Diet, herbs may help relieve menopause symptoms

Posted on: Sunday, February 17, 2002

PRESCRIPTIONS
Diet, herbs may help relieve menopause symptoms

By Amy Tousman RD

Reaching the age of 50 is a milestone. But some women see it as a mixed blessing. Around this age, a woman's body makes less estrogen. This signals the start of menopause.

The word menopause comes from the Greek and Latin words for "moon" and "stop." It refers to the ending of a woman's menstrual cycle, viewed throughout history to be influenced by the moon.

As estrogen levels decrease, some women experience hot flashes, mood swings, insomnia, memory lapses, vaginal dryness, bladder infections and palpitations. Decreased estrogen also increases risk of heart attacks and brittle bones.

To counteract these effects, women have two choices: hormone replacement therapy, commonly known as HRT, or natural remedies. Your family history and health status are important in deciding which option is best.

• Hormone therapy is often a combination of estrogen and progesterone. This strengthens bones, eliminates hot flashes and relieves vaginal dryness.

Some studies indicate that hormone therapy may help prevent heart disease. However, other studies contradict this. In has been suggested that the therapy also may reduce the risk of Alzheimer's disease and osteoarthritis, but these areas need further study.

Drawbacks to hormone therapy include a slightly increased risk of breast cancer and monthly bleeding.

• Herbal remedies and a change in diet also may help prevent or lessen symptoms.

John Westerdahl, a registered dietitian and herbalist at Castle Medical Center, says hot flashes are rare in Asian countries compared to Western countries. In fact, he said, hot flashes are "so rare among women living in Japan, that there is no word in their language to describe them."

"The typical American diet is rich in meat and fat compared to Asian diets. High-fat, low-fiber diets increase the body's estrogen levels. At menopause, those on high-fat diets experience a dramatic drop in estrogen levels. Since Asian women eat less fat, they experience a less dramatic drop in their estrogen levels at menopause. This may explain why their resulting symptoms are milder or even nonexistent."

Westerdahl says that "in addition to a low-fat diet, plant estrogens may be useful in regulating hormone fluctuations that occur during menopause." They mimic the body's natural estrogen, yet are less potent than the real thing. Some sources of plant estrogens include tofu, miso, oats, broccoli, cauliflower and flaxseed.

It has been suggested that soy may suppress hot flashes. Margo Woods, a researcher at Tufts University, disputes this. Her research shows that soy does not stop hot flashes, as hormone therapy does. There is, however, a small decrease in severity and frequency of symptoms. It may be that the combination of a low-fat diet and soy products may explain the shortage of menopausal symptoms among women in Asian countries.

Known benefits of soy products include decreasing heart disease risk, protecting bones and relieving vaginal dryness. Eating soy before menopause may protect against breast cancer, but large amounts after menopause may actually promote it.

Women who have a history of breast cancer or those taking tamoxifen should limit soy to three or four servings per week. Other women can eat two servings daily.

Herbal remedies are usually weaker than hormone replacement therapy, but some are helpful. The following remedies are considered safe and effective (although you should talk to your doctor before taking them):

• Black cohash relieves hot flashes, palpitations, vaginal dryness and mood swings.

• Chasteberry helps regulate irregular periods.

• St. John's wort helps control mood swings.

• Ginkgo improves memory and concentration.

• Cranberry prevents bladder infections (10 ounces of a 27 percent cranberry-juice beverage is recommended daily.)

The following herbal products are advertised to help with menopausal symptoms, but have not been found to work in scientific studies: don quai, ginseng, red clover, licorice root (this may work, but can increase blood pressure) and wild yam.

Gynecologists feel the benefits of hormone replacement therapy outweigh those of natural therapies. Since the therapy does have drawbacks for some folks, natural remedies may be worth a try.

Whichever therapy you choose, make sure you get adequate calcium, eat a heart-healthy diet and exercise regularly.

Amy Tousman is a registered dietitian and a member of the Hawai'i Dietetic Association. Write: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column is not intended to provide medical advice; consult your doctor.

Silent liver disease plagues overweight kids

Posted on: Thursday, October 16, 2008

Prescriptions

Silent liver disease plagues overweight kids

By Amy Tousman RD, CDE

Q. Is it true that my overweight teen is at risk for liver disease?

A. Physicians in children's hospitals are seeing liver disease in more kids and teens than ever before. In a few cases, it is severe enough to require a liver transplant. One of the main causes appears to be too much body fat.

The type of liver disease seen most often in kids is called "non-alcoholic fatty liver." The American Liver Foundation estimates that 2 percent to 5 percent of American children have the condition. Nearly all of them are obese or overweight. There may be even more children with the condition, but it is hard to know since few are tested for it.

The disease begins with excess fat building up in the liver cells. This can cause the liver to become inflamed. Over time, scar tissue can form in the liver and cause a more severe condition called cirrhosis. Cirrhosis is very serious and can lead to liver failure. This is similar to what happens to the livers of some alcoholics and people with hepatitis.

Fatty liver also increases a child's risk for heart disease. If scarring hasn't yet developed, fatty liver can be reversed with weight loss.

What's scary about this disease is that it is silent. Fat can build up for years in the liver without causing any symptoms. Fatigue, stomach pain and unexplained weight loss may be present. However, they usually appear only when the disease is in its advanced stages.

Some liver specialists predict that many more of today's obese children will develop severe liver disease in their 30s and 40s, requiring a liver transplant. This will be a result of developing undiagnosed fatty liver as a child.

Fatty liver is most common in overweight children with belly fat who may also have diabetes, high blood pressure or elevated cholesterol. The American Academy of Pediatrics now recommends pediatricians do a blood test of liver enzymes every two years on obese children.

The group also recommends this test for overweight children with high blood pressure, high cholesterol or a family history of heart disease. Those with type 2 diabetes or pre-diabetes should also be tested.

The best way to combat the problem is to intervene early, while it can be reversed. Researchers are testing the diabetes medication Metformin and vitamin E as possible treatments. For now, healthy eating and exercise are your best defense.

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, Hono-lulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

Turn to fiber to lose weight, not Lipozene

Posted on: Thursday, April 5, 2007

Prescriptions

Turn to fiber to lose weight, not Lipozene

By Amy Tousman RD, CDE

Q. Can Lipozene help me lose weight without dieting and  exercising?

A. Lipozene is a supplement, advertised on infomercials, that promises weight loss without dieting or exercise. I am always suspicious of products making these types of claims.

According to the infomercial, "Lipozene is clinically proven to reduce body fat and weight." They claim that in a "university double blind study, participants not only lost weight, but 78 percent of each pound lost was body fat." This study hasn't been published in any scientific journal nor is it available on the company's Web site.

The company that makes Lipozene has a huge credibility problem. The Federal Trade Commission took legal action against it several years ago for making false, unproven claims about Propolene and Fiberthin (which coincidentally have the same active ingredient as Lipozene). They claimed these products would cause rapid, substantial weight loss without the need for diet and exercise; that weight loss would occur no matter what the consumer ate; and that weight loss would occur in all cases. They were forced to pay $1.5 million back to customers. Would you trust a company with that history?

The active ingredient in Lipozene is a soluble fiber called glucomannan. Like other soluble fibers, glucomannan works by taking up space in the stomach, thereby making you feel full.

Some small studies on glucomannan do show weight loss of approximately three to six pounds in eight weeks in obese subjects. That's less than one pound per week! Not a huge amount of weight loss.

Lipozene is an expensive way to get your fiber. A month's supply costs $45 to $90, depending on dosage. The company recommends four pills daily at $90 per month if you need to lose at least 30 pounds.

Glucomannan is derived from konjar flour, which is found in such Japanese foods as shirataki noodles and konnyaku. Glucomannan supplements are sold online and in health-food stores for a much lower price than Lipozene.

Food sources of fiber can also help you lose weight. Good sources include whole-grain cereals such as Raisin Bran or Fiber One. Other sources include starchy beans, vegetables and fruits.

Although fiber supplements may help some people lose a little weight, they will work better if accompanied by healthful changes in diet and exercise.

Amy Tousman is a registered dietitian and certified diabetes educator for Nutrition Unlimited in Kailua.  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.

Use a microwave to zap sponge germs

Posted on: Thursday, July 12, 2007

Prescriptions

Use a microwave to zap sponge germs

By Amy Tousman RD, CDE

 Q. What is the best way to clean kitchen sponges?

A. The kitchen sponge is a handy cleaning tool.  Unfortunately, kitchen sponges can also become germ magnets. Since sponges retain moisture, bacteria that can cause food poisoning can stick to sponges after clean up. Then, when you wipe something, you're just spreading around the germs.

Recently researchers at the U.S. Department of Agriculture tested several methods of disinfecting sponges. They soaked sponges for 48 hours in a solution made from ground beef and a lab growth medium to attain a high level of microorganisms (about 20 million per sponge).

Next they treated each sponge in one of five ways: soaked in a 10 percent solution of chlorine bleach for three minutes, soaked in lemon juice, or de-ionized water for one minute, heated in the microwave on high for one minute, or placed in the dishwasher operating with a drying cycle. For comparison, some sponges were left untreated.

The treatments that killed the most bacteria were microwaving and running the sponges through the dishwasher. Both methods killed 99.99 percent of the bacteria.

Using the microwave or the top rack of a dishwasher with a drying cycle are convenient ways to sanitize sponges. Be sure the sponge is wet before putting it in the microwave (you can wet it and wring it out so it's not dripping). Microwaving dry sponges can start a fire! Don't use the microwave on sponges that contain metal. Only cellulose sponges (not natural sponges) can be sanitized in the microwave. Be careful when removing the sponge as it will be hot.

Although soaking sponges in diluted solutions of bleach didn't score as high as micro-waving or using the dishwasher in this particular test, it is still effective at killing many types of bacteria that make people sick.

Whether you choose to use the microwave, dishwasher or diluted bleach, it will be better than just rinsing your sponge in hot water.

If you spill juice from raw meat, fish or poultry, you can clean it up with a paper towel that can be discarded. Afterward, you should wash the area with hot soapy water, then sanitize it with bleach and water or a commercial sanitizer.

Ideally, sanitizing should be done each day that you cook food. Discard sponges after two weeks.

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.

Kids should drink up to prevent kidney stones

Posted on: Thursday, February 5, 2009

Prescriptions

Kids should drink up to prevent kidney stones

By Amy Tousman RD, CDE

Q. Can children get kidney stones?

A. Believe it or not, children can get kidney stones. In the past, this problem was seen mostly in middle-aged adults, but it is now being diagnosed in children as young as 5 or 6. Pediatric kidney specialists are seeing a steep rise in young patients with kidney stones.

A kidney stone is made from mineral salts in the urine. If the concentration of a particular mineral in the urine is too high, crystals form. The crystals can gradually increase in size, forming a kidney stone.

Most kidney stones are tiny, about the size of a grain of sand. These small stones are usually passed out of the body, through the urine without intervention. Larger stones cause problems because they can block the drainage of the kidney, resulting in obstruction and extreme pain. Sometimes these stones can be blasted with high-energy sound waves that break them up into smaller pieces. In severe cases, they need to be surgically removed.

Too many salty foods coupled with too little water seems to be fueling the rise in childhood kidney stones. This combination reduces the amount of urine. This increases the concentration of stone-forming substances in the urine.

Children tend to drink too little water. In addition, some children do not want to go to the bathroom at school. Others don't have time or may not even feel thirsty.

Children with kidney stones can experience severe pain in their side, back or stomach. There may be blood in the urine. Sometimes there are no symptoms; the stone is accidentally discovered on an X-ray when the child is being treated for something else.

What can parents do? Make sure your children are getting enough to drink. Water helps dilute the urine so mineral salts cannot crystallize, but are instead removed from the body. If your child's urine is a dark yellow color, he or she may not be getting enough fluid.

Substitute fresh foods for processed foods in your child's meals and snacks whenever possible. Salt lurks in fast foods, canned meats, shoyu, saimin and chips.

Heredity may also play a role, so if an adult in your family ever had kidney stones, it is even more important to instill lifelong habits of good hydration and limiting salty foods in your children.

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.

Be wary of sugar-laden supplements

Posted on: Thursday, May 1, 2008

Prescriptions

Be wary of sugar-laden supplements

Q. My daughter rarely eats fruits and vegetables; can I give her Juice Plus+ gummy supplements instead?

By Amy Tousman RD, CDE

A. The supplement industry continues to play on our fears that our children aren't eating right. They have convinced people that we can fix poor diets by simply taking a magic fruit and vegetable pill. If only things were this simple.

Juice Plus+ supplements are sold as pills, wafers and gummies. They contain dried fruit or vegetable powders, added nutrients and a few phytochemicals. Nearly all the fiber has been removed. Deceptive claims are often used by distributors to market this product.

Juice Plus+ Gummies are made of 85 percent corn syrup (sugar) and 10 percent beef gelatin, as well as added nutrients. How is that healthy?

The Better Business Bureau issued a complaint against promoters of Juice Plus+ Gummies for falsely claiming their supplements are "low in sugar" and the "next best thing to fruits and vegetables."

Fruits and vegetables are loaded with vitamins, minerals, fiber, and thousands of phytochemicals. Health benefits are derived because these substances work together. Juice Plus+ doesn't come close to providing the thousands of naturally-occurring nutrients and phytochemicals we get from the real thing.

Studies on Juice Plus+ are inconclusive overall. Much of this research is flawed. None of the research compares the effects of Juice Plus+ to the effects of eating fruits and vegetables. Funding for most of the studies is provided by the manufacturer of the supplements themselves, which is a potential conflict of interest.

It's impossible to deliver the nutrients of several cups of fruits and vegetables in a Juice Plus+ capsule that weighs 800 milligrams. The University of California-Berkeley Wellness Letter states, "It would take two dozen 800-milligram capsules to provide all the nutrients in just six ounces of carrot juice!"

Folks who skimp on fruit and vegetables often eat more fatty and processed foods. No pill can make up for a poor diet.

Juice Plus+ is distributed through a pyramid marketing scheme. Distributors receive sales commissions based on how many customers they sign up. A year's supply of Juice Plus+ costs approximately $500.

Juice Plus+ is a waste of money. If your child doesn't eat much fruits and vegetables, serve them in a different way. Try smoothies, 100 percent juice pops, dried fruit and nut mixtures, or vegetable sticks with low-fat dip. You can add an inexpensive multivitamin /mineral supplement for extra insurance.

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.

Why one diet affects people differently

Posted on: Thursday, September 13, 2007

Prescriptions

Why one diet affects people differently

By Amy Tousman RD, CDE

 Q. My neighbor and I went on a low-fat diet together. She lost weight and I didn't. Why?

A.  Assuming you both ate the same amount of calories, differences in body composition (percent body fat versus muscle), frequency of past dieting attempts, and amount of physical activity could influence your results.  Differences could also be related to the amount of insulin your body secretes after meals.

Insulin is a hormone that converts blood sugar into energy for cells. A study published in the May 16 issue of the Journal of the American Medical Association showed a relationship between insulin levels and success with different diet plans; 73 obese young adults were assigned to either a low-glycemic load diet (40 percent carbohydrate, 35 percent fat) or to a low-fat diet (55 percent carbohydrate and 20 percent fat). The study lasted 18 months. Researchers wanted to learn why some people have success with low-fat diets and others don't. Although will power can play a role, sometimes there's more to the story.

Food and drinks that are high in processed carbohydrates such as sodas and white rice have a high glycemic load. This means, they cause a rapid rise in blood sugar after they are eaten. Low-glycemic-load foods are sometimes called "slow carbs" because they enter the blood gradually and have less effect on blood sugar. They include vegetables, fresh fruits, whole grains and starchy beans.

In this study, participants who secrete insulin slowly lost equally on both diets. In contrast, those with high insulin levels lost more weight on the low-glycemic-load diet (12.8 pounds) compared with the low-fat diet (2.6 pounds).

In people who pump out a lot of insulin in an exaggerated response to sugary foods and processed starches, reducing the glycemic load of the diet may keep insulin levels steady.

Past studies on low-glycemic-load diets produced mixed results. Sometimes they showed weight loss, sometimes not. This may be because nobody compared insulin levels in the participants!

Just because you're overweight does not mean your body produces excess insulin. The only way to know is by having your doctor do an oral glucose tolerance test.

When it comes to weight control, one size does not fit all. If you've had trouble losing weight on a low-fat diet, you may want to try decreasing the glycemic load in your diet.

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.

Hormones play role in gaining, losing weight

Posted on: Saturday, October 2, 2004

PRESCRIPTIONS
Hormones play role in gaining, losing weight

By Amy Tousman RD, CDE

Q. How can hormones produced by our bodies influence our weight?

A. Our appetites and the amount of fat our bodies store are influenced by the interaction between hormones produced by our bodies and brain chemicals. Some hormones involved in these processes are ghrelin, cholecystokinin, PYY, insulin, and leptin.

Ghrelin, produced by the stomach, lets the brain know when your stomach is empty and you are hungry. Cholecystokinin, produced by the intestines, signals the brain that we are full. Eating slowly allows the fullness message to reach the brain before you overeat.

PYY helps curb your appetite between meals. High-fiber foods increase blood levels of PYY. This may be one way these foods help control our weight.

Insulin influences how much sugar is burned for energy and how much is stored as fat.

Leptin, produced in the fat cells, works to keep body fat levels steady. When leptin levels are high, the brain decreases the appetite. When you try to lose weight, your fat stores decrease and leptin levels fall. The brain assumes you are starving and increases your appetite so that you can replenish your fat stores.

The body's ability to store fat during times of scarcity is a survival mechanism left over from prehistoric times. When food was scarce, the body would slow itself down so that fewer calories were burned and more were conserved. This still happens to us today if we try to lose weight too quickly or regularly skip meals.

Research suggests that some obese people are not getting the chemical signals to their brains that tell them to stop eating. In addition, overconsumption of fatty and fried foods, sugars, and white starches on regular basis can disrupt these signals.

They do this by increasing the levels of fats in the blood. This may interfere with leptin and insulin's actions on the brain, leading to an erroneous signal that the body is in danger of starving.

Hormonal variations can influence our appetites, metabolisms and weight. Even so, we can choose to be physically active rather than couch potatoes. We can choose healthy meals rather than super-sized portions of high-calorie foods.

We can pay attention to our body's hunger and fullness signals. This means we should stop eating when our physical hunger is satisfied. We should not be eating just because we are bored, stressed, or upset.

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

Beware of herbal medicine side effects

Posted on: Sunday, October 7, 2001

Prescriptions
Beware of herbal medicine side effects

By Amy Tousman RD

As herbal supplements become more popular, several adverse side effects have been reported in users who also take other medications or those users undergoing anesthesia. Dietitian Jerald Foote warned in the Journal of the American Dietetic Association, "We need to view herbal supplements as drugs. Legally, they are dietary supplements, but they are drugs as far as their action in the body." Just as you would do before taking prescription drugs, it is important to learn about potential drug reactions before taking herbal medications.

Herbs are medicines derived from plants. Sometimes, even if you take an herb for one certain reason, there can be other unintended reactions. Herbs have chemical properties just as manufactured drugs do. In fact, some prescription medications, such as the heart medication Digoxin, come from plants just as herbal medications do.

Several herbal remedies can produce potentially dangerous interactions with the commonly prescribed anticlotting medication Coumadin, also known as Warfarin. These drugs are used as blood thinners in heart patients. Products that have been documented to decrease Coumadin's effects are ginseng, St. John's wort, the coenzyme Q10 and excessive amounts of green tea. Those that increase the blood thinning effect of Coumadin are vitamin E, garlic, ginger, ginkgo biloba, papain, dong quai, devil's claw, feverfew and danshen. These products may increase bleeding in patients taking Coumadin by slowing the blood's ability to clot. Since aspirin and fish oil are also a blood thinners, they can add to these effects, especially if taken with other supplements listed above.

Some herbs interfere with the way drugs are absorbed or metabolized. Ginseng may induce resistance to diuretic drugs (which increase urination and decrease swelling). Kava, used for anxiety, may increase the action of certain antiseizure medications. St. John's wort, a popular treatment for mild to moderate depression, may interact with some antidepressant medications, chemotherapy, or HIV drugs. This herb can reduce blood levels of the HIV drug, Indinivir by more than half. As a result, the body may clear the drug before it has time to work fully; low blood levels of Indinivir can lead to drug-resistant virus. St John's wort may also affect other HIV drugs that are similarly metabolized by the body.

St. John's wort reduces the effect of the heart drug digoxin and of cyclosporin, which helps prevent organ rejection in people given transplants. It may interact with some oral contraceptives, causing bleeding between periods, and may reduce the effectiveness of oral contraceptives in preventing pregnancy.

Echinacea, used to fight colds and flu may cause inflammation of the liver if used with anabolic steroids or Methotrexate. It may antagonize immunosuppressive drugs such as those used to treat lupus and may decrease the action of corticosteroids such as Prednisone.

This is not to suggest you shouldn't use these herbs. It does suggest that it is imperative that you inform your health care providers that you are taking them and learn what you can about their interactions with medications.

Some herbal products can pose a serious health risk if taken before surgery. People often believe that a product that is "natural" is safe. This is a dangerous assumption that can put surgical patients at risk.

A report issued by the Tang Center for Herbal Medicine and Research and the Pritzker School of Medicine, both in Chicago, listed herbal supplements that are most likely to lead to complications during or after surgery. Garlic, gingko, and ginger may trigger post-operative bleeding and lead to a bleeding stroke. Ginseng may cause bleeding and low blood sugar. Ephedra can lead to heart arrythmias (irregular heartbeats). Kava and valerian can cause increased sedation from anesthesia. St. John's wort can intensify or prolong the effect of some anesthetic agents. Adverse reactions can also occur with echinacea.

If you are going to have surgery, it is important to let your doctor and the anesthesiologist know ahead of time what herbs you may be taking. The American Society of Anesthesiologists warns consumers not to take herbal preparations for two weeks prior to receiving anesthesia because of possible cardiovascular instability, prolonged anesthesia, and excessive bleeding.

When used wisely, herbal medications can add to our choices in treating certain conditions.

Amy Tousman is a registered dietitian and a member of the Hawai'i Dietetic Association.

Hawai'i experts in traditional medicine, naturopathic medicine, diet and exercise take turns writing the Prescriptions column. Send your questions to: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column is not intended to provide medical advice; you should consult your doctor.

Herbs may reduce severity of chemo

Posted on: Saturday, February 19, 2005

PRESCRIPTIONS
Herbs may reduce severity of chemo

By Amy Tousman RD, CDE

Q. Is there any way to stop the damage to healthy cells caused by chemotherapy?

A. Cancer chemotherapy, often called "chemo," involves the administration of toxic chemicals to cancer cells. These chemicals don't directly kill the cancer cells, but instead impair their ability to reproduce. Although chemo targets cancer cells, some healthy cells such as red blood cells, hair follicles and cells of the stomach lining also can be poisoned. This destruction can cause side effects such as hair loss, nausea, poor appetite and fatigue. Kidney and heart damage also are possible.

Some chemotherapy drugs harm cancer cells by generating large amounts of free radicals.

Free radicals also can harm healthy cells. Antioxidant supplements such as vitamins A, C, E or selenium may reduce healthy-cell damage by inactivating these free radicals.

Unfortunately, this potentially could reduce the cancer-fighting effects of some chemo medications.

Most studies on antioxidant or herbal supplements and chemotherapies have been done in animals or test tubes. Human testing is the best way to learn how these substances affect chemotherapy, its side effects and long-term survival.

The mineral selenium has been studied in humans. When given four days before and after the administration of the chemo drug cisplatin, an increased immune cell count and decrease in toxic effects on the kidneys was observed.

The herbs astragulus, panax ginseng and ginger also may be beneficial.

In animals, astragalus reduced immune suppression caused by the chemotherapy drug cyclophosphamide and inhibited the spread of cancer. Human studies are needed before recommending astragalus.

Panax ginseng strengthens immune response and may control cancer cell growth. A study of ginseng added to the chemo drug mitomycin resulted in increased tumor kill. Ginseng interferes with the effectiveness of tamoxifen and is not recommended for patients with estrogen-sensitive breast or uterine cancers.

In patients with tumors of the digestive system, a combination of ginseng and astragulus added to chemo reduced the chemo's toxic effect.

Ginger decreases the severity and duration of nausea after chemo. Leukemia patients who took ginger had less nausea than those given a fake treatment. Ginger can cause abnormal bleeding during chemo, so its use should be monitored by your oncologist.

Herbs and supplements should only be added to a chemotherapy regimen after consulting your oncologist.

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.

Effects of hawthorn extract can vary

Posted on: Thursday, February 7, 2008

Prescriptions

Effects of hawthorn extract can vary

By Amy Tousman RD, CDE

Q. Does hawthorn extract relieve heart failure symptoms?

A. A review of existing studies on extracts of the leaves, berries and flowers of the hawthorn plant shows it could be useful in improving symptoms of mild to moderate heart failure. It may not extend your life span, but could make you feel better.

Heart failure is a serious condition that is both debilitating and deadly. It is often due to clogged arteries that stress the heart by forcing it to work harder. As a result, the heart becomes enlarged and is unable to pump enough blood throughout the body. This causes blood and fluid to back up into the lungs. Fluid also builds up in the feet, ankles and legs, causing swelling. Fatigue and shortness of breath are also common symptoms.

Hawthorn works by relaxing the muscles in arteries around the heart, making it easier for blood to flow to the heart. It also may work directly on the heart by increasing the force of heartbeats.

Researchers from the Cochrane Collaboration combined the results of 10 studies on hawthorn. Seven of these studies looked at using hawthorn as an addition to conventional medications. Results show that hawthorn improves heart function, shortness of breath, fatigue and exercise tolerance in people with heart failure. There is good evidence that when used alongside of conventional therapy, hawthorn could bring additional benefits.

In contrast, a large, unpublished study last year found only limited benefit from hawthorn. This study was looking at longevity. Results showed that hawthorn has little effect on extending longevity.

It must be emphasized that hawthorn should only be taken under a physician's supervision. It can interact with heart and blood pressure medications, requiring doses of these medications to need adjustment. Also, hawthorn may have side effects, although usually they are infrequent and transient. They include dizziness, nausea, sweating and upset stomach.

The patients in these studies had mild to moderate heart failure. Hawthorn might cause greater side effects in patients with more severe cases who must take more powerful drugs to control their disease.

Those with heart failure should follow a low-sodium diet to reduce swelling. They are often asked to restrict their fluid intake, too.

Hawthorn should not replace conventional therapy but may be useful as an addition. Further study is needed to compare hawthorn to conventional medications used to treat heart failure.

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 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.

Glycemic load is what should matter

Posted on: Saturday, October 4, 2003

PRESCRIPTIONS
Glycemic load is what should matter

By Amy Tousman RD

Q. Should I eat foods with a low glycemic index to lose weight and control my diabetes?

 A. You'd be better off paying attention to the glycemic load of foods. Let's talk about the distinction.

Carbohydrates in foods such as rice, fruits and vegetables turn into sugar during digestion. The glycemic index measures how quickly these sugars enter your bloodstream. Foods that release their sugar into the bloodstream quickly are said to have a high glycemic index.

Books such as "Sugar Busters," "Dr. Atkins New Diet Revolution" and "The Zone" promote the idea that high-glycemic-index carbohydrates lead to obesity. They suggest that these foods cause excess insulin in blood. The authors believe this increases our appetites, resulting in weight gain.

The truth is that carbohydrates only cause a temporary rise in insulin levels. This is a natural body process and not an unhealthy one. There is no evidence that excess insulin increases your appetite. Some research suggests insulin actually suppresses the appetite.

Combining foods in a meal such as meat with rice or peanut butter with bread changes the glycemic index. Fat and protein in the meal also influence blood sugar levels.

The glycemic index does not tell you everything you need to know. For example, a carrot and table sugar have a similar glycemic index. Yet, common sense tells us that carrots are healthier than table sugar. The glycemic index also does not take the amount of carbohydrates in a typical portion of carrots into account.

The glycemic index is based on the amount of a food that provides 50 grams of carbohydrate. In the case of carrots, you'd need 1› pounds. One carrot has very little carbohydrate.

A measurement called the glycemic load is a more accurate measure. It is calculated by multiplying the carbohydrates in a serving by the food's glycemic index. Carrots have a low glycemic load. So their effect on blood sugar is negligible.

High-glycemic-load foods, such as white rice, are often low in fiber. You'll end up eating larger portions of low-fiber carbohydrates to feel full. Overeating these foods regularly can contribute to weight gain, diabetes and heart disease.

To keep the glycemic load of meals in control:

• Choose brown rice, and whole grain breads and cereals.
• Increase fresh fruits and vegetables.
• Eat fewer foods with added sugar.
• Limit meals and snacks that contain only carbohydrates. Include protein and some healthful fats.
• Eat small, frequent meals to control blood sugar and hunger.

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.

Ginger may ease nausea, vomiting during pregnancy

Posted on: Saturday, May 1, 2004

PRESCRIPTIONS
Ginger may ease nausea, vomiting during pregnancy

By Amy Tousman RD

Q. Can ginger relieve morning sickness for pregnant women?

A. Those symptoms of nausea, vomiting, or dry heaves in pregnancy, called "morning sickness," can actually occur at any time of day.

Ginger, a popular spice in Hawai'i, may relieve these symptoms. In China, ginger has been used in cooking and as an herbal medicine for digestive problems for centuries.

Studies have shown ginger's ability to prevent many types of nausea, especially motion sickness. There are only a few studies of its use for morning sickness.

A report in the April 2004 journal of Obstetrics and Gynecology has added to the evidence that ginger may be beneficial. Three-hundred women who were less than 16 weeks pregnant and suffered from nausea and vomiting were studied.

The researchers compared the effects of ginger with those of vitamin B6, which is known to improve nausea and vomiting in some pregnant women. Participants were given 350 milligrams of ginger or 25 milligrams of B6 three times a day for three weeks.

Ginger was just as effective as vitamin B6 at relieving nausea and vomiting. Morning-sickness symptoms improved in more than half of the women in each group.

There have been concerns that taking ginger during pregnancy may be harmful to babies. This study found no differences between the ginger and vitamin B6 groups in the amount of birth defects or pregnancy complications. Because this study was relatively small, the authors recommend more study on the safety of ginger during the first trimester.

If you do try ginger, it is recommended to keep the dose to 1,000 mg or less per day. It can be taken as a capsule, or in tea or candy.

Other tips to help ease morning sickness include:

• Eat small, frequent meals, every two to three hours.
• Eat dry soda crackers before getting out of bed in the morning.
• Drink fluids between meals rather than with meals.
• Don't take prenatal vitamins on an empty stomach.
• Avoid greasy and spicy foods.
• Eat or sniff fresh lemon.
• Try lemonade and chips. According to the book "No More Morning Sickness" by Miriam Erick, the combination of tartness and saltiness may help.
• Wear acupressure bands such as Sea-Band.

If all else fails, remember that morning sickness is a temporary condition that usually ends by the 16th week of pregnancy.

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.

Gelatin a protein source and nail strengthener? Better reconsider

Posted on: Saturday, August 3, 2002

PRESCRIPTIONS
Gelatin a protein source and nail strengthener? Better reconsider

By Amy Tousman RD

Q. My fingernails break easily. Should I use gelatin to strengthen them?

A. Gelatin has been touted as a protein source and nail strengthener for many years. Unfortunately, science has not found much nutritional or medical use for it.

Gelatin is made by boiling skin, connective tissue and bones of animals in water. Gelatin contains some protein, but it is poor-quality protein. It is low in essential amino acids. Without those amino acids, it cannot take part in the growth and repair of nails or other body tissues.

Several years ago, Knox gelatin's maker was told by the FTC that it could no longer claim gelatin promotes better hair and nail growth.

Research on gelatin has been going on for at least 100 years. In May 1902, the Journal of the American Medical Association reported that animals fed only gelatin rapidly lose strength and weight and finally die of starvation. According to http://www.nutritionnewsfocus.com/, "gelatin was the main protein source for the liquid diets in the 1970s. These diets caused the deaths of dozens of people from a lack of essential minerals."

Although nutritional deficiencies are rarely the cause of brittle or weak nails, Elizabeth Somer, a registered dietitian writing for http://www.webmd.com/, says nutrients such as protein, iron, selenium, zinc, and vitamins E, K and C are involved in nail growth and circulation of blood to the nails. Deficiencies of these nutrients might result in weak nails. Eating foods containing these nutrients such as whole-grain breads, fruits and vegetables, iron-rich cereals and meats may help.

Many times, the cause of weak and brittle nails is frequent exposure to water or detergents. Hands that go in and out of water all day can dry out, leading to chipped and cracked nails.

Here are tips offered by the Mayo Clinic to toughen and protect weak fingernails:

• Keep nails short, square-shaped and slightly rounded at the top.
• Apply a nail hardener, but avoid products containing toluene sulfonamide or formaldehyde because these can irritate the skin.
• Apply a moisturizer each time you wash your hands.
• Wear cotton-lined gloves when exposing your hands to water or household chemicals.

Gelatin is great in a tasty low-calorie snack, but it has no healthful properties. Don't expect it to cure what ails you.

Amy Tousman is a registered dietitian and a member of the Hawaii Dietetic Association.

Send questions to: Prescriptions, Island Life, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; ohana@honoluluadvertiser.com; fax 535-8170. This column is for information only. Consult your health provider for medical advice. Articles and photos submitted to The Advertiser may be published or distributed in print, electronic or other forms.

Fruit snacks made for kids are no fruit substitute

Posted on: Thursday, March 15, 2007

PRESCRIPTIONS

Fruit snacks made for kids are no fruit substitute

Q. How healthy are those fruit snacks being advertised during children's shows?

By Amy Tousman RD, CDE

A. When it comes to processed fruit snacks, it is a good idea to ask, "Where's the fruit?"

Many children's snacks featuring fruit on their packages along with bright, kid-friendly designs contain little or no fruit.  These "fruit" treats are not a substitute for the real thing.

Processed fruit snacks do not meet the requirements of a fruit serving, according to the food guide pyramid. They often contain as much sugar as candy does. They're not good sources of fiber and nutrients, the way fresh fruits are.

Parents may be drawn to these products because the packaging makes them sound healthier than candy. Often, the front of the package for processed fruit snacks will say: "Made with real fruit" or "contains real fruit juices." Manufacturers are not required to state how much real fruit is in a product that uses this claim. This means the product could contain just one grape or a drop of grape juice and be accurately labeled!

Even parents who read labels may have a hard time identifying actual fruit content and determining the amount of sugars. This is because added sweeteners are often listed under different names, such as corn syrup, fructose, dextrose, maltodextrin, maltose, honey, molasses and fruit juice concentrate.

A recent study conducted by the Prevention Institute looked at 37 products that contained words or images on their packaging related to fruit. They found 51 percent did not contain any fruit, despite packaging claims of "fruity," having "fruit flavors" and being labeled "berry."

Some 27 percent of the products contained fruit, but many of these were still high in added sugars; another 16 percent contained minimal amounts of fruit.

For example, the study noted that Fruit by the Foot, Fruit Roll-Ups and Fruit Gushers all have "strawberry" on their label along with the phrase, "fruit-flavored snacks." They list pear or grape from concentrate as the first ingredient (not strawberry). The second and third ingredients are sugar and corn syrup.

These products contain no fiber and get 50 percent of their calories from sugar.

This implies there isn't much real fruit present.

Choose fruit snacks that list fruit as the first ingredient. If more than one type of added sugar is listed, this is a red flag.

Fresh fruits should be eaten daily. Even so, your child can enjoy an occasional processed fruit snack.

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 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.

'Detoxifying' foot pads yet to be proven

Posted on: Thursday, July 3, 2008

Prescriptions

'Detoxifying' foot pads yet to be proven

By Amy Tousman RD, CDE

Q. Can you remove toxins through your feet with foot baths or pads?

A. Products designed to remove toxins through your feet remove dollars from your wallet, but not much else. Promoters falsely claim that our intestines, colon and bloodstream are easily clogged by undigested foods, and toxins that must be cleaned out using their products.

The human body has its own built-in detoxification system. The liver, kidneys and intestines regularly filter blood to extract waste and contaminants, which are then excreted in the urine and feces. Therefore, commercial detoxification products are unnecessary.

With detoxifying foot baths, your feet are soaked in warm water with added salts. An electric current is passed through electrodes immersed in the water. During the treatment, the water turns brown, green or blue. Promoters claim the color change is from toxins leaving the body.

However, according to chemist Stephen Lower, "This is an old parlor trick, a chemistry classroom demonstration and highly profitable scam. The color of the water actually comes from corrosion of the metal electrodes. These are made of iron, nickel and copper, all of which decompose into colored ions. Colors vary with the amount of salts in the bath, and substances in the 'soaps' used to prepare the patient's feet."

Detoxifying foot pads that you attach to the soles of your feet while you sleep are also fraudulent. The pads supposedly absorb toxins and turn brown or black. Since most toxins produced in the body are colorless, what you see during these treatments is purely for show.

According to University of Pittsburgh toxicology expert Devra Davis, "leaving the foot pads out overnight without their plastic packaging also produces a black or brown color. The pads contain little more than green tea and vinegar." Flavanoids in the tea are known to darken when exposed to oxygen and moisture.

Recently, ABC's "20/20" investigated two popular brands of detoxifying foot pads. Dropping distilled water on the pads turned them the same dark color as wearing them on your feet. Laboratory analysis of pads used by volunteers showed no evidence of heavy metals or toxins. Neither company was able to provide valid scientific studies proving that their products work.

The best way to remove toxins from your body is to drink plenty of water and to eat foods high in fiber. This helps your kidneys, liver and colon eliminate toxins the natural way.

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, Hono-lulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Eating at desk creates a haven for bacteria

Posted on: Thursday, November 13, 2008

Prescriptions

Eating at desk creates a haven for bacteria

Do I need to worry about germs when I eat at my desk?

By Amy Tousman RD, CDE

A. For many working people, including myself, eating lunch is just another task to juggle during a busy working day of e-mails, phone calls and meetings. According to the American Dietetic Association, approximately 70 percent of Americans eat at their desks several times per week. We have become so crunched for time that we feel we need to multitask during lunch.

Eating at your desk can create a haven for unhealthy bacteria. A study by University of Arizona microbiology professor Charles Gerba found that our office areas contain 400 times more bacteria than our toilet seats. Gerba says, "People turn their desks into bacteria cafeterias because they eat at them and never clean them." In his study, telephones came in as the No. 1 home for office germs, followed by desks, then the computer mouse and the computer keyboard.

To help keep germs at bay:

• Disinfect your desk. According to Gerba, "Wiping your desk area with disinfecting wipes once a day is enough to get it clean. Don't just use a damp cloth or paper towel because they will just spread the germs around. Be sure to get your phone, keyboard and mouse as well, and avoid touching those surfaces while you're eating, otherwise you're just contaminating your food over and over again."
• Place food on a napkin or plate, not directly on a table surface. Placemats are a good idea because they create a barrier between the food and the bacteria.
• Many people don't wash their hands before eating lunch or snacks. If you're not leaving your desk for lunch, chances are you are one of them. Ideally, you should wash your hands before and after eating. Although soap and water are best, if you can't get to a restroom to wash your hands, keep hand sanitizer at your desk.
• If you don't have a refrigerator at work, pack your lunch in an insulated lunch bag and add an ice pack to keep food cold. If you bring carry-out food back to your desk, don't wait too long to eat it. Perishable food should never sit out more than two hours. At that point, bacteria start to multiply rapidly, increasing your chances of food poisoning.

So now, in addition to preventing carpal tunnel and eyestrain, you have another reason to get up from your computer at lunch time.

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.

Fiber helps people lose weight, ward off diabetes, heart disease

Posted on: Saturday, May 10, 2003

PRESCRIPTIONS
Fiber helps people lose weight, ward off diabetes, heart disease

By Amy Tousman RD

Q. My doctor told me to eat brown rice to increase my fiber intake. Can I take a fiber supplement instead?

A. Fiber is found in foods such as brown rice, oatmeal, bran, fruits, vegetables, nuts and beans. Fiber is the part of these foods that cannot be broken down by our digestive systems.

Health benefits of fiber include preventing constipation, hemorrhoids, diabetes and heart disease. It even helps you lose weight!

In the digestive system, fiber soaks up water like a sponge. This speeds up the elimination of waste while softening our stools. This is how it prevents constipation and hemorrhoids.

Fiber helps remove cholesterol from the body. It also helps control blood sugar by slowing the blood's carbohydrate absorption.

High-fiber foods take up space in our stomachs, making us feel full. They take longer to chew, forcing us to eat slower. This is how they helps control our weight.

For example, if you drank apple juice made from two apples, you would get no fiber. You could drink it in 30 seconds and feel hungry 30 minutes later. Applesauce, made from two apples, has some fiber. It takes a few minutes to eat. Eating this, you would feel hungry one or two hours later.

If you ate two apples, you would get lots of fiber. They would take 20 to 30 minutes to eat, and you wouldn't be hungry again for several hours.

If you don't eat enough fiber, fiber supplements such as Metamucil or Citrucel may be useful. Supplements are usually single types of fiber. Foods give you many types of fibers. Fiber-rich foods also give a nutrition bonus of vitamins, minerals, antioxidants and phytochemicals.

Health experts recommend 25 to 38 grams of fiber daily. Increasing fruits, vegetables, whole grains and beans helps you meet your fiber needs.

When increasing fiber, whether from food or supplements, it is best to do it gradually. This will help prevent gassiness and bloating.

Fiber in foods

1 cup mango has 5 grams of fiber; 1 apple, 4 grams; 1 cup bran cereal, 7 grams; 1 slice whole-wheat bread, 2 grams; 4 cups popcorn, 4 grams; 1 cup broccoli, steamed, 5 grams; 1 cup cooked taro, 7 grams.

 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.

Getting your omegas without fish

Posted on: Saturday, August 27, 2005

Prescriptions

Getting your omegas without fish

By Amy Tousman RD, CDE

Q. I don't like to eat fish. Can I get the health benefits of fish oils from other foods?

A. Eating fish, especially fatty varieties such as salmon and sardines, is the most efficient way to boost levels of heart-healthy omega-3 fats. Even so, vegans and other nonfish eaters can get adequate amounts of omega-3 fats.

Omega-3 fats help prevent heart disease by reducing inflammation, decreasing the risk of blood clots, and lowering the amount of unhealthy fats in the blood. Omega-3 may also help ease symptoms of rheumatoid arthritis, depression and Crohn's disease.

The omega-3 family of fats includes alpha-linoleic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). EPA and DHA are found in fish. EPA and DHA are the forms of omega-3 most easily used by the body.

Walnuts, ground flaxseed and canola oil are plant sources of omega-3 fats. They contain ALA, which must be converted to EPA and DHA in the body.

Our bodies are not very efficient at making this conversion. Only 5 percent to 10 percent of the ALA from plant foods can be converted to EPA and DHA. There is some evidence suggesting that even this small amount may be enough to meet the needs of most people. This is still being debated by scientists.

Regardless of how much ALA from plant foods can replace the EPA and DHA from fish, plant sources of omega-3s still have health benefits. For example, they help lower cholesterol in the blood.

You can also increase EPA and DHA by:

Limiting processed foods and saturated fats. Trans fats in processed foods and saturated fats in meats and cheeses can block the conversion of ALA from plant sources to EPA and DHA.

Making canola, olive and peanut oil the main fats in your diet. While these oils don't contain huge amounts of omega-3s, substituting them for corn and safflower oils, which are high in omega-6 fats, can improve heart health. Excess omega-6 fats compete against omega-3s for entry into the heart and brain, making it difficult for your body to get enough omega-3s.

Using fish oil supplements. If you eat fish less than twice a week, you can take fish-oil supplements. Be sure they contain both EPA and DHA. If you take blood thinners, such as coumadin or aspirin, check with your doctor before beginning supplements.

 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.

Talk to obstetrician before trying fish oil supplements

Posted on: Thursday, June 21, 2007

Prescriptions

Talk to obstetrician before trying fish oil supplements

By Amy Tousman RD, CDE

Q. I am pregnant and have high cholesterol. Is it OK to take fish oil supplements?

A. Cholesterol levels tend to rise during pregnancy because of pregnancy hormones rather than from foods eaten.

Fish and fish oil supplements don't actually lower cholesterol even in those who are not pregnant.  Instead, they reduce another type of blood fat implicated in heart disease called triglycerides.  They also reduce heart attack risk by thinning blood and reducing inflammation.

Eating fish during pregnancy contributes to the baby's brain development and vision. However, some fish have high levels of mercury and need to be avoided during pregnancy. Mercury can damage the brain in unborn babies and young children, resulting in learning and behavior problems.

Large predatory fish contain the most mercury. These include kajiki (Pacific blue marlin), shark and swordfish (shutome). The state Department of Health recommends pregnant or breastfeeding women, those planning to become pregnant, and children younger than 5 avoid these fish.

A portion of fish is 6 ounces for adults and 3 ounces for children. 'Ahi, ono and opah should be eaten only once in two weeks. Aku, mahimahi, canned tuna, butterfish and striped marlin are examples of fish that can be eaten once per week. Salmon, sardines, moi and fish small enough to fit in a frying pan whole are examples of fish that contain little or no mercury and can be eaten anytime.

Although some fish contain mercury, this does not appear to be true of fish oil supplements. Consumer Labs, an independent laboratory, tested 42 brands of fish oil capsules and found that all were free of mercury and PCB contamination. One brand failed the test because of spoilage and another because it contained less omega-3 (the active ingredient) than stated on the package. To see which brands passed, go to www.consumerlabs.com.

Pregnant women should talk with their obstetricians before taking any supplements. Excess omega-3 fatty acids could thin the blood, resulting in potential bleeding during pregnancy. The best way to get your omega-3 fatty acids may be to consume 6 to 12 ounces of low-mercury fish each week.

Note: In my May 31 prescriptions column, I wrote that the form of niacin needed to lower cholesterol (nicotinic acid) was only available by prescription. A reader has informed me that a product called Slo-Niacin is sold over the counter and contains nicotinic acid in similar doses to prescription products. If you use this product, be sure to tell your physician so that liver function tests can be performed periodically.

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.