Optimal Nutrition

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Healthy regional diets?

Dear Reader,

Delicious and nutritious foods can be found all over the world! Adopting a diet similar to that of another region could positively impact your health and add some variety to what you eat. Ultimately, it’s important to pick a diet that’s right for you and for your lifestyle.

Studying regional diets can (and should!) certainly impact what we decide to put on our plates. Some of the healthiest diets around the world tend to feature lots of fruits, vegetables, whole grains, and fewer servings of dairy, red meat, and poultry. They also limit unhealthy fats and instead include healthier ones. You might want to consider what types of foods you have available because not everything that is available in another country will be readily available where you are.

You specifically mentioned the Mediterranean and Japanese diets. The staples of the Mediterranean diet — which have been associated with a lowered risk of heart disease, cancer, Parkinson’s disease, and Alzheimer’s disease — are fruits, veggies, legumes, and nuts. Cooks also use olive oil instead of butter, limit the use of red meat, and incorporate fish several times a week. The Japanese diet has been linked to long lifespans and lowered risk of heart disease, but also hypertension (high blood pressure). Foods commonly found in the Japanese diet include eating a lot of omega-3-rich fish and protein-dense soy, drinking green tea, and limiting intake of sugar and white flour. Finding fresh olive oil or fresh fish might not be as easy, or inexpensive, for you as it is for someone living on the Mediterranean coast or in Tokyo, but you do not need to eat these all the time. Fresh fruits, veggies, beans and nuts might be easier to come by depending on where you live.   

Overall, the ideal diet for you depends on a lot of things, such as your genetic makeup, hormonal profile, culture, and food preferences. The USDA Ethnic/Cultural Food Pyramids display recommendations for healthy eating from many different countries. Reviewing these may help you find food choices that work for you. You may also want to check out the Get Balanced! Guide for Healthier Eating to look at other healthy food options. Foods that are easily accessible and your level of physical activity are also factors to consider when choosing what to eat. Talking to a health professional may also be helpful — if you’re a Columbia student, you can make an appointment to speak with a registered dietitian or a health care provider at Medical Services (Morningside) or the Student Health Service (CUMC).

Here’s to eating well wherever you are!

Alice

Enough nutrients on a gluten free diet?

Dear Reader,

Eating gluten-free certainly warrants paying attention to what you are excluding and how that may impact your health. Good for you for thinking carefully about your diet and asking questions. As someone with celiac disease, it's even more important to learn about how your food choices may impact the amount of certain vitamins and nutrients in your meals.

Let’s start with some basic facts about gluten-free diets. While eating a gluten-free diet is advised for those with celiac disease, it is not a quick fix, and it is not a flawless nutritional regimen.

  • The pros? Removing gluten will reduce inflammation and hopefully reduce damage to the intestines caused by celiac disease. Initiating and maintaining a gluten-free diet is universally recommended as a lifelong treatment for those with celiac disease.
  • The cons? Gluten-free diets/foods may be low in certain nutrients (like B vitamins, calcium, vitamin D, iron, zinc, magnesium, and fiber). Many gluten-free packaged foods may also be higher in fat and cholesterol.

One way, and perhaps the preferred option, for increasing your intake of vitamins is through food. Some food sources of B-vitamins, calcium, fiber, folate, iron, magnesium, vitamin D, and zinc are:

  • Fruits — apples, berries, figs, oranges, pears, plums, prunes
  • Legumes — lentils, split peas, beans (black, garbanzo, kidney, lima, pinto)
  • Meats, fish, and eggs — all kinds!
  • Nuts and seeds — almonds, chia seeds, flax seeds, pecans, pistachios, sunflower seeds
  • Vegetables — artichokes, broccoli, green leafy vegetables (chard, collards, kale, spinach, etc.), squash
  • Whole grains — amaranth, quinoa, buckwheat, brown rice, teff, millet  

Vitamin D is exceptionally hard to find in a wide variety of foods. The foods with the highest levels of vitamin D per serving are cod liver oil, swordfish, salmon, and tuna. Vitamin D is also produced in our bodies when we exposed to sun. For this reason, many people in northern climates have lower levels and may take supplements. You may want to talk with your health care provider to determine whether taking vitamin D supplements in addition to food sources is right for you.

Maintaining a healthy diet is important for everyone — and especially for those with celiac disease. Some good tips to get the most benefits from your food are:

  • Opt for fresh produce, whenever possible. Fresh vegetables and fruits will have the highest levels of vitamins. Also try to eat foods that are grown local and in season. If you can’t always eat fresh, frozen is second best.
  • Don’t overcook vegetables. Cooking vegetables too long will detract from their nutritional value. Using various cooking methods like sautéing, steaming, blanching, or even baking your veggies will reduce the amount of vitamins and minerals lost so your veggies will still pack a nutritious punch!
  • Aim for “whole” foods. The fewer ingredients in your food, the better. One way of doing this is to avoid processed and packaged goods. Processed foods will have higher levels of unhealthy fats, sodium, and sugars.
  • Eat the rainbow! A diet that includes a variety of colors (like those found in fruits and vegetables) is indicative of different vitamins. Keeping your plate or bowl colorful will ensure you’re eating a wide range of nutrients.

Before beginning a new nutritional program or diet, consider talking with your health care provider about the pros and cons and whether it is right for you. Additionally, a registered dietitian can give you in-depth information about the benefits and risks of excluding and including specific foods or supplements. If you are a Columbia student, you can make an appointment to speak with a registered dietitian or a health care provider by contacting Medical Services (Morningside) or the Student Health Service (CUMC). Checking out the Academy for Nutrition and Dietetics' celiac disease page may also help you get ideas on what to look for at the grocery, how to decipher what is gluten-free, and links to other helpful websites.

Here’s to noshing for nutrients!

Alice

Food aversions and nutrition

Dear Reader,

Being a picky eater is one thing, but having such strong aversions to certain foods that you gag violently is quite another. You’re right to associate symptoms such as ongoing lethargy with an unbalanced diet, and it sounds as though the difficulties you experience when trying to eat certain foods may be preventing you from meeting your most essential nutritional needs, including calories for energy. Good news — studies show that treatment for individuals who experience similar aversions to a wide variety of foods is highly effective, so keep at it!

Parents and babysitters will attest to the fact that picky eating is very common among children and adolescents. However, highly selective eating behaviors that begin in or last through adulthood are much less prevalent. Fortunately, treatment works; in a study with individuals whose diets were composed of six foods or less, phasing new foods into the diet with an emphasis on trying new foods, not eating large quantities of them, was effective. All study participants who accepted treatment were able to incrementally diversify their diet.

One of the principal consequences of eating an unbalanced diet low in nutrients is becoming underweight. Being underweight may cause a variety of short- and long-term health consequences, including fatigue (as you mention), weakened immune system, fragile bones and osteoporosis, anemia, and for women, interrupted periods and fertility issues. One of the best ways to prevent becoming underweight is to maintain a healthy diet. For a thorough summary of what a balanced diet looks like, check out the Get Balanced Guide to Healthier Eating. Looking over the Guide will help you set goals and give you ideas about new foods you may be willing to try, such as delicious and nutritious fruits and vegetables. While maximized for students at Columbia, the key ideas in the guide can work for anyone and there are additional resources listed.

Seems like your current diet is high in carbohydrates, which may give you a short blast of energy but fade away rather quickly. Have you considered trying other foods of various textures that can help sustain your energy, such as fruit smoothies, nuts, yogurt, and berries? Alternatively, consider recombining ingredients in your existing diet — for example, you might try putting some cheese with tomato sauce on your pasta (almost the same as pizza). Experimentation within the range of your “safe foods” list may help you become more open to trying new foods. Once you’re ready to try new foods, take small tastes and evaluate what you like and don’t like about the food. You won’t necessarily like every new food you try, and that’s okay — it’s all about being open to experimentation.

In addition to simply disliking the texture of certain foods, there may be emotional factors that are preventing you from eating a well-balanced diet. In fact, clinical trials show that gagging, vomiting, and retching when exposed to a new food is often stress-related. Meditating, using breathing exercises, and experimenting with other relaxation techniques is highly effective. Seeking treatment from a professional may also be helpful. Columbia students are encouraged to contact Counseling and Psychological Services (Morningside Campus) or Mental Health Services (CUMC Campus) for support.

By slowly incorporating different foods into your diet, you will be on the right path to achieving a healthy weight. For additional input, consider reaching out to a dietician. Columbia students may schedule an appointment with a nutritionist through Medical Services (Morningside) or Student Health (CUMC) and should also check out Alice! Health Promotion Nutrition Initiatives. If you are not a student at Columbia, check with your campus health service or primary care provider for a referral.

The long term health benefits of working to overcome food aversions are well worth it; those who undergo treatment often report enjoying eating more, being less anxious about social situations involving eating, and increased self-confidence both at and beyond the table. Bon appétit!

Alice

Getting your fill of chlorophyll

Dear Reader,

Now that your coworker has planted the idea of chlorophyll’s health benefits in your mind, it’s time to dig up some facts. Chlorophyll has been used as a supplement since the 1960s, although chlorophyllin, a solution of sodium copper salts made from chlorophyll, is more commonly and inexpensively available (this is likely what your coworker’s “chlorophyll water” contained). Although it does have some approved uses and suspected health benefits, no long-term or large-scale studies with humans have been done to conclusively prove its supposed health-boosting properties. Furthermore, while most supplements are made with chlorophyllin, studies suggest that chlorophyll naturally available in vegetables such as spinach, parsley, and garden cress may be a more potent health agent.

Chlorophyllin-containing papain/urea ointments and sprays are sometimes prescribed to treat inflammation, speed healing, and reduce odor in wounds. Patients with colostomies and ileostomies can also take over-the-counter supplements containing chlorophyllin to reduce fecal odor, although some studies dispute the efficiency in this. While these are the only two approved uses for chlorophyllin, other potential positive health effects may include:

  • Reducing damage from carcinogens. Chlorophyll has been shown to bind to carcinogens, such as those in tobacco smoke and cooked meats, thus reducing their ability to enter the bloodstream and reach tissues.
  • Protecting against liver cancer. A study in China showed that a biomarker for aflatoxin, a carcinogen found in improperly stored grains which causes liver cancer, was present at lower levels in participants who simultaneously consumed the toxin and chlorophyll. Because the development of cancer takes many years, however, the long-term effectiveness of chlorophyll is unclear.
  • Treating trimethylaminuria (or fishy body odor). Chlorophyll reduces the amount of trimethylamines, and the associated fishy odor, excreted by people with this hereditary condition.
  • Combating colon cancer. Chlorophyllin has been shown to inhibit DNA synthesis and repair processes in colon cancer cells, giving it potential for use in cancer therapy.
  • Antioxidant properties.

It’s important to note that chlorophyllin also has potential side effects. Taken by mouth, it can cause urine or feces to appear greenish, black or yellow discoloration of the tongue, or occasional diarrhea. Used as an ointment or spray, it can cause a slight burning or itching sensation. Despite these mild side effects, no major toxicity in chlorophyll or chlorophyllin has been discovered in more than 50 years of popular use. Because of the lack of substantial research into chlorophyllins, however, those who are pregnant or breastfeeding may want to avoid this supplement or check in with a health provider before using it.

In summary, while the grass may be greener on the chlorophyll-watered side, science has yet to demonstrate its health benefits outside of a few very specific uses.

Hope this helps!

Alice

I don't get hungry. When should I eat?

Dear Reader,

Although you describe your appetite as being low, the fact that you love food makes your problem much easier to manage. It sounds like you’re losing track of your eating schedule now that you’re on your own, but there are lots of ways to work around this, especially because you like to cook and eat! Establishing healthy habits takes time and effort, but practice makes perfect, and soon enough you’ll get into the swing of a healthy routine. Planning your meals in advance, incorporating food into your daily activities, and sticking to a schedule will all help you get there.

A widely accepted general rule is to not eat if you’re not hungry. However, not eating all day isn’t a particularly healthy pattern— consuming too little food throughout the course of the day may result in shakiness, tiredness, and general mental cloudiness as well as nutritional deficiencies and immune system weakness. The first step: Incorporating a healthy breakfast into your morning routine can help get your metabolism going early in the day, which can help boost appetite later on, helping you remember to eat. Although you may not feel hungry first thing in the morning, consider energizing your body with complex carbohydrates — try whole-grain cereals with milk, whole-wheat toast with peanut butter, or yogurt with nuts and fruit. For more information on other specific meal and snack options, check out the Get Balanced Guide for Healthier Eating.

Once you’ve had your breakfast, you have a solid nutritional base to build off of for the rest of the day. Try sticking to a schedule by eating at approximately the same times every day, whether you choose to eat three large or six small meals per day. Spread your meals apart, and set alarms if needed. When mealtime arrives, make sure to focus on your food, and avoid eating on the go or while watching a movie. Mindfulness will help you get into a routine.

In addition to eating at regular times, try keeping a food journal to analyze your habits. Write down what and when you eat, and after a few days, check your journal for patterns. You might find, for example, that you tend to reach for sweet snacks around 3:00 p.m. for an afternoon pick-me-up. Adjust your food choices and eating schedule according to your observations.

More ideas: Choose a library or workspace that has vending machines with healthy options so you’re reminded to eat, or make a commitment to have lunch with a colleague, classmate, or friend, which will help to incorporate healthy eating into your professional, academic, and social engagements. Always make sure to have healthy snacks on hand so you aren’t forced to make poor nutritional choices under pressure. Nutritious and yummy snack options include string cheese and dried fruit, almonds and low-fat cottage cheese or yogurt, or multigrain crackers with sliced turkey, hummus, or a hard-boiled egg. Prepare your healthy snacks and meals at night so you don’t forget to bring food along with you in the morning.

More generally, have you ever investigated the possible reasons for your lifelong low appetite? Lack or loss of appetite is sometimes indicative of various medical and psychological conditions, so it would be helpful to make an appointment with your healthcare provider to discuss your concerns. Individuals experiencing sudden loss of appetite should meet with a healthcare provider as soon as possible. Columbia students can use Open Communicator or call 212-854-7426 to make an appointment with a healthcare provider on the Morningside Campus or dial 212-305-3400 to book over the phone with Student Health on the Medical Center Campus. Columbia community members are also encouraged to take a look at the Alice! Health Promotion Nutrition Initiatives.

Most importantly, be patient with yourself. Don’t try to make too many changes at once; slowly incorporating these ideas into your day will help you get on track without getting burned out or frustrated. If you slip up every now and then, don’t beat yourself up. Instead, ask yourself what caused you to forget to under- or overeat, and consider ways to adapt and prevent this from happening again. Bon appétit!

Alice

Am I too nuts for nuts?

Dear Reader,

A few things to consider: First, do the nuts and nut butters you’re eating have added salt or sugars? If so, you may want to look at your overall sodium and sugar intake. You can have “toChoose my plate recommendations.o much of a good thing” when it comes to salt and sugar. Second, how’s the rest of your diet? Are you eating lots of vegetables (don’t forget your greens)? What about whole grains and fruits? While the calories in nuts can meet your body’s energy needs and provide protein, fiber, and some vitamins, there are additional nutrients, vitamins, carbohydrates, and sugars that can only be found in vegetables, fruits, starches, and other protein sources. So, dear reader, depending on your answers to the questions above, the amount of nuts you consume may or may not help you achieve a balanced diet. If you're not sure what a balanced diet looks like, head on over to ChooseMyPlate.gov for more information.

Nuts provide a lot of nutritional benefits, not to mention convenience in the form of a quick and tasty snack. As you might already know, nuts are mostly made up of vegetable protein and unsaturated fat, as well as dietary fiber, vitamins, and minerals. Studies have shown that eating nuts lowers the risks of coronary disease and cardiac death, and reduces serum cholesterol levels and risk of type-2 diabetes in women.

Some may worry that too many nuts will contribute to weight gain, but that doesn’t sound like an issue for you.  Weight gain is a result of calories in versus calories out. While nuts are a calorie-dense food, if the remainder of your diet is mostly low-calorie fruits and vegetables, whole grains, and some lean protein source, you probably aren’t eating more calories than you burn. The amount of calories you need is dependent on a number of factors, physical activity levels included. Eating nuts is even potentially protective against weight gain, as nuts can increase feelings of fullness and replace calories that would be consumed in other foods, leading to smaller and less frequent meals. Further, the number on the scale doesn’t necessarily indicate the health of a person. If you feel good, are living an active lifestyle, and consuming a balanced diet, your nutty obsession should be just fine.

If you are a Columbia student, there are lots of ways to find out more about achieving a balanced diet. Check out Columbia’s Get Balanced Guide for Healthier Eating which features information especially for CU students. You can also make an appointment with a Registered Dietician on both the Morningside or CUMC campuses.

Enjoy and happy snacking!

Alice

Tongkat Ali — safe aphrodisiac for men?

Dear Reader,

While many people have probably not heard of it, Tongkat Ali has historically been used to treat health problems ranging from fevers to intestinal worms. This herbal extract is most popularly known (no wonder!) as an aphrodisiac for men. Although it comes from a plant in the Southeast Asian rainforests, it is now widely available either as a pill or an instant coffee additive. This herbal supplement, also known as Eurycoma Longifolia (EL), has not shown any severe health consequences in experiments conducted with rats. However, as a non-FDA approved substance which has not yet been tested extensively in humans, caution and careful consideration should be given along with consulting with a healthcare provider.

In one study, rats given various doses of Tongkat Ali were found to have increased sexual activity and greater sperm quality. Bigger effects were seen at higher doses, and doses ranged from 30 to 150 milligrams of drug per one kilogram of body weight (mg/kg). In another experiment with rats, administering doses of 1200 to 2400 mg/kg caused some liver damage in a few test subjects but did not otherwise harm them. While there are not studies of long-term use in animals or humans (including studies in women), researchers suggested further investigation of the impacts on the liver as well as research into sustained use.

If you are considering or taking Tongkat Ali pills, the largest dose usually recommended for humans is 400 milligrams per day, which is far below the toxic dose observed in the rat study. If you prefer Tongkat Ali-based coffee mix (TACM), a small trial with 20 human subjects showed that drinking 21 grams of TACM daily for four weeks improved participants’ ability to orgasm and sexual satisfaction, but had no significant impact on their body mass index (BMI), waistline, erectile function, or blood pressure. It is important to note, however, that the study subjects were overall healthy individuals. As always, if you have any health problems or are taking other medication, it’s best to talk to your health provider before starting any supplement, including Tongkat Ali. Columbia students can make appointments by contacting Medical Services (Morningside) or Student Health (Medical Center).

Wishing you safe and pleasurable experiences!

Alice

What can I do with egg yolks?

Dear Reader,

What an egg-cellent question! Not only can egg yolks be used for recipes and DIY-beauty products, but also eggs are a healthy component of a balanced diet, as both the yolks and whites are rich sources of nutrients. Egg whites contain 4 grams of protein, only 17 calories, and almost no fat. While egg yolks actually contain more than 90 percent of the calcium, iron, zinc, folate, and Vitamins B6, B12, A, E, D, and K found in eggs, you’re correct that they can also be an unhealthy source of cholesterol

In fact, the American Heart Association recommends that Americans eat less than 300 milligrams (mg) of cholesterol per day, but just one egg yolk has about 185 mg of cholesterol. One recent study even suggests that for people already at risk for heat disease, eating three or more egg yolks per week could be as damaging to arteries as smoking. Other research finds that eating eggs in moderation does not negatively affect cholesterol levels in healthy individuals. Check out the Alice! Health Promotion Nutrition Initiatives for more information about integrating eggs into a healthy diet.

If you do find yourself with extra yolks, you can use them to make custard, crème brûlée, aioli, Hollandaise Sauce, and more. For recipes, just do a quick Internet search for “egg yolk recipes.” Yolks can be saved for later by refrigerating them for three to four days or, for longer-term storage, freezing them in ice cube trays mixed with a pinch of salt or sugar. And for those who should avoid eating egg yolks altogether, there’s a sunny side — you can use egg yolks to create DIY hair treatments. Some people swear by egg yolks as treatments for split ends, dull or dry locks, and for strengthening weak strands. Again, a quick Internet search for “egg yolk hair treatments” will provide more than enough recipes to get you started.

Hope this was egg-ducational,

Alice

It's Greek (yogurt) to me!

Dear It’s Greek to me,

Greek, or strained, yogurt seems to be making all the top healthy food lists and taking up ever more space on the grocery store shelves lately. It’s great that you’re skeptical of what could feel like a healthy food fad. While yogurt is generally considered to be a healthy food and can be part of a healthful diet, Greek yogurt does have an edge over the regular stuff.

Greek yogurt differs from normal yogurt in that liquid whey is strained out of the yogurt to give it a tangier taste and richer, creamier texture. But how different is Greek yogurt from regular yogurt? Not so different, it turns out. In fact, Greek yogurt can actually be made from regular yogurt — all that is involved is placing regular yogurt on a cheese cloth and letting some of the liquid whey drain out into a container below it. Greek yogurt has a similar nutritional profile as regular yogurt in terms of being a good source of protein, calcium, phosphorus, riboflavin (vitamin B2), thiamin (vitamin B1), and vitamin B12, as well as of folate, niacin, magnesium and zinc. Any type of yogurt that contains probiotics (live bacterial cultures) is associated with a number of possible health benefits, such as aiding digestion, having antidiarrheal properties, combatting carcinogens, regulating gut environment, alleviating irritable bowel syndrome, and boosting immune response. 

So from where does Greek yogurt’s slight edge over regular yogurt originate? Greek yogurt has a higher protein and lower complex carbohydrate content than normal yogurt, as the process of making Greek yogurt allows some of the sugars in the yogurt to be strained out in the whey-containing liquid. However, check the label on what you bought — some varieties have added sweeteners, resulting in higher sugar levels. Also, keep the fat content in mind. Though many non-fat varieties of Greek yogurt are now available, fuller fat varieties can pack in the saturated fat.  

If you like the taste and texture, then consider buying it again next week. The consumption of high protein snacks (Greek yogurt is considered to be an excellent choice) has been linked to reduced appetite, increased feelings of fullness and less frequent and heavy meals, compared to not snacking and to consuming regular varieties of yogurt. There are many uses for Greek yogurt besides as a snack. You could try Greek yogurt as a low-fat replacement for sour cream, in cooking, or as a salad dressing. Try swapping it for mayonnaise on a sandwich or in a dish like egg salad. Mixed with seasonings like garlic or dill, it can be made into a unique dip for veggies. Throw some fruit and granola on it for breakfast.

Hope you understand Greek (yogurt) a bit better now!

Alice

One fish, too much fish, how much fish?

Dear Reader,

This is a simple question for which there is no simple answer! How often you should eat fish depends on a variety of factors, including your specific health concerns, the type of fish you like to eat, how much you weigh, whether you’re pregnant or breastfeeding, and how much fish you eat per sitting. In addition to being quite tasty, fish can have many nutritional benefits, including being low in cholesterol, a good source of protein, and chock full of Omega-3 fatty acids. The American Heart Association even recommends eating a variety of fish, preferably oily fish (e.g., salmon, tuna, herring, etc.), at least twice a week.

Most people can eat fish without being concerned, but pregnant and breastfeeding women and young children should be more careful. Nearly all fish and shellfish contain traces of methylmercury, a type of mercury that can be harmful for pregnant women and young children. Mercury is present in both freshwater and oceans throughout the world as a result of industrial pollution. Generally speaking, older fish, larger fish, and fish that eat other fish will have accumulated the most mercury, thus there is lots of variation in mercury levels. There are three primary factors to monitor if you are trying to lower your consumption of mercury. These include the type of fish, the frequency you eat it, and the amount you eat per meal.

Some good general guidelines for fish consumption:

  • Eat fish that are lower in mercury. These include anchovies, clams, oysters, herring, tilapia, whiting, shrimp, sardines, salmon (in some cases), and a few others.
  • Eat less fish that are higher in mercury. These include tuna (especially steaks and sushi), Chilean Sea Bass, sharks, swordfish, eel, halibut, and orange roughy.
  • Eat a variety of fish. As an alternative to completely cutting high mercury fish out of your diet, simply eating a variety will make it more likely that some of the fish you consume is of the lower mercury variety.
  • Eat smaller (or fewer) servings of fish. Eating fish less frequently and eating smaller amounts will help keep mercury levels in check.

To get a more precise calculation of how often you should eat fish, check out the National Resources Defense Council's Mercury Contamination in Fish - Consumer Guide to Mercury in Fish. Other helpful resources include the New York City Department of Health – Mercury and Fish, the Environmental Protection Agency, and New Yorkers can check out New York State Fish Advisories.

If you are still concerned about the amount of fish you should include in your diet and if there are any restrictions based upon your individual health needs, you should make an appointment with your primary care provider or a registered dietitian to discuss. Columbia students on the Morningside campus can make an appointment at Medical Services using Open Communicator or by calling 212-854-2284. Columbia students at the Medical Center can make an appointment with Student Health or by calling 212-305-3400. 

Bon appétit!

Alice

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