May Nutrition Q&A

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.

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

  • We could all benefit from eating more “anti-inflammatory foods,” while lessening our reliance on “pro-inflammatory” foods to help our bodies feel better and to reduce our risk for many chronic diseases such as cancer, heart disease, diabetes, arthritis, depression, and Alzheimer’s disease.

    In general, whole/fresh foods tend to be the best for fighting inflammation while highly processed foods tend to promote inflammation.

    Recommended food choices:

    • Colorful fruits and vegetables: berries, tomatoes, leafy greens

    • Herbs and spices: ginger, turmeric

    • Healthy fats: nuts, seeds, extra virgin olive oil, fatty fish

    • Whole grains

    • Green tea and coffee

    Recommended foods to limit:

    • Processed meats: cold cuts & hot dogs

    • Red meats: beef

    • Refined grain products: white bread, pastries

    • Added sugars: soda, sugar-sweetened beverages, candy

    • Deep fat fried foods

    • High sodium foods

    • Excess alcohol

  • Dietary modifications for GERD can vary from person to person depending on your tolerance.

    In general, it is recommended to limit or avoid:

    • Fried and fatty foods, such as deep-fried foods, pastries, fatty meats, nuts, nut butters, full-fat dairy products.

    • Caffeinated beverages, such as tea, coffee, colas, energy drinks.

    • Carbonated beverages

    • Mint

    • Chocolate

    • Pepper

    • Onions

    Limit any acidic foods that cause you symptoms as well. This may be some of the more acidic fruits and veggies, such as citrus fruits/juices and tomato products.

    Other tips include:

    • Eat small but more frequent meals throughout your day.

    • Avoid lying down right after eating. Give yourself a few hours between dinner and bedtime.

    • Avoid vigorous exercise just after eating.

  • I’m not sure I’m the expert here, but fresh fruits, as well as yogurt and green tea may help to promote more neutral sweat odors.

    A few foods that can negatively impact your body odor include sulfuric vegetables (onions, garlic, cabbage, broccoli, cauliflower) and red meats. Some spices, MSG, caffeine, and alcohol may also affect how much you sweat and the odors that come with it.

    Other lifestyle tips to try:

    • Stay adequately hydrated.

    • Use antibacterial soap when bathing.

    • Wear loose-fitting clothing made of cotton or moisture-wicking materials when exercising.

    If you’ve already tried these suggestions, I recommend discussing with your primary care provider or dermatologist.

  • Menopause can cause a number of hormone-related bodily changes. Some of these common, but less than desirable changes, include weight gain and increased abdominal adiposity, aka “belly fat.”

    To combat this weight gain, I recommend sticking to a healthy eating plan and staying physically active. Our bodies need fewer calories as we age, so we may need to cut back on how much we are eating. When trying to reduce your caloric intake, focus on nutrient-rich foods such as fruits, veggies, whole grains, lean proteins, and healthy fats while limiting low nutritional foods such as sweets, refined grains, and alcohol. If you’re already following a healthy diet, it may simply mean eating smaller portions.

    Our bodies also lose lean body mass (i.e., muscle and bone mass) as we get older. Focus on maintaining a healthy metabolism by increasing your daily activity and building your muscle mass. This means incorporating enough protein in your diet (20-30 grams of protein PER MEAL for most women) and participating in regular exercise to include aerobic activity and resistance/strength training.

    Other tips for managing abdominal weight gain include getting enough sleep and managing your stress appropriately.

    Lastly, I often feel the need to remind many of my post-menopausal clients that the goal is to maintain health and functional ability as we age. It is not realistic to think our bodies will weigh the same, or look the same, as they did in our 20’s, 30’s, or 40’s. As long as we’re living our healthiest lives, we may just need to learn to get comfortable in our ever-changing aging bodies.

  • After chatting with Chef Tim and dietitian Kayla, I think TVP (textured vegetable protein) can be swapped for frozen and then crumbled tofu if you’re aiming to keep it plant based. You could certainly try smashed garbanzo beans or even lentils, though these may add a bit more flavor than desired. If you have no need to keep it 100% plant-based, go ahead and use the more traditional ground chicken or pork in place of the TVP.

    The added sugar is an important ingredient to balance out the acid and the salt in this dish, but you could certainly try coconut sugar, agave, or any of the more neutrally flavored sugars substitutes (in the appropriate ratios of course).

    The Larb Salad recipe can be found here!

  • Great question. Though fruits and veggies are great foods to regularly include in your diet, we need to be thoughtful of pairing them with a little something to promote better sticking power.

    This is where a healthy fat and/or protein will come in handy as these foods digest more slowly from the GI tract: helping your meal or snack be more satisfying and keeping blood sugar levels steady.

    Protein options could include:

    • Lean meats, poultry, fish

    • Eggs

    • Dairy, such as Greek yogurt, cottage cheese, cheese

    • Beans, lentils, including tofu, hummus

    • Nuts, seeds, nut butters

    Fat options could include:

    • Nuts, seeds, nut butters

    • Avocado

    • Cheese

    • Olive oil

    And lastly, avoid going too long between feedings. Follow your hunger cues and try to eat a meal every 4-5 hours, adding healthy snacks between as needed.

  • Yes, you can still consume modest amounts of alcohol if you have high cholesterol, high triglycerides, and/or high blood pressure. The recommendation is to limit alcoholic beverages to 1-2 servings per day for men or 0-1 servings per day for women. In this case, one serving equals 12 oz of beer, 5 oz of wine, or 1.5 oz spirits. Drinking above these amounts contributes to elevated triglycerides, higher blood pressure, increased inflammation, and more.

    Excessive alcohol intake can also contribute to overconsumption of calories, which can lead to weight gain, especially around the midsection. When choosing what to drink, I recommend avoiding high calorie add-ins such as colas, sugary juices, and creamy/fatty mixers to keep the caloric impact of your alcoholic beverages more reasonable.

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.

April Nutrition Q&A

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.

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

  • The amount and quality of the sleep we get certainly plays a strong role in our body weight and overall health. Both too little sleep and poor-quality sleep are associated with weight gain, obesity, metabolic disorders such as type 2 diabetes, depression, and other chronic health conditions.

    Impaired sleep habits cause our bodies to experience hormonal and metabolic dysregulation. We see higher levels of the appetite stimulating hormone ghrelin and lower levels of the satiety promoting hormone leptin. This means that we not only feel hungrier but also have a harder time experiencing fullness and satisfaction when we do eat. These hormonal alterations lead to less than optimal food choices; often causing us to choose more calorie dense, carb- and fat-rich foods. Such altered hormonal regulation is associated with glucose intolerance, insulin resistance, and increased abdominal fat stores (aka visceral fat).

    The fewer hours spent sleeping also means more waking hours. This can cause increased caloric intake throughout the day, often in the form of snacking.

    Poor sleep has also been shown to lead to lower energy levels. As a result, we often see a decrease in physical activities, such as exercise, and an increase in sedentary activities, like watching TV.

    With sleep being so important to managing our weight and overall health, here are a few recommendations to optimizing sleep hygiene:

    • Follow a consistent bedtime routine with stable sleep and wake hours.

    • Go outside during waking hours to exposure yourself to natural light.

    • Get regular physical activity. Ensure exercise is completed at least 1 hour before bedtime.

    • Limit or avoid caffeine intake in the afternoon and evening hours.

    • Avoid alcohol intake after dinner.

    • Avoid eating right before bed.

    • Limit screen time for at least the hour leading up to bedtime.

    • Reduce stress and calm your thoughts as able.

    • Sleep in a cool, dark cool room.

    • Aim for a minimum of 7 hours of quality sleep each night.

    • Talk to your primary care physician about sleep aids and/or obtain a sleep study as needed.

  • There are so many good milk alternative options available these days. However, it is important to note that they can vary quite a bit in their nutritional content (see below for more details). Generally, dairy milk and soy milk are superior in their protein content while carb and fat contents vary between dairy milk and milk alternatives.

    Dairy milk is also known to be a good source of calcium, which many of us lack in our diets. The goal is to consume 1000-1200 mg per day, depending on your age. For that reason, this may be an area to focus on when deciding which milk is best for you. Dairy milk and many milk alternatives are comparable in their calcium content, containing ~300 mg per cup, but note that some may require fortification depending on the product.

    Beyond their nutritional content, it is important to pay attention to the ingredient list of milk substitutes as these products often contain emulsifiers and added sweeteners.

    All things considered, I urge you to pick the milk or milk alternative that best suits your nutritional needs, tolerance abilities, and texture/flavor preferences.

    Here is a list of the nutritional comparisons for types of common milk options and alternatives. Amounts are listed per 1 cup.

    • Cow Milk (Skim): 90 Calories, 0g Total Fat (0g Sat. Fat), 13g Carbohydrate, 8g Protein

    • Cow Milk (2%): 120 Calories, 5g Total Fat (3g Sat. Fat), 12g Carbohydrate, 8g Protein

    • Cow Milk (Whole): 145 Calories, 8g Total Fat (4.5g Sat. Fat), 13g Carbohydrate, 8g Protein

    • Ultra Filtered Cow Milk (Skim): 80 Calories, 0g Total Fat (0g Sat. Fat), 6g Carbohydrate, 13g Protein

    • Soy Milk (Unflavored): 110 Calories per 1 cup, 4g Total Fat (0.5g Sat. Fat), 11g Carbohydrate, 7g Protein

    • Almond Milk (Unflavored): 60 Calories, 2.5g Total Fat (0g Sat. Fat), 8g Carbohydrate, 1g Protein

    • Hemp Milk (Unflavored): 130 Calories, 6g Total Fat (1g Sat. Fat), 14g Carbohydrate, 3g Protein

    • Oat Milk (Unflavored): 100 Calories, 1.5g Total Fat (0g Sat. Fat), 18g Carbohydrate, 4g Protein

    • Rice Milk (Unflavored): 100 Calories, 2g Total Fat (0g Sat. Fat), 23g Carbohydrate, 0g Protein

    • Coconut Milk (Unflavored): 50 Calories, 5g Total Fat (5g Sat. Fat), 1g Carbohydrate, 1g Protein

  • Great question! It is always good to consider healthier ingredient swaps and recipe adjustments when cooking. Below are a few easy alternatives to consider:

    • Use half-and-half or even whole milk in the place of heavy cream.

    • Reduce the amount of heavy cream by half and substitute the rest with chicken or veggie broth.

    • Play around with unflavored regular or Greek yogurt for a creamier milk alternative such as soy or oat milk; adding a bit of olive oil as needed.

    • I have found that blended cashews work amazingly well in some recipes to add creaminess without as much saturated fat. These are best if soaked overnight, with water discarded before blending into a soup or sauce. Check out our Basecamp recipe, Cashew Cream Tomato Sauce and Cauliflower Soup which uses this method.

    • Nutritional yeast can also offer a rich, cheesy flavor to dishes without using any actual cheese.

    • Coconut cream is a plant-based option but comes with a lot of saturated fat, so is likely not a healthier swap.

  • There are so many flour options these days, it becomes a little overwhelming to know which one is best. Flours can vary not only in their nutritional qualities but also in flavor, texture, and culinary functionality. Calorically, most flours are quite similar at ~100 kcals per ¼ cup. See below for a quick comparison between some of the more commonly used flours available.

    • White (All-Purpose) Flour: A mix of soft and hard wheat varieties. It has a moderate protein content, making it quite versatile for baking and cooking. It is low in fiber as it is more refined (the outer bran and germ are removed during processing, and only the carbohydrate heavy endosperm of the grain is used). Enriched flour simply means that vitamins and minerals that were lost during processing have been added back to the end product.

    • Whole Wheat Flour: Also made from wheat, though has higher fiber and nutrient contents (ie: iron, magnesium, and vitamin B6) as it utilizes the entirety of the whole grain (bran, germ, and endosperm). Whole wheat flour offers a more robust flavor but produces a denser end-product.

    • Almond Flour: Significantly higher in fat as compared to all-purpose flour but has almost double the protein, triple the fiber, and a quarter of the carbohydrates. It offers a slightly nutty flavor and works well for moist, tender baked goods.

    • Coconut Flour: Also significantly higher in fat, though higher in fiber (10x that of all-purpose flour) and almost twice the protein. It has a rich, tropical, nutty flavor.

    • Oat Flour: Has three times the fiber compared to all-purpose flour. Offers a mild earthy flavor and chewy texture to baked goods.

    • Chickpea Flour: Nearly double in its’ protein and fiber contents as compared to all-purpose flour. May not lend itself well to some baked goods as it does have a mild bean flavor.

    Consider your health goals, dietary needs, flavor and texture preferences when selecting a flour. And remember that ratios may vary from flour to flour so modify your recipes appropriately.

  • Dark chocolate can certainly be a yummy, and healthy, sweet indulgence. Research shows dark chocolate can have cardiovascular benefits (reduces blood pressure and cholesterol) and anti-cancer benefits due to its high antioxidant content derived from the flavanols of the cocoa. Because dark chocolate uses more cocoa and is less processed as compared to milk chocolate, it tends to offer higher amounts of these healthy compounds.

    But how much is too much? Though the research varies, it is thought that a little dark chocolate (about one ounce per day) can offer a variety of health benefits while still fitting into your overall dietary plan. I would recommend enjoying dark chocolate in moderation and eat only enough to fulfill your need for something sweet and delicious. Be mindful of your overall fat and calorie intake from day to day and make sure your dark chocolate intake is not resulting in excess. I recommend you aim for at least 70% cocoa content and choose those options that are lower in added sugars and unhealthy fats.

  • Absolutely! If you’re not a fan of cottage cheese, Greek yogurt (unflavored), ricotta cheese, hummus, or even avocado would work as great substitutions in this recipe.

    The recipe referenced in this question can be found here!

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.

March Nutrition Q&A

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.

  • 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.

  • 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.

  • 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:

  • 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.

  • 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.

February Nutrition Q&A

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.

  • Refer to the video shared in this blog for more on this topic (:49). Highlights from the answer shared in the video:

    For those folks that haven’t yet heard of the Carnivore diet, it is a diet plan based solely on consuming animal products (namely animal proteins). This diet focuses on meats, poultry, fish, and eggs while eliminating all plant-based foods including fruits, veggies, grains, legumes, nuts and seeds.

    While it claims to support weight loss, improve mood, and regulate blood sugars, this is NOT a clinically proven diet that I would recommend.

    I share many concerns with this diet - similarly to other restrictive fad diet that eliminates entire foods groups - as it certainly lacks vitamins, minerals, and fiber while overdoing protein and likely saturated fat intakes. A meat-only diet is hard on the GI tract as meats are generally harder to digest and are lacking in fiber causing constipation while also negatively impacting the gut microbiome. Excessive protein intake can also put excess strain on the kidneys. As this diet consists solely of animal products it is likely higher saturated fat and cholesterol, so may negatively impact your cholesterol levels and compromise your heart health. While it may result in modest weight loss, it is likely to be short lived as this is also not a sustainable style of eating for most people.

    As always, I recommend a well-balanced diet that is enjoyable and maintainable for you. With hopes that whatever life-long healthy eating plan you choose, it consists of colorful fruits and vegetables, whole grains, legumes, nuts, seeds, fish, and lean unprocessed protein foods.

  • Refer to the video shared in this blog for more on this topic (4:00). Highlights from the answer shared in the video:

    Nutritional recommendations for people with osteoporosis, or those trying to prevent it include:

    • Eat a diet rich in calcium and Vitamin D.

    • Consume adequate amounts of protein and calories to maintain an appropriate body weight.

    • Aim for 5 or more servings of fruits and vegetables each day.

    • Limit sodium intake.

    • Participate in targeted physical activity including strength, flexibility, and balance exercises.

    The goal: eat a diet rich in calcium and Vitamin D foods, though keep in mind that supplemental calcium and Vitamin D may be needed if you are unable to meet your needs through diet alone. Ask your primary care physician for recommended doses and formulations of supplemental calcium and Vitamin D depending on your lab values.

    A general recommendation aims for at least 1,000 mg of calcium each day from dietary sources, while not exceeding 2,500 mg per day from combined dietary and supplemental forms. Shoot for at least 1,000 IU (25 mcg) Vitamin D per day, while not exceeding 2,000-4,000 IU (50-100 mcg) per day, coming from both food and supplemental sources. Keep in mind that living in the gray and cloudy Pacific Northwest puts you at higher risk for Vitamin D deficiency as we lack regular sun exposure which helps our bodies to activate Vitamin D, so it is quite common that Vitamin D supplements are needed even when a balanced diet is achieved.

    High calcium foods include:

    • Dairy foods including milk/milk alternatives, yogurt, cheese, pudding, custard.

    • Fortified products such as calcium fortified juices, cereals, or breads.

    • Tofu, white beans, almonds.

    • Boney fish such as sardines or canned salmon.

    • Green veggies like collard greens, turnip greens, Bok choy, and broccoli.

    High Vitamin D foods include:

    • Dairy milk, soy milk, yogurt,

    • Fortified juices,

    • Egg yolks,

    • Fatty fish such as tuna, mackerel, and salmon or cod liver oil.

    Also ensure you are eating adequate calories and protein foods including lean unprocessed meats, eggs, dairy, and/or beans/lentils each day to support strong bones. Aim to include a variety of colorful produce as these foods are rich in Vitamin C, Vitamin K, and potassium which help to strengthen your bones. Limit sodium intake to ~2300 mg per day to help your body hold onto the calcium it needs instead of excreting it in the urine. A reduced sodium diet typically involves limiting processed foods, restaurant meals, and salty condiments. Plus, paying attention to food labels.

    Though osteoporosis is not reversible, hopefully we can prevent further bone weakening and minimize complications such as falls and fractures by sticking to a healthy eating and exercise routine, as well as taking the appropriate supplements and physician recommended medications.

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.

January Nutrition Q&A

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.

  • Refer to the video shared in this blog for more on this topic (:48). Highlights from the answer shared in the video:

    Microwaving can be a great cooking option, that not only is quick and easy, but also may result in a slightly more nutritious food product (as compared to boiling or even roasting). Keep in mind that all cooking methods cause food to lose some of its nutritional value. Some nutrients are fairly fragile, while others can tolerate more manipulation.

    For example, most plant foods start to lose their nutrient content at time of harvest, so any time off their native plant, any exposure to air, cold, and of course heat can degrade some of their nutrients.

    This serves as a good reminder to eat fresh, local and in season when possible, and to practice appropriate cooking methods to achieve desired flavor and textures without over cooking.

  • Refer to the video shared in this blog for more on this topic (3:30). Highlights from the answer shared in the video:

    Lifestyle improvements can certainly have a huge impact on your health and medical conditions. My hope is always to optimize the diet as well as other modifiable risk factors as a first line intervention, such as: exercise, smoking cessation, stress management etc.

    For cholesterol control, I recommend a diet that is:

    • Reduced in saturated fat (those fats coming from animal products such as fatty meats, butter, cheese, as well as tropical oils). While replacing them with heart friendly fats (such as olive oil, nuts, seeds, avocados, and fish).

    • High in fiber. Think LOTS of veggies, fruits, whole grains, beans, lentils.

    • Reduced in refined grains, added sugars, and concentrated sweets.

    For improved glycemic control, I recommend:

    • Portion controlled amounts of carbohydrate foods at each meal or snack. These are the carbs coming from grains, fruits, starchy veggies, and dairy products.

    • Choosing quality carbs. Think the closer to nature, the better. Examples include complex carbs such as whole grains, fruits and veggies rather than processed grain products, sweets, fruit juice and/or sugar sweetened beverages.

    • Macronutrient balance! Know your carb foods and practice pairing them with some protein or healthy fat to improve your body’s blood sugar response. Easy examples might look like whole grain toast with an egg and avocado at breakfast or a banana with a scoop of peanut butter for a well-balanced snack.

    • Regular exercise of at least 30 minutes most days of the week and weight management are both helpful in improving blood sugar control.

    Now, let’s say you are already doing all of the above and still not able to achieve your cholesterol or glycemic goals. This does not mean you are a failure; it simply means you may need a little help optimizing your health given whatever non-modifiable risk factors you may be dealing with in your life (i.e., genetics, social determinants of health, etc.). This is where medications can certainly be helpful!

    To give you some context, dietary improvements may reduce your cholesterol by up to 30%, but if your cholesterol values are still putting you at risk for cardiovascular disease, statin medications can help reduce your numbers by at least another 25%.

    Diet and lifestyle improvements can reduce your risk of developing diabetes by nearly 60%. However, if you are still not able to achieve good blood sugar control, medications are recommended as an effective treatment option.

    The longer you go with poorly controlled cholesterol and blood sugars, the higher your risk becomes, so it is always good to be proactive and realistic in your management plan.

  • When choosing a cooking oil, it is always recommended to think not only of the nutritional components but also the flavor and functional properties of the oil.

    Calorically, all oils are equivalent at 120 calories per tablespoon. However, they do vary in the quality of fats of which they are comprised. We want to choose oils that are low in saturated fat and higher in mono- and poly-unsaturated fats.

    Fats and oils such as butter, lard, palm, and coconut oils have a much higher saturated fat content so should be used sparingly. Olive oil or avocado oils are my go-to due to their high content of monounsaturated fats which are proven to benefit heart health. Though nutritionally beneficial, olive oil does have functional limitations, as it does not hold up well to high temperature cooking due to its’ lower smoke point.

    What is “smoke point” you’re wondering? Smoke point is the temperature at which an oil can safely be heated without breaking down the chemical structure of the oil. Oils have varying levels of heat tolerance; any oil will burn, taste poorly, and become carcinogenic when heated beyond its smoke point. Smoke point is largely dependent on the amount of processing involved during the production process.

    Terms such refined, extra virgin, or cold pressed can provide some insight into how much or how little an oil is processed. More processed oils are typically more suitable for high temperature cooking methods, where less processed oils are good for low-medium temperature food preparations. For this reason, it is helpful to have multiple oil options available in your kitchen.

    • I tend to choose olive oil or avocado oil for most day-to-day cooking such as pan sautéing, roasting and/or grilling.

    • Peanut oil, vegetable oil, or canola oil are handy to have around for high temp cooking methods such as stir frying or deep fat frying.

    • While flavorful oils such as toasted sesame oil or walnut oil are great to use as finishing oils added at the end of the cooking process or in dressings and sauces as they offer great flavor but are quite heat sensitive.

    Confused on which oil to choose? Refer to the back label of your oil bottle for the recommended smoke point temperatures and monitor for any sight of smoke or smell of burning when you are cooking to alert you if temps are too hot for your oil.

    Here’s a helpful resource for cooking with fats and oils that includes smoke points for commonly used oils.

  • Processed meats can be tempting. They are an easy and tasty protein food and typically a favorite to many for breakfasts, snacks, and lunches. Unfortunately, processed meats are not the healthiest choice for a variety of reasons. Not only do they pack a high sodium punch, but they also often come with a high fat content as well.

    Furthermore, processed meats often contain added nitrates and nitrites to prevent spoilage; these compounds are considered carcinogenic and are linked to increased cancer risk. Keep in mind that the meat products advertised as “nitrate-free” are not a superior option as these often use vegetable-based nitrates (such as celery powder) which are still considered carcinogenic. The World Health Organization has classified processed meats as a Group 1 human carcinogen, which is any substance known to cause cancer. If a carcinogen is classified in Group 1, it means there is sufficient scientific evidence that it can cause cancer.

    It is for these reasons that all processed meat should be limited as part of a healthy, or heart healthy, diet.

    What is considered a processed meat? Bacon, sausage, ham, salami, hot dogs, jerky, and deli meats are all considered processed and should be eaten sparingly if at all.

    Ways to minimize your processed meat intake could include:

    • Swapping your bacon for eggs or Greek yogurt at breakfast

    • Opting for a tuna salad sandwich instead of a deli meat sandwich at lunch.

    • Choosing nuts or hummus at snacks for a nice protein punch.

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.

December Nutrition Q&A

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.

  • Refer to the video shared in this blog for more on this topic (:29). Highlights from the answer shared in the video:

    The healthy plate method recommends ½ of plate as fruits and non-starchy veggies, ¼ plate as lean protein, and ¼ plate as whole grains/starchy vegetables (carbohydrates).

    I like to fine tune this a bit more based on a person’s individual goals.

    • Weight loss and/or diabetes management: Make the 1/2 plate of fruits and veggies all non-starchy veggies. (See our November blog post about starchy vs non-starchy veggies).

    • Managing portions or incorporating more produce: Give fruits and vegetables equal parts of that portion of the plate.

    Many do well with fruit intake but struggle with their vegetable intake. Reminder that we are hoping for a minimum of:

    • 2-3 servings of veggies

    • 1-2 servings of fruits each day

    Serving size references:

    • 1 cup raw or cooked fruits/veggies

    • Exception for leafy greens: 2 cups is considered a serving

    If that seems overwhelming, start small and focus on incorporating a bit of colorful produce at each meal, then gradually try to make your plant-foods more of the meal focus instead of the protein or the carb components.

    As for the other portions of the healthy plate:

    • Protein: lean, unprocessed proteins including plant-based protein options.

    • For carbs, I encourage mostly whole grains and/or complex carb choices which may or may not include fruit.

    The 2023 Providence Heart Guide offers great information on the healthy plate and food ideas supporting all categories. (pg. 10)

  • Refer to the video shared in this blog for more on this topic (3:38). Highlights from the answer shared in the video:

    I suggest taking a gradual approach when trying to cut back on hyperpalatable foods, meaning, those foods that tend to trigger cravings and excessive eating due to high-fat, sugar, and sodium contents.

    Start by reducing the frequency and quantity of your current high sugar foods and/or beverages.

    • Allow a sweet treat once a week instead of every day.

    • Try a half-size serving once a day if you are currently indulging on multiple servings each day.

    • Have a soda addiction? Try drinking the mini-sized cans or transitioning to seltzer water instead.

    Next take a close look at your typical food choices and try to identify foods that may contain hidden amounts of added sugars.

    • Flavored yogurts, coffee drinks, cereals, granola bars, and even salad dressings and sauces can contain surprising amounts of added sugar.

    • Pay attention to food labels and count the grams of “added sugars,” gradually transitioning away from the foods that don’t fit within your goals.

    • Women should limit added sugars to 24 grams (or 6 tsp), and men 36 grams (or 9 tsp) per day.

    Alternatives with lower hidden or added sugars might include:

    • Plain yogurt and adding berries for sweetness

    • Reducing the sugary syrup in your favorite coffee drink by half

    • No sugar-added cereals/bars

    • Making your own salad dressings or sauces

    Remember that concentrated sweets give us a quick boost of energy but offer little nutritional benefit and lack staying power. So, once you’ve successfully cut back on these foods, start replacing them with healthier alternatives.

    Focus on including a good source of fiber (whole grains, fruits and veggies are great fiber options), some protein, and a bit of healthy fat at each meal or snack to support satiety.

    Swap in heart friendly fats such as nuts, seeds, avocados, and olive oil in the place of highly processed oils, trans, and saturated fats which are often found in highly processed snack foods, deep fat fried foods, cheese, and butter.

    Hopefully your cravings will lessen as you reduce your amounts of these foods and the frequency at which you consume them. Over time, eating balanced meals and snacks throughout your day will leave you feeling more fueled and energized throughout your day.

  • Pre-exercise:
    Choose a light meal or snack consisting of a quality carb food and a lean protein food. Examples can include:

    • Oatmeal with a hard-boiled egg

    • Apple and string cheese

    • Fruit with cottage cheese

    • Whole grain toast with peanut butter

    • Fruit smoothie with added protein

    Avoid heavy, rich, high-fat foods as these take significantly longer to digest. Consume these at least 30-60 minutes prior to exercise session to allow for some digestion to occur. Work on consuming small amounts of fluids throughout the day and during exercise to stay adequately hydrated.

    Post-exercise:
    Your body loses hydration, electrolytes, and glycogen (muscle fuel) during strenuous exercise. Be sure to replace fluid and electrolyte losses, especially if sweating excessively or participating in aerobic activity for longer than 60 minutes.

    You will also want to refuel with carbs and protein to replete your glycogen stores and provide the needed amino acids to support muscle repair and synthesis.

    The goal is to refuel with a 3:1 carb to protein snack within 30 minutes of exercise cessation. Think about choosing:

    • Chocolate milk

    • Fruit smoothie

    • Peanut butter and jelly sandwich

    • Greek yogurt with berries

    • Banana and nut granola bar

    Try to eat well balanced meals throughout your day with each meal consisting of quality carbohydrates, lean protein (20-30 grams at each meal), and a bit of healthy fat for satiety.

    Considerations for the collagen supplement question:
    I tend to prefer a food-first approach. A thoughtful whole food diet can safely and efficiently meet your energy needs and fuel your body for optimal exercise; however, you can certainly utilize supplements if you choose to do so. Collagen supplements have become popular and are toted to improve hair, skin, nail, and joint health. Most collagen supplements appear safe for use and come with few side effects. However, they are typically quite expensive.

    You can help your body produce more collagen by incorporating more glycine- and proline-rich foods in your diet such as: chicken, beef, fish, eggs, dairy and beans. Increase your intake of vitamin C, zinc and copper with citrus fruits, strawberries, tomatoes, leafy greens, nuts, whole grains and shellfish.

  • Baking with artificial sweeteners requires a bit of trial and error. I would advise you to choose sweeteners where you enjoy the flavor, while also being prepared that the end product may not turn out as hoped.

    If you are just aiming to reduce the amount of sugar in your homemade baked goods, you can generally get away with reducing the amount of sugar by 1/4th - 1/3rd of what the recipe calls for.

    Munk fruit, stevia or baking Splenda can usually be swapped in a 1:1 ratio.

    Other natural sweeteners such as honey, maple syrup, or agave tend to have a bit more flavor as compared to refined white sugar. This may allow you to use less in a recipe.

    If these modifications aren’t working out for you, consider other healthy baking swaps:

    • Adding grated zucchini, carrot, apples or applesauce, pumpkin puree, dates, raisins, nuts or black beans.

    • Use half whole wheat flour in baking.

    • Swapping in 70% dark chocolate chips in the place of milk chocolate chips.

    I encourage you to enjoy sweet treats in moderation and settle on a recipe that is both tasty and a bit healthier, when possible.

    Keep in mind ratios do vary quite a bit depending on which agent and the recipe you may be working with. As I am no expert baker, this guide from the Bigger Bolder Baking blog may be helpful.

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.

November Nutrition Q&A

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.

  • 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.

  • 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.

  • 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!

  • 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.

  • 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!

  • 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.

  • 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.

  • 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.

October Nutrition Q&A

Our registered dietitian, Jamie, offers answers to nutrition-related questions our community has submitted over the past month. If you have a question to submit, please click here and check our next newsletter for your answer.

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

  • All fats and oils are essentially equal when it comes to calories, packing an impressive 9 calories per gram! However, olive oil is certainly a superior oil to choose as part of a heart healthy eating plan due to its low saturated fat and high monounsaturated fat content. 

    Even though it is a heart friendly oil, we still need to consume olive oil in moderation, as to not “tip the scales” in the wrong direction when it comes to daily caloric intake as well as total fat intake. If your dietary fat intake came exclusively from olive oil, you could consume roughly 4-5 tablespoons per day. But, to allow for fat intake from alternative food sources such as lean meats and poultry, fish, eggs, nuts, seeds, avocados, and reduced fat dairy products, I would recommend sticking to 1-2 tablespoons of olive oil per day.   

    Sources: PREDIMED trial 

  • The good news is this transition can be done successfully, hopefully resulting in better cholesterol control and a happier gut microbiome without causing weight gain.

    First, I would continue to focus on eating A LOT of non-starchy veggies. Think half of each meal plate!

    Second, let's tackle the fats.

    Choose mostly heart-friendly unsaturated fats such as those coming from fish, olive oil, nuts, seeds, and avocados.

    Limit saturated fats coming from animal products and tropical oils.

    Please stop adding extra fat to your foods and beverages. Say goodbye to bullet proof coffees, heavy cream, extra mayonnaise, loads of butter and bacon!

    Next, I would slowly add back small servings of complex carbohydrate foods such as fruits, minimally processed whole grains, beans, and legumes. Not only are these previously forbidden foods rich in vitamins, minerals, antioxidant and anti-inflammatory compounds, but they also pack a ton of fiber! These fiber-foods not only work to keep your gut healthy and your cholesterol in check, but they will also help keep you feeling full and satisfied as you transition away from your high fat keto diet. Do remember to keep carbohydrate portions small so as to not overdo it and cause undesired weight gain.

    Caloric intake and macronutrient balance are still important as well. You may find it helpful to track your eating for a couple of weeks to make sure you are staying on target with your specific needs. For a lower carb but heart healthy eating plan, I typically recommend keeping carb intake to ~40% of daily calories, protein intake as ~25%, and fat intake as ~25-35%.

    Lastly, manage your stress, get good sleep, and maintain adequate amounts of physical activity. Trying to control your weight via dietary modifications alone can be tricky, especially when transitioning to a less restrictive eating plan. Remember that regular and adequate movement helps to promote healthy metabolism and body weight.

  • Avoiding certain foods for medical conditions may be necessary for some people. Those with Celiac disease need to avoid gluten. People with heart disease likely need to limit their fat and sodium intake. Folks with diabetes need to limit their sugar intake. While people with kidney disease need to limit their protein intake. Nutrition is not a one-size-fits-all kind of science and finding the appropriate diet for your health needs and personal goals is important. I would recommend meeting with a registered dietitian to establish an individualized eating plan that can work safely and effectively for you.

    Generally, for those looking to lose a bit of weight, I would recommend a diet that is high in fiber-rich foods with a big push on non-starchy vegetables. As always, focus on consuming mostly fresh/ whole foods and homemade meals instead of their highly processed alternatives. Choose satisfying meals and snacks that are well balanced by pairing a fiber-rich food with a lean protein food or healthy fat.

    Avoid skipping meals to keep you on track with making healthful food choices and maintaining proper portion control. Practice eating mindfully by listening to your body’s hunger and fullness cues and avoid slipping into emotional eating.

    Lastly, incorporate regular physical activity into your day. The goal is 30 or more minutes of exercise most days of the week, though you may need more to promote and/or maintain desired weight loss.

  • Unfortunately, there is no one diet to treat irritable bowel syndrome. It is a matter of trial and error in finding which foods you may tolerate and those that you may not. Think of FODMAPs not as a long-term diet, but instead as a temporary tool to help identify your problem foods.

    A FODMAP is an elimination diet that cuts out foods containing certain sugars (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) and then slowly adds them back to help identify which foods may be causing gastrointestinal (GI) symptoms such as abdominal cramping, bloating, gas, diarrhea, and/or constipation.

    The hope is that once you’ve figured out which FODMAP foods you don’t tolerate, you can continue to avoid them while adding back those that you do. As this diet is quite complicated and restrictive in nature, it should only be used short term (2-6 weeks) and under medical supervision from a GI doctor or registered dietitian.

  • A heart healthy and kidney friendly diet can be achieved with a bit of creativity. Yes, you will need to limit your intake of sodium and red meat, however, that doesn’t mean total elimination.

    I would aim to keep your sodium intake around 1500-2000 mg per day by choosing mostly fresh foods and homemade meals. Over 75% of our sodium comes from processed foods and restaurant meals, so start by reading labels at the grocery store, ensuring only sodium-appropriate food products make the cut. Then get to work in the kitchen doing as much scratch cooking as you can. Add flavor with herbs, spices, garlic, peppers, citrus, or vinegars instead of table salt, bullion, seasoning packets, soy sauce, and other salt-heavy condiments.

    Limit red meat to one 3-4 ounce serving per week. Keep it lean and unprocessed by choosing choice or select cuts or even better if you can choose grass-fed beef, venison, elk, or bison meat as these have significantly less saturated fat.

    Additionally, incorporate a variety of vegetables, fruits, whole grains, and plant-based proteins as well. Choose mostly unsaturated fats from plant and fish sources while limiting animal-based fats and tropical oils. Limit or avoid alcohol completely as recommended by your doctor.

  • Plant-based diets are often higher in carbs as compared to standard diets as many plant-based protein foods also contain carbohydrates. When done well, a vegan diet can be very healthy and adequate, but it does take a bit of thought to meet not only your protein goals but also your nutrient needs.

    Think of layering your protein foods at each meal. Combining beans or lentils with some quinoa for example or keep it lower carb by choosing a high protein food like tofu paired with mixed non-starchy veggies. Nuts and seeds can also be helpful in adding a bit of protein and healthy fat. I like to use these at snacks or add a bit to hot cereal, salads, or grain and veggie bowls for a nice crunch. Try switching to soy milk for more protein plus needed calcium and vitamin D.

    Still having a hard time getting enough protein? You can think about using a plant-based protein powder to fortify your smoothies, soups, and other dishes. I would, however, recommend using vegan meat substitutes sparingly as these often contain unhealthy fats and emulsifiers and typically have high sodium counts. Keep your foods real and minimally processed, as with any healthy diet.

  • Healthy weight gain or weight restoration can be achieved with some careful modifications to your eating habits. We want to avoid turning to junk foods and instead choose foods that are both calorie and nutrient rich.

    For example, adding a little extra olive oil to your cooked veggies or using peanut butter or avocado on your toast in the place of butter can boost up the calories coming from heart healthy unsaturated fats. I typically recommend eating at least 3 meals and 2-3 snacks per day to help get the calories in throughout the day instead of trying to stuff yourself full at a couple of large meals.

    In addition to taking in adequate calories, you will also want to ensure adequate protein intake. I recommend including a good source of protein at each feeding with goal of 20-30 grams of protein per meal as well as a bit at snacks. Support muscle health by staying physically active with both cardio and strengthening exercises.

Jamie Libera, RD, LD, 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.

Let's Have an Introduction

Welcome to our interactive nutrition blog. Yes! You help drive the content of this blog each month by sending in nutrition-focused questions. As a registered dietitian with Providence, I’m excited to answer questions to help guide you to living your best, healthiest life.

Let’s cover a bit of the ground rules to help keep everyone on track.

  1. If you have a medical concern, please consult with your primary care provider. We are unable to respond to questions specifically related to a medical condition or concern; this includes certain medications.

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

  3. Questions are submitted anonymously. We are unable to respond directly as a result. If you have an urgency to your question, please consult with your primary care provider or consider requesting a referral for a dietitian consultation.

Your questions are reviewed each month for response and then published in this monthly blog. New blog posts will be shared in Basecamp’s monthly e-newsletter, Trail Guide. If you’re not subscribed, click here!

So, the most important detail… submitting your questions. Follow the button below!

 

Jamie Libera, RD, LD, 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.

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