Healthy Eating: A guide to the new nutrition 9781614011156, 1614011156

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A Harvard Medical School Special Health Report

Healthy Eating A guide to the new nutrition

In this report: “Good” carbs versus “bad” carbs The skinny on fat Sneaking in more vegetables How much sugar are you really eating? A warning on cured and processed meats Are organics worth it? The power of probiotics SPECIAL BONUS SECTION

17 healthy recipes

Price: $29

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HEALTHY EATING SPECIAL HEALTH REPORT

Faculty Editor Teresa Fung, ScD, RD, LDN Adjunct Professor, Harvard T.H. Chan School of Public Health Professor of Nutrition, Simmons College Nutrition Editor Sharon Palmer, RDN Executive Editor Anne Underwood

Contents A healthy eating style. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 In search of a healthy diet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Harvard’s Healthy Eating Plate. . . . . . . . . . . . . . . . . . . . . . . . . . . Choose whole foods first . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Focus on plants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Dietary Guidelines for Americans . . . . . . . . . . . . . . . . . . . . . Sustainability on the plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 3 4 5 6 8

Choosing healthful carbohydrates. . . . . . . . . . . . . . . . . . . . . 9

Copy Editor Robin Netherton

“Good” carbs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 “Bad” carbs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Creative Director Judi Crouse

Finding the best fats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Production/Design Manager Lori Wendin

Photographer Sharon Palmer, RDN Published by Harvard Medical School Gregory D. Curfman, MD, Editor in Chief Urmila R. Parlikar, Senior Content Editor In association with Belvoir Media Group, LLC, 535 Connecticut Avenue, Norwalk, CT 06854-1713. Robert Englander, Chairman and CEO; Timothy H. Cole, Executive Vice President, Editorial Director; Philip L. Penny, Chief Operating Officer; Greg King, Executive Vice President, Marketing Director; Ron Goldberg, Chief Financial Officer; Tom Canfield, Vice President, Circulation. Copyright © 2016 by Harvard University. Permission is required to reproduce, in any manner, in whole, or in part, the material contained herein. Submit reprint requests to:

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“Good” fats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 “Bad” fats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Picking healthful protein. . . . . . . . . . . . . . . . . . . . . . . . . . . 20 The best protein choices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 What about red meat? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 The lowdown on dairy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Vitamins, minerals, and phytochemicals. . . . . . . . . . . . . . . 25 The benefits of food vs. supplements . . . . . . . . . . . . . . . . . . . . 25 Does your diet deliver the recommended dose?. . . . . . . . . . . . . 26 The power of phytochemicals . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Making healthy beverage choices . . . . . . . . . . . . . . . . . . . 29 Water on tap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Coffee and tea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Drinks to limit or avoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . What about alcohol?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29 29 31 31

Putting it all together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Meal planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sneaking in more vegetables . . . . . . . . . . . . . . . . . . . . . . . . . . Reaping nature’s sweet reward: Fruits . . . . . . . . . . . . . . . . . . . . Boosting flavor with herbs and spices . . . . . . . . . . . . . . . . . . . . Trimming salt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Powering up with probiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . Are organics worth it?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Restaurant survival strategies. . . . . . . . . . . . . . . . . . . . . . . . . .

32 34 35 36 37 38 39 40

Snack food makeover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Smarter snacks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Six snacking strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Get moving!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

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A well-rounded exercise program. . . . . . . . . . . . . . . . . . . . . . . . 44 Sit less—walk more. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

ISBN 978-1-61401-115-6

SPECIAL SECTION: Healthy recipes. . . . . . . . . . . . . . . . . . . . 46

The goal of materials provided by Harvard Health Publications is to interpret medical information for the general reader. This report is not intended as a substitute for personal medical advice, which should be obtained directly from a physician.

Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Dear Reader, Stroll down the aisles of your supermarket, and you will see a burgeoning array of food products that claim to be healthy. But which foods are actually best for your health? We’ll give you a hint. If your diet consists mainly of foods in boxes or other packages, it’s probably not the healthiest. As scientific research continues to affirm, the dietary patterns that are most closely linked to a longer, healthier life tend to be absent of foods that have been peeled, pulverized, and mixed with sugar, salt, and a load of chemicals. Rather, healthy diets are filled with unprocessed or minimally processed foods—that is, whole grains, legumes, fruits, vegetables, and nuts. In January 2016, the USDA and the U.S. Department of Health and Human Services released the newest version of the Dietary Guidelines for Americans—the culmination of our nation’s top nutrition experts’ efforts to review the body of nutrition science and create dietary recommendations that have the potential to make Americans stronger and healthier. The committee stressed the importance of eating more whole plant foods, as well as fish and healthy fats. When you fill your diet with these “real” foods—such as steel-cut oats, pinto beans, blueberries, almonds, and spinach—you not only gain vitamins, minerals, fiber, and hundreds of healthful compounds called phytochemicals. You also crowd out of your diet less healthful processed foods, such as sugary beverages, doughnuts, and cookies, which have been linked with obesity, heart disease, high blood pressure, and type 2 diabetes. Even processed or cured meats such as bologna and bacon are more problematic than, say, minimally processed fish. In 2015, the World Health Organization classified cured and processed meats as potentially cancer-causing. But healthy eating goes beyond nutrition. How you eat food—whether you eat in front of your computer screen or in the car versus sitting down and savoring your meals in the company of others—makes a difference, too. The more you pay attention to the complex flavors, textures, and aromas of your food, the greater the satisfaction you will reap. As a result, you can be content with less food than if you mindlessly devour a bag of chips while watching TV. As nutrition researchers, we have spent years learning to understand both the positive and negative effects that food can have on the human body. And in the pages of this report, we will show you just how easy it is to achieve this simple, wholesome lifestyle that can help you live a longer, healthier life. Bon appétit! Sincerely,

Teresa Fung, Sc.D., R.D., L.D.N. Faculty Editor

Sharon Palmer, R.D.N. Nutrition Editor

Harvard Health Publications | Harvard Medical School | 10 Shattuck Street, Second Floor | Boston, MA 02115

A healthy eating style

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mericans spend an estimated $40 billion each year on diet plans, each of which seems to propound some theory as to why it is the healthiest way of eating or losing weight. But latching onto every new trend is not likely to help you. Fad diets may come and go. But the optimal diet for good health, low disease risk, healthy weight, and long life has been a matter of growing consensus over the last several decades, thanks to a hard-earned body of evidence. Researchers at Harvard are among those who have helped to establish that solid base of knowledge, which shows, among other things, just how powerful the effects of a healthful diet can be. Dr. Walter Willett, chair of the Department of Nutrition at Harvard T.H. Chan School of Public Health, is one of the leading nutrition experts in the world and has devoted much of his career to understanding which aspects of diet play a role in optimal health. “When we began our research on diet and health in the late 1970s, we had a general sense that diet was likely to be important in the prevention of heart disease and cancer,” he says. Over the decades, he and other researchers have confirmed that a healthy diet can help ward off those ailments and others, too. “Aspects of diet play a role in the prevention of disease and dysfunction in almost every organ of the body, including cataracts, infertility, and neurodegenerative conditions, in addition to cardiovascular disease and cancer,” he says. A healthy diet is more important now than ever. More than two in three adults in the United States are overweight or obese, according to the National Institutes of Health. At the same time, preventable, chronic diseases are major killers in our country. Heart disease is responsible for one in four deaths, according to the Centers for Disease Control and Prevention (CDC), and type 2 diabetes is on the increase, with more than 9% of the population affected. Our current eating style—known as the Western diet—contributes to this burden of poor health. But it 2

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doesn’t have to be this way. The concepts in this Special Health Report will give you the information and practical tips you need to remake your diet in the healthiest way possible, based on the latest scientific evidence. Yes, this plan involves eating more vegetables, along with other whole foods—that is, foods like fruits, nuts, and whole grains that are unprocessed or minimally processed. And, as you may have guessed, it doesn’t include a lot of packaged snacks or fast food. But once you know how to prepare healthy meals, you’ll find they can be much more tasty than processed foods. As Dr. Willett says, just think of sitting at an outdoor restaurant in Italy, savoring roasted vegetables in olive oil, perfectly seasoned with herbs and spices. Add in a hunk of hearty whole-grain bread and an entrée of fresh grilled fish, and you can readily imagine just how satisfying this whole-foods diet can be. Now compare that with greasy fried foods and chips at the local diner. “It’s junk food that’s tasteless, requiring large amounts of added salt, sugar, and fat to make it palatable,” he says. If you’re convinced, then there’s no time like the present to start remaking your diet. You have nothing to lose—except perhaps a few unwanted pounds and points off your blood cholesterol and blood pressure numbers.

In search of a healthy diet Surprisingly, given the demonization of both fat and carbohydrates in the media in recent memory, the quest for a healthy diet does not begin with drastically reducing either one. In fact, fat, carbs, and protein all play important roles in the body. Collectively, these three food components are known as macronutrients because the body requires relatively large amounts of each of them (as opposed to micronutrients—essential vitamins and minerals—which are needed in much smaller amounts). w w w.h ealt h .ha r va r d.e du

The key to a healthy diet does not hinge on eliminating any of them, but on picking the best sources of all three. In the lingo of the popular media, there are “good” and “bad” carbs. Similarly, there are healthful and not-so-healthful sources of fat and protein. The more you can tilt your diet in favor of the beneficial ones while reducing the others, the better off you’ll be. It may sound like a daunting task sorting out one from the other, but it’s easier than you’d think. The first rule of thumb is simply to stick with whole foods as much as possible—that is, foods that most closely resemble the natural food. We don’t mean you should eat everything raw. Cooking is fine. Recipes are fine. But start with real ingredients—fruits, vegetables, nuts, whole grains, fish, eggs, skinless poultry. The more a food has been processed before you purchase it, the more goodness has likely been stripped away. The second rule of thumb is to increase the amount of plant foods in your diet. Research increasingly shows that a diet based on fruits, vegetables,

legumes, and whole grains is healthier than one based on large quantities of meat. Rather, think of meat as an accompaniment, not the centerpiece of your meal. The third rule of thumb, of course, is to limit your calories, so that you don’t put on a lot of excess weight. The writer Michael Pollan summed up these points neatly in the opening of his 2008 book In Defense of Food: An Eater’s Manifesto: “Eat food. Not too much. Mostly plants.” This chapter and those that follow will help explain these concepts in greater depth.

Harvard’s Healthy Eating Plate By now you know generally what constitutes a healthy diet. But how do you put it into practice? Over the years, many of us have become used to thinking of the hunk of meat in the center of our plates as “dinner.” The salad or vegetables on the side were fine addons, but not the star attraction. But in recent years,

Figure 1: Harvard’s Healthy Eating Plate

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nutritionists have overturned that view. In 2011, the U.S. Department of Agriculture (USDA) introduced MyPlate—a graphic representation of the ideal dinner. It moved protein to the side of the plate and gave larger roles to vegetables, fruits, and grains. However, for many people, this model (which is still in use) proved too simplistic to be useful. To illustrate what a healthy diet should look like, nutrition experts at Harvard developed Harvard’s Healthy Eating Plate in September 2011. The Healthy Eating Plate gives you basic guidance on food choices and shows you how to apportion foods on your plate (see Figure 1, page 3). Of course, not every meal will look like this (most of us don’t eat vegetables at breakfast), but your meals over the course of the day can add up to this goal. Here is a summary of the main points: • Fully half your plate should contain fruits and vegetables. Most Americans don’t get enough vegetables, so the more you can add, the better. While you’re at it, aim for a variety of colors and types. (Note that for these purposes, potatoes—including French fries—don’t count as vegetables.) • A quarter of the plate should be filled with whole grains—not just any grain. Whole and intact grains, such as barley, quinoa, oats, and brown rice, are good choices. • The final quarter should consist of healthful sources of protein, like fish, beans, nuts, seeds, poultry, and eggs. High-fat meats and processed or cured meats don’t appear here. And red meat and cheese should be limited. • The bottle on the left side is a reminder to use healthy oils like olive and canola in cooking, on salads, and at the table. Limit butter, and avoid unhealthy trans fat (a mostly manufactured fat that is linked to an increased risk of heart disease). • The glass on the right side is a reminder to drink low- or no-calorie liquids like water, coffee, and tea. Skip sugary drinks, and limit milk to one or two servings per day. • At the bottom is a reminder to stay active for good health and weight control. Other models of science-based guidelines are also available. You can find eating pyramids adapted to 4

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Mediterranean, Latin American, Asian, African, and vegetarian diets from the respected nutrition think tank Oldways, at www.oldwayspt.org.

Choose whole foods first Why do researchers and nutritionists place so much emphasis on whole foods? It’s actually quite simple. You gain the most benefit from foods when you consume them in their whole or minimally processed form—the form that comes closest to matching their natural state when harvested. In unprocessed form, fruits, vegetables, legumes, nuts, and whole grains contain a wealth of vital nutrients, such as fiber, vitamins, minerals, and phytochemicals (compounds with antioxidant and anti-inflammatory effects). In fact, there are thousands of phytochemicals in plants, with new ones being discovered all the time. These compounds not only provide health benefits, but also work together to provide even greater effects. Unfortunately, many of them are stripped away in processing. Even healthful foods, such as spinach, whole wheat, and beets, become less nourishing when they are processed so heavily that they hardly resemble their original selves. Some examples are the spinach in “vegetable” chips, the wheat in “wheat” bagels made from refined flour, and the beet sugar used in candy bars. These plant foods start out as something wholesome and health protective, thanks to their cache of hard-working fiber, vitamins, minerals, and phytochemicals. In their whole form, they have the power to help protect your eyes, heart, brain, and more. Yet when they are peeled, ground up, juiced, and stripped of various components—as they are in many processed foods—they lose a great deal of those valuable nutrients along the way. The peel and seeds are usually lost—and these, along with the fibrous pulp, are often the most highly concentrated sources of nutrients in the entire plant. Processing may also degrade sensitive nutrients in the plant, such as vitamin C and many of the B vitamins. And when these processed ingredients are combined to form new foods—such as chips, crackers, cookies, desserts, and beverages—refined sugars, sodium, and fats are often added to the mix. So what w w w.h ealt h .ha r va r d.e du

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you eat more of these plant foods, they tend to replace less healthful foods in your diet, such as fatty meats and high-fat dairy. A plant-based diet can be as tasty as it is healthful. But if you’ve never eaten this way, it can be challenging at first to figure out how to boost your consumption of plant foods. Here are some tips to help you get started. You’ll find more later, in the chapter “Putting it all together” (see page 32), plus a selection of healthy recipes in the special section (see page 46). • Turn your favorite meals into plant-based dishes. If you like lasagna, try eliminating the meat and substituting mushrooms and spinach. Skip ground beef in your burritos in favor of pinto beans. • Find easy recipes for at least a few meatless meals and try to have one or two each week. Some good options are vegetarian chili and veggie burgers. • Instead of animal protein, eat at least 3 cups a week of legumes (see page 21), such as beans, lentils, and peas. There are many ways to enjoy legumes. Toss chickpeas into a salad, add beans to a stew, or include lentils in a loaf. • Include more whole soy foods—another good Packing your plate with more plant foods can help source of plant-based proprotect you from chronic diseases, lengthen your life, tein. Snack on dry roasted and help you maintain a healthy weight. edamame, which you can Focus on plants buy in ready-to-eat packPacking your plate with ages in many supermarkets. Add tofu instead of more plant foods than animal foods may protect you chopped chicken or turkey to your favorite cassefrom disease, lengthen your life, and help you mainrole or other recipe (see “Tofu-Mushroom Tacos,” tain a healthy weight, according to a number of recent page 48). Find a brand of soy burger to replace studies. A large trial called EPIC (European Prospecground beef in your bun—looking for those that tive Investigation into Cancer and Nutrition), which have fewer artificial ingredients and more whole included more than 74,000 adults, found that closer ingredients, such as vegetables, grains, and beans. adherence to a plant-based diet was linked with lower • Combine simmered whole grains, sautéed or raw risk of death from all causes. vegetables, and cooked legumes on your plate. This Why are plant foods so beneficial for your health? age-old combination provides the perfect combinaTo begin with, they are rich in fiber, vitamins, minertion of proteins and nutrients to fuel your body. als, healthy fats, and phytochemicals. Moreover, when do you end up with? A serving of highly caloric food with few nutrients in return. Just walk down the aisle of a supermarket or peruse the menu at a fast-food restaurant and you’ll see many examples of such foods: sugary cereals made of processed grains, salty chips made of peeled, fried potatoes, and juice drinks and fruit turnovers made with refined fruits and sugars. That’s why it’s so important to focus on nutrient-rich, whole foods. That means choosing oranges instead of orange juice, wheat berries instead of white bread, and steamed zucchini instead of deep-fried zucchini wedges. The principle even carries over to fish and poultry, where you’ll do better to focus, say, on fish fillets rather than battered, fried, preformed fish sticks, or a chicken breast rather than chicken nuggets. You’ll find most of these highly processed foods in packages, boxes, bags, and drive-throughs. By contrast, whole foods, such as kale, an apple, a scoop of barley kernels, and a handful of peanuts, don’t often come in splashy packages and boxes. They may not even come in a package at all—a good indicator of a whole food. Purchase most of your foods in their whole form for optimal health.

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The Dietary Guidelines for Americans The U.S. government provides nutrition guidance for Americans that is updated every five years by the USDA and the U.S. Department of Health and Human Services. The Dietary Guidelines for Americans represent the work of a committee of scientists who analyze reams of nutritional research as it relates to national health problems, such as our high rates of obesity, cardiovascular disease, cancer, and type 2 diabetes. They debate the evidence and ultimately make recommendations to the government. As such, the guidelines distill the latest nutritional research and translate it into practical advice. The latest version­—the 2015–2020 Dietary Guidelines for Americans—provides very similar advice to what you will read in this report. The guidelines encourage people to consume more whole or minimally processed plant foods with the aim of reducing disease risk, combating obesity, and meeting nutritional needs for optimal health. To that end, they recommend one of three healthful eating plans: • a healthy U.S.-style dietary pattern, which focuses on plenty of fruits, vegetables, and whole grains with moderate amounts of lean meat and poultry, seafood, and low-fat dairy products • a healthy vegetarian-style pattern, which includes lots of fruits, vegetables, legumes, whole grains, low-fat dairy, and soy foods • a healthy Mediterranean-style pattern, which includes a bounty of fruits, vegetables, whole grains, legumes, fish, nuts, seeds, and olive oil. What do all three have in common? They all focus on whole and minimally processed plant foods, such as whole grains, legumes, nuts, seeds, and healthy fats. Following are some of the main take-home messages from the Dietary Guidelines. You’ll find more about all of these topics later in this report.

Foods to reduce The following advice is designed to help you find the best sources of carbohydrates, fat, and protein, while limiting salt. • Reduce daily sodium intake to less than 2,300 milligrams to help control your blood pressure. Further reduction of sodium to no more than 1,500 6

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milligrams per day may be beneficial for even better effects on blood pressure, and is recommended for those who have high blood pressure (hypertension) or prehypertension. Avoiding processed foods is one way to limit salt intake, since 80% of the salt in the average diet is not from what you add in your kitchen or at the table, but what is contained in packaged, prepared, and processed foods. Use spices and herbs rather than salt to make food more flavorful. • Consume less than 10% of calories from saturated fats. These fats are found in animal products such as butter, cream, cheese, fatty meats, and tropical oils, such as palm, palm kernel, and coconut oil. Instead, try replacing them with monounsaturated and polyunsaturated fats, such as vegetable oils, olives, nuts, seeds, and avocados. (Editors’ note: Red meat, such as beef, pork, and lamb, tends to be high in saturated fat, so it’s best to limit your consumption of these. According to the American Institute for Cancer Research, you should also avoid cured and processed meats, such as ham, sausage, and bacon.) • Eliminate artificial trans fats, such as those found in partially hydrogenated oils. These fats have been linked to heart disease. In 2015, the FDA issued a ban on trans fats in processed foods, but manufacturers have until 2018 to comply; until then, it’s worthwhile to check food labels for them (see Figure 2, page 7). Because amounts less than 0.5 grams can be listed as 0, you should also check ingredient lists for partially hydrogenated vegetable oils. • Limit added sugars to no more than 10% of total calories (about 50 grams or 12.5 teaspoons of sugar for the average person). • Limit the consumption of foods that contain refined grains, such as white flour and white rice, especially those products that contain high amounts of saturated fat, trans fats, added sugars, and sodium. • If you drink alcohol, do so in moderation, meaning no more than one drink per day for women and two drinks per day for men. Saving all your drinking for the weekend means that you take in unhealthy amounts of alcohol at a single sitting. Those who are pregnant or under the legal drinking age should not drink at all. w w w.h ealt h .ha r va r d.e du

Foods to increase While you focus on reducing the previously named foods and food components in your diet, replace them with these healthier foods and nutrients. • Increase your vegetable and fruit intake. Adults should consume about 2½ to 3 cups of vegetables and 1½ to 2 cups of fruit per day. A 2015 report from the CDC found that only about one in 10 Americans eats enough fruits and vegetables. • Also focus on increasing the variety of produce you consume. Eating a broad range of fruits and vegeta-

bles—especially dark green, red, and orange vegetables and fruits—will ensure that you also take in a broad range of nutrients. • Make sure that at least half the grains you consume are whole grains (such as brown rice, barley, or quinoa) rather than refined grains (such as white bread and white rice). • Choose more plant-based proteins, such as beans, peas, lentils, nuts, seeds, and soy foods, including tofu, tempeh, and soy milk. • Make healthy animal protein choices, including

Figure 2: How to read food labels Most of the truly healthful foods like fruits and vegetables don’t have nutrition labels on them. Packaged foods, on the other hand, do, and reading the label is your best guide to choosing the best options. How can you tell whether one breakfast cereal, for example, is better than another? Compare them by checking the Nutrition Facts panel.

Start here. The first place to look is the serving size, which influences all of the nutrient amounts listed on the label, and the number of servings in the package. If you’re eating double the serving size, you’re getting double the calories, sodium, and saturated fat.

Limit these nutrients. The nutrients listed first are identified in yellow in this diagram because they should be limited. Eating too much saturated fat, trans fat, or sodium may increase your risk of certain chronic diseases, like heart disease, some cancers, or high blood pressure.

Get enough of these nutrients. Aim to get enough dietary fiber, vitamin A, vitamin C, calcium, and iron (identified in blue) to improve your health and help reduce the risk of some diseases and conditions.

Check calories. Calories provide a measure of how much energy you get from a serving of this food; keeping track of this can help you manage your weight. A general guide: • 40 calories is low. • 100 calories is moderate. • 400 calories or more is high.

Percent Daily Value (% DV). This helps you determine if a food is high or low in a nutrient. A quick guide: • 5% DV or less is low. • 20% DV or more is high.

Footnote. This footnote tells you the Daily Values (recommended intakes) for certain nutrients, based on a 2,000-calorie-a-day diet. If you consume more calories, your recommended intake will be higher, as shown in this example.

Source: FDA.

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seafood (at least twice a week), poultry, and eggs. • Use healthy vegetable oils to replace solid fats where possible. • Choose foods that provide more potassium, fiber, calcium, and vitamin D, which are nutrients that many Americans don’t get enough of (see “Shortfall nutrients,” page 26). These foods include vegetables, fruits, whole grains, legumes, nuts, seeds, seafood, and milk and milk products.

Sustainability on the plate If you follow the guidelines in this chapter, your health will benefit. But there is another plus to this healthful, whole-foods diet—the health of our planet. Experts are increasingly concerned that our animal-heavy diets and the agricultural policies that sustain them are leading to climate change, greenhouse gas emissions, degradation of water and soil, toxic manure runoff, and the clearing of old-growth forests. The good news is that the best eating style for human health also leaves the lightest footprint on the earth. Compared with animal foods, plant foods require a fraction of the water, acreage, and energy to produce. That means a plantbased, whole-foods diet, with only a small amount of animal foods, can substantially reduce your environmental impact and help sustain our planet. Your diet may be one of the most powerful ways that you as an individual can affect the environment. A plant-based diet is linked with lower carbon emissions, according to a major study called the Adventist Health Study 2. It’s also linked with lower use of resources such as water and fossil fuels, less methane and manure production, and more efficient use of land than a meat-heavy diet. In fact, the United Nations Environment Program now endorses a global shift toward a more plant-based diet to curb climate change and environmental degradation. Its experts estimate that agriculture—especially the raising of cattle and other animals—accounts for 70% of global

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freshwater consumption, 38% of total land use, and 19% of the world’s greenhouse gas emissions. Here are some of the best ways to make your meals more sustainable: • Eat a plant-based diet. Replace red meat with more plant proteins, such as beans, lentils, soy, and peas. • Purchase more foods that are grown closer to home to reduce the number of miles your food has to travel to get to your plate. Also eat more foods that are in season, so that they are not trucked or flown in from faraway places. • Avoid food waste. Every time you throw away food, gallons of water, fossil fuels, and agricultural inputs used to grow the food go in the trash, too. • Choose more whole foods. Foods that are processed require more resources—fossil fuels for production and transportation, for example—compared with simple food, like an ear of corn or a tomato. • Don’t use bottled water. Bottled water uses fossil fuels to produce the plastic bottles, as well as to transport them. Not to mention countless bottles go into the landfill. • Grow your own food. Even if it’s just a tomato plant or a fruit tree, try to produce some of your own food to reduce food transportation. • Buy organic, when possible. Organic foods are grown without the use of synthetic herbicides, pesticides, and fungicides that kill off all life forms in soil—good and bad alike. What’s more, the longest ongoing study of organic food production, conducted by the Rodale Institute, shows that organic soil absorbs more carbon from the atmosphere and that organically raised crops are more drought tolerant than conventionally raised crops, thanks to their sturdier root systems (see “Are organics worth it”? on page 39). • Don’t overeat. Every time you consume more calories than your body needs, you’re consuming more resources required to produce that food. Bonus: you’ll help manage your weight at the same time. 

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Choosing healthful carbohydrates

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C

When you compare these arbs have gotten a bad reputwo groups of carb-rich foods, tation, taking a beating from it’s easy to see the difference. The proponents of both the Paleo “good” carbs come packed with diet, which recommends eating healthful fiber, vitamins, minermore meat and no grains, and als, and phytochemicals, while the Atkins diet, which emphathe “bad” carbs are stripped sizes high-protein, low-carb of these nutrients and provide fare. However, carbohydratelittle more than unneeded calorich foods are important for ries. In addition, these refined your health. This macronutrient, carbs—void of their fiber packwhich is found in a wide range of ages—are often absorbed quickly healthful foods (as well as not-sointo the bloodstream, where they healthful foods), provides your impair the body’s ability to manbody with a source of energy to age blood glucose levels. Over fuel your daily activities. And time this may lead to type 2 diacarb-containing foods, such as betes, which raises your risk for whole grains, vegetables, fruits, Quinoa, once a staple food among the Incas, is high in nutritional value. Quick to cook, it works a number of additional serious and legumes, are rich in other conditions, such as heart disease, important nutrients your body well in salads and side dishes. kidney problems, eye and nerve needs, including fiber, vitamins, and minerals. If you significantly reduce your intake damage, and cognitive impairment. That’s not all. New research has also linked a high intake of refined carboof carbs, you will likely fall short on these nutrients. That’s why a set of guidelines known as the accept- hydrates—the “bad” carbs—with an increased risk for able macronutrient distribution ranges, or AMDRs cardiovascular disease and obesity. In contrast, research links whole grains, legumes, (see “Dietary alphabet soup,” page 10), recommend that your daily menu should supply 45% to 65% of vegetables, and fruits—the “good” carbs—with a your calories from carbohydrates. If you include fruits, reduced risk of heart disease, certain types of cancer, vegetables, and whole grains at each meal and snack, type 2 diabetes, obesity, and cognitive impairment. you’ll easily achieve this level of healthy carbohydrates. Interestingly, research even suggests that the phytoThe important thing, then, isn’t to avoid carbs in chemicals in plants, which act as antioxidants, may general, but to pay more attention to the types of carbs help promote more stable blood glucose levels—addyou choose. The ones to avoid are those in processed ing to the effects of fiber found in whole plants. foods. That includes foods made out of refined grains (such as white pasta and snacks) and refined sugars (such as sweetened beverages, desserts, and baked “Good” carbs goods). Instead, most of your carb choices within your What puts a carb-containing food on the “good” list? healthy diet pattern should come from whole or mini- When you consume a diet that’s rich in minimally promally processed carb-rich foods, such as whole grains, cessed or whole carbohydrate-rich foods, such as whole legumes, vegetables, and fruits. grains, legumes, vegetables, and fruits, you gain all of

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Dietary alphabet soup: What are RDAs, DRIs, and DVs?

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ost people have heard of Recommended Dietary Allowances (RDAs). But how do they differ from DRIs and DVs? Here’s some help.

broader range of nutrients. DRIs are what underlie the Dietary Guidelines for Americans and food labeling regulations. They include RDAs, AIs, and AMDRs (see below).

Recommended Dietary Allowance (RDA): RDAs were established 70 years ago by the Food and Nutrition Board of the Institute of Medicine to prevent diseases caused by inadequate intake of a specific nutrient—for example, scurvy resulting from a lack of vitamin C or rickets caused by insufficient vitamin D. RDAs give the average minimum amount of a nutrient that’s needed to prevent a nutrient-deficiency disease and maintain good health in most healthy people in a particular life stage and gender group. RDAs are now a subset of the broader dietary reference intake values (see below).

Adequate intake (AI): This is a value based on approximations of nutrient intake (made by scientific observation) for groups of healthy people. It is used when an RDA can’t be determined.

Dietary reference intake (DRI): Introduced in 1997, DRI values were created to cover a broader range of nutrients and minerals—and the intent is not just to prevent diseases that are caused by the lack of a single nutrient (which are fairly rare in the United States), but also to enhance health and reduce the risk of chronic diseases such as osteoporosis, cancer, and cardiovascular disease by optimizing the intake of a

Figure 3: Whole-grain anatomy Endosperm Bran

Acceptable macronutrient distribution range (AMDR): This is the range of intake for a particular macronutrient—fat, carbohydrates, or protein—that is associated with reduced risk of chronic disease while allowing intake of essential nutrients. Daily Value (DV): This reference number, developed by the FDA, is designed to help consumers determine if a food contains a lot or a little of a specific nutrient, based on the RDA or AI for that nutrient. DVs—which are used on Nutrition Facts panels—don’t take into account your age, sex, or other factors affecting your daily calorie needs. They’re presented as percentages of total daily intake, calculated for an average person eating 2,000 calories a day.

the rewards of those nutrients they are packaged with, namely fiber, vitamins, minerals, and phytochemicals. Most people intuitively grasp that fruits and vegetables are healthful. But what about whole grains? These constitute one of most misunderstood food groups in this category, thanks to a number of popular diet books and websites bashing grains in general, including whole grains. So let’s set the record straight.

Whole grains Germ

A whole grain is one that contains all the essential parts of the intact grain seed in their original proportions. The three basic constituents of the seed are the vitamin- and mineral-rich embryo, known as the germ; starchy endosperm that serves as the seed’s initial fuel source as it begins to sprout; and the fiber-rich bran coating that surrounds them both. Refined grains, such as white flour, are stripped of bran and germ during processing, depriving them of these rich sources of nutrients. Source: Oldways Whole Grains Council.

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Hundreds of studies link a diet pattern rich in whole grains with a plethora of health benefits, including a reduced risk of cardiovascular disease, type 2 diabetes, and colorectal cancer. In fact, a recent analysis including more than 350,000 participants in the NIH-AARP Diet and Health Study found that whole-grain consumption was linked with reduced rates of death, both from specific causes and in total. Why are these simple plant foods—essentially the seed of grasses—so protective? One reason is the fiberrich outer covering called bran (see Figure 3, at left), which slows down the breakdown of starch into glucose and helps the body maintain a steady blood sugar w w w.h ealt h .ha r va r d.e du

level. Fiber also helps lower cholesterol and move food through your digestive tract. The embryo, or germ, is equally important, containing a wealth of vitamins and minerals, as you’ll realize if you’ve ever read the Nutrition Facts on a package of wheat germ. Among these nutrients are essential B vitamins and minerals like magnesium, selenium, and copper. If you were to completely eliminate whole grains from your diet—as some fad diets suggest—you’d fall short on many key nutrients needed for optimal health. When looking for whole grains, do not limit your search to whole-wheat bread and crackers, which have undergone processing and may contain varying levels of actual whole grains (see “In search of whole grains,” below right). Many whole grains, such as brown rice and quinoa, can be eaten intact. These grains actually form a diverse category of foods with varying flavors, textures, and nutrients. Here’s a list of whole grains to try. Amaranth. This ancient grain of the Aztecs is a small, beige seed with a mild flavor. Rich in calcium and iron, it is a gluten-free grain and good in porridge, added to pilafs, or ground into whole-grain flour for baking. Barley. Rich in a special type of fiber, called beta glucans, barley has special heart health benefits related to its ability to lower blood cholesterol levels. While barley is well known as an ingredient in soup, this crunchy grain is equally delicious in casseroles, side dishes, and salads. Buckwheat. Not a true wheat, buckwheat is actually a cousin to rhubarb and is naturally gluten-free. Its nutty flavor can contribute to much more than pancakes; try it cooked as a grain (also known as kasha) in salads, side dishes, or soups. Soba is a traditional Japanese noodle that uses buckwheat as a key ingredient. Millet. This grain may be tiny, but it’s mighty, serving as a staple food in many cultures in India and South America, among others. It’s delicious cooked in cereals and desserts, and is ground into flour for breads, such as Indian roti. Oats. Another source of the rare group of fibers called beta glucans, oats (when eaten daily) have been linked with significantly lower blood cholesterol levels. But oats can go beyond the breakfast table in dishes like risotto, breads, and fruit-based desserts. ww w. h ealt h . h ar v ar d . e du

Quinoa. This staple grain from the Andes is high in nutritional value, having served as a revered food among the Incas for thousands of years. Mild and quick-cooking, it’s delicious in side dishes, salads, and vegetable fillings. Rice. Brown, colored (black, purple, or red), and wild rice are all whole grains (although wild rice is not a true rice). This mild-flavored grain, which serves as a blank canvas for nutritious vegetable-rich toppings, is a major source of nutrients to millions of people around the world. Rye. A natural part of the cuisine in Northern Europe and Russia, rye is predominantly featured in whole-grain breads. However, whole rye grains— called rye berries—are delicious steamed and served

In search of whole grains It’s easy to tell that you’re eating whole grains when you serve cooked oats, barley, and brown rice, but it gets a bit more complicated when you’re selecting foods that contain whole grains, such as breads, side dishes, and baked goods. Labels may tout a product’s “whole grains,” even if the product contains very little whole grain. There are a couple ways to help solve this problem. First, scan the ingredients list and make sure that a whole grain, such as whole-wheat flour, oats, cornmeal, or brown rice, appears first on the list, indicating that it has the largest volume by weight in the food. Next, take a look at the grams of fiber on the Nutrition Facts panel. Most true whole-grain products should provide at least 3 grams of fiber per serving—but keep in mind that this may not always tell you the true picture. In some cases, isolated fibers, such as inulin, are added to foods to bring up the fiber levels. And some whole grains, such as brown rice, contain more modest levels of fiber than other whole grains, such as whole wheat or barley. Remember, all whole grains are good for you, so choose a variety every day. Another way is to look for the Oldways Whole Grains Council stamps, which identify foods that provide at least half a serving of whole grains. These stamps may be found on hundreds of food products, guiding you to whole-grain food choices in the supermarket aisle. Source: Oldways Whole Grains Council.

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Fiber Aside from vitamins, minerals, and phytochemicals, fiber is one of the reasons why a diet rich in “good” carbs is so healthy. It is actually a form of indigestible carbohydrate found in plant foods. But though you can’t digest it—and therefore, it isn’t absorbed into your bloodstream—fiber does many useful things while it’s in your digestive tract. Among its many benefits are the following. • It slows down digestion and lowers a food’s glycemic index value, a measure of how quickly the sugar in the food enters your bloodstream (see “Glycemic index and glycemic load,” page 13). • It helps you feel more full for a longer period of time, thus helping to control appetite and weight. • It slightly reduces “bad” LDL cholesterol. • It reduces insulin resistance. • It promotes bowel health. A high-fiber diet correlates with lower rates of heart disease, type 2 diabetes, and obesity. There’s also some evidence that it might reduce the risk for duodenal ulcers, breast cancer, and ovarian cancer, but more studies are needed. How much fiber should you aim for? The recom12

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Table 1: High-fiber foods FIBER (GRAMS)

FOOD

Flaxseed, 1 ounce

8

Lentils, cooked, ½ cup

8

Minestrone soup,* 1 cup

7

Artichokes, cooked, ½ cup

7

Chickpeas, cooked, ½ cup

6

Pears, 1 small

5

Raspberries, ½ cup

4

Almonds, 1 ounce

4

Orange, 1 large

4

Figs, 2 dried

4

Whole-grain breads, 1 slice*

3

Snow peas, fresh, 1 cup

3

Banana, 1 small

3

Whole-wheat spaghetti, cooked, ½ cup

3

Quinoa, cooked, ½ cup

3

Broccoli, cooked, ½ cup

3

Whole-grain hot cereal, cooked,* ½ cup

2

Peanut butter, 2 tablespoons

2

Walnuts, 1 ounce

2 *Amount of fiber varies based on brand. Source: USDA National Nutrient Database for Standard Reference.

mended intake for fiber is 38 grams for men up to age 50 and 25 grams for women in this age group (unless pregnant or breastfeeding, in which case the recommendations go up to 28 grams and 29 grams, respectively). The recommendation is lower for people over age 50: 30 grams for men, 21 grams for women. That’s because older people require less food as their energy needs decline. Sadly, Americans fall short on fiber, consuming on average only about 15 grams of fiber a day. w w w.h ealt h .ha r va r d.e du

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as porridge, a side dish, or a filling for vegetables. Sorghum. With roots in Africa, this whole grain is quite nutritious and may be served as porridge, ground into flour for breads, or even popped like popcorn. Teff. The tiniest of grains, teff resembles reddishbrown poppy seeds. Yet these petite grains pack a nutritional wallop, serving as a staple in Ethiopia where they are the main ingredient in the fermented bread injera. Teff is also delicious in cereals, grain side dishes, and baked goods. Wheat. Though we’re most familiar with wheat as a flour, it also comes in other forms, such as bulgur (used in Middle Eastern salads), farro (an ancient Italian variety of wheat traditionally cooked in its intact form), spelt (a variety of wheat), and wheat berries (cooked, intact wheat kernels).

As with other nutrients, fiber is healthiest when it comes from whole foods rather than processed ones. Some “high-fiber” products on store shelves are filled with isolated fibers, such as inulin—a natural substance found in many plant foods, such as asparagus, artichokes, and chicory, that is added to many food products to increase the total volume of fiber. While inulin has been shown to have some benefits related to nourishing friendly gut bacteria (see “Powering up with probiotics,” page 38), it is not linked with the multitude of health benefits found in foods that are naturally rich in fiber. So prioritize whole-food fiber sources in your diet. It’s easy to meet your fiber goals if you’re loading up on whole plant foods—especially legumes and whole grains. But fruits, vegetables, nuts, and seeds are also good sources. (See Table 1, page 12, for a list of foods that are naturally high in fiber.) Every gram adds up to help you meet your goal. Note that if your intake of fiber is low and you increase it dramatically, you may notice some gastrointestinal symptoms.

“Bad” carbs “Bad” carbs are those that are highly refined, such as processed grains (white flour, white rice), fruit juices, and sugars (from beets, cane, or corn, for example). Because these high-carb foods are highly processed, they are stripped of much of their nutrient value—in particular vitamins, minerals, phytochemicals, and fiber. Without that fiber, the natural starches and sugars are metabolized by the body more quickly, and thus they are absorbed into the bloodstream as glucose more rapidly. That’s one reason why a glass of orange juice isn’t as good for you as a whole orange. While most bad carbs are refined foods, some are exceptions—most notably, potatoes. Although baked potatoes with the skins are whole foods that contain good amounts of potassium and vitamin C, along with some fiber, potatoes have a high glycemic index (see “Glycemic index and glycemic load,” at right), and they have been linked with higher weight, so they should be limited. “Quick-cooking” whole grains are another whole food that can be problematic, since the processing needed to reduce their cooking time can raise their glycemic index value. ww w. h ealt h . h ar v ar d . e du

So which foods are on the “bad” carb list? The following should be limited in the diet: • foods made with large amounts of refined sugars (including table sugar, high-fructose corn syrup, and honey), such as desserts, ice cream, pastries, sweetened yogurt, beverages, and sugary cereals • foods made with refined (white) flour, such as breads, bagels, and baked goods • white potatoes • white rice • quick-cooking oats or grits • fruit juice.

Glycemic index and glycemic load “Bad” carbs are typically digested more quickly than good carbs—a fact that is reflected in a measurement called the glycemic index (GI). In general, highly processed carbohydrate-containing foods, such as white bagels, sugary beverages, and white rice, have a higher GI, while minimally processed carbohydrate-containing foods, such as wheat berries, beans, and spinach, have a low GI. The problem with high-GI foods eaten in isolation is that they tend to flood your bloodstream with sugar all at once, triggering a gush of insulin to clear the sugar from your blood and leaving your blood sugar too low after just a few hours. This can make you feel hungry, which can lead to overeating and weight gain. Over time, a steady diet of high-GI meals may impair your body’s system of responding to insulin, causing a problem known as insulin resistance, which in turn can lead to type 2 diabetes and other problems, such as heart disease and perhaps some cancers. However, the glycemic index doesn’t provide a perfect gauge of what happens when you actually eat a meal. For example, if you eat a mixed meal containing both high- and low-GI foods, the sugar rush is blunted. Furthermore, the measuring system itself has limitations. For instance, there’s no standard cutoff for what constitutes high versus low GI. Some foods have a moderate GI, but you can’t really tell that from the numbers alone. More important, the numbers can be misleading. For example, carrots have a high GI, meaning that the sugar from them hits your bloodstream quickly, Healthy Eating

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but because they contain so few total carbohydrates over all, the amount of sugar you get from them is not a problem. That’s where another measurement called the glycemic load (GL) comes into play. GL takes into consideration the amount of carbohydrates (and therefore calories) in a food, in addition to how quickly those carbs are digested. Thus, carrots have a high GI but a low GL, making the GL a much more accurate picture of the glycemic impact of foods. The bottom line: The GL of foods is a better tool than the GI to help you spot carbohydrate foods that are less refined and more healthful. To achieve a low-GL diet, avoid highly processed foods and try to make a higher proportion of your carbs intact grains, legumes, whole fruits, and vegetables. Following are some ways you can lower the GL of your diet:

• Skip fruit juice and instead focus on whole, unsweetened fruits, such as oranges, apples, and berries. • Replace quick-cooking oats and grits with steelcut oats and whole-grain breakfast cereals. • Limit intake of sugar-sweetened pies, cakes, or cookies. Instead, enjoy lightly sweetened and flavored yogurt with ripe berries or chopped fruit. • Swap out white rice for bulgur wheat, quinoa, or hulled barley. • Trade white bread for whole-grain, whole-kernel, or “flourless” breads. • Instead of baked or mashed white potatoes, choose roasted, cubed sweet potatoes. To learn more about the glycemic index and glycemic load of foods, visit www.glycemicindex.com.

Table 2: How much sugar are you really eating? You expect to find sugar in your ice cream. But many other foods contain added sugar, too—from fruit smoothies to bread, tomato sauce, and yogurt. Here are some examples. (Note that the sugar listed in the Nutrition Facts may include the sugars naturally present in foods, such as dairy products, fruits, and vegetables. That why it’s important to search the ingredients list on a product label for key words such as “cane sugar,” “honey,” or “brown rice syrup” that indicate the presence of added sugars.) SUGAR (grams)

SUGAR (teaspoons)**

Tillamook Nectarine 0% Farmstyle Greek Yogurt,* 1 container (5.3 ounces)

16

4

11

Sara Lee Whole Grain Blueberry Muffin,* 1 muffin

16

4

41

10

15

4

Coca-Cola, 1 can (12 ounces)

39

10

Luna Protein, Chocolate Salted Caramel,* 1 bar

Snapple Peach Tea, 1 bottle (16 ounces)

39

10

Capri Sun Original Fruit Punch,* 1 pouch (177 ml)

13

3

PowerBar, Chocolate,* 1 bar

25

6

Bertolli Tomato & Basil Pasta Sauce,* ½ cup

12

3

McDonald’s Fruit ’N Yogurt Parfait,* 1 parfait (5.2 ounces)

23

6

Thomas Blueberry Bagel,* 1 bagel

11

3

Clif Bar, Blueberry Crisp,* 1 bar

22

6

Prego Traditional Pasta Sauce,* ½ cup

10

3

Gatorade Original Thirst Quencher, 12 ounces

21

5

Pillsbury Blueberry Toaster Strudel,* 1 pastry

9

2

Yoplait Original Mixed Berry Yogurt,* 1 container (6 ounces)

18

5

Thomas Cinnamon Raisin English Muffin,* 1 muffin

8

2

SUGAR (grams)

SUGAR (teaspoons)**

Dunkin’ Donuts Strawberry Banana Smoothie,* small (16 ounces)

45

11

Starbucks Caramel Frappuccino,* tall (12 ounces), with whipped cream

45

Pepsi, 1 can (12 ounces)

FOOD

FOOD

*May include natural sugars in addition to added ones. **1 teaspoon of sugar is equivalent to about 4 grams of sugar; values are rounded to the nearest whole number. Source: Company websites.

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Added sugars Once upon a time, the only sugars we consumed were those naturally present in the foods we ate—the sugars in tomatoes or blueberries, for example. But then humans learned how to extract sugar from sugar cane and beets, and they began adding it to foods. Nutritionists use the term “added sugars” to refer to these sugars, which add calories with no added nutritional value. Nutritious or not, we love the sweet stuff. It seems that everywhere you turn, you see foods with added sugar, from sugary sodas and energy drinks in the gas station, to muffins and cookies in the coffee shop, to candy and doughnuts in the vending machine at work. Not surprisingly, this can contribute a lot of daily calories to a person’s diet. Children and adolescents consumed 16% of their total calories in added sugars during the period from 2005 to 2008, according to a recent analysis. Male adults consumed an average of 335 calories per day in added sugars, and women took in an average of 239 calories per day, according to data from the National Health and Nutrition Examination Survey (2005–2010). Research suggests that increased intake of added sugars is linked with obesity, metabolic disorders, and cardiovascular disease. How much sugar is too much? The Dietary Guidelines now recommend limiting added sugar to 10% of your calories—amounting to roughly 200 calories, or about 50 grams (12.5 teaspoons) of added sugar each day for the average person. That’s not much, when you consider how much sugar is added to foods. To keep sugar in check, your best bet is to enjoy most of your foods in their whole or minimally processed form and to avoid too many packaged foods, prepared entrées, baked goods, and fast foods.

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It’s also important to keep an eye out for “hidden” sugar in foods, which can add up quickly. It’s easy to predict that added sugar will be in sweet things, like sodas, cookies, and cakes. But there is also a lot of added sugar in many products that sound healthy, such as tomato sauce, yogurt (which can be as sweet as ice cream), granola bars (often as sugary as candy bars), and breakfast cereals (see Table 2, page 14). The FDA is proposing new food labels that will indicate how much added sugar a food has. That would help to distinguish natural sugars present in the food from sugars that have been added as sweeteners. Until then, the best way to find added sugars is to look for them in the ingredients list. Steer clear of foods that list sugar, honey, molasses, corn syrup, corn sugar, fructose, or high-fructose corn syrup, since those are clearly added—and especially avoid foods that list them among the first three ingredients, indicating that the product contains a lot. Other sugar aliases to watch for include agave nectar, brown sugar, cane sugar, corn sweetener, dextrose, maltose, fruit juice concentrate, brown rice syrup, and glucose. Note that while “natural” sugars, such as agave, coconut palm sugar, and honey are growing in popularity because they are considered less processed than cane or beet sugar, they are still added sugars and should be limited. In addition, low-calorie or no-calorie sweeteners such as stevia, aspartame, and sucralose are present in many food products, such as yogurt and beverages. While these sweeteners don’t add sugar to meals and appear to be safe, they aren’t always linked with effective weight control. You’re better off enjoying the natural flavor of foods without the addition of sweeteners. 

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Finding the best fats

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few decades ago, people feared fats, which were thought to make you fat, as well as raise your risk of disease. But in recent years, scientists and nutritionists have been re-evaluating the role of fats in the diet. Now we know that, as far as health is concerned, the important thing is not so much the amount of fat, but the type of fat you choose. While the wrong ones can clog your arteries and lead to heart disease, the right kinds can actually lower your risk of cardiovascular trouble. Interestingly, the Mediterranean diet pattern is rich in healthful fats, such as olive oil and those found in nuts and avocados—one reason of many why the diet may be so health-protective. Fat is actually an essential element of the diet. It’s a major source of energy, helping to fuel your activities, insulate your body, and keep you warm. In addition, the body requires fat to make cell membranes, sheath nerves, maintain healthy skin and hair, and perform other vital functions. Fat even aids in the absorption of certain key nutrients from your diet. For example, you need to consume some fat in order for your body to absorb the fat-soluble vitamins—vitamins A, D, E, and K—from the digestive tract into your bloodstream and ferry them about the body once they’ve been absorbed. At the same time, fat slows the absorption of sugar and other refined carbs from your digestive tract. If you eat a box of fat-free cookies on an empty stomach, there is nothing to hinder the rush of sugar from your digestive tract into your bloodstream. But fat slows down the process. That’s a positive thing, because it means that your body isn’t hit with a surge of sugar all at once, but can absorb it more gradually. As for weight gain, the role of fat is paradoxical. True, each gram of fat contains 9 calories, as opposed to just 4 calories per gram for carbohydrates and proteins, so a little goes a long way. If you overload on fats on a regular basis, you can easily increase your calorie intake and end up gaining weight. Yet the plethora of 16

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fat-free products that swamped the market for decades didn’t lead to weight loss. In part, that’s because the fat-free label made people feel they could eat a lot of these products. But it’s also because fat has the virtue of making food taste better and helps you feel more satisfied with less. That’s a lot of benefits for a macronutrient that was demonized for decades. Aim to get 20% to 35% of your daily calories in the form of fat—that’s about 44 to 78 grams of fat for the average person, depending on his or her individual needs. If you include two to three servings of healthy fats each day—such as a handful of nuts or seeds, 2 tablespoons of nut butter or seed butter, half an avocado, or 1 tablespoon of olive or sunflower oil—you’ll be within that range of daily recommended fat intake.

“Good” fats Like carbohydrates, fats can be divided into more healthful and less healthful types. In general, the “bad” fats come from animal sources or are artificially created, and they are solid at room temperature. The socalled good fats come mostly from vegetables, nuts, and fish. You can easily spot them because they are liquid at room temperature. There are two categories of healthy fats­—polyunsaturated and monounsaturated.

Polyunsaturated fats Fish oil, flaxseeds, and sunflower seeds are all sources of the healthy group of fats known as polyunsaturated fatty acids (see Table 3, page 17). Polyunsaturated fats are essential in your diet, meaning that your body can’t manufacture them, so you must get them from food. These fats are required for normal body function, including brain development, inflammation control, and blood clotting. These fats are also important components of cell membranes, affecting the structure w w w.h ealt h .ha r va r d.e du

Table 3: Plant foods containing healthy fats In whole foods, various types of fat are rarely found in isolation. Nuts, seeds, and olives all contain mixtures of fats, including healthful monounsaturated fatty acids, polyunsaturated fatty acids, and alpha-linolenic acid (ALA), along with saturated fat. Although saturated fat is generally regarded as a less healthful form of fat, it is more than balanced out in plant-based foods by the higher levels of healthy fats. Food (1-ounce serving)

Calories

Total fat

Saturated fat

Monounsaturates

Polyunsaturates

Almonds

169

15 g

1g

10 g

4g

Avocado

50

4.5 g

0.5 g

3g

0.5 g

Omega-3s (ALA)

0 mg 33 mg

Brazil nuts

185

19 g

4g

7g

6g

5 mg

Cashews

155

12 g

2g

7g

2g

17 mg

Chia seeds

137

9g

1g

1g

7g

4,915 mg

Flaxseeds

150

12 g

1g

2g

8g

6,388 mg

Hazelnuts

181

18 g

1g

13 g

2g

17 mg

Hemp seeds

160

12 g

1g

1g

9g

2,264 mg

Macadamia nuts

203

22 g

3g

17 g

0g

55 mg

32

3g

0g

2g

0g

18 mg

Peanuts

164

14 g

2g

7g

4g

1 mg

Pecans

199

21 g

2g

12 g

6g

278 mg

Pine nuts

190

19 g

1g

5g

10 g

32 mg

Pistachios

157

13 g

2g

7g

4g

72 mg

Pumpkin seeds

153

13 g

3g

4g

6g

51 mg

Sesame seeds

160

14 g

2g

5g

6g

105 mg

Sunflower seeds

163

14 g

2g

3g

9g

19 mg

Walnuts

185

18 g

2g

3g

13 g

2,565 mg

Olives, ripe, canned

Source: USDA National Nutrient Database for Standard Reference.

and properties of the cell. Some of these fats are found in very high concentrations in cells in the retina and brain. They also reduce total and LDL (bad) cholesterol and triglycerides. There are two major types of polyunsaturated fats—omega-3 fatty acids and omega-6 fatty acids. Both offer health benefits. Omega-3 fatty acids. These can consist of either longer or shorter chains of carbon, hydrogen, and other atoms. Research has shown that the long-chain omega-3s in fish and fish oil—specifically, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—help prevent and even treat heart disease and stroke. These fats help reduce blood pressure, lower triglycerides, and prevent heart rhythm disorders, and ww w. h ealt h . h ar v ar d . e du

may raise HDL (good) cholesterol. Evidence also suggests they help reduce the need for anti-inflammatory medications in people with rheumatoid arthritis. Fatty fish, such as salmon, mackerel, and sardines, are especially good sources of omega-3s. Of course, you can buy omega-3 supplements, too. Studies have found that these supplements may reduce cardiac events and the progression of heart disease. However, the evidence suggests that consuming omega-3s in food is more effective than taking them in supplement form. When you consume food sources of omega-3 fatty acids—namely, oily fish and other seafood—you not only gain the healthy fats together with other beneficial compounds present in the food, but you also replace something on Healthy Eating

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your plate—often something less healthy, such as red or processed meat. While the most helpful omega-3s are the longchain ones found in seafood, there is also a short-chain type of omega-3 fatty acid, called alpha-linolenic acid (ALA), that is found in some plants, such as flaxseeds, walnuts, canola oil, and soy. The body can convert ALA into the long-chain omega-3s—EPA and DHA. However, it is not very efficient at doing this, so to ensure that you get enough EPA and DHA, you should consume them in your diet regularly. That said, ALA has some health benefits of its own. Studies have linked it with a reduced risk of certain heart conditions and inflammatory diseases. The adequate intake, or AI (see “Dietary alphabet soup,” page 10), for ALA is 1.6 grams per day for men and 1.1 for women. No AI has been established for EPA and DHA. Omega-6 fatty acids. These fats get relatively little attention in the media, but they may help protect against heart disease, too. Research shows that replacing saturated fats with polyunsaturated ones, including omega-6 fatty acids, consistently lowers levels of LDL (bad) cholesterol—and a pooled analysis of studies found that replacing 5% of total energy intake of saturated fats with omega-6s could reduce the risk of heart attacks, strokes, and similar events by 13% and heart-related deaths by 26%. Linoleic acid, the omega-6 that appears to lower LDL the most, can be found in abundance in such vegetable oils as safflower, soybean, sunflower, walnut, and corn oils. These are good oils to use in sautéing foods, making salad dressings, and baking. (Be aware, however, that high-oleic safflower and sunflower oils, often used in chips, have much lower omega-6 content.) The AI for linoleic acid is 17 grams per day for men ages 19 to 50, 14 grams for men 51 to 70, 12 grams for women 19 to 50, and 11 grams for women 51 to 70.

Monounsaturated fats Olive oil is probably the most famous example of a rich source of monounsaturated fats. While there’s no dietary reference intake set for these fats, the Dietary Guidelines recommend using them as much as possible, along with polyunsaturated fats, to replace satu18

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rated and trans fats in the diet. Monounsaturated fats decrease the risk of cardiovascular disease and type 2 diabetes because they help improve blood cholesterol levels and your body’s responsiveness to insulin. In addition, extra-virgin olive oil, which is cold-pressed and unrefined, contains plant compounds with antiinflammatory activities. Other good sources of monounsaturated fats include olives, canola oil, avocados, and most nuts (and their oils), as well as high-oleic safflower and sunflower oils. All you have to do is look to the Mediterranean diet pattern, with hundreds of studies showing health benefits, to see an example of a diet pattern rich in monounsaturated fats.

“Bad” fats Just as there are healthy fats, so are there unhealthy fats—namely, trans fats and saturated fats. Such fats boost your chances of developing heart disease by increasing blood levels of LDL (bad) cholesterol and triglycerides. Trans fats also lower levels of protective HDL cholesterol, so they’re even worse. That’s why the Dietary Guidelines recommend avoiding them in your diet. How do you spot these unhealthy fats? It’s easy because they’re solid at room temperature. Think of stick butter, shortening, or the fat in meat. But you’ll also find bad fats in some liquids, too, including whole milk and cream.

What’s up with coconut oil? Coconut oil is a trendy new ingredient, turning up in a broad range of food products, health food stores, and media stories. Many so-called experts claim that coconut oil is some sort of tonic, good for all sorts of benefits, such as “burning” fat, killing viruses, lowering cholesterol, and reducing seizures. However, there is little evidence to back up the hype. Coconut oil is made up of 90% saturated fat, which raises LDL (bad) cholesterol. Indeed, if you see a bottle of coconut oil, you’ll notice that it’s solid at room temperature— a hint that it is high in saturated fat. Some people point to the fact that about half the saturated fat comes in the form of lauric acid, which boosts HDL (good) cholesterol. But, given the dearth of data supporting its use, you’re best off limiting it for now and using healthier vegetable oils, such as olive oil and soybean oil.

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Trans fats Trans fats have become the poster child for poor nutrition—this type of fat has no known nutritional value, and there is no safe level of consumption. Although some trans fats occur naturally at very low levels in foods such as in meat and dairy, health experts are mostly concerned about those that are man-made, in the form of partially hydrogenated oils—a once-ubiquitous ingredient found in processed and fried foods. Partially hydrogenated oils are steadily vanishing from the food supply, but you can still find them in products like crackers, cookies, cakes, frozen pies, snack foods, stick margarines, coffee creamers, refrigerated dough products, and ready-to-use frostings. Soon artificial trans fats should be gone for good. In 2015, the FDA took steps to remove artificial trans fat from the food supply for good by taking it off the GRAS (“generally recognized as safe”) list. Manufacturers have until 2018 to complete the process. In the meantime, you can do your best to avoid them by scanning the Nutrition Facts listings, as the FDA requires food labels to list levels of trans fats. But keep in mind a little loophole when it comes to trans fats labeling. Food manufacturers are allowed to list levels below 0.5 grams per serving as “0” in the Nutrition Facts panel. And those amounts can add up quickly. You’re better off scanning food ingredient lists for the presence of partially hydrogenated oils before you purchase foods.

Saturated fats Saturated fat has been the subject of much debate recently, thanks to headlines hinting that these fats are no longer the bad boys of heart health. Unfortunately, many media stories misinterpreted a meta-analysis published in Annals of Internal Medicine in 2014. This study, often cited as “proof ” that saturated fats are not bad, is rife with errors and omissions. The metaanalysis misconstrued research originally performed by scientists at Harvard T.H. Chan School of Public Health, as well as others, according to Dr. Walter Willett, chair of the Department of Nutrition. In addition, the pooled analysis did not include data from studies that found that substituting polyunsaturated fats for saturated fats lowered heart disease risk. In fact, the study has been corrected since it first came out to ww w. h ealt h . h ar v ar d . e du

Table 4: Foods high in saturated fat The following are examples of food products that are high in saturated fat. Eating too many of them can easily put you over your daily allowance. SATURATED FAT (grams)

% DAILY VALUE

Outback Steakhouse Cheese Fries

55

275%

PF Chang’s Butternut Squash Dumplings

53

265%

El Torito Shredded Beef Nachos

41

205%

Sbarro Meat Lasagna

22

111%

Croissant with egg, cheese, sausage

18

91%

Burger King Bacon Double Cheeseburger

17

85%

Banquet Salisbury Steak Dinner

15

73%

KFC Chunky Chicken Pot Pie

13

65%

Au gratin potatoes, 1 cup

12

58%

Cheesecake, one-sixth

8

40%

Butter, 1 tablespoon

7

36%

Fruit danish

7

35%

Domino’s Extravaganzza Feast Pizza, 1 slice

7

33%

Heavy cream, 1 ounce

6

32%

Reese’s Sticks, 1.5-ounce package

5

25%

Cream cheese, 1 ounce

5

27%

Whole milk, 1 cup

5

23%

Bacon, pan-fried, 1 ounce

4

19%

FOOD (per single order or item unless otherwise noted)

Sources: USDA National Nutrient Database for Standard Reference; restaurant websites.

include study results that showed positive effects of omega-3 fatty acids. So, despite news stories suggesting that you don’t need to worry about saturated fat, it’s a good idea to keep levels in your diet low. The Dietary Guidelines, which are based on the entire body of evidence, recommend that saturated fat intake remain below 10% of dietary calories—about 22 grams per day for the average person. That’s because research shows that a diet high in saturated fats elevates harmful LDL (bad) cholesterol. Saturated fats are primarily found in animal foods, including high-fat meats; high-fat dairy products, such as cheese, butter, whole milk, and cream (see Table 4, above); and tropical fats, such as palm, palm kernel, and coconut oils (see “What’s up with coconut oil?” on page 18).  Healthy Eating

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Picking healthful protein

P

rotein is a hot commodity these days. It seems like everywhere you turn, you’re hearing about the importance of this macronutrient. True, protein is important—you need it to maintain your muscles, bones, skin, and every other organ and tissue in your body. Protein has many functions, including building the enzymes that trigger many of the body’s important chemical reactions. A lack of protein in the diet can slow growth, reduce muscle mass, lower immunity, weaken the heart and respiratory system, and even cause death. However, protein deficiency is rare in the United States and other industrialized countries. In fact, the opposite is often true. Americans tend to overestimate how much protein they really need. The recommended intake for protein is 10% to 35% of your total calories—that’s a range of 50 to 175 grams of protein per day for the average person, depending on your energy needs. It’s not difficult to achieve this level of protein intake. All whole foods contain protein— some more than others (see Table 5, below). Protein

Table 5: Good sources of protein These healthful foods contain a hefty amount of protein. PROTEIN (grams)

PERCENTAGE OF CALORIES FROM PROTEIN

Fish, raw, 3 ounces

15

87%

Kidney beans, cooked, 1 cup

15

27%

Low-fat yogurt, plain, 8 ounces

12

33%

Tofu, firm, ½ cup

10

53%

Lentil soup, canned, ½ cup

9

25%

Nonfat milk, 1 cup

8

39%

Peanuts, 1 ounce

7

18%

Broccoli, chopped, cooked, ½ cup

2

28%

FOOD

Source: USDA National Nutrient Database for Standard Reference.

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Healthy Eating 

is even found in whole grains and vegetables, but it’s especially concentrated in foods like meat, fish, poultry, soy, legumes, and nuts. A few servings of proteinrich foods a day, and you’re there. Newer research suggests that some people, such as older adults and athletes, may benefit from slightly more protein to maintain muscle tissue. Other studies suggest that eating enough protein may reduce the risk of heart disease. In the Nurses’ Health Study, the women who ate the most protein—which in this analysis was about 25% of their daily calories—were 25% less likely to have had a heart attack or to have died of heart disease than the women who ate the least protein. However, it’s important to note that when you’re eating less protein, you may be eating more refined carbs, which may help explain these findings.

The best protein choices So which types of protein are best? Start by considering what else you find in the same food. Along with a healthy complement of minerals, does the food in question pack a hefty dose of unhealthful saturated fat (like ground beef)? Or does it come in a lean food with a healthful bonus of side nutrients, such as fiber, vitamins, minerals, and phytochemicals (like lentils)? It’s these other considerations that largely determine whether the proteins you put on your plate will help reduce—or increase—your risk of chronic diseases. Some people also place a high value on the food’s complement of amino acids—the building blocks of proteins. There are 20 amino acids that supply the raw material for the body’s proteins. Following genetic instructions, the body strings together these amino acids into chains to make the specific proteins it needs. Of the 20, only nine are considered “essential” amino acids. Like the essential fats, these are components the body cannot synthesize and must take in from food. w w w.h ealt h .ha r va r d.e du

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pairing grains and legumes. Proponents of meat-heavy For example, Latin cuisines diets often claim that meat is are often based on rice and the superior source of protein beans; any essential compobecause it is a “high-qualnents missing from the beans ity” protein with significant are in the rice. Similarly, in amounts of all nine essential Indian cuisine, rice and dal amino acids. However, you can (lentils) form the basis of many get all nine by eating a variety meals. This formula can apply of plant foods, such as legumes, to many pairings, such as farro soy, and nuts. You may not find and white beans or peanuts significant amounts together and millet, for example. Any in most individual plant foods range of protein-containing (one exception is soy, which plants is likely to supply the has good balances of all nine Fish has been linked with a multitude of benefits, including reduced risks of heart attacks, strokes, nine, so this is not something amino acids, comparable to prostate cancer, depression, and Alzheimer’s disease. you should stress over. levels found in animal proIn order to fuel your body teins), but as long as you consume a variety of plant foods every day, your body with the protein it needs while reducing your risk of chronic disease, focus on the following choices. maintains a pool of amino acids to meet your needs. If you rely on plant foods to supply most of your protein, the easiest way to make sure you get enough Plants high in protein of these amino acids is by eating a range of protein- Legumes. These plant-based foods—including dried containing foods. Many ethnic cuisines do this by beans, lentils, and peas—are not only rich in protein

What to do about mercury in fish

F

ish is an excellent source of protein, and its healthy oils protect against cardiovascular disease. Because a diet rich in seafood protects the heart and aids neurological development, fish remains an important component of a healthy diet. However, nearly all fish and shellfish contain traces of mercury, a toxic metal, and some seafood contains other contaminants known as persistent organic pollutants (POPs). As small fish are eaten by larger fish up the food chain, concentrations of mercury and POPs increase, so that large, predatory deep-ocean fish tend to contain the highest levels. That makes it best to avoid eating large fish, such as shark, swordfish, tilefish, and king mackerel. As long as you avoid these higher sources of mercury, the benefits of eating fish far outweigh the risks of mercury in fish. Recommendations: The FDA recommends that adults should eat up to 12 ounces (two average meals) per week of a variety of cooked seafood as long as they avoid the large predatory ocean fish mentioned above and pay attention to local seafood advisories. For women who are pregnant or may become pregnant, nurs-

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ing mothers, and children ages 12 and younger, the following guidelines apply: • Eat 8 to 12 ounces (two to three meals) a week of a vari-

ety of fish and shellfish that are lower in mercury. Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish. • Another commonly eaten fish, albacore (“white”) tuna, has

more mercury than canned light tuna. So, when choosing your fish, try to select light tuna, and limit albacore to 6 ounces per week. • Follow these same recommendations when feeding

fish and shellfish to your young child, but serve smaller portions. • Check local advisories about the safety of fish caught by

family and friends in your local lakes, rivers, and coastal areas. If no advice is available, eat up to 6 ounces per week of fish from local waters, but don’t consume any other fish during that week. Children under 6 should limit consumption to 1 to 2 ounces per week, and those 6 to 12 years old should limit intake to 2 to 3 ounces per week.

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(about 8 grams per half-cup, cooked), but are also are packed with fiber, folate, manganese, potassium, iron, magnesium, copper, selenium, zinc, and phytochemicals. Studies have linked consumption of legumes with lower risk of heart disease, hypertension, obesity, some types of cancer, and diabetes. Most cultures once relied on these sustainable, nutritious plant proteins regularly, but in modern times our intake has waned. Try to consume more legumes—aim for at least one serving daily as a replacement for meat on the plate. Soy. Actually part of the legume family, soy is an important food source traced back to ancient China. It is uniquely rich in high-quality protein (15 grams per half-cup, cooked), as well as iron, calcium, and—in minimally processed forms—fiber. Soy also possesses phytoestrogens, which have antioxidant properties that may account for some of soy’s health benefits, such as lower risk of heart disease. Don’t believe the hype on soy dangers you might read on the Internet. There is no scientific basis for avoiding this wholesome food source in its whole form in moderate amounts—about two or three servings per day of whole soy foods, including tofu, tempeh, soybeans, soy milk, and soy nuts. Nuts and seeds. Nuts (from almonds to walnuts) and seeds (from chia to sunflower) are packed with plant-based protein (3 to 9 grams of protein per ounce, depending on the variety), as well as healthy fats, fiber, vitamins, minerals, and phytochemicals. Research shows that a handful a day (about 1 ounce) can help cut your risk of heart disease. Turn to these nutritional superstars, such as peanuts (technically a legume, but nutritionally similar to nuts), pistachios, and hemp seeds for a source of protein on your plate.

Good sources of animal protein Fish. The best animal protein you can choose is

fatty fish or seafood, which is high in protein and long-chain omega-3 fatty acids (see “Omega-3 fatty acids,” page 17). Fish consumption has been linked to a plethora of benefits, including reduced risks of heart attacks, strokes, prostate cancer, depression, and Alzheimer’s disease. That’s why the Dietary Guidelines and the American Heart Association suggest that you 22

Healthy Eating 

include at least two 3-ounce servings of fish or seafood in your diet weekly. Try to choose those that are richest in omega-3 fatty acids. However, you should also be aware of mercury in fish and try to avoid those with the highest levels (see “What to do about mercury in fish,” page 21). Poultry. Skinless chicken and turkey provide good sources of protein, with minimal saturated fat, making it a good protein choice. Include this versatile animal protein in casseroles, stir-fries, salads, and stews.

What about red meat? An occasional lean steak isn’t a problem. In fact, it can deliver a hefty dose of protein and minerals, such as iron and zinc. However, several large, ongoing studies indicate that diets heavy in red meat may contribute to disease risk. Harvard researchers analyzed data from the Nurses’ Health Study and the Health Professionals Follow-up Study and found that people who ate the most red meat tended to die younger, and the cause of death was more frequently cardiovascular disease or cancer. Further research from the Nurses’ Health Study found that eating one serving per day of nuts, fish, or chicken in place of red meat lowered the risk of heart disease by 30%. The American Institute for Cancer Research recommends reducing red meat intake— in particular, intake of processed meats. Why is red meat problematic? One factor may be the high saturated fat levels of many cuts and products. Before buying, check the labels on packaged meats. Look for extra-lean cuts, which contain less than 2 grams of saturated fat per 3.5-ounce portion, and limit your intake of cooked lean meat to no more than 6 ounces in a given day. In addition to its saturated fat content, another problem with red meat is that cooking it at high temperatures, such as on the grill, promotes the formation of substances called heterocyclic amines, which can contribute to the development of cancer. However, the least healthful of all meats appear to be processed red meats—a category including bacon, ham, hot dogs, bologna, pastrami, salami, sausage, bratwurst, and pepperoni. In late 2015, an international panel of experts convened by the World Health w w w.h ealt h .ha r va r d.e du

Organization concluded that processed meat is a Group 1 carcinogen, meaning that there is now sufficient evidence to state that it raises the risk of cancer—in this case, colon cancer. (By contrast, the panel classified unprocessed red meat as only a Group 2A­, or probable, carcinogen.) The hazards of eating processed meat are low compared with those of smoking, for example, but they rise in proportion to the amount of processed meat consumed. The panel defined processed meat as meat that is “transformed through salting, curing, fermentation, smoking, or other processes to enhance flavor or improve preservation.” In addition to the problems with red meat in general, some processed meats also contain added nitrates, which can lead to the formation of cancercausing nitrosamines in the body. Moreover, processed meats tend to have higher concentrations of saturated fat and sodium, which may partly explain why they have been linked with heart disease and related problems. A study published in the journal Circulation analyzed data from 20 studies of diet and

health, including 1.2 million initially healthy participants, about 3% of whom went on to develop heart disease, diabetes, or stroke. Results showed that red meat consumption wasn’t associated with heart disease or type 2 diabetes as long as the meat was unprocessed. Processed and cured meats, such as bacon, hot dogs, and ham, boosted the risk of heart disease by 42% and type 2 diabetes by 19%. In short, you’re better off choosing fish, plant proteins, and chicken most often. You only need onefourth of your plate to be dedicated to protein; the rest should come from whole grains, vegetables, and fruits. If you do eat red meat, make it an occasional part of your diet; opt for small portions, choose lean cuts, and avoid charring your meat on the grill. One good option is a lean cut of grass-fed beef. While it is more expensive, grass-fed beef contains less saturated fat than regular beef, and because of the higher nutrient value of grass compared with traditional feed, it also contains higher levels of healthful fats, such as omega3s and conjugated linoleic acid (CLA), which has been linked with a lower cancer risk.

Antibiotics in meat

S

lowly, the word is getting out that the majority of antibiotics used in farming are not used to treat animals when they’re ill. Rather, these medications are used in healthy cattle, pigs, and poultry to increase the rate at which the animals gain weight, so their meat can be brought to market more quickly. This might have seemed like a good idea in the past. But today, there is increasing evidence that this overuse of antibiotics may contribute to antibiotic resistance in humans. That’s because the steady use of antibiotics over long periods allows resistant strains of bacteria to emerge, and these new strains can get into the environment and transfer to humans. Antibiotic resistance is a significant public health issue. It can limit your treatment options when you’re sick, raise your health care costs, and increase the number, severity, and duration of some infections. Many doctors warn that some of our tried-and-true antibiotics are losing their ability to fight disease. Many factors contribute to antibiotic resistance, including the use of antibacterial soaps and hand sanitizers and the unnecessary prescribing of antibiotics. However, you can do your own part to reduce the growth of antibiotic resistance by looking for antibiotic-free meats, in addition to consuming more plant proteins.

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The lowdown on dairy Dairy products, such as milk, cheese, yogurt, and cottage cheese, are rich in protein and calcium, which is important for keeping your bones healthy. However, there may be reason to exercise some restraint in your consumption of dairy products. High intake of dairy has been linked with increased risks of certain cancers. The World Health Organization found a significant link between high consumption of fullfat milk and prostate cancer deaths, though the World Cancer Research Fund (WCRF) Second Expert Report was not as decisive in its conclusion, stating that the evidence linking dairy foods to increased prostate cancer risk was suggestive but limited. In women, the Swedish Mammography Cohort study found an association between high intake of dairy products—particularly milk—and increased risk of ovarian cancer, though the WCRF found the evidence inconclusive. If the association turns out to be real, scientists hypothesize that it might be related to a compound called insulin-like growth factor, which is found in cow’s milk. However, Healthy Eating

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more research is needed—and dairy consumption is actually linked to a lower risk of colorectal cancer. In the meantime, it’s a good idea to limit your intake of dairy products to no more than two servings per day. You also can get calcium from regular consumption of calcium-rich nondairy products, such as leafy green vegetables, broccoli, beans, and calcium-fortified tofu— though the amounts available in these foods are often not enough to meet the recommended level of calcium intake without including some dairy and either calcium supplements or calcium-fortified foods. When you do eat dairy products, choose those that are lower in fat, such as low-fat milk, cottage cheese, and yogurt, instead of high-fat cheese, whole milk, butter, and ice cream.

Eggs in moderation Eggs are a good, affordable source of high-quality protein, with roughly 6 grams of protein per large egg. In addition, they are rich in vitamin B12, vitamin

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Healthy Eating 

D, riboflavin, selenium, choline, lutein, and folate. Eggs were once demonized for their cholesterol. Now, however, they have made something of a comeback. According to the Dietary Guidelines, you needn’t fear the moderate amount of cholesterol in eggs, as it doesn’t seem have a great impact on blood cholesterol levels. Equally important, studies show that moderate egg consumption—up to one egg per day—does not increase heart disease risk for healthy people. That said, people with diabetes or a family history of diabetes may benefit from cutting back on eggs. One study found that eating eggs daily was linked with as much as a 77% increase in the risk of developing type 2 diabetes among the general population. And a meta-analysis of studies including 21,000 men and 36,000 women indicated that people with type 2 diabetes had a higher risk of cardiovascular disease when they consumed eggs. For most people, however, eggs are an excellent protein choice. Just don’t go overboard! 

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Vitamins, minerals, and phytochemicals

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E

very day, your body produces skin, muscle, and bone. It makes tens of thousands of rich red blood cells that carry nutrients and oxygen to every cell in your body, and it produces multitudes of white blood cells to fight invaders. Your nerves send electrical signals skipping along thousands of miles of brain and body pathways, and your tissues make chemical messengers that shuttle from organ to organ, issuing the orders that orchestrate and sustain your life. To do all that, your body requires many different raw materials. In addition to the macronutrients— carbohydrate, fat, and protein, which were covered in earlier chapters—these include nearly 30 vitamins and minerals that your body cannot manufacture in sufficient amounts on its own. These essential compounds perform thousands of roles in the body, from helping to shore up bones and healing wounds, to boosting your immune system, helping to convert food into energy, and repairing cell and tissue damage. The essential vitamins and minerals are often called micronutrients because your body needs only tiny amounts of them. Yet failing to get even those small quantities virtually guarantees disease. British sailors learned centuries ago that living for months without fresh fruits or vegetables—the main sources of vitamin C—caused the bleeding gums and listlessness of scurvy, a disease that often proved fatal. Even today in many low-income countries, people frequently suffer from a variety of nutrient-deficiency diseases, such as rickets, caused by too little vitamin D. True vitamin and mineral deficiencies—in which the lack of a single nutrient leads directly to a specific ailment—are rare in the United States, because of our extensive supply of inexpensive food and the fact that many common foods are fortified with certain key nutrients. However, getting less than optimal amounts of important vitamins, minerals, and other compounds can still contribute to a number of major illnesses, such as heart disease, type 2 diabe-

While a daily multivitamin-multimineral tablet may be a good general insurance policy against nutrient shortfalls, the evidence for high doses of individual supplements is much less convincing.

tes, cancer, and osteoporosis. Hence, concern about “insufficiency”—a controversial topic—is a major driving factor in both the Dietary Guidelines and the mass marketing of over-the-counter supplements. So how can you make sure you’re fulfilling your nutrient needs? The answer may sound familiar by now. Eat a well-rounded diet, with plenty of minimally processed fruits, vegetables, legumes, whole grains, and lean sources of protein, along with healthy fats, such as nuts and olive oil. In most cases, it’s much better to get your vitamins and minerals from real food than from supplements.

The benefits of food vs. supplements A vast amount of research has shown that you can significantly cut your risk for chronic disease and disability by following a healthy diet, as well as by exercising regularly and not smoking. While there is also limited evidence that a daily multivitamin-multimineral tablet may be a good general insurance policy against nutrient shortfalls, the evidence for taking high-dose, individual vitamin and mineral supplements for disease prevention is much less convincing. Healthy Eating

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Supplement manufacturers have not hesitated to exploit positive news from studies about the benefits of vitamins and minerals and use this information to tout their products. But when put to the test in clinical trials, supplements in general have not performed as well as real food—that is, minimally processed or whole foods. For example, broad population studies suggest that people who eat foods rich in vitamin A and beta carotene (which converts to vitamin A in the body) are less likely to develop many types of cancer, especially lung cancer. However, when researchers tested beta carotene supplements in smokers, they found that people who took the supplements were more likely to develop lung cancer. Similarly, in one study, heavy smokers who took 30 milligrams (mg) of beta carotene plus 25,000 international units (IU) of vitamin A daily were 46% more likely to die of lung cancer than those taking a dummy pill (placebo). One problem with taking supplements of the fatsoluble vitamins (A, D, E, and K) is that they aren’t readily passed through the body—unlike the watersoluble vitamins (C and the Bs), which are generally excreted in urine if they’re not needed. Instead, the fat-soluble vitamins are stored in fat and can build up to toxic levels if you take too much. By contrast, it’s hard to get too much from food in its natural form. For one thing, the levels in food are lower than in supplements. For another, in the special case of beta carotene, the body slows down the conversion of this substance to vitamin A when it has enough, making it hard to overdose. While it’s more difficult to consume dangerous levels of water-soluble vitamins, it’s not impossible. Many nutrition bars contain 100% of the RDA for folic acid. Because many other foods are also enriched with folic acid, it’s not hard to exceed the safe upper limit of daily intake for this nutrient if you take a multivitamin and eat fortified products on a regular basis. And contrary to the claims of some so-called experts, megadoses do nothing to enhance any bodily functions. It can also be easy to overload on minerals like calcium, which are added to a broad range of products. The body can only absorb 500 mg of calcium at a time. Total intake beyond 2,000 mg a day may damage kidneys and blood vessels. 26

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Does your diet deliver the recommended dose? Assuming you rely on food rather than supplements to supply your vitamins and minerals, that raises another question: does your diet deliver enough? There are two ways to approach this question. The more laborious method is to total up what’s in your diet. If you choose that route, there are free online tools and calculators that can help you analyze the nutrient content of your meals, such as the USDA’s SuperTracker (https://www.supertracker.usda.gov/foodtracker.aspx). You can also research the nutrient content of various foods using http://ndb.nal.usda.gov. Or you can consult a registered dietitian, who can access computer programs and databases to help with the most difficult calculations. Alternatively, you can take a more relaxed approach—that is, not worrying too much about the details and focusing instead on the big picture: eating a balanced diet that contains a variety of colorful fruits and vegetables, whole grains, beans, nuts, dairy products, seafood, lean meats, and poultry. When choosing what to eat, simply emphasize nutrient-dense foods, which are packed with vitamins and minerals and have relatively few calories. If your dietary pattern is healthful and mirrors these guidelines, then you don’t have much to worry about.

Shortfall nutrients While a balanced diet should meet most of your needs, you may have to work a little harder to get enough of several essential nutrients. Nutrition scientists call these the “shortfall nutrients,” because people often fall short of them. According to the Dietary Guidelines, these are the four to pay attention to. Potassium promotes blood pressure control. Since almost everyone exceeds recommended limits on sodium consumption, dietary potassium’s role in countering harmful effects of excess sodium is especially valuable. Potassium may protect the heart and bones in other ways, too. Yet only 3% of Americans get the 4,700 mg recommended daily for everyone ages 14 and up. You can boost intake by adding more fruits, vegetables, and beans. Bananas and citrus w w w.h ealt h .ha r va r d.e du

aren’t the only fruits rich in potassium; other all-stars include avocado, kiwi, and melon. Calcium is essential for bones and seems to help lower risk of colon cancer. Although less than 50% of Americans have diets that meet the Daily Value (DV) of 1,000 mg, excessive use of calcium supplements can go beyond filling the gap and supply too much. Rather than relying on supplements, boost your intake by including dairy or calcium-fortified nondairy milk and yogurt twice a day. Dark green leafy vegetables are good sources of calcium. The body absorbs more from kale, bok choy, and broccoli than from spinach, however, because the oxalate in spinach binds much of its calcium. Vitamin D helps your body absorb calcium, making this vitamin essential for bone health. In addition, newer research suggests that it may help protect against cancer and other chronic diseases. Unlike other vitamins and minerals, however, D is not abundant in food sources other than fortified dairy and fish that are rich in fats, such as salmon, sardines, mackerel, rainbow trout, and tuna. Hence, you may need supplements in order to meet current recommendations for 600 international units (IU) per day up to age 69 and 800 IU for age 70 or older. Five to 10 minutes a day of unprotected sun exposure on the hands, arms, and legs can also help, since ultraviolet light striking the skin prompts the body to produce vitamin D. Dietary fiber (see page 12) helps prevent constipation and lowers the risk of colon cancer. (Fiber from grains has the strongest cancer-protection link.) What’s more, fiber may play multiple roles in promoting heart health. So it’s a real concern that only 5% of Americans meet their recommended target, 21 to 38 grams per day (depending on age and gender). You can increase your fiber intake by replacing most refined grains you eat with whole grains, including whole-grain versions of bread, cereal, pasta, and rice. Substitute dried beans or lentils for half or more of the meat or chicken in a casserole, stew, or pasta dish.

The power of phytochemicals In addition to vitamins and minerals, a healthful diet will deliver substantial amounts of compounds known ww w. h ealt h . h ar v ar d . e du

as phytochemicals (literally, “plant chemicals”). Even the most humble fruits and vegetables are replete with these compounds, which affect the flavor, color, scent, and other properties of plant-based foods. The searing bite of hot peppers, the pungent whiff of garlic, the deep orange hue of carrots, and the red blush of tomatoes all owe a tip of the hat to various phytochemicals. Although plants develop these compounds for their own purposes, including defense against predators, many of these substances appear to be beneficial for people, too. The results of certain studies on phytochemicals are now well known—the lutein in dark leafy greens may help protect against specific eye ailments; the lycopene in tomatoes may help defend against prostate disease; the proanthocyanidins in cranberries may help ward off urinary tract infections. Many phytochemicals also have antioxidant activities (see “The antioxidant buzz,” page 28). There are thousands of phytochemicals in your fruits and vegetables, and in many cases, they work in networks, so taking a few in supplement form is not the best choice. Instead—you guessed it—try to get them from your food. While you’re at it, try to broaden the repertoire of fruits and vegetables you eat, so that it includes produce of many colors. Consuming a wide variety of colorful produce—red, yellow, orange, green, purple—ensures that you also get a broad range of phytochemicals in your diet. That’s important because different phytochemicals serve different functions in the body. For example, the sulforaphane that comes from cruciferous vegetables (broccoli, Brussels sprouts, cabbage, cauliflower, and others) helps fight cancer by mopping up certain cancer-promoting substances that form in your body during the course of normal metabolism. But you won’t find sulforaphane in your blueberries, even though the anthocyanins—the compounds that give blueberries their deep purplish-blue color—are steeped in antioxidant activity. That’s why you need the variety. Note that, as a general rule, the darker the fruit or vegetable, the higher the level of phytochemicals you’ll find in it, since many of these compounds are plant pigments. Thus, a juicy ripe strawberry that’s red straight through will have higher levels of anthocyanins than one that’s mainly white inside. Healthy Eating

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Despite the importance of color in the diet, certain white vegetables, such as onions and cauliflower, also contain important phytochemicals. For example, the allyl sulfides in onions, garlic, and leeks have been linked with cancer protection.

The antioxidant buzz Antioxidants are hot. Just stroll through the supermarket and you’ll see the word “antioxidants” on a broad range of packaged products, from granola bars to fruit smoothies. Many laboratories have measured the antioxidant content of fruits, vegetables, herbs, and spices and come up with number values, representing the antioxidant power of foods. The most commonly used measurement is called oxygen radical absorbance capacity (ORAC), but there are others. Unfortunately, the power of antioxidants in foods and supplements has been exaggerated in the media. So let’s set the story straight. Your body is faced with the constant threat of free radicals—damaging chemicals formed from metabolism, the environment, and even the sun. These chemicals can alter DNA and body cells, leading to the damage of tissues. They attack proteins, lipids, and DNA—the biological stuff we’re made of. They even harm the cells that line blood vessels, potentially enabling tumor cells to enter the bloodstream and metastasize. According to the free-radical theory of aging, all of this damage promotes the development of many chronic diseases and contributes to the general effects of aging. Fortunately, your body has a natural defense system: antioxidants, which are made by the body and also found in our foods, mop up free radicals like a sponge. Lots of substances act as antioxidants in the body, including vitamins C and E and the mineral selenium. But antioxidants are more complex than simple scores would lead you to believe, and there are reasons to be skeptical of the claims on packages of processed foods in the supermarket. For starters, not all antioxidants are created equal. Some are better than others at counteracting (or

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quenching, to use the proper term) different types of free radicals. The beta carotene in carrots, for example, quenches a particularly damaging free radical called superoxide. By contrast, the vitamin E in nuts and avocados is relatively powerless against it—though it serves the equally important function of bolstering LDL (bad) cholesterol against oxidation, thereby helping to stave off atherosclerosis and heart disease. Further complicating the matter, antioxidants operate in networks, and an ORAC score won’t tell you that. For example, after vitamin C has quenched a free radical and thereby loses its antioxidant power, a phytochemical called hesperetin (found in oranges and other citrus fruits) restores the vitamin C to its active antioxidant form. Vitamin C and hesperetin are found together in citrus fruits, but you won’t necessarily find them both in a processed product. Moreover, processing destroys some antioxidants, so a number obtained for a raw food in a laboratory won’t accurately reflect the antioxidant power of the processed product that you take home. Finally, the antioxidants that survive may behave differently in the lab than they do in the human body, which is far more complex than a test tube. Your genes, your own unique gut microbiome (the trillions of microorganisms that live there), and the way your body digests and absorbs nutrients all come into play. So what’s a shopper to do? It’s simple. Buy actual fruits and vegetables. True, their antioxidant power may decline the longer they sit in your refrigerator— and some antioxidants are bound so tightly to the fiber in foods that they are not readily available for your body to use in the fight against free radicals. But you stand the best chance of getting a wide array of disease-fighting antioxidants from food in this manner. It’s also important to note that the body’s cells naturally produce a host of powerful antioxidants, such as alpha lipoic acid and glutathione, so not all antioxidants come directly from food, though the food you eat serves as the raw material for synthesizing those compounds. The bottom line: Eating a variety of colorful plant foods is a good thing—just don’t get too caught up in their antioxidant content. 

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Making healthy beverage choices

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ot so long ago, the beverage of choice was plain old water—straight from the tap. Now there is a long list of beverages to tempt your palate, including sodas, sports drinks, energy drinks, bottled teas, vitamin waters, and fruit drinks. The beverages you choose every day can make a huge impact on your health, so it’s worth learning to sort the healthful ones from the not-so-healthful.

Water on tap You’re best off getting most of your liquids from water. Water has few, if any, nutrients. Still, it is an important player in your diet. Among its many functions, it helps aid digestion, prevent constipation, normalize blood pressure, and stabilize your heartbeat. Water also carries nutrients and oxygen to cells, cushions joints, protects organs and tissues, helps regulate body temperature, and maintains electrolyte (sodium) balance. In addition, drinking two glasses of water 30 minutes before eating may help you lose weight. A similar strategy is simply to drink water between meals. If you wait until you’re thirsty to drink, it’s easy to mistake thirst for hunger and end up eating food when all you really needed was a tall, cool glass of water. How much water do you need? When a panel of scientists drew up the Healthy Beverage Guidelines, they recommended a total beverage quota of up to 13 cups a day for men and up to nine for women (see Figure 4, page 30), depending on the weather, how active you are, and how much you eat. For most people, 6 to 8 cups of fluids will generally suffice. Anything watery counts, but water itself—because it’s naturally caloriefree—is an excellent choice. If plain water seems too boring, you can make it more interesting by drinking sparkling water, or adding citrus or cucumber wedges, or infusing it with herbs, such as basil or rosemary. Vitamin waters—waters enhanced with vitamins, minerals, and antioxidants—are growing in popularity ww w. h ealt h . h ar v ar d . e du

and will help you meet your daily target for water. But don’t rely on them to meet your quota for anything else, as the added levels of micronutrients are often too low to make an impact on your diet. You’re better off with a balanced diet that provides whole food sources of these micronutrients.

Coffee and tea After water, your second best choice is unsweetened coffee or tea. Both are derived from plants and are packed with antioxidant and anti-inflammatory compounds. They both contain caffeine, which boosts alertness and performance. And they offer a delicious, flavorful choice of beverage, without fat and sugar (as long as you’re not stirring these into the mix), so they can replace less healthful choices during the day. Coffee. Once frowned upon by health professionals, coffee is experiencing something of a renaissance for its numerous health rewards. Originally from Ethiopia, coffee is a brew made from roasted, ground coffee beans that has been enjoyed around the world for hundreds of years. A growing body of research finds many health benefits related to coffee intake; it has been linked to better mental and athletic performance and lower risk of type 2 diabetes, liver disease, heart disease, Parkinson’s disease, colon cancer, and premature death. A new study from Harvard T.H. Chan School of Public Health, which included more than 200,000 people, found that drinking three to five cups of coffee—regular or decaf—each day was linked with up to 15% lower risk of premature death compared with abstaining from coffee altogether. The benefits of consuming coffee may be related to a range of compounds found in coffee beans beyond caffeine, including chlorogenic acid, lignans, quinides, trigonelline, and magnesium, which may help reduce insulin resistance, quell inflammation, block liver scarring, and discourage fat deposition. Healthy Eating

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Tea. Originally from Asia, tea has been enjoyed for

centuries in Asian cultures. Today it is the most widely consumed beverage in the world (besides water). Prepared from the leaves of the Camellia sinensis plant, tea (especially green tea) can be found in just about everything, from facial moisturizers to cookies, but you’ll get the most benefits from drinking it. Tea leaves are very high in catechin compounds, which have strong antioxidant and anti-inflammatory activities. That’s why tea has been linked with heart health, cancer defense, immune function, bone health, and even weight loss.

Pouring a healthy cup Even though coffee and tea are healthful, bear in mind that both can be a source of added calories, depending on how they’re prepared. At coffee shops, many people order large coffee drinks laden with milk and sugar, which can equal the caloric content of an entire meal. Even a modest tall (12-ounce) café latte made with skim milk adds 100 calories to your daily total.

With today’s specialty coffee drinks, it’s easy to load up on unhealthy fat, sugar, and calories without eating a bite of food—and gaining its vital nutrients. And since liquid calories are less filling than solid food, drinking sweet drinks increases the chance that you will consume excess calories. Studies also show that consuming too many sugary foods and beverages can increase your risk of heart disease and diabetes. As for tea, the selection of bottled tea beverages has expanded dramatically in recent years. They may seem like healthy choices, but think again. Many contain as much added sugar (and therefore, calories) as soda, and they may not have as much real tea in them as brewed tea. Studies have shown that bottled teas often contain significantly lower levels of the healthful compounds than a cup you brew yourself. Finally, keep in mind that in some individuals, excessive caffeine can pose problems such as insomnia, esophageal reflux, and migraines. If these are an issue for you, limit caffeine consumption. One way to

Figure 4: The Healthy Beverage Guidelines Because the choice of beverages can make a substantial impact on nutrient intake and health, an expert panel directed by Barry Popkin of the University of North Carolina, Chapel Hill, developed the Healthy Beverage Guidelines to aid the public. The panel consisted of six researchers, including Harvard’s Dr. Walter Willett, who reviewed the evidence on beverages and health and ranked the categories of beverages into six levels, based on calories, contribution to intake of energy and essential nutrients, and evidence for effects on health. The Healthy Beverage Guidelines were distilled into a six-level pitcher, with the bottom level consisting of water as the foundation of your daily beverage consumption, at up to 13 8-ounce servings per day for men and nine for women. (Whether you need that much depends on a number of factors, including how active you are and how hot the weather is.) You can substitute other drinks for part of that total, as indicated in the pitcher. But note that the number of allowable servings per day decreases for drinks at the higher levels. At the top of the pitcher are drinks that you should avoid or drink only occasionally, no more than one serving at a time.

1 serving equals 8 ounces soft drinks, juice drinks

up to 1 serving (110 calories)

100% fruit juices, whole milk, sports drinks

up to 1 serving (115 calories)

diet soft drinks, calorie-free tea/coffee with sugar substitutes

up to 4 servings (0 calories)

skim/low-fat milk, unsweetened fortified soy beverages

up to 2 servings (100 calories)

unsweetened coffee (flavored, non-flavored)

up to 4 servings (0 calories)

unsweetened tea (black, green, white, oolong, herbal)

up to 8 servings (0 calories)

water up to 9 servings for women 13 servings for men (0 calories)

You can mix and match beverages from different levels—just be sure to watch calories and caffeine. Limit calories from beverages to 10%–15% of your total daily caloric intake.

Source: The American Journal of Clinical Nutrition, March 2006, pp. 529– 42.

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do this is by drinking no coffee or tea after a certain hour—say, 3 p.m. Another is by switching to decaf versions later in the day.

Drinks to limit or avoid Studies increasingly link sugary beverage intake to obesity, type 2 diabetes, and heart disease. Sweetened beverages are a leading source of added sugars in the standard American diet. For example, a can of soda provides about 35 grams of refined sugar. In fact, studies show these drinks are one of the top providers of calories in the U.S. diet—the top source among teens. And when you drink calories in the form of liquids, you don’t gain the same sense of satiety as you do from eating solid food, so it’s easy to keep piling on additional calories above and beyond those in the drink. Even artificially sweetened sodas may pose a problem. Although they are very low in calories, some studies have found that they do not necessarily help people lose weight. Some scientists believe that a disconnect between the body and the brain may occur when you guzzle these artificially sweet drinks. The brain thinks energy is going to come along with that sweet-tasting drink, and when no source enters the bloodstream, it may increase feelings of hunger. Intriguing preliminary research also indicates that artificial sweeteners may interfere with gut bacteria in a way that promotes metabolic disorders. While we certainly need more research to understand the full effect that artificial sweeteners have on the body, one thing is certain: there are no nutritional benefits of consuming these beverages, which are often filled with other artificial ingredients. Juice drinks. There’s obviously no comparison between soda and fresh-squeezed orange juice. But when scientists drew up the Healthy Beverage Guidelines­, they included juice drinks along with soda as beverages that people should avoid or drink only occasionally. Many “fruit drinks” are laced with added sugars. Even apple juice, which serves as the basis for many juice drinks, contains a lot of quick-digesting sugars and not much more. If you really enjoy a glass of orange juice every morning, it’s all right to include a single 4-ounce serving every day. Just make sure ww w. h ealt h . h ar v ar d . e du

Sports drinks and energy drinks If you work out, do you need special drinks to fuel your performance? For the most part, no. Most experts agree that water is the perfect hydration beverage for a typical workout. In particular, beware of energy drinks, which can have high levels of sugar and caffeine. Serious endurance athletes, however, may benefit from the extra calories and electrolytes found in sports drinks.

that it’s 100% fruit juice. And remember that it takes several oranges to make a single glass of OJ, so you’re getting more sugar than if you ate the natural fruit. Processing also removes much, if not all, of the fiberrich pulp.

What about alcohol? Some sources may proclaim red wine a health tonic, but the science is a bit more confusing. Moderate consumption of alcohol in general—not just red wine— has been linked with heart health benefits. More than 100 studies have found a link between moderate drinking (no more than one serving per day for women; no more than two for men) and a decreased risk of heart attacks, peripheral vascular disease, strokes, and sudden cardiac death. Moderate drinking has also been linked to lower incidence of type 2 diabetes and to better cognition. However, the bottle also holds some risks. Heavy drinking can result in a range of health problems, including liver disease and heart disease. And studies have found that even moderate alcohol consumption raises the risk of breast cancer. A meta-analysis that combined the results of 98 studies found that women who drank alcohol were 11% more likely than nondrinkers to get breast cancer. Alcohol has also been linked to cancers of the colon, mouth, throat, and esophagus. So, what should you do? If you’re already drinking, you can go ahead and do so in moderation. However, it’s not worth taking up wine—or any type of alcohol—to gain supposed health benefits. And if you’re at high risk for cancer or alcoholism, you may want to avoid alcohol entirely.  Healthy Eating

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Putting it all together

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ow that you’ve got a better understanding of what makes a healthy diet, it’s time to take the plunge. But how do you get started? Knowing the best sources of fat, carbohydrates, and protein is one thing. Figuring out how to pack your diet with these healthful foods is another. The reality is that we all tend to eat the foods that are familiar. So how do you break those habits and start improving your diet? The greatest challenge for most people is incorporating enough vegetables and—to a lesser extent—fruits. This chapter includes ways to boost your intake of produce in delicious ways. We also include tips for meal planning, healthful shopping, and doing everything you can to ensure food safety.

Meal planning If you come home from work to an empty refrigerator, healthful eating can be difficult. It takes a bit of organization and planning to stay on top of healthy meal preparation. Following are some tips that will help you out. • Write out a weekly menu plan before you do your shopping. Rely on a mixture of easy go-to dishes you can prepare without a recipe (see below for some ideas), alternating with one or maybe two new recipes a week on less busy days to make things more exciting. • Jot down a shopping list, making sure to include the fresh items you’ll need, as well as pantry staples

Easy go-to dishes you can prepare without a recipe Easy, healthful meals are within your reach. Just follow these simple ideas for creating meals with supplies you should have on hand in your pantry and refrigerator. MEAL

INGREDIENTS

DIRECTIONS

Tofu-vegetable stir-fry with whole grains

• Whole grain: brown rice, quinoa, or barley

Simmer grain.

• Protein: diced tofu

Stir-fry vegetables in peanut oil, add tofu and soy sauce, and cook until tender.

• Vegetables: onions, bell peppers, snow peas, others • Seasonings: peanut oil, reduced-sodium soy sauce

Whole-grain pasta with greens and poultry

• Whole grain: pasta

Cook pasta and drain.

• Protein: cooked chicken or turkey

Return to stove and add olive oil, chopped garlic, greens, tomatoes, and cooked chicken or turkey. Heat for 5 minutes.

• Vegetables: greens (e.g., spinach, kale, chard), tomatoes • Seasonings: olive oil, garlic

Bean-corn chili with green salad

• Whole grain: frozen corn • Protein: canned beans (e.g., black, kidney, garbanzo) • Vegetables: canned tomatoes, onions, bell peppers,

others; bagged lettuce mix

• Seasonings: garlic, chili powder, olive oil, lemon juice

Mediterranean fish fillet with sautéed vegetables and grains

• Whole grain: steamed farro, brown rice, or millet

Sauté fish fillet with olive oil and garlic until tender.

• Vegetables: kale, broccoli, cauliflower, green beans,

Sauté vegetables in a saucepan until tender.

• Seasonings: olive oil, garlic, sun-dried tomatoes, olives,

Serve cooked fish with grains and vegetables. Garnish with sun-dried tomatoes, olives, and pine nuts.

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Simmer for 30 minutes. Separately, toss lettuce with olive oil and lemon juice.

• Protein: fish fillet (e.g., salmon, cod, or halibut)

others

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Mix beans, tomatoes, chopped onions, chopped bell peppers, frozen corn, garlic, and chili powder in a pot.

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A HEALTHFUL SHOPPING BASKET Make copies of this shopping list to take on your supermarket runs. You won’t buy everything on this list each time you shop, but it will help remind you of healthy categories. Check off the items you need before you go. Grains ❑ Whole grains (e.g., quinoa, spelt) ❑ Brown rice ❑ Bulgur/cracked wheat ❑ Oatmeal, old-fashioned or steel-cut ❑ Popcorn, light ❑ Whole-grain breads, pitas, tortillas ❑ Whole-grain cereal ❑ Whole-grain pasta Legumes, nuts, and seeds ❑ Almonds ❑ Black beans ❑ Chickpeas (garbanzos) ❑ Kidney beans ❑ Lentils ❑ Peanut butter ❑ Peanuts ❑ Pine nuts ❑ Pinto beans ❑ Pistachios ❑ Pumpkin seeds ❑ Sesame seeds ❑ Soybeans/edamame ❑ Sunflower seeds ❑ Tofu ❑ Walnuts

Vegetables ❑ Asparagus ❑ Avocado ❑ Beets ❑ Bell peppers (green, red, orange, yellow) ❑ Broccoli ❑ Brussels sprouts ❑ Cabbage (green, red) ❑ Carrots ❑ Corn, sweet yellow ❑ Green beans ❑ Kale ❑ Lettuce/greens ❑ Mushrooms ❑ Onions (green, red, white, yellow) ❑ Peas ❑ Radishes ❑ Squash (summer, winter) ❑ Spinach ❑ Sweet potatoes ❑ Swiss chard ❑ Tomatoes

you may be low on (see “A healthful shopping basket,” above). • Plan your weekly shopping trips for times when you are least stressed and not hungry, and when you are therefore able to make wise food decisions. • When purchasing perishable foods, buy only those you need for the week, so you won’t contribute to food waste, overeating, or excess spending. • Read food labels, avoiding products with excess sodium, added sugars, and saturated and trans fats. ww w. h ealt h . h ar v ar d . e du

Fruits ❑ Apples ❑ Apricots ❑ Bananas ❑ Blueberries ❑ Cantaloupe ❑ Cherries ❑ Cranberries ❑ Figs ❑ Grapes ❑ Grapefruit ❑ Kiwifruit ❑ Mangoes ❑ Oranges ❑ Peaches ❑ Pineapples ❑ Plums ❑ Prunes (dried plums) ❑ Raisins ❑ Raspberries ❑ Strawberries ❑ Watermelon Oils ❑ Canola oil ❑ Olive oil ❑ Safflower or sunflower oil

Dairy and dairy alternatives ❑ Cheese, reduced-fat ❑ Cottage cheese, low-fat ❑ Eggs ❑ Milk, low-fat or fat-free ❑ Plant-based milk (e.g. soy milk, almond milk) ❑ Yogurt, low-fat or fat-free Fish and shellfish ❑ Cod ❑ Flounder ❑ Halibut ❑ Salmon ❑ Scallops ❑ Shrimp ❑ Sardines, canned in olive oil or water ❑ Tuna, light, canned in water or olive oil Poultry ❑ Skinless chicken breast/ thigh ❑ Skinless ground chicken or turkey breast ❑ Skinless turkey breast/ thigh

• Focus on whole and minimally processed foods— whole grains in their intact form, such as barley or quinoa; chicken breasts, fish fillets, eggs; fresh, frozen, or canned produce (which can be just as nutrient-rich as fresh); and nuts and seeds. • Prep your meals the night before as needed—put frozen fish in the refrigerator to thaw, soak beans, and even chop vegetables for your menu the next day. • Prepare foods with healthful cooking techniques: sauté (in moderate amounts of healthful vegetable Healthy Eating

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oils), roast, bake, poach, or simmer instead of deepfat frying foods. • Use reasonable portion sizes; dish up a single portion of food and savor and enjoy your meals. Avoid eating mindlessly—at the computer, TV, or in front of the refrigerator—without paying attention to what you’re eating. • Consider keeping a food journal, which may help you be more accountable for and successful with your health goals, according to several studies.

Sneaking in more vegetables The vegetable world is filled with a dazzling array of colorful leaves, stems, shoots, bulbs, and roots, all offering delicious, nutritious health potential. Once humans feasted on mounds of a diverse range of vegetables, but now intake is low. Most Americans eat a limited variety of vegetables, relying heavily on potatoes, tomatoes, onions, lettuce, and corn as their main sources. This needn’t be the case. There are many ways to boost your vegetable intake to recommended levels (see Table 6, below), and you can do it without spending hours in the kitchen, chopping, slicing, and dicing. Many supermarkets now have salad bars, which include

Table 6: Vegetables—How much is enough? If you think eating “five a day” of fruits and vegetables is enough, think again. The USDA MyPlate now recommends 2½ to 3 cups of vegetables per day—roughly five to six half-cup servings of vegetables alone—in order to promote optimal health. That’s because vegetable consumption is linked with so many benefits, including weight control and lower risk of chronic diseases. AGE

AMOUNT PER DAY

Women 19–30

2½ cups

31–50

2½ cups

51+

2 cups

Men 19–30

3 cups

31–50

3 cups

51+

2½ cups

Source: USDA MyPlate.

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Healthy Eating 

offerings like chickpea salads or roasted red peppers. You can often find precut vegetables in the produce section. Or you can buy frozen chopped vegetables. You can incorporate vegetables into almost any meal. Here’s how. Don’t be afraid to start your day with vegetables. Some cultures enjoy vegetables at breakfast. Try

radishes on toast, baked tomato halves with eggs, and fajita vegetables with a breakfast burrito. Begin a meal with soup. Vegetable-rich soups, such as French onion, carrot, or celery puree, are an excellent way to pack a couple of servings of vegetables into your meal. Turn vegetables into healthful snacks. For example, bell peppers, carrots, and celery can be delicious dipped in hummus or unsweetened yogurt, or spread with peanut butter or sunflower-seed butter. Aim to have a salad with dinner. Stock your salad with dark green leafy lettuce and toss in petite peas, tomatoes, onions, celery, carrots, and peppers. Bonus: In addition to the nutrient bonanza you’ll get, studies show that starting meals with a low-calorie salad can help you consume fewer calories at the meal, as long as the salad is no more than 100 calories. To help control calories, avoid creamy dressings. A simple dressing you can make yourself is half olive oil and half vinegar or lemon juice, seasoned to taste with herbs and pepper. Cook vegetables the delicious, Mediterranean way. Place any type of fresh vegetables—carrots,

greens, broccoli, or cauliflower—in a skillet or sauté pan with a drizzle of olive oil and water. Season as desired and sauté only until crisp-tender. Roast vegetables along with whatever entrée is in the oven. Roasting is a great way to let the deep,

rich flavors of vegetables shine through because their starches start to convert to sugar at around 375° F, releasing a deep, nutty sweetness. To roast, just bake cut-up vegetables with a drizzle of healthy oil at 375° F for 20 to 25 minutes or until they’re lightly browned. Any vegetable is a roasting candidate—from mushrooms, onions, eggplant, and zucchini to tomatoes, broccoli, and carrots—so don’t limit yourself. Enjoy roasted veggies as a side dish or toss them into pasta dishes and other recipes. w w w.h ealt h .ha r va r d.e du

Poach veggies in low-sodium broth and white wine. Add garlic, basil, thyme, oregano, or tarragon

for a flavor bonus. To poach, boil enough liquid to cover the vegetables. When it boils, add the vegetables. Turn down the heat to just below boiling and cook the vegetables for about five to seven minutes, until they’re brightly colored and tender-crisp. To retain nutrients, keep a watchful eye on the pot or set a timer so you don’t overcook. Add fresh cut vegetables to main dishes. Try adding mushrooms, peppers, zucchini, onions, or carrots into pasta sauce, casseroles, soup, stews, scrambled eggs, and chili. Smuggle pureed vegetables into recipes. A Penn State study found that covertly adding pureed vegetables to classic foods like a casserole, macaroni and cheese, or carrot bread reduced calorie intake and boosted veggie consumption. Pureed cooked vegetables can easily be used as sauces, soups, spreads, and toppings.

Reaping nature’s sweet reward: Fruits Unfortunately, we’re not doing so great on the fruit front either—only 13% of Americans eat the prescribed amount of fruit, which is 1½ to 2 cups per day, according to the USDA (see Table 7, at right). One of the reasons people fall short on fruit intake is that they opt instead for processed snacks, treats, and desserts, thus crowding fruit out of their diets. Fruit is nature’s most perfect dessert. Rich in natural sugars, it is truly the first sweet treat our early ancestors experienced (other than the occasional honeycomb). But unlike processed sweets, fruit comes packed with a vibrant array of healthful nutrients, including slow-digesting carbs, fiber, vitamins, minerals, and phytochemicals—all in a very low-calorie package. A serving of fruit (one small piece, or half a cup) contains about 60 calories, on average. Eating fruit on a regular basis is a very healthy habit and is linked with myriad benefits, including a lower risk of high blood pressure, heart disease, stroke, certain types of cancer, degenerative eye disease, type 2 diabetes, obesity, Alzheimer’s disease, and diverticulitis. ww w. h ealt h . h ar v ar d . e du

Some fruits have particular benefits. For example, berries may help protect the brain from age-related decline, according to data from the Nurse’s Health Study, which found that greater intake of blueberries and strawberries was linked with preserved brain function. And citrus fruit has been found to have cancer-fighting potential, according to preliminary research. So it’s a good idea to enjoy a variety of colorful, seasonal fruits every single day. Start by making fruit your go-to dessert every day. It’s easy, because most fruits—including bananas, oranges, apples, pears, and nectarines—require only peeling or washing rather than elaborate preparation. You can increase your daily intake even more by adding a serving of fruit at breakfast or for snacks. Here are some ideas to help you boost your fruit consumption throughout the day: • At breakfast, include fruit, such as sliced strawberries over cereal, peach chunks stirred into yogurt, or applesauce over whole-grain pancakes. • For breakfast or lunch, whip up smoothies with frozen berries, mangos, pineapple, or bananas, along with water or milk. (To boost your veggies at the same time, try tossing in some spinach or other greens.) • Pack a piece of fruit—which comes with its own

Table 7: Fruit—How much is enough? Aim higher than the old advice of “five a day” for fruits and vegetables. Instead, the USDA suggests that you consume 1½ to 2 cups of fruit each day in your diet for optimal health, which means you should try to include fruit at each meal and even a snack during the day. AGE

AMOUNT PER DAY

Women 19–30

2 cups

31–50

1½ cups

51+

1½ cups

Men 19–30

2 cups

31–50

2 cups

51+

2 cups

Source: USDA MyPlate.

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Table 8: C  ulinary uses of common herbs and spices Don’t be afraid to experiment with herbs and spices to boost the flavor and health of your meals, not to mention the pleasure you can derive from the bounty of scents and colors they provide. Use this guide to help inspire you. SPICE OR HERB

CULINARY USES

Allspice

Use in breads, desserts, and cereals; pairs well with savory dishes, such as soups, sauces, grains, and vegetables.

Basil

Slice into salads, appetizers, and side dishes; enjoy in pesto over pasta and in sandwiches.

Cardamom

Good in breads and baked goods, and in Indian dishes, such as curry.

Cilantro

Use to season Mexican, Southwestern, Thai, and Indian foods.

Cinnamon

Stir into fruit compotes, baked desserts, and breads, as well as Middle Eastern savory dishes.

Cloves

Good in baked goods and breads, but also pairs with vegetable and bean dishes.

Cumin

Accents Mexican, Indian, and Middle Eastern dishes, as well as stews and chili.

Dill weed

Include in potato dishes, salads, appetizers, and dips.

Garlic

Add to soups, pastas, marinades, dressings, grains, and vegetables.

Ginger

Great in Asian and Indian sauces, stews, and stir-fries, as well as beverages and baked goods.

Marjoram

Add to stews, soups, potatoes, beans, grains, salads, and sauces.

Mint

Flavors savory dishes, beverages, salads, marinades, and fruits.

Nutmeg

Stir into fruits, baked goods, and vegetable dishes.

Oregano

Delicious in Italian and Mediterranean dishes; it suits tomato, pasta, grain dishes, and salads.

Parsley

Enjoy in soups, pasta dishes, salads, and sauces.

Pepper (black, white, red)

Seasons soups, stews, vegetable dishes, grains, pastas, beans, sauces, and salads.

Rosemary

Try it in vegetables, salads, vinaigrettes, and pasta dishes.

Sage

Enhances grains, breads, dressings, soups, and pastas.

Tarragon

Add to sauces, marinades, salads, and bean dishes.

Thyme

Excellent in soups, tomato dishes, salads, and vegetables.

Turmeric

Essential in Indian foods; pairs well with soups, beans, and vegetables.

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Healthy Eating 

natural packaging—for on-the-go eating at the office, at school, while commuting, and more. Some of the best choices include bananas, apples, pears, oranges, and nectarines. • Keep a bag of dried fruit—such as raisins, dried berries, and dried apples—in your purse or briefcase for a quick snack when hunger hits. But remember, a quarter-cup is the portion size for dried fruit, so keep portions small. And look for versions without added sugars. • Make fruit your dessert. Enjoy the simple, sweet flavor of fruit at the end of each meal to satisfy that sweet spot. For special occasions, you can indulge in fruit-based desserts, such as apple crumbles, strawberry shortcake, cherry bars, and plum tarts. You’re best off choosing fruit in its whole, natural form, complete with skin and seeds (if edible). When you choose whole fruit, you gain the benefits of its fiber, which slows the release of the natural sugars into your bloodstream. By contrast, fruit juice—concentrated from fruits, usually without the benefit of fiber—is rapidly digested and absorbed, thus having a higher glycemic index (see “Glycemic index and glycemic load,” page 13). Canned, frozen, and (in small amounts) dried fruits are also healthful choices; just make sure you’re choosing products that are unsweetened or packed in water rather than syrup.

Boosting flavor with herbs and spices Spices and herbs have been treasured for their role in healing, food preservation, and flavor since the beginning of time. In fact, spices were so revered they launched the early spice trade route from Europe to the Far East. Snippets of herbs (the leaf of a plant, such as parsley or basil) and pinches of spices (any other part of the plant, such as buds, bark, berries, roots, seeds, or stigma) provide much more than flavor. These plant foods are concentrated sources of phytochemicals with antioxidant and anti-inflammatory properties. The mere act of adding herbs and spices to your salad dressing can boost the level of antioxidant compounds in your salad, as much as doubling it, depending upon the seasonings and the amount you use. w w w.h ealt h .ha r va r d.e du

A growing body of evidence suggests that this may translate into health protection. Some spices have particular benefits. For example, turmeric—an essential spice in Indian curries—has been investigated for its potential in Alzheimer’s disease protection, and ginger has been shown to be effective in fighting nausea during pregnancy and chemotherapy. Studies have found that spices have synergistic benefits—that is, the combination of several at once may have additive effects. Preliminary evidence even suggests that people who eat spicy foods live longer. In a 2015 study published in BMJ, Harvard researchers looked at data gathered from more than 480,000 people in China over a period of 7.2 years and found that those with daily intake of spices, in this case mainly chili peppers, had a 14% chance of living longer than those who consumed spicy foods less than once a week. In addition, those with higher consumption of spicy food were less likely to have died from cancer, heart disease, or respiratory disease during the study period. So, don’t be afraid to liven up your diet with spices and herbs, such as those on our list (see Table 8, page 36).

Trimming salt Another side benefit of spicing up your diet is that it can help boost flavor and allow you to trim salt in foods. Too much salt in the diet is a bad thing. As sodium accumulates in the bloodstream, the body may hold on to water to dilute it, which increases the fluid in blood vessels and surrounding cells. Over time, this can lead to the stiffening of blood vessels, high blood pressure, heart attack, stroke, and heart failure. High blood pressure is a life-threatening condition— it accounts for two-thirds of strokes and half of heart disease cases. A recent study published in Archives of Internal Medicine found that people with the highest sodium intakes had a 20% higher risk of death from any cause than people with the lowest sodium intakes. The Dietary Guidelines recommend that you keep your sodium level to no more than 2,300 milligrams (mg) per day—that’s about 1 teaspoon of added salt per day to help reduce your risk of developing high blood pressure or cardiovascular disease. If you are at risk for developing health problems related to sodium ww w. h ealt h . h ar v ar d . e du

Top 10 sources of sodium More than 40% of the sodium in the average American diet comes from these 10 types of food. • Breads and rolls

• Pizza

• Cheese

• Poultry

• Cold cuts and cured

• Sandwiches

meats • Meat dishes

• Snacks • Soups

• Pasta dishes (not includ-

ing macaroni and cheese) Source: CDC.

intake, you may benefit from even further reduction to 1,500 mg (two-thirds of a teaspoon) per day. People at risk include those with elevated blood pressure (either hypertension or prehypertension). Sadly, Americans are consuming way too much sodium—about 3,300 mg per day on average. Most of our sodium comes from prepared and processed foods (see “Top 10 sources of sodium,” above). Try these tips for reducing salt in your diet: Take it slowly. You get used to a certain level of saltiness and notice right away when a food is missing salt. But your taste buds aren’t sensitive enough to notice small reductions. By gradually cutting back the amount of salt in your foods, you can retrain yourself to be perfectly happy with less salt. Be a reader. Scanning the Nutrition Facts on packaged or processed foods can help you make healthier choices. Look for foods that have less than 240 mg of sodium per serving. Since sodium appears in processed food in many forms, simply checking for salt (sodium chloride) in the ingredient list won’t work. You also need to be on the lookout for the word sodium in various combinations—such as sodium benzoate, disodium or monosodium glutamate, and sodium nitrite. Choose low-salt versions of packaged foods.

Many products, including various soups and crackers, come in low-salt, reduced-salt, or no-added-salt versions. Buy unsalted nuts. Beware of portion distortion. When it comes to packaged food, restaurant food, and even food made Healthy Eating

37

at home, the more you eat, the more sodium you’ll take in. Controlling your portion size will help you trim your salt intake—and maybe your waist as well. Take charge when dining out. Restaurant foods are often loaded with sodium. While that’s most obvious at fast-food and chain restaurants, it also applies to many so-called white-tablecloth restaurants. Fortunately, many dining establishments now offer lowersodium choices. If your food is being made to order, don’t hesitate to ask that it be made without salt. Don’t get sauced. Many traditional gravies and sauces are loaded with salt, as are some salad dressings. When dining out, ask that sauces be served on the side so you can control the amount. When cooking at home, try a low-sodium recipe. Home and professional chefs have cooked up low-sodium versions of barbecue sauce, hollandaise sauce, pesto, and more. You can find hundreds of these updated recipes on the Internet, or make up your own.

Break your fast with less sodium. A bowl of fiber-rich cereal with skim milk and fruit is a great way to start the day. But make sure it isn’t delivering a lot of hidden sodium. Some healthy-sounding cereals contain a wallop of sodium, so check the label.

Powering up with probiotics More and more evidence suggests that probiotics—beneficial microorganisms—may be important for boosting your immune and digestive health and beyond. There are 100 trillion of these “good” bacteria in your large intestine, and their activities range from processing indigestible fibers and helping keep bowel function regular to fending off infections from “bad” bacteria such as Salmonella and E. coli. They may even play a role in regulating weight and mood, though more study is needed to confirm that. Everyone is born with a colony of these beneficial

Food safety

Figure 5: How much should you heat foods?

F

Use the following guide to keep perishable foods at safe temperatures during storage, preparation, and serving.

oodborne illness is a serious matter. The CDC estimates that every year, one in six Americans, or 48 million people, get sick with vomiting, diarrhea, or worse (such as life-threatening kidney failure)—all as the result of pathogens in food or water. The result is 130,000 hospitalizations and 3,000 deaths annually, with untold numbers suffering in silence at home with what they mistakenly call “stomach flu.” Older people and the very young are especially vulnerable to the effects of contaminated food. The best defense against foodborne illness is to be careful about how you buy, clean, separate, cook, and chill the foods you eat. The USDA recommends these strategies to keep you safe from foodborne illness: • Clean your hands and all food surfaces (counters and

chopping boards) with hot soapy water before preparing any food, and wash all fruits and vegetables before preparing or eating them.

F (C) 165° F (74° C)

Poultry, stuffing,casseroles, reheated leftovers

160° F (71° C)

Ground meats (beef, pork, lamb, veal); egg dishes

145° F (63° C)

Beef, pork, lamb, veal steaks and roasts with a 3-minute rest time; seafood*

140° F (60° C)

Ham, fully cooked (to reheat); holding temperature for cooked foods

Danger zone

• Separate raw foods from cooked and ready-to-eat

foods while shopping, preparing, and storing foods. • Cook foods to a safe temperature (see Figure 5, at

right) to kill microorganisms. • Refrigerate perishable foods promptly, and defrost

foods properly by thawing in the refrigerator, in a coldwater bath, or in the microwave.

40° F (4° C) 0° F (–18° C)

• Avoid raw, unpasteurized milk. Source: FDA.

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Healthy Eating 

Refrigerator temperatures Freezer temperatures * Fish is properly cooked when it flakes easily with a fork. w w w.h ealt h .ha r va r d.e du

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But there is another part of the probiotics story that is equally important. Probiotics are living microbes, and they need the right conditions in order to thrive. When you take antibiotics, you deal a blow to the microbe populations—both good and bad—in your gut. There are times when antibiotics are necessary, of course. But protecting your good gut bacteria is one important reason to avoid these drugs when the doctor isn’t sure they’ll help.

Are organics worth it? Organic foods are growing in popularity. About 81% of Americans now report purchasing organic foods at least some of the time, according to the Organic Trade Association. Although organic foods are clearly healthier for the planet, the evidence that they are healthier for people is much weaker. In part, that’s because there simply haven’t been any large, long-term studies comparing the health of people who eat organic food versus conventionally raised food. In part, it’s because there is also insufficient research on the nutrient content of organically grown foods. One widely publicized study from Stanford University found very little difference between the nutritional content of organic and conventional foods, although it did note that pesticide residues were 30% lower on organic produce. However, a meta-analysis in the British Journal of Nutrition, which analyzed 343 studies, concluded that organic produce did in fact come out on top. The study

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microorganisms in their gut, courtesy of their mothers. But others are ingested through food. The microbes that turn milk into yogurt and kefir are among the most helpful. But when buying commercial yogurt and kefir, look for the words “live and active cultures” on the label. Microbes can be killed in processing, so you want to be sure the manufacturer has tested production methods and knows the bacteria can survive. Fermented foods are another good source, under the right circumstances. Beneficial microbes turn cabbage into sauerkraut, cucumbers into sour pickles, soybeans into miso, and sweetened tea into kombucha. But if the products have been pasteurized—as with most fermented foods in packages—the microbes will be dead. In addition, most pickles and sauerkraut are canned and pickled in hot vinegar solutions with high acidity that combines with the heat to kill live, active bacteria. The best solution is to buy from delis where they do the pickling themselves or natural food stores that carry fermented foods. Or make your own; you can find clear and easy instructions in the book The Art of Fermentation by Sandor Ellix Katz (see “Resources,” page 53). There are also probiotic supplements on the market, of course. But it’s not easy to sift through them and find exactly what you need. Usually the number of bacterial strains in these products is limited to a handful, compared with 3,000 or so strains in your gut. And as with antioxidants, different gut bacteria play different roles in the body, so you need to find the right ones. Some gut bacteria play a role in fighting diarrhea, while others may be better at helping to manage irritable bowel syndrome. If you need probiotics for a particular problem as opposed to general health, ask your health care provider about a product that would be specific to your health needs. For general health, look for brands that contain both Lactobacillus and Bifidobacterium. Another way to nurture your good gut bacteria is to eat foods known as prebiotics. These are foods that the bacteria themselves like to feed on, and they include the insoluble fibers that are found in foods like onions, bananas, leeks, garlic, oats, and soybeans. Once again, a whole-foods diet appears to be the most healthful—for both you and your gut bacteria.

Organic foods are growing in popularity. They are better for the planet and clearly contain fewer pesticide residues than conventionally grown food, but they also tend to come at a higher price. Healthy Eating

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found that ascorbic acid, the precursor to vitamin C, was nearly 6% higher in organic foods compared with evenly matched conventional foods, and total antioxidant activity was 17% higher. Certain types of phytochemicals were also found at much higher levels, with phenolic compounds up 25% in organic foods, and flavonols and flavones up 49%. On the downside, protein content was lower. But when you consider the benefits, says agricultural economist Charles Benbrook, one of the study’s authors—“improved content of most nutrients, improved flavor, lower contribution to greenhouse gas emissions from the farming system, and reduced adverse impact on nutrient outflows into surface and ground water”—there’s a strong case to be made for organics. That said, you will generally find that organic foods come at a higher price. If you’re interested in organic production, focus your food dollars where it matters the most. The Environmental Working Group publishes a list called the Dirty Dozen that names the fruits and vegetables with the highest levels of pesticide residues. These are the most important ones to buy organically, if your grocery budget allows: • peaches • apples • potatoes • celery • snap peas (imported) • cherry tomatoes • spinach • cucumbers • strawberries • grapes • sweet bell peppers. • nectarines The Environmental Working Group also publishes a list called the Clean Fifteen, which enumerates the foods that have the lowest levels of residues and are therefore fine to buy in conventional form: • mangoes • asparagus • onions • avocados • papayas • cabbage • pineapples • cantaloupe • sweet corn • cauliflower • sweet peas (frozen) • eggplant • sweet potatoes. • grapefruit • kiwi If you can, it’s also good to buy meat and dairy organically, since no antibiotics or added hormones are used. But the most important step you can take toward a healthier diet is simply eating more fruits 40

Healthy Eating 

and vegetables, whether they’re organic or not. The health benefits of eating more produce—even if it is conventionally grown—far outweigh the downsides of higher pesticide residues. And while you’re at it, steer clear of organic snack foods. After all, organic junk food, such as chips, cookies, and crackers, is just that—highly processed, low-nutrient junk.

Restaurant survival strategies Your best bet for meeting your health goals is to cook your own meals at home, where you can control the ingredients and portion sizes. However, we all enjoy eating out from time to time. Just keep in mind that restaurant meals—in particular, fast-food meals—are linked with higher intakes of calories, sugar, saturated fat, and sodium, and lower intakes of healthful foods, such as fruits, vegetables, and whole grains. One of the biggest problems you’ll face when you dine out is sheer portion size, which has increased dramatically over the years. Those bigger portions translate into more calories, sodium, sugar, and saturated fat. Fortunately, the dining scene has improved. The FDA now requires chain restaurants to provide consumers with clear and consistent nutrition information on menus, menu boards, and in writing, which can help you make healthier choices. And more and more restaurants are meeting consumers’ desires for healthier fare by providing smaller portions, more fruits and vegetables on the menu, more vegetarian options, and lighter preparation styles. Follow these tips for dining out healthfully: • Patronize restaurants where good choices—seafood, whole grains, fruits, and vegetables—abound. • Check out the restaurant website in advance in order to decide what you’ll order, instead of making impulse decisions. Many restaurants show their menus online, enabling you to find the healthiest entrées. Some even list nutritional information on menu items. Beware of those with extremely highcalorie, fat, sugar, and sodium levels (see Table 9, page 41). • Skip pan-fried or deep-fried foods. Instead, look for foods prepared with healthful techniques, such as baking, grilling, poaching, or roasting. w w w.h ealt h .ha r va r d.e du

Table 9: Monster restaurant meals Beware of extremely high levels of calories, saturated fat, sugar, and sodium on the restaurant menu. FOOD TYPE

MENU ITEM

CALORIES

SATURATED FAT

SUGAR

SODIUM 

Beverage

Red Robin’s Monster Chocolate Milkshake

1,018

Not available

128 g

393 mg

Appetizer

California Pizza Kitchen’s Avocado Club Egg Rolls

1,190

20 g

25 g

2,280 mg

Soup

Panera Bread’s Vegetarian Creamy Tomato Soup (in a bread bowl)

990

13 g

9g

1,860 mg

Salad

Applebee’s Pecan-Crusted Chicken Salad

1,340

16 g

64 g

2,630 mg

Entrée

The Cheesecake Factory’s Pasta Carbonara with Chicken

2,640

92 g

Not available

2,569 mg

Entrée

IHOP’s Fried Chicken Dinner (without sides)

1,500

22 g

12 g

3,590 mg

Entrée

Johnny Rocket’s Bacon Cheddar Double Burger

1,750

49 g

11 g

2,440 mg

Entrée

Olive Garden’s Tour of Italy

1,500

47 g

18 g

3,210 mg

Entrée

TGI Friday’s Jack Daniel’s Ribs & Shrimp (without sides)

1,730

22 g

Not available

4,140 mg

Dessert

BJ’s Peanut Butter S’mores Pizookie

1,580

31 g

Not available

670 mg

• Avoid dishes prepared with gravy and heavy sauces. Or ask the waiter to use half the sauce, or alternatively, serve it on the side so you can decide how much of it to use. Because gravy is often made with fatty pan drippings from meat, it’s relatively high in saturated fat. Many sauces are made with butter and cream, which are also high in saturated fat. • Resize your portions: split a meal with a friend, order small plates or side dishes, or take half of it home for lunch the next day. • Ask for extra vegetables. Many restaurant entrées don’t come with a generous serving of vegetables. But you can easily remedy that by ordering vegetables from the side dish selection, substituting vegetables or a salad for a less healthful side dish, or asking for more vegetables. • Lighten up dessert. Skip the indulgent, rich desserts, such as ice cream, cakes, and pastries (some can contain more than 1,000 calories) and go for simple treats, such as berries and sorbet. If you want a sweet dessert, share it with others at your

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Thinkstock

Source: Restaurant websites.

Restaurant meals tend to be high in sugar, saturated fat, and sodium, so patronize restaurants where good choices—seafood, whole grains, fruits, and vegetables—abound.

table. You’ll get the full taste, but just a fraction of the calories, sugar, and unhealthy fats. • Watch those beverages. Sweetened drinks (often refilled during the meal) and alcoholic beverages can add hundreds of calories to your meal. Opt for sparkling water, plain tea, or coffee. 

Healthy Eating

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Snack food makeover

Smarter snacks When snacks contribute such a large percentage of the day’s calories, they need to provide important foods and nutrients, too. It’s easy to see that many common snack foods like chips, cookies, doughnuts, and candy bars are not healthful choices. But many snack foods marketed as healthy, organic, or natural are just as bad for your health. Bran muffins masquerade as nutritious even when they are packed with butter and sugar. The same goes for cereal bars and energy bars. Other foods such as fruit leather, yogurt raisins, and organic

Thinkstock

S

nacking is at an all-time high—90% of American adults report that they snack on any given day, according to a USDA report on snacking patterns; that’s twice what it was 30 years ago. That’s not to say that there is anything inherently wrong with snacking. Many people find that their energy flags unless they eat something every four hours or so. In fact, snacking can even help prevent weight gain, if it staves off the type of ravenous hunger that often derails the best diet intentions. The problem isn’t snacking per se. It’s that, rather than planning ahead to have healthy snacks on hand, people typically grab things like chips, cookies, sweet or salty snack mixes, and chocolate-dipped granola bars from vending machines or checkout counters. Often snacks furnish nothing more than calories in the form of refined grains, sugars, and saturated fat, with a dose of sodium to boot. So how can you get back on track? This chapter will outline some ways.

Snacks can be delicious and nutritious at the same time. For example, plain yogurt with fresh berries and granola makes a filling and healthful snack. A sprig of mint adds a refreshing touch.

candies also hold out a deceitful hand, pretending to be healthful while they are really full of added sugar and excess calories. Many people are confused about what makes a healthful snack, but it’s not complicated. When choosing snacks, simply follow the same guidelines as you do for meals—prioritize whole foods with little processing, and look for the healthiest sources of fats, carbs, and protein. Here are some suggestions, each one providing roughly 150 to 200 calories: • 8 ounces plain Greek yogurt with fresh or frozen berries and a sprinkle of granola • 1 cup garlic-roasted edamame in the shell • 1½ ounces trail mix with dried cherries, dark chocolate, and walnuts • ¼ cup hummus with 1 cup fresh vegetables, such as baby carrots, broccoli florets, and cherry tomatoes • 1 slice whole-grain flatbread with 1 tablespoon

mix& match The most healthful snacks have more than one macronutrient—protein, fat, carbohydrates. Try a handful of whole-grain crackers (carbohydrate) with some low-fat cheese (protein, fat); a small amount of dried fruits (carbohydrate) with nuts (protein, fat); or plain popcorn (carbohydrate) sprinkled with low-fat cheese (protein, fat). The mix is more satiating than straight carbohydrates.

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almond butter and 1 teaspoon fruit spread • 1 banana, sliced and spread with 1 tablespoon peanut butter • 1 cup of cooked oatmeal with a dusting of cinnamon, 1 tablespoon raisins, and ½ cup low-fat milk or soy milk.

Six snacking strategies How can you keep snacking from derailing your healthy eating program, not to mention weight control? Try these tips. Don’t skip meals. Skipping meals may seem like a good way to cut calories, but in fact this just makes you so hungry later in the day that you’re vulnerable to devouring mega-portions of snack food, in order to supply your body with easily digested sugars. Keep junk food out of the house. There’s a lot of truth to the old joke about the “see-food diet”—you see food and you eat it. The opposite is also true. If you don’t have junk food lying around, the sight of it won’t tempt you, so don’t even bring it home. After all, you can’t eat what isn’t there. Or, if someone in your household tends to have chips or other unhealthful snacks, put them out of sight. Snack mindfully. Have you ever watched a show on television with a bag of chips or pint of ice cream in hand, only to find that it was all gone before you knew it? This type of mindless eating can pack on a lot of unwanted calories. The solution is simple. Try not to snack while doing something else like surfing the Web, watching TV, or working at your desk. Instead, stop what you’re doing for a few minutes and pay attention to your snack. Savoring a piece of fine

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chocolate can be more satisfying than gobbling down a whole chocolate bar. Remember, you can take it with you. Think ahead, and carry a small bag of healthful snacks in your purse or the glove compartment of your car. If you have a healthy snack handy—preferably, one you really like—you won’t turn in desperation to the calorie-laden cookies at the coffee counter or the candy bars in the office vending machine. Zero in on hunger. Before you snack, ask yourself, “Am I truly hungry?” Many of us mistake emotions, such as stress and fatigue, for hunger. If the answer is yes (your stomach feels hollow, your head is achy), make sure you’re not confusing hunger with thirst. Drink an 8-ounce glass of water; then wait 10 to 15 minutes. If you’re still hungry, have a healthful snack. Know your cravings. If you want a snack but you’re not hungry, attack cravings from a psychological level. Ask yourself how you’re feeling. Lonely? Bored? Stressed? Then, ask yourself the bigger question: will food fix this problem? The answer is always no. Eating a cookie, for example, won’t address a problem at work that you’re worried about. Go for a walk around the block, do a few stretches, put on some music, or choose another simple activity that might distract you or boost your mood. Then if you still want the food, fine. Ask yourself what food you really want. Then eat only a small amount, and make it good. If you’re craving chocolate, for example, eat one small square and savor it. It’s important that you snack on what you’re craving rather than deny the craving. Eating around a craving may only cause you to eat more because the craving isn’t satisfied. 

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Get moving!

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U.S. Department of Health and our best efforts for healthHuman Services recommend the ful eating have their strongest following combination. chance for success when they’re paired with regular physical Aerobic activity. If you activity. Keeping active provides choose activities at a moderate myriad benefits. It lowers the level, do at least two hours and risk of heart disease, type 2 dia30 minutes a week, with exercise betes, stroke, high blood pressessions spread throughout the sure, osteoporosis, and certain week. Do at least 10 minutes of cancers. It improves sleep. It exercise at a time. If you choose sharpens your thinking. Accordvigorous activities instead of ing to some studies, it even adds moderate, you can reduce the years to your life. In the words total time to at least one hour of Dr. Thomas Frieden, direcand 15 minutes a week. You can tor of the CDC, it’s the “closest also mix moderate and vigorous thing we have to a wonder drug.” activities, with two minutes of And unlike medications—which moderate activity equaling one always seem to have prohibitive minute of vigorous activity. lists of side effects—exercise has Regular physical activity, such as walking, can Strength training. Do mushelp motivate you to eat better, too. And it comes cle-strengthening activities at almost exclusively side benefits. Regular exercise also can help with a host of health benefits. least two days a week. Include all you maintain a healthier weight, the major muscle groups, such as which is essentially a matter of balancing the calories legs, hips, back, chest, stomach, shoulders, and arms. you take in every day against the calories required to Exercises for each muscle group should be repeated fuel your body—or, as researchers put it, calories in eight to 12 times per session. versus calories out. Increasing your activity boosts the Balance exercises. The guidelines also recomamount of energy you burn. mend balance exercises for older adults at risk of Many researchers have also observed that when falling. people start working out on a regular basis, they become more dedicated to fitness in general—and that can carry over into increased motivation to maintain Sit less—walk more a healthy diet. Stand up for your health. We mean that literally. Our society is by and large a sedentary one, in which people spend far more time sitting than they did in previous generations—an average of 13 hours a day A well-rounded exercise program A well-balanced exercise program should include versus three in a true agricultural society—and that’s a both aerobic activities (such as walking, running, problem. The latest research shows that too much sitswimming, or biking) and strength training. The ting may be more dangerous than smoking. It is now Physical Activity Guidelines for Americans from the associated with a total of 34 chronic diseases or condi-

tions, from heart disease to back pain and depression. How can something that seems so safe cause so many problems? The human body is designed for activity. When muscles are inactive, they don’t take up glucose (sugar) from the bloodstream as efficiently. Blood pressure rises. Sleep suffers. The benefits of sitting less are so compelling that in 2013, the American Medical Association issued a recommendation encouraging employers to offer alternatives to sitting, such as standing or treadmill desks. But you don’t have to invest in a standing desk to reap the benefits of getting out of your chair. Simply go for short walks throughout your day. Walking is a low-impact activity, is easy to do, requires no special equipment, can be done almost anywhere, and is very healthful. Walking for 2.5 hours a week—that’s just 21 minutes a day—can cut your risk of heart disease by 30%.

Interval walking Does walking sound too easy to be “real” exercise? It’s actually a very healthful practice to build into your daily routine. But to increase the benefits and ramp up the aerobic workout, try doing interval walking, in which you alternate walking at a moderate pace with equal or shorter bursts of fast or brisk walking. This training method has been used for decades by elite athletes to gain a competitive edge, but recent studies show it’s beneficial for all levels of exercisers. If you walk at the same pace day after day, your body becomes accustomed to that level of activity, and benefits such as weight loss and cardio improvements start to plateau. Intervals are a fun, easy way to get you out of your

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comfort zone for just a little while and get fitter faster, while burning more calories. Intervals are also a good solution to the common “I don’t have time to exercise” excuse, since you can accomplish more in less time. Most interval routines are based on time. For example, you might walk at a normal pace for two minutes, then speed up for 30 seconds, before resuming your normal pace for one or two minutes, and so forth. Fast intervals can last as little as eight seconds or up to four minutes, with recovery for an equal or longer length of time. If you don’t like to watch your watch while you’re walking, try one of these methods to create intervals: • Choose landmarks: walk fast for one block or past two mailboxes, and then go slowly for two blocks or four mailboxes. • Count steps: walk fast for 50 steps, then recover for 100 steps. Some people like the focus and meditative effect of counting. • Let music guide your workout. Walk fast for one song, and then ease up for two songs. If you’re outdoors, keep the volume low and use only one earbud to remain aware of your surroundings. • If you’re on a treadmill, use mileage—speed up for one-tenth of a mile, and then recover for fourtenths of a mile. • Walk on hilly terrain. This provides natural intervals, as you push yourself to climb and then recover on the downhill. No matter how you do it, adding some intensity bursts to your walk will speed up your results and keep your workouts interesting. 

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Healthy recipes You can find thousands of recipes online, but this selection will get you started with some dishes that we know are healthy. These recipes were developed, tested, and photographed by registered dietitian Sharon Palmer, the nutrition editor of this report. All the recipes include a nutritional analysis.

Appetizers, soups, and salads

Avocado Salsa ➤ MAKES 10 SERVINGS

Curried Leek-Vegetable Soup ➤ MAKES 8 SERVINGS

1 cup tomato sauce 1 medium leek, chopped (green and white parts) 1 medium carrot, sliced 2 stalks celery, sliced 2 medium zucchinis, sliced 2 teaspoons curry powder ¼ teaspoon red chili pepper flakes 2 tablespoons fresh cilantro, chopped (or 1 teaspoon dried) Pinch kosher salt (optional) Place all ingredients together into a large pot with 3 cups water. Stir well, cover, and bring to a simmer. Cook for about 40 minutes, until vegetables are tender. If needed, add water to replace liquid lost in evaporation. Nutritional information per serving: 41 calories, 1 g protein, 0 g fat, 0 g saturated fat, 9 g carbohydrate, 2 g fiber, 8 g sugar, 28 mg sodium.

3 medium ripe tomatoes, diced, with juice 2 medium ripe yet firm avocados, diced 1 medium red bell pepper, diced ½ red onion, diced 1½ cups frozen sweet corn, thawed 1 (2.25-ounce) can black olives, drained, sliced 3 cloves garlic, minced ¼ jalapeño pepper, finely diced ¼ cup chopped cilantro or parsley Juice of 1 lemon 1 tablespoon extra-virgin olive oil Black pepper and sea salt as desired In a medium bowl, combine tomatoes (including any tomato juice left on cutting board when chopping), avocados, bell pepper, onion, corn, olives, garlic, jalapeño, and cilantro or parsley and toss together gently. Add lemon juice, olive oil, black pepper, and sea salt, and toss together to distribute. Adjust seasonings as needed. Chill until serving time. Serve with whole-grain or bean chips, tacos, burritos, or fresh veggies. Nutritional information per serving: 120 calories, 2 g protein, 8 g fat, 1 g saturated fat, 12 g carbohydrate, 4 g fiber, 3 g sugar, 134 mg sodium.

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Healthy recipes | SPECIAL SECTION

Zucchini-Orzo Soup ➤ MAKES 8 SERVINGS

1 (14.5-ounce) can diced tomatoes, with liquid 2 teaspoons vegetable broth base 1 small onion, chopped 2 carrots, sliced 3 stalks celery, sliced 2 cloves garlic, minced ¼ teaspoon black pepper 1 teaspoon dried basil 1 teaspoon dried oregano 1 cup whole-wheat orzo, dry 2 small zucchinis, sliced Put tomatoes and 4 cups water in a large pot over medium-high heat. Add broth base, onion, carrots, celery, garlic, black pepper, dried basil, and dried oregano. Stir, cover with lid, and bring to a simmer. Reduce heat to medium. Let cook for 25 minutes. Add orzo and zucchini, cover, and cook an additional 10 to 15 minutes, until vegetables are tender. If needed, add additional water to replace moisture lost in evaporation. Soup should be thick. Nutritional information per serving: 132 calories, 3 g protein, 1 g fat, 0 g saturated fat, 28 g carbohydrate, 4 g fiber, 4 g sugar, 158 mg sodium.

Brown Rice, Chickpea, and Kale Salad with Ginger-Tahini Dressing ➤ MAKES 8 SERVINGS

2 cups cooked brown rice (short or long grain), cooled 1 (15-ounce) can chickpeas (garbanzo beans), rinsed, drained 5 cups finely chopped kale ½ cup dried cranberries Juice and zest of 1 lemon 1½ tablespoons red wine vinegar 3 tablespoons tahini (sesame-seed paste) 1 teaspoon freshly grated ginger ½ teaspoon smoked red paprika Sea salt and black pepper (as desired) Mix together rice, chickpeas, kale, and dried cranberries in a large bowl. In a small bowl, mix together lemon juice and zest, red wine vinegar, tahini, ginger, paprika, and sea salt and black pepper as desired. Pour dressing over salad and combine well. Mix well to redistribute ingredients before serving. Store in an airtight container for up to three days. Note: This recipe is delicious served slightly warm; this can be accomplished by using freshly cooked hot rice. Nutritional information per serving: 240 calories, 7 g protein, 5 g fat, 0 g saturated fat, 44 g carbohydrate, 7 g fiber, 11 g sugar, 32 mg sodium.

Cucumber Salad ➤ MAKES 4 SERVINGS

4 Persian cucumbers, thinly sliced 2 plum tomatoes, chopped ¼ red onion, diced 2 tablespoons chopped fresh cilantro or parsley 2 tablespoons chopped fresh mint Juice of ½ lemon Pinch each of black pepper, sea salt, and cumin Mix all ingredients together. Chill before serving. Nutritional information per serving: 28 calories, 2 g protein, 0 g fat, 0 g saturated fat, 7 g carbohydrate, 3 g fiber, 2 g sugar, 7 mg sodium.

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| Healthy recipes

Entrées and side dishes Asian Salmon with Kale and Tomatoes ➤ MAKES 4 SERVINGS

1 tablespoon sesame oil or olive oil ½ cup thinly sliced red onion 3 cloves garlic, minced 1 teaspoon grated fresh ginger plus 4 slices, divided (see note) 4 cups torn or roughly chopped kale, stems cut into ¼-inch slices ½ cup low-sodium vegetable or chicken broth 2 tablespoons low-sodium soy sauce plus 4 teaspoons, divided ½ teaspoon red pepper flakes 1 cup cherry tomatoes, halved 1 pound salmon fillet, cut into 4 portions 4 thin slices lemon 1 teaspoon toasted sesame seeds or toasted slivered almonds Heat oil in a 12-inch skillet over medium-high heat. Add onion and sauté until softened. Add garlic and 1 teaspoon grated ginger and sauté another minute. Add kale, using tongs to quickly turn and coat the leaves with oil. Add broth, 2 tablespoons soy sauce, and red pepper flakes, continuing to turn the mixture. When kale is just wilted, add tomatoes and salmon portions, placing the fillets directly against the bottom of the skillet. Top each fillet with 1 slice of ginger, 1 slice of lemon, and 1 teaspoon of soy sauce. Cover skillet and cook until salmon is done, about 6 to 8 minutes depending on thickness. Serve salmon on bed of kale and tomatoes. Sprinkle with sesame seeds or almonds and additional red pepper flakes if desired. Note: Instead of fresh ginger, you can use ¼ teaspoon ginger powder, plus a dash of powder on each fillet. Nutritional information per serving: 550 calories, 26 g protein, 12 g fat, 2 g saturated fat, 13 g carbohydrate, 2 g fiber, 2 g sugar, 562 mg sodium.

Tofu-Mushroom Tacos ➤ MAKES 8 TACOS

8 ounces extra-firm tofu, drained 1 teaspoon extra-virgin olive oil 1½ cups mushrooms, finely chopped 2 green onions, diced 1 clove garlic, minced ½ cup plus 2 tablespoons prepared salsa, divided 1 teaspoon taco seasoning 1 teaspoon reduced-sodium soy sauce 1 (15-ounce) can (1¾ cup) unsalted black beans, rinsed, drained 8 small (6-inch) whole-grain tortillas 2 cups leafy green lettuce 2 tomatoes, diced 1 avocado, sliced into eighths 1 cup shredded cheese (plant-based or dairy, optional) Shred drained tofu with a grater. Heat olive oil in a large skillet and add tofu, mushrooms, onions, garlic, 2 tablespoons salsa, taco seasoning, and soy sauce. Sauté for about 5 minutes, until mushrooms are tender. Meanwhile, heat black beans (in the microwave or over the stove) until warm. Warm tortillas in the microwave for 1 minute. To assemble tacos: Fill each tortilla with about ¼ cup tofu-mushroom mixture, ¼ cup beans, ¼ cup lettuce, ¼ tomato, 1 slice of avocado, 2 tablespoons cheese (if using) and 1 tablespoon salsa. Nutritional information per serving: 244 calories, 10 g protein, 10 g fat, 2 g saturated fat, 31 g carbohydrate, 7 g fiber, 2 g sugar, 237 mg sodium.

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Healthy recipes | SPECIAL SECTION

Lentil Patties with Basil-Arugula Cashew Cream ➤ MAKES 10 PATTIES

For Lentil Patties: 1 cup small green lentils, dry 3 cups vegetable broth 1 tablespoon chia seeds 2 medium carrots, finely shredded 1 medium yellow potato, finely shredded 4 green onions, finely chopped ¼ cup finely chopped arugula 2 tablespoons finely chopped basil 1 clove garlic, minced

1 teaspoon Dijon mustard ½ cup old-fashioned oats, dry 1/3 cup whole-grain bread crumbs 1 teaspoon soy sauce Sea salt and black pepper (optional) 2 tablespoons olive oil For Basil-Arugula Cashew Cream: 1 cup Basic Cashew Cream (see recipe, at right) 2 tablespoons fresh arugula 2 tablespoons fresh basil

To make Lentil Patties: Place lentils in a small pot and add broth. Cover and simmer over medium heat about 45 minutes, stirring occasionally, until very tender. Drain any leftover liquid and transfer cooked lentils to a bowl and stir in chia seeds. Add carrots, potato, onions, arugula, basil, garlic, mustard, oats, bread crumbs, soy sauce, and salt and pepper (if using) to taste. Stir well to make a thick mixture. Place 1 tablespoon olive oil in a large skillet (cast iron works well). Heat well. Form patties by pressing a handful of the lentil mixture into a firm, thick patty. Lay in skillet (four or five per batch) and cook for 7 minutes on medium heat. Turn carefully and cook on the other side for 7 minutes. Repeat the process, adding the rest of the oil to the pan as needed, until all patties are cooked. To make Basil-Arugula Cashew Cream: Put 1 cup Basic Cashew Cream into a blender. (Note that the recipe for Basic Cashew Cream makes 3 cups, so you can either cut the amount of ingredients you use or make the full recipe and set aside a portion to use later.) Add fresh arugula and basil and process until smooth, creamy, and light green in color. Serve each Lentil Patty with a dollop of Basil-Arugula Cashew Cream. Refrigerate any leftovers in an airtight container for up to 3 days. Nutritional information per patty with cashew cream: 252 calories, 11 g protein, 10 g fat, 2 g saturated fat, 31 g carbohydrate, 9 g fiber, 3 g sugar, 368 mg sodium.

Basic Cashew Cream ➤ MAKES 12 SERVINGS

(¼ cup per serving)

2 cups raw cashews Juice of 1 small lemon 2 cloves garlic (optional, for savory recipes) Pinch each of sea salt and white pepper (optional, for savory recipes) 1 tablespoon agave or coconut maple sugar (optional, for sweet recipes) 1 teaspoon vanilla (optional, for sweet recipes) Place cashews in a bowl and cover with water. Soak for 3 hours. Drain. Place cashews in a blender with lemon juice, 1 cup water, and optional ingredients as desired— depending on your preference for use in savory or sweet dishes. Process cashews until very smooth, pausing to scrape down the sides as needed, until texture is thick and creamy. Remove from blender and place in an airtight container. Chill for up to 5 days. Use in place of cheese, sour cream, or cream cheese in pastas, casseroles, dips, desserts, and sauces. Excellent as a topping for salads and tacos. May add additional flavorings to suit recipes, such as herbs and green onions for salad dressings, or cinnamon for a sweet topping. Nutritional information per serving: 208 calories, 7 g protein, 16 g fat, 3 g saturated fat, 13 g carbohydrate, 1 g fiber, 3 g sugar, 4 mg sodium.

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| Healthy recipes

Vegetable-Bean Fajitas

Mediterranean Artichoke-Chickpea Bake

➤ MAKES 4 SERVINGS (2 tortillas per serving)

➤ MAKES 6 SERVINGS

2 teaspoons extra-virgin olive oil 1 large onion, sliced 1 green bell pepper, sliced 1 red bell pepper, sliced 2 small zucchinis, sliced 4 ounces fresh mushrooms, sliced 2 cloves garlic, minced ¼ jalapeño pepper, finely diced 1 tablespoon fresh lemon juice 1 teaspoon cumin 1 teaspoon chili powder ¼ cup chopped fresh cilantro 2 cups unsalted cooked beans (e.g. pinto, cranberry, red) 8 small corn tortillas 1 cup guacamole (make your own with mashed avocado, lemon juice, and garlic) 1 cup salsa (look for lower-sodium brands)

1½ cups cooked spelt (prepared according to package directions) 1 (15-ounce) can chickpeas (garbanzo beans), drained 1 (12-ounce) jar marinated artichokes, drained 1 cup frozen peas ½ cup olives (e.g. Spanish, Kalamata), drained ½ cup marinara sauce 1 clove garlic, minced Pinch black pepper 1 teaspoon oregano

Heat olive oil in a large skillet (cast iron works best). Add onion, bell pepper, zucchini, mushrooms, garlic, and jalapeño, and sauté for about 10 minutes, until just tender. Add lemon juice, cumin, chili powder, and stir well. Sprinkle with chopped cilantro. To serve: Fill tortilla shells with beans and vegetable mixture, and garnish with guacamole and salsa. Nutritional information per serving: 385 calories, 14 g protein, 11 g fat, 0 g saturated fat, 63 g carbohydrate, 14 g fiber, 6 g sugar, 235 mg sodium.

Preheat oven to 375° F. Mix all ingredients together and place in a medium casserole dish. Place in oven, on top rack, uncovered, and bake for about 30 to 35 minutes, until golden brown and heated through. Nutritional information per serving: 268 calories, 12 g protein, 6 g fat, 0 g saturated fat, 50 g carbohydrate, 14 g fiber, 9 g sugar, 312 mg sodium.

Edamame and Bok Choy Rice Bowl ➤ MAKES 4 SERVINGS

3 cups brown rice, cooked 1 tablespoon sesame oil 1 red bell pepper, sliced 2 cups frozen edamame (shelled) 6 ounces (about 5 heads) baby bok choy, coarsely chopped 2 tablespoons reduced-sodium soy sauce Cook brown rice in pot or rice cooker according to package directions. While rice is cooking, heat sesame oil in a sauté pan, skillet, or wok. Add sliced bell pepper and edamame, and sauté for 6 minutes. Add bok choy and soy sauce and cook, for an additional 4 minutes, just until bok choy is crisp-tender yet still bright green. Divide rice among 4 large bowls and top each bowl with one-fourth of the vegetable mixture. Nutritional information per serving: 329 calories, 17 g protein, 9 g fat, 1 g saturated fat, 2 g carbohydrate, 10 g fiber, 5 g sugar, 374 mg sodium.

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Healthy recipes | SPECIAL SECTION

Spaghetti Squash with Ratatouille ➤ MAKES 8 SERVINGS

Stuffed Eggplant with Miso and Quinoa ➤ MAKES 4 SERVINGS

2 small eggplants 1 teaspoon olive oil ½ red onion, diced 2 cloves garlic, minced 1 teaspoon minced ginger 1 bell pepper (green, yellow, or red), diced 1 cup mushrooms (e.g., oyster, shiitake, brown), diced 1 teaspoon parsley flakes 2 tablespoons reduced-sodium red miso paste 1 tablespoon reduced-sodium soy sauce 1 tablespoon rice vinegar 1½ cups cooked quinoa 1 cup cooked kidney beans, drained 1 tablespoon sesame seeds Preheat oven to 350° F. Trim the stem ends from the eggplants and slice the eggplants in half lengthwise. Scoop out the inside to create a shell with about ¾ inch of flesh remaining on the eggplant skin. (Reserve scooped-out flesh for soup, stews, or stir-fries.) Heat oil in a large sauté pan or skillet and sauté onion with garlic and ginger for 2 minutes. Add bell pepper and sauté for 2 minutes. Add mushrooms, parsley flakes, red miso paste, soy sauce, and vinegar, and sauté for an additional 2 minutes, stirring well to distribute ingredients. Fold in cooked quinoa, kidney beans, and sesame seeds and stir well. Fill eggplant shells with quinoa filling, heaping it on top. Place in a baking dish with 1 tablespoon water on the bottom of the dish. Bake uncovered for about 40 minutes, until filling is golden and eggplant is tender.

1 small spaghetti squash, quartered 1 tablespoon extra-virgin olive oil 1 onion, diced 1 small eggplant, chopped 1 medium zucchini, chopped 2 cloves garlic, minced 1 (14.5-ounce) can unsalted diced tomatoes, with liquid 1 teaspoon basil 1 teaspoon oregano 1 teaspoon marjoram ¼ teaspoon black pepper salt (optional) 1 tablespoon capers, rinsed, drained ½ cup whole Mediterranean olives, rinsed, drained 1 tablespoon balsamic vinegar 1 teaspoon honey Scoop out the seeds from the spaghetti squash and place the squash in a medium pot with enough water to cover it. Bring to a boil and cook for about 20 minutes, just until tender enough that you can separate spaghetti-like strings from the squash flesh with a fork. Remove from pot and place on a cutting board to cool slightly. While squash is cooking, heat olive oil in a large sauté pan or skillet. Sauté onions, eggplant, zucchini, and garlic for 10 minutes. Add tomatoes, ½ cup water, basil, oregano, marjoram, pepper, salt (if using), capers, olives, vinegar, and honey. Cover and cook for 10 minutes, stirring occasionally, until vegetables are tender and mixture is thick. With a fork, gently separate strings of squash from the squash peel and add to vegetable mixture. Stir together to heat through, and serve immediately. Nutritional information per serving: 100 calories, 1 g protein, 5 g fat, 0 g saturated fat, 15 g carbohydrate, 3 g fiber, 5 g sugar, 371 mg sodium.

Nutritional information per serving: 264 calories, 13 g protein, 3 g fat, 0 g saturated fat, 46 g carbohydrate, 17 g fiber, 9 g sugar, 500 mg sodium.

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| Healthy recipes

Fruit, desserts, and baked goods Grilled Peaches with Basil ➤ MAKES 8 SERVINGS

4 fresh peaches, with skin, cut in half, pit removed 1½ tablespoons basil-infused extra-virgin olive oil 1 tablespoon white balsamic vinegar 1 teaspoon honey 2 tablespoons chopped fresh basil Fresh basil leaves for garnish Place peaches in a dish, cavity facing up. Whisk together olive oil, vinegar, honey, and chopped basil. Drizzle over peaches and marinate for 30 minutes. Heat a grill. Place peaches (cavity facing up) on hot grill and grill for 3 minutes. Turn over and brush peaches with remaining vinaigrette from dish. Grill for 3 minutes. Garnish with fresh basil leaves and serve immediately. Nutritional information per serving: 79 calories, 1 g protein, 5 g fat, 1 g saturated fat, 9 g carbohydrate, 1.5 g fiber, 8 g sugar, 0 mg sodium.

Peanut-Blueberry Scones ➤ MAKES 8 SERVINGS

2 cups white wholewheat flour ¾ cup peanut flour 1 tablespoon baking powder Pinch salt

¼ cup sugar ¼ cup canola oil, expeller pressed 1 cup milk (plant-based or dairy) ¼ cup dried wild blueberries

Preheat oven to 375° F. Mix together flours, baking powder, salt, and sugar. Stir in oil and milk just until well combined. Dough should be soft and slightly sticky. Stir in blueberries. Flour a cutting surface and roll out dough to make a thick circle, about 10 inches in diameter. Cut circle into 8 pie-shaped wedges. Spray a baking sheet with nonstick cooking spray and arrange scones on sheet. Bake for about 20 minutes, until golden brown and cooked through. Serve warm. Nutritional information per serving: 144 calories, 3 g protein, 5 g fat, 0 g saturated fat, 23 g carbohydrate, 3 g fiber, 8 g sugar, 17 mg sodium.

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Apricot Almond Tart ➤ MAKES 12 SERVINGS

For crust: ½ cup white whole-wheat flour ½ cup all-purpose flour ½ cup almond meal ¼ cup coconut palm sugar (or brown sugar) 1/3 cup tub margarine 1 tablespoon chia seeds For filling: 10 apricots, pitted, quartered Juice of ½ lemon 2 tablespoons honey or agave nectar ½ teaspoon vanilla extract ¼ cup slivered almonds Preheat oven to 375° F. Mix flours, almond meal, and coconut palm sugar together. Cut in margarine until crumbly. Soak chia seeds in 3 tablespoons water for a few minutes to make a gel. Stir into pastry dough. Place dough into a 9-inch tart pan with a removable bottom. Pat evenly into pan. Prick with fork. Bake for 8 minutes. Remove crust from oven and arrange apricots on top with skins facing down. Mix lemon juice, honey or agave nectar, and vanilla in a small dish. Drizzle over the apricots and return to oven. Bake at 375° F for 25 minutes. Remove tart from oven and sprinkle with almonds. Bake at 375° F for an additional 20 minutes until golden and tender. Remove, cool slightly, and serve on a platter. Nutritional information per serving: 155 calories, 3 g protein, 8 g fat, 2 g saturated fat, 18 g carbohydrate, 3 g fiber, 10 g sugar, 47 mg sodium.

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Resources Organizations

Foundation Book Award for Reference and Scholarship.

Academy of Nutrition and Dietetics 120 S. Riverside Plaza, Suite 2000 Chicago, IL 60606 800-877-1600 www.eatright.org

Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating Walter C. Willett, M.D., with P.J. Skerrett (Simon & Schuster, 2005)

This large organization of food and nutrition professionals provides information and advice to the general public through its website, outreach efforts, and publications.

The Nutrition Source—Knowledge for Healthy Eating Harvard T.H. Chan School of Public Health Department of Nutrition www.hsph.harvard.edu/nutritionsource

This book provides research-based information about the links between diet and health. An extensive selection of recipes helps readers put the latest nutrition findings into practice.

Eat, Drink, and Weigh Less: A Flexible and Delicious Way to Shrink Your Waist Without Going Hungry Mollie Katzen and Walter C. Willett, M.D. (Hyperion, 2007)

Books

This book teams Mollie Katzen, author of the landmark Moosewood Cookbook, with Dr. Walter Willett, head of the Harvard T.H. Chan School of Public Health’s Department of Nutrition. Together they’ve created a weight-loss plan that’s easy to implement, as well as more than 100 delicious recipes.

The Art of Fermentation Sandor Ellix Katz (Chelsea Green Publishing, 2012)

The Plant-Powered Diet Sharon Palmer, R.D., L.D.N. (The Experiment, 2012)

A comprehensive guide to do-it-yourself fermentation, this book will help those who want to pack more healthful probiotics into their meals. It won the 2013 James Beard

This book, by one of the authors of this report, lays out the arguments for an eating pattern that is based on whole foods. It includes a 14-day meal plan and 75 original recipes.

This website gives free public access to the latest information on nutrition and health.

Glossary body mass index (BMI): An estimate of the body’s fat content, calculated from measurements of height and weight. dietary fiber: The edible, nondigestible component of carbohydrates naturally found in plant food.

dietary reference intakes (DRIs): A comprehensive set of

standards for daily intake of essential vitamins and minerals, based on evidence from scores of observational and clinical studies.

essential amino acids: The nine amino acids (building blocks of

protein) that the body cannot synthesize for itself.

essential fats: Beneficial polyunsaturated fats, including both

omega-3 and omega-6 fatty acids, that come exclusively from foods and supplements; they are not manufactured by the body.

glycemic index: A measure of how soon and how much a serving of a food causes blood sugar to rise. Foods with a high glycemic index are thought to increase the risk of insulin resistance and other health problems. macronutrients: The basic categories of nutrients that humans need for energy and metabolism: fat, carbohydrate, and protein. micronutrients: The vitamins and minerals that humans need to

maintain normal body functions and prevent certain illnesses.

monounsaturated fats: Beneficial fats that contain one double bond between adjacent carbon atoms.

omega-3 fatty acids: Beneficial fats also known as n-3 fatty

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acids. These are polyunsaturated fats in which the last double bond between carbon atoms is located three carbons from the end of the chain.

omega-6 fatty acids: Beneficial fats also known as n-6 fatty acids. These are polyunsaturated fats in which the last double bond between carbon atoms is located six carbons from the end of the chain. phytochemicals: Substances made by plants that have biological effects in the human body. Some are phytoestrogens, chemicals that behave like (or sometimes block the action of) the hormone estrogen.

polyunsaturated fats: Beneficial fats that contain two or more double bonds between adjacent carbon atoms. processed foods: Foods that are refined, stripped of many nutrients, and mixed with other ingredients to form new products. saturated fats: Unhealthy fats in which all the carbon atoms are bonded to the maximum number of hydrogen atoms, so there are no double bonds between the carbons. trans fatty acids (trans fats): Unhealthy fats that occur naturally in meat but come mainly from processed foods made with hydrogenated oils. Hydrogenated oils are polyunsaturated fats that have been chemically altered to be more like saturated fats. whole foods: Foods consumed in their most natural forms, with no processing or only minimal processing.

Healthy Eating

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