Frequently Asked Questions


How many milligrams of calcium are in a food with a label stating “Calcium 35%?”
Does magnesium interfere or help with the absorption of calcium?
Should I use an artificial sweetener?
Can I do Weight Watchers and the Strong Women Program?
Does the temperature of water effect how well it is absorbed?
Is it better to eat certain foods in combination with others?
How do I know how many calories to eat to maintain my weight after weight loss?
What should I eat before an early morning workout?
Is it better to take calcium citrate or calcium carbonate supplements?
Do caffienated beverages count towards my 8 cups of water per day?
Do you have any advice for someone who wants to gain weight?
I have seen childrens cereal that says it will boost immunity, is this true?
How do I know how much weight is realistic to lose?
Should I be drinking more water during the warmer months to stay hydrated?
Is it true that I should take calcium citrate with food?
Does calcium need saturated fat to be absorbed?
What is the difference between regular and instant brown rice?
Is it ok to weight lift on a vegetarian diet?
Is a potato considered a vegetable or a starch?
What is healthier – regular sugar, brown sugar or molasses?
How do I maintain my weight while strength training?
Is it ok to eat French fries?
Are beans a grain or a protein?
Is Fosomax still safe despite the reports about jaw problems?
How many grams of protein are in one portion on the Strong Women plan?
How can I keep from eating as much while eating out?
Should I take calcium citrate on an empty stomach or with food?
Will flaxseed go rancid if it is ground?
Is it ok to remove the skin from salmon or will it lose omega-3 fatty acids?
Should I take vitamin C or E while training for a marathon or while performing intensive exercise?
Should I drink calcium fortified soy milk?
How can I be sure I am staying well hydrated while exercising, especially in the summer?
What are the best snacks to bring hiking?
What is the best way to manage my cholesterol through diet?
How can I help my child who is overweight?
I know I need to drink water, but I don’t like the taste. Do you have an alternative suggestion?
My doctor recommends that I take fish oil, but it leaves an unpleasant taste in my mouth. How do I take the fish oil without the taste?
Does excess fiber prevent calcium absorption?
Do you absorb more calcium from whole or skim milk?
I am thinking about a career in nutrition – Dr. Miriam Nelson’s advice.
Can I eat cake and still follow the Strong Women Stay Slim program?
How much calcium is in seaweed?
Is it possible to take too many supplements?
How do I know how many calories my husband should eat to lose weight on the Strong Women program?
Is there a benefit to taking a women specific multivitamin?
What else can I do to increase my bone density outside of strength training?
Should I be taking a fat burning pill to help me lose weight?
I want to cut down on my fat intake – what is the best way?
What is a reliable source of nutritional information for children?
How much protein should I get daily?
What is CLA and can it help me burn fat?
Is canola oil better than safflower oil? Are walnuts better than almonds?
How can I eat healthfully on a budget?
Is it true that flaxseed should not be eaten if you have a history of hormone sensitive breast or uterine cancer?
Will calcium or other nutrients be lost if I drain yogurt to make a thicker “yogurt cheese”?


Q: When I read the nutritional value on the back of a product, I often see something like “Calcium 35%.” How much is that in milligrams?
A: The US RDA for calcium is 1000 milligrams so you will need to calculate 35% of 1000. For instance, if the food supplies 35 percent of the RDA, that’s 350 milligrams of calcium.

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Q: I have read conflicting information about magnesium. Some sources say that calcium interferes with absorption of magnesium and therefore it is necessary to take magnesium as well. Others sources say extra magnesium are unnecessary. Is it necessary?
A: Magnesium is an essential nutrient – but most of us get enough, so there’s really no need to take a supplement. I’ve seen no scientific evidence that taking magnesium with calcium makes a difference for bone density. There is some interaction between magnesium and calcium, but the effect is not enough to cause problems when calcium consumption is in the normal range. If you decide to take magnesium, don’t go above 100% of the RDA, which is 280 mg.

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Q: I crave sweets – should I use an artificial sweetener?”
A: I don’t recommend it. Taming a sweet tooth isn’t easy – but if you persist, your craving for sweets really will diminish. Many women find that exercise helps regulate their appetite. It’s also very important to eat the full amount of food prescribed on the program; that will help keep your body satisfied and reduces cravings. Here are additional suggestions if sweets are a problem:
• Weigh and measure your food, and keep a food log – this makes you more aware of all consumption. You may find it easier to resist temptation when you’re writing down everything you eat. Similarly, it can be helpful to plan your day’s eating in advance.
• Don’t keep overly tempting items in the house – for instance, it may be easier to enjoy a small dish of frozen yogurt at a shop than to deal with a half gallon in your freezer.
• Include fruit in dessert, to make portion size larger and more satisfying – for instance, garnish a half-cup serving of frozen yogurt with a cup of strawberries.

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Q: I have been a Weight Watcher for some time. Since I know their program so well, do you think it’s OK if I continue to follow that along with your exercises?
A: Yes that’s fine. Use Strong Women Stay Slim for the exercise program, and to help you make sound choices on the Weight Watchers food plan. For instance, choose whole grains and fresh fruits and vegetables, so you get plenty of fiber, vitamins, minerals and phytochemicals. Aim to lose .5 to 2 pounds per week, which is what’s recommended for safe weight loss.

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Q: A long time ago I heard that you should drink your water cold so that your body would l absorb it better. Recently, I have heard the opposite, to drink it warm for better body absorption. Does the temperature of the water I drink really make a big difference, especially when working out?
A: Some experts believe that drinking cold water increases the motility of the stomach. That means cold water can be absorbed more quickly than warm water, so you get the benefits sooner. There’s still debate about this – and very likely the difference, if there is one, is too small to matter to anyone except elite athletes. But one thing is certain for everyone: it’s important to drink enough water throughout the day and after exercise.

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Q: What are your thoughts on diets that promote eating certain things in combination with others such as not eating certain things in combination with others? My sister has a book that recommends such a diet. I tend to be more of a skeptic…I prefer eating in balance. Just wanted to hear, from a nutrition standpoint, your thoughts.
A: There’s no scientific research supporting the idea that particular combinations of food cause weight gain, or that other combinations promote weight loss. Your sister might lose weight on the diet, simply because it’s complicated and involves restrictions, so she winds up eating less. That’s the “secret” behind the temporary success of many fad diets.
What’s best nutritionally is to eat a variety of wholesome foods at every meal. Variety helps provide the nutrients you need, and helps minimize hunger and low energy between meals. I suggest that you try for at least three different food groups at all meals. For instance, if you grab a whole grain bagel for a quick breakfast, add some cheese and a glass of orange juice. When you look at your dinner plate, you should see a variety of colors and textures.

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Q: Once you have lost as much weight as you want to lose, and you did so on the 2000-calorie plan, how many portions should you add and in what categories? I realize that there might be some experimentation required but I don’t want to go too far the other way and find myself putting weight back on that I lost. Personally, I would love to add grains as they’re my favorite, but since I already get eight portions of them I don’t know if it’s the right food group to supplement.
A: First, congratulations on your successful weight loss! Now that you’re maintaining, you can start adding food. I suggest you add one Vegetable and one Grain – preferably a whole grain. You’re right that some experimentation may be necessary. Be careful to monitor your weight so you catch any gain quickly. And keep up with your exercise program. The combination of eating wholesome foods and getting plenty of exercise will keep you at your desired weight.

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Q: What is the best thing to eat before an early morning workout when you don’t have time to wait an hour or more before exercising? I’ve been drinking a Slimfast. Is this a good idea?
A: I am not a big proponent of liquid meals. There’s nothing wrong with occasionally using these meals in a pinch. But if this is your daily breakfast, I hope you’ll rethink your schedule and plan a simple breakfast made from wholesome food. For instance, you could prepare a smoothie of fresh fruit and yogurt the night before. Or have orange juice before exercise and a whole-wheat bagel and cheese right afterward.

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Q: I have a difficult time swallowing pills and most of the chewable calcium supplements are calcium citrate. I have heard that calcium citrate is not easily absorbed. Any other calcium products (chewable or liquid) you can recommend?
A: Well, there’s always milk! Protein-fortified non-fat yogurt and other dairy foods have a lot of calcium. What about calcium-fortified orange juice? Manufacturers are adding calcium to quite a few products now, including breakfast cereal. Watch for new possibilities.
Calcium citrate may be more digestible in some forms than others, and of course this varies from person to person. I suggest you try the chews if that sounds like a convenient form, and see if they agree with you. Check the label for contents, which vary by brand. Usually the chews contain about 500 milligrams of calcium plus some vitamin D.

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Q: I have a question about water and caffeinated drinks. I drink about 3 cups of black or green tea a day, do none of these count towards trying to get my 8 cups of water?
A: We don’t count caffeinated beverages because caffeine is a diuretic. That means you can expect to lose extra fluid after drinking them. So even though you’ve consumed a liquid, there’s no net intake. Since both black and green teas contain caffeine, I suggest you try to consume 8 cups per day of non-caffeinated beverages, preferably water or juice. If you have one cup before each meal and one during the meal, you’re three-quarters of the way there!

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Q: There is a ton of information available for women who want to lose weight, but for women who want to gain, there is very little sensible direction. (I am about fifteen pounds underweight.) Can you advise me?
A: I would suggest you start by recording the foods you eat over the course of three days. Take a look at the foods and the timing of your meals and snacks. Are there any skipped meals? Are there long gaps between meals with no snacks? Everyday are you getting at least five fruits and vegetables, three or four protein rich foods such as fish, eggs, legumes, and lean meats, whole grains, and dairy? I suggest you increase the portion sizes of your main meals with these healthy foods, add a few more snacks between meals, and when you feel like it, indulge a bit more with a favorite dessert. Another important aspect is gaining the right type of weight. Gaining fifteen pounds of fat is not nearly as healthy as gaining most of your weight as muscle and lean tissue. For this reason, I also suggest you participate in at least two sessions per week of strength training. This type of exercise will help you gain weight in the healthiest way.

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Q: I was in the cereal aisle of my local grocery store recently and saw a huge banner on the front of Cocoa Krispies® that said, “Now Helps Support Your Child’s Immunity.” This can’t be true, can it?
A: While Kellogg denies that this front of package health claim was prompted by the H1N1 flu epidemic, I don’t believe it. Kellogg went from 10 percent of the daily value to 25 percent of the daily value for vitamins A, B, C, and E. These vitamins are important for your immune system so Kellogg thought by law they were allowed to print this on the front of the cereal box. The law states that you can place a health claim on the package if nutrient “x” supports or helps health concern “y.” For example, if a product has calcium as an ingredient, the package can state, helps protect your bones. It is not stating that it prevents osteoporosis; just that it helps your bones. Kellogg went too far with this health claim, because there is no evidence that a chocolaty, sweetened cereal with some added vitamins will improve a child’s immune system.The Attorney for San Francisco challenged Kellogg on the basis of false advertising. Kellogg has backed down and removed the health claim from the package. Many of us at Tufts went to the supermarket and bought a box of the cereal to use in our classes as an example of food marketing gone awry. For more on the topic, I encourage you to read Marion Nestle’s December 1, 2009 blog on her website: www.foodpolitics .com

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Q: I am overweight and need to lose weight, but I am not sure how much is a realistic amount to lose. How can I figure this out?
A: You can use a Body Mass Index (BMI) chart to help you determine what a healthy weight range would be for someone your height. In the scientific community, a healthy BMI is anything between 19 and 24. The National Heart Lung and Blood Institute has a link to a BMI chart you can use as a guide: http://www.cdc.gov/healthyweight/assessing/bmi/
If you are in the obese range, then consider a target weight that is in the “overweight range.” This amount of weight loss along with improved fitness will help to make you healthier!

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Q: I am concerned that I don’t drink enough water – especially in the hot weather. Is 64 ounces (8 cups a day) still the recommended amount to drink?
A: There is actually no scientific study to support this recommendation! Everyone’s hydration needs are different and depend on a variety of factors; people who are bigger, sweat a lot, or are more physically active will need more water than others. The research suggests that, in general, you should use thirst to guide how much you drink. Exceptions to that rule are: when it is really hot outside and when you exercise a lot. In those cases, you should try to drink a little bit more than you think you need. Another good guide is the color of your urine. If your urine is pale yellow, you are well hydrated; if it is dark yellow, you need to drink more now and remember to drink more in the future.

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Q: I recall Dr. Nelson saying that if you are taking calcium citrate (such as Citracal® **) you don’t have to take it with food; however, if you’re taking another type of calcium supplement do you need to take it at mealtime?
A: Yes. There are two widely used kinds of calcium supplements: calcium carbonate and calcium citrate. Calcium citrate supplements contain acid and do not require stomach acid for absorption. This means you can take these supplements with or without food. However, calcium carbonate supplements require stomach acid to be absorbed efficiently, so it’s best to take these types of supplements with food-during mealtimes when your stomach secretes extra acid.
**Citracal is a trademark of Bayer Healthcare LLC

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Q: I read in a newspaper article that calcium isn’t absorbed without saturated fat. If this is true, isn’t it better to drink whole milk rather than skim or lowfat milk?
A: Calcium in our diet is absorbed poorly no matter what. On average we absorb only about 20 to 30% of calcium we ingest from food or supplements. If our diet is very high in fiber, we absorb less. If our vitamin D status is low, absorption of calcium can be even lower. I have seen no evidence that drinking low-fat or skim milk will decrease your overall calcium absorption. The problem with whole milk is that it does contain a substantial amount of saturated fat. If you don’t have a weight or cholesterol problem, whole milk is fine. Otherwise, you need to be careful about getting too much fat in your diet.

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Q: Is there a significant nutritional difference between regular brown rice (that takes so long to cook) and instant brown rice that comes in a box?
A: Nutritionally, there is one major difference between traditional brown rice and the instant variety: the fiber content. A 1/2 cup serving of traditional brown rice has twice as much fiber as a 1/2 cup serving of instant brown rice.

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Q: Is there any problem weight lifting on a vegetarian diet? Would there be a difference in the amount of muscle mass acquired?
A: Weight lifting is a great muscle and bone-building activity, regardless of your dietary preferences. Weight lifting helps to build strong muscles and bones. As long as you are following a well-balanced diet, and getting an adequate amount of protein (from animal sources or vegetarian) you will see the same results. Remember, there is no need to take in extra protein when you begin a weight lifting program. Just be sure you are meeting the daily requirement: 15 to 20 percent of caloric intake should be from protein. Good sources of protein on a vegetarian diet are soybeans, other legumes, seeds, some grains, and nuts (and dairy and eggs if you are ovolactovegetarian).

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Q: Are potatoes considered a vegetable or a starch?
A: Potatoes are a vegetable, but they are starchier (contain more carbohydrates) than most other vegetables. So, when you prepare a meal with potatoes, think of them as a grain: use them instead of bread, rice, or pasta, not instead of broccoli.

Q: Which is healthier-white sugar, brown sugar, or molasses?
A: White and brown sugar are nutritionally equivalent- neither one provides any essential vitamins or minerals. Molasses, however, does contain a significant amount of calcium and other minerals, which makes it a healthier choice. But in order to get enough calcium from molasses you have to eat a lot of it! So be careful with the calories.

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Q: I am concerned that I’ll lose weight as a result of the Strong Women, Strong Bones workouts, which I can’t afford to do. Any suggestions on maintaining weight while strengthening my bones?
A: In general, a 150-pound person will burn approximately 350 calories during a 45-minute weight training session. Since the key to maintaining your weight is to consume as many calories as you burn, you will need to eat a little more to make up for those extra calories you’ll burn while exercising. Try having an extra snack a few days a week, such as an apple with peanut butter or a low-fat yogurt. That should provide you with enough extra calories to keep you at a healthy weight. Believe it or not, it is difficult to lose weight with exercise unless you try to decrease your calories too! So monitor your weight periodically and that should do the trick.

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Q: I know there are no forbidden foods. But I’m wondering if/where French fries might fit into the mix. I am talking about real fries, with skin on that you get from good burger joints. I’ve planned my food to be able to enjoy a Green Chile Cheeseburger with my friends who keep raving about it. I’d like to be able to have at least a few fries. Please advise.
A: Of course you can enjoy a few fries! Between the burger and fries, you will probably exceed the recommended fat intake, particularly saturated fat, for the day. To compensate, try to consume very little fat at your other meals (salad, fat free yogurt, vegetable soup, etc) for a day or so. Also, if you’re concerned, consider cutting the burger in half immediately and getting the “extra” half, along with some of the fries, out of sight, and order a salad as a side. While the composition of the burger and fries isn’t ideal, the portions are typically an even bigger consideration.

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Q: I am following the Strong Women Stay Slim eating plan and I don’t know what category beans belong to – should they be counted as a grain or a protein?
A: Beans are a food that can either be counted as a protein or a grain. The reason is that beans — unlike tuna or chicken, for instance – contain carbohydrates and fiber (in addition to protein), and therefore function similarly to a complex carbohydrate, or grain, in the body. Beans are so nutritious they should become a main staple in everyone’s diet.

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Q: I have heard reports about bone problems in the jaw due to taking Fosamax. Is this true? Should I discontinue?
A: This is a great question, and one that we have received a lot recently due to some reports of osteonecrosis of the jaw with long-term use of bisphosphonates, as well as other possible side effects on bone.
It is important to realize that all drugs have side effects. The more we use them, the more we learn about their risks and benefits. The good news here is that the risk of osteonecrosis is very small, whereas the benefits of bisphosphonates in terms of reducing risk of osteoporosis is substantial. Additionally, these benefits continue for a couple of years once you stop taking the drug.
The best course of action to take is to talk to your doctor about your concerns. Continue to concentrate on getting enough calcium and vitamin D in your diet and from supplements; and do your exercise – both strength training and aerobic exercise. Your doctor can give you the best advice because she/he knows your medical history best.

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Q: Can you tell me how many grams of protein are in 1 protein portion in your plan? Most labels list protein in grams and I’d like to be able to easily convert when I’m not weighing portions.
A: For portions, it is really done by calories. One portion of protein ranges from 40-85 calories. Typically, one portion will contain 5-10 grams of protein – although that may be a little higher or lower depending on the food. For instance, one portion of hummus (two tablespoons) has 53 calories and 1.5 grams of protein. A portion of chicken (1 ounce) has 56 calories and 8.5 g of protein.

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Q: I eat dinner out several nights a week. Can you give me a few concrete strategies for how to not eat so much when I eat out?
A: You are not alone. Over fifty percent of Americans eat at least one meal away from home each day and eating in restaurants has been linked to gaining weight and body fat. Here are a few ideas to help you control portion sizes at restaurants. I use many of them myself. Ask your server for half of the meal to be put into a doggy bag before it is served to you and then you have a meal ready-made for tomorrow; for half the potato and double the vegetable; to split the meal with a friend; for a whole-grain starch; for a salad instead of starch; and/or ask for the sauce or dressing on the side. More and more women are following these strategies. You will not come across as pushy, just health conscious.

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Q: I just bought some calcium citrate and the package recommends taking the supplement with meals. In your book, “Strong Women Eat Well,” you advise that calcium citrate can be taken after eating or on an empty stomach. What is best?
A: I am not sure what brand you bought. I know that with Citracal brand calcium citrate it states on their website that you can take at any time of day on an empty or full stomach. Generally speaking, calcium carbonate should be taken on a full stomach so that acids in the stomach can help with absorption. Calcium citrate doesn’t need the stomach acids to work so it doesn’t matter. Perhaps your brand is a little different.

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Q: I order large quantities of flaxseed and then grind them myself. I was recently told that they could go rancid and need to be refrigerated. Is this true?
A: Flaxseeds themselves can be stored at room temperature and be fine; they will not go rancid. The confusion comes from the fact that the flaxseed oil that most people buy will indeed go rancid if not refrigerated. In addition, ground flaxseeds should be kept refrigerated in an airtight, opaque container. It is ideal to only grind as much as you will readily use, since they may develop an off flavor or order if stored more than a month or so. The whole flaxseeds themselves will be fine stored and sealed for up to a year at room temperature.

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Q: Whenever I cook salmon, I skim off and discard the skin. Am I removing the health-promoting omega-3 fats by doing that?
A: The brown matter on the skin that surfaces when grilling is mostly fat, and it is fine to discard it if you prefer. Yes, some omega-3 fatty acids are contained in that fat, but you are by no means losing all of these health-promoting fats by removing that small amount of fat. Large quantities of omega-3s are found throughout the meat of the fish as well.

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Q: I have read that taking vitamin C and E supplements while training for long distance events, such as for a marathon, is a good idea. What is your recommendation?
A: Extra vitamin C and E (above the RDA) may be beneficial during endurance training to help the body to repair tissue damage. If you are consuming a healthy, well-balanced diet that includes plenty of fruits and vegetables, you most likely do not need to take a vitamin C supplement, since it is readily available in a good diet. Some research shows that supplemental vitamin E may help boost immune function and aid in recovery during training; a vitamin E supplement containing 400 International Units (IU) may be a good idea. Vitamin E is not as available in the food supply as vitamin C is; it is found primarily in nuts, oils, wheat germs, and certain greens, which is why taking it in supplement form may be helpful to reach the desired blood levels.

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Q: I drink soymilk but not the calcium-fortified one because I was told that components in the soymilk make you unable to absorb the calcium. I am a little skeptical about this, what do you think?
A: It is true that a component of one food may inhibit the absorption of another. Under almost all circumstances calcium is not well absorbed. In the case of soymilk you will certainly absorb a portion of it. If you have other sources of calcium in your diet and are consuming 1000-1200 milligrams per day, you don’t necessarily have to switch to a calcium-fortified soymilk product. However, if you are concerned about your calcium intake — particularly if you don’t eat dairy foods — you should certainly consider opting for the calcium-fortified variety as one way to boost calcium intake, even if a small portion of it isn’t absorbed. And as always, I recommend that a woman over the age of 40 consider taking a calcium (preferably calcium citrate which is more highly absorbed) and vitamin D supplement.

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Q: In the summertime, I certainly seem to sweat more, especially when I’m walking, biking, or running outdoors. But I don’t seem to be any thirstier than usual. How can I make sure I am hydrated well enough?
A: It is very important that you are well hydrated during exercise, especially in the summer months. When you exercise in the heat, you lose more body water through sweat and you need to replace it. However, many people — especially as they get older — may not be triggered by feeling “thirsty” to drink enough to be sufficiently hydrated. Therefore, it is essential that you drink (preferably water) throughout the day and before and after exercise. If you are exercising for periods longer than one hour you should drink 4-6 ounces of fluids for every half hour of exercise. If it is hot and you are exercising at a moderate or high intensity for longer than one hour you should consider having some of those fluids be an electrolyte-enhanced beverage (such as Gatorade). This will allow you to replace lost body fluid as well as sodium and potassium. If you are exercising for less than one hour, sports drinks are not necessary.

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Q: I am planning on doing a lot of day hikes this summer, and I was wondering if you could tell me what your favorite snacks are to bring along?
A: If it’s a long day of hiking, you should plan on bringing a full lunch—perhaps sandwiches, fruit, and plenty of drink for everyone since staying hydrated throughout the day is so important. In terms of snacking, the best items to bring along are ones that will hold up in your bag for the entire day and won’t perish in the heat. Good options include dried fruit, dry roasted unsalted nuts, apples, and snack bars. In terms of the snack bars, some are more akin to candy bars than a meal or snack bar; choose ones that contain more cereal and dried fruit in the bar, with at least 3 grams each of fiber and protein. Certainly, pack a little chocolate in your backpack if you like and it isn’t too hot out. Especially when hiking with children, a few good treats really helps as an incentive to help them to make it to the top!

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Q: I am confused about how to best manage my cholesterol levels. I have read in some places that egg consumption should be limited or even eliminated; and in other places, I have read that saturated fat in food—more so than dietary cholesterol (as found in eggs)—has a much larger impact on my blood cholesterol levels. What do you advise?
A: It is true that saturated fat consumption seems to have the greatest impact on increasing cholesterol levels in the blood. However, dietary cholesterol, as found in egg yolks, can also have an effect. According to the National Heart, Lung, and Blood Institute you should limit saturated fat intake to 8-10% of total fat intake, and cholesterol intake should be limited to no more than 300mg per day. If you have elevated cholesterol levels, I recommend eating no more than 2 yolks per week; the whites, of course, are fine; and minimize the consumption of full-fat dairy foods and fattier cuts of meat.

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Q: I have a niece in the fourth grade who currently weighs more than I do, and I am very concerned about her. The problem of childhood obesity is constantly in the news, but I still don’t understand how this is happening or how to help. Do you have any suggestions?
A: As you know this is a very complex and serious issue, and your niece certainly is not alone in her weight struggles. There are a host of factors contributing to the epidemic of obesity among children, although the simple equation is, of course, that children are expending fewer calories and consuming more. How to address these issues is a more complicated matter. I believe you can help your niece in a couple of key ways. First, do everything you can to reduce the time she spends doing sedentary activities, such as television and computer time. Help her to identify activities that she enjoys—whether it is structured sports, jumping and skipping games before and after school, or going for walks or hikes. Secondly, try to encourage her (or her parents) to eat meals prepared at home, and ones that are rich in fruits and vegetables; discourage her from drinking her calories in beverages such as soda, and from eating sugary or salty snack foods. Along with her parents, try to be a role model by engaging her in physical activity and choosing appropriate portion sizes of healthful foods whenever you’re together. These tips are helpful to her on an individual level, but you can also help by advocating for more physical education time and more healthful food choices in her school system. I commend you for being aware of the problem and wanting to contribute to the solution, because it is going to take efforts on an individual, community, and environmental level to truly have an impact on this devastating epidemic.

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Q: I know I am supposed to drink at least eight 8-ounce glasses of water each day. The problem is that I just don’t enjoy drinking it and often fall short. I will occasionally drink flavored seltzer or caffeine-free diet cola, but mostly, I enjoy drinking tea iced or hot. In the morning, I usually have tea with caffeine; the rest of the day, it is herbal tea. Does this “count” towards my daily water or fluid intake?
A: Drinking enough fluids each day is very important. Ideally, you will be drinking at least some of those fluids as water. However, the next best options are caffeine-free, sugar-free drinks. Herbal tea certainly falls into this category, assuming you are not adding any sugar. Also, keep in mind that if you are exercising, you should be drinking even more water throughout the day.

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Q: My rheumatologist recommends that I take 3 g of fish oil everyday in capsule form. The problem is that I can’t seem to tolerate the fish oil. My breath is awful and every time I burp, I taste and smell fish. Do you have any suggestions?
A: Increasing the amount of omega-3 oils in your diet has been shown to reduce pain and stiffness associated with rheumatoid arthritis. The problem is that it isn’t always easy to take fish oil capsules, and you have to take a lot of them to make a difference. Smelly breath and fishy burps are the most common complaints. The first thing everyone needs to know is that they should be trying hard to increase omega-3 oils in their regular diet by eating more coldwater fish (like salmon and tuna), walnuts, tofu, and canola oil. This type of diet helps everyone, not just individuals with rheumatoid arthritis. If you can’t seem to tolerate so many fish oil capsules, try cutting back to half the fish oil capsules and mixing a couple of teaspoons of flaxseed oil into some yogurt or dressing that you are using on a salad. Flaxseed oil is also a rich source of omega-3 and is thought to have some of the same beneficial qualities as fish oil, without the side effects. This combination of increased dietary intake of omega-3 with reduced fish oil capsule intake should help. To read more about omega-3 oils and health please see our book entitled, “Strong Women and Men Beat Arthritis.”

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Q: I have a problem with constipation and try to eat lots of fiber (bran cereals) and take Metamucil. I just read that this fiber prevents the absorption of calcium. What should I do to make sure I’m getting enough calcium? I’ve just been diagnosed with osteopenia.
A: Both constipation and osteopenia are conditions that you need to address. First, you should talk with your doctor about both conditions and make sure that you are doing everything possible to help. I recommend that you get plenty of exercise. In addition, make sure that you are eating a well-rounded diet that is full of fruits and vegetables and whole grains, along with 3 to 4 low-fat dairy foods (low-fat milk and yogurt) and a minimum of processed foods. Drink plenty of water and other non-caloric beverages. Exercise and good nutrition will help with both conditions. Take your fiber supplement in the morning with breakfast and take your calcium and vitamin D supplement in the evening. Taking your calcium and vitamin D supplement at a time of day when your gut is dealing with less fiber will help with absorption. Also, taking a calcium citrate supplement (i.e., Citracal) will help with calcium absorption.

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Q: Do I need to take my calcium supplement or eat calcium-rich foods with some fat to increase how much I can absorb? I’ve heard that calcium absorption from whole milk is better than from skim.
A: In general, you can only absorb about one-third of the RDA for calcium at a time. Were you to take a supplement or consume 100% of your calcium from food at a single sitting, much of that calcium would go unabsorbed. Other factors may affect how much calcium you can absorb, such as intake of vitamin D, which is necessary for calcium absorption; and calcium citrate is absorbed better than calcium carbonate. However, assuming that other dietary factors are in check, you do not need to take your calcium supplement or eat your dietary calcium with fat to ensure absorption. Also, although vitamin D is a fat-soluble vitamin, as long as you are consuming fat in your diet throughout the day, you needn’t fret about timing your fat intake with either your calcium or vitamin D intake.

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Q: I am a 42-year-old woman who is strongly considering going back to school. I have become extremely interested in the diet and nutrition field and the effects it has on the human body and am considering a career in that field. Could you please give some advice to someone like myself who really doesn’t know if she has enough time left in life to pursue a Ph.D. in this field. I am at somewhat of a loss of where to begin.
A: I am delighted to hear that you’re interested in this area and considering additional schooling. Please don’t worry about your age. I’ve seen many successful graduate students your age and older – their maturity and life experience are invaluable in their studies and in their professional work afterward. As a first step, I suggest you check out available graduate programs on the Internet or by visiting your local library. Find out what degrees are offered, what the requirements are, and what careers their graduates pursue. Contact schools with programs that interest you – they’ll be delighted to send you more information. I hope you’ll take a look at the Web site of my department at Tufts University, http://www.tufts.edu/nutrition, and consider our program!

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Q: I really like the diet in Strong Women Stay Slim. I’d love to have an exchange for cake. I work at a place that frequently celebrates birthdays and has farewell parties – all seem to include cake.
A: Chapter 9, Soup, Casseroles, and other Multi-Ingredient Foods section of Strong Women Stay Slim suggests an exchange of 1 Grain plus 4 Extras for a slice of chocolate layer cake. That’s a useful average number. However, as you might guess, there’s a lot of variation in cake equivalents, depending on both the type of cake and the portion size. A sliver of unfrosted angel food cake – which is a light, fat-free cake – might be the equivalent of 1 Grain plus 1 Extra. But the numbers could jump to 2 Grains and 5 or more Extras for a thick wedge of a dense fudge cake made with butter and whole eggs, which is filled and frosted with chocolate butter cream. Make your best guess and don’t worry about getting the exchanges exactly right – sometimes you’ll be a little too high and sometimes a little too low. So long as you don’t consistently underestimate what you’re consuming, it doesn’t really matter. If you’re maintaining a healthy weight, or losing half a pound to two pounds a week if you want to lose weight, then you know your estimates are on target.
A few suggestions about cake:
• Keep portions small – the first taste is usually the best anyway.
• Eat slowly; put your fork down between bites.
• Go light on frosting, which is usually the richest part of a cake (and often not the most delicious) – for instance, take an inner piece of a flat cake or the tip of a wedge of layer cake, to avoid the frosting on the side.
• Add fresh fruit to your plate if possible. If you’re the hostess, garnish the cake with fruit rather than frosting.
• Enjoy! Festive food is one of the pleasures of life, something to savor in moderation.

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Q: I was looking at the healthy foods section in Strong Women, Strong Bones – there were soy products mentioned, but what about seaweed as an excellent source of calcium? I know it may not be on everyone’s favorite food list, but seaweed does have 3 times the calcium of milk.
A: Seaweed is becoming more and more popular with increased interest in Asian cuisine. Many Asian cultures use seaweed in a variety of dishes, such as sushi. The calories, calcium and magnesium content for several different types of seaweed are listed below. Try seaweed – it is better than you think and most varieties are rich in calcium!
All serving sizes are 3.5oz*
(Calories, Calcium (mg), Magnesium (mg))
Agar, dried (306, 625, 770)
Agar, raw (26, 54, 67)
Irishmoss, raw (49, 72, 144)
Kelp (kombu/ tangle), raw (43, 168, 121)
Laver (nori) (35, 70, 2)
Spirulina, dried (290, 120, 195)
Spirulina, raw (26, 12, 19)
Wakame, raw (45, 150, 107)
Note: 3.5 oz. of lowfat milk (52, 129,14)

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Q: I would like to know if a person can take too much in supplements when trying to grow back bone density. Should I also try to get more calcium from foods like tofu and yogurt?
A: You CAN take too much calcium and vitamin D. I would recommend that you don’t take more than 1000 mg of calcium and no more than 600 IU of vitamin D per day in supplements. Higher amounts of calcium can cause gas, constipation and kidney stones. Also, work hard to increase your calcium intake from low fat dairy foods, tofu and green vegetables.

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Q: Chapter 12 of Strong Women Stay Slim it says you can do this program with your husband. What it doesn’t say is how he can lose weight with your food plan. Should I put a 6’3″ man on the 2000 calorie plan, or is that not enough for a man who wants to lose weight along with me?
A: Most men can lose weight on calorie plans that are higher than women because their metabolic rate is higher due to a greater amount of lean tissue and muscle in the body. Depending upon how heavy your husband is, I would recommend that he start on the 2000 calorie plan. If he is too hungry on the plan and losing weight too rapidly (more than 2 pounds per week), add one extra portion of each (grain, vegetable, fruit, dairy and protein) to the plan. This should add about 300 extra calories, which will help to make the diet work for him. Also, make sure that he follows along with the exercise program outlined in the book. Exercises are just as important for him as they are for you!

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Q: When I go to the pharmacy, I see all sorts of “women” targeted multivitamin-mineral supplements. Do these supplements have added benefit over your typical formulation?
A: Not necessarily. My rule of thumb is to take a basic multivitamin supplement that contains about 100 percent of the recommended allowance of a range of vitamins. Make sure that the supplement contains: folate, vitamins B6, B12, and C. I also suggest that you take about 400 IU of vitamin E. These vitamins have been shown to decrease your risk of heart disease, vision problems such as macular degeneration, and cataracts. They also boost your immune system. It is also important to make sure that you are taking a calcium and vitamin D supplement to reduce your risk of osteoporosis.

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Q: I read your book and followed your weight-training program for 2 years. The first year my bone density increased. However, the second year, things remained the same. What else can I do besides taking Fosamax, hormones, calcium and weight training?
A: Depending on which program you are currently using, you may want to use the program from my newer book Strong Women, Strong Bones, which includes detailed strategies for preventing and treating osteoporosis, or consider the online Strong Bones program. Also, in your note you mention calcium but not vitamin D, the latter of which is essential for calcium absorption. It is difficult to get enough vitamin D from diet alone so you may want to consider a supplement such as Citracal, which contains both calcium and vitamin D.
I also want to note that the gain in bone density in the first year is great, and so is staying the same thereafter. Maintaining the same bone density from year to year means that you have not lost any bone, which is also very important.

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Q: I have a friend who has been taking some fat burning pills, and he has lost a lot of weight by taking them. If such pills are available and are safe, I think that I would like to try them because I am having a difficult time losing weight. What is your take on fat burning pills?
A: My personal and professional opinion about fat burning pills is that they should be avoided, for a number of reasons – the first one being safety. There are ingredients in these pills that can have adverse health effects, and this has been the case for a number of individuals in the past. In particular, ephedrine and mahuang (a naturally occurring ephedrine) can cause increased heart rate, blood pressure and cause people to be “jumpy” and “on edge”. The first of these two side effects can be particularly dangerous during exercise and also for individuals with heart disease, especially if it is undiagnosed. Although ephedrine is also found in other over the counter medications such as decongestants, these drugs are highly regulated and contain a safe, specified amount of that ingredient. The fat burning pills are not under the same guidelines and regulations, so even if they claim to contain a safe amount of ephedrine, you cannot be certain of the exact amount that you are getting.

Another concern with fat burning pills is the lack of research surrounding them and the lack of prescription required to obtain them. Because of the lack of research, not only do we not know if they are safe, but there is also no solid evidence that they will even work. Furthermore, because you are not obtaining them through your doctor and they are unregulated, the ingredients in these pills may interact with and adversely affect any other medications you are taking. If you experience any negative side effects, your doctor has little information to guide you, because these drugs have not been sufficiently investigated.

If you really want to lose weight, there are healthy, safe options available, namely exercise and a reduced-calorie, nutritious diet. They may not be as simple as taking a pill, but the benefits will be much farther reaching – you will look and feel better, sleep better, and reduce your risk for numerous chronic diseases.

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Q: I am trying to cut down on my fat intake but not sure how to do it. I see so many fat-free foods in the grocery store. Should I be buying these foods? Are they healthy?
A: This is a tricky question and the answer is not straightforward. There are some fat-free foods that I do think are healthy. Dairy foods that have had the fat removed are better for individuals who need to watch their weight because they are lower in calories and saturated fat. Generally speaking, reduced-fat dairy foods have simply had the fat removed with little else added back in. What’s problematic about certain fat-free foods is that they have had the fat removed but have had refined sugars added as well as a number of other food ingredients that are highly processed. This is true for many fat-free snacks such as cookies and cakes. In many cases, these food items have the same amount of calories but with much higher refined sugar content, and I don’t believe such foods to be healthy at all. In my house, we do use 2% milk. Otherwise we don’t buy any reduced-fat food products. We eat whole foods whenever possible. Eating more fruits, vegetables and whole grains will help you to cut down on overall fat content without adding any processed foods to your diet.

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Q: Can you suggest a reliable source of information about sound nutritional guidelines for young children?
A: I suggest you read a fabulous book entitled, Feeding Your Child for Lifelong Health: Birth Through Age Six. A colleague of mine at Tufts, Dr. Susan B. Roberts, wrote the book. It is excellent – very practical and easy to read and packed full of the latest scientific information.

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Q: How much protein should I get in my diet?
A: The minimum amount of protein that a person should consume is 0.8 grams per kilogram of body weight. That means a 70 kg (154 pound) person should consume at least 56 grams of protein each day. However, you should keep in mind that this is the minimum requirement. My recommendation is that approximately 15-20% of the total calories in your diet come from protein. That means that if you eat about 2000 calories a day, approximately 300-400 of those calories should come from protein. This equates to between 75-100 grams of protein from various sources each day.

Although most people think to get their daily protein from meat, poultry, and fish-and these are certainly excellent sources-there are several other foods that provide significant amounts of protein in each serving. Eggs, milk, yogurt, cheese, beans, legumes, nuts, and soy foods are examples of high-quality proteins from other food groups. I recommend that you aim to consume at least one serving of a high-quality protein at each meal such as milk with cereal at breakfast; a bean, cheese, and veggie burrito for lunch; and fish for dinner. You should also try to eat protein-rich snacks such as seeds and nuts.

Making sure that your diet is rich in protein, whole grains, and fruits and vegetables will ensure that your muscles and bones stay strong and healthy while also promoting general good health.

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Q: I saw something on the news the other night promoting a product known as CLA that is suppose to “help” turn fat in muscle. Do you know anything about this product?
A: CLA are the initials for conjugated linoleic acid. CLA is a naturally occurring fat found in milk fat and the meat from ruminants such as cows and sheep. It is a natural variant of linoleic acid, an essential fat. There is some concern that CLA intake in humans is going down because of the increase in fat-free dairy foods (which contain less CLA). It is a potent anticarcinogen and helps to enhance the immune system. It has been well tested in animals where it has been shown to afford cancer protection and to suppress arteriosclerosis. One study showed that when animals are fed diets rich in CLA they ate less and lost muscle and body fat. However, the results of this study and the other animal CLA studies do not translate to humans. In fact, very little research on CLA has been done on humans. Before more research has been done on humans, it is too early to tell if taking concentrated CLA is safe or beneficial to health.

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Q: I am confused about which oils and nuts will provide the most health benefits. I thought that canola oil was preferable to safflower and likewise that walnuts were preferable to almonds because of their omega-3 content. Is this correct?
A: You are correct. In terms of getting the maximum amount of omega-3 fatty acids in your diet canola oil is preferable to safflower. Similarly, walnuts have more omega-3 than do almonds. Because I am allergic to walnuts, almonds are generally my nut of choice – especially because they are a good source of calcium. A very concentrated source of omega-3 fatty acid is flaxseed oil. While you can’t cook with flaxseed oil, you can add it to salad dressings or mix it into yogurt or hummus.

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Q: I am the mother of 5 kids – ages 12, 5, 4, 2, and 1. My biggest problem of all is the meal planning. My family and I are on a very limited income right now. We do a lot of Mac & Cheese, hot dogs, peanut butter sandwiches, and hamburgers with bread. I really need help in this area. My doctor has told me that my bad cholesterol level is 150. I really need to get this down, but I’m just not sure how to do this with what limited food I have in my house. Can you please help me figure out a way to do this?
A: It can be a challenge to cook for a large family on a limited budget, but it can be done! It is important to have basics on hand. First, vegetables and fruit are the mainstay of a healthy diet. While it can sometimes be difficult and costly to keep fresh vegetables on hand, frozen and even canned vegetables are a great alternative, and since you have a large family, you can buy in larger quantities (as you can with loose, whole grains; see my book “Strong Women Eat Well for more tips on this). Also, when seasonal, local fruits and vegetables are inexpensive, stock up and either freeze or jar them for later use whenever possible. Minimize on packaged “snack” foods as well as soda and fruit drinks. Instead, opt to keep frozen juice on hand.

Eggs are an excellent purchase for your money. A dozen eggs cost between $1-$2 and can feed your entire family. There are so many different meals you can make with eggs – so much so that you could use this option several times a week. People generally think of eggs as a breakfast item, but in fact, eggs can be an excellent option for any meal! One great dinner idea is a frittata, which is easy and can feed the whole family. Simply beat the eggs (as if to scramble) and then add whatever ingredients you have on hand – cheese, onion, peppers, tomatoes, broccoli, asparagus (any vegetable really) – and pour into a lightly oiled pan to bake in the over for 35-40 minutes at 350 degrees. Serve with whole grain toast and/or fruit. This is a healthy, protein-rich meal!

Beans are another excellent food to keep on hand for your family. They are rich in both protein and fiber, and are inexpensive. You can buy them dry and then soak them, or buy them canned. Black, white, kidney (or cannellini), pink, garbanzo (chick peas), are some examples. You can serve them with brown rice (or any other whole grain) and vegetables for an inexpensive, healthy meal!

Preparing a large crock of soup can be easy, healthy, and inexpensive – and it can be good for more than one meal. Use vegetable or chicken broth (from the can or cubes) or make a tomato-based broth. Add lots of vegetables, beans, and some whole grains, and you have a hearty, healthy meal for the whole family.

One final tip: if space permits, you might consider growing some fresh herbs and maybe even tomatoes in your windows. Growing things such as parsley, chives, basil, and dill can be extremely inexpensive, easy, and very convenient for adding flavor and variety to dishes like rice and beans.

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Q: I have recently finished reading Strong Women (and Men) Beat Arthritis and have been following the program in order to deal with my rheumatoid arthritis. I’ve been pleased with the results, however I have a question that I can’t seem to answer… In the Sept-Oct edition of Arthritis Today they have printed a supplement guide, which includes information on flaxseed (which I have been taking religiously!). It states that flaxseed should be avoided by “women with hormone-sensitive breast and uterine cancer, and by people with high cholesterol.” At the same time they also state that “flaxseed lowers total and LDL cholesterol, reduces risk of heart disease and cancer…” Since I am a breast cancer survivor, I need to know whether or not I should be avoiding flaxseed… Can you shed any light on the matter? Is it safe for me to be taking flaxseed? Any information would be greatly appreciated!
A: As we outlined in our newest book on arthritis, flaxseeds and flaxseed oil are a rich source of omega-3 fatty acids, which have potent anti-inflammatory effects in the body. The limited research to date shows us that flaxseeds contain phytoestrogens, which have been shown to reduce risk of breast and uterine cancer. The confusion lies in the concern that since phytoestrogens have some estrogenic effect, could they in fact be harmful? Right now the preponderance of the evidence suggests that they are still protective because they dilute the stronger estrogens that are in the body. We will need more research to investigate all the effects of phytoestrogens – but until then, we see no harm in taking flaxseed or flaxseed oil. The phytoestrogens in flaxseed oil come from lignans in the seeds, most of these are removed in the processing of the oil. However you can buy high lignan flax seed oil which contains a significant amount of lignans. (If you really want to be safe, make sure your flaxseed oil does not say high lignan.) In terms of the heart, the research would suggest that adding flaxseed to the diet might actually help to improve cholesterol profile and reduce risk of heart attack. We could find no reference in the literature regarding flaxseeds being harmful to the heart. But because flaxseed oil is highly unsaturated, it is possible that it may lengthen blood-clotting time. Therefore, if you have any problems with blood clotting, we caution you not to eat any extra flaxseed oil before talking with your doctor.

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Q: What, if anything, happens to the nutrients when I drain yogurt to make the thicker “yogurt cheese”. Is there calcium or anything else that is lost in the discarded “whey”? I’m sure others must wonder about this too, and I’ve never seen it discussed anywhere. Thanks so much for your wonderful books, website, and inspiration!
A: Some calcium is lost in the whey. But most of the calcium and other nutrients such as protein remain in the “yogurt cheese.” If you enjoy the yogurt cheese, by all means keep preparing and eating it. If possible, I recommend that you save the whey and add it to soups, or use it in baking instead of water. It will add more flavor and will add a few more nutrients.

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