Hearing Tests

Hearing tests measure the health of your ears, including how well your ears transport sounds to your brain. Most important, hearing tests can determine if you have hearing loss and can help to identify the cause. Your doctors can then let you know what treatment options are right for you.

Who Performs Hearing Tests?

Your doctor can perform basics hearing tests, but for more advanced testing you may be referred to a specialist, such as an ear, nose and throat doctor (called an otolaryngologist) or an audiologist, someone certified in the field of hearing and hearing loss.

Detecting hearing problems in newborns is a team effort. The team may include an otolaryngologist, audiologist, pediatrician, neonatologist and nurses. In children, hearing tests may be provided in school by a licensed speech pathologist or at the pediatrician’s office.

Hearing Evaluation In Children

Hearing loss in children is a disability covered under the Individuals with Disabilities Education Act. This act requires states to identify children aged 3 to 21 with disabilities. Contact your school district or state education department to find out how to have your child’s hearing evaluated.

Newborn Screening

In the United States, hearing loss is the most common birth defect, affecting 3 out of every 1000 newborns. The National Institutes of Health, American Academy of Pediatrics, and other experts recommend that all newborns have their first hearing test before they leave the hospital. As of March 2002, 36 states and the District of Columbia have passed laws related to newborn hearing screening. Many of these states have programs in place to provide the necessary testing in hospitals and birthing centers; other states are working toward this goal.

Infants with significant hearing loss who get help (such as hearing aids or surgery) before 6 months of age develop much better language skills than those who do not. When infants are not screened for hearing loss at birth, this problem typically is not detected until age 2 or even later and often results in language and speech delays that may be permanent.

Newborns who do not pass an initial hearing test are usually given a second screening test. If they fail again, more formal follow-up testing by an audiologist and an ear, nose and throat doctor (otolaryngologist) should occur before 3 months of age.

Screenings For Children

Hearing loss also can develop in the months and years after birth. Children should be tested for possible hearing loss whenever parents or other caregivers have any concerns about decreased hearing. In addition, testing is done routinely for children at high risk of hearing loss. This includes children who have developmental delays, especially in speech; syndromes involving the head that are associated with hearing loss; or other risk factors such as a history of premature birth, bacterial meningitis or a family history of hearing loss.

Routine screenings are recommended as follows:

  • When first starting school
  • Every year from kindergarten through 3rd grade
  • In 7th grade
  • In 11th grade
  • If the child enters any special education classes
  • If the child repeats a grade
  • When a child enters a new school system without evidence of having passed a previous hearing screening

Hearing Evaluation In Adults

Approximately 28 million American adults have hearing loss. Thirty percent of them are older than 65, 14 percent are between 45 and 66, and close to 8 million people are between the ages of 18 and 44. The American Speech-Language-Hearing Association recommends that adults have their hearing tested every 10 years through age 50, then once every three years.

Most visits to a medical office require filling out a registration form and a medical history. A medical (or case) history should include information about your health over the years, as well as that of your family. Typical questions about hearing and hearing health are as follows:

  • Have you had any drainage from your ear(s) in the past 90 days?
  • Have you experienced any pain in you ear(s) in the past 90 days?
  • Do you have difficulty while talking on the telephone with one or both ears?
  • Do you have difficulty hearing in noisy environments?

Once the registration and history forms are completed, the audiologist will review your information and explain what tests you will have during your visit. Based on your answers and examination of your ears, the doctor will order one or more tests to determine the extent of hearing impairment.

Types Of Hearing Tests

Different tests evaluate different parts of the hearing (auditory) system in different ways. The test used depends in large part on your age. The most common tests are:

Otoacoustic Emissions

You can’t hear otoacoustic emissions, but these sound echoes bounce around inside your ear and make hearing possible.

Sound signals enter your ear and hit the cochlea, the bony maze of the inner ear that looks like a snail shell. The cochlea contains nerve endings that pick up sound signals. These sounds then “echo” back into your middle ear, making hearing possible.

Although you can’t hear the echoes, a probe inserted into the outer ear can measure them. This test is very useful in checking whether a newborn or infant can hear because the person being tested does not have to respond to any questions. The test machinery does all the work.

Auditory Brainstem Response

This test doesn’t actually measure how well you hear, but rather how well sounds travel along your auditory pathways. The test measures brain-wave activity in response to sound. This allows the examiner to detect any damage in the cochlea, the auditory nerve or the auditory pathways in the stem of the brain.

Electrodes are placed on the head of the person being tested. Headphones or earpieces send out a series of clicks that trigger brain-wave activity. Because the person being tested does not have to answer any questions, this test is ideal for children.

Visual Reinforcement Audiometry

This test trains a child to look toward an object that makes a sound. When the child gives a correct response (turning his or her eyes or head toward the sound), he or she receives a reward (or a reinforcement), such as a flashing light or moving toy.

The test measures how well a child can hear tones of various frequency (pitch) and speech. Generally used for infants and children aged 6 months to 2 or 3 years, the test takes place inside a booth (with speakers) or with headphones. Headphones are preferable because they give ear-specific information. Hearing loss in one ear (unilateral hearing loss) can be missed when using speakers.

Conditioned Play Audiometry

This test trains a child (aged 2 to 5) to perform a task when a sound is heard. The task can be putting blocks in a box, rings on a cone or pegs in a hole. Once the child learns to respond to the sounds, the sounds are gradually decreased to measure the child’s true hearing ability.

Headphones give the best results because they provide ear-specific information. If a child refuses to wear headphones, the test can be conducted in a sound booth, but the results are not as accurate. If a child can’t learn to respond to the sounds, otoacoustic emissions or auditory brainstem response testing will be used.

Pure Tone Audiometry

This test detects the type and severity of hearing loss at specific frequencies and decibels. It can pick up differences in hearing loss in one ear compared with the other. The test is used in children and adults.

This test requires the person to raise his or her hand when a tone is heard through headphones. A second part to the test has the person wear a headband that places a small plastic rectangular device behind the ear. This measures sound transmitted through bone. If hearing is better when sound does not pass through the middle ear, the middle ear is obstructing the sound. This is called conductive hearing loss. When there is a hearing loss, and the headphone test and the bone test results are the same, the problem is called a nerve or sensorineural hearing loss. Generally, hearing aids or assistive listening devices treat this type of hearing loss.

A person who can’t hear any frequency fails this test and will need additional testing.


This test evaluates the health of the outer and middle ear. All age groups use this test, although it is particularly useful in diagnosing middle ear infections, a common condition among children.

The test can detect fluid or infection in the air-filled cavity of the middle ear, problems with the eardrum (tympanic membrane), including holes, and any air pressure imbalance related to problems along the Eustachian tube, which is responsible for keeping the air pressure equal on each side of your eardrum.

A small probe that looks like an earplug is placed in your ear. A gentle stream of air is pumped into the ear canal. You will feel pressure changes and hear sounds as air pressure hits your eardrum and the vibrations are transmitted to the bones in the middle ear. Some of the sounds may be loud and could even startle you.

Speech Testing Or Speech Audiometry

The first part of the speech test measures how softly a word can be spoken for you to be able to repeat it back properly.

The second part of the speech test measures speech discrimination. This determines how well you can hear and repeat words back that are given at a comfortable listening level. Individuals who have normal hearing generally get 100 percent of the words correct. Hearing loss is associated with reduced sound discrimination. The greater the hearing loss, the worse the discrimination.

How to Add Fruits And Veggies To Your meals

Getting five servings a day of fruits and vegetables is one of the best ways to prevent cancer, heart disease and stroke. Here are easy ways to achieve that daily goal.

In 1991, the National Cancer Institute set a goal for every American to reach by the year 2000: Eat a minimum of five servings of fruits and vegetables a day. How’d we do?  Not very well. Only 32 percent of adults meet the daily goal. Among kids aged 2 to 18, it’s 25 percent. And that’s bad news for our health, young or old. Scientific studies suggest that eating a diet with plenty of fruits and vegetables is a major factor (maybe the major factor) in the prevention of common cancers, heart disease and stroke — the diseases that kill most Americans. That’s because these foods are uniquely rich in disease-fighting antioxidants like vitamin C, in fiber and in health-protecting “phytochemicals” like beta-carotene.

But, experts say, it’s easy to get your five a day. You don’t have to become a vegetarian. You don’t even have to give up any so-called “bad” foods. And if you’ve got kids, it’s easy to help them reach the goal, too. Here’s what to do.

Understand the long- and short-term benefits of eating more fruits and vegetables. Avoiding heart disease, cancer or stroke is reason enough to eat more fruits and vegetables. But if preventing chronic disease in the future doesn’t get you to eat fruits and vegetables today, then consider the immediate health benefits, says Linda Larkey, Ph.D., director of the Women’s Cancer Prevention Office at the University of Arizona: “If you eat five servings a day of fruits and vegetables, it’s likely you’ll have more energy, you’ll look and feel a whole lot better, and you’ll find it easier to maintain or lose weight.”

Know how much a “serving” is. A serving is any of the following:

  • A half cup of cooked or one cup of raw vegetables. (A cup-sized serving is about the size of your fist.)
  • A medium-sized piece of fruit, like an apple or an orange
  • A half cup of canned or frozen fruit
  • A quarter cup of dried fruit, like raisins
  • A three-quarter cup of juice, or six ounces

Have a serving of fruits and vegetables with every meal. “Always think about having fruit with breakfast — raisins on your cereal, for example, a glass of orange juice, or a piece of cantaloupe,” says Alan Kristal, D.P.H., professor of epidemiology at the University of Washington and associate head of the Cancer Prevention Research Program at the Fred Hutchinson Cancer Research Center in Seattle, Wash., and a former chef. “At lunch try to eat one vegetable and at dinner try for two. Eating vegetable soups, mixed dishes with added vegetables, and salads makes it easy. At every meal, I think: ‘Where are the vegetables and fruits?'”

Snack on fruits and vegetables. “Eat any kind of fruit or vegetables for a snack,” says Wendy Demark, Ph.D., R.D., a registered dietitian, and associate professor of surgery at the Duke Comprehensive Cancer Center in Durham, N.C. “Baby carrots, cherries, grapes, to name a few.”

Carrot sticks are particularly good, says Cheryl Rock, Ph.D., associate professor of family and preventive medicine at the University of California, San Diego. “They’re half the price of potato chips, they transport well — they can fit in a handbag, for example — and they’re easy and fast to eat.”

Make small additions to your current diet. You don’t have to restock your refrigerator and pantry to start eating more fruits and vegetables. “Add them to your diet in small ways,” says Larkey. If you make a burrito, for example, add a few more onions and tomatoes. If you eat cereal, add a banana. If you have a can of vegetable soup, toss in 1/2 cup of frozen peas, says Demark. If you’re having ice cream, put strawberries on top, says Rock. “If you’re having pizza, think about putting vegetables on top, like broccoli and sun-dried tomatoes,” she says. A similar suggestion: Add extra vegetables to spaghetti sauce, says Susie Nanney, R.D., a registered dietitian and research project manager for the “High 5, Low Fat” program at the Saint Louis University School of Public Health.

Use any form of fruits and vegetables — canned, frozen, dried or fresh. “Scientific studies show that eating canned or frozen vegetables and fruits also lowers the risk for cancer and heart disease,” says Rock.

Don’t believe the myth that it costs more to eat healthy. “Compare a glass of soda to a glass of juice,” Nanney says. “They’re about the same cost, but the juice has lots of nutrients while the soda is nothing but calories. Fruits and vegetables give you the most nutrition for your money.” In fact, she says, if you cut back on meat and eat more fruits and vegetables, you’ll save money on your grocery bill.

Don’t rely on the following foods to help you reach your goal. Sorry, but that slice of blueberry pie for dessert doesn’t count as a serving — it doesn’t have enough fruit in it, says Tom Baranowski, Ph.D., professor of behavioral nutrition in the Children’s Nutrition Research Center at Baylor College of Medicine in Houston. Here are some other foods that Baranowski says don’t qualify:

  • Fruit jelly
  • Fruit-flavored beverages that aren’t 100 percent fruit juice
  • Fruit-containing cookies
  • Fruit leather
  • Banana chips
  • Maraschino cherries
  • French fries
  • Potato chips
  • Onion rings
  • Ketchup

There’s nothing wrong with these foods, he says. It’s just that they’re not going to help protect you against heart disease, cancer and stroke.

Realize that taking a nutritional supplement will not give you the same health benefits as eating fruits and vegetables. “When we take a supplement, we only get a few protective compounds, but fruits and vegetables contain thousands of different beneficial elements — some that scientists know about, and many that are still undiscovered,” says Johanna Lampe, Ph.D., R.D., a researcher at the Fred Hutchinson Cancer Research Center in Seattle. “Taking a limited amount of specific nutrients in a pill doesn’t have near the protective effect against chronic disease as eating whole fruits and vegetables,” Rock agrees.

Help your kids get their “five a day,” too. First, the experts say, realize that kids don’t dislike vegetables just because they’re kids. “In other countries like Japan and India where vegetables are a natural part of the daily diet, kids eat lots of vegetables,” says Barbara Dennison, M.D., associate professor of pediatrics at Columbia University in New York and scientist physician at Bassett Healthcare in Cooperstown.

Second, if you follow all the tips in this article, your kids will eat more fruits and vegetables. “Kids tend to eat what parents eat,” Dennison says. “If you eat more fruits and vegetables, your kids will eat more fruits and vegetables too.”

For children 2 to 10 years old, the key is familiarity, says Dennison. “It may take eight to 10 times for a parent to serve cooked carrots or broccoli before a child will begin to even think about eating that vegetable. But if you serve the food in a nonchalant, relaxed atmosphere — and particularly if you serve the new food with their favorite food — the child will eventually begin to like the new food.” Don’t force your child to eat the food, says Dennison. It doesn’t work. And don’t bribe your child with other foods. (“If you eat your peas, you can have ice cream.”) “That gives them message that there is something bad about the peas,” she says.

As for adolescents, if they haven’t gotten in the habit of eating vegetables when they’re young, you’ve got a tough job ahead of you. But there are ways to make it easier, says Bettina Beech, D. P.H., assistant professor at the Center for Community Health at the University of Memphis in Tennessee. Make fruits and vegetables accessible. For example, don’t just keep raw, unwashed carrots in the refrigerator. Instead, keep prepackaged baby carrots, cut up, washed and ready to eat.

Realize your teen-ager isn’t likely to eat more fruits and vegetables to prevent chronic illness — teens think they’re going to live forever. “Find reasons why it would be important and interesting to your teen to eat more fruits and vegetables,” Beech says. Let them know that if they eat ‘five a day,’ they’ll have more energy for athletics, a better complexion and be able to maintain a healthy diet without dieting.”

Healthy After-School Snacking Strategies

Healthy Snack

It’s 3:30 p.m. and 17-year-old Jonah Cool bursts through his front door. After a full day of classes at Gunn High School in Palo Alto, Calif. and before he heads for a 20-mile bike ride, he makes a beeline to the kitchen. Healthy After-School Snacking Strategies

“At that time of day, I feel ravenous,” says Jonah, a high school senior. “What I’m looking for are carbohydrates or sugars. I want food that’s quick to grab and eat.”

Across the nation each weekday afternoon, millions of students arrive home hungry and impatient. They don’t want to spend the time cutting up fruit for a salad, boiling water for pasta noodles, or baking low-fat cookies. They want something to munch NOW.

“Some have skipped breakfasts, even lunches, and they get home and start stuffing their faces with anything and everything within reach,” says Lorraine Giangrandi, a registered dietitian at the Johns Hopkins Weight Management Center in Baltimore, MD. “Unfortunately, they usually end up making unhealthy choices.”

But after-school snacks don’t have to be pound-packing junk food. Students like Jonah have discovered how to snack in nutritional ways. Instead of candy bars and potato chips, Jonah reaches for plums and bowls of homemade leftover pasta. His food choices help him maintain his athletic 6’0″ 175-pound build. Through elementary, middle and high school, he has learned how to make the right snack choices that give him the energy to bike and the mental stamina to study.

“I’m not much of a chocolate lover, which helps a lot, and I’m not much of a fast-food guy,” says Jonah. “My mom is a chef and owns an organic food restaurant. She has helped me learn to eat foods that won’t bog me down.”

Food is fuel. The right foods — those loaded with essential vitamins and minerals — keep our bodies revved and humming along. The wrong foods — those high in fat, sugar, and preservatives — can zap our bodies of energy and lead to health problems, including obesity, explains Giangrandi.

After-school snacking can be healthy and nutritious but it takes teamwork between parents and their children.

“Parents need to sit down with children and talk to them about what are good snacks when they are in grade school,” she says. “By the time they reach high school, bad habits are more difficult to break.”

Giangrandi offers these savvy snack strategies:

  • Shop together. As you wheel the cart from aisle to aisle, discuss with your child what makes food healthy or unhealthy. Read labels together. Listen to what your child likes and dislikes. Turn shopping into a educational game: let your child make a case for selecting a particular snack based on its health value.
  • Stock up on grab-and-go foods. These days, everyone is in a dash from here to there, including your children. Keep your kitchen stocked with food such as plums, large pretzels, and string cheese that are easy to handle.
  • Pack in individual containers. Pantries loaded with huge bags of potato chips and cookies lead to mindless munching. Sitting on the couch with a large bag on the lap, your child is apt to reach again and again into the bag, unconsciously eating well beyond satisfying hunger pains. You can still save money by buying in bulk, but transfer snacks into one-serving sized re-sealable plastic bags.
  • Craft creative shapes and designs. Younger children especially enjoy colorful, fun-looking foods. Shape sandwiches into triangles, circles, and squares. Make raisin smiles on bowls of cottage cheese. Cut up oranges and apples into slices.
  • Jazz up leftovers. One last English muffin left in the refrigerator? Dress it up quickly with a few spoonfuls of pizza sauce and a few sprinkles of low-fat mozzarella cheese and toast it in the oven for a few minutes. Instant mini pizza!
  • Strive for compromise. If your child loves cookies, offer oatmeal raisin or low-fat sandwich cookies and wash them down with a calcium-rich glass of 1 percent or skim milk.
  • Dive into dips. Most children don’t beg for raw vegetables. Win them over by encouraging them to plunge cut-up celery and baby carrots into dips made from low-fat ranch dressing or herbed cottage cheese. Sprinkle some garlic, oregano or Parmesan cheese into the cottage cheese to perk up its flavor.
  • Select healthy substitutes. French fries would belong to the major food groups if some students had their say. Bake potato sticks and wedges in the oven with sprinkles of paprika for a healthier, low-fat alternative that kids can quickly heat in the microwave or toaster oven when they return from school.
  • Team up in the kitchen. Perhaps on a lazy Sunday afternoon, spend a couple of hours in the kitchen together, creating some healthy after-school snacks for the week. Make homemade popsicles together using low-fat pudding and yogurt.
  • Tuck in some TLC. Scribble a note that offers praise to your son or daughter and tape it to the inside of the pantry door or inside the refrigerator. “The note can also alert them about something prepared in the refrigerator for them and it makes your child know you care,” says Giangrandi.

What To Eat, When To Eat

Common Sense Is What You Need — Not Special Products

Each year, athletes at all levels, hungry for a competitive edge, eagerly consume billions of dollars worth of sports drinks, power bars and other special “sports” supplements.

Are they performing better or just engaging in an expensive exercise in futility?

From a medical standpoint, it’s likely the latter. Whether you’re a weekend warrior or a big-money pro, you’ll probably perform just fine following the same healthful diet guidelines recommended for everyone else.

Many people get too concerned about what types of foods to eat — this much carbohydrate, and the right amount of protein. The more important message is to eat enough calories to provide the energy for best performance. And while those calories should come from healthful, nutrient-dense foods, they don’t have to be specially formulated — whether by product or even nutrient.

For instance, many athletes tend to eat a lot of protein, believing it will increase their strength and endurance. But there is little scientific evidence supporting the benefits of high-protein diets to enhance performance.

In fact, most Americans — athletes included — get too much protein in their diets. Unless you have a kidney disorder, protein is not harmful, but most high-protein foods, such as meats, are also high in saturated fats, which can increase risk of heart disease, stroke and some cancers.

Instead, athletes and everyone else would do better by eating fruits, vegetables, mono and polyunsaturated oils, and whole grains, with moderate amounts of protein and avoiding saturated fats and sugars. Within that framework, there are a few basic nutrition guidelines for optimal performance:

Drink two 8-ounce glasses of water before you start exercising, and another two glasses after your workout. If you will be exercising continuously for more than 30 minutes, try to drink small amounts every 15 to 30 minutes as you run or during breaks. Water is best; caffeinated beverages such as colas, iced tea and coffee can cause you to lose water and minerals out of your body through the urine.

Sports drinks are useful only if your workout is especially strenuous or long or if you sweat profusely. They are not usually necessary for a child’s weekend soccer or baseball game. A good rule of thumb: If you barely break a sweat, water is better.

Eat at least two hours before exercising, because it takes at least that long for the food to be digested and metabolized. An ideal pre-workout meal includes a vegetarian sandwich (with little or no butter or mayonnaise), a cup of low-fat yogurt or a pasta dish with low-fat sauce — all relatively easily digested foods. Eating huge amounts of pasta or other carbohydrates for “carbo loading” isn’t necessary for the average person — it won’t help your exercise performance and, if you eat more than you burn off, will add pounds to your physique.

If your workout is strenuous, you’ll need to replace the calories you burn with a post-exercise snack. Here, carbohydrates are most important because they replace the energy stores in the body’s muscle tissue. Good post-workout snacks include a bagel with a small amount of fruit preserves, whole grain pasta, a banana, graham crackers, carrots or a cup of low-fat yogurt. Energy bars are fine but are best if they contain no more than 15 percent protein and 25 percent fat.

Athlete or not, most everyone should take a multivitamin/mineral supplement daily. Other than that, the average person needs no other supplements. That means no amino acid powders, no protein drinks, no herbs, no steroids. They haven’t been proven to work, and some could be harmful to your health.

What is Homocysteine? How Important is it?

You’ve heard of cholesterol. But there’s another potential risk factor for heart disease you should know about. Elevated levels of homocysteine, an amino acid in the blood, are associated with an increased risk of heart attacks and strokes, the top and third leading causes of death in the United States. The key question is will the reduction of homocysteine levels in the blood mean less chance of a heart attack and stroke? From a biologic standpoint this makes sense, but it may take a few more years to prove it.

Diet Can Help

The good news is that homocysteine levels can often be managed with diet. Three nutrients in particular can help lower elevated homocysteine levels: folic acid, which is abundant in green leafy vegetables, oranges and fortified cereals; vitamin B-6, found in meats and fortified cereals; and vitamin B-12, found in meats, potatoes, bananas and fortified cereals. These nutrients are believed to help keep homocysteine in check by helping it convert into other substances in the blood that aren’t associated with heart disease.

Some studies show that many people in general – not only those with elevated homocysteine levels – are not getting enough of these nutrients in their diet. The usual recommendation is to injest at least 400 micrograms of folic acid each day – the amount found in a cup of many fortified cereals. You can also get that amount by consuming six asparagus spears, a cup of orange juice, a half cup of lentils and two slices of whole-wheat bread.

The recommended daily consumption for vitamin B-12 is 2.4 micrograms, the amount found in a chicken breast, a hard-boiled egg and a cup of yogurt. The daily recommended dose of vitamin B-6 is between 1.3 and 1.7 milligrams a day, which can be found a baked potato (with its skin) and a banana.

You may even want to take a multiple vitamin or a B-complex vitamin daily to be sure that you are getting enough folic acid, B-6 and B-12.

What’s Normal?

Normal homocysteine levels range between one and 10 micromoles per liter. Unlike cholesterol, which is considered problematic when it rises above 200 milligrams per deciliter, researchers haven’t set a “safe” level of homocysteine.

There is not enough evidence to indicate that widespread screening for elevated homocysteine levels is useful. However, people with known of those whose family members have angina or had a heart attack at a young age might benefit from having a blood homocysteine test.

Homocysteine first came under suspicion 31 years ago when Harvard pathologist Kilmer McCully, M.D., discovered that children with severe arteriosclerosis (clogging of the arteries) also had high homocysteine levels. Dr. McCully speculated the substance might also play a role in adult heart disease. McCully’s hypothesis didn’t get much attention, though, until the 1990s, when several large-scale studies began implicating homocysteine as the possible cause of heart problems.

In a Harvard study of 15,000 physicians reported in 1992 in the Journal of the American Medical Association, 5 percent of the group with the highest homocysteine levels had at least three times the risk of heart attack than people with lower levels. Three years later, researchers from the University of Washington in Seattle reported in the same journal that perhaps 10 percent of the risk of cardiovascular disease might be attributed to elevated homocysteine levels. The researchers based their estimate on an analysis of 38 studies looking at homocysteine’s connection to heart disease.

super foods that fight with diseases

Key Disease fighters

Since different phytochemicals are present in different foods, eating a varied diet is important to ensure that you get all the cancer protection possible. So don’t fall for the “vegetable du jour” only to abandon it when the next vegetable becomes popular. Understanding the categories and key players among phytochemicals is also important:

ALLIUM COMPOUNDS such as allyl sulfides are believed to help detoxify some carcinogenic compounds, facilitate carcinogen excretion and have antibiotic properties. Food sources include onions, garlic, scallions and chives.

CAROTENOIDS such as alpha-carotene, beta-carotene, cryptoxanthin, lycopene and lutein work as antioxidants — helping to offset damage done by environmental pollutants such as pesticides and smoking. Food sources include dark green, orange or red fruits and vegetables — especially carrots, sweet potatoes, tomatoes, spinach, broccoli, cantaloupe and apricots.

GLUCOSINOLATES such as glucobrassicin are metabolized to produce two other phytochemicals, isothiocyanates and indoles, which trigger production of enzymes that block cell damage due to carcinogens. Food sources include cruciferous vegetables, such as broccoli, broccoli sprouts, cabbage and Brussels sprouts.

POLYPHENOLS such as ellagic acid and ferulic acid are thought to prevent conversion of substances into carcinogens and inhibit mutations. Food sources include oats, soy beans and fruits and nuts — especially strawberries, raspberries, blackberries, walnuts and pecans.

FLAVONOIDS comprise more than 2,000 substances that are powerful antioxidants. Food sources include coffee, tea, cola, berries, tomatoes, potatoes, broad beans, broccoli, Italian squash, onions and citrus fruits.

Phytochemicals have been on the front lines in the dietary battle against cancer. Will they help birth a new breed of better disease-preventing foods — and more nutritional-savvy shoppers?

Only a few years ago, hardly anyone knew about beta-carotene. Today, it’s virtually a household word, and its cancer-fighting potential, along with other so-called “phytochemicals,” is the subject of much debate.

The study of phytochemicals is the focus of a well-seasoned scientific discipline, referring to the literally thousands of chemicals contained within plants. In recent years, the term has been popularized to refer in particular to plant chemicals that may affect health.

Research suggests that phytochemicals such as carotenoids, isoflavones, sulforaphane, limonene, flavonoids and allyl sulfides may also protect against cancer and other diseases.

These phytochemicals are natural compounds that protect plants from the ravages of sunlight and other environmental threats. Many of these compounds are currently under investigation for their roles in blocking the formation of some cancers. They may also protect against some forms of heart disease, arthritis and other degenerative diseases.

While present in varying degrees in all plant foods such as fruits, vegetables, grains, oils, nuts and seeds, some of these foods have greater amounts of phytochemicals — making them more useful in a healthy-eating regimen.

Among the thousands of different phytochemicals in plants, each one could potentially have some activity if ingested by humans. Some of these are currently under investigation for their potential to prevent certain cancers. Many studies have provided evidence that eating more fruits and vegetables decreases the risk of cancer at several different organ sites, including the mouth and throat, lungs, stomach, colon and rectum, pancreas, breast and bladder.

Productive Produce

Research on phytochemicals helped prompt the National Cancer Institute to initiate its “5-A-Day” program for healthy eating. Consumers were urged to eat more foods such as garlic, broccoli, onions and soy products.

In the future, shoppers may have an easier time getting the most nutritional bang per bite. Plant breeders and biotechnologists worldwide are developing nutritionally enhanced vegetables and fruit.

“Super” breeds of certain foods may be developed to maximize their beneficial phytochemical content. Seed catalogues already offer home gardeners the opportunity to buy seeds for several of these super vegetables.

Sulforaphane has been identified as a potent inducer of detoxifying enzymes. Broccoli is a good source. In fact, three-day old broccoli sprouts were between 20 and 50 times richer in sulforaphane than mature broccoli. In one study, rats fed sulforaphane developed fewer cancerous tumors, and their tumors developed at a slower rate.

In addition to high-sulforaphane broccoli sprouts, high-lycopene tomatoes and high-beta-carotene cauliflower are also already on the market. Besides developing specific foods richer in phytochemicals, some package labels may even list the amounts of dominant protective substances, just as current food labels list the amount of fats, sodium and carbohydrates. These developments by scientists and the food industry are making it easier for all Americans to become more nutrition-savvy food shoppers and consumers.

how to order the best food in restaurants

If you’re on a special diet and planning to try a new restaurant, call ahead to see whether it offers suitable menu choices or if substitutions can readily be made. With the exception of fast-food restaurants, where everything is already prepared when you get there, most restaurants are happy to modify their dishes by changing the cooking method, leaving out an ingredient or serving part of the dish, such as the gravy or dressing, on the side so you can control the amount you eat.

If you have a food allergy or sensitivity, you should be extremely careful about eating out. Common allergens and irritants include milk, eggs, shellfish (crab, lobster, shrimp), fish, citrus fruits, legumes (soybeans, lima beans), peanuts, spices, artificial food dyes, molds, sulfites and wheat. Ask specific questions, and be sure your waiter understands the different ways an allergen can get into a dish. For example, the stock base in a harmless-sounding corn chowder may contain clam juice, a disaster for someone allergic to clams and other members of the mollusk or shellfish family.

For the average health-conscious person, there’s something for everyone on almost every restaurant menu. Keep these eating-out tips in mind to avoid the major pitfalls of restaurant food:

Translate menu language. Look for entrees on the menu that are broiled, grilled, poached, steamed, roasted or baked, and avoid foods described as fried, crisp, sauteed, creamy, creamed, au gratin, escalloped or breaded.

Share with a friend. You won’t tend to overeat if you split your appetizer and dessert.

Watch portion size. If you know you’ll be tempted to eat more than you should, ask to have your “doggy bag” prepared in advance, so you’ll only get a half order at the table. Some restaurants will even let you order a half order or children’s portion of pasta as an entree.

Eat low-calorie foods first. Order a salad as your first course and when dinner arrives, start with the lowest calorie foods on your plate.

Go for balance. If you really want a high-fat or high-calorie entree, balance it with lean choices for the rest of the meal.

Here are some healthy choices you can make at different types of restaurants:

At a pizzeria, choose plain cheese pizza or pizza with vegetable toppings instead of meat toppings. Plain cheese pizza (181 calories) and vegetable pizza (188 calories) both weigh in with about seven grams of fat and 460 milligrams of sodium. By contrast, meat pizza (234 calories) has 12 grams of fat and 611 milligrams of sodium. [Source: USDA]

In an Italian restaurant, ask for breadsticks instead of bread, and ask for oil and vinegar on the side to dress your own salad. Order pasta with red sauce such as marinara instead of such creamy white or butter sauces as Alfredo. Choose chicken dishes instead of meat and sausage dishes. Have a cappuccino for dessert.

In a Chinese restaurant, choose steamed rice instead of fried rice, steamed dumplings instead of fried and vegetarian entrees that include a number of different vegetables.

In a Japanese restaurant, pass up tempura in any form because fried food should be avoided.

In a Mexican restaurant, choose salsa instead of sour cream or cheese dips. Choose dishes made with plain, soft tortillas that aren’t fried, such as burritos, soft tacos and enchiladas. Have black bean soup as a first course.

In a cafeteria or food-buffet restaurant, fill your plate with plain vegetable side dishes before you go for the meat. Look for grilled, broiled or flame-cooked chicken, fish and lean meats and avoid anything breaded, batter-dipped or fried. If there’s a salad bar, concentrate on crisp, crunchy vegetable and bean mixtures; leave the potato, macaroni and tuna salads behind.

what does food labels mean?

The following glossary of food label terms provides the government definitions of terms used on food labels and packages. The list will help you decipher what a food label tells you about the food.

Calorie-free: A serving contains less than 5 calories

Cholesterol-free: A serving contains less than 2 mg cholesterol and 2 g or less saturated fat

“A good source of “ (a juice label, for example, that claims the product is “A Good Source of Vitamin C”.) A serving contains 10 to 19 percent of the Daily Value for a given nutrient.

Daily Value (DV): The recommended daily intake of a specific nutrient based on a 2,000 calorie diet.

Excellent source of; Rich in; or High: A serving provides at least 20 percent of the Daily Value for the claimed nutrient.

Extra, Added, or More: a serving contains at least 10 percent of the DV of a particular nutrient when compared with a similar food.

Extra lean: Cooked meat, poultry or seafood contains less than 5 g total fat, less than 2 g saturated fat and less than 95 mg of cholesterol per serving.

Fat-free: A serving contains less than 0.5 (1/2) g of fat.

Gram (g): A metric unit of weight equal to about 1/28th of an ounce.

Healthy: To be labeled healthy, a food must meet the standards for low fat and low saturated fat and not exceed maximum levels for sodium and cholesterol. The product must also provide at least 10 percent of the Daily Value for at least one of the following nutrients: protein, fiber, vitamins A and C, iron or calcium. In addition, all raw fruits and vegetables (whether they meet the 10 percent standard or not), plain frozen fruits and vegetables (with no sauces or seasonings) and enriched grain products can claim to be “healthy.”

High in fiber: A serving contains at least 5 g total fiber.

Lean: A serving contains less than 10 g total fat, less than 4 g saturated fat and less than 95 mg of cholesterol.

Light or Lite: A serving contains one-third fewer calories or 50 percent less fat than a similar product. If more than half the calories are from fat, fat must be reduced by 50 percent or more.

Low-calorie: A serving contains no more than 40 calories.

Low-cholesterol: A serving contains no more than 20 mg of cholesterol and 2 g of saturated fat.

Low-fat: A serving contains no more than 3 g of fat.

Low-sodium: A serving contains no more than 140 mg sodium.

Milligram (mg): A metric unit of weight that measures one thousandth of a gram.

Reduced cholesterol: A serving contains at least 25 percent less cholesterol than a similar product and 2 g or less saturated fat.

Reduced fat: A serving contains at least one-third less fat than the same amount of a similar product.

Sodium-free: A serving contains less than 5 mg sodium.

Very low sodium: A serving contains 35 mg of sodium or less.

Last updated July 09, 2001

what is Food Labeling

To assist individuals in translating nutritional requirements into appropriate food selection and the preparation of healthful meals, the Food and Drug Administration has established a system for food labeling. Nutrient labels are required for most foods, except for products that provide few nutrients, e.g. coffee. Restaurant foods, ready-to-eat foods prepared on site, as well as bakery and deli items are also exempt. A food label provides information on calories per serving, calories from fat, saturated fat, cholesterol, sodium, total carbohydrate, dietary fiber, sugars, and protein. The food label also shows the percentage of the daily value (DV) supplied by all of the above nutrients, except protein.

It is important to keep in mind that DV’s are not recommended intakes for individuals, in as much as no one nutrient standard could apply to everyone. Instead, they are based on an intake of 2000 and 2500 calories, and thereby provide a rough guide to daily nutrient needs.

People who consume more or less than 2,000 calories a day must make adjustments to the standard Daily Value figures. A 1,600 calorie diet, for instance, is 20 percent less than a 2,000 calorie diet; therefore the standard DVs need to be reduced by 20 percent. (The DV for fat would be 52 grams instead of the standard recommendation of 65 grams.) On the other hand, a 2,400 calorie diet is 20 percent more than the standard diet. (The DVs for fat would be 78 grams instead of the standard recommendation of 65 grams.)

How to make Meat Healthier

While it’s a good idea to limit the amount of red meat you consume, there’s no reason to give it up completely. A broiled quarter-pound beef burger contains a whopping 20 grams of fat, 8 of them saturated-or about one-third of your recommended daily limit. Instead, try lean ground turkey, seafood and vegetables (chickpeas, for example) to make delicious low-fat burgers. Here are some tips to make burgers as tasty as they are healthy:

  • When making a beef burger, use lean beef and cut the amount in half; then fill your sandwich with vegetables, tomatoes and lettuce.
  • Sear all vegetable burgers first over high heat to lock in moisture.
  • To keep turkey and veggie burgers juicy, don’t press down on the patties while cooking.
  • Instead of hamburger rolls, try pita pockets or English muffins.
  • Spruce up your burger with hearty greens (spinach, arugula, watercress) and fancy mustards, salsas and chutneys, nonfat sour cream plus mustard, which add flavor minus the fat.
  • When making a turkey burger, look for ground turkey made from white breast meat. Dark turkey meat may contain skin and weigh in with as much fat as ground beef.

When meat, poultry and fish are grilled over high heat for a long time, benzopyrene, a chemical compound that can cause cancer in lab animals when given in large amounts, can form in the food. Cooking time, temperature and the amount of fat in the meat and marinades affect the amount of benzopyrene formed.

There’s no evidence linking barbecued food to cancer in humans, but to play it safe, here are some suggestions:

  • Choose lean cuts of meat and trim visible fat, the source of benzopyrene.
  • Thaw frozen meats first to cut down grilling time and prevent charring.
  • Use spice rubs or marinades with little or no fat.
  • Cook meat completely, but don’t overcook.
  • Use hardwood charcoal briquettes, which burn at a more even temperature than softwood charcoal.
  • To prevent fat from dripping onto coals, place a drip pan on top of the coals.