Food as a Means of Preventative Medicine. Chef Leah Sarris Program Director

Transcription

1 Goldring Center for Culinary Medicine Food as a Means of Preventative Medicine Chef Leah Sarris Program Director The Need High incidence of food and obesity-related illnesses such as diabetes, cardiovascular disease and hypertension More than one-third of US adults (34.9%) and approximately 17% of children and adolescents are obese. Centers for Disease Control and Prevention; 1

2 Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Top 10 Causes of Death in US (CDC) 1. Heart Disease 2. Cancer 3. Chronic Lower Respiratory Disease 4. Stroke 5. Accidents 6. Alzheimer s Disease 7. Diabetes 8. Kidney Disease 9. Influenza/Pneaumonia 10. Suicide Centers for Disease Control and Prevention; 2

3 Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Centers for Disease Control and Prevention; Centers for Disease Control and Prevention; 3

4 Every Day Occurrences High Cholesterol Diabetes Heart Disease Hypertension 4

5 Every Day Occurrences Cholesterol Diabetes FOOD Heart Disease Hypertension Heart Disease ~600,000 deaths in US every year (1/4 deaths) Leading cause of death for both men and women. 935,000 Americans have a heart attack per year; 610,000 first heart attack; 325,000 second or more $108.9 billion each year. Centers for Disease Control and Prevention; 5

6 What Foods Impact Heart Health? Fats What Foods Impact Heart Health? Fats Fiber 6

7 What Foods Impact Heart Health? Fats Fiber Sodium What Foods Impact Heart Health? Fats Fiber Sodium Cholesterol? 7

8 Cholesterol Likely to have NEGATIVE impact: Saturated Fat Trans Fat Likely to have POSITIVE impact: Unsaturated Fat Soluble Fiber Focus on: Fats Quality, not quantity Mediterranean-Style Diet, high in monounsaturated and Omega-3 fats, shown to reduce risk of: cardiovascular disease cancer (esp breast) Blood pressure Fasting plasma glucose 8

9 Fats Aim to reduce saturated fats and increase unsaturated fats. Saturated Fat Mostly animal sources Beef, pork, chicken Butter Dairy Some plant sources: Coconut Oil Palm oil Saturated fats are in many processed and junk foods! Rule of Thumb: Saturated fats are SOLID at room temperature, unsaturated are LIQUID 9

10 Unsaturated Fat Sources Vegetable Oils (Olive, Peanut, Canola, Safflower, etc) Nuts Avocados Seeds (sunflower, sesame, poppy, etc) Fish and seafood Fat Fats are not BAD; our body needs themaim to eat mostly unsaturated fats Unsaturated fats tend to come from plant and seafood sources Fats are high in calories, at 9 kcal/g Try replacing half butter with olive or vegetable-based oil 10

11 Hypertension Hypertension can lead to: Arteriosclerosis Heart Disease/Attack Stroke Kidney Disease/Failure Aneurysm Edema Focus on: Sodium Tolerable Upper Limit (UL): 2,300mg for most Equivalent to 1 tsp 1,500mg for 51+, African Americans and those at risk (2011 addition) Realistic? TYPICAL consumption of Americans: 3,400+mg per day Centers for Disease Control and Prevention; 11

12 Sodium Where is salt found? Sodium Bread Cheese Condiments Canned Food Soup Deli Meats Seafood Cereal Meats Nuts Chips Cured & Brined Foods (pickles, olives) Salad Dressings Etc 12

13 Sodium More than 70% of sodium in the American diet comes from processed foods. Cutting Out the Salt Eat minimally processed food Cook at home! Measure your salt Place it in a cup rather than a shaker Pay attention to labels Meals ~500mg or less (less if hypertensive) Utilize natural flavorings to enhance flavor Learn to balance Flavors! 13

14 Natural Flavor Enhancers Acids- vinegars and citrus (zest, too!) enhance salt-like profile Wines, liquors Fruit juices Herbs- thyme, basil, oregano, scallion, parsley, mint, chive, etc. Spices Umami- tomato paste, parmesan, soy sauce Marinades, reductions Onions, garlic Balancing Tastes ALWAYS taste your food THROUGHOUT the cooking process! What do you taste? Sweet? Sour? Salty? Bitter? You ll want multiple dimensions Is it one-dimensional? Sweet? Add something acidic Sour? Add something sweet Salty? Add acid Bitter? Umami, salt, or sweet ingredient Is it bland? Flavor enchancers, umami, salt Need pungency? Pepper, hot pepper, mustard, wasabi How is the texture? 14

15 Umami Umami, you ask? Umami Umami- The Fifth Taste Rounded, robust flavor Meaty The missing piece Mouth-watering From amino acid glutamate 15

16 Ingredients with Umami Aged Cheese, like Parmesan Soy, Fish & Worcestershire Sauce Tomato Paste, Canned Tomatoes Seaweed Miso & other fermented products Olives & other cured products Mushrooms (esp dried) Beef MSG (Bouillon, Canned Broth) Umami Umami can be a great salt-reducing tool! 16

17 Diabetes 29.1 million people (9.3% of population) Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, Atlanta, GA: US Department of Health and Human Services; Diabetes 29.1 million people (9.3% of population) 7 th Leading cause of death (69, 071) Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, Atlanta, GA: US Department of Health and Human Services;

18 Diabetes 29.1 million people (9.3% of population) 7 th Leading cause of death (69, 071) $245 billion each year Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, Atlanta, GA: US Department of Health and Human Services; Focus on: Fiber RDA g Most American adults only eat half High fiber associated with: Lower risk of cancer (esp. colorectal) Lower rates of heart disease Lower risk of diabetes Lower risk of diverticulosis Lower serum cholesterol (esp soluble) Reduced risk Metabolic Syndrome 18

19 High Fiber Foods Fruits Vegetables Legumes Beans, lentils, soy, peanuts Whole Grains Breads, rice, oats, bulgur, barley, quinoa, etc. Nuts Diabetes: Dietary Factors Sugary food and beverages Decreased consumption of fruits and vegetables Obese/overweight 19

20 Diabetes Prevention & Control High fiber Eliminate sugary beverages Consume less meat and leaner proteinslimit saturated fat Consume more unsaturated fats Lose weight Exercise Focus On: Sugar Sugar and refined carbohydrates are found in many processed and junk foods High amounts of sugar are in beverages and should be limited soda, juice, coffee drinks, energy drinks Sugar is also found in many condiments, dressings, sauces and processed foods Read labels! Limit refined flours and processed grains; increase whole grains 20

21 Sugar RE-think your Drink! is about ingredients. 21

22 Nine dietary components Score from 0 9 depending on the ingredients and amounts consumed daily Ancel Keys, PhD (100) 22

23 Lyon Heart Study Prospective study of 605 first heart attack patients 2 groups: study given instruction Med Diet control told to follow a prudent diet. Lyon Heart Study Prospective study of 605 first heart attack patients 2 groups: study given instruction Med Diet control told to follow a prudent diet. Study group with a % reduction in second event 23

24 Adherence to a Mediterranean Diet and Survival in a Greek Population - Antonia Trichopoulou 22,000 study population Prospective Design Significant reduction coronary disease AND cancer A 2 point improvement from 5 7 confers a 25% reduction in death from all causes including heart disease and cancer. (Trichopoulou NEJM 2003; 348: ) 24

25 9 Components. Vegetables Legumes Fruits & Nuts Cereals and Whole Grains Fish Oils/Fats Dairy Meats Alcohol 1. Vegetables Vegetables Legumes Fruits & Nuts Cereals and Whole Grains Fish Oils/Fats Dairy Meats Alcohol 25

26 Vegetables are essential to any healthy diet. Each additional serving of fruit and vegetables per day reduces your risk of heart disease by 4%. Male > 10.8 ounces Female > 8.9 ounces (~2-3 cups/day) 2. Legumes Vegetables Legumes Fruits & Nuts Cereals and Whole Grains Fish Oils/Fats Dairy Meats Alcohol 26

27 Legumes are lentils, peas, peanuts, snap beans, bean pods, okra, chick peas Eating legumes 4 x or more per week reduces the risk of heart disease by as much as 22%. Male > 2.1 ounces Female > 1.75 ounces (~2 ½ cups/week) 3. Fruits and Nuts Vegetables Legumes Fruits & Nuts Cereals and Whole Grains Fish Oils/Fats Dairy Meats Alcohol 27

28 Fruits and Nuts are grouped together in this diet. Avoid fruit juice and instead eat whole fruit because the added fiber will keep you full. Male > 8.9 ounces Female > 7.7 ounces (~2-3 servings/day) 4. Cereals and Whole Grains Vegetables Legumes Fruits & Nuts Cereals and Whole Grains Fish Oils/Fats Dairy Meats Alcohol 28

29 Whole Grains include foods like corn, popcorn, brown or wild rice, whole/multigrain bread, quinoa For cereals and breads, check the ingredient list make sure the phrases whole grain or whole wheat are used first and not just wheat. Male > 10.4 ounces Female > 8.9 ounces (~2-3 serving/day) 5. Fish & Seafood Vegetables Legumes Fruits & Nuts Cereals and Whole Grains Fish Oils/Fats Dairy Meats Alcohol 29

30 Seafood in general is a great choice, but fatty fish is considered ideal because it is high in omega-3 fats. Male > 1 ounces Female >.75 ounces (~2 servings/week) 6. Oils and Fats Vegetables Legumes Fruits & Nuts Cereals and Whole Grains Fish Oils/Fats Dairy Meats Alcohol 30

31 It s the quality, not the quantity of fats that is important. Many people think of olive oil when they consider the Mediterranean diet, but it is actually the ratio of unsaturated to saturated fats that is key. Ratio of 1.6 : 1 (unsaturated : saturated) 7. Dairy Vegetables Legumes Fruits & Nuts Cereals and Whole Grains Fish Oils/Fats Dairy Meats Alcohol 31

32 Dairy is consumed less in Mediterranean countries and they don t drink milk as a beverage. Focus on fermented and reduced-fat dairy products, like yogurt and aged cheese. Male < 7.2 ounces Female < 6.9 ounces 8. Meats Vegetables Legumes Fruits & Nuts Cereals and Whole Grains Fish Oils/Fats Dairy Meats Alcohol 32

33 Meat is consumed in higher quantities than seafood, but it is leaner. Avoid processed meats like bologna and hotdogs. Male < 3.9 ounces Female < 3.25 ounces (~1 serving/day) 9. Alcohol Vegetables Legumes Fruits & Nuts Cereals and Whole Grains Fish Oils/Fats Dairy Meats Alcohol 33

34 Alcohol is part of the Mediterranean diet and is generally consumed at meals. However, this does not mean that if you do not currently drink you need to start now! Male ~ drinks Female ~ drinks and again Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes (Ann Intern Med. 2009;151: ) 4 years, 215 participants Prospective New onset diabetics Endpoint: Medication 34

35 and again Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes (Ann Intern Med. 2009;151: ) 4 years, 215 participants Prospective New onset diabetics Endpoint: Medication After 4 years only 44% in the study group needed medication 70% of the standard low-fat diet needed medication 26% difference with diet alone and again ary Pattern and Prediction of All-Cause Mortality in a US Population Results From the NIH-AARP Diet and Health Study (Arch Intern Med. 2007;167(22): ) In ,000 members of the AARP Prospective No history of cancer, heart disease, diabetes, chronic disease. Five years of follow-up Causes of death in the over 12,000 subjects who had died during Correlated with each subject's dietary score. For men Those with higher levels of the score (7-9) were 23% less likely to die from any cause, including cancer and heart disease, than those whose diets received the lowest scores (0-3). Women saw a 14% lower risk of death from cancer. An increase of just one point in the dietary score meant an additional 5% reduction in risk of death from all causes 35

36 Cooking Demonstration Subway Chicken Salad 6 in Sub on Wheat Homemade Chicken Salad with Apples and Raisins on Wheat Bread Calories Total Fat (g) 8 6 Total Carbohydrate Fiber 2 7 Protein TOTAL COST (per serving): $5.19 $1.62 TIME Spent: 20 min 10 min What are barriers to healthy eating? How can we overcome them? 36

37 Barriers Time Money Lack of Planning Lack of Product Gaps in Knowledge Comparison McDonald s Egg McMuffin with Hash Brown and Orange Juice Homemade Egg, Spinach and Cheese Sandwich with Orange and Coffee Calories Total Fat (g) Total Carbohydrate (g) Fiber (g) 3 8 Protein (g) Total Cost (per serving) $5.78 $1.59 Time Spent 20 min 10 min 37

38 Comparison Subway Chicken Salad 6 in Sub on Wheat Homemade Chicken Salad with Apples and Raisins on Wheat Bread Calories Total Fat (g) 8 6 Total Carbohydrate Fiber 2 7 Protein TOTAL COST (per serving): $5.19 $1.62 TIME Spent: 20 min 10 min Comparison Deli-style egg salad Avocado Egg Salad Calories Total Fat (g) Total Carbohydrate (g) 5 8 Fiber (g) 0 5 Protein (g) 10 8 Total cost (per serving) $2.99 $1.55 Time Spent: 20 min 10 min 38

39 Comparison Long John Silver s Fish Tacos (2 tacos) Homemade Fish Tacos with Corn Relish (2 tacos) Calories Total Fat (g) Total Carbohydrate (g) Fiber (g) 1 5 Protein (g) Total cost (per serving) $3.38 $2.86 Time Spent: 20 min 20 min Planning Meal Planning is the key to healthy eating!pick a day of the week (and stick to it) to plan your menu and create a shopping list. 39

40 Meal Planning Saves time Saves money Lowers consumption of unhealthy and convenience foods Allows cross-utilization and reduced cost Meal Planning Cross-utilize ingredients and leftovers Chicken Salad Fish Taco Shrimp over Salad Bean & Rice Burritos Veggie Tacos Scromblets or Frittatas Make large batches to freeze for convenient and quick meals Soups and stews Breads Muffins Burgers (veggie burgers) 40

41 Healthy Pantry Lean Proteins- such as canned tuna, canned and dried beans, lentils Whole Grains- brown rice, whole wheat flour, cornmeal, quinoa, whole grain pasta, oats Nuts & Nut Butters-walnuts, peanuts, no sugaradded peanut butter, almonds, etc (low or no salt added) Canned Tomato Products- diced, puree, paste, sauce, etc. (low or no salt added) Vinegars- such as red wine, cider, rice, sherry, etc. Olive and Vegetable-based Oils- olive, blended olive, vegetable, canola, etc. Healthy Pantry Frozen Fruits & Vegetables Fresh and/or Dried Herbs & Spices Citrus 41

42 Shopping Tips Beforehand: Create a list by section Look at circulars and sales Eat a healthy snack! Shopping Tips: At the Store Don t shop hungry! Stick to the list Shop the perimeters of store- this is where you ll find the least processed and healthiest foods Spend the most time in produce section (most of your cart should be fresh produce) Once you find a brand, stick with it Buy in bulk if possible (the more you buy, the more money you save) Choose least-processed foods such as whole grains and 100% juice; the less ingredients the better (shoot for under 5) Don t fall for marketing gimmicks, and don t waste your time on coupons 42

43 REMEMBER 1. there is no food! There is only a lack of: Balance Moderation and Variety! REMEMBER 2. Healthy food should LOOK GOOD! 3. Healthy food should TASTE GOOD! And last, but NOT least 4. Healthy food should be AFFORDABLE! 43

44 Intervention Intervention Keep in mind that we are talking about FOOD and not BODY PROCESSES. Speak in terms of food- that is a language most people can understand! 44

45 Intervention Short, simple messages over and over again. Intervention Short on Time? Intervention can be short and concise: Short nutrition/lifestyle questionnaire Pick a few areas to focus on (i.e. portion sizes, calories, reading nutrition labels, etc.) based off needs 45

46 Thank you! Website: (sign up for cooking classes) Facebook/Twitter: Goldring Center for Culinary Medicine Contact: 46