato sauce took about eleven tries before I felt that it was just right. Using a pH meter and finding the least amount that would make an acid neutral sauce and not ruin the taste took time. Making GERD-Friendly Chili

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

A: There’s no selection for a diabetic diet [...]]]>

Dear Dr. Gourmet,

Q: I want to add diabetic to my The Quality Calorie Diet profile of Coumadin and low sodium. It is not a choice on signin. How can I do that?

A: There’s no selection for a diabetic diet because the foundation of Dr. Gourmet recipes and the Quality Calorie Diet is the Mediterranean style diet. Both the American Diabetic Association diet and the American Heart Association diet are based on this style diet. We work hard to keep recipes high in fiber, low in saturated fat and lower in sodium. Diabetes and The Quality Calorie Diet

Q: I was on your site looking at your GERD book, and I noticed a few of the recipes have lemon juice, onion or garlic. It was my understanding that all of those were really big stomach upsetters, what is the truth? Everything I read says to avoid citric acid, but that is in almost everything – they use it as preservative among many other uses. It’s usually at the end of the list of ingredients, but still there nonetheless. Should that be something to look out for? Any advice on this would help; I’ve gone to the doctors more times than I can count and they really are not knowledgeable in this area.

A: GERD triggers are generally specific to each individual and one person might be able to tolerate chocolate where another can’t. The same holds true for such things as lemon juice, onions and garlic.

Start slow. Use recipes with one ingredient that might bother you at a time to see what triggers your reflux. Sometimes that might even be a recipe with a lot of garlic where only a single clove does not provoke symptoms. GERD Triggers in Cooking

Q: A reader from your website asked about Resveratrol. I purchased Resveratrol plus, but noticed that a lot of the ingredients listed Grape Seed Extract. My question is: Would there be any difference in taking just one supplement of Grape Seed Extract that is much cheaper than Resveratrol? Or is the most effect obtained in the Resveratrol?

A: There’s absolutely no evidence that taking such supplements are helpful in any way. The more concerning issue is that we don’t have any evidence about whether such pills might be harmful. We have only early evidence about this molecule in the lab at this time and there is no practical application yet. Resveratrol

Update:

Here’s another comment from one of our readers, Mr. Spitzer, on flaxseed:

“In your column about flax seed, you said that it must be crushed to be digestible. I buy Hodgson Mill flax that is already crushed or milled. After I open the box I store it in the refrigerator. This is more convenient than grinding the whole seed yourself. But, is it as nutritious? Chia seed does not require refrigeration and I eat some whole or crush in a blender.”

To answer your question, Ron, this is a fantastic idea. Chia seed is a great choice and just as nutritious. Refrigeration for both items is a good idea because it does prolong shelf life.

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A: One of the most common areas where we have folks restrict potassium is when they [...]]]>

Dear Dr. Gourmet,

Q: How many milligrams of potassium would be acceptable in a recipe if you are trying to bring your potassium levels down?

A: One of the most common areas where we have folks restrict potassium is when they have kidney problems. The most common diet that is recommended in such cases is 2 grams of potassium per day (2,000 milligrams). All of the Dr. Gourmet recipes now include potassium levels in the Nutrition Facts section. Daily Potassium Levels

Q: What are the foods to avoid for a person with diverticulitis?

A: A good healthy Mediterranean style diet is all you need. The higher the fiber the better. Here’s a link to a recent answer to this question from our Ask Dr. Gourmet Newsletter: Diverticulitis

Q: Lately I have been hearing a lot about the benefits of pomegranate juice from helping with prostate cancer to weight loss and lowering cholesterol. Is this the new “wonder food?” Also, cinnamon seems to be another fabulous supplement, lowering blood sugar is the main claimed help. I am wondering if any of these claims have any medical proof?

A: There is no “wonder food.” It’s a shame, because it would make our lives a bit easier, but it just isn’t true.

There is some evidence that pomegranate juice contains a lot of antioxidants, and we know that consuming antioxidants can help prevent disease. In most research, however, it’s difficult to make substantial claims without having large controlled trials. Time and again, small trials have shown positive results only to be disproven with large scale studies. While pomegranate juice has some encouraging small studies, it requires much larger research to prove this.

There is better evidence for use of cinnamon in folks with diabetes. These are also smaller trials, and there is actually conflicting research, with other researchers not being able to duplicate the results. Pomegranate Juice and Cinnamon

Q: Couldn’t I just substitute 250 mg Resveratrol capsules for my daily 8 mg dosage of Warfarin? Why should I, age 61, who also take 14 units of Lantus insulin for my diabetes, not benefit from the new findings about resveratrol?

A: Resveratrol is one of the substances that is found in wine and grape juice. There is a feeling that this might be a chemical that contributes to the benefits of drinking these beverages. The molecule has been isolated and is being tested in all kinds of non-human subjects now. While some of that research is encouraging, there is only a single human research study that is even close to positive. That is a small research study but did show some mild lowering of blood sugar. Substituting Resveratrol for Coumadin (warfarin)

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Dear Dr. Gourmet,

Q: When I look at some of your recipes I see some of them are way over 250mg Cholesterol, for instance your Eggs Benedict with 283mg. I understand eggs are considered a high source so that doesn’t surprise me with the figure. But…..

I have a Cholesterol problem and am trying to lower it without medication. I came across your recipes by doing a search. What is considered HIGH Cholesterol content in food when looking at a Nutrition Fact section? Just curious as my Doctor really wants me on medication. But every time I take it I feel like crap AND it is so expensive compared to just looking after your dietary intake.

A: This can be a confusing issue because your cholesterol is high and the first thought is to eat less cholesterol. Researchers used to think that eating about 300 mg of cholesterol per day was the key to lowering cholesterol. While it is important to be careful, we understand a lot more about this now.

Even though you eat things with cholesterol in them, it’s important to know that your body makes its own cholesterol — about 300 mg per day. Some people make more but most folks with cholesterol problems have difficulty with how the cholesterol is handled in the body. Eating for High Cholesterol

Q: My husband may have a kidney infection and I want to give him cranberry juice, but he is on Coumadin. Would this affect his medicine?

A: Interestingly, a cup of cranberry juice cocktail has only 2.5 micrograms (mcg) of Vitamin K. There have been some case reports that cranberry juice can have an effect on INR levels, however. Cranberry Juice and Coumadin (warfarin)

Q: Could you clear up a rumor/urban legend?

The story is that people who take Lipitor must not eat grapefruit. Consequently, most seniors who live in Sun City, AZ do not eat this wonderful fruit that grows in their back yard.

It is my belief that if you eat the grapefruit in the morning, and then take the Lipitor at night, there should be no conflict. What do you think?

A: The interaction between grapefruit and some medications is not an urban myth. It is a fact.

This has been known for some time and it wasn’t until about 2 years ago that scientists identified the exact substance in grapefruit that causes the problem. We knew that furanocoumarins (a naturally-occurring substance found in grapefruit juice) had been found in laboratory tests to enhance the absorption of some medications, but lab tests are not the same as tests in human subjects.

A group of scientists created a furanocoumarin-free grapefruit juice to test against regular grapefruit juice and orange juice. Eighteen healthy subjects were recruited and given a medication that is known to be affected by grapefruit juice, along with a glass of either grapefruit juice, orange juice, or furanocoumarin-free grapefruit juice. Their blood was then drawn and analyzed for appropriate levels of the medication. Grapefruit and Medication Interactions

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A: At this time there [...]]]>

Dear Dr. Gourmet,

Q: For several months I have been looking for low-acid tomato canned products. I read someplace that you can buy these items, but there was no source given. Have you heard of this?

A: At this time there is no low-acid tomato sauce on the market that I am aware of. I do know that some companies have explored this but in my research I have not found any that have put this on the market yet. We have a Low Acid Tomato Sauce recipe on the Dr. Gourmet website to help you.

Q: I’ve signed up for The Quality Calorie Diet. I selected 1800 calories per day (not “Let Dr. Gourmet decide”) and it keeps returning to 2300 calories for me. Is there a problem with the program?

A: If you’re exercising regularly and have listed your exercises in your profile, the system will add the calories you burn while exercising to the level of calories you have chosen. So if you’re averaging burning 500 calories per day exercising, choosing 1800 (base) calories per day will yield a 2300 calorie-per-day diet. To be allotted only 1800 calories per day in your diet, you have two choices….

Q: I take 5mg of Coumadin daily. I have a supplement that contains the acai berry. The ingredients are: psyllium seed, fennel seed, buckthorn bark, goldenseal whole herb, cascara sagrada bark, rhubarb root, licorice root, ginger root and acai fruit. From my understanding goldenseal can decrease the effects of Coumadin and ginger can increase it. I was interested in taking this product but I am worried about the overall effects. Any advice?

A: Acai berry as a supplement is just plain silly, whether you are taking Coumadin (warfarin) or not. Being on warfarin, you should be very concerned about taking any sort of supplement. There’s no telling what might might or might not be in what you are taking and what effect it might have on your INR levels.

Q: I have just seen your website for the first time and I certainly find it interesting. I am sure that I will be trying some of your recipes. I couldn’t help but notice an advertisement for Campbell’s Soups, most of which contain MSG. As a person who is severely allergic to MSG, what is your take on advertising such products?

A: This is always a difficult question. We do fund our web site through advertising and we work hard to monitor what ads are displayed. For example, we do not allow ads for pharmaceutical products, supplements or fast food products, and if they do creep in we remove them as soon as they are identified. Campbell’s does have some soups that are advertised on the site through an advertising network that we use. In one recipe on the web site I even use one of their products in a Tuna Noodle Casserole. This is from their Healthy Requests line and does not contain any MSG by their report.

Some of their soups do contain MSG and this can be a problem – not just from the standpoint of the amount of added sodium, but also because of issues like yours. While I am not allergic, I do have what I feel are some mild reactions to too much MSG (I don’t eat at very many Asian restaurants as a result). Allergies are a serious issue for some, but our allowing Campbell’s to advertise is the same as allowing Planter’s nuts to advertise….

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A: As [...]]]>

Dear Dr. Gourmet,

Q: I was reading your article about BMI and WHR today. I didn’t understand what one had to do with the other. What is a good Waist to Hip Ratio and what is a bad one?

A: As a physician I look to have an idea of how my patient’s health might be overall. I am looking for certain risk factors for disease and the research has come to show that being overweight or obese can be an issue. In looking at my patient’s weight I want to have a guide of what a healthy weight is but we now also know that the distribution of the weight on the body is an important factor.

Body Mass Index (BMI) is an indirect measure of weight as it relates to height. It’s not a perfect measurement but for most folks it can give us an indication of whether they are overweight or obese. Because it is an inexpensive measurement, BMI is widely used in research to substitute for much more sophisticated measures of body composition, including such things as body fat percentage. Because the measures only take into account height and weight, the measure can be inaccurate for those who are very muscular (they may weight a lot, but the weight is in healthy muscle not fat). This is where Waist to Hip Ratio (WHR) comes in.

Q: I am a Coumadin user. Recently one of my physicians suggested that I take a dietary supplement: “Dr. Sears ZONE – Metabolic Digestive Support” on the condition that I could find out if the ingredients in the supplement would interact with Coumadin. Usually, I go to the pharmacist for such information. This time, I was told that the ingredients in the supplement are not in their system and they cannot help me, except to verify that the Green Tea Extract would change my Protime.

I am seeking your help. The following are the active ingredients in the supplement: “Green Tea Extract – 250mg; Bromelain (600 GDU) 600mg; Querceint – 50 mg; M.E. Complex 3000mg. In a proprietary blend of papain, lipase, pancreatin, ajowan extract, fennel extract, lactase, multi enzyme complex. Other ingredients: Gelatin, microcrystalline cellulose, magnesium stearate and silica.”

A: I would be very careful about consuming any product that contains Green Tea Extract. While it appears that green tea itself can be healthy, this may not be the case with the extract.

Q: Is sushi high in cholesterol?

A: Sushi in general should not be high in cholesterol. The fish used does contain cholesterol. For instance, a 1/2 ounce piece of tuna that would be served in a typical nigiri sushi contains about 7 milligrams (mg) of cholesterol. Salmon and other fatty fish served at sushi bars like mackerel, eel and abalone can be higher in cholesterol in the range of 10 – 15 mg per piece.

That said, cholesterol content of foods is important to consider, but a more important factor in eating a healthy diet to lower cholesterol is the amount of fat and types of fats in the foods you choose.

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Could you send me a list of foods for a low fat, low cholesterol diet? My husband just had 3 stents put in. He’s only 45 and [...]]]>

Dear Dr. Gourmet,

Q: What type of foods help to raise HDL (good) cholesterol?

Could you send me a list of foods for a low fat, low cholesterol diet? My husband just had 3 stents put in. He’s only 45 and I need to know what kind of meals to cook him.

A: The main foods that might have a positive effect on HDL (good) cholesterol are those that are high in unsaturated fats, especially monounsaturated fats like Omega 3 fats. You can find these in fatty fish like salmon, tuna, halibut and cod. Many nuts and seeds are also very high in monounsaturated fats.

There is no specific list of foods but there is a style of eating that can help.

Q: As a user of Coumadin blood control drugs and the need to watch the level of daily intake of vitamin K, I read in your pages that Kiwi Fruit contain a reasonable amount of this vitamin. Other sources list kiwi as virtually K free. Can you confirm the level of Vitamin K in this fruit?

A: Kiwi does contain Vitamin K. The USDA database reports a moderate amount. A medium kiwi (about 3 ounces) without the skin contains about 31 micrograms (mcg) of Vitamin K.

Q: I have put on warfarin for 6 months following a DVT in the left leg. I understand that it is safe to take pomegranate juice with warfarin.

There are some products here that are almost 70% pomegranate juice, but there are also some pomegranate juice products in the UK which have in addition a small amount of the juice of the Aronia berry added (eg. 23% pomegranate juice 2% of the Aronia berry and the remainder made up of white grape juice). The Aronia (chokeberry) is noted for its health giving properties throughout Scandinavia and Eastern Europe, but I cannot find if it has any interaction with warfarin. I obviously would like to continue taking the pomegranate juice because of its vascular strengthening properties, but would like to know if I could also take a product (these are quite a bit cheaper!) with the Aronia berry in it.

A: I have done a great deal of research on this in the last few weeks and I am not able to find any issues with the Aronia berry.

That said, the issues that have been reported with those drinking cranberry juice while taking Coumadin are clearly well reported in the literature. The reasons for this are not, however, well defined as to what is causing the interaction.

It is certainly possible that the Aronia berry could be an issue as it is somewhat related to cranberries….

Q: I would like to know what you consider the best meal replacement bar? I don’t have time to make a lunch, some days, and would like to be able to have one on hand for those busy days. Thanks for your help!

A: This is a great question. We’re all really busy today and the idea of being able to get a meal in a bar that you can eat on the run is really appealing.

While the ideal is to take the time to make a nice sandwich or pack some leftovers for lunch, you’re right that it doesn’t always happen. And, while most doctors and dieticians aren’t fans of meal bars, I believe that it’s a lot better choice than hitting up the fast food joint where you could toss back 1,000 calories pretty easily.

Keep in mind that choosing such bars is somewhat subjective….

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Q: I checked out your recommended breakfast bars. The number one bar had 1.5 grams of saturated fat. I didn’t purchase it because I was concerned about the saturated fat and I don’t [...]]]>

Dear Dr. Gourmet,

Q: My question is really how much should I weigh? I’m a girl. Almost 13. I’m 5′3″ – almost 5′4″, and my weight is different every day! It’s from 114-118! It changes so much! Can you tell me why, as well?

A: This is a great question. There’s a lot of ways to look at weight but one of the most reliable guidelines that we use is the Body Mass Index or BMI. While the BMI works pretty well for adults, in children and teenagers it is something we use a bit more cautiously. This is because as you grow so much changes. There’s a difference in the amount of body fat as we grow, and boys and girls don’t grow in quite the same way. So we use a set of tables to tell us whether your weight is in a healthy range.

Q: Could you please tell me if paprika, chili powder, salsa with chilis, cinnamon, and nutmeg have Vitamin K?

A: Paprika, chili powder, cinnamon and nutmeg do not contain significant amounts of Vitamin K. Most chili peppers would not be an issue in the salsa, but sometimes salsa can have other ingredients that might be higher in Vitamin K. Often salsas are made with parsley – which could be an issue. Consider using cilantro to season your chili. Two tablespoons contains only 6 micrograms (mcg) of Vitamin K.

More information is available on our Coumadin® (warfarin) pages and in the eatTHISdiet For Coumadin Users book.

Q: y 15 year old daughter just had surgery for a kidney stone. Her maternal grandfather suffered with these all his life, so we feel it is hereditary. It is unusual for such a young girl to have a kidney stone. She runs cross country and we also feel she has hydrated enough on a daily basis. The doctor told us to reduce her protein intake as her stone was a uric acid stone. What types of things should be cut out of her diet? Do you have recipes that are low protein for a lifestyle change?

A: There are a number of types of kidney stones and it is not unusual for children to have them. They are the most common type of kidney stone in kids. This is one of the better articles on the web that can help you understand how the stones form: http://www.emedicine.com/ped/topic2361.htm

Diet can also play a role and reducing the amount of proteins that are high in purines is key to avoiding more stones. This is the same sort of diet that those with gout will follow (gout is also caused by high levels of uric acid in the blood stream). Here’s a set of dietary guidelines for those with kidney stones.

A: [...]]]>

Dear Dr. Gourmet,

Q: I have a salad dressing recipe that calls for food starch, but I have no idea what that is. I tried making the recipe without it, but it was way too thin.

A: It is unusual that your recipe calls for food starch. This is a term usually used by food manufacturers to indicate a starch added to a food that is generally used as a thickening agent. The starch can be made from wheat, potato, rice, corn or tapioca.

Such starches do require heating to activate their ability to thicken sauces and dressings. A good choice might be….

Q: I love your Vit K list showing low, medium, high levels of Vitamin K. I did not see zucchini listed. I roast it with yellow squash and peppers in a small amount of olive oil and need to know if I should peel it. Thank you for your wonderful website. It is very educational and I am going to share the info with my family physician so he can point other warfarin patients to it.

A: Wow, your recipe of roasting squash, zucchini and peppers together sounds fantastic. Having the zucchini is safe whether you peel it or not. A medium sized raw zucchini….

Q: Has science looked into the Iodoral claims? I take Levothyroxine for a high TSH which has normalized. My doctor advised against taking high dose iodine supplements. If Iodoral like supplements are so effective and life changing, how could an endocrinologist not be aware of that, or is it based on erroneous science?

A: In my opinion this is just plain quackery. There’s just no quality evidence to support use of high dose iodine supplements. As with most such supplements you should be very suspect that someone is trying to make money off of you.

Stick with the recommendation of your endocrinologist.

Q: I love tuna and it’s cheap. I have been eating it most days taking a sandwich to work. Is this a problem?

A: There’s no doubt that tuna contains mercury and you do need to be cautious. When it comes to canned tuna for a long time it is has been felt that eating “light” tuna is safer as reported by the FDA. It has been thought that albacore contains more mercury and that this is the higher risk of canned tuna.

Because of the uncertainty it’s probably best to limit the amount of tuna….

A: It’s difficult to say whether such pre-prepared meals are safe for those who use Coumadin® (warfarin) or not.

Dear Dr. Gourmet,

Q: Is Lean Cuisine Coumadin safe?

A: It’s difficult to say whether such pre-prepared meals are safe for those who use Coumadin® (warfarin) or not.

We have asked companies repeatedly to provide us with the Vitamin K content of their products but to no avail. The only way to even possibly be safe might be to check the ingredient list carefully for those foods that are higher in Vitamin K.

Q: Is there a substitute for red wine? Perhaps grape juice made from grapes rather than concentrate? I do not drink alcohol at all and would not do so even for the benefits of red wine.

A: There is good evidence that drinking grape juice has many of the same benefits as drinking red wine. The antioxidant polyphenols in red grape juice have been shown to have positive effects on cholesterol in the same way as red wine. Much of the research that has been done is in the test tube and there are not large scale trials in humans to support this yet. That said, the action of the red grape juice acts very much like red wine.

Q: Living a few miles outside a town of 700 or so people in the middle of nowhere (Nebraska), I have the choice of one grocery store. They do carry some frozen fish. However, it is generally farm raised fish from China like tilapia and salmon. Is that really a good choice?

A: Frozen fish can be a good choice, especially in a situation where you might be in “the middle of nowhere.”

Many of the big grocery store chains sell much of their fish that’s been shipped to them frozen and then thawed at the fish counter.

Q: How can you say that Body Mass Index is “a good tool” when it doesn’t apply to everyone? Lots of athletes and body builders have a BMI in the overweight range (according to your chart), but they have very low body fat. Are you saying these people are fat?

A: You’re correct that there are those who have a Body Mass Index (BMI) that is in the overweight range (or even obese), but they are actually healthy. This because they are very fit and their weight is more in muscle mass than fat mass. This is, unfortunately, the exception to the rule and most folks who have high BMI are overweight and at risk.

Keep in mind the BMI is a guide that we use on an individual basis. Waist to hip ratio is another good guide….

Dear Dr. Gourmet,

Q: I am writing to inquire about the nutrition information for a meal that I love from Outback Steakhouse and was hoping you would be able to provide me with the nutritional breakdown for the meal.

I usually start with a house salad with croutons but without any cheese and I order of the fat free tangy tomato dressing on the side.

I also love their bread which is a small loaf that I can eat by myself.

For the meal itself, I order the salmon without butter which comes with vegetables (of which I would prefer them with the butter but usually order it without but am curious as to what the nutritional breakdown is for both with and without the butter) as well as a Jacket Baked Potato without butter (they do roll their potatoes in margarine and then with sea salt but I eat the inside of the potato itself without butter and also eat the skin.)

If you would be able to provide me with the nutritional breakdown for this meal, I would be ever so grateful. Unfortunately, Outback does not provide a listing for their foods.

A: This is a major problem with chain restaurants such as Outback. Many did offer nutrition facts at one time, but they have since stopped providing the information. I believe this is because they feel you might be discouraged by how many calories are in their food and not choose their restaurant. Judging from how vigorously they have fought having to provide the information, which is becoming law in some areas, this is probably not too far from the truth.

That said, Outback is one of those who goes halfway….

Q: I regularly access your site and enjoy reading your newsletters. I just wanted to comment on a recent posting in which you stated that the chemicals in grapefruit enhance the absorption of certain medications, such as Lipitor. I found this a bit misleading, as the chemicals in grapefruit actually inhibit the metabolism of Lipitor and many other drugs. The interaction occurs because grapefruit and Lipitor are both metabolized via the CYP3A4 system- the grapefruit inhibits Lipitor from being “processed” by this enzyme system, thereby allowingLipitor levels in the body to increase. While this may be more than the average reader needs (or wants) to know, stating that the absorption of the Lipitor is altered may lead some patients to believe that separating the grapefruit and Lipitor would minimize the interaction.

The question remains as to how clinically significant the interaction is- many professional disagree on the answer to that. The safest bet is to avoid the grapefruit altogether.

Signed,

a Pharmacist and Dr. Gourmet Fan

A: You are certainly correct regarding the CYP3A4 enzyme that is made in the liver and its action on different medications. Strictly speaking this enzyme acts by affecting how different medications are broken down. The ongoing presence of the grapefruit in the body continues to have an effect on the system….

Now, can you do the research necessary to clear up another fact/rumor/urban legend?

The story [...]]]> Dear Dr. Gourmet,

Q: Thanks for the info regarding grapefruit and breast cancer.

Now, can you do the research necessary to clear up another fact/rumor/urban legend?

The story is that people who take Lipitor must not eat grapefruit. Consequently, most seniors who live in Sun City, AZ do not eat this wonderful fruit that grows in their back yard.

It is my belief that if you eat the grapefruit in the morning, and then take the Lipitor at night, there should be no conflict.

What do you think?

A: The interaction between grapefruit and some medications is not an urban myth. It is a fact.

This has been known for some time and it wasn’t until about 2 years ago that scientists identified the exact substance in grapefruit that causes the problem. We knew that furanocoumarins (a naturally-occurring substance found in grapefruit juice) had been found in laboratory tests to enhance the absorption of some medications, but lab tests are not the same as tests in human subjects.

A group of scientists created a furanocoumarin-free grapefruit juice to test against regular grapefruit juice and orange juice. Eighteen healthy subjects were recruited and given a medication that is known to be affected by grapefruit juice, along with a glass of either grapefruit juice, orange juice, or furanocoumarin-free grapefruit juice. Their blood was then drawn and analyzed for appropriate levels of the medication….

Q: What is Swiss Chard? My understanding is that this is similar to spinach. I heard this was good for cholesterol and the heart. Is that true?

A: Swiss chard is a green leafy vegetable in the same family as spinach and beet greens. The leaves are large and slightly curly like some spinach. The stalk is either white, red or a yellowish color. Like spinach it has a slightly bitter flavor. Generally speaking the younger smaller leaves are less bitter and go great in salads….

A: There are a lot of different salt [...]]]> Dear Dr. Gourmet,

Q: I was told to go on a low salt diet. Are the salt substitutes a good alternative, or are they just as bad for you?

A: There are a lot of different salt substitutes on the market, and you can find these in the same aisle as the spices and the salt. Most of them use forms of potassium that do a fair job at mimicking how sodium binds to the salt taste buds. There are also some herb preparations that call themselves salt replacements but they usually rely on lemon, which can help.

I feel that the best way for you to lower your sodium is to learn about the amount of sodium that is in foods that you eat. More importantly, keep in mind that a teaspoon of salt has about 2300 mg of sodium. This is about the amount that you need each day. Remember this and use the salt carefully ….

Q: With regard to Asian recipes, is there a product or spice I can use to obtain the flavoring of sesame or peanut without having to use the fatty oil?

A: There are a number of alternatives. Using a smaller amount of the oil in a given recipe may work. So many Asian dishes have more oil than needed.

If sesame oil is used primarily for flavoring and not essential to the recipe, but you want the flavor, try using sesame seeds themselves. Toasting the seeds will bring out their flavor and you can use less. This works well with peanuts as well….

Q: My husband may have a kidney infection and I wanted to give him cranberry juice, but he is on Coumadin. Would this affect his medicine?

A: Interestingly, a cup of cranberry juice cocktail has only 2.5 micrograms (mcg) of Vitamin K. There have been some case reports that cranberry juice can have an effect on INR levels, however.

One report in the British Medical Journal in 2003 is concerning. The patient in question was drinking a great deal of cranberry juice….