Healthy Food & Healthy Living by Dr. Ayala

Pharmaceuticals in drinking water, should we care?

Water is perhaps our most important and precious resource, and for most of us the purity of our drinking water is a serious concern. Being vigilant about our water is a lesson we learnt the hard way from history: Contaminated water spread deadly diseases like cholera and typhoid, and continues to be a major health threat in developing countries.

When Americans were asked to rate their level of worry about 12 environmental concerns in Gallup’s annual environmental survey conduced March 6-9, the top four concerns related to water quality, with pollution of drinking water the top overall concern.

Just a few days later, on March 10, the Associated Press published the shocking results of their five-month investigation, reporting that drugs have been detected in the drinking water supplies of 24 major metropolitan areas, including Southern California, Northern New Jersey, Washington, D.C. and San Francisco.

Of the 62 major water providers contacted, the drinking water for only 28 was tested. Philadelphia (my home town) scored the worst, although it claims it tested for more drugs and byproducts than other utilities. It found 56 of 72 pharmaceuticals or byproducts tested for in treated drinking water, including medicines for pain, infection, high cholesterol, asthma, epilepsy, psychiatric illness and heart disease. Sixty-three pharmaceuticals or byproducts were found in the city's watersheds.

Among the 34 water providers that haven't tested their drinking water for pharmaceuticals are: Houston, Chicago, Miami, Baltimore, Phoenix, Boston, Seattle and New York City.

The presence of pharmaceuticals in the environment is nothing new, and the scientific community has been studying the issue with growing concern for several years. The recent improvements in analytical chemistry now allow detection of trace levels of chemicals and unfortunately, as a result of their growing use, these compounds have been found in aquatic systems, in sewage treatment plant effluents, aquifers deep underground, surface waters and even drinking waters in North America and across Europe.

Is it cause for alarm?

It’s definitely no cause for celebration.

The federal government doesn't require any testing for drugs in drinking water, and there are no standards for acceptable levels.

It’s going to be hard to definitively prove that these trace medications cause harm to people, and impossible to prove they don’t. Scant studies on cell cultures and animal models show negative effects. The amounts found in drinking water are indeed very small, and it would take years of drinking water to reach the dose that is taken therapeutically in one pill of any one of these drugs.

The growing concern in the scientific community centers on the chronicity of the low dose exposure (our body may deal well with a one time ingestion of a chemical, yet suffer damage from much lower exposure spread over time), the unique combinations of these low dosed drugs acting synergistically, allergic reactions that can occur even in low doses, and that these drugs can form new metabolites -- drugs can be transformed into other compounds whose effects are completely unknown.

On top of that there’s the concern for aquatic life exposed to drugs and the contribution to the rise of drug-resistant bacteria caused by the presence of antibiotics in the environment.

The AP report says most standard techniques used by municipal water treatment facilities allow many pharmaceuticals to slip through and only advanced treatments such as reverse osmosis will remove virtually all detectable pharmaceutical traces.

In the interest of full disclosure, Ayala’s Herbal Water, our company’s product, uses a multi-step purification method, including reverse osmosis, that’s intended to remove all dissolved particles.

As water becomes scarcer, the need to reuse waste water only increases. The use of prescription drugs continues to rise. The extent of this problem will only grow if it’s not addressed.

The AP report has finally turned the spotlight on this important issue, and since water has always been a major focus of consumers’ concern I’m sure we’ll be hearing more on this subject.

Ayala

Vitamin Supplements: Should You or Shouldn't You? Part 3: Real food is the best source of nutrients

After looking at the disappointing studies showing no consistent association between antioxidant vitamin supplements and reduced coronary heart disease or cancer, folic acid supplements and colon cancer prevention, or vitamin C and common cold prevention, I’m happy to tell you that I do have some good news.

Following years of research, we can go back to the observation that started this journey: Eating plenty of fruits and vegetables is beneficial to health.

Dozens of studies looking at people eating plant foods-- whole grains, fruits and vegetables--showed the same correlation: lower risk of heart disease, cancer, diabetes stroke and many other chronic diseases.

The scientific pursuit to understand exactly what’s in these foods that does the trick is thrilling, if of no practical use as of yet. Natural foods contain thousands of different chemicals. Some of these, like the thirteen vitamins, have been well studied. Many others -- while known -- aren’t yet sufficiently examined, and I’m certain that better analytical techniques will identify many other compounds. On top of that, human metabolism is so incredibly complex, that understanding our interaction with food compounds seems an almost daunting task. Yet, it’s now clear that fiber, vitamins, minerals and specific fats in isolation don’t seem to give us the same benefits as when they’re present in our fruits and vegetables.

There are many possible explanations: The studies may be flawed (nutrition studies are especially hard to conduct); we have not yet identified the beneficial molecule in these foods; or it’s the combination of vitamins and the synergy between them in the food that’s beneficial, while each in isolation is ineffective.

If you’re lucky enough to have access to plenty of food to choose from, isn’t it obvious that you should stick to what works, and just eat plenty of fruits and vegetables?

Let’s compare white bread, made with enriched flour, to whole grain bread. Whole wheat flour contains nutrients from the three layers of the grain: Bran, germ and endosperm. The outermost bran layer contains fiber, B vitamins and antioxidants. The germ is the embryo of the grain, and contains B vitamins, minerals (magnesium, calcium, zinc, chromium, manganese, selenium, vanadium, and copper), protein, and unsaturated fats. The endosperm is the largest part of the grain and consists primarily of carbohydrate, some protein, and small amounts of vitamins and minerals.

A refined grain has had the germ and bran layers removed, taking with it 25% of the protein, almost all of the dietary fiber, and a number of vitamins and minerals. Manufacturers of refined grains “fortify” the flour by adding back the vitamins and minerals they’ve stripped from the grain, and they even add a little extra. (The FDA requires refined flour fortification with thiamin, niacin, riboflavin, folic acid and iron at a higher level than the original grain.) Many breakfast cereals are fortified with more than a dozen nutrients and fiber.

So why do foods made with refined fortified flour still fall short when compared to those made with whole grain? Is it that we’re missing some key nutrients that we’ve removed, and didn’t identify? Is it that there was a synergistic effect in the way the whole wheat is absorbed? Is the process of refining the grain adding something to the flour that is harmful? We simply don’t know, but clearly whole grain is healthier than refined grain with added vitamins, and there are dozens of studies to show that.

By the same token, 100 grams of apple (with skin) has 85 grams of water, 0.26 grams protein, 0.17 grams fat, 10.4 grams sugar, 4.6 milligrams vitamin C, 3 micrograms folate, 54 International Units of vitamin A, 0.18 milligrams vitamin E, and just trace amounts of other vitamins and minerals. If you look at the apple just from the macro- and micro-nutrient point of view, an apple would be like water with 10% sugar, sprinkled with a few vitamins and minerals, all of them in tiny amounts, so that if you were to put a label on your apple the FDA would not allow to even say it’s a rich source of any of these vitamins, as it does not supply anything close to 20% of RDA.

What are we missing here?

The apple has dozens of phenolic and flavonoid compounds. It has antioxidant activity that is a result of molecules other than the meager 4.6 milligrams vitamin C in it, and it is an excellent food that promotes health, whereas the sugared water with vitamins (even if you put 100% RDA of them) is probably worthless, since what’s missing from the average American diet is not vitamins.

Plant foods contain a host of important compounds that may someday be labeled essential to health. There are literally thousands of these compounds in every plant food. A pill can never contain all that. We have evolved with these plants as our food for millions of years, and we’re therefore brilliantly adapted to metabolize them in the most optimal way.

To most of us, living in this environment of plenty, the pursuit of the “super molecule”, that is the holy grail of good health should be academic only. We already know what works; we have been hearing this advice for years. One of my fondest memories of my maternal grandfather was his daily salad ritual. After a day's work, he would finely chop a mountain of fresh vegetables from the market into a huge green bowl that could easily double as a bathing tub for a newborn baby. As you can imagine, this fine dicing would take a while, and it seemed to me like he was having a Zen moment while we were anxiously waiting for his famous salad, the gentle aroma of scallions, cucumbers and lemon filling the air. And then my grandmother would tell us what my mother already told us so many times: Eat more fruits and vegetables. That is exactly the same advice I give my kids today. By eating this way we’re most likely covered, even if we don’t yet completely understand why.

Would you dream of replacing a friend with a slick, expertly designed computer program that you can talk to anytime, and that gives you comfort, support and great advice? Unlikely. We have deep relationships with friends; we care for them and they give us so much more than a good conversation.

Our traditional foods are like a good friend: so much more than the sum of their known nutrients. They are seeped with customs, memories, emotions and great flavor. We're just scratching the surface of what’s in them. They are in many ways our connection to nature. But we so readily trade them for highly processed foods high in fat and sugar. And we think that a vitamin pill supplement will fix the damage a bad diet can cause.

Don’t be misled by all the vitamin bottles promising wonders, or so-called “enriched” or “fortified” foods. (They need fortification because they are lacking what we need on their own, or to justify a higher price point.) Don’t go for the pill or the fortified foods. They’ll just postpone your commitment to actually doing something for your health and wellbeing.

Instead, do what grandma said: Eat more fruits and vegetables. Improve your diet. You’ll get all of the healthy goodness you need.

Dr.Ayala

Vitamin Supplements: Should You or Shouldn't You? Part 2: Is there a downside to taking multivitamins?

Despite marketing claims, vitamin supplements’ only proven function is correcting vitamin deficiency. But are we risking anything by taking a multi-vitamin, just in case?

Surprising negative outcomes of vitamin supplement treatment in clinical trials

I alluded last week to studies correlating vitamin intake with bad outcomes. I'll mention just a few:

A very large meta-analysis, including 68 randomized trials, and 232,606 participants looking at antioxidant vitamin supplements’ effectiveness, found that treatment with beta carotene, vitamin A, and vitamin E had no significant effects on gastrointestinal cancers and may also increase mortality.

A recent double-blind, placebo-controlled, trial including 1,021 men and women looked at whether high-dose folic acid supplements (1,000 micrograms, about 2.5 times the recommended daily dose) could prevent new polyps in people with a recent history of colorectal polyps. Folic acid treatment was associated with higher risks of having 3 or more adenomas and of non-colorectal cancers.

While many trials are ongoing, and this issue is far from resolved, studies such as these have dampened the enthusiasm for vitamins among experts, and resulted in a more skeptical approach toward them.

Vitamin overdose

Although vitamins are safe at a very wide range of doses, and it’s practically impossible to overdose on vitamins that occur naturally in food, there is an upper safe limit for vitamins from supplements, and most experts warn not to take vitamins in large doses.

The fat-soluble vitamins (A, D, E, and K) have a higher potential for toxicity than the water soluble ones. For instance, Vitamin A overdose can manifest in headaches, liver damage, dry skin, bone loss etc. Large doses of Vitamin A are also highly teratogenic (that is, they cause malformations to the embryo). Vitamin D toxicity may manifest as nausea, constipation alternating with diarrhea, vomiting, pain in the joints, loss of appetite and irreversible calcium deposits in various organs. Most of the excess of water soluble vitamins is excreted (that’s why vitamin supplements are dubbed ‘fish food’ or ‘expensive urine’). But even the innocent seeming water-soluble Vitamin C, which many people take in doses that are multiples of the recommended daily allowance (in the unfounded belief it prevents colds) can have untoward effects, and cause kidney stones, diarrhea and nausea in large doses.

And, most of us need to bear in mind that many processed foods are fortified or enriched with synthetic vitamins, so if you also take vitamin supplements the possibility of overdosing is real.

Are vitamin supplements a viable nutritional safety net, and is having one a good idea?

I contemplate this question in the frantic race to get my kids to school on time. They regularly get up late, and there’s the inevitable rush to make sure they have everything they need for their day. I’m sure that if they thought there’d actually be consequences of their tardiness and inefficiency, they would learn to be more responsible, and I’d achieve a larger goal than just having them at school on time.

I hear that some drivers are aware of how advanced new cars have become, and trust the cars’ ability to take over and prevent skidding and loss of control, to the point they don’t feel the need to be that careful.

The knowledge that you have a safety net with your daily multivitamin has led to a similar attitude of complacency, with some people believing that it’s not that important to eat well, as we’re guaranteed nourishment from the pill. The fact is, no pill or food fortification scheme is likely to ever adequately substitute for a healthy diet.

It’s easy to get enough vitamins from food if you maintain a reasonably healthy diet. Eating a diet that includes a few more fruits and vegetables will provide the safety net, and at a lower cost. On the other hand you’re kidding yourself if you think that taking a pill will correct the damage of poor eating habits. Multi-vitamins do not have the same beneficial qualities as the nutrients from foods, and if taking vitamins is giving you an excuse to eat badly, your safety net is full of holes. Although you get some benefit to address overt vitamin deficiency, the many benefits of eating a healthy diet will be missed by relying on multi-vitamins.

Next week I'll conclude the vitamin discussion series with my strong belief that real food is the best source of nutrients.
Dr. Ayala

Vitamin Supplements: Should You or Shouldn't You? part 1

Do you take vitamins? Multivitamins? Antioxidant vitamins? Vitamin C? “Of course. I want to take good care of myself,” you might say. Yet, increasing evidence shows supplemental vitamins might not be as good for you as was once thought.

In my next few blog posts, I’ll be looking at the pros and cons of vitamin supplements, and compare them to vitamins from whole foods.

When asked about multivitamins, most doctors used to say that if it won’t help, it sure won’t hurt. I’d like to think that a multibillion industry pushing these products, and decades of use would give us a better answer than ‘it probably won’t hurt’. You see, while a lack of vitamins could make you sick, that doesn’t mean that extra vitamins make you healthy. This needs to be proven.

Lately, there’s a shift of opinion among medical professionals concerning the broad and indiscriminate use of vitamins. After decades of suggesting multivitamins as a nutritional safety net, an increasing number of medical professionals are changing their advice.

In this month’s edition, Harvard Men’s Health Watch issued a reappraisal of its recommendation, and suggested that average men give up multivitamins, at least until scientists solve the puzzle of folic acid and cancer. (See: http://www.health.harvard.edu/press_releases/multivitamin-and-cancer-risk.htm)

A few weeks ago I quoted the World Cancer Research Fund and the American Institute for Cancer Research recommendations: “Aim to meet nutritional needs through diet alone”.

The American Heart Association recommends that “healthy people get adequate nutrients by eating a variety of foods in moderation, rather than by taking supplements.” (http://www.americanheart.org/presenter.jhtml?identifier=4788)

What are vitamins supplements good for?

There is one clear and consistent reason for people to take a vitamin supplement: Vitamin deficiency.

A vitamin supplement will correct a primary vitamin deficiency faster than food will. For example, if a patient has scurvy -- a disease caused by vitamin C deficiency that afflicted and killed many sailors that had no access to fresh produce -- vitamin C will resolve his symptoms.

I’m sure you’ve read labels claiming vitamin C helps heal wounds, prevents cell damage, promotes healthy gums and teeth, and strengthens the immune system. If you had scurvy you’d see all these outcomes once you took vitamin C, and fast. But if you eat a varied diet you’re unlikely to experience any effects on your gums, skin, or immune system. Compare that to a hypoglycemic person: He will greatly benefit from anything with sugar, but it would be misleading to market sugar as “provides energy, vitality, and prevents fainting”. This sort of claim is similar to marketing a beautiful house as a solution to homelessness.

Healthy people who eat a varied diet are unlikely to develop a vitamin deficiency. On the other hand extremely restrictive diets, states of malabsorption, chronic diseases, and special situations such as pregnancy (folic acid in early pregnancy is proven to decrease the incidence of neural tube defects), old age and prematurity, may make vitamin deficiency possible and even likely. In such a case, a doctor will prescribe specific vitamins to address specific issues, and will follow up on progress.

Scientists have been searching for proof that vitamin supplements prevent, ameliorate or cure diseases other than vitamin deficiency for many years. The results have been quite confusing. Initially, observational studies, looking at people who take vitamins and comparing them to people who don't, showed a correlation between multivitamin consumption and other parameters such as lower rates of cancer, dementia and heart disease. Yet when randomized double-blind placebo- controlled studies where done, many times no correlation was found.

This discrepancy is largely explained by the fact that studies that look at self-selected groups have an internal bias. People who take vitamins on their own volition may seek other perceived healthy habits such as exercise, good nutrition, healthy weight, smoking avoidance etc., are more affluent or are healthier to begin with.

When the researcher randomly assigns the groups, the result is more indicative of the intervention studied, in this case, vitamin use. Adding the placebo to the control group neutralizes the effect of suggestion, which is very powerful and cannot be underestimated.

Long-term randomized clinical trials -- considered the gold standard for studying a relationship between treatment and health -- have failed to consistently show that supplements of beta-carotene, vitamin A, B-vitamins and vitamin E benefit cardiovascular health. Some trials have even shown them to cause harm. The same is true for cancer prevention and treatment.

These days, vitamin D is the new darling, with recommendations popping up to consider a vitamin D supplement, and at a higher dose than the current recommended daily allowance. Vitamin D is made by the skin in reaction to sunlight exposure, and there are very few foods that are naturally rich in this vitamin (mainly fatty fish). Several foods such as milk products, cereals and margarine are fortified with vitamin D. There have been quite a few encouraging studies correlating vitamin D intake to lower cancer rates, better cancer survival rates and lower rates of cardiovascular disease.

Although I’m hopeful that a vitamin D intervention, so simple and safe, can be possible, it reminds me a little of the antioxidant vitamin initial hype of the past that turned into disappointment with the results of larger, better studies.

Drawing conclusions from a study reported in the news, without looking at the big picture, is like looking at the presidential primaries in just one state or at just one point in time. To draw reasonable conclusions one needs to let the scientific process continue, and see where the results as a whole point to.

When I met my husband, some 14 years ago, he had a bunch of bottles with multivitamins and some vitamins in mega-doses, even though he always ate very well, and there was no reason to think he's deficient in any way. By a conservative estimate I saved at least $2000 by convincing him to quit indiscriminate use of vitamin pills (maybe an excuse to buy myself something nice?).
But the expense wouldn't have changed his mind. My reasoning back then was that there may be a downside to taking vitamin pills.

And that brings us to next week's topic: Is there a downside to taking multivitamins?

Dr. Ayala

Snacks, snacking and snackers

The influence of snacking on the development and maintenance of obesity is likely.

‘Snack’ does not have a unique definition.

One definition centers on when and how the food is eaten, i.e., if it’s eaten in between meals, it’s a snack, or if it’s eaten quickly, it’s a snack.

The other definition centers on what you eat: A snack is a small portion, can be high quality (apple) or low quality (chips)

What's clear is that more and more of us are snackers. A snacker is someone who consumes more than 20% of his calories as snacks. Reports show that most of our school age kids are snackers, and consume more than 30% of their calories from snacks, though since there's no clear definition of what it means to snack I’m not sure what this means.
I will try to be specific and clear despite the ambiguity.

Eating in between meals, on the go, eating something fast: Eating this way is so much our way of life, that I don’t know how much we can change it. Provided the food itself is nutritious, when you eat it should matter little. The problem with this kind of eating is that it’s mostly mindless, and provides relatively little eating pleasure, so we tend to eat more. I try to eat less in between meals, and limit it to good food- fruits, vegetables and nuts. A good start is “no snacks after dinner”. Late day snacking is the time when lots of junk calories are consumed. The other rule I would recommend, especially for kids, is no eating in front of the TV. The combination of food and TV is so sweet, making the duo so seductive, that we consume way too much of both.

Going back to the second definition, a snack is something small. I wish it were so innocent. Since we know that less than 11% of Americans meet their daily requirement in fruit, I don’t think the ‘something small’ eaten is fruit. The word snack is most associated nowadays with individually wrapped processed foods, coming out of a vending machine, or bought in a bigger pack in the supermarket. The snack food industry has invented so many of them, and to further confuse us about what these things are, all kinds of nutrients (vitamins, fiber, minerals) have been added to some of them. If 30% of what school age kids eat is that, this is cause for worry.

The rising obesity rates had everyone rethinking the school lunch and vending machines in schools. You see, even if the school lunch is improved, the snacks sold compete with the cafeteria food. Some of the schools never had vending machines, which is really the way it should be. Some schools removed the machines for the lower grades, and others have had a revision on what’s sold in school vending machines.
Schools now need to decide what a ‘healthier snack’ is. Due to the widespread confusion about all issues of nutrition, this is not that easy.

One of the tools developed for just this purpose is Snackwise (http://www.snackwise.org). It was developed by the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital in Columbus, Ohio. It’s an internet based program that color codes snacks to three categories, “green- best choice, yellow- choose occasionally, red- choose rarely”. The subscription fee is $25/year. Their algorithm takes into consideration calories, sugar, sodium and fat (higher rating if these are low), and protein, fiber, calcium, vitamins A and C, Iron and folate (higher ratings if these high). The user types in the information from the nutrition panel and the calculator gives the rating.
Just a few examples of snacks by snackwise categories:

Green:

Baked Cheetos w/Calcium, Crunchy, Frito Lay (0.875oz/24.8g)
Baked Veggie Crisps, Farmland Cheddar, Flat Earth by Frito Lay (1oz/28.3g)
Cereal Clusters, Snickers, Generation Max (1.1oz/30.1g)
Milk & Cereal Bar, Cocoa Puffs, General Mills (1.4oz)
Special K Snack Bites, Vanilla, Kellogg's (0.81oz/23g)
Stacy's Soy Crisps, Sticky Bun, Stacy's Pita Chip Company (1oz/28.3g)
Teddy Graham Snacks, Cinnamon, Nabisco by Kraft Foods (0.75oz)
TLC Chewy Granola Bar, Peanut Butter, Kashi (1.2oz/35g)

Yellow:
100 Calorie Pack, Oreo, Nabisco (0.81oz)
Bagel Chips, Cinnamon Raisin, NY Style Brand (1.25oz/35g)
Beef Jerky, Hickory Smoked, Oberto (0.9oz/25.5g)
Candy Bar, Chocolate w/Almond 1g sugar, Hershey's (1.1oz/31g)
Candy, Skittles, Smoothie Mix, Mars (2.17oz/61.5g)
Chee-tos, Crunchy Reduced Fat, Frito Lay (0.875oz)
Cookies, Mini Chocolate Chip, Chortles (1oz/28g)
Doritos, Cool Ranch, Reduced Fat, Frito Lay (1oz)
Fruit Roll, Fruit Punch, Fruit Parade (0.75oz/21g)
Lays Potato Chips, KCM BBQ, Frito Lay (1oz/28.3g)

Red:
Candy Bar, 100 Grand, Nestle (1.5oz/42.5g)
Candy Bar, Milk Chocolate w/Almonds, Hershey's (1.45oz/41g)
Candy, Tootsie Roll, Twin Pack, Tootsie Roll Industries (2oz/56g)
Candy, York Peppermint Pattie, Hershey's (1.4oz/39g)
Cookies, Chocolate Chip, Darlington Farms (1.4oz)
Famous Amos Cookies, Chocolate Chip, Kellogg's (3oz/85g)
Ice Cream Cookie Sandwich, Original, Country Fresh (4.5oz)
Pop-Tarts, Frosted Cherry, Kellogg's (3.67oz/104g)
Snack Mix, Granola Berry Crunch, King Nut Co. (1.75oz/49.6g)

And their recommendation-

“Vendors establish a ratio for each of the categories as: 30% Green, 55% Yellow, 15% Red.”

I don’t care if a hospital came up with this. To suggest that one needs a computer program to assess snacks is ridiculous. To color code snacks as green is going too far (a logical color code range of these snacks would be orange, red and black). To recommend that after you deemed some snacks red, they should still be in the school vending machine, just because kids need choices is beyond.

It matters not one bit if the manufacturer added some vitamin A or C to his cookie. It’s still highly processed food, and there’s no proof that adding vitamins does any good. If a fast food restaurant gave its customers a multivitamin pill with the combo meal, would it make the meal nutritious? By devising these criteria food companies are better able to design just the snack to fool us; add some cheap nutrients to the mix, and you get a ‘healthy snack’. Another concern is that the healthier choices (nutrition and power bars) are often more expensive than the junkier choices.

So here’s my take on this. You don’t need to subscribe. This is free and simple.

All of these single serving snack foods in the vending machine are to be eaten infrequently; the best of them should be viewed as dessert. The worst aren’t really food.
In the old pyramid the very top portion was dedicated to fats oils and sweets, and the best of vended snacks fit that definition, and to be eaten sparingly.

Now that we lumped the snack machine’s contents in the dessert category which one to choose?

If you’re eating it infrequently, it shouldn’t matter all that much and I’m sure everyone knows what’s dessert and what’s pure junk. The time honored occasion for dessert is after a meal, when you’re not very hungry and don’t need all that much of it to feel the indulgence of the treat. Therefore, eating these snacks to relieve hunger isn’t a very good idea.

A real healthy snack is made from real food. Examples would be fruits, vegetables and nuts. By the way, a small bag of nuts, one of my favorite snack foods for a hungry active child that needs more energy, scored ‘red’ when I put its nutritional information in the snackwise calculator. One ounce of cashews has 160 calories (their goal is under 150), 82% of them from fat (their goal is no more than 35% fat), and it’s not a good source of vitamin A, C or calcium. On the other hand, every fortified cereal bar or cookie I put through the calculator, no matter how much corn syrup, hydrogenated fat, artificial color and junk in it, scored ‘green’ provided the serving size was small enough. Looking at food from the narrow view of nutrients is sometimes really misleading.

To read more about vending machines in schools I recommend the Center for Science in the Public Interest’s report: "Dispensing junk".

Dr. Ayala