Replacements for Blue Moon Foods

By Liz Moore, RD, LDN


We all have foods we relish and crave, even though they are unhealthy for our bodies or our hearts. Ice cream, pizza, burgers, fries — many all-American foods are best indulged in extreme moderation, just “once in a blue moon.”


A blue moon is the fourth full moon in a 3-month season that normally has only three. This phenomenon occurs once every two to three years, and you may not want to wait that long to nibble your favorite food.  Nor am I advising such a draconian approach. Moderation is the name of the game. Eating healthy is about making good choices based on what’s best for you – most of the time.


My recommendations differ from patient to patient when it comes to defining “once in a blue moon.” For example, a patient who is young and does not have a chronic illness may be able to indulge in a blue moon food once a week, or every other week. For patients living with an illness, such as heart disease or diabetes, or for those who are older and less active, once a month is a good goal for blue moon food consumption.


We dietitians usually give older adults, particularly those ages 51 and older, the same daily sodium intake recommendations (1,500 milligrams per day) as we give people with a history of high blood pressure, diabetes or chronic kidney disease.  The kidneys’ job is to rid the body of sodium, but when excess sodium is consumed, it enters the blood stream where it increases the volume of blood vessels. This makes it more difficult for the heart to move blood through the circulatory system, an illness known as hypertension or high blood pressure, which increases the risk of cardiovascular disease and heart attack.


Unhealthy foods can be deeply implicated in causing hypertension, high cholesterol levels and other conditions that raise the risk of cardiovascular disease. Embracing a healthier alternative for each blue moon food is another way to keep your heart healthy. Here are five big blue moon foods, along with my suggestions for substitutions.


Ice Cream


The heavy cream used to make ice cream is high in saturated fat. The resulting high fat content can have a direct effect on your cholesterol numbers, particularly when it comes to LDL, or bad cholesterol. If ice cream becomes a mainstay of your diet, chances are the regular doses of saturated fat will eventually lead to a rise in your LDL cholesterol. Think clogged arteries, heart attack and/or stroke.




Instead of ice cream, reach for a bowl of non-fat Greek yogurt topped with fresh fruit. The dairy in the Greek yogurt will satisfy your urge for cream, while leaving your arteries unclogged by all that saturated fat.


Fettuccini Alfredo


Fettuccini Alfredo is an Italian dish popular with Americans at the restaurant table and the kitchen table—and it turns the Mediterranean diet on its head. I highly advise consumption under an actual blue moon only. Composed of heavy cream, butter and cheese, Alfredo sauce is loaded with saturated fat which raises LDL cholesterol.




Instead of indulging in a cream sauce with white pasta, try tomato sauce over whole wheat pasta. Tomato sauce cuts out the saturated fat, while whole wheat pasta retains the nutritional value that’s often lost in processing of white pastas like fettuccini. Because whole wheat pasta retains the bran, germ and endosperm of the grain, it’s a more nutritionally balanced choice. Those three sections of the grain contain more vitamins and minerals.


Large Blended Coffee with Whipped Cream


Coffee on its own does not have to be a blue moon food. In fact, coffee can be good for some, aiding in the prevention of Type 2 diabetes by regulating blood sugar, and possibly protecting against certain types of cancer like that of the liver. The unhealthy part is the things we add to coffee, like whipped cream topping and cream in the drink. Whipped cream contains trans-fat, a hydrogenated fat that has been shown to not only raise bad LDL cholesterol levels, but also lower good, HDL, cholesterol levels in the process.




You don’t need to avoid the gourmet coffee shop. You can have your coffee and drink it, too. Substitute less offensive (and trans-fat free) skim milk for the fatty cream with and skip the whipped cream altogether.


Large Soda

On average, a large soda contains 65 grams of sugar – the equivalent of 22 sugar packets! Too much sugar leads to coronary artery disease and heart attack.  Sugary drinks have long been tied to an increase in obesity and Type 2 diabetes, two major risk factors for cardiovascular disease, heart attack and/or stroke. In a cardiovascular study of 88,520 women orchestrated by the Department of Nutrition at Simmons College in Boston, Massachusetts, researchers discovered a direct correlation between drinking sweetened beverages and developing coronary disease when they followed up with those women 24 years later.





Instead of carbonated soda, reach for carbonated water—a much healthier alternative. Squeeze a bit of lemon or lime into seltzer for a sugar-free, flavorful drink.



Fully Loaded Cheeseburger


Consuming too much red meat has been shown to increase risk of both heart disease and cancer, but when it comes to hamburgers, it’s not necessarily the meat that will add to heart troubles. The danger is in the added ingredients like trans-fat-heavy mayonnaise or special sauce and the saturated fat from the cheese and bacon.




You can keep the burger in your diet and still maintain heart health. Choose a plain hamburger, made with lean ground beef, which is lower in fat content. Limit consumption to one serving, about the size of a pack of playing cards. Top your burger with veggies like lettuce, onion and tomato instead of bacon, mayo and cheese.


Potato Chips


Potato chips can be rife with two notorious substances—salt and trans-fats. Salt is used to lend flavor to chips and in doing so, it increases the risk for hypertension. The trans-fats in the oils that are used to cook some chips also contribute to a less than heart-healthy snack. Even chips cooked in plain oil without trans fats, however, are still high in fat. The overall calorie intake is a concern, because most people don’t stick to a single portion.




Popcorn is a trans-fat (and salt free) substitute—as long as you stick with the plain kind. If plain popcorn has no appeal, dust it with parmesan cheese for a tastier treat that’s still healthy enough to enjoy regularly.


These five foods are just samples from the galaxy of blue-moon foods. Any deep-fat fried favorites – like French fries — should also be considered “sometimes” treats. Limit the negative impact by eating smaller portions. Or, to put it more positively, share them with a friend.


My list represents foods that are enjoyed both inside and outside the home. Ice cream is my own guilty pleasure, while others—like fettuccini Alfredo—were suggested by my fellow dietitians at Beth Israel Deaconess Medical Center.


When it comes to blue moon foods, it’s not about avoiding them entirely, but about prioritizing. It’s especially important if you’re living with an illness such as Type 2 diabetes or hypertension to become aware of the blue moon foods and make an effort to limit your intake. If you’re tempted by a cheeseburger and an ice cream sundae, select the one you crave most.


It’s also important to keep track of how often you’re eating blue moon foods. If there are five or 10 blue moon foods you eat just “once in a while” … then are you really avoiding blue moon foods? This applies to seasonal foods, too. For instance, enjoying pumpkin pie every night for a week is an over-indulgence even in October.


As the holidays approach, make informed decisions by thinking carefully about the foods you eat. Pick the blue moon food that is most important to you and enjoy it in moderation. If moderation is difficult, substitute a healthier option that won’t damage your heart.


Elisabeth (Liz) Moore, RD, LDN, is a registered dietitian for BIDMC’s CardioVascular Institute (CVI) and sees patients in BIDMC’s outpatient nutrition clinic and the CVI’s Cardiovascular Health and Lipid Center. Moore received her B.S. degree in human nutrition at the University of Massachusetts at Amherst.


Posted: January 2013