Healthy Food & Healthy Living by Dr. Ayala

Not a healthy choice: junk foods vs. the school lunch program

I devoted a recent post to the school lunch program, a federally sponsored and regulated program, which complies with some (if not altogether satisfactory) nutrition standards for nutrient content and portion size. I was grousing about the sorry state of the food our young ones are served under the guise of an “improved” lunch program.

But to get the full picture of the school food environment, we need to also look at the competitive foods sold in schools–foods that are expressly marketed to our kids–which make up a big part of what kids actually eat while they’re in school.

What are competitive foods? They’re anything sold, served or given to the kids that isn’t part of the school subsidized lunch. They are comprised of foods and beverages sold in the cafeteria or in a school store, from a vending machine or in fundraising events. The lunch money parents give their kids may very well be spent on these offerings, rather than on the school lunch.

Kids love the vending machines and the school stores, but that’s not the only reason these outlets exist. Schools depend on the revenues that vendors bring in to fund much-needed programs. This creates an unusual and worrying conflict, in which schools share an interest with the manufacturers of snacks and junk foods.

The US Department of Agriculture administers and regulates the school lunch program, but has practically no control over other foods and drinks available at schools (although some school districts have taken initiatives to impose restrictions banning some junk food sales in schools). In fact, the only existing federal restriction is that foods of “minimal nutritional values”, such as candy and soda, won’t be sold in the cafeteria during meal times. That of course doesn’t mean they can’t be sold right outside the cafeteria doors.

You can imagine that if the content of the regulated school lunch leaves a lot to be desired, the completely unregulated competitive food scene would be a free-for-all candyland galore.

The Journal of the American Dietetic Association’s special supplement this month analyzed the data from the third School Nutrition Dietary Assessment Study. One of the papers is devoted to competitive foods. The data was collected in 287 nationally representative schools and included 2,314 kids.

These were the main findings:

• Availability: One or more sources of competitive foods was available in 73 percent of elementary schools, 97 percent of middle schools, and 100 percent of high schools. À la carte foods sold in the cafeteria were common in all school levels. Vending machines were available in more than one quarter of elementary schools, 87 percent of middle schools and virtually all high schools.

• Consumption of competitive foods: Overall about 40 percent of the kids consumed these foods on any given day. Consumption was much higher in high school and reached 55 percent.

• Energy contribution of competitive foods: Overall kids consumed about 280 calories/day from competitive foods, and almost two thirds of these calories were from foods of low-nutrient and energy-dense food (the study defined “low-nutrient energy-dense food” to include cakes/cookies and other desserts, donuts, toaster pastries, snack chips, French fries and caloric beverages excluding milk and 100% juice). These numbers varied by school type, with middle and high school kids getting more calories from competitive foods. A typical high school kid gets about 340 calories/day from competitive foods, 65 percent (or 220 calories) of which are from junk food.

• The most commonly consumed competitive foods: Desserts and snacks were selected by just over 50 percent of kids; these products include cakes, cookies, candy and ice cream. Sweetened beverages were consumed by almost half the kids--these include juice drinks (not 100% juice) and carbonated soda.

The authors conclude:

“SNDA-III (third School Nutrition Dietary Assessment Study) data indicate that consumption of competitive foods was widespread, particularly in middle and high schools. Sources of competitive foods varied by type of school, with vending machines and à la carte purchases most common in middle and high schools and fundraisers and other school activities most common in elementary schools. The specific competitive foods consumed most frequently were low-nutrient, energy-dense foods such as fruit drinks/sport drinks, cookies/cakes/brownies, candy, and carbonated sodas. On average, children who consumed one or more competitive foods obtained 177 calories (8% of total daily energy intake) from low-nutrient, energy-dense competitive foods.”

So, we have low-quality foods sold in the schools competing with a low-quality school lunch–a competition that’s a lose-lose for our kids. Wherever our kids turn they have snacking opportunities that contribute mostly empty calories.

Many parents commented on my previous school lunch post, and told me that they opt to pack a lunch for their kids. It’s sad to say, but for most American kids the only potential source for a healthy nutritious lunch may be the lunchbox from home.

No matter how you approach the school lunch issue, I'm convinced that we as parents have more influence on our kids’ food choices–through what we do, what we say and how we eat–than anyone else. It’s within our reach to exert our influence to better our kids' diet and health.

More on vending machines and the foods they offer here.

Do you give your kids money to buy food at school? What advice do you give them about their choices for lunch?

Dr. Ayala

How to make healthy whole-wheat pita bread and the mystery of the pita pocket

Making pita bread at home is really easy and fun. It’s really a beginner baker’s project, and a wonderful first bread recipe to make with kids. The entire process of making pitas takes only about two hours (most of it rising time) and pita bread bakes in minutes. Kids are fascinated when they see the pita balloon in the oven and form its pocket.

Freshness makes all the difference, therefore your own pitas are going to be better than anything you ever bought in a supermarket.

Once you’ve mastered the dough preparation you’ll be able to experiment with baking pitas over any very hot surface. While I usually use an oven with a baking stone, pitas can be made in any oven, on a grill, on a stovetop in a pan and even on hot pebbles!

Ingredients:

3 cups flour. (Use 1 ½ cups whole wheat flour and 1 ½ cups all purpose flour or bread flour for starters. You can then experiment with increasing the proportion of whole to regular flour)

1 package active dry yeast

Scant 1 cup lukewarm water

1 teaspoon salt

1 teaspoon granulated sugar

1 tablespoon olive oil

Preparation:

If you have a bread machine put all the ingredients in the pan, set the machine to the dough setting and skip to step 6.

If making this dough by hand, you’ll get the benefit of exercising your arms a bit—all the more fun:

1. Combine flour and salt in large bowl.

2. Make a small depression in the middle of the flour and pour yeast, water, sugar and oil in the depression.

3. Stir with wooden spoon or rubber spatula until elastic.

4. Place dough on floured surface or in a large bowl and knead for 3-5 minutes. Rest for about 15 minutes (time for a coffee break?) and go back to kneading for another 5-10 minutes. When the dough is smooth, elastic and not sticky your kneading is done.

5. Put your dough into a floured bowl and cover. Set in a warm place to rise, until about double (about an hour).

6. Divide dough into 10-12 equal balls. On a lightly floured surface, roll each ball with a rolling pin into a 5-6-inch circle.

7. Cover rolled dough loosely with a towel. Let rise for about 15-30 minutes, until slightly puffy (you can skip this step if in a hurry).

8. Preheat oven to 450 degrees with the baking sheet or stone in it. Bake for 2-4 minutes, turning over halfway.

9. Pitas are ready when puffy and just slightly browned. A short bake results in softer pitas. If you like your pita crispy, bake a few minutes longer.

I bet someone (usually it’s the kids) will ask why to the pitas puff.

Whenever I have a “why” question in the kitchen I turn to Harold McGee's “On Food and Cooking: The Science and Lore of the Kitchen”, the Bible of cooking science. Mine is as stained with batter and spills as my cookbooks.

Here’s the venerable McGee’s explanation:

“Puffing occurs when the two bread surfaces have set in the heat and become tougher than the inner layer, where steam accumulates and eventually tears the tender interior, forcing the two surfaces apart.”

The way I explain it to young kids is that the dough has lots of tiny air bubbles. In the heat of the oven the air bubbles expand (as any gas would in heat), and since the pita forms a hard crust on both upper and lower sides, the air finds it easier to accumulate in the middle to form a balloon. I hope that’s close enough.

As an experiment, you can prick holes with a fork in one of your pitas and observe that this pita won’t puff.

Serving ideas:

You can eat almost anything in a pita as people in the Middle East do. Hummus, tahini, thinly sliced vegetables and other salads are great.

You can use pita bread to scoop sauces.

We usually eat the pitas as soon as they come out of the oven and have none left, but if you do, they freeze well. When heating a pita bread it’s a good idea is to sprinkle water on either side.

A few more words about bread and nutrition:

In case you didn’t notice, my recipe has very few ingredients. In fact, bread is made out of four main ingredients—flour, water, salt and a yeast. Bread is an ancient food, and the mastery of great bread making is usually not in ingenious new ingredients; it’s in the technique and patience of the baker.

Next time you’re in the supermarket visit the bread isle, which is usually vast, and look at the ingredient lists. Most supermarket bread is made with white flour. If it’s made with white flour it will contain vitamins and iron—law requires refined flour to be enriched, as the refining process robs the wheat grain its germ and bran, and therefore much of its micronutrient and fiber. Many breads also contain a long list of softeners, additives, conditioners, preservatives and many other hard to read and impossible to understand chemicals.

The result is bread that can be made quickly in a factory, has a long shelf life and includes a taste that, I guess, most people like.

Many types of bread also have lots of health claims: Adding a small amount of whole wheat or bran to industrial bread is cause for celebration on the package. Whole grains are good for you.

I have no idea why consumers would want to eat breads with so many additives. If you’re seeking bread with a “shelf life,” a healthier option is to buy real bread with a short ingredient list containing items you can identify and pronounce, then slice it and put it in the freezer. It will keep well.

Enjoy, and please tell me about your bread-making and bread-eating experiences.

Dr. Ayala

Hardly a healthy lunch: The sorry state of the school lunch program

The third School Nutrition Dietary Assessment Study, which evaluates the school meal program, came out recently. The Journal of the American Dietetic Association devoted over 130 pages in a special supplement this month to its findings. There’s much to read and think about in its data.

I’d like to devote this post to just one topic covered by the study, and talk about what our kids get served, and what they actually eat while in the school cafeteria for lunch. I, for one, am quite concerened.

A short introduction to the school meal program:

In 1946 the National School Lunch Act created the National School Lunch Program (NSLP) with a dual purpose—to feed kids and prevent dietary deficiency and to provide an outlet for surplus agricultural commodities. The school lunch program operates in all public schools and in many private schools too.

The School Breakfast Program was established in 1975 to help meet the nutritional needs of children from low-income families and is offered in fewer schools.

On any average school day more than 30 million kids eat a school lunch, and 10 million kids eat a school breakfast. Fifty-nine percent of the kids eating a school lunch are from low-income homes, as are 80 percent of school breakfast eaters.

The USDA-sponsored third School Nutrition Dietary assessment study was based on a sample of almost 400 public schools that offer subsidized school meals, and about 2,300 students grades 1-12.

Here’s a picture of what’s offered for lunch:

• Milk: Milk is offered in practically all schools. One percent fat milk was the most common milk served, and the majority of milk offered is flavored.

• Fruit: Ninety-four percent of schools offered fruit or fruit juices. Only 50 percent of schools offered fresh fruit. The rest offered canned fruit or fruit juice.

• Vegetables: This study considers starchy vegetables such as white potatoes a vegetable. By that classification, 96 percent of kids had a vegetable offering at lunch. But note that while 45 percent of high schools offered French fries (!) only 39 percent of schools offered lettuce salad, 29 percent offered orange or dark green vegetables, and 10 percent offered legumes.

• Grains/bread: The vast majority of grain products (bread, rolls, bagels, crackers etc.) were made of refined white flour. Only 5 percent of grain offering was whole wheat.

• Combination entrée: The most commonly offered combination entrée depended on age; in elementary school, 28 percent of combination entrees were peanut butter sandwiches, followed by meat sandwiches; in middle school the most commonly offered combination entree was pizza with meat, followed by cheeseburgers and sandwiches with breaded meat or poultry.

• Dessert: Those were offered in 47 percent of high schools, 41 percent of middle schools and 37 percent of elementary school. The leading deserts were cookies, cakes and brownies.

This is what the kids actually ate for school lunch:

• Milk: Seventy-five percent of kids drank milk, mostly 1 percent fat, and mostly flavored.

• Fruit: Forty-five percent of kids ate some fruit; most of the fruit eaten was canned. Only 16 percent of kids overall had fresh fruit, and among high school kids it was only 8 percent.

• Vegetables: Fifty-one percent of kids overall had some kind of vegetable, but that includes French fries. Lettuce salads were eaten by 6 percent of kids, orange or dark green vegetables were eaten by 6 percent, and legumes by 2 percent. French fries were eaten by 34 percent of high school kids!

• Grains/bread: Thirty-four percent of kids had grain products. Only 1 percent of grain products eaten were whole wheat.

• Combination entrée: 75 percent of kids selected these entrees, the most popular of which were pizza, sandwiches with breaded meat, fish or poultry, hamburgers or hot dogs.

• Dessert: Thirty-eight percent of kids had dessert, mostly consisting of cookies cake and brownies or candy.

In assessing the quality of the school meals and the school food environment, the study authors and commentators compare the school food to the recommendations set by the Dietary Guidelines for Americans. By these standards:

• The school lunch menu meets the standards for key nutrients such as protein, vitamins and minerals.

• The majority of lunches exceeded the recommendations for total fat (in over 80 percent of schools) and saturated fat (in 72 percent of schools). (The standards require fewer than 30 percent of calories come from fat, and less than 10 percent of fat be saturated fat.)

• Only 6 percent of schools met the standards for all nutrients: fat, saturated fat, protein, vitamins A and C, iron and calcium.

• Very few schools offered lunch that was adequate in fiber.

• Practically all school lunches contained too much salt.

I offer you a very different way to look at the subsidized school lunch. You don’t need to be a nutritionist, you don’t needs charts and a calculator, and you don’t even need to know the Dietary Guidelines for Americans to assess the quality of the offerings we’re serving our next generation.

Picture the food described above and it’s easy recognize and name it: The school lunch is fast food! It’s salty, sweet and fatty, the meat is breaded and crunchy, it’s been highly processed—even the fruit and vegetables aren’t fresh for the most part.

Speaking of vegetables, I have nothing against potatoes; I think they’re nutritious and good to eat in many forms, but French fries aren’t a vegetable by any stretch of the imagination! (And neither is ketchup.)

Most of school lunches are not prepared in the school kitchen—the surplus commodities our food industry produces make their way to our schools as processed food and not as fresh fruits, vegetables and whole grains.

For those who say that a better school menu would be too expensive, I want you to consider that treating a whole host of chronic diseases, ranging from diabetes to heart disease to cancer—which are the dangerous result of the childhood obesity epidemic and the current lack of healthy nutrition—will cost so much more. Forty percent of the public school kids in this study were overweight! We definitely can’t afford that!

There are a few schools that serve healthy, nutritious food, made from real ingredients. There are a few schools that teach kids how to cook healthy meals and even grow their own vegetables.

But what most kids learn from the institution that’s supposed to prepare them for life are really bad eating habits that will set them up for a lifetime of struggle with weight. Even worse is that kids from low income homes—who have less access to wholesome food out of school—get this low quality food at school for lunch and breakfast.

What do your kids eat for lunch at school?

Dr. Ayala

Do fruit and vegetables explain the “French Paradox”?

For years I’ve been watching with jealousy our French friends across the ocean, who indulge in meats, butter, rich pastries, full-fat cheese and other foods high in saturated fat (the classic repas français), yet are thinner and enjoy lower rates of heart disease and diabetes than us Americans.

There’s been a lot of interest in the “French Paradox” and plenty of controversy about it. (Some even doubt its existence.)  We’d all love to draw practical lessons from the French.  Red wine was suggested as one protective food the French consume in plenty.  But there are many other differences between the average American diet and the French one: the French eat smaller portions, consume less added sugar and more fish, indulge in less prepared and snack food, drink less sugary beverages and snack less between meals.  All of these dietary differences may be part of the explanation of why the French have less heart disease.

The bad news is that the French people aren’t as thin as they used to be.  They still enjoy better health than their US counterparts, but the obesity epidemic has spread among them too.  One in ten French kids will be obese by the age of 10 years, and 16% of French kids are overweight (compared to about a third of American kids who are overweight).

We know that people who eat more fruits and vegetables (F&V) are less prone to obesity, heart disease, cancer and many other chronic illnesses.  France is technically a Mediterranean country, and the typical diet in the olive-growing South of France is richer in F&V, but further north the diet pattern is less plant based and more buttery.

Might the French paradox be explained (at least in part) by their F&V consumption?

A study in the current print edition of the European Journal of Clinical Nutrition compares the F&V consumption of French and US adults.

The results don’t paint a pretty picture.  Neither Americans nor the French ate their recommended minimum of five servings a day (the study actually looked at the frequency of consuming fruits and vegetables, not at quantity), but there were significant differences between the two populations.

• French women ate the most F&V, followed by French men. In third place were American women, followed by American men, who ate the least F&V.
• The distribution of the Body Mass Index (BMI, a measurement that estimates a healthy body weight based on how tall a person is) in the two countries was strikingly different: 31% of the US subjects were obese, compared to 8% of the French subjects.
• There was a negative association between fruit and vegetable intake and BMI; in other words, the higher the F&V intake, the lower the BMI.
• Education was correlated with F&V intake for Americans (the higher the education the more F&V people ate), but to a lesser degree in the French, indicating that maybe culture and dietary habits are more important in determining F&V intake in France than is education or that F&V were readily accessible to people of lower socioeconomic strata.

Overall, the Americans sampled in this study had much greater rates of higher education than the French. The authors write:

“Based on our findings, the consumption frequency of fruits and vegetables of the least formally educated group in France is comparable to even the most formally educated group in the United States.”

I personally believe no single food ingredient is responsible for the French Paradox.  It’s dietary pattern—not a dietary ingredient—that’s responsible for better health. I believe that’s true for all people, including the French.

If we look to the French and want to learn from them how to eat for better health it’s tempting to adopt only the attractive message of “drink more wine.”  In fact, we have to look at the rest of their dietary pattern, which includes amongst all the differences mentioned above perhaps the most important lesson—“eat more fruits and veggies!”

Dr. Ayala