Defining Superfoods. Superfoods are nutrient-dense and considered beneficial for supporting health. Rich in vitamins, minerals, antioxidants, and other compounds, they support various functions and help protect against diseases.

Nutrient Density and Health Benefits. The main characteristic of superfoods is their high nutrient density. This means they provide a significant amount of nutrients for relatively few calories, making them an excellent choice for those looking to maintain a healthy weight and support health. Some of these key nutrients include:

1. Antioxidants: These compounds help neutralize harmful free radicals in the body, reducing oxidative stress and inflammation. This can help lower the risk of chronic diseases like heart disease and cancer. Berries, such as blueberries and strawberries, are well-known for their high antioxidant content.
2. Dietary Fiber: Essential for digestive health, fiber can help prevent constipation and promote regular bowel movements. It can also aid in controlling blood sugar levels and lowering cholesterol. Foods like oats, beans, and whole grains are excellent sources of fiber.
3. Omega-3 Fatty Acids: Found in foods like fatty fish and walnuts, omega-3s are known for their heart-protective properties. They can help reduce inflammation, reduce blood pressure, and improve overall heart health. Omega-3s are also beneficial for brain health, potentially lowering the risk of cognitive decline and dementia.
4. Vitamins and Minerals: Superfoods are often packed with essential vitamins and minerals. Leafy greens like spinach and kale provide vitamins A, C, and K, as well as calcium and iron, which are vital for bone health, immune function, and overall energy.

Adding Superfoods Into Your Diet. If you’re interested in incorporating superfoods into your daily meals, this can be both simple and enjoyable. Here are some tips to help you get started:

Start Your Day with Berries: Add a handful of blueberries or strawberries to your morning cereal or yogurt for flavor and an antioxidant boost.

Snack on Nuts: A small handful of almonds or walnuts makes a satisfying and nutritious snack, providing healthy fats and protein.

Choose Whole Grains: Opt for brown rice or quinoa to boost fiber intake and help support heart health.

Try Fatty Fish: Aim to include fatty fish, like salmon or sardines in your diet at least twice a week for a good dose of omega-3s.

Conclusion. While superfoods are not a cure-all, they can play a valuable role in a balanced diet. Focusing on nutrient-rich foods can help support overall health, prevent chronic diseases, and enhance quality of life. Remember, it’s important to combine superfoods with other healthy lifestyle choices, such as regular exercise and adequate hydration. Always consult with a healthcare provider or dietitian when making significant dietary changes to ensure they meet your individual health needs.

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Common Shortfall Nutrients. The U.S. Dietary Guidelines identify several nutrients that are often lacking in the average diet. These include:

Calcium: Vital for bone health and muscle function, calcium is often underconsumed, which can lead to osteoporosis and higher fracture risk.

Vitamin D: Essential for calcium absorption and bone health, vitamin D deficiency is widespread due to limited dietary sources and insufficient sunlight exposure. It plays a crucial role in immune function and inflammation reduction.

Potassium: This mineral helps regulate blood pressure and fluid balance. Most people do not consume enough potassium which can contribute to hypertension and cardiovascular issues.

Fiber: Dietary fiber is often lacking in diets dominated by processed foods. Adequate fiber intake supports healthy bowel movements and can help manage cholesterol and blood sugar levels.

Iron: Essential for producing hemoglobin and red blood cells, iron deficiency can lead to anemia, fatigue, and impaired cognitive function.

Next Steps. To help meet the recommended intake of these nutrients, consider the following ideas:

Diversify Your Diet: Consume a variety of fruits, vegetables, whole grains, lean proteins, and dairy or alternatives to ensure a broad intake of nutrients.

Focus on Nutrient-Rich Foods: Choose foods that are naturally high in shortfall nutrients. For example, opt for leafy greens, nuts, and seeds for calcium and vitamin D, and include bananas or potatoes for potassium.

Consider Supplements: Supplements may help meet nutritional needs. Consult with a healthcare professional before starting any new supplement.

The Bottom Line. Understanding and addressing shortfall nutrients is key to preventing deficiencies and supporting long-term health. Aim for a balanced and varied diet to help ensure that your body gets the nutrients it needs.

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Oats are often considered one of the original superfoods. They contain a unique fiber called beta-glucan. This fiber can help prevent blood sugar from rising after meals, lower total cholesterol and boost gut health. In addition, fiber in general helps you feel fuller longer. That can be especially helpful when trying to achieve and maintain a healthy weight.

For anyone needing to avoid gluten, oats are an ideal fiber-rich ingredient to include in your diet. However, because of growing conditions, some oats may contain trace amounts of gluten. To be safe, read the food label for the gluten-free label.  Fortunately, there are a handful of oatmeal-to-go cups that meet the gluten-free criteria.

Helpful Hints. Consider these tips when making your on-the-go oats.

Extra! Boost the nutrition of your hot breakfast by adding extras like chia or hemp seed, or choose ones that already include them.

Natural. While the flavors are yummy, they often come with a hefty dose of added sugar. Consider adding your own fruit, nuts, and spices for deliciousness without the extra sugar.

Bone builder. For extra protein and calcium, swap out the added water for low-fat milk. FYI, it may take a little longer to cook with the milk, but the creaminess is worth the wait. 

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What is Tofu?

Sometimes called bean curd, tofu is a staple ingredient in Asian cuisines. It is made by extracting soymilk from soybeans, adding a coagulant (like calcium sulfate) to curdle the soymilk, and pressing the curds into blocks. The amount of liquid released from the tofu varies with the degree of pressing, which affects the consistency of the end product. As a result, there are a range of tofu types, from silken to extra-firm.

Nutrition and Health.

Soy is one of the few plant foods considered a complete protein because it contains all nine of the essential amino acids. Tofu is therefore an excellent meat replacement.

Three ounces of firm tofu has around nine grams of protein. The same amount of roasted beef tenderloin has around 20 grams. But, while the tofu has only about half a gram of saturated fat, the beef has eight-and-a-half grams. Research shows that using tofu as a meat alternative supports cardiovascular health by decreasing intake of saturated fatty acids and leading to lower blood levels of LDL cholesterol. (A similar serving of beef also has about 280 calories, versus 70 for tofu.)

Soy is also high in isoflavones, plant compounds being studied for beneficial health effects.

Cooking with Tofu.

When making a dish with tofu, be sure to choose the right texture (See “How to Use Different Types of Tofu” for details on the different textures and how to use them). With the exception of silken tofu, it’s best to press tofu to squeeze out most of the water, especially when grilling, baking, or frying. You can do this by wrapping the tofu block in a clean dish towel or paper towels and setting a cast iron skillet or other weight on top for about 20 minutes. If you don’t have time, wrap the tofu with a towel or paper towel and gently, yet firmly, press with your hands to release water.

Tofu takes on the flavor of other ingredients, so it is often marinated or dredged in a spice mix before cooking. (Pre-seasoned tofu is available but watch out for high levels of sodium in many of these products.) For some ideas of how to cook with tofu, see “How to Use Different Types of Tofu.” It works well in a wide variety of dishes, either savory (like a tofu scramble, baked tofu, or a stir-fry) or sweet (like a non-dairy chocolate mousse). For one way to enjoy tofu, see our featured recipe, Sriracha Sesame Tofu Sandwich, on the next page.

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Judith C. Thalheimer, RD, LDN, executive editor of Tufts Health & Nutrition Letter, answers: “Pasta is traditionally made from refined (white) flour. Ideally, you should limit intake of refined grains and replace them with whole grains. Refined grains are stripped of fiber and beneficial nutrients (although the federal government mandates some of those vitamins and minerals be added back in in a process called enrichment to prevent nutrient deficiencies). “Most refined carbohydrates (refined grains, starches, and sugars) are digested and absorbed quickly, which can cause blood sugar to spike and contribute to the development of insulin resistance and type 2 diabetes. Pasta is a little different: the starch granules in the pasta are packed tightly together in a network of gluten, so pasta is not broken down as quickly as other refined wheat products.

“Still, choosing whole-grain pasta or other alternatives, such as noodles made from legumes (chickpeas, edamame, and lentils) will increase the fiber and general nutritional value of your pasta meal. Whole-wheat pasta is an excellent source of fiber and has about twice as much potassium and calcium per serving as traditional pasta. It takes a bit longer to cook and has a firmer texture and stronger flavor than white pasta. If you find these differences offputting, look for whole grain pasta made from white wheat (a different variety of whole wheat grain that is lighter in color and has a more delicate flavor) or products made from half whole wheat and half refined.

“It matters what you eat with your pasta. For example, fettuccine alfredo contains a lot of saturated fat, while pasta with pesto has hearthealthy unsaturated fat. Whatever type of pasta you choose, toss it with plenty of veggies, top it with a tomato sauce (preferably reduced sodium) or olive oil, and pair it with beans, poultry, shrimp, or fish instead of red and processed meats.

“Portion size is also a consideration. Dietary recommendations say most adults should aim for six servings of grain foods a day (and at least half of those servings should be whole grain). A serving of pasta is one half-cup. In general, if a pasta dish is your main course, start with one cup of pasta and bulk up the dish with vegetables and a source of protein. If it’s a side dish, stick to a half-cup.”

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Signs, Symptoms, and Risk Factors

Pay attention to subtle signs that may signal osteoporosis, such as loss of height and back pain. Compression fractures in the spine can cause a gradual loss of height, which may result in a stooped posture. These compression fractures can also lead to back pain, which may be sudden or develop gradually over time. If you experience any of these symptoms, bring them to the attention of your primary care provider or a rheumatologist. “Certain women are at a higher risk of osteoporosis due to genetics,” says Alana Serota, MD, an osteoporosis expert at the Weill Cornell-affiliated Hospital for Special Surgery. “But aging, illness, medications, poor nutrition, and other lifestyle factors can significantly increase the risk of osteoporosis, as well, particularly in the first five years after menopause.”

Reducing Your Risk

There are steps you can take to reduce your risk of osteoporosis. Weight-bearing exercises such as walking, jogging, dancing, and strength training help stimulate bone formation and increase bone density. “Women over 50 should focus on maintaining a healthy diet and weight, engaging in regular exercise, getting sufficient sleep, and ensuring adequate intake of calcium, vitamin D, and protein. The goal is to consume 1,200 milligrams of calcium per day. Any not obtained through diet should be made up with supplements,” says Dr. Serota. Generally, the daily recommended amount of vitamin D is 600 international units (IU) for women ages 51 to 70 and 800 international units (IU) for women over 70.

Diagnosis and Treatment

If you are diagnosed with osteoporosis there are several treatment options available. “When osteoporosis is treated, women can expect to maintain or even improve their bone density, depending on the medication used. This significantly reduces the risk of fractures. However, if osteoporosis is left untreated, bone density will continue to decrease, leading to a higher risk of fractures,” says Dr. Serota.

Available osteoporosis medications include:

Bisphosphonates: These medications are typically taken orally, usually as a once-weekly or once-monthly tablet.

Hormone therapy: This typically involves the use of estrogen or a combination of estrogen and progestin. Estrogen therapy can be administered orally in the form of tablets, or it can be delivered transdermally through patches or gels applied to the skin.

Selective estrogen receptor modulators (SERMs): Medications such as raloxifene are taken orally as a daily tablet. SERMs act like estrogen in some parts of the body, such as bone, but have anti-estrogen effects in others, such as the breast and uterus.

Monoclonal antibody medications: These medications, such as denosumab, are administered as an injection, and are typically given once every six months by a health-care provider in a clinical setting.

Anabolic Agents: These drugs, which stimulate bone growth, include PTH-analogues—teriparatide (Forteo) and abaloparatide (Tymlos), as well as the sclerostin antagonist romosozumab-aqqg (Evenity). “All of these approved treatments prevent fractures, and their benefits far outweigh their risks. Ultimately, the choice of treatment is a shared decision between the patient and doctor,” says Dr. Serota.

What to Expect

Medicare generally covers bone density testing DXA (dual energy X-ray absorptiometry) scans every other year for women over the age of 65. The Bone Health and Osteoporosis Foundation recommends that scans can begin as early as age 50 for women who have risk factors for fractures. For women who are diagnosed with osteoporosis, regular monitoring and follow-up appointments with health-care providers are crucial to ensure the effectiveness and safety of prescribed treatments.

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A:Vitamin K₂ is a lesser-known but still important nutrient with many related health benefits, particularly for bone and cardiovascular health. Unlike vitamin K₁, which is mainly involved in blood clotting, vitamin K₂ plays a role in calcium metabolism, ensuring that calcium is deposited in bones and teeth, rather than in arteries.

One of the primary benefits of vitamin K₂ is to improve bone health. It activates proteins that bind calcium to the bone matrix, enhancing bone density and reducing the risk of fractures. This is especially important for older adults who are at higher risk for osteoporosis.

Vitamin K₂ is found in fermented foods like natto, a Japanese soybean dish, as well as in certain cheeses and meats. Supplementation may be beneficial for those who struggle with obtaining enough vitamin K₂ through diet alone.

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The Facts. Carob (Ceratonia siliqua) is part of the legume family, along with beans, peas, and lentils. Its fruit is a dark brown pod that resembles a bean or pea pod. The hard-shelled pod contains a sugary pulp and seeds which contain fat and minerals. The seeds produce a gum used in cosmetics and pharmaceuticals and many processed foods like baked goods and ice cream as a stabilizer and for texture. The pulp is dried, roasted, and ground to make carob powder used as a cocoa, cacao, and chocolate substitute in baked goods and beverages. A one and one-half tablespoon serving of carab has 21% DV (DV=Daily Value, based on 2,000 calories/day) of dietary fiber, which supports heart health and digestive health. Carob also contains essential minerals, including calcium and potassium, and is rich in antioxidant polyphenols. 

The Findings. Rich in polyphenols, flavonoids, carbohydrates, minerals, and proteins, carob leaves, bark, and seeds have a long medicinal history of treating various diseases, such as diarrhea, diabetes, and hypertension, due to its antioxidant, antidiarrheal, antibacterial, antiulcer, and anti-inflammatory activities (Plants, 2023). Research shows the potential of carob extract, rich in pectin, gums, and polyphenols, to support a balanced gut flora, improve glucose metabolism, and help in the management and prevention of chronic diseases like diabetes and obesity. Carob also has a small environmental footprint, allowing larger cultivation during long periods of warm temperatures and drought, making it suited to a sustainable Mediterranean dietary pattern (Foods, 2022).

The Finer Points. The drying process of carob pods completes in August, when they begin to fall from the tree. They are sold as pods, both raw and roasted, as powder (also called carob flour), chips, syrup (also called carob molasses), and extract. Carob can be a one-to-one substitute for cocoa and chocolate chips in recipes as a healthier alternative. Try it in baked goods, cookies, granola bars, trail mixes, overnight oats, and yogurt—anywhere you use cocoa powder or chocolate chips. It has a unique flavor, so a half-and-half mix of cocoa and carob might be a good way to begin. 

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1. Prunes. Prunes are uniquely beneficial for bone health due to their composition of vitamin K, potassium, boron, and polyphenols, which support bone density and may reduce the risk of fractures. They also contain dietary fiber, calcium, and magnesium, which may improve nutrient absorption and reduce inflammation. Research shows that regular consumption of prunes can improve bone mineral density and prevent bone loss, particularly in postmenopausal women.
2. Dairy. Dairy products are excellent for bone health as they are rich sources of calcium, vitamin D, and protein. Calcium is essential for building and maintaining strong bones, while vitamin D enhances calcium absorption and bone growth. Protein supports bone structure and repair. Consuming dairy products like milk, cheese, and yogurt can provide these vital nutrients, helping to prevent osteoporosis and maintain bone density throughout life.
3. Leafy Greens. Leafy greens are rich in vitamin K content. Vitamin K plays a crucial role in bone metabolism by helping to regulate calcium and promoting the binding of calcium to the bone matrix, which strengthens bones. Consuming leafy greens like kale, spinach, and broccoli can significantly contribute to maintaining bone density and reducing the risk of fractures and osteoporosis.
4. Collagen. Collagen is essential for bone health as it provides the structural framework for bones, contributing to their strength and flexibility. As a major protein found in the body, collagen supports our bones, as well as surrounding tissues like joints, skin, and connective tissue. It helps maintain bone density and integrity, reducing the risk of fractures and osteoporosis particularly in postmenopausal women. Collagen-boosting foods include bone broth, sources of protein, zinc, and copper (e.g., beans, beef, and chicken), and vitamin C-rich foods (e.g., citrus fruits and peppers).
5. Nuts. Nuts are beneficial for bone health due to their high magnesium content, which is crucial for bone formation and maintenance. Magnesium helps in the conversion of vitamin D into its active form, enhancing calcium absorption and supporting bone density.
6. Salmon. Salmon is an excellent food for healthy bones as it provides vitamin D and omega-3 fatty acids. Vitamin D works together with calcium for proper absorption, while consuming omega-3s may reduce bone breakdown and improve inflammation.

—Caroline Thomason, RD

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Diuretics

There are three types of diuretic: thiazides, loop diuretics, and potassium-sparing diuretics. “All three promote the excretion of excess water and salt from the body,” says Judith Beizer, PharmD, clinical professor at St. John’s University College of Pharmacy and Health Sciences. “This reduces the amount of fluid flowing through the blood vessels, decreasing pressure on the walls of the arteries and enabling the heart to pump more easily.”

Thiazides are the first-line choice (loop and potassium-sparing diuretics are more likely to be used if you have heart failure), but may not be suitable for people with impaired kidney function. They also may increase blood sugar levels in people who have diabetes and raise the risk of gout.

Angiotensin Inhibition

Two drugs inhibit a naturally occurring chemical called angiotensin. There are four different forms of angiotensin—angiotensin II plays an active role in blood pressure because it causes the muscles surrounding blood vessels to contract, narrowing the arteries and raising blood pressure.

• ACE inhibitors stop the body from manufacturing angiotensin-converting enzyme (ACE), which converts angiotensin I into angiotensin II. ACE inhibitors may cause hyperkalemia (elevated potassium levels), which can raise the risk of abnormal heart rhythms, so you’ll need to avoid using potassium-based salt substitutes if taking these drugs. You also may be advised to limit your consumption of potassium-rich foods like such as bananas, oranges, dried peas and beans, and potatoes, and avoid vitamin supplements that contain potassium.

• Angiotensin receptor blockers Known as ARBs, these drugs work by blocking the action of angiotensin II and may be prescribed if ACE inhibitor side effects are intolerable. Like ACE inhibitors, ARBs generally are well tolerated. ARBs can cause elevated potassium levels, so the same dietary precautions apply as for ACE inhibitors.

Calcium Channel Blockers

These may be used to treat high blood pressure in people with angina (a painful squeezing sensation caused by narrowed or blocked arteries in the heart) and those who are at increased risk of stroke. “Calcium channel blockers slow the rate at which calcium— which helps power the heart and maintain its rhythm—passes into the heart muscle and blood vessel walls,” Beizer explains. “This increases the diameter of the arteries and blood pressure falls.”

Very rarely, calcium channel blockers can cause chest pain, a very rapid or very slow heartbeat, and breathlessness. If you should experience any of these reactions, contact your doctor immediately. “Grapefruit juice interferes with the metabolism of some calcium channel blockers,” Beizer adds, “so check with your pharmacist to see if this applies to your medication.”

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