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  • Wednesday, January 25, 2023 12:11 PM | Jessica Tosto (Administrator)

    Fiber Focus Month Blog Post

    By Vida Velasco-Popov, MS Student at PACE University

    January for many is a time for change and new beginnings, so it seems fitting for RDs to celebrate this time as National Fiber Focus month! This topic is especially dear to me, as I am a strong advocate for increasing fiber consumption especially here in the United States where the average American only consumes about 15g of fiber per day When comparing this value to current dietary reference intakes, which are 38g/day for men and 25g/day for women, we see a clear need to encourage further consumption of fiber It is well known that adequate fiber intake plays a role in reducing cholesterol levels, improving blood glucose levels, easing bowl movements, and regulating body weight, all of which contribute to combating disease and improving overall health     

    Fiber comes from a variety of different plant sources, and is categorized as non-starch polysaccharides, resistant starches, or resistant oligosaccharides Within these categories, fiber possesses different properties pertaining to relative solubility, viscosity, and fermentability, which influence overall function Fiber plays a critical function providing fuel for gut microbes resulting in the production of short chain fatty acids, vitamin K, and vitamin B12, all of which are essential components needed in healthy diets Though much is known with regards to health benefits gained by increasing fiber intake, still much remains unknown in terms of how fiber affects different gut microbe populations, and what microbial changes take place in response to specific dietary foods. Looking to the future, we see a tremendous opportunity for RDs to further new discoveries within this domain and to promote a shift toward advancing our current understanding of human nutrition.

    When we think about the human gut microbiome, which contains 150 times more microbial genes than our own, it seems logical for so many researchers to take an interest in understanding the functions and optimization of this key system Though research is still ongoing with regards to fiber and prebiotics, we do know that dandelion greens, chicory roots, chia seeds, artichokes, garlic, almonds, flaxseeds, onions, oats, and barley all serve as prebiotics supporting the growth of healthy gut microbes Though beneficial effects of probiotics, or foods containing live health-promoting microbes are widely explored, prebiotics - the fuel source for probiotics, remain somewhat underrepresented. Prebiotics derived from fiber rich sources play a variety of beneficial roles, including supporting the immune system, promoting the growth of beneficial microbes, increasing production of beneficial metabolites, enhancing calcium absorption, and promoting the growth of lactobacilli species, which for women promotes vaginal health by reducing risk for infections Furthermore, fiber-rich diets have been associated with a higher prevalence of Firmicutes, a bacterial phylum with butyrate producing bacteria protective against colitis 

    An interesting recent study conducted by researchers at Stanford University explored how fiber and probiotics influence the gut microbiome in 36 healthy adults ages 51±12 years over a 17-week period  Participants were assigned to one of two groups where they consumed either a high-fiber or high-fermented food diets. Food intake was recorded and submitted every two weeks to confirm compliance and assess dietary effects on the gut microbiome, overall health, and effects on the immune system. Data was collected using blood and stool samples to assess health biomarkers and varied microbial species. Baseline food intakes revealed the average participant followed primarily a western diet prior to the intervention phase In the high-fiber group, participants ate significantly less packaged food and were able to improve nutrient intake profiles while decreasing overall consumption of salt and animal-based proteins  Additionally, participants from the fiber-rich group reported an increase in softening of stool throughout the study

    What I found particularly interesting were the findings related to changes in microbial species and overall effects on inflammation. Upon the conclusion of the study, microbiota within the high-fiber group was found to have enhanced capacity to degrade complex carbohydrates while bacterial growth increased significantly Though one might expect an overall decrease in inflammation in the high-fiber group, inflammatory biomarkers were surprisingly inconsistent across participants  One sector of the participants from the fiber rich group had increased inflammation while others were found to have decreased inflammation  After comparing baseline microbial genomes among fiber-rich group participants, researchers found that those showing higher inflammation at the end of the study had less microbial diversity and generally ate fewer plant foods than those who showed decreased levels of inflammation at the end of the study These results suggest a more nuanced approach for increasing fiber intake to improve gut health and support the immune system. Limited initial microbial diversity could limit the ability of a fiber-rich diet in supporting the immune system and decreasing inflammation.                

    With regards to the high-fermented foods group, researchers found an overall increase in microbial diversity at the end of the study and an overall decrease in inflammatory cytokines In contrast with the high-fiber group, the high-fermented foods group did not show an increase in microbial proteins as we saw in the high-fiber group, this suggests microbial metabolic capacity within the gut may require fiber to increase capacity Furthermore, the simple introduction of microbial species from fermented foods alone may not contribute to enhancing overall capacity to degrade complex carbohydrates. Though the sample size was relatively small, and study focused on healthy participants, the implications behind this study open the door for further understanding how the gut microbiome varies in its response to the presence of fiber and how the combination of fiber and probiotics may serve to enhance gut health while supporting the immune system. There’s still much to learn with regards to fiber and the gut microbiome, which urges me to look toward the future in which the dietetic field is ever evolving. With the addition of new technologies, we may understand nutrition on an even deeper level, eventually seeing to the gut and its inhabitants as our true canary in the coal mine.


    1.                  Guan Z-W, Yu E-Z, Feng Q. Soluble dietary fiber, one of the most important nutrients for the gut microbiota. Molecules. 2021;26(22):6802. doi:10.3390/molecules26226802

    2.                  Hijová E, Bertková I, Štofilová J. Dietary fibre as prebiotics in nutrition. Central European Journal of Public Health. 2019;27(3):251-255. doi:10.21101/cejph.a5313

    3.                  Kaur AP, Bhardwaj S, Dhanjal DS, et al. Plant Prebiotics and their role in the Amelioration of Diseases. Biomolecules. 2021;11(3):440. doi:10.3390/biom11030440

    4.                  Myhrstad MC, Tunsjø H, Charnock C, Telle-Hansen VH. Dietary fiber, gut microbiota, and Metabolic Regulation—current status in human randomized trials. Nutrients. 2020;12(3):859. doi:10.3390/nu12030859

    5.                  Position of the American Dietetic Association: Health Implications of Dietary Fiber. Journal of the American Dietetic Association. 2008;108(10):1716-1731. doi:10.1016/j.jada.2008.08.007

    6.                  Simpson HL, Campbell BJ. Review article: Dietary fibre-microbiota interactions. Alimentary Pharmacology & Therapeutics. 2015;42(2):158-179. doi:10.1111/apt.13248

    7.                  Wastyk HC, Fragiadakis GK, Perelman D, et al. Gut-microbiota-targeted diets modulate human immune status. Cell. 2021;184(16). doi:10.1016/j.cell.2021.06.019

  • Tuesday, April 12, 2022 2:11 PM | Anonymous

    What is Irritable Bowel Syndrome?

    Irritable bowel syndrome (IBS) is a common chronic intestinal disorder that occurs in the large intestines.1–4 Symptoms of IBS include repeated abdominal pain, bloating, cramping, gas, and constipation or diarrhea, or both.1–3

    Unfortunately, IBS is not fully understood yet, so there are no definitive tests that can be used to diagnose this condition.1,2 In general, IBS tends to be diagnosed in individuals who experience the mentioned signs and symptoms. From those signs and symptoms, a medical practitioner will diagnose you with one of three types of IBS based on your symptoms so they can determine the most effective treatment for you. The types of IBS include constipation-predominant, diarrhea-predominant, or mixed.1,2

    IBS treatment usually focuses on relieving symptoms.1 Some people manage their symptoms by avoiding foods that trigger their symptoms, drinking large amounts of fluids, eating high-fiber foods, and adequate exercise and sleep. Diet changes are individualized for those with IBS.1 Many people eliminate high-gas foods and gluten from their diets, but others may eliminate dairy, fried foods, indigestible sugars, and beans.1,3 Although, the low FODMAP diet has been shown to help people manage their IBS symptoms.5,6 In more severe cases, people are treated with counseling or medication.1

                More recent evidence indicates that IBS may be a brain-gut disorder as studies have found that the gut microbiota produces gases that contain chemicals that affect mood, cognition, and the gut-brain communication.7 Further, IBS treatments including high-fiber foods and reduced stress are associated with both reduced IBS symptoms and healthier gut bacteria.1,8 This association suggests more research is necessary to fully understand the relationship between IBS and the gut microbiome.

    April is IBS Awareness Month

    Back in 1997, the International Foundation for Gastrointestinal Disorders designated April as IBS Awareness Month.9 This designation was provided to increase public awareness about IBS, help others understand the different forms of IBS, and educate others about issues concerning diagnosis, treatment, and quality of life in individuals with IBS.9About 10-15% of people worldwide have IBS where 12% of people in the US have the condition.9 Risk factors of IBS are being a women, being less than age 50, a family history of IBS, a history of stressful or difficult life events, and having a severe infection in the digestive tract.4

    Low FODMAP Diet

    'FODMAP' is an abbreviation for 'fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols.'5 They are sugars that are not completely digested or absorbed in the intestines.5 Instead, gut bacteria ferment those sugars and as a result, produce a gas.5 In those with IBS, this gas can result in the mentioned IBS symptoms since individuals with IBS have highly sensitive guts.5 So, people with IBS are encouraged to ingest food items that contain low FODMAPs so their gut bacteria would produce less gases.

    FODMAPs are found in vegetables, fruits, cereals, breads, legumes, nuts, and some sweets.5,6 Below are some examples of low FODMAP foods items:

         Vegetables: Bell pepper, bok choy, carrot, cucumber, eggplant, lettuce, potato, spinach, zucchini5,6

         Fruits: Banana, cantaloupe, grapes, mandarin, orange, peach, pears, strawberries5,6

         Dairy & alternatives: Lactose-free, almond milk, brie/camembert cheese, feta cheese, hard cheeses5,6

         Protein sources: Eggs, firm tofu, plain cooked meats/poultry/seafood5,6

         Starches: Barley, corn flakes, oats, quinoa, rice, rye, wheat, gluten-free products5,6

         Nuts & seeds: Almonds, macadamia nuts, peanuts, pumpkin seeds, walnuts5,6

         Sweets: Dark chocolate, maples syrup, table sugar, molasses5,6

    If you would like to learn more about Irritable bowel syndrome or other gastrointestinal disorders, then you can visit the International Foundation for Gastrointestinal Disorders website.


    1.   Irritable bowel syndrome - Symptoms and causes. Mayo Clinic. Accessed April 3, 2022. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016

    2.   Irritable Bowel Syndrome (IBS) | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 3, 2022. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome

    3.   IBS: Symptoms, Causes, Diagnosis, Triggers, and Treatment. Healthline. Published September 29, 2014. Accessed April 3, 2022. https://www.healthline.com/health/irritable-bowel-syndrome

    4.   Definition & Facts for Irritable Bowel Syndrome | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 3, 2022. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts

    5.   About FODMAPs and IBS | Monash FODMAP - Monash Fodmap. Accessed April 7, 2022. https://www.monashfodmap.com/about-fodmap-and-ibs/

    6.   Low FODMAP Diet for Irritable Bowel Syndrome | IBS Treatment. Gastroenterology Consultants of San Antonio. Accessed April 7, 2022. https://www.gastroconsa.com/patient-education/irritable-bowel-syndrome/low-fodmap-diet/

    7.   Illuminating the Brain-Gut Axis: Insights from Japan’s Leading IBS Researcher. nippon.com. Published April 5, 2022. Accessed April 6, 2022. https://www.nippon.com/en/japan-topics/c08004/

    8.   Boosting fiber intake for 2 weeks alters the microbiome. Published April 6, 2021. Accessed April 7, 2022. https://www.medicalnewstoday.com/articles/short-term-increase-in-fiber-alters-gut-microbiome

    9.   IBS Awareness Month - About IBS. Published March 8, 2021. Accessed April 3, 2022. https://aboutibs.org/living-with-ibs/ibs-awareness-month

  • Thursday, March 17, 2022 8:28 PM | Anonymous
    What is Epilepsy?

    Epilepsy is a neurological disorder characterized by generally more than 2 unprovoked seizures, which are spontaneous, disordered electrical discharging of cerebral neurons1. The term epilepsy can be interchangeable with the term seizure disorders. During a seizure, periods of electrical discharges take place and can last from a few seconds to several minutes. Seizures can range from brief lapses of attention, to muscle jerks, to severe convulsions2. Different types of seizures include different parts of the brain; generalized seizures involve the entire brain, while partial seizures affect only part of the brain1.

    It is crucial to differentiate between a single seizure and the diagnosis of epilepsy, as there can be many reasons a single seizure may occur such as fever, or hyperglycemia/hypoglycemia1.

    Purple Day

    About 50 million people are diagnosed with epilepsy worldwide, with the most prevalent rates in low- and middle-income countries2 . According to the CDC, 1.2% of the US population has active epilepsy, which equates to 3 million adults and 470,000 children3.

    In 2008, Cassidy Megan founded Purple Day in an effort to bring her own struggles with this disorder to light; she recalls feeling scared, alone, and would often lose friends and be a victim of bullying. Cassidy states that her main goals in founding Purple Day are to dismantle the myths surrounding epilepsy and to inform those with seizures that they are not alone4.

    Purple Day, celebrated on March 26th, is commemorated by people wearing the color purple, as well as hosting events to educate, increase awareness, and support those living with this condition. With the help of Grassroots International, a grantmaking and social action organization, this campaign has raised so much attention that people in over 85 countries, on all continents, participated in Purple Day last year4,5.

    Nutrition Recommendations for Epilepsy

    People with epilepsy may be at great nutritional risk. Infants, children, and adolescents are especially vulnerable for they are in a period of significant and rapid growth and development.

    An impaired ability to consume adequate nutrients, limited food choices, and drug–nutrient interactions pose as the main contributors to nutritional risk1.

    Ketogenic Diet

    The now-popularized diet, known as the ketogenic diet, has gained much attention over the last few years. What many people may not be aware of is that this diet was created for children with epilepsy whose seizures have not responded to antiepileptic drugs (AEDs). The diet is characterized by high-fat, low-carbohydrate components with about 3 to 4 grams of fat for every 1 gram of carbohydrate6. The name ketogenic comes from the word “ketones”, which is the product made when the body is forced to use fat as the main fuel source in the absence of carbohydrates. Unfortunately, the exact mechanism for why following a low carbohydrate, high fat diet seems to help reduce seizure episodes is unknown. However, it has been theorized that the combination of low sugar and high fat components modifies the neuronal metabolism and ‘excitability’ of the brain, thereby reducing the tendency for seizures to occur7,8. With that said, there have been promising results for those who follow the ketogenic diet; over half of children have at least a 50% reduction in the number of their seizures, while about 10-15% children become seizure-free5.

    This diet is usually not recommended for adults because the restriction of food choices proves to be extremely difficult to follow. The modified Atkins diet, however, does work well for epileptic adults as it is less restrictive; fats are not measured, and protein is not limited to a specific daily total calorie intake like in the ketogenic diet9. If an adult does decide to follow the ketogenic diet, it is recommended that they speak to their healthcare provider and take a supplement to avoid deficiencies, as the diet is low in carbohydrates, fiber, calcium, and other nutrients1.

    General Recommendations: 

    • Let to know your medication. 
    Pharmacotherapy is the main seizure treatment used today10. However, many AEDs have major drug-nutrient interactions, so it is crucial to talk to your healthcare provider or an RDN about the potential nutritional risks1.

    • Eliminate simple sugars, and include more natural, whole food options into your diet.
    This can be a daunting process as simple sugars are found in just about everything– processed foods, candy, dairy or milk products, fruits, soft drinks, and more. However, eliminating simple sugars is the first step in controlling glycemic index and starting a healthy eating pattern. Registered Dietitian Nutritionists (RDNs) who work with epileptic clients noted that even simple, yet consistent diet changes have resulted in improvement in seizure control10.
    • Increase your fluid intake. 

    Fluids are encouraged because of the risk of kidney stone development, as well as the diuretic effect of any low-carbohydrate diets used to treat epilepsy10.Any diet supplementation or recommendations should be firstly checked with, and then closely monitored by an experienced team of neurologists and dietitians/RDNs.

    If you would like to learn more about epilepsy or Purple Day, please visit the https://www.purpleday.org/ or https://www.epilepsy.com/ website.


    1.     Nahikian-Nelms M. Nutrition Therapy and Pathophysiology. 4th ed. Cengage; 2020.

    2.     World health organization. Epilepsy. Who.int. Published June 20, 2019. https://www.who.int/news-room/fact-sheets/detail/epilepsy

    3.     “Epilepsy Data and Statistics | CDC.” Www.cdc.gov, 28 Jan. 2019, www.cdc.gov/epilepsy/data/index.html#:~:text=Epilepsy%20Prevalence%20in%20the%20United.

    4.     Purple Day – Supporting Epilepsy Around The World! https://www.purpleday.org/

    5.     Grassroots International | Funding Global Movements for Social Change. Grassroots International. https://grassrootsonline.org/

  • Friday, February 25, 2022 8:05 PM | Anonymous

    February is National Cancer Prevention Month. As registered dietitians, we know that eating well can help prevent and beat cancer in a variety of ways. While we know that there is no guaranteed way to prevent cancer, there are certain risk factors that can increase a person’s likelihood. In the United States, men have a 1 in 2-lifetime risk of developing cancer; and for women, the risk is 1 in 3. Registered dietitians can help patients reduce the risk of cancer by educating and encouraging diet and lifestyle modifications that promote healthy choices, along with following the recommended screening guidelines to encourage early detection.

    While nutrition guidelines for cancer prevention are similar to the prevention of other diseases, such as cardiovascular disease and diabetes, diet is one of the most important aspects a person can control to reduce their cancer risk, along with other lifestyle modifications.

    Here are general nutrition recommendations that help prevent cancer:

    Maintain a healthy weight

    Partake in regular physical activity and consume a healthy, well-balanced diet. Obesity can cause long-term inflammation in the body, which may increase cancer risk. Also, excess weight can also cause increased levels of certain hormones, which can increase the risk of certain cancers.

    Follow a Healthy Eating Pattern

    The U.S. Dietary Guidelines recommends eating nutrient-dense foods including a variety from all food groups. Fill half your plate with fruits and vegetables and make at least half your grains whole grains. Cancer prevention evidence supports the recommendation of a diet that is predominantly plant-based, with limited, if any, intake of red and processed meats. It is also recommended to limit added sugar, sugar-sweetened beverages, highly processed foods, and refined grain products.

    Exercise regularly

    Strive for at least 30 minutes of physical activity as part of your daily routine. At least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic physical activity is recommended to reduce cancer risk.

    Avoid Alcohol

    Studies show that alcohol consumption causes several types of cancer. In order to prevent or reduce the risk of cancer, there is no safe level of consumption. It is believed that the more alcohol a person drinks, the higher their risk of developing an alcohol-associated cancer.

    Quit Smoking

    Tobacco use remains the leading preventable cause of death in the US, accounting for about 1 in 5 deaths each year. Most people know smoking can cause cancer, and about 80% of lung cancers, as well as 80% of all lung cancer deaths, are due to smoking. Lung cancer is the leading cause of cancer death in both men and women. No forms of smoking are safe.

    To learn more about diet and cancer prevention, as well as diet and nutrition during and after cancer treatment, patients are always encouraged to consult a registered dietitian nutritionist.


    1. Rock CL, Thomson C, Gansler T, Gapstur SM, McCullough ML, Patel AV, Andrews KS, Bandera EV, Spees CK, Robien K, et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians 2020;70:245–71.

  • Friday, January 14, 2022 9:00 AM | Krishaveni Drummond (Administrator)

    January is National Thyroid Awareness Month. First off, what is the thyroid? The thyroid is a small butterfly-shaped gland that is located above the collarbone and in front of the windpipe.1–3 It is responsible for producing hormones that maintain the body's energy and regulate the body's breathing, heart rate, nervous systems, body weight, muscle strength, menstrual cycles, cholesterol levels, and other organ systems.2,4 Therefore, thyroid disorders and diseases impair the secretion of hormones and cause dysfunction to the entire body. There are many thyroid disorders and diseases including hypothyroidism, hyperthyroidism, abnormal thyroid growth, nodules/lumps within the thyroid, and thyroid cancer.3 Hashimoto's disease is one condition that can cause hypothyroidism.

    What is Hashimoto's Disease?

    'Hashimoto's disease,' also known as 'Hashimoto's thyroiditis’ is the most common cause of hypothyroidism in the United States.2,4 This condition is an autoimmune disorder that causes chronic inflammation in the thyroid which leads to impaired thyroid function, the under-production of thyroid hormones, and an underactive thyroid (which is also known as hypothyroidism).2 The likelihood of developing Hashimoto's disease can increase if an individual has the following risk factors: being a woman between the ages 30-50, having a family history of Hashimoto's disease, and having other autoimmune disorders such as celiac disease, lupus, rheumatoid arthritis, and type 1 diabetes.4 Further, exposure to certain environmental and nutritional factors contributes to the development of this disease.5

    Nutrition Recommendations for Hashimoto's Disease

    There are currently no specific nutrition recommendations for this condition, but researchers are identifying associations between various nutrients and thyroid function.


    Iodine is essential for the body as it is a necessary component for the two main thyroid hormones triiodothyronine (T3) and thyroxine (T4).3,5,6 Although, long-term intake of excessive or increased amounts of iodine has been associated with increases in circulating antibodies.5 This association likely occurs due to highly-iodinated thyroglobulin (Tg) which is immunogenic, meaning that it can trigger an immune reaction against the thyroid.5 Such a reaction increases the risk of thyroid autoimmunity and has been evident in multiple countries that have supplied iodine-fortified products, including China and Denmark.5 Based on these data, autoimmune thyroiditis, including Hashimoto’s disease, is associated with excess iodine intake. Therefore, it is recommended that sources of iodine should be eaten in moderation to ensure that iodine levels remain at the recommended levels. Iodine can be found in seafood (e.g. seaweed, fish, shellfish), animal products (e.g. cow’s milk, eggs, yogurt), and some fruits (e.g. cranberries, strawberries).7


    Adequate iron intake is necessary for the production of T3 and T4 as the enzyme thyroid peroxidase activates after binding to a prosthetic heme group that contains iron.6 Notably, multiple studies have found that patients with Hashimoto's disease and hypothyroidism have lower serum iron concentrations and a higher prevalence of iron deficiency compared to healthy controls.6 It is good to note that individuals with Hashimoto's disease also tend to have celiac disease or another autoimmune disorder that implies that iron deficiencies may stem from those co-morbidities rather than Hashimoto's disease.6 Similar to iodine, it is recommended that sources of iron should be eaten in moderation so iron levels remain at the recommended levels. Iron can be found in both animal and plant sources, but animal sources are more bioavailable compared to plant sources.8 Some foods that contain iron include lean beef, oysters, chicken, turkey, beans and lentils, tofu, cashews, dark green leafy vegetables, and fortified or enriched bread and cereals.8 It is also recommended to couple a source of vitamin C with these foods to enhance iron absorption.8


    Selenoproteins are proteins that contain selenium and are necessary for thyroid function.5 Glutathione peroxidases are essential selenoproteins for thyroid function as they eliminate excessive amounts of hydrogen peroxide, which is a by-product of the iodination process of highly-iodinated Tg to form thyroid hormones.5 Evidence from observational studies and randomized-controlled trials have demonstrated that selenium, likely when in its selenoprotein form, can decrease thyroid peroxidase-antibody concentration and hypothyroidism.5 Therefore, limited selenium stores can cause thyroid dysfunction, and can especially affect individuals with Hashimoto's Disease.5 Notably, excessive selenium intake is toxic so selenium intake should meet recommended levels.5 Sources of selenium include oysters, tuna, whole-wheat bread, sunflower seeds, mushrooms, rye, and animal meats (e.g. chicken, turkey, pork, beef, lamb).7 Brazil nuts are also an excellent source of selenium as eating one Brazil nut will meet the daily recommended intake for selenium.

    Vitamin D

    Vitamin D is both a fat-soluble vitamin and a hormone as it is responsible for regulating calcium/phosphate homeostasis in the kidneys and bones, it is an immunomodulator, and it modulates cell growth and differentiation.7,9,10 There is potential relevance of vitamin D status to Hashimoto’s disease as research has shown that lower vitamin D has been identified in patients with Hashimoto's disease compared to controls.6 Also, inverse relationships have been found between serum vitamin D status and thyroid peroxidase/Tg antibodies.6 Although, there are limited trials and evidence regarding vitamin D status and thyroid function, and populations with other autoimmune diseases have reported vitamin D receptor dysfunction implying that low vitamin D status is a result of autoimmune disease processes and is not exclusive to Hashimoto's disease.6 Also, one study found no significant changes in the serum levels of T3 and T4 of vitamin D deficient patients with Hashimoto’s disease, even after vitamin D supplementation.9 Therefore, more research is required to better understand the relationship between vitamin D and thyroid function. Vitamin D3 is the most bioavailable form of vitamin D to humans and can be found in fish (e.g. wild fresh salmon, cod liver oil, sardines) and dairy products.7 Further, the body can synthesize vitamin D3 in the skin via adequate sun exposure.7

    Based on these data, individuals with Hashimoto’s disease are recommended to monitor their intake of iodine, iron, selenium, and vitamin D. The Dietary Guidelines for Americans can be referenced to determine recommended amounts for each micronutrient. Further, it may be beneficial to discuss nutrition recommendations about Hashimoto's disease or other thyroid diseases and disorders with dietitians or healthcare providers who specialize in these conditions.

    If you would like to learn more about Hashimoto's disease or other thyroid diseases, then you can visit the American Thyroid Association website.


    1. Clinic TS. National Thyroid Awareness Month: Thyroid Disease. The Surgical Clinic. Published January 15, 2020. Accessed January 4, 2022. https://thesurgicalclinics.com/national-thyroid-awareness-month/

    2. Hashimoto’s Thyroiditis. American Thyroid Association. Accessed January 3, 2022. https://www.thyroid.org/hashimotos-thyroiditis/

    3. Thyroid Gland: Overview. Endocrine Web. Accessed January 4, 2022. https://www.endocrineweb.com/conditions/thyroid-nodules/thyroid-gland-controls-bodys-metabolism-how-it-works-symptoms-hyperthyroi

    4. Hashimoto’s Disease | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Published June 2021. Accessed January 3, 2022. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease

    5. Rayman MP. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proceedings of the Nutrition Society. 2019;78(1):34-44. doi:10.1017/S0029665118001192

    6. Hu S, Rayman MP. Multiple Nutritional Factors and the Risk of Hashimoto’s Thyroiditis. Thyroid. 2017;27(5):597-610.

    7. Liontiris MI, Mazokopakis EE. A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients. Points that need more investigation. Hell J Nucl Med. 2017;20(1):51-56. doi:10.1967/s002449910507

    8. Foods to Fight Iron Deficiency. Accessed April 6, 2021. https://www.eatright.org/health/wellness/preventing-illness/iron-deficiency

    9. Chahardoli R, Saboor-Yaraghi AA, Amouzegar A, Khalili D, Vakili AZ, Azizi F. Can Supplementation with Vitamin D Modify Thyroid Autoantibodies (Anti-TPO Ab, Anti-Tg Ab) and Thyroid Profile (T3, T4, TSH) in Hashimoto’s Thyroiditis? A Double Blind, Randomized Clinical Trial. Horm Metab Res. 2019;51(5):296-301. doi:10.1055/a-0856-1044

    10. Gropper SS, Smith JL. Advanced Nutrition and Human Metabolism. seventh.

  • Saturday, May 29, 2021 1:51 PM | Anonymous

    By Marissa Lau, Pace University, 2022

    Hypertension is a risk factor of multiple chronic diseases including cardiovascular disease, chronic kidney disease, dementia, and other diseases and conditions.1 This disease burdens 1.2 billion individuals worldwide making it a public health issue.2 Hypertension has several  modifiable risk factors that can decrease the likelihood of developing the disease.1 Such risk factors include overweight or obese, diet consisting of high salt intake, sedentary lifestyle, and frequent alcohol use.1,3,4 In particular, low potassium intake in the diet can lead to the disease.1,3,4

    The Role of Potassium on Blood Pressure

    Regarding blood pressure, potassium and sodium play major roles in maintaining blood volume, hydro-electrolyte balance, and cell function via the renal system.3 More specifically, potassium can modify the effect of sodium on blood pressure in the renal system.3

    When potassium intake is high, a negative sodium balance develops, resulting in increased sodium excretion, via urine, which is demonstrated through the downregulation of sodium chloride cotransporters.3 Through this mechanism, high potassium intake leads to high plasma potassium.3 The high plasma potassium maintains sufficient intracellular chloride, resulting in lower blood pressure.3

    This mechanism is one biochemical pathway relating to blood pressure, but other studies have proposed additional renal and non-renal mechanisms that relate to hypertension and involve potassium and sodium mechanisms.3 The pathogenesis of this condition is complex, and more research is necessary to acquire a complete understanding of this topic.3

    How Much Potassium Is Recommended?

    Based on the 2020-2025 Dietary Guidelines for Americans, a daily goal of 2,000-3,400mg of potassium is recommended, depending on gender and age.5(p133) This amount is important as more than 80% of Americans have diets consisting of low intake of vegetables and fruits, which suggests that most Americans have low potassium intake.5(p30)

    Knowing the guidelines’ potassium recommendation can be important, but hypertensive individuals can benefit from following the sodium-potassium ratio. The sodium-potassium ratio consists of low sodium and high potassium intake to lower blood pressure. Studies have even found that this ratio may be more significant for blood pressure maintenance, compared to the exact amount of potassium and sodium that an individual consumes.4

    What Are Good Sources of Potassium?

    Potassium supplementation may be used to increase potassium intake.3 Either potassium chloride or potassium citrate can be taken as one study has demonstrated that subjects that took either supplement had similar blood-pressure lowering effects.3 On the other hand, another study found a more significant decrease in blood pressure in subjects supplemented with potassium chloride, compared to those supplemented with potassium magnesium citrate and potassium citrate.3 Based on these studies, more research is necessary to determine the ideal form of potassium supplementation to provide optimal blood-pressure lowering effects.

    Although studies have shown that potassium supplements are effective, it is not advisable as high intake of vitamins or minerals in a short period of time can lead to toxicity.4 Instead, diets consisting of high-potassium vegetables, fruits, and nuts is recommended.3,4 One study found that from the hypertensive individuals who increased their dietary intake of potassium, 81% of the individuals required less than half of the baseline medication and 38% did not need antihypertensive medication for blood pressure control, when compared to 29% and 9%, respectively, in the control group after 1 year of the follow-up.4

    Following the sodium-potassium ratio, it is recommended to increase potassium consumption via fruits, vegetables, and nuts, in individuals who have moderate excess of sodium intake.3 For individuals with excessive salt intake, they can both reduce sodium intake and increase potassium intake.3 Diets should consist of fresh produce as frozen or canned produce contains lower potassium content.4 Processed foods should be limited as well since they are high in sodium and low in potassium.4 For individuals who prefer to follow a specific diet, the DASH diet or the Mediterranean diet is recommended as these diets emphasize the intake of vegetables, fruits, and nuts, and have shown to decrease risk of hypertension in hypertensive individuals.3,6 


    1.         High blood pressure (hypertension) - Symptoms and causes. Mayo Clinic. Accessed May 5, 2021. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

    2.         Rossier BC, Bochud M, Devuyst O. The Hypertension Pandemic: An Evolutionary Perspective. Physiology. 2017;32(2):112-125. doi:10.1152/physiol.00026.2016

    3.         Burnier M. Should we eat more potassium to better control blood pressure in hypertension? Nephrology Dialysis Transplantation. 2019;34(2):184-193. doi:10.1093/ndt/gfx340

    4.         Samadian F, Dalili N, Jamalian A. Lifestyle Modifications to Prevent and Control Hypertension. Iranian Journal of Kidney Diseases. 2016;10(5):237-263.

    5.         U.S. Department of Agriculture, U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. Published online December 2020.

    6.         Magriplis E, Panagiotakos D, Kyrou I, et al. Presence of Hypertension Is Reduced by Mediterranean Diet Adherence in All Individuals with a More Pronounced Effect in the Obese: The Hellenic National Nutrition and Health Survey (HNNHS). Nutrients. 2020;12(3). doi:10.3390/nu12030853

  • Saturday, May 29, 2021 1:44 PM | Anonymous

    By: Kristen Nicolai

    The Westchester Rockland Dietetic Association (WRDA) held a live webinar on May 19 titled, Understanding and Addressing the Unique Needs of Women with PCOS, presented by Dr. Felice Gersh, MD. Dr. Gersh is board-certified in OB-GYN and Integrative Medicine and the medical director of Integrative Medical Group of Irvine. She is a globally recognized expert on a wide range of female and integrative health topics.

    To start off the webinar, Dr. Gersh provided background on PCOS and explained that for women to have optimized health, they require optimized hormones. We live in a world of endocrine disruptors, including pollutants, toxicants, poor diet, and disrupted sleep-wake cycles. Women develop PCOS by being exposed to endocrine disruptors in utero, including exposure to higher levels of BPA. This causes high oxidative stress causing the endocrine system to be dysregulated. Women with PCOS therefore have altered endocrine receptor function, causing a state of estrogen deficiency. 

    Since estrogen receptors are located throughout the body, every organ system is impacted by this low estrogen, creating pro-inflammatory conditions. Dr. Gersh explained that inflammation is the driving force of PCOS, causing the dysbiosis, abdominal fat, insulin resistance, altered immune cell reactivity, and impaired circadian rhythm seen in PCOS. Because of this, PCOS patients experience a wide range of symptoms including acne, hirsutism, alopecia, irregular cycles, obesity, fatigue, joint pains, gingivitis, mood disorders, and IBS. Therefore, modulating estrogen is a key part of helping women with PCOS.

    When treating PCOS, it is critical to have and maintain a healthy gut microbiota, which supports all systems of the body. Food plays a big role in this as PCOS patients have impaired gut barrier and lower microbial diversity. Dr. Gersh has an integrative approach that includes feeding the gut or microbes, and eating to beat, which includes recognizing the important role of the circadian rhythm in women. Dr. Gersh emphasizes a plant-based diet that includes organic, raw, and minimally processed foods. She stresses eating the colors of the rainbow and lots of fiber. She also advises to limit sugar, fat, salt, and avoid alcohol, antibiotics from agriculture, artificial sweeteners, dairy, emulsifiers, and gluten. She encourages patients to take a daily probiotic, and even eating vegan for six months to help the body reboot.

    Dr. Gersh went on to explain that diet modulates the microbiome, and that a low fat and high complex carbohydrate diet has been proven to improve metabolic syndrome by altering the gut microbiome and increasing the bacterial strain F. prausnitzii that increases butyrate. Butyrate nourishes the cells of the gut ling, and even has a calming effect through its impact on the vagus nerve.  Dr. Gersh also emphasized the importance of a diet very high in fiber and resistant starch, which acts as pure food for the microbes of our gut. She recommended foods such as cold potatoes, plantains, and Jerusalem artichokes, which are high in resistant starch. She also encourages her patients to eat fermented, prebiotic and probiotic foods.

    It was also highlighted that nitric oxide is reduced in PCOS patients, which has an affect on t-regulatory cell generation. Women with PCOS do not make enough of these cells which causes autoimmune disfunction. Since nitric oxide is very related to food, Dr. Gersh highlighted the importance of eating foods containing nitric oxide, such as kale, swiss chard, arugula, and spinach.

    Dr. Gersh concluded that poor diets high in fat and sugar drive gut dysbiosis and the systematic inflammation seen in PCOS women. This also causes circadian rhythm dysfunction. To combat this Dr. Gersh explained her “eat to the beat” philosophy. This includes eating at same time each day, fasting through the night, eating dinner early, and eating a big breakfast, moderate lunch, and small dinner. She advises her patients to eat meals, not snacks, to stop eating at 7pm, and even try adding in a fasting mimicking diet or longer fasts. By correcting the clock to synch meal timing with the circadian rhythm, this can help women with PCOS see significant changes in their symptoms and reductions in glucose, insulin, testosterone, and other important biomarkers. 

    For more information on Dr. Gersh you can visit her website at https://integrativemgi.com/ or follow her on Instagram (@dr.felicegersh).

  • Wednesday, April 07, 2021 8:35 AM | Anonymous

    By Angela Iovine, Pace University, 2021

    Vitamin D is the most commonly used supplement in the U.S., and its popularity has further increased in recent months due to its perceived protective effect against the coronavirus.1  Both a vitamin and a hormone, Vitamin D helps maintain the balance of calcium and phosphorous within the body, which includes increasing the intestinal absorption of dietary calcium and keeping calcium in our bones.  It is therefore essential for strong bones and skeletal growth. Vitamin D may also have an immunomodulatory effect, and it appears to reduce all-cause mortality.2-5

    Vitamin D from the Sun

    Vitamin D is unique in that we can synthesize all that we need from exposure to the sun.  The precursor to vitamin D3 can be found evenly distributed along the surface of our skin.  When exposed to ultraviolet B (UVB) light, a component of sunlight, a molecule in our skin forms previtamin D3, which can then be converted into vitamin D3 in the body.  The amount of vitamin D3 produced from sun exposure is dependent on several factors, including:  how much skin is exposed, your latitude, air pollution and cloud cover, age, the color of your skin, and possibly use of sunscreen.  Clothing blocks UVB light from accessing the skin.  Glass also blocks UVB light, so sitting in the sun by a closed window will not help increase vitamin D production.  Those living above the 35th parallel (above Tennessee and North Carolina), generally receive less sunshine and fewer UVB rays, putting them at greater risk for deficiency.2,3 

    Black Americans have been found to have lower levels of 25-hydroxyvitamin D3 (25-OH D), the form of vitamin D that is used to determine adequacy, than white Americans.  Although research in this field is limited, it is thought that the increased levels of melanin in darker skin can block some UVB light and result in less vitamin D activation.2,6  Black Americans also tend to have less vitamin D binding protein (VDBP), which may lead to more free-circulating vitamin D and explain why they generally have better bone density and lower fracture risk than white Americans despite having lower vitamin D levels.7 

    The UVB rays that promote vitamin D synthesis can also cause sunburn, DNA damage to cells, and lead to skin cancer.  Some organizations, including the American Academy of Dermatology and the American Cancer Society, promote minimizing or avoiding sun exposure.3  Theoretically, sunscreen use could inhibit vitamin D production.  However, several studies have shown that lower SPF values still allow for vitamin D production in lighter-skinned individuals.  There is limited data on the effects of higher SPF values and the effect on darker-skinned people.8,9  For example, a study found that wearing SPF 15 sunscreen with a high UVA blocker was adequate to prevent sunburn while also allowing for vitamin D synthesis.  The study’s participants were all light-skinned people on vacation in the Canary Islands, and the UV index was very high.9 

    Sunburn is not necessarily a marker for DNA damage, and damage can still occur without getting burnt.  Research suggests that exposing more skin to sunlight for shorter duration, or having short, but recurrent, periods of sun exposure may minimize UV-induced skin damage while maintaining vitamin D production.10   

    Vitamin D in Food

                There is a relatively small number of foods that naturally contain vitamin D, most of which come from animals.  Eggs, liver, and fatty fish are good sources.  Smaller amounts can be found in butter and cheese.  Plant foods are generally poor sources of the vitamin, although mushrooms do contain some.  In the U.S., many foods are fortified with vitamin D to help reduce deficiency within the population.  Foods often fortified include orange juice, bread, cereal, milk, cheese, butter, margarine, and yogurt. 

    Most often these foods are fortified with D3 (also known as cholecalciferol), although D2 (also known as ergocalciferol) is sometimes used.  The two forms are similar in structure, with some differences in their side chains, and are utilized within the body similarly.2 

    Absorption of vitamin D in the digestive tract is not well understood, and there is much conflicting data on the subject.  Although vitamin D is better absorbed when taken with a meal that includes fat, it is not necessary for some absorption to take place.  The type of fat consumed does not matter, although this is open to debate.11  The overall amount of fat needed to optimize absorption is unclear; however, an older trial using a single bolus supplementation found some evidence that low-fat meals of about 11g of fat are superior.  Although after one month, regardless of fat intake, all participants had similar vitamin D levels.12

    Vitamin D and COVID-19

    Vitamin D appears to play a role in innate immunity and to exert an anti-inflammatory effect within the body, and it has been associated with improved outcomes for some viral infections, such as pneumonia.  Existing data suggests that vitamin D deficiency is not correlated with a greater risk of infection from coronavirus.  However, the severity of the deficiency is directly related to the severity of disease, hospitalization, and mortality from COVID-19, especially in the elderly.  Vitamin D may play a role in mediating cytokine activity associated with COVID-19 infections.3,13

    There is limited data on this subject, and the studies that do exist tend to have significant limitations, including a high risk of bias due to convenience sampling and use of secondary data analysis.  Further, many of the patients who are hospitalized for COVID-19 infections also have comorbidities or are elderly.  These populations are inherently at greater risk for vitamin D deficiency.  Therefore, it is difficult to know if their vitamin D status played a role in their infection or if it was another factor. Until we have more data, maintaining adequate vitamin D levels and avoiding deficiency via sun exposure, consuming fortified foods, and supplementation as necessary seems the best course.13 

    How is Vitamin D Status Measured?

    Vitamin D status is obtained via a blood test that looks at concentrations of 25-OH D.  There is substantial variability in the laboratory methods used to determine a sample’s vitamin D level, and the same sample sent to different laboratories can yield markedly different results.  Translating these results can also be problematic, as several interpretations of serum levels also exist.  Regular testing is not recommended for individuals who are not at risk of deficiency, as vitamin D supplementation is generally considered a safe and effective way to improve status and testing results tend to be quite variable. 

    Testing variability can also make it difficult to compare results across studies and develop clinical guidelines.  Some researchers have suggested that 25-OH D is not the best marker of the vitamin’s effect on the body, and that other markers should be used.7,14  The Institute of Medicine classifies serum 25-OH D concentrations less than 30 nmol/L as being indicative of deficiency and concentrations between 30-50 nmol/L as insufficiency.  Levels greater than 50 nmol/L are sufficient for most people.3  Levels between 50 – 80 nmol/L have been found to offer the most protection against all-cause mortality, with greater concentrations providing no additional benefit.4,5  Serum levels greater than 150 nmol/L have been linked to adverse events.3

    Deficiency and Toxicity

    About 40% of the U.S. population has either vitamin D insufficiency or  deficiency.  Unsurprisingly, vitamin D status varies by occupation, with up to 78% of people who work indoors having inadequate levels.15  The elderly are also commonly deficient due to being less efficient at making vitamin D and spending more time indoors.  Deficiency is also more common in those with fat-malabsorption disorders, liver or kidney dysfunction, infants who are breast-fed, those who are obese, nursing home residents and hospitalized patients.  Rickets in children and osteomalacia in adults result from severe vitamin D deficiency.2,3

    Deficiency has also been implicated in a number of diseases, including cancer, cardiovascular disease, autoimmune diseases, and diabetes.  Recent evidence suggests that this role has been overstated.  Vitamin D supplementation appears not to have an effect on most non-skeletal conditions.  For example, it does not lower the incidence of cardiovascular events or invasive cancers, improve glucose metabolism, or help one lose weight.  The lower vitamin D status associated with these conditions is likely a product of poor health and not the cause of it.  Vitamin D does appear to play a role in overall cancer mortality and also death from respiratory diseases.  5,10,16,17

                Reaching toxic vitamin D levels due to too much sun exposure is not possible, as vitamin D levels in the body plateau with repeated exposure.  Toxicity via supplementation is possible, although it is quite rare.  It is not recommended to exceed the tolerable upper intake level for vitamin D of 4,000 IU (for adolescents and adults).  However, toxic levels are generally only seen with excessive intake, such as 50,000 IU per day taken for weeks or cumulative intakes of 240,000 IU or more.  The most common manifestations of toxicity include calcinosis and hypercalcemia, calcification of soft tissues, hypertension, hyperphosphatemia, nausea, weakness, headache, anorexia, renal disfunction, and it can sometimes result in death.2,14 

    How Much Do We Need?

    Recommending an adequate level of sun exposure is difficult due to the many confounding factors involved and the association between sun exposure and skin cancer.  Some studies attempt recommendations, however, there is significant variation across references on the amount of exposure needed to prevent vitamin D deficiency. 

    The Dietary Guidelines for Americans acknowledge that it is difficult to get adequate vitamin D from dietary sources, and supplementation may be appropriate for individuals who get limited sunlight. The RDA for vitamin D is based on minimal sun exposure.  The recommendation is for 400 IU per day for infants under 1 year old, 600 IU per day for everyone from 1 – 70 years old, and 800 IU per day for those over 70 years old.18  Recommendations are confounded by the many factors that affect vitamin D status, and different countries and organizations have different recommendations for optimal intake.  Many researchers have proposed that the RDA is too low.  For example, the Endocrine Society recommends a minimum of 600 IU per day up to 2,000 IU per day to maintain adequacy in people aged 19-50.19,20

    There appears to be consensus that 400 IU per day is adequate for infants, and there is no evidence to suggest that higher doses are beneficial.20,21 A meta-analysis of randomized controlled trials from Northern Europe found that intakes around 1,000 IU per day can maintain adequate vitamin D status in 97.5% of children and adults.4,22  Intakes as high as 2,000 IU per day are commonly recommended, are generally considered safe, and should keep vitamin D values well below the upper intake levels.3,14  Because vitamin D can be stored in fat cells, those who are overweight or obese may need more vitamin D to reach adequate levels.2  Intakes that are 1.5 times higher than recommendations may be appropriate for overweight individuals, while intakes 2-3 times higher may be appropriate for obese individuals.23 

                When thinking about adding an oral supplement, consider vitamin D intake from all sources, including fortified foods.  Children can maintain adequate vitamin D levels by consuming fortified foods, such as milk and cereal.24  Despite the vast body of research on vitamin D, there remains uncertainty around making recommendations.  There are many variables that contribute to one’s individual vitamin D status.  It is likely prudent to err on the side of caution and assess your individual circumstances when deciding on how to proceed.  Individuals should partner with a health professional, such as a registered dietitian nutritionist, when deciding to make dietary or lifestyle choices. 



    1.         COVID Changed Supplement Popularity in 2020, ConsumerLab Survey Reveals. ConsumerLab Web site. https://www.consumerlab.com/news/covid-changed-supplement-popularity/02-26-2021/. Published February 26, 2021. Accessed March 27, 2021.

    2.         Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 6th ed. Belmont, CA: Wadsworth Cengage Learning; 2013.

    3.         Matsui MS. Vitamin D Update. Current Dermatology Reports. 2020;9(4):323-330.

    4.         Garland CF, Kim JJ, Mohr SB, et al. Meta-analysis of all-cause mortality according to serum 25-hydroxyvitamin D. Am J Public Health. 2014;104(8):e43-50.

    5.         Heath AK, Kim IY, Hodge AM, English DR, Muller DC. Vitamin D Status and Mortality: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2019;16(3):383.

    6.         Young AR, Morgan KA, Ho T-W, et al. Melanin has a Small Inhibitory Effect on Cutaneous Vitamin D Synthesis: A Comparison of Extreme Phenotypes. Journal of Investigative Dermatology. 2020;140(7):1418-1426.e1411.

    7.         Powe CE, Evans MK, Wenger J, et al. Vitamin D-binding protein and vitamin D status of black Americans and white Americans. The New England journal of medicine. 2013;369(21):1991-2000.

    8.         Neale RE, Khan SR, Lucas RM, Waterhouse M, Whiteman DC, Olsen CM. The effect of sunscreen on vitamin D: a review. British Journal of Dermatology. 2019;181(5):907-915.

    9.         Young AR, Narbutt J, Harrison GI, et al. Optimal sunscreen use, during a sun holiday with a very high ultraviolet index, allows vitamin D synthesis without sunburn. British Journal of Dermatology. 2019;181(5):1052-1062.

    10.       Lucas RM, Norval M, Neale RE, et al. The consequences for human health of stratospheric ozone depletion in association with other environmental factors. Photochemical & Photobiological Sciences. 2015;14(1):53-87.

    11.       Silva MC, Furlanetto TW. Intestinal absorption of vitamin D: a systematic review. Nutr Rev. 2018;76(1):60-76.

    12.       Dawson-Hughes B, Harris SS, Palermo NJ, Ceglia L, Rasmussen H. Meal conditions affect the absorption of supplemental vitamin D3 but not the plasma 25-hydroxyvitamin D response to supplementation. J Bone Miner Res. 2013;28(8):1778-1783.

    13.       Pereira M, Dantas Damascena A, Galvão Azevedo LM, de Almeida Oliveira T, da Mota Santana J. Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2020:1-9.

    14.       El-Hajj Fuleihan G, Bouillon R, Clarke B, et al. Serum 25-Hydroxyvitamin D Levels: Variability, Knowledge Gaps, and the Concept of a Desirable Range. Journal of Bone and Mineral Research. 2015;30(7):1119-1133.

    15.       Sowah D, Fan X, Dennett L, Hagtvedt R, Straube S. Vitamin D levels and deficiency with different occupations: a systematic review. BMC Public Health. 2017;17(1):519.

    16.       Manson JE, Cook NR, Lee IM, et al. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med. 2019;380(1):33-44.

    17.       Autier P, Mullie P, Macacu A, et al. Effect of vitamin D supplementation on non-skeletal disorders: a systematic review of meta-analyses and randomised trials. Lancet Diabetes Endocrinol. 2017;5(12):986-1004.

    18.       U.S. Department of Health and Human Services, U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. Dietary Guidelines for Americans Web site. https://www.dietaryguidelines.gov/sites/default/files/2019-05/2015-2020_Dietary_Guidelines.pdf. Published December 2015. Accessed June 3, 2020.

    19.       Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 2011;96(7):1911-1930.

    20.       Bouillon R. Comparative analysis of nutritional guidelines for vitamin D. Nat Rev Endocrinol. 2017;13(8):466-479.

    21.       Mimouni FB, Mendlovic J. Vitamin D requirements in infancy: an updated systematic review. Curr Opin Clin Nutr Metab Care. 2021;24(3):259-264.

    22.       Cashman KD, Ritz C, Kiely M, Odin C. Improved Dietary Guidelines for Vitamin D: Application of Individual Participant Data (IPD)-Level Meta-Regression Analyses. Nutrients. 2017;9(5):469.

    23.       Ekwaru JP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. The importance of body weight for the dose response relationship of oral vitamin D supplementation and serum 25-hydroxyvitamin D in healthy volunteers. PLoS One. 2014;9(11):e111265.

    24.       Brandão-Lima PN, Santos BDC, Aguilera CM, Freire ARS, Martins-Filho PRS, Pires LV. Vitamin D Food Fortification and Nutritional Status in Children: A Systematic Review of Randomized Controlled Trials. Nutrients. 2019;11(11).

  • Saturday, January 30, 2021 1:22 PM | Anonymous

    February is National Heart Month

    By Kristen Nicolai

    February 1, 2021

                February is National Heart Month. Every year the National Heart, Lung, and Blood Institute partners with The Heart Truthâ  to motivate Americans to adopt a healthy lifestyle to prevent heart disease. This year, heart health has never been more important as those with poor cardiovascular health are at increased risk of severe illness from COVID-19.[1]

                Heart disease is the leading cause of death in the United States. Cardiovascular disease encompasses diseases that affect the heart or blood vessels, including coronary heart disease, which can cause stroke, heart failure, and peripheral artery disease.  In the United States more than 800,000 people die from cardiovascular disease every year.[2] About 15 million people have coronary heart disease, the most common type of heart disease[3] and about 366,000 die from coronary heart disease each year.

    Heart disease can cause heart attacks, but preventative measures can help lower one’s risk of developing heart disease. Risk factors include high blood pressure, high cholesterol, being overweight or obese, having prediabetes or diabetes, smoking, family history, no physical activity or unhealthy eating behaviors.[4]

    The DASH diet or Dietary Approaches to Stop Hypertension eating plan is the recommended heart-healthy diet as it lowers high blood pressure and the “bad” LDL cholesterol in the blood. The DASH diet is abundant in vegetables, fruits, whole grains, fat-free or low-fat dairy, protein-rich foods such as fish, lean meats, eggs, nuts, seeds, and soy products, legumes, and oils or foods high in monounsaturated or polyunsaturated fats. Sodium, saturated/trans fats, added sugars, and alcohol should be avoided. Other ways to lower risk of heart disease are regular physical activity, maintaining a healthy weight, managing stress, getting enough sleep, and quitting smoking.

    To encourage Americans to adopt healthy lifestyles to prevent heart disease, The Heart Truthâ  campaign provides support through the #OurHearts Movement. The movement encourages social support and personal networks to work on heart health.[5]

    In addition, National Wear Red Day takes place annually on the first Friday in February to bring awareness to heart disease as the leading cause of death for Americans. People are encouraged to wear red to help bring more attention to the cause.

    For more ways to take part in national heart month, visit https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-month for additional resources including education materials, fact sheets, social media resources and more.

    [1]  About American Heart Month: Ways to Get Involved | NHLBI, NIH. Accessed January 24, 2021. https://www.nhlbi.nih.gov/health-topics/education-and-awareness/american-heart-month/about


    [2] Know the Difference Fact Sheet | NHLBI, NIH. Accessed January 24, 2021. https://www.nhlbi.nih.gov/health-topics/all-publications-and-resources/know-differences-cardiovascular-disease-heart-disease-coronary-heart-disease



    [3] Heart-Healthy Living | NHLBI, NIH. Accessed January 24, 2021. https://www.nhlbi.nih.gov/health-topics/heart-healthy-living


    [4] Heart-Healthy Living | NHLBI, NIH. Accessed January 24, 2021. https://www.nhlbi.nih.gov/health-topics/heart-healthy-living


    [5]   Join the #OurHearts Movement | NHLBI, NIH. Accessed January 24, 2021. https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-truth/our-hearts

  • Sunday, January 17, 2021 10:50 AM | Anonymous

    Angela Iovine, Pace University

    The new year is upon us, which means that many people will be attempting new year’s resolutions.  While usually 92% of people fail to achieve their resolutions, with most being abandoned by mid-February, 2021 may be different.1,2  After a difficult 2020, the new year brings hope of a fresh start.  We have seen improvements in the medical treatment of COVID-19 and the production of an effective vaccine.  During the pandemic, many people adopted unhealthy habits, such as sitting for long periods, abandoning gyms, drinking excessively, and falling into unhealthy eating patterns.  The advancement of the calendar year may be the impetus for change that many need.2

                Adopting a plant-based vegan diet is becoming an increasingly popular new year’s resolution.  , A nonprofit group called Veganuary began in 2014 and capitalizes on the desire for change this time of year.  Its goal is to inspire people to try a vegan eating pattern during the month of January and throughout the year.  Participants can sign up on the organization’s website to be provided with vegan meal plans, recipes, and tips via email.  It also sends out information about nutrition, the impact of adopting a vegan diet on the environment and animal welfare, as well as news updates and offers.  Since its inception, more than one million people have signed up to take Veganuary’s one-month challenge.  Globally, more than 400,000 people signed up last year.  It is estimated that ten times as many people participate than sign up on the website.3  Other platforms also exist for taking a “Vegan Challenge”.

                This January, it is estimated that more people than ever will try a vegan diet.3  The coronavirus pandemic is already credited with a spike in plant-based meat substitute purchases in the United States, sales of which have been increasing steadily.  This past year, plant-based meat alternatives have become much more mainstream, appearing in both fast-food and fine-dining restaurants.4  Many makers and distributers of vegan products have gotten on board with Veganuary, offering discounts, new menu items, and marketing campaigns for vegan products during the month of January.5

    There are many reasons why a person chooses to try a vegan diet, with optimizing health being the main motivator.6  Studies have shown a myriad of health benefits related to plant-based diets, with most of the scientific community in agreement that eating more plant foods is beneficial to health.  Plant-based vegetarian and vegan diets have been linked to improving cardiovascular health, reducing obesity, and reducing the risk of chronic diseases, including heart disease and type 2 diabetes.  Research suggests that these eating patterns can reverse atherosclerosis, lower cholesterol, lower blood pressure, and reduce the risk of heart attack by 40% and the risk of stroke by 29%.  Risk for developing metabolic syndrome and type 2 diabetes is reduced by 50%.  Plant-based vegetarian and vegan diets are also associated with reduced all-cause mortality.7 

    Improving diet quality can also positively impact cancer risk.  Research suggests that food choices contribute to about 33% of all cancer cases, and that 30-40% of all cancers are preventable with appropriate physical activity, a healthy diet, and an appropriate body weight.8,9  High-fiber, low-fat diets tend to be cancer protective, especially against colon, stomach, and breast cancers.  Plant foods, which are excellent sources of fiber and generally low in fat, are more cancer protective than animal products, such as dairy, eggs, and meat, which do not contain fiber and tend to be higher in fat.  The average American generally falls short of the daily fiber recommendation by 20-30g per day and overconsumes fat.  Red and processed meat have been labeled as carcinogens by the World Health Organization, and the consumption of meat and milk has been linked to ovarian and prostate cancers.9

    A host of cancer-fighting phytochemicals and antioxidants are found in plant foods, including carotenoids, beta-carotene, flavones, indoles, vitamin C, and vitamin E.  Research shows that vegetarians have a lower risk for all cancers than people who eat meat, and that vegans have the lowest risk of all groups.8,9  A meta-analysis concluded that vegetarians have an 8% reduced risk for all cancer while vegans have a 15% reduced risk.10  The efficacy of plant-based vegan and vegetarian diets is also being explored in relation to cancer-related outcomes and cancer recurrence in cancer survivors.11  Research has shown that vegan diets can improve tumor markers and slow tumor growth in patients with prostate cancer.8

    Plant-based diets that limit animal products also play a role in preventing cognitive decline and Alzheimer’s disease.  This is possibly due in part to the reduced risk of obesity, diabetes, and cardiovascular disease associated with this dietary pattern, as these conditions increase the risk of developing dementia.  Higher intake of saturated fats, animal protein, and refined sugars are associated with increased risk, whereas higher intake of plant foods, such as beans and nuts, as associated with reduced risk.  The Mediterranean diet has been extensively studied in regards to dementia prevention, and has been found effective in reducing cognitive decline.12  The link between vegan diets and dementia remains an area of ongoing research.

    Following a plant-based vegan diet has become a popular weight-loss trend.  Studies suggest that this may be an effective strategy for losing weight and maintaining a healthy body weight, even without caloric restriction.13  This may be due to the elimination of less-healthy foods, the increase in fiber intake leading to increased satiety, and the fact that whole plant foods tend to be lower in calories than animal-derived foods.  A study that randomized participants into an omnivore group and four different plant-based diet groups (vegan, vegetarian, pesco-vegetarian, and semi-vegetarian) found that diet adherence and acceptability was similar across all groups; however, the vegan and vegetarian groups lost the most weight.14

                But how necessary is it to follow a strict vegan diet if one’s sole motivation is for its health benefits?  This is a complex question that is not succinctly answered.  However, it is true that there can be a stark difference between a vegan diet that focuses on whole foods and one that includes many processed foods.  For example, white rice and brown rice have different nutrient profiles, as do a baked potato, potato chips, and French fries.  It is possible to follow a nutrient-poor vegan diet.  It is also possible to follow a nutrient-rich, plant-based, non-vegan diet.  A plant-based diet limits animal foods, but it does not eliminate them.  The Mediterranean diet, which has been found to have many positive health implications, is an example of a plant-based diet.  Those who follow this eating pattern generally limit animal products but may occasionally consume them.

    The quality of the foods chosen in a diet is an important consideration when discussing the diet’s healthfulness.  With more processed vegan foods appearing on the supermarket shelf daily, it may become more difficult for people to achieve the health benefits associated with this eating pattern.  The key is to focus on whole foods, such as whole grains, vegetables, fruits, and beans, to find proven nutrient powerhouses that contribute to better health.

    1.         Krockow EM. How to Build Healthier Habits Today. Psychology Today Web site. https://www.psychologytoday.com/us/blog/stretching-theory/201904/how-build-healthier-habits-today. Published April 26, 2019. Accessed January 7, 2020.

    2.         Krockow EM. Why Now is the Time for a Fresh Start. Psychology Today Web site. https://www.psychologytoday.com/us/blog/stretching-theory/202012/why-now-is-the-time-fresh-start. Published December 26, 2020. Accessed January 7, 2020.

    3.         Veganuary 2021 Anticipating Record Sign-ups as Pandemic and Environmental Concerns Grow. Veganuary Web site. https://veganuary.com/en-us/veganuary-2021-anticipating-record-sign-ups-as-pandemic-and-environmental-concerns-grow/. Published December 1, 2020. Accessed January 7, 2020.

    4.         Nierenber A. Plant-Based ‘Meats’ Catch On in the Pandemic. The New York Times Web site. https://www.nytimes.com/2020/05/22/dining/plant-based-meats-coronavirus.html. Published May 22, 2020. Updated May 24, 2020. Accessed January 7, 2021.

    5.         What We Do. Veganuary Web site. https://veganuary.com/en-us/about/about-us/. Accessed January 7, 2021.

    6.         Hopwood CJ, Bleidorn W, Schwaba T, Chen S. Health, environmental, and animal rights motives for vegetarian eating. PLoS One. 2020;15(4):e0230609.

    7.         Kahleova H, Levin S, Barnard N. Cardio-Metabolic Benefits of Plant-Based Diets. Nutrients. 2017;9(8).

    8.         Gray A, Dang BN, Moore TB, Clemens R, Pressman P. A review of nutrition and dietary interventions in oncology. SAGE Open Med. 2020;8:2050312120926877.

    9.         Medicine PCfR. Foods for Cancer Prevention Fact Sheet. Physicians Committee for Responsible Medicine Web site. https://p.widencdn.net/j6o9gp/Foods-for-Cancer-Prevention-Fact-Sheet. Accessed January 7, 2021.

    10.       Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2017;57(17):3640-3649.

    11.        Molina-Montes E, Salamanca-Fernández E, Garcia-Villanova B, Sánchez MJ. The Impact of Plant-Based Dietary Patterns on Cancer-Related Outcomes: A Rapid Review and Meta-Analysis. Nutrients. 2020;12(7).

    12.       Pistollato F, Iglesias RC, Ruiz R, et al. Nutritional patterns associated with the maintenance of neurocognitive functions and the risk of dementia and Alzheimer's disease: A focus on human studies. Pharmacol Res. 2018;131:32-43.

    13.       Barnard ND, Levin SM, Yokoyama Y. A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets. J Acad Nutr Diet. 2015;115(6):954-969.

    14.       Moore WJ, McGrievy ME, Turner-McGrievy GM. Dietary adherence and acceptability of five different diets, including vegan and vegetarian diets, for weight loss: The New DIETs study. Eat Behav. 2015;19:33-38.

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