Spiced Butternut Squash

I know a thoughtful, substantive blog post is well overdue, but for now, a brief recipe will have to do. Unfortunately, it's mid-semester which means that I am studying, reading, or grading assignments pretty much all the time. And when I finally have a minute to myself, the last thing I want to do is think!

Hopefully I'll have something better to post soon, but I am really excited to share this "recipe" nonetheless. I use the term loosely because I don't usually follow recipes, per se. They're more like suggestions for cooking vague quantities of ingredients. This one is something that I decided to try on a whim and really loved.

I was inspired by a couple of butternut squash dishes I've had. My aunt makes  a delicious mashed butternut squash on holidays, but the hefty measures of butter and brown sugar that make it taste so delicious, also add a ton of empty calories and saturated fat. I have also enjoyed some unique salads that included chunks of cooled roasted butternut squash. I thought maybe I could combine these two techniques for preparing the squash to come up with something that was seasoned with fall spices and slightly sweet- reminiscent of pumpkin pie- while retaining its best nutritional qualities. What I love about butternut squash is that it has all of the nutritional benefits of a vegetable- lots of fiber, loads of vitamin A, and low calorie content- with the satisfying texture and weight of something starchier (like its flavor cousin, the sweet potato).

I discovered that I also love cold, roasted sweet potatoes after trying them at aWhole Foods Market salad bar a few months ago. But when I tried to replicate them at home and realized that even a generous 200-calorie portion looked like what one might feed a 2-year old, I was discouraged. But butternut squash tastes similar to sweet potatoes, but has about half the calories! One cup of cooked sweet potato has 180 calories, but a cup of butternut squash only has 80. So, this leads me (finally) to the recipe...

1. Start with a 20 oz. package of pre-cut butternut squash, or a whole one if you're masochistic and want to chop it up and remove the seeds yourself. Place the squash in a large bowl and cover it with plastic wrap, leaving a small part open to vent the steam.

2. Microwave the squash for 5 minutes, stir, and microwave for 2 another two minutes. Repeat until the squash is tender but not falling apart.

3. Spray a large sautee pan with an oil spray, get it warm, and add the squash to it being careful not to add any water from the bottom of the microwave bowl.

4. Add 2 teaspoons of brown sugar, 2 tsp of butter or butter substitute (optional), and a few sprinkles of pumpkin pie spice (to taste).

5. Sautee until the squash is browned.

At this point, the squash is done. You have multiple options for serving it. I prefer it chilled or at room temperature. It just so happens that this also makes it easy for me to take it with me to classes and eat it where I may not have a microwave available. But, it is also good warm.



Enjoy!

How to resist temptation in 3 easy steps

I am always a bit skeptical when I hear people talk about the importance of nutrition education. Sure, there is plenty of misinformation out there and many people really do lack basic knowledge about nutrition. But I think there is a bigger, more prevalent problem. As humans, we all have an innate drive to consume foods that are high in calories, fat, and sugar. In our modern environment, these foods are ubiquitous and very hard to resist. Despite the knowledge that most of us have about what we should and shouldn't be eating, we continue to eat the foods we know we shouldn't. So how do we translate our knowledge into behavior change? Well, I don't claim to have the answer; but I do have some suggestions that I believe can help.

1. Make tempting foods less convenient to obtain. Research has shown that when food is in closer proximity to us, we will eat more of it. So don't keep bowls of candy on your desk at work, for example. When you're at a party, don't sit or mill around near the buffet table. Instead, take a plate of food with you to the other side of the room to eat and mingle. These may seem like insignificant changes, but they can really make a difference. Perhaps the best thing you can do to improve your diet is to rid your home of the foods that you know you need to eat less of. This doesn't mean you have to vow never to eat them again. If you want an ice cream sundae, you can allow yourself to go out and buy one at an ice cream shop. But keeping a half gallon in the freezer when you know you can't resist it is just foolish. The same goes for cookies, chips, soda, etc.

"Everything in moderation" is a popular platitude, but few seem to grasp its meaning. If you claim to only eat desserts occasionally, then there is no need to stock them in your pantry. The healthy staples of your diet should be the only foods you keep in your home. You will have plenty of opportunities to eat those other things at restaurants, social events, holiday gatherings, and other places where you have little or no control over the menu.

2. Cope with temptation in the moment. If you follow my advice above, you will minimize the frequency with which you have to face temptation from food. However, there will of course be times when you can't avoid it. The key to getting through these times with your waistline unscathed is having strategies to lessen the pull of the offending food. Let's take a sample scenario-- an office birthday party. Everyone else is eating cake and talking about how delicious it is. You're trying to eat healthier, and know that eating a highly caloric, dense combination of fat and sugar will not help you achieve your goals. But it looks enticing, and aromas of vanilla-scented cake and chocolate buttercream frosting are invading your nostrils and evoking pleasant childhood memories. How do you decline when you're offered a slice?

There are a few things you can do: a) remove yourself from the situation. Give your well wishes to the birthday girl and excuse yourself to work on some project back at your desk. b) Distract yourself by consuming something else. If there is a healthier option available, like fruit, have that. If not, try a cup of coffee, a diet soda, or a piece of gum. If you have another flavor in your mouth, it will be easier to forget about the cake. c) Remind yourself how you will feel after eating the cake (regretful) and after not eating it(proud, victorious).

3. Give in, sometimes. Although I don't agree with the blind acceptance of all foods as healthy "in moderation," I acknowledge that striving for perfection in eating is unrealistic at best and pathological at worst. Indulgences that are truly occasional may help you maintain an overall healthy eating pattern in the long-term and keep you from reaching a point where you burn out and simply lose the mental energy required to restrict your diet. But, there is a right way and a wrong way to give in to temptation. The wrong way is to wait until it happens by accident and then feel guilty about it. If you take this approach, then every day carries with it a possibility of straying from your plan. This, I think, makes it more difficult to stay on track because your brain is primed for giving in; every tempting food can potentially be eaten.

The better approach is to take a planned vacation from your usual, healthy diet. Once or twice per week, give yourself the freedom to eat something you normally wouldn't. Ideally, plan it ahead of time. Decide when you would most like to treat yourself, and for that one occasion, leave your concerns about nutrition at home. When you decide ahead of time to indulge, you remain in control. Rather than deviating from your plan, you adhere to it. It is not a failure, but rather a deserved  and necessary pit-stop on the road to success. Cheesy metaphor or not, it's true.

How to make a salad that actually tastes good

I don't know about you, but for the better part of my life, I wasn't really a fan of salads. I was a fan of salad dressings, but not actually salads per se. Lettuces were merely vehicles for dressing. I ate them only because it wasn't socially acceptable to eat the dressing with a spoon. If for some reason I didn't like the salad dressing that was available, I didn't eat the salad. It was as simple as that.

Over the course of my palate's evolution, shaped in part by my expanding knowledge of the  immediate and long-term consequences of my dietary habits (weight gain and chronic disease, respectively), I have come to enjoy salads for what they are and not for what I put on top of them. But, I am pretty confident that many adults and certainly the majority of children share my former viewpoint. Evidence supporting my theory abounds. Think about how many times have you been to a restaurant that had all of 3 salads but 15 choices for dressing. Or had a salad served to you that was so drowned in dressing you couldn't tell there was anything green underneath. The problem with these practices is that most salad dressings contain 70-100 calories per tablespoon. They also are typically high in sodium and/or sugar.

So why do people use so much dressing in the first place? My guess is because the salads we buy or make for ourselves tend to include only bland, low-quality ingredients; think iceberg lettuce, underripe tomatoes, and commercial croutons. I'm bored just typing it. I think the key to enjoying salads without turning them into disguised junk food lies in careful selection of ingredients. Here are some simple strategies you can use to make a low-calorie salad you'll actually look forward to eating.

Step 1: Keep it simple
Whether you're at a salad bar or making a salad yourself, it can be tempting to throw everything you like in the bowl. The problem with this approach is twofold. For one, the more ingredients you put in the salad, the more likely it is that you're adding multiple high-calorie items-some nuts here, cranberries there, a little cheese, etc.- and before you know it your "light" meal has more calories than a burger and fries.

Secondly, by mixing so many flavors together, you may create an inefficient salad; that is, one that is unable to satisfy both the stomach and the brain without providing excess calories. This is because appetite-- the desire to eat food, not to be confused with physiological hunger-- is stimulated by variety. The more flavors we have in a meal, the more we tend to eat. Food manufacturers often use knowledge of this phenomenon to their advantage, combining sweet and salty flavors to enhance our liking and consumption of products. I think the best salads are those that contain only 3-5 components. Such simple salads allow you to taste each ingredient fully and become satisfied more quickly. They are also less expensive and time-consuming to prepare.

Step 2: Use herbs and salt

This part is easy to explain. Fresh herbs are virtually calorie-free yet contribute a great depth of flavor to salads. Adding some chopped dill, chives, or basil can completely transform a ho-hum salad into something that tastes complex and expensive. Although salt isn't exactly known for its nutritional value, it can be used judiciously to greatly improve the flavor of healthy foods. Sprinkling a few dashes of salt on a salad will add relatively little sodium to the meal but will really help bring out the natural flavors of the vegetables. Just think of what salt does for a ripe slice of tomato. It can do the same for greens. 
Step 3: Add *a little* fat
If you are trying to create a healthy salad, you may assume that certain foods with less than stellar nutritional reputations are off limits. Cheese, bacon and other meats might come to mind, and maybe even healthy but high-fat foods like avocado, nuts, and seeds. The popularity of low-fat and fat-free salad dressings attest to a widespread fear of full-fat salad dressings as well. But avoiding these foods completely can make your salads bland, boring, and utterly incapable of satisfying your stomach or your brain. Instead, use these items in small quantities to enhance, rather than overpower, the other salad ingredients. And, in keeping with my first bit of advice about simplicity, choose only one high-fat food to include. What constitutes a small quantity? I would suggest 50-100 calories. This amounts to about 2-4 tablespoons of cheese or nuts, 2-3 slices of bacon, or a quarter to half of an avocado. Aim for the lower end of the range for the less-healthy items or for an appetizer or side salad, and the higher end for the healthier items or when making an entree-sized salad.
Step 4: Make your own dressing
If you follow steps 1-3, you may find that you don't even need dressing or that you need very little. But if you do, I recommend making your own dressing. It can be a simple mixture of oil and vinegar or oil and lemon juice; use a 1:1 ratio if you can tolerate more acidity or a 2:1 ratio for a more traditional vinaigrette. Alternatively, you can try a homemade yogurt dressing like this one. If you must use a bottled dressing, choose one that is made with olive oil or canola oil. Whether you use your own dressing or one from a bottle, try not to use more than you need. Add it to the salad little by little as you need it rather than dousing it all at once. Or, dip your fork in the dressing before each bite. Minimizing your use of salad dressing is important if you are trying to lose weight. If you are one of the lucky few who want to gain weight, you can disregard this part.
If you're wondering what a salad that meets these guidelines might look like, it could be a slighlty modified caprese (tomato, mozzarella, and basil) salad. Typically, a caprese salad might contain half a tomato, a few shreds of basil, and several large slices of cheese. It is often topped with a liberal drizzle of olive oil. It's not junk food by any means, but it's not the most nutritious of salads either. It is a lot of cheese with a little vegetables. To maintain the salad's flavor but improve its nutrition profile, I would add a generous handful of mesclun greens and substitute mini fresh mozzarella balls for the thick cheese slices so that I could use less but still have some mozzarella in every bite. If I wanted dressing, a small amount of balsamic vinegar and olive oil would suffice. A recipe for another one of my favorite salads can be found here.

What's the deal with agave nectar?

It seems that agave nectar is the new darling of the sweetener market, cropping up in everything from cocktails to smoothies to snack foods. Last week, I was at a bar and ordered my favorite drink- a caipirinha- and asked the bartender to use very little simple syrup. He obliged, but later suggested I try the drink with agave nectar instead of simple syrup. He said that not only does it complement the flavor of the rum in the drink, but it is also all-natural. I gave him the skeptical look I give anyone who tries to "sell" me on a health food, but said I'd consider it. No use wasting my happy hour debating nutrition with someone who probably didn't know the difference between a monosaccharide and a polysaccharide.

But his suggestion, along with the increasing ubiquity of agave nectar and an inquiry from a facebook friend, has prompted me to look further into the health claims surrounding this product. Agave nectar, or agave syrup, is a sweetener that is made by filtering and heating the juice from agave plants. Thus, although it is natural, it is not entirely unprocessed. The syrup is comprised primarily of fructose (84%). Like table sugar (sucrose), agave nectar has 16 calories per teaspoon, but because it is sweeter than sugar, less of it may be needed to achieve the same level of sweetness. This, I would argue, is one possible benefit of agave nectar. The other is one of its most touted characteristics: its low glycemic index (GI), which is between 20 and 30 on a scale of 1-100. Foods with low GIs do not elicit as great a rise in blood sugar as foods with higher GIs. Therefore, if agave nectar has a lower GI than other sweeteners (honey's GI is 55 and table sugar's is 68), then it would make sense to think that it would be preferable, especially for people with diabetes or glucose intolerance.

To investigate whether the purported benefits of agave nectar are supported by scientific studies, I logged on to PubMed to do an initial search, using only "agave nectar" as my search term. Given that agave nectar is becoming so widespread in grocery stores and restaurants, I expected to get loads of results that I would have to narrow down with more refined searches. Imagine my surprise when this search returned only 9 results, none of which had anything to do with the effects of agave nectar consumption on the human body. In light of the dearth of research on the topic, my opinion on it must necessarily be based solely on deductive reasoning.

So, we don't know exactly what impact agave nectar has on human metabolism. We do, however, know a little about the impact of its component sugars--primarily fructose, and to a lesser extent glucose and sucrose. I had mentioned that agave nectar is 84% fructose. Glucose and sucrose represent approximately 8% each. In comparison, table sugar is 50% fructose and 50% glucose. The much-demonized high-fructose corn syrup typically contains 55% fructose and 45% glucose. Honey has similar ratios: 50% fructose, 44% glucose, 1% sucrose.

There is some evidence to suggest that pure fructose may have some adverse metabolic effects; namely, increasing the amount of hazardous abdominal fat, and raising blood triglyceride levels. This is because fructose is metabolized differently from glucose and in a way that may encourage the liver to produce fat in the form of triglycerides and release them into the bloodstream. The other side of this coin is that fructose doesn't increase blood glucose levels the way glucose does. So, we have something of a paradox in fructose: it doesn't raise blood sugar (Good), but it may promote fat storage and high triglycerides (Bad). Because agave nectar contains a higher proportion of fructose than most, if not all, other sweeteners on the market, the concerns about fructose could reasonably apply to agave nectar as well.

So, as to the benefit of agave nectar's low glycemic index, I would say this is a wash. It does in fact have a low GI, but the other possible negative effects of fructose may very well negate this positive quality. As to the other possible benefit of agave nectar- that it is sweeter than sugar and can be used in smaller quantities- I cannot make a conclusion. Unless and until there are studies that demonstrate that people actually use less agave nectar than they would sugar, and therefore consume fewer empty calories, I remain unconvinced. My guess is that people are more likely to misconstrue the healthy halo around agave nectar as license to use it with reckless abandon. But this, of course, is just a hypothesis.

The bottom line on agave nectar, as I see it, is the same as it is for all other forms of sugar: it provides no nutritional benefit other than calories and is still essentially sugar, albeit much more expensive sugar! If you like the flavor of it, or if you find that you can replace larger amounts of table sugar with smaller amounts of agave nectar, then by  means use it. It's probably not going to hurt you. But you should not be fooled into thinking that it is a health food.

References
Leibman B. Sugar overload: Curbing America's sweet tooth. Nutrition Action Health Letter. January/February 2010.
Agave nectar is in demand, but is it better for you than ordinary sugar? Environmental Nutrition. April 2010.

A salad featuring 3 superstar ingredients

I recently adapted this recipe for a salad with shaved fennel, manchego cheese, and figs. I can't imagine a better trio of ingredients. I have written previously about my love for roasted fennel, but I have discovered that thinly sliced raw fennel is equally delicious when allowed to marinate in a vinaigrette. Manchego cheese, on the other hand, would taste good on the bottom of a shoe. Dried figs provide the perfect sweet foil to the manchego's salty nuttiness. Together, these 3 superstars combine to produce one of the best-tasting salads I've had.

Here is my version of the recipe:

2 bags of arugula salad mix

1 chunk manchego cheese (about 8 oz)

8-10 dried figs (or as many as you'd like)

1 bulb fennel

Juice from 2 lemons
~ 1/2 cup olive oil
salt, pepper

Cut the stems and end off of the fennel bulb and slice it in half. Then slice each half as thinly as possible with a knife, or with a mandoline. Put the fennel in a bowl and set aside.

Mix the lemon juice with an equal volume of olive oil and a sprinkle of salt and pepper in a bowl or cruet.

Pour about a third of the dressing over the fennel and toss to coat. Cover the bowl and place in the fridge until ready to serve.

In the meantime, cut up the dried figs into quarters and shave the manchego cheese with a vegetable peeler. Alternatively, you can soak the figs to rehydrate them (as described in the recipe linked above) or use fresh figs. Place the arugula salad in serving bowl and top with figs and cheese.

When ready to serve, add the fennel to the rest of the salad. You can add the fennel to each portion individually or mix the fennel in; it is up to you. Serve the remainder of the lemon vinaigrette on the side.

Enjoy!

Update: 3 squares vs. small, frequent meals

People trying to lose weight will often hear two conflicting pieces of advice: "don't snack between meals" and "eat frequent snacks to keep from getting too hungry." I have addressed this issue before, and my conclusion was that it probably didn't matter too much which approach is taken, but that it is best to eat when you are hungry rather than when the clock says it's time to eat.

Today, I came across the results of a study which adds to the evidence supporting the traditional, 3-meals-per-day plan. This study found that men who were advised to consume their calorie-restricted diet in the form of 3 larger meals (containing 750 calories) did not feel as hungry as men who ate the same diet in 6 small meals (375 calories each).

One study is certainly not going to "settle" this debate for good, but it is something to think about. And it makes sense to me. Snacks may help prevent excessive hunger between meal, but meals should be large enough to elicit a sense of fullness to begin with. Eating small meals that never satisfy is probably a recipe for diet failure. With this approach, you may not ever become starving, but who wants to experience a constant feeling of even mild deprivation?

In light of these findings, I'd like to clarify my stance on the subject. Eat meals that lead to a feeling of comfortable fullness, and try to space your meals at regular intervals to avoid becoming too hungry. Four to five hours between meals is reasonable. If for some reason you have to eat a meal late or skip a meal, be prepared with healthy snacks to take the edge off. The goal should be to start eating when you are pretty hungry, but not ready to eat your own arm; and to stop eating when you are full, but not so full that you feel uncomfortable, weighed down, or sleepy.

I am in chocolate heaven

Some time ago, I was browsing Whole Foods looking for a healthy, tasty, gluten-free snack- not an easy task- and I came across a display of little plastic tubs full of various kinds of cookies and brownies of a brand called "Laura's Wholesome Junk Food."

Now, I've had some pretty good gluten-free cookies before (Like these, from Enjoy Life Foods), but I still view them as treats. Most cookies that describe themselves as natural, organic, allergen-free, etc., are nevertheless primarily comprised of refined flours and sugar, and in many cases saturated fats. They may be marginally better than the mass-produced types you'd find in most grocery stores, but they are not nutritious by any means.

So, when I saw these snacks by Laura's Wholesome Junk Food, I did not get my hopes up. "Wholesome," if you aren't aware, doesn't mean much of anything and carries no implications whatsoever for the nutritional content of the food it describes. Then I read the ingredient list for one of the varieties: Xtreme Chocolate Fudge Bite-lettes. The first 8 ingredients were: rolled oats, dates, expeller pressed canola oil, fruit juice, natural grain dextrins, chocolate chips, and unsweetened natural cocoa. The remaining ingredients were all similarly natural and mostly healthful. Each 2-bite-lette serving contained 110 calories, 2 grams of fiber, and 7 grams of sugar (most I'd expect comes from the dates and fruit juice). I decided that the product was acceptable from a nutrition standpoint, so I bought them.

It turns out that they are delicious. I can't really compare them to anything else because they are pretty unique in their texture and flavor. They don't exactly taste like brownies or cookies. But they are rich and very chocolatey, with undertones of fruit and a hint of lemon that somehow makes perfect sense. The consistency is a cross between a soft oatmeal cookie and a chocolate truffle. Something about this particular flavor combination gets all the right neurons in my brain firing and is as satisfying to my inner child as a slice of ice box cake fresh out of my grandmother's refrigerator.

Maybe I'm getting a little carried away. I'm sure not everyone will agree with me, but they are certainly worth trying if you are looking for a new healthy snack. Apparently there are lots of other varieties, but I've been so enthralled by this one that I haven't bothered to sample the others! If you can't find them at your local Whole Foods Market, you can order them online at the links posted above.

Mindless eating

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We all do it from time to time. Some of us may do it every day. In front of the TV, while driving, at the movies, or at our desks, we sometimes find ourselves eating without really paying attention to our food. There is a whole body of research dedicated to understanding how and why we eat mindlessly and how to prevent the frequent consequence of this habit- overeating. The Cornell Food & Brand Lab, headed by Dr. Brian Wansink, is foremost among the centers doing this kind of research.

Wansink's studies have found that, regardless of our physiologic hunger level, external cues can encouge us to overeat. Some of these cues are now becoming well-known. Portion size is a good example. By now, many people have heard that serving food on smaller plates is a good strategy. This nugget of wisdom likely came from Wansink's research, which have shown that people will eat more from larger containers, even if the food isn't particurly appetizing- as was the case in his stale popcorn study. In addition to portion size, we are also influenced by the proximity of food and the variety of food available (think about eating at a buffet).

I found the two videos below particularly interesting. In the first, patrons of a diner are served large breakfasts on 2 separate days. On the second day, they are blindfolded. This video illustrates the influence that seeing food on a plate has on how much we eat. In the second video, my pal Brian Wansink describes an experiment in which office workers are allowed access to a candy dish which is sometimes placed on their desks and sometimes placed just a few feet away. This video highlights the importance of proximity. 

Now that you know how you may be tricked into eating more by your surroundings, you can use this information to your advantage. Use small serving dishes, don't keep snacks and candy lying around in plain sight and within reach. Just making it a little less convenient for yourself to eat for eating's sake may be enough to lead to noticeable differences in your diet and ultimately, your body. Finally, when you do eat, try to minimize distractions and really pay attention to your food. Smell it, chew it slowly, and savor it. Take a breath or two between bites. Ask yourself periodically if you are still hungry, and if the answer is no, stop eating. As a culture, we have learned to ignore our internal cues for eating and instead focus on the external ones. It is possible to reverse this behavior, but it takes some practice.

 

Deceptive advertising is getting out of control

I have harangued before about deceptive advertising (here and here), but this instance truly takes the cake. I was in Stop & Shop today, and my husband innocently brought my attention to a display of chocolate and caramel-covered apples which boasted: "Healthy never tasted this good!" I took a closer look at the apples, which appeared to be more candy than fruit, and was appalled- to say the least- by what I found.

Although the display called these apples "healthy" and also claimed that they contained "natural antioxidents and fiber PLUS benefits of dark chocolate," the nutrition label told a different story. The apple did contain about 9 grams of fiber, but at over 800 calories, it's hardly worth it. But what I really take issue with are the claims that the product is "healthy" and provides the benefits of dark chocolate.

First of all, more than half of the fat in the apple is saturated fat. In fact, it provides 35% of the daily maximum recommended level of saturated fat that the average adult should consume in an entire day per serving. And mind you, one serving is less than ONE-FOURTH of the apple- thanks to Joyce Faraj for pointing that out. I almost missed it myself! This means that the whole apple actually contains 27 grams of saturated fat alone (over 150% of the recommended daily limit).

Furthermore, partially hydrogenated oil is listed twice on the ingredient list (in the caramel and chocolate coatings), suggesting that despite the "0g trans fat" listed on the label, the product does in fact contain some trans fat. It also contains a substantial amount of added sugar. Given these facts, I am amazed that this company (Tastee) has the gall to use the word "healthy" in the same sentence as these death snacks.

But the lies don't stop there. Tastee also implies that if you eat their products, you can reap the benefits of dark chocolate. How much dark chocolate do you get from these apples? Beats the hell out of me! The only thing close to chocolate listed on the label is cocoa, the fourth ingredient in the chocolate coating- after sugar, partially hydrogenated oil, and milk powder. The coating itself is only the 6th ingredient. I can't imagine that the amount of cocoa in the trans fat/sugar concoction that covers the apples is anywhere near enough to cause any kind of beneficial effects remotely resembling those associated with real dark chocolate consumption. Even if there was, any positive effects would be more than outweighed by the negative effects of the sugar, saturated fat, and trans fat.

You better believe I will be contacting this company to complain about their ethical standards, and I will also be contacting the FDA regarding the lawfulness of their claims, which I believe may be in violation of current labeling regulations. In the meantime, I made my own small effort to protect my fellow shoppers from Tastee's deceitful advertising (look closely):

High fructose corn syrup- "you know what they say about it"

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You've probably seen the ads, put out by the Corn Refiners Association, poking fun at concerned moms and other folks who are wary of high-fructose corn syrup for.. well, no apparent reason.

Like many people, you may be wondering whether the CRA is trying to pull the wool over your eyes, or if they're right and everyone else is just paranoid. I think it's long past time I address this controversy.

Let's start with the argument against HFCS. In one of the CRA ads, one mom chides another for serving fruit punch made with HFCS at a kids' party. When asked why she's worried about it, she replies, "you know what they say about it." When the other mom asks her to give examples, she is unable to come up with any. So, what exactly do "they" say about HFCS? There are two main arguments that I am aware of:

1. As the amount of HFCS in our food supply has increase, so have obesity rates, suggesting that HFCS may be one of the causes for the epidemic.

2. HFCS contains more fructose, which has a "lipogenic" (fat-generating) effect. Fructose is metabolized differently than sugar and leads to higher levels of triglycerides and LDL in the blood, insulin resistance, and more visceral fat storage. All of these are risk factors for diabetes and heart disease.

However, there are some very big problems with these arguments. In regards to argument #1, a correlation between HFCS and obesity is simply not enough to suggest a causal relationship. I could just as easily point to any other change that happened to occur in the last 50 years or so and blame it for the rise in obesity. I could blame the increases we've seen in college graduation rates, the number of women in the work force, or public interest in vampire romance novels. But this would, of course, be ridiculous.

The second argument lends some scientific credibility to the hypothesis that HFCS could cause some metabolic problems, and it is based on research. The problem is that much of this research is in mice, which are not always good models of human metabolism (and in fact, human studies have not consistently had the same results). But more importantly, the animal studies frequently compared the effects of diets very high in pure fructose or pure glucose-- sweeteners we rarely see in foods or beverages. Instead, our choices are usually HFCS or sucrose (sugar). And we don't typically consume the quantities of either sweetener that are tested in research.

The molecular makeup of these two substances is not remarkably different. A molecule of sucrose is comprised of 1 molecule of glucose and 1 molecule of fructose. Thus, sucrose is 50% fructose and 50% glucose. High-fructose corn syrup, belying its name, ranges from 42-55% fructose and the rest glucose. Therefore, studies comparing the metabolic effects of pure fructose and pure glucose are largely irrelevant to the question of whether HFCS is more harmful than sugar. Finally, studies that have been done on humans comparing HFCS and sucrose have not found any differential effects on metabolism or appetite.

Finally, if fructose is the "bad guy" in HFCS, then why isn't anyone attacking the natural and organic food manufacturers adding fruit juices (60%+ fructose) and agave nectar (84% fructose) to their products and touting it as healthier than the convential stuff? Chew on that one for a bit.

The bottom line is, the evidence doesn't support choosing sugar over HFCS, or choosing products with more natural sweeteners instead of products with HFCS. BUT, evidence certainly does support avoiding BOTH high-fructose corn syrup AND sugar. My goal here is not to vindicate HFCS and encourage people to not feel guilty about buying soda. Quite the opposite. My intent is to emphasize that ALL added sugars of any kind are equally horrible.

References
Melanson et al. High-fructose corn syrup, energy intake, and appetite regulation. Am J Clin Nutr. 2008; 88(6):1738S-1744S.

Schaefer EJ et al. Dietary fructose and glucose differentially affect lipid and glucose homeostasis. J Nutr. 2009;139:1257S-1262S.

"Sugar Overload: Curbing America's sweet tooth." Nutrition Action Healthletter. January/February 2010.

White rice cereal for babies: yes or no?

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While eating breakfast this morning, a story on Good Morning America caught my ear. A pediatrician in California, Dr. Alan Greene, has started a campaign against white rice cereal-- traditionally recommended by pediatricians as an introductory solid food for infants. Parents in the US have been told to feed their babies white rice cereal first because it is free of most allergens and easy to digest.

Dr. Greene believes this advice is misguided, and that white rice cereal may actually predispose children to obesity. According to his theory, feeding babies white rice cereal is akin to feeding them sugar in terms of nutritional value. Furthermore, because the starchy cereal is the first solid food experience many American babies have, it affects their taste preferences for life, setting them up to eat more refined carbohydrates and sugars later on and potentially become obese. Instead of white rice cereal, Dr. Greene recommends that parents choose an iron-fortified whole grain baby cereal. "Let every child's first food be a real food," he says.

Of course there are people who disagree with Dr. Greene. Unsurprisingly, Gerber made a statement noting the lack of scientific studies to support any link between white rice cereal and childhood obesity. The baby food company may be biased, but a presumably impartial associate professor of pediatrics, Dr. Keith Ayoob, has also said that focus on one particular food is probably inappropriate. The American Academy of Pediatrics makes no distinction between white and brown rice cereals in their infant feeding recommendations.

Before I explain my stance on the issue, let me first acknowledge that there isn't any scientific evidence of what Dr. Greene is suggesting. So, his argument is not strictly "evidence-based." But (and this is a big but), a lack of evidence does not disprove any theory. We can only have evidence of what researchers choose to study. It just so happens that no one has studied white rice cereal. If no one ever decided to compare lung cancer rates in smokers and non-smokers, you can be sure tobacco companies would be reminding us that there are no studies to support a link! There are never studies that show something is dangerous.. until there are studies. Another example in recent history of a food presumed to be good until it turned out to be bad is margarine- and other products where saturated fat was replaced by trans fat.

So what should we do when there is no evidence one way or another? Should we assume that white rice cereal is healthy for babies until there are studies proving otherwise, or should we assume it's not healthy until there are studies proving otherwise? Are foods innocent until proven guilty? My answer is: it depends. When you are trying to decide whether a food is likely to be good for you or your child, ask yourself: if I had to grow and produce all of my own food, could I still eat it? In other words, is this food very close to nature or has it been tampered with in some way? If the answer is yes, then I would assume the food is healthy until there is reason to believe differently. If the answer is no, then I would assume it's not. In the case of white rice cereal, you probably could not produce this on a small farm by yourself, so I would agree with Dr. Greene and choose the whole grain cereal instead, unless and until research studies prove that white rice cereal is just as good.

Although I don't have hard evidence to back up my theory this time, I do have quite a bit of logic on my side. Human health is largely the product of interactions between genes and the environment. Natural selection produces organisms that are adapted to their environment. Because human genes have not changed much in the last few million years, it is reasonable to assume that our bodies are best adapted to the environment our ancestors lived in back then- not the one we live in now. White rice didn't exist when our ancestors were evolving. And actually, brown rice wouldn't have been a large part of our ancestors' diets either. Before the advent of agriculture (only about 10,000 years ago), humans didn't eat much grains at all- whole or refined. But refined grains are even more novel; they didn't come on the scene until the Industrial Revolution. The process of removing the bran and germ of grains- the parts that contain many vitamins, minerals, plus essential fatty acids and fiber-requires mechanized mills that were not developed until the late 19th century- practically minutes ago in evolutionary terms!

What are the odds that a food that didn't exist until a little over a hundred years ago would be a more appropriate choice for an infant than one that is not processed and has all of its nutrients intact? If I were a betting woman (and I am), I would put my money on the brown rice cereal over the white rice cereal without hesitation. Whether or not white rice cereal is truly as harmful as Dr. Greene suggests it may be, it is highly unlikely that it provides any benefit at all over the whole grain version.

Irresponsible journalism at work

One of my biggest pet peeves is the sensationalized reporting of nutrition research by the media. I happened to come across a great example of this today: an article on msn.com titled "Big breakfast may make you fat after all, study finds." The article explains the results of a study in which 380 individuals- some normal weight, some obese- wrote down everything they ate for 10-14 days, and researchers used this information to assess whether individuals ate less over the course of a day when they ate a large breakfast. What they found was that, contrary to popular belief, eating more in the morning did not seem to prevent overeating later in the day.

This probably sounds pretty straightforward to anyone unfamiliar with the principles of research methodology in general or nutrition research in particular, which is most people. And most people who read this article probably see nothing wrong with it. In fact, in the 3 hours that this article has been available, it has been tweeted 169 times and "recommended" on facebook 156 times. Who knows how many times it will be re-tweeted and re-posted.

I see a number of problems with the way these study results were presented. For ease of reading, I will outline them:

1. The article suggests that this study has identified a cause and effect relationship. Reading this article, you would think that eating more in the morning causes not only eating more over the course of a day but also that it directly leads to weight gain. The title of the article as well as the statement: "a new study suggests that the only thing a big breakfast does is lard on more pounds" certainly give that impression.

However, because this study was cross-sectional and did not actually test an intervention, any relationships between a behavior (eating a big breakfast) and an outcome (total calorie intake for the day) are purely speculative. We cannot know whether the behavior caused the outcome. For example, perhaps on the days that the study participants happened to eat a big breakfast, they were just hungrier for some reason, and would have eaten more throughout the day regardless of what their breakfast was. Or maybe people tend to eat bigger breakfasts on weekends or holidays or other times when calorie intake is higher.

This may be a bit easier to understand if I use a different example. Let's imagine that I did a study looking at people's clothing choices and activity levels. I might find that people who report wearing sneakers on a given day are more likely to exercise that same day. Would this mean that wearing sneakers causes people to exercise? If I decide to start wearing sneakers every day, will I suddenly start exercising more? Maybe I will a little, because it's easier to be physically active in sneakers than in heels, but probably no one would think that wearing sneakers is a good weight loss strategy. Wearing sneakers and exercising just go together. It doesn't mean that one causes the other.

2. The article suggests that the results of this study negate findings of earlier research. I see this a lot in the news. "We've always been told to do X, but it turns out X may not work at all! Instead, we should be doing Y." But no single study can ever prove or disprove anything. We need to look at the accumulation of evidence on a topic before we jump to conclusions.

3. Speaking of jumping to conclusions, this article goes beyond making inappropriate inferences about cause-and-effect relationships and actually uses these flawed assumptions to give the readers nutritional advice: "If you want to lose weight, cut back on the calories you consume in the morning," the tag line reads. Given the questionable validity of this one study and the complete lack of consideration of any other studies, this advice is unsubstantiated.

Now that I've pointed out the gross misinterpretations presented in the MSN article, I suppose it's only fair to give you my interpretation of the study. After reading the original research article, here is my take.

My first observation is that this is a shoddy piece of writing and I am amazed that it was published anywhere. I guess I ought to start submitting my papers to this journal because apparently they'll take anything. Secondly, there was another interesting finding that was not discussed in the MSN article: although people who ate high-calorie breakfasts ended up eating more calories over the entire day, people who ate a greater proportion of their total calories at breakfast actually ate fewer calories over the entire day.

I realize this may sound confusing. Let  me try to explain it a different way. In this study, obese people who ate 35% of their total daily calories at breakfast ate 100 fewer calories per day than obese people who ate only 7% of their calories at breakfast. For normal weight people, it was a 200 calorie difference. To put this into perspective, for someone eating 1800 calories per day, a breakfast providing 7% of total daily calories would be 126 calories, whereas a breakfast providing 35% of daily calories would be 630.

To sum up, this study found that, eating a bigger breakfast increases total calorie intake; but, eating a bigger breakfast relative to other meals decreases total calorie intake. So which result is more relevant? I would contend that the latter is more useful for the average person. I would be willing to bet that most nutritionists don't recommend that people eat larger breakfasts period. Rather, they (and I) recommend that people eat larger breakfasts AND smaller dinners and/or lunches. I often say that we, as a society, have our eating patterns backwards. We should be eating more calories at the beginning of the day and less at the end. This advice is fully supported by this recent study, despite what the popular media article implies.

A final comment: although it was alluded to in the article, I want to stress that a big breakfast of junk is a far, far cry from a big nutritious breakfast. Even if the former leads to higher calorie intake, it says nothing about the latter.


On an unrelated note, why are my blog posts always so long?! I never, ever intend for them to look like this, but try as I might to be concise, I never seem to succed. Who is actually reading all of this? If you made it to the end, I applaud you.

Recipe: Reduced-fat "Anginette" muffins

Lately, I've been on a muffin-baking kick, which is kind of ironic because I don't even eat muffins. I was diagnosed with a gluten intolerance a while back, so I mostly bake for other people now. My most loyal customer is my husband, Steve. I try out all of my new muffin recipes on him and I also get to live vicariously through him. A couple of days ago, I decided to try to make some low-fat muffins that would taste like my favorite Christmas cookie: anginettes. I made a few batches of anginettes before Christmas for family members and friends, so I guess I still had them on the brain.

If you aren't Italian, or just haven't tasted an anginette before, let me tell you what they are. Anginettes are small, cake-like cookies flavored with lemon and orange juice, topped with a sugary glaze and sprinkles. They are so simple, but so delicious. The trick with anginettes is not to overbake them. Many of the anginettes you might find in a bakery cookie platter have been dried out from too much time in the oven. A properly cooked anginette will be soft and moist and will stay that way for many days.

I came up with the following recipe in an attempt to recreate the taste of an anginette, in a muffin form. Unfortunately, because I don't eat gluten, I cannot vouch for them myself. However, Steve's reaction when he tasted them and the speed with which they disappeared assures me that they are in fact good.

Note that the nutrition facts provided here are based on a recipe yield of 8 muffins and the assumption that you use half of the glaze (no need to completely enrobe the muffins in sugar!).

Anginette Muffins

2 cups all-purpose flour
1/3 cup sugar
3 teaspoons baking powder

3/4 teaspoon salt

1 cup orange juice

1/4 cup unsweetened applesauce

1 large egg, lightly beaten

1 tsp vanilla extract

1 tbs lemon extract

Cooking spray

Glaze

½ cup confectioner’s sugar

2-3 tbs. whole milk

Preparation

Preheat oven to 400°

Combine all-purpose flour and other dry ingredients (including sugar) in a large bowl; stir well with a whisk. Make a well in center of mixture. Combine juice, applesauce, egg, and extracts in a separate bowl. Stir into flour mixture. Spoon batter into 8-12 muffin cups coated with cooking spray. Bake at 400° for 20-25 minutes or until muffins spring back when touched lightly in center. Remove from pan. Cool completely on a wire rack.

To make the glaze:

Pour confectioners sugar in a small bowl. Add 1 tbs. of milk and mix until absorbed. Add 1 tsp of milk at a time, mixing thoroughly after each addition, until the glaze reaches desired consistency (it should be thick enough to coat the muffin tops without running).

When muffins are completely cooled, turn each upside down and dip in the glaze to coat. Place muffins on a plate or baking sheet and sprinkle with decorative candy sprinkles before the glaze dries.

Sarah Palin gets it wrong on childhood obesity campaign

In this country, nutrition issues often become political ones. Although most people seem to agree that eating healthy foods is generally a good idea, there is a lot of disagreement about what role the government should play in promoting healthier food choices. I discussed one example of this kind of controversy a while back, in a post about regulating Happy Meal toys. Another example can be found in Sarah Palin's remarks about Michelle Obama's anti-childhood obesity campaign, "Let's Move."

Back in November, Palin made the following comments on Laura Ingraham's radio show, attacking Michelle Obama's efforts to reduce childhood obesity:

"Take her anti-obesity thing that she is on. She is on this kick, right. What she is telling us is she cannot trust parents to make decisions for their own children, for their own families in what we should eat. And I know I'm going to be again criticized for bringing this up, but instead of a government thinking that they need to take over and make decisions for us according to some politician or politician's wife priorities, just leave us alone, get off our back, and allow us as individuals to exercise our own God-given rights to make our own decisions and then our country gets back on the right track."

The first time I heard this, it really ruffled my feathers, but I tried to ignore it because I knew that if I tried to express my disagreement in a counter-argument, I would end up stressing myself out trying to figure out where to even start to address the many flaws in Palin's logic. But, as time went on, I kept hearing about Sarah Palin's opinion about childhood obesity, and finally decided that I couldn't keep quiet anymore. So here I am, frustrated and seething, blogging about it in hopes that someone reads and understands my point of view so I can feel some sense of relief.

There are 2 major problems with Palin's argument. First, and most important, the assertion that the government shouldn't try to improve children's diets because parents should decide what kids eat is utterly ridiculous and makes no sense. Here's why: the government already does make some decisions about what American children eat. The National School Lunch Program (NSLP) provides cash reimbursement and commodity foods to participating public and private schools, with the requirement that those schools offer free and reduced-price lunches to eligible students. The NSLP also develops certain guidelines about what foods can be served to constitute a "reimbursable" lunch. Sarah Palin doesn't seem to be suggesting that we do away with the NSLP (I'd love to see her try), which implies that she accepts this level of interference from the government in children's diets. However, what she does have a problem with is any effort to improve the standards by which the NSLP and other nutrition programs function. In other words, the government can decide what kids eat at school, as long as it doesn't make them eat anything healthy. If Sarah Palin wants to take a stand against government involvement in childhood nutrition, then she should call for the abolishment of the NSLP altogether, not oppose changes in the program that will ultimately benefit the health of American children.

The fact that the government has an established role in influencing what kids eat renders Palin's points moot. But for argument's sake, let's pretend that the NSLP did not exist and all kids had to bring lunch to school and eat only what their parents gave them. This sounds like exactly the kind of scenario that would restore individual freedoms and get the country "back on the right track," in Palin's view. Responsibility for children's food choices would be placed squarely on parents, where it belongs. This brings me to the second problem.

That Sarah Palin thinks that parents should be the only entities entrusted with ensuring that children grow up nourished and healthy is strong evidence of her detachment from large groups of Americans and the problems they face. For one thing, many, many parents simply do not have the means to provide their children with the quantity and quality of food they need to thrive. They may care a lot about their kids and know how to make good choices for them, but they may be unable to because they can't afford healthy food or can't access it because of where they live; or more likely, both. Then there are parents who can afford to fill their kitchen cabinets with healthy foods but are truly not educated enough to do so. Either they don't know how important nutrition is for their children's immediate and long-term well-being, or they don't know what constitutes good nutrition.

Finally, there are parents who, regardless of whether or not they have the means and know-how to feed their kids nutritious food, just don't care enough to do it. Let's be honest, anyone can be a parent. You don't need any special characteristics or qualifications, and the sad truth is that not all parents are good parents. Just think about how many parents abuse or neglect their children. They're in the news all the time. And these are the people that Sarah Palin thinks should be given sole responsibility for ensuring that the next generation of Americans grows up to become healthy, contributing members of society. Michelle Obama's "Let's Move" campaign states on its website: "We believe every kid has the right to a healthy childhood." Apparently, Sarah Palin believes that a healthy childhood is not a right, but a privilege reserved for those who have loving parents with ample education and financial resources.

Follow-up: what to do after the stomach bug

In my post about gastroenteritis, I discussed what to do when you're sick and how to prevent spreading your germs, but I neglected a very important point: what to do after you've recovered. To many, the notion that there is anything at all to do besides go back to normal living is probably foreign. What I'm talking about is probiotics.

I am not one to promote dietary supplements willy nilly. For the most part, I think people who do have an agenda and are usually out to profit from others' naive trust and willingness to pay for products that some self-professed "expert" recommends. As the title of my blog suggests, I only ever recommend supplements that have substantial scientific evidence supporting their efficacy. I also don't sell any such supplements or receive any funds whatsoever (unfortunately) from anyone who does.

Now that I've gotten that disclosure out of the way, here's the point I'm getting to: after a bout of diarrhea, whether it is from food poisoning, a virus, a course of antibiotics, or even radiation therapy, the "good" bacteria in your gut are lost along with any pathogens. It is important to replace these beneficial microbes in order to maintain a healthy gut immune system. Doing so may help you get back to feeling normal more quickly.

The following are examples of possible beneficial effects of probiotic supplements, as suggested by research studies:

- decrease the incidence, severity, or duration of infectious diarrhea in children

- prevent or treat diarrhea caused by E.coli, Shigella, and Salmonella (main causes of travelers' diarrhea)

- reduce risk of contracting rotavirus infection in children

- prevent and treat radiation-induced diarrhea in cancer patients

- protect against C.diff-associated diarrhea

- improve symptoms of irritable bowel syndrome; specifically, bloating, abdominal pain, and flatulence

I take a probiotic supplement daily, in hopes of preventing GI infections in the first place. But whether or not you care enough to add probiotics to your daily regimen, you should most definitely consider them when traveling, taking antibiotics, or recovering from an illness.

Once you've decided to take probiotics, however, you will undoubtedly be overwhelmed with the choices you have. Here are some guidelines for choosing a probiotic supplement*:

- A large selection of probiotics can be found at natural foods stores (e.g. Whole Foods Market or small local stores)

- Choose a product that is in the refrigerated section

- Look for a high number of "organisms" or "CFU" per capsule; I aim for at least 1 billion.

- Look for products that contain multiple strains of Bifidobacterium and Lactobacillus

- The number of organisms or "potency" should be guaranteed through the expiration date rather than "at date of manufacture." You will notice a statement about this on the bottle or package.

*These tips are based on my own opinion, not on systematic research

Reference

Collado MC, Isolauri E, Salminen S, Sanz Y. The impact of probiotic on gut health. Curr Drug Metab. 2009; 10:68-78

Nuts that taste as good as they are for you!

If you pay any attention at all to health and nutrition research in the news, you've probably heard that nuts are good for you. And this is one bit of information from the mainstream media you can actually trust. Nuts are nutritious; they provide protein, fiber, healthy fats, and vitamins and minerals. People who eat nuts regularly have been found to have lower rates of heart disease, metabolic syndrome, and diabetes. I would call all nuts healthy, but walnuts do have a bit of an edge on other nuts- they are the only ones that contain omega-3 fatty acids.

A lot of people avoid nuts because they are high in calories. I think this is somewhat misguided, and a good example of throwing out the baby with the bath water. It is important not to eat large portions of nuts if you are watching your weight, but it is much better to eat small quantities than to not eat them at all. Observational studies have consistently found that people who eat more nuts actually tend to have lower BMIs. Although paradoxical, this may be partially due to the satiating effects of nuts. In other words, nuts suppress hunger and thus may reduce total calorie intake over the course of a day.

So far, it sounds like nuts would make a perfect, healthful snack. And if nutrition is the only thing that matters, then that would be true. However, most of us think about taste first and nutrition second (even me!). Now, it's not that nuts don't taste good... but let's face it: they don't taste great. Pure, unadulterated nuts are pretty bland. I have long incorporated nuts into my diet, but it has been more out of a sense of obligation or self-righteousness than real desire. This is with the exception of almond butter, of course, which is like sex on a spoon (see my previous ode to AB here).

But in the past couple of months, I have noticed a trend in the snack food industry. There seem to be more and more jazzed-up nut products on the shelves. My feelings towards most of them are mixed. My old airport convenience store/gas station standby is Planters honey roasted cashews. These are quite tasty and only have a few extra grams of sugar in each serving. But I've grown bored with them. Blue Diamond has a new line of flavored almonds that sound like dessert: vanilla bean, cinnamon brown sugar, and dark chocolate. I tried all of these, and was a little disappointed. They were good enough, but they still lacked a certain something.

Then, in the span of a few weeks, I came across two products that HAD that something: YumNuts toasted coconut cashews and Sahale Snacks pomegranate vanilla cashews. I found the YumNuts (gotta love that name) cashews at a Whole Foods Market and instantly fell in love. These cashews have a light coating of sweet, subtle, coconut fairy dust. Eating them was a completely new experience and nothing like any other cashews I'd had before. I thought this was as good as nuts could get.

But THEN, I discovered Sahale Snacks' cashews at my local Starbucks. I was on my way out for drinks with some friends and it was a couple of hours after dinner, so I needed a little something in my stomach. My husband and I stopped at Starbucks so he could load up on caffeine and I could grab something- presumably unsatisfying- to eat. I bought these, fully expecting to have the same disappointing experience I had had with the vanilla almonds. Instead, I discovered that a healthy snack could taste as good as candy. I could not stop eating them. The combination of flavors was perfectly delicious and complementary to the cashews. This product does contain 6g of sugar per serving, but this is is still far less than any other snack food that would taste as good.

Both of these brands have a number of other varieties of nuts, but I have not yet tried them. If you are interested, check out their websites to view their other products:

Yumnuts Naturals

Sahale Snacks

In honor of that thing that's going around

It's that time of year. It seems like everyone's sick. I am usually lucky and manage to only get a cold or two. Last year, I think I had the flu. That was pretty miserable, but still not the the worst that could happen. In my mind, the worst has to be the so-called "stomach flu," which really isn't the flu at all (I like saying I had a "stomach thing"; it seems more accurate). I had been lucky enough to avoid this monster for a whole 8.4 years and had begun to think I could continue to avoid it indefinitely. Not so. The thing caught up with me this year, a day after my birthday-- Happy birthday to me!-- and lasted through December 31st-- Happy New Year to me, too!

When the clouds of darkness finally lifted and could muster the energy to have a thought in my brain, I had the same thoughts that I think most people have when they are struck with the stomach thing: Why was I sick? Was it something I ate? A virus? Am I contagious? I think there is a lot of confusion about this, so I'd like to take this opportunity to try to put all of the information I could find about acute gastroenteritis in one place, so that you all can refer to it as needed (hopefully not often!).

Acute gastroenteritis may be caused by a non-influenza virus or, it may be caused by a type of bacteria. Bacterial infection is often the result of contaminated food. In this case, we would call the illness food poisoning. Usually, people assume that a stomach bug is either a virus or food poisoning. What many people don't realize is that food poisoning can also be caused by a virus. In fact, 58% of foodborne illness is caused by a Norovirus (the kind that frequently runs through cruise ships). One in 6 Americans is sickened with foodborne illness each year, so the odds are pretty high that what you assume is a virus you caught from another person may actually be food poisoning.

I have compiled a list of the most common causes of food poisoning and viral gastroenteritis, along with their symptoms, duration, and likely sources. Unfortunately, you will probably never know what caused your illness, but if you have a compulsion to self-diagnose (like I do), have at it!

Food Poisoning Causes

Norovirus (58% of all foodborne illness)

Symptoms: Nausea, vomiting, diarrhea, abdominal pain, malaise, and low grade fever 1-2 days after exposure

Duration: 24-60 hours

Sources: Any food handled by an infected person; touching contaminated surfaces; direct contact with an infected person

Salmonella (11% of all foodborne illness)

Symptoms: Diarrhea, fever, and abdominal cramps 12-72 hours after infection

Duration: 4-7 days

Sources: Beef, poultry, milk, or eggs, but any food may become contaminated. Raw eggs may lurk in homemade Hollandaise sauces, salad dressings, mayonnaise, or cookie dough.

Campylobacter (10% of all foodborne illness)

Symptoms: diarrhea (may be bloody), cramping, abdominal pain, nausea, vomiting and fever 2-5 days after exposure.

Duration: Usually 2-5 days; can take up to 10 days

Sources: Raw or undercooked poultry, unpasteurized milk, or cross-contaminated food

Staphylococcus (9% of all foodborne illness)

Symptoms: Nausea, retching, vomiting, stomach cramps, and diarrhea within 1-6 hours of eating contaminated food

Duration: Typically 1 day; sometimes up to 3 days

Sources: Foods made by hand that require no cooking (ex. sliced meat, puddings, pastries, and sandwiches); high-salt foods are also vulnerable.

**Staph food poisoning is the result of toxins, which cannot be destroyed by heat.

Viral Gastroenteritis Causes

Norovirus (See above)

Rotavirus (most common in infants and young children)

Symptoms: Fever, vomiting, diarrhea, and abdominal pain

Duration: 3-8 days

Treatments

Regardless of whether you have a bacterial or viral infection, the treatment is the same. For the most part, all you can do is wait it out. You may take products like Tums or Pepto Bismol to try to calm the stomach, but avoid antidiarrheal medications (like Immodium). Over-the-counter antiemetics (like Emetrol) are appropriate to control vomiting and prevent excessive fluid loss. In some cases, pediatricians may even prescribe antiemetics in children who are vomiting a lot.

The primary concern whenever you or your child is experiencing diarrhea and/or vomiting is dehydration. It is very important to replace lost fluids. You should start replacing fluids as soon as symptoms start (as tolerated), by sipping small amounts of water or soda frequently. Oral rehydration solutions (such as Pedialyte) are good to have on hand. Be on the lookout for signs of extreme dehydration. These include:

- excessive thirst and dry mouth

- dark urine or little or no urine

- skin that, when pinched, does not quickly return to its original place

- severe weakness, dizziness, or lightheadedness

For more information about when to call a doctor, see this entry at the MayClinic website.

Prevention

Viruses that cause gastroenteritis are very contagious. To prevent spreading them (or contracting them in the first place), practice good handwashing and keep your hands away from your face. Alcohol-based solutions are not enough, as they do not destroy all noroviruses. Soap and water is best! When you are sick, make sure you wash your hands thoroughly after using the bathroom and disinfect all surfaces with a bleach-based solution. Close the lid on the toilet before flushing and disinfect the lid afterwards. You should consider yourself infectious from the moment you feel sick until at least 3 days after you recover. Do not prepare food for anyone during this time.