Answers Author: Betty Kovacs MS, RD
Title: Nutritionist
Affiliation: Author, MedicineNet
Patients with celiac disease are at risk for some nutritional deficiencies, including folate deficiency, B12 deficiency, and iron deficiency. Celiac disease patients are also at risk of developing low bone mineral density (osteoporosis).
There are two reasons for nutritional deficiencies in celiac disease patients:

1. The diseased small intestine causes a lack of absorption of vitamins and nutrients.

2. Strict gluten restriction can also lead to nutritional deficiencies.
Many of the gluten-free foods are not fortified or enriched with vitamins or minerals. Studies have also shown that gluten-free products are often low in B vitamins, calcium, vitamin D, iron, zinc, magnesium, and fiber.
Fortunately, there are blood tests that your physician can do to determine if you are deficient in any nutrients. It's important to be aware of what deficiencies you are at risk for, and to make every effort to avoid these deficiencies.
The deficiency in nutrients does not mean a deficiency in calories. There is an increased incidence of obesity in persons with celiac disease who are following a gluten-free diet. The dietary goal is to follow a well-balanced diet, with appropriate supplements when needed, and an adequate amount of calories for maintaining a healthy weight.

Medical Reviewer: David Kiefer, MD, August 6, 2011

Source: WebMD Medical Reference: Gluten-Free Diet.

Answers Author: Brunilda Nazario MD
Title: Endocrinologist, WebMD Medical Expert
Affiliation: Medical Editor, WebMD
For a mother's health, and the health of her baby, she is advised to take prenatal vitamins during pregnancy. These are specially formulated multivitamins that make up for any nutritional deficiencies in the mother's diet. While the supplements contain numerous vitamins and minerals, their folic acid, iron, and calcium content are especially important.
Look for a prenatal vitamin that includes approximately:

- 400 mcg of folic acid

- 400 IU of vitamin D

- 200 to 300 mg of calcium

- 70 mg of vitamin C

- 3 mg of thiamine

- 2 mg of riboflavin

- 20 mg of niacine

- 6 mcg of vitamin B12

- 10 mg of vitamin E

- 15 mg of zinc

- 17 mg of iron
Your doctor or midwife can also advise you on certain brands. In some cases, your GP will give you a prescription for a certain type of prenatal vitamin.

Medical Reviewer: David Kiefer, MD, August 6, 2011

Source: http://www.webmd.com/baby/guide/prenatal-vitamins

Answers Author: Richard Weil Med, CDE
Title: Exercise Physiologist, WebMD Medical Expert
Affiliation: Author, MedicineNet
Protein is the building block of muscles and essential for repair and growth of muscle after exercise. Whenever you exercise, and particularly during resistance exercise, you cause microscopic damage to the myofibrils of muscle fiber (myofibrils are small protein filaments in the muscle fiber that help the muscle contract). This isn't the type of damage that you go to the doctor for, but normal biological damage called catabolism. The effect creates a stimulus and environment for muscle repair and growth. The body responds to the damage by sending nutrients, including protein and other growth factors like testosterone, to the muscle to help it grow. Contrary to what many people think, protein is not used by the muscles for fuel unless the circumstances are extreme (for example, starvation). Instead, fat and carbohydrate are the main fuels.
Research shows that protein consumed before exercise and within 30 minutes of finishing your workout will help with growth and recovery. The guideline for protein consumption after exercise is 1 gram for every 3-4 grams of carbohydrate. Peanut butter has 9 grams of protein per 2 tablespoons. Yogurt is another good source of protein. The guidelines for quantity of protein before exercise are not as clear as after, but you can experiment and see if you notice any difference.
You probably won't notice much difference using protein supplements unless you are malnourished or an elite athlete doing tremendous amounts of aerobic or resistance exercise. That's because most Americans, including athletes, get enough protein in their diets. Excess protein is not used by the body; instead, it is excreted in urine. Discuss your recommend protein intake with a doctor or registered dietitian.
Here's one way to calculate your protein needs:

1. Divide your weight by 2.2 to calculate your weight in kilograms.

2. Multiply your weight in kilograms by 0.8-1.7 gm/kg (depending on factors mentioned above).
Here's an example if you weigh 200 pounds and consistently do heavy resistance exercise:

200/2.2 = 91 kg

91 kg x 1.4 = 127 grams of protein per day

Again, keep in mind that most Americans get enough protein in their diets.

Medical Reviewer: David Kiefer, MD, August 6, 2011

Source: WebMD Ask the Experts: Fitness Q&A by Richard Weil.

Answers Author: Stanley A. Cohen MD
Title: Pediatric Gastroenterologist
Affiliation: Children's Healthcare of Atlanta
Absolutely. All of my patients work with a registered dietitian to ensure the missing nutrients from the eliminated food is supplied by other foods or dietary supplements. This is especially important when there are multiple allergies or when dairy is limited or eliminated because it is the best source of calcium in the diet.

Medical Reviewer: David Kiefer, MD, August 6, 2011

Source: WebMD Expert Q&A: Eating With Food Allergies.

Answers Author: James Beckerman MD, FACC
Title: Cardiologist, WebMD Medical Expert
Affiliation: Providence St. Vincent Heart Clinic, Portland, Ore.
Two important lifestyle factors can affect your body weight more than any others.
The first is work-related physical activity. Individuals who walk and stay mobile as part of their jobs are less likely to be overweight. The second factor is dietary fiber.
If you are mostly stationary during your work day, it's a good idea to look at how much fiber you are getting in your diet.
Fiber serves two main purposes that affect your health. Soluble fiber -- in foods like oat bran, nuts, beans, and some fruits and vegetables -- helps prevent your body from reabsorbing bile acids in your gastrointestinal tract, which can help lower your cholesterol without medication.Insoluble fiber -- found in wheat bran, whole wheat bread, and many vegetables -- absorbs water in your colon and can help keep you regular. Because fiber absorbs water, it can also help you feel fuller after taking in fewer calories.
Most of us get fewer than the 25 grams of daily fiber recommended by the American Heart Association. Consuming this recommended amount can help you lose weight while improving your heart health.
You can bulk up on fiber pretty easily by increasing your intake of fruits and vegetables, and making a point of trying higher fiber breads, cereals, and rice. In some cases, you can meet your fiber goals with the use of a fiber supplement, but talk to your health care provider first about that. Making some simple changes in your shopping patterns can help you reach the recommended amount of daily fiber and reduce your risk of heart disease ... and stay regular

Medical Reviewer: David Kiefer, MD, August 6, 2011

Source: WebMD Heart Disease Community With James Beckerman, MD, FACC.

Answers Author: Elaine Magee MPH, RD
Title: Nutritionist, WebMD Medical Expert
Affiliation: Author, Tell Me What to Eat If I Suffer From Heart Disease
Half of us are taking dietary supplements on a daily basis but what you may not know is that some of them come with a kick of caffeine -- and it may not even be listed on the label.
Agricultural Research Service (ARS) scientists analyzed a number of caffeine-containing products including supplements. You see, caffeine is a natural alkaloid in more than 60 plants (including tea and coffee) and in plant derivatives known as "botanicals." These botanicals, such as guarana, yerba mate, kola nut, and green tea extract, are common dietary-supplement ingredients and are printed on the label's ingredient list -- although you might not see any amount of caffeine listed on the label. According to the Agricultural Research Service online report on "Caffeine In Selected Dietary Supplements," there is no requirement to state the amount of caffeine present in a food, beverage, or supplement on the product's label. If caffeine in its pure form is added to a product, however, there is a requirement to add the word "caffeine" to the label's ingredient listing, the report explains.
Dietary supplements -- predominantly weight-loss and sports-nutrition products containing at least one caffeine-containing ingredient -- were chosen for the ARS analysis. Here's what they found:
[Note: According to the Nutrient Data Laboratory, one 8-ounce cup of coffee (240 milliliters) contains about 95 milligrams of caffeine.]
Of the 53 products analyzed, 27 products provided -- by way of a daily serving defined on the label -- the caffeine equivalent of about one to two cups of coffee.

Eleven products had caffeine equivalents ranging from two to four cups of coffee.

Eleven more products had equivalents ranging from four to six cups of coffee.

Four products provided an amount of caffeine ranging from seven to eight cups of coffee.

Of the 28 analyzed products that voluntarily listed a caffeine amount on the label, 25 were found to contain caffeine levels within 20% of the label amount.

Medical Reviewer: David Kiefer, MD, August 6, 2011

Source: WebMD Blog: Food and Cooking.

Answers Author: Laura J. Martin MD, MPH
Title: Internist, WebMD Medical Expert
Affiliation: Medical Editor, WebMD
Nowadays, everything from bottled water to orange juice seems to have souped-up levels of vitamins and minerals in it. That may sound like a way to help cover your nutritional bases, especially if your diet is less than stellar.
But are you in danger of getting too much of these important nutrients? And can these overloads hurt you?
Yes, if you're routinely taking megadoses. For instance, too much vitamin C or zinc could cause nausea, diarrhea, and stomach cramps. Too much selenium could lead to problems including hair loss, gastrointestinal upset, fatigue, and mild nerve damage. Too much vitamin B6 may adversely affect your nerves, and there are suspected risks with too much vitamin E.
Most people don't realize there's no real advantage to taking more than the recommended amounts of vitamins and minerals, and they don't recognize there may be disadvantages," says Johanna Dwyer, DSc, RD, a senior research scientist with the National Institutes of Health's Office of Dietary Supplements.

Medical Reviewer: David Kiefer, MD, August 19, 2011

Source: WebMD Feature: Getting Too Much of Vitamins and Minerals.

Answers Author: Betty Kovacs MS, RD
Title: Nutritionist
Affiliation: Author, MedicineNet
You heard right, not all calcium supplements are the same. The supplements will differ by the kinds of calcium that they contain, the amount that they contain, and anything else that is added to them (other minerals or vitamins). Along with that, there are other factors that will affect how much of the calcium you will actually absorb, including medications that you are taking, your age, your vitamin D levels, the amount of calcium that you are taking and if you are pregnant. If you have any concerns over any of these, it would be best to speak with your doctor before taking anything. And remember, all calcium supplements should be taken separately from other medications or supplements so they don't compete with their absorption. The most common forms of calcium in supplements are calcium carbonate and calcium citrate. The differences between the two are:
Calcium carbonate

- Less expensive

- Don't need to take as many pills to get your calcium requirements.

- If you have low acid in your stomach (achlorhydria), you will have trouble with absorbing this substance.

- May be constipating at higher doses.
Calcium citrate

- More expensive.

- You will need to take more pills to meet your calcium requirements.

- Should be taken with meals to improve its absorption.

- This does not need acid to be absorbed, so it works well for anyone with achlorhydria.

- When choosing your supplement, you will need to check out the label to see how much elemental calcium is in it. This is the actual amount of calcium that your body absorbs. You will not want to take in more than 500 mg of calcium at one time, including that from food and supplements. The Recommended Adequate Intake for calcium is based on your age:

• 0 to 6 months -- 210 mg

• 7 to 12 months -- 270 mg

• 1 to 3 years -- 500 mg

• 4 to 8 years -- 800 mg

• 9 to 13 years -- 1300 mg

• 14 to 18 years -- 1300 mg

• 19 to 50 years -- 1000 mg

• 51+ years -- 1200 mg
While it is important to get an adequate amount of calcium in your diet, you do not want to go overboard and take excessive amounts. Many people follow the thought that if something is good for you then more is better, but that is not always the case with vitamins and minerals. In fact, excessive amounts of some vitamins and minerals can end up damaging your health.
For this reason, Tolerable Upper Limit (UL) levels have been established to let people know the number that you do not want to go beyond when taking supplements. The UL for calcium for children over 1 and adults is currently set at 2500 mg/day. Going beyond that can interfere with your body's ability to absorb other minerals (iron, phosphorus, zinc, and magnesium), it can impair how your kidneys function, it can elevate your blood levels of calcium (hypercalcemia), and it could end up interfering with other medication that you are taking. Sticking with the Recommended Adequate Intake levels is your safest bet.

Medical Reviewer: David Kiefer, MD, August 6, 2011.

Source: WebMD Ask the Experts: Diet and Nutrition Q&A by Betty Kovacs, MS, RD

Answers Author: Jay W. Marks MD
Title: Gastroenterologist, WebMD Medical Expert
Afilliation: Medical Editor/Author, MedicineNet
Fiber is defined as material made by plants that is not digested by the human gastrointestinal tract. Fiber is one of the mainstays in the treatment of constipation though it also may have additional uses such as the treatment of diverticular disease of the colon, cholesterol problems, or diabetes. Many types of fiber bind to water and keep the water within the intestine. The fiber and water adds bulk (volume) to the stool, and the water softens the stool. Increased gas (flatulence) is a common side effect of high-fiber diets. The gas occurs because bacteria within the colon, unlike the intestine of humans, are capable of digesting fiber to a small extent. The bacteria produce gas as a by-product of their digestion of fiber.
There are different sources of fiber, and the type of fiber varies from source to source. Some types of fiber are digested to a greater extent by colonic bacteria than other types of fiber. The better-digested fiber produces more gas.
All fibers, no matter their source, can cause flatulence; however, since bacteria vary in their ability to digest different types of fiber, different sources of fiber may produce different amounts of gas. To complicate the situation, the ability of bacteria to digest one type of fiber can vary from individual to individual. This makes the selection of the best type of fiber for each individual (i.e., a fiber that improves the quality of the stool without causing flatulence) more difficult. The choice becomes a matter of trial and error.
Types of fiber can be categorized in several ways, for example, by their source. The most common natural sources of fiber include fruits and vegetables as well as wheat or oat bran. These fibers are most likely to cause flatulence. Fibers used medicinally to treat constipation include psyllium seed, synthetic cellulose (methyl cellulose), and calcium polycarbophil. (A lesser known source is an extract of malt; however, this extract may soften stools in ways other than by increasing fiber.) Psyllium and methyl cellulose (and probably calcium polycarbophil) do not increase the production of gas; however, they still may result in the sensation of bloating. This may be due to an effect of these fibers that slows the transit of gas through the intestine.
The different sources of fiber should be tried one by one. The fiber should be started at a low dose. The dose should be increased every 1-2 weeks until either the desired effect on the stool is obtained or troublesome bloating or flatulence (or other gastrointestinal symptoms) supercedes. (Fiber does not work overnight!) If bloating or flatulence occurs, the dose of fiber can be reduced for a few weeks, and then the higher dose can be re-instituted. (It generally is said that the amount of bloating or gas that is produced by fiber decreases when it is ingested for a prolonged period of time; however, this has never been carefully studied or proven.) If bloating or flatulence remains a problem and prevents the dose of fiber from being raised to a level that affects the stool satisfactorily, it is time to try a different source of fiber.
When using increasing amounts of fiber, it is recommended that increasing amounts of water be ingested, presumably to provide water for the fiber to bind and prevent "hardening" of the fiber and obstruction of the intestine. This is simple and reasonable advice; however, it has never been shown that the amount of ingested water has any beneficial effect. (There is a lot of water in the normal intestine, and extra water is just absorbed and excreted in the urine.) Despite the lack of demonstrated benefit, it probably is a good idea not to become dehydrated while taking fiber supplements.

Medical Reviewer: David Kiefer, MD, August 6, 2011.

Source: WebMD Ask the Experts: Digestion Q&A by Jay W. Marks, MD.

Answers Author: Brunilda Nazario MD
Title: Endocrinologist, WebMD Medical Expert
Affiliation: Medical Editor, WebMD
Daily value shows the percentage of a certain nutrient in a food, based on a 2,000-calorie diet. The daily value gives you an idea of a food's nutrient contribution to your diet; 5% or less is considered low for that nutrient, and 20% or more is high.

Medical Reviewer: David Kiefer, MD, August 6, 2011.

Source: http://www.webmd.com/food-recipes/definitions-glossary

Answers Author: Brunilda Nazario MD
Title: Endocrinologist, WebMD Medical Expert
Affiliation: Medical Editor, WebMD
There are several types of omega-3 fatty acids. Two crucial ones -- EPA and DHA -- are primarily found in certain fish. Plants like flax contain ALA, an omega-3 fatty acid that is only partially converted into DHA and EPA in the body.
Experts say that DHA and EPA -- from fish and fish oil -- have better established health benefits than ALA. Too little of ALA actually converts to DHA and EPA in the body.
DHA and EPA are found together only in fatty fish and algae. DHA can also be found on its own in algae.

Medical Reviewer: David Kiefer, MD, August 19, 2011.

Source: http://www.webmd.com/healthy-aging/omega-3-fatty-acids-fact-sheet

Answers Author: Celia Esther Dominguez MD
Title: Endocrinologist, WebMD Medical Expert
Affiliation: Emory University
Osteoporosis is often a silent disease -- you don't know your bones are weak until you break one.
Start by seeing your doctor. Together, you can discuss your diet and work out a rough estimate of your calcium intake. If you're coming up short, then you either need to improve your diet or take calcium and vitamin D supplements for bone health.
Keep in mind that the numbers may not tell the whole story. Even if it looks like you're getting enough calcium, you might not be absorbing enough of this mineral. That can be due to many factors, such as smoking, using certain medications, and many health conditions. So make sure to have a frank discussion with your doctor about any other factors that might increase your risk of osteoporosis.

Medical Reviewer: David Kiefer, MD, August 6, 2011.

Source: WebMD Feature: Boning Up on Calcium.