Tuesday, April 4, 2017

How and What to Feed Your Kids

My nephew Hal (now an adult) eats his vegetables!
We've been doing Facebook Live sessions on Tuesday's on the Good Day Alabama show right before or after my nutrition segment. I always get a lot of really good questions from viewers. Today, a lot of people asked questions about getting kids to eat healthy and what to feed kids. When I was an undergrad in clinical nutrition, our textbook for pediatric nutrition was by Ellyn Satter. She's a registered dietitian and a social worker. She's pretty much the queen of child nutrition and her advice is practical, healthy, and based on science. One of my favorite things shes says is that parents are responsible for what foods are offered to the child while the child is responsible for how much they eat. She recommends offering children choices and then letting them decide among those choices.

 You can visit her wonderful website here: Ellyn Satter Institute

While child nutrition is not my expertise, I have learned a few things over the years - particularly the years I worked at Head Start: 

  • Children do like healthful foods - but you as the parent or other responsible adult need to offer the children healthy foods and have them available. I will never forget hearing a child say "Who doesn't love a grape? I just wish my mom would buy them!". 
  • Adults need to model healthful eating. You can't expect kids to eat healthy if you don't - so be a good role model.
  • Kids like to be involved in grocery shopping and food prep. Getting kids involved in the food prep process and trying a variety of foods at family meals can help kids learn to like healthful eating!
  • Don't make foods off limits. When you tell a child that a food is bad and they shouldn't eat it, it only makes them want it more. We adults are the same way! So let your kids have candy and chips - but as part of an overall healthy eating pattern. Read Ellyn Satter's advice on how to handle "forbidden foods" with kids so that they don't feel deprived but also learn to eat healthy foods too!  

 We'll be talking about this topic more on Good Day Alabama so keep watching!  

Beth Kitchin PhD RDN
Assistant Professor Nutrition Sciences
University of Alabama at Birmingham

Tuesday, March 28, 2017

Kids Can Drink Juice Without Weight Gain

There’s been a backlash against juice over the last couple of years. Why? Well, juice has as many calories per ounce as soda. And those calories come from fructose – the natural sugar that gives fruit all of its calories. Juice became a victim of the unfounded hysteria over sugar and fructose. I’ve heard people say “juice is bad for you”. Many people have told me they’ve given up juice and just eat whole fruit. That’s not a bad idea – because whole fruit does have way more fiber in it than juice. But do you have to completely eliminate juice from your diet? Especially if you like it? I’ve always told people that drinking juice is fine – and now I have some research to back it up!

Some health experts have been telling parents not to give their kids juice because it can lead to obesity. Now of course, making a blanket statement like that without any attention to how much juice is pretty ridiculous. This week, an analysis of juice studies published in the journal Pediatrics shows that juice in moderation is not associated with weight gain in children. The researchers analyzed data from eight studies for a total of 34,470 boys and girls under 18. They found only a slight associated increase in BMI (body mass index) in children age 1 to 6 who drank 6 to 8 ounces of 100% fruit juice a day. This slight increase did not put children at risk for obesity. In children and adolescents age 7 to 18, there was no link at all between fruit juice and weight gain. 

So, here are some guidelines for drinking juice:

  • Look for 100% fruit juice

  • Don’t drink juice to quench thirst

  • Limit juice to 8 ounces a day for children particularly

  • Eat whole fruit for most of your daily fruit servings

  • Mix juice with mineral water

100% fruit juice is high in vitamins like vitamin C and folate and also high in potassium – a mineral that helps keep blood pressure low. Some people with diabetes notice that some fruit juices raise their blood sugar, so they may need to limit juices. That makes sense. Otherwise, some juice every day can be good for you! For people who like juice, I recommend drinking a cup a day to count as one of your daily fruits and then eating whole fruit for the rest of your servings! 

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham

Auerbach BJ, Wolf FM, Hikida A, et al. Fruit Juice and Change in BMI: A Meta-analysis Pediatrics. 2017;139(4):e20162454

Monday, March 6, 2017

Taking a Closer Look at Eye Supplements

If you’re taking a nutritional supplement for your eyes, you might want to take a close look at what’s in it.

Back in 2001, a well-done study by the National Eye institute found that a specific combination of nutrients could slow down the progression of age-related macular degeneration. Macular degeneration is one of the biggest causes of blindness in people over the age of 65.

The landmark study is “AREDS” (Age-Related Eye Disease Study). The researchers randomly assigned over 3600 participants either to a placebo or to a high dose supplement. The researchers found that the participants on the AREDS supplement reduced their risk of progressing to advanced disease by about 25%. The researchers also looked at whether the supplement had an effect on cataracts. It did not.

The Original AREDS Formula:

500 mg vitamin C
400 IU’s vitamin E
15 mg beta-carotene OR Lutein/Zeaxanthin
80 mg zinc (as zinc oxide)
2 mg copper (as cupric acid)

While this was great news for people with macular degeneration, there were some problems with the supplement:

1.    The high amount of supplemental beta-carotene had been shown in other studies to increase the risk of lung cancer in smokers.
2.    The high level of zinc caused stomach upset in some of the study participants
3.    The original formula did not have lutein or zeaxanthin or omega-3 fatty acids which some researchers thought might help

So, researchers started the AREDS 2 study to answer these questions.

They found that cutting the beta-carotene and replacing it with lutein and zeaxanthin was effective and safer. They also found that the omega-3 fatty acids did not slow down macular degeneration. So now we have the new AREDS 2 formula that came out several years ago. They also found that reducing the zinc didn’t change the effectiveness.

Here’s what you should look for in an eye supplement:

AREDS 2 Formula:

500 mg vitamin C
400 IU vitamin E
10 mg lutein
2 mg zeaxanthin
80 mg zinc
2 mg copper
These amounts are much higher than what you could get in your diet or in a typical vitamin/mineral supplement.  Of course, after the first AREDS study came out, sales of eye supplements boomed. But some of these eye supplements are not the AREDS formula and probably won’t give you the results you want.

The supplement only helped people at the intermediate and advanced of macular degeneration. People in the early stages did not see much benefit. So this high-dose supplementation is only for people with intermediate or advanced stage macular degeneration and should only be taken under the supervision of an eye doctor.

The Bottom Line: If you have macular degeneration, talk to your doctor about which eye supplement is best for you.  Read the labels carefully to make sure they have the right combination of nutrients in them.  If you are shopping for the supplement, you need to compare directly the label on the bottle with the information from the National Eye Institute.  And remember, if you do not have macular degeneration, there is no proof that an eye health supplement will help prevent diseases of the eye!

For more information on eye supplements, the ARED2 study, and advice on whether you need an eye health supplement, visit the National Eye Institute site. 

Beth Kitchin PhD RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham

Thursday, February 23, 2017

Lower Your Risk of Breast Cancer with these 3 Science Supported Habits

Breast cancer is the most common cancer in women. One in eight women will get breast cancer in her lifetime. Medical treatment can cure it in many women. However, experts estimate that 40,700 women will die of breast cancer this year. Like all women, I want to know how to reduce my risk. I don’t have a family history of breast cancer – but many women who get it don’t have one either. So, I went looking for the best evidence on what we can do to lower our risk.  One of best websites for solid, science based cancer prevention recommendations is the American Institute of Cancer Research (AICR). They estimate that 33% of all breast cancer cases in the U.S. are preventable. That means 81,400 women who could avoid breast cancer. But how?

You can’t avoid all of the risk factors for breast cancer. Age and genetics increase your risk and you can’t do much about them. But there are some things you do have control over. Research shows that these three steps may actually lower your risk:   

Lower Your Breast Cancer Risk:
1.    Get to – and Stay – at a Healthy Weight
Extra body fat correlates with post-menopausal breast cancer risk. About 1 in 5 cases of breast cancer is in women with extra body fat. Fat tissue increases inflammation and hormones that promote cancer cell growth. Overweight and obesity correlate with 10 other cancers as well.

2.    Be Physically Active Every Day
Exercise helps lower the risk of both pre- and post-menopausal breast cancer risk. It can help you stay at a healthy weigh and boost the immune system. Thirty minutes a day may be all you need! It can be any activity – walking, gardening, dancing, swimming, hiking and the list goes on!

3.    Limit Alcohol
Alcohol can act as a carcinogen in the breast tissue. It can damage DNA and increase hormones that promote cancer. Women should limit alcohol to no more than one drink a day or seven per week on average. Less is best when it comes to alcohol and cancer risk. 

Now, those three are the most evidence-based recommendations. There’s a lot of interest in Mediterranean diets and the risk of cancers. One recent study showed that a Mediterranean eating style – particularly nuts and olive oil – reduces breast cancer risk. The study was a randomized controlled trial. That’s the kind of study that can actually show cause and effect. It's a really strong study design. But it’s just one study – so we can’t really make recommendations on it just yet. Also, the women in the study were eating around four tablespoons of olive oil a day! That’s a lot to work into your diet (although I’m pretty sure I’m getting at least two to three a day!). Some new research is also linking smoking with breast cancer.

But at least for now, you can take these three steps and rest assured that you’re doing all you can to lower your risk!

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham


The American Institute for Cancer Research (www.aicr.org)

JAMA Intern Med. 2015;175(11):1752-1760. doi:10.1001/jamainternmed.2015.4838

Published online September 14, 2015. Corrected on November 2, 2015.

Tuesday, February 21, 2017

What Those Food Product Dates Really Mean

Should you toss out those eggs or that carton of milk just because it’s past the “best if used by” date? What does it really mean?
You may be surprised to learn that food producers are not required to put product dating on foods – with one exception: baby food. But, food manufacturers often do put dates on foods. While that can be a good thing, it can also lead to a lot of food waste.

Here are just a few common dates you'll see on food labels and what they mean: 
·         "Best if Used By/Before" tells you when a food will be of best flavor or quality. It is not a purchase or safety date.

·          "Sell-By" tells the store how long to display the product for sale for inventory management. It is not a safety date.

·         "Use-By" is the last date recommended for the use of the food while at peak quality.

Most of the time, the food is still good for a few days (sometimes longer) past these dates. Now, two big food industry groups are trying to decrease the confusion about what these dates mean. The Grocery Manufacturers Association and the Food Marketing Institute are now recommending using only two dates: “best if used by" or “use by”. Manufacturers should use “best if used by” on foods you can use past that date. They should use the “use by” date on foods that really could be unsafe if they sit on the shelf or in the fridge too long.

These are just guidelines but the hope is that most food companies will be using them by sometime in 2018. We hope this will cut down on food waste but it could also be good for your budget!

So how do you know if a food should be thrown out? Give it a sniff. If it smells off, then throw it out. If you see mold or deterioration, definitely throw it out. In the case of hard cheese, you can cut away the mold and it’s still safe to eat. But my big tip is to freeze foods if you know you won’t be able to use it up soon after the date. This works particularly well with meats, shredded cheeses, and breads but just about anything can be frozen (with a few exceptions)! For more information on how long you should keep foods, what to do when the power goes out for a long time, and what foods freeze well, go to www.foodsafety.govhttps://www.foodsafety.gov/. This is a great website for learning about how to keep foods safe and maximize food quality. 

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham 

Monday, January 30, 2017

Eating for IBS: The FODMAP Diet

This is a re-post from a few years ago. This topic is getting continued interest so I thought I would re-visit it! 

            As a registered dietitian, I have been counseling patients with a variety of medical needs for years. The condition that has always left me empty handed when it comes to patient advice is irritable bowel syndrome (IBS). Most of our nutrition texts simply state “the patient has to figure out for themselves what foods they can and cannot tolerate”. Big help huh? Well, after a little searching, I found a little-known diet based on a little-know hypothesis that may help with IBS.

            First, a little background on IBS:

IBS is one of the most common disorders that doctors diagnose.

Ø  As many as 20% of Americans have IBS.
Ø  The good thing about IBS is that it is not a dangerous disease. There is no damage to the intestines with IBS and no risk of any long-term complications. Other intestinal diseases like celiac disease or Crohn’s disease where the intestine is actually physically damaged.
Ø  The bad thing is that IBS can wreck your life. People who have it experience bloating, abdominal discomfort, and can alternate between diarrhea and constipation. And there really isn’t a cure for it.
Ø  But the good news is that some people may respond well to a diet called the “Low FODMAP” diet.

           The idea behind it is that foods from 5 different groups tend to ferment in the intestine and contribute to the symptoms of people with IBS. The idea was developed and studied by an Australian nutritionist. While more research is needed to find out if it really works, it can’t hurt to try it. The foods are abbreviated by the acronym FODMAPS: Fermentable Oligo-, Di-, Mono-saccharides and Polyols. High FODMAP foods tend to ferment in your intestines and cause the symptoms of IBS. High FODMAP foods include prunes, apples, milk, watermelon, asparagus, avocado, corn, and wheat. But there are many more.

            You don’t have to completely eliminate all of the foods on the list – you may be able to handle some in small amounts. You may be more sensitive to some than others. So, if you are struggling with IBS, I recommend that you eliminate the FODMAP foods for several days to a week. If you find that your symptoms subside, then you can add back individual foods (one at a time) from the list to see which are more problematic for you. Obviously, keeping a detailed food record will be very important for sleuthing out the foods you need to ditch from your diet.

            I do recommend that you work with a registered dietitian to help you develop your own healthy, low FODMAP diet! You don’t need to simply eliminate all high FODMAP foods. In fact, cutting them all out could be bad for your diet. However, here is a list from Barbara Bolen, PhD, a leader in this research: 

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham 

Tuesday, January 17, 2017

Brain Food

The MIND diet was one of U.S. News and World’s top diet picks in last week’s big reveal of the best 2017 diets. Some studies show that following the MIND diet is associated with a lower risk of Alzheimer’s disease and better cognitive function.

How good is the research? The data is really preliminary – observational studies that can’t show cause and effect, just associations or correlations. So, what you’re reading is likely over-hyped. But what isn’t overhyped in nutrition news? However, if you’re interested in the MIND diet, it is a healthy, plant based diet that does not cut out large categories of foods. Even if it doesn’t live up to the hype, you could end up with benefits such as weight loss, heart health, and lower blood pressure because it is basically a combo of the Mediterranean diet and the DASH diet. These two diets have stronger research to support their benefits.

Let’s take a look at foods that supposedly give your brain a boost, and the foods you should limit.

Supposedly Brain Healthy Foods:

1.     Green Leafies (think kale, romaine lettuce, spinach) every day
2.     Other Vegetables – at least one a day in addition to the green leafies
3.     Berries – particularly blueberries and strawberries – a half cup several times a week
4.     Nuts & Seeds on most days
5.     Starchy Beans – every other day
6.     Olive Oil – use it as your primary cooking oil
7.      Whole Grains – like brown rice, whole grain breads and cereals – 3 servings a day
8.     Wine – a glass a day - but if you're a non-drinker, just             skip this one! 
9.    Fish at least once a week
10.  Poultry twice a week

Supposedly Brain Unhealthy Foods:
1.     Butter – less than one tablespoon a day
2.     Red Meat – 3 servings or fewer servings a week
3.     Cheese – fewer than 1 serving a week (undoable for cheese lovers and probably not             necessary to cut it out anyway)
4.     Fried Foods/Fast Foods – no more than once a week
5.     Sweets – 5 or fewer a week

Here’s a sample one day MIND meal plan:

3/4 cup bran flakes with ½ cup blueberries
1 slice whole grain toast with 2 tsp peanut butter

1/3 cup cashews
1 cup strawberries

      2 slices whole-wheat bread
3 ounces chicken
      1 teaspoon Dijon mustard
     1 cup romaine lettuce
     ½ cup raw vegetables
     1 tablespoon sunflower seeds
     Olive Oil Dressing


      1/2 cup romaine lettuce
1/2 cup baby spinach
1 tablespoon olive oil vinaigrette
3-ounce salmon cooked in olive oil
1/2 cup brown rice 
1/2 cup zucchini and asparagus spears
1 cup lima beans
5 ounces red wine

1/2 cup sliced almonds

Now, let me tell you what I don’t like about this diet.  Some of the restrictions are reasonable – others are not:

·For us cheese lovers, eating less than one ounce of cheese a week is crazy. And it’s probably not even necessary. And, yes, I have bit of a bias about cheese! I love it and will never give it up! 
·No mayo on your sandwich? For some that’s fine, others it’s not.
·I think the red meat guideline is pretty good – eating several servings a week is not too rigid.
·But I think with sweets, you can have a small amount every day to satisfy your sweet tooth. We should definitely limits sweets – but if you’re like me – I need a little chocolate every day!

So, here’s what I recommend. Start by focusing on the “brain healthy” foods like berries, nuts and seeds, olive oil, fish, and lots of green leafies. Find olive oil based salad dressing that you like or make your own and dress up your salad with nuts and seeds, tuna, chicken, and yes, a little cheese if you like it.  You don’t have to eat all your green leafies in salads. For instance, you can sautee spinach and kale in olive oil. Berries can be expensive – so look for frozen blueberries and strawberries and add them to yogurt or smoothies.  

Check out the U.S. News and World’s evaluation of this diet and many more: http://health.usnews.com/best-diet/mind-diet

Make sure you go to the “Expert Reviews” section for a good analysis of the claims the diets make.  

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham