Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

How Can I Get My Kids To Eat Healthy Food? More Q&As From The Boys & Girls Clubs

I’ve continued to have terrific email questions and answers with the Boys & Girls Clubs’ Fit Family Challenge participants. I thought I’d publish some of our conversations so that you can participate as well. The Lang family shared this image of their son eating dinner next to the latest USDA dietary recommendations “MyPlate” materials. A picture’s worth 1000 words, isn’t it?

This cute fella is a healthy weight, he is very athletic, and he’s also wondering where chicken nuggets, french fries, and pizza fit in to the MyPlate dinner plans… His mom asked me how to make more “kid friendly” healthy meals. Perhaps some folks reading this have some success stories that they’d like to share? Here’s what I had to say to the Langs and others…

1. My son doesn’t think the MyPlate suggested meals are kid friendly. What can we do?

I wonder if your son would be open to trying healthier variations of the foods he likes? You could make a pretty tasty pizza with whole wheat crust, grilled veggies, a little pesto or tomato sauce and some ham cubes (ham is much lower in fat than sausage or pepperoni) and low fat shredded mozzarella. You can get a pizza stone to help crisp the crust in a regular oven. The pizza would probably reheat well so you could make it in advance too.You can bread chicken strips and bake them (instead of frying them) to simulate healthy chicken “nuggets.” Same for fish sticks. You can try sweet potato fries for a healthier fry option – bake them in the oven with a little olive oil, salt and pepper. More nutritious, kid-friendly recipes may be found at

2. Do my kids need 8 cups of water a day?

As far as water is concerned, the amount you need really depends on how much liquid you’re getting from other sources (food, beverages) as well as how much you’re sweating (exercise), how hot/dry the environment is and how much you weigh. Eight cups/day is a very rough rule of thumb. Some people need more or less depending on the day. Unless you are doing extreme exercise (in the heat) that requires fluid replacement before you notice that you’re thirsty, thirst is a good indicator of whether or not you need to drink. Also, I’ll tell you a doctor secret – all you need to know about hydration is in your urine color. Urine becomes very concentrated (dark yellow) when you are dehydrated. If you drink enough water to keep your urine a nice light yellow, then that’s all you need.

3. What are the best vegan protein substitutes for meat?

Concentrated vegetable protein is primarily derived from soy (tofu and tempeh) and wheat (seitan). Nuts and seeds also contain some degree of protein, as well as beans, lentils, and rice. Tofu, tempeh, and seitan can be molded into burger and hotdog shapes and may be prepared to mimic meat flavors. Keep in mind that concentrated soy or wheat proteins may not agree with your intestinal tract (some complain of excessive gas and bloating). So if you have those reactions, at least you’ll know that it’s quite common.

4. Is it healthy to be a vegetarian? Is there such a thing as too much fruit and veggies?

Vegetarianism can be healthy, though it takes some effort to ensure that adequate amounts of nutrients are received – especially if you’re vegan (no dairy, no eggs). The most common deficiencies for vegans are iron, B12, calcium, Omega-3 fatty acids, protein, and Vitamin D. (You can read more about how vegetarians can overcome these deficiencies here.) I guess my main concern with veganism is the low omega-3s. It is basically impossible to get enough omega-3 fatty acids from plant sources (certain seeds, you may have heard, have a good amount of omega-3 fatty acids but what they won’t tell you is that plant omega-3′s aren’t processed by the body so they remain inactive and don’t provide much benefit.) Omega 3 fatty acids form a protective layer on the outside of cell membranes by reducing inflammation. This is particularly helpful in the reduction of plaque build up in heart arteries, and reducing the risk of various dementias (such as Alzheimer’s) that have an inflammatory cause.

Excellent sources of omega 3 fatty acids are oily fish (sardines, salmon, mackerel, sea bass). This is why the American Heart Association (and recommend 2 servings of oily fish/week for optimal health. Vegetarians are missing out on this important benefit.

As far as eating too many fruits/veggies is concerned – I can’t think of too many potential harms from eating large amounts of fruits/veggies (other than weight gain if you really eat a lot of fruit – they have quite a bit of natural sugar). The real harm comes from excluding vital nutrients by eating plants exclusively (without a careful strategy to get the right plant sources of vitamins and minerals, along with omega-3 supplements).

Debunking Nutrition Myths With The Boys & Girls Clubs Of America

This year’s Fit Family Challenge competitors are smart, savvy, and full of great nutrition-related questions! I just finished a one hour conference call with 10 family finalists from across the U.S. and Hawaii. As part of their challenge to adopt healthy diet and exercise practices, they were asked to send me their most burning nutrition questions. One mom told me that her goal was “to teach her girls how to think critically” about health information. I was so pleased to see those values being promoted that I thought I’d share some of our mythbusting FAQs here on the blog:

1. I live in a community that doesn’t add fluoride to the public water supply. Do my kids need to take fluoride supplements?

Fluoridation of our water supply is considered to be one of the top 10 most effective public health initiatives of the 20th century. Enhancing the natural fluoride content of water results in up to a 60% reduction in tooth decay for kids! The cost to a community of adding fluoride to the water supply is about 50 cents per person per year, so it’s really quite affordable. I’m not sure why your community water hasn’t been fluoridated, but it’s estimated that about 1/3 of Americans still live in communities that haven’t supplemented their water with fluoride (so you’re not alone).

Our teeth use fluoride to strengthen our enamel – and we can get fluoride to our teeth in two ways: 1) from our blood stream (e.g from the water we drink, digest, and absorb) and 2) topically (e.g. from toothpaste). Studies have shown that it’s best to get fluoride via both routes for optimal enamel strength. For children living in areas where the water is not fluoridated, the American Dental Association (ADA) recommends fluoride vitamins until at least age 16. There are two strengths of fluoride vitamins, and the dosage required depends on the fluoride levels in the local water supply (you can ask your local Water Department for that information if you haven’t already). Keep in mind that most children’s permanent teeth (with the exception of “wisdom teeth”) erupt by age 13 – and before that age there is no way to get fluoride to them except via the blood stream. So digesting fluoride (via water or vitamins) is critical to strengthen those teeth that haven’t broken through the gums yet.

For more information about fluoride, see this helpful ADA guide.

2. Should parents be concerned about hormone levels in milk? Is there an advantage to buying organic milk?

All mammals release trace amounts of hormones into their milk. Cow’s milk naturally contains a small amount of bovine somatotropin (bST) which is a protein that is quickly broken down by our stomachs when we drink milk. Some farmers give their cows additional amounts of the hormone to stimulate milk production. This rbST (or BGH) is virtually identical to naturally occurring cow hormones and the decades of research we’ve collected has been reviewed by the FDA (Food and Drug Association), WHO (World Health Organization), NIH (National Institutes of Health), AMA (American Medical Association), and ADA (American Dietetic Organization) – and all agree that rbST is safe for human consumption in the levels it occurs in cow’s milk. Interestingly, studies have shown that milk hormone levels in organic milk is essentially identical to levels in regular milk. There is therefore no advantage in buying organic milk insofar as hormones are concerned.

I believe that cow’s milk is safe and nutritious for kids (so long as they have no milk allergies or lactose intolerances). The milk/hormone scare is kind of an urban legend, so I wouldn’t be too worried about it. Your girls haven’t suffered any harm from drinking regular milk – and it’s great that you all enjoy the skim variety, by the way. Lower calorie options can help you maintain your weight over your lifetime.

For more information about milk and hormones please check out this helpful link full of research resources.

3. Are there lifestyle choices that I can make to reduce my risk of getting cancer? Can vitamins help?

You are right that there are lifestyle choices that can substantially reduce your risk (and your childrens’ risk) of getting cancer. However, there is no way to guarantee that you’ll never get cancer, no matter how carefully you control your diet and lifestyle. Nevertheless it’s an excellent idea to do what we can to reduce our risks. Cancer is actually a complicated collection of different diseases, and so specific behavior changes may reduce the risk of certain cancers but not others. For example, a high fiber diet may reduce the risk of colon cancer, but not skin cancer.

Also note that it’s very hard to prove that any one dietary change (such as consuming a larger amount of one particular vitamin or herb) has a direct impact on cancer risk. What works is sometimes more general (such as avoiding becoming obese). Here are some  behavior changes that have been scientifically proven to reduce cancer risks or prevent certain cancers:

1. Smoking cessation
2. Regular use of sunscreen
3. A diet rich in fiber (i.e.lots of fruits and veggies and whole grains)
4. Maintaining a healthy weight
5. Regular exercise
6. HPV vaccines (especially for young girls – can prevent cervical cancer) and hepatitis vaccines (can prevent liver cancer)
7. Drinking very little alcohol (no more than 1 drink/day)

Screening for cancer is also important – because catching a cancer early is often the best way to cure it. The most effective screening tests are:

1. Colonoscopies (for adults over age 50)
2. PAP smears (for sexually active women and women who haven’t had hysterectomies)
3. Physical exams to check for skin cancer, oral cancer, and testicular cancers

Mammograms and prostate blood tests are less effective at catching cancers early, but they are recommended by most medical professional associations.

I recommend reading this page at the National Cancer Institute for more information about avoiding cancer risk factors:

Multivitamins are not recommended for cancer prevention. Although it would seem that vitamins could help reduce the risk of cancer, large studies have shown that they do not reduce the risk of cancer, and may even increase one’s risk (especially vitamin E.) The best source of vitamins is healthy food – and their fiber benefits are excellent as well. For a nice summary of the unhelpfulness of vitamin supplements, please see this ABC News summary of recent research.

The Boys & Girls Clubs Of America Fight Childhood Obesity

Dr. Val & Olympic Gymnast Shawn Johnson

Dr. Val & Olympic Gymnast Shawn Johnson

Because of obesity, this generation of children may be the first in US history to have a shorter lifespan than their parents. The CDC reports that teen obesity rates are growing exponentially, having tripled in the past 20 years. We also know that 70% of obese children become obese adults, and that 75% of our healthcare dollars are spent on chronic disease management – diseases that are 80% preventable with lifestyle modifications. Efforts to curb healthcare costs are unlikely to succeed without addressing America’s obesity epidemic.

So who is addressing the obesity crisis now? One shining example is the Boys & Girls Clubs of America (BGCA). They recognized the impact of obesity on their club members and looked for ways to increase physical activity levels, encourage healthy eating, and repair self esteem in America’s underprivileged youth. After consulting with the Department of Health and Human Services (and obtaining funding from the Coca-Cola company), the BGCA created a multi-faceted initiative, called Triple Play, to combat overweight and obesity. The results are very encouraging.

After 2 years, an analysis of over 2,250 club members suggests that 90% of youth enrolled in the program met the daily, federal physical activity recommendations while a significant number improved their nutritional status, choosing to eat significantly more fruits and vegetables. Perhaps most interestingly, the participants also scored higher on tests of “self-mastery” which are correlated with self esteem and social skills. Overall, girls were impacted more strongly by the program than boys, though the reason for this is unclear.

I had the honor of moderating a panel of experts who discussed the impact of Triple Play on BGCA members. In attendance were Olympic gold medalists Shawn Johnson, Dominique Dawes, and Dr. Tenley Albright in addition to SVP of BGCA, Judith Pickens, former Club kid and Youth of the Year, Stacey Walker, and Chris Spain from the President’s Council on Physical Fitness and Sports. It was heartening to see that there are programs that can bend the obesity curve – because success in this area of disease prevention has been hard to come by.

I hope that healthcare reformers will carefully consider the impact of obesity-driven chronic disease, and look to program success stories like Triple Play as a means to affect long-term improvements of America’s health. Our kids’ lives and the future productivity of our country are dependent upon the implementation of prevention programs that work. Cheers to BGCA for leading the charge against childhood obesity!

Congressman, Olympian, Colombian, Canadian: Fighting Obesity Through The Boys & Girls Clubs Of America

Rep. Steny Hoyer & Dr. Val

Rep. Steny Hoyer & Dr. Val

House Majority Leader Steny H. Hoyer offered the keynote speech at the Youth of the Year awards for the Boys & Girls Clubs of America (BGCA). Rep. Hoyer was himself a member of the club in his late teens, and credits it for turning his life around and setting him up for career success.

Rep. Hoyer reminded the audience about how critical it is for young Americans to have positive role models, a safe place to socialize, and adults who believe in them. The BGCA is also involved in reducing and preventing childhood obesity – a national crisis of great medical importance.


Carolina Correa & Dr. Val

Carolina Correa & Dr. Val

Young Carolina Correa, the 2009 Northeast Region Youth of the Year, introduced herself to me at the event. She was bright and confident – and it was only during her speech to the crowd that I discovered that she had survived a triple family homicide in Colombia, moved to the US with her mom and ailing step dad, and worked as a child laborer to provide for her family and younger brother. Thanks to the Boys & Girls Clubs, she managed to overcome all her obstacles and find peace in the midst of her personal storm, achieving academic and athletic excellence in the process.


Dominique Dawes & Dr. Val

Dominique Dawes & Dr. Val

Olympic gymnast Dominique Dawes is a strong supporter of the BGCA – and helps to inspire young members to get fit and pursue athletic careers.

Tomorrow I’ll be moderating the Be Healthy event on behalf of the BGCA. A panel of experts will be revealing promising new research results – demonstrating how BGCA’s Triple Play program has dramatically reduced obesity rates among those who enroll in the program.

With 70% of obese children becoming obese adults, and obesity itself costing at least 10% of all healthcare spending – any program that bends the obesity curve is welcome news. So stay tuned for more coverage on BGCA’s approach to helping kids get fit – and developing lifelong character in the process.

I myself am humbled to spend time with youth (like Carolina) of such character and perseverance. They are truly inspirational.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »