Posts Tagged ‘Health’

Orange Awareness Ribbon for Anti-Hunger Causes

Orange Awareness Ribbon
for Anti-Hunger Causes
Photo modified from original
by digitalart (

By Shelly Najjar

The term malnutrition is often heard in news stories and international health organization fundraising brochures, but do you know what it means, why it’s important, and what you can do?

This week is Malnutrition Awareness Week (September 23-27, 2013), created by the American Society for Parenteral and Enteral Nutrition (ASPEN). ASPEN is a professional organization for clinical nutrition (nutrition for people in hospitals and other acute, chronic, and transitional care settings), particularly for parenteral (IV nutrition) and enteral nutrition (tube feedings). Although they are focusing on clinical recognition and treatment of malnutrition, this isn’t something that only affects people in hospitals. Malnutrition and its associated problems are seen around the world in a variety of settings.

What is malnutrition?

“Malnutrition” means unbalanced or inadequate nutrition (Source: Merriam-Webster Medical Dictionary). It can occur in many situations, including (but not limited to) the inability to digest and absorb nutrients, having an extended illness, limiting types of foods eaten (for example, not eating any fruits or vegetables), and not eating enough food due to lack of money. Technically, malnutrition can be either “overnutrition” (excessive intake that causes medical problems) or “undernutrition” (deficiency of one or more nutrients) (Source: White, et al). However, it is usually used to mean “undernutrition” or not eating enough (of a one or more nutrients, or of total calories) to maintain optimal health. While both overnutrition and undernutrition are important topics, the rest of this post will be mostly about undernutrition.

The method for diagnosing malnutrition vary slightly depending on which set of criteria are used. Some of the criteria sets are the International  Classification of Diseases Ninth Revision (ICD-9), the Tenth Revision (ICD-10), and the International Dietetics and Nutrition Terminology (IDNT). There are also some guidelines included in the AND/ASPEN Consensus Statement on malnutrition.

Why do we care?

The issue of malnutrition is important because adequate nutrition is essential for our bodies to work correctly. Exactly what the symptoms are depends on which nutrient is deficient (meaning: not meeting the recommendation for intake). Some issues that may be caused by malnutrition include decreased ability to fight off infections, delayed injury healing, and decreased ability to build and maintain muscle. It also can affect fertility, mental function, and overall growth and development (Sources: Nutrition in the Prevention and Treatment of Disease*; Nutrition therapy and pathophysiology* I get commissions for purchases made through those links*).

What can be done?

The treatment for malnutrition is to correct the nutritional deficiencies, whether they are single nutrient (one example: someone who lacks iron in their diet) or total calories (one example: someone who cannot keep food in their stomach due to treatments for cancer). If the deficiency is caused by another problem (for example, an intestinal disease), that problem will need to be treated. Doctors, dietitians, and nurses often help with the treatment of malnutrition.

Malnutrition can happen anywhere. It is often linked to poor diet quality when people cannot afford enough nutritious food. There are several ways you can help prevent malnutrition, and many resources for people who want some help getting food.

Help out:

Donate time (volunteer) or money to organizations that fight hunger, help provide nutritious food, or offer jobs and training so people can afford food. Do your research on organizations before you give, to make sure the organization is legitimate and your money will be used wisely. Some resources that may be useful are Charity Navigator, GuideStarBetter Business Bureau Wise Giving Alliance, and GiveWell.

Get help:

Communities, cities, states, and countries usually all have some form of food assistance programs available. Social workers, doctors, nurses, dietitians, community leaders, community agencies and organizations, schools, and local and state governments may offer help with finding food. Food assistance can include food banks, hot meals, or money for buying food (like Food Stamp programs, now called SNAP in the USA). If you are in the USA, you can use the Benefits Finder to find government benefits you may be eligible to receive.

You may also be interested in…

Shelly Najjar, MPH, RDN is a Registered Dietitian Nutritionist and wellness coach at Confident Nutrition. You can find her on Facebook, Twitter (@ShellyNajjar), and LinkedIn.

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By Shelly Najjar

What is herbal tea?

Regular tea (such as black, white, oolong, and green teas) are drinks made by soaking the leaves of the tea plant (called Camellia sinensis) in water. The leaves are strained out and the water is consumed.

Herbal teas are drinks made from plants (and plant parts) other than the tea plant, soaked in water. The water is consumed but the wet plants are strained out.

Common plants used in herbal tea include

  • Mint
  • Chamomile
  • Licorice root
  • Orange peel
  • Cinnamon (and other spices)
  • Ginger
  • Vanilla
  • Berries
  • Lemongrass
  • Rosehips
  • Other flowers

Herbal teas do have many benefits, and often people drink them for their medicinal properties. Many herbal teas contain antioxidants, which are lower the risk for developing chronic diseases like heart disease and cancer.

However, because they do have medicinal properties, they can often interact with prescription and over-the-counter medications.

Potential problems

Both regular teas and herbal teas (and other herbal supplements) contain compounds that can interact with medications. Some of these interactions enhance the action of the drug, and some of them decrease the action of the drug. Interactions between herbs (which are regulated like food) and medications are called food-drug interactions.

Why is this important?

Medications are given in specific doses based on how they are expected to act in the body. Regular and herbal teas can affect how a drug acts in the body at a certain dose.

For example, if you are taking Coumadin (or warfarin, or aspirin: anticoagulants/blood thinners to prevent blood clots) and you also are drinking chamomile tea (which can interfere with anti-clotting medications), you could end up with not enough clotting action (a little clotting ability is healthy and necessary to stop bleeding if you get a cut, etc.).

It is very important to talk with your health care provider (especially pharmacists) about all the medications and herbal supplements you consume, including regular and herbal teas. In addition, make sure you know what foods and herbs can interact with the medications you take.

Common interaction warnings

Here are a few herbs that can have the potential to interact with medications. Sources: Natural Standard and UMMC’s CAM Index (see Resources, below)

Note: This is not a complete list. You and your healthcare team are responsible for checking your medications for interactions (also see site Disclosure).

  • Licorice root – Licorice should be avoided or consumed with caution if you are taking ACE inhibitors, diuretics, digoxin, aspirin, corticosteroids, insulin, oral contraceptives, or laxatives. These recommendations are based on animal and human studies, case studies, and expert opinion based on the known effects of licorice.
  • Peppermint – One of the most commonly reported side effects of peppermint is that it causes heartburn. Peppermint can relax the lower esophageal sphincter (the par t of the body that keeps food from going out of the stomach back up into your esophagus, which is the tube the food goes down), especially in people with gastroesophageal reflux disease (GERD), despite medications to prevent this from happening.
  • Ginger – The common warning for ginger is to avoid when taking anticoagulants, based on animal studies and human case studies, where ginger has been shown to have similar properties. Taking both ginger and anticoagulant drugs may cause too much bleeding; however, scientific evidence is limited
  • Chamomile – The usual warning for chamomile is to avoid taking it with sedatives (including alcohol) and anticoagulant medication, based on animal and human studies, because of evidence that it can increase drowsiness and may interact with blood clotting. Chamomile also may have some effect on certain drugs like oral contraceptives and statins that are broken down in the liver, based on in vitro studies.


Here are some resources to find out if you may have a potential interaction.

Note: This is not a complete list. You and your healthcare team are responsible for checking your own medications, using resources not limited to those mentioned here.

Note: Regular and herbal teas can also be harmful in certain medical conditions including pregnancy, and you should talk with your healthcare provider and Registered Dietitian if you have any existing medical condition.

(Special Thanks: This post was inspired by 1digitalfingerprint, who wrote a post on herbal tea in September, and suggested I expand my comment on interactions into a full post.)

Shelly Najjar, MPH, RDN is a Registered Dietitian Nutritionist and wellness coach at Confident Nutrition. You can find her on Facebook, Twitter (@ShellyNajjar), and LinkedIn.

I appreciate your support. *Affiliate link = Amazon pays me a small portion of the sale price, at no extra cost to you. I only recommend things that I think are worth buying. You can support me and this blog if you click here before shopping on Amazon, so that a small commission on whatever you buy will be sent to me at no extra cost to you.

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Guest post by Carrie Dennett

Deep fried pastry sticks. Photo Credit: vanillaechoes (via

Photo Credit: vanillaechoes (via
Fried foods, like these deep fried pastries, can be a source of trans fat.

A revolution is under way in the food industry, spurred by science, consumer demand and legal pressure. Trans fats, otherwise known as hydrogenated and partially hydrogenated oils, are surely and steadily being removed from our food. It’s a good thing.

Once hailed as a healthier alternative to saturated fats, trans fats are now being called “metabolic poison” by some health and nutrition experts. Unfortunately, these artificially derived fats made their way into all areas of our food supply, and stayed there for decades, before their true nature was revealed.

What is a “fat”? What is a “fatty acid”?

A fat, also known as a triglyceride, is composed of three fatty acids attached to a glycerol “backbone.” A triglyceride can have three matching fatty acids, or contain a mix (see image below). A fatty acid is made up of a chain of carbon atoms with hydrogen atoms attached. Each type of fatty acid is defined by the length of its carbon chain and how “saturated” it is with hydrogen atoms.

Why is some fat solid at room temperature while others are liquid?

A saturated fatty acid is filled up with hydrogen atoms, which makes the carbon chain straight. An unsaturated fatty acid is missing one (monounsaturated) or more (polyunsaturated) hydrogen atoms, causing the carbon chain to bend at each missing hydrogen.

A triglyceride with saturated fatty acids is compact because the straight fatty acid “tails” fit neatly together, and the resulting fat is solid at room temperature (i.e., butter or the fatty streaks in bacon). If the triglyceride contains unsaturated fatty acids, the bends in the carbon chains create space between the fatty acid tails, and that space makes the resulting fat fluid at room temperature (i.e., oils) (see image below).

Saturated and monounsaturated cis and trans triglycerides. Image created using

–Triglycerides have 3 fatty acids attached to a glycerol backbone. –The fatty acids can all be the same (A) or can be different (B and C). –Saturated fatty acids “stack” nicely with each other and with other saturated triglycerides (A). –Unsaturated fatty acids can be trans or cis. The cis form has bends in it that affect how the fatty acids “stack” together (B), but the trans form (C) “stacks” like the saturated fatty acids. Image created using

A trans fat is an unsaturated fat (usually polyunsaturated) that has been hydrogenated. The hydrogenation process forces extra hydrogen atoms  into the empty slots on the carbon chain, creating an unsaturated fatty acid that looks like a saturated fatty acid. Because saturated fats were linked to heart disease and unsaturated fats were known to be heart-healthy, it was believed that trans fats, would offer the best of both worlds: Heart-healthy unsaturated fats with the culinary properties of saturated fats. As anyone who likes to bake knows, there are some recipes that require a solid fat like butter or shortening.

As it turns out, once unsaturated fats are hydrogenated, they are no longer heart-healthy. In fact, they are even worse for heart health than saturated fats. One reason may be that hydrogenated trans fats are artificial—they don’t occur in nature (very small amounts of natural trans fats are present in meat and dairy products).

Why did it take so long to do something about trans fats?

Although some experts expressed concern about trans fats in their early days, it took decades before their voices (together with mounting scientific evidence) grew loud enough that the mistake could no longer be ignored. In the meantime, trans fats had seeped into all areas of food preparation. Restaurants were frying in hydrogenated oils (trans fats) instead of beef tallow (saturated fat). Home cooks got the message that margarine (trans fats) was heart-healthy and that butter (saturated fat) was not. You would be hard pressed to pick up a box of crackers or cupcakes without seeing hydrogenated oil in the ingredient list.

Finally, we’ve arrived at the point where restaurants and food manufacturers are turning away from trans fats. Trouble is, when you remove a major ingredient, you need to replace it with something.

What exactly is taking the place of trans fats?

Trans fats, and saturated fats before them, were valued for their stability at high heat. Any replacements for trans fats need to have similar qualities.

For commercial frying, partially hydrogenated oils are being replaced by vegetable oils that are naturally stable at high heat (corn, cottonseed, palm, peanut and rice bran) as well as sunflower, soybean and canola oils that have been modified to make them less likely to break down and become rancid at high heat.

The situation becomes trickier when looking for a replacement for solid hydrogenated fats, such as those used for baking. Any candidate must have the right texture and creaming ability, and it can’t turn to liquid too soon. It’s also important that the fat doesn’t go rancid quickly, so the product will be shelf-stable. The trend so far is to produce trans fat-free shortenings using either palm oil or interesterified vegetable oil.

What is palm oil? What are the pros and cons?

Palm oil is a tropical oil that comes from the fruit portion of the palm fruit (as opposed to palm kernel oil, which comes from the kernel of the palm fruit). Palm oil is rich in palmitic acid, a saturated fat, but there is disagreement among scientists and health experts about the effect palmitic acid may have on blood cholesterol and heart disease. Additionally, there are environmental concerns about the harvesting of palm oil.

What is interesterified oil? What are the pros and cons?

Interesterified oils have been used since the 1930s, but interest in them increased as trans fats began to be taken out of foods. Interesterified oils take a small amount of unsaturated triglycerides (usually soybean or cottonseed), fully hydrogenate them, then mix them with a lot of the non-hydrogenated oil. The triglycerides in the mixture are broken apart and their fatty acids rearranged, producing oil that is solid at room temperature. If you buy trans fat-free shortening or chocolate bars that have had their cocoa butter removed, you’re using interesterified oil.

The concern is that whether interesterified oil is harmful to our health or simply neutral may depend on exactly how the fatty acids in the triglyceride get rearranged. Scientists are finding that it’s not just the type of fatty acid that matters, it’s also the position it occupies on the triglyceride. The interesterification process is not precisely controlled, and some of the random arrangements produce triglycerides that are not found in nature.

What are health experts saying about these trans fat “alternatives”?

Most health and nutrition experts agree that palm oil is a lesser evil than trans fats, even if they don’t agree on whether palm oil is good, bad or neutral for health. Many experts also agree that research needs to continue on the possible effects of interesterified oil on health, especially if our consumption of it goes up due to increased use in commercial food preparation.

What can I do now until we know more about these fats?

  • First, don’t assume that the words “trans fat free” on a food package means that food is healthy. It’s wise to also consider what else is in the food. Is it high in…
    • Sugar?
    • Refined flour?
    • Artificial ingredients?
  • Second, if you eat more whole foods and fewer processed foods, you’ll naturally be eating less of whatever type of fat is used in place of trans fats. This means you will be less affected if years from now it turns out that these trans fat alternatives aren’t any better for us.

If you’d like to read more, Harvard School of Public Health’s Nutrition Source website has a nice page on trans fats.

Carrie Dennett is a MPH student in the Nutritional Sciences Department and the Graduate Coordinated Program in Dietetics at the University of Washington. She writes a nutrition column for The Seattle Times; “On Nutrition” runs on the health page every third Sunday. She also blogs at Nutrition by Carrie.

Also read…

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By Shelly Najjar

Bunch of yellow bananas by adamr via

Photo Credit: adamr (via

Can you list at least 3 foods that have more than 500 mg of potassium? (Hint: one is in the title of this post.) If you can’t, that’s okay. A few days ago, I couldn’t either.

A family friend asked me to find some information about potassium, including how much she should get every day and what foods she should be eating to reach that goal. I couldn’t tell her off the top of my head (even though we’ve had assignments on this topic in the past) so I told her I’d get some resources for her.

What is potassium? What does it do?

Potassium is an element/mineral that helps maintain electrolyte and pH balance, affects muscle contraction (including the heart muscle), and allows nerves to transfer signals more efficiently.

How does it work?

Many cells in our body use potassium to transfer other ions (electrically charged particles) across membranes. Sodium (another electrolyte and a part of table salt) has a negative charge. Potassium has a positive charge. These signals are important because they affect how well a signal can travel through the cell (like what nerve cells do).

Potassium and sodium are also transferred in and out of the cells to maintain fluid balance, because water likes to collect in areas where there is a lot of sodium. If the inside of a cell has too much sodium, water will be drawn in to dilute it, through the process of osmosis (water moving from an area of low concentration to an area of high concentration). If too much water collects in the cell, it will burst.

One of the things cells do to prevent this from happening is to exchange sodium for potassium (potassium molecules are pulled into the cell and sodium molecules are pushed out).

Where is it found?

Obviously, potassium is important. It is in many foods, including

  • baked potatoes with skin (925 mg/medium potato)
  • canned white beans (595 mg/cup), and
  • canned clams (535 mg/3 oz).

(Note: You should now be able to answer the potassium question at the beginning of this post.)

There are a couple of lists of potassium-containing foods that I want to share with you.

  1. The first is a list sorted by the amount of potassium per serving: Food Sources of Potassium.
  2. The second is a more comprehensive list, organized by food groups separated into three categories (High Potassium, Moderate Potassium, and Lower Potassium foods), and then alphabetized by food name, rather than by amount: Potassium Values of Food.

How much do we need?

The recommendation for adults without kidney disease ages 19 and over is 4,700 mg (milligrams) of potassium daily. (See the Dietary Reference Intakes. They list it in grams, so you may need to know that 1 g = 1,000 mg.) Dietary Reference Intakes are listed by age and sex for each nutrient.

Important: Your health care professional may recommend a different daily amount if you have certain medical conditions, including but not limited to kidney disease or hypertension (high blood pressure). Please consult a doctor or Registered Dietitian. Also, see my disclosure.


  • Potassium is a mineral that our bodies need to work properly.
  • Many foods contain potassium. Besides potatoes and bananas, some foods with high potassium (more than 200 mg per serving) are avocados, fish, chocolate milk, and turkey. The two lists mentioned above contain many more options.
  • The recommendation for most adults is 4,700 mg of potassium daily.

Also read…

Shelly Najjar, MPH, RDN is a Registered Dietitian Nutritionist and wellness coach at Confident Nutrition. You can find her on Facebook, Twitter (@ShellyNajjar), and LinkedIn.

Like this post? You can support me and this blog if you click here before shopping on Amazon, so that a small commission on whatever you buy will be sent to me at no extra cost to you.

By Shelly Najjar

Alcoholic drinks in minibottles, photo credit: jekert gwapo, Creative Commons: Some Rights Reserved, from

Photo Credit: jekert gwapo via Flickr

The title of this post was my research question for a class paper last quarter, and I wanted to share what I learned with you.

Some background

Alcohol is metabolized (broken down) in the liver, usually by an enzyme called alcohol dehydrogenase (ADH). In the late 70’s, a couple of researchers  did a study on whether women in different phases of their menstrual cycle were affected differently by the amount of alcohol they drank (citation: Jones and Jones, 1976, Ann NY Acad Sci). It was a poorly designed study, so most scientists discussing this study don’t consider it strong of a conclusion as it could have been, but you’ll still hear people state that there may be effects.

Why it’s plausible

Throughout the menstrual cycle, levels of estrogen and progesterone (hormones) rise and fall. Researchers (citation: Holdstock and de Wit, 2000, Psychopharmacology) thought estrogen was going to increase euphoria and a drinker’s preference for alcohol, because they both can act on the dopamine system in the brain. They guessed that progesterone would increase sedation (sleepiness) and decrease ability to do tasks (impaired performance), so the effects of alcohol (which also does these things) may seem stronger. On the other hand, estrogen was thought to increase ADH activity (it would work better and faster), which would lead to faster elimination (citation: Mumenthaler, 1999, Alcsm Clin Exp Res).

So, overall, it was thought that at certain times of the menstrual cycle, the effects of alcohol may be more intense, but that it wouldn’t last as long.

What the research says

Although there are several older studies on the topic, their study designs (how they set up the study) were not very good. There are now three things that researchers say are essential for any study on this topic:

  •  Use a within-subjects design (testing different things on the same person at different times in their menstrual cycle, rather than testing different things on different people at different times). This allows better comparison, since it limits the effects of variation between individual people.

  • Confirm menstrual cycle phase using hormone testing (rather than just relying on counting days since the last period). This increases accuracy, since there is variation and inaccuracies if you just count days.

  • Don’t use people with anovulatory cycles (a cycle when the egg does not get released). This is important because estrogen and progesterone don’t rise when this happens, so effects caused by changes in estrogen and progesterone won’t be seen (citation: previously mentioned Mumenthaler article).

I looked at two studies because they had these three features and were fairly recent.

Study #1: Holdstock and de Wit, 2000 (cited earlier)

These researchers used 16 women who each usually drank an average of 3.5 alcoholic drinks and 6 caffeinated beverages each week. Participants didn’t use drugs for at least 12 hours before and didn’t eat at least 2 hours before the test. Women were tested at 4 times through their cycle, each time being tested in the evening with spiked, sugar-free Kool-Aid. Each person drank 3 drinks over an hour, and their BAL (breath alcohol level) was tested. In addition, each woman did tasks that measured eye movement and mood.

After statistical analysis, this study didn’t show any effect of menstrual cycle on alcohol effects.

The study report was detailed and all measures, tests, and kits they used were reported (this makes a study more repeatable because another researcher has enough details to use the same technique to verify the results). Tests were done in a laboratory setting, which the researchers listed as a strength because it decreased the effect of the environment (example, you don’t have other people in the bar talking or flirting, or music playing, etc). However, this means that generalizability to a “real-world” setting is limited (do you act the same in a bar and a lab?). Although the researchers tested many phases, they decided not to test when estrogen was highest (during ovulation, when the egg is released), because it is very difficult to schedule people to come in for testing (ovulation period is only 2 days long). The researchers admit that there may be the possibility that the effect of estrogen on alcohol is only seen at high levels of estrogen, but since they didn’t test it, we don’t know. Finally, there were only 16 people in this study, but the measurements they used were accurate enough to detect a single drink’s effects, so if there was an effect that wasn’t noticed, it could be because the effect of menstrual phase is smaller than the effect of one additional drink.

Study #2: Corrêa and Oga, 2004 (citation in J Stud Alcohol)

This study used 10 women who, on average, drank 3 alcoholic drinks each, per week. Each woman didn’t use alcohol or drugs 30 hours before the tests, and had no food at least 6 hours before sessions. Women were tested at 2 points in the menstrual cycle, each test started in the morning, and lasted for 6-7 hours. Each person drank Scotch whiskey over a 10 minute time period, and then were tested throughout the day for BAL. Women received a “standard midday meal” 2 hours after they drank the whiskey, and “afternoon snacks” later in the day.

After statistical analysis, researchers didn’t find that menstrual cycle affected alcohol metabolism or elimination.

Like the first study, the tests and kits that were used to determine hormone levels were reported, which increases the study’s repeatability. In addition, since they only tested two phases of the menstrual cycle, it was good that they chose two with the largest potential difference in hormone levels. This would have the best chance of showing whether changes in menstrual cycle hormone levels affect alcohol metabolism. However, food and fasting can both affect alcohol metabolism, but the researchers never discussed this issue, although it has been noted that food, menstrual cycle, and alcohol can all change the amount of time it takes for things that go in your mouth to come out the other end. Although one study (the Mumenthaler study mentioned earlier) found that a “nonfatty breakfast” 1 hour before drinking doesn’t change BAL, the current study didn’t mention that, or the specifics of what they fed the participants.

Why it matters

Although these two studies used different approaches, they both came to the same conclusion, which also agrees with what is considered to be one of the best studies on the topic (Mumenthaler study mentioned earlier).

The implications of these results could range from research settings to social settings. In research, if the menstrual cycle doesn’t affect the metabolism of alcohol or the effects caused by drinking, then researchers may not have to control for which phase of the cycle female participants are in. As noted before, the lab setting is very different from social settings. Also, the doses used in many studies are higher than that of a standard drink and are usually consumed without food (and without having eaten for many hours). With a higher alcohol intake but less food to slow down absorption, you would think that any effects (if they exist) would be more obvious. Still, there is reason to be cautious because although alcohol levels may not be affected by the menstrual cycle, the effects may be seen with some of the things alcohol gets broken down to in the body.

So, like every research topic, more research is needed. However, if you do decide to drink, please do so with moderation, and know your body. If you think alcohol affects you differently at different times, be smart and adjust your intake. 

Shelly Najjar, MPH, RDN is a Registered Dietitian Nutritionist and wellness coach at Confident Nutrition. You can find her on Facebook, Twitter (@ShellyNajjar), and LinkedIn.

Like this post? You can support me and this blog if you click here before shopping on Amazon, so that a small commission on whatever you buy will be sent to me at no extra cost to you.

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