With the 4th of July in the rearview mirror and Labor Day coming down the pike, barbecue season is in full swing. Though some may prefer meatless options like veggie burgers or grilled portabellas, summertime staples like hot dogs and hamburgers still occupy a good bit of that paper plate real estate. In fact, July has been named National Hot Dog Month by the National Hot Dog and Sausage Council and today, July 18, marks this year's National Hot Dog Day.
While these classics have been the center piece of many American BBQs for decades, the harsh reality is that they remain some of the unhealthiest choices.
"Eating foods that are highly processed, high in fat, and high in sodium, such as hot dogs, ground beef, and the toppings used to dress them, can impact one's risk for heart disease and diabetes, among other diseases," said Helene Glassberg, MD, an associate professor of Cardiovascular Medicine. "While enjoying these foods occasionally may not put you at an increased risk, frequent consumption, coupled with other risk factors, such as obesity, sedentary lifestyle, and genetics, can quicken the onset of these life threatening diseases."
Despite these known risks coming from clinicians, and data from organizations such as the World Health Organizations (WHO), which reported in 2015 that processed meat was linked to an increase in cancer risk, these items are not likely to disappear from party menus. So while moderation is king, we asked Penn experts in nutrition to dissect some typical barbecue fare to show just how some of these favorites add up and can affect one's health.
"Eggs have generally been given a bad rap for their cholesterol, but the truth is they are actually quite healthy," Glassberg said. "They only have 80 calories, of course with some fat, but very little carbs, lots of vitamins and minerals, and great protein. But for some, the amount of cholesterol found in eggs can be an issue."
Those with higher than normal cholesterol levels, history of heart disease or who are already taking medications to treat a cardiovascular condition, should steer clear of these. Glassberg said that for the most part "there is a limit to how much direct cholesterol we absorb in our diet, so I generally support egg consumption, but deviled eggs, on the other hand, they're another story."
If made the traditional way, these bite-sized snacks are very high in fat and calories, as a result of the added mayonnaise and mustard. More creative recipes can even call for cheddar cheese and bacon (more on that later), which really put these snacks on the bad list.
But fear not, Glassberg says, "if you decrease the number of yolks used – say if you make 12 eggs but only use the yolks from 6 – and replace the mayonnaise with non-fat Greek yogurt, these can still be a healthy summer snack."
All in all, when made with some slight moderation, these snacks are a keeper.
Corn on the Cob
This one can go either way, depending on how you eat it.
"Corn on the cob by itself can be a healthy choice, but the problem arises when the toppings are added," said Colleen Tewksbury, PhD, RD, LDN, program manager for the Penn Bariatric Surgery Program. "Typically butter, salt, or cheese are added, which bring unnecessary calories, sodium, and added fats to the plate."
Tewksbury and folks in the Bariatric Surgery Program work with patients on the road to bariatric surgery to make adjustments in their eating habits and approach to food in order to set them up for success following surgery. Many patients will start logging their food as part of the pre-surgery steps, either the old fashioned way with pen and paper, or with apps such as My Fitness Pal or the newly launched Penn Life Gained, which was designed to streamline the tasks of tracking steps and exercise, recording caloric and water intake, monitoring sleep time, altering diet, etc. for patients undergoing bariatric surgery. Much of these adjustments also focus on planning ahead when events or parties will be coming up, so patients can think about what they will eat, prepare themselves to avoid certain things, and plan out their days prior to account for the foods served at parties.
Corn alone is high in fiber, and is a good source of vitamins and minerals, but it's definitely slippery slope when toppings are involved. "When in doubt, keep it plain," Tewksbury said.
"These may sound like they are a good option to gravitate toward since beans are typically seen as good sources of fiber and protein, but baked beans are often very high in sugar and calories," Tewksbury said. "The sugar and molasses in the sauce take this protein and fiber-rich item, and turn it into something more akin to a dessert. At the end of the day, the benefits from the beans may not be worth all of the additional calories."
The issue of sugar in traditional BBQ fare is one that William Duffy, MD, an internal medicine specialist at Penn, discussed with Men's Health earlier this month. Duffy stressed the importance of avoiding store-bought dressings and rubs, which can be high in sugar, just like store bought (or even homemade) baked beans – which can pack upwards of 12 grams of sugar in just one-half cup.
To put this in perspective, according to the American Heart Association, the average male should consume no more than 36 grams of sugar a day, and the average woman, no more than 25 grams. With that scale, one serving of baked beans could amount to half of a woman's daily sugar limit.
In this case, Tewksbury urged "portion control is critical," especially if there will be sweets hitting the table at the end of the barbecue.
Pasta and/or Potato Salad
These sides are also a bit tricky. "The calories in pasta or potato salad tend to add up quickly, particularly for such a small side dish," said Tewksbury. "One cup of either salad can be more than 350 calories, which can raise the total calorie content of a meal rapidly."
In addition to the calorie counts, much like with deviled eggs, the addition of "hidden" ingredients like mayonnaise can put this side dish is the "not so healthy" bucket. Substituting again with non-fat Greek yogurt, or avocado (which is full of "good" fats), can make this a bit better. That said, when paired with all of the other items at a barbecue, a green salad might be the better choice.
Linda Sartor, RD, MA, CDE, LDN, a certified diabetes educator, clinical dietitian, and diabetes nutritionist in Penn's Rodebaugh Diabetes Center, said what might actually be best is to "opt for only half of an ear of corn, or to choose just one starch side (either potato/pasta salad or baked beans) instead of eating all of them. Being selective with these items will help manage blood sugars."
Providing these kinds of alternative suggestions is one of the ways Sartor and her team in the Rodebaugh Diabetes Center help patients with diabetes in the clinic navigate cooking and meal planning. Patients newly diagnosed with diabetes participate in nutrition workshops -; often led by Sartor -; where they learn about foods they should avoid, things they can swap to make indulgent dishes less of an issue for blood sugar, and identify new food groups to focus on in order to manage their disease. Some patients are even able to reverse their diabetes by making changes to their diet. Cutting out grains, carbs, sweets, meat, dairy, and eating at night helped Penn patient Elina Veksler do just that. "Diabetes is definitely reversible," she recently shared with the Philadelphia Inquirer.
Hot Dogs and Hamburgers
The main event – and perhaps the items with the most potential for negative impacts.
"Grilling or barbecuing meats creates advanced glycation end products (AEGs) like nitrosamines, that have been linked to increased risks of cancer, specifically colorectal and pancreatic," said Sartor, a fact that made many headlines following the WHO report on this connection.
At that time, the report came on the heels of new USDA dietary guidelines which stressed moderation when consuming not only processed meats, but all processed foods.
While these foods don't necessarily need to be stricken from the diet entirely, they should be eaten sparingly – which Daniel J. Rader, MD, chair of the department of Genetics and chief of the division of Translational Medicine and Human Genetics, noted when the WHO report was released – and perhaps not all in one sitting.
On top of these carcinogens, Sartor added, "processed meats, like hot dogs, hamburgers, wings, and ribs, contain lots of artery-clogging fats and salt, which can raise blood pressure and cholesterol levels in the body." Instead of loading up on red or processed meat, Sartor suggests making baked chicken breast (without the skin) with homemade BBQ sauce, or opting for boneless BBQ chicken "wings" from chicken tenders, and baking them in the oven instead of grilling.
One of the key tips Sartor offers for managing many BBQ staples is to try homemade sauces! Duffy echoed this in the Men's Health article, noting that many meat rubs "are loaded with salt, sugar and preservatives," which the experts seem to agree can lead to unnecessary negative impacts on health.
"The average hot dog and hamburger come in at around 300 calories with a bun, but the real challenge comes with the toppings," Tewksbury said. "Most people load up their burgers or dogs with cheese, ketchup, mayo, and other high calorie, high fat items. If you do decide to have one of these, and opt for a condiment, stick with low calorie ones like mustard and add veggies like lettuce, tomato, onion, or pickles."
Duffy agrees, telling Men's Health that "mustard is also a great sugar-free option -;assuming you don't opt for honey mustard, which tends to include lots of sugar."
Ultimately, consuming BBQ fare sparingly is the key, as is opting for homemade sauces and condiments, being selective with what you chose, and substituting high-fat ingredients for low-cal options. Taken together, this advice can take some of the health risks – and the guilt – out of these summer standards.