The American Diet Has a Sandwich Problem

From a Wall Street Journal story by Andrea Petersen headlined “The American Diet Has a Sandwich Problem”:

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.

Skip processed meat

The processed meats—roast beef, ham, the bacon in your BLT—you find at the deli counter or in packages at the grocery store are loaded with sodium and preservatives, says Tufts’ Dr. Mozaffarian. Each serving a day of processed meat is associated with a 42% increased risk of heart disease and a 19% increased risk of diabetes, according to a review of research co-authored by Dr. Mozaffarian and published in the journal Circulation in 2010. More recent research has found similar results. Eating processed meats has also been linked to an increased risk of certain types of cancer.

While processed turkey slices have less saturated fat and calories than red meat, a turkey sandwich isn’t as virtuous as we think, says Dr. Kenney. It too is high in sodium and preservatives.

Instead of processed meat, choose fresh chicken breast or fresh turkey, which is often offered along with processed turkey at the grocery store deli counter, says Dr. Kenney. If you’re a red meat fan, sliced fresh steak or a burger is healthier than processed roast beef or salami, says Dr. Mozaffarian, since it doesn’t have the sodium and preservatives that processed meat does. Tuna—canned or fresh—is a better choice, too, he says.

Watch the condiments

Be sparing with mustard and ketchup, says Dr. Rimm, who calls them “salt vehicles.” Ketchup is often high in added sugars, too.

Perhaps surprisingly, mayonnaise isn’t a bad option, Dr. Rimm says. It usually is made from eggs and canola or soybean oil, which are high in the mono- and polyunsaturated fats that are associated with a lower risk of heart disease. (Mayo’s bad reputation is a hangover from the days when it used to contain unhealthy trans fats.)

Load your sandwich with tomato, lettuce and other vegetables for fiber and important nutrients.

Back to basics

One surprisingly good option is a healthy version of a kid favorite: peanut butter and jam, says Dr. Roberto, if you use 100% whole wheat bread and the right peanut butter and jam. (Jam tends to have more nutrients and fiber than jelly.)

Peanut butter has protein and healthy fats that keep you full. Use 100% whole wheat bread and look for peanut butter without added sugars, she advises. Choose jam low in added sugar, too; it’s even better if you can see chunks of whole fruit.

Since a soggy PB&J is unappealing, Dr. Roberto says it’s pretty easy to rein in the amount of sweet jam.

“There’s a built-in mechanism against overjellying,” she says. “It’s a really nice type of sandwich.”


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