Registered dietitian nutritionist helps you choose best foods

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: In a recent column, you wrote “nearly everyone can reduce their heart disease risk by having a diet with very little meat but high in vegetables, legumes and nuts, along with whole grains and fruits.” Because of poorly functioning kidneys, my kidney doctor has told me I need to stick to a diet low in potassium, which means avoiding legumes, nuts and whole grains. I do eat lots of vegetables and fruits, but I do have to eat meat to get protein. I also have diabetes. What advice have you for me? — R.S. ANSWER: Your best bet is the personalized advice that will come from a visit with a registered dietitian nutritionist, who has training and expertise to work with you on foods you like that are both low in potassium and appropriate for a person with diabetes. Your kidney doctor can help guide how much potassium you can take in. Some fruits are very high in potassium. Apricots, bananas, mangos and oranges are among the fruits higher in potassium. You should avoid them or eat them sparingly. Apples, berries and cherries are lower in potassium. Among nuts, choices that are lower in potassium include pecans, macadamia nuts and walnuts, and these can be eaten in modest amounts by most people. *** DEAR DR. ROACH: I have been concerned I might have a medical condition. When looking up specific diseases on the internet, there is usually a site that will state the 10 or so symptoms or signs of that particular ailment. Should I be concerned if I have two or less of these particular symptoms? Does that mean I definitely don’t have that condition? — Z. O’B. ANSWER: There are a variety of online tools to help people understand their symptoms. Some of these, usually called symptom checkers, are pretty thoughtful, and can make a reasonable list of possibilities to be concerned about. However, they don’t replace a skilled doctor. Communication isn’t always so easy as asking a single question and being satisfied with the answer. Often a doctor needs to ask the question a couple of different ways, or use language more appropriate to a person’s background. One simple example is the term “chest pain.” If you were concerned, for example, that you might have blockages in the arteries to your heart, which would put you at risk for a heart attack, a symptom checker might ask if you had chest pain. In my experience, only a minority of people with symptomatic blockages in their coronary arteries have chest pain; most people will say they have chest pressure, discomfort or tightness, especially on exertion or when under emotional stress. Still, many or most people with chest discomfort do not have blockages in their arteries. There is a great deal of information that needs to be collected and interpreted to help a doctor formulate a “differential diagnosis,” a list of the most likely conditions the doctor thinks you might have. From there, a physical exam and appropriate lab testing can help narrow down the correct diagnosis. Internet symptom checkers are particular helpful with less-common conditions that a doctor may not think about immediately, but they frequently give possibilities that are very unlikely, and sometimes miss the correct diagnosis entirely. Take them for what they are worth.