Introduction In the beginning there was water—abundant, refreshing, providing everything the body needs to replenish the fluids it loses. Humans relied on it as their only beverage for millions of years. Milk came next, with the advent of agriculture and the domestication of animals. Then beer and wine and coffee and tea, all drunk for taste and pleasure as much as for the fluids they provide. The newcomers—soft drinks, sports and energy drinks, and the like—offer hydration but with a hefty dose of unnecessary calories that the body may have a hard time regulating. With so many choices, all with different, sometimes unexpected effects on health, it’s easy to be confused about the “best” beverages for health. This prompted a group of nutrition experts from across the U.S. to form the independent Beverage Guidance Panel. These six researchers, including Dr. Walter C. Willett of the Harvard School of Public Health’s Department of Nutrition, reviewed the evidence on beverages and health and ranked categories of beverages into six levels, based on calories delivered, contribution to intake of energy and essential nutrients, and evidence for positive and negative effects on health. (1) The winner? Water. But that doesn’t mean that water is the only beverage that’s good for your health, or that everyone needs to drink eight glasses of water a day. Beverage Guidelines from the Experts The Beverage Guidance Panel distilled its advice into a six-level pitcher, much as food experts have done with the food pyramid. The group published its recommendations in the March 2006 issue of the American Journal of Clinical Nutrition. Here is a description of each level: Level 1: Water Water provides everything the body needs—pure H2O—to restore fluids lost through metabolism, breathing, sweating, and the removal of waste. It’s the perfect beverage for quenching thirst and rehydrating your system. When it comes from the tap, it costs a fraction of a penny per glass. Water should be the beverage you turn to most of the time. It’s impossible to set a single requirement for how much water the hypothetical average American needs each day. The amount you need depends on how much you eat, what the weather is, and how active you are. So instead of setting an estimated average requirement for water, as it has done for other nutrients, the Institute of Medicine has set an adequate intake of 125 ounces (about 15 cups) for men and 91 ounces for women (about 11 cups). (5) Note that this is not a daily target, but a general guide. In most people, about 80% of this comes from beverages; the rest comes from food. As for the oft-repeated nutrition advice to “drink eight glasses of water every day,” there’s little evidence to support it, but this would be one excellent way to fulfill most of a person’s fluid requirement. Level 2: Tea and Coffee After water, tea and coffee are the two most commonly consumed beverages on the planet. Drunk plain, they are calorie-free beverages brimming with antioxidants, flavonoids, and other biologically active substances that may be good for health. Up to three or four cups of coffee or tea a day appear to be fine. Green tea, especially the strong variety served in Japan, has received attention for its potential role in protecting against heart disease, while coffee may help protect against type 2 diabetes. (2, 3) More research on the health benefits of tea and coffee is needed, but one thing is for certain: The addition of cream, sugar, whipped cream, and flavorings can turn coffee or tea from a healthful beverage into a not-so-healthful one. For example, a 16-ounce Mint Mocha Chip Frappuccino with Chocolate Whipped Cream contains 470 calories. Tucked in this beverage (which is actually closer to a dessert) are 12 grams of saturated fat—nearly a day’s worth—and 71 grams of sugar, the equivalent of 17 teaspoons of sugar. (4) Keep in mind that for pregnant women, the jury is still out on whether high coffee or caffeine intakes increase the risk of miscarriage, but it seems prudent to limit caffeinated beverages to one cup per day. (For more information about coffee and chronic disease, see Ask the Expert: Coffee and Health.) Level 3: Low-Fat and Skim Milk and Soy Beverages For children, milk is a key source of calcium and vitamin D. Fortified soy milk is a good alternative source of calcium and vitamin D for those who prefer not to drink’s cow’s milk. Both are also good sources of protein and other essential micronutrients. Low-fat milk, sold as 1% or 1.5% milk, or skim milk, which is virtually fat-free, are the best choices because they contain much less saturated fat than reduced-fat milk or whole milk, which contain 2% and 4% milk fat, respectively. Even low-fat milk is high in calories, and high levels of consumption may increase the risk of prostate and ovarian cancer (see The Nutrition Source article Calcium and Milk: What’s Best for Your Bones and Health? for more information). So it’s best for adults to limit milk (and all dairy products) to a glass or two a day; less is fine, as long as you get enough calcium from other sources. For growing children, the ideal amount of milk and calcium is less clear, but not pushing beyond two glasses of milk per day appears to provide sufficient nutrition without being excessive. Level 4: Noncalorically Sweetened Beverages So-called diet sodas and other diet drinks are sweetened with calorie-free artificial sweeteners such as aspartame (Equal®, NutraSweet®, others), saccharin (Sweet’N Low®, Necta Sweet®, others), or sucralose (Splenda®); a new addition to the market are drinks sweetened with stevia, a calorie-free sweetener made from the leaves of a South and Central American shrub. These diet drinks are a better choice than sugar-sweetened soft drinks because they are lower in calories. But the possibility that they may contribute to weight gain suggests that they aren’t an innocuous alternative to water, and should be drunk as the occasional treat rather than as a daily beverage. For those who find it difficult to give up full-calorie soda, these may be useful in making the transition to healthier beverages, like a nicotine patch can do for smokers. Level 5: Caloric Beverages with Some Nutrients This category includes fruit juice, vegetable juice, whole milk, sports drinks, vitamin-enhanced waters, and alcoholic beverages. Each has its pluses and minuses. One-hundred-percent fruit juice has most of the nutrients of the fruit itself, but it usually delivers more energy. The Dietary Guidelines for Americans recommends no more than one serving (4 ounces) of 100% fruit juice as part of the daily fruit intake. Fruit smoothies are usually very high in calories, and so aren’t recommended as daily beverages. Vegetable juice is a lower calorie alternative to fruit juice, but may contain a lot of sodium. Whole milk is a good source of calcium and vitamin D, but has nearly twice the calories as skim milk. Whole milk is also a significant source of saturated fat, with 4.5 grams per glass. Sports drinks have fewer calories than soft drinks, and offer small amounts of sodium, chloride, and potassium. They aren’t needed by casual athletes or daily walkers. The only people who really need them are endurance athletes who exercise for more than an hour at a stretch and who sweat a lot. Vitamin-enhanced waters, meanwhile, are not necessary for anyone who takes a daily multivitamin, and adding vitamins to a sugary drink does not make it a healthy choice. Alcohol may have benefits for some but may be hazardous for others, and entire books have been written on the subject (see The Nutrition Source article Alcohol: Balancing Risks and Benefitsfor more information). Level 6: Calorically Sweetened Beverages The Beverage Guidance Panel gave its “least recommended” designation to beverages that are sweetened with sugar, high-fructose corn syrup, or other high-calorie sweeteners and that have few other nutrients. These include carbonated and noncarbonated soft drinks, fruit drinks, lemonade, and other “ades.” They get the thumbs down as a daily beverage because they provide so many calories and virtually no other nutrients. Routinely drinking these beverages can lead to weight gain and increase the risk of type 2 diabetes. Fruit smoothies, many flavored coffee and tea drinks, and some so-called energy drinks also fall into this category. (For a handy guide to the calories and sugar in popular beverages, see How Sweet Is It? on The Nutrition Source.) Putting It All Together: A Sample Beverage Plan Your body would be perfectly content if you drank nothing but water. You would get all the fluid you need, and you would get all of your nutrients from food. But with so many choices available, most people drink a variety of beverages. To give some perspective to choosing beverages, the Beverage Guidance Panel poured its recommendations into a pitcher (see our version above). The exact number of ounces isn’t what’s important—these are given for a typical person taking in 2,200 calories a day. What matters are the proportions. Here’s one way the Panel suggests getting less than 10 percent of daily calories from beverages: At least half of your daily fluid should come from water. For a person who needs 12 cups of fluid a day, that would mean six cups of water. More is fine—up to 100% of your daily beverage needs. About one-third (or about three to four cups) can come from unsweetened coffee or tea. If you flavor your coffee or tea with a lot of sugar, cream, or whole milk, then drinking less would help manage weight. If you take a pass on coffee or tea, choose water instead. Low-fat milk can make up another 20 percent, or about two 8-ounce glasses. Less is fine, just make sure you get your calcium from another source. A small glass (4 ounces) of 100% fruit juice, and no more than 1 to 2 alcoholic drinks for men or no more than 1 for women. Ideally, zero “diet” drinks made with artificial sweeteners, but up to 1 to 2 glasses (8 to 16 ounces) a day (this is adapted from the Beverage Guidance Panel’s original recommendation of up to 32 ounces per day). Ideally, zero drinks sweetened with sugar or high-fructose corn syrup, but up to a maximum of 8 ounces. *Suggested beverage consumption pattern for a person who requires 2,200 calories per day, providing 10 percent of calories from beverages. The values 50, 28, 16, and 4 fluid ounces are shown for illustrative purposes only; the total should sum to 98 fluid ounces, as shown at the top of the figure. The range listed at each level refers to the Beverage Guidance Panel’s suggested consumption range for each beverage. Caffeine is a limiting factor for coffee and tea consumption; up to 400 mg per day, or approximately 32 fluid ounces of coffee per day (can replace water). Noncalorically sweetened beverages can substitute for tea and coffee with the same limitations regarding caffeine, up to 16 fluid ounces per day (this is adapted from the Beverage Guidance Panel’s original recommendation of up to 32 fluid ounces per day). Adapted with permission from Am. J. Clin. Nutr. (2006; 83:529-542), © American Society for Nutrition.
Good nutrition is one of the keys to a healthy life. You can improve your health by keeping a balanced diet. You should eat foods that contain vitamins and minerals. This includes fruits, vegetables, whole grains, dairy, and a source of protein. Ask yourself the following questions. If you answer yes to any of them, talk to your doctor about your health. You may need to improve your eating habits for better nutrition. Do you have a health problem or risk factor, such as high blood pressure or high cholesterol? Did your doctor tell you that you can improve your condition with better nutrition? Do diabetes, cancer, heart disease, or osteoporosis run in your family? Are you overweight? Do you have questions about what foods you should eat or whether you should take vitamins? Do you think that you would benefit from seeing a registered dietitian or someone who specializes in nutrition counseling? Path to improved health It can be hard to change your eating habits. It helps if you focus on small changes. Making changes to your diet may also be beneficial if you have diseases that can be made worse by things you are eating or drinking. Symptoms from conditions such as kidney disease, lactose intolerance, and celiac disease can all benefit from changes in diet. Below are suggestions to improve your health. Be sure to stay in touch with your doctor so they know how you are doing. Find the strong and weak points in your current diet. Do you eat 4-5 cups of fruits and vegetables every day? Do you get enough calcium? Do you eat whole grain, high-fiber foods? If so, you’re on the right track! Keep it up. If not, add more of these foods to your daily diet. Keep track of your food intake by writing down what you eat and drink every day. This record will help you assess your diet. You’ll see if you need to eat more or less from certain food groups. Think about asking for help from a dietitian. They can help you follow a special diet, especially if you have a health issue. Almost everyone can benefit from cutting back on unhealthy fat. If you currently eat a lot of fat, commit to cutting back and changing your habits. Unhealthy fats include things such as: dark chicken meat; poultry skin; fatty cuts of pork, beef, and lamb; and high-fat dairy foods (whole milk, butter, cheeses). Ways to cut back on unhealthy fats include: Rather than frying meat, bake, grill, or broil it. Take off the skin before cooking chicken or turkey. Try eating fish at least once a week. Reduce any extra fat. This includes butter on bread, sour cream on baked potatoes, and salad dressings. Use low-fat or nonfat versions of these foods. Eat plenty of fruits and vegetables with your meals and as snacks. Read the nutrition labels on foods before you buy them. If you need help with the labels, ask your doctor or dietitian. When you eat out, be aware of hidden fats and larger portion sizes. Staying hydrated is important for good health. Drink zero- or low-calorie beverages, such as water or tea. Sweetened drinks add lots of sugar and calories to your diet. This includes fruit juice, soda, sports and energy drinks, sweetened or flavored milk, and sweetened iced tea. Things to consider Balanced nutrition and regular exercise are good for your health. These habits can help you lose or maintain weight. Try to set realistic goals. They could be making some of the small diet changes listed above or walking daily. Doctors and dietitians suggest making healthy eating habits a part of daily life rather than following fad diets. Nutrition tips and diets from different sources can be misleading. Keep in mind the advice below, and always check with your doctor first. Secret diets aren’t the answer. Fad or short-term diets may promise to help you lose weight fast. However, they are hard to keep up with and could be unhealthy. Good nutrition doesn’t come in a pill. Try eating a variety of foods instead. Your body benefits most from healthy whole foods. Only take vitamins that your doctor prescribes. Diet programs or products can confuse you with their claims. Most people in these ads get paid for their endorsements. They don’t talk about side effects, problems, or regained weight. Questions to ask your doctor How many servings should I eat from each food group? If I’m on a strict diet, such as vegetarian or vegan, how can I improve my health? Are there certain eating habits I should follow for my health condition?
Effective asthma treatment requires routinely tracking symptoms and measuring how well your lungs are working. Taking an active role in managing your asthma treatment will help you maintain better long-term asthma control, prevent asthma attacks and avoid long-term problems. Create a written asthma action plan with your doctor. This written plan will serve as an asthma treatment guide tailored to your specific needs. It will help you follow these three important steps and keep a good record of your asthma treatment: 1. Track your symptoms Write down your symptoms in an asthma diary each day. Recording symptoms can help you recognize when you need to make treatment adjustments according to your asthma action plan. Use your asthma diary to record: Shortness of breath or whistling sounds when you exhale (wheezing). Disturbed sleep caused by shortness of breath, coughing or wheezing. Chest tightness or pain. Quick-relief (rescue) inhaler use — record when you need to use your quick-relief inhaler, such as albuterol (Proventil HFA, Ventolin HFA), and write down how many puffs you take. Disruptions to work, school, exercise or other day-to-day activities caused by asthma symptoms. Asthma symptoms during exercise. Changes in color of phlegm you cough up. Hay fever symptoms such as sneezing and runny nose. Anything that seems to trigger asthma flare-ups. 2. Record how well your lungs are working Your doctor may have you periodically record results of breathing tests (lung function tests). If your lungs aren't working as well as they should be, your asthma may not be under control. There are two main lung function tests: Peak flow. This test is done at home with a simple hand-held device called a peak flow meter. A peak expiratory flow measurement indicates how fast you can force air out of your lungs. Peak flow readings are sometimes gauged as a percentage of how your lungs work at their best. This is called your personal best peak flow. Spirometry. Spirometry tests can be done at your doctor's office with a machine called a spirometer. Some people use a hand-held spirometer to take measurements at home. Spirometry tests measure how much air your lungs can hold and how much air you can exhale in one second after you've taken a deep breath. This measurement is called forced expiratory volume (FEV). Your FEV measurement is compared with the typical FEV for people who don't have asthma. As with your peak flow reading, this comparison is often expressed as a percentage. 3. Adjust treatment according to your asthma action plan When your lungs aren't working as well as they should be, you may need to adjust your medications according to the plan you made with your doctor ahead of time. Your written asthma action plan will let you know exactly when and how to make adjustments. The chart below can help you determine if you're doing a good job of keeping your asthma under control. A similar system should be included in your asthma action plan. Depending on where your asthma control falls on the chart, you may need to make adjustments to your medications. Levels of asthma control in children older than 12 and adults Well-controlled GREEN ZONEPoorly controlled YELLOW ZONEVery poorly controlled RED ZONE Symptoms such as coughing, wheezing or shortness of breathTwo days a week or fewerMore than two days a weekDaily and throughout the night Nighttime awakeningsTwo times a month or fewerOne to three times a weekFour times a week or more Effect on daily activitiesNoneSome limitsExtremely limiting Quick-relief inhaler use to control symptomsTwo days a week or fewerMore than two days a weekSeveral times a day Lung test readingsMore than 80% of your predicted personal best60 to 80% of your predicted personal bestLess than 60% of your predicted personal best There are two main types of medications used to treat asthma: Long-term control medications such as inhaled corticosteroids are the most important medications used to keep asthma under control. These preventive medications treat the airway inflammation that leads to asthma symptoms. Used on a daily basis, these medications can reduce or eliminate asthma flare-ups. Quick-relief inhalers contain a fast-acting medication such as albuterol (Proventil HFA, Ventolin HFA). These medications are sometimes called rescue inhalers. They're used as needed to quickly open your airways and make breathing easier. Knowing when to use these medications can help prevent an impending asthma attack. Long-term control medications are the key to keeping your asthma controlled and in the green zone. If you frequently use a quick-relief inhaler to treat symptoms, your asthma isn't under control. See your doctor about making treatment changes. Make sure you know how to use your asthma medications properly. They will only keep your asthma under control if you use them correctly. Work with your doctor Asthma symptoms and severity are always changing. Following your plan will help you avoid asthma attacks and minimize the disruptions caused by asthma symptoms. Meet with your doctor regularly to review your treatment. Take your asthma diary and action plan with you so that you can review them with your doctor and make any needed changes to your treatment plan. Here are some reasons why you might need to adjust your medications: If you're still having bothersome symptoms even though you're following your plan, talk to your doctor about possibly increasing or changing your medications. If your asthma is well-controlled, you may be able to reduce the amount of medication you take. If you have seasonal allergy triggers, your asthma medication may need to be increased at certain times of the year.