Q & A: Improving Iron Absorption with Vitamin C

My cast iron Griswold #8; one of many ways to get some iron in your diet.

 Q:         I have been trying to increase the level of iron in my blood for the past year. I am on a larger dose of iron, yet no improvement. I had heard taking the iron with orange juice can help the iron be used by the body, and so I tried adding orange juice. But the acidity from the juice really bothers me, so then I end up not taking my iron at all.

Are there any other options instead of the orange juice? H.M. Grand Rapids

A.        Yes, there are a number of options that can help boost iron absorption.  You can take  your pill with water, and include any vitamin-C containing food along with. It’s the vitamin C that has been proven to help enhance absorption of iron. Here is a list of commonly-eaten vitamin C foods.

            What you don’t want to do is take your iron tablet with milk, or at the same time you take your calcium. Why? Because calcium blocks some of the absorption of iron. I had a patient once who was faithfully taking her iron for over a year, but had no change in her blood level of iron (hemoglobin). Upon questioning, I learned she was taking her iron with a big glass of milk; her iron pills didn’t even have a chance to get into her system.

            Some of you may be wondering why take an iron pill when there are foods that contain iron (more about iron-containing foods here).  It’s true that if your iron levels are OK or slightly low, you can choose iron-containing foods and keep your iron levels good. But some people have had a low blood iron level for so long that all of their body’s stores of iron have become depleted. At that point, a larger-dose  iron tablet is required, and even with that, it can take months to build the stores of iron so that the blood iron levels finally reflect that there is enough iron in the body.

Tidbit: Great Reasons to shop the Farmers Market

Photo courtesy of Alice Henneman, University of Nebraska-Lincoln

I missed National Farmers market week (it's earlier in August) but I’m here to declare August Farmers Market Month.

We have a small “Healthy Street” farmers market every Thursday in the summer, directly in front of the hospital where I work in Grand Rapids. It’s fun to browse on my lunch break and find yummy things to bring home for the next few night’s dinners.

My favorite farmers market thing this year was fresh strawberry shortcake served with fresh biscuits, fresh strawberries, and real whipping cream from the Dunneback Girls (local farmers on 6-Mile Road). That day I called it my lunch! (Sorry, I ate it so fast I didn’t get a photo).

There are many great reasons to shop at a local farmers market. (Here is a link to tell you 9 reasons, from University of Nebraska-Lincoln Extension.)  For me, the biggest reason to shop farmers markets is that you are helping support your local farmers.

Did you know that of every dollar spent in the conventional food market, 91 cents goes to suppliers, processors, middlemen and marketers, while 9 cents goes to the farmer? But farmers who sell direct to consumers through the farmers market or through Community Supported Agriculture (CSA) keep 80 to 90 cents of each dollar. That’s huge, because there's no middleman!

I’ll be picking up more squash, tomatoes, green beans and bread tomorrow, and maybe some peaches if there are any left. Yum!

What's for Dinner: Italian Summer Squash and Tomatoes

If you have a garden with abundant summer squash, or a friend/neighbor/relative who likes to gift you with their bounty, here's a simple and healthy side dish idea for you.  This recipe is very forgiving; I like to use both the zucchini and the yellow crookneck squash because it's more colorful.

Summer squash, onions and garlic getting nicely browned.

Recipe: Italian Summer Squash and Tomatoes
2 small zucchini squash ( 6-8 inch), sliced lengthwise in quarters then chopped
1 small crookneck squash, sliced lengthwise in quarters, then chopped
1/2 sweet onion, chopped
2 to 4 cloves garlic, chopped
1 tablespoon olive oil
1 15-ounce can diced tomatoes
1/2 to 1 teaspoon Italian seasoning
salt and pepper to taste

In large non-stick pan, sauté the summer squashes in olive oil over medium-high heat for about 5 minutes. Add the onions and garlic and continue the sautéing. When everything is getting slightly browned, add the diced tomatoes and Italian seasoning. Heat through for about 2 minutes, then serve.

Finished dish.

Serves about 6 people as a side (for us it's 4 servings because we really like vegetables).  We had this with a small steak and leftover broccoli salad.

Nutritional information per serving:  66 calories, 2 grams protein, 2 grams fat, 9 grams carbohydrate, 2 grams fiber, 0 milligrams cholesterol, 104 milligrams sodium.

Tidbit: Are you Treating your Walnuts right?

            I learned some great info at the AADE conference from a vendor booth! Who better to give great advice about walnuts than the California Walnut Board? They want you to be happy with your walnuts and to treat your walnuts right.

As you know, any fresh food needs TLC, and walnuts are no exception.  Walnuts are heart healthy, contain omega-3 fats and are a decent snack for someone with diabetes because they do not affect blood sugar.

Walnuts contain primarily polyunsaturated fat, which makes them more susceptible to the ill effects of oxygen and heat exposure.

            I have always stored walnuts and other baking nuts in the freezer because I use them often enough for various dishes, but I don’t go through a pound bag very quickly. I detest rancid or “off” flavored nuts, and really do not like having to throw them away if they have turned rancid (but there’s no fixing the flavor once it’s gone).

            Here are tips from the California Walnut Board to keep your walnuts the most flavorful and fresh:

• If storing for 6 months or less, keep them in the refrigerator.
• If storing longer than 6 months, keep them in the freezer (0 degrees F).
• Store in air-tight packaging.
• Store away from foods with strong odors, such as cabbage and onions.
• And, don’t chop nuts until you are ready to use them for the best flavor.

           It’s true that walnuts, like other nuts, have quite a bit of fat and calories, but they are a good snack if you can keep your portions in line. About 4 walnuts halves contain 45 calories, so an afternoon snack of 8 to 12 walnut halves can keep  your appetite at bay and maybe keep you from scrounging around for a not-as-healthful candy bar or bag of chips. 

For walnut recipes and more walnut info, check out the California Walnut Board’s site.

Tidbit: How to Avoid Mindless Eating

I attended the 4-day diabetes educators national conference (AADE) in Indianapolis last week.  As a registered dietitian, we are required to obtain at least 75 credits of continuing ed every 5 years.  I got 20 credits for this conference and lots of new ideas to help people, both those with diabetes and others.

I plan to share a few tips and things I found interesting over the next few blog posts.

One of our keynote speakers, Dr. Brian Wansink from Cornell University Food and Brand Labs, spoke about  “From Mindless Eating to Mindlessly Eating Better”.

It seems obvious, but he has done lots of research looking at what things in the environment make a big difference in the amount of food we eat.

Some of his observations:

• You pour less in a skinny tall glass than in a short fat glass.
• You eat more when serving yourself in a big bowl vs. a small bowl.
• Same thing with the size of a plate.
• You eat more when the food has less contrast with the plate or bowl. For instance, spaghetti with red sauce has a good contrast with a white plate; macaroni and cheese has a poor contrast with a yellow plate.

What’s so interesting is that even when people are coached ahead of time not to take as much food because of the bowl size, they still do (apparently they can’t help it).

He also has been doing school lunchroom makeovers to change the environment so that kids can’t help but to choose healthier.  Some of the things they did at schools to increase fruit and vegetable consumption without bribes or reducing the price:

• Put the bowl of fresh fruit at the beginning of the lunch line, not the end. Use a pretty bowl for the fruit, and light it from above.  Fruit sales went up over 100 percent in some schools.
• Move the salad bar from the corner of the lunchroom to the middle, where kids can’t help but see it.  I forgot the exact increase in sales but it was nearly as good as the fruit.

 More info about the Smarter Lunchroom Movement is here. 

Dr. Wansink contends that you can’t make yourself think harder about food in order to do better with food choices. You have to change your environment to make it happen (“the best diet is the diet you don’t know you’re on”).

Three easy things that he recommends everyone do to make a difference in calorie intake without too much effort:

• Start using a smaller plate.
• Portion the ice cream (get the good stuff but have only one scoop)
• Put fresh fruit in a pretty bowl on your kitchen counter.

Q & A: Gluten-Free Pretzels not Better for Weight Loss; Gluten-free cookie recipe

Q.            I was wondering if I should buy gluten-free pretzels to help me lose weight? I have been hearing people comment about using gluten-free foods for that purpose. B.M. Grandville

A.            There is no need to choose gluten-free pretzels over regular pretzels unless you need to avoid gluten, such as with celiac disease. Take a look, but I have noticed that the gluten-free foods seem to have the same or even more calories than traditional foods.

            Even though there are a lot of products proclaiming that they are gluten free, just what does gluten-free mean? It means that the product does not have the grains that contain gluten, such as wheat, rye and barley. Oats are iffy, as they may be contaminated with gluten if they are processed in a facility that packages gluten-containing grains. Oats must be certified gluten free to be OK.

            Gluten is the protein part of a grain that makes bread springy and helps the yeast make the bread rise. Gluten-free breads are often heavier and denser because of this.

            A gluten-free eating plan for celiac disease is one of the most difficult ones to follow, as it means limited restaurant foods. There is no regular breads for sandwiches, no regular pizza, no regular pasta, and no breaded foods, unless these items are made specially gluten-free.

            Celiac disease is an auto-immune disease that can lead to malnutrition because the intestine becomes damaged from the gluten and unable to absorb nutrients. It is very important to follow the gluten-free diet as strictly as possible, because the gluten triggers an immune response that can affect other parts of the body, too.

            If someone is newly diagnosed with celiac disease, they may be referred to a registered dietitian for guidance. I see a number of people with celiac, and I always recommend getting connected with others with celiac (just Google your city for celiac support group to find the nearest one).  There are a number of good resources online for gluten-free ideas, recipes and information such as celiac.com.

            And I always tell people that if it were me, I would start with simple changes first, such as using potatoes and rice as the starchy side dish rather than bread or noodles. Then later you can hunt around for acceptable gluten-free breads and pastas (you may need to try a few before you find one you like).

            I am always scouting recipes for ones that can be used for people with celiac as well as for the rest of us.  You may have seen this peanut butter cookie recipe around, but it turns out great with absolutely no flour. You’ll have to try it to believe it.

Peanut Butter Cookies (Gluten-free)
 from Mennonite Girls Can Cook blog

1 cup peanut butter (they prefer Jif)

1 cup white sugar

1 egg

Beat all ingredients in a bowl. Roll into 1-inch balls and place on ungreased cookie sheet. Press each cookie with a fork.

Bake 350 F oven for 10-11 minutes. Yields 16 cookies (I usually double the recipe).

Nutritional information per cookie:  147 calories, 4 grams protein, 8 grams fat, 15 grams carbohydrate, 1 gram fiber.