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CounselingPatients Withthe African HeritageDiet Pyramid

Menu Ideas, Tips,and More for SuccessfulLow-FODMAP Living

Whole-Body Nutrition

for Healthful Aging

Best BreakfastsfromAround

theWorldTheres Much to LearnAbout the Morning MealFrom Other Countries

Vietnamese rice noodlesoup, called Pho, is atraditional breakast

staple that originated innorthern Vietnam.

NationalNutritionMonth

March 2012

Vol. 14 No

The Magazine or Nutrition Proessiona

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PRESIDENTS SPOT

IN CELEBRATIONOF YOUBy Kathy Czermanski

Happy National Nutrition Month rom all ous at Todays Dietitian! In honor o National

Nutrition Month and Registered Dietitian Day, wed like toinvite you to nominate colleagues you believe are doing excep-tional work in all areas o the dietetics eld.

As we have in the past two years, well select 10 o thenominees to be part o our annual TD10 eature article, whichwill appear this year in our June issue. Each o the TD10nominees will receive an award certicate to display in theiroce or home. So please visit ww w.TodaysDietitian.com to

submit your nominations throughout the month o March.Simply complete a short online orm and, in 300 words orless, explain why you believe your colleague should be one othe TD10 this year.

Also during National Nutrition Month, were very excited toannounce the Todays Dietitians CE Learning Library (CELL)thats scheduled to go live on our website this month. Todays

Dietitian is accredited by the Commission on Dietetic Regis-tration as a CPE provider, and CELL is an expansion o the CEcourses and exams we provide in the magazine. The library

will include a wide range o courses on a variety o current,practical, and thought-provoking topics. As always, distin-guished industry experts will be writing the articles. Our newonline system, located at CE.TodaysDietitian.com , will makeit easy or you to register and earn credits just like you alwayshave with us by simply reading the articles and taking theexams when youre nished.

We know how important continuing education credits areor recertication and to enhance your proessional growthand development. CELL will enable you to manage your tran-script o credits and certicates, interact and discuss thecourses with other dietitians, and chart out your path to recer-

tication all in one place.So take some time to visit CELL during National NutritionMonth.

We look orward to your eedback and support as wecontinue oering this invaluable service to you in the yearsto come.

Please enjoy the issue!

President + CEO

Kathleen Czermanski

Vice President + COO

Mara E. Honicker

EDITORIAL

Editor Judith RiddleEditorial Director Jim KnaubSenior Production EditorTracy DenningerEditorial Assistants Heather Hogstrom,Brandi ReddingContributing Editor Sharon Palmer, RDEditorial Advisory Board Dina Aronson,MS, RD; Jenna A. Bell, PhD, RD;Carol M. Meerschaert, MBA, RD; KyleShadix, MS, RD

ART

Art Director Susan KilcoyneSenior Graphic Designer Charles SlackGraphic Designer Kelly NewtonAd Coordinator Marie Harvey

ADMINISTRATION

Administrative ManagerHelen BommaritoAdministrative Assistants

Kim Mayeld, Pat PlumleyExecutive Assistant Matt Czermanski

Systems Manager Je CzermanskiSystems Consultant Mike Davey

FINANCE

Director o Finance

Je Czermanski

Director o Continuing Education

& New Business Development

Jack Graham

CIRCULATION

Circulation ManagerNicole Hunchar

MARKETING AND ADVERTISING

Publisher Mara E. HonickerDirector o Marketing and Digital MediaJason FrenchmanWeb Designer/Marketing AssistantJessica McGurkMarketing Assistant Leara AngelloDirector o Sales Stephanie MitchellSenior Account Executives

Sue Aldinger, Peter J. Burke,Michael Ferguson, Brian Ohl,Brian SheerinAccount Executives Phil Anderson,Seth Bass, Jason Batchelder,Gigi Grillot, Lindsay Hertzog,Diana Kempster, Beth VanOstenbridge,Kate Wills, Josh YohnkeSales Coordinator Joe Reilly,Dani Kriest-Reisneider

2012 Great Valley PublishingCompany, Inc.

Todays Dietitian (ISSN 1540-4269) ispublished monthly by Great ValleyPublishing Company, Inc., 3801Schuylkill Road, Spring City, PA 19475.Periodicals postage paid at Spring City,PA, Post Oce and an additional mailingoce. Permission to reprint may beobtained rom the publisher.

Phone: 610-948-9500Fax: 610-948-7202Editorial e-mail: [email protected] e-mail: [email protected]: www.TodaysDietitian.comSubscription e-mail: [email protected] ax: 610-948-4202Ad artwork e-mail: [email protected]: The Reprint Outsource, Inc.:877-394-7350 or [email protected]

NOTE: For subscription changeso address, please write to TodaysDietitian, 3801 Schuylkill Road, SpringCity, PA 19475. Changes o address willnot be accepted over the telephone.Allow six weeks or a change o addressor new subscriptions. Please provideboth new and old addresses as printedon last label.

POSTMASTER: Send address changes toTodays Dietitian, 3801 Schuylkill Road,Spring City, PA 19475. SubscriptionRates Domestic: $14.99 per year;Canada: $48 per year; Foreign: $95 peryear; Single issue: $5

All articles contained in Todays Dietitian,including letters to the editor, reviews,and editorials, represent the opinions othe authors, not those o Great ValleyPublishing Company, Inc. or anyorganizations with which the authorsmay be aliated. Great ValleyPublishing Company, Inc., its editors,and its editorial advisors do not assumeresponsibility or opinions expressed bythe authors or individuals quoted in themagazine, or the accuracy o materialsubmitted by the authors, or or anyinjury to persons or property resultingrom reerence to ideas or productsdiscussed in the editorial copy or theadvertisements.

4 todays dietitian march 2012
http://www.ce.todaysdietitian.com/http://www.ce.todaysdietitian.com/

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We all know the old adage

Breakfast: Its the most

important meal of the day. And

in recent years evidence regarding

the benefits of breakfast is

mounting. In addition to research

showing that eating breakfast

is linked to improved weight

control, breakfast eaters have

been shown to haveimproved

nutrient adequacyoverall, and

improved cognitive performance.

Breakfast is a prime occasion for

getting many of the key nutrients

for a healthy diet. The vitamins, minerals and

plant nutrients found in breakfast staples like

whole-grains and fruit including 100% fruit juice

can promote better health.

Unfortunately, the statistics show that far too many

Americans are skipping this all-important meal.

Any breakfast is better than no

breakfast! If youre in a rush,

consider the following quick and

easy options all paired with

100% juice, which earns you

one serving of fruit in just a 4

ounce portion.

Low-fat yogurt topped with

crunchy whole grain cereal

String cheese and a small

handful of whole grain

crackers

Homemade trail mix made

with whole grain/high fiber cereal, nuts, and

dried fruit

A slice of whole grain toast topped with natural

peanut butter and banana slices

Hummus and cucumber slices wrapped in a

whole wheat flour tortilla

For more information on the benefits of breakfast and delicious recipes featuring

nutrient-dense 100% juice, please visit www.fruitjuicefacts.org

ADVERTORIAL

References:

Affenito SG, Thompson DR, et al. Breakfastconsumption by African-American and whiteadolescent girls correlates positively with calcium

and fiber intake and negatively with body massindex. J Am Diet Assoc 2005;105:938-945.

Albertson AM, Franko DL, et al. Longitudinalpatterns of breakfast eating in black and whiteadolescent girls. Obesity 2007;15(9):2282-2292

Rampersaud et al, Breakfast habits, nutritional

status, body weight, and academic performancein children and adolescents. J Am Diet Assoc.2005 May;105(5):743-60

Wesnes et al, Breakfast reduces declines inattention and memory over the morning inschoolchildren. Appetite, Volume 41, Issue 3,December 2003, 329-331

Wyatt H et al. Long-term weight loss andbreakfast in subjects in the national weightcontrol registry. Obes Res 2002;10:7882

Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010

Modest evidence suggests thatchildren who do not eat breakfast are atincreased risk of overweight and obesity.

The evidence is stronger for adolescents.

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eatures

20 Best Breakasts From Around the WorldTheres much to learn rom other countries whenserving this most important meal. See what otherdietitians have to share.

26 Obtaining Health Through Heritage A dietrooted in Arican traditions may be the path to optimalhealth or Arican Americans.

32 Optimize Whole-Body Nutrition or HealthulAging Proessionals say a nutrient-dense diet plusphysical activity will help clients stay younger longer.

36 Successul Low-FODMAP Living Experts

discuss strategies to help clients live ree ogastrointestinal distress.

40 CPE Monthly:Adding Spice for a Healthier LifeEvidence shows antioxidant-rich herbs and spices maycut chronic disease risk.

departments

4 Presidents Spot

8 Reader Feedback

10 Ask the Expert

12 Childrens Health

14 Allergy & Intolerance Awareness

16 Research Bries

18 Focus on Fitness

46 Dynamics o Diabetes

48 For Your Inormation

50 Crossword Puzzle

52 Bookshel

54 Personal Computing

64 Culinary Corner

66 Get to Know

CONTENTS MARCH 2012

26 64

Page 40


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California Raisins arenaturally dried in the sun.Other dried fruits may contain

as much as 40% added sugar.

Everyone knows that natural sugar is better than added

sugar. But you may not know that many reconstituted,

processed dried fruit snacks can contain 40% added

sugar or more. California Raisins, however, are a 100%

natural product. No added sugar, dried naturally in thesun. To find out more, visit LoveYourRaisins.com

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Dear Editor,

The January issue was very nice. TheGet to Know column [eaturing MarionNestle] was cool. Also, I really liked your

article Providing Optimal Diabetes Careto the LGBT Community. When the mag-azine can nd a way to look at a subjectlike diabetes and oer a new viewpointthat really rocks!

Carol M. Meerschaert, MBA, RD

President, Your Favorite Dietitian

Paoli, Pennsylvania

Dear Editor,

The article Providing Optimal Diabetes Care to the LGBTCommunity in your January issue implied that dietitians shouldbecome an avenue to promote widespread acceptance o theLGBT community. I eel that this is in poor taste. It shouldnt bemy responsibility as a registered dietitian to carry LGBT mate-rials in my oce any more than it would be appropriate to dis-play magazines and other literature on Christianity, Judaism, orIslamic Sharia Law!

I dont need to know someones sexual preerence to helphim or her control their diabetes any more than Id need toknow whether someone is a Democrat or Republican. Theyeither wish to improve their health or they do not. The choice o

ones sexual partner shouldnt enter the equation.The article reports that somehow the LGBT population expe-

riences health issues and liestyle choices more challeng-ing than the rest o the population. This is ludicrous as wellas demeaning to both the LGBT population and ones intelli-gence. Many peopleLGBT or notstruggle with emotionalissues that may lead an individual to participate in unhealthybehaviors.

Donna Dodge, RD, LDN

Denmark, Maine

Dear Ms. Dodge,

Thank you or your response to the article Providing Opti-mal Diabetes Care to the LGBT Community. We wrote the arti-cle to present a side o diabetes care that isnt voiced oten andbecause many nutrition proessionals and other healthcarepractitioners believe members o the LGBT community havespecial healthcare needs, and that theyve been treated unairlyand at times with great hostility in the healthcare system as aresult o their sexual orientation. Like many in the healthcareproession, we wanted our readers to know that LGBT diabetes

patients oten suer rom greater health disparities than thegeneral population as well as unique emotional stressors, sotheyd be better equipped to improve patient care in this vulner-able population.

We elt it necessary to report on some o the studies that

have examined the healthcare disparities inherent in the LGBTcommunity. Many in the healthcare proession who are doingthe research and working in the trenches caring or this sub-population are well aware o the problems and are trying toremedy them.

It might be a good idea to listen to the video To Treat Me, YouHave to Know Who I Am on YouTube.com. Youll hear rsthandwhat these patients experience and the opinions o the doc-tors and healthcare practitioners who are caring or them. Itsa proound eye opener that can only move one toward com-passion and action to improve patient outcomes among LGBTdiabetes patients.

Judith Riddle, editor

READER FEEDBACK

Popular Tweets, Retweets

January Issue

@Bmlococo: Just subscribed to Todays Dietitian orthree years! So excited!

Giving Nutrition Adviceto Child Athletes (SportsNutrition)

@JessTheRD: Thanks or tipson how RDs can help childathletes and their parents

with child athlete nutrition needs.

@Kristynhall: Thank you Todays Dietitian. I love yourpublication and look orward to reading it everymonth.

@CandidRD: I love getting Todays Dietitian magazine

because it motivates me to get on the elliptical andstay on until I nish reading it! Here I go.

Omega-3s and Mood Disorders

@AmericaNowNews: Known or heart health, omega-3s are eective therapy or depression, bipolar disor-der, and schizophrenia.

@CherylharrisRD: Nice article on omega-3s and mood.Amazing and tasty to boot!

www.TodaysDietitian.com

ProvidingEnteral

Nutritionfor Esophageal

CancerPatients

HowWilltheName

ChangesoftheADAand

DMAImpact Dietetics?

OfferCulturallySensitive

DiabetesCaretotheLGBTCommunity

Research Suggests TheyCan Help Mild to MajorDepression and EvenSchizophrenia

Mood DisordersOmega-3 Fatty Acids and

ASPENConference

Issue

January2012

Vol.14No.1

TheMagazineforNutritionProfessionals


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PROTEIN POWDERSBy Toby Amidor, MS, RD, CDN

Q:Many o my clients purchase protein pow-

ders. What are the main types availableand the guidelines or recommending them?

A:There are several varieties o protein pow-ders, including those derived rom milk,soy, eggs, and rice. Beore recommending any protein supple-ment, however, its important to determine i your client reallyneeds one.

The Types

Dairy BasedBoth casein and whey protein powder supplements are

derived rom milk. Casein is a milk protein isolate known ascaseinate that provides 22 g o protein per ounce and takeslonger to digest than whey. A 2011 study in theAmerican Journalo Clinical Nutrition ound casein supplementation didnt stim-ulate postprandial muscle protein accretion as eectively aswhey.1 However, a 2007 study inAmino Acids ound the combina-tion o both casein and whey to be more eective in improvingbody composition and muscle strength.2

Whey protein is the most common protein powder sold. Itsmore easily absorbed and helps build and maintain muscles.Its ound in concentrate or isolate orm. Whey protein concen-trates are less expensive and contain between 30% and 85%

protein, while whey protein isolates contain at least 90% pro-tein and provide 24 g per ounce. The isolate orm is more easilyabsorbed but is typically more expensive.

Since casein and whey protein are derived rom milk, dontrecommend them to clients who are lactose intolerant or havemilk allergies.

Soy BasedThis protein is derived rom soy four and is appropriate or

those with allergies or who ollow a vegetarian or vegan diet.Its available as an isolate or concentrate; the isolate orm ispurer and more expensive and provides 15 g o protein per

ounce. Studies have shown that soy protein helps lower LDLcholesterol.3 Clients may voice concern about the hormonelikecompounds ound in soy; however, studies have determined thatup to 60 g o soy protein per day is sae.

Additional VarietiesOther protein powders rom eggs, rice, peas, or hemp are

available. Egg protein is derived rom egg whites, is ree o bothat and cholesterol, and is easily absorbed. It contains 21 g oprotein per ounce. Rice protein is derived rom brown rice andcontains 18 g o protein per ounce. Pea protein contains 20 g o

protein per ounce, while hemp provides 12 g. Rice,pea, and hemp (plant-based protein powders) haveessential amino acids added and are good alterna-tives or those with allergies or clients who ollow avegetarian or vegan diet.

Protein RecommendationsThe Recommended Dietary Allowance or pro-

tein is 0.8 g/kg o body weight (or 0.36 g/lb o bodyweight). On average, this amounts to 56 g/day or men and 46 g/day or women aged 19 and older.

Most individuals can obtain this amount o protein rom dietalone and dont require protein supplements. Typically, proteinsupplements arent needed or clients who exercise a ew timesper week or an hour or less.

I clients insist on using a protein supplement, calculatetheir protein needs and compare them to how much theyre

currently getting to ensure they achieve a proper balancebetween ood and supplement use. Clients also should under-stand that protein powders are neither inerior nor superior toprotein derived rom ood, but theyre pricey and lack certainnutrients ound in whole oods.

CautionsProtein powders shouldnt contain added vitamins, minerals,

and herbal supplements because they can interact with variousmedications, including antibiotics, levodopa used in Parkinsonsdisease, and alendronate used to treat osteoporosis. In addition,synthetic amino acids sometimes are added to protein powders.

Scientic evidence is inconclusive as to whether adding moreamino acids to protein powder ormulations is better.

Consuming too much protein can lead to dehydration and iscontraindicated in those with renal issues.Side eects o large doses include nausea,thirst, cramps, bloating, headache, andupset stomach.

Toby Amidor, MS, RD, CDN, is ounder

o Toby Amidor Nutrition, a nutrition expert

or FoodNetwork.com, and a nutrition

advisor or Sears FitStudio.

ASK THE EXPERT

For reerences, view this article on our website

at www.TodaysDietitian.com.

Have questions about nutrition trends, patient care,

and other dietetics issues youd like to ask our expert?

Send your questions to Ask the Expert at [email protected]

or send a tweet to@tobyamidor.


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PROTECT YOUNG HEARTSHeres What RDs Must Know Aboutthe New Cholesterol Screening Guidelines

By Sari Harrar

Groundbreaking new guidelines written in late 2011 by anexpert panel sponsored by the National Heart, Lung, and BloodInstitute are requiring all children between the ages o 9 and 11to get cholesterol screenings, a test once reserved only or kidsand teens at high risk o heart disease.1

As amily doctors and pediatricians across the nation beginwidespread screenings o young patients, RDs can expect tocounsel more amilies coping with a long-overlooked heart

truth, says Karen Ansel, MS, RD, CDN, a spokesperson or theAcademy o Nutrition and Dietetics (the Academy). Childrensheart health is not on most parents radar screens, but it shouldbe, says Ansel, a Long Island, New York-based RD and coau-thor o Healthy in a Hurry: Simple, Wholesome Recipes or EveryMeal o the Day. Even though heart disease may not be apparentuntil middle or old age, it develops over a lietime. What childreneat and do now has a denite impact.

The new guidelines are endorsed by the American Academyo Pediatrics (AAP) and strongly recommend that doctorsreer children and teens with high cholesteroland their ami-liesto an RD or medical nutrition therapy.

RDs can play a vital role in reversing this serious heart dis-ease risk actor, says Bethany Thayer, MS, RD, director o Well-ness Programs & Strategies at the Henry Ford Health SystemsCenter or Health Promotion and Disease Prevention in Detroitand a spokesperson or the Academy. Very ew kids will everbe prescribed cholesterol-lowering drugs, she says. The rstline o prevention or all amilies and all kids includes health-ul eating, daily activity, and helping kids achieve or maintain ahealthul weight. RDs are the healthcare proessionals who canhelp parents and caregivers adapt these strategies to work intheir own lives.

A Better Saety NetWhy screen all children when heart attacks almost never

happen during the wonder years? Research shows that 10% okids and teens have elevated total cholesterol, according to aCenters or Disease Control and Prevention analysis o National

Health and Nutrition Examination Survey data by Ford and col-leagues, published in the March 3, 2009, issue o Circulation.High cholesterol jump-starts the buildup o plaque in the arter-ies o childrens hearts as early as age 10.2

One reason the guidelines have changed is that medicalimaging has allowed researchers to measure atherosclerosisin the arteries o kids with high cholesterol, demonstrating thatthe damage begins early, Thayer says. This adds cholesterolto other important measures we use to evaluate heart health,which include blood pressure checks, body weight, and askingabout amily history, diet, and exercise.

The danger is growing. Poor ood choices and too little

physical activity are ueling the childhood obesity epidemic aswell as rising rates o high cholesterol, high blood pressure,and high blood sugar, say Northwestern University researcherswho reviewed the health proles o 5,447 teens and preteensor a study presented at the American Heart Associations2011 Scientic Sessions. Their conclusion: Todays youngpeople will ace atal heart disease earlier in adulthood thanany previous generation.

The AAPs previous guidelines called on doctors to checkcholesterol levels only in children and teens with heart diseaserisks such as obesity, high blood pressure, diabetes, or a amilyhistory o early heart disease or those whose amily histories

were unknown. But these criteria may be missing up to 50% okids with dyslipidemia, according to a 2007 US Preventive Ser-vices Task Force report published in Pediatrics.

Not all heart-health experts agree that cholesterol screen-ing in kids is necessary given that the best protection or nearlyeveryone is a healthier liestyle.3 But, Ansel notes, knowing thatchildren have high cholesterol can help their amilies makeadditional adjustments, such as reducing the amount o satu-rated at and dietary cholesterol they consume. I a child isdiagnosed with high cholesterol, parents dont need to panic,she says. Choosing more plant-based ats and ewer animalats can substantially help lower saturated at and cholesterol

and make a dierence.

Tips or Counseling KidsTo help amilies and their children with high cholesterol

bring their numbers into a healthul range, ollow these sevenstrategies:

1. Aim or ve servings o produce daily. Most kids andteens dont get enough ber.4,5 Aim or ve servings a day,Thayer says. Fruits and vegetables arent just lling; they helpwith weight control. Produce that contains soluble ber, suchas apples, oranges, pears, strawberries, cucumbers, celery,

CHILDRENS HEALTH


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and carrots, also help lower cholesterol by orming a gel in theintestines that traps cholesterol-rich bile acids and removesthem rom the body with waste products, she says.

2. Nix the sugary drinks and encourage low-at or at-reemilk or water instead. Up to 30% o some teens daily calories

come rom sugar-sweetened soda and other drinks.6 This raisesthe risk o obesity, which increases the odds o kids develop-ing high cholesterol, according to the AAP report. Milk containscalcium, potassium, and magnesium, which help control bloodpressure and lower the risk o diabetesboth potent heart dis-ease risk actors. [Suggest kids] aim or 2 to 4 cups o milk perday, Thayer says.

3. Go or whole grains. Oatmeal and barley contain solubleber that helps sweep cholesterol rom the body, Ansel says.The AAP recommends breakast cereals enriched with the sol-uble ber psyllium at a dose o 6 g/day or kids younger thanage 13 and 12 g/day or teens.

4. Balance the at. Kids with high cholesterol dont need alow-at diet. The AAP recommends they get 25% to 30% o theirdaily calories rom at while keeping saturated at to a low 7%o daily calories and limiting dietary cholesterol to 200 mg/day.Counsel amilies to avoid artery-clogging trans ats. [Havethem] choose more plant-based ats such as avocados, nuts,canola oil, olive oil, and ewer animal ats, such as butter, redmeat, cream cheese, and ull-at cheese, Ansel suggests.

5. Aim or one hour a day o exerciseand no more thantwo hours o screen time. Kids need plenty o physical activityplus everyday movement to stay healthy and avoid overweight,Thayer says. We encourage amilies to limit computer, videogames, and TV to two hours per day maximum.

6. Focus on healthul living instead o weight loss. Mostchildren who are overweight can grow into their weight througha healthul diet and exerciseweighing and measuring or tryingto restrict ood can backre, Thayer warns. RDs should workclosely with a amily and the childs doctor about weight goals.

7. Suggest amilies get healthier together. Singling outa child can embarrass or shame them, Thayer says. Whena child has high cholesterol, its smart or the whole amily toadopt a healthier liestyle. Kids learn rom what their parentsdo. And oten parents come back to me thrilled because theirown cholesterol numbers have improved, too. Everybody wins.

Sari Harrar is an award-winning reelance writer

specializing in health, medicine, and science.

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RECOGNIZING COWS MILKPROTEIN ALLERGY IN INFANTSEvidence Shows EliminatingMilk and Soy Can Help

By Judith C. Thalheimer, RD, LDN

When my son Matthew was born, he was strong and healthy,growing well and meeting every milestone. However, he wasterribly ussy. He wouldnt sleep or more than two hours at atime, and hed cry inconsolably as i he were in pain. The longwalks, endless car rides, and sleepless nights spent cuddlinghim while pacing the foor didnt calm him down.

Exhaustion, rustration, and worry gave way to depressionand insomnia as I lay awake most nights anticipating thatshrieking cry that might come at any moment. The pediatriciancouldnt nd any medical reason or his behavior. She sympa-thetically inormed us that our son had inantile colic, and that itwould get better with time.

What Is Inantile Colic?All inants have periods o ussing and crying, but those

who cry or three or more hours per day or three or moredays per week and or at least three weeks (known as the Ruleo Threes) meet the basic denition o inantile colic.1 Typi-

cally, colicky behavior begins in the rst ew weeks o lie andresolves spontaneously by age 4 to 6 months. Estimates o theincidence o colic vary widely, but as many as 28% o inantsmay be aected.2

In 1954, when the Rule o Threes was introduced, colic wasthought to be primarily a response to overanxious parenting.Since then, researchers have examined many possible physio-logical causes that could account or the distress colicky inantsexhibit, but no single mechanism has been ound. Besides par-enting, possible explanations or colic have ocused on neuro-logical or gastrointestinal issues.

Anne Eglash, MD, a amily physician, clinicalproessor at the University o Wisconsin School oMedicine and Public Health, and coounder o theAcademy o Breasteeding Medicine, has treatedmany colicky inants in her practice and has con-

cluded that they all into two distinct groups. Someinants are like Dr Jekyll and Mr Hyde: They havecrying episodes around the same time every eve-ning, but theyre happy in between episodes. Thistype o excessive crying is caused by neurologicimmaturity, Eglash says. I the baby is ussy allday and night, however, then something else isgoing on, such as abdominal pain. My son Matthewell into the latter group.

Right beore his our-week checkup, I noticed aspot o bright-red blood in his diaper. The pediatri-cian suspected an anal ssure and recommended I

soak him in warm baths. In the weeks that ollowed, the small,bright-red spots or streaks appeared in almost every stool,alone or encased in globs o mucus. While he was still growingwell, the ussiness and crying worsened.

Convinced that something was wrong, I took my son to apediatric gastroenterologist. Based solely on my description othe symptoms o colic accompanied by blood and mucus in hisstool, the gastroenterologist made an immediate diagnosis: anintolerance to cows milk and soy proteins. To my surprise,Matthews ussiness and excessive crying werent inantilecolic; they were an adverse reaction to ood, treatable withnutrition intervention.

Supporting ResearchMy story is not unique. Cows milk proteins are the most

common cause o ood intolerance in inants, with soy pro-tein ranked second.2 A 1999 study by Tor Lindberg, MD, calledInantile Colic and Small Intestinal Function: A NutritionalProblem?, reported that approximately 25% o inantile colic iscows milk dependent.

Numerous studies have shown that removing cows milkproteins rom a colicky inants diet can cause a signicantreduction in symptoms.3 Some o these inants have an immu-noglobulin-E (IgE) mediated reaction commonly reerred to as

cows milk protein allergy (CMPA). Others may exhibit similarsymptoms caused by nonIgE-mediated, mixed, or cell-mediated reactions. In some studies, these reactions arecalled CMPA as well, while others use the term cows milkprotein intolerance (CMPI).

Iacono and colleagues concluded in a 1991 study pub-lished in theJournal o Pediatric Gastroenterology and Nutri-tion that a considerable percentage o the inants with severecolic also have CMPI and that in these cases, dietetic treat-ment should be the rst therapeutic approach. Dietetic inter-vention is also the standard diagnostic procedure: eliminate

ALLERGY & INTOLERANCE AWARENESS


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the suspected allergen rom the diet andsee i the condition improves. The diag-nosis is conrmed i reintroducing theallergen causes the symptoms to return,but this challenge procedure isnt rou-

tine in colicky inants and should be doneonly under medical supervision at acili-ties equipped to handle serious allergicreactions.

Treating Formula-Fed InantsStandard inant ormulas are either

cows milk or soy based. For ormula-ed inants, Anthony M. Loizides, MD,an assistant proessor o pediatrics atAlbert Einstein College o Medicine andan attending physician in the division o

pediatric gastroenterology and nutritionat Childrens Hospital at Monteore, rec-ommends a two-week trial o extensivelyhydrolyzed ormula when CMPA is sus-pected. I the inant does not respond,he says, its unlikely that she or he hasCMPA. I skin rash or gastrointestinalsymptoms such as blood in the stools arepresent, however, a our-week elimina-tion period is recommended. I theres noimprovement on extensively hydrolyzedormula, an amino acid-based ormula

may be tried. Babies whove begun eatingsolid ood shouldnt be ed oods contain-ing cows milk proteins, soy protein, egg,or peanuts.4

Mothers Role WhileBreast-Feeding

As in my case, breast-ed inantsalso may present with excessive cryingrelated to adverse ood reactions. Mat-thews condition, known as allergic proc-tocolitis, is a typical presentation. Milk

and soy proteins are the most commonculprits, as both have been ound inbreast milk. The breast-eeding mothermust, thereore, exclude all sources

o milk and soy proteins rom her diet.Eglash also has had success with elimi-nating corn i the inant doesnt respondto the removal o milk and soy. Somestudies have suggested eliminating other

oods known to be highly reactive, suchas nuts, wheat, eggs, and sh.

Milk and soy proteins are added toa wide variety o processed oods, butcurrent labeling laws require that man-uacturers clearly identiy any ingre-dients that contain protein derivedrom milk or soybeans as well as eggs,sh, shellsh, peanuts, tree nuts,and wheat. An inants condition otenimproves in as little as 72 hours, buttwo to our weeks is the recommended

trial period. I the elimination dietworks, the mother should continue thisdiet as long as shes breast-eeding,and, as previously mentioned, anyoending ood components must beexcluded rom the inants diet whenintroduced to solid oods.4

Many o the adverse ood reactionsresponsible or excessive crying aretemporary, and a challenge should beconducted under medical supervisionaround the rst birthday to determine i

the baby is still reactive.Ater my sons diagnosis, I contin-

ued to breast-eed, careully avoidingoods with even trace amounts o milk orsoy proteins. My sons behavior steadilyimproved as long as I adhered to the diet,and the appearance o blood in his stoolsgradually lessened. Ater two months onthe elimination diet, all traces o bloodin his stool were gone, and my sweet,happy baby was nally sleeping throughthe night.

Judith C. Thalheimer, RD, LDN, is a

private practitioner based

in Pennsylvania.

For reerences and additional resources, view this article

on our website at www.TodaysDietitian.com.


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Colorectal Cancer StudyExamines Diet, Physical Activity

The Cancer Institute o New Jersey (CINJ) and the ve hos-

pitals o Meridian Health have joined orces to oer a clinicalresearch study that examines physical activity patterns andeating habits in colorectal cancer patients who have recentlynished treatment. The goal o the study is to lay the ground-work or uture research on health promotion among individu-als with colorectal and other cancers.

The death rate rom colorectal cancer has been on thedecline or the past 15 years, which means more patients aresurviving the disease. However, the question is whether theirquality o lie has improved and their risk o cancer recurrencehas decreased. Researchers at the CINJ hope to determinethis in an eort to promote positive health behavior changes in

this population.Elliot J. Coups, PhD, a behavioral scientist at the CINJ andan associate proessor o medicine at the University o Medi-cine and Dentistry o New Jersey-Robert Wood Johnson Medi-cal School, is the lead investigator. Previous research by Coupsshows that 80% o colorectal cancer survivors dont take part inregular physical activity, while 57% dont meet recommenda-tions or consuming enough ruits and vegetables in their diet.Because physical inactivity and poor diet may be risk actors orcolorectal cancer recurrence, Coups notes urther explorationin this area is needed.

We hope to have a better understanding o the degree

to which patients modiy their physical activity and dietary

behaviors as a result o their diagnosis, treatment, and potentialemotional reactions to their illness, Coups says. The inor-mation collected rom this study will help us determine whatinterventions may be successul in helping patients in this pop-ulation make healthy behavior changes. It could also serve asan intervention template or other cancers.

Study participants will complete three surveys over a six-month period to document inormation such as belies aboutdisease recurrence, current physical activity, and dietary intake.Researchers also will measure the infuence o riends andamily on the participants physical activity and eating habits.

SOURCE: CANCER INSTITUTE OF NEW JERSEY

RESEARCH BRIEFS

MARCH IS COLORECTAL CANCER AWARENESS MONTHAccording to the American Cancer Society, about

143,000 new cases o colorectal cancer are expected to bediagnosed in the United States this year. Colorectal canceris the third leading cause o cancer death among both menand women in the United States.

While the exact cause o most colorectal cancers isunknown, risk actors include poor diet, lack o exercise,

and the presence o polyps in the colon or rectal areas.Those over the age o 50 are at increased risk. Beginningat this age, its recommended that both men and womenundergo periodic colonoscopies, ecal occult blood tests,and/or other screenings that can detect colorectal cancer.Earlier testing is recommended or people with increasedrisk, such as those with a amily history o the disease.According to the Centers or Disease Control and Preven-tion, i everyone aged 50 or older were screened regularly,

as many as 60% o deaths rom this cancer could be avoided.Some signs o possible colorectal cancer include the

ollowing:bleeding rom the rectum;dark stools or blood in the stool or toilet ater having a

bowel movement;a change in bowel habits, such as diarrhea, constipa-

tion, or narrowing o the stool that lasts or more than aew days;

cramping pain in the lower stomach; andweakness, atigue, and unintended weight loss.

Studies show that maintaining a healthul weight, eatinga diet rich in ruits and vegetables, keeping physicallyactive, and limiting alcoholic beverage consumption mayprevent colorectal cancer. SOURCE: CANCER INSTITUTE OF NEW JERSEY


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Low Levels o Omega-3s May Cause Memory ProblemsA diet lacking in omega-3 atty acids may cause an individu-

als brain to age aster and lose some o its memory and think-ing abilities, according to a study published in the February 28

issue o Neurology.People with lower blood levels o omega-3 atty acids had

lower brain volumes that were equivalent to about two yearso structural brain aging, says study author Zaldy S. Tan, MD,MPH, o the Easton Center or Alzheimers Disease Researchand the division o geriatrics at UCLA.

For the study, 1,575 people with an average age o 67 andwithout dementia underwent MRI brain scans. They also were

given tests that measured mental unction, body mass, andthe omega-3 atty acid levels in their red blood cells.

The researchers ound that people whose DHA levels were

among the bottom 25% o the participants had lower brainvolume compared with people who had higher DHA levels.Similarly, participants with levels o omega-3 atty acids inthe bottom 25% also scored lower on tests o visual memoryand executive unction, such as problem solving, multitask-ing, and abstract thinking. SOURCE: AMERICAN ACADEMY OF NEUROLOGY

Low-Income Families Kids Drink Too Much JuiceA new report rom the University o Michigan C. S. MottChildrens Hospital National Poll on Childrens Healthshows that many children in low-income amilies are get-ting more than the recommended amount o ruit juice. Toavoid health problems such as childhood obesity and earlytooth decay, the American Academy o Pediatrics (AAP)recommends limiting ruit juiceconsumption in children aged 1 to 6to one serving per day.

The national poll asked parentso young children o all economic

levels about their childrens juiceconsumption. Overall, 35% o par-ents reported that their childrenaged 1 to 5 drink two or more cups o

juice during a typical daytwice theamount recommended by the AAP.

Its important to limit juice con-sumption in young children becausetheres such a strong link betweenconsumption o sugar-sweetenedbeverages and child health prob-lems like obesity and early tooth

decay, says Sarah Clark, MPH, anassociate director o the child healthevaluation and research unit at the University o Michiganand an associate director o the National Poll on ChildrensHealth. For many obese children, sugary beverages makeup a large proportion o their daily energy intake.

O parents whose household income is less than $30,000annually, 49% reported that their children drink two or morecups o juice per day. Only 23% o parents with household

incomes o $100,000 or more reported that their childrendrink the same amount.

These ndings are concerning, Clark says. Both child-hood obesity and early dental problems are more preva-lent in lower-income children, so the children were mostworried about in terms o these conditions are also those

who are drinking the most juice,she says.

Some parents may encour-age their children to drink juicebecause it can help the child

obtain the recommended serv-ings o ruit consumed each day.Parents may think juice is an easyway or their child to get a serv-ing o ruit, but its oten dicult topick out 100% ruit juice amid thesugar-sweetened juice drinks,Clark says. Parents who give theirchild juice as a healthy alterna-tive may actually be eeding themnearly as much sugar as soda.

The poll also ound that 35% o

lower-income parents said theirchilds doctor recommends juice.

This is an important message or healthcare providers aswell as parents, Clark says. Doctors need to be very spe-cic in letting parents know that whole ruit is the best way tohave a child get recommended servings o ruit and that ruit

juice should be limited to no more than one serving per dayor kids 6 years and younger. SOURCE: UNIVERSITY OF MICHIGAN HEALTH SYSTEM


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DROP THOSE POUNDSWITH YOGAStudies Show Yoga Stimulates Weight Loss

By Jennier Van Pelt, MA

Authors Note:This article is the last in a three-part series onthe health benets o yoga. In this nal installment, Ill discuss how

yoga can help promote weight loss and general health.

Most people practice yoga to improve fexibility and balance,relieve stress, and reduce aches and pains. But yoga also canhelp your clients lose weight.

While yoga generally doesnt burn as many calories as car-diovascular exercise, it does have a positive infuence on themental aspects associated with successul weight loss andweight maintenance.

Yoga can increase body awareness; counter negative, sel-judging thoughts related to eating habits; and oster a sense osel-control, according to several articles published in the 2011Yoga Journal weight loss special issue. The exact mechanismthat produces weight loss isnt known, but its likely a com-bination o physical exertion rom poses and mental benetsderived rom relaxation breathing and mindul meditation.

For yoga participants who also practice yoga philosophy,such as the Eight Limbs o Yoga, benets may result rom aocus on honesty, contentment, and letting go outside o yogaclass. Physical poses associated with weight loss involve twiststhat encourage digestion, standing poses that strengthen largermuscle groups, and orward bends that stimulate abdominalorgans and the thyroid gland.

What the Studies SayA large public health study that included

15,550 adults aged 53 to 57 measured physi-cal activity, including yoga and weight changeover several years. Practicing yoga or our or

more years was associated with a 3-lb lowerweight gain among normal-weight partici-pants (BMI o less than 25) and an 18.5-lblower weight gain among overweight sub-

jects. Regular yoga practice was associatedwith less weight gain with aging, especially inthose who were overweight.1

Recently, yoga has been incorporated intoprograms or eating disorders and weightmanagement or obesity. In a small random-ized study o yoga or obese women, thosepracticing yoga or 16 weeks had signicantly

decreased body weight, body at percent-age, BMI, waist circumerence, and visceralat area compared with those who didntexercise.2

Other researchers examined 20 personal journals o obesewomen with binge eating disorder undergoing a 12-week yogatreatment program. Qualitative analysis showed that the wom-ens perspectives about eating changed or the better. Their

journal entries suggested the yoga program developed physi-cal sel-empowerment, encouraged a healthy reconnectionwith ood habits, and cultivated awareness o sel and the pres-ent moment. Program participants reduced the amount o ood

they ate, decreased their eating speed, and improved their oodchoices during the program. Overall, the women reported eel-ing more connected and positive about their physical well-being, which translated to better eating habits.3

Fat-Burning Yoga StylesCertain types o yoga can serve as low-impact cardiorespi-

ratory exercise alternatives or clients who may have stressinjuries rom high-impact activities such as running or or thoselooking to add variety to their exercise program. Athletic andactive clients may enjoy Ashtanga or Bikram yoga that involve aprogressive series o poses designed to generate internal heat

and a puriying sweat, acilitated by a heated room, and Vin-yasa yoga, a aster-paced fowing series o yoga poses. Cli-ents also can practice sun salutations, a series o 12 poses thatcan elevate the heart and breathing rate to the higher end othe participants target heart rate range. A study o the energyexpenditure associated with sun salutations ound that per-orming the series o poses or 30 minutes produced a cardio-respiratory training eect and an energy expenditure o 230kcal4enough to burn o the calories rom eating a candy bar.

Overweight and obese clients may eel sel-conscious or dis-couraged in classes with t participants. For example, heavier

FOCUS ON FITNESS


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clients will require modications in many poses. And whileyoga instructors are trained to provide modications orbeginners and infexible people, modications or heavier indi-viduals are dierent because o anatomy and range o move-ment limitations due to size rather than infexibility.

Nonetheless, the yoga community is evolving and classessuch as Full Figure Yoga and Yoga or Real People are nowemerging.5 These types o classes are best taught by instruc-tors who are heavier themselves. I clients cant locate suchclasses, several instructional books and DVDs are available.

Jennier Van Pelt, MA, is a certied group tness instructor

and healthcare research analyst/consultant in the Reading,

Pennsylvania, area. Shes trained in SilverSneakers

YogaStretch and YogaFit or Seniors.

Reerences1. Kristal AR, Littman AJ, Benitez D, White E. Yoga prac-

tice is associated with attenuated weight gain in healthy,middle-aged men and women.Altern Ther Health Med.2005;11(4):28-33.

2. Lee JA, Kim JW, Kim DY. Eects o yoga exercise onserum adiponectin and metabolic syndrome actors in obesepostmenopausal women. Menopause. 2011;Epub ahead o

print.3. McIver S, McGartland M, OHalloran P. Overeating is

not about the ood: women describe their experience o ayoga treatment program or binge eating. Qual Health Res.2009;19(9):1234-1245.

4. Mody BS. Acute eects o Surya Namaskar on thecardiovascular & metabolic system.J Bodyw Mov Ther.2011;15(3):343-347.

5. Eckel S. Striking a pose or girth. New York Times.May 13, 2009. http://www.nytimes.com/2009/05/14/health/nutrition/14tness.html?pagewanted=all

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Best BreakfastsfromAroundtheWorldDietitians say theres much to learn from other

countries when serving this most important meal.

By Juliann Schaeffer


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T

ake a snapshot o the breakast your client isabout to enjoy and it may showcase dierentshades, textures, and ingredients, depend-ing on what corner o the world theyre rom.Theres no one picture o the perect break-

ast in terms o health, and meals will varybased on preerences within amilies, communities, andregions in a particular country. Yet most would agree thatwhen comparing nutrient proles o the morning meal amongnations, the majority o breakasts eaten in the United Statesarent likely to rank high on the list o healthulness.

I dont think we can give the title o healthiest breakast tojust one country or to a ew countries because I think there aremany denitions o a healthul breakast, says Anne VanBeber,PhD, RD, LD, a proessor and chair o the department onutritional sciences at Texas Christian University. But I de-nitely have my thoughts on what countries have the healthiest

traditional breakasts, and the United States is not one o them.This isnt to say, however, that all Americans orsake nutrient-

rich are or the nearest drive-thru. I do think there are peoplein the US who eat a very healthul breakast, she adds. Unor-tunately, its a subgroup and consists o people who are edu-cated about nutrition and ood.

In VanBebers view, the more healthul versions o breakastthat clients enjoy in the United States can include whole grainbreads with low-at cheese or nut butter or a nutrient-densecarb with a good protein source or low-at yogurt combinedwith ruit or a combination o protein, at, and carbohydrate.

Stepping outside this countrys borders can open up a

whole new world o breakast oerings. In this article, TodaysDietitian asked RDs with the knowledge o world cuisinewhether through personal experience or researchor theirpicks o countries that oer some o the more healthul break-asts rom around the globe as well as their thoughts on whatAmericans can learn rom these regions and how they mightincorporate these oods and traditions into their own morningmeal, stateside.

TurkeyAnn Diker, PhD, RD, an assistant proessor o nutrition and

chair o the health proessions department at Metropolitan

State College o Denver, says Turkey is one country with break-ast traditions worthy o bragging rights.

Diker, whose husband is rom Turkey and who travels thereregularly, says the healthulness o the traditional Turkish break-ast stems rom its inclusion o vegetables, olives, honey, and tea.

A typical Turkish breakast will include cucumbers, toma-toes, olives, eta cheese, honey or jam, French bread, and tea,with eggs or sucuk (spicy lamb sausage) thrown in a ew timesper week, Diker says.

There are many aspects o a Turkish breakast that arehealthul, Diker explains. The meal as a whole provides a

well-rounded macronutrient prole by including carbohy-drate, protein, and at. The cucumbers and tomatoes eaten

at breakast provide another opportunity or vegetables tobe consumed. Olives provide a good source o heart-healthymonounsaturated at. Honey has antimicrobial properties, andtea contains polyphenol compounds, particularly catechins,which are antioxidants.

In addition to the nutrition-packed are traditionally eatenin this country, Diker says Americans can learn rom some otheir other eating habits. For example, Turkish amilies make ita point to eat togethereven at breakastwhereas the ast-paced routine o Americans makes it even dicult to get every-one at the dinner table a ew nights a week.

One thing that Turkey gets right is the importance o gath-

ering the amily together or meals, including breakast, Dikersays. Turkish amilies sit down to breakast together, eat, andhave a conversation as opposed to eating on the run.

While this may be a stretch or many amilies in the UnitedStates, dietitians can suggest clients adopt a simpler habit tomake their morning meal a bit healthier: eat more vegetables.Try including some vegetables at breakast by simply slicingsome tomatoes and cucumbers. Drizzle them with a little oliveoil i desired, sprinkle with salt and pepper, and enjoy, Dikerrecommends.

Israel

Although Brigitte Kochavi, RD, now calls Israel her home,she was born and spent her early years in France. When com-paring the dierent breakast traditions o Europe and theMiddle East, Israel comes out ahead or healthulness, saysKochavi, whos head o pediatric clinical dietitians or Edmondand Lilly Sara Childrens Hospital at Sheba Medical Center inRamat Gan, Israel.

The most healthul breakast oods are located in the coun-tries around the Mediterranean Sea like Israel, Cyprus, andGreece, says Kochavi, whos also the Israel country represen-tation or the American Overseas Dietetic Association (AODA).

Turkey


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The Mediterranean diet emphasizes oods rich in omega-3atty acids, including whole grains, resh ruits and vegetables,sh, olive oil, and garlic consumption.

Reerring to the traditional Israeli breakast as healthul,natural, and simple, Kochavi says its almost impossible to ndmeat on any breakast plate in Israel, partly due to Kosher lawsthat require dairy and meat products be kept separate. Instead,Kochavi says many people choose to eat sh such as herring,smoked salmon, or mackerel, adding some healthul omega-3sinto the diet rst thing in the morning.

The typical Israeli breakast usually consists o the SalatKatzutz, or chopped vegetable salad, Kochavi explains. Thismeal generally includes tomatoes, red onion, parsley, cilantro,and seedless, crunchy cucumbers, with red or green pepperson occasion. All ingredients are nely chopped. Unlike most

salads in the United States, Salat Katzutz is served withoutsalad dressing, nixing the added calories customary o mostAmerican salads.

Cheese is usually a part o ones breakast in Israel, eitherTsatit, which is white cows milk cheese named or the Israelicity o Tsat, or cottage cheese, Kochavi says. Other traditionalbreakast oods include yogurt, hummus and tahini with oliveoil, pita or resh bread, and hard-boiled eggs, olives, avocado,and resh juices.

The Israeli breakast is low in saturated at and high inmonounsaturated at and dietary ber, Kochavi says.

When asked what she thinks Americans can learn rom Isra-els breakasts, she suggests taking note o kosher traditionsand swapping sh or meat or the rst protein source o theday. Instead o meat or bacon, eat sh or egg, which are alsogood sources o protein, she says.

Costa Rica

Malena Perdomo, MS, RD, CDE, an adjunct proessor atMetropolitan State College o Denver, proclaims Costa Rica asa country with breakast benets engrained in its culture.

Costa Rica loves the dish gallo pinto or breakast, whichis rice and black beans and eggs on the side, she says. Thisbreakast will last or several hours, and you will be able towork nonstop until lunchtime, she says, noting that manypeople in this country do just that.

This countrys breakast is also high in ber, another reasonor its healthulness. [People living in Costa Rica] arenteating sweet rolls or sweets or breakast. Instead, theyreeating protein, ber, and complex carbohydrates, with most

enjoying resh ruit or a small glass o resh ruit juice to roundout the meal.

Patricia H. Terry, PhD, RD, LD, a proessor and director othe didactic program in dietetics at Samord University, whohas traveled extensively and who currently is teaching a class inCosta Rica, also believes the country has much to teach aboutbreakast.

Terry explains that the Nicoya Peninsula o Costa Rica isone o the Blue Zones, which are parts o the world that havebeen studied due to their populations living measurably longeron average compared with other countries. She says the typi-cal Costa Rican breakast includes lots o pineapples, oranges,

mango, papaya, corn, beans, rice, squash o all kinds, reshcheese, and eggsoods likely to be oreign to Americans atbreakast time.

Fish, vegetables, soup, and nuts or breakast? Yes, andmuch more, Terry says. Why? Because its not what oodsyou eat or breakast but the nutrients in those oods that areimportant, she says, adding that this is one habit Americansmight do well to adopt to improve their liestyle.

While Perdomo says slowing down to enjoy a regular break-ast is one way to incorporate Costa Rican traditions into Ameri-cans lives, her suggestion or using last nights letovers could

Costa Rica

srael


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be more easible or time-crunched amilies. For example, theCosta Rican breakast o rice and black beans are made withletover rice and beans. We can be reminded o how to throwless ood away and use everything that we cook and eat it orbreakast, she says.

ChinaMargaret Keee, RD, chie representative or Eat Well Shang-

hai in China and a country representation or the AODA, saysAsian and European countries tend to have a leg up on healthulbreakast habits. Having lived in Shanghai or 15 years, Keeesays, Both o these regions tend to have an equal balance oprotein and carbohydrates in the morning meal and dont tradi-tionally have sweet oods or breakast.

Keee is coauthor o the Eat Well China app, a nutrition/travelapp or smartphones and the iPad, which has a whole sectiondevoted to the healthul aspects o the Eastern diet. She says

a typical Chinese breakast might consist o a dumpling or bunlled with vegetables or meat, along with a cup o soymilk tea,or a soupy rice porridge called congee. Keee says both o thesebreakast choices are low in at and sugar and allow or an earlyopportunity to incorporate vegetables into the daily diet.

A avorite street-side breakast ood is a jian bing, Keeesays. Jian bing, considered a popular option with nutrient-dense properties, consists o a very thin, crepelike pancakecooked on a hot drum. The pancake is covered with greenonions, a spicy chili/bean paste, and then topped with an egg.Once the egg cooks, the pancake is rolled up, sliced in hal, andserved hot to the waiting customer.

While she says this option isnt necessarily low calorie, itshearty qualities keep you going until lunch. Its an excellentcombination o carbohydrate and proteinpancake and eggwith a healthul dose o green onion and a bit o ber rom thespicy chili/bean paste.

For Americans looking to behave more like the Chinese atbreakast time, Keee advises stepping away rom the assump-tion that breakast equals sweetness. I think Americans needto try having vegetables or breakast and incorporating dier-ent kinds o protein in their morning meal, Keee says. Alsowe could benet rom giving up the idea that breakast oodsshould be sweet.

For an American-style jian bing, take a crepe and ll it with aried egg, green onions, and chili sauce, then wrap it all togetherand youre good to go, she suggests. Keee says congee, Chi-nese rice, could be made healthier by using brown rice andadding dried ruits as well, noting that congee is great or thoseshort on time, as it can be easily made in a slow cooker.

VenezuelaIn Venezuela, as well as in other Latin American countries

such as Colombia, Ecuador, and Per, the high consumption ocorn is a big part o what gives this cuisine high marks. [Corn]

has been a good source o nutrients as well as ber when itsbeen used rom scratch to make bread, tortillas, or arepas,says Marianella Herrera, MD, MSc, an assistant proessorat the Universidad Central de Venezuela, president o theVenezuelan Scientic Society or Obesity, and Venezuela coun-

try representative or the AODA.A Venezuelan breakast oten includes baked corn four

bread called arepas, which are lled with cheese, sh, bee,or chicken, or eaten as a side with shredded bee, black beans,

Queso Blanco (Farmers Cheese)

Yields 2 cups; serves 16

Farmers cheese is a type o sot, white, unripened

cheese thats made all over the world. Goats, sheep, andcattle all provide milk or armers cheese, which alsocan be made rom the milk o more exotic animals suchas yaks. Many grocers and dairies sell the unaged whitecheese, which is suitable or a wide range o uses. Sincethe cheese is quick and easy to make, its been tradition-ally associated with armers, who originally made it orhome consumption only.

Ingredients

1 gallon whole milk (preerably rom grass-ed

cows)

1 pinch salt1 large lemon, juiced

Directions1. Pour the milk into a large pot and stir in a pinch o

salt. Bring to a boil over medium heat, stirring occasion-ally to prevent the milk rom scorching on the bottom othe pot.

2. When the milk begins to boil (small bubbles willrst appear at the edges), turn o the heat. Stir lemon

juice into the milk, and the milk will curdle. You mayneed to wait 5 or 10 minutes.

3. Line a sieve or colander with a cheesecloth andpour the milk through the cloth to catch the curds. Whatis let in the cheesecloth is the Farmers Cheese. Theliquid is the whey.

4. Gather the cloth around the cheese, and squeezeout as much o the whey as you can.

5. Wrap in plastic, or place in an airtight container.Store in the rerigerator.

RECIPE PROVIDED BY PATRICIA H. TERRY, PHD, RD, LD


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white cheese, avocados, and/or resh ruit juices. So we havegood sources o protein, carbohydrates, dairy, ruit, and ber,Herrera says.

She notes that arepas oer a great gluten-ree ber source,with avocados providing benecial polyunsaturated atty acids.

Typical llings o shredded bee and chicken are good sourceso protein, with shredded sh oering some extra omega-3sand phosphorus.

Black beans, also a mainstay o this countrys breakasts,contain favonoids, ber, and olic acid, and the white cheesetypically eaten with this meal is a great source o calcium. Toround out the meal, Venezuelans enjoy resh ruit juices such aspapaya, mango, watermelon, orange, tangerine, cantaloupe, orpineapple, all o which add their own array o vitamins.

Herrera suggests RDs discuss the benets o resh ruitjuices with clients looking to adopt a Venezuelan breakast tra-dition, noting that resh ruit juices (emphasis on resh) can pro-

vide a great way to obtain ones daily ruit requirements whileavoiding the added sugar rom premade juices.

VietnamAccording to VanBeber, who has extensive travel experience

and teaches a ood and culture course at Texas ChristianUniversity, some o the healthiest breakast habits lie in south-east Asia. The southeast Asian countries, including Vietnam,Cambodia, Laos, and Thailand, consume healthul breakaststhat include a bowl o noodles, she says.

VanBeber explains that the traditional soup o Vietnam, pho,is broth based and includes rice noodles as the base, with a

condiment o protein such as chicken, meatballs, bee, or porkas well as a plethora o vegetables and herbs, including basil,cilantro, bean sprouts, carrots, cucumber, and lime.

All breakasts should include a source o protein, carbohy-drate, and a small amount o at, she says. This breakast opho includes these three energy nutrients in a delicious, low-calorie, low-at way.

Dina Aronson, MS, RD, part o the advisory counsel or Fit-Orbit, whose global breakast knowledge is based primarily onher education and research, also says Asian countries tend tohave breakasts healthier than most. Their breakasts almostinvariably include vegetables, while sweetsi they make an

appearance at allplay only an accompanying role, she says.Clients who are open to eating noodles or breakast can

plan this by making extra or dinner the night beore, VanBebersays. Dont be araid to eat oods or breakast that we mightconsider lunch or dinner oods. These oods oten have a bettercombination o protein, carbohydrate, and at than the commonbreakast, which consists o processed cereal, she adds.

Aronson agrees, noting that it might help RDs to tell clientsthat its OK to see ood as just oodnot breakast vs. non-breakast oods. She says that people in Vietnam eat the sameoods in the morning as those eaten or later meals. Since their

cuisine is so vegetable heavy, this means that veggies play astarring role in their meals several times a day as opposed to

just onceat dinneras is common or so many Americans.Whether its cooking noodles the night beore or simply

slowing down to eat and enjoy the 7 am eating routine, Aronsonsays the most important message to take away rom exploringother cultures traditions is that a healthul breakast is possi-ble or everyoneand whatever healthul habit clients are will-ing to adopt is the best one.

I think that while health is a priority, its also important toexamine and stay true to social, cultural, and dietary preer-

ences, Aronson says. Some o us might embrace a majorchange, while others may not welcome the morning with a bigbowl o noodles and vegetables foating in bee broth with a sideo sh sauce, she says. But there are so many ways to do itright. We can take basic healthul breakast tenetshigh ber,high water, and whole plantsand create our own delectabledelights, whether a ruit smoothie, hot whole grain cereal withnuts and ruit, a hearty soup, or a veggie-packed omelette.

Juliann Schaeer is an associate editor at Great Valley

Publishing Company and a requent contributor to Todays Dietitian.

Arepas

Serves 6

Ingredients2 cups o precooked corn four

2 cups o warm water

Pinch o salt

1 T o canola oil

Directions1. In a bowl, combine salt and four, then add the

water and oil and stir all the ingredients until homoge-neous. Work the mixture by hand until smooth.

2. Divide dough into pieces (12 to 20 or small, six to

10 or medium), based on the preerred size o arepas.Shape each piece into a small ball, then work the ballsuntil they are in the shape o a disc. Put the arepas in ahot pan previously sprayed with oil and let them cook atmedium temperature, fipping once, or 6 to 8 minutes,or until rm. Arepas should be slightly golden and crispyon the outside and smooth inside.

3. For children, you may use carrot juice or spinachjuice to add colors to arepas.

4. Fill them with cheese, ham, turkey, bee, etc.

RECIPE PROVIDED BY MARIANELLA HERRERA, MD, MSC


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Good mornings

begin here.A cereal breakfast. Why its the best way to start the day.

Sugar

Cereal contributes just four

percent of daily addedsugar intake in the US diet.5

4%

Fiber

One of the most beneficial

nutrients in cereal grains is

fiber, and Kellogg has beenan advocate of higher fiber

diets since introducing Bran

Flakes, the first high-fiber

cereal, in 1915.

Convenience

Nine out of ten moms agree

that cereal is a convenient

breakfast choice. Ready-

to-eat cereal gives them an

easy way to give their

families the nutritious start

they need.1

9 10outof

Dairy

Ninety-five percent of

ready-to-eat cereal

is eaten with milk, making

breakfast cereal an

important driver for

milk intake.4

95%

Lower BMIs

Breakfast cereal eaters

have been found to havelower BMIs. Research

suggests that breakfast

consumption, and

specifically ready-to-eat

cereal, has a positive

relationship to healthy

body weights and

improved diet quality

for adolescents.3

Sodium

Cereal contributes just three

percent of the total sodiumin the US diet.2

3%

Hungry for more? Visit kelloggsnutrition.com/td

, TM, 2012 Kellogg NA Co.

1. July 1318, 2010 Braun Research & Kellogg Company. 2. National Health and Nutrition Examination Sur vey Data (20032006). Centers for Disease Control and Prevention (CDC). National Center for Health

Statistics (NCHS). Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; data for boys and girls 617 years of age. 3. ONeil, CE, M. Zanovec, TA Nicklas and

SS Cho (2012) Presweetened and Nonpresweetened Ready-to-Eat Cereals at Breakfast Are Associated With Improved Nutrient Intake but Not With I ncreased Body Weight of Children and Adolescents: NHANES

19992002. Am J Lifestyle Med. 6(1):6374. 4. Song, WO, OK Chun, J Kerver, S Cho, CE Chung, S Chung (2006) Ready-to-Eat Breakfast Cereal Consumption Enhances Milk and Calcium Intake in the U S Population.J Am Diet Assoc. 2006;106:17831789. 5. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans (DGA), 2010. 7th Edition, Washington, DC: U.S.

Government Printing Office, December 2010.

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A

s obesity and chronic disease soar in many cultures around the

world, Arican Americans seem to be the hardest hit. Black

women have the highest rates o obesity compared with other

ethnic groups in the United States. Specically, about our o veArican American women are categorized as overweight or obese.1

Along with the weight disparity come health disparities: Black adults are

twice as likely as white adults to have a stroke,2 twice as likely to be diag-

nosed with diabetes,3 and 1.5 times as likely to have high blood pressure.4

Arican Americans not only experience higher prevalence rates o these

health problems, but theyre also more likely to die rom them. For example,

black Americans are 2.3 times as likely to die rom diabetes complications.3

And although black women are 10% less likely to be diagnosed with breast

cancer, theyre almost 40% more likely to die rom the disease.5

HeritageObtaining HealthThroughA Diet Rooted in African Traditions May Be the

Path to Optimal Health for African Americans

By Constance Brown-Riggs, MSEd, RD, CDE, CDN


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Is Soul Food Putting the Die in Diet?Why are Arican Americans disproportionately aected by

conditions that are so common but oten preventable? Manyexperts blame the proverbial soul ood dietthe cooking andeating traditions that oten include dishes that are deep ried

or cooked all day, soaked in at, and laden with salt, sugar,and calories.

Such severe health problems cant be attributed primarilyto soul ood, according to Sara Baer-Sinnott, president o Old-ways, a nonprot organization perhaps best known or creatingthe Mediterranean Diet Pyramid and other culturally specicdietary guidelines.

These disparities go beyond eating soul ood, she says.There are many actors that have led to poor outcomeseconomics, changes in amily structure, lack o access tohealthul ood, and perceptions about time needed or cookingand shopping.

Still, she and her colleagues at Oldways understand that ahealthul diet goes a long way in improving overall health. Theorganization developed a program or Arican Americans thatemphasizes the relationship between diet and general health;educates them about the possibility o improving ones healththrough a heritage diet; and promotes healthul, delicious,aordable meals to encourage people in black cultural com-munities to eat well.

The important word here is communitiesplural. There areapproximately 40 million people o Arican descent living in theUnited States. Some have been in the United States or manygenerations; others are more recent immigrants rom Arica,

the Caribbean, or other parts o the world.6 What and how theyeat may dier signicantlyat least until immigrants becomeacculturated.

Scientic studies show that many chronic conditions nowprevalent in Arican American communities appear in [blackimmigrant] populations as traditional diets are let behind,Baer-Sinnott says. Studies have shown that when peopleadopt a more westernized diet, their susceptibility to healthproblems increases.

For example, research published in a 2010 volume otheJournal o Biomedical Science ound that the preva-lence o metabolic syndrome in young Tanzanian men

increased as they ate more nontraditional oods suchas donuts and ice cream and less traditional oods.The same trend can be ound in Botswana.7 Asyounger populations shit rom traditional to non-traditional liestyles, weight, blood pressure,and cholesterol levelssigns o metabolic syn-dromerise. The elderly, who are less inclined tochange their eating habits, are actually healthier.

According to Sarah Dwyer, program managerat Oldways and the team leader or the Ari-can Heritage & Health Initiative, since Aricans

who eat traditional oods rom Arica are healthier than thosewho adopt a typical Western diet, the research suggests thata healthul Arican American diet should go back to its roots.To help develop a cultural model or healthul eating based onthe traditional diets o the Arican diaspora, Oldways brought

together a team o culinary historians, nutrition scientists, andpublic health experts to examine oods Aricans ate in Arica aswell as how they adapted their diet when they were brought tothe Americas during the slave trade.

Healthul HeritageCulinary historian and cookbook author Jessica Harris says

the traditional Arican diet is largely vegetarian. There wasnt alot o animal protein, she says. Dried or smoked sh was oundin riverine or ocean areas, and wild game was used as a season-ing unless there was some degree o easting or estivity.

Across Arica, a variety o whole grains and starchy veg-

etables serve as the base or meals. Millet and sorghum areound in the area around Mali; rice in Senegal, Guinea, Liberia,and Sierra Leone. Further south in Ghana and the Ivory Coastyou nd yams, Harris says.

African Heritage Diet Pyramid


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The Transatlantic Slave Trade was one o the major waysthe ood o Arica showed up in various infections on theplate throughout the diaspora, says Harris, also a membero Oldways advisory board. Enslaved Aricans in the Amer-icas cooked and ate in ways that were amiliar to them,

making doand oten making magicwith ingredients theyound around them. In the southern United States, they weregiven some provisions such as cornmeal, beans, or a bit opork, but Harris says, They had to supplement their diet withoraging or growing their own ood. Cabbage, okra, toma-toes, peppers, and a variety o greens were abundant, so theywere added to the pot.

Because o the climate in the Caribbean, they had moreopportunity to grow things that were closer to Arica, likeyams, Harris continues. The Caribbean diet included tropi-cal ruits like papaya and guava as well as rice and pigeonpeas. In South America, tubers such as yucca and cassava as

well as okra, peanuts, and plantains were part o the plate.8

The result: a varied culinary legacy based on Arican reten-tions and the creative resourceulness o Aricans replanted inthe Americasall o which is refected in the Arican HeritageDiet Pyramid that Oldways and its advisory team o expertsintroduced in November 2011.

Baer-Sinnott describes the pyramid as an evidence-basedpractical tool designed to help Arican Americans rerametheir daily diets based on the healthul eating patterns o theirancestors.

As in other pyramids, the Arican Heritage Diet Pyramidillustrates which oods should be eaten in abundance and those

that should be eaten less requently. Based on staples rom theArican diaspora, the Arican Heritage Diet promotes beans andpeas, whole grains, ruits, peanuts and nuts, vegetables, andtubers. Because o their nutritional benet and overwhelmingappearance throughout the diaspora, greens have been placedin a category all their own.

The pyramid suggests sh and seaood be added to the plateat least two times per week as a rich source o omega-3 attyacids that can help lower blood pressure and protect againstheart disease. Like other traditional heritage diets, this pyramidsuggest that eggs, poultry, and other meats be eaten in smallportions or used to garnish other dishes.

Herbs and spices also are given a prominent position in thepyramid to promote the use o homemade sauces and to boostfavor without adding salt. Healthul oils and dairy also areencouraged in small quantities, and sweets top the pyramid asoods to eat only occasionally.



FOODS WITH CULTURALSIGNIFICANCEFoods o Western and Central Arica

Infuences: Portuguese, Asian, Indian, Middle Eastern

Grains:millet,sorghum,wheat,riceBeans:black-eyedpeas,chickpeas,lentils

Tubers:cassava,manioc,yams

Vegetables:leafygreens,cabbage,okra

Fruits:watermelon,tamarind,plums,dates,gs,

pomegranates

Meats:beef,lamb,goat,camel,poultry,wildgame

Oils:sheabutter,sesameoil,palmoil

Milk:cow,goat,sheep,camel

Diaspora Foods: American South

Infuences: French, Spanish, Arican, Haitian, BritishGrains:rice,grits,cornmeal

Beans:black-eyedpeas,kidneybeans

Tubers:sweetpotatoes

Vegetables:dandelion,watercress,otherleafy

greens such as cabbage, okra, tomatoes, peppers,green beans

Fruit:apples,berries,watermelon

Seafood:oysters,crabs,shrimp

Meats:beef,chicken,pork,wildgame

Aro-Caribbean FoodsInfuences: French, Arican, British, Spanish

Grain:rice

Beansandpeas:pigeonpeas,blackbeans,kidney

beans

Tubers:breadfruit,yams,plantains,pumpkins

Vegetables:leafygreenssuchascallaloo,okra

Fruit:papaya,guava

Seafood:saltshandconch,redsnapper

Meat:chicken,goat,beef,pork

Aro-South American FoodsInfuences: Native American, Spanish, Portuguese

Grains:rice,corn,wheat

Beans:blackbeans,pintobeans,redbeans

Tubers:yucca,cassava

Vegetables:okra,cabbage,kale

Fruits:mangoes,guava,acerola

Seafood:redsnapper,codsh,shrimp

Meat:beef,pork,poultry,chicken


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The result is a plant-based diet low in unhealthul ats,sugars, and sodium; high in nutrient-dense whole oods; androbust in favor. It naturally mirrors medical recommendationssuch as the 2010 Dietary Guidelines while ully embracingArican-based ood ways that are centuries old.

Putting the Pyramid Into PracticeTo help black amilies apply the inormation rom the pyra-

mid to the plate, Oldways developed 12 plates o expressionexamples o the kinds o savory, spicy dishes that have animportant place in the realm o healthul soul ood.

These plates also depict real oods and real meals thattranslate the science o the pyramid into a healthul deliciousplate, Baer-Sinnott says. Examples include healthul reci-pes or Hoppin John rom the American South, West Aricanpeanut soup, grilled snapper with mangoes rom the Carib-bean, and Moqueca de Peixe (Brazilian sh stew).

The pyramid doesnt ocus solely on ood; it also advo-cates a holistic approach to a more healthul lie. The base othe pyramid illustrates people engaged in enjoyable activi-ties such as exercise, gardening, cooking, and sharing amilymealsactivities that go hand in hand with a nutritious dietto promote good health.

Claiming History, Claiming HealthAngela Ginn, RD, LDN, CDE, a spokesperson or the Acad-

emy o Nutrition and Dietetics, says the response among herpatients has been most positive.

I see people who are Guyanese, Trinidadian, Jamaican

rom all areas, she says. When they see the Arican HeritageDiet Pyramid, their response is one o nostalgia: This is whatI ate when I was home or This is what I ate when I went to mygrandmothers house.

Ginn believes that a diet option with cultural connectionsresonates more with her patients because, among AricanAmericans, a meal isnt just the ood on the plate; its a wholeexperience. I I can put an experience around healthuleatingeeling good about your past and bringing itto everydaythat will help make it more o a lie-style, Ginn says. Then its not just a diet; its away o lie patients can embrace, sustain, and

be proud o.

Constance Brown-Riggs,

MSEd, RD, CDE, CDN, is the

national spokesperson or the

Academy o Nutrition and Dietetics,

specializing in Arican American

Nutrition, and author o The African

American Guide to Living Well With

Diabetes and Eating Soulfully and

Healthfully With Diabetes.

West Arican Peanut SoupRecipe courtesy o Oldways

Serves 6

Ingredients2 T olive oil

2 medium-size onions, nely chopped

2 large red or green bell peppers, nely diced

6 large garlic cloves, minced

1 (28-oz) can crushed tomatoes, using the liquid

4 cups vegetable broth12 tsp pepper12 tsp chili powder23 cup extra crunchy peanut butter

1 T resh cilantro

Directions1. Heat olive oil in a large pot over medium heat. Cook

onions and bell peppers until lightly browned and tender,adding in garlic when almost done to keep the garlic romburning.

2. Stir in tomatoes and their liquid, vegetable broth,pepper, and chili powder.

3. Reduce heat to low, uncover, and simmer or 15minutes.

4. Stir in peanut butter and cilantro until well blended,and serve.

Nutrient Analysis per servingCalories: 262; Protein: 10 g; Carbohydrate: 24 g; Fiber:

7 g; Total Fat: 16 g; Saturated Fat: 3 g; Trans Fat: 0 g; Choles-terol: 0 mg; Sodium: 297 mg

IMAGECOURTESYOFOLDWAYS

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Moqueca De Peixe (Brazilian Fish Stew)Recipe courtesy o Oldways

Serves 4

IngredientsFour 12-inch llets o any whitesh, like cod

2 garlic cloves, minced

2 lemons or 4 T o lemon juice

A pinch o salt and black pepper (to taste)

2 onions, nely sliced

1 small green bell pepper, seeded and sliced into strips

2 tomatoes, diced

1 tsp coriander

1 T tomato paste13 cup o olive oil34 cup o light coconut milk

Directions1. Rinse the sh and place it in a bowl with garlic, lemon

juice, salt, and pepper. Let the sh marinate while you prepeverything else.

2. Place the oil in a pan and saut the onions, green pepper,tomatoes, coriander, and tomato paste. When the onions aretranslucent, bring the sauce to a boil and add the sh lletsand the marinade. Lower the heat to medium and cook or 5to 8 minutes. When the sh is almost done (about 5 minutes),add the coconut milk and bring the mixture to one last boil ora minute or so.

3. Serve hot, alone or over brown rice, with a watercresssalad. Shellsh can be substituted or whitesh.

Nutrient Analysis per servingCalories: 191; Protein: 10 g; Carbohydrate: 7 g; Fiber: 1 g;

Total Fat: 15 g; Saturated Fat: 3 g; Trans Fat: 0 g; Cholesterol:23 mg; Sodium: 8 mg

Grilled Red Snapper With MangoesRecipe courtesy o Oldways

Serves 4

Ingredients2 to 3 T o olive oil

5 T resh cilantro, nely chopped

3 T resh lime juice

112 tsp grated lime peel

2 pinches o salt, divided

2 pinches o pepper, divided

1 large mango, peeled, cut into thick wedges

4 5- to 6-oz red snapper llets

1 tsp o cumin seeds

1 lb green beans

2 red bell peppers, cut into slices

8 large red-lea lettuce leaves

Directions1. Stir the oil, cilantro, lime juice, and lime peel in small

bowl to make the vinaigrette. Add pinches o salt and pepper.2. With hal o the vinaigrette, cover all sides o the mango

slices rst and sh llets second, saving the rest to drizzle onater theyre cooked.

3. Sprinkle sh and mango with the rest o the salt andpepper and cumin seeds. Grill or broil sh on one side, turningthem over ater about 6 minutes, when the sh centers lookcooked-through and the mango is sot and beginning to brown.

Green beans and peppers

1. In a medium-size pot, boil a small amount o water. Putwashed green beans and bell peppers into a strainer andsteam over the water, covered, or about 6-8 minutes.

2. Place 2 lettuce leaves on each o 4 plates. Top them withthe sh and mango, and ha

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