Off Balance

Confused by the latest food pyramid? Join the club.

Whoever coined the adage, “An apple a day keeps the doctor away,” presumably didn’t work for a government agency. Not that it’s bad advice—especially if you consider the apple’s role in boosting the immune system and lowering cholesterol.

Health advocacy experts contend that the food pyramid—which comes in 12 versions—is too overwhelming for the average American.Regardless, a 2008 study by the American Dietetic Association suggests that the federal government could do a better job with its dietary guidelines. Among those surveyed, 41 percent conceded they might try to eat right if they understood more about nutrition. In short, many of us are confused about the food groups (the latest food pyramid has six), and we avoid worrying about things like portion size and daily caloric intake if it’s going to be a lot of work.

To maintain a well-balanced diet, we’re told to eat foods from each of the six food groups—grains, vegetables, fruits, oils, milk and meat, and beans. But who has the time to keep tabs on whether they’re eating two cups of fruit a day, along with two-and-a-half cups of vegetables and 3 or more ounces of whole grains? You remember the slice of pizza you had for lunch—not that it took up most of the plate. It’s no wonder registered dietitians like Christine Hurley resort to body parts for clarity—a clenched fist equals a cup, an open palm is one serving of red meat or chicken.

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“Many people know that breakfast is important, but they may not think about timing or portion,” says Hurley, who sees about 60 patients a week at Bryn Mawr Hospital’s Newtown Square campus, all of them referred to her through Main Line Health’s Diabetes and Nutrition Management centers. “When you wake up, your brain is saying, ‘Where’s my glucose?’ It needs that little shot of sugar every four or five hours.”

Making sense of “glycemic load,” “body mass index” and “dietary reference index” is crucial if you have a pre-diabetic condition and are susceptible to severe fatigue and drops in blood sugar levels. All three terms appear in Dietary Guidelines for Americans, the official guide to healthy eating published every five years by the U.S. Department of Health and Human Services and the Department of Agriculture. The 2010 edition is still in the works. The food pyramid was revised in the 2005 version, which also recommends fewer calories and “smarter” food choices like whole fruits over fruit juice and whole-wheat bread instead of white.

The most recent recommendations have received mixed reviews from the ADA and other health advocacy groups. Some like the fact that they stress the equal importance of each food group. Others question why daily servings were removed in favor of vague terms like “know the limits on fats, sugars and salt (sodium).”

Still others contend that the food pyramid—which comes in 12 versions—and the accompanying guidelines are too overwhelming for the average American. In recent years, we’ve all heard about the brain’s “craving” center, good and bad cholesterol, and the saturated fats that can either help or hinder protein-carrying molecules in the bloodstream. Then there’s the list of formerly bad foods made good. Who would’ve thought that chocolate—at least the dark, “true organic” kind—is actually good for you? In case you haven’t heard, it’s the stuff with the most cacao beans, which enhance mood and cognitive function.

But you don’t need a calculator, a scale or a pair of reading glasses to learn how to eat healthy. You simply need to know how your lifestyle affects your nutrition. “Timing is huge,” Hurley says. “I ask everyone who comes in here what time they get up, what time they go to bed, and when they have breakfast, lunch and dinner.”

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Hurley also asks patients to complete a lifestyle questionnaire documenting former diets and eating habits, and to keep a food diary—initially, at least. Patients may continue with the diary entries (discreetly recorded in a slender folder the size of a checkbook) or try a neat little menu tool with color-coded cards showing the different food groups.

Many men and women over the age of 55 experience “weight creep” or changes in blood pressure. “Every decade, your metabolism slows down by about 5-10 percent,” says Mary Martin, a nutritionist at Paoli Hospital.

Hence, Martin’s favorite motto: eat less, move more.

Both Hurley and Martin have seen an increase in pre-diabetes. Found in patients with elevated blood sugar levels and abdominal fat, the condition can lead to damage of the heart and arteries. But it also can be reversed with weight loss. can help with that. It offers personalized eating plans and interactive tools to help you lose weight with low-energy-dense foods—those that fill you up but have fewer calories because they’re full of water or fiber. Such suggestions are helpful, Hurley says, but she’d rather customize a plan after consulting with the patient.

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“To be honest, I don’t really use the food pyramid,” she admits. “I like the website, but I don’t really refer to that much.”

Hurley keeps it simple, knowing that people have an easier time sticking to a diet if they have some semblance of control and it fits their lifestyle. “What we’re good at is teaching people how to eat and to cheat within medical guidelines,” she says. “We know all the tricks.”

Hurley’s desk if full of tidy rows of boxes and food packages ready for grabbing when she wants to show patients how to read labels. Avoid the “whole grain” or “high in fiber” marketing lingo on the front, she says. Stick to the “Nutritional Facts,” especially when it comes to fiber content. “The first thing I tell people is that you want 3 or more grams of fiber in everything you buy,” Hurley says.

As for explaining the USDA’s recommendations for a 2,000-calorie-per-day balanced diet, Hurley doesn’t bother. “When it comes to getting people to eat right, a picture is worth a thousand words,” she says.

To show how easy it is to overeat, Hurley keeps a bowl in her office. With something like cereal, it’s tempting to use a large bowl, but even a little more can boost your sugar intake for the day. A three-section picnic plate is a good way to change your eating habits and get used to the idea that veggies, carbs and protein comprise a well-balanced diet. Just remember to “flip” the portion sizes: That little pile of green beans should go in the section once reserved for chicken or meat.

Scientists are still discovering new minerals and vitamins, so don’t even try to keep up. For most, a multivitamin is all they need. And when it comes to food, think color.

“You always want a colorful plate,” Hurley says as she arranges pieces of fake food she keeps in her office. “Here’s your signature salad. I like the stoplight peppers—the reds, yellows and greens. But you also want color on your dinner plate. It’s so important that, about 12 years ago, the National Cancer Institute actually sent notices to every nutritionist in the county telling us to emphasize color.”

As for getting that first dose of glucose each day, Hurley and Martin recommend whole-grain, high-fiber cereals. But if they can’t live without their Fruit Loops, “I tell them that whatever fits into a cup is all right,” Hurley says.

Five Signs That You May Be Eating Poorly

1. You feel tired or stiff all the time.
2. You’re having trouble sleeping.
3. You have bouts of feeling faint or
4. You crave sugar or salt.
5. Your blood pressure is high.

The Nutrition Quiz

1. Whole grains and cereals have a larger space on the food pyramid than meat and beans.
2. Certain fats and oils are now acceptable.
3. Avoiding sleep helps you loose weight.
4. Nutritionists recommend eating every three or four hours.
5. Saturated or trans fats are better than the so-called “monos” or monosaturated fatty acids.
6. Energy-dense foods include organic pears and celery.
7. The three nutritional “sins” are sugar, salt and fat.
8. The three nutritional “good” foods are whole grains, vegetables and fresh fruits.
9. Energy-dense foods include chocolate and cheesecake.
10. Popcorn is a whole grain.


1. True 2. True 3. False 4. True 5. False 6. False 7. True 8. True 9. False 10. True

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