2.1
What Can You Do Right Now?
What should you be eating? With your plate in front of you,
make sure ½ of your plate is fruits and vegetables (think
variety!), ¼ of your plate is grains (½ or more whole grains),
¼ of your plate is protein-containing foods, and off to the
side, a ¼ plate serving of low-fat dairy. Try to cut out the
refined carbs and sugars, and go easy on the cholesterol. This
is according to the excellent USDA website,
“ChooseMyPlate.gov.”
Chapter 2: Diet Planning
What Are Nutrients?
Nutrients are any substance needed by the body to maintain good health. Nutrients are divided
into the macronutrients and the micronutrients. Macronutrients include carbohydrates, proteins
fats, and water. 1,2
Micronutrients include vitamins and minerals. 3 We eat food because they
contain nutrients; nutrients are found in the foods we eat. So, a proper diet is necessary to obtain
all of the nutrients we need to be healthy!
Dietary Guidelines For Average Americans
Every five years, the United States Departments of Agriculture (USDA) and Health and Human
Services (HHS), jointly publish the “Dietary Guidelines for Americans,” targeting individuals
age two and up. 4,105
The guidelines contain information compiled by top nutritional scientists to
help individuals control their calorie intake and to exercise to achieve and maintain weight,
explaining which foods and nutrients to eat less of, which foods and nutrients to eat more of and
how to form healthy eating habits. 5,105
The Key Recommendations are as follows (edited): 105
Calorie Management to Control Weight
Use correct eating habits and physical activity to prevent or reduce excess weight.
Control total caloric intake to maintain weight; reduce total caloric intake to lose weight.
Increase physical activity.
Target special calorie and physical activity needs at each stage of life: Childhood Adolescence Adulthood Pregnancy Breastfeeding Older age
2.2
Foods and Nutrients to Reduce
Reduce sodium intake to less than 2,300 mg per day for most people; reduce to 1,500 mg per day if you’re over 51, black, or have hypertension, diabetes or kidney disease.
Reduce saturated fat intake to less than 10% of daily calories.
Reduce consumption of red and processed meats.
Reduce cholesterol intake to less than 300 mg per day for most people, less than 200 mg for people with a history of heart disease.
Eliminate trans-fats from the diet as much as possible; trans-fats are found in “partially- hydrogenated oils.”
Reduce solid fat intake.
Reduce added sugar intake to a maximum of 10% of total calories by limiting sugar- sweetened beverages, sweets and desserts.
Reduce intake of refined grains, including refined flour.
Reduce intake of foods containing refined flour, sugar, saturated fat and salt.
Consume alcohol in moderation, no more than one drink per day for women, two drinks per day for men.
Foods and Nutrients to Increase
Eat more fruits and vegetables and other plant-based foods.
Eat a variety of vegetables, especially dark green, red and orange vegetables, plus more legumes (beans, peas, peanuts).
Eat more whole grains; make at least ½ of grain choices whole grains.
Eat a variety of protein foods including lean meats, skinless poultry, fish, dairy, legumes and grains, and unsalted nuts and seeds.
Eat more seafood by replacing some meats and poultry with fish and shellfish, especially farm-raised seafood.
Eat more liquid oils by substituting them for solid fats.
Eat more foods containing fiber and potassium, such as fruits, vegetables, whole grains, and legumes.
Eat more foods containing calcium and vitamin D, such as low-fat or fat-free dairy.
Women and girls capable of becoming pregnant: Eat more iron-rich foods that contain heme iron, such as lean meats and fish, and
foods that enhance iron absorption, such as citrus and tomatoes that contain
vitamin C.
Get 400 mcg of folic acid (folate) from supplement or fortified sources, plus increase intake of foods that contain folic acid.
Women who are pregnant or breastfeeding: Consume 8 to 12 oz of seafood per week from a variety of sources; limit tuna
consumption to 6 oz per week, and do not eat swordfish, shark, tilefish or king
mackerel, due to high levels of methyl mercury contamination.
Take an iron supplement, as directed by medical doctor.
Individuals over 50 years of age: Get more vitamin B12 either through foods containing B12 or supplements.
2.3
Building Healthy Eating Patterns
Select and establish an eating pattern over time with the needed calories to maintain weight and with the necessary nutrients.
Be aware of what is consumed and how it fits into a healthy eating pattern. Understand and follow safety recommendations in the preparation and storage of food to
minimize the risk of sickness caused by food contamination.
The Goals Of The DRI Committee
DRI stands for “Dietary Reference Intake.” 5
DRI values are established by the National
Academy of Science Food and Nutrition Board of the Institute of Medicine, in collaboration with
Canadian scientists, 6 to help healthy individuals plan and maintain optimal nutrition. DRI values
include the following:
EAR (Estimated Average Requirement): The amount of a particular nutrient needed to meet
the dietary requirements of 50% of the individuals of a particular age and gender group.
RDA (Recommended Dietary Allowance): The amount of a given nutrient needed by 97%-
98% of healthy people.
Adequate Intake (AI): Estimated when the EAR and RDA cannot be determined, is the
average of the amount of a given nutrient healthy people eat, with the assumption that this
amount is sufficient to keep them healthy.
UL (Upper Limit): The maximum dose of a given nutrient that has been shown to cause no
adverse effects, over time. 7,8
The DRI values are published and available at https://fnic.nal.usda.gov/dietary-
guidance/dietary-reference-intakes/dri-tables.
DRVs (Daily Reference Values) are values on nutrient labels, based on a 2000 and 2,500 calorie
diets, for total fat, saturated fat, cholesterol, sodium, potassium, total carbohydrate, dietary fiber,
and protein. These were established by the FDA. 52
We’ll explore nutrient labels further at the
end of this chapter.
The USDA Food Groups
The USDA Food Groups are as follows, together with recommendations, nutrients and health
benefits of each group, and representatives of high and low nutrient density foods. 9
Foods with high nutrient density have the most nutrients per calorie, because they don’t
contain added sugars, syrups or fats that contribute empty calories; low nutrient density foods
have fewer nutrients per calorie because they do contain added sugars, syrups and/or fats that
contribute empty calories. Essentially, high nutrient density foods are much lower in calories
https://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables
https://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables
2.4
than comparable low nutrient density foods more nutrients that help to restore and maintain
optimal health. Generally speaking, try to avoid eating low nutrient density fruits on a regular
basis; use them as a once-in-awhile treat, as part of your discretionary calories (see below).
Fruits
The USDA lists the following fruits: Apples, apricots, bananas, cherries, grapefruit, grapes, kiwi,
lemons, limes, mangos, nectarines, oranges, peaches, pears, papaya, pineapples, plums and
tangerines. Other fruits include berries such as blackberries, blueberries, raspberries, and
strawberries, melons such as cantaloupe, honeydew and watermelon. Canned or frozen fruits still
retain their nutritional value, but watch out for added sugar and sugar syrups! Dried fruits, such
as prunes and raisins, are nutritious. Also included in the fruit group is 100% pure, unfiltered
fruit juice such as orange and grapefruit juice (not “fruit drink”). 10
Botanically, fruits are fleshy
structures with seeds, so tomatoes and avocados are fruits; however, since they are not sweet,
they are included in the vegetables category.
Recommendations: The USDA’s “Key Consumer Message” is, “Make half your plate
fruits and vegetables.” The Daily Recommendation for Fruits based on USDA’s Supertracker is
below, 42,96
by age and calorie requirements. Higher calories within a particular age group
generally suggests increased physical activity. A sedentary 4 to 8 year old may only need 1 cup
of fruit per day, whereas a very active 4 to 8 year old would need 1 ½ cups of fruit per day.
Overall, about 80% of Americans do not get sufficient fruit in their diet. 105
Table 2-1. Daily Recommendation for Fruits, 96
in cups.
Age Calorie Requirements (see Table 2-7)
1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200
2-3 years 1 c 1 c 1½ c
4-8 years 1 c 1½ c 1½ c 1½ c 2 c
9-18+ years 1½ c 1½ c 2 c 2 c 2 c 2 c 2½ c 2½ c 2½ c
A “cup” of fruit is a cup of sliced or diced fruit, or fruit made into sauce (applesauce), or
a medium to large whole fruit. A cup of unfiltered fruit juice counts as a cup of fruit. A ½ cup
portion of dried fruit is considered a cup of fruit. Variety is the key; eat many different types of
fruits each day.
Nutrients and Health Benefits: Fruits contain beta-carotene, especially orange fruits such
as cantaloupe and apricots, which is the non-toxic form of vitamin A. Fruits are also high in
vitamin C and folate (folic acid), potassium and fiber, and contain essentially no sodium or fats,
and contain no cholesterol, 11
cholesterol only being found in animal-sourced foods. Vitamin A
helps maintain skin and vision, vitamin C is needed for the gums, bones and wound healing,
potassium helps keep blood pressure normal, and fiber reduces the risk of colon cancer and heart
disease by lowering blood cholesterol, and makes it easier to lose weight by making you feel full,
longer, and by being tasty! Diets that are rich in fruits (and vegetables) also lowers the risk of
heart attack, stroke, some cancers, kidney stones, and the development of type II diabetes;
further, high nutrient density fruits (whole fruits), because they contain high amounts of soluble
fibers and low amounts of refined carbohydrates, as explained in Chapter 4, may inhibit the onset
of, or reverse, systemic inflammatory reactions such as asthma, rheumatoid arthritis, and type II
diabetes by promoting beneficial bacteria populations in the gut. Of course, another way of
thinking about this is, when you’re eating an apple, you’re not eating a handful of cookies, so
2.5
fruit is good for the diet in that it replaces empty calorie foods! Note that filtering of fruit juice
removes fiber, so the only fruit juice that is close to equivalent to whole fruit would be
unfiltered, freshly-squeezed juice, without added sugar, of course!
High and Low Nutrient Density Fruits: High nutrient density fruits do not contain added
sugars, syrups (or fats); further, they are usually whole, unprocessed fruits. High nutrient density
fruits contain any fruit that you recognize as a fruit, such as those at the beginning of this section:
apples, oranges, bananas, grapes, kiwis, melons, etc. High nutrient density fruits also include
frozen or canned fruits that do not contain added sugars (or fats); in fact, because frozen fruits
are frozen at peak ripeness, they may actually contain more nutrients than fresh fruits, as fresh
fruits may begin to lose nutrients once picked. 12
This is one reason why “eating locally” and
buying your produce from local farmers’ markets is such a good idea. Low nutrient density fruits
are higher in calories than high nutrient density fruits because they contain added sugars, syrups
or fats. These commonly include frozen fruits with added sugar, canned fruits packed in syrups,
and fried fruits such as fried plantains, a type of banana, common in Caribbean cuisines. Of
course, the fruit included in desserts, especially deep-fried fruit desserts, would be very low
density fruit indeed! (A piece of deep-fried apple pie should not be considered as a serving of
fruit!)
Vegetables
The USDA lists five subgroups of vegetables. These include dark green, starchy, red and orange,
legumes (beans, peas, peanuts), and others. 13
Dark green vegetables include leafy dark green vegetables such as romaine and other
leafy lettuces (not iceberg), mustard greens, kale, turnip greens, bok choy, collard greens,
spinach and others. This category also includes broccoli. Starchy vegetables include white
potatoes and corn, along with plantains, green bananas, green beans and green peas, and
legumes. Red and orange vegetables include tomatoes and red peppers, carrots, pumpkin, sweet
potatoes and yams, and the various squashes such as acorn (green on outside, orange or yellow
inside), summer, banana, spaghetti and butternut. Legumes (beans, peas, peanuts) include all the
different types of dried beans you can get at the store: black, white, navy, pinto, garbanzo
(chickpeas), black-eyed peas, split peas, lentils, as well as peanuts; note that legumes also
contain slowly-digesting starch, so may also be grouped with the starch; we’ll explore this
further in Chapter 4. Others include iceberg lettuce, avocado, bean sprouts, beets, celery, onions,
cucumbers and mushrooms (botanically not a vegetable, but is a fungus), essentially the
ingredients for a good salad; the USDA also lists artichokes, asparagus, Brussel sprouts, cabbage
and cauliflower, eggplant, green beans, green peppers, okra, turnips, wax beans and squash that
don’t have orange or yellow on the inside such as zucchini in the “others” category.
Table 2-2a. Daily Recommendation for Vegetables, 96
in cups.
Age Calorie Requirements (see Table 2-7)
1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200
2-3 years 1 c 1½ c 1½ c
4-8 years 1½ c 1½ c 2 c 2½ c 2½ c
9-18+ years 2 c 2½ c 2½ c 3 c 3 c 3½ c 3½ c 4 c 4 c
Note that these are total daily values; servings from each of the five vegetable subgroups should be
consumed 3-4 times each week; see Table 2-2b below.
2.6
Recommendations: The USDA’s “Key Consumer Message” is, “Make half your plate
fruits and vegetables.” The Daily Recommendation for Vegetables based on USDA’s
Supertracker is above, 43,96
by age and calorie requirements. Higher calories within a particular
age group generally suggests increased physical activity. About 90% of Americans do not get
sufficient vegetables in their diet; about 1/3 of the vegetables that are eaten are white potatoes. 105
A cup of vegetables is 1 cup of cooked vegetables or 1 cup of unfiltered vegetable juice,
or 2 cups of raw, leafy vegetables. 14
As with fruits, variety is the key; several servings of each of
the five vegetable groups should be eaten per week; see Table 2-2b below. Focus on ½ cup
servings of a variety of vegetables each day rather than a large serving of a single vegetable. The
Weekly Recommendation for Vegetable Subgroups based on USDA’s Supertracker is below, 96
by vegetable subgroup and calorie requirements. Supertracker does not establish different
subgroup recommendations within each calorie requirement for different ages.
Table 2-2b. Weekly Recommendation for Vegetable Subgroups, 96
in cups. Vegetable
Subgroup Calorie Requirements (see Table 2-7)
1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200
Dark Green ½ c 1 c 1 c 1½ c 1½ c 1½ c 2 c 2 c 2½ c 2½ c 2½ c 2½ c
Starchy 2 c 3½ c 3½ c 4 c 5 c 5 c 6 c 6 c 7 c 7 c 8 c 8 c
Red/Orange 2½ c 3 c 3 c 4 c 5½ c 5½ c 6 c 6 c 7 c 7 c 7 c 7½ c
Legumes ½ c ½ c ½ c 1 c 1½ c 1½ c 2 c 2 c 2½ c 2½ c 3 c 3 c
Others 1½ c 2½ c 2½ c 3½ c 4 c 4 c 5 c 5 c 5½ c 5½ c 7 c 7 c
Nutrients and Health Benefits: Orange and yellow vegetables such as carrots, pumpkin
and sweet potatoes are particularly high in contain beta- (and alpha-) carotene. 15
Although not
orange or yellow, cooked spinach, and other dark-green vegetables, are also high in beta-
carotene. Note that cooking or pureeing increases the bioavailability of the carotenoids, so
cooked or pureed carrots, pumpkin or sweet potatoes provide more beta-carotene than raw. 16,17
Vegetables are also an excellent source of vitamin C, folate (folic acid), magnesium, potassium,
iron and fiber, and like fruits, contain essentially no sodium and zero cholesterol. 15
Be careful of
canned vegetables, though; these may be loaded with added sodium! Vegetables that are rich in
magnesium include dark leafy greens (spinach), nuts, seeds, legumes, avocados and some others;
unlike with the carotenoids, cooking and draining the cooking fluid from the cooked vegetable
will remove much of the magnesium, so to get magnesium, either eat the veggie raw or consume
the cooking fluid! 18
Many vegetables, such as rhubarb and spinach, do contain some calcium, but
the best source for calcium regarding quantity, absorbability and type, is dairy products. 19
Legumes are a very good source of iron, particularly if they are combined with vitamin C or
meat (see Chapter 8 for more on this), 20
zinc, 23
and are an important source of cholesterol-free
protein (see below). Vitamin E is found in many vegetables, such as avocados, almonds and
olives. 21
Some vegetables, such as avocados, are also high in essentially fatty acids, which we’ll
discuss under the “Oils” food group below. Starchy vegetables my include those that digest
rapidly, such as white potatoes, thereby causing spikes in blood sugar, and those that digest
slowly, such as legumes and sweet potatoes, that don’t cause spikes in blood sugar; we’ll
consider this further in Chapter 4.
The benefits of vegetables parallel those of fruits, and we’ll discuss in depth the health
benefits of the various vitamins and minerals in Chapters 7 and 8. Including half your plate as
vegetables (and fruits) lowers blood pressure and cholesterol, thus lowers the risk of arterial
blockage and hemorrhage, lowering the risk of heart disease, heart attack and stroke. High fiber
2.7
diets, particularly soluble fibers, reduce systemic inflammatory reactions, as explained above,
lowering the risk of developing type 2 diabetes, 11
and possibly facilitating the reversal of type 2
diabetes, as explained in Chapter 4. The risk of kidney stones, bone loss 11
and leg cramps may all
reduced by eating a balanced diet rich in vegetables. 18,22
High and Low Nutrient Density Vegetables: As with fruits, high nutrient density
vegetables are whole vegetables, without added fat, sugar or salt; they give you the most
nutrients with the fewest calories. Fresh vegetables are often the best choice, but frozen
vegetables are sometimes the better choice as they are picked and frozen at the peak of ripeness,
hence, nutritional value; vegetables (and fruits) in your local grocery were probably picked
before they were ripe to increase shelf life. Most vegetables should be picked and used
immediately, so grow your own (if possible), patronize your local famer’s market or buy frozen!
Frozen broccoli contains more beta-carotene, vitamin C, and the B-vitamins riboflavin and
folate, than fresh broccoli. 24
Carrots and green beans that undergo cold storage (not freezing) for
two weeks have a 10% decrease in beta-carotene. 25
Canning reduces the vitamin C content of
vegetables by as much as 90%. 26
The mineral and fiber content of vegetables is not affected by
freezing or canning. 26
If you do choose frozen, make sure you read the label and purchase
vegetables that do not contain added sauces or salt; same idea with canned vegetables. Besides
being possibly higher in nutrients than “fresh,” frozen vegetables (and fruits) may be cheaper!
Grains
Grains are any of the foods made from the cereal grains, which are grasses. These include wheat,
rice, barley, oats, corn, quinoa, and others. Whole grains include the entire grain seed: the
endosperm, the germ and the seed coat or bran. Refined grains have the germ and bran removed,
leaving the endosperm, which is mostly starch. In the refining process, quite a few nutrients are
removed. Enriched grain products have many of the vitamins and minerals restored, specifically
folate, riboflavin, iron, niacin and thiamin, but not all of them. Most of the fiber in grains is
located in the bran, and this is not restored in the enrichment process. 27
Whole grains include
whole wheat flour, brown rice, oatmeal, rolled oats, whole oats, cracked wheat, whole rye,
quinoa and others. Note that whole grain flour must include the word “whole” to be whole grain,
as in “whole wheat.” “Wheat flour” is not whole grain. Grain products that are not whole grain
include white flour, brown flour, wheat flour, white rice, de-germed cornmeal, and foods made
from these such as pastas, couscous, white bread, brown bread, wheat bread, tortillas, crackers,
pretzels, and so forth; of course, if the first entry on their ingredients label includes the word
“whole,” as in “whole wheat flour,” then the product includes a significant amount of whole
grain. 27
We’ll discuss grains further in Chapter 4.
Recommendations: The “Key Consumer Message” is “Make at least half your grains
whole grains.” 27
Indeed, as will be explained further in Chapter 4, you should make as much as
your daily grain intake as possible whole grains.
Table 2-3. Daily Recommendation for Grains, 96
in ounce equivalents.
Age Calorie Requirements (see Table 2-7)
1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200
2-3 years 1½ oz 4 oz 5 oz
4-8 years 4 oz 5 oz 5 oz 6 oz 6 oz
9-18+ yrs 5 oz 6 oz 6 oz 7 oz 8 oz 9 oz 10oz 10oz 10oz
2.8
The Daily Recommendation for Grains based on USDA’s Supertracker is below, 28,96
by
age and calorie requirements. Higher calories within a particular age group generally suggests
increased physical activity. Almost 100% of Americans do not meet the recommended intake of
whole grains. 105
One grain equivalent roughly equals 1 slice of bread; 1 oz dry grains, which equals ½ cup
cooked grains such as brown or white rice, bulgur (cracked) wheat, oatmeal (rolled oats); or 1
cup of cold breakfast cereal. 29
One 2” diameter biscuit, 1 mini bagel, 1 slice of bread, 1 small
piece of cornbread (2 ½” x 1 ¼” x 1 ¼ “), 5 whole wheat crackers, ½ English muffin, 2 3”
pancakes, ½ cooked pasta (1 oz dry), 1 small (2 ½” diameter) muffin or 1 6” diameter corn or
flour tortilla all are 1 oz grain equivalents. 30
For optimal health, make as many of these grain
equivalents whole grains as possible such as whole wheat bread or whole wheat pasta.
Nutrients and Health Benefits: Whole grains are naturally rich in folate, riboflavin,
niacin, thiamin, all B vitamins, as well as the minerals iron, magnesium and selenium. Whole
grains are also rich in fiber and healthy, slowly digestible starch (SDS). Folate is needed for the
formation of healthy red blood cells, is good for the cardiovascular system as it inhibits the
deposition of plaque in arterial walls, 31
and markedly reduces the risk of spina bifida and other
developmental problems in the developing embryo and fetus. Riboflavin, niacin and thiamin are
all needed to allow for the efficient production of energy from carbohydrates, proteins and fats. 32
Iron is needed to make hemoglobin, the red, oxygen-carrying chemical in red blood cells, as well
as myoglobin, the red, oxygen storing chemical in muscle cells; thus, grains and grain products
help to prevent anemia. Magnesium is an important mineral that helps muscles to relax and
selenium is an important antioxidant, allowing the immune system to work efficiently. 32
Fiber,
found in fruits, vegetables and whole grains, lowers blood pressure and cholesterol, thus lowers
the risk of arterial blockage and hemorrhage, lowering the risk of heart disease, heart attack and
stroke. Fiber, particularly soluble fiber, found especially in whole oats and oat bran, but also
found in most fruits, vegetables and whole grains, reduces systemic inflammatory reactions,
inhibiting the development of type 2 diabetes 11
and possibly helping to resolve type 2 diabetes.
(See Chapter 4 for more on this.) Soluble fiber also lowers the risk of colon cancer. Insoluble
fibers, found along with soluble fibers in fruits, vegetables and whole grains, but especially in
whole wheat and wheat bran, strengthens the muscles lining the large intestine and inhibit the
development of constipation and diverticulosis. Fiber makes you feel full longer, thereby helping
with weight loss and management. 32
Slowly digestible starch, found in whole grains, release
glucose into the blood slowly, thereby helping to stabilize blood sugar; note that refined grain
products contain a very high proportion of rapidly digestible starch (RDS) as well as sugars that
cause spikes in blood sugar, destabilizing it.
High and Low Nutrient Density Grains and Grain Products: High nutrient density grains
and grain products are those that are made with whole grains without added fats, sugar or salt.
Pilafs made from steamed or boiled whole grain wheat, bulger (cracked) wheat, oats, whole grain
rye and barley, brown rice, wild rice, amaranth, millet, quinoa and other whole grains are high
nutrient density grains. (Grains are actually grasses; quinoa is more closely related to beets and
chard, so quinoa isn’t a grain, but we usually nutritionally classify it as a grain. Note that because
of its high protein content, we also list quinoa as a protein food!) 33
High nutrient density grain
products include foods made from whole grains such as whole wheat breads, whole wheat pastas,
whole grain rye breads, “meat” balls made with quinoa, hot breakfast cereals made with whole
grains such as rolled oats, Scottish or Irish oatmeal, a few cold breakfast cereals such as
Shredded Wheat and some wheat bran cereals, air-popped pop corn, without added butter or
2.9
other flavorings, whole-grain tortillas, and others. Low nutrient density grains would include
grain products like breads made with refined flour, white rice, fried rice, donuts, cookies, cake,
pie, fried pies, fried breads, oil-popped pop corn with butter and salt (or melted cheese, or
caramelized sugar), deep-fried tortillas, nachos, the plethora of cold breakfast cereals whose
main ingredient is sugar, usually followed by refined corn or rice, and so forth. I think you have
the idea. An important message here is to read labels and make sure the product contains whole
grains and does not contain high amounts of sugar, saturated fat, trans fat, cholesterol or salt!
Protein Foods
Foods that contain a significant amount of protein are considered protein foods. Protein foods
include anything derived from animals such as meats, including beef, pork, lamb, venison and
other game; poultry; dairy products including milk, yogurt and cheeses; eggs; fish and squid; and
shellfish such as lobster, crab, shrimp, oysters, clams, snails and scallops. Plant-sourced protein
foods include the quinoa grain; soy products; legumes such as beans, peas and peanuts; nuts and
seeds, and nut milks.
Recommendations: Most animal-sourced proteins contain saturated fats and cholesterol.
For meats, dairy and eggs, choose lean, extra lean or low fat. 34
Go easy on sausages, salamis and
full-fat hot dogs, and don’t eat poultry skin. Cold-water fish, such as salmon, contain beneficial
fats, so the low-fat goal doesn’t apply to fish; you want to consume cold-water, fatty fish. For
plant-sourced proteins, quinoa and soy products have proteins equivalent to animal-sourced
proteins; legumes and nuts such as almonds should be consumed with whole grains to be
equivalent to animal proteins. Eat a variety of proteins each week, including vegetarian options
for those individuals who are not vegetarians. People who are not vegetarians are advised to also
include at least 8 oz of seafood per week because of the beneficial fat content. 35
The Daily Recommendation for Protein Foods based on USDA’s Supertracker is
below, 39,96
by age and calorie requirements. Higher calories within a particular age group
generally suggests increased physical activity. The USDA uses a concept called “protein
equivalents” to determine the amount of protein foods we each need. One protein equivalent
contains approximately 7 grams of protein. 44
Table 2-4. Daily Recommendation for Protein Foods, 96
in ounce equivalents.
Age Calorie Requirements (see Table 2-7)
1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200
2-3 years 2 oz 3 oz 4 oz
4-8 years 3 oz 4 oz 5 oz 5 oz 5½ oz
9-18+ yrs 5 oz 5 oz 5½ oz 6 oz 6½ oz 6½ oz 7 oz 7 oz 7 oz
On the average, Americans get twice as much protein as needed in the diet, 36
so most of
us need to cut back a bit. About 80% of Americans meet the daily recommendations. 105
The
average adult should get 10 to 35% of total daily calories from protein foods. 37,38
The following roughly equal 1 oz equivalent of protein: 1 ounce of meat, poultry or fish;
1 slice of bacon; 1 egg; ¼ cup boiled legumes (beans, lentils, split peas); 1 tablespoon peanut
butter; ½ oz tree nuts (12 almonds, 7 walnut halves) or seeds; 40
1 oz peanuts; 1 oz cheese; ¼ cup
cottage cheese; ½ cup yogurt; 1 cup (8 oz) milk has 8 g of protein in it, 41
so it’s a little more than
1 oz equivalent of protein. Foods with 2 oz equivalents of protein include 1 cup of legume (bean,
pea, lentil) soup; Foods with 3 oz equivalents of protein include ½ of a small chicken breast, 1
2.10
can (3-4 oz) tuna; foods with 4 oz equivalents of protein include a small (4 oz) steak such as a
filet mignon or an eye of round or ½ of a Cornish game hen. 45
Other foods contain protein as
well and should be considered when determining the total amount of daily protein one is
consuming, but are not considered “protein foods.”
An individual might have two eggs for breakfast (one egg is sufficient) (2 oz
equivalents), along with a glass of milk (1 oz equivalent), ½ cup bean soup for lunch (2 oz
equivalents) perhaps with some cheddar cheese on top (1 oz equivalent), maybe a glass of milk
for a snack (1 oz equivalent), then a small (6 oz) steak for supper (6 oz protein equivalents),
along with toast, a salad, vegetables and fruits. This relatively average meal plan contains 13 oz
equivalents of protein. If the individual is a 25 year-old male that needs 6 ½ oz equivalents of
protein, this is twice the amount of protein he needs. It is easy to see how American consume too
much protein.
Nutrient and Health Benefits. All animal-sourced proteins are complete proteins; that is,
they contain all of the essential amino acids one needs for good health in optimal proportions and
are more digestible and absorbable than plant proteins (see Chapter 6). Further, only animal
proteins contain vitamin B12, essential for the maintenance of the nervous system. However,
most animal-sourced proteins also contain cholesterol, which is associated with coronary artery
disease and stroke. Plant-sourced protein foods do not contain cholesterol. 46
Both animal- and plant-sourced proteins provide calories, vitamin E, riboflavin, niacin,
thiamin, B6, iron, zinc and magnesium, and, of course, protein. Proteins provide calories that the
body can use for energy; as contrary as it may seem, a high-protein diet, over and above the
amount of calories you need for weight maintenance, can make you fat! Vitamin E is an
important antioxidant that fights against some cancers. Riboflavin, niacin, thiamin, which are B
vitamins, and vitamin B6, are all involved in facilitating the body’s use of energy, growth and
development, the formation of red blood cells. Iron is used by the body to store oxygen in muscle
cells to metabolize glucose for quick energy and is used to carry oxygen by hemoglobin
molecules in red blood cells. Women who menstruate, beginning in the teenage years, are
advised to consume a little extra iron, to avoid iron-deficiency anemia, which is a very common
pathology in this group; red meats and legumes are very good sources of dietary iron. 46
Zinc is
an important mineral in development and in allowing for the sense of taste. Magnesium is
involved in bone formation and the relaxation of muscles after contraction.
Found especially in cold-water, fatty fish such as salmon, sardines and anchovies, the
omega-3 fatty acids EPA and DHA are associated with reducing the risk of heart disease, asthma
and other inflammatory diseases, and with enhancing brain function. More on this in Chapter 5.
High and Low Nutrient Density Proteins: High nutrient density protein foods would be
those that are lean or fat free or containing omega-3 fatty acids, low in sodium, and without
added sugars. High nutrient density protein foods include lean beef and pork, super lean ground
beef (4% fat), chicken and turkey without the skin, egg whites, poached fish such as salmon, and
low-fat or zero-fat dairy such as milk, cottage cheese, hard cheeses and yogurt, especially
unsweetened, sweetened with fruit or sweetened with artificial sweetener. Legumes combined
with grains such as beans with brown rice; unsalted almonds, walnuts or other nuts; unsalted
peanuts; peanut butter or almond butter without added salt and sugar; quinoa; and tofu, made
from soy, are plant-based examples of high nutrient density protein foods.
Low nutrient density protein foods include foods that are high in cholesterol and
saturated fats, sodium, and often contain refined carbohydrates such as sugar; they also tend to
be high in calories. Low nutrient density protein foods include organ meats (liver, giblets); prime
2.11
beef and commercial ground beef, which is 20% fat; chicken fried with the skin still on, deep
fried fish, shrimp, chicken—any meat that is deep fried; egg yolks; high-fat processed meats with
added salt and sugar such as sausages, salami, bacon, hot dogs, lunch meats like bologna; full-fat
dairy of any kind such as whole milk, full-fat cottage cheese, soft cheeses and full-fat yogurt,
especially yogurt with added sugar; baked beans; refried beans made with lard. 46
Dairy
The Dairy Group includes milk most commonly from cows and goats, and all of the products
derived from these animals. Common dairy products include milks such as fat-free (also called
“skim”), 1% and 2% milks, whole milk, chocolate- and strawberry-flavored milks, lactose-free
milk; hard cheeses such as cheddar, mozzarella, asiago, Parmesan, Romano and Swiss; soft
cheeses such as Brie, Camembert, feta, ricotta and cottage cheese; yogurts, kefir; milk-based
desserts such as ice cream, milk shakes, puddings and frozen yogurt; butter, cream cheese, cream
and whipped cream. 47
Recommendations: The USDA’s “Key Consumer Message” is, “Switch to fat-free or
low-fat (1%) milk.” The Daily Recommendation for Dairy based on USDA’s Supertracker is
below, 48,96
by age and calorie requirements. Higher calories within a particular age group
generally suggests increased physical activity. The USDA recommendation suggests consuming
low-fat and fat-free dairy. Nearly 40% of toddlers, 80% of Americans as a whole, and 95% of
adult women do not get sufficient dairy in their diet. 105
Table 2-5. Daily Recommendation for Dairy, 96
in cups.
Age Calorie Requirements (see Table 2-7)
1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200
2-3 years 2 c 2 c 2 c
4-8 years 2½ c 2½ c 2½ c 2½ c 2½ c
9-18+ years 3 c 3 c 3 c 3 c 3 c 3 c 3 c 3 c 3 c
One cup of dairy equals one cup (8 oz) of fluid milk or yogurt, 2 cups of cottage cheese,
½ c ricotta, 1 ½ oz hard/firm cheese (cheddar, Edam, feta, mozzarella, Parmesan, Provolone), 2
slices of hard cheese, 1/3 cup shredded cheese, 2 oz processed cheese (American). 97
Other recommendations include considering the fat, which is mostly saturated fat and
cholesterol, found in dairy products that are not fat free, as “empty calories.” These empty
calories should be included as part of one’s daily discretionary calorie allotment. (See below for
a discussion of what discretionary calories are.) Same thing for sweetened dairy products, such
as flavored yogurt, chocolate milk and ice cream; the sugars found in these foods have very little
nutritional value and should be included as discretionary calories. 47
The best bet is to reduce or
eliminate the saturated fat and cholesterol from dairy products by consuming fat-free milk, fat-
free cheeses or hard cheeses, which are much lower in fat than, and fat-free yogurt, and by not
consuming full-fat milk, full-fat cheeses especially full-fat soft-cheeses, butter and cream.
We’ll look at lactose intolerance in greater detail in Chapter 4. Lactose is a sugar found in
most dairy products. A digestive enzyme, lactase, is needed to digest lactose. Most adults have
some degree of lactose intolerance, caused by a reduced ability to produce lactase. Some adults
have no problem digesting lactose; those that can’t produce sufficient lactase suffer from gastric
distress if they ingest even small amounts of dairy. For these individuals, lactose-free dairy
products are available; further, hard cheeses, yogurt and kefir are naturally low in lactose as
2.12
microorganisms pre-digest the lactose in the culturing of the product. Lactase enzyme can also
be purchased and added to dairy.
Nutrients and Health Benefits: The major nutrients found in dairy products include
calcium, potassium, vitamin D and protein. 50
Calcium is, of course, essential for building and
maintaining bones and teeth; further, calcium is involved in virtually every physiological process
in the body, from the operation of the nervous system and muscle contraction, to blood clotting.
Milk, cheese and yogurt are the primary sources of calcium for people in the United States, 51
though there are other sources of calcium, including plant sources; see Chapter 8. Potassium
helps regulate blood pressure. Vitamin D is naturally found in low amounts in cow’s (and
human) milk, and is fortified to provide the most important source of vitamin D in the human
diet, particularly where adequate sunlight is not available to stimulate the synthesis of vitamin D
in the human body. (See Chapter 7.) Vitamin D is necessary for the absorption of calcium and
phosphorus from food in the digestive system, thus is needed for bone formation. We looked at
protein above; dairy-sourced protein is complete protein and is highly absorbable. One cup of
milk also contributes nearly half of the DRI of vitamin B12 for the average adult, 54, 55
needed for
healthy red blood cells and maintenance of the nervous system.
The health benefits of consuming low-fat dairy, including fat-free milk, include building
and maintaining healthy bones and teeth, reducing the risk of osteoporosis in senior adults,
particularly women, lowered blood pressure, reducing the risk of cardiovascular disease and
developing type 2 diabetes, 51
and contributing to the reversal of type 2 diabetes. 53
High and Low Nutrient Density Dairy: The major point of concern with dairy is the
amount of saturated fat and cholesterol associated with full-fat dairy; sugar is also of concern in
some dairy products. High nutrient density dairy would be any dairy that is fat-free, especially
fat-free cultured dairy such as yogurt. Low nutrient density dairy is dairy that is full-fat and with
sugar. The lowest nutrient density dairy is dairy that is nearly pure fat such as butter and cream;
these dairy products are loaded with saturated fat and cholesterol!
Oils (and Solid Fats)
Liquid fats, also called oils, and solid fats are not considered by the USDA to be a food group,
but their importance warrants special consideration here. 56
Solid fats are solid at room
temperature whereas oils are liquid. Oils include things like canola (rapeseed) oil, olive oil and
corn oil. Solid fats include butter, tallow (beef fat), suet (beef fat), lard (pork fat), shortening and
coconut oil. 56,57
Solid and liquid fats are, of course, a major component of many foods. Beneficial oils
derive from fatty fish such as salmon, nuts, olives, avocados and seeds. Oils and solid fats that
are not beneficial include those from beef, pork, poultry skin. In Chapter 5, we’ll explore fats in
greater detail.
Recommendations: Consume more monounsaturated fatty acids (MUFAs) and
polyunsaturated fatty acids (PUFAs), both of which are found in fatty fish such as salmon, and in
non-tropical plant oils especially those like canola oil, olive oil and the other seed oils, and
avocados; consume less saturated fatty acids, cholesterol; and consume no (zero) trans fats. In
general, liquid fats (oils) are healthy and solid fats are not.
The Daily Recommendation for Oils based on USDA’s Supertracker is below, 58,96
by age
and calorie requirements. Higher calories within a particular age group generally suggests
increased physical activity. (Three teaspoons = one tablespoon.)
2.13
Three teaspoons of oils such as canola and olive oil equal 3 teaspoons of oils, so the
addition of oil, for instance olive oil, to foods can be used to guarantee that the daily
recommendation has been met. Foods with the approximate amounts of oils they contain include
½ teaspoon in 4 large olives, 3 teaspoons in ½ medium avocado, 3 teaspoons in 1 oz of nuts and
seeds including peanuts, almonds, cashews and sunflower seeds, 59
and 1 teaspoon in a 3 oz
salmon fillet. 55
Table 2-6. Daily Recommendation for Oils, 96
in teaspoons.
Age Calorie Requirements (see Table 2-7)
1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200
2-3 years 3 tsp 4 tsp 4 tsp
4-8 years 4 tsp 4 tsp 5 tsp 5 tsp 6 tsp
9-18+ years 5 tsp 5 tsp 6 tsp 6 tsp 7 tsp 8 tsp 8 tsp 10 tsp 11 tsp
Nutrients and Health Benefits: Some of the PUFAs that make up oils are essential fatty
acids, meaning the human body requires them for good health and cannot make them. MUFAs
and PUFAs both contain essential fatty acids and other nutrients that are required for good
health; this is why low-fat diets are not healthy diets. Diets including proper ratios of the omega-
6 and omega-3 PUFAs, which generally require increasing the omega-3 consumption in the
average American diet, have been linked to reducing chronic inflammation, as have diets with
reduced levels of cholesterol. Some of the chronic inflammatory diseases that may be helped by
increasing consumption of omega-3 fatty acids include asthma, diabetes, Crohn’s disease, celiac
disease, rheumatoid arthritis, tendonitis, inflammatory bowel disease, atherosclerosis,
Alzheimer’s disease and even obesity. 60
Although not a part of fat molecules, nutrients associated with the oils in fatty and oily
foods include vitamins E and K, 55
both of which are fat-soluble vitamins. Vitamin E is a
powerful antioxidant, anticoagulant and anti-inflammatory; thus, foods high in MUFAs and
PUFAs, which also contain vitamin E, reduce the risk of heart disease, cancer, macular
degeneration, cataracts, and cognitive decline. 61
Vitamin K is necessary for normal blood
clotting. 62
Of course, fats and oils also provide energy (calories), and have the highest amount of
calories per gram of all the nutrients, with 9 calories per gram (compared to 4 calories per gram
for carbohydrates and proteins). And if you’re trying to lose weight, don’t go on a low-fat diet;
decrease overall calories, but don’t go low fat because you most likely will end up gaining
weight! 64
High and Low Nutrient Density Oils: In general, we state that foods with the most
nutrients per gram are the highest in nutrient density. With regard to oils, those that are the
highest in nutrient density are those with the most MUFAs and PUFAs and the least saturated
fat, cholesterol and trans-fats. So, the oils/fats and fatty foods with the highest nutrient density
include canola and olive oils, olives, fatty fish, nuts and avocados, and those with the lowest
nutrient density, butter, cream, lard, tallow, suet, partially hydrogenated fats and coconut oil. 63
2.14
What are Calories and How Many Do We Need?
Calories are units used to measure the amount of energy in a substance. In the physical sciences,
we speak of “little calories” or calories and “big calories” or Calories. A little calorie is the
amount of energy it takes to raise 1 gram of water 1° C. A big calorie (Calorie) is the amount of
energy it takes to raise 1000 grams of water 1° C; thus, big calories are also called kilocalories. A
nutritional calorie is a Calorie or kilocalorie; thus, a nutritional calorie is the amount of energy it
takes to raise 1000 grams of water 1° C.
The number of calories in a given substance is determined by burning the substance in a
device called a bomb calorimeter and measuring the subsequent change in a given mass of water
heated by the released energy. A piece of wood may yield the same number of calories as a slice
of whole-wheat bread, 100 kilocalories (100 dietary calories), yet since humans cannot digest the
bonds holding the wood together, we would only obtain energy from the slice of bread. I mention
this to clearly illustrate that not all calories are equal in the amount of energy they provide.
From Dietary Guidelines for Americans, 2015, a table of the Estimated Calorie
Requirements for average individuals based on gender, age and activity level is below. 49
Note
that this is a rough estimate of the needed required to maintain weight; if you’re trying to lose
weight, you need fewer calories and/or increased physical activity and if you’re trying to gain
weight, you need more calories. Use this table only as a rough guide.
Table 2-7: Estimated Calorie Requirements 49
Groups Ages Sedentary a Moderately Active
b Active
c
Child 2-3 years 1,000 1,000-1,400 1,000-1,400
Females 4-8 years 1,200 1,400-1,600 1,400-1,800
9-13 years 1,600 1,600-2,000 1,800-2,200
14-18 years 1,800 2,000 2,400
19-30 years 2,000 2,000-2,200 2,400
31-50 years 1,800 2,000 2,400
51+ years 1,600 1,800 2,000-2,200
Males 4-8 years 1,400 1,400-1,600 1,600-2,000
9-13 years 1,800 1,800-2,200 2,000-2,600
14-18 years 2,200 2,400-2,800 2,800-3,200
19-30 years 2,400 2,600-2,800 3,000
31-50 years 2,200 2,400-2,600 2,800-3,000
51+ years 2,000 2,200-2,400 2,400-2,800 a. “Sedentary” equals light, day-to-day physical activity. b. “Moderately Active” equates to walking 1.5 to 3 miles per day at 3-4 miles per hour, in
addition to light, day-to-day physical activity.
c. “Active” equals to walking more than 3 miles per day at 3-4 miles per hour, in addition to light, day-to-day physical activity.
2.15
Discretionary Calories
Two factors need to be considered when determining the amount of food a person needs daily.
These two factors are 1) consuming foods to meet the recommended daily intakes of nutrients
and 2) consuming enough calories to maintain weight. If nutrient-dense foods are consumed, and
if the individual is physically active, the number of calories needed to maintain weight is a larger
number than the number of calories in the foods consumed to obtain essential nutrients. The
difference between these two values is the discretionary calories. 65
To maintain weight, foods do need to be consumed that contain these discretionary
calories. Since all of the essential nutrients have been consumed by eating nutrient-dense foods,
low nutrient-dense foods can be added as discretionary calories as part of a relatively healthy
diet. This is where a healthy diet may include occasional “treats” of foods that are not nutrient
dense such as foods high in sugar, fat or other empty calories like a cookie, small piece of cake,
some sugar and cream on the oatmeal, butter on toast, or a glass of beer or wine. Of course, high
nutrient-dense foods could be consumed instead of low nutrient-dense foods as discretionary
calories, if an individual so chooses!
More than 2/3 of American adults are overweight or obese. 66,105
These individuals
typically do not consume nutrient-dense foods, so they must consume more than the number of
calories they need to maintain weight in order to obtain their essential nutrients. As a result, they
store the excess calories as fat and are overweight. These individuals do not have a discretionary
calorie allowance in their daily food budget.
If nutrient-dense, whole foods become the focus of the daily food plan, and if the
individual exercises, there generally will be a discretionary calorie allowance formed between
the calories in nutrient-dense foods and the total calories needed for weight maintenance. If this
individual needs to lose weight, a small reduction in discretionary calories over time is all that is
needed for weight loss. If a person does not lower modify his diet to focus more on nutrient-
dense foods, thereby lowering the number of calories from foods containing essential nutrients,
and increase physical activity, weight loss is generally not achieved.
Table 2-8: Discretionary Calories in Active and Sedentary Individuals
Active Individual Sedentary Individual
200 Calories in
Excess
2200 Calories of
Low Nutrient Dense
Foods Needed to
Supply Essential
Nutrients
2000 Calories
Needed to Maintain
Weight
200 Discretionary
Calories
2000 Calories
Needed to Maintain
Weight
1800 Calories of
Nutrient-Dense
Foods Needed to
Supply Essential
Nutrients
Table 2-8 illustrates how two individuals with the same energy needs for weight
maintenance of 2000 calories can, in one case, have a 200 discretionary calorie allowance by
2.16
consuming foods with high nutrient density that are relatively low in calories and in the second
case, consume 200 calories in excess to acquire essential nutrients from low nutrient density
foods. If your diet consists of whole, unprocessed foods, the number of calories you have to
ingest to obtain all of your essential nutrients is a lot lower than if your diet consisted of fast-
food burgers, fries and milkshakes! Even though most Americans are consuming calories in
excess of those needed to maintain weight, most are still not obtaining all of the essential
nutrients. 65
Table 2-9 gives the Estimated Discretionary Calorie Allowance per calorie level. This is
the approximate number of calories left in a meal plan that follows the nutrient-dense eating
plans of the USDA. Low nutrient-density foods may be consumed at these calorie levels without
causing weight gain. Meal plans that focus on whole, nutrient-dense foods may have higher
discretionary calorie allowances than given here; see Fig. 2-3.
Table 2-9. Estimated Discretionary Calorie Allowance 95
Calorie Requirements (see Table 2-7)
1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200
Discretionary
Calories
154 163 172 181 190 208 235 235 244 262 298 334
Food Labels
The U.S. Food and Drug Administration (FDA) regulated labeling on food packaging. 67
By
Federal law, a food package label must contain six elements. The front of a food package,
otherwise called the Principal Display Panel (PDP), must contain 1) the name of the food and 2)
net quantity or amount of product in the package. Then to the right of the PDP is the Information
Panel. The Information Panel must contain the 3) Nutrition Facts Label, 4) Ingredients List, 5)
allergy warnings and 6) name and physical address of the company that produced, packed or
distributed the product, which may otherwise go on the PDP. 67
Note that it is illegal to place
anything that is not required by law on the Information Panel between these components.
Nutrition Facts Label
The Nutrition Facts Label contains information for one serving of the product. The following are
included in the Nutrition Facts Label, from top to bottom:
Serving Size
The serving size is in standardized units such as cups, portion of package or pieces, including
metric units (grams). For example, in Figure 2-1, serving size is “two whole crackers (31 g).”
Included with the serving size are servings per container. In Figure 2-1, “about 13” servings are
found in one container of the graham crackers.
When you’re reading labels, note the serving size. One way manufacturers can lower the
number of calories, or any of the nutrients we need to reduce, in a serving of a product without
changing the product at all is by simply lowering the serving size. If, for instance, the serving
2.17
Figure 2-1. Representative Food Label
size of a particular cookie is three cookies and three cookies are 225 calories, by simply lowering
the serving size to two cookies, the manufacturer can advertise that a serving size is “only” 150
calories; further, the manufacturer can advertise, quite truthfully, that the number of calories in
one serving of this product has been reduced from 225 calories to 150 calories. Such a deal, you
would think! Also, you may find that you normally consume more than one serving of a
particular product. For instance, canned soups usually contain 2 ½ servings per can. If you
usually consume the entire can, you must multiply all of the calories and nutrients by 2 ½ to get a
true reading of what you’re consuming. One serving of canned soup commonly has over 800 mg
of sodium; if you consume the entire can, you’re getting 2,400 mg of sodium. The RDA for
2.18
sodium is 2,300 mg. 69
So, always ask yourself if the service size is realistic. Labeling changes
proposed for 2014 should make serving sizes more realistic. 70
When looking at the calories per serving, note that the FDA considers 40 calories per
serving as being low, 100 calories per serving as being moderate, and 400 calories and above as
being high, all based on a 2,000 calorie per day diet.
Calories
Calories per single serving and the number of calories from fat are listed next. As most
Americans should be more aware of the amount of fat they are getting in their diet, this is
important information. In Fig. 2-1, there are 140 calories in a single serving, with 25 calories
from fat.
Nutrients With Percent Daily Values
Next is listed a number of nutrients with percent daily values and/or grams found in one serving
of product, based on a 2000 calorie diet.
The grams of total fat, saturated fat, trans fat and cholesterol must be listed, by law, as
these contribute to health problems. Healthy fats, such as mono- and polyunsaturated fats, do not
have to be listed by law, but are often listed voluntarily by food manufacturers because they are a
selling point for the product. Sodium is listed next, again because high amounts of sodium are
not healthy and sodium needs to be limited in the diet. Besides the grams of these nutrients, the
percent daily values are also listed. 72
In Fig. 2-1, 3g total fat, 1.5g saturated fat, 0g trans fat, 0g
cholesterol and 120mg sodium are listed, along with the daily values of 5% total fat, 8%
saturated fat, 0% cholesterol and 5% sodium provided per serving. Most Americans need to eat
less total fat, less saturated fat, zero trans fat, more mono- and polyunsaturated fats, less
cholesterol and less sodium.
The total grams of carbohydrate and dietary fiber, along with the percent daily values are
presented next, followed by grams of sugars and protein. The total grams of carbohydrate include
the total grams of starches, sugars, sugar alcohols and fibers in one serving of the product. 73
In
Fig. 2-1, we learn that one serving of graham crackers contains 24g of total carbohydrate, less
than 1g of dietary fiber, 7g of sugars and 2 g of proteins. How many grams of starch are in the
product? If we allow the dietary fiber to equal 1g, 24g – 8g = 16g of starches. Also listed is the
information that one serving provides 8% of the daily value for total carbohydrate and 4% of
dietary fiber.
The percent daily values of vitamins A and C and the minerals calcium and iron are
presented next. 68
They are listed here because most Americans need to get more of these
nutrients. Fig. 2-1 tells us that there is 0% vitamins A and C, 0% calcium and 6% iron in one
serving, the percentages based on a 2,000 calorie diet. These are very low values, indeed. In
order to obtain a day’s recommended amount of iron from these graham crackers, one would
have to consume enough graham crackers to equal 2,333 calories! That’s almost 17 servings of
graham crackers; from the label in Fig. 2-1, we know there are only 13 servings in the entire box!
Informational Footnote
An informational “footnote” is usually found at the bottom of the Nutrition Facts Label, but may
2.19
be missing or abridged on packaging with insufficient room. This footnote includes the
recommended upper limits, in grams, of total fat, saturated fat, cholesterol and sodium, and
recommended amounts of total carbohydrate and dietary fiber, all based on a 2,000 and 2,500
calorie diet. 68
This information is provided on packages as a handy reference that allows
consumers to compare the nutrient values of one serving of the product with the recommended
upper limits. On our graham cracker label (Fig. 2-1), it is recommended that an individual
consume less than 65g total fat, less than 20g saturated fat and less than 200g cholesterol, based
on a representative 2,000 calorie per day eating plan. We have already learned that one serving
of this product contains 3g total fat, 1.5g saturated fat and 0g cholesterol, so this is a relatively
low-fat product. It is recommended that less than 2,400mg sodium be consumed and the product
contains 120mg sodium, which is only 5% of the upper limit. On a 2,000 calorie diet, 300g total
carbohydrate and 25g dietary fiber are recommended. Since we’re at 24g total carbohydrate and
less than 1g dietary fiber, we’re at 8% of our daily value for carbohydrate; it would be better if
the amount of dietary fiber were higher and the amount of sugar and starch lower. Regarding
dietary fiber, note that the (less than) 1g of fiber costs us 140 calories; in order to get 25g of
dietary fiber, we would have to eat 3,500 calories of graham crackers; that would be 25 servings
of graham crackers! Above, we looked at fact that 6% of the iron value for 140 calories is very,
very low. My point here is we have determined, from the label, that this is a low nutrient-density
product. (Now, I didn’t say not to eat graham crackers! Just treat them as discretionary calories
and enjoy them once in awhile! After all, how can you make smores without graham crackers?)
Ingredients List
The Ingredients List follows the Nutrition Facts Label. All of the ingredients are listed, in order,
by weight, 71
beginning with the predominant ingredient. Knowing this can give you clues as to
the relative amounts of various ingredients in a product. For instance, most loaves of bread are
baked with one teaspoon of salt, so any ingredient that is listed below salt is relatively
insignificant.
In Fig. 2-1, we learn that the predominant ingredient is “enriched wheat flour”; this is
refined flour, not whole wheat. As such, some of the nutrients removed through the refining
process are restored and are included in the Ingredients List in parentheses: “(…niacin, reduced
iron, thiamin mononitrate, riboflavin and folic acid).” You can clearly see that the source of iron
is supplementation; the other nutrients are B-vitamins.
After the flour, sugar is next; so, the top two ingredients, by weight, are refined flour and
sugar. Fortunately, the third ingredient is graham flour, which is a type of whole-wheat flour and
is highly nutritious; unfortunately, the Ingredients List tells us that there is more sugar in the
product than graham flour!
Vegetable oil is listed after graham flour, and consists of interesterfied soybean, canola
and/or palm oils. If you were wondering, interesterfication is a chemical process where
components of the fat molecule are switched around to make a fat solid and creamy at room
temperature, enhancing the quality of the product, largely as a replacement for trans-fats. 74,75
Interesterfied fats do appear to be quite a bit more healthy than trans-fats. 75
Citric acid and TBHQ (t-butylhydroquinone) are added as preservatives. Both are safe as
used here, 76,77
according to both the FDA and the European Food Safety Authority. 78
Then we have high fructose corn syrup and honey, followed by molasses, all sugar. After
molasses is salt. Sodium bicarbonate and ammonium bicarbonate follow, both are leavening
2.20
agents. 79
The emulsifier, soy lecithin is next, followed by malted cereal syrup, which is another
sugar; 80
vanillin, a flavoring; and sodium sulfite, another preservative, that some people have
allergic reactions to (see below).
Allergy Warnings
According to the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), any
of the eight most common food allergens must be listed if proteins from these allergens are found
in the product. 81
These allergens are milk, eggs, fish (e.g., salmon, cod), crustacean shellfish
(e.g., crab, shrimp, lobsters), tree nuts (e.g., almonds, cashews, walnuts), peanuts, wheat and
soybeans. 82
These account for 90% of all food allergens. 83
Allergens may either be listed in a
special “Allergen Statement,” as in Fig. 2-1, or may be listed in the Ingredients List in
parentheses after the products in which they are found. In Fig. 2-1, the Allergen Statement lists
wheat, sulfites and soy. Although sulfites are in the top ten of food allergens, 84
the inclusion of
sulfites on food labels in the United States under allergens is not required by law, but is
voluntary; sulfites do have to be included as an ingredient, however, if they’re added as a
preservative.
Name and Address of Manufacturer
The name and street address of the “manufacturer, packer or distributer” of the food product
must appear on the label, along with the zip code. The street address may be omitted if it can be
found in a current telephone book or city directory. 85
In Fig. 2-1, we learn that this product is
“Distributed by Federated Group, Inc., Arlington Heights, Il, 60005-1096.
What about country of origin labeling? Note that “Made in the U.S.A.” is listed under the
address of the manufacturer. The U.S. Department of Agriculture’s Agriculture Marketing
Service, not the FDA, mandates that certain foods do contain the country of origin under the
Country of Origin (COOL) law, 86
but if the product is made in the U.S., “Made in the U.S.A.
doesn’t have to appear. Foods that must carry the country of origin include cut and ground meats
(beef, pork, lamb, goat, chicken), fish and shellfish, fruits and vegetables (both fresh and frozen),
macadamia nuts, peanuts and pecans, and ginseng. 86
In order for the label, “Made in the U.S.A,”
to appear on a food label, “all or virtually all” of its ingredients must have been grown or
produced in the United States; this is regulated by the Federal Trade Commission. 87
By the way,
in order for pet food labels to be labeled, “Made in the U.S.A.,” again, “all or virtually all” of its
ingredients must be grown in the United States to comply with FTC law, but there is some doubt
that this regulation is being uniformly enforced for pet foods. 88
Nutrient Content Claims on Labels
Nutrient content claims classify the level or relative level of a particular nutrient in one serving
of a food product, 89
using terms like “low calorie,” “high in fiber,” and so forth. These claims are
regulated by the FDA and a particular claim must be covered by the FDA and must be in
compliance with the law in order for it to legally appear on a food label; in other words, the
claim must be true. Some of the Nutrient Content Claims definitions are below, as of 2013. 90,91
The RACC is the Reference Amount Customarily Consumed, and is generally equivalent to
serving size.
2.21
Free. “Calorie free” means product has less than 5 calories per RACC. “Fat Free” means product
has less than 0.5 g of total fat per RACC. “Saturated Fat Free” means that the product has less
than 0.5 g of saturated fat and less than 0.5 g of trans fats per RACC. “Cholesterol Free” means
product has less than 2 mg of cholesterol and 2 g or less of saturated fat per RACC. “Sodium
Free” means product has less than 5 mg of sodium per RACC.
% Fat Free. If a product is “low fat,” “__% fat free” can be used. The term, “100% fat free” is
equivalent to “fat free,” meaning that the product has less than 0.5 g of total fat per RACC.
Low. “Low Calorie” means product has 40 calories or less per RACC. If the RACC is small,
then “low calorie” is 40 calories or less per 50 g. In the case of packaged entrées or entire meals,
“low calorie” is 120 calories or less per 100 g. “Low Fat” means product has 3 g or less per
RACC, or 30% or less of calories from fat for packaged entrées or entire meals. “Low Saturated
Fat” means product has 1 g or less of and not more than 15% of calories from saturated fat per
RACC. “Low Cholesterol” means product has 20 mg or less of cholesterol and 2 g or less of
saturated fat per RACC. “Low Sodium” means product has 140 mg or less of sodium per RACC;
“Very Low Sodium” means product has 35 mg or less sodium per RACC.
Low Sugar? This term is not recognized by the FDA, so cannot be used on food labels!
Light or Lite. Product contains 50% less fat than its reference standard per RACC.
Light in Sodium. Product has 50% or less sodium than the reference food and is low calorie and
is low fat.
Reduced. As in calories, fat, saturated fat, cholesterol, sodium and sugar, product has at least
25% less of the indicated nutrient than its reference standard per RACC.
High in, Rich in or Excellent Source of. Product has 20% or more of the Daily Value (DV) per
RACC of the indicated nutrient. If the product advertises that it’s “High in Fiber,” “Rich in
Fiber” or “An Excellent Source of Fiber,” the product has 20% or more of the DV of fiber and
must be “low fat” or have the fat content clearly listed on the label.
Good Source of, Contains or Provides. Product has 10% to 19% of the DV per RACC of the
indicated nutrient. If the product advertises that it’s a “Good Source of Fiber,” “Contains Fiber”
or “Provides Fiber,” the product must also be low in fat or must contain the amount of fat per
serving on the label, as above. For instance, I just purchased a package of celery at the grocery.
On the package was written, “Good Source of Vitamin A.” Since the serving size was “two
medium stalks,” I know that if I ate two stalks, I would get 10% to 19% of the DV of vitamin A.
The Nutrient Label supported this by stating that 10% of the DV of vitamin A is in one serving
of the product.
More, Fortified, Enriched, Added, Extra or Plus. Product has 10% or more of the DV than its
reference standard per RACC. These terms are only used for dietary fiber, protein, vitamins and
minerals.
2.22
Lean. Used on meats and seafood with less than 10 g total fat, 4.5 g or less saturated fat and less
than 95 mg of cholesterol per RACC.
Extra Lean. Again, used on meats and seafood. Extra lean indicates products that contain less
than 5 g of total fat, less than 2 g of saturated fat, and less than 95 mg of cholesterol per RACC.
High Potency. Product has 100% or more of the DV of a given vitamin or mineral per RACC.
Healthy. For the term “healthy” to appear on a food label, the product must be low fat, low in
saturated fat, low cholesterol, contain 480 mg or less sodium, and have at least 10% of the DV
for at least one of the following: vitamins A, C, calcium, iron, protein or fiber. Raw fruits and
vegetables which might not meet the vitamin, mineral, protein and/or fiber standard, may
nevertheless be termed “healthy.”
Fresh. Product is in its raw, unprocessed state. Milk, which is usually pasteurized, hence
processed, may be termed “fresh.” 92
Health Claims on Labels
Health claims on labels relate how a specific food, food component, ingredient or supplement
reduces the risk of a health-related issue. 93
Health claims must be supported by scientific
evidence, as evaluated by petition by the FDA. Some FDA-approved health claims from the
FDA Modernization Act are as follows, with the specific, required wording of the claim: 94
“Diets rich in whole grain foods and other plant foods and low in total fat, saturated fat and
cholesterol may reduce the risk of heart disease and some cancers.”
“Diets rich in whole grain foods and other plant foods and low in total fat, saturated fat, and
cholesterol may help reduce the risk of heart disease.
“Diets containing foods that are a good source of potassium and that are low in sodium may
reduce the risk of high blood pressure and stroke.”
“Drinking fluoridated water may reduce the risk of dental caries or tooth decay.”
“Diets low in saturated fat and cholesterol, and as low as possible in trans fat, may reduce the
risk of heart disease.”
“Replacing saturated fat with similar amounts of unsaturated fats may reduce the risk of heart
disease. To achieve this benefit, total daily calories should not increase.”
2.23
Food Group Plans and Exchange Lists Food Group Plans
Food group plans focus on meeting the amounts of foods from each of the five food groups (plus
oils) per day, as determined for individuals by sex, age and needed calories. For instance, using
the data provided earlier in this chapter, a food group plan for a 23 year-old, physically active
female would include 2,400 calories (Table 2-7), 2 c fruits (Table 2-1), 3 c vegetables (Table 2-
2), 8 oz grains (Table 2-3), 6 ½ oz protein foods (Table 2-4), 3 c dairy (Table 2-5), and 7 tsp oils
(Table 2-6). These data might be arranged as a table as follows:
Figure 2-2. Representative Food Group Plan.
For 23 year-old, physically-active female.
Food Group
Recommended
USDA
Amounts
Breakfast
Lunch
Snack
Supper
Snack
Fruits 2 cups ½ c ½ c 1 c
Vegetables 3 cups ½ c 1 c 1 ½ c
Grains 8 oz 2 oz 3 oz 3 oz
Protein Foods 6 ½ oz 2 oz 2 oz 2 ½ oz
Dairy 3 cups 1 c 1 c 1 c
Oils 7 tsp 3 tsp 4 tsp
Total Calories Needed: 2,400
Although estimated discretionary calories could be included in Fig. 2-2, 235 estimated
discretionary calories (Table 2-9), the actual number of discretionary calories can be more
accurately determined by subtracting the calories in the meal plan developed from the food group
plan from the total calories needed to maintain weight; an example of how to do this is given in
Fig. 2-3 below.
A meal plan can then be constructed, based on the representative food group plan, as in
Fig 2-3 below. Note that when constructing a meal plan, foods that may be listed in more than
one food group should be included in only one group; for instance, 1 c of skim milk can be
included either as 1 c dairy or 1 oz protein equivalent. Also, once you have constructed a meal
plan using whole, nutrient-dense foods for each food group, discretionary calories are determined
by subtracting the total calories in the meal plan from the calories needed to maintain weight.
Figure 2-3. Representative Meal Plan
Developed from Fig. 2-2 for a 23-year old, physically-active female.
Food Group +
Amount
Menu
Calories*
BREAKFAST
½ c fruit
½ c vegetables
2 oz grains
2 oz protein foods
½ c orange slices
½ c mushrooms (in omelet)
2 slices whole-wheat toast
1 jumbo egg (= 1 oz protein equivalent)
1 slice lean bacon, cooked, drained (= 1oz protein equivalents)
40 cal
8 cal
152 cal
90 cal
54 cal
2.24
1 c dairy
3 tsp oils
1 c (8 oz) nonfat, plain Greek yogurt
1 tsp olive oil mixed in egg
1 tsp olive oil to sauté egg
1 tsp olive oil on toast
12 oz water
133 cal
40 cal
40 cal
40 cal
LUNCH
½ c fruits
1 c vegetables
3 oz grains
2 oz protein foods
1 c dairy
¼ c (= ½ c fruit) dried dates (~ 6 dates, 42 g)
½ c pinto beans, boiled, mashed for burrito
½ cup pico de gallo (diced tomatoes, onions, jalapeňos,
cilantro) for burrito
1 large, whole-wheat tortilla (~ 100 g)
2 oz shredded beef in burrito
1/3 c shredded cheddar cheese for burrito
12 oz water
116 cal
122 cal
20 cal
310 cal
104 cal
151 cal
SNACK
1 c fruit 1 large apple, gala 114 cal
SUPPER
1 ½ c vegetables
3 oz grains
2 ½ oz protein fds
4 tsp oils
2 c mixed green salad (Romaine, tomatoes, onion, shredded
red cabbage) (= 1 cup vegetables)
½ c string beans, boiled
3 oz whole grain pilaf (brown rice, wheat berries, oat grouts,
barley)
3 oz sockeye salmon, sautéed in thyme and olive oil
1 tsp olive oil for salad dressing (with balsamic vinegar)
1 tsp olive oil for sautéing salmon
4 large olives (= ½ tsp oil)
¼ medium California avocado for salad (= 1 ½ tsp oil)
12 oz mineral water
25 cal
22 cal
100 cal
144 cal
40 cal
40 cal
20 cal
57 cal
SNACK
1 c dairy 1 c skim milk 86 cal
Total Calories Needed to Maintain Weight (Table 2-7): 2400 cal
Total Calories in Meal Plan: 2068 cal
Discretionary Calories: 332 cal
DISCRETIONARY FOODS
332 disc calories
allowed
10 oz horchata drink for lunch
2 Famous Amos chocolate chip cookies for snack
½ c fat-free, vanilla ice cream for supper dessert
½ c mushrooms in supper salad
154 cal
76 cal
92 cal
8 cal
Total Calories in Discretionary Foods Added: 330 cal
Subtract Calories in Discretionary Foods from Discretionary
Calories Allowed = Total Calories Over (+) or Under (-):
-2 cal
* Values from USDA National Nutrient Database for Standard Reference 41
Note that in the above meal plan, discretionary foods can be added until the total calories
needed to maintain weight can be achieved. Also note that discretionary calories can be either
2.25
low or high nutrient-density foods. If some of the discretionary foods are eliminated, those
calories are not consumed and slow (and usually permanent) weight loss over time is achieved.
Exchange Lists
Exchange lists help diabetics construct meal plans without counting carbohydrates. Exchange
lists group foods together by 15 g (0.5 oz) servings of carbohydrate, then subdivides these foods
by protein, fat and calorie amounts. Each “exchange” has about the same quantity of
carbohydrate, protein, fat and calories, as another serving of a food from the same group. 98
Diabetics need to consume relatively equal amounts of carbohydrates throughout the day and
from day to day to avoid wide variations in blood sugar.
Table 2-10 gives an abbreviated exchange list from the Academy of Nutrition and
Dietetics 99
as compiled by the University of California, San Francisco, Diabetes Education
Online website. 100,101
One exchange = 15 g carbohydrate.
Table 2-10: Exchange Lists 41,101
STARCHES
BREADS and FLOURS
15 g carbohydrate (1 exchange), 3 g protein, 0-1 g fat, 80 calories per serving
¼ bagel (1 oz) 3 tbsp flour (wheat), corn meal, wheat germ,
1 biscuit (2 ½ inches across) 1 pancake, ¼ inch thick, 4 inches diameter
2 slices bread, reduced calorie (1 ½ oz) 2 taco or tostada shell, crisp (5 inches dia.)
1 slice bread, white, whole-grain, rye (1 oz) 1 tortilla, corn or flour (6 inches diameter)
½ bun (hotdog or hamburger) (1 oz) 1/3 tortilla, flour (10 inches diameter)
1 cornbread (1 ¾ inch cube, 1 ½ oz) 1 waffle (4 inch square or 4 inches round)
½ English muffin (1 oz)
CEREALS, GRAINS and PASTAS
15 g carbohydrate (1 exchange), 3 g protein, 0-1 g fat, 80 calories per serving
1/3 c barley, cooked (1 oz) ¼ c granola (1 oz)
¼ c bran, oat or wheat (dry) (0.88 oz) 1/3 c pasta, cooked (2/3 oz)
½ c wheat, bulgar, cooked (1 oz) 1/3 c polenta, cooked (2/3 oz)
½ c cereals, cold, shredded wheat, bran (1 oz) 1/3 c quinoa, cooked (2/3 oz)
½ c cereals, hot, oatmeal, cooked (1 oz) 1/3 c rice, brown, long-grain (2/3 oz)
1/3 c couscous, cooked (2/3 oz) ½ c rice, wild, cooked (1 oz)