Sunday, July 28, 2013

How to Cook Healthy Food for Kids : Does Milk Do a Body Good?

I grew up height-challenged.  It wasn't enough that I was CRISCO Oil the shortening, but I was also on the short end of the stick, literally.  Being short didn't help my self esteem, status on the soccer field, or non-existent love life.  My parents tried to make me feel better by convincing me that there were actual measurable changes in the pencil markings on the kitchen wall.  My dad told me that drinking milk would help me grow, so I chugged down a gallon a week of the white stuff.  Despite growing up insecure about my height, I am now a happy and secure 5 feet and 10 inch tall man...with shoes.  To this day, my dad swears that milk is a magical elixir, though he is ironically lactose intolerant.

Giving your kids milk won't turn them into giants.  But it will give them important micronutrients to help them reach the maximum growth potential that is otherwise determined by their genetic makeup.  Your child's bones need calcium to grow.  Their bones also need adequate amounts of vitamin D to help them absorb that calcium.  Because vitamin fortified milk is a significant source of both calcium and vitamin D, it is critical for kids to get enough milk for normal growth and development.  But I realize now that my growth was as much about what I was drinking as it was about what I was not drinking.

Between 1965 and 1996, milk consumption amongst adolescents decreased by 36% and was displaced by a corresponding increase in consumption of soft drinks and fruit juices.  I discussed the harms of sugary beverages in the following post:

Indeed, one study showed that sweetened beverage and not milk intake predicted unhealthy weight gain amongst five year old children.  In that study, children who drank two or more servings of sweetened beverages per day had a higher percentage body fat, belly fat, and weight status over the following decade.  Habitual consumption of sugar-sweetened beverages in not only hazardous to the health of children, but it effectively stunts their growth because it displaces milk drinking.  On the flip side, replacing habitual consumption of sugar-sweetened beverages with milk has been associated with increases in muscle mass and height. 

However, one concern with milk is that it contains saturated fat.  As discussed in the previous post, saturated fat is considered a bad fat, which is why I recommend cutting out unnecessary saturated fat.

The operative word here is unnecessary.  Some dietary fat is necessary for the adequate absorption of vitamin D, which is a fat soluble vitamin.  In order to give your children some necessary fat, but also avoid excessive fat intake, parents can consider giving their growing kids reduced fat milk (1% or 2%) starting between the ages of one and two, as recommended by the American Academy of Pediatrics.

How much milk is enough to support the growing bones of children?  One study found that amongst healthy children two to five years of age, two cups of cow’s milk per day was sufficient to maintain healthy vitamin D levels.  One notable exception was that children with darker skin pigmentation required three to four cups of cow’s milk per day during the winter months to maintain healthy vitamin D levels because such children do not otherwise manufacture enough vitamin D from sun exposure.

In addition to drinking milk as a beverage, another common source of saturated milk fat is heavy cream like that found in ice cream.  Everyone likes ice cream...well with the exception of my dad.  I decided to make a healthier ice cream which incorporates all three of my principles for managing fat intake: eating essential fats, cutting down on saturated fats, and substituting good fats for bad fats. 

So, I put in the arduous, pain-staking hours in the kitchen experimenting with different fats, different levels of cream, taste testing, and then taste testing again until I was satisfied with a decent tasting but reduced fat ice cream.  Its tough work, but that's the level of dedication you get from Doctor ChrisKo.  Ultimately, I found that avocados were an ideal ingredient to reduce saturated fat, provide a smooth texture, and still enable peppermint to be the predominant flavor.  Even better, my son Colin absolutely loves avocados, which he refers to as "cados".  Please enjoy the following video highlighting this work:

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Reduced Fat Mint Ice Cream (Cados and Cream)

  • 1.5 ripe avocados, peel and pit discarded
  • 2 cups plain low fat yogurt
  • 1/2 cup half and half
  • 4 tbsp sugar
  • 1/2 tsp pure peppermint extract
  • pinch of salt
  1. Blend all ingredients in a blender until smooth
  2. Transfer blended mixture to an airtight container, freeze, and stir every half hour for 2-3 hours (For a creamier texture, invest in an ice cream maker) 

    Cavadini C et al.  US adolescent food intake trends from 1965 to 1996.  Arch Dis Child 2000;173:378-383.

    Keller KL et al.  Increased sweetened beverage intake is associated with reduced milk and calcium intake in 3-7 y. old children at multi-item laboratory lunches.  J Am diet Assoc 2009;109:497-501.

    Fiorito LM et al.  Beverage intake of girls at age 5 y predicts adiposity and weight status in childhood and adolescence.  Am J Clin Nutr 2009;90:935-42.

    Albala C et al.  Effects of replacing the habitual consumption of sugar-sweetened beverages with milk in Chilean children.  Am J Clin Nutr 2008;88(3):605-11.

    Daniels SR et al.  Lipid Screening and Cardiovascular Health in Childhood.  Pediatrics.  2008;122:198-208.

    Maguire et al.  The Relationship Between Cow’s Milk and Stores of Vitamin D and Iron in Early ChildhoodPediatrics 2013; 131:1 e144-e151.

    Ludwig DS & Willett WC.  Three Daily Servings of Reduced-Fat Milk: An Evidence-Based Reccomendation?  JamaPediatrics; 2013.

    Thursday, July 25, 2013

    Outbreak of Foodborne Illness in Multiple States Caused by Cyclospora

    On June 28, 2013, the CDC was notified of two laboratory-confirmed cases of Cyclospora infection in Iowa.  As of July 24, 2013, the CDC has been notified of at least 285 cases of Cyclospora infection involving residents of multiple states including Iowa, Nebraska, Texas, Wisconsin, Georgia, Connecticut, New Jersey, Minnesota, and Ohio.  Some of these cases warranted hospitalization.  
    Cyclosporiasis is an infection transmitted by a parasite which is often found in tropical countries.  Although no specific food source has been identified as the culprit for the current Cyclospora outbreak, fresh produce has been implicated in previous outbreaks.  

    Foodborne outbreaks such as these remind us of the importance of thoroughly washing our fresh fruits and vegetables before serving them to ourselves or our kids.  Stay up to date with the status of this current outbreak by tuning into the CDC website at the following link:

    Sunday, July 21, 2013

    How to Cook Healthy Food for Kids : You Take the Good and Cut the Bad, and There You Have the Fats of Life

    There comes a time that every parent dreads. Its a conversation that parents know they need to have with their kids, but they may not know where to begin. As a result, many parents put this conversation off and their kids go around making bad choices and suffering the consequences. I'm talking about having an honest conversation with your kids about the fats of life. 

    In the previous post, I recommended a three-pronged approach to fats:

    1. Start with making sure you get the essential fats you need. 
    2. Cut out unnecessary bad fat. 
    3. When possible, substitute good fats for bad fats.
     You can read about step one of this approach at:

    In this post, I focus on cutting out unnecessary bad fat. In order to do that, we need to first differentiate good fats from bad fats. Fats differ in how many hydrogen atoms they contain. Fats that have all their hydrogen atoms are saturated. Fats that have missing hydrogen atoms are unsaturated. Monounsaturated fats have one hydrogen atom missing and polyunsaturated fats have more than one hydrogen atom missing. 

    The point of going through the chemistry of fats is not to saturate your brain with worthless chemical jargon, but to point out that fats are not all the same. The unique chemical structures of fats give them unique properties. For instance, unsaturated fats tend to be liquid while saturated fats tend to be solid at room temperature. Furthermore, an unsaturated fat can become solid through a process called partial hydrogenation. A fat thus produced is called a trans fat and has an enhanced shelf-life.

    Trans fats may be good for shelf life, but they're not good for you. Multiple studies have demonstrated that high trans fat intake is associated with negative effects on blood cholesterol and higher risk of heart disease. As a result, most processed foods have now eliminated trans fats.

    The idea that saturated fat is bad and unsaturated fat is good is based on the opposite effects these types of fats have on "bad" blood cholesterol particles called Low Density Lipoprotein (LDL) particles.  Research shows that LDL particles play a significant role in the development of artery clogging heart disease.  Saturated fats tend to raise LDL levels while unsaturated fats tend to lower LDL levels.  Studies show that reducing intake of saturated fat can reduce your risk of a heart attack by 14%. Additionally, substituting polyunsaturated fats for saturated fats is associated with as much as a 45% reduction in heart disease.

    Based on this data, I recommend cutting out unnecessary saturated fat and substituting unsaturated fat for saturated fat when you can.  Saturated fats are found predominantly in animal meats and products such as butter, milk, and cheese. Unsaturated fats are found in fish, olives, avocado, nuts, seeds, and plant based cooking oils.  

    How To Reduce Unnecessary Bad Fat

    One practical tip to help you cut out unnecessary saturated fat is to avoid buying packaged ground meat.  Most packaged ground meat has much higher amounts of fat than people realize.  The confusion lies in the front of the packaging which describes ground meat in terms of percent lean by weight.  Because meat contains water and water has no calories, weight based descriptions make the protein content seem much higher and the fat content seem much lower than they actually are.

    For example, take a look at the following nutrition label for ground beef, described as 85% lean and 15% fat:

    As you can see, in an eighty-five gram serving of this ground beef, there are twelve grams of total fat, nearly half of which is saturated fat.  Twelve divided by eighty-five gives you 15% fat by weight.  To confirm the lean percentage, you first look at the amount of protein in the same serving, which is twenty-two grams.  But twenty-two divided by eighty-five is not 85%.  The rest of the lean mass comes from water, which contributes a whopping fifty-one grams of weight.  When you add the weight of water to the weight of protein and divide that by eighty-five, you get 85% lean ground beef by weight.  Most people would naturally assume that 15% of the energy provided in a serving of this ground beef comes from fat and 85% of the energy comes from protein.  However, when you look at the top of the nutrition label and look at total calories (204) and calories from fat (110) in a serving of this ground beef, you realize that it actually contains more than 50% fat content by calorie

    Perhaps you aren't surprised by this example because you already assume that beef is fatty.  What about ground turkey?  Turkey is considered a leaner source of protein, but you may be surprised to learn that even turkey can contain quite a bit of fat when the fattier parts of the turkey are sold in ground form.  For example, if you look at the following nutrition label for ground turkey and go through the same calculations as above, you will confirm that a serving of this ground turkey is indeed 93% lean with 7% fat content by weight

    However, if you look at total calories (160) and calories from fat (70), you will realize that even ground turkey can contain nearly 50% fat by calories!

    You can cut out unnecessary saturated fat but still enjoy the texture of ground meat by grinding your own meat.  In the following movie clip, I demonstrate how to grind your own meat and introduce you to a tasty new recipe.  I'm sure you've seen Star Wars.  You've probably also seen Space Balls.  But you've never seen Tofu Chicken Balls!

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    Here is a link to the recipe for tofu ball soup that I featured in the above video.

    I adapted the recipe by grinding up lean chicken breast instead of using store bought ground pork.  If you don't have a meat grinder, you can ask your butcher to grind up lean chicken or turkey breast for you.  For added nutrition, you can also add any dark green leafy vegetable to the soup such as dandelion greens, bok choy, or spinach.


    Dhaka V et al.  Trans fats-sources, health risks and alternative approach - A review.  J Food Sci Technol 2011 Oct; 48(5):534-41.

    Hooper L.  Dietary fat intake and prevention of cardiovascular disease:
    systematic review.  BMJ. 2001 March 31; 322(7289): 757–763.

    Mozaffarian D et al. Effects on Coronary Heart Disease of Increasing
    Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. P
    LoS Medicine.  2010;7(3):1–10

    Sunday, July 14, 2013

    How to Cook Healthy Food for Kids : Steam a Whole Fish Recipe

    Dietary fat can be a confusing topic.  Some of the confusion stems from intentionally misleading food labeling which disguises the amount of fat in foods.  Some of the confusion comes from the assumption that all fat is bad.  Governmental recommendations for daily intake of fat based on percentage of caloric intake add even more confusion as such guidelines are impractical and impossible to apply to day to day life.  Over the next few posts, I am going to simplify the way you think about dietary fats for yourself and your kids.

    First, not all fats are created equal.  A simple way of thinking about dietary fats is to break them up into the good, the bad, and the essential.  Based on this categorization, I deal with dietary fats using a three-pronged approach:

    1. Start with making sure you get the essential fats you need. 
    2. Cut out unnecessary bad fat. 
    3. When possible, substitute good fats for bad fats.
    This post will focus on essential fats and subsequent posts will discuss good versus bad fats.  Humans need some dietary fat to function normally.  For instance, dietary fat is required for the normal absorption of fat soluble vitamins such as vitamins A, D, E, and K.  On top of that, your body requires certain essential fats for normal function and metabolism.

    There are two sets of essential fats that your body needs from your diet: linoleic acid and linolenic acid.  Linoleic acid belongs to a family of fats called omega-6 fatty acids, while linolenic acid belongs to a family of fats known as omega-3 fatty acids.  While both are essential, the fats that most people need to focus on incorporating into their diet are omega-3 fatty acids.  The reason for this is that dietary sources of omega-6 fatty acids such as cooking oils are so abundant in the typical American diet that most people get enough of them even without trying.  Also, there is evidence that a high ratio of omega-6 to omega-3 fatty acids in the diet is associated with inflammation and higher risk of many diseases such as heart disease and cancer.   

    On the other hand, a recent study showed that people with higher levels of omega-3 fatty acids in their bloodstream lived longer and had less fatal heart disease.  Unfortunately, many people do not get adequate amounts of omega-3 fatty acids in their diet.  Omega-3 fatty acids can be found in walnuts, flaxseeds, chia seeds, canola oil, and seafood.  The richest source of omega-3 fatty acids is fish.  And while many people have heard about the benefits of eating fish, they may be concerned about the risks of mercury exposure from fish consumption. 

    In fact, regular but modest fish consumption provides essential fats and significant health benefits with negligible risk.  Eating one to two 6 ounce servings of fish per week reduces the risk of death by 17% and the risk of death from heart disease by 36%.  Particularly rich sources of omega-3 fatty acids are oily fish such as salmon, herring, sardines, and anchovies.  You can reduce your risk of mercury exposure by eating smaller fish that are lower on the food chain such as salmon, herring, sardines, anchovies, pollock, and catfish.    

    How To Steam a Whole Fish 

    One of the easiest and most delicious ways you can prepare fish for yourself and your kids is to steam a whole fish.  I remember growing up enjoying the savory tenderness of fish prepared in this manner.  Steamed whole fish is especially popular in Asian cuisines.  Check out this "catchy" video to learn how easy it is to cook your own catch of the day:  


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    Here is the link that I used to prepare the fish in the above video:


    De Lorgeril M & Salen P.  New insights into the health effects of dietary saturated and omega-6 and omega-3 polyunsaturated fatty acids.  MC Med. 2012. 

    Simopoulos AP.  The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases.  Exp Biol Med.  2008.  

    Mozaffarian D et al.  Plasma phospholipid long-chain w-3 fatty acids and total and cause-specific mortality in older adults.  Ann Intern Med 2013;158:515-525.

    Mozaffarian D & Rimm E.  Fish intake, contaminants, and human health: evaluating the risks and the benefits.  JAMA.  2006;296:1885-1899.

    Sunday, July 7, 2013

    How to Cook Healthy Food for Kids : Make a Healthy Chickpea and Gluten Free Snack For Your Kids

    The house was quiet.  Too quiet.  And then I heard it.  A rhythmic crunching sound.  Out of the corner of my eye, I saw that the kitchen pantry door was ajar.  I knew that I hadn't left the pantry door ajar.  That could only mean one thing.  I walked over and of course, there was Colin gleefully munching away on a bag of shrimp chips.  But how could I be upset with him?  His body told him he was hungry and he was resourceful enough to help himself to a snack.

    In 1977, the average American child was snacking about once per day.  By 2006, the average American child was snacking more than twice per day.  But is snacking good or bad?  I contend that snacking is good, but most of the processed snacks kids are eating these days are bad.  For example, adolescents who regularly snack on candy, ice cream, and packed fried snacks are more likely to be overweight.

    However, while many snack foods are bad for you, snacking can be good for you if you eat healthy snacks.  For instance, one study showed that adolescent females who ate more frequently and snacked more frequently were less likely to have significant weight gain and increases in belly fat over a ten year period.  Healthy snacking is good for your kids for the following reasons:
    1. Snacking controls hunger.
    2. Eating several small meals induces smaller spikes in blood glucose levels.
    3. Scheduled healthy snacking reduces the likelihood of snacking on junk food.
    4. Snacking actually increases the likelihood that your kids will eat their vegetables!
    An interesting study entitled, "First Foods Most" provides insight into this last point.  In this study, college kids who fasted before being served a lunch buffet were three times as likely to start their buffet with starches like bread rolls and french fries and two times less likely to start their buffet with vegetables compared to college kids who did not fast.  Also, regardless of whether subjects fasted or not, all subjects ate 50% more of the food item that they started their buffet with.  Based on this study, if your kids eat more frequently by having scheduled healthy snacks, they will be less likely to be in a "starved" state going into their meals.  Rather than spoiling their appetite, healthy snacking may actually get your kids to eat their vegetables first and most!

    Craving Something Salty?

    Are your kids craving something salty?  Here's a link to a simple recipe to make your own homemade savory seasoning (you don't need to add the brewer's yeast):

    Although the above recipe is for popcorn, I don't recommend popcorn as a snack for kids until they are old enough to floss because the pieces of kernel can get stuck in their teeth and cause cavities.  Instead, try this same seasoning on whole foods such as nuts, seeds, or chickpeas:

    Simple Savory Chickpea Recipe

    • 1 can chickpeas
    • Seasoning
    1. Preheat oven to 400 degrees F. 
    2. Drain chickpeas.  
    3. Shake chickpeas with 1/2 tsp of seasoning in ziplock bag
    4. Bake on foil lined pan for 30 minutes, tossing twice in between  

    Craving Something Sweet?

    In this clip, I show you an easy recipe for homemade cookies that I learned from Kristen Leidelmejier, the personal chef that I work with to improve the health of my patients.  These cookies have no added sugar and are much healthier than the typical store bought cookie.

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    Simple Sugar Free Flourless Cookie Recipe

    (About 18 cookies)


    • 1/2 cup rolled oats
    • 1/2 cup unsweetened applesauce or mashed banana
    • 1/4 cup natural peanut butter
    • 1/2 tsp pure vanilla extract
    • dash of salt
    • 2 tbsp chopped walnuts or dried fruit
    • Optional: 1-2 tbsp dark chocolate chips
    1. Preheat oven to 350 degrees F. 
    2. Mash the applesauce or banana with the peanut butter, then add all other ingredients and mix well. 
    3. Shape into cookies and bake on a greased cookie sheet for 15 minutes.     


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    McDonald CM et al.  Overweight is more prevalent than stunting and is associated with socioeconomic status, maternal obesity, and a snacking dietary pattern in school children from Bogota, Colombia.  J Nutr  2009;139:370-376.

    Griffiths AJ et al.  Immediate metabolic availability of dietary fat in combination with carbohydrate.  Am J Clin Nutr 1994;59:53-9.

    Ritchie LD.  Less frequent eating predicts greater BMI and waist circumference in female adolescents.  Am J Clin Nutr 2012;95:290-6.

    Wansink B et al.  First foods most: after 18-hour fast, people drawn to starches first and vegetables last. Arch Intern Med 2012;172(12):961-963.

    Johansson I et al.  Snacking habits and caries in young children.  Caries Res 2010;44:421-430.

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