Today's Dietitian - March 2012

Counseling Patients With the African Heritage Diet Pyramid

Menu Ideas, Tips, and More for Successful Low-FODMAP Living

Whole-Body Nutrition for Healthful Aging

Best Breakfasts from Around the WorldThere’s Much to LearnAbout the Morning MealFrom Other Countries

Vietnamese rice noodle soup, called Pho, is a traditional breakfast

staple that originated in northern Vietnam.

National Nutrition Month

March 2012

Vol. 14 No. 3

The Magazine for Nutrition Professionals

www.TodaysDietitian.com

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PRESIDENT’S SPOT

IN CELEBRATION OF YOU By Kathy CzermanskiHappy National Nutrition Month from all of us at Today’s Dietitian! In honor of National

Nutrition Month and Registered Dietitian Day, we’d like to invite you to nominate colleagues you believe are doing excep-tional work in all areas of the dietetics field.

As we have in the past two years, we’ll 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, we’re very excited to announce the Today’s Dietitian’s CE Learning Library (CELL) that’s scheduled to go live on our website this month. Today’s

Dietitian is accredited by the Commission on Dietetic Regis-tration 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, distin-guished 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 you’re 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 tran-script of credits and certificates, interact and discuss the courses with other dietitians, and chart out your path to recer-tification 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!

President + CEO Kathleen Czermanski

Vice President + COO Mara E. Honicker

EDITORIALEditor Judith RiddleEditorial Director Jim Knaub Senior Production Editor Tracy Denninger Editorial Assistants Heather Hogstrom, Brandi ReddingContributing Editor Sharon Palmer, RDEditorial Advisory Board Dina Aronson, MS, RD; Jenna A. Bell, PhD, RD; Carol M. Meerschaert, MBA, RD; Kyle Shadix, MS, RD

ARTArt Director Susan KilcoyneSenior Graphic Designer Charles SlackGraphic Designer Kelly NewtonAd Coordinator Marie Harvey

ADMINISTRATIONAdministrative Manager Helen BommaritoAdministrative AssistantsKim Mayfield, Pat PlumleyExecutive Assistant Matt Czermanski

Systems Manager Jeff CzermanskiSystems Consultant Mike Davey

FINANCEDirector of FinanceJeff Czermanski

Director of Continuing Education & New Business DevelopmentJack Graham

CIRCULATIONCirculation Manager Nicole Hunchar

MARKETING AND ADVERTISINGPublisher Mara E. HonickerDirector of Marketing and Digital Media Jason Frenchman Web Designer/Marketing Assistant Jessica McGurkMarketing Assistant Leara AngelloDirector of Sales Stephanie MitchellSenior Account Executives Sue Aldinger, Peter J. Burke, Michael Ferguson, Brian Ohl, Brian SheerinAccount Executives Phil Anderson, Seth Bass, Jason Batchelder, Gigi Grillot, Lindsay Hertzog, Diana Kempster, Beth VanOstenbridge, Kate Wills, Josh YohnkeSales Coordinator Joe Reilly, Dani Kriest-Reifsneider

© 2012 Great Valley Publishing Company, Inc.

Today’s 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: 610-948-7202Editorial e-mail: [email protected] Sales e-mail: [email protected] Website: www.TodaysDietitian.comSubscription e-mail: [email protected] fax: 610-948-4202 Ad artwork e-mail: [email protected]: The Reprint Outsource, Inc.: 877-394-7350 or e-mail [email protected]

NOTE: For subscription changes of address, please write to Today’s 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 Today’s 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 Today’s 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.

4 today’s dietitian march 2012

http://www.ce.todaysdietitian.com

We all know the old adage… Breakfast: It’s 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 you’re 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

ADVERTORIAL

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;10:78–82

—Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010

“Modest evidence suggests that children who do not eat breakfast are at increased risk of overweight and obesity. The evidence is stronger for adolescents.”

in recent years evidence regarding

Any breakfast is better than no breakfast! If you’re in a rush, consider the following quick and easy options –

one serving of fruit in just a 4 ounce portion.

4782_JPA_advetorial_2012indd.indd 1 2/27/2012 11:50:47 AM

features

20 Best Breakfasts From Around the World There’s much to learn from other countries when serving this most important meal. See what other dietitians have to share.

26 Obtaining Health Through Heritage A diet rooted in African traditions may be the path to optimal health for African Americans.

32 Optimize Whole-Body Nutrition for Healthful Aging Professionals say a nutrient-dense diet plus physical activity will help clients stay younger longer.

36 Successful Low-FODMAP Living Experts discuss strategies to help clients live free of gastrointestinal distress.

40 CPE Monthly: Adding Spice for a Healthier Life Evidence shows antioxidant-rich herbs and spices may cut chronic disease risk.

departments

4 President’s Spot

8 Reader Feedback

10 Ask the Expert

12 Children’s 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…

CONTENTS MARCH 2012

26 64

Page 40


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Dear Editor,

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 mag-azine can find a way to look at a subject like diabetes and offer a new viewpoint that really rocks!

Carol M. Meerschaert, MBA, RD President, Your Favorite Dietitian

Paoli, Pennsylvania

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 shouldn’t be my responsibility as a registered dietitian to carry LGBT mate-rials in my office any more than it would be appropriate to dis-play magazines and other literature on Christianity, Judaism, or Islamic Sharia Law!

I don’t need to know someone’s sexual preference to help him or her control their diabetes any more than I’d need to know whether someone is a Democrat or Republican. They either wish to improve their health or they do not. The choice of one’s sexual partner shouldn’t enter the equation.

The article reports that somehow the LGBT population expe-riences health issues and lifestyle choices more challeng-ing than the rest of the population. This is ludicrous as well as demeaning to both the LGBT population and one’s intelli-gence. Many people—LGBT or not—struggle with emotional issues that may lead an individual to participate in unhealthy behaviors.

Donna Dodge, RD, LDN Denmark, Maine

Dear Ms. Dodge,

Thank you for your response to the article “Providing Opti-mal Diabetes Care to the LGBT Community.” We wrote the arti-cle to present a side of diabetes care that isn’t voiced often and because many nutrition professionals and other healthcare practitioners believe members of the LGBT community have special healthcare needs, and that they’ve 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

patients often suffer from greater health disparities than the general population as well as unique emotional stressors, so they’d be better equipped to improve patient care in this vulner-able 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 sub-population 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. You’ll hear firsthand what these patients experience and the opinions of the doc-tors and healthcare practitioners who are caring for them. It’s a profound eye opener that can only move one toward com-passion and action to improve patient outcomes among LGBT diabetes patients.

Judith Riddle, editor

READER FEEDBACK

Popular Tweets, Retweets

January Issue@Bmlococo: Just subscribed to Today’s Dietitian for three years! So excited!

“Giving Nutrition Advice to Child Athletes” (Sports Nutrition)

@JessTheRD: Thanks for tips on how RDs can help child athletes and their parents

with child athlete nutrition needs.

@Kristynhall: Thank you Today’s Dietitian. I love your publication and look forward to reading it every month.

@CandidRD: I love getting Today’s Dietitian magazine because it motivates me to get on the elliptical and stay on until I finish reading it! Here I go.

“Omega-3s and Mood Disorders”

@AmericaNowNews: Known for heart health, omega-3s are effective therapy for depression, bipolar disor-der, and schizophrenia.

@CherylharrisRD: Nice article on omega-3s and mood. Amazing and tasty to boot!


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

Research Suggests They Can Help Mild to Major Depression and Even Schizophrenia

Mood DisordersOmega-3 Fatty Acids and

ASPENConference

Issue

January 2012

Vol. 14 No. 1



PROTEIN POWDERSBy Toby Amidor, MS, RD, CDN

Q: Many of my clients purchase protein pow-ders. What are the main types available

and the guidelines for recommending them?

A: There are several varieties of protein pow-ders, including those derived from milk,

soy, eggs, and rice. Before recommending any protein supple-ment, however, it’s important to determine if your client really needs one.

The Types

Dairy BasedBoth 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 didn’t stim-ulate postprandial muscle protein accretion as effectively as whey.1 However, a 2007 study in Amino Acids found the combina-tion 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. It’s more easily absorbed and helps build and maintain muscles. It’s found in concentrate or isolate form. Whey protein concen-trates are less expensive and contain between 30% and 85% protein, while whey protein isolates contain at least 90% pro-tein 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, don’t recommend them to clients who are lactose intolerant or have milk allergies.

Soy Based This protein is derived from soy flour and is appropriate for

those with allergies or who follow a vegetarian or vegan diet. It’s 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.

Additional VarietiesOther 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

protein per ounce, while hemp provides 12 g. Rice, pea, and hemp (plant-based protein powders) have essential amino acids added and are good alterna-tives for those with allergies or clients who follow a vegetarian or vegan diet.

Protein RecommendationsThe Recommended Dietary Allowance for pro-

tein 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 don’t require protein supplements. Typically, protein supplements aren’t 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 they’re currently getting to ensure they achieve a proper balance between food and supplement use. Clients also should under-stand that protein powders are neither inferior nor superior to protein derived from food, but they’re pricey and lack certain nutrients found in whole foods.

CautionsProtein powders shouldn’t contain added vitamins, minerals,

and herbal supplements because they can interact with various medications, including antibiotics, levodopa used in Parkinson’s 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 Sear’s FitStudio.

ASK THE EXPERT

For references, view this article on our website at www.TodaysDietitian.com.

Have questions about nutrition trends, patient care, and other dietetics issues you’d like to ask our expert?

Send your questions to Ask the Expert at [email protected] or send a tweet to @tobyamidor.


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PROTECT YOUNG HEARTSHere’s What RDs Must Know About the New Cholesterol Screening GuidelinesBy Sari Harrar

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). “Children’s heart health is not on most parents’ radar screens, but it should be,” says Ansel, a Long Island, New York-based RD and coau-thor 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 cholesterol—and their fami-lies—to an RD for medical nutrition therapy.

RDs can play a vital role in reversing this serious heart dis-ease risk factor, says Bethany Thayer, MS, RD, director of Well-ness Programs & Strategies at the Henry Ford Health System’s 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 health-ful 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.”

A Better Safety NetWhy screen all children when heart attacks almost never

happen during the wonder years? Research shows that 10% of kids and teens have elevated total cholesterol, according to a Centers for Disease Control and Prevention analysis of National Health and Nutrition Examination Survey data by Ford and col-leagues, published in the March 3, 2009, issue of Circulation. High cholesterol jump-starts the buildup of plaque in the arter-ies of children’s hearts as early as age 10.2

“One reason the guidelines have changed is that medical imaging has allowed researchers to measure atherosclerosis in the arteries of kids with high cholesterol, demonstrating that the damage begins early,” Thayer says. “This adds cholesterol to other important measures we use to evaluate heart health, which include blood pressure checks, body weight, and asking about family history, diet, and exercise.”

The danger is growing. Poor food choices and too little physical activity are fueling the childhood obesity epidemic as well as rising rates of high cholesterol, high blood pressure, and high blood sugar, say Northwestern University researchers who reviewed the health profiles of 5,447 teens and preteens for a study presented at the American Heart Association’s 2011 Scientific Sessions. Their conclusion: Today’s young people will face fatal heart disease earlier in adulthood than any previous generation.

The AAP’s previous guidelines called on doctors to check cholesterol levels only in children and teens with heart disease risks such as obesity, high blood pressure, diabetes, or a family history of early heart disease or those whose family histories were unknown. But these criteria may be missing up to 50% of kids with dyslipidemia, according to a 2007 US Preventive Ser-vices Task Force report published in Pediatrics.

Not all heart-health experts agree that cholesterol screen-ing in kids is necessary given that the best protection for nearly everyone is a healthier lifestyle.3 But, Ansel notes, knowing that children have high cholesterol can help their families make additional adjustments, such as reducing the amount of satu-rated fat and dietary cholesterol they consume. “If a child is diagnosed with high cholesterol, parents don’t need to panic,” she says. “Choosing more plant-based fats and fewer animal fats can substantially help lower saturated fat and cholesterol and make a difference.”

Tips for Counseling KidsTo help families and their children with high cholesterol

bring their numbers into a healthful range, follow these seven strategies:

1. Aim for five servings of produce daily. Most kids and teens don’t get enough fiber.4,5 “Aim for five servings a day,” Thayer says. Fruits and vegetables aren’t just filling; they help with weight control. Produce that contains soluble fiber, such as apples, oranges, pears, strawberries, cucumbers, celery,

CHILDREN’S HEALTH


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 develop-ing high cholesterol, according to the AAP report. Milk contains calcium, potassium, and magnesium, which help control blood pressure and lower the risk of diabetes—both potent heart dis-ease 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 sol-uble 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 don’t 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 exercise—and 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 exercise—weighing and measuring or trying to restrict food can backfire,” Thayer warns. “RDs should work closely with a family and the child’s 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, it’s 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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march 2012 www.todaysdietitian.com 13

RECOGNIZING COW’S MILK PROTEIN ALLERGY IN INFANTSEvidence Shows Eliminating Milk and Soy Can Help By Judith C. Thalheimer, RD, LDN

When my son Matthew was born, he was strong and healthy, growing well and meeting every milestone. However, he was terribly fussy. He wouldn’t sleep for more than two hours at a time, and he’d cry inconsolably as if he were in pain. The long walks, endless car rides, and sleepless nights spent cuddling him while pacing the floor didn’t calm him down.

Exhaustion, frustration, and worry gave way to depression and insomnia as I lay awake most nights anticipating that shrieking cry that might come at any moment. The pediatrician couldn’t find any medical reason for his behavior. She sympa-thetically informed us that our son had infantile colic, and that it would get better with time.

What Is Infantile Colic?All infants have periods of fussing and crying, but those

who cry for three or more hours per day for three or more days per week and for at least three weeks (known as the Rule of Threes) meet the basic definition of infantile colic.1 Typi-cally, colicky behavior begins in the first few weeks of life and resolves spontaneously by age 4 to 6 months. Estimates of the incidence of colic vary widely, but as many as 28% of infants may be affected.2

In 1954, when the Rule of Threes was introduced, colic was thought to be primarily a response to overanxious parenting. Since then, researchers have examined many possible physio-logical causes that could account for the distress colicky infants exhibit, but no single mechanism has been found. Besides par-enting, possible explanations for colic have focused on neuro-logical or gastrointestinal issues.

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 con-cluded 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 eve-ning, but they’re 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 pediatri-cian 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 cow’s milk and soy proteins. To my surprise, Matthew’s fussiness and excessive crying weren’t infantile colic; they were an adverse reaction to food, treatable with nutrition intervention.

Supporting ResearchMy story is not unique. Cow’s milk proteins are the most

common cause of food intolerance in infants, with soy pro-tein 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 cow’s milk dependent.

Numerous studies have shown that removing cow’s milk proteins from a colicky infant’s diet can cause a significant reduction in symptoms.3 Some of these infants have an immu-noglobulin-E (IgE) mediated reaction commonly referred to as cow’s milk protein allergy (CMPA). Others may exhibit similar symptoms caused by non–IgE-mediated, mixed, or cell- mediated reactions. In some studies, these reactions are called CMPA as well, while others use the term cow’s milk protein intolerance (CMPI).

Iacono and colleagues concluded in a 1991 study pub-lished in the Journal of Pediatric Gastroenterology and Nutri-tion that “a considerable percentage of the infants with severe colic also have CMPI and that in these cases, dietetic treat-ment should be the first therapeutic approach.” Dietetic inter-vention is also the standard diagnostic procedure: eliminate

ALLERGY & INTOLERANCE AWARENESS


the suspected allergen from the diet and see if the condition improves. The diag-nosis is confirmed if reintroducing the allergen causes the symptoms to return, but this challenge procedure isn’t rou-tine in colicky infants and should be done only under medical supervision at facili-ties equipped to handle serious allergic reactions.

Treating Formula-Fed InfantsStandard infant formulas are either

cow’s milk or soy based. For formula-fed infants, Anthony M. Loizides, MD, an assistant professor of pediatrics at Albert Einstein College of Medicine and an attending physician in the division of pediatric gastroenterology and nutrition at Children’s Hospital at Montefiore, rec-ommends a two-week trial of extensively hydrolyzed formula when CMPA is sus-pected. “If the infant does not respond,” he says, “it’s unlikely that she or he has CMPA.” If skin rash or gastrointestinal symptoms such as blood in the stools are present, however, a four-week elimina-tion period is recommended. If there’s no improvement on extensively hydrolyzed formula, an amino acid-based formula may be tried. Babies who’ve begun eating solid food shouldn’t be fed foods contain-ing cow’s milk proteins, soy protein, egg, or peanuts.4

Mother’s Role While Breast-Feeding

As in my case, breast-fed infants also may present with excessive crying related to adverse food reactions. Mat-thew’s condition, known as allergic proc-tocolitis, is a typical presentation. Milk and soy proteins are the most common culprits, as both have been found in breast milk. The breast-feeding mother must, therefore, exclude all sources

of milk and soy proteins from her diet. Eglash also has had success with elimi-nating corn if the infant doesn’t 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 man-ufacturers clearly identify any ingre-dients that contain protein derived from milk or soybeans as well as eggs, fish, shellfish, peanuts, tree nuts, and wheat. An infant’s 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 she’s breast-feeding, and, as previously mentioned, any offending food components must be excluded from the infant’s 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 son’s diagnosis, I contin-ued to breast-feed, carefully avoiding foods with even trace amounts of milk or soy proteins. My son’s 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.


Colorectal Cancer Study Examines Diet, Physical Activity

The Cancer Institute of New Jersey (CINJ) and the five hos-pitals of Meridian Health have joined forces to offer a clinical research study that examines physical activity patterns and eating habits in colorectal cancer patients who have recently finished treatment. The goal of the study is to lay the ground-work for future research on health promotion among individu-als with colorectal and other cancers.

The death rate from colorectal cancer has been on the decline for the past 15 years, which means more patients are surviving the disease. However, the question is whether their quality of life has improved and their risk of cancer recurrence has decreased. Researchers at the CINJ hope to determine this in an effort to promote positive health behavior changes in this population.

Elliot J. Coups, PhD, a behavioral scientist at the CINJ and an associate professor of medicine at the University of Medi-cine and Dentistry of New Jersey-Robert Wood Johnson Medi-cal School, is the lead investigator. Previous research by Coups shows that 80% of colorectal cancer survivors don’t take part in regular physical activity, while 57% don’t meet recommenda-tions for consuming enough fruits and vegetables in their diet. Because physical inactivity and poor diet may be risk factors for colorectal cancer recurrence, Coups notes further exploration in this area is needed.

“We hope to have a better understanding of the degree to which patients modify their physical activity and dietary

behaviors as a result of their diagnosis, treatment, and potential emotional reactions to their illness,” Coups says. “The infor-mation collected from this study will help us determine what interventions may be successful in helping patients in this pop-ulation make healthy behavior changes. It could also serve as an intervention template for other cancers.”

Study participants will complete three surveys over a six-month 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 participant’s physical activity and eating habits.— SOURCE: CANCER INSTITUTE OF NEW JERSEY

RESEARCH BRIEFS

MARCH IS COLORECTAL CANCER AWARENESS MONTHAccording to the American Cancer Society, about

143,000 new cases of colorectal cancer are expected to be diagnosed in the United States this year. Colorectal cancer is the third leading cause of cancer death among both men and women in the United States.

While the exact cause of most colorectal cancers is unknown, risk factors include poor diet, lack of exercise, and the presence of polyps in the colon or rectal areas. Those over the age of 50 are at increased risk. Beginning at this age, it’s recommended that both men and women undergo periodic colonoscopies, fecal occult blood tests, and/or other screenings that can detect colorectal cancer. Earlier testing is recommended for people with increased risk, such as those with a family history of the disease. According to the Centers for Disease Control and Preven-tion, if everyone aged 50 or older were screened regularly,

as many as 60% of deaths from this cancer could be avoided.Some signs of possible colorectal cancer include the

following:•bleeding from the rectum;•dark stools or blood in the stool or toilet after having a

bowel movement;•a change in bowel habits, such as diarrhea, constipa-

tion, or narrowing of the stool that lasts for more than a few days; •cramping pain in the lower stomach; and•weakness, fatigue, and unintended weight loss.

Studies show that maintaining a healthful weight, eating a diet rich in fruits and vegetables, keeping physically active, and limiting alcoholic beverage consumption may prevent colorectal cancer.— SOURCE: CANCER INSTITUTE OF NEW JERSEY


Low Levels of Omega-3s May Cause Memory ProblemsA diet lacking in omega-3 fatty acids may cause an individu-

al’s brain to age faster and lose some of its memory and think-ing abilities, according to a study published in the February 28 issue of Neurology.

“People with lower blood levels of omega-3 fatty acids had lower brain volumes that were equivalent to about two years of structural brain aging,” says study author Zaldy S. Tan, MD, MPH, of the Easton Center for Alzheimer’s Disease Research and the division of geriatrics at UCLA.

For the study, 1,575 people with an average age of 67 and without dementia underwent MRI brain scans. They also were

given tests that measured mental function, body mass, and the omega-3 fatty acid levels in their red blood cells.

The researchers found that people whose DHA levels were among the bottom 25% of the participants had lower brain volume compared with people who had higher DHA levels. Similarly, participants with levels of omega-3 fatty acids in the bottom 25% also scored lower on tests of visual memory and executive function, such as problem solving, multitask-ing, and abstract thinking. — SOURCE: AMERICAN ACADEMY OF NEUROLOGY

Low-Income Families’ Kids Drink Too Much JuiceA new report from the University of Michigan C. S. Mott

Children’s Hospital National Poll on Children’s Health shows that many children in low-income families are get-ting more than the recommended amount of fruit juice. To avoid health problems such as childhood obesity and early tooth decay, the American Academy of Pediatrics (AAP) recommends limiting fruit juice consumption in children aged 1 to 6 to one serving per day.

The national poll asked parents of young children of all economic levels about their children’s juice consumption. Overall, 35% of par-ents reported that their children aged 1 to 5 drink two or more cups of juice during a typical day—twice the amount recommended by the AAP.

“It’s important to limit juice con-sumption in young children because there’s such a strong link between consumption of sugar-sweetened beverages and child health prob-lems like obesity and early tooth decay,” says Sarah Clark, MPH, an associate director of the child health evaluation and research unit at the University of Michigan and an associate director of the National Poll on Children’s Health. “For many obese children, sugary beverages make up a large proportion of their daily energy intake.”

Of parents whose household income is less than $30,000 annually, 49% reported that their children drink two or more cups of juice per day. Only 23% of parents with household

incomes of $100,000 or more reported that their children drink the same amount.

These findings are concerning, Clark says. “Both child-hood obesity and early dental problems are more preva-lent in lower-income children, so the children we’re most worried about in terms of these conditions are also those

who are drinking the most juice,” she says.

Some parents may encour-age their children to drink juice because it can help the child obtain the recommended serv-ings of fruit consumed each day. “Parents may think juice is an easy way for their child to get a serv-ing of fruit, but it’s often difficult to pick out 100% fruit juice amid the sugar-sweetened juice drinks,” Clark says. “Parents who give their child juice as a healthy alterna-tive may actually be feeding them nearly as much sugar as soda.”

The poll also found that 35% of lower-income parents said their child’s doctor recommends juice.

“This is an important message for healthcare providers as well as parents,” Clark says. “Doctors need to be very spe-cific in letting parents know that whole fruit is the best way to have a child get recommended servings of fruit and that fruit juice should be limited to no more than one serving per day for kids 6 years and younger.”— SOURCE: UNIVERSITY OF MICHIGAN HEALTH SYSTEM


DROP THOSE POUNDS WITH YOGAStudies Show Yoga Stimulates Weight LossBy Jennifer Van Pelt, MA

Author’s Note: This article is the last in a three-part series on the health benefits of yoga. In this final installment, I’ll discuss how yoga can help promote weight loss and general health.

Most people practice yoga to improve flexibility and balance, relieve stress, and reduce aches and pains. But yoga also can help your clients lose weight.

While yoga generally doesn’t burn as many calories as car-diovascular exercise, it does have a positive influence on the mental aspects associated with successful weight loss and weight maintenance.

Yoga can increase body awareness; counter negative, self-judging thoughts related to eating habits; and foster a sense of self-control, according to several articles published in the 2011 Yoga Journal weight loss special issue. The exact mechanism that produces weight loss isn’t known, but it’s likely a com-bination of physical exertion from poses and mental benefits derived from relaxation breathing and mindful meditation.

For yoga participants who also practice yoga philosophy, such as the Eight Limbs of Yoga, benefits may result from a focus on honesty, contentment, and “letting go” outside of yoga class. Physical poses associated with weight loss involve twists that encourage digestion, standing poses that strengthen larger muscle groups, and forward bends that stimulate abdominal organs and the thyroid gland.

What the Studies SayA large public health study that included

15,550 adults aged 53 to 57 measured physi-cal activity, including yoga and weight change over several years. Practicing yoga for four or more years was associated with a 3-lb lower weight gain among normal-weight partici-pants (BMI of less than 25) and an 18.5-lb lower weight gain among overweight sub-jects. Regular yoga practice was associated with less weight gain with aging, especially in those who were overweight.1

Recently, yoga has been incorporated into programs for eating disorders and weight management for obesity. In a small random-ized study of yoga for obese women, those practicing yoga for 16 weeks had significantly decreased body weight, body fat percent-age, BMI, waist circumference, and visceral fat area compared with those who didn’t exercise.2

Other researchers examined 20 personal journals of obese women with binge eating disorder undergoing a 12-week yoga treatment program. Qualitative analysis showed that the wom-en’s perspectives about eating changed for the better. Their journal entries suggested the yoga program developed physi-cal self-empowerment, encouraged a healthy reconnection with food habits, and cultivated awareness of self and the pres-ent moment. Program participants reduced the amount of food they ate, decreased their eating speed, and improved their food choices during the program. Overall, the women reported feel-ing “more connected and positive about their physical well-being,” which translated to better eating habits.3

Fat-Burning Yoga StylesCertain types of yoga can serve as low-impact cardiorespi-

ratory exercise alternatives for clients who may have stress injuries from high-impact activities such as running or for those looking to add variety to their exercise program. Athletic and active clients may enjoy Ashtanga or Bikram yoga that involve a progressive series of poses designed to generate internal heat and a purifying sweat, facilitated by a heated room, and Vin-yasa yoga, a faster-paced flowing series of yoga poses. Cli-ents also can practice sun salutations, a series of 12 poses that can elevate the heart and breathing rate to the higher end of the participant’s target heart rate range. A study of the energy expenditure associated with sun salutations found that per-forming the series of poses for 30 minutes produced a cardio-respiratory training effect and an energy expenditure of 230 kcal4—enough to burn off the calories from eating a candy bar.

Overweight and obese clients may feel self-conscious or dis-couraged in classes with fit participants. For example, heavier

FOCUS ON FITNESS


clients will require modifications in many poses. And while yoga instructors are trained to provide modifications for beginners and inflexible people, modifications for heavier indi-viduals are different because of anatomy and range of move-ment 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 instruc-tors who are heavier themselves. If clients can’t locate such classes, several instructional books and DVDs are available.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and healthcare research analyst/consultant in the Reading,

Pennsylvania, area. She’s trained in SilverSneakers YogaStretch and YogaFit for Seniors.

References1. Kristal AR, Littman AJ, Benitez D, White E. Yoga prac-

tice 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, O’Halloran 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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Best Breakfasts from Around the World

Dietitians say there’s much to learn from other countries when serving this most important meal.

By Juliann Schaeffer


Take a snapshot of the breakfast your client is about to enjoy and it may showcase different shades, textures, and ingredients, depend-ing on what corner of the world they’re from. There’s no one picture of the “perfect” break-fast 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 aren’t likely to rank high on the list of healthfulness.

“I don’t 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 defi-nitely have my thoughts on what countries have the healthiest traditional breakfasts, and the United States is not one of them.”

This isn’t to say, however, that all Americans forsake nutrient-rich fare for the nearest drive-thru. “I do think there are people in the US who eat a very healthful breakfast,” she adds. “Unfor-tunately, it’s a subgroup and consists of people who are edu-cated about nutrition and food.”

In VanBeber’s 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 country’s borders can open up a whole new world of breakfast offerings. In this article, Today’s Dietitian asked RDs with the knowledge of world cuisine—whether through personal experience or research—for their picks of countries that offer some of the more healthful break-fasts 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.

TurkeyAnn 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 break-fast traditions worthy of bragging rights.

Diker, whose husband is from Turkey and who travels there regularly, says the healthfulness of the traditional Turkish break-fast stems from its inclusion of vegetables, olives, honey, and tea.

A typical Turkish breakfast will include cucumbers, toma-toes, 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

well-rounded macronutrient profile by including carbohy-drate, 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 together—even at breakfast—whereas the fast-paced routine of Americans makes it even difficult to get every-one at the dinner table a few nights a week.

“One thing that Turkey gets right is the importance of gath-ering 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.

IsraelAlthough Brigitte Kochavi, RD, now calls Israel her home,

she was born and spent her early years in France. When com-paring the different breakfast traditions of Europe and the Middle East, Israel comes out ahead for healthfulness, says Kochavi, who’s head of pediatric clinical dietitians for Edmond and Lilly Safra Children’s Hospital at Sheba Medical Center in Ramat Gan, Israel.

“The most healthful breakfast foods are located in the coun-tries around the Mediterranean Sea like Israel, Cyprus, and Greece,” says Kochavi, who’s also the Israel country represen-tation for the American Overseas Dietetic Association (AODA).

Turkey


“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 it’s 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 one’s breakfast in Israel, either Tsfatit, which is white cow’s 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.

When asked what she thinks Americans can learn from Isra-el’s 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 RicaMalena 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 country’s breakfast is also high in fiber, another reason for its healthfulness. “[People living in Costa Rica] aren’t eating sweet rolls or sweets for breakfast. Instead, they’re 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 typi-cal Costa Rican breakfast includes lots of pineapples, oranges, mango, papaya, corn, beans, rice, squash of all kinds, fresh cheese, and eggs—foods likely to be foreign to Americans at breakfast time.

“Fish, vegetables, soup, and nuts for breakfast? Yes, and much more,” Terry says. “Why? Because it’s 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 break-fast is one way to incorporate Costa Rican traditions into Ameri-cans’ lives, her suggestion for using last night’s leftovers could

Costa Rica

Israel


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.

ChinaMargaret Keefe, RD, chief representative for Eat Well Shang-

hai 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 don’t tradi-tionally 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 nutrient-dense 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 isn’t necessarily low calorie, its hearty qualities “keep you going until lunch. It’s an excellent combination of carbohydrate and protein—pancake 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 assump-tion that breakfast equals sweetness. “I think Americans need to try having vegetables for breakfast and incorporating differ-ent 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 you’re good to go,” she suggests. Keefe says congee, Chi-nese 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.

VenezuelaIn Venezuela, as well as in other Latin American countries

such as Colombia, Ecuador, and Perú, the high consumption of corn is a big part of what gives this cuisine high marks. “[Corn]

has been a good source of nutrients as well as fiber when it’s 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 coun-try 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,

Queso Blanco (Farmer’s Cheese)

Yields 2 cups; serves 16

Farmer’s cheese is a type of soft, white, unripened cheese that’s made all over the world. Goats, sheep, and cattle all provide milk for farmer’s cheese, which also can be made from the milk of more exotic animals such as yaks. Many grocers and dairies sell the unaged white cheese, which is suitable for a wide range of uses. Since the cheese is quick and easy to make, it’s been tradition-ally associated with farmers, who originally made it for home consumption only.

Ingredients1 gallon whole milk (preferably from grass-fed

cows)1 pinch salt1 large lemon, juiced

Directions1. Pour the milk into a large pot and stir in a pinch of

salt. Bring to a boil over medium heat, stirring occasion-ally 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 Farmer’s 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


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 country’s 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 tra-dition, noting that fresh fruit juices (emphasis on fresh) can pro-vide a great way to obtain one’s daily fruit requirements while avoiding the added sugar from premade juices.

VietnamAccording 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 south-east 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, carbohy-drate, and a small amount of fat,” she says. “This breakfast of pho includes these three energy nutrients in a delicious, low-calorie, low-fat way.”

Dina Aronson, MS, RD, part of the advisory counsel for Fit-Orbit, 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 sweets—if they make an appearance at all—play 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. “Don’t 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 “it’s OK to see food as just food—not ‘breakfast’ vs. ‘non-breakfast’ 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 once—at dinner—as is common for so many Americans.”

Whether it’s 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 possi-ble for everyone—and whatever healthful habit clients are will-ing to adopt is the best one.

“I think that while health is a priority, it’s also important to examine and stay true to social, cultural, and dietary prefer-ences,” 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 tenets—high fiber, high water, and whole plants—and 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 Today’s Dietitian.

Arepas

Serves 6

Ingredients2 cups of precooked corn flour2 cups of warm waterPinch of salt1 T of canola oil

Directions1. In a bowl, combine salt and flour, then add the

water and oil and stir all the ingredients until homoge-neous. 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


Good mornings begin here.

A cereal breakfast. Why it’s the best way to start the day.A cereal breakfast. Why it’s the best way to start the day.

Sugar

Cereal contributes just four percent of daily added

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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.

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Nine out of ten moms agree that cereal is a convenient breakfast choice. Ready-to-eat cereal gives them an easy way to give their families the nutritious start they need.1

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Cereal contributes just three percent of the total sodium in the US diet.2

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Hungry for more? Visit kelloggsnutrition.com/td

®, TM, © 2012 Kellogg NA Co. 1. July 13–18, 2010 Braun Research & Kellogg Company. 2. National Health and Nutrition Examination Survey Data (2003–2006). Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; data for boys and girls 6–17 years of age. 3. O’Neil, CE, M. Zanovec, TA Nicklas and SS Cho (2012) Presweetened and Nonpresweetened Ready-to-Eat Cereals at Breakfast Are Associated With Improved Nutrient Intake but Not With Increased Body Weight of Children and Adolescents: NHANES 1999–2002. Am J Lifestyle Med. 6(1):63–74. 4. Song, WO, OK Chun, J Kerver, S Cho, CE Chung, S Chung (2006) Ready-to-Eat Breakfast Cereal Consumption Enhances Milk and Calcium Intake in the US Population. J Am Diet Assoc. 2006;106:1783–1789. 5. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans (DGA), 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.

A 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 diag-nosed 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 they’re 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, they’re almost 40% more likely to die from the disease.5

HeritageObtaining HealthThroughA Diet Rooted in African Traditions May Be the

Path to Optimal Health for African AmericansBy Constance Brown-Riggs, MSEd, RD, CDE, CDN


Is Soul Food Putting the “Die” in Diet?Why are African Americans disproportionately affected by

conditions that are so common but often preventable? Many experts blame the proverbial soul food diet—the cooking and eating traditions that often include dishes that are deep fried or cooked all day, soaked in fat, and laden with salt, sugar, and calories.

Such severe health problems can’t be attributed primarily to soul food, according to Sara Baer-Sinnott, president of Old-ways, a nonprofit organization perhaps best known for creating the Mediterranean Diet Pyramid and other culturally specific dietary guidelines.

“These disparities go beyond eating soul food,” she says. “There are many factors that have led to poor outcomes—economics, changes in family structure, lack of access to healthful food, and perceptions about time needed for cooking and shopping.”

Still, she and her colleagues at Oldways understand that a healthful diet goes a long way in improving overall health. The organization developed a program for African Americans that emphasizes the relationship between diet and general health; educates them about the possibility of improving one’s health through a heritage diet; and promotes healthful, delicious, affordable meals to encourage people in black cultural com-munities to eat well.

The important word here is communities—plural. There are approximately 40 million people of African descent living in the United States. Some have been in the United States for many generations; others are more recent immigrants from Africa, the Caribbean, or other parts of the world.6 What and how they eat may differ significantly—at least until immigrants become acculturated.

“Scientific studies show that many chronic conditions now prevalent in African American communities appear in [black immigrant] populations as traditional diets are left behind,” Baer-Sinnott says. Studies have shown that when people adopt a more westernized diet, their susceptibility to health problems increases.

For example, research published in a 2010 volume of the Journal of Biomedical Science found that the preva-lence of metabolic syndrome in young Tanzanian men increased as they ate more nontraditional foods such as donuts and ice cream and less traditional foods. The same trend can be found in Botswana.7 As younger populations shift from traditional to non-traditional lifestyles, weight, blood pressure, and cholesterol levels—signs of metabolic syn-drome—rise. The elderly, who are less inclined to change their eating habits, are actually healthier.

According to Sarah Dwyer, program manager at Oldways and the team leader for the Afri-can Heritage & Health Initiative, since Africans

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 HeritageCulinary historian and cookbook author Jessica Harris says

the traditional African diet is largely vegetarian. “There wasn’t 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 season-ing unless there was some degree of feasting or festivity.”

Across Africa, a variety of whole grains and starchy veg-etables 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.

African Heritage Diet Pyramid


“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 Amer-icas cooked and ate in ways that were familiar to them, making do—and often making magic—with 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, toma-toes, 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 tropi-cal 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 reten-tions and the creative resourcefulness of Africans replanted in the Americas—all 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.


FOODS WITH CULTURAL SIGNIFICANCEFoods of Western and Central AfricaInfluences: Portuguese, Asian, Indian, Middle Eastern

•Grains:millet,sorghum,wheat,rice

•Beans:black-eyedpeas,chickpeas,lentils

•Tubers:cassava,manioc,yams

•Vegetables:leafygreens,cabbage,okra

•Fruits:watermelon,tamarind,plums,dates,figs,pomegranates

•Meats:beef,lamb,goat,camel,poultry,wildgame

•Oils:sheabutter,sesameoil,palmoil

•Milk:cow,goat,sheep,camel

Diaspora Foods: American SouthInfluences: French, Spanish, African, Haitian, British

•Grains:rice,grits,cornmeal

•Beans:black-eyedpeas,kidneybeans

•Tubers:sweetpotatoes

•Vegetables:dandelion,watercress,otherleafygreens such as cabbage, okra, tomatoes, peppers, green beans

•Fruit:apples,berries,watermelon

•Seafood:oysters,crabs,shrimp

•Meats:beef,chicken,pork,wildgame

Afro-Caribbean Foods Influences: French, African, British, Spanish

•Grain:rice

•Beansandpeas:pigeonpeas,blackbeans,kidneybeans

•Tubers:breadfruit,yams,plantains,pumpkins

•Vegetables:leafygreenssuchascallaloo,okra

•Fruit:papaya,guava

•Seafood:saltfishandconch,redsnapper

•Meat:chicken,goat,beef,pork

Afro-South American Foods Influences: Native American, Spanish, Portuguese

•Grains:rice,corn,wheat

•Beans:blackbeans,pintobeans,redbeans

•Tubers:yucca,cassava

•Vegetables:okra,cabbage,kale

•Fruits:mangoes,guava,acerola

•Seafood:redsnapper,codfish,shrimp

•Meat:beef,pork,poultry,chicken


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.

Putting the Pyramid Into PracticeTo help black families apply the information from the pyra-

mid to the plate, Oldways developed 12 “plates of expression”—examples of the kinds of savory, spicy dishes that have an important place in the realm of healthful soul food.

“These plates also depict real foods and real meals that translate the science of the pyramid into a healthful delicious plate,” Baer-Sinnott says. Examples include healthful reci-pes for Hoppin’ John from the American South, West African peanut soup, grilled snapper with mangoes from the Carib-bean, and Moqueca de Peixe (Brazilian fish stew).

The pyramid doesn’t focus solely on food; it also advo-cates a holistic approach to a more healthful life. The base of the pyramid illustrates people engaged in enjoyable activi-ties such as exercise, gardening, cooking, and sharing family meals—activities that go hand in hand with a nutritious diet to promote good health.

Claiming History, Claiming HealthAngela Ginn, RD, LDN, CDE, a spokesperson for the Acad-

emy of Nutrition and Dietetics, says the response among her patients has been most positive.

“I see people who are Guyanese, Trinidadian, Jamaican—from all areas,” she says. “When they see the African Heritage Diet Pyramid, their response is one of nostalgia: ‘This is what I ate when I was home’ or ‘This is what I ate when I went to my grandmother’s house.’”

Ginn believes that a diet option with cultural connections resonates more with her patients because, among African Americans, a meal isn’t just the food on the plate; it’s a whole experience. “If I can put an experience around healthful eating—feeling good about your past and bringing it to everyday—that will help make it more of a life-style,” Ginn says. Then it’s not just a diet; it’s a way of life patients can embrace, sustain, and be proud of.

— Constance Brown-Riggs, MSEd, RD, CDE, CDN, is the

national spokesperson for the Academy of Nutrition and Dietetics,

specializing in African American Nutrition, and author of The African

American Guide to Living Well With Diabetes and Eating Soulfully and

Healthfully With Diabetes.

West African Peanut SoupRecipe courtesy of Oldways

Serves 6

Ingredients 2 T olive oil2 medium-size onions, finely chopped2 large red or green bell peppers, finely diced6 large garlic cloves, minced1 (28-oz) can crushed tomatoes, using the liquid4 cups vegetable broth1⁄2 tsp pepper1⁄2 tsp chili powder2⁄3 cup extra crunchy peanut butter1 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.

Nutrient Analysis per servingCalories: 262; Protein: 10 g; Carbohydrate: 24 g; Fiber:

7 g; Total Fat: 16 g; Saturated Fat: 3 g; Trans Fat: 0 g; Choles-terol: 0 mg; Sodium: 297 mg

— IMAGE COURTESY OF OLDWAYS

Moqueca De Peixe (Brazilian Fish Stew)Recipe courtesy of Oldways

Serves 4

Ingredients Four 1⁄2-inch fillets of any whitefish, like cod 2 garlic cloves, minced 2 lemons or 4 T of lemon juiceA 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

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 sauté 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.

Nutrient Analysis per servingCalories: 191; Protein: 10 g; Carbohydrate: 7 g; Fiber: 1 g;

Total Fat: 15 g; Saturated Fat: 3 g; Trans Fat: 0 g; Cholesterol: 23 mg; Sodium: 8 mg

Grilled Red Snapper With MangoesRecipe courtesy of Oldways

Serves 4

Ingredients 2 to 3 T of olive oil 5 T fresh cilantro, finely chopped3 T fresh lime juice11⁄2 tsp grated lime peel2 pinches of salt, divided2 pinches of pepper, divided 1 large mango, peeled, cut into thick wedges 4 5- to 6-oz red snapper fillets1 tsp of cumin seeds1 lb green beans2 red bell peppers, cut into slices8 large red-leaf lettuce leaves

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 they’re 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.

Green beans and peppers 1. In a medium-size pot, boil a small amount of water. Put

washed green beans and bell peppers into a strainer and steam over the water, covered, for about 6-8 minutes.

2. Place 2 lettuce leaves on each of 4 plates. Top them with the fish and mango, and have the green beans and peppers on the side. Drizzle the remaining vinaigrette over everything.


Total Fat: 9 g; Saturated Fat: 2 g; Trans Fat: 0 g; Cholesterol: 53 mg; Sodium: 31 mg

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Healthy Hoppin’ JohnRecipe courtesy of Oldways

Serves 4

Ingredients 1 cup dried black-eyed peas (or 1 15-oz can) 41⁄2 cups water 1 T olive oil 1 small onion, chopped 2 garlic cloves, minced 1 tsp salt1 cup uncooked brown rice1⁄2 tsp cayenne pepper 1⁄2 tsp black pepper

Directions 1. Soak the black-eyed peas. (It’s 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, sauté onion and garlic in olive oil for 1 to 3 minutes, until translucent (do not brown).

3. Add peas, salt, brown rice, and 31⁄2 cups of fresh water

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.


Total Fat: 5 g; Saturated Fat: 0.7 g; Trans Fat 0 g; Cholesterol: 0 mg; Sodium: 600 mg

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RESOURCESOldways has many resources available for RDs about the African Heritage Diet Pyramid, including the following:

•AfricanHeritage101brochure

•AfricanHeritageDietPyramidposter

•Grocerylist

•SettingUpanAfricanHeritageKitchenguide

•Recipesforthe12PlatesofExpression

•Diasporafoodglossary

Visit www.oldwayspt.org for more information.


Optimize Whole-Body Nutrition for

Experts Say a Nutrient-Dense Diet

Plus Physical Activity Will Help Clients

Stay Younger Longer

By Lindsey Getz

Healthful Agıng

M 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 patient’s 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, vita-min D, and vitamin B12, so it will be important for RDs to rec-ommend these clients get their blood levels tested so they can begin eating the right foods to boost their intake of these nutri-ents. Potassium-rich foods such as bananas, apricots, car-rots, 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 it’s important that older adults are eating a healthful and bal-anced diet with some variety.”

What’s 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. “It’s 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, Today’s 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.

Heart HealthBecause 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 doesn’t mean they’re following through. As adults age, some educa-tion 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 oil—or a margarine that’s 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 VisionEye health is a big concern for aging adults. Even the

normal aging process can bring on changes that impact eye-sight. 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, scien-tists have established a link between good nutrition and eye

health. It’s believed that some age-related eye diseases may be slowed or even prevented with the right nutrients. Still, eye health doesn’t always get much attention. “The primary focus tends to be on heart disease when it comes to aging and that’s certainly important,” says Joan Salge Blake, MS, RD, LDN, a nutrition educator, clinical associate professor at Boston Uni-versity, 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, col-lards, broccoli, and orange juice.”

Bones and MusclesAging means losing muscle mass. On average, adults

lose 2% of muscle mass per year after the age of 50, which decreases basal energy metabolism. So the body burns fewer calories while at rest. For older adults to avoid weight gain, it’s important for them to reduce their caloric intake or engage in regular physical activity that includes aerobic and weight- bearing exercise. And since adults need more protein as they age, it’s important they eat lower-fat protein sources such as beans, low-fat dairy, and leaner cuts of meat.

“Even if the person’s weight stays the same, their muscle mass often deteriorates and their fat mass increases, which means a lower metabolic rate,” says Terri McNeany, MS, RD, CD, clinical nutrition manager at St Vincent Frankfort Hospital in Indiana. “Maintaining muscle mass is important for overall health. It even contributes to the immune system, which is pro-tein based.”

Adults also lose bone density as they get older, so calcium and vitamin D are obviously vital. “But a lot of older adults find calcium harder to get because many experience lactose intoler-ance as they age,” McNeany says. “Older adults that are avoid-ing dairy need to look at fortified sources of soymilk or fortified juices and spread their intake throughout the day. It’s best to get no more than 400 mg at once so that it’s fully absorbed. [So] spread it out throughout the day.”

While the sun is the most potent source of vitamin D, it’s also a cause of skin cancer. “Nowadays, with more people being conscious of wearing sunscreen, it’s become increas-ingly important that they get their vitamin D from their diet,” Blake says. “Many of today’s products are fortified with vitamin D and people need to pay attention to that and buy products like orange juice that are fortified with both calcium and vitamin D.”


Healthy SkinBecause skin doesn’t 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 who’s a spokesperson for the Academy. “It’s really important to drink plenty of water,” she adds. “You can count other fluids toward hydration but it’s 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 HealthMaintaining mental health is of great concern for those aged

50 and older and another area in which nutrition can play a vital role. “It’s common to become forgetful as we age, so it’s impor-tant to incorporate fruits and vegetables rich in flavonoids in the diet, as there’s evidence they can aid memory,” Sheth says.

THE WONDER OF BERRIESResearch has shown that berries can have a major

impact on the diseases of aging, and it’s 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 raspberries—along with the more exotic and expen-sive varieties, including açaí and wolfberries—may pre-vent 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 study-ing the powers of berries for years. Today’s Dietitian (TD) recently caught up with Howell to find out about some of her research on cranberries.

TD: We’ve 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: It’s 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 infec-tion and disease not only in the urinary tract but also in the stomach and oral cavity. And the benefits don’t 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 recom-mend to get the benefits?

Howell: I’d say one glass a day, but if you’re 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. I’d recommend one in the morn-ing 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, there’s less chance of it becoming resistant. While UTI prevention is a well-known benefit of cranberries, there’s also research being done that points toward disease prevention. For instance, cardio-vascular 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. Ber-ries, 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 flavo-noids 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. They’re now available year-round in the freezer section.”

Good DigestionDuring 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 pas-sage of food through the intestines and ultimately lead to con-stipation, 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 [they’re] able to keep the mus-cles in the GI tract active.”

“When you’re eating fewer calories it’s even more important that each calorie is fiber rich since constipation is a common concern as people age,” Blake says. “Americans should be get-ting a minimum of 4 cups of fruits and vegetables a day, and many aren’t coming close to that,” she adds. “One hundred per-cent [fruit] juices are wonderful, but [clients] need to be careful they’re also eating plenty of whole pieces of fruit. I also recom-mend a high-fiber cereal in the morning for a great kick-start to the system.”

Pain-Free JointsWhen 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 cli-ents 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

fish, flaxseed, and fish oil supplements, all of which are rich in omega-3 fatty acids.

Mouth and Sensory ChangesWhile we tend to focus on the impact of nutrition on major

organs, it’s important to pay attention to the fact many older adults experience changes in the mouth that make getting proper nutrition challenging. Physical changes such as lost or decaying teeth or ill-fitting dentures can make eating prob-lematic, McNeany says. “It can be particularly hard to get the fiber and protein you need when chewing meat is difficult,” she adds. “Suggest your clients choose softer sources of protein like cottage cheese or eggs. Instead of a thicker cut of meat, they can go for ground meat or meatloaf. And keeping the mouth moist by drinking in between bites also can make food easier to chew.”

Besides physical problems with chewing, older adults may develop sensory issues. Food texture suddenly may become a concern, and they may have increased trouble swallowing, par-ticularly if there’s a loss of muscle function from a stroke or a disease such as multiple sclerosis. Modifying food texture by chopping or puréeing is a solution. It’s also common for older adults to experience changes in taste. “I’ve seen many older adults lose [their] sense of taste and suddenly develop a sweet tooth,” McNeany says. “I try to encourage naturally sweet foods like fruit instead of candy. Eating colder foods also can be more tolerable, and you can taste more flavor. Hot foods tend to give off more odors. Colder foods like sandwiches or dairy products may be better tolerated.”

In addition, it’s not uncommon for the sense of thirst to diminish with age, so dehydration becomes a real concern for older adults. “I often find many of my older patients aren’t taking in enough fluids,” McNeany says. “An easy way for patients to think about how much they should be drinking is taking in half of their body weight in water each day. That defi-nitely takes some conscious effort. I recommend a refillable water jug marked in ounces or keeping track of the number of water bottles you drank by numbering the tops. That’s some-thing I do myself. Sometimes it helps to have something visual.”

Balanced DietWhile each system of the body has its own importance, it

all comes back to a diet that’s nutritionally balanced and full of fruits, vegetables, and whole grains. “It’s really the total diet,” Sandquist says. “Many of these areas overlap and that’s because it goes back to just eating a basic healthful diet. Sup-plements 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.


Living with chronic abdominal pain, gas, bloat-ing, 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, Aus-tralia.1 Monash University researchers call this approach the low-FODMAP diet, known as fermentable oligo-, di-, and mono-saccharides 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 follow-ing the low FODMAP diet, it’s 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 health-ful food choices while dining out.

Research Behind FODMAPsFODMAPs are found in everyday foods, including milk and

ice cream (lactose); apples, pears, honey, and watermelon (free fructose); wheat, onions, garlic, and inulin (fructans); legumes (galacto-oligosaccharides [GOS]); and prunes, sugar-free

By Kate Scarlata, RD, LDN

Experts Discuss

Meal-Planning

Strategies to

Help IBS Clients

Better Control

GI Distress

Low-FODMAPLiving


gum, and mints (polyols). FODMAPs have a cumulative impact on gastrointestinal symptoms. Individuals may tolerate small amounts, but symptoms can develop if they consume quantities that surpass their threshold.

Studies have shown that ingesting FODMAPs exacerbates symptoms in most people with IBS, while dietary restriction of FODMAPs improves symptom control. Ong and colleagues2 from Monash University found that in those with IBS, dietary FODMAPs induce prolonged hydrogen production in the intes-tine to a greater degree. More recently, researchers at King’s College London found that the low FODMAP diet, in contrast to standard diet therapy for IBS management, showed improved overall symptom response in 86% of participants compared with 49% in the standard diet group.1 Halmos and colleagues3 found that enteral formula with the highest FODMAP con-tent created a greater risk of diarrhea, a common concern with enteral tube feeding. Research supports the use of the low FODMAP diet in patients whose inflammatory bowel dis-ease is in remission but who have enduring IBS symptoms.4 In patients with strictures, however, a low FODMAP diet is con-traindicated, as the osmotic effects of the FODMAPs are likely to be beneficial in preventing intestinal obstruction.

Balance Good Nutrition With Symptom ControlWhen counseling clients about menu planning, factor-

ing in their food preferences and lifestyle behaviors likely will help them adhere to the low FODMAP diet. The diet is some-what restrictive but can provide adequate nutrients with careful planning. For those with lactose intolerance, meeting calcium and vitamin D requirements can be more challenging. Encour-age consuming lactose-free milk; acceptable cheeses such as Swiss, cheddar, feta, and mozzarella; enriched rice milk; spin-ach; and canned salmon for low FODMAP calcium sources. You can suggest vitamin supplements as needed and choose those free of FODMAP ingredients such as sorbitol and mannitol.

Fiber intake can decrease when clients follow the low FODMAP diet so discuss low FODMAP fiber sources such as oatmeal and rice bran as shown in Table 1 on page 38.

If clients need fiber supplements, suggest a nonfermentable fiber choice such as Citrucel.

FODMAP-Friendly Menu PlanningWhen helping clients plan menus, it’s a good idea to

encourage them to develop a strategy and plan ahead. For example, since most commercial meat and vegeta-ble broths are rich in FODMAP ingredients, suggest clients make a homemade broth by boiling water containing chicken breasts, celery leaves, parsnips, carrots, salt, and pepper. Save the broth and chicken for meals and side dishes during the week. They can make risotto, chicken pot pie, chicken salad, or chicken and rice soup. Recommend they make large

Low FODMAP Vegan MenuBreakfastQuinoa flakesEnriched rice milk3⁄4 cup strawberries1 T sliced almonds

LunchRice cakes with nut butterFruit salad with 1 cup (total) low FODMAP fruits (eg, kiwifruit, strawberries, blueberries)Spinach salad with lemon dressing and cherry tomatoes

SnackCarrots and red peppers dipped in tahiniRice milkHandful of almonds

DinnerTofu and vegetable stir-fry (red peppers, zucchini, summer squash, carrots)Quinoa and millet sauté with pine nutsKiwifruit or orange

Low FODMAP MenuBreakfastErewhon Corn FlakesEnriched rice milk (organic Rice Dream)Banana1 T sliced almonds

LunchUdi’s white breadSliced turkeyLettuce or spinach leavesTomatoSliced cheddar cheeseGreen Valley lactose-free vanilla yogurt1⁄2 cup blueberriesBaby carrots

DinnerGrilled chicken or salmonBaked potato with skin (butter optional)Sautéed spinach and red peppers seasoned with green part of spring onion, salt, pepper, handful of pine nuts, and olive oilKiwifruit


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 FOD-MAPs, 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.

Safe SnackingOnce clients are armed with menu ideas, encourage them

to keep low FODMAP snacks on hand since they’re 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 Udi’s 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.

Add Flavor Not FODMAPsClients who like to cook often use onions and garlic to flavor

their food. But these pungent flavor enhancers aren’t suitable for those following the low FODMAP diet.

For onion flavor, substitute low FODMAP choices such as chives, scallions (green part only), and/or a dash of asafoe-tida powder. Found in Indian markets, asafoetida powder may contain small amounts of wheat, so advise clients with celiac disease to buy a wheat-free brand. For garlic lovers, suggest they sauté large garlic chunks in oil over medium heat until the flavor permeates the oil. Remove the garlic pieces before using the oil as a flavoring to ensure the dish remains tasty but low in FODMAPs. Warn clients not to add chunks of garlic to a water-based recipe and remove them because the fructans in the garlic are water soluble and may seep into the water.

Grocery Shopping the Low FODMAP WayOnce clients plan their menus, they’ll need to shop for

ingredients. Maintaining a low FODMAP pantry is key to sus-taining a low FODMAP diet. Here are some tips to help clients get started:

•Choose colorful fruits low in FODMAPs such as strawber-ries, bananas, blueberries, grapes, cantaloupe, pineapple, oranges, and kiwifruit.

•Select vegetables such as spinach, carrots, red bell pep-pers, 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 heart-healthy 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.

Label Reading StrategiesAs clients shop for low-FODMAP foods, they must learn

how to read labels. Many people assume a gluten-free prod-uct is low in FODMAPs, but that’s not always the case. In fact, many gluten-free products contain honey, pear juice, onions, and garlic, so they aren’t appropriate for those following a low FODMAP diet. Tell clients that ingredients are listed with the most predominant ingredient first. So if honey is the last ingredient in the list (an indication it’s not used to sweeten the product), it’s likely a low-FODMAP food. Suggest clients avoid products in which FODMAPs are more abundant or if multiple FODMAPs are present. Furthermore, clients should take note of added fiber ingredients such as inulin, often labeled as chic-ory root extract and fructo-oligosaccharides. Both are sources of fructans and can trigger symptoms.

The sidebar on page 39 presents ingredients lists to illus-trate a low and high FODMAP product. The bolded items are considered FODMAP sources.

Table 1: Fiber Without FODMAPsFood Portion Size Grams of Fiber

Oatmeal 1⁄2 cup, dry 4.1

Oat bran 1⁄2 cup, dry 7.2

Rice bran 1⁄4 cup, dry 6.2

Strawberries 1 cup, halves 3

Blueberries 1 cup 3.6

Orange 1 medium 3.1

Spinach 1⁄2 cup, cooked 2.2

Baked potato, with skin 1 medium Russet 4

Quinoa 1 cup, cooked 5.2

— Source: USDA National Nutrient Database for Standard Reference


Dining Out Without Consequence Restaurants that serve gluten-free foods may be a good

choice for clients on a low-FODMAP diet. Although the low FODMAP diet isn’t a gluten-free diet, both restrict wheat, which is a big source of FODMAPs. Since onions and garlic added to dishes may pose a problem, instruct patients to order foods without these ingredients. Hidden sources of onions and garlic include salad dressings and broth-based dishes such as risotto and marinades.

Suggest clients follow these tips for dining out: •Bring a low-FODMAP roll, wrap, or bread to the restaurant

and order a burger, grilled fish, chicken, or beef.•Fill a thermos with lactose-free milk or rice or almond milk

to add to your cereal, oats, or coffee when dining away from home.

•Order a salad and dress it with vinegar or lemon wedges and olive oil.

•Choose brown rice or gluten-free pasta with butter and Parmesan cheese, or a baked potato for a side dish.Patsy Catsos, MS, RD, a Maine-based dietitian and FODMAP

diet expert, says, “Many world cuisines are rice based, such as Thai, Chinese, Japanese, and Indian. Have a look at the menu and choose grilled or roasted beef, chicken, shrimp, or fish with traditional seasonings. Add rice or rice noodles with an assort-ment of steamed or stir-fried vegetables and ask to hold the onions. The sauces are likely to contain most of the FODMAPs in these meals, so either find out what they’re seasoned, sweet-ened, and thickened with or ask for them on the side so you can use just a little.”

In a pinch, clients can go to some fast-food restaurants that have low FODMAP options. For instance, clients can eat oatmeal from Starbucks or McDonalds. “Just use 1 table-spoon of dried cranberries or raisins,” Catsos suggests. Other low FODMAP options include Wendy’s baked potato, sushi, a banana, a small fresh fruit cup, a handful of roasted nuts, tor-tilla chips, sliced deli meat, chicken or tuna salad, a chef salad, hard-boiled eggs, cheese sticks, pumpkin or sunflower seeds, and even pickles, Catsos says.

More to ComeThe 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-to-date information. Recently, researchers have developed con-sumption 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 RD’s role: “Dietary restriction of FODMAPs is an effective therapy in the majority of patients with functional bowel symptoms. It’s a diet that should be taught by a dietitian, and it should be first-line 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 Idiot’s Guide to Eating Well With IBS.

Low FODMAP vs. High FODMAP LabelLow FODMAP Bread: Filtered water, tapioca starch, brown rice flour, potato starch, sunflower oil or canola oil, egg whites, evaporated cane juice or sugar, tapi-oca syrup or brown rice syrup, yeast, xanthan gum, salt, baking powder (sodium bicarbonate, cornstarch, cal-cium sulfate, monocalcium phosphate), mold inhibi-tor (cultured corn syrup, ascorbic acid), ascorbic acid (microcrystalline cellulose, corn starch), enzymes.

High FODMAP Bread: Water, potato extract, rice starch, rice flour, sorghum flour, organic high oleic sunflower/safflower oil, organic evaporated cane juice, organic honey, egg whites, organic inulin, yeast, sea salt, organic molasses, xanthan gum.

Honey and molasses are sources of excess fructose and inulin is a fructan, making this bread a poor choice for followers of a low FODMAP diet.



ADDING SPICE FOR A HEALTHIER LIFE Evidence Shows Antioxidant-Rich Herbs and Spices May Cut Chronic Disease RiskBy Megan Tempest, RD

Talk to patients about consuming foods high in antioxidants, and chances are you’ll conjure up images of juicy blueber-ries, deep green kale leaves, or brightly colored fruits such as plums, oranges, and kiwis. What patients may not know, how-ever, 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 1⁄2 teaspoon of ground clove is said to contain more anti-oxidants than 1⁄2 cup of blueberries. And what about that little teaspoon of dried oregano that’s often stirred into a simmering pot of spaghetti sauce? That’s an amount equal to the antioxi-dants contained in a whole cup of sweet potatoes.1

Given the number of scientific studies suggesting the health benefits of antioxidants, it’s important that dietitians counsel clients about the potential benefits of consuming foods contain-ing 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.

The following article examines five herbs and spices that are excellent sources of antioxidants, reviews the major health bene-fits of antioxidant intake, and offers strategies on how to encour-age clients to incorporate more antioxidants into their diets.

Spices Packing a Powerful Antioxidant PunchBy definition, antioxidants are substances that may pro-

tect cells from the damage caused by unstable molecules known as free radicals.2 In nature, antioxidants protect living organisms from oxidative stress. By consuming antioxi-dant-rich foods, it’s believed the human body obtains these protective benefits, ranging from fending off age-related wrinkles to preventing chronic illnesses such as heart dis-ease and cancer. Examples of well-recognized antioxidants are vitamin C, vitamin E, beta-carotene, and plant-derived polyphenolic compounds such as quercetin in citrus fruits; resveratrol in red grapes; and rosmarinic acid in rosemary, basil, and oregano.

Antioxidants are found in variable amounts in the hundreds of herbs and spices that exist in the plant kingdom. Here’s a quick look at five dried herbs and spices that rank highest in antioxidant content per 100 g (based on a list from the McCor-mick Science Institute), and various tips for helping clients incorporate them into their favorite foods.3

1. CloveWhat 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 Hernández University in Spain reported that clove ranks highest

CPE MONTHLY

LEARNING OBJECTIVESAfter 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 believed to protect the body from free radical damage.

3. Evaluate recent research on antioxidants in herbs and spices.

4. Provide guidance to clients regarding the use of anti-oxidant-rich herbs and spices in cooking.


as a natural antioxidant due to its phenol content and demon-strated ability to inhibit several damaging oxidative processes.5

How can clients use it? Due to its pungent aroma, many cli-ents may be unsure how to subtly incorporate clove in cooking. But according to Sheth, clients can use ground clove wher-ever 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.

2. OreganoWhat is it? Cultivated for centuries and widely used in Med-

iterranean and Mexican cuisine, dietitians would be hard-pressed to find someone who hasn’t tasted oregano in foods. Scientifically known as Origanum vulgare and occasionally referred to as wild marjoram (to which it’s a close relative), common oregano comes from the dried leaves of a small perennial flowering shrub that’s 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 rosma-rinic acid, along with humalogs from the antioxidant vitamin E. Studies have shown oregano to have the highest total antioxi-dant 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 sand-wiches (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.

3. GingerWhat is it? Dried, ground ginger comes from the root of the

perennial herb Zingiber officinale. After the plant reaches its 2- to 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 gin-gerol, 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 sick-ness 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

yogurt and sprinkle it on toast to make a quick and easy ginger-bread toast. Ground ginger instantly adds an Asian flair to sau-téed vegetables, salad dressings, and marinades. Encourage clients to sprinkle ground ginger on sweet potatoes for an anti-oxidant-packed side dish.

4. CinnamonWhat 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 char-acteristic curls known as quills.4

What does it contain? Antioxidant components of cinna-mon, 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.”

5. TurmericWhat 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 polyphe-nol compound found in turmeric, has been the focus of intense

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.

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research due to its potential to avert chronic diseases such as cancer, heart disease, arthritis, and Alzheimer’s disease. Cur-cumin has been shown to inhibit the expression of a specific gene that’s believed to lead to the development and progression of breast cancer.9

How can clients use it? “People often don’t know what to do with turmeric,” Sheth says, “but it can be added to any vegeta-ble 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 turmeric’s 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; that’s where tur-meric can really help out a dish,” she says.

Historical Uses of Herbs and SpicesThe use of herbs and spices for medicinal, culinary, and other

functional purposes has persisted through multiple centuries and in regions around the world. It’s been reported that the first documented use of herbs and spices dates back to Egypt as early as 2600 BC, during the age of the pyramids. Fragrant herbs and spices such as cinnamon, anise, and cumin often were integral ingredients in the embalming process. The Romans considered the scent of cinnamon sacred and, therefore, burned it at funeral ceremonies. Chinese courtiers of the third century BC are said to have carried cloves in their mouths to ensure sweet-smelling

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 jaun-dice. Ayurvedic wisdom suggests chewing clove and cardamom after meals to increase the flow of saliva and enhance diges-tion. These are just a handful of examples of the versatile uses of herbs and spices throughout history.10

Reducing Deadly Carcinogens and Disease RiskToday herbs and spices are perhaps best known for their

unique aromas and flavors they impart to food. Researchers are just beginning to understand their potential as disease-fighting sources of antioxidants, yet the available studies on the subject are intriguing. One particular hot topic on the research forefront is the role herbs and spices may play in reducing the formation of harmful carcinogens formed when cooking meat. Joy Dubost, PhD, RD, a spokesperson for the Academy, finds the evidence compelling: “The overall take-home message is that adding spices and herbs seems to reduce the harmful by-products formed in cooked meat that may lead to cancer.”

For example, in the May 2010 issue of the American Journal of Clinical Nutrition, Zhaoping and colleagues reported that adding a polyphenol-rich spice mixture (notably contain-ing rosmarinic acid from oregano) to hamburger meat before cooking reduced the formation and absorption of malondi-aldehyde, a naturally occurring by-product of lipid peroxida-tion thought to cause changes to DNA and promote cancer. A similar study by Smith and colleagues of Kansas State Univer-sity, published in the 2008 issue of the Journal of Food Science, drew parallel conclusions regarding the power of antioxi-dant herbs and spices to reduce harmful meat by-products. The findings suggested that commonly available, spice-con-taining marinades can be effective inhibitors of heterocyclic amine (HCA) formation and lessen exposure to some of the carcinogens formed during grilling. The National Cancer Insti-tute (NCI) defines HCAs as chemicals formed when muscle meat, such as beef, pork, poultry, and even fish, is cooked using high-temperature methods such as pan frying or grill-ing directly over an open flame. More specifically, HCAs are formed when amino acids, sugars, and creatinine react at high temperatures. The potential for antioxidant herbs and spices to reduce or prevent the formation of HCAs during the cooking of meat at high temperatures is important because epidemio-logic studies have found that high consumption of well-done, fried, or barbecued meats, which are the only foods that con-tain significant amounts of HCAs, is associated with a higher risk of cancer of the colon, pancreas, and prostate.11

The power of antioxidant herbs and spices to inhibit the for-mation of HCAs during the cooking of meat was further dem-onstrated by the Puangsombat and Smith study reported in the March 2010 issue of the Journal of Food Science, showing that constituents of rosemary extract—rosmarinic acid, camasol,

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and carnosic acid—may 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. Puang-sombat and colleagues reported in the October 2011 issue of the Journal of Food Science that all five of the Asian spices sig-nificantly 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 carci-nogenic 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, accord-ing 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 con-stituents of cinnamon and clove may lower the risk of develop-ing atherosclerosis and diabetes.

Bioavailability of AntioxidantsDetermining the level of antioxidants various herbs and

spices contain, as well as how well our bodies absorb these antioxidants during digestion, is yet another area of ongoing

scientific investigation. Daly and colleagues addressed this subject in the June 2010 issue of Plant Foods for Human Nutri-tion. Their study analyzed the content of carotenoids—natu-rally occurring plant pigments with antioxidant properties, such as beta-carotene, beta-cryptoxanthin, and lutein and zeaxanthin—in the herbs basil, coriander, dill, mint, pars-ley, 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 bioacces-sibilities ranging from 0% to 42.8%. Basil and coriander con-tained 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 aren’t 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 fol-lowing strategies can help.•Consume herbs and spices for their antioxidant con-

tent, not for specific health benefits. RDs should continue to encourage patients to consume antioxidant-rich foods, includ-ing 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 Dubost’s perspective, the real challenge lies not in prov-ing that herbs and spices have health benefits but in determining what those specific health benefits are. “We do know, based on different tests, that there’s antioxidant content within fruits and vegetables, and spices and herbs,” she asserts. “However, the

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research is quite limited on how their antioxidant content trans-lates to health benefits. That’s important to note. We’re 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 addi-

tives. While dietitians may not have ample evidence to recom-mend 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 haven’t gone out of their way to try other seasonings.” That’s 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 cinna-mon 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 that’s 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 research-ers 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 mixture—retained their antioxidant capacity and phenolic content during the drying pro-cess. 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

Looking AheadAs the scientific evidence continues to unfold, it’s 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 exam-ple, they could encourage the use of turmeric to inhibit cancer

growth or eat oregano to delay Alzheimer’s disease. In the interim, however, the potential health benefits of antioxidants can’t 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.

References1. 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, Sánchez Zapata E, Fernández-López J, Pérez-Álvarez JA. Antioxidant activity of essential oils of five spice plants widely used in a Mediterra-nean 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 sub-stances with cancer preventive and therapeutic potential. Forum Nutr. 2009;61:182-192.

8. Boga M, Hacibekiroglu I, Kolak U. Antioxidant and anti-cholinesterase 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.


CPE Monthly Examination

1. According to the McCormick Science Institute’s antioxi-dant comparison of spices and foods, which of the follow-ing herbs and/or spices does not rank among the highest in antioxidant content?

a. Onion powderb. Oreganoc. Turmericd. Clove

2. In nature, antioxidants protect living organisms from oxidative damage.

a. Trueb. False

3. According to the National Cancer Institute, which state-ment concerning heterocyclic amines (HCAs) is false?

a. They are formed when amino acids, sugars, and cre-atinine react at high temperatures.

b. They are found in significant amounts in plant-based foods cooked at high temperatures.

c. Pan frying or grilling meat directly over an open flame may promote their formation.

d. Fish, when cooked at high temperatures, may form HCAs.

4. Malondialdehyde is a by-product of lipid peroxidation that alters DNA and may cause cancer.

a. Trueb. False

5. The constituent of turmeric that’s being heavily investi-gated for its ability to inhibit cancer growth, among other health benefits, is which of the following?

a. Rosmarinic acidb. Thymerisolc. Curcumind. Curry

6. Which herb is reported to contain humalogs of vitamin E?

a. Cloveb. Oreganoc. Turmericd. Cinnamon

7. When counseling patients, appropriate recommenda-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 medica-tion in favor of using a specific herb or spice to treat a medical condition.

c. Use herbs and spices as substitutions for less health-ful additives such as fat, sugar, and salt.

d. All of the above

8. Research has suggested which of the following constit-uents may inhibit expression of a gene that causes breast cancer?

a. Curcuminb. Cinnamaldehydec. Gingerold. Rosmarinic Acid

9. According to an animal study by Jin and Cho, which of the following herbs/spices were found to potentially treat hyperlipidemia and diabetes?

a. Fingerroot and cloveb. Cinnamon and clovec. Garlic and paprikad. Cumin and oregano

10. According to a study by Henning and colleagues, pro-cessed herbs may contribute significant amounts of anti-oxidants to the diet.

a. Trueb. False


COUNSELING CLIENTS WHO JUST WON’T CHANGERDs Give Sage Advice to Help Fine-Tune Your Approach By Lindsey Getz

Bob has been back for several follow-up visits yet he seems to continue struggling with the same issues: unstable blood sugar and a high hemoglobin A1c level. He’s already on medica-tion for glucose, blood pressure, and lipid control, but he isn’t following the exercise regimen you suggested or making any dietary changes.

As a certified diabetes educator and dietitian, you’ve probably dealt with several patients like Bob who just won’t change, leav-ing you feeling frustrated because they’re not following your directions. Under these circumstances, it may be challenging to take a step back to assess the situation, but it’s the perfect opportunity to examine your approach.

“If you’re frustrated with certain patients and can’t under-stand why they won’t make important changes, you may need to ask yourself what can you do differently,” suggests Ann Constance, MA, RD, CDE, a master trainer for the Stanford Chronic Disease Self Management program and healthcare coordinator and director of the Upper Peninsula Diabetes Out-reach Network in Michigan. “There are many issues that can come into play. Skills like empowerment and motivational interviewing can be used effectively to determine what barriers might need to be overcome.”

This article will discuss the issues involved with patients who are unwilling to make important changes that will benefit their health and strategies to help guide them in the right direction.

Patient ReadinessFirst, 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 Behav-ior Change: A Food and Nutrition Profession-al’s Counseling Guide with Constance. “That’s where listening becomes so important.”

By listening to the patient, you’ll have the ability to recognize if he or she is even ready to change—and if not, you can start to under-stand 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 isn’t 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 won’t relapse.In precontemplation, for example, an RD would simply ask

the patient what positives he or she sees in making a particu-lar 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 patient’s perspective. “The patient may just have a different goal [in mind] than the provider—it’s not that he’s noncompliant,” she adds.

There are three Rs that can help facilitate the opportunity to look at things from the patient’s point of view: reflective listen-ing, rephrasing, and reframing. According to Sauter, reflective

DYNAMICS OF DIABETES


listening is reiterating the same information back to the patient. “You’re letting them know that you hear what they’re saying,” she says. “With reflective listening, you just want to be careful you’re not overusing it or you’ll 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 feel-ings into it, perhaps telling the patient you understand he or she is scared, worried, or confused. “With both reflective listening and rephrasing, you’re allowing them to look into the mirror and either realize that’s not what they meant to say or to confirm that is how they feel,” Sauter says. “And finally, with reframing, you’re helping them see they’re 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 they’re seeing the situa-tion 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, it’s 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 real-ity is that we need to identify what the patient is most concerned about and help the patient to set reasonable goals.”

Motivational Interviewing, EmpowermentThough many link the concepts of motivational interview-

ing and empowerment together, they aren’t the same. Both use the tools of reflective listening, rephrasing, and refram-ing, but with motivational interviewing, the provider is working against ambivalence. The end point of motivational interview-ing is setting a goal, whereas empowerment gives patients the tools they need to succeed. “I believe it’s really important to be trained in motivational interviewing and not to attempt it with-out being well trained,” Sauter asserts. “You’re dealing with a lot of ambivalence and want to make sure you’re able to build a case for behavior change.”

Empowerment helps the patient achieve self-confidence, acceptance, expertise, and emotional and physical well-being while also allowing the patient to become his or her own behav-ior change expert. “You’re not just saying, ‘Here’s the goal and these are the steps,’ but you’re working with the patient to help them become experts on tackling problems they’re faced with,” Sauter explains. “At the end of the day, you’re not going home with the patient, so they need to be able to make the decisions on their own. You need to make sure you’re not setting goals that you want the patient to do. The patient needs to set the goals.”

The bottom line is that you want the patient to put some of the goals you discuss into practice, and the way to do that is to ensure he or she is interested in making those changes. “We can dictate what’s best for the patient, but unless they view it as important and doable, it probably isn’t going to happen,” Constance says. “Make sure you ask open-ended questions such as ‘Tell me how you feel about having type 2 diabetes?’, ‘What’s

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.

SYSTEMS APPROACHThe WHAT System is a practical approach to set-

ting goals discussed in the book Inspiring and Support-ing Behavior Change: A Food and Nutrition Professional’s 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 help-ing 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. “That’s where the patient often needs help. That’s where the WHAT System can come into play.”

Here’s 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 patient’s confidence. Are you confi-dent the patient can achieve this? Is he or she achiev-ing 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 connect—per-haps through e-mail or a phone call—in a shorter time frame to check in on whether the patient is meeting the goal and help him or her make modifica-tions if needed.

— LG


EAT HEALTHFULLY ON A BUDGETDietitians Offer Strategies to Help Struggling Clients By David Yeager

With the economy still in the doldrums and the unemploy-ment rate hovering around 8%, nearly everyone is looking to save a few dollars these days. And one way consumers are pinching pennies is by skimping on nutritious food.

In July 2011, a Pollock Communications survey of 1,000 Americans found that more than 57% of respondents cited cost as a significant barrier to eating a more healthful diet. Judging from this data, one can infer that most people view eating healthful food as a luxury—and they may have good reason to believe so.

An August 2011 study from the University of Washington found that following the FDA’s MyPlate guidelines can add as much as $380 a year—more than $1 a day—to the average consumer’s grocery bill. Perhaps more surprising is that the study also found that for every 1% increase in calories from fat and sugar, consumers’ food costs declined significantly. These results don’t help dietitians convince clients that health isn’t a function of wealth.

Katherine Tallmadge, MA, RD, a spokesperson for the Academy of Nutrition and Dietetics (the Academy) and author of Diet Simple: 195 Mental Tricks, Substitutions, Habits &

Inspirations, says these numbers can be misleading. “If you’re just compar-ing 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 it’s the most calorie-dense food. But that’s not recommended, and that’s 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, that’s not value, in my opinion.”

Good Planning = Good EatingDespite the recent data, there are

numerous ways clients can eat nutri-tious foods without busting their gro-cery budget. For starters, they can buy seasonal fruits and vegetables, which are much less expensive than those purchased out of season.

“If you’re buying out-of-season fruit that needs to be flown in from the southern hemisphere, often you’ll pay several times more per pound than when buying in-season produce,” says Julie Upton, MS, RD, cofounder of Appetite for Health.

Upton says convenience costs such as this often add to an item’s retail price. Another example is precut or prewashed fruits and vegetables. They cost more than those that must be washed and chopped at home. Nonetheless, Upton says it’s important to weigh the convenience cost against the cost of not eating produce at all. If the choice comes down to eating a fruit or vegetable that’s ready to eat out of the bag vs. not buying it because of the extra work it takes to prepare it, the convenience cost over time will be much less than the poten-tial medical costs that may result from not eating enough fruits and vegetables.

When considering restaurant take-out and fast-food meals, the convenience costs are even greater. Preparing meals at home is much less expensive. But for clients with busy lives or few people for whom to cook, preparing meals at home can seem like a great deal of work for a small benefit. To ease their burden and help them save money, dietitians can encourage clients to cook in batches and freeze meal portions to reduce time in the kitchen. Preplanning weekly meals is another cost-cutting strategy.

“Lack of planning often can be a bigger obstacle to health-ful eating than lack of preparation time. How often do you come home and have no idea what to make for dinner and have nothing in the house?” says Karen Ansel, RD, a spokes-

FOR YOUR INFORMATION


person for the Academy and coauthor of The Baby and Toddler Cookbook: Fresh, Homemade Foods for a Healthy Start. “Creat-ing 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 what’s on sale. Making a shopping list has the added benefit of limiting impulse pur-chases, as does shopping after a meal when you’re full rather than before a meal when you’re hungry. Clients can stock up on nonperishable items, such as pasta, beans, and frozen vegetables, when they’re 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. “That’s many, many oatmeal break-fasts for pennies.”

Upton adds that comparing the unit prices of items—how much something costs per pound or per 100 units—helps 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 place-ment 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 posi-tioned 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 they’re inexpen-sive. 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 effec-tive ways to achieve this goal.

“Educating consumers, showing them how it can be done, giving them recipes that demonstrate they can have a great-tasting, healthful meal on a budget. I think that’s what dieti-tians 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.

“Life’stoo short to eat

boring rice.”

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3 cups cooked Texmati Brown Rice1 1/4 cups scalded milk1/4 cup shortening3 tablespoons brown sugar1 teaspoon salt2 packages active dry yeast2 cups all-purpose fl our2 cups whole wheat fl our

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person for the Academy and coauthor of The Baby and Toddler Cookbook: Fresh, Homemade Foods for a Healthy Start. “Creat-ing 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 what’s on sale. Making a shopping list has the added benefit of limiting impulse pur-chases, as does shopping after a meal when you’re full rather than before a meal when you’re hungry. Clients can stock up on nonperishable items, such as pasta, beans, and frozen vegetables, when they’re 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. “That’s many, many oatmeal break-fasts for pennies.”

Upton adds that comparing the unit prices of items—how much something costs per pound or per 100 units—helps 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 place-ment 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 posi-tioned 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 they’re inexpen-sive. 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 effec-tive ways to achieve this goal.

“Educating consumers, showing them how it can be done, giving them recipes that demonstrate they can have a great-tasting, healthful meal on a budget. I think that’s what dieti-tians 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.

“Life’stoo short to eat

boring rice.”

9 974401 400824

0074401-167000

Pour 1 cup scalded milk over shortening, sugar and salt. Add cooked rice. Dissolve yeast in cooled 1/4 cup scalded milk; stir into rice mixture. Work in fl ours to make a fi rm dough. Turn out on fl oured board and knead until smooth and elastic. Place in greased bowl, cover and let rise until doubled. Punch down and knead 2-3 minutes. Shape into loaves and place in well-greased loaf pans. Cover, let rise again until doubled in bulk, then brush tops with melted butter and bake at 375 degrees for 40-45 minutes.

3 cups cooked Texmati Brown Rice1 1/4 cups scalded milk1/4 cup shortening3 tablespoons brown sugar1 teaspoon salt2 packages active dry yeast2 cups all-purpose fl our2 cups whole wheat fl our

Enjoy Texmati®Brown Rice Bread

Save $2 on any RiceSelectTM itemMANUFACTURER’S COUPON EXPIRES 6/30/12

Consumer: One coupon per purchase only. Consumer pays any sales tax. Void if sold, exchanged, transferred, altered or copied. Store Manager: Redeem according to terms stated for consumer. Any other use constitutes fraud. RiceTec will pay 8 cents handling charge for each coupon if redeemed in accordance with the terms of this offer. To obtain payment sent to RiceTec, P.O. Box 1305, Alvin, TX 77512. Invoices showing purchase of stock to cover coupons must be shown upon request. Cash value 1/20 of one cent.


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8. Glut____9. Boost11. Dietary amounts15. Goes with 30 across 16. It’s often advised that this seasoning be cut back to

reduce high blood pressure17. Vitamin amount measurement18. Russia’s Internet symbol19. Mineral recommended to help reduce hypertension22. Blood group system23. Baltimore time25. Fruit seed rich in the antioxidant rutin and a good

source of fiber28. Strip the skin29. Brits’ thank yous30. It contains resveratrol (goes with 15 across)33. ____s, stomach muscles34. Lowest point36. The No. 1 lifestyle recommendation for reducing

blood pressure (2 words)38. Pickle spice40. Life____41. Having a low pH

Down1. Cereal that’s safe for someone on a gluten-free diet2. Assesses3. Electrical power measurement4. Kidney secretion5. Follow as a result6. See 26 down7. Recipe direction10. That is12. Order of corn13. Street, abbr.14. Lab eggs19. Angry crowd20. Relating to organic processes21. Amides combining the amino group of one amino acid

with the carboxyl group of another24. ____ salt26. Fish meal recommended as a good source of calcium

in the diet (goes with 6 down)27. Apple state30. Kind of salad31. Sample32. Pot top35. Fruit coating37. Protein source39. Dosage measurement

1 2 3 4 5 6 7

8 9 10

11 12 13 14 15

16 17

18 19 20

21 22

23 24 25 26 27

28

29 30 31 32 33

34 35

36 37 38

39

40 41

By Myles Mellor

ANSWER KEY ON PAGE 63

Interactive Puzzle


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The Gluten-Free Asian Kitchen: Recipes for Noodles, Dumplings, Sauces, and More By Laura B. Russell2011, Celestial Arts Softcover, 208 pages, $22.99

I must confess that the phrase “gluten free” can make me cringe. I know gluten-free 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 qual-ity of this book. Russell has followed a gluten-free diet since 2008 and is the “Gluten Freedom” columnist for the Orego-nian newspaper. It makes sense for those following a gluten-free 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. I’m 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 you’d 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. It’s 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 read-ers can determine which ingredients contain gluten, why, and how to make substitutions. Every potentially gluten-contain-ing 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 glu-ten-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 gluten-free diet and are interested in spicing up their menus with deli-cious 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 HealthBy Gerard E. Mullin, MD, and Kathie Madonna Swift, MS, RD, LDN2011, RodalePaperback, 356 pages, $19.99

With more than 60 million Ameri-cans known to suffer from digestive dis-orders, 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 aren’t 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 con-nection between small-intestinal bacterial overgrowth and other disorders such as irritable bowel syndrome (IBS), rheumatoid arthritis, and restless leg syndrome. They review common diges-tive 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 diges-tion, the authors suggest evaluation for other contributing fac-tors, such as a dysfunctional lower esophageal sphincter, and emphasize the role of diet and lifestyle modifications.

BOOKSHELF

If you’re looking for a reference with an excellent review of the digestive process, this book provides all the fine details. You’re 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 symp-toms and severity. The Track 2 diet includes a modified ver-sion 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 therapeu-tic dosages for a variety of conditions. Additionally, there are numerous nourishing and appealing recipes. I highly recom-mend 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 Idiot’s 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 ControlBy Hope S. Warshaw, MMSc, RD, CDE, BC-ADM, and Karmeen Kulkarni, MS, RD, CDE, BC-ADM2011, American Diabetes AssociationSoftcover, 180 pages, $18.95

If you work with clients who have diabetes, you can recom-mend 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 cli-ents greater freedom to choose foods for a lifetime of enjoy-ment and help them manage their blood sugar.

The Complete Guide to Carb Counting, not only teaches read-ers 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 count-ing carbs is right for them. This quiz serves as a preview, informing readers that counting carbs is no magical dia-betes cure and that controlling blood sugar requires numerous steps, from recordkeeping to read-ing 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-contain-ing foods, determine whether the food diary represents typi-cal 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 practi-cal. Chapter 7 reviews convenience foods and provides recipes. Chapter 8 discusses restaurant and take-out meals.

After you’ve 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 hypo-glycemia. 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-writ-ten guide. It’d be a great addition to any practitioner’s bookshelf and a great resource for clients.

— Carol M. Meerschaert, MBA, RD, is a freelance writer and consultant in Paoli, Pennsylvania.

PERSONAL COMPUTING

SLEUTH FOR THE TRUTHEven Reputable Websites May Have the Wrong Information By Reid Goldsborough

We’ve all heard the adage, “You shouldn’t believe everything you read.”

This applies doubly to the Internet, where anybody can play expert and post definitive-sounding information on websites, blogs, discussion groups, and elsewhere.

You also can’t be complacent with information at highly repu-table websites, either.

Trans Fat DebacleIn recent years, you might’ve seen partially hydrogenated oil

in the ingredients list of many commercial food products, yet on the Nutrition Facts label the trans fat content indicated is 0 g.

As you know, trans fat is a favorite target of public health professionals because it’s been implicated in numerous seri-ous illnesses. Trans fat raises LDL cholesterol and lowers HDL cholesterol, each of which increases the risk of heart dis-ease, the leading killer of men and women in the United States, according to the Mayo Clinic and other sources.

Trans fat also promotes inflammation, insulin resistance, and obesity, according to The Nutrition Source, a website main-tained by Harvard University (www.hsph.harvard.edu/nutrition source). Along with increasing the chances of developing heart disease, partially hydrogenated oils increase the risk of stroke and diabetes, reports the American Heart Association (AHA).

Food manufacturers use partially hydrogenated soybean, cottonseed, palm kernel, and other vegetable oils because they extend a product’s shelf life. According to the 2004 book Trans Fats: The Hidden Killer in Our Food by Judith Shaw, “Foods made with partially hydrogenated vegetable oils have an indetermi-nate storage time or shelf life. Sometimes it’s years.”

Partial hydrogenation is a food processing technique that turns a relatively healthful liquid vegetable oil into an

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 they’re 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 isn’t the same as trans fat. Despite this truth, reputable websites such as the AHA and the Mayo Clinic describe partially hydro-genated 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 sci-entists 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 vegeta-ble oil isn’t the same as trans fat.

The lesson: Double- or triple-check anything you read that’s both surprising and important. One term that’s sometimes used for this is the “principle of triangulation of data.” Just as a trian-gle has three angles, confirming information with three differ-ent sources is more reliable than relying on one.

Even this isn’t 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 shouldn’t 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 [email protected] or www.reidgoldsborough.com.


*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

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Wright Salt Aims to Support Cardiovascular Health

Wright Salt, available from R-U-Ved Herbs Inc, is a blend based on formulas shown in studies to sup-port cardiovascular health.

In addition to sodium chloride (found in table salt), crucial ingre-dients include potassium chloride, magnesium sulphate, lysine hydro-chloride, silicon dioxide, zinc chlo-ride, copper glycinate, selenium, and potassium iodine.

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Corazonas Foods Infuses Snacks With Plant Sterols

Corazonas snacks, which are all natural and have 0 g of trans fats and feature tortilla and potato chips that are gluten free, includes the following:•Theoatmealsquaresoffer13to16gofwholegrain,5

g of fiber, 6 g of protein, and 0.8 g of plant sterols per serv-ing. They’re available in Cranberry Flax, Chocolate Brownie & Almonds, Chocolate Chip, Peanut Butter, and Banana Walnut.•Thetortillachipsaremadewith18gofwholegrain,3gof

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regular potato chips and 0.4 g of plant sterols per serving. They’re available in Slightly Salted, Par-mesan Peppercorn, Italiano 4 Cheese, Spicy Rio Habañero, and Sea Salt & Vinegar.

For more information, visit www.corazonas.com

Good Health Natural Foods Offers Healthier Snack Choices

Good Health Natural Foods has gluten-free snacks made specifically for those with celiac disease or those sensi-tive to gluten in food products. These snacks include Glories Sweet Potato Chips, all fla-vors of Apple Chips, all flavors of Avocado Oil Potato Chips, all flavors of Olive Oil Potato Chips, and Half Naked Popcorn and Organic Popcorn.

For more information, visit www.goodhealthnatural products.com.

Medical ID Marketplace Launches TextID Jewelry

Medical ID Marketplace, a medical identification com-pany, has announced the launch of TextID, short mes-sage service (SMS)-enabled jewelry. TextID uses SMS technology to relay life-saving information with the speed and efficiency of a text message. In one easy step, EMTs and first responders will be able to access a per-son’s self-created emergency profile, detailing medical information, current medications, emergency contacts, and other potentially life-saving information by text mes-saging a unique PIN to 51020.

TextID enables people to store their medical and per-sonal information in a secure online account. For just $12 for the first year of membership ($10 each year thereafter), customers can register their unique PIN number, which is engraved on their customized medi-cal ID jewelry, and create their personal medical profile in minutes, including up to 10 emergency contacts. This profile can be updated at any time from any computer or smartphone at no additional charge.

An individual’s information can be conveniently deliv-ered in a text message to any cell phone, and TextID is available on all major mobile phone networks.

For more information, visit www.medicalid marketplace.com.


NuGo Creates Protein Bars Coated in Dark Chocolate

NuGo Nutrition makes 13 protein bars coated in dark chocolate, with nutritious options for many lifestyles, including organic, kosher, gluten free, vegan, and low sugar.

Real dark chocolate tastes delicious because it’s made from only cocoa beans (cocoa butter and nonfat cocoa solids). The smooth, creamy texture of cocoa butter allows the rich natural chocolate flavor to melt in your mouth. Dark chocolate is an antioxidant-rich superfood that can help lower bad cholesterol and raise good cholesterol when eaten in appropriate amounts.

Many chocolates substitute vegetable fats, usually palm oil, for cocoa butter, which raises the melting temperature so the chocolate doesn’t melt in your mouth. This results in a waxy texture and overly sweet flavor in addi-tion to adding an unhealthful saturated fat.

NuGo Nutrition makes 28 bars in total, and all are certified kosher. Plus the company makes bars for special dietary needs, including vegan, dairy free, and Pareve. NuGo bars are naturally low in fat because the principal ingredient is protein. They don’t contain high-fructose corn syrup, hydroge-nated oils, or trans fats.

For more information, visit www.nugonutrition.com.

Grain-Based Frankfurter Now AvailableSeattle-based Field Roast Grain Meat Com-

pany has launched its new Frankfurter vege-tarian hot dog.

As with Field Roast’s other offerings, its Frankfurter is made with grains, fresh garlic, traditional seasonings, and a combination of vegetable oils. It’s not processed or made with dehydrated or previously frozen ingredients and doesn’t include soy.

Field Roast uses traditional food-making practices to combine grains, fresh-cut vegetables, legumes, seasonings, and oils into a high-quality vegetarian meat.

For more information, visit www.fieldroast.com.

Choice Organic Teas Introduces Four New Varieties

Choice Organic Teas is adding four new varieties to its line of teas as part of its “go beyond” campaign. The new varieties are Premium Korean Green, Decaffeinated Green, Masala Chai, and Rooibos Chai.

The teas are organic, non-GMO verified, kosher, and gluten free, and three of the four are fair trade certified.

For more information, visit www.choiceorganicteas.com.

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REGISTERED DIETITIANSDIETETIC TECHNICIANS

CERTIFIED DIETARY MANAGERS

R D NETWORK, INC - free national registry forsubcontracting consultants. Celebrating our 20th

year in business. Short-term and long-term nation-wide contracts in all business/ industry, communi-cations, schools and colleges, healthcare.

www.rdnetwork.com; Call 877-482-4991;

E-mail: [email protected]; or fax resume to 215-836-0378.

REGISTERED DIETITIANSDIETETIC TECHNICIANS

CERTIFIED DIETARY MANAGERS

Acute care patient population; performs dailynutritional assessment and patient educationfor the appropriate patients; recommends and monitors enteral feedings and parenter alnutrition therapy; notifies respective physicianof situations where nutritional intervention may be required; participates in employee andcommunity functions that promote wellness.

•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 anoccasional evening or weekend activity

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Apply online at www.lakeregional.com.

Registered DietitianFull Time & Part Time

Requirements

Located in the foothills of Salt Lake City, Utah, Primary Children’s Medical Center is a 289-bed freestanding level-one trauma center with a service area covering fi 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.

Clinical DietitianPortage Health is looking to fill a full-time dietitian position to deliver medical nutrition therapy inthe inpatient and outpatient settings.

Duties include:

•Dietary assessments of patients of all agesas ordered by the provider

•Determine required diet and patienteducation needs

•Provide evidence-based nutrition education

The successful candidate will be a graduate ofan accredited school of dietetics. RD/CDEdesired. Two years of experience in diabetescare and education desired.

Interested candidates should apply onlineat www.portagehealth.org. EOE

Portage Health is located in Michigan’s beautifuland scenic Upper Peninsula near Lake Superior,home to Michigan Technology University andFinlandia University. This warm, family-orientedcommunity with excellent schools offers year-round recreational opportunities.

Winchester Medical Center, located in Winchester, VA, is recruiting a full-time Clinical Nutrition Manager to join our team. WMC is a 400+ bed, level II trauma center. We are located approx. 1 hour west of Washington, DC, in the beautiful Shenandoah Valley. The ideal candidate will have the skills and knowledge base to understand and be responsible for TJC, state, and federal standards. This position is the primary liaison with the medical and nursing staff.

REQUIREMENTSMust be certifi ed by CDR as a Registered Dietitian; National Certifi cation Board of Diabetes Educators is desired. Must hold a BS in nutrition/dietetics; master’s degree and CNSC preferred. Minimum of 5 years of related supervisory experience preferred.

For more information on this outstanding opportunity, please contact

Susan Lessar, RD, CNSD, nutrition therapy director,

at 540-536-1882.

Clinical Nutrition Manager

For consideration, log on to www.valleyhealth.jobs and complete the online application.

EOE M/F/D/VWe provide specialized care for young people whose disabilities, injuries, or lifelong illnesses are compounded by emotional and/or behavioral problems. Our campus is located on 98 acres of riverfront land in New Kent County, Virginia, between Richmond and Williamsburg.

We are seeking a professional with experience in diabetes education, pump training, and individual and group teaching. Our program is recognized by the American Diabetes Association for our unique treatment approach to adolescent holistic care.

For more information, please e-mail us [email protected].

Registered Dietitian/Diabetes Educator

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Come and join us as a Clinical Dietitian!

For more information, please contact Brad Wiegel at 307-633-7767

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Atascadero State Hospital

REGISTERED DIETITIANLive on the scenic California central coast!

Join our team of >15 RDs to provide nutritionassessment and education. Atascadero StateHospital is a forensic mental health facility

for >1,000 men recovering from mental illness.Contact 805-468-3125 or

[email protected].

Download California app. form 678 fromwww.dmh.ca.gov/jobs and send to

Atascadero State Hospital Employment Office

P.O. Box 7005, Atascadero, CA 93423.

Enjoy spectacular wilderness areas, scenic lakes & rivers, and enjoy fresh seafood and Northwest wines while still within an easy

drive of a thriving metropolitan area!

Yakima Valley Farm Workers Clinic has employment opportunities for nutrition services professionals like you to join the region’s largest community health center! Join our growing nutrition team! We have several new openings at various sites in WA and OR.

Positions include:

Nutrition Services Regional MgrNutrition Supervisors

Dietitians

For more information about our opportunities or to apply, please visit our website at

www.yvfwc.org.

Live and work in the beautiful Pacifi c Northwest!

60594Today’s Dietitian1/8 Page (2.292 x 3.948”)March 2012jlr

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 Bachelor’s 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 atwww.pvhmc.org

CliniCal DietitianClinical Nutrition Supervisor

Adventist Health Central Valley Network, located in Hanford, CA,

is seeking to fi ll a Full Time Clinical Nutrition Supervisor position.

Responsibilities include: Management of Clinical Nutrition Department, monitoring and ensuring regulatory compliance, and working as a clinical dietitian.

Requirements include: Bachelor’s or master’s degree in nutrition or dietetics required, minimum of 5 years of experience in clinical nutrition required, and management experience preferred. Must be a current RD with CDR.

For more information and to apply online, please visit our website at www.AdventistHealthCV.com

or e-mail [email protected]. EOE

The following facilities would like to give special thanks to their

staff by recognizing them during National Nutrition Month.

Generate new business. Vitalize existing client relationships.

Promote a greater understanding of your industry.

ORDER REPRINTS!Reprints connect you with clients, students,

and colleagues in an exciting, informative way. They’re the ideal tools for sales teams, and they

make great trade show handouts.

Call 877-394-7350 or e-mail [email protected].

TTT

time, such as Walter Willett, PhD; Barbara Shukitt-Hale, PhD; and Penny Kris-Etherton, PhD. The content is always relevant, science based, and fresh—the writers don’t shy away from a little sarcasm. Just check out the newsletter’s 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 didn’t even know about. For example, it petitioned the FDA to require sodium labeling on all foods and fat content labeling on pro-cessed meats back in 1978 because this basic information wasn’t 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 pack-aged foods and ban deceptive health claims. It even led efforts to get a federal law passed that would defi ne organic foods. And the list goes on.

Today, it’s 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 CSPI’s accomplishments over the past 40 years, you’ll note that Jacobson and his team led the way to many signifi cant nutrition breakthroughs, such as adding trans fat to food labels and including calorie labeling in chain restau-rants. There’s no doubt that the CSPI has been one of the lead-ing voices for change in nutrition policy during the past four decades and that Jacobson can be considered the Steve Jobs of the organization.

Up Close and PersonalI recently sat down with Jacobson to talk about the CSPI’s

role in food nutrition policy and to listen to his advice on how dietitians can make a difference in public health today.

Palmer: What was the impetus behind the creation of the CSPI?

Jacobson: I was working with [political activist] Ralph Nader in 1970 and met two other scientists who were interns or volun-teers. We were interested in setting up a public interest orga-nization run by scientists instead of lawyers in which we could encourage other scientists to get involved in social issues. We spent most of our time on food safety and nutrition. We got sci-entists involved in writing letters to government agencies, sign-ing petitions, doing research, and doing lectures primarily on public policy. Somehow we survived setting up an organization with no experience and no money. And now we celebrated our 40-year anniversary.

Palmer: How did the CSPI take off and become so well known? Jacobson: In the 1970s, we published Nutrition Scoreboard,

a book that got tremendous publicity and sold 100,000 to

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 spon-sored the fi 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 years—it was high profi le, 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 fi 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 Nutri-tion Education [now known as the Society for Nutrition Educa-tion 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 we’d communicate with them. We started with a newsletter and got a very nice recep-tion but realized that we couldn’t afford to continue giving it away. So we charged for it and started publishing a nice version in 1974. We’ve been lucky to have Bonnie Liebman [director of the CSPI] writing many of the articles since 1978, and she com-mands great respect from journalists.

We work hard to give objective scientifi c information that isn’t colored by political beliefs, and we don’t try to bend the sci-ence to match our beliefs. In the nutrition world, it can be tough to fi nd straight advice. Our bias is in favor of public health; when it requires judgment, we favor the idea “let’s protect consum-ers.” We want to see good evidence, but sometimes you don’t 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, we’ve been very involved in food policy initiatives, such as trans fat menu labeling, getting junk foods out of schools, getting healthier foods into schools—we’ve led the efforts in all of these areas. In fact, Margo Wootan [director of nutrition policy at the CSPI]

A CANDID INTERVIEWWith MICHAEL JACOBSON

By Sharon Palmer, RD

The Center for Science in the Public Interest, led by Founder and Executive Director Michael

Jacobson, turns 40 this year. Today’s Dietitian sat down with

Jacobson to discuss how the CSPI has forever made its mark on

the nutrition world—and to gain insight into how dietitians can

jump on board the movement for change in nutrition policy.

M ichael Jacobson, PhD, founder and executive director of the Center for Science in the Public Interest (CSPI), doesn’t mind a bit of controversy. It seems like every time you read about a progres-

sive movement to change nutrition policy, from calling on the FDA to remove sodium from the GRAS (Generally Recognized as Safe) list to putting a stop to the marketing of junk foods to children, Jacobson’s name is linked. And he’s testifi ed in front of numerous congressional hearings and appeared frequently in the news media.

Jacobson’s overarching goal for the CSPI is to fi ght for change in the nutrition landscape to promote optimal health for the public. This philosophy can be traced to the CSPI’s origins, which date back to 1971. As a consumer advocacy organization, the CSPI’s mission included conducting research and advocacy programs in health and nutrition and providing consumers with current, useful information about health and well-being.

Of course, one thing that sets the CSPI apart from other organizations is that it built its structure transparently from the ground up. Since it’s funded entirely by subscribers and donors—it doesn’t accept advertising, corporate funding, or government grants—it isn’t beholden to supporters who can infl uence 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 dieti-tians have been reading this publication for years, we’re 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 pub-lication 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

44 today’s dietitian february 2012 february 2012 www.todaysdietitian.com 45

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44 today’s dietitian


February 2012

Vol. 14 No. 2


EXPO WEST CONFERENCE ISSUE

Lowering Blood Pressure

With Natural Therapies

Get Clients Cookin’

With Whole Plant Fats

A Candid Interview

With CSPI Founder

Michael Jacobson

Research Still Shows It May

Cut Heart Disease Risk

American

Heart

Month

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AZ•WA•CA

NEWS BITES

Plate Size Doesn’t Help Reduce Calories

The size of a person’s dinner plate doesn’t help curb energy intake or control portion sizes, according to a recent study conducted at Texas Christian University in Fort Worth.

“Smaller plates are often recommended as a way of controlling intake, but that simply isn’t an effective strat-egy,” says Meena Shah, a senior researcher and pro-fessor of kinesiology. “There was no plate size, weight status, or plate size by weight status effect on meal energy intake.”

Researchers examined 10 normal-weight women and 10 overweight or obese women over two different days at lunch. Subjects were randomly assigned to consume lunch using either a small (21.6 cm) or large (27.4 cm) plate. The meal, which consisted of spaghetti and tomato sauce, was served in an individual serving bowl. Each subject was asked to self-serve the food from the bowl onto the assigned plate and instructed to eat until sat-isfied. The meal was consumed alone and without any distractions. During the second lunch, each subject went through the same procedure but using the alternative size plate.

“It’s possible that plate size doesn’t have an impact on energy intake because people eat until they’re full regardless of what utensils they’re using,” Shah says.

Plate size also didn’t affect ratings of palatability, hunger, satiety, fullness, and prospective consumption in either normal-weight or overweight/obese women.

“Those who were overweight/obese reported lower levels of hunger and prospective consumptions before the meals and felt less full after the meals compared with normal-weight subjects despite no difference in energy consumption between two groups,” Shah says. “This suggests that overweight/obese individuals may have a lower ability to sense hunger and fullness than normal weight adults.”— SOURCE: DICK JONES COMMUNICATIONS

Receptor for Tasting Fat Identified in Humans

Our tongues apparently recognize and have an affinity for fat, according to researchers at the Washington Univer-sity School of Medicine in St Louis. They’ve found that varia-tions in a gene can make people more or less sensitive to the taste of fat, as detailed in a study available online in the Journal of Lipid Research.

Investigators found that people with a particular variant of the CD36 gene are far more sensitive to the presence of fat than others.

“The ultimate goal is to understand how our percep-tion of fat in food might influence what foods we eat and the quantities of fat that we consume,” says senior investigator Nada A. Abumrad, PhD, the Dr Robert A. Atkins Professor of Medicine and Obesity Research. “In this study, we’ve found one potential reason for individual variability in how people sense fat. It may be, as was shown recently, that as people consume more fat, they become less sensitive to it, requir-ing more intake for the same satisfaction. What we’ll need to determine in the future is whether our ability to detect fat in foods influences our fat intake, which clearly would have an impact on obesity.”

People who made more CD36 protein could easily detect the presence of fat. In fact, study subjects who made the most CD36 were eight times more sensitive to the presence of fat than those who made about 50% less of the protein.

The researchers studied 21 people with a BMI of 30 or more, which is considered to be obese. Some participants had a genetic variant that led to the production of more CD36. Others made much less, and some were in between.

Participants were asked to taste solutions from three different cups; visual and odor clues had been eliminated. One contained small amounts of a fatty oil. The other two contained solutions that were similar in texture to the oil but were fat free. Subjects were asked to choose the cup that was different. The same test was repeated several times to learn the thresholds at which individuals could identify the fat solution.

The CD36 discovery follows research that had identified a role for the gene in rats and mice. Scientists had learned that when animals are genetically engineered without a working CD36 gene, they no longer display a preference for fatty foods. In addition, animals that can’t make the CD36 protein have difficulty digesting fat.

Up to 20% of people are believed to have the variant in the CD36 gene that’s associated with making significantly less CD36 protein. That, in turn, could mean they’re less sensitive to the presence of fat in food.— SOURCE: WASHINGTON UNIVERSITY IN ST LOUIS


Nutrient-Rich Foods Index Instills Better ChoicesWith the obesity epidemic impacting American health-

care, a new study led by Karen Glanz, PhD, MPH, at the Uni-versity of Pennsylvania Perelman School of Medicine and the School of Nursing, with researchers at RTI International and the Nutrient Rich Foods Coalition found that educating consumers to use the Nutrient Rich Foods (NRF) approach to eating is an effective means of promoting healthful shop-ping and eating patterns, and improving diet quality.

The study, published in the January issue of the Journal of the Academy of Nutrition and Dietetics, found that among consumers who participated in innovative, positive nutrition education designed to help them identify and choose more nutrient-rich foods, overall diet quality improved, total fat and saturated fat decreased, and consumption of health-ful foods increased. Additionally, consumers participating in the new program significantly increased their meal planning and their ability to select nutritious foods.

The NRF approach to eating recommends choosing nutri-ent-rich foods from all food groups to build healthier meals

and dietary patterns. Foods and beverages were ranked using the NRF Index, a nutrient profiling metric that scores foods based on their nutrient density or their content of vita-mins, minerals, and other nutrients per kilocalorie.

“Educating consumers about nutrient richness is a simple method to help consumers identify and choose foods that contribute to overall healthful eating patterns,” says James Hersey, PhD, a senior scientist at RTI Interna-tional and one of the study’s authors. “This study shows that when consumers are armed with useful informa-tion about nutrient content in a useable format, they make smarter choices. Those smarter choices lead to better diets and healthier lives.”

For the study, the researchers conducted a randomized controlled trial of almost 200 adult food shoppers from Feb-ruary to May 2009, with participants randomly assigned to receive either education on the NRF approach or standard nutrition education.— SOURCE: RTI INTERNATIONAL

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JULY 1-4, 2012FLORIDA DIETETIC ASSOCIATION ANNUAL SYMPOSIUM AND EXPOBuena Vista Palace Hotel across

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Alaska Salmon Wild Jerky, www.alaskasalmonwildjerky.com ............................................................................ 67Bakery On Main, www.bakeryonmain.com.......................................................................................................... 63Bob’s Red Mill, www.bobsredmill.com ................................................................................................................ 31California Raisins Marketing Board, www.loveyourraisins.com ........................................................................... 7CinSulin, www.cinsulin.com ................................................................................................................................ 55DietMaster Systems, www.dietmaster.com ........................................................................................................ 62Dole Nutrition Institute, www.dolenutrition.com ................................................................................................ 63ESHA Research, www.esha.com............................................................................................................................ 3Food for Life Baking Company, www.foodforlife.com ........................................................................................... 9Gourmet Garden, www.gourmetgarden.com ...................................................................................................... 63Growing Naturals, www.growingnaturals.com .................................................................................................... 63JR Carlson Laboratories, Inc, www.carlsonlabs.com ............................................................................................ 2Juice Products Association, www.fruitjuicefacts.org ............................................................................................ 5Kellogg’s, www.kelloggsnutrition.com/td ........................................................................................................... 25Kibow Biotech, Inc., www.kibow.com .................................................................................................................. 15Konsyl Pharmaceuticals, www.konsyl.com ..........................................................................................................11Llorens Pharmaceuticals, www.llorenspharm.com............................................................................................. 19Lundberg Family Farms, www.lundberg.com ...................................................................................................... 13The Nutrition Company, www.nutritionco.com ................................................................................................... 62Omega, www.omegajuices.com ......................................................................................................................... 57Penn Foster, www.pennfoster.edu ...................................................................................................................... 43RiceSelect, www.riceselect.com ......................................................................................................................... 49Robot Coupe, www.robotcoupeusa.com ............................................................................................................. 61UAS Laboratories, www.uaslabs.com ................................................................................................................. 63Walden 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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CROSSWORD PUZZLE KEY FROM PAGE 50

For delicious recipe ideas, be sure to check out

Culinary Corner!www.TodaysDietitian.com


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BRUSSELS SPROUTSThey’ve Now Become the Old New Favorite By Bryan Roof, RD, LDN

Brussels sprouts, someone recently told me, are now trendy. The once shunned, boring vegetable that’s been around since the 13th century, a result of selective breeding between members of the cabbage family, is now en vogue? This gives me hope that my prime is still on the horizon. Yet I’m forced to wonder why Brussels sprouts are just now gaining gastronomic notoriety. It seems as though nearly everyone is quick to tell you how much he or she once despised Brussels sprouts. I’d ven-ture a guess that the cooking method is partly to blame. The accepted approach has long been to boil these petite cabbages, which fills the house with a smell so potent that it leaves every-one at dinner suspiciously eyeballing the person to their left.

But things change, and this change has seen a massive shift of affection toward the humble sprout. Those who once hated are now in love and, again, the cooking method is responsible. Roasted Brussels sprouts have burst onto the scene as some-thing of a game changer. Intense heat caramelizes the sprouts, and they take on a marked sweetness that pairs well against their inherent bitter edge. The outer leaves become crispy while the heart turns as tender as a marshmallow. And roast-ing couldn’t be easier: Turn on the oven, preheat a baking sheet, and drop the sprouts on top. It may be easier than boiling—surely less odoriferous!

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, I’ll put my money on underloved produce and a hot oven. Maybe, just maybe, I’ll be ahead of the trend.

— Bryan Roof, RD, LDN, is a chef, dietitian, and food writer living in Boston.

CULINARY CORNER

Roasted Brussels Sprouts With Apple and Pine Nuts

Serves 4 as a side dish

Ingredients 1 lb Brussels sprouts, stems trimmed, halved

lengthwise61⁄2 oz cooked, peeled chestnuts, halved1 large red apple (such as Fuji, Pink Lady, or Gala),

cut into a 3⁄4-inch dice1 large shallot, sliced into thin rings2 T extra-virgin olive oil1⁄4 tsp sea salt1⁄4 tsp pepper2 T pine nuts, toasted

Directions1. Adjust oven rack to lower-middle position, place

large, rimmed baking sheet on rack, and heat oven to 425˚F.

2. Toss Brussels sprouts, chestnuts, apple, shallot, oil, salt, and pepper together in large bowl until thor-oughly 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.

Nutrient Analysis per servingCalories: 280; Total fat: 12 g; Sat fat: 1.5 g; Trans fat:

0 g; Cholesterol: 0 mg; Sodium: 170 mg; Total carbohy-drate: 43 g; Dietary fiber: 7 g; Sugars: 14 g; Protein: 6 g



February 2012 Vol. 14 No. 2


EXPO WEST CONFERENCE ISSUE

Lowering Blood PressureWith Natural Therapies

Get Clients Cookin’ With Whole Plant FatsA Candid Interview With CSPI Founder Michael Jacobson

Research Still Shows It May Cut Heart Disease Risk

American Heart Month

RichesMining


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

Research Suggests They

Can Help Mild to Major

Depression and Even

Schizophrenia

Mood DisordersOmega-3 Fatty Acids and

ASPENConference

Issue

January 2012

Vol. 14 No. 1


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DAVID GROTTOADD for All Things DietaryBy Juliann Schaeffer

Owning and operating a natural foods store offered David Grotto, RD, LDN, his first taste of the nutrition world. More than 20 years later, after first returning to school for his dietet-ics degree and then working in varying capacities in food and nutrition com-munications, he’s still smitten with an industry that’s brimming with options. “I always joke that I have ADD—not offi-cially diagnosed—but it works for me. There are so many things under the ‘nutrition’ umbrella that keep me chal-lenged and interested,” he says.

Early in his career, Grotto tried his hand in clinical and foodservice settings until the media bug bit him; he’s stayed consistently in the public eye ever since. Having hosted his own shows in both radio and TV in Chicago, he’s also worked as a national spokesperson for the Academy of Nutri-tion and Dietetics and has written two books, 101 Foods That Could Save Your Life and 101 Optimal Life Foods, to date.

These days, when he’s not communicating his “Enjoy (but don’t eat) it all!” message through his nutrition consulting firm Nutrition Housecall, LLC, you may find him promoting health-ful eating habits while blogging on WebMD, consulting for food companies, or counseling clients. Grotto’s must-have accesso-ries for the average workday? A positive attitude, humor … and bunny slippers. “Most of my work is conducted from my home office with my bunny slippers on,” he says with a smile.

Today’s Dietitian (TD): Who inspires you and keeps you motivated?

Grotto: My family. I want them to have a good life and that always spurs me on to doing more things that bring in income. I’m also motivated by wanting to help people feel better through healthful eating—such an enjoyable thing to do!

TD: What is your proudest career accomplishment? Grotto: Undoubtedly it would have to be my first book, 101

Foods That Could Save Your Life. That was a labor of love that many friends, colleagues, and family members had a hand in.

TD: If you could offer clients/patients only one piece of advice, what would it be?

Grotto: Enjoy (but don’t eat) it all! Quality over quantity is such an important message that may be falling on deaf ears as we continue to battle portion distortion. I think including

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: What’s your favorite way to pre-pare/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 per-

cent 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! Don’t 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; she’s quite a cook. I’m 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 Today’s Dietitian.

GET TO KNOW…


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Visit waldenfarms.com/TDM2 for Buy One Get One Free Offers. Try up to 5 Free - SAVE $24.95Healthcare Providers visit waldenfarms.com/HCP for Free Single Serve Packets for your Patients

Walden Farms Calorie Free Specialties are all prepared with rich Natural Flavors like Natural Parmesan & Romano Cheese and Sour Cream flavors in our Alfredo Sauce. Your patients can enjoy the foods they crave while maintaining their dietary program. In fact, they can use all the Walden Farms they want…it’s Calorie Free!

Walden Farms helps individuals comply with healthy eating programs.

Switch & Save Hundreds of Calories Every Day The Walden Way””

Help clients and patients complyThe Walden Way””

No Calories, Fat, Carbs, Gluten or Sugars of Any Kind !

More than 60 Calorie Free Specialties

Great Taste and Calorie Free

Today's Dietitian - March 2012

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Transcript of Today's Dietitian - March 2012