Calcium is the most plentiful mineral found in the human body.  About 99 percent of the calcium is stored in the teeth and bones where it supports their structure and function.  Bone undergoes continuous change, with constant resorption and depositing of calcium into new bone.  The remaining 1 % is found in nerve cells, body tissues, blood and other body fluids where it is used in neurotransmitter release and muscle contraction.

Calcium is required for  vascular contraction and vasodilation, muscle function, nerve transmission, intracellular signaling and hormonal balance.  The body uses bone tissue as a reservoir for and source of calcium to maintain constant concentrations of calcium in the blood, muscle and intercellular fluids.

Serum calcium is well regulated and does not fluctuate with changes in dietary intakes.

Calcium, (chemical symbol Ca)  is essential for living organisms, especially in cell physiology, where movement of the calcium ion into and out of the cytoplasm functions as a signal for many cellular processes.

Calcium helps your body with:

Building strong bones and teeth

Clotting blood

Sending and receiving nerve signals

Squeezing and relaxing muscles

Releasing hormones and other chemicals

Keeping a normal heartbeat

Many foods contain calcium but dairy products are the major food source of this nutrient to people in the United States. Milk and dairy products such as yogurt and cheeses contain a form of calcium that the body can absorb easily. Removing the fat in a dairy product does not substantially lower the amount of calcium. Yogurt and most cheeses and milk are excellent sources of calcium and come in low fat or fat-free versions.

Persons allergic to dairy products,  lactose-intolerant  and vegans (those who avoid dairy products) can include other sources of calcium such as:

Green leafy vegetables such as broccoli, collards, kale, mustard greens, turnip greens, Chinese cabbage.

Salmon and sardines canned with their soft bones

Almonds, Brazil nuts, sunflower seeds, and dried beans.

Blackstrap molasses.

Foods with calcium added such as orange juice, soy milk, ready-to-eat cereals, and breads.

Some vegetables such as spinach, chard, and rhubarb have a high calcium content, but may also contain varying amounts of oxalic acid and that binds calcium and reduces its absorption.   The same may affect the absorption of calcium from collard greens and  chicory greens,.  This may also be related to the generation of calcium oxalate.

2010 Dietary Guidelines for Americans notes that “nutrients should come primarily from foods.”

CALCIUM CONTENT IN fOOD

Food                                                     Milligrams               Percent

                                                         (mg) per serving)    (Daily Values)

Yogurt, plain, low fat, 8 ounces                      415                 42

Sardines, w/bones, 3 ounces                           325                33

Cheddar Cheese, 1 1/2  ounces                        307                31

Milk, nonfat, 8 ounces                                      299                30

Milk, 3.25 fat, 8 ounces                                    276                28

Tofu, firm, made w/ ca sulfate, 1/2 cup            253               25

Salmon, pink, canned w/bone, 3 ounces            181                18

Cottage Cheese, 1% fat, 1 cup                           138                 14

Tofu, soft, made w/ Ca sulfate, 1/2 cup            138                 14

Turnip Greens, boiled, 1/2 cup                           99                  10

Ice cream, vanilla, 1/2 cup                                  84                   8

Bread, white, 1 slice                                            73                   7

Tortilla, corn, one-6″ diam, ready-to-bake            46                   5

Tortilla, flour, one-6″ diam, ready to bake            32                    3

Bread, WholeWheat, 1 slice                                  30                    3

Broccoli, raw, 1/2 cup                                           21                   2

Vitamin D is needed to absorb calcium.   Milk is fortified with vitamin D for this reason.  Vitamin D is converted to a hormone in the body, which then induces the synthesis of intestinal proteins responsible for calcium absorption.

Recommended daily calcium intake for adults ranges from 1000 to 1300 mg.

Recommended Dietary Allowance (RDA):

AGE                        CALCIUM (mg/day)

0-6 months                                  200

7-12 months                                 260

1-3 years                                      700

4-8 years                                     1000

9-18 years                                   1300

19-50 years                                 1000

51-70 years (male)                      1000

51-70 years (female)                   1200

71+ years                                    1200

Pregnancy and Breast-feeding

14 – 18 years   -  -    1300 mg/day

19 – 50 years   -  -    1000 mg/day

Calcium Deficiency-  Inadequate intakes of dietary calcium from food and supplements produce no obvious symptoms in the short term.  Circulating blood levels of calcium are tightly regulated.  Hypocalcemia results primarily from medical problems or treatments such as surgery and diuretics.  Symptoms of hypocalcaemia include  numbness and tingling in the fingers, muscle cramps, convulsions, lethargy, poor appetite, and abnormal heart rhythms.  Signs of more severe deficiency can be mental confusion  and/or skeletal malformation, and in infants, delayed development.  If untreated, calcium deficiency can lead to death.

Menopause leads to bone loss because decreases in estrogen production both increase bone resorption and decrease calcium absorption.  Hormone replacement with estrogen and progesterone helps increase calcium levels and prevent osteoporosis and fractures.

Long-term calcium deficiency can lead to rickets and poor blood clotting and osteoporosis in older women.  A lifelong deficit can affect bone and tooth formation.

Getting too much calcium from foods is rare.  Excess intakes are more likely to be caused by the use of calcium supplements.

Dietary Supplements - The two main forms of calcium in supplements are carbonate and citrate.  Calcium carbonate is more commonly available and is both inexpensive and convenient.  Due to its dependence on stomach acid for absorption, calcium carbonate is absorbed most efficiently when taken with food whereas calcium citrate is absorbed equally well when taken with or without food.  Calcium carbonate is found in some over-the-counter antacid products, such as Tums and Rolaids.  Depending on its strength, each chewable pill or soft chew provides 200 to 400 mg of elemental calcium.  As noted above, calcium carbonate is an acceptable form of supplemental calcium, especially for individuals who have normal levels of stomach acid.

The percent of calcium absorbed decreases as the amount of calcium in the supplement increases.   Absorption is highest in doses less than 500 mg.  So, for example, one who takes 1,000 mg/day of calcium from supplements might split the dose and take 500 mg at two times during the day.

Calcium supplements have the potential to interact with several types of medications.

Calcium can decrease absorption of biphosphonates ( to treat osteoporosis), fluoroquinolone and tetracycline classes of antibotics, levothyroxine, phenytoin (an anticonvulsant) and tiludronate disodium (to treat Paget’s disease).  Thiazide-type diuretics can interact with calcium carbonate and vitamin D supplements, increasing hypocalcaemia and hypercalciuria.  Both aluminum and magnesium containing antacids increase urinary calcium excretion. Mineral oil and stimulant laxatives decrease calcium absorption.  Glucocorticoids, such as prednisone can cause calcium depletion and eventually osteoporosis when used for months.

High calcium intakes or high calcium absorption or lower calcium intakes or absorption  have been discussed as contributing to various medical conditions.  At this time there seems to be mixed conclusions from the scientific community as to the role of increased calcium on such things as cancer, kidney stones, cardiovascular disease, blood pressure and hypertension, weight management, etc.  Continued studies are needed.

*  National Instutite of Health

* U.S. National Library of Medicine, MedicinePlus

* Wikipedia

Setting the dishes and flatware at each position or place setting depends on the food and/or menu to be served, the less-formal or more formal atmosphere desired, the number of persons to be served and size of the table and the size of the room, the dishes and flatware available, etc.  However there are some general suggestions for “setting the table”.

Table covering – one may use a tablecloth – linen, lace, or plastic or individual place mats.

Placemats should be placed flush  with the table edge or ½ – 1 inch from the table edge.

Napkins may be folded – rectangular, square or a “fancy” fold of your choice.   Often the napkin is laid to the left of the place setting – left of the forks.  If space is a concern, then the napkin may be placed under the forks or in the center of the plate.  (If using place mats, the napkin may be placed on the mat, partly on the mat and partly on the table or entirely on the table.)  Place the napkin so that the lower edge is at the same distance from the edge of the table as the plate and flatware. Put the open corner of the napkin at either the lower right or lower left – traditionally the open end is at the lower right.  This allows the guest to pick up the napkin with the left hand and it can be easily unfolded with the right hand.

Table Decorations  can be used, such as a floral arrangement or other attractive item.  Keep centerpieces low, so that persons can see those on the other side of the table.  There is certainly nothing wrong with omitting centerpieces and using the main entrée or other food in the center of the table.

Arranging the flatware should be done to make a balanced appearance, for convenience of eating and with common sense – using the flatware necessary for the menu and not adding additional pieces ( if soup will not be served, omit the soup spoon, etc.)   It is easiest to place all the flatware to be used for the meal at each place setting when setting the table.  Lay the flatware in the order of use – from the outside of the place setting to the plate.  Lay pieces close together but not touching.  Place all pieces so that the bottoms form a straight line at the lower edge of the place setting and about  a  ½ – 1 inch from the table edge.  (If mats are used and the mat is placed one inch from the table edge, then place the flatware at the edge of the mat.  If mat is placed at the table edge, then place flatware ½ inch -1 inch from the edge of the mat.)

Pieces are places at the same position for all place settings.  Place the plates in the center of the place setting or if adding the plates later, leave space for the plate in the center of the setting.

Lay the dinner knife to the right of the plate with the cutting edge directed toward the plate.   Lay spoons with bowls facing up to the right of the knife.    Lay forks with tines facing up to the left of the plate.  Lay the salad fork nearest the plate and the dinner fork to the left of it if you plan to eat the salad with the main course or after it.  (Lay the dinner fork nearest the plate and the salad fork to the left of it, if you plan to serve the salad before the main course.  Since in most homes the salad is eaten with the main course and thus placed nearest the plate.)   It is not necessary to provide a salad fork when the salad is ate with the main course.  However you may like to lay the additional fork nearest the plate for use as the dessert fork, if your dessert requires a fork.

Placing beverages -  Place a water glass at the tip of the knife or a little to the right or left of the knife depending on the amount of space at the place setting.  Additional glasses, for milk or iced tea are placed to the right and in front of the water glass.  No more than three glasses should be placed at a setting.  A saucer or small plate may be placed under the glasses.  If coffee is served with the meal, a cup and saucer may be placed to the right of the spoon and the lower edge of the saucer in line with the lower edge of the plate.

There is more – what to do with bread & butter plates, soup bowls, salad bowls or plates, dessert plates.  What is the American pattern of service or the family pattern?   How to set a buffet?  If interested, we’ll cover this later, but perhaps the above will help get you started with confidence and a pleasing table.

For those of you who do want to partake of the regular food served yet retain some control, I have a few suggestions.

1.  Avoid the obvious – sugar, rich desserts made with lots of sugar and that have sugary glazes and sauces, icings on cakes and cookies, jam, jellies, candy, foods with much added sugar such as candied sweet potatoes and sweetened cranberries, regular soda and punches, and regular gelatin, stacks of pancakes and regular pancake syrup and honey.

2.  Take small servings of carbohydrate (starch) rich foods such as potatoes, bread, biscuits, gravies, sauces, thickened vegetables and casseroles and combined food.

3.  Okay are plain meats- beef, chicken, lamb, turkey, ham, pork, fish, etc.  Just be careful with the gravies and sauces.

Plain vegetables, cooked or fresh such as asparagus, broccoli, cauliflower, string beans, green peas, etc.  Relish trays or salads of fresh vegetables such as lettuce, celery, tomatoes, baby carrots, broccoli, and cauliflower are fine.

Fresh fruit such as apples, berries, grapes, grapefruit, oranges, and pears are good.

Do enjoy regular portions of plain meat, vegetables and fruit.  Just skip the gravies and sauces.  If you choose some of the sugary and high carbohydrate foods,  just take a small portion.  Enjoy the meal.

If you are the host and/or hostess you likely will have one or more diabetic guests.  Have available some plain food for these persons.  Plain sliced meat and plain vegetables and fresh veggies and a fresh fruit plate.  Do not label these foods for diabetics, but rather present them as foods for those who do not like the gooey, mixed dishes.  This is the sign of a thoughtful host or hostess.  Some diabetics do not like to mention that they are diabetic.  So respect that and do not mention the word diabetic or weight loss duing the entire meal.

Food is to be enjoyed!

Holiday dinners are to be enjoyed!

Some people are almost advocating that it should be an illegal substance.  I become completely angered at such foolish talk.  I believe that sugar is a fine food and an important  part of our daily food supply.

In all fairness I must qualify all comments with the thought that all foods should be consumed in moderation and for those individuals that are diabetic, since we do not know if sugar contributes to or causes diabetes and / or elevated blood sugars, it is possibly very wise for diabetic persons to not use additional sugar.  ( I say contributes or causes, because – remember we used to say that eggs and butter caused high cholesterol levels.)

Sugar, cane sugar or beet sugar, both are chemically the same, has been an important part of our food supply.  Sugar has made many foods much more palatable and enjoyable to eat, which has resulted in persons eating a larger variety of foods and consuming more vitamins and minerals.

Sugar has many additional attributes.  It is and has been for years, important in food preservation.  Curing meats with a dry mixture of salt, sugar and spices or smoking meat, which is usually rubbed with salt, sugar and spices and then smoked or using a brine -a solution of water, salt, sugar and  spices.  All methods basically inhibit the growth of bacteria to make the meat safe to eat.  In so doing the methods also add flavor and moisture and tenderize the meat.  Sugar is an important part of these processes.

Pickling is a method of  preserving vegetables and fruits.  Pickling is adding the food to a vinegar solution at room temperature and holding for several days.  The vinegar prevents bacteria growth.  Sugar is important in pickling to balance  the flavor of the vinegar and more importantly to strengthen the cell structure of the vegetables and fruits, making them more firm.  Otherwise the vegetables and fruits may end up as “mush”.

Sugar is also important in  canning and freezing of vegetables and fruits.  Through osmosis, sugar enters the cells of the food items and replaces some of the water but prevents the remaining water  from leaving the cells and thus maintains the shape and size of the cell walls and of the vegetable or fruit.  The sugar also helps  the food item to retain its color.

Sugar is a natural preservative and prevents spoilage in jellies and jams and delays spoilage in fruits and other foods it is in.

Sugar cookery is very interesting and explains additional characteristics of sugar.  Boiling sugar solutions may be varied so either crystalline (like fondant and fudge) or non crystalline candies (like caramels -which are chewy- and brittles -which are hard- are formed.  Caramelizaion  occurs  when sugar is heated to a temperature above its melting point.

Caramelization of meat and vegetables occurs in sautéing when the food is cooked at a high temperature and the sugars and starches brown the food and add desired flavor.

Adding sugar to tomato and vinegar mixtures, such as barbecue sauces and salad dressings, balances the strong acid taste and enhances the flavor.

Sugar glazes on vegetables, fruits, meats and over baked goods adds flavor and retains moisture.

Sugar is a tenderizer as it weakens the gluten structure in flours and creates a finer and more tender texture in baked products.

Sugar helps as a creaming agent incorporating air with the fat or shortening in cake batter and other mixtures as the fat  breaks the gluten strands and tenderizes the product.

Sugar helps in maintaining structure in beaten egg whites.

Sugar is essential in precipitating the pectin to form a gel in making jellies and jams.

Perhaps before we start restricting and condemning the use of sugar, we may like to think about the palatability of our food, the many ways sugar helps in food preservation,  it’s many means of  creating a  variety of desired tastes, and the invaluable role it has in baked goods, desserts and candy making.

Vitamin E is the collective name for a group of fat-soluble compounds with distinctive antioxidant activities.  Naturally occurring, vitamin E exists in eight forms -(alpha-, beta-, gamma- and delta-tocopherol and alpha-, beta-, gamma-,and delta-tocotrienol.

The varying forms have varying levels of biological activity.

Gamma-tocopherol is the most common form in the American diet, found in corn oil, sunflower oil and safflower oil.  Alpha- tocopherol is the second most common, found in wheat germ oil, sunflower & salflower oils, and is the most biologically active form and the form recognized to meet human requirements.

Serum concentrations of vitamin E (alpha-tocepherol) depend on the liver, which takes up the nutrient after the various forms are absorbed from the small intestine. The liver metabolizes and excretes the other vitamin E forms. The liver returns only alpha-tocopherol.  (Thus there is less of the other forms of vitamin E in the blood and cells and therefore there has been less research of the other forms.)

Vitamin E has been proposed for the prevention or treatment of numerous health conditions, often based on its antioxidant properties.

Antioxidants protect cells from the damaging effects of free radicals, which are molecules that contain an unshared electron.  Free radicals damage cells. Unshared electrons are highly energetic and react rapidly with oxygen to form reactive oxygen species (ROS).  The body forms ROS when it converts food to energy and antioxidants might protect cells from damaging effects of ROSs.  (Vitamin E is a fat-soluble antioxidant that stops the production of ROS formed when fat undergoes oxidation. )  The body is also exposed to free radicals from air pollution and ultraviolet radiation from the sun.

The antioxidant function is considered to be the most important function of vitamin E and the one it is best known for.  However the importance of the antioxidant properties of this molecule at the concentrations present in the body are not clear and it is possible that the reason it is required in the diet is unrelated to its ability to act as an antioxidant.

Other functions of vitamin E are: a regulatory effect on enzymatic activities, effect on gene expression, effect on the connective tissue growth factor, repair of the wounds and regeneration of the extra cellular tissue lost or damaged during atherosclerosis, a role in neurological functions, and inhibition of platelet aggregation. It is a signaling molecule, may protect neurons from damage and may help in cholesterol reduction.

Vitamin E is also involved in immune function, cell signaling  (the transfer of information from one cell to another or across different structures inside a cell), and regulation of  metabolic processes.  Vitamin E inhibits an enzyme involved in cell proliferation and differentiation in smooth muscle cells and platelets. It increases the expression of two enzymes that dilates blood vessels and inhibits platelet aggregation.

Vitamin E is found naturally in:

Wheat germ, sunflower oil, safflower oil

Nuts and nut oils, like almonds and hazelnuts

Green leafy vegetables like lettuce, spinach, turnip, beet, collard and dandelion greens

Tomato products

Pumpkin

Sweet potato

Mangoes

Asparagus

Broccoli

Eggs

Fortified cereals

Fruit,  meat, nuts, vegetable oils – corn, cottonseed,  soybean, olive oil,

Wheat germ

Whole grains.

(Cooking and storage may destroy some of the Vitamin E.)

Most individuals in the U.S. are believed to  obtain sufficient vitamin E from  dietary sources.

Vitamin E deficiency is rare.  It may occur in people with diminished fat absorption in the intestine, The digestive track requires fat to absorb Vitamin E and  people with fat-metabolism disorders are more likely to become deficient.  Thus it can be found in  Chrohn’s disease, cystic fibrosis, malnutrition, very-low-fat diets, after surgery and in infants taking unfortified formulas. Supplementation for deficiency should be under the care of a physician and nutritionist.

The recommended dietary allowance (RDA)  obtained through food consumption is considered to be safe and beneficial. Recommended dietary allowances (RDSs) for Vitamin E are provided in alpha-tocopherol equivalents (ATEs) to account for  the different biological activities of the various forms  of Vitamin E., as well as in international units (IU) which food and supplement labels often use.

Conversion:  one milligram of an ATE = 1.5 IU.

The RDA for adults older that 14 years is 15 milligrams (or 22.5 IU).

Pregnant women, any age, it is 15 milligrams ( or 22.5 IU)  and for breastfeeding women of any age it is 19 milligrams ( or 28.5 IU.)

To convert from mg to IU:   1 mg = 1.5 IU of natural form or 2.22 of the synthetic form

To convert from IU to mg:  1 IU = .67 mg or the natural form and .45 mg of the synthetic form.

Research has not found any adverse effects from consuming Vitamin E  in food.

For adults 18+ years, there are tolerable upper limits of dosing for supplementary  alpha-tocopherol recommended by the U.S. Institute of Medicine which is 1000 milligrams daily (equivalent to 1,500 IU).

The Upper Limits apply to all forms of supplemental alpha-tocopherol. Doses of up to 1000 mg/day (1500 IU) of the natural form or 1,100 IU /day of the synthetic form in adults appear to be safe.

Vitamin E can  be obtained as a supplement in natural or synthetic form.  Natural forms are usually labeled “d” and synthetic forms labeled “dl”

Supplements of vitamin E usually provide only alpha-tocopherol, although “mixed” products contain other tocopherols.  Naturally occuring alpha-tocopherol exists in one sterosometric form.  In contrast, synthetically produced alpha-tocopherol contains equal  amounts of its 8 steroisomers.

The synthetic vitamin E is only half as active as the same amount of the natural form.

Many claims have been made about Vitamin E’s potential to promote health and prevent and treat disease.  The mechanisms by which Vitamin E might do this include its function as an antioxidant and its roles in anti-inflammatory processes, inhibition of platelet aggregation and immune enhancement.   Current evidence, however does not indicate any positive effects for treatment in such medical conditions.  Results often show no effect or a negative effect or are controversial.    There are many promotions suggesting help in several conditions such as  heart, cancer and aging.    These are of interest with the following considerations.

-Coronary heart disease – Evidence that Vitamin E could help prevent or delay coronary heart disease (CHD) comes from several sources – studies have found that vitamin E inhibits oxidation of low-density lipoprotein (LDL) cholesterol and it may help prevent the formation of blood clots that could lead to a heart attack. To date, there has been no evidence that vitamin E prevents or helps in the treatment of cardiovascular disease.

Cancer – Vitamin E might protect the cells from the damaging effects of free radicals. It may also block the formation of carcinogenic nitrosamines, formed in the stomach  from nitrites in foods and protect against cancer by enhancing immune function . Unfortunately human trials and research that have attempted to associate Vitamin E intake have found that Vitamin E is not beneficial.  Evidence  is insufficient to support taking Vitamin E to prevent cancer.

Cognitive  decline – Most research results do not support the use of Vitamin E supplements to maintain cognitive performance or slow its normal decline with normal aging.

Also often mentioned as potential  conditions in which Vitamin E may help are: acne, air pollution protection, allergies, anti-aging, athletic performance, childhood growth, heart failure, diabetic foot ulcers, eye disorders, hair loss, hypertension, skin aging,  etc.   These conditions are very serious and should be evaluated by a physician.

More research must be done to support the use of Vitamin E supplements to aid in treatment or to slow or prevent disease.  There is a lack of clearly proven medical uses of Vitamin E supplementation beyond the recommended daily allowance. There is ongoing research in many diseases, especially cancer and heart disease.

Concerns, however, have been raised about the safety of vitamin E supplementation, especially in high doses.  High doses of supplements have been found to cause hemorrhage and interrupt blood coagulation in animals and clinical trials have found an increased risk of hemorrhagic stroke in participants and possible increased bleeding in patients taking blood-thinning agents.  Some evidence suggests that use of regular high supplementation may increase the risk of death from all causes by a small amount.

Interaction with medications – Vitamin E can inhibit platelet aggregation and antagonize vitamin K-dependent clotting factors. Taking Vitamin E with other antioxidants, such as vitamin C, selenium, and beta-carotene has slowed the rise of high-density lipoprotein (HDL) cholesterol levels.

Oncologists usually advise against the use of antioxidant supplements during cancer chemotherapy or radiotherapy because they might reduce the effectiveness of these therapies by inhibiting cellular damage in cancerous cells.

Some evidence suggests that long-term use of daily supplementation with 400 IU or greater daily may have adverse health effects.  Although controversial, long-term supplementation should be approached cautiously until there is further evidence. Skin  reaction or allergy has been reported with topical vitamin E preparations, such as ointments or vitamin E-containing deodorants.

For short periods of time, vitamin E supplementation is generally considered safe at doses up to the recommended tolerable upper intake level. Chronic use of vitamin E should be used cautiously and high-dose vitamin E should be avoided.*

*Reference sources: Mayo Clinic, National Institute of Health, and Wikipedia.

Cheese is a food made by separating milk solids from whey by curdling or coagulation.

This is done by adding bacteria or the enzyme, rennet, into the  milk.  Curds are then formed  and they are drained, processed and cured or aged.  The many different methods used in curdling, temperatures, ingredients result in the many kinds of cheeses produced.

Ripening is the process of changing curds into cheese by adding bacteria or molds.

Classifications of Cheese:

1. Very hard (for grating)

a.  ripened by bacteria – Parmesan, Romano, sapsago

2.  Hard

a.  Ripened by bacteria, without eyes – Cheddar, Caciocavallo

b. Ripened by bacteria with eyes – Swiss, Gruyere

3.  Semisoft

a.  Ripened mostly by bacteria – brick and Muenster

b.  Ripened by bacteria and surface microorganisms – Limburger, Port du Salut,

Liederkranz

c.  Ripened by blue mold in interior – Roquefort, Danish blue, Gorgonzola, Stilon

d.  Ripened by white mold – Nuworld.

4.  Soft

a.  Ripened – Camembert, Bel Paese, Brie

b.  Unripened – cottage, cream, Neufehatel, Ricotta, Mysost, Primost

Hard cheeses are cured cheeses with a firm texture and varying degrees of mildness or sharpness, depending on the age.*

Hard grating cheeses have a grainy texture.  Best know is Parmesan. Romano is a bit stronger than Parmesan.

Cheddar ranges in flavor from mild to sharp and in color from light yellow to deep yellow.  Colby and Monterey Jack are similar to mild cheddar.  Swiss cheese is made in many countries, although originally made in Switzerland is a firm rubbery cheese.  The holes are formed by gases during ripening.

Gruyere is similar but with smaller holes and a bit sharper.  Edam and Gouda have the yellow and red wax rinds.   Provolone is an Italian cheese, which becomes sharper as it ages.

Blue-veined cheese get their flavor and appearance from the blue or green mold in their interior. The most famous is Roquefort.  Stilton is also well known is mellower and firmer than Roquefort.  Also in this category is gorgonzola and Cabrales.

Soft-ripened cheeses  ripen from the outside-toward the center.  At first they are firm then they become softer and when completely ripe may even be runny.

There are two types:

a  mold-ripened (Brie and Camembert) and

b  washed-rind or bacteria-ripened. (Limburger, Liederkranz)

Semisoft Cheeses  are a large group of cheeses that are more bland when young and develop more flavor as they get older.  Examples are brick and Muenster and Bel Paese.

Unripened Cheeses – are soft, white and freshly made – such as cottage, cream ricotta, mozzarella and feta.

The above cheeses are  referred to as natural cheeses.  Natural Cheese is made by curdling the milk and ripening the curds.

Processed Cheeses

- are made by using one or more natural cheeses and heating and blending with emulsifiers and other ingredients and pouring the mixture into molds to solidify.  The result will be a uniform product that will not age or ripen.  Processed cheese is mild in flavor, melts easily, and keeps very well.  In the United States it is usually referred to as American Cheese although some people mean Cheddar, when they refer to American Cheese.  In the United States most process cheese is made from cheddar cheese.*

*  Gisslen, “Professional Cooking”, 6th edition, John Wiley & Sons, 2007

There are several forms of vitamin D.  The two major forms are vitamin D3 or cholecalciferol and D2 or ergocalciferol.  They are known collectively as calciferol.

Vitamin D3 is produced by ultraviolet irradiation (UV) of its precursor 7-dehydrocholesterol.  This molecule occurs naturally in the skin of animals and in milk.  Vitamin D3 can be made by exposure of the skin to UV, or by exposing milk directly to UV (a commercial method).  Vitamin D2 is a derivative of ergosterol, a membrane sterol named for the ergot fungus, which is produced by some organisms of phytoplankton, invertebrates, and fungi.  The vitamin D2 is produced in these organisms from ergosterol in response to UV irradiation. *

Most people get some of their vitamin D through exposure to sunlight.  Ultraviolet (UV) B radiation with a wavelength of 290-320 nanometers penetrates uncovered skin and converts cutaneous 7-dehydrocholesterol to predicament D3, which then becomes vitamin D3.  The season, time of day, cloud cover, smog and sunscreen are factors that affect the UV radiation exposure and vitamin D synthesis.

Ten-15 minutes of sunshine, three times a week is usually considered enough to produce the body’s requirement of vitamin D  The sun needs to shine on the skin of your face, arms, back or legs (without sunscreen).  (Because exposure to sunlight is a risk for skin cancer, you should use sunscreen after a few minutes in the sun.   Skin exposed to sunshine indoors through a window will not produce vitamin D.  Cloudy days and shade reduce amount of vitamin D the skin makes.  **

Moderate use of commercial tanning beds that emit 2% – 6% UVB radiation also aid in vitamin D synthesis. (However it is wise to limit the exposure of skin to sunlight from tanning beds as UV radiation  is a carcinogen responsible for skin cancer and death.

Vitamin D helps the body absorb calcium in the intestine and maintains adequate serum calcium and phosphate concentrations to enable normal mineralization of bone.  Without sufficient vitamin D, bones can become thin, brittle, or misshapen.  Vitamin D  prevents rickets in children and osteomalacia in adults.  Together with calcium, vitamin D also helps protect older adults from osteoporosis.  Vitamin D also helps in the modulation of cell growth, neuromuscular and immune function, and reduction of inflammation.

Serum concentration  is the best indicator of vitamin D.  It reflects the vitamin D produced from sunlight and that obtained from food and supplements.  Levels > 50 nmol/L is the serum level that covers the needs of  most of the population and is considered adequate for bone and overall health in healthy individuals.

The Food and Nutrition Board established a Recommended Dietary Allowance for vitamin D representing a daily intake that is sufficient to maintain bone health and normal calcium metabolism in healthy people.  RDAs for vitamin D are listed in both International Units (IU) and micrograms (mcg), the biological activity of 40 IU is equal to 1 mcg.  Even though sunlight may be a major source of vitamin D, the vitamin D RDAs are set on the basis of minimal sun exposure.

Recommended Dietary Allowances (RDAs) for Vitamin D

Age 0-12 months -  400 IU/day  (10 mcg)

Age 1-70 years     -  600 IU/day  (15 mcg)

Age 71+  years     -  800 IU/day  (20 mcg)

Pregnant/Lactating- 600 IU/day  (15 mcg)

Dietary sources of vitamin D – Very few foods contain vitamin D.  Some fatty fish such as salmon, tuna, mackerel and fish liver oils are the best sources.  Small amounts of vitamin D are found in beef liver, cheese and egg yolk.  Vitamin D in these foods is primarily in the form of vitamin D3 and its metabolite 25(OH)D3.  Some mushrooms provide vitamin D2.  Fortified foods provide most of the vitamin D in the American diet.  Most U.S. milk is voluntarily fortified with 100 IU/cup. (In Canada milk is fortified, by law, with 35-40 IU/100mL as is margarine at > 530 IU/100 g.)   The milk fortification program was implemented in the 1930’s  to combat rickets, which was then a huge health problem. Other dairy products made from milk, such as cheese and ice cream are usually not fortified.  Ready-to-eat cereals often contain added vitamin D as do some brands of orange juice, yogurt, margarine, etc.   Both the United States and Canada mandate the fortification of infant formula with vitamin D: 40-100 IU/100 kcal in the U.S. and 40-80 IU/100 kcal in Canada.

Selected food Sources of Vitamin D

In supplements and fortified foods, vitamin D is manufactured  by the UV irradiation of ergosterol in yeast, and vitamin D3 is manufactured by the irradiation of 7-dehydrocholesterol from lanolin and the chemical conversion of Cholesterol.   The two forms have traditionally been regarded as equivalent based on their ability to cure rickets and, indeed, most steps involved in the metabolism  and actions of vitamin D2 and vitamin D3 are identical.  Both forms, in foods and from the sun, effectively raise serum levels.**

Vitamin D Deficiency

Nutrient deficiencies are usually the result of dietary inadequacy, impaired absorption and use, increased requirement, or increased excretion.  Deficiency can occur when intake is lower than recommended levels over time, exposure to sunlight is limited, the kidneys cannot convert 25(OH)D to its active form, or absorption of vitamin D from the digestive tract is inadequate.  Vitamin D-deficient diets are associated with milk allergy, lactose intolerance, ovo-vegetarianism, and veganism.

Rickets and osteomalacia are the classical vitamin D deficiency diseases.  In children, vitamin D deficiency causes rickets, a disease characterized by a failure of bone tissue to properly mineralize, resulting in soft bones and skeletal deformities.  In adults, vitamin D deficiency can lead to osteomalacia, resulting in weak bones.

Obtaining sufficient vitamin D from natural food sources alone is difficult.  For many people, consuming vitamin D-fortified foods and being exposed to some sunlight are essential for maintaining a healthy vitamin D status.  In some groups supplements might be required to meet the daily need for vitamin D. Older adults are at increased risk of developing vitamin D insufficiency in part because, as they age, skin cannot synthesize vitamin D as efficiently, they are likely to spend more time indoors and they may have inadequate intake of the vitamin.

People with dark skin

Greater amounts of the pigment melanin in the epidermal layer result in darker skin and reduce the skin’s ability to produce vitamin D from sunlight.  Various reports consistently show lower serum 25(OH)D levels in persons with darker skin compared with those of lighter skin.  However it is not clear that lower levels of serum 25(OH)D for persons with dark skin have significant health consequences.   Those of African American ancestry, for example, have reduced rates of fracture and osteoporosis compared with Caucasians. **

People with fat malabsorption-

As a fat soluble vitamin, vitamin D requires some dietary fat in the intestine for absorption.  Individuals with a reduced ability to absorb dietary fat might require vitamin D supplements.  Fat malabsorption is associated with a variety of medical conditions including some form of liver disease and Crohn’s disease.

Obese persons and persons who have had gastric bypass surgery.

Greater amounts of subcutaneous fat hold more of the vitamin and alter its release into circulation.  Individuals who have undergone gastric bypass surgery may become vitamin D deficient over time without a sufficient intake of this nutrient, since part of the upper small intestine where vitamin D is absorbed has been bypassed.

Osteoporosis – a disease characterized by low-bone mass and structural  deterioration of bone tissue that increases bone  fragility and significantly increases the risk of bone fractures.  Osteoporosis is most often associated with inadequate calcium intakes, but

insufficient vitamin D contributes to osteoporosis by reducing calcium absorption.

Vitamin D toxicity can cause non-specific symptoms such as anorexia, weight loss, polyuria, heart arrhythmias, nausea, and weakness.    Also it can  raise blood levels of calcium which leads to vascular and tissue calcification, (calcium deposits in the heart and lungs) with subsequent damage to the heart, blood vessels and kidneys.  The use of supplements of both calcium and vitamin D by postmenopausal women  was associated with an increase in the risk of kidney stones.**

Safe Upper Intake  Levels of Vitamin D*

defined as the highest average daily intake of a nutrient that is likely to pose no risk of adverse effects for most people are:

0-6 months    -  1000 IU

6-12 months  -  1500 IU

1-3   years     -  2500 IU

4-8   years     -  3000 IU

9-71 years     -  4000 IU

Pregnant/lactating – 4000 IU

Excessive sun exposure does not result in vitamin D toxicity.**

Vitamin D toxicity almost always occurs from too many supplements.  Toxicity is not reported from ultraviolet B light alone.

Vitamin D supplements have the potential to interact with several types of medications, such as steroids, some weight loss and cholesterol-lowering drugs and epileptic drugs. Hypercalcemia during pregnancy can lead to mental retardation and facial deformities.   Pregnant and breastfeeding women should always consult a physician before taking increased amounts of vitamin D

Vitamin D is an important nutrient and essential for good health.   However increased amounts can have adverse effects.  As always, everything  in moderation.  Before taking amounts above the recommended amounts for one’s age, one should consult with a physician.

*  Wikipedia, the free encyclopedia, Vitamin D

**NIH (National Institute of Health) Office of Dietary supplements, Dietary Supplement Fact Sheet

Products such as sherbet and ice milk are similar, except that by definition, they contain less amount of milk fat. Governments, including the U.S. government regulate the commercial use of the terms based on the quantities of ingredients. Commercial ice cream must have greater than 10% milk fat. Some ice creams may have as high as 16% milk fat.

The ingredients are combined and then frozen.
The mixture is stirred slowly while freezing to prevent large ice crystals from forming.

Ice cream is churn frozen, meaning that it is mixed constantly while being frozen.
If it is not churned, it would freeze into a solid block of ice. The churning keeps the ice crystals small and incorporates air into the ice cream.

Smoothness is related to the size of the ice crystals in the product. Ice cream should be frozen rapidly and churned well during freezing so large crystals do not have a chance to form. Rapid freezing helps keep crystals small. Eggs and emulsifiers or stabilizers added to the mix also help keep crystals small.

One can make ice cream with or without an ice cream Maker or ice cream making machine. Ice Cream machines agitate or churn the mixture while it is freezing and keeps large ice crystals from forming. Ice cream makers come in all styles and sizes. Most are electric but can be hand-cranked. Some models require lots of ice and rock salt for the process which can be bulky and messy but produce a fine quality product. Newer machines are smaller and require less space but may only make a quart per batch. One must choose what is best for their needs.

However one does not need an ice cream machine to make good ice cream.
Simply combine the ingredients and freeze. Remove the bowl with the mixture, a few times during the freezing process and mix with a wire whisk, a hand mixer or food processor and return to freezer. This stirring the mixture during the freezing will keep large crystals from forming and result in a creamer product. Freezing anything from liquid-to-solid will create hard ice crystals. Thus one wants to break up the ice crystals as much as possible so the final result will be smooth and creamy. As the mixture starts to freeze near the edges, remove it from the freezer and stir vigorously. Return to freezer. Depending on the quantity and the temperature, stir every 30-60 minutes.

After the mixture is frozen it can be stored at zero degrees to harden, until ready to serve. This is referred to as hardening. The mixture can be served immediately after freezing, “soft-serve”, omitting the hardening, . Soft-serve or soft-serve ice creams are served directly as they come from the churning or freezer, without being hardened.

Now find a recipe, mix the ingredients, freeze (with or without a machine) and ENJOY!

He complained of being tired, saying it was from the Diabetes. I countered with, no you are not eating enough calories to have any energy.  I explained that I doubted that he was getting 500 calories a day.  He said No, that he was too heavy, overweight, and the doctor said he must lose weight.

Nothing I said made any sense to him. He really didn’t seem to understand the diet.

Later I was talking with a lady friend whom also had recently been diagnosed with Diabetes. She too expressed confusion regarding the diet for her diabetes. She said she really didn’t know what she should be eating. She explained that she was told to eat less than 40 grams of carbohydrate at a meal.. So she is busy each day reading labels and counting the grams of carbohydrate she is eating at each meal. When she has eaten the 35 or 40 grams, she says she is suppose to stop eating; however, she doesn’t always do that as she hasn’t finished the meal, so she continues on.

I was flabbergasted. I have taught the diabetic diet to many people in my career. Believe me, they understood what they should and should not eat at each meal and they knew why. And there was nothing confusing about it. If they wanted to include a special food, they knew how.

We used the exchange lists. Yes, it is old-fashioned and it is a bit stringent.  However it works.

Today patients are told about carbohydrate counting and using the glycemic index. Both plans are fine, but they must be confusing because patients say they can not understand them and they allow the patient too much leeway -personal interruption without the knowledge to make the decisions they are making.  Both programs are fine and allow the patient flexibility and choice.  If they work well for an individual -why change a good thing?  However for those who are confused and having difficulty and uncertainty  understanding what to eat, I think the Exchange List  method may be the answer. 

 The diabetic diet exchange lists are so simple and allow patients to understand what they can eat at each meal and the amount.  There is no guessing and carrying over from a previous meal or forwarding a portion to the next meal. With this understanding, one can eat fairly normally – memorizing the diet in a day or two. The patient can also work with the Dietitian and calculate the diet with favorite foods and omitting foods not liked. In this manner, one can eat normally, anywhere -home, restaurant, etc, with the confidence they are eating correctly for their health.  They are eating the proper amount (the correct amount of calories) without carrying a calculator with them. They also understand how to adjust their diet for emergencies and special events.  The Exchange List program helps the patient plan the entire day’s meals – including calories, carbohydrates, protein and fat, not just the carbohydrate. Thus one will not elimate or indulge in proteins and fats.  Since the patient can easily memorize the diet plan, and will feel confident in his food choices, there is not the constant discussion about the patient’s diet at the family dinner table.   

To explain how the Exchange Lists work in detail is another topic, which I will work on this upcoming week.