writer: Dr

We eat too much salt. Simple but true. As a culture today, the developed world consumes a tremendous amount of sodium. It’s not just in the U.S., but the United Kingdom has had a campaign for about three years to convince people to reduce the amount of salt they consume. Most Asian diets are high in sodium as well, with almost every sauce, from soy sauce to fish sauce to hoisin, having added salt.

As a population it’s a major issue for policy makers to get folks to cut back from over 6000 milligrams (mg) (that’s 6 grams) of sodium per day (about 2 1/2 teaspoons of salt) to the more reasonable 2400 mg. Tough to do, because there’s so much salt in the processed foods that Americans eat. A report this week by the Council on Science and Public Health estimates that such a lowering of salt intake might save 150,000 lives each year.

That’s a lot of your friends, family and co-workers.

Step number one to making this difference in your life is to take the processed food out of your life. If you want Mac and Cheese, make Mac and Cheese. Cooking your own fresh food from scratch takes a little more time, but it tastes so much better and it’s so much better for you. If you’re used to frozen or packaged meals, snagging fast food for dinner, or eating on the run, start slowly by making just two meals per week at home. Beyond the meals on this website, there are so many recipes out there that anyone can cook easily.

Step number two is that when you do eat packaged or processed foods, pay attention to the salt. The sodium content is the one item on the Nutrition Facts label that isn’t confusing. There’s no high fat, low-carb, low-fat, Mediterranean, Atkins, South Beach or other “diet” to worry about. Simply eat less sodium and you’ll likely prolong your life. Your goal should be less than 3000 mg per day.

Step three: There is great research that shows that your salt taste buds do learn to want less. In effect, the more you saturate them the more you can’t taste how salty something is. For some this will mean working a bit harder. (Interestingly, if you’re making fresh food, adding salt at the table and not while cooking makes food taste saltier and research shows that you’ll use less.)

Lastly, keep in mind that that the 2,400 mg per day recommendation is about 1 teaspoon salt. Measure your salt when you do cook. It’s easy and a simple step to being healthier.

Here’s a listing of lower-sodium recipes on the web site.

The government created rules back in the 1980s for nutrition information labeling on packaged foods. Before the regulations were passed the only information required was a listing of the ingredients in the package. Other than that we were pretty much on our own and had to guess what might or might not be in any particular food.

Reading a food label can be a bit of a challenge because of all the different numbers one is faced with. While the percentage values are helpful, it’s best to use them only as a guideline. The key numbers are those that show the amount in grams, milligrams or micrograms of each nutrient.

For sodium the percentages listed on packages are based on a total daily intake of 2,000 milligrams (mg). This is a much lower sodium intake than most of us are eating today, with the average American consuming between 4,000 and 6,000 mg per day. There are estimates that place intake much higher — in the 10,000 mg per day range for western diets (that’s ten GRAMS of sodium).

Even though we have much better research on this now, it turns out that the guideline of 2,000 mg was a pretty good target. For those simply trying to eat healthier, the American Heart Association recommends 2,300 mg per day (this is about the amount in a teaspoon of salt). Most physicians have their patients with conditions such as Congestive Heart Failure (CHF) and hypertension eat less, however, with a target of 1,500 mg.

This may seem low but your taste buds can learn. In one study a group of people was placed on a low-sodium diet for five months. Their taste response to salt in solutions, soups and crackers were measured before and while they were following the diet. During the study period the same measurements were made in a control group that did not change their diet.

In the group that lowered their salt intake, the perceived intensity of salt in crackers increased. In addition, the amount of salt needed for “maximum pleasantness” of taste in soup and crackers fell in the experimental group but not in the control group.

Keeping the sodium levels above 300 mg for a main course dish is about the level that most people find “salty enough.”

The best way to approach reducing your sodium intake is to divide your day into meals with targets at breakfast and lunch under 500 mg sodium and dinner under 1,000 mg. Look at the Nutrition Facts on any package of food and add the total milligrams of sodium for the foods that you are eating.

Our recipes are labeled as “Low sodium” if a main course dish is under 500 mg sodium and side dishes or other meals are under 250 mg sodium. Here’s the listing of Low Sodium recipes.

Like all foods carbohydrates are actually good for you. Choosing what types of carbs and how many you eat is the key.

Carbohydrates are chains of basic sugar molecules called saccharides (SACK-a-rides). Single sugar molecules are known as monosaccharides while two sugars linked together are disaccharides. Such one and two sugar carbs are generally called simple sugars because they are easily broken down in the body into the monosaccharides.

The monosaccharide glucose is important because it’s the primary fuel for your body. All edible carbohydrates contain glucose. Combining the monosaccharides glucose and fructose results in the disaccharide called sucrose (good old fashioned table sugar). Granulated sugar is sucrose and is a highly refined product usually made from sugar cane or beets. You hear all the time that white sugar is bad for you and using “natural” sugars is healthier. This is silly. Sugar is sugar and your body digests it all in the same way.

When monosaccharides form chains longer than two they are called polysaccharides or complex carbohydrates (sometimes called starches or complex sugars). Starches as a rule contain at least some glucose.

Fiber is made up of long chain carbohydrates, but they’re not absorbed into the body like other carbs because humans don’t have the enzymes to break them down. As a result, foods that are higher in fiber are generally lower in calories.

When you look at the nutrition facts on food labels there is a line for carbohydrates. This is for all carbs – both simple and complex. The sugars line is for simple carbohydrates only. Notice that there’s a line for fiber. Both of these are O.K. for you but getting more fiber is really good for you.

So what does this mean in day to day terms? A good example is the difference between an apple and apple juice. The same weight of the juice and the apple contain about the same amount of calories and carbohydrate but there’s 5 grams of fiber in the apple and none in the juice. Both essentially carbohydrates and both good for you but the apple is better. More fiber, more satisfying — healthy.

Look at the carbs in the foods that you are choosing. Pick those that are higher in fiber and lower in sugars.

First and foremost, there’s no doubt of the tremendous health benefit in eating seafood. There are hundreds of studies clearly showing that consuming fish high in Omega 3 fats reduces the risk of sudden death, death from heart disease and stroke. In a meta-analysis of numerous studies published in the Journal of the American Medical Association (JAMA 2006; 296: 1885 – 1898) Drs. Mozaffarian and Rimm conclude that eating 1 – 2 servings each week reduces the risk of death from heart attack by 36% and reduces total mortality by 17%.

There is also evidence that consumption of fish or shellfish may prevent heart disease and progression of already established heart disease. Other studies have linked Omega 3 fats to prevention of certain types of cancers as well as heart rhythm problems. This research is not, however, as conclusive.

What about contaminants though? There is risk from heavy metals — mercury being the most important and the most common. The health effects of mercury poisoning are mostly neurologic and involve such symptoms as numbness, tingling, difficulty thinking, problems with sensation and even paralysis. And there is some question of whether long term exposure to mercury can effect the heart.

The other main contaminant risk in fish comes from PCBs and dioxins. These are chemicals that were the byproducts of many manufacturing processes in the middle of the last century. PCBs have been banned since 1977. While dioxin release into the environment is still going on the levels of contamination have dropped. Research on animals shows that both of these chemicals may cause some types of cancers. There seems to be less risk from these contaminants and there are often higher levels of PCBs and dioxins in beef, chicken, eggs, milk and pork than in fish.

Mozaffarian and Rimm (and others) feel that that when the risks from contaminants are compared to the advantages of eating fish the evidence clearly shows that the benefit of including fish in your diet far outweighs any risk. As with anything one wants to reduce the risk and here are the guidelines that they feel will help you best: (These are along the guidelines of most health organizations based on the research as we know it.)

• Eat 1 – 2 servings of fish per week.
• Women of childbearing age should avoid fish that may contain higher levels of mercury.
• Choose fish that are higher in mercury less often and make sure that you eat a variety of different fish.

Here’s a list of common fish with the amount Omega 3 fats as well as the mercury content in parts per million (ppm) for a 3.5-ounce serving. The CDC recommends avoiding fish with more than 1.0 ppm.

You can see that there are a lot of good healthy fish on this list with lower mercury content. It is clear from the research that the risk from contaminants is far less than the benefit from eating fish that is high in Omega 3 fats.

The take home message is to eat fish at least one or two times a week and eat a wide variety of fish and shellfish. The risk from “mercury and other stuff” is far outweighed by the benefit.

Shrimp is OK for you.

At the core of eating healthy is to eat less saturated fat and trans-fats, more fruit and vegetables, more legumes like beans, good fats like olive oil and nuts and more seafood. And shrimp does qualify as seafood.

Shrimp does have a more cholesterol than many other ingredients. While the amount of cholesterol that you eat is important, by eating lean meats, fish, veggies, legumes, fruits and nuts that are low in cholesterol, it’s OK to have shrimp or (gasp!) eggs. The more important factor is saturated fat and trans-fats.  While saturated fats are not evil and are part of a healthy diet trans-fats are not.

Let’s compare:

Notice that the shrimp and chicken breast have about the same number of calories and fat but the shrimp has far more Omega 3 fats. This is a trade off that’s more than worth it for only an extra 105 mg of cholesterol. The shrimp is far better than the ground beef, which has almost 5 grams of saturated fat (and again the shrimp has only about 100 mg more cholesterol).

The take-home message here is that eating healthy is about balance and the table above supports the research showing that eating lean red meat is OK about once a week. Eating foods that are lower in calories and saturated fat are equally important, and how much cholesterol you eat is less important. The bonus with the shrimp is the extra Omega 3 fats.

One key is how you cook your shrimp. Deep fried foods really aren’t all that healthy, and cooking the shrimp swimming in butter just adds saturated fat. The best way to eat shrimp and enjoy it is the good old fashioned Shrimp Cocktail. Try Barbecue Shrimp with Romano Grits (now that’s eating). Or even better, Linguine with Shrimp in Tomato Cream Vodka Sauce or Whole Wheat Linguine with Shrimp and Leeks.

There’s enough to focus on in eating healthy. The amount of cholesterol in any particular food is one that we now know is not as important.

Lactose, often called milk sugar, is a carbohydrate made up of two sugar molecules (glucose and galactose) bound together. The enzyme lactase is responsible for breaking the bond that holds the two sugar molecules together and is manufactured by cells that line the small intestine. There are a number reasons that people don’t have the ability to produce lactase (a discussion too extensive for this column). The most interesting fact is that a whopping 70% of the world’s population has some degree of primary lactase deficiency.

Ethnicity has a lot to do with this. For instance, northern Europeans have only about a 2% incidence of lactase deficiency while that number is in the 65% range for Hispanics, 70% for blacks and near 100% in Asians. Both Ashkenazi Jews and American Indians have a high proportion of their population who are lactose intolerant as well.

The most important issue centers around the concept of “dose dependence.” Put simply people will sometimes not have side effects to a medication or substance until they consume over a certain amount. The side effect is “dependent” on the “dose.”

Such a concept is emphasized by the Guidance Statement in this month’s journal Pediatrics (2006;118:1279-1286). In an excellent review of lactose intolerance in infants, children and adolescents, Dr. Melvin Heyman notes that ‘the amount of lactose that will cause symptoms varies from individual to individual, depending on the amount of lactose consumed, the degree of lactase deficiency and the form of the food substance in which the lactose in ingested.’

This is true for children and adults who have trouble with eating foods that contain lactose. Some can have 1/2 cup of milk on their cereal and not have problems but will experience symptoms if they drink a full glass of milk. Others will have problems with as little as two tablespoons. Many people who cannot tolerate fresh milk can eat milk that has been cultured’like sour cream, yogurt and cheese’but, again, there are those who have problems with even these.

There’s no specific level where this might cause issues. The list below is a guide to the amount of lactose in common dairy products:

Looking at the amount of sugars on a package can help you as well. Since lactose is considered a sugar if there is no or very little sugar in a product it will likely have little lactose. Goat cheese, for instance, has only 1/3 gram of sugar in an ounce and is generally well tolerated by many with lactose intolerance.

The recipes on the web site have been sorted into three categories: Lactose Free, Cheese-Containing Recipes and Borderline Recipes. The Borderline category has dishes that have some milk but may not be a problem because there’s little milk or dairy products used. Some people may be able to tolerate these and others not. Even so, for most people with lactose intolerance, trial and error is the only way to know for sure just how much dairy will cause a problem.

For those who are very sensitive, hidden lactose can be a major problem. Often lactose is added to manufactured foods and those with very low tolerance for lactose should be aware of this. These foods can include:

• breads and other baked goods
• breakfast cereals
• instant potatoes
• instant soups
• instant breakfast drinks
• margarine and spreads
• lunch meats (other than kosher)
• bottled salad dressings
• packet salad dressing mixes
• many candies
• snack foods such as chips and crackers
• pancake mixes
• biscuits mixes
• cookie mixes
• powdered meal-replacement supplements

Many products that are labeled non-dairy can be made with ingredients that are derived from milk products and will sometimes contain lactose. These include:

• powdered coffee creamer
• whipped toppings
• puddings
• pudding mixes

Eating healthy is about knowing what is in the foods you are consuming. It is always best to make fresh whole foods but if you are going to use prepared foods read the label carefully. Ingredients other than milk can be an indication that something contains lactose. Generally such products affect only those with the most severe lactose intolerance. Look for words like:

• whey
• curds
• milk by-products
• dry milk solids
• non-fat dry milk powder.

Interestingly, about 20% of prescription and 6% over the counter medications contain lactose. This includes many types of birth control pills as well as tablets for indigestion, stomach acid and gas.

We know that fiber can help prevent some cancers, reduce your cholesterol, help you avoid problems with heart disease and help diabetics control their blood sugar. Almost every week there is another positive study on how great high fiber foods are for you health. While there’s no magical dietary cure eating foods that are higher in fiber is pretty close and is one of the easiest changes that you make in your diet.

Fiber is what your grandma used to call roughage. It’s not one particular food but the part of plant foods that your body can’t digest. Fibers are technically carbohydrates but your body doesn’t have the enzymes to break them down. As a result, they’re not absorbed and essentially have no calories.

Most of us need to increase the amount of fiber in our diet. The average American gets only 10 – 15 grams of fiber per day. 25 – 30 grams per day is optimum.

There are two types of fiber – soluble and insoluble:

• Soluble fiber is often called a “sticky” fiber and is the one that is more effective in lowering cholesterol. It is found in dried beans and grains, such as oat bran, oatmeal and rye. Almost all fruits, such as apples, grapes, peaches, oranges and pears are high in soluble fiber (think sticky fruits). Most vegetables are high in soluble fiber as well.
• Insoluble fibers are found in whole grain products, such as whole wheat flour, breads and pastas. Cereal grains like rice, wild rice and seeds are high in insoluble fiber.

Here are some simple ways to make those changes. The best part is that it is very easy.

• For breakfast, whole grain cereals like Shredded Wheat, bran flakes and oatmeal are great choices. Take a few moments to look at the box to compare the amounts of fiber in these cereals with the one you are eating. Look carefully because many cereals will have higher fiber but will sometimes have a lot of sugar as well.
• If you like toast for breakfast, choose breads with higher fiber. Most bread will have only about two grams but it’s easy to find choices with 5 grams or more per slice. Even if the label says “whole wheat” you may find that it doesn’t have that much fiber. Check the label. Use the same high fiber breads for your sandwiches at lunch.
• Simply substituting ingredients in your favorite dinner recipes can help you get more fiber. Use whole wheat pastas, brown rice and wild rice. Replace potatoes with sweet potatoes or yams. Choose recipes that contain beans and other legumes like lentils and split peas.
• Snacking on fruit is a great choice for getting more fiber. Fruits that are good high fiber choices are.

Here’s a few recipes to get you started:

Chickpea Salad

Lemon Pork with Lentils

Roasted Yams

Here are some links to recent research on fiber:

Eating Whole Grains May Help Prevent Age-Related Weight Gain

Sex, Fiber, and Cancer

More on eating an apple a day…

It’s never too late to reduce your risk of heart disease

Want to avoid gaining weight? Get more fiber!

Bean there, done that!

Here’s a handy table to help guide you.

Here is a quick list for you to get started eating healthy.

1. Take half of your restaurant meal home with you. Because the portions in restaurants are so large, and you likely need only half of what you have been served, put the other half into the doggie bag. Hmm… that leads us to number two:

2. When you eat out, ask for a doggie bag right away. Order whatever you wish, but again, take half home with you. By putting what you are not going to eat in a doggie bag first then you can eat everything that remains on the plate. And that leads us to number three:

3. Make your lunch before work or maybe even the night before (or eat the leftover from your doggie bag). When you are cooking dinner plan to use the extra rather than eating everything you’ve made. For instance, you can double a recipe that makes two servings and have four 1/2 servings for the next two day’s lunches for yourself and your mate. You will save time because not only is fast food not any good for you, it’s not really all that fast any more.

And eating lunch out is expensive. If you spend $6.00 on lunch at the fast food joint (instead of the $1.00 or so making your own) that’s $25.00 per week. You’ll save $1,250.00 per year on lunch alone! That’s enough for your gym membership with money left over for a trip to the islands and a week of R&R.

4. Embrace food. Ask yourself every day, “What’s for dinner tonight?” Think about what you really want to eat rather than eating whatever is in the house. Find a simple recipe, make a shopping list, and get the ingredients. Consider the meal that you are going to cook and make sure that is something that you love.

After you have the hang of this, begin planning further in advance. Go grocery shopping for the week on Saturday and purchase the ingredients that you need to make your favorite recipes during the week (see Number 3).

5. Always have snacks in the fridge that you like to eat. The best things to snack on are fresh veggies and fruit. Plus, if you have something in the house that you can eat as much of as you want, you won’t snack on what you were planning to use for dinner.

Make a list of fruit you do like.  You might be amazed how many you not only like, but love. Keep celery, cauliflower, broccoli, carrots and radishes on hand. Fruits that are great to cut up and eat, like apples, pears and melon work well too.

6. Read everything that you can. Read recipes in magazines and online. Look at the ingredients and then check the nutrition facts to see how many calories are in that meal. Don’t make a dish if there’s no nutrition information available with the recipe.

Look at every package of food or ingredient that you purchase and read the Nutrition Facts label. Over time you will learn what is in the food you are eating.

7. It’s not a diet. Make changes in how and what you eat (see Number 4 about embracing food).

By trying silly fad diets over and over, most people just end up not liking what they eat. There’s been dozens of research studies to show that this sort of dieting doesn’t work, including a recent research article out of Scandinavia that proves this once again.

Don’t diet — eat great healthy food.

8. A little chocolate goes a long way (and so does an apple). In a recent study women were studied after snacking on chocolate, an apple or nothing. Both the chocolate and the apple helped reduce huger and elevated mood. While the effects of the chocolate lasted longer than the apple, some did feel guilt when eating the chocolate (some also experienced a joy that they did not with the apple).

Planning to have snacks when you want them is an important part of eating healthy. Choose great quality chocolate and have it occasionally–and at other times eat the apple. It’s clear that both are satisfying. The key is to eat small snacks and to eat them when you feel good.

9. Eat nuts. Like apples, nuts make fantastic snacks. Many studies have shown that snacking on nuts is good for your cholesterol and other blood markers associated with heart disease. The majority of the research shows that when you eat nuts in place of other snacks, you won’t gain weight and you’ll be very satisfied.

10. Eat breakfast. Simple as that. There’s great research that has shown that eating a healthy breakfast with a complex carbohydrate like whole wheat bread or whole grain cereal, along with a protein like an egg or milk, helps you to lose weight and maintain what you have lost.

Add one of these tips to your life each week and ten weeks later you’ll be eating healthier without even having to think about it.

Portion size is the single most important key to eating healthy.

You read every day that there has been a dramatic increase in the size of portions. Everything from fast food to candy has been “supersized” in the last 30 years. The good news is that there are also a lot of great ingredients that have been produced with less fat and fewer calories. By using those foods and combining them with the right portion size it’s easy to eat healthy. There’s great research that shows you can do this and not go hungry.

Here are five simple steps to help you with portions:

1. Use a scale and weigh everything you eat for at least a month. By doing this you will get used to how large a 4 ounce portion of beef, chicken or fish is. Weighing pasta or potatoes is the best way to eat “low carb” and still eat carbs. (Carbohydrates are good for you but too much of a good thing is just that — too much.)

2. Use measuring cups and spoons. While this may seem a repeat of number one, there’s a whole lot of ingredients that can add unnecessary calories to your dish.

A teaspoon of any fat, whether it is olive oil or butter, has about 45 calories, for instance. A teaspoon of salt has about 2300 mg of sodium. While you see many TV chefs slosh ingredients into their pans with abandon, most of the fat and salt that goes in is not needed for great tasting food. By measuring accurately, the right amount of the right ingredient goes into your dish.

3. Know what a real portion is. Here’s a short list.

4. Read every nutrition label.  This is the easiest way to get to know normal portion sizes. By looking at the labels of every product you buy you quickly learn what is in the foods that you are eating. Start with the portion size reported in the Nutrition Facts box. How big is it? How many portions are in the package?

Next is calories. How many calories are in each portion? Check other basics like fats and sodium as well.

5. Don’t cook a recipe if it doesn’t report nutrition information. By using recipes that tell you what is in the final dish, combined with reading nutrition labels, you will quickly learn what is in the food you are eating. By taking a few extra minutes to get an idea of what is in your food, you’ll know what is a good portion size for you. This is especially helpful when you go out to eat.

The real key to portion sizes is to pay attention. Using these five simple guidelines helps you to focus on what’s going into your meals. It’s easy to both eat great food and eat healthy.