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.