Ask the RD | November

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 any supplements safe and healthy? Are there any that can’t be taken at the same time?

  Refer to the video shared in this blog for more on this topic. Highlights from the answer shared in the video (1:05):

  Supplements are a bit tricky as they are not regulated in the same ways that medications or even foods are regulated. As there is limited FDA oversight, supplements may or may not contain the components they say they do.

  Try to meet vitamin & mineral needs through whole foods and a balanced diet when at all possible as we know our bodies recognize, utilize, and tolerate micronutrients coming from food sources far better than those coming in pill form. Examples might be to:

  • Use more spices in your cooking (think garlic, pepper, turmeric, oregano, cinnamon etc) for anti-inflammatory and antioxidant benefits

  • Incorporate 2 or more servings of cold-water oily fin fish into your eating plan each week for more omega-3's and their anti-inflammatory benefits

  • Consume at least 3-5 servings of colorful fruits and veggies each day to get more potassium, fiber, and other helpful phytonutrients

  • Eat more legumes, nuts, seeds and whole grains to up your magnesium intake

  • Increase your intake of dairy, leafy greens, and tofu to get more calcium in your diet

  • Choose more whole/fresh foods and limit processed foods to help fight inflammation

  Some dietary patterns, medical conditions, and medications can lead to increased needs of certain vitamins and minerals. This is where supplements may come in handy. One example is Vitamin D. Vitamin D is hard to get in adequate amounts from diet alone as it requires sun exposure for body activation. Therefore, those populations living at northern latitudes often need to supplement, and that’s OK.

  Look for brands that have been third party verified to make sure I am getting the product as advertised. USP (United States Pharmacopeia), NFS (National Sanitation Foundation), and NPA (Natural Products Association) are all good examples of quality control markers.

  If you suspect dietary supplements are needed, I recommend that you get informed, ask your primary care doctor if certain supplements might be right for you, and check with your pharmacist to ensure proper dose, timing, and safety of all supplements.

• Are there any nuts I should avoid if I have high cholesterol?

  Refer to the video shared in this blog for more on this topic. Highlights from the answer shared in the video (5:04):

  All nuts and seeds are high in fat, though most of the fats they contain are heart healthy monounsaturated and polyunsaturated fats: these fats are good for cholesterol control by decreasing LDL levels and increasing HDL levels.

  Some nuts offer additional health benefits as well:

  • Walnuts high in ALA omega-3's

  • Almonds rich in vitamin E and calcium

  • Brazil nuts high in selenium

  Make nuts and seeds part of your heart healthy eating plan, just be thoughtful of portion control to avoid overconsumption of fat and calories. Stick to 1-2 servings per day: a serving size being 1 oz. of nuts/seeds or 2 Tbs nut/seed butter.

• My palate has expanded greatly from being a picky eater as a child, but unfortunately, I still dislike the taste of green vegetables. Everything I read says leafy greens are an important part of a healthy diet. Are there creative ways to help incorporate these into my diet without tasting them?

  Refer to the video shared in this blog for more on this topic. Highlights from the answer shared in the video (7:20):

  We always want to include a variety of colorful fruits and veggies in the diet, but that doesn’t mean you have to force yourself to eat those that you simply don’t care for! I’d advise you to focus on the veggies that you do like and try to eat at least 2-3 servings of those each day.

  Still want to incorporate some of your less than favorite veggies? Sneak them into dishes.

  • Add spinach to a morning berry smoothie. Yes, it makes it an ugly greenish brown color, but it really doesn’t change the taste at all.

  • Try kale in a soup! This leafy green is very fibrous, so a bit tough to eat raw, but works great when added to a soup towards the end of cooking.

  • Add pureed veggies to soups and sauces.

  • Add zucchini or mushrooms to ground taco meat or pasta sauce.

  • If you dislike broccoli, try something else in the cruciferous veggie family such as cabbage or cauliflower. Try either of these grilled or roasted for some delicious flavor and texture.

  Of course, continue to experiment with different cooking methods and flavor combinations. And who knows, maybe you’ll find that you like some green veggies after all!

• What are healthier cheese options for someone who is lactose intolerant? Are lactase pills a safe and effective option?

  Lactose intolerance is fairly common and occurs when your body doesn’t produce enough lactase enzyme to properly digest lactose (a naturally occurring milk sugar). Most people that have lactose intolerance can tolerate varying types and amounts of lactose-containing products, such as milk, cheese, yogurt, and ice cream, before experiencing digestive symptoms such as GI upset, bloating, gas or diarrhea.

  Generally, naturally aged hard cheeses (such as cheddar, parmesan, Havarti, Swiss and gouda) have a lower lactose content than fresh, soft cheeses (cream cheese, cottage cheese, feta, or ricotta).

  As lactose is a naturally occurring milk sugar, you can also check the nutrition facts panel and try to choose cheeses with less than 1 gram of Total Sugar per serving. Other low to no dairy options could include Fairlife milk (ultra-filtered and lactose free dairy milk), soy milk or soy yogurt, or even coconut milk-based ice creams.

  You could also consider trying lactase enzyme supplements such as Lactaid whenever you eat lactose-containing foods. These may lessen lactose-associated GI issues and are generally considered safe.

• Are eating tomatoes bad for arthritis?

  Nope. Thankfully there is no research supporting the myth that tomatoes are bad for arthritis. Same goes for other “nightshade” vegetables such as eggplant, bell peppers, and potatoes. Keep enjoying these colorful veggies as much as you like!

• Can you please give a list of starchy vs. non-starchy vegetables? why is non-starchy so often recommended?

  Starchy vegetables have higher amounts of carbohydrates compared to non-starchy vegetables. Often, the goal is to increase intake of non-starchy veggie as they are lower in carbs and calories, therefore, quite helpful when it comes to managing blood sugar and weight.

  Common examples of starchy vegetables include potatoes, corn, peas, beans, and lentils. Non-starchy vegetables include leafy greens, asparagus, green beans, zucchini, broccoli, and bell peppers.

  Keep in mind that starchy veggies can still be included as part of healthy eating plan as they offer fiber and other nutrients, we just need to remember that they act more like a carb food (similar to pasta, rice, bread) as compared to a vegetable.

• Is pasture-raised, whole milk yogurt nutritionally better for you than low or non-fat products, if eaten in smaller quantities?

  Full fat dairy products can certainly be a part of a healthy eating plan. Remember that they do contain more saturated fat as compared to their reduced fat or non-fat alternatives. Saturated fat (sat fat) should be kept to less than 10% of your total calories per day; staying within this range, full-fat dairy products can be okay. For reference, 10% of a 2,000 calorie diet = 22 grams sat fat, 10% of 1,600 calorie diet = 18 grams sat fat.

  The higher fat content can also lead to better flavor, mouth feel, satiety, and blood sugar management, so they do offer some benefits. Additionally, dairy products made from pasture-raised or grass-fed animals typically offer a better nutritional profile with lower saturated fat counts and higher nutrient values as compared to conventional (more omega-3's, fewer omega-6's, more B vitamins).

  Something else to consider, low-fat and non-fat dairy products often contain higher amounts of food additives such as sugar, sodium, and emulsifiers.

  Weigh your options based on what is most important to you: your health, your dietary goals, and your food preferences.

• Do you have any recommendations for a healthy and nutritious diet that is low in fiber and does not include nuts? (Limitations due to a medically restricted diet.)

  This is quite a challenge, but you can definitely make the best of it with your food choices. I would still strive to include as many fiber-rich foods as possible, they may just have to be modified a bit to avoid aggravating your GI issues.

  I would suggest cooked, peeled, pureed, or even canned veggies and fruits.

  For grains, choose those that have been semi-processed such a white jasmine or basmati rice instead of brown rice, cream of wheat instead of oatmeal, multigrain or sourdough bread instead of whole wheat bread with seeds.

  Try smashed, pureed, or blended beans and lentils (think refried beans or hummus) if you can tolerate them.

  You could also incorporate some seed butters such as sunflower seed butter or tahini as these are significantly easier on the gut while still offering heart healthy fats.

  Prioritize color and variety when choosing your produce, and eat “in season” when possible, to get the most nutrient benefit.

  Opt for scratch-prepared meals and as always, minimize highly processed foods as these tend to come with less than desirable amounts of added fats, sugars, sodium, and food additives.

  Lastly, lessen the work on your gut by chewing thoroughly and eating slowly.

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.