If you haven’t noticed, spring has sprung! In addition to crocus and daffodils, we’ll have a new crop of fruit to explore and enjoy in local markets now. While citrus fruit may still be in season in some parts of the country until the end of April, it’s almost time to embrace berries, grapes and melon. This is the second part of our series to help support the My Plate Simple Campaign, which offers easy, lifelong tips to consumers to explore foods from each food group.1

There seems to be some consumer confusion around fruit. While dietitians recognize that fruit contains natural sugar, the proliferation of low carb, “anti-sugar” fad diets has given fruit a bad name.

Fruit is made up of sucrose, glucose and fructose, which are naturally occurring sugars. In addition to carbohydrate, fruit contains fiber, vitamin C, beta-carotene, potassium and other nutrients.

Added or refined sugar from soft drinks, sports drinks, candy, ice cream and high calorie desserts is what should be limited in our diets. These types of sugars are associated with obesity and heart disease and should make up less than 10% of total calories.2 For the average 2000 calorie diet, 200 calories may come from added sugars, or 50 grams per day or less. This is equivalent to roughly one, 12 oz. regular soda or one regular sized candy bar. Of course, there are hidden sugars in packaged foods like crackers, frozen meals, canned goods and sauces as well. Fruit juice may contain added sugar, so it’s best to purchase 100% fruit juice or eat whole fruit instead.

Fruit can be incorporated into our diets in several ways. One of the benefits of adding fruit at breakfast is that the vitamin C from citrus fruit, melon or berries makes iron from fortified breads and cereals, more bioavailable and absorbed. This is important for women, children, vegetarians and vegans, who may have increased iron needs or do not obtain enough in their diets.3 Fresh, canned or frozen fruit goes well with yogurt or in smoothies, while dried fruit is great to add to oatmeal, muesli, granola or dry cereal.

Fruit makes a convenient, portable snack for kids and adults on the go. It can be paired with a cheese stick, nut butter or a handful of mixed nuts or seeds. Grapes, apples or citrus fruit are great to take when traveling as is dried fruit. Dried fruit is handy to add to trail mix and does not require refrigeration.

Other ways to increase fruit consumption include adding apples, pears or grapes to tossed salads or using chopped fruit in compotes or sauces over fish, pork or chicken. They are delicious when paired with spices such as cinnamon, ginger or nutmeg. Tropical fruits like pineapple, mango and melon go well with fresh herbs like basil or cilantro.

Don’t forget about cooking fruit! Baked apples or pears with cinnamon and pecans make a simple dessert or over-ripe bananas are great for banana bread, cake or pudding. No matter how you slice it, a variety of fruit should be added to our diets regularly. Here are a few more ideas:

  • Add chopped apricots, dates or prunes to energy bites or granola
  • Cut grapes in half and add to chicken or tuna salad
  • Use bruised apples in apple sauce or apple butter
  • Include kiwi, strawberries or pomegranate in salad
  • Use mashed berries,  kiwi or pears in a compote

References:

  1. https://www.choosemyplate.gov/start-simple-myplate
  2. James M. Rippe1,2,*and Theodore J. Angelopoulos3 Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding. Nutrients. 2016 Nov; 8(11): 697.
  3. https://www.medicinenet.com/iron_and_iron_deficiency/article.htm#what_causes_iron_deficiency

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As we gear up for the next round of US Dietary Guidelines, it’s great that we still have My Plate to guide clients about eating healthy, balanced meals. The newly launched My Plate Start Simple Campaign is meant to provide simple, sustainable tips to consumers for each food group. This is the first of a series to highlight each food group and simple ways to encourage your clients to “put their best food forward”. 1

Did you know that only 1 in 10 adults meet the recommended number of servings for fruits and vegetables according to the CDC’s Morbidity and Mortality Weekly Report? 2 With so much research supporting vegetable intake as a way to combat obesity, improve our gut microbiome, and reduce risk of cancer and heart disease, this is a crime. My clients often consider vegetables just at dinner. Why? There is such a wide variety of vegetables to choose from, we can be recommending them as part of all meals and snacks. Vegetables are low in calories and can be easily incorporated in several ways.

Let’s start with breakfast. Beyond adding peppers, onions and spinach to omelets or frittatas, vegetables can be roasted and served as a side dish. Asparagus, broccoli, kale or peppers add color and flavor to any plate and are a great source of vitamin C and fiber. Try a blend of roasted vegetables such as a California blend of carrots, cauliflower and broccoli. Add a dash of turmeric and garlic for color and spice.

Encourage fresh vegetables for snacks. Go beyond baby carrots and celery sticks and consider sugar snap peas, jicama sticks or fresh green beans with hummus or a yogurt-based, savory dip. Pepper strips, raw broccoli and cauliflower, cucumber slices and grape tomatoes are also easy to prep and pack for snacks.

Suggest frozen vegetables at lunch if time is limited. Mixed vegetables, broccoli or peas can be added to leftovers to easily increase vegetable intake. Frozen peppers and spinach are also great to have on hand and can be tossed into pasta dishes, soup or rice. I often use fresh spinach or kale in leftovers, too. They wilt down to nothing when cooked but pack a wallop of nutrients including beta-carotene, vitamin C and potassium.

Dinner is where most people think to include vegetables, but with meat-heavy fad diets, serving sizes are still likely too small. I advise clients to make half their plates vegetables and include a variety of seasonal favorites daily. The key is to keep things interesting. Toss seasonal fruit like apples, pears, citrus fruit or berries into a spinach or kale salad. Add onions, peppers and peas to rice or other grain dishes. Try zucchini and mushrooms in spaghetti sauce or Indian dishes. Vegetables are also great stir fried in Asian cuisine. Purple cabbage is beautiful and adds flavonoids such as anthocyanin to your dish.

Be creative! Meals need not be monotonous or tasteless to be nutritious. Remember, variety is the spice of life!

References:

  1. https://www.choosemyplate.gov/start-simple-myplate
  2. https://www.cdc.gov/media/releases/2017/p1116-fruit-vegetable-consumption.html

Submitted by Lisa Andrews, MEd, RD, LD

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While no one is fond of stepping on a scale, the annual weigh-in is one of the simplest ways health care providers can evaluate risk of chronic disease that can be easily tracked over time. Without any blood drawn, BMI may tell a lot about a person’s potential health risks. Body Mass Index (BMI) measures a person’s height to weight ratio and the higher it is, the more likely a person may develop health problems including diabetes, hypertension, heart disease, arthritis or other medical issues. 1

A normal BMI is between 18.5 and just under 25. A low BMI (below 18.5) is considered underweight and may be suggestive of malnutrition, while a BMI between 25 and 29.9 indicates that a person is overweight. An individual is considered obese once that number climbs to 30 or higher. BMI does not measure body composition, so theoretically, a very muscular person with a BMI over 30 would be placed in the obese category. However, most adults are not elite athletes. As of 2016, nearly 39% of US adults were considered obese and 31% of the US population is considered overweight. 2 It is no wonder there is a rise in diabetes in this country.

Weight gain is a complicated problem. Risk factors for overweight and obesity include age, heredity, race, ethnicity and sex, which unfortunately, are not controllable. According to the CDC in 2016, 47% of Hispanics and 46.8% of non-Hispanic blacks had the highest age-adjusted prevalence of obesity with non-Hispanic whites at 37.9% and non-Hispanic Asians at 12.7%.  Education also seems to be a factor. College educated men and women have lower rates of obesity than those with less education. Income may also impact weight, though variations are seen amongst lower and higher incomes compared to middle class. Lower and higher incomes tend to experience less obesity than middle class in non-Hispanic black men. 2

Certain medications such as steroids, anti-anxiety, anti-psychotic or anti-depressants may be responsible for weight gain. Diabetic medications including insulin and sulfonylureas have also been associated with unwanted pounds. 3 Medical conditions such as arthritis or MS, which impact movement may also lead to weight gain. And finally, the abundance of highly processed, high calorie food cannot be ignored in having an effect on the rising numbers on the scale. Thankfully, lifestyle changes can prevent and control weight gain, which seems to be inevitable for most adults over time.

It’s been said that you “cannot outrun a bad diet” and most nutrition experts advise people trying to lose weight to adopt a lower calorie diet for weight control. But it’s not always that simple. People often “stuff” their emotions down with high calorie comfort food like dessert, chips or fast food. They eat due to boredom, anxiety, stress, fatigue and sadness. Or, like many chronic dieters, they fall into a pattern of eating too little, then overeating later. 4

So, where to start when a person arrives with a higher BMI than desired? For starters, look at their whole lifestyle, not just diet. Are they eating enough, or starving then binge eating later? Are they active or sedentary? How do they handle stress? Do they obtain adequate sleep? Are they snacking too often? These are all factors that may impact their weight. Reassure your patient that they don’t need to get down to a “normal” BMI. A drop in BMI of 2-3 points can still improve the person’s health risks. This is equivalent to a 10% weight loss in an overweight or obese individual. 5 Setting realistic goals may help your client reach an acceptable weight. Normal weight loss is only .5-1 lb per week.

Clients may be tempted to try the latest fad diet such as Keto, Paleo or celery juice for weight loss. While these diets may show results in the short term, stick to science and remind them that sustainable changes will not only help them lose weight, but keep it off long term.

 

References:

  1. https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity
  2. https://www.cdc.gov/obesity/data/adult.html
  3. https://obesitymedicine.org/medications-that-cause-weight-gain/
  4. The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis,” Gariepy, G., Nitka, D., and Schmitz, N., International J of Obesity 21;2010 34: 407-419
  5. https://www.cdc.gov/healthyweight/losing_weight/index.html

Submitted by Lisa Andrews, MEd, RD, LD

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Do you cringe a bit when your clients say their blood pressure is a little high, but they’re “not too worried about it”?  It’s not called the “silent killer” for nothing. The American Heart Association states blood pressure is absolutely the most important risk factor for stroke. 1 Lifestyle changes matter. How can we convince our clients to manage it?

For starters, there are new guidelines regarding acceptable blood pressure numbers. For years, a blood pressure of 140/90 was considered safe. Now, the Heart Association, American College of Cardiology and nine other health care boards advise a level below 130/80 mm Hg. Elevated blood pressure is defined as a systolic blood pressure of 120-129 mm Hg over diastolic above 80 mm Hg. Stage 1 hypertension means a persons’ blood pressure is consistently running 130-139 mm Hg systolic or diastolic of 80-89 mm Hg. Medication for high blood pressure may be advised at Stage 2. Stage 2 is where blood pressure is running regularly at 140/90 mm Hg. Hypertensive crisis is scary and requires immediate medical attention. This occurs when blood pressure is above 180/120 mm Hg. Left untreated, blood pressure this high can cause organ damage to the heart, brain and kidneys. 1

The changes to blood pressure numbers were decided after a 2017 study called SPRINT (the Systolic Blood Pressure Intervention Trial). This study evaluated over 9,000 people aged 50 and up with blood pressure of 130 mm Hg and up and at least one cardiovascular risk factor. The study meant to assess whether reducing blood pressure to 130 mm Hg or less was better than the traditional 140 mm Hg. The research showed that lowering blood pressure below 120 mm Hg lowered risk of cardiovascular events over a 3-year period. 2 The numbers are no longer specific to younger people or those over the age of 65.

Several lifestyle factors impact blood pressure and many are diet-related. One of the best treatments of blood pressure is mild weight loss. According to the National Heart Lung and Blood Institute (the people that developed the DASH diet), a 10 lb weight loss result in blood pressure reduction. For many clients, this is a more realistic weight loss target even if their BMI is still elevated. 3

Reducing sodium intake also impacts blood pressure, though clients may think giving up the salt shaker is enough. In reality, the majority of dietary sodium is in processed foods like frozen meals, fast food, lunch meat, snack foods, sauces and condiments and breakfast meats like bacon and sausage. Teach clients simple cooking methods so they rely less on already prepared food. Foods should have less than 140 mg sodium per serving to be considered low sodium.

Push produce! Fruits and vegetables are a big part of the DASH diet given their potassium content, which lowers blood pressure. Encourage more dark, green leafy vegetables and deep orange fruits and vegetables like melon, mango, citrus fruit, squash and sweet potatoes. Don't forget about kiwi, bananas and tomatoes. Nuts, seeds and beans are also good sources of potassium. Once new food labels are uniformly enforced, potassium will be listed to make things easier for consumers.

Encourage low-fat dairy products. Dairy products like low-fat yogurt, skim milk and low-fat cheese are the best sources of calcium, which has been found to reduce blood pressure. For clients with lactose intolerance, calcium-fortified, plant-based milks such as soy or almond milk are good substitutes. Dark green leafy vegetables like kale, collard greens, Brussels sprouts and broccoli also sources of calcium, though consumers would need to consume big quantities to meet calcium needs, which is not necessarily a bad thing.

Teach the difference between unhealthy and healthy fats. Healthy fats are beneficial to blood pressure reduction and include olive and canola oil, fatty fish such as salmon, avocado and low salt nuts and seeds. Reduce intake of saturated fats from full fat dairy, beef, bacon, butter, lamb, pork and other animal products. Limit consumption of processed/trans fats found in snack foods, commercial baked goods and fast foods.

Clients need to know the risks of alcohol intake. While a drink now and then (1/day for women, 2/day for men) is considered moderate, excessive alcohol consumption is inked with elevated blood pressure. According to previous studies, blood pressure increases about 1 mmHg for each 10 g alcohol consumed and can be reversed within 2-4 weeks of abstinence or reduction in alcohol consumption. 4 Have clients try a “mocktail” of flavored seltzer water with a twist of lemon or lime.

References:

  1. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings
  2. Dharam J. Kumbhani, MD, SM, FACC Systolic Blood Pressure Intervention Trial - SPRINT N Engl J Med2017;377:733-44.
  3. https://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf
  4. Puddey IB, Beilin LJ.Alcohol is bad for blood pressure. Clin Exp Pharmacol Physiol. 2006 Sep;33(9):847-52. Review

Submitted by Lisa Andrews, MEd, RD, LD

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Your client has been waking up to urinate in the middle of the night and has been feeling sluggish after meals. What gives? If they've got a family history of diabetes or a history of gestational diabetes, take note. Their risk for developing diabetes is higher than someone without these risks, but may be avoidable. Studies show that losing just 5-7% of body weight and getting regular exercise may reduce the risk of diabetes by 58%. For a 200 lb. person, that’s roughly 10-14 lbs. of weight. 1

What is considered “high” anyway? A fasting (nothing to eat/drink for at least 8 hours) blood sugar over 100 mg/dL is considered elevated. What an individual forgot to fast and added cream or sugar in your AM coffee? Welcome to the non-fasting state. In this case, blood sugar should be below 140 mg/dL within two hours of eating or drinking anything with calories to be considered normal. Other numbers to consider- if two blood sugar readings in a row are over 126 mg/dL or a a random blood sugar reading is 200 mg/dL or higher, a diabetes diagnosis may be given. 2

A post-prandial (after meal) glucose test may also be performed to check for gestational diabetes. This is the test administered to pregnant women between the 24th to 28th week of pregnancy. In this situation, a woman fasts overnight, then is given a 75 gram “load” of sugar, typically through a syrupy, soda-like beverage. Blood sugar is then checked after 2 hours or more frequent intervals. A level below 140 mg/dL is considered normal in this case. It’s estimated that a woman with gestational diabetes is 7 times as likely to develop type 2 diabetes in her lifetime than someone without diabetes. 3

As some people have increased risk of diabetes, their doctor may suggest having a Hga1c done to evaluate blood sugar. A Hga1c is a measure of what your average blood sugar has been running for the past 3 months. A normal level is below 5.7 mg/dL. Pre-diabetes is defined as a Hga1c of 5.7-6.4%. This means your blood sugar is higher than normal, but not quite diagnostic of diabetes. A Hga1c above 6.4% is diagnostic of diabetes. If no lifestyle changes are made (diet, activity), about 25% of people with pre-diabetes may develop diabetes within 2-3 years, according to the CDC. 2

Diabetes is not just an issue with blood sugar. People with diabetes have higher rates of heart disease and stroke. Diabetes impacts circulation to every organ in your body. It’s the leading cause of blindness as well as kidney disease. 4

So, how can you help your clients prevent diabetes? Most experts point to weight reduction for starters. Losing weight improves insulin sensitivity as fat cells can become resistant to insulin over time. For sustainable weight loss, it’s important not to go on any crash diets, though reducing intake of processed or refined carbohydrates will help with both weight loss and blood sugar reduction. Limit intake of cake, cookies, regular soda, candy, ice cream and other high calorie/high fat desserts. Don’t forget about other common processed carbs including potato chips, pretzels, and sports drinks.

Swapping whole grains for refined grains will also aid in glucose control. Whole grains contain fiber as well as selenium, two nutrients found to aid in blood sugar management. Dietitians can advise clients to choose brown over white rice, quinoa, farro, and bulgur. Whole grain breads and cereals over more processed varieties like white bread and pasta are optimal choices. Increased vegetable intake may also be beneficial since vegetables are low in calories and carbohydrate and may take the place of higher calorie foods that lead to weight gain.

Regular physical activity cannot be stressed enough for both the prevention and treatment of diabetes. Exercise not only aids in weight loss, but walking for 10-15 minutes after meals has been found to lower post-prandial blood sugar. However, the larger the meal and potential increase in glucose, the more intense an exercise may need to be to have an impact on blood sugar. In theory, it may be easier to eat less to control blood sugar than to try to “outrun or outwalk” a bad diet. 5

References:

  1. https://www.cdc.gov/features/diabetesprevention/index.html
  2. https://www.medicalnewstoday.com/articles/317536.php
  3. https://www.medicinenet.com/glucose_tolerance_test/article.htm
  4. http://www.diabetes.org/living-with-diabetes/complications/
  5. Erickson ML1Little JP2Gay JL3McCully KK4Jenkins NT4. Effects of postmeal exercise on postprandial glucose excursions in people with type 2 diabetes treated with add-on hypoglycemic agents. Diabetes Res Clin Pract.2017 Apr;126:240-247

Submitted by Lisa Andrews, MEd, RD, LD

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It’s that time of year again. The time you must forgo breakfast and cream in your coffee to fast for your annual physical or bio-metric screening at work. Black coffee or water only allowed. We’ve all been through it at least once in our adult lifetime.

You have your blood drawn or finger pricked and anxiously await the results. Did my overindulgence over the weekend affect my results? And then the bad news hits- your cholesterol, LDL or triglycerides are out of the “desirable” range. Now what?

Cholesterol is a waxy material found naturally in our bodies.  It is made in the liver and needed to make hormones and bile, which is necessary for fat digestion.  If the level of blood cholesterol becomes too high, cholesterol and other fats can stick to artery walls.  This increases the risk of heart attack and stroke. A normal level is below 200 mg/dL.

Blood cholesterol is carried in the body in packages called lipoproteins.  HDL (high density lipoprotein) is considered “healthy” cholesterol because it collects excess cholesterol and brings it to the liver to be disposed.  A desirable HDL level is over 40 for men and over 50 for women.  The higher, the better.  Your ratio of cholesterol to HDL should be < 4.0 to be a low risk for heart disease.  For example, if total cholesterol is 200, but HDL is 20, the ratio is 10, which is very high.  If cholesterol is 220 and HDL is 60, the ratio is 3.66. Exercise, medication and moderate alcohol intake raise HDL.

LDL cholesterol (low density lipoprotein) is “lousy” cholesterol.  It is the type of cholesterol that builds up on the arterial walls and increases the risk of heart disease.  Your level should be below 100 unless you have multiple risk factors for heart disease such as family history, smoking, high blood pressure, diabetes or metabolic syndrome. In these cases, your LDL cholesterol, ideally, should be below 70 mg/dL. For many people, diet alone won’t reduce LDL cholesterol enough to lower their risk of coronary artery disease or stroke. Your doctor may discuss medication in this case. 1

A low-fat diet is advised to reduce cholesterol and prevent heart disease.  A low-fat diet is also suggested for individuals with diabetes as they are at higher risk for heart disease, though the type of fat matters.  Fat contains 9 calories/gram and can add up. Take a look at the different types & their health effects. Approximately 25-30% of calories should come from fat if you are limiting your fat intake.

Saturated fats are solid at room temperature.  This type of fat raises blood cholesterol and has been linked with development of certain cancers. These are typically animal-based (with the exception of coconut oil) and should be limited in your diet.  Sources include:

  • Beef or lard
  • Butter, pork fat, bacon, sausage
  • Chicken and turkey skin
  • Cream cheese, sour cream
  • Whole milk, yogurt or cheese made from whole milk, full fat ice cream
  • Coconut and other palm and palm kernel oils

Trans-fat is a type of processed fat that’s formed when hydrogen is added to liquid fat, making it solid.  Read the ingredients label.  If the words “partially hydrogenated” or “hydrogenated” are listed, the food contains some trans-fat.  This type of fat raises blood cholesterol as well as inflammation, and is linked with some cancers.  Experts recommend no more than 2 grams trans-fat per day.  Sources include:

  • Baked goods such as cakes, cookies, doughnuts, pastries, and pies
  • Fast food
  • Margarine (stick and tub)
  • Potato and corn chips
  • Snack crackers, cakes, cookies, pastries, microwave or movie popcorn

Unsaturated fats include monounsaturated and polyunsaturated fats.  These types of fat are liquid at room temperature (with exception of olives and avocado) and are heart healthy.  Mono and polyunsaturated fats improve blood cholesterol by lowering total cholesterol and raising HDL (‘healthy’) cholesterol and may also reduce inflammation.  Sources include:

  • Avocado
  • Canola
  • Olive
  • Peanut oil

Polyunsaturated fats come from plant sources and include:

  • Corn oil
  • Flaxseed oil, flaxseeds, walnuts
  • Safflower oil
  • Sunflower oil
  • Vegetable oils

Fats from salmon, tuna, mackerel and flaxseed are a good source of omega-3-fatty acids, and have been found to lower triglyceride levels and risk of heart disease in populations that consume fish often.

How much should I eat?

Fat should make up approximately 30% of your total caloric intake.  This means if you consumed 2000 calories per day, about 600 calories should come from fat (66 grams).  Only 7-10% of total calories should come from saturated fat.  Experts suggest we eat no more than 2 grams of trans fat per day.  About 10% of calories should be from monounsaturated and 10% should be from polyunsaturated fat.

A low-fat food contains no more than 3 grams of fat per 100 calories.  Read the label for fat content, not just cholesterol!  Cholesterol-free food may still contain fat (such as stick margarine).

Cholesterol intake is no longer a restriction. As of 2015 information has changed as new research does not support the previous restriction of 300 mg per day for most individuals and 200 mg/day for those at high risk for heart disease. 2

What else can I eat to control cholesterol?

Whole grains such as oatmeal, oat bran, or Cheerios should be consumed often as they contain soluble fiber- the type that binds cholesterol.  Legumes and dried beans are also a good source of soluble fiber, as are fresh fruits such as apples, citrus, pears and grapes.  Include at least 5-9 servings of fruits and vegetables daily for vitamins, minerals, antioxidants and fiber.

Eat a diet that’s low in saturated fat, trans fat, and cholesterol.  Choose more mono and polyunsaturated fats when possible.  Eat fatty fish twice per week if possible. Get regular exercise to raise HDL and lower LDL levels. Eat plenty of vegetables, fruit, whole grains and beans and consume adequate water. For more information on how to control your cholesterol, check with your health care provider.

References:

  1. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/09/14/28/2018-guideline-on-management-of-blood-cholesterol
  2. https://www.ahajournals.org/guidelines/cholesterol

Submitted by Lisa Andrews, MEd, RD, LD

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