Drinks, Desserts, Snacks, Eating Out, and Salt

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Marvin Jeremy Andrews
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1 Snacks, Eating Out, Session 3 Assessment Background Information Tips Goals

Assessment On an average DAY, Desirable Could be improved Needs to be improved 1a. How many 12-ounce servings of sugar-sweetened beverages do you drink?

3 Assessment On an average DAY, Desirable Could be improved Needs to be improved 1a. How many 12-ounce servings of sugar-sweetened beverages do you drink? Sugar-sweetened beverages include regular sodas, bottled fruit drinks, and Kool-Aid (including drinks like Coke, Pepsi, Sprite, Snapple, lemonade, or fruitade and sports or energy drinks). Do NOT include coffee or tea, or beverages with artificial sweeteners like Crystal Light b. How many 12-ounce servings of iced tea or coffee do you drink a day? If 1 or more, answer the next question. Is the iced tea or coffee unsweetened (include artificially sweetened), half sweetened, or sweet tea or coffee? unsweetened half sweetened sweet tea or coffee 1c. How many cups of hot tea or coffee do you drink per day? If 1 or more, answer the next question. How much sugar do you add to each cup (do not include artificial sweeteners)? None 1-2 teaspoons 3+ teaspoons In an average WEEK, how many servings of these foods do you eat? 2. Doughnuts, sweet rolls, pies, cakes, cookies, or candy (do not include dark chocolate) 3. Frozen desserts like ice cream, ice milk, sherbet, or frozen yogurt 4. Snack chips (like potato chips, corn chips, tortilla chips, or cheese puffs), crackers, or pretzels In an average WEEK How many times do you eat out at restaurants, get food delivered, or get carry-out from restaurants? (Include fast-food restaurants.) UNC-CH Center for Health Promotion and Disease Prevention & Salt 53

Background Information Why Should I Limit Sugar-Sweetened Drinks, Like Regular Soda, Sports and Energy Drinks, and Sweet Tea? Sugar-sweetened drinks contain a lot of sugar to make them taste good.

4 Background Information Why Should I Limit Sugar-Sweetened Drinks, Like Regular Soda, Sports and Energy Drinks, and Sweet Tea? Sugar-sweetened drinks contain a lot of sugar to make them taste good. It is the high sugar content that makes these drinks unhealthy for everyone and raises the blood sugar for those with diabetes. About ½ of the typical Americans sugar intake is from sugar-sweetened drinks. Sugars add lots of extra calories, but no nutrition (they don t have vitamins, minerals, fiber, etc.). An average 12-ounce soda has 140 calories, which is about 9 teaspoons of sugar. Sugar-sweetened drinks don t make you feel full, leaving you hungry and wanting more food. Drinking sugar-sweetened drinks each day can increase your risk of becoming overweight or developing diabetes. How Do I Know if My Drink Has Added Sugar? One way to do this is by checking the drink label for sugars. Also, common types of sugar-sweetened drinks include: Non-diet sodas (soft drinks) Fruit punch and lemonade Sports and energy drinks Sweet tea Kool-Aid Sweetened coffee drinks Limit sodas and other sugary drinks. If I Limit Sugar-Sweetened Drinks, What Can I Drink Instead? When people hear they should limit sugar-sweetened drinks, they often ask, What can I drink instead? In fact, there are many options that don t have a lot of added sugar, including: Plain water, with a twist of lemon or lime for a fresh taste. Carbonated water (Seltzer water) mixed with a splash of 100% fruit juice. A small amount of 100% fruit juice (half a cup). Plain milk. Unsweetened or lightly sweetened iced tea, hot or herbal tea, or coffee. If you need to sweeten your tea or coffee, 1 to 2 teaspoons of sugar per cup or glass is okay. Half and half or milk are OK too. 54 & Salt 2017 UNC-CH Center for Health Promotion and Disease Prevention

Background Information What Else Should I Know About Choosing Drinks? In some studies, artificial sweeteners seem to cause weight gain and increase the risk for diabetes.

Some studies suggest a small amount of alcohol may reduce the risk of heart disease and most studies suggest small amounts of alcohol do not cause harm.

5 Background Information What Else Should I Know About Choosing Drinks? In some studies, artificial sweeteners seem to cause weight gain and increase the risk for diabetes. So it is best to limit diet sodas and use of artificial sweeteners in tea or coffee to once a day or less (or not drink artificially sweetened drinks at all). Small amounts of alcohol are okay. Some studies suggest a small amount of alcohol may reduce the risk of heart disease and most studies suggest small amounts of alcohol do not cause harm. A small amount of alcohol is 1 drink per day for a woman or up to 2 drinks per day for a man. A drink is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of liquor. Alcohol is not recommended as a way to avoid heart disease because of its other effects. For instance, even small amounts of alcohol in women may increase a woman s chance of getting breast cancer. Additionally, drinking large amounts has many other harmful effects. Now that you ve learned about how to choose healthier drinks, it is time to learn some more about desserts, sweets, and snacks. Desserts, Sweets, and Snacks As you have been learning, making healthy food choices doesn t mean you can t enjoy what you eat. There are many foods that are naturally sweet or enjoyable and are still good for you. How Can I Enjoy Desserts and Sweets and Still Eat Healthy? You can eat desserts and sweets and still have a healthy diet. Whether you have diabetes or not, think carefully about what type of sweets to eat and how much and how often. About 1/3 of Americans sugar intake comes from snacks and sweets. So, it is a good idea to fill up on healthy foods, so that you are not as hungry for desserts and sweets. Here are some tips for enjoying desserts and sweets: 2017 UNC-CH Center for Health Promotion and Disease Prevention & Salt 55

Background Information Save sweets for special occasions (birthdays and holidays) and a couple of times per week or less. Try eating fruit as a naturally sweet and healthy dessert.

A small amount of dark chocolate (more than 50% cocoa solids), such as half to one ounce, is a good choice for dessert. The higher the cocoa solid content, the less sugar.

6 Background Information Save sweets for special occasions (birthdays and holidays) and a couple of times per week or less. Try eating fruit as a naturally sweet and healthy dessert. Chocolate may reduce the risk of heart disease and dark chocolate may be better for your heart than regular chocolate. A small amount of dark chocolate (more than 50% cocoa solids), such as half to one ounce, is a good choice for dessert. The higher the cocoa solid content, the less sugar. For those with diabetes, 70% cocoa or higher is best. In general, stay away from store-bought doughnuts, sweet rolls, pies, cakes, cookies, caramel candies, and cream-filled desserts. These foods have lots of sugar. Try making your own desserts (See pages in Cookbook.) How Can I Enjoy Snacks and Still Eat Healthy? There is nothing wrong with eating snacks between meals. As you ve heard before, fruits, vegetables, and nuts are good snack choices. But, many people crave other snacks such as chips and crackers. It is okay to eat chips and crackers now and then. Healthier options for snack chips and crackers can be found in most stores. Here are some tips for healthier chip and crackers choices: Choose chips and crackers that are made with vegetable oils. Consider the lightly salted options. For crackers, choose whole wheat or whole grains. Pay attention to portion size since it is easy to overdo it on the chips. Take a small serving out of the bag and then close the bag and put it away. Try making popcorn at home. It s easy, does not cost much, and tastes great. You can even try adding your own spices. 56 & Salt 2017 UNC-CH Center for Health Promotion and Disease Prevention

Background Information Eating Out When eating away from home it is often hard to make healthy choices. Knowing what to eat at restaurants can be especially hard.

7 Background Information Eating Out When eating away from home it is often hard to make healthy choices. Knowing what to eat at restaurants can be especially hard. In this section, we review ways to eat out and still be good to your heart. What Are Some Healthier Choices I Can Make When Eating Out? Fast food can be convenient, tasty, and doesn t cost a lot, but many options at fast food restaurants are not healthy. If you eat at fast food restaurants, remember: Stay away from the large or supersized sugarsweetened beverages. Consider other drink options reviewed earlier in this section. Select healthy sides like fruit cups or side salad. Order whole wheat bread or buns if available, rather than white bread. Ask for the Nutrition Facts sheet to help make the best choices. Û Û At fast food restaurants, spicy often means salty. Check the menu item and if it has more than 1000 mg of sodium, consider ordering something else that has less sodium UNC-CH Center for Health Promotion and Disease Prevention & Salt 57

Background Information When You Eat at Sit-Down Restaurants: If you think you may not finish the meal, ask for a take-away container when you first get your meal, so you will not be tempted to clean

When eating out, there may not be as many healthy options as you d like. So it s important to have a plan for picking the most healthful foods.

8 Background Information When You Eat at Sit-Down Restaurants: If you think you may not finish the meal, ask for a take-away container when you first get your meal, so you will not be tempted to clean your plate when you are full. Avoid all-you-can-eat buffets or, if you eat at one, have a good plan about what you will eat. What Are Some Other Strategies for Eating Out? When eating out, there may not be as many healthy options as you d like. So it s important to have a plan for picking the most healthful foods. Planning ahead is especially important if you are eating fast food. To make healthy choices when dining out, Limit sugar sweetened beverages. For breakfast, try eggs on a whole wheat muffin or with whole wheat toast. Enjoy a burger or sandwich as your meal, on a whole wheat bun or bread, if available. Pizza with veggies is a reasonable choice. Most entrees at sit down restaurants are fine. Consider a side other than fries or potatoes, such as salad, fruit, or vegetables. Or consider ordering a large salad for your meal. Û Û If you order fries or dessert, get a small portion or share a larger one. 58 & Salt 2017 UNC-CH Center for Health Promotion and Disease Prevention

Background Information What About Sodium (Salt)? Experts are not sure how much sodium is best for heart health, but most agree that large amounts of sodium should be avoided.

If you follow the food suggestions in this program and do not eat out very often (often is more than twice a week), your sodium intake will likely be fine.

9 Background Information What About Sodium (Salt)? Experts are not sure how much sodium is best for heart health, but most agree that large amounts of sodium should be avoided. To lower the amount of salt you are eating, keep in mind that most of the salt in your diet comes from processed and restaurant foods rather than from the salt shaker. If you follow the food suggestions in this program and do not eat out very often (often is more than twice a week), your sodium intake will likely be fine. When eating at fast food restaurants, try to keep the total sodium amount of each meal less than 1500 mg. Most fast food restaurants have lists with sodium content of all menu items. At fast food restaurants, spicy often means salty. Check the menu item and if it has more than 1000 mg of sodium, consider ordering something else that has less sodium. Avoid regular consumption of food high in sodium. If you eat canned vegetables or beans, it is best to use the lower sodium option. Which Types of Foods Are Usually High in Salt? The following processed foods are high in sodium: Boxed and frozen dinners (like macaroni & cheese or Hamburger Helper ) Canned soups and vegetables Frozen vegetables with sauces Frozen pizzas Cheese sauces Bacon, ham, sausage, hot dogs Limit High Salt Boxed Dinners 2017 UNC-CH Center for Health Promotion and Disease Prevention & Salt 59

Background Information What Can I Use Instead of Salt to Season My Food? Lowering salt doesn t have to mean poor taste. Many herbs and spices can be as flavorful as salt.

10 Background Information What Can I Use Instead of Salt to Season My Food? Lowering salt doesn t have to mean poor taste. Many herbs and spices can be as flavorful as salt. To bring out the flavor in your foods without adding salt, try the following herbs and spices. For beef: Use sage, garlic, thyme, pepper, or turmeric. For chicken: Use paprika, rosemary, curry, or garlic or onion powder. For pork: Use thyme, basil, sage, pepper, curry, or garlic or onion powder. For fish: Use lemon or lime juice, dill, or garlic or onion powder. Try Mrs. Dash or make your own herb and spice mixture. Keep it in a shaker and use when cooking or at the table. Û Û Be careful! Some seasonings and sauces have lots of salt: garlic and onion salts, poultry seasoning, soy sauce, barbecue sauce, ketchup, some hot sauces, and spaghetti and tomato sauces. Summary Here is a summary of key points from Snacks, Eating Out,. ÂÂ Try to limit the amount of sugar-sweetened beverages you drink, because they add calories and no nutrition. If you drink 2 or more sugarsweetened beverages per day, reducing the amount you drink to 1or less per day is one of the most important changes you can make to improve your health. Also, it is best to avoid using artificial sweeteners. ÂÂ Go easy on desserts and sweets, and try fruit instead. ÂÂ Choose healthier snack food options. ÂÂ Make smart choices when eating out at restaurants, and try to eat out less often. ÂÂ Be careful about the amount of salt that is in processed and restaurant foods. 60 & Salt 2017 UNC-CH Center for Health Promotion and Disease Prevention

It is also best to limit diet sodas and other drinks that use artificial sweeteners. Good choices are unsweetened or lightly sweetened iced tea, hot tea, or coffee.

11 Tips Check the goals you want to work on for the next contact. 1. Choose healthy drinks. Aim to replace sugar-sweetened drinks with healthy drinks like water, lightly sweetened tea or coffee, milk, or small portions of 100% fruit juice. It is also best to limit diet sodas and other drinks that use artificial sweeteners. Good choices are unsweetened or lightly sweetened iced tea, hot tea, or coffee. If you need to sweeten your tea or coffee, 1 to 2 teaspoons per cup or glass is okay. It is fine to use 1 to 2 tablespoons of milk or half and half in tea or coffee. Most experts think it is better to use half and half or milk in coffee rather than sugar. Other good choices are: Seltzer water with a splash of lemon, lime, or fruit juice. 100% fruit juice, but aim for 1/2 cup or less per day. Plain milk. 2. Watch out for sweets. Choose other foods for snacks or desserts. Fill up on healthy foods so you are not as hungry for sweets. Try fruit for dessert. Save sweets for special occasions (birthdays and holidays), not every day. When you do eat sweets, eat small amounts. Stay away from store-bought doughnuts, sweet rolls, pies, cakes, cookies, candy bars (except dark chocolate), caramel candies, and cream-filled desserts. These foods are very high in sugar. A small amount of dark chocolate (dark chocolate should have more than 50% cocoa solids) is a good choice for dessert. Dark chocolate in small amounts (half to one ounce per serving) is thought to be good for your heart. The higher the cocoa solid content, the less sugar. For those with diabetes, 70% cocoa solids or higher is best UNC-CH Center for Health Promotion and Disease Prevention & Salt 61

12 Tips 3. Choose cold and frozen desserts with care. Aim to eat 2 or fewer servings of frozen dessert each week. For a refreshing summer dessert, have a chilled slice of watermelon or a bowl of fresh berries with regular vanilla yogurt. Try popsicles as a tasty treat. Be sure store-bought popsicles are made with 100% fruit juice, or make your own. Freeze 100% fruit juice in small cups with popsicle sticks. If you want a frozen dessert, eat a small amount (about half a cup) of ice cream or frozen yogurt. 4. Be careful with snack chips and crackers. Choose lightly salted chips and crackers made with vegetable oil. When possible, choose whole grain crackers. Instead of snack chips or crackers, try raw vegetables, fruit, or a small handful of nuts. These are healthier options. Try making popcorn at home. 5. Make good choices when you eat at restaurants. When you eat out, choose what you eat carefully. Choose healthy menu items such as: For breakfast, try eggs on a whole wheat muffin or with whole wheat toast. Enjoy a burger or sandwich as your meal, on a whole wheat bun or bread, if available. Pizza with veggies is a reasonable choice. Continued 62 & Salt 2017 UNC-CH Center for Health Promotion and Disease Prevention

Tips Most entrees at sit down restaurants are fine. Consider a side other than fries or potatoes, such as salad, fruit, or vegetables. Consider a large salad for your meal.

13 Tips Most entrees at sit down restaurants are fine. Consider a side other than fries or potatoes, such as salad, fruit, or vegetables. Consider a large salad for your meal. Full fat salad dressings and spreads are made from healthy vegetable oil use these instead of the low-fat or no-fat options. Instead of eating out, prepare food at home because you know what ingredients are used. This is especially true for fried foods because sometimes it is not easy to find out if restaurants use healthy oils. Avoid drinks with lots of sugar. In restaurants that have unsweetened and sweetened tea, ask for a mixture (half unsweetened and half sweetened). As portions sizes are often large, split an order with a friend, or eat half of the portion and take the rest home for another meal. Order small portion sizes UNC-CH Center for Health Promotion and Disease Prevention & Salt 63

My Goals and First Steps My Goals and First Steps To make changes, it is important to make goals and keep track of your progress. Enter the 2 goals you selected to work on today.

14 My Goals and First Steps My Goals and First Steps To make changes, it is important to make goals and keep track of your progress. Enter the 2 goals you selected to work on today. Then enter your First Steps for achieving these goals. First Steps should be specific and realistic to get you started. To plan First Steps, think about: ÂÂ ÂÂ ÂÂ When you will start working towards this goal. What you need to get started. If you can actually reach the goal. Finally, keep track of your progress using the tables provided. 64 & Salt 2017 UNC-CH Center for Health Promotion and Disease Prevention

15 My Goals and First Steps Date: Goal 1: First Steps: Goal 2: First Steps: Place this sheet where you will see it often (refrigerator or bathroom mirror). You may monitor goals by the week (left side of table) or by the day (right side of table). GOAL 1: Did you meet your goal? (Check for Yes, or for No) Week Weekly Goal Daily Goal Monday Tuesday Wednesday Thursday Friday Saturday Sunday GOAL 2: Did you meet your goal? (Check for Yes, or for No) Week Weekly Goal Daily Goal Monday Tuesday Wednesday Thursday Friday Saturday Sunday UNC-CH Center for Health Promotion and Disease Prevention & Salt 65

Fish, Meat, Poultry, Dairy, and Eggs

Fish, Meat, Poultry, Dairy, and Eggs Poultry, Dairy, Session 4 Background Information Tips Goals Assessment In an average WEEK, how many servings of these foods do you eat? Desirable Could be improved Needs to be improved 1. Fish, including