It is true, however, that you may be more likely to neglect your body’s needs for water and other fluids as you get older. Older people often have a reduced sensation of thirst, so it’s easier to miss the warning signs that you’re becoming dehydrated.

Older individuals also tend to have lower reserves of fluid in their bodies, may eat less regularly, and may drink insufficient water following fluid deprivation to replenish their fluid deficit. Because of this, older people may need to pay more attention to their fluid intake, particularly during hot weather, and may need to drink fluids regularly, even if they are not thirsty.

Fluid Recommendations

The Adequate Intake (AI) of fluid is actually more than the popular notion of eight cups a day. But that’s deceptive, because the AI includes water from all food and beverage sources—not just guzzling from water bottles. For men over age 50, the AI is 3.7 liters (almost 4 quarts) a day, which includes about 13 cups from beverages including water; the rest is typically obtained from food. For women over age 50, the AI is 2.7 liters (a little less than 3 quarts) a day, with about 9 cups coming from water and other beverages.

Despite what you may have heard, the water in caffeinated beverages such as coffee and tea does count toward keeping you hydrated. So does the fluid content of foods, which can contribute significantly to your daily fluid intake.

Hydration Basics

To ensure that you’re obtaining enough fluids, eat regular meals and drink plenty of water. And eat plenty of produce with a high water content—fruits like watermelon, grapes, melon, and oranges, and vegetables like cucumbers, celery, cauliflower, and lettuce.

Avoid sports drinks such as Gatorade unless you’re engaged in extended vigorous activity in hot weather. Other sugar-sweetened beverages, such as sodas, sweetened tea and coffee drinks, and energy drinks aren’t healthy choices.

In addition to drinking plenty of water and other healthy liquids to avoid dehydration, you can reduce your risk of becoming dehydrated by exercising regularly. Fit people of any age sweat more, keeping the body cool, but they also have more diluted sweat, losing fewer electrolytes as they perspire.

Dehydration Danger Signs

Especially as you get older, you may not recognize the warning signs of dehydration until you’re in danger. Signs of dehydration include:

• Decreased urine output
• Dark-yellow or amber-colored urine
• Dry, sticky mouth
• Dry skin that doesn’t spring back when pinched
• Sleepiness
• Headache
• Feeling dizzy or lightheaded
• Rapid heartbeat and/or breathing.

Why Nothing Beats Water

As we’ll see, some plant-based beverages offer nutrients with health benefits, but your best daylong choice for staying hydrated is still plain water. It contains zero calories and has none of the potential downsides of drinking alcohol or sugary beverages. Best of all, water is virtually free—most municipal drinking water in the U.S. is safe, meaning you don’t need to spend money on bottled or filtered water.

Water makes up most of your body, ranging from about 75 percent of body weight in infancy to 55 percent of body weight in older age. Your brain and heart are almost three-quarters water, your muscles and kidneys are almost 80 percent water, and even your bones are about 30 percent water. Every cell in your body needs water to function. Water transports nutrients and oxygen throughout your body and flushes away waste materials.

Your kidneys work more efficiently when your body has plenty of water; if they are deprived of adequate fluids, your kidneys must work harder. Recurrent dehydration can lead to kidney damage.

Your brain needs water to manufacture hormones and neurotransmitters. Research on the effects of dehydration on the brain is inconsistent, however, with short-term fluid deficiencies appearing to have the greatest impact on your mood and alertness.

Other ways in which your body uses water include:

• Serving as a “shock absorber” for your brain and spinal cord
• Lubricating your joints
• Making saliva for food consumption and digestion
• Keeping mucosal membranes moist; these include membranes in your mouth, nose, eyelids, windpipe, lungs, stomach, intestines, and urinary system.

How Water Helps

Fluids including water can help prevent or ease constipation when coupled with increased fiber intake. In your intestines, fiber needs adequate fluid to create bulkier, softer stools and help keep stools moving. If you increase your fiber intake but don’t get enough fluids, the fiber could cause constipation rather than easing it.

If you suffer from osteoarthritis, staying hydrated can help fight the inflammation associated with that disease. The Arthritis Foundation recommends “prehydrating”—drinking water before you exercise, not just after you’ve worked up a sweat—to help people with arthritis engage in physical activity with less discomfort. Increasing fluid intake also may help reduce the recurrence of gout.

On the other hand, ignore the claims of “water cures” touted in popular magazines, websites, and books: You can’t “cure” heart disease, diabetes, cancer, or chronic pain simply by drinking lots of water. In fact, even the evidence linking healthy hydration to reduced risks of chronic diseases or conditions is relatively thin. The exception is strong evidence that links good hydration with a reduced risk of kidney stones and other stones in the urinary system.

Benefits from Tea

Foods aren’t the only way to get important nutrients as you age—certain beverages also can contribute beneficial nutrients while helping keep you hydrated. You can think of these beverages as a form of “liquid plants,” since they are derived from plants and retain many of their sources’ healthy nutrients, especially the phytonutrients. The most convincing evidence linking plant-based beverages to reduced risks of chronic diseases relates to tea and coffee. When you brew a cup of tea or a mug of coffee, you are extracting many of the nutrients from the tea leaves or coffee beans.

“If there’s anything that can confidently be communicated to the public, it’s the strong association of tea drinking with a lower risk of common chronic diseases, particularly heart disease, and the demonstration of that benefit through clinical trials,” says Tufts expert Jeffrey Blumberg, PhD, who chaired an international symposium on tea and human health.

“About one-third of the weight of a tea leaf is flavonoids, which is high, especially when you consider that they are accompanied by virtually no calories,” Dr. Blumberg explains. “There are a lot of related flavonoids in fruit and vegetables, but many people aren’t consuming the amount of flavonoids in their diets as are being found necessary to promote health. Another way to get them is tea. A cup of tea is like adding a serving of fruit or vegetables to your diet.”

It’s possible to get too much of a good thing, especially if you’re sensitive to caffeine. But tea contains about half the caffeine of coffee, and most of tea’s benefits can be derived from decaffeinated teas (though some of the flavonoids are lost in the decaffeination process).

Research on Tea

Studies have found that tea drinking seems to benefit both your heart and brain. One study reported that drinking three cups of tea daily was associated with an 11 percent drop in the risk of heart attacks. Research on green tea has suggested that it might play a role in reducing the risks of stroke and death from cardiovascular disease and improving total and LDL cholesterol levels.

Studies also have linked tea drinking to beneficial effects on blood pressure. For example, men with high blood pressure who drank just one cup of black tea daily lowered their blood pressure, even when they ate a meal of foods that tend to constrict blood vessels and boost blood pressure.

Don’t overlook herbal teas, which don’t contain caffeine. Hibiscus, a common ingredient in herbal teas, is rich in antioxidants including anthocyanins, flavones, flavonols, and phenolic acids. Research led by Tufts’ Diane L. McKay, PhD, scientific advisor for this Special Health Report, has shown that a few cups a day of herbal tea containing hibiscus can help lower high blood pressure as effectively as some medications do.

Lowering blood pressure might also have brain benefits, but that’s not the only way tea seems to help protect your brain as you age. A phytonutrient in green tea, epigallocatechin-3-gallate, has antioxidant and anti-inflammatory properties that are believed to benefit brain function. Several animal studies have suggested that green tea extracts enhance learning and memory.

Evidence from human studies suggests a link between the nutrients in tea and improved memory, as well as a possible protective effect against Alzheimer’s disease.

Good News on Coffee

If your mother warned that coffee was a health risk that could “stunt your growth,” she’d be surprised to learn that coffee is now recognized as another “plant food” that can benefit your health. The 2015-2020 Dietary Guidelines for Americans mentions coffee specifically: Drinking three to five 8-ounce cups a day (up to about 400 milligrams of caffeine) is associated with minimal health risks and possible benefits, according to the experts.

Recently, two large studies reported that drinking coffee is associated with a modestly (less than 20 percent) reduced risk of dying from various conditions, compared to not drinking coffee.

In both studies, people who reported drinking coffee when they enrolled in the research were less likely than those who didn’t drink coffee to have died during the follow-up period. Greater risk reduction generally was associated with daily intakes of two to three cups or more. The findings held regardless of ethnicity or where people lived and after adjusting for diet, lifestyle, and health status (like smoking and weight). In one study, coffee drinking was associated with a decreased risk of dying from heart disease, cancer, respiratory disease, stroke, diabetes, and kidney disease. In the other study, coffee drinkers had a decreased risk of dying from digestive diseases, including liver disease (men and women) and circulatory diseases, like heart disease and stroke (particularly women).

Coffee vs. Diabetes

Other research has linked increasing coffee consumption with lower risk of developing diabetes. Participants who increased their coffee intake by more than one 8-ounce cup per day over a four-year period were 11 percent less likely to be diagnosed with diabetes during the subsequent four years. On the other hand, people who decreased their coffee consumption by more than a cup per day were at 17 percent greater risk of type 2 diabetes.

Researchers credited phytonutrients in coffee with the apparent benefit—not the caffeine. They noted that effects on glucose metabolism have previously been found in studies of decaffeinated coffee.

Calming A-fib Fears

What about worries that the caffeine in coffee might increase the risk of atrial fibrillation (A-fib, a type of abnormal heart rhythm that can increase the risk of stroke)? Coffee is best known for its stimulating effect that boosts alertness, improves focus, and increases productivity. For some people, however, too much coffee causes “jitters,” and some health experts have voiced concerns that too much stimulation might contribute to A-fib. Researchers who studied this possibility found little reason for worry, however: A meta-analysis concluded that it’s unlikely habitual caffeine intake from coffee and other dietary sources increases A-fib risk. In fact, the analysis found that A-fib risk fell with increasing caffeine intake.

Pros and Cons of Alcohol

The health picture is more complicated for another popular type of beverage—alcohol, such as wine, beer, and spirits. On the plus side, moderate alcohol consumption has been linked to a reduced risk of cardiovascular disease, and the resveratrol compounds in red wine are being studied for a wide range of health effects. Moderate drinking also may  reduce osteoporosis risk in postmenopausal women by slowing the rate of bone “remodeling”—the body’s ongoing replacement of old bone with new.

According to a study in Diabetologia, frequent—but not heavy—alcohol consumption might reduce the risk of developing diabetes. The large study followed more than 70,000 Danish men and women for almost five years. Compared to non-drinkers, women who consumed nine alcoholic beverages a week had a 58 percent lower diabetes risk, and men who consumed 14 drinks a week had a 43 percent lower risk than teetotalers. The findings aren’t a license to overdo alcohol, however: Researchers reported a U-shaped curve in associations between drinking and diabetes risk, with the lowest risk in the middle (moderate, frequent consumption) and higher risk both for non-drinkers and heavy drinkers. Men and women who drank alcohol three to four days a week were at lowest risk.

When making decisions about alcohol consumption, don’t overlook the array of harmful effects that may result from alcohol abuse and dependence. The 2015-2020 Dietary Guidelines for Americans advises women who choose to drink alcoholic beverages to limit intake to one glass a day and men to limit their intake to two drinks. Excessive alcohol consumption has health consequences including liver damage and increased cancer risk, as well as social, psychological, and legal risks.

Alcohol and Aging

Even if you could “hold your liquor” when you were younger, your body’s ability to metabolize alcohol declines with age; this is especially true with women. This means that older adults need to be especially cautious with their alcohol use. According to AARP, one in 10 older adults who drink alcohol are at risk of excessive or potentially harmful alcohol use. In older adults, alcohol also is more likely to interact with medications, which may interfere with or amplify the drugs’ intended effects.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests that people over age 65 limit themselves to no more than one alcoholic drink a day, and not more than two on any occasion. High levels of alcohol in the body can mask or worsen symptoms of stroke, diabetes, memory loss, heart disease, or mood disorders.

Alcoholic beverages also provide a significant number of calories without contributing any important nutrients. A 12-ounce glass of beer has about 150 calories, a 5-ounce glass of red wine has about 125 calories, and a 1.5-ounce shot of liquor has about 100 calories, according to the NIAAA. Your brain doesn’t process the signals from beverage calories the same way it does from food calories, so drinking doesn’t decrease feelings of hunger. Instead, it can loosen your inhibitions and lead to excess eating or snacking.

Skip Sugary Beverages

Sugary beverages such as soft drinks account for almost half the added sugar in the American diet. These beverages also include sports drinks, energy drinks, “gourmet” tea and coffee drinks, and juice drinks that are not 100-percent fruit juice. Such beverages are major contributors to the obesity epidemic. It doesn’t matter what sweetener is used: High-fructose corn syrup, dextrose, honey, evaporated cane juice, agave nectar, and many other forms of sugar all contain calories and affect the body similarly.

Sugary beverages can quickly add up to meet or exceed the dietary guidelines’ limit on added sugars of less than 10 percent of calories per day. In a 2,000-calorie daily diet, that means no more than 200 calories from added sugars, or roughly 12 teaspoons—about the amount in just one regular 16-ounce soft drink.

Health Effects

The risks of consuming sugar-sweetened drinks are not limited to putting on a few pounds. These beverages also contribute to conditions linked with obesity, including cardiovascular disease and type 2 diabetes. For example, people who averaged seven non-diet soda servings per week—just one a day—were 29 percent more likely to die from cardiovascular causes than those consuming less.

Tufts researchers have reported that sugary drinks may also increase your odds of developing non-alcoholic fatty liver disease (NAFLD). NAFLD, which is characterized by a buildup of fat in the liver unrelated to alcohol consumption, may cause the liver to swell and become inflamed, which can lead to scarring (cirrhosis) and, eventually, to liver failure. CT scans showed a higher prevalence of NAFLD among people who reported drinking more than one sugar-sweetened beverage per day compared to people who said they drank none.

Debating Diet Soda

You may be tempted to avoid sugary beverages simply by choosing a “diet” version of the same type of drink. However, concerns also have been raised about the safety of non-caloric sweeteners such as aspartame used in diet sodas. Some have suggested that non-caloric sweeteners might somehow contribute to weight gain. One study even linked diet soda consumption to increased stroke and dementia risk.

According to the FDA, however, “Food safety experts generally agree there is no convincing evidence of a cause-and-effect relationship between these sweeteners and negative health effects in humans.” While it’s best not to overdo diet drinks, based on current evidence, artificial sweeteners remain an acceptable option for people who are working to control their weight—but water or unsweetened coffee, tea, or low-fat milk are healthier choices.

Cola Caution

Cola drinks, whether sugared or diet, may present special concerns about bone health, especially for postmenopausal women. In one study, women who drank three or more cola drinks daily had lower bone mineral density (BMD) in areas of bones that are common sites for fractures. In men, however, there was no link between cola consumption and lower BMDs, and consumers of non-cola soft drinks did not have lower BMDs.

Phosphoric acid, an ingredient found in cola drinks but not other flavors of sodas, might be to blame. In addition, caffeine, also found in colas but not most other soft drinks, can interfere with calcium absorption, and the study found a greater decrease in bone density among caffeinated soda drinkers.

Another factor may simply be that people who drink soft drinks and sweetened beverages of any type tend to drink less milk, which reduces their intake of calcium necessary to build healthy bones. If you’re an all-day soda drinker, consider substituting water for some of those sodas.

Eating for Healthy Aging

Making smart choices—whether beverages or foods—as part of an overall healthy dietary pattern is increasingly important as you get older. Following a scientifically proven nutrition plan such as that shown in Tufts’ MyPlate for Older Adults can help you lower your risks of illness and live healthier longer.

While minimizing your risks of chronic diseases is a lifelong concern, as you get older, this concern inevitably looms larger. As peers, friends, and loved ones are diagnosed with chronic conditions more common among older adults, it’s natural to wonder: What can I do to improve my odds? As we’ve seen throughout this book, with many of these conditions, making healthy modifications to your diet can protect you as you age.

It’s never too late to benefit from eating better, and there’s no better time to start than right now.

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“We are beginning to have an adversarial relationship with food,” says Alice H. Lichtenstein, DSc, director of Tufts’ HNRCA Cardiovascular Nutrition Laboratory and co-creator of MyPlate for Older Adults. “We need to eat to live, to consume certain foods to meet our nutrient requirements. There are many ways of doing that, and you should be able to eat foods that you really enjoy while optimizing health outcomes and maintaining a healthy body weight.”

Know Your Food Facts

You might even feel that simple grocery shopping has become a daunting task because of all the types of foods you’ve heard should be avoided. For example, some people think it’s important to buy cage-free eggs, grass-fed beef, and wild-caught fish, or to buy foods that don’t contain any genetically modified (GMO) ingredients (despite the weight of scientific evidence that these foods are safe). You’ve probably heard that it’s best to reduce your intake of artificial colors, preservatives, and other additives—although no additives currently in the food supply have been definitively shown to present a hazard.

Add up all of these concerns, along with advice to avoid unhealthy fats, added sugars, and sodium, and it becomes challenging to feel good instead of guilty about eating.

Start with a reality check about what foods do and don’t provide. “You shouldn’t expect that each food will provide all the nutrients you need,” says Dr. Lichtenstein. “You can’t get your protein from fruits or your vitamin C from fish; it’s the combinations that are important.”

You can simplify your shopping by filling your grocery cart with whole and minimally processed foods. Since these foods have undergone few, if any, modifications, they don’t contain a long list of ingredients you’ll often find in heavily processed food products, such as salt, sugar, added fat, and additives. Whole, fresh foods don’t have any ingredients lists because there are no added ingredients.

Don’t Skip the Spices

MyPlate for Older Adults emphasizes spices as way to make healthy foods tastier. Research suggests that some spices might even trick your brain into liking less-salty foods. A large study in China reported that people with a penchant for spicier foods preferred less salt, which was associated with less sodium consumed overall and lower blood pressures. The results imply (but do not prove) that people who eat relatively spicy foods prefer less salt to satisfy their tastes—and vice versa.

Researchers further explored the connection using functional brain scanning. They scanned the brains of 60 volunteers, measuring activity in two regions of the brain involved in salt perception. The participants tasted salty water at two concentrations, with and without a bit of capsaicin (the compound that makes peppers hot)—though not enough to cause a burning sensation on the tongue. People who got capsaicin preferred the less-salty water. Moreover, the two brain regions associated with salt taste preferences were not as active when participants were given salty water with capsaicin, compared with people who just got salty water.

Eat Right on a Budget

Another misconception about healthy food is that it always costs more. You might think that eating a nutritious diet, especially one with lots of fruits and vegetables, must be more expensive than the typical American fare that includes packaged, processed, and fast foods. The good news is that eating right doesn’t have to mean spending more money.

“Healthy food is not necessarily expensive,” says Parke Wilde, PhD, an associate professor at Tufts’ Friedman School who previously worked for the USDA’s Economic Research Service. “It is true that some healthy food is high-priced, but many other healthy options are both tasty and affordable.”

Dr. Wilde cites a USDA report that identified six changes that could improve consumers’ diet quality; of the changes, none cost more, and most actually cost less, with savings up to $1.19 a day. The greatest cost savings and dietary improvement came from substituting a table-service restaurant meal with one prepared at home, along with switching from fast-food fare to home cooking. Another change that paid off as much as eating at home more often was skipping weekend splurges. Eating the same on Friday through Sunday as on weekdays saved money—and it improved consumers’ scores on an index of healthy eating.

None of those changes will break your budget. In fact, making more meals at home from whole, unprocessed ingredients will save you money.

Find Your Pattern

Focusing on dietary patterns such as those we looked at in the previous chapter rather than on individual foods is one tasty way to change your thinking about healthy food choices. “The emphasis on dietary patterns reflects a shift from more prescriptive nutrition recommendations to more general ones,” Dr. Lichtenstein says. “It provides flexibility to customize our everyday dietary patterns to foods that are both healthy and enjoyable. What works for one person does not necessarily work for someone else. The worst thing to happen is arguing over whether blueberries are better for you than raspberries, or canola oil is better than corn oil.”

The Mediterranean diet, for example, has gained popularity not only because of research linking it to positive outcomes but also because it’s fairly easy to follow—and it tastes good. It includes many foods people actually enjoy: a nice piece of fish, a handful of nuts, vegetables sautéed in olive oil, and even alcohol in moderation.

Other dietary patterns also can satisfy your palate while meeting your nutritional needs. Real Chinese food—as opposed to Chinese-American restaurant fare—leans heavily on vegetables, with minimal portions of poultry, seafood, or meat. Substitute brown rice for the refined white rice with your vegetable-laden moo goo gai pan or kung pao chicken, serve the sauce on the side, and you have a healthy meal that’s also delicious. Similarly, authentic Mexican fare—not the cheese-laden, fast-food, Tex-Mex version—emphasizes beans, avocados, tomatoes, seafood, and other mostly healthy choices with a spicy kick that makes otherwise bland foods more appealing.

The Power of Portions

Whatever dietary pattern you prefer, don’t overdo it; it’s possible to eat too much, even if your food is healthy. Taking the time to savor your food can help control how much you eat, as can simply putting less food on your plate. Here are some tips for controlling portion size:

• Use smaller plates, bowls, and serving spoons. A plate nine inches in diameter is appropriate for lunch and dinner.
• Avoid eating straight from the package. If you’re dipping directly into a box or bag, you won’t know how much you’ve eaten.
• For foods you eat regularly, such as cold cereal or nuts, keep an inexpensive measuring cup or measuring spoon in or with the container so you can easily dish up an appropriate portion.
• At a restaurant, choose the smallest size available. If meals are oversized, put half in a to-go box as soon as you get your food or plan in advance to split your dish with a friend.
• At home, dish up a single serving at mealtime and leave extra portions in the kitchen. For snacks, fill reusable containers with single-serve portions from a bigger package.
• Look for recipes that include nutrition information and the number of servings.
• Especially watch portion sizes of starch- and sugar-rich foods, such as white bread, white rice, crackers, sweets, soda, sports drinks, and fruit juice, as well as alcohol, which are all easy to overdo and linked to weight gain.
• Opt for nutrient-rich, minimally processed foods, such as whole fruits, non-starchy vegetables, legumes (beans), nuts, and unsweetened low-fat or nonfat yogurt, which can more naturally help fill you up and help you manage your weight.

Helpful Kitchen Strategies

You can make it easier to choose tasty, affordable foods every day by having a variety of healthy choices in your pantry and fridge. With healthy options on hand, you’ll be less tempted to eat junk food or run to the nearest fast-food place when hunger strikes. Here are some examples of items to keep in your pantry, fridge, and freezer.

In the Pantry or Cupboards

• Whole-grain pastas
• Instant, quick-cooking, or microwaveable brown rice and other whole grains
• Whole-wheat flour
• Canned vegetables (choose low-sodium varieties)
• Reduced-sodium tomato sauce
• Canned beans (drain and rinse before using)
• Canned fruits in juice (no added sugars)
• Dried fruits
• Unsalted or low-salt nuts and seeds
• Peanut butter or other nut butters, preferably the “natural” type with little to no sugar, oil, or salt added
• Reduced-sodium chicken and vegetable broth (refrigerate after opening)
• Canned (in water) or pouch-packed fish, such as salmon, sardines, and tuna
• Vinegars to use in homemade salad dressings
• Dried herbs and spices, pepper, and low-sodium seasoning blends
• Powdered egg whites
• Popcorn (kernels, not microwavable packages that contain added fats and salt)
• Whole-grain sandwich breads, “thins,” pita bread, and crackers
• Whole-grain, high-fiber, low-sugar cereals and oatmeal
• Onions, garlic, and sweet potatoes (store in a cool, dark pantry)
• Oils high in unsaturated fat, such as olive, canola, soybean, and corn oils
• Cooking oil spray

In the Refrigerator

• Fat-free or low-fat milk, yogurt, cheese, and cottage cheese
• Plain, unsweetened non-dairy “milk” (almond, soy, cashew, etc.)
• Fruits and vegetables with a relatively long shelf life (e.g., apples, carrots, grapes)
• Light “buttery” vegetable-oil spread that contains no partially hydrogenated oil
• Eggs/egg substitutes
• Whole-wheat flour tortillas
• Low-sodium condiments such as mustard, salsa, and hot sauce
• Salad dressings low in sodium and added sugar
• Lemons and limes or lemon and lime juice

In the Freezer

• Frozen vegetables and vegetable mixes (no added salt or sauces)
• Frozen berries (no added sugar)
• Pre-portioned seafood, lean meats, ground turkey, and boneless, skinless chicken breasts and thighs

Supplement these staples on your supermarket shopping trips by purchasing an assortment of perishable produce, such as salad greens, peppers, tomatoes, fresh berries, bananas, and melons.

“Processed” Foods: Pros and Cons

Often, eating more healthfully is seen as synonymous with avoiding all processed foods, but that’s not necessarily the case; it depends on the degree of processing. The U.S. government defines “processed food” as “any food other than a raw agricultural commodity that has been subject to processing, such as canning, cooking, freezing, dehydration, or milling.” There are varying degrees of processing; many highly processed foods contain added salt, sugar, fat, additives, and other ingredients that contribute nothing in terms of nutrition.

But that doesn’t mean all “processed” food is automatically bad. Many minimally processed foods provide plenty of valuable nutrients, are more convenient, and reduce the risk of foodborne illness. Minimally processed foods include:

• Pasteurized milk
• Prewashed lettuce and spinach
• Canned beans, vegetables, and fruits
• “Baby” carrots
• Oatmeal
• Frozen and canned fish
• Whole-grain flours
• Frozen fruits and vegetables
• Yogurt

“You hear the term ‘processed food’ thrown around a lot these days, but you have to use common sense,” says Tufts’ Dr. Lichtenstein. “For example, pasteurized milk is safer than unpasteurized, even though, technically, it is ‘processed.’”

Some forms of processing actually boost the nutrition you’ll get from certain foods. For example, cutting and chopping produce can make nutrients more available to your body by doing some of the work of breaking down cell walls. So can heating, including the heat of canning: The lycopene in canned tomatoes and tomato sauces is more accessible than in fresh, uncooked tomatoes. However, heat depletes some other vitamins, such as vitamin C and some B vitamins.

And, when you consider food costs, both in dollars and in preparation time, research indicates that using minimally processed foods is less costly.

Frozen vs. Fresh

Another form of processing that there’s no need to avoid is freezing. Freezing makes seafood more readily available, for example. Unless you live near a coast, frozen seafood can be the best way to meet recommendations to eat fish twice a week. Shop for flash-frozen fish labeled “Frozen-at-Sea” (FAS), caught by ships that operate like floating processing plants. Each day’s catch is processed, frozen in a matter of seconds, and stored at zero degrees or below. The result is fish that’s often fresher than what’s sold as “fresh,” which might be kept on ice for as long as two weeks between ship and supermarket.

Produce is another smart choice in the frozen-food aisle. Research has confirmed that frozen produce is at least as nutritious as fresh, and certain nutrients are better preserved in frozen vegetables and fruits than in fresh produce after a few days in your fridge. In as little as five days, fresh produce loses some of its vitamin content, especially vitamins A and C and folate.

Think of freezing as “nature’s pause button.” Freezing foods maintains freshness, slows down enzymatic reactions, and increases the time it takes the food to degrade. Fresh produce, by contrast, is a living material, with oxidation and enzyme activity. It degrades over time and loses nutrients.

Not everything about frozen veggies “pauses” perfectly, of course. Texture can suffer when vegetables are frozen, such as with bell peppers or green beans, even if the nutrients mostly survive intact. As a result, you’re better off incorporating some frozen vegetables into stews, soups, and other mixed dishes. Other vegetables freeze with little loss of texture, such as peas, lima beans, and corn, and can be as appealing (and easier to prepare) as fresh.

Dr. Lichtenstein adds, “When buying frozen vegetables and fruits, an easy rule is to get the item only and nothing else; that means skipping the sauces and seasonings.” When in doubt, check the package for the ingredients; it should show only the name of the food (for example, spinach or strawberries), with no other added ingredients.

Processed Meat Cautions

When applied to meats, however, the term “processed” has a very distinct meaning. The American Institute for Cancer Research (AICR) defines processed meat as “meat preserved by smoking, curing or salting, or addition of chemical preservatives,” and says that even small amounts eaten regularly increase the risk of colorectal cancer. The World Health Organization (WHO) also has announced that foods such as hot dogs, ham, bacon, sausages, and deli meats contribute to the risk of colon, stomach, and other cancers.

According to the WHO, about 34,000 cancer deaths per year worldwide are attributable to diets high in processed meats. While that number pales in comparison to the 1 million or so global cancer deaths related to smoking, it is significant enough to warrant a hard look at processed meats in your diet, especially because they also are associated with cardiovascular disease and other health conditions.

What counts as “processed meat”? Bacon, sausages, hot dogs, jerky, salami, pepperoni, and cold cuts like bologna, ham, or smoked turkey are examples of processed meat. Scientists believe that chemicals added to meat during processing may be responsible for the increased cancer risk, but a cause-and-effect relationship has not been conclusively established.

Nitrates and Nitrites. Sodium nitrite and sodium nitrate (which naturally converts to sodium nitrite) are used as preservatives in processed meats because they prevent bacterial growth. Nitrates  also are found naturally in a number of foods, including celery, beets, arugula, and other vegetables. “It is common nowadays to find the statement ‘no added nitrates’ on processed meat products,” says Joel B. Mason, MD, professor of medicine and nutrition at Tufts and director of the HNRCA Vitamins and Carcinogenesis Laboratory. “In most instances, these products are manufactured using celery juice or other natural sources of nitrates.”

But don’t be fooled by this labeling. Dr. Mason cautions that there is no evidence that the nitrates in celery juice act any differently in the body than nitrates added as food-grade chemicals. “In fact, unlike food-grade sodium nitrate or nitrite, there is no federal regulation that limits how much celery juice can be added to a processed meat, so it is feasible to actually be consuming more nitrates with a processed meat that says, ‘no added nitrates’.”

When consumed in vegetables, nitrates are safe, and may even have protective health effects such as improving blood flow. But in meats, nitrites can react during processing, cooking, and storage to form compounds called nitrosamines, which are classified as carcinogens. “Keep in mind, however, that the link between sodium nitrate and cancer risk is still unclear,” says Dr. Mason.

Healthy, Satisfying Snacks

When planning your healthy dietary pattern, don’t overlook snacks. Between-meal foods and beverages now total a quarter of Americans’ average daily calorie intake—amounting to what researchers call a “full eating event.” Eating healthier meals won’t improve your overall diet if you grab high-calorie, nutrient-poor foods at snack time.

Everything a person eats and drinks contributes to their overall dietary pattern. “Snacks should fit into total dietary intake for the day,” says Helen Rasmussen, PhD, RD, a senior research dietitian at Tufts’ Jean Mayer USDA Human Nutrition Research Center on Aging and co-developer of MyPlate for Older Adults.

Shifting away from thinking of daily snacks as treats or extras to seeing them in their rightful place as part of the overall dietary pattern can help you make choices that contribute to the quality of your diet, rather than detracting from it. “People should choose snacks that fill holes in their diet,” says Dr. Lichtenstein. “For some people it’s dairy, for some fruit and vegetables or whole grains.”

So healthy snack foods should meet the same standards you set for mealtime choices. Pick foods that are nutrient-dense—delivering plenty of nutrition per calorie—and select whole, minimally processed snacks over refined products high in added sugars and sodium. Go for whole grains and high-fiber snacks, which will satisfy your hunger longer between meals.

Snack Survival Tips

Keep these tips in mind when reaching for between-meal bites:

• Plan ahead to have healthy snacks like washed and cut-up fruits and vegetables, yogurt, hard-boiled eggs, whole grain crackers, cheeses, nuts and nut butters, hummus, and air-popped popcorn on hand.
• Portion out snacks. Research has found that people consistently consume more food and drink when offered larger-sized portions or packages than when offered smaller-sized versions. Portion out foods ahead of time for grab-and-go snacking, and use smaller bowls and plates.
• Deal with boredom and stress. Eating out of boredom or for emotional reasons can lead to overeating. Stop and rate your true hunger level before reaching for a snack.
• Eat mindfully. Eat slowly and pay attention to fullness cues to avoid mindless eating.
• Avoid temptation. Notice when you’re in a setting or situation with unhealthy snacks. Change your route to avoid a habitual stop at the doughnut shop, and move the office candy jar out of sight or out of reach.
• Don’t be fooled by labeling. In one study, women who had eaten pasta labeled as a “snack” later ate significantly more candy than women who were given the same pasta serving labeled as a “meal.” Trust visual clues or the body’s hunger/satiety cues, not the package label.
• Sit down. The same study found that participants who stood and ate their pasta from a container consumed more sweets in a follow-up taste test than those who sat and ate the pasta from a plate. Distracted eating (like eating in front of the television or while reading or working) also may lead to increased food intake.
• Practice food safety. When carrying snacks, keep perishable foods refrigerated or in a cooler bag with ice packs.
• Remember it’s optional. While snacking is appropriate for some people, it is not a mandatory part of a healthy eating pattern.

Finally, avoid wasting valuable calories on sodas or other sweet drinks. For between-meal beverages, choose low-sodium tomato or mixed vegetable juices, unsweetened iced tea, fat-free milk, or low-or no-calorie flavored sparkling or seltzer water.

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In one study, for example, participants with the highest intake of dietary fiber had an almost 80 percent greater likelihood of “successful aging,” defined as reaching old age free of chronic disease, disability, cognitive impairment, symptoms of depression, and respiratory symptoms. In the study, the group of participants with the highest total fiber intake averaged 37 grams per day, while those in the group with the lowest intake averaged only 18 grams daily.

You probably aren’t getting 37 grams of daily fiber—and it’s likely you may not even be consuming the recommended minimum amounts. The daily recommended fiber intake is 38 grams for men ages 18 to 50 and 25 grams for women ages 18 to 50. Calorie needs decrease as you get older, as we’ve noted, and so does the recommendation for fiber; for men and women over age 50, it drops to 30 grams per day and 21 grams per day, respectively. The “% Daily Value” (% DV) for fiber shown on Nutrition Facts labels has been based on a recommendation of 25 grams of fiber per day, but that number will be increased to 28 grams as nutrition labels are updated. The change reflects research demonstrating the cardiovascular benefits of increased fiber intake.

Despite these recommendations and the research, most Americans fall short of even the lowest fiber targets. The average American eats only 10 to 15 grams of fiber per day, and fewer than 5 percent of all Americans get enough fiber in their daily diets.

Not Just Cereal

You get fiber from various plant sources in your diet, including vegetables, fruits, nuts, seeds, and grains. Fiber from grains is known as “cereal fiber,” a term that applies to the fiber in foods such as brown rice, millet, barley, and bulgur wheat, as well as to your morning breakfast cereal. Higher cereal fiber intake is associated with a lower risk of cardiovascular disease and a decreased risk of dying after surviving a first heart attack.

Although this chapter focuses on fiber and other nutrients from healthy grains, you shouldn’t overlook other sources of fiber. The fiber naturally found in fruits and vegetables, for example, is why you should skip the “juicing” trend—which leaves that fiber behind—and consume whole fruits and veggies. Beans and other legumes, which we’ll cover in the chapter on protein, are especially rich in fiber; one cup of cooked black beans, for example, has 15 grams of fiber. Even nuts and seeds can contribute significantly to your daily fiber intake: An ounce of almonds (about 23 nuts) contains 3.5 grams of fiber.

Greater intake of dietary fiber aids in regulation of blood glucose levels, which in turn contributes to better heart health and a reduced risk of diabetes (diabetes is a risk factor for heart disease). Research also has shown that consuming soluble fiber (the type that absorbs water) modestly reduces levels of LDL (“bad”) cholesterol in your blood.

Fiber also may help reduce your risk of cancer, particularly in the digestive system. Many, but not all, studies have reported an association between greater fiber intake and lower incidence of colorectal cancers.

Consuming fiber can make you feel full more quickly and help the feeling of fullness last longer. As a result, you may eat fewer total calories, which reduces your risk of obesity and heart disease.

What About Added Fiber?

Some food manufacturers have added fiber to their products to entice health-conscious shoppers to buy their brands. But are these added fibers as good for you as naturally occurring fiber from grains, nuts, and produce?

“Many consumers are not aware that some of these added fibers may not have the same physiological health benefits as fibers found naturally in plant foods,” says Nicola McKeown, PhD, a scientist with Tufts’ Nutritional Epidemiology program and an associate professor at the Friedman School. For example, research studies have suggested that the added fibers psyllium and beta-glucan are effective at reducing cholesterol, but inulin (sometimes called chicory root) appears to have no effect on cholesterol levels (although it may have some benefit as a prebiotic).

Unlike natural fibers found in foods, added fibers (also called isolated fibers) must be included on ingredient lists. Isolated fibers commonly added to processed foods include pectin, guar gum, psyllium, cellulose, and inulin (often sourced from chicory root).

The FDA recently reviewed the scientific literature to determine which added or isolated fibers are associated with health benefits including lower blood glucose and cholesterol levels, lower blood pressure, regularity, increased absorption of minerals in the intestinal tract, and calorie control. The FDA review identified these added fibers as providing these benefits: beta-glucan, psyllium husk, cellulose, guar gum, pectin, locust bean gum, and hydroxypropyl-methylcellulose. Further, the FDA announced it intends to propose that eight other non-digestible carbohydrates, including inulin, be added to the definition of dietary fiber.

Make Your Grains Whole

Fiber is only part of the reason to prefer whole grains, however. Switching your breakfast cereal, upgrading your sandwich bread, and giving the grains on your dinner plate a makeover could help protect your heart. Whole grains have been associated with reduced risk of cardiovascular disease, better cholesterol levels, and lower blood pressure. People who eat more whole grains are also at lower risk of cancer, respiratory disease, infectious diseases, diabetes, and early death.

What makes a grain food “whole”? Whole grains contain all parts of the entire original grain kernel—the bran, germ, and endosperm. Contrast that with refined grains that have been milled, a process that removes the bran and germ to give the flour made from the grain a finer texture and a longer shelf life. During this process, significant amounts of nutrients are lost, including fiber, iron, and many B vitamins.

Many products made with refined grains are enriched, however, meaning that certain B vitamins (thiamin, riboflavin, niacin, folic acid) and iron—but not fiber—are added after the grain has been milled. Although whole grains are the healthiest choice, if you are going to buy refined-grain products, check the ingredient list to make sure that the word “enriched” is included in the grain name (for example, “enriched wheat flour”). Some grain products are made from mixtures of whole grains and refined grains.

Not all whole grains are particularly high in fiber—cooked brown rice has only 2 grams per one-half cup, for example. But whole grains are higher in all sorts of nutrients, and even those relatively low in fiber exceed the amount in processed, refined alternatives: Cooked white rice contains a meager 0.6 grams of fiber per one-half cup.

How Much Do You Need?

The 2015-2020 Dietary Guidelines for Americans (DGA) recommends making at least half your grains whole grains. For most people, the total recommended daily intake is six servings of grains, so three or more servings of your daily grains should be whole. Grains include the grains themselves, such as oats or barley, as well as foods in which grains are an ingredient, such as bread or pasta.

Servings (called “ounce equivalents” in the DGA) are described in kitchen measures. Examples of one serving of whole grains include one slice of bread, one-half cup of cooked oatmeal, pasta, quinoa, bulgur wheat, or wild rice, and three cups of air-popped popcorn.

Benefits of Whole Grains

If you need convincing to switch from familiar white sandwich bread to whole wheat, or from white rice to brown rice, barley, or farro, consider recent research findings. Like cereal fiber in general, whole grains can help improve unhealthy cholesterol levels. In one analysis of 24 randomized controlled trials, study participants who consumed whole grains had lower “bad” LDL cholesterol and total cholesterol levels overall than participants who did not eat whole grains, and they also tended to have lower triglyceride levels. Whole-grain oats had the greatest beneficial effects. The longer the participants consumed whole grains, the greater were their improvements in LDL and total cholesterol. Other studies have linked consumption of several specific varieties of whole grains, including oats, barley, sorghum, and amaranth, to healthier cholesterol levels.

Even if you’re already taking a statin medication to improve your cholesterol levels, Tufts research has shown that you can reap additional benefits from consuming more whole grains. In one study, statin users who consumed more than 16 grams a day of whole grains had healthier cholesterol levels than statin patients who ate fewer whole grains.

In other research, whole grains were found to help protect against aortic stiffness, even among people who are overweight or obese. Aortic stiffness is a thickening or hardening of the body’s main artery and it is a significant predictor of heart disease, heart failure, and stroke. The study, focused on obese men, reported that of all food choices, greater intake of whole grains was the only factor significantly associated with less aortic stiffness.

Another study reported a strong association between greater whole-grain consumption and a lower risk of chronic diseases. Consuming five to six servings daily of whole grains (was associated with a lower risk of death from cancer, respiratory disease, diabetes, and even infectious diseases. People whose diets were rich in whole grains were also at a lower risk of coronary heart disease, cardiovascular disease, and stroke, as well as deaths from those causes. Even a modest intake of one or two servings a day of whole grains was associated with health benefits.

Getting Your Whole Grains

To start consuming more whole grains, look for ways to swap them for less healthy choices rather than adding them to the grains you’re already eating. The goal isn’t to eat more food, but to eat healthier food that contains more nutrients.

The recommendation is to eat 48 grams or more of whole grains daily. According to the Whole Grains Council, each of these food servings will provide you with about 16 grams of whole grains:

• One-third cup of cooked whole-wheat pasta
• One-third cup of cooked brown rice, bulgur, barley, or other cooked grain
• One slice of whole-grain bread
• Half of a whole-grain English muffin
• 4 Triscuit crackers
• Two-thirds cup of Cheerios
• One-third cup of Wheat Chex
• Two-fifths cup of cooked oatmeal

Whole Grains Labeling

To make sure you’re buying whole grains, look for a Whole Grain Stamp from the Whole Grains Council. The ingredients list is another reliable source of information; look for phrases such as “100% whole [name of grain].” (Just because a food product is made with whole grains doesn’t guarantee that it is healthy, however; continue reading to see if the product contains added sugar or salt.)

All of these ingredients indicate that a product contains whole grains:

• Whole grain [name of grain]
• Whole wheat
• Whole [name of grain]
• Stoneground whole [grain]
• Brown rice
• Oats, oatmeal (including steel-cut, old-fashioned, quick-cooking, and instant oatmeal)
• Buckwheat (even if it isn’t preceded by the word “whole”)

Ingredients that indicate only a “maybe” include wheat, wheat flour, semolina, durum wheat, and organic flour. Other “maybe” terms are “stoneground” (without “whole”), and the ubiquitous “multi-grain.” Ingredients that never mean whole grains include enriched flour and degerminated corn meal. If you see wheat germ or oat bran, it typically indicates that supplemental fiber was added to the product.

Cooking Whole Grains

What befuddles many novices about whole grains is cooking time. Because whole grains include the tougher outer layers of the grain, they sometimes take more time (and often more liquid) to cook. However, several grains, including quinoa, buckwheat, and bulgur wheat cook in 20 minutes or less.

If you can cook regular white rice, you can master whole grains, as the basic techniques are the same: Combine a dry grain in a pan with water or broth, bring to a boil, and simmer until the liquid is absorbed. (Pastas made from whole grains are cooked just like regular spaghetti, with extra water drained away before serving.)

You can get a little fancy by toasting whole grains in a few teaspoons of olive oil before adding the cooking liquid. Or make a simple pilaf by browning finely chopped onions and other vegetables in a little oil, adding the grain, and then stirring in broth.

Some planning can reduce the cooking time, too: Just soak the grains in water for a few hours before mealtime. When it’s time to prepare dinner, top off the pan with more water or drain the water and add broth, and then bring to a boil and simmer until the grains are tender. Some of the hardiest grains require an overnight soak prior to cooking.

Another time-saving strategy is to cook a big batch of whole grains and store the leftovers for later meals. Cooked grains will keep three or four days in the refrigerator and up to four months in the freezer. Add a little water and reheat in the microwave, or use in soups or cold salads.

Pre-cooked whole grains, such as 90-second brown rice, make side dishes as simple as moving a package from your pantry to the microwave.

Smart Substitutions

Start your day with whole grains by building breakfast around them. Having a bowl of hot oatmeal means you’ve already got one serving of whole grains—but consider other whole-grain options for variety. For example, you can make porridge with amaranth, barley, teff, or millet, or create breakfast bowls with quinoa, cornmeal (not degerminated), or wheat berries.

Not all hot cereals are whole-grain choices, however. While all versions of oatmeal, from instant to steel-cut, are whole grain, some popular hot cereals, such as the original Cream of Wheat (farina) and the original Cream of Rice, are not whole grain. (Cream of Wheat has, however, introduced a special whole-wheat version.)

Even when you’re buying a whole grain such as oatmeal, the way it’s processed can make a difference. Steel-cut oats are the best choice for supplying your body with the slow, steady stream of glucose that supports good health.

Steer clear of flavored oatmeal products, which usually are high in added sugar. Instead, buy plain cereals and add your own finishing touches, such as fruit or nuts. Even if you add a touch of sugar, honey, or maple syrup, you’ll end up with less added sugar than in the packaged, sweetened varieties that contain as much as 12 grams, or three teaspoons, of sugar per serving. Spices such as cinnamon and nutmeg also can help enhance the flavor.

Ready-to-eat breakfast cereals can deliver whole-grain nutrition, too, but you’ll need to be a label detective. Look at the ingredients for the whole-grain terms discussed earlier in this chapter, and check to make sure the first item in the ingredients list is a whole grain. (Hint: If the first ingredient is sugar, it’s not a healthy choice.) Don’t assume “multi-grain” ready-to-eat cereals are whole-grain choices.

Include whole grains in your lunchtime sandwiches simply by choosing whole-wheat rather than white bread. If you’re concerned about calories, you can find ultra-slim whole-wheat options with as little as 45 calories per slice, or sandwich “thins” that provide 100 calories total. Or, skip the bread and choose whole-grain flatbreads or tortillas. Even burgers can be made healthier by switching to whole-wheat buns.

A Variety of Whole Grains

The world of whole grains ranges from such familiar foods as wheat, oats, and corn to more exotic varieties like quinoa and farro. Here are some examples of whole grains that will help provide you with the fiber and nutrients you need for healthy aging.

Corn and Popcorn

Americans eat a lot of corn, a versatile food that can be a grain, a vegetable, a source of cooking oil, and the main ingredient in a common sweetener.

“With respect to meal planning, sweet corn falls under the vegetable category,” says Tufts expert Nicola McKeown, PhD, who is also a scientific advisor to the Whole Grains Council. “The dried, ground corn we eat in foods such as corn bread, grits, and polenta falls under the grain category. Make sure cornmeal, corn flour, grits, corn tortillas, and polenta packages have ‘whole corn’ or ‘whole grain corn’ listed as an ingredient; degerminated corn is not a whole grain.”

When corn is dried and milled, it is considered a grain. Whole-grain cornmeal or corn flour is higher in vitamin A and carotenoids and slightly lower in dietary fiber than other whole grains, such as whole wheat or whole rye.

Popcorn also is considered a grain. “Air-popped popcorn is an excellent whole-grain snack that provides dietary fiber,” Dr. McKeown notes. Adding butter and salt makes popcorn decidedly less healthy, so try eating it plain, or use just a teaspoon of butter (or a spritz of butter-flavored cooking spray) and a sprinkle of salt if you can’t resist.

Although corn is a “starchy” vegetable that is high in carbohydrates and natural sugars (9 grams per cup), it releases sugar into the bloodstream steadily rather than causing a spike in blood sugar due to its fiber content. The American Diabetes Association includes it as a “best choice” among starchy vegetables as well as whole grains.

Cooked corn is a good source of fiber, potassium, and niacin. One cup of corn contains almost 5 grams of protein—more than a comparable serving of broccoli, for example. Yellow corn contains lutein and zeaxanthin, two carotenoid antioxidants that are important to eye health.

Quinoa

Once virtually unknown in the U.S., quinoa can now be found in a variety of colors (white, red, black) and forms (grains, flakes, cereals, pasta) in most large supermarkets. Though it’s touted as a “super grain,” this ancient Incan staple isn’t technically a grain at all; it’s the seed of a plant related to spinach, beets, and chard.

What makes quinoa such a nutritional standout? Quinoa ranks highest among all grains in potassium (159 milligrams in one-half cup), a mineral associated with reducing high blood pressure. It’s high in iron and most B vitamins and is a good source of zinc, copper, magnesium, and manganese.

Quinoa is also one of only a handful of plant foods that supplies all the amino acids in adequate amounts necessary for a “complete” protein. Quinoa has an unusually high ratio of protein to carbohydrates, since its protein-rich germ makes up about 60 percent of the grain. A half-cup of cooked quinoa packs more than 4 grams of protein. It’s also gluten-free, making quinoa a nutritious option for people with celiac disease.

Wheat and Wheat Varieties

The average American eats more than 100 pounds of wheat flour per year. Much of that is refined, however, meaning we’re missing out on nutrients: Whole-wheat flour contains 13 grams of fiber, 16 grams of protein, and 436 milligrams of potassium per cup, plus 41 percent of your daily magnesium. Compare that to 3 grams of fiber, 13 grams of protein, 134 milligrams of potassium, and 7 percent of daily magnesium in a cup of refined, all-purpose flour.

In addition to switching to whole-wheat flour and breads, you can explore many varieties and forms of wheat, including bulgur, farro, Kamut (khorasan), einkorn, spelt, and wheat berries. (Despite its name, buckwheat is not a type of wheat; instead, it’s a seed that does not contain gluten.) Each of these grains has a slightly different texture and taste; here is a brief description of a few members of the wheat family.

Bulgur, or bulgur wheat, consists of whole-wheat kernels that have been steamed, dried, and cracked but have retained all of their nutrients. In America, bulgur is perhaps best known as the main ingredient in the popular Middle Eastern dish tabbouleh, which usually contains tomatoes, lemon juice, olive oil, and fresh herbs and is served as a cold salad. Since the grain kernels have been cracked, bulgur cooks more quickly than some other whole grains, in 10 to 15 minutes.

Farro is often referred to as an “ancient grain,” since historical records indicate that it has been around for thousands of years. Farro and other ancient grains such as spelt, millet, and amaranth have been “rediscovered” in recent years by chefs and others in the food industry who have embraced the trend of integrating ancient grains into modern culinary styles.

When buying farro, avoid products that are “pearled” or “semi-pearled”; these terms indicate that some or all of the outer bran has been removed from the grain. (This is also the case with “pearled” barley.)

Wheat berries are wheat kernels from which the outer husks have been removed. They have a chewy texture and a slightly nutty flavor. Wheat berries, which take about an hour to cook, can be served hot as an accompaniment to chicken, fish, or beans, or cooled and combined with vegetables, fruits, nuts, and/or seeds for a filling summer dish. Like other varieties of wheat, wheat berries are a good source of plant protein, so you can use them as a base upon which to build a meatless meal.

The Gluten-Free Craze

These days, it seems everybody is “going gluten-free.” For people with celiac disease, avoiding gluten—a protein found in wheat, rye, and barley—is a medical necessity. In celiac disease patients, gluten triggers an immune reaction that damages the small intestine and decreases nutrient absorption. It is believed that about 3 million Americans have celiac disease. However, many people who have celiac disease are undiagnosed; diagnosis requires a blood test and, sometimes, further testing to confirm inflammation in the small intestine.

Robert M. Russell, MD, emeritus professor at Tufts’ Friedman School, advises, “If you are having a problem with intermittent abdominal bloating and pain, unintentional weight loss, or chronic diarrhea, you should consult your doctor.… It is not prudent, however, to attempt to diagnose yourself by cutting out gluten-containing foods to see if you feel better. This can actually make celiac disease more difficult to clinically diagnose.”

Many people have adopted a gluten-free diet because they believe avoiding gluten will help them feel healthier or lose weight, even though they don’t have celiac disease. However, in terms of nutrition, gluten-free grains are no healthier than grains that contain gluten.

Nutrient Shortfalls

Should you go gluten free? Pamela Cureton, RD, LDN, a research dietitian at the Center for Celiac Research, says, “There is no evidence that gluten is harmful in healthy people without a gluten-related disease.” Moreover, gluten-free diets can come up short on nutrients. A report from the American Dietetic Association cautioned that gluten-free products averaged lower amounts of B vitamins, calcium, iron, zinc, magnesium, and dietary fiber than products that contain gluten.

Many food manufacturers would like you to believe that “gluten-free” is synonymous with “healthy,” but there are plenty of gluten-free junk foods, including chips, snack foods, and sweets, that are packed with calories, sugar, and/or sodium. Going to a gluten-free bakery and indulging in cupcakes, cookies, or pies is no healthier than getting similar products at a conventional bakery.

If you don’t have celiac disease, there’s no scientifically valid reason to deprive yourself of the nutrition you’ll get from consuming moderate amounts of wheat, barley, and rye, especially in their whole-grain forms.

Wheat Is Not Unhealthy

Similarly, you may have heard that eating wheat contributes to abdominal fat (so-called “wheat belly”) or even hurts your brain (“wheat brain”). But there’s no cause for concern: There is nothing inherently unhealthy in wheat.

“It is true that Americans overconsume refined wheat products—energy-dense, nutrient-poor foods that are high in sugar and fat—so wheat is often a ‘co-passenger,’” says Dr. McKeown. “Yes, cutting out these refined foods will lead to weight loss. However, the trouble lies in the message that wheat is the culprit. There is a lack of scientific evidence to support the claims that eating wheat is an independent risk factor for greater abdominal adiposity or weight gain.” What is actually important, she says, is learning how to identify whole-grain options that replace refined grains in your diet.

Research by Dr. McKeown and colleagues has shown that substituting whole grains for refined grains is associated with less—not more—belly fat. If you’re trying to lose weight, limiting processed foods that contain refined wheat flour, along with sugar and saturated fat, also can be helpful.

As for the notion that eating wheat may increase your risk of Alzheimer’s disease, that simply doesn’t stand up to scientific scrutiny. After all, grains, including wheat, are key foods in both the DASH dietary plan and the Mediterranean-style diet, and research has linked both regimens to a lower risk of dementia.

A Note on the Glycemic Index

Another concept in popular diets, the glycemic index (GI), has more solid science behind it. However, recent research has cast doubt on how reliable or useful this measurement might be as a tool for weight loss and avoiding or managing diabetes.

The GI is simply a score of how rapidly carbohydrates in specific foods boost blood glucose (sugar). But Tufts researchers have previously found that GI measurements vary widely, making them unreliable dietary guides. And a new Tufts study reveals that what you eat with high-carb foods also can skew blood-glucose effects.

Scientists looked at how blood glucose and insulin levels were affected by adding foods with different amounts of carbohydrate, protein, fat, or fiber to a standardized portion of white bread, which has a high GI because it’s low in fiber and digested quickly. They found that the blood-glucose impact of a high-carbohydrate food was blunted when eaten with a high-protein food. That’s likely because protein slows stomach emptying, so glucose from carbohydrates enters the bloodstream more slowly. The researchers commented, “This suggests that glycemic index values, which by definition do not account for other foods eaten at the same time, shouldn’t be used in isolation to modify your food choices.”

Instead of chasing the latest food fads, make an effort to consistently choose whole-grain, high-fiber foods and substitute them in place of processed, low-fiber products. You don’t need a fad-diet book to eat better as you age—just a keen eye for nutrition labels.

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In all of the various rating systems for foods, she adds, certain groups of foods always come out on top—those that are plant-based. Vegetables are excellent sources of fiber, as well as many of the nutrients you may need more of as you age. The health benefits are clear: People who consume more plant-based foods, including vegetables, fruits, and whole grains, have a lower risk of cardiovascular disease and certain cancers.

Not surprisingly, on the Tufts’ MyPlate for Older Adults, vegetables occupy more space than any other food group.

Five-a-Day Is Just a Start

You’ve probably also heard that eating five servings a day of vegetables and fruits is a healthy goal. According to research published in the International Journal of Epidemiology, however, that’s just a good start. The analysis of 95 observational studies concluded that eating five servings of vegetables and fruits daily was associated with a 14 percent lower risk of heart disease, while eating 10 servings a day was associated with a 24 percent lower risk, compared to zero servings. (A serving is one-half cup cooked vegetables or a small piece of fruit.)

The researchers commented, “If you can’t fit in 10 servings of fruits and vegetables, it may be worthwhile to at least make sure you eat some of the specific ones we found were associated with reduced heart disease risk,” such as leafy greens, cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, and cabbage), citrus fruits, apples, and pears.

Lesser-Known Nutrients

What makes vegetables so good for you? Most are excellent sources of essential vitamins and minerals, along with fiber. But some of the health benefits of vegetables (as well as fruits) also can be attributed to lesser-known natural plant compounds called phytonutrients (also referred to as “phytochemicals”). Phytonutrients help protect plants from bugs, fungi, and infections. Phytonutrients often are found in the highest amounts in vegetables’ outer surfaces or peels, and usually, they are responsible for the pigments that give many vegetables their distinctive colors.

“Phytonutrients are not classic nutrients like vitamins,” says Dr. McKay. “These are compounds that several studies have shown have biological activity that confers health benefits, such as improving markers of chronic disease risk. Nearly all phytonutrients have antioxidant activity, but that is not necessarily their mode of action in the body. Within cells, they may turn signals on or off, reduce inflammation, or trigger a whole cascade of events.”

Types of phytonutrients include carotenoids (found in carrots, winter squash, tomatoes, and yellow peppers), organosulfides (found in onions, garlic, broccoli, and cabbage), and phytosterols (found in peas, soybeans, and vegetable oils).

There are no minimum daily requirements for the more than 25,000 phytonutrients that scientists have identified in plants. These compounds are not essential to keeping you alive the way that, say, protein, carbohydrates, water,  or vitamins are. Many of the health benefits of phytonutrients, which also are found in tea, coffee, cocoa, whole grains, and fruits, are still being studied. “Thousands of different phytonutrients have been identified to date, and we’re still going,” Dr. McKay says.

Some research suggests phytonutrients in vegetables and fruits might help protect against some forms of cancer. For example, eating foods containing beta-cryptoxanthin (BCX)—a red pigment abundant in sweet red peppers, paprika, winter squash, oranges, and tangerines, among other foods—might work at the molecular level to thwart lung cancer. And a dietary pattern high in colorful vegetables and fruits, such as carrots, pumpkin, sweet potatoes, peppers, cantaloupe, and dark leafy greens, seems to help protect against breast cancer.

A Variety of Phytonutrients

One reason to consume a wide mix of plant foods in your diet is to obtain a variety of phytonutrients. “Each plant food provides a different array of phytonutrients that work together synergistically,” Dr. McKay says.

The combinations of phytonutrients found in plant foods produce greater benefits than you’d get if you were to isolate the individual nutrients and then take them together. The many nutrients present in whole foods are uniquely balanced, and they produce an effect greater than any effect you can get by taking nutrients in supplement form. This is one reason why nutrition experts advise getting nutrients from whole foods rather than supplements.

Trending Vegetarian

You don’t have to become a vegetarian to eat more veggies, but studies of vegetarians do provide convincing evidence of the health benefits of eating more plant-based foods. In one such study, vegetarians were 32 percent less likely to suffer coronary artery disease than non-vegetarians. The benefits were seen in participants who had been following a vegetarian diet for less than five years, as well as in long-term vegetarians. Other research has found that vegetarians tend to have lower risks of heart disease, certain cancers, diabetes, obesity, and hypertension.

The health benefits of vegetables and other plant foods and/or concerns about animal welfare and the environment lead some people to choose a vegetarian dietary pattern. Vegetarian diets are becoming more mainstream, and the 2015-2020 Dietary Guidelines for Americans includes a vegetarian eating pattern as one of its three examples of healthy diet plans.

Another healthy option is to limit or give up meat but keep seafood on the menu: Other research suggests that a pescatarian diet—one that includes fish as well as an abundance of plant foods—might be even more healthful than a strict vegetarian regimen. One report showed that people who are otherwise vegetarians but eat fish at least once a month had the lowest incidence of colorectal cancer. Adding fish to a vegetarian diet was associated with less risk than any other type of vegetarian diet, including a vegan regimen, which includes no dairy, eggs, fish, or animal products of any kind.

You can follow a plant-based diet even if you’re not a vegetarian; it’s not an all-or-nothing choice. There’s no ironclad definition for the term “plant-based diet”; generally, it means that the majority of foods eaten are from plant rather than animal sources. If your diet includes several servings of animal proteins each day, chances are you’re not getting enough fruits, vegetables, and whole grains. It would be a healthy move to eat more plant-based foods and fewer animal-sourced foods, even if you’re not giving up beef, pork, or poultry completely.

Moreover, following a vegetarian diet doesn’t guarantee that the diet is healthy; it all depends on which plant-based foods you choose. “Fries and a Coke are vegetarian,” says Dariush Mozaffarian, MD, DrPH, dean of Tufts’ Friedman School of Nutrition Science and Policy. “More important than what you avoid is what you actually eat. The healthiest diets are rich in fruits, nuts, fish, vegetables, yogurt, beans, vegetable oils, and whole grains. Being or not being a vegetarian does not add much to that.”

Boosting Your Veggies

Whatever dietary pattern you choose, you’ll want to put lots of veggies in your shopping cart. You can find nutritious vegetable options in the produce section, the frozen foods case, and even the canned goods aisle. To be a smart vegetable consumer, keep these tips in mind:

• Buy fresh vegetables in season, adapting your menus to match the harvest. In-season vegetables will be cheaper and are likely to be at their peak of flavor and nutrients.
• Keep frozen vegetables handy in your freezer to quickly heat up in the microwave as a side dish or to add to soups, stews, and casseroles. (Remember that frozen veggies are at least as nutritious as fresh.)
• Pay a little more for convenience if it means you’ll eat more veggies. Pick up pre-washed bags of salad greens, spinach, or kale, packages of baby carrots, or pre-cut celery sticks.
• Microwaving and steaming generally preserve more of the nutrients in vegetables than boiling them, in which nutrients are lost to the cooking water. Roasting and grilling bring out the sweetness in many veggies; if that tempts you to eat more, it’s worth sacrificing some nutrients to prolonged or high heat.
• Beware of sauces and seasonings that can add calories, saturated fat, and sodium to vegetables. Before buying pre-seasoned canned or frozen vegetables, check the Nutrition Facts label and/or the ingredients list to see if the product is high in sodium, calories, and/or saturated fat.
• Look for canned vegetables labeled “reduced sodium,” “low sodium,” or “no salt added.” You can further reduce the sodium content of canned vegetables by draining and rinsing them in water.

A Sampling of Super Vegetables

In the rest of this chapter, we provide more information about an array of vegetables that will help you meet your nutritional needs as you age, including tips on how to store and serve them. You may be less familiar with some items than others, such as fennel and celeriac, so consider this an invitation to experiment. Since all vegetables are good sources of a variety of valuable nutrients, select those that most appeal to your taste buds and budget.

In our list of vegetables, you’ll find avocados, pumpkins, and tomatoes—foods that are technically fruits based on their botanical classification. However, since these foods are typically treated like vegetables and used in savory dishes, we’re including them here. (Beans, peas, and other legumes will be covered in the chapter on protein foods.)

Artichokes

The artichoke packs a nutritional punch, though identifying the edible part is somewhat tricky for the uninformed. The tender artichoke heart is at the bottom of the vegetable. Once steamed, the cactus-like leaves can be eaten by biting down on the soft, bottom end and scraping the tender flesh into your mouth. The edible parts of the artichoke contain fiber, folate, lutein, zeaxanthin, potassium, and vitamins C and K. It is very low in calories (64 in one medium artichoke) but high in fiber, especially the soluble fiber that’s been shown to improve cholesterol levels.

Select artichokes that are compact and heavy for their size, with tight leaves. To loosen the leaves of a mature artichoke, cut off the top one-third and remove the tough outer leaves by hand, then simmer in boiling water with a little lemon juice. The bases of each leaf can be eaten as well as the delicate artichoke heart. Cook only in a non-reactive pan such as stainless steel, enamel or glass, because cast-iron, copper or aluminum cookware will cause artichokes to discolor (as can carbon-steel knives).

Asparagus

Asparagus is a good source of several B vitamins, including thiamin, riboflavin, niacin, B₆, and especially folate. Low in calories, it also provides iron, potassium, and vitamin C. Asparagus contains more vitamin E than most vegetables, and it’s high in dietary fiber, including a type of soluble fiber that acts as a “prebiotic,” which feeds the “good” bacteria in the gut.

One downside to asparagus is that it’s high in purines, which some advise gout sufferers to avoid because these compounds are thought to raise uric-acid levels. Some people also find that asparagus gives a distinctive odor to their urine, but this has no health consequences.

Select asparagus spears that are firm, with closed, deeply-colored tips. Store asparagus in the refrigerator. Thin spears aren’t necessarily more young and tender; those at least a half-inch in diameter at the base are best. To extend its shelf life, place the asparagus, tips pointing up, in a container filled with about an inch of water; replace the water when it becomes cloudy.

Avocados

These days, avocados are eaten in everything from guacamole and salads to smoothies and trendy avocado toast. If you’ve avoided avocados because they’re high in fat, think again: Of the 18.6 grams of fat in a typical avocado, only 2.9 grams are unhealthy saturated fat; the rest is heart-healthy monounsaturated fat. Research suggests that the unsaturated fat in avocados may have cardiovascular benefits. In particular, eating an avocado a day has been found to lower unhealthy LDL cholesterol.

Adding an avocado to other vegetables, such as the leafy greens in a salad, can help you absorb carotenoid compounds such as beta-carotene. One study found that topping salads with avocado boosted carotenoid absorption by three to five times.

Avocados also are being studied for joint health. They contain compounds called unsaponifiables (ASUs), and ASUs derived from avocado and soybean oils are being tested as a treatment for osteoarthritis. One study found that avocado-soybean ASUs improved symptoms of hip and knee arthritis and reduced the need for anti-inflammatory drugs. Another study reported that ASUs significantly reduced the progression of hip arthritis over a three-year period.

Avocados are good sources of several B vitamins, dietary fiber, potassium, copper, carotenoids, and vitamins C, E, and K. However, consume avocados in moderation—one cup of avocado slices contains 230 calories, a much higher calorie count than most other vegetables.

Like bananas, avocados will ripen at room temperature after purchase, so choose less-ripe fruit that is firmer and less likely to be bruised. Ripe, whole avocados can be kept in the refrigerator for up to a week. Peel avocados carefully, since the greatest concentration of carotenoid compounds is in the dark-green flesh immediately under the skin.

Beets

Look for fresh beets in early summer. Nutrients are generally highest in the familiar purple-red varieties, including phytonutrients called betalains that give beets their vivid color (but which are depleted with longer cooking times). Beets also are a good source of fiber, vitamin C, potassium, folate, and iron. Although beets are high in natural sugar (hence their use in sugar production), they are low in calories.

Smaller beets are more tender and cook faster; select those that are unblemished, hard, and evenly round. Don’t wash beets before storing, though you may want to trim most of the greens to reduce moisture loss. (If you also eat the greens, they are high in lutein and zeaxanthin, which are phytonutrients that play an important role in eye health.) Peel beets only after cooking to keep their rich red color from bleeding out. When handling beets, it’s smart to wear gloves and an apron, because the juice will create stubborn stains.

Like carrots, beets can be eaten raw; add shredded beets to green salads for a sweet crunch. If you’re not keen on handling whole beets, you can try beet juice; this beverage has become more popular and easier to find since research found that it might help control high blood pressure.

Broccoli

The prototypical healthy veggie, broccoli is indeed a good source of nutrients, including fiber, vitamin C, calcium, folate, riboflavin, potassium, and iron. It’s also high in beta-carotene and other carotenoids, such as lutein and zeaxanthin, that help protect eye health. Phytonutrients found in broccoli, such as indoles, glucosinolates, kaempferol, and isothiocyanates, are believed to have cancer-fighting properties. One phytonutrient in broccoli, sulforaphane, may help prevent stomach ulcers and inflammation by killing bacteria called Helicobacter pylori in the stomach. The leaves and stalks of broccoli are packed with nutrients, too, though the florets are generally the most nutrition-rich.

Research has shown that people who ate cruciferous vegetables such as broccoli were at significantly lower risk of lung cancer. Another study showed that nonsmokers who ate three or more monthly servings of raw cruciferous vegetables had a 73 percent reduced risk of bladder cancer than those who ate the fewest cruciferous foods.

Look for tightly closed, dark-green or purplish-green florets (indicating more beta-carotene and vitamin C) with tender stalks; avoid yellowing florets that are past their prime. Broccoli can be eaten raw, which retains more vitamin C, but cooking releases more carotenoids for absorption by the body. Like most of its cruciferous cousins, broccoli can be microwaved, steamed, boiled, or even roasted.

Brussels Sprouts

These suddenly trendy cruciferous veggies are high in potassium and provide thiamin, riboflavin, vitamin B₆, antioxidant flavonoids, and potentially cancer-fighting phytonutrients. Pick bright-green sprouts with no cabbage-y odor; smaller sprouts are more tender and less likely to have the bitterness that makes people think they dislike Brussels sprouts. Steam Brussels sprouts, braise them in a flavorful liquid such as vegetable or chicken stock, or toss them with olive oil and roast them in the oven.

Cabbage

Another cruciferous cousin of broccoli, cabbage shares many of broccoli’s nutritional benefits. All three common varieties of cabbage—red, green, and Savoy—are good sources of potentially cancer-fighting phytonutrients, along with fiber and folate. As you might guess from its color, red cabbage is higher in vitamin C, but Savoy cabbage contains more beta-carotene.

Select heavy, solid heads of cabbage with only a few outer wrapper leaves, which should be clean and undamaged. Hold off washing cabbage until you’re ready to serve it, and don’t cut with a carbon-steel knife to avoid discoloration. If cooking red cabbage, use nonreactive cookware to preserve the color.

Carrots

A single medium carrot delivers almost twice the recommended daily value of vitamin A, mostly in the form of beta-carotene. Studies have shown that beta-carotene and other carotenoids are linked with protection against conditions that can cause vision loss: For example, women who eat more carrots have lower rates of glaucoma, and animal studies have linked nutrients in carrots to a reduced risk of cataracts.

Carrots are also good sources of potassium and vitamin C, and contain calcium, zinc, and magnesium—all for just 25 calories. The fiber in carrots includes pectin, which may have cholesterol-
lowering properties.

Scientists are studying phytonutrients in carrots called polyacetylenes for possible cardiovascular benefits. These compounds are thought to have anti-inflammatory properties and to keep blood cells from clumping together. Other studies are investigating these compounds’ ability to inhibit the growth of cancer cells.

Look for brightly colored carrots that are smooth, firm, and relatively straight. Larger carrots are sweeter because they’ve had more time to develop natural sugars.

Store carrots in the coolest part of the refrigerator for up to about two weeks, wrapped in a damp paper towel and placed in an airtight container or bag. Keep carrots away from foods such as apples or pears that release ethylene gas, which will promote spoiling and bitterness. Wash carrots thoroughly before using.

Cauliflower

The plain white color of cauliflower belies its rich nutrient content. (There’s also purple cauliflower, an antioxidant-rich variety that turns green when cooked, and orange cauliflower, which adds vitamin A to the equation and tastes more like winter squash.) Another mainstay of the cruciferous family of vegetables, one cup of cooked cauliflower contains 3 grams of fiber and 2 grams of protein, as well as vitamin C, folate, vitamin B₆, and potassium.

Look for cauliflower that’s firm and free of bruises and blemishes, with compact florets; any leaves should be crisp and green.

Be gentle if you choose to boil cauliflower in water, as heat diminishes its vitamin C content, and its B vitamins leach into the cooking water. Roasting this vegetable brings out an earthy sweetness that may appeal to people who think they don’t like cauliflower. Cooked, mashed cauliflower can be served in place of mashed potatoes or combined with them to lower the carbohydrate and calorie count. Or you can use cauliflower “rice” to make low-carb, gluten-free pizza crust.

Collard Greens

Collard greens are less familiar to Americans outside the South than other dark, leafy greens such as spinach or kale. Collards and their cousins, such as turnip and mustard greens, belong to the cruciferous-vegetable family. Among the milder of these bitter leaves, collards are a source of fiber, beta-carotene, vitamin C, folate, iron, and calcium (one of the best sources among dark leafy greens).

Shop for collards that have been kept cool, as they wilt quickly, and choose smaller, tender leaves with fresh green color and no signs of discoloration. At home, wrap unwashed collards in damp paper towels and store them in the crisper. Wash thoroughly right before using and discard stems and tough leaves. Try using collards in recipes that call for cooked spinach, or add to whole grains.

Fennel

A flowering plant related to the carrot family, fennel provides vitamins A, C, and K, carotenoids (beta carotene, lutein, and zeaxanthin), fiber, and potassium. One half of a bulb has just 36 calories. While fennel is commonly used in Italian and French cooking, it is often misunderstood and neglected in the U.S. The hollow stalks are considered an herb, chopped and sautéed, then added to salads, soups, or vegetables. The part of fennel most commonly used in cooking is the cultivated bulb, called the “Florence fennel.” Its inflated leaf base has a mild anise flavor with a sweeter taste. Sliced Florence fennel can be grilled, roasted, or baked.

Kale

The popularity of this leafy green member of the cruciferous family has surged in recent years. Unlike some food fads, however, kale deserves the attention: With a mere 36 calories, one cup of cooked kale delivers 5 grams of fiber and more than 100 percent of your daily vitamin A, as well as vitamins C and K, magnesium, calcium, and potassium, plus at least 45 antioxidant flavonoids. Like other cruciferous veggies, it contains glucosinolates—sulfur compounds associated with a reduced risk of cancer.

The fiber in kale is good for your digestive system, and it also benefits your arteries. Research has shown that fiber-related nutrients in kale help the liver and intestines bind cholesterol and carry it out of the body. Although raw kale can help lower cholesterol, steam it for five minutes to get the maximum benefits from its nutrients.

Kale is typically available year-round. You’ll find three common varieties:

• Curly kale, with ruffled, deep-green leaves and a pungent, bitter, peppery flavor.
• Dinosaur kale, also called Tuscan or Lacinato kale, with textured, dark blue-green leaves, and a sweeter, more delicate flavor that kale newcomers might prefer.
• Ornamental kale, which is edible despite its name, also is called salad savoy. Its leaves may be purple, pink, red, yellow, cream, and/or green, and it has a mild flavor and tender texture.

Select firm, deeply colored leaves with sturdy stems, free of wilting or discolored spots; smaller leaves tend to be milder in flavor. Store unwashed kale in a zip-top plastic bag in the refrigerator and use within five days, since kale’s nutrient content declines rapidly.

Lettuce and Salad Greens

Generally, the darker the lettuce or other salad greens, the higher the overall nutritional content—and yet Americans eat more pale-green iceberg lettuce than kale, romaine, and spinach combined. Compared to iceberg lettuce, deeply colored greens are higher in vitamins A, C, and K, beta-carotene, the carotenoids lutein and zeaxanthin, calcium, folate, and fiber. Green and red leaf lettuces, for example, contain nearly 15 times as much vitamin A as iceberg lettuce, six times the vitamin K, almost 20 times the beta-carotene, and six times the lutein and zeaxanthin. Other popular varieties, such as romaine, Bibb, and Boston lettuce, also outshine iceberg in nutrients.

All salad greens provide vitamin C, folate, calcium, iron, and other nutrients, though amounts vary widely by type—another argument for consuming a variety. Choose the crispest salad greens you can find; in prepackaged mixes, check the sides and bottom of the container or bag for any signs of wilting, sliminess, or browning. Wrap loose salad greens in a damp paper towel and store in the refrigerator crisper, away from fruits such as apples or ripe bananas that give off ethylene gas.

Remember that even the healthiest salad can be made less healthy by slathering on dressings and other toppings high in calories and saturated fat, such as cheese and bacon. For healthier homemade dressing, try a simple recipe of whisking together one part vinegar to two parts oil. Adding a dash of mustard will help keep the oil and vinegar from separating.

Keep in mind, too, that salad greens of all sorts are prime targets for contamination with bacteria that can cause food-borne illness. Romaine lettuce, for example, has been the source of multiple headline-making outbreaks. Follow these safety tips for all varieties:

• At the market, place fresh greens in plastic bags to keep them separate from raw meats and poultry.
• Refrigerate greens at 35–40 degrees.
• Wash hands and surfaces before preparing salad.
• Wash all non-prewashed greens thoroughly under running water just before using, including produce grown conventionally or organically at home or purchased from a grocery store or farmer’s market. The FDA does not recommend washing with soap or detergent or using commercial produce washes.
• Use a salad spinner and/or blot greens dry with paper towels.
• If the label on packaged greens indicates that the contents are pre-washed and ready-to-eat, the FDA says you can use the produce without further washing (which might actually expose clean greens to contaminants in the sink).

Okra

A member of the hollyhock family, this vegetable—familiar in the American South—is technically a fruit. Its gooey liquid emitted during cooking makes it a popular thickening ingredient in gumbo stew. Turned off by the goop? Cook the okra separately at high heat and then add it to the dish. This low-calorie food (12 calories for five pods) adds flavor to any meal, as well as fiber, lutein, vitamin K, and potassium.

Onions

Members of the allium family, onions are related to garlic, which has been extensively studied for its potential health benefits. Onions are a good source of vitamin C, potassium, and dietary fiber. They also are among the richest sources of quercetin, a phytonutrient with antioxidant and anti-inflammatory properties.

Organosulfur compounds are released by cutting or crushing the onion; in garlic, these compounds have been associated with cancer protection, improved cholesterol levels, and decreased stiffness in blood vessels. It may be that allowing onions to sit for a few minutes after cutting, prior to cooking, helps preserve these beneficial compounds, as has been demonstrated with garlic.

Research has shown that the more pungent, stronger-smelling onions, which are highest in sulfur compounds, exhibit anti-platelet activity. That might help prevent platelets from clumping together in your blood vessels, reducing the risk of atherosclerosis, stroke, and heart attack. Generally, yellow and red onions are highest in beneficial compounds, while milder (sweet or Vidalia) varieties are lowest. Those sulfur compounds, as well as quercetin, may be responsible for onions’ apparent cancer-protective effects.

When selecting dry bulb onions, look for those that are firm and have little or no smell. Avoid any with cuts, bruises, or blemishes. Store unpeeled onions in a cool, dry, dark place to better preserve their antioxidant compounds. Peel your onions carefully, as the phytonutrients tend to be more highly concentrated in the outer layers.

Peas

Peas are members of the legume family (which also includes beans and lentils), so they are higher in protein than most green vegetables. Their fiber includes pectin, which may aid in combatting unhealthy cholesterol. Nutrition numbers vary by type, with green peas higher in B vitamins and zinc, while snow peas stand out for vitamin C and folate. Snow peas are lower in protein and calories than green peas.

Frozen green peas provide a go-to option for an easy vegetable suitable for side dishes, stews, casseroles, and pilafs. When buying fresh peas still in the pod, look for firm, glossy, medium-sized pods. Keep fresh peas refrigerated, as their sugars rapidly turn to starch at room temperature, and rinse thoroughly before using. Young green peas can be eaten raw along with the pods, as can snow peas and sugar snap peas.

Pumpkin

It’s time to think of pumpkins beyond Halloween jack-o’-lanterns and Thanksgiving pie. Despite their high water content (90 percent), nutrient-dense pumpkins deliver a modest amount of protein and fiber, vitamins C and E, and beta-carotene—with only 49 calories in one cup of cooked pumpkin. That single cup of cooked pumpkin contains 564 milligrams of potassium—more than a banana and almost an eighth of what you need in a day. Pumpkin also provides copper, manganese, zinc, iron, selenium, and magnesium.

The pumpkin is a type of winter squash and a member of the gourd family; it works well in savory preparations, whether it is baked, puréed in soups, or added to stews. Canned pumpkin purée is as good a choice as fresh pumpkin and far more convenient—just be sure to select 100-percent pumpkin, rather than pumpkin pie filling, which contains added sugar. If you buy a whole pumpkin, save and roast the seeds for a nutritious snack, salad topping, or granola ingredient.

Snap Beans

A favorite with gardeners, these edible-pod beans are most commonly seen as green beans or yellow wax beans; both are actually immature forms of kidney beans. Formerly known as “string beans,” snap beans are now bred to grow mostly without the tough “string” down the pod’s seam. Nutritionally, green beans and yellow wax beans are similar, except that the latter contain less beta-carotene. Both types are good sources of dietary fiber, potassium, vitamin C, folate, and iron.

Look for crisp, not stiff, pods of uniform size for even cooking. Thin French beans known as haricots verts are more tender and fast-cooking in simple sauté preparations. Trim the ends before cooking, but otherwise, keep them whole during cooking to keep nutrients from leaching out.

Spinach

Popeye was right about spinach: This leafy green nutritional powerhouse has been linked to health benefits including boosting muscle strength, reducing diabetes risk, and protecting against cataracts. Spinach is rich in carotenoids and vitamin K. It’s also a good source of vitamins C and E, and B vitamins, calcium, potassium, and magnesium.

Though spinach is famously high in iron, the oxalates found in these nutritious greens interfere with the absorption of iron as well as calcium. That high oxalate content also means people at risk for the most common type of kidney stones, calcium oxalate stones, may need to limit their spinach consumption. Patients on blood-thinning medications such as warfarin should check with their physicians before changing their consumption of leafy greens, such as spinach and kale, which are high in vitamin K, which can counteract the effects of warfarin.

Buy smaller, vividly green, sweet-smelling spinach leaves with thinner stems and no signs of yellowing. Spinach, especially loose-leaf, requires rigorous rinsing to remove grit; dry in a salad spinner unless you plan to cook the spinach, which can be cooked damp. Because carotene compounds are fat-soluble, you’ll get the most from your spinach when it’s combined with a little heart-healthy unsaturated vegetable oil, such as olive oil in a salad; cooking also will release more of these compounds.

Summer Squash

Summer squash vary widely in appearance, color, and nutritional values, but all are gourds—relatives of melons and cucumbers. Unlike their harder-rind winter cousins, summer squash, including zucchini and crookneck or yellow squash, are picked while still immature. Their high water content leaves little room for calories, but summer squash still deliver fiber, magnesium, potassium, and vitamins A and C. The green rind of zucchini is packed with eye-protecting lutein and zeaxanthin.

Select small to medium squash that feel firm and heavy for their size and are free of nicks. Store in the refrigerator (unlike winter squash). Try grilling lightly oiled summer squash, shredding into a slaw, or adding to stir fries.

Sweet Potatoes

Sometimes mistakenly called yams, sweet potatoes are not even distantly related to the tuber that is popular in African cooking but seldom seen in the U.S. Sweet potatoes can be found in a range of colors, from pale orange to deep red and purple. Their rich, deep color indicates a high concentration of carotenoids. One cup contains enough beta-carotene to produce 769 percent of the daily value of vitamin A. That one cup also delivers 7 grams of fiber (versus 2 grams in a white potato).

A heart-healthy reason to eat sweet potatoes is their potassium content—950 milligrams in one cup. You’ll also get a healthy dose of vitamins B₆ and C.

When cooking sweet potatoes, leave the skins on—that’s where the majority of the phytonutrients are located. Sweet potatoes can be baked or roasted, but some data suggest that boiling them (with the skin on) results in the best conservation of nutrients and the lowest impact on blood glucose levels. While sweet potatoes are loaded with nutrients, they’re starchy vegetables, which means they’re higher in calories than non-starchy vegetables, so keep an eye on your portion size.

Tomatoes

Tomatoes provide more than 10 percent of your recommended daily value of vitamin C, vitamin K, copper, potassium, and manganese per cup, with only 30 calories. Their high potassium content may explain why tomato consumption has been associated with a reduced risk of cardiovascular disease. One cup also contains 2.2 grams of fiber—more than some breakfast cereals.

Tomatoes are an important source of phytonutrients, including the flavonols quercetin and kaempferol, which are found primarily in the skin, as well as beta-carotene and lycopene. Lycopene, the phytonutrient that gives tomatoes their rich, red color, also may contribute to cardiovascular protection. High levels of lycopene in the blood have been associated with a lower risk of stroke in men, as well as improved cholesterol and triglyceride levels. By countering the aggregation of platelets in the blood, lycopene and other tomato compounds may reduce the risk of atherosclerosis. Lycopene also may be key to tomatoes’ possible anti-cancer benefits. Studies have linked high intake of lycopene with reduced risks of breast and prostate cancer.

Cooked tomatoes, including canned tomatoes and sauces, actually are a better source of lycopene than raw tomatoes, because heat breaks down the cell walls in the tomatoes and releases the lycopene. Because lycopene is fat soluble, combining tomatoes with a little olive oil or other healthy fat makes it easier for your body to absorb it.

Look for smooth, plump, unblemished tomatoes with a sweet fragrance. Store fresh tomatoes in a cool, dark place such as a pantry—not in the refrigerator, where cell walls and volatile flavor compounds will break down. Tomatoes that must be refrigerated to prevent spoilage   still can be used in a sauce; try putting them out on the counter for a few hours before cooking them. Canned tomatoes are a convenient option and a pantry staple; check labels to make sure your tomatoes aren’t loaded with sodium.

Winter Squash

Though nutrient contents vary by species, winter squash are at least as nutritious as pumpkin and deliver more nutrients than varieties of summer squash such as zucchini. Winter squash are low in calories; for example, one cup of cooked butternut squash provides just 80 calories. They are an excellent source of carotenoids and vitamin C, and also contain B vitamins and potassium. One cup of winter squash has 6.6 grams of dietary fiber, most of it the insoluble form that promotes digestive health. The pectins and other polysaccharides in winter squash also may have anti-inflammatory and insulin-regulating properties.

All winter squash have an interior hue that falls along the spectrum of yellow to orange—a signal that, like carrots and pumpkins, they’re rich in alpha- and beta-carotene, precursors to vitamin A. Some studies have rated winter squash as among the best sources of these compounds. One cup of cooked butternut squash provides nearly 23,000 IU of vitamin A—560 percent of the recommended daily value. Foods high in vitamin A may help protect against certain cancers, and vitamin A is essential to maintaining eye health. Vitamin A also supports cell growth and differentiation, playing an essential role in the maintenance of the heart, lungs, kidneys, and other organs.

Winter squash also deliver lutein, zeaxanthin, and a vitamin A precursor called beta-cryptoxanthin, which has been studied for anti-inflammatory properties and may reduce the risk of rheumatoid arthritis.

Winter squash belong to a subgroup of the Cucurbitaceae family of plants, the Cucurbita genus, whose extracts are being studied for anti-cancer properties. Compounds in Cucurbita foods also may inhibit an enzyme that contributes to the buildup of cholesterol.

Winter squash also serve up significant amounts of five B vitamins, including B₂, B₃, B₆, folate, and pantothenic acid. B vitamins, along with a compound called d-chiro-inositol that also is found in winter squash, are important to the body’s regulation of blood sugar.

Despite their name, winter squash are at their best in autumn. Select squash that are unblemished, firm, and heavy for their size. Look for rinds that are hard (a soft rind signals a watery interior) and dull or matte, not glossy (a sign of squash picked too soon before it can sweeten). If present, the stem should be firmly attached. Along with familiar varieties, such as acorn and butternut, try other types such as buttercup, delicata, carnival, turban, hubbard, kabocha, and sweet dumpling. Try serving stringy spaghetti squash in place of pasta.

Whole winter squash can be stored in a cool, dark place for as long as six months, depending on the type. Wash the rind thoroughly in running water before using. Once cut, store in the refrigerator for up to two days, or freeze.

What About Potatoes?

You may have noticed an omission from this list—America’s most popular vegetable, the potato. We consume more than 50 pounds of potatoes per person annually, more than 20 pounds more than the second-most popular veggie, tomatoes. For many Americans, potatoes—white, red, Russet, or colorful varieties such as Yukon Gold or Adirondack Blue—are a dietary staple. It’s not surprising, considering that potatoes are affordable, easy to store and prepare, and filling.

However, many popular potato dishes, including loaded baked potatoes, au gratin potatoes, potato skins, French fries, and potato salad, often contain heaping helpings of unhealthy fat and sodium. Plain potatoes that are simply boiled, roasted, or baked have plenty of nutritional benefits; they are good sources of potassium, vitamin C, and folate. Potatoes eaten with the skin deliver fiber that can help offset the negative effects of their dietary starch. You can still enjoy potatoes; just make them one of the many vegetables you eat, and keep your portion sizes in check.

As you’ve seen in this chapter, there’s a considerable variety of nutrient-packed vegetables available. If you’ve been eating the same four of five vegetables for years, now is a great time to add some new ones to your dietary pattern.

The post 4. Vegetable “Superfoods” appeared first on University Health News.

Eating fruit can help you pass up less healthy choices, too, which is why they make smart snacks and desserts. One study found that women of normal weight were more likely to keep fresh fruit out on the kitchen counter, while women who were overweight or obese were more likely to have boxed cereals, cookies, chips, or soft drinks sitting on their counters.

Don’t Fear Fruit’s Sugar

Because fruits taste so sweet, some people think they can’t possibly be as good for you as vegetables. People with type 2 diabetes, in particular, often believe they should avoid fruit because it contains naturally occurring sugar. The American Diabetes Association, however, advises: “Fruits are loaded with vitamins, minerals, and fiber just like vegetables. Fruit contains carbohydrate, so you need to count it as part of your meal plan. Having a piece of fresh fruit or fruit salad for dessert is a great way to satisfy your sweet tooth and get the extra nutrition you’re looking for.”

In fact, consuming certain fruits—including blueberries, grapes, and apples—at least three times a week has been linked to a lower risk of diabetes. The fiber in whole fruits helps decrease the rate at which glucose (sugar) is released into the bloodstream.

Fruit also is associated with a lower risk of obesity. One study found that participants with dietary patterns characterized by higher intakes of fruit were 12 percent less likely to be obese than those with lower fruit intakes. (On the other hand, people who had a diet higher in sugary soft drinks and chocolate were about 9 percent more likely to be obese.) The researchers commented, “Natural sugars, such as in fruits, and added sugars, such as in sugar-sweetened drinks, are chemically similar, but research suggests they have opposite effects on our health. This is because the combination of other nutrients that make up the food (and your overall diet) is very important. Fruits should be encouraged as they are an important source of many beneficial nutrients, such as potassium and fiber.”

A Good Source of Antioxidants

Another reason to consume fruit that’s much touted in commercials—especially for juice products—is the miraculous-sounding power of antioxidants. But before you buy “super” beverages or supplements packed with antioxidants, realize that these nutrients are just another reason to eat an overall healthy diet. And it’s better to eat whole fruits with their fiber intact than to drink juices, especially juices with added sugars.

Antioxidants include such familiar nutrients as vitamins C and E, carotenoids such as beta-carotene, and the mineral selenium, as well as many different phytonutrients, notably polyphenols. Antioxidants neutralize substances called “free radicals,” some of which are natural byproducts of the body’s use of oxygen. Other sources of free radicals include cigarette smoke, pollution, radiation, and some pesticides and cleaning products. Antioxidants reduce the “oxidative stress” that is caused by an excess of free radicals and the associated damage to DNA believed to contribute to diseases.

Antioxidant Benefits. Some observational studies have reported that antioxidants might reduce the risk of cardiovascular disease and some cancers. Laboratory tests show that antioxidants may slow or possibly prevent cancer development, according to the National Cancer Institute.

Numerous studies suggest that eating fruit and other healthy foods rich in antioxidants is associated with health benefits. Higher dietary intake of vitamins C and E and selenium has been linked to a sharply lower risk of pancreatic cancer, for instance. A diet rich in antioxidants, especially from fruits and vegetables, has been associated with a reduced risk of stroke. And, in a 2018 study, women with higher antioxidant intake from foods such as fruits and vegetables were at lower risk of developing diabetes.

Don’t Count on Supplements. Researchers have learned that the benefits of antioxidants now seem to be more complex than simply fighting free radicals. That complexity may explain disappointing—or worse—results in tests of the same compounds in pill form. One controversial meta-analysis even reported that antioxidant supplements were associated with an increased mortality risk. A large trial of supplemental vitamin E and selenium was halted over concerns that the treatments were doing more harm than good. Smokers should avoid extra beta-carotene, which can increase lung cancer risk.

The most recent negative findings include a sweeping review of supplementation studies in the June 2018 Journal of the American College of Cardiology. No benefit in cardiovascular disease outcomes and all-cause mortality was seen for extra vitamin C, beta-carotene, or selenium, among other supplements.

The best advice seems to be to consume plenty of foods high in antioxidants, which may have more beneficial functions than fighting free radicals, and to skip the supplements. Oranges and other citrus fruits, strawberries, and kiwifruit are among the best sources of vitamin C. You can get plenty of beta-carotene and other carotenoids in orange-colored fruits such as cantaloupe, peaches, and apricots. Berries of all types, as well as grapes, are excellent sources of polyphenols. In general, eating fruit with the skin, in which polyphenols are most concentrated, is the best way to get the most antioxidants from fruits such as apples, pears, and plums.

Getting Enough Fruit

How much fruit should you consume? According to the USDA, women over age 50 should aim for one-and-a-half cups of fruits daily, and men over 50 should try for two cups. People who are physically active may need even more. In general, one cup of fruit, a half-cup of dried fruit, or an 8-ounce glass of 100-percent fruit juice counts as “one cup” of fruit; one small apple, a large orange or peach, a medium pear, or one large banana also is equivalent to “one cup.”

In Tufts’ MyPlate for Older Adults, fruits play a prominent role for several reasons. Fruits are sources of many essential nutrients, including potassium, dietary fiber, vitamin C, and folate, and they are rich in phytonutrients, the beneficial plant compounds discussed in the previous chapter. Fruits contain no cholesterol and minimal or no saturated fat or sodium, and they are low in calories. Two cups of apple slices, for example, contain about the same number of calories as five Hershey’s kisses.

Increasing Your Consumption

It’s easy to increase your intake of healthy fruits. Keep a bowl of whole fruit on the table or kitchen counter. Pre-cut packages of fruit, such as melon or pineapple chunks, make handy snacks. Dried fruits are easy to pack in lunches or for munching on the go.

As with vegetables, frozen fruit is at least as nutritious as fresh, since it’s picked at the peak of ripeness, and freezing locks in nutrients that otherwise deteriorate over time. If you buy canned fruits, make sure to choose those packed in water or 100-percent juice with no added sugar.

The USDA’s MyPlate offers these tips for including more fruits in your diet from breakfast to bedtime:

• At breakfast, top your cereal with fruit, add blueberries to pancakes, or mix fresh fruit with plain yogurt.
• Make a fruit smoothie for breakfast or a snack by blending fat-free or low-fat milk or yogurt with fresh or frozen fruit. Try bananas, peaches, strawberries, or other berries. (Note that, unlike “juicing,” puréeing fruits in a blender preserves the dietary fiber.)
• For lunch, pack fruits protected by peels (bananas, oranges, tangerines) for safe transport, or take containers of single-serving fruits (choose products that contain no added sugar).
• For fresh fruit salads, mix apples, melon, grapes, and berries with acidic fruits like grapefruit or pineapple, or add lemon juice to prevent browning.
• At dinner, add fresh or dried fruits to green salads. Try meat dishes that incorporate fruit, such as chicken with apricots or fish with mango salsa, or add chunks of pineapple or peaches to kabobs.
• For dessert, have baked apples, pears, or a fruit salad.

Fruit Favorites

In the rest of this chapter, we highlight the nutritional and health benefits of a variety of fruits. Of course, these are just examples—your supermarket’s produce section is packed with other good choices. For the best value and nutrient content, buy whatever fruit is in season.

Apples

This fruit is famously said to “keep the doctor away”—and apples actually are beneficial to your health. One meta-analysis concluded that eating one or more apples a day was linked with lower risks of many types of cancer compared to consuming less than one apple a day. Similarly, in a large U.S. population study, the number of servings of apples and pears eaten was correlated with a reduced risk for lung cancer.

Apples are high in phenolic acids and flavonoid compounds—phytonutrients that may protect against cell and DNA damage. In the laboratory, these compounds have been found to inhibit growth of cancer cells, decrease lipid oxidation, and lower cholesterol.

Experts recommend washing apples well so you can consume the peel as well as the flesh. Apple peels contain the majority of phytonutrients compared to the flesh, and peels add an extra boost of fiber. While storage doesn’t affect the levels of most phytonutrients, processing does. If whole fruit isn’t an option, cloudy, unsweetened apple cider has significantly higher amounts of phytonutrients than clear apple juice. (Don’t risk unpasteurized cider, however, which may harbor dangerous microorganisms.)

Select firm apples that are free of soft spots or bruises. Apples keep best in the crisper of a refrigerator with a damp cheesecloth added for moisture. Apples do lose some nutrients over months of storage, but they retain enough to remain a healthy choice.

Apples produce ethylene gas, which can cause other fruits and vegetables to become overripe, so keep apples separated from other produce whenever possible.

Blueberries

The MIND diet, mentioned in chapter 2, specifically advocates consuming more berries, and blueberries are among the most-studied for brain benefits. For example, researchers analyzed data on strawberry and blueberry consumption among 16,010 women over age 70 and found that women with the highest intake of berries experienced slower mental decline than women who ate the fewest berries.

Polyphenol compounds in blueberries also may help normalize blood pressure, according one study of postmenopausal women with early-stage hypertension. Women who consumed freeze-dried blueberry powder—equivalent to eating a cup of berries a day—averaged 7 mmHg lower systolic blood pressure (the top number in a blood-pressure reading) than a control group after eight weeks.

Other clinical trials are testing blueberries’ possible benefits for vision, gout protection, arterial function, blood sugar, and more. Research has suggested that blueberries may have a positive effect on cardiovascular health by improving cholesterol levels.

Blueberries are rich in anthocyanins, the phytonutrients that give them their distinctive color, as well as quercetin, kaempferol, ellagic acid, and resveratrol, and they provide vitamins C and K, manganese, and dietary fiber.

Choose firm, uniformly colored berries, and don’t be concerned if you see a whitish bloom on the berries—that’s a natural coating that protects their skins. Keep fresh berries in a covered container in the refrigerator, and don’t wash them until just before eating them.

Frozen is fine for blueberries: Research has shown that frozen blueberries retain most of their anthocyanin content. Cooking at temperatures above 350 degrees Fahrenheit damages these polyphenols, however, so keep that in mind if you add blueberries to muffin, pancake, or quick-bread batters.

Cranberries

Don’t limit your cranberry consumption to Thanksgiving. The polyphenol compounds in cranberries include high levels of anthocyanins, which contribute to the berries’ bright red color. Processing, such as in making cranberry juice, does cause some loss of these and other phytochemicals. High heat also can damage compounds in cranberries.

In terms of health benefits, cranberries are probably best known for their effects against urinary tract infections (UTIs). Several studies and two meta-analyses have supported the effectiveness of this long-standing folk remedy, but other studies have failed to find a link between cranberry intake and reduced UTI recurrence.

Another promising, if lesser-known, area of research into cranberries’ possible health benefits relates to cardiovascular health. Studies have shown cranberries might protect the heart and blood vessels by improving cholesterol, combating oxidative stress, decreasing inflammation and inflammatory compounds, and reducing arterial stiffness. Cranberries also seem to improve the function of the lining of blood vessels and increasing levels of nitric oxide, which dilates blood vessels.

Grapes

Botanically, grapes are in the berry family, and they are rich in anthocyanins (especially red and purple grapes), much like similarly-colored berries, so scientists have theorized that grapes and grape juice may have brain benefits similar to those associated with berries. Some research suggests that grapes and berries may have beneficial effects on the ways that neurons in the brain communicate. By boosting the brain’s signaling functions, the anthocyanins and other phytochemicals in these fruits may prevent damaging inflammation in the brain and have a protective effect on cognition and motor control. Tufts researchers have previously reported that Concord grape juice reversed brain aging in rats.

Other studies have linked health benefits with moderate consumption of red wine, but if you’d rather not tipple, you can probably get similar health advantages from plain grape juice. Red grape juice (made from red and/or purple grapes) contains the same phytonutrients as red wine, which help improve blood vessel health and protect against high blood pressure.

Grapes contain resveratrol, a compound that has been associated with boosting memory and preventing platelets from clumping together. As with all fruit juices, though, be wary of the high sugar content in grape juice. Although fruits contain natural sugar, fruit juices lack the fiber found in whole fruits that helps slow the rate at which glucose (sugar) enters your bloodstream.

Guava

We’ve included this less-familiar fruit because it’s a nutritional powerhouse. Guavas are the fruits of an evergreen shrub or small tree. Guavas grown in Florida are at their peak from August through October and in February and March.

One cup of guava pieces provides more than six times the daily value of vitamin C, with the highest concentrations found in the flesh just under the rind. Guava is also the tropical fruit with the highest potassium content, with nearly 20 percent of the daily value per cup—more than is found in a comparable amount of the famously potassium-rich banana. Potassium can help control blood pressure and regulate your heart rate, and consuming more potassium has been linked with a lower stroke risk.

The pink color of guavas is a clue that they are one of the few fruits high in lycopene, an antioxidant carotenoid that also gives tomatoes their red color. By weight, guavas contain nearly twice the lycopene of tomatoes. Lycopene has been associated with lower stroke risk, reduced markers of inflammation, and improved cholesterol and triglyceride levels, and may help protect against prostate cancer.

Kiwifruit

Like the people of New Zealand, known as “kiwis,” the kiwifruit is named for the flightless bird native to that country. Originally grown in China and known as “Chinese gooseberries,” this fruit came to New Zealand with missionaries in the early 20th century and was renamed upon introduction to the U.S. in the 1960s. Kiwifruit from New Zealand can be found on supermarket shelves from June through October; fruit from California is available from November through May.

The bright green flesh, speckled with tiny black seeds, contains more vitamin C per cup than an orange. Kiwifruit has been studied for its antioxidant properties, which research has indicated may help ease asthma symptoms such as wheezing and shortness of breath in children. In one study, volunteers who ate two or three kiwifruit a day for four weeks showed an 18 percent improvement in platelet aggregation response, an indicator of a reduced risk for blood clots, and a 15 percent reduction in triglyceride levels.

Consume kiwifruit soon after cutting and add to fruit salads just before serving, as enzymes released by slicing cause it and nearby fruits to soften. Kiwifruit contain oxalate, a substance that can combine with calcium and produce kidney stones or gallstones. If you’ve had either of these stones, ask your doctor what type they were; if they were calcium oxalate stones, limiting your intake of oxalate may help prevent more stones from forming.

Mangos

Mangos are among the world’s most widely consumed fruits, and they are available year-round due to the many varieties that are grown. The golden-yellow flesh reveals that mangos are high in beta-carotene, which is a precursor to vitamin A. Diets high in beta-carotene have been associated with a lower risk of certain cancers. Mangos also are a source of zeaxanthin, a carotenoid compound associated with eye health.

Unripe mangos will continue to ripen on the counter; lightly squeeze the fruits to test ripeness rather than relying on color. To serve, slice close and parallel to the seed on either side to make two halves. With the skin side down, cut a checkerboard pattern in the flesh of each half, and then run a spoon or knife between the flesh and the skin to pop off the pieces.

Some people have an allergy to a chemical compound called urushiol that is found in the skins of mangos, so make sure no skin remains on the flesh. As an added precaution, rinse the mango flesh before eating it, and wash your hands thoroughly after handling a mango and/or wear gloves when peeling it. (Incidentally, urushiol is the compound in poison ivy and poison oak that causes allergic reactions; if you’re allergic to these plants, you may be more likely to be allergic to mangos.)

Oranges

Practically synonymous with vitamin C, oranges deliver about 130 percent of the recommended daily value per fruit. Vitamin C is vital for the body’s production of collagen, a key connective protein found in bones, teeth, and cartilage. Vitamin C is also an antioxidant that may prevent cell damage. One orange also provides 12.5 percent of the recommended daily value of dietary fiber—most of which is lost if the orange is squeezed into juice.

But it’s not all about the vitamin C. Oranges contain a wealth of other, lesser-known phytonutrients, including:

• Beta-cryptoxanthin, a carotenoid that helps give oranges their distinctive color, has been associated with a reduced risk of lung cancer.
• Limonoids, which have been studied for cholesterol-lowering benefits and anticancer properties.
• Polymethoxylated flavones, found in the orange’s peel, which significantly lower unhealthy cholesterol levels in laboratory animals.
• Zeaxanthin, which may help reduce your risk of rheumatoid arthritis (RA).

Buy oranges with smoothly textured skin that are firm and heavy for their size, which indicates a higher juice content. Smaller fruit with thinner skins are typically juicier. Fully ripened oranges are highest in nutrients, including carotenoids and flavonoids. Don’t worry about non-uniform peel color (perfect-looking oranges may get that way from Citrus Red #2 dye), but do avoid mold or soft spots.

Store oranges loose rather than in a plastic bag. Oranges last about two weeks with little loss of nutrients whether they are kept in the refrigerator or at room temperature.

Papaya

Native to Central America but now grown throughout the tropics, papayas are at their peak from early summer into fall. Most supermarket papayas come from Hawaii, but you also may see the much larger, less intensely flavored Mexican variety. Partially ripe fruit will continue to ripen on the counter (you can speed the process by placing near an apple or a banana); ripe papayas will keep a day or two in the refrigerator.

Almost as rich in vitamin A as mangos, papayas also are a source of lycopene. One study found that men who drank green tea and also consumed tropical fruits, including papayas and guavas, were at lower risk of prostate cancer.

Papayas contain an enzyme called papain that helps digest proteins and can be used to tenderize meat; papain also may have anti-inflammatory effects. Concentrations are highest in green papayas.

Peaches

Peaches are one of the many fruits with a high water content, which translates into a modest calorie count—there are only 39 calories in a medium-sized peach. But peaches still pack plenty of nutrients: One medium peach contains two grams of fiber—mostly in the form of soluble fiber, shown to improve cholesterol levels. Eating a peach gives you more than 10 percent of your recommended daily intake of vitamins A and C, plus modest amounts of B vitamins, vitamin E, vitamin K, potassium, and minerals. Antioxidant phytonutrients in peaches include lutein, zeaxanthin, and beta-cryptoxanthin.

Peaches have not been studied as extensively as have some other fruits. However, lab tests have shown that polyphenol compounds in peaches (as well as plums) selectively killed breast-cancer cells, leaving healthy cells unharmed. Other researchers have found that peach extracts slowed the growth of aggressive breast-cancer cells in mice.

Shop for peaches that are richly colored, and free from blemishes or bruises. Ripe fruits yield to gentle pressure with the whole hand and have a sweet smell. Unlike some fruits, peaches will continue to ripen after picking; keep underripe peaches at room temperature and store them in a paper bag to hasten ripening. Ripe peaches can be stored in the refrigerator but are best brought to room temperature before eating to maximize their flavor. Wash peaches in cold water just before using. You’ll obtain the most nutrients by eating the whole peach, including the skin.

Strawberries

Strawberries are packed with healthy phytonutrients as well as essential vitamins and minerals, and they’re the world’s most popular berry variety. Studies have linked strawberry anthocyanins to improved blood vessel function and lower blood pressure. The phytonutrients in strawberries also may reduce levels of C-­reactive protein (CRP), a marker of inflammation that’s associated with several chronic health conditions, including cardiovascular disease.

Surprisingly, one cup of strawberries (about eight whole berries) contains more vitamin C than a medium orange—about 140 percent of the recommended daily value. A cup of strawberries also delivers more than a quarter of your daily manganese, an essential nutrient that must be obtained from your diet. Manganese helps your body process cholesterol, carbohydrates, and protein, and it plays an important role in bone formation.

Strawberries have a very short shelf life; their nutritional content drops sharply after just a few days, and they deteriorate rapidly. Buy medium-sized, fully ripe fruit; underripe strawberries aren’t as nutritious and won’t ripen further after picking. Store unwashed, unhulled strawberries in a cold, humid part of the refrigerator, preferably in a sealed container, and wash them thoroughly before eating.

If your meal plans change and you’re not going to eat the strawberries within a few days of buying them, wash them thoroughly, cut in halves or quarters, place them in a tightly sealed plastic bag, and store them in the freezer.

It’s fine to eat whichever fruits are your favorites, and all of the examples listed here are nutrient-rich choices. Remember, though, that the greater variety of fruits (and other foods) you eat, the wider diversity of nutrients you get. Other healthy fruits include bananas, cherries, grapefruit, melons, blackberries, plums, apricots,
and pineapple.

The post 5. The Power of Fruit appeared first on University Health News.

Dairy Benefits

Research has linked dairy consumption with many health benefits. Consumption of dairy products is linked to improved bone health and may reduce the risk of osteoporosis. Research continues to show that dietary sources of calcium are the most effective and safest way to obtain this mineral that is essential to bone health.

Consuming dairy products also is associated with a reduced risk of cardiovascular disease and type 2 diabetes, and with lower blood pressure in adults.

Low-fat dairy consumption has been linked to a reduced risk of frailty—defined as exhaustion, weakness, low physical activity, slow walking speed, and unintentional weight loss. In one study, participants age 60 and older who consumed seven or more servings per week of low-fat milk and yogurt had a 48 percent lower incidence of frailty than those who consumed less than one serving per week. Consuming whole milk or full-fat yogurt or cheese, however, was not linked to lower frailty risk.

Consuming milk, primarily fat-free or low-fat milk, also has been associated with reduced progression of osteoarthritis. Again, no benefit was seen for other dairy products, and cheese consumption was linked to increased arthritis progression.

Changing Tastes

Despite these benefits and the efforts of dairy marketers, Americans’ consumption of milk has declined. According to a U.S. Department of Agriculture (USDA)report, however, dairy consumption has dropped 40 percent since 1970, and each younger generation is consuming less milk than the one before. Non-dairy beverages made from soy, rice, almonds, coconuts, and cashews have made significant gains in the market share. At the same time, the popularity of yogurt, especially Greek yogurt, has boomed.

The 2015-2020 Dietary Guidelines for Americans made reference to these changing tastes and trends, advising, “Healthy eating patterns include fat-free and low-fat (1%) dairy, including milk, yogurt, cheese, or fortified soy beverages (commonly known as ‘soymilk’).” The guidelines recommend that adult men and women of any age should aim for three cups of dairy or the equivalent per day. Here are some strategies to help you get those three cups:

• Use fat-free or low-fat milk instead of water to make oatmeal and hot cereals.
• Make smoothies by combining yogurt with fruit and ice in a blender.
• Include fat-free or low-fat milk or calcium-fortified milk alternatives as a beverage at meals.
• Use yogurt as the base for dips for fruits or vegetables.
• For dessert, make pudding with fat-free or low-fat milk, or top cut-up fruit with yogurt.

To minimize your risk of food-borne illness, avoid raw (unpasteurized) milk or any products made from raw milk.

Possible Downsides to Dairy

Not everything in milk and other dairy foods is necessarily good for you, however. Whole milk and products made from whole milk, including butter, cream, cheeses, and yogurts, are contributors to dietary saturated fat. That’s why the USDA’s MyPlate advises, “Choose fat-free or low-fat milk, yogurt, and cheese. If you choose milk or yogurt that is not fat-free, or cheese that is not low-fat, the fat in the product counts against your limit for calories from saturated fats.”

But these recommendations are controversial, as some research has challenged the choice of reduced-fat dairy products. One study, for example, followed the development of type 2 diabetes among more than 3,000 adults over two decades. Those with the highest initial level of dairy fat in their bloodstream actually had about a 50 percent lower risk of diabetes than those with the lowest amounts.

Another surprising study reported that middle-aged men who consumed high-fat milk, butter, and cream were significantly less likely to become obese over a period of 12 years than their peers who avoided whole-milk dairy products. A meta-analysis of 16 observational studies similarly associated whole-fat dairy intake with a lower risk of obesity.

One possible explanation for these counterintuitive results is that the fat in dairy products makes you feel “full” and less likely to eat other, less-healthy foods such as starchy, salty snacks. Dariush Mozaffarian, MD, DrPH, dean of Tufts’ Friedman School and a co-author of the dairy and diabetes study, says there’s evidence that “when people consume more low-fat dairy, they eat more carbohydrates” as a way of compensating.

As the science sorts itself out, Dr. Mozaffarian says, advice “should be neutral about dairy fat, until we learn more.”

Calories and Added Sugar Cautions

It is true that reduced-fat dairy products contain fewer calories than full-fat versions of the same products, simply because fat is a concentrated source of calories. One cup of skim milk has only 83 calories, compared to 149 calories in one cup of whole milk. Fortunately, when the fat is removed from milk, the nutrients remain intact; skim, 1%, and 2% milk all have as much calcium and protein as whole milk. Also make sure your dairy choices have been fortified with vitamin D—not all yogurts, for example, are good sources of vitamin D.

Some yogurt products also contain high amounts of added sugars, making them nutritionally more like a dessert than a healthy choice. Check the Nutrition Facts panel: A 6-ounce container of plain, low-fat yogurt contains about 12 grams of natural sugars (from the lactose in milk), and the same serving size of plain, low-fat Greek yogurt contains about 6 grams. Numbers much higher than those indicate added sweeteners, which you can identify by checking the ingredients list.

Easy on the Cheese

Even as Americans have been drinking less milk, we’ve been eating more cheese than ever before. Recent USDA reports put U.S. cheese consumption at the highest levels since the agency began tracking it in 1975. Americans eat cheese on burgers, pizza, and sandwiches, in dips and sauces, and with crackers as snacks.

Cheese is a good source of protein (6 to 8 grams per serving in most varieties) and calcium (most varieties provide between 200 and 450 milligrams per serving). However, one serving of most varieties of regular, full-fat cheese contains 7 or 8 grams of saturated fat: That’s about 50 percent of your total recommended daily saturated fat—just 16 grams for a 2,000-calorie-per-day diet, according to the American Heart Association.

If you eat cheese often, keep your portion sizes in check and opt for reduced- or low-fat cheeses, which contain 25 to 70 percent less saturated fat than full-fat versions. Cheese also may make it harder to keep your sodium intake under control; for example, one ounce of cheddar cheese contains about 175 milligrams of sodium.

Healthy News on Yogurt

We’ve already mentioned yogurt, which is a prime example of good-for-you dairy. Tufts researchers have found that eating yogurt—even just a couple of times a week—might substantially reduce your risk of developing high blood pressure. People who consumed at least 2 percent of their daily calories from yogurt were 31 percent less likely to develop hypertension over a 14-year period than people who consumed less yogurt. (In a 2,000-calorie daily diet, you’d need to eat only two cups of plain yogurt per week to add up to 2 percent of total calories.)

Other studies have reported that yogurt eaters have lower levels of circulating triglycerides and blood glucose. People who consume more than three servings of yogurt per week appear to be better able to manage their weight. Yogurt also has been linked with better bone health: One study found that eating more than four servings of yogurt a week was associated with higher bone mineral density and fewer hip fractures.

Yogurt is a nutrient-dense food, which may be why yogurt eaters are less likely to be deficient in vitamins B₂ and B₁₂, calcium, magnesium, and zinc. The acidity of yogurt also makes it easier for the body to absorb some nutrients, including calcium, zinc, and magnesium. And depending on what type of yogurt you choose, a 6-ounce portion provides between 8 and 17 grams of protein (Greek yogurt is highest).

Good-for-You Bacteria

Yogurt is simply milk that has been fermented using cultures of “friendly” bacteria. This makes yogurt a “probiotic”—a fermented food containing healthful bacteria that promote the growth of similarly good-for-you bacteria in the body, especially in the gastrointestinal tract. For a refrigerated product to be labeled as yogurt under U.S. Food and Drug Administration (FDA) regulations, it must be cultured using two strains of bacteria, Lactobacillus bulgaricus and Streptococcus thermophilus, although other bacteria may be included. (This criterion does not apply to frozen yogurt or “yogurt products,” such as candies or dips.) Although all yogurts begin with live bacteria, they don’t all end with them: Some manufacturers heat-treat their yogurt after fermentation to prolong shelf life or alter the taste, which kills the beneficial bacteria.

To make sure you’re getting yogurt’s probiotic benefits, look for the “Live & Active Cultures” seal from the National Yogurt Association, which identifies products that meet a certain threshold of the two primary yogurt bacteria. Even if your yogurt’s label doesn’t have this logo, it may contain live cultures; check the ingredients for names of bacteria (for example, Bifidobacterium lactis, Lactobacillus casei, and Lactobacillus acidophilus), or look for a blurb on the label that mentions live and/or active cultures.

As a probiotic, yogurt may affect the community of more than a trillion microbes called the “microbiome” or “microbiota” that inhabit your intestines. Mounting evidence suggests that the bacteria in your gut affect far more than your intestinal health. The composition of the microbiota is believed to play a role in immune response, susceptibility to certain cancers or infectious diseases, and perhaps even allergies, obesity, and diabetes.

Some studies suggest that consuming yogurt with live bacteria supports digestive health and may ease symptoms of irritable bowel syndrome, as well as helping treat and prevent conditions associated with antibiotic use, such as diarrhea and yeast infections. Another bonus is that the bacteria in yogurt break down the sugars (lactose) in the milk, making yogurt a food that can be more easily digested by those with lactose intolerance.

Greek and Icelandic Options

In 2008, the thicker style of yogurt called “Greek” yogurt accounted for only 4 percent of U.S. yogurt sales; today, that market share is above 50 percent. Despite the name, Greek yogurt usually isn’t imported; the thicker style is simply what is most common in many Mediterranean countries. Greek yogurt starts out the same as regular yogurt, by adding bacteria to milk. To make it “Greek,” the yogurt is then strained to remove much of the liquid whey, leaving behind a thicker product.

The FDA does not regulate the term “Greek yogurt,” so check ingredients carefully to make sure you’re buying the real thing. Some so-called “Greek” yogurt is actually regular yogurt that’s thickened with pectin, corn starch, and/or gelatin, rather than being strained.

The extra straining alters Greek yogurt’s nutritional profile in some ways. Since it’s more concentrated, Greek yogurt has more protein and saturated fat per ounce, but fewer carbohydrates and sugars, since some of these are removed with the whey. Some calcium is lost along with the whey, too. Amounts vary—check the Nutrition Facts label—but a typical plain, nonfat yogurt supplies about 300 milligrams of calcium, versus only 150 milligrams for plain, nonfat Greek yogurt.

Like other yogurt, Greek yogurt is made from milk that has not been fortified with vitamin D, so it’s not automatically a source of this vitamin. Some brands, however, add vitamin D to all of their yogurt products.

Greek yogurt isn’t just for snacking and spooning. Its thicker, creamy texture makes it a perfect substitute for mayonnaise, cream, or sour cream. Its acidic quality means it can stand in for buttermilk, and it works well in dips, as well as boosting the degree of leavening (how much the dough rises) in quick-bread or muffin recipes.

You also may see Icelandic-style yogurt in your supermarket’s dairy section. Technically, this is an Icelandic cheese called “skyr,” made from skim milk and bacterial cultures and then strained. Its nutritional properties are almost identical to Greek yogurt, meaning it’s a good source of protein and calcium. Skyr is made with different bacterial cultures than Greek yogurts, and it is even thicker and tastes a little sweeter than Greek yogurt.

There are also Australian-style yogurts that are sweetened with honey and flavored with fruit (except for the plain varieties). This style of yogurt reportedly is based on yogurt made in Australia (although two companies that make it are in Colorado and California); it is not strained but thickened in other ways, and it is said to be creamier than Greek yogurt.

Plant-Based Milk Alternatives

The market for plant-based alternatives to dairy products continues to grow as lactose intolerance, dairy allergy, veganism, environmental concerns, and other factors lead Americans to look for alternatives to dairy. Where do these beverages fit into a healthy dietary pattern?

To understand the nutrient profiles of plant-based beverages, it helps to know how they are made. The raw materials (nuts, grains, legumes, or seeds) are soaked in water and ground (or ground and then soaked). The resulting slurry is strained to remove solids, and then flavorings, sweeteners, thickening agents (such as locust bean gum, carrageenan, or xanthan gum), stabilizers, and desired nutrients such as calcium can be added. The products then undergo heat treatment that kills any microorganisms.

The nutritional properties of these beverages depend on the plant source, processing, and fortification. A plant source like hemp, for example, may provide omega-3 and omega-6 fatty acids, and soymilk may contain soy isoflavones, which have been purported to be associated with a range of health benefits. Most milk substitutes are fortified with calcium and vitamins (such as vitamins A and D) to make them more similar to cow’s milk.

Nutritional Trade-Offs

If milk substitutes are being used to replace cow’s milk in the diet, it’s important to be aware that they are not nutritionally equivalent. Only soy has a protein level approaching that of dairy, for example, with 7 grams of protein per one-cup serving, just slightly less than whole milk’s 7.7 grams per one-cup serving. However, not all non-dairy choices are equally high in protein. Dairy also has more phosphorus, potassium, and vitamin B₁₂.

You should also be aware that drinking almond milk is not equivalent to eating almonds, for example. While whole plant foods are rich in beneficial compounds such as micronutrients and fiber, many of these (particularly fiber) are lost when they are processed into drinks.

When choosing plant-based beverages, be aware that some contain significant amounts of added sweeteners. Calories vary among plant-based milks, with sweetened, flavored varieties significantly higher, so check the Nutrition Facts label.

If you have food allergies, choose your plant-based beverages carefully: Many people who are allergic to dairy protein also are allergic to soy, and people with nut allergies should avoid nut-based beverages. Also, high levels of inorganic arsenic have been found in many rice crops, and one study found levels of this contaminant above the standard limits for drinking water in all 19 rice milks tested.

On the plus side, if you’re concerned about saturated fat and don’t like skim, 1%, or 2% milk, plant alternatives might be worth a try. Some varieties of plain, unsweetened plant milks contain only 30 calories per cup. The most popular alternative, soymilk, has only 0.5 grams of saturated fat per cup.

Close-up on Soymilk

As the best-selling dairy alternative, soymilk—a milky liquid produced from pressing ground, cooked soybeans—has been most thoroughly scrutinized for its health pros and cons. The most common concern about soymilk centers around phytonutrients called isoflavones that are found in soybeans.

Isoflavones are a form of plant estrogens. Although they are not identical to the estrogen hormone produced in human bodies, at one time, consuming plant estrogens was linked with the possibility of a higher cancer risk. However, recent research has largely dispelled these concerns. The American Cancer Society advises, “Moderate consumption of soy foods appears safe for both breast cancer survivors and the general population, and may even lower breast cancer risk.”

Moreover, soy protein may have a protective effect against heart disease, and studies have linked it to lower LDL (“bad”) and higher HDL (“good”) cholesterol levels.

On the other hand, soymilk is much higher than cow’s milk in phytic acid, which may reduce absorption of some minerals. Patients taking medication such as levothyroxine (Synthroid) for an underactive thyroid (hypothyroidism) should be aware that soy protein may inhibit the absorption of these drugs. If you take any medication, let your doctor or pharmacist know if you’re making the switch to soy so they can check for potential interactions.

Almond Milk: A Nutty Alternative

Another popular alternative milk comes from almonds. Almond milk is low in saturated fat but contains heart-healthy mono- and polyunsaturated fats, much like the nuts from which it is made. When fortified, almond milk contains roughly as much vitamin D and vitamin A as dairy milk, and, typically, about two-thirds the amount of calcium; it has no vitamin B₁₂, however, and less phosphorus and potassium than dairy.

Almond milk is the lowest of the popular dairy-milk alternatives in saturated fat, at just 0.2 grams per cup. Almond milk is lower than soymilk in phytic acid, so you don’t need to worry about reduced absorption of minerals. Almond milk also has none of the phytoestrogen concerns associated with soymilk.

Almond milk is high in vitamin E, but it’s low in protein: One cup of almond milk contains just 1.3 grams of protein, compared to almost 8 grams in the same amount of dairy milk.

Other Options

You’ll also find alternative “milks” made from cashews, rice, coconut, and even hemp. Among the latest entrants in the plant-milk craze is macadamia milk; it’s richer and creamier because more of its calories come from fat (mostly unsaturated fat), but it provides no protein.

These beverages are all too new to have been extensively studied for possible health benefits, so check the Nutrition Facts label to see how they stack up against your current choices. Cashew milk, for example, which is made much like almond milk (and is sometimes combined with almond milk), contains only 25 calories in unsweetened form, no saturated fat, very little protein, and about 45 percent of your daily calcium. Cashew milk delivers even more vitamin E than almond milk.

Coconut milk in particular has been growing in popularity as part of the whole coconut health craze. Extracted from the grated flesh of ripe coconuts, canned coconut milk is popular in Asian and Caribbean cuisines; however, it is extremely high in saturated fat and calories. The thinned-down type of coconut milk sold in cartons in the dairy case is more similar to other milk alternatives, though it’s still higher in saturated fat. Coconut milk contains less protein and calcium than almond, soy, cashew, or cow’s milk but provides a creamy texture and light flavor.

If you like to drink cow’s milk and prefer to pour it on your cereal, there’s no health or nutrition reason to switch to any of these plant-based alternatives. Sticking with what you grew up with, in this case, is perfectly fine for healthy aging.

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For one thing, older adults are more likely to be falling short on protein intake. “Although the RDA for protein is substantively the same for all adults, older adults tend to consume less protein than younger adults, primarily due to reduced energy needs,” according to Paul F. Jacques, DSc, director of Tufts’ HNRCA Nutritional Epidemiology Program. “Approximately one-third of adults over 50 years of age fail to meet the RDA for protein, and an estimated 10 percent of older women fail to meet even the lower Estimated Average Requirement for protein.”

Your Protein Needs

The recommended dietary allowance (RDA) for protein is 46 grams for women and 56 grams for men, while the Daily Value percentage (% DV) used on nutrition labels is based on 50 grams. That’s about as much protein as found in seven ounces of salmon or ground beef, one 6-ounce skinless chicken breast, or three cups of black beans.

However, experts say those general numbers should be adjusted according to a person’s body weight. Most adults should aim for about 0.36 grams of protein per pound, so a person weighing 150 pounds needs about 54 grams of daily protein, while a 120-pound person requires 43 grams, and a 180-pound person needs 65 grams. Endurance runners and strength-training athletes need more—up to 0.8 grams per pound.

Many experts have argued that older adults should aim for more: 0.45 grams to 0.68 grams of protein per pound of body weight. For a 150-pound person, that translates to between 67.5 and 102 grams of protein daily—substantially more than the 50 grams used to calculate the % DV used in the Nutrition Facts panel.

Timing Matters

Even as scientists continue to study older adults’ protein needs, evidence is mounting that the timing of that protein consumption may be important. A more even intake of protein throughout the day, rather than concentrating consumption at dinner, may provide maximum benefit.

One study found that spreading protein intake evenly throughout the day was associated with greater muscle mass and strength in 1,741 healthy adults, ages 67 to 84. Scientists commented, “Including one or more protein-rich foods at every meal is a simple way to stimulate your muscle-protein-building machinery, but it doesn’t require a big portion—three to four ounces of fish or chicken breast, for example, is adequate. Breakfast is usually the meal that contains the least protein, so think about including at least one protein-rich food, such as dairy products, eggs, tofu, or quinoa.”

Those findings echo an earlier clinical trial, in which eating extra protein at breakfast and lunch improved lean tissue mass in healthy older adults. Scientists randomly assigned participants, ages 55 to 66, to receive either protein supplements or a control compound at breakfast and lunch; the extra protein was split evenly between the two meals. Initially, most participants were consuming the majority of protein at dinner; adding the extra breakfast and lunch protein achieved a balance of about 30 percent of total protein intake at each meal. After 24 weeks, the participants who consumed roughly equal portions of protein throughout the day increased lean tissue mass by a significant amount—almost a pound on average—while those in the control group lost an average of more than a third of a pound.

According to Dr. Jacques, “Meeting a protein threshold of approximately 25 to 30 grams per meal represents a promising yet relatively unexplored dietary strategy to help maintain muscle mass and function in older adults.”

Smart snacking also can add protein at times other than dinner. One study found that older adults who snack consume about 6 grams more protein daily than their non-snacking peers. An ounce of mixed nuts—about a handful—is a good snacking choice that provides 4.4 grams of protein. Another protein-rich option is a smoothie made with low-fat or nonfat yogurt.

Fending Off Frailty

An important reason why older adults in particular need to pay extra attention to protein is the role that protein plays in lean muscle mass. Sarcopenia, the gradual loss of lean muscle mass that can occur with aging, affects 15 percent of people older than age 65 and 50 percent of people older than age 80.

“Low muscle mass is a cause of poor muscle strength,” says Martha Savaria Morris, PhD, a scientist in Tufts’ HNRCA Nutritional Epidemiology Program. “One risk of having weak muscles is the inability to carry out activities of daily living and, consequently, a lack of independence. Another risk is falls, which often result in serious injury among older adults.”

Research has shown that older adults who consume the most protein, including protein from animal as well as plant sources, are more likely to have the greatest muscle mass and strength. One study found that participants who scored highest in muscle mass and strength averaged substantially more than the RDA for protein: 93.4 grams daily for women and 101.1 grams for men.

The take-home message: Make sure you get enough protein from high-quality sources—perhaps even a bit more than recommended for your size—but don’t go overboard. When you do consume protein, spread it out during the day rather than concentrating it at dinnertime.

Choosing Protein Sources

It’s important to be selective when choosing sources of protein, because many less-healthy ingredients and nutrients often ride along with Americans’ favorite protein foods. For example, topping your burger with bacon and cheese or digging into a slab of prime rib or other fatty meat will add a heaping helping of saturated fat. The Mediterranean-style diet offers a useful model of healthy protein sources; it includes more protein from fish and plant proteins and less from red meat. We’ll look at these healthy protein powerhouses in the next chapter.

In any case, every gram of protein contains four calories, so if you incorporate more protein into your diet, be careful to avoid calorie overload. Rather than simply adding more protein to your regular diet, substitute lower-calorie foods containing protein for less healthy food choices, such as refined carbohydrates, fried foods, or sugary desserts.

On the plus side, some protein sources contribute other desirable nutrients as a bonus. For example, salmon and some other fish provide omega-3 fatty acids that may benefit your heart and brain as you age. Beans, peas, lentils, nuts, and seeds deliver dietary fiber as well as protein. We’ll take a closer look at seafood and plant sources of protein in the next chapter.

Causes for Caution

Another reason not to overdo your protein intake, despite the marketing and fad-diet hype, is concern that too much might contribute to certain medical conditions. A 2018 study concluded that middle-aged men who ate higher amounts of protein-rich meats and dairy foods had a slightly higher risk of heart failure than those who ate less protein. Protein from fish and eggs was not associated with heart failure, however.

The association between high protein intake and heart failure found in this study was small—but this study serves as a reminder that dietary intake in excess of recommendations can have unintended consequences.

If you have certain medical conditions, you may be advised to limit your protein intake. For example, people with chronic kidney disease should avoid high-protein diets, which may further damage kidney function. Diets high in protein may increase the risk of kidney stones, even in those with otherwise healthy kidneys.

And patients with gout should consult their physicians about protein intake. Many protein sources, including red meat, poultry, and fish, contain purines, which the body breaks down to form uric acid, the cause of the painful swelling in gout.

Protein from Red Meat

Red meat is a prime source of protein in the U.S. diet, but health concerns have Americans loving it a little less lately. A study by the Natural Resources Defense Council reported that Americans reduced their intake of beef by nearly one-fifth between 2005 and 2014. Pork consumption also fell, though not as drastically.

Beef and pork, along with veal, lamb, and goat meat, are considered “red” meat because they contain more of a protein called myoglobin. Found in the muscle tissue of almost all mammals, myoglobin binds iron and oxygen. According to the USDA definition, all meats obtained from mammals are considered red meat, as opposed to “white” meat obtained from fish and poultry.

Red Meat Risks

Red meat, it’s true, is a concentrated source of protein and other healthy nutrients. A 3.5-ounce portion of 90%-lean ground beef delivers 20 grams of protein, along with significant amounts of niacin, vitamin B₁₂, iron, zinc, and selenium. However, that portion of beef contains 10 grams of saturated fat, which is more than half the total recommended daily limit. Beef cuts with a higher fat content, including many varieties of steak, push the calorie and saturated fat numbers even higher—as do the larger portion sizes typically found in restaurants. For example, a 12-ounce ribeye steak tips the scales at more than 800 calories and more than 20 grams of saturated fat.

We’ve already seen why it’s important to limit intakes of processed red meats, such as bacon, ham, salami, and sausage: Studies have consistently linked consumption of processed red meats to increased risks of mortality, cardiovascular disease, and cancer. Findings for unprocessed red meat have been less conclusive. Nonetheless, an expert panel of 22 scientists from the World Health Organization’s International Agency for Research on Cancer concluded that red meat probably contributes to colon, prostate, and pancreatic cancer risk.

However, even the association between red meat consumption and cancer risk may be complex. It is possible, for example, that high-temperature cooking of red meat, which forms possible carcinogens such as heterocyclic amines, polycyclic aromatic hydrocarbons, and advanced glycation end-products, may be responsible for increased cancer risk, rather than the meat itself. So, your slow-cooked brisket or pork shoulder may be safer than those steaks or chops sizzling on the grill.

Expert Advice

Most nutrition experts suggest eating less red meat. The Dietary Guidelines Advisory Committee, a group of nutrition experts tasked with assisting in the update of those guidelines, recommended that a healthy dietary pattern should be “lower in red and processed meats.” While no longer emphasizing limiting total fat consumption, the expert panel did focus on limiting foods high in saturated fat—including many cuts of red meat. Their report also noted that a diet that emphasizes more plant foods and less meat is “more health promoting and is associated with less environmental impact.”

The resulting 2015-2020 Dietary Guidelines for Americans (DGA) similarly recommends eating a variety of protein foods, including lean meats along with seafood, poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products. But Dariush Mozaffarian, MD, DrPH, dean of Tufts’ Friedman School, notes that this recommendation was watered down from the original expert panel’s “strong, explicit recommendations that Americans should eat less of two major food groups: red and processed meats, and refined grains. The harms of these foods, and the need to reduce them, was a major focus. Notably, the scientific panel only advised sensible reductions—not elimination—of meats and refined grains; they did not say that all Americans should become vegans, or eat only quinoa. Yet, the final DGA ignores (for meats) or hides (for refined grains) this strong, sound advice.”

A review of the scientific evidence authored by Dr. Mozaffarian identified dietary priorities for cardiovascular and metabolic health. He concluded that individuals should limit their consumption of processed meat to no more than one serving per week and have no more than one to two servings of unprocessed red meats per week. Keep in mind that one serving is generally 3.5 ounces of meat—not the platefuls of ribs or double-patty burgers so many Americans commonly consume.

To sum up, eat small servings of red meat once or twice a week (if you enjoy it) and have processed meat only occasionally. When you do cook meat, avoid charring and high-heat cooking. Low, slow, moist braises—which are perfect for more affordable cuts—may minimize the formation of carcinogenic compounds while allowing much of the fat to cook out.

What About Eggs?

Eggs are another favorite—and affordable—protein source, but the evidence on eggs and health is more mixed than for red and processed meats. Because the yolks are high in dietary cholesterol, eggs have long been viewed as unhealthy. But experts have discovered that dietary cholesterol plays a much smaller part in raising unhealthy blood cholesterol levels than previously believed, and now eggs—in moderation—are back on the menu. Both the American Heart Association and the DGA say it’s no longer necessary to strictly recommend limiting dietary cholesterol to 300 milligrams daily for healthy people. (One large egg contains about 186 milligrams of cholesterol.) As science continues to sort out the health impacts of eggs, however, it’s wise not to go overboard; unlimited dietary cholesterol might not be the best advice for everyone.

Eggs deliver many important vitamins and minerals, including vitamins B₁₂ and D, choline, selenium, and iodine, and are an exceptional source of protein. The 7 grams of protein in a large egg contain all of the essential amino acids you need to obtain from your diet; in fact, the World Health Organization uses eggs as the standard for evaluating the biological value of protein in all other foods.

Egg yolks are a source of lutein and zeaxanthin, caroteinoids that help protect your eyes against conditions such as macular degeneration. Although the amounts in eggs are relatively small, Tufts research has shown that the carotenoids in egg yolks may be more readily available for use by the body than those from other foods.

The nutrients in eggs are split between the yolk and the white, with a little more than half the protein found in the white and all of the saturated fat in the yolk. The yolk also contains all of the carotenoids and most of the calories.

Liquid egg substitutes are made from the white only, so they have fewer calories and no fat or cholesterol. Some varieties have been fortified with vitamins and minerals to make up for the nutrients found in the yolk; check the ingredients list to see if any nutrients have been added.

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Alzheimer’s Drug Discovery Foundation
alzdiscovery.org
212-901-8000
57 West 57th St., Suite 904
New York, NY 10019

Alzheimer’s Foundation of America
alzfdn.org
866-232-8484
322 Eighth Ave., 16th Fl
New York, NY 10001

Association for Frontotemporal Degeneration (AFTD)
theaftd.org
866-507-7222
Radnor Station Bldg 2, Suite 320
290 King of Prussia Rd.
Radnor, PA 19087

Caregiver Action Network
caregiveraction.org
202-454-3970
1150 Connecticut Ave., NW, Suite 501
Washington, DC 20036

Friedman School of Nutrition Science and Policy—Tufts University
nutrition.tufts.edu
617-636-3737
150 Harrison Ave.
Boston, MA 02111

Jean Mayer USDA Human Nutrition Research Center of Aging
hnrca.tufts.edu
617-556-3000
711 Washington St.
Boston, MA 02111

Lewy Body Dementia Association
lbda.org
800-539-9767
912 Killian Hill Rd., SW
Lilburn, GA 30047

National Institute on Aging Alzheimer’s Disease Education and Referral Center
nia.nih.gov/alzheimers
800-222-2225
Bldg 31, Room 5C27
31 Center Dr., MSC 2292
Bethesda, MD 20892

National Institute of Mental Health (NIMH)
Public Information and
Communications Branch
nimh.nih.gov
866-615-6464; 866-415-8051 (TTY)
6001 Executive Blvd., Rm 6200, MSC 9663
Bethesda, MD 20892-9663

National Institute of Neurological Disorders and Stroke
NIH Neurological Institute
ninds.nih.gov
800-352-9424
PO Box 5801
Bethesda, MD 20824

Oldways Whole Grains Council
wholegrainscouncil.org
617-421-5500
266 Beacon St.
Boston, MA 02116

Tufts University Health & Nutrition Letter
nutritionletter.tufts.edu
800-274-7581
PO Box 5656
Norwalk, CT 06856

U.S. Department of Agriculture
Choose My Plate
choosemyplate.gov
888-779-7264

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The post 8. Brain Power Recipes appeared first on University Health News.

To understand how the brain works, think of it like a team composed of specialized players. The hindbrain, which includes the upper spinal cord, brainstem, and cerebellum, controls the body’s vital functions, such as heart rate and breathing. The cerebellum also manages movement and the actions your body has “memorized,” such as swinging a golf club or playing the piano. The midbrain, the uppermost part of the brainstem, controls some of your reflexes and is part of the process that coordinates eye movements and other voluntary motions.

The brain works so well in part because of specialization, but this also makes it vulnerable. Think of it like a baseball team: Each specialized part of the brain—like the pitcher, catcher, shortstop, and others on a baseball team—performs a specific job. If any one part of the team fails, such as a pitcher serving up a “gopher” ball or a shortstop bobbling a fielding play, a whole inning can be lost.

Where Thinking Happens

The activities we broadly call “thinking” take place in the cerebrum, part of the forebrain, located at the top of the brain. When you read a novel, play chess, compose an email or recognize a loved one’s face, your cerebrum is at work. It stores your memories and enables you to plan and carry out those plans—what cognitive scientists call “executive function.”

What about your “left brain” and “right brain”? These terms refer to the cerebrum’s two hemispheres. Each hemisphere specializes in certain kinds of tasks the brain performs: Typically, the right side of the brain is responsible for more “creative” functions, while the left hemisphere performs grammar, vocabulary, and “logical” functions. However, both hemispheres contribute to many of these processes.

Each hemisphere controls the opposite side of the body, which means that nerve signals crisscross between the brain’s right hemisphere and your left hand, and vice versa. So when one side of the brain is damaged, such as by a stroke or traumatic injury, it’s the opposite side of the face and body that may droop or be paralyzed.

Locating Gray Matter

The term “gray matter” is sometimes loosely used as a synonym for the whole brain, but it refers only to the coating of the surface of the cerebrum and cerebellum. This coating is about an eighth of an inch thick—sort of like the bark on a tree. Formally called the cerebral cortex—from the Latin for “bark”—it really is gray in color. That’s because the cortex lacks a white insulating material called myelin that is found elsewhere in the brain; this myelin sheath allows electrical impulses to be transmitted quickly and efficiently along nerve cells. Myelin makes most of the brain white, so you will also see references to “white matter.”

The cortex also is famously wrinkled, and these folds serve a purpose: Much of the brain’s information processing occurs in the cerebral cortex, and its wrinkles create more surface area for this processing.

Meet the Lobes

You also may have heard the term “lobe” as it relates to the brain. Each lobe of the brain controls specific brain functions. The frontal lobes, located behind the forehead, take charge of planning, weighing alternatives, and envisioning possible consequences. One way they seem to do this is by temporarily storing options and thoughts you are considering (“Italian food tonight … or hamburgers?”) in working memory.

At the back of each frontal lobe, a motor area helps manage voluntary movement. Nearby, in the left frontal lobe, Broca’s area is responsible for turning your thoughts into words.

The parietal lobes, located behind the frontal lobes, handle sensory input and are important for math and reading. The occipital lobes, at the back of the brain, process visual information from the eyes. The temporal lobes, located under the parietal and frontal lobes, perform similar chores with input from the ears, as well as integrating sensory information and memories.

Interior Structures

Going deeper into the brain, several interior structures, including the thalamus and basal ganglia, act as mediators between the cerebral hemispheres and the spinal cord. The hypothalamus, also in the interior of the brain, is important for maintaining your sleep/wake cycle, food and water intakes, and responses to stress.

Deep inside the brain, the tiny hippocampus is important to your brain at a level far out of proportion to its small size. The hippocampus “indexes” your memories—acting sort of as a hard drive—and sends them to other parts of the brain when needed.

Communicating via Neurons

Much as the players on a baseball team communicate with each other and the dugout using signals, the various specialized parts of the brain exchange messages with unique signals. At the microscopic level, this signaling depends on cells called neurons. An adult brain contains approximately 100 billion neurons, with branches that connect at more than 100 trillion junction points called synapses.

Neurons consist of several parts: the cell body, which includes the nucleus and most of the molecules that keep the neuron alive; dendrites, which act like telegraph wires bringing data from other neurons; and axons, which carry the signals away to other cells in the body.

Jumping Synapses

Tiny electrical charges and chemical messengers combine to enable signals to jump across synapses. When a neuron is activated, a small difference in charge—called an action potential—is created by the concentration of electrically charged atoms (ions) on the cell membrane of an axon. This charge zooms down the axon until it comes to the end junction point, the synapse.

In most neurons, the action potential then causes the release of a chemical messenger called a neurotransmitter, which travels across the microscopic gap of the synapse. On the other side of the synapse, the neurotransmitter binds to receptors on the dendrites of the receiving neuron. The signal then continues in the same way from one neuron to the next, via electrical charges and neurotransmitters.

Ultimately, when the message reaches its destination, a neurotransmitter might set off a fresh chain of messages along the neurons. Or the result could be the stimulation of another kind of cell, such as those found in glands. When your body sends a “fight or flight” signal, for example, neurotransmitters stimulate the adrenal gland.

When Neurotransmitters Go Awry

In healthy people, this messaging of neurotransmitters usually proceeds without any glitches and without our even being aware of what’s happening. When things go wrong, however, malfunctions of these neurotransmitters are associated with certain diseases of the brain. For example, Parkinson’s disease is linked to low levels of dopamine, a neurotransmitter important in controlling movement. When the body lacks adequate amounts of dopamine, the result can be tremors, shaking, stiffness, and other symptoms characteristic of Parkinson’s disease.

Dopamine also affects the reward systems in the brain and assists in the flow of information to the front of the brain, where thinking and emotions reside. So research has suggested that low levels of dopamine or issues with utilizing dopamine in these parts of the brain might be factors in attention-deficit/hyperactivity disorder (ADHD). Some studies have pointed to a role for inadequate or ineffective amounts of dopamine in the development of schizophrenia.

Another neurotransmitter, serotonin, works to help control functions such as sleep, mood, and appetite. People who suffer from depression often suffer from abnormally low levels of serotonin. That’s why the most commonly prescribed medications to treat depression are called selective serotonin-reuptake inhibitors (SSRIs). SSRIs work by blocking the automatic reuptake of serotonin, in which the sending neuron recycles the serotonin used to cross a synapse. That leaves more serotonin to bind onto the receiving neuron, encouraging more normal functioning and moods.

Disruptions in Alzheimer’s

A characteristic feature of Alzheimer’s disease is a reduction in levels of acetylcholine, a neurotransmitter involved in memory. Alzheimer’s disease disrupts the normal functioning of these chemical messengers and the cells they affect. The disease damages the brain’s communications system by destroying synapses and killing neurons.

Some of the FDA-approved medications for the treatment (but not cure) of Alzheimer’s disease work by trying to counter these communication breakdowns. According to the Alzheimer’s Association, these drugs promote this communication process through two different mechanisms:

• Cholinesterase inhibitors (donepezil, galantamine, rivastigmine), which work by slowing down the process that breaks down acetylcholine.
• Memantine, an N-methyl-D-
  aspartate (NMDA) receptor antagonist, that works by regulating the activity of glutamate. By partially blocking NMDA receptors, the drug prevents the excess release of glutamate from damaged cells. Too much glutamate lets excess calcium enter cells, which can trigger further damage.

Plasticity and Aging

Scientists used to believe that neurons could only form new connections during early brain development. Now, however, we know that the brain continues to change in response to new inputs—a characteristic called plasticity. Even as an adult, your brain can form new neuronal connections, strengthen existing ones, or eliminate old ones as you continue to gather new knowledge and accumulate experiences. Stimulating neurons can cause them to grow and form new synaptic connections, while those that go without stimulation may weaken.

Even the oldest brains may be able to produce new neurons, according to a study in Cell Stem Cell. Columbia University scientists studied the hippocampus in brains of 28 people, ranging in age from 14 to 79, who died suddenly but who had been previously healthy and were not taking any drugs that might affect the brain. They found that older people can make thousands of new hippocampal neurons, much as younger people do. The study also found equivalent volumes of the hippocampus across ages. Older brains, however, had fewer new blood vessels in the hippocampus, which might negatively affect the capability of neurons to make new connections. A 2018 study contradicted research published only a month before in Nature, in which University of California scientists said new neuron production after the late-teenage years was “undetectable.”

This plasticity helps explain why practicing a task, such as learning to play a musical instrument, helps a person perform that task better and more efficiently. Doing something over and over again strengthens the synapses involved in that task—like paving a road to make repeated journeys go more smoothly. Even in old age, you may be able to continue training your neurons.

Signs of Dementia

The complex workings of your brain and the neurons and neurotransmitters that keep it functioning aren’t foolproof. The symptoms of Alzheimer’s disease and other forms of dementia occur when things go wrong in the brain. These symptoms of a decline in cognition—what we loosely call thinking and memory—affect a person’s ability to conduct everyday activities. The umbrella term for a wide range of such symptoms is “dementia,” which is not a specific disease or single condition. The best-known form of dementia, Alzheimer’s disease, accounts for 60 to 80 percent of all cases.

The serious cognitive losses associated with Alzheimer’s disease and other types of dementia are not natural parts of aging. It’s true that occasional lapses in memory occur more frequently as people get older. Memory loss and other signs of cognitive decline are not inevitable, however. Forgetting where you put your car keys or slipping on a person’s name is normal; putting your keys in the stove or being unable to recognize your grandchildren is not.

Mild Cognitive Impairment

The earliest signs of dementia may be what’s called mild cognitive impairment (MCI), a stage between normal forgetfulness due to aging and more serious cognitive decline. Mild cognitive impairment manifests as problems with thinking and memory that do not interfere with everyday activities. People with this condition often are aware that they are showing signs of impairment. Not everyone who develops mild cognitive impairment progresses to Alzheimer’s or other dementia.

Symptoms of mild cognitive impairment include:

• Difficulty performing more than one task at a time
• Inability to solve problems or make decisions
• Forgetting recent events or conversations
• Taking longer to perform difficult mental activities.

Developing Dementia

Many of the first symptoms of dementia, such as being unable to come up with a word that’s on the tip of your tongue or misplacing things, are common in everyday life for people who are perfectly normal. Many of the early signs of dementia also are similar to the symptoms of mild cognitive impairment. To be considered dementia, at least two of these core mental functions must be significantly impaired:

• Ability to focus, pay attention
• Communication, language
• Memory
• Reasoning and judgment
• Visual perception

As dementia worsens, symptoms grow more obvious and interfere with the ability to take care of oneself and conduct everyday life. People with severe dementia may no longer be able to perform basic activities of daily living, recognize family members, or even understand language.

Understanding Alzheimer’s

Unlike dementia in general, Alzheimer’s disease is associated with specific changes in the physical condition of the brain. A brain affected by Alzheimer’s has far fewer nerve cells and synapses than a healthy brain. The gray matter begins to shrivel, impairing the ability to process information. The hippocampus, vital to the formation of new memories, shrinks. Fluid-filled spaces within the brain, called ventricles, grow larger.

Alzheimer’s disease is also characterized by two types of brain formations, called plaque and tangles. Plaque is formed when pieces of a “sticky” protein called beta-amyloid, which comes from fatty membranes that surround nerve cells, clump together. Scientists suspect that larger plaques may not be as damaging to brain function as smaller clumps of beta-amyloid that block the messaging between the brain’s synapses.

In a healthy brain, parallel strands of “tau” proteins function like highways, carrying essential nutrients. Tangles are like traffic jams in this system. In people with Alzheimer’s, tangles of collapsed tau block the orderly flow of nutrients to the brain. Eventually, the cells deprived of nutrients die.

Alzheimer’s disease progresses as these plaques and tangles spread through the gray matter of the brain. Typically, plaques and tangles strike first in areas important to learning, memory, thinking, and planning.

Diagnosing Alzheimer’s

Scientists believe that the earliest stages of Alzheimer’s may begin as many as 20 years before the disease is severe enough to be diagnosed. When Alzheimer’s strikes relatively younger people, however, it may not be characterized by the memory problems we associate with the disease. That means tests for non-memory cognitive problems should not be overlooked when screening for Alzheimer’s.

In mild and moderate stages of Alzheimer’s, the growing plaques and tangles impair mental functions enough to affect everyday activities and to be noticed by loved ones. This is when the disease is most often diagnosed.

A new definition of Alzheimer’s disease—based on tests of biological markers (biomarkers)—could change how participants in clinical trials of the condition are classified. Researchers at the National Institute on Aging and the Alzheimer’s Association proposed a new framework under which Alzheimer’s would be defined by its characteristic beta amyloid deposits and tau pathology.

Someone with biomarker evidence of both would be classified as having Alzheimer’s disease. A person with evidence of amyloid deposition but a normal pathologic tau biomarker would be defined as having “Alzheimer’s pathologic change.” Both conditions would be viewed as phases along the Alzheimer’s continuum, independent of clinical symptoms.

Scientists said the new framework shifts the definition of Alzheimer’s in living people from a focus on symptoms to biological factors: “Our hope is that, by defining the disease biologically, clinical trials will be far more effective than they have been in the past and will enroll only people who have the disease they’re being treated for.”

Brain Pictures

Dr. Alois Alzheimer first described the “peculiar disease” now named for him in 1906. For many years, however, the diagnosis of Alzheimer’s disease could be definitively confirmed only via autopsy, after death. Today, advanced imaging techniques make it possible to see the damage the disease causes in a living brain and to better understand how healthy brains function.

You may have undergone some of these scans yourself, for other parts of your body, such as the CT scan. Short for “computed tomography,” these computer-assisted scans assemble a static cross-section of the brain using x-rays.

More detailed pictures of the brain, without the use of x-rays, can be obtained by magnetic resonance imaging (MRI). This technology takes advantage of the fact that hydrogen atoms in the brain can be affected by rotating a powerful magnet around a person’s head; the resulting changes in these atoms’ energy levels can be captured to create detailed images. Both CT and MRI scans are static—like snapshots of the brain.

The Brain at Work

To see the brain in action—like movies or videos—scientists employ fMRI scans, short for “functional magnetic resonance imaging.” These scans track the movement of oxygen-carrying hemoglobin—the protein in red blood cells. Because these look different from hemoglobin not carrying oxygen, active areas appear lighter, creating a moving image of the blood flow in the brain.

Another functional imaging technique is the PET scan, short for “positron emission tomography.” PET scans track special molecules that are tagged with a radioactive substance. Because patients can be awake and engaged in mental tasks while undergoing PET scanning, this technology can monitor changes in the activity of the brain as it works.

Heart and Brain

An fMRI scan of the brain’s blood flow reveals that the brain is fed by one of the richest networks of blood vessels in the body. Each heartbeat sends roughly one-fifth to one-quarter of your total blood supply to the brain—an even greater percentage when your brain is working hard. So, changes in your cardiovascular system affect brain function—with important consequences for protecting your aging brain.

Recent research has suggested that a healthy heart and blood pressure in midlife might be associated with brain volume decades later. An observational study of participants in the Framingham Offspring cohort compared results from a treadmill test when the volunteers were about age 40 to brain volume almost 20 years later, measured by MRI scans. Participants with initial lower cardiovascular fitness and elevated blood pressure and heart-rate responses subsequently averaged smaller brain volumes.

Vascular Dementia

Vascular dementia, the second-most common form of dementia after Alzheimer’s disease, more directly shows the impact of the cardiovascular system on the brain. Vascular dementia begins with blood vessel damage in the brain: A stroke or a series of tiny strokes cuts off or restricts the flow of blood to brain cells, interfering with their ability to communicate with other brain cells. That, in turn, affects everything from your ability to think to your emotions. Vascular dementia may manifest in different ways, depending on which areas of the brain suffer damage.

Blood-vessel changes also can increase the degree of impairment or the speed of cognitive decline in other forms of dementia, such as Alzheimer’s disease, or a condition known as Lewy-body dementia. Survivors of a stroke are at significantly greater risk of subsequent cognitive decline.

Drugs Against Dementia

As with other diseases, researchers have labored long and hard to develop pharmaceutical interventions against Alzheimer’s disease and other forms of dementia. Unfortunately, according to Keith Fargo, PhD, director of scientific programs and outreach for the Alzheimer’s Association, the history of the results of clinical trials of such drugs “has been a history of disappointment.”

The Food and Drug Administration (FDA) has approved only four drugs for the treatment of Alzheimer’s disease—donepezil (Aricept), galantamine (Razadyne), memantine (Namenda), and rivastigmine (Exelon). Thus far, clinical trials using these drugs have had a 99 percent failure rate. Since 2003, only one new Alzheimer’s therapy, Namzanic—a combination of two previously approved drugs, donepezil and memantine—has won federal approval. In March 2019, drugmakers announced that they would terminate the global phase III trials of aducanumab, which they had hoped could target beta-amyloid protein in Alzheimer’s disease, after analyses indicated that it was ineffective.

Encouraging Trends

Despite these disappointments from drug trials, there is some surprising good news: Predictions that rates of Alzheimer’s disease and other dementias will explode as the nation’s population ages may have been pessimistic. According to one study, rates of dementia have declined in recent years. The study found that the rate of dementia fell by 24 percent over 12 years, from 11.6 percent in 2000 to 8.8 percent in 2012. Moreover, when people do develop dementia, it is striking at an older age: The average age of diagnosis increased over the same period from 80.7 years old to 82.4.

“The dementia rate is not immutable,” says Richard Hodes, MD, director of the National Institute on Aging, which funded the study. “It can change.”

A few smaller studies have shown similar encouraging signs, but experts have previously been reluctant to draw conclusions based on limited data. Now, Dr. Fargo says, “Here is a nationally representative study. It’s wonderful news.” The findings suggest that roughly 1.5 million people ages 65 and older who do not have dementia now would have it, if the rate in 2000 had continued unchanged.

Lifestyle Effects

Experts on aging credit this encouraging trend to our improved understanding of the brain, coupled with a population better informed about health and nutrition. Evidence shows, for example, that people who take steps to control their blood pressure and cholesterol have a lower incidence of dementia.

The connections between heart and brain mean that many of the ways in which you can protect your brain also benefit your heart, and vice versa, because a healthy brain depends on a healthy cardiovascular system. Although you can’t control some risk factors for Alzheimer’s and other dementias, you can help protect your brain by improving your cardiovascular health with these steps:

• Keep your blood cholesterol levels healthy by cutting down on saturated fats and, if prescribed by your doctor, taking cholesterol-lowering drugs, such as statins.
• Replace saturated fats with unsaturated fats; current evidence suggests that polyunsaturated fats, found in liquid vegetable oils and nuts, are the most heart-healthy choice, though other benefits have been associated with monounsaturated fats, found in olive and canola oils and avocados.
• Control your blood pressure by reducing salt intake, following a healthy diet (the DASH—Dietary Approaches to Stop Hypertension—eating plan is specially formulated to combat hypertension), and taking blood-pressure medications if prescribed by your doctor.
• If you smoke, protecting your brain is another reason to quit; if you don’t smoke, don’t start.
• Follow a heart-healthy diet, such as a DASH or Mediterranean-style diet, which we’ll explore in the next chapter.
• Keep a healthy weight.
• Maintain healthy blood-glucose levels by watching your weight and reducing intake of refined carbohydrates, starches, and sugar to avoid diabetes, which in turn contributes to heart disease.
• Follow exercise guidelines, which generally advise getting 30 minutes a day of at least moderate physical activity on most days of the week. Exercise seems to directly benefit brain health by increasing blood and oxygen flow to brain cells and benefits your overall cardiovascular system.

As we’ll see in the rest of this Special Health Report, smart choices about nutrition and lifestyle can make a big difference. While some things about your aging brain are beyond your control, these simple steps can improve your odds and help protect what makes you uniquely you.

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