How Swedes Spell "Nutritious": P-O-T-A-T-O

What's wrong with potatoes?

By Ed Bruske

aka The Slow Cook

U.S. potato growers and members of Congress who support them are ready to storm the U.S. Department of Agriculture over proposed regulations that would sharply curtail the use of potatoes and other starchy vegetables in school meals. Kids love potatoes, but school food activists say they need "more balance" by eating things they hate, like green vegetables and whole grains. And there's good scientific evidence indicating that too much starch in the diet only contributes to the childhood obesity epidemic.

But in Sweden, the spud is still king. "Pupils’ consumption of potatoes, pasta, rice, barley, couscous, bulgur and millet should be encouraged as much as possible," read the school meal recommendations published by Sweden's National Food Administration. "From an environmental point of view, potatoes and barley are at the top of the list," says the NFA.

The agency suggests children eat 4.25 portions of potatoes every two weeks, but acknowledges that "it is often difficult to get pupils to eat 175 grams [6.2 ounces] of potatoes if they are served boiled. Add variety with potato wedges or potato gratin."

The recommendations, developed by a group of "school meal experts" from several municipalities, along with the Center for Applied Nutrition, and based on the 1997 Swedish Nutrition Recommendations, call for Swedish school children to get a minimum 47 percent of their calories from carbohydrates.

"A good-sized portion of a foodstuff rich in carbohydrates and fiber is the cornerstone of every meal. The food we eat in Sweden today often contains too few carbohydrates," the food agency intones. "A school lunch with too few carbohydrates is not as filling and provides less energy to get through afternoon activities."

As to the green and orange vegetables the USDA and lobbying groups such as the Center for Science in the Public Interest say kids should eat much more of instead of potatoes, the Swedish recommendations are virtually silent.

A potato a day, it seems,will keep the doctor away in Stockholm.

The Swedish school lunch program has been in place since the 1940s and since 1997 every school district is required to provide a free lunch to all students enrolled in primary school, or between the ages of six and 16--about 1.4 million. Remarkably, in all that time, the Swedish program has not had firm nutrition requirements in place for school meals. The country's 290 municipalities are supposed to each have a "dietary plan," but according to the advocacy group Swedish School Meal Supporters, fewer than a third of the country's school cooks know what's in their local plan or follow it.

The situation in Sweden contrasts sharply with the school meals program here in the U.S. The USDA has book-length regulations stating exactly what kinds of foods schools should be serving--even the serving sizes children must be offered in order for schools to collect the federal reimbursement dollars on which the program depends. This year those regulations are being revised to restrict starchy vegetables such as potatoes, lima beans and corn to no more than one cup per week, and require bigger servings of green and orange vegetables and whole grains.

Importantly for Swedish schools, the government there this year amended its education act to require that school lunch be not only free, but also "nutritious." Exactly what that means remains unclear. But according to School Meals Sweden--a collaboration of the Karolinska Institute, the Swedish Association of Local Authorities and Regions, and the Swedish National Institutes of Public Health--the precise nutritional requirements are likely to be determined by the agency tasked with monitoring compliance, Skolsinspektion.

School Meals Sweden says it will soon unveil a questionnaire it plans to send to all of the nation's school districts that should reveal in great detail the kind of lunch service the schools are providing. The schools could then use the questionnaire results to demonstrate compliance with the new nutrition requirements.

Meanwhile, I thought it might be instructive to look at the guidelines already in place at the National Food Administration and see how they compare with the buffet lunches I ate at two schools during my visit to Stockholm and described in parts one and three of this series.

In Sweden, school lunch should provide 30 percent of daily calorie requirements, or 625 calories for children aged 10 to 12. It should consist of at least one and preferably two cooked main dishes, along with bread and "low-fat margarine," mixed salad, skimmed milk and water. Children should be getting 20 percent of their calories from protein, a maximum 33 percent from fat (11 percent saturated fat), and 47 percent from carbohydrates. Bread should be a part of every lunch.

A hearty salad or soup can serve as an alternative main course as long as they contain enough carbohydrates. The agency urges the following rules of thumb to provide enough energy with soups and salad:

"All soups should have potato, pasta, rice or dried pulses as their base, and this should make at least one third of a portion."

"Supplement the soup with dessert or soft bread and cold cuts, cheese, etc."

"Include potatoes, pasta and rice or couscous-based salad in the salad."

Beware of dishes too heavy on protein, and light on carbs. "Dishes like black pudding, fish pudding, lasagna and beef casserole often contain too few carbohydrates, so it is good to supplement them with filling salads or extra bread," the agency suggests.

On the subject of bread, the agency says kids can hardly get enough.

"The aim is for each pupil to eat at least one, and preferably two, pieces of bread with lunch. An appetizing range of both soft and hard breads can be a way of encouraging pupils to eat more bread," according to the recommendations. "The bread should be served with a 5 grams portion of low-fat margarine. Soup should always be served with extra bread if there is no dessert, and often three slices of hard or soft bread with cold cuts, cheese, etc. are needed to supplement the soup."

Milk and dairy products "provide valuable protein and are also an important source of calcium," the guidelines state. But full-fat milk, cheeses and yogurt should be limited because of the saturated fat they contain. "If these guidelines are followed and pupils eat the recommended amounts of main dish, salad, bread and fat, they will get the calcium they need even without drinking milk with their food, mainly from the milk products used in the meals themselves."

Children should eat 100 to 125 grams (3.5 to 4.4 ounces) of fruits and vegetables with every lunch. From the protein category, the following number of servings every two weeks is considered optimal: boneless meat or poultry, two servings; minced meat, two servings; sausage, 1.5; black pudding or liver, .5 minimum; fish, two servings; dried pulses, .5 minimum; eggs, .5; cheese or milk, 1 serving.

If you must serve porridge such as rice pudding for lunch (hopefully not very often), make sure to accompany it with milk, three slices of bread with margarine, enough cold cuts to cover two slices of bread, a mixed salad and fruit.

A yogurt-based meal should be served with musli or corn flakes, fruit or jam, three slices of bread with low-fat margarine, enough cold cuts for three slices of bread, and enough cold cuts to cover three slices of bread (think ham, fish, eggs, cheese), plus a salad and fruit.

Lunch buffets in Swedish schools typically contain a wide variety of "salad," although I did not see many leafy greens or other garden-type vegetables we typically association with a salad bar here in the U.S. Here are what the Swedish guidelines recommend for salads:

At least two items from the "Vitamin C list": cauliflower, broccoli, pepper, mixed salad, white cabbage, orange, kiwi, small citrus fruit.

At least three items from the "carbohydrate/dietary fiber list": beans, lentils, chickpeas, carrots, parsnip, rutabaga, sweetcorn, peas, peas-sweetcorn-pepper, American vegetable mix, green beans, potato salad, pasta salad, rice salad, salad with couscous or bulgur, pear, kiwi, apple.

An "unlimited amount of garnish": tomato, lettuce--iceberg and head lettuce, cucumber, radish.

"The salad dressing should contain no more than 15 percent fat."

The recommendations also contain a long section on constructing vegetarian meals, and suggestions for making lunch more international and welcoming for immigrants.

And besides providing adequate and balanced meals, schools should maintain a dining environment that promotes healthful eating.

"Lunch sitting should be organized in such a way that all pupils are able to eat their lunch in peace and quiet."

"Each class should be served lunch at the same time each day."

"Lunch should be served more or less in the middle of the pupils' working day, and at the very earliest at 11."

And what are Swedish kids supposed to drink with their lunch?

"Skimmed milk and water should be served with school lunch. No other drinks are suitable to be served on a daily basis," the National Food Administration admonishes. "Vitamin C-rich juice may occasionally be served."

You can read the full text of school food recommendations set forth by Sweden's National Food Administration in English here [PDF].

New Report Challenges Dairy Campaign Promoting Chocolate Milk in Schools

A little sugar with that calcium?

By Ed Bruske

aka The Slow Cook

A landmark study on calcium and vitamin D nutrition recently published by the Institute of Medicine poses a serious challenge to a dairy industry campaign to sell chocolate milk to the nation’s school children, finding that only girls aged 9 to 18 might need more calcium and only by an amount contained in a half-serving of calcium-fortified cereal .

In setting new dietary standards, the IOM found claims that Americans are deficient in calcium and vitamin D to be greatly exaggerated. But the dairy industry has spent millions of dollars promoting sugary flavored milk in schools based on the idea that children are threatened with a “calcium crisis.” The industry is fighting efforts to remove flavored milk from school menus, saying kids will be in danger of not getting the calcium they need to build strong bones.

Meanwhile, a growing body of scientific evidence links sugar with an epidemic of childhood obesity as well as a host of related health problems: diabetes, hypertension, heart disease and even an unprecedented outbreak of non-alcoholic fatty liver disease in children.

According to the IOM, girls leading up to and during puberty typically consume around 823 milligrams of calcium daily. Because they experience a growth spurt during this period, they should aim to get about 200 milligrams more calcium, or “between 1,000 and 1,100”milligrams, said Dr. Steven A. Abrams, a professor of pediatrics at Baylor College of Medicine who specializes in the calcium intake of children and was one of the panelists who wrote the IOM report.

By comparison, a one-cup serving of Total cereal contains 1,000 milligrams of calcium, a cup of low-fat milk around 300, and a half-cup of cooked collard greens 200, about the same as in a single serving of string cheese.

“I’ve never been a fan of the term ‘calcium crisis.’ I’m much more in favor of policies that ensure we meet that 1,000 milligrams,” said Abrams. “What we need to do is make sure that we have a lot of different ways for kids to get to it.”

Sources of calcium besides milk, cheese and yogurt include fortified cereal and fruit juice, as well as certain green vegetables, such as bok choy, broccoli and collard greens. Dairy products contain more calcium, but the calcium in vegetables is more readily absorbed.

Abrams declined to address the question of using sugar and flavorings to entice children to drink milk at school, saying “people have different perspectives,” and noting that he sits on a board that advises MilkPEP, the dairy group responsible for the “Got Milk?” and “Raise Your Hand for Chocolate Milk!” campaigns.

But a leading medical voice on the dangers of sugar, Dr. Robert Lustig, a professor of clinical pediatrics at the University of California at San Francisco specializing in endocrinology and obesity, said schools should not be offering flavored milk to children. “But it won’t get fixed any time soon,” Lustig said. “The dairy industry is very tight with the USDA.”

The IOM report created a sensation when it was released in November because it debunked rampant promotion of vitamin D supplements as a treatment for everything from cancer to arthritis to diabetes. The IOM panel said there was no scientific basis for those claims and found that calcium supplements also are not necessary. Their report, based on a review of more than 1,000 studies and testimony from medical professionals, constitutes the most authoritative dietary recommendations on calcium and vitamin D to date.

Calcium and vitamin D working in tandem are essential to skeletal health throughout life. Vitamin D actually acts as a hormone, enabling calcium in its job of building and “remodeling” bones, as well as performing vital functions elsewhere in the body. In fact, there is very little study of how much calcium and vitamin D are needed independent of each other. Complicating the task of setting dietary requirements , the IOM panel said, is the fact that as well as being contained in some foods, such as oily fish and egg yolks, vitamin D is synthesized by the skin from sunlight.

Most Americans don’t consume enough vitamin D in theory, but measurements of the hormone in their blood consistently show they have more than enough, indicating they get at least some from sunshine, the panel reported.

Also unknown is the minimum amount of calcium needed for healthy bone growth. Abrams said some experts put the number as low as 600 milligrams in pubescent girls. But he said the IOM panel “chose not to set a minimum number.”

The committee took a more cautious route, adopting 1,100 milligrams of calcium daily as the “estimated average requirement” for all children aged nine to 18, meaning the amount that would ensure that at least half the children in that age group get the calcium they require. But because genetic differences can affect how well some people’s bodies utilize calcium, Abrams said the committee went a step further and established 1,300 milligrams as a “recommended dietary allowance” that would cover 97 percent of all children in the group.

Well-designed studies of children’s calcium intake and its effect on bone health are scarce. One study cited by the panel found that while children who were given extra calcium did show increased bone growth, it did not last after the supplementation ended.

The IOM report makes no mention of bone impairment being suffered by children not getting enough calcium or vitamin D outside the rare cases of rickets experienced by infants, typically those with dark skin who are breastfed. Breast milk contains less vitamin D than infant formula and dark pigment inhibits the skin’s ability to synthesize sunlight.

Milk sold commercially is fortified with vitamin D. Exactly how much calcium children consume or where they get it isn’t known, although some surveys have attempted to establish a rough idea. For many children, the federally-subsidized meals program, where milk is a required element at breakfast and at lunch, is an important source of calcium and vitamin D—at least when school is in session.

The 2007 School Nutrition Dietary Assessment Study published by the USDA found that the mean 24-hour calcium intake among middle-school students was 1,137 milligrams—or well within the acceptable range—for those who participated in the meals program, but 906 milligrams—less than the amount recommended—for children who ate outside the subsidized lunch line.

The USDA reports that children who participate in the federally-subsidized lunch program are four times as likely to drink milk at school than other children.

A “study” commissioned last year by the dairy industry, and performed by a company that conducts marketing research for corporate food clients, suggested that 35 percent fewer elementary school students drank milk when flavored milk was removed from the cafeteria. But the dairy industry has refused to release the full study, and some experts have dismissed it as inherently biased.

Estimates indicate that anywhere from 60 to 70 percent of all milk consumed in schools is chocolate or another flavor with added sugar. An eight-ounce serving of chocolate milk, for instance, typically contains about 14 grams of high-fructose corn syrup, the equivalent of three and a half teaspoons.

According to Lustig and other anti-sugar activists, the dangers of sugar in the form of fructose outweigh any calcium or vitamin D benefits children might get from drinking flavored milk.

Beginning in fall 2010, schools in the District of Columbia ceased serving flavored milk, following districts such as Berkeley, Calif., and Boulder, Co. The state board of education in Florida also has been considering such a move, but recently was asked by the state’s newly appointed agriculture secretary to put that decision on hold pending further study.