What is vaginitis?

Vaginitis is an inflammation of the vagina. As many as one third of women will have symptoms of vaginitis sometime during their lives. Vaginitis affects women of all ages but is most common during the reproductive years.

What can cause vaginitis?

A change in the balance of the yeast and bacteria that normally live in the vagina can result in vaginitis. This causes the lining of the vagina to become inflamed. Factors that can change the normal balance of the vagina include the following:

  • Use of antibiotics
  • Changes in hormone levels due to pregnancy, breastfeeding, or menopause
  • Douching
  • Spermicides
  • Sexual intercourse
  • Infection

How is vaginitis diagnosed?

To diagnose vaginitis, your health care provider will take a sample of the discharge from your vagina and look at it under a microscope. Your health care provider also may suggest other tests.

How is vaginitis treated?

Treatment will depend on the cause of the vaginitis. Treatment may be either with a pill or a cream or gel that is applied to the vagina.

What is a yeast infection?

Yeast infection also is known as candidiasis. It is one of the most common types of vaginal infection.

What causes yeast infections?

A yeast infection is caused by a fungus called Candida. It is found in small numbers in the normal vagina. However, when the balance of bacteria and yeast in the vagina is altered, the yeast may overgrow and cause symptoms.

What factors increase the risk of getting a yeast infection?

Use of some types of antibiotics increase your risk of a yeast infection. The antibiotics kill normal vaginal bacteria, which keep yeast in check. The yeast can then overgrow. A woman is more likely to get yeast infections if she is pregnant or has diabetes. Overgrowth of yeast also can occur if the body’s immune system, which protects the body from disease, is not working well.

What are the symptoms of a yeast infection?

The most common symptoms of a yeast infection are itching and burning of the area outside the vagina called the vulva. The vulva may be red and swollen. The vaginal discharge usually is white, lumpy, and has no odor. Some women with yeast infections notice an increase or change in discharge.

What treatments are available for vaginal yeast infection?

Yeast infections can be treated either by placing medication into the vagina or by taking a pill.

Should I use an over-the-counter medication to treat a yeast infection?

Over-the-counter treatments are safe and often effective in treating yeast infections. But many women think that they have a yeast infection when they actually have another problem. In these cases, a medication for a yeast infection will not work and may cause a delay in proper diagnosis and treatment of the actual problem.

Even if you have had a yeast infection before, it may be a good idea to call your health care provider before using an over-the-counter medication to treat your symptoms. If this is the first time you have had vaginal symptoms, you should see your health care provider. If you have used an over-the-counter medication and your symptoms do not go away, see your health care provider.

What is bacterial vaginosis?

Bacterial vaginosis is caused by overgrowth of the bacteria that occur naturally in the vagina.

What are the symptoms of bacterial vaginosis?

The main symptom is increased discharge with a strong fishy odor. The discharge usually is thin and dark or dull gray, but may have a greenish color. Itching is not common, but may be present if there is a lot of discharge.

How is bacterial vaginosis treated?

Several different antibiotics can be used to treat bacterial vaginosis, but the two that are most commonly used are metronidazole and clindamycin. They can be taken by mouth or inserted into the vagina as a cream or gel.

What is trichomoniasis?

Trichomoniasis is a condition caused by the microscopic parasite Trichomonas vaginalis. It is spread through sex. Women who have trichomoniasis are at an increased risk of infection with other STDs.

What are the symptoms of trichomoniasis?

Signs of trichomoniasis may include a yellow-gray or green vaginal discharge. The discharge may have a fishy odor. There may be burning, irritation, redness, and swelling of the vulva. Sometimes there is pain during urination.

How is trichomoniasis treated?

Trichomoniasis usually is treated with a single dose of metronidazole by mouth. Do not drink alcohol for 24 hours after taking this drug because it causes nausea and vomiting. Sexual partners must be treated to prevent the infection from recurring.

What is atrophic vaginitis?

Atrophic vaginitis is not caused by an infection but can cause vaginal discharge and irritation, such as dryness, itching, and burning. This condition may occur any time when female hormone levels are low, such as during breastfeeding and after menopause. Atrophic vaginitis is treated with estrogen, which can be applied as a vaginal cream, ring, or tablet. A water-soluble lubricant also may be helpful during intercourse.


The American Congress of Obstetricians and Gynecologists.

Urinary Tract Infections


Urinary tract infections (UTIs) are responsible for more than 8.1 million visits to physicians’ offices per year and about five percent of all visits to primary care physicians. Approximately 40 percent of women and 12 percent of men will experience at least one symptomatic urinary tract infection during their lifetime. How do you know if you have one? What is the best treatment? The following information should help you.

What happens under normal conditions?

The urinary tract makes and stores urine, one of the waste products of your body. Urine is made in the kidneys and travels down the ureters to the bladder. The bladder serves as a storage container for urine, which is then emptied by urinating through the urethra, a tube that connects the bladder to the skin. The urethra connects to the end of the penis in a male and connects to an area above the vagina in a female.

The kidneys are a pair of fist-sized organs located in the back that serve as a filtration system to filter liquid waste from the blood and remove it from the body in the form of urine. Kidneys adjust the body’s balance of various chemicals (sodium, potassium, calcium, phosphorous and others) and monitor the blood’s acidity. Certain hormones are also produced in the kidneys. These hormones help regulate blood pressure, stimulate red blood cell production and promote strong bones. The ureters are two muscular tubes that transport the urine down to the bladder.

Normal urine is sterile and contains no bacteria. However, bacteria may get into the urine from the urethra and travel into the bladder. A bladder infection is known as cystitis and a kidney infection is known as pyelonephritis. Kidney infections are much less common — but often more serious — than bladder infections.

What are the symptoms of a urinary tract infection?

When you have a urinary tract infection (UTI), the lining of the bladder and urethra become red and irritated just as your throat does when you have a cold. The irritation can cause pain in your abdomen and pelvic area and may make you feel like emptying your bladder more often. You may even try to urinate but only produce a few drops and/or feel some burning as your urine comes out. At times, you may lose control of your urine. You may also find that your urine smells unpleasant or is cloudy.

Kidney infections often cause fevers and back pain. These infections need to be treated promptly because a kidney infection can quickly spread into the bloodstream and cause a life-threatening condition.

UTIs are often categorized as simple (uncomplicated) or complicated. Simple UTIs are infections that occur in normal urinary tracts. Complicated UTIs occur in abnormal urinary tracts or when the bacterium causing the infection is resistant to many antibiotic medications.

What causes urinary tract infections?

Large numbers of bacteria live in the rectal area and also on your skin. Bacteria may get into the urine from the urethra and travel into the bladder. It may even travel up to the kidney. But no matter how far it goes, bacteria in the urinary tract can cause problems.

Just as some people are more prone to colds, some people are more prone to UTIs. Women who have gone through menopause have a change in the lining of the vagina and lose the protective effects of estrogen that decrease the likelihood of UTIs. Postmenopausal women with UTIs may benefit from hormone replacement. Some women are genetically predisposed to UTIs and have urinary tracts that allow bacteria to adhere to it more readily. Sexual intercourse also increases the frequency of UTIs.

Women who use diaphragms have also been found to have an increased risk when compared to those using other forms of birth control. Using condoms with spermicidal foam is also known to be associated with an increase in UTIs in women. Women are more prone to UTIs because they have shorter urethras than men so bacteria have a shorter distance to travel to reach the bladder.

You are more likely to get a UTI if your urinary tract has an abnormality or has recently been instrumented (for example, had a catheter in place). If you are unable to urinate normally because of some type of obstruction, you will also have a higher chance of a UTI.

Disorders such as diabetes also put people at higher risk for UTIs because of the body’s decrease in immune function and thus a reduced ability to fight off infections such as UTIs.

Anatomical abnormalities in the urinary tract may also lead to UTIs. These abnormalities are often found in children at an early age but can still be found in adults. There may be structural abnormalities, such as outpouchings called diverticula, that harbor bacteria in the bladder or urethra or even blockages, such as an enlarged bladder, that reduce the body’s ability to completely remove all urine from the bladder.

How are urinary tract infections diagnosed?

If you are concerned about a UTI, then you should contact your doctor. Frequently, you can be diagnosed and treated without going to your doctor’s office. Ways to diagnose a UTI are via urinalysis and/or urine culture. A sample of urine is examined under a microscope by looking for indications of infection — bacteria or white blood cells in the urine. Your physician may also take a urine culture if needed. If you ever see blood in your urine, you should contact your doctor right away. Blood in the urine may be caused by a UTI but it may also be from a different problem in the urinary tract.
If you are having fevers and symptoms of a UTI, or persistent symptoms despite therapy, then medical attention is advised. You may need further tests, such as an ultrasound or CT scan, to assess the urinary tract.

How are urinary tract infections treated?

A simple UTI can be treated with a short course of oral antibiotics. A three-day course of antibiotics will usually treat most uncomplicated UTIs. However, some infections may need to be treated for several weeks. Depending on the type of antibiotic used, you may take a single dose of medication a day or up to four daily doses. A few doses of medication may relieve you of the pain or urge to urinate frequently but you should still complete the full course of medication prescribed for you even if all symptoms have been relieved. Unless UTIs are fully treated, they can frequently return. You should also remember to drink plenty of liquids, especially around the time of a UTI.

If the UTI is a complicated UTI, then a longer period of antibiotics is given and usually is started intravenously in the hospital. After a short period of intravenous antibiotics, then the antibiotics are given by mouth for a period up to several weeks. Kidney infections have usually been treated as a complicated UTI.

What can be expected after treatment for urinary tract infections?

Simple UTIs routinely improve with the three days of oral antibiotics and you do not need a urine culture to prove that it is gone. If you have a complicated UTI, however, you should have a urine culture to show that the UTI is gone. If your symptoms continue even with medication, then you may need a longer course of medications, a different drug or different delivery method (for example, if you are taking medication by mouth, then you may need it intravenously).

Frequently asked questions:

Will a UTI cause damage to the kidneys?

If the UTI is treated early, then there will probably be no lasting influence on your urinary tract. Recurrent or unrecognized UTIs could cause damage if not remedied expeditiously.

Why do I get UTIs?

Most UTIs are solitary events that, if treated, will not recur. Some patients have anatomical and genetic predispositions that tend to make one person more susceptible than another.

How do I avoid UTIs?

  • There are some simple steps women can use to avoid UTIs. Women who have gone throughmenopause and have lost the normal estrogen output have a change in the lining of the vagina.Estrogen replacement under the guidance of a gynecologist and/or primary care doctor can be a simple solution. Since certain patients cannot take estrogen replacement, you should contact your doctor prior to beginning any regimen.
  • Urination after sexual intercourse may also decrease the risk of UTI because it can flush out any bacteria that were introduced during intercourse. Sometimes a dose of antibiotics after intercourse can help prevent recurrence of UTIs.
  • Certain forms of birth control, such as spermicidal foam and diaphragms, are known to increase the risk of UTIs in women who use these as their form of contraception.
  • You should also drink plenty of fluids to keep well hydrated.
  • You should not delay urinating and should not rush when urinating. Also, holding in urine and not emptying your bladder completely can increase your risk of UTIs.
  • You should wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.

When should I be concerned?

If you have symptoms of a UTI and are being treated without improvement in your symptoms or you have symptoms of a UTI accompanied by nausea and vomiting, then you should seek medical attention. If you ever see blood in your urine, you should contact your doctor immediately.

What if I am pregnant?

If you are pregnant and have symptoms of a UTI, then you should contact your doctor immediately. UTIs during pregnancy can put both mother and baby at risk if not addressed quickly and properly.

If UTIs are recurring, can I get over them?

If you are having recurrent UTIs (three or more per year), then you should see your doctor for possible further testing like a urinalysis. You may also need an ultrasound or CT scan to look for any abnormalities of the urinary tract. If you continue to have UTIs, you may benefit from a longer course of low-dose antibiotics or by taking an antibiotic after sexual intercourse. There are also methods of self-testing that your urologist may help coordinate with you to institute both diagnosis and treatment of UTIs at home.


Urology Care Foundation. The Official Foundation of the American Urological Association.

Polycystic Ovary Syndrome

What are common signs and symptoms of polycystic ovary syndrome (PCOS)?

Common PCOS signs and symptoms include the following:

  • Irregular menstrual periods—Menstrual bleeding may be absent, heavy, or unpredictable.
  • Infertility—PCOS is one of the most common causes of female infertility.
  • Obesity—Up to 80% of women with PCOS are obese.
  • Excess hair growth on the face, chest, abdomen, or upper thighs—This condition, called hirsutism, affects more than 70% of women with PCOS.
  • Severe acne or acne that occurs after adolescence and does not respond to usual treatments
  • Oily skin
  • Patches of thickened, velvety, darkened skin called acanthosis nigricans
  • Multiple small cysts on the ovaries

What causes PCOS?

Although the cause of PCOS is not known, it appears that PCOS may be related to many different factors working together. These factors include insulin resistance, increased levels of androgens, and an irregular menstrual cycle.

What is insulin resistance?

Insulin resistance is a condition in which the body’s cells do not respond to the effects of insulin. When the body does not respond to insulin, the level of glucose in the blood increases. Higher than normal blood glucose levels may eventually lead to diabetes mellitus. Insulin resistance also may cause more insulin to be produced as the body tries to move glucose into cells. High insulin levels may cause the appetite to increase and lead to imbalances in other hormones. Insulin resistance also is associated with acanthosis nigricans.

What can high levels of androgens lead to?

When higher than normal levels of androgens are produced, the ovaries may be prevented from releasing an egg each month (a process called ovulation). High androgen levels also cause the unwanted hair growth and acne seen in many women with PCOS.

What can irregular menstrual periods lead to?

Irregular menstrual periods can lead to infertility and, in some women, the development of numerous small cysts on the ovaries.

What are the health risks for women with PCOS?

PCOS affects all areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences.

Insulin resistance increases the risk of type 2 diabetes mellitus and cardiovascular disease. Another condition that is associated with PCOS is metabolic syndrome. This syndrome contributes to both diabetes and heart disease.

Women with PCOS tend to have a condition called endometrial hyperplasia, in which the lining of the uterus (theendometrium) becomes too thick. This condition increases the risk of endometrial cancer.

Are treatments available for women with PCOS?

A variety of treatments are available to address the problems of PCOS. Treatment is tailored to each woman according to symptoms, other health problems, and whether she wants to become pregnant.

How can combination birth control pills be used to treat women with PCOS?

Combination birth control pills can be used for long-term treatment in women with PCOS who do not wish to become pregnant. Combination pills contain both estrogen and progestin. Birth control pills regulate the menstrual cycle and reduce hirsutism and acne by decreasing androgen levels. They also decrease the risk of endometrial cancer.

What effect can weight loss have on women with PCOS?

For overweight women, weight loss alone often regulates the menstrual cycle. Even a small weight loss of 10–15 pounds can be helpful in making menstrual periods more regular. Weight loss also has been found to improve cholesterol and insulin levels and relieve symptoms such as excess hair growth and acne.

How can insulin-sensitizing drugs help treat women with PCOS?

Insulin-sensitizing drugs used to treat diabetes frequently are used in the treatment of PCOS. These drugs help the body respond to insulin. In women with PCOS, they can help decrease androgen levels and improve ovulation. Restoring ovulation helps make menstrual periods regular and more predictable.

What can be done to increase the chances of pregnancy for women with PCOS?

Successful ovulation is the first step toward pregnancy. For overweight women, weight loss often accomplishes this goal. Medications also may be used to cause ovulation. Surgery on the ovaries has been used when other treatments do not work. However, the long-term effects of these procedures are not clear.


The American Congress of Obstetricians and Gynecologists.

Painful Urination (DYSURIA)

Painful urination (dysuria) is pain or burning with urination, usually felt in the tube that carries urine out of your bladder (urethra) or the area surrounding your genitals (perineum). Anyone may experience bouts of painful urination. Painful urination is the most common symptom of a urinary tract infection, especially in women. In men, urinary tract infections are less common, so painful urination is most commonly caused by urethritis and certain prostate conditions.


Painful urination can be caused by a number of conditions and certain substances, including:

  • Bladder stones
  • Chlamydia
  • Cystitis (bladder infection)
  • Drugs, such as those used in cancer treatment, that have bladder irritation as a side effect
  • Genital herpes
  • Gonorrhea
  • Ingredients in personal-care products, such as soaps or perfumes
  • Kidney infection
  • Kidney stones
  • Prostatitis (prostate inflammation)
  • Sexually transmitted diseases
  • Vaginitis (vaginal infection)
  • Urethritis (infection of the urethra)
  • Urinary tract infection (UTI)
  • Yeast infection (vaginal)

When to see a Doctor:

Make an appointment to see your doctor if:

  • Your painful urination persists
  • You have drainage or discharge from your penis or vaginal area
  • You see blood in your urine
  • You have a fever
  • You have back pain or pain in your side (flank pain)
  • You pass a kidney or bladder (urinary tract) stone

*If you’re pregnant, tell your doctor if you have any pain when you urinate.

Overactive Bladder (OAB)

What is Overactive Bladder (OAB) and what are the symptoms of OAB?

Overactive Bladder (OAB) isn’t a disease. It’s the name given to a group of troubling urinary symptoms.
The major symptom of OAB is a “gotta go” feeling—the sudden, strong urge to urinate that you can’t control. You may also worry that you will not be able to get to a bathroom in time. You may or may not leak urine after feeling this urge.
If you live with OAB, you may also experience:

  • Leaking urine (incontinence): Sometimes people with OAB also have “urgency incontinence.” This means that urine leaks after they feel the sudden urge to go. This isn’t the same as “stress urinary incontinence” or “SUI.” Women with SUI leak urine while sneezing, laughing or doing other physical activity. You can learn more about SUI at our It’s Time to Talk about SUI campaign web pages.

  • Frequent urination: You may also need to go to the bathroom many times during the day. The number of times someone urinates varies from person to person. But many experts agree that going to the bathroom more than eight times in 24 hours is “frequency.”

  • Waking at night to urinate: Having to wake from sleep to go to the bathroom more than once a night is another symptom of OAB.

What causes OAB, and who is at risk?


The bladder and kidneys are part of the urinary tract—the organs in our bodies that produce, store and pass urine. You have two kidneys that produce urine. Then urine is stored in the bladder. The muscles in the lower part of your abdomen hold your bladder in place.
When it isn’t full of urine, the bladder is relaxed. When nerve signals in your brain let you know that your bladder is becoming full, you feel that you need to urinate. Then the bladder muscles squeeze and push urine out through the urethra, the tube that carries urine from your body. The urethra has muscles called sphincters. They help keep the urethra closed so urine doesn’t leak before you’re ready to go to the bathroom.
OAB can happen when the nerve signals between your bladder and brain tell your bladder to empty even when it isn’t full. OAB can also happen when your bladder muscles are too active. Then your bladder muscles “contract” to pass urine before your bladder is full, and that causes a sudden, strong need to urinate. We call this “urgency.”


: As you grow older, the risk for OAB symptoms increases. Both men and women are at risk for OAB. Women who have gone through menopause (also called “change of life”) and men who have had prostate problems seem to be at greater risk for OAB. Also, people withneurological diseases, such as stroke and multiple sclerosis (MS), have a high risk of OAB.
Eating a diet that is rich in “bladder irritating” food and drinks (such as caffeine, alcohol and highly spiced foods) can increase some people’s OAB symptoms.

How is OAB diagnosed?

In order to diagnose OAB, your health care professional will first gather facts about your past and current health problems, the symptoms you’re having and how long you have had them, what medicines you take, and how much liquid you drink during the day.
Your health care professional may also conduct a physical exam to look for something that may be causing your symptoms, including examining your abdomen, as well as the organs in your pelvis and your rectum in women, or prostate and rectum in men.
He or she may collect a sample of your urine to check for infection or blood and, in some cases, conduct other tests, such as a urine culture or ultrasound.
Your health care professional may also ask you to keep a “bladder diary” to learn more about your day-to-day symptoms.

What treatments are available for OAB?

There are several treatments available to help manage OAB. These include:

  • Behavioral therapy: Lifestyle changes—known as “behavioral techniques”—are often the first treatments used to manage OAB. In behavioral therapy, you make some changes in the way you live day-to-day.

This may include changing your diet to see if less caffeine, alcohol, and spicy foods will reduce your symptoms. Your health care professional may ask you to keep a daily “bladder diary” to track your trips to the bathroom. Behavioral changes may include going to the bathroom at scheduled times during the day, and doing “quick flick” Kegel exercises to relax your bladder muscle. Most patients don’t get rid of their symptoms completely with lifestyle changes. But many do have fewer symptoms using this type of treatment.

  • Medications: There are several drugs available to relax the bladder muscle and stop it from contracting at the wrong times. You take some of these medications by mouth. With other drugs, you may use a gel or adhesive patch to deliver the drug through the skin. You may take the drug alone or along with behavioral therapy.

  • Neuromodulation therapy: These treatments deliver harmless electrical impulses to nerves that can change how the nerves work. Specialists use this type of therapy only for some patients when medications or behavioral therapies don’t work, or when patients have serious side effects from medications.

  • Botox injections: Some experts think that injections of botulinum toxin, better known as Botox®, can help patients who don’t respond to other treatments. The injections into the bladder muscle may help keep it from contracting too often.


Urology Care Foundation. The Official Foundation of the American Urological Association.

Ovarian Cyst

What is an ovarian cyst?

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. Ovarian cysts are quite common in women during their childbearing years. A woman can develop one cyst or many cysts. Ovarian cysts can vary in size. In most cases, cysts are harmless and go away on their own. In other cases, they may cause problems and need treatment.

There are different types of ovarian cysts. Most cysts are benign (not cancerous). Rarely, a few cysts may turn out to be malignant (cancerous).

What are the symptoms of ovarian cysts?

Most ovarian cysts are small and do not cause symptoms. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause torsion (twisting) of the ovary that causes pain. Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.

How are ovarian cysts diagnosed?

An ovarian cyst may be found during a routine pelvic exam. If your health care provider finds an enlarged ovary, tests may be recommended to provide more information:

  • Vaginal ultrasound —This procedure uses sound waves to create pictures of the internal organs that can be viewed on a screen. For this test, a slender instrument called a transducer is placed in the vagina. The views created by the sound waves show the shape, size, location, and makeup of the cyst.
  • Laparoscopy—In this type of surgery, a laparoscope—a thin tube with a camera—is inserted into the abdomen to view the pelvic organs. Laparoscopy also can be used to treat cysts.
  • Blood tests — If you are past menopause, in addition to an ultrasound exam, you may be given a test that measures the amount of a substance called CA 125 in your blood. An increased CA 125 level may be a sign of ovarian cancer in women past menopause. In premenopausal women, an increased CA 125 level can be caused by many other conditions besides cancer. Therefore, this test is not a good indicator of ovarian cancer in premenopausal women.

How are ovarian cysts treated?

Birth control pills may be prescribed to treat some types of ovarian cysts. This treatment will not make cysts you already have go away. But it will prevent new cysts from forming.

If your cyst is large or causing symptoms, your health care provider may suggest surgery. The extent and type of surgery that is needed depends on several factors:

  • Size and type of cyst
  • Your age
  • Your symptoms
  • Your desire to have children

Sometimes, a cyst can be removed without having to remove the ovary. This surgery is called cystectomy. In other cases, one or both of the ovaries may have to be removed. Your doctor may not know which procedure is needed until after the surgery begins.


The American Congress of Obstetricians and Gynecologists.

Nutrition During Pregnancy

Nutrition During Pregnancy

How can I plan healthy meals during pregnancy?

Planning healthy meals during pregnancy is not hard. The United States Department of Agriculture has made it easier by creating This web site helps everyone from dieters and children to pregnant women learn how to make healthy food choices at each mealtime.

How does MyPlate work?

With MyPlate, you can get a personalized nutrition and physical activity plan by using the “SuperTracker” program. This program is based on five food groups and shows you the amounts that you need to eat each day from each group during each trimester of pregnancy. The amounts are calculated according to your height, prepregnancy weight, due date, and how much you exercise during the week. The amounts of food are given in standard sizes that most people are familiar with, such as cups and ounces.

What are the five food groups?

1. Grains—Bread, pasta, oatmeal, cereal, and tortillas are all grains.

2. Fruits—Fruits can be fresh, canned, frozen, or dried. Juice that is 100% fruit juice also counts.

3. Vegetables—Vegetables can be raw or cooked, frozen, canned, dried, or 100% vegetable juice.

4. Protein foods—Protein foods include meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds.

5. Dairy—Milk and products made from milk, such as cheese, yogurt, and ice cream, make up the dairy group.

Are oils and fats part of healthy eating?

Although they are not a food group, oils and fats do give you important nutrients. During pregnancy, the fats that you eat provide energy and help build many fetal organs and the placenta. Most of the fats and oils in your diet should come from plant sources. Limit solid fats, such as those from animal sources. Solid fats also can be found in processed foods.

Why are vitamins and minerals important in my diet?

Vitamins and minerals play important roles in all of your body functions. During pregnancy, you need more folic acid and iron than a woman who is not pregnant.

How can I get the extra amounts of vitamins and minerals I need during pregnancy?

Taking a prenatal vitamin supplement can ensure that you are getting these extra amounts. A well-rounded diet should supply all of the other vitamins and minerals you need during pregnancy.

What is folic acid and how much do I need daily?

Folic acid, also known as folate, is a B vitamin that is important for pregnant women. Taking 400 micrograms of folic acid daily for at least 1 month before pregnancy and 600 micrograms of folic acid daily during pregnancy may help prevent major birth defects of the baby’s brain and spine called neural tube defects. It may be hard to get the recommended amount of folic acid from food alone. For this reason, all pregnant women and all women who may become pregnant should take a daily vitamin supplement that contains the right amount of folic acid.

Why is iron important during pregnancy and how much do I need daily?

Iron is used by your body to make a substance in red blood cells that carries oxygen to your organs and tissues. During pregnancy, you need extra iron—about double the amount that a nonpregnant woman needs. This extra iron helps your body make more blood to supply oxygen to your baby. The daily recommended dose of iron during pregnancy is 27 milligrams, which is found in most prenatal vitamin supplements. You also can eat iron-rich foods, including lean red meat, poultry, fish, dried beans and peas, iron-fortified cereals, and prune juice. Iron also can be absorbed more easily if iron-rich foods are eaten with vitamin C-rich foods, such as citrus fruits and tomatoes.

Why is calcium important during pregnancy and how much do I need daily?

Calcium is used to build your baby’s bones and teeth. All women, including pregnant women, aged 19 years and older should get 1,000 milligrams of calcium daily; those aged 14–18 years should get 1,300 milligrams daily. Milk and other dairy products, such as cheese and yogurt, are the best sources of calcium. If you have trouble digesting milk products, you can get calcium from other sources, such as broccoli; dark, leafy greens; sardines; or a calcium supplement.

Why is vitamin D important during pregnancy and how much do I need daily?

Vitamin D works with calcium to help the baby’s bones and teeth develop. It also is essential for healthy skin and eyesight. All women, including those who are pregnant, need 600 international units of vitamin D a day. Good sources are milk fortified with vitamin D and fatty fish such as salmon. Exposure to sunlight also converts a chemical in the skin to vitamin D.

How much weight should I gain during pregnancy?

The amount of weight gain that is recommended depends on your health and your body mass index before you were pregnant. If you were a normal weight before pregnancy, you should gain between 25 pounds and 35 pounds during pregnancy. If you were underweight before pregnancy, you should gain more weight than a woman who was a normal weight before pregnancy. If you were overweight or obese before pregnancy, you should gain less weight.

Can being overweight or obese affect my pregnancy?

Overweight and obese women are at an increased risk of several pregnancy problems. These problems include gestational diabetes, high blood pressure, preeclampsia, preterm birth, and cesarean delivery. Babies of overweight and obese mothers also are at greater risk of certain problems, such as birth defects, macrosomia with possible birth injury, and childhood obesity.

Can caffeine in my diet affect my pregnancy?

Although there have been many studies on whether caffeine increases the risk of miscarriage, the results are unclear. Most experts state that consuming fewer than 200 milligrams of caffeine (one 12-ounce cup of coffee) a day during pregnancy is safe.

What are the benefits of including fish and shellfish in my diet during pregnancy?

Omega-3 fatty acids are a type of fat found naturally in many kinds of fish. They may be important factors in your baby’s brain development both before and after birth. To get the most benefits from omega-3 fatty acids, women should eat at least two servings of fish or shellfish (about 8–12 ounces) per week and while pregnant or breastfeeding.

What should I know about eating fish during pregnancy?

Some types of fish have higher levels of a metal called mercury than others. Mercury has been linked to birth defects. To limit your exposure to mercury, follow a few simple guidelines. Choose fish and shellfish such as shrimp, salmon, catfish, and pollock. Do not eat shark, swordfish, king mackerel, or tilefish. Limit white (albacore) tuna to 6 ounces a week. You also should check advisories about fish caught in local waters.

How can food poisoning affect my pregnancy?

Food poisoning in a pregnant woman can cause serious problems for both her and her baby. Vomiting and diarrhea can cause your body to lose too much water and can disrupt your body’s chemical balance. To prevent food poisoning, follow these general guidelines:

  • Wash food. Rinse all raw produce thoroughly under running tap water before eating, cutting, or cooking.
  • Keep your kitchen clean. Wash your hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.
  • Avoid all raw and undercooked seafood, eggs, and meat. Do not eat sushi made with raw fish (cooked sushi is safe). Food such as beef, pork, or poultry should be cooked to a safe internal temperature.

What is listeriosis and how can it affect my pregnancy?

Listeriosis is a type of food-borne illness caused by bacteria. Pregnant women are 13 times more likely to get listeriosis than the general population. Listeriosis can cause mild, flu-like symptoms such as fever, muscle aches, and diarrhea, but it also may not cause any symptoms. Listeriosis can lead to miscarriage, stillbirth, and premature delivery. Antibiotics can be given to treat the infection and to protect your unborn baby. To help prevent listeriosis, avoid eating the following foods during pregnancy:

  • Unpasteurized milk and foods made with unpasteurized milk
  • Hot dogs, luncheon meats, and cold cuts unless they are heated until steaming hot just before serving
  • Refrigerated pate and meat spreads
  • Refrigerated smoked seafood
  • Raw and undercooked seafood, eggs, and meat


The American Congress of Obstetricians and Gynecologists.


What is Menopause?

Menopause is the point in a woman’s life when regular menstruation has stopped permanently, usually between the ages of 45 and 55. It is a normal consequence of the aging process.

Often called the “change of life,” menopause is the last stage of a gradual biological process in which the ovaries reduce their production of female sex hormones — a process which begins about three to five years before the final menstrual period. This transitional phase is called the climacteric, or perimenopause. Menopause is an individualized experience. Some women have severe symptoms that disrupt their lives, while others have only mild symptoms and notice little difference in their bodies or moods.

What Happens During Menopause?

During the transition period preceding menopause, a woman’s fertility is reduced as the supply of eggs in her ovaries diminishes and ovulation becomes irregular. Also, the production of estrogen and other hormones drops. At menopause, the ovaries stop releasing eggs completely and the production of estrogen decreases significantly.

Estrogen is a hormone that plays many roles in the body. In addition to regulating a woman’s menstrual cycle, it affects the reproductive tract, the urinary tract, the heart and blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles and brain. It is the enormous drop in estrogen levels that causes the most common symptoms during menopause. Some women pass through menopause without any significant problems, although most women experience at least some symptoms.

What are the Symptoms?

Many woman find that the first sign of menopause is irregularity in their menstrual cycle. Symptoms disappear when menopause is complete (which usually lasts between one and five years).

Other symptoms can include:

  • Menstrual periods that occur less often and eventually stop
  • Hot flashes, usually worst during the first 1-2 years
  • Heart pounding or racing
  • Night sweats
  • Skin flushing
  • Sleep problems such as insomnia
  • Anxiety, panic or depressive feelings

How is it Treated?

Treatment for menopause depends on many things, including how bad your symptoms are, your overall health, and your preference. It may include lifestyle changes or hormone therapy.

Hormone Therapy

Hormone therapy may help if you have severe hot flashes, night sweats, mood issues, or vaginal dryness. Hormone therapy is treatment with estrogen and, sometimes, progesterone.

Talk to your doctor about the benefits and risks of hormone therapy. Your doctor should be aware of your entire medical history before prescribing hormone therapy (HT). Learn about options that do not involve taking hormones.


American College of Physicians. Internal Medicine.

Mammography and Breast Self-Awareness

Breast Screening: Mammography and Breast Self-Awareness

What is a screening test?

A screening test is used to find diseases, such as cancer, in people who do not have signs or symptoms. This allows early treatment. The earlier cancer is treated, the greater the chance of survival.

What screening tests are used to screen for breast problems?

Screening for breast problems includes mammography, clinical breast exams, and breast self-awareness.

What is mammography?

Mammography is an X-ray technique used to study the breasts. No dyes have to be injected or swallowed, and no instruments will be put in your body.

Why is mammography done?

Mammography is done for two reasons:

1) as a screening test to regularly check for breast cancer in women who do not have signs or symptoms of the disease, and

2) as a diagnostic test to check lumps or other symptoms that you have found yourself or that have been found by a health care provider.

When should I start having annual mammograms?

Age 40 years is recommended as the starting point in order to find cancer at an early and more treatable stage.

What if the result of my mammography reveals a lump?

Mammography by itself cannot tell whether a lump or other finding is benign (not cancer) or malignant (cancer). If a mammography finding is suspicious for cancer, a biopsy is needed to confirm that cancer is present. In a biopsy, the lump or a small sample of cells from the lump is removed and looked at under a microscope.

How do I prepare for a mammogram?

The day you have a mammogram, do not wear powders, lotions, or deodorants. Most of these products have substances that can be seen on the X-ray and make it hard to read.

What happens during mammography?

To get ready for the test, you will need to completely undress from the waist up and put on a gown. You will be asked to stand or sit in front of the X-ray machine. One of your breasts will be placed between two smooth, flat plastic or glass plates. You will briefly feel firm pressure on your breast. The plates will flatten your breast as much as possible so that the most tissue can be viewed with the least amount of radiation. After the first X-ray, the plates may be removed so that another X-ray can be obtained from one or more other positions. The test then is done on the other breast.

What are the risks of mammography?

You may be concerned about the risk of cancer from the radiation used in mammography. Mammography uses a low level of radiation. The risk of harm from the level of radiation used in mammography is low. Having a yearly screening mammogram does not increase cancer risk.

What is digital mammography?

Digital mammography is a type of mammography technique. It differs from standard mammography only in the way the image is stored. Instead of using film, the image in digital mammography is stored as a digital file on a computer. A computer program allows the image to be enlarged or enhanced or specific areas to be magnified. Digital mammography may be better at detecting cancer in some groups of women, such as those with dense breast tissue, women younger than 50 years, and women who have not gone through menopause.

What is a clinical breast exam?
Your health care provider will examine your breasts during routine checkups. This is called a clinical breast exam. Women aged 29–39 years should have a clinical breast exam every 1–3 years. Women aged 40 years and older should have one every year.

How is a clinical breast exam done?

The exam may be done while you are lying down, sitting up, or both. You may be asked to raise your arms over your head. The breasts are first checked for any changes in size or shape. Your health care provider also looks for puckers, dimples, or redness of the skin. He or she then feels for changes in each breast and under each arm. The nipple may be gently squeezed to check for discharge.

What is breast self-awareness?

Breast self-awareness is an understanding of how your breasts normally look and feel.

How is breast self-awareness different from the traditional breast self-exam?

In the traditional breast self-exam, you use a precise method to examine your breasts on a regular basis, such as once a month. Breast self-awareness does not require you to examine your breasts once a month or with a precise method. Instead, it focuses on having a sense of what is normal for your breasts so that you can tell if there are changes—even small changes—and report them to your health care provider.

Low Cholesterol Diet

Fat is a major energy source for the body. However, it is not the body’s only source of energy. Too much fat in the diet can be harmful. It is especially bad for the circulatory system, because it raises blood cholesterol levels that can contribute to heart attack or stroke. This diet is designed to reduce fat and cholesterol blood levels. The diet goals are:

  • decrease total dietary fat, especially saturated and trans fat, also known as hydrogenated fat
  • decrease dietary cholesterol
  • limit sodium intake
  • increase intake of fiber, especially complex carbohydrates and prebiotic fibers
  • decrease calories, if needed, to reach a healthy body weight

Cholesterol in the Diet

The heart pumps blood through blood vessels called arteries. This blood carries vital oxygen and nutrients needed by tissues and organs throughout the body. The heart itself is supplied with blood vessels called coronary arteries. When cholesterol levels rise above normal limits and stay high, some cholesterol is left behind in the arteries. Over the years, waxy cholesterol plaques build up on the artery walls, and so reduce or block blood flow. When blood flow to the brain is blocked, a stroke occurs. When plaque blocks a coronary artery, angina or a heart attack may be the outcome.

Cholesterol in the body comes from two sources. Most cholesterol is made by the liver from various nutrients and especially from ingested fats. The liver makes just about all the cholesterol the body will ever need. Since all animals can make their own cholesterol, some cholesterol in the human body comes directly from eating animal foods. These foods include meats, poultry, egg yolks, organ meats, whole milk and milk products. This cholesterol is absorbed through the intestines and added to what the liver makes. It is also known that a diet high in saturated fat increases cholesterol production in the body. Therefore, reducing dietary cholesterol and fats helps to keep blood cholesterol levels within a healthy range. Most important of all is to significantly reduce the amount of animal meat, meat products and trans fat in the diet.

Fats in the Diet

Dietary fats can be saturated (bad) or unsaturated (good). An easy way to remember the difference is that saturated fats solidify or remain solid at room temperature. Unsaturated fats do not; they are soft or liquid at room temperature. To reduce blood cholesterol levels, it is especially important to limit saturated fats. Saturated fats are found mainly in meats and dairy products made with whole milk.

Unsaturated fats (polyunsaturated and monounsaturated) are found mostly in plants, and are less likely to raise blood cholesterol levels. In fact, monounsaturated fats such as olive, peanut, or canola oils may even help to lower blood cholesterol. There are a few vegetable fats such as coconut oil, palm oil, and cocoa butter (found in chocolate) that act like saturated fats in the body, so they should be avoided.

In the past, food manufacturers “hydrogenated” vegetable oils to prevent rancidity and increase shelf life. These chemically derived oils are commonly known as

trans fats

. They act in the body exactly as do the saturated animal fats, raising cholesterol and, especially, the bad LDL cholesterol. These trans fats should be avoided. Always read the ingredients label on foods. For example, coconut and palm oils are bad, as are saturated fats, and should be avoided. Mono- and polyunsaturated oils like olive oil, canola and cottonseed are good.

Butter and Spreads

Butter is a highly saturated fat and should be avoided. Most of the stick margarines contain trans fat. These too should be avoided. Tub spreads generally contain mono- or polyunsaturated fats, so these are suitable. However, even some of these may contain trans fats so it is important to read the label and ingredients. The tub spreads, Promise and Smart Balance, can particularly be recommended.

Gut Bacteria and Prebiotic Fibers

The human intestine, especially the colon, is home to huge numbers of bacteria. These bacteria are part of the normal physiology within the gut. There are good and bad bacteria present. When the good colon bacteria are fed healthy prebiotic plant fibers, they thrive and produce many health benefits. The fibers that do this best are the prebiotic fibers present in vegetables such as artichoke, banana, onions, garlic, asparagus, leeks and many others. Eating 25-35 grams of varied fruits and vegetables a day will usually provide lots of these beneficial fibers.

Fiber in the Diet

Fiber in the diet is now known to be increasingly important for cholesterol control and for those with known or suspected heart disease – heart attacks and angina. These are two reasons that 30 grams of fiber a day is important. First, ingested fiber blunts hunger, gives a feeling of fullness and in so doing, helps to control weight. Secondly, certain types of food fiber actually help to reduce cholesterol and triglyceride levels.

There are two main types of fiber – insoluble and soluble. All fiber moves through the gut into the colon unchanged. Within the colon, insoluble fiber, as present in wheat and corn, is not fermented by colon bacteria but rather clings to water and helps provide a bulky stool. Soluble fiber, on the other hand, is fermented by the good colon bacteria and, in so doing, helps to lower cholesterol and especially triglyceride, another nasty fat that is of concern to some heart patients.

The supplement psyllium and also oats are especially important in lowering cholesterol. Both of these fibers, along with the healthy prebiotic fibers, are present in Prebiotin-Heart Health™.

Special Considerations

In the not too distant past, obtaining food and providing shelter and protection for the family were the highest priorities. Before villages developed, finding food in the wild was a difficult task. Now, food is incredibly abundant. Even very poor families can get enough calories. So, the following are some practical considerations to help you reach a heart healthy diet.


Fresh foods purchased at a local market are almost always the best. However, we usually can’t avoid getting some packaged foods. Food labels provide a wealth of information. Read them. You will find:

  • Serving size – Many manufacturers will have an unrealistically low serving size simply so they can artificially lower the amounts listed in the Nutrition Fact portion of the label. Be sure the serving size conforms to what you eat at a sitting.
  • Nutrition Facts – Here is where you get information on calories, cholesterol, fat, fiber and sodium. It is best to avoid foods with an unrealistic low serving size and high fat content.
  • Ingredients – In the very smallest print, you will find all the ingredients in the product. They have to be placed in the order of the highest to lowest amounts within the food. Packaged foods with perhaps 8 or more ingredients, many of which you do not recognize, may be packed with calories and fat in hidden ways. Be wary! An example of how one can be misled on labels is to see that there are 0 grams of trans fat in a product. The FDA allows the manufacturer to say this even when there is 0.5 gm of trans fat per serving. So, you must read the ingredients part of the label.

Packaged and Fast Foods

Packaged foods, fast food restaurants, and the ready availability of sugar and calorie laden liquids are in front of us at all times. To the extent you can, restrict your eating to those foods you and your companion have control over. It may not be as fast as packaged food and fast food restaurants, but the enjoyment of food preparation and taking control of your eating has its own rewards.

Sugar and High Fructose Corn Syrup

Nature never intended us to have so much sugar. Honey, molasses and sweet fruits were natural flavors. Now, enormous amounts of simple table sugars (sucrose) are put into many foods. The body processes these as calories, and the weight and cholesterol may both go up.

As bad as sugar has been, high fructose corn syrup (HFCS) may be worse, as our bodies were never designed to receive such large amounts of fructose, a natural fruit sugar. Again, calories, weight and cholesterol may go up. So, the advice is to limit sugar and HFCS. Together, excess sugar and HFCS may cause weight gain, metabolic syndrome and accompanying atherosclerosis. Read the labels.


The meat industry and farming has been one of the enormously successful businesses in the Western World. Not too many generations ago, meat on the dinner table was a rarity. Then, families in the US raised their own meat on farms. Finally, the meat industry, helped enormously by subsidized corn-based feed, was able to spread cuts of meat in front of us at very affordable prices. The answer for a cholesterol/weight concerned person is to cut back drastically on the frequency and the amount of meat. Remember, marbling in meat is saturated fat, and prepared and processed meats such as bacon, sausage, scrapple, bologna, etc., are very high in saturated fat. So, one should restrict the frequency of meats, where possible, trim away the fat, and select those meats with the lowest amounts of saturated fats.

Fish and Fish Oil

It is now well known that fish, and especially certain types of fish such as salmon, albacore tuna, lake trout, herring and mackerel, contain very healthy types of oils that actually lower cholesterol. The oils in these and other fish are particularly healthy for the heart patient. Fish should be consumed 3-4 times a week, preferably baked or broiled rather than sauteed or deep-fried with extra fats.

Fish oil capsules are a concentrated form of this oil and many cardiologists now recommend them for heart patients.

Whole Grains

Complex carbohydrates come from natural plants and not from processed foods. Sugar and high fructose corn syrup are simple carbohydrates and, to the extent possible, should be restricted. In particular, one should select whole wheat or grain foods. The FDA has strict requirements when this phrase is used. Almost every other term such as multigrain, 7 grain, grain plus, etc., can mean almost anything the manufacturer wants. Read the labels. In particular, avoid foods where the word “enriched” is used. What this means is that the flour has been refined down to white flour (no fiber and few complex carbohydrates) and it has been “enriched” by adding a few vitamins. It is a bit of a deceit.

Sodium and Salt

Excess sodium is quite often linked closely to high cholesterol and heart disease. It certainly is directly related to high blood pressure. Low sodium foods are now widely available. There are many other spices that can be used other than table salt. Again, read the labels and especially the salt/sodium content on the nutrition part of the label.


In restaurants, ask the server how items are prepared. It should be remembered that tubs of butter sit around the kitchen simply because adding butter increases flavor and is used copiously by most chefs. Tell your server you are on a low saturated fat, low butter diet.

Food Groups

Meat, Poultry, Fish, Other Protein



Lean Meats: Select meats with minimal marbling. Trim away excess fat. Generally, a serving size is about the size of a deck of cards. Broil or grill to allow excess fat to drip away. Fatty Meats: Corned beef, mutton, ham, bacon, luncheon meat, short ribs, spare ribs, sausage, hot dogs, scrapple, sandwich spreads, all organ meats
Poultry: Chicken and turkey with skin removed. Self basted poultry; processed poultry products such as turkey franks or bacon; chicken frankfurters, or scrapple
Eggs: Egg whites and low cholesterol egg substitutes. Whole eggs as recommended by a physician or nutritionist. Check with your physician or nutritionist regarding how many whole eggs per week.
Seafood: Fish oils are particularly heart healthy. Those with the highest fish oil include swordfish, mackerel, albacore tuna, salmon, walleye, Pollack, and blue fish. Fish should be eaten at least 3 times per week. Any seafood that is sauteed or deep fried
Cheese: Select low fat cheese such as cottage cheese, pot cheese, mozzarella, ricotta and Swiss. Most cheeses are high in saturated fat. Avoid cream cheese, processed cheese and cheese spreads.
Wild Game: Elk, deer (venison), Bison, pheasant, rabbit, wild duck and squirrel Domestic duck or goose
Beans: Beans of almost any type, peas, lentils; tofu; peanut butter Canned baked beans (sugar and extra calories added). Check labels.
Milk: Skim, non-fat (fluid, powdered, evaporated, condensed), buttermilk, lactose-reduced and sweet Acidophilus made from skim milk Any milk product made with whole or 2% milk, chocolate milk, milkshakes, eggnog, coconut milk
Yogurt: Made from skim or non-fat milk Made from whole milk or custard style
Creamers: Only those containing polyunsaturated oils Any containing coconut or palm oils; whipped, sour, light, heavy, half & half creams

Cereals, Grains, Complex Carbohydrates



Cereals, Dry or Cooked: Oat cereals are particularly heart healthy. Check labels on all cereals for total calories, sugar and sodium. Cereal grains are low in saturated fat. Coconut containing cereals, instant hot cereals, granola
Pasta & Rice: Noodles, spaghetti, macaroni, brown rice (preferred), wild rice Prepared with whole eggs, cream and cheese sauces; canned or boxed noodle and macaroni dishes; canned spaghetti dishes
Baked Goods: Whole grain breads and rolls; low fat or homemade muffins, pancakes, waffles and biscuits using polyunsaturated spread or oil and non-fat milk Butter or cheese rolls and breads; croutons; commercial biscuits, muffins, pancakes, pastries, sweet rolls, donuts, croissants, popovers
Tortillas: Corn, soft flour made with unsaturated oils Soft flour tortillas made with lard, shortening, hydrogenated fats, coconut and palm oils
Crackers/Snacks: Unsalted crackers, pretzels, popcorn prepared with air popper or mono/polyunsaturated oil Salted crackers or snacks; fried snack foods; any snacks or crackers containing saturated fats, coconut or palm oils, hydrogenated or partially hydrogenated fats; cheese crackers or snacks; potato chips; corn chips; tortilla chips; chow mein noodles; commercial buttered popcorn

Fruits and Vegetables



Vegetables: Fresh, frozen or low sodium canned; low sodium tomato and vegetable juices Spaghetti sauce; creamed, breaded or deep-fat fried vegetables; vegetables in sauces
Fruit: Fresh, unsweetened dried fruits; canned or frozen packed in water, own juice or light syrup preferred; all fruit juices (unsweetened preferred) Canned or frozen packed in syrup, sweetened dried fruits, coconut, fried snack chips


Fats in nuts, seeds and avocado are mostly unsaturated and healthy. They are high in vitamins and minerals, but they also contain high calories and should be limited.



Polyunsaturated Fats: Sunflower, safflower, corn, soybean, cottonseed, sesame oilsMonosaturated Fats: Canola, olive, peanut oils Butter, lard, beef tallow, salt pork, bacon, bacon drippings, ham hock, animal fat, shortening, suet, chocolate, cocoa butter, coconut, coconut oil, palm and palm kernel oil, hydrogenated fat
Spreads: Tub type vegetable spreads made with canola or other mono- or poly- unsaturated fats Hardened stick margarine or butter, any spread made with saturated or trans fat
Salad Dressings: Olive oil and balsamic vinaigrette. Check labels for saturated or trans fats. Made with saturated or trans fats, egg yolks
Seeds and Nuts: Unsalted, pumpkin, sesame, sunflower and others not on avoid list Cashews, macadamia, pistachio, Brazil




Desserts: Homemade baked goods made with unsaturated oils or spreads, skim or 1% milk and egg substitute or egg whites; gelatin; angel food cake; ginger snaps; fruit ice, fruit whips, sorbet, sherbet; low-fat frozen desserts; puddings, custards or junkets made with non-fat milk and egg allowances Made with whole milk, cream, butter, chocolate and egg yolk; commercially prepared cakes, pies, cookies, pastries; ice cream; chocolate desserts; frozen cream pies; commercial dessert mixes such as cake and brownie mixes; chocolate; candies made with cream fillings
Beverages: Sparkling or mineral water, seltzer, club soda – unsweetened preferred; coffee; tea; Postum Tonic, commercially or home softened water, instant cocoa mixes, Dutch processed cocoa
Soups & Sauces: Fat-free, low-salt broth, consomme and bouillon; homemade soup skimmed of fat; cream soup and sauces made with non-fat milk and fat allowance Soup made with whole milk or cream; broth containing fat; canned soups; dehydrated soup mixes; bouillon not labeled low-sodium; gravy and sauces made with butter, other animal fat and whole milk
Other: Spices, herbs, pepper, lemon juice, garlic and onion powder, Tobasco, catsup, mustard, vinegar, relishes, jam, jelly, marmalade (unsweetened preferred) Commercially fried foods, pickles, any foods containing items not allowed

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