Food Swaps for a Heart-Healthier Diet with Registered Dietitian Kate Patton
Food Swaps for a Heart-Healthier Diet with Registered Dietitian Kate Patton
Nada Youssef: Hi, thank you for joining us. I'm your host, Nada Youssef and today we're talking to our featured experts about heart-healthy eating, and as always, we are taking your questions so send any questions you have in the comment section below. Today, our featured expert is registered dietician Kate Patton. Kate works specifically in Preventive Cardiology here at Cleveland Clinic. Thank you so much for coming in today. And as always keep in mind that this is for informational purposes only and not to replace your own physician's advice. So thank you again for being here. If you can just take a few minutes to introduce yourself to our viewers.
Kate Patton: Sure. I work here at main campus in Preventive Cardiology, which is a specialty clinic for patients who are either at risk for heart disease or who already have heart disease. It's a multidisciplinary clinic with cardiologists and dieticians, exercise physiologists, nurses, so if you're really concerned about your risk for heart disease, you can make an appointment and you don't need a referral either.
Nada Youssef: Great. Do you need to be a heart patient then to see-
Kate Patton: You don't necessarily have to, no. Like I said, if you're just at risk for heart disease, so you know you have some risk factors like high blood pressure or high cholesterol or diabetes or if you're overweight, just any of those risk factors, or just a really high family history, strong family history, then you can still come make an appointment.
Nada Youssef: Great, great. I want to kind of talk a little bit about fat, because fat used to be such a taboo thing and now there's healthy fats that we can kind of talk about and it's very important. heart-healthy fats are known to lower bad LDL cholesterol and raise good HDL cholesterol. Can you talk a little bit about where we can find these heart-healthy fats? What kind of foods?
Kate Patton: Sure, sure. That's true. What we know is that the key is actually trying to replace, though, some of the bad fat in your diet, with the better types of fat. So, the better fats are monounsaturated and polyunsaturated fats. Monounsaturated fats come from things like olives and avocado, they're found in all types of nuts, and found in certain oils, so olive oil, extra virgin olive oil, canola oil, peanut oil. Those are good sources of fat, monounsaturated fat, that we do want to consume daily.
Polyunsaturated fats come from a variety of different sources, both some plant based sources, so actually more abundant in walnuts and actually in soy products. And then we get some polyunsaturated fats, specifically omega-3 fats, that's a really healthy type of fat that has a lot of heart protective benefits, we found that in fish like salmon and tuna and some plant-based sources too like flaxseed and walnuts too.
Nada Youssef: Great. So, you said plant-based and also fish. Is there a specific kind of fish that we can find the most healthy fats?
Kate Patton: Yeah, so omega-3 fats are found in pretty much all types of fats, but the fish that are more dense in those omega-3 fats are like the salmon, the tuna, sardines, herring, those have more of the threes. So it's good to get the fish twice a week in your diet, even up to three times per week. In a more Mediterranean style diet, they eat it three times a week.
Nada Youssef: Great. Now when we talk about nuts, studies suggest that eating just 30 grams of nuts per day may help reduce the risk of developing heart disease by 30 to 50%. But what is 30 grams of nuts?
Kate Patton: Good question. 30 grams is one ounce if you're actually weighing them. So, if you have a food scale at home, you can weigh it. If not, I tell patients typically like a handful to around like a fourth of a cup is a good portion to have either just as a snack or kind of spread that out and maybe have some in your cereal in the morning, have some in a salad at lunch. That's a good way to get that.
Nada Youssef: Do the nuts vary, because I know some probably have more oil than others?
Kate Patton: Yeah, that's true. One of the major studies that we know that has a lot of proven research on heart health benefits is a Mediterranean style diet. And in this big study that came out a couple of years ago, subjects were eating the 30 grams per day and it was almonds, walnuts, and hazelnuts. So I always tend to promote those first as trying to get those. But I know some patients like more like cashews-
Nada Youssef: Pistachios.
Kate Patton: ... or peanuts, yeah, pistachios. I think it's okay to still get a variety, but I promote the walnuts, the almonds, hazelnuts the most.
Nada Youssef: So 30 grams.
Kate Patton: Mm-hmm (affirmative).
Nada Youssef: Okay. Great. And speaking of healthy fats, I want to talk a little bit about the ketogenic diet because it promotes healthy fats and low carbs. I guess we will talk about ketosis and that's what your body goes through. Can you tell our viewers a little bit about what ketosis is and if it's good for your heart?
Kate Patton: Sure, sure. Ketogenic diet's fairly trendy right now. Ketogenic diet is where actually the majority of calories in your diet are coming from fat. So it's almost about like 70% of your calories, and then another 20% from protein, and only 10% from carbohydrate. So since you're eating mostly fat, that's what your body's going to use actually as a fuel source too, for energy, so you'll be getting fat that you eat in your diet, but then your body can also burn its own fat for fuel.
And so that's where a ketogenic diet can be pretty beneficial for weight loss because your body starts to burn its own fat for fuel and so you lose weight that way. However though, there hasn't been a lot of research on ketogenic diet longterm and its effect on our heart, so if you do have heart disease, I would still caution against it or consider talking to your doctor before you start a ketogenic diet.
Nada Youssef: Sure. So what you're saying is ketosis is your body using your own fat to burn energy? Is that correct instead of glucose?
Kate Patton: To get energy, yes. Right, instead of glucose. Yeah. Carbohydrate is your body's, typically, the main source of energy in our diet, but so then when you eliminate it pretty much from your diet, then the next source of energy would be fat because protein, your body needs just to stay intact, it's not an efficient energy source.
Nada Youssef: Right, right. Great. Well, as a registered dietician in preventive cardiology, what do you eat? What do you eat for breakfast? What do you promote? What do you eat for lunch?
Kate Patton: Yeah, so like I mentioned before, I really promote the Mediterranean diet the most just because it's proven to have such heart health benefits. So starting off the day, breakfast could vary from oatmeal, to sprouted grain toast with some almond butter, or natural peanut butter, or some whole green cereal with Greek yogurt, and some slivered nuts and flax seed. And obviously for a Mediterranean style diet, you want to eat a variety of both the plant-based protein sources and the animals, so trying to get in, especially, the beans and lentils.
So that's sometimes a tricky part for patients who might not like those types of foods, to consider eating a meal without meat. Especially for men, it's hard, I think to sometimes think about not having a real burger and having a bean burger or having a salad with chickpeas instead of chicken. But I encourage patients to try and make some of those swaps and substitutions so that they're not getting as much of the animal fat, which if in excess, you're consuming too much saturated fat, that can raise your LDL cholesterol.
Whereas the beans and lentils have no animal fat, but they still give you protein and lots of fiber and they have a type of fiber in them that helps with cholesterol lowering so that's why they're really healthy.
Nada Youssef: Oh great. So variety of all that is-
Kate Patton: Yeah. So a variety of, right, the plant-based proteins from the beans or nuts, as well as getting in the fish a couple times a week. Lean poultry, choosing that and avoiding fried types of foods. And then trying to keep the beef and pork, veal, lamb to just a little bit more sparingly and making sure you choose lean cuts when you do consume it.
Nada Youssef: Okay, great. Well let me start with some questions that we have here. I have Michael, "How does fasting with a standard American diet compared to a ketogenic diet that doesn't require any fasting?" Can you talk a little bit about fasting and if that's-
Kate Patton: Sure. So fasting on an American diet would mean, I assume, you're only eating during certain amount of time period during the day. So that obviously A, kind of limits your total caloric intake, it also then limits the amount of time that your pancreas is working to actually help digest food and release that insulin so it can help with improving blood sugar levels. But you'd still be eating carbs, protein, fat just during a specific time period. So that, again, to kind of control the calories and help control blood sugars.
Whereas then a ketogenic diet without fasting, like I said, that's completely different. That's when you're just on a really high, high fat diet and your body's burning that fat. But depending on what your goals are, even eating too many calories on a ketogenic diet without fasting can be harmful. It just depends on what your goals are and what you're looking for as far as fasting.
Nada Youssef: Sure. Perfect. And then I have Jeanette, "Is regular salt unhealthy for a 60 year old man that has had a heart attack?"
Kate Patton: So salt in general, we do need to limit in our diets, actually for all Americans, because the average American diet is very high in sodium. Too much sodium, even if you have a healthy heart though, puts you at risk for developing high blood pressure and things like that. So given that he has had a heart attack and he's over the age of 50, his sodium needs are a lot less, so only about 1500 milligrams per day is what's recommended. So when she says is regular salt unhealthy-
Nada Youssef: What is regular?
Kate Patton: Right. So regular salt versus sea salt, no matter what, all forms of salt really come down to the same sodium chloride. So, you still want no more than 1500 milligrams a day.
Nada Youssef: 1500 milligrams a day. Okay.
Kate Patton: Yeah. So, averages out to be 500 milligrams. And that's not impossible to follow if you kind of choose more whole foods that are minimally processed, not packaged, so going back to eating lots of fruits and vegetables and eating ... oatmeal has no sodium versus some box cereals are really high in sodium, or cooking yourself versus eating out.
Nada Youssef: Speaking of, I mean, 1500 milligrams a day. What is like a normal canned processed food item?
Kate Patton: Yeah, good question. Yeah. Or another way to look at it too is even considering actual table salt. One teaspoon of table salt is 2300 milligrams, so if you're A, eating processed foods and B, adding salt to that, like seasoning your food, then you're really consuming too much. A good rule of thumb, though, is to start reading the nutrition facts labels and an individual food that has 140 milligrams of sodium or less per serving, that's considered a low sodium food so that's still acceptable if you want to have a serving of cereal or like a slice of bread.
Breads are actually one of the biggest sources of sodium in American diet. The American Heart Association's labeled six foods the salty six that are biggest sources of sodium. So one is breads, rolls, tortilla, anything like that because salt is added as a preservative to keep the bread fresh. Deli meats, so any type of deli meat or cured meat is very salty, again has a preservative. And then other big source would be canned soups or any type of soup in general because of the broth.
Another thing to watch out for would be chicken sometimes is like injected with a sodium solution to preserve it and keep it fresh. Often sometimes when it's in those big freezer bags, if it's frozen and has a coating on it, so watch out for that. And then sandwiches are considered a big source of sodium because of the bread and the deli meat and cheese, condiments-
Nada Youssef: It has everything you just said in one meal.
Kate Patton: Yeah, exactly. So that's one, and then the other one is pizza, which is similar because the crust is a bread. Sauces and condiments like tomato sauce can be salty but it's the cheese and then the toppings, so the pepperoni, sausage, things like that.
Nada Youssef: Wow. There's a lot of salt in a lot of places we don't think about. So I have Jameela, "FDA has issued a warning against binging on black licorice. Can you explain why?"
Kate Patton: Sure. It has an ingredient that research shows can really affect the rhythms of your heart and cause fast palpitations, and so we just don't want people to be at risk for that.
Nada Youssef: Is it like an ingredient in black licorice and just the black colored licorice?
Kate Patton: Right. Just black licorice.
Nada Youssef: That's very interesting.
Kate Patton: Yes, exactly.
Nada Youssef: That's very interesting. Okay.
Kate Patton: So just like everything else, only in moderation.
Nada Youssef: Moderation. Yes. How about Chuck, he recently had heart surgery and, "When is it okay for me to eat red meats?" Because there's red meat eaters out there, you know.
Kate Patton: Right, yeah, and that's fine. Obviously red meat has benefits, it's a really good source of iron. So after heart surgery, there's no problem immediately eating it as long as you're able to eat solid foods. But like I said, as part of a Mediterranean diet, we just want red meat to be not very often. So sparingly, once or twice a week, and just making sure it's like I said, a lean cut, nothing like prime rib with a lot of fat on it, and avoid bacon, sausage, those higher fat meats. But something lean with a lot of the fat trimmed off would be okay. And it's important to watch the portion size too, so just trying to keep that meat about the size of the palm of your hand.
Nada Youssef: Great. Awesome. And then Tanner, "I use coconut oil regularly in my recipes. Should I stop because of the saturated fats?"
Kate Patton: Right. Coconut oil is considered a plant-based source of saturated fat and it is very high. We know saturated fat's the type of fat that can raise your bad cholesterol. And so coconut oil has been studied and you hear a lot of mixed things about it in the research, but really as far as being heart protective, there really isn't any research to support it. So I would say definitely if you are free of heart disease and don't have high cholesterol, it's definitely okay to use occasionally in cooking, but as far as using it every single day, I would caution against that.
Nada Youssef: Olive oil instead.
Kate Patton: Right. And they're very different too in how you cook with, like the coconut oil is beneficial because it can be cooked at a very high heat and so using small amounts for that's okay. Whereas like extra virgin olive oil, you're really not supposed to cook with at a very high heat because it's going to kill a lot of the benefit. So the extra virgin olive oil is better for dressings, salad dressings, and dips, but coconut oil, sparingly, is okay.
Nada Youssef: So you're referring to like the smoking point, right? Because every oil needs-
Kate Patton: Correct. You got it.
Nada Youssef: Okay. Excellent. So extra virgin olive oil, don't really cook with it, put it on your salads, on top of things, just not cooking.
Kate Patton: Right.
Nada Youssef: Okay, great. Let's see. And then Jess, "I changed my entire family's diet to fish, skinless chicken, and veggies, all cooked in olive oil. Is there such a thing as too much olive oil?"
Kate Patton: There is, because oils, even the healthy oils and the healthy fats, fats are more calorie dense than carbohydrate and protein, so just like one teaspoon of oil is 50 calories. Obviously we still want patients to watch their weight because that's a risk factor for heart disease, so yeah, there's still a thing of too much.
Nada Youssef: So again, moderation.
Kate Patton: Right. But obviously if you're cooking for an entire family, you may use a larger portion but that's dispersed among the whole family. But no, I would still encourage you to use ... And then that's the thing is like you can use olive oil, which is from like the later pressings of olives, you can use that to cook with at [inaudible 00:17:08] heats, just not-
Nada Youssef: So you're saying not extra virgin versus-
Kate Patton: Mm-hmm (affirmative). There's a difference. Yeah.
Nada Youssef: Okay. Can I ask you, like what is extra virgin?
Kate Patton: Yeah, so that's from the very first pressing of olives, like once olives are ripe, the very first press that comes out of it is the extra virgin, so then you're kind of getting like the freshest flavor and the most nutritional value.
Nada Youssef: Great, great. That's good to know because I always look at the different varieties, I'm like what does it really actually mean? And then Mark, "What is the best fish for heart health?" And we touched a little bit about that.
Kate Patton: Okay. You know, fish is one of those things that people tend to only like certain types. And so I mean I'm happy seeing patients eat any fish. But like I said, we do know that the omega-3 rich fish like salmon and tuna, herring, sardines, you get more of that, which is a really heart-healthy type of fish, so encourage those most. But you know, shellfish, yes, it has a little bit more cholesterol in it, but I think that's still okay if you like shrimp and scallops and things like that to eat those in moderation.
Nada Youssef: So shrimp is heart-healthy, you'd say?
Kate Patton: Yeah, yeah. It's actually really low in calories and so it is okay. But if your cholesterol is high, you still want to be a little cautious of it. [inaudible 00:18:24].
Nada Youssef: Sure, sure. Great. And then I have Mickey, "Do the amount of nutrients change when cooked versus raw? So when you cook a meal versus raw, are the nutrients changing?"
Kate Patton: Typically patients ask this question about vegetables, because if you're steaming something to death and that's really mushy, then yes, you do lose some of that nutritional value. So yeah, raw vegetables are going to be kept intact so we have a little bit more nutrient dense. Cooked vegetables though, try not to cook them to death, just until they're soft or the consistency you like, and you'll still get the nutritional value, vitamins, minerals, fiber. There's even certain vegetables like tomatoes actually, their ability to be absorbed in our body actually is enhanced when they're cooked and you combine it in a meal with some healthy fat because certain vitamins like A, D, E, and K, they're called the fat soluble vitamins, so you do want to consume fat with them when you eat those.
Nada Youssef: Oh okay. So tomatoes are more nutrient when-
Kate Patton: Yeah. You're going to absorb it better when you consume it with a fat like olive oil.
Nada Youssef: Oh interesting. Interesting. Because I know like sometimes garlic is-
Kate Patton: Yeah. That's kind of a similar thing. The PREDIMED Study, which is that big Mediterranean study that I was referring to earlier, subjects in that study consumed a dish called sofrito a couple times a week, and that's where it was like sauteing the tomatoes and the olive oil and the garlic together. So that combination is very heart-healthy.
Nada Youssef: Sounds delicious. Do you have a Instapot because I've heard about Instapots, that it cooks food really fast and I don't know if that's going to make it more nutritious when you're cooking your vegetables. I mean, it cooks it in like half the amount.
Kate Patton: Right. Yeah, because of the higher heat, I think?
Nada Youssef: Yeah, it's like a pressure cooker. So I heard that it's also nutritious because a lot of people were like, "Is it nutritious to use the Instapot or not?"
Kate Patton: No fat added or oils, right?
Nada Youssef: Yeah, you can do, I think, either or, you can even saute in it. But yeah, that's a really good one as well. I actually have this question because I actually just saw something about bananas and too much potassium can mess with your heart? Something about the electric as well. Is that true about bananas?
Kate Patton: So yeah, bananas are very high in potassium and so the average American diet though actually tends to be low in potassium because fruits and vegetables are the best source of potassium in our diet, and most Americans don't eat enough fruits and vegetables. But if you do eat a lot of fruits and vegetables or a lot of bananas, yeah, too much potassium actually can throw off, again, the rhythm of your heart. Just like the ingredient in the black licorice. Because potassium is a mineral that helps with our hydration and it helps with a lot of physiological functions in our body and one is heart rhythms.
So yeah, too much can do that. I think one of the reasons is nowadays too, just the way fruits are grown, they're so large. A banana could be like a foot long, but really a serving of a banana from a weight management perspective or just a controlled portion size, is only like four inches. So that's the thing is people might be eating that entire fruit thinking it's good for them. But even, you know, too many calories from fruit, isn't always good either.
Nada Youssef: Sure, or sugar. Yeah.
Kate Patton: Right. Yeah, it is natural sugar, but yeah, too much even natural sugar.
Nada Youssef: Oh very interesting. And then avocado has even more potassium than bananas, is that correct?
Kate Patton: They're very high in potassium too.
Nada Youssef: Okay. Yeah, yeah.
Kate Patton: And high calorie because they're high fat. So that's the thing, patients come in and tell me like, "I eat an avocado every day." I'm like, "Okay, that's very good, a lot healthy fat," but oftentimes their goal is weight loss, so we need to try and cut back on the portions.
Nada Youssef: Yes, yes. Okay, great. Let's see, I have Michelle, "I go out to eat with my family at least once a week at different restaurants. Do you have any tips when choosing heart-healthy options off the menu?"
Kate Patton: Yeah. Sure. One of the biggest things you have to watch out for when dining out really is the sodium content in food. I would, number one, just make sure you kind of tell your server to try and prepare things without added salt so you can control that. And just be mindful of your choice and try and choose something that includes a lean protein, maybe a whole grain starch, and still has vegetables either as a side or get a side salad with it. Try and just tweak things even though the meal might not come the way you like it, try to do things maybe even more just a la carte on the side so it should be a little bit more balanced.
Nada Youssef: Sure. That's a really good idea.
Kate Patton: And just avoid the obvious things like the fried things and the breaded things and ask for salad dressing on this side so you can control how much you're using.
Nada Youssef: Sure, sure. Great.
Kate Patton: Yeah. And obviously portions are usually very big at restaurants, so-
Nada Youssef: Share.
Kate Patton: Yes. Consider sharing or asking for a box right away so you can box up half your portion, or ask for like a lunch size portion.
Nada Youssef: Now, when we talk heart-healthy, we don't think about kids usually, but I have two little ones, I know you have little ones. Is it too early to to think about heart-healthy eating for little ones?
Kate Patton: No, not at all. Not at all.
Nada Youssef: Not at all? Start when you can.
Kate Patton: Absolutely, yeah, you can start that Mediterranean diet from the beginning. Yeah, with obviously lots of fruits and vegetables and introducing them to beans and fish and nuts. And yeah, giving them the leaner proteins and not too much burgers and cheese. Obviously milk is still important part of kids' growing bodies, but low fat milk is what most pediatricians recommend.
Nada Youssef: Great, thank you.
Kate Patton: Yeah, still cooking with the olive oil and ...
Nada Youssef: And getting their taste buds used to fish and things. I think that's what a lot of people maybe struggle with because if your kids are not used to that kind of taste, and more, you know, mac and cheese. Yeah, I struggle with that myself with my kids. Carl is asking, "How can someone know how much of their cholesterol came from diet versus what was created by their own body?"
Kate Patton: Yeah. So unfortunately we really can't know that because our liver does make cholesterol for us and so it's hard to identify. But we do, you know, obviously total cholesterol when we get our blood drawn is made up of three different types, triglycerides, your HDL, and your LDL. So we do know that triglycerides are affected by our diet, dietary choices, HDL not too affected too much by our diets, affected more by genetics and whether you exercise and smoke, and the LDL cholesterol though is affected by our diets. So we can improve it by making adjustments. But a lot of patients have genetic conditions or familial hyperlipidemia, so it's hard to know exactly-
Nada Youssef: Hard to tell where it's coming from.
Kate Patton: But your cardiologist often can run some other blood tests too, to tell if there's other genetic kind of risk factors that puts you at greater risk of heart disease.
Nada Youssef: Okay, great, thank you. Jenny, speaking of bananas, "My 16 month old eats most of a banana every morning. Is that too much?"
Kate Patton: No, I don't think so. I mean, I think kids who are growing and need those calories, that shouldn't hurt them and cause any heart rhythms at that age.
Nada Youssef: Yeah, yeah. Too young. Okay, awesome. So we're good with a banana every morning.
Kate Patton: Yeah. And obviously kids aren't consuming that many calories.
Nada Youssef: Sure. Right, right. Compared to adults. Laura, "What do you recommend for getting caffeine while still being heart-healthy?"
Kate Patton: I think there's nothing wrong with caffeine, unless typically doctors want you to limit it if you do have arrhythmias or abnormal heartbeats, then typically it's recommended to avoid caffeine. But caffeine in moderation is definitely a part of a healthy diet. So obviously coffee tends to be the most dense source of caffeine, but tea is lower in caffeine, herbal teas are typically very low or have none. I would discourage caffeine from soda, because soda really has no nutritional value at all.
Nada Youssef: Sure, sure. So one to two cups of coffee would you say is probably okay?
Kate Patton: Absolutely, yeah.
Nada Youssef: Okay, excellent. Okay, we have a few minutes left, I'll do one more question here. Phil's asking, "Should I still be getting just egg whites for breakfast or am I okay to consume the yolk?"
Kate Patton: Good question. The yolk is a big source of cholesterol, but it's also a source of a lot of other good nutrients too, a lot of different vitamins and minerals in there. My opinion on that is if your cholesterol is normal, nothing wrong with having a yolk every day. If your cholesterol is high and you're working on trying to lower it, then that would discourage the yolks to maybe just a few times per week, and eating more of the egg whites. There was a paper that was released last year and the consensus from a group of cardiologists was that cholesterol from eggs does have a cholesterol raising effect, so eating too many yolks can raise your cholesterol. So that's right, I would-
Nada Youssef: So as long as you're heart-healthy, you can, in moderation, eat some yolks with your eggs.
Kate Patton: Sure, sure. Yes.
Nada Youssef: Awesome. Awesome. Well before I let you go, is there anything you want to tell our viewers or listeners that maybe we haven't touched on? Or we kind of touched on everything I think.
Kate Patton: I think we covered a lot.
Nada Youssef: Great. So Mediterranean diet, definitely.
Kate Patton: Right, yeah. Mediterranean diet, the most, try to comply with that as much as you can and watching your sodium.
Nada Youssef: Great.
Kate Patton: Yeah. We didn't talk about beverages, well coffee, but yeah, trying not to drink your calories. We didn't talk a lot about dairy, which is another kind of controversial type of topic [crosstalk 00:29:07] as far as kids.
Nada Youssef: Do you think adults should be drinking dairy?
Kate Patton: I think you can. Milk is going to be a source of saturated fat too, so if you're trying to watch your cholesterol then we'd want to limit that. So then the alternatives would be there's lots of nondairy milks though. For example, soy has almost the same amount of protein as cow's milk does, and then nowadays though you have like the almond milk and even coconut milk, really popular, trendy.
So almond milk has no saturated fat, but it's also a lot lower in protein, so just depends on what you're looking for. If you just want that milk consistency and taste and you're getting protein from somewhere else, then almond milk is a great choice. Also, low calorie too, just depends on what the patient's-
Nada Youssef: What your goals are.
Kate Patton: Yeah, what your goals are.
Nada Youssef: So research what you're drinking, what you're eating-
Kate Patton: But the thing is like all types of milk though, have the same amount of calcium and vitamin D and usually the nondairy milks should be fortified, most of them, with vitamin D which is important vitamin that we need too.
Nada Youssef: Great. Well thank you so much for coming in today. Appreciate that. And that's all the time that we have for today. And for more health tips and information, please follow us on Facebook, Twitter, Instagram, and Snapchat at Cleveland Clinic, just one word. Thank you and see you again next time.
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