This Issue

Decoding the food we eat

Healthy?
Read the fine print first

Grains: It's better to be whole than refined

Q & A

A closer look


What’s in a name?


Many nutrients go by several different names. Learn to spot the “hidden” ingredients.


Sugars

• Words ending in “ose,” such as fructose and sucrose

• Molasses

• Honey

• Maple syrup and corn syrup

• Fruit juice concentrate

Salt

• Sodium

• Baking soda

• Monosodium glutamate (MSG)

• Sodium bicarbonate

• Sodium phosphate

How to spot added sugar

Tips to reduce salt

What's in a name?

Helpful Resources:


A closer look

Where you least
expect it


The words “calcium carbonate” in the list of ingredients give it away. If the labels don’t tell you the entire story, the ingredients can fill in the blanks. Ingredients are listed in descending order by weight, which means the first ingredient makes up the largest proportion of the food.

This is actually a supplement that contains calcium and vitamin D — both recommended for strong bones and overall good health.

The chews contain more sugar than either calcium or vitamin D. And the words “hydrogenated coconut oil” may indicate a small amount of trans fat, one of the leading contributors to cardiovascular disease. In addition, although some oils, such as olive and safflower are recognized as healthy fats, coconut oil does not make the list.

The bottom line is: Read all nutrition facts — even on medicines and supplements, and decide what works best for you.

Size matters

A step-by-step approach

Risk factors
• Tobacco use

• Heavy alcohol use

• Combined tobacco and
alcohol use

• HPV infection
• Sun (cancer of the lip)

• Exposure to chemicals,
such as asbestos

• Poor diet — lacking in
fruits and vegetables
Another good reason to visit the dentist


“All you have to do is open your mouth.”

— The Head and Neck Cancer Alliance


The oral cancer examination is painless and quick … and life-saving. When cancers of the head and neck are found early, the cure rate is high. Annual screenings by a doctor or dentist should be a part of your regular physical or dental checkup. The provider:

• Inspects your face, neck, lips and mouth.

• Feels the area under your jaw and the sides of your neck, checking for unusual lumps.

• Asks you to stick out your tongue to check for swelling, color and texture.

• Using gauze, lifts your tongue and pulls it from one side, then the other.

• Checks the roof and floor of your mouth and the back of your throat.

• Feels and examines the insides of your lips and cheeks for red or white patches.

• Places one finger on the floor of your mouth and, with the other hand under your chin, presses down to check for unusual lumps or sensitivity.

Source: National Institute of Dental and Craniofacial Research

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.


Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon
617-638-8260

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
617-636-1664
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
617-573-3340
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.
781-326-4600

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
617-726-0218
Remember to call ahead to confirm
time and date
of screenings.

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Keeping children on a safe path

Wondering how to keep children from starting to drink or smoke? Start young — preferably before your child experiments with either one — to build a sturdy foundation.

• Talk to a school guidance counselor or your child’s doctor about free, helpful programs for parents on guiding healthy behaviors.

• Brainstorm with your child about ways to say no to risky behavior. Aim for a full scale of options between “No, thanks” and “Stop asking — I said no.”

• Discuss good reasons not to drink or smoke. Ask children what they think and share your beliefs and values. Talk honestly about relatives who had health problems or died due to tobacco or alcohol addictions. Problems like bad breath, yellow teeth and embarrassing behavior may be persuasive, too.

• Set expectations for healthy behaviors. Use simple rewards and consequences to encourage good behavior.

• Set an example. If necessary, try to quit smoking or drinking too much.

• Keep lines of communication open. Check in regularly about how the day went. Ask about plans, friends and activities.

• Call your child’s doctor or guidance counselor for more help if you think your child is smoking or drinking.

Food Nutrition Labels:
Decoding the food we eat


Understanding nutrition facts labels helps consumers make wise choices when purchasing foods. The labels are on the back of all packaged goods and beverages.

In this case, the numbers tell a surprising story. Though a recent national poll determined that the number of adults who read a book within the past year is on the decline, the percentage of people who reported checking nutrition facts labels on foods is on the rise.

According to its most recent survey in 2008, the U.S. Food and Drug Administration (FDA) found that more than 50 percent of those interviewed — a 10 percent increase in six years — indicated that they frequently check labels to determine whether they should buy or avoid certain foods.

Furthermore, 91 percent of the interviewees said they understand the link between diet and heart disease and 62 percent pointed a guilty finger at trans fat as one of the culprits for the disease.

Nutrition facts labels were mandated by the Nutrition Labeling and Education Act of 1990. Food manufacturers are required to show the facts of the nutrition of their products and include serving size, calories, nutrients and percent daily values of those nutrients. The law applies to all packaged foods and beverages, excluding meat, poultry, fish and fresh fruits and vegetables.

Since 1994, two changes to the law have occurred. Effective Jan. 1, 2006 — thanks in part to researchers at Harvard University’s School of Public Health — the number of grams of trans fat was added, and as of Jan. 1, 2012, meat and poultry must comply with labeling guidelines.

The food labels are a boon to consumers — if they pay attention and interpret them correctly. “The food label gives consumers the power to compare foods quickly and easily so they can judge for themselves which products best fit their dietary needs,” explained Barbara Schneeman, Ph.D., the director of the FDA’s Office of Nutrition, Labeling and Dietary Supplements.

Stephanie Spaide, the director of the outpatient services in the Nutrition and Weight Management Center of Boston Medical Center, agrees. “They [food labels] give people the ability to identify what they are putting in their body,” she said. “It helps to understand what’s good to eat or what to avoid.”

In addition, she explained, the labels allow a person to compare products. For instance, if one container of yogurt contains 80 calories and another 240 calories, “there’s a lot of something in that higher container,” she said.

Spaide recommends a simple and practical approach to mastering nutrition labels. “Start out with the one thing you’re focusing on.” Some may be concerned about calories, while others are trying to increase their calcium intake. “Pick one thing and start at ground zero,” she recommended.

High blood pressure is a case in point. People prone to high blood pressure should choose foods that are lower in sodium, which takes some doing given the high salt content in several foods, such as soups, salad dressings and frozen meals. “Foods that contain 400 milligrams (mg) or more of sodium per serving have a high sodium content,” said Spaide.

The nutrition facts are listed on the side or back of the packaging. Key to understanding the labels is serving size, which is typically measured in cups, grams or number of pieces. The serving size dictates the rest of the nutrition facts. For instance, if a person consumes two cups — or twice the serving size — the rest of the nutrition information is doubled as well.

That means if 150 of the calories come from fat in a single serving, 300 of the calories come from fat in two servings — a significant factor for those on a restricted fat diet.


Stephanie Spaide, M.S., R.D., L.D.N.
Director, Outpatient Nutritional Services
Boston Medical Center
Serving sizes can be a bit tricky and are usually much smaller than one estimates. A serving size of ice cream is half a cup — not the heaping bowl people are more prone to dole out. A portion of a bran muffin can be one-third of the muffin — a mere bite for some. Yet, eating the entire muffin may result in consuming 30 percent of a person’s total daily calories.

Container size can be deceiving as well. A small bag of chips, which averages about 2 ounces, often contains two servings. Many interpret the small size to be an individual portion. Only the label will tell.

Calories count. Eating too many calories a day is one of the leading causes of overweight and obesity, but there’s a trick to understanding if the food is high or low caloric. Products that contain 40 calories or fewer per serving are considered low in calories. Serving sizes of 100 calories are considered moderate, while those containing 400 calories or more are deemed high.

Certain nutrients — fat, cholesterol and sodium — should be limited in consumption, but the nutrition labels do not indicate this. The American Heart Association (AHA) recommends limiting total fat each day to about 30 percent of total calories and saturated fats to 7 percent of total calories. Cholesterol intake should not exceed 200 mg — particularly for people with cardiovascular disease. Currently, no upper limit of trans fat has been determined. Most health providers recommend abstaining completely.

Too much sodium can be harmful to those with hypertension, heart disease or stroke. Doctors suggest a limit of 2,300 mg a day — about a teaspoon of salt. But the Centers for Disease Control and Prevention recommend a daily maximum of 1,500 mg of salt for those with high blood pressure, those over 40 and all African American adults. Labels do not reflect this measurement, forcing consumers to do the math.

Some nutrients, on the other hand, are highly recommended. Experts recommend at least 25 grams of dietary fiber each day. Fiber is the undigested part of plant foods and helps regulate the gastrointestinal tract. Serving sizes of 5 grams or more of fiber are considered high in fiber, while good sources of fiber contain 2.5 to 4.9 grams.

In addition to fiber, vitamins, proteins and calcium are recommended in varying quantity based on age and gender.

Percent daily values describe how much or how little the nutrients contribute to each serving. There’s a catch though. The values are based on a 2,000 calorie a day diet and require adjustment to accommodate each person’s individual daily calorie intake.

Some nutrients, such as cholesterol and sodium, remain unchanged in their percent daily values regardless of calories, while total fat and vitamins and minerals vary. As an example, if the product lists that the serving contains 30 percent of the daily value of total fat, it means that each serving contains roughly 20 grams of fat. Two servings of the product would bring the percentage to 60 percent and 40 grams of fat. That also means that the remainder of the food you consume that day should not exceed 24 grams of total fat to meet the recommendation of less than 65 grams each day.

There is a simple rule of thumb to use whether you are trying to limit or increase nutrients. A serving that contains 5 percent or less of the nutrient is considered low — a good thing for sodium; 20 percent or greater is high — a desirable reading for calcium.

People tend to overlook beverages, which are subject to nutrition facts as well. It’s almost as though calories don’t count if they are drunk instead of eaten. It’s often assumed that juices can be consumed without caution. “Drinking too much juice is not a good thing,” Spaide said. “It is 100 percent natural and can be a good source of vitamin C, but it is still high in calories.” She also explained that the popularity of sports drinks doesn’t make them healthier alternatives. “You don’t need a sports drink to hydrate,” she said, acknowledging that water will do just fine.

Think about it. “If you drink a 250 calorie drink each day, that results in 25 pounds a year,” she said.

Spaide recognizes that people can become too zealous in their approach to healthy eating. “Too much of a good thing is not always good,” she said. “Calories still count.”