Lunchbox tips

Planning ahead and packing a tasty and nutritious lunchbox can avoid reliance on the energy-dense, nutrient-poor options that often make up a quick meal on the move.
A nutritious lunch will help children and adults maintain energy levels and concentration through the afternoon.

Make your own lunch
If lunch is dictated by what's available - whether a sandwich bar, petrol station, corner shop or fast-food outlet - then choosing to make your own meal provides a nutritious and healthy alternative, and saves money.

Lunchboxes don't need to contain just a soggy sandwich and a packet of crisps. Ensuring the meal contains fruit and/or vegetables, a good helping of starchy carbohydrates and some dairy products will result in a nutritionally balanced lunch.

Healthy options
Avoid boredom setting in with some alternatives to sandwiches.

Try soup - a flask of warm vegetable soup can provide a portion of your five-a-day and boost fibre intake. Homemade versions can be tailored to personal taste, but shop-bought ones are fine, too (check the label to avoid those with a high salt content).
Rice, noodles, lentils, couscous, bulghur wheat and pasta can form the basis of salads, accompanied by chopped vegetables, fruit, seeds and nuts to boost vitamin and mineral intake. You can also add protein such as chicken, tuna, prawns and soya.
Leftovers from your meal the night before, such as homemade pizza, omelette or quiche, can all be eaten cold the next day, accompanied by a green salad.
Use different varieties of bread throughout the week, such as wholemeal, granary, oat-topped, seed-based, ciabatta, rye, bagels, wraps, pitta, baguettes and rolls. Choose wholemeal varieties for maximum nutrients (such as fibre, B vitamins, vitamin E and magnesium).


Accompaniments
Fill out your lunchbox with the following:

Fruit – include fruit such as apples, grapes, plums and berries. Chopped fruit, fruit salad or dried fruit such as apricots, raisins and dates can be easily handled and eaten by children. A fruit smoothie is also a healthy option.
Vegetables - chopped vegetables such as carrot, celery and cucumber can be included with dips such as hummus to provide a nutritious snack. Cherry tomatoes, sliced peppers, baby corn and sugar snap peas are great for adding colour and are easy for young children to eat.
Desserts - fruit can be added to low-sugar jelly, or mixed in with natural yoghurt for a tasty dessert. Yoghurt drinks or small pots of custard or rice pudding can top up calcium intake and provide an alternative to more sugary or fatty options. If you like cakes and biscuits, try varieties such as hot-cross buns, scones and malt loaf. Include your favourite cake once in a while, but keep the portion small.
Variety is key to keeping lunchboxes appetising and appealing. Sandwich fillings can be packed with salad to add colour and nutrients, and accompanied by low-fat nutritious options such as lean meat, fish, egg and low-fat cheese.
Adding a treat every now and then is fine - try fun-size chocolate bars, snack-sized packets of biscuits and sweets to keep portions small and the calorie, fat and sugar content low.
Drinks - use tap water, or mix it with low-sugar squash or some fruit juice to add flavour. Unsweetened fruit juice and smoothies count towards one of your five a day, but avoid too many sugary drinks which can add lots of extra calories. Milk-based drinks, without added sugar, are a healthier option for teeth than sugary alternatives.

Eating out - choosing healthier options

More and more of us are eating out on a regular basis, whether it's for a business lunch, a girls' get together, or for a family meal.
The 2006 Family Food Survey found that households where the head of the household was under 30 years old were spending more than 40 per cent of their food budget on eating out.

Eating out usually means that we have little control over how the food is prepared or how large the portion is. Foods eaten out tend to be higher in fat and research has shown that those who eat out regularly generally have higher intakes of fat, salt and calories. Studies have also shown that eating with friends can tempt us to overeat. Meals with multiple courses eaten over longer periods and with alcohol are all associated with overindulgence. Large serving bowls and spoons increase the likelihood of piling more food on your plate than you usually eat.

Unlike packaged food, foods bought from cafes, restaurants etc don't have to carry nutritional information and so opting for the healthiest option might not always be obvious, or easy. However, with some knowledge and thought, eating out can be enjoyable and healthy!

General tips
If you're unsure as to what something is, or what it contains - ask! If the waiter/waitress doesn't know, then the chef will.
Think ahead, if you know you're eating out later and it could be a lavish affair, choose wisely earlier in the day to keep calories, fat, sugar and salt intakes under control.
Don't eat an extra course just to be polite.
Only order a sweet after the main course, and only if still hungry. Opt for sorbets, or fruit dishes to balance out a heavy main course.
Think about sharing a course with a companion if the portions look large.
Speak up about how you'd like a dish prepared eg ask for no mayonnaise, dressing on the side.
You're more likely to overeat at an 'all you can eat' style buffet.
Choose side orders of salad or vegetables to fill up on.
Cut off any visible fat from meat to keep saturated fat intake down.
Look out for smaller portions ie a main meal option as a starter size.
Opt for dishes which are grilled, baked, steamed, poached or cooked in own juice rather than fried.
Check the menu for dressings on salads and ask for it to be served separately. An otherwise healthy and nutritious salad could be drowned in a high fat sauce, bumping up its calorie content.
Avoid cheese, cream or butter-based sauces
If you're a cheese lover, think about sharing the cheese board option to keep saturated fat, salt and calorie intakes in check.

Takeaways
A takeaway provides a convenient night off from cooking, but they can be a poor choice for health-conscious consumers. Portion sizes can often be large, so think about sharing to keep the amount of food to a sensible limit.

Chinese
Choose side orders of salad or vegetables to fill up on.
Often high in salt and can be oozing in fat, avoid dishes described as deep-fried or battered.
Opt for stir-fried chicken or vegetables to keep fat content as low as possible.
Choose plain boiled rice rather than fried rice.
Avoid the prawn crackers and crispy seaweed dishes - both moreish and loaded in calories.


Indian
Often high in fat, especially those with creamy sauces such as korma and masala.
Avoid those pre-meal poppadums and chapattis - both high in fat. Bhajis and naan breads are also surprisingly high in calories.
The best dishes to limit fat and calorie intakes are oven-cooked tandoori and tikka dishes. Madras, jalfrezi, balti or dupiaza are also all right.


Italian
Go for the thin crust pizzas rather than the deep-pan or 'filled crust' options.
Ask for small amounts of cheese or opt for the reduced fat versions some outlets now offer.
Keep the meat-based pizza toppings like pepperoni and salami to a minimum and go mad with vegetable and fish-based options instead.
Pasta dishes served with a tomato or vegetable-based sauce are much better than creamy or cheese-based varieties.
Forego the garlic bread or focaccia and try either plain bread or a mixed salad to accompany your meal instead.
Choose fruit or plain ice cream rather than fancy desserts.


Fish, chips, burgers and kebabs
Portion sizes are often huge, so think about sharing a portion of chips between two.
Eat the fish and leave the batter.
Avoid small fried items such as scampi or chicken nuggets as they contain more fat than a single larger item.
Forget the super-size deals, a small, plain burger is fine! Ask for salad and forego the mayo.
Try shish kebab instead of the fat-laden doner.


Sandwiches
Look out for different bread types to add variety and taste.
Go for protein-based fillers such as ham, lean meat, fish, low fat cheeses like cottage cheese and Edam.
Avoid mayonnaise and other high-fat dressings. Try chutneys and pickles instead.
Look out for vegetable-based or salad-packed varieties to fill out the sandwich and keep calories low.
Look carefully at pre-packed versions. Some are very high in calories - opt for those less than 400kcal per pack.


Special occasions
Occasions like Christmas, parties, weddings and so on can often be difficult times for those trying to eat healthily and watch their weight. Thinking ahead and preparing for such times can help. In addition to the tips for eating out, the following may also help:

At buffets, don't stand near the food table - the temptation to keep grabbing a handful or plateful of something nearby can be overpowering. Talk to friends in another part of the room.
Just because food is offered doesn't mean it has to be eaten. Feel free to pass.
Avoid pastry-based foods such as mince pies, canapés, tarts, sausage rolls etc.
Aim to fill at least half your plate with healthier options, and add some colour to your plate. Naturally colourful fruits and vegetables like crudités are not only low in calories but contain vitamins and antioxidants which are beneficial to your health.
Try not to arrive at the event hungry. Have a light meal or healthy snack prior to getting there to prevent overindulgence.
Mix alcoholic drinks with low-calorie soft drinks and water. Not only does alcohol contain calories, but the more that is consumed, the more likely that good intentions go out of the window!
At functions like weddings and christenings, choose the cake course as a dessert instead of having dessert and the cake.

Caffeinated drinks
Many popular drinks contain the stimulant caffeine. It has a bad reputation, but what effects does it really have and does it bring any health benefits?
Effects of caffeine
Caffeine acts as a stimulant to the heart and central nervous system, and is also known to increase blood pressure in the short term, although there's no conclusive evidence of long-term effects on blood pressure.

The effects on blood pressure are most likely when caffeine is taken in excessive quantities or by people who are highly sensitive to it. People who are hypertensive (have habitual high blood pressure) are advised to avoid caffeinated drinks, and pregnant women should limit their intake of caffeine to less than 300mg a day.

Food Caffeine content
Coffee (mg/cup)
Instant 61 to 70
Percolated ground 97 to 125
Tea (mg/cup) 15 to 75
Cocoa (mg/cup) 10 to 17
Chocolate bar 60 to 70
Cola drinks (mg/12oz can)
43 to 65


Caffeine and weight loss
Caffeine has been shown to have very modest effects on increasing metabolism, and is sometimes added as an ingredient to weight loss pills. These pills often make claims about speeding metabolism to 'effortlessly melt' excess fat, but in reality the amount of calories that slimming pills containing caffeine would actually burn is very small.

Caffeine may also suppress appetite, but without making other changes to your diet and lifestyle caffeine is unlikely to make a significant difference to your weight.

Coffee
Coffee has been linked with a number of the risk factors for coronary heart disease, including increased blood pressure and raised blood cholesterol levels. But no relationship has been found between drinking coffee and the likelihood of developing coronary heart disease.

Coffee may be beneficial in some areas of health - for example, research has found it may reduce the risk of developing gallstones and kidney stones.

It's difficult to suggest a safe limit for coffee intake because of the huge variation in caffeine content across different brands and an individual's sensitivity to the drug. People with high blood pressure and pregnant women are advised to limit their caffeine consumption.

For the rest of the population, there's no evidence coffee does any long-term harm. Caffeine does have a very mild diuretic effect but, drunk in moderation, you don’t need to increase fluid intake to any significant degree as the loss of fluid is very minimal.

Tea
Tea contains some useful minerals such as zinc, manganese and potassium, and scientists are researching its potential to reduce the risk of coronary heart disease and some cancers.

Tea contains antioxidant substances called flavonoids, which have been shown to help slow or inhibit the chemical reactions thought to take place during the development of coronary heart disease.

Green tea
There's also a lot of interest in the health benefits of green tea, particularly in relation to cardiovascular health. Again, this is due to flavonoids, which are powerful antioxidants found in high concentrations in both green and black teas. The concentration of these compounds depends on how long the tea has been brewed, but can range from 125mg to 140mg.

Some studies have compared the concentration of these antioxidant compounds to that found in fruit and vegetables. Flavonoids bring potential benefits to heart health, as well as possible reductions in the risk of Alzheimer’s disease and other neurodegenerative conditions.

Caffeine and iron absorption
Both tea and coffee contain polyphenols that can bind to iron, making it difficult for our bodies to absorb. Avoiding tea and coffee during and around mealtimes is important for people at risk of iron deficiency.

Milk and dairy products
The foods in this group are important sources of protein, vitamins and minerals, and are particularly rich in calcium, which is essential for healthy bones and teeth.
What foods are in this category?
This food group includes milk and milk products - cheese, yoghurt and fromage frais - but not butter, margarine or cream. They belong in the fat and sugar group of the Food Standards Agency's 'eatwell plate'.

Varieties of milk
Supermarkets now stock many different varieties of milk. The most common in the UK is still cow's milk, but others include sheep and goat's milk, as well as a number of plant-based substitutes - including soya, rice, oat and almond milk - for those with lactose intolerance.

Milk in the UK (generally cow's milk) is distinguishable by its fat content.

Whole or full-fat milk contains about 3.5 per cent fat
Semi-skimmed contains about 1.7 per cent fat
Skimmed milk contains 0.1 to 0.3 per cent fat


Even whole milk is relatively low in fat and certainly semi-skimmed milk can be labelled as a low-fat food. Contrary to popular belief, lowering the fat content in milk does not affect the calcium content, so an adequate calcium intake can still be obtained from lower-fat dairy products. However, low fat milk contains less energy and lower amounts of fat soluble vitamins and isn't suitable for children under two years.

Some supermarkets have now started selling milk with a 1 per cent fat content which has almost half the fat of semi-skimmed milk but retains a more creamy flavour. This is a good option for those people who want to lower the amount of fat they're consuming but don’t like the taste of skimmed milk.

Milk products
Cheese contains the same beneficial nutrients as milk, but most cheeses contain much more saturated fat and high levels of added salt, so it's important to only eat full-fat cheese occasionally and in small portions.

Yoghurt is rich in protein and vitamin B2: essentially the same nutrients as in milk. Some varieties contain living bacteria that are healthy for your digestive system (probiotics). Yoghurt can be made from whole or low fat milk, but be careful. Fruit yoghurts often contain added sugar. Low fat doesn't necessarily mean low calories. If you're watching your weight, look for 'diet' versions, or make your own by mixing fruit with natural, low fat, unsweetened yoghurt. Check out the labels of packs for details.

The importance of calcium
Calcium is a mineral that helps build strong bones and teeth, regulates muscle contraction (including the heartbeat) and makes sure the blood is clotting normally. Milk and dairy products have long been held as an important source of calcium, although more recently the role and safety of dairy calcium sources have been questioned by some scientists and more research is needed to draw a firm conclusion.

Other sources of calcium include:

Fish (for example sardines)
Dried fruit
Sesame seeds
Almonds
Soya
Dark green leafy vegetables


More importantly, research also suggests that calcium in your diet is less important in developing healthy bones than vitamin D (from your daily diet or from the sun's effect on the skin). Similarly, sufficient exercise is now seen as another vital factor in maintaining healthy bone structure and density - concerns have been voiced that a lack of excercise in growing children will have a detrimental effect on their bones.

Calcium can continue strengthening your bones until the age of 20 to 25 when peak bone mass is reached. After this point, your bones can only maintain or lose their density and grow weaker as a natural part of the ageing process. Inadequate dietary calcium intake before this age can increase the risk of brittle bone disease and osteoporosis, as calcium is drawn from the bones as a reserve.

Each year in the UK, over £1.7 billion is spent on treating osteoporosis. Health professionals estimate that one in two women and one in five men over the age of 50 in the UK will break a bone, mainly because of osteoporosis. Women are more affected as they have less bone mass than men, and may lose it faster as they get older, especially after the menopause when falling oestrogen levels result in the loss of the protective effect of oestrogen on bone density.

Why children need calcium
Calcium is an essential nutrient for all children to help grow strong bones and reduce the risk of developing osteoporosis when they're older. But many children and teenagers don't receive their recommended daily intake. Encouraging children and adolescents to drink more milk, rather than other drinks, can provide not only calcium, but also important proteins, carbohydrates and micronutrients.

Daily recommendations for calcium intake in children:

Age (years) Calcium requirement (mg/day)
0 to 12 months 525
1 to 3 years 350
4 to 6 years 450
7 to 10 years 550
Male Female
11 to 14 years 1,000 800
15 to 18 years 1,000 800
19+ years 700 700


Calcium for vegans and the lactose intolerant
If your diet excludes milk and dairy products, or if you can't tolerate milk sugar lactose, then you need to look for calcium alternatives. Other dietary sources of the mineral include:

calcium-enriched soya milks, yoghurts and cheeses
dark green leafy vegetables, such as spinach, broccoli and watercress
almonds or sesame seeds – try as a topping on salads, cereals or desserts
dried fruits - apricots, dates and figs all contain small amounts of calcium
(for non vegans) fish such as sardines and anchovies, especially the bones


Three-a-day
As dairy products are such a rich source of calcium, three portions of dairy products each day should be sufficient to meet your body's calcium needs. Try to choose low or reduced fat versions to avoid too much unhealthy saturated fat.

The following are examples of individual servings:

200ml milk (whether it is whole or full-fat, semi-skimmed or skimmed)
250ml calcium-fortified soya milk
40g hard cheese (such as cheddar, brie, feta, mozzarella or stilton)
125g soft cheese (such as cottage cheese or fromage frais)
1 small pot of low-fat plain or fruit yoghurt (150g)
Fruit smoothie made with 200

Meat, fish, eggs and alternative sources of protein
It's vital our diets contain protein, either from animal or plant sources.
Foods containing protein
Meat, poultry, fish, shellfish and eggs
Pulses, nuts and seeds
Soya products and vegetable protein foods


Why is protein important?
From hair to fingernails, protein is a major functional and structural component of all our cells. Protein provides the body with roughly 10 to 15 per cent of its dietary energy, and is needed for growth and repair.

Proteins are large molecules made up of long chains of amino acid subunits. Some of these amino acids are nutritionally essential as they cannot be made or stored within the body and so must come from foods in our daily diet.

Although all animal and plant cells contain some protein, the amount and quality of this protein can vary widely.

Animal protein
Protein from animal sources contains the full range of essential amino acids needed from an adult's diet. But red meat, in particular, should be eaten in limited amounts due to the high level of saturated fat it contains, which may raise blood levels of 'unhealthy' LDL cholesterol.

A high intake of saturated fat can lead to an increased risk of cardiovascular disease and other related disorders. As an alternative source of animal protein, choose poultry, fish and shellfish.

The 2007 World Cancer Research Fund report recommended meat eaters limit their consumption of red meat to no more than 500g a week, with very little processed meat, as these have both been linked to certain forms of cancer.

Fish is a good source of animal protein. Oil-rich fish such as salmon, mackerel, herring, tuna, trout and sardines are all rich in omega-3 fatty acids, which help to reduce the risk of developing cardiovascular disease.

Shellfish is also a good source of protein and is low in fat.

Aim to eat a couple of portions of fish every week, with at least one portion being an oily fish.

Advice for vegans and vegetarians
Vegetarians rely on plant sources for their daily protein. Plants don’t contain the full range of essential amino acids and so are not as high in nutritional value as animal protein. But by eating a well-balanced diet that contains a variety of different foods, it's possible to consume the required amino acids, regardless of the time of day they’re eaten or in what combinations within a meal.

Foods such as nuts, seeds, beans, pulses, vegetable protein foods and soya products all contain protein. There are also small amounts in grains and dairy products. Due to this variety of protein-rich foods available in the UK, protein deficiency is rare.

How much is enough?
Health professionals suggest men should eat 55.5g protein a day and women 45g. In practical terms, eating a moderate amount of protein - in one or two meals every day – should give you all the protein you need. Most people in the UK eat far more protein than they actually need.

Serving size
You should eat two to three servings of protein every day from both plant and animal sources. Here are some examples of one serving (about the size of a standard pack of playing cards):

100g boneless meat (eg lean beef, lamb or pork)
100g boneless poultry (eg chicken or turkey breast)
100g fish (eg salmon, sardines or tuna)
2 medium eggs
3 tablespoons of seeds (eg sunflower or pumpkin seeds)
3 tablespoons of nuts (eg almonds or walnuts)


Choosing the right protein
If you can, choose to eat low-fat protein foods as these will help to:

Keep your heart healthy
Keep cholesterol low
Minimise the risk of developing cardiovascular disease and other related disorders


Use this table to choose foods rich in protein but low in saturated fat.

Food
(100g) Protein
(g) Total fat
(g) Saturated fat
(g)
Almonds 21 55.8 4.4
Salmon 20.2 11 1.9
Beef (lean) 23 9.3 3.8
Prawns (peeled) 10.5 7.5 1.1
Pork (lean) 21.4 4.0 1.4
Eggs (1 medium) 8.1 7 2
Chicken breast (no skin) 30.1 4.5 1.3
Turkey breast (no skin) 29.9 3.2 1.0
Cod fillet 19.4 0.7 0.1
Lentils (cooked) 7.6 0.4 0


Protein and weight management
High-protein diets are sometimes popular with people wanting to lose weight, and there have been many studies looking at the effect of such diets on weight loss.

Regardless of the composition of the diet, weight loss will only occur if you expend more energy through activity than your body produces from food.

Protein-rich foods tend to make people feel fuller than foods rich in carbohydrates or fat. This can have a knock-on effect on appetite, minimising feelings of hunger, and helping to reduce overall energy intake.

Diets rich in protein at the expense of carbohydrates, for example, have been associated with slightly greater losses of weight in the short term compared with the recommended high-carbohydrate, low-fat eating plans. But after one year, studies have found there is no difference in weight loss between the two diets.

To control your weight it's important to find an eating pattern that suits your lifestyle and that you can sustain over a long period.

Bread, cereals and other starchy foods
This food group is your body's main source of energy and contains bread, pasta, rice, potatoes, noodles, chapatti, cereals and other starchy carbohydrates.
Refined and unrefined grains
The foods listed above (apart from potatoes) are all produced from grains, such as wheat, corn or rice. They should be a part of all meals, filling about a third of your plate. They can come in two forms – refined or unrefined (often known as whole grains).

Refined grains have been stripped of their outer bran coating and inner germ during the milling process, leaving only the endosperm. They include white rice, white bread and white pasta.

In a whole grain the bran, germ and endosperm are all still present. The bran is an excellent source of fibre; the germ is a source of protein, vitamins and minerals; and the endosperm supplies most of the carbohydrates, mainly in the form of starch. Unrefined or whole grain forms provide far more nutrients than their refined counterparts.

Whole grains are rich in phytochemicals and antioxidants, which help to protect against coronary heart disease, certain cancers, and diabetes. Studies have shown people who eat more whole grains tend to have a healthier heart.

Most people get their whole grain from wholemeal bread or whole grain breakfast cereals such as porridge, muesli or whole wheat cereals. Choose a whole grain variety over processed or refined grains, and look out for added sugar or salt.

Other whole grains include:

Wheat
Oats
Maize
Barley
Rye
Millet
Quinoa
Wild rice


Fibre
Dietary fibre is found in plant foods (fruit, vegetables and whole grains) and is essential for maintaining a healthy digestive system. Fibre cannot be fully digested and is often called bulk or roughage. The two types of fibre found in food are soluble and insoluble.

Soluble fibre, which can dissolve in water, is found in beans, fruit and oat products, and can help to lower blood fats and maintain blood sugar.

Insoluble fibre cannot dissolve in water, so passes directly through the digestive system. It’s found in whole grain products and vegetables and it increases the rate at which food passes through the gut.

Evidence for health benefits of fibre
High-fibre foods take longer to digest, so keep you feeling fuller for longer. The slow and steady digestion of food through the gut helps control blood sugar and assists with weight maintenance
Fibre helps in the digestive process and can help lower blood cholesterol
Fibre promotes bowel regularity and keeping the gastrointestinal tract clean to help reduce the risk of developing diverticular disease and constipation
A high-fibre diet may reduce the risk of developing diabetes and colorectal cancer


To eat more fibre, try these healthy swaps:




Refined Swap Unrefined
Frosted flakes Bran flakes
White toast Porridge oats
Cereal bar Rice cakes
French bread Wholemeal bread
Normal pasta Wholewheat pasta
Breadstick Dark rye crispbread



How much is enough?
Bread, rice, potatoes, pasta and other starchy foods should make up about one third of your diet. Try these recipes from the BBC Food website:

Banana and Oat Smoothie
Wholemeal pizza baguettes
Ham and watercress sandwich on wholemeal bread
Creamy lentils and brown rice
Using wholemeal flour in baking, as in this Irish Soda Bread or half and half as in these Carrot and Pineapple Muffins


What about GI?
The glycaemic index (GI) is a way of ranking carbohydrate foods based on how quickly they increase blood sugar levels. Low GI foods are especially helpful for people with diabetes, who need to have more control over their blood sugar levels than the general population.

Ideally foods with a low GI, such as those rich in soluble fibre like oats and legumes, should be eaten more frequently than those with a high GI. But the texture, type of cooking or processing used, and the amount and type of sugars present can all affect the GI. Since foods are often consumed as part of a meal or snack, it can be difficult to calculate the GI. Focusing on unrefined, high-fibre, whole grain cereals and minimising rapidly absorbed, refined cereals and sugary foods will all help to lower the GI of your diet

Balance of good health
The Food Standards Agency has designed the 'eatwell plate' to help people get the appropriate balance of foods and nutrients in their daily diet.
Eat a healthy, balanced diet and stay active
The key to a healthy balanced diet is not to ban or omit any foods or food groups but to balance what you eat by consuming a variety of foods from each food group in the right proportions for good health.

The five food groups on the eatwell plate are:

Fruit and vegetables
These should make up about a third of your daily diet and can be eaten as part of every meal, as well as being the first choice for a snack.

You should eat at least five portions of fruit and vegetables each day. Research suggests this can help to protect against cancer, obesity and various chronic diseases such as heart disease. This is because of the unique package of nutrients and plant compounds they contain.

Bread, rice, potatoes and pasta
This food group should also make up about a third of your diet and contains the starchy carbohydrates that are the body's main source of energy.

When selecting products from this food group, choose unrefined carbohydrates over those that have been refined, as they will contain the whole of the grain. Wholegrain foods are rich in fibre and other nutrients that have many health benefits, and people who consume wholegrains seem to have a reduced risk of certain cancers, diabetes and coronary heart disease.

The final third of the eatwell plate is made up of three groups containing foods that need to be consumed in smaller proportions than the other two principal categories. These food groups also contain nutrients essential to our diet, so it's important not to leave them out altogether.

Milk and dairy foods
These should be eaten in moderation because of their high saturated fat content, but they're an important source of calcium, which is essential for healthy bones and teeth. Choose low-fat or reduced-fat versions.

Meat, fish, eggs and beans
This food group includes both animal and plant sources of protein, which is a major functional and structural component of all cells. Protein provides the body with between 10 and 15 per cent of its dietary energy, and is needed for growth and repair.

Foods and drinks high in fat and/or sugar
This group makes up the smallest section on the eatwell plate and includes foods that should only be eaten sparingly because, although they're an important energy source, they contain very few nutrients and are often known as 'empty calories'.

Foods from this group are high in unhealthy components such as saturated fat, trans fatty acids, sugar and salt - all of which are associated with an increased risk of developing certain diseases.

They should only be eaten as occasional treats, or to increase the palatability of other important foods (such as olive oil on salads, a scraping of spread on bread, or a sprinkling of sugar on some tart fruits).

How to eat a balanced diet
Eat a variety of foods to obtain all of the essential nutrients
Too much as well as too little can be bad for you – balance is required
Everyone's plate will look slightly different as we all have different requirements depending on our body’s shape and size, and our levels of activity.

Cancer

What we choose to eat is one of the factors involved in cancer risk. It's estimated a third of cancers could be prevented by making healthier food choices, being physically active and having a healthy body weight
What is cancer?
The growth and function of all the cells in our body are carefully controlled by many processes. The term cancer is used when these control systems go wrong and our cells start to grow out of control. The process usually involves damage to the DNA in cells, which can be caused by chemicals found in cigarette smoke, radiation and even some viruses. The food we eat also affects DNA function, but the exact mechanisms are unclear.

In most cases, cancer is caused by many different factors, with several processes being involved in DNA damage in cells.

Food and the prevention of cancer
The link between diet and cancer is complicated, and scientists have not yet unravelled the exact mechanisms involved. This is because diets are made up of different foods containing many nutrients that interact in different ways in individuals.

Nutrition scientists need to study very large groups of people over many years to give us more specific answers to how and what foods increase the risk of cancer. These studies are ongoing, but the World Cancer Research Fund has examined all the existing evidence.

It has produced recommendations on food, nutrition and physical activity to help reduce the risk of cancer, based on current scientific evidence.

Achieve and maintain a healthy weight
Aim to stay in the healthy body mass index range of 18.5kg/m2 to 25kg/m2.

Excess body fat is a particular risk factor for cancer of the oesophagus, pancreas, colon, rectum, endometrium and kidney, as well as postmenopausal breast cancer.

Cut calories by reducing dietary fat and eating plenty of fruit and vegetables, and foods rich in fibre. Avoid sugary drinks and keep a check on portion sizes.

Develop regular physical activity habits
Aim for at least 30 minutes of moderate activity a day, then build up to either 60 minutes of moderate activity or 30 minutes of intense activity every day.

Activity not only helps protect against weight gain but also decreases the risk of colon cancer and possibly endometrium and postmenopausal breast cancer.

Moderate activity should raise your heart rate and breathing, but not make you completely breathless and unable to talk. Examples of moderate activity include brisk walking, gardening and dancing. Examples of intense activity include jogging and swimming.

Moderate alcohol intake
Men should not exceed two drinks a day and women no more than one. Check up on the risks of alcohol and find out about sensible drinking limits.

Over the past few years, research has shown alcohol increases the risk of cancer, especially of the breast and colon.

Limit intake of red meat and avoid processed meat
Try to eat no more than 500g (18oz) each week and have very little, if any, processed meat such as bacon and salami.

Red meat is an important source of nutrients, especially iron, but we only need to eat red meat in modest amounts, probably no more than two to three times a week.

Eat foods that mostly come from plants
This means eating more fruit, vegetables and unrefined cereal foods and pulses, as they are mostly rich in fibre, low in calories and packed with the nutrients that lower the risk of cancer.

Limit consumption of salty foods
Salt and salt-preserved foods are linked to an increased risk of stomach cancer. Avoid salty snacks and don't add salt at the dinner table or during cooking - use herbs and spices to flavour food instead.

Use supplements wisely
Following the principles of healthy eating should provide most individuals with the nutrients they need to minimise the risk of cancer. There's no good evidence to show supplements will protect the general population from cancer. Some studies have shown beneficial effects of supplements in groups of people who have a high risk of developing certain cancers, but these findings can't be applied to the general population.

Cancer patients and diet
If you've been diagnosed with cancer, it’s vital you continue to eat well during treatment, as it will help you to

cope with your treatment
withstand infections
reduce the risk of nutritional deficiencies
generally improve your quality of life


Maintaining a good dietary intake can be challenging because tumour growth can increase energy needs. Also, physical symptoms such as difficulty swallowing, sore mouth, taste changes, nausea, vomiting or diarrhoea make it difficult to eat well and maintain a good weight.

Ask to see a dietitian if you're struggling to eat well - you'll receive support and specific advice for maintaining your nutritional intake. Some of these practical solutions may also be helpful:

Try to regain any weight lost during acute treatment periods
Keep ready-meals in the freezer for when you're too tired to cook
Eat regularly - keep nutritious snacks to hand
Add an extra dash of olive oil in cooking or on salads and don’t worry too much about sugar intake
Try a glass of wine to stimulate your appetite


Alternative diets for cancer prevention and treatment
There are many so-called anti-cancer diets that claim to prevent or even cure cancer. They often recommend excluding whole groups of foods or eating only a few specific foods. These diets are not supported by robust scientific evidence and tend to be based on anecdotal reports of success, so be wary of those that:

suggest excessive food restrictions
are based on eating raw foods only
recommend single large doses of supplements


Before following any diet that claims to prevent or cure disease, consult your GP or a dietitian.

Allergy shots: Hope for long-term allergy relief
If you wonder whether allergy shots are right for you — or your child — there's plenty to consider. Here's how the shots work, when they're recommended and more.


Getting monthly allergy shots certainly isn't your idea of fun — much less your child's. But it might be a worthwhile investment in the long run. Successful treatment with allergy shots generally requires three to five years of regular injections. But, allergy shots can provide relief from symptoms that may continue after treatment is complete.

Allergy shots may offer the best relief if you have persistent allergies that don't respond to medication or if the side effects of allergy medication are intolerable. In children, allergy shots can reduce asthma symptoms and may even play a role in preventing asthma in children who have hay fever.

How do allergy shots work?
Allergy shots are a form of treatment called immunotherapy. Each shot contains a tiny amount of the substances that trigger allergic reactions (allergens). Allergy shots contain just enough allergens to stimulate your immune system — but not enough to cause a full-blown allergic reaction. Over time, your doctor will increase the dose of allergy-causing substances in each shot. This helps get your body accustomed (desensitized) to the allergens. Your immune system will build up a tolerance to the allergens, and allergy symptoms will diminish over time.

To be effective, allergy shots are given on a schedule that involves two phases:

The buildup phase generally lasts three to seven months. Typically you'll get shots one to three times a week. During the buildup phase, the allergen dose is gradually increased with each shot. This helps get your immune system more and more sensitized to the allergens that affect you.
The maintenance phase generally lasts three to five years or longer. After your dose has been increased to an effective level during the buildup phase, you'll need a maintenance dose — which contains a consistent amount of allergens — about once a month.
In some cases the buildup phase is accelerated, which requires the injection of several injections of increasing doses during each doctor visit. This can decrease the amount of time you need to reach the maintenance phase and get relief from allergy symptoms, but it also increases your risk of having an adverse reaction.

What allergies do allergy shots work for?
Allergy shots are commonly used to control symptoms triggered by:

Seasonal allergies. If you have seasonal allergic asthma or hay fever symptoms, you may be allergic to pollens released by trees, grasses or weeds.
Indoor allergens. If you have year-round symptoms, you may be sensitive to indoor allergens such as dust mites, cockroaches, mold or dander from pets such as cats or dogs.
Insect stings. Allergic reactions to insect stings can be triggered by bees, wasps, hornets or yellow jackets.
Are allergy shots recommended for everyone with allergies?
Allergy shots may be a good treatment choice if:

It's impossible to avoid the things that cause your allergic reactions — and allergy medications aren't enough to control your symptoms
Allergy medications cause intolerable side effects or interactions with other medications you need to take
You want to reduce your long-term use of allergy medication
You're allergic to insect stings
Allergy shots may not be a good choice if you have severe uncontrolled asthma, certain heart or lung problems, or if you take a beta blocker for heart problems.

If you're pregnant, starting treatment with allergy shots is usually not recommended. But if you're already getting allergy shots when you become pregnant, you can continue your treatment.

Allergy shots don't work for people with food allergies or chronic hives (urticaria).

Are any tests needed ahead of time?
Yes. Before starting allergy shots, your doctor may use a skin test to confirm that your reactions are caused by an allergy and determine which specific allergens cause your signs and symptoms. During a skin test, a small amount of the suspected allergen is scratched into your skin and the area is then observed for about 20 minutes. Swelling and redness indicate an allergy to the substance.

Your doctor may also use a blood test, such as the radioallergosorbent test (RAST) or the ImmunoCap test.
How long does it take to get relief?
Allergy symptoms won't stop overnight. They usually improve during the first year of treatment, but the most noticeable improvement often happens during the second year. By the third year, most people are desensitized to the allergens contained in the shots — and no longer have allergic reactions to those substances. Most people need allergy shots for a few years. After that, some people remain desensitized after treatment stops. Others need to continue regular allergy shots to keep symptoms from returning.

If your symptoms don't improve after one year of regular allergy shots, your doctor will evaluate the situation. Perhaps the allergen dose needs to be adjusted or additional allergens must be added to the shots. Sometimes, allergy shots may be stopped in favor of other treatments.

How long will relief last?
It varies. For some people, treatment leads to a life without allergy symptoms, especially for children and people who undergo longer periods of treatment. Other people need to continue getting shots on a long-term basis to keep allergy symptoms at bay.

Can allergy shots cause allergic reactions?
Allergy shots are generally safe. But they contain the substances that cause your allergies — so reactions are possible. These reactions could include:

Local reactions. You may notice redness, swelling or irritation at the site of the injection. These normal reactions typically clear up within four to eight hours.
Systemic reactions. These widespread reactions are less common — but potentially more serious. You may notice sneezing, nasal congestion and hives. More-severe reactions may include throat swelling, wheezing or chest tightness.
Anaphylaxis. In rare cases, allergy shots can trigger a severe allergic reaction called anaphylaxis that causes low blood pressure and trouble breathing. An anaphylactic reaction can be life-threatening. If you get weekly or monthly shots on a regular schedule without missing doses, you're less likely to have a serious reaction.
The possibility of a severe reaction is scary — but you won't be on your own. You'll be observed in the doctor's office for up to 30 minutes after each shot, when the most serious reactions are likely to occur. If you have a reaction after you leave, return to your doctor's office or go to the nearest emergency room.

Are there special considerations for children?
For children with allergies, allergy shots may prevent allergy-related asthma later in life. Allergy shots may keep kids from developing new allergies as well. Allergy shots can begin as early as age 5.

Weighing the pros and cons of allergy shots
If you wonder whether allergy shots are right for you — or your child — there's plenty to consider. Ask yourself these questions:

How severe are your symptoms? Allergy shots might be worth considering if your symptoms are severe or tough to manage. If you have seasonal allergies, the length of the season that gives you the most trouble might influence your decision.
Are you happy with your current allergy medication? Shots are uncomfortable — or even frightening, especially for kids. But shots might be appealing if your allergy medication isn't working as well as you'd like or if you're struggling with significant side effects.
Can you avoid your allergens? If the allergens that trigger your symptoms are unavoidable, allergy shots might offer an alternative to medication.
Are you prepared for long-term treatment? Allergy shots require frequent clinic visits for at least several years.
Is cost a concern? Find out whether allergy shots are covered by your health insurance plan.
Work with your doctor to better understand the pros and cons of allergy shots. Together, you can develop the best allergy management plan for you.

Color your diet: Fresh fruit 10 ways
With little effort, you can transform fresh fruit into interesting and delicious creations. Here are 10 ways to reinvent these sweet options.

Nature offers many sweet choices for eating well: juicy red cherries, plump purple plums and luscious tangerines — just to name a few. In fact, all fruits fit into a colorful and healthy diet. The Mayo Clinic Healthy Weight Pyramid suggests at least three servings a day.

You can enjoy fresh fruits as they come: whole or perhaps sliced. But with minimal work, you can transform fresh fruit into lively snacks, side dishes, desserts and meals. Here are 10 ways to reinvent and rediscover these sweet options.

Grilled fruit slices. Cut apples, pears or peaches into chunks, brush lightly with canola oil and sprinkle with cinnamon. Place on skewers or wrap in foil. Grill on low heat for 3 to 5 minutes.
Peach honey spread. In a bowl, add 1 sliced peach, 2 tablespoons honey and 1/2 teaspoon cinnamon. Mash with a fork until the mixture is the consistency of chunky applesauce. Serve as a topping for pancakes or French toast, or serve it over roast chicken or pork.
Lemon-lime fruit dip. Mix together 1/2 cup low-fat, sugar-free lemon yogurt, 1 teaspoon fresh lime juice and 1 teaspoon lime zest. Serve with pineapple chunks, strawberries, diced kiwi, sliced bananas and grapes.
Frozen fruity pops. In a blender, add sliced strawberries and bananas, 1/4 cup orange juice, and 3/4 cup low-fat strawberry yogurt. Blend until smooth. Pour into 2- to 3-ounce molds or paper cups with sticks placed in the centers. Freeze for 3 hours or until completely frozen.
Romaine and fresh strawberry salad. Combine 2 cups romaine lettuce and 1/2 cup sliced strawberries in a bowl. Drizzle with 1 1/2 tablespoons raspberry vinaigrette dressing and toss well. Sprinkle with 1 tablespoon cashews.
Blueberry-banana smoothie. In a blender, add 2 fresh or frozen bananas, 1/2 cup fresh or frozen blueberries, and 1 cup low-fat vanilla yogurt. Blend until smooth.
Plum salsa. Mix together 1 cup chopped plum, 1 teaspoon dried cilantro, 2 tablespoons chopped onion, 2 teaspoons cider vinegar, 1/4 teaspoon hot sauce and 1/8 teaspoon salt. Serve with roasted or grilled chicken breasts.
Broiled fruit kebabs. Thread cubed fruit, such as cantaloupe, pineapple, mango or honeydew, onto skewers. Place skewers on a baking sheet and sprinkle with brown sugar. Broil until slightly bubbly, about 2 minutes on each side.
Berries a la mode. Place 2 cup berries, such as raspberries, blueberries or strawberries, in a baking dish. Sprinkle with 1/8 teaspoon cinnamon and 1/3 cup low-fat granola. Bake at 350 F until fruit is bubbling, about 30 minutes. Top each serving with 1/2 cup fat-free vanilla ice cream.
Mango salsa pizza. Mix together 1 cup chopped red or green bell peppers, 1/2 cup chopped onion, 1/2 cup chopped mango, 1/2 cup chopped pineapple, 1 tablespoon lime juice, and 1/2 cup fresh cilantro. Spread over a 12-inch prepared pizza crust. Bake at 425 F until the toppings are hot and the crust is browned, about 5 to 10 minutes.

Food pyramid: An option for better eating
A food pyramid is one tool to help you eat better. Find out how to use a food pyramid to create a healthy diet.


A healthy-eating plan can be illustrated in many ways, but it's often found in the shape of a pyramid. Food pyramids outline various food groups and food choices that, if eaten in the right quantities, form the foundation of a healthy diet.

Guidelines for choosing foods are widely represented in various food pyramids. The triangular shape of the pyramid shows you where to focus when selecting foods. Foods to eat the most of create the base of the pyramid, and foods to eat in smaller amounts or less frequently are shown farther up the pyramid.

A food pyramid familiar to many Americans is MyPyramid (formerly known as the Food Guide Pyramid), established by the United States Department of Agriculture (USDA) and the Department of Health and Human Services. Many other pyramids exist, however. These include the Asian, Latin American, Mediterranean and Vegetarian diet pyramids developed by Oldways Preservation Trust, and the Mayo Clinic Healthy Weight Pyramid, just to name a few.

Basic principles of all food pyramids
With the variety of food pyramids available, you may wonder which one to follow. It may help to know that the basic principles of food pyramids are largely the same and generally emphasize the following:

Eat more fruits, vegetables and whole grains.
Reduce intake of saturated fat, trans fat and cholesterol.
Limit sweets and salt.
Drink alcoholic beverages in moderation, if at all.
Control portion sizes and the total number of calories you consume.
Include physical activity in your daily routine.
Food pyramids place foods in categories — such as dairy products or meat and beans — to help guide your food choices. No single food provides all of the nutrients that your body needs, so eating a variety of foods within each group ensures that you get the necessary nutrients and other substances that promote good health.

Food pyramid differences
Although food pyramids reflect the same general principles of healthy eating, they demonstrate different food choices. These differences reflect dietary preferences, food availability and cultural eating patterns. For example, the Latin American Diet Pyramid might include tortillas and cornmeal within the grains food group, whereas the Asian Diet Pyramid might emphasize noodles and rice.

Other differences include:

Food groups. The food groups among food pyramids may vary somewhat. For example, some might group plant-based proteins — soybeans, beans and nuts — separately from animal proteins found in meat, poultry, eggs and dairy products. This is because animal proteins are often higher in fat and cholesterol, and some diets limit or avoid animal proteins.
Serving recommendations. How food pyramids address servings also varies. The Mayo Clinic Healthy Weight Pyramid, for example, recommends a daily number of servings from each food group. And it specifically defines serving sizes; for example, a serving of cooked brown rice is 1/3 cup and a serving of milk is 1 cup. But other plans offer more general guidelines, such as eating particular foods at every meal, or on a weekly or monthly basis. For example, the Latin American Diet Pyramid recommends that you eat whole grains, vegetables and fruits at every meal but eat red meat, sweets and eggs once a week or less.
How to use a food pyramid
To see how your diet matches up to any of these pyramids, keep a food diary for several days. Then compare how much of your diet comes from the various levels. If you're top-heavy, work your way toward the bottom of the pyramid by making small, gradual changes, such as eating more vegetables, fruits and whole grains and limiting fats and sweets.

Here are a few simple practices to help get or keep you on track:

Choose a variety of foods from each major food group. This ensures that you get all of the calories, protein, vitamins, minerals and fiber you need. Choosing a wide range of foods also helps make your meals and snacks more interesting.
Adapt the plan to your specific tastes and preferences. For example, a serving of grains doesn't only mean a slice of wheat bread. It can be wild rice, whole-wheat pasta, grits, bulgur, cornmeal muffins or even popcorn.
Combine foods from each major group however you like. For example, you might make a meal of tortillas (grain group) and beans (meat and beans group). Or you could top your fish with fruit salsa or serve steamed vegetables over pasta. The possibilities are endless.
Select your meals and snacks wisely. Make the most of what you eat by choosing nutrient-rich foods within each group. And if you need to avoid foods from one or more food groups — for example, if you don't consume dairy products because of lactose intolerance — choose other foods that are good sources of the nutrients found in those foods.
Remember to be open and creative, and go for good taste! Eating well and eating healthy are very compatible.

Alcohol use: Why moderation is key
Can alcohol benefit your health? It depends on how much you drink.
You've likely heard to drink in moderation, but what does that mean? And why is moderation important?

Moderate alcohol use seems to offer some health benefits, particularly for the heart. But too much alcohol raises the stakes, putting you at risk of adverse health consequences.

Whether you drink is up to you and your doctor. But here are some points on alcohol consumption to consider.

Benefits of moderation
Moderate drinking is defined as two drinks a day if you're a male 65 and younger, or one drink a day if you're a female or a male 66 and older. A drink is defined as 12 ounces (355 milliliters) of beer, 5 ounces (148 milliliters) of wine or 1.5 ounces (44 milliliters) of 80-proof distilled spirits.

Moderate alcohol consumption may provide some health benefits. It may:

Reduce your risk of developing heart disease, peripheral vascular disease and intermittent claudication
Reduce your risk of dying of a heart attack
Possibly reduce your risk of strokes, particularly ischemic strokes
Lower your risk of gallstones
Possibly reduce your risk of diabetes
Risks of excessive drinking
Though moderate alcohol use seems to have some health benefits, anything more than moderate drinking can negate any potential benefits. Be cautious because excessive alcohol consumption can lead to serious health problems, including:

Cancer of the pancreas, mouth, pharynx, larynx, esophagus and liver, as well as breast cancer
Pancreatitis, especially in people with high levels of triglycerides in their blood
Sudden death in people with cardiovascular disease
Heart muscle damage (alcoholic cardiomyopathy) leading to heart failure
Stroke
High blood pressure
Cirrhosis of the liver
Miscarriage
Fetal alcohol syndrome in an unborn child, including impaired growth and nervous system development
Injuries due to impaired motor skills
Suicide
Who shouldn't drink alcohol?
People with certain health conditions shouldn't drink any alcohol, as even small amounts could cause problems. Don't drink alcohol if you have:

A history of hemorrhagic stroke
Liver disease
Pancreatic disease
Evidence of precancerous changes in the esophagus, larynx, pharynx or mouth
If you have a family history of alcoholism, be particularly cautious when it comes to drinking, as you're at higher risk of alcoholism. And if you're pregnant, avoid alcohol entirely because of the health risks for your unborn baby.

Also, alcohol interacts with many common prescription and over-the-counter medications. Check with your doctor if you take:

Antibiotics
Anticoagulants
Antidepressants
Diabetes medications
Antihistamines
Anti-seizure medications
Beta blockers
Pain relievers
Sleeping pills
If you combine alcohol with aspirin, you face an increased risk of gastrointestinal bleeding. And if you use alcohol and acetaminophen, you increase your risk of liver damage. In fact, the Food and Drug Administration requires all over-the-counter pain relievers and fever reducers to carry a warning label advising those who consume three or more drinks a day to consult with their doctors before using the drug.

Drink in moderation — or not at all
Above all, don't feel pressured to drink. Few medical experts, if any, advise nondrinkers to start drinking. But if you do drink and you're healthy, there's no
need to stop as long as you drink responsibly and in moderation.

Prenatal vitamins: OK for women who aren't pregnant?
You may be tempted to take prenatal vitamins because of unproven claims that they promote thicker hair and stronger nails. While prenatal vitamins are generally safe for healthy adults, they may not be suitable if you're not pregnant or planning to become pregnant. Prenatal vitamins are formulated specifically for a mother-to-be, her developing fetus and women who are breast-feeding, with particular emphasis on:

Folic acid. The Institute for Clinical Systems Improvement recommends that women get 800 micrograms (mcg) of folate or folic acid a day before conception through diet or supplements and then increase that to 1,000 mcg a day during pregnancy. Other healthy adults — both men and women — need only 400 mcg a day. While uncommon, getting too much folic acid by taking supplements can mask the symptoms of vitamin B-12 deficiency and delay diagnosis and treatment.
Iron. During pregnancy, the recommended intake of iron is 27 milligrams (mg) a day. Women between the ages of 19 and 50 who aren't pregnant need only 18 mg a day, and women age 51 or older and all adult men need only 8 mg a day. Getting too much iron can be toxic because it can build up in your body, causing constipation, nausea, vomiting, diarrhea and in severe cases, possibly death.
Calcium. Pregnant adult women and healthy men and women ages 19 to 50 all need 1,000 mg a day. Men and women age 51 and older need 1,200 mg a day. Because prenatal vitamins are intended to supplement calcium you get in your diet, they generally contain only 200 to 300 mg of calcium. If you rely on prenatal vitamins to meet your calcium needs, you likely won't get enough, raising your risk of osteoporosis and other health problems.
It's best to take a multivitamin tailored to your sex, age and specific medical needs.

Vitamin water: Better than plain water?
Is vitamin water a healthier choice than plain water?

Vitamin water is fortified with various vitamins and other additives, and some include sweeteners that add calories. If you're eating a balanced diet or taking a multivitamin, you won't likely benefit from drinking vitamin water. If you're trying to lose weight, the calories in vitamin water will only work against you. As always, it's important to check the label for ingredients. Remember, fruits, vegetables and other whole foods are the best sources of vitamins and minerals. And it's tough to beat plain water as a healthy, no-calorie drink. If you don't care for plain water, try sparkling water or a squirt of lemon or cranberry juice in your water.

Vitamin D toxicity: What if you get too much?What is vitamin D toxicity, and should I worry about it since I take supplements?
Vitamin D toxicity, also called hypervitaminosis D, is a potentially serious but treatable medical condition that occurs when you get too much vitamin D.

Vitamin D toxicity usually results from taking an excessive amount of vitamin D supplements — not from your diet or too much sun exposure. That's because your body produces only a limited amount of vitamin D from sun exposure, and even fortified foods don't contain large amounts of vitamin D. Although vitamin D toxicity is rare even among people who take supplements, you may be at greater risk if you have health problems, such as liver or kidney conditions, or if you take thiazide-type diuretics.

The main consequence of vitamin D toxicity is a buildup of calcium in your blood (hypercalcemia), causing symptoms such as:

Nausea
Vomiting
Poor appetite
Constipation
Weakness
Confusion
Heart rhythm abnormalities
Kidney stones
Treatment of vitamin D toxicity may include:

Stopping vitamin D supplements
Restricting calcium intake
Medications
Hydration with fluids
Hospitalization in severe cases
Vitamin D is an essential nutrient. The Institute of Medicine recommends that children and adults up to age 50 get 200 international units (IU) of vitamin D daily. The recommendation for adults over age 50 is 400 to 600 IU daily. However, many health experts consider these recommendations to be too low. The American Academy of Pediatrics, for instance, now recommends that children and adolescents get 400 IU of vitamin D daily. Many experts now "unofficially" recommend that adults get as much as 1,000 to 2,000 IU of vitamin D daily. In addition, it's likely that the vitamin D guidelines will be revised upward.

Supplements can be a reasonable way to meet recommended levels — as long as you pay attention to how much you take. And be sure to tell your doctor about any supplements you take.

Herbal supplements: What to know before you buy
Herbal supplements aren't right for everyone. Get the facts before you buy.


Echinacea to prevent colds. Ginkgo to improve memory. Flaxseed to lower cholesterol.

The list of herbal remedies goes on and on. Herbal remedies, sometimes called botanicals, aren't new; plants have been used for medicinal purposes for thousands of years. However, herbal supplements haven't been subjected to the same scientific scrutiny and aren't as strictly regulated as medications. For example, herbal supplement manufacturers don't have to get approval from the Food and Drug Administration (FDA) before putting their products on the market.

Yet some herbal supplements — including products labeled as "natural" — have drug-like effects that can be dangerous. So it's important to do your homework and investigate potential benefits and side effects of herbal supplements before you buy. And be sure to talk with your doctor, especially if you take medications, have chronic health problems, or are pregnant or breast-feeding.

Are herbal supplements safe?
Herbal supplements are regulated by the FDA, but not as drugs or as foods. They fall under a category called dietary supplements. The rules for dietary supplements are as follows:

Manufacturers don't have to seek FDA approval before putting dietary supplements on the market. In addition, companies can claim that products address a nutrient deficiency, support health or are linked to body functions, if they have supporting research, and they include a disclaimer that the FDA hasn't evaluated the claim.
Manufacturers must follow good manufacturing practices (GMPs) to ensure that supplements are processed consistently and meet quality standards. GMPs are intended to keep the wrong ingredients and contaminants, such as pesticides and lead, out of supplements, as well as make sure that the right ingredients are included in appropriate amounts.
Once a dietary supplement is on the market, the FDA is responsible for monitoring its safety. If the FDA finds a product to be unsafe, it can take action against the manufacturer or distributor or both, and may issue a warning or require that the product be removed from the market.
These regulations provide consumers with the assurance that herbal supplements meet certain quality standards and that the FDA can intervene to remove dangerous products from the market. The rules do not, however, guarantee that herbal supplements are safe for anyone to use. Because many supplements contain active ingredients that have strong effects in the body, these products can pose unexpected risks. For example, taking a combination of herbal supplements or using supplements together with prescribed medications could lead to harmful, even life-threatening results. For this reason, it's important to talk with your doctor before using herbal supplements.

How do you know what's in an herbal supplement?
The FDA requires that the following information be included on the labels of all herbal supplements:

The name of the herbal supplement
The name and address of manufacturer or distributor
A complete list of ingredients — either in the Supplement Facts panel or listed beneath it
Serving size, amount and active ingredient
If you don't understand something on an herbal supplement's label, ask your doctor or pharmacist for clarification. An easy way to compare ingredients in different products is by using the Dietary Supplements Labels Database, which is available on the National Library of Medicine's Web site. The database has information on the ingredients of over 3,000 dietary supplements sold in the United States. You can look up products by brand name, uses, active ingredient or manufacturer.

How do you know if herbal supplements' claims are true?
Manufacturers of herbal supplements are responsible for ensuring that the claims they make about their products aren't false or misleading and that they're backed up by adequate evidence. However, supplement makers aren't required to submit this evidence to the FDA. So be a smart consumer and do a little homework. Don't just rely on a product's marketing. Look for objective, research-based information to evaluate a product's claims. To get reliable information about a particular supplement:

Ask your doctor or pharmacist. Even if they don't know about a specific supplement, they may be able to point you to the latest medical guidance about its uses and risks.
Look for scientific research findings. Two good sources include the National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Dietary Supplements. Both have Web sites that provide information to help consumers make informed choices about dietary supplements.
Contact the manufacturer. If you have questions about a specific product, call the manufacturer or distributor. Ask to talk with someone who can answer questions such as what data the company has to substantiate its products' claims.
Who shouldn't use herbal supplements?
If you have health issues, it's essential that you talk with your doctor before trying herbal supplements. In fact, in some high-risk situations, your doctor will likely recommend that you avoid herbal supplements altogether. You may be placing yourself at risk by using herbal supplements if:

You're taking prescription or over-the-counter (OTC) medications. Some herbs can cause serious side effects when mixed with prescription and OTC drugs such as aspirin, blood thinners or blood pressure medications. Talk to your doctor about possible interactions.
You're pregnant or breast-feeding. Medications that may be safe for you as an adult may be harmful to your fetus or your breast-feeding infant. As a general rule, don't take any medications — prescription, OTC or herbal — when you're pregnant or breast-feeding unless your doctor approves.
You're having surgery. Many herbal supplements can affect the success of surgery. Some may decrease the effectiveness of anesthetics or cause dangerous complications, such as bleeding or high blood pressure. Tell your doctor about any herbs you're taking or considering taking as soon as you know you need surgery.
You're younger than 18 or older than 65. Older adults may metabolize medications differently. And few herbal supplements have been tested on children or have established safe doses for children.
Safety tips for using herbal supplements
If you've done your homework and decide to try an herbal supplement, play it safe with these tips:

Follow supplement instructions. Don't exceed recommended dosages or take the herb for longer than recommended.
Keep track of what you take. Take only one supplement at a time to determine if it's effective. Make a note of what you take — and how much for how long — and how it affects you.
Be extra cautious about supplements manufactured outside the United States. Herbal products from some European countries are highly regulated and standardized. But toxic ingredients and prescription drugs have been found in supplements manufactured elsewhere, particularly China, India and Mexico.
Avoid products with a tainted past. A number of herbal weight-loss pills have been found to have serious side effects or to contain prescription drugs or contaminants. For this reason, they're probably best avoided.
Check alerts and advisories. The FDA and NCCAM maintain lists of supplements that are under regulatory review or that have been reported to cause adverse effects. Check their Web sites periodically for updates.

Nutritional supplements


Nutritional supplements are meant to complement a healthy diet, not replace it. If you're generally healthy and eat a wide variety of foods, you may not need to take nutritional supplements.

However, if you don't eat enough healthy foods or don't eat a healthy variety of foods, you may need to consider nutritional supplements. Talk with your doctor or a dietitian about which nutritional supplements might be appropriate for you and in what doses. Be sure to ask about possible side effects of nutritional supplements you're considering — and if they have interactions with medications you take