Janalou Phelan MS, RD, LD

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Dietary Guidelines for Americans 2005

• Janalou Phelan MS, RD, LD
• Presbyterian Hospital of Dallas
• Outpatient Nutrition Clinic
• 4-1-5

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Purpose of Dietary Guidelines

• Updated every five years
• Provide science-based advice to promote health
  and reduce risk for chronic diseases such as CVD,
  DM, HTN, osteoporosis, some cancers
• Geared towards healthcare providers and nutrition
  educators rather than the general public
• Provide recommendations for eating and activity
  to improve health and lower disease risk
• Intended for Americans over two years of age

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The 2005 Updated Guidelines

• Adequate Nutrients within Calorie Needs
• Weight Management
• Physical Activity
• Food Groups to Encourage
• Fats

• Carbohydrates
• Sodium and Potassium
• Alcoholic Beverages
• Food Safety

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Adequate Nutrients within Calorie Needs

• Consume a variety of nutrient-dense foods and
  beverages among the basic food groups, limiting
  SFA, trans fat, cholesterol, added sugar, salt,
  and alcohol.
• Nutrients consumed should come primarily from
  foods which provide an array of nutrients
• Supplements may be useful when there is a
  nutrient gap that cannot be met by food intake
• Meet energy needs by adopting a balanced eating
  pattern via the Food Guide Pyramid or the DASH
  eating plan

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The Food Pyramid
Fats, Oils SweetsUSE SPARINGLY
Milk, Yogurt Cheese Group2-3 SERVINGS
Meat, Poultry, Fish, Dry Beans, Eggs Nuts
Group2-3 SERVINGS
Vegetable Group3-5 SERVINGS
Fruit Group2-4 SERVINGS
Bread, Cereal, Rice Pasta Group6-11 SERVINGS
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Suggestions for Getting Adequate Nutrients within
Calorie Needs

• Eat more dark green vegetables, orange
  vegetables, legumes, fruits, whole grains,
  low-fat milk products
• Eat less refined grains, total fat (especially
  cholesterol, SFA, and trans fat), added sugars,
  calories
• Emphasize lean meats, poultry, fish moderate
  amounts of nuts/seeds non-meat protein (beans,
  soy)
• Specific nutrients of concern calcium,
  potassium, fiber, magnesium, vitamin A, C, E

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Weight Management

• Approximately 2/3 of all Americans are overweight
  and about one third of those are obese (BMIgt30)
• Up to 16 of children/adolescents are overweight
• Even small weight loss (five to 10 of BW) may
  improve health
• Also need to prevent further weight gain
• Lifestyle change in diet and exercise is the best
  approach for wt loss

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Weight Management

• Fad diets are mostly ineffective long term weight
  management
• Calories count more than the proportion of fat,
  carb, and protein
• Moderate calorie reduction of about 500
  calories/day will promote one pound of wt loss
  per week, coupled with regular activity
• Lifestyle change is essential for long term wt
  management

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Physical Activity

• About 25 of Americans do not partake in any
  physical activity
• Increased activity is linked to lower risk of
  chronic disease
• Sedentary lifestyle increases risk for obesity,
  CAD, HTN, DM, osteoporosis, and some cancers

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So How Much Exercise is Enough?

• To reduce risk of chronic disease
• 30 minutes of moderate-intensity activity on most
  days of the week
• To help manage body weight and prevent gradual wt
  gain
• 60 minutes of moderate to vigorous activity on
  most days of the week
• To sustain wt loss for previously
  obese/overweight people
• 60-90 minutes moderate intensity activity daily

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Physical Activity

• Men gt 40 years women gt 50 years who plan a
  vigorous program, or have a chronic disease or
  risk factors, should consult their MD first
• Gradually build up to recommended levels!
• Even getting someone to walk 5-10 minutes a day
  is improvement!
• Cardiovascular, stretching, and resistance
  exercise all important
• Tell patients to go out and play

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What is Moderate Activity?

• Hiking
• Light gardening/yard work
• Dancing
• Golf (walking, carrying clubs)
• Cycling (lt10 mph)
• Walking (3.5 mph)
• Weight lifting light
• Stretching

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What is Vigorous Activity?

• Running/jogging (5 mph)
• Cycling (gt10 mph)
• Swimming (laps)
• Aerobics
• Walking (4.5 mph)
• Heavy yard work (chopping wood)
• Weight lifting vigorous
• Basketball - vigorous

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But I Dont Have Time to Exercise!

• Short bouts are ok (10 minute bouts of moderate
  activity)
• Aim for three to six 10-minute bouts over the day
• Increase activity wherever you go take the
  stairs, park farther from the entrance
• Consider getting a pedometer and build up to
  10,000 steps per day

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Food Groups to Encourage

• Fruits and Vegetables
• Whole Grains
• Low fat/fat free milk or milk products

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Fruits and Vegetables

• 4.5 cups (nine servings) recommended daily
• 2 cups of fruit
• 2.5 cups vegetables
• Variety nutritional insurance
• Colors
• Whole fruits rather than juice

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Whole Grains

• Good source of fiber (along with FV) need 25-40
  g fiber/day
• Three or more ounce-equivalent servings of whole
  grains is recommended per day (or at least half
  of all grains consumed per day)
• May help lower risk of chronic disease and
  promote weight maintenance
• Whole grains cannot be identified by color read
  labels!
• Whole grain should be first ingredient listed on
  label

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Whole GrainsThink Outside the Bread Box

• Whole Oats
• Barley
• Brown rice
• Quinoa
• Whole grain pasta
• Popcorn
• Whole rye
• Aramanth

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Milk and Milk Products

• Recommended intake is 3 cups/day of fat free/low
  fat milk or equivalent milk products
• Supplies calcium Important for bone health
• Lactose intolerance usually up to one cup at a
  time of milk or milk products is tolerated
  yogurt and low fat cheese lower in lactose
• Lactaid milk or pills/drops
• Non-dairy food sources of calcium soy milk,
  leafy greens, sardines, canned salmon with bones,
  tofu (vegetable sources usually less bioavailable)

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Fats

• High intake of saturated fats, trans fats, and
  cholesterol may increase risk of unhealthy blood
  lipid levels
• High fat intake (i.e. gt35 of calories) may
  increase SFA and calorie intake
• Low fat intake (i.e. lt 20 of calories) may lower
  HDL, raise TGs, and make it hard to get adequate
  Vitamin E and essential fatty acids

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Functions of Fat

• Supply essential fatty acids linoleic and
  linolenic acids
• Help absorb fat soluble vitamins A, D, E, K, and
  carotenoids
• Building blocks of cell membranes, help make
  hormones, protects organs
• Energy source

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Recommended Intakes of Fat

• 20-35 of calories with most fat coming from
  unsaturated sources (mono- and polyunsaturated
  fats)
• Consume lt 10 of calories from SFA and less than
  300 mg/day of cholesterol
• Keep trans fatty acids as low as possible (more
  on this later on)

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Saturated Fat Intake

• Calories /day
• 1600
• 2000
• 2200
• 2500
• 2800

• Limit on SFA Intake
• lt18 g
• lt 20 g
• lt 24 g
• lt 25g
• lt 31g

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Saturated Fat Comparison

• Cheese (1oz)
• Regular
• Light
• Ground beef (3 oz)
• Regular (75 lean)
• Extra lean (95 lean)
• Milk (1 cup)
• Whole
• 1
• Bread (one medium)
• Croissant
• Bagel

• 6 g
• 1 g
• 6.1 g
• 2.6 g
• 4.6 g
• 1.5 g
• 6.6 g
• 0.2 g

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So What are the Best Sources of Fat?

• Olive oil
• Canola oil
• Peanut oil
• Nuts especially walnuts and almonds (unsalted)
• Avocados
• Flax meal
• Sunflower seeds (unsalted)
• Peanut Butter
• Reduced Fat margarines
• Fatty fish salmon, trout, herring

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Omega 3 Fats And Trans Fats

• More to come on this later!

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Bread and Pasta Group

• Carbohydrates
• The food group that gets the most press time!
• Carbohydrates are healthful foodsif you choose
  wisely
• Provide main energy source for the body,
  especially the brain, CNS, placenta, and fetus
• Also good source of vitamins, minerals, and
  fiber
• Choose healthful sources
• Should supply 45-60 of calories

• List a few examples of bread and pasta products
  that are plentiful in your area.
• Discuss how many servings a day children should
  eat and when they might have them.
• Together, research and discuss the health
  benefits of bread and pasta.
• Encourage children to list foods that they like
  from this food group.

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What are the Best Sources of Carbs?

• Whole grains bread, cereal, rice, pasta
• Fruits mostly whole fruit rather than juice
• Vegetables
• Low fat milk/yogurt
• Legumes dry beans and peas

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What about Fiber?

• Insoluble does not dissolve in water helps
  with constipation and may help lower risk for
  some cancers
• Soluble dissolves in water helps lower
  cholesterol and regulate blood sugar
• Helps with weight management
• Aim for 25-40 grams/day from FV, beans, whole
  grains

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Is Sugar OK?

• Choose and prepare foods and beverages with
  little added sugars and caloric sweeteners
• Reduce the incidence of dental caries by
  practicing good oral hygiene and consuming sugar
  and starch containing foods and beverages less
  frequently

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Sugar

• Empty calories
• Especially watch intake of sweetened beverages
  which are high in calories 10 tsp sugar in 12
  oz. soda
• Rule of thumb no more than 10 of total
  calories
• Example 2000 calories/day eat no more than
  200 calories of sweets

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Sodium and Potassium

• Most Americans consume more salt than they need
  (only 500 mg/day)
• Excess sodium may increase BP
• Normal BP helps reduce risk for CHD, CVA, CHF,
  and kidney dz
• Lifestyle change can help lower BP, including
  reducing salt intake, increasing potassium
  intake, losing weight, increasing exercise, and
  eating a healthful diet

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What are the Recommendations for Sodium and
Potassium?

• Consume less than 2300 mg of sodium per day
  (about 1 tsp salt)
• Choose and prepare foods with little salt
  consume potassium-rich foods, such as fruits and
  vegetables

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Wheres the Sodium?

• About 10 of sodium is naturally occurring in
  foods
• About 5-10 from the salt shaker or added in
  cooking
• About 75 from food processing
• Typical fast food meal may contain 1400 mg sodium
  before the fries are salted!
• Read food labels!

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Salt Tips

• Buy low or reduced sodium foods
• 140 mg or less is considered a low sodium food
• The taste of salt is a habit. After a couple
  months taste buds will usually adjust to
  preferring less sodium in foods
• Other herbs and seasonings are great to use
  including vinegar and lemon juice
• Be careful of salt substitutes they contain
  potassium but may be harmful for some medical
  conditions consult MD before using these

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Potassium

• A diet rich in potassium may also lower BP
• Recommended intake is 4700 mg/day
• Should come from food sources fruits and
  vegetables

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Alcohol

• About 55 of Americans use alcohol
• May have beneficial effects when consumed in
  moderation
• Lowest all cause mortality and CAD mortality
  occurs at an intake of one to two drinks per day
• Heavy alcohol consumption may increase risk of
  liver cirrhosis, HTN, cancer of the upper GI
  tract, injury, violence, and death
• Morbidity and mortality are highest among those
  who drink large amounts of alcohol

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Recommendations for Alcohol Intake

• Those who choose to drink alcohol should do so
  sensibly and in moderation
• Up to one drink per day for women and two drinks
  per day for men one drink is
• 12 oz. regular beer
• 5 oz. wine
• 1.5 oz. 80-proof distilled spirits

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Recommendations for Alcohol Intake

• Alcohol should not be consumed by those who
  cannot restrict their intake, women of
  childbearing age who may become pregnant,
  pregnant and lactating women, children and
  adolescents, individuals taking medications that
  can interact with alcohol, and those with
  specific medical conditions
• Alcohol should be avoided by individuals engaging
  in activities that require attention, skill, or
  coordination, such as driving or operating
  machinery

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More about Alcohol

• Supplies calories but few essential nutrients
• Heavy drinkers may be at risk of malnutrition if
  alcohol substituted for food
• It is not recommended that anyone begin drinking
  or drink more frequently on the basis of health
  considerations
• Definition of moderation is NOT intended as an
  average over several days but as the amount
  consumed on any single day
• Compared with women who do not drink, women who
  consume one drink per day appear to have a
  slightly higher risk of breast cancer

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Food Safety

• About 76 million people per year in the US become
  ill from pathogens in food and about 5000 of
  these die
• Signs and symptoms of foodborne illness include
  upset stomach, diarrhea, fever, vomiting,
  abdominal cramps, dehydration, and even paralysis
  and meningitis
• The most important food safety problem is
  microbial foodborne illness

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Food Safety Recommendations

• To avoid microbial foodborne illness
• Clean hands, food contact surfaces, and fruits
  and vegetables. Meat and poultry should not be
  washed or rinsed.
• Separate raw, cooked, and ready-to-eat foods
  while shopping, preparing, or storing foods.
• Cook foods to a safe temperature to kill
  microorganisms

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Recommendations for Food Safety

• Chill (refrigerate) perishable food promptly and
  defrost foods properly
• Avoid raw (unpasteurized) milk or any products
  made from unpasteurized milk, raw or partially
  cooked eggs or foods containing raw eggs, raw or
  undercooked meat and poultry, unpasteurized
  juices, and raw sprouts.

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Hand Washing

• Primary way to prevent spread of foodborne
  illness
• Wash hands often especially before and after
  handling raw meat, poultry, eggs, or seafood
• Wet hands, apply soap, rub hands vigorously
  together for 20 seconds, rinse hands thoroughly
  under clean warm water, dry hands completely
  using a clean disposable cloth towel

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Food Safety - Produce

• Remove and discard outer leaves, wash produce
  just before cooking or eating, wash under running
  water, scrub with a clean brush or hands, dry
  using a clean disposable cloth towel
• Ready-to-eat pre-washed bagged produce can be
  used without further washing if kept refrigerated
  and used by the use-by date or it can be
  washed again

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Temperatures

• Bacteria grow most rapidly in the range of
  40-140oF
• Refrigerated leftovers may become unsafe within
  3-4 days
• Despite the appearance of food, It may not be
  safe to eat
• If in doubt, throw it out.

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Temperatures

• Beef steaks, roasts, veal and lamb - 145o (medium
  rare)
• Eggs, pork, ground meats, and meats (medium) -
  160o
• Stuffing, ground poultry, and reheated leftovers
  - 165o
• Poultry breasts - 170o
• Whole poultry - 180o

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Food Safety and High Risk Individuals

• Pregnant women, older adults, and those
  immunocompromised are at risk of developing
  listeriosis, a potentially life-threatening
  bacterial infection
• Some deli meats, hot dogs, and ready-to-eat foods
  should be reheated to steaming hot before eating
• These individuals as well as infants and young
  children should also not drink unpasteurized
  milk, products made from unpasteurized milk (such
  as some soft cheeses), raw or partially cooked
  eggs, raw or undercooked meat/poultry,
  unpasteurized juices, and raw sprouts

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For More Information

• Go to
• www.healthierus.gov/dietaryguidelines