The other side of the economic crisis ...
Scientific studies are pointing out that we are too fat, we eat too much red meat and we eat or drink too much sugar, and all this has a negative effect on our health. If in this time of economic crisis we are forced to reduce our expenses for food, we can try to change our food habits and aim at better food choices. Once the crisis will be over, we will see if we are able to maintain the newly acquired good habits.
A recently published study shows that in the recession period in the USA (2008-2012), when income dropped by 6.3%, obesity grew less than in the previous three years period (in which income was growing). The analyses of this study are focusing on women, as they are considered a high risk group.
This news goes against stream. Up to now we usually thought that during economic recession consumers would choose cheaper food, that are lower quality and energy dense (loaded with sugars and low quality fats). We thought that consumers would make choices that help saving money, but cause a worsening of health conditions. This new study shows that every cloud has a silver lining: if we learn to tighten the belt since we have learned that we feel better if we eat less, we can obtain savings on grocery shopping, weight reduction and better health conditions.
While I keep an eye on this topic, to see if any other research will confirm this finding, what can we do to turn this hard period into something positive?
By choosing to eat less red meat and to drink less sugary beverages, we can gain a better health and save money. Do we need protein? The cheaper options work equally well, especially those of vegetable origin, abundant in legumes, nuts and seeds.
If you look for hints and for low cost recipes, you can read my article on the journal La Nostra Salute, of the Florence section of the Italian League against Cancer. The article is attached (Italian version only) and you will find the suggested dishes in the "recipes" section.
More about salt: GIRSCI Newsletter n. 2 2012
More about salt/sodium in the diet. Attached you can find the very interesting newsletter of the GIRSCI group (GRUPPO DI LAVORO INTERSOCIETARIO PER LA RIDUZIONE DEL CONSUMO DI SALE IN ITALIA). It is very informative and provides comments about some recently published scientific papers.
These are the topics:
- Habitual salt intake and risk of gastric cancer: A meta-analysis of prospective studies. D'Elia L et al. Clin Nutr. 2012 Jan 30. [Epub ahead of print]
- Urinary Sodium and Potassium Excretion and Risk of Cardiovascular Events. O’Donnell et al. JAMA 2011; 306:2229-2238.
World Salt Awareness Week 2012
Do you know that every day we consume more than twice our daily requirements of sodium? And that sodium increases the risk of hypertension and of stroke, a very serious, often invalidating disease, that hits every year 200.000 people in Italy? Worldwide, 5.5 million people die of stroke, every year.
Table salt (sodium chloride) is the main source of sodium in our diet.
Also this year the Italian Society for Human Nutrition (SINU), in collaboration with the Intersociety group for Sodium reduction in Italy (GIRCSI) supports the World Salt Awareness Week 2012 (March 26 - April 1, 2012) proposed by WASH (World Action on Salt and Health).
The World Health Organization (WHO) recommends to limit salt consumption: not more that 5 g per day. 5 grams correspond to 2 grams of sodium.
Sodium is a key to the well functioning of the human engine, and the amount of sodium naturally present in food is more than enough to cover these needs. Excess sodium in our diet is provided by salt added to processed food.
Bread is one example: it is the main source of sodium in the diet of the Italian population. 100 g of bread contain approximately 1.6 grams of salt (630 mg of sodium). Moreover, all baked products are rich in added salt: pizza, focaccia, crackers, grissini, salty snacks, cookies. During past centuries, salt has been fundamental for humanity, since it has made the preservation of hunting, fishing, and agricolture products possible, before refrigerators were invented. This is how our beloved processed meats, canned vegetables and cheeses were born: 50 grams of ham or salami contain from 2 to 4 grams of salt. One table spoon of parmesan cheese contains approximately 0.2 grams, 50 g of medium aged cheese contains approximately 0.9 grams. One small can of tuna fish has approximately 0.5 grams. Olives, pickled vegetables, chips and salted peanuts are a real salt mine....
In addition, we also have the bad habit to add salt while cooking, even in boiling vegetables, that already contain enough sodium. Not to mention the salt that we add directly on the plate.
The experts tell us that if we reduced our intakes by five grams a day, we could avoid 46.000 stroke cases a year, in Italy.
Why don't we try? In this way:
- bread: we could bake it at home, without salt, or we could purchase the no salt (or low salt) types (in Italy it is called pane sciocco or pane sciapo in some areas of the country). If you usually eat 200 g of bread per day, you will cut in this way 2-3 grams of salt.
- a processed meat sandwich? Let's try a wholegrain bread without salt, filled with one sliced hard boiled egg, some tomato slices, some extra virgin olive oil and finally thyme or oregano to add some Mediterranean flavor. In this way 2 more grams of salt are gone.
- a snack? toasted, not salted, hazelnuts and pistachios, carrot sticks and peppers will be the perfect replacement to salty snacks, like chips and crisps: an additional reduction of at least 1 gram in your daily salt intake.
And if we also use salt very carefully while cooking, we will be all set!
- processed food: choose the less salty ones and boycott the others. If the label does not show the sodium content, just taste the product...and stay away from it if you feel it too salty.
- do you adore olives and capers? Rinse them off and soak them in water for a few hours before consumption. You will be able to feel the real taste after eliminating the excess salt that covers all nuances.
- herbs, spices, hot pepper: add generously to salads, vegetables, meat and fish. It is a healthy and tasty way to season your favourite recipes.
For more info about the concentration of sodium in Italian food, you can visit the BDA food composition database.
If you would like to share your special tricks for salt reduction, just write to me and I'll be happy to publish your suggestions on this web site.
For additional info, you may read the attached file and check out the following links:
Happy New Year!!
In Italy we say "the good day is seen from the morning". We could therefore say that a Good Year is seen from January...
I don't know if it happens also to you, but for me the new year is an occasion for good intentions. How about you? Do you happen to have listed, among the good intentions for the year 2012, a greater attention for your health and the commitment to change, at least a little, your life style to stay more active, to eat less and in a healthier way? These are the first steps towards the prevention of cardiovascular disease, cancer and diabetes. Also staying lean is a way to reduce your risk.
Some say "fat is beautiful": maybe, but it is not only a matter of beauty. Overweight and obesity are strong risk factors! Combining these with an unbalanced diet, hypertension and a sedentary life style, the risk gets even higher.
I would like to follow you step by step during this year 2012, to help you making some changes. Little by little, without changing all your habits at once.
If you like the idea, follow this web site: I will try to provide small suggestions that you should then adapt to your way of being and to your taste. You can contact me for any specific request.
And since a good day is seen from the morning, lets start form breakfast. We already discussed it (Nov 12, 2011), but today I suggest reading the attached article (unfortunately only in Italian), that was just published on the jurnal of the LILT (the Italian League Against Cancer), Florence section.
By the way: if among your good intentions you are also trying to quit smoking, a new course, organized by LILT, will start in Florence on January 17.
Enjoy your reading and your breakfast.
CME course - Efficacy of interventions to promote a healthy diet
Let me bring to your attention the course for the health professions "Efficacy of interventions to promote a healthy diet", organized by University Hospital Santa Maria della Misericordia of Udine.
We discuss diet and health in children and adults. Prof. Adriano Cattaneo will speak about children, and I will present data on adults. The course is in Italian.
December 16, 2011 - Civic Center Tavagnacco (UD).
CME credits have been requested for all health professions.
Enclosed is the flyer with specific information.
The ancient varieties of fruit trees in the Casentino region
The volume "Le antiche varietà di fruttiferi del Casentino" (The ancient varieties of fruit trees in the Casentino region) will be presented on monday December 5th, 2011 at 3pm, at the Scuola Superiore Sant'Anna di Pisa. Tasting of typical products provided by the Comunità Montana del Casentino will follow.
The program is attached below. If you plan to attend, please request the participation form, that entitles you to receive a free copy of the book.
"The text presents the results of the project of Recovery, preservation and valorization of the local fruit germoplasm of the Casentino region, funded by ARSIA-Tuscany Region and conducted by the Scuola Superiore Sant’Anna di Pisa in collaboration with the Comunità Montana del Casentino ..."
I hope to be able to attend, since it is a really interesting topic!
Let's bake some bread tonight...
Bread, at least in Italy, has always been the staple food. Bread is bread, all the rest is what we call "companatico", i.e. whatever comes with bread.
Before modern times will invade the world too much and people will forget the meaning of kneading, I will provide some simple suggestions mainly for those who never baked any bread and think that baking bread is too complicated: a task for people that have nothing to do and time to waste.
By the way: all the home-bread bakers I know, are very busy working people of both genders and of all ages. So, what are you waiting for?
Do not expect sophisticated breads here in my web-site: the aim of these few lines and of the recipes you’ll see is only to invite you to do something easy, tasty and healthy. Therefore, if you are experts and are looking for professional recipes, you are in the wrong place. Here you’ll find only basic hints, that I hope will serve to convince you that if you prepare the dough at 5.30PM, you’ll be able to have freshly baked bread for dinner or to offer a pizza dinner. And while the bread is rising, you will have time to continue working, playing, preparing the rest of the dinner or go out for a run or a walk. Baking bread and pizza is a nice activity for you and your kids together, if you are not afraid to get some flour spread around in your kitchen.
The basic ingredients should always be available in the kitchen: water, flour, brewers' yeast. All the rest is optional: honey, vinegar, some extra virgin olive oil, a variety of flours, seeds and nuts, raisins, spices, herbs and, if you really want to add it, a pinch of salt.
Fresh brewers’ yeast: it is usually sold in small 25 g cubes (in Italy). In supermarkets, you will find it in the refrigerated compartments. Keep refrigerated, but the expiration date is quite short. I keep it in the freezer, so that I almost never run out of it. Take it out 15 minutes before baking. If I’m in a rush I thaw it in the microwave oven, at low power for 30-60 seconds: it will not get damaged. I dissolve it in lukewarm water and then I add the flours.
Dry brewers’ yeast: this is also fine, it is sold in small bags (1 bag corresponds to 1 cube fresh yeast). It is very handy, since it can be kept for several months at room temperature. I use it when I’m away from home. It is light weight and easy to store. Read the label for instructions.
The flour: during summer it might be a problem to store large quantities at home, since, at least here in my pantry, it attracts hundreds of little moths, the “tignole”, especially if the flour is good quality and minimally processed. But it can be kept in the fridge to avoid this inconvenience. In winter it is usually not a problem. We will discuss about different type of flours more in depth one day. For now, I just recommend that since we are caring about taste but also about health, you should try to use unrefined flours. But, especially at the beginning, I suggest avoiding to use only whole grain flour: it is a bit heavier to rise and if you are not successful at your first experiment, the risk is that you will never try again: use fifty percent all purpose and fifty percent whole grain flour.
Which flour? For best results the four should be “strong”, i.e. rich in gluten, the protein that forms a network that gives the elasticity to the bread by trapping the gases formed during the fermentation process. More gluten, and longer kneading, and better the result. I have to confess that I recently started going in depth in these details, after decades of “instinct” bread making, with common supermarket flours. I therefore leave all these technical details to specialized web sites and come to the point. A plain flour and a whole wheat flour are the starting point. I recommend using whole wheat since we know how much more nutrients they have: fiber and micro-nutrients: your bread will be tastier and in line with guidelines.
Be careful: gluten shall not be consumed by people with celiac disease. I will soon provide recipes for some alternatives.
But since “la donna è mobile” or also, as I recently was told by a patient, “Paganini never gives an encore”, my bread is always different. If some hard wheat semolina is in the pantry, I use one third of each (white, whole wheat and semolina). Buckwheat flour make a very soft bread: probably since it is gluten free (as well as corn) it contributes in some way to form a different network with a great result: also in this case one third of each. And then leave your fantasy free: rye, barley, oats …. And remember, if you keep your flours in the fridge, remember to take them out in time: if they are too cold the dough will not rice properly.
Water: I do not know if the hardness of water affects the result as much as the strength of the flour, but for sure I know that water should be lukewarm (colder if the environment is warm, warmer if the temperature is lower). I do not use a thermometer, I use my finger.
The dough: manually or with a machine? Both are good, it is just a matter of preference and time availability. I confess that I have always had the possibility to use a kitchen appliance that does thousands of things, including bread mixing. It is very convenient, it reduces time and effort. This is of course also the negative side, since nowadays we are supposed to burn as much calories as possible, also doing everyday actions. I leave the choice to you: I knead my bread by hand when I am on vacation, away from home. In fact it does not take much longer. I never used a bread machine: I almost bought one, in several occasions, but I always resisted, since I don’t like the kind of square bread that comes out, and as far as I know that’s the only shape you get. But I recommend it if that makes home-bread making possible within your busy routines.
- to facilitate the rising, I add a teaspoon of honey (or sugar) and 1 tablespoon of vinegar, in the water where I disperse the yeast
- the dough should be protected for cold and draughts. Keep it covered (with a canvas) while rising and place the bowl in the pantry, or in the oven (not heated) or in a cupboard.
At this point I think I told you all I know about bread baking. Details can be found in the recipe section.
Ready for a change? Let's start from breakfast...
How many times have you thought: I have to change my food habits, I’ll start tomorrow.
If this has been in your mind at least once, now it is time for action. This week, in the recipe section, you’ll find a Mediterranean breakfast based in yogurt, honey, walnuts, some fuit, whole wheat bread, good olive oil, some olive, cucumbers, tomatoes…well exactly like those yummy breakfasts during holidays.
It’s a very simple breakfast. The important thing is to have the ingredients at home and, just to save time in the morning, I suggest washing fruit and vegetables the night before.
The only processed ingredients are bread and yogurt.
whole wheat bread: you can bake it or purchase it, as you prefer.
yogurt: also this can be homemade, but I never succeeded. But also purchasing it needs some attention. Among the huge selection of yogurts, fermented milks, sometimes I am also confused. But this is my philosophy: buy a plain yogurt, without ingredients added and then “season” it at home, with you preferred healthful ingredients. Pay attention: creamy white yogurt, natural yogurt etc are sometimes synonyms for sweet yogurt (naturally or artificially sweetened) or for extra fat yogurt (with higher fat content than a regular whole milk yogurt).
Therefore, READ THE LABEL: check that no sugars nor artificial sweetners are listed.
The other breakfast ingredients are all basic ingredients, as recommended: simple food, minimally processed.
This simple breakfast has many advantages:
- you will feel full until lunch time. Maybe you may want a mid-morning fruit or drink a coffee with your colleagues.
- It is more filling than a classic “bar” breakfast (cappuccino, croissant, fuit juice) since it is low in sugars, contains some whole wheat and is therefore richer in fibre from bread and from fresh fruit and nuts and vegetables
- Its very rich in minerals and vitamins and of many micronutrients, maybe still unknown to us, that are present in all simple food of vegetable origin (e.g. licopene, a potent antioxidant present in tomatoes)
Is it hard to give up your cappuccino and croissant? This is a direct comparison of the two types of breakfast (see below the attached table).
As you see in the table, the Mediterranean breakfast provides more than 20% of daily energy: great!
It provides more fat, this is true, but only 3 grams are saturated fats. The remaining are all mono and poly-unsaturated fats that we do not need to worry for: they come from the oil and the milk. The breakfast with croissant provides instead 6 grams of saturated fat, and the other 5 grams are unsaturated fats that might be, at least in part, the so called trans fats, often present in shortening/margarine used in baking products
Carbohydrates? Only 23 grams are sugars (from honey, fruit and lactose from yogurt). The classic breakfast is loaded with refined sugar: in the cappuccino, in the croissant and in the fruit juice: 48 grams in total, corresponding to 53% of the maximum recommended daily intake.
The Mediterranean breakfast provides 7.1 g of fibre, the”bar type” breakfast only 1.4 g (and a whole wheat croissant would not help much)
Also all other micronutrients (minerals and vitamins) are more concentrated in the Mediterranean breakfast, apart from vitamin C, that is more concentrated in the the “bar type” breakfast where it is provided by the fruit juice: in this case it is likely to be vitamin C added as an antioxidant
The bottom line? You do not need to give up your cappuccino and croissants forever: you could start alternating it with other types of breakfast. Little by little that breakfast will be just an occasional treat and you will not miss it at all.
Keep an eye on the recipe section: in the section “BREAKFAST AND SNACKS” you will soon find other suggestions for switching to a healthier breakfast.
The project "FOOD INTAKE and HEALTH" is ready to go...
After the presentation held on October 28, "FOOD INTAKE and HEALTH" is now starting. It is a nutrition education project sponsored by ChiantiMutua, in collaboration with LILT - Italian League against Cancer - Florence section.
- November 18 and 25th: first individual sessions
- in December the first group meeting
The project is dedicated to the members of ChiantiMutua
For information, call the toll free number 800 26 56 57
What’s in our plate?
In the last months you might have heard about the new symbol adopted by the US Department of Agriculture, to guide citizens towards appropriate food choices: the food Pyramid, that has been used for several decades, was replaced by the plate, to be more precise by MyPlate (www.choosemyplate.gov).
This new icon suggests in a simplified way the proportion of food to be put on the plate, at each meal: vegetables, fruit, cereals, protein and dairy. It is not easy to simplify without losing important details, and in this case it seems that the simplification has been a bit excessive, although completed by additional text, that is found immediately below the icon or that can be reached by following the ad hoc links.
For readers in a hurry, the image is really a bit scarce and misleading. And in fact after a few months form the appearance of MyPlate, epidemiologists and nutritionists from Harvard University, Boston, MA, have proposed a new Plate, the Healthy Eating Plate http://www.health.harvard.edu/plate/healthy-eating-plate (il Piatto del Mangiar Sano) which tried to fill some gaps and to specify some crucial points, according to scientific evidence.
Which are the differences?
In the attached file the two images and the comparison between the two plates can be found. Briefly, these are some of the points for discussion.
One section of MyPlate is dedicated to “cereals”: only further down there is a sentence stating that at least 50% of grains should be “whole grains”. By reading more carefully it can be observed that potatoes are classified together with vegetables. But nowadays, it is commonly agreed,not only in Mediterranean countries, that potatoes should be grouped together with refined cereals, because of their rapidly absorbed carbohydrates: potatoes have therefore the same bad effect of refined carbohydrates and sweets on our blood sugar.
Attached to the plate there is a circle, representing a glass, stating “dairy”. This is also a bit misleading: does it mean that we should have milk or a dairy product at each meal? There is no evidence encouraging this habit. And nothing is mentioned in relation to sodas and juices, that are far too much consumed today, especially in the US. Maybe a glass of water, as shown in the Heathy Eating Plate, would have been more appropriate to remind of this important element, of vital importance.
Physical activity is not mentioned, nor are the healthy oils.
And when it comes to protein, there are no distinctions. We have known for many years that to prevent chronic disease (cancer, cardiovascular, diabetes) it is appropriate to prefer fish, poultry, legumes, nuts and to leave the consumption of red meats , fresh and processed, just for special occasions.
But, what are we putting in our plate?
It is easy to criticize others, but this comparison can be useful to think about ourselves and check what we eat.
We are in the cradle of the Mediterranean Diet, but our way of eating is getting more and more distant from the tradition.
Are we sure to always remember to have our veggies or does it often happen to completely forget about it, at least at lunch? We have been recommended to eat at least 400-500 g of vegetables and fruit per day: how are we doing? Is our consumotion close to these quantities?
In 2009, the PASSI study in Italy (a survey based on approximately 39,000 subjects, aged 18-69 years) shows that only 9% of the sampled subjects declares to consume at least 5 portions of fruit and vegetables per day, and that 48% of the sample (ie. half of the sample) have only 1-2 portions of vegetables and fruit per day. We often just tend to follow the trends of what happens in the US, but it would be good if we could wake up and change our attitudes, before reaching the levels of overweight and obesity currently seen in the USA.
Here you can read the Guidelines for Healthy Eating in Italy
Click here to read the recommendations of the World Cancer Research Fund
At http://sapermangiare.mobi/ you can find an answer to some of your questions.
Below the comparison between MyPlate and the Healthy Eating Plate can be found