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Timi Gustafson, R.D.

Helping people to live healthy and fulfilling lives.

Should Obesity Qualify as Child Abuse?

July 16th, 2011 at 2:18 pm by timigustafson
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Parents of severely obese children should lose their custody rights for not controlling their kids’ weight, according to the authors of a recently published opinion piece in the Journal of the American Medical Association.

“In severe instances of childhood obesity, removal from the home may be justifiable […] because of imminent health risks and the parents’ chronic failure to address medical problems,” wrote Dr. David Ludwig, an obesity expert at the Children’s Hospital Boston and author of the article, which he co-wrote with Lindsey Murtagh, a lawyer and researcher at Harvard’s School of Public Health. Under these circumstances, “state intervention may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors.”

As an example, Dr. Ludwig cited a case of a three-year-old girl who weighed 90 pounds when her parents brought her in for treatment. At the age of 12, her weight exceeded 400 pounds. By then she suffered from diabetes, high cholesterol, hypertension and sleep apnea. Eventually, the state placed the girl in foster care, where she was put on a weight loss diet and lost 130 pounds.

The idea of government intervention when there is a serious threat to a child’s life is not new. In cases of obesity, such actions may not even need backing up by new laws. Health care providers are already required to report instances where children are at immediate risk, and that can be for a number of reasons, including neglect, abuse and what is called “failure to thrive,” which is a term commonly used by doctors to describe children who are severely underweight.

Ludwig and Murtagh are not the first to call for better protection of children with weight problems. In an article published in 2009 in the journal Pediatrics, its authors argued in favor of “temporary removal from the home […] when all reasonable alternative options have been exhausted.”

While this discussion may just have begun in earnest, some states have already taken action on several occasions. For instance, in South Carolina, a mother lost custody over her 14-year old son who weighed 555 pounds at the time. Childhood obesity was cited as the reason for loss of custody in California, New Mexico, Texas and New York. Other countries have taken similar steps. A Scottish couple had their children removed from home because of “failure to reduce the kids’ weight” after repeated warnings from social services were ignored.

Childhood obesity in the U.S. is reaching crisis level. According to the Centers for Disease Control and Prevention (CDC), over 12 million children and adolescents are obese today. Two million children are considered morbidly obese with a body-mass-index (BMI) at or above the 99th percentile.

Not everyone in the health care community agrees with the measures proposed by Ludwig and Murtagh. Dr. David L. Katz, founder of the Yale Prevention Center, expressed doubts that state-appointed caregivers would do a better job of feeding children than the parents. “Without knowing cost and benefit tradeoffs when the state takes children from their parents, it’s too early to say whether this is an appropriate response. I do believe that severe obesity in a child is a serious problem. The best approach [is] to prevent it rather than fix it. But when we need to fix it, for now, the state should identify the problem and offer solutions, but not impose them,” said Katz.

Others have pointed out that it can be extremely difficult for parents to monitor their kids’ weight, especially when they reach adolescence and parental control is diminished. “It’s unfair to blame solely the parents, when there’s a myriad of other factors influencing a child’s weight,” said Dr. Dana Rofey, professor at Pittsburgh University and director of a weight-management clinic. In her work, she said, she sees an array of contributing factors to childhood obesity, including genetic predisposition, socioeconomic status, environmental factors and exposure to advertising.

Predictably, the Ludwig/Murtagh article has caused considerable controversy. While the obesity epidemic is widely acknowledged as one of the biggest health problems today that may affect even more the next generation, there is little consensus on what countermeasures to take. “Forcing heavy children out of their homes is not the solution,” insists Dr. Arthur Caplan, the director of the Center for Bioethics at the University of Pennsylvania. “I am not letting parents off the hook,” he wrote in response to the article, “but putting the blame for childhood obesity on the home and then arguing that moving kids out of homes where obesity reigns is the answer is short-sighted and doomed to fail. We need the nation to go on a diet together and the most important places to start are the grocery store, schools and media.”

These are all good points, but I don’t think it has to be one or the other. Parents, like the rest of us, need to be educated about the ins and outs of healthy nutrition for themselves and their kids. These messages are extremely hard to get through, as we can see from the efforts of the First Lady, Michelle Obama, who has made the fight against childhood obesity a high priority. We are dealing with multi-faceted, complex issues and it would be foolish to hope for simple solutions. Resorting to drastic measures when everything else fails may be part of the equation.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog and at Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at

Eating Out and Frequent Snacking Seen as Main Causes for Obesity

July 13th, 2011 at 5:27 pm by timigustafson
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Two studies have recently been published, both trying to shed more light on the causes of the ever-growing obesity crisis in America. One of them blames restaurant food, the other sees snacking as the main culprit – both point to the changing eating habits in American culture. They each make good points.

Approximately a third of all calories consumed by Americans come from restaurants, including fast food places, according to the U.S. Department of Agriculture (USDA). More than half of adults eat out at least three times a week and 12 percent eat restaurant food almost every day, including on weekends. People have less time for grocery shopping and home cooking; they work longer hours, have longer commutes, don’t have a large enough kitchen or lack cooking skills.

Even the poor economy has not made much of a difference. “The data suggest that the recession is not making us eat out less, but we are eating out cheaper, choosing more fast food and takeout options over restaurants with tableside service,” says Lisa Mancino, a food economist who works for the USDA.

The problem is that eating away from home only once a week can translate into weight gain of two extra pounds per year. This may not sound much, but it adds up – and these are the low-end numbers.

Eating lunch out has the greatest effect, adding an average of 160 calories compared to lunch made at home. Going out for dinner increases the calorie intake by 140 calories and breakfast out adds about 75 calories, according to USDA data.

The main reasons for this are portion sizes. Restaurants try to lure in customers by offering big plates and other “extra values.” The nutritional quality of restaurant food is also a factor. Added sugar, high-fructose corn syrup, processed and refined grains, oils and trans fats are liberally used in restaurant kitchens to add flavor and keep costs down. These are also the ingredients known to contribute to weight gain. “One meal out typically lowers diet quality enough to shift the average adult’s diet from fair to poor,” said Dr. Mancino.

While customers don’t have a lot of influence over the nutritional quality of the meals they order, they also quickly lose control over the quantity of the food they consume. “People often associate eating out as a special occasion, or a time to splurge – even if eating out has become a routine,” said Dr. Mancino.

A different study blames frequent snacking for the dramatic rise of obesity in recent times. Over that last three decades, Americans have gone from consuming about four snacks to five snacks per day on average, an almost 30% increase. “The real reason why we seem to be eating more is [that] we are eating often,” said Dr. Barry Popkin, professor of nutrition at the University of North Carolina at Chapel Hill and lead author of the study. “The frequency of eating is probably […] becoming a huge issue.”

Popkin and a co-author analyzed data from several food surveys conducted by the USDA and the Centers for Disease Control and Prevention (CDC) between 1977 and 2006. Their report was published in the June issue of PLoS Medicine journal.

The most striking part of their findings was that snacking has become more frequent and the time periods between snacks and regular meals have become shorter over the years. Dr. Popkin concludes that, although portion sizes have substantially grown larger, it is more likely the frequency of eating that seems to be driving widespread weight gain.

The reason why people are now snacking almost constantly throughout the day is that consumers are faced with snack food everywhere and all the time. “You never used to see food staring you in the face when you went to a drugstore. You go get a magazine [and] you can get a candy bar,” said Dr. Lisa Young, professor of nutrition at New York University and author of “The Portion Teller,” who was not involved in the study.

“We overeat because there are signals and cues around us that tell us to eat. It’s simply not in our nature to pause […] and contemplate whether we are full,” writes Dr. Brian Wansink, professor of marketing and nutritional science at Cornell University and author of “Mindless Eating – Why We Eat More Than We Think.”

The only way out is to become more aware of our eating habits and to pay better attention to our actions, said Dr. Young. “In our food-filled environment we need to be conscious of when we eat, how much we eat and what we eat.”

Learning to watch both portion sizes and control snacking may not be as easy as some experts seem to think. Food plays many roles in people’s lives other than just stilling hunger. Many of us reach for edibles to cope with stress or boredom, or perhaps simply because they are so easily available.

Some researchers have suggested that sweet, fatty and salty snacks are irresistible because their intake results in the release of certain chemicals, both in the gut and in the brain, that keeps us craving for more. (Remember the potato-chip commercial that had the slogan: “Bet you can’t eat just one.”?)

Still, being more alert about the ways we eat is certainly a necessary step and, so far, our best hope.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog and at Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at

U.S. News Ranks “The Best Diets” – DASH Diet Comes Out on Top

July 9th, 2011 at 4:22 pm by timigustafson
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Are there any diet programs that work better than others? Do any of them work? As most seasoned dieters will tell you, dieting is a hard and often frustrating undertaking. Commercial diets are notorious for promising astonishing results in no time and without much effort and (heaven forbid) deprivation.

A team of journalists of U.S. News has spent six months investigating 20 of the best-known diets. The results of their research were then submitted to a panel of 22 leading experts in the fields of nutrition, diabetes and heart disease. The panelists were asked to rate each diet program on a scale from 1 to 5 in seven categories: Short-term weight loss, long-term weight loss, user-friendliness, nutritional completeness, safety, ability to prevent or manage diabetes and ability to prevent or manage heart disease.

The experts were also quizzed about the reasons for their preferences of one diet over another. All had to disclose beforehand whether they had any affiliation or commercial interests in the programs they were to vote on. None did.

In the end, the DASH diet (Dietary Approaches to Stop Hypertension) was selected as the best overall diet, just ahead of the Mediterranean Diet as the runner up. The DASH diet also came out first as the best diabetes diet, followed by the Mayo Clinic diet. The Ornish diet captured the top spot for heart healthy eating, followed by the TLC (Therapeutic Lifestyle Changes) diet. In terms of effectiveness for weight loss, two commercial diet plans won the nomination: Weight Watchers, closely followed by Jenny Craig.

The overall winner, the DASH diet, was found to fulfill all the demands of being easy to follow, nutritious, safe, effective for weight loss and able to prevent or control both diabetes and heart disease.

Interestingly, the DASH diet did not originate as a commercial diet but as a dietary recommendation by the National Heart, Lung and Blood Institute, a department of the National Institute of Health (NIH), which is a U.S. government agency.

The main purpose of this diet plan is not weight loss but control of hypertension (high blood pressure). The idea is to provide patients with liberal amounts of key nutrients, such as potassium, calcium and magnesium, all of which are associated with lowering blood pressure. One of its unique features is the focus on dietary patterns rather than on single nutrients like proteins or carbohydrates. Equally important is the emphasis on anti-oxidant rich foods to prevent or control an array of other chronic health problems, including heart disease, stroke and certain types of cancer.

The DASH diet guidelines recommend a rich variety of fresh fruits, vegetables, whole grains and low-fat dairy products. It allows meat, fish, poultry, nuts and beans in moderate amounts. But it advises to restrict consumption of salt, fat and sugar in both food and drink. Although at first intended for heart patients, the diet is now considered to be highly beneficial for anyone who wishes to eat healthily. It is officially endorsed by the U.S. Department of Agriculture (USDA) as an ideal eating plan for all Americans.

Starting the DASH diet
Here are some tips to get started on the DASH diet:

• Add at least one serving of vegetables at lunch and dinner.

• Add at least one serving of fruit to all your meals, including snacks. Frozen, canned (in their own natural juices) and dried items also work if fresh fruit is not available or out of season.

• Reduce the use of butter, margarine and salad dressings by half. Buy only low-fat or fat free condiments.

• Consume only low-fat or skim dairy products.

• Limit meat (especially red meat) to six ounces or less a day. Eat more vegetarian meals.

• Add brown rice and dry beans to your diet.

• Reduce or eliminate consumption of sweet, fatty and salty snacks.

• Read Nutrition Facts labels carefully and choose products that are low in sodium.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog and at Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at

Several states have recently passed new laws prohibiting local governments and municipalities from imposing their own rules and regulations on restaurants and fast food chains, such as labeling requirements or the mandatory elimination of trans fats and other ingredients in the food they serve.

As of late, a growing number of local legislators has been trying to take measures in their own hands to curb obesity and improve public health within their districts. Now lawmakers at the state level are responding to complaints from restaurant owners who say they have to comply with a patchwork of regulations that can differ not only from state to state but even from one city to another.

Some state level legislators readily admit that their actions are primarily intended to make life easier for the restaurant industry. “Hodgepodge regulations, requiring nutrition labeling on menus and other requirements would put restaurant owners in an unsustainable dilemma,” according to one representative from Alabama who co-sponsored what he called “pre-emptive legislation.”

These efforts will not affect federal law requiring menu labeling for chains with more than 20 outlets (the law is scheduled to go into effect nationwide by 2013). Still, more than half of all restaurants in the country won’t fall under the federal rules. Individually owned eateries and smaller franchises operate under state regulations, and they hope they will continue to benefit from a favorable business environment that imposes no new restrictions on them.

Any movement among cities and counties to take on the obesity crisis and promote public health will be frustrated by the state legislators’ growing assertion of their power, say health advocates who support these local initiatives. As a case in point, they cite places like Louisville in Kentucky where recently new policies were adopted for the improvement of the nutritional quality of school lunches and the creation of public parks and bike paths, all of which received nationwide attention. However, when the city tried to set higher nutritional standards for restaurant foods, it faced predictable resistance (not only from restaurant owners).

Cleveland in Ohio introduced a ban on the use of trans fats in restaurants within its city limits as part of a public health program called “Healthy Cleveland.” Now, Ohio’s governor is expected to sign a bill that strictly limits local control over restaurants by enforcing the state’s “sole and exclusive authority” to regulate marketing, labeling and other consumer incentives in restaurants.

When Santa Clara County in California banned fast food places from giving away toys for promotional purposes, at least one state government reacted swiftly: Earlier this year, Arizona forbade local law makers anywhere in the state to interfere with the use of consumer incentives by restaurants, including toys.

Many public health advocates applaud the legislative efforts by local community leaders. “This battle will involve policy changes at all levels of government,” says William H Roach Jr., chairman of the American Heart Association, “but it is easier fought locally because it allows greater accountability to ensure implementation and addresses the unique needs of communities.”

The “battle,” of course, is also waged over political and ideological differences. The (mostly conservative) lawmakers who oppose local policy-making say they are concerned about interference with private enterprise and over-regulation. Progressives, on the other hand, see a role for government intervention when there’s a threat to the safety and wellbeing of the public.

It would seem that our national obesity crisis qualifies as such a threat. A report by the Surgeon General in 2001, titled “Call to Action to Prevent and Decrease Overweight and Obesity,” warned that the weight problems in America constitute the greatest risk to our national security, ahead of terrorism and climate change.

Since then, governments on all levels have begun experimenting with ways to reverse the tide of obesity through imposing taxes and offering subsidies. An example is the attempt to curb soda consumption by adding surtaxes on sugary drinks. Other measures include giving employers tax credits if they install exercise equipment in their work places or offer free health club memberships to workers.

Those who support the notion of government taking an active role in the fight against obesity say that intervention is necessary because the actions of some cause substantial costs to all others, comparable to environmental pollution, food safety, smoking in public places and the likes. In other words, because obesity-related costs place such a large burden on society as a whole, government may not only be justified but may be required to intervene.

While government should not become overbearing in terms of controlling individual behaviors and practices, it has a greater responsibility to protect the public from harmful consequences. Part of good governance is also to accept the fact that people don’t always make decisions that are long-term in their own best interest. For these reasons and others, an all-out hands-off approach on part of the government is not always the answer.

This article is based in parts on a report by Stephanie Strom, titled “Local Laws Fighting Fat Under Siege,” which was published in the New York Times (7/1/2011) as part of the series, “The Big Picture.” (

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog and at Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at

The Mid-Summer Diet

July 5th, 2011 at 10:53 am by timigustafson
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Millions of Americans think of the beginning of the year as the best time to diet and get back in shape. It’s called resolution season, and for many it is almost an annual ritual. The weight loss industry strongly supports this tradition and does the bulk of its business during this period.

It’s not really a good plan when you think about it, though. With all this overindulging in festive meals, party foods and sweet treats over the holidays, your metabolism is most likely out of whack by the time you finally try to wean yourself from these unhealthy eating habits. So you face an uphill battle on two fronts by having to change your behavior and also to readjust your digestive system.

By contrast, I find the summer season a much better opportunity to do something for good health. There are several reasons for this.

First: Quality food is more abundant and affordable in the summer. Farmers markets offer locally grown fruits and vegetables for less money than supermarkets that depend on imports from far-flung sources. Food that is fresh and full of flavor will satisfy your cravings better and makes you eat less.

Second: Warm weather tends to make you feel less hungry. Instead of eating a big meal, you may be happier with a mixed green salad, fruit or some other small dish to cool down your body temperature.

Third: Let’s just admit it: Vanity is a great motivator. There is nothing wrong with wanting to look attractive in swimsuits and revealing summer clothes. If that’s what it takes – I can think of much worse reasons for slimming down.

Fourth: Summer is a time when things can slow down a bit. Even if you don’t go on an actual vacation, you probably find it easier to carve out a little extra time for yourself with the additional daylight. Your mornings are less hectic when the kids don’t have to get up early to go to school. Perhaps, you find more time for sit-down breakfasts and lunches together as a family.

Fifth: There are more opportunities for exercise. Baseball, soccer, swimming and other outdoor activities are all much easier to pursue this times of the year. Instead of having to chauffer your youngsters from one event to another, you can go together to the beach or to a nearby park where everybody can get some the fresh air.

Sixth: Summer offers plenty of opportunities for relaxation and managing stress. I don’t mean to say that nicer weather makes your life less busy or less stressful, but a little sunshine does have the power to lift most people’s spirits. In fact, depression and other emotional imbalances are often associated with lack of vitamin D due to insufficient sun exposure. Spending the evening outside by going on walks in the neighborhood or reading a good book on the front porch can do wonders for your emotional well-being. Speaking of neighbors: Summer is a good time to peek over the fence once in a while and say hello to people you haven’t seen for ages or have never really met.

Those who read my columns regularly know that I’m a great fan of the so-called “Mediterranean diet.” What I like about it the most is that it is not simply a guide for healthy eating; it is not even a “diet” in the strict sense of the word. I prefer to think of it as a lifestyle.

As the name indicates, the Mediterranean diet is based on the culinary traditions of the Mediterranean region that includes Italy, Greece, Turkey, Portugal, Spain, southern France and North Africa. The weather here is warm and sunny for most of the year and remains mild even in the winter. Consequently, there is a rich supply of fresh fruits and vegetables available as well as wine, olive oil, legumes, nuts and other staples. And, of course, there is an abundance of seafood.

Much has been written about the numerous health effects of this diet and Americans are being urged by many nutrition experts to incorporate more of it in their own eating styles. The World Health Organization (WHO) has reported that the citizens of the Mediterranean countries have dramatically longer life expectancies and lower rates of heart disease and cancer than other nations around the world, including America.

However, it has become clear that the differences in food choices alone are not sufficient to explain these differences in overall health and well-being. After all, southern Europeans are known for eating large portions, drinking (especially wine) and even smoking. Physical exercise like running or working out at a gym are much less common than, for example, in the U.S.

Researchers have pointed out that there may be other factors influencing the health benefits of the Mediterranean lifestyle. Some suspect that the people’s attitude toward eating and sharing meals as part of a joyful social event may play a significant role. In other words, taking time and enjoying the moment over a plate of good food and perhaps a glass of wine with family and friends may make all the difference.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog and at Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at

Potatoes Named a Major Culprit for Weight Gain

June 30th, 2011 at 6:15 pm by timigustafson
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Researchers at Harvard University say that the potato, an all-time American favorite, contributes to our national obesity crisis much more significantly than previously thought. Our love for French fries, chips and baked potatoes gives cause for concern, according to a report issued by the Harvard School of Public Health in Boston, Massachusetts and published in the New England Journal of Medicine (6/23/2011).

Surprisingly, potato consumption was singled out as one of the worst culprits, causing about 0.8 pounds weight gain per year. While this may not sound particularly alarming, the compounding effects over time are not to be discarded. Gaining 16 to 20 pounds extra weight over two decades just from one item on your dinner plate is enough to pay closer attention, says Dr. Walter Willett, chairman of the Nutrition Department of Harvard School of Public Health and co-author of the study.

According to the U.S. Department of Agriculture (USDA), the typical American eats about 117 pounds of potatoes per year and almost a third of that in form of French fries.

One of the reasons why potatoes contribute more easily to weight gain than other vegetables, says Dr. Willett, is that we don’t eat potatoes raw but cook, bake or fry them. This way it is easier for the body to transform the starch to glucose. This can prompt sudden spikes in blood sugar, causing the pancreas to release additional insulin to bring the levels back down to normal. The combined burst of blood glucose and insulin secretion has the unfortunate side effect of making us feel hungry again and wanting to eat more. If this cycle continues over long periods of time, weight gain is inevitable. What’s worse is that the pancreatic functions fatigue, which increases the risk of developing type 2 diabetes.

Also, unlike most other vegetables, potatoes are quite caloric. A large baked potato without any fixings contains about 275 calories. A medium-size bag of potato chips has 450 calories or more. And a large serving of French fries can deliver 500 to 600 calories, close to a third of a healthy daily calorie intake for adults.

The report names plenty of other causes for weight gain among the participants in the study as well: Drinking sugary sodas accounted for about one quarter of a pound per year. Similar effects had the consumption of both processed and unprocessed meats. Alcohol was also seen as a factor.

“Our findings indicate that small dietary and other lifestyle changes can together make a big difference, for bad or good,” says Dr. Dariush Mozzafarian, professor of epidemiology at the Harvard School of Public Health and the study’s lead author. By consuming fewer starches and refined foods, like potatoes, white bread, low-fiber breakfast cereals, processed meats, sweets and sodas, and by adding more fresh fruits and vegetables to their meals, most people could manage to stay within their healthy weight range over long periods of time, preferably for life.

The U.S. Potato Board (USPB), a marketing organization for the potato industry, has challenged the Harvard study, citing “unfortunate myths and misconceptions.” “Singling out the potato as a cause of weight gain is misleading and contrary to existing research,” said Tim O’Connor, president and CEO of the Potato Board. He also complained that the participants’ calorie intake was not controlled in the study and that the data were largely based on self-reports of portion sizes, which may often be understated.

Potato defenders have pointed out that there may be more correlation than causation at play. People who like potato chips and French fries often eat them with other less-than-healthy items, like hamburgers or hotdogs as well as sugary sodas and desserts. Since many of these contain high amounts of calories and fat, it would be unfair to put all the blame on the potatoes.

Nutrition experts generally acknowledge the health benefits of potatoes. They are good providers of potassium, fiber and vitamin C. Therefore, potatoes can be part of a healthy diet and successful weight management. In its response to the Harvard study, however, even the USPB admits that “the overall diet quality is better when adults and children consume non-fried white potatoes.”

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog and at Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at

How Concerned Should We Be About Pesticides?

June 26th, 2011 at 12:03 pm by timigustafson
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The Environmental Working Group (EWG), a Washington-based non-profit organization that studies food contaminants, has released new studies on pesticides on produce we all eat. The EWG uses several criteria to categorize fruits and vegetables in terms of the amount and varieties of pesticides found on them.

The group has compiled a list of food items it calls the “Dirty Dozen,” intended to warn consumers about high doses of pesticides, which may reach levels of harmfulness, especially to young children and expecting mothers.

While the EWG’s “Shopper Guide to Pesticides” urges people to reduce exposure to pesticides as much as possible, it also emphasizes that conventionally grown (that is non-organic) produce is still preferable to not eating fruits and vegetables at all. Still, it says that consumers should lower pesticide intake by avoiding or restricting consumption of the most contaminated foods.

According to clinical data cited by the group, pesticides in high amounts have been linked to brain- and nervous system toxicity, cancer, hormone disruption as well as skin, eye and lung irritation.

The EWG acknowledges that the science linking pesticides to specific health problems has so far been less than conclusive. The group does not undertake studies on its own but relies essentially on data published by the U.S. Department of Agriculture (USDA) and the Food and Drug Administration (FDA). Their research is not so much built on the assessments of health risks from pesticides in general but rather on surveys of the overall quantities of pesticides used by agricultural industries.

At the same time, the EWG does not want to discourage anyone from eating fresh produce. “We recommend that people eat healthy by eating more fruits and vegetables, whether conventional or organic,” says Ken Cook, its president and founder.

Still, according to the EWG’s estimates, consumers could lower pesticide intake by up to 92% if they avoided the worst items on its list.

“Where is the produce industry in all of this?”, asks Marion Nestle, Professor at the Department of Nutrition, Food Studies and Public Health at New York University. Unfortunately, she says, “produce trade associations are working hand-in-glove with the pesticide industry to attempt to keep information about these chemicals out of the public eye.” Professor Nestle calls for more research to shed some light the long-term health effects of pesticides on the public’s health. “I cannot imagine that pesticides are good for health. In high doses, they are demonstrably harmful for farm workers,” she says.

Alternative solutions
So, what can consumers do? Buying organic is always the best choice, according to the EWG and most other experts. “But sometimes people do not have access to that produce or cannot afford it, says Ken Cook. “Our guide helps consumers concerned about pesticides to make better choices among conventional produce and lets them know which fruits and vegetables they may want to buy organic.”

Washing produce thoroughly and peeling the skin off can also be useful measures, although the effects may be limited since many pesticides penetrate the outer surface and also enter most fruits and vegetables through the roots in contaminated soil.

Growing your own vegetable- and fruit garden in your backyard or on your balcony may be your best solution. Even a small plot can be made very productive and fulfill at least partially the needs of a family.

Additional tips
Apples rank high in terms of pesticide residue. If you don’t want to buy organic apples, apple juice may be a better choice. Similarly, canned peaches are lower in pesticides than fresh ones, simply because the processing involves vigorous washing, which removes the most concentrated residues.

Some imported fruits and vegetables may have higher rates of pesticides than locally grown ones. So, you may wish to inquire about the countries of origin before you buy. However, that does not mean that U.S. produced items are always the lowest in contamination.

The EWG’s “dirtiest”
The EWG recommends to buy the following fruits and vegetables organic whenever you can: 1. Apples, 2. Celery, 3. Strawberries, 4. Peaches, 5. Spinach, 6. Nectarines (imported), 7. Grapes (imported), 8. Sweet Bell Peppers, 9. Potatoes, 10. Blueberries (domestic), 11. Lettuce, 12. Kale/Collard Greens.

The EWG’s “cleanest”
The EWG found these items to have relatively low amounts of pesticide residues:
1. Onions, 2. Sweet Corn, 3. Pineapples, 4. Avocado, 5. Asparagus, 6. Sweet Peas, 7. Mangoes, 8. Eggplants, 9. Cantaloupe (domestic), 10. Kiwi, 11. Cabbage, 12. Watermelon, 13. Sweet Potatoes, 14. Grapefruit, 15. Mushrooms.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog and at Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at

Food Allergies Among Children Dramatically on the Rise

June 21st, 2011 at 6:08 pm by timigustafson
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Childhood food allergies are apparently much more common in America than previously believed. A clinical study, recently published in the journal Pediatrics, found that about eight percent of children under the age of 18, almost 6 million, suffer from one or more food allergies. The numbers are twice as high as the latest data released by the Centers for Disease Control and Prevention (CDC) in 2007, which showed a rate of just under four percent, or about three million kids.

The new findings came from online interviews that included 40,000 households all over the United States. Participants were recruited through random telephone calls. Based on the information gathered from the survey, experts now believe that allergies among the young, including food allergies, are dramatically on the rise.

“Based on our data, about one in 13 children has a food allergy,“ says Dr. Ruchi Gupta, assistant professor of pediatrics at Northwestern University Feinberg School of Medicine in Chicago and lead author of the report. “What’s more, nearly two out of every five affected children suffer from a severe food allergy. For these children, accidental ingestion of an allergenic food may lead to difficulty breathing, a sharp drop in blood pressure, and even death.”

Dr. Gupta, who also works as a pediatrician at Chicago’s Children’s Memorial Hospital, acknowledges that her study provides only a snapshot of the prevalence of food allergies in America today and does not track developments over time. Still, she says, “eight percent is a pretty significant amount. […] We are seeing a lot more cases in schools than we used to see. It does seem that food allergy is on the rise.”

The CDC estimates that eight types of foods are responsible for 90 percent of all food allergies in children. They are milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat.

Allergy is a condition that occurs when a person’s immune system is hypersensitive or over-reactive. Ordinarily, the human immune system has the ability to distinguish between harmless substances in the environment and potentially harmful agents, such as viruses and bacteria. For a person with allergies, however, the immune system reacts swiftly and with great intensity to substances that are not dangerous as if they were. So, when an individual who has certain allergies eats, touches or inhales an allergen (a foreign substance he or she is allergic to), the immune system mistakenly responds with an all-out counterattack.

Many experts believe that the tendency to develop allergies is primarily hereditary. However, in addition to genetic traits, long-term exposure to certain health hazards in the environment, such as tobacco smoke, pesticides and other pollutants, can provoke allergic reactions. So can emotional factors and other stressors.

People who suffer from food intolerances are not necessarily allergic to these foods. The symptoms can be similar, but with intolerance the physical reactions are usually due to problems with digestion. For instance, people with lactose intolerance are unable to produce enough of a digestive enzyme needed to break down milk sugar. They are lactose intolerant, but the immune system is not involved in the resulting digestive distress.

There can be conditions, however, where food intolerances and allergies sort of overlap. Celiac disease, for example, generates an abnormal immune response to foods containing gluten, like wheat and some grain products. Despite of this, celiac disease is classified as a food intolerance, although it is triggered by autoimmune activity.

Another difference between food intolerances and allergies is that the symptoms of intolerances generally intensify with age, while those of allergies get worse with exposure.

Allergies should not be taken lightly, especially when children are affected. Possible reactions range from mild to severe. They include swelling of lips and face, hives, itching, flushing or eczema flare. The severest cases, known as anaphylaxis, are potentially life-threatening. Symptoms include wheezing, trouble breathing, vomiting, persistent coughing and dangerous swelling of the airways.

“Especially for kids with multiple food allergies, it complicates their lives and makes it really tough on these kids to avoid multiple foods to stay healthy and stay alive,” says Dr. Gupta.

Parents of children with serious food allergies are urged to always carry antihistamine as well as an epinephrine shot (EpiPen) with them. The most effective measure people can take against allergic reactions is avoidance. That means paying close attention to ingredient labels, taking precautions when eating at restaurants and bringing along one’s own food if safe alternatives are unavailable.

Many children outgrow their allergies or tolerate them better as they grow older, including those against milk, eggs and wheat, while peanuts, tree nuts and shellfish often remain a lifetime threat.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog and at Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at

Fast Food Chains Lobby for the Use of Food Stamps in Restaurants

June 19th, 2011 at 6:16 pm by timigustafson
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Yum! Brands, the parent company of several national fast food chains, including KFC, Pizza Hut and Taco Bell, is lobbying the Kentucky state government to allow the use of food stamps in its restaurants. If the change in the law passes, Kentucky will join a very short list of only three other states – Michigan, Arizona and California – that permit food stamps to be used this way.

As reported by the local newspaper, the Courier Journal, Louisville-based Yum! intends to accept so-called EBT cards for payment, which proponents say will provide a much needed service for food stamps recipients who otherwise have difficulties to find a ready-cooked meal.

Supporters of the petition, including advocacy groups for the homeless, argue that any restaurant business willing to accept food stamps should be allowed to participate in the program. Natalie Harris, a spokesperson for the Coalition for the Homeless, is strongly in favor of the idea. “For those […] who don’t live near a large grocery store and can’t afford a restaurant, sometimes their only option is the nearest gas station. […] This would allow people to get a reduced price meal at a small deli or a restaurant, and that does include fast-food restaurants.”

Of course, this is not only a concern for homeless people. Elderly and disabled people, who are unable to cook at home for whatever reasons, can’t get a prepared meal if they depend on government help to pay for it.

Currently, Kentucky provides support to the needy mainly through its Food Assistance Program, which does not (yet) cover fast food items. Opponents of the proposed law change want to keep it that way. They argue that the government should not help push more sales of junk food on poor people at the expense of their health. In the long run, it would adversely affect the well-being of entire communities and drive up health care costs for the state.

In 2010, Kentucky was ranked number seven in the U.S. in terms of obesity rates, with over 30 percent of obese adults. Childhood obesity and Type 2 diabetes are also on the rise here. Critics say these numbers will only go up if low-income families are enticed to spend their food stamps at hamburger joints.

Louisville, where Yum! is headquartered, has been in the news lately for other reasons as well. Ironically, one might say, the town wants to be known for its fight against obesity. In 2003, city hall received a grant from the Robert Wood Johnson Foundation to help with the construction of bicycle lanes and to develop a number of small “pocket parks” as part of its affordable housing projects. To motivate people to drive less and move their bodies more instead, wider and safer sidewalks are being built.

These may be humble beginnings, but they point in the right direction. Still, if these few well-meaning efforts remain sporadic and isolated, they will not make much of a dent. Access to decent food sources and opportunities to maintain a health-promoting lifestyle should not be so hard to come by, even in less than affluent communities.

If government can afford to subsidize big industries – and let’s face it, allowing fast food places to accept food stamps is ultimately a subsidy program for the corporations who own them – it can also show some support for small produce farms. Our taxes would be well spent by keeping healthy nutrition affordable for everyone and by investing in our local agriculture at the same time. Food stamps should be made welcome at all farmers markets and urban farms. We also need more grocery outlets in the so-called “food deserts,” the underserved communities in many inner cities.

These are not revolutionary ideas and they are not hard to implement. What is missing, mostly, is enough political will.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog and at Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at

Will Quitting Smoking Make You Fat?

June 14th, 2011 at 11:52 am by timigustafson
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Many smokers who want to quit are afraid they will gain weight, so they rather not kick the habit. The fear of getting fat after quitting is not altogether unwarranted. Many ex-smokers do put on some extra weight, about five pounds on average.

Now, scientists think they know why. Recent studies have shown that nicotine helps suppress appetite by activating certain receptors in the brain, especially those in the so-called “reward regions,” where we sense pleasure and from where many of us also develop addictions.

A team of researchers at Yale University School of Medicine now found that nicotine can also bind regulator neurons to these receptors, which send out satiety messages, much like the signals our brain receives when our stomach is full to make us stop eating.

This mechanism may explain why smokers are usually not as hungry when they smoke and why they tend to eat more after quitting.

Considering the implications of their study results, some scientist now hope to develop a drug that can simulate the effects of nicotine on the brain, thereby eliminating the health hazards commonly attributed to tobacco use. Appetite-controlling drugs, like cytisine, to help quitters avoid unwanted weight gain are already available in Eastern Europe but not in the U.S.

Developing drugs that target specific receptors in the brain is a difficult challenge. Some scientists involved in this kind of research have warned that even if drug treatments were to prove effective, they may also trigger some unwanted side effects. The reason is that the receptors in charge of regulating appetite are also closely connected to the body’s stress responses, which normally are only mobilized in times of acute danger. Activating these receptors on an ongoing basis through medication could lead to symptoms similar to chronic stress and, over time, to diseases like high blood pressure and heart disease.

Of course, everyone agrees that fear of gaining weight should not ever prevent smokers from quitting. Instead of waiting for a wonder drug that might help people stay slim, there are many better ways to regulate one’s appetite and manage one’s weight more naturally.

A good way to start is to be more conscious of the metabolism. Smoking raises the metabolic rate and also increases the heart rate up to 20 times of normal. This is one reason why many smokers suffer from high blood pressure and heart disease.

When smokers quit, their metabolism slows down considerably. It can take weeks or even months before metabolic levels stabilize at normal levels. Meanwhile, calories are being burned at a much lesser rate. At the same time, many recovering smokers eat more food to cope with withdrawal symptoms or boredom. Senses of taste and smell come back to life after quitting, which may increase appetite as well.

Alcohol is often used to “take the edge off” when the cravings become more intense. Alcoholic beverages, of course, have lots of calories, and all too often these are not taken into account.

Another reason for increase of food intake is what smokers call “oral gratification.” Many ex-smokers miss the feeling of “having something to do with their mouths and hands.” Frequent snacking often serves as a substitute to fill the void.

Many people reach for food for similar reasons smokers reach for cigarettes, namely to handle stress, to reward or comfort themselves, to pass time, deal with boredom or to be social. For smokers trying to quit, the choice of means may change but not necessarily their behavioral tendencies.

So, is there a special regimen for ex-smokers to avoid falling into the weight gain trap? Not really. Ultimately, they have to act just like the rest of us who try our best to stay in shape: Healthy eating, limiting portion sizes, no snacking, regular exercise, stress reduction and enough sleep. Following all these measures combined should render any wonder drug of the future obsolete right now.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog and at Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at

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About timigustafson

Timi Gustafson, RD, LDN, FAND is a registered dietitian, health counselor, book author, syndicated newspaper columnist and blogger. She lectures on nutrition and healthy living to audiences worldwide. She is the founder and president of Solstice Publications LLC, a publishing company specializing in health and lifestyle education. Timi completed her Clinical Dietetic Internship at the University of California Medical Center, San Francisco. She is a Fellow of the Academy of Nutrition and Dietetics, an active member of the Washington State Dietetic Association, a member of the Diabetes Care and Education, Healthy Aging, Vegetarian Nutrition and the Sports, Cardiovascular and Wellness Nutrition practice groups. For more information, please visit

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