Whole Fruit versus Juice

Whole Fruit versus Juice

Fruit has a solid reputation because the various types have been linked with many health benefits. But does fruit juice deserve a similar reputation?

Along side the nutrients found in fruits, there is sugar. The sugar in fruit, however, isn’t as harmful as sugar in desserts and other sweet foods because the fiber in fruit slows its release. This is why fruit usually has a relatively low glycemic index. That’s important because it isn’t just the amount of sugar in a food that is harmful but how quickly it makes the blood sugar rise.

The loss of fiber with juice means a loss of the protective effect of fruit fiber. Less fiber translates to a loss of other fiber benefits too such as the feeling of fullness it provides and cholesterol lowering. High fruit juice intake has been linked to diarrhea, flatus, and abdominal distension.

Because juice has the sugar from many pieces of fruit, it is often high in sugar. Excess fruit juice intake has been correlated with tooth decay, increased risk of obesity, liver injury and metabolic syndrome. Rates of childhood obesity have paralleled the increased consumption of beverages, especially soft drinks and juice.

The U.S. Department of Health and Human Services as well as the U.S. Department of Agriculture found that half of 2 to 18-year-old children’s daily fruit consumption is in the form of juice. The American Academy of Pediatrics discourages juice for kids. The organization stated that it offers no nutritional benefits for those under one year of age and should be avoided. It also recommends that children aged one to three get no more than 4 ounces of juice a day, those ages four through six get no more than 6 ounces a day, and that children seven through eighteen limit their juice intake to a maximum of 8 ounces a day. Juice isn’t recommended for children that are overweight or obese or for those with poor weight gain.

Are adults exempt from the negative aspects of juice? Unfortunately, we aren’t. But in a world with trucks and refrigerators, fruit really is not that hard to find.




McNulty, T. Choosy mothers choose fruit! Contemporary Pediatrics, June, 2017.


Wojcicki, J. Reducing Childhood Obesity by eliminating 100% Fruit Juice. American Journal of Public Health, Sept. 2012, Volume 102, number 9.


Calcium supplements – helpful or harmful?

Calcium supplements – helpful or harmful?

The need for calcium, especially in women over age 50, isn’t exactly news. But reports of a possible link between calcium supplementation and increased cardiovascular events, constipation and kidney stones have surfaced over the last decade (Downing and Ilam, 2013). Given the need for calcium and the difficulty getting enough through the diet makes this a potential crisis. People die from cardiovascular events but they also die from fractures caused by osteoporosis. Is there a way to meet the need for calcium without increasing the chances of other developing other diseases?

When bones are too thin, the individual is diagnosed with osteoporosis (literally porous bones). The major complications with that disease is fractures and a fracture can easily lead to other problems such as blood clots and skin sores from immobility.

In women over age 50, the rate of bone destruction is usually greater than the rate of bone building. On average, they lose about 1% of their bone every year. It doesn’t take much calculating to appreciate the effects of such bone thinning in older women. The same loss occurs in older men but males have thicker bones and the accelerated bone loss tends to start much later in life. A diet high in calcium from dairy products, sardines, oatmeal and leafy green vegetables or regular calcium supplementation both lead to an increase in bone mineral density but not many people consume enough dietary calcium (AFP, 2016).

A high blood calcium level is associated with thicker carotid artery plaque and that correlates with an increased stroke risk. Arterial plaque calcification is also associated with increased cardiovascular disease and death. Excess calcium doses appear to interfere with normal calcium regulation and allows excess calcium into tissues. That may destabilize arterial plaque and lead to a heart attack or stroke (Downing, L., 2013). In addition, it was reported in the December 2015 issue of Urology Times that those with a history of kidney stones form new stones more quickly and at a higher rate if they’re taking calcium supplements (Urology Times).

The key to solving this dilemma lies in the amount of calcium supplementation. Taking more than 3 grams (3,000 mg.) a day of calcium tablets is associated with hypercalcemia, especially if taken with vitamin D because that increases absorption. Hypercalcemia is associated with an increased risk of kidney stones, constipation, lethargy, depression and arrhythmias (Burcham, J., and Rosenthal, L, 2016). Also, in an article that summarized data from multiple studies on calcium supplementation, no association between moderate calcium supplementation and adverse cardiovascular outcomes was uncovered in healthy people (Downing, L., 2013).

It is also critical to take calcium supplements properly. Calcium tablets with more than 250 mg. of the element competes with magnesium absorption, and if calcium intake is greater than magnesium intake, arterial calcification is more likely. Such deposition of calcium in arteries is associated with an increased cardiovascular disease risk. Taking calcium tablets with an equivalent amount of magnesium is recommended. It is best to take it with food and in smaller amounts two or three times a day. Also, it should not be taken with iron or zinc.

Glucocorticoids like prednisone decrease calcium absorption, as does insoluble fiber, phytic acid (in whole grain cereal and wheat bran), and oxalates (in spinach, rhubarb, beets and Swiss chard). Loop diuretics like furosemide (Lasix) increase the excretion of calcium but thiazide diuretics like hydrochlorothiazide (HCTZ) decrease the loss of calcium into the urine. Conversely, calcium can decrease the absorption of some medications including tetracycline and fluoroquinolone antibiotics, thyroid hormone (levothyroxine), phenytoin and the bisphosphonates (drugs like alendronate used for osteoporosis treatment).

Finally, it should be noted that several hours of weight-bearing exercise per week, such as walking or dancing, provides the mechanical stress to increase bone formation, a phenomenon that strengthens bones in a way that is separate from the calcification of bone tissue. Calcium supplementation can help keep bones strong even in postmenopausal women, but excess doses and other pitfalls need to be considered and avoided to keep supplementation a positive thing. This article is not intended to replace the medical care provided by your health care provider, but instead to make you more aware of important information and prompt you to discuss it with your health care provider.



American Family Physician Audio Digest for October, 2016

Burcham, J., and Rosenthal, L. Lehne’s Pharmacology for Nursing Care, 9th edition. St. Louis, MO:  Elsevier, 2016.

Downing, L, and Ilam, M. Influence of Calcium supplements on the occurrence of cardiovascular events. American Journal of Health-Systems Pharmacy, vol. 70, July, 2013.

Turner, L. Perfect Timing:  When and how you take your supplements may be as important as what you take. Better Nutrition, February, 2018.

Calcium supplements may heighten risk of kidney stone recurrence. Urology Times, December, 2015.

Chemical Exposures in Swimming Pools

Chemical Exposures in Swimming Pools

Pool water, like drinking water, can host a variety of germs that can infect swimmers. Chlorine is the customary chemical used to obliterate bacteria and other pathogens in water, but it isn’t the only chemical found in chlorinated water. Drinking and pool water contain a lot of organic matter. In swimming pools, skin, sweat and other matter contributes to that. When chlorine is combined with organic matter, over 600 chemicals are produced and some of them cause mutations in cells as well as carcinogens.

Chlorination by-products in drinking water are monitored and many of their effects have been studied. Exposure and effects of disinfection by-products in pool water haven’t been studied nearly as much. Although the concentration of chlorine and disinfection by-products may be similar in both types of water, there are differences in absorption because volatile chemicals can be inhaled by swimmers and others can be absorbed through the skin. Trihalomethanes (THMs), for example, can be inhaled and taken in through the skin, and such absorption is greater than with drinking treated water. This intake of THMs has been linked to an increased risk of bladder cancer.

Nitrosamines are also produced with chlorine pool disinfection. Some of these chemicals are carcinogens but the effects of that haven’t been studied. Swimmers have an increased chance of developing melanoma, the deadliest of the skin cancers. Could that risk be increased by chlorination by-products? That question has been raised but research investigating it hasn’t been uncovered.

Another pool disinfection risk is created by mixing and applying pool disinfection chemicals. Sometimes combining these products forms a cloud or fume that irritates the throat, nose, lungs, skin or eyes. Using personal protection equipment decreases the chances of that occurring.

Swimming has numerous health benefits. Unlike running or contact sports, injuries to joints and tendons are rare. Sill, do all the health gains associated with swimming outweigh the risks? Maybe not. Until we know more about the risks associated with disinfection by-products, pools treated primarily with salt may be the better choice.



  1. Kogevinas, et al. Genotoxic effects in Swimmers Exposed to Disinfection By-products in indoor Swimming Pools. Environmental Health Perspectives. Vol. 118, #11, Nov. 2010, pages 1531-1537.


Acute Illness and Injury from Swimming Pool Disinfection and other Chemicals – United States, 2002-2008. MMWR, 10/7/2011, Vol. 60, #9.


  1. Richardson, et al. What’s in the Pool? A Comprehensive Identification of By-products and Assessment of Mutagenicity of Chlorinated and Brominated Swimming Pool Water. Environmental Health Perspectives. Vol. 118, #11, Nov. 2010, pages 1523-1530.


The Stress Response: Lifesaver and Killer

The Stress Response: Lifesaver and Killer

The stress response, or fight or flight reaction, is the body’s emergency system. It is meant to help deliver oxygen and glucose to vital organs like the brain and heart so that threats to life can be managed and chances of survival enhanced. It does do that, but the sympathetic response was never meant to be frequently activated and when it is, it can cause tremendous harm. The damage from chronic stress can cause many diseases.

The hormones and neurotransmitters released with the fight or fight response, most notably norepinephrine, epinephrine and cortisol, help increase the blood pressure, increase the heart rate, increase the force of heart contraction and increase the blood sugar level. If those chemicals continue to be elevated, they can cause high blood pressure and subsequent damage to the lining of arteries leading to arteriosclerosis, a major killer. A chronically elevated blood sugar level also damages arteries and makes the insulin receptors on fat and muscle cells resistant to insulin. This can cause type 2 diabetes. There is a strong correlation between cortisol and chronic disease (Lustig, Dr. R, 2012).

A prolonged stress response can also make obesity more likely to develop. It has been noted that it can increase stress-induced eating. Cortisol is the metabolic support of the fight or flight reaction, and it helps direct extra calories into abdominal fat deposition. In children, excess cortisol destroys the nerve cells that help inhibit food consumption. High cortisol may also make high-fat and high sugar foods more appealing. Stress also can interfere with sleep and that too increases cortisol and decreases the hormone leptin which acts as an appetite suppressant (Lustig, Dr. R, 2012).

It may seem impossible to stop responding to difficult situations but there are ways to lessen the effects of cortisol. Exercise is one of the best ways to decrease cortisol. Art, music, dance, writing, laughing, hugs, conversation with a good friend, prayer, vacations, hobbies, and other things that help a person relax are powerful antidotes to our high stress lifestyle. Anyone who can incorporate these into daily life can reap a lot more joy and help prevent diseases.

Robert Lustig, M.D., 2012. Fat Chance:  Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. NY, NY:  Hudson Street Press.


Wash, Cook and enjoy a Tomato a Day

The tomatoes are just starting to ripen so what better time to analyze their health benefits. In the last blog article antioxidants were examined and how they act as a shield from free radical injury. Controlling such oxygen free radical damage is vital to preventing many chronic illnesses (Tweed, V., 2016). Tomatoes are one of many types of whole foods with many antioxidants and nutrients.

Tomatoes contain beta-carotene, vitamin E, potassium, lutein/zeaxanthin, phytoene/phytofluene, polyphenols, magnesium, zinc, manganese, and alpha-carotene. They are also low in calories and high in fiber. Raw tomatoes are high in vitamin C (Pratt, S and Matthews, K, 2004).

But the real gold in tomatoes is the lycopene. This compound is a carotenoid – one of a group of nutrients that provide pigmentation for plants and act as antioxidants. It may be as powerful an antioxidant as beta-carotene. Lycopene gives many red foods their color, so yellow or orange tomatoes don’t have this antioxidant. Cooking makes more lycopene available for absorption so aim for canned or otherwise cooked tomatoes. Adding some fat to the cooked tomatoes also increases lycopene absorption. Lycopene can be found in a capsule form but, as with many nutrients, it is best to eat it in the whole food form where other nutrients support or even enhance its benefits (Harvard Health Letter, 2013). Numerous studies have linked tomato consumption with decreased cancer risk, especially lung, prostate and stomach cancer. It may also lower the chances of getting breast, bladder and GI cancers.

Lycopene also decreases inflammation so it causes less damage. In addition, it strengthens the immune system, and decreases blood clotting.

Some scientists recommend getting 10 mg. of lycopene a day.  Sources:

  • 1 cup canned tomato sauce has 37 mg.
  • 1 cup of tomato juice has 21 mg.
  • A slice of watermelon 12 mg.
  • 1 Tbsp. tomato paste 3 mg.
  • 1 Tbsp. Salsa 1.7 mg.
  • Half a pink or red grapefruit 1.7 mg. (Harvard Health Letter, 2013).

Recent research has lead some to suggest lycopene-rich foods for prevention of chronic diseases, including those caused by obesity. For a long time, it was believed that fat cells are inert. But obesity is linked to many chronic diseases, in part because fat cells secrete substances that increase the blood pressure and promote systemic inflammation. The latter process increases oxygen free radical production that damages cell components – the start of many chronic illnesses. Lycopene is readily taken up by fat cells and leads to a decrease in such inflammatory chemicals being released.

Because the body doesn’t easily store lycopene, it is essential to get it regularly. Since the skin contains the highest levels of lycopene don’t pass up cherry and grape tomatoes. Even so, pesticides and germs are found in the greatest amount in the skin of produce so it is essential to wash them well. So, wash, cook and enjoy these red wunderfruit.




Tomatoes and stroke prevention, Harvard Health Letter, February, 2013


Khan, J. Effect of Tomato Derived Lycopene on Obesity Induced Inflammation. International Medical Journal, Vol. 21, No. 5, pages 477-479.


Pratt, Dr. S, and Matthews, K. Fourteen Foods that will change your life SuperFoods Rx, (HarperCollins, 2004).

Tweed, V. Red Revolution, Better Nutrition, May 2016.


Diuretics – Good drugs but Precautions needed

It would be wonderful if medications were never needed but not taking pills if your blood pressure isn’t well controlled can be deadly. With hypertension, blood hits the inner walls of the arteries with great force and injures them. The body attempts to repair the resulting damage with the inflammatory process and in arteries that takes the form of arteriosclerosis. This is a major cause of illness and death worldwide. But high blood pressure can be easily treated and cardiovascular diseases like heart attack, stroke, kidney injury prevented.

Blood pressure can be lowered with lifestyle changes like exercise and weight loss, but that may not be enough. The many types of antihypertensive drugs work in different ways. Diuretics decrease blood pressure by forcing the kidneys to get rid of more salt and that leads to less water being reabsorbed back into the blood. This increases the amount of urine produced but decreases the amount of water in the blood so that there is less force hitting the inner arteries. Diuretics are effective in treating hypertension. They are also inexpensive.

Like all medications, diuretics have side effects. In fact, they are the most common cause of drug-related side effects and interactions in the elderly. That is not a reason to abandon these drugs. The side effects can be managed or even prevented.

There are three major classes of diuretics:  thiazide, loop, and potassium-sparing diuretics. All of them can cause the blood pressure to fall too much, causing hypotension. That is why it is important to check your blood pressure before you take each dose. If it is too low, call the person who prescribed it before taking it. Diuretics can also cause orthostatic hypotension, a significant drop in the blood pressure with sitting up after lying down or with standing. This big drop in the blood pressure can cause dizziness or even fainting. That effect can be managed by changing position slowly.

All three classes of diuretics can cause or worsen dehydration because they’ll cause salt and water loss even if you are dehydrated. They essentially block the body’s normal management of dehydration. This is another reason to check your BP before taking an antihypertensive.

Loop diuretics and thiazide diuretics can lead to a low potassium level. Most providers recommend eating plenty of potassium-rich foods while taking these drugs, such as oranges, yogurt, and bananas. Potassium-sparing diuretics cause the body to retain potassium, so usually people taking them need to avoid foods high in potassium to prevent a high potassium level. A potassium level that is too high or too low can affect heart function. Usually diet changes are sufficient to prevent a potassium imbalance.

Loop diuretics are the most powerful diuretics, usually reserved for treating heart failure. They can cause trouble with balance and hearing. They can also worsen gout, as can thiazide diuretics. If those problems develop, see your health care professional so your medications can be adjusted without risking control of your blood pressure. Diuretics can also worsen incontinence, especially if taken in the morning when kidney function is at its peak. If this is a problem, ask your doctor about taking it at noon instead.

Also see your health care provider if you develop headaches or become confused. This can be from your blood salt level falling too much and has to be quickly checked and corrected. All diuretics can worsen kidney function, so it is important that a blood test be done to check that periodically.

Managing hypertension is still the best way to prevent heart and blood vessel disease, a major killer. With a little extra effort, diuretics can still be a lifesaver. As with all articles, this is not intended to replace the medical care provided by your health care provider, but instead to make you more aware of important information and prompt you to discuss it with your health care provider.



Kaufman, G. (2014). Diuretics:  how they work, cautions and contraindications. Clinical Reviews, Feb. 2014, vol. 16, #2, pages 83-87.

Rosenthal, L., and Burchum, J. (2016). Lehne’s Pharmacology for nursing care, 9th edition. St. Louis, MO:  Elsevier.

Antioxidants: Biochemical Life Savers

Antioxidant – Biochemical Life Savers

For many years, the field of nutrition focused on illnesses caused by a lack of macronutrients like protein, or micronutrients such as iron. More recent research has made it clear that antioxidants are just as critical to preventing the diseases that weaken or kill most people. Numerous chemicals act as antioxidants, including vitamins A, C and E. But there are many others compounds that are found in a variety of foods.

Why are antioxidants such key components of disease prevention? Because our bodies are constantly producing unstable compounds in the course of normal functioning. One such essential processes is cellular energy production. That creates oxygen free radicals, a form of oxygen that can cause a lot of damage. Antioxidants deactivate these harmful compounds and that is why they are life savers.

The body usually makes sufficient antioxidants but there are situations where oxygen free radical production is increased and overwhelms the body. One such circumstance is chronic inflammation. Inflammation is a protective response of the body to anything deemed to be a threat. It can be caused by germs that have gotten into the tissues, a chemical like carbon tetrachloride, or even unhealthy foods such as sugar, or cigarette smoke. This inflammatory response can help eliminate the foreign substance but in the process oxygen free radical production increases. If inflammation is quickly resolved, no permanent harm is likely. But if the cause of the inflammation isn’t removed or avoided, as with years smoking, the inflammatory process continues and the long-term increase in oxygen free radicals injures tissues and cause diseases.

The very good news is that antioxidants can also be consumed and boost the level of antioxidants in the body. This is why you’ve probably read a lot about eating fruits, nuts, vegetables, whole grains and other healthy foods. Different foods contain different types of antioxidants and the greater the variety of foods consumed, the more likely you are to be protected from a wider array of diseases. Eating an assortment of various colored fruits and vegetables is just one way to help ensure this. For example, yellow and orange vegetables and fruits are rich in carotenoids. And carotenoids like beta-carotene act as antioxidants.

Many research studies have supported the disease-preventing power of antioxidants. One large, long study found that the research subjects who consumed more than 27 servings of vegetables, berries and fruit per month, when compared with an otherwise similar group that ate less than that amount, had an 8 to 10% decrease in all cause mortality, as well as a 20% lower stroke death rate. Higher fruit consumption was linked most strongly with lower cancer rates, and regular produce intake was associated in particular with less gastrointestinal cancer.

It should be noted that cooked vegetables seem to offer fewer benefits than raw. Also, fruit juices aren’t as protective as whole fruit, in part because the fiber in the fruit slows the release of sugar into the bloodstream. The pesticides on many types of produce can make them less healthy. If cost is a concern, stick to organic for the “dirty dozen” such as apples and strawberries, but not for the “clean fifteen,” produce like oranges with a thick skin that can be removed.

Damage from oxygen free radicals is a major threat to health. It has been linked to the start of diseases ranging from cardiovascular disease to neurological disorders like Alzheimer’s disease, certain dermatological disorders, endocrine disorders like type 2 diabetes, and immune disorders, to cancers. But antioxidants are plentiful in a wide variety of healthy foods. This certainly makes them a lifesaver in my book!


  1. Hjartaker, et al, (2015) “Consumption of berries, fruits and vegetables and mortality among 10,000 Norwegian men followed for four decades.” European Journal of Nutrition (2015) 54: 599-608
  2. Pratt, M.D. and K. Matthews (2004). SuperFoods Rx. NY, NY: Harper Collins.
  3. Yang, et al (2018). “Proanthocyanidins against Oxidative Stress: From Molecular Mechanisms to Clinical Applications.” Biomedical Research International. https://doi.org/10.1155/2018/8584136