health tips

Preterm birth linked to phthalates in personal products

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Chemicals widely used in household products and toiletries may increase the risk giving birth before 37 weeks of pregnancy, a new study suggests.

Pregnant women exposed to phthalates, a group of hormone-mimicking chemicals found in personal care products and processed foods, may have an increased risk of preterm delivery, a new study suggests.

The study included 130 women in the Boston area who had given birth early, before 37 weeks of pregnancy, and 352 women who delivered at full term between 2006 and 2008. The researchers measured the levels of common phthalates such as DEHP in the women’s urine up to three times during their pregnancies.

They found that women who had the highest levels of phthalate metabolites in their urine had a risk of preterm birth that was two to five times higher when compared with women who had the lowest levels.

What’s more, when the researchers looked only at the 57 women who had “spontaneous preterm delivery,” meaning they didn’t have a medical condition that could explain their early delivery, they found the link between exposure to phthalates and risk of preterm delivery was stronger, according to the study published today (Nov. 18) in JAMA Pediatrics.

“These data provide strong support for taking action in the prevention or reduction of phthalate exposure during pregnancy,” the researchers wrote in their findings.

Phthalates are chemicals widely used in making flexible and durable plastics, and many other products such as adhesives, detergents, soaps, shampoos, hair sprays, perfumes and deodorants. People are exposed to these potentially hormone-disrupting chemicals through contact with phthalate-containing products, and eating certain processed and canned foods.

“For women who are interested in reducing their exposure, reducing use of personal care products, buying phthalate-free [products] when possible, and eating fresher foods may help, although research on that is limited,” said study researcher John Meeker, an associate professor of Environmental Health Sciences at University of Michigan School of Public Health.

Preterm birth, defined as the birth of an infant before 37 weeks of pregnancy, is a leading cause of death or long-term neurological disabilities in children. The rate of preterm birth in the United States has increased by more than a third between 1981 and its peak at 12.8 percent in 2006. The rates slightly decreased in the subsequent years, to about 11.5 percent in 2012, which means one out of every eight children is now born prematurely, according to the Centers for Disease Control and Prevention (CDC).

A recent review of studies looking for what might underlie the increase in preterm birth rates identified risk factors such as increasing maternal age and use of assisted reproduction. However, nearly half of the increase remains unaccounted for, said Shanna Swan, a professor of preventive medicine at Icahn School of Medicine at Mount Sinai, New York.

The new study provides “strong evidence that environmental chemicals, and phthalates in particular, likely contribute significantly to that unknown and other category,” Swan wrote in an editorial published along with the new study.

The study showed an association, not a cause-and-effect relationship, between phthalates and preterm birth. However, there are reasons to think phthalates could cause preterm births; for example, phthalates may cause inflammation in the uterine lining, the researchers said.

Lab studies have shown that phthalates can cause inflammation, but this needs to be studied in humans. Other ideas about possible mechanisms by which phthalates affect pregnancy involve women’s immune response, oxidative stress, and hormone disruption.

“There’s a list of things phthalates have been shown to do in experimental studies. Much work is left to be done in human observational studies,” Meeker told LiveScience.

Other factors that contribute to higher risks of preterm delivery include smoking, drinking, infection, stress and high blood pressure during pregnancy. A study published in January 2013 in the journal Lancet predicted that current interventions to address known risk factors would decrease preterm birth rates by only 5 percent by 2015.

Exposure to phthalates may be one risk factor that could be prevented by behavioral modification or through policies aiming at reducing the use of phthalates, the researchers said.

Source: Mother Nature Network

How to Buy the Healthiest Yogurt

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Yogurt has earned itself a reputation as a true health-food superstar. But know this: “Yogurt can turn into junk food really quickly,” says Caroline Kaufman, RDN, a nutrition expert in San Francisco and an expert panelist for the Health Must-Eat List. Even if you skip the obvious offenders, like yogurts with crushed cookies or candy toppings, some pile on the sugar and excess calories. With so many choices out there—since 2010 alone, 671 new yogurt products have hit store shelves—how can you be sure you’re choosing wisely? These guidelines will lead you to the standouts.

Keep it simple

To make yogurt, all that’s needed is milk and two live bacterial cultures, Lactobacillus bulgaricus and Streptococcus thermophilus, which turn the milk into yogurt via fermentation. “Beyond that, a few added extras for flavor, like a little sugar or some fruit, are fine,” Kaufman says. Steer clear of products that have long lists of ingredients with things you can’t pronounce or wouldn’t expect to see in yogurt, like hydrogenated oils and artificial sweeteners.

Look for good bugs

Probiotics—good bacteria similar to the ones living in your digestive tract—are yogurt’s key ingredient. These beneficial bugs have been shown to help with digestion and gut health. But surprisingly, not all yogurt sold in stores actually contains “live and active cultures,” as the bacteria in yogurt are known. Some companies heat-treat yogurt after culturing, which kills off bacteria, both good and bad, to make it more shelf-stable and reduce tartness.

Make calcium count

Yogurt is a stellar source of bone-building calcium, but the amount can vary from brand to brand. Aim for one that has at least 15 percent of the daily value for calcium; the yogurts on our list contain anywhere from 15 to 35 percent.

Do a sugar check

Trying to cut back on added sugar? Don’t rely only on the number of grams listed on the label. Yogurt has a fair amount of naturally occurring milk sugar, aka lactose (about 9 grams in a 6-ounce container of plain regular yogurt, and about 7 grams in Greek yogurt), and the sugar figure includes both natural and added sugars. Our shortcut: Avoid any product that lists sugar as the first or second ingredient.

Beware of fake fruit

Adding your own fresh fruit to plain yogurt is always a healthy choice. But sometimes you want the convenience of yogurt with fruit already added. Make sure you see actual fruit on the list of ingredients, ideally before any added sugars, Kaufman advises. “Otherwise it probably just contains a mix of sugar and food coloring or vegetable juice,” she says.

Don’t fear the fat

Opting for nonfat yogurt can help you keep calories and saturated fat in check. But, Kaufman warns, “nonfat doesn’t always mean low in calories. Many nonfat yogurts have a lot of added sugar.” Go for a version that gets most of its sweetness from real fruit, or try adding a teaspoon of honey to plain nonfat yogurt.

If you prefer the taste of a higher-fat yogurt, it’s OK to move up to 1 or 2 percent. “Some new research indicates that saturated fat in dairy might not be the bad guy we once thought,” Kaufman notes. For example, a 2011 study from Brown University found that eating dairy products wasn’t linked to heart attack risk, “possibly because there is other protective nutrients in dairy that balance out the effects of saturated fat,” she says. You can even go for full-fat if you have the cals to spare; just make it your saturated-fat splurge of the day.

Read labels carefully

Luckily, it’s easy to tell if your yogurt includes probiotics. The National Yogurt Association has created a Live & Active Cultures seal for products that contain significant amounts of L. bulgaricus and S. thermophilus. (These two bacteria, in particular, must be used in order for a product to be called “yogurt,” per federal regulations. You might see additional cultures listed, but the research on their health benefits is still emerging; a yogurt that contains more cultures isn’t necessarily better for you.) Not every company chooses to carry the seal, so you can also look for “Live and Active Cultures” on the label or L. bulgaricus and S. thermophilus in the ingredient list. If a product has been heat-treated after culturing, the company is required to say so on the label.

Source: Health

 

 

Bedroom computers, TV may add to autism sleep issues

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Kids with autism and related disorders are prone to sleep disturbances but a new study finds that screen time, especially in the bedroom, may make their sleep problems worse.

When researchers compared boys with autism spectrum disorders (ASD) to other boys, they found that all the kids with bedroom access to media slept fewer hours, but the relationship was twice as strong for the boys with autism.

“In-room media access was associated with about 1.5 fewer hours of sleep per night in the group with autism,” said Christopher R. Engelhardt, who led the study at the University of Missouri-Columbia.

“This association can potentially be problematic, particularly if the reduction in sleep interferes with other daily activities, such as school, homework, interactions with other people, or driving,” he told Reuters Health in an email.

Past studies suggest that up to 80 percent of kids with autism, and related conditions like Asperger syndrome, experience sleep troubles, including difficulty falling asleep or staying asleep through the night. Children with attention deficit hyperactivity disorder (ADHD) also are known to have a high rate of sleep disturbances.

With both conditions, it’s unclear why sleep is so difficult. Theories include a disruption in sleep-wake cycles that are regulated by the hormone melatonin, which is often deficient in kids with ASDs, Engelhardt and his colleagues write in Pediatrics.

Because kids with autism spectrum disorders, like those with ADHD, also tend to spend a lot of time watching TV and playing video or computer games, the researchers wondered whether that could be contributing to their sleep problems.

So they recruited the parents of 49 boys with autism spectrum disorders, 38 with ADHD and 41 comparison boys with typical development to fill out questionnaires about their children’s bedroom screen access and sleep patterns. All the kids were between ages eight and 17.

Boys with autism who had TV, computers or video games in their bedrooms got less sleep than all the other boys, including boys with autism who didn’t have media in their bedrooms.

Without a TV in their room, boys with autism spent an average of about nine hours sleeping, compared to less than eight hours among kids with an ASD and a bedroom TV.

In contrast, bedroom TVs didn’t seem to make a difference for boys with ADHD or typical development.

Boys with autism with computers in their rooms slept nearly two hours less than boys with autism and no bedroom computer.

A lot of time spent playing video games, regardless of where they were located, was also linked to shorter sleep times among boys with ASDs.

Even for typical children, too much time with TV or video games has been linked to attention problems, hyperactivity, arguments and physical fights, Engelhardt said.

“We can’t say that access to a TV causes less sleep,” only that the two are linked for some kids, he said.

Last month, the American Academy of Pediatrics called for limiting screen time for all kids to one or two hours per day “This is a good recommendation for all children,” Dr. Beth Marlow, Burry Chair in Cognitive Childhood Development and director of the Sleep Disorders Division at Vanderbilt University Medical Center in Nashville, Tennessee.

“Following this recommendation for kids with (autism spectrum) and ADHD is good, although children with (autism spectrum) or ADHD who are still having difficulty with sleep despite limiting electronics really deserve a sleep evaluation by their pediatrician or sleep specialist.”

Sleep troubles can also stem from anxiety, sleep apnea, pain that the child might not be able to express, gastrointestinal problems or seizures, she said.

For typically developing kids, bedroom TV access doesn’t usually seem to cut into sleep.

“However, (Engelhardt’s) finding for teens with ASD concurs with our clinical impressions – that these teens have difficulty ‘switching off’ videogames,” Michael Gradisar said.

Gradisar is a clinical psychologist who studies technology use and sleep, especially among teens, at Flinders University in Adelaide, South Australia.

“Many teens have a distorted sense of time passing when playing videogames, however, it may be that this time distortion is stronger for teens with ASD,” he said.

Parents can have a tough time managing how much their children play games or watch TV, he said. “It may take quite some time to do, but one option is for parents to introduce other hobbies and activities into their teens lives, so that videogaming eventually occupies less time.”

People with autism tend to spend more time with media outlets, researchers think, because the electronic worlds have engaging audio and visual features and their social interactions are easy relative to real life interactions.

This doesn’t necessarily mean that parents should take TVs or video games out of their autistic children’s rooms, but might consider limiting or monitoring media consumption, he said.

“Screen media can certainly be good for kids with autism,” he said. “Scientists have long known that video games are great at teaching and reinforcing certain behaviors, so it’s possible that these games can be used to adjust and shape the types of behaviors generally valued by society, such as behaviors intended to help others.”

Source: Reuters

 

Teenage girl dies of toxic shock syndrome after using tampon

 

Teenage girl, 14, died from toxic shock syndrome caused by using her first tampon, say family as they launch campaign about rare infection

A teenager who dreamed of starring in the West End died from an ultra-rare infection after using a tampon for the first time, her heartbroken family have said.

Natasha Scott-Falber, 14, died suddenly on Valentine’s Day in Caerwent, Wales, and five days after she fell ill with what was thought to be the norovirus.

Her family now believes the teenager died of toxic shock syndrome – a bacterial infection which affects just 40 people a year in Britain.

Posting on Facebook, her family – which includes her mother Mandy Scott, 52, Brother Daniel Falber, stepfather Mike Scott and stepmother Linda Falber – have launched a campaign to raise awareness of the condition so other sufferers spot the signs earlier.

They said: ‘Natasha died of toxic shock syndrome the first time that she used tampons.

‘Generally speaking, it is accepted knowledge that leaving a tampon in for too long can cause toxic shock syndrome. In Natasha’s case, she followed all of the instructions and used the tampon correctly; it was simply the introduction of the tampon into her body which caused toxic shock syndrome to take effect.

‘Tash became ill five days before she died but remained in good spirits, and only the evening before she died, she was telling Mandy off for fussing over her, and saying that she was feeling much better.
She died peacefully at approximately 6.45am on Valentine’s Day after falling asleep watching one of her favorite TV programs.

‘We cannot express how much we miss our beautiful, gifted, kind and funny Natasha. All of our family, and many others close to us, are still reeling from the shock of losing our wonderful girl.

‘We hope that you and your family never have to go through what we have gone through, and are still going through.’

Natasha, who was found dead by her father Mike Falber, was described as an ‘all-singing and all-dancing’ youngster who enjoyed acting and playing the guitar.

She had been selected last year to perform in a backing choir for English tenor Alfie Boe at one of Wales’ most prestigious concert halls, St David’s Hall, Cardiff.

After Natasha’s death it was initially believed she had fallen victim to septicaemia, better known as blood poisoning.

Toxic shock syndrome affects about 40 people each year in the UK.

The infection is caused when usually harmless Staphylococcus aureus or Streptococcus bacteria, which live on the skin, invade the bloodstream and produce dangerous toxins.

A statement from BUPA said: ‘It’s not exactly understood why using a tampon is linked with toxic shock syndrome, but tampon absorbency (the amount of menstrual blood a tampon absorbs) is thought to be a factor.

‘If you’re a woman using tampons, use a tampon with the lowest absorbency suitable for your menstrual blood flow, change your tampon frequently, use a sanitary towel or panty liner from time to time during your period, never insert more than one tampon at one time and use a sanitary towel at night instead of a tampon.’

The family said: ‘We thought that one thing we could do, to honour Natasha, and to help others, would be to start an awareness campaign about toxic shock syndrome.

‘We are in communication with Public Health Wales, the two main tampon companies, and we have already had some success with GPs and with the education system in Gwent. All the age-appropriate pupils attending schools in Gwent have been made aware of toxic shock syndrome.

‘We are determined to make at least everyone in the UK aware of what the symptoms are, and what the risks are.’

Toxic shock syndrome is a highly dangerous bacterial infection – but it can be misdiagnosed, because the symptoms are the same as other illnesses and because it is so rare.

It occurs when usually harmless Staphylococcus aureus or Streptococcus bacteria, which live on the skin, invade the bloodstream and produce dangerous toxins.

This causes a sudden high fever, a massive drop in blood pressure resulting in dizziness and confusion, and occasionally vomiting and diarrhoea.

Other symptoms – none of which are exclusive to toxic shock syndrome, which is extremely rare – include a sunburn-like skin rash, the whites of the eyes becoming red or pink and the shedding of the skin in large sheets, especially from the palms of the hands and soles of the feet, one or two weeks after becoming ill.

Women are most at risk of getting toxic shock syndrome during menstruation and particularly if they are using tampons, have recently given birth, or are using an internal barrier contraceptive such as a diaphragm.
Source: Mail Online

Kids Are Less Fit Than Their Parents Were

Today’s kids can’t keep up with their parents. An analysis of studies on millions of children around the world finds they don’t run as fast or as far as their parents did when they were young.

On average, it takes children 90 seconds longer to run a mile than their counterparts did 30 years ago. Heart-related fitness has declined 5 percent per decade since 1975 for children ages 9 to 17.

The American Heart Association, whose conference featured the research on Tuesday, says it’s the first to show that children’s fitness has declined worldwide over the last three decades.

“It makes sense. We have kids that are less active than before,” said Dr. Stephen Daniels, a University of Colorado pediatrician and spokesman for the heart association.

Health experts recommend that children 6 and older get 60 minutes of moderately vigorous activity accumulated over a day. Only one-third of American kids do now.

“Kids aren’t getting enough opportunities to build up that activity over the course of the day,” Daniels said. “Many schools, for economic reasons, don’t have any physical education at all. Some rely on recess” to provide exercise.

Sam Kass, a White House chef and head of first lady Michelle Obama’s Let’s Move program, stressed the role of schools in a speech to the conference on Monday.

“We are currently facing the most sedentary generation of children in our history,” Kass said.

The new study was led by Grant Tomkinson, an exercise physiologist at the University of South Australia. Researchers analyzed 50 studies on running fitness — a key measure of cardiovascular health and endurance — involving 25 million children ages 9 to 17 in 28 countries from 1964 to 2010.

The studies measured how far children could run in 5 to 15 minutes and how quickly they ran a certain distance, ranging from half a mile to two miles. Today’s kids are about 15 percent less fit than their parents were, researchers concluded.

“The changes are very similar for boys and girls and also for various ages,” but differed by geographic region, Tomkinson said.

The decline in fitness seems to be leveling off in Europe, Australia and New Zealand, and perhaps in the last few years in North America. However, it continues to fall in China, and Japan never had much falloff — fitness has remained fairly consistent there. About 20 million of the 25 million children in the studies were from Asia.

In China, annual fitness test data show the country’s students are getting slower and fatter over the past couple of decades.

Experts and educators blame an obsession with academic testing scores for China’s competitive college admissions as well as a proliferation of indoor entertainment options like gaming and web surfing for the decline.

China’s Education Ministry data show that in 2010 male college students ran 1,000 meters 14 to 15 seconds slower on average than male students who ran a decade earlier. Female students slowed by about 12 seconds in running 800 meters.

Tomkinson and Daniels said obesity likely plays a role, since it makes it harder to run or do any aerobic exercise. Too much time watching television and playing video games and unsafe neighborhoods with not enough options for outdoor play also may play a role, they said.

Other research discussed global declines in activity.

Fitness is “pretty poor in adults and even worse in young people,” especially in the United States and eastern Europe, said Dr. Ulf Ekelund of the Norwegian School of Sport Sciences in Oslo, Norway.

World Health Organization numbers suggest that 80 percent of young people globally may not be getting enough exercise.

Source: abc News

 

BSc (community health) programme gets clearance from the Union Cabinet

The union cabinet on Wednesday cleared the health ministry’s proposal to institute a three-year BSc (community health) program that aims to help raise a cadre of public health professionals for rural areas, reports.

 

The course that had the nomenclature of Bachelor of Rural Medicine and Surgery (BRMS) was met with objections from the Medical Council of India (MCI) and the medical community.

Subsequently, the course nomenclature was changed to BSc (community health) and the process of framing the syllabus for the course was taken out of the MCI’s ambit and handed over to the National Board of Examinations (NBE).

The bachelor in community health program will act as a bridge between auxiliary nurse midwife and a doctor and overrides the objections raised by a parliamentary panel and the MCI.

The parliamentary panel in March had said instead of creating a new pool of health professionals whose mandate and education are grey areas, there should be a compulsory one-year rural posting for fresh medical graduates to meet shortage of doctors in rural areas.

Source: India Medical Times

2 mins walk for every half an hour around office keeps diabetes at bay

A new study suggests that taking a two-minute stroll around the office every half hour could save millions from the misery of diabetes.

Leaving the desk for a walkabout can have a bigger impact on your health than a brisk 30-minute walk before work, the Daily Express reported.

Anthony Barnett, Emeritus Professor of Medicine at the Heart of England NHS Foundation Trust, said lifestyle changes can significantly reduce the risk of Type 2 diabetes, which is reaching epidemic proportions in Britain.

He said that short bursts of regular exercise in people with sedentary occupations appears to be at least as good as longer, but less frequent, periods of exercise in improving sugar and fat levels.

Scientists at Otago University in New Zealand found that volunteers who regularly walked for just one minute and 40 seconds had lower blood sugar and insulin levels.

Raised sugar and insulin readings are warning signs that Type 2 diabetes, a major risk factor for heart disease and stroke, could be setting in.

But the latest findings show that brief walkabouts could be all that is needed to lower the risks.

The study is published in the American Journal of Clinical Nutrition.

Source: Deccan Chronicle

 

India is world’s coronary, diabetic capital, says expert

India has earned the dubious distinction of becoming the world’s capital of coronary heart disease and diabetes, says a wellness expert.

Conducting a fitness workshop for journalists at Mumbai Press Club here, leading wellness expert Namita Jain said that several studies exposed the health hazards faced by stress-ridden Indian society. She was speaking on the occasion of ‘World Diabetes Day’ observed recently.

According to the World Congress of Cardiology, it is estimated that by 2020, heart diseases will be the cause of over 40 per cent deaths in India as compared to 24 per cent in 1990.

“World Health Organisation (WHO) estimates that nearly 200 million people all over the world suffer from diabetes and this number is likely to double in the coming years. In India, there are nearly 50 million diabetics,” Jain said.

The enormity can be gauged from a recent report that states many heart patients are below the age of 30.

In a study of 350 heart attack patients conducted by a team of doctors, around 9.5 per cent of cases were below 40 years of age and 3 per cent below 30, she said.

According to the November 2009 issue of Harvard Men’s Health Watch, as many as 10 per cent of all heart attacks in men occur before the age of 45.

Smoking was invariably a common factor in almost all the young patients. Apart from Smoking, sedentary lifestyle, obesity, stress, high-blood pressure, high cholesterol levels, diabetes, increasing age, family history are some other factors that increase chances of heart ailments.

Jain also touched upon a common problem experienced by many people – indigestion and acidity. This is due to bad eating and dietary habits, especially when we copy the West in
their eating patterns, whereas we in India have the most complete and wholesome meal – like Thali.

“Digest what you eat, eat slowly, chew well, drink water, and watch what you eat will help in somewhat alienating the problem. Your diet should consist of cereals, fruits / vegetables, proteins and fats”, she added.

Source: Deccan Chronicle

Why kids don’t like to eat veggies

A new study has revealed that children tend to dislike vegetables because they may be programmed to avoid plants as part of a survival strategy left over from our days in the wild.

Psychologists at Yale University found that young children didn’t like to pick natural things, like plants, when given an option with plastic or metal objects, News.com.au reported.

According to researchers Dr Annie Wertz and Dr Karen Wynn, this behaviour was programmed into children from birth to avoid them being harmed or poisoned by flowers or plants.

The researchers said that throughout human evolution, plants have been essential to human existence. Yet, for all of these benefits, plants have always posed very real dangers.

Source: News Track India

 

Healthy Recipe: Pumpkin Pie

One of my all-time favorite pies, this one is sweet with spices but not very sugary. Because of the small amount of molasses, this is darker than classic pumpkin pie. Make it with fresh roasted pumpkin, or use canned pumpkin. I am finding small “pie pumpkins” in supermarkets, and they’re perfect for the job.

1 gluten-free dessert pastry shell (or another crust of your choosing), lining a 9-inch pie pan (unbaked)

3 eggs

1 1/2 cups puréed roasted pumpkin (see below) or canned pumpkin

1/2 cup plus 1 tablespoon packed light brown sugar or raw light brown sugar

2 tablespoons almond flour

1 tablespoon molasses

1 teaspoon vanilla extract

2 teaspoons ground cinnamon

1/2 teaspoon ground ginger

1/4 teaspoon ground cloves

1/2 teaspoon freshly grated nutmeg

1/4 teaspoon salt

1 1/4 cups milk

2 tablespoons drained yogurt (or crème fraiche)

To roast the pumpkin: Use a small pie pumpkin, which is perfect for pumpkin pie. Cut away the stem, cut in half and scoop out the seeds. Preheat the oven to 425 degrees. Cut the pumpkin into chunks. Line a baking sheet with foil, lightly brush the foil with butter and place the pumpkin on top. Cover the sheet pan tightly with foil and place in the oven. Roast for 30 to 40 minutes, until the pumpkin is thoroughly soft. Remove from the oven and allow the pumpkin to cool until you can handle it. Cut away the skin (or scrape the pumpkin from the skin) and purée the pumpkin in a food processor fitted with the steel blade, or with a hand blender.

1. Turn the oven down to 350 degrees. Place the rack on the lowest setting. Beat the eggs in a large bowl and brush the pastry lightly with the beaten egg. Place in the oven and prebake 7 minutes. Remove from the heat and allow to cool.

2. Combine the pumpkin purée, brown sugar, almond flour, molasses, vanilla, cinnamon, ginger, cloves, nutmeg and salt in a saucepan and heat over medium heat, stirring with a heat-proof rubber spatula, until the mixture begins to sputter. Turn the heat to low and simmer, stirring, for 2 to 3 minutes. Remove from the heat and transfer to a food processor fitted with the steel blade or to a bowl if using a hand blender. Add the eggs, milk, and yogurt and blend until thoroughly combined and the mixture is very smooth.

3. Scrape the purée into the pie shell. Place on a baking sheet and bake in the preheated oven for 50 minutes, or until a knife inserted in the center comes out almost clean and the pie jiggles when gently shaken. It should not bake until it cracks. Remove from the heat and cool on a rack.

Yield: 1 9-inch pie, serving 10 to 12 (small portions)

Advance preparation: You can make the pie a day ahead. It will taste even better the day after it’s made.

Nutritional information per serving (10 servings): 269 calories; 13 grams fat; 6 grams saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 89 milligrams cholesterol; 33 grams carbohydrates; 3 grams dietary fiber; 222 milligrams sodium; 7 grams protein

Nutritional information per serving (12 servings): 224 calories; 11 grams fat; 5 grams saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 74 milligrams cholesterol; 27 grams carbohydrates; 3 grams dietary fiber; 185 milligrams sodium; 6 grams protein

Source: New York Times