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  14 on the cover STORIESBY Ann-Marie Vazzano AND Lynne Thompson PHOTOGRAPHY BY Jeff Downie BEYOND THE FOOD PYRAMID 1 2 3 4 5 6 2 3 n-Marie Vazzano hompson 33 4 5 6
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  C ut fat. Avoidsugar. Limit red meat. Carbs are the enemy. There’s a lot of focus these days on the things we shouldn’t eat. But what about the things we should? In 2011, the USDA retired its antiquat- ed food pyramid. We’re all familiar with it — the illustrated triangle encouraging us to eat six to 11 servings of grains dai- ly, three to five servings of vegetables, two to three servings of meat and poultry — and the list goes on. The problem was, Americans’ notions of what constituted a “serving” were foggy at best. To simplify things, USDA introduced MyPlate, a graphic representation of a round plate, with one quarter dedicated each to protein and grains, with vegetables and fruit making up the remaining half. But there’s more to eating well than just enjoying your broccoli. Doctors and nutritionists now recommend incorporating the whole spectrum of color. “If you get a lot of different colors into your diet, you’ll be getting a lot of different nutrients,” says Michele Hiatt, clini- cal dietitian at St. John Medical Center. “It also helps spruce up the plate and makes it look more appealing.” Purple Step away from the pop machine and pour yourself a glass of purple grape juice (no sugar added). Research has found that pressing grape seeds and skins releases flavonoids — a heart- healthy substance that helps reduce bad cholesterol. 1 // COLOR WHEEL MEALS Colorful foods provide fiber, as well as all the essential vitamins and minerals. “I notice when I do nutrient analyses for people that oftentimes they don’t get enough fiber in their diet,” says Hiatt. But rather than focus on what patients are doing wrong and what they shouldn’t be eating, Hiatt prefers to counsel them on what they can add to their diets. “Sometimes saying, ‘aim for five fruits and vegeta- bles a day’ — it becomes more of a positive thing — it’s something to add to your diet,” she says. In turn, patients often end up eliminating some of the not-so-healthful foods because they fill up on fruits and vegetables. “If you can say one thing to eat, sometimes that makes a big difference to people,” says Hiatt. In addition to adding more color to their plates, many people are taking their diets to a whole new level. Whether they want to be healthier, protect animals or lose weight, these diners are following special diets that require them to be more attentive to their food choices. Read on for popular eating regimens you might want to investigate before stopping at the drive-thru for lunch. Think you don’t have time to incorporate all the colors into your diet? Think again. It just takes some small changes to your daily routine. Red Toss some tomatoes into your salad. Tomatoes contain lycopene, which studies have shown to reduce the risk of cardiovascular disease and cancer. Orange Orange foods are packed with immune system-boosting beta carotene and vitamin C. Swap your regular baked or mashed potatoes for the sweet variety — one large sweet potato counts as one cup of orange vegetables, according to USDA’s MyPlate. Yellow “Bananas kind of get a bad rap because they’re starchy and higher in calories than most fruits, but they do contain a lot of potassium,” says Michelle Hiatt, clinical dietitian at St. John Medical Center. “When you have low potassium, sometimes you have problems like muscle cramping.” Plus, bananas make a great grab- and-go snack. Green Green veggies contain antioxidants, including folic acid, which also helps prevent heart disease. As an alternative to potato chips, Hiatt suggests keeping kale chips on hand. Toss fresh kale leaves in olive oil with any herbs. Spread them on a baking sheet and bake at 350 degrees for about 10 minutes, or until crisp. Blue Blueberries are an antioxidant-rich super food. Top your morning cereal with a handful for added sweetness and a healthy dose of manganese, which helps process cholesterol, protein and carbs into energy. 1 2 3 4 5 6
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  16 fall 2013• circleeastmag.com 2 // THE PALEO PLUNGE ‘Caveman diet’ calls for fresh fruits and vegetables and ethically raised meat, but no dairy, legumes or grains. TIPS FOR GOING PALEO Commit to it for 30 days. Lytle says most people can conceive of going without current staples such as milk and bread for that short period. But it’s long enough for them to experience the benefits of life without them. “A lot of people just honestly feel better,” she says. “They feel more energized.” • Take a multivitamin and vitamin D supplement. “There’s some debate over what level of vitamin D in the blood is optimal,” Cimperman says. Check with your doctor to determine how many international units you require each day. • Eat fish and chicken rather than beef and pork. Handley advises keeping portions to 3 or 4 ounces. “The more vegetables that you put on your plate, the better off you’re going to be,” she advises. • Eat a wide range of vegetables and fruits. Doing so not only provides variety but necessary nutrients. • Two words: sweet potatoes. Lytle recommends eating the popular veggie to get more energizing carbohydrates, particularly for those feeling a tad sluggish. • Get in the Zone. If you discover your body just can’t function without some dairy, grains or legumes, consider trying the Zone diet, a variant of the Paleo diet that includes foods such as oatmeal, whole milk and cheese from grass-fed cows, soy products and peanut butter. Daily food consumption is prescribed in “blocks” of protein, carbohydrates and fat based on gender, age, activity level and body type. For more information, log on to library.crossfit.com/free/pdf/cfjissue21_may04.pdf. What It Is. Janine Lytle, a certified nutritionist with CrossFit Akron, refers to the Paleo (short for “Paleolithic) diet as “the caveman diet,” one based on foods our hunter-gatherer ancestors ate before the advent of agriculture: fresh meat and seafood, seasonal vegetables and fruits, nuts and seeds. It includes game, beef, poultry, eggs, almond and coconut milks, sweet potatoes and oils from nuts and seeds. Off the menu are dairy, legumes (beans, peas, peanuts, soybeans, etc.), white potatoes, grains, refined sugars, soft drinks and alcoholic beverages, along with products made with or derived from them. Adherents differ in how they observe the “no processed foods” rule. Some avoid cured and processed meats; make their own almond and coconut milks; and use only raw honey as a sweetener. Others indulge in bacon, ham and deli meats; buy almond and coconut milks at the grocery store; and sweeten with pure maple syrup, molasses and stevia. THE BENEFITS THE DRAWBACKS It is based on fresh, whole, “real” foods. Cutting out processed foods (in other words, foods not in their original form) eliminates preservatives and artificial colorings. According to Kim Handley, a holistic nutritionist with Debi’s Personal Training based in LaGrange, many researchers and health professionals believe these ingredients contribute to the development of diseases such as cancer and diabetes, perhaps because the body has difficulty processing them. It emphasizes eating ethically raised, hormone- and antibiotic-free animal proteins. That means pastured grass-fed beef and pork, free- range poultry and wild-caught seafood. Lytle explains that livestock allowed to roam at will and subsist on what Nature intended are leaner and therefore a more healthful entrée option. “When livestock is fed grains, that increases their fat deposits,” she says. “So you have a fattier piece of meat.” It is free of refined sugars. “Sugar consumption today is very high — it seems [food manufacturers] are putting sugar in everything,” laments Michelle Kaluzne, a registered and licensed dietician at Summa Health System. “Those who eat more refined sugars tend to be overweight or obese, which is a risk factor for Type 2 diabetes.” It relies on animal proteins as a staple. For decades, doctors have been warning their patients that red-meat consumption contributes to developing high LDL, or “bad,” cholesterol and heart disease. Kaluzne observes, while fresh, grass-fed beef is a more healthful option, it still must be consumed in moderation. Some people, she adds, see the Paleo diet as a license to consume Fred Flintstone-sized cuts of meat. It excludes whole grains. Lisa Cimperman, a clinical dietician at University Hospitals Case Medical Center in Cleveland, explain whole grains are a common source of complex carbohydrates, fiber and B vitamins, the last of which are important in converting food into energy. Lytle has encountered Paleo devotees who feel tired and lethargic. “Carbs are energy,” she notes. It cuts out dairy products. There are plant-based sources of calcium — leafy greens such as collard greens, kale and okra, for example. But, Cimperman says, eschewing fortified dairy products eliminates a common source of vitamin D. The nutrient is necessary for more than calcium absorption. She cites a recent study that showed individuals with sub-par vitamin D levels had a higher risk of dying from all causes.
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  circle east livewell • fall 2013 17 The Paleo Shopping List INGREDIENTS: For the spaghetti squash: 1 spaghetti squash 4 tablespoons coconut oil, divided 2 teaspoons garlic salt 1 small butternut squash, peeled and cubed 2 cups portabella mushrooms, sliced 1 medium onion, chopped salt and pepper to taste 4 cups kale, shredded For hot turkey-sausage meatballs: 2 teaspoons garlic salt 1 teaspoon black pepper 2 teaspoons Italian seasoning 1 teaspoon crushed red pepper 1 teaspoon fennel seeds 1/2 pound ground white turkey meat 1/2 pound ground dark turkey meat For the sauce: 1 cup canned pumpkin, plain (not pie filling) ¼ cup chicken broth 1 teaspoon garlic salt 1 teaspoon crushed red pepper 2 teaspoons thyme 1 teaspoon nutmeg 2 tablespoons raw honey ¼ cup almond milk, unsweetened INSTRUCTIONS: 1 Preheat oven to 425 degrees. 2 Cut spaghetti squash in half and scoop out seeds. Brush flesh of each half with 1 tablespoon coconut oil, then sprinkle each half with 1 teaspoon garlic salt. Place spaghetti squash halves cut-side down on a baking sheet and roast for 20 to 25 minutes, or until rind yields to gentle pressure. Remove from oven and set aside. 3 For the meatballs, mix seasonings with the ground meats. Roll into medium-sized meatballs and place in a foil-lined roasting pan. Reduce oven heat to 375 degrees and bake, uncovered, 10 to 12 minutes, or until meatballs are lightly browned. 4 While the meatballs are baking, heat 2 tablespoons coconut oil in a skillet. Saute butternut squash over medium heat for 5 to 7 minutes, or until tender. Add mushrooms, onion, salt and pepper and continue cooking until tender. Remove from heat and set aside. 5 For the sauce, whisk together pumpkin, chicken broth, seasonings and honey in a saucepan over low heat. Slowly whisk in almond milk. Continue simmering until bubbles form. 6 Scrape spaghetti squash from rinds with the tines of a fork and toss with other vegetables, including the kale. Divide on plates, ladle sauce over vegetables, and top each portion with 2 to 3 meatballs. Serves 4. TRY IT Nutritionist Janine Lytle encourages anyone who thinks they can’t live without pasta to try her fall favorite. She replaces spaghet- ti with spaghetti squash and traditional tomato sauce with a seasonal pumpkin counterpart. Spaghetti Squash with Savory Pumpkin Sauce • Vegetables (fresh and in season if possible; plain frozen is OK) • Large-leaf lettuce (for sandwich wraps) • Spaghetti squash (to replace pasta) • Sweet potatoes • Fruits (fresh and in season, if possible; plain frozen is OK) • Eggs (cage-free) • Almond or coconut milk (unsweetened) • Almond or cashew butter (to spread on apples, bananas, strawberries, etc.) • Fresh meats • Fresh seafood • Nuts and seeds • Oils and seasonings (to make salad dressings) • Raw honey (for sweetening) STOCKING THE PALEO KITCHEN is all about shopping the perimeter of the grocery store. Janine Lytle, a certified nutritionist with CrossFit Akron, suggests picking up the following items.
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  Gluten-Free Substitutes 1 / Cornstarch:works well as a thickener for soups/sauces 2 / Amaranth: high in protein and fiber; adds a nutty flavor to baked goods 3 / Almond Meal Flour: made from whole almonds ground into powder; works well in cookies, cakes and other desserts (use a half a cup for every 1 cup in recipes) 4 / Quinoa: packed with protein and other vitamins and minerals, it adds texture and moisture to baked goods 5 / Coconut Flour: high in fiber and adds sweetness and moisture to baked goods 6 / Buckwheat: makes great pancakes and low-cal, gluten-free breads 6 1 2 4 5 3 2 WANT TO COOK AND BAKE gluten-free at home? With these substitutes, you won’t even miss your all-purpose flour: 3 4 18 fall 2013 • circleeastmag.com
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  circle east livewell • fall 2013 19 3 // GLUTEN-FREE GUIDE Should you avoid gluten? Here’s the lowdown on this pervasive protein.  T en years ago, you’d be hard-pressed to find a single product labeled “gluten-free” in your local grocery store. But now, many supermarkets are catering to the increasing number of consumers avoiding gluten, a protein substance found in wheat, rye and barley. Stroll through your grocery store today and you’ll undoubtedly stumble upon an entire section dedicated to gluten-free foods. So why the sudden anti-gluten movement? Increased awareness of celiac disease — an intolerance to gluten — created a growing demand for gluten-free products, which in turn created a unique marketing opportunity for food manufacturers. But there’s a lot to consider before going gluten free. HOLD THE GLUTEN How do you stick to a gluten-free diet when out and about? Here’s a list of helpful smartphone apps and websites to try: • Eating Out G-Free: an app that offers tips on finding gluten-free menus, lets you create a gluten-free shopping list and lists foods to avoid • Find Me Gluten Free: this app rates restaurants and businesses on gluten-free friendliness, allows you to view gluten-free menus for chains and fast food restaurants and helps you find local gluten- free establishments • Gluten Freed: an app that displays a list of nearby gluten- free restaurants • Gluten Free Daily: an online guide featuring gluten-free recipes, tips on what to eat, a grocery list and a daily journal Should You Avoid Gluten? Sharon Minjares, registered dietitian and Wellness Institute director at Lake Health, says she generally suggests a gluten-free diet only to patients who have been diagnosed with celiac disease or gluten sensitivity. “Being diagnosed means typically that they have to have some blood work done by their physician, and they also probably need to have a biopsy of the intestines,” she explains. Symptoms of celiac disease include stomach cramps, bloating, diarrhea, constipation, nausea, vomiting and weight loss, but the cause of the disease is poorly understood. Minjares says she has dealt with several patients who have not been formally diag- nosed with the disease but experienced gastrointestinal distress after eating wheat products. After eliminating gluten, they found relief. But she’s quick to note that foods contain many ingredients, so without a proper diagnosis, it’s impossible to know if glu- ten is to blame for gastroin- testinal issues. For individuals suffer- ing from celiac disease, the body’s immune system sees gluten as an enemy and re- acts accordingly, causing damage to the lining of the small intestine. “Most of the nutrients in food are actually absorbed through the small intestine, so damage to the small intestine is going to mean you’re not absorbing nutrients into the body,” Min- jares explains. “It can lead to some significant nutrient defi- ciencies.” But avoid- ing gluten can come with risks, too. “Adher- ing to a glu- ten-free diet may actu- ally result in a diet that’s low in carbohy- drates, iron, folate, niacin, zinc and fi- ber,” Minjar- es says. These vitamins and minerals are commonly found in glu- ten-rich foods. Therefore, she recommends supplementing with a multivitamin. Gluten and Weight Loss Many people who have not been diagnosed with celiac disease or gluten sensitivity are adopting gluten-free diets to aid in weight loss. But Minjares says there is no evidence that a gluten- free diet itself will promote weight loss. What it can do, however, is lead to decreased carbohydrate intake. Because gluten is found in breads, cookies, cakes and other baked goods that also tend to be higher in fat and sugar, decreased consumption of these types of foods can lead to weight loss and improved health. Where people sometimes run into trouble, notes Min- jares, is if they simply buy packaged gluten-free products thinking they’re more healthful than their tradition- al counter- parts. In fact, a person could ac- tually gain weight on a gluten-free diet. “If you compare a serving of pretzels — regular pret- zels provide approximately 108 calories and 1 gram of fat, and glu- ten-free pretzels contain 140 calories and 6 grams of fat,” Minjares says. And for individ- uals who have celiac disease, eliminating gluten can lead to weight gain simply because the small intestine is now able to absorb more nutrients. The good news for those avoiding gluten is that help- ful resources for living gluten- free are abundant. “There are some really nice apps that are available that people can download on their smart- phones,” says Minjares. “It’s a safe place to go to learn how to eat.” HIDDEN GLUTEN Gluten is found in more than just baked goods. Other products that frequently contain gluten include: broths/ soups, lunch meats and hot dogs, chips and candy, salad dressing, soy sauce, gravy, imitation seafood, dairy substitutes, lip gloss/ lipstick, toothpaste, medication/vitamins
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  20 fall 2013• circleeastmag.com 4 // GOING VEGAN • almond milk • beans (dried or canned) • brown rice • fruit (fresh or plain frozen) • peanut butter, almond butter or cashew butter • vegetables (fresh or plain frozen) • whole-grain bread • whole grain cereal • whole-grain pasta The Vegan Shopping List REGISTERED DIETICIAN Kristin Kirkpatrick, wellness manager at the Cleveland Clinic Wellness Institute in Lyndhurst, advises against picking up items such as tofu (soybean curd) and seitan (flavored wheat gluten) during your first few trips to the supermarket. Instead, buy what you already know how to work with: vegetables, fruits, whole grains and legumes. This plant-based diet respects animal rights and promotes healthy living. What it is. The vegan diet is one that excludes “anything that has a mom or a face,” according to registered dietician Kristin Kirkpatrick, wellness manager at the Cleveland Clinic Wellness Institute in Lyndhurst. Those who adhere to it not only eschew meat, poultry and seafood, but other animal products such as gelatin (derived by boiling specially prepared skin, bones and connective tissue), eggs and dairy. “If you’re a true vegan, you wouldn’t have honey, either,” she says. “Honey comes from bees.” Kirkpatrick estimates that 50 percent of her vegan clients maintain the diet for health reasons; the other 50 percent do so because of concerns about how animals are raised or an objection to killing them for food. Kim Handley, a holistic nutritionist with Debi’s Personal Training based in LaGrange, points out that going vegan is often a lifestyle that eliminates wearing leather and fur, using cosmetics tested on or containing products derived from animals, etc.
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  circle east livewell • fall 2013 21 THE BENEFITS THE DRAWBACKS It cuts out sources of saturated fat and cholesterol and increases intake of fruits, vegetables and whole grains. Studies of cultures around the globe show that a plant-based diet contributes to living a longer, healthier life, Kirkpatrick says. It doesn’t cause discomfort in those who have trouble digesting meat. “Some people just don’t have enough acid in their stomachs to break down meat very well,” Handley explains. “It just makes them feel heavy.” It is devoid of vitamin B12. Kirpatrick notes animal products are the only food source of vitamin B12, a nutrient essential to maintaining a healthy nervous system and repairing cells. “It doesn’t take a lot to keep you sufficient in those levels,” she says. “But once you have a B12 deficiency, it’s very difficult to reverse the process.” It is not easy to do. The challenges extend beyond fighting cravings for a big, juicy burger or a wedge of creamy, dreamy cheese — the food Kirkpatrick says her vegan clients have the most trouble giving up. She observes that maintaining a vegan diet can require spending more money at the grocery store and more time planning and preparing meals, particularly for those who rely on the fast-food drive-thru. When it comes to the number of vegan restaurants and menu selections in Northeast Ohio, she adds, “we’re still a little behind New York City, for example, or the West Coast.” Those who adopt a vegan diet without proper education and preparation often end up subsisting on breads, pastas, cereals and processed foods (veggie burgers, soy sausages, etc.), the last of which often are high in calories, sodium, preservatives, artificial colorings and other additives. INGREDIENTS: 2 cups broccoli florets 3 cups water 2 tablespoons vegetable base 1 tablespoon extra-virgin olive oil 1 cup onion, diced small 2 tablespoons fresh garlic, minced 1 cup red, yellow and/or orange bell pepper, diced small 1½ cups white button mushrooms, sliced salt and pepper, to taste ½ cup jarred or canned roasted red peppers, julienned 4 threads saffron, crushed ¼ teaspoon red pepper flakes 1 14.5-ounce can diced tomatoes 1 cup brown rice, uncooked ½ cup scallions, sliced thinly ½ cup frozen peas, thawed 1 cup frozen baby lima beans, thawed INSTRUCTIONS: 1 Preheat oven to 350 degrees. 2 In a pot, par-cook broccoli in 3 cups water. Remove broccoli and set aside. Reserve 2 cups water; mix with vegetable base and set aside. 3 Heat a 4-quart cook pot, add olive oil and sauté onion until translucent. Add garlic and cook until fragrant. Add remaining ingredients except for cooked broccoli, scallions, peas and lima beans. Mix well and bring to a simmer. Remove pot from heat, cover and place in oven for 20 minutes. 4 Remove pot from oven and let stand, covered, for 10 minutes to finish cooking. Add broccoli, scallions, peas and lima beans. Mix well. Makes 10 1-cup servings. TRY IT Cleveland Clinic Wellness Institute executive chef Jim Perko’s version of the classic Spanish dish removes the meat and seafood and leaves the flavor, along with the veggies and rice, in the pot. Vegan Paella TIPS FOR GOING VEGAN Getting Started Explore what a vegan diet might look like. Kirkpatrick asks her clients to write down a week’s worth of typical meals and snacks. She then suggests healthful vegan alternatives where necessary. A go-to breakfast of coffee with half-and-half, eggs and whole-grain toast, for example, might be modified by trading the half-and-half for a soy creamer or almond milk and replacing the eggs with a slathering of all-natural peanut butter on the toast. Kirkpatrick suggests tackling the exercise with a vegan dietician or nutrition-savvy vegan doc. He or she not only will be able to recommend vegan alternatives but can assess your specific nutritional needs and suggest how to best meet them. Go vegan gradually. “People tend to be more successful when they take the diet they already enjoy and start to make some small changes,” Kirkpatrick observes. She gives the example of eliminating eggs the first month, cutting out poultry the second month, swearing off cheese the third month and so forth. The practice allows time to experiment with new foods and recipes, introduce them into menus over time and find new favorites. Slowly increasing servings of vegetables, fruits and legumes also is a good idea for adults whose diets are lacking in fiber. Eat more vegetables than fruits. Handley points out vegetables contain protein as well as vitamins, minerals and fiber. Dark, leafy greens — spinach and kale, for example — are high in calcium. And unlike fruit, they don’t contain large amounts of natural sugar. Schedule extra grocery-shopping time. Some processed foods that appear to be vegan-friendly actually contain animal products. Kirkpatrick notes, for example, that some rice cheeses contain the milk protein casein. Handley adds that some soy, almond and coconut milks contain a lot of sugar. Therefore, scrutinizing labels is necessary. Keeping It Going Include a protein source or two in each meal. Michelle Kaluzne, a registered and licensed dietician at Summa Health System, says dietary analyses indicate most of her vegan clients are consuming enough protein. But she still suggests they eat a serving of nuts, seeds, legumes or soy milk at each sitting to keep it that way. Pair iron- and vitamin C-rich foods when possible. Kirkpatrick points out the iron from, say, a steak is better absorbed by the body than iron from plant sources such as lentils, nuts, quinoa, soybeans and spinach. Vitamin C actually enhances that absorption. One tasty idea: “Put some mandarin oranges or some strawberries on top of your spinach.” Try blackstrap molasses as a calcium supplement. Kaluzne says one tablespoon contains 200 milligrams. Pay attention to how you feel. “If you feel very lethargic, your body might actually need that meat,” Handley says. “And that’s OK. If you don’t want to eat beef, add in chicken or fish.”