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About the Authors
Frances Sienkiewicz Sizer
M.S., R.D.N., F.A.N.D., attended Florida State University where, in 1980, To my family, near
she received her B.S., and in 1982 her M.S., in nutrition. She is certified as a and far, and especially to
charter Fellow of the Academy of Nutrition and Dietetics. She is a founding Joan Spencer Webb.
member and vice president of Nutrition and Health Associates, an informa- –Fran
tion and resource center in Tallahassee, Florida, that maintains an ongoing
bibliographic database tracking research in more than 1,000 topic areas of
nutrition. Her textbooks include Life Choices: Health Concepts and Strategies;
Making Life Choices; The Fitness Triad: Motivation, Training, and Nutrition; and
others. She also authored Nutrition Interactive, an instructional college-level
nutrition CD-ROM that pioneered the animation of nutrition concepts in
college classrooms. She consults with an advisory board of professors from
around the nation, and attends workshops on innovations in nutrition educa-
tion. She has lectured at universities and at national and regional confer-
ences and supports local hunger and homelessness relief organizations in her
community.

Eleanor Noss Whitney

Ph.D., received her B.A. in biology from Radcliffe College in 1960 and her To Max, Zoey, Emily, Rebecca,
Ph.D. in biology from Washington University, St. Louis, in 1970. Formerly Kalijah, and Duchess with
on the faculty at Florida State University and a dietitian registered with the love.
Academy of Nutrition and Dietetics, she now devotes full time to research, –Ellie
writing, and consulting in nutrition, health, and environmental issues. Her
earlier publications include articles in Science, Genetics, and other journals.
Her textbooks include Understanding Nutrition, Understanding Normal and
­Clinical Nutrition, Nutrition and Diet Therapy, and Essential Life Choices for
college students and Making Life Choices for high school students. Her most
intense interests presently include energy conservation, solar energy uses,
alternatively fueled vehicles, and ecosystem restoration. She is an activist
who volunteers full-time for the Citizens Climate Lobby.

Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Brief Contents
Preface xvii

1 Food Choices and Human Health 1

2 Nutrition Tools—Standards and

Guidelines 31

3 The Remarkable Body 70

4 The Carbohydrates: Sugar, Starch, Glycogen,

and Fiber 113

5 The Lipids: Fats, Oils, Phospholipids,

and Sterols 160

6 The Proteins and Amino Acids 201

7 The Vitamins 240

8 Water and Minerals 292

9 Energy Balance and Healthy Body

Weight 343

10 Performance Nutrition 389

11 Diet and Health 428
12 Food Safety and Food Technology 470
13 Life Cycle Nutrition: Mother and Infant 516

14 Child, Teen, and Older Adult 558

15 Hunger and the Future of Food 599
Appendixes A-1
Glossary GL-1
Index IN-1

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Contents
Preface xvii CONSUMER’S GUIDE TO: Reading Nutrition

1
News 19
Chapter Taking Stock and Setting Goals 20
Food Choices and Human Start Now 20
Health 1 FOOD FEATURE: How Can I Get Enough
Nutrients Without Consuming Too Many
A Lifetime of Nourishment 2 Calories? 21
The Diet and Health Connection 3 Concepts in Action: Track Your Diet 22
Genetics, Nutrition, and Individuality 4 Self Check 23
Other Lifestyle Choices 4 CONTROVERSY 1: Sorting the Imposters from
Think Fitness: Why Be Physically Active? 5 the Real Nutrition Experts 24

Healthy People: Nutrition Objectives for

the Nation 5
Chapter 2
The Human Body and Its Food 6
Nutrition Tools—Standards
Meet the Nutrients 7 and Guidelines 31
Can I Live on Just Supplements? 8 Nutrient Recommendations 32
The Challenge of Choosing Foods 9 Dietary Reference Intakes 32

The Abundance of Foods to Choose The DRI Lists and Purposes 33

From 9 Understanding the DRI Recommended
How, Exactly, Can I Recognize a Nutritious Intakes 34
Diet? 11 How the Committee Establishes DRI
Why People Choose Foods 12 Values—An RDA Example 35
Determining Individual Requirements 36
The Science of Nutrition 14
Setting Energy Requirements 36
The Scientific Approach 14
Why Are Daily Values Used on Labels? 37
Scientific Challenge 14
Can I Trust the Media to Deliver Nutrition Dietary Guidelines for Americans 37
News? 17 Diet Planning with the USDA Eating
National Nutrition Research 17 Patterns 39
MY TURN: Lose Think Fitness: Recommendations
Weight While You for Daily Physical Activity 42
Sleep! 17
The Food Groups and
Norman Chan/Shutterstock.com

Changing Subgroups 42
Behaviors 18 Choosing Nutrient-Dense
The Process of Foods 43
Change 18 Norman Chan/Shutterstock.com

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Diet Planning Application 44 The Digestive System 80
MyPlate Educational Tool 46 Why Do People Like Sugar, Salt,
MY TURN: Right Size—Supersize? 46 and Fat? 80

Flexibility of the USDA Eating The Digestive Tract 81

Patterns 47 The Mechanical Aspect of Digestion 83
CONSUMER’S GUIDE TO: The Chemical Aspect of Digestion 85
Controlling Portion Sizes at Home Microbes in the Digestive Tract 87
and Away 48 Are Some Food Combinations More Easily
Food Lists for Diabetes and Weight Digested Than Others? 87
Management 50 If “I Am What I Eat,” Then How Does a
The Last Word on Diet Planning 51 Peanut Butter Sandwich Become “Me”? 89
Absorption and Transport of Nutrients 90
Checking Out Food Labels 51
A Letter from Your Digestive Tract 92
What Food Labels Must Include 51
The Excretory System 96
What Food Labels May Include 54
FOOD FEATURE: Getting a Feel for the Nutrients Storage Systems 96
in Foods 57 When I Eat More Than My Body Needs, What
Concepts in Action: Compare Your Intakes Happens to the Extra Nutrients? 97
with USDA Guidelines 60 Variations in Nutrient Stores 97
Self Check 61 Conclusion 97
CONTROVERSY 2: Are Some Foods Superfoods Self Check 98
for Health? 62
MY TURN: I Am What I Drink 99

Chapter 3 CONTROVERSY 3: Alcohol: Do the Benefits

Outweigh the Risks? 100
The Remarkable Body 70
The Body’s Cells 71 Chapter 4
Genes Control Functions 72 The Carbohydrates: Sugar,
Cells, Tissues, Organs, Systems 73 Starch, Glycogen, and
The Body Fluids and the Fiber 113
Cardiovascular System 74
A Close Look at Carbohydrates 114
The Hormonal and Nervous Sugars 115
Systems 76
Starch 117
What Do Hormones Have to Do
Glycogen 117
with Nutrition? 76
Fibers 117
How Does the Nervous System
Interact with Nutrition? 77 The Need for
The Immune System 79 Carbohydrates 119
iStockphoto.com/Floortje
iStockphoto.com/Floortje

If I Want to Lose Weight and

Immune Defenses 79
Stay Healthy, Should I Avoid
Inflammation 80
Carbohydrates? 119

vi Contents  

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 Why Do Nutrition Experts Recommend
Fiber-Rich Foods? 120 Chapter 5
Fiber Intakes and Excesses 125 The Lipids: Fats, Oils,
Whole Grains 127 Phospholipids, and
From Carbohydrates to Glucose 128 Sterols 160
Digestion and Absorption of
Carbohydrate 129
Introducing the Lipids 161
How Are Fats Useful to the Body? 161
CONSUMER’S GUIDE TO: Finding Whole-Grain
Foods 130 How Are Fats Useful in Food? 163
Why Do Some People Have Trouble A Close Look at Lipids 164
Digesting Milk? 134
Triglycerides: Fatty Acids and Glycerol 164
The Body’s Use of Glucose 135 Saturated vs. Unsaturated Fatty Acids 165
Splitting Glucose for Energy 135 Phospholipids and Sterols 167
How Is Glucose Regulated in the
Lipids in the Body 168
Body? 136
How Are Fats Digested and Absorbed? 168
Excess Glucose and Body Fatness 137
Transport of Fats 169
Think Fitness: What Can I Eat to Make
Workouts Easier? 139 Storing and Using the Body’s Fat 171
The Glycemic Index of Food 140
Dietary Fat, Cholesterol, and Health 172
Diabetes 141 Recommendations for Lipid Intakes 172
The Dangers of Diabetes 141 Lipoproteins and Heart Disease Risk 174
Prediabetes and the Importance of What Does Food Cholesterol Have to Do
Testing 142 with Blood Cholesterol? 176
Type 1 Diabetes 142 Recommendations Applied 176
Type 2 Diabetes 143 Think Fitness: Why Exercise the Body for the
Medical Nutrition Therapy 144 Health of the Heart? 177

MY TURN: 21st-Century Epidemic? 144 Essential Polyunsaturated Fatty

Physical Activity 146 Acids 178
Why Do I Need Essential Fatty Acids? 178
If I Feel Dizzy between Meals, Do I Have
Hypoglycemia? 146 Omega-6 and Omega-3 Fatty Acid
Families 178
Conclusion 147 Health Effects of Omega-3 Fatty Acids 179
FOOD FEATURE: Finding the Carbohydrates Where Are the Omega-3 Fatty Acids in
in Foods 147
Foods? 180
Concepts in Action: Analyze Your
Carbohydrate Intake 152 The Effects of Processing on Unsaturated
Fats 181
Self Check 153
CONSUMER’S GUIDE TO: Weighing Seafood’s
CONTROVERSY 4: Are Added Sugars “Bad” Risks and Benefits 182
for You? 154

Contents vii

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 What Is “Hydrogenated Vegetable Oil,” Providing Energy and Glucose 215
and What’s It Doing in My Chocolate Chip The Fate of an Amino Acid 217
Cookies? 183
CONSUMER’S GUIDE TO: Evaluating Protein
What Are Trans-Fatty Acids, and Are They and Amino Acid Supplements 218
Harmful? 184
MY TURN: Heart to Heart 184
Food Protein: Need and Quality 219
How Much Protein Do People Need? 219
Fat in the Diet 185 Nitrogen Balance 220
Get to Know the Fats in Foods 185 MY TURN: Veggin’ Out 221
Fats in Protein Foods 186 Protein Quality 222
Milk and Milk Products 187
Protein Deficiency and Excess 224
Grains 188
What Happens When People Consume Too
FOOD FEATURE: Defensive Dining 189
Little Protein? 224
Concepts in Action: Analyze Your Lipid Is It Possible to Consume Too Much
Intake 194 Protein? 224
Self Check 195 Is a Gluten-Free Diet Best for
CONTROVERSY 5: Is Butter Really Back? The Health? 225
Lipid Guidelines Debate 196
FOOD FEATURE: Getting Enough but Not
Too Much Protein 226
Chapter 6 Concepts in Action: Analyze Your Protein
The Proteins and Amino Intake 230
Self Check 231
Acids 201 CONTROVERSY 6: Vegetarian and Meat-
The Structure of Proteins 202 Containing Diets: What Are the Benefits and
Pitfalls? 232
Amino Acids 202
How Do Amino Acids Build Proteins?
The Variety of Proteins 204
204
Chapter 7
Denaturation of Proteins 207 The Vitamins 240
Think Fitness: Can Eating Extra Protein Make Definition and Classification of
Muscles Grow Stronger? 209
Vitamins 242
Digestion and Absorption of Dietary The Concept of Vitamin Precursors 242
Protein 209 Two Classes of Vitamins: Fat-Soluble
Protein Digestion 209 and Water-Soluble 242
What Happens to Amino The Fat-Soluble
Acids after Protein Is Vitamins 243
Digested? 210
Vitamin A 244
iStockphoto.com/only_fabrizio

The Importance
iStockphoto.com/only_fabrizio

Roles of Vitamin A
of Protein 212
and Consequences of
The Roles of Body Deficiency 244
Proteins 212

viii Contents 

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 Vitamin A Toxicity 246 The B Vitamins in Unison 264
Vitamin A Recommendations B Vitamin Roles in Metabolism 265
and Sources 247 B Vitamin Deficiencies 265

Evgeny Karandaev/
Shutterstock.com
Beta-Carotene 248
The B Vitamins as
MY TURN: Take Your
Vitamins? 249 Individuals 266
Thiamin 266
Vitamin D 249 Riboflavin Roles 268
Roles of Vitamin D 250 Niacin 269
Too Little Vitamin D—A Danger to Folate 269
Bones 250
Vitamin B12 272
Too Much Vitamin D—A Danger to Soft
Vitamin B6 273
Tissues 252
Biotin and Pantothenic Acid 275
Vitamin D from Sunlight 253
Non–B Vitamins 275
Vitamin D Intake Recommendations 254
FOOD FEATURE: Choosing Foods Rich
Vitamin D Food Sources 254
in Vitamins 280
Vitamin E 255 Concepts in Action: Analyze Your Vitamin
Roles of Vitamin E 255 Intake 283
Vitamin E Deficiency 255 Self Check 284
CONSUMER’S GUIDE TO: Sources of CONTROVERSY 7: Vitamin Supplements:
Vitamin D 256 What Are the Benefits and Risks? 285
Toxicity of Vitamin E 257
Vitamin E Recommendations and U.S. Chapter 8
Intakes 257
Water and Minerals 292
Vitamin E Food Sources 257
Water 294
Vitamin K 258 Why Is Water the Most Indispensable
Roles of Vitamin K 258 Nutrient? 295
Vitamin K Deficiency 259 The Body’s Water Balance 296
Vitamin K Toxicity 259 Quenching Thirst and Balancing Losses 296
Vitamin K Requirements and Sources 259 How Much Water Do I Need to Drink
in a Day? 298
The Water-Soluble Vitamins 260
CONSUMER’S GUIDE TO: Liquid Calories 299
Vitamin C 260
Think Fitness: Vitamins for Athletes 261 Drinking Water: Types, Safety, and
Sources 301
The Roles of Vitamin C 261
Hard Water or Soft Water—Which Is
Deficiency Symptoms and Intakes 262
Best? 301
Vitamin C Toxicity 262
Safety of Public Water 301
Vitamin C Recommendations 263
Water Sources 302
Vitamin C Food Sources 263
Body Fluids and Minerals 304

Contents ix

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 Water Follows Salt 304 Concepts in Action: Analyze Your Calcium
Fluid and Electrolyte Balance 305 Intakes 333
Acid-Base Balance 305 Self Check 334
CONTROVERSY 8: Osteoporosis: Can Lifestyle
The Major Minerals 305 Choices Reduce the Risk? 335
Calcium 305
Phosphorus
MY TURN: Drink Your Milk! 309
308
Chapter 9
Magnesium 310
Energy Balance and
Sodium 312
Healthy Body Weight 343
Potassium 316 The Problems of Too Little or Too Much
Chloride 317 Body Fat 344
Sulfate 317 What Are the Risks from Underweight? 345
What Are the Risks from Too Much
The Trace Minerals 318 Body Fat? 345
Iodine 318
What Are the Risks from Central
Iron 319 Obesity? 346
Think Fitness: Exercise-Deficiency How Fat Is Too Fat? 347
Fatigue 321
Zinc 324
The Body’s Energy Balance 349
Energy In and Energy Out 349
Selenium 326
How Many Calories Do I Need Each
Fluoride 326
Day? 349
Chromium 327
Estimated Energy Requirements (EER) 351
Copper 328
The DRI Method of Estimating Energy
Other Trace Minerals and Some
Requirements 351
Candidates 328
FOOD FEATURE: Meeting the Need for Body Weight vs. Body Fatness 352
Calcium 331 Using the Body Mass Index (BMI) 352
Measuring Body Composition and Fat
Distribution 352
How Much Body Fat Is Ideal? 353

The Appetite and Its Control 354

Hunger and Appetite—“Go” Signals 354
Satiation and Satiety—“Stop” Signals 356

Inside-the-Body Theories of Obesity 358

Robyn Mackenzie/Shutterstock.com

MY TURN: How Many Calories? 359

Outside-the-Body Theories of Obesity 359

Think Fitness: Activity for a Healthy Body
Weight 361

x Contents  

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
How the Body Loses and Gains How Do Muscles Adapt to
Weight 362 Physical Activity? 394
The Body’s Response to How Does Aerobic Training
Energy Deficit 362 Benefit the Heart? 395
The Body’s Response to Think Fitness: Exercise

Nativania/Shutterstock.com
Energy Surplus 364 Safety 396

Achieving and Maintaining Three Energy

a Healthy Body Weight 365 Systems 396
CONSUMER’S GUIDE TO: Fad Diets 367 The Muscles’ Energy
Reservoir 397
What Food Strategies Are Best for Weight
Loss? 369 The Anaerobic Energy System 398
Physical Activity in Weight Loss The Aerobic Energy System 398
and Maintenance 372 The Active Body’s Use of Fuels 399
What Strategies Are Best for Weight The Need for Food Energy 399
Gain? 373
Glucose: A Major Fuel for Physical
Medical Treatment of Obesity 374 Activity 400
Obesity Medications 374 Other Factors Affecting Glycogen 402
Obesity Surgery 374 MY TURN: How Much Is Enough? 403
Herbal Products and Gimmicks 376 Carbohydrate Recommendations for
Once I’ve Changed My Weight, How Can Athletes 403
I Stay Changed? 377 Lipid Fuel for Physical Activity 404

Conclusion 378 Protein for Building Muscles and for

Fuel 406
FOOD FEATURE: Behavior Modification for
Weight Control 379 How Much Protein Should an Athlete
Consume? 407
Concepts in Action: Analyze Your Energy
Balance 381 Vitamins and Minerals—Keys to
Self Check 382 Performance 408
CONTROVERSY 9: The Perils of Eating Do Nutrient Supplements Benefit Athletic
Disorders 383 Performance? 408
Iron—A Mineral of Concern 409
Chapter 10 Fluids and Temperature Regulation
Performance in Physical Activity 410
Nutrition 389 Water Losses during Physical
Activity 410
The Benefits of Fitness 390 Fluid and Electrolyte Needs during Physical
The Nature of Fitness 390 Activity 411
Physical Activity Guidelines 392 Sodium Depletion and Water
Intoxication 412
The Essentials of Fitness 393

Contents xi

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 CONSUMER’S GUIDE TO: Selecting Sports CONSUMER’S GUIDE TO: Deciding about
Drinks 413 CAM 450
Other Beverages 414 How Does Cancer Develop? 453
Putting It All Together 415 Which Diet Factors Affect Cancer Risk? 455
FOOD FEATURE: Choosing a Performance
Conclusion 458
Diet 416
FOOD FEATURE: The DASH Diet: Preventive
Concepts in Action: Analyze Your Diet Medicine 459
and Activities 420
Concepts in Action: Analyze Your Diet
Self Check 421
for Health Promotion 462
CONTROVERSY 10: Ergogenic Aids:
Self Check 463
Breakthroughs, Gimmicks, or Dangers? 422
CONTROVERSY 11: Nutritional Genomics:

11
Can It Deliver on Its Promises? 464
Chapter

Diet and Health 428 Chapter 12

The Immune System, Nutrition, Food Safety and Food
and Diseases 430
Technology 470
The Effects of Malnutrition 430
The Immune System and Chronic Microbes and Food Safety 472
Diseases 432 How Do Microbes in Food Cause Illness
in the Body? 472
The Concept of Risk Factors 433
Food Safety from Farm to Plate 473
Cardiovascular Diseases 435 Safe Food Practices for Individuals 477
Atherosclerosis 436
Which Foods Are Most Likely to Cause
Risk Factors for CVD 437 Illness? 481
Think Fitness: Ways to Include Physical Protein Foods 482
Activity in a Day 441
Raw Produce 484
Recommendations for Reducing CVD
Other Foods 485
Risk 442
Advances in Microbial Food Safety 487
Nutrition and Hypertension 444
Is Irradiation Safe? 488
How Does Blood Pressure Work
in the Body? 445 Other Technologies 489

Risk Factors for Toxins, Residues, and

Hypertension 446 Contaminants in
How Does Foods 490
Nutrition Affect
Viktar Malyshchyts/Shutterstock.com

Natural Toxins in
Hypertension? 446 Foods 490
MY TURN: Fast-Food Pesticides 491
Generation? 448
CONSUMER’S GUIDE
TO: Understanding Organic
Nutrition and Cancer 449 Foods 493

xii Contents 

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 MY TURN: Organic: Does It Matter? 495 Some Cautions for the Pregnant
Animal Drugs—What Are the Risks? 495 Woman 530

Environmental Contaminants 497 Drinking during Pregnancy 532

Are Food Additives Safe? 499 Alcohol’s Effects 532

Regulations Governing Additives 500 Fetal Alcohol Syndrome 533

Additives to Improve Safety and Experts’ Advice 534

Quality 500 Troubleshooting 534
Flavoring Agents 501 Diabetes 534
Fat Replacers and Artificial Fats 504 Hypertension 535
Incidental Food Additives 504 Preeclampsia 535
Conclusion 505 Lactation 535
FOOD FEATURE: Processing and the Nutrients MY TURN: Bringing Up Baby 536
in Foods 505
Nutrition during Lactation 536
Self Check 508
When Should a Woman Not Breastfeed? 537
CONTROVERSY 12: Genetically Engineered
Foods: What Are the Pros and Cons? 509 Feeding the Infant 538
Nutrient Needs 538
Chapter 13 Why Is Breast Milk So Good for

Life Cycle Nutrition: Mother Babies? 540

Formula Feeding 542
and Infant 516 CONSUMER’S GUIDE TO: Formula Advertising
Pregnancy: The Impact of Nutrition on the versus Breastfeeding Advocacy 543
Future 517 An Infant’s First Solid Foods 544
Preparing for Pregnancy 517 Looking Ahead 547
The Events of Pregnancy 519 FOOD FEATURE: Mealtimes with Infants 548
Increased Need for Nutrients 521 Concepts in Action: Analyze the Adequacy
Food Assistance Programs 526 of a Diet for Pregnancy 549
How Much Weight Should a Woman Self Check 550
Gain during Pregnancy? 526 CONTROVERSY 13: Childhood Obesity and
Weight Loss after Pregnancy 527 Early Chronic Diseases 551
Should Pregnant Women Be Physically
Active? 528 Chapter 14
Teen Pregnancy 528
Child, Teen, and Older
Think Fitness: Physical Activities for the
Pregnant Woman 529 Adult 558
Why Do Some Women Crave Pickles and Ice Early and Middle Childhood 559
Cream While Others Can’t Keep Anything Feeding a Healthy Young Child 559
Down? 529
Mealtimes and Snacking 563

Contents xiii

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 How Do Nutrient Concepts in Action: Analyze Three
Deficiencies Affect a Diets 592
Child’s Brain? 566 Self Check 593
The Problem of CONTROVERSY 14: Nutrient–
Lead 567 Drug Interactions: Who Should
Food Allergy, Be Concerned? 594
Intolerance, and
Aversion 568
iStockphoto.com/marmo81
iStockphoto.com/marmo81
Chapter 15
Can Diet
Make a Child
Hunger and the
Hyperactive? 571 Future of Food 599
Dental Caries 572
U.S. Food Insecurity 600
Is Breakfast Really the Most Important Meal
Food Poverty in the United States 600
of the Day for Children? 573
What U.S. Food Programs Address
How Nourishing Are the Meals Served at
Low Food Security? 602
School? 573
World Poverty and Hunger 604
Nutrition in Adolescence 574
Nutrient Needs 576 The Malnutrition of Extreme Poverty 606
Common Concerns 577 Hidden Hunger—Vitamin and Mineral
Deficiencies 606
Eating Patterns and Nutrient Intakes 578
Two Faces of Childhood Malnutrition 607
The Later Years 578 Rehabilitation 608
CONSUMER’S GUIDE TO: Nutrition for PMS
Relief 579 The Future Food Supply
and the Environment 608
Nutrition in the Later Years 581 Threats to the Food Supply 609
Energy, Activity, and the Muscles 581
Fisheries and Food Waste 610
Protein Needs 582
MY TURN: How Responsible Am I? 611
Think Fitness: Benefits of Physical Activity
for the Older Adult 583 How Can People Help? 612
Carbohydrates and Fiber 583 Government Action 612
Fats and Arthritis 583 Private and Community Enterprises 613
Vitamin Needs 584 Educators and Students 613
Water and the Minerals 585 Food and Nutrition Professionals 613
Can Nutrition Help People to Live Longer? 587 Individuals 613
Immunity and Inflammation 588 Conclusion 613
Can Foods or Supplements Affect the Course CONSUMER’S GUIDE TO: Making
of Alzheimer’s Disease? 588 “Green” Choices (Without Getting
“Greenwashed”) 614
Food Choices of Older Adults 589
Self Check 616
FOOD FEATURE: Single Survival and Nutrition
on the Run 590 CONTROVERSY 15: How Can We Feed Ourselves
Sustainably? 617
MY TURN: Eating Solo 591

xiv Contents 

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Appendixes G Answers to Chapter Questions G-1
A Table of Food Composition A-3 H Physical Activity Levels and Energy
B Dietary Guidelines B-1 Requirements H-1
C Aids to Calculations C-1 I Chemical Structures: Carbohydrates,
Lipids, and Amino Acids I-1
D Food Lists for Diabetes and Weight
Management D-1
E Eating Patterns to Meet the Dietary
Guidelines for Americans E-1
Glossary GL-1
F Notes F-1 Index IN-1

Contents xv

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 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Preface
A billboard in Louisiana reads, “Come as you are. Leave dif-
ferent,” meaning that once you’ve seen, smelled, tasted,
and listened to Louisiana, you’ll never be the same. This book
entitled A Consumer’s Guide To . . ., lead readers through an
often bewildering marketplace with scientific clarity, prepar-
ing them to move ahead with sound marketplace decisions.
extends the same invitation to its readers: come to nutrition Each Consumer’s Guide ends with review questions to improve
science as you are, with all of the knowledge and enthusiasm recall of the main points.
you possess, with all of your unanswered questions and mis- By popular demand, we have retained our Snapshots of
conceptions, and with the habits and preferences that now dic- vitamins and minerals, which now reflect the 2015 Daily Val-
tate what you eat. ues. These concentrated capsules of information depict food
But leave different. Take with you from this study a more sources of vitamins and minerals, present DRI values, and offer
complete understanding of nutrition science. Take a greater the chief functions of each nutrient along with deficiency and
ability to discern between nutrition truth and fiction, to ask ­toxicity symptoms.
sophisticated questions, and to find the answers. Finally, take New or major terms are defined in the margins of chapter
with you a better sense of how to feed yourself in ways that not pages or in nearby tables, and they also appear in the Glossary
only please you and soothe your spirit but nourish your body at the end of the book. The reader who wishes to locate any
as well. term can quickly do so by consulting the Index, which lists the
For over 35 years, Nutrition: Concepts and Controversies has page numbers of definitions in boldface type.
been a cornerstone of nutrition classes across North America, Two useful features close each chapter. First, our popular
serving the needs of students and professors. In keeping with Concepts in Action diet and exercise tracking activities inte-
our tradition, in this, our 14th edition, we continue exploring grate chapter concepts with the Diet & Wellness Plus program.
the ever-changing frontier of nutrition science, confronting its The second is the indispensible Self Check that provides study
mysteries through its scientific roots. We maintain our sense of questions, with answers in Appendix G to provide immediate
personal connection with instructors and learners alike, writ- feedback to the learner.
ing for them in the clear, informal style that has become our
trademark. Controversies
The Controversies of this book’s title invite you to explore
Pedagogical Features beyond the safe boundaries of established nutrition knowl-
Throughout these chapters, features tickle the reader’s inter- edge. These optional readings, which appear at the end of each
est and inform. For both verbal and visual learners, our logi- chapter, delve into current scientific topics and emerging con-
cal presentation and our lively figures keep interest high and troversies. These fast-changing topics are relevant to nutrition
understanding at a peak. The photos that adorn many of our science today.
pages add pleasure to reading.
Many tried-and-true features return in this edition: Each Chapter Contents
chapter begins with What Do You Think? questions to pique Chapter 1 begins the text with a personal challenge to stu-
interest. What Did You Decide? at the chapter’s end asks read- dents. It asks the question so many people ask of nutrition
ers to draw conclusions. A list of Learning Objectives (LO) ­educators—“Why should people care about nutrition?” We
offers a preview of the chapter’s major answer with a lesson in the ways in which
goals, and the LO reappear under sec- nutritious foods affect diseases and present a
tion headings to make clear the continuum of diseases from purely genetic in
main take-away messages. Do the origin to those almost totally preventable
Math margin features challenge by nutrition. After presenting some
readers to solve nutrition prob- beginning facts about the genes,
lems, with examples provided. nutrients, bioactive food compo-
My Turn features invite the nents, and nature of foods, the chap-
reader to hear stories from stu- ter goes on to present the Healthy
dents in nutrition classes around
Workmans Photos/Shutterstock.com

People goals for the nation. It con-

the nation offer solutions to real-life cludes with a discussion of scientific
Workmans Photos/
situations. Think Fitness reminders alert Shutterstock.com research and quackery.
readers to links among nutrition, ­ fitness, Chapter 2 brings together the con-
and health. Food Feature sections act as cepts of nutrient standards, such as
bridges between theory and practice; they are practical the Dietary Reference Intakes, and diet
applications of the chapter concepts. The consumer sections, planning using the Dietary Guidelines for

x vii

Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Americans 2015–2020. Chapter 3 presents a thorough, but • Condensed and enhanced Tables C1–2 and C1–3.
brief, introduction to the workings of the human body from • Condensed Tables C1–5 and C1–6.
the genes to the organs, with major emphasis on the digestive
system and its microbiota. Chapters 4–6 are devoted to the Chapter 2
energy-yielding nutrients—carbohydrates, lipids, and protein. • Integration of the Dietary Guidelines for Americans
Controversy 4 has renewed its focus on theories and fables 2015–2020.
surrounding the health effects of added sugars in the diet. • New table of shortfall and overconsumed nutrients.
Controversy 5, new to this edition, considers the scientific • Defines empty calories.
debate surrounding lipid guidelines. • Introduces the American Diabetes Association’s Choose
Chapters 7 and 8 present the vitamins, minerals, and water. Your Foods lists.
Chapter 9 relates energy balance to body composition, obesity, • New figure of dining-out trends.
and underweight and provides guidance on lifelong weight • Updated labeling discussion and new figure to illustrate
maintenance. Chapter 10 presents the relationships among proposed changes to the Nutrition Facts Panel.
physical activity, athletic performance, and nutrition, with • Newly approved Daily Values used in inside back cover,
some guidance about products marketed to athletes. Chapter 11 figures, and discussions.
applies the essence of the first 10 chapters to disease prevention. • New front of package labeling information and figure.
Chapter 12 delivers urgently important concepts of food • New phytochemical Point/Counterpoint table.
safety. It also addresses the usefulness and safety of food addi-
tives, including artificial sweeteners and artificial fats, and Chapter 3
explains the widely varying effects of processing on nutrients in • Clarified Figure 3–4.
foods. Chapters 13 and 14 emphasize the importance of nutri- • New section to introduce microbiota of the intestinal tract.
tion through the life span, with issues surrounding childhood • New table of definitions of common digestive disorders.
obesity in Controversy 13. Chapter 14 includes nutrition advice • New Point/Counterpoint table summarizing issues of
for feeding preschoolers, schoolchildren, teens, and the elderly. alcohol and health.
Chapter 15 devotes attention to hunger and malnutrition,
both in the United States and throughout the world. It also Chapter 4
touches on the vast network of problems that threaten the • Expanded coverage of the health effects of fermentable
future food supply, and explores sustainable diets as part of fibers and their products.
the solution. • New coverage and table of the glycemic index.
• New nutrition guidelines for diabetes.
• New section on relationship between obesity and diabetes.
Our Message to You • Updated table of diabetes diagnostic criteria.
Our purpose in writing this text, as always, is to enhance our • New figure illustrating sugar alcohols on a label.
readers’ understanding of nutrition science. We also hope the • New table of added sugar intake through the life span.
information on this book’s pages will reach beyond the class- • New coverage of added sugars and blood pressure.
room into our readers’ lives. Take the information you find • New Point/Counterpoint table on the health effects of
inside this book home with you. Use it in your life: nourish added sugars.
yourself, educate your loved ones, and nurture others to be
healthy. Stay up with the news, too—for despite all the conflict- Chapter 5
ing messages, inflated claims, and even quackery that abound • Expanded coverage of dietary fat and satiety.
in the marketplace, true nutrition knowledge progresses with • Updated lipid intake recommendations.
a genuine scientific spirit, and important new truths are con- • New emphasis on fat sources in Mediterranean eating
stantly unfolding. patterns.
• Updated presentation of fast food choices.
• New figure explaining the Supplement Facts panel of a fish
New to This Edition oil supplement.
Every section of each chapter of this text reflects the changes in • New Do the Math feature on percentages of fat in ground
nutrition science occurring since the last edition. The changes meats.
range from subtle shifts of emphasis to entirely new sections • New practical tips for consuming fish and seafood in Food
that demand our attention. Appendix F supplies current ref- Feature.
erences; older references may be viewed in previous editions, • New Controversy on scientific debate surrounding lipid
available from the publisher. guidelines, concluding with new eating patterns approach.
• New Point, Counterpoint table on lipid guidelines debate.
Chapter 1
• New introductory section on water. Chapter 6
• Defines NHANES. • Expanded section on gluten-free diets, celiac disease, and
• Defines registered dietitian nutritionist (RDN). gluten sensitivity.

x viii Preface  

Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
• New discussion of protein labeling. • Newly revised tables of recommendations and strategies
• New figure highlighting protein labeling. to reduce the risk of CVD and recommendations and strat-
• New Point/Counterpoint table on vegetarian and meat- egies to reduce the risk of cancer.
containing diets. • Emphasizes the role of obesity as a major risk factor for
other chronic diseases throughout the chapter.
Chapter 7 • New information related to the 2013 American College
• Introduces the role of obesity in vitamin D deficiency. of Cardiology/American Heart Association guidelines for
• New table highlighting current research on the role of assessment of CVD risk and lifestyle modifications for
vitamin D in disease. reducing the risk of heart disease.
• New Daily Values for vitamins reflected in the Snapshots. • New emphasis on risks and benefits of alternative therapies.
• New explanation of food fortification with B vitamins. • New figure summarizing the relationship between risks
• New Point/Counterpoint table on arguments for and and benefits.
against dietary supplements.
Chapter 12
Chapter 8 • Updated hand washing figure to reflect new guidelines.
• New sports-drink labeling figure in Consumer’s Guide. • New table on how to wash produce.
• New Daily Values for minerals throughout the Snapshots. • New figure depicting imported food in the U.S. diet.
• Revised and updated graph on sodium intakes of U.S. • Updated figure on organic food labels.
adults. • New table on natural toxins.
• Revised and updated graph on calcium sources in the • New discussion of arsenic in apple juice and rice.
U.S. diet. • New discussion of artificial sweeteners and GI flora.
• New presentation of lifetime plan for healthy bones.
• New Point/Counterpoint table on arguments for and Chapter 13
against calcium supplements. • New discussion of choline during pregnancy.
• New table of complications associated with smoking dur-
Chapter 9 ing pregnancy.
• New table on underweight, overweight, and obesity in • New discussion of the importance of zinc in complemen-
U.S. adults. tary foods for breastfed infants.
• New table presents American College of Cardiology/­ • Restructured and simplified table of nutrient supplements
American Heart Association Task Force Guidelines. for infants.
• New coverage of intermittent fasting for weight control. • Reorganized Controversy 13.
• Updated table of eating patterns for weight loss to reflect • New table of physical complications of obesity during
recent research and reviews. childhood.
• New figure and text coverage of calorie labels on restau- • New figure demonstrating how to read a growth chart.
rant menus. • New figure of sleep, screen time, and obesity in children.
• New section on potential benefits and risks, including
nutrient deficiency risks, of obesity surgery. Chapter 14
• Added Contrave and Saxenda information. • Updated energy intake needs for children.
• New discussion of the idea of binge eating as addiction. • New table of healthy snack ideas from each food group.
• Updated USDA Eating Pattern calorie intakes for children.
Chapter 10 • New figure of physical symptoms of lead toxicity in
• New table on benefits of fitness. children.
• New discussion of exercise factors as molecular links • New discussion on vitamin D and PMS.
between physical activity and health. • Increased coverage of dietary protein and muscle protein
• Condensed and reorganized fitness sections. synthesis in the elderly.
• New major section on the body’s three energy systems • Caffeine information from the Scientific Report of the 2015
that support physical activity. Dietary Guidelines Advisory Committee.
• Explains the “train low, compete high” theory.
• Expanded coverage of protein intakes for athletes. Chapter 15
• New table of protein-rich snacks for athletes. • Title change reflects current trends in sustainability
• New coverage of vitamin D for athletes. research.
• Added DMAA and DMBA as unsafe supplements for athletes. • New table of U.S. food security terms.
• New figure of expenditures for U.S. food programs.
Chapter 11 • Reorganized world hunger and malnutrition section.
• Enhanced the table of selected nutrients’ roles in immune • New figure on mid-upper arm circumference.
function. • Defines wasting, stunting, and marasmic kwashiorkor.

Preface xix

Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Appendixes:
Appendix D: Presents the 2014 Food Lists for Diabetes and
Acknowledgments
Our thanks to our partners Linda Kelly DeBruyne and Sharon
Weight Management.
Rolfes for decades of support. Thank you, Spencer Webb, RD,
Appendix E: Presents Eating Patterns recommended by the
CSCS, for your guidance in Chapter 10 (and for getting us into
2015–2020 Dietary Guidelines for Americans: Healthy U.S.-
shape, too). Thank you, K. Autumn Ehsaei, R.D.N., for generat-
Style, Healthy Vegetarian, and Healthy Mediterranean-Style,
ing our orderly endnote lists. And to Kathy Guilday, the Queen
and support materials for the Mediterrranean diet.
of Minutiae, many heartfelt thanks for your meticulous work
Appendix H: Offers tables and figures to support physical
and cheerful nature.
activity.
We are also grateful to the nutrition professionals who
Appendix I: New appendix of selected nutrient chemical
updated sections of this edition.
structures.
• Linda DeBruyne, M.S., R.D.N. (Chapter 11 and Chapter 13).
Ancillary Materials Linda received her master’s degree in nutrition from Flor-
Students and instructors alike will appreciate the innovative ida State University and is a founding member of Nutri-
teaching and learning materials that accompany this text. tion and Health Associates. She also coauthors the college
nutrition texts Nutrition and Diet Therapy and Nutrition for
MindTap: A new approach to highly personalized online Health and Health Care.
learning. Beyond an eBook, homework solution, digital supple- • Crystal Clark Douglas, Ph.D., R.D.N./L.D.N. (Controversy 13
ment, or premium website, MindTap is a digital learning plat- and Chapter 14). Crystal holds a doctoral degree in nutri-
form that works alongside your campus LMS to deliver course tion sciences from the University of Alabama at Bir-
curriculum across the range of electronic devices in your life. mingham and is the coauthor of multiple peer-reviewed
MindTap is built on an “app” model allowing enhanced digital publications. After teaching nutrition at Florida State Uni-
collaboration and delivery of engaging content across a spec- versity, she has maintained her professional skills working
trum of Cengage and non-Cengage resources. as a clinical dietitian and continuing to write on topics in
nutrition.
Instructor Companion Site: Everything you need for your
course in one place! This collection of book-specific lecture and • Shannon Dooies Gower-Winter, M.S., R.D.N./L.D.N.
class tools is available online via www.­cengage.com/login. ­Access (­Controversy 2, Chapter 7, and Chapter 8). Shannon grad-
and download PowerPoint presentations, images, ­instructor’s uated from Florida State University with her master’s
manual, videos, and more. degree in nutrition. She has taught nutrition at Florida
State University and lectured on topics related to child-
Test Bank with Cognero: Cengage Learning Testing Pow- hood nutrition throughout the state. She currently con-
ered by Cognero is a flexible online system that allows you to: ducts research in the area of nutritional neuroscience,
where her work focuses on various roles of zinc in the
• Author, edit, and manage test bank content from multiple brain. Her research has been presented at regional and
Cengage Learning solutions. national scientific conferences, and she has coauthored
• Create multiple test versions in an instant. multiple articles in peer-reviewed journals.

• Deliver tests from your LMS, your classroom, or wherever Our special thanks to our publishing team—Miriam Myers,
you want. Heidi Allgair, and Carol Samet—for their hard work and ded-
ication to excellence. Thank you to our marketing manager,
Diet & Wellness Plus: Diet & Wellness Plus helps you un- Tom Ziolkowski, for ensuring that our text finds the hands of
derstand how nutrition relates to your personal health goals. its readers.
Track your diet and activity, generate reports, and analyze We would also like to thank Chimborazo Publishing, Inc.
the nutritional value of the food you eat. Diet & Wellness Plus for their work on the student and instructor ancillaries for the
includes over 75,000 foods as well as custom food and recipe 14th edition, which includes the test bank, instructor’s man-
features. The new Behavior Change Planner helps you identify ual, and PowerLecture.
risks in your life and guides you through the key steps to make
positive changes. Reviewers of Recent Editions
As always, we are grateful for the instructors who took the
Global Nutrition Watch: Bring currency to the classroom time to comment on this revision. Your suggestions were
with Global Nutrition Watch from Cengage Learning. This invaluable in strengthening the book and suggesting new lines
user-friendly website provides convenient access to thou- of thought. We hope you will continue to provide your com-
sands of trusted sources, including academic journals, news- ments and suggestions.
papers, videos, and podcasts, for you to use for research
Alex Kojo Anderson, University of Georgia, Athens
projects or classroom discussion. Global Nutrition Watch
Sharon Antonelli, San Jose City College
is updated daily to offer the most current news about topics
L. Rao Ayyagari, Lindenwood University
­r elated to nutrition.

xx Preface  

Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Exploring the Variety of Random
Documents with Different Content
 In three minutes she was back with the hot-water bottle.

“There! it’s not very hot, just right to hold in your hands. Now tell
—no, I won’t take cold; I have my wrapper on, and it’s warm as
soup. Tell me all about it, Maria!”

Maria drew a long sobbing breath.

“How good you are!” she said. “But you won’t believe me, Honor:
nobody would; and then you will go, and I shall be all alone in the
world!”

“Nonsense!” said Honor decidedly. “I shall believe you! Go ahead!”

Brokenly, in a voice shaken by sobs, with bursts of bitter weeping,

Maria told her piteous story; how she had seen and admired the ring
on Patricia’s finger; a curious little ring, a circle of gold wire with a
tiny golden mouse running loose on it. She wanted to see how it
went; Patricia hated her so, she could not ask. Then—one day—
Patricia’s door was open, and Maria knew she was in the garden.

“Honor, I didn’t mean any harm! I swear to you I didn’t mean any
harm. I went in, and the ring was on the pincushion, and I tried it
on, and—and—just then Sophie came in, and I didn’t want her to
see me with it, and I slipped it into my pocket, meaning to put it
back when she had gone out—oh, dear! oh, dear! how could I?” The
wailing sobs broke out again.

“Quiet! quiet!” Honor was stroking her forehead with a firm soft
hand. “There! there! Go on! You meant to put it back; of course you
did. And then—”

“The bell rang for class, and Sophie was still there, sweeping, you
know—and I had to go. It was dictée, and you know that takes all
there is of me, and then I can’t do it decently! Honor, could any one
believe I could forget it—the ring, I mean? I did! oh, truly, truly I
did! And out in the garden at recess—I pulled out my handkerchief,
and—and—”

“And out it came!” Honor finished for her. “Of course I believe
every word, Maria. Of course any one would who had any sense.
Didn’t you tell Patricia? Didn’t you tell them all, that moment?”

“I couldn’t!” Maria’s voice fell into an agonized whisper. “I couldn’t,

Honor! Patricia looked at me—oh, pray to God that no one will ever
look so at you as long as you live!” cried the poor girl. “And she said
—”

“What did she say? Quiet, my dear! quiet! words never killed
anybody!”

“She said, ‘Tiens! are there two mouse-rings in the Pension? Or

perhaps only one?’ Then she picked it up and went away, and I saw
her telling the other girls. None of them has spoken to me since
then!”

“You poor child! what a wicked, wicked shame!”

“Do you—do you really believe me, Honor?”

Maria spoke timidly, and in the half darkness of the room, Honor
could feel her eyes peering anxiously into her own.

“Of course I believe you!” she cried. “Every single word, Maria.
Nobody could possibly doubt you. Of course it was a pity, and a silly
thing to do, and all that; but—why—there’s nothing dreadful about
it, Maria. It has only to be explained, and every one will understand
in a minute, and everything will be all right. You see if it isn’t!”

“But I can’t explain! How can I, when no one will speak to me? It’s
no use, Honor!”
 “I’ll explain! I’ll tell the girls all about it to-morrow, after breakfast,
and then everything will be all right. Now you must go to sleep like a
good girl. Shut your eyes and let go, and I’ll sing to you.”

Exhausted with misery and weeping, Maria was only too glad to
shut her eyes and “let go,” while Honor, still stroking her forehead,
crooned softly,

“‘On the Alp the grass is sweetest,

Li-u-o, my Queen!’”

It was midnight when Honor, chilly but happy, crept back to bed,
leaving Maria fast asleep. She nestled down on her pillow cozily.

“Play the heads are here!” she murmured. “Play they are smiling
at me:

“Matthew, Mark, Luke and John,

Bless the bed that I lie on!”

Honor was sleepy enough next morning after her vigil; but the
thought of what she had to do soon roused her. She ran into Maria’s
room, hairbrush in hand; it was not permitted, but she could
explain; the Sister would understand.

“Hush! listen!” she cried. “Don’t come out in the garden after
breakfast, Maria! Come straight back here, and wait till I come for
you. It will be all right, see if it isnt!”

Poor Maria, her eyes swollen with weeping, gave her a look of
such dog-like devotion and gratitude that Honor could only give her
a pat in return, and hurry away. Her heart was beating high. It was a
shame; but they had not known; they had not understood; in a little
hour now, all would be well.
 How slow they were at breakfast! It seemed as if the meal would
never end. Nobody looked at Maria; none of the girls at least. Soeur
Séraphine cast a keen glance at her swollen, discolored face; one,
and then another; but said nothing. Madame called from the head of
the table, “Marie, thou dost not eat, my child! How then! It is
necessary to eat; finish at least thy little bread!”

Maria crumbled her roll, and made a pretence of eating.

“Tiens!” said Soeur Séraphine. “The child is without appetite, my

sister. I myself will give her a cup of tea presently. That encourages
the stomach.”

After what seemed a really interminable time, the girls streamed

out once more into the garden. It was the custom after every meal
in good weather. Honor, breathless with eagerness, led the way,
beckoning the others to follow. They flocked to the seat under the
great trumpet vine.

“What is it?” they all cried. “More tells, Moriole? We haven’t heard
half enough!”

“Sit down, girls! I’m out of breath. I want to tell you all—you first,
Patricia, but all together—you are all wrong about Maria. Poor thing,
she meant no harm. Listen!” and she poured out Maria’s story, the
words tumbling over one another with eagerness; the girls listening
with wide-open eyes.

“So you see,” she concluded, “it wasn’t wicked, it was only silly;
very silly, of course, and she knows it, and is—oh, so dreadfully sorry
and ashamed! Pat, you can’t be angry with her any more; you must
forgive her, and take her back, don’t you see?”

Patricia laughed. “I’m afraid I don’t see!” she said. “Stealing is

stealing, Moriole, my child! No doubt she is sorry. Thieves are apt to
be—when they are found out. They are also apt to trump up a pretty
story to tell to sympathetic people. This is a very pretty story, my
dear, but I don’t see that it alters the facts of the case. The ring was
in Maria’s pocket. Et voilà!”

“You—you mean—that you do not believe what Maria says?”

Honor spoke slowly, as if bewildered.

“I mean precisely that! I don’t believe one solitary word!”

Honor looked from one to another.

“Girls! Vivette! Stephanie! You believe it?”

No one spoke; all looked embarrassed, except little Loulou, who

was pirouetting about, paying little attention.

“I see—you don’t!”

Honor was silent for a moment, thinking. Then, suddenly, a flame

seemed to surge up within her. She did not need dark hair this time;
red hair would do to be angry with. She sprang to her feet. Her blue
eyes flashed, and she clenched her hands, facing them all.

“Very well!” she said. “Then—that is all! You have sent Maria to
Coventry: I go with her! Good-by!”

She was gone. The girls looked at one another with blank faces.

“Oh, Patricia!” cried Stephanie. “We can’t send Moriole to

Coventry! She has just come back to us, and we all missed her so
dreadfully! Do make up with Maria!”

“Pooh!” said Patricia. “She’ll come back. Honor isn’t going to leave
us and take up with Maria Patterson. I give her half an hour!”

Honor flew to Maria’s room, her eyes blazing, her cheeks on fire.
As she entered, Maria looked up, a spark of hope in her eyes; but at
sight of Honor’s face, she cowered down in her chair and covered
her face with her hands, with a broken moan.

“You couldn’t!” she said. “I knew you couldn’t! I knew they

wouldn’t believe you. Thank you just as much for trying, Honor!”

“Hateful, hateful creatures!” Honor stamped her foot and clenched

her hands. “I never want to speak to any of them again. Come,
Maria, come out with me! They needn’t speak to us, and we
certainly will not speak to them. We’ll live in Coventry together!” And
she laughed a defiant laugh.

Maria shook her head drearily.

“No! I can’t go out; and I will not keep you from them. Go, please,
Moriole! I will not bring disgrace on you. Please go!”

Honor stood her ground hotly, determined to carry her point;

finally the school bell settled the matter by summoning all hands to
the classroom.

It was a wretched morning. Maria drooped in her corner. Honor

blazed and flashed in hers like a Catherine wheel. She flung her
scornful glances here and there, and all quailed beneath them,
except Patricia, who only laughed. Stephanie was on the verge of
tears and made sad work of her lessons.

“What then ails these children?” said Madame to Soeur Séraphine

at recess. “Do they conspire, or are they sickening? There is a fever
in the suburbs, Margoton tells me. Perhaps it would be well to send
for the doctor?”

“Wait a little, my sister! We shall soon know.” Soeur Séraphine was

her usual serene self. “Our little casserole bubbles furiously; soon it
will overflow, and we shall learn all about it. They are like that, our
dear children! No, they are not sickening: I have examined tongue
and pulse of all; all are perfect, except this poor Maria, who is the
root of the trouble, I am convinced, and who as yet can tell me
nothing. To-morrow I look to know all.”

That was the Sister’s way. She never “poked the nose,” as we said.
She hardly ever asked a question; she simply waited and things
came to her.

This time she had not long to wait.

The day wore through somehow; a dreadful day. Honor never

liked to recall it. In the afternoon walk, she stalked ahead of the
rest, her arm round Maria, her head thrown back defiantly, her heart
full of rage and bitterness. If only Maria had a particle of spirit, it
would be easier, she felt; but Maria had no thought of anything but
despair, with the added misery of having involved Honor in her
disgrace. She was not in the least a bad girl, poor Maria; only a silly,
inquisitive one.

“Look, Maria! what a strange-looking old lady! Isn’t she beautiful?

She is looking at us, so don’t stare, but just glance as you go by!”

Maria did not even glance. “I don’t care!” she said, “and how can
an old lady be beautiful, anyhow? I don’t dare about anything; I
wish I were dead!”

“That,” said Honor, “is wicked! You are a goose, Maria, but there is
no need of your being wicked, and you shan’t, either. And old ladies
are some of the most beautiful in the world, when they are
beautiful! Look at our Sister!”

Soeur Séraphine was thirty-three, to be precise; but fourteen

takes little count of degrees in age.

A wretched afternoon. A wretched evening, Maria’s forlorn face

casting a gloom over the pleasant reading hour, a gloom only
accentuated by Honor’s flame of anger, which still burned brightly.
Soeur Séraphine, reading aloud peacefully, looked benignantly over
the top of her “Télémaque,” and felt that a crisis was approaching.
These dear children! By to-morrow all would clear itself, and they
would be themselves once more. But for this poor Maria, and our
Moriole, it was indeed desolating; nor was Stephanie less unhappy. A
special prayer must be offered for these three.

Bedtime came. The girls separated without the usual merry

chirping over their lighted candles. Honor, after a brief but energetic
effort to make Maria “cheer up,” gave it up in despair for the
moment, and hurried to bed, thereby saving five minutes of the
allotted fifteen, of which half was usually spent in happy fluttering
and twittering from room to room. Placing her candle on the little
bedside table, she drew from under her mattress a square leather-
bound volume, and settling herself among the pillows, began to
write hurriedly.

“My young life was full of sorrows. Treacherous friends deserted

me because I just tried to behave decently. My cheek grew pale and
thin, but my spirit was undaunted. My tears flowed like a crystal
fountain—” Here Honor blinked hard and thought she did perhaps
feel something like a tear in one eye—“My silken pillow was wet with
them. The poor thing I tried to rescue was no help at all, but of
course that made no difference, and I spurned the others from me
with flashing eye and regal gesture. One of them was my bosom
friend. I never thought she would desert me—

“Who’s there? Maria? Come in! Anybody else, stay out!”

But Stephanie was already in: Stephanie was flinging herself on

Honor’s neck, weeping, begging for forgiveness.

“Moriole darling! Speak to me! look at me! Do be friends! Won’t

you, Moriole? I can’t bear it without you!”

Did Honor spurn her with flashing eye and regal gesture? No! she
hugged her close, and they cried together, and kissed and “made
up” like the affectionate creatures they were.
 “But—but you forgive Maria?” cried Honor. “You’ll take her back,
Stephanie? You can’t have me without her!”

“I’ll take twenty Marias!” whispered Stephanie, “to get back my

own, own Moriole!”

Ting! ting! went the bell. Lights out! One parting hug; off flew
Stephanie; back went the book under the mattress; out went the
candle. Honor nestled down in bed with a warm heart, for the first
time since leaving the Châlet.

“Thank you, Matthew, Mark, Luke and John!” she murmured. “You
have blessed the bed that I lie on!” and she fell happily asleep, to
dream of the Twins and Zitli.

Never yet in all her peaceful years had Honor had two broken
nights in succession; but there is a first time for everything.

Late in this second night she was again waked suddenly; not by
sobbing this time: not by any noise; all was still. What was it, then?
Why was she sitting up in bed, frightened? She sniffed: a strange
smell was in her nostrils: acrid, pungent—fire? She was springing out
of bed, when she heard some one enter the next room hurriedly;
heard a smothered cry; heard the window flung violently open;
heard her own name called, low but urgently.

“Honor! Honor! come!”

Honor flew, to find the strange odor pouring out of Maria’s room;
to see, by the moonlight which flooded it, Maria lying apparently
unconscious, and bending over her, dragging her from the bed—
Patricia!
 “Help me get her to the window!” said Patricia briefly. “So! Now
call the Sister, and get my salts! Quick!”

Again Honor flew, down the corridor, at the end of which a light
glanced from the crack under Soeur Séraphine’s door. The little
Sister, kneeling at her prie-Dieu, turned as the door opened. Her
eyes widened at sight of Honor’s horrified face; her delicate nostrils
expanded as the pungent odor crept into them; all this Honor saw
afterwards. It seemed hardly a breathing-space before the Sister
had flashed past her, flashed down the corridor, and had Maria in her
arms by the open window, while Patricia knelt beside her with the
salts. A pure cool breeze blew into the room, driving out the choking
vapor. A few anxious moments, a convulsive movement, a quiver of
the eyelids: Maria opened her eyes, and looked feebly about her.

“Let us thank the merciful Lord and the blessed saints!” said Soeur
Séraphine. “My child, behold you restored to us! How do you find
yourself?”

“Oh, dear!” said Maria. “Am I not dead? oh, dear!”

At this moment she caught sight of Patricia’s pale face close

beside her. She shrank back with a cry.

“Why couldn’t you let me die?” she cried. “Don’t—don’t laugh at

me, Patricia! Please go away, and let me die!”

Patricia was about to speak, but Soeur Séraphine signed to her to

be silent.

“A little later!” she murmured. “Go now, my child! Thou also,

Honor; return in ten minutes.”

As they turned to go, a piece of paper blew off the table and fell
at Patricia’s feet. She picked it up mechanically, and saw her own
name on it. The two girls passed into Patricia’s room, which was on
the other side of Maria’s. Patricia lighted her candle, and read,
 “Patricia, it is true, what I told Honor. I did not mean to steal the
ring. Please take Honor back. I will not disgrace her when she was
so good to me.
“Maria Patterson.”

“Oh, Patricia!” cried Honor. “What—what did she do? What was
that dreadful smell? Patricia! you are white as a sheet! Are you going
to faint? Don’t—don’t cry, my dear!”

“I am not crying!” Patricia wiped two large tears from her cheeks.
“What did she do? She tried to kill herself. If it had not been for you,
I should have been a murderess!”

“Patricia, don’t say such dreadful things! And what have I to do

with it?”

“You kept me from going to sleep!” said Patricia curtly. “You little
thing—” Patricia laid her hands on Honor’s shoulders, and held her at
arm’s length a moment. “You little thing!” she repeated. “You have
saved me, as well as Maria!”

“Oh, Patricia!” faltered Honor, her own eyes bright with tears.
“What was it? was it poison?”

“Charcoal! The poor creature must have taken some from

Margoton’s brazier. Mercifully she didn’t know enough to stop up the
keyhole between her room and mine. I smelt it, and then I saw a
thin blue thread come creeping through the keyhole; and then—all in
a minute I knew! Hark! the Sister calls us. Honor, I can’t talk about
it, but I never shall forget this night!”

Honor was almost awe-stricken as Patricia pressed a warm kiss on

her cheek; Patricia, who never kissed any one. She returned the
caress shyly, but tenderly, and hand in hand the two entered Maria’s
room.
 Soeur Séraphine’s lovely face was more nearly stern than they had
ever seen it. She was sitting on the bed, Maria’s hand in hers. She
addressed the two girls gravely.

“Here we have,” she said, “one who has sinned and repented. Her
first sin was not grievous, as it appears to me; her repentance was
deep and sincere, but it has not been accepted—save by thee, my
little Honor! Thy part in this affair has been all that I could wish.
Patricia, of thee I would ask, art thou entirely without sin thyself?”

“No, my Sister!” Patricia’s voice was low, her eyes were bent on
the floor.

“Thou art right. Pride, vain glory, envy—no, perhaps not that!” as
Patricia made an involuntary movement; “hatred, malice and all
uncharitableness. Of these thou hast been guilty; is it not so, my
child?”

“Yes, my Sister!”

“Dost thou repent of these thy sins? Are they hateful in thine
eyes?”

“Oh, yes! yes!”

Soeur Séraphine’s face softened; her eyes shone with their own
kind light. She said no word, but with a lovely gesture held out
Maria’s hand. Patricia clasped it, and knelt down by the bedside.

“Maria,” she said, in a low, stifled voice, “I have been wicked and
hateful, and I beg your pardon!”

“Oh, don’t, Patricia!” gasped Maria. “Oh, please don’t! I—of course
it was horrid of me; of course you thought—oh, do get up, Patricia!
Oh, of course I forgive you, if you forgive me!”
 “So!” The Sister raised Patricia, and seated her beside her. “That is
well. Now you are friends once more, and that part of this sad
matter may be forgotten. For her second and far more grievous sin,
that of attempting to renounce the gift of life given her by the good
God, Maria is deeply repentant; is it not so, my child?”

“Oh, yes!” murmured Maria, clasping her hands over her face. “I
don’t see how I could have done it!”

“Fitting penance will be devised for thee!” the Sister went on

serenely. “Thou preferest to leave it to me and Madame, and it is
well. For thee, Patricia; wouldst thou prefer to choose thine own
penance, or shall we devise one for thee also?”

“I think—” Patricia spoke slowly, but with something of her usual

assured tone: “I think, my Sister, that I will go to Coventry myself!”

“Go to—Cov—what is that, my child? A city of England, is it not?

We could not permit—”

Patricia hastened to explain.

“Sending a person to Coventry means—not speaking to her, not

having anything to do with her. We—I—sent Maria to Coventry, and
made all the other girls do it—except Honor! she wouldn’t! Now I
will go myself, for a week. I will not speak to anybody, and nobody
shall speak to me. Will that do, my Sister?”

“Oh, Patricia!” cried Honor and Maria in one breath. “You shall not!
You must not!”

But Soeur Séraphine nodded approval.

“The idea,” she said, “appears to me admirable!”

 CHAPTER XIV

THE STRANGE OLD LADY

Patricia performed her penance faithfully. At her request, Soeur

Séraphine explained matters briefly to the girls next morning; so far,
that is to say, as she considered explanation desirable. Patricia, she
told them, had become convinced that she had been unjust to Maria,
and had taken upon herself the punishment which she and they had
inflicted upon that imprudent but well-meaning young person. For
the space of a week, they would hold no communication with
Patricia, nor she with them: Madame approving this entirely. After
that time, their happy relations with one another would be resumed,
and never again, the Sister trusted, would their clear horizon be
clouded in such manner. The girls were to remark that a little folly,
arousing the evil passions of our sinful nature, had brought about
this sad state of affairs. Let them pray without ceasing for truth,
courage and kindness, since these three formed the tripod on which
humanity must stand. Dismissed!

As the girls left the classroom, Patricia, who was standing at the
door, shook hands with each of them, as if taking leave. She did not
speak, nor did any one dare speak to her. Her face was grave, but
the scornful look was gone; the insolence of her beauty was veiled,
as it were, by a thoughtful, almost a sorrowful look. She gave Honor
a lovely smile; Honor’s arms were open in an instant to embrace her,
but Patricia shook her head, and laid her finger on her lips.

“I don’t see how I can!” said Honor to herself, as she passed out,
“but I must!” she added, “and so I will!”
 This sensible resolve she communicated to the other girls, as they
clustered round her under the trumpet vine. Patricia was walking by
herself at the other end of the garden, pacing up and down in a
sober, business-like way.

“How can we?” cried one and another. “Maria made no difference
one way or another: but Patricia—it will be like losing you over
again, Moriole!”

“We just plain have to!” said Honor stoutly. “That’s all there is
about it. And mind you be good to Maria, girls! It’s the least you can
do, after treating her so horribly. Poor thing! she is really sick this
morning, so our Sister made her stay in bed; but she will be down to
dinner, and I say, let’s all try to make her forget about it.”

All agreed, though without any special enthusiasm. They were

ashamed of the part they had played, but after all, Maria was Maria.

“Tiens, la Moriole!” It was Jacqueline de la Tour de Provence who

spoke, in her languid, graceful drawl. “Why this sudden interest in
Maria,—for thee, I mean? Thou hast never shown it before. She is
bourgeoise to a degree! She cannot belong to even the lowest order
of noblesse!”

“We are Americans!” said Honor shortly. “We have no noblesse.

And if we had—how about noblesse oblige, Jacqueline?”

Jacqueline blushed slightly, and murmured something about her

House; but it was noticed that she was moderately civil to Maria,
when the latter, still depressed, and sniffing at intervals, appeared at
dinner.

“But, Maria,” cried Honor, dragging her into a corner after dinner,
“you simply must buck up! You can’t go round cringing and sniffing
like—like a poodle that’s just been shaved! Hold up your head! Look
them in the eye! Show them that you are as good as they are!”
 “But I am not!” said poor Maria, who did seem to be made of
putty, as Patricia once said, and poor putty at that.

“You are! a great deal better than some of them. Buck up, I tell
you!”

“Bokope!” Soeur Séraphine, passing, paused with a smile of

inquiry. “Eet ees to me a word wholly new, la Moriole. It means—vat,
for example?”

Honor colored hotly, and hung her head.

“It’s—it’s argot, my Sister!” she confessed meekly. “Slang, you

know, we call it. It means to—to collect oneself—to—to take a brace
—oh, dear! that’s slang too! I’m afraid ‘buck up’ is really what it does
mean, my Sister. Papa used to say it!” she added timidly.

The little Sister glowed sympathetic.

“Tiens! If thy honored father used the expression, it is without

doubt a valuable one. Bokope! it is to remember, that!”

She passed on, leaving Honor struggling between amusement and

remorse.

The days passed quickly, as days do; they missed Patricia woefully.
Even Stephanie confessed to missing her, though she declared,
pacing the Garden, arm in arm with her newly-recovered Moriole,
that this was nothing compared with the desolation of last week.

“Patricia has behaved nobly, I grant that!” she said. “I forgive her
much, even her pride, which is insufferable. But to have thee back,
my cherished one, that makes to bound the heart; I could better do
without all than to lose thee, my Moriole!”

Was Stephanie always so sentimental? Had she herself been so,

before she went to the Châlet? Honor wondered; then she fell to
wondering what they were all doing up there. It was four o’clock.
The goats would be coming home soon. Perhaps Big Pierre was
there, courting Gretli. In that case Zitli would be in his own nook
behind the garden, sitting alone, looking at the mountain, thinking
perhaps a little of his friend. She must write to them to-night. She
had already written once, but Zitli said letters were a rare treat, and
she loved to write them.

“Look, Honor! that old lady again who regards thee. My faith, but
her eyes devour thee. One would say she was hungry, not so?”

Honor looked up, to find a pair of bright dark eyes fixed on her
with singular intentness. They belonged to a lady whom the girls
had seen several times of late in the Garden; an old lady, richly
dressed, who sometimes drove slowly in a victoria, sometimes, as
to-day, sat on a garden chair under the trees. She was accompanied
by a trim, rosy little person, who might be nurse, companion or
courier. She seemed interested in all the girls, but specially in Honor,
whose looks and motions she studied openly and deliberately.

To-day, after a prolonged look which yet was not a stare, she said
a few words to her companion, who stepped forward and in turn
addressed Soeur Séraphine, who was shepherding her little flock.
The Sister looked up in surprise; glanced toward the lady on the
garden chair; then hastily adjuring the girls to be extremely sage
and to observe well the beauties of Nature, she advanced with an air
of respectful interest toward the old lady, who, with a civil nod,
beckoned her to a seat beside her. The nurse, companion or courier
retired to a discreet distance. The girls, devoured by curiosity, paid
scant attention to the beauties of nature.

“Stephanie, you must not stare!” whispered Honor. “Look at that

swan; he is pecking the young one as hard as he can.”

Stephanie glanced anxiously at the swan. “They are savage

creatures!” she said. “A swan once pecked my grandmother, tearing
large portions of flesh from her bones. It was a frightful thing; she
turned black with terror. Observe her dress, Moriole! It is richness
itself, though sombre, and in distinguished taste.”

“Your grandmother’s? Or the swan’s?” Honor laughed.

“A squirrel! a squirrel!” cried little Loulou. “Where are the nuts,

Vivette?”

Squirrel and nuts made a brief diversion, but it was hard not to
glance more often than one should at the couple on the garden
chairs. They were talking earnestly; the Sister with her pretty,
fluttering gestures, the other with an occasional wave of a delicate
ringed hand, or an emphatic nod. Finally—oh, wonder! oh, thrill
upon thrill!—the Sister rose and beckoned—to whom? Jacqueline de
la Tour de Provence rose with dignity, and was gliding forward,
swanlike, when the Sister’s voice was heard, silver clear.

“Honor! Approach, my child!”

Jacqueline drew back with an air of elaborate unconcern. Honor,

with a deprecating glance at her, and a round-eyed flash at
Stephanie, advanced timidly.

“Honor, my little one,” the Sister’s voice trembled; “that I present

thee to Madame—”

“Mrs. Damian!” The lady spoke in an odd, abrupt tone. “How do

you do, child? Your grandfather Bright was my first cousin; you are
therefore my second cousin once removed. Sit down! If you open
your eyes too wide, they might drop out. I asked you how you did!”

Honor blinked and sat down hastily, trembling and amazed.

“I am very well, I thank you, madame!” she answered. “I trust

your distinguished health is also good.”
 “My distinguished health is as good as can be expected, I thank
you!” with an amused twinkle. “Your name is Honor? So is mine!
There is always an Honor in the family. You never heard your father
speak of me, I suppose? No! how should you? I haven’t seen him for
twenty years. He was a nice boy then. Well! you wonder what sky I
have dropped from, eh? I heard of your parents’ death a year or
more ago; I was in Russia at the time. I am a traveler, child; I have
been traveling for many years. I was in Russia, and since then I
have been in the East. I have always meant to look you up; I wrote
your guardian, Mr. Stanford, that I would. You have never seen Mr.
Stanford?”

Honor shook her head. “He writes to Madame,” she said. “Twice a
year he writes, to make inquiry for me, and to send money; he
comes never.”

“Busy man! You’ll see him—” Mrs. Damian spoke in short, abrupt
sentences, each one punctuated with a nod. The last sentence
remained unfinished, and she nodded twice.

“Folly!” she spoke over her shoulder, and the rosy person
approached. “This is the little cousin! Honor, this is Miss Folly, who
keeps me alive. A ridiculous fuss she makes about it, too. What now,
Folly? Why do you look at me?”

“It’s time to come home, Mrs. Damian!” Miss Folly spoke in a

cheerful, cordial voice which struck Honor’s ear like music. “Shall I
call the carriage?”

“Do so! Honor, your teacher gives you permission to take supper
with me at the hotel this evening. Will you come?”

Honor faltered her thanks; with great pleasure would she do

herself the honor—

“That’s good! Miss Folly will come for you at a quarter before six.
Au revoir, child!”
 She nodded dismissal. Honor’s head was spinning; her heart was
beating fast; but she made her best courtesy, and murmuring, “Au
revoir, madame! Au plaisir, mademoiselle!” she turned and scurried
away toward the group of girls, who, at the further end of the
Gardens, were turning eager heads in her direction. On the way, she
caught sight of Patricia, taking her solitary walk in a shady by-path,
and stopped short, her heart beating louder than ever. She could not
—how could she pass Patricia without a word?

A squirrel was hopping along the path, expectant of nuts.

“Squirrel!” cried Honor. The squirrel stopped; Patricia turned, saw

her, and stopped too. “Give my love to Patricia!” Honor addressed
Master Frisky, breathlessly. “Tell her we miss her dreadfully! And—
squirrel—tell her I am going to supper at the hotel with my
grandfather’s cousin, Mrs. Damian, who has been in Russia. Tell her
it’s that beautiful old lady we saw the other day. That’s all!” and
kissing her hand—but not to the squirrel—Honor ran on.

The girls surged round her like a wave; questions flew like spray.
What? Who? Why? How? She was explaining as well as she could,
when Miss Folly appeared, very bright-eyed, a little out of breath
from walking quickly.

“Excuse me!” she said with a smile, as the girls drew back in
confusion. “Miss Honor, Mrs. Damian asks what you like best to eat.”

Honor fairly gasped. “Oh! oh, mademoiselle, it is of no import!

Anything that Madame—”

Miss Folly dismissed the remark with a gesture. “What do you like
best?” she repeated. “Mrs. Damian wishes to know.”

“Oh! oh, dear! ice-cream!” faltered Honor.

Miss Folly smiled again. “That, naturally! but before ice-cream?”

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