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From The Desk Of Clarence Bass

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“You don’t need to be a scientific investigator to eat right, constantly counting milligrams or calculating percentages. It simply involves keeping the emphasis on the whole foods available on the perimeter of the supermarket rather than on the boxed, bagged, canned, and other packaged goods lining all the center aisles.” Miriam E. Nelson, Ph.D., and Alice H. Lichtenstein, D.Sc. (Strong Women, Strong Hearts, Putnam 2005)

  Simple Diet Patterns for Good Health

A visitor to our site wrote recently: “There is so much confusion out there regarding trans fats and other dietary matters. I think it would be a good idea if you wrote an article about this in simple terms.” This suggestion came to mind when I was reading the latest book by Tufts University professor and researcher Miriam Nelson, author of the best-selling Strong Women health series. In my opinion, no one does a better job explaining complex health matters in an easy-to-understand way. Nelson’s primary expertise is in physical activity, but she teams up with authorities in other areas to write about a wide variety of health and fitness issues. Strong Women, Strong Hearts, written in collaboration with Tuft’s nutrition and cardiovascular disease expert Alice H. Lichtenstein, D.Sc., includes the clearest explanation I’ve seen on how women (and men) should eat to avoid heart disease and generally stay healthy. What follows draws heavily on their Don’t Think Diet—Think Food Patterns chapter to help our inquisitive visitor (and others) think clearly about eating to stay healthy.

  Vegetables and Fruits

Healthy eating starts with lots of vegetables and fruits. Four or five servings of vegetables and two to four of fruits is a good goal. Carol and I don’t count servings, but we have one or both with almost every meal and snack. We use both fresh and frozen produce. Carol likes to buy in-season produce; she peels, slices, dices and cooks, if necessary, from scratch. Left to my own devices, I like the year-round convenience of the frozen food department, which offers up every imaginable variety and combination of produce, frozen at the peak of freshness without anything of consequences added. We always have a bowl of fresh fruit--usually apples, but it could be any fruit in season--on the counter in the kitchen; fruit is our default snack at any time of the day or night.

What’s so special about vegetables and fruits? For starters, produce is high in fiber and bulk, and low in calories. It’s also high in potassium and very low in sodium, both of which help keep your blood pressure low. (High potassium and low sodium also improve muscle definition; see Ripped 2.) Moreover, Nelson and Lichtenstein say there is a remarkable “consistency” in the studies showing that diets rich in vegetables and fruits are “associated with a decreased risk for developing heart disease and stroke.” Truth is, vegetables and fruits are good for whatever ails you (see FAQ on The China Study).

Carol and I almost never drink fruit or vegetable juice, however. Professor’s Nelson and Lichtenstein explain why: “Whole fruit [or vegetables], unlike juice, offers fiber. And it tends to be more filling. An orange will stave off mid-morning hunger much better than a glass of orange juice.” (See Ripped 2 for a complete explanation.) Whole produce makes you feel full and satisfied, without giving you too many calories. It takes up room in your stomach that might otherwise be filled with fat-and-sugar-laden foods.

No discussion of produce would be complete without a word or two about the much-maligned potato. “Potatoes are decent vegetables that have been unfairly criticized,” Nelson and Lichtenstein write. “Their skin is a decent source of fiber, and the fleshy part contains lots of potassium and a reasonable amount of vitamin C, along with other nutrients.”

Potatoes are starchier than other vegetables, and they do contain more carbs. “Think of potatoes as a grain rather than a vegetable,” the Tuft’s professors suggest. “That is, they’re not instead of broccoli; they’re instead of bread, rice, or pasta.

Carol and I often share a big baked potato at dinner, but almost never with butter or sour cream and chives; Balsamic vinegar or non-fat yogurt is our favorite topping. Needless to say, we rarely eat French fries, which are loaded with salt and extra calories—and, according to Nelson and Lichtenstein, often contain trans-fatty acids because of the fat in which they are fried. We steer clear of potato chips for the same reasons.

Any kind of plain, unembellished vegetable or fruit is good. A wide variety is best. Try to include several different colors in each meal; green, red, yellow, make your plate look like a rainbow. For example, sliced carrots and a few cherries or slices of watermelon go well with a nut-butter sandwich at lunch. Broccoli, sweet potato and a green salad with tomatoes enliven any dinner. Use your imagination and you can’t go wrong.

The Right Fats

The idea is to replace most unhealthy fats with healthy fats—and not eat too many calories in the process. “[Unhealthy fat] includes the saturated fat in beef, poultry, and other meat as well as full-fat dairy foods, and the trans-fatty acids in commercially fried and baked foods and other items, including the legions of packaged foods that run the gamut from cookies, cakes, and crackers to microwavable popcorn and frozen entrees,” the Tufts professors state. That doesn’t mean you can never eat a juicy T-bone or filet mignon or a chocolate cake, just that such indulgences should be infrequent. Healthy eating is not a black-and-white proposition; it’s about eating the right foods most of the time.

Nelson and Lichtenstein say low-fat diets are out and moderate-fat diets are in—“as long as you have the right fats.” Those include the omega-3 fatty acids in fish, seeds, nuts and most vegetable oils. Conventional wisdom says that oils high in monounsaturated fatty acids, such as olive and canola oils, are exceptionally healthy.  “The scientific evidence no longer supports that line of thinking,” Nelson and Lichtenstein report. “The aim is simply to shoot for more unsaturated fat and less saturated and trans fats.”

Carol uses some olive oil in cooking and I have a teaspoon of canola oil in coffee before workouts, but other than that we prefer to get most of our fats from whole foods. We have fish several times a week (more on that later) and ground flaxseeds in my breakfast cereal and in her morning smoothie. I have a nut-butter sandwich most days and Carol likes walnuts. That’s about it.

A gram of fat contains nine calories, compared to four in protein and carbohydrate. Too much fat is still fattening. As note above, the idea is to replace bad fat with good fat, not overdose on good fat. We don’t count calories, but calories do count, especially fat calories, which are easily converted to body fat. Overloading with fat on any kind will make you fat, so be careful. (See Don’t Add Good Fat to a Bad diet, Diet and Nutrition category, article 20.)

Whole Grains

Carbohydrates, the major component of grains, have been blamed for our ever-expanding waistlines. “It’s not so,” Nelson and Lichtenstein state emphatically. “Carbohydrates are GOOD FOR YOU.”

Refined carbohydrates are a problem, however. Sugar and white flour are two of the purest forms of refined carbohydrates; all the fiber and bulk have been removed, leaving nothing but concentrated--and empty--calories. Sugar is the main component in soda pop, and sugar and white flour are the main ingredients in white bread, pizza dough, and pretzels. Compound the problem by adding butter or lard to make cakes, cookies and the like, and you’re really in trouble. Refined-grain foods will add calories to your diet and inches to your body. Plus, they lack vital nutrients needed to keep you healthy.

The good grains are whole grains, such as those found in whole-grain breads and cereals, brown rice, and whole-wheat pasta. “Unlike refined grains, they contain fiber plus a host of nutrients and healthful plant chemicals that are eliminated when grains go through the refining process,” the professors explain.

Whole-grain foods are sometimes hard to identify, however. The no-brainers are whole grains available in natural food markets and many traditional supermarkets. These are the intact, unbroken grains as they come from the field; examples are oat groats, rye, barley, millet, spelt, kamut, amaranth and many others. Whole grains can be cooked like rice and served plain or take the place of pasta. Carol and I use whole grains as breakfast cereal or in place of rice at lunch or dinner.

It gets more complicated from there. “Only 5 percent of the packaged grain-based products in the supermarket are whole grain,” the co-authors warn. “And it’s not easy to tell which ones they are.” Terms such as multi-grain, seven-grain, and unbleached don’t tell you whether the grain is whole. The magic word is whole and it must be part of the first ingredient on the label to insure that the food contains whole grain. Brown rice means whole-grain rice is in the package. Popcorn is also whole grain. “Make sure it’s air-popped rather than made with butter or partially hydrogenated fat (trans-fatty acids),” Nelson and her colleague caution.

About the only packaged grain product Carol and I use regularly is bread. We like the whole and sprouted grain breads made by Food For Life, which are now widely available. Our favorite is Ezekiel 4:9 Sesame, a sprouted grain bread. For more tips on choosing bread, see article 116, Diet & Nutrition category.

Four to nine servings are recommended, at least half from whole grains. Half would be an improvement for most Americans, but more would be better. Almost all the grain products Carol and I eat are whole grain. Again we don’t count servings, but I have grains at least three or four times a day, usually in the form of whole grains, bread or oatmeal. (Some oats are more refined than others, but the whole-grain components are in all forms: groats, rolled, steel-cut and oatmeal. Instant oats are best avoided, because they find their way into the blood stream too fast.)

Nonfat Dairy Foods

 “Diary products are associated with stronger bones and may keep down blood pressure,” Nelson and Lichtenstein write. They are, of course, an excellent form of complete protein, calcium and other nutrients. The downside is the saturated fat they contain, so it’s important to select the low- or nonfat form. I always buy nonfat dairy, usually skim milk or nonfat yogurt. Being a little more adventurous, Carol sometimes goes for low-fat cheese or cottage cheese. Low-lactose varieties are available for those who have trouble digesting dairy products. Soymilk is also an acceptable substitute for milk and other dairy foods. (Not for babies, however.) I alternate soymilk and skim milk. (See The Story On Soy, article 79, Diet & Nutrition category.)

I use skim milk on my breakfast grains, and nonfat yogurt as a topping for fruits, vegetables and baked potatoes. Nonfat yogurt is an extremely versatile food and goes with just about anything; see the recipe suggestions in Ripped 3.

Two to three servings daily are recommended. I often have more than that, but some authorities question whether that’s a good idea. Walter C. Willett, M.D., chairman of the Department of Nutrition at Harvard School of Public Health, believes dairy may have a dark side. “A diet high in dairy products has been implicated as a risk factor for prostate cancer,” Willett wrote in Eat, Drink, and Be Healthy (Simon & Schuster 2001). Surprisingly, saturated fat isn’t the troublemaker; it is a problem, of course, but doesn’t seem to be the cancer connection. “Calcium might be the culprit,” Willett opines. Here’s the doctor’s plausible explanation: “Inside the prostate (and elsewhere), the active form of vitamin D may act like a brake on the growth and division of cancer cells. Too much calcium slows or even stops the conversion of inactive vitamin D to its biologically active form and so may rob the body of a natural anticancer mechanism.” This is far from settled--Nelson and Lichtenstein do not cite a possible cancer connection--but it’s something to be aware of.

Moderation in all things is probably good advice, even when it comes to something as innocuous and wholesome as diary products. (See also FAQ 3, Worry About Milk?)

Healthy Proteins

We’ve mentioned dairy products as a good source of protein, but there are many excellent sources. A wide range of protein containing foods is probably best, not all at once, of course, but over time. Nelson and Lichtenstein list fish, beans, soy, eggs, nuts, skinless poultry, and lean forms of beef, pork and lamb. Get your protein from a variety of sources, but you don't need a whole lot. Most Americans eat more protein than they need, often the wrong kind. Twenty percent of calories is about right. Have at least one source of protein with each meal and you'll be fine. Three or four servings daily is recommended.

Saturated fat, again, is a problem. The professors suggest proteins that don’t come packed with a lot of saturated fat. Fish should be near the top of the list. “The evidence is overwhelming that including fish in the diet helps stave off heart disease,” the authors write. They suggest at least two fish meals a week.

Fish high in omega-3 fatty acids, such as salmon (wild or farmed), sardines, herring, mackerel and other fish with darker-colored flesh are good for your heart. “But we don’t want you to get hung up on the type of fish you eat,” they state. Vary the type of fish you eat, and almost any fish that suits your taste is fine. “Your risk of mercury toxicity or toxicity of other contaminants [PCBs] is quite low,” says Doctor Lichtenstein. Remember, you're eating a variety of fish, and only a few times a week. (For small children and women of childbearing age, check Food and Drug Administration guidelines for restricted species, which are very few.)

With a few limited exceptions, any fish is good for you. “Even tuna sandwiches count—but fish sticks, fried clams, and fried, breaded shrimp do not.” The method of cooking is important. Baked or broiled is best. Deep-fried is a no-no, however, because of added calories and often trans or saturated fatty acids. Carol sometimes adds flour and seasoning and cooks fish in the skillet with a little olive oil. (Works for chicken too.) She usually bakes or broils our fish, however. 

Beans are often overlooked as a protein source. Uniquely, beans are relatively low calorie—and contain lots of fiber and basically no saturated fat. Canned beans are the most convenient. Look for brands with little or no added sugar and fat. Ideally, what you want is beans, and nothing else. The international section of your supermarket is a good place to look. “Throw them into tossed salads, add to vegetable stir-fries and to your favorite soups, or simply have them as a side dish,” the doctors suggest. Tofu fits into much the same category—high in protein and practically no saturated fat. It can be used in many of the same ways.

“Beef, pork, and chicken are fine on our heart healthy plan, too, especially if you broil or grill them,” the Tufts professors write. The key is to buy the leanest cuts of meat and skinless chicken—and “keep the portions on the small side.” It’s not exactly the American way, but think of chicken and meat as a side dish, not the main course. Works great for Carol and me. Gives us the wonderful flavors and complementary protein, while keeping calories and saturated fat low.

And don't overlook the high-quality protein in eggs. Moderation, again, is the key. Yes, eggs are high in cholesterol, but that’s not as much of a problem as once thought. “We now know that while the cholesterol in food can raise blood cholesterol, saturated fat and trans-fatty acids generally raise blood cholesterol--and heart disease risk--considerably more,” the Tufts experts relate. “The amount of cholesterol in your food doesn’t correlate with the amount of cholesterol in your bloodstream.”

Dietary cholesterol is still important, but two or three eggs a week are fine—especially if the rest of your diet is relatively low in cholesterol. Or you can have more eggs, and discard half the yokes. The important thing is the total amount of cholesterol in your diet. Keep in mind that all animal-based proteins (meat, fish, dairy) contain some cholesterol.

With cholesterol as well as the other components we’ve been discussing, it’s the overall balance that counts. Miriam Nelson and Alice Lichtenstein have created an acronym to help you remember the dietary patterns we’ve been discussing: HEART.  

Heap on the vegetables and fruits.

Emphasize the right fats.

Accentuate whole grains.

Revere low- and nonfat dairy foods.

Target heart-healthy proteins.

Pick up a copy of Strong Women, Strong Hearts at your local bookstore or order on Amazon.com. Man or woman, you’ll be glad you did. What I like about the dietary advice in this book is that it doesn't confuse the reader with a lot of complicated and questionable rules. Nelson and Lichtenstein give you the fundamental facts, and don't sweat the small stuff. 

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