Be Well - May 2011 Issue

Rethinking Snacks & Comfort Foods: 7 Tips

The next time you feel like foraging in the cupboard or fridge, consider that mindless snacking can pack on the pounds. Here, Cleveland Clinic registered dietitians team up to offer you seven healthy alternatives to time-honored comfort foods:

1. Crunch time: Rethink chips & dip.

Crunching your way through a big bag of salty potato chips, corn chips or cheese doodles will make your fat, calorie and sodium intake skyrocket. Onion or ranch dip adds calories, saturated fat and sodium.

Instead, try 1-ounce snack packs of tortilla, multigrain or baked, reduced-fat potato chips — or measure out one serving in a small bowl. Scoop up salsa (loaded with lycopene and vitamin C, but watch sodium content), hummus (filled with fiber and protein) or yogurt-based dip (providing calcium and protein).

2. Ice cream: Find a better way to chill.

A big bowl of ice cream seems like a great way to treat yourself. The bad news is that it’s high in saturated fat, sugar and calories.

Instead, try an all-fruit frozen bar, ½ cup of low-fat ice cream or frozen yogurt, or sugar-free popsicles or fudge bars. Make your own treat by stirring blueberries or raspberries into fat-free yogurt and freezing. Or try frozen grapes. If you must have the real thing, go out for a single scoop of single-flavor ice cream. Stick to chocolate, vanilla or strawberry — forget the moose tracks and chunky monkey — and then take a 30-minute walk.

3. PB&J: Time for an upgrade.

Talk about a comfort food — peanut butter and jelly sandwiches take us straight back to childhood! Peanut butter has fiber, protein, B vitamins and monounsaturated fats, but it’s high in calories. Store brands have added sugar and salt. Traditional white bread has little nutritional value, and jelly is 100 percent sugar.

Instead, try spreading just 2 tablespoons of all-natural peanut butter (no added salt, sugar or oils) or almond butter on whole-grain bread. Sweeten with sliced bananas or strawberries, or with 1 tablespoon of pure fruit spread, or drizzle with a teaspoon of honey. Or forgo the bread entirely, and spread natural peanut butter on apple slices.

4. Thirsty? Get tough on soft drinks.

Pop open a can of soda when you’re thirsty, and you’ll feel refreshed. But you’re basically drinking sugar water with zero nutritional value. And the phosphates in soft drinks aren’t healthy for your bones.

For a healthier alternative, try making a juice spritzer. Add a splash of soda water, diet ginger ale or diet lemon-lime soda to half a cup of 100 percent grape, orange or cranberry-blend juice with ice. Or cool off with diet tonic water and a wedge of lemon. Better yet, try water —it truly is “the real thing!”

5. Cake cravings: Take on your sweet tooth.

Leftover birthday cake just begs to be eaten. Store-bought cakes are high in sugar, saturated fat and trans fat (especially that fabulous butter cream frosting).

Try baking home-made angel food or sponge cake, then dressing it up with a fruit topping or spreading fruit-flavored “lite” yogurt on top. Or choose to limit the damage by ordering a single decadent piece of cake at a restaurant and sharing it. Then you’ll have no leftovers to tempt you at home.

6. Starved? Build a better sandwich.

Old-fashioned bologna and cheese sandwiches, typically made with white bread, are high in fat, saturated fat and sodium. Bologna and other processed deli meats also contain preservatives and other agents linked to increased risks of heart disease, diabetes and cancer.

Instead, buy low-fat, reduced-sodium turkey, chicken or lean beef slices, or water-packed tuna. Place them on whole-grain, rye, pumpernickel, light or thin-sliced bread. Top with reduced-fat cheese, avocado slices, lettuce, spinach leaves, alfalfa sprouts, or thin-sliced apples or carrots for extra vitamins, nutrients and fiber.

7. Condiments: Get creative.

Slathering sandwiches with ketchup, mayo or butter only adds unwanted fat and/or sugar. The sugar in ketchup comes in the form of unsavory high-fructose corn syrup.

But don’t settle for a dry sandwich — try mustard, hummus, olive- or canola-oil based mayo or sandwich spreads, or low-fat cream cheese. Moderate use of apricot chutney or marmalade and additive-free organic ketchup can also add flavor and moisture.

Maxine Smith, RD, LD, Outpatient Nutrition Therapy; Julia R. Zumpano, RD, LD, Preventive Cardiology and Rehabilitation; Kathleen McLaughlin, RD, LD, Inpatient Nutrition Therapy; and Andrea Dunn, RD, LD, CDE (Certified Diabetes Educator), provided these nutrition tips.

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Tip – Blood pressure: Sugar can help you and hurt you

If you’re trying to lower high blood pressure (hypertension), then you’ll want to watch sugar as well as salt. Frequent consumption of sugary soft drinks, lemonade and fruit punch can pack on the pounds, which raises blood pressure. On the other hand, eating a small amount of dark chocolate every day actually lowers blood pressure.

Be Well – May 2011 Issue

Preventing Blood Clots in the Lungs and Legs

When clots travel, trouble arrives

When Serena Williams was sidelined in 2010 with a blood clot in the lungs (pulmonary embolism, or PE), you may have wondered, “If it can happen to an elite 29-year-old athlete, can it happen to me?”

PE and blood clots that lodge in the leg veins (deep vein thrombosis, or DVT) occur in more than 100 people per 100,000. The risks increase after age 40.

Clots that travel from the legs to the lungs have devastating effects on the heart’s circulation. PE is instantly fatal in about one-fourth of patients, and those who survive remain at increased risk for future blood clots if not treated. When clots remain in the legs, DVT can cause leg swelling and ulcers.

It pays to know if you have any risk factors for this dangerous duo — and to learn about prevention.

Double trouble

“PE and DVT — together known as venous thromboembolism, or VTE — can be caused by a variety of hereditary and acquired risk factors. Prolonged immobility, medical illness, surgery, trauma and a genetic predisposition to form clots are just a few of them,” explains John R. Bartholomew, MD, Head of the Section of Vascular Medicine in Cleveland Clinic’s Heart & Vascular Institute.

“Serena had undergone surgery for an injury to her foot and had recently taken a long flight. This likely contributed to the DVT, which migrated to her lungs."

Most common risk factors

There are many risk factors for VTE, but immobility may partly explain the five strongest risk factors:

  1. Recent hip fracture
  2. Recent hip or knee replacement surgery
  3. Recent major (including laparoscopic) surgery, particularly to the abdomen or chest
  4. Recent major trauma
  5. Spinal cord injury

Studies have found the incidence of VTE is about 135 times higher among hospitalized patients than community residents.

Immobilized? Take precautions

If you are immobilized for an extended period (more than three days), you are at increased risk for DVT. Your doctor will likely prescribe compression stockings to keep blood from pooling in your legs. If you are hospitalized, you may be given an anticlotting medication or intermittent pneumatic compression stockings.

Long flights triple the risk of VTE due to immobility, which is why many airlines suggest you get out of your seat and walk around. On long flights, Dr. Bartholomew advises these precautions:

  • Drink plenty of juice and water.
  • Avoid alcohol.
  • Forgo dehydrating caffeine-containing products.
  • Don’t overeat.
  • Stay away from sleeping pills.
  • Follow exercises in flight magazines to stretch your ankles.
When to seek care

PE causes shortness of breath and chest pain. Patients may cough up blood or pass out. “These symptoms require emergency evaluation and confirmation of the diagnosis with a CT scan of your lung arteries,” says Dr. Bartholomew.

The most common symptoms of DVT are leg pain and swelling, but clots can be asymptomatic. If you experience pain or swelling in your leg, seek immediate attention from your healthcare provider, who may recommend evaluation with an ultrasound of your legs.

“A clot above the knee is more dangerous than in the calf veins. Go to your doctor or ER right away,” Dr. Bartholomew says, adding that “rubbing your leg won’t make it go away.”

Banishing clots

In the old days, VTE was treated with bed rest. Today, patients are treated with an anticlotting medication such as low-molecular-weight heparin or fondaparinux. If the cause of the clot is known, treatment may continue for three months. If the cause is unknown, treatment may continue indefinitely.

While it may not be entirely possible to prevent every case of VTE, two simple measures could eliminate many of them: “Stay active and well-hydrated,” Dr. Bartholomew advises.

Venous thromboembolism: Other causes

Besides the common risk factors for deep vein thrombosis and pulmonary embolism mentioned above, other risk factors include:

  • Central venous line
  • Certain chemotherapy agents
  • Congestive heart failure/respiratory failure
  • Hereditary causes of clotting
  • Hormone replacement therapy/oral contraceptives
  • Malignancy (cancer)
  • Obesity
  • Paralytic stroke
  • Pregnancy/recently having a baby
  • Thrombophilia (genetic or acquired)
  • Varicose
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Be Well – May 2011 Issue

Your Free Guide to Voice Disorders

Voice disorders can cause hoarseness and difficulty speaking or singing. This Cleveland Clinic Voice Center guide describes the many causes of voice problems and how team evaluation and treatment are required.

Recipe: Lemon and Fresh Herb Tabbouleh


½ cup medium- or fine-grain bulgur wheat
2 tablespoons extra virgin olive oil
2 garlic cloves, minced
2 cups finely chopped fresh flat-leaf parsley (about 3 bunches)
¼ cup diced red onion
2 medium tomatoes, seeded and diced
⅓ cup finely chopped fresh mint
¼ cup finely chopped fresh basil
3 tablespoons finely chopped fresh dill
3 tablespoons finely chopped fresh cilantro
⅓ cup fresh lemon juice

  1. Bring kettle of water to a boil. Stir together the bulgur and 1 tablespoon of the olive oil in a heatproof bowl. Add boiling water to cover. Cover the bowl tightly with plastic wrap and let stand for 15 minutes. Drain in a sieve, pressing on the bulgur to remove any excess liquid.
  2. Transfer the bulgur to a large bowl and toss with the remaining 1 tablespoon olive oil and the rest of the ingredients until everything is well mixed. Cover and refrigerate for at least 3 hours. Serve cold.

Makes 8 servings.

Per serving:
Calories: 80 (45% calories from fat)
Fat: 4g
Saturated fat: 0.5g
Protein: 2g
Carbohydrates: 12g
Dietary fiber: 3g
Cholesterol: 0mg
Sodium: 15mg
Potassium: 237mg

One of more than 150 heart-healthy recipes from the Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook, available from Broadway Books and wherever books are sold.

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Be Well – May 2011 Issue

Let's Move It! Free Mobile App

Let Cleveland Clinic and your mobile phone keep you motivated. More than just a pedometer, our free mobile app offers walking challenges, a calorie tracker and videos to encourage and inspire.