What’s inside your cereal box

From the Tufts Nutrition Newsletter

Ready-to-eat breakfast cereals can be a smart choice for a healthy breakfast, but picking the right one in the circus of colorful packaging the grocery store can prove challenging.

Here we list key nutrition information for the bestselling breakfast cereals, along with some popular choices promoted as “healthy”—and plain oatmeal, for comparison. The cereals here are listed in descending order of fiber content, which is also generally a good indicator of whole grains.

Besides fiber, nutrients listed here to look for are protein, potassium and B12. Those to look for less of are calories, sugar and sodium.

What about fat? Few cereals are a significant source of saturated fat. Of those listed here, only Quaker Natural Granola contains as much as one gram of saturated fat in three- quarters of a cup. Most contain no trans fat, and none have as much as a tenth of a gram.

Serving sizes on cereals’ Nutrition Facts panels can be confusing because they vary so widely, from half a cup to one and a quarter cups. Sometimes this is simply because smaller servings of dense cereals fill you up; other times it may be to inflate good nutrients or “lowball” calories and sugar. For easier comparison, we’ve calculated all cereals in this chart at a common three-quarter-cup serving.

Note, too, that all cereals are listed before adding milk and without any sweetener you might add. Keep in mind that every teaspoon of sugar contains 16 calories.

Keep your kids safe this winter

Hard as it is to believe with the relatively warm temperatures we’ve seen so far this winter, but frostier times are expected soon. Before you send your little ones out to build a snowman, check out some very good winter safety tips from the Chicago Children’s Memorial Hospital website:

http://www.childrensmemorial.org/parents/safetynews/winter-safety.aspx

MRSA

From Kids Health

By now you've probably heard about MRSA skin infections. The good news is that serious MRSA infections are rare, and most infections can be treated easily. So what is MRSA and how can you protect yourself?

What Is MRSA?

MRSA stands for methicillin-resistant Staphylococcus aureus. Staphylococcus aureus is a type of bacteria with lots of different strains.

Many strains of staph bacteria are quite common. Most people have staph bacteria living on their skin or in their noses without causing any problems. If staph bacteria get into a person's body through a cut, scrape, or rash, they can cause minor skin infections. Most of these heal on their own if a person keeps the wound clean and bandaged. Sometimes doctors prescribe antibiotics to treat more stubborn staph infections.

What makes the MRSA different from other staph bacteria is that it has built up a resistance to the antibiotics doctors usually use to treat staph infections. (Methicillin is a type of antibiotic, which is why the strain is called "methicillin-resistant.")

MRSA skin infections often develop around open sores, like cuts, scrapes, or bites; but they also can occur on intact skin. Red, swollen, painful bumps appear that sometimes weep fluid or pus. Some people also develop a fever.

How Do People Get It?

MRSA is making headlines, but it's not a new infection. The first case was reported in 1968. In the past, MRSA usually affected people with weakened immune systems, such as those living in long-term care facilities like nursing homes.

But now some otherwise healthy people who are not considered at risk for MRSA are getting the infection. Doctors call this type of infection community-associated MRSA (CA-MRSA) because it affects people outside of hospitals and nursing homes. People at greater risk for becoming infected with this germ are those who spend a lot of time together in groups, such as in schools, college dorms, gyms or military barracks.

When lots of people come together and are likely to touch the same surfaces, have skin-to-skin contact, or share equipment that has not been cleaned, an infection can spread faster than it would otherwise. If the MRSA bacteria get onto a kneepad, for example, and someone with a skinned knee wears the pad without cleaning it, that person's risk of infection is higher.

MRSA is contagious while there is a skin infection. Sometimes, people can be "carriers" of MRSA (meaning the bacteria stay on or in their body) for days, weeks, or even years. They can spread it to others, even if they have no symptoms. That's why things like hand washing are so important.

How Can I Protect Myself?

MRSA may sound scary because it is resistant to some antibiotics. But it's actually easy to prevent MRSA from spreading by practicing simple cleanliness.

Protect yourself by taking these steps:

   • Wash your hands often using plain soap and water for at least 20 seconds each time.

   • Carry alcohol-based instant hand sanitizers or wipes in your bag  at times when you can't wash your hands..

   • If you have a cut or broken skin, keep it clean and covered with a bandage.

   • Don't share razors, towels, uniforms, or other items that come into contact with bare skin.

   • Cover shared sports equipment with a barrier (clothing or a towel) to prevent skin from touching it.

1. •All equipment, including toddler gym mats, should be cleaned before use with a disinfectant that removes MRSA.
   

How Is MRSA Treated?

MRSA infections can require different medications and approaches to treatment than other staph infections. For example, if a person has a skin abscess caused by MRSA, the doctor is more likely to have to drain the pus from the abscess in order to clear the infection.

In addition to draining the area, doctors may prescribe antibiotics for some people with MRSA infections. In a few cases, MRSA can spread throughout the body and cause problems like blood and joint infections — although complications like these are very rare in healthy people.

When Should I Call the Doctor?

Call the doctor if:

   • You have an area of skin that is red, painful, swollen, and/or filled with pus.

   • You have an area of swollen, painful skin and also feel feverish or sick.

  • If two or more family members have skin infections at the same time.

New fat rules

From the Tufts Nutrition Newsletter

According to the American Heart Association’s revised checkmark labeling, some fats are now OK. The changes reflect the evidence that monounsaturated and polyunsaturated fats are part of a heart-healthy diet. Foods such as nuts and fish that are high in these healthy fats, while low in unhealthy saturated fat, can now receive the association’s sign of approval. “We know that consumers have relied on the American Heart Association’s Heart Check mark to easily identify heart-healthy foods for more than 15 years,” said spokesperson Rachel Johnson, PhD, RD. “Adding nuts, fish and other foods that are rich sources of good fats, monounsaturated and polyunsaturated fats, enhances the program and gives more healthy options consumers can choose with the same trust factor.”

That guidance may be welcome. A recent survey found that while Americans are getting the message that not all fats are bad for you, many are still confused about which to choose. The 2011 Consumer Attitudes about Nutrition Survey, conducted by a soybean industry group, reported that only 9% of the 1,000 people surveyed still think “reducing all fats” is the best strategy. But just one-third correctly identified monounsaturated and polyunsaturated fats as healthier choices. Nearly 1 in 10 wrongly called saturated and trans fats “very” or “somewhat” healthy. Similar confusion reigned over butter versus margarine and spreads, with 54% picking butter (high in saturated fat) as healthier than margarine and spreads, which are typically made from vegetable oils and are high in polyunsaturated or monounsaturated fat and low in saturated fats. At least consumers do “get it” about heart-healthy omega-3 fats, with 79% rating them as healthy. The oversimplified “low fat is healthier” message reigned in the American consciousness for decades, says Alice H. Lichtenstein, DSc, director of Tufts’ HNRCA Cardiovascular Nutrition Laboratory—with unfortunate results. Simply eating less fat doesn’t improve your diet if you replace fat with carbohydrates such as sugar or refined grains; you could actually be increasing your risk of heart disease.

“The emphasis should be on displacing saturated fat and trans fat with unsaturated fat, particularly polyunsaturated fat, because that is what the data supports in terms of heart health,” says Lichtenstein. Moderate-fat diets—if the fat is unsaturated, as in liquid vegetable oil—are actually better heart-wise than low-fat diets, especially compared to diets high in refined carbohydrates.

“We need to stop worrying about individual dietary components,” Lichtenstein adds. “It’s the whole package that makes the difference.” So, even though polyunsaturated fat is heart-healthy, that doesn’t mean it’s a good idea to douse everything with vegetable oil.

Lichtenstein says, “If you add some- thing ‘healthy’ to the diet, you need to take something out, preferably something that is less ‘healthy’—otherwise you add calories, hence weight gain. For most individuals, that should be avoided.”

Saturated vs. Un-

So how do you make smart choices about fats and oils, in the context of an overall healthy diet? If you remember nothing else about fats as you go to the grocery store, keep in mind this rule: Pick cooking oils that are liquid at room temperature.

Saturated fats, mostly obtained from animal sources, are solid at room temperature, like butter, or are found in animal foods such as meat and dairy. Foods from plants that contain saturated fat include coconut, coconut oil, palm oil and palm kernel oil—often called “tropical oils”—and cocoa butter.

Saturated fats, typically derived from plants, are liquid at room temperature. Indeed, the chemical manipulation required to make them solid and thus more convenient and stable is what led to the invention of partially hydroge- nated vegetable oils—trans fats, which we now know are at least as unhealthy as saturated fats. Monounsaturated and polyunsaturated fats are primarily found in liquid vegetable oils such as soybean, corn, safflower, canola, olive and sunflower. The especially heart-healthy omega-3 fats, such as those found in fish, are also polyunsaturated fats.

Does the type of fat really make a difference to your health? A 2010 analysis found that replacing saturated fat with polyunsaturated fat reduces the risk of heart disease. The review of randomized clinical trials concluded that those who switched from saturated to polyunsaturated fat cut their risk of coronary heart disease by 19% compared to control groups. For every 5% increase in calories from polyunsaturated fat, while reducing saturated fat, heart disease risk dropped by 10%.

Other studies have touted the benefits of monounsaturated fat, such as in canola and olive oil, which is also a key component of the so-called Mediterranean diet shown to have a variety of health benefits. The Optimal Macro- nutrient Intake Trial for Heart Health (OmniHeart), for example, found that replacing a high-carbohydrate diet with one rich mostly in monounsaturated fat improved cholesterol and other lipid levels and reduced blood pressure.

As long as you avoid saturated and trans fats, does it matter for cardiovascular health whether you opt for mono- unsaturated fats versus polyunsaturated fats? Tufts’ Lichtenstein advises, “The current thinking is that polyunsaturated fat is better than monounsaturated fat, but that may be a bit like splitting hairs. The important thing to remember is to displace sources of saturated and trans fat with unsaturated fat, and always keep calories in check.”

Substitutions Encouraged

Keeping calories in check means not overdoing it even with healthy fats. All fats and oils contain about 90 calories per tablespoon (9 per gram). The American Heart Association advises:

   • Consume a diet in which 25%- 35% of calories come from fat, primarily unsaturated fats.

   • Limit saturated fat intake to less than 7% of total calories.

   • Limit trans fat intake to less than 1% of total calories.

Our new crew!

We were all sad to see Dr. Alex McCollum leave. Alex always wanted to live in the City, and she finally made the move. She and her hubby have relocated to Park Slope. She’s taken a clinic job at Methodist Hospital and we know they’ll love her there just as much as we did out here in “the sticks.” Her 4th floor walk-up will give her lots of exercise, especially when she’s “shlepping” a baby carriage up 4 flights of stairs. That’s right, Alex is pregnant! We wish her and her family all the best.

Fortunately, we were able to lure our wonderful former colleague, Dr. Marcia Rubinos, back into the Kidfixer family. We’ve missed Marcia and can’t wait to welcome her back later this month. For those of you who don’t know Marcia, you can read about her on our “Meet the Docs” web page.

Are you addicted to snacks?

From the Tufts Nutrition Newsletter

You can’t seem to succeed in your healthy-eating goals, despite nutritious meal planning, maybe the problem is what you eat between meals— snacks. Americans are now eating so much between meals that snacks add up to a quarter of the average calorie intake. According to researcher Richard Mattes, PhD, MPH, RD, of Purdue University, "snacking in the American diet has grown to constitute ‘a full eating event,’ or a fourth meal, averaging about 580 calories each day.”

“We’ve been blindsided,” says Susan B. Roberts, PhD, director of Tufts’ HNRCA Energy Metabolism Laboratory. “People always loved calories, but opportunities to enjoy them have increased dramatically. Forty years ago, few people ate outside of mealtimes and regular snack times. And with the exception of an occasional ice-cream cone, almost no one ate while walking down the street. Nowadays, it’s hard to make a quick trip to the mall without encountering the enticing odor of a Cinnabon (730 calories per roll).”

The effects of this “snack attack” are felt at the cash register as well as in our waistlines. According to the Packaged Facts market-research firm, annual US packaged-snack sales hit $64 billion last year, up 14% from 2006, and are predicted to grow to $77 billion by 2015.

What's the chief culprit? A Harvard study pointed to potato chips. About half the 3 1/2 pounds an American gains over four years can be traced to potato chips. Sugar-sweetened beverages, a favorite liquid “snack,” were also major contributors.

Addicted to Snacks?

If snacks are so bad for us, why do we keep eating more of them? Another new study may suggest clues to the answer: Scientists reported that when laboratory rats were given foods high in fat, their digestive systems immediately began releasing natural chemicals similar to the active ingredient in marijuana. These chemicals, called endocannabinoids, caused the rats to crave still more fatty foods. When given fat, the rats began producing the natural marijuanalike compounds as soon as the fatty liquid hit their taste buds. Only liquid diets high in fat, not those high in sugar or protein, produced the endocannabinoids.

The addictive nature of snacks and other fatty foods is no surprise to David A. Kessler, MD, who served as commissioner of the US Food and Drug Administration (FDA) from 1990 to 1997. In his book, The End of Overeating, he explores how packaged foods and restaurant meals are crafted to be “hyperpalatable” by the layering of sugar, salt and fat. Such foods are engineered to trigger your brain to release dopamine, a neurotransmitter associated with the brain’s pleasure center—the same chemical connection that makes people crave alcohol or tobacco. Soon, your brain “lights up” with dopamine at even the thought of potato chips or Twinkies or Oreos.

“Once your working memory and thoughts are engaged by hyperpalatable food, you’re almost in a trance,” Dr. Kessler explains. The body’s dopamine and opioid responses to such foods combine with “cues” from the food and your associations with it to create a vicious circle of “conditioned overeating.”

Taking Charge

So what can you do to break this vicious circle and fend off those “snack attacks” that can derail your best intentions to eat healthier? Start by taking control of your eating. When you eat only planned meals and snacks at planned times, your familiarity instinct stops prodding you with triggers that try to get you to eat at other times. This basic human instinct wants structure, she explains, “and when it gets what it wants, it’s less inclined to encourage you to break the rules.

Plan your grocery shopping, too. If you don’t keep unhealthy snacks in the house, you can’t lose control and gobble them up. Shop the perimeter of the grocery store, where most stores stock fresh produce and other from-scratch foods, and avoid the packaged-goods aisles.

Use the Nutrition Facts labels when you do venture in from the perimeter. Surprisingly, a recent Harris Interactive survey found that consumers are less likely to study nutritional information on “indulgence opportunities” such as crackers, cakes and candy. Apparently, consumers take a “what the heck” attitude toward treats: Only 54% check nutritional info on cakes, compared to 67% who use Nutrition Facts data to pick canned goods.

And don’t forget that in-between-meal beverages count as “snacks,” too. In fact, half the calories contributed by snacks come from beverages. Between 2006 and 2008, the time spent drinking beverages outside of meals jumped from 45 to 85 minutes a day. Experts warn that liquid calories are "sheer poison" because they don’t make us feel as satisfied as solid calories and we end up having a drink on top of other things, not instead of them.

Satisfying Substitutions

Clues to some smarter snacking selections come from that Harvard study that got headlines for implicating potato chips in the obesity epidemic. The researchers also looked at what foods were most associated with losing weight over a four-year pe-riod, per added serving per day. All five foods most linked to weight loss could also serve as snacks:

   • Yogurt (-0.82 pounds)
   • Nuts (-0.57 pounds)
   • Fruits (-0.49 pounds)
   • Whole grains (-0.37 pounds) • Vegetables (-0.22 pounds)

If those don’t fit your definition of “snacks,” maybe you need to redefine your between-meal thinking. Plain low-fat yogurt topped with berries can satisfy your sweet tooth while helping meet your daily calcium needs. Roast chickpeas for a crunchy treat, or turn them into hummus; use carrot or celery sticks instead of high-calorie crackers for dipping. Apples make a portable, sweet-tasting snack. They’re low in calories, high in fiber, and hard to eat too quickly.

Nutritionists actually recommend planning two snacks a day if you’re trying to lose weight, to control hunger. Healthy snacks can also be part of rituals with associations as positive as Thanksgiving turkey or Fourth of July barbecue.

Don’t let the cold weather turn you into a couch potato

When the weather turns cold and it gets dark early, keeping kids active can take some creativity. Here are some ideas for keeping your family moving all winter long.

1. 1.Discover Indoor Facilities
   Visit an indoor pool, ice skating rink or basketball court at a local gym, school, or community center. You can visit to locate your local YMCA and find out about indoor programs they offer.
   

2. 2.Dance Your Heart Out!
   Encourage your child to pick the music, crank it up and then dance away! March, box step, bounce, spin, shake it...it is a great way to burn calories.
   

3. 3.Take it Outside
   If there is snow where you live get the whole family outside to do some sledding, build snow forts and throw snowballs, build a snow sculpture—anything that keeps the kids moving and having fun.
   

4. 4.Walk the Mall
   When it’s too cold to venture outdoors take the family for a brisk walk around the nearest mall. Walk up the stairs versus taking the escalators.
   

5. 5.Keep it Clean
   Recruit your kids to help with the house cleaning. Pick jobs based on age and capability: younger children can pick up toys while older kids can vacuum, sort laundry, or scrub the bathtub.
   

6. 6.Visit the Library
   Libraries are a great resource for children’s fitness videos and books, which you can use to teach your child about indoor exercises. Best of all, it’s free!
   

7. 7.Hit the Trails
   Go snow trekking, skiing or snowboarding with the kids for a fun aerobic workout. If you don’t have the equipment (or a nearby resort), find a hill ideal for sledding or tubing. Climbing back up after each run will get hearts pumping.
   

8. 8.Visit a Zoo or a Farm
   Zoos and farms are fun winter destinations for learning how life changes through the seasons. Kids can also learn how animals are taken care of during winter.
   

9. 9.Sign ‘Em Up
   Enroll your child in an instructional group class. Try dancing, gymnastics, martial arts, fencing, indoor swimming lessons—anything that will get him or her excited about staying active.
   

10. Find Middle Ground
If it’s impossible to pry kids away from the TV, encourage them to do jumping jacks, sit-ups, and push-ups during commercial breaks, or play Wii sports .