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’13 h c r a M Breakfast Breakfast of Champions p. 3 Breakfast really is the most important meal of the day. By Dr. Jo® Lichten Recipe IT’S NUTRITION MONTH! u need? the tools yo Do you have Red Pepper Soup p.4 Add some color! Client Handouts School Lunches, Calories p.5-6 Is Being Overweight Healthier? n January 2nd, just in time to damper the enthusiasm of many overweight people's New Year's resolutions to eat healthier, exercise more, and lose excess body weight, we have the Journal of the American Medical Association publish yet another seriously flawed study from Dr. Flegal and her associates at the Center for Disease Control.1 Flegal's study certainly got a lot of press. While some of the press coverage pointed out some of the reasons the study's data was misleading, many presented the data with little criticism, suggesting this study showed being overweight actually helped reduce the risk of O dying. In too many cases the media, along with the study's authors, failed to understand that correlation should not be confused with causation. Critics of this study focused on some of the questionable methods Flegal used in compiling statistics from previous studies. For example, Flegal included people too thin to fit what most consider to be normal weight range (BMI 20 to 24.9). Many of these ultra thin individuals were likely already somewhat emaciated by cancer or other serious disease at the time their BMI was measured. She also included smokers, who tend to be thinner but who have a much greater risk of dying (continued on next page) Here are engaging and informative handouts for your clients. Ideas You Can Use Top Ten Apps: Part Two p.7 Catherine Frederico, MS, RD, LDN lists a few of her favorite apps for health in the second installment of our new series. Research Is Being Overweight Healthier? p.1-2 Evaluating the facts in a misleading study. Is Fructose Fattening p. 8 Take an in-depth look at the effects of fructose. Comprehensive content library at communicatingfoodforhealth.com Looking for a tour of our site or a bit of help? Call us at 800-462-2352! from heart disease, emphysema, and cancer than nonsmokers. The statistical associations created by this study's inclusion of smokers and people with preexisting illnesses was likely largely responsible for producing questionable correlations between lower BMI and an increased risk of dying. ated due to chronic ills are in hospitals or hospices as she assumed. Far more are in nursing homes and they were included in her study. A far better way to statistically correct for illnesses that lead to weight loss and then death is to wait several years after BMI is measured to start looking for deaths. Willett did that but Flegal did not. This statistical adjustment largely eliminates most of those whose sickness-caused weight loss lead to their deaths. Failure to note this creates a noncausal statistical correlation between lower BMI and increased mortality, which distracts from the biological reality of diseaserelated illness leading to weight loss and a greater risk of dying. One of Flegal's most vocal critics was Dr. Walter Willett of the Harvard School of Public Health. He claimed that Flegal's study was "an even greater pile of rubbish" than Flegal's 2005 study. Willett and others have done research since the 2005 study that eliminated most of the questionable correlations between lower BMI and an increased risk of dying. In a 2010 study, Willett did a metaanalysis of several large studies that looked at people who never smoked. He also looked at the deaths that occurred in the first few years after BMI was measured, eliminating data from those subjects in order to get rid of data from people whose low BMI was likely caused by some serious illnesses that had already caused them to lose a lot of weight. Data from Willett's 2010 study is shown in Figure 1. promotes type 2 diabetes, increases gallstones, osteoarthritis, senility, heart failure, and numerous other ills that can increase both morbidity and mortality. We all know people who were overweight or obese most of their lives, but unless they die suddenly from a heart attack or stroke, they typically lose a lot of weight before dying. Bottom Line: There is a big difference between losing weight unintentionally and intentionally. People with Alzheimer's, congestive heart failure, emphysema, renal failure, and numerous other ills often lose weight unintentionally for years before succumbing to their disease. Unintentional weight loss is often associated with serious disease that markedly increases the risk of dying. However, this is very different than healthy but overweight people intentionally losing weight by adopting a healthful diet and exercise program. This results in a marked improvement in numerous disease risk factors and ultimately reduces the risk of dying from many serious degenerative diseases. For most, this almost certainly increases longevity. By James J. Kenney PhD, FACN Research in numerous animals shows a reduced calorie intake slows down the aging process, which suggests that eating more calories and gaining weight may actually cause people to age a bit faster. On the other hand, being very lean may not always improve survival. For example, older people with more body fat may survive a serious infection simply because their weight while sick is less likely to reach a critically low BMI level, leaving them better able to fight off the infection. However, being overweight or obese promotes many types of cancer, raises blood pressure, Willett's data indicate that the risk of death was significantly greater in people whose initial BMIs put them in the overweight (25 to 29.9) and obese (30 or greater) categories, compared with those with normal weight BMIs (20 and 24.9). Even Willett's data found that the risk of dying for those who were very thin (BMI< 18) was higher even for people who appeared to be healthy nonsmokers. 1 Flegal KM, et al. JAMA 2013;309: 71-‐82 or h;p://jama.jamanetwork. com/arDcle.aspx?arDcleid=1555137 Flegal defended her work by claiming she used standard categories for weight classes and made some statistical adjustments for smokers, but she included data from studies that defined normal weight as being well below BMI of 20. Obviously not all people who become emaci- 2# # # # # # # # # # # ©www.foodandhealth.com B re akf as t of Champions It’s called “break-fast” for a reason. That first meal of the day is our “break” from the evening’s “fast.” A timely breakfast is critical because our blood glucose is running low by the time we wake up in the morning. While much of our body can fuel itself on fat-including our heart and other muscles -- our brain and red blood cells demand glucose and only glucose! By the time we wake up in the morning, our body has burned through dinner and our liver glycogen stores (which are a quick source of glucose) and is on the search for another glucose source. And do you know where it finds that source? No, not in your fat cells, unfortunately. Fat can’t effectively be converted into glucose. I hate to tell you, but if you don’t eat breakfast, your body starts chewing on your lean muscle mass to meet your glucose need. Yes, that’s right, it eats the stuff you worked so hard on at the gym! So, stop cannibalizing your lean muscle mass and eat breakfast instead! Not only will it improve your body shape, researchers have shown that eating a healthful breakfast can improve focus and concentration while reducing hunger throughout the day. Breakfast eaters tend to be leaner than those who eat most of their calories later in the day. The key is to eat an adequate breakfast – not just a nibble (which can increase your appetite). What to eat? Pair proteins (dairy, meat, beans, nuts) and carbohydrates (bread, cereal, grain) together for an even source of energy all morning. Then, in order to meet your daily fruit and vegetable needs, add at least one fruit or vegetable to your plate. Carbohydrates provide glucose while proteins help to rebuild your body protein and keep you full longer. Make sure you add at least one fruit or vegetable to your meal in order to meet the USDA recommendations. Remember, that’s 4-10 daily servings of fruits and vegetables. Try some of these great breakfast combinations! • Oatmeal with skim milk, raisins, and nuts • Peanut butter on a whole grain English muffin, topped with fresh raspberries • Eggs, grits, and sliced tomato • Vegetarian sausage on a whole grain roll with a banana on the side By Dr. Jo® Lichten, PhD, RD. Find out more about Dr. Jo’s speaking schedule and Reboot, her upcoming book, at http://www.DrJo.com/. More Breakfast Inspiration You can find tons of tasty, healthful recipes at www.foodandhealth .com/recipes.php. Check out our amazing breakfasts, simple lunches, tasty dinners, and dreamy desserts. ts n a d i x o Anti We’ve all heard about the joys of antioxidants, but today we want to discuss what they do and where to actually find them. There are many different types of antioxidants, but they all appear to play a similar role: protecting your cells from free radicals, which would otherwise damage those cells. Where can you find antioxidants? In healthful foods, of course! • Orange foods are rich in the antioxidant called beta-carotene. Stock up on carrots, sweet potatoes, mangoes, and squash. • What do tomatoes, pink grapefruit, and watermelon have in common? Why, they’re all sources of lycopene, another amazing antioxidant. • Vitamin E, yet another great antioxidant, is found in nuts, mangoes, broccoli, and a slew of oils, including corn oil, safflower oil, and soybean oil. ©www.foodandhealth.com 3 Red Pepper Soup when the skins get brown and a bit blistery. Ingredients: 4 red bell peppers, halved, stems and seeds removed 1 cup chopped leeks or onions 1 tsp olive oil 1 tsp minced garlic 3 cups low-sodium chicken broth 1 cup chopped canned tomatoes, no salt added 1 tablespoon freeze dried basil Dash garlic powder Dash cayenne pepper Dash black pepper Dash dried thyme 1 cup fat-free half and half In a large nonstick wok or Dutch oven, heat the olive oil & add the garlic. Stir for 15-30 seconds, then add the roasted peppers, leeks (or onions), broth, tomatoes, & seasonings. Bring to a boil, then lower to simmer. Cover and let cook for 20 minutes. Pour soup into a blender or food processor and blend until smooth. You can also use an immersion blender to puree the soup in the pot. After it is smooth, return it to the heat & add fat-free half and half. Directions: Turn on the oven broiler. Place the peppers cut side down on a large tray. Surround with leeks or onions. Set your oven to broil and roast the vegetables for 20 minutes. You’ll know they’re done Serves 4. Each 1 cup serving: 129 calories, 4g fat, 1g saturated fat, 0g trans fat, 3mg cholesterol, 128mg sodium, 19g carbohydrate, 3g fiber, 10g sugars, 7g protein. This soup goes well with a large tossed salad and whole grain bread or rice. F e at ur e d Ing re d i e nt: Be ll Pe p p ers M ee t B el l P ep p er s! Bell peppers are crun chy, sweet vegetables that come in a variety of colors. D id you know that red bell pe ppers are often simply rip ened green bell peppers? Red bell Nutrition Facts: Red Bell Pepper peppers are usually th e sweet• A single medium-sized red bell est kind of bell pepp er , folpepper contains 30 calories, 0 g lowed by yellow and orange fat, 0 mg cholesterol, 8 g carbobell peppers, with gr een bell hydrate, 2 g fiber, 3 g sugar, and 1 g peppers as the least sw eet. Purple and white be protein. ll peppers • That serving also contains 140% also exist, though these are rarer than the others DV of vitamin A, 380% DV of . Bell peppers are supe r versatile, adding a livel y crunch when raw and a mel low sweetness when cook ed. Tr y them in salads and so ups! vitamin C, and 4% DV of iron. Stats from caloriecount.about.com. Brought to you by: 4# # # # # # # # # # # ©www.foodandhealth.com School Lunches: What’s New? There are big changes coming to school lunches near you, but don’t worry! We’re here to help. We’ve put together a breakdown of everything that you need to know about the new face of school lunch. Out with the Old Foods that do not promote good health are going to be restricted. That means... • No more trans fat. In anything. • Saturated fat must contribute no more than 10% of a meal’s total calories. • Refined grains are going to be cut way down. In fact, at least half of all grains purchased must be whole grains. • Say sayonara to whole milk. Thanks to its saturated fat content, it is being replaced with healthful alternatives. In with the New In order to craft healthful and balanced school lunches, the following foods are vital... • Fruit. Every day. Whole fruits are encouraged. In fact, no more than half of all foods in the fruit category can be served in the form of juice. • Vegetables are going to play a central role in the new system. In addition to daily vegetable options, all 5 MyPlate vegetable subgroups must make an appearance over the course of each week. • Subgroups: leafy greens, red & orange veggies, beans & peas, starchy veggies, and other veggies. • Nonfat and 1% milk will replace all other milk options. All flavored milk must be nonfat and at least two different milk choices must be offered per day. • Half of all grains must be rich in whole grains.* • According to schoolnutrition.org, meat and meat alternatives must be offered in one entree and only one other additional food. One ounce of cooked protein, without breading or skin, counts as a single ounce portion.* Calorie Guidelines and Options The new system involves calorie minimums and maximums. These are calculated based on average calorie needs per grade level. For reimbursable meals, the following requirements must be met... • At least 1/2 cup of fruits or vegetables must be on the lunch tray. • At least 3 of the 5 food groups from MyPlate must be represented. • These groups include vegetables, fruit, dairy, protein, and grains. • The total calorie count of the foods on the tray must be within the specified window for the appropriate grade level. • Grades K-5: 550-650 calories / lunch • Grades 6-8: 600-700 calories / lunch • Grades 9-12: 750-950 calories / lunch Note that the children can move outside of these requirements, but at that point, they must also pay for the food. For example, if a child does not include at least half a cup of a fruit or vegetable, that child will be charged for a meal “a la carte.” Foods over the calorie limit are available, but will also include an “a la carte” charge. * After initial complaints that calorie needs weren't being met, the USDA temporarily rescinded the calorie maximums for meat and grains, but the change is temporary. Brought to you by: ©www.foodandhealth.com 5 Savoring Calories Let’s face it, calories count... but savoring them is even better. It’s time to forget the word “diet” and give up on deprivation. Enjoy your food and be mindful of what you are eating. Embrace the fact that permanent weight loss -- and a lifetime of successful weight management -- depends on calories in versus calories out. However, it’s the quality of the calories the make a difference to your overall health. Enjoy a variety of plant foods like fruits, vegetables, beans, legumes, nuts, and seeds. Add some lean meats and a smattering of healthy fats like avocado or vegetable oil and you should be good to go. Note that these foods are all nutritious and often minimally processed. • Fat: 1 serving = 45-50 calories. These servings are small. Think 1 teaspoon of vegetable oil, 1 tablespoon of regular salad dressing, 1 slice of bacon, 1/5 of an avocado, etc. Tips for Cutting Calories: 1. Decipher the Nutrition Facts panel. Make sure that you are reading the Nutrition Facts for a single serving of food. Often, packaged foods have more than one serving per container. For example, sugar-sweetened iced tea usually contains more than one serving in a bottle. So though it appears as though the bottle only has 80 calories, that’s actually all that’s found in one serving. The bottle has closer to 160 calories. 2. Switch to smaller plates. If you eat from a smaller plate, you are likely to eat less food. Choose a salad plate (8 inches) instead of a dinner plate (10-12 inches). 3. Be a mindful eater and slow down. This allows you to recognize hunger and fullness cues. It takes your brain 20 minutes to register fullness, so allow your body and brain enough time to sync up before taking a second helping. 4. Downsize, don’t supersize. Budget your calories like money. Just because fast food is cheap doesn’t mean that it is worth the calories and fat. A small popcorn at the movie theatre has about 150 calories, but a large can have over 1,000 calories (and that’s without butter). 5. Limit alcohol. Many people forget to add up liquid calories. Alcoholic beverages can pack more extra calories than you might think. After all, there are 7 calories per gram of alcohol. That’s 70 calories per ounce (2 Tbs). The higher the proof, the more calories the alcohol has. For example, 80-proof alcohol averages 65 calories per ounce, and 100-proof alcohol has closer to 85 calories per ounce. Plus, when you are under the influence, willpower can go by the wayside! How Whole Food Calories Stack Up: • Whole grains: 1 serving = 80-100 calories. That’s 1 slice of bread, 1/3 cup of brown rice, 1/2 cup of oatmeal, ¾-1 cup of high-fiber cereal, etc. • Whole fruits: 1 serving = 60-80 calories. Think 1 medium apple, orange, pear, etc, 1 cup of cut fruit, ¼ cup of dried fruit, or ½ cup of fruit juice. • Vegetables: 1 serving = 25-50 calories. Try 1 cup of raw vegetables, ½ cup of cooked vegetables, ½ cup of V/8 juice, etc. • Protein: 1 serving = 70-160 calories. That serving is 1 ounce of lean meat, poultry, or fish, ½ cup of beans, 1 egg, 1 tablespoon of peanut butter, or 1 ounce of nuts. By Victoria Shanta Retelny, RD, LDN, author of The Essential Guide to Healthy Healing Foods. Brought to you by: 6# # # # # # # # # # # ©www.foodandhealth.com To p 1 0 App s f or H e a l t h : Par t 2 Here’s the second installment of my guide to the top 10 apps for health! With all of the great resources available today, it can be much easier to make informed and balanced choices. Guide to Vegan and Vegetarian Food Ingredients: If you are a vegetarian or thinking about eating a more plant-based diet, then you will want to download this free app from the Vegetarian Resource Group (www.vrg.org). Its guide to deciphering 200 food label ingredients will help explain food sources. Plus, the app offers links to the VRG resource store and newsletters. Salad Secrets: Pledges to eat more vegetables are much easier to uphold with this healthful collection of 55 chefinspired salad recipes to boost your vitamin and mineral intake while reducing your risk of heart disease. With this app, you can choose from 5 salad categories -- enjoy the gorgeous photography and helpful cooking tips. Restaurant Nutrition: Tired of asking for nutrient analyses when dining out? The Restaurant Nutrition app is here to save the day! Consult it when choosing where to dine, or search its database of over 60,000 foods while reading menus at over 250 restaurants. You can also search by diet plans and food allergies, set diet goals, and log progress. Max's Plate: Share this free app with the kids in your life. Max's Plate teaches kids about food groups using the USDA’s MyPlate format. It also serves ©www.foodandhealth.com as a food tracker -- sections of a divided plate disappear each time a food group serving is eaten. This app won an honorable mention in the US Surgeon General's 2012 Healthy App challenge. Food Focus: Fruits: Gamification is the hottest trend in health education. This app challenges young and old, new cooks and experienced chefs alike to identify macro close-up photos of a wide variety of fruit. Tired of the same 4 fruit choices? This app teaches identification of 50 different fruits to jazz up your meals and add more vitamins and minerals to your diet. Players agree -"It's plum fun!" Look for its companion app, Veggie Garden Palooza, in the App Store soon. 2013 promises continued development of an exciting, evolving menu of food and nutrition apps. If you are hungry for more ideas, check out the ebooks, An App A Day and An App A Day for Health Professionals, available at www.AppyLiving.com. Both offer over 400 app suggestions in about a dozen categories, including nutrition, grocery store shopping, cooking, restaurants, fitness, health games, disease management, and more! By Catherine Frederico, MS, RD, LDN Catherine Frederico is a nutrition and food science professor in New England. She is an app developer and was part of the teams that created App reSolutions, Max's Plate, and Food Focus: Fruits. ’13 h c r a M Calendar ONLINE: These are featured at foodandhealth.com and in our Member Library. Health observances: Chronic Fatigue Syndrome Awareness Colorectal Awareness Month Hemophilia Month Kidney Month Nutrition Month® Peanut Month Workplace Eye Health and Safety Juvenile Arthritis Awareness Week (Mar 3-9) Save Your Vision Week (Mar 3-9) School Breakfast Week (Mar 4-8) Chocolate Week (Mar 10-16) Pulmonary Rehabilitation Week (Mar 10-16) Brain Awareness Week (Mar 11-17) National Agricultural Week (Mar 17-23) Great American Meatout (March 20) Featured March Handouts: • 7 Strategies for Nutrition Month • Choose MyPlate Nutrition Month • Diet for Colon Cancer Prevention • Go Vegan Starter Guide • Melting the Myths about Chocolate • Nutrition Month Bingo • Peanut Spotlight Newsletter Archive Clip Art Library Practitioner News and Ideas: • Nutrition Month Greatest Hits • Nutrition Month Presentation Ideas Find hundreds of handouts in our online library at communicatingfoodforhealth.com Looking for a specific item and having trouble finding it? Just email or call us -- we’re happy to help, anytime! 7 Is Fructose Fattening?! nother study adds to growing concerns that dietary fructose may be more likely to promote weight gain and contribute to type 2 diabetes mellitus (DM) compared with other sources of dietary carbohydrates. In this new study, researchers used an MRI to measure blood flow in 20 healthy, normal-weight adult volunteers before and after drinking a 75 g beverage containing either glucose or fructose. They observed that glucose (but not fructose) ingestion reduced activation of parts of the hypothalamus associated with hunger. Glucose ingestion also increased functional connections between the hypothalamic-striatal network, which are also known to increase ratings of satiety and fullness. The results of the MRI scan data were consistent with how hungry the subjects said they felt after consuming drinks with different sugars. [Page KA, Chan O, Arora J, et al. Effects of fructose vs glucose on regional cerebral blood flow in brain regions involved with appetite and reward pathways. JAMA 2013; 309:63-67]. ! ! Communicating Food for Health is published monthly by Food and Health Communications, Inc. ISSN 1070-1613. © 2013. All rights reserved. P.O. Box 271108, Louisville, CO 80027 Phone: 800-462-2352 Fax: 800-433-7435 http://communicatingfoodforhealth.com Editorial Advisory Board Alice Henneman, MS, RD Barbara Hart, MS, RD, LDN Cheryle Syracuse, MS James J. Kenney, PhD, FACN Jill Eisenberg, RDH, MS, RD, CDN Karla Logston, RN, BS, CDE, CHC Linda Rankin, PhD, RD, LD, FADA Stephanie Correnti, BS, RD # # the development of both type 2 DM and cardiovascular disease (CVD). Table sugar (aka sucrose) is half fructose and half glucose. Highfructose corn syrup (HFCS) is typically 55 percent fructose and 45 percent glucose, but can be as high as 90% fructose. The evidence is leading more nutritionists to suspect that dietary fructose may pose unique metabolic risks not seen with other dietary sources of carbohydrate. It may not be a coincidence that the incidence of obesity has increased along with the increased consumption of fructose -- largely as HFCS-sweetened drinks -- over the past 50 years. Bottom Line: This study adds to mounting evidence from epidemiologic, metabolic-feeding, and animal studies that the increasing consumption of fructose may well be contributing to weight gain and host of other metabolic changes associated with the development of type 2 DM and CVD. Name: _________________________________________ Title/Company: ___________________________________ Address: _______________________________________ City/State/Zip: ___________________________________ Phone: _________________________________________ E-mail: _________________________________________ __ Check enclosed or __ Charge Visa/MasterCard/AMEX Card number: ____________________________________ Expiration date: __________________________________ Name on card: ___________________________________ Mail to Food and Health Communications, Inc., P.O. Box 271108, Louisville, CO 80027; Phone: 800-462-2352; Fax: 800-433-7435; www.foodandhealth.com Contributing Writers James J. Kenney, PhD, FACN Lauren Swann, MS, RD, LDN Victoria Shanta Retelny, RD, LD Jill Weisenberger, MS, RD, CDE Jo Licthen, PhD, RD Stephanie Ronco # By James J. Kenney, PhD, FACN subscribe to CFFH electronic Newsletter and member Resource 1 year, 12 issues of Communicating Food for Health Newsletter, online member area for recipes, photos, menu planner, special discounts, handout archive and PowerPoint templates and license to reproduce for one site. • 1 year: $89 • 2 years: $155 • Additional site and bulk subscriptions: call for details Executive Editor Judy Doherty, PC II # ! The results of this study, coupled with earlier research on human subjects and animals, suggests that dietary fructose may provide considerably less satiety per calorie than other sources of dietary carbohydrates. This appears to be particularly true when the fructose is consumed as a beverage. While all sugars have about the same number of calories per gram, there is growing evidence that fructose has different effects on metabolism and satiety that may contribute to weight gain compared to other sources of dietary carbohydrates. Unlike glucose, fructose does not stimulate insulin release and has relatively little immediate impact on blood sugar levels, both of which are known to increase activity in the brain's satiety centers. In addition, large amounts dietary fructose stimulates fat synthesis in the liver and tends to raise both serum triglyceride and LDL-C levels. Fructose also increases uric acid levels and appears to increase insulin resistance relative to the consumption of starch or glucose and so may contribute to A 8# ! The content of Communicating Food for Health is not intended to provide personal medical advice; this should be obtained from a qualified health professional. Recipes analyzed using Nutritionist Pro. # # # # # # ©www.foodandhealth.com