Nutrition

Overview

It's a cliché, to be sure, but a balanced diet is the key to good nutrition and good health. Following that diet, however, isn't always that easy. One challenge is that women often feel too busy to eat healthfully, and it's often easier to pick up fast food than to prepare a healthy meal at home. But fast food is usually high in fat and calories and low in other nutrients, which can seriously affect your health. At the other extreme, a multimillion dollar industry is focused on telling women that being fit means being thin and that dieting is part of good nutrition.

Between our busy lives and the messages we hear, it's no wonder that many women suffer from poor nutrition or are confused about nutrition messages.

Good nutrition means eating a balanced diet. Poor nutrition is just the opposite, and it can lead to a myriad of health problems. It's important to learn how to eat right, which means including the right amounts of the right kinds of food.

In theory, nutritious eating isn't that difficult. It comes down to basics you probably already know. Eat a varied diet that includes plenty of 100 percent whole-grain products, vegetables and fruits, and reduce your intake of saturated and trans fats, sugars and salt.

And eat regularly. If you skip breakfast and eat lunch on the run, you will be ravenous in the afternoon. Studies suggest that skipping breakfast can backfire and actually increase eating later in the day, contributing to weight gain. Some experts advise planning healthy snacks like fruit and yogurt throughout the day to stave off the munchies.

Getting enough water also is important. Many experts recommend at least eight 8-ounce glasses of water daily—more if you exercise frequently or are exposed to extremes of heat and cold. The 2010 Dietary Guidelines for Americans emphasize drinking more water and other calorie-free beverages, along with fat-free or low-fat milk and 100 percent fruit juices, instead of calorie-packed regular sodas.

The new guidelines encourage eating more nutrient-dense food and beverages. Many of us consume too many calories from solid fats, added sugar and refined grains. The guidelines promote a diet that emphasizes vegetables, fruits, whole grains, fat-free or low-fat dairy products, seafood, lean meat and poultry, eggs, beans and peas, and nuts and seeds.

Activity is the other half of the equation. The 2010 Dietary Guidelines stress healthy eating habits and balancing calories and physical activity to manage weight through all stages of life.

To help you learn how to eat healthfully, start with the U.S. Department of Agriculture's (USDA) dietary guidelines system, which you can find at https://www.choosemyplate.gov/. The ChooseMyPlate system, which looks somewhat like the familiar food pyramid of old, offers guidance based on individual needs and replaces "serving" recommendations with actual amounts of food. It also emphasizes the importance of balancing nutritious (and tasty!) food choices from all food groups every day with daily physical activity.

The interactive ChooseMyPlate system lets you see specific daily food amount recommendations based on your level of daily moderate to vigorous activity (such as brisk walking or yard work). For instance:

• A 45-year-old woman who gets less than 30 minutes of daily physical activity in addition to her normal routine should consume six ounce of grains; two and a half cups of vegetables; one and a half cups of fruit; three cups of milk; five ounces of meat and/or beans; five teaspoons of oil; and just 195 calories of additional fat and sugar. With a higher level of daily activity (30 to 60 minutes), this woman would be able to consume a little more in certain food groups: her fruit intake could rise to two cups; meat and beans to five and a half ounces; oils to six teaspoons; and extra fat and sugar to 265 calories.
• A 55-year-old woman who gets less than 30 minutes of daily physical activity should eat five ounces of grains; two cups of vegetables; one and a half cups of fruit; three cups of milk; five ounces of meat and beans; five teaspoons of oils, and no more than 130 calories of additional fat and sugar. If she got 30 to 60 minutes of daily exercise, she could increase her intake to six ounces of grains; two and a half cups of vegetables; and up to 265 additional calories of fat and sugar.

How much food is that?

If you want to test your knowledge of what a healthy portion looks like—and see how long it takes to burn off excess calories from unhealthy portions—visit the National Heart, Lung, and Blood Institute's Portion Distortion site at: https://www.nhlbi.nih.gov/health/educational/wecan/eat-right/portion-distortion.htm.

For some simple suggestions about eating a healthy, balanced diet, check out the "New American Plate Concept" from the American Institute for Cancer Research. This concept suggests you fill your plate with two-thirds or more of vegetables, fruits, whole grains or beans and only one-third or less of animal protein. This simple principle can guide you toward healthier eating. For more details, visit https://www.aicr.org/cancer-prevention/food-facts/aicrs-new-american-plate/.

For nutritious eating, choose from these groups every day:

Grains (bread, cereal, rice and pasta)

At least half should be whole grains, such as whole-wheat flour, brown rice, whole cornmeal or oatmeal.

One ounce equals:

• One slice of bread
• One cup of ready-to-eat cereal
• One-half cup of cooked cereal, rice, or pasta

Vegetables

Vary by color and type to get the best benefits. Include dark green, orange and red vegetables, beans, peas, starchy vegetables and others.

One cup equals:

• One cup of most raw or cooked vegetables or vegetable juice
• Two cups of raw, leafy greens

Fruits

Eat a variety of fruit—fresh, frozen, canned or dried. Choose 100 percent fruit juices.

One cup equals:

• One cup fresh fruit
• One-half large apple, one large orange, 32 seedless grapes, one large banana
• One-half cup dried fruit
• One cup of 100 percent fruit juice

Milk

Choose fat-free or low-fat milk, yogurt and cheese.

One cup equals:

• One cup of milk or yogurt
• One and one-half ounces of natural cheese; two ounces of processed cheese
• Two cups cottage cheese
• One and one-half cups ice cream

Meat and Beans

Eat varied protein—fish, beans, low-fat or lean meat, eggs, beans, peas, nuts and seeds.

One ounce equals:

• One ounce of lean meat, poultry, fish
• One-fourth cup tofu; one ounce cooked tempeh
• One-fourth cup cooked dry beans
• One egg
• One tablespoon peanut butter or almond butter
• One-half ounce nuts or seeds

Oils

Most oils are low in saturated fat, except for coconut oil and palm kernel oil.

Limit oils to balance total calories.

One teaspoon equals:

• Three teaspoons vegetable oil (canola, olive, soybean, corn, etc.)
• One-half of a medium avocado
• Four teaspoons peanut butter
• One ounce cashews, dry roasted

Unhealthy Foods: Too Much Fat, Sugar and Salt

Grains, vegetables and fruits are essential to getting the vitamins, minerals, complex carbohydrates (starch and dietary fiber) and other nutrients you need to sustain good health. Some of these nutrients may even reduce your risk of certain kinds of cancer. But experts say we rarely eat enough of these foods. To make matters worse, we also eat too much of unhealthy types of food, including fat (and cholesterol), sugar and salt.

Fat

Some fat is an important part of your diet; fat is part of every cell. It maintains skin and hair; stores and transports fat-soluble vitamins A, D, E and K; keeps you warm; and protects your internal organs. It even helps your mental processes—not surprising given that fat comprises about 60 percent of your brain. But many women consume too much fat. The American Heart Association (AHA) recommends that you keep your total fat intake between 25 and 35 percent of your total calories.

Fat, whether from plant or animal sources, contains more than twice the number of calories of an equal quantity of carbohydrate or protein. So cutting back on a small quantity of fat reduces your calorie intake more than cutting back on a similar quantity of carbohydrates.

Fats contain both saturated and unsaturated (monounsaturated and polyunsaturated) fatty acids. Saturated fat raises blood cholesterol more than unsaturated fat, which may even help lower harmful cholesterol. Reducing saturated fat (most comes from meat, dairy and bakery products) to less than seven percent of total daily calories may help you reduce your cholesterol level. Whenever possible, replace saturated fat with monounsaturated and polyunsaturated fats.

The AHA recommends eating no more than six ounces of lean meat, poultry, fish or seafood a day. A three-ounce serving is about the size of a deck of cards. You also should avoid whole-fat dairy products, opting for low-fat, 1 percent, or fat-free dairy whenever possible.

Trans fatty acids, also known as trans fats, are solid fats produced artificially by heating liquid vegetable oils in the presence of metal catalysts and hydrogen. They also pose a health risk, increasing LDL or "bad" cholesterol and increasing your risk of coronary heart disease. They are often found in cookies, crackers, icing and stick margarine, and in small amounts in meats and dairy products. Beginning in January 2006, all food manufacturers had to list the amount of trans fatty acids in foods, resulting in a significant reduction in the amount of these fats used in prepared foods. In its guidelines, the American Heart Association notes that trans fats increase risk of heart disease by raising "bad" LDL cholesterol and should be avoided as much as possible. In addition, research has shown that trans fats can also decrease "good" HDL cholesterol, increase inflammation, disrupt normal endothelial cell function and possibly interfere with the metabolism of other important fats—even more evidence that they are very bad for overall health.

Monounsaturated and polyunsaturated fats do not appear to raise LDL cholesterol and may even help lower LDL cholesterol when eaten as part of a healthy diet low in saturated fats and trans fats, some studies indicate. Unsaturated fats are found in such foods as nuts, seeds, fish, avocados, olives and most vegetable oils (not coconut or palm oil.

If you count calories, count fat calories, too. Food labels indicate how many calories come from fat, both in actual grams and in percentages. This helps you assess the percentage of fat in your diet. If the total number of fat calories is 30 percent or more of the total calories you consume in a day, you probably need to cut back. But don't be misled by terms like "lower fat." Ask yourself "lower than what?" and look at the overall percentage of fat calories in the food.

Also limit the amount of cholesterol you consume. Cholesterol is a fat-like substance found in every cell of the body. It helps digest some fats, strengthen cell membranes and make hormones. But too much cholesterol can be dangerous: When blood cholesterol reaches high levels, it can build up on artery walls, increasing the risk of blood clots, heart attack and stroke. Although dietary cholesterol can contribute to heart disease, the greater risk comes from a diet high in saturated and trans fats.

You get cholesterol in your diet through animal products such as meat and eggs, particularly through saturated fats like butter and cheeses. Experts suggest you limit your daily intake of cholesterol to less than 300 mg (one egg contains about 215 mg; 3.5 ounces of cooked hamburger contains approximately 90 mg).

You can begin to cut your intake of fat and cholesterol at the supermarket. Read the nutrition labels—you may be stunned to see how much you are consuming. Use fats and oils sparingly, and choose low-fat dairy products, lean meats, fish, poultry and beans to get the nutrients you need without taking in excess fat.

Sugar

Sugar is a source of calories, not nutrients. Consuming too much sugar can lead to weight gain and tooth decay. Contrary to what many people think, there is no evidence linking high-sugar diets to hyperactivity or diabetes. However, high-fructose corn syrup, found in most processed foods, is linked with obesity, and obesity increases your risk for developing diabetes and other conditions.

The American Heart Association recently released guidelines that say women should consume no more than 100 calories of added sugar per day, which is about 6 teaspoons. The average American currently consumes about 22 teaspoons of sugar per day, or about 355 calories.

Much of the sugar we eat is added to other foods, such as regular soft drinks, fruit drinks, puddings, ice cream and baked goods, to name just a few. Soft drinks and other sugary beverages are the No. 1 offenders in American diets. A 12-ounce can of regular soda contains 8 teaspoons of sugar, exceeding the daily maximum amount recommended for women.

Research from Tufts University nutrition scientists shows that Americans are drinking so much soda and sweet drinks that they provide more daily calories than any other food. Obesity rates are higher for people consuming sweet drinks. Also watch for hidden sugar in the foods you eat. Sugar may appear as corn syrup, dextrose, fructose, fruit juice concentrate or malt syrup, among other forms, on package labels.

Salt

Studies link high sodium intake to higher blood pressure, and evidence suggests that many people at risk for high blood pressure can reduce their risk by consuming less salt or sodium, as well as following a healthy diet. Most Americans consume more sodium than they need. The recommended amount is less than 2,300 mg per day for children and adults to age 50. The limit drops to 1,500 mg per day for those 51 and older or those of any age who are African American or have hypertension, diabetes or chronic kidney disease. You get 2,300 mg in just one teaspoon of salt. One good way to reduce your sodium intake is to eat fewer prepared and packaged foods.

Alcohol

Notice that alcohol isn't included in a food group. If you drink alcohol, do so in moderation, up to one drink per day for women and two drinks per day for men. Alcohol offers little nutritional value, and when used in excess, can cause short-term health damage, such as distorted vision, judgment, hearing and coordination; emotional changes; bad breath; and hangovers. Long-term effects may include liver and stomach damage, vitamin deficiencies, impotence, heart and central nervous system damage and memory loss. Abuse can lead to alcohol poisoning, coma and death. Pregnant women should not drink at all because alcohol can harm the developing fetus and infant. According to the March of Dimes, more than 40,000 babies are born each year with alcohol-related damage. Even light and moderate drinking during pregnancy can hurt your baby. If you are breastfeeding, discuss drinking alcohol with your health care professional. After clearing it with your doctor, you may be able to have an occasional celebratory single, small alcoholic drink, but you should abstain from breastfeeding for two hours after that drink.

Getting the Right Nutrients

Although the USDA sets dietary guidelines for whole foods, the Institute of Medicine develops Dietary Reference Intake (DRI) recommendations for essential vitamins and minerals. The amounts below represent 100 percent of the daily value of each nutrient.

Reference Daily Intakes (RDI) for women aged 19-50

Nutrient / Amount

• Vitamin A / 700 micrograms (mcg)
• Vitamin C / 75 milligrams (mg)
• Thiamin / 1.1 mg
• Riboflavin / 1.1 mg
• Niacin / 14 mg
• Calcium / 1,000 mg
• Iron / 18 mg
• Vitamin D / 15 mcg*
• Vitamin E / 15 mg
• Vitamin B6 / 1.3 mg
• Folic acid / 400 mcg
• Vitamin B12 / 2.4 mcg
• Phosphorus / 700 mg
• Iodine / 150 mcg
• Magnesium / (19 to 30: 310 mg, 31 to 50: 320 mg)
• Zinc / 8 mg
• Copper / 900 mcg
• Biotin / 30 mcg
• Pantothenic acid / 5 mg
• Potassium/ 4.7 grams
• Sodium/ 1.5 grams

Reference Daily Intakes (RDI) for women aged 51-70

Nutrient / Amount

• Vitamin A / 700 micrograms (mcg)
• Vitamin C / 75 mg
• Thiamin / 1.1 mg
• Riboflavin / 1.1 mg
• Niacin / 14 mg
• Calcium / 1,200 mg
• Iron / 8 mg
• Vitamin D / 15 mcg*
• Vitamin E / 15 mg
• Vitamin B6 / 1.5 mg
• Folic acid / 400 mcg
• Vitamin B12 / 2.4 mcg**
• Phosphorus / 700 mg
• Iodine / 150 mcg
• Magnesium / 320 mg
• Zinc / 8 mg
• Copper / 900 mcg
• Biotin / 30 mcg
• Pantothenic acid / 5 mg
• Potassium / 4.7 grams
• Sodium / 1.3 grams

*In the absence of adequate exposure to sunlight.
**Due to age-related modest decreases in the ability to use the B12 from natural sources, fortified foods or supplements can help to meet the recommendation.

Macronutrients

Carbohydrates (starches and sugars)

• 45 percent to 65 percent of daily total calories
• About 130 grams daily (some people may need less, and pregnant and lactating women need more)
• Choose whole grains, vegetables, fruits and beans—all of which are carbohydrates that deliver vitamins, minerals, fiber and healthy phytonutrients.
• Avoid white bread, white rice, pastries, regular sodas and other highly processed foods.
• Added sugars (from processed foods and drinks) should comprise no more than 25 percent of total calories

Cholesterol

• Consume less than 300 mg per day as part of a healthy diet.
• Cholesterol helps in the formation of cell membranes, vitamin D and some hormones.
• The body typically makes all the cholesterol it needs (about 1,000 milligrams a day). Therefore it is important to limit the high-cholesterol foods you eat, such as meat, egg yolks, poultry, shellfish and whole-fat milk and dairy products.

Fat

• 25 percent to 35 percent of daily total calories
• Eat healthy fats. According to the American Heart Association, women should get at least five to 10 percent of total daily calories from omega-6 fatty acids (equal to 12 to 20 grams), and between 0.5 and 3 grams of omega-3 fatty acids, depending on individual risk for heart disease. Good sources of omega-6 fatty acids include sunflower, safflower, corn, cottonseed and soybean oils. And good sources of omega-3 fatty acids include fatty fish, tofu and other forms of soybeans, canola, walnuts, flaxseed, and their oils. Talk with your health care professional about how much of these beneficial oils you should be getting, how you can best incorporate them into your diet and whether or not you should be taking them in supplement form.
• Keep consumption of harmful saturated fatty acids, trans fatty acids and cholesterol as low as possible in a nutritional diet.
• Includes dietary fiber and functional fiber that has been shown to have beneficial effect.

Fiber

• You need 25 grams daily (age 19 to 50); 21 grams (over age 50). The average American only consumes about 15 grams a day.
• Eat dietary fiber and functional fiber that has been shown to have beneficial effect. Fruits, vegetables, whole-grain foods, beans and legumes are good sources of soluble and insoluble dietary fiber.
• At least half of your grain intake should come from whole-grain foods, such as whole-grain breads and cereals.

Protein

• 10 to 35 percent of daily total calories
• Females 19 and older need 46 grams a day
• Pregnant and nursing women need more grams of protein; the percentage of daily calories remains the same but the amount consumed will be higher with the increased calorie intake. Consult your health care professional.
• Eat varied sources, such as fish, beans, tofu, low-fat or lean meat, eggs, beans, peas, nuts and seeds.

Nutrients You Need: Are You Getting Enough?

Women, especially those of childbearing age, need to be particularly careful to get adequate amounts of certain nutrients, including:

Calcium

Many women and teenage girls don't get enough calcium. Calcium-rich foods are critical to healthy bones and can help you avoid osteoporosis, a bone-weakening disease. Additionally, recent studies suggest that consuming calcium-rich foods as part of a healthy diet may aid weight loss in obese women while minimizing bone turnover. The National Institute of Medicine recommends the following calcium intake, for different ages:

You can get calcium from dairy products like milk, yogurt and cheese, canned fish with soft bones (sardines, anchovies and salmon; bones must be consumed to get the benefit of calcium), dark-green leafy vegetables (such as kale, mustard greens and turnip greens) and even tofu (if it's processed with calcium sulfate). Some foods are calcium-fortified; that is, they contain additional calcium. Examples include orange juice, certain cereals, soy milk and other breakfast foods. Talk to your health care professional about whether you should take calcium supplements if you don't think you're getting enough calcium from food sources.

If you have asthma, allergies, a thyroid condition or other chronic medical conditions you may need a higher daily calcium intake. Why? Medications used to treat these conditions can interfere with your body's absorption and use of calcium and may reduce bone mass.

Fiber

Dietary fiber is found in plant foods like whole-grain breads and cereals, beans and peas, and other vegetables and fruits. At least one study suggests that women who eat high amounts of fiber (especially in cereal) may have a lower risk for heart disease. High-fiber intake is also associated with lower cholesterol, reduced cancer risk and improved bowel function. And one long-term study found that middle-aged women with a high dietary fiber intake gained less weight over time than women who ate more refined carbohydrates, like white bread and pasta.

Women age 19 to 50 should consume 25 grams of total fiber daily; women older than 50, 21 grams. Most women, however, barely consume 12 grams a day. You don't want to shock your digestive system by going up to 25 grams all at once, so increase your daily fiber intake gradually over several days.

Folic acid

The U.S. Public Health Service recommends that all women of childbearing age consume 400 mcg of folic acid (a B vitamin) daily to reduce the risk of having a baby affected with spina bifida, anencephaly or other neural-tube birth defects. Pregnant women should take 600 mcg, and lactating women should take 500 mcg.

Foods that contain natural folic acid include orange juice, green leafy vegetables, peas, peanuts and beans. (One cup of cooked kidney beans contains 230 mcg of folic acid.) Fortified foods, such as ready-to-eat breakfast cereals, also contain a synthetic form of folic acid, which is more easily absorbed by your body than the natural form. Folic acid is now added to all enriched grain products (thiamin, riboflavin, niacin, and iron have been added to enriched grains for many years).

Iron

Everyone needs iron—especially children, teenage girls and women of childbearing age. The recommended daily amount for women 19 to 50 is 18 mg; for women over 50, 8 mg.

Good sources of iron include liver, kidneys, red meat, poultry, eggs, peas, legumes, dried fruits and dark, green leafy vegetables. Three ounces of cooked chicken liver contains 7.2 mg of iron; a cup of cooked spinach contains 6.4 mg. Your health care professional will probably recommend iron supplements during pregnancy (probably starting at 30 mg per day).

Otherwise, don't take iron supplements or vitamins with iron unless your health care professional recommends it. This is particularly important if you're postmenopausal since some evidence suggests too much iron could lead to heart disease.

Carbohydrates

According to the American Heart Association, it's better to eat more complex carbohydrates (vegetables, fruits and whole grains) than simple carbohydrates found in sugars. Complex carbohydrates add more fiber, vitamins and minerals to the diet than foods high in refined sugars and flour. Foods high in complex carbohydrates are usually low in calories, saturated fat and cholesterol.

Protein

The average woman should get 10 to 35 percent of her daily calories from protein. Protein helps prevent muscle tissue from breaking down and repairs body tissues. Sources of animal proteins include meat, fish, poultry, eggs, milk and cheese. Vegetable proteins include dried beans and peas, peanut butter, nuts, bread and cereal. (A three-ounce serving of cooked chicken contains about 21 grams of protein.)

Vitamin D

Vitamin D is critical to calcium absorption and bone formation. Vitamin D deficiency can lead to the softening of bones in children and babies (rickets) and adults (osteomalacia). But high doses of vitamin D can cause kidney and abdominal problems.

The national Institute of Medicine recommends the following vitamin D intake amounts for healthy individuals:

RECOMMENDED VITAMIN D INTAKE

You can get your allowance of vitamin D through egg yolks, herring, sardines, tuna, salmon and fortified milk, and through exposure to sunlight if you're not wearing a sunscreen. Three ounces of canned pink salmon provides you with 13.3 micrograms of vitamin D.

If you think you aren't getting enough of the nutrients you need, your health care provider may recommend changing your diet or adding supplements.

Antioxidants

Dietary antioxidants like vitamins A, C and E, are nutrients that help protect cells from a normal but damaging process known as "oxidative stress." These nutrients are part of the natural makeup of many foods, particularly fruits and vegetables. They are also added to some foods and are available as supplements.

Many studies suggest that consuming foods rich in dietary antioxidants can reduce your risk of diseases such as cancer; cardiovascular disease; cataracts; age-related macular degeneration, a common form of blindness in elderly people; diabetes mellitus; and neurodegenerative diseases.

How much of these antioxidant-containing nutrients do you need? Below are the recommendations:

Vitamin C

What's the recommendation?
The recommended daily intake for vitamin C is 75 mg. Limit your intake of vitamin C to no more than 2000 mg a day (from both food and supplements). Amounts higher than that may cause diarrhea.

Where is it found?
Good food sources of vitamin C include broccoli, cantaloupe, grapefruit, green peppers, kiwi fruit, oranges, potatoes with skin, strawberries and tangerines.

Vitamin E

What's the recommendation?
The recommended daily intake for vitamin E is 15 mg. Don't take more than 1,000 mg of alpha-tocopherol per day. This amount is equivalent to approximately 1,500 IU of "d-alpha-tocopherol," sometimes labeled as "natural source" vitamin E, or 1,100 IU of "dl-alpha-tocopherol," a synthetic form of vitamin E. Consuming more than this could increase your risk of bleeding because vitamin E can act as an anticoagulant (blood thinner).

Where is it found?
Good food sources of vitamin E include oils such as sunflower, safflower and cottonseed, sunflower seeds, almonds, tomato paste, avocados and peanut butter.

Selenium

What's the recommendation?
Women should consume 55 mcg a day of the mineral selenium.

Where is it found?
Selenium is found in nuts, tuna, meat and grains.

Experts find that most American adults get sufficient quantities of these three nutrients (vitamin C, vitamin E and selenium) from their food.

Beta-carotene and other carotenoids

What's the recommendation?
Carotene (also called beta-carotene) is an orange pigment in some plants that is important for photosynthesis. Carotenes are un-oxidized carotenoids.

In lab tests, these nutrients act as antioxidants. However, clinical studies in humans using supplements don't necessarily show they have a protective effect. Plus, beta-carotene supplements can be dangerous, particularly in people who currently smoke or have smoked in the past. You're better off getting these nutrients through foods.

Where is it found?
Beta-carotene is found in red, orange, deep-yellow and some dark-green leafy vegetables, such as tomatoes, carrots, sweet potatoes and broccoli.

The Evolution of Nutrition

As the science of nutrition continually evolves, researchers recognize that nutrients needed to maintain a healthy lifestyle must be tailored to the individual for maximum effectiveness. Recognizing that people are not all alike and that one size does not fit all when it comes to planning and achieving a healthful diet, the Institute of Medicine's dietary guidelines, titled "Dietary Reference Intakes for Macronutrients," stress the importance of balancing diet with exercise and recommends total calories based on an individual's height, weight and gender for each of four different levels of physical activity.

You can access the DRI tables at https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx.

The guidelines also establish ranges (called acceptable macronutrient distribution ranges or AMDR) for fat, carbohydrates and protein, instead of exact percentages of calories or numbers of grams. The report maintains that since all three categories serve as sources of energy, they can, to some extent, substitute for one another in providing calories.

Additionally, the guidelines recommend tolerable upper intake levels (UIL) to help avoid harm from consuming too much of a certain nutrient. The guidelines were primarily established for nutritional professionals to help them develop realistic, individualized eating plans for their clients.

Pregnancy

Nutrition is particularly important during pregnancy to ensure your health and the health of the baby. It's normal to gain weight during pregnancy—not just because of the growing fetus, but because you'll need stored fat for breast-feeding. The Institute of Medicine (IOM) recommends a gain of 25 to 35 pounds in women of normal weight when they get pregnant; 28 to 40 pounds in underweight women; and at least 15 pounds in women who are overweight when they get pregnant. The IOM has not given a recommendation for an upper limit for obese women, but some experts cap it as low as 13 pounds. If you fit into this category, discuss how much weight you should gain with your health care professional.

Pregnancy is not the time to diet. Restricting your calories during pregnancy can result in a low birthweight baby, which increases the risk of physical and developmental problems.

You should eat a healthful, well-balanced diet during pregnancy. However, you should avoid certain foods, including raw or undercooked fish, poultry and meat; raw or partially cooked eggs or foods containing raw eggs; unpasteurized juices; raw sprouts; unpasteurized milk products; and some soft cheeses (cream cheese is OK). Avoid deli meats and frankfurters unless they have been reheated to steaming hot before eating. To prevent food-borne illnesses, take the following precautions:

• Clean your hands and food contact surfaces in hot, soapy water, and wash fruits and vegetables well. Don't wash or rinse meat or poultry.
• Separate raw, cooked and ready-to-eat foods while shopping, preparing or storing.
• Cook foods to a safe temperature to kill microorganisms.
• Chill or refrigerate perishable foods right away, and always defrost foods properly—never defrost foods at room temperature or in hot water; instead, defrost in the refrigerator. Only defrost foods in the microwave that you plan to cook right away.

Going Meatless

Whether for health or moral reasons, millions of Americans prefer to avoid eating meats.

Many women decide to forego animal-related foods altogether; others follow a modified vegetarian plan. The four main types of vegetarian eating plans are:

1. Semi-vegetarian: a vegetarian eating plan, but with occasional meat, fish or poultry
2. Lacto-ovo-vegetarian: includes eggs and dairy products along with plant foods
3. Lacto-vegetarian: includes dairy products (except eggs) and plant foods
4. Vegan: no animal products at all; only plant foods

A healthy vegetarian diet falls within the guidelines offered by the USDA. However, meat, fish and poultry are major sources of iron, zinc and B vitamins, so pay special attention to these nutrients. Vegans (those who eat only plant-based food) may want to consider vitamin and mineral supplements; make sure you consume sufficient quantities of protein, vitamin B12, vitamin D and calcium. You can obtain what you need from non-animal sources. For instance:

Vitamin B12:

Fortified soy beverages and cereals

Vitamin D:

Fortified soy beverages and sunshine

Calcium:

Tofu processed with calcium, broccoli, seeds, nuts, kale, bok choy, legumes (peas and beans), greens, soy beverages, grain products (including bread, breakfast cereal and other breakfast foods) and calcium-enriched orange juice.

Iron:

Legumes, tofu, green leafy vegetables, dried fruit, whole grains and iron-fortified cereals and breads, especially whole-wheat (absorption is improved by vitamin C, found in citrus fruits and juices, tomatoes, strawberries, broccoli, peppers, dark-green leafy vegetables and potatoes with skins)

Zinc:

Whole grains (especially wheat germ and bran), whole-wheat bread, legumes, nuts and tofu.

Protein:

Tofu and other soy-based products, legumes, seeds, nuts, grains and vegetables

For the millions of people in the United States who follow vegetarian eating plans, the American Dietetic Association recommends you:

• Consult a registered dietitian or other qualified nutrition professional, especially during periods of growth, breast-feeding, pregnancy or recovery from illness.
• Minimize intake of less nutritious foods such as sweets and fatty foods.
• Choose whole or unrefined grain products instead of refined products.
• Choose a variety of nuts, seeds, legumes, fruits and vegetables, including good sources of vitamin C to improve iron absorption.
• Choose low-fat or nonfat varieties of dairy products, if they are included in the diet.
• Ensure adequate intakes of calories, vitamin D, calcium, iron and zinc for infants, children and teenagers. (Intakes of vitamin D, calcium, iron and zinc are usually adequate when a variety of foods and sufficient calories are consumed.)
• Take iron and folate (folic acid) supplements during pregnancy.

In addition, vegans should:

• Use properly fortified food sources of vitamin B12, such as fortified soy beverages or cereals, or take a supplement.
• Take a vitamin D supplement during pregnancy or while breast-feeding if they don't get at least 15 minutes a day of unobstructed sunlight.

If you are considering becoming a vegetarian or vegan, the American Dietetic Association recommends that you:

• Make a list of the meatless dishes you already enjoy and make an effort to eat these dishes more often
• Cut back on the amount of meat you eat at meals and replace it with vegetables, fruits and grains
• Look through vegetarian cookbooks and note what recipes appeal to you
• Order a vegetarian meal at your favorite restaurant
• Try an ethnic restaurant that offers vegetarian options

You may find the following Web sites helpful in deciding if a vegetarian or vegan lifestyle is for you:

The Vegetarian Society
www.vegsoc.org

VegWeb
https://vegweb.com

American Vegan Society
www.americanvegan.org

Vegan Outreach
www.veganoutreach.org/

Diagnosis

Poor nutrition may be one of the easiest conditions to self-diagnose. Look at the food pyramid and the suggested servings. Look at your diet. Are you getting the recommended daily amounts of fruits and vegetables? Enough calcium? Read the labels and compare what you eat to what you need. You may discover that even if your weight is ideal, you are not getting enough nutrition.

Poor nutrition can manifest itself in many ways. The more obvious symptoms of a nutritional deficiency include dull, dry or shedding hair; red, dry, pale or dull eyes; spoon-shaped, brittle or ridged nails; bleeding gums; swollen, red, cracked lips; flaky skin that doesn't heal quickly; swelling in your legs and feet; wasted, weak muscles; memory loss; and fatigue.

Underweight and Nutritional Problems

It's not always easy to tell why you are underweight, but being underweight often coincides with nutritional deficiencies that can show up in the symptoms described above. There are other potential dangers with being underweight, however. Thus, your health care professional should test levels of:

• Electrolytes. An electrolyte imbalance may indicate dehydration, malnutrition, self-induced vomiting and laxative and/or diuretic abuse.
• B12 and folic acid. These vitamins play a role in depression and anxiety. Additionally, lack of B12 and folic acid is associated with problems with protein, carbohydrate and fat metabolism, and with your body's ability to absorb nutrients.
• Blood glucose (blood sugar). Elevated or low blood sugar levels can be dangerous.
• Liver enzymes. A liver function test checks for gallbladder disease, liver disease, wear and tear due to excessive exercising or even a heart attack.
• Cholesterol. High cholesterol levels are more common in those who have problems with binging and anorexia.
• Thyroid function. A thyroid function test will rule out any possible problems with the thyroid gland, which can affect weight loss and gain.
• Urine. A urinalysis tests for a variety of systemic diseases and gauges kidney function, urine sugar and ketone levels. Ketones can quickly accumulate in the blood when the body is deprived of food and nutrients. High ketones can lead to coma and death.

Your health care professional may also take a blood pressure reading, a bone density test, test your red and white blood cell counts or perform an electrocardiogram to check your heartbeat.

Young Women and Eating Disorders

If you lose weight suddenly or for unknown reasons, talk to your health care professional immediately. Unexplained weight loss may indicate a serious health condition. And even if it doesn't, simply being underweight is linked to menstrual irregularity, menstrual cessation (and sometimes, as a result, dental problems, such as erosion of the enamel and osteoporosis) and a higher risk of early death.

While it's important to maintain a healthy weight and lose excess weight, excessive concern about weight may lead to eating disorders that include over exercising, self-induced vomiting and the abuse of laxatives or other medications.

Eating disorders usually affect women in their teenage years. One reason that women in this age group are particularly vulnerable to eating disorders is their tendency to go on strict diets to achieve an "ideal" figure. Researchers have found that such stringent dieting can play a key role in triggering eating disorders.

An estimated 0.3 to 1 percent of females suffer from anorexia nervosa, a dangerous condition in which they can literally starve themselves to death. Another 1 to 1.5 percent of women develop bulimia nervosa, a destructive pattern of excessive overeating followed by vomiting or other "purging" behaviors to control their weight.

Not everyone who is underweight suffers from an eating disorder, but anorexia and bulimia are serious health problems in this country; an estimated 500,000 women suffer from anorexia, and 1 to 2 million women struggle with bulimia. Women with anorexia nervosa starve themselves and/or exercise excessively, losing anywhere from 15 percent to 60 percent of their normal body weight. Some die. Women with bulimia nervosa binge on large quantities of food—up to 20,000 calories at one time—and then try to get rid of the excess calories. Some purge by inducing vomiting, abusing laxatives and diuretics or by taking enemas. Others fast or exercise to extremes.

But it's important to note that the problem here isn't food: Eating disorders are disorders that need to be treated by a psychiatrist and/or psychologist.

If you have an eating disorder, you not only run the risk of nutrition deficiencies, but damage to your throat and teeth (from vomiting), your bones (from lack of calcium and vitamin D) and your heart (from imbalanced electrolytes), among other problems.

A similar disorder is binge eating disorder, which involves uncontrolled eating without purging. Another disorder—"eating disorders not otherwise specified" (EDNOS)—refers to symptoms that don't fit into the other two categories of eating disorders.

Treating Eating Disorders

Not every underweight woman has an eating disorder. But for those who do, treatment is difficult and can require a team of health care professionals, including a dietitian, psychologist and physician. Methods include:

• Weight and eating normalization

• Psychotherapy (individual, group and family). Two specific types of psychotherapy have been found to help: cognitive behavioral therapy and interpersonal therapy

• Medical evaluation to stabilize you physically

• Nutritional counseling

• Medications for bulimia nervosa or to prevent relapse in women with anorexia nervosa who have managed to regain lost weight.

Aging and Nutrition Problems

As you age, you may have difficulty getting and absorbing certain nutrients.

Older people may not get the nourishment they need for several reasons:

• Difficulty chewing. Substitute softer foods, such as puréed and cooked fruits and vegetables and juices, ground meats and dairy foods (unless you have lactose intolerance).

• Loss of taste. Some medicines alter your sense of taste making you lose your appetite. Ask your health care professional if there are alternatives to the medicine you're taking. You might also experiment with spices to make foods tastier. Also, rotating tastes of each food on your plate, rather than eating one food at once, can help you taste various flavors better. Foods with strong scents also taste better, since taste and smell are linked.

• Loneliness. If you don't feel that cooking a healthful meal is worth the bother just for yourself, try to eat with family or friends whenever possible or try a senior center nutritional program.

• Stomach upset. Identify triggers and make substitutions. For example, if milk disagrees with you, try cream soups, yogurt and cheese to get your calcium. Likewise, swap troublesome vegetables like cabbage and broccoli for gentler ones, such as potatoes, green beans and carrots. Try fruit juices instead of fresh fruit.

• Difficulty preparing healthful meals. Because of the advent of healthful ready-to-eat meals or a daily visit from a care provider (such as Meals on Wheels), an elderly woman can have both convenience and nutrition.

• Medications. Some medications block or hamper absorption of certain nutrients in addition to hampering your ability to taste food. Talk to your health care professional about alternatives if this is a problem for you.

It's also important that you get enough liquid, since you may have a decreased sensitivity to thirst. Make it a priority to sip from a glass of ice water or other low-calorie, low-sugar beverage throughout the day.

Given the possibility of nutrient deficiencies in the elderly, talk to your health care professional about the possibility of supplementing your diet with calcium, vitamin D and vitamin B12.

Food Allergies and Intolerances

Everyone seems to have food allergies these days, but, in fact, such allergies are rare. According to the National Institute of Allergy and Infectious Diseases, while one in three adults either believe they have a food allergy or modify their family's diet, only about four percent actually do.

Actually, more people suffer from food intolerances, which don't involve the immune system. However, food intolerance symptoms—such as intestinal distress—may mimic those of a food allergy. If you have a food intolerance, talk to a nutritionist about diagnosis and treatment; if you have food allergies, you need to see an allergist. Whether you have food allergies or intolerance, you will need to develop a diet that fits your needs and avoids foods that trigger a reaction.

Treatment

Obviously, the best treatment plan for poor nutrition is to change your diet. Most Americans eat too little of what they need and too much of that they don't. For many women, decreasing fat and sugar consumption and increasing fruit, vegetables and grains in your diet can make a big difference. Many women also need to boost consumption of foods containing fiber, calcium and folic acid. Compare your diet to that suggested by the food pyramid and compare your nutrient intake to the suggested daily levels. Adjust accordingly, and you may be able to dramatically improve your health.

Health care experts haven't reached a consensus on the issue of vitamin and mineral supplements. Many say that if you are healthy and eat a well-balanced diet, you don't need any. But not all of us eat a well-balanced diet. And sometimes, you may follow a nutritious diet and still be deficient. Many women fail to get the adequate amount of vitamins and minerals. Stress increases your need for vitamins and minerals, especially C, B-complex and zinc.

Specifically:

• Women of childbearing age should take a folic acid supplement to reduce the risk of certain birth defects in their baby if they get pregnant.
• Many women and adolescent girls don't get adequate calcium, which is critical to healthy bones and avoiding osteoporosis.
• Women with diabetes may want to talk with their health care professionals about supplementing with chromium, which some studies suggest may enhance blood sugar control.
• Vegetarians, especially vegans, may want to consider supplements to obtain nutrients they aren't getting from their diets.

In most cases, a multivitamin with minerals meeting 100 percent of the daily reference intakes (DRIs) minerals is adequate. Consult your health care professional if you have questions.

Dieting to Achieve Your Ideal Weight

If you are considerably over your ideal weight, you and your health care professional may consider a weight-loss program. But be realistic. Popular culture says that losing weight is simply a matter of willpower, but that's not really true.

The American Society of Bariatric Physicians maintains that obesity results from a complex interaction of genetic, behavioral and environmental factors; this interaction causes an imbalance between energy intake and energy expenditure. Accordingly, any weight-loss program should include an exercise and behavioral component.

Something else to remember: an estimated 90 to 95 percent of dieters who lose weight regain all or part of it within five years, and the consequences can be even worse than simply being overweight. Those who exercise regularly as part of a weight loss diet and maintenance program are more likely to keep the weight off. Also note that an overly restrictive diet can lead to more overeating, a natural reaction to food deprivation.

• If you do decide to diet, you still need to maintain good nutrition. You want to cut back on calories, not nutrients. And while you want to reduce fat, don't eliminate it entirely. Some studies suggest that older women who maintain a higher body-fat percentage are less likely to suffer from osteoporosis and other conditions associated with menopause. Fat cells also retain estrogen, which helps maintain the calcium in your bones. Younger women should be careful, too: a low body fat percentage can lead to infertility; below 17 percent may lead to missed periods, also known as amenorrhea.
• Don't take dramatic steps alone. You need to work closely with an experienced health care professional to lose weight, particularly if you have other medical problems, plan to lose more than 15 to 20 pounds or take medication on a regular basis. An initial checkup can identify conditions that might be affected by dieting and weight loss. Make sure you find out how much experience your health care professional has dealing with nutrition. It's not always well covered in medical schools. You may want to talk to a registered dietitian before embarking on a diet.
• Slow and steady wins the race. Your weight-loss program should be geared toward slow, steady weight loss. Unless your health care professional advises otherwise, don't plan to lose more than a pound or so per week. And don't be deceived by an initial rapid weight loss; that's just "water weight" loss as your body tissue releases retained water.
• Focus on the long term. Diets fail when people fall back into poor eating habits; maintaining weight loss over the long term is exceedingly difficult. Most people regain the weight they've lost. In fact, some studies indicate that 90 to 95 percent of all dieters regain some or all of the weight originally lost within five years. Your program should include plans for ongoing weight maintenance, involving diet, exercise and a behavioral component. While there are some physical reasons for obesity, there are also behavioral reasons for excessive eating. For example, many women use food as a source of comfort (perhaps to deal with stress). For these women, a weight loss program with a behavioral component will offer alternatives to replace food in this role.
• Be a careful consumer. Evaluate diet books, commercial weight-loss programs and medications carefully. Before you sign up with a weight-loss center, get a detailed statement of fees and costs of additional items, such as dietary supplements and food.

Facts to Know

1. You should consume only 25 percent to 35 percent of your total calories per day from fat, with a significant portion from good fats like omega-3 and omega-6 fatty acids. According to the American Heart Association, women should get at least five to 10 percent of their total daily calories from omega-6 fatty acids (equal to 12 to 20 grams), and anywhere from 0.5 to 3 grams of omega-3 fatty acids, depending on individual risk for heart disease.
2. The recommended amount each day for sodium intake is less than 2,300 mg—you get that much in just one teaspoon of salt. If you're 51 or older the recommended amount is 1,500 mg.
3. Vegetarians—especially vegans (who eat no meat or animal products at all, just plant-based foods)—need to monitor their eating to make sure they get enough iron, zinc, B vitamins, protein, vitamin D and calcium.
4. Some experts recommend supplements of calcium, vitamin D and vitamin B12 for seniors.
5. Over 35 percent of adult women in the United States are considered obese; this puts them at increased risk of hypertension, type 2 diabetes, heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems and certain types of cancers. Studies also find a correlation between obesity and early death.
6. For women, obesity is usually defined as having a BMI of 30 or greater. You are morbidly obese if your BMI is equal to or greater than 40.
7. Any weight-loss program should focus on slow, steady weight loss.
8. Before starting on any "dietary supplement," check with your health care professional and gather information via the International Bibliographic Information on Dietary Supplements at https://medlineplus.gov/dietarysupplements.html.
9. Not everyone who is underweight suffers from an eating disorder, but anorexia and bulimia are serious problems in this country, affecting 500,000 and 1 to 2 million women respectively.
10. Refrigerate or freeze perishables, prepared food and leftovers within two hours, and never defrost food on the kitchen counter. Use the refrigerator, cold running water or the microwave.

Questions to Ask

Review the following Questions to Ask about nutrition so you're prepared to discuss this important health issue with your health care professional.

1. Should I take supplements to meet my nutritional needs?
2. What is my body mass index (BMI)? What does BMI mean?
3. Do I need to lose or gain weight? What is the best strategy?
4. How much experience do you have handling nutrition and weight issues? Should I see a specialist? What type of specialist?
5. Should I take weight-loss drugs?
6. I'm pregnant. Are there ways to limit my weight gain?
7. Do any of my health conditions require a special diet?
8. Do I need more of certain nutrients?
9. What is my cholesterol level? How does my diet affect my cholesterol level?
10. What role are diet and weight playing in my overall health?
11. Do any of the medications I take cause weight gain or weight loss?

Key Q&A

Organizations and Support

For information and support on Nutrition, please see the recommended organizations, books and Spanish-language resources listed below.

American Dietetic Association
Website: https://www.eatright.org
Address: 120 South Riverside Plaza, Suite 2000
Chicago, IL 60606
Hotline: 1-800-877-1600
Email: adaf@eatright.org

FDA Center for Food Safety and Applied Nutrition
Website: https://www.fda.gov/AboutFDA/CentersOffices/OfficeofFoods/CFSAN/default.htm
Address: Outreach and Information Center
5100 Paint Branch Parkway
College Park, MD 20740
Hotline: 1-888-SAFEFOOD (1-888-723-3366)

Food Allergy Research & Education
Website: https://www.foodallergy.org/
Address: 7901 Jones Branch Drive, Suite 240
McLean, VA 22102
Phone: 703-691-3179

Food and Nutrition Information Center (FNIC)
Website: https://www.nal.usda.gov/fnic
Address: National Agricultural Library
10301 Baltimore Ave., Rm. 105
Beltsville, MD 20705
Phone: 301-504-5414
Email: fnic@nal.usda.gov

Food Safety and Inspection Service
Website: https://www.fsis.usda.gov
Address: 1400 Independence Ave., SW
Room 3168 South Building
Washington, DC 20250
Hotline: 1-800-336-3747

National Dairy Council
Website: https://www.nationaldairycouncil.org
Address: 10255 W. Higgins Rd., Suite 900
Rosemont, IL 60018
Email: ndc@dairyinformation.com

Office of Ground Water and Drinking Water
Website: https://www.epa.gov/safewater
Address: Office of Ground Water and Drinking Water (4601)- Ariel Rios Building
1200 Pennsylvania Avenue, NW
Washington, DC 20460
Hotline: 1-800-426-4791
Phone: 202-564-3750

United States Department of Agriculture
Website: https://www.usda.gov
Address: 1400 Independence Ave., S.W.
Washington, DC 20250
Email: agsec@usda.gov

Vegetarian Resource Group
Website: https://www.vrg.org
Address: P.O. Box 1463, Dept. IN
Baltimore, MD 21203
Phone: 410-366-VEGE (410-366-8343)
Email: vrg@vrg.org

Books

American Heart Association Quick & Easy Cookbook: More Than 200 Healthful Recipes You Can Make in Minutes
by American Heart Association

The China Study: The Most Comprehensive Study of Nutrition Ever Conducted And the Startling Implications for Diet, Weight Loss, And Long-term Health
by T. Colin Campbell , Thomas M. Campbell II , Howard Lyman, and John Robbins

Collins Alternative Health Guide
by Steven Bratman

Eat, Drink, and Be Gorgeous
by Esther Blum and James Dignan

Fight Fat After Forty: The Revolutionary Three-Pronged Approach That Will Break Your Stress-Fat Cycle and Make You Healthy, Fit, and Trim for Life
by Pamela Peeke

Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health
by Gary Taubes

Good Cholesterol Bad Cholesterol: An Indispensable Guide to the Facts about Cholesterol
by Anita Hirsch R.D.

Health and Nutrition Secrets That Can Save Your Life
by Russell L. Blaylock M.D.

How It All Vegan!: Irresistible Recipes for an Animal-Free Diet
by Sarah Kramer and Tanya Barnard

Month of Meals: Meals in Minutes
by American Diabetes Association

Month of Meals: Vegetarian Pleasures
by American Diabetes Association

Prescription for Nutritional Healing
by Phyllis A. Balch

Skinny Bitch
by Rory Freedman and Kim Barnouin

Strong Women Eat Well: Nutritional Strategies for a Healthy Body and Mind
by Miriam E. Nelson and Judy Knipe

You: The Owner's Manual: An Insider's Guide to the Body that Will Make You Healthier and Younger
by Michael F. Roizen and Mehmet C. Oz

Spanish-language resources

Medline Plus: Nutrition
Website: https://www.nlm.nih.gov/medlineplus/spanish/nutrition.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov