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Joint Assets: An Osteoarthritis Update

The aching, swollen, stiff joints associated with osteoarthritis (OA) have long been considered a “wear and tear” condition, associated with aging. It was thought that cartilage, the smooth connective tissue on the end of bones that cushion the joints, simply breaks down over a lifetime of walking, exercising and moving. New research shows that it is a disease of the entire joint that also causes bony changes of the joints, deterioration of tendons and ligaments and inflammation of the synovium (lining of the joint). While more prevalent in people over 50, OA can show up in younger patients, especially those who’ve experienced a joint injury such as a torn ACL or meniscus. The promising news is that according to the Arthritis Foundation, “OA is not an inevitable aging disease” and the Cleveland Clinic notes: “Age is a contributing factor, although not all older adults develop osteoarthritis and for those who do, not all develop associated pain.”

Still, currently OA is by far the most prevalent form of arthritis, affecting more than 32.5 million Americans, and primarily targeting knees, hips, hands and spine. A variety of factors contribute to the development of OA, including congenital joint deformity, family history, previous joint injury, and years of physically demanding work or contact sports. However, reducing risk is possible with attention to these modifiable factors:

  • Obesity adds stress and pressure to joints. Consider that your knees bear a force equivalent to three to six times your body weight with each step, so a lighter weight relieves the burden considerably – losing one pound takes 3 pounds off the knees.
  • Lifestyle. Being physically active is crucial, as a sedentary lifestyle and obesity are associated with a higher risk of OA. While sports such as football, baseball and soccer may pose a risk because of their impact on joints, most types of regular or moderate exercise can be safely done.

Living with Osteoarthritis

Unfortunately, there is no cure for OA, and managing symptoms such as joint stiffness, tenderness, swelling, and popping or crackling can become increasingly difficult over time. While seeking a pill to alleviate discomfort is a natural reaction, consider trying alternative solutions to help break the cycle of chronic pain.

“The longer the brain processes pain, the more hypersensitive it becomes to pain,” explains Rachel Welbel, MD, a physiatrist who is extensively trained in physical medicine and rehabilitation and sports medicine. “The brain, now constantly on high alert, may respond to non-painful sensations as if they are painful. Poor diets and stress can increase chemicals in the brain that reinforce this response, prolonging the pain cycle.”

Reflecting a more holistic and multi-faceted approach to managing pain, she says: “Opioids are almost never the answer.” Instead, she recommends lifestyle modifications, treatments and medications that help tackle pain in a variety of ways.

Lifestyle Modifications, Treatments and Medications for Osteoarthritis

Weight management. Obesity is not only a leading risk factor for OA, but adds to the pain for those with the condition. Body fat produces proteins called cytokines that cause inflammation, and in the joints, can alter the function of cartilage cells. Shedding even a few pounds can make a difference: losing just 10% of your body weight can cut arthritis pain in half, and losing another 20% can reduce the pain by an additional 25% or more, and may slow or even halt progression of the disease.

Exercise and movement. “Exercise is key to living well with OA,” says Welbel. “While resting aching joints may bring temporary relief, lack of movement ultimately leads to more discomfort. The focus is not on weight loss but on minimizing pain and maximizing strength.” Plan on 150 minutes of light to moderate exercise each week. She recommends working with a physical therapist who can analyze your joint biomechanics and suggest exercises to strengthen muscles and improve range of motion while reducing stiffness and pain. “In addition, exercise is a natural mood elevator,” says Welbel. “Walk, swim, or try mindfulness-based, stress-reducing exercise such as yoga and tai chi.”

Anti-inflammatory diet. Increasing consumption of fruits, vegetables, whole grains, legumes and fish, while reducing consumption of red and processed meats, refined grains, and sugar-containing beverages and foods, may play an important role in reducing pain associated with inflammation from OA, says Welbel. Try incorporating into your diet fatty fish; herbs and spices such as garlic, turmeric and cinnamon; yogurt and other fermented foods; and healthy fats such as avocados, extra virgin olive oil and walnuts.

Supportive devices. A cane or walker can help lighten the load on your joints, decrease pain, and reduce your risk of falling. Intermittent use of a knee brace may be helpful for added stability, especially if walking on uneven surfaces. Foot orthotics such as arch supports and metatarsal pads may reduce foot pain.

Medications. Over-the-counter (OTC) pain relievers like acetaminophen (Tylenol) may help joint pain and stiffness for some. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also used to relieve pain, including OTC medications such as Advil or Aleve, or Celebrex, a prescription medication with a somewhat lower risk of ulcers and upper gastrointestinal bleeding than other NSAIDs. Topical NSAIDS such as Aspercreme and other creams or patches containing ingredients such as capsaicin, menthol or lidocaine can help.

Injections. Corticosteroids injections may provide temporary relief for acute flare-up of OA pain in knees and finger joints, but effectiveness can vary, and you must wait at least 3 to 6 months to repeat an injection in a specific joint if needed. Viscosupplementation involves injection of a gel-like substance containing hyaluronic acid, which acts as a lubricant in the fluid between bony surfaces and is decreased in OA joints. Research results for significant pain reduction or improved function are not yet convincing, but there appear to be a number of patients with mild to moderate knee OA who report symptom relief.

Supplements. Research results are mixed, but we note some of the more well-known supplements with the caution that these are not recommended to be used alone as treatments for OA. Glucosamine and chondroitin sulfate, naturally occurring compounds found in healthy cartilage, may help reduce joint pain and stiffness, and have been available in the U.S. and Europe for several decades. Other supplements such as tart cherry and turmeric may help reduce OA symptoms for some.

Other promising but not yet proven treatments. Platelet-rich plasma (PRP) injections and stem cell therapy have been used to treat pain of mild to moderate knee OA, but evidence of effectiveness is mixed, and these are still considered experimental. Elements of Eastern medicine, including herbs and acupuncture, may help control OA symptoms, but have not yet been confirmed in large clinical studies.

A Generation of Joint Replacements

When diet and exercise modifications, supportive devices, medications and injections no longer sufficiently ease the pain of OA, a hip or knee replacement may be recommended. The number of people opting for this surgery increases each year, now totaling more than 790,000 knee and 450,000 hip replacements annually.

The implants, made of plastic, metal or ceramic, are traditionally kept in place with bone cement, which is gradually being replaced by newer cementless and porous titanium systems to improve bone fixation and durability. Also on the rise is computer-assisted surgery to increase placement accuracy of the prosthetic components, and patient-specific implants using 3D printing technology. The combination of modern materials and advanced surgical techniques have extended the durability of most implants to 20 years, a marked improvement over the previous standard of 10 to 15 years.

Recovery time has also changed for the better. With rehabilitation to regain strength and motion, normal activities can usually be resumed within weeks to months. Most importantly, the majority of patients are highly satisfied with the results, reporting minimal to no pain and significantly improved function and quality of life. However, outcomes can vary and potential complications should be discussed before proceeding.

Additional breakthroughs may be on the horizon: researchers at Duke University start trials this spring of a hydrogel-based cartilage substitute that may prove more durable than natural cartilage…stay tuned!

Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.

Sources: Arthritis Foundation, AAOS, Orthoworld, Cleveland Clinic, National Academy of Medicine (formerly Institute of Medicine), UpToDate, US Department of Agriculture, American College of Rheumatology.

 

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Bone Up: What Is Osteoporosis?

Except for dedicated thespians, saying “break a leg” is most definitely not a harbinger of good luck. More than 10 million Americans are living with osteoporosis, a condition of low bone mass that results in increased risk of bone fracture, sometimes even from a minor fall or pressure from a big hug. Over 1.5 million osteoporotic fractures occur annually, and 1/3 of women and 1/5 of men over 50 will experience an osteoporotic bone fracture in their lifetime. The good news is that reliable diagnostic testing and treatments are available, which we share below.

Who’s at Risk for Osteoporosis?

Osteoporosis is sometimes referred to as a “silent disease” because it is painless unless a fracture occurs, so people often are unaware they have it until that happens. Post-menopausal women are at highest risk, in part due to the decline in estrogen levels. Estrogen, and to an even greater extent, testosterone, are hormones that help ward off osteoporosis, which is why it is not as common in men. Others at risk include those with autoimmune diseases such as rheumatoid arthritis and celiac disease, those with high parathyroid or thyroid levels and certain other chronic diseases.

Medications including corticosteroids, proton pump inhibitors and certain antidepressants and anti-seizure medications may increase risk of bone thinning. Inherited factors may affect risk, such as race (more common in Caucasians and Asians), body shape and size (smaller/thinner individuals more at risk) and family history of osteoporosis. Physical activity level and diet play a role, placing those who are sedentary and/or have a diet low in calcium at higher risk. Cigarette smoking and higher alcohol intake are also risk factors.

How Osteoporosis is Diagnosed

A bone density measurement test is the best way to diagnose osteoporosis, using the DEXA (dual energy x-ray absorptiometry) scan of hip and spine. The severity of decrease in bone mass is determined by your T-score: Between -1.0 and -2.5 is defined as osteopenia, when bones are weaker than normal, while -2.5 or less indicates osteoporosis.

Osteoporosis Medications

A number of medications are available to treat osteoporosis.

  • Bisphosphonates to slow the breakdown and removal of bone are typically tried first. Fosamax, used most, is a weekly pill often taken for 5 years followed by a “drug holiday.” The IV bisphosphonate Reclast is generally continued for three years.
  • Evista is a daily pill for post-menopausal osteoporosis that protects against bone loss and also reduces the risk of breast cancer in high-risk women.
  • Prolia is injected every 6 months to slow breakdown and removal of bone and help increase bone density. It should not be discontinued once started or must be followed by another medication if stopped.
  • Evenity is injected once a month for a year to increase new bone and reduce breakdown and removal of bone.
  • Forteo and Tymlos are drugs that help build bone for people at high risk of fracture. These are injected daily for two years.

Managing Osteoporosis

Peak bone mass is achieved by age 25-30 years, but at any age, a healthy lifestyle can aid in strengthening bones. Focus on eating a balanced diet rich in vitamin D and calcium (see sidebar), and remember that exposing the body to natural sunlight increases production of vitamin D. Eliminating tobacco use and limiting alcohol is strongly recommended to promote maximum absorption of calcium and vitamin D. Taking fall prevention measures is crucial: consider that 95% of hip fractures are caused by falls.

Aim for 30 minutes of weight-bearing and muscle strengthening exercises on most days:

  • Walk or run on level ground or a treadmill
  • Dance
  • Climb stairs
  • Lift weights without straining your back
  • Sit-to-stand exercises: start with an elevated seat height, and progress to a lower chair as you get stronger
  • Strengthen thighs: stand against a wall and slide down into a slight knee bend, hold for 10 seconds and repeat a few times
  • Tai Chi: combines slow movements, breathing exercises, and meditation

Nourishment Know-How for Bone Health

For optimal bone health, a daily intake of 1200-1500 mg of calcium and 400-800 IU (international units) of Vitamin D is recommended for adults. In many cases, supplementation may be appropriate.

Selected sources with calcium and/or Vitamin D:

  • Dairy products
  • Calcium- and vitamin D-fortified foods and beverages (soy or almond milks, cereals, cheese)
  • Dark green, leafy vegetables
  • Fish such as salmon, trout, mackerel, tuna, sardines
  • Egg yolks
  • Sesame or chia seeds, figs, almonds

Fall Prevention Measures for Those with Osteoporosis Include:

  • Avoid ladders, step-stools and roof work
  • Eliminate tripping hazards like throw rugs, obstacles or cords on the floor
  • Be careful around pets and leashes
  • Use good lighting, night lights, update glasses and eye care to optimize vision
  • Stay fit with regular strengthening and balance exercises
  • Wear non-slip shoes
  • Install handrails and grab bars in the bathroom

Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.

Sources: Arthritis Foundation, AAOS, Orthoworld, Cleveland Clinic, National Academy of Medicine (formerly Institute of Medicine), UpToDate, US Department of Agriculture, American College of Rheumatology.

 

 

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Nourish Body, Brain and Heart with the MIND Diet

Mindful Eating for Your Brain

Harkening back to ancient civilizations, the concept of food as medicine represents one of today’s most cutting-edge approaches to prevention and disease management. Inspired by the intricate connection of mind and body wellness, a small, special group of diets have made their way into the mainstream offering benefits far beyond short-term weight loss. Among them are DASH (Dietary Approaches to Stop Hypertension), a low-sodium diet that encourages consumption of foods rich in nutrients such as potassium and calcium and magnesium; the Mediterranean diet for heart health, emphasizing fish, fruits, and vegetables, with olive oil as the main source of fat; and combining both, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, which shows real promise in helping its adherents preserve cognition and reduce the risk of dementia.

Launched in 2015 by researchers at Rush University Medical Center, the MIND diet encourages selecting foods from categories that include leafy greens and vegetables, legumes, fish and seafood, poultry, nuts and berries, while limiting high fat, high sugar and processed foods. Longitudinal observational studies showed the rewards of shifting to this healthier way of eating, with a 53% reduction in the risk of dementia for seniors who rigorously followed the diet, and somewhat surprisingly, a 35% risk reduction even for those who followed it only moderately well.

“This is my favorite feature,” says Jennifer Ventrelle, MS, RD, lead dietitian for the MIND Diet Intervention to Prevent Alzheimer’s Disease at Rush, “you don’t have to be perfect! It’s not necessary to eat from every preferred category to achieve your goals.”

Although it’s not intended as a reducing diet, Ventrelle says people who follow it naturally lose weight by focusing on the preferred categories of foods. “It’s too difficult for many people to consider banishing all sweets or giving up red meat forever, so we haven’t eliminated these foods but allow them with limited frequency and close attention to portion sizes,” she explains.

Additional research pointed to a host of other benefits associated with eating MINDfully for older adults: slower cognitive decline and progression of Parkinsonian signs in aging, and reduced risk of functional disability, depressive symptoms, metabolic syndrome, cardiovascular disease and all-cause mortality. “The literature continues to grow, with new studies that point to the key role diet plays in preventing cognitive decline,” says Puja Agarwal, PhD, nutritional epidemiologist and assistant professor of internal medicine at Rush.

But it is the gold-standard randomized controlled trial begun several years ago by Rush and Harvard School of Public Health that may ultimately establish a causal relationship between diet and dementia. More than 600 participants at higher risk for Alzheimer’s disease – overweight, suboptimal diets and a history of dementia in the family – were enrolled in the study designed to directly measure whether following the MIND diet versus a low-fat diet can prevent neurodegenerative ills – results are expected by the end of 2022. According to Agarwal, who is fully aware of its significance at a time when more than 6 million people in the U.S. are living with Alzheimer’s disease, a number expected to double in the coming decades. “We don’t have a cure for these diseases, so prevention strategies are essential. We’re hoping for intervention trial results for the effect of MIND diet in protecting the brain to further establish the role of diet in healthy aging.”

What a day of meals on the MIND diet might include*:

BREAKFAST
Greek Yogurt Parfait: ½ cup whole grain, high fiber cereal, ½ cup berries, ½ cup low-fat Greek yogurt, 2 tbsps (raw, unsalted) walnuts, almonds or pecans.

LUNCH
Whole Wheat Turkey Wrap: 1 tortilla wrap + 3-5 oz turkey breast lunchmeat or carved white meat + 1 slice reduced fat cheese + lettuce, tomato and veggies of choice.

3-Bean Salad: Mixture of kidney beans, black beans, chickpeas, red onions + 1 tbsp extra-virgin olive oil + 1 tsp balsamic vinegar + Italian seasoning mix such as oregano, parsley, basil, etc.

SNACK
Mediterranean Rice Cake: 1 whole grain rice cake spread with 2 tbsps hummus topped with cucumber slices, tomato slices + fresh lemon juice.

DINNER
Baked Salmon over Spinach and Grains with Asparagus

  • 3-5 oz salmon filet topped with fresh or dried dill or parsley + a squeeze of fresh lemon juice baked on top of 1 cup baby spinach leaves
  • 8 asparagus spears topped with ½ tbsp extra-virgin olive oil + fresh lemon juice + zest
  • 1 cup cooked whole grain such as brown rice, quinoa, or bulgur mixed with ½ tbsp. extra-virgin olive oil

DESSERT
1 oz of dark chocolate (at least 75% cocoa) and ½ cup frozen berries

*Please consult with your physician to determine if these foods are appropriate for you.

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Summer Fruits and Veggies

Picking the Season’s Prime Produce

A seasonal bounty of fruits and vegetables is in bloom everywhere from your grocery’s fresh foods section to local farmers’ markets, and in your own backyard garden. The following is advice from experts on how to purchase summer fruits and veggies at its peak, and store them safely, until ready to enjoy.

Berries and Cherries. Look for plump, unblemished fruits with no dark spots or fuzzy white mold; raspberries, blackberries and strawberries should be fragrant. All are shiny when ripe – except for blueberries, which will have a dull matte finish. While most berries can be refrigerated for up to a week, raspberries can start fading more quickly; when that occurs, The Spruce Eats recommends freezing them for use in smoothies and other recipes. To extend their life, do not wash fruit when you unpack your groceries; wait until right before you eat them.

Corn. Choose uncut silks coming out of tightly closed, bright green husks that smell slightly grassy, advises Martha Stewart; and peel back a tad to make sure the kernels look plump and healthy. Refrigerate corn with husks on and use as soon as possible.

Cucumbers and Peppers. Look for firm, shiny vegetables without blemishes, wrinkles or soft spots. According to Have a Plant, cucumbers and peppers can be refrigerated in a plastic bag for up to one week.

Grapes. Choose firm, plump grapes with green healthy stems. They can last up to two weeks when refrigerated. Or try an easy frozen treat: Place on a baking sheet; freeze until firm, and enjoy. Store leftovers in a freezer-safe bag for up to 12 months.

Lettuces. Eliminate those with wilted or broken leaves. Lettuce can be stored for up to four days when refrigerated; darker lettuces tend to last longer than pale, tender varieties. Wash all lettuces just before using.

Melons. Select watermelons without flat sides or dents, and choose ones with a heavy weight for optimal juiciness. Cantaloupe and honeydew melons are best when they have a pale yellow rind and flowery smell at the stem. Harvest to Table recommends storing whole ripe melons in the refrigerator for up to a week to avoid spoiling; cut melons will keep for up to three days.

Plums, Nectarines, Peaches. Opt for vibrant colors, a firm feel, and beautifully fragrant aroma for nectarines and peaches. Store unripe plums, nectarines and peaches in a paper bag until ripe. When ripe, peaches and nectarines can be stored at room temperature for use within a few days; plums can be kept fresh for up to five days in the refrigerator.

Tomatoes. Pick vividly colored, medium-firm tomatoes with smooth, shiny skin. To preserve the freshness and natural flavor of unripe tomatoes, Master Class recommends storing them on a countertop away from direct sunlight. They will last a week on countertops and up to two weeks if stored in the refrigerator.

Zucchini and Summer Squash. Look for smooth-skinned, small to medium size vegetables. Eating Well advises storing zucchini in the crisper drawer of your refrigerator, in either a plastic or paper bag with one end open to ensure good ventilation.

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Color Your World with Every Hue of Fruit and Vegetable

Eating Your Fruits and Veggies May Help Reduce the Risk of Chronic Disease

Fill your plate with a vibrant, colorful array of fruits and vegetables for a naturally delicious way to meet your daily requirement of vitamins, minerals and nutrients. Plant foods contain thousands of natural compounds called phytonutrients, which may have anti-inflammatory benefits that can help reduce the risk of chronic diseases. Every color has a contribution to make – aim for a few different ones each day, and enjoy the entire spectrum.

Red and pink:

These fruits and vegetables are an abundant source of the carotenoid lycopene, which may help balance free radical activity in the body, offering protection against prostate cancer and heart and lung disease. Additional picks: red onions, persimmons and raspberries.

  • beets
  • cherries
  • cranberries
  • pink grapefruit
  • pomegranates
  • radicchio
  • red radishes
  • red apples
  • red grapes
  • red peppers
  • red potatoes
  • rhubarbs
  • strawberries
  • tomatoes
  • watermelons

Orange and yellow:

Enjoy an extra boost of beta cryptoxanthin, which supports intracellular communication and may help prevent heart disease. Orange and yellow fruits and vegetables also contain vitamin C and carotenoids, including beta-carotene, which is associated with promoting healthy vision and cell growth. Additional picks: pomelos, turmeric root and star fruit.

  • acorn squash
  • butternut squash
  • apricots
  • cantaloupes
  • carrots
  • corn
  • grapefruit
  • lemons
  • mangoes
  • nectarines
  • oranges
  • orange peppers
  • papayas
  • peaches
  • pineapples
  • pumpkins
  • summer squash
  • sweet potatoes
  • tangerines
  • yams
  • yellow apples
  • yellow peppers
  • yellow squash

Green:

These are some of the healthiest fruits and vegetables, rich in chemicals like sulforaphane, isocyanate and indoles, which may inhibit the action of carcinogens. Dark green and leafy vegetables have the highest concentration of both antioxidants and fiber. They’re also packed with potassium, lutein, isothiocyanates, isoflavones and vitamin K, which can be important for vision, bone and blood health. Greens like kale have as much calcium as milk. Additional picks: Swiss chard, arugula, zucchini, edamame, alfalfa sprouts and green herbs (mint, rosemary, sage, thyme and basil).

  • artichokes
  • asparagus
  • avocados
  • bok choy
  • broccoli
  • Brussels sprouts
  • celery
  • collard greens
  • cucumbers
  • green beans
  • green cabbage
  • green grapes
  • green onions
  • green peppers
  • kale
  • kiwis
  • leeks
  • limes
  • mustard greens
  • okra
  • pears
  • peas
  • romaine lettuce
  • snow peas
  • spinach
  • sugar snap peas
  • watercress
  • zucchini

Blue and purple:

Anthocyanins – powerful antioxidants that may help delay cellular aging, block the formation of blood clots and boost urinary tract health – abound in these fruits and veggies. Additional picks: beetroot, radishes and purple cabbage.

  • blackberries
  • blueberries
  • black currants
  • dates
  • eggplants
  • grapes
  • plums
  • prunes
  • purple figs
  • raisins

White:

These foods may not be as brightly hued as the others, but they shine with valuable phytonutrients. These include the potentially anti-tumor properties of allicin and quercetin, found in garlic and onions; the healthy compound sulforaphane in the cruciferous cauliflower; and immune-supporting selenium in mushrooms. Additional picks: leeks, white beans (cannellini, navy beans, lima beans, soybeans), lychees, white peaches and daikon radish.

  • bananas
  • cauliflower
  • garlic
  • Jerusalem artichokes
  • mushrooms
  • onions
  • potatoes
  • parsnips
  • shallots

Sources: American Heart Association, Rush.edu, Harvard Health

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Healthier Eating

Fish skewers, baked potatoes, vegetables and yogurt greens sauce on dark background, top view

How to Pare Down Protein & Cut Back Carbs

Inspired by a belief that our diets can be redefined to integrate both healthier eatting and environmental responsibility , Menus of Change encourages a meaningful “flip” in the emphasis on animal proteins and highly processed carbohydrates to an emphasis on highly appealing alternatives.

Menus of Change, a collaboration of the Harvard T.H. Chan School of Public Health and the Culinary Institute of America (CIA), authors a creative approach to enjoying delicious, nutritional and sustainable foods: “The Protein Flip” and its companion, the
“Carbohydrate Flip.”

The Protein Flip, introduced in 2016, laid the groundwork for the Menus of Change health- oriented methodology, stating, “Higher intake of red meat, irrespective of its total fat content, increases risk of heart disease, stroke and diabetes when compared to poultry, fish, eggs, nuts, or legumes.”

The Menus of Change solution was to challenge chefs in every setting to place meat, poultry and seafood in a supporting role or as a side and make vegetables and plant proteins the stars – for example, burger blends composed of primarily mushrooms, other vegetables, grains or legumes; surf and turf reimagined as seafood with bountiful vegetables and only a bite or two of meat; use of tapas, mezze and other plant-forward small plate replacements for entrees. The public response was immensely gratifying, spurring further innovation and the mainstreaming of vegan options, such as lentil, barley and black bean burgers or wild rice polenta burgers made with mushrooms, carrots and leeks.

Building on their successful work with proteins, the collaborative is now developing a complementary program centered on advancing carbohydrate quality on the American plate. “From fluffy pancakes to soft hamburger buns, refined, fast-metabolizing carbohydrates are still found in many a diet and are contributing to the rise in diet-linked chronic conditions such as
diabetes and heart disease,” according to a recent Menus of Change summit panel discussion headed by Sarah Schutzberger, RD, CSO (certified in oncology nutrition). “In large part because of our food choices, scientists project that 75 percent of chronic diseases are attributable to diet and lifestyle.”

A substantial emphasis on whole, minimally processed carbohydrates can help change the trajectory, beginning with these flips described by the panel:

  • Take on the Three Pleasures challenge: Create a delicious dessert using dark chocolate, nuts, and fresh-cut or dried fruit. “Instead of forcing a choice between a whole slice of cheesecake with a single strawberry as garnish or a plain bowl of berries, enjoy a dessert made from a healthy market basket that includes dark chocolate, fruit, whole grains, nuts and yogurt,” advised Greg Drescher, Culinary Institute of America.
  • Look to world food cultures for inspiration:
    • Mediterranean region: “This type of cooking features a healthy fat versus a low fat approach to diet, with olive oil as the foundation of flavor,” said Drescher. Try tabouli, made of cracked bulgur wheat, chopped parsley and olive oil, or a salad made with hydrated, whole-grain barley rusks, topped with chopped tomatoes and fresh feta cheese and tossed with olive oil. Also important: improve the health profile of pasta by using a whole-grain type and cooking al dente to make it a source of slower-releasing carbohydrates.
    • France: The niçoise salad suggests ways to include potatoes in limited amounts by pairing with green beans and other vegetables, hard-boiled egg, and a light vinaigrette for a slow-metabolizing lunch.
    • Asia and India: Try a salad featuring soba noodles made from buckwheat flour; a Buddha bowl with foundational ingredients that include legumes, fresh vegetables and plant proteins, paired with small amounts of salmon or roasted tofu; and whole-grain flatbreads.

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The Art of Cooking Without Sugar

Picture of Lemon slices

A Chef’s Tasteful Look at Taking Sugar Off the Table

In part two of our series with professional chef Stan Hodes, he shares some artful substitutes, both natural and man-made, to sweeten up recipes without dipping into the sugar bowl.

“It’s almost impossible to eliminate sugar completely because it appears, sometimes stealthily, in just about all foods,” says Chef Stan, “but there are many alternatives available that won’t substantially raise your blood sugar level and leave you craving even more sweetness.”

Cutting back can produce a number of important benefits, as evidence links added sugar to poor oral health, obesity, diabetes, heart disease and cancer.

“Keep your primary goal in mind – reduced insulin levels, decreased caloric intake, weight loss or disease prevention – when considering substitutions and tailor accordingly,” he urges.

When Cooking, Chef Stan Recommends:

    • Minimize use of salt and you’ll bring out the natural sugars in your ingredients by at least half.
    • Focus on lower-sugar ingredients that coax out sweetness: dark chocolate, coconut or coconut oil, prunes and berries. Carrots and dates are terrific for sweetening stews.
    • Try robust spices that enhance sweetness: cinnamon (whole or powdered), fennel, star anise, licorice root, vanilla.
    • Make dehydrated fruit: Thinly slice fruit, cook in a convection oven at 160º to 180º for 2 to 4 hours, depending on the firmness and chewiness you prefer. Dehydrated fruit contains more calories than fresh fruit (because the sugar content becomes concentrated) so cut portion size in half.

Choose your Fruits Carefully

Some naturally contain substantially more fruit sugar, or fructose, making it best to limit: mangos (the highest), grapes, cherries, pears, pineapple, watermelon, dried figs, dates and bananas. Lower-sugar choices include: blackberries, cranberries, strawberries, grapefruit, starfruit, rhubarb, casaba melon, cantaloupe, papaya and guava.

Natural Sweeteners

Most natural sweeteners contain more nutrients and antioxidants than refined sugar, but beware, a calorie is still a calorie, and these contain approximately the same amount as sugar. Look for:

  • Date sugar, a powder made by pulverizing dried dates, is high in potassium.
  • Maple syrup, in its pure form, is one of the most natural forms of sugar, processed simply by boiling the sap of maple trees.
  • Honey, one of the oldest replacements for sugar around the world, made by bees from flower nectar and then mechanically filtered and strained. The complex range of flavors is ideal for baked goods and easily incorporated into desserts requiring a smooth texture such as custards and puddings.
  • Blackstrap molasses, made by boiling down sugar cane or sugar beet juice for a syrup-like consistency, is high in iron, potassium and calcium.
  • Organic coconut sugar, naturally processed from coconut palm sap, offers a rich brown sugar-like flavor, nutrients such as zinc and iron, and some inulin (fiber), but has a high fructose content.

Sugar Substitutes Offer Reduced or No-calorie Alternatives to Table Sugar:

  • Monk fruit, extracted from the Asian luo hang guo fruit, has been used for centuries in Chinese medicine. It contains no carbohydrates or calories, drawing its sweetness (up to 200 times sweeter than table sugar) from antioxidants called mogrosides.
  • Sugar alcohols such as xylitol and erythritol, processed from plant fibers like birch and cornhusks, have a sweetness similar to sugar. Most of it is not broken down by enzymes in the body, but excreted in urine. In large doses, these sweeteners can cause digestive issues such as gas and diarrhea in some people.
  • Stevia, made from the leaves of a South American shrub, has been considered by some as the most natural sugar substitute, but it is highly refined and often blended with additives.

Avoid completely:

  • Agave Syrup contains 75-90% fructose, which rapidly raises blood sugar levels.
  • High Fructose Corn Syrup contributes to diabetes, inflammation, high triglycerides and non-alcoholic fatty liver disease. It’s not typically used as an individual ingredient at home, but is commonly found in store-bought sauces, salad dressings and other condiments – check the labels before you buy.

Stan Hodes served as Executive Chef and Manager of Dining Services Operations at Baptist Hospital of Miami for 27 years, and worked as chef for the Marriott Hotels, Cancun’s Casa Magna Resort, and Royal Caribbean and Norwegian cruise lines. He was recognized by HealthLeaders Magazine as one of the top 20 Most Innovative Foodservice Executives in America.

The post The Art of Cooking Without Sugar appeared first on Specialdocs Consultants.

Cooking without Sodium or Sugar

Assortments of spices, white pepper, chili flakes, lemongrass, coriander and cumin seeds in jars on grey stone background. Copy space

Executive Chef Stan Hodes Shares Secrets of the Spice Rack

The benefits of reducing sodium and sugar in the diet are compelling, backed by well- documented studies. The flip side is an equally powerful human craving for enhanced flavor, compounded by years of exposure to products boosted with salt and sugar and the ongoing quest for umami (the fifth taste, defined by experts as the essence of deliciousness).

“Salt and sugar were once basic to preserving foods, and we’re predisposed to enjoy the sweet and the salty, the yin and the yang, such as salted caramel,” explains executive chef Stan Hodes, who has spent three decades bringing the “wow” factor to hospital and senior living meals with strict nutritional requirements. In this two-part series, he shares how to coax out natural flavors with no shakers of salt or spoonsful of sugar.

Hodes encourages a holistic approach to meeting recommended limits for calories, sodium, sugar and fat.

“All too frequently, reducing sodium in a particular product or recipe can mean amping up the sugar instead, so it’s best to consider the overall nutritional value rather than a single component,” he explains. “Then, be inspired by natural substitutes from other cultures that don’t use salt to create their remarkable flavor profiles with real punch from the very first bite, such as Cajun spice mixes or Indian garam masala (a coriander, cumin, cardamom, cloves, black pepper, cinnamon and nutmeg blend).”

Hodes’ spicy recommendations

Bagel seasoning. Low-sodium versions of this blend of poppy seeds, toasted sesame seeds, dried garlic, dehydrated onions and other spices provide a welcome bit of crunch and texture as well as flavor.

Black pepper, cayenne pepper or red pepper flakes. Eliminate the need for salt with a light dusting of these pungent peppers.

Cinnamon. A peppery and semi-sweet spice ideal for tomato sauces, curries and marinades. Hodes uses a potent mix of cinnamon and coffee as the closely held keys to flavor in his popular chili.

Citrus juices. Drizzle over cooked vegetables, tenderize meats and fish, and transform vinaigrettes with an acidic zing from the juice of a lemon, lime, orange, grapefruit or yuzu (a small Japanese citrus fruit). Additionally, try grating (zesting) the peel of a lemon and mix it into soups, marinades and beverages to bring out the flavors.

Coffee. A rich source of flavor sometimes found in Mexican moles, brewed coffee can be reduced by half in a saucepan and used in sauces, stews and gravies, or try a sprinkle of instant coffee instead.

Ginger. Chop and mix fresh ginger root into stir-fries, sauces, soups and beverages; this pungent and sweet spice is also known for its possible anti-inflammatory effects.

Infused oils. Place stalks of fresh garlic, rosemary and oregano, each in a separate bottle of olive oil, for freshly flavored dressings.

Mushrooms and beets. These naturally occurring sources of umami can easily be added to recipes for a burst of flavor: Dehydrate mushrooms by roasting until crisp and store them in a jar for future use; oven-roast beets, slice, and add to salads, soups or root vegetable platters.

Nutritional yeast. This deactivated yeast, available as flakes or powder, provides a cheesy, salty flavor without using either. Ideal on roasted vegetables or baked taco chips; when blended with carrots, potatoes, lemon juice, garlic and onion powder, “It tastes exactly like Velveeta cheese,” promises Hodes. Pour it over cooked elbow noodles for a lower-sodium, non-dairy mac ’n’ cheese.

Olives. Known for their salty taste and high sodium content, olives can be used more healthily if you soak the sodium out. Cut them in half, immerse overnight in a bowl of tap water and drain the next day.

Paprika. Warm up any recipe with fresh or smoked varieties of this vibrant red spice made from a variety of red peppers.

Sage. Strongly aromatic, with an earthy taste of citrus and pine, this herb can be used fresh or dried to flavor sauces, roasted vegetables and bean dishes.
Salsa. Store-bought salsas can bring too much sodium into the mix, so make your own fruit salsa with finely diced melons and a dash of orange juice as a colorful, phytonutrient-rich topping for grilled fish, chicken or salads.

Vinegars. Another way to use the power of acidity is with rice wine vinegars for seasoning; the sweetly sharp tang of balsamic vinegar to wake up dressings, stews and marinades; and the strong kick of apple cider vinegar.

Wines. Cook red or white wine until reduced by half, let it thicken and cool, and store in a squeeze bottle to use as a glaze for proteins.

Stan Hodes served as Executive Chef and Manager of Dining Services Operations at Baptist Hospital of Miami for 27 years, and worked as chef for the Marriott Hotels, Cancun’s Casa Magna Resort, and Royal Caribbean and Norwegian cruise lines. He was recognized by HealthLeaders magazine as one of the top 20 Most Innovative Foodservice Executives in America.

The post Cooking without Sodium or Sugar appeared first on Specialdocs Consultants.

Cooking without Sodium or Sugar

Assortments of spices, white pepper, chili flakes, lemongrass, coriander and cumin seeds in jars on grey stone background. Copy space

Executive Chef Stan Hodes Shares Secrets of the Spice Rack

The benefits of reducing sodium and sugar in the diet are compelling, backed by well- documented studies. The flip side is an equally powerful human craving for enhanced flavor, compounded by years of exposure to products boosted with salt and sugar and the ongoing quest for umami (the fifth taste, defined by experts as the essence of deliciousness).

“Salt and sugar were once basic to preserving foods, and we’re predisposed to enjoy the sweet and the salty, the yin and the yang, such as salted caramel,” explains executive chef Stan Hodes, who has spent three decades bringing the “wow” factor to hospital and senior living meals with strict nutritional requirements. In this two-part series, he shares how to coax out natural flavors with no shakers of salt or spoonsful of sugar.

Hodes encourages a holistic approach to meeting recommended limits for calories, sodium, sugar and fat.

“All too frequently, reducing sodium in a particular product or recipe can mean amping up the sugar instead, so it’s best to consider the overall nutritional value rather than a single component,” he explains. “Then, be inspired by natural substitutes from other cultures that don’t use salt to create their remarkable flavor profiles with real punch from the very first bite, such as Cajun spice mixes or Indian garam masala (a coriander, cumin, cardamom, cloves, black pepper, cinnamon and nutmeg blend).”

Hodes’ spicy recommendations

Bagel seasoning. Low-sodium versions of this blend of poppy seeds, toasted sesame seeds, dried garlic, dehydrated onions and other spices provide a welcome bit of crunch and texture as well as flavor.

Black pepper, cayenne pepper or red pepper flakes. Eliminate the need for salt with a light dusting of these pungent peppers.

Cinnamon. A peppery and semi-sweet spice ideal for tomato sauces, curries and marinades. Hodes uses a potent mix of cinnamon and coffee as the closely held keys to flavor in his popular chili.

Citrus juices. Drizzle over cooked vegetables, tenderize meats and fish, and transform vinaigrettes with an acidic zing from the juice of a lemon, lime, orange, grapefruit or yuzu (a small Japanese citrus fruit). Additionally, try grating (zesting) the peel of a lemon and mix it into soups, marinades and beverages to bring out the flavors.

Coffee. A rich source of flavor sometimes found in Mexican moles, brewed coffee can be reduced by half in a saucepan and used in sauces, stews and gravies, or try a sprinkle of instant coffee instead.

Ginger. Chop and mix fresh ginger root into stir-fries, sauces, soups and beverages; this pungent and sweet spice is also known for its possible anti-inflammatory effects.

Infused oils. Place stalks of fresh garlic, rosemary and oregano, each in a separate bottle of olive oil, for freshly flavored dressings.

Mushrooms and beets. These naturally occurring sources of umami can easily be added to recipes for a burst of flavor: Dehydrate mushrooms by roasting until crisp and store them in a jar for future use; oven-roast beets, slice, and add to salads, soups or root vegetable platters.

Nutritional yeast. This deactivated yeast, available as flakes or powder, provides a cheesy, salty flavor without using either. Ideal on roasted vegetables or baked taco chips; when blended with carrots, potatoes, lemon juice, garlic and onion powder, “It tastes exactly like Velveeta cheese,” promises Hodes. Pour it over cooked elbow noodles for a lower-sodium, non-dairy mac ’n’ cheese.

Olives. Known for their salty taste and high sodium content, olives can be used more healthily if you soak the sodium out. Cut them in half, immerse overnight in a bowl of tap water and drain the next day.

Paprika. Warm up any recipe with fresh or smoked varieties of this vibrant red spice made from a variety of red peppers.

Sage. Strongly aromatic, with an earthy taste of citrus and pine, this herb can be used fresh or dried to flavor sauces, roasted vegetables and bean dishes.
Salsa. Store-bought salsas can bring too much sodium into the mix, so make your own fruit salsa with finely diced melons and a dash of orange juice as a colorful, phytonutrient-rich topping for grilled fish, chicken or salads.

Vinegars. Another way to use the power of acidity is with rice wine vinegars for seasoning; the sweetly sharp tang of balsamic vinegar to wake up dressings, stews and marinades; and the strong kick of apple cider vinegar.

Wines. Cook red or white wine until reduced by half, let it thicken and cool, and store in a squeeze bottle to use as a glaze for proteins.

Stan Hodes served as Executive Chef and Manager of Dining Services Operations at Baptist Hospital of Miami for 27 years, and worked as chef for the Marriott Hotels, Cancun’s Casa Magna Resort, and Royal Caribbean and Norwegian cruise lines. He was recognized by HealthLeaders magazine as one of the top 20 Most Innovative Foodservice Executives in America.

The post Cooking without Sodium or Sugar appeared first on Specialdocs Consultants.

How Red Meat Went from Taboo to Acceptable and Back Again

What’s the Beef With Red Meat?

It’s long been the case that provocative headlines, unexpected findings and misinformation travel far faster than conventional wisdom, especially in the internet age. Even respected medical journals like the Annals of Internal Medicine can become caught in a crossfire of disagreement, as occurred last year when a controversial nutritional study by the NutriRECS Consortium concluded that three servings of red and/or processed meat weekly resulted in a very small increased risk of cancer or heart disease.

NutriRECS further suggested that the evidence surrounding potential harm from regular consumption of red meat was weak, and therefore people needn’t abstain from eating it for health reasons.

So misleading was the journal’s press release headline, “New guidelines: No need to reduce red or processed meat consumption for good health”, that the entire study was offered as a cautionary tale at the most recent Menus of Change conference, an influential initiative on plant-forward eating from the Harvard T.H. Chan School of Public Health and the Culinary Institute of America.

A panel headed by Walter Willett, MD, professor and past chairman of the department of nutrition at the Harvard School of Public Health, dissected why a message that flew in the face of decades of research and established guidelines from the American Heart Association and the World Cancer Research Fund, made its way into the mainstream.

According to Dr. Willett, the major flaw was the authors’ decision to disregard numerous studies done over the years regarding red meat and health as “weak evidence” because they weren’t based solely on randomized clinical trials. While these are the gold standard of scientific research, the reality for nutrition studies can be different.

“There are no double-blinded, placebo-controlled trials of red meat and its links to cardiovascular disease or cancer,” explained Dr. Willett. “It’s not really possible to get this kind of study because people won’t stay on specific diets for years to track and compare.”

The result was elimination of influential studies and meta-analyses clearly pointing to increased risk of disease for meat eaters. This included a pivotal 2015 Harvard School of Public Health study of more than 121,000 individuals followed for an average of 26 years that showed every daily serving of processed meat was associated with a 13% higher risk of death from all causes; processed red meat increased the risk to 20%. A 2019 meta-analysis in the Annals itself showed that reducing processed red meat by three servings per week decreased the incidence of diabetes by 22%; lowered mortality from cardiovascular disease by 10% and from cancer by 7%; and decreased overall mortality by 7%.

“These statistics alone could have been the basis for a blockbuster drug,” asserted Dr. Willett.

Additionally, as came to light after the study was published, the authors’ ties to food industry groups were not accurately disclosed. In January, the journal issued a correction detailing those connections, but the panel’s experts were concerned that the damage had been done, and the study’s misleading headlines had negatively affected public acceptance of traditional nutritional guidance.

“The global consensus remains unchanged: largely replacing red meat with plant protein sources and (optionally) modest amounts of fish, poultry and dairy foods will reduce the risk of coronary heart disease, diabetes and premature death,” said Dr. Willett.

Beyond the Burger: What’s Next in Plant-Based Alternatives

Also featured at Menus of Change was a look at the growing American appetite for alternative proteins. The trend, kick-started by the popularity of plant-based burgers, intensified during the pandemic as consumers sought what they perceived as healthier foods produced in safer, sterile environments. Note: plant-based items are not always nutritionally sound, so please check the labels carefully when these products become available.

Coming soon:

  • Plant-based ground meat, sausages, deli slices, chicken tenders, even cookie dough
  • Plant based seafood, including tuna, crab cakes, fish burgers, eel and shrimp
  • Egg substitutes and oat-based dairy products
  • Lamb substitutes using organic compounds to replicate the earthy taste
  • Cell-based seafood and cultured meats grown from the cells of fish and animals

“Plant proteins are becoming the growth story of the decade, on the cusp of replacing fish and seafood as the fourth-most-popular protein in America.”

— Zak Weston, The Good Food Institute

The post How Red Meat Went from Taboo to Acceptable and Back Again appeared first on Specialdocs Consultants.

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