Current Topics in Food Safety & Nutrition

IFIC Foundation http://ific.org September / October 2006

Shopping for Health? Check Out these Food Components

ore and more consumers The Produce Department— and many different flavonoids in Mare aware of the relationship A Cornucopia of Healthful berries, cherries, grapes, cranberries, between diet and health and are apples, onions, and more. The interested in learning more about Components tongue-twisting antioxidants, lutein foods that can promote health. With Fruits and are and zeaxanthin, may contribute to this is mind, it is important that especially praised for being chock- maintenance of healthy vision. Look consumers understand how to put full of an array of plant components for them in kale, collard greens, nutrition information into practice. that contribute to good health spinach, corn, and citrus fruits. Where better to practice nutrition including , minerals, fiber knowledge than the grocery store! and phytonutrients, not to mention Even the most saavy shoppers their high levels of antioxidants, can discover something new when which defend against damaging free it comes to shopping for foods radicals that occur in the body. Free that promote health. Nutrition radicals are linked to diseases such communicators can assist shoppers as cancer, cardiovascular disease, by applying the latest nutrition cognitive impairment, Alzheimer’s science to everyday tasks, such as disease, immune dysfunction, grocery shopping. cataracts and macular degeneration. Fortunately, there are tools all Some common antioxidants over the grocery store to direct in fruits and vegetables are consumers to make healthful food beta-carotene (which the body choices. In-store nutrition staff also converts to A) in and pamphlets are two resources carrots, pumpkin, sweet potato consumers can be directed to. They and cantaloupe; vitamin C in can also consult food packages strawberries, guava, sweet red for Food and Drug Administration or green pepper, kiwi, and citrus regulated nutrition information fruits such as oranges, grapefruit, including the Nutrition Facts panel, lemons, and limes; sulforaphane • Shopping tip: Eggs are also an claims about the nutrient content of and dithiolthiones in cabbage and excellent source of lutein and foods, and claims related to how that its cousins cauliflower, broccoli, zeaxanthin. food might be beneficial in reducing Brussels sprouts, kohlrabi and kale; • The antioxidant lycopene in risk of disease or promoting health. sulfides in garlic, onions, and leeks, tomatoes, watermelon, papaya, and red or pink grapefruit may Carbohydrate Confusion: help keep the prostate healthy and may also contribute to heart What You Need to Know about the Glycemic Index...... 2 health. Nutrition and Food Safety Myths and Facts...... 4 (continued on page 6)

INSIDENewsBites...... 7 that it raises blood levels by less Carbohydrate than half (41 percent) of what an equal amount of glucose does.

Confusion: What Is Glycemic Load? Glycemic load (GL) is a related What You Need to Know concept that considers both the glycemic index and the amount of about the Glycemic Index carbohydrate in a typical serving of food, giving a somewhat more accurate picture of a food’s effect on blood sugar. For example, carrots arbohydrates are an important What is the Glycemic Index? have a relatively high glycemic nutrient and a significant index because the carbohydrates C Almost all carbohydrates ( part of a balanced diet. Experts in carrots are mostly sugars. But and starches), regardless of the form generally encourage people to build a serving of carrots contains a low in which they are consumed, are their diets around nutrient-dense amount of carbohydrate compared digested to glucose which enters the carbohydrates, incorporating a to high GI foods such as bread and bloodstream, causing a temporary moderate amount of protein and potatoes. To calculate glycemic rise in blood glucose levels. This some . Exercise and weight load, you multiply the grams of glycemic response is influenced control are key elements of a carbohydrate in a serving of food by by many factors, including how healthful lifestyle to help reduce risk that food’s glycemic index. Carrots, much food is eaten, the amount and for heart disease, diabetes, and high which have a glycemic index of 71, type of carbohydrate in the food, blood pressure. have 8 grams of carbohydrates per how the food is processed, or how About 20 years ago a group of serving and are assigned a glycemic it is prepared. Under laboratory researchers developed the glycemic load of 6 (8 x 0.71). conditions, glycemic index (GI) index as a tool to measure how much is assessed by having a group of a carbohydrate-containing food is people eat a specific amount of a It’s Not That Simple likely to raise blood sugar. Since that single food (usually 50 grams of time “glycemic index” has become On the surface GI and GL sound digestible carbohydrate, i.e., total a popular nutritional catchphrase like straightforward concepts for carbohydrate minus fiber) and then and the basis for some popular enabling meal and diet planning, measuring the change in blood sugar “magic bullet” diets that advocate but experts say it’s not that simple. levels compared with the levels strict limitations on carbohydrate Here’s why. achieved after they have eaten a intake. The National Academies’ The GI value of a food varies control food (either glucose or white Dietary Reference Intake for Energy, depending on how ripe it is, its bread) containing the same amount Carbohydrates, and Fiber states, variety and how it is cooked and of digestible carbohydrate. The “Research is needed to determine the processed. Also, GI is determined International Table of Glycemic Index effect of low glycemic index foods using standard test portions of foods, and Load lists the values of both and low glycemic load diets on serum which are not the usual portion sizes control foods. The average change in lipids and other risk factors for that people consume. blood sugar levels over a set period chronic disease and complications, of time, relative to the levels after Many variables affect GI especially in high risk groups.” Is consumption of the control food, is calculations, including the fact that it really necessary to “eat by the the food’s glycemic index. the GI of a food depends on whether numbers” to lose or maintain weight? it is eaten alone or consumed with The index assigns foods a number Here are some answers to questions another food. “In the real world, on a scale of one to 100, in comparison about the glycemic index, glycemic people eat meals and diets, not with pure glucose, which has a load, and their relationship to diet single foods,” says Susan Borra, a reference score of 100. Regular pasta and health. registered dietitian and president of has a glycemic index of 41, meaning

(continued on page 3)  Food Insight http://ific.org/foodinsight September / October 2006 (continued from page 2) Carbohydrate Confusion the International Food Information Council Foundation. A high GI ... using glycemic index or food combined with a low GI food produces a moderate response. Think of spreading some strawberry glycemic load… jam on whole wheat bread with peanut butter. The protein, fat, and it’s not that simple. fiber in the sandwich temper the relatively high GI of the jam. What about using glycemic load instead of GI? Again, it’s not that simple, since the GL calculation begins with a food’s glycemic index Think Nutrient Density investigation, these theories and thus includes all the inherent remain unproven. Also, concerns uncertainties that pertain to GI. GI and GL calculations depend on about the measurement and too many factors to enable science- GI’s rising popularity has been reliability of GI have yet to be based meal planning. However, most fueled by claims that low GI foods resolved. Glycemic index may nutrition scientists concur that a can help control appetite, weight, have the potential to be a valuable food’s nutrient density (a measure and may be useful to people with clinical tool, but it is clear that of the proportion of nutrients a diabetes. These claims are based on more research, including long- food supplies to the calories it the theory that high GI foods raise term clinical studies, is needed to contains) is more important than the blood sugar levels, cause excess prove its worth in reducing risk of glycemic index. The good news is insulin to be secreted, and lead to disease. that consumers can plan healthful the storage of fat. However, the Prevailing nutrition wisdom meals and diets without complicated American Dietetic Association (ADA) is represented by the 2005 calculations for each item on their says: “At this time, research does Report of the Dietary Guidelines dinner plates. not support the claim that a low GI Advisory Committee which states, diet causes significant weight loss or It is helpful to remember that “Current evidence suggests helps control appetite.” For people many low glycemic index foods are that the glycemic index and/or glycemic load are of little utility with diabetes, monitoring total grams naturally high in fiber. They take for providing dietary guidance for of carbohydrate continues to be the longer to digest, and may, therefore, Americans.” key strategy, ADA says, although the be more satisfying. Often they are GI concept may supplement“ blood less energy dense than their higher glucose monitoring to “fine-tune” GI counterparts. These are the food choices and modestly improve very foods—whole grains, fruits, What’s New @ blood glucose levels. vegetables, legumes—that nutrition IFIC.org? experts have always recommended A recent recommendation for Coming this fall, we’re launching and continue to emphasize as the people with diabetes from the the IFIC Foundation Publications cornerstones of a healthful diet. American Diabetes Association, Store, where you’ll be able to published in the September 2006 The Bottom Line order IFIC Foundation publications issue of Diabetes Care says, “The ”securely online and even pay by Over its 20-year history the use of glycemic index and load may credit card! Visit www.ific.org/ glycemic index has generated provide a modest additional benefit publications to learn more about much interest and controversy. A over that observed when total our exciting new store and sign number of hypotheses relate high carbohydrate is considered alone.” up to receive notification when GI foods to increased blood sugar the store is launched. You’ll also and insulin levels, suggesting the receive free monthly updates from potential for increased disease risk. While worthy of further the IFIC Foundation. (continued on page 0) September / October 2006 http://ific.org/foodinsight Food Insight  Nutrition and Food Safety M y t h s and FAC t s

It comes as no surprise that Americans are suffering from “information overload.” Most are also aware that the current information environment is a breeding ground for the propagation of myths. This situation certainly applies to nutrition and food safety issues. The following seeks to shed some light and provide the scientific facts to address some common myths about the food you eat. MYTH: Low-calorie sweeteners increase the risk of MYTH: Lactose intolerant children should not drink . cancer in humans. FACT: New guidelines by the American Academy of FACT: There is no scientific evidence of a link Pediatrics actually recommend that lactose between low-calorie sweeteners and cancer intolerant children not only consume milk, in humans. Questions arose when early but other dairy products such as cheese studies indicated a possible (bladder) cancer ? and . While tolerance varies among link between cyclamate in combination with individuals, it is recommended to introduce saccharin in laboratory animals. However, small amounts of dairy to determine how according to the National Cancer Institute, much can be tolerated without triggering recent research results from subsequent symptoms. This is especially important as studies on these and other approved low- many lactose intolerant children may not be calorie sweeteners have not provided any getting enough . The guidelines are evidence of a link. Recent research by explained in detail in the September 2006 the National Cancer Institute confers no issues of Pediatrics. association between aspartame consumption Pediatrics 2006;118;1279-1286. with an increase of cancer risk. Cancer Epidemiol Biomarkers Prev 2006;15(9);1654- MYTH: in food are bad. 1659. Additional resource materials about FACT: Fats got a bad rap many years ago and that the safety and use of low-calorie sweeteners reputation seems to have stuck. Over the are available at: http://www.ific.org/ years, scientific knowledge has evolved publications/other/lcsresources.cfm. yielding interesting new developments. The focus now is also on consuming a MYTH: Low-calorie sweeteners have an effect on moderate intake (20 to 30 percent of calories appetite and promote weight gain. or 44 to 77 grams per 2,000 calorie diet) FACT: Research on the effect of consuming foods with more of some types of fats (fatty acids) and beverages containing aspartame, for and less of others (i.e., higher intake from example, has not been shown to increase polyunsaturated and monounsaturated fats food intake or hunger in children, nor does it from sources such as oils, nuts, and indicate an increase in food intake in normal fish. Keeping intake oftrans fat and saturated weight or overweight adults. (Blackburn fat as low as possible, while consuming a GL World Rev Nutr Diet 1999;85:77-87). ?nutritionally balanced diet, which can be Additional studies in overweight individuals determined by looking at the Nutrition Facts showed improved body weight when panel on the food label. they consumed a diet that included foods sweetened with low-calorie sweeteners MYTH: It is better to look at the ingredients list to see if instead of foods sweetened with sugar. (Raben there is trans fat in a product than the Nutrition A, Vasilaras TH, Moller AC, Astrup A Am J Facts box. Clin Nutr 2002;76:721-9). In fact, low-calorie FACT: Consumers were told to look for “partially sweeteners can be an essential tool in weight hydrogenated vegetable oil” in the ingredient management when used as part of the caloric ? statement before trans fat was listed on equation for the general population and help the label. Now that grams per serving are to achieve the calorie goals/limits of people listed consumers have the necessary tool with diabetes. to determine if trans fat is in the product and also how much. Sometimes it can be

(continued on page 5)  Food Insight http://ific.org/foodinsight September / October 2006 (continued from page 4) Nutrition and Food Safety — MYTHS and FACTS

confusing to mesh old and new advice. For food can be fatal. The Centers for Disease instance, a product may have 0 grams of trans Control and Prevention (CDC) estimates that fat on the label and still contain some partially foodborne diseases cause approximately 76 hydrogenated vegetable oil. The reason for million illnesses, 325,000 hospitalizations, this is that partially hydrogenated vegetable and 5,000 deaths in the United States each oil, depending on a variety of factors year. For more information visit the IFIC including how much it is hydrogenated, can Foundation’s Consumer’s Guide to Microbial contain varying amounts of trans fat and Risks to Food Safety at http://ific.org. sometimes only a small amount will be used. The FDA says that if a product contains less MYTH: Sugar causes diabetes. than .5 grams per serving, it is considered FACT: There are two types of diabetes: type 1 and nutritionally insignificant and therefore type 2. In type 1 diabetes, the pancreas fails is rounded to zero. Another point: many to produce the hormone, insulin, which is people confuse the terms “hydrogenated” required by the body for energy utilization and “partially hydrogenated.” If a product by muscles and other cells. Type 2 diabetes contains “partially hydrogenated” oils then it results when the body is unable to respond will contain some amount of trans fat, but if properly to the insulin produced by the a product contains “hydrogenated” oil it will pancreas. Type 2 diabetes is the most contain no trans, only saturated fat. common. Individuals who are overweight MYTH: Filling your sink with water and putting your or obese may be more at risk for developing produce in the standing water is the best way to type 2 diabetes. Consumption of sugars and clean it. carbohydrates does not cause either type of FACT: According to the Partnership for Food Safety diabetes. People with diabetes need to be Education (PFSE), soaking your produce is especially careful about the carbohydrates risky business. Sinks with standing water can that they consume, usually by counting grams harbor bacteria which can transfer to foods of carbohydrate, but sugars are not “off and make you sick. limits” even for people with diabetes. Regular exercise improves insulin sensitivity for They advise; to properly clean fresh fruits people with diabetes and everyone else, too. and vegetables including those with skins and rinds that are not eaten, rinse them under MYTH: High fructose corn syrup (HFCS) causes obesity. running tap water. Rub firm-skin fruits and FACT: No single food or ingredient is the sole cause vegetables under running tap water or scrub of obesity. Too many calories combined with with a clean cloth towel or paper towel. Never too little exercise is the primary cause. Like use detergent or bleach to wash fresh fruits dietary fats, carbohydrates, and proteins, or vegetables. Bleach and other cleansers are HFCS, if consumed in excess, can contribute not intended for consumption. to weight gain. However, there is no scientific The PFSE is a not-for-profit organization that proof of cause and effect with respect to unites industry associations, professional the consumption of HFCS rather than other societies in food science, nutrition and health, sugars, such as sucrose, regarding obesity consumer groups, and the U.S. government to rates. Speculation of a cause-and-effect educate the public about safe food handling. relationship between HFCS and weight gain www.fightbac.org, the website of the PFSE, is based on preliminary research that tested is a resource for food safety and safe food fructose levels at least three to four times handling information. higher than the average amount consumed by Americans. The research did not test HFCS, MYTH: “If it tastes okay, it’s safe to eat.” which, like sucrose, is made up of almost FACT: If you trust your taste buds to detect unsafe equal amounts of fructose and glucose. food, you will eventually be in trouble. Taking even a tiny bite to test the safety of a questionable food can be dangerous. For some foodborne illnesses, such as botulism, eating just a small amount of a contaminated September / October 2006 http://ific.org/foodinsight Food Insight  (continued from page 1) Shopping for Health?

• Shopping tip: Processed tomato servings of whole grains such as and cheese, helps the body products such as canned tomatoes, oatmeal, ready-to-eat cereals, and absorb calcium for strong bones. tomato paste, and ketchup breads containing whole grains Emerging research on vitamin D are more bioavailable and (look for the phrase “whole grain” shows that it may also play a role in concentrated sources of lycopene. or “whole” before the grain’s name), promoting immune function as well • The mineral potassium, which brown rice, barley, popcorn, pasta, as reducing risk of certain cancers, may reduce the risk of high crackers, and couscous, wild rice, and improving balance in the elderly. blood pressure and stroke buckwheat, triticale, bulgur, millet, • Shopping tip: Calcium and as part of a low-sodium diet, quinoa, and amaranth. vitamin D are also added to is plentiful in orange and Fiber is found both in whole grains some cereals and . grapefruit , bananas and and in certain enriched grain-based Probiotics are beneficial bacteria potatoes. Potassium chloride, foods. A special type of soluble that may improve gastrointestinal a salt replacement, is another fiber called beta glucan, found in health and immunity by increasing option for those looking to oatmeal and barley, may reduce the population of friendly bacteria increase potassium intake. the risk of coronary heart disease in the digestive tract. Examples Look for it in the spice and by binding cholesterol in the gut are certain strains of Lactobacilli baking aisle. Spinach, nuts, soy, and transporting it out of the body. and Bifidobacteria. Look for these pumpkin, beans, and squash Insoluble fiber found in wheat bran specific strains of probiotic bacteria all contain magnesium, which and corn bran, and in some cereals in certain fermented dairy products helps maintain normal muscle, and breads may contribute to a like yogurt and kefir (a tangy milk immune, and nerve function, and healthy digestive tract and reduce drink). Probiotics are also becoming also contributes to bone health. risk of certain cancers. available in shelf-stable foods. Consumers can be adventurous • Shopping tip: Fruits and • Shopping tip: Prebiotics are and discover other aisles of the vegetables also contain a mix non-digestible food components grocery store where they may find of soluble and insoluble fibers. that help beneficial probiotics a variety of foods that are full of Legumes like lentils and kidney multiply in the intestine, so healthful components. For instance, beans are especially rich in pair them up to maximize frozen and canned fruits and soluble fiber and can be found effectiveness. Foods with vegetables are also great choices with dried and canned foods. prebiotics include certain because they are picked, packed, • Many grain foods are fortified whole grains such as oatmeal frozen, or canned at peak of ripeness, with (called folic acid on and barley, bananas, berries, when antioxidant and nutrient the label), which may reduce a onions, garlic, leeks, artichokes, content are also at their peak. woman’s risk of having a child greens like spinach and kale, with a brain or spinal cord defect. legumes and honey. Great Grains: Folate, when consumed with a Soy milk—plain or flavored— The Bread, Cereal, Rice, diet rich in other B-vitamins, contains the same amount of calcium and Pasta Aisles may also help reduce the risk of as an equivalent glass of milk. Research cardiovascular disease. shows that soy protein may reduce the Here’s where you can find whole • Shopping tip: Folate is also risk of coronary heart disease. grains, which may reduce risk of found in legumes such as beans, heart disease, certain types of • Shopping tip: Soy-based foods peas, soybeans and lentils, as cancer, type 2 diabetes, and may are found all over the store. well as citrus fruits and juices, even help with weight management. Scan the shelves for soy nuts, spinach, and peanuts. soy butter and soy-containing How? A whole host of components drink powders, and the in whole grains work together The Case for Dairy and refrigerated section for tofu to provide protection. These and tempeh. Check the freezer include fiber, vitamins, minerals, Calcium-Fortified Soy Milk and refrigerator cases for beneficial enzyme inhibitors, and Dairy products such as milk, alternatives such as soy burgers, hundreds of phytonutrients, such as cheese and yogurt are well-known hot dogs, and sausage, and for phytoestrogens, antioxidants, and as exceptional sources of calcium, bags of edamame (eh-dah-MAH- polyphenols. needed for strong bones and to meh)—green soybeans sold To reap the benefits, consumers reduce risk of osteoporosis. Vitamin shelled or in the pod. should try for at least three daily D, found in fortified milk and some (continued on page 7)  Food Insight http://ific.org/foodinsight September / October 2006 (continued from page 6) Shopping for Health? NewsBites NewsBites News- The Meat & Seafood Shoppe the risk of coronary heart disease Myths & Facts about by lowering LDL (bad) blood Low-Calorie Sweeteners Protein-packed , poultry, cholesterol. and fish provide an assortment of • Shopping tip: Some brands of ow-calorie sweeteners play B-vitamins that may help regulate a safe and healthful role metabolism, support cell growth salad dressing, orange juice, L in providing a variety of foods, and contribute to healthy immune yogurt, and snack bars are also beverages, and other products function. Red meat and fish contain fortified with plant sterol and for consumers. In today’s age of the antioxidant mineral, selenium, stanol esters. too. Researchers are studying increasing rates of obesity and conjugated linoleic acid (CLA), a fatty Coffee, Tea or Wine? obesity-related illness, low-calorie acid in beef, lamb and dairy products, sweeteners can play a role as a Like many fruits and vegetables, for its possible role in helping to weight management tool. For these beverages contain beneficial maintain desirable body composition more information visit http:// antioxidants. In particular, flavonoids and healthy immune function. www.ific.org/publications/other/ in tea and wine and phenolic acids in Salmon, sardines, herring, trout, lcsresources.cfm . coffee may promote heart health, if and tuna are terrific sources of the you choose to drink these beverages. omega-3 fatty acids, docosahexaenoic acid (DHA), and eicosapentaenoic • Shopping tip: Cocoa and Up-to-Date Crop Composition acid (EPA), types of polyunsaturated dark chocolate also contain Database: A Resource for fats shown to reduce the risk of flavonoids. Multiple Uses coronary heart disease. • Shopping tip: Walnuts, Chew on this in the he International Life Sciences flaxseed, and canola oil contain Checkout Line TInstitute (ILSI) released Version 3.0 of its crop composition an omega-3 fatty acid called Satisfy your sweet tooth with database, which provides up-to-date alpha-linolenic acid (ALA), chewing gum made with a sugar information on the natural variability which may help keep the heart alcohol such as xylitol, sorbitol, healthy. Eggs from hens fed a mannitol, or lactitol. They help in the composition of conventional high-flax diet contain omega- reduce the risk for dental caries crops and provides a reference 3s. Check the label, omega-3s (cavities). for comparing the composition of are also added to some brands Don’t rely on one food or food new crop varieties, including those of peanut butter, mayonnaise, component as a shortcut to good developed through biotechnology. cooking oil, cereal, pasta and health—no single food can do it all. The information in this database nutrition bars. It is best to encourage consumers to includes data on the nutrients, anti- utilize the whole grocery store and nutrients, and secondary metabolites Slick Choices for Oils and to choose a wide variety of foods as for corn and soybean samples Spreads part of a balanced diet. And don’t obtained from controlled field trials, eat too much just because a food in multiple locations worldwide over Times have changed and contains a healthful constituent— a six-year period. The approximately consumers are now instructed calories are important and more of 118,000 data points may be searched to enjoy the health benefits of a a nutrient may not necessarily be moderate fat diet by choosing oils and and accessed on the basis of user- better. Also engage in a lifestyle that selected queries. spreads rich in monounsaturated fat includes other healthful habits such (olive, canola, peanut, or high oleic as regular physical activity, stress The database complements existing safflower oil) or polyunsaturated fat management, and not smoking. food and nutrient databases and (sunflower, corn or soybean oil). Finally, adding new foods or should be of interest to research and • Shopping tip: Nuts and food components to a diet may regulatory scientists in many areas, seeds and the butters made necessitate removing or reducing such as plant biology, food science, from them also contain others in order to maintain a and human and animal nutrition. mostly monounsaturated and healthful weight. To determine your For more information and to polyunsaturated oils plus the ideal daily calorie intake, go to: www. access the ILSI Crop Composition antioxidant, vitamin E. mypyramid.gov. Database, visit http://www. Some margarine-like spreads are For more information on cropcomposition.org. For fortified with plant sterols and stanol functional foods and beneficial food background information on food esters, which, when consumed in components, go to http://www.ific. biotechnology, go to http://ific.org/ appropriate amounts, may reduce org/nutrition/functional/index.cfm. food/biotechnology. September / October 2006 http://ific.org/foodinsight Food Insight  Nonprofit Org. U.S. Postage Current Topics in Food Safety & Nutrition PAID Merrifield, VA Food Insight (ISSN 1065-1497) is published by the International Food Information Council (IFIC) Foundation. The International Food Permit No. 1112 Information Council (IFIC) Foundation will effectively communicate science-based information on health, nutrition, and food safety for Address Service Requested the public good. The IFIC Foundation is supported primarily by the broad-based food, beverage and agricultural industries. Editor: Ann Bouchoux Associate Editor: Nick Alexander Contributors: Elizabeth Baily, RD, Sarah Barnett, Andy Benson, Susan Bond, MS, Susan Borra, RD, Amy Coddington, RD, Alison Cuomo, Gretchen Dueñas, MS, MPH, Dick Elder, Stephanie Ferguson, Anthony Flood, Winifere Jenkins-Ford, Shelley Goldberg, MPH, RD, Jillian Goode, Kimberly Hamilton, Laura Hatch, MPH, Christa Lancellotti, Jania Matthews, Geraldine McCann, Diane Quagliani, MBA, RD, LD, Wendy Reinhardt, MS, RD, Joan Rothenberg, MS, MA, Jennifer Schleman, Dave Schmidt, Elver Ariza Silva, Matt Tarka, Cheryl Toner, MS, RD Copy Editor: Michael Hayes Design: Lighthouse Concepts, LLC Permission is granted to reprint information contained herein with appropriate credit. This newsletter is not intended to provide medical advice on personal health matters, which should be obtained directly from a qualified health professional.

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