Home ยป RD Q&A (vol. 36)

RD Q&A (vol. 36)

It’s been awhile since the last RD Q&A, but this series is designed for readers to ask a question they’d love to have answered! Enjoy!

Andrea: Which is healthier, almond butter or peanut butter?

Prevention RD: Hey girl! 🙂 That’s like asking a mother to choose her favorite child! 😉 The good news is that both are healthy (note: buy natural nut butters to avoid trans fats, or double check the ingredient list for “hydrogenated” oils and avoid those products). Comparing the two, however, I’d choose almond butter. There is 1.5 grams of saturated fat as compared to the 2.5 grams per serving in peanut butter, and an additional 3 grams of monounsaturated fat. Almond butter is twice as high in fiber, too. Hope that helps…great question!


Chuy Norma: Is VUR a leading cause of kidney damage among kids? My daughter is going through 3rd stage chronic kidney disease and both kidneys got damaged.

Prevention RD: Hi Chuy! I am so sorry to hear about your daughter – that breaks my heart. Even having worked with end-stage renal disease patients for several years, I am not familiar with VUR. A quick search and a look at this trusted source would indicate, however, that VUR affects up to 30% of children. That’s staggering. It looks as though nutrition does not play a role until the kidney damage has caused reason for nutritional concern. Typically, protein, hydration, potassium, calcium, and phosphorus levels can be of concern in kidney patients. My advice is to have each of these labs performed regularly, as well as blood pressure and vitamin D checks. The kidneys are incredibly complex organs that perform so many vital functions. Close monitoring is integral to good health. With stage 3 kidney failure, hydration (water) is probably the biggest concern, but individual lab work would help determine any other necessary diet changes. I hope this helps…hugs.


Suzanne: I would like to know what the story is on alcohol. First it was only red wine and one glass, now they are saying any alcoholic beverage had health benefits? Seems too good to be true….

Prevention RD: I think alcohol is like eggs – it probably depends who you ask. 😛 My opinion? Alcohol in moderation (up to 1 drink/day for women and 2 drinks/day for men) is good – for mood, stress, enjoyment, health…all of it! As someone who does enjoy partaking in alcohol on a regular and very moderate basis, calories are of most concern. Those who choose to drink alcohol should be sure it fits into their daily caloric intake. As for the proposed health benefits, alcohol has been touted to help increase healthy HDL levels and provide antioxidants (amounts varying based on the type of alcohol). While alcohol may slightly reduce risk of heart disease, there is a lot more evidence in support of a calorie-controlled, active lifestyle to help keep the heart healthy. 😉 For those who choose to drink (me!), I recommend choosing calorie-controlled alcoholic beverages and drinking  in moderation. Alcohol does not have near the impact of other healthy habits such as not smoking, exercise, fiber intake, etc. Great question!


Robyn: What is your thought on grains? So many people are saying to avoid wheat products due to undiagnosed allergy and GMO issues. Its so hard to know who is right. I am an RN and have read many books that make sense to avoid them. But there is just as much literature and research to include them. What are your thoughts?

Prevention RD: Hi Robyn! I totally agree with you. Some of the facts out there on GMO’s and what’s in our food supply are, frankly, very scary. Is omitting grains for those without diagnosed allergies recommended? Not by me. I think you’re on to something when you said, “it’s so hard to know who is right.” The answer is that there probably isn’t one right answer…it’s finding what’s right for you. If GMO’s are concerning, organics are an option. I don’t know that in today’s world, eliminating GMO’s in the diet is actually feasible for most of the population. The important thing is getting in the nutrients that are supplied by grains – fiber, B vitamins, etc. if grains are removed from the diet. Those nutrients are plentiful in the food supply and there is any number of ways to compile a diet that is adequate in all of the macro and micronutrients. What I will say for grains, is that generally speaking, people eat too much of them. Similar to protein, grains displace fruits and vegetables in the diet. Consuming appropriate portions of grains as a part of a healthy diet is a good first step, much less extreme, and more maintainable. For most people, omitting grains is neither a short-term, nor long-term solution to better health or weight loss unless there is an underlying reason for the omission.


Robyn: I am also working to eliminate processed foods from our lives. Any tips for a busy mom of 2 boys?

Prevention RD: This is a tough one, no doubt. Convenience foods…processed foods are tasty, cost-effective, and loved by children. Herein lies the problem. I would start building a repertoire of super quick, home-cooked and crock pot meals. I think it’s also crucial to involve kids in the meal-making process whenever possible. It’s amazing how much buy-in you can receive when kids get involved in the kitchen. I’ve seen this first-hand and it’s truly amazing. Keep fruits, vegetables, nuts and other whole, unprocessed foods around for snacks. Involve the boys in grocery shopping, too. Can they try a new fruit or vegetable every week for a month? Two months? A year? Can they choose ONE item that comes from a box (cereal, granola bars, cookies, etc.) each grocery trip? I strongly suggest meal planning and making (and stick to) a grocery list, prepping ahead on the weekends, freezer meals, and so on. It can be done!


Liz: I recently had a little boy and was wondering about foods & supplements that are said to increase / support milk supply. Oats, brewer’s yeast, fenugreek, and coconut supposed to help with milk supply. I’ve also heard that lecithin can help prevent plugged ducts. Are these supported in the literature? Are there any hidden dangers?

Prevention RD: Liz, CONGRATS!! I wish I could help more but I will defer on this one. I don’t know much about breastfeeding and nutrition. I do recommend, however, being very, very cautious with any supplements with breastfeeding. Supplements are not FDA regulated. I have heard that oats are helpful for lactation! I’m sorry I’m not of more help! 🙁 Can anyone else weigh in?


Melinda: My neighbor’s eight year old son was diagnosed with Type I diabetes in September. We play together a lot and over the summer we have them over to swim a lot. I have shied away from providing snacks because I have no idea what to make. They’ll be coming over more soon during meal time and for longer periods so I’ll need something. What are some kid friendly, diabetic friendly things I can make?

Prevention RD: So tough, so tough. The general “rule” is that snacks with less than 120 calories and 20 grams of carbohydrate do not need to be covered with insulin. I would aim to have snacks that meet this criteria. As for meals, consult with the child’s mother on the amount of carbohydrate that should be provided. Does the child give their own insulin injections? Wear a pump? It’s important that for extended periods of time, the child is not missing doses of insulin. Taking insulin with others knowing can be a source of embarrassment for children, so be sure to make the child feel comfortable and “normal”. Type 1’s generally eat a very “typical” diet, but simply need to match their insulin dose with their meals. In young children, the insulin is often given after the meal because of the unpredictability of how much the child will actually eat. Try and plan balanced meals with plenty of fiber.

Have a question you’d love answered? Send it on over. Nicole at preventionrd dot com.

Thanks for reading!

Be well,


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  1. Kayley Maybe
    May 22, 2013 / 6:58 am

    On the breastfeeding question, the thing that always worked best for me was staying super hydrated. You lose a lot of liquids to your little one, so you need to take in a lot of water. I never took any supplements, but I did eat oatmeal and have an occasional beer when my milk supply was low. Whether it helped or my supply just came back, I’m not sure. Just hang in there! I breastfed each of my kids for a year, and my supply always fluctuated!

  2. Kate
    May 22, 2013 / 7:21 am

    Hi! I wanted to weigh in the Liz on the breastfeeding question. I exclusively pumped for my son for 25 months and didn’t start solids until 9 months. The months where he was older and needed more milk, I supplemented with “more milk special blend” from motherlove company. They have a great site with lots of products, take the supplement made me produce an extra 5 ounces per day roughly. Here’s the link to the product and site!

    • Nicole, RD
      May 24, 2013 / 9:27 am

      Kate, you are a rockstar – 25 months!! ๐Ÿ™‚ Thanks for the info…and I don’t know why I didn’t ask you about this reader question when we talked on the phone on Monday! Silly me ๐Ÿ™‚

  3. Lizzie
    May 22, 2013 / 11:15 am

    I love reading your Q&As! I still want to know who your favorite famous food people are… who do you like on Food Network? Who do you NOT like?

  4. May 23, 2013 / 7:32 am

    Great post Nicole!!! I love reading these.
    Ok, for the breast milk question, fenugreek is supposed to be good (and they have teas too). As for the lecithin, I’m not really sure….but with all the information now about lecithin in eggs, and heart disease, I wouldn’t take a lecithin supplement unless recommended by your doctor.

    • Nicole, RD
      May 24, 2013 / 9:27 am

      That’s great advice, thanks Gina! Supplements and micronutrients are not my strongest suits ๐Ÿ˜‰

  5. Jennifer
    May 23, 2013 / 11:27 am

    Hello, Nicole!

    I am also an RD (turned stay-at-home mommy) and I’ve had personal experience with breastfeeding and LOTS of professional reading on it. Just wanted to share with Liz that lecithin can be useful in prevention clogged ducts, but it’s only recommended when you have a recurrent problem with them (it’s thought that diets higher in saturated fat can possibly promote subsequent clogged ducts and milk blebs in someone who has them frequently. The lecithin may help to prevent them from forming). If you haven’t had a lot of clogged ducts, I don’t believe that the lecithin is necessary. And even if you ARE having them, there are other ways to combat the problem, namely by checking latch and breast emptying first. http://www.kellymom.com is an excellent resource for breastfeeding mothers as the author, Kelly, is an International Board Certified Lactation Consultant. There are many articles and literature links on her site to support her recommendations. If you are wondering if your supply is adequate, Kelly’s website has some fantastic resources for determining that. Lots of moms think they aren’t making enough, when, in reality, they are. Props to you for nursing! It can be tough, but it’s worth fighting for!

  6. May 23, 2013 / 12:56 pm

    I love this post! Thank you!!! I have a friend that is GF that I hang out with A LOT! Sometimes its hard because I want to eat non- gluten free products because I believe its better for me, but gluten free products are better for her. It can rough sometimes!

    Sara ๐Ÿ™‚

  7. Addie
    May 23, 2013 / 5:30 pm

    I’d like to weigh in on the breast milk question also. The only way to make more breastmilk is to remove more milk from the breast, ie pumping or nursing more often. Many women have a perceived inadequate supply just because their baby cries or wants to nurse so often, they think the baby isn’t getting enough. But babies nurse for comfort, too. That being said… hydration is also really important. I recommend at least 60 oz a day of fluids. Even women starving in the Holocaust made adequate milk for their babies!

    • Nicole, RD
      May 24, 2013 / 9:28 am

      I think that’s very consistent with what I know of breastfeeding (as someone who has never breastfed, that is!). Thanks, Addie!!

  8. Libby
    May 27, 2013 / 5:52 am

    I love this post! I have been concerned/confused with the whole “no grains” trend. I can understand if you have an allergy or intolerance but I can’t figure out why they should be eliminated from a healthy diet. I know you said to consume an appropriate amount of grains in our diet, and not eat too many…any suggestions or tips on that?

    • Nicole, RD
      May 30, 2013 / 8:55 pm

      Hi Libby! Great question! Six ounce equivalents of grain for adults is appropriate. Here’s a link on what equates to an ounce: http://www.choosemyplate.gov/food-groups/grains-counts.html. The other key point is to be sure that at least half of consumed grains are whole grains ๐Ÿ™‚

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