Step Up to the Plate: Nutritionists Weigh in on Healthy Eating

Picturing a healthy meal has never been more accessible, thanks to the ubiquity of visual aids such as MyPlate, successor to the well-known Food Pyramid of the ‘90s. A quick scan of the plate’s
quadrants enables users to see at a glance proportions of vegetables, proteins and other foods recommended for a nutritionally balanced day of eating. Hailed as a significant breakthrough when
it debuted in 2010, for many dietitians and health experts, MyPlate did not go far enough in revamping the American diet. For instance, Harvard’s Healthy Eating Plate limited red meats but not healthy oils, while the American Institute of Cancer Research’s New American Plate relied even more heavily on vegetables and fruits, accounting for fully two thirds of the plate. The most recent federal guidelines, just issued for 2015-2020, now emphasize shifts needed to choose nutrient-dense foods and beverages in place of less healthy options, and the interconnected relationships between each dietary component. Illustrated at right are what a healthy, and even healthier meal, can look like at your table this year.

MyPlate breaks it down:

• A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
• Fruits, especially whole fruits
• Grains, at least half of which are whole grains
• Fat-free or low-fat dairy, including milk, yogurt, cheese and/or fortified soy beverages
• A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds and soy products
• Oils
• Limited saturated fats and trans fats, added sugars and sodium (less than 2,300 milligrams per day)
• Alcohol in moderation, up to one drink per day for women and up to two drinks per day for men
• Physical activity: Weekly, strive for 150 minutes of moderate intensity activity (brisk walking) and 75 minutes of vigorous intensity aerobic activity (swimming laps)

The American Institute of Cancer Research (AICR) offers a portion-controlled diet based on fruits, vegetables, whole grains and other plant-based foods that provide an array of cancer-protective compounds while serving as powerful weight-management tool. According to the AICR, the fiber and water in plant foods gives a feeling of satiety with a minimum of calories. Their main message: maintaining a healthy weight is one of the most important steps you can take to reduce your risk of cancer.

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Got Milk? Or Calcium Supplements? Or Neither?

Calcium, so essential to strong bones and teeth, as well as nerve transmission, muscle contraction and blood clotting, can be in short supply as we age. Exactly how much is needed of this important mineral, and Vitamin D, its companion to ensure optimal absorption, has been the subject of intense scrutiny over several decades. However, a clear cut consensus has yet to be reached from data that is by turns contradictory, reassuring or confusing. A cluster of respected studies have cast doubt on the efficacy of calcium – either in supplements or from dietary sources – in reducing the risk of osteoporosis or bone fractures. Some reports cast supplements in an even more negative light, pointing to potential side effects that range from gastrointestinal issues to increased risk of cardiovascular disease.

A quick look at research highlights, beginning with the study that arguably set the stage for use of calcium supplements in seniors, illustrates why there is still a considerable amount of debate:

• 1992: Over 18 months, a trial of elderly French women finds the number of fractures was reduced by up to 43 percent among women treated with 1200 mg of calcium and 800 units of vitamin D daily. In subsequent years, the significant levels of vitamin D deficiency of the subjects in this study created uncertainty about applying the results to healthier adults.
• 1994: Guidelines vary. National Institutes of Health recommends 1500 mg of calcium and 600-800 units of vitamin D per day for post-menopausal women; Institute of Medicine recommends 1200 mg of calcium and 400-600 units of vitamin D daily for those over 50.
• 2006: Fracture risk not reduced. A report from the Women’s Health Initiative showed that 18,000 postmenopausal women who took calcium supplements and vitamin D were no less likely to break their hips than an equal number who took a placebo pill, although the density of their hip bones increased slightly.
• 2010: Mixed results on heart issues. A report from the Women’s Health Initiative showed no significant increase in heart problems among 36,000 women who were taking calcium supplements. However a study in the British Medical Journal (BMJ) reported they were associated with an increased risk of heart attack, concluding that “a reassessment of the role of calcium supplements in the management of osteoporosis is warranted.”
• 2012: No-supplement recommendation. The U.S. Preventive Services Task Force, a panel that advises doctors on matters of public health, stated there is not enough conclusive evidence to recommend taking calcium or vitamin D supplements to prevent fractures in healthy women.
• 2015: The case against supplements builds. According to a meta-analysis in the BMJ, additional calcium from supplements may build up in the arteries or kidneys, causing heart disease or kidney stone formation. An accompanying editorial reads: “The weight of evidence against such mass medication of older people is now compelling.”

Confusing, to be sure. While the optimal dose has yet to be determined, today’s best guidelines call for calcium intake below 1,600 mg a day for women over 50 and men over 70, and 1,000 mg a day of calcium for those under 50, along with appropriate amounts of vitamin D to enhance absorption. However, experts agree, more is not necessarily better, and supplements should be considered only if the daily goal cannot be met through food sources. In addition, strength training, for arms and upper spine, and weight-bearing exercise such as walking or stair climbing, for legs, hips and lower spine, are essential to build and maintain bone density. Remember: every patient has different needs, and these can change over time.

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Salt Shake Down: Sodium Reduction is on the Table

Turkey sandwiches…soups…deli meats. Are these the building blocks of a healthy meal or stealthy contributors of excess sodium? Both, according to experts, but improved versions are in the works, thanks to June 2016 Food and Drug Administration (FDA) recommended guidelines and commitments from food manufacturers and restaurant operators to shake down the salt.

Implicated in a litany of ills from increased risk of heart disease and stroke to higher blood pressure, sodium is one of today’s major targets for elimination in the quest for a healthy diet. According to the Institute of Medicine, reducing sodium intake to 2,300 mg daily can significantly reduce blood pressure, ultimately preventing hundreds of thousands of premature illnesses and deaths. Currently, Americans consume on average, about 3,400 mg a day (a teaspoon and a half), most of it involuntarily.

“While a majority of Americans reports watching or trying to reduce added salt in their diets, the deck has been stacked against them,” the FDA stated. “The majority of sodium intake comes from processed and prepared foods, not the saltshaker.”

The guidelines set targets for reducing sodium over the next decade in the majority of processed and prepared foods, including pizza, deli meats, canned soup, snacks, breads and rolls. Already Nestle has reduced the salt in its pizzas, General Mills reduced sodium in more than 350 products, and Mars Food, Unilever and PepsiCo have pledged to follow suit.

Experts at the Harvard School of Public Health and the American Heart Association urge even further downward pressure on sodium in the diet, recommending a limit of 1,500 mg per day. Dr. Frank Sacks, the Principal Investigator in the groundbreaking Dietary Approaches to Stop Hypertension (DASH) Sodium-Trial, concurs, saying the effect of sodium intake on blood pressure is strong and causal, and called the new guidelines “a tremendous step forward to lower heart attacks and strokes in the US.”

Start shrinking the sodium in your diet with these simple, tasty strategies:

• • Plant-based foods such as carrots, spinach, apples, and peaches, are naturally salt-free.
  • Add sun-dried tomatoes, dried mushrooms, cranberries, cherries, and other dried fruits to salads and foods for bursts of flavor.
  • Enhance soups with a splash of lemon and other citrus fruits, or wine; use as a marinade for chicken and other meats.
  • Avoid onion or garlic salt; instead use fresh garlic and onion, or onion and garlic powder.
  • Try vinegars (white and red wine, rice wine, balsamic). Maximize flavor by adding at the end of cooking time.
  • For heat and spice, try dry mustard, fresh chopped hot peppers and paprika.

On vegetables:

• • Carrots – Cinnamon, cloves, dill, ginger, marjoram, nutmeg, rosemary, sage
  • Corn – Cumin, curry powder, paprika, parsley
  • Green beans – Dill, lemon juice, marjoram, oregano, tarragon, thyme
  • Tomatoes – Basil, bay leaf, dill, onion, oregano, parsley, pepper

On meats:

• Fish – Curry powder, dill, dry mustard, lemon juice, lemongrass, paprika, pepper, saffron
• Chicken – Poultry seasoning, rosemary, sage, tamarind, tarragon, thyme
• Pork – Cilantro, garlic, onion, sage, pepper, oregano
• Beef – Marjoram, nutmeg, paprika, sage, thyme

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