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Healthy Eating for Women

In November 2007, our guest expert in Le Club's Ask the Expert segment was Suzanne Côté-Grimes, BSc, a registered dietician and certified diabetes educator (C.D.E.) at Montfort Hospital in Ottawa.

Suzanne graduated from the University of Ottawa with a specialization in biochemistry and nutrition. She is a member of the College of Dietitians of Ontario, Dietitians of Canada, the Canadian Diabetes Association and the Canadian Association of Cardiac Rehabilitation.

Suzanne lives in Ottawa where she has worked as a registered dietitian since 1987. During her career she has had the opportunity to help people with a variety of health problems and has helped them change their diets.

Suzanne has worked at Montfort Hospital since 2000. During this time she offered private consulting services with Santé Montfort, a satellite office of the hospital. Her clients included women seeking assistance with weight management, nutrition during pregnancy, the prevention of osteoporosis, and a nutritional approach to menopause.

Suzanne is currently working with an interdisciplinary team that treats cardiovascular illness, metabolic syndrome and diabetes.

Here are Suzanne’s answers to your questions on Healthy Eating for Women:

Q: I drink GALLONS of tea that is decaffeinated with ethyl acetate. Is it safe? Thank you.

A: The Government of Canada has approved three chemical methods for decaffeinating coffee and tea: carbon dioxide, ethyl acetate and methylene chloride. These substances are considered food additives under the category of solvents. These solvents are volatile and quickly eliminated.

Canada’s Food and Drug Act dictates the amount of residue that can remain in the final product. The preferred method for decaffeinating tea is carbon dioxide. Read the list of ingredients on the package to determine which teas have been prepared using this specific process.


Q: I struggle with my weight - something new for me since I began to take an SSRI for depression. What healthy eating advice can you give me?

A: Depression is known to cause several symptoms, including loss of appetite or an increase in appetite. Once the clinical symptoms of depression have been dealt with, normal appetite and an increase in food intake usually occur. Research suggests that most SSRIs do not cause short-term weight gain. To learn the specific effects of your medication on weight, speak to your doctor or pharmacist. It may be possible to take a different medication.

The following general guidelines may prove useful:

  • Set realistic weight loss goals. Do not base your progress solely on the scale. Instead, focus on healthy eating and the benefits it provides. Make every bite count.
  • Make small gradual changes. Examine your food choices and implement one or two small changes that you can maintain over the long term.
  • Be aware of the foods you eat and their nutritional value and take note of whether you are eating in response to hunger or your emotions.
  • Eat a balanced breakfast every day to avoid overeating later in the day.
  • Eat more fruits and vegetables. They are high in fibre and offer a wide veriety of beneficial antioxidants. At lunch and dinner, half of the food on your plate should be vegetables.
  • Be physically active for 30 to 60 minutes every day.

For other ideas, consult the interactive tools and more on the Dietitians of Canada website.


Q: I have been diagnosed with Irritable Bowel Syndrome (IBS) and am finding it hard to eat responsibly, such as including raw vegetables in my diet. Most vegetables, raw or cooked, are problematic. I have not had luck in finding a diet geared to IBS/weight loss. Can you help?

A: A person’s body weight maintenance is influenced by the number of calories (food energy) she consumes and the number of calories she burns. To lose weight, you must reduce your caloric intake and/or increase the number of calories you burn. Often, combining both calorie reduction and increased physical activity is the most effective approach. The recommendations for people with irritable bowel syndrome are not different in this respect.

It is important to:

  • Eat your meals at regular times beginning with breakfast and not skipping meals.
  • Choose a variety of foods based on the Canada Food Guide, including fruits and vegetables, grains and cereals, dairy products and meat products or their substitutes.
  • Choose foods low in fat and sugar.
  • Drink water rather than sweetened beverages such as juice.
  • Do 30 to 60 minutes of physical activity every day.

People with IBS can have difficulty tolerating some foods, especially certain fruits and vegetables and, sometimes, wheat and dairy products. Dietary recommendations for the treatment of IBS are based on each patient’s symptoms and vary according to whether you are experiencing constipation, diarrhea, pain or flatulence.

It’s important to undergo a nutritional evaluation complete with specific recommendations for your situation. The Dietitians of Canada website contains a list of dietitians in Canada who can offer nutrition consultation to help you better manage the IBS.


Q: Can you please tell me what drinking in moderation means? How many drinks is that per day and what kind of alcohol does it include? Does it make a difference if it is red or white wine?

A: The recommendations concerning alcohol consumption are general in nature and do not necessarily apply to every individual. It is always preferable to consult your family doctor about possible interactions between alcohol and your medications, any chronic diseases you may have, as well as your family history. Each country has established its own recommendations.

In Canada, women are advised to limit their alcohol use to nine drinks per week with a maximum of two in one day. One drink is considered to be a beverage containing 13.6 grams of alchohol, or the equivalent of:

  • One 341 ml (12 ounces) bottle of beer (5% alchohol)
  • One 142 ml (5 ounces) glass of wine (12% alcohol)
  • One 43 ml (1 ½ ounces) shot of distilled alcohol (40 % alcohol)
  • One 85 ml (3 ounces) glass of port or sherry (18 % alcohol)

Several published studies have demonstrated an association between alcohol consumption and reduced mortality in some populations. Current evidence is insufficient to make recommendations based on specific types of alchoholic beverages, such as white wine or red wine. Red wine is high in antioxidants such as flavonoids.

However, these substances are also found in red grapes, red grape juice and balsamic vinegar. A higher consumption of alcohol increases the risk of cardiovascular disease, liver disease, obesity, alcoholism, osteoporosis and breast cancer.


Q: These days, experts are touting the benefits of the "Mediterranean diet" as a cure for cardiovascular illness and cancer. This is difficult to believe because Italy, like other Mediterranean countries, does not have a higher life expectancy than Canada. I have never read anything to explain this contradiction, which leaves me skeptical. What are your ideas on this matter?

A:  The term "Mediterranean diet" suggests that everyone living near the Mediterranean eats the same things. The countries in this region have different diets and cultures. The reduced mortality rates and increased life expectancy you have heard about refer to the Greeks, specifically people living in Crete before 1960.

Their diet consisted of large amounts of wild fruits and vegetables, nuts and seeds, more fish than meat, olives, olive oil, more cheese than milk and a moderate amount of wine. These observations [regarding the Mediterranean diet] have led to several intervention studies, the results of which demonstrate favourable effects in people who have already experienced cardiac events, as well as a reduction in the incidence of cancer in obese people.


What should we eat to strengthen our immune system?

A: A variety of nutrients have a positive effect on the immune system, including vitamins A, C, E and B12, iron, zinc, copper, selenium and various phytochemical substances.

Things to do to maximize your immune system:

  • Eat a variety of fruits and vegetables every day. The Canada Food Guide recommends seven servings per day for women over 30. To get the most antioxidant vitamins possible, choose fruits and vegetables that are dark green, red, orange and mauve in colour.
  • Choose lean sources of protein at least twice per day. The amino acids found in protein-rich foods are necessary for the formation of protective cells.
  • Stress healthy fats such as olive oil, canola oil, nuts, avocados and seeds. Increase your intake of omega-3 fatty acids by eating cold water fish such as salmon, sardines, trout, herring, mackerel and tuna.
  • Consume an appropriate amount of calories for your needs. Avoid rapid weight-loss diets because they can cause dietary deficiencies.
  • Eat foods containing probiotics, such as yogurt and kefir. Probiotics are healthy bacteria that help your intestines resist damaging bacteria.

Finally, remember that no multivitamin or commercial preparation can meet all of your needs.  A well-balanced diet is key.


Q:  I have heard that Omega-3 oils “may” lower the risk of memory problems. Is there any point in eating foods or beverages that “may” be beneficial but haven’t been proven to be beneficial?

A: Omega-3 supplements are being widely studied for their health benefits. We know that omega-3 fatty acids, particularly DHA and EPA, play an important role in the development and support of the central nervous system. However, most of the research is observational and provides little evidence of the effect of omega-3 supplements on memory.

Population studies suggest that people whose diet is rich in omega-3 fatty acids have a lower prevalence of cognitive disorders and dementia.

In light of the lack of clear evidence about supplements, diet remains your best tool. Be sure to get omega-3 fatty acids from a variety of sources by eating both plant foods (flaxseed, canola oil, flaxseed oil, soya oil) and fish.


Q: I have been hearing quite a bit about the importance of adding omega-3 to my diet. However, I have a severe allergy to fish. Will taking a supplement be as effective?

A: The three types of omega-3 fatty acids are: alpha-linoleic acid (ALA), eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA). Alpha-linoleic acid is called “essential” because the human body cannot produce it and its needs must be met through our diet. Plant foods such as flaxseed, canola oil and soya oil are rich in ALA. The body is able to convert alpha-linoleic acid (ALA) into EPA and DHA. However this conversion yields only a small amount of EPA and DHA. 

Cold water fish like trout, mackerel, salmon, sardines, herring and tuna provide a rich source of EPA and DHA. There is mounting evidence to suggest that a consistent intake of both EPA and DHA reduces the risk of heart attack and stroke.  In addition, some population studies have reported lower rates of death and cardiovascular disease in countries where fish is consumed regularly. This is why Health Canada recommends two servings of fish per week.

For people with fish allergies, it is not advisable to take fish oil supplements in order to obtain DHA and EPA.  To make sure you are getting some of these important omega-3 fats into your diet look for foods such as milk, cheese, yogurt and eggs that are fortified with DHA.  There are several varieties available in the market which can provide you with these beneficial fats. 

If you’re still having a difficult time increasing your DHA intake, there is still evidence to suggest that diets which include ALA do offer some protection from heart disease.  However the evidence is not as compelling as the data on DHA.  With that being said, you can still reap the benefits of DHA (even if you don’t or can’t eat fish) by increasing your intake of foods containing omega-3 from ALA sources. Remember ALA is converted in the body to produce some DHA.

The daily recomendation of ALA for women is 1,100 mg daily. The following foods can help you acheive this amount.

Source of ALA

Amount of ALA (mg)

1 tsp flax oil

2416 mg

2 Tbsp ground flax seed

2400 mg

14 walnut halves

2575 mg

1 tsp canola oil

419 mg

Naturegg Omega 3 Eggs, 1 egg

300 mg

Beatrice Omega 3 Milk Beverage 1 cup

300 mg

Astro Biobest Omega 3 Yogurt, 113g

300 mg

* Source: USDA Nutrient Database and Food Manufactures

Q: I have a few questions about glycemic index and glycemic load. I have heard that eating a high fibre cereal in the morning is good because it takes time to digest and raises blood sugar slowly. But what if there is refined sugar in it, would this make it a bad choice? Also, someone told me that drinking orange juice after eating a high fiber cereal would change its glycemic load on the body. Is this true? Does it matter what order we eat foods in - does it affect how quickly (or slowly) our blood sugar rises?

A: To begin, it’s important that we clarify these two concepts.

Glycemic index (GI): This is a scale that classifies foods rich in carbohydrates according to the increase in blood sugar that occurs after they are ingested. The glycemic index is influenced by the amount and type of fibre contained in the food, the way the food is prepared, its fat, protein or acid content. Foods with a low glycemic index are digested more slowly and lead to a less exagerated increase in blood glucose levels, which is why they are often recommended for prevention and management of diabetes and obesity.

Glycemic Load (GL) and Available Carbohydrate: GL is calculated as: GI divided by 100 multiplied by available carbohydrate. To calculate the amount of available carbohydrate, the amount of fibre is subtracted from the total carbohydrate in a carbohydrate containing food. Every 15 grams of available carbohydrate is considered 1 Serving of carbohydrate, for example 4 ounces of unsweetened orange juice and 1 slice of whole wheat toast each contains 15 grams of carbohydrate. 

To answer your questions, a high-fibre cereal with a low GI would be advisable for breakfast, even if it contains a small amount of refined sugar. Starches and sugars both have an effect on blood glucose. For this reason, a cereal made of rice flakes would cause a significant glycemic increase because it has a high GI, contains little fibre and sugar but is rich in starch.  Hot cereals such as large flake oatmeal and Red River are better choices. Juices, which are low in fibre, high in simple sugar and therefore have a high GI.  Drinking small amounts of juice (4-6 ounces) with a balanced meal that includes other foods would diminish the effet of the GL. In pratice, it is recommended that a food with a low GI be served with each meal.


Q: I'm finding it difficult to create satisfying, low-carbohydrate meals for myself (family history of diabetes) that are vegetarian, and include sufficient amounts of protein. I'm 55 years old.

A: Based on your question it does not appear to me that you are a diabetic, and that your primary interest is prevention. I am happy that you are being so thoughtful with your dietary choices, however avoiding or excessively limiting carbohydrates from your diet is not recommended. I would suggest incorporating whole grain carbohydrate foods which are going to offer you a good source of fibre as well as other important nutrients. Whole grains to consider are Quinoa, Wheat Berries, Kamut, Spelt, Barley, Whole Rolled Oats, and breads and cereals made with these whole grains. Theses foods will help minimize potential increases in blood sugar and insulin levels after meals and help maintain insulin sensitivity in the body. I would recommend limiting any refined carbohydrate foods such as baked goods, white breads and refined cereals.

If your goal is to reduce your risk of developing diabetes, your approach to vegetarian meals should be varied and well-balanced.  When placing food on your plate, portion it so that half of you plate is made up of vegetables.  The other half of your plate should be divided between your whole grain choice and your protein source (legumes, tofu, fish, nut or seeds, all natural nut butters, egg whites etc.)

You may find it useful to consult a dietitian who can help you plan a personalized diet that meets your needs.


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