The end of November is approaching and Americans are getting ready for the celebration of Thanksgiving. If you are not American you may not know that it is a public holiday always celebrated the fourth Thursday of November commemorating a feast held in 1621 by the Pilgrims and the Native Americans. Even though this the most American holiday of all, other countries have adopted this celebration. For instance, U.S. Canadian neighbors celebrate Thanksgiving the second Monday of October giving thanks for a successful harvest, a tradition from European heritage. It is a statutory holiday in most jurisdictions, being optional in some Canadian provinces.  Thanksgiving dishes in Canada are similar to the ones in the U.S. (roasted turkey, stuffing, mashed potatoes and gravy, pumpkin pie, sweet potatoes and other fall vegetables). Puerto Rico, an American territory, is another place where Thanksgiving is celebrated but with a Caribbean hint, especially in the dinner menu. Dishes with plantains like tostones (fried plantains) and mofongo (a plantain mash used as stuffing), pavochon (a slow roasted turkey), morcilla (blood sausage) and tembleque (a kind of cinnamon coated coconut custard) are part of the feast. As in the U.S., most businesses are closed, families gets together and people go shopping the next day.

Going a little more far away, I found that Thanksgiving is also celebrated in Liberia and in a remote Australian island. The commemoration in Liberia (the first Thursday of Nov) may be explained by the fact that it was a country founded by U.S. colonization. In this part of the world, settlers replaced turkey and pumpkins with more local ingredients like chicken and cassavas. The Australian territory, Norkfold Island, celebrates Thanksgiving the last Wednesday of November giving thanks to American trader Isaac Robinson. Traditional foods in this region are cold pork and chicken and pumpkin pie.

Lastly, expats and Americans that circumstantially find themselves outside the U.S. (vacations, business) have to celebrate abroad. I used to live in the U.S. Midwest and have the wonderful experience of having Thanksgiving dinner at friends’ houses. There, I´ve learn not only about the typical foods but also about values and sharing. I didn´t felt foreign. Once back to my home town, Buenos Aires (Argentina), I kind of miss this Holiday. So, every year I try to have a special meal with family at home or in a restaurant (I´m not that good at roasting turkey). The best place to celebrate Thanksgiving in Buenos Aires is Kansas Grill and Bar.

-Romina

A recent article, “Applying the Precautionary Principle to Nutrition and Cancer” (Gonzales, 2014), was published in the Journal of the American College of Nutrition with guidelines for eating and cancer prevention. What is new about the report is the recommendation to limit or avoid milk and dairy products as part of a more plant based diet to prevent cancer. The evidence comes from the 2007 report of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and other evidence sources published after the WCRF/AICR report. The authors say that people cannot wait for evidence based consensus and that families have to act now on the best available evidence. So, they developed 6 dietary principles (see box) in which evidence of dietary influence in cancer risk is substantial, even if not conclusive. The report lists 6 guidelines that recommend eating more vegetables and fruits, more soy products, little or no alcohol, little or no dairy and red meats and avoidance of meat that has been fried, grilled or broiled.

SUGGESTED DIETARY GUIDELINES FOR CANCER PREVENTION*:
1.       Limiting or avoiding dairy products may reduce the risk of prostate cancer.

2.     Limiting or avoiding alcohol may reduce the risk of cancers of the mouth, pharynx, larynx, esophagus, colon and rectum, and breast.

3.       Avoiding red and processed meat may reduce the risk of cancers of the colon and rectum.

4.     Avoiding grilled, fried, and broiled meats may reduce the risk of cancers of the colon, rectum, breast, prostate, kidney, and pancreas. In this context, meat refers to red meat, poultry, and fish.

5.      Consumption of soy products during adolescence may reduce the risk of breast cancer arising in adulthood. Soy products may also reduce the risk of recurrence and mortality for women previously treated for breast cancer.

6.     Emphasizing fruits and vegetables in your diet will likely reduce the risk of several common forms of cancer.

* Note that this review specifies suggested dietary guidance in which evidence of a dietary influence on cancer risk is substantial, but not necessarily conclusive



It is not new that there are many advocates for a diet that totally excludes dairy products –milk, yoghurt, cheese and butter- arguing that this helps to stop cancer cells from growing, especially hormone-related cancers such as prostate, testicle and ovarian cancer (see the Milk article in the latest FNM). But, what says the evidence? Studies that investigate a link between dairy and cancer are inconclusive. Some research shows an increase in the risk of developing prostate cancer (Li-Qiang Qin 2009), while others show possible protective role of dairy products on colorectal cancer risk (Murphy, 2013). And, consumption of dairy products has not been identified as a risk factor for breast or other types of cancer (Pala, 2009).

Despite evidence limitations, when it comes to milk and dairy, the article published in the JACN suggest: “Limiting or avoiding dairy products may reduce the risk of prostate cancer”. It was found that eating 35 grams of dairy protein (more than 4 cups of milk) increases the risk of prostate cancer by 32%. It´s believed that the mechanism to increase prostate cancer risk is the ability of a large oral calcium dose to suppress vitamin D activation and the tendency of milk to increase serum insulin-like growth factor-I (IGF-I) concentrations.

The authors acknowledge disadvantages of this recommendation and suggest eating other sources of calcium (leafy vegetables, legumes, and calcium-fortified foods).  As a food and nutrition professional, I believe that the recommendation of limiting dairy for cancer prevention can be risky and confusing for the press and for the public, specially, because dairy products are the main dietary source of calcium, an essential nutrient for bone health and may even prevent colon cancer.  I think that, for now, we should focus on a total diet approach and recommend a healthy, well balanced diet (with more than 5 serving of fruits and vegetables daily). Calcium should be part of that diet, and milk is an important source of calcium. 

This August is going to be the first ever Kids Eat Right month, a national educational and action campaign promoted by Kids Eat Right (KER) from the Academy of Nutrition and Dietetics. Coincidence or not, in some countries of the world like Argentina, Uruguay, Perú and Paraguay, Children´s Day is recognized the second Sunday of August to honor children. What a great idea to celebrate this month with healthy nutrition and active lifestyles for children and families, offering simple steps to help families cook healthy, eat right and shop smart. The Academy has developed information resources to share with family, schools, community leaders and dietitians. We all have a role in ensuring a healthy future for our children. Find out all of these resources 

·  Parents and Kids

·  Registered Dietitian Nutritionists

·  Schools

·  Community Leaders and Groups

·  Media

You can also volunteer in many ways for this campaign and don´t forget to follow KER on social media!

Soccer teams are now in Brazil playing the 2014 FIFA World Cup, one of the most important sport events worldwide. Here in Argentina, it means more than a sportive event. The whole country paralyzes, people literally stop working to watch the games (while eating not very healthy snacks…) The most exciting part of the World cup starts today with the best 16 teams (Argentina, Argelia, Chile, Colombia, Uruguay, USA, Suiza, Honduras, Brazil, France, Mexico, Netherlands, Belgium, Greece, Costa Rica, Nigeria). Now, elite players prepare to play each game at maximum pace with not much time between games to recover. Diet may have its biggest impact in this phase.

Getting the right amount of energy to perform well is key, says FIFA on a nice nutrition segment of its website.  Each team has people that carefully choose the right foods and fluids for players to eat during training, pre and post game and for recovery. A good diet can help support consistent intensive training while limiting the risks of illness or injury. That’s why many teams have dietitians or nutritionists on their delegations. For instance, USA´s team coach Jürgen Klinsmann has Danielle LaFata, MS, RD, balancing the high calorie needs of athletes with healthy eating. Klinsmann himself models healthy eating by emphasizing organic and local varieties of whole foods in his own diet.  “He’s very involved,” team dietitian Danielle LaFata said to the Associated Press. “I think he’s more nutrition conscious than myself sometimes.” The US soccer team is urged to eat more fruits and vegetables and goes through a case of avocado each day!  Meanwhile, Italy´s team nutritionist Elisabetta Orsi, emphazises a tricolor diet: “Pasta is our preferred fuel, and before matches we play with the tricolore: pasta with parmesano (white), prosciutto (red) and extra virgin olive oil (green), our natural medicine brought from Italy”, said Elisabetta to the Corriere dello Sport. But, unfortunately Italy couldn´t do it to this round of the Cup and were sent home. Lastly, according to the AFA website, Argentina´s delegation in Brazil does not have a dietitian in the team. They have chef and a kitchen assistant.  They are not fueling on alfajores anymore... The New York Times reported that, Lio Messi used to be rewarded alfajores for scoring goals when was a kid. Now, Argentine players’ diet is based on carbs (pasta, potatoes, sweet potatoes and rice), proteins (grilled meats like chicken, fish and beef) and vegetables (like broccoli, asparagus, spinach and green beans). For dessert, seasonal fruits and queso y dulce (an Argentinean dessert made of cheese and dulce de batata which is a sweet potato hard jam). All foods are local (Brazil) except from dulce de leche and dulce de batata that were brought from Argentina. What about the Argentinean asado? They eat this typical Argentinean barbecue while in Brazil but without organ meats. And, I suppose mate is present too!


At this stage of the Cup, the margin between victory and defeat is small. Attention to detail can make that vital difference. Maybe we can learn from players to chose foods (our fueling) more wisely to “perform” better in our life. See the FIFA nutrition booklet here and:

From the Academy Website: U.S. Men’s National Team Dietitian Fuels Performance:
http://www.eatright.org/Public/content.aspx?id=6442481504

Proper hydration. Even the slightest dehydration will impact performance. Playing soccer in Brazil's hot and humid weather increases fluid needs, and players may require as much as 10 liters per day. Electrolyte beverages, fruit and vegetable juices and smoothies contribute to a player's hydration needs. All contain vital nutrients such as potassium and magnesium, which are lost in sweating.

Food first. In a sports world of heavy supplementing, Team USA's goal is to get their primary fuel from nutrient-rich foods. If needed, supplementing is customized for the individual, but food always comes first. An example of a meal three to four hours prior to a game would include whole grain pasta with Bolognese sauce, chicken breast, grilled asparagus, watermelon and pineapple.

Post workout eating. In order to minimize muscle soreness and maximize muscle recovery, post workout smoothies with the right amount of protein and carbohydrates are given after workouts within 30 to 45 minutes. One post-workout snack LaFata makes for the team includes 25 grams of whey protein mixed with water and 1½ bananas.

80/20 principle. Athletes should eat highly nutritious foods including lean proteins, brightly colored fruits and vegetables, whole grains, beans, nuts, seeds and low-fat dairy 80 percent of the time. The other 20 percent can be other foods that might be higher in fat and sugar. Team USA has their "20-percent meal" 24 to 48 hours after a game. After that, it's back to fit eating.

High nutrition with healthy fats. Players achieve high calorie needs by blasting their diet with a variety of plant-based foods while also adding healthy fats through nuts, seeds and olive or canola oils. The higher the calorie needs, the more generous you can be with healthy fats.

Healing foods for injuries. Team USA has dealt with their share of injuries at the World Cup. For injury recovery, LaFata recommends emphasizing whole-grain foods such as oatmeal, quinoa and wild rice. Other injury recovery foods include fatty fish, green leafy vegetables and legumes.

As of today, trans fat still the villain in the diet and unsaturated fats the good ones, but when it comes to saturated fats, it seems that the paradigm is shifting. A study published last March, questions –again- the harmful effects of saturated fats. I said again because, I remember an article in Science magazine from 2001 questioning the medical community and the US government for misinterpreting the scientific evidence, arguing that fat (whether saturated or not) are not the culprit of obesity and cardiovascular diseases, and blaming refined carbohydrates for this.

The study I was mentioning at the beginning is the one published in the Annals of Internal Medicine and is a systematic review and meta-analisis (with more that seventy studies included) concluding that current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats. Contrary to this, the latest 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk recommend a reduction of saturated fats to 5-6% of the total calories, when the 2010 Dietary Guidelines for Americans recommend a 10% of saturated fats.

The old study of the Seven Countries (1958), authored by Dr. Ancel Keys, and widely referenced because it found a correlation between saturated fats and increased LDL cholesterol and cardiovascular risk is also criticized. Many put in doubt the methodology of the study and it’s believed that Dr. Keys picked certain countries and left outside of the study countries that have high consumption of saturated fat with lower rates of heart disease, like Sweden, Germany and others.   

So, what we recommend now as food and nutrition professionals? Of course that LDL cholesterol is not the only one factor to consider when assessing cardiovascular risk. Other factors are now important like being overweight, lifestyle, other serum lipids, etc. I don’t personally believe that is necessary to further decrease saturated fat intake to 5-6% of calories. Even more, the AHA/ACC guidelines don’t distinguish the type of saturated fats, when it is believed that dairy fats and vegetable saturated fats like coconut may not affect cardiovascular risk and may be even beneficial.  I think that the answer is the total diet approach, considering ALL factors in the diet, like intake of fiber, omega 3 fatty acids, antioxidants total calories, etc. I agree with the AHA/ACC in promoting a Mediterranean style diet, encouraging consumption of vegetables and fruits, nuts, legumes, fish and vegetable oils. Lastly, we have to be careful because this reconsideration of saturated fats can be misunderstood with what people want to hear…like eating free amounts of butter, cheese and other sources of saturated fats.  

What do you think?

Check out my chimichurri rub recipe published at Food and Nutrition Magazine and other healthy tailgating recipes: http://www.foodandnutrition.org/May-June-2014/Spicy-Chimichurri-Rub/

May used to be “National Mediterranean Diet month” but what a great idea to make it the “International Mediterranean Diet Month”! This campaign was created in 2009 by Oldways (a nonprofit food and nutrition education organization, known for the introduction of the Med Diet Food Pyramid in the U.S) and the Mediterranean Food Alliance to promote delicious foods and the health benefits of the Mediterranean diet.

 It doesn´t matter where in the world you live, you can always have a Mediterranean way of eating and living. The Med diet came out of the combination of different cultures that lived around the Mediterranean Sea and it remains to be dynamic and vital. In my country, Argentina, because of the massive immigration from Europe during and after the World Wars, we have a huge cultural influence from the Mediterranean.  But, I have to say, it got mixed with the gaucho heritage of beef. Many families gather around to eat pasta one Sunday (very Italian) and “asado” (Argentine barbecue) the other Sunday.  Italians introduced lots of pasta dishes and also the pasta industry in Argentina. From them we also learn how to enjoy food and to take the time to share meals with family.  My dad, who is Italian, taught me how to plant herbs, tomatoes, zucchini and others in the backyard.  The Mediterranean Diet is a valuable piece of cultural heritage that from simplicity and variety has resulted in a complete and balanced combination of foods, known to reduce the risk of chronic diseases. Fresh and local ingredients (like olive oil, legumes, lots of fruits and vegetables, fish, nuts), cooking methods, shared meals, celebrations and moderate physical activity makes this lifestyle one of the healthiest in the world. In my country (as in many others), to eat Mediterranean way we have some work to do… for example, we need to eat more legumes and fish and less red meat.

Check International Mediterranean Diet Month for more information and resources. This year they organized a virtual dinner party: people from around the world can share photos of themselves enjoying Mediterranean dishes at home or at restaurants and win prizes!

To start, here you have the 8 basic tenets of the Mediterranean diet from Olways:

1. Eat lots of vegetables. From a simple plate of sliced fresh tomatoes topped with crumbled feta cheese to healthy pizzas, vegetables are vitally important to the fresh tastes of the Mediterranean Diet.  The recommendation is to fill half your plate with them.

2. Change the way you think about meat. If you eat meat, add small strips of sirloin to a vegetable sauté, or garnish a dish of pasta with diced prosciutto. As a main course, eat 3 ounces or less of chicken or lean meat.

3. Always eat breakfast. Start your day with fiber-rich foods such as fruit and whole grains that can keep you feeling pleasantly full for hours. Layer granola, yogurt, and fruit, or mash half an avocado with a fork and spread it on a slice of whole grain toast.

4. Eat seafood twice a week. Fish such as tuna, herring, salmon, and sardines are rich in heart-healthy omega-3 fatty acids, and shellfish including mussels, oysters, and clams have similar benefits for brain and heart health.

5. Cook a vegetarian meal one night a week. Build these meals around beans, whole grains, and vegetables, and heighten the flavor with fragrant herbs and spices. Now, try two nights per week.

6. Use good fats. Include sources of healthy fats in daily meals, especially extra-virgin olive oil, nuts, peanuts, sunflower seeds, olives, and avocados.

7. Enjoy some dairy products. Eat Greek or plain yogurt, and try small amounts of a variety of cheeses.

8. For dessert, eat fresh fruit. Choose from a wide range of delicious fresh fruits — from fresh figs and oranges to pomegranates, grapes and apples. Save sweets like cookies and ice cream for a special treat.

And here is my Mediterranean recipe (modified from my mom´s recipe):




Spinach and ricota cannelloni (Developed by Romina Barritta Defranchi)

Serves 3

Ingredients:
For the crepes:
1 cup low fat milk
1 egg
½ cup flour
¼ tsp salt
1 teaspoon butter


For the filling:
1 or 2 bunches of fresh spinach (about 1 lb), stemmed and washed
2 cups of low fat ricotta
1 egg
2 tablespoons parmesan cheese
½ teaspoon salt
½ teaspoon pepper
¼ teaspoon fresh grated nutmeg
 
Toping:
1 ½ cup tomato sauce
1/3 cup of grated parmesan cheese


Directions:
Preheat  oven to 400 F
1.       Cook the spinach in boiling water until just wilted. Drain and cool.
2.       Meanwhile make the crepe batter by mixing the low fat milk, egg, flour and salt with a whisk, until smooth.
3.       Heat an 8 inches non-stick pan over medium high heat. Melt the butter in the pan and pour about ¼ cup of batter into the pan with one hand, and with the opposite hand, swirl the pan until the batter coats the bottom of the pan. Cook the crepe until patchy light brown on the bottom, about 20- 30 seconds. Loosen the edges of the crepe, flip it to the other side and cook until golden brown, about 15 seconds. Remove the crepe and keep cooking the rest of the batter.
4.       To make the filling, squeeze up spinach moisture very well and finely chop. Combine spinach with the ricotta, egg, parmesan cheese, salt, pepper and nutmeg.
5.       To assembly, spread half of the tomato sauce on a gratin dish. Spoon some filling (about 2 tablespoons) in the middle of the crepe, roll up and transfer to the gratin dish (do not overlap; cannelloni are baked on a single layer). Ladle the rest of the tomato sauce and sprinkle with the cheese. Bake for about 15 minutes or until bubbling. Let rest a few minutes and serve with extra parmesan cheese and/or sauce if desired. 

The following is a guest post (from my husband´s website medicosmba.com) that I found very interesting for us food and nutrition practitioners. Check it out!

When I think how healthcare has change with Google, the first thought that comes to my mind is how useful searching is for keeping up to date and easily learn new things. Well, Google’s mission is to organize the world’s information and make it universally accessible and useful. However, this is just the beginning: there are lots of things that healthcare should look up into Google’s ways. Let me show you why…

Google has been one of the fastest growing companies in the world. Let’s just mention their some financial data: FY ending 2013 reported revenue for almost USD 60B and a net income of almost 13B. Both revenue and net income have steadily increased in the last few years. What Google has done to achieve this impressive results?

You might be able to resume everything with the first statement of Google’s beliefs: “Focus on the user and all else will follow”. Just think of how many things we do everyday with Google’s services and how almost everything is for free: searching, email, docs, analytics, maps and so on. Also, user experience with each one of these products is great. There are designed to solve some aspect of our everyday life. So, how does Google make any money? Advertising is the answer. It’s kind of making money from the back door. Google reinvented advertising, it charges for performance (what is called pay-per-click) and not any more for time or space.

So, where are the healthcare links here? First, think about this “focus on the user and all else will follow”. Focusing in the patient is the key. It seems so obvious, but how many times we rush with things that so little have to do with our medical practice? Most of us studied medicine to care for patients, right?  So, here’s the first thing: just care about the patient and do what you think is best right thing for him.

Let’s go one step further: data that is accessible and transparent. Google has made it possible for everyone to find almost everything on the web. If a client had a bad experience with a brand, you’ll find it. Healthcare has just begun the journey of opening data up. It is common among doctors to be jealous about our knowledge and more often than not, data is kept and not shared. This is especially true when the results are not good ones: how much common is to hear about the great results of some surgery than about the complications. You can learn much more from the cases that didn’t go that well, than from the straightforward case. Why should we private ourselves from this kind of learning? It’s a fact that many hospitals started to show their data and made it accessible for everyone. However, this doesn’t happen everywhere and some parts of the world are even far from starting with initiatives like this. Why a patient that comes to visit me shouldn’t be aware of how many patients I treated with his condition? Or what my complication rate is?

Lastly, another Google’s statement: “Great just isn’t good enough”. As health care practitioners, its necessary to be great but clearly this is not enough to surpass yourself. And when it comes to do the best for our patients that extra mile always counts.


Guest post from Sebastian Defranchi, MD -  MedicosMBA

In Argentina and many other Latin American countries, Catholicism is the main religion and is very common the avoidance of meats (other than fish) on Holy Friday.  So, based fish dishes such as “Empanadas de vigilia” (vigil empanadas) are very popular at this time of the year. Also “Rosca de Pascua” (a Passover breadroll) is traditional sweet bread originated in Italy with simple ingredients (flour, milk and egg) to compete with the traditional eggs. Chocolate eggs are a must! You can find them in all sizes, colors and filled with a wide variety of candy or mini pieces of chocolate. The tradition of exchanging eggs originated in Europe as eggs are a symbol of fertility in coincidence with Easter occurring during spring. So, Christianity sees eggs as symbol of resurrection. Easter eggs weren’t made from chocolate at first! Now we have chocolate eggs themed with kids favorites cartoons (Mickey Mouse Clubhouse, Hello Kitty, Barbie, etc.) and also personalized eggs. The U.S. traditional Easter egg hunt is uncommon in our country. In Argentina, people (specially kids) exchange decorated chocolate eggs and eat them on Easter Sunday. 

As Holy Thursday and Friday are holiday in our country, many people uses these days for tourism. 

How is Easter celebrated in your area? Do you have any traditional recipe to share?