Individuals who are vegan, vegetarian, or allergic to fish may want to avoid fish sauce and foods made with it. What are fish-free sauce substitutes?
Fish Sauce Substitutes
Fish sauce is a liquid ingredient that adds a salty fish flavor to recipes. It is made by coating fish, like anchovies, in salt and letting them ferment in large barrels. The result is bottled fish sauce. Commonly associated with Asian cooking, fish sauce adds flavor to recipes like noodles, stir-fries, and more. The sauce is described as having an earthy, umami flavor. Because the sauce has a unique flavor that is difficult to replicate, removing it altogether is an option for those who do not consume fish products or do not have this ingredient readily available. There are fish sauce substitutes that are vegan—and vegetarian-friendly.
Options
Fish and fish products can be part of a balanced diet and a nutritious source of omega fatty acids. However, fish sauce can be substituted for those who follow a meat-free meal plan, have seafood allergies, or do not have fish sauce available. Omitting some or all animal products from one’s diet is not as easy as avoiding fish. Individuals must also check ingredient labels for animal-based ingredients and byproducts. According to the Asthma and Allergy Foundation of America, fish and shellfish are among the most common food allergies in the U.S. (Asthma and Allergy Foundation of America, 2022)
Fish sauce is usually added in small amounts so that it is not a significant source of calories, protein, fat, or carbohydrates. However, it does contain 1,410 milligrams of sodium. Guidelines recommend 2,300 milligrams of sodium per day for adults, and the recommended serving size of sauce contains around 61%. (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2020)
Substitutes
Fish sauce substitutes typically replace the salty, savory flavors and help deepen the taste of recipes by adding salty and umami flavors. The vegan and vegetarian-friendly alternatives do not provide the fish flavor.
Soy Sauce
Soy sauce is a liquid condiment made with fermented ingredients. It replicates the salty flavor, and although it can be high in sodium, it yields a similar nutritional profile. Soy sauce can be substituted at a 1:1 ratio. Adding minced fish, such as anchovies or sardines, is optional to satisfy the fish flavor.
Tamari
Tamari is a gluten-free Japanese-style soy sauce that can naturally substitute fish sauce and be used in equal amounts.
Worcestershire Sauce
Worcestershire sauce can substitute the fish sauce flavor and saltiness. It is a condiment that deepens the flavor of dishes like steaks, stews, sauces, marinades, etc. Though it is not a traditional ingredient in Asian cooking, it can be used in recipes like noodles, dumplings, marinated meat, and salads. It is lower in sodium, so it may be preferred for a low-sodium meal plan. It can be used at a 1:1 ratio.
Hoisin Sauce
Hoisin sauce is made from fermented soybeans. It has the fermented aspect of fish sauce and the salty flavors of soy sauce, with a slightly sweet flavor. Compared to American-style barbecue sauce, it is thick and usually used as a glaze or dipping sauce. To substitute, mix hoisin sauce with soy sauce at a 1:1 ratio to offset the sweetness of hoisin sauce. Use the mixture to replace the fish sauce in equal amounts.
Oyster Sauce
Oyster sauce is a fish product with the closest flavor profile to fish sauce. It has a thicker consistency, offers a salty fish flavor, and can be used at a 1:1 ratio.
Integrative and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment plans through an integrated approach to restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, trainers, and health coaches to provide the most effective clinical treatments.
Body Signals Decoded
References
Asthma and Allergy Foundation of America. (2022). Food allergies. Allergies. https://aafa.org/allergies/types-of-allergies/food-allergies/
U.S. Department of Agriculture, FoodData Central. (2018). Sauce, fish, ready-to-serve. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/174531/nutrients
U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary Guidelines for Americans, 2020-2025. Retrieved from https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
Can electrolyte chewing gum help physically active individuals, fitness enthusiasts, and athletes experiencing extreme heat and dehydration?
Electrolyte Chewing Gum
Electrolyte powder mix and drinks have been marketed as efficient and time-saving for fast-paced lives. Now, electrolytes are in chewing gum form. These gums work by activating salivary glands and making the mouth water. Manufacturers claim the gum’s sour taste makes the mouth water, quenches thirst, and replenishes some electrolytes. Some brands don’t list the percentages or amounts of ingredients, making determining each gum’s electrolyte content difficult. However, electrolyte chewing gum is designed to eliminate feelings of thirst and is not meant to hydrate the body. This can be dangerous because it gives the individual a false sense of hydration. When the thirst mechanism is impaired, an individual may not drink enough fluids, leading to dehydration. The Food and Drug Administration has not studied the effectiveness of electrolyte gum.
Signs The Body Is Not Getting Enough Electrolytes
Electrolyte deficiency can result from insufficient fluids or excessive sweating (National Library of Medicine, 2024). Signs that the body is not getting enough electrolytes can vary because the body needs each electrolyte for specific functions. The symptoms can range from neurological symptoms such as headaches and seizures in the case of low sodium to muscle cramps and weakness when there are low potassium levels. (National Library of Medicine, 2023) (National Library of Medicine, 2023) However, individuals can still have electrolyte imbalances even if they do not have symptoms. This is why proper hydration and intake of electrolytes through water and food are important.
Ingredients
The ingredients listed on electrolyte chewing gum include:
Sugar
Gum base
Corn syrup
Citric acid
Glycerin
Natural flavors
Soy lecithin
Artificial sweeteners
Artificial color
Electrolytes in sodium citrate and potassium citrate
However, gum brands fail to include the percentages of the ingredients, making it hard to figure out the actual electrolyte content. The amount can determine their effectiveness. Given their size, estimates point to very little electrolyte content, possibly around 10 milligrams of sodium per piece, which is insufficient to hydrate the body.
Rehydrating the Body
Food and fluids are reliable sources of electrolytes that the body can absorb. Sources include:
Fruits like bananas and oranges contain potassium and magnesium.
Vegetables also contain potassium and magnesium.
Dairy for calcium.
Electrolyte supplements are generally unnecessary if you eat a balanced diet. However, these products could be useful during exercise, especially for their sodium content (National Library of Medicine, 2024). When exposed to the heat, consider a rehydration solution like sports drinks or making your own. The presence of sugar increases the absorption of sodium by the intestine. Sugar in electrolyte solutions does not add calories; it helps the intestine absorb the sodium faster and holds water in the bloodstream, helping maintain blood pressure. While chewing a piece of electrolyte gum might make it easy to get balanced electrolytes, it is not enough to replenish the body. Individuals who need more electrolytes should talk to their healthcare provider about the best way to meet their body’s needs. They may recommend drinks or powders specially formulated to provide an electrolyte boost.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.
Balancing Body and Metabolism
References
National Library of Medicine, MedlinePlus. (2024). Fluid and electrolyte balance. Retrieved from https://medlineplus.gov/fluidandelectrolytebalance.html
National Library of Medicine, MedlinePlus. (2023). Low blood sodium. Retrieved from https://medlineplus.gov/ency/article/000394.htm
National Library of Medicine MedlinePlus. (2023). Low blood potassium. Retrieved from https://medlineplus.gov/ency/article/000479.htm
For individuals looking to improve their gut health, can learning about the supportive digestive organs help with how digestion works and how it can be affected by inflammatory bowel disease/IBD?
Supportive Digestive Organs
Most people are familiar with food movement from the mouth through the esophagus, stomach, small intestine, and large intestine. However, digestion begins in the mouth with the formation of saliva, and the supportive digestive organs provide the necessary fluids to digest food and used by the body. The digestive tract runs from the mouth to the anus in one long, continuous tube. Several supportive digestive organs assist digestion but are not considered part of the digestive tract, including the salivary glands, pancreas, liver, and gallbladder.
Salivary Glands
The salivary glands produce saliva passed through ducts and into the mouth. Saliva is a clear liquid containing various substances important for digestion and the beginning of the food breakdown process (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). Saliva is important to digestion because it aids chewing, contains antibodies, and helps keep the mouth clean. Infections, mumps, obstructions, Sjogren’s syndrome, and cancer are diseases and conditions that can affect the salivary glands.
Pancreas
Behind the stomach is the pancreas, which is important to digestion because it is where digestive enzymes and hormones are produced. Digestive enzymes help break down food (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). The pancreas also creates Insulin, a hormone that helps balance blood sugar levels. Individuals with Type 1 diabetes are unable to make insulin and need insulin shots to balance sugar levels. Individuals with Type 2 diabetes also need insulin because their body is either resistant to insulin or their pancreas does not respond correctly. (American Diabetes Association, 2024) Glucagon is another hormone produced in the pancreas to raise blood sugar when the levels are very low. For individuals who have diabetes, glucagon can increase blood sugar levels too high. Insulin and glucagon work together to regulate blood sugar. (American Diabetes Association, 2024) Some diseases and conditions affecting the pancreas include pancreatitis, cancer, and cystic fibrosis.
Liver
The liver is one of the largest organs. Its functions include creating bile, storing nutrients and glycogen, converting toxins into harmless substances, and/or enabling their removal. Bile is passed through ducts that run from the liver to the duodenum of the small intestine. Blood circulates through the digestive tract and liver, where vitamins and nutrients are processed and stored (Johns Hopkins Medicine, 2024). The liver is also the body’s detox organ, helping remove byproducts produced by alcohol and medications. The liver also helps break down old or damaged blood cells and produces substances to help with blood clotting. (Johns Hopkins Medicine, 2024) Diseases and conditions of the liver include cirrhosis, hepatitis, hemochromatosis, and cancer.
Gallbladder
The gallbladder is a much smaller organ located just under the liver. This supportive digestive organ stores bile after it is made in the liver. After eating, the small intestine releases a special hormone called cholecystokinin, which prompts the gallbladder to send bile through ducts and into the small intestine. Once in the small intestine, the bile breaks down the fat from the food. Conditions that can affect the gallbladder include gallstones. Surgery to remove the gallbladder, known as a cholecystectomy, is common. Some individuals may initially need to make adjustments to their diet after surgery. (Johns Hopkins Medicine, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.
Healthy Diet and Chiropractic
References
National Institute of Diabetes and Digestive and Kidney Diseases. Dis (2017). Your digestive system & how it works. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works
American Diabetes Association. (2024). About diabetes: common terms. https://diabetes.org/about-diabetes/common-terms
Johns Hopkins Medicine. (2024). Liver: anatomy and functions. https://www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy-and-functions
Can incorporating lemongrass into a diet help individuals manage anxiety, colds, fever, inflammation, and insomnia?
Lemongrass
Lemongrass, or lemongrass or citronella, is a tall grass-like herb commonly used in Southeast Asian cooking. The lower stalks and bulbs of the plant have a fresh, clean, lemony scent that is sometimes added to marinades, teas, curries, and broths. In addition to its flavoring use, lemongrass’s essential oils are used for medicinal purposes, supported by scientific evidence.
Benefits
Lemongrass has been shown to help with common ailments, such as anxiety, colds, fever, inflammation, and insomnia. It can be eaten, rubbed on the skin, or inhaled as an aromatherapy treatment. When taken orally, it is often used to calm stomach discomfort and other gastrointestinal issues, including cramps and vomiting. (DeFilipps, R. A. et al., 2018) When used as a tea, it protects the stomach lining by treating stomach ailments, indigestion, and gastric ulcers. (Khan, Nida. 2020) Lemongrass or oil is applied to the skin to treat headaches and musculoskeletal pain. As an aromatherapy treatment, the oil extract may be inhaled to treat muscle pain, infections, colds, and flu symptoms. Consumed it can help treat:
Musculoskeletal pain
Sleeplessness
Rheumatism
Cough
Common cold
Fever
Anxiety
Hypertension
Diabetes
Epilepsy
Cancer prevention
However, a few studies support certain lemongrass benefits. Research has suggested that lemongrass oil added to a hair tonic may reduce dandruff. However, more studies are needed to confirm. (Chaisripipat, W. et al., 2015)
Essential Oil
Lemongrass essential oil has been studied and has been found to contain significant bioactive compounds that include:
Citral
Isoneral
Isogeranial
Geraniol
Geranyl acetate
Citronellal
Citronellol
Germacrene-D
Elemol
These compounds contain antifungal, antibacterial, antiviral, anticancer, and antioxidant properties. (Mukarram, M. et al., 2021) Research also shows that essential oils can be therapeutic agents for treating inflammatory skin conditions and help reduce dandruff because of their antimicrobial and anti-inflammatory properties. They can also inhibit the growth of the fungi associated with causing dandruff. (Khan, Nida. 2020)
Nutrition
One tablespoon of fresh lemongrass provides around five calories, most from carbohydrates/fiber and protein. (U.S. Department of Agriculture, 2018) It is a source of fiber, carbohydrates, and vitamins A, B, and C, strengthening the body’s immune system, repairing tissue damage, and promoting cell division. It also contains:
Magnesium – Necessary for protein synthesis, glycolysis, and muscle activity,
Selenium – Necessary for cognitive function and fertility.
Phosphorus – Necessary for DNA/RNA and cell membrane synthesis.
Zinc for wound healing, growth, and development. (Khan, Nida. 2020)
Minerals include:
Calcium – 3 milligrams
Potassium – 34 milligrams
Manganese – 0.2 milligrams
Magnesium – 2.9 milligrams
Iron – 0.4 milligrams
It also provides small amounts of vitamins, including A and C, folate, and niacin. However, lemongrass-flavored oil contains significantly more calories because it usually combines cooking oil with lemongrass extract.
Preparation and Storage
Lemongrass is becoming easier to find in stores. When choosing lemongrass, look for firm green stalks with healthy-looking bulbs attached. Some stores may sell the stalks with a good portion of the top removed. This is fine, as many recipes require using the bottom of the stalk or the bulb. To use lemongrass in teas, soups, broth, or other liquids, crush the stalks’ bottom area to release the aromatic oil. Then, immerse the pieces in the liquid to release the oils. Remove the stalks before eating or drinking the beverage. In other recipes, chopping or mincing the bulb or lower area of the stalks may be necessary before adding to a curry, salad, marinade, or stir-fry. Lemongrass can be wrapped in plastic and refrigerated for two to three weeks or frozen for up to 6 months.
Potential Side Effects
Lemongrass is safe for most when consumed in typical amounts in food. However, some concerns may arise when using it for medicinal purposes.
Used topically, lemongrass may cause skin irritation.
Additionally, consuming high amounts of lemongrass may cause dizziness, drowsiness, dry mouth, excess urination, and increased appetite. (Memorial Sloan Kettering Cancer Center, 2022)
High amounts of essential oil can damage liver and stomach mucous membranes, and excessive tea intake may also affect kidney function. (Memorial Sloan Kettering Cancer Center, 2022)
It is recommended that pregnant women should avoid lemongrass.
Additionally, individuals undergoing chemotherapy should avoid lemongrass because it may interfere with the actions of some chemotherapeutic agents.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment plan through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to optimal function. Our providers use an integrated approach to create customized care programs for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.
Fighting Inflammation
References
DeFilipps, R. A., & Krupnick, G. A. (2018). The medicinal plants of Myanmar. PhytoKeys, (102), 1–341. https://doi.org/10.3897/phytokeys.102.24380
Khan, Nida. (2020). Therapeutic benefits of lemongrass and tea tree. Annals of Civil and Environmental Engineering. 4. 027-29. 10.29328/journal.acee.1001022.
Mukarram, M., Choudhary, S., Khan, M. A., Poltronieri, P., Khan, M. M. A., Ali, J., Kurjak, D., & Shahid, M. (2021). Lemongrass Essential Oil Components with Antimicrobial and Anticancer Activities. Antioxidants (Basel, Switzerland), 11(1), 20. https://doi.org/10.3390/antiox11010020
U.S. Department of Agriculture. (2018). Lemon grass (citronella), raw. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/168573/nutrients
Memorial Sloan Kettering Cancer Center. (2022). Lemongrass Purported Benefits, Side Effects & More. https://www.mskcc.org/cancer-care/integrative-medicine/herbs/lemongrass
For individuals trying to lose weight or improve their diet, can incorporating more fish help improve overall health?
Fish Nutrition
The American Heart Association recommends eating at least two servings of fish each week (American Heart Association, 2021). The type of fish chosen makes a difference, as fish nutrition and calories vary. Some can have a higher calorie count but contain healthy fat.
Nutrition
Comparing fish calories and nutrition data can be tricky. How it is prepared can significantly change its nutritional makeup, and the exact nutrition also varies depending on the variety. As an example, a half portion of a Wild Alaskan Salmon Fillet contains: (U.S. Department of Agriculture. FoodData Central. 2019)
Serving Size 1/2 fillet – 154 grams
Calories – 280
Calories from Fat – 113
Total Fat – 12.5 grams
Saturated Fat – 1.9 grams
Polyunsaturated Fat – 5 grams
Monounsaturated Fat – 4.2 grams
Cholesterol – 109 milligrams
Sodium – 86 milligrams
Potassium – 967.12 milligrams
Carbohydrates – 0 grams
Dietary Fiber – 0 grams
Sugars – 0 grams
Protein – 39.2 grams
The following guide includes other types of fish based on USDA nutrition data (U.S. Department of Agriculture. FoodData Central). Fish calories and nutrition are listed for a 100-gram or 3.5-ounce serving.
Halibut
Raw with skin
116 calories
3 grams fat
0 grams carbohydrate
20 grams protein
Tuna
Yellowfin, fresh, raw
109 calories
Less than one gram of fat
0 grams carbohydrate
24 grams protein
Cod
Atlantic, raw
82 calories,
0.7 grams fat
0 grams carbohydrate
18 grams protein
Mahimahi
Raw
85 calories
0.7 grams fat
0 grams carbohydrate
18.5 grams protein
Ocean Perch
Atlantic, raw
79 calories
1.4 grams fat
0 grams carbohydrate
15 grams protein
Research suggests that fatty fish is the best for weight loss and improved health. Certain types of fish contain an essential fatty acid called omega-3. This polyunsaturated fat provides the body with various health benefits, like reducing the risk of heart disease. Studies show that individuals who eat seafood at least once per week are less likely to die from heart disease. (National Institutes of Health. National Center for Complementary and Integrative Health, 2024) Researchers also believe that omega-3 fatty acids may help reduce symptoms of rheumatoid arthritis and could even improve brain and eye health. Essential omega-3 fatty acids can be taken as a supplement. However, research has not shown that supplements can provide the same benefits as eating omega-3 foods. (Rizos E. C. et al., 2012)
The way that the fish is prepared can change the calorie count. Baked, grilled, and broiled fish are usually the lowest in calories.
Storage and Safety
Fish experts suggest that individuals buy the freshest available. What questions should you ask when visiting the local market?
When was it caught?
The fresher, the better. Fish may remain edible for five days after being caught but may not taste as fresh.
How was it stored?
How the fish is stored and delivered to the market will impact its taste. Fish should be chilled immediately after catching and kept cold throughout delivery and transport.
How does it look and smell?
If the fish has a bad odor, it is likely not fresh. Fresh fish should smell like seawater. If buying fillets, look for a moist texture with clean-cut edges. If the fish is whole, look for clear eyes and a firm texture.
Where is it from?
Buying local fish from sustainable fisheries is recommended but not always possible, depending on where individuals live. There is a Smart Seafood Buying Guide that advises on buying American fish and provides a list of fish with lower mercury levels for health and safety. (Natural Resources Defense Council, 2024)
What is the best way to prepare this fish?
Sometimes, the fishmonger is the best source for simple and healthy recipes and preparation methods. Use fresh fish within two days, or store in the freezer. When ready to use frozen fish, thaw in the refrigerator and never at room temperature. For individuals who don’t like fish taste, there are a few things to help improve the taste. First, try less fishy types. For example, many report that around 100 calories per serving of red snapper tastes less fishy than heavier fish like salmon. Second, try adding fresh herbs and citrus to manage the taste.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment plan through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to optimal function. Our providers use an integrated approach to create personalized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.
Nutrition Fundamentals
References
American Heart Association. (2021). Fish and Omega-3 Fatty Acids. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids
U.S. Department of Agriculture. FoodData Central. (2019). Fish, salmon, king (chinook), raw (Alaska Native). Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/168047/nutrients
National Institutes of Health. National Center for Complementary and Integrative Health. (2024). 7 things to know about omega-3 fatty acids. Retrieved from https://www.nccih.nih.gov/health/tips/things-to-know-about-omega-fatty-acids
Rizos, E. C., Ntzani, E. E., Bika, E., Kostapanos, M. S., & Elisaf, M. S. (2012). Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA, 308(10), 1024–1033. https://doi.org/10.1001/2012.jama.11374
Natural Resources Defense Council. (2024). The smart seafood buying guide: five ways to ensure the fish you eat is healthy for you and for the environment. https://www.nrdc.org/stories/smart-seafood-buying-guide
Can fruit help with a sweet craving for individuals trying to limit sugar?
Fruits Low In Sugar
Fruits and their natural sugars: Whether following a low-carbohydrate diet or having diabetes and watching your A1C, many have heard that fruit is either bad or okay because of its natural sugars. Sugars in fruit are natural. How they affect blood sugar depends on various factors, like which foods they’re paired with and if diabetes is a factor. Counting carbs or noting the glycemic index or glycemic load of foods being eaten, understanding low-sugar fruits can help make choices that best fit your dietary needs. Certain fruits are considered lower in sugar because they contain fewer carbohydrates and sugar, allowing you to consume a larger portion.
One serving of fruit has about 15 grams of carbohydrates.
A serving is one small apple, half a medium-sized banana, or a cup of berries.
Fruits like berries can be eaten in more significant portions for the same amount of carbohydrates but less sugar.
Fruits
Low-sugar fruits include:
Lemons and Limes
Rhubarb
Apricots
Cranberries
Guava
Raspberries
Blackberries
Kiwi
Figs
Tangerines
Grapefruit
Natural Sugar
How much fruit an individual eats may differ if they follow a specific low-carb meal plan or are counting or modifying their carbohydrate intake because of diabetes. Adults should consume two cups of fruit or juice or a half-cup of dried fruit daily. (U.S. Department of Health and Human Services and U.S. Department of Agriculture, 2015) Most fruits have a low glycemic index/GI because of the amount of fiber they contain and because the sugar is mostly fructose. However, dried fruits like raisins, dates, sweetened cranberries, melons, and pineapples have a medium glycemic index. Sweetened dried fruits have an even higher glycemic index.
Fruits from Lowest to Highest Content
Fruits are a healthy way to satisfy a sweet craving. The fruits listed are ranked from lowest to highest sugar content, providing a quick way to assess sugar content. The fruits lowest in sugar have some of the highest nutritional values, plus antioxidants and other phytonutrients.
Limes and Lemons
Limes contain:
1.1 grams of sugar
7 grams of carbs
1.9 grams of fiber per fruit
Lemons contain:
1.5 grams of sugar
5.4 grams of carbs
1.6 grams of fiber per fruit
Rhubarb
Rhubarb contains:
1.3 grams of sugar
5.5 grams of carbs
2.2 grams of fiber per cup
Apricots
Apricots contain:
3.2 grams of sugar
3.8 grams of carbs
0.7 grams of fiber per small apricot
Apricots are available fresh in spring and early summer. They can be eaten whole, skin and all. However, watch portions of dried apricots as they shrink when dried.
Cranberries
Cranberries contain:
3.8 grams of sugar
12 grams of carbs
3.6 grams of fiber per cup when fresh.
While they’re low in sugar, be aware that they are usually sweetened when dried or used in a recipe.
Guavas
Guava contains:
4.9 grams of sugar
7.9 grams of carbs
3 grams of fiber per fruit
They can be sliced or dipped in salty sauce, including the rind.
Berries
These fruits generally have the lowest sugar content and are among the highest in fiber, antioxidants, and other nutrients. Berries, lemon, and lime can be added to flavor water.
Raspberries
Raspberries contain:
5.4 grams of sugar
14.7 grams of carbs
8 grams of fiber per cup
Eat a handful, or use them as a topping or ingredient. Fresh in summer or frozen year-round.
Blackberries
Blackberries contain:
7 grams of sugar
13.8 grams of carbs
7.6 grams of fiber per cup
Strawberries contain:
7.4 grams of sugar
11.7 grams of carbs
3 grams of fiber per cup
Berries are excellent choices for a snack, a fruit salad, or an ingredient in a smoothie, sauce, or dessert.
Blueberries
Blueberries contain:
15 grams of sugar
21 grams of carbs
3.6 grams of fiber per cup
While blueberries are higher in sugar than other berries, they’re packed with powerful antioxidants.
Kiwis
Kiwis contain:
6.2 grams of sugar
10.1 grams of carbs
2.1 grams of fiber per kiwi
Kiwis have a mild flavor, and the seeds and skin can be eaten.
Figs
Figs contain:
6.5 grams of sugar
7.7 grams of carbs
1.2 grams of fiber per small fig
These figures are for fresh figs, and it may be harder to estimate for dried figs of different varieties, which can have 5 to 12 grams of sugar per fig.
Tangerines
Tangerines contain:
8 grams of sugar
10.1 grams of carbs
1.3 grams of fiber per medium fruit
These low-sugar citrus fruits have less sugar than oranges and are great for salads. They are also portable, making them healthy additions to packed lunches and snacks.
Grapefruit
Grapefruit contains:
8.5 grams of sugar
13 grams of carbs
2 grams of fiber per half fresh grapefruit
Individuals can enjoy fresh grapefruit in a fruit salad or by itself, adjusting the amount of sugar or sweetener.
Low-Carb Diets
Individuals following a low-carb eating plan should remember that while some popular diet plans factor in the glycemic index or glycemic load of foods, others only factor in the number of carbohydrates.
20 Grams of Carbohydrates or Less
Individuals will likely not consume fruit or rarely substitute it for other food items with less than 20 grams of carbohydrates daily.
Nutrients are obtained from vegetables.
Some diets don’t even allow low-sugar fruits in the first phase.
20-50 Grams of Carbohydrates
These eating plans allow 20 to 50 grams of carbs daily, allowing room for one daily fruit serving.
50-100 Grams of Carbohydrates
If the eating plan allows 50 to 100 grams of carbs per day, individuals may be able to follow the FDA guidelines for two fruit servings a day, as long as other resources of carbohydrates are limited.
Other popular plans, like the Paleo diet and Whole30, don’t place a limit on fruit.
Although not necessarily a low-carb diet, Weight Watchers also allows fruit.
In general, individuals following a low-carb diet are recommended to try to eat fruits low in sugar.
Diabetes
Fruit choices when managing diabetes will depend on the type of diet being followed. For example, when counting carbohydrates, individuals should know that 1/2 cup of frozen or canned fruit has about 15 grams of carbohydrates.
Enjoy 3/4 to 1 cup of fresh berries, melon, or 17 grapes for the same carbs.
If using the plate method, add a small piece of whole fruit or 1/2 cup of fruit salad to the plate.
When using the glycemic index to guide food choices, remember that most fruits have a low GI and are encouraged.
Melons, pineapples, and dried fruits have medium GI index values, so watch portion size.
Individuals with diabetes may want to consult their primary doctor or a registered dietitian to help design an eating plan that incorporates fruit appropriately.
Body In Balance: Chiropractic, Fitness, and Nutrition
References
U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/
Can incorporating tonic water benefit individuals who want to drink more water?
Tonic Water
Tonic water is more than just water. Its bitter taste comes from quinine, a natural substance found in the bark of the Peruvian cinchona tree. Most store-bought tonic water contains quinine, with natural or artificial flavors from fruits or herbs to temper the bitterness, varying from brand to brand.
Tonic water calories can be high. Some brands can have up to 114 calories per bottle. The reason is they use a sweetener. Some brands have a diet version with zero calories and no sugar but may contain more sodium.
Fats and Protein
There is no fat or protein in tonic water.
Sugar
Some brands use high fructose syrup, while others use cane sugar or sugar from the other ingredients. For example, adding an alcoholic ingredient to make a tonic cocktail can significantly increase the calorie count.
Sodium
Depending on the variety and the amount drunk, tonic water can be a source of sodium. However, sodium intake should be 1500 milligrams per day.
Carbohydrates
There are 33 grams of carbohydrates per serving with the estimated glycemic load or the numerical value that estimates how much a food will raise an individual’s blood sugar to around four.
Micronutrients
There are no significant vitamins or minerals but a small amount of sodium, zinc, and copper.
Health
Quinine is FDA-approved in specific doses to treat malaria. However, the quinine in tonic water is less than prescribed for medicinal purposes. (Achan, J. et al., 2011) Some individuals have tried to use quinine for leg cramps. However, the FDA has warned that this is not recommended and can cause harm. (U.S. Food and Drug Administration. 2017)
Other Water Beverages
There are other water alternatives to reduce calories, sodium, and added sugar.
Seltzer
Seltzer is carbonated water, similar to club soda, with no calories or added sweeteners.
Add lemon or other fruit for flavor.
Mineral water
Mineral water tastes like seltzer, but the carbonation is usually natural.
Flavored water
Flavored water provides some nutrients and antioxidants from the vegetables and fruits.
It is a great alternative if the other options don’t work.
Allergies
It is possible to have an allergy to quinine that could cause a reaction when drinking tonic water. (Winter F. D., Jr. 2015) In these cases, the research suggests, the allergy may cause:
Individuals can make tonic water with online recipes using different herbs and flavors. Tonic water made at home may or may not be lower in calories than store-bought brands, but the ingredients can be controlled to create beverages that cater to personal tastes. Using tonic or sparkling water, keep the bottled water tightly capped and chilled to maintain carbonation and ready to serve.
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Learning About Food Substitutions
References
U.S. Department of Agriculture. FoodData Central. (2018). Beverages, carbonated, tonic water. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/171869/nutrients
Achan, J., Talisuna, A. O., Erhart, A., Yeka, A., Tibenderana, J. K., Baliraine, F. N., Rosenthal, P. J., & D’Alessandro, U. (2011). Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria. Malaria journal, 10, 144. https://doi.org/10.1186/1475-2875-10-144
U.S. Food and Drug Administration. (2017). FDA drug safety communication: New risk management plan and patient medication guide for Qualaquin (quinine sulfate). Retrieved from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-new-risk-management-plan-and-patient-medication-guide-qualaquin
Howard, M. A., Hibbard, A. B., Terrell, D. R., Medina, P. J., Vesely, S. K., & George, J. N. (2003). Quinine allergy causing acute severe systemic illness: report of 4 patients manifesting multiple hematologic, renal, and hepatic abnormalities. Proceedings (Baylor University. Medical Center), 16(1), 21–26. https://doi.org/10.1080/08998280.2003.11927884
Winter F. D., Jr (2015). Immune thrombocytopenia associated with consumption of tonic water. Proceedings (Baylor University. Medical Center), 28(2), 213–216. https://doi.org/10.1080/08998280.2015.11929233
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