Target the 'dirtiest' fruits, veggies; shop at farmers markets

Tips for going organic on a budget

By Amy Tousman

Q. How can I feed my family organic fruits and vegetables while watching my food budget?

A. Since organic food is often more expensive than nonorganic food, many families are faced with the decision of whether to incorporate these foods. Nutritionally there's little difference between conventionally farmed foods and organic foods, however limiting exposure to pesticide residues and promoting sustainable agriculture are reasons to consider buying organic.

Not all conventionally grown foods have pesticide residues. Insects have a natural aversion to strong-smelling foods such as onions, cabbage and broccoli. Foods with a hard outer coating, such as pineapples and avocado, are also well-protected.

An organization called the Environmental Working Group used data from tests conducted by the U.S. Department of Agriculture to rank 47 fruits and vegetables by their pesticide residue levels. Results showed some nonorganic fruits and vegetables had little to no pesticide residues, while others contained residues from several pesticides.

The working group created a list of the worst offenders, called the "dirty dozen," as well as a list of fruits and vegetables with the least pesticide residues, called the "clean 15." The dirty dozen are peaches, apples, bell peppers, celery, nectarines, strawberries, cherries, kale, lettuce, imported grapes, carrots and pears. The clean 15 are onions, avocados, sweet frozen corn, pineapple, mango, frozen sweet peas, kiwi, cabbage, eggplant, papaya, watermelon, broccoli, tomato, sweet potato and grapefruit. To view the complete list, check out the food news portion of the Environmental Working Group Web site at www.foodnews.org.

The group suggests buying organic versions of the foods listed in the dirty dozen. To save money, the clean 15 foods can be purchased as nonorganics. Luckily, local favorites such as mango and papaya are on the clean 15 list.

A great way to limit pesticide exposure and save money is to buy produce from local farmers markets. Even nonorganic items sold there are often produced in smaller amounts using sustainable farming methods that require less pesticide. Since these foods are not imported, they are fresher, which means improved taste and nutritional value. Best of all, you are also supporting local farmers.

To reduce pesticide residues, wash fresh fruits and vegetables under running water. If you plan to eat the skin on foods such as apples, potatoes or cucumbers, use a small scrub brush. Peel carrots. Discard outer leaves of leafy vegetables.

Whether your produce is conventional, organic or locally grown, be sure to eat lots of fruits and vegetables. Their health benefits outweigh their risks.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

'Whole grain' is not whole story

Posted on: Saturday, June 4, 2005

PRESCRIPTIONS
'Whole grain' is not whole story

By Amy Tousman RD, CDE

Q. Are foods labeled whole grain more healthful than foods without this label?

A. With health guidelines stressing more whole grains, whole grains are suddenly being added to breakfast cereals, crackers, energy bars and other foods. Before rushing out to buy these reformulated products, consumers need to examine the food labels closely.

The main nutritional advantage of whole grains is fiber. Fiber is the indigestible carbohydrate in plant foods. The type of fiber found in whole grains helps prevent heart disease, colon cancer and constipation.

Health organizations recommend we eat at least 25 grams of fiber daily. Half of this fiber (approximately 12 grams) should come from grains. The remainder should come from fruits, vegetables and beans.

Unfortunately, many products sporting the words "whole grain" in big letters on the front of the package are no higher in fiber than they were before they were reformulated. This is because they may include a small amount of whole grain, but are not 100 percent whole grain. Sugar, white flour, or rice replaces some the whole grains.

This means that high-sugar products will usually have a smaller percentage of whole grain. Adding whole grains to cereal that is mostly sugar such as Lucky Charms or Trix does not turn these "candy cereals" into health food. These cereals are about 43 percent sugar.

When comparing the sugar and fiber content of a 1 cup serving of several varieties of Cheerios, it's easy to see how sugar affects fiber content. The unsweetened Cheerios has one gram of sugar and three grams of fiber; Honey Nut Cheerios has 10 grams of sugar and two grams of fiber; and Frosted Cheerios contains 13 grams of sugar and only 1 gram of fiber.

Shopping Tips:

• Choose cereals, crackers, breads and other grain products that are excellent sources of both whole grains and fiber.

• Sugar should not be listed as the first or second ingredient.

• Don't be fooled by cereal labels that say, "Reduced sugar." These cereals have extra carbohydrates added that are not whole grains.

• Excellent fiber sources containing at least 5 grams of fiber include Milton's Whole Grain Bread, made with whole-wheat flour, Wheat Chex and Shredded Wheat Cereals.

• Good fiber sources containing at least 3 grams of fiber include Cheerios cereal, Loves North Shore Wheat and Oats Bread and Triscuits crackers.

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

Some sun exposure OK for vitamin D

Posted on: Thursday, October 19, 2006

Prescriptions

Some sun exposure OK for vitamin D

By Amy Tousman RD, CDE

Q. Will increasing sun exposure to enhance vitamin D production cause skin cancer?

A.  Although excess sun increases the risk of wrinkles and skin cancer, new medical evidence suggests some sunlight is beneficial. Sunlight prompts our bodies to make Vitamin D. Luckily, the amount of sunlight needed to make Vitamin D is much less than the amount that causes skin cancer.

Vitamin D is essential to building bones. It also regulates cell growth and is involved in immunity.

Research shows that vitamin D decreases the risk of many types of cancers. It prevents runaway cell proliferation often seen with cancer.

Vitamin D deficiency has been linked to immune system disorders including multiple sclerosis, rheumatoid arthritis and type 1 diabetes. It also may play a role in inflammation seen in heart and gum diseases. More research is still needed in these areas.

In recent years, deficiency has been observed in all age groups. In light of research showing vitamin D's potential to prevent diseases and the prevalence of deficiencies, experts recommend we get at least 1,000 International Units daily from a combination of sun, supplements and food.

Food sources include oily fish, milk and eggs. It's difficult to get enough vitamin D from food alone. As we age, our ability to absorb vitamin D from the sun decreases so those older than 50 may need supplements. Choose supplements containing vitamin D3, as this is the most effective form.

Some experts think we have gone overboard with sunscreen. While protecting ourselves from wrinkles and skin cancer, they say we are risking more deadly forms of cancer and other diseases. A balance is needed between the amount of sun that prevents vitamin D deficiency and the amount that prevents skin cancer.

Vitamin D experts recommend limited sun exposure. Skin should not turn red. For most people, 10 to 15 minutes daily of sun without sunscreen is adequate. If your skin is fair, 5 minutes is better. Dark skin absorbs less vitamin D from the sun, so people with dark skin may need 20 minutes. Individuals at high risk for skin cancer may be better off with supplements rather than sun exposure. Check with your dermatologist.

Exposing lots of skin for a short time works best. Shorts and T-shirt or a bathing suit provide adequate exposure. When your time is up, protect your skin and slather on the sunscreen!

Amy Tousman is a registered dietitian and certified diabetes educator. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Vitamin C may lower smoke-exposure risk

Posted on: Thursday, July 27, 2006

PRESCRIPTIONS
Vitamin C may lower smoke-exposure risk

  By Amy Tousman RD, CDE

 Q. Can vitamin C supplements protect me from getting lung cancer from secondhand smoke?

  A.  The surgeon general recently warned that any amount of secondhand smoke exposure is dangerous. Although smoking has been banned in restaurants and many workplaces in Hawai'i, those who live with smokers might not be able to avoid exposure to it.

The levels of vitamins C and E are reduced in smokers. Vitamin E is one of the first lines of defense against toxins generated by cigarette smoke. Vitamin C supplements reduce vitamin E losses in smokers.

Vitamin C supplements also decrease oxidative damage to the cells of smokers. Oxidation in the body is similar to the process of rust damaging metal. Oxygen mixes with certain chemicals in the body, damaging cells. This increases cancer and heart disease risk. Vitamins C and E are called anti-oxidants because they help prevent oxidation.

Nonsmokers exposed to secondhand smoke also have low vitamin C levels. Several years ago, University of California researchers wanted to find out if vitamin C could reduce oxidative damage in folks exposed to secondhand smoke as it does in smokers.

The study divided 67 nonsmokers who were regularly exposed to secondhand smoke into three groups. One group was given 500 milligrams of vitamin C daily. The second group was given a mixture of vitamin C, vitamin E and the antioxidant alpha-lipoic acid. The third group took placebo capsules.

Levels of F2-isoprostanes were measured. These substances cause cell damage and form artery-blocking plaque. After two months, blood levels of F2-isoprostanes dropped by 11 percent for the vitamin C group and 12 percent in the group taking the mixture.

Vitamin C was beneficial even without the addition of vitamin E and alpha-lipoic acid.

This study was done for too short of a time to predict whether the vitamin takers are less likely to develop lung cancer or heart disease in the future.

In a later study, vitamin C supplements reduced C-reactive protein in smokers and those exposed to secondhand smoke. High levels of this protein can increase heart disease risk.

Taking vitamin C doesn't make smoking or exposing others to smoke healthy. However, if you can't escape frequent exposure to second-hand smoke, it may be worthwhile to take vitamin C supplements. You should also eat lots of vitamin C-rich foods such as papayas, mangos, strawberries, bell peppers and broccoli.

Amy Tousman is a registered dietitian and certified diabetes educator. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

Soluble fiber can relieve irritable bowel syndrome

Posted on: Thursday, February 9, 2006

Prescriptons

Soluble fiber can relieve irritable bowel syndrome

By Amy Tousman RD, CDE

Q. What can I eat to control my irritable bowel syndrome?

A. Imagine dealing with stomach cramps, bloating, gas, diarrhea and constipation on a regular, even daily, basis. That is what many sufferers of irritable bowel syndrome live with. IBS is a disorder in which the bowel (large intestine) and the nerves in the stomach are extra sensitive. Many with this condition suffer in silence, too embarrassed to discuss it with anyone.

Fear of eating is often an issue for IBS suffers.  Different foods cause symptoms in different people, so there isn't a standard diet for all people with this condition. Even so, there are some foods that seem to be universal triggers for most IBS suffers. They include red meats, pork, fatty or fried foods, milk products, alcohol, sodas, coffee (decaf or regular). Fructose found in honey or high-fructose corn syrup causes symptoms in many people.

Increasing a type of fiber called soluble fiber is helpful in both preventing and relieving symptoms. Soluble fiber is found in oatmeal, barley, carrots, sweet potatoes, soybeans, bananas, applesauce, peas, strawberries, blueberries, mangoes and papayas. It also is found in Metamucil. This is a different type of fiber found in whole wheat, bran and many raw vegetables, which may aggravate symptoms.

Soluble fiber prevents diarrhea and constipation by forming a gel in the intestines. This controls the speed that food flows through the intestines and normalizes contractions of the colon. Normalizing these contractions also prevents spasms in the stomach that are responsible for abdominal pain. Eating a source of soluble fiber at the beginning of each meal improves digestion.

It also helps to eat small portions at each meal, but eat more frequently, up to six times daily. Smaller meals will produce less stimulation of your stomach and intestines, making them less sensitive.

Drink hot peppermint tea several times daily. This soothes the stomach and relieves spasms.

When you can't eat anything, these foods go down easily:

French or toasted white bread.

Toasted bagels or English muffins, plain

Pretzels

Fat-free saltines

Plain angel food cake Plain cooked noodles

Rice 

If you think you may have irritable bowel syndrome, see a gastroenterologist for a diagnosis. IBS has similar symptoms to several other conditions including Crohn's disease, ulcerative colitis and celiac disease, which have different treatments than IBS.

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice. 

Prescription niacin differs from over-the-counter form

Posted on: Thursday, May 31, 2007

Prescription niacin differs from over-the-counter form

By Amy Tousman RD, CDE

Q. My doctor gave me a prescription for niacin to lower my cholesterol. Since niacin is a vitamin, can't I just buy it at the health food store?

A. Many over-the-counter niacin pills are not acceptable substitutions for prescription Niacin. Niacin is a B vitamin found in meat, fish, milk, eggs, green vegetables and cereals. It is sold in two forms: nicotinic acid and nicotinamide. When taken in low doses (20 to 40 mg) for nutritional purposes, these two forms have identical effects. However, at high doses, each has its own effect. Over-the-counter niacin supplements sold in health food, grocery and drug stores are often in the form of nicotinamide. The type found in prescription niacin is nicotinic acid. In the 1950s, it was shown that large doses of nicotinic acid (but not nicotinamide) could lower blood cholesterol. Nicotinic acid lowers cholesterol in a different way than the widely prescribed statin medications. Statins mainly lower LDL cholesterol, while niacin dramatically raises HDL. HDL is often referred to as "good cholesterol" because it helps remove LDL cholesterol (the type that causes heart attacks) from the body. HDL is like a garbage truck, picking up stray LDL and sending it to the liver for disposal. Niacin is the most effective medication for increasing HDL; therefore if your HDL levels are too low, your physician may prescribe niacin. Nicotinic acid used to be available only in an immediate-release form. This meant the whole dose entered the blood stream at once. High doses caused flushing of the skin (redness, tingling and itching). Although this side effect was harmless, it was still annoying. Now, an extended-release version is available by prescription. The extended-release form reduces flushing by approximately 80 percent. There is at least one over-the counter product called Slo-Niacin that contains nicotinic acid in similar doses to prescription products. As with other cholesterol-lowering medications, there is a possibility of liver damage when taking large doses of niacin. It also may affect the blood sugar in some people. For these reasons, your physician should monitor your liver function and blood sugar levels while on high-dose niacin therapy. Dosage for lowering cholesterol is usually 250 to 2,000 milligrams per day. This is quite a bit higher than the 14 to 16 milligrams per day that is recommended to meet our nutritional needs. Because the doses needed to lower cholesterol are much higher than the amount needed for nutrition, and the risk for side effects greater, prescription niacin is considered to be drug therapy rather than nutritional therapy. Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

Supplements might ease some arthritis

Posted on: Thursday, May 25, 2006

PRESCRIPTIONS
Supplements might ease some arthritis

By Amy Tousman RD, CDE

Q. Will glucosamine and chondroitin supplements relieve my arthritis pain?

A. The jury is still out on whether folks with one type of arthritis, called osteoarthritis, may benefit from the supplements glucosamine and chondroitin.

These substances, which occur naturally in our bodies, help produce and maintain cartilage, our built-in joint cushions. Osteoarthritis occurs when cartilage is worn down and not replaced.

Studies of the effectiveness of these supplements in preventing cartilage deterioration and reducing pain show mixed results. Some small studies show positive effects from glucosamine.

Results from the first phase of a large study sponsored by the National Institutes of Health add to the confusion. For six months, 1,583 patients with osteoarthritis of the knee were given one of five treatments: glucosamine, chondroitin, a combination of the two, Celebrex (a prescription medication used for arthritis pain), or a placebo, or fake pill.

Overall, neither glucosamine nor chondroitin, alone or in combination, worked better than the placebo pill. In fact, 60 percent of those given the fake pill felt less pain after taking it!

A small subgroup of participants who had moderate to severe pain showed positive results. This group felt more relief from the combination supplement than those who took the placebo.

The type of glucosamine used may have influenced the results. This study used glucosamine hydrochloride. Many previous studies that showed positive results used a different form — glucosamine sulfate.

Phase 2 of this study is now under way. When this phase ends, participants' knees will be X-rayed to see if the supplements slow loss of cartilage over the long term. Medications such as Tylenol, aspirin, ibuprofen and naproxen help relieve arthritis pain but don't affect the underlying loss of cartilage. They may also cause stomach bleeding or ulcers.

If glucosamine and chondroitin delay cartilage loss without the side effects of other treatments, they may be worthwhile.

If you have moderate to severe knee pain from osteoarthrithis, check with your doctor about trying these supplements. They make take up to two months to start working.

Glucosamine supplements are derived from the shells of shrimps, crabs or lobsters, so those with seafood allergies should avoid them. Glucosamine also may raise blood sugar in some diabetics.

You can also relieve pain and increase mobility by doing exercises such as tai chi, water-exercise or walking. If you are overweight, losing weight takes pressure off your joints.

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Ho-nolulu, HI 96802; fax 535-8170; or islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

Jury's still out on coconut oil benefits

Posted on: Thursday, April 10, 2008

Prescriptions

Jury's still out on coconut oil benefits

By Amy Tousman RD, CDE

Q. Should I take extra-virgin coconut oil to lower my cholesterol?

A. The effects of coconut oil on health are not entirely clear. Coconut oil is high in saturated fat. Saturated fats and partially hydrogenated fats are known to clog our arteries. Hydrogenation is the process of adding hydrogen to liquid fats to make them more solid.  The coconut oil that is added to foods is partially hydrogenated.

A product which is not partially hydrogenated, called "extra-virgin coconut oil" is being promoted on the Internet as being healthful. Advocates claim that it promotes weight loss, lowers cholesterol, controls diabetes, prevents cancer and improves digestion. Many of these Web sites make claims that go beyond what the limited research tells us. The FDA has taken action against several companies that promote extra-virgin coconut oil for making unproven claims.

The saturated fatty acids in coconut oil are shorter in length than those found in animal foods. This means the body may use the fat in coconut oil differently than the fat in meat. This is why coconut oil might not be as harmful to your heart as a loco moco or chicken katsu plate.

Studies on the effects of coconut oil on heart health have shown mixed results. Some research indicates it may increase heart disease risk. Studies of people in Indonesia, the Philippines, and India, where coconut products are routinely eaten, have not shown a link between coconut oil and heart disease. This may be because people in these countries tend to eat a healthy diet overall, consuming lots of fruits, vegetables and grains, while keeping meat intake low.

In a study on Pacific Islanders, coconut oil added to the regular diets of participants improved cholesterol levels compared to butter fat. However safflower oil improved cholesterol more than coconut oil.

When it comes to heart health, the jury is still out on coconut oil. It may end up being neutral like the fats in dark chocolate. Extra-virgin coconut oil is certainly not a miracle food! In contrast, the benefits of fish oil, canola oil, and extra-virgin olive oil have lots of research showing their benefits to heart health.

Fresh coconut contains fiber and vitamins. If you use extra-virgin coconut oil or fresh coconuts, do so in moderation. Extra-virgin coconut oil is just as high in calories as other oils — approximately 120 calories per tablespoon.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Although nutritious, acai not a cure-all

By AMY TOUSMAN RD, CDE
Publication: The Honolulu Advertiser (Hawaii)
Date: Thursday, January 15 2009

Although nutritious, acai not a cure-all

Q. Is acai healthier for me than other fruits?

Although nutritious, acai not a cure-all

A. A purple berry called acai (pronounced "ah-sah-ee") is being touted as the latest superfood. The Internet is full of claims that acai can help you lose weight, fight cancer, slow aging, lower cholesterol,

increase energy, improve sleep, alleviate joint pain and more.

Research shows acai is loaded with antioxidants and nutrients that are well absorbed by the human body. These studies are a good start, but should not be the basis for some of the outrageous claims being made. It is unknown whether acai provides a greater health benefit than other high-antioxidant foods such as blueberries, concord grapes, pomegranates and dark chocolate.

Some claims about acai may prove to be true. To find out, a large group of people need to be given a daily dose of acai, while another group takes a placebo. These people should be monitored for disease over several years. Nobody has done this, therefore health claims for acai are only speculation. The hype is getting way ahead of the science.

In a recent study, acai extracts destroyed a large amount of leukemia cells in culture dishes. Mango and grape extracts do the same thing. This is far from showing these extracts have any effect on leukemia cells in the body. Acai has not yet been proven to be effective for cancer in humans. In fact it may actually interfere with the actions of certain chemotherapy drugs.

You can't find fresh acai berries in a store or farmers market. They are only grown in the Amazon rainforest. The berries spoil very quickly, making it impossible to ship them long distances.

Acai is sold as a frozen pulp, juice, powder or capsules. There's a huge difference between eating the berries or pulp and using acai capsules. It's difficult to package all of the beneficial substances in foods into a capsule.

Acai products are often promoted on the Internet for weight loss. There's no research proving they work. It's easy to find complaints from disappointed consumers who didn't get results when using acai to lose weight.

Bottom line: Acai is a highly nutritious fruit that can be consumed as part of a healthy diet. Just don't expect it to cure all your ills. If you smoke, eat unhealthy foods, and don't exercise, taking a daily dose of acai will not keep you healthy.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Weight-loss expenses get some tax breaks

Posted on: Saturday, March 20, 2004

PRESCRIPTIONS
Weight-loss expenses get some tax breaks

By Amy Tousman RD

Q. Can I deduct the cost of a weight-reduction program from my taxes?

A. It depends.

The Internal Revenue Service allows some taxpayers to deduct expenses for weight management. Deductible expenses include gastric-bypass surgery, nutrition counseling, physician and hospital-based programs, some commercial weight loss programs, and FDA-approved weight-loss drugs.

To qualify, you must have a physician document that you are either obese or have a medical condition that would benefit from weight loss. Examples of such conditions are heart disease, high blood pressure, type 2 diabetes and high cholesterol.

You can't deduct health-club dues, nutritional supplements, over-the counter products, diet foods, or exercise equipment. Joining a weight-control program to improve your appearance, for general health or to lose a few pounds does not qualify.

There are two categories of taxpayers eligible:

1) Taxpayers who itemize deductions can add weight-management costs to their medical and dental expenses. The catch is: You can only deduct for expenses that exceed 7.5 percent of your adjusted gross income. This means that if your adjusted gross income is $50,000, you could only deduct medical expenses exceeding $3,750.

2) Employees who set aside pre-tax dollars in Medical Savings Accounts or Flexible Spending Accounts can include weight-management costs.

With these accounts, your employer deducts money from your paycheck before taxes. This money can be used for weight-management, medical, and dental expenses during the year. Your employer reimburses you for these expenses as they occur. You are not taxed on the money deducted.

The advantage of Medical Savings or Flexible Spending accounts is that any amount can be deducted. Expenses do not need to exceed 7.5 percent of your income.

You still need a written doctor's order for weight-loss treatment. The types of deductible expenses are the same as for those who itemize.

Anyone who has a medical need for weight loss should have access to the appropriate programs. Unfortunately, many insurers do not cover nutritional counseling or weight-management programs.

Ask your employer to request these programs be included in insurance packages for employees.

If your doctor refers you to a dietitian or a weight management program, demand reimbursement from insurers.

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column.

Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or e-mail islandlife@honoluluadvertiser.com.

This column is not intended to provide medical advice.

Forget fad diets for long-term weight loss

Posted on: Thursday, July 6, 2006

PRESCRIPTIONS
Forget fad diets for long-term weight loss

By Amy Tousman RD, CDE

Q. Will I lose more weight on a low-carbohydrate diet or a low-fat diet?

A. In the short run, you can lose weight on many types of diets. The more important question to ask is which plan keeps the weight off permanently. Since many fad diets come and go, it is important to study several approaches.

Last January, the Journal of the American Medical Association published a study comparing four popular diets. Outcome measures included effectiveness of the diets for weight loss and cardiac risk factor reduction over a one year period.

The study looked at 160 overweight or obese adults known to have high blood pressure, abnormal cholesterol levels or elevated blood sugar levels. They were randomly assigned to one of four diets:

Atkins (low carbohydrate): 20 grams daily carbohydrate initially, gradually increasing to 50 daily carbohydrate grams.

Zone (moderate carbohydrate): 40 percent carbohydrate, 30 percent fat, 30 percent protein at all meals.

Weight Watchers: restriction of portion sizes and calories to 1,200 to 1,600 calories daily.

Ornish (very low fat): 10 percent fat, vegetarian diet.

Dietary advice was given for the first two months. After this time, participants chose their own level of adherence to the recommended diet.

Dropout rates were high on all plans. Only 53 percent of those on the Atkins plan and 50 percent of those on the Ornish plan completed the study. Completion rates were somewhat better for Zone and Weight Watchers with 65 percent staying on each of those plans. The higher dropout rates for the Atkins and Ornish groups suggest many individuals found these diets to be too extreme.

For those who completed the study, weight loss also was similar between all diet plans. After one year, average weight loss for those on Atkins was 5 pounds, while the average for each of the other plans was 7 pounds. In each diet group, approximately 25 percent of the initial participants kept off more than 5 percent of their initial body weight after one year.

None of the diets reduced blood pressure or blood sugar significantly; however the ratio between bad and good cholesterol improved on all four plans.

This study demonstrates that different approaches work for different people. It is important to choose an eating plan that you can stick with over the long haul. Sometimes making a few small changes works best. Forget the latest diet fad and make changes you can live with permanently.

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

Properties of 'real' wasabi fight germs

Posted on: Thursday, December 21, 2006

Properties of 'real' wasabi fight germs

 By Amy Tousman RD, CDE

 Q. Can wasabi prevent food poisoning?

A. Lately, we have been bombarded by headlines of illnessness caused by foods, contaminated with E. coli bacteria. A few months ago, it was spinach, and a few months ago, it was lettuce at several mainland Taco Bell restaurants. It would be great if there was a magic substance that could protect us from all these nasty germs.

Well, there sort of is. In the 10th century, a Japanese medical encyclopedia describes germ-fighting properties of the Wasabia japonica plant, from which "real" wasabi is derived. Because raw fish may be prone to bacterial contamination, it is thought that this was one reason that wasabi was eaten with raw fish by the Japanese in the old days.

Recent studies have shown that substances called allylisothiocyanates found in the roots, stems and leaves of the W. japonica plant inhibit the growth of several types of food poisoning bacteria. They are especially effective against E. coli and staphyloccocus bacteria, common culprits in contaminated food.

Unfortunately, the green paste we see on our plates when we order sushi is usually not "real" wasabi. Neither are the tubes of green paste or powder we get from the grocery store. They are usually made of horseradish, starch binders, green food coloring, and possibly mustard. They don't contain any part of the W. japonica plant, which is difficult to grow. It is quite expensive compared to the European horseradish that is used as a substitute.

Although horseradish comes from a different plant than wasabi, it may still offer some protection against food poisoning. Horseradish contains bacteria-killing allylisothiocyanates but in different amounts than wasabi. Results of a Japanese study discussed in the journal Biofactors showed that both European horseradish and wasabi inhibit food poisoning bacteria.

The best protection from food poisoning is to avoid eating contaminated food. Unfortunately, we don't always know when food has pathogens until we become sick. They're not usually detectable by smell or taste.

As for wasabi, fresh wasabi root grown in Oregon and New Zealand is available on the Web. Big Island farmer Lance Yamashiro also grows it. It may be available at some Japanese markets. It is served in some upscale restaurants on the Neighbor Islands and at Alan Wong's on O'ahu.

Because of the high cost of real wasabi, I will probably continue to enjoy the rush of heat in my nostrils provided by faux wasabi for now.

Amy Tousman is a registered dietitian and certified diabetes educator. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Form of vitamin E may help heart

Posted on: Saturday, November 15, 2003

PRESCRIPTIONS
Form of vitamin E may help heart

By Amy Tousman RD

. Should I take vitamin E supplements to prevent a heart attack?

A. This has been the subject of much recent debate. Past research showed that vitamin E could improve heart health by preventing cholesterol from combining with oxygen and damaging arteries. It also seemed to help prevent blood clots that could cause blockages in arteries. Many recent studies have failed to show such a benefit from vitamin E.

These conflicting results may be due to the form of vitamin E studied. There are several types of vitamin E. A form called alpha-tocopherol is found in most supplements. Another form called gamma-tocopherol is the main type in food.

In most of the studies where no benefit was found, alpha-tocopherol supplements were used. Few studies have tested gamma-tocopherol. This is surprising because people with heart disease have less of the gamma form in their blood than healthy people. Also, too much alpha-tocopherol can suppress gamma-tocopherol.

A study published in the March 2003 American Journal of Clinical Nutrition sheds some light on this. In this study, healthy volunteers took either alpha-tocopherol alone or mixed tocopherols which included alpha, delta and high amounts of gamma-tocopherol. A control group took no supplement.

A test called "Platelet aggregation" was done on participants. This test measures the ability of blood platelets to clump together and form dangerous blood clots. After supplementation, platelet aggregation decreased in the mixed-tocopherol group but not in the alpha-tocopherol group or the control group. These results indicate a decreased risk of a heart attack or stroke. It seems that a combination of tocopherols has a more powerful effect than any one type alone.

Although this is only one study, it seems reasonable to recommend a supplement of 200 to 400 international units daily, especially if you are at increased risk for heart disease.

Choose a "mixed tocopherol" formula containing several forms of vitamin E including d-alpha-tocopherol and gamma-tocopherol. Examples include Nature's Bounty High Gamma Complete, GNC Isomer E and Natrol Tocotrien-All.

Include vitamin E-rich foods such as avocados, peanuts, pistachios, walnuts, almonds, sunflower seeds and safflower oils in your diet. Although foods have less vitamin E than supplements, they contain the right mix of all forms of vitamin E.

These foods are high in calories, so if you are watching your weight, limit portions of these foods to 1 to 2 tablespoons per day.

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice

Video games not a substitute for exercise

Posted on: Thursday, March 20, 2008

Prescriptions

Video games not a substitute for exercise

By Amy Tousman RD, CDE

Q. Does playing Wii tennis count as exercise?

A. Video games like Wii sports can help get kids off the couch and involved in physical activity, but are not a replacement for real exercise. Although they may help motivate a child who is less active, parents should not be lulled into a false sense of security. Virtual sports are not nearly as intense as the actual sports they imitate and therefore should not be a child's only form of physical activity.

Wii sports are different than traditional joy-stick controlled games because they use a motion-sensitive wireless controller, requiring players to swing their arms to simulate swinging a tennis racket or hitting a baseball.Another interactive video game, Dance Dance Revolution, requires players to step on a pad andcopy dance moves.

A recent study found that teenagers playing an active Wii game (tennis or boxing) burned approximately 60 more calories per hour than playing a sedentary X-Box 360 game. This isn't a huge amount of calories.

A child at rest burns about 70 calories per hour. An hour of XBox Project Gotham 3 Racing burns about 107 calories. An hour of Wii Tennis burns about 179 calories. This is certainly less than an hour of real tennis which burns 300-500 calories.

The Centers for Disease Control and Prevention recommend that kids perform 60 minutes of moderate to vigorous physical activity daily. Physical activity should burn up at least three times as many calories as when they are at rest.

Virtual sports games offer some benefits. They can improve hand-eye coordination and build a child's confidence. Active virtual sports can be part of a healthy lifestyle by getting a sedentary child up on their feet and moving.

These games may make a small contribution toward weight loss, but keiki should also be encouraged to participate in other physical activities as part of a balanced life.

Families should take advantage of our beautiful mountains, ocean and climate by hiking, biking, swimming and enjoying other outdoor activities.

  Amy Tousman is a registered dietitian and certified diabetes educator. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice

During Wii tennis, players move their arms, but are not running around chasing tennis balls. Most virtual sports games are not intense enough to qualify as aerobic exercise. To burn a lot of fat and calories, you need to use the large muscles in your legs. If set to the "workout" level, however, the Dance Dance Revolution game burns a substantial amount of calories since participants are actually dancing.

Certain foods may irritate bladder

Posted on: Thursday, February 1, 2007

Prescriptions

Certain foods may irritate bladder

By Amy Tousman RD, CDE

 Q. How does my diet affect urinary incontinence?

A. Urinary incontinence can be an embarrassing problem. Leaking a bit of urine when you cough, sneeze, or lift heavy objects is called "stress incontinence." Frequent, strong urges to urinate often followed by a slight leakage is called "urge incontinence" or overactive bladder.  Limiting certain foods and beverages, controlling weight, and doing Kegel exercises may provide relief.

Approximately 13 million people in the United States, mostly women who are middle-aged and older, experience urinary incontinence.

Overweight women and women with Type 2 diabetes have a 50 percent to 70 percent increased risk of suffering from incontinence.

Women who were at risk for diabetes and lost 5 percent to 7 percent of their body weight while participating in the National Institute of Health's Diabetes Prevention Program had fewer episodes of stress incontinence. Other studies have found that weight loss can reduce symptoms of stress incontinence and overactive bladder.

Overactive bladder symptoms may improve with some dietary changes. Caffeine, alcohol, acidic foods, spicy foods and carbonated drinks can irritate the bladder.

Caffeinated coffee and tea stimulate the bladder. They are also diuretics, meaning they remove water from the body. The carbon dioxide in carbonated sodas can irritate the bladder.

Alcohol, a mild diuretic, can affect both types of incontinence. It also interferes with the nerve signals from the brain to the bladder that tell it when to go and when to hold urine.

If you have overactive bladder, spicy foods such as chili peppers and horseradish may irritate the lining of the bladder. This is also true of acidic foods such as oranges and cranberry juice. Although cranberry juice can clear up bladder infections, it does not help with urge incontinence.

Some of these foods and drinks may cause symptoms in one person and not in another. You can try eliminating the foods or drinks you suspect are causing the problem, then re-introduce them one by one to see what amount you can handle (if any) without evoking symptoms.

Kegel exercises can strengthen the muscles that control urine flow. Do them by contracting the muscles you would use to stop urinating. Squeeze the muscles for 5 to 10 seconds, then relax. Repeat 10 to 15 times per session several times daily.

If none of these suggestions provide relief, your doctor can prescribe medications to decrease the severity of these symptoms.

Amy Tousman is a registered dietitian and certified diabetes educator. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Before you blame turkey for lethargy ...

Posted on: Thursday, November 30, 2006

Prescriptions

Before you blame turkey for lethargy ...

 By Amy Tousman RD, CDE

 Q. Can turkey really make you sleepy?

A. Another Thanksgiving has passed and the last of the leftover turkey has disappeared. Many of you will eat turkey again as part of your Christmas dinner, so this question deserves an answer.

It is common to feel tired after a holiday meal.  Many people mistakenly believe it is the fault of the turkey. They blame it on an amino acid in turkey called tryptophan.

This belief is fostered by the fact that once tryptophan enters the brain, it is converted to serotonin, a brain chemical that elicits relaxation and calmness.

However, for tryptophan to have a sedative effect, it must be taken on an empty stomach. It loses its sleep-promoting abilities when eaten with other foods. Since turkey is usually eaten with gravy, stuffing, sweet potatoes and other treats, its tryptophan would be rendered useless.

In order for tryptophan to make you tired, it needs to get into the brain. When other foods are eaten in the same meal as the turkey, the amino acids in these foods compete with the tryptophan for entry into the brain. Tryptophan is at a disadvantage because it is found in smaller amounts than other amino acids in most foods. Not enough tryptophan reaches the brain to have a sedative effect.

Many other foods have tryptophan: Salmon, cheese, beef and soybeans contain even more tryptophan than turkey. No one complains about being tired after eating these foods.

Then why are you sleepy after a holiday meal?

Overeating is the most likely explanation. Feeling sleepy after consuming large quantities of food is normal. Many of the foods consumed during the holiday meal are heavy, containing a lot of fat. These types of foods take a long time to digest, therefore inducing sluggishness.

Alcohol consumption during the meal can also have a sedative effect.

To avoid feeling tired after a holiday meal, watch your portions. Rather than gobbling up your food, eat slowly. This helps you recognize when you have had enough to eat. Stop eating when you are approximately 80 percent full. The carbohydrates in your meal will expand in your stomach, and later you will feel 100 percent full.

It is OK to leave some food on your plate. You can always have leftovers later.

Amy Tousman is a registered dietitian and diabetes educator for Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Tomato products may lower heart disease risk

Posted on: Saturday, September 13, 2003

PRESCRIPTIONS
Tomato products may lower heart disease risk

By Amy Tousman RD

Q. I have heard tomatoes can help prevent pro-state cancer; can they also prevent heart disease?

A. A recent Harvard University study suggests that eating one serving daily of tomato-based foods such as tomato sauce could lower your risk for heart disease. The study results were reported in the July issue of the American Society for Nutritional Sciences.

Researchers reviewed the diets of 40,000 women from the ongoing Women's Health Study. Controlling for factors such as age, family history, and health indicators, they found that the women who consumed seven or more servings of tomato-based foods per week, including tomato juice, tomatoes, tomato sauce, or pizza had a nearly 30 percent reduction in risk for heart disease compared with women who ate less than one and one half servings per week.

It is well known that an antioxidant called lycopene found in tomatoes reduces risk for prostate cancer. The Harvard researchers wanted to see if lycopene in tomatoes might also lower heart disease risk.

In this study, the lycopene intake itself was not significantly associated with reduced heart disease risk. However, when the researchers looked at food intake, there was a clear benefit to heart health for those who consumed the tomato-based products on a regular basis.

It is possible that a substance in the tomatoes other than lycopene could be providing the heart benefit. Some researchers have previously found that a substance called P3 found in tomatoes stops platelets from clumping together in the blood. This prevents formation of dangerous clots that can cause heart disease.

This study is promising due to the large number of women studied. The results agree with those of other studies on the health benefits of tomatoes. Even so, it is possible that people who showed benefits from eating the tomato foods might eat healthier overall than those who ate less tomatoes. Their diets may have been higher in fruits and vegetables to begin with. More research is needed to control for these factors.

Although these results are preliminary, this study suggests that tomatoes can have a beneficial effect on cardiovascular disease prevention. If choosing pizza, chili, or spaghetti for your tomato sauce serving, try the vegetarian varieties which give you the benefits of tomato sauce without the artery clogging fatty meats found in these foods. For great flavor, try our locally grown Kamuela and Hau'ula tomatoes.

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column.

Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

Eating more balanced meals can ease sugar cravings

Posted on: Saturday, September 4, 2004

PRESCRIPTION
Eating more balanced meals can ease sugar cravings

By Amy Tousman RD, CDE

Q. I am trying to lose weight, but I often crave sweets.Why I don't have the will power to avoid sweets?

A. We are born with a love for sweets. Studies reveal that when infants are fed something sweet, they want more. This is a survival mechanism leftover from prehistoric times.

Early man mostly ate fruits, shoots and nuts from wild plants. He had to walk many miles in search of plant foods. Climbing trees to find nuts and fruits, and digging for tubers, required stamina. Because wild plants are low in calories, they needed to be eaten all day long.

Fruits contain natural sugars that provided much-needed energy. The instinct to eat fruits helped sustain our ancestors.

This "sweet tooth" was passed on to future generations.

Eventually, man learned to hunt. The protein and fat from meats took longer to digest than sugars. This allowed for longer intervals between meals.

The addition of meat didn't eliminate the desire for sugar. For one thing, meat wasn't always available. Also, a sugar called glucose is needed to fuel the brain. The brain uses glucose 24 hours a day. Fruits, grains and other plant foods provide the brain with sugar.

Hunting was extremely strenuous. Chasing wild animals with spears and clubs was physically challenging, and often took many days. Once caught, animals needed to be butchered and carried miles back to camp.

We evolved during a time of scarcity. This is why we developed an instinctive desire for sweets and fat.

Fast forward to 2004. Evolution has not changed our body chemistry to accommodate modern lifestyles. No work is needed to obtain food. Technology has dramatically decreased the physical activity in our lives. Our meats are much fattier than the wild game our ancestors ate. Sugars from high-calorie sodas and desserts are cheap and plentiful.

In addition to evolution, brain chemicals and hormones influence our food intake and weight. These will be discussed in my next column.

To reduce sweet cravings:

• Eat balanced meals containing whole grains, lean proteins, vegetables, fruits and low-fat dairy products. This decreases sweet cravings by keeping your blood sugar stable.
• Eat plenty of fruits. Their sugar and fiber helps curb cravings for higher calorie desserts.
• Choose low-calorie sweets such as Fudgesicles, sorbets and hard candies.
• Satisfy a sweet craving by adding chocolate to a glass of skim milk or spreading jelly on whole wheat toast.

Amy Tousman is a registered dietitian and a member of the Hawai'i Dietetic Association. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Vitamin B12 comes in many forms

Posted on: Thursday, July 9, 2009

Prescriptions

Vitamin B12 comes in many forms

Consider severity, cause and age when treating deficiency

By Amy Tousman RD, CDE

Q. I was told I was deficient in vitamin B12. Is taking a sublingual vitamin B12 supplement better than a regular B12 tablet?

A. There are many ways to treat a vitamin B12 deficiency. B12 pills can be swallowed or taken in sublingual form, meaning they are dissolved under the tongue. Other treatments include diet, nasal gels and injections. The best method depends on the cause of the deficiency, severity and your age.

If your diet is low in vitamin B12, either increasing your food intake of B12 or taking an oral B12 tablet should be sufficient. B12 is found in meats, chicken, fish, pork, eggs and dairy products. Since B12 is only naturally found in foods of animal origin, vegans need to eat foods that have the vitamin added or take a supplement.

Stomach acid is needed to remove B12 from food so it can be absorbed in the intestines. Most people who develop a deficiency have a stomach or intestinal disorder that limits their ability to absorb vitamin B12.

B12 supplements don't need stomach acid for absorption. Sublingual pills are absorbed directly into the bloodstream, bypassing the digestive system completely. They may be a good option for some individuals.

Groups who may produce less than optimal stomach acid include the elderly, folks who take medicines that decrease acid production and folks who have undergone gastric bypass surgery. It is unclear from research whether sublingual pills work better than traditional oral B12 tablets in elderly folks. Sublingual B12 is generally recommended for folks who've had gastric bypass surgery. After the surgery, stomach acid is virtually eliminated.

A severe B12 deficiency can lead to pernicious anemia, a disorder in which your body destroys cells in the stomach that help you absorb B12. If you've been diagnosed with this condition, you may want to check with your doctor if sublingual pills could be used as an alternative to B12 injections.

Some signs of B12 deficiency include fatigue, confusion, memory loss and numbness or tingling in your hands or feet. Many of these symptoms can be caused by medical conditions other than vitamin B12 deficiency. If your blood levels of B12 are low, your doctor can perform a test that measures your ability to absorb B12. This will help determine the most appropriate treatment.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Manage stress to avoid gaining weight

Posted on: Thursday, February 28, 2008

Prescriptions

Manage stress to avoid gaining weight

By Amy Tousman RD, CDE

 Q. Can stress cause weight gain?

A. If your job is stressful, your teenager is threatening to quit school or you are caring for sick parents, it could affect your weight. Several studies have shown a relationship between chronic stress and our weight.

Our prehistoric ancestors feared being attacked by wild animals. When they were in danger their bodies reacted by flooding the bloodstream with "stress hormones" such as adrenaline and cortisol to improve alertness and strength. This reaction is often called the "fight or flight" response.

Today, we often experience emotional stress rather than physical threats, but our body's reaction is the same.

Adrenaline increases our heart rate and muscle strength. Cortisol sends sugar to our brain and muscles so we can think clearly and run fast.

After a stressful event, adrenaline exits, but cortisol lingers. Cortisol helps your body recover by increasing your appetite to help replace the energy burned while fleeing or fighting. Since you weren't running away from a saber-toothed tiger, but are sitting around stewing about your hectic life, this stress reaction can pack on the pounds.

Your body doesn't know that you didn't fight or flee, so it still responds to stress with the hormonal signal to replenish nutritional stores, making you feel hungry.

People with high cortisol levels often choose fatty, starchy or sugary foods to ease their stress. This extra sugar increases insulin levels. When faced with stress regularly, excess cortisol and insulin cause your body to accumulate belly fat. Too much belly fat increases your risk for heart disease and diabetes.

If you let your hormones rule, you will eat more. Instead, engage in activities that help reverse the stress response. These include yoga, tai chi, meditation or breathing exercises. They produce a relaxation response by slowing down your heart rate and breathing.

Another stress-buster is exercise. It burns calories and helps your brain release "feel good" chemicals. Exercise can also reduce cortisol levels.

For some people, eating in response to stress is a learned habit, rather than a hormonal response. Simply reducing cortisol won't stop you from eating fatty, sugary snacks if they're lying around your house or you're in the habit of munching whenever you're upset.

To keep your blood sugar steady, don't skip meals. Balanced meals and steady blood sugar levels reduce insulin and cortisol levels, ultimately controlling your appetite and weight.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.