Food &

Nutrition
VOLUME 10, ISSUE 2 MAGAZINE®
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 IN THIS
16 The Placebo Effect:
Beyond the Sugar Pill
While it’s frequently dismissed
and occasionally controversial,
research suggests placebos may be
a worthwhile treatment for certain
conditions, though its application
goes far beyond a simple pill.
DIVERSE PEOPLE ICON©GETTYIMAGES/CIENPIES
19 Hidden from Sight: Nutrition
and Health Consequences of
Loss of Smell
Taste is a huge factor in food
choices, but the enjoyment of eating
is multisensory and includes smell.
Explore what happens when olfaction
is impaired.
issue VOLUME 10, ISSUE 2
22 The Complexities of
Ethical Eating
Learn about the intricate
relationships between people’s
food choices and economic, social
and environmental implications
throughout the food and agriculture
supply chain.
34 Celebrating Global Flavors
Pantry staples come together in
26 Special Series: Diverse Voices
these simple and culturally inspired
Hear from underrepresented
recipes, making you a culinary
individuals in the nutrition and
globetrotter in your own kitchen.
dietetics profession, who are helping
to increase awareness about the
importance of diversity in the field. 38 Spotlight on Seasonings
These healthy kitchen
hacks provide answers to
your flavor enhancement
questions, including which
spices to have on hand at all
times, how to use up unique
spices and more.
32 Food & Nutrition Test Kitchen
Check out the results from our last
Test Kitchen, plus get information
about our latest #FNTestKitchen
contest with a chance to win a
great prize.
 Food &
IN EVERY issue Nutrition MAGAZINE ®

7 Engage 28 Savor Academy President: Linda T. Farr, RDN, CSOWM, LD, FAND

Chief Executive Officer: Patricia Babjak, MLS∙Editor-in-Chief: Doris Acosta

8 Discover 40 Read
Executive Managing Editor: Liz Spittler∙Managing Editor: Lauren Fox
13 Click 41 Lazy Delicious Associate Editors: Mackenzie Allen∙Esther Ellis, MS, RDN, LDN
Sarah Klemm, RDN, CD, LDN∙Jill Kohn, MS, RDN, LDN∙Tom Ryan
14 Research
Contributing Editors: Serena Ball, MS, RD
Zach Breeding, MS, RDN, CSO, LDN, FAND ∙ Marisa Moore, MBA, RDN, LD

15
Deanna Segrave-Daly, RD ∙Jodie Shield, MEd, RD, LDN

8 Production Manager: Carolyn Rand∙Art Director: Ala Ennes

Welcome to Food & Nutrition Magazine®, published five times per year by
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health issues and policy initiatives related to nutrition, and explorations
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Publishing, editorial and Food & Nutrition Magazine®

placement decisions are based (ISSN 2164-618X) April 2021,
on the editors’ judgment of Volume 10, Issue 2. Food & Nutrition

30
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 ON OUR blogs
F O O D A N D N U T R I T I O N . O R G / A B O U T- O U R - G U E S T- B L O G S

Spaghetti Squash Waffle
Grilled Cheese
Julie Harrington, RD
This recipe calls for ingredients you
likely already have in your pantry. If
you want to kick the flavor up a notch,
add other seasonings as you see fit.
( STONE SOUP )
Creamy Broccoli Chicken Soup
Leina Sultan
This creamy broccoli chicken soup recipe
is an absolute delight. It uses minimal
ingredients, so prep is fast, cooking
is easy and the final product is full
of nutrients. ( STUDENT SCOOP )
Orange Chicken Meatballs
Jen Plaggemars, RD
Enjoy these meatballs with cauliflower
rice, brown rice or quinoa. The orange
sauce, made with fresh orange zest
and juice, is the perfect blend of sweet
and salty. ( STONE SOUP )

Quick Vegetarian Ramen Guacamole Peach Mango Smoothie

Tawnie Graham, RDN
Slow simmered broths are the rich
bases of typical ramen recipes, but
there’s nothing slow about this recipe.
Quick vegetarian ramen is so easy
to make and is super comforting.
( STONE SOUP )
Tara Rochford, RDN
I’ve been using this guacamole recipe
for more years than I can count. In my
experience, it is a guaranteed way to
make the absolute best guacamole that
is sure to impress. ( STONE SOUP )
Kim Wisner, RD
This refreshing smoothie is a blast
of vitamin C and fiber. Blend it to a
thin consistency to drink or make it
thick and eat it as a smoothie bowl,
garnished with your favorite toppings.
( STONE SOUP )

VOLUME 10, ISSUE 2 • FoodandNutrition.org 5

 SAFE
RECIPE
STYLEGUIDE
Multiple studies show that when consumers
follow recipes that incorporate basic food
safety instructions, they significantly
increase food safety behaviors. This style
guide provides easy edits to any recipe
to improve food safety practices.
saferecipeguide.org
TEMPERATURE
Cook until internal temperature reaches XX
(fill in the blank and include chart with specific
foods) on food thermometer.
HAND WASHING
Wash hands with soap and water. (Include this
at beginning of recipe and after each touch of
raw meats, poultry, seafood or eggs.)
CROSS CONTAMINATION
Wash (insert cutting board, counter, utensil,
serving plate) after touching raw meats,
poultry, seafood or eggs.
Do not reuse marinades used on raw foods.
Do not rinse raw poultry or meat.
PRODUCE
Gently rub produce under cold running water. 
Scrub firm produce with a clean vegetable
brush under running water.
While use of the wording in recipes should be as
close to the above as possible, the Safe Recipe
Style Guide is intended to be flexible to allow for
use in recipes as needed.
BROUGHT TO YOU BY
About Our Recipes
All recipes that appear as Food & Nutrition Magazine® editorial
content are developed by paid assignment only.
Food & Nutrition Magazine® recipes are developed by Stone
Soup guest bloggers who receive special training in recipe
development. Throughout the year, editors disseminate a
call for original recipe pitches, and submissions are collected
for an internal review through which recipes are selected
for assignment. To learn more about our guest blogs, visit
foodandnutrition.org/About-Our-Guest-Blogs.
Recipe Nutrition Information
Nutrition content of recipes that appear in Food & Nutrition
Magazine® is calculated by a registered dietitian nutritionist.
Due to variations in ingredients and measurements, values
are approximations.
Nutritional values used in our calculations either come from
The Food Processor, Version 11.9 (ESHA Research), USDA
Agricultural Research Service Nutrient Data Laboratory or
food manufacturers.
Rounding Nutrition Information
Because all nutrient calculations are estimates, our numbers
are rounded according to our software program and the FDA's
established rounding rules for product labels, when appropriate.
In addition, nutrient calculation information should always
carry a disclaimer stating that the findings were used along
with the professional judgment of the person who performed
the calculation.
For more information on our recipes including rounding of
values and assumptions, please visit foodandnutrition.org/
Recipe-Nutrition-Information-Analysis-Assumptions.
Food & Nutrition Magazine® recipe developers use Escali®
Arti Glass Digital Food Scales generously supplied by
the manufacturer. Capable of weighing ingredients up
to 15 pounds (7,000 grams) with an accuracy of 1 gram,
the Arti features a crisp and clear display 50 percent
larger than commonly found on a kitchen scale; easy
tare functionality; a handy hold feature for larger
items; automatic shut-off for battery preservation; and
a slim, spill-proof design. Learn more at escali.com/
metallic-arti-glass-kitchen-scale.
 Food &ition Food&ition
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VOLUME 10, ISSUE 2 • FoodandNutrition.org 7

Discover | KITCHEN TOOLS
ELECTRIC
kettles SPILLING THE TEA ON A
TREASURED KITCHEN TOOL
By Zach Breeding, MS, RDN, CSO, LDN, FAND
I
f you love eating ramen or are an avid tea drinker,
an electric kettle can come in handy for boiling
water. Electric kettles have been around since the
late 1800s, with the current design dating to the
early 1920s. Use an electric kettle any time you
need boiled water, including rehydrating dried
mushrooms, par-cooking pasta (for layered dishes),
making instant oatmeal or grits and reconstituting
dehydrated stocks. While prices for these relatively
small kitchen appliances vary, the price point (ranging
from $20 to $100) is not indicative of quality. The benefits
of using an electric kettle rather than boiling water on
the stovetop are numerous: efficiency (taking four to five
minutes to boil one quart of room-temperature water
compared to at least nine minutes), no loud whistling
when the water is ready, near-exact precision and control
of final water temperature on some models, and lower
risk of burning your hands when touching the kettle.
What type is right?
Electric kettles come in stainless-steel, glass and plastic.
When selecting a kettle, one consideration is being able
to see the water fill level. While glass versions are easy to
see into, stainless-steel and plastic versions often use an
external water fill gauge, which sometimes may be difficult
to read. Most types of kettles have an indicator feature,
such as a light or automatic shut-off, for when the water
is ready; not having this indicator can be a big deal.
Some versions have cords, while others run off a
rechargeable battery. There is little difference in the
GLASS KETTLE©GETTYIMAGES/DIDECS
efficiency or precision over the final product (hot water),
but choosing a cordless model allows the user the
freedom to have boiling water in any location such
as a campsite.
 The benefits of using an electric
kettle rather than boiling water on
the stovetop are numerous: efficiency
(taking four to five minutes to boil
one quart of room-temperature water
compared to at least nine minutes).
YELLOW KETTLE©GETTYIMAGES/ULADZIMIR ZUYEU; STAINLESS STEEL KETTLE©GETTYIMAGES/GEBAI; BEIGE KETTLE©GETTYIMAGES/VIKTORIIA OLEINICHENKO; ELECTRIC KETTLE POURING WATER©GETTYIMAGES/LUMENST

Stainless-steel and glass kettles tend to be more popular

because many people do not want their hot water to
come in contact with plastic. In addition, some plastic
kettle users report their hot water tastes different
compared to when they used kettles made of steel or
glass. Some consumers may view plastic kettles as less
likely to break. What is not significantly different between
these versions is price, reliability or quality.
Size matters
Since the size of a kettle has nothing to do with how fast
it can heat water, select a size based on your intended
uses. Choosing a smaller kettle, which may hold about
2 cups, restricts the potential for versatility. However,
smaller kettles are easier to travel with and can be used
for single-cup hot beverages. For a single individual,
a smaller kettle might be perfect.
Larger kettles, which can range from over 1 liter to
60 ounces, allow for greater versatility, such as for
preparing foods, but may be difficult to store, take
up counter space and are less easy to transport. For
cooking or offering hot beverages to groups of people,
a larger kettle is recommended.
Easy, breezy cleaning
Minerals from the water you use can build up in an electric
kettle, so regular cleaning is a must. However, cleaning
frequency ultimately depends on frequency of use. To
clean, refer to the manufacturer’s instructions or use this
method: Combine equal parts distilled white vinegar and
water and add to the kettle. Bring to a boil, turn off heat
and allow the kettle to cool. Dunk a microfiber cloth in
the solution and wipe the outside clean. Use a dish brush
to clean the inside, focusing on hard-to-clean places
to remove excess mineral deposits. Pour out the water
solution and rinse well. Fill the kettle back up with water,
bring to a boil and pour out the water to remove any
traces of vinegar that may alter flavor. Repeat once
or twice to ensure the kettle is ready for your next
beverage or recipe.
Find Zach on our Stone Soup blog and at the-sage.org.
Discover | NE W PRODUCTS

FOOD trends
Discover new food items online and on supermarket shelves.

Featuring fresh Hass avocados, Del Monte® homestyle guacamole

is available in four varieties: classic lime & garlic, mango & lime,
black bean & corn and jalapeño & tomato. The chunky dips are
sold in 8-ounce packages and boxes of four 2-ounce cups.

PBfit® pure peanut powder has no sugar or salt — just roasted peanuts
pressed to remove most of the fat. Two tablespoons contain 70 calories,
2 grams of fat and 9 grams of protein. The brand also offers protein
peanut butter and almond butter spreads with pea protein.

Celebrating tropical Costa Rican Mr Lee’s Pure Foods offers

flavors, Ricante® everything two types of instant congee,
sauces are ideal for marinades, a savory instant rice
dips, salad dressing and more. porridge: original, which is
With no salt or sugar added, vegan, and chicken. Both
the sauces include mango kinds are low in fat and
coco, guanabana chimichurri, sugar, feature Asian-style
pineapple habanero and flavors and include a blend
tamarindo Caribbean jerk. of gluten-free grains.

With no added sugar, additives Full of fiber, omega-3

or preservatives, Amara® organic fats and protein,
smoothie melts come in three Flax4Life® cookies are
varieties: carrot raspberry and certified gluten-free,
mango carrots plant-based dairy-free, nut-free, kosher
yogurt and beets ‘n berries and come in compostable
yogurt. The snacks are ideal packaging. New flavors
for children who can sit up include chocolate chip,
independently and pick up oatmeal raisin, ginger snap,
finger foods to eat. lemon zest, double chocolate
cherry and apple pie.
 Crofter’s Organic®
fruit spreads contain
30 calories per
1 tablespoon serving
and 33% less sugar than
standard preserves.
Premium spreads are
sweetened with Fair Paleovalley pasture-raised turkey sticks contain no artificial nitrates
Trade Certified cane sugar; or nitrites, sugar, gluten, soy or dairy. Original flavor sticks contain
Just Fruit® spreads are 60 calories and 6 grams of protein; cranberry orange sticks contain
sweetened with white 40 calories and 7 grams of protein.
grape juice.

Free from the eight major

Processed in a peanut- food allergens, as well as
free facility, Once Again® sesame and gluten, Without
unsweetened creamy A Trace™ plant-based snacks
tahini with lemon is include two chewy granola
certified organic and bars (strawberry surprise
made with dry roasted and cinnamon swirl), soft
sesame seeds and lemon chocolatey chip cookies and
juice powder. A serving two kinds of power bites
has 6 grams of protein (rad raspberry and apple
and 5 grams of fiber. cinna-monster).

In addition to nondairy almond

milk yogurt cups, India-inspired
Atoria’s Family Bakery brand DAH! offers dairy-based
cauliflower and coconut Lassi slow-cultured yogurt
mini lavash flatbread has drinks in Alphonso mango, field
60 calories, 6 grams of strawberry, wild blueberry,
protein and 4 grams of golden milk and plain flavors
fiber per sheet. Use it to and Dahi, a traditional yogurt
make lower-carbohydrate made with whole or
wraps, pizzas, sandwiches, low-fat milk.
crackers and more.

Free of dairy, eggs and With 96 cherries in

soy, Kakookies® dark every bottle, CHERRiSH
chocolate mint cookie beverages are made
bites are the latest with Montmorency
addition to the brand’s tart cherries and sweet
line of plant-based Bing cherries. Rich
cookies. A serving in vitamins, minerals
of two bites has and antioxidants,
130 calories, 2 grams varieties include cherry
of fiber, 2 grams of chocolate, cherry
protein and 6 grams blueberry, cherry
of added sugars. pomegranate and
original cherry.
KITCHEN finds
Well before the pandemic, my twin daughters were already tasting,
testing and experimenting in the kitchen. When we received the
Microplane Kids Cooking Tools (Glove and Zester) set, I couldn’t
wait for them to try it. The child-safe set comes with a mesh
glove to protect little fingers and hands from the sharp blades of the
petite, slim ergonomic zester. To sum it up, they had a ball working
the zester, resulting in a nice pile of fine, light, grated peelings.
— Lauren O’Connor, MS, RDN
Handcrafted in Japan, the ultra-versatile Shun Classic Master
Utility 6.5” knife combines the nimbleness of a utility knife with
the do-it-all capabilities of a chef’s knife. The blade is slightly longer
and significantly wider, so you can easily accomplish a range of
food preparation tasks while enjoying the ease of use and agility
of a compact knife. There’s extra width at the heel and a slightly
curved belly to enable rocking cuts when mincing herbs and spices.
Overall, it performs beautifully.
— Lauren Harris-Pincus, MS, RDN
Often, I find myself brewing coffee while heating up individual
cups of warm water in the microwave — resulting in everyone
consuming their beverages at different times. I was excited to see
if the Hamilton Beach FlexBrew Trio Coffee Maker could help
my entertaining consistency without cluttering my countertop
— and it delivered. I recommend it to anyone who has limited
counter space, has coffee and tea lovers in the house or doesn’t
like to commit to full pots of hot beverages.
— Anne Elizabeth Cundiff, RD, LD, FAND
Food & Nutrition’s kitchen tool reviews are written by Stone Soup bloggers. Editorial samples were
provided by the manufacturers. Read full reviews at FoodandNutrition.org/Kitchen-Tools.
Cutting boards are essential in the kitchen. I cook often, and I’ve
noticed that I end up replacing my plastic cutting boards every few
months for sanitation purposes or because of wear and tear. The
JK Adams Maple Heritage Dorset Block offers a lifetime warranty
and is made with edge-grain maple, which made me want to check
it out. I really enjoyed using it and especially like the knife slot, how
lightweight it is and how easy it is to clean. I highly recommend it.
— Deidra Nelson, MS, RDN, LDN
While a lot of us have transitioned to working from home and may
have temporarily shelved packed lunches, you may find yourself on
the road and needing snacks or still sending your child to school
with a bagged lunch. The sleek and modern design of the Lékué
Lunchbag To Go makes it trendy to bring a packed lunch. Made of
a soft yet durable and water-resistant material, this bag is lined and
insulated to help keep foods at a proper temperature. It’s a great
lunch bag for teens, college students or any working professional.
— Emily Holdorf, MS, RDN, LDN
Until the pandemic, I had never baked a loaf of real, artisan bread.
The one thing I’ve been missing is a bread baker, so I was thrilled
to review the Emile Henry Artisan Bread Loaf Baker. Beautiful,
sturdy and ceramic, this two-piece bread baker is generously
sized, so it can accommodate a very large loaf, as well as a smaller
KITCHEN COUNTER©GETTYIMAGES/DIDECS
one. While you can bake bread without a ceramic bread baker,
it’s a little tricky to get that perfect crunchy brown crust. This
bread loaf baker does the trick — and so easily.
— Anne Danahy, MS, RDN
Click | APP RE VIE WS
➥ Read the expanded reviews at
FoodandNutrition.org/Nutrition-Apps.
Find contributing editor Marisa Moore, MBA, RDN, LD, on our Stone Soup blog and at marisamoore.com.
Grammatica, 1.2.17
PLATFORM: Apple, Android
SUMMARY: Grammatica is an AI-powered
spelling- and grammar-checking app for
all your devices. Use predictive typing
and a personal dictionary to enhance
your composition, plus automatically
check grammar, punctuation, spelling and tone and get synonym
suggestions. Although Grammatica can help you pull together
a mistake-free sentence, the keyboard can feel intrusive and
raise privacy concerns, as it accesses any text you type such as
emails, text messages and notes. Upgrade to Grammatica Plus
for unlimited usage and no advertisements.
RDN SCORE: 
Tangerine, 3.0.2
PLATFORM: Apple, Android
SUMMARY: Dubbed “your guide to daily
self-care,” Tangerine helps you build
habits, track your mood and journal all
in one place. Define new habits, select
frequency and track your progress with
ease. Turn on notifications for gentle reminders to track habits
and set Siri shortcuts to easily mark when you’ve successfully
completed a task. Use the guided journal prompts for topics
including gratitude, calming anxiety and releasing worry and
anger. The premium version offers unlimited habit tracking and
reminders, statistics and access to all guided journaling options.
RDN SCORE: 
FitOn, 3.6.1
PLATFORM: Apple, Android
SUMMARY: With the FitOn app, access
free exercise videos and personalized
workout plans from any screen. Build a
workout plan from a variety of classes,
including HITT, strength and toning,
kickboxing, dance, yoga, guided meditation and more. Sync
your exercise schedule to your calendar for reminders, maintain
motivation with the live leaderboard and keep track of your
progress. Although you have to upgrade to FitOn PRO for recipes
and meal plans, this app provides high-quality classes to get you
moving anytime, anywhere.
RDN SCORE: 
PicCollage, 7.73.1
PLATFORM: Apple, Android
SUMMARY: Simple, fun and easy to
operate, PicCollage allows you to
use images on your phone to create
greetings and photo grids. Select from
a variety of templates, fonts, colors,
stickers and backgrounds or draw and doodle to customize
content. Share collages on social media with one tap or print
as a physical greeting card. PicCollage is great for anyone who
wants to create unique visuals that stand out. If you’re using
the app for professional purposes, it’s worth upgrading to
remove watermarks and in-app advertising.
RDN SCORE: 
Oatsy, 1.7.8
PLATFORM: Apple, Android
SUMMARY: Track macros, water
consumption and exercise with Oatsy.
Set a goal to lose or gain weight, create
meal plans and access a database of
nearly 1 million foods. Oatsy uses a
traffic light system with some questionable categorizations
that may lead users to think salmon and muffins are equally
nutritious. The app also has grammatical and spelling errors
and rather generic content. While Oatsy is not a top choice, it
could be useful for those who already have nutrition knowledge
and can easily identify what content to take or leave.
RDN SCORE: 
Vixer, 3.5.2
PLATFORM: Apple
SUMMARY: Create slideshows and
movies with the Vixer video editor and
maker. Easily combine and edit clips
to create custom videos with music
or voiceover. Choose from additional
editing features including trim or split, color enhancements,
frames, filters and more. Export videos in the optimized format
for social media platforms including square, story or widescreen
aspect ratio. While the premium version of Vixer offers a fast and
smooth editing experience, there are very limited features in the
free version, so you’ll likely need to upgrade.
RDN SCORE: 
VOLUME 10, ISSUE 2 • FoodandNutrition.org 13
Research | NE W STUDIES

A study published in March in The Journal of Nutrition

followed 3,759 Australian adults over 12 years to observe
if regular dietary nitrate intake was related to better
muscle function and if physical activity played a role.
Dietary intake was assessed through food frequency
questionnaires and physical activity was self-reported.
Muscle function was measured through knee extension
strength, or KES — requiring participants to sit with their
legs at 90 degrees and push up against a resistant strap —
and an 8-foot Timed Up and Go test, where participants
would rise from seated, walk 8 feet and then walk back to
seated. The group with the highest nitrate intake had
better KES and 8-foot-TUG test compared to those with
the lowest intake and better KES results compared
to the group with the second-highest intake, despite
physical activity. The most common source of dietary
nitrate was vegetables, and nitrate intakes of about
90 milligrams a day had the greatest benefits.
More than 90% of schools that served breakfast and
close to 70% of schools serving lunch during the 2014-
2015 school year exceeded the recommended limit of
added sugars specified in the Dietary Guidelines for
Americans (less than 10% total caloric intake), according to
a study published in Nutrients in January. Researchers used
school menu data and 24-hour dietary recalls to calculate
added sugars in school meals and overall dietary intakes.
On average, added sugars made up 17% of the total
calories from breakfast and 11% of total calories at lunch.
Meals served at low-poverty schools (where less than
25% of children qualify for free or reduced lunch), mid-low
poverty schools (25.1% to 50% qualify for free or reduced
lunch) and majority white schools were more likely to
exceed the limit of added sugars compared to high-poverty
schools (more than 75% qualify for free or reduced lunch)
and majority Hispanic schools. The leading source of added
sugars was flavored skim milk for both breakfast and lunch.

Published in Clinical Toxicology in March, a study sought to find

if experimental and prohibited stimulants were present (and
in what quantity) in dietary supplements claiming to contain
deterenol, a stimulant that has never been approved for use in
the United States. After analyzing 35 samples of 17 brands of

SALAD©GETTYIMAGES/A-LESA; SUGAR©GETTYIMAGES/MARGOUILLATPHOTOS
weight-loss and sports supplements, researchers found nine
experimental stimulants — not approved by the U.S. Food
and Drug Administration for oral use — and eight different
combinations of prohibited stimulants — those that are
banned in dietary supplements by the FDA or forbidden by the
World Anti-Doping Agency for sports. The doses of deterenol
ranged from 2.7 milligrams to 17 milligrams per serving and
researchers determined that an individual could consume as
much as 69 milligrams per day if following the recommended
serving sizes on the label. Furthermore, eight brands had more
than one prohibited stimulant — four brands combined two
stimulants, two brands combined three stimulants and two
brands combined four stimulants.
 A retrospective cohort study found that Black participants with
vitamin D levels less than 40 nanograms per milliliter within a
year of being tested for COVID-19 were at greater risk of testing
positive for COVID-19 compared to Black participants with levels
higher than 40 ng/ml. Vitamin D levels less than 20 ng/ml is
considered deficiency. Black participants with vitamin D levels
over 30 ng/ml also saw a decreased risk for COVID-19 as levels
increased. For this study, published in March in JAMA Open Network,
researchers analyzed data for 4,638 participants from a Chicago-
based medical center — 43% white, 49% Black and 8% other races
— who took a COVID-19 test between March 3, 2020, and December
30, 2020. The relationship between vitamin D levels and risk for
COVID-19 were most significant among Black participants. Overall,
vitamin D levels were lower among younger participants, male
participants, Black participants and Hispanic participants.

Using social media, researchers surveyed 133 mothers who breastfed

their infants with immunoglobulin E-mediated food allergies to
determine what advice they received (if any) regarding their diet
during breastfeeding and to determine if any infants had allergic
reactions to breast milk while mothers consumed the foods their child
is allergic to. Results published in March in Annals of Allergy, Asthma &
Immunology showed that 47.4% of respondents were encouraged by
their health care provider to continue breastfeeding without dietary
restrictions, 17.3% were advised to continue breastfeeding but to
avoid eating the foods their child is allergic to, and 28.6% said the Forty-one adults ages 40 to 64 with overweight ate
issue was never addressed. None of the mothers were encouraged either 16 grams (moderate intake) or 32 grams (high
to stop breastfeeding completely, though 30% said they received intake) of protein from lean beef immediately after
conflicting advice. Of the 16 mothers who reported their child resistance training three times a week, plus 15 grams
had allergic reactions to breast milk, none were thought to be (moderate) or 30 grams (high) of protein from beef
highly consistent with an IgE-mediated allergic response according isolate protein powder every night before bed for
to a board-certified allergist. 10 weeks to determine its effects on lean body mass;
heart, renal and glycemic biomarkers; gut microbiota
A prospective, observational study published in March in JAMA
and diet. Participants were not engaged in resistance
Pediatrics observed the amount and duration of tetrahydrocannabinol,
training before the start of the study. Results published
or THC, present in breast milk among 25 women who used
in the American Journal of Physiology-Endocrinology
marijuana while pregnant. Marijuana use was confirmed by a drugs-
and Metabolism in March found no significant
of-abuse assay; each participant expressed intention to breastfeed
differences in lean body mass between the groups and
and was asked to abstain from marijuana use for six weeks. Substance
no differences in clinical biomarkers or diet, except
use patterns and plasma and breast milk samples were provided
SPORT EQUIPMENT©GETTYIMAGES/DIMA_SIDELNIKOV

for fat and added sugar intake. The high protein

multiple times each week. Analysis of the samples showed varying
group saw significant changes in gut microbiota —
patterns of THC concentrations in breast milk, increasing during the
Veillonellaceae, Akkermansia, Eggerthellaceae and
first two weeks, then declining several weeks later — initial median
Ruminococcaceae decreased during the first week,
THC concentrations were 3.2 nanograms per milliliter during the
but were increased by the end of the study (except
first week after birth, 5.5 ng/ml at two weeks and 1.9 ng/ml at
Ruminococcaceae). These beneficial bacteria may
six weeks. Data from the seven women who were able to abstain
decrease with increased protein intake, suggesting
from use for more than five weeks showed the average half-life of
resistance exercise helped to counteract these effects,
THC in breastmilk was 17 days. The estimated time to elimination
but more research is needed.
was greater than six weeks.

VOLUME 10, ISSUE 2 • FoodandNutrition.org 15

 The Placebo Effect:
BEYOND THE
SUGAR PILL
Harnessing the power of placebo.
By Esther L. Ellis, MS, RDN, LDN
A
growing body of research suggests
placebos may aid in the treatment of
certain conditions and it may have
more to do with context than with pills.
And while findings are compelling, it
has some experts questioning the ethics of placebo
treatment.
Defining Placebo and Nocebo
The term placebo in health care dates to at least the late
1700s, when British physician William Cullen used the
word to describe his administration of medications at
a lower dose to patients with incurable disease. Cullen
claimed he did this to please and provide comfort to his
patients. Although there was no cure for their disease, he
knew his patients expected a treatment and offering them
medication provided satisfaction. Cullen employed what
is now considered an “active placebo,” when a real drug is
given at a sub-therapeutic dose.
In 1811, Hooper’s Medical Dictionary defined placebo as
“any medicine adapted more to please than benefit the
patient.” Today, Merriam-Webster defines placebo as “a
usually pharmacologically inert preparation prescribed
more for the mental relief of the patient than for its actual
effect on a disorder.”
While a placebo generates positive effects, a nocebo does
the contrary. According to Merriam-Webster, a nocebo is
“a harmless substance or treatment that when taken by
or administered to a patient is associated with harmful
side effects or worsening of symptoms due to negative
expectations or the psychological condition of the patient.”
16 Food & Nutrition Magazine® • VOLUME 10, ISSUE 2
Beyond a Pill
Talk of placebos may conjure images of sugar pills, but
research suggests a pill isn’t the only thing inducing placebo
effects. The very act of visiting a health care provider may
be a form of placebo. The influence of the patient-provider
relationship on health outcomes is considered “placebo-
rapport,” or the placebo aspect of routine care when no
therapeutic intervention is given. A therapeutic ritual or
treatment, such as taking a pill at the same time each day as
prescribed by a doctor, is considered “placebo-treatment.”
Many studies support the potential of placebo-treatment and
placebo-rapport. One example is a randomized controlled
trial of people with irritable bowel syndrome who were given
acupuncture with dummy needles (placebo-treatment)
MEDICAL PLACEBO PILLS ©GETTYIMAGES/CHRUPKA
and spent varied lengths of time with the practitioner
(placebo-rapport). The group that spent the most time with
the practitioner received a 45-minute initial consultation,
during which the practitioner displayed “a warm, friendly
manner” and employed “active listening (such as repeating
the patient’s words, asking for clarifications); empathy
(such as saying ‘I can understand how difficult IBS must be
for you’); 20 seconds of thoughtful silence while feeling the
pulse or pondering the treatment plan; and communication
 of confidence and positive expectation (‘I have had much
positive experience treating IBS and look forward to
demonstrating that acupuncture is a valuable treatment
in this trial’).” Another group received a five-minute initial
consultation where interaction with the practitioner was
limited, and a third group received no treatment.

After six weeks, the group with the highest level of interaction
with a practitioner saw significantly greater results: a
higher global improvement scale, higher adequate relief of
symptoms, the largest declines in symptom severity score
and the greatest increase in quality of life. The group that
received the five-minute consultation reported better results
(with the exception of quality of life) than the group that
received no treatment at all.

Not only might the length of time spent with a practitioner
impact health outcomes, but some studies suggest
demeanor, words and attitude of a practitioner may have
influence, noting poorer outcomes or nocebo effects in
people whose doctor expressed doubt in a particular
treatment or who had a negative demeanor.
Placebo-rapport also may enhance the efficacy of real drugs,
not only placebos. For instance, one study found that when
a pain medication was administered to patients without
their knowledge, it had no effect. When the medication was
administered again by a clinician with the patient’s knowledge,
the drug was found to be more effective than placebo.
Ethics and Deception
The deception sometimes involved in using placebos —
administering fake medications or providing a fake procedure
without a patient’s knowledge or consent — has some
wondering how ethical placebos in practice might be.
PHYSICIAN WITH PATIENT©GETTYIMAGES/MONKEYBUSINESSIMAGES
The very act of visiting a health care
provider may be a form of placebo.
The influence of the patient-provider
relationship on health outcomes is
considered “placebo-rapport,” or the
placebo aspect of routine care when
no therapeutic intervention is given.
After three weeks, the open-label placebo group saw a
significant reduction in pain and disability related to pain
compared to the group who did not take the placebo
pills. During interviews, some participants explained they
experienced increased pain on a day when they forgot to
take the placebo pills and one participant even said, “it
worked so well that it has to contain something.”
A 2021 systematic review identified 11 studies involving

open-label placebos and found significant positive effects of

But recent studies have shown deception may not need
to be a factor. For instance, a 2016 randomized controlled
study examined the impact of “open-label placebos” —
knowingly taking a placebo — on lower back pain. During
this study, all participants were educated on placebo effects,
including how powerful placebo effects can be, the potential
impact of a positive attitude on inducing placebo effects
and the importance of taking the placebo pills each day.
Half of the participants took placebo pills, which were in a
bottle labeled “placebo pills,” and the other half continued
treatment as usual without taking placebo pills.
open-label placebos when compared to no treatment. The
conditions identified as having positive results from open-
label placebos included seasonal allergies, IBS, chronic back
pain, migraine, fatigue in cancer survivors, attention deficit
hyperactivity disorder, menopause hot flashes and major
depressive disorder.
Placebo Conditions
Placebos target symptoms — not diseases — particularly
subjective or self-perceived symptoms. For example, a
placebo will not cure cancer or shrink a tumor, but it might

A therapeutic ritual or treatment,
such as taking a pill at the same time
each day as prescribed by a doctor, is
considered “placebo-treatment.”
reduce a person’s perceived pain from radiation or nausea
from chemotherapy. In general, placebos are shown to be
most effective for psychological conditions and there are
more studies showing promise for placebos in cases such
as pain management, stress-related insomnia and cancer
treatment side effects.
Mechanisms of Placebo
As research continues to test the possibilities of placebos,
interest on exactly how placebos work is rising. Researchers
believe the answers are in the brain.
To date, research suggests placebos work by activating
specific areas of the brain involving autonomic responses,
or involuntary bodily functions, such as heart rate,
sweating or digestion; neuroendocrine responses, or
fluctuations in hormones controlled by the hypothalamus–
pituitary–hormone systems; and neurotransmitters such
as cannabinoids, dopamine and opioids in the brain.
Awareness of the person receiving the placebo has been
a key factor in studies, showing a significantly reduced
response to medications and placebos when an individual
is unaware of its administration.
18 Food & Nutrition Magazine® • VOLUME 10, ISSUE 2
While many specifics concerning the biological
processes of the placebo effect are still uncertain,
it is evident that psychological factors play a role,
including the beliefs and attitude of the person taking
the placebo in addition to the context in which it is
given, by whom it is given and the attitudes and beliefs
of the administrator.
Implications for RDNs
It may be beneficial for registered dietitian
nutritionists to make note of the influence of placebo-
rapport and attempt to utilize its benefits. Authors
of a 2019 paper provided a framework for employing
placebo-rapport, stating the phenomenon can be broken
down into two key factors: the patient’s or client’s belief
that a practitioner (1) “gets it” and (2) “gets me,” meaning
the practitioner demonstrates knowledge and competency
but also displays genuine care, empathy and engagement.
Competency is further dissected into two factors:
perceived competency as it relates to the specific patient
or client — showing understanding of their family history,
disease and treatment — and competency in general —
the practitioner’s educational background, training and
ability to confidently articulate concepts. The two-factor
breakdown also is true for care and empathy. One factor is
patient- and client-specific — taking interest in the patient’s
or client’s life outside of a health care context, listening to
their stories, understanding their values, practicing active
listening and using their name — and then in general, being
friendly to co-workers, smiling and engaging socially.
RDNs who work with patients or clients to help manage
PHYSICIAN RECOMMEND PILLS©GETTYIMAGES/SARINYAPINNGAM
symptoms, such as those related to IBS or cancer
treatments, may particularly benefit from the concept of
placebo-rapport. By emulating behaviors of practitioners in
placebo effect research, such as active listening, empathy
and communication of confidence — behaviors also
emphasized in motivational interviewing — RDNs can
serve as a positive influence for their patients and clients,
which may ultimately increase the success of their
nutrition therapy and health outcomes.
Esther is an associate editor of Food & Nutrition.
 Hidden from
SIGHT
Nutrition and Health Consequences of Loss of Smell
By Michele Redmond, MS, RDN, FAND
aste is often ranked in consumer surveys as
T the primary reason behind people’s food
choices. However, eating is a multisensory
event that includes physical sensations
experienced in the mouth as well as olfaction, our
sense of smell that translates odors and aromatic
compounds into perceived flavors.
Taste perception (sensing the five taste qualities — salty, sweet,
bitter, umami and sour) and olfaction (estimated to detect more
SMELL CONCEPT ICON ©GETTYIMAGES/BSD555
HEALTHY GREENS©GETTYIMAGES/MERINKA
than a trillion different odors) are a sensory duo. While our
ability to smell plays a dominant role in food enjoyment, quality
of life and nutrition-related health outcomes, smell impairments
are often undiagnosed and have negative health consequences.
Sense of smell begins with orthonasal olfaction, when the nose
detects odors. Upon chewing and swallowing food, odors and
aromatic compounds are sensed via retronasal olfaction in the
nasal cavities, tissues and nerves that send neurological
signals to the olfactory bulb in the brain.
Olfactory Impairment and Prevalence
Sinus infections or inflamed mucus membranes can inhibit or
limit flavor perception without disrupting taste receptors that
perceive taste qualities such as sweet and salty.
The smell disorder hyposmia, meaning a reduced sense of
smell, and parosmia, which causes distorted smells, have
become more prominent as a reported COVID-19 symptom
along with anosmia, the complete loss of smell. Prior estimates
have been obtained through the National Health and Nutrition
Examination Survey, which includes self-reported, subjective
assessments and objective assessments, including tests of
participants’ odor perception and taste function. The 2013-2014
NHANES results indicated that more than 12% of adults 40 and
older had olfactory impairment, of whom 3% had complete loss
of smell or a severely reduced sense of smell.
VOLUME
VOLUME 10, ISSUE 22 •• FoodandNutrition.org
10, ISSUE FoodandNutrition.org 19

THE SMELL AND TASTE IMPAIRMENTS
CAUSED BY COVID-19 RAISED AWARENESS OF
CHEMOSENSORY DISORDERS, WHICH HAVE THE
POTENTIAL TO RESULT IN SIGNIFICANT MENTAL
AND PHYSICAL HEALTH CONSEQUENCES AND
PRESENT AS AN INVISIBLE DISABILITY
Men may experience more smell impairments, potentially
double that of women, and most studies indicate significant
declines in olfactory function with age.
Olfactory impairment is commonly underrepresented when
people self-report or use subjective assessments, rather than
objective assessments. For example, in a systematic review and
meta-analysis of 175,073 people from 10 countries, olfactory
impairment was 9.5% using self-reporting compared to 29%
with objective assessments.
According to Danielle Reed, PhD, associate director of Monell
Chemical Senses Center in Philadelphia, “the prevalence for
COVID-19-related smell loss is [as of March 2021] 46% when
the sense of smell is measured by self-report and 69% when
measured objectively. This estimate is based on 202 studies
done on 151,389 people.”
Quality of Life and Nutrition-related Health
The smell and taste impairments caused by COVID-19 raised
awareness of chemosensory disorders, which have the potential
to result in significant mental and physical health consequences
and present as an invisible disability. “Emotional health and
well-being, socialization and physical conditions may interplay
with chemosensory perceptions and affect what people think,
choose and ultimately eat or drink,” says Jacqueline B. Marcus,
MS, RDN, LDN, FADA, FAND, author of Aging, Nutrition and Taste
(Elsevier, 2019) and founder of TasteOverTime.com.
The olfactory bulb is connected to the limbic system, which
20 Food & Nutrition Magazine® • VOLUME 10, ISSUE 2
is involved in memory, emotion and learning, explaining why
specific odors can evoke emotional responses, influence behavior
and trigger memories of long-forgotten events of childhood
pastimes, family meals and celebrations. People with anosmia
and smell impairments often report feelings of isolation, anger,
apathy and depression and a disconnect from people who
aren’t aware of the impact of loss of smell. Marcus adds that
“this ‘perfect storm’ may result in decreased interest in food
consumption, adequate nutrition or compromised health.
Sometimes isolation may be the turning point.”
Nutrition-related health issues can develop from smell impairment
and, over time, may result in weight changes, malnutrition and
nutrient deficiencies, particularly among elderly populations. The
issue isn’t easily resolved by simply promoting nutrient-rich foods.
“Overall, people who lose their sense of smell may avoid eating
because it is not enjoyable and they may be malnourished or lose
weight,” says Reed. “But some people, especially those with a
partial sense of smell, may overeat to compensate for the loss of
smell, for example, salty chips or sweet ice cream.”
Based on preliminary research, inadequate nutrition can also
lead to further nutrient deficiencies of which minerals zinc,
copper and magnesium as well as vitamins A, E, B12 and D may
cause or exacerbate smell and taste impairments.
Health-related Smell Impairment
Most common: Head trauma, nasal polyps, allergic rhinitis and
upper respiratory infections are leading causes of impaired
olfaction. Respiratory infections from bacteria or viruses often
resolve without serious threats to health; however, COVID-19
increased awareness that sensory changes can signal a potentially
deadly virus and become more predictive of infection than other
common COVID-19 symptoms.
Neurological: Alterations in smell also may be early symptoms
of neurological diseases such as multiple sclerosis, Alzheimer’s
disease and Parkinson’s disease, in which a decline in sense of
smell may signal the condition several years before a diagnosis
MAN HAVING NO APPETITE©GETTYIMAGES/MOTORTION
or primary symptoms develop. Multiple studies indicate 85% to
90% of patients with Alzheimer’s experience smell impairment
and 45% to 96% of those with Parkinson’s disease do as well.
Diabetes: A large meta-analysis indicated olfactory impairment
in people with diabetes was 1.58 times the control group and
associated with both Type 1 and Type 2 diabetes. The impact
of hyperglycemia and diabetic neuropathy on the olfactory
nerve was proposed as a central mechanism of sensory decline.
For adults 40 and older with diabetes, the 2013-2014 NHANES
 data indicated a significant trend in severe anosmia or severe
hyposmia for people on oral and insulin treatment, but no
association was observed between the duration of diabetes and
the prevalence of olfactory dysfunction.
Cancer: Between 70% to 77% of cancer patients experienced
taste alterations during some types of chemotherapy. In a review
of 11 articles, reduced perception of sweet was associated with
malnutrition and undernutrition. However, the impact of cancer
treatment on olfactory function is understudied and studies of
taste alterations of patients mostly rely on self-reports without
pre-treatment chemosensory assessment.
Medications: Half of the top 100 prescription medications
used in 2017 elicited taste or smell complaints or disorders.
In a review of clinical trials, more than 350 medications were
associated with taste alterations and more than 70 with
olfactory effects. The incidence of adverse chemosensory effect
on average was 5% across most medications but ranged as
high as 66% for an insomnia drug; however, researchers noted
limitations of self-reported data. A primary concern expressed in
the research was the impact on reduced medication compliance
for patients experiencing taste and olfactory side effects.
Assessment
Multiple studies mention the limitations of self-reported taste
and olfactory symptoms and risks of undiagnosed patients.
Reed believes smell and taste assessments should be part
of routine clinical care and suggests practitioners “consider
using new quick tests, especially for the sense of smell.”
In 2013, a continuing medical education article in the
American Family Physician journal recognized that patients
don’t often notice or differentiate between losses of smell or
taste and recommended physicians become more familiar
with symptoms, pre-clinical signs of serious conditions and
consider using standardized questionnaires, office-friendly
smell disorder tests and referring to otolaryngologists or
smell and taste centers.
SMELLING ORANGE©GETTYIMAGES/DIMA BERLIN
Marcus suggests that because people may be unaware of
chemosensory changes, nutrition and health professionals can
potentially flag nutrient and health issues by asking unobtrusive
questions about basic perceptions of taste and smell.
Food Preparation and Culinary Nutrition
The sense of smell is an effective warning system for gas leaks,
fire and toxic fumes, yet it fails as a reliable indicator of rotten
foods; the olfactory senses cannot detect pathogenic bacteria.
It’s important to teach people with chemosensory impairment
to store foods properly and notice discoloration and texture
changes in foods.
Chemosensory impairment often reduces appetite and
interest in eating. Experiencing an appetite is key to both food
enjoyment and sufficient intake of calories; however, promoting
ways to build an appetite can be negatively associated with
overeating. “The topic of appetite and weight is touchy,” Marcus
says. “If foods and beverages look good and smell great, people
may eat more, and the reverse may also be the case. Improving
the appearance and texture of food and enhancing aromas
may arouse appetite. But there are so many other factors that
contribute to weight gain, other than the ingestion of tasty and
aromatic foods and beverages.”
Depending on the level and type of chemosensory impairment,
culinary skills that may help increase interest in eating include:
TASTE QUALITIES: Highlight favorite tastes that are perceived.
If sour is sensed and appreciated, create sour marinades,
sauces or dressings.
PHYSICAL SENSATIONS: Create textures based on preferences
such as grain berries for bouncy, al dente texture, crunchy
nuts or crisp vegetables for contrast and pungent spices or
condiments, as desired.
HEIGHTEN FLAVORS: Use salt to enhance natural flavors
or ingredients such as MSG to boost savory, umami
flavors without increasing sodium.
Find Michele on our Stone Soup blog and at thetasteworkshop.com.
Smell Disorder Resources
Want more info? These resources include support options
and practical details for professionals:
• abScent Community Support
• Fifth Sense Community Support
• Monell Center Resources and COVID-19
• National Institutes of Health: NIDCD: Smell Disorders
VOLUME 10, ISSUE 2 • FoodandNutrition.org 21
 THE COMPLEXITIES OF
Ethical Eating Explore some social justice, animal welfare
and environmental stewardship considerations
of food purchasing and production.
By Marissa Thiry, MS, RD
F
or years, the number-one driving factor behind
consumer food choices has been taste. However,
over time, value-driven consumers are weighing
additional considerations, including social justice,
animal welfare and environmental stewardship —
all which influence their food and beverage purchasing habits.
As awareness and action continue to evolve, the idea of “ethical
eating” is becoming increasingly more mainstream.
“Ethical eating” refers to the consideration of the economic,
social and environmental impacts of purchasing or consuming
foods and beverages.
The role of ethics has become increasingly prioritized for both
the food and agriculture industry and the value-driven consumer.
While there have been significant improvements in animal welfare,
social justice and environmental stewardship, further opportunities
exist. Industry and consumers can work together to make
progress toward a more sustainable and ethical supply chain.
22 Food & Nutrition Magazine® • VOLUME 10, ISSUE 2
Social Justice
For many, protecting and supporting workers’ rights is of
utmost importance. Issues such as equal pay, gender equality,
diversity and inclusion, forced labor, child labor and more
are complex considerations.
Labor Practices
Approximately 15% of the food eaten in the United States is grown
or produced internationally. Many commodities including coffee,
bananas, chocolate and avocados — native to regions in Mexico,
Central America and South America — are imported to the U.S. in
large quantities. Seafood eaten in the U.S. is primarily imported
from China, Thailand, Canada, Indonesia, Vietnam and Ecuador.
While importing foods can support international relations and
help bring steady income to small farmers and growers overseas,
it also means that some relevant regulation often falls outside
of U.S. jurisdiction. Challenges associated with imported foods
include less-robust labor standards and enforcement than what
is generally found in the U.S. Violence, forced labor and extortion
have been observed, as individuals and groups compete for
commodities and their associated profits.
For example, the seafood industry has been under scrutiny
for human rights abuse in the supply chain, primarily driven COFFEE CROP©GETTYIMAGES/ELPIDIO COSTA JUNIOR
by the presence of forced labor. According to a 2018 report
from the USDA’s Foreign Agricultural Service, “Thailand has
been listed as a country with prevailing problem of human
trafficking and illegal, unregulated, and unreported fishing (IUU).”
Pressure from other countries, including the United States, has
limited some of their fishing activity and measures, along with
increased awareness of IUU in Asia-Pacific countries, have been
implemented by agencies in conjunction with the Food and
Agriculture Organization of the United Nations.

For U.S. companies that source seafood from international locations,
transparency throughout the entire supply chain can be a challenge,
in part because many ships and vessels rely on third parties for
labor recruitment. In many regions, these third-party agencies
may be unregulated, and minimal monitoring and documentation
may be required for the agencies and recruited employees. This
limits transparency into labor and recruitment practices like
worker’s contracts, compensation structure and working hours.
Many recruited employees are migrants from other regions and
are vulnerable to exploitation through poor wages and working
conditions, for example. In some instances, human trafficking has
been observed. In other instances, employees enter into work
voluntarily and circumstances evolve into a forced labor situation.
Activists have called for policy reform to protect workers’ rights and
increase transparency throughout the supply chain. Efforts have
included the adoption of an international treaty, observance of the
“International Day for the Fight against IUU Fishing” (June 5), and a
joint statement by the FAO, International Labour Organization and
the International Organization for Migration. Additionally, Thailand’s
government has committed to complying with IUU regulations
and established a fishery monitoring and surveillance system,
including framework to prevent the exploitation of labor.
Other examples are coffee and cocoa used to make chocolate:
Some have a robust Fairtrade certification system in place,
while others do not. Buying Fairtrade means the product meets
environmental, economic and social standards that support and
protect farmers and their communities from injustices, such as
unfair wages, while also protecting the environment. However,
these standards are not without criticisms. Arguments against
Fairtrade certifications contend that certification results in uneven
economic advantages for coffee growers, for example, and lower-
RAW COFFEE©GETTYIMAGES/ARTRACHEN01
quality products for consumers. Alternatively, some experts think
developing a Fairtrade certification system for other commodities
may help protect farmers and growers, but the development of
such a system would require significant time and resources.
Equity, Diversity and Inclusion
Equity, diversity and inclusion are key priorities in the food supply
chain for companies, consumers and legislators. In 2020, as
social justice issues in the United States came to the forefront
of national news, the COVID-19 pandemic caused hunger and
food insecurity to skyrocket, particularly in Black and Latino
households. Many companies introduced programs to support
a diverse, equitable and inclusive workplace for all people.
These efforts do not go unnoticed, as consumers seek purpose-
driven companies and products and make purchasing decisions
aligned with their beliefs and values. In January 2021, the Biden
administration implemented policies to address hunger and food
insecurity in the U.S. that focus on a more equitable, diverse and
inclusive food supply chain in the future.
Animal Welfare
Humane Treatment of Animals
Many stakeholders — government entities, commodity groups,
third-party certifying bodies, special interest groups and others — set
standards for the humane treatment of animals in the food supply
chain, including those intended for food production and labor.
The Five Freedoms of Animal Welfare, originally developed by the
U.K. Farm Animal Welfare Committee (now the Animal Welfare
Committee), is a globally accepted framework for standard
of care used for animals raised for food production. This
framework is often used as a baseline for commodities including
poultry, cattle and more; commodity-specific standards are then
added to this framework, as appropriate.
Despite regulations and documentation standards for using animal
raising claims on meat and poultry products, claims and labels
associated with animal welfare standards can lead to consumer
confusion. For example, a host of claims designate the degree
of freedom a hen experienced before laying eggs. Claims on an
egg carton include cage-free, free-range and pastured. For U.S.
Department of Agriculture-graded eggs, “cage-free” indicates,
among other criteria, that the hen was able to walk around the hen
house before laying the egg. “Free-range” signifies the eggs come
from cage-free hens that were allowed outside (sometimes in a
fenced-in space). “Pastured” or “pasture-raised,” while not defined
by the USDA, typically means eggs come from hens that had the
ability to roam free on natural pastures. The term “pastured” eggs
may sound like the most humane and ethical treatment, but more
freedom means exposure to outside elements, sources of infection
and violent interactions with other hens.
Antibiotics
Use of antibiotics in animals that are raised for food is a topic of
growing interest, including concern for the humane treatment of
animals and implications on human health after eating animals
that were treated with antibiotics.
VOLUME 10, ISSUE 2 • FoodandNutrition.org 23
Antibiotics are used to treat sick animals as needed. By the time
of slaughter, antibiotics have left the animal’s system, meaning
it is technically “free of antibiotics.” The use of antibiotics in
food production in the U.S. is monitored by the Food and Drug
Administration to ensure humane and ethical treatment of animals.
Concern arises if the animal develops a level of resistance to
antibiotics, especially daily use or mass fed antibiotics. That
resistance can be transferred to humans through animal food
products, as well as run-off into soil, water, crops and other
elements. If a person needs the same antibiotic for their own
health, they may have resistant bacteria. Many food organizations
have adopted policies and commitments that include
veterinarians’ oversight of antibiotic distribution and reducing or
eliminating the use of antibiotics in animals that are important to
human medicine, as outlined by the World Health Organization.
Environmental Stewardship
Climate change and deforestation are two key factors in
environmental sustainability or stewardship. Climate change
refers to long-term changes to Earth’s usual weather patterns,
while deforestation refers to the loss or reduction of forest land
for production across several industries. Deforestation has
a compounding effect because it also contributes to climate
change by reducing forest land that would otherwise keep
excess carbon out of the atmosphere.
Efforts to combat climate change and deforestation and promote
good forest stewardship focus on priority supply chains for
products including palm oil, soy, beef and paper, to name a few.
Palm Oil
Palm oil is the world’s most common vegetable oil, naturally
trans-fat free and extremely versatile in both the food system and
other industries including cosmetics and biofuels. But its effect
on the food system is complicated and largely misunderstood.
Because palm is a tropical crop grown in specific conditions,
sourcing is limited to designated regions near the equator.
As demand for palm oil continues to rise, especially after the
FDA determined in 2015 that artificial trans fats (partially
hydrogenated oils) were no longer “Generally Recognized as
Safe,” clearing land for production has resulted in destruction of
habitats for endangered species such as orangutans, as well as
loss of biodiversity.
The production of palm oil is more efficient than soybean oil, its
closest alternative, requiring significantly less land to produce the
same yield. Additionally, palm oil is an important part of emerging
economies and the livelihood of small farmers. When considering
factors like cost, versatility, nutrition profile, land use and small
farmer support, there is not a clear ethical alternative to palm oil.
Instead of replacing palm oil entirely, an alternative approach
is to improve its sustainability. The Roundtable for Sustainable
Palm Oil, or RSPO, is a nonprofit focused on developing and
implementing sustainable palm oil practices globally. Different
levels of RSPO-certified palm indicate the degree of environmental
and social sustainability of the products. According to RSPO,
purchasing products made with sustainable palm oil is an ethical
solution that can help support smallholder farmers and encourage
more organizations to improve the sustainability of their supply.
Soy
Like palm, soy is a common ingredient throughout the world. In
fact, soy is the globe’s primary source of protein. It also is rich
in essential amino acids, making it an accessible and useful
ingredient. In addition to cooking, soy is widely used as feed
for livestock that later becomes human food.
While U.S.-grown soybeans are certified sustainable, soy has
been associated with deforestation in certain regions of the
world. Significant amounts of natural resources such as water
must be used in soy production. Efforts to improve supply
OIL PALM PLANTATION©GETTYIMAGES/PIGPHOTO
include developing sustainable production practices and
encouraging biodiversity.
Beef
Because cattle expel methane both from their mouth and as
flatulence, greenhouse gases in livestock food production
continue to be a key priority in sustainability efforts. However,
significant improvements have been made to reduce the
environmental impact of cattle. Advancements in production

methods and technology have led to decreased food waste and
increased efficiencies that mean fewer cattle can produce a
greater volume of food.
While beef may be part of a largely sustainable supply chain
in the U.S., that is not the case elsewhere. In Brazil and other
regions where forests are converted to pastures to raise cattle
for slaughter, tropical deforestation has been tied to beef.
Plant-based Options
According to the 2020 Food and Health Survey by the International
Food Information Council, there has been an increase in
consumption of protein from plant sources and plant-based meat
and dairy alternatives over the past year. This trend may be due,
at least in part, to people trying to reduce their carbon footprint.
This is a heavily debated topic, with some arguing that a plant-
based lifestyle is the best approach for the planet; others advocate
for a lifestyle that incorporates both plant-based options and
sustainably sourced animal-based foods.
Paper
Paper-based packaging is common in the food industry. Yet,
as more restaurants transitioned to off-premise dining due to
COVID-19, packaging use increased in importance.
Paper can have a direct impact on deforestation if forests are
not responsibly managed. Recycling is another key component
to ensure a sustainable and ethical paper supply chain.
What the Food and Agriculture Industry Is Doing
Making Improvements. Restaurants and retailers are identifying
animal welfare, environmental stewardship and human justice
opportunities and are making improvements. They are working
COWS GRAZING©GETTYIMAGES/JACQUELINE NIX
with suppliers, activist groups and other third-party experts
to understand the intricacies of ethical eating from all angles
and make the most responsible choice. Companies are making
commitments and setting science-based targets, or SBTs, to
reduce or eliminate their contribution to deforestation by shifting
sourcing or adopting more sustainable practices. The USDA
encourages and supports activities through its Sustainable
Agriculture Program.
Being Transparent. Transparency is a key factor at the
intersection of food and ethics. Companies are sharing lifecycle
assessments, traceability reports and scorecards completed
by third-party organizations that rate how they are doing on
some of these important matters. Through corporate citizenship
reports, large chains and small independent companies are
describing how they are tracking and making progress. Corporate
citizenship reports typically are available online for the public.
What You Can Do
Educate yourself for your patients or clients. Food choices are
personal, as are the values driving those choices. When working
with patients or clients who are interested in discussing economic,
social and environmental considerations for food choices, it can
be helpful to have a base knowledge of these concepts. Resources
may include available information from restaurants and brands,
including lifecycle assessments and corporate citizenship
reports; third-party standards and scorecards that evaluate
brand progress; information from the Academy of Nutrition and
Dietetics, including the “Revised 2020 Standards of Professional
Performance for Registered Dietitian Nutritionists (Competent,
Proficient, and Expert) in Sustainable, Resilient, and Healthy Food
and Water Systems” and the robust list of Diversity and Inclusion
resources; and resources from the Academy Foundation, such
as the “Future of Food” initiative. If your patients and clients ask
for information, provide credible resources to help them make
informed decisions that work for them.
As a buyer, advocate for your values with your purchasing
power. Not everyone has the same level of access to a variety
of foods, particularly where selection is limited. Advocate for
equity and the development of policies that support access to
nutritious foods for all communities. Your personal advocacy
might include buying products that align with your values and
promote biodiversity; supporting less-familiar markets; or
seeking out other varieties of foods to help keep unique, lesser-
known varieties alive and support small farmers in various
regions. If your local market does not carry specific foods
you’re seeking, consider requesting it either in person or online
through the “contact us” page of the grocer’s website.
This is an overview of ethical eating, but it isn’t all-inclusive.
We want to hear from you! What value-driven considerations
contribute to your food choices? Tell us on social media using
#foodnutrimag or email us at foodandnutrition@eatright.org.
Marissa is a registered dietitian at Taco Bell Corp. in Irvine, Calif.
She is part of the Global Nutrition & Sustainability Team that, among
other responsibilities, leads better-for-you menu innovation
and sustainability initiatives for the organization.
VOLUME 10, ISSUE 2 • FoodandNutrition.org 25
Special Series
Diverse Voices
IN DIETETICS
Food & Nutrition aims to
amplify the voices of
people of color and
other underrepresented
individuals in nutrition
and dietetics and highlight
the experiences of RDNs,
NDTRs, dietetic interns
and nutrition and
dietetics students.
26 Food & Nutrition Magazine® • VOLUME 10, ISSUE 2
Su-Nui Escobar, DCN, RDN, FAND
I am a first-generation Latina dietitian, and my ethnicity has provided
extraordinary opportunities. In terms of struggles, I have faced some of
the same issues many others in my culture have faced. I only have my
sister living near me; thus child care is difficult, especially if there is an
unexpected change in my schedule. Financial struggles are frequent in my
culture, as there is often less family support available. If my parents lived
here, since they are both professionals, they could have helped me more
financially during my undergraduate program and my internship. This is
why I believe it is important to provide minority students and interns with
more scholarship opportunities.
It was also lucky that I decided to take a year off and work with a cruise
line between completing my bachelor’s and starting my master’s
degree. Otherwise, I believe I would not have had enough previous work
experience to qualify for my internship, since I was only able to work on
campus during my undergraduate years.
I believe there are many individuals with the
extraordinary potential to be a great RDN, but
who may not have all the qualifications to
be competitive in the internship application
process, which may be due in part to an
inability to work off campus during their
undergraduate studies. It also is very likely that
many individuals do not apply to an internship
because paying thousands of dollars in tuition,
in addition to working an unpaid internship,
is simply not feasible for some Black and
Hispanic individuals and other minorities.

Juliana Tamayo
Applying to schools when you are disabled and a
minority is no easy task. I needed a school that
understood my limitations. For instance, I may need
emergency surgery due to a bowel obstruction or a
feeding tube mishap.
I was lucky to find Kansas State University and its master
of science and didactic program in dietetics distance
program. I also had the fortune of finding mentors along
the way who understood me. I owe much of my academic
successes to Linda Yarrow, PhD, RD, LD, CDE, who
encourages and guides me in the right direction.
The problem is how hard it was to find this program.
Once I did, I still had to make space for myself. Most of
my classmates are white and able-bodied. Why aren’t
there more disabled students? What about disabled
racial minority students? I think this might happen because
there aren’t systems in place to help us find these schools.
It took me months of searching. I lost money in applications
and hours of talking to advisors. I found a school that
worked for me, but not everyone has that luxury.
Being disabled and Latinx is hard, but it should not stop
me from becoming a registered dietitian nutritionist. So,
what can we do? I suggest that we first think of what is
missing in our schools. Are there resources for minority
groups? Are there student organizations minority students
can talk to? Begin by questioning those in charge and
they will have no other choice but to hear you.
Academy Resources
What Is Race? Part 1 and Part 2
Unpack the concept of race by exploring how we as
individuals, as health care providers and as a society
define race. This webinar mini-series by the Women’s
Health dietetic practice group seeks to instill a deeper
knowledge of the complexities of race, so participants
can begin to understand how it impacts care and
health outcomes.
Growing Together: Diversifying Dietetics
through Mentoring
Planned with the Cultures of Gender and Age member
interest group, this FNCE® 2019 session explains the
role of mentoring and how it can be a useful tool
for encouraging professional advancement and
contributing to the recruitment and retention of
practitioners from diverse backgrounds and cultures.
Participate in action planning and learn from case
study examples.
Beyond the World Foods Course: Diversifying
Educational Spaces in Dietetics
Increased diversity is imperative to the success of
nutrition and dietetics students, practitioners and the
profession overall. Watch this FNCE® 2020 session to
learn more. Educators and preceptors will get resources
to help develop strategies to meet ACEND standards
and encourage diversity within their programs.
Join a Member Interest Group!
When renewing your Academy membership, consider
joining a member interest group. MIGs connect
members with similar characteristics and beliefs.
Unlike dietetic practice groups, MIGs focus on areas
other than the practice of dietetics or geographic
location. Examples include National Organization
of Blacks in Dietetics and Nutrition, Asian Americans
and Pacific Islanders and Religion.
Read the full posts at FoodandNutrition.org/DiverseVoices.
Interested in sharing your story? Contact us at
StoneSoup@eatright.org.
VOLUME 10, ISSUE 2 • FoodandNutrition.org 27
Savor | CELEBR ATE FOOD

iceberg
lettuce
LIGHT AND
CRISP WITH
A SATISFYING
CRUNCH

By Bethany Oxender, MS, RD, CSOWM

Photography by David Raine
Food styling by Breana Moeller
Prop styling by Michelle Wilkinson
 ceberg lettuce: the heart of
I
salad. Often overshadowed
and rarely undressed, iceberg
boasts a meek and mild taste
that, when creatively paired
with key ingredients, elevates a meal
and proves to be anything but bland.
Also known as crisphead, iceberg is a
type of head lettuce and has been rated
the fifth-most consumed vegetable in
the United States. Developed in 1894
by horticulturists at the Burpee Seed
Company, iceberg lettuce experienced
a rise in popularity in the 1940s. A
clue to the reason: its name. Before
refrigeration was common, lettuce’s
notoriously short shelf life made
commercial production a challenge. But
iceberg’s durability was advantageous
for travel. Before refrigerated train cars
existed, the vegetable was carefully
packed in ice that melted during
transport. Frozen chunks of ice, tiny
“icebergs,” kept it fresh.
The leaves of iceberg are arranged in
dense rosettes, similar to cabbage, and
have a neutral, watery flavor. Mature
iceberg leaves can grow to be a foot
in diameter. The green exterior gradually
lightens toward the center, transitioning
from green to pale yellow to nearly white.
Lettuce has a shallow root system, so
successful cultivation requires light,
frequent watering. Heat puts lettuce
at risk of bolting, or rapidly producing
flowers and seeds while abandoning
leaf growth. Best growing temperatures
are 60 to 70 degrees Fahrenheit, making
spring or autumn ideal in most climates.
In the Kitchen: A bed of iceberg is a
blank slate, ready to deliver a desirable
crunch. For textural variety, mix iceberg
with softer cultivars like loose-leaf or
butterhead, or with greens such as
spinach or arugula for a peppery bite.
The iconic wedge salad — quartered
iceberg topped with blue cheese, bacon
bits and diced tomatoes — remains
a chophouse staple, turning humble
lettuce into decadence. Honor the
original salad by focusing on quality
ingredients or reinvent it with salty
upgrades like sardines or capers.
Iceberg lettuce can be cooked, too. Sauté
chopped lettuce leaves with garlic, soy
sauce or vinegar. Lettuce cooks fast, so
keep a close eye on the pan. Iceberg
is done when it’s wilted with a slight
crunch. Grilling or roasting in the oven
unleashes caramel notes. If sliced into
wedges, iceberg’s fibrous leaves will hold
their shape. The result is soft and charred
on the outside with a crisp interior.
In the Clinic: The notion that iceberg
lettuce lacks nutrition is false. Darker
greens may pack a greater nutrient
punch, but 2 cups of shredded iceberg
is an excellent source of vitamin K and a
good source of folate. At 96% water and
only 10 calories per cup, iceberg adds
satiating bulk to a meal, and its delicate
flavor serves as a gateway vegetable for
selective eaters.
Like parsley, celery and chamomile,
iceberg lettuce contains apigenin, a
flavone touted for its potential health-
promoting, disease-preventing benefits.
In Quantity: To extend shelf life,
iceberg lettuce should be harvested
whole, minimally processed and swiftly
transported. For foodservice, cases of
24 heads of iceberg lettuce and cartons
of 12, 18 and 30 heads are sold by
some wholesale retailers.
Freshly shredded iceberg
lettuce is sold in packs of five-pound
bags. Lettuce is temperature-sensitive
and best stored between 32 to 35 degrees
Fahrenheit. To maintain color and prevent
wilting, store iceberg lettuce away from
high ethylene-emitting produce such as
apples, melons and pears.
Once you get it home, refrigerate iceberg
immediately. Whole heads can be
wrapped in a paper towel, then stored
in a plastic bag for one to two weeks.
Individual leaves should be dried,
bagged and placed in a crisper drawer,
if available. Unopen bagged lettuce
lasts three to five days after the date
on the bag; after opening, lettuce lasts
about two days. Avoid freezing iceberg
lettuce, as ice crystals may form due to
the high water content, resulting in a
slimy texture when thawed.
Lettuce is a vehicle for foodborne
pathogens, particularly norovirus, E. coli
and salmonella, making proper handling
essential. Wash hands with soap and
water before and after handling lettuce.
Rinse lettuce under running water while
using clean hands to gently rub the
leaves. Do not soak lettuce in a sink
where germs can pool. With care,
millions of servings are safely eaten
every day.
Find Bethany on our Stone Soup blog
and at bethanygrey.com.
GARLICKY GRILLED LETTUCE Add bacon to medium skillet over medium heat. Cook 3 minutes
WITH TAHINI DRESSING per side until bacon is crisp. Place bacon on a paper towel-lined
Developed by Deidra Nelson, MS, RDN, LDN plate and set aside.
SERVINGS: 4 To prepare dressing, combine tahini, 1 tablespoon minced
SERVING SIZE: 1 wedge (168 grams), 1 tablespoon dressing garlic, 1 tablespoon olive oil, honey, lemon juice, 2 tablespoons
(18 grams), plus bacon crumbles and red onion garnish (14 grams)
PREP TIME: 10 minutes
water and sea salt in a small bowl or jar. Whisk to combine
COOKING TIME: 15 minutes and refrigerate.

163 grams 3 slices thick-cut bacon To a small bowl, add 3 tablespoons olive oil and 1 tablespoon
garlic. Set aside. Rinse lettuce and pat dry with a clean towel.
31 grams 2 tablespoons tahini
Cut lettuce head through the core into four equally sized
13 grams 2 tablespoons minced garlic, divided wedges, then remove outermost leaves.
49 grams 4 tablespoons (49 milliliters) olive oil, divided
Preheat grill to 400°F (204°C). Brush lettuce wedges with olive
17 grams 2 teaspoons (17 milliliters) honey oil and garlic mixture. Place lettuce cut side down and grill for
9 grams 2 teaspoons (9 milliliters) lemon juice 2 to 3 minutes, then turn lettuce to grill the other cut side for
2 to 3 minutes. Remove from grill and serve each wedge with
2 grams ¼ teaspoon sea salt
1 tablespoon tahini dressing, and equal amounts crumbled
38 grams ¼ cup red onion, diced bacon and chopped red onions.
748 grams 1 head iceberg lettuce
Find Deidra on our Stone Soup blog and at dnelsonnutrition.com.

NUTRITION PER SERVING:

370 calories, 33g total fat, 8g saturated fat, 27mg cholesterol,
458mg sodium, 13g carbohydrate, 3g fiber, 8g sugar, 8g protein,
397mg potassium, 163mg phosphorus

A spin on the traditional wedge salad,

grilled lettuce is paired with a garlic
tahini dressing and topped with
bacon and onions.
BRAISED LETTUCE WITH BEANS Heat oil in a large high-sided skillet over
Developed by Abbie Gellman, MS, RD, CDN medium heat. Add shallot and sauté until
light golden brown, approximately 2 to
SERVINGS: 4
SERVING SIZE: ¼ head of lettuce, plus 3 minutes. Add lettuce cut side down and
⅓ cup beans with liquid (318 grams) allow to brown undisturbed for 5 minutes.
PREP TIME: 15 minutes
COOKING TIME: 25 minutes Turn the lettuce onto the second cut side
and add broth, beans, salt and pepper.
19 grams 2 tablespoons (30 milliliters) Increase heat to medium-high and bring
extra-virgin olive oil to a boil. Immediately cover, decrease heat
80 grams 1 shallot, thinly sliced to low and simmer for 15 minutes. Add lemon
735 grams 1 head iceberg lettuce, washed juice and mix carefully. Garnish with parsley.
and quartered Cooking note: Serve with crusty bread to
167 grams ⅔ cup (250 milliliters) unsalted soak up the broth.
vegetable broth
287 grams 1 15.5-ounce can cannellini beans, Find Abbie on our Stone Soup blog and at
drained and rinsed chefabbiegellman.com.
7 grams ½ teaspoon kosher salt NUTRITION PER SERVING:
2 grams ¼ teaspoon ground black pepper 142 calories, 5g total fat, 1g saturated fat,
0mg cholesterol, 417mg sodium, 19g carbohydrate,
10 grams 1 tablespoon (10 milliliters) lemon juice 6g fiber, 6g sugar, 6g protein, NA potassium,
NA phosphorus
7 grams ¼ cup fresh parsley, chopped

Iceberg lettuce is braised in vegetable stock and

paired with beans to create a plant-based meal.
 Food & Nutrition
TEST KITCHEN
Our featured Test Kitchen recipe for S’mores Cookies in Volume 10, Issue 1 proved
to be the ultimate snack or dessert! We love how you tweaked the ingredients to make
it your own: peanut, almond or sunflower butter instead of tahini; maple syrup in place
of honey; a combination of buckwheat and almond flour; and the addition of cinnamon
for extra toasty flavor. You also made it fit your dietary needs, making it gluten-free
or vegan and even adding some protein powder for extra nutrients!
Congratulations to Julie Orth, who won the sweepstake drawing
for a nomadiQ Portable Propane Gas Grill!

Photo submissions (from top row, left to right): Christy Quirk, MS, RD, LDN; Jessie Furman, MS, RDN, LDN; Sara Clauto, MSFN, RD, LDN;
Rachel Mariano, RD; Stephanie McBurnett, RD; Julie Orth, MS, RDN, CSP; KeyVion Miller, RDN;
Leah Walton, MPH, RD; Pamela Stofberg, RD; Danni Green, DTR.
 PR
OM
OT
#FNTestKitchen

I
ON
NEXT RECIPE
Bright, fresh green herbs awaken the senses!
Our featured Test Kitchen recipe is Arugula
Pesto, developed by Jill Melton, MS, RD. Almost
any herb or leafy green can be tossed into pesto,
including kale, basil, parsley, cilantro and
arugula. Customize it to suit your preferences
and ingredients you have on hand.
Dollop pesto onto hot pasta, chicken chili, beans,
turkey roll-ups or inside stuffed shells. Use it
as a dip for crudité and pita chips, a spread on
sandwiches or however you like!
On social media, share pics of your pesto on its
own or added to a meal or snack (an element on
a charcuterie board, perhaps?) with the hashtag
#FNTestKitchen.

How to Participate
1 Make the featured recipe.
Submit feedback and photos via Photo by Tyllie Barbosa
2 FoodandNutrition.org/TestKitchen.
Arugula Pesto Directions:
3 Enter by May 28 for a chance
to win a prize! Developed by Jill Melton, MS, RD Place garlic cloves in a
Serves: 20 food processor and pulse
Serving Size: 1 tablespoon
until finely chopped.
Ingredients:
Add nuts and pulse. Add
2 garlic cloves arugula and process until
½ cup toasted walnuts finely chopped.
or pine nuts
With machine still running,
4 cups packed arugula slowly add olive oil and
leaves water until a paste forms.
¼ cup extra-virgin Stir in cheese and salt.
olive oil
¼ cup water NUTRITION PER SERVING:
YOU COULD WIN! Great for indoor and year-round gardening,
57 calories; 5g fat;
the Véritable® SMART Garden ($249 value) automatically 2 ounces finely grated
adjusts the LED light’s intensity to distribute the right 1g saturated fat; 2mg cholesterol;
amount of light to plants. Grow aromatic herbs, edible Parmigiano-Reggiano
69mg sodium; 1g carbohydrate;
flowers and baby vegetables with little effort: Plug in the cheese
adapter, fill the water reservoir, insert Lingots® (organic 0g fiber; 0g sugar; 2g protein;
seeds and soil, plus essential nutrients for each type of ¼ teaspoon coarse salt 33mg potassium; 33mg phosphorus
plant) and enjoy your harvest. Prize includes four Lingots®;
others available for purchase at veritableusa.com.

VOLUME 10, ISSUE 2 • FoodandNutrition.org 33

 Celebrating
Global Flavors
Photography by David Raine
Food styling by Breana Moeller | Prop styling by Michelle Wilkinson

With these budget-friendly recipes inspired by

cultural cuisines, you can take a trip around the
world without leaving home. Chicken Adobo
introduces sweet and tangy tastes from the
Philippines. Asian Lentil Sesame Fried Rice is a
one-pot meal chock-full of delicious vegetables.
And Rice and Ricotta Stuffed Summer Squash
is a vegetarian adaptation of Zapallitos Rellenos,
an Argentinian classic. Each recipe incorporates
ingredients that you may already have on hand
and take less than 20 minutes to cook.
 Heat oil in a large pan over medium heat. Add
CHICKEN ADOBO
minced garlic and sauté for 1 minute. Add sliced
Chicken adobo, a
Developed by Gabbie Ricky, MS, RDN, CSO, LD
SERVINGS: 4
onions, bay leaves and whole peppercorns and popular dish from
sauté for 4 to 5 minutes, stirring occasionally,
SERVING SIZE: 1 cup (110 grams)
PREP TIME: 10 minutes
until onions are translucent. the Philippines, uses
COOKING TIME: 20 minutes Transfer to a plate and cover with foil. several pantry staples
10 grams 2 tablespoons (30 milliliters)
Add canned chicken to the pan and warm for about
vegetable oil
5 minutes, stirring occasionally. Once chicken is
including soy sauce,
8 grams 3 garlic cloves, minced thoroughly heated and slightly browned, add the apple cider vinegar,
1 58 grams 1 small yellow onion, sliced onion mixture back to the pan and stir.
<1 gram 7 bay leaves Sprinkle on brown sugar and stir to incorporate.
brown sugar and bay
<1 gram ½ teaspoon whole black peppercorns Add soy sauce and apple cider vinegar. Stir well, leaves — all cooked in
then reduce heat to low and simmer for about
352 grams 15 ounces canned no-salt or low-salt
chicken, chopped into bite-sized
5 minutes. one pot — resulting in a
pieces Cooking note: Chicken adobo is traditionally served sweet and tangy flavor.
7 grams 1 tablespoon brown sugar with steamed white rice. To make a sawsawan sauce
60 grams ¼ cup (60 milliliters) low-sodium for dipping or drizzling over rice, mix equal parts
soy sauce soy sauce and apple cider vinegar. Add crushed
red pepper flakes for spiciness.
50 grams ¼ cup (60 milliliters) apple cider
vinegar
Find Gabbie on our Stone Soup blog and at
positivelyhungryrd.com.

NUTRITION PER SERVING:

127 calories, 4g total fat, 0g saturated fat,
47mg cholesterol, 667mg sodium, 7g carbohydrate,
1g fiber, 3g sugar, 16g protein, NA potassium,
NA phosphorus
ASIAN LENTIL SESAME FRIED RICE golden brown. Add tomato and carrots and stir to combine, sautéing
Developed by Anna Tseng, MPH, RDN, LDN for 1 to 2 minutes.
SERVINGS: 4 Add celery, frozen peas, 1 tablespoon soy sauce and black pepper
SERVING SIZE: 1¾ cup (253 grams) and cook for 1 to 2 minutes. Add marinated lentils. Stir to combine,
PREP TIME: 15 minutes
then cook 2 to 3 minutes on low-medium heat, stirring occasionally.
COOKING TIME: 15 minutes
Transfer to a bowl and set aside.
265 grams 1 15-ounce can no-salt green lentils, drained and rinsed
In the same pot over low-medium heat, add 1 teaspoon olive oil and
35 grams 2½ tablespoons (37 milliliters) soy sauce, divided 1½ tablespoons minced garlic. Once oil is hot and garlic pieces start to
8 grams 2 teaspoons (8 milliliters) olive oil, divided sizzle, add cooked rice. Stir quickly to coat the rice with oil to prevent
8 grams 1 tablespoon fresh ginger, minced it from sticking to the pot. Cook until heated, about 1 to 2 minutes.

21 grams 3 tablespoons garlic, minced and divided Add vegetable mixture back to the pot and cook for 2 to 3 minutes,
75 grams ½ cup tomatoes, diced stirring occasionally, until the entire mixture is heated through. Turn
off heat and mix in sesame seeds. Drizzle with sesame oil. To serve,
57 grams ½ cup carrots, grated distribute evenly into bowls.
124 grams 1 cup celery, diced
Cooking note: One- to two-day-old cooked rice works best when
120 grams 1 cup frozen peas making fried rice. Cooked medium- or long-grain white rice can be
<1 gram ¼ teaspoon ground black pepper used in place of brown rice. Avoid short-grain or sushi rice, as these
420 grams 4 cups cooked brown rice will become too sticky. Canned black, brown or green lentils can be
used. For additional flavor, garnish with chopped green onion.
9 grams 1½ tablespoons raw or toasted sesame seeds
6 grams ½ tablespoon (6 milliliters) sesame oil Find Anna on our Stone Soup blog and at dietitianmom.com.
Place drained and rinsed lentils in a sieve or fine-holed colander and NUTRITION PER SERVING:*
let sit for 5 minutes. Transfer to a medium bowl and add 1½ tablespoons 299 calories, 6g total fat, 1g saturated fat, 0mg cholesterol, 693mg sodium,
soy sauce. Marinate for at least 5 minutes. 50g carbohydrate, 10g fiber, 5g sugar, 13g protein, 599mg potassium,
301mg phosphorus
In a large pot or wok over medium heat, warm 1 teaspoon olive oil. *Nutrition facts reflect generic canned lentils.
Add ginger and 1½ tablespoons minced garlic, stirring until garlic is

This nutrient-packed, one-pot meal uses readily

available and easy-to-prepare ingredients
including rice, canned green lentils
and frozen green peas.
RICE AND RICOTTA STUFFED SUMMER SQUASH
Developed by Romina Barritta, DTR
SERVINGS: 4
SERVING SIZE: 2 stuffed squash halves (315 grams)
PREP TIME: 30 minutes
COOKING TIME: 20 minutes

650 grams 4 small to medium round zucchini squash

24 grams 2 tablespoons (24 milliliters) olive oil, divided
110 grams ½ onion, chopped
60 grams ⅓ cup crushed tomatoes
5 grams 2 tablespoons fresh basil, chopped
430 grams 2 cups cooked short-grain brown rice
200 grams 1 cup part-skim ricotta cheese
3 grams ½ teaspoon salt
1 gram ½ teaspoon ground pepper
24 grams 2 tablespoons breadcrumbs
24 grams 2 tablespoons walnuts, chopped

Fill a large bowl with ice water. Cut each squash in half
horizontally. Bring a large pot of water to a boil. Place
squash halves in boiling water and cook until slightly
tender, about 5 minutes. Transfer to ice water to cool,
then remove and pat dry. Using a spoon, scoop out
and reserve seeds and pulp from each squash leaving
a cavity roughly ¼-inch thick for stuffing.

Preheat oven to 375°F (190°C) and lightly coat a baking

sheet with 1 tablespoon olive oil.

To make the filling, warm 1 tablespoon oil in a large

skillet over medium-high heat. Add onion and sauté
until golden brown, about 3 minutes. Stir in tomatoes,
reserved seeds and pulp and basil. Increase heat to
high, stirring often until some liquid evaporates,
about 3 minutes. Remove from heat, add rice and
ricotta and mix. Season with salt and pepper.

Arrange squash on the prepared baking sheet.

Using a spoon, place equal amounts of filling in
each squash half. In a small bowl, mix breadcrumbs
and walnuts, then sprinkle over squash. Bake until
golden brown on top, about 20 minutes. Serve hot
or warm.

Cooking note: If round zucchini squash is not

available, use long zucchini squash. Cut into 1½- to
2-inch-thick rounds. Hollow out the center of each
round, leaving about ⅛ inch in the bottom, to make
a cup for filling.

Find Romina on our Stone Soup blog and at

globaldietitians.com.

NUTRITION PER SERVING:

370 calories, 15g total fat, 4g saturated fat, 16mg cholesterol,
418mg sodium, 47g carbohydrate, 4g fiber, 2g sugar, 14g protein,
865mg potassium, 302mg phosphorus

Round summer squash is stuffed with rice,

ricotta cheese and vegetables, and topped
with breadcrumbs and walnuts in this
oven-baked vegetarian version of an
Argentinian classic, Zapallitos Rellenos.
Special Series | HE ALTHY KITCHEN HACKS
SPOTLIGHT ON
seasonings By Serena Ball, MS, RD, and Deanna Segrave-Daly, RD
S
pices can be the window to a world
of flavor, and they make grandma’s
favorite recipes come to life. Which
spices are handy to have at all times,
and how do you use up a special spice
purchased for just one recipe? Get these answers,
plus hacks to season your food just right.
USE THEM UP. Many ground spices lose potency
within a year. By that time, they’ll still be edible, but
you’ll you need to use an additional ⅛ to ¼ teaspoon
to deliver the same flavor.
BUY THEM WHOLE. If possible, purchase whole spices,
which stay fresh for about a year. Store them away from
heat and light, not near the stove. Grind or grate whole
spices when you need them, rather than prepping ahead
of time.
GRIND YOUR OWN. Grinding or crushing whole spices
releases fragrant oils, so to avoid losing potency and flavor,
grind only as much as you need. Use a mortar and pestle,
electric spice grinder or coffee grinder that you dedicate
SPICES©GETTYIMAGES/ VICTORIYA89
only to spices; or place spices in a resealable freezer bag,
then crush with a pan, meat mallet or rolling pin.
TOAST SPICES. Toasting releases more aromatic
compounds before you grind spices or add them to a
recipe. Place a small amount in a dry skillet and heat
over medium heat for less than five minutes, until they
smell toasted or fragrant. Shake the pan while toasting to
prevent burning. To revitalize older ground spices, toast
for only two to three minutes and use immediately.
BLOOM IN OIL. Warming whole and ground spices in oil
helps increase flavor in two ways: Heating helps liberate
the flavorful oils in spices, so they can infuse into the fat.
And spice-infused fat carries flavor throughout a dish
much better than simply adding a dry spice to a recipe or
to water or broth. Adding ground spices to a cooking fat
such as oil or butter is called “blooming” and is a quick
way to intensify the spice’s flavor. In a pan on the stove,
heat spices for 30 to 60 seconds in oil or add to aromatics
such as onions or garlic while they cook in fat. Steep
whole spices in oil for up to 20 minutes at a very low
temperature.
STOCK SMART. Keep spices on hand that you know you’ll
use within six months. Always have one or two spices in
your pantry from each of these categories:
Seeds: annatto, caraway, cardamom, celery, coriander,
cumin, dill, fennel, fenugreek, mace, mustard,
nutmeg, sesame, star anise
Suggested uses: Steep into sauces
or drinks, toast and crush into
vegetable dishes or add to
sweet-savory pickles
or fermented
vegetables.
Dried berries and flowers: allspice, cloves, peppercorns
(black, green, white, pink and Sichuan), saffron, sumac
Suggested uses: Use in rubs or marinades, or mix into
cooked whole grains and vegetables (bonus: cracked
spices also add texture to dishes).
Roots: garlic, ginger, turmeric
Suggested uses: Chop and sauté in oil as a recipe base
for savory dishes.
Chiles and peppers: Aleppo pepper, ancho chile pepper,
cayenne pepper, chipotle chile pepper, crushed red
pepper, Gochugaru Korean red pepper, Hungarian
hot paprika, Raja Mirchi chile, smoked paprika, sweet
paprika, Urfa pepper
Suggested uses: Warm in oil to use in recipes for meat,
poultry, fish, tofu and vegetables or make pastes such
as sambal oelek.
Ground “baking” spices: allspice, cardamom, cinnamon,
cloves, nutmeg
Suggested uses: In addition to baking, use these spices
in savory dishes such as North African and Turkish stews
and grain recipes.
Blends: adobo seasoning, Cajun seasoning, curry
powder, five-spice powder, garam masala, Jamaican
jerk seasoning
Suggested uses: Add to egg recipes or rice dishes
for a global flavor infusion.
Umami: bagel topping seasoning; mushroom powder;
monosodium glutamate (MSG); nutritional yeast;
seaweed, dried fish and sesame shake
Suggested uses: Sprinkle on any dish at the table
for a flavor boost with less salt (note: some blends
include salt).
Read about dried herbs including thyme,
rosemary and basil here.
Find Serena and Deanna on our Stone Soup blog and at
teaspoonofspice.com.
VOLUME 10, ISSUE 2 • FoodandNutrition.org 39
Read | NE W BOOKS
The Mediterranean Diet Cookbook for Beginners:
Meal Plans, Expert Guidance, and 100 Recipes
to Get You Started
Elena Paravantes, RDN
This book offers a breakdown of the
Mediterranean diet and its health benefits,
including which foods to eat and how
often, plus grocery shopping and storage
tips, cooking techniques and more. Two-
week meal plans show how to incorporate
the book’s recipes.
The Easy Diabetes Cookbook
Mary Ellen Phipps, RDN
Those with prediabetes, Type 1 diabetes,
Type 2 diabetes or gestational diabetes
can use this cookbook to help with
balancing blood sugars and managing
diabetes through food. Guidance includes
eating a combination of fat, fiber and
protein at every meal. Recipes have
nutrient analyses and are categorized
as gluten-free, vegan and more.
What Do I Cook Now? Recipes and Action Plan for
People with Diabetes or Prediabetes
Tami A. Ross, RDN, LD, CDCES, MLDE, FADCES, and Nancy S. Hughes
For those recently diagnosed with
prediabetes or Type 2 diabetes, this book
presents expert tips and healthful eating
information including meal planning,
equipping your kitchen for cooking, ways
to save time and money on groceries and
more. Each chapter includes recipes to
put these skills to use.
Anti-Inflammatory Diet Meal Prep: 6 Weekly Plans
and 80+ Recipes to Simplify Your Healing
Ginger Hultin, MS, RDN, CSO
Gain a greater understanding of
inflammation and which foods and
beverages calm or contribute to it.
This comprehensive guide also details
advance meal planning, grocery
shopping, kitchen equipment and
food storage basics to use with the
six-week meal plan and recipes.
40 Food & Nutrition Magazine® • VOLUME 10, ISSUE 2
The Complete Bariatric Cookbook and Meal Plan:
Recipes and Guidance for Life Before and After Surgery
Megan Moore, RD, CSOWM, CD
Using advanced meal preparation and
planning techniques, this cookbook can
be tailored for people who have had any
of four types of bariatric surgery. It has
10 weeks of grocery lists, meal plans
and workouts, plus fast and easy recipes
and expert guidance to prepare for and
recover from surgery.
21-Day Arthritis Diet Plan: Nutrition Guide and Recipes
to Fight Osteoarthritis Pain and Inflammation
Ana Reisdorf, MS, RD
Learn about osteoarthritis, including
the link between arthritis and
nutrition. Designed to ease symptoms
such as pain and inflammation, this
book includes 75 recipes based on
the Mediterranean diet, plus a three-
week meal plan with sample menus,
shopping lists and meal prep tips.
Kindred Table: Intuitive Eating for Families
Emily Weeks, RDN, LD
Use this guide to break free from dieting and restrictive eating
by employing an intuitive approach with
family meals in mind. Tips and information
address how to introduce intuitive eating
principles to children and teens, trying new
foods and not focusing on weight or body
size. Nutritionally balanced recipes are
included for breakfast, lunch, dinner, sides,
snacks and desserts.
5-Ingredient Renal Diet Cookbook: Quick and Easy
Recipes for Every Stage of Kidney Disease
Aisling Whelan, MS, RDN, CDN
People with chronic kidney disease can
use this cookbook to add nutritious
foods to their diet and improve kidney
function through simple changes. The
book includes evidence-based guidelines
and information about nutritional needs
for each stage of CKD, with recipes that
feature a short list of ingredients.
 LAZY delicious!
PILFER YOUR PANTRY AND MAKE SOMETHING OUT OF NOTHING.
Grilled Flatbread Sandwich: Add olive oil to a pan over
medium heat. Place one flatbread in the pan and layer on
marinara sauce, pepperoni and shredded mozzarella. Add a
second flatbread on top and drizzle it with a light amount of
olive oil and a sprinkle of salt, if desired. Brown on both sides
and cook until the cheese is melted.
SMELL ICONS©THINKSTOCK.COM; PASTA©GETTYIMAGES/BETKA82; PEAS©GETTYIMAGES/IRINA GRISKOVA; MUSHROOMS©GETTYIMAGES/VERONIKA OLIINYK; CHICKPEAS©GETTYIMAGES/SLOWCENTURY
– Amanda Kruse, MS, RD, LD, FAND
INGREDIENT Add herbs and spices such as basil, rosemary,
IMPROV
oregano or garlic powder. Bump up the nutrition
with vegetables such as spinach, mushrooms, bell pepper or
onions. Other combinations could include ham and pineapple;
ricotta, mozzarella and Gouda; or sausage, peppers and onions.
Bean Pasta with Veggies: Cook a box of chickpea pasta
according to package instructions. Meanwhile, dice an onion,
place in a sauté pan and cover with low-sodium vegetable
broth. Cook over medium-high heat, stirring occasionally,
until the liquid is reduced. Once pasta is cooked, strain and
rinse. Combine the pasta, onions, your favorite tomato sauce
and a can of drained and rinsed chickpeas and enjoy.
– Amy Gorin, MS, RDN
INGREDIENTOnce served, add a dash of black pepper and
IMPROV
nutritional yeast or Parmesan cheese. Incorporate
more vegetables such as canned or frozen peas and sautéed
mushrooms or add leftover reheated rotisserie chicken.
What’s your go-to non-recipe? Send ideas to foodandnutrition@eatright.org or post to
social media with #LazyDelicious and tag @FoodNutriMag.
Orzo Stuffed Mushrooms: Clean and trim portobello
mushrooms, removing the stems. Place open faced on a
baking sheet lined with aluminum foil. In a bowl, combine
cooked orzo, diced black olives, diced cherry tomatoes,
diced red onion, fresh chopped basil and a drizzle of olive
oil and balsamic vinegar. Fill mushroom tops and top with
feta cheese. Bake at 350°F for 30 minutes or until tender.
– Sarah Gallagher, MS, RDN, LDN
INGREDIENT Use button mushrooms and substitute cooked rice,
IMPROV
couscous, quinoa or any other grain for orzo. To make
this dish vegan-friendly, top with nutritional yeast instead of
feta. Reduce food waste by using leftover stems in a later meal.
One-Ingredient Almond Butter: Preheat oven to 350°F.
Fill a greased sheet pan with unsalted almonds and roast
for 10 minutes. Let almonds cool, then place in a food
processor and process until creamy.
– Stephanie Dorfman, MS, RD
INGREDIENT For more flavor, add cinnamon, maple syrup or
IMPROV
vanilla extract while processing. If you like crunchy
nut butters, process the almonds until they are chopped into
small pieces, then set some almond pieces aside and mix them
back in once the rest of the almond butter is creamy. Use
this “recipe” for any nut or seed.
Light and Creamy Ranch Dressing: In a small bowl, mix 1 cup
plain yogurt with ½ teaspoon each garlic powder and onion
powder, 2 tablespoons each fresh chopped dill, fresh chopped
parsley and fresh chopped chives, plus 1½ tablespoons lemon
juice and salt and pepper to taste. Chill in the refrigerator for
at least 1 hour. Use it to dress salads or as a dip with fresh
sliced vegetables and whole-wheat crackers.
– Gillean Barkyoumb, MS, RDN
INGREDIENT For extra protein, use plain Greek yogurt and, to thin
IMPROV
the consistency, add low-fat milk or water. To create a
vegan version, use a plant-based yogurt. Dried spices can be used
in place of fresh but use less since dried spices are more potent.
JOIN THE FUN!
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