Cheating babies.

"Nutritionally You Can't Buy A Better Baby Food Than Gerber," says the ad.

Actually, it would be hard to buy one that's worse.

Take Bananas with Tapioca, Gerber's best-selling flavor. What with all that added filler, a jar ends up with a little more than half the banana of an equivalent competing brand like Beech-Nut.

And so it goes. The baby-food giant runs ads that tout the nutritional superiority of products that have been diluted with cheap fillers like water, chemically modified starch, and sugar. When you get right down to it, Gerber's golden reputation has been woven out of a campaign of misleading ads.

"And that's cheating babies and their parents out of good food in order to increase profits," says Michael Jacobson, executive director of the Center for Science in the Public interest (CSPI). So, in February, CSPI filed a petition with the Federal Trade Commission (FTC), asking it to halt Gerber's "pervasive campaign of false and misleading advertising."

CSPI also mailed a letter to more than 20,000 pediatricians, asking them to support a CSPI petition to the Food and Drug Administration to require baby food manufacturers to disclose the percentage of the main ingredient on the front labels of their products.

That way, Gerber could still make its Bananas with Tapioca, but at least parents would know that it "Contains 50% Bananas."

And while half bananas aren't great, it's worlds better than the half truths Gerber's been telling for decades.

Vitamins B-12, A & Folate 

Q: What vitamins are older people most likely to run short on?

A: Folate and vitamins B-12 and D stand out as most likely to be problems.

Q: Are seniors' diets to blame?

A: Not necessarily. For example, with B-12, we think a large part of the story is that many older people lose the ability to secrete gastric acid and pepsin in sufficient amounts in the stomach. That makes them much less able to separate B-12 from food proteins. So they absorb less.

Another problem is that older people have an overgrowth of bacteria in the stomach that are normally killed by acid. These bacteria can compete for the B-12. They take it up for their own use.

Q: What happens in B-12 deficiency?

A: It damages the myelin sheath surrounding the nerves, so that electrical impulses can't travel along them. Over time, the neurological problems that impair balance and sensation can become irreversible. It can also cause dementia and mental confusion.

Q: Should older people with memory loss get their B-12 checked?

A: Absolutely. It may not be huge, but there's a definite population of elderly people who have dementia related to B-12 deficiency that is still correctable. The earlier you can catch it, the better.

If their B-12 levels are well within the high range-above 300 or 400--they could be assured that there's not a problem. If it's lower, I would give them a B-12 supplement and check again two or three months later. Q: Can they absorb B-12 from supplements?

A: Yes. Vitamin pills contain pure, crystalline B-12, which isn't bound to protein. Older people with little gastric acid can absorb that B-12 quite well, particularly if you give it at amounts of, say, 25 micrograms a day, which is quite a bit above the U.S. Recommended Daily Allowance (USRDA) of six micrograms.

Q: Should all older people take B-12?

A: If they don't get their B-12 levels checked, it's not a bad idea to take a multivitamin containing about 15 to 25 micrograms, which is customary in multivitamins marketed to seniors.

Q: Why is folate a problem?

A: There's growing concern that low folate intakes cause high homocysteine levels, which is a risk factor not only for heart disease, but for stroke. You can lower high homocysteine levels in most people by giving folate. But many older people eat too few folate-rich fruits and vegetables (see "Filling Up on Folate" .

Severe folate deficiency causes anemia, and there's growing evidence that it can also cause psychological depression.

Q: How much folate do older people need?

A: About 400 micrograms a day, which is the USRDA.

Q: Do older people get too much of some vitamins?

A: They may get too much vitamin A. It builds up in the body with age.

Q: What harm does extra A cause? A: If people take 10,000 IU a day from a supplement--not including what's in their diet--it begins to raise liver enzyme levels, which could be a sign of liver damage. Over the short term--up to three years--we've seen no evidence that a slight excess of vitamin A causes damage. But if you extend that period for 10 to 15 years of an elderly person's life, you might begin to pick up liver damage due to too much vitamin A.

Q: Should people avoid vitamin A in foods? A: No. The contribution from diet is small. Our advice is that if you're going to take a multivitamin, make sure it doesn't have more than the USRDA--which is 5,000 IU. in some supplements, the vitamin A comes from beta-carotene, but there's no evidence that that amount of betacarotene causes liver damage or other harm. Q: Should seniors take a multivitamin for "insurance"

A: Taking a multi is reasonable, because there are many reasons--like chewing difficulties--why some older people can't eat a healthy diet. But a multi isn't really an insurance policy, because you're still missing out on so many other things in food that may turn out to be important. Lycopene--the carotenoid in tomatoes that may reduce the risk of prostate cancer--is a good example.

VITAMINS E

Q: Does immune function worsen with age?

A: Yes. In all species we've looked at, including humans, T-cell response declines with age. T-cells--which help B-cells produce antibodies and are involved in killing viruses and tumors--are affected most. But there are other changes.

As we age, we produce fewer antibodies, which fight infection. We also produce more of some cytokines that cause inflammation, and more autoantibodies, which could create autoimmune diseases.

Q: Can the decline be reversed?

A: Our studies have shown improvements in tests of T-cell function in older people given vitamin E supplements. Two other studies have, shown that older people who are given a multivitamin-and-mineral supplement with most nutrients at the USRDA -- level show improvement in immune function tests. In one of those studies, researchers also saw a decrease in the number of sick days.

Q: What does the extra vitamin E do?

A: Our hypothesis is that it's decreasing the production of free radicals and of prostagiandins, which suppress T-cells. But vitamin E is an antioxidant and could also affect cell membranes, the way in which cells send signals to each other, and the proteins that cells make. We're not sure.

Q: Should seniors take vitamin E?

A: I think we're pretty close to making that recommendation. We've tested 60 IU, 200 IU, 400 IU, and 800 IU a day. We see some improvement even with 60 IU, but it's not as strong as at higher levels. I'd like to wait until our recent studies are peer-reviewed before giving specific advice.

Q: What's next?

A: We'd like to look at how often people taking vitamin E get infectious diseases. In animal models, we've seen encouraging results.

Q: What else boosts immunity?

A: It's good to get adequate levels of all the nutrients. For example, we found that people who were depleted of vitamin B-6 had immune function abnormalities that were corrected when we gave them B-6.

And when researchers do studies with multivitamin-and-mineral supplements that supply USRDA-levels of most nutrients, they see enhanced immune function. That's probably because a lot of older people have one or two marginal deficiencies.

Q: Should older people take a USRDA-level multi?

A: Older people should have adequate intakes of all nutrients, whatever way they can get them. Whether they benefit from intakes higher than USRDA-levels should await more studies measuring sick days.

Q: But more isn't always better.

A: Right. Vitamin E might be the exception in that you can see improvements when you give far more than the USRDA. Giving zinc, for example, improves immune response if you correct a marginal deficiency. But if you go far above the USRDA--to50 mg a day--you see adverse effects on immune function.

Calciums & Vitamin D 

Q: Is it tougher to maintain strong bones as we age?

A: Yes. We know that bone mass is relatively stable in young adults. In women, bone loss--especially at the hip--starts to pick up shortly before menopause. Then there is very rapid bone loss--an average of about three percent of skeletal mass per year--for about five years.

After that, the rate of bone loss declines to about one percent per year, and it doesn't slow down.

Q: And less bone means a greater risk of fracture?

A: Yes. And ounce for ounce, the bones of an individual who's 90 aren't as strong as the bones of a younger person.

Q: What can people do to protect their bones?

A: It's important to recognize that calcium and vitamin D matter at all ages. You can't slack off at age 50 or 60 or 70. We saw a wonderful example of that in the French study of institutionalized older women who were in their 80s. After getting 1,200 mg of calcium and 800 IU of vitamin D a day for three years, they had lower hip fracture rates.

Q: Do most people get enough calcium?

A: No. Current intakes are about 600 milligrams a day for women. That's only 30 to 40 percent of the levels recommended by the June 1994 Consensus Conference (see "Counting Calcium" . There are fewer studies in men, but we presume that older men would need more calcium than younger men because calcium absorption declines after age 65.

Q: Don't those 1994 levels exceed the Daily Values " on labels?

A: Yes, the Daily Value is 1,000 mg, and we're recommending 1,500 mg a day for older men and for postmenopausal women who don't take estrogen. The healthy postmenopausal women who benefitted most from a boost in calcium were those who had been getting less than 400 mg a day from their usual diets.

Q: Does 1,500 mg mean three or four glasses of milk a day?

A: Yes, or other dairy products. Few people can eat other calcium-rich foods, like broccoli or canned salmon, on such a repetitive basis. I strongly recommend that people get their calcium from food sources to the greatest extent possible. But if you can't get to the recommended levels with food, you can use pills to go the rest of the way.

Q: And we need vitamin D to absorb calcium?

A: Yes. But aging unfavorably influences vitamin D status. First, we know that women over 60 absorb vitamin D from food less efficiently than women under 30. And the elderly tend to be outside less, so they produce less vitamin D from exposure to the sun.

Q: How does sunlight make vitamin D?

A: The skin contains a precursor of vitamin D. When it's exposed to ultraviolet-B light, the precursor is changed to vitamin D. But the amount of precursor in the skin declines as people age.

Q: Can we make up for the lost D?

A: Yes. We recruited several hundred women in their 50s and 60s and gave them all 500 mg of calcium a day, to at least prevent bone loss due to insufficent calcium. Then we randomly assigned the women to either an inactive but look-alike placebo or 400 IU of vitamin D a day, and tracked them for one year.

We saw that, in everyone, bone mass tended to drop in the winter and spring and rise in the summer and autumn. But in the manter and spring, the group treated with vitamin D had half the bone loss of the placebo group. So the vitamin D group ended up with a net increase in bone, while the placebo group had no net change.

Q: Is 400 IU a day optimal?

A: We don't know. You get a big step up in vitamin D levels as you go from no supplement to 400 IU a day. As you go from 400 IU to 800 IU, there's a very small increase in blood vitamin D levels, so it's hard to nail down whether 400, 600, or 800 IU is ideal.

Q: Does vitamin D help in the summer?

A: It had the greatest benefit during the winter and spring, but about 30 percent of the benefit occurred during the summer and fall. Vitamin D would help people who go out in the summer but wear sunscreen or sit in shade, because they don't get adequate vitamin D synthesis.

Q: What if you live further south?

A: There's less ultraviolet (UV) light in vanter at any latitude. It's a graded problem that's less a less as you go south.

Q: So women as far south as Baltimore or San Francisco aren't out of the woods?

A: That's right. And no matter where they live, people indoors need roughly 400 to 800 IU a day of vitamin D year round.

Q: Can 800 IU a day be harmful?

A: No. People who have a predilection for kidney stones could get into trouble at levels over 1,000 IU a day. They tend to excrete more calcium in the urine, and the vitamin D could make it worse. So everyone should keep below 1,000 IU a day.

Q: Does our vitamin D come mostly from milk?

A: Yes. That's probably why vitamin D levels aren't as low in the U.S. as in Europe and Japan, where they have no fortified milk or other madely consumed food with vitamin D. People don't realize that no other dairy products have vitamin D. It's not in yogurt. About 40 to 50 IU is added to a fair number of breakfast cereal. There's also vitamin D in fatty fish like salmon.

Q: So if you don't drink four glasses of milk a day....

A: You would need a multivitamin with 400 IU of vitamin D.

Q: Do younger people need more vitamin D?

A: We have no studies of what happens when you supplement young adults with vitamin D. But there was a fascinating report from Paris where children had declines in vitalevels during the winter.

Paris is to the north, and they don't fortify milk with vitamin D. But it would be unwise to assume that winter declines in vitamin D don't contribute to bone loss in middle-aged and younger people. How much D it would take to Ape out winter declines in people in their 30s or 40s, we don't know, but they're likely to need less than seniors. Q: What other nutrients affect bones?

A: A recent study showed that higher-sodium diets lead to bone loss. We've suspected the link for a long time because sodium pulls calcium out in the urine. But now we have good evidence.

Q: Would we need less calcium if we ate less protein?

A: Really high protein intakes will cost a little calcium, but I don't see that as a major contributor to calcium loss in most people. I don't want to get too zealous in knocking protein. Elderly hip fracture patients have lower blood protein levels than other elderly hospital patients. And protein malnutrition delays healing and extends their hospitalization.

Q: Should people who take a calcium supplement also take magnesium?

A: No one knows. If everyone were getting 1,500 mg of calcium a day, we might see magnesium deficiencies popping up, because higher calcium intakes could reduce magnesium absorption and handling. But at current calcium intakes, it's not a problem.

Protein

Q: Is too little protein a problem for older people?

A: Yes. We expected that they would adapt to less protein, but they take a metabolic hit when they get less than the Recommended Dietary Allowance (RDA), which is about 50 gram a day for women over 50, and grams a day for men over 50 (s "Protein on Your Plate" .

Q: What kind of hit?

A: We fed our volunteers basically RDA-levels of protein or half that amount. We found that lean body mass and immune function were impaired in the low-protein group, but not in those getting roughly the RDA.

The low-protein group also had a decrease in upper body strength, as reflected by their reduced ability to do chest presses. And we saw a decline in a test measuring how effectively a muscle contracts. That's a sensitive index of protein malnutrition.

Q: Is loss of lean mass a problem in older people?

A: Yes. We know that as they age, the elderly lose 25 to 30 percent of their lean mass--mostly muscle--and much of the loss occurs after age 65.

It's my theory that this may be partially due to inadequate protein intake over time. People get sick and don't eat well, lose a marginal amount of lean mass, and don't get it back again. it's a downward spiral. We don't know to what extent older people can increase their lean mass once they've lost it.

Q: Can exercise help?

A: Not significantly. Strength-training doesn't increase muscle size very much, but it may help people avoid losing muscle as they age. And it improves strength. In our recent study on older cardiac rehabilitation patients, the improvements in physical strength were quite impressive, not because strength-training increased muscle size, but because it improved the way the nerves connect with the muscles.

Q: Is the RDA for protein too low?

A: There's some controversy over the exact level, but no controversy over the fact that people shouldn't eat marginal intakes over long periods of time. Our study showed that marginal levels will clearly have a negative impact on seniors.

Q: What percentage of seniors get too little?

A: If you look at data from the National Health and Nutrition Examination Survey, about I 0 to 25 percent of women over 55 get less than 30 grams of protein a day--about half the RDA. We're especially worried about low-income women--because many protein foods are expensive--and about the more frail because they can't go out to shop.

Q: Can older people eat too much protein?

A: Some research suggests that if you make the kidneys handle protein in excess of what's needed, it may be a risk factor for kidney failure. That would be about double the RDA--it's what people who eat half a pound of meat a day or more get. About 30 percent of the population consumes well in excess of the RDA and that includes some elderly. My advice is to shoot for between RDA and one-and-a-half times the RDA.

RELATED ARTICLE: Filling Up on Folate

If you eat five to nine servings of fruits and vegetables a day, chances are you get enough folate. But some foods are better sources than others.

Experts think that 400 micrograms (mcg) a day will lower the risk of heart disease and stroke. Women who may become pregnant should make sure they get 400 mcg a day-either from food or a supplement-to reduce the risk of spina bifida and other neural tube birth defects. food Folate (1/2 cup, unless specified) (mcg) Product 19 cereal (1 cup) Total cereal (314 cap) Brewer's yeast (1 Tbs.) Lentils(*) 180 Pinto beans(*) or chickpeas(*) 145 Okra, frozen(*) 135 Spinach* 130 Red kidney beans(*) 115 Asparagus* (5spears) 110 Orange juice (1 cup) 110 Spinach, raw (1 cup) 110 1/2 cup, unless specified) (mcg) Mostbreak fast cereals(1 cup) 100 Wheat germ, toasted (1/4 cup) 100 Romaine lettuce, shredded (1 c) 75 Collards, frozen(*) 65 Split peas(*) 65 Green peas(*) 50 Beets(*) or parsnips(*) 45 Brussels sprouts(*) 45 Broccoli(*) 40 Orange 1) 40 Peanuts, dry roasted (1 oz.) 40

Source: USDA Handbook 8 and manufactures. (*) cooked.

RELATED ARTICLE: Counting Calcium

The USRDA, or Daily Value, for calcium that appears on food and supplement labels is 1,000 mg a day. There's what you really need: Age Optimal Daily intake (mg) 1 to 5 800 6to 10 800-1,200 11 to24 1,200-1,500 women 25 to 50 1,000 women 50 to 65 taking estrogen 1,000 women 50 to 65 not taking estrogen 1,500 men 25 to 65 1,000 men or women over 65 1,500 pregnant or lactating women 1,200-1,500

Source: Optimal Calcium Intake. NIH Consensus Statement 1994; 12(4):1-31.

RELATED ARTICLE: Craving Calcium

People get about 300 mg of calcium a day from miscellaneous foods in their diets. Here's where to get the rest: Food Calcium (mg) Calcium Fortified Lactaid Milk, non-fat (1 cup) 500 Yogurt, non-fat plain I cup) 450 Milk, skim or 1%, protein fortified (1 cup) 350 Yogurt, low-fat fruit-flavored (1 cup) 250-350 Tropicana Premium Plus Orange Juice with Calcium Extra Vitamin (1 cup) 330 Milk, skim or 1% I cup) 300 Minute Maid Calcium Rich Orange Juice (1 cup) 300 Swiss cheese I oz. 270 Ricotta cheese, fat-free (1/4 cup)(1) 250 Total cereal 314cup) 250 Cheddar cheese I oz. 205 Ice cream or frozen yogurt, fat-free or low-fat (1 cup)(1) 200 Collards, frozen (1/2 cup cooked) 180 Sardines canned in water, drained (2 oz.)(1) 175 Tofu (3 oz.)(2) 100 Kale, frozen 1/b cup cooked) 90 Soybeans (1/2 cup cooked) 90 Bok choy (1/2 cup cooked) 80 Cottage cheese, low-fat (1/2 cup) 75 Parmesan cheese, grated (1 Tbs.) 70 Orange 1) 50 Bread, white or whole wheat (2 slices) 45 Broccoli 1/2 cup cooked) 35

(1) Average of major brands. (2) Average of major brands made using calcium sulfate or gypsum as a coagulant. Sources: USDA Handbook 8, Bowes and Church's Food Values of Portions Commonly Used, and manufacturers.

RELATED ARTICLE: Protein on Your Plate

It's not hard for most people to get enough protein, unless they're eating too little food. The trick is getting protein without the saturated fat that can clog arteries. Most of these foods contain no more than two grams of saturated fat per serving. Shoot for 50 to 80 grams of protein a day (women) or 60 to 90 grams (men).

Food Protein (4 oz. cooked, unless noted) grams) Chicken or turkey breast, skinless 34 Pork tenderloin, trimmed(1) 34 Beef, eye of round steak, trimmed 32 Fish or shellfish 23-29 Dried beans, peas, or lentils (1 cup cooked) 13-17 Green Giant Harvest Burger (1)(2) 17 Tuna or salmon, canned 114 cup) 11-15 Cottage cheese, 1% (1/2 cup) 14 Yogurt, non-fat plain (1 cup) 13 Yogurt, low-fat fruit-flavored (1 cup) 9-11 MHF, skim or 1% (1 cup) 8-10 Tofu (3 oz. 4-10 Cheese, Kraft 1/2 Less Fat (1 OZ.)(1,2) 4 Oscar Mayer Free Oven Roasted Turkey Breast (4 sl.) 8 Egg whites (2 large) 7 Healthy Choice Beef Frank (1) 7 Pasta (1 cup cooked) 7 Bulgur or oatmeal (1 cup cooked) 6 Bread, whole wheat (2 slices) 5 Green peas (1/2 cup cooked) 4

(1) Contains 3 to 4 grams of saturated fat. (2) Average of varieties. Sources: USDA Handbook 8, Bowes and Church's Food Values of Portions Commonly Used, and manufacturers.

Super Foods for Seniors

Here are five super foods for seniors. No, we've not saying that older people should eat only these foods, or that eating them is a guarantee that you'll be well-nourished. But when it comes to supplying several key nutrients that many older people could use more of, these foods are standouts.

1 Skim or 1% Milk. Vitamin D (that's rare), calcium (a lot), protein (with little or no fat), plus potassium, vitamin B-12, riboflavin ... what more could you ask for? Many people think that milk's lactose (milk sugar) causes gas or bloating, but drinking just a glass at a time usually doesn't. If you're worried, try one of the lactose-free brands now on the market.

2 Whole-Grain or High-Fiber Cold Breakfast Cereals. Check the label: Most are fortified with at least 25 percent--and some with 100 percent--of a day's worth of vitamin D, folic acid, and a dozen other vitamins and minerals. Plus, the cereal fiber can help prevent constipation and may reduce the risk of colon cancer and heart disease. All for very little fat (assuming you use 1% or skim milk).

3 Collards, Kale & Spinach. Their lutein may reduce the risk of macular degeneration, the most common cause of blindness in older Americans. They're also rich in folate, vitamin C, and beta-carotene. The calcium in spinach is bound up by oxalic acid, but collards are still a good source.

4 Calcium-fortified Orange Juice. What with folate, vitamin C, and thiamin, orange juice is the most nutritious fruit juice you can drink. And it counts as one of your five-to-nine servings of fruits and veggies. If you're shooting for 1,000 to 1,500 mg of calcium a day and you're not a big milk drinker, try a calcium-fortified brand of OJ.

5 Canned Salmon or Sardines. Protein, vitamin D, calcium (from the bones), and fish oil that may help reduce the risk of heart attacks. All those--and the convenience of having something in the cupboard--are the pluses. There's only one catch: Like all canned fish, they're high in sodium. Our advice: Eat them with low-sodium foods like pasta vegetables (see p. 14) or a salad.

RELATED ARTICLE: The Bottom Line

* Eat a low-fat diet with adequate protein (see "Protein on Your Plate") and five-to-nine servings of fruits and vegetables a day.

* Shoot for 1,000 to 1,500 mg of calcium a day from low-fat foods (see "Counting Calcium") and/or a supplement.

* Take a multivitamin-and-mineral supplement that has roughly 100 percent of the USRDAs for most nutrients, including vitamin D, vitamin E, and folic acid (folate). Exceptions:

* few multis have enough calcium or magnesium--you may have to take them separately,

* look for at least 15 to 25 micrograms of vitamin B-12,

* take no more than 5,000 IU of vitamin A (excluding beta-carotene), and

* consider a supplement with little or no iron, even though the evidence that iron increases the risk of cancer is still scanty (see Jan./Feb. 1996, p. 8).