able to delay the physical decline that impacts quality of life and their activities of daily living.11 Food Insecurity Food insecurity also is associated with less access to food, which can lead to decreased nutrient intake and difficulty managing chronic disease.12 The State of Senior Hunger, a report published by Feeding America in 2022, evaluated rates of food insecurity and very low food security using the Food Security Supplement from the USDA.7 This information forms the basis for the official rates of food insecurity in America.7 The latest report illustrated that 6.8% of seniors are food insecure, and 2.6% of seniors are classified as having very low food security; these numbers have risen by 29% and 84%, respectively.7 The number of living seniors also significantly increased, indicating that though their life spans are increasing, their food security is not.7 Within these trends, Blacks and Hispanics, individuals with lower socioeconomic status, renters, and seniors aged 60 to 69 are most likely to be food insecure.7 Understanding the communities most likely to be affected by food insecurity and how to adequately resource them is a critical piece of the senior nutrition puzzle, as food insecurity is associated with malnutrition.7 Feeding Programs Community-based food and nutrition programs enable an aging population to remain independent while providing social support, food security, and adequate nutrition.12 These include programs such as the Older Americans Titles I-VII, the Nutrition Services Incentive Program, SNAP, the Commodity Supplemental Food Program, the Senior Farmers’ Market Nutrition Program, the Emergency Food Assistance Program, and the Child and Adult Care Food Program. Eligibility for these services depends on a variety of factors, including age and income level. Advantages of these types of community-based programs include a general improvement in quality of life and decreases in falls and loneliness.13 Another facet of senior feeding is resident meals at senior care facilities. The Academy of Nutrition and Dietetics (the Academy) advocates for an individualized nutrition approach to be used in long term care and postacute care settings, arguing that food is directly related to the quality of life experienced by seniors in residence.14 This type of feeding approach is known as liberalized feeding, or the opposite of a therapeutic or modified diet. The more involved seniors can be in formulating their meal plans and expressing their dietary preferences, the less likely they are to experience malnutrition and a worsening in their chronic conditions.14 By actively working with a dietitian and other members of the health care team, seniors are more likely to consume adequate quantities of food, fluids, and nutrients.14 Malnutrition The dietary needs of adults will change as they age, and one of the biggest risk factors they face is malnutrition.11,15 Malnutrition is present in at least 22% of this population, which manifests in physical and mental bodily changes.1 These include, but aren’t limited to, decreased bone and muscle mass, changes in oral health, altered sense of taste and smell, a reduction in cognitive function, increased frailty, and social/emotional changes like loneliness and isolation.1,15 Malnutrition also can exacerbate previously existing chronic illness, as well as act as a risk factor for other age-related changes.11 Malnutrition can be identified by a combination of the following criteria: if clients have lost >5% of their body weight within the last six months or >10% in over six months; if BMI is <20 kg/m2 and if <70 years, or <22 kg/m2 and if >70 years; if muscle mass decreases; if dietary intake decreases to ≤50% of energy requirements within a week or any reduction in two or more weeks; or if they experience a chronic gastrointestinal condition.11 These parameters were published in 2019 at the Global Leadership Initiative on Malnutrition, and a formal diagnosis requires one physical and one biological symptom.11 Food Safety Educating clients on food safety practices also is critical, as older adults can experience a decrease in immune function, which can leave them more susceptible to foodborne illness.6 Older adults may not consistently follow one set dietary pattern due to many factors, including preference, illness, expense, accessibility, and diminishing appetite. But empowering them to understand the modifiable factors they have control over, like their diets, can help them improve their macro- and micronutrient intake and influence their purchasing decisions.16 Healthy Aging and Dietary Needs Ideally, a diverse and nutritionally dense diet is available and consumed beginning in childhood to promote positive health outcomes as a person grows and ages.1 As this isn’t always possible for a variety of social, environmental, and economic factors, understanding the unique needs of the body in different life stages is crucial to aging resiliently.1 Members of the interdisciplinary team can help clients understand their changing needs through regular education sessions with a focus on disease prevention and eating to best serve their current life stage. The WHO notes that individualized education focused on diet and physical activity can positively impact health outcomes and is cost effective.1 Visit www.TodaysDietitian.com/SS24 to register for our Spring Symposium! AUGUST/SEPTEMBER 2023 • WWW.TODAYSDIETITIAN.COM 51
Relationship Between Aging and Sustainable Diets A global modeling analysis published in the Lancet Planetary Health studied the intersection of nutrients, disease mortality, and the environment in 150 countries.17 The analysis used the Global Expanded Nutrient Supply, Harvard University, and the USDA databases for nutrient information; calorie information and dietary patterns were provided by the United Nations Food and Agriculture Organization and the WHO.17 The meta-analyses found an association between all types of processed meat and nonprocessed red meat consumption and all-cause mortality.17 The researchers hypothesized this was due to the composition of the meat, in particular the elevated cholesterol, sodium, nitrates, nitrites, and type of fat.17 Replacing these types of animal-based proteins with plant-based proteins such as legumes and nuts, and whole grains may positively impact mortality rates.17 Dairy consumption had no association with mortality, while low-to-moderate seafood intake decreased all-cause mortality, particularly if one serving per day was consumed.17 This is attributed to the high levels of omega-3 fatty acids in fish and the integrity they provide to cell membranes. Increased produce intake saw a similar decrease in mortality, particularly when five to 10 servings of fruits and vegetables were consumed daily.17 This decrease is thought to be due to antioxidants, fiber, and various phytochemicals.17 Macronutrient and Fluid Recommendations Adequate macronutrient intake for aging adults can be difficult to achieve, as many in this population struggle to consume a sufficient amount of energy throughout the day.11 General recommendations for caloric intake in this population are 25 to 30 calories/kg body weight, though needs may be tailored to an individual depending on overall health status and potential noncommunicable diseases.11 Educating older adults on what constitutes a healthful and appropriate diet in this life stage also is important. Many older adults believe they should follow broad public health advice for younger healthy adults, which includes consuming low-sugar and low-fat items and eating an abundance of produce.18 While fruits and vegetables certainly are important to the diet at any age, overconsumption of these foods added to a suppressed appetite may limit overall protein and energy consumption and lead to unnecessary or unintended weight loss.18 Protein Current protein recommendations for adults aged 65 and older are 1 g/kg or roughly 57 g per day for women and 67 g per day for men.19 Higher rates of intake may be needed as individuals enter new decades or develop new acute or chronic illness, up to 1.2 to 1.5 g/kg body weight.11,20 Risk factors for inadequate protein consumption in this population include inactivity, age, reduced protein synthesis, acute or chronic illness, anabolic resistance, reduced postprandial amino acids availability, decreased muscle blood flow, and strength and mobility.19,21 Consuming an even dispersion of protein throughout the day may be helpful to aid postprandial anabolism and prevent muscle loss and strength.21 Individuals should aim for 25 to 30 g dietary protein per meal, which is thought to be the ideal quantity to ensure adequate muscle protein synthesis.20 Decreases of roughly 30% to 50% of muscle mass are seen in those aged 40 to 80, which is the ideal time to regularly evaluate dietary patterns.20 Ideal dietary protein sources include lean meats, poultry, eggs, seafood, dairy, fortified soy products, and legumes.6 Fat Fats are essential to maintain cellular structure and provide energy.9 As the body ages, consuming primarily unsaturated fat can decrease the risk of CVD, reduce inflammation, maintain muscle mass, improve insulin resistance, and lower overall mortality risk.9 Polyunsaturated fatty acids, like omega-3 and omega-6 fatty acids, can be found in fatty fish, plant-based oils, nuts, seeds, and avocados.9 If older adults can’t or are uninterested in consuming these foods, supervised supplementation may be recommended.9 Carbohydrates A diet rich in a variety of carbohydrates can help provide much needed energy for an aging population.5 Carbohydrates include grains, dairy products, most plant-based dairy alternatives, starchy vegetables, fruits, and legumes.9 Ideally, whole grains are selected over refined grains to provide dietary fiber. The Dietary Reference Intake for men aged 51 and older is 31 g/day, and for women in the same age group it’s 21 g/day; the average current intake for Americans is 15 g/day.23 Excellent sources of dietary fiber include 100% whole wheat bread, whole grains (eg, millet, amaranth, brown rice), beans, peas, and lentils.6,22 In addition to adding calories to the diet, carbohydrates also may decrease the risk of heart disease, stroke, hypertension, and cancer while reducing mortality risk that comes with those noncommunicable diseases.5,9,24 Fiber intake is an important consideration when increasing or changing carbohydrate intake. Up to 50% of older adults have chronic constipation, and currently there’s little existing research specific to laxative use in the older population.25 Untreated constipation can negatively impact quality of life and can cause incontinence, fecal impaction, and hospitalization.25,26 This might be an embarrassing topic for individuals to broach unprompted, and conversations should be initiated by the interdisciplinary team, particularly physicians, nurses, or dietitians.26 If a laxative is needed to help alleviate constipation, older adults should opt for an osmotic laxative as opposed to a bulk-forming laxative because fluid needs also would increase; examples include milk of magnesia.26 A stool softener should have less impact on overall fluid intake but still may affect electrolyte balance; regularly assessing labs and dietary intake may be needed to help correct an imbalance.25 Fluids A decrease in thirst correlates with aging, and combined with limited mobility and potential bladder control issues many older adults don’t consume adequate quantities of fluids.6 This can lead to dehydration as well as issues with digestion and absorption, which is problematic since many older adults already struggle with micronutrient deficiencies.6 Chronic dehydration also may be linked to cognitive decline.27 The 2020–2025 Dietary Guidelines for Americans estimate that older adults consume roughly 16 oz less fluid per CPE Monthly 52 TODAY’S DIETITIAN • AUGUST/SEPTEMBER 2023
day than adults under the age of 60.6 To help increase fluid intake, dietitians can encourage clients to add 100% unsweetened fruit or vegetable juice and low- or fat-free dairy and fortified soy beverages to their diets.6 The WHO, the US National Academy of Medicine, and the US National Center for Health Statistics all recommend older adults consume 2.7 L or 3.7 L of fluid per day for women and men, respectively.28 Micronutrients of Concern Vitamins and minerals are vital to help the body grow, develop, and function normally.9 Micronutrient deficiencies are more difficult to identify than malnutrition and often are discovered through dietary intake forms or lab work.11 The most common micronutrient deficiencies include iron, zinc, folic acid, calcium, and vitamins B6, B12, C, and D.11,22,29,30 When working with older adults to correct these deficiencies, it’s important to use a threepronged approach that targets variety, type, and quantity of their chosen foods.11 Personalized dietary education provided by the interdisciplinary team and supplement usage also can be helpful tools.30 Calcium Calcium needs range from 1,000 to 1,300 mg per day for older adults, and postmenopausal women and individuals following a vegan diet are at risk of deficiency.6,31,32 Adding calcium-rich foods and beverages to the diet is important to meet these needs and prevent potential fractures and asymptomatic deficiency. Seniors can incorporate fortified breakfast cereals, plant-based milks, and juice in the morning; yogurt, cheese, or kefir for snacks; and canned fish and dark leafy greens for lunch and dinner. Adequate calcium consumption helps seniors maintain bone mass and may improve cardiac health.29 Zinc Bodily inflammation can cause a decrease in plasma stores of zinc, which is problematic as older adults typically underconsume dietary sources of zinc.11,33 Malabsorption and dentition also can affect zinc status.11 Zinc deficiency is associated with decreased appetite and cognition, depression, frailty, a suppressed immune response, and an increase in muscle catabolism.11,34 Dietary sources of zinc include fish and other types of seafood, meat, and fortified or enriched foods like breakfast cereals. The WHO recommends women consume 3 mg and men consume 4.2 mg of high bioavailable zinc daily, with needs increasing as the quantity of zinc becomes less bioavailable. Phytate, a compound found in plants, limits the bioavailability of zinc and its subsequent absorption.33 Individuals who consume a plant-based diet are more likely to struggle with zinc absorption as their phytate intake is higher than an omnivore’s.33 Zinc is also more readily absorbed when consumed with or as an animal-based protein.33 Vitamin B12 Seniors can become deficient in vitamin B12 (cobalamin) primarily by underconsuming foods containing B12 or if their bodies are not absorbing the nutrient; this is common in an elderly population.22,35-37 Secondary causes include infection, intestinal bacterial overgrowth, physical inactivity, and drug interactions.36 This water soluble vitamin is most often found in red meat, dairy, eggs, and fortified breakfast cereals.6,35,38 The WHO recommends adults consume 2.4 μg of vitamin B12 daily.31 Vitamin B12 requires intrinsic factor to be absorbed and properly utilized; a lack of B12 in the diet can lead to pernicious anemia and neurologic complications.35,38 Seniors who follow a strict vegan diet are most likely to become deficient in B12 if not properly supplemented.35 There’s currently no standardized diagnostic toolset to assess deficiency, but clinicians are encouraged to use available labs and physical symptoms to make supplement recommendations.37 Vitamin D Vitamin D is a fat soluble vitamin that’s available as ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3), as well as via sunlight exposure.39 It’s responsible for maintaining bone health and aiding in healthy metabolic processes and function.39 Seniors are most likely to be deficient due to a decrease in physical activities and less time spent outdoors in the sun or participating in outdoor activities.36,39 Dietary sources of vitamin D include fatty fish, egg yolks, and fortified foods and drinks, like certain breakfast cereals and cow/plantbased milks. The average daily intake of vitamin D in many developed countries is 100 to 200 international units (IU) in seniors, with recommendations ranging from 400 to 1,000 IU.39 Supplementation is the most effective way to increase vitamin D levels back to an appropriate range, though up to 90% of seniors don’t take a vitamin D supplement.39 KORA-Age Study A population-based study from Nutrients called the KORA (Cooperative Health Research in the Region of Augsburg)-Age study reviewed the serum concentrations of community-dwelling older adults to determine potential micronutrient deficiency.36 The 1,079 adults who were studied ranged in age from 65 to 93 and all lived in Germany.36 The participants filled out health questionnaires regarding diet and physical activity in addition to being interviewed, undergoing a physical examination, and participating in a nonfasting blood draw.36 Baseline data indicated that 47.7% of the participants weren’t physically active, 30.2% had a BMI in an obesity class, and 4.6% were frail.36 Nearly one-quarter of the population had one disease and 66.8% had two; the authors acknowledged that gender, family support, education background, and alcohol consumption all influenced these statistics.36 After analysis, 52% of the participants had low vitamin D levels, though this was more common in women than men.36 In addition, 27.3% of participants were deficient in vitamin B12, which is higher than the estimated 10% to 15% of older adults in the United States who have the same deficiency.36 Folic acid and iron deficiencies weren’t as common, at 8.7% and 11%, respectively.36 The researchers theorize that folic acid deficiency isn’t as common because of national folic acid fortification policies and individuals’ regular consumption of fortified foods.36 Iron deficiency in this population isn’t as robustly studied or well documented, but it’s estimated that anemia and deficiency generally is around 11%.36 Supplementation Regular, supervised vitamin and mineral supplementation may be important for older adults to stabilize their micronutrient levels.6,11,36 The KORA-Age study researchers theorized that regular supplementation of vitamins B12 and D and folate could help older adults achieve ideal AUGUST/SEPTEMBER 2023 • WWW.TODAYSDIETITIAN.COM 53
serum micronutrient levels.36 Consuming 500 to 1,000 mg of a calcium supplement may help increase bone density but may not impact fracture risk.40 Oral nutrition supplements also may improve overall appetite and energy intake in older adults who struggle to maintain appropriate caloric intake.41 Screening older adults earlier and more regularly may help prevent subclinical levels and preserve quality of life and functionality.36 All supplements, regardless of form, should be discussed with the interdisciplinary team, particularly pharmacists, dietitians, and physicians.6 Plant-Based Approach to Aging Traditionally, one of the main concerns when recommending a plant-based diet to older adults is ensuring they consume adequate quantities of diverse proteins, thus preventing amino acid deficiency.21 Branched-chain amino acids (eg, leucine, isoleucine, and valine) may help to encourage postprandial anabolism, or protein formation, after meals.21 Leucine is similarly available in animal and plantbased proteins, at an average of 9.5 g/100 g and 8 g/100 g, respectively.21 A plant-based diet may aid in preventing age-related cognitive decline, as there’s an association between the types of foods featured in plant-based diets and their neuroprotective properties.42 Foods rich in antioxidants, polyphenols, vitamins, and fatty acids may improve focus and memory, decrease insulin resistance, and positively impact the gut microbiota.5 More research is needed to determine how, why, and what foods may be impactful or if it’s the overall interaction of many different fruits and vegetables working together that yield these results.5,20 The Blue Zones, or areas of the world where older adults live longer and healthier lives, emphasize the role of a plant-based diet in healthy aging.5 The Adventist Health Study 2 showed that after 5.79 years, the 96,000 individuals studied who consumed a vegetarian diet had a lower risk of total mortality.5,43 Other similar analyses emphasize this finding and also report a lower risk of cerebrovascular, cardiovascular, and kidney diseases as well as type 2 diabetes.5 The Nordic Diet and Quality of Life Quality of life has long been linked to dietary patterns, with 13 out of 15 studies reviewed in the journal Nutrients noting that the higher the dietary quality, the higher the self-reported quality of life.27 A traditional Western diet high in fast food, red meats, and sweetened grains is fairly common among older American adults and is linked to a lower satisfaction with quality of life and cognitive decline.27,44 This is attributed to the Western diet’s abundance of saturated fats and refined grains and decreased emphasis on produce and whole foods. In contrast, a Nordic diet is associated with a high quality of life and preserved cognitive function, possibly because it boasts a higher concentration of omega-3 fatty acids, antioxidants, and fluids.27,44 A Nordic diet is rich in nonroot vegetables; herbs; seaweed; high-fiber fruits like berries, apples, pears, and peaches; whole grains; poultry; fatty fish like herring, mackerel, salmon, and sardines; vegetable oil (primarily rapeseed); tea; and water.5,44 The primary source of calories should be plant based as opposed to animal based.9 This type of dietary pattern aligns with the notion of a sustainable diet, as the building blocks of the Nordic diet are organically and locally sourced products and limited in processed or refined foods.5 Areas of Future Research and Study Limitations Continuing to expand the education of and resources available to the interdisciplinary team is a necessary step in preparing practitioners who serve an aging population.1 Designing long-term, highquality studies that further investigate the relationship between diet and quality of life is important, as a better understanding of the link between the two may impact diet education.27 Developing a screening tool that can assess diet and quality of life is essential as the older adult population continues to grow.44 A study published in the American Journal of Clinical Nutrition studied the quantity and type of protein consumed for five years by older adults aged 70 to 79 to determine how it affected muscle mass in the thigh.45 The study determined that greater dietary consumption of total, animal-, or plant-based protein didn’t directly correlate to a change in muscle mass. The researchers recommended additional research be conducted to determine the ideal type and quantity of protein for muscle mass preservation in older adults.45 While studying protein’s impact, formulating studies that focus on subclinical micronutrient deficiencies, particularly serum iron, could be an important tool for better understanding the role of iron and wellbeing in an aging population.36 Putting It Into Practice Dietitians can help clients to understand that living nutritionally dense lives is possible through careful management and understanding of their metabolism, inflammation, and oxidation levels.1 By optimizing their dietary patterns through the inclusion of key macro- and micronutrients, food groups, and fluids, clients can age resiliently while preventing malnutrition and wasting.1 The entire multidisciplinary team, especially case workers and nurses, can aid in the organization and establishment of screening services at local and national levels by utilizing food insecurity screening questions and coordinating care across a variety of transitional living situations.12 Though dietitians aren’t required to be involved in communitybased food and nutrition programming for older adults at a local level, advocating for inclusion and participating in nutrition education at these programs can benefit participants. Acknowledging the eating environment of their older clients is important, as consuming food in a community setting is shown to improve intake and enjoyment.6 Healthy aging can be summarized as growing older but keeping a high quality of life, functionality, vitality, and overall well-being.16 Ultimately, it’s a journey that all individuals, regardless of age, are on together that are affected by their diets, environments, economic status, community support, and many more variables.3 It’s the position of the Academy that ongoing research is needed to provide evidencebased outcomes regarding nutrition screening, education, and assessment and the development of food and nutrition programs to aid in the prevention and treatment of illness related to aging.12 n Alexandria Hardy, RDN, LDN, is a content creator and a freelance food and nutrition writer based in Pennsylvania. CPE Monthly For references, view this article on our website at www.TodaysDietitian.com. 54 TODAY’S DIETITIAN • AUGUST/SEPTEMBER 2023
CPE Monthly Examination 1. What percentage of the population will be composed of older adults by 2050? a. 5% b. 15% c. 25% d. 35% 2. What is a modifiable risk factor for aging well? a. Home cooking b. Family status c. Access to medical care d. Sleep hygiene 3. What age of seniors are most likely to report food insecurity, according to Feeding America? a. 60- to 69-year-olds b. 70- to 79-year-olds c. 80- to 89-year-olds d. Those 90+ years old 4. Identify a benefit to liberalized feeding at senior care facilities. a. Improved quality of life b. Improved mobility c. An increase in food security d. An increase in community 5. What percentage of older adults experience malnutrition? a. 2% b. 12% c. 22% d. 32% 6. A global modeling analysis published in the Lancet Planetary Health stated daily serving(s) of seafood was/were associated with a decrease in all-cause mortality. a. One b. Two c. Three d. Four 7. What are three micronutrients of concern for older adults? a. Potassium, calcium, phosphorus b. Vitamin B12, vitamin D, zinc c. Vitamin A, vitamin E, folate d. Vitamin C, choline, biotin 8. What is a symptom of chronic dehydration in older adults? a. Inflammation b. Incontinence c. Low blood pressure d. Cognitive decline 9. What is the bioavailability of leucine in plant-based proteins? a. 6 g/100 g b. 8 g/100 g c. 10 g/100 g d. 12 g/100 g 10. Which micronutrient deficiency was most prevalent in the KORA-Age study? a. Iron b. Vitamin B12 c. Folic acid d. Vitamin D Become a CPE Monthly Pass holder for access to CPE Monthlies and their associated exams for about $8/credit! Go to CE.TodaysDietitian.com/CPEMonthlyPass and get your Pass to Monthly CPEUs. For more information, call our continuing education division toll-free at 877-925-CELL (2355) M-F 9 am to 5 pm ET or e-mail [email protected]. AUGUST/SEPTEMBER 2023 • WWW.TODAYSDIETITIAN.COM 55
Age-Related Muscle Loss and Strength The Importance of Exercise to Preserve Both U se it or lose it” is a common expression when it comes to aging—especially with regard to muscle mass. As individuals age, they lose both muscle mass and strength, which can lead to loss of function and independence. Everyone loses some muscle mass and strength as they age, but “the rate of decline is within our control,” says Sharon Collison, MS, RDN, LDN, CSSD, clinical instructor of nutrition in the department of behavioral health and nutrition at the University of Delaware. It’s difficult to say exactly when adults start to lose muscle mass because it’s highly dependent on their activity level. For some, loss can begin in the fourth decade, and it’s estimated that healthy adults lose about 24% of muscle mass between the ages of 40 and 70, which can rapidly increase after 70.1,2 Bob Murray, PhD, FACSM, an exercise scientist; president of Sports Science Insights in Crystal Lake, Illinois; and coauthor of Food and Fitness After 50, says, “We lose muscle mass as we age, but we also lose strength; 70-year-olds are about 30% weaker than they were at age 50 … a large drop in strength over just 20 years.” The average strength of those in their 80s is about 40% less than those in their 20s.3 Loss of muscle mass and strength can lead to sarcopenia, defined as an age-related decline in muscle mass, setting the stage for poor balance, increased fall risk, lack of independence, and disability.1,4 The good news is that with modest changes in physical activity and dietary patterns, it’s never too late to reverse the loss of muscle mass and strength as individuals age. This article will explore ways dietitians can help clients “use it and not lose it” as the years go by. Why Muscle Loss Occurs The reasons for loss of muscle mass and strength related to age, lifestyle, and disease are hard to untangle. Researchers have identified several contributors, including the decline in the signaling pathways that regulate muscle size, decreased capacity of mitochondria, increased oxidative stress, and impaired satellite cell function.5 Satellite cells are a muscle’s resident stem cells, crucial for regenerating muscle, especially when muscle is injured or stressed. Older muscles have a reduced number of these important cells, decreasing the ability to regenerate muscle.5,6 Satellite cells can be further reduced by an individual’s disuse, critical illness, and continued aging. Sedentary behavior is a major contributor to muscle and strength loss, and older adults are the least active of any age group.4 In fact, researchers have coined a new term, “active couch potatoes,” for those who do some exercise each day but then spend the rest of the day sitting. Research shows that spending greater than 10 hours per day sitting (not counting sleep) is associated with poorer health outcomes.7 Retaining Strength Skeletal muscle is important for the ability to move, walk, climb stairs, get in and out of a chair, bend and lift, and other physical functions necessary for activities of daily living. Declining muscle mass is a strong predictor of several detrimental outcomes, such as slower walking speed, increased risk of falls, higher risk of hospitalization and greater length of stay, larger risk of postoperative complications, and mortality.1 Muscle strength also is a predictor of all-cause mortality. “The strong live long,” Murray says. “It’s estimated that about one-quarter to one-third of those over age 70 are sarcopenic and it’s likely that even more are dynapenic, which is muscular weakness with or without sarcopenia.”8 Muscle also affects our whole-body metabolism. Muscle mass contributes to our resting metabolic rate and is a reservoir for glucose and lipids and, as such, modulates blood sugar by insulinmediated glucose uptake.5,9 When glucose metabolism is impaired, the stage is set for type 2 diabetes. Lower resting metabolic rate is associated with fewer calories burned throughout the day, leading to accumulating fat mass, which in turn contributes to hypertension and cardiometabolic disorders.10 Exercise Solutions “Resistance training is the most potent intervention for increasing and maintaining skeletal muscle mass, strength, and function,” says Stuart Phillips, PhD, research chair in skeletal muscle health in aging and a professor of kinesiology at McMaster University in Ontario, Canada. “Muscle is ‘plastic’ or adaptable and progressive. Resistance exercise training is the most powerful stimulus for muscles to adapt.” Progressive refers to the principle of overloading muscles for an anabolic stimulus or, in other words, lifting a weight until the muscle says, “no more,” and making that weight heavier as an individual gets stronger. Physical activity guidelines from all major health organizations recommend adults and older adults follow the Physical Activity Guidelines from the US Department of Health and Human Services, which say muscle-strengthening activities of moderate or greater intensity should be performed two or more days per week. Muscle-strengthening activities can include weight training with machines or free weights, working with resistance bands, performing exercises that use body weight for resistance (such as push-ups, pull-ups, and planks), climbing stairs, or the lifting and pulling that accompanies heavy gardening.4 There’s no specific amount of time suggested for muscle strengthening, but clients and patients should use the principle of progressive training. They should perform the exercises to the point at which Focus on Fitness By Christine Rosenbloom, PhD, RDN, FAND 56 TODAY’S DIETITIAN • AUGUST/SEPTEMBER 2023
it’s challenging to do another repetition. Most exercise experts suggest one set of eight to 12 repetitions of each exercise is effective, but performing two or three sets (with rest between sets) is recommended to be most effective.4 For more detail on resistance exercise for older adults, the National Strength and Conditioning Association published a position statement in 2019, suggesting that beginners should aim for one set of exercises per muscle group, progressing to two to three sets. The recommendation for intensity of exercise is 70% to 80% of one repetition maximum, starting with lighter weights for beginners and progressing to greater intensity over time. The organization also recommends performing the exercises two to three times per week on nonconsecutive days to give muscles a chance to adapt.11 While strength training is the best way to build and maintain muscle mass and strength, aerobic or endurance exercises have more than cardiorespiratory benefits. Activities such as brisk walking, jogging, cycling, pickleball, tennis, basketball, and swimming increase blood flow to muscles, the number and function of mitochondria, and the number of glucose and fat transporters in muscles. These adaptations result in a positive net protein balance and contribute to decreasing cardiometabolic disorders.12 For optimal results, aerobic exercise of moderate intensity should be performed 150 minutes (two hours and 30 minutes) to 300 minutes (five hours) each week or 75 to 150 minutes of vigorous-intensity activity.4 Nutrition Recommendations In addition to physical activity, diet and nutrition play an important role in maintaining muscle and strength. Dietary protein works synergistically with resistance training to promote muscle strengthening.13 The quality, quantity, and timing of protein appear to be crucial to support muscle protein anabolism. Protein quality refers to proteins that supply all the essential amino acids necessary to stimulate muscle protein synthesis (MPS). Animal-sourced protein (dairy milk, eggs, meat, fish, poultry, and even the plant protein, soy) is the most well-studied for MPS, but other plant-based proteins can support muscle mass when consumed in higher quantities due to amino acid composition and lower digestibility. Leucine, the amino acid identified as the anabolic trigger for MPS, is found in higher amounts in animal-sourced foods than plant-sourced foods.13,14 Protein quantity also is important due to a condition called “anabolic resistance” observed in older muscles. It’s a blunting of the normal stimulation of muscle in response to protein. When older adults consume protein at the same level as younger adults, muscle protein stimulus isn’t at the level seen in younger adults.6,13 Researchers suggest that to overcome anabolic resistance, 1.6 g protein/kg/body weight be consumed each day.13,14 To maximize MPS, protein intake should be distributed throughout the day, using 0.4 g protein/kg/meal as a guide.13 While many older adults consume slightly more protein than the recommended dietary allowance of 0.8 g/kg/ day, they do so in a skewed pattern. A typical pattern is 10 g protein at breakfast, 25 g protein at lunch, and 35 g at dinner.14 Research suggests that a more evenly distributed pattern of protein intake is preferred for greater MPS.1,15 Phillips says, “Dietary protein works synergistically with resistance training to support muscle mass and strength,” which is crucial for muscle health as we age. While we focus on the MPS effect of protein, sufficient energy, and other nutrients also are important. “Whole food protein provides not only amino acids but other nutrients needed for optimal aging,” Phillips says. Counseling Strategies Almost 20 years ago, researchers demonstrated that strength training in frail nursing home residents wasn’t only doable but also highly effective in counteracting muscle weakness and frailty in the very old.16 It’s never too late to build muscle mass and strength and extend the health span. While it may be intimidating for some, the best motivation for an older person to start, or continue an exercise program, may be the emphasis on functional fitness. Ask clients what they like to do and what they hope to continue to do as they age. For some, it may be running after their grandchildren, tending the garden or other yard care tasks, walking the dog, or engaging in newly discovered activities such as pickleball. Muscle mass and strength are important for all the activities that make life enjoyable, so teaching clients ways to maintain their strength by engaging in activities they enjoy can help ensure a higher quality of life. Dietitians also should encourage clients to explore community options for exercise, especially for those who have been sedentary and want to get started but don’t know where to begin. Many Medicare and supplemental insurance programs offer free access to community exercise programs. For example, SilverSneakers® is a health and fitness program designed for adults aged 65 and older that’s included with qualifying Medicare health plans. Clients may want to consider hiring a qualified personal trainer who can help reduce the chances of injury during exercise by safely demonstrating correct form. Some trainers offer “buddy” sessions so a couple or two friends can take advantage of a reduced rate, with the added benefit of social support. Suggest they look for trainers who have a nationally recognized, education-based certification approved by the National Commission for Certifying Agencies, such as the American Council on Exercise, the American College of Sports Medicine, and the National Academy of Sports Medicine. Don’t let clients forget that home exercise can be effective, too. There are many exercise videos clients can follow at home. They also can use resistance bands as another effective option, as they’re affordable and come with a set of exercises to follow, starting with low resistance and moving up to higher resistance over time. Easy exercise ideas can include getting up and down off the floor, up and down from a chair, or simply walking up and down stairs several times per day. Whatever it is, finding time to move throughout the day is the most important thing. n Christine Rosenbloom, PhD, RDN, FAND, is nutrition professor emerita at Georgia State University in Atlanta. She’s president of Chris Rosenbloom Food & Nutrition Services, LLC, and coauthor of Food and Fitness After 50. For references, view this article on our website at www.TodaysDietitian.com. AUGUST/SEPTEMBER 2023 • WWW.TODAYSDIETITIAN.COM 57
Madhu Gadia Demystifying and Dispelling the Myths of Indian Cuisine W hen her father nudged her toward a career in nutrition, Madhu Gadia, MS, RDN, CDE, had no inkling it would start her on a winding journey that’s taken her from clinical to corporate to publishing, culminating in a fourth act focused on dispelling the myths and misconceptions around Indian cuisine. Gadia’s passion led her to become the first dietitian to write about Indian cuisine and cooking in multiple books that have won over audiences worldwide. “Somewhere in between my work counseling patients, I started teaching Indian cooking classes locally, and realized I could write a book … It took me two or three years to figure out how, but I did. I wrote and self-published Lite and Luscious Cuisines of India. Which was the trajectory into my future,” Gadia says. Marketing that book led to cooking demonstrations and speaking engagements, which positioned her as the Indian cuisine expert. That first book acted as her springboard into the publishing industry and Meredith Corporation, where she was a health and nutrition editor working on titles like Diabetic Living and Heart-Healthy Living. She also sold her first book to Penguin Putnam, which was republished as New Indian Home Cooking: More Than 100 Delicious and Easy Low-Fat Recipes and helped lead to the publication of The Indian Vegan Kitchen: More Than 150 Quick and Healthy Homestyle Recipes. From there, she developed an interest working in both the culinary and nutrition fields. While attending the Healthy Kitchen, Healthy Lives conference at the Culinary Institute of America, she met dietitians that were doing the same, which led her to Flik Hospitality Group, where she would serve as wellness director for eight years. “People are at work almost 10 hours of their day, so my goal was to make sure there were adequate healthful options in the cafeteria. I worked with chefs helping them to see that, in some ways, nearly all foods can fit into a healthful diet, as well as provided modified recipes and nutrition information for food served in the cafeteria. I loved it,” she says. Showing people how to prepare fast, healthful and, most importantly, tasty meals remains her passion. “I want to give [people] options that are tasty. That aren’t going to be meals they eat and think ‘oh, I ate a healthful meal,’” she says. “Hopefully, they’ll think it was a delicious meal that was healthful. It’s that kind of all-in-one cooking that inspires me … because taste trumps nutrition every time.” Today’s Dietitian (TD): When did you know you wanted to pursue a career in nutrition? Gadia: I received my bachelor’s in India, in home economics. Then, I admit, my father steered me toward nutrition. I moved to the United States, earned my master’s in food and nutrition from the University of Illinois, and I’ve never looked back. I love it. The science of food and health excites me. It’s something that I thoroughly enjoy, so it was a good steer. TD: Your career has taken you from diabetes education and media to consulting and corporate hospitality. What experiences stand out most to you, and why? Gadia: My career has been a complete journey, and I love that it always has worked out. What stands out is writing that first book. It’s what changed everything. My most fun and fulfilling experience was when I was at Flik Hospitality Group. We did an Indian food station where I taught chefs how to cook authentic Indian dishes using all my recipes. It was a huge success. It was Get to Know … By Elizabeth S. Goar 58 TODAY’S DIETITIAN • AUGUST/SEPTEMBER 2023
a personal accomplishment and boost to see my recipes work in a larger service environment. TD: You were one of the first dietitians to write about Indian cuisine and cooking. In fact, your work in this space is popular even outside of the dietetics world—coming at a time when it wasn’t a cuisine familiar to many Americans. What were some of the myths and misperceptions you were hoping to dispel, and what’s the overarching message to your audience? Gadia: I had two reasons for writing the book. One was to show that Indian cuisine is easy to cook. People think it’s hard, and some cookbooks do make it seem that way because there are so many spices. But I can make an Indian meal for my family in just 30 minutes. My second reason was, of course, nutrition. In America, there’s an overarching opinion that Indian food is high in fat, cream, and calories, because most people have eaten Indian food only in restaurants. My goal was, and still is, to show the world that Indian food is healthful. In my books, I talk about diabetes, weight loss, and heart disease and how you can fit my recipes into everyday eating and healthful diets, such as for diabetes or heart-healthy living. Today, we talk about the Mediterranean diet with lots of vegetables and grains. Indian food is very similar. It’s what I grew up eating. Lots of vegetables, beans, and whole grains. Very little meat. Each recipe has nutrition information, which no other Indian cookbook had. My expertise lies in the homestyle healthful, and authentic Indian cooking, and I want to show people how easy it is to cook. I’m a firm believer that “healthful and tasty foods go hand in hand.” If it doesn’t taste good, people aren’t going to eat it. I don’t care how healthful it is. I also wanted to demystify Indian cooking and dispel the misconception that Indian food is only curry and curry powder. That’s such a small, small part of Indian food. TD: What is Cuisine of India, and what inspired the website’s launch? Gadia: When I wrote the first book in the mid-1990s, I went to a book fair and was told I had to have an online presence— which I certainly wasn’t aware of at the time. I created the URL CuisineofIndia. com, which made it easy to market my book and spice boxes (a business venture that wasn’t flourishing). Today, you’ll find everything about cooking authentic Indian dishes. I share cooking videos, recipes, books, and more. I also post healthful information on Indian cuisine and 500-calorie meal plans for customers’ and dietitians’ convenience. As I went into my next act, I just focused on Indian cuisine, so I redid my website, created more cooking videos, and started blogging with the goal of helping people master the art of Indian cooking easily and effortlessly. TD: Who or what inspires you as a dietitian, nutritionist, and/or Indian cuisine expert? Gadia: Numerous dietitians, authors, and entrepreneurs have inspired me over the years. There are so many now, but when I authored my first book, there were just a few. I was impressed by dietitians Marion Franz, Maye Musk, and Brenda Ponichtera, as they were paving the road. As for Indian cuisine experts, Madhur Jafferey was my initial inspiration. I’m impressed by and follow many dietitians and Indian cuisine experts as I’m always learning. TD: What’s left on your professional bucket list? Gadia: I’m toward the end of my career, and I have to say, I am very happy with my career journey. The book helped me achieve things and meet people beyond my imagination. There’s just one career goal left on my bucket list: a cooking series. It would reach more people, and I could help them master the art of Indian cooking—that would be the cherry on top. TD: What does your typical workweek look like? Gadia: This is my next act, so to speak. While I did retire from work, I still follow my passion for Indian cuisine, and I’ve been reevaluating what I’m going to do next. My workweek involves making sure I get some postings out on social media. I may write a blog, take some photos. I’m always looking at recipes to see what I can do that’s different, easy, and can share with my audience. TD: When you’re not working, how do you like to spend your leisure time? Gadia: I love to travel and have been doing a fair bit of it the last few years. I also go out to parks and see friends. Walking is my stress reliever, and I do some yoga and pranayama. I also belong to a book club, love having tea with my friends, and just hanging out and enjoying the fruits of my labors. I also love to entertain; my house is always open. TD: What are some of your favorite meals or foods? Gadia: Naturally Indian. But I also love anything flavorful—Mexican, Chinese, pizza, etc. As for examples of foods I make, a typical Indian meal is my go-to fare. It’s fast, nutritious, and satisfying—for example, dal (beans) cooked vegetable with basmati rice or roti (whole wheat flatbread). I primarily cook vegetarian dishes. I love to cook desserts, too, anything from Indian desserts to cakes and cookies. I also make a variety of vegetarian pasta, pizza, and Mexican dishes. Anything that I cook has to be flavorful. TD: If we were to peek into your pantry or refrigerator, what would we find? Gadia: One thing you’ll always find in my pantry is a whole rack of dried beans. Every Indian bean and any other bean. There are probably 20 kinds of dry beans in my pantry, along with canned beans and tomato products because they help when preparing meals in a hurry. You’ll also find extra bags of spices, because I never want to run out of those, and whole wheat flour. In the refrigerator, you’ll always find plenty of fresh vegetables and plain yogurt, which we use a lot of as part of an Indian diet. In my freezer, there’ll always be frozen vegetables and Indian flatbreads, because they can be convenient, and other ingredients like shredded coconut, paneer, etc. But frozen vegetables are a must. n Elizabeth S. Goar is a freelance health writer based in Benton, Wisconsin. Today, we talk about the Mediterranean diet with lots of vegetables and grains. Indian food is very similar. … Lots of vegetables, beans, and whole grains. Very little meat. AUGUST/SEPTEMBER 2023 • WWW.TODAYSDIETITIAN.COM 59
Health Matters Myth Becomes Reality Cranberry Products Can Prevent UTIs Drinking cranberry juice has long been a mythical prevention strategy for women who develop a urinary tract infection (UTI)—and new medical evidence shows consuming cranberry products is an effective way to prevent a UTI before it gets started. A global study looking at the benefits of cranberry products published in Cochrane Reviews has determined that cranberry juice, and its supplements, reduce the risk of repeat symptomatic UTIs in women by more than one-quarter, in children by more than one-half, and in people susceptible to UTI following medical interventions by about 53%. Cranberry juice and health care supplements that commonly include the fruit, such as capsules and tablets, have long been promoted as a readily available solution to ward off the infection, but the most recent review in 2012, with evidence from 24 trials, showed no benefit from the products. The medical scientists behind this updated review from Flinders University and The Children’s Hospital at Westmead aimed to update these findings as an important step in determining the effectiveness of cranberry products by looking at 50 more recent trials that included almost 9,000 participants. “This incredible result didn’t really surprise us, as we’re taught that when there’s more and better evidence, the truth will ultimately come out. UTIs are horrible and very common; about a third of women will experience one, as will many elderly people and also people with bladder issues from spinal cord injury or other conditions,” says the study lead author Gabrielle Williams, PhD, MPH. “Even back in 1973, my mum was told to try cranberry juice to prevent her horrible and frequent UTIs, and for her it’s been a savior. Despite me chiding in her ear about evidence, she’s continued to take it daily, first as the nasty sour juice and in recent years, the easy to swallow capsules. As soon as she stops—wham, the symptoms are back. As usual, it turns out that mom was right! Cranberry products can help some women prevent UTIs.” Flinders University epidemiologist Jacqueline Stephens, PhD, a coauthor of the study, says if the UTI persists untreated, it can move to the kidneys and cause pain and more complications, including sepsis in very severe cases, so prevention is the most effective way to reduce risks. “Most UTIs are effectively, and pretty quickly, treated with antibiotics, sometimes as little as one dose can cure the problem. Unfortunately, in some people, UTIs keep coming back. Without being sure if or how it works, some health care providers began suggesting it to their patients. It was a harmless, easy option at the time. Even centuries ago, Native Americans reportedly ate cranberries for bladder problems, leading somewhat more recently, to laboratory scientists exploring what it was in cranberries that helped and how it might work.” “The studies we looked at included a range of methods to determine the benefits of cranberry products. The vast majority compared cranberry products with a placebo or no treatment for UTI and determined drinking cranberries as a juice or taking capsules reduced the number of UTIs in women with recurrent cases, in children and in people susceptible to UTIs following medical interventions such as bladder radiotherapy.” “It’s also important to consider that few people reported any side effects with the most common being tummy pain based on the results. We also did not find enough information to determine if cranberry products are more or less effective compared with antibiotics or probiotics in preventing further UTIs.” The data also don’t show any benefit for elderly people, pregnant women, or people with bladder emptying problems. Senior author Jonathan Craig, MBChB, DCH, MMed(Clin Epi), FRACP, PhD, AAHMS, a professor, vice president, and executive dean of the College of Medicine & Public Health at Flinders University, says the real benefits of cranberry products became clear when the researchers expanded the scope of the review to include the most recently available clinical data. “This is a review of the totality of the evidence and as new evidence emerges, new findings might occur. In this case, the new evidence shows a very positive finding that cranberry juice can prevent UTI in susceptible people,” Craig says. “We have shown the efficacy of cranberry products for the treatment of UTIs using all the evidence published on this topic since the mid ’90s. The earlier versions of this review didn’t have enough evidence to determine efficacy and subsequent clinical trials showed varied results, but in this updated review, the volume of data has shown this new finding.” The study authors conclude that while cranberry products do help prevent UTIs in women with frequent recurrence, more studies are needed to further clarify who with UTI would benefit most from cranberry products. SOURCE: FLINDERS UNIVERSITY 60 TODAY’S DIETITIAN • AUGUST/SEPTEMBER 2023
Swapping Out Drinks Linked to Fewer Deaths in Adults With Diabetes For adults with type 2 diabetes, replacing sugary drinks with coffee, tea, or plain water is linked to lower rates of early death due to CVD and other causes, finds research published by The BMJ. A greater increase in coffee and tea consumption from before to after a diabetes diagnosis was also associated with lower death rates. These findings highlight the potential role of healthy beverage choices in managing risk for adults with type 2 diabetes, the authors say. In 2021, over 500 million adults worldwide had type 2 diabetes, which carries an increased risk of CVD and premature death, and this number is set to rise to 783 million by 2045. Diet plays a key role in managing diabetes, but little is known about intake of specific types of beverages in relation to death and CVD among adults with type 2 diabetes. To fill this knowledge gap, researchers drew on data from 15,486 adults (74% women; average age was 61 years) with a diagnosis of type 2 diabetes who were part of the Nurses’ Health Study (1980 to 2018) and Health Professionals Follow-Up Study (1986 to 2018) in the United States. Beverage consumption was assessed using a validated food questionnaire and updated every two to four years. This included sugar-sweetened beverages (SSBs), artificially sweetened (low-calorie) beverages (ASBs), fruit juice, coffee, tea, low-fat and full-fat milk, and plain water. During an average 18.5 years of follow-up, the researchers recorded 3,447 cases of CVD and 7,638 deaths. After accounting for other lifestyle factors and medical history, they found that participants with the highest intake of SSBs (more than one serving a day) had a 20% increased risk of death from any cause compared with participants with the lowest intake (less than one serving a month). In contrast, high intakes of certain beverages (up to six servings a day) were associated with lower mortality: 26% lower for coffee, 21% for tea, 23% for plain water, and 12% for low-fat milk. Similar associations were seen between the individual beverages and CVD rates and mortality. In particular, SSB intake was associated with a 25% higher risk of CVD and a 29% higher risk of CVD-related mortality, whereas intake of coffee and low-fat milk was associated with an 18% and 12% lower risk of CVD, respectively. Compared with those who did not change their consumption of coffee in the period after a diabetes diagnosis, an 18% lower all-cause mortality was seen in those who increased their consumption of coffee. A similar pattern for allcause mortality was also found for tea and low-fat milk. Replacing SSBs with ASBs was also associated with lower all-cause mortality and CVD mortality, and replacing SSBs, ASBs, fruit juice, or full-fat milk with coffee, tea, or plain water was consistently associated with lower allcause mortality. This is an observational study, so it can’t establish cause, and the researchers acknowledge that individual beverage consumption may be linked to other dietary and lifestyle risk factors for CVD and mortality among adults with diabetes, and they can’t rule out the possibility that measurement errors or misclassification may have influenced the results. However, this was a large study with a long follow-up period, high response rates, and detailed and repeated assessments of dietary and lifestyle variables before and after a diabetes diagnosis. As such, they conclude: “Overall, these results provide additional evidence that emphasizes the importance of beverage choices in maintaining overall health among adults with diabetes.” Additional studies are warranted to replicate and further explore these important associations, they add. This new study extends our understanding of the health implications of different beverages to adults with type 2 diabetes, says Nita Forouhi, PhD, at the MRC Epidemiology Unit in the University of Cambridge, in a linked editorial. Questions remain, however, such as the effect of adding sugar to coffee or tea, and the impact of other popular drinks, like milkshakes, smoothies, and hot chocolate, she wrote. It’s also unclear whether the findings apply to different population groups as the study focused on predominantly white US health professionals. Nevertheless, choice of beverage clearly matters, she says. The case for avoiding SSBs is compelling in the general population, and it’s reasonable to shift the focus to drinks that are most likely to have positive health effects: coffee, tea, plain water, and low-fat milk, she concludes. SOURCE: BMJ AUGUST/SEPTEMBER 2023 • WWW.TODAYSDIETITIAN.COM 61
Products + Services Howl at the Spoon’s Debut Howl at the Spoon has announced its line of single-serve sauces it says rivals restaurant-quality sauces. These single-serve sauce packets come in four flavors: Marion Berry, Lemon Dill, Al Pastor, and Chimi Churri. Each sauce is made in small batches and is plant-based with about 15 g fat, 210 mg sodium, 0 g carbohydrate, and 0 g added sugars. howlatthespoon.com Quest’s New Protein Chips Bring the Spice The portfolio of Quest Protein Chips just got a little bigger with its new Hot & Spicy flavor. The flavor joins the ranks of Nacho Cheese, Spicy Sweet Chili, Chili Lime, BBQ, Ranch, Loaded Taco, Cheddar & Sour Cream, and Sour Cream and Onion. The spicy chips have 20 g protein, 3 to 4 g net carbs, and 1 g sugars per serving. The Quest Protein Chips are available on Amazon and retailers nationwide. questnutrition.com Kid-Friendly Alternative Milks Kiki Milk has developed the first plant-based alternative milk designed specifically for kids, called Mac Nut Kiki Milk. This all-organic milk is made with only whole food ingredients such as cashews and macadamia nuts. It’s free of any additives/fillers, and it’s sweetened with low glycemic organic coconut sugar. Mac Nut Kiki milk contains omega-3s, 35 mg magnesium, and 310 mg calcium. kikimilk.com Unbound Snacks Announces Nutty Snack Unbound Snacks has released a new and healthful bagged walnut snack with 4 g protein per serving. The novel lineup includes flavors such as Original, Chili Lime, Butter Toffee, Cinnamon, and Sea Salt and Pepper. Each serving of walnuts also has about 210 mg sodium, 2 g fiber, and 2 g sugars. unboundsnacks.com 62 TODAY’S DIETITIAN • AUGUST/SEPTEMBER 2023
Low-Sodium Spices Launch Casa M Spice has revealed its new low-sodium spices. These spice blends have been tinkered with for more than two decades, and they’re now ready for the public. Casa M wants to help home cooks add flavor to their dishes while enabling them to control sodium levels. The blends are made specifically for the meat being seasoned, such as Cattle Drive for beef or Free Range for chicken. Casa M’s spice blends are low sodium, free of nuts and soy, and contain no fillers, MSG, gluten, or animal products. casamspice.com Nut Butter Bites Fresh Flavors Sweet Nothings has added to its Nut Butter Bites snack bars line with the release of Oatmeal Raisin and Peanut Butter and Chocolate and Peanut Butter. The snack bars offer an organic alternative with no added sugars, stabilizers, preservatives, or artificial flavors, and up to 4 g plant-based protein per package. Nut Butter Bites are available on Amazon, Thrive Market, FreshDirect, and Gopuff. sweetnothings.com Naera Cheese Snacks Premier Naera (Nye-rah) is a new Icelandic snack brand looking to expand what’s possible in protein snacking. Naera cheese snacks are made with 100% premium Icelandic cheese and are naturally high in A2 milk proteins, with 22 g protein per serving. Naera uses a drying process that helps add a unique texture and flavor without frying. The cheesy snacks come in three flavors: Very Gouda Crunch Jalapeño, Premium Aged Cheese Crunch Garlic and Herb, and Power Protein Crunch Sour Cream and Onion. Naera’s Cheese Snacks can be found on Amazon and Naera’s website, as well as through select retailers in the United States. usa.naerasnacks.com Skinny Mixes Introduce Mexico-Inspired Flavors A Mexico-inspired syrup collection has been unveiled in the Skinny Mixes’ product line with flavors such as Churro, Horchata, and Dulce De Leche. Each syrup flavor has zero sugars and zero calories—helping to make bitter mornings a little sweeter. skinnymixes.com AUGUST/SEPTEMBER 2023 • WWW.TODAYSDIETITIAN.COM 63
AUGUST 23-24, 2023 1,438th International Conference on Sports Nutrition and Supplements Miami, Florida https://academicsera.com SEPTEMBER 8-11, 2023 11th Annual International Plant-Based Nutrition Healthcare Conference Palm Desert, California https://pbnhc.com SEPTEMBER 9, 2023 American Diabetes Association 2023 Tour de Cure: Rocky Mountain Littleton, Colorado www.diabetes.org SEPTEMBER 28-29, 2023 international Conference on Diabetes and Nutrition New York, New York www.diabetesworld.net OCTOBER 7-8, 2023 International Conference on Human Nutrition and Health Sciences New York, New York https://waset.org OCTOBER 9-13, 2023 National School Lunch Week https://schoolnutrition.org OCTOBER 10, 2023 2023 Step Out: Philadelphia Philadelphia, Pennsylvania https://diabetes.org OCTOBER 14-17, 2023 The Obesity Society ObesityWeek® 2023 Dallas, Texas https://obesityweek.org OCTOBER 16-18, 2023 Second Edition of International Conference on Diabetes, Metabolism and Endocrinology Boston, Massachusetts https://magnusconferences.com OCTOBER 26-27, 2023 International Conference on Diabetes and Nutrition New York, New York www.diabetesworld.net NOVEMBER 1-2, 2023 International Conference on Pediatric Obesity and Interventional Cardiology San Francisco, California https://waset.org NOVEMBER 6-7, 2023 Iowa Academy of Nutrition and Dietetics Annual Meeting Ames, Iowa www.eatrightiowa.org NOVEMBER 11, 2023 2023 Florida State of Diabetes Community Event and Expo Daytona Beach, Florida https://diabetes.org NOVEMBER 17-18, 2023 International Conference on Sports Nutrition and Supplements New York, New York https://wrfase.org DECEMBER 17-18, 2023 International Conference on Sports Nutrition and Supplements New York, New York https://wrfase.org JANUARY 14-16, 2024 School Nutrition Association School Nutrition Industry Conference Orlando, Florida https://schoolnutrition.org FEBRUARY 23-26, 2024 American Academy of Allergy Asthma and Immunology Annual Meeting Washington, D.C. https://annualmeeting.aaaai.org Datebook NOVEMBER 10, 2023 Register Now for The Renfrew Center Foundation’s 2023 Conference for Professionals — Feminist Perspectives and Beyond: Expanding Our Reach. Held in-person in Philadelphia, PA, and virtually beginning November 10, 2023. Featured Keynote Panel: Ragen Chastain, Chrissy King & Whitney Way Thore Featured Keynotes: Adele LaFrance, PhD Amy Banks, MD & Isaac Knapper, Authors of Fighting Time Phone: 1-877-367-3383 Contact E-mail: [email protected] www.renfrewconference.com Datebook listings are offered to all nonprofit organizations and associations for their meetings. Paid listings are guaranteed inclusion. All for-profit organizations are paid listings. Call for rates and availability. Call 610-948-9500 Fax 610-948-7202 E-mail [email protected] Send Write with your listing two months before publication of issue. EMPLOYMENT OPPORTUNITY Dietitian Jobs in Washington and Oregon At Yakima Valley Farm Workers Clinic, we’ve woven nutrition into our primary care model. From managing digestive issues to preventing chronic conditions like high cholesterol, high blood pressure, and diabetes, our clinics o er a diverse range of primary care MNT services. And dietitians serving our WIC program are ensuring healthy food and nutrition education reach pregnant patients, new moms, and children under fi ve, impacting over 30,000 lives. We o er competitive pay, generous benefi ts, continuing education, and relocation allowance. Whether you’re a new grad or experienced RD, if you’re seeking an exciting opportunity in nutrition and dietetics in the vibrant Pacifi c Northwest, APPLY TODAY to join us in shaping a healthier future for all. Our mission celebrates diversity. We are committed to equal opportunity employment. www.yvfwcjobs.com/dietitian 64 TODAY’S DIETITIAN • AUGUST/SEPTEMBER 2023
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Live and recorded presentations from expert dietitians with over 50 years of combined ketogenic experience in pediatrics through adults. Achieve mastery with our FOUNDATIONAL plus ADVANCED Course. CPEUs approved for Registered Dietitian Nutritionists. www.ketomastery.pro Everyone knows someone who can’t have tomatoes! Nomato by Norine makes the best tomato-free sauces. Made with root vegetables; carrots and beets. Nomato Marinara can be used in any recipe. Nomato products are mild, have less sugar, sodium, and potassium than typical tomato products. Our Marinara has no added sugar. Your clients, and patients will love Nomato and the variety it brings to their meals. http://nomato.com News Bite Biomarker Score Could Help Measure Adherence to the Med Diet Researchers have developed a novel way to detect whether a person follows a Mediterranean diet using a blood test and, applying this method, have shown that a Mediterranean diet is associated with lower risk of type 2 diabetes. Jakub Sobiecki of the University of Cambridge in the United Kingdom and colleagues presented these findings on April 27 in the open access journal PLOS Medicine. Previous research has shown that people who self-report that they follow a Mediterranean diet have a modestly lower risk of type 2 diabetes. However, the subjectivity of selfreports makes that link uncertain. Until now, the potential link between a Mediterranean diet and type 2 diabetes risk has not been evaluated using objective biological indicators— biomarkers—of adherence to the diet. Sobiecki and colleagues developed a novel biomarkerbased indicator of a Mediterranean diet that incorporates levels of certain molecules in the blood. First, the researchers identified that blood levels of 24 fatty acids and five carotenoids could be applied to predict whether participants from a clinical trial of 128 people were assigned to follow a Mediterranean diet. Levels of these molecules in a person’s blood were used to calculate a biomarker score, which the researchers used as a measure of the extent to which they followed a Mediterranean diet. Next, the researchers applied the biomarker score in a study of 340,234 people living in eight European countries, of whom 9,453 developed type 2 diabetes during follow-up and had relevant biomarkers measured. Comparing them with 12,749 participants who remained free of type 2 diabetes, the researchers found that people whose biomarker score indicated greater adherence to a Mediterranean diet were less likely to develop type 2 diabetes. For comparison, the researchers also asked participants to self-report their diet. They found that using the biomarker score identified a stronger link between the Mediterranean diet and reduced risk of type 2 diabetes than when self-reporting was used. This finding suggests that previous self-report-based studies may have underestimated the association. Based on these findings, the researchers argue that even a modest improvement in people’s adherence to a Mediterranean diet could meaningfully reduce the incidence of type 2 diabetes. However, they also point out that additional research will be needed to confirm and extend these new findings since it’s currently unknown to what extent the biomarker score is specific to the Mediterranean diet. Senior author professor Nita Forouhi, PhD, says, “Our research combining information from a dietary clinical trial and a large cohort study to identify and apply blood biomarkers for a dietary pattern is exciting and should stimulate development of improved methods to study dietdisease associations, which are typically limited by reliance on subjective recall of eating.” SOURCE: PUBLIC LIBRARY OF SCIENCE AUGUST/SEPTEMBER 2023 • WWW.TODAYSDIETITIAN.COM 65
Dates A Great Addition to Sweet and Savory Dishes S ome of my favorite things when traveling around the country are getting to try the local food favorites and visiting the family farms unique to each region. Last March, I did just that when my husband and I spent a few weeks in Palm Springs, located in California’s Coachella Valley. Unbeknownst to me, our trip took us straight into the heart of the state’s date-growing region. Dates are a fruit native to North Africa and the Middle East but were introduced to the Coachella Valley in the late 1800s by the Department of Agriculture, and today, 90% of US dates are grown in California.1,2 They grow in large clusters at the top of date palm trees, which can grow as high as 100 feet. Dates are a small, oval-shaped fruit with wrinkled skin and a fibrous inner seed. They have a naturally sweet, caramel-like flavor with a soft and chewy texture, and their color ranges from dark brown and black to bright red or yellow. Thousands of date varieties are grown around the world, but the two most popular varieties in the United States are the Medjool and Deglet Noor. I had a chance to visit Shields Date Garden while we were in the area. Walking through Shields, established in 1924, is like taking a step back in time. You can amble through their date grove, learn how dates are grown by viewing The Romance and Sex Life of the Date (yes, that’s the name of their film!), sit at their 1960s date shake counter, and spend time in their gift shop. I felt like a kid in a candy store when I was there! I purchased their “assorted date plate,” which came with Blonde and Brunette dates (a variety created in 1927 by Mr. Shield), as well as Deglet Noor, Halawi, Khadawi, Medjool, and Zahidi dates … all with varying degrees of sweetness and texture. Dates are nutritious and versatile. According to the USDA, two Medjool dates (48 g) have 133 kcal, 36 g carbohydrate, and 3.2 g fiber, and contain potassium (7% daily value), magnesium (6% DV), and vitamin B6 (7% DV).3 RDs and clients can enjoy this delicious fruit in both sweet and savory dishes. Eat them as a stand-alone snack, include them in a grazing or charcuterie board, blend a few into smoothies (soak them first to soften), chop them up and add to colorful salads, wrap some dates in bacon and bake (a preparation I first tried at Shields), add them to beef stew, or incorporate dates into no-bake balls and other sweet treats. Another way to enjoy dates is to blend them into a “date shake,” a California favorite typically made with dates, milk, and vanilla ice cream. The best I tried was at Windmill Market in North Palm Springs: the flavor was sweet with a hint of caramel, and the texture was smooth and creamy. n Liz Weiss, MS, RDN, shares recipes and healthful living advice on LizsHealthyTable.com and her podcast, EAT, DRINK, LIVE LONGER. Weiss is a cooking instructor, frequent lifestyle guest on TV shows across the country, and a Have a Plant Ambassador for the Produce for Better Health Foundation. Culinary Corner By Liz Weiss, MS, RDN For references, view this article on our website at www.TodaysDietitian.com. Dark Chocolate Orange Date Balls Serves 8 These easy no-bake Dark Chocolate Orange Date Balls are one of my favorite ways to satisfy a sweet tooth, and they have just a scant amount of added sugars from the maple syrup. Each date ball has 3.5 g fiber and can be served as a snack or dessert. Ingredients 8 dates, pitted and cut into quarters (I used Medjool) 3 T orange juice 1/4 cup quick-cooking or oldfashioned oats 2 T almond or peanut butter 3 T unsweetened cocoa powder 4 tsp maple syrup 1 tsp orange zest 3 T unsweetened coconut flakes, toasted Directions 1. Place dates in a bowl and cover with orange juice. Let soak for 10 minutes to soften. 2. Place dates, juice, oats, almond butter, cocoa powder, maple syrup, and orange zest in food processor bowl and pulse until well combined. You may need to open food processor and scrape down sides of bowl once or twice. 3. Transfer batter to a bowl, cover with plastic wrap, and place in refrigerator to chill for about 15 minutes. 4. Arrange coconut on plate. Roll batter into eight 1-inch balls; roll in coconut until well coated. Store in airtight container in the refrigerator. Nutrient Analysis per serving (1 date ball) Calories: 135; Total fat: 4 g; Sat fat: 1.4 g; Cholesterol: 0 mg; Sodium: 7 mg; Total carbohydrate: 23.5 g; Total sugars: 17.6 g; Added sugars: 5.7 g; Dietary fiber: 3.5 g; Protein: 2 g SOURCE: RECIPE AND PHOTO COURTESY OF LIZ WEISS, MS, RDN 66 TODAY’S DIETITIAN • AUGUST/SEPTEMBER 2023
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