Addressing the Fiber Gap

This post originally appeared in fiberfacts.org and can be read here.

Choose higher fiber versions of the foods you now eat to help close the fiber gap

More fiber rich foods can be added to your meals and snacks to help close the fiber gap.

WHY IS SO MUCH FIBER MISSING FROM U.S. DIETS?
The Dietary Guidelines for Americans (DGA), first published in 1980 and revised every five years since, have each contained recommendations that provide ample sources of dietary fiber to meet every American’s needs.   If all Americans ate the recommended daily servings of whole grains; beans, peas and lentils; nuts and seeds; vegetables; and fruits there would be no “fiber gap,” or shortfall between our consumption of fiber and our requirements.  But Americans are not eating the recommended servings each day, or most days, of the foods rich in this indigestible carbohydrate that provides numerous health benefits (1).

The reasons Americans don’t consume enough dietary fiber are as diverse as the population itself. For some, it is simply a matter of taste preferences. Many who are “finicky eaters” in childhood grow up to be adults who still won’t eat broccoli.  For others, the reason is time constraints. Their schedules are so full they don’t believe they have the extra 20 minutes it takes to cook brown rice instead of white or slice a tomato for their sandwich.  Other reasons include perceived higher cost of high fiber foods, limited cooking skills to prepare them, lack of awareness about their options, and concern over digestive issues to name a few.

Whatever the reason for not eating enough fiber, the first step to closing the gap requires a change in one’s dietary pattern.

THE CHALLENGE OF DIETARY PATTERNS
The 2015-2020 DGA acknowledge that no individual food or nutrient is more important to our health than our overall dietary pattern (2). That is because dietary patterns reflect the amounts, variety and combinations of the different foods and drinks we regularly consume. Dietary patterns can also provide insight into where and when we eat, with whom, and how our food was prepared. (3). They are the key to knowing what our usual caloric and nutrient intake is over time.

If adequate amounts of fiber-rich foods are not part of someone’s dietary pattern, their habitual way of eating will have to be modified to incorporate them. This requires changes in long-established eating behaviors.

USING NUDGES FOR BEHAVIOR CHANGE
There is no one best way to help individuals, let alone entire populations, change their dietary patterns, but one method that has broad appeal is the use of “nudging” (4).  Nudge theory was popularized in the 2008 book, Nudge, co-authored by Richard Thaler and Cass Sunstein, and helped Richard Thaler win a Nobel Prize in Economics in 2017 (5).Simply stated, nudge theory encourages people to make decisions that are in their own best self-interest by making it easier for them to do so.

The current recommendations for fiber intake are 14 grams for every 1000 calories or a total of 25 – 38 grams a day for adults. These are difficult goals for most people to comprehend, let alone calculate. But if we nudge someone to eat just one more serving a day of a good source of fiber from choices that are already part of their dietary pattern, they have a goal that is both doable and sustainable.

ADDING ONE MORE SERVING                                                                                                                                For example, if someone eats lunch in their school or workplace cafeteria every Monday through Friday and makes a salad from the salad bar, we can encourage them to add one more serving of a fiber-rich food to their bowl. This could be 6 cherry tomatoes, ½ cup chickpeas or barley salad, or 2 tablespoons of sunflower seeds or dried cranberries. They don’t have to know how many grams of fiber they added or go out of their way to find these options. They just have to add one more serving of a vegetable, bean, grain, seed or fruit that they like and is right in front of them.

The next nudge to add one more serving could be to put an extra can of kidney beans in their homemade chili or mix a cup of frozen lima beans into a can of minestrone soup or blend some chopped walnuts with the bread crumbs they’re using to coat chicken cutlets. Little by little these nudges can help people increase their fiber intake by using foods that fit within the framework of their existing dietary pattern.

There are endless ways to “nudge” more sources of fiber into a dietary pattern by using higher fiber options in place of, or in addition to, the foods already being eaten, including the use of foods containing added fiber. The chart below provides examples of some ways to get started.

WAYS TO INCREASE FIBER IN THE DIET*
By replacing a Current Choice with the New Choice illustrated below, fiber intake can be nudged higher with each selection.

GRAINS

Current Choice Portion Size Fiber (gm) New Choice Portion size Fiber     (gm)
Bagel, pumpernickel 3.5” diameter 3 Bagel, whole wheat 3.5” diameter 8
Bread, whole wheat 1 ounce slice 3 Bread, whole wheat with added fiber 1 ounce slice 7
Pasta, white 2 ounces dry 1 Pasta,  with added fiber 2 ounces dry 6
Corn Flakes 1 ounce 1 Bran Flakes 1 ounce 5
Tortilla, flour 1 ounce 0 Tortilla, whole wheat 1 ounce 2

VEGETABLES

Yam, cubed without skin ½ cup 2 Yam, cubed with skin ½ cup 4
Spinach ½ cup 2 Collard Greens ½ cup 4
Hearts of Palm, canned 3 pieces 2 Artichoke Hearts, canned 3 pieces 3
Tomato Juice 1 cup 1 Vegetable Juice 1 cup 2
Zucchini Squash 1 cup 2 Acorn Squash 1 cup 6
Lima Beans ½ cup 4 Edamame, shelled ½ cup 9

FRUITS

Strawberry Milkshake 8 ounces < 1 Strawberry Smoothie 8 ounces 3
Peach medium 2 Pear medium 5
Pineapple 1 cup 2 Kiwi 1 cup 5
Fruit Leather 1 ounce 0 Apricots, dried 1 ounce 2
Grapes 1 cup 1 Raspberries 1 cup 8
Jam, concord grape 1 tablespoon 0 Jam, concord grape with added fiber 1 tablespoon 3

BEANS, NUTS & SEEDS

Tofu, firm ½ cup 3 Split peas, cooked ½ cup 8
Peanuts 1 ounce 2 Almonds 1 ounce 4
Black-eyed peas ½  cup 5 Navy beans ½ cup 9
Sesame seeds 1 tablespoon 1 Chia Seeds, dried 1 tablespoon 4
Sunflower Seeds 1 ounce 3 Pumpkin Seeds 1 ounce 5
Butter, salted 2 tablespoons 0 Peanut Butter, creamy 2 tablespoons 2

* Values are averages for similar items and rounded to nearest whole number


TIPS FOR DIETITIANS AND OTHER HEALTHCARE PROFESSIONALS 

  • Discuss the changes in bowel frequency and possible flatulence up front to avoid unexpected problems that could derail someone’s commitment.
  • Show respect for individual food preferences by basing recommendations on what clients like rather than the foods highest in fiber, many of which they may not like.
  • Avoid leading with the message that it is “easy” or “simple” to change one’s dietary pattern when it isn’t, but it can be done when the change is not too disruptive to one’s established routines.
  • Always include lower cost options in messaging, such as using canned, frozen and dried fruits and vegetables, to reinforce the fact all forms contribute needed fiber and other nutrients.
  • Make it clear the fiber in foods is not destroyed by preparation methods, such as chopping and pureeing or by temperature changes, such as boiling and freezing.
  • Suggest foods containing added fiber(s), such as granola bars, yogurts, and pasta, to replace lower fiber choices they may now be consuming.
  • Remind them that the claim “Made with Whole Grains” does not mean the food is a significant source of fiber so they must use the fiber information on the Nutrition Facts Panel to compare these foods to other products.
  • Look for the claims “High in Fiber” or “Good Source of Fiber” on product labels to easily find higher fiber foods.
  • Recommend fiber from a variety of food sources that contain different types of fiber since they have different benefits.
  • Encourage the use of QR scans and websites to find fiber information for foods that don’t have labels, like fresh fruits and vegetables and bulk grains and seeds.

REFERENCES:

  1. Hoy MK, Goldman JD. Fiber intake of the U.S. population What We Eat in America, NHANES 2009-2010. Food Surveys Research Group Dietary Data Brief No. 12. September 2014.
  2. S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th Edition. December 2015 https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf
  3. Tucker KL. Dietary patterns, approaches, and multicultural perspective. Appl Physiol Nutr Metab. 2010;35(2):211-218 doi: 10.1139/H10-010.
  4. Arno A, Thomas S. The efficacy of nudge theory strategies in influencing adult dietary behaviour: a systematic review and meta-analysis. BMC Public Health. 2016;16:676. doi:10.1186/s12889-016-3272-x.
  5. Thaler RH, Sunstein CS. Nudge. Improving Decisions About Health, Wealth, and Happiness. 2009, Penguin Books, London.

 

Items of Interest

Blending More Fiber into Meals

This post originally appeared in fiberfacts.org and can be read here.

It's easy to blend more fiber into meals with these helpful tips

Blending more fiber into meals is easier than you think

We’ve all seen the child who refuses to take even one bite of the steamed carrots on his or her plate, yet gobbles up the macaroni and cheese right next to it made with mashed carrots in the sauce. For many parents, this may feel like a nutrition success story, but is it really?  When children will only eat vegetables if they are hidden in something they like, they are missing an important lesson about the foods that make up a balanced diet. That is why I’ve always recommended “blending” instead of hiding foods to help children recognize and appreciate the contributions made by every food group to their health.  This lesson applies to teens and adults, as well.

Blending more vegetables (or other nutrient-dense food) into a recipe isn’t just a good way to enhance the nutritional value of a meal, it’s also a great way to extend the yield or lower the cost without significantly changing the look, texture or taste of the dish. It is also a valuable way to reduce food waste, like blending the heels of white and whole wheat bread to make bread crumbs for a meatloaf.

Another big benefit of blending is the way it can help close the gap in our intake of dietary fiber since many higher fiber foods blend well with the foods people regularly eat, such as smoothies, hamburgers and brownies. And since eating habits are so hard to change, blending a new food into an existing dietary pattern is a practical way to get more fiber into meals and snacks without having to give up the foods you already enjoy.

REVISE THE RATIO
A simple way to use blending to add more fiber to your diet is to increase the amount of one or more of the high fiber ingredients called for in a recipe while using a little less of something else that is lower in fiber. For example, you can “revise the ratio” by adding:

  • 1 ½ cups of raspberries to a smoothie and just ½ cup of melon cubes instead of one cup of each,
  • Swap another cup of beans in the chili to replace a cup of ground meat
  • Extra chia seeds on your yogurt and less granola
  • Add more cucumber and tomato slices into your salad and less lettuce

BLEND TO EXTEND
Blending is a great way to stretch or extend a recipe so you get a few more servings while increasing the fiber content. One way is to add a 15 ounce can of rinsed navy beans to a 28 ounce can of baked beans. There’s enough sauce in the baked beans to flavor the additional beans, but you’ll end up with ten half-cup servings instead of six, and each will all have more fiber and less sodium and added sugars than the original can of baked beans. Similarly, a cup of canned mixed vegetables can be blended into a can of vegetable soup to extend the servings from two to four while increasing the fiber content in them all.  And any recipe that starts with simmering diced vegetables, such as onions, carrots, and celery will taste even better and be higher in fiber if you extend the amounts of the vegetables called for. You can even add a cup or two of complementary frozen vegetables to a stew or soup simmering in a slow cooker during the last hour to extend the fresh ones added in the beginning.

BLEND TO ENHANCE
Ground meat, poultry or fish mixtures used to make things like meatballs, croquettes and fish cakes are an ideal place to blend in high fiber whole grain crumbs to “enhance” the fiber content. Crushed whole grain cereal or cracker crumbs can also be used or oatmeal. Stuffing mixtures made with white rice to fill peppers, acorn squash, and other hollowed vegetables can be blended with whole grains, such as brown rice, bulgur or barley to easily enhance the fiber content. And when making quick breads and muffins, part or all of the all-purpose flour called for can be blended with whole wheat or white whole wheat flour to boost the fiber content.

BLEND TO SWEETEN
Sweet potatoes are true to their name and the purple ones are even sweeter than the orange. When peeled, cooked and mashed they can be used to make much more than pie. Look for recipes that blend sweet potatoes into the batter for brownies, donuts, cookies and other sweet treats to replace some or all of the sugar and flour while increasing the fiber.  Sweetness and fiber are also available by blending pureed dates into recipes for granola bars, pudding, fudge and more. Don’t overlook the many ways to sweeten a smoothie without sugar and increase the fiber by using naturally sweet and fiber-rich fruits and vegetables like carrots, apples and mangoes.

BLEND TO BULK UP
Beans, peas and lentils are true superfoods due to the many vitamins and minerals they contain, the plant-based protein they provide and the great source of fiber they add to any diet. Even more important to their superfood status, they are inexpensive and available everywhere all year long. To bulk up the nutrition and fiber profile of any meal, all you have to do is blend in some beans. Try using pureed beans or lentils to thicken a soup or make a sauce. You can bulk up your Bolognese with kidney beans or your guacamole with green peas. Pureed beans can also be added to cake batter for a more moist and dense dessert. Popular recipes include black beans in brownies, cannellini beans in coconut cake and baked beans in spice cake. The options are endless!

In every example I’ve provided, and those you come up with on your ownit is important to remember that the goal is to celebrate the benefits of blending more high fiber foods into your meals, not to hide or disguise them.

RESOURCES

Get More Fiber in Your Diet

High Fiber Chef: Cooking Tips to Prepare High Fiber Foods Like a Pro

Finding Fiber in the Grocery Store

 

Finding Fiber in the Grocery Store

This post originally appeared on fiberfacts.org and can be read here.

Food shopping today is very different from just 50 years ago when shoppers pushed a cart up and down the six to eight parallel aisles of a grocery store that only sold food.  Supermarkets now cover over 45,000 square feet and offer everything from the food we eat to the fuel we put in our cars to get it home. And if that’s too much trouble, consumers can simply place an order online and have their groceries delivered to their front door.

The food choices available today have changed, too. Shoppers can now buy every ingredient they need to prepare exciting new recipes or purchase meals kits that contain all of the pre-cut ingredients they need to make dinner for two in 20 minutes, or select a different complete meal for every member of the family from the prepared food department.

All of these changes in the food shopping experience mean the messages wellness professionals share with consumers about how to make the best food choices when shopping must change, too. This is especially true when guiding the public to all of the fiber-rich foods in the grocery store since so many Americans do not meet the recommended daily intake for dietary fiber.

One of the best ways to help consumers find fiber rich foods is to remind them they can be found throughout the store, not just in the fresh produce section or the cereal aisle. Encourage them to seek higher fiber options for the foods they already buy by comparing the fiber content on the Nutrition Facts labels and to take advantage of the many products that are a good, or better, source of fiber because they contain added fibers. Filling their carts (or online orders) with more fiber is easier when consumers realize the entire store offers them choices that they may not have taken advantage of before.

Suggestions for Finding Fiber in the Grocery Store

Serve Yourself Food Bars

  • Salad Bars with assorted leafy greens and pre-cut vegetables and fruits can be used to make customized salads or get the vegetables needed for a recipe
  • In-store buffets offer ready-to-eat vegetable, grain, and bean side dishes, and many high fiber plant-based ethnic entrees
  • ‘Mediterranean’ bars feature different types of hummus, roasted vegetables, tabbouleh, and stuffed grape leaves
  • Soup bars contain assorted varieties with vegetables, beans, peas, lentils and grains and chili with beans

Prepared Foods Department

  • Family-sized heat-and-serve side dishes with different types of prepared vegetables, potatoes, and grain mixtures can complement any entrée

Produce Department

  • Fresh fruits and vegetables, whole and sectioned, including international varieties and seasonal selections
  • Peeled, diced, sliced, shredded, riced and spiralized fruits and vegetables that are recipe-ready
  • Bulk and bagged onions, potatoes, yams, and sweet potatoes available all year round
  • Ready-to-serve Vegetable platters and fruit trays for entertaining

International Food Section

  • Greater assortment of bagged and canned beans, peas, lentils, whole grains, nuts and seeds
  • Baby corn, assorted salsas, falafel mix, and other specialty vegetables and grain mixtures
  • Soba, ramen, udon and other whole grain Japanese noodles

Freezer Cases

  • Vegetables in single varieties or medleys, including edamame and other beans and peas, and vegetable mixtures combined with whole grains
  • Fruits and berries in single varieties or medleys and mixtures pre-cut for smoothies
  • Whole wheat and multigrain waffles, pancakes, French toast, pizza dough, and bake-and-serve dinner rolls
  • Vegan and vegetarian frozen meals, including meals-in-a-bowl, featuring beans, peas, and lentils and whole grains
  • Veggie burgers, veggie crumbles and other meat substitutes
  • High fiber ice creams containing added fibers

‘Center Store’ Packaged Food Aisles

  • Canned and jarred vegetables, including diced and stewed tomatoes and pureed pumpkin
  • Canned and jarred fruits in household and single serving sizes
  • Soups in cans, pouches and heat-and-eat single servings featuring vegetables, beans, lentils, peas and grains
  • Canned beans, peas and lentils and baked beans
  • Bagged dried beans, peas, lentils
  • Barley, buckwheat, bulgur, millet, sorghum, wild rice, brown rice and other whole grains
  • Assorted whole grain and high fiber breakfast cereals, including whole bran and cereals some with added fibers
  • Breakfast bars, cereal bars, and snack bars including some with added fiber
  • Whole wheat panko and bread crumbs, croutons and stuffing mixes
  • High fiber pasta and whole wheat couscous
  • Whole wheat and buckwheat pancake mix
  • Assorted whole grain flours and corn meal for cooking and baking
  • Whole grain quick bread and muffin mixes
  • Prune juice and some vegetable juices with added fiber

Condiments Section

  • Jars of roasted peppers, artichoke hearts, caponata and other marinated and pickled vegetables
  • Dry pack and oil-packed sun-dried tomatoes

‘Natural Foods’ Department

  • Bulk bin dried fruits, nuts, and seeds
  • Assorted nut butters in jars or freshly ground
  • Meal replacement bars, high protein bars, granola bars, and high fiber bars, some made with added fibers

Fresh Bakery Department

  • Artisanal multi-grain breads and rolls, many with seeds on top
  • Bran muffins, whole wheat croissants, multigrain crostini and seeded bread sticks

Deli and Packaged Bread Departments

  • Coleslaw, broccoli slaw, carrot salad, pickled beets, 3-bean salad, salads, vegetable fritters and other prepared vegetable grains and beans salads
  • Assorted whole grain and high fiber breads, rolls, English muffins, wraps, tortillas, flatbreads, pita, naan and other specialty breads
  • Ready-to-assemble whole wheat pizza crusts

Dairy Department

  • High fiber yogurts containing added fibers
  • High fiber cottage cheese containing added fiber

Refrigerated

  • Sauerkraut in bags and pouches
  • Guacamole and hummus in a variety of flavors and container sizes
  • Sectioned citrus and other fruits in jars, fresh salsa, and fresh bruschetta

Snack Food Aisles

  • Whole grain crackers, chips, pretzels, and popcorn
  • Single-pack nuts, seeds, and trail mix
  • High fiber brownies, cookies and cakes made with added fiber
  • Dry roasted peas, garbanzo beans and soybeans

Health and Beauty Department

  • Fiber supplements in capsules, tablets, gummies, and powdered mixes

REFERENCES

Dietary Fiber on the Food Label

Closing the Fiber Gap

Finding More Fiber-Rich Foods When Eating Out

This post was originally published on fiberfacts.org and can be read here.  

 

Research on the eating habits of Americans shows that our consumption of “foods away from home”* has been steadily rising since 1987. The amount of household food budgets spent on foods away from home surpassed the amount spent for “food at home” in 2010 when it reached 50.2 percent. (1) It has held that lead ever since.

Sources for the meals, snacks and beverages Americans eat away from home include quick-service, fast-casual and full-service restaurants; cafeterias, canteens and concessions; convenience stores, mobile food vendors and vending machines; and delis, bakeries, and drinking places. While a wide range of menu options are available in these outlets, the nutrient quality of the foods selected when eating in them traditionally has been higher in calories, fat, sodium and sugar than food from home. (1)

More recently, the quality of foods eaten away from home has become more similar to that of foods eaten at home due, in part, to the greater availability of healthy options on menus and the declining quality of the choices being served at home. (1)  Unfortunately, our intake of dietary fiber, an “underconsumed” nutrient according to the Dietary Guidelines for Americans 2015-2020, is still not at recommended levels in either setting. (2)

Wellness professionals can help their clients close this gap by guiding them to fiber rich options when eating away from home in addition to those they can readily find in the grocery store for meals prepared at home.

One way to add more fiber-rich foods away from home is by making Smart Swaps and Substitutions. For example, rather than ordering the most popular “combos” on the menu, consumers can swap out something in those combos for one more serving of  fruit, vegetable, whole grains, beans, nuts or seeds as illustrated in the chart. If they don’t see the swap they want on the menu, they should be encouraged to ask for it since the more requests a restaurant receives for an item the more likely it will be to provide it in the future. The establishment may also suggest an alternative. Additionally, consumers may find higher fiber options by looking for the “healthier choice” icon featured on many menus today.

SMART SWAPS AND SUBSTITUTIONS TO INCREASE FIBER WHEN EATING AWAY FROM HOME

SUBSTITUTE THIS FOR THIS
For Breakfast  
Fruit cup or sliced tomato Home fried potatoes or hash browns
Half grapefruit or citrus sections Orange juice or grapefruit juice
Whole wheat toast or seeded rye toast White bread toast, English muffin or biscuit
Oatmeal with fruit or quinoa porridge Cream of wheat or grits
Pancakes or waffles with berries or bananas Pancakes or waffles with syrup or whipped cream
Bran muffin or corn muffin Donut or pastry
Vegetable omelet or burrito Ham or sausage omelet or burrito
Fruit and yogurt parfait with granola Fruit smoothie
Avocado on toast or bagel Cream cheese on toast or bagel
Huevos Rancheros (eggs, beans, salsa, tortilla) Eggs Benedict
For Lunch or Dinner: 
Cole slaw or apple slices French fries or potato chips
Whole wheat bread, roll or wrap White bread, roll or wrap
Black bean, lentil, or split pea soup Chicken noodle, chicken rice or matzo ball soup
Minestrone or mushroom barley soup Cream of potato, broccoli or mushroom soup
Salad topped with nuts, beans or seeds Salad topped with croutons, bacon bits or cheese
Extra lettuce, tomato, onions or peppers on a burger or sandwich Extra cheese or meat on a burger or sandwich
Brown rice with Chinese food or in sushi White rice with Chinese food or in sushi
Salsa or guacamole with corn chips Queso dip or nacho cheese with corn chips
Double vegetables with entree White rice or mashed potato with entree
Baked potato topped with salsa or chili Mashed potatoes with gravy
Peppers, onions or broccoli on pizza Sausage, pepperoni or meatballs on pizza
Roasted asparagus or Brussel sprouts appetizer Fried zucchini or onion blossom appetizer
Corn on the cob or baked beans side order Fried onion rings or macaroni and cheese
Meatless bean or veggie burger Beef or turkey burger
Beans and rice side dish Biscuits and gravy side dish
Snacks:
Popcorn, trail mix, or nut and seed packs Potato chips, cheese crackers, or pretzels
Granola bar or fig-filled cookies Candy bar or sandwich cookies
Freeze-dried fruits or dried fruit Fruit roll-up or gummy fruit
Hummus or guacamole with vegetables Cheese dip or spread with crackers
Fiber One® bars, brownies, or snack cakes Regular cookies, brownies, or snack cakes
Whole fruit  or non-browning apple slices Fruit cups or applesauce

Another way people can find more fiber when eating away from home is by patronizing ethnic restaurants featuring more plant-based cuisines.  This is also a good way to sample different fruits, vegetables, beans, lentils, grains, nuts and seeds when they are properly prepared and seasoned. Once new dishes are tried away from home and enjoyed, it may increase the likelihood of their being purchased for home consumption when seen in the grocery store.

While everything on the menus in these restaurants is not high in fiber, there are many more plant-based choices than found on standard American menus and the chefs are often more willing to accommodate special requests. The key is to ask!

ETHNIC CUISINES WITH MORE PLANT-BASED CHOICES ON THE MENU

  • Chinese
  • Ethiopian
  • Indian
  • Indonesian
  • Japanese
  • Korean
  • Middle Eastern (Lebanese, Israeli Syrian)
  • Thai
  • Vegetarian or Vegan
  • Vietnamese

*“Foods away from home” can include foods prepared and purchased away from home but eaten at home and “foods at home” can include foods prepared at home but eaten elsewhere.

 REFERENCES

1.Saksena MJ, Okrent AM, Anekwe TD, et al (17). America’s Eating Habits: Food Away From Home, EIB-196, U.S. Department of Agriculture, Economic Research Service, September 2018.

https://www.ers.usda.gov/webdocs/publications/90228/eib-196.pdf?v=1045.6

2. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th Edition. December 2015

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

Robyn Flipse, MS, MA, RDN is a registered dietitian, cultural anthropologist and scientific advisor to the Calorie Control Council, whose 30+ year career includes maintaining a busy nutrition counseling practice, teaching food and nutrition courses at the university level, and authoring 2 popular diet books and numerous articles and blogs on health and fitness. Her ability to make sense out of confusing and sometimes controversial nutrition news has made her a frequent guest on major media outlets, including CNBC, FOX News and USA Today. Her passion is communicating practical nutrition information that empowers people to make the best food decisions they can in their everyday diets. Reach her on Twitter @EverydayRD and check out her blog The Everyday RD.

artificial sweeteners and cancer

Nonnutritive Sweeteners and Cancer: Evaluating the Evidence

This article was written for the dietetic practice group of Nutrition Education for the Public and published in the 2017 summer issue of their newsletter, Networking News. You can read the original post here.

Research to find a cure for cancer is matched only by the efforts to find the cause. Studies have shown that the types and amounts of food eaten over time, or our dietary pattern, can both increase the risk of certain types of cancer and decrease the risk for others. If individual foods or additives are suspected of causing cancer, they are removed from the food supply when evidence confirms their carcinogenicity. And other factors, such as genetic predisposition and environmental exposures, can influence whether someone will develop cancer regardless of diet.

Establishing the safety of any food, additive,or even drinking water must consider exposure and risk. Dietary Reference Intakes(DRI) and Acceptable Daily Intakes(ADI) . provide safety thresholds for nutrients and food additives, respectively,by determining the risk associated with their consumption over a lifetime. These are valuable references for registered dietitian nutritionists (RDNs) who want to provide evidence-based answers to questions,such as how much Vitamin A or aspartame can be safely consumed.

Where does the public get answers to their questions about artificial sweeteners? If someone asks, “Do artificial sweeteners cause cancer?”, they will get over three million search engine results. The first one in my Google search was from the National Cancer Institute, the federal government’s principle agency for cancer research. The second was from the site of Dr. Mercola, whose mission statement says, in part, to expose government hype that diverts you away from what is truly best for your health. The answers offered by these two sources could not be more opposed. Other articles in my search included one with quotes from“actress and health expert” Suzanne Somers to those embedded among the recipes on Delish.com.

Is it any wonder the public is confused about the safety of low- and no-calorie sweeteners (LNCS)? Even people who never search for nutrition information online are being influenced by the extreme results found there, and this is a challenge for RDNs and health professionals. According to the International Food Information Council’s 2017 Food & Health Survey, consumers feel personal healthcare professionals are more trustworthy than looking online about what to eat or not eat, but they turn to family and friends more often to guide their food choices.

What does the science say about low- and no-calorie sweeteners?

Consumers may be confused about the safety of LNCS, but there is no reason for RDNs to be. Our education in a science-based curriculum prepares us to understand the merits of different types of study design and the interpretation and application of their results. We know we can rely on the findings reported in systematic reviews and meta-analyses to assess whether the amount and quality of evidence on a subject is sufficient to guide client decisions. And as members of the Academy of Nutrition and Dietetics (AND), we can also access the Evidence Analysis Library to find practice guidelines drawn from completed systematic reviews that answer specific questions based on the quality and extent of the evidence. Our training and these resources allow us to provide the public with consistent, accurate and ethical information within our scope of practice.

So when asked if LNCS cause cancer, one of the first sources we can check is the Surveillance, Epidemiology, and End Results Program (SEER) of the NCI. It collects, analyzes, interprets and disseminates data on cancer prevalence. Here we can see if the incidence of any type of cancer can be attributed to the worldwide increase in the use of LNCS over the past several decades or to any one of them as an individual sweetener. To date, there is no data to support either query.

The next source is, “Guidelines on Nutrition and Physical Activity for Cancer Prevention” from the American Cancer Society (ACS) and published in CA: A Journal for Clinicians. It states:

Current evidence does not show a link between these compounds [nonnutritive sweeteners and sugar substitutes] and increased cancer risk. Aspartame,saccharin and sucralose are a few of the nonnutritive, synthetic sweeteners approved for use by the FDA. Current evidence does not demonstrate a link between ingestion of these compounds and increased cancer risk.”

These Guidelines reflect the scientific consensus on cancer prevention from the ACS and are comparable to the Position Paper: Use of Nutritive and Nonnutritive Sweeteners. They are also supported by the National Cancer Institute, Food and Drug Administration, European Food  Food Safety Authority, and many other food safety authorities around the world.

Why all the controversy over low-and no-calorie sweeteners and cancer risk?

Despite the approval of LNCS for use by populations in more than 100 countries, questions about possible cancer risks are still raised. I have two explanations to help you address this with your clients and consumers.

The early history of saccharin and cyclamate, the first two artificial sweeteners widely used in the U.S., is riddled with cancer claims, warning labels, bans, moratoriums and research reversals. When new research proved they posed no cancer threat for humans, only saccharin was reapproved in the U.S. by the FDA, while cyclamate remained banned. It is, however, approved in 130 other countries. Ever since, suspicions have remained that use of any LNCS might increase cancer risk. This is the result of what I call the“Satan Effect.”

Like the “Health Halo” that imbues foods of questionable nutritional value with a more righteous reputation because of the company they keep, the “Satan Effect” does the opposite. It disparages an otherwise safe food because it is associated with a negative trait and cannot shake the bad reputation, even if undeserved. In the case of LNCS, the effect is reinforced by news outlets that continually exploit any study that finds tumors in lab animals exposed to huge quantities of LNCS, even when the findings cannot be extrapolated to humans, or studies that report associations based on methodology that cannot demonstrate causality. This leads to the second explanation for all the controversy.

All low- and no-calorie sweeteners are not the same

One thing all LNCS sweeteners have in common is their intense sweetening power compared to sugar, but that is where their similarities end. Nine LNCS have been approved for use in the U.S. by the FDA or meet the standards for Generally Recognized As Safe (GRAS) exemptions. They are acesulfame potassium, advantame, allulose*, aspartame, monk fruit extract (GRAS), neotame, saccharin, stevia (GRAS), and sucralose.

As reported in the Special Article, “Biological fate of low-calorie sweeteners” published in Nutrition Reviews in 2016, LNCS do not have the same structures and chemical compositions, are not derived from the same sources, and do not have the same metabolic outcomes or excretion pathways once ingested. Some are digested and indistinguishable from amino acids consumed in any other protein source. Some are not metabolized by humans and excreted unchanged in feces. Others are partially absorbed into the systemic circulation before being excreted in the urine.

These unique features of LNCS are critical, yet are often overlooked in the headlines and tweets that proclaim “artificial sweeteners cause cancer” (or any other disease). As translators of science for the public, our job is to read the studies, or consult with colleagues who have,to get the story right.We need to confirm which LNCS were used, or the product containing them, and not rely on headlines regarding the findings. We must also compare the study design and results to the existing body of research in order to evaluate the impact of new evidence.

A final point worth noting is level of exposure, as discussed earlier in this article. The available LNCS are 200 to 20,000 times sweeter than sugar,which greatly limits the amount found in any product. They are also regularly used in combination with one another, further minimizing the amount of any one likely to be consumed over a lifetime. At present,the Estimated Daily Intakes for LNCS fall below 10 percent of the Acceptable Daily Intakes, as explained in my article, “It’s the Dose that Matters.”With market reports showing a steady increase in the number of new LNCS expected to become available over the next 20 years, there is little reason for anyone to be concerned about over exposure to LNCS in the food supply.

Doing what we do best

Knowing that RDNs are one of the most trusted sources of nutrition information in the eyes of the public gives us a valuable opportunity to redirect the conversations surrounding LNCS from those steeped in opinions and inaccuracies to ones based in facts and truth. This effort is greatly enhanced when we are all sharing the same evidence-based information. I hope this article will strengthen your resolve to do just that.

*A low calorie sugar

References

World Health Organization. International Agency for Research on Cancer. Accessed June 20, 2017. https://www.iarc.fr/en/about/index.php

U.S. Department of Health and Human Services. National Institutes of Health. Nutrient Recommendations: Dietary Reference Intakes (DRI). Accessed June 26, 2017. https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx

European Union Food Information Council. Acceptable Daily Intakes (ADIs) Q&A. Posted December 1, 2013. Accessed June 20, 2017. http://www.eufic.org/en/understanding-science/article/qas-on-acceptable-daily-in takes-adis

National Cancer Institute. Artificial Sweeteners and Cancer. Reviewed August 5, 2009. Accessed June 22, 2017. https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet

Mercola.com. Artificial Sweeteners Cause Cancer http://articles.mercola.com/sites/articles/archive/2016/03/30/artificial-sweetenerscause-cancer.aspx

Newsmax.com/health.Do Artificial Sweeteners Cause Cancer? Ask Suzanne Somers http://www.newsmax.com/Health/Headline/Somers-artificial-sweeteners-cancer/2 011/12/22/id/477953/

Delish.com. The Truth About Splenda Causing Cancer http://www.delish.com/food-news/a46349/is-splenda-really-linked-to-leukemia/

International Food Information Council. 2017 Food & Health Survey Executive Summary on Food Confusion. Accessed June 21, 2017. http://www.foodinsight.org/sites/default/files/2017-ExSum-FoodConfusion.pdf

Tappenden KA. A Unifying Vision for Scientific Decision Making: The Academy of Nutrition and Dietetics’ Scientific Integrity Principles, JAcadNutriDiet. 2015;115(9):1486-1490. https://www.andeal.org/vault/2440/web/files/EAL/Tappenden_et_%20al_%20201 6_SIP.pdf

Handu D, Moloney L., et.al (4). Academy of Nutrition and Dietetics Methodology for Conducting Systematic Reviews for the Evidence Analysis Library JAcad Nutri Diet. 2016;116(2):311-318 http://jandonline.org/article/S2212-2672(15)01705-0/pdf

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA:Cancer J Clin. 2016;66(1):7-30 http://onlinelibrary.wiley.com/doi/10.3322/caac.21332/full

Kushi LH, Doyle C. et. al (8) Guidelines on Nutrition and Physical Activity for Cancer Prevention. CA: Cancer J Clin. 2012;62:30-77. https://sinaitemple.org/pdf/STMC/ACSGuidelines.pdf

Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners. J Acad Nutr Diet. 2012;112(5):739-758 http://jandonline.org/article/0002-8223(93)91762-F/pdf

National Institutes of Health. National Cancer Institute. Common Cancer Myths and Misconceptions. Posted February 3, 2014. Accessed June 26, 2017. https://www.cancer.gov/about-cancer/causes-prevention/risk/myths

European Food Safety Authority. Sweeteners. Accessed June 20, 2017. https://www.efsa.europa.eu/en/topics/topic/sweeteners

U.S. Food & Drug Administration. Additional Information about High-Intensity Sweeteners Permitted for use in Food in the United States. Last updated 05/26/15. Accessed June 23, 2017. https://www.fda.gov/food/ingredientspackaginglabeling/foodadditivesingredients /ucm397725.htm

National Research Council (US) Committee on Comparative Toxicity of Naturally Occurring Carcinogens. Carcinogens and Anticarcinogens in the Human Diet: A Comparison of Naturally Occurring and Synthetic Substances. Washington (DC): National Academies Press (US); 1996. 4, Methods for Evaluating Potential Carcinogens and Anticarcinogens. Available from: https://www.ncbi.nlm.nih.gov/books/NBK232624/

Calorie Control Council. Worldwide Approval Status of Cyclamate. Posted September 29, 2009. Accessed June 23, 2017. http://www.cyclamate.org/pdf/Cyclamate_worldwidestatus.pdf

Magnuson BA, Carakostas MC, Moore NH, Poulos SP, Renwick AG. Biological fate of low-calorie sweeteners. Nutr Rev. 2016;74(11):670-689 Accessed June 22, 2017 http://nutritionreviews.oxfordjournals.org/content/nutritionreviews/74/11/670.full.pdf

Marinovitch M, Galli CL, et. al (3). Aspartame, low-calorie sweeteners and disease: regulatory safety and epidemiological issues. Food Chem Toxicol. 2013;60:109-115 https://www.ncbi.nlm.nih.gov/pubmed/23891579

Flipse R. It’s the Dose that Matters. CalorieControl.org. Posted June 14, 2016. Accessed June 23, 2017. http://caloriecontrol.org/its-the-dose-that-matters/

Green M. Sweeteners Round-up. PreapredFoods.com. March 23, 2017. Accessed June 21, 2017 http://www.preparedfoods.com/articles/119583-sweeteners-round-up?

Tray of vegetables kebabs ready to put on the barbecue grill

Is a Plant Based Diet a Good Diet Plan?

This post was originally written during my 2 1/2 year tenure as a blogger for Health Goes Strong. This site was deactivated on July 1, 2013.

FOLLOWING A PLANT BASED DIET IS A GOOD PLAN WITHOUT GOING VEGETARIAN

It’s the first day of summer, let the harvest begin! This is my favorite time of year because it makes eating a plant based diet so easy. With so many more seasonal fruits and vegetables to choose from during the summer months, having meatless meals is the default menu option in my house.

You don’t have to become a full-fledged vegetarian to have the benefits of aplantiful” diet, just head in that direction by making more of your meals plant centered.

I not only get to reap the bounty from my own vegetable garden this time of year, I also enjoy the variety that shows up in my local farmer’s market. See my tips for shopping at farm stands to take advantage of this wonderful source of locally grown crops.

Why is a Plant Based Diet a Good Diet Plan?

Edible plants, which include fruits, vegetables, grains, nuts and seeds, provide us with the ideal combination of high nutrient-density and low caloric-density. That means you get more nutrients per calorie you eat, a great strategy for staying properly nourished without gaining weight. Plus, the high water and fiber content of plants helps us feel full, without filling us out.

Then there are all the phytonutrients (plant compounds that have health benefits but are not essential nutrients) you can only get from plants foods. Things like beta-carotene, lutein, lycopene, quercetin and resveratrol can’t be found in beef, poultry or fish but are valued for their cancer-fighting, immunity-building, anti-aging, free-radical-fighting properties.

No matter what the Paleo Diet crowd may say, you are better off living exclusively on plants than on animals in this day and age.

How to Enjoy More Meatless Meals

As I said before, the goal isn’t to eliminate meat, but to eat less meat at meals. It’s not as hard as you may think. You can start by approaching every meal with a focus on what fruit, vegetable, grain, nut and/or seed you will feature in that meal, and treat the animal portion as a side-dish. This can be as simple as cutting the meat serving size in half while doubling up on the plants you normally serve.

Imagine a sandwich on whole wheat bread spread with hummus, stacked with layers of grilled vegetables and topped with sliced avocado. You don’t need, and won’t miss, the deli meat and cheese one bit. But if you want some, a single slice will do.

How about a baked potato (yes, it’s a vegetable) stuffed with black beans (another vegetable) and salsa (a 3rd vegetable), topped with shredded cheese?

For some great outdoor dinner ideas try assorted vegetable pieces threaded onto kebab skewers with just a few cubes of chicken or salmon basted with a flavorful marinade and grilled to serve over a bulghur pilaf. Or you can grill eggplant and tomato slices and stack them up with a bit of parmesan cheese and fresh basil in between for a satisfying summer appetizer.

You can find entrée ideas in vegetarian cookbooks that are easily embellished with a few ounces of meat or cheese, if needed, or just add a few shrimp or some diced turkey to your salad.

Summer is here. It’s time to start moving toward a plant based diet while the pickings are good!

Help yourself to some of these other posts on eating more vegetables, too.

  • 9 Nutritious Salad Toppers From Your Pantry Shelf
  • Make a Healthy Homemade Salsa – It’s Easy!
  • Quick Healthy Meals Begin With Pasta
  • Need Dinner Ideas? Soup Makes Quick Easy Meals
  • Winter Vegetables Make Meatless Meals More Satisfying
  • Focus on Healthy Eating Habits, Not Superfoods
Older man in a kitchen wearing an apron and cooking at stove

Father’s Day Gift Idea: Help Him Learn to Cook

This post was originally written during my 2 1/2 year tenure as a blogger for Family Goes Strong. This site was deactivated on July 1, 2013, but you can read the post here.

ANYONE CAN LEARN TO COOK WITH SOME BASIC COOKING LESSONS AND SIMPLE COOKING TIPS

I grew up in a household with very a clear division of labor when it came to the household chores done by my parents. My mother did everything inside of the house and my father did everything outside.

The kitchen and all of the food that passed through it was my mother’s domain.

If my dad was home when my mom returned from the grocery store he would help carry the bags from the trunk of the car into the kitchen, but that’s as close as he ever came to putting a meal on the table.

I never saw him cook anything. On a few occasions I believe he made himself a sandwich.

Then after 52 years of marriage and eating the three meals a day my mother prepared for him, she died suddenly. How was my dad ever going to able to fend for himself in the kitchen?

If this sounds familiar, or possible, in your world, I’ve got a great Father’s Day gift idea for you. Teach your dad (husband, boyfriend, son) to cook. In fact, everyone you care about should learn to cook.

Here’s how I taught my dad to cook.

Cooking Tips For All First-Time Cooks

My dad’s cooking lessons did not begin with a cutting board and knife. They began with a pad and pencil.

Cooking requires planning.

Even though there was plenty of food in the house when my mother died, my father had no idea what was on hand or what to do with all those random ingredients in the pantry, refrigerator and freezer. To figure it out and provide a template for his future food shopping trips, I divided a piece of paper into six sections and headed them according to the basic food groups:

  • Meats/Poultry/Fish
  • Milk/Dairy
  • Fruits/Vegetables
  • Breads/Cereals/Pasta/Rice
  • Oils/Spreads
  • Seasoning/Sauces/Condiments

Once we completed the inventory, we were able to plan a menu for the coming week using simple recipes I found online. (My mother’s cookbooks and recipe card index were no help.) As we reviewed each recipe I showed him what pot or pan they called for and any small appliances mentioned. We then made a shopping list of what was needed to execute the week’s menu.

Navigating the grocery store was the next lesson in my dad’s training program. Unlike the chefs in those well-stocked kitchens on the cooking shows he loved to watch, if he wanted to learn to cook he had to buy the food. It definitely helped to have the shopping list arranged according to the store layout and cross off things as they went into the cart.

Learning how to properly store all the groceries when we got them home was an equally important lesson. All this happened before he actually prepared anything he could eat.

Cooking 101: Skills for a Lifetime

One of the skills my dad had going for him when his cooking lessons began was that he could carve a roasted turkey. I decided to build on his knife skills and teach him to cut, chop, slice and dice a variety of vegetables. Once he could do that, it was a natural progression for him to learn how to sauté those vegetables.

Sautéing vegetables led to sautéing meats, which led to making finishing sauces in the pan. He could now make pork chops smothered in onions, skillet chili and a chicken and broccoli stir-fry.

The skills we focused on after that were ones that allowed him to make the foods he liked best. Since he enjoyed stews, he learned to use the slow-cooker. He also liked pancakes, so learned to measure and mix the batter (but not over mix) and use the electric griddle. And since he didn’t like pasta, he didn’t need instructions for the colander.