Tag Archives: nutrition

To ‘G’ or not to ‘G’: Should you go gluten-free?

The gluten-free diet is the latest nutrition craze. Books, articles and TV shows tout the benefits of axing gluten, and it’s hard to walk down the grocery store aisle without encountering a raft of gluten-free products. A survey by Consumer Reports shows over 60% of Americans think that going gluten-free can improve their physical and mental health.

Advocates claim avoiding gluten leads to better digestion and gastrointestinal function, weight loss, higher energy, lower cholesterol, and a stronger immune system. There are even products to help you “detox” your body from gluten, suggesting that it is harmful.

So what is gluten, and are there health benefits to going gluten-free?

Gluten refers to a protein found in wheat, barley and rye. Cutting gluten out of your diet means cutting out gluten-containing bread, soup, pasta, cereal, and virtually any food or drink containing wheat, barley, rye or triticale (a newer grain with a similar quality as wheat).

There are people who definitely need to avoid gluten. Those with celiac disease ─ around 1% of Americans ─ may experience severe inflammation and damage to the lining of their small intestine. Even a small amount of gluten can cause bloating, cramping or skin rashes. Other people, who have gluten intolerance or sensitivity, do not suffer intestinal damage but may experience headaches, bloating, fatigue or diarrhea after eating foods with gluten.

For this relatively small group of people, a gluten-free diet functions as a detox diet by relieving their system of an irritant, and it can make a significant improvement in their quality of life.

For everyone else, research does not support the idea that cutting out gluten promotes good health. In fact, there are some good reasons not to go gluten-free:

Because wheat is ubiquitous in the American diet, completely eliminating gluten requires adopting a whole new diet. You would have to give up most breads, crackers, breakfast cereals, conventional pastas, pastry goods, beer and a wide range of processed foods made with small amounts of gluten.

Whole grains, which contain gluten, are rich in an array of vitamins and minerals, such as B vitamins and iron, as well as fiber. Studies show that whole-grain foods may help lower the risk of heart disease, type-2 diabetes, and some forms of cancer. The government’s Dietary Guidelines for Americans recommends that at least half of all carbohydrates in your diet come from whole-grain products.

A report from the American Dietetic Association warned that gluten-free products tend to be low in a wide range of important nutrients, including B vitamins, calcium, iron, zinc, magnesium, and fiber, so eliminating them may contribute to a nutritional deficiency.

Gluten-free does not automatically equal weight loss. Some gluten-free products make up for gluten by adding sugar and fat. In fact, a review of studies published in the Journal of Medicinal Food revealed that a gluten-free diet seems to increase the risk of overweight or obesity.

Most gluten-free alternatives, such as pasta and bread, are significantly more expensive than their conventional counterparts. A 2007 survey found that gluten-free pastas and breads were twice the price of conventional products, for instance.

If there are no proven benefits to a gluten-free diet, why do some people swear by it? It’s possible that, in addition to cutting out gluten, these people also make other, healthy changes, such as eating more fruits, vegetables, and lean meats, and fewer desserts and junk foods. These changes would naturally lead to feeling better and losing weight.

So, if you suspect you may have celiac disease or are gluten intolerant, see you doctor for testing and a diagnosis. If not, enjoy your gluten.


Tracy Jansen, M.D.Dr. Tracy Jansen is an MPCP partner and sees patients in the Pasadena office. She received her medical degree from Virginia Commonwealth University School of Medicine and completed her residency program in Family Practice at the Medical College of Georgia. She is certified by the American Board of Family Medicine.

Limiting Sugars in Your Diet

A Q&A with Dr. Pio Poblete of MPCP’s Columbia office

Q: How much sugar do people typically consume?

A: On average, Americans get about 16% of their daily calories from added sugars, according to the Food & Drug Administration.

While many foods naturally contain sugar, a lot more sugar is added to processed foods. For example, a 12-ounce can of cola contains seven teaspoons of sugar, although you might not see that word on the label. Other names for added sugars include high-fructose corn syrup, fruit juice concentrate, molasses, honey, and sucrose.

Even foods that you wouldn’t think of as sweet have added sugar, often in the form of high-fructose corn syrup. High-fructose corn syrup is a preservative, giving packaged foods a longer shelf life, and it plays a role in color and texture.

Q: 16% added sugars sounds like a lot. Are we eating too much?

A: Faced with mounting evidence about sugar’s harms, the 2015 Dietary Guidelines Advisory Committee has recommended that people limit added sugars to a maximum of 10% of their total daily calories.

Q: If I want to reduce my sugar consumption from 16% to 10%, how much sugar is that?

A: On a 2,000-calorie-a-day diet, that equals 12 teaspoons of sugar.

Q: Is added sugar a health concern?

A: Added sugars probably have a greater impact on high blood pressure (hypertension) than does sodium, and fructose in particular may increase cardiovascular (heart and blood vessel) risk. There’s evidence that added sugars, especially sugar-sweetened drinks, raise the risks of excess weight and obesity, as well as type 2 diabetes. And, of course, sugar is a major contributor to tooth decay.

Q: How can I reduce added sugar in my diet?

  1. Use these simple tips to consume less:
  • Drink water or other calorie-free drinks instead of sugary, non-diet sodas or sports drinks. That goes for blended coffee drinks, too.
  • When you drink fruit juice, make sure it’s 100 percent fruit juice — not juice drinks that have added sugar.
  • Choose breakfast cereals carefully. Although healthy breakfast cereals can contain added sugar to make them more appealing to children, skip the non-nutritious, sugary and frosted cereals.
  • Instead of adding sugar to cereal or oatmeal, add fresh fruit (try bananas, cherries or strawberries) or dried fruit (raisins, cranberries or apricots).
  • Opt for reduced-sugar varieties of syrups, jams, jellies and preserves. Use other condiments sparingly. Salad dressings and ketchup have added sugar.
  • Choose fresh fruit for dessert instead of cakes, cookies, pies, ice cream and other sweets.
  • Buy canned fruit packed in water or juice, not syrup.
  • When baking cookies, brownies or cakes, cut the sugar called for in your recipe by one-third to one-half. Often you won’t notice the difference.
  • Instead of adding sugar in recipes, use extracts such as almond, vanilla, orange or lemon.
  • Enhance foods with spices instead of sugar. Try ginger, allspice, cinnamon or nutmeg.
  • Substitute unsweetened applesauce for sugar in recipes (use equal amounts).

For a list of common foods and the amount of sugar they contain, see this article in Medical News Today.

Pio Poblete, M.D.Dr. Pio Poblete is an MPCP partner and practices in our Columbia office. He is certified by the American Board of Internal Medicine.

Rethinking Drinking: What’s the Healthy Choice?

James Chamberlain, M.D.

I am often asked questions about alcohol use, such as how much is safe and are there any health benefits. I tell my patients that drinking in moderation is fine. Alcohol is a part of our social fabric and there is nothing inherently bad about it. I tell my patients they don’t have to give up their glass of wine with dinner or a beer or two at a party, as long as they aren’t driving home. But I remind them that there are well-known downsides to excessive alcohol use and I urge caution for anyone who chooses to drink.

Clearly, the key is moderation. According to the Mayo Clinic, that is one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

Examples of one drink include:

  • Beer: 12 fluid ounces
  • Wine: 5 fluid ounces
  • Distilled spirits (80 proof): 1.5 fluid ounces

Risks of Heavy Drinking

Heavy drinking is defined as more than three drinks on any day or more than seven drinks a week for women and for men older than age 65, and more than four drinks on any day or more than 14 drinks a week for men age 65 and younger. Binge drinking is four or more drinks within two hours for women and five or more drinks within two hours for men.

Heavy drinking can increase your risk of serious health problems, such as:

  • Certain cancers, including breast cancer and cancers of the mouth, pharynx, larynx and esophagus
  • Pancreatitis
  • Sudden death if you already have cardiovascular disease
  • Heart muscle damage (alcoholic cardiomyopathy) leading to heart failure
  • Stroke
  • High blood pressure
  • Liver disease
  • Brain damage and other problems in an unborn child

When to Avoid Alcohol

In certain situations, even moderate drinking may pose health risks. Ask your doctor whether you should avoid alcohol if:

  • You’re pregnant or trying to become pregnant
  • You have liver or pancreatic disease
  • You have heart failure or you’ve been told you have a weak heart
  • You take prescription or over-the-counter medications that can interact with alcohol
  • You’ve had a hemorrhagic stroke (when a blood vessel in your brain leaks or ruptures)
  • Any time you are going to get behind the wheel
  • In combination with a variety of medications – always consult your doctor about the “drug interaction” potential of your medication with alcohol

Warning signs of problem drinking

  • You feel guilty or ashamed about your drinking
  • You lie to others or hide your drinking habits
  • Your friends or family members are worried about your drinking
  • You need to drink in order to relax or feel better
  • You “black out” or forget what you did while you were drinking
  • You regularly drink more than you intended to
  • You have had problems in relationships, with work or with the law related to drinking
  • You have had medical problems related to alcohol use

Are There Benefits?

Over the years, several studies have suggested possible benefits for moderate alcohol use, including:

  • Reducing risk of developing and dying from heart disease
  • Lowering risk of ischemic stroke (when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow)
  • Reducing risk of diabetes
  • Slight reduction in overall mortality for moderate drinkers when compared to non-drinkers

The key again is moderation. Many people find it difficult to stay under one or two drinks a day. A glass of wine or a beer each evening followed by heavier drinking on weekend nights is too much. It’s the average consumption per day that matters. If you know you will be drinking on the weekends it’s best to avoid those weeknight drinks. And everyone should be aware of the signs of problem drinking and seek help if they find themselves unable to control their alcohol use.
Talk to your family doctor if you are concerned about your drinking. We can help you figure out if it’s a problem and get you the help you need if it is.

Additional resources:

James Chamberlain, M.D.Dr. James Chamberlain is a Maryland Primary Care Physicians, LLC partner and is certified by the American Board of Family Medicine. He received his medical degree from University of Maryland School of Medicine in 1985 and completed his residency program in Family Practice at The Medical University of South Carolina in 1988. Dr. Chamberlain sees patients in the Queenstown office.

Diet After 50: Food Choices & Exercise Prove Critical

For adults age 50 and over, making healthy food choices and staying active are crucial lifestyle habits. Recent studies show that a good diet can not only help you resist illness and prevent certain diseases, but also defy or delay some of the common effects of aging.

“We need fewer daily calories as we age because our metabolism naturally begins to slow,” says MPCP Arnold physician, Amanda Malone, M.D. “Since you don’t need as many calories, those calories you do consume become very important. Your diet after age 50 should include a variety of healthy, nutrient-dense foods. Add in daily exercise and you’re on the path to a higher quality of life and enhanced independence as you age,” she adds.

Body Changes & Diet Needs

As we all know, our body changes with age. There is a reduction in muscle, an increase in body fat, and your total body water decreases by up to 20 percent. You need fewer calories than you did at a younger age since your basal metabolic rate decreases as muscle mass declines.

The good news is that moderate exercise helps preserve muscle mass and can slow the rate of this process. Of course, regular exercise has other benefits, including cardiovascular fitness, bone strength, better mobility and balance, as well as feelings of well-being. Dr. Malone adds, “Try to include exercise that increases lean muscle mass, like weight training. And consider yoga or pilates, which are great for flexibility and boosting your metabolism.”

Another effect of aging is that the body becomes less efficient at absorbing vital nutrients and minerals from our diet– including calcium, vitamin B and folate. Certain medications can also affect appetite, or block absorption of some vitamins and nutrients.

So, what should we “over 50s” do?

1. Make calories count.

“When patients ask ‘How many daily calories do I need?,’ I tell them it depends on how active they are and where their calories are coming from,” says Dr. Malone. Just counting calories isn’t enough for making smart food choices, but here are some general guidelines for maintaining (not losing) weight:

A woman over 50 who is:
-not physically active needs about 1600 calories a day
-somewhat active (housework, yard work, etc.) needs about 1800 calories a day
-very active (exercises regularly 30 mins. or more most days) needs about 2000 calories a day

A man over 50 who is:
-not physically active needs about 2000 calories a day
-somewhat active needs 2200-2400 calories per day
-very active needs 2400-2800 calories daily

These calories should come from a variety of fresh fruits and vegetables (5 a day when possible), unprocessed grains, and good sources of protein. To include more high quality protein in your diet, try replacing red meat and processed meat with fish, skinless chicken and turkey, low-fat dairy, and plant-based protein like beans, nuts and seeds.

“A variety of foods is best because you’ll have several sources of required vitamins and you won’t get bored by the same foods. Also, the more ‘whole’ unprocessed foods you can eat, the better. Go for the whole fruit, not fruit juices. Go for fresh, grilled or baked chicken, not processed lunch meat,” says Nurse Practitioner, Rachel Sweeney, of MPCP Arnold.

Also, if you are trying to maintain- or lose weight- keep track of daily calories with a food diary or a free app, such as myfitnesspal.com.

2. Drink water & eat more natural fiber.

As we age, we can become more prone to dehydration. Post a note in your kitchen reminding you to sip water throughout the day and to drink water with meals. Nutritionists say in general that 3-5 large glasses of water a day is adequate after age 50…you don’t need to go for 8-10 as we often hear. Make drinking more water a daily habit and you will help keep your mind sharp, and body regular. Staying hydrated keeps skin looking younger too!

Dietary fiber also helps keep the body and bowels regular, but can do much more, such as lower your risk of heart disease, diabetes, and certain cancers. Women over 50 should aim to eat at least 21 grams of fiber a day, and men over 50 at least 30 grams per day. Good sources of fiber include whole grains, oatmeal, beans, and uncooked fruits and vegetables like carrots, apples and berries.

3. Don’t skip meals.

While it’s okay to skip meals occasionally, regularly missing meals or heavily restricting calories is unhealthy. Nutritionists advise those over 50 to eat three meals a day, or to break meals up into 5 smaller meals.

“Skipping meals causes our metabolism to slow down, which affects energy level and usually doesn’t help with weight loss,” says Rachel Sweeney, CRNP. “When we skip eating, our blood sugar levels drop, but they can surge again when we eat a big meal. This yo-yo effect is unhealthy and it’s much better to keep our blood sugar levels more even throughout the day with regular, healthy meals.”

Starting the day with a healthy breakfast gets your body going and is a good way to get some fruit, fiber and protein in your diet. Try yogurt topped with bran cereal and berries, or a veggie-packed omlette, peanut butter on whole grain toast or old-fashioned oatmeal with walnuts and fruit.

Snacking is okay as well to tide you over and keep your energy up during the day. Choose healthy options like almonds over chips and fruit instead of cookies. Other good snacks are a slice of cheese and whole grain crackers, veggies and hummus, and even a small cup of soup.

4. Read labels, and cut added sugar and sodium.

While it takes a bit more work, reading food labels can definitely help you make better food choices. Labels break down how much protein, carbohydrates, fats, sodium, key vitamins and minerals, and calories are in a specific serving.

Each label also has an ingredients list, which lists the ingredients from largest amount to smallest. Once you start reading labels you’ll be surprised how many foods list sugar or high fructose corn syrup as the first (largest) ingredient! Sugar is added to many of our foods to enhance the flavor, but many are crediting all the sugar in our diet to the obesity epidemic. Sugar may also cause inflammation in the body, so limiting it is good not only for weight control, but also possible disease prevention.

Reducing sodium (salt) will help prevent water retention and high blood pressure. Look for “low-sodium” options when shopping or try to season meals with herbs and spices other than salt.

5. Be cautious about supplements.

If you are over 50, some of the key vitamins and minerals you should get enough of are vitamin B12, vitamin D, folate and calcium. It is better to meet your needs through diet, but these are so important that you might want to consider taking supplements. Talk to your doctor about which, if any, supplements you need and don’t overdo it. High doses of certain supplements can be harmful, especially if you are on medications.

6. Stay Active!!

The benefits of exercise throughout your life can’t be over-stated. But as you age, even moderate exercise has been proven to add years to your life—and to make those years more enjoyable and independent.

“Regular exercise slows the effects of aging and many age-related disorders such as diabetes, stroke, cardiovascular disease and osteoporosis,” says Dr. Malone. “But that’s only the tip of the iceberg. We know that exercise reduces the risk and seriousness of falls and fractures, keeps our minds sharp, and encourages social interaction,” she adds.

It’s never too late to start exercising either. Start slow– take the stairs instead of the elevator, keep carrying your groceries, and try a new exercise class. As always, talk to your doctor about an exercise plan, and which activities you should consider given your age and current health status.

Amanda Malone, M.D.
Dr. Malone joined Maryland Primary Care Physicians, LLC in 2006 and is certified by the American Board of Family Medicine. She received her medical degree from Wake Forest University School of Medicine in 2002 and completed her residency program in Family Practice at Stamford Hospital in 2005.
Rachel Sweeney, CRNP
Rachel Sweeney, CRNP joined Maryland Primary Care Physicians, LLC in 1999. She received her Bachelor of Science in Nursing degree from Villanova University in 1991 and her Master of Science in Nursing degree from Marymount University in 1997. Ms. Sweeney is board certified by the American Nurses Credentialing Center in Family Practice.