A Vitamin Chart From the National Women’s Health Information Center

Lately I’ve been worrying about Kevin’s refusal to eat broccoli, and wondering what exactly is so good about those green bunches of roughage. In browsing the Web for more detailed information on the matter, I found a helpful vitamin chart.

This table comes from the HHS-sponsored National Women’s Health Information Center – a good spot to know of if you’re a woman looking on-line for reliable sources. It’s a bit simple for my taste. In the intro, we’re told there are 13 essential vitamins our bodies need. After some basics on Vitamin A – good for the eyes and skin, as you probably knew already – the chart picks up with a quick review of the essential B vitamins 1,2,3,5,6, 9 and 12 (my favorite), followed by a rundown on Vitamins C, D, E, H (that would be biotin) and K:

Vitamins, Some of their Actions, and Good Food Sources
Vitamin Actions Sources
A
  • Needed for vision
  • Helps your body fight infections
  • Helps keep your skin healthy
Kale, broccoli, spinach, carrots, squash, sweet potatoes, liver, eggs, whole milk, cream, and cheese.
B1
  • Helps your body use carbohydrates for energy
  • Good for your nervous system
Yeasts, ham and other types of pork, liver, peanuts, whole-grain and fortified cereals and breads, and milk.
B2
  • Helps your body use proteins, carbohydrates, and fats
  • Helps keep your skin healthy
Liver, eggs, cheese, milk, leafy green vegetables, peas, navy beans, lima beans, and whole-grain breads.
B3
  • Helps your body use proteins, carbohydrates, and fats
  • Good for your nervous system and skin
Liver, yeast, bran, peanuts, lean red meats, fish, and poultry.
B5
  • Helps your body use carbohydrates and fats
  • Helps your body make red blood cells
Beef, chicken, lobster, milk, eggs, peanuts, peas, beans, lentils, broccoli, yeast, and whole grains.
B6
  • Helps your body use proteins and fats
  • Good for your nervous system
  • Helps your blood carry oxygen
Liver, whole grains, egg yolk, peanuts, bananas, carrots, and yeast.
B9 (folic acid or folate)
  • Helps your body make and maintain new cells
  • Prevents some birth defects
Green leafy vegetables, liver, yeast, beans, peas, oranges, and fortified cereals and grain products.
B12
  • Helps your body make red blood cells
  • Good for your nervous system
Milk, eggs, liver, poultry, clams, sardines, flounder, herring, eggs, blue cheese, cereals, nutritional yeast, and foods fortified with vitamin B12, including cereals, soy-based beverages, and veggie burgers.
C
  • Needed for healthy bones, blood vessels, and skin
Broccoli, green and red peppers, spinach, brussels sprouts, oranges, grapefruits, tomatoes, potatoes, papayas, strawberries, and cabbage.
D
  • Needed for healthy bones
Fish liver oil, milk and cereals fortified with vitamin D. Your body may make enough vitamin D if you are exposed to sunlight for about 5 to 30 minutes at least twice a week.
E
  • Helps prevent cell damage
  • Helps blood flow
  • Helps repair body tissues
Wheat germ oil, fortified cereals, egg yolk, beef liver, fish, milk, vegetable oils, nuts, fruits, peas, beans, broccoli, and spinach.
H (biotin)
  • Helps your body use carbohydrates and fats
  • Needed for growth of many cells
Liver, egg yolk, soy flour, cereals, yeast, peas, beans, nuts, tomatoes, nuts, green leafy vegetables, and milk.
K
  • Helps in blood clotting
  • Helps form bones
Alfalfa, spinach, cabbage, cheese, spinach, broccoli, brussels sprouts, kale, cabbage, tomatoes, plant oils. Your body usually makes all the vitamin K you need.

(from womenshealth.gov, table accessed 2/19/2011)

Overall I’d say the chart is useful, a good place to start if you want to know, say, what’s a good, non-citrus source of Vitamin C. It could be improved by provision of more details, like the precise amount of Vitamin B2 per cupful of Swiss chard, and how preparing foods in distinct ways – like roasting, sautéing, boiling, or serving them raw – affects the nutritional value.

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Contemplating Diet and Nutrition: A First Look at the USDA’s New Guidelines

On Sunday afternoons I tend to think about food for my family. Sometimes that’s because we’re having a few more than usual at the dinner table. Also, it’s a time when I order the bulk of fish, meat, produce and other ingredients for the week ahead.

Since I had cancer, I’ve paid much more attention to the food I serve in our home than before. While a balanced diet is no fail-safe for avoiding disease, I do think it’s prudent to be aware of the variety and quantity of food we eat. In medical school we learned surprisingly little about nutrition. Most of what I know I’ve learned from reading books – like Michael Pollen’s In Defense of Food – and reading through detailed reports like the USDA’s new Dietary Guidelines for Americans (7th Edition) issued a few days ago.

From the press USDA and HHS joint press release:

Because more than one-third of children and more than two-thirds of adults in the United States are overweight or obese, the 7th edition of Dietary Guidelines for Americans places stronger emphasis on reducing calorie consumption and increasing physical activity.

The Times summed up the new guidelines nicely in its headline: Government’s Dietary Advice: Eat Less.

But it’s not a trivial report. Rather, it’s a hefty-if-printed (I didn’t) 112-page pdf with some fluff (even blank pages for notes) and some excellent, hard-to-find-elsewhere details on nutrients. Some highlights include Figure 5-1, which demonstrates with abundant clarity that we don’t eat sufficient fruits, vegetables, whole grains or most other recommended foods:

I’m still digesting (sorry, I can’t help myself) detailed chapters and tables in the full report. There’s a lot of useful information to take in. For example, Appendix 11, on p. 85, charts the “Estimated EPA and DHA and Mercury Content in 4 Ounces of Selected Seafood Varieties” – handy if you serve fish for dinner at least twice per week, and like me, figure it’s best to hedge on potential toxic effects by serving a variety of fish.

More from the press release, on tips that will be provided to help consumers translate the Dietary Guidelines into their everyday lives:

• Enjoy your food, but eat less.

• Avoid oversized portions.

• Make half your plate fruits and vegetables.

• Switch to fat-free or low-fat (1%) milk.

• Compare sodium in foods like soup, bread, and frozen meals – and choose the foods with lower numbers.

• Drink water instead of sugary drinks.

All of these seem wise, but obvious. Still, it’s clear that most of us aren’t following the guidelines, or even common sense.

Setting guidelines should help, so teachers in schools and cafeteria-caterers can know what to tell and feed kids, so they develop good eating habits. But really I think that most of the information, if you can call it that – what constitute our dietary habits begun in childhood – has to be cultivated in our homes, the popular culture and community at large. So my plan is to delve further into the USDA report, and elsewhere, and once each week (maybe) post a nutritional ML. I hope it won’t be too simple or boring.

Like a diet, we’ll see how this goes –

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The Broccoli Connection

(considering the Future of Health Care in America, and Life on TV in the Office)

This week’s NEJM is filled with good stuff.

There’s a super-extra-really important article on a new breast cancer drug, a PARP inhibitor called iniparib, for patients with triple negative breast cancer, and an accompanying editorial that matters. (Some ML readers might want to take a look at an article I wrote for Cure Magazine on new drugs, including PARP inhibitors, for treatment of metastatic breast cancer.)

There’s a perspective I still need to read on the scope of what nurses might do. Another on future nurses, and another on how to assess an ACO, which by the end of this health news-rich week every citizen should know stands for an Accountable Care Organization.

And there are some stomach-churning letters about the mammography screening debate.

But for this Friday morning, I’ll just mention the perspective piece called Can Congress Make You Buy Broccoli? And Why That’s a Hard Question. Really I think the better question is whether or not the government can force people to eat broccoli.

Michael waves a broccoli stalk in front of Kevin on the Office

And how could those NEJM authors have anticipated last night’s episode of the Office, that Michael would break HR rules by forcing Kevin to eat a stalk of raw broccoli, because he’d made a new year’s resolution to eat more vegetables? Kevin spat it out, forcefully and problematically for some viewers.

My tentative conclusion is that someone needs to teach Kevin and his colleagues how to cook.

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The U-Shaped Curve of Happiness

This evening, when I finished cleaning up the kitchen after our family dinner, I glanced at the current issue of the Economist. The cover features this headline: the Joy of Growing Old (or why life begins at 46). It’s a light read, as this so-influential magazine goes, but nice to contemplate if you’re, say, 50 years old and wondering about the future.

The article’s thesis is this: Although as people move towards old age they lose things they treasure—vitality, mental sharpness and looks – they also gain what people spend their lives pursuing: happiness.

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Cooking With Universal Precautions

A half-billion or so eggs were speedily pulled off semi-cooled supermarket shelves this week. The concern is that bacteria-laced eggs can cause serious and even deadly illness. The companies that produced and disseminated those marked eggs fear more lawsuits. Some people who usually enjoy their eggs in the morning, sunny-side up, are thinking twice.

The greatest egg recall ever set off alarms on CNN (Paging Dr. Gupta), on the front page of my newspaper’s business section, on some health blogs and in some homes. I’m concerned and saddened by this, about the cost of all this – the frank wastefulness of it. Our food supply is not infinite.

But I’m not particularly worried about getting sick from eating eggs at this time. Rather, I’ve been aware of this potential problem at least since 1984, when I took classes in microbiology. That raw or undercooked, runny eggs can effectively deliver salmonella to the digestive tract is something doctors learn in medical school. (And, maybe, the rest of the population should be taught in what used to be called home economics?)

In my home we don’t eat a lot of eggs, mainly because of my personal aversion and fear of cholesterol-lowering drugs. We go through perhaps a dozen eggs in most months. But when I do cook with eggs, whether that’s in baking a quiche, vegetable soufflé or cake, or rarely, for breakfast in omelet or scrambled form, I cook them thoroughly, applying heat through-and-through, and keep any utensils that have touched raw egg apart from anything else in the sink or on the kitchen counter.

Shifting gears, just a bit – this story reminds me of a gradual change in how we practiced medicine in the years after the start of the AIDS epidemic. In 1983, when I entered medical school, few doctors wore gloves except when they were performing surgery. At Bellevue Hospital in 1985 and 1986, my classmates and I helped to deliver babies with our bare hands.

Gradually, and as fear caught on, some doctors started to discriminate – they’d wear gloves while drawing blood from a patient with obvious risk factors for HIV, such as a promiscuous homosexual man or an intravenous drug user. But I always thought to myself, you never know who’s got what virus, we should be careful more often.

A few years later, when I was a resident physician and pregnant fellow, the concept of universal precautions came into widespread practice.  Doctors and nurses learned – had to be instructed – to don gloves whenever they drew blood or potentially came into contact with any patient’s body fluids because, the idea emerged, anyone might have HIV. Better to be careful in general, without prejudice.

These practices annoyed some at first. For doctors, they cost us time and the value of touch. Among other problems, it became suddenly more difficult to insert an IV catheter in one shot because feeling a patient’s vein is a lot harder when there’s a layer of material between your fingers and the patient’s skin. I suspect, also, that some hospital administrators must have resisted, too, because of all the money needed to buy all those gloves and new-fangled needle-dispenser boxes.

Some food-minded folks and editorialists suggest that risk might be reduced by buying less-travelled eggs from local producers. But regardless of where you live and shop for food, local farmers vary in their practices and habits. As for organic farms, there’s no real evidence that those are cleaner than other agricultural sources. (Some may be, but which? It could go either way.)

This situation bears some analogy to the reason why doctors implemented universal precautions in medicine. Some of us harbor prejudice (and maybe even some anger or resentment…) against efficient, industrial-sized food-growers and may be, accordingly, biased and even lenient in attitudes on standards and regulations for local farmers’ markets. And so the danger is, we may be less careful with eggs from a small-scale farm down the road. Those eggs seem OK, or at least we feel better about their purchase.

My point is, it’s generally better to behave without bias.

I think it would be smart for cooks to use universal precautions when handling eggs. There’s always some risk of contamination by salmonella and other disease-causing bacteria. I cook eggs well, regardless of their source or what’s picked up in today’s news.

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The High Cost of Food-Borne Illness, and Some Steps To Avoid These in Your Home

A new report from the “Make our Food Safe” project, based at Georgetown University, makes clear that food-borne illnesses – from bacteria, parasites and a few viruses – are ever-present and costly.

The study, authored by Robert Scharff and funded by the Pew Charitable Trusts, finds that food-borne illnesses tally nearly $152 billion per year. This measure includes some subjectively-measured expenses like pain, suffering and missed work. Even without those, the toll registers above $100 billion – a huge sum, either way.

The main culprits are familiar: salmonella, that commonly reside in uncooked poultry and eggs, sometimes lace vegetables and lately tinge peanut butter, causes some 1.5 million illnesses per year. E coli 0157:H7, a dangerous bacterial strain that turns up disproportionately in ground beef and recently on fresh spinach leaves, is less prevalent but more often damaging; it takes kidneys and sometimes lives.

The Centers for Disease Control (CDC) provides a lot of useful information on its website regarding food safety.

As a doctor, and as a mom, I see this report as a nudge to be mindful in our kitchens, to follow what should be obvious advice from a collectively-conjured grandmother.

1. Before starting to prepare food, wash your hands with soap. Do this again after handling any raw meat, eggs or fish.

2. Keep raw meat, especially poultry, apart from any surfaces where cooked food is placed, stored or served. Cook chicken thoroughly, always.

3. The same goes for eggs.

4. Salad is one of the most dangerous foods we eat. It’s loaded with dirt from the ground. To wash lettuce for salad, let water pass over each leaf and rinse, fully, at least three times. Tomatoes should be handled similarly. Carefully peel carrots, cucumbers and most other vegetables if they’re to be eaten raw.

5. Unpeeled fruits like grapes and berries are handled like vegetables for salad; they’re washed at least three times.

(N.B.: this method of aggressively washing produce 3x is hardly full-proof; it reduces the amount of dirt on the surface of fruits and vegetables but does not completely eliminate germs.)

6. It’s hard, if not impossible, to adequately wash leeks, scallions, potatoes, mushrooms and most other vegetables. These are best washed and then cooked by sautéing, roasting, steaming or another method. The point is to cook with heat – of sufficient duration and intensity – to kill most bacteria, parasites and other germs.

7. Hygiene matters, especially around the kitchen and eating area. It’s a good idea to wipe down the table and kitchen counter surface after each meal.

These are just some suggestions for ways we can reduce the likelihood of being affected by food-borne illness at home. For people whose immune systems are compromised, such as those undergoing chemotherapy, with HIV and some other conditions, there’s reason to take extra care with salad and raw produce.

Knowing what we do about food-borne illnesses can influence choices we make when we eat outside of our homes. For example, in a restaurant, I’ll eat cooked but not raw spinach, because I know how difficult it is to properly wash that vegetable. If I order a burger, I’ll ask that it be very well-done, to minimize the risk from e. coli.

When traveling, I sometimes avoid uncooked fruits and vegetables entirely – but that’s another story.

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