Boston Public Health Commission
VOL. 3 • NO. 7
© MARCH 2009
Healthy eating key to living well Americans. It decreases the risk of several Let’s face it. chronic diseases — heart disease, stroke, type Eating healthy has as much sex appeal 2 diabetes, hypertension and certain cancers as watching grass grow on an inner city — as well as obesity. playground. It is so important that the federal governNone. Nada. Zippo. ment has stepped in. The U.S. Departments But like everything else associated with of Health and Human Services and Agrilife and death, it’s almost mandatory. culture have established dietary guidelines Take eating five servings of fruits and — science-based advice to promote health vegetables each day. It’s considered a benchand reduce major chronic diseases. The most mark of healthy eating and the Centers for recent guidelines, pubDisease Control lished in 2005, provide and Prevention In a 2007 report, the a general framework. (CDC) tried to The new guidespread that word CDC determined lines stress a balanced years ago. that less than onediet of six food groups The response — whole grains, fruits, has been less than fourth of adults in this vegetables, low-fat enthusiastic. In a country claimed to dairy products, lean 2007 report, the meats, poultry and fish, CDC determined have consumed the and legumes, nuts and that less than onerecommended amount seeds. Although not a fourth of adults group, unsaturated in this country of fruits and vegetables. food fats — olive oils, avocaclaimed to have dos and nuts – are also consumed the recrecommended. ommended amount Whole grains provide energy and fiber, of fruits and vegetables. and are found in cereal, whole wheat bread The numbers ranged from a low of 16 and brown rice. Fruits and vegetables are a percent in Oklahoma to a high of almost 33 good source of vitamins, minerals and fiber, percent in Washington, D.C. while milk, meat, fish, beans and nuts are rich In Massachusetts, more than 27 percent in proteins. of adults said that they had consumed the The guidelines also limit the consumpdesired amount. Unfortunately, the statistics tion of sodium, added sugars and unhealthy for blacks were not as good. Only 23 percent of black adults in the state said they ate five or fats — those found in fatty meats, dairy products and fried foods — that have been shown more servings of fruits and vegetables a day. to increase the risk of heart disease. It doesn’t have to be that way. By now, To facilitate a healthy regimen, the fedmost know that healthy eating helps avoid a eral government has provided two eating patslew of problems prevalent among African
terns that consumers may follow — MyPyramid (http://www. mypyramid.gov) and Dietary Approaches to Stop Hypertension (DASH) eating plan. Research studies have shown that the DASH plan is effective in lowering blood pressure and preventing hypertension in those without the condition. Even the National Cancer Institute (NCI) has entered the fray. NCI, in affiliation with black churches such as the Greater Love Tabernacle in Dorchester, developed the “Body and Soul” program that encourages church Fruits and vegetables contain health-promoting nutrients that combat members to eat a cardiovascular disease — the leading cause of death in this country. healthy diet rich in service establishments. The law’s second fruits and vegetables. In some situations, government officials phase, effective March 2009, bans trans fat in baked goods. are taking strong actions. In July 2007, New But even with governmental intervenYork became the first city to prohibit restaution, people are still not getting the message. rants from using trans fats in an attempt to One of the reasons is information overload. lower the risk of heart disease. In MassachuAnd confusion. Take carbohydrates, for setts, Brookline followed suit, and in September 2008, Boston implemented the first phase example. Carbohydrates are essential — they make glucose, or sugar, which provides fuel of its own ban on trans fat, prohibiting its use in cooking oils in restaurants and other food Nutrition, continued to page 4
A salad a day Wiley Mullins is on a mission to improve the health of black people — one salad at a time. It hasn’t been easy. After earning a business degree from the University of Alabama and an MBA from Duke University, he gave up his job in marketing with Procter & Gamble to start his own business, Uncle Wiley’s Inc., that brings out the flavor of soul food without using ham, bacon, lard or butter. But he found out the hard way that many doctors do not emphasize preventive care and weren’t as supportive as he initially had hoped. Still, he persisted and developed a line of 13 products that, according to Mullins, enables one to eat their favorite soul food without the added unhealthy salts, fats and sugars. To Mullins, 50, it’s personal. At one point in his own life, Mullins said he carried more weight than he liked. But he exercised and changed his eating habits
and was able to lower his body mass index to a more acceptable level. Diabetes runs in his family, he explained, and he has seen too many friends and relatives suffer the consequences of hypertension and obesity. Mullins grew up in Alabama and knows all about soul food. But he also realized that soul food involves taking healthy foods — collard greens, sweet potatoes, black-eyed peas — and making them unhealthy with added fats and salts. Instead of warning people against soul Wiley Mullins — dubbed the “Salad Man” — compiles food, he embraced it, making it palatable and healthy at the same one of his famous salads called Under the Big Top. Connecticut Post photo by Jesse Neider. time. His seasoning for sweet potatoes or cholesterol or fat and 30 milligrams of yams includes cinnamon, nutmeg, cloves, sodium. Typically, flavorings for the same fresh brown sugar and just a hint of pinedish have 8 grams of total fat, 21 milapple essence. The seasoning contains no ligrams of cholesterol and 170 milligrams
of sodium. Mullins is big on fruits and vegetables and encourages people to try different types. “Most of us tend to eat the same three or four vegetables over and over,” he said. Yet nutritionists recommend choosing a variety of fruits and vegetables in a wide array of colors — the deep greens of broccoli, collard greens and spinach; the oranges of carrots, acorn and butternut squash; the reds of strawberries and watermelon. Mullins has introduced America’s Wellness Team, which is endorsed by the National Medical Association, the largest professional group of African American physicians. The team offers nutrition and wellness advice for consumers through a free monthly electronic newsletter. He also works with diabetes educators in an effort to stem the high incidence of the disease among blacks. Mullins is big on salads. “There’s more to salads than iceberg lettuce, tomato and Miracle Whip,” he said. He plans to take full advantage of Mullins, continued to page 4
March is National Nutrition Month
Dining out: Food can be fast and healthy
http://www.kfc.com/nutrition. usy families rely on fast food, • Select the vegetable entrée take-out and local restaurants first and build the meal around that. to supplement home-cooked Vegetables available at some fast food meals. Today, average Amerirestaurants include salads, carrots cans eat one-third of their calories away and celery sticks, corn, green beans, from home — almost twice the amount greens, potatoes and other items. If in the 1970s. According to the U.S. DeFrench fries are selected, opt for the partment of Agriculture, families also smallest size or plan on sharing a spend almost half of their food dollars larger size. on away-from-home food. • Avoid “supersized” portions. Surveys have shown that low-inChild-sized meals may be sufficient come neighborhoods have more fast for older children and adults as well. food restaurants than upper-income • Select baked, broiled or grilled neighborhoods. The high concentration Vivien Morris, M.S., R.D., M.P.H., L.D.N. entrees and avoid fried foods. Havof fast food restaurants may increase Director of Community Initiatives ing the grilled chicken breast instead convenience, but families are chalNutrition and Fitness for Life Program of the breaded and fried breast can lenged to find healthy and appealing Department of Pediatrics save as many as 200 unwanted calofood offerings in the limited menu ofBoston Medical Center ries. ferings of fast food restaurants. Adver• Go easy on the cheese on pizzas and select the tising also affects our food choices. In 2007, the Kaiser thin crust rather than the thick crust. Add lots of vegFamily Foundation determined that 8- to 12-year-old etables as toppings— peppers, onions, spinach, etc. children watch more than 20 food advertisements daily. • If soup is available, start the meal with a soup. Food advertising targeted to youth places parents in an Soups often contain vegetables and the liquid will give a uphill battle to encourage their children to select non-adsense of fullness to prevent overeating. vertised healthy options. Here are a few tips for parents • When you can, select a full service restaurant when eating out with your children. rather than a fast food restaurant. There will be a • Plan ahead. Select a restaurant that includes fruits greater variety of selections and more vegetable options. and vegetables on the menu. Set guidelines for food item • Try making some of your restaurant favorites at selection beforehome, but with a healthy twist. Examples might include hand with your chiloven-“fried” chicken, oven-roasted potato wedges and dren. Use the Web healthy cole slaw. These are tasty and healthy alternatives sites of national to soul food staples. chain restaurants to review the nutritional quality of Below are two tasty and easy recipes. entrees. Look for Kid-Pleasing Oven Fried Chicken entrees that are Serves 4 lower in calories Ingredients: and saturated 4 each — 4 oz. boneless, skinless chicken breast, cut into fat. Examples of nuggets chain restaurant 1 cup flake-type cereal, crushed Web sites: http:// ½ tsp each onion powder, garlic, black pepper, parsley www.mcdonalds. leaves, thyme, paprika com/usa/eat/nutri 1 egg, beaten tion_info.html;
Directions: 1. Preheat oven to 375 F. 2. In a bowl, combine cereal and seasoning. 3. In a separate bowl, beat egg to create an egg wash. 4. Dip chicken in egg wash, and then coat in cereal mixture. 5. Arrange chicken on a non-stick sheet pan 6. Bake at 375 F for 20-25 minutes. Nutrition Facts: Per serving (makes 4 servings): 140 calories, 1.5 g total fat (0.5 g saturated fat), 6 g carbohydrates, 1 g dietary fiber, 28 g protein, 0 mg cholesterol, 200 mg sodium. Recipe created by Adam W. Korzun, M.S., R.D., a dietician at Boston Medical Center Haley House Healthy Ginger Slaw Serves 4-6 people The Dressing: 4 inches of fresh ginger ¼ cup canola oil 2 tbs white sugar 1 cup white vinegar 2 cloves minced garlic ½ teaspoon salt Pepper or hot sauce to taste To make the dressing: 1. Wash the ginger well with a scrub brush and warm water, cutting off any knobby spots. Chop the ginger into ½ -inch pieces. Chop until minced. 2. In a bowl, combine this mixture and the remaining ingredients, whisk well. 3. This dressing keeps well for 4 weeks refrigerated in an air-tight container. The Slaw Veggies: 3 carrots, grated ½ head red cabbage, thinly sliced ½ onion, thinly sliced or 6 scallions chopped ½ napa or Chinese cabbage, thinly sliced ½ cup currants or raisins 1 cup slaw dressing To make the slaw: Combine all the ingredients in a large bowl and toss well. Nutrition Facts: Per serving (based on 6 entrée servings): 210 calories, 10 g total fat (1 g saturated fat), 28 g carbohydrates, 6 g dietary fiber, 3 g protein, 0 mg cholesterol, 260 mg sodium. Note: Dozens of vegetables can be used instead of those above. Try chopped tomatoes, grated raw beets, raw green beans, raw chopped broccoli, sliced cucumbers, sliced apples, fresh corn, raw or blanched raw celery, raw bok choy, all sorts of lettuces including radicchio, watercress and arugula, baby spinach, and thinly sliced raw zucchini or summer squash. Recipe courtesy of Haley House Bakery Café, 12 Dade Street, Roxbury
Know your limitations Healthy eating includes not only what you should eat, but what you should not. Learn to read food labels to keep track of limited substances. Substance
Daily limit — less than ...
2,300 milligrams (about a teaspoon)
7 percent of total calories ― 15 grams or 140 calories for a 2,000 calorie diet
1 percent of total calories ― 2 grams or 20 calories for a 2,000 calorie diet
Source: American Heart Association
2 BE Healthy • www.behealthy.baystatebanner.com
Nutrition Questions & Answers 1. Why are blacks in particular cautioned against consuming too much salt? Several studies suggest that African Americans and older adults have heightened salt sensitivity or greater blood pressure response to an increase in salt intake. Studies have also demonstrated that African Americans lowered their blood pressure with a low sodium diet. Experts recommend a daily limit of 2,300 milligrams of salt — about one teaspoon. Those with high blood pressure are advised to limit their intake of salt to 1,500 milligrams a day.
A closer look A key to good health is a well-balanced diet. The foods you eat and the amount largely depend on your age, gender, physical activity and daily required calories. Consult a physician or nutritionist to learn to eat healthy or refer to educational resources, such as http://www.mypyramid.gov to help plan a program that is right for you.
Lisa Michelle Owens, M.D. Medical Director Brigham Primary Physicians at Faulkner Hospital
2. Why are whole grains more nutritious than processed grains? Whole grains contain both the outer layer of bran as well as a starchy interior layer, or germ, that are packed with nutrients including protein, fiber, B vitamins, antioxidants and trace minerals, such as iron, zinc, copper and magnesium. A diet rich in whole grains has been shown to reduce the risk of heart disease, type 2 diabetes, obesity and some forms of cancer. Whole-grain diets also improve bowel health by helping to maintain regular bowel movements and promote growth of healthy bacteria in the colon. Processed grains remove the healthy layers, thus depriving the body of essential nutrients. 3. How do fruits and vegetables lower the risk of high blood pressure? An important study called the Dietary Approaches to Stop Hypertension (DASH) study examined the effect on blood pressure of a diet that was rich in fruits, vegetables and low-fat dairy products, and that restricted the amount of saturated and total fat. The researchers found that people with high blood pressure who followed this diet reduced their systolic (top number) blood pressure [by] 6 to 11 points — as much as medications can achieve.
• Eat a variety of fruits and vegetables, whole grains and fat-free or low-fat milk products. • Include lean meats, such as beef sirloin, or choose fish, poultry and legumes as a substitute for fatty meat. • Choose foods that are low in trans and saturated fats, cholesterol, salt and added sugars. • Drink water instead of fruit drinks and regular soda. • Choose liquid oils for cooking instead of solid fats. • Watch portion sizes. Eating too much of even healthy foods can lead to weight gain.
Health benefits associated with healthy eating IT LOWERS THE RISK OF: Cardiovascular disease
• High blood pressure • Stroke
Diverticular disease — development of pouches in the large intestine
• Heart disease
Iron deficiency anemia
• High cholesterol
Type 2 diabetes
Overweight and obesity
Source: Dietary Guidelines for Americans, 2005
4. Is there value in taking a daily multivitamin? The broad consensus from nutrition experts is that while vitamins are indeed essential, big doses are usually pointless and can even be harmful. And no pill is likely to ever adequately substitute for a healthy diet. It’s easy to get enough micronutrients from food if you maintain a healthy diet with plenty of variety. But most people fail that test; they’ll eat two or three servings of fruits and veggies per day rather than the recommended five. That’s why nutritionists suggest a multivitamin as a sort of nutritional safety net for many of their patients. Whole foods like veggies and whole grains contain fiber and a host of other important nutrients that can’t be adequately delivered through pills. In fact, scientists are still finding new “trace elements” in whole foods that may someday be labeled essential to health — but aren’t found in any pill. 5. Why do nutritionists recommend eating an orange rather than drinking orange juice? If you eat the fruits in their natural form, they are very low in calories and very nutritious — full of fiber, vitamins, minerals and many antioxidants. Juices tend to have quite a bit of added sugar and are thus sources of concentrated calories, which can contribute to weight gain. 6. Why are legumes, such as black-eyed peas, often suggested as a substitute for meat? Dried beans or legumes are an excellent source of protein — also found in meat — and a good source of B vitamins, potassium and fiber, which promotes digestive health and relieves constipation. Eating beans may help prevent colon cancer and reduce blood cholesterol, a leading cause of heart disease. Meat, on the other hand, is a major source of cholesterol.
The facts about fiber Fiber — carbohydrates that cannot be digested — comes only from plant foods and is important for our digestive health. It prevents constipation and keeps us regular. At least 25 grams of fiber a day are recommended. Look for products that contain five grams or more per serving. MAJOR SOURCES: Fruits and vegetables Whole grains Legumes Nuts
The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors and make timely visits to your primary care physician.
BE Healthy • www.behealthy.baystatebanner.com 3
many of the foods they like — even soul food. “People make the mistake of categorizing food as ‘good’ or ‘bad,’ ” she says. for the body. Most people think of carbohyThat misses the point. drates as breads, cereal and pasta, and they The foods that many blacks eat are very are right. But many do not realize that fruits, high in nutrition — it’s how they are cooked vegetables and milk are also carbohydrates. People with diabetes or glucose intoler- that’s the problem. Collard greens, for example, are an ance have to be mindful of their intake of excellent source of vitamins, minerals and carbohydrates. Another problem is that one dietary plan fiber. But when “doctored up,” they contain salt, fats and added sugars — all of which doesn’t fit all. The amount of recommended contribute to chronic health problems. food varies by age, gender, physical activity Brown-Riggs offers a solution. Seasonand health status. More importantly, it varies ing with smoked turkey by taste. breast instead of ham That’s the point hocks allows the flavor that Constance Brownwithout the added fat. Riggs tries to instill in If you cannot do her clients. Brown-Riggs without candied yams, works for the American use less sugar or a brown Dietetic Association, and sugar substitute. Sweet is a registered dietician potato casserole is even and certified diabetes better since it requires less counselor. fat. The reason is simple. Brown-Riggs stressSweet potatoes already es practicality. “You have contain naturally occurto reach people where ring sugars and complex they are,” she says. “You carbohydrates, proteins, can’t suggest a diet that vitamins A and C, iron includes cottage cheese and calcium. and cauliflower if a person She recommends doesn’t like that particular Constance Brown-Riggs, M.S. Ed., R.D., C.D.E., C.D.N. patience to those trying to food.” Registered Dietitian-Certified Diabetes lose weight. “Don’t get on The first step, she Educator says, is taking a personal National Spokesperson for the American the scale every day,” she explains. “You probably inventory and determining Dietetic Association won’t notice that much individual health risks. A person should then look at the general of a difference … You didn’t gain the weight overnight; you won’t lose it overnight either.” dietary guidelines and compare it to what he If there is a recipe you like, look at the or she is doing. “Then make a plan,” she says. “Be prac- ingredients. Pay attention to the fat content. Use 1 or 2 percent milk instead of whole tical and realistic. Start from square one and milk. take small steps.” Sodium is particularly harmful. It conShe cautions not to do everything at tributes to high blood pressure and can cause once. “It will not last,” she warned. a buildup of fluid in those with congestive Brown-Riggs says she recognizes the heart failure or kidney disease. Brown-Riggs difficulty in changing eating habits. But recommends using a small amount in food health professionals often add to the problem preparation and not at the table. by making the mistake of not showing a perShe offers hope. “Taste buds change son how to eat what he or she likes to eat. and that’s good news,” she says. “Give it a And that’s a big part of the problem. chance.” Brown-Riggs says that people can eat continued from page 1
How much of what? There is not one eating plan for all to follow. The types and amount of food depend on a person’s age, gender, weight, level of physical activity and medical condition. The point is to choose wisely from each food group ― maximize consumption of fruits, vegetables and whole grains while minimizing fatty meats, dairy products and unhealthy fats. It is also important to balance the intake of calories with the calories the body uses daily. Healthy eating should be combined with moderate exercise ― 30 minutes a day at least ﬁve days a week. Below is an example of a healthy eating plan based on roughly 2,000 calories a day. It shows the recommended number of daily servings for each food, examples of serving sizes and correlating health beneﬁts. Although not listed, two servings of fat, such as a teaspoon of vegetable oil, are allowed each day. Just remember that your particular plan will change according to personal taste, lifestyle and health care needs.
WHOLE GRAINS 6 servings
VEGETABLES 2½ cups
FRUIT 2 cups
Sample serving 1 slice whole wheat bread ½ cup brown rice 1 cup dry cereal ½ cup cooked oatmeal
Sample 1 cup equivalent 1 cup collard greens 1 cup vegetable juice 1 ear of corn 2 cups lettuce
Sample 1 cup equivalent 1 large banana 1 large orange ½ cup raisins 1 small wedge watermelon
Nutrients Fiber, vitamins, minerals
Nutrients Fiber, vitamins, minerals, phytochemicals*
Nutrients Fiber, vitamins, minerals, phytochemicals*
Health benefits Lowers bad cholesterol Helps prevent constipation
Health benefits Reduces risk of heart disease and stroke, controls high blood pressure, may prevent some cancers, guards against cataracts and macular degeneration, may help avoid diverticulitis — buildup of bacteria in pouches in the colon
*Naturally occurring health-protecting substances in fruits and vegetables
DAIRY PRODUCTS 2 servings
LEAN MEATS, POULTRY, FISH 6 ounces or less
LEGUMES, NUTS, SEEDS 4 servings a week
Sample serving 1 cup non- or low-fat milk 1 cup non- or low-fat yogurt 1½ ounces cheese
Sample serving 1 to 6 oz. skinless chicken 1 to 6 oz. sirloin steak 1 to 6 oz. salmon
Sample serving ¹/³ cup nuts ½ cup black-eyed peas 2 tablespoons peanut butter or seeds
Trans. Source: Fried foods, commercially baked goods, processed foods, vegetable shortening.
Nutrients Calcium, protein
Nutrients Protein, fiber
Health benefits Builds strong bones
Health benefits Builds strong bones
Health benefits Builds strong bones, reduces risk of heart disease
Keep your fats straight Not all fats are bad. Actually, fat is essential to the body ― it stores extra energy, provides insulation and helps support cell growth. But too much of the wrong type of fat can increase the risk of heart disease, while good fats lower its risk. The point is, you have to know which is which. UNHEALTHY FATS: Saturated. Source: Meat and dairy products (cheese, butter, whole milk).
Monounsaturated. Source: Vegetable oils*, avocados, nuts and seeds. Polyunsaturated. Source: Vegetable oils*, fatty ﬁsh, walnuts and seeds. *Not all vegetable oils are healthy ― coconut, palm and palm kernel oils are high in saturated fats.
continued from page 1
National Salad Month in May. Wiley is trying to get people to look at salads in a different light. It’s not that little side dish you eat before the entrée, Mullins proudly proclaimed. They can be the main course. And he has written a book — “Salad Makes the Meal: 150 Simple and Inspired Salad Recipes Everyone Will Love” — to prove it. “A salad can serve as lunch, dinner, or even dessert,” said Mullins. “You can get a lot of your daily required nutrients from one salad.” Mullins has other plans for this year. He is working with the Congressional Black Caucus to continue on his road to wellness. It will start in his home state of Alabama. “We’re doing a ‘wellness march’ to get the point across,” he said. Despite Mullins’ efforts, many still believe that food should be about taste — and lots of it.
Marc Anthony Bynum Executive Chef Tellers Restaurant, Long Island, New York Jim Lennon/Jim Lennon Photographer, Inc.
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Source: American Heart Association, www.mypyramid.gov.
But according to Marc Anthony Bynum, there are healthful ways to achieve that taste. Bynum, 30, the executive chef at Tellers Restaurant in Long Island, N.Y., is skilled in all kinds of cooking. “I cook everything,” he said as he ticked off his specialties. “I cook Caribbean, Kosher, soul food. I have to be well-versed.” He got started not only because he enjoys cooking, but oddly enough because he likes to please people. “Food makes people happy and gives them pleasure,” he said. “I like to watch their expression as they eat something they like.” Bynum did not learn his skills in school — at least not technically. He learned from trial and error and from watching others, starting with his mother. He also leans on his background — his family is African, Caribbean and Latin. He recognizes that it is hard to make changes in one’s diet. “Take small steps,” he advised. “Make minor changes that won’t be so noticeable.” He recommends sautéing instead
of deep frying. He swears by his fried chicken, but it’s pan-seared instead of deep-fried. He uses a coating of panko (Japanese bread crumbs), flour and egg, pan-sears it quickly, and then lets it finish cooking in the oven. “It retains its moisture that way and is still crispy,” he said. Bynum emphasized that there’s “more than steak and chicken. Try fish — salmon and swordfish, for example. And if you do start eating more fish, grill or bake it instead of frying it.” He rails against people who overcook collard greens. “All the nutrients come out with extended cooking,” he said. “Probably the water is more healthful than the greens themselves by that point.” Instead, he recommends cooking greens quickly in olive oil with finely chopped onions and turkey bacon or turkey breast as seasoning. But he does caution again shocking the system totally. “Move slowly until your taste buds have adapted to the changes,” he said.
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