Ask the RD | March

Our registered dietitian, Jamie, offers answers to nutrition-related questions you - our community - has submitted over the past month.

The information shared within this blog is meant for informational purposes only and should not be received as medical advice.

Each month, Jamie selects a few questions to highlight in our video blog for Ask the RD with host Dr. James Beckerman, cardiologist, Providence Heart Institute.

If you have a question to submit, please click here and check our next newsletter for your answer.

• Are the prepared and bagged salad kits at the grocery store healthy or should we make them from scratch?

  Refer to the video above for more on this topic (1:03).

  Highlights from the answer shared in the video:

  These pre-made salad kits can be a great way to easily increase your veggie intake. However, it is good to consider a few things when selecting these grab-and-go options. Here are a few tips to keep you on the right track:

  • Use caution when it comes to the crunchy, crispy add-ons. Items like croutons, tortilla chip/wonton strips are often high fat, low fiber options that can add up quickly. I suggest you use these sparingly or opt for healthier crunchy options such as nuts or seeds.

  • Include a bit of heart healthy fat with your salad. Keep in mind we want to limit saturated fat sources (often coming from cheese and creamy dressings) and instead opt for unsaturated fat additions (nuts, seeds, or avocado and vinaigrette-style dressings). Try using half the dressing pouch to keep the fat and calorie count in check.

  • Make it a balanced meal by upping the protein content. Tuna pouches, leftover chicken, a couple hard boiled eggs, cottage cheese, cubed tofu, precooked edamame, lentils, or a scoop of garbanzo beans are all great options.

  • Bulk up the veggies! Don’t stop at the provided salad base. Feel free to add some more greens (arugula, spinach, kale, cabbage), extra crunchy veggies (carrots, cucumbers, bell peppers, jicama) or other yummy flavor pops such as tomatoes, fresh herbs, olives, or leftover roasted veggies.

  Also worth mentioning that you can certainly DIY your own salad kits! I recommend you wash, dry, and chop your produce at the beginning of each week. Portion the greens into single serving containers and top with cold toppings. Keep any dry crunchy toppings separate as well as any additions you may want to heat up before eating. Make a quick homemade salad dressing and portion for to-go servings. This can be a good cost saving option, a fantastic way to repurpose leftovers and increase flavor variety, but it’s also a great way to build-in quick and convenient veggie options throughout your week.

• What are the heart-healthy guidelines for coconut milk and coconut oil?

  Refer to the video above for more on this topic (3:40).

  Highlights from the answer shared in the video:

  I recommend using coconut products such as coconut oil and coconut milk sparingly due to their high saturated fat content. Any product that contains some or all of the coconut meat will come with a high amount of saturated fat. This includes coconut oil, canned coconut milk, and coconut flakes. Products such as coconut water and coconut milk to drink as a dairy milk alternative are typically low in saturated fat as they do not contain a significant amount of the coconut solids.

  We know we want to limit our saturated fat intake as part of a heart healthy diet as they are linked to increased levels of LDL cholesterol (bad cholesterol). The recommendation is to keep saturated fats as less than 10% of our daily calories, or about 15-20 grams per day for most folks.

  Though all fats and oils contain the same number of calories (120 calories per tablespoon, or 9 kcal/gram) they do vary in their ratios of saturated fats to unsaturated fats. For reference, good ol’ fashioned butter is comprised of ~65% saturated fat while coconut oil is over 90% saturated fat. Per teaspoon breakdown as follows:

  • 1 tsp coconut oil= 3.9 g saturated fat

  • 1 tsp butter= 2 g saturated fat

  • 1 tsp olive oil= 0.6 g saturated fat

  With this, it's easy to see why we need to limit coconut oil and coconut milk in our diets. That does not mean you can never consume these products, we just need to do so sparingly and in moderation, choosing more heart-friendly fats most often.

• What does it mean when vitamins and minerals are added to juices? (i.e., calcium in orange juice.)

  Refer to the video above for more on this topic (6:01).

  Highlights from the answer shared in the video:

  I am no expert on the “how to” of food fortification and enrichment but can speak to the differences as well as the benefits of such processes. Enriched means adding back nutrients that were lost during the processing of the food. Examples of this include enriched wheat flour. Fortified (fortification) means adding nutrients that were not originally present in the food. Common examples include milk fortified with vitamin D or orange juice fortified with calcium.

  Both these methods aim to increase the vitamin or mineral content of certain foods in efforts to reduce micronutrient deficiencies and maintain/improve public health. Over the years, enrichment and fortification have drastically reduced once common health problems and diseases such as:

  • Goiter: improved with iodized salt (1920’s)

  • Rickets: improved with vitamin D fortified milk (1930’s)

  • Pellagra & beriberi (niacin, thiamine and riboflavin deficiencies): improved with vitamin B-fortified grains (1940’S)

  • Neural tube defects: improved with folic acid fortification (1990’s)

  The process of food enrichment and fortification can be achieved using a variety of methods including selective breeding, biologic modification, and of course commercial or industrial fortification. For more information on food fortification, check out the resources below:

  • World Health Organization: Food Fortification Questions and Answers

  • Dietary Reference Intakes: Guiding Principles for Nutrition Labeling and Fortification: Overview of Food Fortification in the United States and Canada

  • CDC: Folic Acid Fortification and Supplementation

• What foods are best for high-performance youth athletes? (i.e., meals and snacks)

  In our December 2023 post, we answered the question, “What are the best foods pre- and post-exercise to fuel my body?” You may find the information helpful in guiding your son to eat to reach his performance goals.

• What is your best nutritional advice for lowering your A1C levels and combatting diabetes? Are there food swaps or tips you recommend?

  Additional information on this topic can be found in our January 2024 post – the video that month includes a more detailed discussion plus more tips within the written answer.

  The best ways to improve your A1C levels and combat diabetes or even prediabetes with your diet come down to timing of carbohydrate intake, type of carbohydrate, amount of carbohydrate, and finding the right balance of carbohydrates with proteins and fats.

  • Timing: Eat regularly timed meals and snacks. This includes a balanced breakfast within an hour of waking up, portion-controlled meals every 4-5 hours thereafter, and small healthy snacks as needed between meals.

  • Type: Choose quality “complex carbohydrates.” Think fiber-rich options such as whole grains, beans, lentils, starchy veggies, and whole fruits. Reduce your intake of “simple carbs” (those that are more refined or processed), concentrated sweets, and foods/beverages with added sugars. Easy swaps could include choosing oatmeal instead of sugared breakfast cereal, brown rice instead of white rice, whole wheat bread instead of white bread, or a piece of fresh fruit instead of fruit juice.

  • Amount: Practice proper portion control using one of these simple methods:

    • Carb counting: Most women need 45-60 grams of carbs per meal, while most men need 60-75 grams. Keeping snacks to 15-30 grams.

    • Portion estimation with your hands: A fist-size portion of carb food equals about a cup.

    • Plate method: Limit carb foods to approx. ¼ of your meal plate.

  • Balance: Avoid eating carb foods alone, this includes grains, starches, fruits, dairy foods and sweets. Instead practice pairing any of your carb foods with some protein and/or healthy fat. Think toast with avocado and an egg, a banana with scoop of peanut butter, whole grain crackers with veggie sticks and hummus, or even a serving of pasta with turkey meat balls and a green salad. Not only will this help you stay fuller longer, but also supports a slower, more sustained release of sugar into your blood steam, therefore avoiding quick blood sugar spikes and subsequent drops.

  In addition to dietary changes, other lifestyle improvements can be of benefit as well.

  • Movement: Regular movement helps your body use the sugar (or glucose) that comes from the foods we eat. Remember, glucose is the preferred fuel source for our brains and our muscles, however, this glucose isn’t utilized efficiently when our insulin isn’t working properly, which occurs with diabetes. Activating your muscles with regular movement and consistent exercise can help our bodies become more responsive to glucose and improve its uptake into the cells where it can be used for energy. Regular physical activity can also help to manage our body weight and reduce stress levels. Two more great ways to combat diabetes.

  • Stress Management: Chronic stress (both physical and emotional stress) can do a number on glycemic control. As stress triggers our “fight or flight” response, we see an increase in the release of stress hormones such as cortisol. These stress hormones cause our bodies to release sugar from our body’s liver stores, which can of course cause elevate blood sugars but are also linked to weight gain (especially around the midsection), and higher levels of inflammation throughout the body. This is why it is so important to manage your stressors and take good care of both your mental and physical health!

Jamie Libera, RD, LD, CCTD, is a clinical dietitian within the Providence health system. She works closely with the heart programs in offering consultations for heart failure patients, cardiac rehab patients, and serves as the nutrition consultant for Basecamp Prevention + Wellness. Jamie offers monthly nutrition-based classes and a monthly heart-healthy recipe as part of Basecamp’s free community programming.