Choose my plate empty calories

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)