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The Nutrition Blog
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 Kirsten Gram, a registered dietician, has worked for Cascade Health Solutions’ Center for Healthy Living for over 20 years. She loves sharing her professional wisdom and healthy living tips as part of her blog.
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Gluten-Sensitive Enteropathy (GSE) is a genetic disorder that affects 1 out of every 133 people in the United States. GSE includes celiac disease and dermatitis herpetiformis and can be managed by food choices. That’s right – food is the only medicine that can be used to manage and control the disease. The prescription: a life free of gluten. Sounds simple, right?
A friend of mine, recently diagnosed with celiac disease, assumed this
dietary change would be a simple transition. But she soon learned that
it was more complicated than she first thought. Gluten is a protein found in wheat, rye and barley. Most types of cereals and many types of breads contain gluten. Not all foods from the grain family, however, contain gluten. Gluten-free grains, starches and proteins include: corn, rice, potatoes, starch, tapioca, arrowroot, buckwheat, quinoa, garfava, sorghum, amaranth, teff, nut flours, beans and products made from these.
Did you know that gluten is found in less-obvious foods, such as soy sauce, package mixes, some cheeses, prepared foods, and beer, among others? And it’s important to note that “wheat free” is not the same as “gluten free.”
Committing to a gluten-free diet requires a new way of eating, shopping, learning to love new favorites, and experimentation. Here are a few tips to help you get started: • Meet with a dietitian: To better understand how to shop and indentify gluten-free foods, meet with a dietitian who can teach you how to read labels and create a menu to make shopping and meal planning less stressful. A dietitian can also provide a list of recommended resources that might include the Internet, books and local support groups. • Shop at a store that carries gluten-free products: Many of the foods you’ve eaten in the past, such as corn tortillas, rice, fruits, vegetables and meats are likely gluten free. Some foods, such as breads, cereals, pancake mix and noodles are made gluten free and are labeled as such. Market of Choice offers a wide variety of gluten-free (GF) products, from sweet to savory and fresh to frozen. Be sure to check labels – when in doubt, go without. • Organize your pantry: Keep your gluten free foods separate from other foods in the pantry. Mark those that are to be kept gluten free with a marker – foods like mayonnaise, butter and jam that might get cross-contaminated. • Keep it simple: Buy and prepare unprocessed foods, such as fresh fruits, vegetables and unprocessed meats. Keep the starches simple: baked potatoes, yams, or steamed rice.
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What is vitamin D?
Vitamin D is a fat-soluble vitamin that's formed when skin is exposed to the sun's ultraviolet rays. Vitamin D is also found in food and dietary supplements.
There are two major types of vitamin D:
• Vitamin D3 (cholecalciferol) is made naturally by the body when its exposed sun; it’s also found in certain foods.
• Vitamin D2 (ergocalciferol) is the most common form found in supplements; it's also used to fortify certain foods, such as milk.
Both types of vitamin D must be converted in the liver and kidneys to its active form to be useful to the body.
What does vitamin D do?
The main function of vitamin D is to maintain normal levels of calcium and phosphorus in the blood, which helps support bone mineralization (hardening of bones), assists with cell function and proper nerve and muscle function. Vitamin D is needed for normal growth.
Vitamin D deficiency may result in: muscle and bone pain, diabetes, fibromyalgia, psoriasis gum disease, mood disorders, depression, improper immune function, osteoporosis, cancer, and autoimmune disease.
What are good sources of vitamin D?
Sun: the main source of vitamin D comes from exposure to the sun's UVB rays.
Food:
• Fish: vitamin D naturally in certain types of fish, such as herring, mackerel, salmon, and sardines.
• Fortified Foods: milk, some juice products, breakfast cereals, and other foods fortified with vitamin D
Supplements:
Multivitamins and calcium supplements provide vitamin D, but the amount varies widely so it's important to read labels. Vitamin D3 (cholecalciferol) is the preferred form. Vitamin D2 (ergocalciferol) is 25 percent less potent. You can find Vitamin D3 in pill form, as well as in drops.
What is the recommended vitamin D intake?
In the United States, the Institute of Medicine's recommendations for vitamin D intake are as follows:
• Birth to 50: 200 IU (5 mcg)
• 51-70: 400 IU (10 mcg)
• Over 71: 600 IU (15 mcg)
• Pregnant and nursing women: 200 IU (5 mcg)
These recommendations were set in 1997. There is growing consensus that vitamin D reference intakes need to be reassessed, based on increasing evidence that vitamin D insufficiency is widespread in the general population and that vitamin D plays a key role in bone health and the prevention of chronic health conditions.
FOOD |
Vitamin D IU |
Catfish 3 oz |
570 |
Salmon, canned 1/4 cup |
480 |
Salmon, wild 3 ½ oz |
500 |
Salmon, farmed 3 ½ oz |
75-200 |
Mackerel, 3 ½ oz |
345 |
Shrimp 3 oz |
290 |
Tuna, 3 oz |
200 |
Soymilk, Silk 1 c |
120 |
Milk |
100 |
Dannon Lite and Fit Yogurt 6 oz |
80 |
Fortified Breakfast Cereal |
40 |
Egg 1 |
20 |
Cod Liver Oil, 1 T |
1200 |
Sensible sun exposure (6-20 minutes, between 10 a.m. -3 p.m., May-Sept. |
10,000 – 20,000 |
Who may require extra vitamin D?
• People with limited sun exposure: The amount of vitamin D formed from exposure to the sun is affected by season and latitude. In general, we don’t get enough UVB rays to form vitamin D during the fall and winter months in our area.
• People who are homebound, women who wear robes and head coverings for religious reasons, and people whose jobs or work hours limit their exposure to sunlight are likely not obtaining significant amounts of vitamin D from sunlight.
• People who use sunscreen: The use of sunscreen prevents the formation of vitamin D, too. Even sunscreen with an SPF of 8, an amount found in many daily moisturizers, can greatly reduce vitamin D production.
• People with greater skin pigment: People with darker skin have more melanin, the pigment that gives skin its color. Melanin absorbs UV rays, which reduces the skin's ability to produce vitamin D. The more pigment in a person's skin, the more important it is that he or she consume enough vitamin D.
• Older people: Older people are at greater risk of vitamin D deficiency, as the ability to produce vitamin D dwindles with age. In fact, vitamin D levels in elderly subjects have been found to be approximately 30 percent of the levels found in young adults.
• People who can't properly absorb fat (fat malabsorption): Vitamin D requires some dietary fat in order to be absorbed in the small intestine. People with conditions that cause fat malabsorption, such as cystic fibrosis, celiac disease, Crohn's disease, and chronic liver disease, are more prone to vitamin D deficiency.
• People with kidney disease may not be able to convert vitamin D to its active form.
Side effects and safety:
Vitamin D is a fat-soluble vitamin. This means that, if consumed in excess, it can build up in the body and cause toxic symptoms, unlike vitamin C and other water-soluble vitamins. Because the buildup is slow, it can take months or years before toxic levels are reached. The safe upper limit of vitamin D is 2,000 IU (50 mcg) for men and women. For infants (up to 12 months), the safe upper limit is 1,000 IU (25 mcg). There is growing evidence suggesting that these upper limits may be too low. Until a new limit is set, however, it's recommended that you not exceed the upper limit unless under physician supervision. People with hyperparathyroidism or sarcoidosis should not consume vitamin D, unless they have consulted their physician.
Possible drug interactions:
The combination of vitamin D and calcium should not be taken with thiazide diuretics, because it could lead to excess calcium levels in the body. Consult your physician before taking either. People taking calcium-channel blockers should not take vitamin D and calcium, unless under a doctor's supervision, because it may interfere with the effect of the medication. Certain medications, such as phenytoin (Dilantin), primidone (Mysoline), phenobarbital, valproic acid (Depakene), corticosteroids, cimitidine (Tagamet), heparin, isoniazid (INH) and rifampin may interfere with the absorption or activity of vitamin D.
Spring is a great time to try a new vegetable or prepare one of your all-time favorites in a new way. Have you ever roasted your vegetables? Have you tried barbecuing your asparagus with other vegetables? Both are easy and they produce a taste that’s quite different than the steamed or microwave versions. Asparagus
1 cup, 32 calories, 3 grams fiber
Asparagus offers a source of protein, vitamins A and C, calcium and iron. It’s also loaded with naturally occurring phytochemicals of glutathione, rutin, and folic acid. Asparagus, next to orange juice, is regarded as the second best whole-food source of folic acid.
Roasted Asparagus
2 bunches fresh asparagus, trimmed
4 med shallots, thinly sliced
2 - 4 T olive oil
3 T red wine vinegar, divided
Salt and pepper to taste Preheat oven to 400º. Place the asparagus and shallots in a large bowl. Drizzle olive oil and 2 T vinegar and season with salt and pepper. Toss to coat evenly. Spread the asparagus spears out, on a single layer, on a baking sheet. Bake for 20 min, or until tender and bright green. This can vary, depending on the thickness. Shake the pan about half way through to roll the spears over so they cook evenly. Remove from the oven and drizzle the remaining vinegar over the asparagus. Toss lightly to coat. Serve immediately.
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Thin or thick?
Asparagus comes in several sizes, ranging in diameter from thinner than a drinking straw to fatter than your thumb. Cooks of the world have debated for ages over which are more delicious: thin asparagus or thick. Some prefer the smaller spears for their delicacy and tenderness. Others enjoy the fatter ones for their more robust flavor and meaty texture – something they can really sink their teeth into. Whichever size you chose, look for firm, brightly colored stalks with tightly closed tips.
Prepping & preparing
• Tiny, tender spears come from young asparagus plants, fatter ones derive from older plants. The smallest spears will only need to have their very bottoms trimmed before cooking. They can be sautéed, or rubbed lightly with olive oil and grilled.
• The bottom portions of larger asparagus spears can be chewy and woody; they will need to be trimmed or snapped off. To prepare them, steam or boil to make them tender. To snap off the tough portion, simply grasp the stalk with both hands and bend the bottom portion until it breaks off. The asparagus will naturally break at the point where the tender portion ends and the tough, stringy part begins.
• If you want to be less wasteful, you can peel your asparagus instead. Simply lay a stalk of asparagus flat on the countertop and strip away the tough outside layer with a vegetable peeler, beginning just below the tip and working your way toward the bottom.
Storage
Asparagus begins to lose its sweetness as soon as it's picked, so try to cook it as soon as possible after you buy it. If you plan to store it in your refrigerator for a few days, treat it like a bouquet of flowers: trim a small amount from the bottoms of the stalks using a sharp knife and place them in a tall glass with a little water in the bottom. Cover the top loosely with a plastic bag, and store in the refrigerator. This will keep the stalks firm and crisp until you’re ready to cook them.
Spring is one of my favorite times of year. The mornings are warmer, the days are longer and daffodils cheerfully bloom to remind us of new beginnings. It is also when I plan and prepare my garden with an annual goal of having a few seeds sowed prior to Mother’s Day. Once the nights get a tad warmer, the rest of the garden is ready and waiting to be planted. Spring is a time to refresh, rejuvenate, wake up, and come out of our winter hibernation. And it’s a great time to resume outdoor exercises. When spring arrives, I enjoy riding my bike, taking my dog for long weekend walks and spending time perfecting my yard and garden. Crisp cool mornings, longer days and warmer weather provide a perfect setting for these types of outdoor activities. One of my new spring activities is to commute to work on my bike. It’s a great means of exercise, saves gas money and provides an opportunity to self reflect on what I need to accomplish that day. Then, after work, it allows me to decompress on my journey home. Best of all, I have completed my exercise for the day, and it only added 20 minutes to my work commute!
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