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Wall Street Journal: The American Diet Has a Sandwich Problem

From The Wall Street Journal:

The humble sandwich is the saboteur of the American diet.

Most Americans consume too much sodium, sugar and saturated fat, according to government survey data. Sandwiches—which almost half of Americans eat on any given day—are a primary culprit. Nutritionists, doctors and public-health officials are trying to nudge people to make their sandwiches healthier, believing that even simple changes can improve health.

Sandwiches are the number one source of sodium and saturated fat in Americans’ diets, making up about one-fifth of our daily sodium intake and 19% of our daily saturated fat calories, according to an analysis of federal survey data. Sandwiches contribute 7% of daily added sugars, the same percentage as breakfast cereals and bars.

“The standard deli sandwich with processed meat and cheese, you’re literally eating a heart bomb,” says Dariush Mozaffarian, a cardiologist and professor of nutrition and medicine at Tufts University.

Excess sodium increases blood pressure, which raises the risk of heart disease and stroke. People also eat an extra nearly 100 calories on the days they eat sandwiches, according to federal survey data analyzed by University of Illinois at Urbana-Champaign researchers. Sandwiches are often high in calories compared with other meals.

Time-strapped Americans reach for sandwiches because they are tasty, portable, often inexpensive and ubiquitous, dominating the menus of fast-food joints, corporate cafeterias and brown-bag school lunches.

“Americans eat so much of their meals not sitting down at a table. They are eating in their cars or at their desks, so sandwiches are easy,” says Erica Kenney, assistant professor of public-health nutrition at the Harvard T.H. Chan School of Public Health.

You don’t have to stop eating sandwiches, nutritionists say. But you can make them healthier, with more-nutritious breads and fillings.

Our sandwiches weren’t always this bad for us. Sandwiches have grown less healthy in the past 40 years, Dr. Mozaffarian says. Culprits include highly processed grains in bread and the low-fat push that took off in the 1980s, which nutritionists now say led to the consumption of more deli meats marketed as low-fat.

Sandwiches’ size—and their calorie content—have ballooned, too. A typical turkey sandwich in the 1980s contained about 320 calories, according to a report from the National Heart, Lung and Blood Institute. Twenty years later, a turkey sandwich contained about 820 calories.

Switch your bread

The problem with sandwiches starts with the bread, researchers say. The classic white bread, submarine bun or French baguette is mostly carbohydrates in the form of highly processed white flour.

“It turns into sugar as soon as it hits your tongue,” says Eric Rimm, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health.

The sugar rush causes blood glucose to shoot up, and then insulin spikes to compensate. Then blood glucose crashes, causing you to quickly become hungry again. Studies have found that eating a lot of highly processed carbohydrates over time contributes to weight gain and diabetes.

Choose whole grain bread, says Christina A. Roberto, associate professor of health policy at the University of Pennsylvania’s Perelman School of Medicine. Whole grains contain a lot of fiber, which helps regulate the processing of carbohydrates to prevent blood sugar spikes and keeps you fuller longer, says Dr. Roberto.

Look for bread made from 100% whole wheat or whole grain, suggests Dr. Rimm. Visible grains and seeds are good, too, since that signals less processing and more fiber.

Check the label for added sugars and sodium content, ideally less than 150 milligrams of sodium per slice, Dr. Rimm says. Thin-sliced bread is another good way to cut sodium and calories in your sandwich without resorting to the lettuce wrap, an often-suggested dieters’ hack.

Read more at The Wall Street Journal.