Questions and Answers with Marlo Mittler, RD

Marlo Mittler, RD, of Woodbury, NY, specializes in pediatrics, adolescent and family nutrition. In this article, she answers questions about trans fats, diabetes, diet drinks, healthy snacks and more.

There has been a lot of news about trans fats recently and I've noticed that many food companies are using the term "No Trans Fats" on their labels. What does that mean?

You're right. There has been a lot of news about "trans fats" and many food companies, and now restaurants, are adding the "No Trans Fat" claim to their roster. In fact, many states, including New York, are starting to make it mandatory for restaurants to no longer use products which contain trans fats. So what are trans fats? Trans fats are artificially created through a chemical process of the hydrogenation of oils and are very unhealthy for you since they not only increase your bad cholesterol but also take away your protective good cholesterol. Be prepared to see a lot of new products, and even some of your old favorites, with this new claim. Whether dining out or at the grocery store, it is important for your heart health to choose items with this important label.

What are the types of diabetes?

Diabetes is an illness that is often  misunderstood since there  are various types. Type 1 diabetes, which was known as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, accounts for 5% to 10% of all diagnosed cases. In Type 1 a person no longer produces insulin and therefore needs to take injections or go on an insulin pump.  Dietary changes are then needed to provide a calculated balance of carbohydrates into the body.  At present there is no cure for Type 1, making it a lifelong illness. Type 2 diabetes, which was known as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, may account for about 90% to 95% of all diagnosed cases of diabetes. In Type 2 the amount of insulin produced by the body is compromised, requiring medication to be taken to make up the difference.  Diet is also manipulated to help the blood sugars to stabilize.  If left untreated some people with Type 2 can wind up with Type 1.  In some cases where diet, medication and weight is controlled, Type 2 can be reversed.  Gestational diabetes is a type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 5% of all pregnancies but usually disappears when a pregnancy is over. Other specific types of diabetes that  are caused by  specific genetic syndromes, surgery, drugs, malnutrition, infections or  other illnesses may account for 1% to 2% of all diagnosed cases of diabetes    It is important to note that with proper treatment, people with diabetes can lead happy and healthy lives.

I was just recently diagnosed with Celiac Sprue so I need to eat gluten free products. Is True Lemon gluten free? Also what is the best option for incorporating whole grains?  I worry I don't get enough fiber, although I have increased my consumption of fruits and vegetables.

When you are diagnosed with Celiac Sprue there are certain dietary changes you need to make to help decrease any symptoms or complications of this illness.  This diet change means you need to avoid gluten from your diet.
This requires that you exclude the following from your diet: wheat, oats, rye and barley. (In nutrition school they used the acronym WORB to help you to remember.)  These foods don't get completely broken down when you have Celiac, and may further flatten your villi in your intestines, which is important to your overall immune system.  The other thing you need to become familiar with on food labels are the hidden gluten that can be noted with the words modified food starch or preservatives.

Fortunately, there are many other grains that a person with Celiac can still include in their diet such as those from: potatoes, corn, millet, soy, buckwheat, and quinoa. There are many products on the market that are labeled "gluten-free" just for a person with Celiac.  Many grocery stores contain aisles devoted to these products and of course the health food stores contain a large array to choose from. There are gluten free pastas, breads, desserts and much more. 
The good thing is when it comes to protein, vegetables and fruits there are no real limitations. As long as you opt for fresh or plain varieties there would be no gluten in any of these.  The gluten would only be a result on one of these if used in a recipe, such as in sauce or in baked goods. Always read labels for prepared foods.

To make sure you take in enough fiber is often tricky with Celiac; however, you can do it by adding plenty of leafy green vegetables, berries of any kind, artichoke hearts, cherries and beans.  All of these are very high in fiber and will help you to meet your fiber needs.

As far as True Lemon, there is no gluten in our product, so you can continue to enjoy it. In fact, taking in enough water is always beneficial to staying healthy.
So living with Celiac requires some diet changes, that once you are familiar with (remember WORB) it will become second nature.  You will feel better and your body will be healthier on the inside.

My two boys (11 and 13) are very active in sports throughout  the day, but my oldest is small for his age at about 82 lbs. My husband insists that protein is the answer to get him to grow  (taller) and wants them to eat every two hours and has the boys drink an awful  tasting protein drink every day.  I think their bodies know what they need  and should eat when they're hungry.  Is my husband correct in his  method?  I hate seeing them choke food down when they're not really hungry. What would be a good diet for active boys in the pre-teen years?

In fact, your husband has part of it right , extra protein is important in helping the body to grow.  However, I must point out that first the protein shake is not appropriate and second there are other factors to consider.

As for protein, it is one of the essential building blocks for growth.  Your boys need to work on taking in between two and three servings of protein everyday.  Acceptable sources include such foods as: turkey, chicken, eggs, cheese, nuts, peanut butter, meat, fish and beans. Be sure to educate them on ways to include this in their diet.  Perhaps they have a turkey sandwich as lunch, trail mix as an afternoon snack and chicken for dinner.  On another day they might opt for eggs in the morning, tuna fish for lunch, and chili for dinner.  Regardless, we need to increase protein.  As for the protein shake, the problem is many of those contain a very dense amount of protein at one time.  In order to breakdown the protein one's kidneys have to work extra hard.  For growing bodies this can put the kidneys at risk for kidney stones. So at the young age of 10 to 15 it is not recommended to use any supplements such as a protein bar or shake.

Overall, growth is also influenced by calcium, fat, calories, carbohydrates and hydration as well.  I would encourage frequent meals, along with regular snacks; two glasses of milk a day minimally, balanced meals with proteins and carbohydrates and calories to match their active lifestyle.  Be sure your boys are eating every three hours or so to increase hunger and allow for maximum growth.  Don't be afraid to offer mini-meals at snack times, especially around sporting events, to replenish muscle and energy stores.  This might include a peanut butter sandwich or bowl of cereal and milk as a snack instead of chips or cookies. That will feed a body much better.

I wanted to know why there is so much in the news about trans fats? What are they any way?

Luckily we have learned a great deal about how harmful trans fats are in our bodies and that the FDA is taking a step in further educating the public. Trans fats are a type of fat that increases our bad cholesterol and also lowers the good cholesterol that actually helps protect out heart. It was found in many snack foods, until recently when many have taken it out of their products. Within the next two years it will be required by law to be mentioned on products labels so you can opt to avoid them. Many products have already stepped up to declare "No trans fats".

My kids are not into sports, what can I do to get them to be more active?

It is so important to get your kids moving. We know that everyone, even those who are thin, need to spend at least 30 minutes 3-5 days a week doing physical activity to reduce their risks for heart disease. Why not try to have your whole family find an activity to do together such as ride bikes, play Frisbee, jump rope or go for a hike. Even having your kids try doing push-ups and sit-ups at night for fun is a great way to start. Get down and do this with them to make it even more meaningful. You would be surprised how much more motivated they are once you are committed to it also.

Is it true that diet drinks make you hungrier?

In fact, it is the truth. Diet sodas and drinks have been shown to increase hunger by sending a signal that you have taken in sweets with no calories. This causes your body to then crave food to fill those calorie needs. In addition, when you use artificial sweeteners you then raise your taste buds for what you think is sweet. Another words, you start out with one packet of sweetener and eventually need more for it to taste sweet enough. Bottom line is try to stay away from diet drinks and stick to water!

How much fiber do you need in a healthy diet?

Fiber is one thing we all should be sure to work in our diets! Fiber helps to prevent colon cancer, diabetes, obesity, heart disease and many other medical conditions. Believe it or not we have the highest rates of colon cancer and obesity in the world, and the lowest amounts of fiber in our diet! Yikes! Time to fiber up! It is recommended that an adult take in 25 grams of fiber a day, while for kids a good rule of thumb is their age plus 5. For example, your ten year old should aim for 15 grams.

My kids swear they don't like carrots or many other vegetables for that matter. Is it worth fighting with them about it? Will they ever like it?

When it comes to eating healthy I believe it is always worth fighting for, except don't fight. What I mean is explain to your kids that it takes 10 exposures in 12 days to develop a new taste bud. So the deal is you need to try a food over and over to help the taste bud to develop. You can change how you cook it, serve it with sauces or dips, but you must not wait weeks and weeks to try it again. It is also important to know that if is very difficult to develop a new taste bud after age 16 so starting early helps a lot. After 15 of course we can rationalize to eat something because it is good for us. So go ahead and serve up those veggies!

My four year old has always been a great eater at dinner time. Most recently she has been claiming she is not so hungry and is not eating as much as she had been. Should I be concerned?

No need to worry if this is only happening at dinner time. For many children as they are growing their body clocks offer shift, changing both sleep and eating patterns. Take a look at your child's daily intake. Maybe you will notice they are eating a bigger lunch or are very hungry an hour before you usually serve dinner. Perhaps it might be more effective to give a larger healthier afternoon snack when they have a bigger appetite. For others it is best to give dinner earlier if possible. Your child can still participate at dinner time by having a smaller portion or if they have already eaten dinner you can give yogurt, fruit or a small healthy snack.

I try to make time each day to exercise, however I feel that days go by and I can't seem to fit it in. Do you have any suggestions? Any good ideas on getting fit even with a busy schedule?

It is very common for people to feel overwhelmed when trying to start a new exercise routine. We often look for the perfect time, and we all know there often is never a perfect time. First, take a minute and map out your week on paper. Look for any window of 30 minutes to do some form of physical activity: walking with a colleague at lunch hour, use the treadmill in the am, take a dance class with a friend, or even peddle away on the stationary bike while watching t.v. with you kids. You might want to buy a pedometer that measures steps. Each day when you wear it take a look at the average steps you take and set a goal to increase by 400 steps each week. Using this tool might inspire you to increase your exercise just to reach those numbers. And on the days when you are running errands or busy in the office, you might get to your goals with no real effort at all.

My son refuses to drink milk of any kind. I am not sure he is getting enough calcium. He is otherwise healthy and very active. Do you have any suggestions?

Calcium is one part of your child's diet you don't want to ignore. This mineral plays an important role on growth, bones, and teeth and in the prevention of osteoporosis during adult years. The recommended daily intake for kids is: 500 mg (about 1 cups of milk) for toddlers 1-3 years old , 800 mg (about 3 cups of milk) for those 4-8 and 1300 mg (about 4 cups of milk) for those 9-18 years old. Fortunately for your child milk is not the only source of calcium. Other sources of calcium include: yogurt, cheese, soy or rice milk, broccoli, white beans and instant oatmeal. There are also several calcium fortified foods on the market including orange juice and certain cereals. So despite your child's dislike for milk, there are many other ways to be sure their calcium needs are met.

Can you give me some ideas on some healthy snacks for my kids after school. As soon as they run in the house they head straight for the pantry. Any ideas on what might be a good choice to serve?

When you have the opportunity to feed "hungry" kids I say that is the perfect time for a nutritious choice not for junk! The truth is the foods that help to feed hunger and leave you satisfied are protein foods and grains packed with fiber. Why not try for a combination of both. Try some of these the next time the kids come running in: whole wheat toast and peanut butter, cheese and crackers, yogurt and a whole grain cereal, turkey sandwich, 2 hard boiled eggs, hummus and pita, or a fruit smoothie made with milk. Yum!

 

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