February 24th, 2012 | by Pam Stuppy
Printed in Seacoast Online
February has been proclaimed as “American Heart Month” in the United States. The purpose of this designation is to recognize and reaffirm our commitment to fighting cardiovascular disease.
Statistically, heart disease is the leading cause of death in this country, causing about 2,200 deaths per day. This averages to be about one in three deaths due to heart disease and stroke. For women, it causes more deaths than all forms of cancer combined.
Besides the risk of fatality, heart disease can also affect quality of life. It can result in disability to work and not being able to participate in pleasurable activities or time with family and friends. It is also expensive. In 2010, it is estimated that it cost us all about $444 billion in health-care expenses and lost productivity.
There are genetic factors that can predispose some people to a greater risk of cardiovascular disease. The good news, however, is that there are modifiable risk factors as well. This means that even if you have a family history, there are a number of steps you can take to reduce your risk. As you read through the following lifestyle factors over which you have some control, think about what steps you can take towards better heart health.
Some of the lifestyle goals to strive for include consuming an overall healthy diet, aiming for a healthy body weight, keeping blood lipids (LDL, HDL, triglycerides) and blood pressure in the recommended range, being physically active, and avoiding exposure to tobacco products.
When it comes to how we eat, there are numerous action steps to get us on track. It is important to balance calorie intake with our physical activity. Survey research tells us that many Americans underestimate the number of calories they consume, while over-estimating how much they exercise.
To lower calories, here are a few hints. Try increasing your intake of fruits and vegetables — these contain numerous nutrients but have fewer calories than many other foods. Make these food groups fill half of your lunch and dinner plates. Choose high fiber foods (whole grains instead of refined grains, beans, fruits, vegetables, etc.) because in addition to the nutrients they contain, these will also fill you up and allow the energy from your foods to last longer. This means you are not grabbing for a candy bar or bag of potato chips shortly after eating a healthy meal or snack.
Plant-based foods also contain substances that can reduce your risk of cardiovascular disease. Food sources of antioxidants and other protective nutrients are recommended rather than supplemental forms. Not only do foods contain a wider range of these nutrients, but you are less likely to “overdose.” In the case of many nutrients, more is not better.
Plant sterols and stanols are other substances found in plants that appear to lower LDL cholesterol. You will see these terms on an increasing number of food labels. The recommended daily intake is 2gm/day.
Take a look at what you had to eat yesterday. What form of fats did you eat? The goal is to limit saturated fat and cholesterol, avoid trans fat, and consume unsaturated fats in moderation. To reach these goals, limit portions of animal proteins (the size of a deck of cards at lunch and dinner is a good goal for most adults), limit processed or fatty meats, choose non-fat or low fat dairy products, and minimize foods containing partially hydrogenated fat. Use oils like olive or canola oil.
The Dietary Guidelines for Americans suggests having at least two servings of fish per week. This can mean lower fat intake if it is white fish, or the addition of heart-healthy omega three fatty acids if it is oily fish. Some people prefer to take a daily fish oil supplement (consider taking about 600-1000 mg of EPA plus DHA — the omega three’s in fish oil).
Sugar can negatively affect heart health. Limit your intake of juices and foods/beverages with added sugar. The current recommended goal for men is not more than 150 calories (37gm) of added sugar a day and for women, no more than 100 calories (25gm).
Sodium is everywhere. Check out food labels. Purchase and prepare foods that are lower in sodium and higher in potassium (like fruits and vegetables). If you are over 50 years of age or have risk factors for heart disease, try for less than 1500 mg of sodium a day. These steps can help to lower your blood pressure. Getting adequate calcium from foods is also beneficial.
When it comes to alcohol, men should limit their intake to no more than two servings a day and women, no more than one.
Becoming and remaining physically active is a huge plus for reducing cardiovascular risk. If you have not been active or have health concerns, check with your health-care provider before starting or increasing activity. The general goal is at least 30 minutes of moderate to vigorous activity most days. If you are trying to lose weight or if you have diabetes, high blood pressure, polycystic ovary syndrome, or high blood lipids, shoot for 30-60 minutes most days. Strength-building exercises (two to three times a week, all major muscles) are also very helpful, as increased muscle can positively affect weight loss, blood glucose, blood pressure, and blood lipids.
Other healthy lifestyle habits include limiting screen time (computer, TV, gaming, video, etc.), spending time around active people, eating out less often, controlling the types of foods purchased at the grocery store (so you are not tempted to eat less healthy foods), watching portion sizes, and reducing stress.
Although many of us know what we need to do for better heart health, it is easy to let our busy lives get in the way of consistently taking care of ourselves. Here’s hoping American Heart Month will be a reminder for us to step back and look at what we can do to improve our habits for a healthy cardiovascular system and to reduce our risk of being a victim to heart disease. For more information, see www.heart.org)
Pam Stuppy, MS, RD, CSSD, LD is a registered, licensed dietitian with nutrition counseling offices in York, Maine, and Portsmouth. She is also the nutritionist for Phillips Exeter Academy. Visit www.pamstuppynutrition.com for more nutrition information, some healthy cooking tips, and recipe ideas.
February 17th, 2012 | by Pam Stuppy
Printed in Seacoast Online
Many people do not even think about bone health until midlife or later. By then, however, they may have already compromised their bones in some way.
Bone growth, development, and strength building actually begin at conception. From this point forward, many lifestyle factors can affect the status of our bones. These can include our eating habits, physical activity, some medications, smoking, menstrual status in women, some medical conditions, and others.
The density of our bones increases until the late teen years for girls and early twenties for boys. At the end of this period, we have reached what is called “peak bone mass” — the most bone we will have for a lifetime. Assuming that bone is not compromised in some way, bone density generally remains relatively constant until the premenopausal years for women and the early 60s for men.
Because of some current lifestyle patterns, there is concern about children and teens not reaching maximal peak bone mass. This can lead to both short- and long-term bone health issues. One of the short-term concerns is a higher risk of stress fractures. Long-term, there is the risk of early osteopenia and/or osteoporosis as an adult.
Inadequate nutrient intake during these developmental years can be part of the problem, since nutrients make up the structural part of bone. Some nutrients are also needed in many of the processes that help to create bone.
Physical activity is beneficial to bone, but there is concern that today’s youth are getting inadequate amounts on a regular basis. Teens that smoke are another concern, as smoking is very detrimental to bone, especially during times of growth and development.
Another negative for bone is loss of circulating natural estrogen in girls/women. Estrogen helps the body to build or sustain bone. With the incidence of eating disorders or disordered eating that cause a loss of natural menstrual cycling, estrogen is then not present to support bone. In the teen years, this means that girls may not be able to maximize bone density. Beyond the teen years, it can mean an unrecoverable loss of bone density.
Studies suggest that in the teen years, oral contraceptives are not a good substitute for a natural menstrual cycle when it comes to bone. To make matters worse, if food intake is restricted, bone can be compromised further.
Bone is structurally made up of protein, calcium, phosphorus, zinc, magnesium, and many other minerals. As noted previously, other nutrients may not be part of the structure of bone, but can be part of the process of creating bone tissue, such as vitamin C.
Survey studies indicate that many of today’s children and teens are not consuming the recommended intake of a number of nutrients, including calcium. Even more problematic is that there appears to be a dramatic drop in calcium intake in the preteen and teen years, especially by girls. Beverages with minimal nutritional value tend to replace milk. The recommended intake of calcium for this age group is about 1300 mg or the equivalent of four servings of dairy (or a fortified food/beverage like soy milk) daily.
Vitamin D is another nutrient related to bone health. Think of it as a wagon that carries calcium from the intestinal tract into the blood and from the blood into the bones. It can also regulate the amount of calcium that comes and goes from the body.
Particularly in the northern latitudes, we are finding that many people of all ages are vitamin D deficient or insufficient (as noted by blood tests). Last year, the Institute of Medicine increased the recommended daily intake of vitamin D for bone health to at least 600 IU for children, teens, and adults up to 70 years of age (the goal is 800 IU beyond 70 years). Since dietary sources of vitamin D are limited, a supplement might be prudent. The American Academy of Pediatrics recommends that starting in the first few weeks after birth, infants (whether breast or bottle fed), get 400 IU a day.
In the summer months in New England, the UV light is strong enough for our skin to make vitamin D. Since sunscreen blocks this, parents should consider having their children get about 15 minutes of sun exposure before applying sunscreen.
When it comes to physical activities that benefit bone, it is recommended that we frequently participate in those that are weight bearing or activities that challenge muscle and bone to get stronger. In studies of children and teens, jumping types of exercise, like volleyball, jump rope, etc., appear to be especially helpful. Swimming and other non-weight bearing activities should be supplemented with those that challenge the bones to get stronger.
The goal for children and teens is to get a total of about 60 minutes of moderate to vigorous physical activity daily. Studies suggest that children as young as 5 years of age who do the most physical activity, have better bone density than children who do the least.
If a child is taking medications, these should be examined for any potential negative impact on bone. A possible response might be another medication or lower dose. Parents can also be proactive about their teen not smoking, as the negative impact on health involves bone and other body systems.
For children and teens then, the goal is to consume a nutrient-rich diet with adequate calcium, vitamin D, and a wide range of other nutrients. Providing a variety of healthy foods and limiting the availability of less healthy foods can make a major positive impact on bone. Regular exercise should be encouraged and negative lifestyle habits discouraged. By helping your child or teen to maximize their bone health, you are giving them a gift of health for the future.
February 7th, 2012 | by Pam Stuppy
Printed in Seacoast Online
For the first time in 15 years, the USDA has raised the standards for the nation’s school meals, with the final ruling made last week. These changes are part of the 2010 Healthy, Hunger-Free Kids Act and the “Let’s Move” campaign being promoted by first lady Michelle Obama. The recommendations are also based on those of the Institute of Medicine and the 2010 Dietary Guidelines for Americans.
The changes have been developed to combat childhood obesity, hunger, and the risk of preventable diseases (like diabetes and heart disease) that are becoming more prevalent in our children. Nearly one out of every three children in this country is at potential risk for these preventable diseases owing to being overweight or obese. Unless corrective steps are taken, it is believed that today’s children could have shorter lifespans than their parents.
Because more than 32 million children participate in the school meal program each school day, this new set of standards could have a major positive impact. In addition to dietary changes made in the home, these changes in the school meal program will promote a healthy future for our nation’s children and adolescents.
The standards target both the school lunch and breakfast programs. The new standards are slated to be phased in over a three-year period, with specific time goals for different parts of the standards. The school lunch program changes are to start July 2012 and begin with the 2012/2013 school year. The school breakfast standards will be implemented beginning July 2013 for the 2013/2014 school year.
Some of the key changes for the school lunch program include a daily serving of both fruit and vegetables, instead of just one or the other. With regard to the vegetables offered, they must meet requirements based on specific type — the weekly requirement needs to include dark green, red/orange, beans/peas (legumes), starchy, and “other.” The quantities of fruits and vegetables offered has also increased. In addition, no more than half of the fruit or vegetable offerings can be from juice. All juice must be 100 percent fruit juice.
There is also the goal of increasing the frequency of whole grains served in place of refined grains. In the first year of implementation, at least half the grains served need to be “whole” grains. In the third year of implementation, all grains must be whole. Whole grain foods include those in which the first ingredient is a whole grain or is at least 51 percent whole grain by weight.
Milk must be either fat-free (unflavored or flavored) or unflavored low-fat. Milk over 1 percent is not allowed.
As noted, new standards were also established for the school breakfast program. These include increasing the amount of fruit offered from one-half cup per day, to one whole cup. There are also more specific guidelines for grain or meat/meat alternatives based on age. At least half the grains must be whole grains beginning July 2013 and beginning July 2014, all grain foods must be whole grains. The milk standards are the same as for the school lunch program.
In both the school breakfast and lunch programs, there are also calorie minimums and maximums set for each meal based on the child’s age. Foods of minimal nutritional value are not allowed.
Other improvements for all school meals are specific limitations on the amount of saturated fat, trans fat, and sodium available at each meal. The maximum amount of sodium allowed will be based on the child’s age.
When it comes to trans fats, the nutrition label or manufacturer specifications must indicate zero grams of trans fat per serving. For saturated fat, the maximum amount is set for less than 10 percent of total calories.
For the sodium standards, there are three target levels of sodium to be phased in. The first level must be achieved by 2014/2015, the second by 2017/2018, and the final level by 2022/2023. One of the reasons for phasing in this goal is to allow time for manufacturers to make changes in their products. It also gives children more time to become accustomed to less salty foods.
Along with the change in standards, is improvement in the health of the foods made available by the USDA for use in schools. An example is lower sodium canned beans and vegetables. Another is improved variety of frozen fruits and vegetables. Visit www.fns.usda.gov/fdd for a list of the USDA foods.
There is also a provision for training and technical assistance to schools to assist in the implementation of the new standards.
By aligning the school food standards with current health and nutrition science, the ultimate goal is to improve the short- and long-term health of our nation’s children. It will also better support their academic efforts in school and the recommended level of physical activity.
For information about the new “Nutrition Standards in the National School Lunch and Breakfast Programs,” see www.fns.usda.gov/cnd/Governance/Legislation/nutritionstandards.htm.
Pam Stuppy, MS, RD, CSSD, LD ,is a registered, licensed dietitian with nutrition counseling offices in York, Maine, and Portsmouth. She is also the nutritionist for Phillips Exeter Academy. Visit www.pamstuppynutrition.com for more nutrition information, some healthy cooking tips, and recipe ideas.
February 1st, 2012 | by Pam Stuppy
¾ C. slivered almonds
¾ C. oats
½ C. dried apricots
1 ¾ C. flour
1/3 C. sugar
2 tsp. baking powder
½ tsp. baking soda
½ tsp. mace
½ tsp. nutmeg
½ C. golden raisins
2 Tbsp. butter
8 oz. fat free cream cheese, softened
½ tsp. vanilla extract
½ tsp. almond extract
2 Tbsp. Amaretto
Preheat oven to 350 degrees.
In a food processor, combine first five ingredients. Process until crumbly; place in large bowl.
Stir in next 5 ingredients.
In the food processor, combine butter, cream cheese, egg, extracts, and Amaretto; process about 30 seconds or until well blended.
Gently stir cream cheese mixture into dry ingredients with a fork; turn onto floured board; gently knead a few times. Divide in half to form two rectangles about 3” wide by 12” long.
Place on baking sheet and bake about 25 minutes or until lightly golden; place on rack to cool slightly, about 5 minutes.
With serrated knife, cut into ½” slices. Serve or lay pieces on baking sheet in 350 degree oven for 10 more minutes, turning once to toast each side.
Contributions to better health
- ground oats add a good source of both soluble and insoluble fiber plus other vitamins and minerals
- almonds are a good source of heart-healthy mono-unsaturated fat; they also contain about 80mg calcium per ¼ cup plus fiber and protein
- fat free cream cheese is used so a minimal amount of butter is needed; this lowers saturated fat, cholesterol and calories
- flavor is provided by the spices so salt is not needed
- less sugar is needed due to the extracts and dried fruit (which adds fiber and nutrients)