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Q: Are the new flavored milks for kids just a high-sugar gimmick, or are they okay?
A: The new varieties of flavored milk, including orange, strawberry and vanilla, are an attempt to reverse the trend of children and teens drinking more soft drinks and fruit "drinks" (with less than 10 percent real fruit juice) than milk. Largely because of this trend, adequate calcium consumption is below recommended levels, for example, for 70 to 90 percent of teenagers. With the wide availability of high-sugar foods and drinks, offering more would not seem desirable. But if your children are among those whose dairy consumption falls below the recommended three to four servings daily, these flavored drinks may help. A new study in the Journal of the American Dietetic Association shows that children and teens who drink flavored milks tend to drink less soda and fruit drinks (but not less juice). The extra sugar from one source is compensated by less sugar from others. Whether it's the sugar or another aspect of the diet, remember it's the overall content that counts. Consider serving some fruit with the flavored milk to improve another weak area in many kids' diets.
Q: How long is it safe to keep cold cuts in the refrigerator?
A: Good question. Meats kept too long pose a risk of food-borne illness that is too often ignored. You can keep sandwich meat from the grocery deli counter for three to five days. Lunch meats in unopened, vacuum-sealed packages can be stored in the refrigerator up to two weeks, but not more than one week after the "sell by" date on the label. Hard sausage that is "dry" or "semi-dry" can be kept two or three weeks, but hopefully you don't use this meat often, since its fat and sodium content is quite high. Remember that leftover meat and poultry cooked at home are excellent and economical sandwich meats. They will keep longer than three or four days if frozen.
Q: How bad, nutritionally, are pre-packed lunch meals with mini pizzas, tacos, etc.?
A: It's no surprise that many of the pre-packed lunches are relatively high in fat and sodium compared to a turkey sandwich, for example. But it's not necessarily any worse if the alternative would have been a high-fat lunchmeat sandwich or "junk" food. This is especially true for children and teens. Their calorie needs are so high, due to growth and physical activity, that there is room for some high-fat foods, as long as other meals and snacks are relatively lean. The biggest problem may be what goes with the lunch. Where are the vegetables and fruits so vital for good health? Rounding out a meal with extra sweets and sugar-laden fruit drinks containing little or no juice leaves a meal nutritionally lacking, whether it's pre-packaged or one you've packed yourself. If you prefer pre-packaged meals, look for those with very little of the less nutritious fillers. Supplement them with your own fruits, raw vegetables, or both. On the other hand, packing a healthy lunch takes only a few minutes (and less money) if you add the ingredients to your weekly shopping list. You might question whether it's worth paying more for a nutritionally incomplete, pre-packed meal.
Q: Is apple juice the best drink for toddlers?
A: Apple juice is a nutritious drink that can supply some of the health-promoting phytochemicals found in apples. But there's no reason to use it as the main beverage, the way many parents do. The idea that apple juice is somehow easier than citrus juice on children's stomachs is quite untrue. The stomach's digestive juices are far more acidic than any food or drink. Unless the apple juice is fortified with vitamin C, orange juice (or a 100% juice blend) that supplies vitamin C is probably a better choice for daily use. Regardless of what juice is used, child nutrition experts warn that doling out multiple glasses of juice between meals can leave a toddler too full to get adequate nutrition at meals. Milk, or a calcium-fortified alternative for those who can't drink it, should be emphasized at meals. Some snack-time juice is fine, but getting children in the habit of drinking water to satisfy thirst between meals will bring them many short- and long-term benefits. .
Q: How can I be sure the weight gained while pregnant won't leave me overweight later?
A: Gaining too little weight in pregnancy puts your baby at risk for many serious health problems, so don't let the fear of becoming overweight result in hurting your baby. Just keep in mind that research at Cornell University suggests women who gain beyond the current recommended ranges tend to retain one to ten or more extra pounds a year after their baby is born. Try to keep within the Institute of Medicine's recommendation that normal-weight women gain 25 to 35 pounds, underweight women gain 28 to 40 pounds and overweight women (body mass index of more than 26) 15 to 25 pounds. Studies suggest that women are not always given adequate or accurate advice on this question. Don't look at your increased calorie needs while pregnant as a chance to go crazy with sweets or "junk" food. The extra food required to satisfy your need for protein, calcium and other nutrients adds up to the extra 300 calories a day you need while pregnant. Be especially careful in the first three months of pregnancy, when you need few if any extra calories; make sure that hunger, nausea, or hormone-induced emotional swings don't lead to eating beyond what you and your baby need.
Q: Is it true that pizza isn't good for you?
A: Reports on how high in fat and calories a pizza can be recently made headlines and surprised many people who thought pizza was a healthier alternative to fast-food burgers and fries. But it isn't pizza per se that's bad. Pizza becomes an unhealthy choice when it's made with lots of high-fat ingredients, or when we eat excessive portions. Just two slices of pizza with mounds of extra cheese on top or stuffed into the crust, or loaded with fatty meat, can contain 700 to 1,000 calories and 40 to 70 grams of fat. Even with fewer high-fat additions, you'll be heading toward the same tally if you have three or four average slices. Pizza can be part of a healthy meal, but remember that a major portion of the meal should come from vegetables, fruits and other plant-based foods. The tomato sauce on pizza is an excellent source of the phytochemical called lycopene, but using some sauce and a few sliced vegetables on top won't achieve that balance. Limit your pizza portions to control fat and calories, and include veggies not only on your pizza, but on the side as well (in a salad or side dish), and have fruit for dessert. Ordering "half cheese" will cut about 20 calories and 2 grams of fat for a typical two-slice serving, but that's minimal compared to the savings if you limit your portions.
Q: Up to what age should children be given fluoride supplements?
A: Giving children adequate fluoride offers dramatic power to prevent dental cavities. Children in communities with fluoridated municipal water supplies do not need and should not use additional fluoride supplements. But families who use well water, or whose communities do not fluoridate water, should give their children fluoride supplements from age six months to 16 years. To benefit from these supplements, they should be taken every day throughout this period. The American Dental Association and American Academy of Pediatrics recently released an updated dosage schedule for flouride. Your child's physician or dentist can prescribe the correct dose, depending on your child's age and the level of fluoride that naturally occurs in your water.
Q: Are shakes at fast food restaurants a good source of calcium?
A: Fast-food milk shakes are generally good sources of calcium, with a small or medium serving often providing about a third of the daily calcium now recommended for most adults. But these shakes also give you 300 to 400 calories and 5 to 12 grams of fat. Those numbers are even higher for a few restaurant shakes and, of course, a large serving size provides even more. On the other hand, you could get just as much calcium in an eight-ounce glass of skim milk for only about 90 calories and 0 grams of fat. An eight-ounce glass of reduced-fat milk (2 percent) or one and one-half ounces of reduced-fat cheese has 120 calories and 5 to 8 grams of fat. So think of these shakes not as beverages, but as desserts - desserts with more protein and calcium than most, but nonetheless desserts.
Q: How concerned should consumers be about additives and colors in food?
A: Some consumers see food additives as a major health concern, but most researchers disagree. These substances may seem unsafe because they have names we don't recognize, but many food additives are actually antioxidants that are added to prolong a product's shelf life. They may also contribute some of the same health benefits as the vitamin antioxidants occurring naturally in foods. Other additives are simply purified carbohydrates, added to thicken food, similar to the effect of flour or cornstarch. Some additives are inactive parts of fat molecules that help maintain a desirable texture in food. Food colors have been studied and ruled as safe for everyone, except for the rare individual who may have an allergic reaction. Rather than focusing on avoidance of foods with additives and colors, researchers encourage us to focus on the food choices and other lifestyle habits that have been linked over and over again with lower cancer risk and better overall health. Those include a diet centered around vegetables, fruits, whole grains and beans; maintaining a healthy weight and staying physically active; using fat and salt in moderation; limiting alcohol, if used at all; and avoiding tobacco.
Q: How much do the toppings on a pizza affect its nutritional content?
A: A topping of high-fat sausage and pepperoni can double the fat content of pizza. In two medium slices of pizza, pepperoni adds two to five grams of fat and 20 to 60 calories, while sausage adds four to eight grams of fat and 45 to 70 calories. Compare that to two medium slices of pizza with virtually any vegetable topping, or a variety of vegetables, that would add zero grams of fat and just two to eight calories. Olives are also a reasonable choice, adding only about one gram of (mostly unsaturated) fat and 11 to 14 calories to those two slices; but, since olives are usually considered a rather high-sodium food, they would not be appropriate for those on a low-sodium diet.
Q: What are some healthy snacks I can offer to my child's pre-school class?
A: When sending snacks for an entire class, check first with the teacher to see if any children have food allergies that must be considered. Treats that are healthful and popular with children include string cheese, fresh or dried fruit, crackers or celery with peanut butter, or a dry cereal mix. Or, you might ask the teacher if you may send a large container of vanilla yogurt that can be served in cups and topped with each child's choice of cereal or fruit toppings.
Q: Is it safe to leave leftovers to cool before chilling, to avoid heating up the refrigerator?
A: Once food is cooked it should not be kept at room temperature for more than two hours, including time for serving, eating and cooling. Small amounts of bacteria that may be in or on meat or other perishable foods reproduce rapidly at room temperature and can cause serious illness when the food is eaten later. Allow food to cool only briefly before refrigerating it. If you want to speed cooling, cut food into smaller portions or divide it into several shallow containers.
Q: At what age do children start needing dietary fiber?
A: Too much fiber is not good for young children, but most researchers believe that some dietary fiber, about the amount in a slice or two of whole-wheat bread, is good even for toddlers. Beginning at age three, current recommendations call for the grams of dietary fiber equal to a child's age plus five. For example, a five-year old needs 10 grams a day, which could come from one or two servings of whole grains, along with other refined grain products and several servings of fruits and vegetables. Fiber offers the immediate benefit of helping children avoid constipation, but a life-long habit of taking in enough fiber helps lower the risk of some cancers and heart disease, which tend to develop later in life.
Q: Is there much difference between grilled chicken and breaded chicken at fast-food restaurants?
A: Yes. While the coating on crispy chicken patties and nuggets may not seem like much, it absorbs a lot of fat during the frying process. A breaded and fried chicken sandwich at most fast-food restaurants typically has 500 to 700 calories and 25 to 45 grams of fat. (You can lower that to around 20 grams of fat if you skip the mayonnaise.) A grilled (unbreaded) chicken fillet sandwich is a better choice, at 430 to 530 calories and 20 to 26 grams of fat. If you hold the mayo or "special sauce," this leaner option brings the total down to to 200 to 400 calories and just five to nine grams of fat. While the roll contributes some calories, even a modest three-and-a-half ounce portion of breaded and fried chicken without the bun contains as much as 20 grams of fat.
Q: Does fruit yogurt count as a serving of fruit?
A: Most commercial fruit yogurts contain about 2 tablespoons of fruit preserves, not nearly enough to count as a serving of fruit. One serving is considered either a half-cup of fresh, canned, or frozen fruit, or a quarter-cup of dried fruit, like raisins. To make a more nutritious fruit yogurt with a serving of fruit, spoon some plain unflavored yogurt into a bowl and add a half-cup of fruit. You can flavor this with a little vanilla and a teaspoon of sugar too, if you like. The result will be lower in calories and sugar, higher in fiber and vitamins, fresher-tasting and less expensive. The American Institute for Cancer Research calls the goal of boosting fruits and vegetables one of the most important steps to lower cancer risk, so it's worth creating some new ways to work more of them into our diet.
Q: What size portions do my children need?
A: It's great that you are thinking about this. You don't want to provide children with too little to meet their needs for growth. On the other hand, servings that are too large tend to overwhelm children, and they may have trouble eating all of them. Serving small portions to young children is often the best way for them to learn to eat only until satisfied, instead of overeating. Start kids off with less and encourage them to ask for more if they're still hungry. For each year of age, the American Dietetic Association (ADA) recommends one tablespoon of every food offered at a meal. That means three-year-olds would start with three tablespoons of every food offered, and if they eat it all, they can ask for more. Don't make the mistake of scolding children for not finishing all you have served. If you view this as a "waste" of food, serve less instead of forcing them to overeat. Respect your children's ability to tell when they've had enough. But don't hand out snacks an hour after dinner if they are suddenly hungry because they ate too little at the previous meal. Eventually, they will learn to gauge their own appetites and get most of what they need at regular meals.
Q: Is it true that carbonated soft drinks are bad for our bones?
A: Suggestions that soft drinks "leach" calcium out of our bones are not supported by research. In fact, a new study in the American Journal of Clinical Nutrition tested several different kinds of carbonated beverages and found that only those with caffeine increased the excretion of calcium in the urine. Earlier studies showed that the body compensates for an increase in calcium excretion later in the day, and that overall, caffeine is not a significant cause of calcium loss or osteoporosis. The link between increased bone fractures and carbonated soft drinks observed in some population studies probably indicates that bones are weakened by inadequate calcium consumption when soft drinks are consistently substituted for milk.
Q: Is there any sandwich meat besides turkey that doesn't have too much fat?
A: Check package labels or ask at the deli counter – most of the ham and roast beef used for sandwiches are now quite lean. Look for selections that have no more than three grams of fat per ounce. You can also make a tuna salad sandwich with water-packed tuna and reduced-fat mayonnaise, or make a veggie sandwich with two ounces of part-skim mozzarella or reduced-fat cheese and lots of vegetables like tomato, lettuce, sliced pepper, cucumber, or any fresh vegetables of your choice.
Q: Everyone talks about the "Freshman 10," meaning everyone who goes away to college gains weight. Is this inevitable, or can I avoid it?
A: Weight gain is common, but not inevitable. Take time for regular meals. Studies show that when people skip meals they get so hungry they tend to overeat at the next meal. Make fruits and vegetables a major part of every meal, but avoid those that are deep-fried. Compared to other foods, fruits and vegetables are low in calories, so you can eat more of them to achieve that full feeling. Since college students tend to keep late hours, you'll probably need evening snacks. Keep fruit around for a light snack instead of vending machine chips or candy. Try not to get into the habit of ordering pizza every night at midnight. When you do have a high-calorie snack, watch your portions carefully, and eat only as much as you need to satisfy your hunger. Some coffee and soft drinks as well as alcoholic beverages can make calories add up fast, so rely on water as your primary beverage. When you get stressed, don't use food to help you feel better. Work it off in activity. Exploring opportunities for sports and work-outs is good for body, mind and spirit, and a great way to meet people.
Q: Is it true that pediatricians now think juice isn't good for children?
A: Juice in moderation is a healthy choice for children. The American Academy of Pediatrics has issued a statement that warns against inappropriate uses of juice for children. Juice should not be given to babies younger than six months because they need the nutrients in milk. Juice should not be given to toddlers at bedtime because it can pool around their teeth all night and promote serious tooth damage. Infants and children should not be given unpasteurized juice because it can result in serious illness. The bacterial contamination of unpasteurized juice cannot be handled by the immature immune systems of babies and children. Juice for children under age six should be limited to four to six ounces a day, and those seven to 18 years should limit consumption to two small glasses a day. Drinking too much juice can lead to gas and diarrhea, and even to inadequate growth if juice takes the place of other foods that growing children need. Several servings of solid fruit a day remain an excellent choice for meals or snacks.
Q: Does orange juice labeled "calcium-fortified" have a meaningful amount of calcium, or is this feature a gimmick?
A: You're right to be cautious, because sometimes foods are advertised as having added nutrients which don't represent a significant amount. The fortified orange juice products, however, really are good sources of calcium. An eight-ounce glass provides about 300milligrams (mg) of calcium, equal to a glass of milk, and in an easily-absorbed form. Just remember that when you get calcium from milk, you also get the vitamin D our bodies need to use calcium. If you're also drinking two cups of milk a day, you will have all the vitamin D you need until after age 50, when needs increase. But if you don't get it from milk, make sure that you are meeting your vitamin D needs with fortified soy milk, cereal, or a supplement.
Q: Is there much nutritional difference between onion rings and French fries?
A: Both are high-calorie, high-fat foods, usually fried in not-so-healthy hydrogenated shortening. Because they are coated in batter, onion rings are usually higher in calories. A six- or seven-ounce portion of onion rings may run about 700 calories and 40 grams of fat, while the same size portion of fries usually contains 540 to 600 calories and 25 to 30 grams of fat. Portion size, however, is a far bigger influence. A three- to four-ounce serving of onion rings (a "small" or "medium," depending on the restaurant, or about half an order from a table-service restaurant) is lower in fat, calories and sodium than a six- to seven-ounce (or "large") order of fries. Better than either onion rings or fries, of course, would be a leafy green or fruit salad with a modest amount of dressing.
Q: How big is a "serving" of a fruit or vegetable?
A: Nutrition recommendations are based on standardized serving sizes, like those in the Food Guide Pyramid. Each of the following is considered one serving: one cup of raw leafy greens (like lettuce or raw spinach), a half-cup of chopped vegetables (cooked or raw), a half-cup of fruit (fresh, frozen or canned), one medium piece of raw fruit (like an apple or orange), a quarter-cup of dried fruit (like raisins), and a six-ounce glass of fruit or vegetable juice. For most adults, a cup is about the size of their fist, while a half-cup is about the size of a rounded handful. The American Institute for Cancer Research (AICR) and other major health organizations recommend a total of five to ten servings of fruits and vegetables daily as a vital step in reducing our risk of cancer and promoting overall health. But that doesn't have to be five to ten separate servings of different fruits and vegetables each day. A hearty portion of a vegetable like broccoli or beans could contain a cup or even one and one-half cups, which would count as two or three servings. On the other hand, putting just one leaf of lettuce or one slice of tomato in a sandwich is not enough to be considered a serving. The five-to-ten servings goal can most easily be met by looking for ways to include two to three servings of fruit or vegetable in each meal, and by developing the habit of having fruit for snacks.
Q: What is a healthy rate of weight loss?
A: The general recommendation from the National Institutes of Health (NIH) and other experts for safe weight loss is that after the first week or two, people should lose no more than a pound a week unless they are in a special program with intense medical supervision. For some people, a half-pound of weight loss a week is most realistic. For another way to view this question, the most recent government report on various approaches to weight loss recommends that those who are overweight aim to lose up to ten percent of their weight in six months. (For someone who weighs 180 pounds, this means up to 18 pounds.) Most overweight people could meet this goal by cutting 300 to 500 calories a day. This reduction would result in a loss of one-half to one pound per week which, in six months, would equal 12 to 24 pounds. In order for people who weigh over 240 pounds to lose 10 percent of their weight in six months, a cut of 500 to 1,000 calories per day would be necessary to lose one to two pounds a week, which may be reasonable. For those who have more weight to lose after reaching their goal in the initial six-month period, the key recommendation is to first maintain that loss before readjusting diet and exercise plans to lose more weight.
Q: I hear conflicting reports about how many eggs we should eat. What's the truth?
A: In the past, health experts thought the egg's high cholesterol content might endanger heart health. But in recent years, several studies have shown that egg consumption does not necessarily raise blood cholesterol or increase risk of heart disease. Current heart-related nutrition recommendations still encourage limiting eggs to no more than four a week, especially the yolk, which raises health concerns. But it is clearly much more important to limit foods high in saturated fat (fatty meats and dairy products) and trans fatty acids (stick margarine and commercial baked goods, doughnuts and deep-fried foods). When it comes to cancer risk, a landmark report from the American Institute for Cancer Research (AICR) notes that high intake of eggs or cholesterol could possibly increase risk of some forms of cancer, but many other aspects of what we eat have a much greater influence on cancer risk. Set your priorities on a low-fat, plant-based diet. Eggs are an inexpensive source of protein and other nutrients, so if they don't send your blood cholesterol soaring, enjoy them in moderation. Just have fruit on the side, instead of sausage or bacon.
Q: What's the difference between albacore, white and light tuna?
A: "White" tuna is albacore tuna. It has a milder flavor and whiter flesh than the tuna labeled "light," which can come from skipjack or yellowfin tuna. Albacore (or "white") tuna is usually a little more expensive and slightly higher in calories and fat, but from another point of view, the extra cost could be worthwhile. The tuna's fat is the type known as "omega-3 fatty acids," which has been linked with possible protection against heart disease. Researchers are exploring whether this fat might also offer some protection against cancer. When buying canned tuna, you can save money by choosing "chunk tuna," which includes smaller pieces than "solid tuna."
Q: At a fast food store, which is healthier: chicken nuggets or a small burger?
A: People often assume that chicken is always leaner than beef, especially hamburger meat. But when chicken is breaded or battered and deep-fried, it’s not a low-fat choice. One of the biggest impacts on the calorie and fat content is the portion size you choose. But between approximately equal portions, like a small nugget order versus the smallest size hamburger, or a medium-to-large order of nuggets versus a medium burger, the chicken nuggets will have 50 to 100 percent more fat than the burger. The overall calorie load of the two orders will be about equal, but the chicken nuggets contain less protein and more fat than the burger. On the other hand, most restaurants now have some sort of grilled, marinated unbreaded chicken breast, which would be the best choice of all. Order the sandwich with no mayonnaise (many come drenched in it if you don’t specify), and you’ll get a 300-calorie choice that’s quite low in total and saturated fat.
Q: Do the white patches on frozen food mean it’s unsafe to eat?
A: No. Those white, dried-out patches, called “freezer burn,” affect the quality, but not the safety of frozen food. To avoid the somewhat “off “ flavor that freezer burn causes, wrap food well before freezing in heavyweight foil, freezer paper or freezer bags, pushing air out before sealing the package. Freezer containers are also fine, as long as they have a good seal.
Q: Does vegetable-topped pizza supply at least one serving of vegetables?
A: Most commercial pizzas don’t supply that much. If you order a combination of several different veggies, the entire pizza might contain a cup or so. When you have pizza delivered, it’s easy to add a few veggies of your own to get a half-cup serving for one or two slices of pizza. While waiting for the delivery, microwave, steam, or sauté some vegetables like mushrooms, bell peppers, broccoli, or artichoke hearts (frozen, then thawed or canned, rinsed and drained). You can even use fresh spinach, and microwave it right in the bag. (You can sprinkle them lightly with a little Parmesan for extra flavor.) Don’t forget that making homemade pizza is easy with pre-made crust or dough. You can load the pizza with vegetables, making it that much tastier.
Q: What are the best and worst nutritional choices at a Mexican restaurant?
A: To keep dietary fat to a healthy level, choose grilled chicken, seafood and lean cuts of beef or pork. Choose chicken, seafood and vegetable fillings for tortillas rather than ground beef. Dishes made with cheese contain a lot of fat. Although chicken fajitas may be cooked with some fat, ordering them instead of chicken enchiladas (which are covered with melted cheese) will save over 100 calories. You can also save fat by avoiding or carefully limiting your use of sour cream and guacamole. Some restaurants offer reduced-fat sour cream and cheese, but you should still eat these foods in limited amounts because their fat and calories can add up quickly. You may want to take the edge off your hunger and reduce your risk of over-eating by ordering some low-fat black bean or gazpacho soup to start the meal. And, as at all restaurants, try not to order too much. If you're served a large portion, put aside the excess before you begin eating and ask for the remainder to be packaged to take home. If you're trying to limit calories, it would be smart to decline the basket of tortilla chips offered as an appetizer. Most people find that once they start eating them, it's hard to stop.
By Karen Collins, MS, RD, CDN
American Institute for Cancer Research
Reproduced with Permission
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