Substitution Resolutions: Health Literacy and the Holidays

Dr. Maribeth Buie

Dr. Maribeth Buie

Season’s Greetings, or Season’s Eating?  This time of year is renowned for excess – excessive decorating, excessive gifts, and excessive eating.  Eating, however, is not only about the food.  Eating revolves around tradition, culture, and fellowship.  Traditional dishes vary from home to home, but the holiday season is an optimal time to help your students discover the joys of learning through cooking.

Recipes can be a great teaching tool for your students to impart measurement, math, and healthy eating skills.  Knowing how to measure food and medicine is important, such as knowing the difference between a tablespoon (T or Tbsp) and a teaspoon (t or tsp).  Recipes often require math skills, such as working with fractions when doubling ¾ cup of flour or converting 12 ounces to 1 ½ cups.  Healthy eating is only a step away when using easy substitutions to lighten up the calorie/fat load without losing flavor.  For example, unsweetened applesauce may be substituted for oil or butter in sweet or savory dishes.  Greek yogurt is a great base for creamy dips instead of mayonnaise or sour cream.  In addition, low-fat or fat-free dairy products (skim or 1%-milk, low-fat or fat-free sour cream, and low-fat or part-skim cheese) may easily be substituted for their higher fat counterparts.

Below are two examples of traditional holiday foods in my home (yes, I’m from the south) – the original recipe is provided alongside a lighter version.  In both cases, the lighter version tastes just as good without the guilt (you can eat them all year long)!  Try this substitution exercise in the classroom (and on your own), and reap the rewards of learning via class cooking demonstrations or a potluck dinner – bon appétit!

Sweet Potato Casserole
Original Recipe Lighter Version Recipe
2 cans yams, drained, mashed 3 cups sweet potatoes, cooked and mashed
1/2 cup sugar Honey or low-glycemic sweetener to taste
2 eggs 1/2 cup chopped nuts
5 Tbsp butter 3/4 cup unsweetened applesauce
1/2 cup raisins (plumped) 1/2 cup raisins (plumped)
2 Tbsp frozen orange juice 2 Tbsp frozen orange juice
Beat ingredients together, and place in a greased casserole Stir ingredients together. Serve Warm
Top with: 1/4 cup melted butter, 2 Tbsp flour, 1/2 cup brown sugar, 1/2 cup chopped nuts * Note: I use the microwave to cooke the potatoes, pegans for the nuts, and Splenda for sweetener- that is personal preference of course.
Bake at 350 degrees for 35-45 minutes
Frozen Cranberry Dessert
Original Recipe Lighter Version  Recipe
1-16 oz. can whole cranberreis with sauce 1-16 oz. can whole cranberries with sauce
1- 8 oz. package cream cheese 1-8 oz package fat-free cream cheese
3 Tbsp sugar 1/2 cup pecans chopped
2 Tbsp mayonnaise 1 small can crushed pineapple
1/2 cup pecans, chopped 1- 8 oz. container Cool Whip Free or alternative light whipped cream
1 small can crushed pineapple
8-oz. whipped cream
Beat cream cheese, sugar, and mayonnaise together. Add craberry sauce, drained pineapple, and nuts- mix well. Fold in whipped cream. Freeze. Beat cream cheese. Add cranberry sauce, drained pineapple, and nuts- mix well. Fold in whippped topping. Freeze.


Maribeth Buie: Prescribing Change for Prescription Container Labeling

Prescription container labeling has long been an enormous obstacle in improving health literacy, as readers often struggle with ease of understanding, terminology, directions, and formatting issues.  However, for the first time ever, the U.S. Pharmacopeial Convention is publishing new standards for prescription container labeling.  The new standards will provide a universal approach to the format, appearance, content, and language of instructions inherent in such labeling.

The approach outlines how to organize prescription container labels in a patient-friendly way, to use clear language to describe dosages and intervals, and to improve readability with clear formatting [including “purpose for use” (e.g. – “for high blood pressure”) and addressing the visually impaired and those with limited English comprehension].  For example, to improve readability, the standards state that label formatting should use high contrast, lots of white space, and simple large fonts.  To provide explicit instructions, the standards specify that the phrase, “Take 2 tablets twice daily,” should state, “Take 2 tablets in the morning and 2 tablets in the evening.”  These examples are a small sampling of the patient-centered changes these new standards prescribe for prescription container labeling.

As 77 million Americans have limited health literacy, these standards are definitely a step in the right direction to help individuals understand their medications, to adhere to medication regimens, and to use their medications safely.  Look for improved labeling at pharmacies nationwide in the near future.

Maribeth Buie: How Your Local Pharmacy Can Help

Every day, unintentional poisonings account for nearly 87 deaths and over 2,200 emergency room visits in the United States.  A large proportion of unintentional poisonings may be attributed to low health literacy.  This is such an important topic that an entire chapter in the Staying Healthy curriculum is devoted to ‘Medicines,’ including the difference between over-the-counter and prescription drugs, reading a prescription label, measuring medicines, side effects/warning labels, etc.

Prescription labels and drug information can be confusing for native English speakers at any education level.  Difficulties arise with small print, ambiguous wording, unfamiliar drug names, and inconsistent formats.  Logic follows that it will be even harder for adult learners.  As they make gains in their health literacy, the local pharmacy can help!

Some pharmacies offer prescription labels and drug information in languages other than English, all your students have to do is request it!

I took an informal poll of four major pharmacies in Florida – Walgreens, CVS, Publix, and WalMart.  Walgreens offers the most in terms of language translation.  They offer prescription labels/drug information in thirteen languages (other than English):  Arabic, Chinese, English, French, German, Italian, Japanese, Korean, Polish, Portugese, Russian, Spanish, Tagalog, and Vietnamese.  Walgreens registers all pharmacists able to speak multiple languages to provide translation services.  So, for example, if a Japanese-speaking customer arrives at the pharmacy, the Walgreens computer system can locate and call a pharmacist that speaks Japanese to provide information or answer questions (if one is on staff anywhere in the United States).  In addition, Walgreens offers large-print labels in English or Spanish upon request.

Other pharmacies also offer translation services.  CVS offers prescription label/drug information in Spanish and French, and Publix offers prescription label/drug information in Spanish.  WalMart does not offer any type of reliable translation service.

It is important to teach your students that a pharmacist is a great resource.  Pharmacists not only help with understanding prescription medicines, but they can also help with understanding over-the-counter medicines – especially which medicine is right for an individual’s particular symptoms.  Another great idea, invite your local pharmacist to speak to your class. Most pharmacies value and encourage community involvement and education.

The ultimate goal is to help adult learners improve their health literacy, including understanding labels and information in English.  However, on the way toward accomplishing that goal, the local pharmacy can be a literal life saver.

Staying Healthy tips: Nutrition

New Year’s resolutions often include a resolve to get healthier, by moving more or eating better.  Staying Healthy is a great health literacy tool to teach about good nutrition.  According to Florida’s adult ESOL learners, learning about healthy eating habits is the most important tool gained from the Staying Healthy section of adult literacy courses.

Staying Healthy’s chapter on nutrition explains about important nutrients, how to decipher a nutrition label, what to eat, what not to eat, and how to determine a healthy weight using the BMI scale.  When teaching about nutrition, there are a few simple tips that make nutrition easy to understand:

1.  Aim for more fruits and vegetables (5 to 9 per day), more fiber (20 grams per day), and less sodium (less than 1,200 milligrams per day).  Try to incorporate whole-grains.  Switch to fat-free or low-fat milk and dairy products instead of their full-fat counterparts.

2.  Balance calories by enjoying your food, but eating less.  Avoid oversize portions.  The plate rule, promoted by the FDA and Michelle Obama, is an easy way to do this at meal time.  Half of the plate should be fruits and vegetables, one quarter o the plate should be whole grains, and one quarter of the plate should be protein.  See Figure 1.

Figure 1.  Plate Rule.  Source:

3.  Try frozen or canned fruits and vegetables if fresh produce is too expensive – just try to avoid added ingredients like sodium, sugar, butter, or sauces.

4.  Drink 8-10 eight-ounce glasses of water a day.  Avoid sugary drinks.

Combined with moving more, these simple steps will put you on the right track toward staying healthy in the new year!