Professional Documents
Culture Documents
March 2012
Best Breakfasts
from Around the World
Theres Much to Learn About the Morning Meal From Other Countries
Counseling Patients With the African Heritage Diet Pyramid Menu Ideas, Tips, and More for Successful Low-FODMAP Living Whole-Body Nutrition for Healthful Aging
Vietnamese rice noodle soup, called Pho, is a traditional breakfast staple that originated in northern Vietnam.
www.TodaysDietitian.com
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PRESIDENTS SPOT
IN CELEBRATION OF YOU
By Kathy Czermanski
Happy National Nutrition Month from all of us at Todays Dietitian! In honor of National Nutrition Month and Registered Dietitian Day, wed like to invite you to nominate colleagues you believe are doing exceptional work in all areas of the dietetics field. As we have in the past two years, well select 10 of the nominees to be part of our annual TD10 feature article, which will appear this year in our June issue. Each of the TD10 nominees will receive an award certificate to display in their office or home. So please visit www.TodaysDietitian.com to submit your nominations throughout the month of March. Simply complete a short online form and, in 300 words or less, explain why you believe your colleague should be one of the TD10 this year. Also during National Nutrition Month, were very excited to announce the Todays Dietitians CE Learning Library (CELL) thats scheduled to go live on our website this month. Todays
Dietitian is accredited by the Commission on Dietetic Registration as a CPE provider, and CELL is an expansion of the CE courses and exams we provide in the magazine. The library will include a wide range of courses on a variety of current, practical, and thought-provoking topics. As always, distinguished industry experts will be writing the articles. Our new online system, located at CE.TodaysDietitian.com, will make it easy for you to register and earn credits just like you always have with us by simply reading the articles and taking the exams when youre finished. We know how important continuing education credits are for recertification and to enhance your professional growth and development. CELL will enable you to manage your transcript of credits and certificates, interact and discuss the courses with other dietitians, and chart out your path to recertification all in one place. So take some time to visit CELL during National Nutrition Month. We look forward to your feedback and support as we continue offering this invaluable service to you in the years to come. Please enjoy the issue!
Systems Manager Jeff Czermanski Systems Consultant Mike Davey President + CEO Kathleen Czermanski Vice President + COO Mara E. Honicker EDITORIAL Editor Judith Riddle Editorial Director Jim Knaub Senior Production Editor Tracy Denninger Editorial Assistants Heather Hogstrom, Brandi Redding Contributing Editor Sharon Palmer, RD Editorial Advisory Board Dina Aronson, MS, RD; Jenna A. Bell, PhD, RD; Carol M. Meerschaert, MBA, RD; Kyle Shadix, MS, RD ART Art Director Susan Kilcoyne Senior Graphic Designer Charles Slack Graphic Designer Kelly Newton Ad Coordinator Marie Harvey ADMINISTRATION Administrative Manager Helen Bommarito Administrative Assistants Kim Mayfield, Pat Plumley Executive Assistant Matt Czermanski FINANCE Director of Finance Jeff Czermanski Director of Continuing Education & New Business Development Jack Graham CIRCULATION Circulation Manager Nicole Hunchar MARKETING AND ADVERTISING Publisher Mara E. Honicker Director of Marketing and Digital Media Jason Frenchman Web Designer/Marketing Assistant Jessica McGurk Marketing Assistant Leara Angello Director of Sales Stephanie Mitchell Senior Account Executives Sue Aldinger, Peter J. Burke, Michael Ferguson, Brian Ohl, Brian Sheerin Account Executives Phil Anderson, Seth Bass, Jason Batchelder, Gigi Grillot, Lindsay Hertzog, Diana Kempster, Beth VanOstenbridge, Kate Wills, Josh Yohnke Sales Coordinator Joe Reilly, Dani Kriest-Reifsneider
2012 Great Valley Publishing Company, Inc. Todays Dietitian (ISSN 1540-4269) is published monthly by Great Valley Publishing Company, Inc., 3801 Schuylkill Road, Spring City, PA 19475. Periodicals postage paid at Spring City, PA, Post Office and an additional mailing office. Permission to reprint may be obtained from the publisher. Phone: 610-948-9500 Fax: 610-948-7202 Editorial e-mail: TDeditor@gvpub.com Sales e-mail: sales@gvpub.com Website: www.TodaysDietitian.com Subscription e-mail: subscriptions@ gvpub.com Ad fax: 610-948-4202 Ad artwork e-mail: TDads@gvpub.com Reprints: The Reprint Outsource, Inc.: 877-394-7350 or e-mail bwhite@reprintoutsource.com NOTE: For subscription changes of address, please write to Todays Dietitian, 3801 Schuylkill Road, Spring City, PA 19475. Changes of address will not be accepted over the telephone. Allow six weeks for a change of address or new subscriptions. Please provide both new and old addresses as printed on last label.
POSTMASTER: Send address changes to Todays Dietitian, 3801 Schuylkill Road, Spring City, PA 19475. Subscription Rates Domestic: $14.99 per year; Canada: $48 per year; Foreign: $95 per year; Single issue: $5 All articles contained in Todays Dietitian, including letters to the editor, reviews, and editorials, represent the opinions of the authors, not those of Great Valley Publishing Company, Inc. or any organizations with which the authors may be affiliated. Great Valley Publishing Company, Inc., its editors, and its editorial advisors do not assume responsibility for opinions expressed by the authors or individuals quoted in the magazine, for the accuracy of material submitted by the authors, or for any injury to persons or property resulting from reference to ideas or products discussed in the editorial copy or the advertisements.
ADVERTORIAL
Modest evidence suggests that children who do not eat breakfast are at increased risk of overweight and obesity. The evidence is stronger for adolescents.
Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010 We all know the old adage Breakfast: Its the most important meal of the day. And in recent years evidence regarding the benefits of breakfast is mounting. In addition to research showing that eating breakfast is linked to improved weight control, breakfast eaters have been shown to have improved nutrient adequacy overall, and improved cognitive performance. Breakfast is a prime occasion for getting many of the key nutrients for a healthy diet. The vitamins, minerals and plant nutrients found in breakfast staples like whole-grains and fruit including 100% fruit juice can promote better health. Unfortunately, the statistics show that far too many Americans are skipping this all-important meal. Any breakfast is better than no breakfast! If youre in a rush, consider the following quick and easy options all paired with 100% juice, which earns you one serving of fruit in just a 4 ounce portion. Low-fat yogurt topped with crunchy whole grain cereal String cheese and a small handful of whole grain crackers Homemade trail mix made with whole grain/high fiber cereal, nuts, and dried fruit A slice of whole grain toast topped with natural peanut butter and banana slices Hummus and cucumber slices wrapped in a whole wheat flour tortilla
For more information on the benefits of breakfast and delicious recipes featuring nutrient-dense 100% juice, please visit www.fruitjuicefacts.org
References: Affenito SG, Thompson DR, et al. Breakfast consumption by African-American and white adolescent girls correlates positively with calcium and fiber intake and negatively with body mass index. J Am Diet Assoc 2005;105:938-945. Albertson AM, Franko DL, et al. Longitudinal patterns of breakfast eating in black and white adolescent girls. Obesity 2007;15(9):2282-2292 Rampersaud et al, Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc. 2005 May;105(5):743-60 Wesnes et al, Breakfast reduces declines in attention and memory over the morning in schoolchildren. Appetite, Volume 41, Issue 3, December 2003, 329-331 Wyatt H et al. Long-term weight loss and breakfast in subjects in the national weight control registry. Obes Res 2002;10:7882
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features
20 Best Breakfasts From Around the World
Theres much to learn from other countries when serving this most important meal. See what other dietitians have to share.
departments
4 8 Presidents Spot Reader Feedback
10 Ask the Expert 12 Childrens Health 14 Allergy & Intolerance Awareness 16 Research Briefs 18 Focus on Fitness 46 Dynamics of Diabetes 48 For Your Information 50 Crossword Puzzle 52 Bookshelf 54 Personal Computing 64 Culinary Corner 66 Get to Know
rooted in African traditions may be the path to optimal health for African Americans.
32 O ptimize Whole-Body Nutrition for Healthful Aging Professionals say a nutrient-dense diet plus
physical activity will help clients stay younger longer.
Evidence shows antioxidant-rich herbs and spices may cut chronic disease risk.
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READER FEEDBACK
Dear Editor,
January 2012
Vol. 14 No. 1
The January issue was very nice. The Get to Know column [featuring Marion Nestle] was cool. Also, I really liked your article Providing Optimal Diabetes Care to the LGBT Community. When the magazine can find a way to look at a subject like diabetes and offer a new viewpoint that really rocks!
Mood Disorders
Conference Issue
ASPEN
Providing Enteral Nutrition for Esophageal Cancer Patients How Will the Name Changes of the ADA and DMA Impact Dietetics? Offer Culturally Sensitive Diabetes Care to the LGBT Community
www.TodaysDietitian.com
Dear Editor, The article Providing Optimal Diabetes Care to the LGBT Community in your January issue implied that dietitians should become an avenue to promote widespread acceptance of the LGBT community. I feel that this is in poor taste. It shouldnt be my responsibility as a registered dietitian to carry LGBT materials in my office any more than it would be appropriate to display magazines and other literature on Christianity, Judaism, or Islamic Sharia Law! I dont need to know someones sexual preference to help him or her control their diabetes any more than Id need to know whether someone is a Democrat or Republican. They either wish to improve their health or they do not. The choice of ones sexual partner shouldnt enter the equation. The article reports that somehow the LGBT population experiences health issues and lifestyle choices more challenging than the rest of the population. This is ludicrous as well as demeaning to both the LGBT population and ones intelligence. Many peopleLGBT or notstruggle with emotional issues that may lead an individual to participate in unhealthy behaviors.
Donna Dodge, RD, LDN Denmark, Maine
patients often suffer from greater health disparities than the general population as well as unique emotional stressors, so theyd be better equipped to improve patient care in this vulnerable population. We felt it necessary to report on some of the studies that have examined the healthcare disparities inherent in the LGBT community. Many in the healthcare profession who are doing the research and working in the trenches caring for this subpopulation are well aware of the problems and are trying to remedy them. It might be a good idea to listen to the video To Treat Me, You Have to Know Who I Am on YouTube.com. Youll hear firsthand what these patients experience and the opinions of the doctors and healthcare practitioners who are caring for them. Its a profound eye opener that can only move one toward compassion and action to improve patient outcomes among LGBT diabetes patients.
Judith Riddle, editor
Dear Ms. Dodge, Thank you for your response to the article Providing Optimal Diabetes Care to the LGBT Community. We wrote the article to present a side of diabetes care that isnt voiced often and because many nutrition professionals and other healthcare practitioners believe members of the LGBT community have special healthcare needs, and that theyve been treated unfairly and at times with great hostility in the healthcare system as a result of their sexual orientation. Like many in the healthcare profession, we wanted our readers to know that LGBT diabetes
PROTEIN POWDERS
By Toby Amidor, MS, RD, CDN
Q: A:
Many of my clients purchase protein powders. What are the main types available and the guidelines for recommending them? There are several varieties of protein powders, including those derived from milk, soy, eggs, and rice. Before recommending any protein supplement, however, its important to determine if your client really needs one.
protein per ounce, while hemp provides 12 g. Rice, pea, and hemp (plant-based protein powders) have essential amino acids added and are good alternatives for those with allergies or clients who follow a vegetarian or vegan diet.
Protein Recommendations
The Recommended Dietary Allowance for protein is 0.8 g/kg of body weight (or 0.36 g/lb of body weight). On average, this amounts to 56 g/day for men and 46 g/ day for women aged 19 and older. Most individuals can obtain this amount of protein from diet alone and dont require protein supplements. Typically, protein supplements arent needed for clients who exercise a few times per week for an hour or less. If clients insist on using a protein supplement, calculate their protein needs and compare them to how much theyre currently getting to ensure they achieve a proper balance between food and supplement use. Clients also should understand that protein powders are neither inferior nor superior to protein derived from food, but theyre pricey and lack certain nutrients found in whole foods.
The Types
Dairy Based
Both casein and whey protein powder supplements are derived from milk. Casein is a milk protein isolate known as caseinate that provides 22 g of protein per ounce and takes longer to digest than whey. A 2011 study in the American Journal of Clinical Nutrition found casein supplementation didnt stimulate postprandial muscle protein accretion as effectively as whey.1 However, a 2007 study in Amino Acids found the combination of both casein and whey to be more effective in improving body composition and muscle strength.2 Whey protein is the most common protein powder sold. Its more easily absorbed and helps build and maintain muscles. Its found in concentrate or isolate form. Whey protein concentrates are less expensive and contain between 30% and 85% protein, while whey protein isolates contain at least 90% protein and provide 24 g per ounce. The isolate form is more easily absorbed but is typically more expensive. Since casein and whey protein are derived from milk, dont recommend them to clients who are lactose intolerant or have milk allergies.
Cautions
Protein powders shouldnt contain added vitamins, minerals, and herbal supplements because they can interact with various medications, including antibiotics, levodopa used in Parkinsons disease, and alendronate used to treat osteoporosis. In addition, synthetic amino acids sometimes are added to protein powders. Scientific evidence is inconclusive as to whether adding more amino acids to protein powder formulations is better. Consuming too much protein can lead to dehydration and is contraindicated in those with renal issues. Side effects of large doses include nausea, thirst, cramps, bloating, headache, and upset stomach.
Toby Amidor, MS, RD, CDN, is founder of Toby Amidor Nutrition, a nutrition expert for FoodNetwork.com, and a nutrition advisor for Sears FitStudio.
Soy Based
This protein is derived from soy flour and is appropriate for those with allergies or who follow a vegetarian or vegan diet. Its available as an isolate or concentrate; the isolate form is purer and more expensive and provides 15 g of protein per ounce. Studies have shown that soy protein helps lower LDL cholesterol.3 Clients may voice concern about the hormonelike compounds found in soy; however, studies have determined that up to 60 g of soy protein per day is safe.
For references, view this article on our website at www.TodaysDietitian.com. Have questions about nutrition trends, patient care, and other dietetics issues youd like to ask our expert? Send your questions to Ask the Expert at TDeditor@gvpub.com or send a tweet to @tobyamidor.
Additional Varieties
Other protein powders from eggs, rice, peas, or hemp are available. Egg protein is derived from egg whites, is free of both fat and cholesterol, and is easily absorbed. It contains 21 g of protein per ounce. Rice protein is derived from brown rice and contains 18 g of protein per ounce. Pea protein contains 20 g of
0.25g
0.44g
0.49g
0.90g
0.67g
1.09g
0.94g
0.99g
1.38g
0.58g
1.25g
0.58g
1.12g
0.77g
1.17g
0.61g
1.45g
1.36g
1.02g
1.31g
0.44g
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0.67g
0.47g
1.51g
0.98g
1.37g
0.92g
0.15g
Betty W. Li, Karen W. Andrews, Pamela R. Pehrsson, Individual Sugars, Soluble, and Insoluble Dietary Fiber Contents of 70 High Consumption Foods, Journal of Food Composition and Analysis, Volume 15, Issue 6, December 2002, Pages 715-723, ISSN 0889-1575, 10.1006/jfca.2002.1096.
CHILDRENS HEALTH
Heres What RDs Must Know About the New Cholesterol Screening Guidelines
Groundbreaking new guidelines written in late 2011 by an expert panel sponsored by the National Heart, Lung, and Blood Institute are requiring all children between the ages of 9 and 11 to get cholesterol screenings, a test once reserved only for kids and teens at high risk of heart disease.1 As family doctors and pediatricians across the nation begin widespread screenings of young patients, RDs can expect to counsel more families coping with a long-overlooked heart truth, says Karen Ansel, MS, RD, CDN, a spokesperson for the Academy of Nutrition and Dietetics (the Academy). Childrens heart health is not on most parents radar screens, but it should be, says Ansel, a Long Island, New York-based RD and coauthor of Healthy in a Hurry: Simple, Wholesome Recipes for Every Meal of the Day. Even though heart disease may not be apparent until middle or old age, it develops over a lifetime. What children eat and do now has a definite impact. The new guidelines are endorsed by the American Academy of Pediatrics (AAP) and strongly recommend that doctors refer children and teens with high cholesteroland their familiesto an RD for medical nutrition therapy. RDs can play a vital role in reversing this serious heart disease risk factor, says Bethany Thayer, MS, RD, director of Wellness Programs & Strategies at the Henry Ford Health Systems Center for Health Promotion and Disease Prevention in Detroit and a spokesperson for the Academy. Very few kids will ever be prescribed cholesterol-lowering drugs, she says. The first line of prevention for all families and all kids includes healthful eating, daily activity, and helping kids achieve or maintain a healthful weight. RDs are the healthcare professionals who can help parents and caregivers adapt these strategies to work in their own lives.
and carrots, also help lower cholesterol by forming a gel in the intestines that traps cholesterol-rich bile acids and removes them from the body with waste products, she says. 2. Nix the sugary drinks and encourage low-fat or fat-free milk or water instead. Up to 30% of some teens daily calories come from sugar-sweetened soda and other drinks.6 This raises the risk of obesity, which increases the odds of kids developing high cholesterol, according to the AAP report. Milk contains calcium, potassium, and magnesium, which help control blood pressure and lower the risk of diabetesboth potent heart disease risk factors. [Suggest kids] aim for 2 to 4 cups of milk per day, Thayer says. 3. Go for whole grains. Oatmeal and barley contain soluble fiber that helps sweep cholesterol from the body, Ansel says. The AAP recommends breakfast cereals enriched with the soluble fiber psyllium at a dose of 6 g/day for kids younger than age 13 and 12 g/day for teens. 4. Balance the fat. Kids with high cholesterol dont need a low-fat diet. The AAP recommends they get 25% to 30% of their daily calories from fat while keeping saturated fat to a low 7% of daily calories and limiting dietary cholesterol to 200 mg/day. Counsel families to avoid artery-clogging trans fats. [Have them] choose more plant-based fats such as avocados, nuts, canola oil, olive oil, and fewer animal fats, such as butter, red meat, cream cheese, and full-fat cheese, Ansel suggests.
5. Aim for one hour a day of exerciseand no more than two hours of screen time. Kids need plenty of physical activity plus everyday movement to stay healthy and avoid overweight, Thayer says. We encourage families to limit computer, video games, and TV to two hours per day maximum. 6. Focus on healthful living instead of weight loss. Most children who are overweight can grow into their weight through a healthful diet and exerciseweighing and measuring or trying to restrict food can backfire, Thayer warns. RDs should work closely with a family and the childs doctor about weight goals. 7. Suggest families get healthier together. Singling out a child can embarrass or shame them, Thayer says. When a child has high cholesterol, its smart for the whole family to adopt a healthier lifestyle. Kids learn from what their parents do. And often parents come back to me thrilled because their own cholesterol numbers have improved, too. Everybody wins.
Sari Harrar is an award-winning freelance writer specializing in health, medicine, and science.
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Anne Eglash, MD, a family physician, clinical professor at the University of Wisconsin School of Medicine and Public Health, and cofounder of the Academy of Breastfeeding Medicine, has treated many colicky infants in her practice and has concluded that they fall into two distinct groups. Some infants are like Dr Jekyll and Mr Hyde: They have crying episodes around the same time every evening, but theyre happy in between episodes. This type of excessive crying is caused by neurologic immaturity, Eglash says. If the baby is fussy all day and night, however, then something else is going on, such as abdominal pain. My son Matthew fell into the latter group. Right before his four-week checkup, I noticed a spot of bright-red blood in his diaper. The pediatrician suspected an anal fissure and recommended I soak him in warm baths. In the weeks that followed, the small, bright-red spots or streaks appeared in almost every stool, alone or encased in globs of mucus. While he was still growing well, the fussiness and crying worsened. Convinced that something was wrong, I took my son to a pediatric gastroenterologist. Based solely on my description of the symptoms of colic accompanied by blood and mucus in his stool, the gastroenterologist made an immediate diagnosis: an intolerance to cows milk and soy proteins. To my surprise, Matthews fussiness and excessive crying werent infantile colic; they were an adverse reaction to food, treatable with nutrition intervention.
Supporting Research
My story is not unique. Cows milk proteins are the most common cause of food intolerance in infants, with soy protein ranked second.2 A 1999 study by Tor Lindberg, MD, called Infantile Colic and Small Intestinal Function: A Nutritional Problem?, reported that approximately 25% of infantile colic is cows milk dependent. Numerous studies have shown that removing cows milk proteins from a colicky infants diet can cause a significant reduction in symptoms.3 Some of these infants have an immunoglobulin-E (IgE) mediated reaction commonly referred to as cows milk protein allergy (CMPA). Others may exhibit similar symptoms caused by nonIgE-mediated, mixed, or cellmediated reactions. In some studies, these reactions are called CMPA as well, while others use the term cows milk protein intolerance (CMPI). Iacono and colleagues concluded in a 1991 study published in the Journal of Pediatric Gastroenterology and Nutrition that a considerable percentage of the infants with severe colic also have CMPI and that in these cases, dietetic treatment should be the first therapeutic approach. Dietetic intervention is also the standard diagnostic procedure: eliminate
the suspected allergen from the diet and see if the condition improves. The diagnosis is confirmed if reintroducing the allergen causes the symptoms to return, but this challenge procedure isnt routine in colicky infants and should be done only under medical supervision at facilities equipped to handle serious allergic reactions.
of milk and soy proteins from her diet. Eglash also has had success with eliminating corn if the infant doesnt respond to the removal of milk and soy. Some studies have suggested eliminating other foods known to be highly reactive, such as nuts, wheat, eggs, and fish. Milk and soy proteins are added to a wide variety of processed foods, but current labeling laws require that manufacturers clearly identify any ingredients that contain protein derived from milk or soybeans as well as eggs, fish, shellfish, peanuts, tree nuts, and wheat. An infants condition often improves in as little as 72 hours, but two to four weeks is the recommended trial period. If the elimination diet works, the mother should continue this diet as long as shes breast-feeding, and, as previously mentioned, any offending food components must be excluded from the infants diet when introduced to solid foods.4 Many of the adverse food reactions responsible for excessive crying are temporary, and a challenge should be conducted under medical supervision around the first birthday to determine if the baby is still reactive. After my sons diagnosis, I continued to breast-feed, carefully avoiding foods with even trace amounts of milk or soy proteins. My sons behavior steadily improved as long as I adhered to the diet, and the appearance of blood in his stools gradually lessened. After two months on the elimination diet, all traces of blood in his stool were gone, and my sweet, happy baby was finally sleeping through the night.
Judith C. Thalheimer, RD, LDN, is a private practitioner based in Pennsylvania.
For references and additional resources, view this article on our website at www.TodaysDietitian.com.
RESEARCH BRIEFS
behaviors as a result of their diagnosis, treatment, and potential emotional reactions to their illness, Coups says. The information collected from this study will help us determine what interventions may be successful in helping patients in this population make healthy behavior changes. It could also serve as an intervention template for other cancers. Study participants will complete three surveys over a sixmonth period to document information such as beliefs about disease recurrence, current physical activity, and dietary intake. Researchers also will measure the influence of friends and family on the participants physical activity and eating habits.
SOURCE: CANCER INSTITUTE OF NEW JERSEY
FOCUS ON FITNESS
RESOURCES
DVDs Yoga: Just My Size with Megan Garcia HeavyWeight Yoga: Yoga for the Body You Have Today HeavyWeight Yoga 2: Change the Image of Yoga Yoga for the Rest of Us with Peggy Cappy Books Plus-Sized Yoga: Beginners Yoga for People of All Sizes MegaYoga Yoga for Fat Guys: From Lumpy to Limber in Just Six Weeks Big Yoga: A Simple Guide for Bigger Bodies
clients will require modifications in many poses. And while yoga instructors are trained to provide modifications for beginners and inflexible people, modifications for heavier individuals are different because of anatomy and range of movement limitations due to size rather than inflexibility. Nonetheless, the yoga community is evolving and classes such as Full Figure Yoga and Yoga for Real People are now emerging.5 These types of classes are best taught by instructors who are heavier themselves. If clients cant locate such classes, several instructional books and DVDs are available.
Jennifer Van Pelt, MA, is a certified groupfitness instructor and healthcare research analyst/consultant in the Reading, Pennsylvania, area. Shes trained in SilverSneakers YogaStretch and YogaFit for Seniors.
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References
1. Kristal AR, Littman AJ, Benitez D, White E. Yoga practice is associated with attenuated weight gain in healthy, middle-aged men and women. Altern Ther Health Med. 2005;11(4):28-33. 2. Lee JA, Kim JW, Kim DY. Effects of yoga exercise on serum adiponectin and metabolic syndrome factors in obese postmenopausal women. Menopause. 2011;Epub ahead of print. 3. McIver S, McGartland M, OHalloran P. Overeating is not about the food: women describe their experience of a yoga treatment program for binge eating. Qual Health Res. 2009;19(9):1234-1245. 4. Mody BS. Acute effects of Surya Namaskar on the cardiovascular & metabolic system. J Bodyw Mov Ther. 2011;15(3):343-347. 5. Eckel S. Striking a pose for girth. New York Times. May 13, 2009. http://www.nytimes.com/2009/05/14/health/ nutrition/14fitness.html?pagewanted=all
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ake a snapshot of the breakfast your client is about to enjoy and it may showcase different shades, textures, and ingredients, depending on what corner of the world theyre from. Theres no one picture of the perfect breakfast in terms of health, and meals will vary based on preferences within families, communities, and regions in a particular country. Yet most would agree that when comparing nutrient profiles of the morning meal among nations, the majority of breakfasts eaten in the United States arent likely to rank high on the list of healthfulness. I dont think we can give the title of healthiest breakfast to just one country or to a few countries because I think there are many definitions of a healthful breakfast, says Anne VanBeber, PhD, RD, LD, a professor and chair of the department of nutritional sciences at Texas Christian University. But I definitely have my thoughts on what countries have the healthiest traditional breakfasts, and the United States is not one of them. This isnt to say, however, that all Americans forsake nutrientrich fare for the nearest drive-thru. I do think there are people in the US who eat a very healthful breakfast, she adds. Unfortunately, its a subgroup and consists of people who are educated about nutrition and food. In VanBebers view, the more healthful versions of breakfast that clients enjoy in the United States can include whole grain breads with low-fat cheese or nut butter for a nutrient-dense carb with a good protein source or low-fat yogurt combined with fruit for a combination of protein, fat, and carbohydrate. Stepping outside this countrys borders can open up a whole new world of breakfast offerings. In this article, Todays Dietitian asked RDs with the knowledge of world cuisine whether through personal experience or researchfor their picks of countries that offer some of the more healthful breakfasts from around the globe as well as their thoughts on what Americans can learn from these regions and how they might incorporate these foods and traditions into their own morning meal, stateside.
Turkey
well-rounded macronutrient profile by including carbohydrate, protein, and fat. The cucumbers and tomatoes eaten at breakfast provide another opportunity for vegetables to be consumed. Olives provide a good source of heart-healthy monounsaturated fat. Honey has antimicrobial properties, and tea contains polyphenol compounds, particularly catechins, which are antioxidants. In addition to the nutrition-packed fare traditionally eaten in this country, Diker says Americans can learn from some of their other eating habits. For example, Turkish families make it a point to eat togethereven at breakfastwhereas the fastpaced routine of Americans makes it even difficult to get everyone at the dinner table a few nights a week. One thing that Turkey gets right is the importance of gathering the family together for meals, including breakfast, Diker says. Turkish families sit down to breakfast together, eat, and have a conversation as opposed to eating on the run. While this may be a stretch for many families in the United States, dietitians can suggest clients adopt a simpler habit to make their morning meal a bit healthier: eat more vegetables. Try including some vegetables at breakfast by simply slicing some tomatoes and cucumbers. Drizzle them with a little olive oil if desired, sprinkle with salt and pepper, and enjoy, Diker recommends.
Turkey
Ann Diker, PhD, RD, an assistant professor of nutrition and chair of the health professions department at Metropolitan State College of Denver, says Turkey is one country with breakfast traditions worthy of bragging rights. Diker, whose husband is from Turkey and who travels there regularly, says the healthfulness of the traditional Turkish breakfast stems from its inclusion of vegetables, olives, honey, and tea. A typical Turkish breakfast will include cucumbers, tomatoes, olives, feta cheese, honey or jam, French bread, and tea, with eggs or sucuk (spicy lamb sausage) thrown in a few times per week, Diker says. There are many aspects of a Turkish breakfast that are healthful, Diker explains. The meal as a whole provides a
Israel
Although Brigitte Kochavi, RD, now calls Israel her home, she was born and spent her early years in France. When comparing the different breakfast traditions of Europe and the Middle East, Israel comes out ahead for healthfulness, says Kochavi, whos head of pediatric clinical dietitians for Edmond and Lilly Safra Childrens Hospital at Sheba Medical Center in Ramat Gan, Israel. The most healthful breakfast foods are located in the countries around the Mediterranean Sea like Israel, Cyprus, and Greece, says Kochavi, whos also the Israel country representation for the American Overseas Dietetic Association (AODA).
Costa Rica
When asked what she thinks Americans can learn from Israels breakfasts, she suggests taking note of kosher traditions and swapping fish for meat for the first protein source of the day. Instead of meat or bacon, eat fish or egg, which are also good sources of protein, she says.
Costa Rica
Malena Perdomo, MS, RD, CDE, an adjunct professor at Metropolitan State College of Denver, proclaims Costa Rica as a country with breakfast benefits engrained in its culture. Costa Rica loves the dish gallo pinto for breakfast, which is rice and black beans and eggs on the side, she says. This breakfast will last for several hours, and you will be able to work nonstop until lunchtime, she says, noting that many people in this country do just that. This countrys breakfast is also high in fiber, another reason for its healthfulness. [People living in Costa Rica] arent eating sweet rolls or sweets for breakfast. Instead, theyre eating protein, fiber, and complex carbohydrates, with most enjoying fresh fruit or a small glass of fresh fruit juice to round out the meal. Patricia H. Terry, PhD, RD, LD, a professor and director of the didactic program in dietetics at Samford University, who has traveled extensively and who currently is teaching a class in Costa Rica, also believes the country has much to teach about breakfast. Terry explains that the Nicoya Peninsula of Costa Rica is one of the Blue Zones, which are parts of the world that have been studied due to their populations living measurably longer on average compared with other countries. She says the typical Costa Rican breakfast includes lots of pineapples, oranges, mango, papaya, corn, beans, rice, squash of all kinds, fresh cheese, and eggsfoods likely to be foreign to Americans at breakfast time. Fish, vegetables, soup, and nuts for breakfast? Yes, and much more, Terry says. Why? Because its not what foods you eat for breakfast but the nutrients in those foods that are important, she says, adding that this is one habit Americans might do well to adopt to improve their lifestyle. While Perdomo says slowing down to enjoy a regular breakfast is one way to incorporate Costa Rican traditions into Americans lives, her suggestion for using last nights leftovers could
Israel
The Mediterranean diet emphasizes foods rich in omega-3 fatty acids, including whole grains, fresh fruits and vegetables, fish, olive oil, and garlic consumption. Referring to the traditional Israeli breakfast as healthful, natural, and simple, Kochavi says its almost impossible to find meat on any breakfast plate in Israel, partly due to Kosher laws that require dairy and meat products be kept separate. Instead, Kochavi says many people choose to eat fish such as herring, smoked salmon, or mackerel, adding some healthful omega-3s into the diet first thing in the morning. The typical Israeli breakfast usually consists of the Salat Katzutz, or chopped vegetable salad, Kochavi explains. This meal generally includes tomatoes, red onion, parsley, cilantro, and seedless, crunchy cucumbers, with red or green peppers on occasion. All ingredients are finely chopped. Unlike most salads in the United States, Salat Katzutz is served without salad dressing, nixing the added calories customary of most American salads. Cheese is usually a part of ones breakfast in Israel, either Tsfatit, which is white cows milk cheese named for the Israeli city of Tsfat, or cottage cheese, Kochavi says. Other traditional breakfast foods include yogurt, hummus and tahini with olive oil, pita or fresh bread, and hard-boiled eggs, olives, avocado, and fresh juices. The Israeli breakfast is low in saturated fat and high in monounsaturated fat and dietary fiber, Kochavi says.
be more feasible for time-crunched families. For example, the Costa Rican breakfast of rice and black beans are made with leftover rice and beans. We can be reminded of how to throw less food away and use everything that we cook and eat it for breakfast, she says.
China
Margaret Keefe, RD, chief representative for Eat Well Shanghai in China and a country representation for the AODA, says Asian and European countries tend to have a leg up on healthful breakfast habits. Having lived in Shanghai for 15 years, Keefe says, Both of these regions tend to have an equal balance of protein and carbohydrates in the morning meal and dont traditionally have sweet foods for breakfast. Keefe is coauthor of the Eat Well China app, a nutrition/travel app for smartphones and the iPad, which has a whole section devoted to the healthful aspects of the Eastern diet. She says a typical Chinese breakfast might consist of a dumpling or bun filled with vegetables or meat, along with a cup of soymilk tea, or a soupy rice porridge called congee. Keefe says both of these breakfast choices are low in fat and sugar and allow for an early opportunity to incorporate vegetables into the daily diet. A favorite street-side breakfast food is a jian bing, Keefe says. Jian bing, considered a popular option with nutrientdense properties, consists of a very thin, crepelike pancake cooked on a hot drum. The pancake is covered with green onions, a spicy chili/bean paste, and then topped with an egg. Once the egg cooks, the pancake is rolled up, sliced in half, and served hot to the waiting customer. While she says this option isnt necessarily low calorie, its hearty qualities keep you going until lunch. Its an excellent combination of carbohydrate and proteinpancake and egg with a healthful dose of green onion and a bit of fiber from the spicy chili/bean paste. For Americans looking to behave more like the Chinese at breakfast time, Keefe advises stepping away from the assumption that breakfast equals sweetness. I think Americans need to try having vegetables for breakfast and incorporating different kinds of protein in their morning meal, Keefe says. Also we could benefit from giving up the idea that breakfast foods should be sweet. For an American-style jian bing, take a crepe and fill it with a fried egg, green onions, and chili sauce, then wrap it all together and youre good to go, she suggests. Keefe says congee, Chinese rice, could be made healthier by using brown rice and adding dried fruits as well, noting that congee is great for those short on time, as it can be easily made in a slow cooker.
has been a good source of nutrients as well as fiber when its been used from scratch to make bread, tortillas, or arepas, says Marianella Herrera, MD, MSc, an assistant professor at the Universidad Central de Venezuela, president of the Venezuelan Scientific Society for Obesity, and Venezuela country representative for the AODA. A Venezuelan breakfast often includes baked corn flour bread called arepas, which are filled with cheese, fish, beef, or chicken, or eaten as a side with shredded beef, black beans,
Ingredients
1 gallon whole milk (preferably from grass-fed cows) 1 pinch salt 1 large lemon, juiced
Directions
1. Pour the milk into a large pot and stir in a pinch of salt. Bring to a boil over medium heat, stirring occasionally to prevent the milk from scorching on the bottom of the pot. 2. When the milk begins to boil (small bubbles will first appear at the edges), turn off the heat. Stir lemon juice into the milk, and the milk will curdle. You may need to wait 5 or 10 minutes. 3. Line a sieve or colander with a cheesecloth and pour the milk through the cloth to catch the curds. What is left in the cheesecloth is the Farmers Cheese. The liquid is the whey. 4. Gather the cloth around the cheese, and squeeze out as much of the whey as you can. 5. Wrap in plastic, or place in an airtight container. Store in the refrigerator.
RECIPE PROVIDED BY PATRICIA H. TERRY, PHD, RD, LD
Venezuela
In Venezuela, as well as in other Latin American countries such as Colombia, Ecuador, and Per, the high consumption of corn is a big part of what gives this cuisine high marks. [Corn]
white cheese, avocados, and/or fresh fruit juices. So we have good sources of protein, carbohydrates, dairy, fruit, and fiber, Herrera says. She notes that arepas offer a great gluten-free fiber source, with avocados providing beneficial polyunsaturated fatty acids. Typical fillings of shredded beef and chicken are good sources of protein, with shredded fish offering some extra omega-3s and phosphorus. Black beans, also a mainstay of this countrys breakfasts, contain flavonoids, fiber, and folic acid, and the white cheese typically eaten with this meal is a great source of calcium. To round out the meal, Venezuelans enjoy fresh fruit juices such as papaya, mango, watermelon, orange, tangerine, cantaloupe, or pineapple, all of which add their own array of vitamins. Herrera suggests RDs discuss the benefits of fresh fruit juices with clients looking to adopt a Venezuelan breakfast tradition, noting that fresh fruit juices (emphasis on fresh) can provide a great way to obtain ones daily fruit requirements while avoiding the added sugar from premade juices.
Arepas
Serves 6
Ingredients
2 cups of precooked corn flour 2 cups of warm water Pinch of salt 1 T of canola oil
Directions
1. In a bowl, combine salt and flour, then add the water and oil and stir all the ingredients until homogeneous. Work the mixture by hand until smooth. 2. Divide dough into pieces (12 to 20 for small, six to 10 for medium), based on the preferred size of arepas. Shape each piece into a small ball, then work the balls until they are in the shape of a disc. Put the arepas in a hot pan previously sprayed with oil and let them cook at medium temperature, flipping once, for 6 to 8 minutes, or until firm. Arepas should be slightly golden and crispy on the outside and smooth inside. 3. For children, you may use carrot juice or spinach juice to add colors to arepas. 4. Fill them with cheese, ham, turkey, beef, etc.
RECIPE PROVIDED BY MARIANELLA HERRERA, MD, MSC
Vietnam
According to VanBeber, who has extensive travel experience and teaches a food and culture course at Texas Christian University, some of the healthiest breakfast habits lie in southeast Asia. The southeast Asian countries, including Vietnam, Cambodia, Laos, and Thailand, consume healthful breakfasts that include a bowl of noodles, she says. VanBeber explains that the traditional soup of Vietnam, pho, is broth based and includes rice noodles as the base, with a condiment of protein such as chicken, meatballs, beef, or pork as well as a plethora of vegetables and herbs, including basil, cilantro, bean sprouts, carrots, cucumber, and lime. All breakfasts should include a source of protein, carbohydrate, and a small amount of fat, she says. This breakfast of pho includes these three energy nutrients in a delicious, lowcalorie, low-fat way. Dina Aronson, MS, RD, part of the advisory counsel for FitOrbit, whose global breakfast knowledge is based primarily on her education and research, also says Asian countries tend to have breakfasts healthier than most. Their breakfasts almost invariably include vegetables, while sweetsif they make an appearance at allplay only an accompanying role, she says. Clients who are open to eating noodles for breakfast can plan this by making extra for dinner the night before, VanBeber says. Dont be afraid to eat foods for breakfast that we might consider lunch or dinner foods. These foods often have a better combination of protein, carbohydrate, and fat than the common breakfast, which consists of processed cereal, she adds. Aronson agrees, noting that it might help RDs to tell clients that its OK to see food as just foodnot breakfast vs. nonbreakfast foods. She says that people in Vietnam eat the same foods in the morning as those eaten for later meals. Since their
cuisine is so vegetable heavy, this means that veggies play a starring role in their meals several times a day as opposed to just onceat dinneras is common for so many Americans. Whether its cooking noodles the night before or simply slowing down to eat and enjoy the 7 am eating routine, Aronson says the most important message to take away from exploring other cultures traditions is that a healthful breakfast is possible for everyoneand whatever healthful habit clients are willing to adopt is the best one. I think that while health is a priority, its also important to examine and stay true to social, cultural, and dietary preferences, Aronson says. Some of us might embrace a major change, while others may not welcome the morning with a big bowl of noodles and vegetables floating in beef broth with a side of fish sauce, she says. But there are so many ways to do it right. We can take basic healthful breakfast tenetshigh fiber, high water, and whole plantsand create our own delectable delights, whether a fruit smoothie, hot whole grain cereal with nuts and fruit, a hearty soup, or a veggie-packed omelette.
Juliann Schaeffer is an associate editor at Great Valley Publishing Company and a frequent contributor to Todays Dietitian.
9 10
out of
Convenience
Lower BMIs
Breakfast cereal eaters have been found to have lower BMIs. Research suggests that breakfast consumption, and specifically ready-to-eat cereal, has a positive relationship to healthy body weights and improved diet quality for adolescents.3
Nine out of ten moms agree that cereal is a convenient breakfast choice. Readyto-eat cereal gives them an easy way to give their families the nutritious start they need.1
Fiber
One of the most beneficial nutrients in cereal grains is fiber, and Kellogg has been an advocate of higher fiber diets since introducing Bran Flakes, the first high-fiber cereal, in 1915.
Ninety-five percent of ready-to-eat cereal is eaten with milk, making breakfast cereal an important driver for milk intake.4
95%
Sugar
Dairy
Sodium
3%
Cereal contributes just three percent of the total sodium in the US diet.2
Cereal contributes just four percent of daily added sugar intake in the US diet.5
4%
Obtaining Health
Through
A Diet Rooted in African Traditions May Be the Path to Optimal Health for African Americans
By Constance Brown-Riggs, MSEd, RD, CDE, CDN
Heritage
s obesity and chronic disease soar in many cultures around the world, African Americans seem to be the hardest hit. Black women have the highest rates of obesity compared with other ethnic groups in the United States. Specifically, about four of five African American women are categorized as overweight or obese.1 Along with the weight disparity come health disparities: Black adults are twice as likely as white adults to have a stroke,2 twice as likely to be diagnosed with diabetes,3 and 1.5 times as likely to have high blood pressure.4 African Americans not only experience higher prevalence rates of these health problems, but theyre also more likely to die from them. For example, black Americans are 2.3 times as likely to die from diabetes complications.3 And although black women are 10% less likely to be diagnosed with breast cancer, theyre almost 40% more likely to die from the disease.5
who eat traditional foods from Africa are healthier than those who adopt a typical Western diet, the research suggests that a healthful African American diet should go back to its roots. To help develop a cultural model for healthful eating based on the traditional diets of the African diaspora, Oldways brought together a team of culinary historians, nutrition scientists, and public health experts to examine foods Africans ate in Africa as well as how they adapted their diet when they were brought to the Americas during the slave trade.
Healthful Heritage
Culinary historian and cookbook author Jessica Harris says the traditional African diet is largely vegetarian. There wasnt a lot of animal protein, she says. Dried or smoked fish was found in riverine or ocean areas, and wild game was used as a seasoning unless there was some degree of feasting or festivity. Across Africa, a variety of whole grains and starchy vegetables serve as the base for meals. Millet and sorghum are found in the area around Mali; rice in Senegal, Guinea, Liberia, and Sierra Leone. Further south in Ghana and the Ivory Coast you find yams, Harris says.
The Transatlantic Slave Trade was one of the major ways the food of Africa showed up in various inflections on the plate throughout the diaspora, says Harris, also a member of Oldways advisory board. Enslaved Africans in the Americas cooked and ate in ways that were familiar to them, making doand often making magicwith ingredients they found around them. In the southern United States, they were given some provisions such as cornmeal, beans, or a bit of pork, but Harris says, They had to supplement their diet with foraging or growing their own food. Cabbage, okra, tomatoes, peppers, and a variety of greens were abundant, so they were added to the pot. Because of the climate in the Caribbean, they had more opportunity to grow things that were closer to Africa, like yams, Harris continues. The Caribbean diet included tropical fruits like papaya and guava as well as rice and pigeon peas. In South America, tubers such as yucca and cassava as well as okra, peanuts, and plantains were part of the plate.8 The result: a varied culinary legacy based on African retentions and the creative resourcefulness of Africans replanted in the Americasall of which is reflected in the African Heritage Diet Pyramid that Oldways and its advisory team of experts introduced in November 2011. Baer-Sinnott describes the pyramid as an evidence-based practical tool designed to help African Americans reframe their daily diets based on the healthful eating patterns of their ancestors. As in other pyramids, the African Heritage Diet Pyramid illustrates which foods should be eaten in abundance and those that should be eaten less frequently. Based on staples from the African diaspora, the African Heritage Diet promotes beans and peas, whole grains, fruits, peanuts and nuts, vegetables, and tubers. Because of their nutritional benefit and overwhelming appearance throughout the diaspora, greens have been placed in a category all their own. The pyramid suggests fish and seafood be added to the plate at least two times per week as a rich source of omega-3 fatty acids that can help lower blood pressure and protect against heart disease. Like other traditional heritage diets, this pyramid suggest that eggs, poultry, and other meats be eaten in small portions or used to garnish other dishes. Herbs and spices also are given a prominent position in the pyramid to promote the use of homemade sauces and to boost flavor without adding salt. Healthful oils and dairy also are encouraged in small quantities, and sweets top the pyramid as foods to eat only occasionally.
The result is a plant-based diet low in unhealthful fats, sugars, and sodium; high in nutrient-dense whole foods; and robust in flavor. It naturally mirrors medical recommendations such as the 2010 Dietary Guidelines while fully embracing African-based food ways that are centuries old.
Ingredients
2 T olive oil 2 medium-size onions, finely chopped 2 large red or green bell peppers, finely diced 6 large garlic cloves, minced 1 (28-oz) can crushed tomatoes, using the liquid 4 cups vegetable broth 1 2 tsp pepper 1 2 tsp chili powder 2 3 cup extra crunchy peanut butter 1 T fresh cilantro
Directions
1. Heat olive oil in a large pot over medium heat. Cook onions and bell peppers until lightly browned and tender, adding in garlic when almost done to keep the garlic from burning. 2. Stir in tomatoes and their liquid, vegetable broth, pepper, and chili powder. 3. Reduce heat to low, uncover, and simmer for 15 minutes. 4. Stir in peanut butter and cilantro until well blended, and serve.
RTE SY O
F OL D W AYS
Ingredients
Four 12 -inch fillets of any whitefish, like cod 2 garlic cloves, minced 2 lemons or 4 T of lemon juice A pinch of salt and black pepper (to taste) 2 onions, finely sliced 1 small green bell pepper, seeded and sliced into strips 2 tomatoes, diced 1 tsp coriander 1 T tomato paste 1 3 cup of olive oil 3 4 cup of light coconut milk
Ingredients
2 to 3 T of olive oil 5 T fresh cilantro, finely chopped 3 T fresh lime juice 112 tsp grated lime peel 2 pinches of salt, divided 2 pinches of pepper, divided 1 large mango, peeled, cut into thick wedges 4 5- to 6-oz red snapper fillets 1 tsp of cumin seeds 1 lb green beans 2 red bell peppers, cut into slices 8 large red-leaf lettuce leaves
Directions
1. Rinse the fish and place it in a bowl with garlic, lemon juice, salt, and pepper. Let the fish marinate while you prep everything else. 2. Place the oil in a pan and saut the onions, green pepper, tomatoes, coriander, and tomato paste. When the onions are translucent, bring the sauce to a boil and add the fish fillets and the marinade. Lower the heat to medium and cook for 5 to 8 minutes. When the fish is almost done (about 5 minutes), add the coconut milk and bring the mixture to one last boil for a minute or so. 3. Serve hot, alone or over brown rice, with a watercress salad. Shellfish can be substituted for whitefish.
Directions
1. Stir the oil, cilantro, lime juice, and lime peel in small bowl to make the vinaigrette. Add pinches of salt and pepper. 2. With half of the vinaigrette, cover all sides of the mango slices first and fish fillets second, saving the rest to drizzle on after theyre cooked. 3. Sprinkle fish and mango with the rest of the salt and pepper and cumin seeds. Grill or broil fish on one side, turning them over after about 6 minutes, when the fish centers look cooked-through and the mango is soft and beginning to brown.
to the pot and bring to a boil. Lower heat to simmer, and add the cayenne and black pepper. Cook for 45 minutes, covered, adding water as needed.
Calories: 177; Protein: 7 g; Carbohydrate: 28 g; Fiber: 5 g; Total Fat: 5 g; Saturated Fat: 0.7 g; Trans Fat 0 g; Cholesterol: 0 mg; Sodium: 600 mg
RESOURCES
Oldways has many resources available for RDs about the African Heritage Diet Pyramid, including the following: African Heritage 101 brochure African Heritage Diet Pyramid poster Grocery list Setting Up an African Heritage Kitchen guide Recipes for the 12 Plates of Expression Diaspora food glossary Visit www.oldwayspt.org for more information.
Directions
1. Soak the black-eyed peas. (Its best to soak the peas for 6 to 8 hours before cooking.) In the morning, carefully comb through the black-eyed peas with your hands (for any small stones or bad peas) and rinse them thoroughly in a bowl. Cover them with water and let sit for the day. Drain the water from the peas. 2. In a deep sauce pot, saut onion and garlic in olive oil for 1 to 3 minutes, until translucent (do not brown). 3. Add peas, salt, brown rice, and 312 cups of fresh water
www.bobsredmill.com/td 1.800.349.2173
Winner of the 16th Annual Golden Spurtle World Porridge Making Championship.
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Healthful
Agng
Experts Say a Nutrient-Dense Diet Plus Physical Activity Will Help Clients Stay Younger Longer
By Lindsey Getz
aintaining healthful eating habits becomes increasingly important as clients from the baby boom generation continue to age. This puts even greater emphasis on your role as dietitians to educate them about the foods they should be eating for optimal health and wellness. Eating right and staying fit are important no matter what your patients age, but as we get older our bodies do have special needs, says Vandana Sheth, RD, CDE, a nutrition educator and a spokesperson for the Academy of Nutrition and Dietetics (the Academy). As clients age, many will become deficient in calcium, vitamin D, and vitamin B12, so it will be important for RDs to recommend these clients get their blood levels tested so they can begin eating the right foods to boost their intake of these nutrients. Potassium-rich foods such as bananas, apricots, carrots, mushrooms, and sweet potatoes as well as heart-healthy omega-3 fats found in salmon, albacore tuna, walnuts, and flaxseed also are needed as clients grow older, Sheth says. Each nutrient plays a key role in different systems, but overall its important that older adults are eating a healthful and balanced diet with some variety. Whats more, as people get older, energy needs decrease. This makes it more challenging for them to achieve proper nutrition because they should be eating fewer calories. Its important that the calories coming in are more nutrient dense so that all of the nutrients are being obtained in a smaller number of calories, Sheth says. With these facts in mind, Todays Dietitian spoke to several RDs about the key areas of health to pay attention to as clients age and how diet can play a vital role.
health. Its believed that some age-related eye diseases may be slowed or even prevented with the right nutrients. Still, eye health doesnt always get much attention. The primary focus tends to be on heart disease when it comes to aging and thats certainly important, says Joan Salge Blake, MS, RD, LDN, a nutrition educator, clinical associate professor at Boston University, and spokesperson for the Academy. But eye health is something to think about. Once you lose your vision, it affects your entire lifestyle. According to the Centers for Disease Control and Prevention, approximately 2 million people suffer from AMD, which is the leading cause of blindness, and another 7 million boomers are at risk. Educate your clients about the facts as well as the foods they can incorporate into their diet. Omega-3 fatty acids can help protect against the inflammation [associated with AMD] that can damage eyes, so people should incorporate two fatty fish meals on a weekly basis, Blake says. We also know that lutein and zeaxanthin are wonderful for eye health. They can potentially reduce the risk of both cataracts and AMD. Foods that contain these two carotenoids include spinach, kale, collards, broccoli, and orange juice.
Heart Health
Because heart disease is the leading cause of death in the United States, many Americans already are clued in to the importance of eating a heart-healthy diet but that doesnt mean theyre following through. As adults age, some education on which fats to include in the diet and which ones to limit is important. Get to know your fats, Sheth says. Remind clients to avoid saturated and trans fats and to instead opt for omega-3 fatty foods like salmon, flaxseed, or walnuts. Advise clients to avoid products such as butter, lard, and shortening when cooking. Suggest they switch to olive or canola oilor a margarine thats at least free of trans fats. Clients also should be advised to switch to low- or fat-free foods and to incorporate more fruits and vegetables into their diet.
Sharp Vision
Eye health is a big concern for aging adults. Even the normal aging process can bring on changes that impact eyesight. On top of that, the chance of developing eye conditions and diseases such as cataracts and age-related macular degeneration (AMD) increases with age. Fortunately, scientists have established a link between good nutrition and eye
Healthy Skin
Because skin doesnt produce or retain moisture as well when it ages, dry and itchy skin tends to become a common problem among older adults. Simply staying better hydrated can make a difference, says Dee Sandquist, MS, RD, LD, CDE, of Sandquist Consulting whos a spokesperson for the Academy. Its really important to drink plenty of water, she adds. You can count other fluids toward hydration but its always best to opt for water. Beta-carotene can help boost skin health by keeping it vibrant and helping reduce damage, Sheth says. An easy way to get more beta-carotene is through vegetables like sweet potatoes, carrots, and spinach, she says.
Vitamin A is also important, Sandquist adds, and clients should look for low-fat dairy products. Antioxidants found in berries like blueberries and strawberries may benefit the appearance of skin as well as foods containing fatty acids such as salmon, walnuts, and flaxseed.
Cognitive Health
Maintaining mental health is of great concern for those aged 50 and older and another area in which nutrition can play a vital role. Its common to become forgetful as we age, so its important to incorporate fruits and vegetables rich in flavonoids in the diet, as theres evidence they can aid memory, Sheth says.
Research has shown that berries can have a major impact on the diseases of aging, and its not just the exotic variety. In a study published in Pharmaceutical Research, researchers found that even the more readily available and affordable berries such as blueberries, strawberries, and red raspberriesalong with the more exotic and expensive varieties, including aa and wolfberriesmay prevent cancer about as well as the previously studied black raspberries. In another study, published in the Journal of Agricultural and Food Chemistry, it was found that drinking blueberry juice can improve memory. Researchers such as Amy Howell, PhD, an associate research scientist at the Marucci Center for Blueberry and Cranberry Research at Rutgers University in New Jersey, have been studying the powers of berries for years. Todays Dietitian (TD) recently caught up with Howell to find out about some of her research on cranberries. TD: Weve been used to encouraging people to eat whole fruit, but your research seems to indicate that other forms of cranberries are just as good. Is there really no difference? Howell: Its almost impossible to get consumers to eat cranberries. They are very tart. But we found that the active compounds in cranberries called proanthocyanidins (PACs) survive the cooking process, so even relishes and sauces will have the benefits of a whole cranberry. The same goes for dried cranberries and, of course, cranberry juice. PACs have been widely studied and are thought to be responsible for inducing a bacterial antiadhesion effect, preventing bacterial colonization and subsequent infection and disease not only in the urinary tract but also in the stomach and oral cavity. And the benefits dont stop there. Emerging research suggests that cranberries may play a positive role in heart disease and cancer prevention.
TD: How many glasses of cranberry juice do you recommend to get the benefits? Howell: Id say one glass a day, but if youre starting a cranberry regimen to prevent UTIs (urinary tract infections) or are serious about some of the other benefits, you might want to drink two glasses. Id recommend one in the morning and one before bed because research has shown the effects of cranberries can wear off in about 10 to 12 hours. TD: Can you explain how it works? Howell: The proanthocyanidins in cranberries bind to the bacteria that cause a urinary tract infection and prevent it from adhering to the bladder wall. Because the cranberries remove rather than kill the bacteria, theres less chance of it becoming resistant. While UTI prevention is a well-known benefit of cranberries, theres also research being done that points toward disease prevention. For instance, cardiovascular disease is influenced by a number of processes, including oxidative stress and inflammation. Cranberries are very high in both antioxidants and anti-inflammatory compounds including PACs, anthocyanins, and flavonol glycosides.
LG
This would include apples, which are rich in quercetin. Berries, which are a rich source of antioxidants, also are believed to help prevent the breakdown of brain cells. Research on the power of antioxidants continues to grow, and Sandquist says she encourages clients to include plenty of berries in their diet. To maximize nutritional benefits, she says clients should aim to eat all types and colors of berries red, blue, and purple. Of course the impact of blueberries on memory has been studied, and research has shown their flavonoids may help improve not only memory but also learning and general cognitive function. One of my favorite ways to eat them is to mix them into plain yogurt, Sandquist says. But you also can toss berries on cereal or just eat them plain. Theyre now available year-round in the freezer section.
fish, flaxseed, and fish oil supplements, all of which are rich in omega-3 fatty acids.
Good Digestion
During the natural aging process, the muscles that help move food through the digestive tract weaken along with other lost muscle mass, McNeany says. This can slow down the passage of food through the intestines and ultimately lead to constipation, which is quite common among older adults. Getting adequate amounts of fiber and staying hydrated are the two biggest combatants in fighting constipation and hard stools. Older adults often know they should eat their oatmeal for their cholesterol, but choosing bran cereals, whole grains, and lots of fruits and vegetables with the peel still on are really important in getting lots of fiber into the diet and preventing constipation, McNeany says. And get moving. [Clients should] try to avoid being sedentary so [theyre] able to keep the muscles in the GI tract active. When youre eating fewer calories its even more important that each calorie is fiber rich since constipation is a common concern as people age, Blake says. Americans should be getting a minimum of 4 cups of fruits and vegetables a day, and many arent coming close to that, she adds. One hundred percent [fruit] juices are wonderful, but [clients] need to be careful theyre also eating plenty of whole pieces of fruit. I also recommend a high-fiber cereal in the morning for a great kick-start to the system.
Pain-Free Joints
When it comes to joint health, antioxidants can help reduce the damage associated with inflammation. Clients should eat a diet that provides a lot of vitamin A, C, and selenium, Sheth says. Plant foods and some nuts and seeds are a good source of selenium, while vitamins A and C are found in fruits and vegetables. Ideally, dietitians should suggest clients eat yellow and orange fruits and vegetables that contain anti-inflammatory properties, such as grapefruit, oranges, papaya, and berries. Research has shown that foods rich in omega-3 fatty acids also can help reduce joint swelling and inflammation, Sheth says. So have clients look for foods like walnuts, cold-water
Balanced Diet
While each system of the body has its own importance, it all comes back to a diet thats nutritionally balanced and full of fruits, vegetables, and whole grains. Its really the total diet, Sandquist says. Many of these areas overlap and thats because it goes back to just eating a basic healthful diet. Supplements should be a last resort. People should try to get all of their nutrients from whole foods. In the end, healthful eating is a win-win. People who eat a healthful diet feel better and have more energy, even as they grow older.
Lindsey Getz is a freelance writer based in Royersford, Pennsylvania.
Low-FODMAP
Living
Experts Discuss Meal-Planning Strategies to Help IBS Clients Better Control GI Distress
iving with chronic abdominal pain, gas, bloating, diarrhea, or constipation is no walk in the park. For clients suffering from irritable bowel syndrome (IBS), these symptoms can greatly impact their quality of life. And yet 76% of those who suffer from IBS can better manage them by following a novel dietary approach that originated in Melbourne, Australia.1 Monash University researchers call this approach the low-FODMAP diet, known as fermentable oligo-, di-, and monosaccharides and polyols, a group of short-chain carbohydrates. These carbohydrates can exert luminal distention via osmotic effects and rapid fermentation, resulting in gas, pain,
and diarrhea in sensitive individuals. Since the majority of IBS sufferers acknowledge symptom improvement when following the low FODMAP diet, its important for RDs to be proficient in providing dietary guidelines and strategies to clients to help them plan menus, grocery shop, read labels, and make healthful food choices while dining out.
batches of grains such as quinoa and rice and use them throughout the week to top salads, add to soups, or make a pudding. Since meats and oils are free of FODMAPs, clients can include them in recipes as desired. Using gluten-free pasta, pizza crusts, and bread instead of wheat-based products is a simple way clients can reduce fructans in their diet. Clients who have functional gut disorders such as IBS or functional bloating often self-limit their diet beyond the low FODMAP guidelines. It may be necessary then to create menus that include other dietary restrictions in addition to the low FODMAP diet. The sidebars on page 37 feature a typical low FODMAP vegan and nonvegan menu for breakfast, lunch, and dinner that you can share with patients.
2 cup, cooked
Safe Snacking
Once clients are armed with menu ideas, encourage them to keep low FODMAP snacks on hand since theyre not always available while on the go. Here are a few ideas: Glutino pretzels and a mozzarella cheese stick Two rice cakes spread with a layer of peanut butter One banana and a handful of almonds Blue Diamond Almond Nut thins and Swiss cheese Lactose-free yogurt (Green Valley) with 1 cup of blueberries and 1 T of almonds Half of a sandwich using Udis white bread filled with sliced chicken, lettuce, and tomato slices One celery stick filled with peanut butter. Suggest clients eat just one, as celery contains mannitol, a polyol source.
Choose colorful fruits low in FODMAPs such as strawberries, bananas, blueberries, grapes, cantaloupe, pineapple, oranges, and kiwifruit. Select vegetables such as spinach, carrots, red bell peppers, eggplant, bok choy, tomatoes, zucchini, and potatoes. Purchase gluten-free, all-purpose flour blends that are free of soy. Bean flours such as Namaste Foods Perfect Flour Blend (www.namastefoods.com) or King Arthur Gluten-Free Multi-Purpose Flour (www.kingarthurflour. com) also are good choices. Select lactose-free dairy foods such as hard cheeses, including Parmesan, cheddar, and Swiss, and Green Valley Lactose-Free Yogurt and Lactose-Free Kefir Milk. Select a variety of meats, fish, and poultry and hearthealthy oils, which are all FODMAP free. Choose nuts and seeds low in FODMAPs such as walnuts, almonds, peanuts, pecans, pine nuts, macadamia nuts, and sesame seeds. Avoid FODMAP-rich pistachios.
More to Come
The low FODMAP diet will continue to undergo additional modifications as food samples are evaluated. Staying abreast of the research is essential to provide clients with the most up-todate information. Recently, researchers have developed consumption cut-off levels for foods containing FODMAPs for those suffering from FODMAP-induced GI distress (less than 0.5 g per sitting as long as individuals meet FODMAP guidelines). Monash University researchers have provided the following recommended limits: Excess fructose limit is less than 0.2 g per serving. GOS and fructans limit is less than 0.2 g (less than 0.3 g for breads/cereals) per serving.
Sugar polyol limit is less than 0.3 g per individual polyol or less than 0.5 g per total polyols per serving. Australian researchers are preparing a food composition booklet called FODMAP Food Facts. This booklet should serve as a great tool to help clients and dietitians understand the FODMAP content of foods, make safe food choices, and stick to limits to avoid triggering symptoms. IBS is a common condition, and dietitians are best suited to teach and translate the science to clients. Peter Gibson, a professor of medicine at Monash University and leading FODMAPs researcher, emphasizes the importance of the RDs role: Dietary restriction of FODMAPs is an effective therapy in the majority of patients with functional bowel symptoms. Its a diet that should be taught by a dietitian, and it should be firstline therapy provided the dietitian is trained in the technique.
Kate Scarlata, RD, LDN, is a Boston-based dietitian in private practice who specializes in digestive health and the author of The Complete Idiots Guide to Eating Well With IBS.
CPE MONTHLY
The following article examines five herbs and spices that are excellent sources of antioxidants, reviews the major health benefits of antioxidant intake, and offers strategies on how to encourage clients to incorporate more antioxidants into their diets.
Evidence Shows Antioxidant-Rich Herbs and Spices May Cut Chronic Disease Risk
Talk to patients about consuming foods high in antioxidants, and chances are youll conjure up images of juicy blueberries, deep green kale leaves, or brightly colored fruits such as plums, oranges, and kiwis. What patients may not know, however, is that numerous herbs and spices, such as turmeric, clove, and oregano, also are rich sources of antioxidants. Most people think of antioxidants as coming strictly from foods like fruits and vegetables, dark chocolate, or red wine, says Los Angeles-based dietitian Vandana Sheth, RD, CDE, a spokesperson for the Academy of Nutrition and Dietetics (the Academy), but many herbs and spices not only provide flavor but also a big bang of antioxidants. A little bit goes a long way. Just 12 teaspoon of ground clove is said to contain more antioxidants than 12 cup of blueberries. And what about that little teaspoon of dried oregano thats often stirred into a simmering pot of spaghetti sauce? Thats an amount equal to the antioxidants contained in a whole cup of sweet potatoes.1 Given the number of scientific studies suggesting the health benefits of antioxidants, its important that dietitians counsel clients about the potential benefits of consuming foods containing them and provide suggestions for increasing their intake. The use of herbs and spices in cooking is an easy way for clients to accomplish this.
1. Clove
What is it? Native to the islands of Indonesia, clove is derived from the dried flower buds of the evergreen clove tree. Clove lends its distinctively strong flavor and aroma to ketchup and Worcestershire sauce preparations and historically has been used as a natural numbing agent.4 What does it contain? Dried clove is rich in polyphenolic compounds, a large class of plant-based compounds thought to impart antioxidant properties. In 2010, scientists at Miguel Hernndez University in Spain reported that clove ranks highest
LEARNING OBJECTIVES
After participating in this continuing education activity, nutrition professionals should be able to:
1. List at least five herbs and spices that are high in
antioxidants.
2. Examine the mechanism by which antioxidants are
spices.
4. Provide guidance to clients regarding the use of anti-
as a natural antioxidant due to its phenol content and demonstrated ability to inhibit several damaging oxidative processes.5 How can clients use it? Due to its pungent aroma, many clients may be unsure how to subtly incorporate clove in cooking. But according to Sheth, clients can use ground clove wherever they add cinnamon or ginger. For example, stir ground clove into applesauce, stewed pears, or oatmeal. Clove is also a pleasant addition to muffins, cookies, whole grain pancakes, and sweet breads.
yogurt and sprinkle it on toast to make a quick and easy gingerbread toast. Ground ginger instantly adds an Asian flair to sauted vegetables, salad dressings, and marinades. Encourage clients to sprinkle ground ginger on sweet potatoes for an antioxidant-packed side dish.
4. Cinnamon
What is it? Cinnamon, considered one of the first known spices, is the dried inner bark of various evergreen trees within the genus Cinnamomum. When harvested, the tree bark is stripped and allowed to dry in the sun where it forms its characteristic curls known as quills.4 What does it contain? Antioxidant components of cinnamon, such as cinnamaldehyde, identified in cell cultures and animal studies, suggest cinnamon may act as an antioxidant in humans. A recent study comparing the antioxidant potential of several plants, including cinnamon, spinach, chard, Jerusalem artichoke, and red cabbage, found that extracts of cinnamon had the most potent antioxidant effects.8 How can clients use it? Cinnamon is incredibly versatile, says Atlanta-based dietitian Marisa Moore, MBA, RD, LD. Cinnamon can be sprinkled on foods like oatmeal [and] yogurt, or mixed in your glass of milk. She suggests using cinnamon to jazz up plain cereal, sprinkling cinnamon on toast with almond butter, or adding it to baked apples or pears. When counseling clients who prefer something sweet, Moore recommends using cinnamon for extra flavor and a sense of sweetness without adding actual sugar. Moore says cinnamon is an excellent addition to savory dishes as well, such as quinoa, whole wheat couscous, or barley salad. Take a whole grain salad, throw in some dried fruit, and then add a little cinnamon to bring the whole dish together.
2. Oregano
What is it? Cultivated for centuries and widely used in Mediterranean and Mexican cuisine, dietitians would be hardpressed to find someone who hasnt tasted oregano in foods. Scientifically known as Origanum vulgare and occasionally referred to as wild marjoram (to which its a close relative), common oregano comes from the dried leaves of a small perennial flowering shrub thats native to the Mediterranean and cultivated worldwide. What does it contain? Within its green, oval-shaped leaves, oregano is rich in phytochemicals such as thymol and rosmarinic acid, along with humalogs from the antioxidant vitamin E. Studies have shown oregano to have the highest total antioxidant capacity and phenolic content when compared with thyme, sage, rosemary, mint, and sweet basil. In addition, oregano may increase brain antioxidant activity and total antioxidant status.6 How can clients use it? With a little creative thinking, clients can use oregano for far more than pizza and spaghetti sauce. Sheth recommends a sprinkle of oregano to enliven sandwiches (eg, grilled cheese) as well as casseroles and salad dressings. In the morning I may have a slice of whole grain toast with mozzarella and a sprinkle of oregano, Sheth says. Want a unique twist on scrambled eggs? Instead of adding cheese, mix in some vegetables such as mushrooms and Swiss chard with a healthful dash of oregano.
5. Turmeric
What is it? Like ginger, dried turmeric originates from the root of the plant Curcuma longa. Noted for its bright yellow color, turmeric gives curry powder its distinctive hue and has been used to add color and flavor to prepared mustard, pickles, relish, chutneys, and rice dishes.4 What does it contain? Curcumin, the bright yellow polyphenol compound found in turmeric, has been the focus of intense
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3. Ginger
What is it? Dried, ground ginger comes from the root of the perennial herb Zingiber officinale. After the plant reaches its 2to 4-ft growth potential, the leaves die and the thick roots are dug up for consumption.4 What does it contain? Ginger contains several compounds that are thought to provide health benefits. Among them is gingerol, a relative of capsaicin found in chili peppers, which lends the root its characteristic spiciness. Historically, ginger has been used to treat everything from the common cold to motion sickness and gastrointestinal ailments. Cell cultures and animal studies show that ginger may protect tissues and organs against oxidative damage and prevent cancer development and growth.7 How can clients use it? Suggest clients consider ground ginger when they want to add a gentle spice to their foods. Sheth recommends clients add it to fruit smoothies, cereals, or
Read this article and select your answers for the examination. Then visit our CE Learning Library at CE.TodaysDietitian.com to purchase access to complete the online exam and earn your credit certificate. For more information, call our continuing education division toll-free at 877-925-CELL (2355) (M-F, 8 am - 6 pm ET) or visit www.TodaysDietitian.com. Suggested CDR Learning Codes: 2010, 2090, 3100, 4040; Level 2
research due to its potential to avert chronic diseases such as cancer, heart disease, arthritis, and Alzheimers disease. Curcumin has been shown to inhibit the expression of a specific gene thats believed to lead to the development and progression of breast cancer.9 How can clients use it? People often dont know what to do with turmeric, Sheth says, but it can be added to any vegetable side dish for a little curry flavor, noting that dried turmeric has a strong taste and is best cooked a bit before consumption. Moore highlights turmerics unique ability to add rich color to any dish, such as roasted cauliflower or a plain couscous salad. Everyone knows we eat with our eyes first; thats where turmeric can really help out a dish, she says.
breath when they addressed the emperor. India boasts a long history of using spices like cardamom and turmeric to alleviate numerous conditions such as urinary tract ailments and jaundice. Ayurvedic wisdom suggests chewing clove and cardamom after meals to increase the flow of saliva and enhance digestion. These are just a handful of examples of the versatile uses of herbs and spices throughout history.10
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and carnosic acidmay behave synergistically to inhibit the formation of HCAs. The same researchers later supplemented their previous studies involving rosemary and analyzed HCA formation in the presence of five Asian spices: turmeric, cumin, coriander, and lesser-known galangal and fingerrot. The HCA levels in fried beef patties containing the Asian spices were compared with fried beef patties containing rosemary. Puangsombat and colleagues reported in the October 2011 issue of the Journal of Food Science that all five of the Asian spices significantly decreased HCA formation; however, only turmeric and fingerroot were found to be as effective as rosemary in reducing its development. They concluded that the addition of Asian spices can be an important factor in decreasing the levels of HCAs in fried beef patties. In addition to inhibiting the formation of potentially carcinogenic by-products, antioxidant herbs and spices may prove beneficial in the prevention and treatment of other diseases. Extracts of cinnamon and clove have been shown to potentially treat diseases such as hyperlipidemia and diabetes, according to an animal study by Jin and Cho published in the July 2011 issue of Food and Chemical Toxocology. When compared with ground pepper, rosemary, and ginger, the spices cinnamon and clove demonstrated the strongest antiglycation and antioxidant activity as well as the strongest inhibition of activity against LDL oxidation. Further demonstrating its overall hypolipidemic activity, the subjects treated with clove extract experienced a 68% reduction in serum cholesterol and an 80% decrease in triglyceride levels. Participants had the lowest increase in body weight and the strongest antioxidant activity following five weeks on a high-cholesterol diet. These findings suggest constituents of cinnamon and clove may lower the risk of developing atherosclerosis and diabetes.
scientific investigation. Daly and colleagues addressed this subject in the June 2010 issue of Plant Foods for Human Nutrition. Their study analyzed the content of carotenoidsnaturally occurring plant pigments with antioxidant properties, such as beta-carotene, beta-cryptoxanthin, and lutein and zeaxanthinin the herbs basil, coriander, dill, mint, parsley, rosemary, sage, and tarragon. Daly and colleagues also studied the bioavailability of the carotenoids in these herbs, which they defined as the amount of carotenoids transferred to micelles after digestion when compared with the original amount present in the food. The results indicated variable levels of carotenoid content among these herbs and bioaccessibilities ranging from 0% to 42.8%. Basil and coriander contained the highest levels of the carotenoids beta-carotene and beta-cryptoxanthin as well as lutein and zeaxanthin. Based on the findings, the researchers reported that herbs arent rich only in carotenoid content but also can significantly contribute to the intake of bioaccessible carotenoids.
Counseling Patients
Armed with the latest research on antioxidants in foods and herbs and spices, dietitians will want to encourage clients to boost their intake of these disease-fighting nutrients. The following strategies can help. Consume herbs and spices for their antioxidant content, not for specific health benefits. RDs should continue to encourage patients to consume antioxidant-rich foods, including fresh fruits, vegetables, herbs, spices, berries, and whole grains, as part of a healthful diet. However, further scientific research is needed for RDs to make clinical recommendations to patients regarding the protective health effects of specific herbs and spices related to disease prevention. From Dubosts perspective, the real challenge lies not in proving that herbs and spices have health benefits but in determining what those specific health benefits are. We do know, based on different tests, that theres antioxidant content within fruits and vegetables, and spices and herbs, she asserts. However, the
Bioavailability of Antioxidants
Determining the level of antioxidants various herbs and spices contain, as well as how well our bodies absorb these antioxidants digestion, is Page yet another area of ongoing 479G_Layoutduring 1 1/25/12 1:26 PM 1
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research is quite limited on how their antioxidant content translates to health benefits. Thats important to note. Were really just beginning to understand how they work in the body. Munch on a wide variety. Just as Dubost advises patients to eat the rainbow of fruits and vegetables, she believes the same recommendation applies to herbs and spices so clients can get all the different antioxidants they contain. I like adding cinnamon to coffee or adding oregano to my Italian dishes. Whatever you like, the key is to consume a variety, just as we recommend with fruits and vegetables. Use herbs and spices instead of less healthful food additives. While dietitians may not have ample evidence to recommend herbs and spices to provide specific health benefits, they can recommend them as healthful substitutions for ingredients such as salt, fat, and sugar. Experts agree that seasoning food with herbs and spices not only enhances the flavor and aroma of food but also prevents negative health risks. For patients who are watching their weight or trying to reduce caloric intake, herbs and spices can help them cut back on fat and sugar by adding flavor, Sheth says. Moore encourages dietitians to become familiar with the culinary uses and antioxidant content of various herbs and spices, as this is an area of opportunity for them to educate patients. People are used to using salt and pepper or that familiar bottle of Italian seasoning, but many havent gone out of their way to try other seasonings. Thats where the RD can make an impact. For instance, for people trying to lower their sodium, I recommend using paprika, which adds color and a ton of flavor, Moore says. If you consider the implications of cinnamon replacing sugar in cereal or paprika replacing salt in chili, over time that will bring additional health benefits. Opt for dried herbs and spices. Some say fresh is better, but thats not always the case, says Dubost, who regards herbs and spices in fresh or dried form as equally beneficial. For those who enjoy growing their own herb garden, fresh herbs are great. But for the convenience factor, dried herbs and spices are perfectly fine. In fact, a 2011 study12 by researchers at the UCLA School of Medicine reported that nine herbs basil, chili, cilantro, dill, garlic, ginger, lemongrass, oregano, and parsley, as well as an Italian herb mixtureretained their antioxidant capacity and phenolic content during the drying process. Oregano displayed the highest antioxidant content of all the herbs tested in both dry and fresh forms. The researchers concluded that processed herbs contribute significant amounts of antioxidant compounds to the diet.12
growth or eat oregano to delay Alzheimers disease. In the interim, however, the potential health benefits of antioxidants cant be ignored, and dietitians should encourage patients to increase their intake of a variety of antioxidant-rich foods. The use of the antioxidant-rich herbs and spices discussed in this article is an accessible and convenient strategy for patients to achieve such an increase in their daily diets.
Megan Tempest, RD, is a freelance writer based in Colorado.
References
1. Top dried and fresh herbs and spices for antioxidants. Eating Well. http://www.eatingwell.com/nutrition_health/ nutrition_news_information/top_fresh_and_dried_herbs_ and_spices_for_antioxidants 2. Antioxidants and cancer prevention: fact sheet. National Cancer Institute website. http://www.cancer.gov/cancertopics/ factsheet/prevention/antioxidants 3. Antioxidant comparisons of spices and foods: the 50 foods ranked highest in antioxidant compounds gram for gram. McCormick Science Institute website. http://www.mccormick scienceinstitute.com/content.cfm?id=10480 4. Learn about 12 spices and herbs used in US cuisine. McCormick Science Institute website. http://www.mccormick scienceinstitute.com/content.cfm?id=10458 5. Viuda-Martos M, Ruiz Navajas Y, Snchez Zapata E, Fernndez-Lpez J, Prez-lvarez JA. Antioxidant activity of essential oils of five spice plants widely used in a Mediterranean diet. Flavour Fragr J. 2010;25(1):13-19. 6. Singletary K. MSI funded paper: potential health benefits of oregano. McCormick Science Institute website. http://cfprod. mccormick.com/msi2prod/content.cfm?id=10532 7. Kundu JK, Na HK, Surh YJ. Ginger-derived phenolic substances with cancer preventive and therapeutic potential. Forum Nutr. 2009;61:182-192. 8. Boga M, Hacibekiroglu I, Kolak U. Antioxidant and anticholinesterase activities of eleven edible plants. Pharm Biol. 2011;49(3):290-295. 9. Kim SR, Park HJ, Bae YH, et al. Curcumin down-regulates visfatin expression and inhibits breast cancer cell invasion. Endocrinology. 2012;153(2):554-563. 10. Rosengarten F Jr. The Book of Spices. New York, NY: Jove Publications; 1969: 23-96 11. Chemicals in meat cooked at high temperatures and cancer risk. National Cancer Institute website. http://www. cancer.gov/cancertopics/factsheet/risk/cooked-meats. Updated October 15, 2010. 12. Henning SM, Zhang Y, Seeram NP, et al. Antioxidant capacity and phytochemical content of herbs and spices in dry, fresh and blended herb paste form. Int J Food Sci Nutr. 2011;62(3):219-225.
Looking Ahead
As the scientific evidence continues to unfold, its possible that someday dietitians may get the green light to recommend patients consume antioxidant-rich herbs and spices to prevent and even slow the progression of specific diseases. For example, they could encourage the use of turmeric to inhibit cancer
dant comparison of spices and foods, which of the following herbs and/or spices does not rank among the highest in antioxidant content? a. Onion powder b. Oregano c. Turmeric d. Clove
7. When counseling patients, appropriate recommenda2. In nature, antioxidants protect living organisms from
ment concerning heterocyclic amines (HCAs) is false? a. T hey are formed when amino acids, sugars, and creatinine react at high temperatures. b. They are found in significant amounts in plant-based foods cooked at high temperatures. c. P an frying or grilling meat directly over an open flame may promote their formation. d. Fish, when cooked at high temperatures, may form HCAs.
tions regarding the use of herbs and spices may include which of the following? a. Liberally consume a wide variety of herbs and spices, as many are high in antioxidant content. b. Do not discontinue the use of a prescribed medication in favor of using a specific herb or spice to treat a medical condition. c. Use herbs and spices as substitutions for less healthful additives such as fat, sugar, and salt. d. All of the above
uents may inhibit expression of a gene that causes breast cancer? a. Curcumin b. Cinnamaldehyde c. Gingerol d. Rosmarinic Acid
gated for its ability to inhibit cancer growth, among other health benefits, is which of the following? a. Rosmarinic acid b. Thymerisol c. Curcumin d. Curry
the following herbs/spices were found to potentially treat hyperlipidemia and diabetes? a. Fingerroot and clove b. Cinnamon and clove c. Garlic and paprika d. Cumin and oregano
cessed herbs may contribute significant amounts of antioxidants to the diet. a. True b. False
DYNAMICS OF DIABETES
Patient Readiness
First, RDs must be aware of whether the patient is ready to change. The theory of Stages of Change can help you to recognize whether the patient is ready to make a change or not, Constance says. You cannot work with someone who is not ready, says Cecilia Sauter, MS, RD, CDE, clinical project manager at the University of Michigan who coauthored the book Inspiring and Supporting Behavior Change: A Food and Nutrition Professionals Counseling Guide with Constance. Thats where listening becomes so important. By listening to the patient, youll have the ability to recognize if he or she is even ready to changeand if not, you can start to understand what it will take to get the patient to a place where he or she will be ready. Sauter and Constance have identified the Stages of Change as precontemplation, contemplation, preparation, action, maintenance, relapse, and termination. Identifying where a patient falls on this continuum is key to understanding their ability to change. The following is a listing of what takes place during each stage: Precontemplation: The person isnt ready to make a change and may not even see his or her behavior as problematic. Contemplation: The person is thinking about making a change but not right away. Preparation: The person is getting ready to make a change. Action: The person has started taking some steps toward making a change. Maintenance: The person has been successfully working on a change for at least the past six months. Relapse: The person has returned to his or her old behaviors. Termination: The change has become a habit, and the person is absolutely certain that he or she wont relapse. In precontemplation, for example, an RD would simply ask the patient what positives he or she sees in making a particular behavior change. In contemplation, an RD would help the person take a look at the pros and cons of a particular behavior change, Constance says.
Better Listening
Sauter says part of listening is moving away from the idea that the patient is automatically noncompliant and looking at the situation from the patients perspective. The patient may just have a different goal [in mind] than the providerits not that hes noncompliant, she adds. There are three Rs that can help facilitate the opportunity to look at things from the patients point of view: reflective listening, rephrasing, and reframing. According to Sauter, reflective
listening is reiterating the same information back to the patient. Youre letting them know that you hear what theyre saying, she says. With reflective listening, you just want to be careful youre not overusing it or youll sound like a parrot. The point is just to make sure the patient knows you heard what they said. With rephrasing, you add more context and put some feelings into it, perhaps telling the patient you understand he or she is scared, worried, or confused. With both reflective listening and rephrasing, youre allowing them to look into the mirror and either realize thats not what they meant to say or to confirm that is how they feel, Sauter says. And finally, with reframing, youre helping them see theyre not alone. You might say, I have another patient that has had a very similar situation. Would you like to hear what we did with her? Now theyre seeing the situation in a new frame. Letting the patient do most of the talking and focusing more on listening can be a challenge for the provider, Constance admits. When working with patients, its easy to be the one doing all the talking because you have a lot of knowledge, and you know how you want to help them, she says. But the reality is that we need to identify what the patient is most concerned about and help the patient to set reasonable goals.
SYSTEMS APPROACH
The WHAT System is a practical approach to setting goals discussed in the book Inspiring and Supporting Behavior Change: A Food and Nutrition Professionals Counseling Guide by Ann Constance, MA, RD, CDE, and Cecilia Sauter, MS, RD, CDE. A concept created by Constance, the WHAT System is based on smart goal setting and was designed to assist clinicians when helping their patients make their goals specific, measurable, and achievable. Often a clinician will tell a patient simple statements like Get more exercise or Eat less fat. These are all great things to work toward, but how do you really put them into practice? Constance says. Thats where the patient often needs help. Thats where the WHAT System can come into play. Heres what the WHAT System stands for and how you can put it to use with get more exercise as the goal. The purpose is to get as specific as possible, dissecting the goal and making it doable for your client. W = What, when, and where?: What are you going to do? When are you going to do it? Where are you going to do it? H = How much, how many, or how often?: How much are you going to exercise? How many times a week? How often? How many miles or how long? A = Achievable (and believable): This goes back to checking on the patients confidence. Are you confident the patient can achieve this? Is he or she achieving it? If no, talk about the barriers. Maybe the patient needs better sneakers or to rethink the days when exercise is planned. Get specific about the barriers. T = Time frame for achieving the goal: How long is the patient going to try to meet this goal? Be realistic here. Most follow-up appointments are three months later, so you need to set up a way to connectperhaps through e-mail or a phone callin a shorter time frame to check in on whether the patient is meeting the goal and help him or her make modifications if needed.
LG
the most difficult thing about changing your eating habits? Once you get those responses, work from there on the solution.
Lindsey Getz is a freelance writer based in Royersford, Pennsylvania.
Inspirations, says these numbers can be misleading. If youre just comparing calories for calories, you get more calories from potato chips than you do from a potato, but if you follow that line of reasoning, the cheapest way to eat would be to [consume] pure oil because its the most calorie-dense food. But thats not recommended, and thats not healthful, Tallmadge says. While a bag of potato chips has more calories [than a potato], what counts is [nutritional] value. Calories have some value, but if you have calories without nutrients, thats not value, in my opinion.
person for the Academy and coauthor of The Baby and Toddler Cookbook: Fresh, Homemade Foods for a Healthy Start. Creating a weekly meal plan and shopping list makes it easy to fill your fridge, freezer, and pantry with foods that you can make a meal out of in a hurry. Ansel recommends clients check grocery store circulars for deals and to plan meals around whats on sale. Making a shopping list has the added benefit of limiting impulse purchases, as does shopping after a meal when youre full rather than before a meal when youre hungry. Clients can stock up on nonperishable items, such as pasta, beans, and frozen vegetables, when theyre on sale to reduce costs over time and buy dried goods such as grains in bulk, which is much less expensive than buying prepackaged varieties. I can go to the bulk bin and buy rolled oats for $1.29 a pound, and that gives me my oatmeal breakfast for a long time, Tallmadge says. Thats many, many oatmeal breakfasts for pennies. Upton adds that comparing the unit prices of itemshow much something costs per pound or per 100 unitshelps clients compare apples to apples, figuratively speaking. She also says less expensive store brands often are similar in quality to name brands. Becoming aware of product placement on store shelves is another cost-cutting strategy. Typically, less costly items are placed higher and lower on store shelves, while premium-priced items usually are positioned at eye level. Moreover, protein often is the most expensive part of the food budget, but clients can meet their protein requirements without buying high-end items such as fresh salmon and premium cuts of beef. Canned fish, eggs, beans, and peanut butter are excellent sources of protein, and theyre inexpensive. Suggesting that clients eat one or two meatless meals per week can reduce food costs considerably. With a little planning and research, anyone can stretch their grocery budget while maintaining a well-balanced, healthful diet. Upton says dietitians can be a valuable resource for clients by showing them how to get the most from their food dollars without sacrificing nutrition. She says writing articles for local newspapers, sharing recipes and tips with clients, and organizing supermarket tours are effective ways to achieve this goal. Educating consumers, showing them how it can be done, giving them recipes that demonstrate they can have a greattasting, healthful meal on a budget. I think thats what dietitians are all about: educating people and dispelling these myths that are so prevalent in nutrition, Upton says. I can see things like this being a great service to consumers who are really struggling in this tough economy.
David Yeager is a freelance writer and editor based in Royersford, Pennsylvania.
Enjoy Texmati
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person for the Academy and coauthor of The Baby and Toddler Cookbook: Fresh, Homemade Foods for a Healthy Start. Creating a weekly meal plan and shopping list makes it easy to fill your fridge, freezer, and pantry with foods that you can make a meal out of in a hurry. Ansel recommends clients check grocery store circulars for deals and to plan meals around whats on sale. Making a shopping list has the added benefit of limiting impulse purchases, as does shopping after a meal when youre full rather than before a meal when youre hungry. Clients can stock up on nonperishable items, such as pasta, beans, and frozen vegetables, when theyre on sale to reduce costs over time and buy dried goods such as grains in bulk, which is much less expensive than buying prepackaged varieties. I can go to the bulk bin and buy rolled oats for $1.29 a pound, and that gives me my oatmeal breakfast for a long time, Tallmadge says. Thats many, many oatmeal breakfasts for pennies. Upton adds that comparing the unit prices of itemshow much something costs per pound or per 100 unitshelps clients compare apples to apples, figuratively speaking. She also says less expensive store brands often are similar in quality to name brands. Becoming aware of product placement on store shelves is another cost-cutting strategy. Typically, less costly items are placed higher and lower on store shelves, while premium-priced items usually are positioned at eye level. Moreover, protein often is the most expensive part of the food budget, but clients can meet their protein requirements without buying high-end items such as fresh salmon and premium cuts of beef. Canned fish, eggs, beans, and peanut butter are excellent sources of protein, and theyre inexpensive. Suggesting that clients eat one or two meatless meals per week can reduce food costs considerably. With a little planning and research, anyone can stretch their grocery budget while maintaining a well-balanced, healthful diet. Upton says dietitians can be a valuable resource for clients by showing them how to get the most from their food dollars without sacrificing nutrition. She says writing articles for local newspapers, sharing recipes and tips with clients, and organizing supermarket tours are effective ways to achieve this goal. Educating consumers, showing them how it can be done, giving them recipes that demonstrate they can have a greattasting, healthful meal on a budget. I think thats what dietitians are all about: educating people and dispelling these myths that are so prevalent in nutrition, Upton says. I can see things like this being a great service to consumers who are really struggling in this tough economy.
David Yeager is a freelance writer and editor based in Royersford, Pennsylvania.
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CROSSWORD PUZZLE
1 2 3 4 8 11 16 18 21 23 28 29 30 34 36 37 39 40 41 38 31 32 35 33 24 22 25 26 27 19 12 13 14 17 20 5 6 9 15 10 7
By Myles Mellor
Interactive Puzzle
Across
1. Research shows these fatty acids are an effective
Down
1. Cereal thats safe for someone on a gluten-free diet 2. Assesses 3. Electrical power measurement 4. Kidney secretion 5. Follow as a result 6. See 26 down 7. Recipe direction 10. That is 12. Order of corn 13. Street, abbr. 14. Lab eggs 19. Angry crowd 20. Relating to organic processes 21. Amides combining the amino group of one amino acid
treatment for mood disorders and depression (2 words) 8. Glut____ 9. Boost 11. Dietary amounts 15. Goes with 30 across 16. Its often advised that this seasoning be cut back to reduce high blood pressure 17. Vitamin amount measurement 18. Russias Internet symbol 19. Mineral recommended to help reduce hypertension 22. Blood group system 23. Baltimore time 25. Fruit seed rich in the antioxidant rutin and a good source of fiber 28. Strip the skin 29. Brits thank yous 30. It contains resveratrol (goes with 15 across) 33. ____s, stomach muscles 34. Lowest point 36. The No. 1 lifestyle recommendation for reducing blood pressure (2 words) 38. Pickle spice 40. Life____ 41. Having a low pH
Introduces
A new, stress-free way to earn CPE credits from a name you trust.
For more than a decade, Todays Dietitian magazine has served the nations registered dietitians by providing the news, trends, and expert opinions you need to assist clients and develop your career. Weve also been a trusted source for continuing education and now, to serve you even better, weve expanded our program with the launch of the Todays Dietitian CE Learning Library. Accredited by the CDR, our new CE Learning Library offers articles on a variety of topics written by respected industry professionals. Our online system makes it easy to register and earn your credits. Well be adding new courses on a regular basis, so bookmark the website and check back often for updates. Log on to the Todays Dietitian CE Learning Library today at CE.TodaysDietitian.com, create your free account, and earn CPE credits like you always have with us. Our growth is tied to yours, so lets do it together.
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BOOKSHELF
The Gluten-Free Asian Kitchen: Recipes for Noodles, Dumplings, Sauces, and More By Laura B. Russell 2011, Celestial Arts Softcover, 208 pages, $22.99 I must confess that the phrase gluten free can make me cringe. I know glutenfree foods have gotten so much tastier, but I still have flashbacks of the gluey white stuff that was the result of my trying to follow gluten-free recipes. However, the results of my testing the recipes from The Gluten-Free Asian Kitchen offered an experience that was the total opposite. My kids came into the kitchen asking what smelled so good. Dinner made everyone very happy. The author is the former associate editor of Food & Wine cookbooks, and her culinary experience shows in the quality of this book. Russell has followed a gluten-free diet since 2008 and is the Gluten Freedom columnist for the Oregonian newspaper. It makes sense for those following a glutenfree diet to expand their menus to include more Asian foods. The rice-based cuisine already contains many gluten-free ingredients. The author states in the introduction that she includes recipes with naturally gluten-free foods to introduce readers to new ingredients and techniques. Im sure many of us would appreciate the instructions on how to make rice paper salad rolls. I developed skills not only in gluten-free cooking but in all types of Asian cooking. Yakuza Cucumber and Avocado Salad, named after the Yakuza Longue in Portland, Oregon, offered a tasty delight, melding the crisp cucumbers with the smooth creamy avocados. Winter Squash and Tofu Curry paired an Indian-style curry with ingredients youd find in Thai cuisine, such as peanuts, lime juice, cilantro, and coconut milk. Since sauces are part of Asian dining, Russell discusses them in the first chapter. Each sauce recipe page lists the other recipes in the book that use that sauce and the page numbers. Its these little touches that make a cookbook so useful. The author created a helpful table called Identifying Sources of Gluten in Common Asian Ingredients so readers can determine which ingredients contain gluten, why, and how to make substitutions. Every potentially gluten-containing ingredient is marked in the ingredient list of every recipe so readers know to shop for a gluten-free version. The section in Chapter 1 called Stocking the Gluten-Free Asian Kitchen: A Guide to Ingredients lists the ingredients found in the recipes and tells readers where they can find them, as some are sold in traditional grocery stores and others at
natural food stores or Asian markets. Again, any potentially gluten-containing food is flagged. The nearly 100 recipes in this book are also dairy free to accommodate those who have food sensitivities. If a recipe involves a time-consuming task, such as chilling an ingredient or contains a sauce that needs to be prepared ahead, the author provides a heads up notice in red to outline the steps. I really like this feature because no one wants to be surprised with a portion of a recipe that may take four hours to prepare. The Gluten-Free Asian Kitchen is one of those books that will benefit anyone but especially those who must follow a glutenfree diet and are interested in spicing up their menus with delicious Asian cuisine.
Carol M. Meerschaert, MBA, RD, is a freelance writer and consultant in Paoli, Pennsylvania.
The Inside Tract: Your Good Gut Guide to Great Digestive Health By Gerard E. Mullin, MD, and Kathie Madonna Swift, MS, RD, LDN 2011, Rodale Paperback, 356 pages, $19.99 With more than 60 million Americans known to suffer from digestive disorders, the arrival of The Inside Tract: Your Good Gut Guide to Great Digestive Health is a timely and welcome resource. The authors provide an excellent overview and detailed nutrition plans for digestive health. The introduction in the book states this important concept: You arent what you eat. You are what you absorb. As dietitians, we certainly realize the importance of digestive health for wellness and disease prevention. The authors elucidate the connection of digestive discord to various disease states, providing a broader look at digestive health and systemic symptoms. For example, they note a connection between small-intestinal bacterial overgrowth and other disorders such as irritable bowel syndrome (IBS), rheumatoid arthritis, and restless leg syndrome. They review common digestive diseases and impart the limitations of conventional therapies, such as the use of proton pump inhibitors in gastroesophageal reflux disease (GERD). Rather than relying solely on reducing gastric acid levels to treat GERD, which may further impair digestion, the authors suggest evaluation for other contributing factors, such as a dysfunctional lower esophageal sphincter, and emphasize the role of diet and lifestyle modifications.
If youre looking for a reference with an excellent review of the digestive process, this book provides all the fine details. Youre taken on a guided tour of your gut. Since a large component of the immune system is located in the intestines, the authors review common diet and lifestyle stressors that can impact the gut-immune system as well as strategies to keep your digestive tract well nourished and balanced. Nutrition intervention is a key component of the book and is introduced with 10 Principles of Nutritional Integrity, which provide sound big picture nutrition tips such as reminders to hydrate, eat in a relaxed state (a reminder most Americans need in our rushed world), and support gut flora. The book provides a Gastrointestinal Patient Symptom Assessment Tool to help determine what nutrition plan (the authors provide three nutritional tracks) is appropriate depending on symptoms and severity. The Track 2 diet includes a modified version of the FODMAPs approach. From my personal experience working with IBS patients, some of the allowed foods such as hummus and garlic often trigger symptoms; however, the authors encourage modifying the diet per individual tolerance. An introduction to digestive health supplements is reviewed for various digestive disorders such as GERD, IBS, chronic liver disease, and inflammatory bowel disease. An easy-to-read chart provides recommended supplements with therapeutic dosages for a variety of conditions. Additionally, there are numerous nourishing and appealing recipes. I highly recommend this book as an adjunct to your digestive health library.
Kate Scarlata, RD, LDN, is a Boston-based dietitian in private practice who specializes in digestive health and the author of The Complete Idiots Guide to Eating Well With IBS.
Complete Guide to Carb Counting: How to Take the Mystery Out of Carb Counting and Improve Your Blood Glucose Control By Hope S. Warshaw, MMSc, RD, CDE, BC-ADM, and Karmeen Kulkarni, MS, RD, CDE, BC-ADM 2011, American Diabetes Association Softcover, 180 pages, $18.95 If you work with clients who have diabetes, you can recommend a book that will teach them how to count carbohydrates. Gone are the days when we taught strict exchanges and the importance of avoiding simple carbs. Now we can offer our clients greater freedom to choose foods for a lifetime of enjoyment and help them manage their blood sugar. The Complete Guide to Carb Counting, not only teaches readers how to count carbs in meals but also helps them determine
the number of carbs they should eat. The book shows how to count carbs when reading food labels, restaurant menus, and while making a visual estimate. The book begins with a short quiz to help readers discover whether counting carbs is right for them. This quiz serves as a preview, informing readers that counting carbs is no magical diabetes cure and that controlling blood sugar requires numerous steps, from recordkeeping to reading every food label. Following the quiz is a chart showing how much carbohydrate is appropriate for people based on their age and gender. Chapter 3, Keeping Track, offers a seven-step guide to keeping a food diary. Clients must record the food, calculate the number of carbs consumed, identify carbohydrate-containing foods, determine whether the food diary represents typical intake, become familiar with the carb counts of commonly eaten foods, calculate carb needs, and match the food with blood sugar readings. Following these carb-counting basics, the book discusses other sources of calories: protein, fat, and alcohol. The authors offer basic descriptions and guidelines for intake. Chapter 5 discusses portion control and how to weigh and measure foods. Chapter 6 gives a primer on how to read food labels and discusses health claims. With the basics under our belt, the book gets more practical. Chapter 7 reviews convenience foods and provides recipes. Chapter 8 discusses restaurant and take-out meals. After youve read Chapter 8, you reach the part of the book that separates it from all other carb-counting guides. The authors years of diabetes counseling experience shine in the next couple chapters. Chapter 9 discusses blood glucose management and how to look for patterns. Chapter 10 covers medications with discussions on insulin, oral agents, and hypoglycemia. The authors provide a second quiz to determine whether readers are ready for advanced carb counting and offer intensive diabetes management techniques. The book ends with a listing of the carbohydrate content of many foods, a list of resources, and data-collection forms. The Complete Guide to Carb Counting is a readable, well-written guide. Itd be a great addition to any practitioners bookshelf and a great resource for clients.
Carol M. Meerschaert, MBA, RD, is a freelance writer and consultant in Paoli, Pennsylvania.
PERSONAL COMPUTING
unhealthful semisolid fat that has the consistency of lard or butter. Manufacturers have been using partially hydrogenated vegetable oils since the early 20th century, replacing lard and butter, because theyre less expensive and people previously thought they were more healthful. The FDA allows food manufacturers to list the content of any ingredient, including trans fat, at 0 g if a product has less than 0.5 g per serving of that ingredient. But how can a product that uses partially hydrogenated oil as its main fat list its total fat content per serving at 7 g and list its trans fat content at 0 g? The answer is that partially hydrogenated vegetable oil isnt the same as trans fat. Despite this truth, reputable websites such as the AHA and the Mayo Clinic describe partially hydrogenated fat as being the same as trans fat. Furthermore, other websites and some magazines and newspapers have copied this misinformation. This was discovered during an interview with two food scientists teaching at major universities: Eric Decker, a professor and head of the department of food science at the University of Massachusetts; and Susan Berkow, an adjunct professor of global community health at George Mason University. Both professors said trans fat is only one of the fats that results from the partial hydrogenation of vegetable oil and that other fats, depending on the specific process used, can include saturated, monounsaturated, and polyunsaturated fats. Decker said partially hydrogenated oil typically is only about 10% trans fat. A nutritional scientist and dietitian representing the AHA and the Mayo Clinic indicated that these organizations were only trying to simplify the point for consumers that they should beware of partially hydrogenated vegetable oils because of their trans fat content. The larger truth each pointed out was that even relatively small amounts of trans fat in individual servings can add up to unhealthful levels over the course of a day. But the fact remains that partially hydrogenated vegetable oil isnt the same as trans fat. The lesson: Double- or triple-check anything you read thats both surprising and important. One term thats sometimes used for this is the principle of triangulation of data. Just as a triangle has three angles, confirming information with three different sources is more reliable than relying on one. Even this isnt foolproof, as the above case illustrates, when many sources copy information from what they regard as a reliable source. Critical thinking often can get to the bottom of things. As nutrition professionals, you shouldnt be cynical about information gleaned from the Internet. But a healthy dose of skepticism can only help.
Reid Goldsborough is a syndicated columnist and author of the book Straight Talk About the Information Superhighway. He can be reached at reidgold@comcast.net or www.reidgoldsborough.com.
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march 2012 www.todaysdietitian.com 57
UTWYMOMIVANATIONWIDE
Registered Dietitian
Full Time & Part Time
Clinical Dietitian
Portage Health is looking to fill a full-time dietitian position to deliver medical nutrition therapy in the inpatient and outpatient settings.
Duties include:
Dietary assessments of patients of all ages as ordered by the provider Determine required diet and patient education needs Provide evidence-based nutrition education The successful candidate will be a graduate of an accredited school of dietetics. RD/CDE desired. Two years of experience in diabetes care and education desired. Interested candidates should apply online at www.portagehealth.org. EOE Portage Health is located in Michigans beautiful and scenic Upper Peninsula near Lake Superior, home to Michigan Technology University and Finlandia University. This warm, family-oriented community with excellent schools offers yearround recreational opportunities.
Acute care patient population; performs daily nutritional assessment and patient education for the appropriate patients; recommends and monitors enteral feedings and parenteral nutrition therapy; notifies respective physician of situations where nutritional intervention may be required; participates in employee and community functions that promote wellness.
Requirements
Registered Dietitian Licensed Dietitian in the State of Missouri Hours are routinely 8:00 a.m. - 4:30 p.m. on weekdays with the possibility of an occasional evening or weekend activity Weekend call every 3rd - 4th weekend.
Located in the foothills of Salt Lake City, Utah, Primary Childrens Medical Center is a 289-bed freestanding level-one trauma center with a service area covering ve states: Utah, Idaho, Montana, Wyoming, and Nevada. We are seeking an Administrative Dietitian that will be responsible for the operation, leadership, and management of all retail food service businesses. Utilizes critical thinking skills and advanced knowledge to implement best practices from the culinary arts, nutrition, and their integration into retail sales. The incumbent is also responsible for major department function, such as retail operations, catering, cafeteria, and Wasatch Canyons Behavioral Health Food Services.
For additional information, please visit our website at www.intermountainhealthcare.org and reference job# 122178 or call Alicia Duersch at 801-662-6256.
Give Gi ve You our r Job Job Sear Search h a Stab abl ble le Cor ore. e.
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CliniCal Dietitian
Pomona Valley Hospital seeks to recruit an experienced Clinical Dietitian to serve our acute care 453-bed not-for-profit organization. The Clinical Dietitian will assess and care for patients at nutritional risk, approve programs & menus related to nutritional care, participate in case conference, perform regular clinical rounds, and maintain discharge planning activities. He/she will also train, educate, support, and monitor fellow Associates providing direct nutritional care. Applicants must have a current CDR, 2 years of experience, and excellent communication skills. Preferred candidates will possess a Bachelors degree in Food & Nutrition and/or bi-lingual proficiency. This position is being offered at full-time days with a competitive benefits package. All eligible applicants should apply at
www.pvhmc.org
For more information and to apply online, please visit our website at www.AdventistHealthCV.com or e-mail LowKJ@ah.org. EOE
The following facilities would like to give special thanks to their staff by recognizing them during National Nutrition Month.
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Generate new business. Vitalize existing client relationships. Promote a greater understanding of your industry.
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Lowering Blood Pressure With Natural Therapies Get Clients Cookin Fats With Whole Plant A Candid Interview With CSPI Founder Michael Jacobson
Nutrition Professionals
The Center for Science in the Public Interest, led by Founder and Executive Director Michael Jacobson, turns 40 this year. Todays Dietitian sat down with Jacobson to discuss how the CSPI has forever made its mark on the nutrition worldand to gain insight into how dietitians can jump on board the movement for change in nutrition policy.
A CANDID INTERVIEW
By Sharon Palmer, RD
time, such as Walter Willett, PhD; Barbara Shukitt-Hale, PhD; and Penny Kris-Etherton, PhD. The content is always relevant, science based, and freshthe writers dont shy away from a little sarcasm. Just check out the newsletters popular column titled Food Porn, which reviews examples of food products that are off the charts in terms of calories, fat, saturated fat, sugar, or sodium, as proof. Over the years, the CSPI has made its mark on many public nutrition issues that you may have forgotten or perhaps didnt even know about. For example, it petitioned the FDA to require sodium labeling on all foods and fat content labeling on processed meats back in 1978 because this basic information wasnt available at that time. In 1989, the CSPI campaigned to stop the frying of French fries in beef fat. For 10 years, it battled for a federal law that would require nutrition labeling on packaged foods and ban deceptive health claims. It even led efforts to get a federal law passed that would dene organic foods. And the list goes on. Today, its hard to believe that at one time the CSPI had to step in and campaign for such basic nutrition policies that we, as dietitians, take for granted and rely on every day. If you examine the CSPIs accomplishments over the past 40 years, youll note that Jacobson and his team led the way to many signicant nutrition breakthroughs, such as adding trans fat to food labels and including calorie labeling in chain restaurants. Theres no doubt that the CSPI has been one of the leading voices for change in nutrition policy during the past four decades and that Jacobson can be considered the Steve Jobs of the organization.
200,000 copies. In the book, I created a food rating system with a composite score that factored in protein, vitamins, saturated fat, and other nutrients and rated foods on a scale so that something like soda scored very low and spinach scored very high. People really related to that kind of rating system, and it generated a huge amount of publicity. Then, in 1975, we sponsored the rst national Food Day, and it was a tremendous success. We sponsored additional Food Days in 1976 and 1977. There was a lot of interest in world hunger in those yearsit was high prole, with churches heavily involved. Then we worked on food labeling in the 1980s and ultimately got the Nutrition Labeling and Education Act passed, which led to Nutrition Facts labels. We became very involved in the policy area rather than just education. Then, in 1993, we started our rst study on restaurant food in Chinese restaurants, and then Italian restaurants with fettuccini alfredo is a heart attack on a plate, and we revealed the facts on movie theatre popcorn that got worldwide attention. Palmer: How did the idea arise for Nutrition Action Newsletter? Jacobson: I had the idea for Nutrition Action Newsletter in 1973. I went to the annual meeting of the Society for Nutrition Education [now known as the Society for Nutrition Education and Behavior] and collected signatures for a petition on whether junk foods should be advertised to kids and ended up with a list of nutritionists and thought wed communicate with them. We started with a newsletter and got a very nice reception but realized that we couldnt afford to continue giving it away. So we charged for it and started publishing a nice version in 1974. Weve been lucky to have Bonnie Liebman [director of the CSPI] writing many of the articles since 1978, and she commands great respect from journalists. We work hard to give objective scientic information that isnt colored by political beliefs, and we dont try to bend the science to match our beliefs. In the nutrition world, it can be tough to nd straight advice. Our bias is in favor of public health; when it requires judgment, we favor the idea lets protect consumers. We want to see good evidence, but sometimes you dont need 100% proof before you can give advice on something to protect people. Nutrition Action Newsletter circulation gradually increased, and it soared in the 1990s. At one point we had 1 million subscribers. Palmer: How has the CSPI been involved in nutrition policy over the years? Jacobson: Since our nutrition labeling efforts, weve been very involved in food policy initiatives, such as trans fat menu labeling, getting junk foods out of schools, getting healthier foods into schoolsweve led the efforts in all of these areas. In fact, Margo Wootan [director of nutrition policy at the CSPI]
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Of course, one thing that sets the CSPI apart from other organizations is that it built its structure transparently from the ground up. Since its funded entirely by subscribers and donorsit doesnt accept advertising, corporate funding, or government grantsit isnt beholden to supporters who can inuence or shape its health messages. The CSPI is in the pretty position of saying what it feels and believes. Many people know about the CSPI due to its award-winning Nutrition Action Newsletter, which debuted in 1974. While dietitians have been reading this publication for years, were not the only ones. Today, more than 900,000 people subscribe to Nutrition Action Newsletter, making it a preeminent voice in nutrition education across the country. In each issue, the publication takes on current nutrition topics, from the latest research on multivitamins to optimal diet strategies for losing weight and reducing chronic disease risk. Featured articles call on some of the leading nutrition researchers and experts of our
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ADVERTISER INDEX
For advertising information, please call 800-278-4400 or visit our website at www.TodaysDietitian.com.
Alaska Salmon Wild Jerky, www.alaskasalmonwildjerky.com............................................................................. 67 Bakery On Main, www.bakeryonmain.com.......................................................................................................... 63 Bobs Red Mill, www.bobsredmill.com................................................................................................................. 31 California Raisins Marketing Board, www.loveyourraisins.com............................................................................ 7 CinSulin, www.cinsulin.com................................................................................................................................. 55 DietMaster Systems, www.dietmaster.com......................................................................................................... 62 Dole Nutrition Institute, www.dolenutrition.com................................................................................................. 63 ESHA Research, www.esha.com............................................................................................................................ 3 Food for Life Baking Company, www.foodforlife.com. ........................................................................................... 9 Gourmet Garden, www.gourmetgarden.com....................................................................................................... 63 Growing Naturals, www.growingnaturals.com. .................................................................................................... 63 JR Carlson Laboratories, Inc, www.carlsonlabs.com............................................................................................. 2 Juice Products Association, www.fruitjuicefacts.org. ............................................................................................ 5 Kelloggs, www.kelloggsnutrition.com/td. ........................................................................................................... 25 Kibow Biotech, Inc., www.kibow.com. .................................................................................................................. 15 Konsyl Pharmaceuticals, www.konsyl.com...........................................................................................................11 Llorens Pharmaceuticals, www.llorenspharm.com............................................................................................. 19 Lundberg Family Farms, www.lundberg.com....................................................................................................... 13 The Nutrition Company, www.nutritionco.com.................................................................................................... 62 Omega, www.omegajuices.com .......................................................................................................................... 57 Penn Foster, www.pennfoster.edu....................................................................................................................... 43 RiceSelect, www.riceselect.com.......................................................................................................................... 49 Robot Coupe, www.robotcoupeusa.com. ............................................................................................................. 61 UAS Laboratories, www.uaslabs.com.................................................................................................................. 63 Walden Farms, www.waldenfarms.com/TDM2................................................................................................... 68
This index is a service to our readers. The publisher assumes no liability for errors or omissions.
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CULINARY CORNER
When shopping, choose small sprouts, as they tend to be sweeter and less woody than large ones, and avoid those with yellowing or wilted leaves, a sign of aging. Waiting for the next fad to emerge from my crisper drawer, Ill put my money on underloved produce and a hot oven. Maybe, just maybe, Ill be ahead of the trend.
Bryan Roof, RD, LDN, is a chef, dietitian, and food writer living in Boston.
Ingredients
1 lb Brussels sprouts, stems trimmed, halved lengthwise 612 oz cooked, peeled chestnuts, halved 1 large red apple (such as Fuji, Pink Lady, or Gala), cut into a 34-inch dice 1 large shallot, sliced into thin rings 2 T extra-virgin olive oil 1 4 tsp sea salt 1 4 tsp pepper 2 T pine nuts, toasted
BRUSSELS SPROUTS
By Bryan Roof, RD, LDN
Directions
1. Adjust oven rack to lower-middle position, place large, rimmed baking sheet on rack, and heat oven to 425F. 2. Toss Brussels sprouts, chestnuts, apple, shallot, oil, salt, and pepper together in large bowl until thoroughly combined. Carefully remove hot baking sheet from oven and pour contents of bowl onto sheet in even layer, working quickly and taking care to flip Brussels sprouts cut side down. 3. Roast until sprouts are well browned, about 25 minutes. Transfer to platter and sprinkle with pine nuts. Drizzle with additional olive oil and salt if desired.
Vol. 14 No. 1
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GET TO KNOW
DAVID GROTTO
By Juliann Schaeffer
foods you love (decadent or not) makes life worth living. The good news I share with my patients is that we can find a place for anything they want to eat, but there are a finite number of rooms to fill. TD: Give us a peek inside your refrigerator/cupboard. Grotto: OMG! I have to go shopping! Glad you made me look! TD: Whats your favorite way to prepare/eat vegetables? Grotto: I love to grill veggies and then drizzle on single-variety, cold-pressed, extra-virgin olive oil from southern Greece. Then sprinkle on coarse black pepper and a touch of kosher salt. Yum. TD: Coffee or tea? Grotto: Why not both? Just not at the same time. Ninety percent of the time I have dark roast coffee (two cups a day). The other 10%, I have sencha green tea. TD: You saved room for dessert. What will you have? Grotto: My death row, last dessert on earth is without a doubt Georgia Pecan Pie. TD: What foods do you crave? Grotto: Gruyere cheese, Honeycrisp apples, Lodi jammy Old Vine Zinfandel, varietal beans, Brussels sprouts, rotini pasta, edamame, and Five Guys Burger and Fries (how did they sneak in there?) TD: What is your preferred form of exercise? Grotto: None! Dont like it one bit but must do it because I will become as big as a house. (See above food cravings!) I used to love running but have a bum knee now. I enjoy activities that could second as exercise, such as softball, volleyball, hiking, swimming, and such. TD: How often do you cook/eat out? Grotto: I cook 90% of the time and eat out 10%. Admittedly, I spend more of my time doing demos or talking about cooking than actually cooking at home. I have to give props to my wife; shes quite a cook. Im slurping down her famous veggie chili as we speak.
Juliann Schaeffer is an associate editor at Great Valley Publishing Company and a frequent contributor to Todays Dietitian.
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