A National Confectioners Association survey recently revealed that 94% of Americans reported wanting chocolate on Valentine’s Day.  I didn’t participate in the study but you can count me among them.  I want it every day.  I’m health conscious.  Read on.

For hundreds of years however, Europeans felt chocolate was heart healthy and even aided the liver and one’s digestion, among other benefits.

Chocolate in this country has traditionally been an indulgence, where the expectation is merely good taste and satisfaction – with some calories and fat.

That’s changing.  A lot of research during the past 20 years or so is telling us that chocolate can be heart-healthy, and via a variety of mechanisms.

Science for chocolate nerds

Two components in chocolate seem to be giving the benefits: antioxidants and the fat.

Eating foods rich in antioxidants, such as fruits, vegetables, beans, and whole grains, has long been associated with numerous measures of health benefits and reduced health risks, including lower risk for cardiovascular disease, diabetes, and hypertension.

Chocolate is rich in a subclass of antioxidants called “flavonoids”.  Catechins, epicatechins, and procyanidins are the main flavonoids in chocolate and they’re present in higher concentrations than in most other plant foods, even tea and red wine on a per-serving basis.  Dark chocolate is the third largest contributor of antioxidants to the American diet, after fruits and vegetables.

The fat in cocoa is mostly saturated – usually something we advise reducing in the diet. But not all saturated fats are created equally, and the primary one in chocolate is stearic acid, which seems to have more neutral, not harmful, effects.

Here are some of the benefits studies have consistently shown for chocolate:

  • Lower blood pressure: The reduction isn’t huge, but it seems to lower both the top number (systolic) by about 5 points and the bottom number (diastolic) by about 3 points. Not huge, but better than for most “treat” foods!
  • Improved markers of cardiovascular health: It seems to reduce LDL-cholesterol (the bad one) and raise HDL-cholesterol (good one) – at least when it replaces butter. It doesn’t top olive oil in this respect, but swapping a pastry for some chocolate makes sense.
  • Reduced “platelet aggregation”: This is beneficial because it helps prevent plaque build-up in your arteries.

How to do chocolate right

Yes, chocolate can fit into a healthy diet.  It might even be a good thing, in the right amount.  Here are a few tips if you want to have chocolate regularly:

  • Go dark. Really dark.  The benefits come when the cocoa content is 70% of higher.
  • Take 1.  Figure 1 ounce a day (about 30 grams). It’s only about 160 calories, so it’s lower in calories than most desserts!
  • Swap right. Use your daily chocolate to replace lower-quality foods. This usually means junk snacks.  You’ll find that an ounce of dark chocolate is satisfying.
  • No chewing allowed! Bite a small piece, notice the crackle of the bar, and let it melt in your mouth. Why rush?
  • Take a powder.  Leverage the flavor of cocoa powder! Hot chocolate, smoothies, on Greek yogurt!  Even shake it onto sliced apples or added it to coffee.  It’s almost calorie-free.  Trader Joe’s and Ghirardelli both have great cocoa powder.
  • Don’t “go Dutch”.  Cocoa labeled as “processed with alkali”, or “Dutched cocoa”, has lost most of the antioxidants. I avoid this kind of chocolate. It’s not harmful, just has no antioxidants.

Chocolate caveat

If you have reflux or heartburn, chocolate can irritate the stomach and stimulate acid production.  Chocolate doesn’t have much caffeine, but dark chocolate has more than milk chocolate, and it does have theobromine, which can also get you buzzy if you have it before bedtime.  Also, the antioxidant activity can vary, based on origin and handling methods.

Finally, file this under “nice-to-know”: Mondelez, the huge mega candy company, has a goal of 200,000 cocoa farmers participating in its “Cocoa Life” sustainable cocoa farming program, by year 2020.  They recently announced that they are nearly halfway there, with participation nearly doubling in the year 2015 alone.  Props to Mondelez.

Chocolate on Valentine’s Day.  Call it a gift from the heart, and for the heart!


Do you shy away from drinking milk and yogurt because you don’t like the low-fat/fat-free stuff but also avoid cheese because of the saturated fat?

Well, have a slice of cheese and read on.  And while you’re at it, scoop some full-fat yogurt on some fruit, too.  Your cardiologist probably won’t cringe, either, and may even give you a high-5.  That’s because several recent studies, both randomized clinical trials, (considered the “gold standard” of research), and observational studies that look at tens of thousands of people and are less rigorous, suggest that full-fat dairy foods — but not butter — may be better for us than we thought.

Dietary guidelines have traditionally advised us to reduce our consumption of saturated fat, and full-fat dairy foods are a significant source of it.  These newer studies are suggesting that saturated fat isn’t all the same, shouldn’t all be under one big umbrella.  Dairy fat, in particular, may behave differently than other saturated fats.

Cheese vs. butter

The fat in these two foods have similar levels of saturated and unsaturated fat.  Makes sense, as they both contain dairy fat from milk.  Butter is simply isolated from the milk, whereas cheese has the fat as well as protein and even a small amount of carbohydrate, depending on how long it was cultured.   Since the fats are of similar type, you could also reason that similar amounts of saturated fat from butter and cheese would behave the same way in the body.

That doesn’t seem to be the case, at least not in this study that reviewed randomized controlled trials, — the gold standard of research – to compare the effects of cheese and butter on blood lipids.  Here’s what they concluded from the studies they reviewed:

  • Compared with butter, cheese reduced both LDL-cholesterol (the bad stuff) by 6.5% and HDL-cholesterol (the good stuff) by 3.9%. Note that the more hazardous LDL dropped much more than the desirable HDL.
  • Cheese intake had no effect on triglycerides.
  • When compared to tofu or reduced-fat cheese, full-fat cheese increased LDL cholesterol.

Foods vs. nutrients

Just as not all saturated fat is the same, it may be a mistake to see all dairy fat as the same, even though it all has the same origin and composition.  Why? Because we’re learning that there’s more to food than just its nutrients.  (You may think, “duh” but in the nutrition world, it’s always been just about nutrients!)

In this 2016 synopsis of several symposia that looked at 131 studies, the research did not show any increased risk for cardiovascular disease from the consumption of full-fat dairy foods.  Moreover, for weight gain, there was actually an inverse relationship with weight gain and obesity risk, meaning that higher consumption of full-fat dairy foods was associated with less obesity and weight gain.

The thought is that when dairy fat exists in foods, it’s bound to a complex matrix that includes milk proteins (chiefly casein and whey) as well as minerals and even bacterial cultures, in the case of cheese and yogurt.  These along with the compounds of digestion, may reduce the absorption of some of the cholesterol and/or saturated fats.

I actually like this type of research because it helps me work with patients who couldn’t care less about the biochemistry of it all, they just want to know how to eat a healthy diet that also tastes good.

Cut-to-the-Chase take-aways:

  • Overall, good news here about cheese and full-fat dairy foods.
  • Keep eating the fatty fish and olive oil!  But it’s OK to replace butter and fattier cuts of meat with cheese and full-fat dairy.
  • IF you like fat-free yogurt and you’re used to 1% or fat-free milk, keep at it!
  • If your diet is short of calcium and vitamin D because you don’t care for low-fat or fat-free diary, and including more full-fat dairy foods would help correct that
  • Spend wisely: Full-fat dairy foods have more calories than lower-fat versions, so be sure you balance calories elsewhere in your diet.



You’ve heard it forever: “breakfast is the most important meal of the day.”  Sounds exactly like something you’d hear from picture-perfect TV moms like June Cleaver on “Leave It To Beaver, or Mrs. Cunningham on “Happy Days.”

Well, it’s really true, according to the latest research – and a lot of studies that preceded it.  This study involved 698 students, average age was about 7½ years, so primary grade school kids.  Just before they were given a standard achievement test, they completed a recall of what they’d eaten for breakfast.

The kids who ate breakfast before taking the test scored significantly higher than those who had not eaten breakfast.  One review looked at breakfast eaters among urban minority youth and the conclusions were horrifying:

  • The prevalence of skipping breakfast was “highly and disproportionately prevalent among urban minority children.”
  • Breakfast skipping negatively impacted academic achievement.
  • Was associated with increased absenteeism.
  • Despite the availability of school breakfast programs, not enough vulnerable children take advantage of them.

But What KIND of Breakfast Works?

berries-1851148_1280glass-of-milk-being-pouredwhole-grain-cereal-bowl-with-spoonBreakfast is a true opportunity for filling the gaps in kids’ diets that probably won’t be filled if they skip breakfast.  Here are the food groups of particular concern that most kids’ (and adults’) diets are lacking:

  • Low-fat/fat free dairy,
  • Fruits & vegetables,
  • Whole grains.

Breakfast is an ideal meal for getting all three of the food groups of concern. A simple serving of whole grain cereal, milk, and fruit covers so much nutritional ground.  These are foods they need multiple times during the day, and when kids miss breakfast, they don’t eat more of them later to compensate, they just miss out.  When they make a habit of skipping breakfast, it’s a lifestyle with a nutritional concern.

The US Dietary Guidelines for Americans points out 4 “nutrients of concern” so named because over half the population is falling short:

  • Calcium
  • Vitamin D
  • Potassium
  • Fiber

Indeed, at least 60% of kids (up to 90% of teen girls) don’t get enough calcium, yet a simple glass of milk – real milk, not a “milk alternative” – is a top source of three of those 4 nutrients of concern: calcium, potassium, and vitamin D.  The fresh fruit and whole grain cereal both have fiber, so you can see how that simple bowl of cereal, fruit and milk adds up to so much.  And kids like it!  Of course, for older kids, you can do some add-ons, too.  milk-ricotta-cheese-on-breadAdding some yogurt (Greek yogurt, too) or an egg, or some string cheese, just ups the protein and nutrition further, keeping them full and better able to focus until lunchtime.

Doing School Breakfast Smarter

The above review also called for a universal breakfast program that allows kids to actually have their breakfast in their own classrooms.  This is becoming more popular but it’s still in its early stages and needs to be greatly expanded because it has to be one of the best ideas yet about how to give kids breakfast at school and ensure they have it every day.  Here’s how it works:

  • Kids pick up their breakfast in a package as they enter their classroom.
  • They eat at their seat during the first 10 minutes or so of the school day, while announcements are made.
  • Remaining trash is collected, the kids continue with class, ready to learn.

I like this idea for a few reasons:

  • It always includes milk & fruit – two groups kids need more of.
  • Kids get a structured meal that’s balanced and meets federal nutrition standards.
  • They eat with their friends in a familiar place.
  • They get nourished when they need to concentrate.
  • Convenience! No having to go to the cafeteria, just go to class and it’s there.

The best part of breakfast in the classroom is that eating breakfast becomes part of their regular routine.  Breakfast is a meal of habit, and a good habit is one they can keep forever.

This column was supported by the Milk Processor Education Program



You’ve heard about protein, you know it’s important for building muscle, and you know meat, poultry and fish have a lot of it.

No worries about getting enough protein, either, at least here in the US. But according to research by the US government, we tend to “backload” our protein – meaning we get most of it at dinner. Their stats show that dinner gives us nearly 60% of our daily protein. Breakfast is arguably the most important meal of the day, yet it brings us only about 13% of our protein.

We may be getting enough protein, but do we get it EARLY ENOUGH in the day?


WHEN you eat protein is important. Kids (and adults) eat most of their protein and calories from after school on, but they NEED most of it earlier, when the demands of their day are greatest, starting at breakfast. Sadly, up to 40% of kids don’t even eat breakfast daily.

Load ‘em up with breakfast protein and they’ll work and feel better all day.­ It’s true. They’ll also be more focused at school and research has shown they also tend to eat less during the rest of the day. Anecdotally, in my practice, I’ve noticed that breakfast-skippers who start eating a good, high-protein breakfast also seem to be less tired after school, allowing them to be more active. It does makes sense, because without breakfast, they run out of energy. Kids shouldn’t want a nap after school, they should want to play, and protein-packed breakfast helps them do just that.

But what KIND of protein?

Meat has good protein but dairy and eggs actually have the highest quality protein, for most efficient use by your body. Most kids would especially benefit from more dairy. Why? The vast majority of kids (and adults!) also don’t get enough calcium, potassium, or vitamin D, and a simple glass of milk is like a cargo truck of these nutrients, and 6 other essential ones as well, so it covers a lot of ground, nutritionally. And, kids LIKE it.

yogurt-smoothieYou might think cereal and milk takes care of the protein at breakfast. For young kids, maybe. But for older kids, especially teens, that’s only about 10 grams of protein. Aim for 20-30 grams and they’ll stay full until lunch. Here are some options and their protein amounts, to help get them to that 20 grams. Combine them as you like:

  • Glass of milk (any percentage of fat, white or flavored): 8 grams (some brands have 9 or 10 grams)
  • Greek yogurt, flavored (a 5.3-oz cup): 12 grams
  • String cheese (2 oz. portion): 12 grams
  • 1 egg, any style: 6 grams
  • 1 oz. cheese (cheddar, Swiss, etc.): 6 grams
  • Cottage cheese, ½ cup: 14 grams
  • Ricotta, low-fat, ¼ cup: 7 grams
  • Peanut butter, 2 Tablespoons: 7 grams (but also about 190 calories, so use wisely if kids are overweight)

Cottage and ricotta cheese for kids? Yes, and they’re perfect in smoothies, as is Greek yogurt.

Keep it COW

To be clear: I’m talking about real milk. The “milk alternatives” like almond, coconut, rice, and other “milk” have almost no protein or naturally occurring calcium. Milk is naturally loaded with good stuff.

Nice add-on: the milk you buy is probably locally produced. Most places in the US are within a few hours’ drive of a dairy farm, even if you live in a big city. Pour a glass and feel good about supporting your local diary people.

Just as nice: milk is one of the best protein buys today. Even at $4.00/gallon, it’s only 25 cents a glass.

Supported by the Milk Processor Education Program

Family Meals Need to Come Back


When I was a kid, my family ate dinner together every night – later than was usually promised, because we waited for Dad to get home and he was always later than he said he’d be – but eat together we did.  We even ate breakfast together.  Nothing major, just a few minutes in the morning to organize schedules and plans and start with a balanced simple meal.

Last month the Food Marketing Institute (FMI), a supermarket trade group, declared September to be National Family Meal Month with the goal of getting families to have one more meal together each week.  I fully support this, and there’s some good research that supports it, too.

The news on family meals is actually good.

At least it’s better than I thought.  Just when you heard family meals were a thing of the past, according to a Harris Poll, about 7 in 8 families still have dinner together.  As a nutritionist, this matters to me because family meals have been shown for years to be strongly associated with better diets.  Research from the EAT study (Eating and Activity in Teens), for example, showed that more family meals aligned with better dietary quality and healthier weights.

  • 7 out of 8 families still eat dinner together
  • 4 in 10 adults without kids eat in front of the TV (ouch!),
  • 1 in 4 adults WITH kids eats in front of the TV
  • Better than 1 in 5 eat on the couch

When I was growing up the TV during meals was absolutely not going to happen – and we had a small family business that SOLD TVs and appliances!  Looking back, I’m glad we had that rule.  When the TV is on, maybe it’s a peaceful meal but it also means there’s not much talking and communication between family members.


That’s sad, because family meals are about more than food and eating.  They’re a great opportunity – a “vehicle” if you will – for social development and learning communication and interpersonal skills.   And that opportunity comes every day.  Indeed, a 2014 study found that family meals had a positive effect on the development of healthy social behaviors in 6- to11-year-olds.  We shouldn’t waste this opportunity just to watch Wheel of Fortune.

Even worse, in my book, is when people (kids AND adults) bring “technology” to the table.  No.  Disconnect, and make it a priority.  A family dinner is only about 30 minutes, so make having conversation with each other as important as the food you’re serving.

If you find you get pushback from adolescents about family meals, don’t just think of today.  In the Harris Poll 4 in 10 adults said they wished they’d had more family meals growing up.

Bottom line

I’m a nutritionist, so of course good, healthy meals are important to me, but they also are to many of the surveyed families, most of which said they’d made efforts to improve the quality of their family meals.

Six out of 7 though, said that eating together was even more important than where the food comes from.   Ten years from now, the kids might not remember what they ate for dinner, but they’ll remember that you ate it with them.  Maybe you can get them to remember both – have a family meal you made with love.



I’ve worked with children and families of all backgrounds for many years and I love what I do.  Given that I’m a registered dietitian/nutritionist, there isn’t much that’s more important than feeding children well, right from the start.

I always parents of infants to be patient about introducing solids.  Many can’t wait to give them something with a spoon because seeing a baby eat and enjoy it is one of the joys of parenthood.

But babies aren’t little adults, and introducing solids too soon isn’t a good idea.  Even a baby born right on time still isn’t completely developed on the inside.  That takes time, and you want to wait at least four months before introducing solid foods.  Ideal is to wait six months, but that’s difficult for many parents.

What food to introduce first?  Usually you want an iron source, especially if babies have been breastfeeding or getting a formula that doesn’t contain iron.  That often means fortifies cereal.  That’s fine, but give it with a baby spoon, please, don’t put it into the bottle.  Babies need practice learning to eat with a spoon and there’s no substitute for some patience and some practice.

Fortified cereal is good, but there are other options too.  I recently co-authored some research on first foods for babies that looked at over 100 studies about the needs of babies.  In short, we concluded that choosing first foods for your baby should be based on 3 factors:

  • Nutrient richness: high in the nutrients they need for growth and development, moderate in calories, low in sugars.
  • Texture and Consistency: If they can’t eat it, they won’t, not matter how good the food is. First foods should be smooth and soft, pureed, and mashed.  This way they gradually learn to chew and swallow.
  • Neutral flavors: keep it without added salt and sugar, so babies can learn pure tastes and avoid developing too much of a sweet tooth before they even have teeth of their own.

This work was funded by the Haas Avocado Board and yes, avocados are a terrific first food, if not the only one.  Babies have a higher need for fat and avocados are one of the few fruits with fat, and a healthy fat.  They have a nice neutral flavor profile and also easily mashed, although parents usually prefer an adult preparation of avocados known as guacamole.

I grew up in California – real avocado country, and I’m happy to encourage avocados as a first food – especially because there seems to be some good scientific justification for doing just that.  Read more about this announcement here, and if you want to read about the research abstract, published in the journal Nutrients, here it is.


For a number of years I was lucky to be involved in helping The Walt Disney Corporation formulate a global nutrition policy.  Not only in their theme parks, but also for the products to which they lend their characters and that are sold in supermarkets around the world.

This effort started in 2006 but was advanced even further in 2012 to include ground rules for the type of food advertising that child-oriented Disney media would accept.
The 2012 initiative was announced with the support of First Lady Michelle Obama and outlined the changes that would be made in theme parks but also how it expanded Disney’s efforts to into other areas, such as the types of foods that could be advertised on child-centered Disney media and develop public service announcements that encouraged physical activity in children and healthy eating.

One of the changes implemented in the Disney theme parks was the concept of healthier default options in the family-oriented “quick-serve” restaurants.  Being interested in how this could change eating behavior in the theme parks, my colleague on the initiative, Dr. James O. Hill of the University of Colorado, Denver, and I, wanted to see how this impacted food choices, so we recommended to Disney that they consider the concept of healthier default beverages and side dishes for the bundled meals.

I’ve always liked the idea of healthier defaults because it doesn’t remove anything from a consumer’s choices – it just gently leads them to a good place.  If they want to keep the soda and the high-calorie fries, they need to ask for it.  In most restaurants, it’s the other way around: the bundled meal comes with the fries and large soda as the default – if you want water or a sugar-free drink, you make the effort yourself to ask for it.

With healthier defaults, the passive decision is the better-for-you one.  But would consumers respond by accepting the healthier defaults?  It was a loud and clear, “YES.”  Not unanimous, mind you, very little in human behavior is.  But here’s what we found in the quick-serve restaurants:

  • Half of the time they accepted the healthier sides.
  • 2/3 of the time they accepted the healthier drink.

In the sit-down restaurants, it was a little less robust, with a little more than 2 in 5 consumers accepting the healthier sides and drinks.

It’s not about 100% though and it never should be.  That’s a horrible bar to set because it would never be met.  People make changes gradually and these percentages are far better than before the healthier defaults were implemented.
Here are the improvements I liked seeing with the healthier defaults:

  • 21% fewer calories for these meals
  • 44% less fat
  • 43% less sodium

And remember these were family-friendly restaurants – kids were involved here, and these healthier defaults helped parents give their kids a better meal even though they were eating out.

Imagine if we implemented these healthier default concepts everywhere?  Again, we removed no options, just made the defaults better.  That’s meeting families where they live – and where they like living.

The abstract for this research is available here:

Custodial Grandparents: Where Nutrition Meets Family Dynamics

grandparentsI’m not a grandparent but I work with so many of them.  Many are de-facto parents, either because they have full custody of their grandchildren, but others are the primary caregivers to their grandchildren because of working parents.  They’re often the ones who not only prepare meals for their grandchildren, but who eat with them and spend lots of awake hours with them.   

They may be spending more time with their grandkids than the actual parents do, so they can have a real influence on a child’s attitude about food and their whole food experience growing up.  And that’s why I want to meet with them.  

Grandparenting is serious business and read about my approach to counseling these “key influencers” in children’s lives about nutrition and the family dynamics around food and eating in The Doctor’s Tablet.    

Could Fasting Be Good for Healthy Adults — and Kids?

fastingEvery so often fasting – the conscious abstaining from all food or specific foods, sometimes for religious observance but sometimes for other reasons – like weight loss or “detoxing” has come back into vogue again.  There’s actually some recent research that suggests it might have some limited benefits – in rats but in a recent human study, too.   

Fasting, even if it can be useful, for how long?  How severe? Would I recommend it?  What about kids?  Read my take on this new research and my recommendations in my post in The Doctor’s Tablet.

Spice Can Be Nice for Kids – and Improve Nutrition

spic-e-bazaar-iostanbulThe Academy of Nutrition and Dietetics always declares March as National Nutrition Month.  This year’s theme is “Savor the Flavor of Eating Right”.  I love this theme because people forget that eating a healthy diet isn’t just about nutrition.  We need to get there in a flavorful way.  

And flavor is for kids, too, and having fun with flavor is one way I’ve found to motivate my patients to make great dietary changes that last.

Read more about kids’ tastes and how to use flavor – and that can mean spices – to both improve  their diets and make them happier about the foods they eat, in my Huffington Post article.


Photo, courtesy of Creative Commons: