The New Holiday Plate: Healthy, Wholesome, and Welcoming For All

As dietary restrictions become more commonplace (an estimated 10% of Americans have a food allergy, another 5% are vegetarian or vegan), serving a holiday meal that satisfies a diversity of diners may seem intimidating. Below we show some easy ways to deconstruct or reconstruct your dishes to give everyone – whether they’re heart-healthy, diabetic, gluten-sensitive, lactose-intolerant, nut-free or plant-forward – a prime seat at the table.

Keep it fresh

Opt for meats or poultry that haven’t been pre-seasoned or injected with a brine that adds sodium and sugar. Offer a small tofurky as an alternative option for committed vegetarians and adventurous eaters.

Keep it traditional with a twist

Prepare a rice-based stuffing or quinoa-centric pilaf with time-honored holiday seasonings like celery, sage and thyme. Swap out canned cranberry sauce, high in preservatives and sugar, for a tasty new recipe of fresh cranberries boiled and simmered with fruit juice, applesauce and orange zest.

Keep it versatile

Small adjustments can make a big difference. Use olive oil instead of butter, vegetable stock instead of chicken or beef broth, or a plant-based milk instead of regular.

Keep it neutral

Serve sauces and gravies on the side so everyone can enjoy the main dish without concerns about hidden allergenic ingredients.

Keep it simple

Place nuts, croutons, cheese, dried fruits and dressings adjacent to the greens, and let guests build a salad according to their individual preferences.

Keep it seasonal

Pile a colorful selection of winter’s best, from sweet potatoes and beets to broccoli and Brussels sprouts, in a single layer on a baking sheet, spray lightly with olive oil, season with black pepper and herbs, and roast at 425 degrees for about 45 minutes. The heat will coax out the exquisite natural flavors in the veggies for a dish that’s suited to any type of diet.

Keep it light

Substitute apple sauce for oil when baking to cut down on fat and sugar.

Keep it non-alcoholic

Stir up an appealing selection of ‘mocktails’ for all who choose not to imbibe.

Allergens: Off the Plate

Be aware of these ingredients, which account for more than 90% of all food allergies:

1. Fish
2. Milk
3. Peanuts
4. Crustacean shellfish
5. Soybeans
6. Tree nuts
7. Wheat
8. Eggs
9. Sesame (added in 2021)

Sources:

• Academy of Nutrition and Dietetics
• Food Revolution Network

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Unpacking the Mysteries of the Microbiome

In the past decade it has become well recognized that the millions of bacteria in the gut, collectively known as the microbiome, can influence the health of the brain, lung, heart, metabolism and the immune system. Thousands of studies have been conducted since the term was first introduced in 2001, with research shifting from an early focus on cataloging microorganisms in the human microbiome to pathogen identification and now to understanding their functional roles and how they interact with the host. Following are some of the key learnings to date, including a conversation with a leading microbiome researcher on behalf of our Well Read Patient readers. Please keep in mind that microbiome research is still in its infancy, and probiotic/prebiotic treatments are not the standard of care at this time.

What exactly is the microbiome?

Scientists define it as the sum of the microorganisms (bacteria, viruses, fungi, etc. that live in the body in healthy conditions), their genetic information, and their ecological niches. The microbiome is spread across different organs and tissues of the human body, but the most important and best studied is the gut microbiome. Studies show that under normal conditions, formation of the adult gut microbiome occurs over the first 3 years of life and is affected by events such as birth method, cessation of breastfeeding and starting solid food. Over time, it is thought that diet, drugs, age, smoking, exercise and host genetics affect the composition of the gut microbiome, and that some of these changes may contribute to metabolic, neurological, and immune disorders.

A high fiber, low animal fat diet may have beneficial effects on the gut microbiome.  With this in mind, the principle of “You are what you eat” is further clarified as “You are what your gut microbes do with what you eat,” according to the European Society of Neurogastroenterology & Motility. This is precisely the area that has long fascinated Christopher Damman, MD, a gastroenterologist who has studied the microbiome’s role in health and disease for the past two decades.

“While there are many ways to consider the role microbes play in our health, most essentially they activate or transform components of food that the body can’t process by itself,” he explains. “The microbiome converts polyphenol, the colorful compounds that occur naturally in plants, and fiber, a carbohydrate prebiotic that resists host digestion, to metabolites, which are molecular byproducts of digestion. These in turn influence the mitochondria, our cells’ metabolic powerhouses, that generate most of the energy needed for the cell to function.”

Metabolites also underly the gut’s natural production of hormones GLP and GLP-1, best known for its use in weight loss and type 2 diabetes drugs like Wegovy and Ozempic. Together, with another lower gut hormone called PYY, they help coordinate the body’s response to food by regulating appetite and blood sugar.

The traditional focus has been on therapeutic use of live microbes to repopulate the gut; for some, however, says Dr. Damman, there may be more power in postbiotics. “It can be very difficult to repopulate the microbiome of individuals whose guts may resemble a bleached coral reef as opposed to a vibrant aquarium, by just increasing intake of prebiotics through whole foods. The next best approach may be to therapeutically provide the metabolites naturally produced by a healthy gut microbiome,” he says.

While the gut responds to everything in your environment, from exercise to stress levels, food appears to be disproportionately important, asserts Dr. Damman. “The key to fostering a healthy microbiome may focus on four nutrients: fiber, phenols, bioactive fats, and ferments.” To that end, he has created a tool to help guide people to microbiome-friendly choices by assigning a Nutrient Consume Score (NCS) from one to 100 for a wide range of foods. Based on an algorithm that promotes increased fiber, phytonutrients, bioactive fats and potassium, and decreased amounts of simple carbs, additives, saturated fats and sodium, NCS is available as a prototype online at Dr. Damman’s website gutbites.org.  An app is in development that will enable easier use, such as scanning UPC codes at the grocery store. “I believe this is the first microbiome-focused nutrient calculator, and my intent is to have it validated scientifically and clinically before a beta release, possibly by early next year,” he says.

The takeaway from all this is deceptively simple. “We have gone on these really interesting, complex journeys intellectually, but at the end of the day, we return to our original understanding of healthy eating,” muses Dr. Damman. “As Michael Pollan (influential best-selling author and fellow at the Radcliffe Institute for Advanced Study at Harvard) says, eating mostly plant-based food, and not too much, is the way to go. All the research on the microbiome, metabolites, mitochondria, bioactives, etc. points in screaming ways right back at something we’ve known all along. We’ve evolved over centuries in concert with our microbiome and healthy whole foods that naturally regulate our appetites.”

In terms of preventing obesity, diabetes and metabolic disease, Dr. Damman maintains: “There’s no substitute for a healthy diet complemented by mindfulness, movement, and adequate sleep.”

New Tools, New Strategies for Gut Microbioma Therapy

Initially, gut microbiome therapies ranged from probiotics and prebiotics to fermented foods and fecal transplants.

But these are still early days, and new approaches are continually under the microscope, including:

• According to research from Nature Aging, in healthy individuals the microbiome can continue to change after age 50, in contrast with a static microbiome composition seen in people who are less healthy and die earlier. Of particular note is the finding that each person’s microbiome becomes more distinct as they age, emphasizing the ineffectiveness of a ‘one size fits all’ approach and influencing the need for personalized health therapies.
• Mayo Clinic’s recently announced Gut Microbiome Wellness Index 2, a tool designed for healthcare practitioners to identify adverse changes in their patients’ gut health before serious symptoms arise. By screening a gut microbiome sample, the tool can predict with 80% accuracy or greater whether a person’s gut is healthy or trending toward a diseased state. The ability to detect shifts in gut health was tested in various clinical scenarios, including people who had undergone fecal microbiota transplantation, or had made changes in dietary fiber intake, or who had antibiotic exposure. Additional testing is in progress.
• New technologies that allow physicians to more easily examine the small intestine and upper part of the colon are sure to shine a bright light on these often neglected areas of microbiome research, according to Dr. Damman. Most exciting is the recent launch of swallowable devices with compartments that open up when certain acidity levels are reached to sample the small intestine. “This could be a real breakthrough for exploring how to best help those with small intestinal bacterial overgrowth (SIBO), Crohn’s, irritable bowel syndrome (IBS) and other conditions who frequently experience significant gastrointestinal symptoms from macro nutrient-rich diets.” Future possibilities may include partnering small intestine bacteria with their preferred prebiotics and personalized combinations of prebiotics.

Sources:

• Mayo Clinic Gut Microbiome Laboratory
• World Journal of Methodology
• Gutbites
• Nature
• Nature Aging

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Sustainable Eating: The Planetary Healthy Diet

The Lancet Planetary Health Diet

Is there a way to eat that not only reduces the risk of disease and promotes well-being, but is also sustainable? Could a certain diet provide enough food for the 9.8 billion people estimated to be living on earth by 2050? This was the challenge first taken on in 2019 by the EAT-Lancet Commission, comprised of top scientists from around the globe.

Combining analysis of more than 30 years of the best available nutritional studies and randomized trials with planetary boundaries for key environmental systems and processes, in 2023, the Commission found it to be “an achievable reality that would improve the health and well-being of billions and allow us to pass on to our children a viable planet.” However, cautions Walter Willett, MD, professor of epidemiology and nutrition at Harvard’s T.H. Chan School of Public Health and Commission co-chair: “It won’t be easy and will take the engagement of almost everyone.”

Implementing and Following the Planetary Health Diet

The basics of the Planetary Health Diet include:

• No more than one serving of protein, like poultry, fish, red meat or eggs, and one serving of dairy per day. Focus on fruits and vegetables (at least five servings daily), nuts, legumes (dry beans, lentils and peas), whole grains and plant oils. “We emphasize plant-based protein sources to help prevent major health issues such as diabetes, cardiovascular disease, cancer and dementia,” explains Willett. “We also explored if there is a certain amount of red meat, for example, that that could be consumed while still remaining at low risk for disease. One serving a week (about 14 grams daily) met our criteria, but increasing to two servings weekly made a significant, and unacceptable, increase in the risk for type 2 diabetes.”
• Nutrient-dense items such as nuts and legumes are also emphasized to ensure food production and consumption practices will not exceed the earth’s ecological limits. Foods sourced from animals have a relatively high environmental footprint per serving compared to other food groups which impacts greenhouse gas emissions, land use and biodiversity loss, according to the Commission.
• Among major protein sources, lentils are considered the healthiest, with the highest ratio of polyunsaturated fat to saturated fat, followed by tofu, almonds and salmon.
• Less healthy foods to avoid include red meat, eggs, dairy, refined grains and sugar-sweetened beverages.

Variety Through a Flexible Diet

“It really comes down to a flexitarian diet. There’s incredible variety in the ways you can put it together and keep animal sources of protein to a minimum,” says Willett. His only asterisk: “Lower vitamin B12 levels can occur when less than two servings of animal protein is consumed daily, with serious health consequences.” He recommends getting adequate amounts of the vitamin through either supplements or fortified foods.

Only a few parts of the world currently meet scientific targets for the planetary health diet, and the U.S. in particular will need to significantly decrease consumption of animal proteins. “Higher intakes of vegetables, fruits, legumes, and especially nuts and whole grains would be desirable for almost every country, preventing about 11 million deaths per year,” says Willett. “It is not a question of all or nothing, but gradually making small changes for a large and positive impact.”

 Rooting for Vegetables

Bring the benefits of plant-forward eating to your table with seasonal root vegetables this winter. These veggies are high in vitamins and nutrients, and low in calories. Many root vegetables listed below may have anti-inflammatory, antioxidant and cholesterol lowering properties as well. Enjoy these versatile veggies:

• Allium Bulbs (onions, shallots, garlic). Roast or caramelize for pizza garnishes, bread toppings and quesadilla fillings.
• Avocados. At their creamy best for use in wraps, salads, and dips, including guacamole.
• Belgian Endive. Chop for salads; braise whole or brush with a vinaigrette and grill for side dish.
• Beets. Grate to sprinkle in salads or on sandwiches; sautee or roast with garlic and olive oil for side dish.
• Broccoli/Broccoli Rabe/Broccolini. Use in pasta dishes and winter salads; puree for soup.
• Brussels Sprouts. Roast for optimal flavor and serve as appetizer, side dish, even a pizza topping.
• Carrots (white, yellow, purple, red and orange varieties). Eat raw with yogurt-based dip; steam, boil or roast for side dish.
• Celeriac (celery root). Sub for potatoes in soups and stews; blend for creamy sauce; grate into salad.
• Chayote. Add to salads; use as soup base.
• Fennel. Chop raw and freeze for use in soups and stews.
• Kale, Collards, Mustard and Turnip Greens. Roast or boil until tender and dress for salad while still warm.
• Parsnips. Eat raw; boil lightly; roast with carrots and potatoes.
• Rutabagas. Use in place of or in addition to turnips and potatoes.
• Sunchokes (Jerusalem artichokes). Serve in salads; puree as base for main course; roast with olive oil for side dish.
• Sweet Potatoes. Make healthy fries by quartering, drizzling with olive oil and baking at 400 degrees for 40-60 minutes; steam chunks and mash; bake whole and unpeeled.
• Turnips. Bake, boil or steam like a potato; shred for coleslaw; julienne as garnish.
• Winter Squash (butternut, acorn, delicata, kambocha, spaghetti and pumpkin varieties). Steam or microwave as low-calorie alternative to pasta; roast, stir fry or puree for soups.

Sources: Have a Plant, Spruce Eats, Datassential

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Staying Hydrated This Summer: Water Infused with Fruits, Vegetables, and Herbs

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Nourish Body, Brain and Heart with the MIND Diet

Mindful Eating for Your Brain

Harkening back to ancient civilizations, the concept of food as medicine represents one of today’s most cutting-edge approaches to prevention and disease management. Inspired by the intricate connection of mind and body wellness, a small, special group of diets have made their way into the mainstream offering benefits far beyond short-term weight loss. Among them are DASH (Dietary Approaches to Stop Hypertension), a low-sodium diet that encourages consumption of foods rich in nutrients such as potassium and calcium and magnesium; the Mediterranean diet for heart health, emphasizing fish, fruits, and vegetables, with olive oil as the main source of fat; and combining both, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, which shows real promise in helping its adherents preserve cognition and reduce the risk of dementia.

Launched in 2015 by researchers at Rush University Medical Center, the MIND diet encourages selecting foods from categories that include leafy greens and vegetables, legumes, fish and seafood, poultry, nuts and berries, while limiting high fat, high sugar and processed foods. Longitudinal observational studies showed the rewards of shifting to this healthier way of eating, with a 53% reduction in the risk of dementia for seniors who rigorously followed the diet, and somewhat surprisingly, a 35% risk reduction even for those who followed it only moderately well.

“This is my favorite feature,” says Jennifer Ventrelle, MS, RD, lead dietitian for the MIND Diet Intervention to Prevent Alzheimer’s Disease at Rush, “you don’t have to be perfect! It’s not necessary to eat from every preferred category to achieve your goals.”

Although it’s not intended as a reducing diet, Ventrelle says people who follow it naturally lose weight by focusing on the preferred categories of foods. “It’s too difficult for many people to consider banishing all sweets or giving up red meat forever, so we haven’t eliminated these foods but allow them with limited frequency and close attention to portion sizes,” she explains.

Additional research pointed to a host of other benefits associated with eating MINDfully for older adults: slower cognitive decline and progression of Parkinsonian signs in aging, and reduced risk of functional disability, depressive symptoms, metabolic syndrome, cardiovascular disease and all-cause mortality. “The literature continues to grow, with new studies that point to the key role diet plays in preventing cognitive decline,” says Puja Agarwal, PhD, nutritional epidemiologist and assistant professor of internal medicine at Rush.

But it is the gold-standard randomized controlled trial begun several years ago by Rush and Harvard School of Public Health that may ultimately establish a causal relationship between diet and dementia. More than 600 participants at higher risk for Alzheimer’s disease – overweight, suboptimal diets and a history of dementia in the family – were enrolled in the study designed to directly measure whether following the MIND diet versus a low-fat diet can prevent neurodegenerative ills – results are expected by the end of 2022. According to Agarwal, who is fully aware of its significance at a time when more than 6 million people in the U.S. are living with Alzheimer’s disease, a number expected to double in the coming decades. “We don’t have a cure for these diseases, so prevention strategies are essential. We’re hoping for intervention trial results for the effect of MIND diet in protecting the brain to further establish the role of diet in healthy aging.”

What a day of meals on the MIND diet might include*:

BREAKFAST
Greek Yogurt Parfait: ½ cup whole grain, high fiber cereal, ½ cup berries, ½ cup low-fat Greek yogurt, 2 tbsps (raw, unsalted) walnuts, almonds or pecans.

LUNCH
Whole Wheat Turkey Wrap: 1 tortilla wrap + 3-5 oz turkey breast lunchmeat or carved white meat + 1 slice reduced fat cheese + lettuce, tomato and veggies of choice.

3-Bean Salad: Mixture of kidney beans, black beans, chickpeas, red onions + 1 tbsp extra-virgin olive oil + 1 tsp balsamic vinegar + Italian seasoning mix such as oregano, parsley, basil, etc.

SNACK
Mediterranean Rice Cake: 1 whole grain rice cake spread with 2 tbsps hummus topped with cucumber slices, tomato slices + fresh lemon juice.

DINNER
Baked Salmon over Spinach and Grains with Asparagus

• 3-5 oz salmon filet topped with fresh or dried dill or parsley + a squeeze of fresh lemon juice baked on top of 1 cup baby spinach leaves
• 8 asparagus spears topped with ½ tbsp extra-virgin olive oil + fresh lemon juice + zest
• 1 cup cooked whole grain such as brown rice, quinoa, or bulgur mixed with ½ tbsp. extra-virgin olive oil

DESSERT
1 oz of dark chocolate (at least 75% cocoa) and ½ cup frozen berries

*Please consult with your physician to determine if these foods are appropriate for you.

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Summer Fruits and Veggies

Picking the Season’s Prime Produce

A seasonal bounty of fruits and vegetables is in bloom everywhere from your grocery’s fresh foods section to local farmers’ markets, and in your own backyard garden. The following is advice from experts on how to purchase summer fruits and veggies at its peak, and store them safely, until ready to enjoy.

Berries and Cherries. Look for plump, unblemished fruits with no dark spots or fuzzy white mold; raspberries, blackberries and strawberries should be fragrant. All are shiny when ripe – except for blueberries, which will have a dull matte finish. While most berries can be refrigerated for up to a week, raspberries can start fading more quickly; when that occurs, The Spruce Eats recommends freezing them for use in smoothies and other recipes. To extend their life, do not wash fruit when you unpack your groceries; wait until right before you eat them.

Corn. Choose uncut silks coming out of tightly closed, bright green husks that smell slightly grassy, advises Martha Stewart; and peel back a tad to make sure the kernels look plump and healthy. Refrigerate corn with husks on and use as soon as possible.

Cucumbers and Peppers. Look for firm, shiny vegetables without blemishes, wrinkles or soft spots. According to Have a Plant, cucumbers and peppers can be refrigerated in a plastic bag for up to one week.

Grapes. Choose firm, plump grapes with green healthy stems. They can last up to two weeks when refrigerated. Or try an easy frozen treat: Place on a baking sheet; freeze until firm, and enjoy. Store leftovers in a freezer-safe bag for up to 12 months.

Lettuces. Eliminate those with wilted or broken leaves. Lettuce can be stored for up to four days when refrigerated; darker lettuces tend to last longer than pale, tender varieties. Wash all lettuces just before using.

Melons. Select watermelons without flat sides or dents, and choose ones with a heavy weight for optimal juiciness. Cantaloupe and honeydew melons are best when they have a pale yellow rind and flowery smell at the stem. Harvest to Table recommends storing whole ripe melons in the refrigerator for up to a week to avoid spoiling; cut melons will keep for up to three days.

Plums, Nectarines, Peaches. Opt for vibrant colors, a firm feel, and beautifully fragrant aroma for nectarines and peaches. Store unripe plums, nectarines and peaches in a paper bag until ripe. When ripe, peaches and nectarines can be stored at room temperature for use within a few days; plums can be kept fresh for up to five days in the refrigerator.

Tomatoes. Pick vividly colored, medium-firm tomatoes with smooth, shiny skin. To preserve the freshness and natural flavor of unripe tomatoes, Master Class recommends storing them on a countertop away from direct sunlight. They will last a week on countertops and up to two weeks if stored in the refrigerator.

Zucchini and Summer Squash. Look for smooth-skinned, small to medium size vegetables. Eating Well advises storing zucchini in the crisper drawer of your refrigerator, in either a plastic or paper bag with one end open to ensure good ventilation.

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