additives. However, the amount of most of these substances that we might eat during the course of a year is small. Here the safety records of a few of the most widely used additives are reviewed.

The most studied of all food additives is the artificial sweetener saccharin. Though saccharin causes bladder cancer in some species of animals raised in the laboratory, there is no convincing evidence of a link between saccharin and bladder cancer in humans.

Aspartame, another artificial sweetener, does not appear to cause cancer, either. And at levels 2 to 3 times higher than even the biggest diet soda drinkers would consume, aspartame does not produce any other harmful effects. However, people with the rare genetic disorder phenylketonuria should avoid foods flavored with aspartame, and these foods carry a warning label to this effect.

Nitrite is a common preservative in lunch meats and other cured meat products. It also occurs naturally in many foods and in human saliva. A recent survey found that the average U.S. diet contains approximately 0.8 mg of nitrite per day. More than one-third of the nitrite comes from cured meats; baked goods and cereals provide another third, and vegetables contribute about one-fifth of the nitrite in the U.S. diet. The nitrite in baked goods, cereals, and vegetables is there naturally, whereas the nitrite in cured meats is added as a preservative.

By itself, nitrite is probably not a cancer-causing substance. But nitrite can react with other naturally occurring chemicals to form nitrosamines, compounds that are carcinogenic. Smoke also contains significant levels of nitrosamines. Several studies in different parts of the world have shown that people who frequently eat cured pickles and meat and smoked foods have a higher risk of developing stomach cancer than people who eat such foods sparingly. One study showed that the odds of getting stomach cancer increased nearly threefold for every milligram of nitrite in the diet. It would



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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease additives. However, the amount of most of these substances that we might eat during the course of a year is small. Here the safety records of a few of the most widely used additives are reviewed. The most studied of all food additives is the artificial sweetener saccharin. Though saccharin causes bladder cancer in some species of animals raised in the laboratory, there is no convincing evidence of a link between saccharin and bladder cancer in humans. Aspartame, another artificial sweetener, does not appear to cause cancer, either. And at levels 2 to 3 times higher than even the biggest diet soda drinkers would consume, aspartame does not produce any other harmful effects. However, people with the rare genetic disorder phenylketonuria should avoid foods flavored with aspartame, and these foods carry a warning label to this effect. Nitrite is a common preservative in lunch meats and other cured meat products. It also occurs naturally in many foods and in human saliva. A recent survey found that the average U.S. diet contains approximately 0.8 mg of nitrite per day. More than one-third of the nitrite comes from cured meats; baked goods and cereals provide another third, and vegetables contribute about one-fifth of the nitrite in the U.S. diet. The nitrite in baked goods, cereals, and vegetables is there naturally, whereas the nitrite in cured meats is added as a preservative. By itself, nitrite is probably not a cancer-causing substance. But nitrite can react with other naturally occurring chemicals to form nitrosamines, compounds that are carcinogenic. Smoke also contains significant levels of nitrosamines. Several studies in different parts of the world have shown that people who frequently eat cured pickles and meat and smoked foods have a higher risk of developing stomach cancer than people who eat such foods sparingly. One study showed that the odds of getting stomach cancer increased nearly threefold for every milligram of nitrite in the diet. It would

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease be prudent therefore to limit the amount of smoked and cured foods that you eat, many of which are high in saturated fats anyway. Two of the most common food additives are the preservatives BHA (butylated hydroxyanisole) and BHT (butylated hydroxytoluene). They are used extensively in dry cereals, shortenings, instant potato products, active dry yeast, and dry drink and dessert mixes. These two compounds have been around for many years, with no convincing evidence that they cause cancer or any other chronic diseases. There is no evidence, either, that the 100 or so milligrams of various food colors that we eat every day increases our risk of developing cancer. Many of the indirect contaminants present in food can cause illness in humans at high levels. The amounts found in food, though, are so small that any risk they might pose is negligible. The one exception to this might be the microbial contaminant called aflatoxin, produced by a mold that infects corn and peanuts. Aflatoxin is among the most potent cancercausing substances known, and its effect is mostly in the liver. In parts of Africa and Asia, it is not uncommon for people to eat corn and peanut products contaminated with aflatoxin. In those parts of the world, the incidence of liver cancer is much higher than anywhere else. In the United States an effort is made to limit the amount of aflatoxin that gets into the food supply, though we still consume minute amounts daily. Nevertheless, liver cancer is still a rare disease in this country. Overall, there is not enough safety information on the complete range of nonnutritive additives and contaminants present in our food. But it seems unlikely that they contribute to our overall risk of chronic disease. But just to play it safe, wash your fresh fruit and vegetables to remove traces of pesticides that might be present on the surface. And do not eat the seemingly unspoiled parts of moldy or spoiled foods, for although they appear okay, they may in fact contain microbial contaminants.

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease Chapter 10 MAKING THE CHANGE TO THE NEW EATING PATTERN After reading the first nine chapters of this book, you should be convinced that diet can play an important role in causing chronic diseases, including heart disease, cancers, high blood pressure, and stroke. It should also be clear that changing your diet can help to reduce your risk for these chronic diseases and therefore increase your chances of living a long and healthy life. Now you must be wondering how to actually accomplish these changes. What types of food should you eat? What types of meals should you plan? Do you need to make changes in how you shop and cook? What can you eat at restaurants? In short, how do you translate the Eat for Life guidelines into a real, practical eating pattern?

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease WHAT FOODS SHOULD I EAT? SOME GENERAL GUIDELINES Following the nine Eat for Life guidelines is mainly a matter of choosing the right foods to eat. Your main emphasis should be on limiting the amount of fat, saturated fatty acids, and cholesterol that you eat; eliminating added salt from your diet; eating more complex carbohydrates; eating a moderate amount of protein; and cutting down on your consumption of added sugars. In addition, you need to exercise enough to balance out the number of calories you consume. You will need to select leaner cuts of meat, moving away from grades of meat that are heavily marbled with fat. Trim your meat of any excess chunks of fat, and remove the skin from poultry. And eat smaller and fewer portions of meat. Also, replace some of the meat you normally eat with fish and shellfish. You should also get more of your protein from plant sources. Legumes—beans and peas—are good sources of both protein and complex carbohydrates. So, too, are cereal grains, such as whole wheat, rye, corn, and rice. So the next time you make chili, replace some of the ground beef with ground turkey and kidney beans. It will taste good but have significantly less fat, saturated fatty acids, and cholesterol. Dairy products are an important source of calcium and protein, but whole milk, whole-milk cheeses and yogurt, ice cream, and other whole-milk products are high in saturated fatty acids. Therefore you need to emphasize low-fat and nonfat, or skimmed, milk products. Since eggs yolks are high in cholesterol and saturated fatty acids, substitute an egg white for every other whole egg you use in a recipe. For example, if you normally eat a two-egg omelet, use one whole egg and one egg white, and add a little skim milk to the mixture. Perhaps the simplest change to make is to switch from butter and lard to margarine with a low saturated fatty acid

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease content. Margarine made from canola oil, for example, is rich in monounsaturated fatty acids, which when substituted for saturated fatty acids help lower LDL-cholesterol levels. Also, use less oil and fat in your cooking. Go easy on the salad dressing and limit fried foods in your diet. Cutting down on fats in your diet means you will need to get more of your calories from carbohydrates. Eat more potatoes, bread, and whole-grain cereals, but go easy on bakery goods such as pies, pastries, and cookies since these are typically high in fat, saturated fatty acids, and added sugars. Besides cutting out fat, limit your use of the salt shaker and sugar bowl at the table. Go easy on the salt, too, when cooking. If you now eat a lot of salt, your food may taste a little bland at first. Try other seasonings instead. You will be surprised at how good food tastes and how much better it gets as your taste buds adjust over the next few weeks. Eat more fruits and vegetables. Though they contribute little in the way of calories, they are excellent sources of vitamins, minerals, and dietary fiber. They also add flavor to foods, making the transition to a reduced-salt diet even easier. PLANNING A MENU Sitting down with your family, a pile of cookbooks, and a list of favorite recipes in front of you and planning meals for the week ahead can be an enjoyable part of ensuring that your eating pattern is a healthful one. But besides being fun, planning your meals is an important part of eating to reduce your risk of chronic disease. For one thing, meal planning allows you to see in advance where the fat, cholesterol, and salt in your diet are coming from, information that can help you develop a more healthful eating pattern. If you know, for example, that you are going to have a hot dog and fries—a high-fat meal—at the ballpark Wednesday night, then you might choose dishes that are particularly low in fat and cholesterol

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease for the meals before and after. You need to be concerned only with the average nutritional content of your diet, not every single food and every single meal. Meal planning offers other benefits, such as saving time and money. Shopping for specific foods for several days of meals takes less time than shopping haphazardly or for just one day at a time. In addition, shopping for these foods, a topic covered later in this chapter, will reduce the amount of food—and therefore money—that goes to waste in your refrigerator because you forgot to use it. Planning meals should also help keep you from getting into an eating rut. Each time you sit down to plan your meals, bring out the family recipe file and your cookbooks and look for favorite meals that you may have neglected for some time. Keep an eye out, too, for new recipes in newspapers and magazines. While some of these will probably be high in fat, cholesterol, and salt, it is not difficult to modify most recipes so that they are easier to fit into a dietary pattern that meets the Eat for Life guidelines without losing their appeal, as you will learn in the section on cooking below. There are three keys to planning an eating pattern that is delicious and nutritious and that helps to reduce your risk of chronic disease. The first is to meet the recommendations for daily servings of fruits and vegetables and complex carbohydrates. Filling your menu each day with at least five servings a day of fruits and vegetables and six servings of cereals, breads, and legumes will give you many of the vitamins and minerals you need without adding fat, saturated fatty acids, cholesterol, and salt to your diet. This is assuming, of course, that your complex carbohydrates do not come from French fries, potato chips, and donuts and that you do not cover your vegetables with lots of fatty salad dressings. The second key is to develop a feel for which foods are low in fats, saturated fatty acids, cholesterol, and salt, and which are not. In some foods, you can see the fat and salt, while in others it is hidden. The visible fats are easy to spot—the marbling in meat, oil in salad dressings, butter on bread,

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease cream bases for soups and sauces. Examples of hidden fats are the butterfat in whole milk and cheese, cooking oil absorbed by French fries, the fat in many cookies and crackers, and the oil in avocados and nuts. You can often see the salt on foods like pretzels, peanuts, and crackers, but salt is also added to many processed foods and is a component of steak and soy sauces. There are some foods that you might think are high in fat but really are not. Pizza, for example, easily fits into a moderate-fat diet. Two slices of a typical 12-inch cheese pizza contain only about 350 calories, of which only about 16 percent are fat, and 10 milligrams (mg) of cholesterol. Topping it with onions, green peppers, and mushrooms adds a few calories, but no fat. Those two slices also supply a good amount of calcium and iron. The only drawback to pizza is that it contains about 1.5 g of salt, one-quarter of the daily maximum. For those foods for which you have no clue as to their fat content, consult the references recommended in Appendix B. The third key to healthful eating is to limit the amount of meat, poultry, and seafood that you eat. You do not have to eliminate these foods entirely from your diet, but try to eat smaller portions—about 3 ounces per meal, with a maximum of 6 ounces per day, is a good compromise. Trim any visible fat from the meat and poultry and buy lean cuts. (For more advice, see the sections later in this chapter on shopping for meat, poultry, and seafood.) In planning your eating pattern, you do not have to ignore snacks and desserts. A wisely chosen snack can add an extra serving of complex carbohydrates or fruit to your daily intake. Fruit is an excellent snack. So is air-popped popcorn; it's filling and virtually all complex carbohydrates. Limit snacks that are high in fat, added sugar, and salt, the main nutritional disadvantages for most snack foods sold in the United States. In small amounts, some crackers are good snacks, although some are high in saturated fatty acids. If you love pretzels, look for low-salt or no-salt varieties.

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease Desserts need not be fat-filled creations, either. Angel food cake, for example, is virtually fat-free. Desserts centered on fruits are your best bet for low-fat dishes without much added sugar. Fruit cobblers, crisps, and compotes are good choices. But even cookies and ice cream, though high in fat, occasionally can be a part of your diet. Just don't eat large quantities of them. Menu planning may seem time-consuming now, but with practice you will find that it becomes much easier. For example, chances are good that when you sit down to plan your meals, you will think of more meals than you can eat in a week. Jot those down for the following week. SHOPPING Now that you know what you are going to eat, you will need to make a trip to the grocery store. To become a smart shopper, you must learn how to read food labels, how to look for lean meats, and how to read past some of the ''health" claims on product labels in order to get to the real nutritional content of an item. The following sections will help you to develop these skills. Fruits and Vegetables Perhaps the single best place to start shopping is the produce department. Here there is little fat, salt, added sugar, or cholesterol. The two exceptions are avocados and coconuts. Because both are high in fat (coconuts in particular are rich in saturated fatty acids), you should eat them in moderation at best. The produce aisle is a good place to find new foods to enliven your diet. In the lettuce section, for example, try leaf, bibb, Boston, or romaine lettuce or endive. Use fresh spinach

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease to add variety—and nutrients—to your salad bowl. If you like spicy foods, use a small amount of hot-tasting mustard greens in your tossed salad. Potatoes are a great source of complex carbohydrates and some vitamins and minerals. So, too, are sweet potatoes, which you can bake just like regular white potatoes. Squashes are poorly appreciated by most U.S. adults, but they are simple to cook and cheap and plentiful in winter when many vegetables go up in cost. Next time you make boiled potatoes, add a turnip or parsnip to the pot as well. Many fruits are good sources of vitamins and minerals. For example, bananas are one of the best sources of potassium. Citrus fruits are the best natural source of vitamin C, and watermelon supplies a good bit of vitamin C and carotenoids for vitamin A. Grain Products Grain products include breads and cereals made from wheat, rye, corn, rice, and other grains. They are rich in complex carbohydrates and usually low in fat. The notable fatty exceptions are croissants, pastries, cakes, and granola. By combining grain products with meat, poultry, or fish, you will reduce your dependence on these animal foods as the centerpiece of dinner. Try combining rice or pasta, for example, with lightly sautéed vegetables, beans, and herbs and spices—perhaps with a small amount of beef, chicken, or fish—to make a nutritious, low-fat entrée. Eat plenty of grain products each day, but try to select those made with whole or unrefined grains as often as possible. Foods like whole wheat bread, brown rice, oatmeal, and cereal and pasta made from whole grains are not as heavily refined as white bread, white rice, and corn flakes, for example, so they have more vitamins, minerals, and fiber.

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease Legumes Most people should eat more legumes (or beans, as they are more commonly called). Black beans, pinto beans, kidney beans, navy beans, soybeans, black-eyed peas, split green or yellow peas, chick peas (garbanzos), and lentils contain plenty of complex carbohydrates, fiber, protein, vitamins, and minerals. They are also inexpensive and low in fat. One cup of cooked kidney beans, for example, contains less than 1 g of fat. Legumes are versatile foods. Add them to salads, for example, or to dishes where meat or cheese are combined with a grain and vegetables. Substitute lentils for some or all of the ground beef when making meat sauce for spaghetti. Legumes like lentils or split peas can be prepared in under an hour, but you have to boil others for several hours to make them edible. You can buy many legumes in cans or frozen packages, ready to use. Drain or rinse them before use to remove the salt or sugar in the packaging liquid. Beware of canned refried beans, however, which can be high in fat. Dairy Products As a group, dairy products are the best sources of calcium in the U.S. diet, but they are also the second-largest source of saturated fatty acids. Food manufacturers are now making cheeses and other dairy products that have less fat and salt than those we are used to eating. For example, while part-skim-milk mozzarella cheese has been available for years, you can now find part-skim Swiss, muenster, jack, cheddar, and cream cheeses as well as skim-milk ricotta cheese. Some of these new products have less than half the fat and cholesterol of their whole-milk cousins. Many of them are lower in sodium as well. Regular large-curd cottage cheese seems to be a good buy because the package says it is only 4 percent fat. But that

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease only means that fat constitutes 4 percent of the total weight of the product. In fact, 40 percent of the calories in regular cottage cheese comes from fat. Low-fat cottage cheeses, in contrast, get 13 to 18 percent of their calories from fat. Dry curd cottage cheese, which is crumbly, gets only 7 percent of its calories from fat. When buying milk, choose skim milk or 1 percent milk. Two percent milk is not as low-fat as you might think; although it is 2 percent fat by weight, it actually gets 36 percent of its calories from fat. Whole milk, in contrast, derives almost half its calories from fat. Most buttermilk is made from skim or 1 percent milk. Yogurts, too, come in several forms. One 8-ounce carton of regular yogurt, made from whole milk, contains 140 calories, half of which comes from fat. A carton of low-fat yogurt, made from partially skimmed milk, contains 113 calories, of which 30 percent comes from fat. Nonfat yogurt, made from skim milk, is virtually fat free; one carton contains about 90 calories. One myth about margarine is that it is less fattening than butter. In fact, butter and margarine contain the same amount of calories per serving—all of it from fat. However, margarine has no cholesterol and less saturated fatty acids than butter. Don't be deceived by the "no cholesterol" claims of some margarines, for all margarines are cholesterol-free—they are made from cholesterol-free vegetable oils. Brands of margarine do differ, however, in the amount and types of saturated fatty acids they contain, and most margarine packages list the number of grams of saturated and polyunsaturated fatty acids in one serving. Buy brands that are lowest in saturated fatty acids. Meats and Poultry Meats constitute the biggest source of fat in the U.S. diet. Limiting the amount of meat in your meals is one way to

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease you have to figure out how much fat you are getting from the number of crackers you do eat. Unfortunately, most food labels do not yet provide information on the kind of fat the product contains. However, you can get some clues by looking at the list of ingredients. Look for the types of shortening and vegetable oil in the product. Most crackers contain shortening. These crackers are made with lard plus either partially hydrogenated soybean oil or partially hydrogenated coconut oil. Lard, being an animal fat, is high in saturated fatty acids, particularly those fatty acids that raise LDL-cholesterol (see Chapter 3). Partially hydrogenated coconut oil is also high. Partially hydrogenated soybean oil, while not as high in saturated fatty acids as the other two, still contains a good deal of these cholesterol-raising fatty acids. It is safe to assume, then, that much of the fat in these crackers is LDL-cholesterol-raising saturated fatty acids. Crackers made with vegetable shortening alone are a better choice, especially if the shortening is partially hydrogenated soybean oil. The information on vitamins and minerals in the middle of the label is clear. Foods that contain more than 10 percent of the U.S. RDA per serving are considered good sources of that nutrient. (U.S. RDAs are a set of values developed by the Food and Drug Administration to be used as standards for the nutritional labeling of foods and dietary supplements. See Appendix A.) Not all packaged foods are labeled, though, because nutritional labeling is voluntary. The Food and Drug Administration is considering ways to improve the nutritional information on labels and to make labeling mandatory. Until new regulations go into effect, you will have to make do with the labels now available. Frozen Food Reading labels carefully is a must in the frozen food section. For example, some frozen yogurts and tofu creations are low in fat, but others have as much or even more fat than

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease ice cream. Also be careful with frozen entrees and TV dinners. Many of these are billed as "diet" foods. They may, indeed, be low in calories, but some are also high in fat, cholesterol, and salt. If you buy these products, choose wisely. Frozen vegetables can be a good buy, particularly when the fresh vegetable is out of season. But products that come packed in butter or cream sauces can be high in saturated fatty acids, cholesterol, and salt. COOKING You have planned your menu wisely, and you have been a smart shopper. Now it's time to be a clever chef and prepare your meals with a minimum of fat and salt. Methods and Equipment Certain ways of cooking food are inherently better than others from a nutrition point of view. Steaming, for example, adds no fat to food and should become an important part of your cooking procedures. Deep-fat frying, on the other hand, adds loads of fat, and you should cook as little food as possible by this method. Steaming vegetables—instead of boiling them—is a wonderful way to cook because it spares nutrients and keeps the vegetables tender. To steam vegetables, cut them into serving-size pieces and place them in the steamer basket. Put a half-inch or so of water in the bottom of the pot, nestle the basket inside, cover tightly, and turn on the heat. When steam starts escaping from the pot, turn the heat down and continue cooking. Do not remove the lid. Most vegetables will cook in 3 to 5 minutes. Some, such as Brussels sprouts, can take as much as 10 minutes, and artichokes require about 45 minutes. The Chinese invented a good method for cooking with little fat called stir-frying, which uses intense heat and a small

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease amount of oil to quick-cook vegetables and meat, sealing in flavor and nutrients. There are two keys to stir-frying: cutting the meat and vegetables into thin pieces and getting the pan hot and keeping it hot while you cook. The best pan for this is a work, but a large cast-iron skillet will also work. To cook in a wok, heat the pan over high heat and add a tablespoon or so of oil. Add whatever meat you are using, stirring until it is browned on all sides, which should take only a minute or two. Add slow-cooking vegetables such as broccoli and carrots first, stir for a minute or so, and then add quick-cooking vegetables such as green beans, snap peas, and bean sprouts. If the food begins to stick to the pan, add a little water, low-sodium broth, or salt-reduced soy sauce. Sautéing is a common food preparation method that should be modified somewhat. Most recipes call for too much oil for sautéing; you can usually reduce the oil substantially, especially if you use a nonstick frying pan. Broiling is a useful technique for sealing flavor into meats, poultry, and fish. Do not preheat the broiler, for then you are really baking food at high temperature. For the same reason, leave the broiler or oven door open slightly when broiling. Beforehand, season food with herbs and spices, or soak it for several hours in a marinade. Many people do not buy fish because they are not sure how to cook it. To cook fish under the broiler—or by any method—use the rule of ten: measure the piece of fish at its thickest point, and cook 10 minutes for every inch of thickness. In other words, a half-inch-thick fillet needs 5 minutes to cook; a one-inch-thick fish steak needs 10 minutes. A microwave oven can save both calories and time. Fish and vegetables stay tender and fresh when cooked in a microwave with no added fat. Having a microwave also enables you to make quick, nutritious meals from frozen soups, pasta sauces, and some casseroles. This might keep you from visiting your favorite fast-food restaurant—and eating high-fat foods—when you do not have time to prepare a meal from scratch.

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease Substitutions Many recipes in cookbooks or magazines were created for the age when we were ignorant about the effects of fat, cholesterol, and salt on our health. Unfortunately, many chefs and cookbook writers still choose to ignore what we know about diet and health, but that does not mean you have to. You can modify certain ingredients without changing the recipe significantly. Eggs. The major source of cholesterol in the U.S. diet is the egg. One large egg yolk contains approximately 215 mg of cholesterol and nearly 5 g of fat, about 2 g of which is saturated. Eggs play two roles in cooking. The yolks, because they are almost exclusively fat, add tenderness, smoothness, and richness to baked goods. The egg whites, which are mostly protein, provide structural strength. In recipes that include margarine, shortening, or vegetable oil, simply use the egg white alone wherever a whole egg is called for. If you find that the resulting product is a little tough, next time add an extra teaspoon of vegetable oil along with the egg white. About the only time this substitution does not work is with pound cake or flourless cakes. If the egg yolk is the only source of fat in the recipe, substitute one egg white and 1 teaspoon of vegetable oil. You can use the same substitution in recipes that use egg as a coating for meat. If you love scrambled eggs or omelets, you have two options for reducing their fat and cholesterol content. Instead of using two whole eggs, use one egg and one egg white, and add a pinch of dried dillweed or chives to the eggs. The alternative is to use one of the egg substitute products available in the dairy case. Egg whites themselves can be used to lower the amount of fat in certain baked goods. Next time you make a fruit pie, leave off the top crust and use a meringue—made from egg

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease whites, cream of tartar, and sugar—instead. Meringue is also a good substitute for whipped cream as a dessert topping. Baked meringues, with a little almond or vanilla extract added, can replace cookies for dessert. Dairy products. One easy change to make in the way you cook is to replace the whole milk in recipes with skim milk. In most cases, you can simply substitute skim milk for whole milk without making any other adjustments. Nondairy coffee whiteners are poor substitutes for milk or cream; they are usually high in fat, often saturated fat. Instead, use a little skim milk and nonfat milk powder. Cream soups will be a little thin using skim milk for whole milk or cream. Instead, use evaporated canned skim milk. Another option is to peel and slice thinly one potato, cook it in a little bit of water or in the microwave, and puree it with regular skim milk. The starch from the potato will thicken your soup enough that you will not notice the missing whole milk or cream. Nonfat plain yogurt is a good substitute for sour cream in baked goods. When you make mashed potatoes, instead of adding butter and whole milk, use a tablespoon of yogurt and a splash of skim milk. Yogurt cheese—made simply by draining off the liquid from nonfat plain yogurt in a cheesecloth-lined colander overnight and refrigerating for a day—is a good no-fat, no-cholesterol substitute for cream cheese in any recipe. It tastes and feels so much like cream cheese that you can even use it on toast. Salad dressings. Use salad dressings sparingly. Most of them are high in fat and salt, but there are some available that are oil-free and low in sodium. Condensed creamed soups. Instead of one can of condensed creamed soup, use a homemade white sauce with

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease flavoring. To make a white sauce, melt 1 tablespoon of margarine in a saucepan. Stir in 2 tablespoons of flour, and cook over medium heat for a minute or two. Increase heat and slowly add 1 cup of skim milk while stirring. Cook until the sauce thickens. To replace a can of cream of celery soup, add some finely chopped celery to your white sauce. For a can of mushroom soup, add finely chopped fresh mushrooms. Salt. There is no doubt that salt can add to the flavor of food. But once you wean yourself from putting salt on everything you eat, you will be surprised at how good food tastes on its own and how salty most processed food tastes. To help kick the salt habit, season your food with herbs and spices. The secret is to use these flavoring ingredients in moderation. Also, when experimenting with herbs and spices, do not use too many at once. Used sparingly, they add to the natural flavor of food rather than overwhelming it. Sprinkling a little dried or fresh basil, tarragon, or dill on your salad, together with a squeeze of lemon, can add flavor to your favorite greens without adding calorie-laden salad dressing. When cooking chicken, add a sprig of rosemary or a pinch of tarragon to the dish. Lean hamburgers go well with a sprinkling of minced marjoram and chives and a slice of tomato. Add a pinch of cayenne pepper or a dash of hot sauce to stews, soups, and casseroles. (By the way, recent studies have shown that spicy food does not irritate the stomach.) Commercially prepared spice and herb mixtures that contain little or no salt can promote flavorful low-salt cooking. Meat. In recipes such as chili, meat sauce, or shepherd's pie that call for ground beef, you can substitute ground turkey; about 45 percent of the calories in ground turkey come from fat, whereas even the leanest ground beef gets about 50

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease percent of its calories from fat. The texture of cooked ground turkey is no different from that of ground beef, and in heavily seasoned dishes you will not be able to detect any difference in flavor, either. EATING OUT Food served in many restaurants and cafeterias in the United States tends to be high in fat, cholesterol, salt, and added sugar. Some changes are being made as chefs realize that consumers want and enjoy nutritious meals, but this shift is only beginning. Until it becomes more widespread, there are some things you can do to protect your health while enjoying a meal out. The first thing you should know is that most chefs are eager to please the customer. The restaurant business is very competitive, and regular customers can make the difference between a restaurant's success or failure. An accommodating chef will often prepare dishes to order for you. If the fish listed on the menu is sautéd in butter, ask to have yours broiled with a little lemon. Sometimes your request can be as simple as putting sauces or dressings on the side. Most restaurants will also give you smaller servings if you request them. In many Chinese restaurants, each dish is prepared fresh, so you can ask that yours be prepared with only a small amount of salt. In many cases, though, you can get a nutritious meal simply by choosing wisely from the menu. Some menus have special "healthy heart" selections—these are prepared to keep fat and salt content low. The so-called "diet plates," however, are no nutritional bargain. Usually, they consist of a hamburger minus the bun or mayonnaise-heavy tuna salad on a piece of lettuce—meals with very little carbohydrate but plenty of fat and protein. Look for foods that are baked, grilled, or broiled with lemon juice or wine instead of butter. Dishes prepared by steaming, roasting, or poaching also tend to be

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease low in fat. By the same token, limit or avoid foods that are au gratin, buttered, creamy, marinated in oil, or fried. Cream, hollandaise, béchamel, cheese, and butter sauces are all fat heavy. Some chefs, influenced by French nouvelle cuisine, are using lighter sauces, but often these are lighter only because they do not use flour—they still use cream and butter. Also, watch out for smoked and pickled foods, or those served au jus, for they are likely to be salty. Italian restaurants tend to be good choices for those in search of low-fat food. Eat only small portions of cheese- and meat-stuffed dishes, such as lasagna, ravioli, and manicotti, or split a stuffed dish with someone who orders pasta with red clam sauce. Marinara and marsala sauces are also low in fat. Chicken and fish cooked Italian style are often simply prepared using wine and herbs and thus are good selections. Asian cuisines are usually low in fat and cholesterol because they rely heavily on vegetables and stir-frying. But be careful of fried appetizers like wontons and egg rolls, and dishes cooked in coconut milk. Szechuan dishes sometimes involve frying meat in hot oil. Remember, moderation is the key with foods such as these. Pancakes are a good choice for a restaurant breakfast, but ask to have the butter served on the side, and leave most of it there. Order your toast, English muffin, or bagel plain, and use jam on it instead of butter: you get some added sugar, but no extra fat or cholesterol. Also, if you have an occasional egg, order it poached or soft-boiled instead of fried. An increasing number of restaurants and cafeterias now offer salad bars with a wide range of selections. A well-stocked salad bar can provide a nutritious, low-fat meal if you choose vegetables, fruit, garbanzo beans, or flaked tuna or chicken. Cottage cheese, hard cheese, pasta salad, potato salad, guacamole, diced ham, and olives are okay, but only in small amounts; the ham and olives are salty, and the rest of these items are high in fat. Use little, if any, bacon bits, chopped eggs, pickled foods, and regular salad dressings. If you want

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease dressing, choose a low-calorie selection or use lemon and a sprinkling of pepper with perhaps a bit of oil. Fast-food is often rich in fat, cholesterol, and salt, but this situation is changing. Fast-food restaurant chains have discovered that improving the nutritional value of their products is good for sales. When you eat at one of these chains, choose a plain hamburger (instead of a larger one topped with a sauce), a roast beef sandwich, a skinless grilled or baked chicken sandwich, a pizza without meat, or a baked potato with low-fat toppings. Select prepared vegetable salads or items from the salad bar if one is available, and use only a small amount of low-calorie dressing. And choose skim or 1 percent milk, fruit juice, water, a small soda, or a low-fat milkshake to drink. Some fast-food chains now publish nutritional information for their fare. Request it, and pick those items that make a positive contribution to your eating plan. Every day, millions of children and adults in the United States eat lunch in a cafeteria. Unfortunately, some of the food served in these cafeterias is far from ideal from a health standpoint. But you can do something about it—give the food service director at your firm a copy of this book. And talk to your school principal about the food served in your child's cafeteria. Schools are places of learning, so why not educate them about the benefits of a healthful diet? TAKING THE NEXT STEPS You probably purchased this book because you are interested in eating better. Now, armed with facts, figures, and advice, it's time for you to put it all into action. Improving eating habits is never easy, especially at the beginning, so begin slowly. Make your dietary changes one at a time—for example, eat more fruit or vegetables, cut back on cakes and pies, reduce the amount of meat you eat at a meal,

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Eat for Life: The Food and Nutrition Board's Guide to Reducing Your Risk of Chronic Disease or substitute 2 percent milk for whole milk in cereal. As you become comfortable with one change, make another. Within several months, you may very well be surprised at how close you are to meeting the Eat for Life guidelines. Seek out people who have the knowledge and skills to help you to eat better. Professional nutritionists (especially registered dietitians, or RDs) can teach you as much as you want to know about healthful eating, discuss food shopping strategies and cooking techniques, suggest useful sources of information, provide recipes, and help identify restaurants where it's easy to get a delicious, nutritious meal (see Appendix B). Doctors and nurses, as well as friends or neighbors who have already begun to improve their eating habits, can also be important sources of information and support. By reading this book, you have taken an important first step to eating for life. Now it's time to think about how you can improve your next meal. Bon appétit!

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