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Nutrition Know-How

- Dr. Gourmet, Timothy S. Harlan, M.D.

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- Joan Garbow, MSW, LCSW, CCM

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Nutrition Know-How

Tim Harlan, MD, is currently the Medical Director at Tulane University School of Medicine and an assistant professor of medicine. He writes extensively on diet and health on his website DrGourmet.com, the easy-to-use resource to navigate complex nutrition and wellness info translated for the American kitchen.
Q:

I am 79 years old and had a triple heart by-pass 10 years ago. A year ago, I was in a minor car accident and hit my forehead. I see fog in my right eye when there isn't fog. Can I take ProSight vitamin to help this problem? I am in good health.  


Mary from FL
A:

You should see an ophthalmologist immediately. If you have any change of vision due to an auto accident that should be investigated thoroughly and it is unlikely that any vitamin will help.  

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Q:

My father is 83 and a diabetic. His appetite has decreased to the point I am going to start him on a supplement. Are there any vitamins I should also consider adding to his diet—B vitamins for example? 


Cathy from OH
A:

This is a situation that I would really want to know about if I was your father's physician. There can be a lot of reasons for change in appetite in our geriatric patients, both acute and chronic. At the same time depending on your father's diabetes, I would want to be very careful about supplement use. I am not much of a fan of supplement drinks. Many of these are simply a simple sugar (corn syrup, sugar, maltodextrans) combined with milk and flavoring. They usually contain added vitamins.

My belief is that if your dad will drink such a shake it's best to make the shake with fresh, wholesome ingredients. Choose smoothies made with yogurt, milk or soy milk and fresh fruit for a much better quality drink. Speak with your father's physician about the best choice of vitamin supplements for his particular condition. There are some that could be a problem depending on certain medications that he might be taking. Thanks for writing.
 

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Q:

I have recently developed a balance problem, actually more disorientation than balance. Scans have been done (didn't show anything), medication given to no avail and no improvement. Do you think it is possible that diet or medication build-up of some kind could be causing the problem. Triglycerides are high, and I recently started triplex for that. It has been going on for about three months. 


George from OH
A:

Dear George,

There are a number of causes of balance issues. The most common is Benign Positional Vertigo (BPV). There can be clear signs of this on physical exam that can help confirm this but oftentimes BPV is a diagnosis of exclusion with negative brain scans and lab tests. While medication can help this, interestingly, there are a set of maneuvers that can be of great benefit. The Mayo Clinic has one of the best explanations of this treatment:

Read the explanation.

While there is no clear link between high triglycerides and dizziness another common issue can be reactive hypoglycemia. This is an abnormality of how the body handles glucose with blood sugars plummeting after eating. This is easier to diagnose and we use a test called the three hour Oral Glucose Tolerance Test. A specific amount of glucose is given and blood sugars are checked at hourly intervals and a positive result occurs with abnormally low blood sugar. This can be a challenge for folks and the treatment includes eating smaller meals more often and choosing more complex carbohydrates.

Another less common reason for dizziness is Meniere's Disease. We're not exactly sure of the cause but the predominate theory is that there is a build up of fluid in the inner ear. It may also be that the makeup of that fluid is somewhat abnormal. There is some research to indicate that eating regularly, avoiding monosodium glutamate (MSG) and eating a lower sodium diet may help.

As far as medications are concerned, as a physician this is always one of the first areas that I look at. There are many medications that can cause the sorts of symptoms you are having and consulting with your doctor about each of those that you are taking is an important step.

Thanks for writing,

Timothy S. Harlan, MD
 

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Q:

I am concerned about the use of aluminum foil. I've heard that it is an unsafe metal and it leaks into foods when cooked with. What do you think? Do you have any information on this metal?


A:

Aluminum will react with certain foods, especially those that are more acidic. In some cases this can result in a metallic flavor to your dish or possibly discoloration of food.
There was evidence as early as 1965 showing a link with aluminum and Alzheimer's disease. The main source for concern was brain lesions in those who had died of Alzheimer's disease. The abnormal brain tissue contained high levels of aluminum, and it was thought that excess intake of the metal might be the cause. To date, however, there has not been convincing evidence to demonstrate that environmental exposure to aluminum causes the lesions or Alzheimer's disease. Likewise, even if there were a relationship between aluminum and disease, there are a number of other environmental sources for aluminum, including many foods, packaging, water supplies as well as medications such as antacids.

I personally use aluminum pans and aluminum foil for cooking. There are a number of treatments employed that can help reduce the tendency of aluminum to react with foods. The most common is anodized aluminum, where the outer layer has been thickened and hardened through electrolysis to render the surface less reactive. This works well for most recipes and ingredients, but for recipes where there may be a reaction between the metal of the pan and the ingredients, I will use stainless steel or enamel lined cast iron.

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Q:

Does Green Tea Extract Help Control Blood Sugars? Is green tea extract effective in controlling blood glucose or is it better just to drink a cup of green tea daily?


A:

I would avoid all green tea extract products. They have been clearly associated with liver failure. There's no guarantee that the company making them has quality controls in place to make sure of no contaminants. Likewise, many have been taken off the market by the FDA because of the inclusion of pharmaceutical-grade medications. There are very poor controls on the supplement industry and I never recommend any of these sorts of products to anyone for any reason.

Green tea, on the other hand, has been shown to have health benefits and would be a great choice. This speaks to the idea that fresh products are good for you and those that are processed are not.

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Q: Apart from calcium, what nutrients might my parents be missing?
A: Answered by Joy K. Richardson, RD, CDE

The experts have spoken: Current recommendations for vitamin D are inadequate. “National recommendations from the Food and Nutrition Board are 400 to 600 International Units (IU) a day,” said Neil Binkley, MD, an Associate Professor in Geriatrics and Endocrinology at the University of Wisconsin, speaking at the recent American Association of Clinical Endocrinologists 18th Annual Meeting & Clinical Congress. “That’s simply not enough.” Vitamin D is considered to be a very safe vitamin and many doctors are encouraging a range of supplementation from 1,500 to 2,600 IUs daily. Most of us are aware that Vitamin D is essential for bone health, but it seems that Vitamin D may also improve muscle function, which is a factor in fall prevention. As Dr. Binkley went on to say, “One of the primary killers among older adults is falls.” Young people can easily produce vitamin D through their skin following 10 to 15 minutes of exposure to sunlight. However, most of us have been encouraged to stay out of the sun and, if we do go outdoors, to slather on sunscreen or sunblock. In addition, as we age we have less ability to make Vitamin D naturally through sunlight. One health practice in Florida found that nearly 40 percent of endocrinology clinic patients over 50 years old and with diabetes and other endocrine problems, have inadequate Vitamin D levels. While the use of sunscreen may be part of the issue, doctors feel there are multiple other reasons, and more research is being done to find out why this ability diminishes. Meanwhile, folks, have your Vitamin D levels checked by your doctor and, if you need to up your daily amounts, try a few minutes of mid-morning sun on your face, arms and chest, along with Vitamin D3 (cholecalciferol)—believed to be more effective than D2— enriched lowfat dairy products and/or a Vitamin D3 supplement in the amount best determined by your doctor. This strategy may prove to be one more tool in the prevention box.

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