INSIDE Consumer Education: Food News You Can Use 19 Recipes: 20 Handout: 21 Handout: 22 For Professionals: Educators: 23 Dr. Jay: 24 Supplement: Online Password Past Issue Highlights Poster Coupon PAST ISSUES: • Mar 08 - 3 Week Plan • Mar 07 - Fat • Mar 06 - Salad A high salt intake is known to be the primary cause of the rise in blood pressure in age seen in nearly everyone who lives in societies where large amounts of salt are added to the food. Data from the DASH trials have led some to believe that a Mediterranean-style diet may be helpful for the treatment and prevention of hypertension even if salt intake is not limited. However, it is well known that blood pres- sure rises with age in all Mediterranean countries just as it does in the United States and Asian countries. Over 90% of these populations devel- op hypertension sooner or later. Indeed, a recent study in Spain showed that adherence to a more Mediterranean-style diet does not prevent the de- velopment of hyperten- sion. 1 The lower saturated fat and higher potassi- um, calcium and magne- sium content of the DASH diet and a more Mediterranean-style diet may mitigate some of the damage to the car- diovascular system over time and possibly slow the development of hy- pertension and cardio- vascular disease and re- duce the risk of cardiovascular events. However, as the DASH Sodium Trial showed, reducing salt intake from about 3,400 to 1,500 mg of sodium per day makes all the differ- ence. In addition to re- ducing saturated fat and increasing whole grains, beans, fruits, vegetables, and low-fat dairy prod- ucts, the reduction in salt lowered blood pres- sure more than double the reduction from diet alone in just over 8 weeks. MARCH 2009 Continued on page 18 Dietary Salt Reduces Blood Flow There are so many reasons to cut salt intake, even if you don’t have high blood pressure yet and now there is one more. Too much salt inhibits the flow of blood in the arteries and artery function.
Transcript
I N S I D E
Consumer Education:Food News You Can Use
19
Recipes: 20
Handout: 21
Handout: 22
For Professionals:
Educators: 23
Dr. Jay: 24
Supplement:
Online PasswordPast Issue Highlights
Poster Coupon
PA S T I S S U E S :
• Mar 08 - 3 Week Plan• Mar 07 - Fat• Mar 06 - Salad
A high salt intake isknown to be the primarycause of the rise inblood pressure in ageseen in nearly everyonewho lives in societieswhere large amounts ofsalt are added to thefood. Data from theDASH trials have ledsome to believe that aMediterranean-style dietmay be helpful for thetreatment and preventionof hypertension even ifsalt intake is not limited.However, it is wellknown that blood pres-sure rises with age in allMediterranean countriesjust as it does in theUnited States and Asiancountries. Over 90% ofthese populations devel-op hypertension sooneror later. Indeed, a recentstudy in Spain showedthat adherence to a moreMediterranean-style dietdoes not prevent the de-velopment of hyperten-sion.1
The lower saturatedfat and higher potassi-um, calcium and magne-sium content of theDASH diet and a moreMediterranean-style dietmay mitigate some ofthe damage to the car-diovascular system overtime and possibly slowthe development of hy-pertension and cardio-vascular disease and re-duce the risk ofcardiovascular events.However, as the DASHSodium Trial showed,reducing salt intakefrom about 3,400 to1,500 mg of sodium perday makes all the differ-ence. In addition to re-ducing saturated fat andincreasing whole grains,beans, fruits, vegetables,and low-fat dairy prod-ucts, the reduction insalt lowered blood pres-sure more than doublethe reduction from dietalone in just over 8weeks.
M A R C H 2 0 0 9Continued on page 18
Dietary Salt Reduces Blood FlowThere are so many
reasons to cut salt
intake, even if you
don’t have high blood
pressure yet and now
there is one more. Too
much salt inhibits the
flow of blood in the
arteries and artery
function.
18 Communicat ing Food for Health M A R C H 2 0 0 9
A recent observationalstudy looked at the riskof stroke and heart dis-ease in over two thou-sand participants 30-52years of age followed for1.5 to 3 years. Theamount of sodium andpotassium in their urinewas measured severaltimes during this periodand researchers found asignificant increased riskof stroke and heart at-tacks developing in thosewith a higher ration ofsodium to potassium intheir urine.2
The adverse effects ofexcess salt on the cardio-vascular system are notlimited to its effects onblood pressure. A recentstudy by Australian re-
searchers examined theimpact of feeding agroup of 29 overweightand obese subjects a typi-cal Western diet or a dietwith less salt but thesame amount of saturatedfat and potassium for twoweeks. Urinary sodiumwas measured to deter-mine compliance withthe two diets. On the nor-mal high-salt diet, sodi-um excretion was about3,600 mg per day com-pared to only about1,500mg per day on thelow-salt diet. The sub-jects had normal bloodpressure and all followedboth diets for two weeksin a crossover design.
The researchers as-sessed flow-mediated di-lation (FMD) of the
brachial artery on thehigh and low salt diets.Impaired FMD is gener-ally due to dysfunctionof the endothelial cellsthat line the arteries andis believed to be in-volved in the pathologyof cardiovascular disease.The results of this studyshowed FMD was re-duced by 45% on thehigh-salt diet comparedto the low-salt diet.3 Im-portantly, this studyfound that the impairedFMD caused by in-creased salt intake wasindependent of its effectson blood pressure.
The authors conclude“These findings suggestadditional cardioprotec-tive effects of salt reduc-tion beyond blood
pressure reduction.”
Bottom Line: Excessive salt intake
appears to interfere withnormal artery functionand impair blood flowlong before it leads to thedevelopment of hyper-tension. Clearly waitingfor the development ofhypertension before re-stricting salt intake is illadvised.
By James J. Kenney,PhD, RD, FACN
References:1. Am J Clin Epidemi-
ol 2009;169:339-462. Arch Intern Med
2009;169:32-403. Am J Clin Nutr
2009;89:485-90
Continued from front page
Summary of Research on Salt Intake:• Blood pressure rises with age in all populations who add as much or more
salt to their food as is typical in the USA.• In populations where as much salt is added to foods as in the USA over 90%
of the population will develop hypertension at one point in their lives. un-less they take measures to consume less than 1500 mg of sodium per day.
• Increased blood pressure is the #1 risk factor for stroke, heart and kid-ney failure and a major risk factor for heart attacks as well.
• The Sodium-DASH trial showed that if you lower your sodium intake to1,500 mg per day you will more than double the decrease in blood pressureversus just following the DASH diet by itself.
• Excess salt intake interferes with normal artery function and impairsblood flow even if blood pressure is within the normal range.
• Added dietary salt increases the loss of calcium in the urine promoting kidney stones and osteo-porosis.
• Salty foods promote reflux espohagitis and atrophic gastritis, which can lead to a marked in-creased risk of espohageal and stomach cancer, respectively.
For more information on salt toxicity, visit http://www.foodandhealth.com/continuinged.php and clickon the link under Diet and Heart Disease, “Diet, Hypertension and Salt Toxicity.”
Denny’s LowersSodium by 25% in aFew Items
We were delighted toread that Denny’s wasdoing something tolower the sodium by25% in some of theirfoods. But a little inves-tigation online withtheir nutritional analy-sis shows that theyhave a long way to go.
All items on thebreakfast menu, withthe exception of 2 plaineggs, are upwards of1,300 mg of sodiumwith some going ashigh as 3,180! Ofcourse if you use thebreakfast sides menuyou can do okay withan order of 2 Egg Beat-ers and 1 piece of drytoast. Other meals:
- Sandwiches: 770 to3880
- Entrees: 600 to2580 mg
So, what exactly isgetting lowered? Thehash browns will belowered by 25%; thecheese sauce by 25%and the shrimp skewersby 20%. Children’smenus will change outhigh-sodium items formore fruits and vegeta-bles. These changeswill take place summerof 2009 and we believethey are a good start
but not nearly enoughto make the items lowin sodium. For more in-formation visit online atdennys.com.
Survey shows con-sumers do let caloriecounts influencetheir decisions
Technomic foundthat 86 percent of NewYork City restaurant-goers were surprised bythe calorie count infor-mation now listed onmenus or menu boards,with 90 percent of themclaiming that the calo-rie count was higherthan expected. As aconsequence, 82 per-cent say that caloriedisclosure is affectingwhat they order and 60percent say it is affect-ing where they visit.FMI visittechnomic.com
We were pleased tofind that other states arerequiring nutrition re-porting including: Cali-fornia, Maryland, Penn-sylvanie, Indiana,Florida, South Carolina,Seattle, and West Vir-ginia.
Oatmeal $1Jamba juice is offeringoatmeal for one dollarvia their site oatmealforabuck.com
FDA conducts re-search on claims
The FDA completeda study of consumer re-action to foods with alowcarbohydrate claim.
Their analysisshowed that without theNutrition Facts labelavailable, respondentswho saw claims thatimply "low in carbohy-drate" on the front offood packages hadsome positive associa-tions with these prod-ucts that may or maynot be accurate.
When the NutritionFacts label was avail-able side-by side withthe front panel, respon-dents made appropriateproduct judgmentswhen evaluating prod-ucts with claims thatimply either fewer ormore carbohydrates.You can read the fullresults here: fda.gov.
Funny NamesYounger kids who
are picky about eating
fruits and vegetablesmay eat more if yougive them funny names.This is what researchersfrom Cornell Universityfound out in a studythat was presented tothe School NutritionAssociation and fundedby the Robert WoodJohnson Foundation.The funny names in-cluded X-Ray VisionCarrots, Power Peas,Dinosaur BroccoliTrees and TomatoBursts. Although thestudy was conducted onpreschoolers, re-searchers believe thiswould also work witholder kids, too. Andsome restaurants havefound this to be thecase with more catchynames for menu items.The study author wasBrian Wansink and heis the author of "Mind-less Eating: Why WeEat More Than We EatMore Than We Think."FMI see schoolnutrition.org
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Preheat oven to 350 degrees.Arrange chicken tenderloins in ashallow baking pan and top withfresh lime juice and black pepperto taste. Cook until chicken is nolonger pink in center, about 20minutes. Remove from oven.
Meanwhile, make Tabboulehsalad: Toss cooked bulgur withdiced tomato, parsley, lemonjuice, garlic and oil.
Serve the bulgur on top of thefresh lettuce, 1 cup per personand serve with the baked chick-en.
Serves 4: Each serving (about2 cups): 280 calories, 4.5 g fat, 1g saturated fat, 72 mg choles-terol, 75 mg sodium, 29 g carbo-hydrate, 6 g fiber, 30 g protein.
Salmon with Peach Jellyand Ginger, Steamed GreenBeans, Brown Rice
3 cups cooked brown rice (1 cup rice, 2 cups water)
4 3-ounce fillets of salmon2 tablespoons peach or apricot
preserves1 tablespoon grated ginger1 pound green beans
Start the rice cooking accord-ing to package directions. Pre-heat the oven to 350 degrees.
Place defrosted fillets ofsalmon in a flat baking dish witha little water. Place ginger andpreserves on the top and bakeuntil the fish is no longer raw inthe center, about 20 minutes. Re-move from the oven.
Steam the green beans in themicrowave by putting in a cov-ered microwave-safe container.Cook on high for 3 minutes oruntil tender.
Serve the fish hot with therice, the beans and the rice. Op-tional: serve a salad to the side.
Serves 4. Each 2-1/2 cup serv-ing: 382 calories, 11 g fat, 2 gsaturated fat, 50 mg cholesterol,62 mg sodium, 49 g carbohy-drate, 6 g fiber, 23 g protein.
20 Communicat ing Food for Health M A R C H 2 0 0 9
Budget Whole MealIdeas OnlineWe now have a budgetcooking section in ourblog. Go towww.foodandhealth.comand under “free re-sources” at the top clickon Food Blog. In the“topics” drop-down boxyou can select budgetcooking.Here is the best idea:- 1 cooked whole chick-en, 6 different meals.Cook a whole chicken inthe crock pot or theoven. Pick the meat off;use the bones to make abroth for soup; and cookand discard skin andgrizzle. Freeze the meatin 1 cup bags for the fol-lowing 6 meals: stir-fry,burrito, chicken chili,chicken pasta, chickensoup and chicken withrice.
Whole DinnerIdeas
Receive more recipes,photographs and
cooking tips from ourblog at
foodandhealth.com/blog/
21 Communicat ing Food for Health M A R C H 2 0 0 9
Grains
Brown or white riceOatmealBarleyCorn meal or gritsStore brand pasta
Dairy
Skim milkYogurt
Protein
Beans and lentilsEggsWhole chickenPeanut butterStore specials on fish, meat, poultry
Produce
CabbagePotatoesRomaine Leaf lettuceCauliflowerCarrotsZucchiniCucumberCornBananasMelonOrangesApplesFrozen veggies on saleSeasonal produce specials
1. Having the right ingredients on hand forpreparing meals means you won’t spendextra dollars dining out.
2. Some options, such as chicken breast cut-lets or ground turkey breast are good be-cause they enable you to serve less meatper person.
3. Vegetarian options, such as lentils andrice, or bean soup with vegetables, arehearty and cheap and good for you!
4. Cabbage is often forgotten. You can use itfor slaw, tacos, stir fry dishes and more. Itis cheaper than lettuce so helps you stretchthe budget - buy one head of lettuce andwhen that runs out serve slaw - or stretchyour tossed salad with shredded cabbage.
5. Apples and carrots make great snacks,brown bag treats and side dishes for meals
and they are cheap when bought in bulk.6. Grapes get used better and are great grab
and go snacks when you wash them andportion them into baggies in your refriger-ator. Choose them instead of chips!
7. Potatoes are underused. You can makeoven fries, mashed potatoes, baked pota-toes and even pizza with them!
8. Coupon clipping is only good when youare buying things you use on a regular ba-sis otherwise the time is better spent tolearn to cook more dishes rather than buymore convenience foods.
9. The best place to shop is often in yourown pantry or freezer. Plan meals aroundusing up things you have on hand.
Search for recipes with these items atwww.foodandhealth.com.
Cheap and Healthy Shopping List
9 Often Overlooked Cost Savers
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Plan Menus By Produce
Here is a new way to plan your mealson the go. Start in the produce sectionand plan meals based on what you
see that looks good and is a good price. Basemeals more around fruits and vegetables ratherthan meat. If you think of 5-6 good dinners andmake a few in quantity for “plannedovers” youwill usually have enough food to get through aweek. Your wallet, waistline and heart willthank you!
Here are some fresh ideas for meals:• Pasta with fresh broiled vegetables in sea-
son. Toss pasta and broiled veggies withherbs, broth and a little oil.
• Find a green veggie to go with baked fishand rice - usually zucchini or green beans
• Vegetable to go with chicken or turkeybreast - usually broccoli or zucchini orgreen beans in a steam bag; can also bewinter squash or spaghetti squash
• Ingredients for salsa that can be used tomake burritos, tacos, fish, chicken as wellas a tasty vegetable-consumption-boostingdip for veggies and tortilla chips.
• Stir fry veggies - consider carrots, mush-
rooms, spinach or peppersand these can be used forsalads and other dishes,too. A stir fry is a great wayto use up a lot of leftoverveggies at the end of theweek, too.
• Salad• Fruit for breakfast, snacks and desserts• Cabbage for slaw - and it doubles as a great
stir fry ingredient, too. • Seasonal produce for risotto - risotto is a
creamy rice dish made with arborio rice, foundin most grocery stores. Arborio rice is a short-grain rice that is very inexpensive and it is easyto cook, too! Use 3 cups water to 1 cup rice andadd vegetables and seasonings half way throughcooking. Stir well to make creamy and servehot.
Here is a healthy meal using many of theitems on the Cheap Healthy Shopping List onpage 21 of this issue.
• Turkey burger with lettuce and tomatoserved on an English Muffin
• Carrot sticks• Oven fried potato wedges• Slaw dressed in oil and vinegar with a
pinch of oreganoRecipes and pictures are found on our blog
at http://www.foodandhealth.com/blog/
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What to Eat - WellnessFair Both Activity Ideas
What do these foods havein common? (fiber)
Display beans, oatmeal, ap-ples, brown rice, canned peas,shredded wheat and wholegrain bread (and other highfiber foods). The question forthe display should be, "What dothese foods have in common?"
The answer of course, is"fiber"! Anyone who guessescorrectly can receive a raffleticket that is good towards afree prize - or the food basketon the table. You might want togive them a few choices to helpthem guess the right answer.
Can you remember whatyou see? (fiber)
Show a variety of ten highfiber foods and then cover witha cloth. See if they can remem-ber all ten - whoever remem-bers gets a prize. We recom-mend: orange, can of blackbeans, bag of brown rice, con-tainer of oatmeal, box of shred-ded wheat, apple, bag of lentils,box of whole grain pasta, wholewheat bread, sweet potato.
Make a healthy plate.(Healthy Plate)
Use paper plates and cut outsof foods to help people learn
the method of making a healthyplate. You can have quarter-plate-size pieces of vegetables,grains and meats. They shouldput them together on a plate us-ing half the plate for veggies,half for a lean protein and halffor a starch or whole grain. Usethe Healthy Plate Poster as aguide - and let them take theirplate home with them. It is fun,too, if you trip them up withmeat or grains that are too big.Whoever makes a healthy platecan get a ticket for a raffle. Werecommend using cut outs ofconstruction paper, magazinefood cut outs or food models -you can get those from a toystore or enasco.com
Another idea is to createplates using magazine cut outsof food and display them. Havesome balanced and some notbalanced. See if they can guesswhich ones are healthy platesand which ones are not sohealthy plates.
One more idea is to make 2plates - one balanced and onenot balanced. See if they canguess the calorie difference be-tween the two - correct answersget a raffle ticket!
MyPyramid Quiz (MyPyra-mid)
Use the handout in the packetfor participants to fill out thequiz on MyPyramid.
Name 5 food groups ofMyPyramid - (MyPyramid)
Have participants name the 5food groups of MyPyramid fora prize or raffle ticket: rains,vegetables, fruit, milk,
meat/beans. Make MyPyramid groups
(MyPyramid)Using one colored foam
board in a color to match eachgroup (orange for grains, greenfor veggies, red for fruit, bluefor milk and purple formeat/beans). Each group shouldhave a hole to fit a bean bag.Create beanbags with differentpatterns and shapes of food fab-rics for every food group. Par-ticipants can have fun with abean bag toss while learningwhere the foods go for eachgroup.
Budget and MyPyramidUse the foods listed on the
Cheap and Healthy ShoppingList on page 21 of this issueand encourage participants tocome up with healthful recipesand meal ideas using thesefoods. Have a contest to see ifanyone can come up with aweek’s worth of meals usingthe list presented.
These items are less than .04per ounce in most areas. Notehow food that is less processedand better for you is also lowerin price! We have a great hand-out that would match this wellin the online subscriber sectioncalled “Budget Eating”.
Make a display from eachfood group using the list offoods on page 21 or in BudgetEating and some other expen-sive prepared foods and haveindividuals try to arrange thefoods in each set from least ex-pensive per serving to most ex-pensive per serving.
E d u c a t o r s ’ I d e a F i l e
One very important factor thatimpacts calcium balance and bonestrength has received little atten-tion. Human beings evolved on adiet consisting largely of fruits andvegetables supplemented withmodest amounts of animal prod-ucts. The metabolic residue fromfruits and vegetables is highly al-kaline due largely to their highpotassium content and less so totheir calcium and magnesium con-tent. Foods of animal origin yieldan acidic residue. In modern diets,calories from fruits and vegetableshave been displaced by grains,which yield a modestly acidresidue. There has also been an in-creased consumption of animalproducts, some of which are meta-bolically very acid forming. As aresult, the urine of modern humansis generally acidic, whereas that ofour ancient ancestors was likelyalkaline. Aging lowers the body’sability to deal with more acidity.
A recent study by Dr. Dawson-Hughes examined the impact ofadding sodium or potassium bicar-bonate supplements to a typicalmodern diet in 171 subjects age 50and older. This study found not
only a decrease in calcium lost inthe urine in response to the bicar-bonate supplements but also a re-duction in urinary N-telopeptide –a marker for more rapid bonebreakdown. Sodium bicarbonateand potassium bicarbonate in-crease the alkalinity of blood andurine. Dr. Dawson-Hughes con-cluded that alkalinizing the urine“… had a favorable effect on boneresorption and calcium excretion.This suggests that increasing thealkali content of the diet may at-tenuate bone loss in healthy olderadults.”1
Bottom Line: The evidence ismore than sufficient to encourageAmericans to consume more fruitsand vegetables and cut way backon foods like meats, eggs, andcheeses that acidify the blood andurine. Those with already weak-ened bones should replace some ofthe grain products in their dietswith potatoes and yams. While salthas little impact on acid-base bal-ance it increases calcium loss andis best limited in those with thin-ning bones. By James J. Kenney,PhD, RD, FACN
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