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Frequently Asked Questions Dietitian's Responses

Do you have a nutrition question we haven't answered here at nutriSOURCE™? nutriLINK is your connection to AVI's dietitians at Cleveland Clinic, one of the world's premier healthcare facilities. For twenty years, AVI has been proud to serve patients and guests at the world renowned Cleveland Clinic.

Step 1: Click here for a review of diners' frequently asked questions and answers from our AVI Dietetic team.

Step 2: If your question is not one of the frequently asked questions published here, type your question to send to our AVI dietitians at Cleveland Clinic. You will receive a reply within two (2) business days. Thank you for using nutriLINK and have a healthy day!

Information supplied by our dietetic team is not a substitute for medical advice, or treatment. For advice on a medical condition, and/or a personalized treatment plan, see your physician or dietetic professional.



I can't seem to get control of my weight — help!

According to the University of California Wellness Letter, the average American gains about two pounds a year. Since every pound of body weight equals 3500 calories, two pounds translates into an extra 19 calories a day. Nineteen calories is easy to surpass so if you look at the overweight incidence it's feasible to think in terms of 100 extra calories on a daily basis. Making a change in your intake that equals 100 calories is very simple; try:

  • Water — packed tuna instead of oil.
  • One cup of whole-grain cereal instead of two.
  • Tomato slices, lettuce leaves and pepper strips on a sandwich instead of mayo.
  • Two cups of skim milk, instead of whole, per day.
  • A cup of low-fat, sugar-free yogurt instead of a doughnut.
  • A cup of water flavored with a lemon instead of a soft drink.

In addition to making small changes in food choices, increase activity by walking fifteen minutes a day or climb stairs instead of taking the elevator or other options

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Vegetarianism: Is there a key to it?

Vegetarian eating continues to grow in popularity. The key to a healthy vegetarian eating plan is proper planning.

Vegetarians fall into two categories - those who eliminate all animal foods and those who eliminate select animal foods. While all vegetarians need to learn how to meet their nutrient needs, those who eliminate all animal foods need the greatest amount of planning.

The American Dietetic Association and Dietitians of Canada agree that vegetarian eating plans are healthful, nutritionally adequate and provide health benefits in the prevention and treatment of certain diseases. Making a vegetarian eating plan work for you starts with knowing your nutritional needs and then selecting foods that meet those needs.

For help in developing an enjoyable and healthful vegetarian eating plan, contact a dietetics professional.

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Can vegetarian eating supply your body with enough nutrients?

The answer is yes. Both vegetarian and nonvegetarian eating styles can be healthful. The bottom line depends on your food choices over time. Studies show a positive link between vegetarian eating and health.

In general, heart disease, high blood pressure, adult-onset diabetes, obesity and some forms of cancer tend to develop less often among vegetarians than nonvegetarians.

If you're considering a vegetarian lifestyle, follow these tips to help you get started:

  • Make a list of all the meatless dishes you already enjoy
  • Browse through vegetarian cookbooks and write down recipes that sound appealing
  • Go to a natural food store and experiment with some products
  • Try meat-alternative products made with soy.

For more help developing a vegetarian eating plan, log onto www.eatright.org or contact a registered dietitian.

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Is calcium the only way to build bone strength?

When you think of ways to build strong and healthy bones, most people immediately mention calcium. However, new research indicates that iron might also make a difference in your bone health.

The role of iron in bone density may be linked to its role in the production of collagen, a key component of our bones. Good sources of dietary iron include beef, poultry, fish and beans.

Iron and calcium are among other important nutrients for healthy bones so be sure to include a variety of foods from the Food Guide Pyramid every day.

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Why should I add more calcium to my daily routine?

It is important to eat and drink a wide variety of calcium-rich foods and beverages every day. Getting calcium in your diet can be easier than you think if you try and work it into your daily routine.

  • Drink low-fat milk or fortified fruit juice during your coffee break.
  • Try drinking low-fat flavored milk.
  • Enjoy calcium-rich snacks like yogurt, cheese and crackers and pudding.
  • Order a latte or cappuccino (skip the fat by requesting skim milk) in place of black coffee. While caffeine can interfere with calcium absorption, consuming the amount of steamed milk typically added to latte or cappuccino readily offsets this effect.
  • Choose foods with more calcium such as dark green leafy vegetables, fortified fruit juices and fortified cereals.
  • Try some freshly baked cookies with a glass of cold milk.

Start slowly, adjust your menus to include more dairy, and before long calcium will be a part of your daily routine.

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I don't like to exercise. Why should I add regular physical activity to my daily routine?

Along with a well-balanced eating plan, exercise is important for losing weight and maintaining your overall health. With planning, you can easily fit 30 to 60 minutes of aerobic activity into your routine most days of the week.

Aerobic activity includes walking, riding a bike, inline skating, ice-skating and dancing. It is important to your health because it strengthens your heart, lungs and blood vessels.

To increase your levels of aerobic activity, first decide which activities you enjoy and look at your daily schedule to see where you can fit these activities in.

If you're starting from little or no daily physical activity, plan for five to 10 minutes per day. Once you achieve that level, increase it every week by 10-minute increments until you're up to 30 to 60 minutes most days of the week.

For maximum cardiovascular health, try to engage in all your aerobic activity at one time. But if your schedule doesn't permit it, you can break up the time throughout the day.

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Why is adequate hydration so important?

From the hot, sultry days of summer to the bone-chilling days of winter, your body needs water to maintain its normal temperature.

Staying well hydrated is important no matter what the weather. Extreme temperatures act more quickly to dehydrate the body, making it important to drink water-based beverages even though you may not feel like it. Try to drink eight 8-ounce glasses every day, with increased amounts for added activity. If you spend lots of time outside, your need will increase.

Beverages that best meet hydration needs include water, juices, milk or caffeine-free coffee or tea. Carrying a water bottle makes it easy to remember to drink. Alternating water and coffee in your mug is another way to meet your needs.

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I love to snack. Are there any snack foods that are good for me?

Healthy snack foods should include some carbohydrates and a little protein. For the greatest variety of nutrients, try to incorporate whole grains, fruits, vegetables or beans into your snack-eating plan. Some ideas include:

  • A bean burrito
  • A cheese quesadilla with salsa and lettuce
  • A yogurt and fruit smoothie with graham crackers
  • A bowl of whole-grain cereal topped with sliced fruit and milk
  • A small salad with sliced deli meat, tuna or beans
  • Fruit, cheese and whole-grain crackers.

For more healthful snack ideas as well as the most reliable food and nutrition information, contact a dietetics professional.

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How can I tell if I'm really hungry, or just eating from impulse?

We often eat when we're not hungry. One reason may be that many of us can't recognize when our bodies need food.

The sensation of hunger is instinctual. For many people the first twinge of hunger sends them searching for food, often before they need to eat. Feeling a little hungry at the start of a meal is good, but knowing when you could wait longer is also important.

Eating every time you feel hungry can result in overeating. If you struggle with this, ask yourself these questions before your next meal:

  • Am I hungry? (If you're not sure, wait 20 minutes and ask again.)
  • When was the last time I ate? (If it's less than three hours, it may not be real hunger.)
  • Could a small snack tide me over until the next meal? (Try and have ready-to-eat fruit or vegetables on hand.)

If you can't recognize when you're hungry, make a schedule - eat small meals every three to four hours until you learn what hunger feels like. If you overeat at a meal, get back on track at the next one.

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How can I tell if I'm getting all the nutrition I need?

Eating a variety of foods is the best way for most people to get the nutrition they need. However, recent research has revealed that many people are not eating a variety of foods and are therefore lacking in essential nutrients for a healthy body.

If you're eating a healthful diet — following the guidelines of the Food Guide Pyramid — you're likely getting all the nutrients you need already.
However, some people, such as those who consume fewer than five servings of fruits and vegetables each day, women of childbearing age, older adults, people who smoke, vegetarians, people with food allergies or people who consume fewer than 1,600 calories a day, may benefit from the addition of a multivitamin. Talk to your physician or a dietetics professional to determine if this is right for you.

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What's all the fuss about antioxidants?

Just like rust on a car, oxidation can cause damage to cells and may contribute to aging.

Antioxidants help prevent oxidation, may help increase immune function and possibly decrease risk of infection and cancer. Antioxidants exist as vitamins, minerals and other compounds in foods.

A few of the better-known antioxidants include carotenoids — the substance that gives fruits and vegetables their deep, rich colors. Apricots, broccoli, pumpkin, cantaloupes, spinach and sweet potatoes are some good choices in addition to lycopene in tomatoes. Vitamin C and E are also good antioxidants, as well as magnesium, copper and zinc.
Increasing the range of foods you eat is the first step in getting more antioxidants. If you're struggling, contact a registered dietitian for a nutrition check-up.

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I love fruit juice. Is it good for me?

Drink 100 percent juice for the greatest nutritional benefit. Good examples include pink grapefruit juice and orange juice.

Read the label. Check to be sure that the product is 100 percent juice. Read the ingredient list carefully to make sure that juice is one of the first ingredients. As with most fruits and vegetables, the more colorful the juice, the more nutrients it contains that may help protect against some cancers, heart disease and other chronic health conditions. As more and more juices are fortified with calcium, you can double your benefit.

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How can I tell if I'm an emotional eater?

Do you eat whenever you're anxious? Is food one of the few things that make you feel better? If so, you may have been conditioned to turn to food for comfort.

For many people, food is more than just nutrition. Eating is something to do when you're bored, tired, anxious or when dealing with emotions. Often these behaviors can lead to overeating.

If you eat because of emotions, you may want to start keeping a food record of what you eat, when you eat and why you eat. Recognizing what triggers your eating can often make it easier to make changes.

To help break the habit of turning to food when emotions begin to take over, find other things to do, such as walking around the block, taking a bike ride or playing with the dog. Find a balance between eating and your emotions and still enjoy your comfort foods!

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What's the "Freshman 15," and how do I avoid it?

The weight gain that many incoming freshman college students experience, termed the "freshman 15," is often a result of stress, lifestyle changes, new food choices and a change in level of physical activity. Here's how to control it:

  • Try to avoid skipping meals so you don't overeat at the next meal.
  • Watch portion sizes, especially those late-night snacks.
  • Keep healthy grab-and-go snacks available like granola or breakfast bars, fresh fruit, peanut butter and crackers or trail mix.
  • Finally, don't forget about physical activity. Walk or bike across campus. Take advantage of recreation facilities to workout or swim. Join an intramural team.

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What is binge eating, and is it more common than suspected?

Binge eating disorder is defined as consuming a large amount of food in a short period of time and feeling out of control. New research shows binge eating disorder may be more common than previously thought.

A study published in a recent issue of the journal Eating Behavior found that, compared to women who were just trying to lose weight, women with binge eating disorder had higher body mass indexes, became overweight at an earlier age, were more likely to suffer from depression and reported trying unhealthy methods of controlling weight.

Breaking the binge eating cycle isn't easy, and it takes time and patience. If you're struggling with binge eating, contact a dietetics professional.

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BMI: What Does It Mean?

BMI stands for body mass index - a way to judge your body weight in relationship to your height. This index can provide some insight into whether you weigh more than you should.

To calculate your BMI for adults, multiply your weight in pounds by 703. Divide that number by your height in inches, squared (i.e., height x height). The ideal number should be between 20 and 25. If you're below, you may be underweight and if you're above, it could mean you are overweight.

There are many other factors that need to be considered when judging how much you should weigh. Use BMI as a guide only. If your BMI falls out of the range, contact a dietetics professional for help.

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I need to build muscles. Is there a "best" way to do it?

Nutrition and working out go hand-in-hand to help you build muscles. You need to work your muscles to build strong muscle mass and consume enough calories to repair muscles after a hard workout.

Maximize your muscle development by developing a regular lifting routine supplemented with adequate aerobic activity. A good weightlifting routine consists of lifting several times per week, resting a day in between each muscle group. Work with a physical fitness expert to learn to lift weights properly.

Before you start any physical activity plan, remember to check with your physician. For proper fuel, you need carbohydrates to help the body during a workout, repair muscles afterward and to aid in rebuilding muscle mass.

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Is there a good breakfast to properly fuel my body?

Start your day off right with carbohydrates for energy and protein for sustained energy. Consider the following breakfast ideas:

  • Cereal topped with yogurt and fruit
  • Whole-grain toast with peanut or soy nut butter with a glass of milk
  • Scrambled eggs, toast and fruit.
  • Stay hydrated during the day by drinking a total of two cups of water, juice, coffee or tea at breakfast. Take a bottle of water along with you. Carry peanut butter crackers, dried fruit, or a cereal bar to nibble on in-between meals.

For lunch, refuel with more carbohydrates and protein and again, plenty of water.

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Are there health risks in caffeine and coffee?

Coffee is the most popular food consumed at breakfast in the United States. While many studies have explored connections between caffeine and health issues like cancer, cardiovascular disease and osteoporosis, no evidence has been found to link moderate caffeine intake to these or other health risks.

Caffeine does act as a diuretic, but the water in a cup of coffee tends to balance out the diuretic effects.

Caffeine acts as a mild stimulant to the central nervous system and both regular and decaf coffee can irritate the stomach. Caffeine can also act as an analgesic and may help protect against gallstones, cavities, type 2 diabetes and Parkinson's disease, but more research is needed before caffeine can be proclaimed a "disease preventer."

How much coffee is too much? Your caffeine sensitivity depends on the amount you drink, the frequency, your weight, physical condition and other factors. For most healthy adults, 200 to 300 milligrams of caffeine per day - about two to three cups of coffee - pose no physical problems.

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Can Food Prevent Migraines?

Anyone who suffers from migraine headaches knows how they can ruin a whole day. Your food choices may be able to help prevent migraines.

The cause of migraines is still something of a mystery. Everything from changing hormone levels to poor sleeping habits to low blood sugar can trigger them. Common food migraine triggers are red wine and aged cheese.

If you get migraines, keep a diary of what you eat each day. This can help discover what might be triggering the migraines. Eat small, frequent meals that contain magnesium, which can reduce migraine frequency. Foods that are rich in magnesium include nuts, fish, legumes, bran flakes, and dark green leafy vegetables.

If you think your migraine headaches may be food related, contact your doctor or dietetics professional for more information.

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College: all you can eat, but should you?

The excitement going off to college means new challenges and new freedoms, including the opportunity to control what and when you eat.

For many college freshmen, walking into an all-you-can-eat dining hall can be overwhelming. Here are some suggestions:

  • Try just one new food each day.
  • Limit your meal to one plate of food.
  • Eat a salad first, then go back for the meal.
  • Eat a piece of fruit before going to dinner.
  • Take small portions of each of your food choices.
  • Don't feel the need to try everything the first day. Don't worry, it will be served again. And remember to take time to visit with friends during meals, which will help control how much you eat.

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Breaking "the habit" can improve your nutrition

Quitting smoking is good for your health and it has implications for your nutrition as well.

Stopping smoking may cause some weight gain but most people gain fewer than 10 pounds, and some people don't gain any weight at all. Control your eating by spacing meals three to four hours apart and include carbohydrates and protein with each meal.

If you have the urge to smoke after a meal, consider instead a fruit cup, a scoop of frozen yogurt or a slice of angel food cake to finish your meal and satisfy your craving. For between-meal cravings, try sugarless gums or candies, baby carrots with fat-free salad dressing or popcorn with seasoned salt.

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How can I develop a plan for lifelong health, not just short-term weight loss?

Amid the daily barrage of fad diets and weight-loss books, it can be easy to lose sight of the big picture: achieving overall good health.

Too often, people adopt the latest diet, which may work for a while, but then they hit weight-loss plateaus and ultimately end the diet in frustration. By putting more emphasis on your health, you can raise your overall self-esteem, resulting in healthy eating, weight loss and improved health.

It is the official position of the American Dietetic Association that if food is consumed in moderation with appropriate portion size and combined with regular physical activity, all foods can fit into a healthful diet. If you've gone from one diet to the next throughout your life, it's time to get back to basics and focus on your overall health.

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I'm gluten intolerant. What's the best way to eat in a college situation?

Gluten intolerance is an intestinal disorder, and people who have it must avoid foods containing wheat, rye, barley and oats to prevent damage to the small intestine. Gluten intolerance is a genetic disorder that affects about one in every 150 Americans.

If you are gluten intolerant, you can make adjustments in your food choices without sacrificing enjoyment. In place of wheat pasta, have potatoes, buckwheat, brown rice, wild rice or beans. Add plenty of fruits, vegetables, dairy foods and protein to your eating plan to maintain nutrition and variety.

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Why do they call fish "brain food?"

Old legends claimed that eating fish would make you smarter. New research says those old legends may be right.

Researchers recently found that those who ate at least one fish meal per week were significantly less likely to develop Alzheimer's than those who never ate fish.

This study supports other research on the positive role of omega-3 fatty acids in brain cell health. Omega-3 DHA is known to keep brain cell membranes healthy and appears to aid communication within brain cells.

So you can eat well and keep your brain sharp and your heart healthy by adding more fatty fish like tuna, salmon, mackerel and sardines to your eating plan.

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How can I "fuel up" for sports?

College and professional athletes need to focus on consuming adequate amounts of calories, carbohydrates, protein and water.

Athletes need enough calories to maintain their growth and an additional amount to accommodate their working muscles. Spreading meals throughout the day is a good way to get the fuel you need. Also, plan your meals around carbohydrates and protein. Good food choices include:

  • Peanut butter and whole-grain bread
  • Sliced turkey in a whole-wheat pita
  • Whole-wheat pasta topped with baked chicken
  • Scrambled eggs and whole-wheat toast.
  • Add fruits, vegetables and dairy foods to all meals and snacks to round out your nutritional benefits and your training needs.

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I choose to drink sports drinks instead of water when playing sports. Am I right?

It depends on what sport and how long you're playing. If you're active for less than an hour, water should be adequate. But for sustained activities longer than an hour, sports drinks are appropriate. As you use up readily available stores of electrolytes and carbohydrates, you need to start replacing them, and a sports drink is an easy way to do that. It helps prevent a drop in energy from a lack of readily available glucose.

In warmer weather, you'lll sweat more, and it's important to prevent dehydration with fluid replacement. However, overhydrating can cause problems as well. Aim for about 12 ounces an hour. Too much water can dilute the sodium in the bloodstream and is associated with collapse during exertion. On the other hand, too much sports drink may upset the stomach and provide too much sodium, causing water retention. Sports drinks diluted with an equal amount of water may be easier on the stomach. *

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Is healthful eating really possible at college?

New college freshmen quickly learn that food is an essential part of their existence. Balancing what they eat can be tricky. The opportunity to eat whatever you want, whenever you want, and as much as you want causes many new college students to gain weight. The best way to enjoy food and maintain a healthy weight is to develop a plan.

Space meals three to four hours apart. Include a small amount of protein and carbohydrates at each meal. Try cheese and crackers, cereal and milk, or yogurt and fruit.
And … always eat from a plate. Grabbing from boxes and bowls is tempting when you're busy studying, but it can easily lead to overeating.

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Is there a relationship between what I eat and how my moods change?

How we feel can often be a result of what we eat. But what we eat can also be due to how we feel. Food and body chemicals interact to keep us going. When our moods change, so do our body chemicals. There are things we can do to manage the foods we eat when our moods change.

Stress often leads to a craving for carbohydrates, because they boost serotonin, which has a calming effect. Choosing more complex carbohydrates, such as whole-grain products, beans and vegetables, can help you increase the nutritional content of your meals and snacks.

"Afternoon lows" are often a result of poor meal timing or food choices. Space meals three to four hours apart and choose low-fat protein and complex carbohydrates for your meals.

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How can I stay adequately hydrated all day long?

You probably know the health benefits of drinking plenty of water, but actually drinking enough of it may be another story. If you need to increase the amount of water you drink:

  • Take water breaks during the day instead of coffee breaks or keep a cup or bottle on your desk to drink throughout the day.
  • Patronize vending machines that sell bottled water and skip the high-calorie or sweetened beverages.
  • Anytime you walk past a water fountain, take a drink.
  • Alternate sparkling water and alcoholic drinks at parties or restaurants.
  • Drink water before, after and during physical activity.
  • Carry a bottle of water as you commute, work and/or run errands.

Do not wait until you are thirsty to drink water; stay hydrated all day long!

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What is lactose intolerance?

Getting enough calcium is easy when you drink milk but for people who are lactose intolerant it can be more difficult.

Lactose is the carbohydrate in milk. Digesting it requires the enzyme lactase. For individuals without enough of this enzyme, lactose intolerance develops. Given the nutritional importance of calcium, overcoming this deficiency is important.

Research has shown that most people can tolerate lactose when consumed in small amounts or with other foods. A half-cup of milk at a time generally is tolerable. Eating dairy foods with other foods slows down absorption of lactose, making it easier for lactase to break it down. Other options for calcium are dark green vegetables, sunflower seeds, soy, tofu or calcium-fortified foods and juices.

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What are food allergies? Are they the same as food intolerances?

Food allergies are abnormal responses of the body's immune system to certain foods or food ingredients. Food allergies can show up as rashes, swelling of the skin, nasal congestion, nausea and diarrhea or the most serious reaction, anaphylactic shock, which is life threatening.

About one percent of adults suffer from food allergies, so knowing what to avoid is important. Most common allergens are peanuts, shellfish and eggs.

Food intolerances do not involve the immune system, but reactions can mimic those of allergies. With food intolerance, the body can't adequately digest a certain component of a particular food. Intolerances can involve many different foods, which makes it important to learn what substances trigger a reaction.

Food allergies and food intolerances should be diagnosed by a physician. A dietetics professional can help develop an eating plan that's right for you.

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What's the nutrition scoop on nuts?

Nuts provide protein, carbohydrates and a wide variety of vitamins and minerals. New research shows that eating plans that include nuts are more satisfying (unless you're allergic to them!), leading people to eat less and control their weight. So enjoy nuts in your eating plan. The key is watching your serving sizes.

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* The Ohio State University Medical Center



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