* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Healthy Express - University of Minnesota Extension
Survey
Document related concepts
Transcript
Healthy Express 91 92 Healthy Express Overview Need State Description Healthy Express is described as eating healthy and quickly, with minimum preparation time. Defining Needs "I want to..." Feel like I am eating responsibly, controlling and limiting calorie intake, spreading calories across the day, and eating light Eat quickly and minimize effort in planning, preparation, and clean-up Energize and care for myself Benefits Sought in Food "I want something that..." Is easy, fast, and ready to eat Is healthy; low in calories, fat, cholesterol, salt, and carbohydrates; provides fiber, vitamins, minerals, nutrients, calcium; is natural and organic Defining Eating Occasions Eating occasions include breakfast and lunch Weekdays, alone, at home Little preparation and eating time – average of 10 minutes Healthy Express Lessons Healthy Express lessons focus on strategies for preparing and eating healthy, well balanced meals quickly. Activities include planning convenient and healthy breakfasts and lunches, changing home and work settings so convenient, healthy foods are available for breakfast and lunch, identifying time-saving strategies for food preparation, and strengthening the belief that eating healthy on the go is worth the effort. Lesson 1 ....................................................................................................... 94 Lesson 2 ..................................................................................................... 124 Lesson 3 ..................................................................................................... 151 93 Healthy Express: Lesson 1 Objectives By the end of this lesson, the participant will be able to: Identify components of healthy and balanced meals based on recommendations for food groups, nutrients, and appropriate portion sizes. Plan menus or components of menus for convenient and healthy breakfasts and lunches. Identify time-saving strategies for preparing healthy breakfasts and lunches. Describe ways to modify home and/or work environments to have components on hand for quick and healthy breakfasts and lunches. Improve the perception that eating healthy on the go is worth the effort. Time for this Lesson: 45-50 minutes Activities in this Lesson 1. Introduction and Review (5 minutes) 2. Learning the Basics of a Healthy Express Meal (10 minutes) 3. Planning On-the-Go Meals (15 minutes) 4. Go Healthy and Keep Going! (7 minutes) 5. Review and Goal Setting (7 minutes) Preparation and Handouts Needed Preparation Print and prepare handouts as indicated below. Bring felt-tip marker pens in the five MyPlate colors: red for fruits, green for vegetables, purple for protein, brown for grains, and blue for dairy. Also bring a yellow pen for fats/oils. Handouts 94 What's on Your Plate? (Print this double-sided poster on a color printer, if possible.) Meal Planning with MyPlate (Double-sided) Healthy Express Lesson 1 MyPlate Serving Equivalents Guide Fiber FAQs Creating Breakfast and Lunch Meal Plans Tips for Healthy Express Meals Healthy Express Calendar Goal Setting Worksheet Healthy Express Lesson 1 95 Activities 1. Introduction and Review (5 minutes) Review points from the last lesson with the participant. Ask the participant what she remembers or what was most notable from the last lesson. 2. Learning the Basics of a Healthy Express Meal (10 minutes) Using information obtained from the participant’s needs assessment, discuss her meal-planning responses and the benefits of meal planning: Help ensure a well-balanced diet Alleviate some of the stress that comes with making on-the-fly meal decisions Help save money Save time in the long run Review the recommendations on the What's on Your Plate? handout (poster), and discuss how they can be used to eat a well-balanced diet – after making adjustments for calorie needs. Next, ask the participant to examine the two meal plans for a 1,800-calorie diet on the Meal Planning with MyPlate handout. Questions to Guide Discussion Does anything about this surprise you? Does this look realistic? (Some participants may think this seems like a lot of food. Explain that making healthier choices often means more food with fewer calories.) Breakfast and lunch are often the most unplanned meals. Why? (Possible answers: May be less likely to be eating with the rest of the family; time restrictions; may be away from home at work or running errands; may be more likely to have the same thing every day) On the second page of Meal Planning with MyPlate, have the participant use the felt-tip markers to indicate the food group in the box next to each item. For example, in the food group column next to 1 cup skim milk, the participant should mark a blue X for dairy. Use the MyPlate Serving Equivalents Guide for reference. 96 Healthy Express Lesson 1 Optional activity: If the participant is interested in fiber, have her mark her menus with F’s for foods that are a good source of fiber. Use the Fiber FAQs handout as a reference. On the Meal Planning with MyPlate handout, have the participant record her most recent breakfast and lunch on the blank menus and mark colored X’s in the food group column for each food item. Now read through Creating Breakfast and Lunch Meal Plans and ask the participant to compare her meals from Meal Planning with MyPlate to these recommendations: Foods from at least three food groups for breakfast Foods from at least four food groups for lunch If her meals fell short of recommendations, have the participant suggest ways she could meet them. Commend the participant if her meals fulfilled recommendations. 3. Planning On-the-Go Meals (15 minutes) Discuss Tips for Healthy Express Meals with the participant. Ask her to write any additional strategies she has for quick and healthy breakfasts and lunches. Any of these tips could be used as strategies for the Goal Setting Worksheet. Using Creating Breakfast and Lunch Meal Plans and ideas from Tips for Healthy Express Meals, have the participant plan one week of breakfasts and lunches by filling out the Healthy Express Calendar (during the lesson). As homework for the next lesson, have the participant complete at least one additional weekly meal plan on the Healthy Express Calendar. 4. Go Healthy and Keep Going! (7 minutes) Have the participant reflect on eating on-the-go. Healthy Express Lesson 1 97 Questions to Guide Discussion Do you ever feel like you sacrifice healthy eating for fast eating? What are the benefits? What are the consequences? Is it worth it? What are some barriers to eating well on the go? What are some reasons that eating well on the go is important to you? Reinforce the importance of the participant’s commitment to eating healthy while on the go, noting that: Doing so keeps the "engine" tuned so she can keep going full speed. If she is often on the go, she will likely fall short on nutrition if she is not making healthy choices. If she is not prepared, it is much easier to make unhealthy choices, such as fast food, when on the go. 5. Review and Goal Setting (7 minutes) Ask the participant if she has any questions. Have the participant discuss one or two things she learned today. Have the participant set goals for the next two weeks using the Goal Setting Worksheet. Review the homework assignment to plan at least one week of breakfasts and lunches with the Healthy Express Calendar. Remind the participant to bring the completed menu plan to the next lesson. Schedule the date and time for the next lesson. Briefly describe the topic and activities for the next lesson to arouse interest: • Control portion size for breakfast and snack foods eaten for comfort and relaxation. • Use food labels to identify healthier options for breakfasts and snacks. • Plan breakfasts and snacks to include convenient foods that are good for you. • Choose healthy, convenient or portable foods for breakfast and snacks when looking for comfort and relaxation at home, work, or on the road. Thank the participant for coming. Additional Reading U.S. Department of Agriculture. (n.d.). Daily food plans. Retrieved from http://www.choosemyplate.gov/myplate/index.aspx 98 Healthy Express Lesson 1 Healthy Express Lesson 1 99 100 Healthy Express Lesson 1 Meal Planning with MyPlate Below is an example of two days of meals and snacks for a 1,800 calorie diet. Day 1 Breakfast Lunch Dinner 1 toasted English muffin 1 tbsp peanut butter 2 tsp jam or preserves 4 oz calcium-fortified orange juice 1 ½ c red beans and rice, prepared without meat or added fat 1 c raw vegetables (peppers, cucumbers, tomatoes, etc.) 2 plums 4 oz marinated, grilled salmon 1 medium baked sweet potato 1 c steamed broccoli Large salad with mixed salad greens and 1 tbsp olive oil-based salad dressing Snacks: 6 oz low fat yogurt, ¼ cup almonds, 1 cup skim milk or soy milk, 3 cups air-popped popcorn Day 2 Breakfast Lunch Dinner 1 c oatmeal, prepared with water topped with: 2 tsp honey 1 tbsp chopped dates ¼ cup skim milk 4 oz calcium-fortified orange juice Sandwich: 2 slices whole grain bread 3 oz oven roasted turkey Spinach leaves Mustard 1 snack-sized bag of pretzels 1 large apple Mediterranean salad: 2 - 3 c romaine lettuce Half of a red bell pepper 10 cherry tomatoes Red onion 3 large black olives, sliced 3 oz grilled chicken breast 1 oz feta cheese ¼ cup chick peas 2 tbsp Greek dressing 1 small slice Italian bread, dipped in 2 tsp olive oil Snacks: Low-fat string cheese stick, large stalk celery with 1 tbsp peanut butter, 1 c sugar-free hot cocoa, made with skim milk Healthy Express Lesson 1 101 For the examples of healthy breakfasts and lunches below, use colored markers to identify the MyPlate food group for each meal item. Breakfast Food Group Lunch Food Group 1 ½ c bran flakes (or another highfiber cereal) ¾ c tuna salad: water packed tuna light mayo relish chopped celery 1 c skim milk 6 whole grain crackers 1 boiled egg 1 medium raw carrot 4 oz calcium-fortified orange juice ½ c mixed fruit, in own juice Breakfast Food Group Lunch Food Group 1/2 c mixed fruit (banana, kiwi, orange, strawberries, etc.) 1 6-inch sub on whole wheat bread: 3 oz turkey breast 1 oz Swiss cheese lettuce, peppers, tomatoes, cucumbers, vinegar ½ c low-fat vanilla yogurt 1 medium apple 1 low-fat granola bar 1 small bag multigrain chips Now, recall your last breakfast and lunch and record each food item in the boxes below. Use colored markers to identify the food group for each meal item. Breakfast 102 Food Group Lunch Food Group Healthy Express Lesson 1 MyPlate Serving Equivalents Guide What counts as an ounce equivalent of grains? In general, 1 slice of bread, 1 cup of ready-to-eat cereal, or ½ cup of cooked rice, cooked pasta, or cooked cereal can be considered a 1-ounce equivalent from the grains group. The chart lists specific amounts that count as 1-ounce equivalents of grains toward daily recommended intake. Food Applicable varieties Amount that counts as 1 ounce equivalent of grains Bagels WG* whole wheat RG* plain, egg 1 mini bagel Biscuits RG baking powder, buttermilk 1 small (2" diameter) Breads WG 100% whole wheat RG white, wheat, French, sourdough 1 regular slice 1 small slice French 4 snack-size slices rye bread Bulgur WG cracked wheat ½ cup cooked Cornbread RG cornbread 1 small piece (2 ½" x 1 ¼” x 1 ¼") Crackers WG 100% whole wheat, rye 5 whole wheat crackers 2 rye crisp breads RG saltines, snack crackers 7 square or round crackers English muffins WG whole wheat RG plain, raisin ½ muffin Muffins WG whole wheat RG: bran, corn, plain 1 small (2 ½" diameter) Oatmeal WG oatmeal ½ cup cooked 1 packet instant 1 ounce (1/3 cup) dry (regular or quick) Pancakes WG whole wheat, buckwheat RG buttermilk, plain 1 pancake (4 ½" diameter) 2 small pancakes (3" diameter) (continued on next page) Healthy Express Lesson 1 103 (continued from previous page) Amount that counts as 1 ounce equivalent of grains Popcorn WG varieties Ready-to-eat breakfast cereal WG toasted oat, whole 1 cup flakes or rounds 1 ¼ cup puffed rice wheat flakes RG corn flakes, puffed rice Rice WG brown, wild RG enriched, white, polished ½ cup cooked 1 ounce dry Pasta – spaghetti, WG whole wheat RG enriched, durum macaroni, noodles ½ cup cooked 1 ounce dry Tortillas WG whole wheat, whole grain corn RG flour, corn 3 cups, popped 1 small flour tortilla (6" diameter) 1 corn tortilla (6" diameter) *WG = whole grains, RG = refined grains. These are shown when products are available both in whole grain and refined grain forms. 104 Healthy Express Lesson 1 What counts as a cup of fruit? In general, 1 cup of fruit or 100% fruit juice, or ½ cup of dried fruit can be considered 1 cup from the fruit group. The following specific amounts count as 1 cup of fruit (in some cases equivalents for ½ cup are also shown) toward your daily recommended intake. Amount that counts as 1 cup of fruit Apple Amount that counts as ½ cup of fruit ½ large (3.25" diameter) 1 small (2.5" diameter) 1 cup sliced or chopped, raw or cooked ½ cup sliced or chopped, raw or cooked Applesauce 1 cup 1 snack container (4 ounce) Banana 1 cup sliced 1 small (less than 6” long) 1 large (8" to 9" long) Cantaloupe 1 cup diced or melon balls Grapes 1 cup whole or cut-up Grapefruit 1 medium wedge (1/8 of a medium melon) 32 seedless grapes 16 seedless grapes 1 medium (4" diameter) ½ medium (4" diameter) 1 cup sections Mixed fruit (fruit cocktail) 1 cup diced or sliced, raw or canned, drained 1 snack container (4 ounce) drained = 3/8 cup Orange 1 large (3-1/16" diameter) 1 small (2-3/8" diameter) 1 cup sections Orange, mandarin 1 cup canned, drained Peach 1 large (2 ¾" diameter) 1 small (2" diameter) 1 cup sliced or diced, raw, cooked, or canned, drained 1 snack container (4 ounce) drained = 3/8 cup 2 halves, canned (continued on next page) Healthy Express Lesson 1 105 (continued from previous page) Amount that counts as 1 cup of fruit Pear 1 medium pear Amount that counts as ½ cup of fruit 1 snack container (4 ounce) drained = 3/8 cup 1 cup sliced or diced, raw, cooked, or canned, drained Pineapple 1 cup chunks, sliced or crushed, raw, cooked or canned, drained Plum 1 cup sliced raw or cooked 3 medium or 2 large plums Strawberries Watermelon 1 snack container (4 ounce) drained = 3/8 cup 1 large plum About 8 large berries 1 cup whole, halved, or sliced, fresh or frozen ½ cup whole, halved, or sliced 1 small wedge (1" thick) 6 melon balls 1 cup diced or balls Dried fruit (raisins, prunes, apricots, etc.) ½ cup dried fruit is equivalent to 1 cup fresh fruit, e.g., ½ cup raisins ½ cup prunes ½ cup dried apricots ¼ cup dried fruit is equivalent to ½ cup fresh fruit, e.g., 1 small box raisins (1.5 ounce) 100% fruit juice (orange, apple, grape, grapefruit, etc.) 1 cup ½ cup 106 Healthy Express Lesson 1 What counts as a cup of vegetables? In general, 1 cup of raw or cooked vegetables or vegetable juice, or 2 cups of raw leafy greens can be considered 1 cup from the vegetable group. The chart lists specific amounts that count as 1 cup of vegetables (in some cases equivalents for ½ cup are also shown) toward your recommended intake. Amount that counts as 1 cup of vegetables Amount that counts as ½ cup of vegetables Red and Orange Vegetables Carrots 1 cup, strips, slices, or chopped, raw or cooked 2 medium 1 medium carrot 1 cup baby carrots (about 12) About 6 baby carrots Pumpkin 1 cup mashed, cooked Red peppers 1 cup chopped, raw, or cooked 1 large pepper (3" diameter, 3¾" long) 1 small pepper Tomatoes 1 large raw whole (3" diameter) 1 cup chopped or sliced, raw, canned, or cooked 1 small raw whole (2¼" diameter) 1 medium canned Tomato juice 1 cup ½ cup Sweet potato 1 large baked (2¼" or more diameter) 1 cup sliced or mashed, cooked Winter squash (acorn, butternut, Hubbard) 1 cup cubed, cooked ½ acorn squash, baked = ¾ cup Beans and Peas Dry beans and peas (black, garbanzo, kidney, pinto, or soy beans, or black eyed peas or split peas) 1 cup whole or mashed, cooked (continued on next page) Healthy Express Lesson 1 107 (continued from previous page) Amount that counts as 1 cup of vegetables Amount that counts as ½ cup of vegetables Dark Green Vegetables Broccoli 1 cup chopped or florets 3 spears, 5" long raw or cooked Greens (collards, mustard greens, turnip greens, kale) 1 cup cooked Spinach 1 cup, cooked Raw leafy greens (spinach, romaine, watercress, dark green leafy lettuce, endive, escarole) 2 cups raw is equivalent to 1 cup of vegetables 1 cup raw is equivalent to ½ cup of vegetables 2 cups raw is equivalent to 1 cup of vegetables 1 cup raw is equivalent to ½ cup of vegetables Starchy Vegetables Corn, yellow or white 1 cup 1 large ear (8” to 9” long) Green peas 1 cup White potatoes 1 cup diced, mashed 1 small ear (about 6" long) 1 medium boiled or baked potato (2½" to 3" diameter) French fries: 20 medium to long strips (2½" to 4" long);contains added calories from solid fats (continued on next page) 108 Healthy Express Lesson 1 (continued from previous page) Amount that counts as 1 cup of vegetables Amount that counts as ½ cup of vegetables Other Vegetables Bean sprouts 1 cup cooked Cabbage, green 1 cup, chopped or shredded, raw or cooked Cauliflower 1 cup pieces or florets, raw or cooked Celery 1 cup, diced or sliced, raw or cooked 2 large stalks (11" to 12" long) Cucumbers 1 cup raw, sliced or chopped Green or wax beans 1 cup cooked Green peppers 1 cup chopped, raw or cooked 1 large stalk (11" to 12" long) 1 large pepper (3" diameter, 3¾" long) 1 small pepper Lettuce, iceberg or head 2 cups raw, shredded or chopped is equivalent to 1 cup of vegetables 1 cup raw, shredded or chopped is equivalent to ½ cup of vegetables Mushrooms 1 cup raw or cooked Onions 1 cup chopped, raw or cooked Summer squash or zucchini 1 cup cooked, sliced or diced Healthy Express Lesson 1 109 What counts as a cup in the dairy group? In general, 1 cup of milk, yogurt, or soymilk (soy beverage), 1½ ounces of natural cheese, or 2 ounces of processed cheese can be considered 1 cup from the dairy group. The chart lists specific amounts that count as 1 cup in the dairy group toward your daily recommended intake. Amount that counts as a cup in the dairy group Common portions and cup equivalents Milk [choose fat-free or low-fat milk] 1 cup milk 1 half-pint container milk ½ cup evaporated milk Yogurt [choose fat-free or low-fat yogurt] 1 regular container (8 fluid ounces) 1 small container (6 ounces) = ¾ cup 1 cup yogurt 1 snack size container (4 ounces) = ½ cup 1 ½ ounces hard cheese (cheddar, mozzarella, Swiss, Parmesan) 1/3 cup shredded cheese 1 slice of hard cheese is equivalent to ½ cup milk 2 ounces processed cheese (American) ½ cup ricotta cheese 1 slice of processed cheese is equivalent to 1/3 cup milk 2 cups cottage cheese ½ cup cottage cheese is equivalent to ¼ cup milk Cheese [choose reducedfat or low-fat cheeses] Milk-based desserts [choose fat-free or low-fat types] Soymilk (soy beverage) 110 1 cup pudding made with milk 1 cup frozen yogurt 1 ½ cups ice cream 1 scoop ice cream is equivalent to 1/3 cup milk 1 cup calcium-fortified soymilk 1 half-pint container calcium-fortified soymilk Healthy Express Lesson 1 What counts as an ounce equivalent in the protein group? In general, 1 ounce of meat, poultry or fish, ¼ cup cooked beans, 1 egg, 1 tablespoon of peanut butter, or ½ ounce of nuts or seeds can be considered a 1 ounce equivalent from the protein foods group. The chart lists specific amounts that count 1 ounce equivalent in the protein group toward your daily recommended intake. Amount that counts as 1 ounce equivalent in the protein foods group Common portions and ounce equivalents 1 ounce cooked lean beef 1 small steak (eye of round, filet) = 3½ to 4 ounce equivalents 1 ounce cooked lean pork or ham 1 small lean hamburger = 2 to 3 ounce equivalent 1 ounce cooked chicken or turkey, without skin 1 small chicken breast half = 3 ounce equivalent 1 sandwich slice of turkey (4 ½ x 2 ½ x 1/8”) ½ Cornish game hen = 4 ounce equivalent 1 ounce cooked fish or shell fish 1 can of tuna, drained = 3 to 4 ounce equivalents 1 salmon steak = 4 to 6 ounce equivalents 1 small trout = 3 ounce equivalent Eggs 1 egg 3 egg whites = 2 ounce equivalent 3 egg yolks = 1 ounce equivalent Nuts and seeds ½ ounce of nuts (12 almonds, 24 pistachios, 7 walnut halves) ½ ounce of seeds (pumpkin, sunflower or squash seeds, hulled, roasted) 1 tablespoon of peanut butter or almond butter 1 ounce of nuts or seeds = 2 ounce equivalent ¼ cup of cooked beans (such as black, kidney, pinto, or white beans) ¼ cup of cooked peas (such as chickpeas, cowpeas, lentils, or split peas) ¼ cup of baked beans, refried beans 1 cup split pea soup = 2 ounce equivalent 1 cup lentil soup = 2 ounce equivalent 1 cup bean soup = 2 ounce equivalent ¼ cup (about 2 ounces) of tofu 1 ounce tempeh, cooked ¼ cup roasted soybeans 1 falafel patty (2 ¼”, 4 ounces) 2 tablespoons hummus 1 soy or bean burger patty = 2 ounce equivalent Meats Poultry Seafood Beans and peas Healthy Express Lesson 1 111 How much is my allowance for oils? Some Americans consume enough oil in the foods they eat, such as: Nuts, Fish, Cooking oil, and Salad dressings. Others could easily consume the recommended allowance by substituting oils for some solid fats they eat. A person’s allowance for oils depends on age, sex, and level of physical activity. Daily allowances are shown in the chart. Daily Allowance* Children Girls Boys Women Men 2-3 years old 3 teaspoons 4-8 years old 4 teaspoons 9-13 years old 5 teaspoons 14-18 years old 5 teaspoons 9-13 years old 5 teaspoons 14-18 years old 6 teaspoons 19-30 years old 6 teaspoons 31-50 years old 5 teaspoons 51+ years old 5 teaspoons 19-30 years old 7 teaspoons 31-50 years old 6 teaspoons 51+ years old 6 teaspoons *These amounts are appropriate for individuals who get less than 30 minutes per day of moderate physical activity, beyond normal daily activities. Those who are more physically active may be able to consume more while staying within calorie needs. 112 Healthy Express Lesson 1 Fiber FAQs What is fiber? Fiber is a type of carbohydrate (like sugars and starches) found in plant foods. Unlike sugar and starches, fiber is not digested (broken down) by the human body, and therefore does not contribute any calories. There are two types of fiber: insoluble, or “roughage,” found in fruit and vegetable skins, whole grain husks, and nuts; and soluble, found in citrus fruits, apples, barley, oatmeal, oat bran, peas and beans. What can fiber do? Absorb water in the intestine and help relieve constipation (insoluble fiber) Help lower blood cholesterol level (soluble fiber) Aid in weight loss (the added bulk helps you feel full with less food) Do I need to take a fiber supplement? No. A diet containing a variety of fruits, vegetables, and whole grains should provide adequate fiber as well as essential vitamins and minerals. How should I increase the fiber in my diet? Eat at least 5 servings of vegetables and fruits and at least 2 servings of whole grain products each day. The recommended goal for daily fiber intake is 25-35 grams. Increase the amount of fiber in your diet slowly over several weeks to allow your body to adjust and avoid stomach discomfort. Be sure to drink more water as you increase fiber in your daily diet. Following are some examples of high fiber fruits, vegetables, and grains. High Fiber Fruits (serving size is ½ cup fresh unless otherwise noted): Over 3 grams fiber per serving: prunes (5 dried), raisins, apple (unpeeled), pear, blackberries 2-3 grams fiber per serving: blueberries, orange, apple (peeled), raspberries, banana High Fiber Vegetables (serving size is ½ cup fresh unless otherwise noted): Over 3 grams fiber per serving: Brussels sprouts, canned pumpkin, potato with skin, kidney beans 2-3 grams fiber per serving: mushrooms, carrot (1 large), spinach (2 cups), broccoli, green peas Bread, Cereal, Rice, and Pasta (check the Nutrition Facts label on food packaging for fiber content): High fiber choices: bran, including oat and wheat bran; brown rice, buckwheat, oatmeal; foods made with whole oats, rye flour, wild rice, or whole-wheat flour Cereals that contain 5 grams of dietary fiber or more per serving are considered high fiber. Whole-grain breads that list whole wheat, whole-wheat flour or another whole grain as the first ingredient on the label and have at least 2-3 grams of dietary fiber per serving are good sources of fiber. Healthy Express Lesson 1 113 Adapted from University of Wisconsin Health Services. (2011). Fiber. Retrieved from http://www.uhs.wisc.edu/health-topics/digestive-system/fiber.shtml 114 Healthy Express Lesson 1 Creating Breakfast and Lunch Meal Plans Step 1: Available Food Write the names of foods in your refrigerator or cupboards that will need to be eaten soon. Items such as fresh fruits and vegetables and dairy products tend to spoil fastest. Keep these items in mind when you are thinking about menus for each meal. Step 2: Sale Items Take into consideration the weekly sales at your grocery store or coupons for items you frequently purchase. Don’t clip the coupon if you and your family won’t eat it. Record these items. Step 3: Make a Calendar Create a list of foods that you like to eat for breakfast and lunch. Then, on the calendar, plan out what you will eat each day. Aim to eat a variety of foods from day to day. Are there some days that are especially busy? If so, plan leftovers or simple meals for these days. Breakfast Plan: Don’t skip breakfast! It can help give you a better start to your day. Breakfast also gives you a good opportunity to get nutrients like fiber and calcium that may be lacking in your diet. Try to create a breakfast that includes foods from three of the five food groups. Try to include one whole-grain item in most of your breakfasts. Cereals with 5 or more grams of fiber per serving are considered high fiber. A healthy breakfast does not have to be cooked or even include traditional "breakfast foods." Quick and healthy ideas for breakfast: yogurt mixed with whole grain cereal and sliced fresh fruit; whole grain frozen waffles or toast topped with peanut butter and a glass of milk; a boiled egg over an English muffin with a glass of vegetable juice Lunch Plan: Skipping lunch may set you up for low energy or overeating later. Lunch gives you a good opportunity to get in a serving or two of vegetables. Try to create a lunch that includes foods from four of the five food groups. Leftovers make a quick and easy lunch. Quick and healthy ideas for lunch: pita pocket stuffed with lean turkey, low-fat cheese and tomatoes; left-over chili with half of a whole-grain tortilla and red pepper strips; chicken salad with grapes and cucumbers on whole-grain crackers Healthy Express Lesson 1 115 Step 4: Compare to MyPlate Check if each breakfast and lunch has foods from the recommended number of food groups. Does your plan include a variety of foods? Adapted from University of Nebraska-Lincoln. (2011.). Nebraska’s Nutrition Education Program: Meal planning and shopping. Retrieved from http://liferay.unl.edu/web/nep/meal-planning-and-shopping-lesson 116 Healthy Express Lesson 1 Tips for Healthy Express Meals Stock the refrigerator and your desk with healthy and portable snacks, such as small bottles of flavored low-fat milk, easy-to-eat yogurt tubes, cubed cheese, whole grain cracker packs, low-fat string cheese, snack bags of mini carrots and pre-measured bags of nuts. These can be combined for emergency on-the-go meals. Make a batch of smoothies with fruit and low-fat milk, and freeze in individual containers. Thaw one out for breakfast while you are in the shower. Pack lunches the night before. Form a lunch group with three or four other health-minded co-workers, with each member taking turns bringing a nutritious, low-calorie lunch for everyone once a week. Keep pre-cut fruits, ready-to-eat vegetables, and a small bowl of low-fat dip on the most visible shelf in the refrigerator to quickly complement your lunches. For faster, healthier lunches, stock no-fuss bagged salads, individually frozen poultry pieces, and plenty of canned and frozen vegetables. Consider grilling extra chicken at dinner to slice and freeze for quick chicken quesadillas or barbecue chicken sandwiches, or to add to soup. Your Own Ideas Healthy Express Lesson 1 __________________________________ __________________________________ ____________ __________________________________ __________________________________ ____________ __________________________________ __________________________________ 117 Healthy Express Calendar 118 Healthy Express Lesson 1 Healthy Express Lesson 1 119 120 Healthy Express Lesson 1 Healthy Express Lesson 1 121 Date: _______________ Goal Setting Worksheet Short-term goals are specific and intended to be accomplished in a short timeframe. Short-term goals should be: Clear and specific; Something you can accomplish in about 1-2 weeks; Something you really want to do; Personal (creating expectations of yourself and not other people); Positive; Stated in the present tense; and Brief enough to commit to memory. Write one or two short-term goals along with several strategies to help you meet these goals. The following example may help you. Example Goal: Replace two of my usual snacks this week with fruit or vegetables. Strategy 1: Buy baby carrots and cut-up broccoli and vegetable dip at the store. Strategy 2: Set out a bowl filled with apples on the counter. Strategy 3: Don’t buy cookies or chips for snacks. Short-Term Goal #1: ________________________________________________________ __________________________________________________________________________ Strategy 1: _________________________________________________________________ __________________________________________________________________________ Strategy 2: ________________________________________________________________ __________________________________________________________________________ Strategy 3: _________________________________________________________________ __________________________________________________________________________ 122 Healthy Express Lesson 1 Short-Term Goal #2: ________________________________________________________ __________________________________________________________________________ Strategy 1: _________________________________________________________________ __________________________________________________________________________ Strategy 2: ________________________________________________________________ __________________________________________________________________________ Strategy 3: _________________________________________________________________ __________________________________________________________________________ For each goal, think about how you would answer the following questions: • How will you keep your goals on your mind (post on refrigerator, write on calendar, etc.)? • Who will support you in meeting your goals? • What roadblocks can you anticipate and how will you get around these? 4. How will you reward yourself for taking action? Date of next counseling lesson: _____________________ Please bring this worksheet to your next lesson. Healthy Express Lesson 1 123 Healthy Express: Lesson 2 Objectives By the end of this lesson, the participant will be able to: Assess current food choices made on the go from fast-food restaurants, convenience stores, and the like, for ways to improve their healthfulness (nutritional value). Examine convenience items, such as meal replacement bars and beverages, for healthfulness. Recognize how beverage choices and portion size affects daily calorie and nutrient intakes. Practice making healthy choices for foods eaten quickly, at home and away from home. Time for this Lesson: 50-60 minutes Activities in this Lesson 1. Introduction and Review (7 minutes) 2. Stop-n-Go Eating (7 minutes) 3. Adding It Up (10 minutes) 4. Fast Food – Beyond Fast-Food Restaurants (7 minutes) 5. Bar Exam (5 minutes) 6. Rethink Your Drink (7 minutes) 7. Review and Goal Setting (7 minutes) Preparation and Handouts Needed Preparation 124 Print and prepare handouts as directed below. Bring fake money, including bills in $1, $10, $20, and $100 denominations. NOTE: You can make $100 bills by printing out the $100 InSNC bills included in the Fake Money handout in the Basic Nutrition Lesson. You can make the other bills by revising the denominations on the $100 InSNC bills, then printing out what you need. Healthy Express Lesson 2 After reviewing the participant's needs assessment form to determine which fast-food restaurant menus are relevant, print out them out (including nutrition information) from http://www.bd.com/us/diabetes/hcp/main.aspx?cat=3066&id=3285. Bring a calculator. For the "Rethink Your Drink" activity, bring: About a half pound of sugar; Three 8-ounce plastic cups; One-teaspoon measuring spoon; and A clear, 20-ounce soda bottle without the soda, but filled with 14 teaspoons of sugar (before the lesson). Handouts Goal Setting Worksheet Stop 'n Go Eating (Print double-sided with Adding It Up Worksheet.) Adding It Up Worksheet (Print double-sided with Stop 'n Go Eating.) Thinking Outside the Kitchen: Healthy Choices Frozen Meals Purse Card (Print sheet and cut out individual cards on card stock or on regular paper and laminate.) Vending Machine Purse Card (Print sheet and cut out individual cards on card stock or on regular paper and laminate.) Energy and Snack Bar Comparison Chart (pdf and available from http://www.runnersweb.com/running/EnergySnackBarChart.pdf Snack and Meal Replacement Bars Purse Card (Print sheet and cut out individual cards on card stock or on regular paper and laminate.) List of Common Drinks Rethink Your Drink (optional) Healthy Express Lesson 2 125 Activities 1. Introduction and Review (7 minutes) Review points from the last lesson. Ask the participant what she remembers or what was most notable from the last lesson. Use Goal Setting Worksheet to record responses. Questions to Guide Discussion How did you do with your goals from the last lesson? (insert goals) What went well? What did you struggle with? What were some of the barriers? 2. Stop 'n Go Eating (7 minutes) First discuss the nutritional differences between foods made at home and those consumed when eating out. Also talk about what instances would be considered eating out. Here’s what the latest literature says about the nutritional differences between meals prepared and eaten at home and meals eaten away from home. Meals eaten away from home usually contain: 1 More calories, saturated fat, sodium and cholesterol, and Less fiber, calcium and iron. 1 Eating on the go not only includes meals eaten away from home, but also things, such as snacks and beverages, that “tide you over” until the next meal. Talk with the participant about the importance of being aware of these on-the-go eating behaviors, i.e., what she’s doing and how often she’s doing it, because these bites and sips often add up to an unexpectedly high number of calories. Have the participant think about the times she eats on the go (when time is a priority). Question to Guide Discussion In general, what is the most important thing to you when eating on the go? (For the facilitator: Because this is the Healthy Express need state, the participant may typically value health. This probing gives the participant the opportunity to re-state that focus or to reveal discrepancies.) 126 Healthy Express Lesson 2 Next, read through the examples on the Stop 'n Go Eating handout and ask the participant to write information about at least one recent or habitual stop 'n go eating occasion. (If necessary, use the information from the participant’s needs assessment to prompt for places she frequents when eating outside the home.) As homework for the next session, have the participant complete the remainder of Stop 'n Go Eating. Suggest she keep the handout in a handy spot, such as her purse or car. 3. Adding It Up (10 minutes) First, distribute fake money for a 1,800 or 2,000 calorie diet (depending on the participant’s needs) with 1 calorie equaling $1 (one dollar). Then, using the fast food menus and nutrition information you printed out, have the participant complete the Adding It Up Worksheet. Once completed, have her count out what her fast food meal “cost” her. Discuss with the participant the stresses that fast-food meals can put on a day's “food budget,” particularly since according to one survey, 75 percent of individuals eat out at least once a week 2 and 25 percent eat out 2-3 times per week. Ask the participant to recall the composition of optimally healthy breakfasts and lunches. A healthy breakfast includes: Foods from three of the five food groups One whole-grain item Fiber and calcium A healthy lunch includes: Food from four of the five food groups A serving or two of vegetables Using the Thinking Outside the Kitchen: Healthy Choices handout, have the participant identify a healthier choice from the fast-food menu to replace her original choice named on the Adding It Up Worksheet. Then have her re-do the math. Healthy Express Lesson 2 127 4. Fast Food – Beyond Fast-Food Restaurants (7 minutes) Talk with the participant about where her stop 'n go eating occurs in addition to fast food restaurants. If she needs prompting, suggest vending machines, convenience stores, and coffee or smoothie shops. Review the pertinent sections of Thinking Outside the Kitchen: Healthy Choices with the participant. Have her write down two or three strategies that she will try to incorporate in her daily eating occasions and write them on the “Personal Summary” page of the handout. Give the participant a Frozen Meals Purse Card and a Vending Machine Purse Card. 5. Bar Exam (5 minutes) Ask participant if she purchases snack and meal replacement bars or drinks. If not, you may want to review the content, but skip the activity in this section. Discuss the advantages and disadvantages of snack or meal replacement bars or drinks; inform the participant of the need to know what to look for in these kinds of products given the wide variety available. Advantages of such bars include: Portion controlled Easy and portable Can provide a well-balanced snack with fiber and protein Disadvantages include: Expense Potential for such bars to be glorified candy bars, with high sugar and fat content, i.e., empty calories Whole foods, such as fruit, vegetables and whole grains, are always a better nutrition bet than bars, especially for meals. Review the "Choosing Snack and Meal Replacement Bars or Drinks" section of Thinking Outside the Kitchen: Healthy Choices. Next, explain the 5:100 Rule: Add the total grams of fiber and total grams of protein, using a calculator, if necessary. If the sum equals 5 grams or more per 100 calories, the bar should satisfy hunger. 128 Healthy Express Lesson 2 Using the Energy and Snack Bar Comparison Chart, have the participant choose a bar she often buys (or a type of bar she might choose) and apply the 5:100 Rule. Give the participant a Snack and Meal Replacement Bars Purse Card. 6. Rethink Your Drink (7 minutes) Talk with the participant about the importance of choosing healthy beverages. Mention that: A study reported in the Journal of the American Medical Association found that higher intake of sugar-sweetened beverages was associated with increased weight gain and risk 3 of type 2 diabetes in women. Drinking one sugar-sweetened beverage per day, without cutting back on calories, for a 4 year could cause a weight increase of 15 pounds. Use the following activity to visually demonstrate the amount of sugar in soda and other drinks. Explain that for a 2,000-calorie diet, the Dietary Guidelines for Americans recommends that added sugars and solid fats (called SoFAS) amount to no more than 13 percent of total daily 5 intake. That is roughly 65 grams, or15 teaspoons. Tell the participant that this activity assumes that the allotted calories for SoFAS are consumed solely through added sugars. Next, place 15 teaspoons of sugar in one of the 8-ounce plastic cups. Now show the participant the 20-ounce clear soda bottle pre-filled with sugar. Explain that the bottle contains 14 teaspoons of added sugar, about the same amount in a 20-ounce bottle of regular (not diet) soda – with 1 teaspoon of sugar equaling 4.2 grams. Have the participant pick a beverage she drinks from the List of Common Drinks and repeat the activity, measuring out the number of teaspoons of added sugar for that beverage into another 8ounce cup. Compare it to the first cup containing the maximum amount of SoFAS that should be consumed daily (15 teaspoons). Help her understand that if a 20-ounce bottle of regular soda contains 13-14 teaspoons of added sugar, drinking just one bottle uses up nearly all the recommended daily allowance of SoFAS. Finally, show the participant an empty 8-ounce cup, and say it represents the amount of added sugar in any amount of water, milk and 100 percent fruit juice, i.e., zero. This leaves her free to consume more SoFAS, if she wishes, from more healthful foods. You may also want to provide the participant with the Rethink Your Drink handout. This is optional. Healthy Express Lesson 2 129 7. Review and Goal Setting (7 minutes) Ask the participant if she has any questions. Have the participant discuss one or two things she learned today. Have the participant set goals for the next two weeks using the Goal Setting Worksheet. Review homework for Stop 'n-Go Eating, if applicable, and remind the participant to bring it to the next session. Schedule the date and time of the next lesson. Briefly describe the topic and activities for the next lesson to arouse interest: 130 • Find nutrition information online and print it out for guidance on controlling calorie intake and consuming all necessary nutrients daily. • Make a recipe or menu file of healthy foods or meals that can be prepared and eaten quickly. • Understand the benefits of eating organic foods and "superfoods." Thank the participant for coming. Healthy Express Lesson 2 Sources Cited 1. Lin, B., Frazão, E., & Guthrie, J. (1999, January). Away-from-home foods increasingly important to quality of American diet (Agriculture Information Bulletin No. 749). Washington, D.C.: Economic Research Service, U.S. Department of Agriculture. 2. Stewart, H., Blisard, N., & Jolliffe, D. (2006, October). Let’s eat out: Americans weigh taste, convenience, and nutrition (Economic Information Bulletin No. 19). Washington, D.C.: U. S. Department of Agriculture, Economic Research Service. 3. Schulze, M.B., Manson, J.E., Ludwig, D.S., Colditz, G.A., Stampfer, M.J., Willett, W.C., & Hu, F.B.. (2004). Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Journal of the American Medical Association, 292(8), 927934. 4. Harvard School of Public Health. (n.d.). Sugary drinks or diet drinks: What’s the best choice? Retrieved from http://www.hsph.harvard.edu/nutritionsource/healthy-drinks/sugary-vs-dietdrinks/index.html 5. U.S. Department of Agriculture, U.S. Department of Health and Human Services. (2010, December). Dietary guidelines for Americans, 2010 (7th ed.). Washington, D.C.: U.S. Government Printing Office. Healthy Express Lesson 2 131 Date: _______________ Goal Setting Worksheet Goal Check-In Think about your goals from last time and answer the following: 1. Which goals did you achieve? 2. What did you find easy to do? 3. What roadblocks did you encounter and how did you cope with these? 4. If you didn’t reach your goals, how might you revise them to make them more manageable? New Goals for Next Lesson Write down one or two short-term goals you would like to work on before your next nutrition counseling lesson related to the topics you discussed today. Short-Term Goal #1: ________________________________________________________ __________________________________________________________________________ Strategy 1: _________________________________________________________________ __________________________________________________________________________ Strategy 2: ________________________________________________________________ __________________________________________________________________________ Strategy 3: _________________________________________________________________ __________________________________________________________________________ 132 Healthy Express Lesson 2 Short-Term Goal #2: ________________________________________________________ __________________________________________________________________________ Strategy 1: _________________________________________________________________ __________________________________________________________________________ Strategy 2: ________________________________________________________________ __________________________________________________________________________ Strategy 3: _________________________________________________________________ __________________________________________________________________________ Date of next counseling lesson: _____________________ Please bring this worksheet to your next lesson. Healthy Express Lesson 2 133 Stop 'n Go Eating: What? Where? When? How Often? Fill out this worksheet to record the times you buy something to eat while on the go. Examples are in italics. Start making your entries in the empty boxes. Where did you stop? What did you get? What was going on/ what were you doing? What time of day was it? Was this planned? How many days per week do you make these types of stops? Gas station Snickers bar Bottle of green tea Stopped for gas while running errands Afternoon No, I was hungry because I skipped lunch 1 Coffee shop Small vanilla skim latte Bran muffin On my way to work Morning Yes, it’s my breakfast ritual 3-4 When you're done, circle the occasion you think is least healthful in red. Circle the occasion you think is most healthful in green. 134 Healthy Express Lesson 2 Adding It Up Worksheet Name a place where you sometimes catch a quick bite to eat: __________________________________________________________________________ List the food or menu items (including beverages) that you usually get at this place: Food Item Calories Total Meal Calories: Now, do the math: 1. Total calories recommended per day for you (1,800 or 2,000): 2. Total meal calories (recorded in the chart above): Subtract Line 2 from Line 1 to obtain the remaining calories you can eat that day and stay within your recommended limit. List some healthier foods you could choose next time you grab a bite at this place so you spend less on your daily calorie "budget" and can eat more later in the day. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Healthy Express Lesson 2 135 Thinking Outside the Kitchen: Healthy Choices At Fast-Food Restaurants Choose small (or even children’s) sizes. Is the good “value” really worth all those extra calories? Choose simple. A regular hamburger has 250-300 calories and 9-12 grams fat. Choose the chicken. When in doubt, order grilled, baked or broiled — not fried or breaded. Go for whole-wheat. Whole-wheat buns have more fiber than regular white bread. Some restaurants (including McDonald’s) offer wheat buns as an alternative — all you have to do is ask. "Veg out" on the sandwich. Ask for tomato, lettuce, onion, or other veggies on your sandwich. Thin crust it. Go for a thin-crust pizza with veggies instead of a thick-crust with meats. Avoid double meat and bacon. A serving size of meat (2-3 ounces) is about the size of a deck of cards. Go light on the sauce, or skip it altogether. There are lots of hidden calories in mayo, sour cream, salad dressing and other “special” sauces. Mustard, catsup, and barbecue sauce are better bets. Skip the sides. Eating a burger or sandwich by itself is often filling enough. If you do want a side dish, consider ordering a fruit cup or small salad. Most fast-food restaurants now offer these options. Swap out the fries and onion rings. Order a side salad, with light dressing, or baked potato instead. Pass on the regular soda and shakes. Treat yourself. Go for low-fat frozen yogurt, fruit popsicles, sorbets, and sherbets, rather than ice cream or cookies. Sprinkles are lower in calories than caramel or chocolate sauces. Know before you go. Most chain restaurants post their nutrition information online, and it is also available at the counter. Keep the information handy in your car’s glove compartment. At Smoothie Places 136 Order the smallest size available. Order a child’s size if available. Order smart. Ask to see the nutrition information for each type of smoothie and pick the one with the fewest calories. Healthy Express Lesson 2 Hold the sugar. Many smoothies contain added sugar in addition to the sugar naturally in fruit, juice, or yogurt. Ask that your smoothie be prepared without added sugar. In general, smoothies purely made of fresh fruit and ice contain fewer calories than those made with milk or yogurt; those made with fat-free milk contain fewer calories than those made with fat-free yogurt. At Coffee Shops Go "skinny." Request that your drink be made with fat-free or low-fat milk instead of whole milk. Order the smallest size available. Forgo the extra flavoring. The flavor syrups are sugar-sweetened and mean extra calories. Or try sugar-free syrups now offered by many places. Skip the whip. The whipped cream on top of coffee drinks adds calories and fat. Get back to basics. Order a plain cup of coffee with fat-free milk or drink it black. Try tea. It’s calorie-free and there are many different flavors to tempt you. At Continental Breakfast Buffets Fill up on a variety of fresh fruit. Try fruit you wouldn’t normally buy. Enjoy a small serving (1/2 cup or less) of granola. This contains significant calories and fat, so eat in moderation — golf-ball size or small handful. Mix granola with low-fat yogurt or milk. Sneak in a serving of vegetables by ordering tomato or vegetable juice. Pick up a cup of low-fat yogurt and top it with granola, whole-grain cereal, or fresh fruit. Enjoy low-fat or fat-free milk with whole-grain and fiber-filled (at least 3 grams per serving) cereal. Go for the oatmeal. It is almost standard in breakfast bars and even the instant kind provides some whole grains and fiber. A hard-boiled egg is a good source of protein that will help keep you satisfied longer. Choose an English muffin over a bagel. The average gourmet bagel contains over 400 calories. Top it with protein. A small cup of peanut butter is portion-controlled and a good source of satisfying protein (5 grams protein and 120 calories in ¾ ounce). Avoid bear claws, pastries, and make-your-own waffles. All these are high in fat and calories; they are also mainly refined carbohydrates, setting you up for a blood sugar high and a crash soon after. Healthy Express Lesson 2 137 Watch out for croissants. Even a small croissant contains almost 9 grams of fat and 170 calories. Skip the big muffins. Large muffins can easily have 300-400 calories. Enjoy a single mini-muffin instead. At Salad Bars 138 Color your plate. The richer the colors, the higher the antioxidants. Start with darker greens, such as spinach or romaine lettuce, and add reds, oranges, yellows, and purples, as well as more greens. Be adventurous! Use the opportunity to try new vegetables or fruits. Fresh is best. Undressed vegetables or fruit should make up ½ to ¾ of your salad. Avoid pre-dressed salads, such as coleslaw, tuna, potato, and pasta salads. The mayo or oil-based dressing tips the scales for fat and calories. If you must have a predressed salad, take only a condiment-size serving. "Power up" with smart protein choices. Balance out your salad with healthy protein sources, such as grilled chicken or shrimp, tuna, beans, or low-fat cottage cheese. Love legumes. Beans and chickpeas are a terrific high-fiber addition to your salad. Dress smart. Two tablespoons of regular dressing can contain over 160 calories and 16 grams of fat. One salad bar ladle can contain over 4 tablespoons of dressing. Avoid creamy dressings. Types like Ranch and Caesar tend to be higher in saturated fats. Use dressings made with heart-healthy fats, such as an olive or canola oil. Do-it-yourself dressing. Try a splash of seasoned vinegar and olive oil. Use low-fat cottage cheese and fresh pepper if you prefer creamier dressings. Dip, don’t dress. Place dressing on the side and dip the tip of your fork in it. You get the flavor punch with fewer calories. Go for the good fats. Avocado, olives and nuts can enhance a salad with flavor and "good" monounsaturated fats. Just remember that a little bit of these toppings goes a long way. Watch the last-minute toppings. Cheese, nuts, seeds, bacon, olives, croutons and fried chow mein noodles can rack up the calories and fat. Pick one or two and use sparingly. Don’t be too cheesy. Use a sprinkle of a stronger-flavored cheese, like sharp cheddar, parmesan or feta cheese; bigger flavors require smaller portions. Soup it up. Broth or vegetable-based soups (rather than cream-based ones) make a filling and healthy accompaniment to your salad. Start smaller. If you have a tendency to overdo it at salad bars, as well as any kind of buffet, try using a smaller plate or container. It helps you eat less and still feel satisfied. Healthy Express Lesson 2 At Convenience Stores and Vending Machines Buyer be aware: Think about what you really need: a snack or a meal. • If you're looking for something to keep you going for awhile, try choosing from a variety of food groups. Include some protein and fiber. • For a snack, look for between 100 and 250 calories. • Always check serving size and calories per serving on the label. Don't get snack amnesia. Later in the day, it's easy to forget about that fresh convenience store cookie you ate. Write down what you eat to jog your memory. Choose water or no-calorie beverages. Calories put the "energy" in energy drinks. Control the crave. Buy a small or single pack if nothing will satisfy you except a bite of your favorite treat; eat only 100 calories or less. Be snack savvy. At vending machines you can’t usually read labels, so stick with items you know are healthy and calorie-controlled. Use the chart below for help making healthy choices. Snack Options: Convenience Stores and Vending Machines Foods Healthiest Healthier Once-in-Awhile Nuts and seeds—plain or with spices Sugar coated or honey roasted nuts Chocolate or yogurt-covered nuts Trail mix—Whole grain cereals (with no added sugars) and dried fruit (no added fat) Popcorn/nut mix with no salt or butter Trail mix with chocolate, yogurt, or candy Fresh fruit, canned or single-serve fruit cups with natural juices only Canned or single-serve fruit cups in light syrup Canned or single-serve fruit cups in heavy syrup Unbuttered, no salt popcorn Light popcorn Popcorn—butter or "movie style" Granola bars, whole-grain fruit bars Animal crackers, graham crackers Cookies (including low-fat) Dried fruit—raisins, dried cranberries, 100% fruit leather Whole-grain pretzels Chocolate or sugar-coated dried fruit Pretzels Low-fat beef jerky Chocolate- or yogurt-covered pretzels Sausages, pork rinds Yogurt, preferably non-fat, low-fat, or light Mozzarella string cheese, reduced-fat Regular cheese cheese cubes Fat-free pudding Sugar-free gelatin Pudding made with whole milk Chart adapted from YMCA of Greater San Antonio. (2002, December). Healthy vending guidelines: A Fit City initiative. San Antonio, TX: Fit City: The Health Collaborative. Healthy Express Lesson 2 139 Choosing Snack and Meal Replacement Bars or Drinks Feed your need. As a meal replacement, choose bars with at least 250-300 calories and 10 to 15 grams protein. For a light snack, look for a bar with 100 to 200 calories and at least 3 grams of fiber. Bars with 5 grams of protein or more should satisfy your hunger. Use the 5:100 rule. Add the grams of fiber to the grams of protein in the bar. If they add up to 5 (for every 100 calories), the bar will keep you satisfied longer. Avoid trans fat. A company can list a product as having zero grams of trans fat even when it has up to 0.5 grams per serving. If you see partially hydrogenated oils or shortening listed in the ingredients of a meal replacement bar, choose another kind. Limit saturated fat. Look for less than 2 grams. Look for whole grains, such as rolled oats, whole wheat, or barley, listed as one of the first ingredients. Substitute for low protein. If the bar you choose is low in protein, try eating it with a few nuts or some low-fat dairy. Beware of too much of a good thing. Many bars are fortified so you could end up with too much iron and vitamin A. Look for bars with no more than 100 percent of your RDA. Add a "side." Make a bar into a more nutritious meal by eating it with a piece of fruit, which contains fiber, and/or a low fat dairy item that contains protein and calcium. Rethink your drink. In general, meal replacement drinks and shakes are going to be lower in fiber and other nutrients than the whole foods, such as raisins, nuts, or oats that some bars provide. Choosing Frozen Meals Buyer be aware. Decide what you are looking for. A light frozen dinner with no more than 300 calories and 8 grams of fat. A regular frozen dinner with 360-500 calories and 25 grams of fat or less. Ideally, you want no more than 500 calories and no more than 15 grams of fat in a frozen dinner. Add a side salad and/or a serving of fruit to round out your meal. This is even more important if you're having a light frozen meal. Adding salad or fruit will boost the vitamin; mineral and fiber content, and help fill you up. What good is a portion-controlled serving if you‘re still hungry after you eat it? Choose meals with less than 5 grams saturated fat and no trans fats. 140 Healthy Express Lesson 2 Choose meals with less than 700 milligrams sodium. Select meals with at least 2-5 grams of fiber. Look for meals that include plenty of vegetables. They tend to be lower in calories and higher in vitamins, minerals, and fiber. Opt for meals with brown rice and other whole grains whenever possible. Choose lean meat, fish, or chicken. Read the label. Don't assume a product is healthy without checking the Nutrition Facts label. Healthy Express Lesson 2 141 Thinking Outside the Kitchen: Personal Summary At Fast-Food Restaurants ___________________________________________________________________ ___________________________________________________________________ At Smoothie Places ___________________________________________________________________ ___________________________________________________________________ At Coffee Shops ___________________________________________________________________ ___________________________________________________________________ At Continental Breakfast Buffets ___________________________________________________________________ ___________________________________________________________________ At Salad Bars ___________________________________________________________________ ___________________________________________________________________ At Convenience Stores and Vending Machines ___________________________________________________________________ ___________________________________________________________________ Choosing Bars and Drinks for Meal Replacement or a Snack ___________________________________________________________________ ___________________________________________________________________ Choosing Frozen Meals 142 ___________________________________________________________________ Healthy Express Lesson 2 Healthy Express Lesson 2 143 144 Healthy Express Lesson 2 Energy and Snack Bar Comparison Chart Healthy Express Lesson 2 145 146 Healthy Express Lesson 2 List of Common Drinks Red Bull Size: 8.3 oz can Calories: 110 Fat: 0 g Sugars: 27 g (about 7 tsp) Dunkin Donuts Vanilla Bean Coolatta Size: 16 fl oz Calories: 500 Fat: 17 g Sugars: 82 g (20.5 tsp) Hawaiian Punch Juicy Red Size: 8 fl oz Calories: 120 Fat: 0 g Sugars: 28 g (7 tsp) Jamba Juice Green Tea Blast Size: 16 fl oz Calories: 340 Fat: 0 g Sugars: 67 g (almost 17 tsp) Hershey's Chocolate Milk Size: 1 cup, or 8 fl oz Calories: 270 Fat: 5 g Sugars: 45 g (a little more than 11 tsp) Gatorade Frost Size: 20 oz bottle Calories: 125 Fat: 0 g Sugars: 35 g (almost 9 tsp) McDonald's McFlurry with M&M's candies Size: 12 oz Calories: 620 Fat: 20 g Sugars: 85 g (a little more than 21 tsp) Fuze Green Tea Size: 8 fl oz Calories: 60 Fat: 0 g Sugars: 16 g (4 tsp) Wendy's Chocolate Twisted Frosty with M&M's Size: 16 oz Calories: 560 Fat: 19 g Sugars: 72 g (18 tsp) Glaceau Vitamin Water Size: 20 oz Calories: 125 Fat: 0 g Sugars: about 33 g (a little more than 8 tsp) Tropicana Fruit Smoothie Size: 11 fl oz Calories: 220 Fat: 0 g Sugars: 44 g (11 tsp) Starbucks Grande Vanilla Latte (with nonfat milk) Calories: 230 Fat: 0 g Sugars: 38 g (9.5 tsp) Starbucks Frappuccino Blended Crème, Double Chocolate Chip Crème (without whipped cream) Size: Venti, 24 fl oz Calories: 550 Fat: 11 g Sugars: 79 g (almost 20 tsp) Healthy Express Lesson 2 147 Rethink Your Drink As you can see in the example below, calories from drinks can add up. The good news is that you have plenty of options for reducing the number of calories in what you drink. Substituting no- or low-calorie drinks for sugar-sweetened beverages cuts about 650 calories in the example below. Eating Occasion Instead of… Calories Try… Calories Morning coffee shop run Medium café latte made with whole milk (16 oz) 265 Small café latte made with fat-free milk (12 oz) 125 Lunch Bottle of regular cola (20 oz) 227 Bottle of water or diet cola (20 oz) 0 Afternoon break Bottle of sweetened lemon iced tea (16 oz) 180 Sparkling water with natural lemon flavor (not sweetened, 16 oz) 0 Dinner A glass of regular ginger ale (12 oz.) 124 Water with a slice of lemon or lime, or Seltzer water with a splash (2 oz) of 100% fruit juice 0 30 796 Total Beverage Calories 125-155 Learn to Read Nutrition Facts Labels Carefully Be aware that the Nutrition Facts label on beverage containers may give the calories for only part of the beverage in the container. The example below shows the label on a 20-ounce bottle that contains two and a half (2.5) 8-ounce servings. To figure out how many calories are in the whole bottle, you need to multiply the number of calories in one serving by the number of servings in the bottle (100 x 2.5). The entire bottle actually contains 250 calories even though what the label calls a “serving” only contains 100. NUTRITION FACTS Serving Size 8 fl. oz. Servings Per Container 2.5 Amounts Per Serving Calories 148 100 Healthy Express Lesson 2 Sugar by Any Other Name: How to Tell Whether Your Drink Is Sweetened Sweeteners that add calories to a beverage go by many different names and are not always obvious to anyone looking at the ingredients list. Some common caloric sweeteners are listed below. If these appear in the ingredients list of your favorite beverage, you are drinking a sugarsweetened beverage: High-fructose corn syrup Fructose, sucrose, and dextrose Fruit juice concentrates Honey Sugar Syrup or corn syrup High-Calorie Culprits in Unexpected Places Coffee drinks and blended fruit smoothies sound innocent enough, but the calories in some of your favorite coffee-shop or smoothie-stand items may surprise you. Check the website or instore nutrition information for your favorite coffee or smoothie shop to find out how many calories are in different menu items. Better Beverage Choices Made Easy Choose water, diet, or low-calorie beverages instead of sugar-sweetened beverages. For a quick, easy, and inexpensive thirst-quencher, carry a water bottle and refill it throughout the day. Don’t stock the refrigerator with sugar-sweetened beverages. Instead, keep a jug or bottles of cold water in the fridge. Serve water with meals. Make water more exciting by adding slices of lemon, lime, cucumber, or watermelon, or drink sparkling water. Add a splash of 100 percent juice to plain sparkling water for a refreshing, low-calorie drink. When you do opt for a sugar-sweetened beverage, go for the small size. Some companies are now selling 8-ounce cans and bottles of soda, which contain about 100 calories. Be a role model for your friends and family by choosing healthy, low-calorie beverages. Healthy Express Lesson 2 149 Source Cited Agricultural Research Service. (n.d.). USDA national nutrient database for standard reference. Retrieved from http://www.nal.usda.gov/fnic/foodcomp/search/ Chart adapted from Department of Health and Human Services, Centers for Disease Control and Prevention. (n.d.). Rethink your drink. Retrieved from http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/rethink_your_drink.pdf. 150 Healthy Express Lesson 2 Healthy Express: Lesson 3 Objectives By the end of this lesson, the participant will be able to: Find and use reliable nutrition information online or in print. Incorporate foods made from new, healthy, easy recipes into meals. Understand the benefits of eating organic foods and those promoted as “superfoods.” Time for this lesson: 30-45 minutes Activities in this Lesson 1. Introduction and Review (5 minutes) 2. Be Web Aware (5 minutes) 3. Using New Recipes (5-10 minutes) 4. Organic Foods 101 (5-10 minutes) 5. What's Super About Superfoods? (5-10 minutes) 6. Review and Goal Setting (5 minutes) Preparation and Handouts Needed Preparation Print and prepare handouts as indicated below. Verify Internet access at the counseling location; if no computer is available for use, bring a laptop, if possible. (If you have no computer or Internet access, follow instructions for alternative activities.) Print the Almost Homemade recipe for "Citrus-Poached Snapper with Black Bean Salad" from the Food Network website at http://www.foodnetwork.com/recipes/sandra-lee/citruspoached-snapper-with-black-bean-salad-recipe/index.html. Print the Almost Homemade recipe for "Chicken with Peach and Melon Salsa" from the Food Network website at http://www.foodnetwork.com/recipes/sandra-lee/chicken-withpeach-and-melon-salsa-recipe/index.html. Healthy Express Lesson 3 151 Handouts 152 Goal Setting Worksheet Evaluating Health Resources on the Web Useful Consumer Health Websites Tips for Healthier Substitutes Almost Homemade: A Blend of Scratch and Convenience Cooking Organics Quiz Organic Foods 101 Organics Flash Cards (Print each sheet on a color printer, if possible. Next, fold each sheet vertically down the center so the text and photos are on opposite sides. Finally, cut horizontally between each photo and description, so you can use these as flash cards, i.e., show the participant the photo side before revealing the text side.) Dirty Dozen, Clean 15 Purse Card (Print sheet on card stock and cut out individual cards, or print on regular paper and laminate individual cards. Use a color printer, if possible.) What's Super About Superfoods? Healthy Express Lesson 3 Activities 1. Introduction and Review (5 minutes) Review points from the last lesson with the participant. Ask her what she remembers or what was most notable from the last lesson. Use the Goal Setting Worksheet to record responses. Questions to Guide Discussion How did you do with your goals from the last lesson? (Insert goals.) What went well? What did you struggle with? What were some of the barriers? 2. Be Web Aware (5 minutes) Discuss with the participant how to find reliable nutrition and health information on the Internet. Question to Guide Discussion Where do you go for health and nutrition information on the Internet? Talk about the advantages and disadvantages of using the Internet to find health and nutrition information; ask the participant why it is important to look at websites with a critical eye. Then discuss advantages and disadvantages of using the web. Advantages include: Information can be easily updated on the web, so it is probably more current than print materials; Information is easy to access and print; Some websites are interactive and can provide customized information; and You can access different opinions on the web, which improves your ability to assess what’s right for you. Disadvantages include: Some online information can be biased and promote false claims; Accuracy of some information is not guaranteed; and Some websites promote extreme views and take partisan stands. Healthy Express Lesson 3 153 Review Evaluating Health Resources on the Web with the participant and select one of the activities below based on computer and Internet availability, as well as time. With computer and Internet access: Activity 1. Ask the participant if she has a specific nutrition topic she would like to research online. Using the computer, enter the topic into a search engine and use Evaluating Health Resources on the Web to evaluate two different health websites. Aim to review one reputable website and one with less credibility. Activity 1 (variation). Use the handout to evaluate and compare the following websites: http://www.nutrition.gov to http://www.dietfacts.com/list.asp. Activity 2. Review a Medline Plus tutorial on evaluating Internet health information, available from the National Institutes of Health at: http://www.nlm.nih.gov/medlineplus/webeval/webeval.html. Without computer or Internet access: Activity 3. Ask the participant to complete Activity 1 as homework, using a computer at home, at a friend's house, or at the public library. Give the participant the Useful Consumer Health Websites handout for her own reference. 3. Using New Recipes (5-10 minutes) Ask the participant how often she uses new recipes and how she might benefit from doing this. Benefits might include reducing boredom and providing a more varied and well-balanced diet. Talk about how to determine if a recipe is healthy. A recipe is the sum of its parts. A healthy recipe contains: • More nutritious ingredients, including fruits and vegetables, lean meats, low-fat and no-fat dairy, whole-grain flours, olive and canola oils, broth or vegetable puree-based sauces. • Fewer less nutritious ingredients, including fatty cuts of meat, full-fat dairy, refined flours, tropical oils, butter, cream-based sauces and dressings. The cooking method is also important. Healthy cooking methods include: • Broiling, baking, braising, grilling, poaching, roasting, sautéing, steaming, and stirfrying in a small amount of oil. Give the participant the Tips for Healthier Substitutes handout. 154 Healthy Express Lesson 3 Question to Guide Discussion What barriers prevent you from trying new recipes? After determining the barriers that prevent the participant from trying new recipes, have her think about some solutions. Use the suggestions below if she needs some ideas to get started. Choose recipes with fewer ingredients and steps. Use convenient foods like pre-chopped vegetables in recipes. Keep your recipes together in a folder or expandable file so they are ready when you need them. Once a week (or once a month) choose a new recipe to try. Schedule the recipe on a day where you have extra time and add the ingredients to your shopping list. Prepare "halfway homemade"’ recipes, using ideas from the Almost Homemade: A Blend of Scratch and Convenience Cooking handout. Give the participate Almost Homemade: A Blend of Scratch and Convenience Cooking, and review the points with her. Using the Almost Homemade Recipes you printed from the Food Network website, ask the participant to identify some of the almost homemade strategies and the convenience foods (prepared or partially prepared) used. 4. Organic Foods 101 (5-10 minutes) Use the Organics Quiz as a pre- and/or post- test, as needed. Answers and explanations are provided below. Organics Quiz Key Correct answers are in boldface. 13. How do you differentiate between an organic product and a non-organic product? a. Use the “squeeze test” b. The cost – organics are usually more expensive c. The organic label d. There is no difference While organics are typically more expensive, the cost of the product is not a good indicator of organic status. The USDA has strict rules defining use of the term "organic," as well as use of the 1 label. Healthy Express Lesson 3 155 2. What percent of product content must be organic in order for a package to display the “made with organic ingredients” label? a. 15-33 percent b. 0-15 percent c. 70-90 percent d. 33-70 percent According to USDA rules, a product labeled “made with organic ingredients” must contain 70-90 1 percent organic ingredients. 3. In order to bear the organic label, organic products cannot be subject to: a. Synthetic pesticides b. Genetic engineering c. Antibiotics or growth hormones d. All of the above The USDA does not allow use of synthetic pesticide or genetic engineering in crops, nor does it 2,3 allow antibiotic or growth hormone use in meat, poultry or eggs. 4. Organic foods have been proven to be: a. Healthier b. Better tasting c. Safer d. None of the above Organic produce has not been proven to be healthier or safer, and taste is usually an individual 2,3 preference. 5. Organic produced foods are more expensive than conventionally grown products because: a. Higher taxes b. Grocery stores can make a bigger profit on organic foods c. Higher production costs d. None of the above Higher prices are due to more expensive farming practices, tighter government regulations, and lower crop yields. Because organic farmers don't use herbicides or pesticides, many 3 management tools used to control weeds and pests are labor intensive. 6. Consumption of non-organic produce can lead to exposure to: a. Potentially harmful pesticide levels b. Safe levels of pesticide residue c. The chilly refrigerated produce section d. Consumption of non-organic produce has not been shown to have any ill effects on health Non-organic produce is still required be below required pesticide tolerance levels set by the 4 Environmental Protection Agency (EPA). 156 Healthy Express Lesson 3 7. Other than purchasing organic produce, pesticide exposure can be reduced by a. Washing all fruits and vegetables b. Peeling or trimming fruits and vegetables c. Eating a wide variety of fruits and vegetables d. All of the above Use of all of the above methods will reduce exposure to any one pesticide, remove bacteria and 3,5 ensure you are consuming enough nutrients. Quiz adapted from Brigham and Women’s Hospital. (2011). Fielding questions on organic foods. Retrieved from http://healthlibrary.brighamandwomens.org/InteractiveTools/Quizzes/40,OrganicFoodOrganicFoQuiz Questions to Guide Discussion Do you choose organic foods? If so, why? Do you only buy certain organic foods? Give the participant the Organic Foods 101 handout and review the points, emphasizing the following: Organic produce has not been shown to be any more nutritious than non-organic produce. Eating a wide variety of produce is most important, whether it is organic or not. Proper washing and handling of produce can reduce residues and risk of food borne illnesses. Using the Organics Flash Cards, review the “Dirty Dozen” and “Clean 15” with the participant. Give the participant a Dirty Dozen, Clean 15 Purse Card for her own use. 5. What's Super About Superfoods? (5-10 minutes) Review the What's Super About Superfoods? handout with the participant and discuss the superfoods she currently eats. Ask the participant to select a superfood she would like to add to her diet and discuss specific ways that she could make that happen. Advise the participant to look up a recipe containing her chosen superfood and add it to her recipe file. 6. Review and Goal Setting (5 minutes) Ask the participant if she has any questions. Have the participant discuss one or two things she learned today. Healthy Express Lesson 3 157 Have the participants set goals for the next two weeks on the Goal Setting Worksheet. • If this is the final lesson, the participant should evaluate her goals on her own in two weeks. If applicable, briefly describe the topic and activities for the next lesson to arouse interest. • If the participant will be continuing lessons, the facilitator should consult the Need State Activities Overview to determine the next lesson’s topics and activities. If she is continuing lessons, remind the participant to bring her paperwork from this lesson to her next one. Thank the participant for coming. Sources Cited 1. Agricultural Marketing Service, U.S. Department of Agriculture. (2010). National Organic Program: Understanding organic labeling. Retrieved from http://www.ams.usda.gov/AMSv1.0/ams.fetchTemplateData.do?template=TemplateA&na vID=NationalOrganicProgram&leftNav=NationalOrganicProgram&page=NOPUnderstandi ngOrganicLabeling&description=Understanding%20Organic%20Labeling&acct=nopgenin fo 2. Agricultural Marketing Service., U.S. Department of Agriculture. National Organic Program: Going organic. Retrieved from http://www.ams.usda.gov/AMSv1.0/ams.fetchTemplateData.do?template=TemplateN&lef tNav=NationalOrganicProgram&page=NOPGoingOrganic&description=Going%20Organi c&acct=nopgeninfo 3. Mayo Clinic. (2011). Organic foods: Are they safer? More nutritious? Retrieved from http://www.mayoclinic.com/health/organic-food/NU00255# 4. National Pesticide Information Center. (2011). Pesticide residues in food. Retrieved from http://npic.orst.edu/health/residue.html 5. National Pesticide Information Center. (2011). Minimizing pesticide residue in foods. Retrieved from http://npic.orst.edu/health/foodprac.html 158 Healthy Express Lesson 3 Date: _______________ Goal Setting Worksheet Goal Check In Think about your goals from last time and answer the following: 1. Which goals did you achieve? 2. What did you find easy to do? 3. What roadblocks did you encounter and how did you cope with these? 4. If you didn’t reach your goals, how might you revise them to make them more manageable? New Goals for Next Lesson Write down one or two short-term goals you would like to work on before your next nutrition counseling lesson related to the topics you discussed today. Short-Term Goal #1: ________________________________________________________ __________________________________________________________________________ Strategy 1: _________________________________________________________________ __________________________________________________________________________ Strategy 2: ________________________________________________________________ __________________________________________________________________________ Strategy 3: _________________________________________________________________ __________________________________________________________________________ Healthy Express Lesson 3 159 Short-Term Goal #2: ________________________________________________________ __________________________________________________________________________ Strategy 1: _________________________________________________________________ __________________________________________________________________________ Strategy 2: ________________________________________________________________ __________________________________________________________________________ Strategy 3: _________________________________________________________________ __________________________________________________________________________ Date of next counseling lesson: _____________________ Please bring this worksheet to your next lesson. 160 Healthy Express Lesson 3 Evaluating Health Resources on the Web The Internet has made finding health and nutrition information easier and faster. Much of the information on the Internet is valuable; however, the Internet also allows rapid and widespread distribution of false and misleading information. Use the following check sheet to decide whether the health and nutrition information you find on the Internet is likely to be reliable. Provider 1. Who runs the website? Any website should make it easy for you to learn who is responsible for the site and its content. Look under “About Us” or a similarly named link for contact and related information. 2. What is the website's purpose? To learn about a website’s purpose, look under an “About this Site” or similarly named link to understand the site's goals and objectives, as well as help verify its trustworthiness. Also consider motivation. Although many legitimate websites contain advertisements and sell health, nutrition, and medical products and services, keep in mind that the website owner's desire to promote these products or services can compromise the accuracy of information on a site. At the least, this desire to sell something might indicate the omission of important information. Validate the accuracy of information on a website through an independent and unbiased source, such as a University Cooperative Extension site. 3. How does the website manage interactions with users? Websites should always offer a way for users to contact the website owner with problems, feedback, and questions. If the site hosts a chat room or some other form of online discussion, it should explain the terms of using the service. For example, the site should explain whether anyone moderates the discussions and, if so, who provides the moderation and what criteria the moderator uses to determine which comments to accept and which to reject. Funding 4. Who pays for the website? It costs money to run a website. The source of a website's funding should be clearly stated or readily apparent. A website's source of funding can influence its content and how it's presented, depending on the funder's interests. Web address endings may give some indication on the nature of funding. For example, the U.S. government funds websites with addresses ending in ".gov," educational institutes maintain ".edu" sites, nonprofit organizations' addresses often use ".org," and ".com" denotes a for-profit business or other commercial enterprise. Healthy Express Lesson 3 161 Quality 5. What is the original source of the website's information? Many health, nutrition, and medical websites post information that the owner has collected from other websites or sources. If the person or organization in charge of the site did not write the material, the original source should be clearly identified. 6. How does the website document the evidence supporting its information? Websites should identify the medical and scientific evidence that supports the material presented on the site. Medical facts and figures should have references, such as citations of articles published in medical journals. Also, opinions or advice should be clearly set apart from information that is "evidence based" (that is, based on research results). Testimonials from people who said they have tried a particular product or service are not evidence-based and usually cannot be corroborated. 7. Who reviewed the information before the owner posted it on the website? Health-related websites should provide information about the medical or scientific credentials of people who prepared or reviewed the website material. 8. How current is the information on the website? Experts should review and update the material on websites regularly. Medical information needs to be current because research is constantly generating new information about medical conditions and how to best treat or prevent them. Websites should clearly post the most recent update or review date. Even if the information has not changed in a long time, the site owner should indicate that someone has reviewed it recently to ensure that the information is still valid. 9. How does the website owner choose links to other sites? Owners of reliable websites usually have a policy governing which links to other sites they post. Some health and medical websites take a conservative approach and do not provide links to any other sites; some sites provide links to any site that asks or pays for a link; and still others provide links only to sites that have met certain criteria. Reviewing a website's linking policy can help you understand how and why links to other sites are chosen. Privacy 10. What information about users does the website collect, and why? Websites routinely track the path users take through their sites to determine what pages people are viewing. However, many health-related websites also ask users to "subscribe" to or "become a member" of the site. Sites sometimes do this to collect a user fee or select relevant information from the user. Some sites also collect personal information about users. 162 Healthy Express Lesson 3 Any website asking you for personal information should explain exactly what the site will and will not do with the information. Many commercial sites sell "aggregate" data—such as what percent of their users take dietary supplements—about their users to other companies. In some cases, sites collect and reuse information that is personally identifiable, such as your zip code, gender, and birth date. Be sure to read and understand any privacy policy or similar language on the site and do not sign up for anything that you do not fully understand. Adapted from Office of Dietary Supplements. (2011, June 24). How to evaluate health information on the Internet: Questions and answers. Retrieved from http://ods.od.nih.gov/Health_Information/How_To_Evaluate_Health_Information_on_the_Internet_Questions _and_Answers.aspx Healthy Express Lesson 3 163 Useful Consumer Health Websites Health and wellness The following websites are sponsored by credible organizations and provide a wide variety of information, tools and resources on health and health-related topics. Cancer.gov at http://www.cancer.gov is the official website of the National Cancer Institute, the federal government's principal agency for conducting and supporting cancer research, training physicians and scientists, and providing information about cancer detection, treatment, prevention and more. Centers for Disease Control and Prevention at http://www.cdc.gov provides resources and information about a variety of health and safety topics, including diseases and healthy living, emergency preparedness and response, and more. The site also includes an "Outbreaks" section on current infectious disease outbreaks. FamilyDoctor.org at http://familydoctor.org is operated by the American Academy of Family Physicians, a national medical organization representing more than 100,000 family physicians, family practice residents and medical students. The site offers health information for the entire family, including sections on diseases and conditions, prevention and wellness, and more. Healthfinder.gov at http://www.healthfinder.gov is a health information website provided by the U.S. Department of Health and Human Services. The site contains information on over 1,600 health topics, as well as personal health tools, such as an online checkups, health calculators, and activity and menu planners. KidsHealth at http://www.kidshealth.org provides doctor-approved health information about children from before birth through adolescence. The site is sponsored by the pediatrician-led Nemours Center for Children's Health Media, which is part of the Nemours Foundation – a nonprofit organization. The Mayo Clinic in Rochester, Minn., sponsors a website at http://www.mayoclinic.com that provides health education to patients and the general public. The website also includes interactive tools to assist consumers in managing their health. MedlinePlus at http://medlineplus.gov is the National Institute of Health's consumer health website produced by the National Library of Medicine. The website includes information about more than 900 diseases, conditions, and wellness issues, as well as tutorials, podcasts, videos, and interactive tools on a wide variety of health-related topics. New York Online Access to Health (NOAH) at http://www.noah-health.org is a collection of state, local, and federal health resources. Topics are listed alphabetically in "Health Topics" and then narrowed to include definitions, care and treatment, and lists of information resources. All content is in both English and Spanish. 164 Healthy Express Lesson 3 Nutrition The following websites are sponsored by credible organizations and provide a wide variety of information, tools and resources on food and nutrition topics. Nutrition.gov at http://www.nutrition.gov provides access to government information on food and nutrition for consumers. It serves as a gateway to reliable science-based information on nutrition, healthy eating, physical activity, and food safety. Eatright.org at http://www.eatright.org is the official website of the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). Useful information on nutrition, exercise, and other food-related topics can be found under the “Public" tab at the top of the home page. CalorieKing at http://www.calorieking.com is a respected commercial website that provides nutrition information in a comprehensive database of foods, including brand name and restaurant foods. Adapted from Consumer and Patient Health Information Section. (2010). 2010 CAPHIS top 100 list: Health websites you can trust. Chicago, IL: Medical Library Association. Healthy Express Lesson 3 165 Tips for Healthier Substitutes These lower-calorie alternatives provide new ideas for old favorites. When choosing foods, avoid those that are high in sugar and fat. Instead, select healthier alternatives with a higher proportion of vitamins and minerals. Milk and Milk Products If you usually buy: Try these instead: Whole milk Fat-free (skim), low-fat (1%), or reduced fat (2%) milk Ice cream Sorbet and ices, sherbet, or low-fat or fat-free frozen yogurt Whipping cream Imitation whipped cream made with fat-free (skim) milk Sour cream Plain low-fat yogurt Regular cream cheese Neufchatel or “light” cream cheese, or fat-free cream cheese Regular cheese (cheddar, Swiss, or jack) Reduced-calorie or low-calorie processed cheeses. Examples include: Trader Joe’s low-fat, Laughing Cow Light, Jarlsberg Lite Swiss, Kraft 2% milk cheese, Sargento reduced-fat, Tillamook reduced-fat, Baby Bell Light, Cabot 50% reduced-fat, Weight Watchers cheese Regular American cheese Fat-free American cheese Regular (4%) cottage cheese Low-fat (1%) or reduced fat (2%) cottage cheese Whole-milk mozzarella cheese Part-skim, low-moisture mozzarella cheese Coffee cream (half and half) or non-dairy creamer (liquid or powder) Low-fat (1%) or reduced fat (2%) milk; non-fat dry milk powder; or fat-free half and half Cereals, Grains and Pastas If you usually buy: Try these instead: Ramen noodles Rice or other noodles (spaghetti, macaroni, etc.) Pasta with white sauce (Alfredo) Pasta with red sauce (marinara) Pasta with cheese sauce Pasta with vegetables (primavera) Granola Bran flakes or crispy rice, cooked grits or oatmeal, or reducedfat granola White rice Brown rice 166 Healthy Express Lesson 3 Meats, Fish and Poultry If you usually buy: Try these instead: Cold cuts or lunch meats (bologna, salami, liverwurst, etc.) Low-fat cold cuts (95% to 97% fat-free lunch meats or low-fat pressed meats) Regular hot dogs Reduced-fat hot dogs Bacon or sausage Canadian bacon or lean ham Regular ground beef Extra-lean ground beef, such as ground round, or ground turkey (read labels) Chicken or turkey with skin, duck or goose Chicken or turkey without skin (white meat) Oil-packed tuna Water-packed tuna (rinse to reduce sodium content) Beef chuck, rib, or brisket Beef round or loin; trim external fat; choose select grades Pork (spareribs or untrimmed loin) Pork tenderloin or trimmed, lean smoked ham Frozen breaded fish or fried fish (homemade or commercial) Unbreaded fish or shellfish, fresh, frozen, or canned in water Whole eggs Egg whites or egg substitutes Frozen TV dinners containing more than 13 grams of fat per serving Frozen TV dinners containing less than 13 grams fat per serving and lower in sodium Chorizo sausage Turkey sausage, drained well (read label) or vegetarian sausage made with tofu Baked Goods If you usually buy: Try these instead: Croissants, brioches, etc. Hard French rolls or soft brown ‘n serve rolls Donuts, sweet rolls, scones, or pastries English muffins, bagels, reduced-fat or fat-free muffins, or fatfree scones Party crackers Low-fat, reduced-sodium party crackers, or reduced-sodium soda crackers Cake (pound, chocolate or yellow) Cake (angel food, white, or gingerbread) Cookies Fat-free or reduced-fat cookies, such as graham crackers, ginger snaps, or fig bars; compare calorie levels Healthy Express Lesson 3 167 Snacks and Sweets If you usually buy: Try these instead: Nuts Popcorn (air-popped or light microwave), fruits, vegetables Ice cream, including cones and bars Frozen yogurt, frozen fruit, or chocolate pudding bars Custards or puddings made with whole milk Puddings made with fat-free milk Miscellaneous If you usually buy or make: Try these instead: Canned cream soups Canned broth-based soups (low-sodium) Homemade gravy with fat drippings and whole milk or gravy mixes made with milk Homemade with the fat skimmed off and fat-free milk, or gravy mixes made with water Fudge sauce Chocolate syrup Guacamole dip or refried beans with lard Salsa Adapted from U.S. Department of Health and Human Services. (2005). Tips for healthy substitutes. Washington, DC: U.S. Government Printing Office. Baking Substitutes Instead of: Try these instead: Sugar Substitute with Splenda. Use ½ cup of Splenda for every cup of sugar in the recipe. Check Splenda’s website for specific recommendations on 1 substitutions: http://www.splenda.com/cooking-baking/granulated Sugar Reduce sugar by 1/4 to 1/3. Cookies, quick breads, and cakes can be successfully baked this way. Substitute flour for the omitted sugar. Do not 2 decrease sugar in yeast breads, because sugar feeds the yeast. Sugar Use spices rather than sugar. Adding cinnamon, nutmeg, or vanilla to your 2 recipes instead of sugar will mimic sweeteness. Butter, shortening or oil Use applesauce, prune or other fruit puree, or plain non-fat yogurt. Replace up to half of the butter, oil or shortening with any of these ingredients based on the flavor of the dish. Keep an eye on your dish once it is in the oven as the baking 2 time may decrease up to 25 percent. Oil Reduce oil by 1/3. Avoid this method when baking yeast breads or pie crusts. Solid fats Use vegetable oils, such as corn, canola, or peanut, instead of solid fats, such as shortening, lard, or butter. To substitute liquid oil for solid fats, use about 1/4 2 less than in the recipe. Sour cream Swap yogurt for sour cream. If the recipe calls for sour cream, add plain low-fat yogurt in the same amount. Two other acceptable substitutes are buttermilk or TM 168 3 Healthy Express Lesson 3 3 low-fat cottage cheese blended in a food processor. Whipped cream Refrigerate one 13 ounce can of evaporated skim milk overnight. Combine with 4 1 teaspoon of lemon juice and beat until stiff. Whipped Cream Combine 1/2 cup of ice-cold water and 1/2 cup non-fat dry milk and whip until it forms peaks. While still mixing, gradually add 1/2 cup sugar. Finally, add 2 4 tablespoons of lemon juice and stir until well incorporated. Eggs Use egg substitute or egg whites. Replace one egg with two egg whites or 1/4 2 cup egg substitute. Sources Cited 1. McNeil Nutritionals. (2012). Cooking and baking with Splenda® No Calorie Sweetener. Granulated. Retrieved from http://www.splenda.com/cooking-baking/granulated 2. Brinkman, P., & Syracuse, C. J. (n.d.). Modifying a recipe to be healthier. Columbus, OH: Ohio State University Extension (Fact Sheet No. HYG-5543-06). 3. The Cooking Inn. (2012). Modify a recipe. Retrieved from http://www.thecookinginn.com/modify.html 4. Garden-Robinson, J. (1999, July). Ingredient substitutions. Fargo, ND: University of North Dakota (Fact Sheet No. HE-198). Healthy Express Lesson 3 169 Almost Homemade: A Blend of Scratch and Convenience Cooking "Almost homemade" cooking is a compromise between spending a lot of time making everything from scratch and using only (usually less healthy) already prepared convenience foods. Almost homemade cooking can help save time while making meals more nutritious. Two Halfway-Homemade Options Enhance certain convenient supermarket products by adding ingredients to them. Use "shortcut" products in homemade recipes to cut down on preparation time. Helpful Shortcut Products Here are some prepared or partially prepared "shortcut" products to use in homemade recipes and meals: Frozen bread dough. Choose whole wheat options most often. Whole rotisserie chicken. Remove the skin before using in recipes. Shredded cheese. Choose reduced-fat types most often. Bottled marinara sauce. Bottled salsa. Reduced-fat Bisquick. Instant pudding. Choose sugar-free most often. Reduced-fat cream of mushroom soup, or similar flavors, such as cream of celery. Use instead of making gravy or cream sauce for casseroles and similar recipes. Canned broth. Canned beans and refried beans. Choose fat-free or vegetarian. Reduced-fat salad dressings. Instead of making your own high-fat dressings or dips, try light bottled dressings in your recipes. Frozen chopped spinach. Slightly thaw (don’t cook!) in the microwave and drain. Seasoning blends. Use them in recipes instead of measuring and mixing separate seasonings. Enhancement Ideas Here are some ideas for making prepared or partially-prepared dishes your own by dressing them up with extra ingredients: 170 Reduced-fat crescent rolls. Make them into fancy rolls by adding herbs, dried fruit, etc. Healthy Express Lesson 3 Salad in a bag. Add ingredients to create your own gourmet salads, such as extra vegetables, nuts, fresh or dried fruit, or lean meats. Boxed macaroni and cheese. Use half the amount of butter or margarine called for and add flavorful ingredients, such as green onions, frozen spinach or peas, tomatoes, and water-packed tuna. Prepared pizza crust, such as Boboli. Use this as a base for your own "gourmet" pizzas with marinara sauce and plenty of vegetables. Reduced-fat Bisquick. Use this as a base for blueberry pancakes or herb biscuits. Instant pudding. Add ingredients like light-whipped topping or fresh fruit for a mousse or parfait. Frozen tortellini and ravioli. Make your own pasta salad by adding cherry tomatoes, light vinaigrette, grilled chicken breast strips, and so on. Seasoned tuna. Use it to create sandwiches and wraps by adding the ingredients of your choice. Adapted from Magee, E. (n.d.). Halfway homemade: Cooking with convenience foods. Retrieved from http://www.webmd.com/food-recipes/guide/halfway-homemade Healthy Express Lesson 3 171 Organics Quiz Choose the best answer. _____ 1. How do you differentiate between an organic product and a non-organic product? a. Use the “squeeze test” b. The cost – organics are usually more expensive c. The organic label d. There is no difference _____ 2. What percent of product content must be organic in order for a package to display the “made with organic ingredients” label? a. 15-33 percent b. 0-15 percent c. 70-90 percent d. 33-70 percent _____ 3. In order to bear the organic label, organic produce cannot be subject to: a. Synthetic pesticides b. Genetic engineering c. Irradiation d. All of the above _____ 4. Organic foods have been proven to be: a. Healthier b. Better tasting c. Safer d. None of the above _____ 5. Organic produced foods are more expensive than conventionally grown products because: a. Higher taxes b. Grocery stores can make a bigger profit on organic foods c. Higher production costs d. None of the above _____ 6. Consumption of non-organic produce can lead to exposure to: a. Potentially harmful pesticide levels b. Safe levels of pesticide residue c. The chilly refrigerated produce section d. Consumption of non-organic produce has not been shown to have any ill effects on health _____ 7. Other than purchasing organic produce, pesticide exposure can be reduced by: a. Washing all fruits and vegetables b. Peeling or trimming fruits and vegetables c. Eating a wide variety of fruits and vegetables d. All of the above 172 Healthy Express Lesson 3 Organic Foods 101 Choosing Organics Many factors may influence your decision to buy – or not to buy – organic foods. Consider these: Nutrition – The USDA makes no claims that organically produced foods are safer or 1 more nutritious than conventionally produced foods. Quality and Appearance – Organic foods are required to meet the same safety and quality standards as those set for conventional foods. Organic foods differ from conventionally produced foods in the way they are grown, handled, and processed. You may find that organic fruits and vegetables spoil faster because they are not treated with waxes or preservatives. Also, do not be surprised to see less-than-perfect looks – sometimes organic produce may be oddly shaped, have color variations, or be smaller in size. But remember – odd appearances do not indicate any problems with safety or 2 quality. Pesticides – In conventional growing methods, pesticides and fungicides are sprayed on crops to prevent pest damage, molds and other diseases. These practices can leave a residue on fruits or vegetables. One reason individuals may purchase organic foods is to 2 limit consumption of these chemicals. Environment – People may also purchase organic foods to support a healthy, natural environment. Organic food is produced by farmers who value the use of renewable resources and the conservation of soil and water to help ensure environmental quality for 1 future generations. Cost – Organic foods are often more expensive than conventionally grown foods. Higher prices are due to more expensive farming practices, tighter government regulations and lower crop yields. Because organic farmers don't use herbicides or pesticides, many 2 management tools that control weeds and pests are labor intensive. Taste – Some people say they can taste the difference between organic and non-organic food. Others say they find no difference. Taste is a subjective and personal 2 consideration, so decide for yourself. Healthy Express Lesson 3 173 Understanding Organic Terminology When buying organic foods, look for the following USDA-regulated terms on labels3: “Natural” and “organic” are not interchangeable. Other truthful claims, such as freerange, hormone-free, and natural, can still appear on food labels. However, don't confuse these terms with "organic.”4 Organic meat, poultry, eggs, and dairy products come from animals that are given no antibiotics or growth hormones.1 Buying and Handling Tips Whether you are already a fan of organic foods or you just want to shop wisely and handle your food safely, consider these tips:2 1. Buy fruits and vegetables in season to ensure the highest quality. Also try to buy your produce the day it's delivered to market to ensure that you're buying the freshest food possible. Ask your grocer what day new produce arrives. Farmers' markets are also a good source of fresh produce. 2. Eat a variety of fruits and vegetables. This will reduce the chances of overexposure to any one residue. 3. Read food labels carefully. Beyond the produce section, remember that just because a product says it is organic or contains organic ingredients does not mean it is healthier than its conventional counterpart. The calorie, fat, salt and sugar content of organic foods are often remarkably similar to that of conventional foods. 4. Wash all fresh fruits and vegetables thoroughly. This will help remove most dirt and bacteria. Use a small scrub brush to clean produce eaten with its skin intact. Examples include apples, potatoes and cucumbers. 5. To reduce exposure to pesticides, peel fruits and vegetables after washing them and discard the outer leaves of leafy vegetables. A wax coating is applied to some vegetables (such as cucumbers) to help retain moisture. Although the wax is considered edible, it may taste bitter. Keep in mind that peeling your fruits and vegetables may also reduce the amount of nutrients and fiber. Some pesticide residue also collects in fat, so remove fat from meat and the skin from poultry and fish. 174 Healthy Express Lesson 3 The Dirty Dozen and Clean 15 The Environmental Working Group, a non-profit organization in Washington, D.C., recommends going organic on the “Dirty Dozen” – produce that is most susceptible to pesticide residue. Produce on the "Clean 15" list bears little or no traces of pesticide residue and is safe to consume 5 in non-organic form. The Dirty Dozen The Clean 15 Apples Grapes – imported Onions Cantaloupe – domestic Celery Sweet bell peppers Sweet corn Kiwi Strawberries Potatoes Pineapples Cabbage Peaches Blueberries – domestic Avocado Watermelon Spinach Lettuce Asparagus Sweet Potatoes Nectarines – imported Kale & Collard greens Sweet peas Grapefruit Mangos Mushrooms Eggplant Sources Cited 1. Agricultural Marketing Service, U.S. Department of Agriculture. (2010). National Organic Program: Going organic. Retrieved from http://www.ams.usda.gov/AMSv1.0/ams.fetchTemplateData.do?template=TemplateN&leftNa v=NationalOrganicProgram&page=NOPGoingOrganic&description=Going%20Organic&acct= nopgeninfo 2. Mayo Clinic. (2011). Organic foods: Are they safer? More nutritious? Retrieved from http://www.mayoclinic.com/health/organic-food/NU00255# 3. Agricultural Marketing Service, U.S. Department of Agriculture. (2010). National Organic Program: Understanding organic labeling. Retrieved from http://www.ams.usda.gov/AMSv1.0/ams.fetchTemplateData.do?template=TemplateA&navID =NationalOrganicProgram&leftNav=NationalOrganicProgram&page=NOPUnderstandingOrga nicLabeling&description=Understanding%20Organic%20Labeling&acct=nopgeninfo 4. Agricultural Marketing Service, U.S. Department of Agriculture. (2010). National Organic Program: Understanding organic. Retrieved from http://www.ams.usda.gov/AMSv1.0/ams.fetchTemplateData.do?template=TemplateA&leftNav =NationalOrganicProgram&page=NOPUnderstandingOrganic&description=Understanding%2 0Organic&acct=nopgeninfo 5. Environmental Working Group. (2011). Executive summary. Retrieved from http://www.ewg.org/foodnews/summary/ Healthy Express Lesson 3 175 176 Celery Buy Organic Strawberries Apples Buy Organic Buy Organic Peaches Buy Organic Healthy Express Lesson 3 (Imported) Grapes (Imported) Spinach Nectarines Buy Organic Buy Organic Sweet Bell Peppers Buy Organic Buy Organic Healthy Express Lesson 3 177 Buy Organic Buy Organic 178 (Domestic) Potatoes Blueberries Lettuce Buy Organic Kale/ Collard Greens Buy Organic Healthy Express Lesson 3 Onions Buy Conventional or Locally Grown Sweet Corn Buy Conventional or Locally Grown Healthy Express Lesson 3 Avocado Buy Conventional or Locally Grown Pineapples Buy Conventional or Locally Grown 179 180 Buy Conventional or Locally Grown (Domestic) Sweet Peas Mangos Buy Conventional or Locally Grown Eggplant Buy Conventional or Locally Grown Cantaloupe Buy Conventional or Locally Grown Healthy Express Lesson 3 Cabbage Buy Conventional or Locally Grown Watermelon Kiwi Buy Conventional or Locally Grown Buy Conventional or Locally Grown Sweet Potatoes Buy Conventional or Locally Grown Healthy Express Lesson 3 181 182 Asparagus Grapefruit Buy Conventional or Locally Grown Buy Conventional or Locally Grown Mushrooms Buy Conventional or Locally Grown Healthy Express Lesson 3 The Dirty Dozen Apples Grapes – I Celery Bell peppers Strawberries Potatoes Peaches Blueberries – D Spinach Lettuce Nectarines – I Kale/Greens I= Imported D= Domestic The Clean 15 Onions Sweet corn Pineapples Avocado Asparagus Sweet peas Mangos Apples Cantaloupe ‐ D Kiwi Cabbage Watermelon Sweet potatoes Grapefruit Mushrooms The Dirty Dozen D= Domestic The Dirty Dozen Apples Grapes – I Celery Bell peppers Strawberries Potatoes Peaches Blueberries – D Spinach Lettuce Nectarines – I Kale/Greens I= Imported D= Domestic The Clean 15 Onions Apples Sweet corn Cantaloupe ‐ D Pineapples Kiwi Avocado Cabbage Asparagus Watermelon Sweet peas Sweet potatoes Mangos Grapefruit Mushrooms The Clean 15 Onions Apples Sweet corn Cantaloupe ‐ D Pineapples Kiwi Avocado Cabbage Asparagus Watermelon Sweet peas Sweet potatoes Mangos Grapefruit Mushrooms The Dirty Dozen Apples Grapes – I Celery Bell peppers Strawberries Potatoes Peaches Blueberries – D Spinach Lettuce Nectarines – I Kale/Greens I= Imported D= Domestic The Clean 15 Onions Apples Sweet corn Cantaloupe ‐ D Pineapples Kiwi Avocado Cabbage Asparagus Watermelon Sweet peas Sweet potatoes Mangos Grapefruit Mushrooms Healthy Express Lesson 3 Apples Cantaloupe ‐ D Kiwi Cabbage Watermelon Sweet potatoes Grapefruit Mushrooms The Clean 15 Onions Apples Sweet corn Cantaloupe ‐ D Pineapples Kiwi Avocado Cabbage Asparagus Watermelon Sweet peas Sweet potatoes Mangos Grapefruit Mushrooms The Dirty Dozen Apples Grapes – I Celery Bell peppers Strawberries Potatoes Peaches Blueberries – D Spinach Lettuce Nectarines – I Kale/Greens I= Imported D= Domestic The Dirty Dozen Apples Grapes – I Celery Bell peppers Strawberries Potatoes Peaches Blueberries – D Spinach Lettuce Nectarines – I Kale/Greens I= Imported D= Domestic Onions Sweet corn Pineapples Avocado Asparagus Sweet peas Mangos The Dirty Dozen Apples Grapes – I Celery Bell peppers Strawberries Potatoes Peaches Blueberries – D Spinach Lettuce Nectarines – I Kale/Greens I= Imported D= Domestic The Clean 15 Apples Grapes – I Celery Bell peppers Strawberries Potatoes Peaches Blueberries – D Spinach Lettuce Nectarines – I Kale/Greens I= Imported The Clean 15 Onions Apples Sweet corn Cantaloupe ‐ D Pineapples Kiwi Avocado Cabbage Asparagus Watermelon Sweet peas Sweet potatoes Mangos Grapefruit Mushrooms The Dirty Dozen Apples Grapes – I Celery Bell peppers Strawberries Potatoes Peaches Blueberries – D Spinach Lettuce Nectarines – I Kale/Greens I= Imported D= Domestic The Clean 15 Onions Apples Sweet corn Cantaloupe ‐ D Pineapples Kiwi Avocado Cabbage Asparagus Watermelon Sweet peas Sweet potatoes Mangos Grapefruit Mushrooms 183 What's Super About Superfoods? Eating right is more than adding a handful of healthy foods to your diet or eliminating unhealthy ones, but rather the healthfulness of your entire diet – which should include a variety of foods. However, a few foods are truly "super" – packing more than their share of nutrients and phytochemicals that lower risk for diseases such as cancer and heart disease. In addition, many of these “superfoods” are low in calories and high in fiber, which can help with weight loss and weight maintenance. Phytonutrients or phytochemicals are chemicals in plants (apart from vitamins, minerals, and macronutrients like proteins and carbohydrates) that have a beneficial effect on the body. There are hundreds, if not thousands, of phytochemicals in foods. Highly colored vegetables and fruits tend to be highest in these chemicals, but tea and nuts are also excellent sources. What's one key thing superfoods have in common? They are all "real," i.e., unprocessed, foods. Garlic Why it’s super: 1 Studies have shown that garlic may help to reduce cholesterol , have anti-inflammatory and anti2 3 arthritic properties and contain sulfur compounds that may prevent heart disease. How to include more in your diet and other advice: Studies have shown that crushing garlic cloves prior to cooking reduces the loss of 4 garlic's healthful properties during cooking. Fresh garlic may inhibit the development of heart disease more than processed garlic. Look for cloves that are plump and smooth. Avoid those that have begun to sprout because they could be spoiled. Add chopped garlic when sautéing greens, such as spinach, kale, or rapini (also called broccoli rabe). Add chopped garlic to soups, stews, and pasta sauces. Roast potatoes with whole cloves of garlic, then puree them together with a bit of olive oil for garlic-mashed potatoes. Add a bit of finely minced garlic to salad dressings. 5 Oats Why it's super: 6 7 Oats has been found to lower cholesterol and blood pressure, and the phenolic compounds in oats have been found to inhibit the oxidation of LDL (“bad”) cholesterol, which protects against 8 the development of heart disease. 184 Healthy Express Lesson 3 How to include more in your diet and other advice: Eat more oatmeal, which tastes better with a toasted flavor. You can enhance this flavor by cooking oatmeal in a nonstick pan over low heat until it's slightly fragrant and darker. Take care not to burn it, though. Garnish oatmeal with raisins, dried cranberries, blueberries, or toasted nuts. Blueberries Why they’re super: 9 Studies have shown that blueberries increase insulin sensitivity, protect brain and memory 10 11,12 health, and protect against oxidation, the principal cause of cellular damage. How to include more in your diet and other advice: The best of the berries is in the pulp and seeds, so choose the whole fruit, not juice. Frozen berries are just as nutritious as fresh berries. Switch from ice cream to frozen blueberries for an after-dinner snack. Add berries to tossed salads, salsas and muffin batter. Briefly cook berries with a little sugar or other sweetener, lemon juice, and cornstarch, and use as a topping for pancakes, French toast, waffles, and ice cream. Nuts Why they’re super: Multiple studies have found a moderate amount of nuts inhibits the development of heart 13,14 Limit yourself to about an ounce of nuts a day – about what fits in one layer on the disease. palm of your hand. How to include more in your diet and other advice: Use as a crunchy addition to oatmeal, salads, or yogurt. Because of their high concentrations of fats, nuts have a tendency to go rancid. In general, whole nuts keep better than pieces; unprocessed nuts keep better than processed ones; nuts in the shell keep better than shelled. Keep nuts in a cool place in a sealed container for up to four months. Keep in the fridge for about six months and in the freezer for up to a year. Dry-roasted or raw nuts are a good choice. Avoid nuts with added salt, oil or flavors. Green Tea Why it’s super: 15 16 17 Green tea may reduce the risk of heart disease , stroke and cancer. Additionally, a 18 compound in green tea called EGCG may support brain health and memory. Healthy Express Lesson 3 185 How to include more in your diet and other advice: Aim to drink at least two cups per day. Replace coffee drinks or sugary sodas with tea. Brewed tea offers more health benefits than instant tea. Brew tea for at least three minutes. Sources Cited 1. Reinhart, K. M., Talati, R., White, C. M., & Coleman, C. I. (2009). The impact of garlic on lipid parameters: A systematic review and meta-analysis. Nutrition Research Reviews, 22(1), 39-48. 2. Ban, J. O., Oh, J. H., Kim, T. M., Kim, D. J., Jeong, H. S., Han, S. B., et al. (2009). Antiinflammatory and arthritic effects of thiacremonone, a novel sulfur compound isolated from garlic via inhibition of NF-κB. Arthritis Research & Therapy, 11(5), R145. 3. Benavides, G. A., Squadrito, G. L., Mills, R. W., Patel, H. D., Isbell, T. S., Patel, R. P., et al. (2007). Hydrogen sulfide mediates the vasoactivity of garlic. Proceedings of the National Academy of Sciences of the United States of America, 104(46),17977-17982. 4. Cavagnaro, P. F., Camargo, A., Galmarini, C. R., & Simon, P. W. (2007). Effect of cooking on garlic (Allium sativum L.) antiplatelet activity and thiosulfinates content. Journal of Agricultural and Food Chemistry, 55(4), 1280-1288. 5. Mukherjee, S., Lekli, I., Goswami, S., & Das, D. K. Freshly crushed garlic is a superior cardioprotective agent than processed garlic. Journal of Agricultural and Food Chemistry, 57(15), 7137-7144. 6. Van Horn, L., Moag-Stahlberg, A., Liu, K., Ballew, C., Ruth, K., Hughes, R., et al. (1991). Effects on serum lipids of adding instant oats to usual American diets. American Journal of Public Health, 81(2), 183-188. 7. Saltzman, E., Das, S. K., Lichtenstein, A. H., Dallal, G. E., Corrales, A., Schaefer, E. J., et al. An oat-containing hypochaloric diet reduces systolic blood pressure and improves lipid profile beyond the effects of weight loss in men and women. Journal of Nutrition, 131(5), 1465-1470. 8. Chen, C. Y., Milbury, P. E., Kwak, H. K., Collins, F. W., Samuel, P., & Blumberg, J. B. (2004). Avenanthramides and phenolic acids from oats are bioavailable and act synergistically with vitamin C to enhance hamster and human LDL resistance to oxidation. Journal of Nutrition, 134(6), 1459-1466. 9. Stull, A. J., Cash, K. C., Johnson, W. D., Champagne, C. M., & Cefalu, W. T. (2010). Bioactives in blueberries improve insulin sensitivity in obese, insulin-resistant men and women. Journal of Nutrition, 140(10), 1764-1768. 10. Krikorian, R., Shidler, M. D., Nash, T. A., Kalt, W., Vinqvist-Tymchuk, M. R., Shukitt-Hale, B., et al. (2010). Blueberry supplementation improves memory in older adults. Journal of Agricultural and Food Chemistry, 58(7), 3996-4000. 186 Healthy Express Lesson 3 11. Hurst, R. D., Wells, R. W., Hurst, S. M., McGhie, T. K., Cooney, J. M., Jensen, D. J. (2009). Blueberry fruit polyphenolics suppress oxidative stress-induced skeletal muscle cell damage in vitro. Molecular Nutrition & Food Research, 54(3), 353-63. 12. Ahmet, I., Spangler, E., Shukitt-Hale, B., Juhaszova, M., Sollot, S. J., & Joseph, J. A. (2009). Blueberry-enriched diet protects rat heart from ischemic damage. Public Library of Science (PLoS) ONE, 4(6), e5954. 13. Kelly, J. H., Jr., & Sabaté, J. (2006). Nuts and coronary heart disease: An epidemiological perspective. British Journal of Nutrition, 96(suppl2), S61-S67. 14. Blomhoff, R., Carlsen, M. H., Andersen, L. F., & Jacobs, D. R., Jr. (2006). Health benefits of nuts: Potential role of antioxidants. British Journal of Nutrition, 96(suppl2), S52-S60. 15. Aneja, R., Hake, P. W., Burroughs, T. J., Denenberg, A. G., Wong, H. R., & Zingarelli, B. (2004). Epigallocatechin, a green tea polyphenol, attenuates myocardial ischemia reperfusion injury in rats. Molecular Medicine, 10(1-6), 55-62. 16. Choi, Y. B., Kim, Y. I., Lee, K. S., Kim, B. S., & Kim, D.J. (2004). Protective effect of epigallocatechin gallate on brain damage after transient middle cerebral artery occlusion in rats. Brain Research,1019(1-2), 47-54. 17. Chen, D., Daniel, K. G., Kuhn, D. J., Kazi, A., Bhuiyan, M., Li, L., et al. Green tea and tea polyphenols in cancer prevention. Frontiers in Bioscience, 9, 2618-2631. 18. Haque, A. M., Hashimoto, M., Katakura, M., Tanabe, Y., Hara, Y., & Shido, O. (2006). Long-term administration of green tea catechins improves spatial cognition learning ability in rats. Journal of Nutrition, 136(4), 1043-1047. Healthy Express Lesson 3 187