The legacy of “conventional wisdom” that advocates avoiding introducing peanuts to babies and children–even up to ages 1 through 3– continues to this day, despite the fact that the American Academy of Pediatrics (AAP) has retracted previous endorsements of this practice due to lack of scientific evidence.  Indeed, evidence is trickling out to the contrary, suggesting that perhaps delaying introduction of peanuts beyond year one may unwittingly *increase* the risk of childhood peanut allergy.  More evidence is needed to clarify the relationship between timing of peanut introduction with risk of peanut allergy for certain, though.

And yet, among those families who choose to introduce peanuts in early childhood, the sticky issue (no pun intended) of how to do so technically remains.  Peanut butter is often considered a choking hazard for young children (though a supremely thin layer spread on an appropriate delivery mechanism can be safe for many babies in their final few month stretch toward turning one).  And peanuts themselves–whole or chopped–are also a choking hazard.

The buzz on the NYC mommy listservs is that pediatricians-in-the-know have a workaround for these issues that’s appropriate for babies ready for finger foods (~8-10 months, roughly): they’re recommending Bamba.

Bamba is a beloved Israeli snack food that’s essentially a puffed corn doodle lightly coated in peanutty powder (rather than, say, cheese powder as in a Cheez Doodle.)  Similar to ‘toddler puffs’ snacks marketed by a variety of companies, Bamba easily melts in the mouth, making it a safer delivery system for peanut protein than thick, sticky peanut butter itself.

And although it comes in a brightly-colored, crinkly bag, Bamba is surprisingly benign, nutritionally speaking.   It’s very low in sugar, relatively low in sodium (5% of the daily value) and is vitamin and iron-fortified, though I’d stop short of calling it a “healthy” food, per se.  Each 1 ounce serving has 160 calories, 4g of protein and 1g of sugar; it also has 4.5 mg of iron (25% of the daily value for adults, but 64% of the recommended intake for children aged 1-3 years and 45% of the recommended intake for kids aged 4-8).  The product is also Vitamin C fortified, which should help with the iron absorption.

Bamba is vegan, making it appropriate for kids/families who avoid dairy.  And Bamba is also gluten-free, in case any of you Celiac parents accidentally lick your fingers after serving Bamba to your little ones.

While some people are quick to point out that the incidence of peanut allergy in Israel is significantly lower than it is in the US– experts rightfully point out that the unscientific observation that Israeli babies and kids coincidentally also eat lots of  Bamba cannot be mistaken for proof that early introduction of peanut protein causes lower allergy risk.

Still, if you and your pediatrician agree that there’s no medical reason to delay peanut introduction in your young child but are concerned that your little one can’t handle the texture of peanut butter yet, Bamba may be a good solution for you.  I think we’ll probably try it out in our house as soon as Max & Stella master the pincer grasp in another month or so, though I view it as a stopgap measure until they’re ready for real peanut butter rather than a staple snack for the long haul.

Unless you live in a community with a large Israeli population, your best bet to finding Bamba would be to order it online.  Amazon sells large-sized bags of it by the case (go in with a few other families in your area; no one family needs 84 ounces of snack food laying around in the pantry just for the sake of introducing junior to peanut protein!)

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No topic has inspired more conflicting advice and controversy–not even vaccination, mind you– among relatives, healthcare practitioners, “expert” authors and well-meaning strangers than the question of when and what to introduce beyond breastmilk. 

Here is a sampling of the advice I’ve encountered, paraphrased: 

• ‘For exclusively breastfed babies, wait until 6 months to start solids’ (-Pediatrician)
• ‘Start now. They’ll start sleeping through the night once you start them on (rice) cereal because they won’t wake up hungry’ (-Babysitter)
• ‘When you kids were little, the doctors told us to start feeding applesauce and pears as early as 2-3 months, and you turned out fine.’ (-Mom)
• ‘Skip rice cereal altogether.  The poor quality of today’s grains can contribute to food allergies.  The first food should be a ‘superfood’ like winter squash.’ (-Occupational therapist)
• ‘White rice cereal, a refined grain, should not be a baby’s first food.  Start with an unpackaged food, like a banana or an avocado.’  (-Dr. Alan Greene)
• ‘Breastfed babies may benefit from pureed meat as a first food for the iron and zinc content’ (-Expert baby feeding book author/registered dietitian)
• ‘Risk of developing celiac disease was lower among high-risk infants exposed to gluten between 5-7 months of age versus earlier or later than that window’ (-Recent research)

A Dietitian’s Take on Starting Solids, and Some Nutrition Myths Busted

As a relatively self-confident RD by day and a relatively neurotic new mom by night, here’s what I make of it all: 

• Let’s start with the official position of the American Academy of Pediatrics (AAP), which is that ideally, infants should be breastfed exclusively for the first 6 months (26 weeks) of life.   My guys are 22 weeks and currently exclusively breastfed.  We will probably start solids some time between now and 26 weeks, at a point when the stars all align as follows: (1) babies both well-rested; (2) neither baby acutely teething and miserable; (3) husband home with a camera to document it all.  You can see why I’ve given us a 4 week window for this perfect constellation of conditions to occur.

• Further research published in the AAP’s journal, Pediatrics, supports the recommendation that for all babies–formula-fed or breastfed– complementary foods (solids) should not be introduced before 4 months of age, period.   Studies have linked the early introduction of solids to certain health conditions later in life, namely an increased risk of childhood obesity (particularly among formula-fed infants), and a possible increased risk of food allergy.

• Next, there’s a lot of opinion on the topic of first foods and very little hard evidence to back it up.  Cultural food traditions vary widely, and I’m guessing the majority of the world’s infants aren’t starting with iron-fortified rice cereal.  There is no evidence basis for a “right” first food, assuming that what you choose is of an appropriate texture and fed when baby is developmentally ready.  Don’t let anyone tell you otherwise.  The right first food for your baby will vary based on a variety of factors, including whether s/he is breast or formula-fed, what foods your family typically eats, and what is convenient/available to you.  Remember: for the first few months of solids, your baby’s primary source of nutrition–including both calories and protein– will remain breastmilk or formula.  First foods are just as much (if not more) about getting baby acclimated to the mouthfeel of solids, the practice of swallowing textures and introduction to a variety of flavors as they are about delivering a substantial portion of nutrition.  So there’s really no need to overthink the first food decision.  Just pick one and go for it!
  

  Iron-fortified rice cereal is a popular--but by no means the only-- first food

• Furthermore, unless your child actually has a diagnosed food allergy, there is virtually no evidence to support the commonly held practice of delaying introduction of certain ‘allergenic’ foods until 12 months or later for the purpose of food allergy prevention, even though many pediatricians–and some dietitian/authors of infant feeding books– still advise it.   This includes wheat and eggwhites.  Moreover, this appears to be true even for infants at high risk for food allergy based on family history.   Emerging evidence suggests–but is far from conclusive– that such food avoidance practices may actually contribute to an increased risk of food allergy.

• The exception to this rule is that liquid cow’s milk as a beverage should be delayed until 12 months, though this is more about preventing iron deficiency than it is about avoiding dairy allergy; in fact, there’s no reason dairy foods such as yogurt can’t be introduced as an early/first food if desired so long as the texture is thin enough.   The objection isn’t to milk protein itself per se, but rather the fact that drinking cow’s milk –which has virtually no iron–would displace relatively iron-rich breastmilk or formula in baby’s diet and can lead to iron deficiency and anemia.   Furthermore, cow’s milk is high in calcium, which can interfere with iron absorption from other foods.  Lastly, in younger infants, drinking cow’s milk has been linked to increased risk of small bleeds in the small intestine, and the subsequent loss of iron-rich blood can further contribute to iron deficiency.  For all these reasons, it makes sense to avoid giving babies younger than 12 months milk to drink. A common myth I see perpetuated in many online parenting forums, however, is that cow’s milk need to be completely avoided in mixed dishes as well until 12 months of age.  In fact, older infants under age 12 months may start to share family meals that include mixed dishes which contain some milk as an ingredient; this should be perfectly fine and there’s no reason to avoid such foods.

My Solids Introduction Strategy

So taking all of this into account, here’s what I plan to do for my little people.  As you can see, it’s a strategy tailored to their unique needs, and may differ from what makes sense for other peoples’ kids.  If you’re still perplexed, talk to a registered dietitian about what makes sense for the little people in your life. 

• We’ll probably start with either iron-fortified organic brown rice cereal (a leftover box from our friend, the “Everything Borrowed Baby“) or ripe, mashed avocado as a first first food, since both are very convenient.  Organic butternut squash will probably be the second veggie they get, since it’s super nutritious, easy to buy frozen and pre-cut to facilitate quick cooking/pureeing, and will blend into the color of our living room rug when it inevitably winds up all over the floor.

• Because my kids are at increased risk for Type I Diabetes and Celiac Disease due to their family history (read: my stellar genes), my goal is to get some gluten into the babies at around the 6 month mark (which is why I plan to start on cereals first): we’ll advance from rice cereal to barley cereal, and I’ll aim to get some wheat cereal into them before 7 months of age.  My goal is to also continue to breastfeed them during the introduction of gluten and wheat to help further reduce their risk of developing these autoimmune diseases.

• We’ll aim for some iron-and-zinc rich foods relatively early on in the process, since babies’ needs start to outpace breastmilk’s content of these important nutrients sometime around the 6 month mark.  (Because formula is fortified with these nutrients, formula-fed babies have more latitude with timing when it comes to introducing foods with these nutrients.)  I’m thinking some pureed, ground organic lamb will be the first protein food we introduce, since red meat is high in bioavailable iron (and zinc), lamb is relatively easy to digest, and my husband will delight in the opportunity to make merguez with the leftovers.
  

  Pureed salmon and avocado: haute cuisine for babies

• The next protein foods we’ll probably go for will be Wild Alaskan Salmon and either Pasture-raised or DHA-enhanced eggs, due to their high omega-3 fatty acid contents.  While there’s no reason to only feed babies the egg yolk rather than the whole egg (as some experts advise), the fact is that the yolks contain the majority of vitamins and omega-3 fats whereas the whites have a higher relative amount of protein.  Therefore, if you wanted to maximize the amount of these necessary nutrients baby gets given their relatively small tolerance for volume, feeding them yolks-only could be a reasonable practice if you wished to do so.  (Once again, they get most of their protein at this stage from formula or breastmilk.)  Note that many premium infant formulas are enhanced with DHA, which means some formula-fed babies are already getting a steady stream of these essential fatty acids.  Omega-3 content of breastmilk, however, will depend to some extent on the mother’s diet.

Beyond this, it’s anyone’s guess where we’ll go.  There will surely be some mashed banana in the mix, and likely a good number of summer fruits and veggies that find their way into our kitchen in these coming months.  Plain greek yogurt with fruit will almost certainly enter into the fray, as will hummus and canned, refried beans–since they’re easy, nutritious and a regular part of our family’s diet. 

 A Quick Note of Caution: Canned Foods

If feeding baby canned foods, choose BPA-free brands

Speaking of refried beans, if you plan to feed them–or any other canned food–to baby, I recommend buying brands that do not use Bisphenol-A (BPA) in their can liners.  Recent research has shown that over 90% of canned foods sampled contained BPA, with the highest levels found in certain brands of  green beans and peas–common baby-friendly foods.   Currently, national brands that do not use BPA in their can liners include Eden Foods (beans), Native Forest (veggies and fruits) and Muir Glen (tomatoes).  If you plan to make your own baby food from canned ingredients and can’t access these brands, it’s best to use fresh or frozen fruits and veggies instead.

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Alex's Drunken Veggies with Noodles

Even the most righteous eaters have a few guilty pleasures, and one of mine is rice noodles.  While I like the linguine-esque thinner ‘rice sticks’ sold dry just fine, my real passion is the wide, flat kind sold fresh and known as “Chow Fun” in Chinese restaurant menu parlance (fun, indeed!) or used in Thai stir-fry dishes like Pad See Ew.

Why so guilty, you may ask?  After all, rice noodles are a standby in the diets of many Asian cultures, and for gluten-free eaters they make eating out at Asian restaurants (particularly Thai and Vietnamese) a much easier affair.

Indeed, fresh, boiled rice noodles have a lower glycemic index (~40, which is considered “low”) than dried boiled rice noodles (~61, which is considered “intermediate”), according to the International Glycemic Index database hosted by the University of Sydney.  Surprised?  Yes, I was too!  As the keepers of the database explain, despite their high starch content, many pastas and noodles are low-to-intermediate on the glycemic scale due to the fact that some starch granules get tangled up in a web of protein and remain “ungelatinized” when the pasta dough is boiled.  Since ungelatinized starch is very difficult for our digestive enzymes to break down into usable sugar (glucose), high-carb foods with significant amounts of ungelatinized starch may actually have a more modest effect on blood sugars than an equivalent portion of other high-carb foods, like, say, plain old white rice (GI=72-89, depending on the variety).

The only catch, then, is portion size.  While they may not be a high-GI food, rice noodles are almost pure carbohydrate, and when they form the basis of a meal, portions can add up to lots of calories quite quickly.  (That’s the guilty part.)

Cooking with Dry Rice Noodles

A recent feature on rice noodles by Martha Rose Schulman in the New York Times “Recipes for Health” column highlighted a week’s worth of rice noodle-based dishes.  Her recipes for Rice noodles with Zucchini, Tomatoes and Fresh Mint and Rice Sticks with Walnut and Basil Pesto and Green Beans are both particularly tempting as we head into spring and summer.

Another favorite dish of mine is David Lebovitz’s Cold Noodles with Peanut Sauce; hands-down, it’s the best peanut sauce I’ve ever tasted.  Use rice noodles (fat or thin) instead of the wheat-based noodles he calls for, and substitute wheat-free Tamari sauce for the soy sauce.  I use Lite Coconut Milk instead of the peanut oil or regular coconut milk  he calls for to keep the calories in check.  Don’t be intimidated by the long ingredient list; it all just gets tossed into a blender for the peanut sauce.  To make it vegetarian, substitute baked tofu cubes for the chicken.  This recipe is *bound* to be hit with kids as well as adults… it’s terribly delicious.

Cooking with Fresh Rice Noodles

Oh… but if you can get your hands on fresh rice noodles, do it.  We recently discovered that the small Vietnamese grocery** in our neighborhood gets deliveries of fresh, wide rice noodles on the weekends.   We started swinging by the place on weekend mornings while the babies napped in their strollers, and before we knew it, a new Saturday night tradition of Alex’s Drunken Vegetables with Noodles was born.  (Drunken because they’re so darn spicy and cause you to drink a lot of water, not because two overtired teetotalers like us are actually consuming any alcohol with them.)

We started with a basic Drunken Noodle recipe from Sripraphai, the best Thai restaurant in New York, and then started riffing on it until it morphed into a gluten-free Drunken Vegetables with Noodles recipe.  In fact, we loaded it up with so many veggies that we now cook the dish in a huge stockpot to accommodate the sheer volume.  Feel free to take significant liberties with the veggies: swapping in and out as you please, adding others that appeal to you.  Leave out the chicken if you want to keep it vegetarian, or use tofu instead.

Thai basil and chilis

Recipe: Alex’s Drunken Vegetables with Noodles (gluten-free)

Serves 6 generously

• 1 lb fresh flat rice noodles (or 1 lb cooked rice noodles as per package instructions)
• 1/4 cup vegetable oil (preferably peanut or canola)

• VEGGIES: your favorite combination of at least three–and ideally all – of the following vegetables:
• 1 red pepper, thinly sliced
• Florets from one full head of broccoli, cut thinly for quicker sauteing
• 3/4 lb green beans, ends trimmed (use a kitchen scissor to speed the process) and cut into 1-2 inch segments
• 1 lb spinach, chopped
• 1/2 lb fresh shiitake mushroom caps, thinly sliced
• 2-3 cups fresh mung bean sprouts

• 12 garlic cloves, chopped
• 1/4 cup chopped fresh Thai chiles, seeded

• 1 lb ground chicken OR chicken breast, sliced thinly into 1-inch pieces (optional; substitute tofu if you wish)
• 1/4 cup fish sauce (nam pla or nuoc nam)
• 2 TBSP molasses
• 1/2 cup wheat-free Tamari (preferably reduced-sodium)

• 3 large eggs, scrambled, fried, and set aside
• 1 14-oz can diced tomatoes
• 1/2 cup fresh Thai basil leaves or regular basil leaves, chopped

Directions:

1. Heat 2 TBSP oil in heavy large pot over medium-high heat.
2. When oil is heated, add the longest-cooking veggies (will depend on what you’re using… if following recipe above, start with green beans, broccoli, mushrooms and red pepper) and cook, stir frying frequently, until veggies soften but are still firm.
3. Add shorter-cooking veggies to the pot (sprouts, spinach) and continue stirring until well-mixed and the new veggies start to wilt.
4. Set vegetables aside. Cover with a towel to keep warm.
5. Add remaining 2 TBSP oil to the pot.
6. Add garlic and Thai chiles; sauté 30 seconds.
7. Add chicken (or tofu), fish sauce, Tamari and molasses, and sauté until cooked through, about 4 minutes.
8. Add noodles, tomatoes, half the basil, and eggs, and toss to coat.  Continue stirring until mixture is well-heated throughout.
9. Add back the vegetables to the pot and stir to combine.
10. Transfer to large platter, sprinkle with basil leaves, and serve.  (If need be, dig down to the bottom of the pot to spoon up some of the sauce for serving).

**It’s Nha Trang market on Newark Avenue in Jersey City, in case you’re passing through my ‘hood.  Dare to do as I do and ignore the ripe smell of the place and the fact that these moist, starchy noodles are not stored under refrigeration.  While this would appear to be a food safety hazard, since we’ve never gotten sick from eating them, I’m assuming that in heating the noodles, any unsavory freeloaders are killed in the process.  Besides, we erroneously tried refrigerating the fresh noodles once, and when we tried to use them, they were a solid block of crumbly messiness.  (Thankfully, were able to salvage them by microwaving, but it taught us a lesson: buy fresh noodles on the same day you plan to use them!)

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In case you missed the dedicated section of greeting cards commemorating this occasion in your local Hallmark store, March 9 is the (albeit self-proclaimed by the American Dietetic Association) day where we come together as a nation to recognize the important role that RDs play in helping maintain the collective health of our population.  It’s not too late to send me an Edible Arrangement!

To mark the day, I’ve decided to offer you all a glimpse into my clinical practice by sharing some common pitfalls my clients encounter when they come to me and say they “can’t” lose weight.  I see these themes over and over again, and when my clients focus on addressing them, the weight invariably starts to come down.  I figured there was no harm in offering these valuable tips up for free, since your insurance companies refuse to reimburse me for them anyway.

Three Reasons Why You’re Not Losing Weight

• Alcohol has calories! While virtually everyone knows this intellectually, even the most obsessive calorie-counting females tend to conveniently exclude their booze when keeping mental tallies of their daily caloric intake.  A rule of thumb is that one standard sized drink contains about 100 calories, assuming it has no caloric mixers like juice or tonic water (yes; tonic water has about as many calories as a regular soda.  You can ask for diet tonic water if that’s your mixer of choice).  What’s more is that most bar and restaurant servings of wine in particular are far more generous than a typical serving size, which is a very modest 5 oz.  So if you drink one glass of wine per night on average, but the serving is closer to 8oz than 5 oz, you’re really drinking the equivalent of 11 servings of wine per week.  That’s 1,100 calories–or close to an extra day of eating per week–for a woman trying to lose weight on a 1,200 calorie per day diet.  My advice?  Measure out what 5oz of wine looks like in a typical wine glass to calibrate your idea of a 100-calorie serving, and set a weekly alcohol budget of 1/2 the number of (appropriately-sized) drinks you’re currently drinking.  When my clients who drink regularly do this, they start losing weight immediately.

• Your low-carb mornings are sabotaging you.  I have patients who are frustrated that, after a morning and afternoon of righteous eating, their “incurable” sweet tooth rears its ugly head at around 3-4pm daily and undermines their efforts.  I have other patients who are ready to enter therapy because they think they have Binge Eating Disorder, driving them to crave–and binge on– sugar, pasta and pizza in the late afternoons and evenings, despite an otherwise healthy diet.  What do these patients have in common? After I take a diet history, I see that they’re eating almost no carbohydrates for breakfast and lunch; which, if you start counting after dinner the previous night (9pm?), means many of them go as long as 18 hours without consuming more than a trace amount of carbohydrate.  Let’s review: carbohydrates are your body’s main form of usable energy, and assuming you eat enough of them in a day, you can store about a 12 hour supply of them to fuel your body’s activities for a short period of time.  But once that supply runs out, if you don’t eat some carbs, you blood sugar will dip low enough to cause some pretty powerful cravings.  Precisely the type of cravings that can cause you to gorge yourself on the office candy jar or stand in front of the fridge shoveling spoonfuls of leftover rice from last night’s Chinese take-out.  It’s not that you have a sweet tooth, and it’s not that you have an eating disorder.  You’re just hungry.  So if this sounds like you, and your first half of the day looks like an eggwhite omelet with veggies and an 80-calorie Dannon Light-and-Fit yogurt for breakfast, followed by a salad for lunch (no bread), I might suggest adding some complex carbohydrates into the mix in the first half of the day (think whole wheat toast with that omelet, a piece of fruit with that yogurt, and a cup of lentil soup with lunch) and saving the low-carb dieting for dinnertime only. 

• You’re not eating enough fruits and vegetables.  No one likes dieting and being told to cut out their favorite foods.  So one approach I use–for myself included– is to set my goals around foods I want to *add* into my daily diet.   If I told you you could continue to eat what you wanted so long as you also ate 2 fruits and at least 2.5 cups of veggies per day, chances are you’d lose weight.  Why?  Because all that darn fiber and water from the fruits and veggies fills you up and tends to naturally displace more calorie-dense foods from the diet.  Clients who live alone often tell me they avoid buying fruits and vegetables because they spoil before you get the chance to eat them.  To me, this is the beauty of it!  If you’re even half as frugal as I am, the thought of wasting money on uneaten food kills you.  Those fruits and veggies are ticking time bombs that must be eaten *today* before they go bad, whereas the processed snacks in your cupboard can wait a few more months and be no worse for the wear.  The choice makes itself.  Keep enough fruits and veggies on hand and before you know it, the constant pressure to eat them in time will force a healthy dietary change without your ever having to officially banish other, more calore-dense foods.  Keep your home and workspace well-stocked with easy-to-eat choices like grape tomatoes, baby carrots, sliced bell peppers, sugar snap peas, apples, bananas, grapes, clementines, pears, cantaloupes (cut in half, scrape out seeds and eat straight from the rind with a spoon), peaches, plums apricots, cherries and berries.  After all, you can’t eat them if you don’t buy them!  Along these lines, I am very skeptical of any diet that seeks to limit your fruit or vegetable intake due to their carbohydrate content–with the notable exception of watching fruit intake when you have diabetes.  Let’s be honest: no one ever got fat from eating too many carrots.

Hungry for more?

These are three common themes, but there are plenty of other pitfalls people encounter on the road to weight loss.  Any registered dietitian who’s worth her salt can look through your daily eating habits to help uncover what might be coming between you and your inner skinny.  So what better time than RD Day to make an appointment with your favorite neighborhood RD (and for you New Yorkers, that would be me!) to start addressing your nutrition and health goals for 2011?

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Still, a trial elimination diet certainly won’t kill me, and if less gas for the kiddies buys me more sleep at night, I’m all for it.  And so all of a sudden, I’ve become the most annoying eater I know.  I don’t even want to have lunch with me, and can’t imagine anyone else would want to, either.  (Luckily, we don’t get out of the house much so I don’t have to subject others to me at mealtime.)

Of course, every food cloud has a potentially silver lining, and my latest restrictions have forced me to try out some different foods to replace some of the former staples of my diet.  And so, I share with you some of the nutritious food swaps I’ve made, all of which I think are actually tasty enough in their own rights to earn a place in any diet that wants for some healthy variety.

Swap #1:  Sunbutter for Peanut Butter

Made from ground Sunflower seeds instead of peanuts, Sunbutter resembles peanut butter visually, texture-wise and nutritionally, with an almost identical number of calories and protein and slightly more fiber.  While I wouldn’t say it tastes exactly like peanut butter (though if you add a touch more salt, it does get a smidgen closer), if you shmear it on an apple, a rice cake or some gluten-free toast with jam, you most certainly get the peanut butter effect.  (Particularly if you cram food down your gullet as fast as I do these days and don’t bother mulling over flavors for too long.)  If you’re nut-free but CAN eat dairy, you’re in luck!  A product called Sun Cups, which I sampled at the Fancy Food Show this past June, is a sunflower-butter version of the chocolate/peanut butter cup, and delivers a *very* respectable nut-free interpretation of the classic.

Swap #2: Hemp Milk for (Lactose-free) Lowfat milk

For those lactose-free or dairy-free souls who can’t tolerate soy either, rice milk and almond milk tend to be the most popular substitutes.  While I have nothing against either of these products– so long as they are calcium-enriched and unsweetened– why not kill two birds with one stone and get some omega-3′s in while you’re at it? (In case you’ve forgotten why omega-3 fats are so important for good health, check out my previous post on flaxseeds for a quickie reminder).  The end-products of omega-3 fat metabolism, DHA and EPA, are especially important for breastfeeding moms, by the way, as they are critical components of brain and eye development for the wee ones.

Hemp seeds naturally contain omega-3 fatty acids, so depending on how they are processed to make hemp milk (and hemp milk based products), the end products can also contain a reasonable amount of these essential nutrients as well.  According to the leading manufacturer of hemp milk, Living Harvest, their product contains about 50% of the recommended intake of omega-3′s--which should amount to about 800 milligrams, though the exact content is not listed on the nutrition label.

While it’s true that plant-based omega-3′s are less potent than fish oil because they contain the precursors to EPA and DHA which must then be converted in our bodies (as opposed to fish oil which contains the end products EPA and DHA directly), I contend that when it comes to omega-3′s, every little bit counts.  As it happens, research seems to suggest that the RATIO of (pro-inflammatory) omega-6 fats to (anti-inflammatory) omega-3 fats in our diets may actually be more important than the amounts themselves.  The ideal ratio is reported to be about 4:1.  The actual ratio in a typical Western diet is reportedly closer to 20:1.  Which leads me to think that getting your omega-3′s from a variety of sources–including hemp seeds, flaxseeds, walnuts, fish (or fish oil supplements), canola oil and dark leafy greens– is a great way to skew the ratio more in your favor.

Another factor in hemp milk’s favor is that it’s among the lowest-carb milk substitutes around.  Unsweetened hemp milk contains just 1g of carbohydrate total (great for diabetics and eco-Atkins dieters!), and even the sweetened vanilla version can have an almost identical carb content as regular cow’s milk (13g, compared to 12g in cow’s milk, per cup), though this will certainly vary by brand.  Would I personally drink unsweetened hemp milk straight?  No.  But it works great in breakfast cereal, smoothies or in various recipes that call for milk.

Swap #3: Nutritional Yeast for grated or shredded cheese

I’ve been a fan of nutritional yeast as a popcorn topping for a long time now, as it’s a nutritious and low-calorie substitute for Parmesan cheese that gives a strikingly similar salty-nutty-cheesy flavor.  But now that actual cheese is off-limits for me, I’ve been much more heavy-handed with the nutritional yeast, using it as a topping for everything from pasta with red sauce to tortilla soup.

The deal with nutritional yeast is that it’s a common strain of yeast (the same one used to brew beer and bake bread) that’s grown on molasses and contains all of the essential amino acids (protein building blocks).  Most brands are also fortified with a variety of B-vitamins, including a hefty dose of Vitamin B-12, and marketed as a dietary supplement for vegetarians.  (There are no naturally vegetarian sources of B-12, and only a select few vegetarian complete sources protein that contain all of the essential amino acids). It’s worth mentioning that nutritional yeast is inactive.  Or stated more simply: it’s dead.

I mention this because yeast tends to elicit misconceptions among some eaters, who think that yeast-containing foods contribute to “yeast overgrowth” in the body, often manifested as a vaginal yeast infection.  Not so.  If anything, eating too much sugar–which feeds the live yeast that live naturally in the gut–or taking antibiotics, which kill the friendly bacteria which keep yeast in check, are more likely to fuel yeast overgrowth than eating inactive yeast such as that found in bread, beer or nutritional yeast flakes.  After all, inactive yeast cannot magically activate itself and colonize your digestive tract after passing through your acidic stomach.  And even if it could, yeast can’t travel from your gut to your ladyparts without hitching a ride in your bloodstream; and if it did so, you’d have way bigger problems than a yeast infection: you’d have sepsis.

However, if you have a yeast allergy, which is pretty uncommon and should be diagnosed by a credentialed physician, a yeast-free diet would then be appropriate and beneficial.

Look for nutritional yeast at health food stores, in vitamin stores, or in the dietary supplement section of a progressive grocer like Whole Foods.

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What Probiotics Are… and Aren’t

Probiotics are strains of live, “friendly” bacteria that, when eaten, colonize your intestines and provide some sort of health benefit.  The difference between a probiotic and any ol’ friendly bacteria is that to be called a probiotic, the particular species and strain of that bacteria has to have proven health benefits in humans.   A few species of bacteria have been studied as probiotics most extensively (e.g. Lactobacilli and Bifidobacteria), but since there are so many different strains of these bacteria species, unless a particular strain has been studied and shown to demonstrate a specific benefit, you can’t assume it will have the same benefit as another strain in the same species.

If the idea of eating bacteria to colonize your intestines weirds you out, get over it.  Your gut is already home to billions of these bacteria–collectively called your “gut flora” (sounds so pretty, no?).  In fact, the majority of your poop is made up of these dead flora, so you encounter them more often than you probably even realized.  The makeup of your particular gut flora is unique to you, and is influenced by a variety of factors including how you were delivered at birth, your diet, your environment, use of various medication, and who you’ve been kissing.  Both helpful and harmful bacteria live in your gut, but when everything is in balance, the good ones keep the bad ones in check and prevent them from replicating too fast.  Trouble happens when enough good guys get killed off (say, by antiobiotics) or you’re exposed to an infectious strain of bacteria that the harmful ones get out of control.

Scientists are only just now starting to discover all of the roles for your gut flora in maintaining good health.  We’ve known for years that they play a role in helping digestion (breaking down fiber and some starches), manufacturing some vitamins, helping to prevent yeast infections, and producing substances called Short Chain Fatty Acids (SFCAs) that help you absorb minerals like calcium and iron.  But new research is also emerging to suggest that a diverse gut microflora may also play a role in preventing food allergies or obesity (!).  Since our Western diets are pretty processed and unvaried  and our urban lifestyles are pretty sanitized, it won’t surprise you to learn that people living in industrialized countries have also been obseved to have a lot less variation in the gut flora than, say, people in developing countries.

Where the Probiotics Are

As the definition above suggests, only a live bacteria species and strain that has been demonstrated to have beneficial health effects in people can actually be called a “probiotic.”  Of course, this doesn’t necessarily mean that you can’t benefit from the live, active bacteria found in traditional fermented or cultured foods like:

• cultured dairy products such as yogurt or kefir
• fermented drinks like Kombucha tea
• fermented foods like miso, sauerkraut and kimchi
• (gluten-free) fermented Indian breads like Dosas or Iddli

It just means that the people who make those foods didn’t have the time or money to invest in a costly clinical trial to prove the “probiotic” benefits of the bacteria strains present in their particular products. In fact, Dannon was sued for false advertising as a result of marketing that implied its Activia yogurt somehow conferred a health benefit over and above that of any plain ol’ yogurt brand.  (The company has since changed its marketing and settled the lawsuit in 2008 without admitting wrongdoing.)  In other words, all yogurts that contain live Lactobacillus species or Bifidobacteria species as their cultures may be beneficial, assuming they contain the same dose of bacteria.  So if general digestive benefits like regular bowel movements are what you’re after, don’t let marketers trick you into thinking that their expensive products are necessarily better for you.

Having said that, some companies (particularly manufacturers of probiotic supplements, like VSL #3) do make the effort to test specific bacterial strains so that they can make specific claims about what conditions their probiotics will benefit.  If you have a specific

Don't be fooled: Expensive (and sugary!) "probiotic" yogurts don't appear to be more beneficial than plain ol' yogurt

health concern beyond just improving your overall regularity or counteracting the impact of a recent course of antiobiotics, seeking out these types of products may be worth the time and money for you.  For example, VSL #3 (which must be refrigerated, so ask for it at the pharmacy counter of your drugstore) contains a combination of 8 specific strains of lactobacillus bacteria that have demonstrated clinical benefits in patients with Ulcerative Colitis, Irritable Bowel Syndrome and prevention of “pouchitis” (inflammation of an ileal pouch in people who have had intestinal resection surgeries.)  Be aware, however, that they company claims it contains trace amounts of gluten if that’s a concern for you.  The strain of bacteria used in Align appears to have a small amount of scientific data behind it supporting its benefit in reducing the symptoms of Irritable Bowel Syndrome.  Other products, including supplements like Culturelle (Culturelle for Kids is gluten-free) or probiotic beverages like GoodBelly (note to celiacs: only the powdered drink, GoodBelly ToGo, is 100% gluten-free), can only make more general claims about “improving digestive health” based on the available scientific evidence, but if an ocassional bout of diarrhea is an issue for you, particularly if it results from recent use of antiobiotics or an infectious agent, these types of products may help do the trick just fine.

Probiotic supplements are considered safe for most people, though if you are immunocomprimised due to a disease or medical treatment (e.g., radiation or chemo), you are advised to confer with a doctor before initiating a probiotic supplment regimen.

Additionally, people who must follow low-tyramine diets due to a potential interaction with a medication they take (e.g., MAO Inhibitors) should avoid fermented foods in particular.

As far as other foods go, be very wary of dry, shelf-stable foods like cereals (e.g., Kashi Vive, recently discontinued) or granola bars that claim to contain probiotics.  Since probiotics are living bacteria, they need the same things that other living bacteria need to stay alive: namely, water, and a specific temperature range.  It is highly unlikely that enough of the probiotic bacteria contained in a breakfast cereal will have survived their long, hot, dry journey from the factory to distribution warehouse to storage room to supermarket shelf alive enough to do your intestines any good.

Scouting Out Live-Culture Foods

• Hit the dairy aisle: Yogurt and kefir are among the easist, most portable sources of live, beneficial bacteria available.  There are plenty of dairy free options available as well; cultured soy or coconut milk yogurts are widely available, for example.
• Have a cultured smoothie: Use cultured low-fat Buttermilk instead of regular milk in your favorite fruit smoothie recipe (essentially, this is what a “Lassi” is at Indian restaurants)
• Go Asian: Munch on kimchi (a spicy Korean condiment), miso soup (Japanese) or seek out other traditional Asian fermented soy foods like Natto or Tempeh (note: the latter, widely sold under the brand name Lightlife, is not gluten-free).
• Make Your Own: My fermenting friends-in-the-know swear by Sandor Katz’s (a.ka. “Sandorkraut”) book, Wild Fermentation, for recipes and inspiration.  (Click here for a list of recipes featured in his book to get an idea for what types of foods it features.)  One such friend, Vered M., shared her recipe for Radish Kimchi elsewhere on the web.
• Invite some Microscopic Friends to your Lunch: Have some sauerkraut on your sandwich, or look for products by a small Pennsylvania-based company called Zukay, which sells condiments such as relishes and salad dressings that contain live cultures.

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