As we stroll the isles of the grocery store, we are inundated with numerous food brands that use creative ways to entice us into buying those brands. For kids it tends to be a certain character on a cereal box, or bright colored packaging, however, as adults we too fall into the advertising trap if we are not well informed. However, in some cases these labels can tell us a lot about a food at quick glance thereby allowing us to make informed decisions.
Are these words/labels regulated by a scientific body? Well, that depends on the word!
The word “organic” is regulated by the National Organic Program of the United States Department of Agriculture (USDA). The USDA requires annual inspection of sites where food is grown and processed. During that inspection, the USDA looks at many factors including but not limited to soil health, pest control methods, water systems, non-GMO conditions and record keeping.
100% organic: Must be 100% organic ingredients. The label includes the name of the certifying agency and may have the USDA Organic seal (see image). in addition to the words “100% organic”
Organic: Must be at minimum 95% organic ingredients with up to 5% of non-organic ingredients that fall under a selected list (National List of Allowed and Prohibited Substances) as determined by the USDA. Examples include fish oil and baking soda. The label includes the name of the certifying agency and may have the USDA Organic seal in addition to the words “organic”
Made with organic/ Specific ingredients that are organic: Must have 70% organic ingredients to qualify for this label. Organic products are identified on label as organic.
Alternatives to the USDA organic label, are two non-governmental programs that are run by volunteers within the farming community and the farms themselves: Certified naturally grown and Non-GMO. Although all USDA organic labels require Non-GMO products.
Free range and natural are two labels that do not have a defined standard or definition. These terms are not regulated by a third party agency (https://www.farmaid.org/food-labels-explained/).
The word “Low sodium” and “Reduced sodium” are regulated by the Food and Drug Administration (FDA). Low sodium has a set number of milligrams of sodium (140 mg or less per serving) that a product cannot exceed to be deemed low sodium on its label. The dietary guidelines state that individuals should consume less than 2,300 milligrams per day of salt so knowing a product has less than 140 mg of sodium is advantageous. However, reduced sodium does not use a set amount in terms of milligrams but rather a percentage (25%) of the regular product. This is a bit more concerning as if the regular product has an excessive amount of sodium, then 25% is great but are you still getting to much salt? Some other claims that are regulated by the FDA include lightly salted, no salt or salt free.
The heart healthy label was initiated by the American Heart Association (AHA) and corresponds to FDA dietary guidelines. The certification of a food as heart healthy by the AHA requires that product to fall within or under certain limits of fats (saturated and trans), carbohydrates, cholesterol, sodium, vitamins and minerals as well as other specified requirements based on the food product. But be careful as not are hearts are the same! Ensure it states AHA certified on the label.
The examples above are just a few regarding the labels placed on food packages by the company. Bottom line is due your research and look at those food labels on the back or side as those are regulated by the FDA!
To understand more about the food choices we make based on food labels and your body, check out the book entitled “Atherosclerosis Attack: Traffic Jam in Your Arteries.” This book is intended to help middle schoolers understand the impact of their daily lifestyle choices through a story. During this stage when children are learning to make informed choices and becoming more independent about choosing what to eat or which physical activities to engage in, the book helps them understand the long-term effects of their choices. If you haven’t yet, buy your child a copy of Atherosclerosis Attack: Traffic Jam in Your Arteries, then provide the support and environment your child needs to make healthy choices and hopefully establish healthy dietary patterns and physical activity.
Statistics from the Centers for Disease Control (CDC) show that 6 in 10 adults in the United States have a chronic disease and 4 in 10 have two or more chronic diseases. According to the CDC, the key lifestyle factors that increase risk for chronic disease are tobacco use, poor nutrition, lack of physical activity and excessive alcohol use. With these numbers and risk factors, the chances are that many of our children will grow up to be adults burdened with at least one chronic disease.
As parents, we nurture our children, guide them, and do all we can to teach them our values including which football team to love and support. We do this hoping that they grow up to be responsible adults, who take care of themselves and contribute positively to society. One of the factors that contributes to a good productive life, is one’s health. Unfortunately, when one is young, the least of their problems is nurturing their body so that it can serve them well throughout their life. In most cases, when our children are really young, we feed them what we believe is good and try to ensure they get enough sleep and run around.
The new edition of the Dietary Guidelines (2020-2025) (DGA) presents the figure below, showing how the population of the United States adheres to the dietary guidelines. In this figure, a score of 100 means that people are meeting or exceeding dietary recommendations and a score lower than 100 means that people are having a diet that is of lower quality than what is recommended. The figure shows a score of 61 for children aged 2-4 years old. This age group is completely dependent on parents (or other caregivers) to provide food, so what explains the poor quality of diet consumed by these young children?
Of course, the scores only get worse as children get older, dropping by a whole 10 points to a score of 51 by age 14-18. The worsening quality of diet through childhood and into adolescence makes sense as the DGA further report what every parent of children in this age group already knows. “As children transition to school-age and through adolescence, they are exposed to new food choices and they begin to have more independence in the foods they choose to eat. Peer pressure and increasing amount of time these children spend away from home as they mature into adolescents contribute to the food choices made as children get older.”
As you look at the figure above (scores increasing from 51 to 56 to 59 to 63) and probably from your own experiences, you might say, “well, my children will start improving the quality of their diet when they become adults, so let them eat what they want now.” The big deal, however, according to the Dietary Guidelines, is that “the children and adolescents life stage (ages 2 through 18), is characterized by transitions and the formation of dietary patterns. The dietary patterns established during this life stage tend to continue into adult years.” Another way to look at it is, the lifestyle choices made during this stage of life generally set the stage for problems associated with chronic diseases later in life.
So, there are two important questions every parent needs to answer with respect to the health of their children; one that is proactive and the other that looks back. As a parent, what can I do to change or affect the path my children choose regarding healthy lifestyles? In other words, how can I help my children work towards establishing healthy dietary patterns and physical activities, which are essential to preventing chronic diseases? God forbid a child ends up with a lifestyle-related chronic disease, as a parent, can I say that I did all I could to help them, that it’s not my fault, that there is nothing else I could have done to help them?
It is possible that you want to do better in helping your children make healthier choices regarding their diet but are wondering where to start. Dietary Guidelines “provide advice on what to eat and drink to meet nutrient needs, promote health, and prevent disease. The guidelines are based on scientific evidence which also shows that it’s never too late to start and maintain a healthy dietary pattern.” If you click on the link to the guidelines above, it is very possible that you will be overwhelmed by the amount of information and wonder where to start. The main message as summarized in the figure below is to, “make every bite count”. The figure shows how to accomplish this in the 4 steps shown and expanded in another figure.
Since our mission at Chronic Disease Patrol is to help children take a stand against preventable chronic diseases, it’s exciting to see that the new edition of Dietary Guidelines provides dietary recommendations for each life stage, from birth to adulthood. Chapter 1 explains the guidelines and key recommendations in detail, giving examples of foods that contribute to increased intakes of added sugars, saturated fat, and sodium. Also, examples of meal plans that meet healthy dietary pattern requirements are given in this chapter. Chapter 3 of these dietary guidelines focuses on children and adolescents, identifying nutritional needs of this life stage and presenting recommendations along with how current intakes compare with the recommended dietary patterns. For example, current intake data shows that children and adolescents (ages 2 through 18) consume more than the recommended amounts of added sugars, saturated fat, and sodium, while they consume less than the recommended amounts of fruits and vegetables. The Dietary Guidelines are generally designed for policymakers and nutrition and health professionals with the responsibility of helping all individuals and their families consume a healthy, nutritionally adequate diet. However, these guidelines also provide resources for consumers such as MyPlate Plan, which presents a good visual for children, an easy-to-read consumer brochure, and ideas about eating healthy on a budget, including tips and tricks for making healthier meals that can fit the busy schedules of most families with school-age children.
One recommendation the Dietary Guidelines give to help support healthy dietary patterns among children and adolescents is involving them in meal decisions, shopping, and cooking at home, and guiding adolescents’ selection of food purchased and consumed away from home. As a parent or caregiver, I might wonder whether this really works because I know that as children get older, it is harder to make them do what I want them to do – especially if they don’t understand why they need to do it. Similarly, getting them to make the right dietary and exercise choices is a big challenge if they don’t understand why that’s important. To help with this big challenge, Kate and I wrote a book entitled “Atherosclerosis Attack: Traffic Jam in Your Arteries.” This book is intended to help middle schoolers understand the impact of their daily lifestyle choices through a story. During this stage when children are learning to make informed choices and becoming more independent about choosing what to eat or which physical activities to engage in, the book helps them understand the long-term effects of their choices. If you haven’t yet, buy your child a copy of Atherosclerosis Attack: Traffic Jam in Your Arteries, then provide the support and environment your child needs to make healthy choices and hopefully establish healthy dietary patterns and physical activity.
Next, I use my two children as examples to show the impact we can have as parents in helping our children establish good habits regarding what they choose to eat or physical activity. My 16-year-old son surprised me recently. We did a couple of remodeling projects in the kitchen which meant that we could not use the kitchen sink for 3 days. During those days we ate out, and like I have said in my previous posts, I let everyone loose when it comes to eating out because we don’t do it often. My son loves pizza, pasta and everything Italian foodwise and he got good servings of those during the 3-day period. I was surprised though when I asked him at the end of day 3 if he wanted to take some pizza to school for his lunch the following day. His response, “Ma, no! Are you going to cook soon? There is something about all this food we have been eating. Maybe it is my ‘system’ but can you please cook tomorrow?”
I reminisced over this as I planned the meal for the following day. The meal would include steamed broccoli, a cabbage roll dish (red cabbage plus ground turkey), which is a modified recipe from the Trim Healthy Mama’s Trim Healthy Table, and a zucchini-chicken dish based on my son’s recipe which I often modify because the rest of us can’t handle the amount of Italian seasoning he uses. Of course, my quite athletic son would need a real good source of energy, so we added the usual pasta. But this pasta is different from what he got in his takeout during the 3-day period because we use only whole grain pasta and his ‘system’ is used to that. So, the point is, if you establish healthy habits at home, they can pay dividends later even though in the moment your kids will probably be complaining about what’s served for dinner. In the case of our son who actually likes to cook, we let him choose healthier options from the categories of foods he likes and from those he doesn’t really care for, like zucchini, we ask him for ideas about what he or we can do to make them enjoyable. He has come up with several dishes that have become staples at our house.
Now if you have a child who doesn’t care for cooking, like my daughter, implementation is a bit tougher. But the starting point is still to make sure that they understand why they need to eat healthy. That’s where “Atherosclerosis Attack: Traffic Jam in Your Arteries,” came in handy since she likes solid reasons for doing anything, unless we are talking about the dangers of too much screen time, in which case all reasoning is futile.
Anyway, the conversation of making the right dietary choices and physical activities is ongoing in our home. This 14-year-old with a sweet tooth recently surprised me when she turned down sweets on a couple of occasions. I found out that she planned to eat better this year and she had formed an accountability group with some of her friends. Somehow, the accountability group didn’t work out but my daughter is still keeping up by making small steps and small sacrifices here and there. Not wanting to cook makes it harder for her to fix herself healthy dishes but she is willing to eat what I prepare and she even asked for a turmeric – ginger – lemon drink (Trim Healthy Mama’s Trim Healthy Table) that I prepare just for me and my husband since both kids didn’t care for it when we first made it. Also, this sweets-loving girl decided to opt out of the track season that’s about to start, which led to the conversation of calorie requirements for a sedentary life compared to an active one. We have talked about the fact that “school-aged children and adolescents need at least 60 minutes of moderate to vigorous activity every day.” So, she decided that she will continue pursuing opportunities to play basketball and jump rope while waiting for her brother to finish track practice.
The point of this article is to encourage you (if you haven’t yet) and me to make helping our children establish healthy dietary and physical activity patterns an important part of our parenting. This undoubtedly comes with additional demand on your time but resources are available to help you, for example, tips and tricks for making healthier meals that can fit busy schedules. You can also check out some of our older blog articles for practical ideas about getting your children involved in choosing right for their bodies. Please visit us again for more ideas.
Last month Kate’s blog post considered the issue of sugar addiction and here I am again talking about sugar a few weeks later. I agree with Kate’s idea of “the triad of sweetness beginning at Halloween,” or what others celebrate as Fall Festival. I exercise a certain degree of discipline when it comes to what I eat but this “triad of sweetness” is a challenge. I looked at my teenage daughter piling up covers ripped from chocolate and other candy that our neighbor had brought as a gift to her. As I hoped that she would stop herself without me having to say anything, my mind rushed through the upcoming days and festivities going right into the first few months of 2021, of course praying that we will safely navigate through this truly unprecedented 2020.
It seems as if before we fully recover from the sweet goodness of the Thanksgiving and Christmas holidays, the sweet Valentine comes along, paving way for sweet Easter. A few years ago, we filled more than half of the Easter eggs with coin money and the rest with candy, and marveled as we saw the disappointment on our children’s faces. They actually started carefully looking through the eggs so they could select the ones with candy. The conversation that followed related to us trying to understand why the kids preferred candy even when they could use money to buy whatever they wanted, including candy. Of course, having a sweet tooth myself, I could see how hard it would be for a child to curb the instant gratification that the piece of candy brings and how disappointing it would be to open the plastic egg expecting to find candy but instead finding a dime or a quarter.
The struggle is not only with children but with adults too. During the recent Fall Festival at our church, a friend found me eating my second serving of a caramel pecan cream slab pie. She laughed and asked, “aren’t you the one who posted that article on sugar?” I said yes and proceeded to give my excuse. First of all, I think the servers had learned the popularity of that pie from last year so they cut very small pieces. Towards the end of the function I found a few pieces of this pie left and I allowed myself to get a second helping- one more tiny piece as I convinced myself. I explained that after I tasted that pie for the first time, I felt like I needed to get the recipe. But by the time I got home, I had come back to my senses and realized that it would be a bad idea for me to make the pie. Therefore, I decided that I will wait for the next year’s Fall Festival to grab a bite. Needless to say, in addition to that pie, I enjoyed some bite-sized caramel-glazed cake doughnuts before the Fall Festival was over.
You are probably wondering where I am going with all these stories. It is to acknowledge that even when we know the harmful effects of added sugar, the battle is real for those of us endowed with a sweet tooth. It is also to acknowledge that this is a battle we can fight to obtain a significant degree of victory. From my circles, I know the good news confirmed by the American Heart Association (AHA) that most American consumers want to have less sugar in their diets and are willing to give up a favorite sugary product in favor of finding a healthier alternative. I also love what they said in the same article, “The willingness is there. For now, your best defense is education.” So how do you move from willingness to actually reducing added sugar in your diet? Education is at least the first half of the battle and the AHA has done a great job providing information in easy to read articles or infographics.
Some of the questions I have heard commonly asked by friends trying to make changes are: Is brown sugar better for you than white sugar? What about honey? Well this is one of the issues addressed in the articles you will find on the AHA website. Here is an excerpt from the article, “But high fructose corn syrup isn’t the only type of sugar contributing to our over consumption. Some sugars are assumed to be healthier than others, but added sugars like agave nectar, honey, maple syrup, coconut sugar, or date sugar have a similar effect on the body as other added sugars.”
You can visit their website to find information about main sources of added sugar in the diet, tracking added sugars in food, tips for cutting down added sugar, and many others, including taking control of excuses to overindulge. So how did education or knowledge about the effects of sugar help me, considering my overindulgence during the most recent Fall Festival? Well, that knowledge has been the foundation for me to exercise control and discipline over what I eat for majority of the time. I have had to develop strategies like keeping tempting food items out of my house, reducing eating out and using the no-calories sweeteners like stevia or monk fruit, which are plant based, to prepare a sweet dish. The point is, once you know the effects of sugar you can come up with a strategy that works for you to cut down on sugar consumption, especially as we go into the season of festivities. Thankfully, our bodies can be weaned off added sugar so that when you choose to give in to the pie craving like I did, your body will let you know. It took me several days to get over the unwellness I felt after appeasing my taste buds with the sweet goodies during the Fall Festival.
Even for children, education is a critical step. For instance, in the story above about my daughter, I finally had to say something about how much candy she was consuming in that sitting. I’m not sure she would have stopped on her own but her response to me was, “mom these are actually tiny pieces and I’m planning to work them off.” We have of course previously had the conversation about the daunting amount of physical activity that would be required to work off a seemingly small amount of added sugar. We have also talked about the fact that you can eat some added sugar but there are recommended amounts even children shouldn’t exceed on a regular basis for the sake of their health. We have also helped our children visualize how much added sugar different foods and drinks contain, with respect to recommended amounts. Even when it is hard, my daughter’s knowledge about the effects of added sugar makes this conversation easier and helps her choose better options more often than she would be able to without that knowledge.
It is in this light that Kate and I wrote a book, “Atherosclerosis Attack: Traffic Jam in Your Arteries,” to give middle schoolers the opportunity to understand the impact of their daily lifestyle choices in a FUN way. If you haven’t yet, buy a copy of Atherosclerosis Attack for the child you care about. This book allows children to discover for themselves through a story, how their diet & exercise choices affect a real disease and what they can do about it, while learning the science about one of the major lifestyle-related chronic diseases affecting Americans.
Halloween begins what I like to call the triad of sweetness. With Halloween, the candy that we do not give out stays in our home for us to eat then we dive into November which taunts us with sweet pies for thanksgiving. Moving forward we head to Christmas, with candy, cookies and more sweet treats! Ofcourse sugar is not only found in these sweet treats, but also the stuffing and bread we eat during these times. But is sugar addictive? We know that the brain has pleasure centers that when activated makes us feel happy or content. With certain chemicals such as nicotine, it enters the brain and activates a multitude of neuronal pathways that end in the release of dopamine in what are known as our pleasure centers of the brain. As more nicotine is taken in, the pathway becomes desensitized hence more nicotine is needed for a desired effect. There is biochemical data that supports the activation of this pathway and the desensitization of this pathway leading to nicotine addiction. Other drugs work in the same manner. The model for addiction is also measured on certain behaviors such as using a specific drug despite the poor outcomes both mentally and physiologically as well as excessive consumption marked by a lack of control. In addition to the aforementioned behaviors other behaviors associated with addiction include binging, craving and withdraw symptom’s (1).
Is food addiction real? Do you ever feel cravings for certain foods? Do you ever binge on food that is not deemed healthy? The question is do these feelings have a connection with brain chemistry.
Does sugar activate these pathways in the brain? The food addiction model has been accepted in the scientific world since the 50’s but there is some evidence that calls into question this model in humans hence separating scientific opinion on whether food addiction follows that of other addictions. Most of the models for sugar addiction come from work in animal models with few being derived from human subjects. For addiction to be validated there are 11 criteria based on the Diagnostic and Statistical Manual of Mental Disorders (DSM). In mouse studies five of the eleven categories were supported by animal data. For example, mice will increase their sugar intake over time and develop cravings as measured in behavior tests for addiction (2). In 2008, the Yale Food Addiction Scale (YFAS) was developed to explain food addiction in humans (3). The YFAS is a questionnaire to measure the addictive behavior of an individual with regards to processed foods, but does not include any biochemical data that show changes in brain chemistry. This study was also modified to look at children’s addictive behavior to various foods (3). The study used a more simplified language in the questionnaire and the questionnaire was administered to 75 children ranging from lean to obese (see example questionnaire below). Despite the small sample size (75 children), the study demonstrated that it is a useful tool for assessing addictive-like behavior in children similar to adults model.
Questions from the YFAS include
In other words, our eating habits are based on both psychological and neurobiological factors. Whether eating certain foods cause changes in brain chemistry in certain people holds true will require further investigation, but the reliance on food as a source of comfort, pleasure and want is real. So how do we handle such urges with regard to foods that contain sugar? As with any addictive behavior the key is to ween away slowly from it. I will use soda as an example. I am a soda fanatic, and it does not make me feel great in the long term! But I want it, I crave it, however, as I reduce my soda intake over time, eventually I no longer have those urges, however, if I decide to drink it again then those urges come back. It is about discipline, which for me is extremely hard as I enjoy soda. But in order to maintain a healthy lifestyle we must start with good habits when we are young.
Our book, Atherosclerosis Attack, uses a story to help children see how what they choose to eat, like sugar affects a real disease. If you have not yet obtained a copy for your younger loved one, we encourage you to obtain one from Amazon or Barnes and Noble.
Hoebel BG, Avena NM, Bocarsly ME, Rada P. Natural addiction: a behavioral and circuit model based on sugar addiction in rats. J Addict Med. 2009 Mar;3(1):33-41. doi: 10.1097/ADM.0b013e31819aa621. PMID: 21768998; PMCID: PMC4361030.
Wiss, D. A., Avena, N., & Rada, P. (2018). Sugar Addiction: From Evolution to Revolution. Frontiers in psychiatry, 9, 545. https://doi.org/10.3389/fpsyt.2018.00545
Gearhardt, A. N., Roberto, C. A., Seamans, M. J., Corbin, W. R., & Brownell, K. D. (2013). Preliminary validation of the Yale Food Addiction Scale for children. Eating behaviors, 14(4), 508–512. https://doi.org/10.1016/j.eatbeh.2013.07.002
Your body is equipped with systems that work together to enable proper body function. The immune system plays the role of defender, defending your body against intruders like the Corona virus responsible for the current COVID-19 pandemic. This virus has brought the importance of having a strong immune system to the attention of many since survival depends on the body’s ability to fight off the viral infection. Fortunately, this has been the case for most of the people who have been infected by the virus.
Even though the number of people who have died from COVID-19 is a small fraction of those who are infected, these statistics don’t ease the pain for the ones that have suffered loss. Learning more about this disease has made it possible to identify groups of people who are at increased risk of getting seriously sick or dying. People with underlying medical conditions including those with lifestyle-related (diet & exercise) chronic diseases such as obesity, type 2 diabetes, and coronary heart disease made the list.
How these underlying conditions make the outcomes of COVID-19 infection worse, could be as simple as the viral infection overwhelming body systems that are already overwhelmed with the constant battling of the chronic disease. It could be that COVID-19 makes the specific chronic disease worse like it is suggested to worsen heart disease. Or it could be that these chronic diseases have already compromised the immune system such that it just cannot fight COVID-19. This seems to be one reason type 2 diabetes and obesity increase the risk of serious sickness and even death from COVID-19.
“Obesity is a complex disease involving an excessive amount of body fat.” Type 2 diabetes is a chronic condition that affects the way your body metabolizes sugar, resulting either from reduced ability of the body to produce insulin or making the body resistant to the effects of insulin. Obesity causes defects in some immune cells in addition to increasing the risk for type 2 diabetes. And in the case of type 2 diabetes, high blood sugar weakens the immune system making it less able to fight off COVID-19.
These chronic diseases don’t develop overnight but over a life time. Little by little as you make your daily choices of what to eat and whether to exercise or not, you prevent or pave the way for these lifestyle-dependent diseases. As these diseases get established, your immune system suffers. This underscores the importance of you making choices that protect your immune system in order for it to defend you at a later date. The other name for type 2 diabetes, adult-onset diabetes, is becoming obsolete because there are increasing numbers of children developing type 2 diabetes, probably due to increasing obesity in children.
The aim of our chronic disease patrol efforts is to partner with caretakers to help children take charge of protecting their health starting at an early age and reduce the burden of chronic diseases later in life. To that end, we wrote and published a book, Atherosclerosis Attack, meant for middle schoolers. The Atherosclerosis Attack book allows children to discover for themselves through a story how their choices affect a real disease and what they can do about it. Learning and incorporating the information presented in our book early would allow kids to adopt lifestyles that would be helpful in preventing not only atherosclerosis and associated heart issues but also other lifestyle- dependent chronic conditions such as obesity and type 2 diabetes.
Bottom line is, taking care of your immune system is a lifetime job. It begins with you as it is your decision on what foods will be available for your child. Unfortunately, as they grow older and more opinionated, it becomes harder to make them eat or do what you know is good for them. You still care that they are healthy, but day after day you are faced with endless breakfast, lunch or dinner negotiations and constant reminders to your child to put away the electronics and get moving. Our book can help you. So give that child you care about an opportunity to really understand the impact of their daily lifestyle choices in a FUN way. Buy them a copy of Atherosclerosis Attack, work through it with them, so you are on the same page, and experience the power of useful knowledge. See what a parent/reviewer writes about the book.
All books have lessons to be learned. This could be conflict resolution, how to deal with a bully, or even how-to problem solve. Many ask me how I would classify our book; my response is that it is not a science textbook but nor is it a Harry Potter novel. Our book is unique in that it allows kids to really take a hands-on approach to learning while using a fun action filled book. In these uncertain times, continuing to raise children in a hands-on world while fostering creativity is tough. Our book allows students to enhance their reading skills and to engage in the book with science-based activities we as educators deem curriculum. As the child engages in the material from the book, they are challenged to reflect on their eating habits and activity levels. This allows the child to take control of their life by promoting healthy choices and the reason behind these choices.
Cate and I are collaborating with educators from the public schools to develop a curriculum for our book. More recently we had the opportunity to develop and submit curriculum to an online summer camp (CAMP SCBWI) which focuses on food and nutrition. This curriculum is posted on our website (https://chronicdiseasepatrol.com/upcoming-book/) as downloadable files for all to use alongside the book. For this curriculum we focused on Chapters 12-17 of the book as these are the chapters that emphasize nutritional value.
So, what would you expect from this curriculum?
In the book, the scientific sleuths talk about the defenders and villains of the body with regards to factors leading to atherosclerosis. They include discussions on salt, carbohydrates, and fats in this process, breaking down each as a defender, villain or in some cases both.
In one activity, the child uses the book to research whether a molecule is a villain or defender of the body. The child digs deeper by providing an example of a food source that has that molecule in it.
For example on page 115 of the book it states “Fiber, the soluble one, like fiber in oatmeal. It’s the one we need to reduce absorption of cholesterol. Scientists say it holds on to water and makes a very thick mix in the intestines, which makes it hard for absorption.” This provides the child with information about soluble fiber and allows them to make a connection that fiber is a defender as it prevents cholesterol from being absorbed into the blood stream. The child can then investigate foods that are high in soluble fiber such as oatmeal. The child uses the table below to fill out the villains and defenders and lists some examples of foods that may contain these molecules.
As the curriculum builds, it allows the child to apply these concepts to real world applications. For example, the students have a lesson focused on reading a food label and calculating total caloric intake, a lesson that will serve them well for a healthier life. In addition, the child can reflect on their own eating habits by filling out a food journal which is presented in the curriculum as a formatted table to guide the child to not only write down the food eaten but also think about the foods they selected (see abbreviated table provided below).
The activity book is filled with critical thinking type questions that force the child to engage in the book and in the activities without being too challenging that the child feels overwhelmed. Moreover, if needed, an answer key is provided for the parent to assist in managing the child’s progress.
Our book, Atherosclerosis Attack, uses a story to help children see how what they choose to eat, like sugar, affects a real disease while the curriculum challenges the child to apply this concept to their own life. Although the book is fiction, the science behind it is based on fact which has been validated using the scientific method. Hence, using the curriculum along with the book is a wonderful teaching tool! If you have not yet obtained a copy for your younger loved one, we encourage you to obtain one from Amazon or Barnes and Noble. Also check out the curriculum at https://chronicdiseasepatrol.com/upcoming-book/, scroll down to facilitator’s guide.
Check back with us soon as a full set of curricula with fun hands on learning will be available soon!
In normal times, grocery shopping for me was like any other shopping experience. I had no list, no plan and perused the isles while grabbing items that looked good. I had no worries as the grocery store was a few miles from my house and if need be, I could always stop by again after work. Meal prep for us was on a day by day basis depending on what we had in the house and what we were willing to stop and get. Having said that, in normal times I was not panicked, and I read food labels for salt content and other nutritional value. This all changed during the pandemic both for the good and bad. During the beginning parts of this pandemic, my food shopping was a mission. I made a list and organized it by isles, skipping those isles that were not the list. I was quick, grabbing items without looking at the food labels and hoping for the best. On the plus side, the pandemic made me meal plan and not shop haphazardly, thereby picking junk food I did not need, on the negative side I ignored food labels. As things appear to be calming down, I have found that grocery shopping during the pandemic taught me two important lessons: 1. Take the time to look at food labels and 2. Make a shopping list. Below are hints and cautions when reading a food label that I have learned over the years.
With regards to the food labels what do I look for and what have I learned over the years about food labels? The food label is mandatory per the Federal Drug Administration (FDA). The major categories on a food label include: Serving size, Calories and amount per serving, Total Carbs, Sugars, Added Sugars, Fiber, Fats (Saturated, Unsaturated and Trans fat), sodium, list of ingredients, and %DV.
The serving size is the most important components as the nutritional parameters are based on it. This can also cause issues for buyers, because if one does not pay attention to the serving size, calories, salt, fats and carbohydrates may add up quickly. Let’s take a look at the example below. At first glance the label draws your attention to the calories which state 25. You think to yourself, that is not too bad, 25 calories, especially when you look at a bag of potato chips which have a 160 calories.
The food label for the olives has a total fat content of 2.5 g whereas in the chips the total fat is 10 g. According to the labels neither contain trans fat, and the saturated fat is 0.5 g in olives vs. 1.5 g in chips. Looking at the sodium content, the olives have 230 mg whereas the chips have 170 mg. As expected, the chips have carbohydrates whereas the olives do not.
Olives
Chips
Calories
25
160
Total Fat
2.5 g
10 g
Sodium
230 mg
170 mg
Total Carbohydrates
0 g
15 g
However, this comparison is not taking into account the serving size! Let’s say you eat 15 chips and 15 olives, what will the numbers look like if we take into account serving size.
Olives
Chips
Olives
Chips
Amount you eat
15
15
Serving size
4
15
4
15
Calories
25
160
93.75
160
Total Fat
2.5 g
10 g
9.375 g
10 g
Sodium
230 mg
170 mg
862.5 mg
170 mg
Total Carbohydrates
0 g
15 g
To calculate this, take the number of olives eaten and divide by the serving size (15/4 = 3.75). Then multiply all the food label amounts by 3.75 to get the actual nutritional value (red text). WOW! Because the values were based on such a low serving size (4) eating more than 4 olives can really increase the calories, fat and sodium levels that you consume. Of particular note is that now the 15 olives no longer have the attractive 25 calories, and the fat content is now similar to the same amount of potato chips. Although realistically, who eats just 15 potato chips! What is really astounding is the sodium levels. The 230 mg was high to begin with but eating more than 4 really increased this to levels that may be concerning especially for those with high blood pressure. The main point is to make sure you do not get taken in by the large bold text that claims the calories as one must take into account serving size!
Total Carbohydrates:
The food labels below are from sourdough and multigrain bread. The serving size is the same at 1 slice although the sourdough bread (32 g) is a bit more food compared to the multigrain bread (27 g).
Let’s take a look at the total carbohydrates which is 15 g for the sourdough and 12 g for the multigrain. If you look at the label, the components under the total carbohydrates do not add up. Why?
Sourdough
Multigrain
Total Carbohydrates
15 g
13 g
Dietary Fiber
1 g
1 g
Total Sugars
0 g
2 g
Includes added sugars
0 g
2 g
The total carbohydrate include the fiber (listed above), Sugars (both natural and added, with specific amount of added sugar), and starch (https://www.fda.gov/food/new-nutrition-facts-label/added-sugars-new-nutrition-facts-label#:~:text=1.,to%20eat%20in%20a%20day). The remaining carbohydrates in the total once you subtract fiber and sugars is that of starch. Starch is a polysaccharide that consists of many sugar molecules that are held together by chemical bonds. The total sugars listed are the natural sugars along with the added sugars, and the added sugars are specific amount added to the food. For the multigrain bread the total sugar content is 2 g with all 2 g coming from added sugar and none coming from natural sugars.
The reform to the Nutrition Facts label by the FDA required that the amount of and percent Daily Value for Added Sugars be declared. This was to enable consumers to construct diets more consistent with the Dietary Guidelines for Americans. This change was in response to an acknowledgement that Americans on average are consuming Added Sugars in amounts that exceed recommended limits.
It’s possible that America’s sweet tooth has developed over the years as sugar has increasingly been added to more foods. This increase has seemed to parallel an increase in all sorts of health problems and currently there is plenty of evidence that added sugars play a significant role in these problems.
We probably all know that once one develops a sweet tooth, the habit is very hard to break. Cate and I’s goal through these posts and the book we have written is to help children who are still at an impressionable age get information that can help them make simple choices that would help them adopt lifestyles that would reduce the burden on chronic diseases later in life. Our book, Atherosclerosis Attack, uses a story to help children see how what they choose to eat, like sugar affects a real disease. If you have not yet obtained a copy for your younger loved one, we encourage you to obtain one from Amazon or Barnes and Noble.
My pastor called the times we find ourselves in “unique”. I thought about this word and it seems to capture a lot of what is going on during this COVID-19 pandemic period. For many, this means a lot of pain and heartache because they are infected and battling the disease. Some have lost loved ones and are experiencing unthinkable pain. For others their businesses, investments, jobs and livelihoods are in trouble. Then there is the quarantine that has kept the majority in their homes. I had never had to associate with the phrase “stir crazy,” until I heard it about 3 times from different people within a couple of days. Well, now I know that it describes a condition of being “distraught because of prolonged confinement.”
These unique times have given all of us an opportunity to step back and reflect on what really matters. One of the things that is certain during these uncertain times is that life is fragile. As we consider what we have believed to be important and realign our priorities, hopefully we consider the condition of our hearts – whatever that looks like for each one of us.
One of the things Kate and I focus on, as chronic disease patrol agents, is the condition of the physical heart you feel beating in your chest. Our goal is to encourage your young ones to start safe guarding their heart health at a young age. You might wonder why I would bother with this topic during this “unique” time.
Well, I was surprised when I saw people rushing for toilet paper in Walmart. I definitely hadn’t done a good job anticipating what was coming with the looming quarantine. A couple of days into the quarantine I realized I didn’t have oatmeal. No big deal, I thought, I will just run to Sam’s club, do a good job keeping 6 feet from everyone, grab my usual big pack and return home. You can imagine my feelings when I couldn’t find my regular rolled oats at Sam’s, Walmart and several stores I usually don’t buy groceries from, like Walgreens. Oatmeal has been my breakfast staple for more than a decade and I guess the frustration was not being sure how to replace it within the short time I had given myself for grocery shopping. I ended up visiting more stores than I had planned, stores that were quite crowded and I still didn’t have oats at the end. I switched to online stores with no success.
But my frustration didn’t last long as I realized that people had stocked up on oats as a sign that they care about the condition of their physical hearts. Of course, this maybe because of the long shelf life of oats but there are plenty of less healthy options with a long shelf life, so the fact that oats were stocked up was satisfying. As this is my passion, I settled for not having oatmeal and thankfully my freezer had some oatmeal cups that I had prepared sometime back, following recipes in the Trim Healthy Table book. Now oats are back in some grocery stores but before then, I actually got some from a friend, who had an extra container that her husband bought not knowing she had already purchased oats. My hope is that all the youngsters stuck at home are eating oatmeal and other health alternatives. For more information on why oatmeal is heart healthy visit the following website: https://www.hsph.harvard.edu/nutritionsource/food-features/oats/.
It has also been encouraging to see that items like beans and cauliflower rice have been selling out too. But while I was still celebrating the possibility that people are choosing to eat healthy during this time, I realized that along with some stores having to ration eggs the sugar isles were also emptying out. The quarantine has forced people to cook more, but more of what? It is tough to focus on healthy eating under the circumstances we find ourselves in. I have had to prepare some comfort food just to lift our spirits. In fact, we are having to work very hard not to fall for the temptation of regular comfort eating that we know is not good for our hearts.
I believe we are not the only ones struggling in this regard, so I decided to share a couple of ways that families can choose to be intentional about protecting their hearts during this time.
1. Choose to shop for heart healthy foods.
Grocery shopping has become a challenge but we all have to find ways to make it happen, and while at it, why not make it count. Whenever you get an opportunity to shop, choose heart healthy options. Now that we are at home, we need more snacks and the last time I was at Sam’s I considered buying chips which would make a really easy snack for my kids but I decided against it. Fortunately, I was still able to get fruit so I stocked up on apples and oranges instead. I considered buying some dried fruit, unsalted or lightly salted nuts, skinny popcorn and other healthy options available in the grocery stores. My daughter also found some healthy recipes for smoothies and I bought the ingredients. The point is to make a conscious choice not to make too many unhealthy alternatives available at home. If you are one of those buying eggs, hopefully you are choosing to prepare healthy recipes instead of sugar-loaded desserts for each day you are at home.
2. Work with your children to discover and prepare heart-healthy recipes.
One of the things our family has had to work hard at, is to find activities that will occupy our kids and minimize the time they spend on technology, with no more gym to go to. We have tried several things including pulling weeds from the backyard and it was amazing that we got better attitudes after pulling weeds than after a couple of hours of Nintendo Switch. However, the best part has been involving them with cooking. We made our first carb–free pizzas and each of them assembled theirs as they desired and were really happy with what they made. The process used up quite a bit of time, kept us on our feet and it was fun for the whole family. If getting your kids to eat healthy has been a struggle, this is the time to involve them in finding healthy recipes and let the family work together to prepare them. You might be surprised with what they come up with, like I was when my daughter asked for ingredients to make a smoothie that had okra as one of its ingredients. If you are not sure where to start, we have a couple of posts on our blog that you can read to get ideas, including, How to use my plate and Eating for your taste buds or your body? And there are other website with healthy recipes like, https://www.hsph.harvard.edu/nutritionsource/recipes-2/home-cooking/
Please stay connected with us on Facebook, Twitter, Instagram and Pinterest and share your ideas on how you are maintaining a heart-healthy lifestyle during the quarantine.
Finally, this unique time is very difficult for many. Let’s look for opportunities to be grateful in the midst of this trying time and look for opportunities to creatively help others while honoring the mandated quarantine and praying that this COVID-19 will be eliminated from our world sooner than later.
We have talked about a couple of people who have been affected by heart complications in the recent past. These ladies in their 40s and early 50s were getting on with their normal lives. One died of a sudden heart attack and one is alive because the constant discomfort she felt caused her to search for answers, which resulted in medical intervention that saved her life. It is important to note that a heart attack can happen to even younger people. For example, statistics reported in an article published last year (September 2019) indicated a rise in heart attacks in people in their 40s, 30s and even 20s. One factor that can be a lifesaver is knowing the symptoms of a heart attack and these can be different for men and women.
Squeezing chest pressure or pain Jaw, neck or back pain Nausea or vomiting Shortness of breath
Chest pain, but not always Pain or pressure in the lower chest or upper abdomen Jaw, neck or upper back pain Nausea or vomiting Shortness of breath Fainting Indigestion Extreme fatigue
A heart attack happens when blood flow that supplies the heart with oxygen and nutrients is cut off, leading to death of the heart muscle. Usually the underlying culprit is atherosclerosis, a process by which plaque deposits in arteries causing them to narrow or causing a complete blockage as a result of plaque presence. This process of atherosclerosis takes place slowly, usually starting in childhood and showing no symptoms until a heart attack occurs. Granted, there are factors beyond one’s control that increase one’s chance of getting a heart attack, which include age, gender and heredity. Fortunately, there are several factors that we can control. These include, cholesterol, blood pressure, diabetes, stress, exercise, diet and avoiding smocking or exposure to tobacco smoke.
American Heart Association advises that it is beneficial for a person to understand their risks for heart attack and then embark on heart attack prevention – this prevention should start early in life. We wrote Atherosclerosis Attack to provide a fun way for middle schoolers to learn about this important topic. The atherosclerosis story is told through the eyes of children and seeks to help other children understand why they need to start at a young age to work towards lowering their risk of a heart attack.
This book is also beneficial to the parents and care takers who want to help their loved young ones be proactive about preventing a heart attack. The reasons behind the need to start at a young age are presented in a story that children can identify with and would provide them with a clearer understanding of why they need to make certain dietary and lifestyle choices. To assist with learning about and executing healthy living, the book provides some great resources in the last chapter to help engage schools, students and parents. In addition to those resources, here we provide a few more tips and links to keep the family in an active role regarding prevention of chronic diseases.
Getting kids interested in healthy living: Using Pinterest, YouTube and other social media platforms, it is easy for parents to design an experiment that kids can do to actively engage in the science of healthy living.
How much sugar is in what you eat and drink? A food label lists the amount of sugar in a substance, but often 22 g or 12 g is not visualized well with kids or adults. Hence in this visual experiment, kids can measure the amount of sugar into baggies and see firsthand the amount of sugar in their favorite soda, juice or fruit.
Nimali Fernando, MD: In response to the growing rates of childhood obesity, pediatrician Nimali Fernando MD, MPH started the website https://doctoryum.org/ in 2011 to teach her patients and their families about the benefits of healthy eating. What started out as a recipe and parenting site, grew to a bigger project of teaching a healthy lifestyle to the greater community. You can check her website for webinars, recipes and other fun items that emphasize cooking as a whole family affair.
PBS Website: This website contains creative games that enable young kids to engage in healthy living and learn about the human body. It offers exciting games, printables, recipes and videos. And best of all, it is free! The following links will show you examples of what you can find on the PBS website. https://pbskids.org/games/healthy-habits/ and https://pbskids.org/lunchlab/
CDC Website: This website contains a downloadable book with fun coloring pages, games and stickers that demonstrate healthy eating and regular activity. https://www.cdc.gov/family/kidheroes/index.htm
If you don’t already have a copy of Atherosclerosis Attack for your children or those in your care, we encourage you to get one from Amazon or Barnes and Nobles and explore how you can help your children learn to be become a force against the unwelcome intruder of their bodies.
One question I have heard several times in the last few weeks is, “Athero…….., how do you say that word?” That question has often come after someone says congratulations on getting your book published. Atherosclerosis Attack is a book we published to help middle school students learn about atherosclerosis through a story that they can identify with. Of course, we have received feedback that the book communicates the message about atherosclerosis well and would benefit readers of all ages.
When we decided to write this book, we knew that atherosclerosis is a big word, a difficult word, not an everyday word, a word that seems like it should belong on the spelling bee list. However, whether we know how to say this word or not, it is affected by decisions we make every day regarding how we take care of our bodies. Atherosclerosis happens when plaque builds up in your arteries, the blood vessels that carry oxygen-rich blood. This leads to narrowing of the blood vessels and restricting the flow of blood to other parts of your body. Also, if a piece of the plaque breaks off, it gets carried by the blood, and gets stuck, completely blocking off blood supply leading to serious complications like a heart attack, stroke, or other conditions depending on which artery is blocked.
Even so, why is it important to bother children with a big word like atherosclerosis? The answer is, atherosclerosis is a disease that doesn’t develop overnight but over a life time. In fact, according to American heart association, atherosclerosis may start in childhood and progress rapidly for some people in their 30’s even though it usually doesn’t become dangerous until they are in their 50’s or 60’s. The danger is that atherosclerosis develops silently; for instance, someone may not have any symptoms until they have a heart attack. But atherosclerosis is preventable because it is very much affected by diet and exercise.
So hopefully you understand why we would like to make atherosclerosis a common word even for children. In reality, atherosclerosis is an everyday word whether we can pronounce it or not. This is because it is affected by the choices we make daily about what we put into our bodies, one meal at a time, and whether we choose a physically active lifestyle or not. Kate and I want to make this word part of children’s vocabulary because the best remedy against atherosclerosis is prevention – developing a preventative lifestyle. We believe it is possible to get children excited about knowing this big word, and having that knowledge can affect their diet and exercise choices. Children have a great imagination and a tremendous ability to learn, and we seek to give them reasons to learn and care about the big word, atherosclerosis.
My husband asked our son how he got into the spelling bee and his response was, “well, I was able to spell most of the words the teacher gave us, including the bonus word, cholesterol.” He was quite excited about being able to spell the word cholesterol that had become a part of his vocabulary because we often talk about it at home. The reasons other children might be interested in learning a big word like atherosclerosis might be different. But why not give children an opportunity to learn a word that prefers to remain a silent part of their daily lives even with the dangers it poses, dangers which need to be exposed for the long-term well-being of the children. If you don’t already have a copy of Atherosclerosis Attack for your children or those in your care, we encourage you to get one from Amazon or Barnes and Nobles and explore how you can help your children learn to be become a force against the unwelcome intruder of their bodies.
Now, to help with the pronunciation, click on the following volume emoji 🔊. It should take you to the Merriam Webster dictionary and once there, click on the volume emoji to listen to the pronunciation of atherosclerosis \ ath·ero·scle·ro·sis \ a-thə-ˌrō-sklə-ˈrō-səs
Cate and Kate 