Neutropenic Diet

Cross section of blood vessel with normal amounts of red blood cells, platelets, and white blood cells in plasma. Below it is another cross section of blood vessel with neutropenia showing normal amounts of red blood cells, platelets, and too few white blBy: Nikki Nies

Neutropenia is the abnormal level of neutrophils.  What are neutrophils you ask? Good question!

Neutrophils are a type of white blood cell that fights off infection that can lead to bacteria and/or fungi issues. The standard screening of neutropenia is adults is  1,700 or less neutrophils per microliter of blood. The count for children varies with age.  However, it’s safe to say that the lower the neutrophil count is, the more likely you’re prone to infectious diseases.

The cause of neutropenia can be due to, but not limited to: cancer, damage to bone marrow, congenital disorders, viral infections, autoimmune disorders that destroy neutrophils and/or bone marrow, overwhelming infections that use neutrophils faster than produced, drugs that destroy neutrophils or damage bone marrow, alcoholism, aplastic anemia, chemotherapy, hepatitis A, B or C, HIV/AIDS, hyperthyroidism, Kostmann’s syndrome, leukemia, lupus, Lyme disease, malaria, myelodysplastic syndrome, myelofibrosis, stem cell or organ transport, radiation therapy, rheumatoid arthritis, salmonella infection, sepsis, syndrome associated neutropenia and/or vitamin deficiencies.

A neutropenic aims to provide one with the necessary foods to protect from harmful bacteria and/or growth of other organisms.  By cooking foods thoroughly (i.e. beef, chicken, eggs) can make sure these organisms are destroyed. Meat should be cooked to “well done” and eggs shouldn’t contain any “runny yolks.”

Characteristics of Neutropenic Diet:

Original Image by Emma Line via Flickr
Original Image by Emma Line via Flickr
  • Opt for instant and/or decaf coffee or tea
  • Opt for individual cans and/or bottles of carbonated beverages
  • Avoid unpasteurized fruit and vegetable juice as these are “hubs” for bacterial growth
  • Avoid breads or cereals that contain raw nuts and/or oats.  Since oats and/or nuts are not exposed to heat, it can lead to bacterial growth
  • Avoid uncooked pasta and making bread with yeast
  • Avoid deli counters, instead opt for vacuum packed meat
  • Avoid yogurt and yogurt products that contain live cultures
  • Make sure all dairy products are pasteurized
  • Avoid raw or fresh foods (i.e. salads, garnishes, herbs, fresh salsa and some fruits) 
  • Thick skinned bananas and/or oranges are permissable

Additionally, be careful while handling food. Make sure to wash your hands before handling foods, to wash all surfaces cutting boards and utensils. While these precautions may seem overly cautious, it’s better to be safe than sorry! Besides, with the colder months upon us, it’ll be much easier to eat ‘warm’ foods!

Photo Credit:Fairview Health Services and Siamca


Nitrates & Nitrites

By: Nikki Nies esphoto_cold_cuts_meat_nitrites-504x334

While nitrates are not harmful in normal amounts, when consumed in excess, like any other food or ingredient, it can have adverse effects.  excess nitrates can be especially harmful for children who tend to eat more nitrate rich foods, leading to a higher risk of leukemia, non-Hodgkin lymphoma, and ovarian, colon, rectal, bladder, stomach, esophageal, pancreatic, and thyroid cancer.

Nitrates are naturally found in vegetables, such as spinach and celery and also synthetically added into foods.  For example, sodium and potassium nitrate are added to cured meats, added to fats to prevent rancidity and to bacteria to prevent further growth.  Also, found naturally in tap water due to nitrogen based fertilizers.  Yet, when nitrates are used as a food additive and/or consumed, the nitrates can quickly turn into nitrites, which when exposed to high heat during cooking can lead to the conversion to nitrosamines.  Bear with me!

Nitrosamines are chemical compounds that are carcinogenic properties.   However, this doesn’t mean you have to give up your leafy greens.  Not all nitrates are the same.  There’s a stark, but good difference between the nitrates from produce and the nitrates from preserved foods.  The nitrates in produce inhibit the conversion to nitrosamines, unlike the nitrates and nitrites in the artificially, synthetically made foods.

Suggested tips to nitrate success:

  • Limit intake of processed foods and cured meats (i.e. hot dogs, sausage and/or cold cuts).
  • Read nutrition fact label of prepackaged foods, watch out for ingredient lists that include nitrates, nitrites and/or nitrosamines compounds
  • Skip the “uncured” and “nitrate free” brands: these products usually contain a high content of nitrates from celery juice
  • When possible, opt for 100% organic products as they’re guaranteed to not have been exposed to nitrogen filled fertilizers
  • If you live in an agricultural region, may want to opt for a home water distiller, which will limit the amount of nitrates in your tap water
  • By eating well balanced meals, you’ll naturally include antioxidant rich foods, which combat the effects of nitrates!

This post is meant to help, not scare you.  Again, naturally grown produce may have nitrates, but do not have the same harmful effect as the nitrates that are synthetically added into prepackaged foods.  Make sure to give yourself plenty of time to read through the ingredient next time you’re grocery shopping! Happy shopping!

Photo Credit: Healthy Child



temp_safetyBy: Nikki Nies

If you’re familiar with the food service industry, the temperature danger zone (TDZ) is an infamous zone you don’t want to find your food in, yet a zone you must be familiar with! Yet, knowledge of the TDZ is not and should not be limited to food service workers and employees, but for all those consuming foods.  Yes, that includes YOU!

The numerical “zone” that’s dangerous is between 5°C and 60°C.  For the folks that use Fahrenheit, that’s equivalent to 40-140°F.  It’s important to be mindful of this range as the TDZ is when it’s easiest for harmful bacteria (i.e. staphylococcus aureus, Salmonella Enteritidis,Escherichia coli O157:H7, and Campylobacter) to grow in food.

To limit bacterial growth, it’s the responsibility of food service handlers to limit time in the TDZ and to monitor the temperature of food on a consistent basis. Cold foods needs to be kept at 5°C or below  and hot foods held at 60°C or above.

Additionally, there is a 4 hour/2 hour rule.  If cold food (i.e. sandwiches, salads or fruit) or hot foods (i.e. meat, pie or lasagna) has been in the TDZ for:


 If the 4 hour/2 hour rule is intended to be used, it must be demonstrated that food is safe by use of temperature logs and frequent testing with a thermometer. Don’t have a thermometer? Get one! It’s one of the most important life saving tools in the kitchen, literally!

Photo Credit: Thermapen


Foodborne Illnesses

infographic-foodborne-disease-640By: Nikki Nies

Sanitation and food safety are two aspects that the food industry and restaurateurs are constantly reminded are important aspects of keeping loyal customers and sanitation boards at bay.  One of the biggest enemies to sanitation and food safety are the development of foodborne illnesses (aka food poisoning, foodborne infection and/or foodborne disease) in a food establishment.  Foodborne illnesses are due to consumption of contaminated food that is raw or undercooked. Annually, 1 in 6 Americans become sick from contaminated foods and beverages.

Foodborne illnesses can be deadly, figuratively and literally to a business, yet, they are preventable.  More than 250 different foodborne illnesses have been found to be due to bacteria, viruses and/or parasites.  With varying causes, symptoms and outcomes, prevention and treatment for foodborne illnesses require equal attention to other aspects of one’s restaurant or food business.

Pathogens cause the most illnesses, hospitalizations and deaths per year. Symptoms include, but are not limited to diarrhea, fever, dehydration, upset stomach, abdominal cramps, nausea and/or vomiting that last from one to seven days.  Some examples include norovirus, listeriosis, salmonella, staph aureus, e. coli, campylobacter spp., -borne-illnesses

The best method to limit exposure to foodborne illnesses is to practice safe food handling, recognize food safety practices and correct others when you see “short cuts.”

Foods Associated with Foodborne Illnesses:

  • Raw fruits and vegetables can become contaminated when they intersect with animal waste when manure is used to fertilize produce in field or unclean water
  • Raw foods of animal origin (i.e. poultry, eggs, meat, unpasteurized milk, raw shellfish)
  • Raw sprouts due to the growing conditions are optimal for growing microbes
  • Unpasteurized fruit juices or ciders if there are pathogens on the fruit used to produce the juice or cider
  • Any food that has come in contact with a foodservice handler that is vomiting and has diarrhea.


There is no “one size fits all” treatment plan for foodborne illnesses, but often include increasing one’s fluid intake and seeking treatment from a primary cary physician (PCP). If there is severe diarrhea, Ceralyte, Pedialyte or Oralyte shoudl be consumed to replace lost electrolytes.  Use  of bismuth subsalicylate (aka Pepto Bismol) can also reduce the duration and severity of symptoms.

Have you personally experienced food poisoning?  What was your individual situation?  Was it due to poor food safety?


July’s National Pickle Month

By: Nikki Niesvariety-of-pickled-produce

I’m sure you know pickles are no longer limited to being served as a garnish to a hamburger or with your fries.  Since the 1960s, the act of pickling has been a time of relishing.  Pun intended.

Pickling’s a creative way to alter food’s taste and texture. With so many ways to pickle, there’s bound to be at least one type you like–vinegar, fermented, fruit, cucumber, beets, bean paste, relishes, kimchi, kraut, etc.  The variety of pickling is dictated by ingredients used and preparation method.

Caution–pickling requires a good amount of salt to inhibit spoilage and and bacteria.  In moderation, one can enjoy a pickle or two.  1 pickle spear=300 mg of sodium. Also, when able opt for dill or lacto fermented variety instead of sweet or bread and butter.  Check out previous post on The Salt Review for a refresher course on the difference between salt and sodium.

Furthermore, to reduce risk of spoiling, it’s recommended to process pickles in boiling water.

To celebrate National Pickle Month, try the Pickled Cucumbers  or Salt Free Dill Pickles recipes for some great flavor without the guilt of high sodium!


Diarrhea 101

By: Nikki Nies

Diarrhea can be caused by a variety of instigators (i.e. parasites or poor water).  It can also be indicative of an underlying disease.  Either way you look at it, when diarrhea is present, it’s worth looking into.

The definition of diarrhea is relative and is individualized to situations.  Although, the determination of diarrhea often includes the talk of frequency and consistency of one’s stools.  Absolute diarrhea is defined as having more bowel movements than normal.  Among healthy individuals, the maximum number of bowel movements is three.

Why are you having more than 3 bowel movements you ask?

Potential Causes:diarrhea

  • Stomach Flu–viral gastroenteritis: will go away in a matter of days
  • eating or drinking products that have bacteria or parasites
  • Certain antibiotics
  • Chemotherapy for cancer
  • Laxatives containing magnesium
  • Celiac Disease
  • Irritable Bowel Syndrome
  • Ulcerative Colitis or Crohn’s Disease
  • Lactose Intolerance
  • Malabsorption syndrome
  • Nerve Disorders that supply the intestines
  • Radiation
  • Gastrectomy

Without proper treatment of diarrhea, it can lead to dehydration, which can then lead to orthostatic hypotension. Electrolytes, such as potassium or sodium, may become lost with water, leading to electrolyte or mineral deficiencies.

Treatment: Oral Rehydration Solutions (ORS) are a mixture of carbohydrate (glucose) and electrolytes (sodium, potassium, chloride, citrate or bicarbonate). The glucose forces the small intestine to quickly absorb the fluid and electrolytes.  Name brands of ORS includes Rehydralyte, Pedialyte or Resol.  Infants with diarrhea should not be given antibiotics, but be seen by their pediatrician to identify underlying cause.  For older children and adults, should drink diluted fruit juices, sports drinks (i.e. Gatorade) and water.

Caffeine and lactose containing products should be limited with diarrhea as it can exacerbate the situation.  If there is no nausea or vomiting, solid foods can be continued to consumed.  It’s suggested to consume rice, bananas, toast, tea, cereal and/or lactose free products to calm one’s stomach.

It’s important to gauge diarrhea’s appearance.  If you’re finding black, blood or pus in stool, stomach pain that isn’t relieved after a bowel movement, diarrhea worsens or does not get better after 2 days, moderate or severe dehydration, diarrhea with a fever greater than 101F and/or you’ve developed diarrhea after visiting a foreign country,  contact your primary care physician (PCP).

Prevention of bacteria can include the regular consumption of probiotic rich foods, such as yogurt.  Also, frequent hand washing and hand gels, before eating and after using the restrooms can be a great way to limit germs.  When traveling outside of the country, especially those underdeveloped, only drink bottled water, do NOT consume dairy products, raw shellfish or raw meat and/or fruits and vegetables without peels.

Diarrhea is inevitable at least in once in a lifetime, yet hopefully you’re confident in the passing of stool.  Pun intended.

Photo Credit: Gena Livings



By: Nikki Nies kefir

Kefir, a fermented milk drink made of fermenting milk with kefir grains,polysacharides and  yeast, impacts the way foods are digested.  While it’s not commonly found in your local Dollar Store, kefir is worth the investment. Cultured milk products have been around for more decades than can be counted, yet asking someone to ask about some of the health benefits of kefir, is not always easy.

Probiotics are found in foods such as yogurt and may be found in some dietary supplements.

Health benefits of kefir:

  • May help treat diarrhea, esp. if antibiotics have been recently used
  • Treat irritable bowel syndrome (IBS)
  • Prevent or treat eczema
  • Prevent or reduce the severity of colds
  • Contains lactobaccilus caucasus, leuconostoc, Acetobacter species, Streptococcus species, Saccharomyces kefir and Torula kefir–which are beneficial bacteria that help with digestive health and prevent the growth of harmful microorganisms
  • Can help facilitate the production of vitamin K and B12 in the gut
  • Through the fermenting process of kefir, it’s lactose free

One cup of kefir provides 8-11 g of protein.  It also provides 10% of the day’s recommended vitamin A content and 25% of the day’s vitamin D. Based on a 2,000 calorie diet, kefir provides 30% of the day’s calcium needs.

While probiotics aren’t a required food item to maintain one’s health, consumption of these microorganisms can aid in digestion and provide protection from harmful bacteria.  While none of the health claims for kefir have not been scientifically proven, how can you not deny the great nutrients! Some have complained that use of kefir can lead to intestinal cramping and/or constipation with initial use. 


Rheumatoid Arthritis (RA)

By: Nikki Nies arthritic_joints

Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that often impacts one’s extremities–hands and feet.  Impacting more than 1.3 million Americans, RA is an autoimmune disease and can last several years without displaying symptoms.  Symptoms can begin in childhood, called juvenile RA.  With progression, it can lead to joint destruction and functional disability.

The joint inflammation of RA can lead to stiffness, pain, swelling and/or stiffness in joints.  Additionally, pain can occur in the tendons, ligaments and/or muscles.

The direct cause of RA is unknown, yet it’s suspected viruses, bacteria and/or fungi may play a contributory role.  There may be some hereditary contributions to the cause, but information on specific genes is not concrete.  While the exact trigger of RA is also unknown, it’s understood when RA does develop, it promotes inflammation in the joints and possibly surrounding areas/organs. Lymphocytes  (i.e. TNF, interleukin-6)are expressed in the inflamed area.

Periods of flare ups and remission is common, with fluctuating levels of pain. Furthermore, fatigue, loss of appetite, fever, muscle aches, low energy and/or stiffness may be exhibited. Joints may become red, tender and/or swollen due to the lining of the tissue becoming inflamed.

Risk factors:

  • Sex: Women are more likely to develop RA than men
  • Age: While it can occur at any age, there’s an increased risk of development between 40-80 years old
  • Family History: If a family member has RA, you may be at increased risk

In the early stages of RA, it can be difficult to diagnose as the pain and inflammation could be due to another underlying cause.  Secondly, there’s no specific physical or blood test that can be used to confirm the diagnosis. However, during a physical exam, a physician may check one’s reflexes, muscle strength and/or your joints for swelling, warmth and redness.

Those with RA have the tendency to have an elevated erythrocyte sedimentation rate (ESR or sed rate), which is indicative of inflammation in the body. Blood tests may look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Complications can include osteoporosis and chronic anemia. There’s no specific cure to RA, yet there are some proactive nutrition recommendations suggested to alleviate pain and inflammation: fruit-grid

  • Simplify meal prep–i.e. purchase precut veggies and fruits
  • Support immune system by consume antioxidant rich food (i.e. carotenoids, vitamin E, selenium and vitamin D)
  • Restrict sodium intake if needed
  • If there’s elevated homocysteine levels or hyperlipidemia present, may need to limit fat intake
  • If malnourished, it’s encouraged to consume a high protein, calorie diet
  • If methotrexate’s used, increase folic acid rich foods or supplements
  • Make sure to stay hydrated regularly with adequate fluids
  • Since olive oil contains oleocanthal, a natural anti-inflammatory agent, it’s recommended as the “go to” oil

While RA can become a debilitating disease, don’t let it stop you from enjoying life to the fullest.  With these nutrition recommendations, inflammation can be alleviated!


Escott-Stump, Sylvia. (2008) Nutrition and diagnosis-related care /Philadelphia : Wolters Kluwer Health/Lippincott Williams & Wilkins,



By: Nikki Nies

Sepsis is a life threatening disease that occurs when chemicals are released into the blood to fight infection, leading to inflammation throughout the body.  Blood clotting decreases the blood flow to limbs and internal organs.  The condition can worsen, to septic shock, with one’s blood pressure significantly worsening and can lead to death.

While sepsis contributes to only 1-2% of hospital visits, it’s degree of seriousness should not be taken lightly.  The most common cause is from bacterial infections.  Those most susceptible to developing sepsis have diabetes;elderly; those with recent invasive medical problems, with immune problems–HIV/AIDS, cancer, drugs; very young babies and/or recently hospitalized. Sepsis can accompany osteomyelitis, the infection of the bone.

Symptoms: what_is_sepsis_figure2_thumb

  • Fever
  • Decreased urination
  • Rapid pulse/breathing
  • Nausea
  • Vomiting
  • Diarrhea
  • Chills

In addition, it is recognized by the appearance of 2 or more of the following: temperature: >38 degrees C or <36C; heart rate >90 beats/min; respiratory rate >20 breaths/min or partial pressure of CO2 in arterial gas <32 mm Hg; white blood cell count >12,000 mg/uL or >10% band forms

Medical Nutrition Therapy (MNT): Management of septic shock includes the ABCDEF system, which stands for Airway, Breathing, Circulation, Drugs, Evaluate and Fix the source of sepsis.   Enteral feeding is the preferred method of feeding over parenteral feeding, with monitoring needed to ensure tolerance with impaired GI motility.   

  • When possible, patient should consume soft diet and liquids of high energy and nutrient value
  • Inclusion of omega 3 fatty acids can help increase plasma eicosapentaeonic acid, improve gas exchange, shorten hospital stay and modify inflammatory cytokine concentrations
  • May need to monitor for signs of malnutrition, as vitamin A, C,D,K, thiamin and folic acid may become depleted
  • Use of branched chain amino acids (BCAA) may become useful for energy since they don’t need to be metabolized to glucose
  • Monitor fluid needs; ensure intake’s excreted properly

While, the above information has been provided with references from the Nutrition and Diagnosis-Related Care in mind, each patient’s case is different and it is recommended one is seen by a RD to ensure proper nutritional needs are met.


Underrated disease keeps killing – World Sepsis Day 2012



By: Nikki Nies

The underlying causes and impact of inflammation is exhaustive.  While I can’t account for every known reason that inflammation occurs, it’s worth noting some of the most common causes of inflammation, in addition to possible treatment options.  Nonetheless, no matter situation that inflammation unfolds, it is part of the body’s way of healing.

Inflammation is the body’s immune system response to a stimulus.  The particular response can be to due to an interaction with bacteria, virus, fungi, effects of chemicals or radiation, external injuries or scrapes, bronchitis, otitis, dermatitis and/or cystitis.

Signs of local acute inflammation: redness, itching, swelling, pain and/or loss of function. 248423-wrist-inflammation

Specifically a loss of function can be to a particular limb that can no longer do it’s proper movement or an altered sense of smell when someone has a cold.  Contrary to popular belief, inflammation is already present in the body once a wound has become infected by bacteria and/or fungi.

When inflammation occurs, inflammatory mediators are released, such as histamine and bradykinin.  These mediators expand blood vessels that have been narrowed and allows increased permeability so more defense cells can enter inflamed area.  Expansion allows an adequate amount of blood to reach the injured tissue, which explains why an inflamed area becomes red and hot.  These hormones also send signals to brain that a specific body part needs to be monitored and somehow treated.


Acute inflammation: rapid onset; signs and symptoms are present from a couple days to a several weeks; i.e. acute bronchitis; infected ingrown nail; sore throat; acute appendicitis; acute sinusitis, etc.; primary mediators: eicosanoids, vasoactive amines; causative agent: bacteria or injury to tissue
Chronic inflammation: can last from several months to years; can result from the failure to eliminate whatever is causing acute inflammation, chronic irritant of ow intensity that persists, an autoimmune response to an antigen; i.e. asthma, tuberculosis, rheumatoid arthritis, Crohn’s disease, ulcerative colitis, and/or chronic hepatitis, etc.

Treatment:Depending on the part of the body inflamed, cause of inflammation and perspective on how things the inflamed area will be treated.  There’s an area of treatments, ranging from natural remedies to prescribed medications and surgery.  Also, the adaption of an anti-inflammatory diet, that includes phytochemicals, has been sworn by many!

A lot of people gravitate to consuming anti inflammatory foods, which is great!  Be sure to check with your physician before you start consuming certain foods in case there may be a reaction that occurs.  Hope this information helped!

Photo Credit: Bikram Yoga Vancouver