Be Well - March 2011 Digestive Health Issue

New Guidelines: What to Buy at the Grocery Store

By Maxine Smith, RD, LD

You want to shop healthy, but that trip to the grocery store can be daunting. With so many choices and misleading advertising, it’s hard to know what to put in your cart.

The 2010 USDA dietary guidelines released on Jan. 31, 2011, can make it easier to shop wisely in our “obesogenic” environment. The USDA’s main goal is to decrease obesity in America — and with it, the risks of obesity-related illnesses: diabetes, heart disease, stroke and some cancers.

There’s a lot to chew on in the 95-page guidelines, but two overarching themes emerge:

  1. Increasing the "nutrient-dense" foods we eat
  2. Reducing our intake of sodium, and of solid fats and added sugars (now called SoFAS)
The most nutritious bang for the buck

What you want to put in your grocery cart are nutrient-dense foods and beverages. These have relatively few calories yet are rich in vitamins, minerals and other healthy substances. Nutrient-dense foods are also low in solid fats and have not been diluted with “junk” calories such as added sugars.

Top choices include:

  • All vegetables and fruits
  • Whole grains
  • Seafood
  • Eggs
  • Beans and peas
  • Unsalted nuts and seeds
  • Fat-free and low-fat milk and milk products
  • Lean meats and poultry

Shop around the perimeter of the grocery store to find these nutrient-dense foods.

Beware the middle aisles

The middle aisles of the grocery store are where you’ll find these dietary culprits linked to obesity: SoFAS and sodium.

1. Solid fats are found in:

  • Fatty animal products — marbleized steak, full-fat (regular) cheeses and ice cream
  • Baked goods such as cookies and crackers
  • Convenience foods that contain hydrogenated fats (liquid vegetable oils put through a chemical process to solidify them)

Compare saturated fat and trans fat amounts on the “Nutrition Facts” box on packaged foods and look for hydrogenated fats on the “Ingredients” lists to identify foods with solid fats.

2. Added sugars don’t occur naturally in fruit, milk or other foods. These sugars include:

  • Corn syrup, corn syrup solids and high-fructose corn syrup
  • Juice concentrates
  • Raw, brown and white sugar
  • Fructose, fructose sweetener and liquid fructose
  • Malt, maple and pancake syrup
  • Honey and molasses
  • Anhydrous and crystal dextrose

Steer clear of foods with added sugars at the top of their ingredients panels.

3. Sodium is the mineral in salt. It helps to flavor and preserve canned and packaged foods. Sodium is abundant in:

  • Processed meats
  • Cheese
  • Salted snacks

Comparing labels for sodium content can be a real eye-opener.

Get off the SoFAS and have fun

Filling your grocery cart with nutritious foods can be rewarding and fun for your family. With each trip, try comparing a few similar products for SoFAS and sodium content. Before you know it, you’ll have added new favorite foods and brands to your weekly shopping list. For kids, it can be like solving a puzzle. Plus, they’ll take pride of ownership in the foods they choose.

What You Need Every Day

The 2010 USDA dietary guidelines set the following daily limits or targets:

  • Fat: 20 to 25 percent of total calories
  • Saturated fat: less than 10 percent of total calories
  • Trans fat: less than 1 percent of calories
  • Cholesterol: less than 300 milligrams (mg)
  • Fiber: 14 grams per 1,000 calories
  • Potassium: 4,700 mg
  • Sodium: 2,300 mg — but less than 1,500 mg for everyone over 50, all African Americans, and everyone with hypertension, diabetes or chronic kidney disease, including children
  • Fruits and vegetables: at least 2.5 cups
  • Refined grains: less than 3 ounces

Maxine Smith is a clinical dietitian in the Section of Nutrition Therapy in Cleveland Clinic’s Digestive Disease Institute.

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Be Well – March 2011 Issue

Antibiotic May Relieve Irritable Bowel Syndrome

It has many names: irritable bowel syndrome (IBS), spastic colon, irritable colon, nervous stomach. No matter what you call it, IBS is not an easy condition to cope with, producing abdominal pain, bloating, gas, and diarrhea or constipation.

Most IBS sufferers are young women, and some have a family history of IBS. The condition appears to be caused by a colon that contracts more readily, producing the undesirable symptoms. Although IBS can be embarrassing, it is not life-threatening, yet its tendency to flare and fade throughout life can be frustrating and discouraging.

If IBS affects you, you may spend years avoiding certain foods — as well as stressful situations — to avoid triggering symptoms. Now it appears that for some people, taking an antibiotic may bring substantial relief.

Benefits substantial for some

A large, well-received study has shown that the antibiotic rifaximin (Xifaxan®) provided significant relief for 40 percent of IBS patients whose symptoms included diarrhea. The multicenter study was published in the New England Journal of Medicine on Jan. 6, 2011.

“Rifaximin only works in some patients, so it is not a panacea. However, it has few side effects or drug interactions, so it may be worth trying,” says John Vargo, MD, MPH, Cleveland Clinic’s Chairman of Gastroenterology and Hepatology.

Research suggests that 30 to 80 percent of IBS patients might benefit from rifaximin. The broad-spectrum antibiotic is currently used to treat traveler’s diarrhea.

The FDA is ruling on rifaximin for IBS in March 2011. If approved, it will be the first new medication approved for the treatment of IBS with diarrhea in 10 years.

Fewer side effects

When it comes to antibiotics, rifaximin causes fewer side effects than other drugs because it stays in the intestines. After two weeks on the drug, study participants remained free of IBS symptoms for several months. Moreover, even after two or three courses of treatment, there was no evidence that bacteria were becoming resistant to the antibiotic. This suggests that when the drug works, it may continue to work for a long time.

Rifaximin is not suitable for people with IBS and constipation. Talk to your doctor if you are interested in trying the antibiotic to see if you are one of the people for whom it works.

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Recipe: Grilled Pizza


1 package prepared whole-wheat pizza crust (found in refrigerated section)
½ cup prepared pesto sauce
4 ounces soft, low-fat goat cheese, cut in small cubes
1 large ripe tomato, sliced thin
⅓ cup canned roasted red pepper, drained well and cut in thin strips
6 ounces precooked chicken breast, cut in small chunks


Spray or brush grill grate with oil. Preheat grill to medium-high.

Brush or spray a cutting board or large pan with olive oil. Spread out pizza dough with oiled fingers into the desired crust shape.

Prepare vegetables, chicken and cheese in small cups or bowls. Set aside.

When you are ready to grill, put pizza dough on grill and cover. Cook for approximately 2 to 3 minutes, or until the top begins to bubble and the bottom is lightly browned. Flip over and brush with pesto sauce. Working quickly, add the tomatoes, roasted red peppers and chicken. Dot with cheese. Cover and cook for another 2 to 3 minutes or until the cheese is melted.

Take off the heat and enjoy!

Makes 6 Servings

Nutrition Information

Per Serving:

  • Calories: 428
  • Protein: 24 g
  • Total Fat: 12 g
  • Saturated Fat: 5 g
  • Sodium: 540 mg
  • Calcium: 95 mg
  • Fiber: 6 g
  • Sugar: 3 g
  • Potassium: 410 mg
  • Magnesium: 80 mg
Did You Know?

Grilling animal products causes formation of potent carcinogens called heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) within food. These substances can trigger the cancer process. Grilling vegetables and other nonmeat foods and decreasing cooking time for animal foods lowers this risk. Experiment with different vegetables and fruits on your grill this upcoming season for a healthy grilling experience.

Recipe created by Digestive Disease Institute registered dietitians

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Be Well – March 2011 Issue

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