Substitute a Fruit for a Fat

I’ve been looking for more ways to modify recipes to make them more healthful.  This quest started as part of my recent Heart-Healthy Cooking class, but it has continued as part of my regular life. Revising recipes to make them better for your health can be an objective for anyone who wants to eat a little less fat, cholesterol, and sugar.

Prunes in BlenderLet’s start small.

Two great replacements for butter, oil, and sugar in baking projects are applesauce and prune puree.

Why?

Well, both applesauce and prune puree can replace half of the fat in many recipes. So if the recipe calls for 1 cup of oil, you can use ½ cup of applesauce and ½ cup of oil. You may also need to reduce the baking time by up to 25%. Watch your baked goods closely and pull them out as soon as they’re cooked through.

So why do applesauce and prunes make decent fat replacements in recipes? The answer lies in the fruit. You see, the fruit provides both moisture and structure to the baked goods. That’s why this substitution is best for foods like apple cakes or brownies, though it works well in cookies and cakes too.

Let’s take this a little further. There are other benefits to these substitutions.

For example, when you add applesauce or prune puree to a recipe, you may be able to reduce the amount of sugar. The natural sugars in the applesauce and prune puree provide additional sweetness, which can be balanced by a reduction in the sugar you add to the recipe. To avoid over-the-top sugar content, be sure to purchase unsweetened applesauce.

By making this substitution, you’re also adding a little more fruit to the recipe! Yay! That’s more fiber and nutrients than you would have gotten with the original recipe.

So, how can you put this plan into action?

You can buy ready-made prune puree or just make your own by combining six tablespoons of hot water and eight ounces of prunes (about 23) in the blender. This makes about ¾ cup of prune puree.  Note: for diabetics, this approach does increase the carbohydrate count in the end product.

And of course, you can make your own unsweetened applesauce or pick up a jar at the store.

Brownies, ReimaginedSubstitution Tips:

Applesauce seems to go best with lighter colored and flavored products. Think apple cakes or oatmeal cookies.

The prune’s flavors and colors go well with chocolate and spicier treats like gingerbread, spice cake, and brownies.

These substitutions do work with box mixes, but you have more control over the other ingredients if you make the entire recipe from scratch.

By Cheryle Jones Syracuse, MS, Professor Emeritus at The Ohio State University

Yes, there’s totally a free handout too. Check it out!

Healthful Holiday Baking

There are tons of other ways to make your holiday celebrations more healthful! Check out these wonderful holiday education resources

Holiday Challenge Kit

Holiday Challenge Kit

Holiday Secrets Book and Cooking Demo Program

Holiday Secrets Book and Cooking Demo Program

Holiday Poster Value Set

Holiday Poster Value Set

Holiday Fruit Lights Cards

Holiday Fruit Lights Cards

 

Heart Attack Prevention: Are Statins or Eating Habits More Important?

Medication or Diet?If elevated low density lipoprotein cholesterol (LDL-C) levels were the only source of cholesterol deposited in the artery wall, then high doses of potent statins should be reversing (rather than reducing) the build-up of atherosclerotic plaques, largely eliminating deaths from coronary heart disease (CAD). Sadly, the number one cause of death in Americans taking statins to lower their elevated LDL-C to prevent heart attacks is still heart attacks?

Yes, statin drugs are very effective for reducing high LDL-C levels, and they do slow the progression of cholesterol-filled plaques. However, they rarely reverse the build-up of cholesterol in the artery wall. More importantly, statin drugs alone do not come close to eliminating the risk of heart attacks and most strokes despite impressive reductions in LDL-C levels. Research now shows that other lipoproteins besides LDL particles can and do carry cholesterol from the blood into the artery wall, promoting the growth of cholesterol-filled plaques and CAD. These lipoproteins are neither LDL-C or high density lipoprotein cholesterol (HDL-C), but rather consist of the cholesterol-rich remnants of triglyceride-rich lipoproteins produced by the liver (VLDL) and the small intestine (chylomicrons)(1). Both genetic factors and dietary factors influence the amount of these triglyceride-rich lipoproteins produced and also the amount of cholesterol-rich remnant particles derived from each of them in the blood. Fat and cholesterol-rich meals can dramatically increase the production of chylomicrons and lead to greater amounts of cholesterol-rich chlyomicron remnants in the blood for several hours after each fat-rich meal (2).

Dr. Borge Nordestgaard’s recent study followed nearly 12,000 people with established CAD in Denmark and found that each 1 mmol (38.7 mg/dl) increase in non-fasting remnant cholesterol caused 2.8 times greater risk of a CAD event that was independent of HDL-C levels. The increased causal risk of CAD from elevated cholesterol remnant particles appeared much stronger than for changes in either LDL-C or HDL-C levels (3). Most doctors (MDs) now check only fasting blood lipids and focus largely on LDL-C and HDL-C to assess their patient’s future CAD risk. This was based on the simplistic notion that it was only the LDL-C particles delivering cholesterol to the artery wall, making it the “bad” cholesterol, while the HDL-C particles were removing the cholesterol from the artery wall and bringing it back to the liver, making their cholesterol content “good”. Of course, we now know HDL-C particles can actually become proinflammatory and proatherogenic “bad” HDL particles, perhaps partly in response to biochemical changes in the HDL particles triggered in part by chylomicrons and other remnant cholesterol particles in the blood.

Chylomicrons and their cholesterol-rich remnants remain in the blood for several hours after each fat-rich meal and likely play a major role in promoting inflammation (by increasing IL-6 & CRP), thrombosis (by activating clotting factor VII), and atherosclerosis (by delivering more cholesterol-rich remnant particles to the artery wall). The fact that damage to the endothelium (inside “skin” of the artery wall) as evidenced by reduced flow mediated dilation (FMD) occurs to a much greater extent after a single fat-rich meal than after a meal high in carbohydrate points to the fact that pathological changes must be occurring in the artery wall in response to fat and cholesterol-rich particles coming from the intestines (4). Indeed, this reduced FMD is likely the main reason why many people with angina tend to experience far more chest pain after a large, fat-rich meal than they do after a meal high in carbohydrate-rich plant foods. The only legitimate debate is not whether LDL-C or other cholesterol-rich remnant particles promote atherosclerosis and increase the risk of CAD, but rather which is more atherogenic. Clearly both LDL-C and other remnant lipoprotein particles deliver cholesterol to the artery wall and promote foam cell formation and atherosclerosis. Unlike LDL-C particles (which must first be oxidized), remnant cholesterol particles are readily taken up by scavenger receptors of macrophages in the cell wall to form foam cells (5,6). Increasing evidence suggests that damage to the artery wall from cholesterol-rich remnant particles appears to be at least as important as either fasting LDL-C or HDL-C levels for predicting future CAD events.

It should be noted that diets high in refined carbohydrates (particularly large amounts of refined sugars) combined with inactivity can contribute to a marked increase in the liver’s production of VLDL particles because the liver converts some of the excess carbohydrate (especially fructose) into triglyceride. This leads to more triglyceride-rich VLDL particles being released into the blood, which then degrade into cholesterol-rich remnant particles and eventually also LDL particles. This is particularly true in people who are genetically prone to develop insulin resistance and type 2 diabetes and who experience significant increases in fasting triglyceride levels as visceral fat stores accumulate.

Bottom Line: Reducing LDL-C levels with statin drugs alone is insufficient for stopping and reversing CAD and preventing most heart attacks and strokes. A diet low in fat, salt, cholesterol, and refined carbohydrates coupled with increased activity and loss of excess weight may also be necessary to stop and reverse CAD in part by reducing remnant cholesterol levels in the blood.

By James J. Kenney, PhD, FACN

Sources:

  1. Mark Nordestgradd BG, Freiberg JJ. Clinical relevance of nonfasting and postprandial hypertriglyceride and remnant cholesterol. Curr Vasc Pharm. 2011;9:281-6
  2. Mark Cesar TB, et al. High cholesterol intake modifies chylomicron metabolism in normolipidemic young men. J Nutr 2006;136:971-6
  3. Mark Varbo A, et al. Remnant cholesterol as a causal risk factor for ischemic heart disease. J Am Col Cardiol. 2013;61:427-36
  4. Mark Tomaino RM, Decker EA. High-fat meals and endothelial function. Nutr Rev. 1998;56:182-5
  5. Mark Zilversmit DB. A proposal linking atherogenesis to the interaction of endothelial lipoprotein and triglyceride-rich lipoproteins. Circ Res.1973;33:633-8
  6. Mark Nakajima K, Nakano T, Tnaka A. The oxidative modification hypotheis of atherosclerosis: the comparison of atherogenic effects of oxidized LDL and remnant lipoproteins in plasma. Clin Chim Acta. 2006;367:534-42

Looking for fun ways to improve your clients’ understanding of cholesterol and its health risks? Check out this free handout: Cholesterol Puzzle.

Cholesterol Puzzle Handout

And, as you well know, there are tons of other heart health education materials available in the Nutrition Education Store. Pay special attention to the posters, which have been flying off the shelves lately!

LDL Cholesterol Poster

Premium Heart Health Education Kit

Heart Health Brochure: Lower Your Heart Attack Risk

Blood Pressure Poster

Sodium Samples

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The author Janet Evanovich calls it the “Senior Buffet”.  Other folks call them the “sample ladies.”  I bet you know what I’m talking about. The folks who offer food samples at the big box stores.  Just wander the aisles of the store while shopping and graze along the way.I have noted that most of the time, the foods being sampled are the higher in calories, more processed and easy to prepare items.

It’s easy to eat eight to ten samples during one lap of the store. These sample ladies (and men) are very popular.  Samples are gobbled up by almost everyone.  Have you ever calculated how much food you’re eating on one of these shopping trips?  Or more specifically, have you looked at the sodium counts of the foods?

Since my husband has been on a healthier diet due to his heart disease he has really been watching the nutrition labels more closely.  One of the things he’s specifically checking out is the sodium content of the food.    I was proud of him last week when I heard him say “no, thank you” to several of the sample ladies.  The discussion in the car on the way home was interesting.  He asked me “did you know how much sodium was that French onion soup they were sampling”.  SMILE

Yes, I did notice.  One cup of soup had about 800 milligrams of sodium.  They were offering generous samples, I’m guessing they were  ¼ cup each.  If you’re counting that’s 200 milligrams.  Add to that:

  • 178 mg in a barbecued chicken wing
  • 172 mg from a 1-ounce sample of frozen pizza
  • 58 mg in an 1-ounce serving of prepared chicken Alfredo
  • 75 mg in a ¼ ounce sample of Romano cheese on a whole grain cracker

I admit those little bits don’t really seem like much. But if you add them up the total was 683 milligrams of sodium. And that’s just a few of the items they were sampling that day.  If I asked someone what they had to eat throughout the day, they would probably not mention the “senior buffet.”   This is sometimes called distracted eating—people eat because it’s there and then don’t even realize they’ve done it.

If you finished off your visit to the store in the food court with one of their inexpensive hot dogs (1750 mg) and a fountain diet soda (76 mg in 16 ounces) your whole shopping trip could have you consuming a whopping 2509 mg of sodium.

How much sodium should a person have in a day?  The 2010 Dietary Guidelines say that younger, healthy people without high risk for hypertension should reduce sodium to less than 2300 mg. It is recommended that some folks keep the sodium to less than 1500 mg/day.  This is a fairly large group of people (including my husband and my self). You fit into this lower group if:

  • you are over 51 years old, or
  • you have high blood pressure or hypertension, or
  • you have diabetes, or who have ever been told you are diabetic, or
  • you have chronic kidney disease, or
  • if you are African American.
Just a few samples and a hot dog and you’re well over the 2300 recommendation and way over the 1500 mg recommeded for this special group.

How can you thwart this sodium overload?

  • Avoid shopping during sample hours—it’s usually mid-day (10 a.m. to 4 p.m.)
  • Avoid shopping when you’re really hungry.
  • Read the nutrition label before you bite or buy.
  • Set a limit for yourself in numbers of samples you’ll eat before you enter the store.
  • Avoid purchasing prepared and processed foods.

What do we do?  Now, I’m not saying we’re perfect on this, it’s hard. These foods are tempting, most of the time they taste great and make food preparation easy.  It’s just another hurdle we’re trying to jump over.  But I think we’re getting there, one shopping trip at a time.

By Cheryle Jones Syracuse, MS
Professor Emeritus, The Ohio State University

Check out the sodium education supplies in the Nutrition Education Store! They include include sodium education posters, sodium PowerPoint shows, sodium education displays, sodium brochures, and sodium handouts.

But wait, there’s more! Because we love you, we’ve set up a free sodium infographic for you to download. Get your copy today!

SodiumInfographicWhy

Invisible Eggs

In the process of my husband’s recovery from a heart attack, he has been working hard at improving his diet and exercise habits. He’s also been going to Cardiac Rehab three days a week.  Near the end of the program, they sent him home with a survey to complete so that he and his instructors could see how his diet has changed.

Before the heart attack, my husband was eating a fairly healthful diet. Needless to say, I was curious to see how his survey would be “graded.” As he was completing the survey, one of the questions stood out to us both. It asked, “How many visible eggs have you eaten in the last week?”

This got him joking about “invisible eggs.” How could he eat an egg that he couldn’t see?

After some thought (and a few laughs), we realized that the questionnaire was really asking about the number of whole eggs he was eating.  These would be eggs eaten as scrambled eggs, over-easy, or even deviled eggs. This type of egg is easy to see and easy to count.

The other type of eggs, “invisible eggs,” must be the ones that are combined with other foods. You know, the eggs in cakes, cookies, meat loaf, crab cakes and combination foods. These are the eggs that you don’t see, and that makes them more difficult to count.

The American Heart Association recommends cutting back on foods that are high in dietary cholesterol. They say to eat less than 300 milligrams (mg) of dietary cholesterol each day. That’s been the recommendation for all Americans with normal blood cholesterol levels for at least 20 years. That’s nothing really new.

Research is still showing that diets high in dietary cholesterol do have an effect on blood cholesterol levels, especially LDL (a.k.a. “bad”) cholesterol. I have seen some recommendations for people with heart disease to try to keep this number to 200 mg a day — but no one has made that recommendation to us.

What does 200-300 mg of cholesterol per day look like? Not a lot.

A medium-sized egg has about 185 mg of cholesterol. A large egg has about 215 mg. Two eggs for breakfast would quickly wipe out the recommendation of less than 300 mg a day.

All the cholesterol in eggs is in the yolks.  Egg whites without the yolks are a heart-healthy protein.  We’ve gone to substituting liquid egg whites for most of the eggs we eat. In most recipes, two whites will equal a whole egg. Replacing an egg with egg whites also helps reduce total fat and total calories in the diet.

Baked goods and other foods often contain “invisible” eggs. Those “invisible” eggs count toward that 300 mg a day limit too.

Keep in mind that two eggs spread over 12 muffins or a whole cake don’t add up as quickly as those two eggs eaten sunny-side up.*

Remember, eggs are only part of the cholesterol equation. It’s also recommended for people with high blood cholesterol levels to reduce not only the amount of dietary cholesterol they eat but also reduce their saturated fat and trans fat consumption.  In addition to helping with the cholesterol levels, reducing saturated and trans fats can help with overall calories, getting people closer to meeting their weight loss goals. Family history and genetics also play a big role in blood cholesterol levels.

Like many folks with heart disease, my husband is also on a cholesterol-lowering drug.  His cardiac doctor is recommending them for at least a year for overall artery health.

Thinking that drugs are not the only answer, we’re being aware of all eggs — visible or invisible — for the long haul.

By Cheryle Jones Syracuse, MS
Professor Emeritus, The Ohio State University

Are you looking for ways to reduce cholesterol, saturated fat, or trans fat consumption? Check out these great resources!

How Much Fat is in That? Poster

Cholesterol 101 Education Bundle

Make the DASH: Heart Health Brochure

* The fat and sugar and other ingredients in that cake or muffins is another story for another day.

Presentation Idea: DASH to a Healthy Heart

Did you know the DASH diet won first place in a recent USA Today Diet Survey? Stay tuned for a post coming up about the contest and the DASH Diet.

Trying to teach the basics of the DASH diet and promote heart health? Do this great activity, which is perfect for a class session or a break during a heart health presentation.

Assemble a display of elements of the DASH diet. This should include pictures, models, or empty containers of healthful foods. Add some exercise equipment (to represent the importance of physical activity), and a scale or tape measure (to represent weight management). Arrange these items into your display before participants arrive.

Once everyone has made it to the classroom, discuss the display:

  • What is included?
  • What is absent?
  • Why?

Ask participants to brainstorm the link between all these items. After the discussion, reveal that these are all key elements of the DASH diet, which was developed to help fight high blood pressure.

DASH to Better Blood PressurePass out copies of the Make the DASH for Heart Health (available in the store). Have students read through it. Discuss its main points as a group, then have participants list the steps they are going to take in order to reduce their high blood pressure (or their high blood pressure risk, if they currently don’t have high blood pressure) on the back of the page. These can remain private or be shared with the class, depending on your group’s comfort level.

No handout? No problem! Have students extrapolate from the display and discussion to create a guide to the DASH diet in their notes.

If you need decorations for your classroom or office, have the participants make and illustrate their own handouts, then turn them in to you. You can make the DASH handout design into a contest and display the winners, or just photocopy the best ones for distribution to the rest of the class.

If you have access to computers or smartphones, participants could also do further research on the DASH diet with those, incorporating what they find into their handouts.

This presentation idea is an excerpt from the educational program, The 12 Lessons of Diabetes. This program follows the same format as the other fantastic 12 Lessons packages and is chock-full of insight from a wide variety of health and nutrition professionals. If you are interested in Diet and Heart Disease, see the 6 Lessons of Heart Health Program

View all DASH Diet Education Materials here.

Free Handout: Substitute Your Way to Heart Health

It’s time for another free nutrition handout! This week’s installment is all about simple substitutions that your clients can make in order to improve their heart health. There’s a preview below, and, if you like what you see, scroll down for a link to download the PDF for free.

Choose OatmealBaked Goods

  • Choose oatmeal or another whole grain cereal instead of baked goods. Top your oatmeal with fruit and skim milk.
  • You can also try 100% whole wheat breads instead of sugary baked goods. After all, MyPlate does insist that people should make at least half of all the grains they eat whole grains, every day.

Butter

  • Try trans-fat-free light tub margarine instead of butter.

Cheese

  • Substitute fat-free ricotta for regular or reduced-fat ricotta.
  • Use a little bit of cheese that has a strong flavor instead of a lot of cheese that has a mild flavor. For example, try Swiss, Parmesan, or cheddar cheese as flavoring agents and keep the amount you use in the dish on the small side.

Egg Yolks

  • Use egg whites instead of whole eggs.
  • Try a nonfat egg substitute.

To see the whole handout, download it today!

If you’re looking for more nutrition education resources or items that address the diet and heart health education theme, check out the amazing featured products below…

Heart Health Poster Value Set

Lighten Up Your Cooking Handout

Lower Your Heart Attack Risk Score Heart Health Brochure