Article: The Versatile Cranberry

November 24th, 2012 | by Pam Stuppy
Published in: Articles

Printed in Seacoast Online

The cranberry harvest has begun. Their appearance in the produce section of the grocery store heralds the fall and winter holiday seasons. This tangy, colorful fruit adds a unique flavor plus special health benefits. They are also available in a number of forms — fresh, dried, sauced, fresh frozen, and juiced.

Cranberries are native to North America and were originally called “crane berries.” They are generally grown in bogs on low vines, some of which can be more than 100 years old. Native Americans used them to treat wounds. Today they are best known for reducing the risk of urinary tract infections.

Substances found in cranberries can actually prevent bacteria from attaching to membranes, such as those of the urinary tract. The bacteria can then not take up residence and are passed out of the body. These substances are useful in prevention, but cannot treat an established infection.

Studies suggest that this anti-adhesion effect can also reduce bacteria in the mouth, lessening the risk of periodontal disease. Some mouthwashes and toothpastes contain extracts of cranberry for this purpose.

The stomach can benefit from cranberries as well. A particular bacteria is to blame for stomach and intestinal ulcers. Similar to their effect in the urinary tract, the intake of cranberries can prevent adhesion of this bacteria to the lining of these organs.

Cranberries also contain substances that are powerful antioxidants. This means they can help reduce tissue damage in the body. Such damage could otherwise increase the chance of problems like premature skin aging, some cancers, and heart disease.

The heart and blood vessels get a boost from cranberries. Special nutrients in cranberries can reduce the risk of atherosclerosis because of their anti-inflammatory properties, can have a positive effect on the immune system, can help cholesterol levels, and can promote blood flow through the arteries by their effect on certain enzymes.

Even better news, is that all forms of cranberries can provide these health benefits and cooking does not counter the anti-adhesion properties of the cranberry. Starting about two hours after consuming, the anti-adhesion begins and can last up to 10 hours. This means that for maximal effect, people who get frequent urinary tract infections might consider getting two servings a day — one in the morning and one in the evening.

When looking at the nutritional content of these tiny fruit, one whole cup contains only about 46 calories and 12 grams of carbs, but packs a 5-gram dose of fiber. Because of the high fiber and low sugar content, the fresh berries are low in the glycemic index, which can be important for people with blood glucose issues. They also provide potassium (great for blood pressure numbers) and some vitamin C.

Many forms of cranberries are available all year, so can be a frequent part of the diet. Try freezing fresh berries so they are at your fingertips when looking for a fruity, tart flavor and a dash of red color. When buying cranberry juice, look for brands that contain at least 27 percent juice to ensure the health benefits.

If cranberries have not been a frequent part of your diet, think about all the places you could slip them in. Fresh berries can be used in quick breads like cranberry nut bread or muffins. They can be used to make a cranberry crisp or cobbler. They can be cooked into a sauce or preserves.

Dried cranberries are great in a salad, stirred into yogurt or pudding, added to quick breads, in a bread pudding, in your morning oatmeal, added to granola, used as a topping for your bagel with cream cheese, as part of a trail mix, added to boxed cereals, added to a peanut butter sandwich, on top of peanut butter in celery, added to cooked hot grain dishes (rice, quinoa, couscous, barley, bulgur, etc.), added to cold grain salads, added to apple crisp, as a filling for baked apples, or in pancakes.

Cranberry juice adds tartness to a smoothie. A festive beverage could be some cranberry juice with a splash of seltzer. Did you know that there is a cranberry juice available that contains 50 percent lower sugar content if you are trying to lower your carb intake but still want to get the nutritional benefits?

What is considered a serving? Try for one cup of fresh, ½ cup of dried, ¼ cup of cranberry sauce, or 8-10 ounces of cranberry juice. Pills and powders are also available in which 250-1000 mg would be considered a dose — but the real deal is a tastier way to get the health benefits.

With all the positive health benefits, delicious flavor, perky color and versatility of the mighty cranberry, how can you resist adding several versions to your grocery cart this week.

Grocery Shopping Tips for Diabetes Planning

November 6th, 2012 | by Pam Stuppy
Published in: Articles

Printed in Seacoast Online

The grocery store can be a daunting place if you have blood glucose issues like diabetes. The good news about a diabetic diet is that when done well, it can be an excellent example of healthy eating for almost everyone.

Someone with diabetes has a higher risk of heart disease, so the guidelines for keeping blood pressure and cholesterol/triglycerides within the normal range, also apply. Instead of thinking of these as restrictions, think of these guidelines as an opportunity to make positive eating and exercise changes. These recommendations are consistent with the Guidelines for Americans that are in place to promote a healthy lifestyle for all Americans.

The overall goals that pertain to choices at the grocery store would be to increase fruit and vegetable intake, increase fiber (whole grains, fruit, vegetables, beans, nuts, seeds), choose plant-based protein foods more often (beans/legumes, nuts, seeds, nut butters, soy products), choose lean animal protein foods and consume in moderation, use heart healthy oils (olive, canola, etc.) in moderation in place of saturated/trans fats, and include low-fat calcium sources (low-fat dairy or calcium-fortified foods like soy milk).

The goals would also include food quantities and choices that contribute to a healthy body weight. For weight loss, this means enjoying “extras” (foods or beverages high in sugar, refined carbs, and/or fat; foods that do not fit into a healthy food group) less often and in smaller amounts. Foods should also be lower in sodium to keep daily intake below 1500 mg/day. Combining sources of protein, fiber, and healthy carb sources at meals/snacks can be helpful.

Hints for the grocery store — follow a grocery list as this can reduce impulse buying (often less healthy choices), read food labels, consider trying some new healthy foods for variety, and shop often enough so that healthy foods are always available.

The produce section should fill a large percentage of your cart. These colorful foods are high in nutrients, but many are low in carbs and calories. Remember that at least half your lunch and dinner plates should contain foods from this area of the store. The fresh herbs in this section can enhance food flavors without the need for added salt.

In the dairy aisle, look for lower fat products that you enjoy — low-fat milk, yogurt, cottage cheese, cheese. Choosing lower fat can help you save calories. Some studies are suggesting that low-fat dairy products can also promote fat loss when total calories are appropriate for gradual weight loss. These foods also contain protein which, when combined with carb and fiber sources, can reduce the surge in blood sugar you would otherwise get from consuming a carb source alone.

Other proteins that can help moderate blood glucose levels are found scattered throughout the store — lean meat, poultry (preferably without the skin), fresh fish, canned tuna, shellfish, reduced sodium canned beans or dry beans/lentils/split peas, unsalted nuts/seeds, peanut butter/nut butters.

Omega three fatty acids in the form of fish oils (EPA, DHA) can help to reduce the inflammation associated with diabetes and cardiovascular disease. Flax seed and some nuts are examples of another source of omega three’s (ALA) that is positive for health but not as potent for heart health as the fish oil or algae forms. The Dietary Guidelines encourage at least two servings of fish per week.

In the frozen food aisle, pick up frozen fruit and vegetables (not the ones with added sodium or high fat sauces), but limit how often you buy frozen dinners. These are generally high in sodium, do not contain enough of the food groups represented, are often low in fiber, and may be low in protein. If you decide to buy these products, look for the ones lower in sodium, lower in fat, and add some additional vegetables on the side when you prepare the meal. Adding a low-fat dairy product to the meal (like a glass of low-fat milk or some low fat yogurt for dessert) can help boost the protein.

When passing down the aisles of canned and jarred products, read food labels for sodium. The numbers can be extremely high. Fortunately, there are many products appearing on the shelves that have reduced sodium and are still very flavorful. Buy the low-sodium broths for making healthy soups, instead of buying the higher sodium prepared soups. Foods like low-sodium canned tomatoes/tomato sauce and canned pumpkin/squash can add healthy nutrients like antioxidants.

In the bread aisle, look for products where whole grains are the first ingredient. Some labels are also including the number of grams of whole grain a serving contains. The goal for adults is at least 48 gms of whole grain a day. Examples of other higher fiber grains are brown rice, quinoa, whole grain pasta, bulgur, and barley.

In the cereal aisle, add a box of oatmeal — great heart healthy fiber and nutrients. Try grinding up oats and adding them to pancake batter or baked good recipes in place of some of the flour. Other whole grain hot cereals may also be available. Look for dry cereals that are low in sugar and high in fiber/whole grain. These can be used for breakfast or a snack with low fat milk or yogurt, or can be part of a healthy train mix (about ¾ cup of the cereal and ¼ cup of unsalted nuts/seeds).

In the baking aisle, choose whole grain flour, heart healthy oils and nuts. Look for some interesting seasonings that do not contain sodium. Herbs or herb mixes work for marinades, rubs, soups, and add flavor to many other recipes. The sweet spices (like cinnamon) can add a sweet taste so you can often reduce the amount of sugar noted in a recipe. Vinegars and mustards are other options for flavor enhancement.

In the snack aisle, look for unsalted baked chips, air-popped popcorn, low sodium/low fat/high fiber crackers. Be aware that many of the calorie-controlled snack packs may not be the healthiest choice — they may have a set calorie content but not necessarily contain healthy ingredients.

By making healthy choices in your weekly shopping trips, you are more likely to be following the guidelines meant to provide you with better health outcomes.

Article: Healthy Lifestyles for Older Adults

September 29th, 2012 | by Pam Stuppy
Published in: Articles

Printed in Seacoast Online

Numerous factors determine the length and quality of our lives. A healthy lifestyle, early detection and prevention of disease, proper immunizations, and injury prevention are examples of contributors to more positive health outcomes.

Taking good care of ourselves throughout the adult years is important and can positively affect our health over the years ahead. Action steps such a consuming a nutrient-rich diet, maintaining a healthy body weight, and staying physically active are important precursors to maintaining physical and mental health. Continuing to work toward these goals is equally important as we move into the category of “older adult.” The Older Americans Act defined an “older adult” as someone 60 years and older.

Since 1900, the percentage of adults over 65 has more than tripled. Interestingly, of the most common causes of death of adults 65 and older, five out of eight are influenced by nutrition. This supports prioritizing the nutritional quality of a person’s food intake for short- and long-term health and for better physical and mental functioning.

The Academy of Nutrition and Dietetics (previously called The American Dietetic Association) recently updated its position statement about food and nutrition for older adults. In the report, it cites research suggesting that higher intakes of fruit, vegetables, whole grains, poultry, fish, and low-fat dairy products are associated with “superior nutritional status, quality of life, and survival.”

Because of the diversity within the older adult category, nutrient and calorie needs vary. For most older adults, calorie needs are lower than when they were younger. Nutrient needs, however, are generally higher. For this reason, older adults should focus on nutrient-rich foods while limiting calories from less nutritious foods.

Older adults should give special attention to intake of fiber (at least 25gm/day), fluid (> 64 ounces/day), protein (needs are actually higher than for most younger adults to prevent muscle and bone loss), calcium (1200-1500mg preferably from dietary sources — like four servings of a low-fat dairy product daily), vitamin D (> 800 IU/day), vitamin B12 (2.4 ug/day from a supplement), folic acid (400 ug/day), and food sources of antioxidants. Note that high supplemental doses of B12, folic acid, calcium, and antioxidants are not recommended.

Antioxidants available from a wide range of plant-based foods can help reduce the effects of the aging process. They are especially important for eye, bone, immune system, brain, and cardiovascular health. Besides bone health, calcium and vitamin D are also being studied for their possible connection to reduced risk of some cancers, cardiovascular disease, diabetes, and the immune system. Having a blood test done periodically to assess vitamin D status is helpful in determining actual vitamin D needs. Many older adults are vitamin D deficient.

The Tufts’ “My Plate for Older Adults” contains a number of guidelines. It encourages making at least half of lunch and dinner plates brightly colored vegetables and deeply colored fruit. It also suggests whole, enriched, or fortified cereals and grains (for nutrients and fiber). For protein, calcium, and other nutrients, it recommends low- and non-fat dairy products. Additional protein sources include dried beans, nuts, poultry, fish, lean meat, tofu and eggs.

The Tufts plan also encourages liquid vegetable oils instead of trans and saturated fat sources. Spices and other seasonings are recommended instead of added salt. The total sodium intake for the day should stay below 1500 mg. Purchasing lower sodium products can be helpful in achieving this goal.

Adequate fluid intake is also crucial. Many older adults experience a decline in the thirst mechanism, so are more prone to dehydration. Milk, tea, coffee, low-sodium soups and water are good choices. Older adults should talk to their health-care provider if they are limiting fluids because of urinary incontinence, as there are ways to address this issue.

Two major health issues in older adults are sarcopenia and obesity. Sarcopenia is a loss of muscle because of the aging process, reduced physical activity and poor dietary intake. This means a greater risk of falling, a lower metabolism, which means a lower rate of calorie burning, and an increased risk of elevated blood pressure, blood sugar and high blood cholesterol/triglycerides.

Many nutrients are involved in building and maintaining muscle. Adequate protein intake is especially important. Some experts recommend 25-30 gm of high quality protein at each meal. Research suggests that spreading protein intake more evenly throughout the day supports muscle in older adults better than having most of the protein at one meal. Also note that adequate calories are required to spare dietary protein for muscle building. Otherwise, some of it is burned for energy needs.

How many grams of protein are in some common foods? An ounce of meat/poultry/fish/cheese or an egg contain 7 gm, 8 ounces of milk has 8 gm, 8 ounces of yogurt can provide 10-16 gm, ½ cup beans/¼ cup nuts or seeds/2 tablespoon peanut butter each provide 6 gm.

Older adults can have both sarcopenia and obesity, which greatly increases the risk of medical issues. Obesity also puts undue pressure on joints, while sarcopenia lowers the support to the joints otherwise provided by muscle tissue.

Moderating body weight through appropriate food intake and regular exercise is a good idea. Adequate intake of nutrients for building and maintaining muscle, as well as activities that frequently challenge the muscles to get stronger are important in countering sarcopenia. They also help to maintain bone density. In addition, daily physical activity helps reduce the risk of many medical problems and supports mental health.

Article: Navigating School Dining Halls and Cafeterias

September 29th, 2012 | by Pam Stuppy
Published in: Articles

Printed in Seacoast Online

Many adults and students have at least one of their daily meals in a business cafeteria or school dining hall. In the past few years, the number of food options available in these facilities has tended to expand so there is greater variety.

This increase, however, can be a little overwhelming when it comes to putting together a healthy meal.

Most of these dining situations have a main “hot line” containing cooked meal entrees and side dishes. They may also have a “scatter system” with separate specialty areas — like a salad bar, deli/sandwich bar, pasta bar, dessert bar, etc. Some might have areas divided by ethnic foods — Asian, Italian, Mexican, etc. Others may offer “cooked to order” foods — like an omelet station or stir-fry station.

Some will offer specialty areas like one for vegetarian options or gluten-free foods. Most identify at least some of the major allergens contained in the foods — like those containing nuts, peanuts, shellfish, etc. Alternative beverages may also be available — like lactose-free milk, soy milk, rice milk, almond milk (all contain or are generally fortified with calcium at a level similar to dairy milk or yogurt).

As a consumer trying to eat healthfully, it can be helpful to think in food groups when confronting a cafeteria or dining hall. When it comes to portion sizes think of the “My Plate” proportions — about half the meal vegetables, a quarter of the plate a protein source, a quarter of the plate a whole grain or starchy vegetable, a good source of calcium and some fruit.

Entrees contain one or more food groups. When trying to make healthy choices, think of how the food has been prepared. If it has been fried, has a cream sauce, or contains cheese, you know it will contain more fat and calories than one that is broiled, baked, grilled, or otherwise prepared with lower fat ingredients.

Many people are opting to limit animal proteins in their diets even if they are not true vegetarians. Vegetarian eaters often do not get enough protein. Since plant-based proteins tend to contain less protein for the volume, it might be necessary to include several protein sources at a meal. If there is inadequate protein in a vegetarian entrée served, other protein sources can be added to it or eaten on the side.

Examples of plant-based proteins would be beans, tofu/tempeh/edamame/soy milk and other soy products, hummus, nuts, seeds, or veggie burgers. Vegetarians consuming eggs and dairy could add protein through milk, cheese, cottage cheese, yogurt and eggs from the salad bar.

Choosing an entrée that contains a lot of vegetables tends to boost the nutritional content while keeping the calories to a minimum. An example might be a stir fry with chicken or shrimp. Vegetables can also be found as cooked vegetables on the hot line, items on the salad bar, as tomato sauce on the pasta bar, as toppings in the sandwich bar, or in soups. Make these colorful foods a major part of your meal.

Seek out the sources of whole grains available. This could be a cooked grain like brown rice, quinoa, barley, whole grain pasta, or bulgur that are offered as a hot side dish, part of an entrée, on the salad bar, or in a soup. Note what whole grain bread items are available — whole grain bread, pita, tortillas, English muffins, etc.

Fruit might be in a fresh fruit salad, as dried fruit like raisins or dried cranberries on the salad bar, or as a grab-and-go whole piece of fruit. Fruit is better than juice since it contains fiber. It is also easy to consume large amounts of calories from high intakes of juice. Real fruit juice (100 percent juice), however, is better than fruit drinks, which are mostly sugar water.

Busy adults dashing through the company cafeteria or students rushing though the dining hall on the way to class, often depend on the hot line entrees as their primary meal source. Some people do not find these foods appealing and feel at a loss as to how to create a healthy meal on their own. In this case, thinking of all the foods available as ingredients can be helpful. The foods chosen do not have to look like a traditional meal, as long as the five food groups are represented.

How about taking a whole grain bread item like a whole grain tortilla, add a source of protein like grilled chicken from the salad bar or hot line, add some cooked or raw vegetables, top with a little salad dressing and roll up. Then maybe add some yogurt with fruit.

Another idea might be to get a bowl of soup and enhance it with some of the cooked vegetables, a whole grain like whole wheat pasta from the pasta bar, and some beans from the salad bar. Add a glass of milk and an apple.

For a main dish you could also make a modified stir fry by combining a cooked meat/poultry item or beans with some of the cooked vegetable and a cooked whole grain.

A vegetarian option might be a whole wheat pita spread with hummus and then topped with beans and veggies from the salad bar. Or you could add beans to whole grain pasta and tomato sauce from the pasta bar. Enhance either of these with a side salad containing nuts, seeds, and dried fruit, plus a glass of soy milk to make a complete meal.

Sodium can be a concern with eating out. Soups, foods containing cured meats, deli meats, marinades or sauces using soy sauce, some salad dressings, tomato sauces, and condiments like steak sauce are common sources of sodium. Reduce the portion size and/or frequency of eating these foods if you are trying to limit your sodium intake.

So the next time you are eating in a cafeteria or dining hall setting, scout out the options available, think by food groups, and see what creative combinations you come up with for a healthy meal.

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 for more nutrition information, some healthy cooking tips, and recipe ideas.

Tip: Getting grains on the Table

July 19th, 2012 | by Pam Stuppy
Published in: Nutrition Tips

Are you in a rut with the grains you put on the table?  There are a number of whole grains available that can expand the tasty options you have at meals and also give a boost to your fiber and nutrient intake.  Why not try a new grain this week – like quinoa, bulgur, brown rice, or barley.  Go online to find recipes that include these grains.  Most can be prepared similar to rice in that you simmer them in about twice the amount of water or other liquid.  Be creative with added spices, herbs, vegetables, or dried fruit.  An example might be barley with apples and dried cranberries to go with pork.  Another might be sautéed onions and mushrooms added to cooked quinoa.

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