A Poster for Healthy Eating, 1940s Style

A curious diagram appeared in the most recent NEJM, in a perspective on U.S. dietary guidelines. It’s a USDA food wheel from the early 1940s. With Twitter-like style, it says: “For Health…eat some food from each group…every day!

The details are rich: “butter and fortified margarine” constitute 1of the 7 groups. Further inspection-worthy, IMO.

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New York City Mayor Bloomberg Promotes Healthy Lifestyle Choices

In the city where I live, it’s hard to buy a muffin at a Starbucks without stepping back from the counter and reconsidering. Swallowing 460 calories for a minimal-nutrient breakfast seems foolish.

So I eat fewer muffins than I used to. The posted nutritional tidbits, however imprecise, on the contents of pieces of quiche, slices of pizza and cups of thick soup, stick with me when I travel, and at home.

That’s me, just n=1.

Yesterday the mayor gave a speech at the U.N. He’s quoted in today’s WSJ health blog:

In a speech to the U.N. General Assembly earlier this week, Mayor Michael Bloomberg rattled off New York’s achievements: a tough anti-tobacco campaign that made cigarettes, at about $11.20 a pack, the most expensive in the nation and led to a reduction in adult smoking rates to 14%  in 2010 from 22% in 2002 (the national rate is 19.3%). A ban on artificial trans fats. Calorie labeling in restaurants. Ad campaigns linking soda consumption to obesity, and a national salt-reduction initiative.

No wonder, he noted, that life expectancy for New Yorkers has risen faster and is higher than for Americans overall, having increased 1.5 years to 79.4 years from 2001 to 2008.

These are just correlative findings. But they support, circumstantially and in my mind, for one, that public policy can impact human behavior and health.

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Mars Chocolate Company Advertises With Broccoli

MARS chocolate ad

The other day, over lunch, I was reading the Sept 2011 issue of the Atlantic and came upon this image on p. 37. According to the not-so-fine print, this full-page broccoli fix is sponsored by MARS chocolate, North America, website listed:


So we can find out about nutrition from the company that manufactures M&M’s, Snickers, Twix, MilkyWay and 3Musketeers.

Part of a trend –

The New Yorker recently ran a profile of PepsiCo CEO Indra Nooyi that almost persuaded me the super-sized soda-based conglomerate does the right thing in the healthy living department.

Kinda like Shell, Exxon and BP doing good work for the environment.

Got it?

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New Fairway Delivers Fresh Produce to My Neighborhood

On the local, national and nutritional fronts:

How refreshing, in this heat, that Fairway opened a new store on East 86th Street yesterday. Coincidently, Michelle Obama’s push to eliminate “food deserts” – places where it’s hard to find affordable fresh produce and other healthy foods – was highlighted this week when several big retailers signed on to the initiative.

PHOTO CREDIT: DNAinfo/Amy Zimmer (Manhattan Local News)

There was a carnival-like atmosphere on the sidewalk outside the new store, which occupies a large, multilevel space where there used to be a Circuit City (bankrupt, closed) and a Barnes & Noble (moved). Inside, I made a rough tally of unpackaged (6 varieties), nectarines (4), plums (3), string beans (4, including a yellow variant I’ve never seen before), potatoes (11 non-sweet, +  yams and “yellow yams”), onions (7), mushrooms (5), not counting the pre-packaged kinds), peppers (11), tomatoes (9) and beets (3).

You get the picture: if you’re looking for a fresh ingredient and it’s available anywhere New York, chances are you can find it here. Downstairs, there’s fresh fish, meat, coffees, baked goods, and tons of regular and organic grocery items. I counted 22 types of pure honey, not including differently-sized items of the same brand and flavor, and then stopped. Upstairs, there’s a limited selection of prepared foods, a competitively-priced smoked fish counter, a wide cheese selection, dried fruits, nuts and more.

I spent a while meandering through, and heard only positive comments. The shoppers seemed happy; the employees registered glee. A woman next to me on a briskly-moving line summed up the consensus: “This is the best thing that’s happened to the neighborhood in years.”

We should all be so lucky –

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Cooking With Leeks

A note on cooking with leeks, inspired by a NYT Well post with a list of related Recipes for Health:

I use leeks all the time, as my neighbors are probably too aware. I use leeks sautéed in olive oil as filler, mixed with an egg and flour for a tart, or to season simple pasta, or to flavor and decorate roasted potatoes.

How I prepare leeks is this:

First I cut off the base and ragged tips of 3-4 stems, slice the mainly dark-green stems lengthwise, and then cut the stalks into 1 – 3 inch sections, depending on what they’ll be used for. Because there’s often dirt from the ground deep in the lower, paler sections of the leeks, I manually expose and separate each rounded layer, and then wash everything  under briskly-running water, thoroughly rinsing at least three times.

You don’t have to dry the cut, washed leeks. What I do is heat a heavy, wide pan on the stove, add a thin layer of olive oil, and then throw on the damp (or dry) leek pieces. With the flame set low, I toss on about a half teaspoon of salt for a volume of 3-4 large stalks. Sometimes I add fresh ginger, cut into tiny pieces, into the mix.

And then I work on other things in the kitchen – often while listening to NPR or talking to my mom on the phone – while the leeks wilt. If I’m running late, I’ll put a lid on the pan, which makes the leeks soften faster, but that’s not ideal. Every few minutes I stir them around a bit with a wooden spoon or spatula, until they’re soft and, typically, shiny with varied shades of green.

You can store cooked leeks in the refrigerator for a few days, if they’re in a sealed container. So you might, as I have, use a small amount with pasta on a Monday, and then use the remainder for a goat cheese and leek tart later in the week. There are many variations, and I’ve only started using this vegetable in the past four years or so.

This summer I intend to try making a potato-leek soup.

According to Martha Rose Shulman, writing for the Times, leeks are milder than onions but contain sulfur compounds present in onions and green garlic that some people find hard to digest. Leeks are a good source of nutrients like lutein and zeaxanthin, carotenoids – thought to be important in vision, calcium, iron, magnesium, phosphorus, potassium and vitamin K. Leeks are fiber-rich, I might add.

I should learn more about each of these elements; how they’re best cooked and absorbed. Unfortunately I’m still searching for the nutrition textbook they never assigned in med school.

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A Nutritional Tidbit, on Quinoa

I first heard about quinoa a few years ago, when food-sellers started marketing the stuff as a cereal-like, cholesterol-lowering nutritious substance.

Chenopodium Quinoa (Wiki Commons)

It’s from the Andes, I knew, and comes in some varieties. If you purchase the raw stuff or receive a gift, say, from a Peruvian person who knows her quinoa, you’ll find quickly that you have to rinse it a few times with water before cooking it with whatever seasoning you choose, such as cilantro or just a pinch of salt, or with some olive oil and ground pepper, cinnamon or curry, because the starch has to be rinsed of its saponin (soapy) coating.

What I learned yesterday, beginning with an informative feature in the Times, is that quinoa is not a grain but a seed. According to that article and Wikispecies (a fabulous web-find, in itself), quinoa belongs to the chenopod family or subfamily of plants which includes the likes of beets and spinach. The word chenopod stems from the Greek roots: <chen> (goose) and pod (foot), as in goosefoot. These are said to be flowering plants that lack petals.

The U.S. MyFoodPedia site is devoid of information on quinoa, as is the USDA’s Nutrient Database, as of this morning. Sellers say it’s rich in fiber, protein and minerals. A research study published by agricultural scientists based in Santiago, Chile, found an ideal balance of amino acids and minerals mixed in the starch, along with omega-6 oils and vitamin E.

In my fourth year of medical school, I spent most of two months in Bolivia studying infectious and other diseases in Cochabamba. But I don’t think I ever tried quinoa. And it’s definitely not something I learned about in class.

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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
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Needed for healthy bones, blood vessels, and skin
Broccoli, green and red peppers, spinach, brussels sprouts, oranges, grapefruits, tomatoes, potatoes, papayas, strawberries, and cabbage.
  • 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.
  • 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.
  • 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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